Exam 1 - Study Material Flashcards by Elias Cortez

What is gerontology?

The scientific study of the effects of time on human development, specifically the study of older persons; it encompasses ALL aspects of the aging process and the consequences of these problems for both the elderly population and society.

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What is geriatrics?

A specialty that focuses on healthcare of elderly people and aims to promote health by preventing and treating disabilities in older adults

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Define aging

The chornological, biological, psychological, sociological, and spiritual aspects that determines how old one feels.

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What are the different age categories?

Pre-elderly = 55-64 years
Young-old = 65-74 years
Middle-old = 75-84 years
Frail-old = 75+ needing services; or 85+
Oldest-old = 85+
Elite-old = 95+
Centenarians = 100+
Super centenarians = 110+

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What is the fastest growing segment of the US population?

Adults aged 85+ Is the fastest growing segment of the population.

13% of the population are elderly people

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What is the goal in studying aging?

To use our knowledge and skills to help people of all ages, races, and cultures acheive healthy aging.

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What is the rationale for the study of aging?

Increasing interest in the biology of aging – Why do we get old? Can we retard the process?
Phenomenal shift in life expectancy – Growing population of the older adults.
Diseases of affluence are abundant in old age – Looking at more long-term illnesses, i.e., cardiovascular disease, cancer, stroke.
Cost of health care has increased.
Negative attitudes toward elders persist.
*

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What are some demographic characteristics related to aging and the aged?

Most people 65+ are high school graduates (78%)
More women 65+ live alone, more men living with a spouse
Women tend to live longer then men
Some minority groups tend to not live as long as the white population, but at a certain age (the minorities) live longer than their white counter parts. (this is known as the Racial Mortality Crossover Phenomenon)
More men marry, and if you’re married you live longer.
Most elderly people live in houses, apartments, and public housing
Main source of income for the elderly has been social security
50% of elderly people will have probelms with hypertension. arthritis and heart disease are other common problems
Make up 85% of hospitalized patients
Aging population is growing
Minorities increasing in population while nonwhite population is decreasing.

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What are the 4 main reasons for the increase in life expectancy?

Life expectancy in America has trended upward as a result of:

reduced death rates for children and young adults
new drugs
medical tenchology
better disease prevention.

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What is compression of morbidity?

A concept that proposes that premature dealth will be minimized, and disease and functional decline will be compressed into a period of 3 to 5 years before dealth.

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What are the ANA Standards of
Gerontological Nursing Practice?

Assessment
Diagnosis
Outcomes Identification
Planning
Implementation
Evaluation

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What is the role of a Gerontological Nursing generalist?

A nuse who has completed a basic-entry level educational program.

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What is the role of a Gerontological Nursing specialist?

Provide direct & indirect care to patients and their families.
Serve as nurse consultants to staff on complex issues of patient care.
Advanced preparation at the master’s level; clinical expertise (Educator & Advanced Practice Nurse Roles)

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What is the role of a Nurse Educator?

Nurses who teach & practice as faculty in colleges and universities, or as staff development educators in health care facilities.
Design, implement, evaluate and revise academic and continuing education programs.
Have a masters or doctoral degree

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What is the role of a Gerontological Nurse Practitioner?

Provide primary care for older adults in an independent practice or a collaborative practice with a physician.
Have considerable autonomy in treating common illnesses.
Prescriptive authority

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What role do Gerontological Nurse Entrepreneurs play?

Nurse Entrepreneurs combine their nursing background with business and utilize their individual creativity and resourcefulness to start their own companies.

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Define “certification” as it relates to nursing.

The formal process by which clinical competence is validated in a specialty area of practice

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What organization gives certifies nurses?

ANCC = American Nurses Credentialing Center

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What are the 6 steps you need to complete to obtain your Gerontologic Nurse (BSN) Certification?

Need a BSN
RN license
2 years full time nurse expierence

2000 hrs. of clinical practice in specialty area (geriatrics) within last 3 yrs.

30 hrs. of C.E. in Gero in the last 3 years
Pass the specialty certification exam

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What is Ageism?

Discrimination or prejudice against people of specific ages, especially in employment

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What is the Impact of Ageism?

Fosters myths and stereotypes
**Decreases opportunity for elder employment - People think they can’t work as well as younger people. **
Rehabilitation and health education not a priority (it is for the younger adult)
Decreases self-esteem on part of the elder
May result in self-fulfilling prophecy in the elder - Becomes a self-fulfilling prophecy for the elderly, i.e., dressing the elderly for them; they might start to think that they are actually slow.
Fosters social isolation or dependence on part of the elder - They know these myths so they won’t take time to be around people. Need to include them in patient teachings and communication.
Creates Gerontophobia for the aging adult
Lack of empathy and patience, disrespect common
Decreased compensation and respect for nurses etc. working in LTC settings

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What is the mortality crossover effect?

Minorities tend to not live as long as the white population. This is usually due to access to health care, economics, and socioeconomic status.
However, after age 75, minorities tend to have lower death rates than the white population and this is due to the fact that they tend to have hardy personalities and they have access to better health care.

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How do children and adolescents view aging compared to adults?

Children:

View it more positively, they want to grow up. (able to drive a car, go out, do more things)

Adults:

Tend to view aging negatively, more problems, dying, less strength.

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What is the Biological Theory of aging?

states that some form of breakdown at the organic and cellular level leads to decline, aging, and death of the cell, which results in aging of the entire body.

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Biological Theories of Aging can be classified under what 2 categories?

