GERO Final Flashcards
Gero review is complete with all four reviews
Define social security
Intended to supplement other sources of income but is how the MAIN source of income for older adults
Define medicare
Health insurance program for older adults
Define Federal old-age insurance law
1st significant step in improving the lives of older americans ; provided some financial security for the elderly
What should nurses consider when planning & developing care plans or programs for older population
Increasing diversity of this group means developing appropriate care plans should meet the needs of older population; optimal planning- includes both life expectancy the increasing % of people over the age 65 in the coming years
How does financial status of the older adults population influence their overall health & their lives?
“asset rich & cash poor”, High prevalence of home ownership % of older adults living below poverty level has declined to aid programs
Nurse Advocacy: how can nurses connect client with needed resources
if a pt cant afford supplies like a walker, refer them to social services
what phenomena about older women is different when compared to males
females are more likely to live longer & be widowed
What is the impact of chronic illness on the older population
Chronic illness is a major, leading cause of death. Hypertension is leading chronic condition; highest priority! other chronic conditions: High cholesterol, asthritis, diabetics, heart failure, depression, ischemic heart disease, chronic kidney disease, COPD & alzheimers disease. dementia
Define Error theory of aging
genetic DNA mutations, causing organ decline as a result of self perpetuating cellular mutations
Define Biogerontology
the study of the connection between aging & disease
Define disengagement theory
Process of gradual disengagement between societys interepts & those of the indiviual interests (beneficial for both parties)
Define free radical theory
Oxidative metabolism & effects of free radicals; damage proteins, enzymes & DNA & replace normal processes: causes genetic disorder
Define Anatgnostic pieiotrophy
Accumulated & mutant genes that have NEGATIVE EFFECTS IN LATE LIFE, may have beneficial effects in early life but how harmful late in life
Define continuity theory
Personality & basic patterns of behavior will remain unchanged as the individual ages
Define activity theory of aging
older adults should continue a middle-aged lifestyle & should be treated as if they are still middle-aged adults
Define empowerment
To make informed decisions about health; leads to positive health outcomes
Tasks of EGO vs despair
Ego integrity- to accept & find meaning in life lived
Task of ego vs DESPAIR
Despair integrity- feelings of anger, bitterness, depression or inadequancey
Nurse role in discussing death & dying with older clients
Listen to pt & encourage to share their feelings
How dow a failing immune sx affect body sxs or overall health
Increases the incidence of cancer; body recognizes aged cells as foreign & attacks them
Define Ethnogeriatrics
the effects of ethnicity & culture on the health and well being of older adults
Developing culturally competant care
Nurses role: increase knowledge base about different cultures & ethnicities, practices, behavior & views; understanding cultural & ethnic differences help eradicate stereotypes & biases; recognization will increase appreciation for unique characteristics of each individual
what health issues should be considered when providing care for different ethnic groups & developing programs to increase positive health outcomes?
Black americans: hypertension, heart diease, cancer, diabetes, higher death rates from heart disease, stroke, asthma, cancer, flu, pneumonia, HIV/AIDS, homicide (higher risks. of smoking, obesity or cancer
what health issues should be considered when providing care for different ethnic groups & developing programs to increase positive health outcomes?
Asian americans: may not report pain; Hispanic americans: less likely to visit physician, more likely to have difficulty obtaining care; Native americans: high prevalance & risk in preventable diseases: stroke, diabetes, hypertension, heart disease, cancer ,cirrohsis , chronic lower respiratory disease
Identify different ways to learn about cultural influences & ethnic diversity
Ensure cultural, religious, & sexual differences of older adults are understood, appreciated or respected; find ways to increase cultural competance; try to understand what cultural influences dictate a clients health care pracitces, needs & what is allowed/denied
Define Old age
A lot of things changing, this aging process requires stamina, ability & flexibility
Define widowhood:
loss of a spouse, alters family roles, adjustment to changes
Independent vs Depencdency
Older adults have fears associated with dependency illness or disability may cause them to loss their independence
The older adult & sexuality
Older adults still may be sexually active
Define preretirement:
preparation phase; planning; fantasy regarding retirement role
Define retirement
Belief that work is dues paid for being an active member of a productive society “honeymoon period”
Define Disenchantment
Persons whole identity or form of social interaction; significiant void is felt; a letdown or disappointment; depression
Body changes related to advanced aging & how they impact the body
shift in self concept, body image & roles; difficulty in acceptance of physical changes, things they could do before, they are not able to how; illness & disability, development of chronic disease
Is memory loss/ intelligence decline a normal process of aging?
