Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gero > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

adult cognition is the process of…

A

Acquiring
Storing
Sharing
Using information

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

components of adult cognition

A
  • Language
  • Thought
  • Memory
  • Executive function
  • Organization (gather info)
  • Regulation (evaluate and change behavior)
  • Judgment
  • Attention
  • Perception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

adult cognition in action

A
  • Orientation
  • Problem solving
  • Psychomotor ability
  • Reaction time
  • Social intactness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

cognition physiological changes with age

A

Neuron loss
- most pronounced in cerebral cortex

Brain atrophy
- decreased weight

Dendrites atrophy

  • impaired synapse
  • changed transmission of dopamine, serotonin, and acetylcholine

not consistent with deteriorating mental function

Slowing is NORMAL (not processing as quickly
- IMPAIRMENT IS NOT NORMAL (not being able to remember things at all)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

cognitive reserve (CR)

A

Ability to compensate for age-related changes

“use it or lose it” - applied to cognitive function as well as physical health

  • based on the concept of neuroplasticity (capacity of the brain to change in response to stimuli)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

maximizes cognitive reserve

A
  • Engage in cognitive, sensory, and motor activities

- Engage in meaningful social interaction regularly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

fluid intelligence

A

Native intelligence or “street smarts”

Biologically determined skills INDEPENDENT of learning or experience
- thinking, inductive reasoning, abstract thinking, and integration

Ability to identify and draw conclusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

crystallized intelligence

A

“book smarts”

Knowledge and skills acquired during life
- verbal meaning, word association, social judgment, number skills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

classic aging pattern

A
  • Fluid intelligence decreases while crystallized intelligence remains stable
  • Related to speed of cognitive processing and slower reaction time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

learning late in life

A

basic intelligence remains unchanged with increasing years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

cognitive assessment

A
  • Evaluation of cognitive function requires formal focused assessment
  • Complete assessment, including lab workup, should be performed to rule out any medical causes of medical impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

myths about the aging brain

A

box 5.1, p 57

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

tips to improve memory

A

table 5.1, p 59

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

3 components to memory

A
  • Immediate recall
  • Short term memory
  • Remote or long-term memory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

memory retrieval

A

Recall of newly encountered information decreases with age

- Memory declines noted for complex tasks and strategies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

age-associated memory impairment (AAMI)

A
  • Considered normal memory loss (general slowness in processing, storing, and recalling new information and difficulty in remembering names and words)
  • Offset with cognitive stimulation and memory training
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

mental health and aging

A
  • Nearly 20% over 55 y/o experience mental health disorders that are not part of normal aging
  • Underreported and not well researched
  • Can be affected by cognitive and affective functioning earlier in life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

common mental disorders later in life

A
  • Depression
  • Anxiety
  • Mood disorders
  • Alcohol abuse and dependence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

stress overload

A
  • Increased by changing environmental needs and reduced of biopsychosocial homeostatic resilience
  • Diminishes ability to cope effectively
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

effects of stress

A
  • Reduces coping ability
  • Impairs neuroendocrine response that blunts immune function
  • Research on psychoneuroimmunology explored relationship between stress and various health conditions, cancers, Alzheimer’s disease, frailty, an functional decline - pro inflammatory cytokines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

flourishing despite adversity (tend to develop as you age)

A

Resilience

  • successfully adapting to difficult and life challenging experiences
  • positive interpersonal relationships
  • high self-esteem and self-efficacy
  • sense of purpose
  • creativity and sense of humor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

control, commitment, & challenge

A

Hardiness

  • stress is a challenge and an opportunity for growth
  • social connectedness
  • confronting problems head-on
  • extending oneself to others
  • spiritual grounding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

toolbox of self-control skills & belief that the tools may be used effectively

A

Resourcefulness

  • self-control
  • self-direction
  • self-efficacy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Coping

A
  • Coping may contribute more to health of older adults because they use it to optimize their resources
  • Coping strategies are factors that help individuals maintain psychosocial balance during stressful periods
  • Includes identifying stressor – good, bad, indifferent
  • Using skills & resources
  • Using past experiences as a resource
  • Using these appropriately
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Assessment for Coping

A
  • Risk factors of life transition, loss, and loss of social support
  • History of ability to cope with stress and life events
  • Assessment of cognitive function and/or impairment
  • Assessment of substance abuse and suicide risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Coping Interventions

A
  • Enhancing characteristics of hardiness, resilience, and resourcefulness
  • Enhancing functional status and independence
  • Promoting sense of control
  • Fostering social supports and relationships
  • Education regarding available resources
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Factors Influencing Mental Health Care

A

Attitudes & Beliefs

  • stigma
  • myth that it is normal

Availability & Adequacy of Care

  • access
  • ability to pay

Care Settings

  • place of treatment
  • who is providing care (staffing)

Cultural & Ethnic Disparities

  • poverty
  • language
  • cultural understanding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

anxiety disorder

A

NOT part of the normal aging process
- Life events and stressors may contribute to development of anxiety disorders

Associated with:

  • excessive healthcare use
  • decreased physical activity and functional status
  • substance abuse
  • decreased life satisfaction
  • increased mortality rates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

anxiety assessment

A
  • Difficult to diagnose in older adults
  • Denial
  • Coexisting medical conditions can mimic anxiety
  • Common side effect of certain drugs
  • Drug and alcohol withdrawal also can cause anxiety symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

anxiety interventions

A

Treatment choices depend on symptoms, specific anxiety diagnosis, comorbid medical conditions, and current medications

Therapeutic relationship between patient and HCP is the foundation for any intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

anxiety pharmacological treatment

A

Antidepressants - SSRIs
- First line

Short acting benzodiazepines
- Second line and short, bridge course

Non-benzodiazepine anxiolytic agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

anxiety non-pharmacological interventions

A
  • Cognitive behavioral therapy (CBT)
  • Mindfulness-Based Stress Reduction (MBSR)
  • Meditation
  • Exercise (Yoga)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

depression

A

NOT a normal part of aging

  • MOST common mental health problem of late life
  • one in ten older adults visiting a physician suffers from depression
  • Depression and illness are likely to co-occur
  • r/t medical conditions
  • Medication SE - ACEI, antidysrhythmic, antibiotics…
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

depression is associated with

A
  • Major source of morbidity in older adults
  • Increased disability
  • Delayed recovery from illness and surgery
  • Excessive use of health services
  • Cognitive impairment
  • Decreased quality of life
  • Increased suicide and non-suicide related death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

etiology of depression

A

Multifactorial

  • Health and chronic conditions (box 28.14, p 357)
  • Gender (female)
  • Developmental needs
  • Socioeconomics
  • Environment
  • Personality
  • Losses
  • Functional decline
  • Medications (box 28.16, p 357)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

presentation of depression in older adults

A
  • Comedic medical conditions strongly related to depression in older adults
  • More somatic complaints (physical symptoms)
  • Hypochondriasis (constant complaining and criticism)
  • Decreased energy and difficulties completing ADLs
  • Social withdrawal
  • Decreased libido
  • Preoccupation with death
  • Memory problems
  • *Strong association of depression with dementia
  • Risk factors for depression in older adults (box 28-16)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

depression assessment

A
  • geriatric depression scale (GDS), H&P, functional and cognitive assessment, medication review, lab analysis, comorbid conditions

