X Gerentology Flashcards

1
Q

Young Old

A

55 - 74

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2
Q

Old-Old

A

75 - and up

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3
Q

Frail Elderly

A

75 yrs w health concern

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4
Q

Is Chronological age an indicator of old age?

A

NO

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5
Q

Wellness is

A

based on belief that each person has optimal level of function, and even in chronic illness and dying some level of well being is attainable.

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6
Q

Traits of Healthy Person

A
Self-Responsibility
Nutritional Awareness
Physical Fitness
Stress Management
Evnt. Sensitivity (social)
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7
Q

Primary prevention

A

exercise for prevention of cardio vascular disease, falls and depression

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8
Q

Secondary Prevention

A

early detection and treatment of disease

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9
Q

Suggested Screening for Elders (Table 33-1)

A

MEN
Prostate Exam (2yrs)
Testicular Self Exam (monthly)

WOMEN
Pelvic Exam, Pap, Breast Exam (annual)
Mammo (2yrs)
Breast Self Exam (monthly)

BOTH
Physical (annual)
BP (p/visit)
Rectal Exam (2yrs)
Stool for occult blood (annual)
Eye exam (2yrs)
Glaucoma (annual)
Dental (annual, 2/dentures)
Hearing (2-5yrs)
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10
Q

Common Theories of Aging (Box 33-4)

A
BIOLOGICAL
.Programmed aging
.Genetic 
.Immunological
.Free Radical
.Wear and Tear
PSYCHO SOCIAL
.Erickson's Dev Stages (acceptance of one own lifestyle/inability to achieve level of acceptance results in anger/despair)
.Disengagement Theory
.Exchange Theory
.Activity Theory
.Continuity Theory
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11
Q

Ageism

A

term that describes prejudice in America against older adults

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12
Q

End of Life care

A

nurse works with older adult and entire family to meet the physical, spiritual and psycho-social needs of dying patient

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13
Q

1991 PSDA (Patient Self-Determination Act)

A

relates to advance directives, living wills, durable powers of attorney, DNRs

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14
Q

Physiological Changes of Aging

A

DOWN Immune response
DOWN compensatory reserve
DOWN ability to efficiently repair damaged tisue

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15
Q

Integumentary Changes

A

.Dry and thin, loses tone and elasticity
.less adipose causes wrinkles
.less melanin, grey, thin hair
.Nails grow slow developing horizontal ridges
.thinner skin causes changes in touch sensation
.response to meds or disease
.susceptabe to infection, ecchymosis, tears
.slow would healing
.age spots (lentigo)

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16
Q

Table 33-3

Integumentary Changes

A

PHYSIOLOGIC CHANGE RESULTS
-DOWN vascularity of dermis ,decreased melanin / UP pallor in white skin
-DOWN sebaceous gland / UP skin dryness
-DOWN sweat gland function / DOWN perspiration
-DOWN subcutaneous fat /
UP wrinkling
-DOWN thickness of epidermis / UP susceptibility to trauma
-UP localized pigmentation / UP incidence of brown spots (senile lentigo)
-UP capillary fragility / UP purple patches (senile purpura)
-DOWN density of hair growth / DOWN amount and thickness of hair on head and body
-DOWN melanin production in the hair bulb / Graying hair
-DOWN hormone production / DOWN vaginal secretions, breast tissue mass/DOWN erection and ability to maintain erection
/ UP brittleness of nails
-Decreased peripheral circulation / UP thickening yellowing nails
-DOWN nail growth / UP longitudinal ridges on nails
-UP androgen-to-estrogen ratio /UP facial hair in women

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17
Q

ASSESSMENT: Integumentary

A
  • observe for signs of excessive dryness, openings, tears, lesions.
  • Examine for lesions that have changed in size, shape, raised, crusty, pitted etc.
  • Observe hair loss, dryness, oiliness
  • Observe nails for color, length, shape, symmetry, cleanliness
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18
Q

Pruritis

A

dryness and itching, reduced glandular secretions

NURSING INTERVENTIONS

  • use soap sparingly
  • rinse completely
  • NO antibac soap, extra drying
  • showers only 2 p/week
  • water based lotion, oil residue uncomfortable for some
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19
Q

