GERO Exam 1

Question 1

What is primary prevention?

Answer 1

Refers to strategies that can and are used to prevent an illness before it occurs; wellness is promoted
o	Healthy lifestyle
o	Behavior teaching
o	Walking- helps respiratory and cardiac
o	Stress management
o	Social engagement
o	Cognitive stimulation ex. puzzles, 
o	Immunizations 
o	Intellectual stimulation
o	Restful sleep

Question 2

What is secondary prevention?

Answer 2

Early detection of a disease or health problem that has already developed
o Evidence based screenings and guidelines ex. mammograms, eye screening
o A1C
o Personal prevention plan
o Target diet

Question 3

Health disparity

Answer 3

Differences in the state of health and health outcomes between groups of persons ex. generation vs generations, one race with another, men and women

Question 4

Health inequity

Answer 4

o Excess burden of illness or the differences between the expected incidence or the prevalence of the incidence
o Most prevalent in this group, older adults

Question 5

What is health disparity?

Answer 5

Differences in the state of health and health outcomes between groups of persons ex. generation vs generations, one race with another, men and women

Question 6

What is health inequity?

Answer 6

o Excess burden of illness or the differences between the expected incidence or the prevalence of the incidence
o Most prevalent in this group

Question 7

What is reducing health disparities in cultural awareness?

Answer 7

• Self-level… requiring self-understanding of one’s values and experiences’ how is ones’s value affect one valuez
• Ability to… work and build relationships with members from another cultural group
• Recognition of… factors beyond culture such as health, safety that affect any cultural group such as age, gender.

Question 8

What is reducing health disparities in cultural knowledge?

Answer 8

• Both… what the nurse brings to the caring situation and what the nurse learns from the older adults (from communication and listening)
• Essential knowledge… includes elder’s way of life, means how they think and how they act

Question 9

How do you reduce health disparities?

Answer 9

Cultural skills: use of communication

Unspoken Communication: handshakes, eye contact, hugs (always ask their preferences). be aware that your body language, etc, are extremely communicative

Spoken Communication: jargon, idioms, inflection (always get a professional interpreter)

*Box 4-10 (guide for working with interpreters)

Question 10

What is wellness?

Answer 10

The concept of wellness incorporates all aspects of one’s being Such as

• phsyical: ability to walk, feed self, general ADLs
• emotional: living alone, lose and grief
• intellectual: dementia
• social: living alone
• spiritual: faith/religion
• cultural: are they still able to interact culturally
• environmental: are they in a healthy living situation

Question 11

Genitourinary assessment

Answer 11

o	Renal Function 
o	Ability to void
o	BP for Hypotension (<90/60 mmHg)
o	Fall Risk
o	Pain 
o	Frequency (may mean UTI) - normal: 6-7 times in 24 hr period
o	Urgency (may mean UTI)
o	Constipation
o	Inactivity 
o	Dehydration (big cause of UTI) (encourage fluids every hour, if not contraindicated)
o	Indications of drug toxicity
o	Mental status change

Question 12

Genitourinary intervention

Answer 12

o Encourage fluids
o Fall Precautions
o Monitor for drug toxicity
o Health Promotion: Bladder training and fluid intake (ex. Kegel exercises)

Question 13

Pneumonia

Answer 13

A leading cause of death in older adults.
Contributing Factors:
o Poor chest expansion and more shallow breathing
o Lowered resistance to infection
o Reduced Mobility
o Increased mucus formation and bronchial obstruction
o Increased incidents of hospitalization and institutionalization (long-term care) leads to increased nosocomial pneumonia.
o Changes due to aging may mask signs and symptoms:
o Pleuritic pain
o Lower Temperature

Question 14

Pneumonia symptoms

Answer 14

o	Slight cough
o	Fatigue
o	Rapid respiration
o	Confusion *  
o	Restlessness (low O2 stat)
o	Behavioral changes *  (can be from UTI)

Question 15

Cardiac changes

Answer 15

o Heart valves increase in thickness and rigidity R/T sclerosis and fibrosis
o Aorta becomes dilated
o Slight ventricular hypertrophy
o Myocardial muscle loses some of its contractile strength causes a reduction in cardiac output, meaning it is less efficient with increased activity or demands on the heart. (due to stiffening)
o Diastolic filling and systolic emptying require more time to complete the cycle.
o Calcification and reduced elasticity of vessels. Becomes less sensitive to baroreceptors Reduces regulation of blood pressure. Reduced arterial BP leads to decreased tissue profession.
o Changes are usually gradual and become more apparent when the older adult is placed under increased activity. Consider early morning walks to restroom – increased death.

Question 16

Pneumonia Interventions

Answer 16

o Encourage good fluid intake (thins secretions and keep them hydrated)
o Manage bronchial secretions
o Prevent obstructions (for possible aspirations)
o Preventative measures for infections
o Instruction in breathing exercises
o Raise HOB at least 30 degrees (unless it is contraindicated)
o Educate and instruct patient to turn, cough and deep breath every two hours
o Health Promotion: Vaccines: Pneumonia and Influenza

Question 17

Genitourinary or Urinary elimination changes related to aging

Answer 17

o Hypertrophy of the bladder muscle and thickening decreases the ability of the bladder to expand and reduces capacity, leading to urinary frequency and nocturia. Kidney circulation improves when a person is in a recumbent position and increase the need to void. This is not a normal part of aging and is related to other aging issues.
o Retention of urine due to neurological inefficiencies and a weaker bladder that does not empty properly.
- Woman: fecal impaction
- Men: prostatic hypertrophy
o Reduced filtration efficiency of the kidneys affects the body’s ability to eliminate drugs and causing higher blood urea nitrogen levels.
o Incontinence Also not a normal part of aging, but usually caused by age-related physical or mental disorders.

Question 18

GU-Labs

Answer 18

BUN >20 mg/dL
Creatinine > 1.1 mg/dL
Proteinuria 30 mg/g or higher

Question 19

Genitourinary nursing considerations

Answer 19

o	Potential for adverse drug reactions or toxicity (because the motility is not working, elimination is important)
o	Pain
o	Risk for Infection - UTI
o	Risk for Falls
o	Need for toileting assistance 
o	Potential for skin breakdown
o	Sleep disruption
o	Potential for social isolation (may get depression -> not leaving bed -> death)

Question 20

Pulmonary changes in older adults

Answer 20

o The trachea stiffens due to calcification of its cartilage. This reduces the ability to cough because it blunts the laryngeal and coughing reflexes.
o Reduced number of nerve endings may lead to a weaker gag reflex.
o The lungs become smaller in size and weight. Connective tissues needed for effective respiration and ventilation in the lungs weaken. This leads to decreased elastic recoil. Respiration then requires the use of accessory muscles.
o Alveoli are less elastic, develop fibrous tissue, contain fewer functional capillaries and have less surface area. This reduces gas exchange.
o Loss of skeletal muscle strength in the thorax and diaphragm. This combined with the loss resilient force (tissues) that holds the thorax in slightly contracted leads to Kyphosis or a look of having a “barrel chest”.
o These changes add up to a reduction in vital capacity. = Less air exchange and more secretions remaining in the lungs.