No it is not
Family education regarding periods of solitude for older adults
Periods of solitude allows for life analysis for family concerns of parent being “alone/lonely”; reflection & understanding
How will one determine the emotional well-being & self concept of the client?
by what roles they accept & what roles they reject
Changes in the urinary body sx
reduced bladder capacity, frequent urination, urgency, nocturia, urinary incontience( not a normal part of aging)
Changes in the cells of body
Extracellular fluid remains constant, but intraceullular fluid decreases = less body fluid (risk for dehydration)
changes in the respiratory sx
Risk for aspiration, assessment: swallow test, lung sounds, cough/choking; loss of elasticity & increased rigidity in tissues, prescence of serous fluid in or around lung or tissues could indicate a pathologic process
Changes in the GI sx
Decreased esophageal motility (presbyesophagus, food remains in the esophagus longer); increased risk for aspriation, indigestion & constipation; tooth loss not normal part of the aging process, decreased stomach motility (peristalsis)
Changes in the immune sx
decrease immune response (immunosenescence), decreased serum activity of the thymic hormones; almost undectable in older adults; risk for INFECTION
changes in the musculoskeletal
kyphosis, increased risk for fractures & falls = reduced bone minerals & mass, diminished calcium, bones more brittle, most common in hip, spine & femur fractures; sarcopenia: age related loss of muscle mass
changes in sensory organs; auditory
presbycusis: progressive loss of hearing, changes in structures of inner eat
changes in sensory organs; vision
presbyopia: inability to focus on close objects clearly; catacts & glaucoma, night blindess (nyctalopia); Arcus Senilis: white, gray, or bluish ring around eye
Why is a digitial rectal exam important
prostate enlargement in men, risk of being malignant, follow up is vital
Define family centered care
this improves client & family outcomes by providing needed support and or resources
Define educator
share knowledge & skills related to care of older adults in all areas, use effective communication
Define advocate
aid individuals in asserting their rights & obtaining required services, facilitate communities or other groups efforts to effect change & achieve benefits & promote gerontological nursing
Define evidence based practice (EBP)
best practices aare evidence based & built on their expertise of the nurse
Define American Nurses Association (ANA)
the only set of standards developed by & for gerontological nurses, used as a guide to direct nursing care for this population
Nurses role as an educator
organize material before teaching, avoid medical jargon, speak on a level & language that is understandable & provide written materials to complement verbal instruction; should be able to address knowledge defecits & find out how much they know & teach from there
Define cost effective care
family inclusion “helping hands” treatment options & various resources ex family member feeding, dressing client
Holistic model of gerontological care
perform an assessment 1st, integration & quality of life, considers mind, body & spirit. considers a state of wholeness & considers the unique physiologic , psychiatric, social & spiritual challenges IN EVERY PHASE OF NURSING PROCESS
Nursing actions to promote inner resources for self care & attain optimal health & wholeness
eliminate/minimize selfcare limitations; provide direct services when demands can not be met independently; promote maximum independence for positive outcomes; evident by active participation in their own care on a regular basis; increasing autonomy & empowerment
Define coaching
to improve compliance & motivation
define education
for understanding; knowledge deficit
define coordination
multidisiplinary care from entire health care team
Define empowerment
involving client in their care; needed any time a care plan is developed, need responsible & active participants in their care
Define prescence
giving patients full, undivided attention, actively listen, protect interactions with patients from distractions
define availability
provide time & space for patients to express, explore & experiences, convey openness & interest, allow patient a safe space
Willingness to form connections
offer insights, commitments to learning & engage with openness, respect, acceptance & nonjudgemental attitude
Modeling holism
Starts with good self care practice, attentive & physical emotional spiritual well being, behave as you desire others to behave
inner resources & empowerment
meet lifes challenges, need inner resources to meet self care needs; active client participation on a regular basis, empowerment, promotes normalcy, independence & individuality
What is the goal of gerontological nursing What does that mean?