Nail Abnormalities

A
  • BILATERAL CLUBBING could indicate possible pulmonary or cardiac issue
  • YELLOWING, possible fungal infection
  • SPLINTERING, possible malnutrition
  • PITTING, signals peripheral vascular disease, psoriasis, diabetes mellitus or syphilis
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20
Q

Pressure Ulcers

A
Nursig Interventions
prevent shearing forces
-reposition every 2 hrs
-use padding to reduce friction on skin to bedding
-gentle handling
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21
Q

Gastrointestinal Changes

A
  • Decreased secretion of saliva,
  • DOWN gag response,
  • UP risk for aspiration/choking
  • DOWN gastric motility
  • DOWN production bicarbonate, gastric mucous, Intrinsic factor (leads to pernicious anemia)
  • DOWN gastric enzymes
  • less firm abdominal wall, muscle weakness
  • DOWN peristalsis, UP constipation
  • DOWN liver function
  • DOWN drug metabolism
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22
Q

Table 33-4 Gastro Changes w Aging

A
  • UP dental caries
    and tooth loss = DOWN ability to chew, DOWN nutrition
  • DOWN gag reflex = UP choking/aspiration
    -DOWN muscle tone at
    sphincters = UP pyrosis (heartburn); esophageal reflux
    -DOWN gastric
    secretions = DOWN digestion
    -DOWN peristalsis = UP constipation/bowel impaction
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23
Q

Gastro ASSESSMENT

A
  • ASSESS oral cavity for lesions, loose/missing teeth, ill fitting dentures, edematous gums, halitosis
  • ASSESS chewing/swallow ability, heartburn? Nausea?
  • ASSESS dietary intake, fiber, fat, Na, fluid
  • ASSESS appetite
  • ASSESS weight. compare w norms, asses sudden change
  • ASSESS elimination, amount, odor, consistency. bowel tenderness, sounds
  • ASSESS ability to control BMs
  • Annual fecal occult blood
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24
Q

Obesity

A

need to reduce calories as age.
1800 - 2400 daily (varies)

NURSING IMPLICATIONS
-more quality nutricious foods (grain, vege, fruit for vit/mis/roughage/fiber
reduce sugar, fats
-respect individual food preferences

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25
Q

Fluids/Dehydration

A

minimum 1500 ml/day fluids

  • due to difficulty holding cups
  • purposely reduce intake due to difficulty getting to bathroom, incontinence

NURSING INTERVENTION

  • make fluids readily available and within reach
  • accessible toilet
  • rearrange room if necessary
  • start bathroom schedule, every 2 hrs/waking, 4 hrs/sleep
  • double handed cups easier to hold
  • prompt disoriented to drink
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26
Q

Loss of Appetite

A
  • DOWN saliva
  • DOWN taste buds
  • DOWN gastric motility, loss of smooth muscle in stomach
  • Physiologic (anorexia)

NURSING INTERVENTION

  • prepare food using color, garnish, make attractive
  • more seasoning if no restrictions
  • homemade frozen dinners
  • extra portions of favorite foods
  • eat with company, social
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27
Q

Gastric Reflux

A

due to less efficient esophageal spincter, heartburn, sour stomach

NURSING INTERVENTION

  • eat small meals
  • avoid eating before bed
  • elevate bed head
  • achieve/maintain body weight
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28
Q

Dysphagia

A

Difficulty swallowing, stroke, neuro disfunction, local trauma, tumor obstruction

ASSSES
-Dysphasia with liquid, solid, or both

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29
Q

Constipation

A

abnormally infrequent or difficult passage of hard, dry feces.

Risk for fecal impaction

ASSESSMENT
dietary intake of fiber, fluid, med (antacid, iron, anticholinergics, laxatives), mechanical obstruction (fecal impaction, volvulus, adhesions, strangulated hernia cancer)

NURSING INTERVENTION
ensure adequate fluid, exercise, diet containing fiber.
up to 10g bran per day

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30
Q

Fecal incontinence

A

appearance of diarrhea, soft stool ooze around impaction.

most common cause of invontinence, associated w immobility and DOWN Fiber DOWN Fluid

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31
Q

Genitourinary System

A

DOWN Kidney function decreases w age.