Stochastic
Non-Stochastic

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Stochastic theories view aging as what?

aging occurs as a random event and occurs over time

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Non-Stochastic theories view aging as what?

aging is a predetermined and timed phenomenon – non-random

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What are some examples of stochastic theories of aging?

Free Radical / Oxidative stress theory
Cross link or Collagen theory
Wear & Tear theory

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Describe the Free Radical / Oxidative stress theory

States that errors are the result of random damage from free radicals, and that over time the production of free radicals increases and the body’s ability to remove them decreases.
Mitochondiral DNA is most affected by the ROS damage

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Describe the Cross link or Collagen theory

Describes aging as the result of accuulated damage from errors associated with corss-linked proteins.
Substances that may act as cross-linking agents include unsaturated fats, aluminum, zinc, and magnesium

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Describe the wear and tear theory

Proposes that cell errors are the result of “wearing out” over time because of continued use.
Cells are aggravated by the harmful effects of internal and external stressors which include pollutants and free radicals

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What are some examples of Nonstochastic theories of aging?

Immunity theory
Neuroendocrine control or pacemaker theory

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Describe the Immunity theory

Presents aging as a programed accumulation of damage and decline in the function of the immune system, with damage being the result of oxidative stress.

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Describe the Neuroendocrine control or pacemaker theory

Views aging as a programmed decline in the functioning of the nervous, endocrine, and immune systems. The cells lose their ability to reproduce, called replicative senescence.

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How would you promote healthy aging consistent with the biological theories of aging?

Excercise on soft surfaces, using good body mechanics (wear n tear theory)
Avoid skin dryness and joint stiffening (cross-link theory)
Watch for research related to the effect of unsaturated fats and heavy metals on cell health (cross-link theory)
Avoid environmental pollutants and unecessary radiation (oxidative stress theory)
Watch for research on the use and presence of antioxidants (oxidative stress theory)
Avoid stress (oxidative stress theory)
Minimize the potential for infection; wash hands frequently, undergo immunizations, and avoid those who are ill (Immunity theory)

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What do Psycho-Social Theories of aging try to explain?

Attempts to explain and predict the behaviors, feelings, mental processes, and role changes of the aging individual

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What are the different psycho-social theories of aging?

Role Theory
Disengagement Theory
Activity Theory
Continuity Theory
Age Stratification Theory
Modernization Theory

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Describe the role theory of aging

Proposes that the ability of an individual to adapt to changing roles over the course of life is a predictor of adjustment to personal aging
Individuals go through different stages in life with new roles in each stage.
Successful aging inovlves completing one role to take on another.

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Describe the disengagement theory of aging

Proposes that the natural course of aging inolves the individual slowly withdrawing from his or her former roles and activities to allow the transfer of power to yougner generations.
Transfer was viewed as necessary for social equilibrium
Elder’s withdrawl is seen as successful aging

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Describe the activity theory of aging

Proposes that activity is necessary to maintain life stisfaction, positive self-concept, and being able to “stay young”.
This theory is based on the asumptiom that it is beter to be active than inactive, and better to he happy than unhappy
Activity is the indicator for successful aging

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Describe the continuity theory of aging

Proposes than an individual develops and maintains a consistent pattern of behavior, substiuting one role for a similar one as the person matures.
Late life roles, responsibilities, and activites are a refluction of a continuation of life patterns.
Successful aging is associated with one’s ability to maintain and continue previous behaviors, roles, or find suitable replacements

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Describe the age-stratification theory of aging

Proposes that aging can best be understood by considering the individual as a member of an age group, with similarities to others in the group

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Describe the modernization theory of aging

Attempts to explain the social changes that have resulted in the devaluing of both the contributions of elders and the elders themselves.
The status and value of elders is lost when their labors are no longer considered usful, kinship networks are dispersed, the infromation they hold is no longer pertinent to the society in which they life, and the culture in which they live no longer reveres them
Proposed that these changes are the result of advancing technology, urbanization, and mass education

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What is the Relevance of Theories of Aging to Nursing?

Serve as backdrop for development of one’s philosophy of care & senior programs
provide insight on factors that impact the aging process
provide information on age-related changes & pathology
nurses should educate patients
shed light on the unique ways older adults achieve healthy aging & respond to illness
may be used as a framework for addressing various issues and initiating programs

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What are Erickson’s Developmental Stages?

Young Adulthood (20-30)
- Stage – intimacy vs isolation
Middle Adulthood (30-60)
- Stage – Generativity (“making your mark” on the world) vs stagnation (not doing anything)
Older Adulthood (60+)
- Stage – Ego integrity (able to look back at life accomplishments) vs despair

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What are Peck’s Developmental Tasks of Aging?

Ego Differentiation vs. Work-Role Preoccupation
Body Transcendence vs. Body Preoccupation
Ego Transcendence vs. Ego Preoccupation (looking at the end of life)

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What are Havighurst’s Developmental Tasks of Aging?

Adjusting to decreasing physical strength and health
Adjusting to retirement and reduced income
Establishing an affiliation with one’s age group
Meeting civic and social obligations
Establishing satisfactory living arrangements
Adjusting to death of spouse

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What is Self-Actualization or Gerotranscendence?

Achieving wisdom through personal transformation

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Which two senses are most affected &/or bother people the most?

Vision and hearing
There is a Decline in all five senses however

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What is Presbyopia?

loss of elasticity of lens causes decreased accommodation and inability to focus sharply for near vision.

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What are some vision changes with aging?

decreased visual acuity
Presbyopia (difficulty reading –up close, happens around 40 yrs old)
decreased accommodation
reduction in pupil size & more sluggish
decreased light adaptation & night vision
increase sensitivity to glare
decreased depth perception
yellowing of the lens

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What are some normal anatomic changes seen with the eyes with aging?