Goal is to address maximize the quality of life when one possess an incurable illness or disability. This means to help the older adult transition to death with comfort, peace, and dignity as death approaches
Define consent
granting permission to have an action taken or procedure performed
define durable power or attorney
allows competent individuals to appoint someone to make decisions on their behalf if they become incompetent
define privacy legislation
law protects the clients rights & confidentiality & health information from being released without their consent
define negligence
failure to conform to the standard of care by nurses actions
define standard of care
the normal for what a reasonable indivudal in a similar circumstance would do
define malpractice
deviation from standard of care
Define living will
Written, legal document that states what the client will or would not use to save their life
Define DNR
Do Not Resuscitate, do not bring back to alive; needs a medical order and consent
where do nurses go for guidance when there is an ethical decision to make or a conflict of interests
follow nursing board guidelines; follow institutional policies & procedures
Define elder abuse
can be physical, emotional or psychological, sexual abuse, exploitation, neglect, abandoment or self neglect; nurses have legal responsibility to report abuse and ensure client safety
Define doctrine of respondent supervisor
nurses can be help liable for the actions of (UAP) persons under their supervision, may not directly go to DON/manager
Define Scope of pracitce
Things you can and cannot do, ex performing an act/duty despite of lacking education or experience which can lead to negligence
Define assault
A deliberate threat to harm
Define invasion of privacy
publicity of health info; unlawful release to an unauthorized person
define larceny
theft
Restraints
anything restricting movement; a cause for litigation for false imprisonment/negligence; alternatives to restraints should be considered & used 1st (bed alarm, increased staff & direct supervison); should be used for conveince of staff
Telephone orders
to minimize risks when taking phone orders: have physicals follow up with a written order, read back order to verify & obtain physican signature within 24 hrs
What dental changes affect nutrition in older adults?
Decreased chemical production, atrophy of digestive tissue, reduced signaling to tissues, and changes in tissue structure and function.
What is essential about calorie needs for older adults?
Older adults have a reduced need for calories but require the same amount of nutrients.
How does basal metabolic rate affect weight in aging patients?
Basal metabolic rate declines, contributing to weight gain when eating the same amount of calories as before; it decreases by 2% each decade of life after 25 years old.
What are the benefits of soluble fibers?
Soluble fibers lower serum cholesterol and improve glucose tolerance.
Found in oats and pectin.
What are the benefits of insoluble fibers?
Insoluble fibers promote bowel activity.
Found in grains, vegetables, and fruits.
What are the risks associated with a high-fat diet?
High fat intake is associated with risks of heart disease.
Client education regarding RDA of calcium intake and risk associated with taking too much calcium #1
Calcium, vitamin D, magnesium absorption ability is decreased with age
Client education regarding RDA of calcium intake and risk associated with taking too much calcium #2
Calcium intake no more than 2000 mg per day calcium minimum of 1000 mg per day to prevent osteoporosis
Client education regarding vitamin B deficiency
Piloerection (goosebumps) is indicative of a vitamin B deficiency
Nursing care and interventions to improve side effects related to pancreatitis & aspiration prevention
Pancreatitis avoid fried foods aspiration prevention sit in high Fowlers position while eating and 30 minutes after eating
Nursing care and interventions to improve side effects related to dysphasia, delayed gastric, emptying and concentrated urine
Dysphasia cut food into small bites no talking while eating check for pocketing of food, Sit in high Fowlers position;
Delayed gastric emptying slowly emptying time identify nausea and eat several small meals;
Concentrated urine administer fluid signs of dehydration.