DOWN Bladder capacity (50%, 150ml)

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32
Q

Urinary Incontinence

A

not normal part of aging

due to weak bladder, cancer, UTI, female perennial estrogen changes, male prostate

TYPES (SOUF)
Stress, Overflow, Urge, Functional

ASSESSMENT

  • frequency, amount, odor, color, constancy
  • ability to control urination
  • satisfaction with dexualtiy and affectionate relationships
NURSE INTERVENTIONS
Nocturia (excessive urination at night): 
-limiting fluids in pm, 
-diuretics in am, 
-Bladder retraining
-Kegels
-easy access to comode
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33
Q

Stress Incontinence

A

involuntary loss of small amount with increased abdominal pressure (coughing, sneezing) vaginal births, weak muscles

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34
Q

Overflow Incontinence

A

chonically full bladder increases bladder pressue to higher level than rethral resistance is able to ounter. weak uring stream difficulty starting to passs, interrutped voiding, incomplete emptying

(can be caused by
anticholinergics, spinal cord injury, mechanical obstruction)

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35
Q

Urge Incontinence

A

Involuntary urine loss ater a sudden urge to void.

cystitis, urethritis, tumors, stones, CNS disorders (stoke, dementia, Parkinsons)

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36
Q

Functional Incontinence

A

inability or unwillingness to toilet resulting from physical limitations, depression, confinement to bed or restraints.

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37
Q

Cardiovascular Changes

A
  • DOWN structural elasticity (heart takes longer to contract and chambers to fill) heart valves thicker, more rigid = DOWN venus return, UP dependent edema, UP orthostatic hypotension, UP varicosities, hemmroids
  • DOWN Cardiac output = UP heart failure, DOWN peripheral circulation
  • DOWN elasitity
  • DOWN pacemaker cells
  • DOWN electrical conduction (dysrythmias)
  • UP Arteriosclerosis = UP BP, UP Myocardial infarction
ASSESSMENT
Difficulty breathing
Signs of pallor, Rubor, cyanosis 
Chest pain
Apical / peripheral pulse
Capillary refill time
Vertigo, syncope, fatigue
Assess BP lying, sitting, standing
Assess for edema 

INTERVENTIONS

  • promote circulation
  • ambulating
  • avoid standing for long periods
  • no crossing legs
  • TED stockings
  • pneumatic compression pump
  • wide shoes giving support but not bind or rub
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37
Q

Respiratory System

A

Tissue of lungs and bronchi less elastic and more rigid.

Ribs less mobile, osteoporosis and calcification of rib cage, affect breathing

DOWN Hemoglobin
DOWN Cillia reduce clearing of secretions
DOWN gas exchange w alveoli

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38
Q

HTH contributes to coronary artery disease and stroke and…

A

CHF, renal failure, peripheral vascular disease

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38
Q

Musculoskeletal

A

DOWN bone calcium = osteoporosis, kyphosis
DOWN fluid in invertebrates discs = DOWN height
DOWN blood supply = DOWN muscle strength
DOWN joint mobility = DOWN mobility, flexibility
DOWN muscle mass = DOWN strength, UP risk of falls

INTERVENTIONS
am warm bath and shower to reduce stiffness
Walking devices
ROM exercises

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39
Q

Major risk factor for Coronary Artery Disease

A

Elevated Serum cholesterol

INTERVENTIONS
low saturate fat diet
30 min excercise 4/5 x pweek
Walking

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39
Q

ENDOCRINE

A

DOWN pituitary excretions = DOWN muscle mass
DOWN TSH = DOWN metabolism
DOWN parathyroid = DOWN blood calcium
DOWN insulin = UP blood glucose
DOWN testosterone, estrogen, progesterone = menauoause

INTERVENTIONS
manage medicine

40
Q

Dysrythmias

A

heart less effective in suppying blood to body

INTERVENTIONS

  • observing response to treatment,
  • vital signs
  • I&O
  • response to meds
  • keeping stress on heart down
  • monitor response to activity and provide appropriate rest periods
40
Q

REPRODUCTIVE

A

DOWN estrogen = vagina shortens, loose elasticity, DOWN vag secretions, pubic hair, uterus size, UP pain w intercourse, fragility

UP vag alkalinity = UP risk for infection

Male
DOWN testosterone = DOWN facial, pubic hair
DOWN circulation = DOWN ejaculation, rate, force, speed

41
Q

Peripheral Vascular Disease

A

Spasms or atheosclerosis allow insufficient Oxygenated blood to circulate legs and feet