Laxity & downward shift of eyelids
Atrophy of orbital fat

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What is glaucoma?

Vision loss due to damage to the optic nerve
Central vision is spared, however peripheral vision is compromised.

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What are cataracts?

an eye disease in which the lens becomes covered in an opaque film that affects sight, eventually causing total loss of sight
Fuzzy or cloudy images
Contrast sensitivity is decreased or lost.

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What is Macular degeneration?

a gradual loss of the central part of the field of vision usually affecting both eyes that occurs especially in the elderly

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What are some hearing changes with aging?

Loss of auditory neurons, calcification of auditory mechanisms, loss of hair cells
middle ear membranes less flexible; bones stiffen
Decrease ability to hear

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What are some nursing interventions for hearing changes with the elderly?

Make sure hearing aid is in
Shut the door to lower down background noise
Face them when talking

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What is presbycusis?

Difficulty hearing high frequency sounds

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What are some sensory changes seen with aging?

Taste:

atrophy of the tongue
diminished taste sensation
decreased saliva production
increased sensitivity to bitterness
decreased sensitivity to sweetness & salt

Smell:

decrease in smell receptors
decreased smell acuity

Touch:

decrease in # of touch receptors
decrease in sensitivity

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What ares some changes seen with the integumentary system?

↓ Moisture
Dermis thins; more fragile
Loss of subcutaneous fat
Wrinkling
Variation in pigmentation
Increased melanocytes in people of color’s skin
Nail growth slows
Less sweat gland activity

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What are Implications and Nursing Interventions for changes in the integumentary system?

Be careful when putting on IVs, especially with tearing off the tape
Advise them to use lotion
Advise them to use sunscreen

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What is Candidiasis?

A common yeast infection that usually affects the vagina

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What is herpes zoster?

Also known as Shingles
a disease caused by the same virus that causes chickenpox

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What is onychogryphosis?

A hypertrophy that may produce nails resembling claws or a ram’s horn, possibly caused by trauma or peripheral vascular disorders, but most often secondary to neglect and failure to cut the nails for extended periods of time.[

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What is Onychomycosis?

the most common of all diseases of the nails in adults
Individuals who are especially susceptible include those with chronic diseases such as diabetes and circulatory problems and those with diseases that suppress the immune system
More common in men than in women

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What are some changes seen in the nervous system with aging?

Reduction of brain weight - 10% by 70
Reduction in nerve cells
Slower autonomic & voluntary reflexes
Increase pain threshold
Increase in senile plaques & neurofibrillary tangles
Decreased:
- Cerebral blood flow
- Neurotransmitters
- Impulse velocity

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What are Implications and Nursing Interventions for nervous system changes with aging?

Provide mental stimulation
Encourage them to be mentally active (crossword puzzles) •

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What are some changes in sleeping patterns with aging?

40% complain of sleep problems
Decrease in total sleep time in stages 3 & 4.
Frequent awakening
Changes in circadian rhythms – more multiphasic

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What are some changes in the cardiovascular system with aging?

↓ in tone and elasticity of aorta and great vessels → Aorta & other arteries stiffen
Heart sz. may increase slightly → slight increase in systolic BP
Heart valves thicken & stiffen
↓ # pacemaker cells
↓ cardiac reserve & output
Myocardium is slower to recover its contractility
Baroreceptors which monitor B/P become less sensitive

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What are some changes in the respiratory sytem with aging?

Lungs stiffen / chest wall rigid
Total lung capacity constant

Decreased:

mobility of chest wall → elastic recoil of lung
cough reflex
vital capacity ↓ up to 50% by age 75
number of alveoli → Pa02 decreases with age
number & activity of cilia

Increased:

A-P diameter
residual volume

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What are some nursing interventions for respiratory system changes with aging?

Deep breathing exercises
Encourage them to get the flu (yearly) and pneumonia vaccines (every 5 years)

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What are some changes in the musculoskeletal system with aging?

Ht. ↓ (2-3 in.) due to loss of cartilage, thinning of vertebral disks, & curvature of spine
Kyphosis
↓ in muscle mass (up to 30%) → ↓ in muscle strengt
Bone becomes more porous and brittle
↓ Bone mineral & mass
Loss of Ca from bone → osteoporosis

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What is Rheumatoid arthritis and what are some nursing considerations of this disease?

Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues.
It involves symmetric joints (if one joint is inflammed, the other one will be too). Other musculoskeletal illnesses invovle isolated or unilateral joints.
RA pain is worse in the morning when arising.
RA stiffness occurs in the morning and after rest periods
Movement decreases pain
S/S: fatiuge, weakness, anorexia, Weight loss, low grade fever, lymphadenopathy.

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What is Osteoarthritis and what are some nursing implications for this disease?

Osteoarthritis (OA) is the most common joint disorder, which is due to aging and wear and tear on a joint.
asymetric pain is localized and is worse usually later in the day
Movement increases pain

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What is Osteoporosis?

A decrease in skeletal bone mass occuring when rate of bone resorption is > than that of bone formation

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What are some risk factors w/ osteoarthritis?

age > 50
Family history ( eg Rheumatoid Arthritis)
Obesity
Joint abnormality
History of trauma

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What are Bouchard & Heberden’s nodes and what is the difference between them?

they are nodes found on people’s hands with osteoarthritis
Bouchard’s nodes – proximal – closest to hand
Heberden’s nodes – distal – near fingertips

What are some changes with the gastrointestinal system with aging?

