exam 3 Flashcards
developmental stages
YA development
- formal operations (think rationally, predit outcomes)
- postformal operations (2+ PoV valid)
- self evaluate at age 30
- Erikson’s intimacy vs Isolation to establish lasting friendships and relationships
- Freud Genital stage - form intimage sexual relationships
problems in YA
- STI’s
- traumatic injuries is leading cause of death
- Domestic violence
- Obesity, diabetes, HTN
- substance abuse
- suicide
assessment YA
- assess for all problems
- diabetes and HTN for overweight or fmy his
- testicle exam in routine cancer screenings
- breast exam by clinician every 3 yrs
- pap 21+ every 3 years
- mammo if risk factors like early periods before age 12, late childbirth and obvious ones like fmy his or personal his. NOT ABORTION.
Middle adult 40 to 64 development
- thin hair, grey hair, loss of MT
- reduced muscle tone
- decreased bone mass
- reduced elasticity of blood vessels
- menopause age 51 and perimenopause 5-7 years before it
- andropause
- formal operations and concrete operations
- peak of creativity
- reaction time slows but memory intact
- Generativity vs Stagnation (guide next generation)
- caring for aging parents vs peak career vs raising children
define andropause vs menopause
what does HRT cause
- andropause is less testosterone, less sperm count, longer time before getting an erection, but still fertile
- menopause is cessation of periods for at least 12 months
- menopause has symptoms like hot flashes, decreased breasts, vaginal dry, awake at night, mood swings
HRT causes hypertension and terrible ass symptoms like blood clots, cancer
problems in MA
- chronic illness becomes a major concern like cancer, obesity, diabetes, HTN, CVD. many YA interventions focused on preventing these from occuring
- joint pain and mobility problems from obesity
- CVD is leading cause of death
MC cancer WW
lung cancer
when does prostate cancer occur
after age 65 typically
assessments for MA men
- digital recetal exams are not routine
- AA men or w fam his is highest risk for prostate cancer
assessments unique to MA
- annual eye exam to test for farsightedness presbyopia
- colon cancer screening for stool occult, sidmoid, colonosc
- osteoporosis screening - DEXA - rec. for menopause women
- DEXA scan also rec. for smoking or low body weight
What should menopausal women be recommended
- Calcium and vitamen D
- alternatives to HRT like estrogen only, natural remedies
600 IU D
1200 mg calcium
How much exercise to reccommend
- minimum 30 minutes daily but 60 minutes daily is ideal
- gradual increase in activity for sedentary or obese
population shapes rectangle vs pyramid
- modern resembles a rectangle bc of fewer births and longer life expectancy
- traditional is a pyramid shape with old people at the tip and babies at the base
Do most older adults live independantly
yes
What does aging in place mean
Staying in your own home while getting services there
Age friendly community
- a place where you can get affordable housing for older adults
- benefit is just living in a community, socializing, affordable, and some transportation help
- its like living in a nice neighborhood or apartment but not like a nursing home
Naturally occuring retirement communities
a random apartment complex that just so happens to have a lot of adults stay there for a while long enough to age together
* neighbors help neighbors
retirement community
- PLANNED housing one level homes
- annual fees for amenities, social activity
- limit because it wont accept grandparents raising grandchildren and you must be either 55, 60 or 62+ ish
Continuing care retirement communities
- full range of options for living depending on needs.
- amenities and activities but also option of healthcare providers like nurses, physical therapists, doctors, dentists
- can choose options like independant living, assisted living, skilled nursing care, rehabilitation and dementia care
- requires physical health, mental health exam, and financial review
- contract based
- high costs
- sometimes university affiliated to allow older adults to participate in academic life
Assisted living facilities
- provide housing and assistance with daily living activities for seniors who need help with tasks like bathing, dressing, and medication management, while promoting independence and maintaining a home-like environment
- can be separate apartments, rooms w common area, or residents may share rooms
- nurses or medication aids to manage help but not the level of medical care at nursing homes
Aging theories
- wear and tear from damage, stress, and metabolic waste
- death is pre programmed and cells have finite number of divisions
- errors in cells from free radicals, cross links, toxins
- autoimmune progressively
Three stages of older adulthood
- young old: 65
- middle old: 75
- oldest old: 85
Young old summary
and barriers
- retirement and leisure, extra time for health promotion
- chronic illness
- barriers - lack of supplemental insurance besides medicare, getting old mindset, reduced physical activity levels, deconditioning
Middle old 75
- lack of physical activity increases which can exacerbate disability
- sedentary but more lesiure time than young old
Adapated activity programs
Group exercise for older adults offered at senior centers
Oldest old adults 85
- hearing loss
- vision loss
- “edentualism” loss of natural teeth exacerbated by poverty
- nutrition challenges
- problems with stooping, kneeling, reaching overhead, walking a few blocks, and lifting 10 lbs
Who is frail?
