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SENIORS HEALTH > Comprehensive Assessment > Flashcards

Comprehensive Assessment Flashcards

1
Q

When do we need to do a comprehensive assessment

A
  • when there has been a change in ADLs or IADLs - when a change in health status occurs (illness or deterioiration) -when there is a change in behaviour - when a fall occurs - when carnivore are no longer able to cope with challenges of care giving
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2
Q

Difference between ADLs and IADLs

A

ADLs: can they dress and feed themselves? IADLs: can they live alone? Ie. Do banking, make phone calls, cook meals

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3
Q

Functional impact framework

A

Accumulation of age related changes, risk factors with it, and how much decline have we noticed with this combo

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4
Q

Where do nurses okay the biggest role in the function impact framework?

A

Reducing the risk factors

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5
Q

Nursing assessment

A

Age related changes Risk factors Negative functional consequences

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6
Q

Miller functional consequences model: key concepts

A

Functional consequences Negative functional consequences Positive functional consequences ARCs Risk factors Older adult Nursing Health Environment

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7
Q

Functional consequences model

A

observable effects of actions, risk factors, and age related changes that influence the quality of life or day to day activities of older adults

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8
Q

Negative functional consequences

A

those that interfere with the older adult’s functioning or quality of life.. result in dependency

Ex. Constipation from medication, urinary incontinence Nursing can do a medication review - increase in vulnerability to risk factors - decrease in health functioning - decrease in quality of life

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9
Q

Positive functional consequences

A

Those who facilitate the highest level of functioning, least dependency, and the the best quality of life

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10
Q

What us the outcome of the functions, consequence model

A

Improved outcome, improved quality of life, *wellness promotion

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11
Q

What are functional consequences vs wellness outcomes?

A

Observable effects of actions, risk factors and age related changes.Wellness is when positive functioning consequences are the result of nursing interventions

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12
Q

Wellness outcomes

A

Goals of the patient

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13
Q

Age related changes

A

• Decreased physiological function
•Increase potential for psychosocial
and spiritual growth
•Inevitable, progressive, and
irreversible changes that occur and
are independent of extrinsic or
pathologic conditions

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14
Q

Risk factors

A

Conditions that increase the vulnerability to
negative functional consequences
Common sources of risk factors include
diseases, environment, lifestyle, support
systems, psychosocial circumstances, adverse
medication effects, and attitudes based on lack
of knowledge

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15
Q

Focus of nursing

A

The focus of nursing care is to minimize the
negative effects of age-related changes and risk
factors and to promote wellness outcomes.
Goals are achieved through the nursing
process, with particular emphasis on health
promotion and other nursing interventions that
address the negative functional consequences.

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16
Q

What is health?

A

The ability to function at the highest level of capacity, despite the presence of age related changes and risk factors

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17
Q

Psychosocial loss model

A
  • role loss occurs
  • impact of loss
  • increased susceptibility
  • impact of stereotypes
  • increased dependency
  • loss of self Inability to function
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18
Q

Functional assessment tools

A

mesurement of their ability to perform basic self care tasks and tasks that require more complex activities for
independent living referred

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19
Q

Geriatric Giants

A
20
Q

Consequences of non recognition

A

Increased mortality and morbidity

Missed diagnosis

Unnecessary use of emergency rooms

21
Q

Difference between vulnerability and frailty

A

risk factors cause vulbnerability, and vulnerability leads to frailty

22
Q

3 D’s

A

dementia

delirium

depression

23
Q

SPICES

A

S- sleep disorders

P- problems with eating and feeding

I- Incontinence

C- Confusion

E- Evidence of falls

S- Skin breakdown

24
Q

atypical presentation : “silent” MI

A

•Absence of chest pain
•Vague symptoms of fatigue, nausea and a decrease in functional
status.
•Classic presentation: shortness of breath more common
complaint than chest pain

25
Q

Atypical presentation: Non-dyspneic
pulmonary edema

A
  • May not subjectively experience the classic symptoms such as paroxysmal nocturnal dyspnea or coughing
  • Typical onset is insidious with change in function, food or fluid intake, or confusion
26
Q

Atypical presentation: silent acute abdomen

A
  • Absence of symptoms (silent presentation)
  • Mild discomfort and constipation
  • Some tachypnea and possibly vague respiratory symptoms
27
Q

Atypical presentation: depression

A

Lack of sadness

Somatic complaints, such as appetite changes, vague GI
symptoms, constipation, and sleep disturbances
Hyper activity
Sadness misinterpreted by provider as normal consequence of
aging
Medical problems that mask depression

28
Q

what is vulnerability?

