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Gero exam 1 Flashcards

1
Q

Fastest growing age group is ____ and older

A

85

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2
Q

What is the role of nurses in research for our older population?

A

Innovations in care, research, provision of services for growing populations

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3
Q

What is primary prevention?

A
  1. healthy lifestyle behaviors -PREVENTATIVE; exercising, refraining from smoking/drinking
  2. stress management
  3. active social engagement
  4. cognitive stimulation
  5. immunizations- High dose flu vaccine
    (60mcg hemagglutinin per strain vs. 15 mcg)
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4
Q

What is secondary prevention?

A
  1. evidence-based SCREENING guidelines -ex: screening an older adult for diabetes by checking BG & hgb A1c
  2. annual wellness visits -physical exam & labs
  3. personalized prevention plan - presenting a diabetic person with a diet plan
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5
Q

What is programmed aging?

A

Natural cell changes that occur to nearly everyone over time (wrinkles, low skin turgor, etc)
CELLS DESIGNED TO AGE

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6
Q

What are error theories?

A

random errors in synthesis of DNA to RNA
- Wear & tear theory
- Cross-linkage theory

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7
Q

What is the biological aging theory of Wear & Tear?

A

Accelerated aging due to continued use or damage (sun tanning, injuries, chemotherapy, etc)
- Cells that “wear out” or become damaged over time from continued use

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8
Q

What is biological aging?

A

referred to as senescence, is an exceedingly complex interactive process of change, resulting in decreased physiological reserves, increased rate of cellular deterioration, and increased vulnerability to disease

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9
Q

What is the biological aging theory of Cross-Linkage?

A

Aging caused by chemical changes from errors with cross-linked proteins. Results can be internal, external, or both (collagen thickening and causing stiff and swollen joints)
- damage from error with cross-linked proteins

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10
Q

What is the psychological theory of ACTIVITY?

A

Activity and “staying young” indicate successful aging
- = maintaining a productive life (physically & mentally); maintain involvement in activities/ hobbies that they have enjoyed all their life

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11
Q

What is the psychological theory of CONTINUITY?

A

Individuals develop and maintain a consistent pattern of behavior throughout their lifetime (leadership positions in post-retirement ie. church and volunteer roles)
- Con. roles, resopnisibilties, & activités for successful aging

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12
Q

What are the four theoretical proposals of Erikson and Peck?

A

Erikson: Generativity vs Stagnation, Ego integrity vs Despair,
Peck: Ego Differentiation vs Work Role Preoccupation, and Body/Ego Transcendence vs Body/Ego Preoccupation

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13
Q

What is Erikson’s theory of generativity?

A

Established oneself and contributes to society in meaningful ways

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14
Q

What is Erikson’s theory of Stagnation?

A

Self is restricted to identification with one’s major role (e.g., nurse)

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15
Q

What is Erikson’s theory of Ego Integrity

A

Attaining a sense of completeness and cohesion of the self

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16
Q

What is Erikson’s theory of Despair

A

A sense that oneself no longer has a purpose in life, physically or mentally

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17
Q

What is Peck’s theory of Ego Differentiation

A

Begins to define self as separate from work role

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18
Q

What is Peck’s theory of Work Role Preoccupation

A

Inability to identify as someone outside of a work role
Difficulty identifying oneself outside of a work role

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19
Q

What is Peck’s theory of Body/Ego of Transcendence

A

Body changes are accepted as part of life and sees oneself as part of a greater whole

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20
Q

What is Peck’s theory of Body/Ego Preoccupation

A

Body changes as a source of focus and sees oneself as an individual needing special attention

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21
Q

The Meaning of Successful; What is Role Theory

A

As one role is completed it is replaced by another one of comparative value to the individual and society
- The ability of an individual to adapt to changing roles as a predictor of adjustment to aging

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22
Q

What is the Disengagement Theory

A

Natural course of aging; the individual does, and should, slowly withdraw from society to allow the transfer of power to the younger generations

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23
Q

What is the Social Exchange Theory

A

Ability to maintain control of their financial resources in order to remain fully participating members of society

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24
Q

What is the Modernization Theory

A

Status is maintained, skills remain valuable, and kinship groups remain intact

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25
Q

What is the Gerotranscendence Theory

A

To achieve wisdom through personal transformation

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26
Q

What is Socioemotional selectivity theory

A

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

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27
Q

What is Selective optimization with compensation

A

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

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28
Q

What are the 5 steps in Maslow’s Hierarchy of Needs?