(box 28.17, p 358)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

depression interventions

A
  • If GDS is positive, need further assessment
  • Treatment should begin promptly
  • Combination of pharmacologic therapy and psychotherapy (CBT) and counseling (BEST)
  • Music, dance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

medications for depression

A

SSRIs (fluoxetine, sertraline)
SNRIs - second line (venlafaxine)

  • Tailored to specific patient needs
  • Trials of alternate medications and psychotherapy required in many patients
  • ECT therapy

Avoided: tricyclics, older MAOIs (higher risk of falls)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

ECT therapy

A

Safe therapy for older adult patients at risk for harm due to suicidal ideation, psychotic depression, or severe malnutrition
- Efficacy rates ranging from 60-80%

depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

suicide and older adults

A
  • Older adults account for 15% of population but 20% of suicide deaths
  • Higher than any other age group
  • White and Native American men have the HIGHEST suicide rate in older adult population
  • Older widowers MOST vulnerable
  • Up to 75% of older adults who die from suicide visited physician within one month of death (routine depression screening important for all older adults)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

suicide assessment

A
  • ANY reference to ending life must be taken seriously
  • Establish trusting and respectful relationship
  • Behavioral cues (goodbyes, giving away possessions)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

suicidal interventions

A

If suicide risk suspected, as direct questions

  • Have you ever thought about killing yourself?
  • How often have you had these thoughts?
  • Do you have a plan to carry it out/How would you do it?

High risk patients need to be hospitalized

Moderate and low risk treated as outpatients

  • adequate social support
  • no access to lethal means
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

substance abuse in older adults

A

Alcohol

  • Often a coping mechanism in old age to deal with loss, anxiety, depression, chronic illness
  • Most severe abuse seen in ages 60-80

Gender Issues

  • Late onset alcohol abuse associated with illness, retirement, loss of spouse
  • White men 4x more likely to abuse alcohol
  • Number and impact of older female drinkers expected to increase

Drug effects
- Prescription and OTC medications have many adverse effects when combined with alcohol

Physiology

  • Age related changes in water and body fat cause higher blood alcohol levels
  • Liver and kidney function interferes with alcohol metabolism and excretion
  • Increased risk of GI bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

substance abuse assessment

A
  • Screening for alcohol and drug use

- Comorbid conditions may mask decline caused by alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

substance abuse interventions

A
  • Must address quality of life and adapt it to meet needs
  • Treatment focuses on cognitive and behavioral approaches
  • Screening for alcohol and drug abuse
  • Education and counseling about alcohol and prescription, OTC, and illicit drug use
  • Referral to specialist and community resources
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

acute alcohol withdrawal

A
  • Life threatening emergency

- Detoxification should be done in inpatient setting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

substance abuse concerns

A
  • Misuse of prescription and OTC medications
  • Polypharmacy effects exacerbated with alcohol use
  • Inappropriate prescribing and ineffective monitoring of controlled substances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

delirium

A

MEDICAL EMERGENCY

  • Cognitive changes in older people often labeled as confusion by providers and frequently accepted as a normal part of aging
  • Delay in treatment contributes to negative outcomes with delirium
  • Associated with increased length of stay, morbidity and mortality, institutionalization, and comorbid illnesses
  • Significant distress for patient and family

Assessment tool: CAM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

delirium incidence and prevalence

A
  • Occurs in older adults across the continuum of care
  • Among medical inpatients, delirium is present on admission to the hospital in 10-31% of older patients
  • During hospitalization, 11-42% of older adults develop delirium
  • Highest incidence is in ICUs and subacute settings
  • Prevalence of delirium in the community is low
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

delirium superimposed on dementia

A
  • Older patients with NCDs are 3-5x more likely to develop delirium
  • Delirium superimposed on NCDs can accelerate the trajectory of cognitive decline and is associated with a high mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

risk factors for delirium

A
  • Acute illness
  • Infections*
  • Medications
  • Invasive equipment
  • Metabolic disturbances
  • Dehydration*
  • box 29.2
  • Alcohol or drug abuse
  • Sensory impairments
  • Unrelieved pain
  • Surgery
  • Hip fracture
  • Cognitive impairment (hx of dementia)
  • Age

Early onset dementia (<60) is more related to genetic susceptibility (if their daily life is impaired, it’s more likely dementia, not delirium)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

mild cognitive impairment

A

Gradual onset with steady decline

In elderly, often seen as a normal part of aging
- Decline - Yes, “forgetfulness”
- Dementia - No
(represent serious pathological alterations)

Any mental status change in older adult warrants a comprehensive assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

dementia

A

IRREVERSIBLE state that progresses over years in decline of intellectual function

Clinical features include at least one of the following:

  • Aphasia
  • Apraxia
  • Agnosia
  • Disturbances in executive functioning (attention, decision making, consciousness, memory, problem solving)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

partial or total loss of the ability to articulate ideas or comprehend spoken or written language

A

aphasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

partial or total loss of the ability to perform coordinated movements or manipulate objects in the absence of motor or sensory impairment

A

apraxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

loss of the ability to interpret sensory stimuli, such as sounds or images

A

agnosia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Alzheimer’s disease (AD)

A

Most common form of dementia

Age 30-60 (early onset) - less than 5%
- Familial Alzheimer’s disease (FAD) - genetic

Age 60+ (late onset) - accounts for most cases

  • Not specifically genetic
  • Environmental factors, lifestyle, and genetic mutations

2/3 are women -> r/t “survivor bias”

6th leading cause of death and 3rd most expensive medical condition

Increased number of ß-amyloid proteins (plaques) outside the neuron and accumulation of tau proteins (tangles) inside the neuron

Starts where memories are stored
- Most recent memories lost first d/t issues learning/retaining information

Decrease the risks for neurodegenerative disorders (box 23.11)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

preclinical stage of Alzheimer’s disease

A

NO symptoms

  • Biological/neurological changes started
  • Amyloid building may be detectable with:
  • > PET scan
  • > CSF analysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Mild Cognitive Impairment (MCI) stage of Alzheimer’s disease

A

Noticeable changes in memory and thinking

  • Can be measured
  • May not yet effect day-to-day life
  • Difficulty managing money issues
  • Increased forgetfulness
    • > Appointments
    • > Social engagements
    • > Lose train of thought
  • Decision making becomes overwhelming
  • Trouble finding way around
  • Impulsive
  • Irritability/aggression
  • Anxiety
  • Apathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Alzheimer’s Dementia stage of Alzheimer’s disease

A

Multiple changes and deficits now present

Other cognitive aspects:

  • word finding
  • vision/spatial issues
  • impaired reasoning/judgment

At this stage, individuals may:

  • Require full-time assistance with ADLs
  • Lose awareness of experiences and surroundings
  • Have changes in physical abilities
    • > Walking, sitting, eating/swallowing
  • Have increased difficulty communicating
  • Become vulnerable to infections, especially pneumonia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Alzheimer’s disease diagnosis

A

Decline from previous level of functioning
- Documented exam

Onset was insidious
- Without being specifically apparent

Gradual regression in cognitive abilities
- Beyond what is expected of age and education

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

AD non-pharmacological interventions

A

More effective and improve quality of life

Activities, therapies, exercise, sensory stim, reminiscence, environmental design, staffing, lighting, relaxation, distraction, non-confrontational approaches

  • Person-centered care
  • Foster abilities
  • Support limitations
  • Ensure safety
  • Enhance QOL
  • Prevent disability
  • Maintain function
  • Structured environment
  • Promote relationships
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

AD pharmacological interventions

A

Aimed at slowing cognitive decline

First Line: Cholinesterase Inhibitors (CIs)

  • Acetylcholine -> memory and thinking
  • Donepezil (Aricept) -> all stages
  • Galantamine (Razadyne) & Rivastigmine (Exelon) -> mild to moderate decline

Other medications:

  • Memantine (Namenda) -> used in combination with CIs for learning and memory
  • Sleep aids
  • Antidepressants
  • Antipsychotics

Communication box 29.14
Precipitating factors box 29.17

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

AD behavior concerns

A 
Anxiety
Depression
Hallucinations
Delusions
Aggression
Screaming
Restlessness
Agitation
Resistance to care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Progressively Lowered Stress Threshold model (PLST)

box 29.16

A

Stressors that may trigger symptoms

  • Fatigue
  • Change in environment, routine, caregiver
  • Misleading or inappropriate stimuli
  • Demands to perform beyond abilities
  • Pain, illness, depression

Care

  • Structured to decrease stressors
  • Provide safe and predictable environment

Outcomes
- Improved sleep, less sedatives, better nutrition, socialization, decreased anxiety/agitation, care giver satisfaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Need-Driven Dementia-Compromised Behavior Model (NDB)

box 29.15

A

Behaviors have meaning and are attempted to communicate
- Interaction between background and proximal factors

Background
- Cognitive changes, gender, ethnicity, culture, education, personality, responses to stress

Proximal - physiologic needs
- Food, pain relief, mood, physical environment (light, noises)

Care

  • Manipulate proximal factors
  • Maximize strengths
  • Minimize limitations of background factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

AD nursing assessment

A

Behavior and psychological symptoms of dementia (BPSD)
- All behavior is meaningful and expression of need

First rule out medical problems

  • > infection, dehydration, pain, fractures, impaction
  • > GI/GU problems cause much distress

Consider psychosocial problems

  • > fear, discomfort, unfamiliar things, fatigue, depression, loss of control/autonomy, etc.
  • > May misinterpret stimuli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

AD nursing intervention care: Wandering

A

Wandering

  • Difficult problem to manage
  • Not well understood
  • Risk -> falls, elopement, injury, death

Things to do:

  • Music, exercise, refreshments, social interaction
  • Camouflage doorways, enclosed areas for walking, electronic bracelets

60% will wander and become lost at some point

wandering interventions/avoiding getting lost (box 29.25)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

AD nursing intervention care: Bathing

A

Can lead to distressing behaviors

Nursing Actions:

  • Explain actions
  • Don’t push
  • Positive feedback
  • Demonstration
  • Encourage self-care
  • box 29.23
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

AD nursing care: Nutrition

A

Older adults with dementia are particularly at risk for weight loss and inadequate nutrition

  • Patients need to be fed
  • Choke
  • Refuse food

Tube feeding at end-stage dementia

  • Not generally recommended (not shown to extend life or improve QOL)
  • Careful hand feeding -> as they want (box 29.27)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

AD care of patient: 4 nursing roles

A

Magician

  • See the world through their eyes
  • Use tricks to augment behavior

Detective
- Investigate clues r/t behaviors

Carpenter
- Tools to individualize care

Jester

  • Use humor
  • Spread joy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

dementia in rural settings

A

Rates of dementia:
Rural - 5.1%
Urban - 4.4%

Lack of HCPs in rural areas

  • Neurologist and/or psychiatrists rarely in rural areas
  • Primary care may be the only option (often limited access)
Virtual/telehealth
Home health services
Rural community engagement and collaboration
Transportation assistance
Access to day services and respite care
74
Q

most important capacity in humans

A

Communication

- inability to communicate is dehumanizing (need)

75
Q

meaningful communication and engagement

A
  • Precipitates healthy aging
  • Prolongs lifespan
  • Better response to medical interventions

development of therapeutic relationships between nurse and older person

76
Q

elderspeak

A

assume all older people can’t hear, understand, or comprehend

77
Q

elderspeak may be characterized by

A
  • Simplistic vocabulary and grammar
  • Shortened sentences
  • Slowed speech
  • Elevated pitch and volume
  • Inappropriate terms of endearment
  • Speaking as if person is not there
  • Using familiar/informal communication without permission
  • Using the royal “we”
78
Q

why do we use elderspeak?

A 
Tradition
Modeling by others
Unawareness
Intent to control
Insensitivity
79
Q

effects of elderspeak

A

Decreased self-esteem
Depression, withdrawal
Assumption of dependent behaviors

80
Q

therapeutic communication with older adults

A

Give more time/Silence
- must sort through any years of memories to answer

Closed ended

  • to get specific answer
  • may feel put on the spot

Open ended

  • allow for client elaboration
  • not sure what you are asking/want to please

Proper body positioning
Seek clarification
Pay attention to non-verbal communication

81
Q

communication and neurological disorders

A

Major communication issues related to neurological

Reception

  • Anxiety
  • Hearing deficits
  • Changes in cognition

Perception

  • Dementia
  • Delirium

Articulation

  • Mechanical difficulties
  • Respiratory disease
  • Larynx disorders
82
Q

difficult word retrieval

A

anomia

83
Q

impairment in processing language (ability to speak and/or understand)

A

aphasia

  • Intelligence not affected
  • Damage to brain (CVA or head trauma)
84
Q

impaired ability to articulate speech

A

dysarthria

  • damage to neurological system
  • weakness of speech muscles

Causes:

  • injury to brain
  • CVA, head injury, brain tumor, Parkinson’s, MS

Care:
- collaboration with SLPs for speech therapy

85
Q

dysarthria CMs

A
  • Have “slurred” or “mumbled” speech that can be hard to understand
  • Speak slowly
  • Talk too fast
  • Speak softly
  • Not be able to move tongue, lips, and jaw very well
  • Sound robotic or choppy
86
Q

hearing impairment

A
  • Worst to lose (as described by older people)
  • Most common communication disorder
  • 3rd most common chronic condition in older adults
  • Men more affected
  • Underdiagnosed and undertreated
  • QOL diminished
    • > Decreased function
    • > Miscommunication
    • > Low self-esteem
    • > Depression
    • > Cognitive decline
  • Screening (usually not done)
  • Medicare doesn’t pay for hearing aids
  • Medicare does pay for diagnostic hearing testing
87
Q

sensorineural hearing loss

A

Damage to inner ear or neural pathways

  • Presbycusis (type of sensorineural r/t aging)
    • > Most common
    • > Bilateral
  • Intolerant to loud noises
  • Difficulty in distinguishing between consonants (Z, S, Sh, F, P, K, T, G)
  • Raised voices often exacerbate the problem
  • High frequency sounds lost first
  • Difficulty filtering background noises (healthcare setting often noisy)

Treatment:

  • Hearing aids
  • Cochlear implants
88
Q

conductive hearing loss

A

Vibrations can’t get to the tympanic membrane or TM impaired

Causes:

  • Infection, otosclerosis, perforated TM, fluid in middle ear
  • Cerumen impaction common cause

Treatment:

  • Eliminate underlying cause
  • Review cerumen removal procedure, box 12.2
89
Q

tinnitus

A

Abnormal sounds

  • Constant or intermittent
  • Worsens with age
  • Ringing, humming, buzzing, roaring, hissing, etc.

Risk factors:

  • Presbycusis
  • Loud noises
  • Head and neck trauma
  • Tumors
  • Cerumen impaction
  • CV disease
  • Ototoxic meds
  • Meds SEs
  • ASA common
90
Q

vision impairment

A
  • 2/3 with impairment >65
  • Among the top 10 causes of disability in the US
  • Lower quality of life and life expectancy
  • Low vision to to legal-blindness
    • > 20/40 to 20/200
    • > how nurses screen vision?

Leading causes:

  • Age-related macular degeneration
  • Cataract
  • Glaucoma
  • Diabetic retinopathy
  • Optic nerve atrophy
91
Q

vision impairment major implications

A
  • Affects nearly all ADLs
  • Increase risk of falls
  • Increase risk of cognitive decline
  • Presbyopia
  • Age related vision changes
  • Lens loses elasticity
  • Difficulty focusing on near objects
  • Readers, bifocals
92
Q

leading cause of blindness

A

glaucoma

93
Q

glaucoma

A

Leading cause of blindness

Open and Closed angle

  • Angle controls outflow
  • Open angle most common and non-acute
94
Q

glaucoma pathophysiology

A

Increase in intraocular pressure (IOP)

imbalance between inflow and outflow of aqueous humor -> pressure increases -> vision impaired -> possible blindness if not treated

95
Q

glaucoma manifestations

A

Initially none

  • Reduced peripheral vision
  • Tunnel vision
  • Blurred vision
  • Halos around lights
  • Eye or brow pain
96
Q

glaucoma diagnostics

A
  • Vision exam
  • Tonometry (tests IOP)
  • Other advanced exams
97
Q

glaucoma treatment

A

Reduce IOP

Surgery

  • Argon laser trabeculoplasty (ALT)
  • Opens outflow channels

Medications

  • PO or eye drops (nursing considerations)
  • Lower IOP by increasing drainage of AH or reducing AH production
  • BETA BLOCKER drops are first line treatment
98
Q

glaucoma nursing care

A

Prevention

  • Yearly eye exam for 65 and older
  • Report any eye s/sx immediately
  • African American at higher risk (yearly exams younger)

Intervention

  • Eye provider follow up
  • Ongoing questions and vision testing
  • Care surrounding medication management
99
Q

cataracts

A

Oxidative damage to lens (protein and fat deposits)

  • By age 80, more than half have a cataract
  • Usually bilateral
100
Q

cataracts manifestations

A
  • Clouding of lens
  • Absent red reflex or appear black
  • Appearance of halos around objects
  • Blurred vision
  • Yellow tint to vision
  • Sensitivity to glare
101
Q

cataracts diagnosis

A
  • Eye exam

- History

102
Q

cataracts treatment

A

Surgical replacement of lens (plastic)

  • When vision 20/50 or worse
  • QOL or safety an issue
  • Outpatient
  • One eye at a time

Nursing care peri-op

  • Prepare for changes in vision post-op
  • Avoid heavy lifting, straining, and bending
  • Eye drops
  • Eye shield
103
Q

leading cause of vision loss in 60 and over

A

age-related macular degeneration

104
Q

age-related macular degeneration

A

Leading cause of vision loss in 60 and over

Dry (non-exudative) = 90% of cases

Wet (exudative) = more severe

105
Q

risk factors for age-related macular degeneration

A
  • UV light
  • Cigarette smoking
  • Light colored eyes
106
Q

age-related macular degeneration pathophysiology

A

drusen deposits in retinal epithelium -> atrophy and degeneration of macular cells -> vision impairment

107
Q

age-related macular degeneration manifestations and diagnosis

A
  • Blurred and dark vision
  • Scotomas (blind spots)
  • Metamorphopsia (vision distortion)

Diagnosis:

  • Drusen seen on opthalmascopy
  • Fundus photography
  • IV angiography and fluorescein
108
Q

age-related macular degeneration nursing care

A

Promotion

  • After age 40 = dilated eye exam q2yr
  • After age 60 = eye exam yearly

Supplements/diet

  • Vit C&E, beta-carotene, zinc
  • Dark green leafy vegetables
  • Smoking cessation
  • Management of HTN and DM
  • Sunglasses
  • Hats
  • Safety eye wear
  • Interventions to utilize remaining vision (vision won’t return)
109
Q

interventions to enhance vision (age-related macular degeneration)

A

Use contrasting colors

  • Black and white
  • Reds and oranges easiest to see

Assistive devices

  • Image magnification
  • Text-to-speech scanners
  • Tablets

General

  • Closer to objects
  • Large type
110
Q

touch in older adults

A
  • 10x stronger than verbal or emotional contact
  • Most neglected of the senses

Response to touch:

  • Procedural vs. non-procedural touch
  • Boundaries of touch is often cultural
  • Don’t assume one wants to be touched
  • A handshake (if appropriate) gives a lot of info (firm or soft, fast or hold on, warm or cold, sweaty or dry)

Fear of touching:

  • Social status
  • Condescending touch (pat on the head, squeezing the toes)
111
Q

touch deprivation in older adults

A
  • Desire for touch more powerful in old age
  • Cause of illness may be greatly influenced by quality of tactile support received
  • Higher death rates are more closely related to quality of human relationships than to degree of cleanliness, nutrition, physical disabilities on which we focus
112
Q

intimacy and sexuality in older adults

A

Expectations

  • Cultural, biological, psychosocial, environmental factors influence sexual behavior of older adults
  • Factors affecting attitudes on intimacy and sexuality include family dynamics and upbringing, cultural and religious beliefs
  • Myths about sex and older women (box 33.1)