NOT defined by AGE.
defined by health status.
* vulnerability to negative health outcomes. it is a syndrome.
* body reaches lowest survival capacity. common cold can kill you
* impaired mental abilities, muscle weakness, ADL assistance needed, slow performance, fatigue, low physical activity
memory problems in older adults
- short term memory is way worse than long term memory
- memory improves with active lifestyle, mental stimulation, and good nutrition
How does the respiratory system change because of againg
decreased chest wall elasticity, weaker cough reflex, AP diameter increase, stiffer lung
assess mouth breathing (dry?), o2 levels, use of accessory muscles, cough reflex effectiveness for aspiration risk
how does the GI change because of aging
stomach less acidic, lower motility in GI, drier mouth because less saliva production
assess ability to chew, pattern of bowel movement, meal portion/frequency
integumentary aging changing
- decr. skin elasticity, incr skin dryness
- skin is thinner
- nails grow thicker but slower
- hair thins
kidney changes from aging
decr. glomerular filtration, blood flow
lower bladder capacity
neuro aging changes
less NT
less nerve cells
decreased REM sleep
reflex response is delayed
endocrine changes aging
- reduced insulin production (high sugar)
- decreased thyroid (run cold)
- lower estrogen and T
sensory system changes aging
- presbyopia: diff seeing up close
- decreased depth perception, pupil size, tear production
- cataract risk from lens thickening
- hearing loss esp high frequency
- reduced smell and taste
- weakened balance
- reduced pain perception
- MACULAR DEGEN IS NOT NORMAL BUT COMMON
what is disengagement theory
- society and older adults withdraw from each other at the same time
- due to retirement, illness, death of friends, and in turn it gives them more time to reflect
*power to the young
What is activity theory
- staying active
travel, exercise, hobbies, and volunteering should replace work to stay socially and physically active
Eriksons psychodevelopmental theory for older adults
Ego Integrity vs. Despair
* Older adults reflect on their lives to accept all they have done and accept death is close
* if they dont accept it, they are regretful, bitter, and fear death.
leading causes of death for older adults
- CVD
- cancer
- traumatic injury like falls or accidents
so its either a chronic disease or a truamatic injury
Osteoporosis risk factors
Old woman smoking a cigarette, drinking moderately and sedentary
Dementia signs
- depends on others for ADLs
- can’t recall specific instances of memory loss
- family members seem more concerned than the person
- Recent memory not intact
- frequent word finding difficulty, long pauses, word substitutions
- get lost in familiar places
- cant use familiar objects and can’t learn a new object
- inappropriate behavior
- abnormal mental status exam
Typical aging signs
- complain of memory lapses but cant recall how they forgot
- independance in ADLs
- more concerned about memory loss than family members
- recent memory intact
- occasional difficulty finding words
- momentary pause to remember directions in familiar place
- unwilling to use new technology but can use famiilar appliances
- interpersonal skills maintained
- normal MME
is dementia a normal part of aging?
no
1 in 5 over age 70
50% over age 80
fun fact, over age 90 can still be cognitively intact
Cues of dementia definition
memory impairment + either aphasia, apraxia, agnosia, or executive functioning problem
- agnosia is impaired recognition
- apraxia is impaired movement execution
- aphasia is impaired ability to communicate
interventions for demenia
- safe environment
- facilitate communication with short simple sentences and repeat if they dont understand
- read, play, dance to stimulate brains
- orient them to reality
- life review and reminiscence
- ADL assist
- support and educate caregivers
- encourage social engagement
evaluate oucomes of not experience fear, following simple commands, remain free from harm
as dementia progresses what happens
- Personality changes
- communication difficulty
- difficulty thinking
Mandatory elder abuse report is based on evidence of:
- repeat injuries, bad nutrition, poor hygiene, fearfulness when a caregiver is around
- financial exploitation
MC cause of dementia?
Alzheimers
What is ageism
Discrimination based on age
leads to underdiagnosis
Polypharmacy increases risk of
in older adults
delirium, confusion, depression
What can depression be mistaken for in older adults
dementia because they both cause slow movements, low motivation, and memory problems
depression can also be a side effect of medication
Examples of elder abuse behavior
- infantilization (elderspeak or treat like a child)
- silent treatment
- enforcing social isolation
- demeaning
- neglect basic needs
examples of physical injuries in older adults to suspect abuse
- jaw or face injury
- broken teeth
- subdural hematoma
- periorbital
- laryngeal
- rib fracture
- upper extremity injury
- wasting, malnutrition, unkempt
What to do when suspecting elder abuse
- Call adult protective services
- Call 911 immediately if in life threatening danger
Identify basic ADLs
✅ Bathing.
