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Gero > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

What is anomia?

A

Difficult word retrieval

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2
Q

What is aphasia?

A

Impairment in processing language
* Ability to speak and/or understand
* Intelligence not affected
* Damage to brain
* CVA or head trauma
* Often left side

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3
Q

What is dysarthia?

A
  • Impaired ability to articulate speech
  • Damage to neurological system
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4
Q

How many ppl age 65 and over have vision impairment?

A

2/3

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5
Q

Leading causes of vision impairment?

A
  • Age-related macular degeneration
  • Cataract
  • Glaucoma
  • Diabetic Retinopathy
  • Optic Nerve atrophy
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6
Q

Manifestations of glaucoma?

A
  • Initially none (early dz)
  • Reduced peripheral vision (subtle at initially)
  • Tunnel vision
  • Blurred vision
  • Halos around lights
  • Eye or brow pain
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7
Q

What is the leading cause of blindess?

A

glaucoma

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8
Q

What are diagnostics for glaucoma?

A

vision exam, tonometry (tests IOP)

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9
Q

Treatment for glaucoma?

A

Reduce IOP
* Surgery
* Argon laser trabeculoplasty (ALT)
* Opens outflow channels

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10
Q

Medications for glaucoma?

A

PO or eye gtts
* Lower IOP by increasing drainage of AH or reducing AH production
* Beta blocker gtt first line tx

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11
Q

Prevention for glaucoma?

A
  • Yearly eye exam for 65 and over
  • Report any eye s/sx immediately
  • African Americans at higher risk (yearly exams younger)
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12
Q

Interventions for glaucoma?

A
  • Eye provider follow up
  • Ongoing questions and vision testing
  • Care surrounding medication mgmt
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13
Q

Manifestations of cataracts?

A
  • Clouding of lens
  • Absent red reflex or appear black
  • Appearance of halos around objects *
  • Blurred vision
  • Yellow tint to vision
  • Sensitivity to glare
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14
Q

Treatment for cataracts?

A

Surgical replacement of lens (plastic)
* When vision 20/50 or worse
* QOL or safety an issue
* Outpatient
* One eye at a time

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15
Q

Nurse peri-op for cataract surgery?

A
  • Prepare for changes in vision post-op
  • Avoid heavy lifting, straining, and bending
  • Eye drops
  • Eye shield
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16
Q

Risk factors for mac degen?

A
  • UV light
  • Cigarette smoking
  • Light-colored eyes
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17
Q

Manifestations of mac degen?

A
  • Blurred and dark vision
  • Scotomas
  • Blind spots
  • Metamorphopsia
  • Vision distortion
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18
Q

Diagnosis of mac degen?

A
  • Drusen seen on opthalmoscopy
  • Fundus photography
  • IV angiography and fluorescein
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19
Q

Nursing care for mac degen?

A
  • Promotion
  • After age 40 – dilated eye exam q2yr
  • After age 65 - eye exam yearly
  • Supplements/Diet
  • Vit C & E, beta-carotene, Zinc
  • Dark green leafy veggies
  • Smoking cessation
  • Manage HTN and DM
  • Sunglasses
  • Hats
  • Safety eye wear
  • Interventions to utilize remaining vision
  • Vision won’t return*
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20
Q

What is conductive hearing loss?

A

Vibrations can’t get to tympanic membrane or TM impaired

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21
Q

Causes of conductive hearing loss?

A
  • Infection, otosclerosis, perforated TM, fluid in middle ear
  • Cerumen impaction most common cause
  • Cerumen thicker with age
  • Higher risk: African American, hearing aids, men with increased ear hair
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22
Q

What is tinnitus?

A

Constant or intermittent
* Worsens with age
* Ringing, humming, buzzing,
roaring, hissing, etc.
* More common in men

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23
Q

risk factors for tinnitus?

A
  • Presbycusis
  • Loud noises
  • Head and neck trauma
  • Tumors
  • Cerumen impaction
  • CV disease
  • Ototoxic meds
  • Med SEs
  • ASA most common
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24
Q

Treatment for tinnitus?

A
  • Hearing aids
  • Amplify sounds to drown tinnitus
  • Electrostimulation, biofeedback, cochlear implants
  • Hypnosis, acupuncture, chiropractic, medication tx
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25
Q

Nursing interventions for tinnitus?

A
  • Identify when sounds are most irritating
  • Keep log/diary
  • Reduce/eliminate
  • ETOH, caffeine, cigarettes, stress, and fatigue
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26
Q

What is the plissit model for disucssing sexualilty in older adults?

