Exam 1 Flashcards
Define gerontology
The scientific study of the effects of time on human development
What is a super-centenarian?
Person at 110 years of age
What is a centenarian?
Person between 100 & 109 years
What is a typical centenarian?
White female living in urban south
What is survivorship?
Remaining life expectancy - for persons who have reached a particular age
What is the wellness-based model?
Encompasses the idea that health is composed of multiple dimensions; more than just the absence of disease
What is the flower model?
Wellness is expressed in 7 dimensions of human experience within the context of culture
What are the 7 dimensions in the flower model?
Functional
Environmental
Intellectual
Psychological
Spiritual
Social
Biological
What is the wellness-based model for healthy aging?
- Health is viewed on a continuum, and health promoting strategies are important to achieving highest level of wellness
- Healthy aging must be viewed from the prenatal period to death
What are primary, secondary, and tertiary prevention strategies?
Primary - prevent illness before it occurs
Secondary - early detection of problem that has already developed
Tertiary - slowing disease or limiting complications
Why is the wellness model better than the biomedical model of aging?
Wellness model is more holistic (focuses on the whole person)
Certification hospitals can get that is designed to improve outcomes for hospitalized older adults
NICHE
(Nurses Improving Care of Health System Elders)
What does NICHE especially focus on in older adults?
Iatrogenic complications
Why are older people more vulnerable to poor outcomes due to having complex problems?
They require care from multiple settings which makes them more vulnerable to poor outcomes during transition
Factors contributing to poor transitional care outcomes after discharge from the hospital
Fragmented system of care
Poor communication
Patient-related factors (unable to follow instructions or lack of follow up care)
*Medication discrepancies (most prevalent adverse event)
What is the goal behind hospital readmission reduction program (HRRP)
Fixing the way pts are prepared and educated for discharge to prevent readmission
(Nurses role to help prepare pts for release)
Learned values, beliefs, expectations, and behaviors of a group of people
Culture
Guides our thinking and helps us know what is appropriate when interacting with family and friends
Culture
Cultural beliefs passed down from one generation to another
Enculturation
A process where persons from one culture adapt to another culture
Acculturation
Existence of more than one group with differing values and perspectives
Diversity
Differences in health outcomes between groups
Health disparity
Social status, economic status, and health status of older women
Social - differs by culture (some more, some less respected)
Economic - disadvantaged
Health - live longer, greater number of chronic diseases
Social status, economic status, and health status of older men
Social - usually higher
Economic - usually higher
Health - black men = shortest lifespan
Belief that one ethnic/cultural group is superior to another
Ethnocentrism
Application of limited knowledge of race, ethnicity, age, or culture to an individual
(Assumptions about someone)
Stereotyping
Systematic elimination of the recognized culture
Cultural destructiveness
Belief that there are no differences
Cultural blindness
How to move toward cultural proficiency and healthy aging
Become familiar with own perspectives
Examine own personal/professional behavior
Remain open to different viewpoints/behaviors
Appreciate worth of all people
Develop skill of attending to both verbal & nonverbal communication
Be sensitive to clues given by others
Learn to negotiate rather than impose
Outward physical appearance
Phenotype
Phenotype as expressed in observable traits (esp skin tones)
Race
Cultural group with which one self-identifies
Ethnicity
What are the types of beliefs about health, illness, and treatment paradigms
Biomedical perspectives
Magico-religious
Naturalistic or holistic
What is the biomedical model?
Disease = result of abnormalities in structure/function of body or illness caused by pathogens
Drawback of biomedical model
Impersonal
Focuses on part or disease vs. the whole person
What is the magico-religious model?
Illness is caused by actions of higher power
(Health = blessing, illness = punishment)
Uses prayer
What is the naturalistic/holistic model?
Balance of diet, exercise, food, sleep, evacuation (elimination), IPR (inner personal relationship), and forces in the universe
What is cultural proficiency?
Can easily work with all cultures and provide care that is respectful, compassionate, and relevant
Processing of one spoken language into another in a matter that preserves meaning
Interpretation
Exchange of one written language for another
Translation
What is the learn model used for?
Based on a negotiated plan of care, and guides nurses while interacting with elders of any ethnicity
What is the learn model?
Listen to what the pt has to say
Explain your perception of the problem
Acknowledge the similarities and differences of perception
Recommend a plan of action that takes into account both perspectives
Negotiate a plan that is mutually acceptable
The process of acquiring, storing, sharing, and using information
Cognition
Components of cognitive function
Language
Thought
Memory
Executive function (decision making)
Judgement
Attention
Perception
Why does the brain slow down with aging?
