Exam 3 Study Guide Flashcards
Anxiety
a feeling or worry, nervousness, or unease.
De-escalate
to (cause to) become less dangerous or difficult
Depression
feelings of sadness and/or a loss of interest in activities once enjoyed
Mental Health
a resident’s ability to cope with and adjust to everyday stresses in ways that society accepts
Mental Illness
a disturbance in the ability to cope or adjust to stress; behavior and function are impaired; mental disorder, emotional illness, psychiatric disorder
Causes of Mental Illness
- Physical factors such as illness, disability, aging, substance abuse, and chemical imbalances
- Environmental factors such as weak interpersonal or family relationships
- Traumatic past experiences, such as abuse
- Inherited traits
- Ability to cope with stress
Anxiety Disorders
- Generalized anxiety disorder is characterized by anxiety and worry, in the absence of an imminent event
- Obsessive-compulsive disorder is categorized by obsessive behavior or thoughts, which may cause an individual to repeatedly perform a behavior or routine such as washing their hands over and over
- Posttraumatic stress disorder is brought on by experiencing or witnessing a traumatic event, such as a violent crime or combat in the military
- Phobia is an intense, irrational fear of an object, place or situation, such as flying.
Mood Disorders
- Depression may cause a loss of interest in activities once enjoyed, such as eating, sleeping, and work. The individual may suffer intense emotional and physical pain. If left untreated, depression may lead to suicide, especially in older adults.
- Bipolar disorder is a condition in which an individual has mood swings and changes in energy levels including the ability to function. The mood swings can alternate from extreme activity (a manic episode) to periods of deep depression (a depressive episode).
- Schizophrenia interferes with an individual’s ability to interact with others, make decisions, think normally, and communicate clearly. Individuals who experience hallucinations may see someone or something that is not really present or hear a conversation that is not real. Individuals who experience delusions may believe that other people are controlling their thoughts.
Mental Health and Mental Illness – Treatment
- Medication
- Psychotherapy
- Cognitive behavioral therapy
What are the pain statistics in nursing homes?
In nursing homes, 71-83% of residents experience pain; up to 80% experience pain that interferes with activities of daily living and quality of life
Acute Pain
- Temporary, lasts for a few hours, or, at most, up to six months
- Usually comes on suddenly, as a result of disease, inflammation or injury
- Goes away when the healing process is complete
- Serves a purpose because it warns the body of a problem that needs attention
- Identifying and treating the cause of acute pain is usually possible
- When people are in acute pain, their discomfort tends to be obvious
- In fact, acute pain can rev up the body and may cause pale sweaty skin and an increase in heart rate, respiratory rate and blood pressure
Chronic Pain
- Considered chronic when it is long-term, lasting for six months or more
- Often comes on gradually, people may have a hard time pinpointing when it started and/or describing it to others
- Chronic pain serves no purpose since it continues after the healing process is complete
- Diagnosing the cause of chronic pain can be difficult and may persist despite treatment
- When people are experiencing chronic pain, the source of their discomfort may not be obvious to others; they may just seem depressed. This is because chronic pain can slow down the body, causing a decrease in both heart rate and blood pressure
Person-centered Care
The practice of basing resident care on individual resident needs, preferences, and expectations
Cognition
the manner in which messages from the five senses are changed, stored in memory, recovered from memory, and later used to answer questions, respond to requests, and perform tasks
Learning
the gaining of information, skills, and knowledge measured by an improvement in some obvious response
Memory
involves the storing of information in the brain for later use and the ability to recall the information when needed
Pacing
the awareness and adjustment of nursing care based on how slow or how fast a person is functioning
Patience
the ability to deal with slowness, delay, or boredom without complaining or appearing rushed
Reaction Time
the time it takes for a person to begin an answer or a movement after someone asks him/her a question or makes a request
TRUE or FAULSE:
Healthy older adults Do Not have notable decreases in cognitive ability and are able to learn new information.