Redefinitions in older adulthood

  • Sexuality in older person not about procreation
  • Emphasis shifts to
    • > companionship
    • > physical nearness
    • > intimate communication
  • Era in which a person was born influences attitudes about sexuality
    • > current older people often uncomfortable talking about sex/sexuality
    • > baby boomers more open
113
Q

LGBTQ+ and older adulthood

A
  • Less likely to seek out health services
  • Less likely to identify themselves as LGBT to HCP
  • Often have differing or augmented healthcare needs
  • Older LGBT more likely to have kept their relationship hidden than younger people
  • National Gay and Lesbian Task Force Aging Initiative estimates about 3million Americans over 65 are LGBT, likely to double by 2030
  • May face real or perceived discrimination in senior centers or long-term care facilities

Assessment of need include use of strategic questions to obtain health history

  • “Do you have a romantic partner?”
  • “How do you identify with regard to your sexuality?”
  • Don’t assume heterosexuality
114
Q

biological changes with aging: women

A
  • Menopause
  • Dyspareunia (painful intercourse) from vaginal dryness and thinning of the vaginal tissue

Female dysfunction

  • Considered persistent impediment to person’s normal pattern of sexual interest, response, or both
  • Influenced by culture, ethnicity, emotional state, age, previous sexual experiences, as well as changes in sexual response with normal aging

Causes of female dysfunction

  • Physiologic changes (menopause/hormonal changes)
  • Water soluble lubricants, low-dose estrogens introduced into the vagina may also help restore tissues and lubrication

Chronic illnesses and related treatments may bring many challenges to intimacy and sexual activities (table 33.2)

115
Q

biological changes with aging: men

A
  • Erectile dysfunction
  • Refractory period extended between episodes of intercourse

Male dysfunction

  • Impotence (ED)
  • For most older men, caused by underlying medical diagnosis and/or the treatment
    • > Endocrine problems
    • > CV problems
    • > Depression
    • > Neurological problems
  • Phosphodiesterase inhibitors such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) (risk for drug interactions

Chronic illnesses and related treatments may bring many challenges to intimacy and sexual activities (table 33.2)

116
Q

factors affecting intimacy and sexuality in long-term care

A

Environmental factors

  • Lack of privacy
  • Absence of suitable partner
  • Family and staff attitudes
  • Dementia
117
Q

STDs and older adults

A

On the rise

HIV

  • Many symptoms mimic other disease conditions
  • Virus may be in late stages by time of diagnosis
  • Medicare in 2010 began covering HIV screening for high-risk individuals
  • All adults should have an HIV test at least once
  • Educational materials need to be developed for older adults
118
Q

PLISSIT Model

A

guide for discussion of sexuality in older adults

Permission
Limited Information
Specific Suggestions
Intensive Therapy

box 33.8

119
Q

nursing responsibilities to enhance healthy intimacy and sexuality in older adults

A
  • Educator
  • Facilitator
  • Consultant
  • Counselor
  • Advocate
  • Assessment of any medical conditions or medications associated with poor sexual health
  • Counseling for older adult to adapt to natural physiological changes or body-image alterations from surgical procedures
120
Q

retirement and older adults

A
  • Retirement no longer just a few years of rest from rigors of work before death - it is a developmental stage that may occupy 30 years
  • US retirement depends on the “three-legged stool”
    • > social security benefits
    • > savings
    • > private pension
  • Now more often a “one-legged stool”
121
Q

retirement planning

A
  • Retirement preparation programs are usually aimed at employees with high levels of education and occupational status, those with private pension coverage, and government employees
  • Retirement planning often lower priority
  • Retirement planning is advisable during early adulthood
  • Successful retirement depends on multiple factors (box 34.1)
122
Q

retirement nursing interventions

A

Interventions that demonstrate effective care for an individual who has expressed a wish to retire

  • Asking about when they plan to retire
  • Assessing their ability to handle the stresses of retirement
  • Engaging them in conversation about their interest
  • Inquiring about the existence of any chronic illness
  • Scheduling a full physical exam
123
Q

social security

A
  • Established in 1935 - during the Great Depression
  • Set up as an “age-entitlement” program under President Franklin D Roosevelt
  • Funded by payroll taxes - employees & employers contribute

Amount of benefit calculation
- Average salary during 35 of working years

Current full benefit is 65-67y/o (have to wait to 70 to get the max amount)
- May start at 62y/o at reduced benefit amount (25% reduction)

May earn up to $18,960/yr from employment if under full retirement age

  • Will lose $1 of annual benefit for every $2 earned
  • Unlimited income if over full retirement age (up to max benefit)

“Credits” 40 - box 30.2

124
Q

other income later in life

A

Supplemental Security Income (SSI)

  • Provides for minimum level of economic support to persons 65+, blind or disabled regardless of earning power in early life or when capable of working
  • SSI either provides “total support” or supplements a low Social Security benefit (box 30.3)
  • May come from private retirement investments or employer pensions

In the US, healthcare has always been a purchased service, not a right

Federal government provides majority of care via its insurance plans

  • Medicare - an insurance plan for persons age 65, blind or totally disabled, including persons with ESRD
  • Railroad Medicare
  • Medicaid
  • TRICARE for lide - medigap for Medicare-eligible Vets
  • Veterans Administration - now need must be service related
125
Q

Medicare

A
  • Specifically designed to provide almost universal health care for those who are eligible for Social Security
  • As soon as one is 65, they are automatically enrolled in Medicare Part A
    • > Medicare Parts B, C, D are selected on personal preference and availability
  • “Wellness visits” are available every 12 months after the initial exam (box 30.6)
  • CMS nurse
126
Q

Medicare Part A

A

a hospital insurance plan covering:

  • acute care
  • short-term rehab in a skilled nursing facility or at home
  • most costs associated with hospice care

box 30.7

127
Q

Medicare Part B

A

Based in part on income reported to the IRS

  • Provides insurance coverage for many services provided on an outpatient basis, such as visits to providers (box 30.8)
  • Choice of PCP and referrals not usually necessary
  • Providers who “accept assignment” agree to charge only the “allowable” fee that Medicare determines
  • A provider that does not accept assignment may charge the patient 15% above the allowable charge
128
Q

Medicare Part C

A

Referred to as Medicare advantage plans

  • Uses a prospective payment system to include traditional health maintenance organization and other managed plan
  • All traditional services covered by Medicare Parts A & B must be provided, and additional services, copays, and deductibles are predetermined
  • No care is obtained without a referral from the assigned PCP
129
Q

Medicare Part D

A

The Medicare Modernization Act of 2003 established s prescription drug benefit for eligible recipients of Medicare (box 30.9)