Client education and recommendations related to nutritional supplements
Take note of what herbal supplement and dosage, frequency &potential side effects
Nursing considerations related to dehydration and overhydration
Dehydration can be life-threatening for older adult, sign, and symptoms dry or poor turgor, dry and brown tongue, sunken eye or cheek orbitals
Overhydration IVF hydration can lead to this signs of symptoms, edema, nausea, vomiting, excessive urination
Define insomnia
Inability to fall asleep, difficulty staying asleep & premature waking
Define nocturnal myoclonus
Condition characterized by at least five leg jerks or movement per hour of sleep
Define phase advance
Falling asleep earlier in the evening and awakening earlier in the morning comment among adults same amount of sleep, but hours shift
Define restless leg syndrome
Neurological disorder, characterized by uncontrollable urge to move the legs when one lays down
Define central sleep apnea
Defect in central nervous system affecting diaphragm
Define obstructive sleep apnea
Blockage in upper airway interfering with normal airflow snores erratic breathing patterns may need cpap machine
Sleep stage one
Dozing off easily
Sleep stage two
Deeper sleep, but easily awakened. Eye movement noted under eyelids.
Sleep stage one and two
Older people spend more time in stage one and two
How does alcohol or caffeine affect sleep?
Both disturb sleep
Different ways to promote better sleep
Bedtime, routines, warm, bass, restrict foods or fluids before bedtime, limit blue light, and only use sedatives if needed`
Special considerations regarding sleep sedatives
Use with utmost care serious adverse reactions only use if absolutely needed
Define neuropathic pain
Occur occurs from abnormal processing of sensory stimuli by the central or peripheral nervous system
Define nocieptive pain
Arises from mechanical, thermal, or chemical noxious stimuli
Define somatic pain
Located in bones or soft tissue masses metastasis called somatic nociceptive pain (bone cancer)
Define visceral pain
Associated with injuries or disorders that cause generalization or referred pain, deep, aching, cramping, and pressure type of pain
Define chronic pain
Pain consistent for three months or longer can be mild to severe pain or intensity
What are the essential steps and Data a nurse must collect when performing a pain assessment
1) needs to be qualitative and quantitative 2) detailed pain history, 3) signs and symptoms of pain or changes in behavior
What are the essential steps and data of a nurse must collect when performing a pain assessment on verbal and nonverbal patients
Verbal patients ask if they have any pain ask any questions versus nonverbal patients look in assess for cues of pain
Integrative approach to effective pain management
Individualized, comprehensive pain management plan, collect qualitative income, quantitative assessment of symptoms. Identify underlying causes or factors of pain ,goals need to be realistic and achievable.
Signs and symptoms of pain, other than verbal response
Agitation, grimacing, crying, moaning pacing
Nutritional suggestions to ease pain and inflammation
Individual within inflammatory condition should consider avoiding these foods, animal products, high fat dairy products, eggy, beef, fat, junk food, sugar
Foods to encourage
Green leafy veggies, omega-3 garlic, ginger, turmeric, red blue fruits, and flaxseed
Deficiency of what complex vitamin can contribute to
Pain (green leafy veggies)
Addressing risk associated with functional impairment
Cognitively, impaired individuals may not understand significance of symptoms, may lack the capability to avoid hazards, may be unable to communicate, needs and problems to others, visual defects, hearing impaired weakness, and fatigue
Nurses role
Assessment to determine how activities of daily living are affected interventions than planned
Step-by-step approach for pain management
START LOW & GO LOW
1) acetaminophen most commonly used with older adults for mild and moderate pain. First line treatment.