Tongue atrophies, loss of papillae, teeth become brittle
Some atrophy of L & S intestine but motility of feces not largely affected

MOTILITY:

Decreased: esophageal peristalsis & emptying
Decrease in stomach motility

ABSORPTION:

Slower absorption of fat, Vitamins B, B12, D, Ca, & Iron

SECRETION:

Saliva is diminshed
Decrease in digestive enzymes (HCL acid & pepsin)
Increase in biliary lipid secretion (gallstones)

What are some not normal changes with the gastrointestinal system with aging?

Tooth loss is abnormal. Causes: poor dental care, periodontal dz., poor diet.
Constipation is not normal. Other factors such as poor diet, lack of fiber & exercise are culprits.

What are some changes to the kidney with aging?

**Delayed and less thirst response **
Blood flow to kidneys declines
Number / size of nephrons decrease
Tubular function decreases
Glomerular filtration rate decreases
Decreased ability to concentrate urine
Heightened risk of trauma, infection, etc.

What are some changes to the bladder with aging?

Bladder muscles weaken
Increase in urgency & frequency
Increase in residual urine &urinary retention
Increase in nocturia
Bladder capacity decreases
Higher rate of UTI’s
Stress incontinence more common

What are some changes to the female reproductive system with aging?

Estrogen production decreases
Ovaries become fibrotic & atrophy
Cessation of ovulation & Menopause
Loss of capacity to reproduce
Uterine lining thins & shrinks
Atrophy of vulva, cervix, & ovaries
Vaginal wall becomes thinner, drier, & lose elasticity

What are some changes to the male reproductive system with aging?

Decrease in testosterone production
Size & firmness of testes decreases
Decline in rate of sperm production
Prostate enlargement
Takes longer to achieve erection, smaller, less firm, but maintained longer
Erectile dysfunction increases with age

What are some changes to the endocrine system with aging?

Pituitary gland shrinks
Thyroid gland atrophies but function remains adequate
Reduced sensitivity to insulin
Decrease in adrenal gland secretion of glucocorticoids & steroids
Decrease in aldosterone levels
Decrease secretion of cortisol

What are some changes to the immune system with aging?

Shrinkage of thymus gland
Decreased production of thymic hormones
Less production of antibodies
Response to antigens diminishes
Vulnerable to infections, tumors, & immune diseases

What are “Geriatric Syndromes?”

S – leep disorders
P – roblems with eating and feeding (P) - ain
I – ncontinence
C – onfusion
E – vidence of falls
S – kin breakdown

What are some changes in blood work with aging?

Decrease:

Hgb, Hct, & WBC (slight)
Creatinine, serum
Iron & B12
Potassium
T cells
T3 & T4
Protein
PO2

Increase:

E. Sed. Rate (slight)
B cells & Monocytes
BUN
Glucose (higher normal)
Cholesterol
Uric Acid

What is a comprehensive functional assessment?

It is a thorough evaluation of a person’s ability to carry out basic tasks for self-care and tasks needed to support independent living.

What is the goal of a comprehensive functional assessment?

To improve functional status and independence and enhance quality of life.

What is the purpose of a thorough functional assessment?

The purpose of this is to get a baseline for the patient.
Should be performed on admission
Or when the patient’s condition changes

How is the process of assessment of older adults strikingly different than assessment of younger adults?

Communication is different, they may not be able to understand what you are saying, and or physically able to do things, mobility and reaction time, looking for age related changes
Might have to be more patient with the pts.

What are some myths related to functional ability?

# of conditions on problem list correlates with degree of functional status
Objective indicators of health are the best indicators of a person’s ability.
Severity of disease determines the presence of functional impairment
All problems of elderly are related to a result of “aging or having lived a long life.”

What are the major components of a comprehensive functional assessment?

Physical Functioning
Cognitive Status
Psychological Status
Social Functioning / Support
Environmental Characteristics

What is the acronym FANCAPES evaluate, and what does it stand for?

It is an acronym that assess basic functions

Fluids
Aeration
Nutrition
Communication
Activity
Pain
Elimination
Social skills

What do you assess for in the fluids section of the acronym FANCAPES?

Evalue client’s current state of hydration
Assess client’s ability to obtain adequate fluids independently, to express thirst, to awallow effectively, and to evalue medications that affect intake an output

What do you assess for in the aeration section of the acronym FANCAPES?

This section refers to the adequacy of oxygen exchange
You observe fro RR, depth of respirations at rest and during activity
Evaluate breath sounds and medications that may affect breathing
Determine O2 saturation level

What do you assess for in the nutrition section of the acronym FANCAPES?

Examine mechanical and psychological factors in addition to the type and amaount of food consumed.
Assess ability to bite, chew, swallow, dentures, and condition of gums and teeth
Assess diet, medical restrictions, economic resources, and living conditions

What do you assess for in the communication section of the acronym FANCAPES?

Assess the client’s ability to send and receive verbal and nonverbal information
Determine sight and sound acuity, adequate function of tongue, teeth, pharynx and larynx.
Determine client’s ability to red, write, and understand spoken language

What do you assess for in the activity section of the acronym FANCAPES?

Asses the client’s ability to ambulate, eat, toliet, dress, and groom
Coordination, balance, finger dexterity, grip strength, and other abilities are necessary in daily life should also be assessed.

What do you assess for in the pain section of the acronym FANCAPES?

Assess for physical, mental, and spiritual pain
Gather infromation about any recent losses or anxiety

What do you assess for in the elimination section of the acronym FANCAPES?