TRUE
What are some cognitive changes due to aging?
• Size of neurons (brain cells) progressively decrease
• Total brain mass decreases
• Physiological/psychological responses slow down
• Increased learning time needed for new activities
• More difficulty in learning motor skills
• Decrease processing, response time and reaction time, making fast-paced instruction more challenging
• More deliberate, less frequent responses and less effective performance when pace is fast – particularly in stressful/unfamiliar surroundings
• Slow with tasks when response speed is needed
• Cannot adapt as well, especially in stressful/unfamiliar environments and with impaired senses
• Easily confused when too many changes or losses happen at one time or when moved to a different environment
• Mild short-term memory loss often occurs (forgetting names, misplacing items, poor recall of recent conversations)
• Motivation to learn decreases
• Feels threatened more when declining cognitive abilities may be publicly demonstrated
• Difficulties in doing more than one task or dealing with more than one request at a time occur
• Unable to ignore irrelevant stimuli
• Reaction time – the time it takes for a person to begin an answer or a movement after someone asks him/her a question or makes a request
o Changes in reaction time vary from person to person
o Reaction time slows gradually after age 60 (it takes longer for resident to begin with an answer or to start a movement), especially when the older adult has to make a choice or change movement from one direction to another
o Impaired by aging process, sensory deficits, or chronic disease
Social Breakdown Syndrome
- May occur if resident is rushed too much and not allowed enough time to begin to do tasks, respond to requests, or answer questions
- Will likely keep quiet and not ask for slower pace and tends to blame self for not being able to keep up and then become frustrated
- Gradually begins to feel incompetent and has decrease in self-esteem
- May give up doing things leading to dependence and helplessness
- Often labeled as slow and unable to keep up in society
- Living in an advanced, high technological society, where everything and everyone is functioning at a high rate of speed, leads to lower self-esteem among older adult population
- Society becomes impatient with those who cannot keep up
Pacing and Patience
- Pacing – the awareness and adjustment of nursing care based on how slow or how fast a person is functioning
- Patience – the ability to put-up with slowness, delay, or boredom without complaining or appearing rushed
- Pacing and patience can be used to offset effects of a resident’s slowed reaction time
• When allowed to take their time and set own pace, residents
o Are better able to perform tasks or learn new things
o Have time to use their physical and physiological assets to respond to the best of their abilities
o Feel better about themselves, feel competent, and feel more in control
Family Support
offers of encouragement, assurance, and sense of connection for the resident offered by blood relatives or group of individuals close to the resident
Defense Mechanisms
unconscious behaviors that residents (and all of us) may display when stressed.
Psychological Effects of Aging
an exploration of feelings, emotional stress, physical, psychosocial and psychological adjustments that are part of the aging process
Cyanosis
What is turning blue called?
a bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood.
Self-actualization may be difficult for older adult due to unmet…
- physical needs such as lack of mobility or pain
- security needs such lack of privacy or fear
- love and affection needs such as social isolation or lack of family support
- Self-esteem needs such as negative feelings about self or lack of confidence
About how many men and how many women who turn 65 are expected to live in a nursing home before they die?