2) non-steroidal anti-inflammatory drugs, ibuprofen before moving into an opioid try another NSAID
3) opioids for moderate to severe pain first choice codeine, oxycodone hydrocodone
Negative effects
Nausea , constipation , urinary retention, itching , myoclonus = fast sudden muscle jerks or twitches, irregular breathing, cognitive dysfunction addiction
Define & describe Solitude
Alone time; time of inactivity; therapeutic to the older adult; include periods of solitude in the care plan
Define & describe Gratitude
Appreciative; sense of thankfulness & positivity; focus on what one has opposed to what they do not have
Define & describe Transcendence
A reality beyond oneself; makes sense of circumstances
Identifying/Acknowledging the importance of spirtuality for aging clients #1
Concept or philosophy of spirituality; comfort in knowing connection greater than self
Describe Eriksons sense of integrity (final G&D task)
Life experiences have meaning & sense of purpose
Identifying/Acknowledging the importance of spirtuality for aging clients #1
Foster holistic care;
Faith beliefs & practices (Ask “is there anything or practice that can bring you comfort)
Nurse role: Assessment of spiritual needs & how to support clients #2
Affiliation with faith community;
are spiritual needs met?
Nurse role: Assisting in discovering meaning in challenging sitituations
express an open & nonjudgemental attitude
Nurse role: be familiar with steps to assist & facilitate religious practices or behaviors
Contact clergy for confession; allow pt to display religious articles & ensure safe care of these articles
Nurse role: noted spiritual distress
Red flags- depression, flat affect, crying (Offer help & honor clients wishes)
Praying with & for
Positive link between health &. healing & prayer; offer prayer, hold their hand(if nurse doesn’t feel comfortable find a coworker so they can pray for pt)
Performing a sexual health assessment on the aging client
Perform a sexual health assessment; ask permission to ask questions (increase knowledge, promote understanding)
Be familiar with medications that contribute to a lack of sexual interest & an example
-Prescribed medications
-otc’s
-herbal & alternatives
(ex antidepressants- decrease libido)
Be familiar with medical conditions that contribute to a lack of sexual interest & an example
Review medical health for health conditions that interfere with sexual function (Ex. diabetics- causes ED, diuretics- diminish sexual function
Hormone therapy for the menopausal woman
-Age @ the start of HRT altus risk, risk benefit ratio <60 yrs within 10 yrs of menopause , individualized treatment; based on age; time since menopause
Identifying barriers to sexual activities for the aging male #1
-unavailability of a partner(most older men are married, most older women are widowed)
Identifying barriers to sexual activities for the aging male #2
Psychological barriers
- fear of losing sexual abilities, concern about body image, relationship issues
-Key concept: many may suppress sexual needs rather than deal with stresses of establishing new relationships
Be familiar with how medications affect sexual activity (women)
Decreased level of estrogen, virginity, prolapsed, uterus, cystocele
Be familiar with how medications affect sexual activity (men)
Prostatisis, infections of genitalia, arterischolsis
Name some non-drug treatment modalities to prevent sexual activity barriers #2
Physical Health – Encourage exercise, good nutrition, and weight management.
Adaptations – Suggest positions, lubricants, or techniques for physical limitations.
Name some non-drug treatment modalities to prevent sexual activity barriers #3
Emotional Connection – Promote non-sexual intimacy like cuddling or massage.
Assistive Devices – Recommend aids (e.g., glasses, hearing aids) if needed.
Be familiar with how medications affect sexual activity (both sexes)
Cardiovasculor & respiratory disease, arthritis, diabetics, stroke & alcoholism
Impotence also known as
Erectile Dysfunction (ED)
Changes due to andropause
ED, Reduced libido, Breast enlargement, emotional/cognitive changes, osteopenia/osteoporosis(higher risk for chronic renal disease; type 2 diabetes)
Medication adverse effects (can affect potency, libido, orgasm & ejaculation)
-antianxiety/ bensodiazepines
-antidepressants
-antihistimines, antihypertensive, diuretics
Be familiar with how some medical conditions can affect sexual activity
Review how medications for these conditions (e.g., antihypertensives, antidepressants) might affect libido or sexual performance.