Bladder and bowel elimination are asseessed
Examine for any urinary dribbling, incontinence, use of protective garments, or medications that affect voiding and intestinal peristalsis
Don’t use complex words when talking about bowel and bladder functioning

What do you assess for in the social skills section of the acronym FANCAPES?

Asess the client’s ablity to negotiate in society, to give and receive love and friendship, and to feel self-worth
This assessment focuses on the individual’s ability to deal with loss and to interact with other people in give-and-take situations

What does Katz ADL scale consist of?

Eating
Bathing
Dressing
Toileting
Transferring
Urine & Bowel Continence

What does Lawton’s IADL scale consit of?

Telephone Use
Shopping
Food Preparation
Housework
Transportation
Medication Use
Money Management

What are different tests uses to assess cognitive function?

Folstein Mini-Mental Status Exam
The Mini Cog
Clock Drawing
Time & Change Test

What are the different parts of the folstein mini-mental status exam?

Orientation
Registration
Attention and Calculation
Recall
Language

How would you conduct a mini-cog exam?

Instruct pt. to listen carefully to and remember 3 unrelated words and then to repeat the words.
Instruct pt. to draw face of a clock on a blank sheet of paper or on a sheet with the clock circle already drawn. After pt. puts numbers on clock face, ask him/her to draw hands of clock to read a specific time (11:10).
Ask pt. to repeat the 3 previously stated words.

How would you conduct the time & change test?

Tell time on clock with hands set to 11:10.
Count out one dollar in change (provide 3 quarters, 7 dimes, & 7 nickels)

What tools are used for a psychological assessment?

Geriatric Depression Scale
Spiritual Assessment (Jarel Spiritual Well-Being Scale & Stoll’s Guidelines for Spiritual Assessment)

What does a family APGAR test consist of?

I am satisfied that I can turn to my family for help when something is troubling me.
I am satisfied with the way my family talks over things with me and shares problems with me.
I am satisfied that my family accepts and supports my wishes to take on new activities or directions.
I am satisfied with the way my family expresses affection and responds to my emotions, such as anger, sorrow or love.
I am satisfied with the way my family and I share time together.

Responses: Always, Some of the time, Hardly ever

What does OARS Economic Resource Scale consist of?

It assess the availability & relationship with family, relatives, & friends

It lalso looks at :

employment,
Income & assets,
expenses,
financial resources, &
medical insurance

What is a nursing facility resident assessment instrumenta and what is it used for?

It is an assessment required by CMS (Centers for Medicare & Medicaid Services) for all residents of Medicare/Medicaid approved N.H. & SNF
Required within 14 days of admission, major “permanent” change in condition, quarterly (selected items), & annually
Resident Assessment Protocols
Assists with care planning

What is the purpose of the minimum data set?

Care Planning
Quality Improvement
Reimbursement – Medicare
Coordination
Delegation
Attestation of accuracy for some parts

Who develops pressure ulcers?

Patients with:

Fx hip
Stroke
Severe arthritis
Paraplegia/Tetraplegia
Children following heart surgery (back of the head)

What are some risk factors for pressure ulcers?

Friction
Shear forces
Incontinence, perspiration, urine, feces, drainage
Blood or serum concentrations

What is the purpose of a pressure ulcer risk assessment?

Reduce the incidence of pressure ulcers/improve quality
Identify who is and who is not at risk
Plan care based on risk factors and level of severity of risk factors
Avoid unnecessary expensive care
Improve quality of care and decrease costs

When should a pressure ulcer risk assessment be done?

Pressure ulcers develop in the early days & hours following admission
Study of support surfaces….5 of 20 developed ulcers in one day
Risk assessment should be done on admission for both prevention and treatment
Skin assessment must be done on admission or hospitals can be penalized

What are the different levels of risk scores for pressure ulcers and what does each group score represent?

Risk for pressure ulcer development based on score:

15-18 Mild Risk
13-14 Moderate Risk
10-12 High Risk
9 or less Very High Risk

What are some nursing interventions for mild risk (15-18 braden score) patients in regards to pressure ulcers?

Turning reminders at night for some
Maximal remobilization
Protect heels—for some
Manage moisture, nutrition and friction and shear
High density foam mattress and chair cushions
* If other major risk factors present, advance to next level of risk

What are some nursing interventions for moderate risk (13-14) braden score) patients in regards to pressure ulcers?

High density foam replacement mattress
Turning schedule (2, 3, or 4 hour) when in bed with 30 degree rule
Maximal remobilization
Protect heels through elevation
Manage moisture, nutrition and friction and shear
* If other major risk factors present, advance to next level of risk

What are some nursing interventions for high risk (10-12) braden score) patients in regards to pressure ulcers?

High density foam replacement mattresses
Turn 2, 3 or 4 hour, 30 degree rule with foam wedges or pillows
Supplement with small shifts if necessary
Maximal remobilization
Protect heels
Manage moisture, nutrition and friction and shear

Describe nutrition management in relation to pressure ulcers

Increase protein intake
Increase calorie intake to spare protein
Supplement with commercial product when meals are missed
Supplement with Multi-Vitamins (esp A, C, E)
Act quickly to alleviate deficits
Consult a dietitian

Describe mostiure management in relation to pressure ulcers

Toilet at regular intervals
Use commercial moisture barrier
Use absorbent pads that wick and hold moisture…take off at intervals to let skin breathe
Address causes of incontinence
Provide plenty of water

Describe friction and shear management in relation to pressure ulcers

Elevate HOB no more than 30o
Use trapeze when indicated
Use lift sheet and friction reducing devices to move patients
Protect elbows and heels if being exposed to friction
Watch for friction from assistive devices, casts, bedrails, etc.