Symptoms
intermittent Claudication: Cramping in calves.
Cold feet
varicose veins

INTERVENTION
techniques to promote circulation
ambulating
avoid standing in place for long periods of time
no leg crossing
compression stockings
pneumatic compression pumps
unna boots
clean legs and feet
wide fitting shoes, provide support but no rubbing, tightness
teaching to be aware
42
Q

Respiratory

A
  • tissues of lungs and brochi become less elastic, more rigid.
  • Ribs less mobile,
  • osteoporosis and calcification of cartilage, rigidity of thoracic cage
  • DOWN Vital Capacity
  • DOWN cilia to clear secreations (trachea)
  • UP risk for respiratory infections
  • DOWN elasticity of alveoli
  • UP shortness of breath
  • risk for Kyphosis (chest less able to expand because of changes in skeletal system)
  • COPD, Pneumonia, Lung cancer
ASSESSMENT
respiration
chest shape, symmetry, accessory muscles
breath sounds (wheezing, cracking: Adventitious sounds)
amount of activity patient can tolerate
presence of cough
43
Q

COPD

A

Chronic Obstructive Pulmonary Disease
common respirator condition, combination of chronic bronchitis, chronic asthma and emphysema

INTERVENTIONS
pulmonary hygiene
breathing retraining
chest physiotherapy
medication
smoking cessation
exercise programs
44
Q

Pulmonary Hygiene

A

hydrating to liquify secretions and removing secretions by teaching dee diaphragmatic breathing and variety of coughing techniques.

Pursed lip breathing

45
Q

Musculoskeletal System

A

-Joints less elastic, less mobility
-calcification of cartilage, rigid rib cage
-female: DOWN estrogen (increases bone resorption)
-DOWN calcium deposition = BONE LOSS, Kyphosis,
-DOWN fluid in invertebral disks = lose 1.5 - 3” height
-DOWN blood supply to muscles = DOWN muscle strength
-DOWN muscle mass = DOWN strength, UP risk for falls
changes in bone density affect long bones and vertebrae

ASSESSMENT
Vital signs
I&O
turning, deep breathing
movement ,circulation
mental status
use pillows
avoid movements such as crossing legs, adduction of hips
canes, walkers
declutter
46
Q

Endocrine System

A

DOWN Pituitary excretions ACTH = DOWN Muscle Mass
DOWN TSH = DOWN Metabolism
DOWN PTSH = UP blood calcium
DOWN production/use Insulin = UP Blood glucose
DOWN release of testosterone, estrogen, progresteone = menopause and other changes

ASSESSMENT
Lab results, ca, glucose, thyroid

INTERVENTIONS

47
Q

?Diabetes: Type 1

A

Insulin dependent, Diabetes Mellitus
body produces NO insulin.

SIGNS
not always signs
thirst, Polydipsia
UP appetite, Polyphasia
Polyurea
DOWN awareness of pain, temp
DOWN circulation
INTERVENTION
provide education
maintain stable metabolic rate
diet management
weight control
exercise
medication
motoring blood glu
48
Q

?Diabetes: Type 2

A

Inability to produce and use insulin appropriately

SIGNS
slow healing
blurred vision
weight gain or loss

INTERVENTIONS
provide education
maintain stable metabolic rate
diet management
weight control
exercise
medication
motoring blood glucose, hyperglycemia, sick day mgmt
foot care
49
Q

Reproductive

A

DOWN hormone
WOMEN: estrogen, progesterone
MEN: Androgen, Testosterone

changes to arousal, orgasm, post orgasm, extragenital changes

TABLE 33-10

ASSESSMENT
history of past experiences
signs of vaginal, penile ulceration, edema, discharge
presence of lumps, dimpling, drainage from breast
alternative sexual orientations

INTERVENTIONS
allow verbalization of sex concerns
provide private time
maintain good hygiene/cosmetic needs
provide distractions and alternative activities for individuals who masturbate, or provide privacy.
50
Q

Sensory Perception

A

DOWN Vision, DOWN Hearing = DOWN social interaction, mobilization

DOWN taste, smell, touch

VIsion:
Presbyopia (farsightedness from loss of elasticity of lens)can’t focus near. pupil small, less reactive to ligh

ASSESSMENT

  • eyes for dryness, tearing, signs of irritation
  • ability of individual to see close up and distance.
  • hearing, not use of hearing aids and effectiveness
  • report changes in taste or smell
51
Q

