Gero exam 1 Flashcards

Question

What is the Gerotranscendence Theory

Answer 1

To achieve wisdom through personal transformation

Answer 2

Selectively choosing positive rather than negative memories, companions, and activities

Answer 3

The ability to adapt and cope with the common losses in late life by focusing on strengths; compensatory strategies are used when challenges occur

Answer 4

1. Physiological (breathing, food, water, homeostasis) 2. Safety (security of body, employment of resources, family) 3. Love/Belonging (friendship, family, sexual activity) 4. Esteem (confidence, achievement, respect of others) 5. Self-Actualization (morality, creativity, spontaneity, problem-solving, acceptance of facts)

Answer 5

The Theory of Gerotranscendence which theorizes that human aging is moving from birth to death and maturation toward wisdom. Looking inside (withdrawing) & spiritual reflection can lead to wisdom

Answer 6

Statistically minorities assuming the majority

Answer 7

Differences in the state of health and in health outcomes between groups of persons

Answer 8

Excess burden of illness or the differences between the expected incidence and prevalence and that which actually occurs in excess, in a comparison population group

Answer 9

The development of cultural proficiency with increased awareness of our own beliefs and attitudes and those commonly seen in the community of healthcare.

Answer 10

Knowledge means what the nurse brings to the caring situation and what the nurse learns about all older adults, their families, their communities, their behaviors, and their expectations.

Answer 11

Western medical paradigm Focus on disease/abnormalities in body systems

Answer 12

God or supernatrual forces cause disease Good health is a blessing or reward

Answer 13

Health is a sign of balance Illness occurs with imbalance or disharmony

Answer 14

Belief that one’s system is superior

Answer 15

simplified and standardized conception of a group

Answer 16

EX: AgeISM: discriminating against people for their age

Answer 17

Listen carefully to what the elder is saying. Verbal and nonverbal. Meaning behind the stories. Explain your perception of the situation and the problems. Acknowledge and discuss both the similarities and the differences between perceptions and goals. Recommend a plan of action that takes both perspectives into account. Negotiate a plan that is mutually acceptable

Answer 18

Anatomical and physiological changes that are attributed to aging…All cells are affected by AGING

Answer 19

Anatomical and physiological changes are attributed to aging All cells are affected by aging.

Answer 20

Study of the movement and actions of a drug in the body Absorption Distribution Metabolism Excretion

Answer 21

Kidneys decrease by 10 % every decade after 40 Half life longer; build up in system

Answer 22

There is an increased gastric pH and decreased surface for absorption, blood flow to spleen and go activity. GI absorbing less; surface area of small intestine smaller so absorbs less Decrease absorption with longer half life

Answer 23

There is an increased body fat and a decreased cardiac output, total body water, lean body, serum albumin, and protein binding. Fat soluble meds may have increased affect compared to water soluble IV vs tablet may have different distribution bc IV skips breakdown so quicker and different dosage

Answer 24

there is an increase in body fat but a decrease in hepatic mass, hepatic blood flow, enzyme activity, and enzyme induct ability. Liver- enzyme activity, size

Answer 25

there is a decrease in Renal blood flow, GFR, Tubular secretory function, and Kidney size Treat symptoms so may not give meds just on schedule Kidneys excrete think = toxicity

Answer 26

Taking multiple medication at same time - 20% 65+ adults take 10+ meds - More meds taken in LTC facilities - Disabled have higher % Increased risk for drug interactions - Can block mother meds or increase the affects of other meds Increased risk of adverse events

Answer 27

Drugs identified to have a higher than usual risk when used in older adults Overwhelming benefit vs. risk documentation when prescribing these drugs considered a standard of practice Not an absolute! Can’t always be avoided. Collaborate w/ provider to reduce or change to other options when possible. Use as guide, not absolute direction

Answer 28

Cold and flu therapy Taken in tea form, but can be used as tincture Side Effects: Fever, sore throat, N/V/D, abd pain Contraindications: allergy to daisy plant, HIV, autoimmune disease increases immune system but can weaken immune as well DRUG - SUPPLEMENT INTERACTION: - risk of bleeding; digoxin level altered

Answer 29

To prevent stroke and arteriosclerosis Mixed results from the research - Reduced blood clots, reduce LDL - Two meta-analyses show it lowers BP Side effects: Flatulence, bleeding risk, nausea, heart burn, hypotension, hypoglycemia Contraindications: Use with anticoagulants - Remember many cardiac patients are anticoagulated Should be approved by healthcare provider DRUG - SUPPLEMENT INTERACTION: - risk of bleeding monitor glucose