What is a fall?

Unintentionally coming to rest on a lower area such as the ground or floor
Inadvertently coming to rest on the ground, floor or other lower level, excluding change in position to rest in furniture, wall or other objects

What is the importance of falls to gerontologic nursing?

Older adults are at greatest risk for falls
Falls and/or their consequences can be fatal
The cost of falls is high and is expected to increase
Hospitals and Healthcare Professionals are responsible for fall prevention
Rate of falls in the hospital setting is used as a Nursing Quality Indicator

What are some risk factors for falls?

Times of highest risk:

Acute Illness
Exacerbation of chronic illness

The risk of falls increases with the number of risk factors

Risk factors are categorized as:

Intrinsic
Extrinsic

Most falls occur from a combination of intrinsic and extrinsic risk factors

What are hospital acquired conditions?

Conditions that are:

High cost and/or high volume
Result in the assignment of a case to a DRG that has a higher payment when presented as a secondary diagnosis
Could have reasonably been prevented through the application of Evidenced Based guidelines – Such as falls

What are some intrinsic risk factors for falls?

Reduced vision
Unsteady gait
Cognitive impairment
Foot deformities
Hypotension
Acute and Chronic Illness
Effect of Medications

What is the relationship between foot deformities and falls?

Foot Deformities can cause unsteady gait:

Neglect of corns, bunions and overgrown nails

Other Causes of foot problems:

Loss of fat cushioning related to aging
DM- ulcers, neuropathy
Poor fitting shoes

As part of the head to toe assessment- inspect feet (top and bottom) and foot wear

What are some extrinisic risk factors for falls?

Lack of support equipment by bathtubs and toilets
Height of beds
Condition of floors
Poor lighting
Inappropriate footwear
Improper use of assistive devices
Inadequate assistive devices

What are some nursing intreventions to prevent falls related to foot deformities?

Instruct older adults/caregivers on proper foot care:

Wash and thoroughly dry feet daily
Trim toenails regularly
Check top and bottom of feet as well as in between toes daily
Report decreased sensation, tingling, etc to healthcare provider
Wear properly fitting shoes and socks

What is postprandial hypotension?

It is a sudden drop in blood pressure after eating caused by increased blood flow to the digestive tract with failure of circulatory compensation.
More common in the elderly and those with DM and Parkinson’s disease

What are 3 consequences of falls?

Hip fractures
Traumatic brain injury
Fallophobia

What are the outcomes of hip fractures?

Mortality
Limitations in mobility
Decline in bone mineral density, lean body mass, strength
Decreased quality of life
Persistent pain
Depression
Only ½ of patients with hip fractures recover to their pre-fracture ambulation status within 1 yr.

What is a traumatic brain injury and what are some risk factors for it?

It is damage to the brain as the result from a violent blow or jolt to the head

Factors placing the older adult at risk:

Comorbid conditions
Use of Aspirin, Anticoagulants
Age related brain changes

What are the symptoms of a mild TBI?

Low grade headache
Memory loss
Trouble with daily tasks
Fatigue
Change in sleep pattern
Blurred vision
Mood changes

What are the symptoms of a moderate-severe TBI?

Severe headache that gets worse
Repeated vomiting or nausea
Seizures
Dilation of one or both pupils
Weakness
Confusion, restlessness, agitation

What is fallophobia and what its effects?

It is the fear of falling
Falls lead to loss of confidence which reduces physical activity which increases dependency and leads to social withdrawal.

What is a postfall assessment and what does it consist of?

Purpose is to identify the underlying cause, implement risk reduction programs and prevent future falls

Postfall Assessment:

Assess for any obvious injuries and provide appropriate care
Physical Exam including vital signs
Notify MD
Description and circumstances of the fall from the patient or witness
Associated Symptoms that occurred with fall
Medication Review
Environmental Assessment

How would you instruct a person to get up from a fall?

Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.
Decide if you’re hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse.
If you think you can get up safely without help, roll over onto your side.
Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.
Put your hands on the chair seat and slide one foot forward so that it is flat on the floor. Keep the other leg bent so the knee is on the floor.
From this kneeling position, slowly rise and turn your body to sit in the chair.

What is the purpose of using assistive devices in older adults?

Broadens patient’s base of support
Improves balance and stability
Redistributes weight from lower extremities to: alleviate joint pain, compensate for weakness or injury

What are the goals of using assistive devices?

Improve independent mobility
Reduce disability
Delay functional decline
Decrease the burden of care

How would you instruct a patient to use a cane/walker when ambulating?

Advance cane/walker with affected leg, then move the unaffected leg forward
Posture should be upright without leaning forward

How would you instruct a patient to use a cane when walking up stairs?

Walking up stairs- place cane on unaffected side and lead with unaffected leg
Moving cane with affected leg step up (keep cane in line with affected leg)
Healthcare provider remains behind patient

How would you instruct a patient to use a cane when walking down stairs?

place cane on unaffected side. Place cane on lower step.
Step with affected leg first, then unaffected leg
Healthcare provider remains in front of patient

What is nursing jurisprudence?

It is a system of ethical principles and legal mandates which govern the behavior of professional nursing practitioners to further the goal of promotion and protection of the health, safety, and welfare of the public

What are laws?

binding rules of conduct enforced by authority.

What is ethics?

Examines values, choices, and actions to determine right and wrong.

–Values: strongly held personal and professional beliefs about worth and importance of human beings upon which choices are made and actions taken.