1/3 of men
over 1/2 of women
Activity-based Care
care focused on assisting resident to find meaning in his or her day, rather than doing activities just to keep the person busy
Catastrophic Reactions
out-of-proportion, extreme responses to activities or situations
Delirium
- State of severe sudden confusion that is usually reversible
- Triggered by acute illness or change in physical condition
- Can be life threatening if not recognized and treated
• Symptoms of delirium o Rapid decline in cognitive function (ability to think) o Increased confusion o Disorientation to place and time o Decreased attention span o Poor short-term memory and immediate recall o Poor judgment o Restlessness o Altered level of consciousness o Suspiciousness o Hallucinations, delusions
• Notify nurse and stay with resident
• Communicating with a resident who is showing signs of delirium
o Stay calm
o Keep voice at a normal volume; do not shout
o Use resident’s name
o Speak clearly in simple sentences
o Use facial expressions and body language to aid in understanding
o Reduce distractions in the environment, such as turning down TV or closing curtains to block bright sunlight
Delusion
a false belief
Dementia
usually progressive condition marked by development of multiple cognitive deficits, such as memory impairment, aphasia, and inability to plan and initiate complex behavior
Independence
ability to make decisions that are consistent, reasonable and organized; having the ability to perform activities of daily living without assistance
Meaningful Activities
have value to the resident with dementia
Paranoia
an extreme or unusual fear
Progressive
the way a disease advances
Quality of Life
overall enjoyment of life
Respect
treated with honor, show of appreciation and consideration
Sundowning
• Sundowning is behavioral symptom of dementia that refers to increased agitation, confusion, and hyperactivity that begins in late afternoon and builds throughout the evening
• Interventions
o Encourage rest times
o Plan bulk of activities for the morning hours
o Perform quieter, less energetic activities during the afternoon
Trigger
an event that causes other events
Alzheimer’s disease and the Stages
- Most common cause of dementia. Thought to be caused by clumps of proteins (referred to as tangles) in the brain
- Average life span in 8 years, but survival may be from 3 to 20 years
- Progressive disease made up of 7 Stages; gradual decline in memory, thinking and physical ability over several years
Stage 1 – No Impairment
• Alzheimer’s disease is not evident
• No memory problems
Stage 2 – Very Mild Decline
• Minor memory problems
• Lose things around the house
• Unlikely to be noticed by family members
Stage 3 – Mild Decline
• Family members and friends may begin to notice cognitive problems
• Difficulty finding the right word during conversations
• Difficulty organizing and planning
• Difficulty remembering names of new individuals
Stage 4 – Moderate Decline
• Difficulty with simple math
• Poor short-term memory (may not recall what they ate for lunch)
• Inability to manage finances
Stage 5 – Moderately Severe Decline
• Maintain functionality
• Usually able to bathe and toilet independently
• Still know their family members
• Difficulty dressing appropriately
• Inability to recall simple details, such as their own address or telephone number
• Significant confusion
Stage 6 – Severe Decline
• Need constant supervision, usually require professional care
• Confusion or unawareness of environment and surroundings
• Inability to remember most details of personal history
• Loss of bladder and bowel control
• Major personality changes
• Possible behavior problems
• Need assistance with bathing and toileting
• Wandering
Stage 7 – Very Severe Decline
• Final stage and nearing death
• Lose ability to communicate or respond to their environment
• May be able to utter words or phrases
• No awareness regarding their condition
• Need assistance with all activities of daily living
• May lose their ability to swallow
Dementia or Delirium?
- Delirium and dementia are often confused
- Remember, delirium is sudden, severe, and usually reversible; dementia is progressive and irreversible
- A resident who has dementia may experience delirium; immediately report any sudden change in behavior or a sudden increase in behaviors associated with dementia to the nurse – a resident with dementia may be experiencing delirium
Wandering
• Wandering is a known and persistent problem behavior that has a high risk factor for resident safety
• Safety risk factors may include
o Falls
o Elopement
o Risk of physical attack by other residents who may feel threatened or irritated by the activity
• Residents wander for several reasons and may include
o Trying to fulfill a past duty, such as going to work
o Feeling restless
o Experiencing difficulty locating their room, bathroom or dining room
o Reacting to a new or changed environment
• Preservation of resident safety is the main objective when caring for the wandering resident and interventions include
o Establish a regular route
o Provide rest areas
o Accompany the resident
o Provide food and fluid
o Redirect attention to other activities or objects
o Determine if behavior is due to environmental stress
How long do you leave on a hot and cold treatment on?
HOT: Max 20 minutes - check every 5 minutes
COLD: Max 20 minutes - check every 10 minutes
What color(s) would the skin turn if the patient is too hot or too cold?
