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Older Adult OT > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Palliative Care

A

Begins at diagnosis
Can be utilized while patient is receiving active treatment
Typically happens in hospital
Goal
- Pain relief and symptom management
- Offer support systems to clients and their families
- Integrate psychological and spiritual aspects of care with medical treatments
- Enhance quality of life

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2
Q

Goals of hospice

A

Goals
- Maintain independence as long as possible
- Provide supplemental services
- Provide family and caregiver support
- Improve quality of life
- Pain and symptom management

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3
Q

Qualifications of hospice

A

Physician certification
Prognosis of 6 months or less
No longer receiving active treatment for terminal illness
Complete 2 90-day face-to-face certification periods with physician and unlimited subsequent 60-day period

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4
Q

Hospice

A

End of life care that focuses on quality of life and surrounding patients and their family with care and support
Begins after treatment has been stopped
Right for everyone
Paid by Medicare, Medicaid, Insurance
Typically occurs wherever patient calls home

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5
Q

Role of OT in palliative and hospice care

A

Maintaining independence
Adaptation and compensation
Family and caregiver education
Psychosocial support
Improve safety
Pain management
Improve quality of life
Educate family and caregivers
Patients change rapidly and require weekly reevaluations

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6
Q

Advanced care planning

A

Learning about and making decisions on medical care ahead of time
Includes CPR, ventilator use, artificial nutrition and artificial hydration, and comfort care

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7
Q

Living will

A

Detailed document about what medical treatments the person does or does not want

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8
Q

Power of attorney/medical power of attorney

A

Designates someone to make decisions for the individual if they are unable to

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9
Q

Physician/medical orders for life-sustaining treatment

A

More detailed type of DNR followed by all healthcare professionals and overrises procedures that may be legally required

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10
Q

Alzheimer’s Disease/dementia mental health directive

A

Comprehensive advanced directive of specific topics related to dementia and mental health
- Who they want to provide personal care
- Long term care facility preference
- Addressing combative or aggressive behaviors
- Intimate relationships
- Driving

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11
Q

Kubler-Ross Stages of Grief Model (Seven Stages of Grief)

A

Shock and disbelief
Denial
- Person is in denial of person’s death or denial that they’re having a difficult time
Guilt
Anger and bargaining
Depression
Reconstruction
- Looking for ways to move forward and get back to normalcy
Acceptance
- Successful coping with loss

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12
Q

Interacting with a dying person

A

Let person talk about death and feelings
Let person plan death and legacy
Mark special events and make each visit meaningful
Keep conversations normal and natural
Use touch when the patient is not responding

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13
Q

Signs of impending death

A

Increased sleep
Decreased food and drink
Shallow respirations
Congested rattled sounding lungs
Loss of bowel and bladder control
Mottled skin
Cyanotic lips and extremities
Excessive sweating (diaphoresis)
Increased restlessness, calling out, or talking to people who are not there
Expressing a need for reconciliation

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14
Q

Caregiver demographics

A

49-year-old female
Care provided for an average of 4.5 years
60% are employed
60% Caucasian
35% have high school education or less

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15
Q

Care recipient demographics

A

2/3 are women
68.9 year old average and 72 year old median
Typical reasons
- Long-term physical condition
- Short term physical condition
- Memory problems

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16
Q

Most and least expensive caregiving options

A

Most expensive: nursing facilities
Least expensive: adult day health care

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17
Q

Most difficult care activities for caregivers

A

Incontinence
Toilet transfers
Bathing/showering assistance

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18
Q

ADL burden of care on caregivers

A

Bed/chair transfers
Dressing
Showering
Feeding
Toilet transfers
Incontinence

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19
Q

IADL burden of care on caregivers

A

Transportation
Grocery shopping
Housework
Meal preparation
Finances
Giving medications, pills, or injections
Arranging outside services

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20
Q

How can occupational therapists support caregivers?