  • It is an elective prescription drug plan with associated out-of-pocket premiums and co-payments
  • All persons with Medicare, except those in MAP-PD programs, are eligible to voluntarily purchase a PDP
    • > However, if one chooses to do so, the same rules and timing related to enrollment and incurring of penalties seen in Medicare B apply
130
Q

supplemental insurance/Medigap policies

A
  • Because of potentially high deductibles and co-payments, people who are able to often purchase supplemental insurance plans
  • Medigap plans serve as a secondary insurance
  • Cover only deductibles and part of coinsurance amounts based on Medicare
    • > Approved amounts contracted with provider
131
Q

Medicaid

A

Covers the cost of health services for low-income children, pregnant women, those who are permanently disabled, and persons age 65 and older who meet the States eligibility criteria

  • The majority of Medicaid funds are used to provide long-term nursing home care for older or disabled adults
  • “Spousal Impoverishment” limit of 1/2 of joint funds per spouse for use of eligibility determination and reimbursement
132
Q

costs of long term care

A

Medicaid

  • Primary payer for LTC services
  • There are large differences across states

Medicare

  • Would not cover unless there was some skilled need
  • Many rules to being eligible for coverage

Private LTC insurance

  • Relatively few people have purchased this insurance
  • Need to be aware of the exclusions in these policies before purchasing

Out-of-pocket spending
- Accounts for about 17% of national spending LTC

133
Q

LTC and the US healthcare system

A
  • In the US, the LTC system is complex, fragmented, isolated from other service providers, poorly funded, and confusing and difficult for the individual and the caregiver to negotiate
  • There is no comprehensive approach to care coordination and as a results, services and supports may not be provided in the most appropriate setting and by the most appropriate provider
  • Focus of acute care and LTC (box 32.2)
  • Goal of LTC (box 32.3)
134
Q

typical resident of LTC facility

A
  • Women >80yrs
  • Widowed
  • Dependent in ADLs and IADLs
  • If 85y/o -> 1 in 2 chance of spending some time in NH
135
Q

selecting a nursing home (box 32.13)

A
  • Central focus
  • Interaction
  • Milieu (“feel” of the environment)
  • Environment
  • Individualized care
  • Staff
  • Safety
136
Q

where to find & compare LTC options

A
  • MDS (minimum data set)
  • QAPI (quality assurance performance improvement)
  • Nursing Home Compare (5-star)
  • Advancing Excellence in America’s Nursing Homes
  • INTERACT (interventions to reduce acute care transfers)
137
Q

community care

A

Program for All-Inclusive Care for the Elderly (PACE)

  • Medicaid and Medicare program that provides community services to people 55 or older who would otherwise need a nursing home level of care
  • Participants must meet the criteria for nursing home admission, prefer to remain in the community and be eligible for Medicare and Medicaid
  • National PACE Association (box 32.6)

Adult Day Services (ADS)
- Community-based group programs designed to provide social and some health services to adults who need supervised care in a safe setting during the day

Continuing Care Retirement Communities (CCRCs)
- Provide full range of residential options, from single family homes to skilled nursing facilities (SNFs) all in one location

Residential care/Assisted living (RC/AL)

  • Provides housing and services to older adults in the US
  • Many older adults would move to an assisted living community if they could no longer care for themselves
  • Not covered by Medicare

Assisted living (AL)

  • Popular type of RC/AL
  • Profile of a resident living in assisted living (box 32.7)
  • With the growing numbers of older adults with dementia residing in AL, many are establishing dementia-specific units

Less disruptive if you age in place
Chronic care is paid by medicaid

138
Q

SNFs (Nursing Homes)

A

Delivery of around the clock care for those needing specialized care

Characteristics:

  • Often includes up to two levels of care: skilled nursing care (subacute) and chronic care (long term, custodial)
  • Approximately 16,000 certified nursing homes in the US 1.7million beds
  • The majority of nursing homes are for-profit organizations

Subacute care (short term)

  • More intensive and more costly
  • Most frequent site of post-acute care
  • Length of stay usually no more than 1-3 months
Chronic care (long term)
- May not need intensive care, but still need ongoing 24hr care
139
Q

professional nursing in LTC

A
  • More RN direct-care time per resident in nursing facilities is associated with few pressure ulcers, fewer hospitalizations, fewer UTIs, less weight loss, fewer catheterizations, and less deterioration in the ability to perform ADLs
  • Nurses plat a key role in improving quality of care in nursing homes through EBP and leadership in quality improvement initiatives
  • The need for expert nursing is the most essential service provided

Nursing Assistants
- Provide the majority of direct care in nursing homes and significantly contribute to the quality of life for residents

140
Q

Resident Bill of Rights

A
  • Residents in LTC facilities have rights under both federal and state law
    (box 32.11 - on exam)
  • LTC Osbudsman Program is a nationwide effort to support the rights of both the residents and the facilities
  • Each facility is required to post the name and contact information of the ombudsman assigned to the facility
141
Q

improving quality of transitional care in nursing homes

A
  • Providing a seamless continuum of care through improved coordination of acute care, post-acute care, and long-term care services and better management of transitions between care settings are essential in health care today to address both cost and quality issues
  • Interventions to Reduce Acute Care Transfers (INTERACT) is an exemplary program for reducing frequency of transfers to the acute hospital from nursing homes
142
Q

the cultural change movement (LTC)

A
  • The ultimate vision of culture change is to improve the lives of residents and staff by centering facilities’ philosophies, organizational structures, environmental design, and care around practices that support resident’s needs and preferences
  • Institution-centered vs person-centered culture (box 32.14)
  • Principles of culture change (box 32.15)
  • Nursing home culture change competencies for nurses (box 32.16)
143
Q

decision making

A

Self-determination (autonomy) is documented or expressed through what we refer to as informed consent, and in most circumstances is implied when a person accepts or cooperates with care

  • More complex consent is needed under certain circumstances (box 31.1)
  • Informed consent is only possible with the assumption that adults have decision-making capacity (a person can understand a problem, the risks and benefits of a decision, the alternative options, and the consequences of the decision)
144
Q

advanced care planning

A

Power of Attorney

  • Legally appointed to act on behalf of another in ways specifically indicated in a legal document
  • DPOA-HC -> Durable POA for health care continues after person can no longer speak for themselves

Healthcare Proxy
- Authority to act on a person’s behalf when he or she has lost the capacity to male decisions and has not documented what they want (box 31.4 - hierarchy of appointments)

Guardians & Conservators
- Individual, agencies, or corporations appointed to take care, custody, and control of an incapacitated person and assure needs are met (box 31.6)

What is the nurses responsibility?