✅ Dressing.
✅ Toileting.
✅ Transferring (mobility).
✅ Continence.
✅ Feeding.
Identify “instrumental” ADLs
more complex needed for basic ADLs
✅ Shopping.
✅ Using the telephone.
✅ Housekeeping.
✅ Managing finances.
✅ Preparing meals.
✅ Managing medications.
How do you identify that someone needs to be in an assisted living, nursing home, or caregiver aging in place?
Loss of IADLs and obviously ADLs
how to identify depression in older adults
geriatric depression scale
What measures ADLs
Katz Index.
How to measure body of older adult
- Compare to previous height to screen for osteoporosis esp. after age 65.
- weight changes are important for fluid status, nutrition status
- lower baseline temperature so someone with pneumonia might only have a mild fever
older adult screenings text dump
- Routine Health Screenings for Older Adults
✅ Lipid Panel:
* Total cholesterol, triglycerides, HDL, LDL.
✅ Blood Glucose Screening:
* Diabetes risk assessment.
✅ Breast Cancer Screening (Women):
* Annual clinical breast exams starting at age 40.
* Breast self-awareness: Encourage women to recognize changes in their breasts.
* Mammograms:
o Ages 45-54: Annual screening.
o Ages 55+: Biannual screening OR continued annual screening if desired.
o Continue as long as the woman is in good health and has a life expectancy of at least 10 years.
✅ Cervical Cancer Screening (Women):
* Women over 65 with normal past Pap tests do not need further testing.
* Women with a history of cervical precancer should continue screening for 20 years.
* Women with a total hysterectomy (unrelated to cancer) do not require further screening.
✅ Colorectal Cancer Screening (Ages 50-75):
* Annual high-sensitivity fecal occult blood test.
* Sigmoidoscopy every 5 years + fecal occult blood test every 3 years.
* Colonoscopy every 10 years.
* CT Colonography (“virtual colonoscopy”) is a safe, non-invasive alternative.
* Screening decisions for ages 76-85 should be individualized based on health status.
✅ Prostate Cancer Screening (Men):
* Digital Rectal Exam (DRE): No longer recommended for routine screening.
* Prostate-Specific Antigen (PSA) Test:
o Men 55-69 should discuss risks/benefits with their provider.
o Not recommended for men over 70.
✅ Eye Exams:
* Every 2 years if no eye issues.
* Annual exams for those with diabetes, hypertension, or cardiovascular disease.
✅ Bone Density Scan (Women):
* All women aged 65+ should be screened for osteoporosis.
* Women at high risk (postmenopausal, smokers, low body weight) may need earlier screening.
* Not recommended for men.
When do you perform an ADL assessment
Middle old adult 75 yrs old
also do mental status exam
When to screen for fraility
85+ oldest old
also do MME
What to encourage when someone turns 65
transition into retirement in a positive way that retains civic and social engagement
CDC recommendation for physical activity in older adults
- Aerobic Exercise:
o 150 minutes of moderate-intensity aerobic activity per week.
o OR 75 minutes of vigorous-intensity aerobic activity per week.
o Exercise should be spread throughout the week (e.g., 10-minute sessions).
o Additional benefits can be gained by increasing exercise to 300 minutes per week. - Muscle Strengthening:
o Moderate or high-intensity resistance training at least 2 days per week.
o Exercises should engage all major muscle groups. - Balance-Promoting Activities:
o Especially important for fall prevention.
o Examples: Tai chi, yoga, balance exercises. - Adapted Physical Activity for Chronic Conditions:
o Adjust physical activity based on individual limitations.
o Encourage participation in modified exercises as tolerated.
practical exercise suggestions for older adults
- two 15 brisk walks meets aerobic goals
- strength building like exercise bands or carry small weights
- inactive people should start with 10 mins of walking a day and gradually increase it
even a short period of inactivity can lead to loss of functional ability
How does the WHO define health
- Health is a state of complete physical, mental, and social well-being, not just the absence of disease.
how does florence nightingale define health
- Health is disease prevention through fresh air, clean water, proper drainage, cleanliness, and light.
