Exam 2 Flashcards
Describe the stochastic biological theory of aging
Aging is an accumulation of random changes that occur over time
Describe the non-stochastic biological theory of aging
Aging occurs because of genetically programmed events and cellular damage accelerates aging
Ericksons Psychosocial Development: Age 1 (infancy)
Crisis: Trust vs Mistrust
Strength: Hope
Influence: Maternal
Ericksons Psychosocial Development: Age 2-3 (early childhood)
Crisis: Autonomy vs Shame/Doubt
Strength: Willpower
Influence: Both parents
Ericksons Psychosocial Development: Age 4-5 (preschool)
Crisis: Initiative vs Guilt
Strength: Purpose
Influence: Parents, family, friends
Ericksons Psychosocial Development: Age 6-11 (middle childhood)
Crisis: Industry vs Inferiority
Strength: Competence
Influence: School
Ericksons Psychosocial Development: Age 12-18 (adolescence)
Crisis: Identity vs Role Confusion
Strength: Fidelity
Influence: Peers
Ericksons Psychosocial Development: Age 18-35 (young adulthood)
Crisis: Intimacy vs Isolation
Strength: Love
Influence: Spouse, lover, friends
Ericksons Psychosocial Development: Age 35-36 (Middle age)
Crisis: Generativity vs Stagnation
Strength: Care
Influence: Family, society
Ericksons Psychosocial Development: Age 65+ (Old age)
Crisis: Integrity vs Despair
Strength: Wisdom
Influence: All humans
Aging ______ IQ and _______ reaction time
does not affect
slows
Aging affects short term memory by
decreasing recall
Aging affects long term memory by
N/A
When assessing older adults, what physiological changes should you look for?
CLEAR
Cognition and agitation
Loss of bladder control and altered elimination
Eating and nutritional changes
Activity and energy changes
Recurrent falls/injury
as well as:
impaired mobility, altered skin integrity, and altered sleep
When assessing older adults, what cognitive changes should you look for?
Memory
Perception
Intelligence
Confusion
When assessing older adults, what functional changes should you look for?
ADLs (self-care, activity intolerance)
Fall assessment
Environmental
When assessing older adults, what psychosocial needs should you ask about?
Social support and coping
Grieving and hopelessness
Impaired body image
Economic status
Independent vs Dependent living
Pain is
what the patient says it is
When should patient/caregiver education take place?
Every shift
What is the degree of insertion for intramuscular injections?
90 degrees
What size needle do you use for IM injections?
20-25 gauge
Adults: 1 - 1 1/2 inch
Children/elderly/emaciated: 5/8 - 1 1/4 inch
What is the degree of insertion for subcutaneous injections?
45 - 90 degrees
What size needle do you use for SubQ injections?
Generally 25-27 gauge
3/8 - 1 inch (depending on pt)
What is the degree of insertion for intradermal injections?
10 - 15 degrees
What size needle do you use for intradermal injections?
25 - 27 gauge
1/4 - 1/2 inch needle
What is the degree of insertion for IV’s?
25 degrees
What are common areas for IM injections?
Deltoid
Ventrogluteal
Vastus lateralis
What are common medications given through IM injection?
Steroids
Vaccines
Hormones
What are common injection sites for SubQ injections?
Abdomen
Back of arm
Top of thigh
What are common medications given through SubQ injection?
Heparin
Insulin
Ozempic
Describe the Z-track method for injections:
Used to “lock” injection into muscle
Hold skin taught before inserting needle
Inject at 90 degrees
After removing needle, release skin to move back to normal position
For intramuscular injections, 1-2 mLs should go into the
deltoid
For IM injections, 1-5 mLs should go into the
ventrogluteal
(large muscle)
When doing an intradermal injection, what should enter the skin?
Only the bevel
When drawing up from an ampule, what kind of needle should you use?
Filter needle
Define hemoptysis
Blood in sputum (cough up blood)
What causes barrel chest?
Labored breathing that requires the use of accessory muscles
What causes nail clubbing?
Low O2 (hypoxia)
Results in slow capillary refill and no window between thumb nails
How do you test for thoracic respiratory excursion?
Place hands on back (around 10th ribs)
Have pt breathe in deeply
Watch hands move (should be symmetrical, only about 3-5 cm movement)
How do you test for tactile fremitis?
Palpate down back, have pt repeat “ninety-nine”
(Should feel vibrations toward top near vocal chords, less toward bottom)
What is respiratory crepitus?
Sub-Q air “rice krispies”
Where are bronchial sounds heard?
Toward top of chest (larynx and trachea)
Where are bronchovesicular sounds heard?
Around 1st/2nd intercostal area and between scapula
Where are vesicular sounds heard?
Heard closer to bottom (“apices”) of lungs
What is cranial nerve I?
How do you test it?
Olfactory nerve
Smelling - close eyes and identify scent
What is cranial nerve II?
How do you test it?
Optic nerve
Visual acuity - Snellan chart, peripherals
What is cranial nerve III?
How do you test it?
Oculomotor nerve
PERRLA, convergence, and 6 cardinal fields of gaze
What is cranial nerve IV?
How do you test it?
Trochlear nerve
6 cardinal fields of gaze (move in and down)
What is cranial nerve V?
How do you test it?
Trigeminal nerve
Clench teeth and close eyes and identify sensation on sinus/jaw/forehead/neck
What is cranial nerve VI?
How do you test it?
Abducens nerve
Six cardinal fields of gaze (move out)
What is cranial nerve VII?
How do you test it?
Facial nerve
Facial expressions (puff cheeks, smile, raise eyebrows)
What is cranial nerve VIII
How do you test it?
Acoustic nerve
Close eyes and rub fingers near each ear, identify which side and perform Romberg test
What are cranial nerves IX and X?
How do you test them?
Glossopharyngeal and Vagus nerve
Have pt. say “Ah”, watch uvula rise, make sure it is midline
What is cranial nerve XI?
How do you test it?
Spinal Accessory nerve
Have pt shrug shoulders against resistance and move head side to side against resistance
What is cranial nerve XII?
How do you test it?
Hypoglossal nerve
Have pt stick out tongue, move side to side, make sure it is midline
Have pt repeat “Light, bright, dynamite”
Define stereognosis
The ability to identify an object without seeing it
Define graphesthesia
The ability to perceive writing on the skin without seeing it
What are 5 questions to determine if pt is AAOx5
Name and DOB?
Todays date?
Where are you?
Why are you here?
Current president?
What is the Romberg test?
Tests the patient’s balance
Pt closes eyes while standing with feet together, should be able to stand for 20 seconds without falling
Describe lethargic
Able to rouse by saying name and touching pt
Describe obtunded
Decreased alertness and more difficult to rouse patient (requires vigorous shaking and loud voice)
Describe stupor
Little to no spontaneous activity, will only be roused by painful stimuli