A

Attend to their own physical, emotional, recreational, spiritual, and financial needs
Provide psychosocial support
Investigate outside support groups
Suggest proper nutrition and exercise
Ask for help with caregiving or support from other family members and friends
Provide caregivers/family with education regarding
- Transfer training
- ADL training
- Adaptive equipment
- Compensatory strategies
- Activity modification
- Stress management strategies
- Environmental modification
- Body mechanics
- Fall prevention

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21
Q

Driving Rehabilitation Specialist

A

Advanced training and education
Complete behind the wheel evaluations
Prescribe adaptive equipment for driving
Perform in-vehicle training
Collaborate with DMV to support client through licensing process

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22
Q

Range of driver rehabilitation programs

A

Basic
- For individuals with cognitive impairment
- Not equipment based

Low tech
- For individuals who need of modification to vehicle

High tech
- For an individual who needs a specialty vehicle

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23
Q

Model for classifying driver risk

A

Red
- Risk factors clearly exceed threshold for safe driving
- Promote retirement and support transportation

Yellow
- Driving risk or potential is not clear
- Further evaluation is needed
- Rehab to optimize subskills and consider need for further services

Green
- No or limited risk factors for driving safety
- Encourage fitness, strength, and flexibility
- Promote driver safety programs
- Discuss warning signs

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24
Q

DRIVE Model

A

Develop
Readiness
Intervention
Verification
Evaluation

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25
Q

Generalist’s Resource to Integrate Driving (GRID)

A

Resource for generalists to assess the client’s fitness to drive
Includes client factors and contextual factors

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26
Q

GRID client factors

A

Medical history such as seizures, neurological status, diabetes, etc.
Driving history
Insight
Physical skills
Visual skills
Cognitive/perceptual skills
- AMPS
- Trail Making A
- Trail Making B
- Clock drawing
- Brief cognitive assessment
- MOCA
- Snellgrove maze

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27
Q

GRID contextual factors

A

Falls
State guidelines
Medical condition prognosis

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28
Q

Preparing client for return to driving

A

Remediation of function
Compensation for deficits
Integration of skills
- Visual motor skills
- Speed of processing
- Divided attention
Educate on state laws

29
Q

Specialist evaluation

A

Clinical evaluation
- 1.5 hours
- Visual function (contrast sensitivity and binocular function_
- Reaction time
- Motor and sensory assessmnet
- Performance based test
- Diagnosis specific assessments (ex. Dementia screen)

Behind the wheel evaluation
- 1.5 hours
- Driver evaluation vehicle with instructor brake
- Start in a low challenge environment
- Increase demands to include use of executive function skills
-> Ex. “Find and pull into a gas station” or “Drive me to a familiar location from here”

30
Q

Driver specialist intervention

A

Specialized driver education
Adaptive equipment training
Compensatory strategies
- Ex. Modifying a driving route to avoid left turns
Communicate conclusions to family, client, and referring physician

31
Q

CarFit 12-point item checklist

A

Are you the only driver?
Is the driver using a seat belt?
Steering wheel tilt/head restraint device
Distance between chest and steering wheel
Line of sight above steering wheel (should be at least 3 inches)
Positioning to gas pedal (should not need to reach with toes)
Positioning to brake pedal (should not need to reach with toes)
Mirror use
Neck mobility for blind spot check
Ignition key
Operation of vehicle controls
Driver walking around vehicle

32
Q

Measurements recommended from driver to steering wheel

A

At least 10 inches

33
Q

Measurement recommended for line of sight above the steering wheel

A

At least 3 inches line of sight

34
Q

CarFit

A

Community based educational program by American Society on Aging with AAA, AARP, and AOTA
Uses a 12-point checklist to help older drivers find out how well they currently fit their personal vehicle and helps to promote conversations about driver safety and community mobility
Typically for drivers 55+
Events are set up by a coordinator in a big parking lot and each appointment takes 20 minutes to complete

35
Q

Need for CarFit

A

Over 1/3 of participants have at least one critical issue
1/10 was seated too close to steering wheel
20% did not have line of sight at least 3” over steering wheel
Older drivers are safer drivers but more likely to be killed or seriously injured when a crash occurs due to increased fragility
Properly adjusting cars can increase the safety of older adults and other drivers

36
Q

CarFit technician

A

Facilitate check-in, check-up, and check-out

37
Q

CarFit event coordinator

A

Train technicians, secure dates and locations, participate in and monitor CarFit events
Communicate with the national organizations, AAA, AARP, and AOTA

38
Q

CarFit instructor

A

Educate event coordinators

39
Q

OT role at CarFit event

A

Address red flag concerns from 12 point checklist
Begin conversation about vehicle fit
Offer basic suggestions and demonstrate readily available devices
Offer education and describe specialized resources and service

