Geriatric Nursing Care of The Elderly and Chronically Ill – Flashcards
Unlock all answers in this set
Unlock answersquestion
aging population is due to
answer
-survivng acute illness -living with chronic illness -becoming more educated and resourseful -more ethnically diverse
question
life expectancy for men
answer
77.8
question
life expectancy for women
answer
80.8
question
young old
answer
65-74
question
old old
answer
85 +
question
frail old
answer
some dysfunction
question
reasons why women live longer
answer
-women are more likely to seek medical help -men are more accident prone -about 6% of 65+ live in nursing homes -25% 85+
question
aging is normal
answer
-older adults have diverse characteristics -care should not be based off age alone -myths and sterotypes can lead to poor care -ageism leads to discrimination and disparate care
question
genetic theory
answer
genes control genetic clocks
question
immunity theory
answer
focuses on the functions of the immune system
question
cross-linkage theory
answer
chemical reaction produces damage to the DNA and cell death(chemical exposure throughout life)
question
free radical theory
answer
molecules with separated high energy electrons have adverse effects on adjacent molecules(exposure)
question
common myths of older adults (ageism)
answer
-Old age begins at 65 years. -Most older adults are in nursing homes. -Older adults are sick, and mental deterioration occurs. -Older adults are not interested in sex. -Older adults do not care how they look and are lonely. -Bladder problems are a problem of aging. -Older adults do not deserve aggressive treatment for illnesses.
question
changes of older adults
answer
-Physical strength and health -Retirement and reduced income -Health of spouse Relating to one's age group -Social roles -Living arrangements Family and role reversal
question
physiologic development
answer
all organ systems undergo some degree of decline, body less efficient
question
cognitve development
answer
does not change appreciably, may take longer to respond and react
question
psychosocial development
answer
self-concept is relatively stable throughout adult life
question
kohlberg theory of spirituality
answer
older adults have completed their moral development and most are at a conventional level
question
moral and spirituality development
answer
-Spiritually, an adult may be at earlier level, often at individuative-reflective level -Many adults demonstrate conjunctive faith and trust in a greater power -Self-transcendence is characteristic of later life
question
housing options for odler adults
answer
Home modifications Home sharing Accessory apartments Elderly cottage housing opportunities Senior retirement communities Continuing care retirement communities Assisted living Board and care homes Nursing homes
question
homeless older adults
answer
-Numbers are increasing. -Mortality rates are 3 times higher than for those with housing. -Have more health problems and appear older -Require an interdisciplinary services approach
question
elder mistreatment/abuse
answer
-From 2-10% of community-dwelling older adults in the United States are abused, neglected, or exploited by trusted others. -Mortality risk is 3 times higher. -self neglect
question
medicare
answer
federally funded insurance for people >65. Also covers those < 65 with disabilities or end-stage kidney disease
question
medicaid
answer
Medicaid is a state-administered, needs-based program to assist eligible low-income people with medical expenses.
question
speical care needs
answer
-Need assistance with ADLs -Cognitively impaired -Homebound -No longer able to live at home -Homeless
question
home health care
answer
-Homebound -Intermittent or acute health needs -Supportive caregiver involvement
question
long term care
answer
-Transition may be difficult for patients and families -Relocation stress syndrome
question
specialty of gerontology nursing
answer
-Complex, skilled, creative care -Older adult disease symptoms are often atypical and underreported. -Patients may be fearful and anxious about both health problems and institutions of care.
question
aspects of geriatric nursing
answer
-Physical -Psychosocial & Cognitive -Pharmacological Safety
question
goal of nursing care
answer
-Promote independent function. -Support individual strengths. -Prevent complications of illness. -Secure a safe and comfortable (recognize fall risks and leave bed, walkers, and wheelchairs locked environment. -Promote return to health.
question
when collecting data
answer
-have the interview be as convo like as possible -Adapting interview techniques -Determining functional status -Family and caregiver assessment -Recognizing geriatric syndromes
question
metabolism changes
answer
-liver mass shrinks -hepatic blood flow + enzyme activity decrease -metabolism drops to 1/2 to 2/3 the rate of young adults
question
absorption
answer
-gastric emptying rate and GI motility slow -absorption capacity of cells + active transport mechanisms decline
question
circulation
answer
-vascular nerve control is less stable -antihypertensives, for example, may over shoot, dropping BP too low -digoxin, for example, may slow to heart rate too much
question
excretion
answer
-in kidneys, renal blood flow, glomenular filtration rate, renal tubular secretion + reobsorption, and number of functional nephrons decline -age related changes increase halflife for renally excreted drugs -oral antibiotic drugs, among others, stay in blood longer
question
distribution
answer
-lean body mass falls -adipose tissue stores increase -total body water declines, raising the concentration of water-solubale drugs, such as digoxin, which can cause heart dysfunction -plasma protein levels decrease, reducing sites available for protein-bound and rises blood levels of free drug
question
special considerations of the older adult
answer
-Skin & Sensory Organs -Dysphagia and Nutrition -Elimination -Functional Status
question
SPICES
answer
addresses the most common issues in the elderly -sleep disorders -problems with eating or feeding -incontinence -confusion -evidence of falls -skin breakdown
question
signs + symptoms of dysphagia
answer
-bed up to 90 degrees -tuck chin down so food goes down -watch for exsessive coughing(aspiration), hands to neck, increase respiratory rate+decreased 02 stat
question
What else with Nutrition?
answer
-Fluid Status -Elimination -Vitamin intake -Protein intake Specialty diets: -Cardiac (low fat, low sodium, fluid restrictions*) -Pureed -Soft -Nectar thick
question
important nutrition!