OA take longer to process constantly increasing amounts of information
Common cognitive function that declines with aging
Object naming
Brain’s ability to modify its connections or “retire” itself
Neuroplasticity
Refers to the strength of the connections in the brain
Cognitive reserve
Three components of memory
Immediate recall
Short-term recall
Remote or long term
Memory difficulties considered normal in light of a person’s age and education
Age-associated memory impairment (AAMI)
Brain exercises to include memory should be:
- new, unfamiliar, out of comfort zone
- challenging and takes mental effort
- fun and enjoying
Application of principles of adult learning theory to teach interventions for older adults
Geragogy
An intensely private soul-searching activity involving the process of putting one’s life in order
Life review
Physical assessment tools nurses should use
FANCAPES and spices
What does FANCAPES stand for?
Fluids
Aeration
Nutrition
Communication
Activity
Pain
Elimination
Socialization
What does spices stand for?
Sleep disorders
Problems eating
Incontinence
Confusion
Evidence of falls
Skin breakdown
What is a functional assessment used for?
To evaluate a person’s ability to carry out basic tasks for self-care and tacks needed to support independent living
(Identifies areas of help and where to assess further)
What are IADLs measured by?
The Lawton scale
What is the functional independence measure used for?
To assess need for assistance with ADLs during inpatient hospital stays and for discharge planning, especially following a stroke
What does the Mini-Mental State Exam (MMSE) monitor for?
Cognition
(Orientation, short term memory and attention, calculation ability, language, and construction)
What is the clock drawing test used to assess?
Cognitive function
Can be helpful to rule out dementia
What is the mini-cog?
Combines test of short term memory in MMSE with clock drawing
As accurate/reliable as MMSE, but less biased and more sensitive to dementia
What score on the Geriatric Depression Scale (GDS) indicates the potential for major depressive disorder?
5 or more
Gold standard of assessing mood in persons with dementia
Cornell scare for depression in dementia
What is the OARS and how is it scored?
Comprehensive geriatric assessment
Most capable = 6
Total disability = 30
What is RAI?
Comprehensive geriatric assessment required for skilled nursing facilities
What is OASIS?
Comprehensive geriatric assessment required for skilled care from a home health agency
Focuses on nursing interventions
How can the effect of lipophilic drugs differ in older adults?
May concentrate in increased fat in OA and increase effect
How does the effect of a hydrophilic drug differ in older adults?
Less TBW so drug may get too concentrated in blood and increase effect
How does lower albumin levels in older adults affect drugs?
Effects will be increased for drugs that bind to protein
How are drugs primarily excreted?
Through the kidneys
Why aren’t anticholinergic drugs good for OAs?
Risk of injury with BP changes
Confusion
Dizziness
Dry mouth
Examples with strong anticholinergic and sedating side effects
Antihistamines
Antimuscarinics
Antispasmodics
Benzodiazepines
Antipsychotics
Antidepressants
Opioids
Potential side effects of drugs with strong anticholinergic and sedating properties
Constipation
Dry mouth
Blurred vision
Dizziness
Confusion
Urinary retention
Functional impairment
Increased heart rate
What is poly pharmacy?
Use of 5 or more meds, meds that are medically unnecessary, or use of multiple meds for the same problem
3 most common errors when administering medications via enteral feeding tubes
Incompatible route
Improper preparation (some meds cant be crushed, some cant be mixed together)
Improper administration
Common culprits of adverse drug reactions
Anti-platelets
Anti-coagulants
Insulin
Oral hypoglycemics
Digoxin
Why are allergic reactions more common in older adults?
The immune system decreases in function
How should you minimize the likelihood of ADRs?
Start low, go slow, but go
What is the Beer’s criteria?
Potentially inappropriate meds (PIMS) associated with confusion, falls
Identified to have higher than usual risk in older adults
Issues associated with antipsychotics
Neuroleptic malignant syndrome (high temp and liver damage)
Movement disorders (extrapyramial syndrome (EPS))
Abnormal involuntary movement (mouth, face, tongue)
Acute dystopia
Compulsion to be in constant motion
Akathisia
Possible irreversible movement disorder from taking antipsychotics for 3-6 months
Tardive dyskinesia
What is the brown bag approach?
Asks the person to bring in all meds taken, including over the counters, herbals, and dietary supplements
(Ask person how he or she actually takes meds rather than depending on label)
Most common intervention to promote medication adherence
Education
What is the prescribing cascade
Adding new meds without consideration of those to be discontinued