A

*Permission
*Limited Information
*Specific Suggestions
*Intensive Therapy

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27
Q

What is medicare?

A
  • An insurance plan for persons who are age
    65, blind or totally disabled, including persons
    with ESRD
  • Includes A, B, C, & D
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28
Q

What does medicare part a cover?

A

inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care, inpatient psychiatric care

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29
Q

What does medicare part b cover?

A

Services from doctors and other health care providers. Outpatient care. Home health care. Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)

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30
Q

What does medicare part d cover?

A

brand-name prescription drugs and generic drug coverage.

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31
Q

What does medicaid cover?

A

Health insurance program jointly funded
by federal and state governments using
tax dollars
*Provides health services for low-
income children, pregnant women,
those who are permanently disabled,
and persons age 65 and older who are
eligible
(eligibility decided by state)

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32
Q

Nursing interventions for elder abuse?

A
  • Observe for obvious bruises or body marks
  • Observe and ask about medications
  • Looks for signs of restraints
  • Note 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)
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33
Q

What is shadow grief?

A

moments of intermittent sadness – often with triggers (anniversary of
event)

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34
Q

What is disenfranchised grief?

A

when a person cannot openly acknowledge or publicly
mourn a loss – socially disallowed or unsupported – same sex, AIDS, suicide

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35
Q

What is the grief cycle?

A
    1. Normal Existence
    1. Receipt of Bad News
    1. Denial
    1. Anger
      – Aggression
    1. Depression
      – Confusion, early bargaining, and continued anger and denial
    1. Bargaining
    1. Acceptance
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36
Q

What are the six C’s for nursing actions?

A
  • Control
  • Composure
  • Communication – p. 481 Read this section!
    – Type & content varies by patient
    – Auditory, visual & tactile
    – Verbal & Non-verbal
    – Closed awareness
    – Suspected awareness
    – Mutual pretense
    – Open awareness
  • Continuity
  • Closure
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37
Q

Indicators of appropriate and good death?

A
  • Care needed is received expertly and in a timely manner
  • One is able to control one’s life and environment to extent desired and possible and in a way culturally
    consistent with one’s past life
  • One is able to maintain composure when necessary and to the extent desired
  • One is able to initiate and maintain communication with significant others for as long as possible - Life
    continues as normally as possible while dying with added tasks needed to deal with and adjust to
    inevitable death
  • One maintains desirable hope at all times
  • One reaches sense of closure that is culturally consistent with one’s practices and life patterns
    Know This
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38
Q

When is palliative given?

A

when 2 physicians have agreed the person has 6 months or less to live

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39
Q

Nurse responsibilities for palliative care?

A
  • Recognize physical changes preceding eminent death
  • Deal with own feelings
  • Deal with angry patients and families
  • Be knowledgeable and deal with ethical issues in administering end-of-life palliative therapies
  • Be knowledgeable and inform patients about advance directives
  • Be knowledgeable of legal issues in administering end-of-life palliative care
  • Be adaptable and sensitive to religious and cultural perspectives
  • Explain meaning of hospice
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40
Q

What is self-actualization?

A

highest expression of one’sindividual potential and implies inner motivation that hasbeen freed to express the most unique self or the “authenticperson”

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41
Q

What are characteristics of self-actualized individual?

A
  • Time competent: The person uses past and future to live more fully in the present.
  • Inner directed: The person’s source of direction depends on internal forces more than on others.
  • Flexible: The person can react situationally, without unreasonable restrictions.
  • Sensitive to self: The person is responsive to his or her own feelings.
  • Spontaneous: The person is able and willing to be himself or herself.
  • Values self: The person accepts and demonstrates strengths as a person.
  • Accepts self: The person approves of self, in spite of weaknesses or deficiencies.
  • Positively views others: The person sees both the bad and the good in others as essentially good and constructive.
  • Positively views life: The person sees the opposites of life as meaningfully related.
  • Acceptance of aggressiveness: The person is able to accept own feelings of anger and aggressiveness.
  • Capable of intimate contact: The person is able to develop warm interpersonal relationships with others.
42
Q

What is gerotranscendence?

A

Human aging brings about a general potential forgerotranscendence, a shift from the material world tocosmic, and (concurrent with that), life satisfaction​

43
Q

Characteristics of individuals with good gerotranscendence?

