Geri

Question 1

What does DRIP mean

Answer 1

Delirium, restricted mobility, infection, inflammation, impaction, pharmaceutical, polyuria, psychological

Question 2

_____ incontinence is the most common form of incontinence in older adults. They feel the urge to go but does not have enough time to get to the toilet before urine is released

Answer 2

Urge incontinence

Question 3

_____ incontinence is when a small amount of urine is released after there is a sudden increase in intra abdominal pressure caused by coughing, sneezing, laughing, or lifting. Happens when the bladder outlet spinchter is incompetent or weak

Answer 3

Stress incontinence

Question 4

____ incontinence is more common in women and is often a result of poor pelvic muscle tone and a shorter urethra

Answer 4

Stress incontinence

Question 5

_____ incontinence is caused by impaired bladder emptying and over distention of the bladder. Happens when the bladder is not emptied sufficiently and has frequent dribbling of urine

Answer 5

Overflow incontinence

Question 6

_____ incontinence is when the individual is unable or unwilling to attend to toileting needs. The bladder and urethra function normally but cognitive, physical, psychological, or environmental impairments make it difficult for the older person to get to the toilet

Answer 6

Functional incontinence

Question 7

Which two types of incontinence are most common?

Answer 7

Urge and functional

Question 8

Which type of incontinence is where the patient has a large amount of urine loss

Answer 8

Urge incontinence

Question 9

What type of incontinence is where you lose a small amount of urine released and can also relate with obesity

Answer 9

Stress incontinence

Question 10

Which type of incontinence is related to neurologic and are unable to completely empty

Answer 10

Overflow incontinence

Question 11

Which incontinence can relate to inaccessible toilets, unavailable caregivers, depression, and inability to find the toilet are also causes of ____ incontinence

Answer 11

Functional incontinence

Question 12

____ ____ is used to restore the normal pattern of voiding by inhibiting or stimulating voiding

Answer 12

Bladder retraining

Question 13

In ____ ____ you learn to suppress the urge to void in an attempt to increase the amount of urine the bladder can hold

Answer 13

Bladder retraining

Question 14

In ____ ____ you begin with a schedule of toileting every 2 hours between voidings to every 3 to 4 hours while awake

Answer 14

Bladder retraining

Question 15

In bladder retraining when should you schedule for the patient to toilet

Answer 15

Upon awakening
After meals
Bedtime
And if awake at night

Question 16

____ ____ works best with cognitively impaired or confused people and requires the caregiver to take the patient to the toilet at regular intervals

Answer 16

Habit training

Question 17

In ____ ____ the toileting schedule may be every 2 to 4 hours or the caregiver may toilet the individual on awakening, after meals, mid morning; mid afternoon, at bedtime and at night if awake

Answer 17

Habit training

Question 18

Pelvic floor exercises are also known as

Answer 18

Kegel exercises

Question 19

How long should you hold kegel exercises before relaxing the muscle and how many times should you do this exercise

Answer 19

3-4 seconds and should be done 15 times a succession three times a day

Question 20

Incontinence is not a normal part of aging but it is more prevalent in elderly

Answer 20

Know

Question 21

Immobility, decreased exercise, and a lack of fiber and water in the diet are common problems for constipation in elderly

Answer 21

Know

Question 22

____ ____ is a loss of tone in the muscles of the intestine and generalized weakness of the muscles necessary for the expulsive mechanism of evacuation that occur during periods of immobilization

Answer 22

Muscular atrophy

Question 23

Nursing interventions for constipation

1. Establish a regular pattern for bowel elimination that is not associated with straining or discomfort
2. Increase water intake
3. Increase Physical Activity
4. Increase dietary fiber
   Regular exercises stimulate motility in the gut

Answer 23

Know

Question 24

The use of bed pans should be avoided not when they are used the patient should be in the _______ position

Answer 24

Up right position. (High Fowler’s)

Question 25

____ ____ occurs over bony prominences such as sacrum, ischium, trochanters, heels, elbows, and the back of the head, where normal tissue is squeezed between the internal pressure of the bone and an external source of pressure or friction like the bed or chair

Answer 25

Pressure ulcers

Question 26

___ is the most important risk factor in the development of pressure ulcers

Answer 26

Immobility

Question 27

____ occurs when the head of the bed is elevated more than 30 degrees and the person slides toward the foot of the bed. In this situation the skin over the sacrum doesn’t move

Answer 27

Shearing

Question 28

____ is when the skin is loved across the sheets such as when the person is being pulled up rather than lifted up in the bed