40
Q

Female sexuality changes

A

Decreased rate and amount of vaginal lubrication
Decreased number of vaginal contractions
Quicker return to pre-arousal stage
Atrophy of labia, uterus, and reduction in expansion of vagina width
Thinning of lining of vagina
Low desire
Difficulty with vaginal lubrication or inability to climax

41
Q

Male sexuality changes

A

Slower and less full erection
Erection disappears quickly after orgasm
Longer refractory period (12-24 hours)
Testicles do not achieve full elevation and will not increase in size
Decreased volume of sperm
Ejaculatory control increases
Ejaculation is less powerful and orgasm is less intense
Decrease in ejaculatory testosterone

42
Q

LGBTQ+ older adults sexuality

A

Fears in seeking out care
Higher rates of physical limitations, weakened immune system, mental distress, and chronic disease
Gay and bisexual men are twice as likely to live alone and have a higher risk of cancer and HIV
Transgender older adults have higher rates of discrimination, victimization, mental distress, poor health, less support
May identify with chosen family rather than biological family

43
Q

STDS and older adults

A

51% of diagnosis of HIV/AIDS was among people over 50 and is diagnosed in later stages
Older adults may have weaker immune systems to fight infections
Important to teach safe sex
CDC recommends annual chlamydia screening for all sexually active older women with risk factors
Healthcare providers do not routinely discuss STDS with older adults and may misdiagnose signs
Higher mid-life divorce
Many older adults did not get sexual education
Men may not want to wear condoms

44
Q

Erectile dysfunction

A

23% of older adults are diagnosed with ED
Individuals usually seek help from a personal physician
Associated with disease conditions such as cardiac disease, diabetes, and neurogenic factors such as Parkinson’s
Medications should be prescribed with caution

45
Q

Ex-PLISSIT model

A

Permission
- Listen non-judgmentally, knowledgably, and relaxed as patient discusses sexual concerns

Limited information
- Educate the client about normal physiological changes with aging, psychosocial factors, and myths and stereotypes about the sexual health in the older adult population

Specific suggestions
- Provide patient specific suggestions to improve sexual functioning
- Refer to a specialist

Intensive therapy
- Pelvic floor exercises (OT/PT)
- Involves expertise of skilled social worker, psychologist, or psychiatrist

46
Q

General sexual education intervention suggestions

A

Experiment with different sexual positions and positioning aids for comfort
Explore different adaptive equipment
Educate on energy conservation techniques
Encourage other forms of sexual expression
Reassure person
Discuss fears about sex
Exercise to increaseor maintain ROM and muscle strength

47
Q

Challenges with sexual health in individuals with arthritis

A

Older adults with rheumatoid arthritis are more likely to have concerns about sexual functioning than those with osteoarthritis
Hip abduction contractures are the greatest obstacle to sexual functioning

48
Q

Sexual health interventions for arthritis

A

Take a warm bath prior or use of mattress warmer during sex
Use energy conservation techniques (rest prior, consider timing)
Take pain medication prior
Use a side by side position
Change positions to decrease joint pressure
Use pillows and bolsters for comfort and to support joints
Communicate pain
Encourage seeking physician guidance if pain occurs
Reduce stress and fears related to sex

49
Q

Hip precautions

A

Critical 4-6 week period of precautions
Do not bend hip more than 90 degrees
Do not adduct hips
Do not internally rotate hips

50
Q

Sex for total hip precautions

A

Sex in missionary position with client on bottom, hips abducted, feet pointed up and with knees in extension
When lying on unaffected side, keep affected leg outside of midline of body by putting a pillow between legs or using their partner’s legs for support

51
Q

Total knee replacement hip precautions

A

Do not kneel
Do not squat
Do not twist knee

52
Q

Sex positions for total knee replacements

A

Males
- Side-lying
- Cowgirl
- Reverse cowgirl
- Sitting on a chair

Females
- Missionary
- Standing
- Side-lying

Gender neutral
- Sitting in chair
- Side-lying

53
Q

Cardiac diseases and sexual health

A

Extreme anxiety and depression
Link between cardiovascular disease and diabetes with sexual dysfunction
Sexual activity can begin after acute phase of illness with average recovery time 8-16 weeks after physician approval

