quizlet final Flashcards
(354 cards)
1
Q
Sub categories of older adults
A
young-old: 65-74
middle-old: 75-84
old-old: 85-99
centenarians: 100+
2
Q
do men or women live longer?
A
women
3
Q
what are the leading causes of death in older adults?
A
- cancer
- CVD / stroke
- chronic lung disease
- diabetes
4
Q
what does the term “ageism” refer to?
A
thinking about older persons based on negative attitudes and stereotypes about aging
and
failing to structure society for the needs of older people
5
Q
ethnogeriatrics
A
cultural diversity of the older adult population
6
Q
primary aging
A
physiological aging related to time, also called senescence
7
Q
secondary aging
A
changes related to trauma or disease process
8
Q
healthy aging
A
positive or optimal aging
not the absence of sickness but rather the optimal possible health conditions that individuals adapt to their aging process
9
Q
what contributes to healthy aging?
A
resilience, hope, injury prevention, lifestyle choices, healthy weight maintenance, adequate nutrition, sleep
10
Q
what are the three levels of prevention with examples
A
- PRIMARY: vaccinations, lifestyle choices, education
- SECONDARY: screening for early detection
- TERTIARY: prevention and prophylaxis from reoccurrence (medications, exercise)
11
Q
normal changes in aging: body composition
A
decreased muscle mass (sarcopenia), skeletal mass, total body water, & creatine production.
increased adipose tissue
leading to: decreased strength/function, increased drug levels
12
Q
normal changes in aging: cells
A
decreased: DNA repair capacity
increased: DNA damage, cell senescence, lipofuscin accumulation, fibrosis
leading to: cancer, inflammation risk, infection
13
Q
normal changes in aging: CNS
A
decreased: dopamine receptors, connectivity/nerve conduction, brain mass, nerve endings
increased: adrenergic responses
leading to: increased muscle tone, sensitivity to environment, increased response time, delayed reaction time, sleep changes, balance chances
14
Q
normal changes in aging: endocrine system
A
decreased: estrogen, progesterone, testosterone, growth hormone, vit D
increased: glucose intolerance, insulin resistance, thyroid abnormalities, bone mineral loss, ADH secretion
leading to: diabetes, fractures, low muscle/bone mass, vaginal dryness, water intoxication
15
Q
normal changes in aging: auditory / ears
A
thickening of tympanic membrane, stiffening of ear structures, increased production of cerumen
leading to: loss of hearing, decreased ability to recognize speech, unsteadiness, vertigo
16
Q
normal changes in aging: visual / eyes
A
decreased: lens flexibility, ciliary muscle, tear production, pupil size
increased: time for pupillary reflexes
leading to: sensitivity to light, decreased visual acuity, cataracts risk, poor depth perception, glaucoma, diabetic retinopathy, dry eyes, presbyopia (decreased visual acuity)
17
Q
normal changes in aging: GI tract
A
decreased: visceral blood flow, digestive uses, saliva production, thirst mechanism, motility
increased: food transit time, pH
leading to: constipation, diarrhea, aspiration, gastric irritation, GERD, diverticulitis
18
Q
normal changes in aging: cardiovascular
A
decreased: elasticity of vessels, pacer cells, heart rate, diastolic reaction
increased: atrioventricular conduction time
leading to: a-fib, diastolic dysfunction risk, decreased antibody response
19
Q
normal changes in aging: musculoskeletal & joints
A
decreased: cartilage, muscle mass, strength, bone density, elasticity
leading to: falls, osteoarthritis, osteoporosis
20
Q
normal changes in aging: liver
A
decreased: hepatic mass, hepatic blood flow, CYP 450
leading to: decreased metabolism, fat absorption, metabolism of meds
21
Q
normal changes in aging: urinary system
A
decreased: renal blood flow, volume, filtration, renal reabsorption, bladder capacity, creatinine production
increased: urea nitrogen
leading to: dehydration, retention, low output, incontinence
22
Q
normal changes in aging: sensory
A
decreased: taste buds, sense of smell, nerve conduction
leading to: decreased taste, appetite, pain sensitivity, risk of smoke poisoning
23
Q
normal changes in aging: respiratory system
A
decreased: functional capacity, elasticity, gas exchange, cilia
increased: residual volume, mucous production, stiffness
leading to: SOB, mental changes, cough, exercise intolerance, pneumonia, respiratory failure risk
24
Q
normal changes in aging: skin
A
decreased: elasticity, moisture, sweat glands, oil, subcutaneous fat tissue
increased: dryness
leading to: hyperthermia, hypothermia, skin breadown, delayed healing
25
presbycusis
age related hearing loss
26
DASH diet
dietary approach to stop hypertension
high fruits, vegetables, and plant proteins, low sodium and plant protein
27
importance of orodental health
risk factor for dehydration, malnutrition & systemic diseases (pneumonia, joint infections, cardiovascular disease, poor glycemic control)
28
what is the most common theme across all theories of aging?
