ch 8 management of the older adult

Question 1

what is the leading cause of death in the older adult

Answer 1

cardiovascular disease

Question 2

depression

Answer 2

most common affective disorder of older adult with high risk of suicide

Question 3

depression symptoms

Answer 3

empty moods, hopelessness, irritability, restlessness, loss of interest, decreased energy & fatigue

Question 4

depression risk factors

Answer 4

medical condition (stroke, cancer, thyroid), genetics, stress, sleep probelems, lack of exercise

Question 5

medications in older adults for depression

Answer 5

SSRI/ SSNI

Question 6

adverse effect of SSRI/SSNI medications

Answer 6

orthostatic hypotension

Question 7

delirium

Answer 7

sudden onset of confusion, most common complication of hospitalized older adult, may be sign of underlying medical condition

Question 8

outcomes of delirium

Answer 8

may cause long term cognitive decline, falls

Question 9

confusion assessment methods (CAM) diagnostic algorithm

Answer 9

acute onset -> fluctuating course ->inattention -> disturbance of thought/ disturbance of consciousness -> delirium

Question 10

hyperactive delirium

Answer 10

increased psychomotor activity, rapid speech, irritability, restlessness

Question 11

hypoactive delirium

Answer 11

lethargy, slowed speech, decreased alertness, apathy

Question 12

mixed delirium

Answer 12

shift between hyper & hypo active delirium

Question 13

delirium management

Answer 13

use hospital admission risk profile, prevention activities (close to nurses station, watched closely), prompt treatment (CBC, urinalysis), supportive environment

Question 14

dementia

Answer 14

a clinical syndrome of cognitive, functional, and behavioral changes/ progressive, NOT REVERSIBLE

Question 15

dementia involves

Answer 15

subtle onset, slow progression, memory impairments

Question 16

common forms of dementia

Answer 16

alzheimers, vascular, dementia with lewy bodies (effects people at younger age)

Question 17

Alzheimers disease

Answer 17

fifth leading cause of death in older adults, increases with age (doubles every 5 years after 65 y.o), no known cause

Question 18

some causes of Alzheimers

Answer 18

neurological changes, vascular changes, (things that accuse with HTN, stroke), stress hormones, head trauma, genetics, alcohol abuse

Question 19

two types of AD

Answer 19

familial: genetic, early onset & sporadic: late onset

Question 20

early signs of Alzheimers

Answer 20

forgetfulness, sudden memory loss, difficulty in work and social activities but still able to compensate

Question 21

AD nursing management

Answer 21

support cognitive function (crosswords/ coloring), promote safety (remove rugs, car keys), promote independence in self care activities (don’t give to many choices), reduce anxiety (do not argue with them), improve communication, promote adequate nutrition, promote balanced activity & rest, avoid restraints, encourage & support advance care planning

Question 22

geriatric syndrome

Answer 22

impaired mobility, dizziness (falls, urinary incontinence, changes in cognitive status), increased susceptible to infection, atypical responses (different adverse effects from younger pts), altered emotional impact

Question 23

3 components/ signifies the components of geriatric triad

Answer 23

falls & falling, urinary incontinence, changes in cognitive status

Question 24

Ohio revised code

Answer 24

mandated by law to report suspected abuse, and neglect

Question 25

Ohio administrative code

Answer 25

abuse or neglect that occurs in long term care facility that is reported to department of health

Question 26

risk factors of elder neglect and abuse

Answer 26

separated or divorce, low income area

Question 27

types of abuse

Answer 27

physical, emotional, psychological, sexual, financial

Question 28

physical abuse

Answer 28

physical force that may result in injury, pain, or impairment/ shaking, slapping, kicking, pinching, use of physical restraints, force feeding/ s/sx: bruises, black eye, injuries of various stages

Question 29

psychological/ emotional abuse

Answer 29

infliction of pain or distress through verbal or nonverbal acts/ verbal threats, harassment, silent treatment, treating like an infant/ s/sx: extreme withdrawal, emotional upset

Question 30

sexual abuse

Answer 30

non-consensual sexual contact/ unwanted touching, rape, nudity, sexual photography/ s/sx: genital bruising, unexplained STDs

Question 31

financial exploitation/ abuse

Answer 31

taking advantage of elder for monetary or personal benefit/ numerous unpaid bills, credit cards missing, unable to pay for food or medications/ s/sx: expensive gifts to care giver, new will when elder is incapable of writing will, frequent checks to cash, false signatures

Question 32

caregiver neglect

Answer 32

intentional or unintentional to meet the needs for the elders physical and mental wellbeing/ failure to provide necessities (food, water, shelter…), s/sx: dehydration, malnutrition, uirne burns, left alone

Question 33

self neglect

Answer 33

personal disregard or inability to perform self care/ poor hygiene, unkept home environment/ s/sx: malnutrition, skin or nail infections, insect infestation

Question 34

abandonment

Answer 34

willful desertion of an elder/ dropping off elder in the ED/ elder inappropriately left alone

Question 35

institutional mistreatment

Answer 35

disregard of contractual arrangement resulting in abuse or neglect

Question 36

delirium onset

Answer 36

acute, sudden, often at twilight

Question 37

depression onset

Answer 37

recent, may correspond to life event, can be acute or chronic

Question 38

dementia onset

Answer 38

slow and often unrecognized

Question 39

delirium course

Answer 39

short, diurnal fluctuating, may be worse at night and upon awakening

Question 40

depression course

Answer 40

diurnal effects, may be worse in morning, situational fluctuations

Question 41

dementia course

Answer 41

long, symptoms progressive, but relatively stable over time

Question 42

delirium factors/ triggers

Answer 42

physical illness, stress, environmental, sensory deficits

Question 43

depression factors/ triggers

Answer 43

stress (loss of spouse, health, friends, independence, lifestyle)

Question 44

dementia factors/ triggers

Answer 44

Alzheimers disease, multiple infarct dementia: AIDS, vit B12 deficiency

Question 45

delirium is described as

Answer 45

fluctuating levels of consciousness with decreased attention

Question 46

depression is described as

Answer 46

sadness; loss of pleasure and interest in usual activities

Question 47

dementia is described as

Answer 47

memory impairment