1.0 Human Flourishing

Question 1

Factors that affect functional health of older adult

Answer 1

Acute vs chronic illness
Optimum wellness
Prevention of chronic illness
Rehabilitation
Continuing care
**frailty and vulnerability: multisystem reduction in physiological capacity, lower recovery

Question 2

Common health problems

Middle adult

Answer 2

Obesity
CV disease
Cancer
DM
Substance abuse
Stress

Question 3

Common health problems

Older adult

Answer 3

Obesity
CV disease
Cancer
DM
Substance abuse
Stress
Chronic, multisystem disease
Injury (fall, fire, MVA)
Pharmacologic effects

Question 4

Acute VS chronic illness

Answer 4

Acute:
rapid onset, short term, self limiting

Chronic:
Persistent and progressive

70% deaths in US and 85% health care spending

Increasing problems

Requires LT management: lifestyle modification

Periods of remission and exacerbation possible

Individual response and challenges

Adaptation and complication prevention- goals

Significant role for nurses

Question 5

Challenges of chronic illness

Answer 5

Recognize and respond to symptoms

Medication
Manage ongoing treatment plan

Lifestyle modification

Coping with psychosocial effects

Maintaining feelings of control

Interaction with healthcare system

Question 6

Optimal wellness

Answer 6

Potential for the individual is optimized

Functional focus

Question 7

Promoting optimal health

Answer 7

Health promotion: (primary prevention) true prevention

Illness prevention: (secondary prevention) screenings, risk factor identification

Health restoration: (tertiary prevention) rehabilitation and recovery, reduce effects

Question 8

Health promotion

Primary prevention examples

Answer 8

Immunizations
Exercise/activity
Nutrition
Sleep
Safety
Eliminate smoking
Focus: true prevention

Question 9

Immunizations for adult

Answer 9

Pneumonia:
Pneumovac (PPSV23)
Prevnar 13 (PCV13)

Influenza

Tdap

Herpes Zoster (shingles):
Shingrix (RZV) 50+ yr, 2 shots.
Zostavax (ZVL) 60+ yr, 1 shot (no longer recommended)

Covid

Question 10

Exercise guidelines

Answer 10

Integrate exercise into lifestyle
Weight bearing: bone benefits
Resistance/agility: reduce falls risk
Walking
Community resources
Middle age: 
moderately strenuous, 30+ min, 5 days/wk
Older adult:
moderately strenuous 30-60 min/day

Question 11

Factors affecting nutrition in elderly

Answer 11

Cost
Availability
Mobility: carrying home heavy groceries

Question 12

Nutrient deficiency in older adults

Answer 12

Dehydration risk
Protein deficiency
Reduced Vit D synthesis
Anemia
Zinc deficiency
Dental health problems
Taste changes
Mobility problems
Motility problems
Reduced GI secretion
Social issues

Question 13

Illness prevention

Secondary prevention

Answer 13

Secondary prevention: early diagnosis and treatment
Screening
Lifestyle and diet management
Specific treatment for illness
Focus: diagnosis and prompt intervention

Question 14

Screening

Secondary prevention

Answer 14

Secondary prevention:
Physical exams- annual
HTN: BP
CAD: cholesterol, lipids
Diabetes: blood sugars/Hgb A1C
Breast cancer: mammogram and BSE
Cervical cancer: pap
Colorectal cancer: FOB (fecal occult blood), colonoscopy
Prostate cancer: DRE (digital rectal exam), PSA (prostate surface antigen)
Eye exam

Question 15

Medicare overview

Answer 15

Part A: hospital (80% coverage at 65 years old)
Part B: medical (not required, outpatient, doc office)
Part D: prescription drug (required to purchased)

Medicare Advantage Plans: all of the above plus, but may have coverage limits (hospital system, coverage limits, approved providers)

Medicaid

Question 16

Health restoration

Tertiary prevention

Answer 16

Tertiary prevention
Rehabilitation
Focus: minimize disease and disability
Prevent decline and complications

Question 17

Restorative and continuing care options

Tertiary prevention

Answer 17

Tertiary prevention:
Home care (who qualifies for Medicare reimbursed skilled care?= Home bound, need of skilled services such as PT/OT etc)
Assisted living
Extended care: skilled/basic
Skilled rehab
Respite care: provides relief to care givers
Adult day care
Hospice
PACE: program of all inclusive care for the elderly) LifeCycles and Tanglewood

Question 18

Define exacerbation

Answer 18

Increases in the gravity of a disease or disorder as marked by greater intensity in signs and symptoms

Question 19

Define remission

Answer 19

Partial or complete disappearances of the clinical and subjective characteristics of chronic or malignant disease; remission may be spontaneous or the result of therapy

Question 20

Daily energy needs after age 50 decrease by?