change
change is considered development in early life, and aging in later life
29
life expectancy factors
heredity, disease processes, medical procedures, lifestyle choices, nutrition
30
senescence
aging-related changes that lead to a decreased ability for adjustment and survival
31
programmed theories (non-stochastic)
aging has a biological timetable or internal biological clock
aging is predetermined, timed phenomena
(programmed senescence, gene theory, endocrine theory, immunologic theory, nutritional theory)
32
damage/error theories (stochastic)
aging is a result of internal and external assaults that damage cells; random processes accumulate overtime and inflict damage
(wear & tear, cross-linking, free radicals, somatic mutation, environmental theory)
33
programmed senescence
cells natural loss of function overtime
(eg. "Hayflick's Limits": fibroblasts can only divide a certain amount of times)
34
gene theory
aging is programmed due to one or more harmful genes within each organism
35
endocrine theory
biological clocks act through hormones to control the pace of aging
dysfunction in the hypothalamus causes age-related changes
36
immunologic theory
aging is due to decreased T cells and causes increased susceptibility to diseases
decline in immune system
37
nutritional theory
diet affects aging
quality of diet is important due to vitamin and nutrient deficiencies
38
wear and tear theory
internal and external stressors damage body components over time
39
cross-linking theory
DNA/proteins cross link with sugars, become stiff and inhibit normal metabolic activities
40
free radicals
accumulation of toxins damages the cell membrane; anti-oxidants neutralize toxins
41
somatic mutation
DNA damage (telomeres) leads to chromosome abnormalities
42
environmental theory
number of environmental factors are known to threaten health
ingestion of lead, arsenic, pesticides, second hand smoke, & air pollution
43
role theory
as people evolve through life stages, their roles evolve as well
adaptability is a predictor of adjustment to aging
44
person-environment fit theory
changes in competencies and needs due to aging influence ability to deal with environment
45
activity theory
activity is necessary to maintain life satisfaction and positive self-concept
46
continuity theory
maintain a consistent pattern of behaviour, continuation of life roles slows aging
47
disengagement theory
no longer supported
natural seperation of old people from society to transfer power to younger generations
48
age stratification
society consists of cohorts that age collectively and influence each other, and are influenced by significant events
49
selective optimisation with compensation theory
individuals develop strategies to manage and cope with losses of function that occur over time
50
gerotranscendence
spirituality has a greater role in life and in acceptance of death
51
Maslow's hierarchy of needs
higher level needs (self-actualization, esteem, love/belonging) cannot be met before meeting basic needs (safety, physiological)
52
Jung's theory of individualism
self-realization is the goal of personality development
53
Erickson's eight stages of life
ego-integrity vs despair
psychological development and tasks that one needs to master in a step-wise fashion
54
Peck's integrity
new identity and new meanings beyond self-centerdness
55
Havinghurst's theory
adjustment and adaptation tasks for late life changes
56
functional consequences theory
environmental and biopsychosocial consequences of aging impact functioning
57
theory of thriving
environment is an important contributor to how people age
people thrive when they are in harmony with environment and personal relationships
58
theory of successful aging
successful aging as a process of adaptation
59
age-related changes
inevitable, progressive, and irreversible changes that occur during later adulthood
typically degenerative physiologically
60
macular degeneration
chronic eye disease marked by deterioration of the macula (tissue layer inside the back wall of the retina)
number one cause of vision loss in Canada
61
xerostomia
reduced saliva production
62
sarcopenia
decrease in muscle mass, strength, and endurance
63
what are the normal vital sign changes in older adults
TEMP: lower
HR: no change
RESP: no change
BP: systolic increases
64
prebyopia
impairment of vision as a result of old age
65
lentigos
a brown macule resembling a freckle usually caused by sun exposure
66
what are the 4 "I's" warning red flags of atypical presentation in older adults?
INSTABILITY
INCONTINENCE
IMMOBILITY
INTELLECTUAL IMPAIRMENT
67
what are common atypical presentations of illness in the older adult?
CONFUSION*, anorexia, absence of fever, lethargy, agitation, incontinence, falls, weakness, dizziness.
68
goals of care for the older adult
1. maintain self care
2. prevent complications of aging
3. delay decline
4. achieve the highest possible quality of life
69
gerontology
the study of aging
70
responsive behaviours / protective behaviours
indicate unmet needs
71
gentle persuasive approaches (GPA)
1. BODY CONTAINMENT STRATEGIES: learning about brain changes that lead to responsive behaviours
2. PERSONHOOD: focus on the person behind the disease
3. UNMET NEEDS: learning how to interpret aggressive behaviour as a response to unmet needs
72
body containment strategies
STOP & GO
when the person is resistive to care, stop, pause & reapproach.
MANIPULATE ENVIRONMENT
remove potential hazards, reduce stimuli, provide natural light, provide diversion
73
GPA care tips
- provide what makes them happy
- concentrate on the person, not task
- be calm
- allow space & time
- identify triggers & unmet needs
74
neurogenic reflex grab
person with dementia instinctively grabbing on when someone is in close contact
neurological reflex response
do not pull away
75
the eden alternative
utilizes children, plants, and animals to fight loneliness, helplessness and boredom experienced by elderly in care facilities
76
the GRACE model
Geriatric Resources & Care of Elders
a support team & multidisciplinary team who assess and develop an individualized care plan while working with the patient, and family
77
chronic care model
nurses provide patient-centered, cost-effective care to patients with chronic conditions through in home assessments, self-management strategies and access to resources to reduce hospital admissions
78
how to reduce hospitalization in the older adult
- standardize transition plans, procedures, forms
- send discharge summaries directly to primary care provider
- easy to understand discharge plans
- ensure timely follow up and coordination of support
79
validation therapy
approach for those with cognitive impairment and dementia
help resolve past unfinished issues through validation, empathy, and listening
80
what are three validation techniques that can be used for dementia patients?
1. REPHRASE
2. UTILIZE THE VISUAL
3. REMINISCING
81
P.I.E.C.E.S Model
enhance ability of long-term care home staff to meet the care requirements of individuals with complex physical and cognitive needs
Physical
Intellectual
Emotional
Capabilities
Environment
Social & Cultural
82
Teepa Snow's positive approach
SUPPORTIVE communication techniques:
- give examples
- use gestures & pointing
- acknowledge and accept emotions
- empathy & validation
- use familiar phrases or known interests
- avoid the negative
83
48/6 Assessment model of care
acute care settings in BC require 6 areas to be assessed within 48 hrs
1. BOWEL & BLADDER
2. COGNITION
3. FUNCTIONAL MOBILITY
4. MEDICATION MANAGEMENT
5. NUTRITION & HYDRATION
6. PAIN MANAGEMENT
84
Fulmer SPICES screening
geriatric syndrome screening tool
S - Sleep disorders
P - problems with eating or feeding
I - incontinence
C - confusion
E - evidence of falls
S - skin breakdown
85
what is a medication reconciliation form
medications are reviewed to ensure accuracy and they are up to date
86
what may a low prealbumin level point to?
malnutrition
87
what blood tests can detect inflammation?
ESR & CRP
88
IADLs
activities needed to live independently (housework, preparing meals, medication adherence, managing finances, using a phone)
89
what tools are used to assess cognition?