Low risk
- Patients with controlled hypertension can safely resume sex
Medium risk
- Patients with mild angina require further cardiac evaluation
High risk
- Patients with unstable angina or hypertension
- Recommended to be stabilize condition before resuming sexual activity

54
Q

Interventions for cardiac patients’ sexual health

A

Reassure person that heart attack is unlikely as a result of sex
- Sexual activity causes 1% of all MI
Promote physical activity
Educate to stay away from extramarital affairs
Encourage a gradual return to sexual activity to reduce anxiety
Suggest grading sexual activity
Discuss fears
Consult with physician or pharmacist about possible medication side-effects
Teach relaxation techniques
Teach energy conservation
- Ex. Rest before sexual activity

55
Q

Cardiac patients and sexual health precautions

A

Shortness of breath
Chest pain
Excessive fatigue
Continuous increase in blood pressure
Heart palpitations lasting longer than 15 minutes after sex
Medication side effects

56
Q

Physical demands of sex

A

Equal to mild to moderate exercise

57
Q

Challenges with sexual health after stroke (CVA)

A

Patient may have hyper or hyposensitivity to touch
Perceptual changes
Personality changes
Executive function changes
Hemiparesis/hemiplegia
Changes in tone
Decreased fatigue and endurance

58
Q

Sexual health interventions for stroke

A

Use of non-verbal communication such as touch
Educate on effects of perceptual deficits on sexual functioning
Teach energy conservation
Use positions that require less efforts for motor deficits such as side lying and client on their back
Experiment with different positions
Encourage use of vibrator
Use visual compensation with anesthesia
Use warm water prior to sexual activity to decrease spasticity
Do not overstimulate involved side of body if patient has hyperesthesia
Minimize distractions for patients with cognitive deficits
Use lubrication
Lie on affected side to free “good” arm

59
Q

Challenges with sexual health in cancer patients

A

Decreased libido due to psychosocial issues
Pain
Radiation therapy may cause erectile dysfunction
Radiation therapy in women may lead to hormonal decline and a decrease in libido erection

60
Q

Sexual health interventions for cancer patients

A

Plan ahead of time
Use positions that decreased pressure * Notify physican of use of lubricants
Use energy conservation techniques
Use pillows and bolsters to increase comfort

61
Q

Challenges with sexual health in diabetes patients

A

Neuropathy
Decreased circulation
Increased glucose levels
Men
- Erectile dysfunction
- Retrograde ejaculation
- Less ejaculation as semen enters the bladder instead of penis during orgasm

Females
- Decreased lubrication
- Difficulty achieving orgasm
- Increased risk of yeast infection

62
Q

Sexual health interventions for diabetes patients

A

Use different positioning for increased comfort
Female
- Side-lying
- Use pillows or bolsters
- Incorporate stimulation during penetrative sex
Pelvic exercises
Adaptive equipment
- Lubrication
- Vacuum pump to increase erection
- Talk to physician about oral medications

63
Q

Sexual health with cognitive impairments (Alzheimer’s disease)

A

20-30% of couples with a spouse with dementia continue sexual activity
Hypersexuality or inappropriate sexual behaviors
Inappropriate behaviors involve a thorough assessment
- With true cognitive incapacity, boundaries must be placed on person for inappropriate behavior
- Programming and re-direction should be used

64
Q

Vulnerable adult

A

Person 18 or older who has a substantial mental or functional impairment
- A substantial mental disorder is a disorder of thought, mood, perception, orientation, or memory that grossly impairs judgment, behavior, or ability to live independently or provide self-care

Person whom a guardian has been appointed under the Nebraska Probate Code

65
Q

APS Investigation timeline

A

Someone makes a report to DHHS
Intake
Investigation assessment
Ongoing service coordination
Case closure

66
Q

APS services

A

Discontinue abuse of an vulnerable adult, promote self-care and independent living, and prevent further abuse
Receiving and investigation reports of alleged abused
Developing social service plans
Arranging for medical care, mental health care, legal services, fiscal management, housing, home health
Arrange for items such as food, clothing, or shelter
Arrange or coordinate services for caregiverss

67
Q

Most common type of elder abuse

A

Financial abuse

68
Q

Geriatric Depression Scale Norms

A

Normal: 0-4
Mild depression: 5-8
Moderate depression: 9-11
Severe depression: 12-15

Older Adult OT (6 decks)

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