Vision: 4 main cases of visual impairment

A

Cataracts
Glaucoma
Macular Degeneration
Diabetic Retinopathy

INTERVENTIONS
clean eyeglasses, within reach
inrease light in environment
reduce glare
use night lights
large print
contrasting colors
magnifying glasses
52
Q

Glaucoma

A

2nd leading cause, blindness

occlusion in drainage of fluid in anterior chamber of eye, which produces an increase in intra-occular pressure

Pressure transfers to optic nerve, damage of blindness. Irreversible

INTERVENTION
medication

53
Q

Cataracts

A

most common disorder found in eye

Clouding of normally clear lens

degenerative changes to lens protein and fatty deposits (lipofuscion) in lens.

SYMPTOMS
blurred, misty vision
need more light to read

INTERVENTIONS
surgery

54
Q

?Hearing

A

extrenal ear
middle ear
inner ear

Hearing loss NOT normal part of aging

Presbycusis - sonsoneural hearing loss

eardrum loses elasicity, ossicles of middle ear become more rigid, atrophy of auditory nerve and end-organs in inner ear.

also due to loud noises throughout life

INTERVENTIONS

  • provide good visual contact
  • allow lip reading
  • avoid rooms with glare or shadow’s in patients field of vision
  • reduce/eliminate background noise
  • speak at normal rate and volume
  • do not over articulate
  • use short sentences
  • pause after each sentence
  • use facial expressions/gestures
  • ask how you can help listening
  • be patient, stay positive
55
Q

Touch

A

decrease in number of receptor cells througtou skin adn joints

DOWN sensing temp
DOWN maintain balance
UP risk for burns and fall
DOWN blood flow to body parts

56
Q

Nervous System

A

DOWN brain cells, peripheral nerve cells and fibers
synaptic changes to affect transmission and sensitivity

Longer reaction time
decreased efficiency maintaining normal body temp
low perception to stimuli

57
Q

Memory

A

short term memory may decline with age, but long term is usually maintained.

ASSESSMENT

  • alertness level and consciousness including eye opening, verbal responses nad ability to follow simple commands
  • behavior and responses
  • mental status
  • presence of pain
  • sleep patterns
  • lab resulsts
  • CT scan, MRI
58
Q

Insomnia

A

INTERVENTIONS

  • encouraging bed time rituals
  • excercise during day
  • nap in morning
59
Q

Delirium

A

NOT a disease, its the syndrome resulting from variety of causes

Rapid onset (hours to days)
brief course

CAUSES

  • environmental
  • social isolation
  • unfamiliar surroundings
  • sensory overload
  • immobilization
  • sleep deprivation
  • metabolic
  • endocrine
  • cardiovascular (low O to brain)
  • cerebrovascular
  • nutritional
  • infections
  • cerebral and extracranial neoplasms
  • trauma
  • medication/drug toxicity
  • substance withdrawal

INTERNVENTIONS

  • education to sign/symptoms
  • orientatoin and communications
  • mobilization
  • environmental modicications
  • education and caregivers
  • pain control
  • mgmt of elimination patterns
  • medication mgmt
  • discharge planning
  • Reality orientation
60
Q

Reality Orientation (used for Delirium ptns)

A
  • call ptnts by correct names or name desired
  • make eye contact
  • converse about familiar subjects
  • provide familiar objects in living space
  • explain events and procedures in concise, simple language
  • be honest
  • set a routine and be consistent
  • engage older adult in familiar simple activity such as ADLs.
61
Q

4a) Dementia

4b) definitions

A

Progressive impairment of intellectual (cognitive) function that interferes with normal social and occupational activities.

SYMPTOMS

  • loss of memory
  • and one other function of intellectual function (i.e. orientation, attention, calculation, language, motor kills)
  • difficulty abstract thinking and will (i.e. unable to define differences in objects or words)
  • Aphasia (inability to understand words)
  • Agnosia (can’t recognize familiar objects)
  • Agraphia (difficulty writing/drawing)
  • sometimes personality changes

affects SHORT TERM, INTERMEDIATE, and LONG TERM memory

62
Q

4c) Alzheimers

A

most common cause of DEMENTIA.
(Dementia of the Alzheimer’s type)

progressive disorder where the brain atrophies

usually in patients over 60, loss of cortical neurons, ventricles enlarged, senile plaques and neurofibrillary tangles appear in cortex of brain.