What does patient advovacy involve?

recognizing conflicts in values and beliefs
mediating, negotiating, clarifying, explaining, intervening (important to determine competency of elder’s understanding)
assuring respect, equality/fairness and right of human dignity toward others without discrimination
serving as a liaison between patient receiving health care and the health care system;

What is competence?

A legal term used to indicate a person has decision-making capacity

Why would you need to determine the decisional capacity of an individual?

To determine decisional ability of a person:

have an “ordinary” conversation
observe person’s behavior
talk with family, friends or staff

How would you determine decisional capacity?

Discuss interactions between you and individuals whom you have interviewed, assessed their functional capacity and/or their nutritional status (identify age, gender, psycho-social being)

What are some potential risk factors with the elderly regarding value based decisions?

Employment vs. Retirement:

(Medicare A and B; Social Security; Pension funds; Medicaid)

Living accommodations:

Independent /alone or with spouse or child; assisted-living facility; LTC/nursing home; CCRC/senior residential community (rental vs. “life-care”); use of day care facility

Driving:

continuing licensure vs. cessation

Polypharmacy:

prescriptive; OTC

Nutrition (adequate vs. inadequate)

Dehydration

Financial management:

cash; credit card/s;
bank account/s; investments; property ownership…Vulnerability to fraud/scams

Healthcare resources:

availability; accessibility

Healthcare insurance:

no coverage; Medicaid; Medicare; MCO/HMO; PPO; supplemental health insurance; Long Term Care insurance. “Fee for Service” as a choice for whom?

What is decisional incapacity/in-competency?

Individuals who clearly lack capacity to decide for themselves, as manifested in “dementia” or in situations of “disorientation” or “delusions” whether transitory or irreversible

should have a surrogate decision-maker
even if person might be seriously incapacitated in decision-making, he/she might retain ability to designate an appropriate surrogate; allow him/her this choice to name the surrogate person

How is Elder Abuse/Neglect/Exploitation defined?

It is defined by state law

What does elder abuse incorporate?

Physical abuse (force with body injury)
Sexual abuse
Emotional/psychological abuse
Financial exploitation
Neglect “passive abuse” or Self-neglect

What are some common signs and symptoms of elder neglect/abuse?

Vision and hearing problems
Decubiti; Unexplained bruises, burns, skin tears
Pain: What ways can be used as determinants?
Mobility vs. restraints (physical, drug/s)
Nutritional status; thirst and dehydration
Urinary and/or bowel incontinence
Over-medication or under-medication
Infection (URI, UTI; others?)
Poor personal hygiene; clothing appearance
Residential appearance (interior)
Social withdrawal; loneliness; despair; anger/hostility; fear

What are some ethical issues with prolonging life in the elderly?

escalating medical costs; scarce public resources
increasing use of high technology for procedures/treatments
rationing of health care: decisions made by society vs. medical professionals
State law and the court system

What does the patient self-determination do?

Ensures rights of individual/client/patient to “author or execute” written and signed instructions about his/her wishes for medical treatment in the event of becoming “incapacitated” and appropriately witnessed.
Requires health care facilities receiving Medicare funds to provide information about Advance Directives to patients on admission.

What is an advance directive?

written statement that directs health care providers concerning consent or refusal of treatment when the individual patient does not possess decision-making capacity.

What is a living will?

document that establishes a written mechanism for an individual to specify wishes about withdrawing or forgoing life-sustaining treatment (treatment that only prolongs or delays the process of dying

How can advance directives/living wills be revoked?

Oral revocation
Destroying the document
Amending document in writing

What does JCO mandate regarding advance directive and hospital policies?

that each hospital provides adult patients information to initiate Advance Directives; unless patient
has a valid document that is available to physician or on patient’s chart

If an individual does not have a valid Advance Directives and does not have decisional-making capacity who make make decisions?

may use a Healthcare Proxy (surrogate) or
decisions can be made through state “guardianship” laws

What are guardians?

individuals, agencies or corporations appointed by the court to have care, custody, and control of a legally disabled person (not medically disabled; cite examples).

What are the functions of guardians?

Manage his/her personal and/or financial business
Make provisions for one’s physical health and safety, such as health care, food, shelter, personal hygiene (partial dependency) vs. “total dependency” person unable to meet basic needs for survival and manage his/her environment
Consider high risk for exploitation

What is a terminal patient?

Any patient with a “lethal/deadly” disease or condition.

Is refusal of life-sustaining treatment suicide?

nnot considered suicide by ethical standards; courts have ruled these practices as legally acceptable.

What does a DNR order mean?

do not perform endotracheal intubation in event of cardiac arrest or respiratory failure;
do not resuscitate by chemical/drug, electrical or manual means;
do not contact “code team”; all other medical care will be provided unless ordered otherwise

What is acculturation?

It is the willingness to modify one’s own culture as a result of contact with another culture. An individual’s adaptation to customs, values, beliefs, and behaviors of a new country.

What is assimilation?

willingness of a person emigrating to a new culture to gradually adopt and incorporate characteristics of the prevailing culture

What is Cultural competence?

conscious process of demonstrating knowledge and understanding of a client’s culture to recognize, accept, respect cultural differences; be able to incorporate these cultural beliefs and practices about wellness and illness into the delivery of care; and adapt interventions to be congruent with the client’s culture

What is Health literacy?

knowledge and fundamental ability to manage illness as well as navigate the health care system

What is a cultural assessment?

A systematic appraisal or examination of individuals, groups, and communities about their cultural beliefs, values, and practices to determine explicit needs and intervention practices.

What is ethnicity?