HOT: Red Skin, Swollen, Blisters
COLD: Pale/White/Greyish Skin
What do you want to watch out for when applying an elastic bandage?
Pain?
Pulse?
Pale (Is the skin pale in color)?
Semi-Fowler’s Position
Position in which a patient, typically in a hospital or nursing home in positioned on their back with the head and trunk raised to between 30 and 45 degrees. Although, 30 degrees is the most frequently used bed angle.
High/Full Fowler’s Position
Position in which a patient, typically in a hospital or nursing home in positioned on their back with the head and trunk raised to 90 degrees.
Standard Fowler’s Position
Position in which a patient, typically in a hospital or nursing home in positioned on their back with the head and trunk raised to between 45 and 60 degrees.
Low Fowler’s Position
Position in which a patient, typically in a hospital or nursing home in positioned on their back with the head of the bed raised 15-30 degrees
Vascular dementia
can occur when blood circulation to the brain decreases as a result of a stroke or another problem, damaging blood vessels in the brain
Dementia with Lewy bodies
deposits of protein that develop throughout the brain. These protein deposits damage and kill nerves in the brain over time.
Confusion
inability to think clearly, causing disorientation and trouble focusing
An individual’s personality is created by his/her background, including…
o Ethnic group membership (race, nationality, religion)
o Cultural or social practices
o Environmental influences, such as where and how they were raised as children
o Career choices
o Family life
o Hobbies
What are the 5 stages of Grief?
stages of grief in response to near death, based on personal, cultural and religious beliefs and experiences, according to Elizabeth Kubler-Ross
1st Stage - Denial 2nd Stage - Anger 3rd Stage - Bargaining 4th Stage - Depression 5th Stage - Acceptance
Advance Directive
a living will written while resident is mentally competent or by resident’s legal representative which outlines choices about withdrawing or withholding life-sustaining procedures, if terminally ill
Cheyne-Stokes Breathing
when resident takes several shallow breaths followed by periods of no breathing for 5, 30, or even 60 seconds; does not cause the resident discomfort
Do Not Resuscitate (DNR)
an order written by a doctor at the request of a resident, which tells the health care team that the resident does not wish any extraordinary measures to be used when resident suffers cardiac or respiratory arrest
End of Life Care
support and care provided during the time surrounding death
Extraordinary Measures
interventions used to restore heart beat or respiratory effort (cardiopulmonary resuscitation or CPR)
Hospice Care
health care agency or program for people who are dying (usually less than six months to live) that provides comfort measures and pain management, preserves dignity, respect and choice, and offers empathy and support for the resident and the family
Mottling
changes in skin color (pale and bluish) of the hands, arms, feet, and legs when death is near
Obituary
a description (typically placed in a local newspaper) of a resident’s life, including listing of relatives, birth information, accomplishments/activities, and death, written upon the death of the resident
Chain of Survival
1st Link : You - Recognition of cardiac arrest and activation of the emergency response system
2nd Link: CPR - Early cardiopulmonary resuscitation with an emphasis on chest compressions
3rd Link: AED: Rapid defibrillation
4th Link: Advanced resuscitation by Emergency Medical Services and other healthcare providers
5th Link: Post-cardiac arrest care
6th Link: Recovery (including additional treatment, observation, rehabilitation, and psychological support)
Ways to administer Narcan (Naloxone)?
Nasal, Invarvenous (IV), intramuscular (IM), or Subcutaneous (SubQ)
What are the first 4 action steps when you encounter an unresponsive infant/adult/child?
Step 1: Make sure scene is safe for you & victim
Step 2: Check for responsiveness
Step 3: Activate emergency & response and get AED
Step 4: Assess for breathing & Pulse
What is the differences between an infant & child under 8 CPR and Adult CPR?
