Approach to NH client Flashcards
Crystallized intelligence
refers to knowledge and skills that are accumulated over a lifetime
Fluid Intelligence
the ability to reason and thin abstractly. This type of intelligence decreases as you age
What percent of the elderly population is in the nursing home?
5%
old
65-75 years
old old
76-85 years
frail old
> 85 years old
What percentage of the elderly population live in communities
95%
What is the leading cause of death in elderly patients
heart related diseases
What are the Error Theories in nursing (stochastic)
Wear and Tear Theory
Free Radical Theory
Cross - Link Theory
What are the sociologic theories of aging
Disengagement Theory
Activity Theory
Continuity Theory
Disengagement Theory
Withdrawal from one’s society and community is natural and acceptable
** very controversial because it implies that as we age we withdraw from society to allow younger people to take our roles
Activity Theory
Individuals need to stay active if they are to age successfully.
Promotes satisfaction and positive self concept
Physical or Intellectual
** want them to remain as active as possible
Continuity theory
With aging personality traits remain stable
As they age try to maintain previous habits, preferences, commitments & beliefs.
Iexplains that life satisfaction with engagement and disengagement depends on personality traits. 3 ideas about personality are important:
In the normal progression of aging personality traits remain stable
Personality influences role activity and one’s level of interest in particular roles
Personality influences life satisfaction regardless of role activity.
Basically-how they have been throughout their life they will remain. Keep previous habits
What are the Psychosocial Theories
Jung’s Theories of Personality
Developmental Theories
Theory of Gerotranscendence
Jung’s Theory of Personality
Jung a contemporary Freud, proposed a theory of development of personality through life. One moves from extroversion to introversion. One examines at midlife. Question their dreams, values and priorities. The development of the inner person and psyche are accomplished by search for personal meaning and the spiritual self
Developmental Theories
Erik Erikson - Ego Integrity vs Despair.
Individuals can look back on their lives with joy, view the mistakes they have made and be content.. He later
Theory of Gerotranscendence
associated with wisdom and spiritual growth. Similar to Erikson’s concept of integrity and Maslow’s self-actualization.
Value family.
When choosing a nursing intervention remember to choose an intervention that is
consistent
professional
supportive
therapeutic
What are the 5 Cs
competance compassion conscience commitment confidence
When using Restorative Nursing you should work to
Maintain Bowel & Bladder Function Promote Social Well-Being Maintain Sensory Perception Promote Psychosocial Health Enhance Self-Esteem Avoid Elder Talk Avoid Ignorance
When talking to a hearing impaired patient one should
Never Assume Hearing Loss is because of age
Face the individual, stand and sit at same level.
Gain the individuals attention
Speak distinctly
Pause between sentences and phrases
Remove background noise
When communicating with a visually impaired patient one should
Use contrasting colors Use low-vision assistive devices Use orientation strategies Have the person’s Attention prior to talking Speak promptly and clearly Speak normally
What are some hazards related to hospitalization?
Decline in Muscle strength Vasomotor Instability Reduced Bone Density Diminished Pulmonary Ventilation Sensory Deprivation Tendency to Urinary Incontinence.
How can you avoid hazards related to hospitalization
De-emphasize Bed rest
Remove High Hospital Bed with Rails
Actively Facilitate Ambulation
Socialization - talk with patient (they are the ones that need the extra time with you)
Interdisciplinary Care & Shared Objectives - talk with other nurses and physicians abut how to make the stay less hazardous
What is delirium
any altered state/change in mental status that can be reversible
What are some interventions to prevent delirium
Know baseline mental status Assess and underlying mental status - they may not normally be that way Assess sensory deficits Attention to basic needs Medication Review - are their medications causing this altered state; don't assume they are always like this Understand Behavior Maintain Safety Minimize Use of Invasive Equipment Environmental Modifications
How do you assist Alzheimer’s patients
Give one direction at a time Speak slowly: give simple directions Do not force Avoid Restraints Repeat yourself as often as necessary Give encouragement Praise accomplishments as activity progresses Be patient
On a skin assessment of the elderly what should you see
Skin uneven in certain areas, increased creases, wrinkle lines and skin lesions
Warm skin, but hand and feet may be cool
Decreased skin turgor and dry and flaky skin
Increased facial hair in women
Coarse dry hair and flaky scalp (senile xerosis)
Nails- yellow, dry, brittle, and longitudinal ridges
HEENT for elderly
could see decrease ROM caused by musculoskeletal changes
Lymph tissue decreases in size with aging and should not be palapabe
Non palpable thyroid
Typically have decreased near vision, but far vision might still be intact; decreased peripheral and dry eyes
Increased difficulty hearing high pitched sounds
Equilibrium and balance problems
Ears still elongate/grow
Decreased sense of smell
Buccual mucosa and gums thin and pale
Dry oral mucosa
Decreased sense of taste, gag refelc, and papillae on tongue, varicose veins on tongue
Enophthalmus
recess of eyeball into orbit
Arcus senilis
White to yellow deposit at outer edge of cornea
Fundoscopic Retina
retina and optic disc become smaller with age
Respiratory for elderly
Senile kyphosis (barrel chest/increased A+P diameter)
Decreased respiratory excursion
Cheyne-Stokes breathing may occur during sleep
decreased breath sounds with few crackles at bases
CV for elderly
Increase in premature beats and irregular pulse
Stiffer arteries
slight increase in BP and wider pulse pressure
Orthostatic drops in BP
GI for elderly
Soft abdomen (decreased musculature)
Decreased bowel sounds
Look for old scars - could help provide info about surgeries
Prostate soft and smooth; not enlarged
Female Reproductive for elderly
saggy, cordlike breasts
decrease and greying of pubic hair
skin in peritoneal think elastic and shiny
pale vaginal walls and glistening cervix d/t reduced estrogen
ovaries should not be palpable
Male reproductive for elderly
Gynocomastia decrease and greying of pubic hair decrease in size of scrotum and penis low hanging testes and few rugae prostate enlargement
Musculoskeletal in elderly
decreased arm swing in gait
wider base of support
decline in step length, decrease spinal rotations
slowing of motor responses
increased unsteadiness
decreased ROM = crepitation/stiffness in ROM
decreased muscle strength and tone; hand grip usually remains intact
Neurological in elderly
Use MMSE and Clock Scoring test to screen for dementia
Memory Loss does increase with age
CN nerves
olfactory and optic = decreased (fundoscopic probs)
III oculomotor - pupils smaller
V - trigeminal -increased stimulation needed to elicit corneal reflex
VII-facial IX-glossopharyngeal - decreased taste
Reflexs - Rombergs sign (swaying) normal
decreased deep tendon reflexes