MMSE, MoCA, CDT (clock drawing test), CAM
90
Global Deterioration Scale
measures clinical characteristics at 7 levels based on the progressive stages of Alzheimer's disease
91
agitation chart
a tool that allows staff to plot when an individual is calm and agitated, and assists staff in identifying patterns
has a column to chart PRNs and effectiveness
92
ABC Assessment
Antecedent, Behaviour, Consequence
identifying triggers and effectiveness of interventions
93
movement chart
helpful when tracking movements for individuals with Parkinson's disease
movement prior and following administration of medications
94
assessment tools for nutrition
- weight records
- intake sheets
- calorie counts
- MNA (Mini Nutritional Assessment)
95
dysphagia screening
sitting upright a pt is asked to drink a 90 mL cup of water in single sips with a breath in between
96
SBAR
Situation
Background
Assessment
Recommendation
97
triage risk screening tool
detects geriatric risk profile
1. presence of cognitive decline
2. living alone
3. reduced mobility/fall in past 6 months
4. hospitalized in past 3 months
5. polypharmacy
98
what is the 'brown bag test'?
taking ALL of a patients over the counter, prescription and herbal supplements to the doctor
99
delirium
an acute, fluctuating syndrome of altered attention, awareness, and cognition
100
diagnostic criteria for delirium
disturbance in ATTENTION and AWARENESS
sudden onset, change in baseline and tends to fluctuate in severity during the course of a day
physiological consequence
101
hypoactive delirium
most prevalent
"quiet" delirium
lethargic, drowsy, quiet, withdrawn
102
hyperactive delirium
agitated, combative, disoriented, psychotic features
103
how to distinguish a psychiatric disorder from delirium?
a psychotic disorder almost always LACKS the disorientation, memory loss, and cognitive impairment
104
PRISM-E (underlying causes of delirium)
Pain
Restraint / Retention
Infection
Sensory impairment / Sleeplessness
Medication
Emotional / Environment
105
CAM
confusion assessment method
1. evidence of acute change in mental status
2. inattention, difficulty focusing attention, or keeping on track
3. disorganized thinking
4. altered LOC
106
what should you do when you suspect delirium?
- vital signs
- blood work
- urine
- hydrate
- bowel/bladder function
- unrelieved chronic/acute pain
- trauma
- blood sugars
- chest sounds
- med history
- MSE
- change in ADLs
107
treatment goals for delirium
- establish routine, provide comfortable surroundings
- encourage family/friends to stay
- reassurance and emotional support
- reduce sensory stimulation
- promote rest & orientation
- ensure adequate nutrition & fluids
108
delirium prevention triad
1. prevent sleep deprivation
2. monitor hydration / prevent dehydration
3. prevent stimuli deprivation / ensure vision & hearing
109
use the NICE & EASY approach when working with delirious clients
Name
Introduce yourself every time
Contact
Eye contact
Explain what you are doing BEFORE doing it
Avoid arguments
Smile
You are in control
110
mild cognitive impairment
cognitive decline beyond that normally expected in a person of the same age with preservation of function
cognitive impairment is NOT normal in old age
111
dementia
a slowly progressive decline in mental abilities, including memory, thinking, and judgment, that is often accompanied by personality changes
112
what are the key features of dementia
- insidious onset (months to years)
- persistent disorientation
- symptoms depend on the area of brain affected by the disease
113
anosognosia
lack of insight
114
amnesia
loss of memory
last thing learned is first thing lost
115
apathy
loss of initiation
116
agnosia
loss of recognition
117
apraxia
loss of purposeful movement
118
aphasia
loss of language skills
119
altered perception
loss of depth perception, illusions, delusions, hallucinations
120
attention deficit
difficulty maintaining and is easily distracted
121
alzheimer's disease
most common form of dementia
memory loss, mood and behaviour progressive changes
caused by neuritic (senile) plaques and neurofibrillary tangles in the brain
122
vascular dementia
due to interrupted blood supply to the brain (post-stroke)
123
Lewy body dementia
protein deposits, called Lewy bodies are found in deteriorating nerve cells
marked by fluctuating cognitive ability and often accompanied by visual hallucinations
124
frontotemporal dementia
cells in the frontal and temporal lobes of the brain shrink, die, or swell
frontal lobe regulates behaviours
125
responsive behaviours (BPSD)
indicate an unmet need
[ABC method: Antecedent, behaviour, consequence]
126
pharmacological treatment for BPSD
citalopram & sertraline: controlling irritability
risperidone: tx of aggression/psychosis
quetiapine & haldol: aggression
trazodone: sleep aid
carbamazepine, gabapentin: impulsivity
cyproterone: hyper-sexuality
127
sun-downing
increase in behavioural problems that begin at dusk and last into the night
(d/t end of day exhaustion, upset in internal body clock, shadows, disorientation lack of activity)
128
pharmacological treatment for alzheimer's?
- Cholinesterase Inhibitors
- Memantine
129
Aricept (donepezil)
health warning d/t possible rhabdomyolysis & NMS
130
ADUCANUMAB
recommended for mild cognitive impairment or early alzheimer's disease
131
symptoms of late life depression
low energy, motivation, anhedonia, hopelessness, increased dependency, poor grooming, difficulty completing ADLs, withdrawal from people, decreased sexual interest, "giving up", preoccupation with death
132
typical presentation of depression in an older adult
typically present for physical complaints rather than a mood disorder
early morning awakening, anorexia, weight loss, substance use, exaggerated of pre-morbid personality traits, violent suicide attempts, thinking problems
memory difficulties may be the chief complaint and get mistaken for early signs of dementia
133
pseudodementia
behavioral disorder resembling dementia but is not caused by brain tissue abnormalities
134
psychotic depression
depression accompanied by psychotic thought content
delusions of self-depreciation of often seen, eg. describing themselves as "unworthy, ugly, foul smelling"
135
SIGECAPS depression
Sleep disorders or problems
Interest decreased
Guilt
Energy decreased
Concentration difficulties
Appetite disturbance
Psychomotor retardation or agitation
Suicidality
136
what older adult populations are at highest risk for suicide?
male, caucasian/first nations, 65-85, single, alcohol, isolation, suffering from chronic disease etc..