Infant & Child Under 8 :
1 1/2” / 30:2 (1 Rescuer) 15:2 (2 Rescuers) /
1 Breath every 2 - 3 seconds
Child over 8 & Adult :
2” / 30:2 (Always) /
1 Breath every 6 seconds
Signs someone is chocking
- clutching at the throat.
- neck or throat pain.
- inability to speak, breathe or swallow.
- coughing.
- wheezing or other unusual breathing sounds.
- gagging.
- a change in color (eg. blue lips or red face)
- chest pain.
Dyspnea
Difficulty breathing
What are the steps for when and Adult, Child and Infant are choking?
Adult: pg 30
Child: pg 50
Infant: pg 68
CAB
C - Compressions First
A - Airway Clear
B - Breaths of Rescue
What is the Nurse Aide Role in Caring for Residents who are Stressed?
- Listen to concerns
- Observe and report nonverbal messages
- Treat with dignity and respect
- Attempt to understand behavior
- Be honest and trustworthy
- Never argue with residents
- Attempt to locate source of stress
- Support efforts to deal with stress
What is the Nurse Aide Role in Caring for Residents who are Demanding?
- Attempt to discover factors responsible for behavior
- Display a caring attitude
- Listen to verbal and nonverbal messages
- Give consistent care
- Spend some time with the resident
- Agree to return to see the resident at a specific time and keep your promise
What is the Nurse Aide Role in Caring for Residents who are Agitated?
- Encourage to talk about fears
- Remind resident of past ability to cope with change
- Encourage to ask questions about concerns
- Involve in activities that promote self-esteem
- Observe for safety and to prevent wandering
- Assign small tasks
- Use reality orientation
What is the Nurse Aide Role in Caring for Residents who are Paranoid?
- Reassure the resident that you will provide safety
- Realize behavior is based on fear situations
- Avoid agreeing or disagreeing with comments
- Provide calm environment
- Involve in reality activities
What is the Nurse Aide Role in Caring for Residents who are Combative?
- Display a calm manner
- Avoid touching the resident
- Provide privacy for out-of-control residents
- Secure help if necessary
- Do not ignore threats
- Protect yourself from harm
- Listen to verbal aggression without argument
Impending Death Signs That the Resident is Within Hours or Days of Death?
• Psychological and physical withdrawal
• Decreased level of alertness, with increased periods of sleeping
• Body temperature rises
o Feels cool, looks pale, and perspires
• Circulatory system fails
o Pulse is fast or slow, weak and irregular
o Blood pressure drops
o Extremities become cold and pale, mottling occurs (bruise-like discoloration
• Respiratory system fails with erratic breathing patterns occurring
o irregular, rapid and shallow or slow and heavy
o Cheyne-Stokes breathing – when resident takes several shallow breaths followed by periods of no breathing for 5, 30, or even 60 seconds; does not cause the resident discomfort
o Noisy respirations
o Mucus collects in airway, a rattling or gurgling sound as the resident breathes (what some people refer to as “death rattle”)
o Apnea – respiration stops
• Digestive system – slows down
o Distention of abdomen
o Fecal incontinence due to relaxed muscles
o Nausea and vomiting
• Urinary system
o Dark-colored urine in very small amounts due to decreased blood supply to the kidneys
o Incontinence due to relaxed muscles
• Muscle tone
o Starting in the feet and legs movement and muscle tone are lost
o Eventually mouth muscles relaxes and jaw sags;
o Body becomes limp
• Sensory – sensory perception decline
o Blurred and failing vision; may stare yet not respond, lack of blinking;
o Touch is diminished
o Hearing is believed to be the last sense to be lost
o Pain decreases with loss of consciousness
Signs That the Resident has Died?
- No pulse/heartbeat
- No respirations
- No blood pressure
- Pupils are fixed (do not respond to light) and dilated (big)
- No response when resident is talked to or touched
- Eyelids may remain opened; enlarged pupils that do not respond to changes in light
- Mouth may remain open
- May have bowel and bladder incontinence