Answer 28

Friction

Question 29

____ can lead to perspiration or incontinence can increase the friction between the surface and the skin.

Answer 29

Moisture

Question 30

Physiological risk factors that increase skin break down. 1. Aging skin 2. Immobility 3. Malnutrition

Answer 30

Know

Question 31

List the stage of pressure ulcers ________ is nonblanchable erythema of intact skin. Reddened skin even in absence of direct pressure

Answer 31

Stage 1

Question 32

Name the stage of pressure ulcer _____ partial thickness skin loss involving epidermis or Dermis the ulcer is superficial and manifests clinically as a abrasion, blister, or shallow crater

Answer 32

Stage 2

Question 33

_____ is full thickness of skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through underlying fascia. Ulcer manifests clinically as a deep crater with or without undermining as a deep crater of adjacent tissue

Answer 33

Stage 3

Question 34

____ is full thickness loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures. Undermining and sinus tracts also may be associated with stage __ pressure ulcers

Answer 34

Stage 4

Question 35

When do falls typically happen most

Answer 35

At night

Question 36

______ is a vital first step in prevention of pressure ulcers

Answer 36

Assessment of risk

Question 37

In ___ ____ you will access on admission and every 24 hours or sooner if patients condition changes

Answer 37

Acute care

Question 38

In ____ ___ you will access on admission and weekly for 4 weeks. Then access every quarter or as the residents condition changes

Answer 38

Long term

Question 39

In ____ ___ you will access on admission and on every nurse visit

Answer 39

Home care

Question 40

How frequent should a person be repositioned to reduce risk for pressure ulcers

Answer 40

Every 2 hours

Question 41

If suspicion of pressure ulcer who should you notify first (on page 326)

Answer 41

The RN

Question 42

Nursing care is aimed at maintaining skin integrity by preventing irritation to the skin from friction to moisture. Provide adequate nutrition and good hygiene are also important to assist with healing process

Answer 42

Know

Question 43

You can use air filled, water filled, or gel filled chair pads or mattresses. Walking programs and passive and active ROM exercises are important in the prevention of skin breakdown

Answer 43

Know

Question 44

Needing to void frequently during the night is called

Answer 44

Nocturia

Question 45

_____ ____ is a medical condition in which one stops breathing for 10 seconds or longer numerous times throughout the night, more common in elderly

Answer 45

Sleep apnea

Question 46

_____ sleep apnea is caused by a defect in the CNS that effects the diaphragm

Answer 46

Central sleep apnea

Question 47

____ sleep apnea is caused by an obstruction in the upper airway that impedes air flow

Answer 47

Obstructive sleep apnea

Question 48

______ _____ is defined as the appearance of exacerbation of symptoms of confusion associated with the late afternoon or evening hours. Marked by behaviors such as agitation, confusion, wandering, and screaming

Answer 48

Sundown syndrome

Question 49

What are three things commonly used to promote sleep but should be avoided in elderly. Try to do things that are not meds, back rubs, warm milk, assisting with toilet needs, providing socks or extra blankets, repositioning

Answer 49

Know

Question 50

____ disorders can be defined as disorders that a person acquired as a result of receiving treatment by the physician nurse or other member of IDT. Can occur if patient doesn’t receive treatment or receives wrong treatment

Answer 50

Iatrogenic disorders

Question 51

The most common type of dementia is associated with

Answer 51

Alzheimer’s disease

Question 52

____ is the loss of intellectual abilities to the extent that it interferes with normal activities of daily living

Answer 52

Dementia

Question 53

____ occurs gradually, over months or years and is the result of deterioration of the brain

Answer 53

Dementia

Question 54

_____ is the first stage of disorientation

Answer 54

Malorientation

Question 55

Treatment method of changing behavior is called

Answer 55

Behavior modification

Question 56

Sudden, reversible state of confusion

Answer 56

Delirium

Question 57

False fixed idea or belief

Answer 57

Delusion

Question 58

False sensory impression, often seeing or hearing something that’s not there

Answer 58

Hallucination

Question 59

The perception of a real event or object

Answer 59

Illusion

Question 60

A way of using communication using neurological, behavioral, and sleep patterns

Answer 60

Neurolinguistic programming

Question 61

Condition of decreased stimulation that can cause hallucinations, illusions& disorientation

Answer 61

Sensory deprivation

Question 62

Problems with calculating

Answer 62

Acalculia

Question 63

When one forgets important info and functions

Answer 63

Apraxia

Question 64

When a person cannot match a name with something

Answer 64

Anomia

Question 65

A way to communicate with people with dementia

Answer 65

Validation therapy

Question 66

___ is the most important risk factor for Alzheimer’s disease

Answer 66

age

Question 67

____ and ___ ___ develop in the brain are two of the main features of Alzheimer’s disease that are responsible for the changes in cognitive abilities