137
IS PATH WARM
Ideation
Substance use
Purposelessness
Anxiety
Trapped
Hopelessness
Withdrawal
Anger
Recklessness
Mood changes
138
CBT
thoughts or interpretation of a situation evokes emotions that drives our behaviours
thoughts - feelings - physical symptoms - behaviours
139
steps in CBT
1. therapeutic relationship
2. generate a problem list
3. turn problems into goals
4. behavioural action
5. thought testing
140
selective optimisation with compensation
to achieve goals in spite of losses
find a new way to do things, practice makes perfect, make the best out of it
141
wisdom enhancement
past experiences and lessons learned can guide present challenges
142
timelines
review a person's life without getting stuck on the past
focus on coping and resilience
143
acute vs chronic illness
ACUTE: sudden, without warning, treated aggressively for short period of time, may quickly lead to death in later life
CHRONIC: insidious onset, continues indefinitely, periods of exacerbation & remission
144
what are the most common chronic conditions of the elderly in Canada?
1. arthritis
2. hypertension
3. glaucoma
4. heart disease
5. diabetes
6. COPD
145
what are the 8 stages of the chronic illness trajectory model?
1. PRE-TRAJECTORY: no s/s
2. TRAJECTORY ONSET: s/s present
3. CRISIS: life threatening
4. ACUTE: acute illness & complications
5. STABLE: symptoms controlled
6. UNSTABLE: symptoms difficult to control
7. DOWNWARD: progressive deterioration
8. DYING
146
shifting perspective model of chronic illness
clients can achieve wellness in spite of illness/disability; wellness is defined by the client
focused on maximizing function and quality of life
147
nonfatal chronic illness
arthritis, vision impairment
148
serious, potentially fatal chronic illness
cancer, stroke, dementia, diabetes
149
fraility
health state related to multiple bodily systems gradually losing their built-in reserves (weakness) leading to severe functional impairment
at greater risk for catastrophic outcomes
40% of people over 80 years old area affected
150
risk factors for frailty
smoking, poor diet, inactivity, impaired immune system
151
frailty causes & symptoms
1. CHRONIC MALNUTRITION --> weight loss
2. SARCOPENIA --> weakness
3. DIMINISHED STRENGTH --> chronic fatigue
4. SLOW GAIT --> falls
5. DECLINE IN ACTIVITY --> immobility
6. SENSORY DEPRIVATION --> low mood/depression
7. COGNITIVE IMPAIRMENT --> dependency/isolation
152
geriatric syndrome
common health conditions of older adults that don't fit into specific disease categories
falls, functional decline, cognitive impairment (3 Ds), incontinence, susceptibility to adverse reactions to meds, pressure ulcers
153
contributing factors to development of geriatric syndromes
- chronic inflammation
- autonomic dysregulation
- immune system deficiency
- hormonal/vitamin deficiencies
- sarcopenia
- atherosclerosis
154
PRISMA - 7 Questionnaire
identifying frailty
3 or more "yes" answers require further review
1. Over 85 yrs?
2. Male?
3. Health problems that limit your activities?
4. Do you require help on a regular basis?
5. Health problems that require you to stay at home?
6. Support?
7. Mobility aid?
155
gait speed test
average gait speed of longer than 5 seconds to walk 4 meters is an indication of frailty
156
failure to thrive (dwindles)
state of progressive functional decline, progressive apathy, and a loss of willingness to eat or drink
characterized by nutritional abnormalities with no obvious explanation of these symptoms
IS NOT A NORMAL CONSEQUENCE OF AGING
157
four domains critical to the development of failure to thrive
1. impaired physical function (abnormal sensory impairment)
2. malnutrition (diminished smell/taste, cost of food, meds)
3. depression (r/t post stroke, Parkinson's, early dementia)
4. cognitive impairment
158
etiology of failure to thrive - 11Ds
Diseases
Dementia
Delirium
Drinking alcohol
Drugs/medication
Dysphagia
Deafness, blindness, other sensory deficits
Depression
Desertion by family, social isolation
Destitution (poverty)
Despair (giving up)
159
what are the signature consequences of failure to thrive?
- weight loss
- dehydration
- low cholesterol and albumin
- increased infection rate
- fractures
- pressure ulcers
- increased mortality
160
internal vulnerability factors of FTT
older age, female, medical comorbidities, substance abuse, mental illness, cognitive impairment, sensory impairment, impairment in ADLs, malnutrition
161
external vulnerability factors of FTT
lack of social network, dependence on care provider, living alone, lack of community resources, inadequate housing, unsanitary living conditions, high-crime, adverse life events, poverty
162
what are some red flags indicating elderly vulnerability?
- repeated ER/hospital admissions
- neglect of medical problems
- noncompliance with medication
- acute deterioration in ADLs
- unexplained weight loss
- poor grooming/hygiene
- refusal of needed assistance
- threat of eviction
163
what are the 4 areas of assessment to determine a client's vulnerability for developing frailty?
1. FALLS
2. WEIGHT
3. INCONTINENCE
4. CONFUSION
5. MOBILITY
164
stress urinary incontinence
leakage of urine when coughing, sneezing, straining, exercise or any other type of exertion
165
urge incontinence
leakage of urine associated with the urge to void that cannot be delayed
166
overflow incontinence
constant leaking or dribbling from a full bladder suggesting normal urination is impossible
167
functional incontinence
incontinence related to causes outside of the urinary system such as physical barriers, lack of mobility, anxiety, depression etc.