How members of a group perceive themselves and how they are perceived by others; associations due to customs, and cultural patterns, rather than biological origins; a shared kinship.

What is race?

generally defined as a biological factor of discrete group whose members share distinctive genetic, biological, and other factors from a common or claimed or ancestor.

What is cultural marginality?

“situations and feelings of passive betweeness when people exist between two different cultures and do not yet perceive themselves as centrally belonging to either one.”

What is Ethnocentrism?

universal tendency of persons to think that their ways of thinking, believing and behaving are the only right, proper and natural ways.

What is a folk health system?

It embodies beliefs, values and treatment approaches of a particular cultural group that are products of cultural development.
It ses a holistic approach of family and support systems. When folk healing is not effective, person may turn to Western health care (scientific).

What is the 4 step approach to providing culturally sensitive care?

Examine personal culture
Get familiar with client culture
Identify adaptations made by client
Modify the client teaching based on data from earlier steps

What is the nurse’s role in the general assessment and when providing teaching assessments?

Observe interactions between client and family members and among family members.
- Who makes the decisions? How are decisions made?
Consider communication abilities & primary language: verbal, non-verbal; etiquette of interaction-acceptable, nonacceptable.
** Explore** customs or taboos to clarify beliefs and practices that may restrict care or treatment.
Determine importance of time and time periods to client and family.
Be aware of cues for interaction: respect is key behavior. Know correct way to address the persons.

When would you consider the use of a professional translator/interpreter?

If client speaks foreign language, whenever possible the client’s primary language should be used.
Use of family or friends for translation of communication is not recommended; use professionally trained interpreters. Family or friends:
- May choose to omit portions of content they believe to be unnecessary or unacceptable
- Presence with client may inhibit communication & violate confidentiality.

What are the 4 major cultural groups in the U.S.?

American Indians/Native Americans/Eskimos: unique to the U.S.
Asian/Pacific Islanders: composed mainly of people from Korea, Viet Nam, Laos, Thailand, Cambodia, Taiwan, Japan, China, Philippines, India, Pakistan
Blacks: origins are mainly from Africa and Caribbean Islands.
Hispanics: Mexicans, Puerto Ricans, Central and South Americans, Cubans.

What are some characteristics of the hispanic culture regarding healthcare?

The centrality of the family and extended family is single most important source of social support
Heavy reliance on family has been linked to Hispanics’ low use of health care services
May view physical illness as an act of God; something to be endured; mental illness as an enemy’s hex or witchcraft from envy or vengeance; remains a stigma and not discussed with strangers; genetic defects attributed to God’s will; mother’s failure to care for herself or a hex

How should a nurse communicate verbally and nonverbally to a hispanic patient?

Verbal:

Consider loudness as rude; requests should be in non-confrontational tone of voice
Converse in warm, respectful manner
Communicate serious/terminal illness with patient and family together

Nonverbal:

Direct eye contact may interpret as intimidation or “evil eye” from authority and opposite gender
Personal space: prefer to keep appropriate social distance
Silence may indicate disapproval, disappointment or anger; politeness or not understanding
Gestures: handshake appropriate between strangers
Touch: enjoy touching family members, friends but not by strangers
Time: usually focused on here and now; leave the future in God’s hands
Modesty greatly valued
Privacy: usually share info about illness with selected family/extended members. Do not share problems/conflicts outside the family
Self-care: expect hospital staff to give help or will wait for family member to help
Self-care management: may self-treat, especially if uninsured or questionable legal status
Special clothing includes crucifixes, religious medals, amulets. Clinicians should handle with respect

What are some characteristics of the african american culture regarding healthcare?

Their strong religious values and beliefs (inner strength from their trust in God) may extend to feelings about health promotion and illness. “What happens is God’s will”.
May have folk practice beliefs about spirits in the world: animate or inanimate objects which have good or evil spirits (religious priests, witch doctor or medicine man have power to release hostile spirits). May use faith and “root healers” (herbalists) with biomedical resources

What are major philosophical orientations of the asian/pacific islander culture?

Buddhism: “all existence is suffering”; pattern of authority is inferior to superior; man in harmony with universe; ancestor worship.

Hinduism: Dharma, traditional law of morality and ethics that establishes norms and expectations; roles/ceremonies based on caste system, focus on birth, marriage, death.

Muslim: Islam religion guides and governs all aspects of life; reading of the Quran; prayer highest form of worship; communicate with Allah. Do not expect Muslim leader (imam) to visit patient; summoned after death.

What are some common values reflected Asian/Pacific Islander Culture?

Male authority and dominance
Strong family ties
Respect for parents, elders, teachers and other authority figures
Personal behaviors are a result of a sense of pride

What are some common health behaviors of Asian/Pacific Islanders?

Older generation tend to have more difficulty adapting to acculturation; children usually adapt more quickly
Medical practices differ significantly from Western scientific medicine
Tend to seek health care only when seriously ill; “crisis oriented” (especially immigrants)

What are some Major Characteristics of the Native American Culture?

Spiritual attachment to land and harmony with nature
Intimacy of religion and medicine; varies by individuals and with practices/rituals
Strong ties to extended family network, including entire tribe
Elders view children as assets, not liabilities; children given much freedom to learn from their decisions and live with the consequences of their actions
nBelief that supernatural powers exist in animate and inanimate objects

nDesire to remain Native American and avoid acculturation, especially elders

nLack materialism and desire to share with others

Describe women in the arab american culture

Women expected to act in submissive role:

Preservation of female chastity
Fidelity prohibits adult males to be alone with female, except with spouse
Females omit handshakes; touching in marriage only

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