answer
-increase fluid intake but after 6 PM stop if pt is incontinent -high fiber/fluids help with constipation -vitamins help tissue repair
question
albumin levels
answer
-meaures nutrition levels because albumin is a large protien found in blood that helps with healing + skin integrity
question
culturally competent care
answer
-talk to patients about culture+needs -cultural awarness is very important -asian culture prefers medical personal talking to family over patient
question
family caregivers
answer
Primary and preferred
question
semiformal levels of support
answer
Clubs, faith-based organizations, neighborhoods, senior centers
question
formal systems of support
answer
Social welfare agencies, health facilities, government agencies
question
mental health
answer
Depression Delirium Dementia "Sundowning" Alzheimer's
question
depression
answer
-Range: 16-30% of nursing home residents. -Events, loss, chronic illness, pain -75% of elderly suicides have seen their doctor within that month
question
delirium
answer
-Acute, confused state that begins with disorientation. -If not immediately evaluated and treated, can progress to changes in level of consciousness, irreversible brain damage, sometimes death -can be indicator that pt has something wrong ex. UTI, phenomena, cold
question
dementia
answer
-Broad term for syndrome characterized by general decline in higher brain functioning (reasoning) with pattern of eventual decline in ability to perform even basic activities of daily living (toileting, eating). -Vascular Dementia -Alzheimer's disease=80% of cases -make sure pt is not at risk to others. if so, move near nurses station
question
sundowning
answer
-Common observed tendency for people with dementia to become more confused and agitated around late afternoon to nightfall. -May resemble delerium. -Decreased attention, altered sleeping/waking pattern, and disturbed psychomotor behavior. -No specific cause. -Modified and/or managed with behavioral interventions.
question
alzheimers disease
answer
-Chronic, progressive, degenerative disease of the brain -Most common form of dementia -5.2 million Americans suffer from AD. -11% people over age 65 have AD. -33% of those over age 85 have AD. -6th leading cause of death in the United States
question
alzheimers continued
answer
-Only cause of death among the top 10 that cannot be prevented, cured, or even slowed Burden of care is staggering. -Known as the "long good-bye" or "death in slow motion"
question
alzheimers etiology and pathophysiology
answer
-Exact cause is unknown. -Likely a combination of genetic and environmental factors Age is most important risk factor: -Early-onset: 60 years old -Results in structural damage -Affected parts of brain shrink -Brain atrophy -Significant in final state of AD
question
familial alzheimers dieases
answer
-Clear pattern of inheritance -Onset before age 60 -Rapid disease course
question
sproadic alzheimers diease
answer
no familial connection
question
retrogenisis
answer
-Process where degenerative changes occur in the reverse order in which they were acquired -Developmental stages in children compared with deterioration in AD patients
question
early signs of AD
answer
Memory loss that 1affects job skills 2Difficulty performing familiar tasks 3Problems with language 4Disorientation to time and place 5Poor or ↓ judgment 6Problems with abstract thinking 7 misplacing things 8 changes in mood or behavior 9 changes in personaility 10 loss of initiative
question
initial manifestations related to changes in cognitive function
answer
-Memory loss -Mild disorientation -Trouble with words and numbers -Often first noted and reported by a close family member
question
as the disease progresses
answer
-Personal hygiene -↓Concentration and attention -Unpredictable behavior -Delusions and hallucinations
question
additional cognitive function
answer
-dysphagia -apraxia (trouble speaking) -visual agnosia (cant visually recognize) -dysgraphia (cant write) -some long term memory loss -wandering
question
severe late stage
answer
-Unable to communicate -Cannot perform activities of daily living (ADLs) -Patient becomes unresponsive and incontinent. Total care is required
question
no cure for alzheimers
answer
-No treatment exists to stop the deterioration of brain cells in AD. -Collaborative management aimed at Controlling undesirable behavioral manifestations Providing support for the family caregiver
question
nursing management
answer
-Supporting cognitive function -Promoting physical safety -Promoting independence in self-care activities -Reducing anxiety, agitation -Improving communication
question
more nursing management
answer
-Providing for socialization, intimacy needs -Promoting adequate nutrition -Promoting balanced activity, rest -Supporting home and community-based care
question
use of restraints (Acute care)
answer
-Physical restraints -Chemical restraints -Used to ensure safety ONLY -Least restrictive approach -Highly regulated
question
pharmacology for the older adult
answer
-Pharmacokinetics -Interactions -Polypharmacy -Quality of life -Financing -Adherence -Risk -Safety
question
safety
answer
-Medications, Falls, Environment, Toileting, Turning, etc. -safety is key!!!
question
causes of accidental injuries in older adults
answer
-Changes in vision and hearing -Loss of mass and strength of muscles -Slower reflexes and reaction time -Decreased sensory ability -Combined effects of chronic illness and medications -Economic factors
question
patient education for older adults
answer
-Chronic illness limits activities in almost half of older adults. -Meeting expenses of healthcare is often difficult. -Medication costs, hospitalization costs, and costs of special equipment and supplies -Family members must learn to cope with needs of the ill person. -Family members must adapt to psychological stressors.
question
what are some of the changes that can occur as a result of increasing age in an older adult?
answer
-Physical strength and health -Retirement, reduced income -Spouse's health -Relating to one's age group -Social roles -Living arrangements
question
Social gatherings, travel, attending sporting events, and so on are part of the residents' daily lives. What are some of the purposes of these activities?
answer
-Assists in adapting to life role changes -Need for one's socialization doesn't change with aging -Prevents loneliness and isolation -Results in increased life satisfaction I-ncreases the ability to maintain high levels of activity and function -Allows one to share common interests and concerns -Enables one to find status among peers