168
Parkinson's disease etiology
degeneration of neurons in the basal ganglia leading to a dopamine deficiency
severity of disease is associated with the degree of neuron loss and reduction of dopamine receptors in the basal ganglia
169
cardinal symptoms of Parkinson's disease
tremor*, muscle rigidity, slow movements (bradykinesia), shuffling gait, mask-like face, muffled speech
170
risk factors for Parkinson's disease
- advancing age, more oftenly affecting men
- head trauma
- exposure to toxins (heavy metals and carbon monoxide)
- declining estrogen levels, vitamin B12, & folate
171
what are the two types of Parkinson's disease
PRIMARY (idopathic) - cause is not known
SECONDARY - d/t another disorder causing loss of dopamine in the basal ganglia
172
"shuffling gait"
Parkinson's disease
arm-swing impaired, tendency to fall forward which results in the steps becoming fast to catch up (festination)
173
hypophonia
soft speech, may be seen in Parkinson's disease
174
micrographia
small handwriting, seen in Parkinson's disease
175
what does a clinical diagnosis of Parkinsonism require?
presence of at least 2/4 of the cardinal signs
lack of specific diagnostic test
176
Tx for Parkinson's Disease
- treatment of symptoms (anticholinergics, dopamine agonists)
- MED: Levodopa and Carbidopa (dopamine replacement)
- deep brain stimulation (brain pacemaker implanted to improve tremor)
- transplantation of stem cells into the substantia nigra
- rehab (PT, OT, ST)
*NEW: non-contact boxing
177
what surgeries can be used to reduce tremors of Parkinson's?
1. Pallidotomy (globus pallidus, reduces tremors & stiffness)
2. Thalamotomy (thalamus, controls involuntary movements)
178
nursing considerations for Parkinson's Disease
- risk of falls & choking
- monitor orthostatic hypotension
- assess mood * risk of depression
- prevent infection
- sleep hygiene
- promote cognitive stimulation & communication
179
etiology of shingles/herpes zoster virus
varicella zoster virus acquired as chicken pox and stays dormant until reactivated due to compromised immunity
180
who can acquire shingles? and it is part of normal aging?
YES, it is part of normal aging but only for those who have previously had chicken pox
181
what serious complications are associated with shingles?
postherpetic neuralgia, ocular involvement, and CNS disease
182
S/S of shingles
EARLY SYMPTOMS: fever, weakness, pain/burning or tingling sensation over an area on one side of body or face
RASH STAGE: unilateral lesions (vesicles filled with fluid) which eventually crust over
POST: post herpetic neuralgia (severe pain)
183
what is post herpetic neuralgia?
pain that stays with the patient after the rash has healed (could last months or years). Increased sensitivity to touch/light is also very common. Treat with antiviral (acyclovir)
184
why does shingles cause a unilateral rash?
it occurs in the dermatome (area of the skin) supplied by a single spinal nerve
185
most common site of shingles
ophthalmic division of the trigeminal nerve and mid-thoracic sensory roots
186
herpes zoster ophthalmicus
singles affecting the eye, can have potential vision-threatening complications
187
client teaching for shingles
- wear rubber gloves when applying tx cream
- trim fingernails short, clean hands
- wash sores and skin with soft washcloth and mild soap
- wear a clean undershirt everyday
- wash soiled linens in hot water and soap
188
TX for shingles
antiviral medications
Zovirex, Valtrex, Famvir
* within 72 hrs of rash appearing
189
transmission of shingles
only those who have had chickenpox can get shingles, if someone with shingles infects someone without previously having chickenpox they will likely get chickenpox
190
goal of tx for shingles
control pain and restore function and quality of life
191
osteoporosis
skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture
"silent thief"
192
how is osteoporosis diagnosed
DEXA scan
Dual-Energy X ray Absorptiometry
low energy x-rays
193
T-score measurements
+1 to -1 SDs = NORMAL
-1 to -2.5 = OSTEOPENIA
below -2.5 = OSTEOPOROSIS
below -2.5 with 2 fragility fractures = SEVERE OSTEOPOROSIS
194
risk factors of osteoporosis
- family hx
- osteopenia
- low body weight
- low calcium diet
- low physical activity
- ovaries removed or early menopause
- post-menopausal
- vitamin D deficiency
- smoking
- caffeine intake
- race (caucasian, asian)
- excessive alcohol intake
195
TX goal of osteoporosis
PREVENTION OF FRACTURES & FALLS
- adequate calcium and vitamin D
- mobility exercises
196
medications used for osteoporosis
- Alendronate (Fosamax)
- Risedronate (Actonel)
- Ibandronate (Bonvia)
- Zoledronic acid
197
what is the most common complication of osteoporosis?
vertebral compression fracture
198
S/S of osteoporosis
height loss, spinal deformity, chronic back pain, impaired breathing
199
what is Calcitonin?
a hormone produced by the thyroid gland that slows bone loss and reduces risk of spinal fractures
200
arthritis
inflammation of a joint
consists of more than 100 related conditions ranging from tendinitis to rheumatoid arthritis
201
rheumatoid arthritis
autoimmune condition that causes chronic inflammation
painful and deformed swelling of the joints
TX: NSAIDS; disease-modifying antirheumatic drugs (DMARDs)
202
osteoarthritis
cartilage breaks down and wears away which causes bones to rub together
most prevalent type of arthritis
203
treatment for osteoarthritis
CANNOT BE "CURED" W/O JOINT REPLACEMENT
- pain management (hot & cold, medications)
- steroid injections into the joint
- acupuncture
- music
- glucosamine & chondroitin sulphate
204
etiology of gout
inflammatory arthritis that occurs due to raised uric acid levels in the blood which may lead to the accumulation of urate crystals in joints, soft tissues and kidneys
205
what is uric acid?
waste product secreted when the body breaks down purines (protein)
206
S/S of gout
joint inflammation, pain, tophi (large and gritty deposits of uric acid d/t chronic hyperuricemia)
207
tophi
clusters of urate crystals that form deposits in joints, cartilage, bones, kidneys or soft tissues
typically 10-12 years after onset of symptoms
may break through the skin and appear white or yellowish-white chalky nodules
208
risk factors for gout
- male sex
- high intake of foods high in protein and alcohol
- obesity
- those taking diuretics, aspirin, ciclosporin & kidney disease
- hypertension
- diabetes
- CVD
- CKD
- metabolic syndrome
209
what foods should those with gout avoid?