A

Vulnerability is the outcome of complex interactions of discrete risks, namely of being exposed to a threat, of a threat materializing and of lacking the defences or resources to deal with a threat”

29
Q

Physical attributes of vulnerability and their results

A

Biological and
physiological changes
Vision
Hearing
Mobility
Frailty

—>

Complex needs
Falls
Hypothermia
Malnutrition
Abuse
Unsafe to live alone
Delayed discharges

30
Q

psychosocial attributes of vulnerability and their effects

A

Mental Health changes
Dementia
Depression
Bereavement
Fear of ageing

–>

Loss of dignity
Social isolation
Loss of identity
Incapacity

31
Q

Basic premise of The Functional Consequences theory

A
  1. holistic nursing address the mind, body and spirit.
  2. most problems are caused by risk factors
  3. they experience positive and negative functional consequences because of a combo of age related changes and risk factors
  4. interventions alleivate or modify the negative consequences of risk factors
  5. address negative functonal consequences with health promotion
  6. These interventions result in postive functional consequences (wellness outcomes)
32
Q

what is the difference between the functional consequence theory and functional assessment?

A
  1. FCT distinguishes between age related changes that increase a persons vulnerability and risk factors that affect function and quality of life
  2. focuses on consequences that can be addressed in nursing intervention
  3. doesnt just identify functional level, it assesses the cause
  4. leads to interventions
  5. leads to wellness outcomes
33
Q

what is the difference between age related changes and risk factors?

A

age related changes: cannot be reversed or altered, but we can compensate for their effects so wellness is found

Risk factors: can be modified or eliminated to improve functioning

34
Q

why are risk factors worse in older adults?

A
  1. they are cummulative and progressive (smoked their whole life)
  2. the effects are exacerbated by age related changes (ie. low muscle makes arthritis worse)
  3. mistakenly viewed as age related changes instead of treatable
  4. no negative function consequences in the younger adults
35
Q

what is health defined as in the FCT?

A

ability of older adults to function at their highest capacity, despite the presence of age related changes and risk factors

36
Q

Key Concepts of MoCa

A

attention and concentration

executive functions
memory

language

visuoconstructional skills

conceptual thinking

calculations

orientation

37
Q

MoCa: what is Alternating Trail Making?

A

The examiner instructs the subject: “Please draw a line, going from a
number to a letter in ascending order. Begin here [point to (1)] and draw a line from 1 then to A
then to 2 and so on. End here [point to (E)].”

38
Q

MoCa: how do you assess Visuoconstructional Skills (Cube)?

A

The examiner gives the following instructions, pointing to the cube: “Copy
this drawing as accurately as you can, in the space below”.

39
Q

Moca: what assessment is done for Visuoconstructional Skills (Clock)?

A

Indicate the right third of the space and give the following instructions:
“Draw a clock. Put in all the numbers and set the time to 10 after 11”

40
Q

MoCa: how do we assess Naming?

A

“tell me the name of this animal”

41
Q

MoCa: how do we assess Memory?

A

tell them a list of words and they must recall them 2 times during the test, and at the end (the last recall is the only one that counts for points)

42
Q

MoCa: how do we assess Attention?

A

Forward Digit Span: “I am going to say some numbers and when I am through, repeat them to me exactly as I said them”. Read the five number sequence at a rate of one digit per second.
Backward Digit Span: “Now I am going to say some more numbers, but when I am through you must repeat them to me in the backwards order.” Read the three number sequence at a rate of one digit per second.
Vigilance: “I am going to read a sequence of letters. Every time I say the
letter A, tap your hand once. If I say a different letter, do not tap your hand”.

Serial 7s: Administration: “Now, I will ask you to count by subtracting seven from 100, and then, keep subtracting seven from your answer until I tell you to stop.” Give this instruction twice if necessary.

43
Q

MoCa: how do we assess Sentence repetition?

A

“I am going to read you a sentence. Repeat it after me, exactly as I say it [pause]: I only know that John is the one to help today.” Following the response, say: “Now I am going to read you another sentence. Repeat it after me, exactly as I say it [pause]: The cat always hid under the couch when dogs were in the room.”

44
Q

MoCa: assessing Verbal fluency

A

“Tell me as many words as you can think of that begin with a certain letter of the alphabet that I will tell you in a moment. You can say any kind of word you want, except for proper nouns (like Bob or Boston), numbers, or words that begin with the same sound but have a different suffix, for example, love, lover, loving. I will tell
you to stop after one minute. Are you ready? [Pause] Now, tell me as many words as you can think of that begin with the letter F. [time for 60 sec]. Stop.”

45
Q

MoCa: assessing Abstraction

A

: “Tell me how an orange and a banana are alike”

46
Q

Moca: assessing Delayed recall

A

“I read some words to you earlier, which I asked you to remember. Tell me as many of those words as you can remember

47
Q

MoCa: assessing Orientation

A

Time, Year, place, person

SENIORS HEALTH (14 decks)

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