A
  • Have high degrees of life satisfaction
  • Engage in self-controlled social activity
  • Experience satisfaction with self-selected social activities * Social activities not essential to their well-being
  • Midlife patterns and ideals no longer prime motivators
  • Demonstrate complex and active coping patterns
  • Have greater need for solitary philosophizing
  • May appear withdrawn when engaged in inner development
  • Have accelerated development of gerotranscendence fomented by life crises
  • Feel shifts in perception of reality
44
Q

What is spirituality?

A

a broader concept than religion andencompasses a person’svalues or beliefs, search for meaning,and relationships with a higher power, with nature, and withother people​

45
Q

What would be found in elders at risk for spritual distress?

A
  • Individuals experiencing events or conditions that affect the 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
  • Evidence of depression
  • Cognitive impairment
  • Verbalized questioning or loss of faith * Loss of interpersonal support
46
Q

What are questions to ask for a spiritual assessment?

A
  • Does your religion/spirituality provide comfort or serve as a cause of stress? (Ask to explain in what ways spirituality is a comfort or stressor.).
  • Do you have any religious or spiritual beliefs that might conflict with health care or affect health care decisions? (Ask to identify any conflicts.)
  • Do you belong to a supportive church, congregation, or faith community? (Ask how the faith community is supportive.)
  • Do you have any practices or rituals that help you express your spiritual or religious beliefs? (Ask to identify or describe practices.)
  • Do you have any spiritual needs you would like someone to address? (Ask what those needs are and if referral to a spiritual professional is desired.)
  • How can we (health care providers) help you with your spiritual needs or concerns?
47
Q

What are nursing responsibilities for retirement?

A

Discuss retirement with clients (esp in primary care)
Discuss transition to retired status
Health issues affecting retirement
Resources for planning and support

48
Q

Where to find and compare options for nursing home/ltc facility?

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

49
Q

What are common bruising patterns in abuse?

A

wrap around and linear bruises

50
Q

What are prevention ways for elder abuse?

A
  • Make professionals aware of potentially abusive situations.
  • Help families develop and nurture informal support systems.
  • Link families with support groups.
  • Teach families stress management techniques.
  • Arrange comprehensive care resources.
  • Provide counseling for troubled families.
  • Encourage the use of respite care and day care.
  • Obtain necessary home health care services.
  • Inform families of resources for meals and transportation. * Encourage caregivers to pursue their individual interests.
51
Q

What is fluent aphasia?

A

Inability to perceive/understand speech
Reading and writing impaired
Receptive aphasia

52
Q

What is nonfluent aphasia?

A

Impaired speaking
Speech is effortful
Expressive aphasia

53
Q

What is verbal aphasia?

A

Difficult to get brain signals to speech muscles
Frequently occurs with aphasia

54
Q

What is anomic aphasia?

A

Severe word finding difficulties

55
Q

What is global aphasia?

A

Can’t understand or express
Says meaningless things

56
Q

Manifestations of dysarthria?

A

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

57
Q

Care for dysarthria?

A

Collaboration with SLPs for speech therapy

58
Q

Patho of glaucoma?

A

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

59
Q

What is cataracts and prevalence?

A

Oxidative damage to lens
Protein and fat deposits
By age 80, more than half have a cataract
Usually bilateral

60
Q

Patho of mac degen?

A

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

61
Q

What are the easiest colors to see?

A

orange and red

62
Q

Characteristics of sensorineural hearing loss?

A

Damage to inner ear or neural pathways
Presbycusis (age-related hearing loss)
Most common hearing loss
Progressive and often permanent
Bilateral

63
Q

CMs of SN hearing loss?

A

1st Sign is difficulty hearing in noisy environment (restaurant)
Intolerant to loud noises
Difficulty in distinguishing between consonants
Raised (louder) voices – make it worse
High frequency sounds lost first
Difficulty filtering background noises (hospital)
Can’t hear women and children …WHY?

64
Q

Treatment for SN hearing loss?

A

Hearing aids
Cochlear implants

65
Q

What are the touch zones?

A

Intimate, vulnerable, consent, and social zones

66
Q

What is the intimate zone?

A

genitalia

67
Q

What is in the vulnerable zone?

A

face, neck, front of body

68
Q

What is in the consent zone?

A

mouth, wrists, feet

69
Q

What is the social zone?

A

hands, arms, shoulders, back

70
Q

What are some adaptions to help with touch deprivation?