PURINE FOODS
- red meats
- anchovies, herring, mackerel, sardines, trout, caviar
- seafood
- meat and yeast extracts
- sweetened soft drinks
- highly processed foods
210
protective foods for gout
low fat dairy, high vitamin C, sour cherries or cherry juice
211
treatment for gout
NSAIDS for approx 2 weeks
may alternately be prescribed glucocorticoids or Colchicine
allopurinol used for repeated attacks
212
why is insomnia common among the elderly?
melatonin, cortisol and growth hormone production drops dramatically with age
213
changes in sleep with aging
- sleep reduced
- takes longer to fall asleep
- disorders occur earlier in men, common in men 65+
214
insomnia in the older adult
more common in women
causes mood changes, memory deficits, diminished concentration, poor judgement, impaired performance, and immune system changes
215
sleep apnea
cessation of respirations for more than 10 seconds
treated with either a dental appliance or CPAP therapy
216
restless leg syndrome
uncomfortable sensation in legs causing movement, numbness and loss of sleep
cause unknown, may be d/t some medications such as antidepressants and caffeine
217
REM behavioural sleep disorder
loss of voluntary sleep atonia (core muscle relaxation) during REM sleep
complex behaviours while dreaming
mean age 60 years
more common in males
218
what can adverse reactions related to dopamine agonists cause?
impulse-control disorders (eg. gambling or sex addiction)
219
why is benztropine used with caution in pts with Parkinson's?
may cause serious side effects that include hallucinations and urinary retention
220
paternalism
withholding information and not offering certain options, impending the patient's ability to act upon their wishes
221
justification of limiting autonomy
lack of capacity/competency
potential harm to self
potential harm to others
but, they must be the least invasive or restrictive and no more than is necessary to accomplish the purpose
222
what are the 3 risk assessment rules?
#1: never based on convenience or gratification
#2: negotiating risk involves minimal use of power to attain max benefit and minimum infringement on client's liberty
#3: the more grave consequences, the greater obligation to intervene
223
encumbered client
whose judgement and decision making ability are hindered by distorting factors, impaired emotional state, undue influence and inadequate/partial information
224
unecumbered client
competent and not subjected to distorting factors
225
substituted judgement
making a decision for a patient based off his/her own values
226
best interest judgement
what a reasonable person, in the patient's position would want with consideration
227
life prolongation vs futility of treatment
circumstance under which life-sustaining treatment can be suspended
there is irreversible progression of disease, tx will be harmful and ineffective, life with be shortened regardless of tx, non-tx will allow greater comfort
228
withholding vs withdrawing treatment
morally equivalent
229
moral distress
when we know what is the right/ethical action but cannot act upon it
230
Adult guardianship laws
- health care (consent) and care facility (admission) act
- representation agreement act
- adult guardianship act
- public guardianship and trustee act
231
consent to health care
voluntary decision made by a capable adult in BC to accept or refuse an offer of medically appropriate health care tx
232
when is an adult's consent NOT required?
- when urgent or emergency health care is required
- when involuntary psych tx is needed
- preliminary examinations such as triage and assessment
- when communicable diseases are involved
233
Two types of substitute decision makers
1. FORMAL: pt has a duly appointed committee of person or representative
2. TEMPORARY: pt does not have a committee of person or representative, a decision maker is chosen by the HCP
234
committee of person
personal guardian whose formal name is committee of person
if an incapable adult did not make a representation agreement or AD while capable
235
Public Guardian and Trustee of BC
protects the legal and financial interests of children under the age of 19 years, and adults who require assistance in decision making
administers the estates of deceased and missing people
236
advance directive
written instructions telling medical providers what treatments a person does or does not want
may be detailed or as vague as desired
237
representation agreement
document in which a capable adult names their representative to make health care and other decisions on his/her behalf
two types (section 7 & section 9)
238
what is the list in order for temporary substitute decision maker?
1. SPOUSE
2. CHILD
3. PARENT
4. BROTHER or SISTER
5. GRANDPARENT
6. GRANDCHILD
7. RELATED BY BIRTH OR ADOPTION
8. CLOSE FRIEND
9. PERSON RELATED BY MARRIAGE
239
advance care plan
written summary of the capable adult's wishes or instructions to guide a substitute decision maker if that person is asked to make tx decisions on their behalf
240
instructional directives
state what or how health care decisions ar to be made when they are unable to make them themselves
"living will"
241
proxy directives
specific person who will make decisions for the pt when they are unable too
242
section 7
routine financial management, personal care, and some health care decisions
DOES NOT allow person to accept or refuse life support
243
section 9
personal care and other health care decisions as well as ACCEPTANCE or REFUSAL of life support
244
enduring power of attorney
decisions in relation to financial affairs, business and property
NO HEALTH CARE DECISIONS
245
MAID
Medical Assistance in Dying
competent adult consents to termination of life
246
EOL care
End of Life Care
term used by those in health care when referring to care provided to individuals in their last weeks to days of life
247
SPEAK - EOL decisions
S- substitute decision maker
P - preferred treatment options
E - expressed wishes
A - advanced directives
K - knowledge of benefits and tx prognosis
248
MOST
Medical Orders for Scope of Treatment
M3 - full treatment
M2 - transfer only when comfort measures cannot be achieved
M1 - comfort measures only
C2 - intubation
C1 - no intubation
249
palliative care
care designed to improve the quality of life, prevent and relieve suffering, optimize function and provide opportunities for personal growth
can occur at anytime in a chronic declining condition
250
hospice care
holistic and compassionate care given to terminal patients in their last stage of life
251
how is death pronounced?