STAGES:
EARLY: gradual onset of memory loss and difficulty focusing attention

MIDDLE: diff w language, object recognition and judgement

TERMINAL/FINAL: urinary/fecal incontinence, inability to ambulate or provide self-care, inability to communicate. little/no response to family or surroundings. Mute and bedridden

Duration 8-20yrs.

63
Q

4d) MID

A

Multi-infarct Dementia

second most common cause of dementia
related to vascular disorders within brain resulting from stroke and sever HTN.

SYMPTOMS

  • Abrupt onset
  • remission (absence of symptoms)
  • preservation of personality
  • mood swings
  • confusions
  • problems w recent memory
  • wandering, getting lost in familiar places
  • moving with rapid shuffling steps
  • loss of bladder/bowel control
  • inappropriate display of emotions
  • difficulty following instructions

CAUSES

  • arteriosclerosis
  • blood dyscrasias
  • cardiac decompensation
  • HTN
  • atrial fibrillation
  • cardiac calve replacements
  • systemic emboli arising from other causes
  • DM
  • peripheral vascular disease
  • obesity
  • smoking
  • vasospasms in brain (Transient Ischemic Attacks, TIAs)

** Stair step decline, not slow and steady like Alzheimers

64
Q

TIA

4b) one def word - Ataxia

A

Transient Ischemic Attacks

changes in vascular system cause small spasms or occlusions in cerebral vessels of brain

SYMPTOMS (last as little as 20min)

  • vary depending on location of vessel in brain
  • changes in vision
  • headache
  • disorientation
  • ATAXIA (imparied ability to coordinate movement)
  • drop attack (falling without losing consciousness)

prompt treatment can prevent stroke

INTERVENTIONS
provide safe environment
safety devices
mobility aids
memory aids
schedules
lists
neuro exam
65
Q

Parkinson’s Disease

A

second most common disorder affecting nervous system

SYMPTOMS

  • muscle rigidity
  • tremors
  • AKINESIA (abnormal state of -motor and psychic hypoactivity)
  • mask-like appearance
  • drooling
  • shuffling gait
  • sometimes emotional instability

Stress/Frustration increase symptoms

INTERVENTION

  • observe response to medication (levodopa, amantadine HCL, anticholinergics
  • maintaining mobility
  • ROM exercise
  • massage to relieve spasms
  • de-clutter
  • canes/walkers
  • if intellectual function not impaired, allow time to respond to questions
  • encourage efforts to communicate
  • show acceptance
  • non-verbal communications
66
Q

Akinesia

A

abnormal state of -motor and psychic

Parkinson’s

67
Q

Anticholinergics

A

Anticholinergic: Opposing the actions of the neurotransmitter acetylcholine. Anticholinergic drugs inhibit the transmission of parasympathetic nerve impulses, thereby reducing spasms of smooth muscles (for example, muscles in the bladder). Side effects of anticholinergic medications include dry mouth and related dental problems, blurred vision, tendency toward overheating (hyperpyrexia), and in some cases, dementia-like symptoms.

68
Q

Stroke

A

brain attack.

3rd leading cause of DEATH in USA.

SYMPTOMS

  • HEMIPLEGIA (paralysis one side body)
  • DYSARTHRIA (difficult, poor articulated speech)
  • Dysphagia (diff swallowing)
  • hemianopia (defective vision or blindess in half of visual field)
  • Aphasia (defective language function)
  • Intellectual/emotional changes

INTERVENTIONS

  • support of life functions IMMEDIATELY after stroke. symptoms usually dissapear 3-6 months w quick action.
  • rehab of ADLs
  • pull on/off clothing
  • wheelchair/canes
  • encourage excercise
  • listen carefully
  • lower distracting sounds
  • speak slowly
  • short direct statements
  • no interrupting their speech
  • do not rush patient
  • de-clutter
  • use touch to communicate
69
Q

Hemiplegia

A

paralysis on one side of body

70
Q

Dysarthria

A

(difficult, poorly articulated speech, resulting
from interference in the control over the muscles of
speech),