Answer 20

Women 2200 to 1920 kcal

Men 2900 to 2300 kcal

Question 21

Risk factors for malnutrition in older adults

Answer 21

Alcoholism
Anorexia
Chewing/swallowing, dysphagia
Consuming only one meal/day
Dental difficulties
Depression/dementia
Diabetes
Diminished physical functioning
Feeding problems
Food purchasing/preparation difficulties
Impaired acuity of taste/smell
Living in long term care
Loss of spouse
Taking multiple medications
Nerve disorder
Poverty
Pulmonary disease
Surgery

Question 22

Strategies for overcoming bariers to good nutrition

Answer 22

Counteract decreased sense of taste/smell:
refrain from smoking 1 hour before meals
sipping water before and during meals (moisten mouth)
amplify flavors with seasonings, no salt
recommend chewing food thoroughly
vary food textures and flavors

Encourage social interaction:
share food prep and mealtimes
congregate meal programs
lighting to see food

Provide outside support:
meals on wheels
supplemental nutrition assistance programs (SNAP)
grocery store delivery

Question 23

Primary prevention examples (true prevention)

Answer 23

Primary prevention: is true prevention; it precedes disease or dysfunction and is applied to pt considered physically/emotionally healthy.

Health education programs
Immunizations
Nutrition programs
Physical fitness activities

Question 24

Secondary prevention examples (Illness prevention)

Answer 24

Secondary prevention: focuses on individuals who are experiencing health problems/illness and are at risk for developing complications/worsening conditions.

Diagnosis and prompt interventions (reducing severity)

Question 25

Tertiary prevention examples (Health restoration)

Answer 25

Tertiary prevention: occurs when defect/disability is permanent/irreversible. Involves minimizing the effect of long term disease/disability by interventions directed at preventing complication/deterioration

ADL’s, wheel chair
PT/OT

Question 26

Physical changes of aging

Middle adult 40-65 yr

Answer 26

40-65 yr physical changes:
Skin: decreased turgor, moisture, SQ fat (deposited in ab/hip)

Hair: loss of melanin causing graying, hairline recedes for males

Sensory: near vision decreases, high frequency sounds decrease, taste diminishes

Musculoskeletal: mass decreases, thinning intervertebral disk, postmenopausal low bone density/osteoporosis

Cardio: vessels lose elasticity, systolic B/P increase

Respiratory: vital capacity loss

GI: large intestine loses muscle tone, constipation may result, gastric secretions decrease

GU: hormonal changes; women estrogen decrease, men testosterone decrease

Endocrine: decrease in glucose tolerance

Question 27

Physical changes in older adult 65+

Answer 27

65+ physical changes:
Skin: decrease turgor, sebaceous gland activity, age spots

Hair/nails: scalp, axillary, pubic hair thins, nose/ear hair thickens, women may facial hair, nails grow slowly brittle/thick

Sensory: visual narrows, depth perception distorted, cataracts. pupils smaller reducing light. lenses yellow resulting in green/blue/violet tones increased sensitivity. tears decreases, smell decreases, hearing loss, pain/touch increases, physical position

Musculoskeletal: mass/strength/movement loss, bone deterioration of joint cartilage, kyphosis, fracture risks, ROM restrictions

Cardio: systolic B/P rises, cardiac output decreases, peripheral resistance increases, cap walls thicken

Respiratory: vital capacity loss, lungs become less elastic/rigid. anteroposterior chest diameter and residual volume increases, O2 levels decrease 10-15%

GI: decreased saliva, loss of taste buds, gag reflex decreases, stomach motility reduced, delayed gastric emptying. large/small atrophy w/ decreased peristalsis, liver decreases in weight/storage, gallstones increase, pancreatic enzymes decrease

GI: kidneys lose mass, glomerular filtration is reduced, bladder capacity decrease, urinary retention, stress incontinence, enlarged prostate

Reproductive: men: testosterone/sperm count decrease, testes smaller, ED. Women: estrogen/breast tissue decrease, vagina/uterus/ovaries/urethra atrophy, lubrication decrease, secretions alkaline

Endocrine: pituitary loses weight/vascularity, thyroid more fibrous, plasma t3 decrease, pancreas releases insulin slowly, increase glucose levels, adrenal produce less cortisol

Question 28

Pneumococcal conjugate (PCV13) and pneumococcal polysaccharide (PPSV23)
Schedule?
Administration?

Answer 28

Schedule:
PCV13:
Age: 19-64 years, 1 dose

Age: 65 years, 1 dose if never received previous dose or provider recommended

PPSV23:
Age: 19-64 years if indicated (at risk), 2 doses with 5 year between each dose.
ex: 50 year old, never received dose but is at risk (COPD, smoker, DM etc) can get one dose then can have another dose at 55 or after 65.

Admin: IM
Needle gauge: 22-25
Length: 1-1.5”

Question 29

Influenza vaccine?

Adminstration?

Answer 29

Influenza:
Given annually starting at 6 mo
Admin: IM
Needle gauge: 22-25
Length: 1-1.5"

Question 30

Tdap vaccine?

Administration?

Answer 30

Tdap:
Given every 10 years
Admin: IM
Needle gauge: 22-25
Length: 1-1.5"

Question 31

Herpes Zoster (Shingles)?
Shingrix
Zostavax
Admin?

Answer 31

Herpes Zoster (Shingles):

Shingrix (RZV): 2 doses starting at age 50, not a live vaccine, 2-6 months between each injection

Zostavax (ZVL): no longer recommended vaccine however still given due to shortage of the RZV vaccine

**RZV and ZVL are not interchangeable

Admin: SQ
Needle gauge: 23-25
Length: 5/8”