Answer 30

Used to improve memory There is no evidence showing it improves memory Side Effects: Bleeding risk, Gi upset, headache, heart palpitations, dizziness, weakness, constipation, hypotension, Contraindications: Use with anticoagulants, antihypertensives, antidepressants, pts with seizure disorder Should be approved by healthcare provider - Most will say to avoid; stay active with word puzzles instead high risk low benefit DRUG - SUPPLEMENT INTERACTION: - Risk of bleeding; several meds contraindicated; monitor glucose

Answer 31

Many uses - Reduce stress, lower LDL, lower glucose, immune stimulant, erectile dysfunction - Research is weak, overall Side Effects: Hypertension (possible hypo), risk of bleeding, edema, diarrhea, mania (in those with bipolar) Contraindications: Use with antidiabetics, anticoagulants, antihypertensives, immunosuppresants, stimulants, MAOIs Should be approved by healthcare provider DRUG - SUPPLEMENT INTERACTION: - Risk of bleeding; several meds contraindicated

Answer 32

Reduce joint pain Improve function of knees with OA Often used in conjunction with chondroitin Evidence leans toward supporting efficacy Side Effects: GI upset, headache, insomnia, rash, hypoglycemia - Overall, well tolerated Contraindications: Shellfish allergy and glaucoma (increases. Interopticular eye pressure IOP) Use with caution - With antidiabetics, hypertension

Answer 33

Used to lower LDL Evidence leans toward supporting efficacy Side Effects: Muscle pain, liver damage, heartburn, bloating, flatulence, dizziness Contraindications: Liver dysfunction or elevated LFTs - Use with other hepatotoxic meds Like statin Should not take if no cholesterol issue DRUG - SUPPLEMENT INTERACTION: Risk of bleeding; monitor glucose

Answer 34

Mostly used to treat depression Evidence is mixed Side Effects: Photosensitivity, rash, GI upset, restlessness, anxiety, headache Severe reactions: Mania, hypomania, suicidal/homicidal ideations Contraindications: Use with triptans, MAOIs, digoxin, antidepressants - Overall, avoid in older adult: Can have severe reactions especially with older pop Should be approved by healthcare provider; Must monitor, ask question to assess issues, geriatric depression scale DRUG - SUPPLEMENT INTERACTION: - several meds contraindicated

Answer 35

Powerful antioxidant To reduce risk of MI, improve HF and BP - Mixed evidence Most common use - Along with statins - Statins reduce natural levels of CoQ10 Side Effects: Some GI upset - Overall tolerated well Increase effectiveness of antihypertensives (monitor BP) Reduce effectiveness of anticoagulants - Be careful if taking anticoagulant Commonly used and may be recommended by MD

Answer 36

Temporary Postoperative, procedural, and traumatic pain Easily controlled by analgesic; easily treatable

Answer 37

No time frame; always there Persistent at varying levels of intensity More difficult to control/treat - can be chronic pain and another injury

Answer 38

Arthritis- meds but also hot/cold Degenerative spinal conditions

Answer 39

Health assessment of older adults includes: Physical data Biological Cultural – religion, beliefs, practices Psychosocial – family relationships, social activities Functional aspects – physiological & anatomical Growth & development

Answer 40

Past Medical History Review of Symptoms Medication history - Prescription, OTC, &. Herbs & Supplements Social History - Living arrangements, Resources, & Support systems

Answer 41

• Be aware of past experiences in the health care setting. • Ask if there are persons (e.g., males in the family) who need to be present or involved in some way with the exam. • Respect the communication style used in the health care setting. • Do not intrude into personal space without permission. • Determine general health orientation related to time (past, present, future). • Inquire as to appropriate wording reference to the person; presume use of last name unless otherwise welcomed (e.g., Mrs. Jones). • Inquiry as to acceptability of touch during appropriate parts of the exam. • Inquire as to the acceptability of the gender of provider.

Answer 42

Fluids - state of hydration or ability to obtain fluids Aeration - oxygen stuff Nutrition - diet, ability to eat Communication - sight, see, talk Activity- adls Pain - perception, relieve Elimination - voiding or not Social skills - love, hope

Answer 43

Sleep disorders Problems with eating/feeding Incontinence Confusion Evidence of falls Skin breakdown

Answer 44

Tasks for independent living Needed to maintain one's home

Answer 45

Tasks of self-care Needed to maintain one's health

Answer 46

Screen for and monitor cognitive function Gross screening of dementia – rule-out not diagnosis Tests: orientation, short-term memory and attention, calculation ability, language & construction 30 items Must be able to read, write & be English proficient

Answer 47

Free an assessment tool for mild cognitive impairment and dementia

Answer 48

Screen & diagnose dementia Not for MCI (mild cognitive impairment) Manual dexterity and visual acuity required (not appropriate for blind, Parkinson’s disease, stroke, severe arthritis) - must be able to see, hold a pencil, and hear instructions Directions: Provide white plain paper with circle drawn on it, ~ 5 in diameter Ask person to draw numbers in the circle so that it looks like a clock and then put hands to read “10 after 11” Scoring: A score of 1 or 2 is considered normal. A score of > 3 represents a cognitive deficit.

