Exam 3: Care of older adults

Question 1

variability among older adults

Answer 1

Physiological, cognitive, and psychosocial health
Wide range of functional ability
Functionality
Chronic conditions add to the complexity of assessment and care
Do not assume that all older adults have signs, symptoms, or behaviors representing disease
Identify an older adult’s strengths and abilities

Question 2

Statements that demonstrate ageism

Answer 2

Ill, disabled, and unattractive
Forgetful, confused, rigid, boring, and unfriendly
Unable to learn and understand new information
Not interested in sex or sexual activities

Question 3

Nurses must assess their own attitude toward older adults and their own aging.

Answer 3

Come from personal experiences with older adults, education, employment experiences, and attitudes of co-workers and employing institutions
Forming positive attitudes toward them and gaining specialized knowledge about aging and the health care needs of older adults are priorities for all nurses

Question 4

Nurses need to gain knowledge about aging and health care needs of older adults

Answer 4

Respect
Dignity
Involvement in care decision and activities

Question 5

Gerontology

Answer 5

Study of aging process

Question 6

Gerontological nursing

Answer 6

caring for the aging adult

Question 7

Current fastest growing subgroup is

Answer 7

85-99 years old

Question 8

Ego integrity vs. despair

Answer 8

older adult need to look back on life and feel a sense of fulfillment, success at this stage leads to wisdom, failure results in regret and despair.

Question 9

Developmental tasks for older adults

Answer 9

Adjustment

Maintaining quality of life

Question 10

functional status includes

Answer 10

• ADL’s: sensitive indicator of health or illness.

- Instrumental ADLs

Question 11

older adults and acute cared

Answer 11

Delirium
Dehydration
Malnutrition
Health care–associated infections
Urinary incontinence
Skin breakdown
Falls
------Medications, increased urine output, orthostatic BP

Question 12

Risk of acute care go up with

Answer 12

sleep deprivation, infections, dehydration, pain, sensory impairment, drug interactions, anesthesia, hypoxia.

Question 13

Delirium

Answer 13

Acute confusion state
Reversible
Underlying medical condition (UTI, anesthesia, electrolytes, sleep deprivation, pain, etc….)

Question 14

Dementia

Answer 14

Irreversible

Gradual/chronic confusion/impaired cognitive functioning

Question 15

Depression

Answer 15

Most common, yet most undetected and untreated, impairment in older adulthood
Mood disturbance: sadness and despair

Question 16

Nursing management of dementia and delirium

Answer 16

Safety!
Meet physical & psychosocial needs 
Correct underlying physical problem
Maintain routine
Modify the environment for safety
Compensate for sensory deficits
Encourage fluids
Individualize nursing care to enhance quality of life
Maximize functional performance by improving cognition, mood, and behavior.

Question 17

Illness in older adults

Answer 17

Confusion:
–Infection
–Acute illness
–Medications
Chronic dehydration esp. with illness
ADL decline can signal underlying illness
Depression common w/chronic illness
Monitor for drug to drug interactions and toxicity
Classic S/S of disease are sometimes absent/atypical in older adults. EX:
–UTI presents w/confusion and incontinence, maybe no fever, but increased RR
–MI: dyspnea and anxiety rather than crushing pain
–Change in mental status, falls, dehydration, decreased appetite, loss of function.
Pain often undertreated: look for non-verbal cues (inspection/observation)

Question 18

Decreases nutrition and hydration

Answer 18

Increased need for Calcium, Vit’s D, C, A
Decreased metabolism: need for fewer calories
Decreased sense of smell/taste and dental care/dentures
Reduced income; starvation or fast foods
At risk for Geriatric failure to thrive: under nutrition, physical impairment, depression and cognitive impairment
Limit fluid consumption r/t immobility, diuretics, incontinence

Question 19

Advantages of physical activity in the elderly

Answer 19

Decreased 
--risk for falls
--Depression symptoms 
--Risk of diabetes, CAD and dementia
--Body weight/BMI
Increased 
--Muscle strength and balance
--Sleep
--Sense of well being and self esteem
--Longevity

Question 20

what is the most common accident in elderly

Answer 20

Falls!

Question 21

what is the second most common accident in elderly

Answer 21

motor vehicle accident

Question 22

fall prevention

Answer 22

• Handrails, Slip proof pads for rugs, adequate lighting, avoid scatter rugs, slippery floors, and clutter.
• Grab bars in bathrooms, raised toilet seats, caution with icy and wet surfaces
• Concentrate on one activity at a time

Question 23

Poly pharmacy

Answer 23

use of multiple drugs, duplicative drugs, excessive dosages and drugs prescribed for a long period of time.

Question 24

Age-related changes affect drug absorption/excretion/metabolism

Answer 24

Decreased GI blood flow/motility, renal excretion, water distribution, metabolism
Increased fat storage
Altered liver metabolism of drugs

Question 25

Elderly are at risk for _____ with self administration of medication

Answer 25

toxicity

Question 26

Nursing care of elderly

Answer 26

See a list of all medications (including OTC)
Educate on each med and use (duplicative drugs)
Collaborate with Pharmacists suggest once a day dosing if possible
Verbal and written information
Organizing administration with medication containers

Question 27

Physical restraints

Answer 27

Straight jackets/Posey’s
Limb restraints
Torso restraints
Bed rails
Household items: pillows, sheets, wheelchair brakes while at the table; ANYTHING that prevents free mobility

Question 28

Chemical restraints

Answer 28

medications, alcohol, illicit drugs

Question 29

Psychological restraints

Answer 29

Alarms

Question 30

Alternative use to restraint s

Answer 30

Meet underlying physical needs: food, water, toileting
Reorientation
Validation of feelings
Check often, at least every hour
Hide tubes and lines with gauze or clothing 
Keep patient busy 
Calm music 
Place in common area for supervision
Turn off TV if agitated
Visitors/“Sitters”

Question 31

Psychosocial changes

Answer 31

Occur with transitions and loss
Coping and adjustments 
Retirement
Finances, role and function
Personal identity
Social isolation
Social network, transportation
Sexuality
Love, warmth, sharing, touching
Housing and environment
Promote independence and functioning
Death
Spouse, alone, suffering burden

Question 32

Sources of stress and loss

Answer 32

Changes in lifestyle: retirement/illness
Loss of significant others
Financial hardships
Relocation

Question 33

Nursing Care: Stress and Loss

Answer 33

Establish trusting relationship 
Encourage participation in decisions
Explain relocation before it happens
Validation therapy
Special keepsakes at bedside/in apartment
Reminiscence
Reorient to new environment
Encourage family and friends to visit often
Therapeutic touch

Question 34

Neglect and abuse can be

Answer 34

Verbal, physical, sexual, emotional and financial
Abuser is often family member
Under reported and under investigated

Question 35

Neglect

Answer 35

Failure to provide basic needs: Food, clothing, shelter, meds, ADL’s

Question 36

Abuse

Answer 36

use of force/power that results in injury: Hitting, burning, pushing, raping, molesting, stealing, humiliating, intimidating, isolating.

Question 37

Depression

Answer 37

Most common undetected in elderly
15% of elderly are depressed (NIH)
Increases with hospitalizations
Classification: Mild/severe/major

Question 38

Primary depression

Answer 38

Lack of neurotransmitters norepinephrine and serotonin

Question 39

Secondary depression

Answer 39

situational–sudden change in life such as illness or loss