71
Q

Hemianopia

A

(defective vision or blindness in half of the visual field),

72
Q

5) Nursing Diagnoses - neuro

A
  • Impaired verbal comm, related to memory loss and diff focusing attention
  • caregiver role strain, related to diff coping w cognitive losses and progressive deterioration of self-care abilities
  • wandering related to search for security
  • unilateral neglect, related to neurologic involvement

etc

73
Q

6) General Fall Guidelines
pg 1114

GENERAL CARE

A
  • Wear low-heeled shoes with small wedge platforms.
  • Wear leather or rubber-soled shoes.
  • Leave night-lights on at night.
  • Keep items within reach to prevent overreaching.
  • Check the tips of canes and walkers for evenness.
  • Paint the last step a different color, indoors and outdoors.
  • Dangle the legs between positional changes, and rise slowly.
  • Avoid the use of alcohol.
  • Avoid rushing.
  • Avoid risky behavior, such as standing on ladders unaided.
74
Q

General Fall Guidelines
pg 1114

STEPS AND FLOOR SURFACES

A

• Be careful to avoid slippery floors and frayed carpets.
• Watch for the last step when descending the stairs.
• Count the number of steps as a cue while ascending and
descending the stairs.
• Install and use sturdy banisters on both sides of staircases.
• Tack down throw rugs or remove them entirely.
• Remove obstacles in the path of traffic.
• On landings, use carpeting that has color contrast.

75
Q

General Fall Guidelines
pg 1114

BATHROOM

A

• Install grab rails in the tub and shower and near the toilet.
• Avoid throw rugs; install carpeting.
• Apply oils to skin after showering or bathing.
• Avoid using bar soaps; use liquid soap from a dispenser
mounted in the shower.

76
Q

7a) Polypharmacy

A

Polypharmacy is the use of four or more medications by a patient, generally adults aged over 65 years. Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes.

77
Q

7b) Polypharmacy patients at risk

A

(1) take 5 or more Rx meds
(2) sometimes borrow meds
(3) use OTC meds ,
including vits, supplements, or herbal preps
(4) request refills w/out seeing Dr.
5) take meds whose Rx come from more than one HCP
(6) have Rx filled at more than one pharmacy.

78
Q

7c) Changes in body that alter ability to absorb, transport, eliminate meds - 33-12

A
  • impaired circulation
  • change in vessel walls
  • DOWN number and efficiency of glomeruli in kidneys
  • DOWN bloodflow in liver, fewer functioning liver cells
  • DOWN liver enzymes that break down meds
79
Q

7d) Changes, CNS

A

Brain receptors become more sensitive, making psychoactive drugs very potent.

80
Q

7d) Changes, Circulation

A

Vascular nerve controls grow less stable.
Antihypertensives, for example, may drop
blood pressure too low. Digoxin, for
example may slow the heart rate too much.

81
Q

7d) Changes, Metabolism

A

Liver mass shrinks. Hepatic blood flow and
enzyme activity decline. Metabolism drops
to 1/2 to 2/3 the rate of young adults. Enzymes lose ability to process some drugs
that reduce irregular heart rhythms or
breathing disorders.

82
Q

7d) Changes, Excretion

A

In kidneys, renal blood flow, and number
of functional nephrons decline. Blood flow
and waste removal slow and drugs stay in
the body longer.

83
Q

7d) Changes, Absorption

A

Absorption
Gastric enzymes and secretions decrease;
gastric pH rises. Gastric emptying rate and
gastrointestinal motility slow. Absorption
capacity of cells and active transport
mechanism declines.

84
Q

7d) Changes, Distribution

A

Adipose stores increase. Total body water
declines, raising the concentration of
water-soluble drugs, such as digoxin, which
can cause heart dysfunction.

85
Q

7e) Encourage older adults to
avoid taking any herb, supplement, or other over-thecounter products without contacting the health care provider or a pharmacist who will review the complete drug profile

A

.

86
Q

7f) INTERVENTIONS for ability to take meds properly

A
  • chart

- pillbox

87
Q

mistaken for Old Age, but could be reaction to Meds

A
  • Disorientation
  • fatigue
  • anorexia
  • falls
  • vertigo
88
Q

7i1) Antihypertensives

A
  • Observe for depression, anxiety, disorientation.

- Monitor for bradycardia, angina, hypotension.