Answer 49

SCREENS for MCI & dementia Equivalent to MMSE Combination of MMSE and CDT Short-term memory and executive function Must hear, hold pencil, write numbers Directions: Step 1 - Say 3 unrelated words, clearly, 1 second each.Ask person to repeat these. Step 2 - Ask person to draw a clock as in Clock Drawing Test. Step 3 - Ask person to recall the 3 words from step 1. Scoring: 0-2 postive for dementia 3-5 negative for dementia

Answer 50

- to asses mood Scoring: 0-9 normal 10-19 mild depressive 20-30 severe depressive

Answer 51

includes information about history of falls and hip fractures and an assessment of balance during transitions and walking (moving from seated to standing, walking, turning around, moving on and off toilet, and transfers between bed and chair or wheelchair)

Answer 52

to determine how steady a patient is on their feet

Answer 53

Patient questionnaire Patient completes answer questions about: Background- school hx, race, marital status, occupation Daily activities- ADL assessments Nutritional status - current weight, lost any weight recently Overall health - how far you can walk, any recent falls Medications Other medical conditions Social activities Mood Social support Global health measures (via Likert Scale) Health behaviors - smoking? drinking? activity level?

Answer 54

Increasing vulnerability to environmental risks and mistreatment by others as older adults become less physically or cognitively able to cope or recognize real or potential hazards - A safe environment allows an older person to live without fear of attack, accident, or imposed interference - Decreased sensory deficits can impair the individual’s awareness of dangerous conditions or imminent threats

Answer 55

the body's ability to maintain temperature Neurosensory changes - diminish or delay perception of environmental temperature changes Physiological changes - impair cooling and warming responses to environmental temperature changes Medications and alcohol - impair vasomotor response, inhibit neuromuscular activity, suppress metabolic heat generation, and/or dull awareness of surroundings

Answer 56

More older adults DIE from excessive HEAT than from all other natural disasters combined HEAT FATIGUE: temp normal -> pale & diaphoretic -> elevated HR HEAT EXHAUSTION: Temp-normal or mild elevation -> cold & clammy -> tachycardia, thirsty, AMS, Nausea, cramping HEAT STROKE: Temp quickly elevates to >104 F -> Flushed, hot & DRY -> Tachycardia, MS change, hypotension, hyperventilation -> Cellular & organ damage - Medical emergency w/ high mortality in older adults

Answer 57

Drink - Drink 2 to 3 L of cool fluid daily (as tolerated) Minimize - Minimize exertion, esp. heat of day Stay in - Stay in air-conditioned, or use fans Wear - Wear hats and loose clothing (natural fibers) when outside; remove most clothing when indoors Take - Take tepid baths or showers Apply - Apply cold, wet compresses, or immerse hands and feet in cool water Evaluate - Evaluate medications for risk of hyperthermia Avoid - Avoid alcohol

Answer 58

Nearly 50% of hypothermia deaths occur in older adults Defined as core temp. < 35 C (98 F) Mild, moderate, or severe depending on core temperature First Sign may be confusion and disorientation Can occur with exposure to extreme cold environmental conditions or exposure in room temperature without protection GOAL: Temp >97 F

Answer 59

Impaired circulation Diabetes Adrenal or thyroid dysfunction Malnutrition Excessive alcohol use Inadequate housing or supervision Use of sedatives, anxiolytics, antidepressants

Answer 60

S Safety record A Attention skills F Family report E Ethanol use D Drugs R Reaction time I Intellectual impairment V Vision and visuospatial function E Executive functions

Answer 61

• Do not smoke in bed or when sleepy. • When cooking, do not wear loose-fitting clothing (e.g., bathrobes, nightgowns, pajamas). • Set thermostats for water heater or faucets so that the water does not become too hot. • Install a portable hand fire extinguisher in the kitchen. • Keep access to outside door(s) unobstructed. • Identify emergency exits in public buildings. • If you consider entering a boarding or foster home, check to see that it has smoke detectors, a sprinkler system, and fire extinguishers. • Wear clothing that is nonflammable or treated with a permanent fire-retardant finish. • Use several electrical outlets rather than overloading one outlet.

Answer 62

- delirium - decreased continence - decreased appetite - decreased mental status