How does jean watson define health
🔹 Jean Watson (1979) – Nursing Theorist:
* Health has three key components:
1. High level of physical, mental, and social functioning.
2. Ability to adapt and maintain daily functions.
3. Absence of illness OR efforts that lead to its absence.
* Perception-based: A person with a terminal illness can still be “healthy” if they function well and actively cope with their diagnosis.
what is the experience of illness
Illness is a unique, personal experience that disrupts health. The way people experience illness varies greatly depending on their physical, emotional, and psychological state.
Health illness continuum
Health and illness exist on a spectrum rather than as separate states.
Dynamic and changes daily
1 is gravely ill to 10 which is peak health
what is the concept of wellness
- Wellness is more than just the absence of disease.
- It is a way of life focused on optimal health and well-being, integrating body, mind, and spirit (Myers et al., 2000).
Dunns health grid
- health status in relation to their environment
- People with poor physical health but strong support systems may still have a high quality of life.
Neuman’s Continuum
Betty Neuman’s theory views health as a balance of energy
- High Energy = Wellness
- Low Energy = Illness/Death
✅ Wellness occurs when more energy is generated than expended.
✅ Illness occurs when more energy is expended than generated.
effects of sleep deprivation
❌ Cognitive decline (memory issues, poor concentration).
❌ Mood disturbances (irritability, anxiety, depression).
❌ Increased risk of chronic conditions (obesity, heart disease).
while sleep aids in
✅ Tissue regeneration
✅ Bone synthesis
✅ Red blood cell formation
- Rest is just as important as exercise and nutrition.
Is it ok to want to be alone when sick
🔹 Independent Coping vs. Seeking Support:
* Some prefer independence, refusing help during illness.
* Reality: Support from family, friends, pastors, or counselors improves recovery and coping with disruptions.
Stages of illness
- Denial - initial symptoms
- stay home
- seek out medical advice, carry expectations
- become dependant on medicine and carry out treatment
- return to new normal or gradually return to normal life
what is remission vs exacerbate
remission means symptoms become minimal or absent
exacerbate is flare up
how to communicate handoff report
✅ SBAR Handoff Report:
✔ S (Situation) – Why is the patient being transferred?
✔ B (Background) – Key medical history, medications, treatments.
✔ A (Assessment) – Current condition, vital signs, concerns.
✔ R (Recommendation) – Special instructions for care team.
✅ Example:
A patient with pneumonia is being discharged home. The nurse communicates:
✔ Situation: Patient is stable and ready for discharge.
✔ Background: COPD history, on oxygen therapy.
✔ Assessment: O2 sat at 95% on 2L nasal cannula.
✔ Recommendation: Home health nurse to monitor oxygen use and breathing exercises.
Define family
Structure: 2+ people that can be married, adopted, or genetically related
Function: can be anyone that offers support in any way like 2 best friends. Could also be financially, physically, emotionally, socially
Transition: shared values, rituals, relationships beyond legal ties
Traditional family
married w kids, SAHM and working dad
grandparent families
grandparents take full custody of grandchildren, often due to parental instability
blended families
- single parents marry and bring children from previous relationships.
- Children may have multiple caregivers, which affects parenting roles and discipline methods.
extended families
🔹 Relatives beyond parents and children (e.g., grandparents, aunts, uncles) are involved in caregiving and decision-making.
🔹 Some cultures prioritize multi-generational households.
sandwich families
🔹 Middle-aged adults care for both aging parents and their children, leading to financial and emotional strain.
Multigenerational & Intergenerational Families
3+ generations
cohabiting adults
& kith relationships
- Cohabiting Adults: Many couples live together without marriage.
- Kith Relationships: Close friendships function as family when there are no blood ties.
✅ Example: - J.B. and Mike are not related but provide strong mutual support, making them family by function.
💡 “Nurses should recognize diverse family dynamics beyond traditional biological ties.”
8 stages of the family cycle
📌 The 8 Stages of the Family Life Cycle:
1️⃣ Beginning Family (Newly married couple)
2️⃣ Childbearing Family (Birth of first child)
3️⃣ Family with Preschoolers (Balancing parenting & work)
4️⃣ Family with School-Age Children (Education & socialization)
5️⃣ Family with Teenagers & Young Adults (Encouraging independence)
6️⃣ Launching Young Adults (Children leave home)
7️⃣ Postparental Family (Adjusting to empty nest)
8️⃣ Aging Family (Retirement & late-life adjustments)
developmental theory
- can skip stages or overlap
Previously eradicated diseases now a threat
- Measles (due to vaccine hesitancy).
- Pertussis (Whooping Cough) (due to declining herd immunity).
age group most vulnerable to neglect and abuse
- Children under 3 years old (72% of abuse cases).