Answer 67

Plaques and protein tangles

Question 68

Stages of disorientation in dementia 1. Malorientation 2. Time confusion 3. Repetitive motion 4. Vegetation

Answer 68

Know

Question 69

___ is stimulating memories of child hood or early adulthood can serve to improve feelings of self worth and provide an opportunity to review their lives. Memories may stimulate laughter and happiness r other emotions and all serve as a way of coping

Answer 69

Reminiscence

Question 70

_____ is the use of real objects to stimulate senses and provide new motivation in life and the surrounding world. Pictures, plants, animals or sounds can be used to encourage group interaction

Answer 70

Remotivation

Question 71

If a person becomes physically aggressive remember that the thumb is the weakest point of the hand and if a person has a hold on you the way to remove yourself is by rotating away from the thumb of the persons hand.

Answer 71

Know

Question 72

Some people in early stages of Alzheimer’s disease and bipolar disorders tend to sexually act out. Notice any factors that may be a trigger and intervene before behavior occurs

Answer 72

Know

Question 73

Ways to communicate effectively for persons with psychological problems

Answer 73

Preferred sense of words. Vague pronouns(refer to women as she) Speak slowly (wait a little longer for a response) asking the extremes (what is the worst/best)

Question 74

What type of communication is the most honest?

Answer 74

Nonverbal

Question 75

Within person

Answer 75

Intrinsic

Question 76

In environment

Answer 76

Extrinsic

Question 77

____ ____ is initiated after an older person has reached the rehabilitative goal or has not shown any further improvements

Answer 77

Restorative care

Question 78

Rehabilitation provides individuals with intensive short term strengthening and retraining, where as restorative care continues the process over time

Answer 78

Know

Question 79

For successful rehabilitation and restorative program must include

Answer 79

``` Independence and self care Mobility Involvement in activity Fulfillment in life goals Holistic approach to living with a disability ```

Question 80

Walking programs (Strengthening exercises should be provided while person is still confined to bed) includes muscles of arms, shoulder, chest and back. Patient needs to be taught how to move from bed to chair and needs to be capable without assistance

Answer 80

Know

Question 81

____ ____ means providing care requested by the older person in terms of advanced directives and a living will

Answer 81

Palliative care

Question 82

A second major clinical challenge is maintenance of bladder and bowel continence In a traumatized disabled older adult.... this is called continence training.

Answer 82

Bladder retraining is generally successful when a regular time is established for emptying the bladder

Question 83

Feeding and self feeding programs Elderly should be fed at regular mealtimes and snacks should be provided Promoting the older person to a self feeding program is a definite sign of progress.

Answer 83

Know

Question 84

Self promoting behaviors and ADLS Independence in personal care is a challenge for elderly with disabilities that affect their ROM mobility, strength, coordination, and dexterity. Allow them to have time to perform aspects of their own care. A chair in the tub may help a weak individual. Lowered sinks, mirrors, devices with long handed shoe horns to insert ones socks, clothing with Velcro fasteners

Answer 84

Know

Question 85

Scissors and tweezers are used for ____ for a stage ___

Answer 85

Debridement stage 4

Question 86

____ is the absorption for bacteria filler and is used on what stage

Answer 86

Aquacel stage 3

Question 87

___ is for speciality absorption, gels to maintain moisture in wound bed and what stage wound

Answer 87

Aquacel foam and stage 3

Question 88

Unable to communicate in the form of writing

Answer 88

Agraphia

Question 89

Inability to process sensory info. Loss in ability to recognize people, sounds or shapes

Answer 89

Agnosia

Question 90

Inability to see words or read

Answer 90

Alexia

Question 91

The loss of control of full bodily movements

Answer 91

Ataxia

Question 92

is a neurological disorder which explains the loss of ability to conceptualize, plan, and execute the complex sequences of motor actions involved in the use of tools or otherwise interacting with objects in everyday life.

Answer 92

Ideational apraxia

Question 93

Tegaderm can be used on stage

Answer 93

One

Question 94

Specialty alignate silver also bacterial is used on stage

Answer 94

3

Question 95

Duoderm CGF dressing is used on stage

Answer 95

3

Question 96

Hydrogel dressing stage

Answer 96

2 if no drainage stage 3

Question 97

Special absorption turns liquid to gel, gel is to maintain moisture in wound bed is used on stage

Answer 97

3

Question 98

Speciality absorptive used on stage

Answer 98

3