A
  • stimulation of rocking
  • slowly stroking an animal’s fur
    -wearing something that provides sensory stimulation
    -Music and dancing
71
Q

What is intimacy?

A

Encompasses more than just sexuality
Commitment
Affective intimacy
Cognitive intimacy
Physical intimacy
Love and affection
Examples: Touch, holding, cuddling, being present

72
Q

What is sexuality?

A

Specific type of intimate activity
Sexual acts
Sexual desire
Activity
Attitudes
Body image
Gender-role activity
Acceptance and Companionship

73
Q

How many people identify in LGBTQ community?

A

3 million ,expected to double by 2030

74
Q

What are questions to ask for gender and sexuality affirming care?

A

“Do you have a romantic partner?” not “Do you have a boyfriend/girlfriend or married?”
“How do you identify with regard to your sexuality?”
Don’t assume heterosexuality

75
Q

What is menopause?

A

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

76
Q

What is ED?

A

Refractory period extended between episodes of intercourse

77
Q

What can ED be caused by?

A

Endocrine problems
CV problems
Depression
Neurological problems

78
Q

What is treatment for ED?

A

Phosphodiesterase (PDE) inhibitors such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis)
Revolutionized treatment for ED
ABSOLUTE – CONTRAINDICATION with nitrates/nitroglycerin – LIFE-THREATENING

79
Q

What is treatment for menopause?

A

Water soluble lubricants, low-dose estrogens introduced into the vagina may also help restore tissues and restore lubrication

80
Q

Medicare and HIV?

A

Medicare in 2010 began covering HIV screening for high risk individuals
All adults should have an HIV test at least once

81
Q

What is the leading cause of vision loss in 60 and over?

A

mac degen

82
Q

Who is at highest risk for mac degen?

A

caucasians and asiansq

83
Q

What is the 3rd most common chronic condition in older adults?

A

hearing loss

84
Q

What is retirement prep mostly aimed at?

A

High education
High occupational status
Gov’t employees
Employed in companies with pensions

85
Q

What is retirement prep not aimed at?

A

Poor health
Minorities
Women
Lower socioeconomic status
Lower education

86
Q

What is the criteria for SS eligibility?

A

American citizens or legal residents, at a predetermined age, who are totally and permanently disabled (including blind) or who are married to or an eligible partner of or dependent of someone receiving Social Security are eligible to receive Social Security benefits.

87
Q

Who is SS most beneficial for?

A

current cohort of older adults, this calculation has been most beneficial to white men, who are more likely to have worked the most consistently and at higher salaries than all other groups of workers.

88
Q

What is SSi?

A

provide a minimal level of economic support to persons age 65 and older such as Aida (above), those who are blind, or disabled
regardless of their earning power in early life or when capable of working. SSI either provides “total support” or supplements a low Social Security benefit

89
Q

When was medicare established?

A

1934, FDR

90
Q

What is supplemental/medigap?

A

Help with high Medicare co-payments
Cover only deductibles and part of coinsurance amounts based on Medicare
Approved amounts contracted with providers

91
Q

What pays for LTC usually?

A

medicaid, medicare, priv LTC insurance, out-of-pocket spending

92
Q

What are the 2 levels of of nursing homes?

A

Skilled nursing facilities (sub-acute)
Chronic care (long-term/custodial)

93
Q

What % of americans die in NH/

A

23%

94
Q

What is PACE?

A

PACE - Program for All Inclusive Care for the Elderly

95
Q

What is NICHE?

A

NICHE – Nurses Improving Care for Healthsystem Elders

96
Q

What is ACE?

A

acute care for the elderly

97
Q

What is culture change model?

A

Home like, directed by residents, relationships fostered

98
Q

What is transitional care model?

A

Med mgmt., discharge planning/teaching, etc. (RNs and APRNs)

99
Q

Overview of PACE program?

A

provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits.
Age 55 or older
Live in the service area of a PACE organization
Eligible for nursing home care
Be able to live safely in the community

100
Q

What is the emphasis of NICHE model?

A

stresses nurse involvement in hospital decision-making regarding care of older adults. (acute care)

101
Q

What are the stages of grief?

A

Beginning
Physical and psychological manifestations
Middle
Day to day functioning affected
End
Griever emerges refocused and adjusted

102
Q

How to provide spiritual comfort?

A

sharing caring words​
reminiscence​
listening to life stories​
validating their lives​
praying with and for​
reading scripture​
referring clergy​
providing for religious objects and rituals

Gero (5 decks)

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