- no apical heart beat for 1 minute
- no spontaneous respiration for 1 minute
- pupils dilated and fixed
252
what is meant by a "good death"
- adequate pain and symptom management
- avoiding a prolonged dying process
- clear communication
- a sense of control
- spiritual or emotional sense of completion
- strengthening relationships with loved ones
- not being alone
253
approaching death symptoms
- decreased LOC
- muscle relaxation/dysphagia
- restlessness
- congestion
- breathing laboured/irregular/apnea/Cheyene-Stokes
- incontinence/dark urine
- mottling (red/purple marbled spots on skin)
- non-reactive pupils
- weak pulse, dropping BP
254
nursing interventions for palliative comfort
- pain control
- reduce air hunger and anxiety
- skin and mucous membrane care
- choices
- grooming/assistance with all ADLs
- spirituality needs
255
BATHE communication
Background information
Affect
Trouble
Handling things
Empathy
256
acute grief
a crisis
manifests as somatic and psychological symptoms of distress
257
anticipatory grief
the response to a real or perceived loss before it occurs
258
ambiguous loss & grief
a person is physically present but psychologically absent
259
disenfranchised grief
loss cannot be acknowledged or publicly mourned
(eg. health care workers in response to a pts death)
260
chronic/dysfunctional grief
begins with normal grief but obstacles interfere with its normal evolution towards adjustment
261
elder abuse
single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person
262
types of elder abuse
PHYSICAL
SEXUAL
EMOTIONAL / PSYCHOLOGICAL
MEDICAL
FINANCIAL * most common
NEGLECT
ABANDONMENT
263
transgenerational violence
children who were abused when they were young and are now abusing their parents when caring for them
264
risk factors for elder abuse
- 80 years and older
- female
- disability
- dementia/cognitive dysfunction
- depression
- social isolation
265
more than ___ % of persons with dementia live at home with family members
70
266
what does caregiver stress derive from?
1. personal characteristics of caregiver
2. needs of cared for persons
3. challenges in accessing formal systems of care
267
what are the two major trends responsible for family members assuming the caregiver role?
1. SCARCE RESOURCES: efforts to reduce health care spending
2. PHILOSOPHY OF CARE: care of aging individuals is best offered in community
268
is relocation to a long term care facility looked forward to by the elderly
no, it is one of the most stressful kinds of relocation
269
caregiver burden
commonly used to describe the financial, physical and psychosocial problems that family members experience when caring for older adults suffering from illness
270
what type of stressor is caregiving considered?
a chronic stressor
d/t the persistent and often physically demanding caregiving tasks and emotional toll
271
ambiguous loss
loss when a person with dementia is physically present, but psychologically absent
confuses relationships and prevents closure/moving on
272
medication use concerns in older adults
- differences in metabolism
- overuse, underuse
- polypharmacy
- adverse drug reactions (ADRs)
- drug interactions
273
what age group is the largest users of OTC medications?
65 +
274
pharmacokinetics
the study of the movement and action of a drug in the body
275
what is the "golden rule" of prescribing drugs for older adults?
start low and go slow
276
what are the four major pharmacokinetic processes in the body?
ABSORPTION: how it is taken in
DISTRIBUTION: where the drug is dispersed
METABOLISM: how it is broken down
EXCRETION: how the body gets rid of the drug
277
effect of starvation on drug absorption
can reduce protein binding of drugs which will make levels of the free drug rise
278
changes in distribution of drugs in the older adult
LOWER ALBUMIN LEVELS
needs lower dose of acidic protein bound drugs (digoxin, warfarin, diazepam)
INCREASED a1-acid glycoprotein & lipoproteins
needs higher dose of basic protein bound drug (propranolol, lidocaine)
LESS TOTAL BODY WATER
need lower dose of hydrophilic drugs (lithium, aminoglycosides)
HIGHER FAT CONTENT
caution in CNS drugs
LOWER LEAN MUSCLE MASS
279
metabolism changes in the older adult
REDUCED HEPATIC BLOOD FLOW
increased bioavailability of the blood
REDUCED HEPATIC MASS
DECLINE IN OXIDATIVE METABOLISM
280
excretory changes in the older adult
kidney function decreases, renal blood flow is reduced
prolongation of the half-life of medications providing the potential for toxicity
281
what is the best indicator of renal function in the elderly?
creatinine clearance NOT serum creatinine
282
pharmacodynamics
the physiological process between a drug and the body
283
polypharmacy
an individuals use of multiple medications
284
polypharmacy prevention: SAIL & TIDE
Simplify
Adverse effects
Indication
List
Time
Individualize
Drug interactions
Educate
285
How much more common are ADRs in the elderly than the younger population?
7x
286
causes of ADRs
- improper dosages or drug
- non-adherence
- altered pharmacokinetics
- multiple meds or prescribers
287
common ADRs in elderly
falls, delirium, GI distress, incontinence, constipation, confusion, depression, anxiety
288
akathisia
motor restlessness
may be mistaken for agitation
289
tardive dyskinesia
movement disorder, worm like movements of the tongue or other facial movements
may be reversible if caught early, otherwise permanent
290
risk factors for TD
elderly, asian/african, female, previous mood disorder, diabetes
291
neuroleptic malignant syndrome
LIFE THREATENING
extreme rigidity, fever, autonomic disturbances, fluctuating level of consciousness
due to high serum creatinine kinase level
292
severe cardiac dysrhythmias
antipsychotics pose this risk of a prolongation of the QT interval
ECG monitoring
293
drug-drug interactions
more medications, greater risk of interactions
over 7 meds = 82% risk
294
what foods should be avoided with use of MAOIs?
tyramine foods
aged cheese, wine, organ meats
cough syrup, cold medications
295
serotonin syndrome
myoclonus (involuntary twitching), shivering, tachycardia, tremors, hyper/hypotension, seizures, delirium
296
BEERS criteria
potentially inappropriate medications which should be avoided in persons 65 years + as they are ineffective or pose high risk
48 meds to avoid
297
LR: What is ageism?
a way of thinking about older adults based on negative attitudes/stereotypes
298
what are some barriers that older adults face in regards to accessing health care?
1. cultural influences on understanding of mental health
2. limited transportation accessibility
3. lack of technology knowledge
4. negative views towards HCPs
299
All older adults do not want to participate in care. T/F
False
300
what does genetic aging theory suggest?
there is a potential genetic predisposition for longevity of life
301
what nursing implication promotes cognitive stimulation?
a. providing a balance between activity and rest
b. providing activities they enjoyed in the past
c. assessing the client's memory on a daily basis
B - providing activities they enjoyed in the past
302
which elevated plasma level is linked to healthy aging and longevity?
HDLs
303
what are the 5 R's of practicing reconciliation?