  • Dealing with potential questions of the right to decision-making (box 31.15)
  • Do not attempt to provide legal advice, but instead refer to an elder law attorney
145
Q

caregiver needs (box 34.9, p 463) (hospice)

A
  • Time for oneself
  • Keeping person safe
  • Balancing other responsibilities
  • Physically moving the person
  • Managing medical/medication regimens
  • Recreation

Goals and best nursing practice

  • Education
  • Support
  • Resources
  • Coaching
  • Following up
146
Q

types of abuse of older adults (box 31.10)

A
  • Physical abuse
  • Psychological abuse
  • Medical abuse
  • Financial abuse
  • Confinement
  • Sexual abuse

Factors affecting identification of abuse (box 31.11)
Cultural variation abuse/neglect (box 31.12)

147
Q

elder abuse

A
  • Complex phenomenon
  • All socioeconomic, racial, and ethnic groups
  • Can be intentional, accidental, episodic, or recurrent
  • Elder abuse is reportable by law

Most abuse…

  • Occurs in home
  • Spouses or adult children
  • Majority of documented cases are white elders (84%)
148
Q

risk for abuse (box 31.8)

A
  • Women
  • Single
  • Cognitive impairment/dementia
  • Dependent on caregiver
  • Incontinent
  • Frail or mental disability
  • Previous abuser of the caregiver
  • Institutional setting
149
Q

impact of abuse

A
  • Posttraumatic syndrome and lowered self-efficacy, even after the move away from abusive situation, may never be resolved
  • Those subjected to even minimal abuse have been found to have a 300% higher risk for death
  • Older adults who have been victims of violence have more health problems, including bone or joint problems, digestive problems, depression or anxiety, chronic pain, hypertension, and CV disease
150
Q

signs of abuse

A

Wrap around bruises (box 31.16)

  • Accidental bruises don’t form a wrapped appearance
  • A bruise that wraps the wrist, arms, neck, or ankle may indicate force
  • Look for thumb pad on one side and finger pads on the other

Linear bruising

  • Accidental bruising doesn’t follow a linear pattern
  • Striking with an object can cause linear bruising
  • May be seen on back, buttocks, thighs, or arms
151
Q

abuse nursing interventions

A

Evidence collection

  • Observe for obvious bruises or body marks
  • Observe and ask about medications
  • Look for sign of restraints
  • Note for body odor, dirty clothing or body, or other signs of neglect
  • Observe for pressure ulcers, dehydration, or malnutrition
  • Photograph injuries and general conditions (follow facility policy)

Prevent abuse from continuing

  • Licensed nurses are considered mandatory reporters (required to report suspicions of elder abuse to Adult Protective Services)
  • Reasonable belief that a vulnerable person has, is, or likely to be abused, neglected or exploited
152
Q

mandatory reporting

A
  • In most states and US jurisdictions, licensed nurses are “mandatory reporters” and are required to report suspicions of abuse to the authorities
  • In each state, ombudsman are either volunteers or paid staff members who are responsible for active as advocates for vulnerable residents in institutions
153
Q

preventing elder abuse (box 31.18)

A

Gerontological nurses should be alert to potential mistreatment of vulnerable elders and take steps to prevent the occurrence of abuse or neglect

  • Educate professionals and public
  • Support systems and groups
  • Stress management
  • Care resources
  • Counseling and caregiver self-care
  • Respite care and home health
  • Resources for meals and transportation
154
Q

undue influence

A

A means of financial or maternal exploitation

  • Undue influence may occur in an insidious way if the perpetrator isolates the victim from family and friends
  • If a person provides false affection and even marriage to a lonely person for the purpose of defrauding him or her of assets
  • Signs (box 31.13)
155
Q

neglect

A

Results from failure of action by caregiver or through one’s own behavior choices

Neglect by caregiver
- Requires a socially (formal/informal) recognized role and responsibility of one to provide care to a vulnerable other (box 31.14)

Self-Neglect
- People fail to meet their own basic needs in the manner in which the average person would in similar circumstances

156
Q

advocacy

A

An advocate is one who maintains or promotes a cause; defends, pleads, or acts on behalf of another; and fights for someone who cannot fight for themself

Nurse advocates function in various arenas:

  • With their own discipline and other disciplines within their own agencies
  • With other agencies, physicians, and families
  • With neighbors and community representatives
  • With professional organizations, legislators, and the courts
157
Q

spirituality and religion

A

Religious beliefs and church participation are often avenues of spiritual expression, but are not necessarily interchangeable

Religion = organized social institution
Spirituality = broader concept that embraces one's values/belief system
158
Q

elders at risk for spiritual distress

A

Individuals experiencing events or conditions that affect ability to participate in spiritual rituals

Diagnosis and treatment of a life-threatening, chronic, or terminal illness

Expressions of interpersonal or emotional suffering, loss of hope, lack of meaning, need to find meaning in suffering

  • Does your religion/spirituality provide comfort or stress?
  • Do you have religious or spiritual beliefs that might conflict with health care or affect health care decisions?
  • Do you belong to a supportive congregation or faith community?
  • Do you have any practices or rituals that help you express your spiritual or religious beliefs?
  • Do you have spiritual needs you would like someone to address?
  • How can we help you with your spiritual needs or concerns?
159
Q

spiritual nursing response

A
  • Promote physical comfort
  • Provide psychosocial comfort
  • Provide spiritual comfort

Personal reflection

  • What do I believe in?
  • How do I find purpose and meaning in my life?
  • How do I take care of my physical, emotional, and spiritual needs?
160
Q

hope promoting activities

A
  • Feel warmth of the sun
  • Share experiences children are having
  • See crystal blue of sky
  • Enjoy garden or fresh flowers
  • Savor richness of black coffee
  • Feel tartness of grapefruit to wake up tastebuds
  • Listen to symphony
  • Watch activities of animal in tree outside
  • Benefit from each social encounter
  • Write messages to grandchildren/family
  • Study favorite painting
  • Build highlights into each day (meals, visits, religious reading)
  • Keep journal
  • Write letters
  • Make tape recording of life story
  • Have hope objects or symbols nearby
  • Share hope stories
  • Focus on abilities, strengths, past accomplishments
  • Encourage decision making about daily activities to foster sense of control
  • Extend care and love to others
  • Appreciate expressions of caring concern
  • Renew loving relationships
161
Q

legacies

A

One’s tangible and intangible assets transferred to another

  • Purpose of legacies is to supersede death
  • Older people must be encouraged to identify that which they would like to leave and who they wish recipients to be

Autobiographies and life histories

  • Creating life history
  • Creating self through journaling

Collective legacies
- Generational accomplishments

Legacies expressed through others

  • Mentorship
  • Organ donation

Living legacies - donate body to science
- Transcend death

Property and assets - plan estates

Knowledge - we build on thoughts and works of other

Personal possessions - tender experiences that provides memories and meaning

Examples of legacies
	Oral histories
	Recipes 
	Autobiographies
	Shared memories
	Taught skills
	Works of art, music
	Publications
	Endowments
	Objects of significance
	Written histories
	Tangible or intangible assets
	Personal characteristics such as courage or integrity
	Bestowed talents
	Traditions and myths perpetuated
	Philanthropical causes
	Progeny children and grandchildren
162
Q

loss

A

Loss, dying, and death are universal, incontestable events of the human experience

  • Loss of any kind has the potential to trigger grief and mourning
  • In later life one loss and its accompanying grief is often superimposed on others
163
Q

loss response model

A

In the Loss Response Model, grievers are viewed as part of a system that is striving to maintain equilibrium or stability

  • Person/Family/Grievers are a system
  • Loss creates chaos and disequilibrium
  • System must restore equilibrium

Step 1:

  • Make sense of the loss
  • Search for meaning (why did this happen to me/us?)
  • Why wasn’t it me?