Name some non-drug treatment modalities to prevent sexual activity barriers #1
Education – Teach about normal aging changes and promote open communication.
Comfort – Create a private, relaxing environment.
Counseling – Address emotional concerns like anxiety or depression.
Define Frailty
condition where person has poor endurance and weakness
Define Disability
inability to perform activities normally
Define Rehabilitative care
Therapies developed by physicians and therapists focused on returning individuals to their previous level of function
Define Restorative care
care that assists people in maintaining or improving current level of function, avoiding decline & complications and achieving highest possible quality of life
Define ADLs
activities of daily living: toileting, feeding, dressing, grooming, bathing and ambulation
What is the main focus of care when dealing with the significance and prevalence of chronic conditions that lead to frailty & disability
saving lives, preserving quality of life, focus on function not dysfunction
what would the nurse emphasize & identify key concepts the lead to frailty & disability
to maximize self care capabilities, remind the client what they still have; continue to treat them as a responsible individual
identifying s/s of frailty (s/s)
s/s: poor endurance, fatigue, low activity levels, inactivity, reduced speed in ambulations, weak grip strength, heightened risk of adverse outcomes; slow recovery for infection (injury: psychosocial stresses; other stressors)
Describe the nurses role regarding & assessment of frailty
A review of body systems & s/s of frailtyment, interventions aiimed at postponing frailty & improving self care
Identify examples of nurse guided interventions to prevent or postpone fraitly
ex muscle strengthening excercises, correct weight loss, improved nutrition
Identify the priority goal of rehabilitative care
improvement of functional capacity, ensuring the return of previous level functioning, promotes sense of well-being
identify the key concepts of rehabilitative care
emphasize function rather than dysfunction; ex skilled rehab care involves physical, occupational & speech therapies; lack of financial reimbursement limits options for some individuals
Name 2 recommendations associated with range of motion
1) all joints should be put through full ROM at least once a day
2) most important is joint movement
identify signs that warrant stopping an exercise
-Resting heart rate ≥100 beats/min
-Exercise heart rate ≥35% above resting heart rate
-Increase/decrease in systolic blood pressure by 20 mm Hg
-Angina
-Dyspnea, pallor, cyanosis
-Dizziness, poor coordination
-Diaphoresis
-Acute confusion, restlessness
Define Hypoxia
condition in which the body’s tissues don’t receive enough oxygen
define UTI
a bacterial infection that occurs when bacteria enter the urinary tract and multiply
Identify recommendations regarding urinary catheter insertion
avoidance of urinary cath. if possible, foley insertion only when necessary. Increases risk for inection; uti
Be familiar with preoperative considerations - preoperative assessment & provide example #1
-Review of medications: Patient may not have informed health care provider of all medications, OTC, or herbal preparations—Always review meds
-Preoperative screening completed
Be familiar with preoperative considerations - preoperative assessment & provide example #2
-Provide appropriate padding if needed: Reduce post-op muscle & bone soreness
-Promote infection control: Reduce incidence nosocomial infections
-Ensure informed consent has been obtained
Describe factors responsible for the high risk of infection in older adults #1
Atypical presentation of symptoms: infection- any abrupt, unexplained change in physical or mental function
Describe factors responsible for the high risk of infection in older adults #2
Driven by age-related changes:
- altered antigen-antibody response
-Decreased respiratory activity; reduced ability to expel secretions from lungs
-Weaker bladder muscles:urinary retention; prostatic hypertrophy; increased alkalinity of vaginal secretions
-Increased fragility of the skin & mucous membrane