A
  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)
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29
Q

What was the Developmental theory conceptualized by Tornstam

A

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

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30
Q

What is emerging majority?

A

Statistically minorities assuming the majority

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31
Q

What is health disparity?

A

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

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32
Q

What is health inequity?

A

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

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33
Q

What is cultural awareness?

A

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

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34
Q

What is cultural knowledge?

A

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.

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35
Q

Cultural Beliefs About Health, Illness, & Treatment: BIOMEDICAL

A

Western medical paradigm
Focus on disease/abnormalities in body systems

36
Q

Cultural Beliefs About Health, Illness, & Treatment: MAGICO-RELIGIOUS

A

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

37
Q

Cultural Beliefs About Health, Illness, & Treatment: NATURALISTIC OR HOLISTIC

A

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

38
Q

What kind of obstacle is Ethnocentrism?

A

Belief that one’s system is superior

39
Q

What kind of obstacle is Stereotyping?

A

simplified and standardized conception of a group

40
Q

What kind of obstacle is -ISMS?

A

EX: AgeISM: discriminating against people for their age

41
Q

What is the LEARN model

A

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

42
Q

What are Aging changes?

A

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

43
Q

What are the aging changes?

A

Anatomical and physiological changes are attributed to aging

All cells are affected by aging.

44
Q

Whta is Pharmacokinetics?

A

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

45
Q

How are pharmacokinetics altered in the older adult?

A

Kidneys decrease by 10 % every decade after 40

Half life longer; build up in system

46
Q

Aging Changes Affecting: Absorption

A

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

47
Q

Aging Changes Affecting: Distribution

A

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

48
Q

Aging Changes Affecting: Metabolism

A

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

49
Q

Aging Changes Affecting: Excretion

A

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

50
Q

What is Polypharmacy?

A

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

51
Q

What is Beer’s list?

A

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

52
Q

what does Echinacea do?

A

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

53
Q

What does Garlic do?

A

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

54
Q

What does Ginkgo biloba do?

A

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

55
Q

Ginseng (Root of Plant)

A

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

56
Q

What does Glucosamine sulfate do?

A

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

57
Q

What does Red yeast rice do?

A

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

58
Q

What does St. John’s wort do?

A

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

59
Q

What does Coenzyme Q 10 do?

A

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

60
Q

what is acute pain?

A

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

61
Q

what is persistent pain?

A

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

62
Q

What are the most common musculoskeletal pain syndromes?

A

Arthritis- meds but also hot/cold
Degenerative spinal conditions

63
Q

What is a comprehensive assessment?

A

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

64
Q

What is health history?

A

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

65
Q

how to do a culturally sensitive assessment?

A

• 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.

66
Q

What is FANCAPES?

A

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

67
Q

What is SPICES?

A

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

68
Q

What is Lawton’s IADLs assessment?

A

Tasks for independent living
Needed to maintain one’s home

69
Q

What is Katz ADLs assessment?

A

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

70
Q

What is Mini-Mental State Examination (MMSE)?

A

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

71
Q

What is SLUMS?

A

Free
an assessment tool for mild cognitive impairment and dementia

72
Q

What is a Clock Drawing Test (CDT)?

A

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.

73
Q

What is a Mini-Cog?

A

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

74
Q

What is the Geriatric Depression Scale GDS?

A
  • to asses mood
    Scoring:
    0-9 normal
    10-19 mild depressive
    20-30 severe depressive
75
Q

What is Falls - Hendrick II?

A

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)

76
Q

What is the Tinetti Balance & Gait test?

A

to determine how steady a patient is on their feet

77
Q

An example of a comprehensive assessment tool

A

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?

78
Q

What is vulnerability?

A

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

79
Q

What is thermoregulation?

A

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

80
Q

Hyperthermia in older adults

A

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

81
Q

What is the prevention for hyperthermia?

A

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

82
Q

Hypothermia in older adults

A

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

83
Q

Risk Factors for hypothermia

A

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

84
Q

What is SAFE DRIVE?

A

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

85
Q

What is Fire safety? (Box 20-4)

A

• 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.

86
Q

What are the Urinary tract infection (UTI) symptoms?

A
  • delirium
  • decreased continence
  • decreased appetite
  • decreased mental status

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