89
Q

7i2) Cardiovascular Agents

A
  • Explain importance of keeping appointments for laboratory examinations.
  • Observe for orthostatic hypotension.
  • Monitor heart rate, rhythm, and blood pressure.
  • Observe for adverse reactions—disorientation, depression, vertigo, lethargy.
90
Q

7i3) Diuretics

A
  • Observe for orthostatic hypotension, delirium, changes in mental function.
  • Explain reasons for taking in the morning.
  • Observe for hypokalemia.
  • Weigh daily.
  • Record I&O.
91
Q

7i4) Oral anticoagulants

A
  • Monitor prothrombin time (PT) and International Normalized Ratio (INR).
  • Observe for bleeding.
  • Explain importance of keeping appointments for laboratory examinations.
  • Explain the need to avoid aspirin-containing products.
  • Institute safety measures to prevent injury.
92
Q

7i5) Oral hypoglycemic agents

A
  • Observe for signs of hypoglycemia—weakness, headache, malaise.
  • Monitor blood glucose levels.
93
Q

8a) 5 classes of Elder abuse

A

1) Physical/Sexual
2) psychological
3) misuse of
assets
4) medical abuse (withholding necessary treatment or aids for ADLs)
5) neglect

94
Q

8b) 2 indicators of elder abuse

A

1) frequent unexplained crying

2) unexplained fear of or suspicious of a particular person in the home

95
Q

Type of Older Adult Abuse

Box 33-6

A

-Physical abuse: The use of physical force that has potential
to result in bodily injury, physical pain, or impairment.
-Sexual abuse: Nonconsensual sexual contact of any kind
with an older adult, including those persons unable to
give consent.
-Emotional or psychological abuse: The infliction of anguish, pain, or distress through verbal or nonverbal acts,
including intimidation or enforced social isolation.
-Neglect: The refusal or failure to fulfill any part of a person’s
previously agreed obligation or duties to an older adult
dependent on the person for care or assistance.
-Abandonment: The desertion of an older adult by an individual who had assumed the responsibility of providing
care or assistance.
-Medical abuse: Subjecting a person to unwanted medical
treatments or procedures; medical neglect occurs when
a medically necessary and desired treatment is withheld.
-Financial or material abuse or exploitation: The illegal or
improper use of older adult’s funds, property, or assets.

96
Q

9i) Effects of Immobility on body

A
  • stasis of secretions
  • orthostatic hypotension
  • digestive disorder
  • perceptual disorders
97
Q

9ii) INTERVENTIONS to prevent immobility

A
  • turning, deep breathing, coughing (ventilation)
  • removal of respiratory secretions (DOWN infection)
  • ambulate 8-24hrs after surgery if possible
  • getting up and standing, take a few steps (stimulate circulation and muscle activity)
  • encourage performing self care
98
Q

9iii) Types of facilities and care

A
  • Home
  • Assisted Living
  • Long-Term Care
99
Q

Discharge Planning

A

• Teach when the older adult is alert and rested. Allow for
several shorter sessions, watching for signs of fatigue.
• Involve the individual in discussion or activity.
• Focus on the person’s strengths.
• Use approaches that adapt for the presence of pain and impaired range of joint motion, impaired reception of stimuli
such as slower reaction time, muscular weakness, reduced
pain and temperature perception, reduced depth perception
and color discrimination, or reduced visual acuity.
• Consider need for adaptive devices, such as a syringe magnifier.
• As needed, enlist the help of the patient’s significant other,
and/or provide assistive personnel.

100
Q

9iv) Bill of Rights for Long Term Care Residents: Box 33-7

A

• The right to voice grievances and have them remedied.
• The right to information about health conditions and treatments and to participate in one’s own care to the extent
possible.
• The right to choose one’s own health care providers and to
speak privately with one’s health care providers.
• The right to consent to or refuse all aspects of care and
treatments.
• The right to manage one’s own finances if capable, or
choose one’s own financial advisor.
• The right to be transferred or discharged only for appropriate reasons.
• The right to be free from all forms of abuse.
• The right to be free from all forms of restraint to the extent
compatible with safety.
• The right to privacy and confidentiality concerning one’s person, personal information, and medical information.
• The right to be treated with dignity, consideration, and respect in keeping with one’s individuality.
• The right to immediate visitation and access at any time for
family, health care providers, and legal advisors; the right
to reasonable visitation and access for others
NOTE: This list of rights is a sampling of federal and several
states’ lists of rights of residents or participants in long-term
care. Check the rules of your own state for specific rights in
law for that state.