Respect all worldviews
Reciprocity in all relationships
Relevance to holistic wellness
Responsibility for informed practice and pedagogy
Relationships grounded in safety and humility
304
"Aboriginal" is an inclusive term referring to indigenous people across the world. T/F
False, "Indigenous" is the inclusive term
305
Chronic health conditions of Indigenous peoples reported to be expressed in later life. T/F
False, they are experienced earlier in life
306
Which psychiatric nursing care implications would you incorporate when working with older indigenous population?
a. speak louder
b. ask them about your culture
c. incorporate cultural safety into care
d. explain to them you don't understand their culture
e. none of the above
C
307
effects of vitamin D deficiency
osteoporosis, weak bones
308
effects of vit b12 def
cognitive function altered, and decreased energy
309
what is the recommended dose of vitamin D per day?
800-2000 IU
310
what can help maintain bone mass in older adults?
regular weight bearing exercises/flexibility, balance exercises, calcium supplements
311
recom diet for OA
plant based/mediterranean
312
older adults are more susceptible to conditions like hypothermia and heat stroke than younger people. T/F
True, as we get older the body's ability to regulate temperature decreases overtime
313
physiological changes affecting thermoregulation in the older adult
1. PERSPIRATORY CHANGES (less active sweat glands)
2. CARDIOVASCULAR DECLINE
3. DECREASED THERMORECEPTOR RESPONSE
4. CHANGES IN BLOOD GLUCOSE
314
psych & social contributions affecting thermoregulation in the older adult
1. IMPAIRED FUNCTIONAL CAPACITY (adjusting for temp)
2. HEALTH CONDITIONS
3. IMPAIRED ABILITY TO SENSE THERMAL STATE
4. ENVIRONMENTAL and FINANCIAL (unwilling to use air conditioning)
315
which of the assessments below is the most important to include when working with older adults with impaired thermoregulation?
a. assessing the client's urinary output
b. assessing the client's pain status
c. assessing the client's short term memory
A
316
what are the most commonly misused substances among older adults?
benzos, alcohol, cannabis, opioids
317
why is substance use rarely detected in older adults?
MOST screening & TX protocols are developed for younger population
318
why OA at increased risk for SUD
- increased health issues
- chronic pain
- psych stressors
319
approved drugs to tx opiate misue in OA
buprenorphine, methadone, naltrexone
320
1 example of physiological change in aging that may alter an OA perception of sexual intimacy
menopause
321
sex orientation considered mental illnes until
1996
322
to reduce stigma & discrimination, what interventions can be used in regads to sexuality & OA
trauma informed care, building rapport, education, assessmentof medications & sexual history
323
what genre of music is best for sedation?
sedative
324
why muscial interventions gaining more traction for OA
feasibility
325
what is music reminiscence therapy
free intervention, recollection of life, and improves well being
326
key aspect of nursing education in preventing aspiration penumonia in OA
provide tailored education on swallowing techniques
327
what role do nurses play in antibiotic stewardship for UTIs in women?
educating patients on completing the antibiotic course as prescribed
328
how do nurses contribute to collaborative care for older adults at risk of aspiration pneumonia?
coordinating care plans with interdisciplinary teams
329
what is NOT a consequence of malnutrition?
a. increased life expectancy
b. delayed healing
c. longer hospital stays
d. anemia
A
330
what vitamin do we give as a nutritional supplement?
vitamin D3
331
what type of enriched foods should our older adult patients be eating?
protein
332
physical activity is encouraged prior to bedtime to promote sleepiness. T/F
False, it should be encouraged in the day but avoided 4 hours prior to bedtime
333
which sleep disorder is highly prevalent in the older adult?
insomnia (may be from nocturia or GERD)
334
medications are used to treat sleep concerns but may also cause sleep disturbances. T/F
true
335
what is incorrect regarding visual and auditory changes in old age?
a. increased risk of developing late-life depression and anxiety
b. hearing impairment can result in inaccurate MMSE scores
c. visual and hearing impairment decreases the risk of falls and prolonged hospitalization
d. many older adults underutilize visual or hearing assistive devices because of difficulties adapting to wearing or operating them
C
336
older adults with visual and hearing impairments are at an increased risk of developing cognitive impairment. T/F
T
337
what nursing interventions can be used for elderly individuals with visual and hearing impairments?
proper lighting, use visual/hearing aids, engage pt in oscially and mentally stimulating activities
338
frailty is not associated with an increased risk for infection. T/F
false
339
respiratory illness is associated with a greater loss of independence. T/F
t
340
what is the main benefits of getting vaccinated for older adults?
it can prevent up to 70% of hospitalizations and 80% of deaths caused by influenza
341
what lifestyle modifications can help prevent CVD in older adults?
adapting to a heart healthy diet, engaging in mild-moderate physical activity, smoking and ETOH management
342
change in heart structure and function do not occur as a natural part of aging. T/F
False, changes in vessel structure and reduced elasticity are contributors
343
which of the following is a risk factor for CVD?
a. a healthy lifestyle
b. increased sodium diet
c. medication adherence
d. none of the above
B
344
there are higher incidence rates amongst older women compared to older males for cancer. T/F
false, in males
345
leading cancer in older women
breast
346
what is the recommended approach when caring for older adult patients with cancer?
timely assessments and interventions
347
mineral significant to thyroid function
iodine
348
what is the synthetic alternative used for thyroid hormone replacement in hypothyroidism?
levothyroxine
349
which method is considered safe in the older population to identify thyroid cancers and distinguish between benign and malignant nodules?
Fine-Needle Aspiration Cytology (FNAC)
350
which of the following is NOT a microvascular complication associated with chronic hyperglycemia in older adults?
a. diabetic retinopathy
b. diabetic nephropathy
c. peripheral artery disease
d. diabetic neuropathy
C - PAD macrovascular
351
how does uncontrolled blood glucose levels affect older adults with diabetes in terms of macrovascular complications?
macrovascular complications such as hypertension and peripheral artery disease due to atherosclerosis
352
what is a common symptom of GI disorders in the older adult?
constipation / diarrhea
353
what is a common treatment for GI disorders
increase fluids & fibre
354
what should you not do for a patient with a GI disorder?
restrict fluids