Step 2:

  • Integration and acceptance of the loss
  • Emotions stabilized or channeled
  • Others step in ready to assume roles of one lost

Step 3:

  • System redefines itself
  • Reframing memories
  • Things may be different, but that is accepted
164
Q

five stages of grief

A
  1. Denial
    - Shock (will wear off eventually)
  2. Anger
  3. Bargaining
    - Guilt
  4. Depression
  5. Acceptance
  • May be in any order
  • May repeat or happen simultaneously
  • Multiple stages may be experienced at once
165
Q

the response to a real or perceived loss before it occurs

A

anticipatory grief

166
Q

a crisis of grief symptoms that occur in waves of varying lengths during the period of impact

A

acute grief

167
Q

memories have been “reframed”; moments of intermittent sadness

A

shadow grief

168
Q
  • the “shadows” are debilitating
  • the memories are not “reframed”, but are experienced as if recent
  • strong feelings such as guilt or anger impede the grieving process until resolved
A

complicated grief

169
Q

the grief is stigmatized, socially unacceptable, or unsupported

A

disenfranchised grief

170
Q

grief work

A

Factors affecting the ability to cope with loss and grief (box 35.2)

  • Physical
  • Emotional
  • Social

Identifying those with better coping skills (box 35.3)

“Good Copers” acknowledge the loss and try to make sense of it

Talking with people experiencing grief:

  • “I know how you feel”
  • “Your loved one is not sick anymore/is in a better place”
  • Invalidating feelings, making it about you
171
Q

grieving interventions

A
  • Helping grievers move through the impact of loss to the reestablishment of new memories (box 35.6)
  • Impact and functional disruption
  • Searching for meaning, engaging emotions, and informing others
  • Adaptation
  • Memories reframed and the return to equilibrium and a new steady state
172
Q

loss of spouse or partner

A

One of the most difficult life losses (second to loss of child)

Spousal bereavement

  • greater in women than men (??)
  • Men tend to remarry sooner and more often than women
    • > loneliness, need to be cared for
    • > high suicide risk on widowers
  • 73% women over 85 widowed
  • 35% men over 85 widowed

Whole person effects
- physical, psychological, social, practical, and economic

  • Adjusting to loss 2-4 years
  • Support
  • Offer self
  • Caring
  • Nursing interventions
  • Assessment of grief stages and progress
  • MI and stroke risk increase in month after partner loss
  • Mental health
  • Suicide risk
  • Grief
173
Q

nurse’s role in loss and grieving

A
  • Nurses are on the front lines during loss and death
  • Must be able to respond properly to loss, dying, death, and grief
  • Patient-centered care during death/dying
  • Care behaviors should be exhibited (table 35.14)
  • S/S in terminal phase of dying (table 35.1)
  • A good death (box 35.9)
174
Q

six needs of the dying (6 Cs approach)

A
  1. Care:
    - Free from pain - ATC (all types), listening, constant and ongoing support
  2. Control:
    - Collaboration with patient (dignity)
  3. Composure:
    - Moments of relief
  4. Communication:
    - Closed awareness, suspected awareness, mutual pretense, and open awareness
    - Verbal, physical, tactile, sight
    - Information, decisions, relaying to others
  5. Continuity:
    - Preserving as normal a life as possible while dying
  6. Closure:
    - “resolution” of end of life (very individualized)
175
Q

promoting a good death

A

Spirituality
- The spiritual dimension of persons who are dying deals with the transcendental or existential relationship between the dying person and another - between the person and their god or the person and significant others

Hope
- As death approaches, the hope may be for a good death, one that is symptom free

Promoting equilibrium for the family
- Nursing interventions that promote health at the time of loss include actions that empower the family to cope with the death, in a manner consistent with their traditions

176
Q

palliative care

A

is an approach to care which improves the quality of life of patients and their families facing life-threatening illness, through prevention, assessment, and treatment of pain and other physical, psychological, and spiritual problems

177
Q

hospice care

A
  • “Expectation” of 6 or less months of life
  • Comfort
  • Dignity
  • Support the caregiver
178
Q

nursing actions families report as helpful

A
  • keep them informed
  • ask how they are doing and offer support
  • put their arm around them when they cried
  • brought them food
  • knew their name
  • cried with them
  • brought them a bed and encouraged
  • told me to hold his hand
  • got the chaplain for me
  • let me take care of my husband
179
Q

the silver hour

A

The Silver Hour model focuses exclusively on the care given between the time that death is “first recognized” as an imminent possibility and until the patient leaves the site of death for burial

Three phases of The Silver Hours

  1. Dying
    - recognition that death is immanent
    - goals
    - ensure patient and family understands that death will occur
    - allow family as much access to dying patient as possible
    - promote shared decision making
    - transition from life-saving care to comfort care (this is a late time to start)
  2. Death
    - declaration of death (brain or bodily death)
    - goals
    - available for support
    - facilitate grieving
    - follow wishes r/t death rituals
    - allow family to say goodbye
  3. Dead
    - the body released to the next care provider (funeral home, morgue, etc.)
    - goals
    - discharge procedures
    - maintenance of family/patient wishes
    - make sure family knows how to contact funeral home/morgue
    - walk family to elevator, door, car, etc.
    - need for info and support after death is very important
    - what questions might a family ask the day after death?
180
Q

sedation at end of life

A
  • Physician assisted suicide illegal in most states
  • Sedation for/treatment of symptoms is appropriate and managed by nurses

Palliative sedation

  • Giving sedation and pain medication
  • Give as much as needed (even if it does speed death)
  • Death is not the goal – comfort is the goal
181
Q

geriatric orphans

A
  • Those without family support during the dying process
  • “No one dies alone” campaign (1986)
  • Seek out an opportunity to be with someone when they die
182
Q

hierarchy of dying person’s needs

A

(top to bottom)

  1. Biological & Physiological Integrity
    - to obtain relief from physical symptoms
    - to conserve energy
    - to be free from pain
  2. Safety & Security
    - to be given the opportunity to voice hidden fears
    - to trust those who care for him or her
    - to feel that they are being told the truth
    - to be secure
  3. Belonging & Attachment
    - to talk
    - to be listened to with understanding
    - to be loved and to share love
    - to be with a caring person when dying
  4. Self-Esteem & Self-Efficacy
    - to maintain respect in the face of increasing weakness
    - to maintain independence
    - to feel like a normal person, a part of life right to the end
    - to preserve personal identity
  5. Self-Actualization & Transcendence
    - to share and come to terms with the unavoidable future
    - to perceive meaning in death

Gero (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions