Lessons 1-4 Flashcards

Question

What are the psychological theories of aging?

Answer 1

Jung’s Theories of Personality Developmental Theories Theory of Gerotranscendence

Answer 2

Adjusting to decreasing health and physical strength Adjusting to retirement and reduced or fixed income Adjusting to the death of a spouse Accepting one’s self as an aging person Maintaining satisfactory living arrangements Redefining relationships with adult children Findings ways to maintain quality of life

Answer 3

Spiritual well-being can be considered the ability to experience and integrate meaning and purpose in life through connectedness with self, others, art, music, literature, nature, or a power greater than oneself

Answer 4

Integumentary System - Skin becomes thinner, loses moisture and elasticity (with fat loss), glandular atrophy, spots may appear on the skin (pigmentation changes), skin becomes paler, hair loss, hair turning grey or white, nail thickening and hardening. Musculoskeletal System - Tendons, ligaments, joints dry and harden (less flexible), bone mass decreases, degenerative joint changes, sarcopenia, replacement of lean mass by adipose tissue, thinning of vertebral discs. Cardiovascular System - Stiffening of the myocardium and blood vessels, thickening of left ventricle, reduced blood flow, stroke volume, and cardiac output, decreased response to sudden changes in oxygen demand, blood vessel thickening, venous valve efficiency. Respiratory System - Loss of elastic recoil, stiffening of the chest wall, inefficiency in gas exchange, increased air flow resistance, fewer alveoli, decreased cough reflex. Genitourinary System - Blood flow, ability to regulate body fluids, loss of nephrons, decreased bladder capacity. Endocrine System - Changes in thyroid structure and diminished secretion of hormones. Reproductive - Female: changes after menopause, decrease in estrogen. - Male: enlargement of prostate. Gastrointestinal System - Dry mouth (xerostomia), decreased saliva, vulnerable teeth, periodontal disease, presbyesophagus (less effective propulsion), decreased gastric motility and volume, decreased nutrient absorption in intestines Neurological System - Decreased number of neurons, sleep changes (loss of deep sleep), increased risk for injury (loss of nerve endings in the skin and changes in proprioception), sensory alterations (visual and auditory) Immune System - Decrease in innate immunity, adaptive immunity, and self-tolerance decreases T-cell function which can create an autoimmune response

Answer 5

Functional status refers to the ability for an older person to safely participate in activities of daily living (ADLs) - Often linked to independence Physical, psychosocial, and cognitive health all impact functional status Factors that promote function: diet, activity, regular visits to and follow-up with health care providers, meaningful activities, stress management and avoidance of substance use A change in functional status can be an indicator of a change or decline in health

Answer 6

Activities of daily living is a term used in healthcare to refer to people's daily self-care activities. Dressing Ambulating Bathing Eating Transferring Toileting

Answer 7

Instrumental activities of daily living (IADL) are those activities that allow an individual to live independently in a community. Food preparation Housekeeping Doing laundry Shopping for groceries Using the telephone Managing medications Managing finances Using transportation

Answer 8

Sight (visual) Hearing (auditory) Touch (tactile) Smell (olfactory) Taste (gustatory) Kinesthetic (proprioception)

Answer 9

Reception: stimulation of a receptor nerve cell Perception: integration and interpretation of stimuli (in the brain) Reaction: to meaningful and significant stimuli

Answer 10

Sensory deficits: loss in the normal function of sensory reception and perception Sensory deprivation: inadequate quality or quantity of stimulation (reduced sensory input), elimination of pattern or meaning (strange environments), restriction of environment (bed rest) Sensory overload: multiple sensory stimuli that cannot be perceptually disregarded or selectively ignored (excessive sensory stimulation)

Answer 11

*Age-related macular degeneration (AMD) *Cataract Diabetic retinopathy *Glaucoma Refractive errors Dry eyes Retinal detachment

Answer 12

Taste - Xerostomia: decrease in salivary production that leads to thick mucus and dry mouth. Can result in taste alterations and decreased food intake Balance - Benign peripheral vertigo resulting in vertigo or disequilibrium from vestibular dysfunction - Impact balance, coordination - In conjunction with peripheral neuropathy, can lead to falls

Answer 13

Conductive hearing loss *Presbycusis (age related hearing lose) Central auditory processing disorders *Cerumen accumulation (earwax) Meniere’s disease Otitis media Otosclerosis Sensoineural hearing loss *Tinnitus (ringing in the ears)

Answer 14

A serious, often preventable disorder - Medical emergency - Sudden onset, rapid fluctuations in symptoms Most often the result of complex interactions among predisposing factors Individuals with a diagnosis of dementia are at higher risk Early recognition and immediate treatment of the underlying cause(s) are essential - Often reversible Characterized by fluctuations in cognition, mood, attention, arousal, self-awareness

Answer 15

Advancing age, male sex Cognitive status Functional status Sensory impairment Decreased oral intake Medications Coexisting medical conditions

Answer 16

Medications Primary neurological disease Intercurrent illnesses (infections, dehydration, etc.) Surgery Environmental Pain Emotional stress Prolonged sleep deprivation

Answer 17

An irreversible state that progresses over years - An umbrella term for major neurocognitive disorder - Typically has a gradual onset, irreversible Memory impairment (amnesia) and decline in other cognitive abilities that is severe enough to interfere with daily life Other key features: - Aphasia: loss of ability to express and understand language - Apraxia: inability to carry out purposeful movement or perform familiar tasks - Agnosia: inability to recognize common objects or familiar people - Disturbances in executive functioning: difficulty planning, organizing, sequencing, abstracting Approximately 6.9% of the Canadian population has a diagnosis of dementia (PHAC, 2021) Prevalence tends to be higher in certain groups: - Women - Racial minorities - Indigenous persons Numerous subtypes: Alzheimer’s disease, Lewy body dementia, Parkinson’s dementia, vascular dementia, Creutzfeldt-Jakob disease (CJD) (Alzheimer’s Society of Canada) Results in the loss of ability to perform activities of daily living (ADL) or functional decline

Answer 18

The most common mental health issue in later life – not a normal part of aging - A syndrome that includes numerous affective, cognitive, and somatic or physiological symptoms - Older persons tend to report more somatic complaints like pain, changes in appetite Prevalence of major disorder in older persons in Canada between 1.5% and 3.3% (2016) - Higher in hospitalized persons or those residing in LTC Prevalence of ‘milder’ depression between 4% and 18% (2015) In general, prevalence of individuals with symptoms of depression is higher and individuals with persistent conditions have higher rates of depression Often under diagnosed and undertreated There continues to be stigma and negative attitudes towards depression and mental illness Depression is associated with myriad negative outcomes including functional decline, decreased quality of life, malnutrition, substance use, etc. Essential that health care provides assess and treat depression and depressive symptoms Be aware of risk factors

Answer 19

Female Widowed or divorced Major physical and chronic illness Medications Excessive alcohol consumption Isolation and low social support Family caregiving

Answer 20

Recent bereavement Moving to a LTC home Adverse life events Long-term stress Persistent sleep difficulties

Answer 21

Cancer Nutrition Falls Heart disease Oral health Sensory impairments Smoking Exercise Pain Substance use Arthritis Medication use

Answer 22

The inter-relation between physical and psychosocial aspects of aging Effects of disease and disability on functional status The decreased efficiency of homeostatic mechanisms The lack of standards for health and illness norms - Aging is unique for each individul Altered manifestations of response to different disease processesSensory impairments (visual, auditory) Memory changes (deficits) Cultural aspects Presentation of symptoms or disease Early indicators of change or acute illness

Answer 23

Consider some of the unique psychosocial challenges: social isolation, cognitive impairment, stresses related to retirement, relocating, and loss Emphasize the strengths of the older person, recognize resilience, identify the resources they have available to them - Interventions aimed at promoting independence and supporting self-care and participation in ADLs. The nurse’s role is to promote and advocate for each individual to reach their optimal level of health within their context General lifestyle preventive measures: Regular exercise (150 minutes/week) Balanced nutrition Management of hypertension and chronic disease Smoking cessation Immunizations Dental care Sleep Therapeutic communication Touch Cognitive stimulation Reminiscence Body image interventions

Answer 24

Promote health, prevent injury, and mange chronic conditions. Facilitate social engagement. Optimize physical, cognitive, and mental health.

Answer 25

Growth: “the quantitative, or measurable, aspect of an individual’s increase in physical measurements” (Astle & Duggleby, 2024, p. 345)

Answer 26

Development: “the (qualitative) progressive and continuous process of change leading to increased skill and capacity to function… the result of complex interactions between biological and environmental influences” (Astle & Duggleby, 2024, p. 345)

Answer 27

People progress through the various phases of growth and development at individualized rates (not predictable) Nurses should understand the ‘typical’ phases to be able to assess and identify any changes from expected patterns and develop plans of care accordingly The developmental theories from natural, biomedical, social, and behavioural sciences can help us to understanding the impact of early experience on development throughout the lifespan

Answer 28

Heredity Temperament Family Peer group Health environment Nutrition Rest, sleep, exercise Living environment Political and policy environment Life experiences Prenatal health State of individual health

Answer 29

Describe and explain how the physical body grows and changes with age and in various stages of life Changes can be compared against standardized norms Gessell’s Theory of Maturational Development: G&D is directed by the activity of genes; fixed sequence; critical periods exist where presence/absence of experiences make a person functional/nonfunctional Chess and Thomas’s Theory of Temperament Development: biologically derived temperament characteristics influence how children interact with others and their environment (Slow to warm child that needs more time vs the easy child)

Answer 30

Focus on reasoning and thinking operations. How people learn and understand the world they live in. Emphasis on the interaction between the person and the environment. - The person has an active role in the developmental process.

Answer 31

Sensorimotor Stage: Birth to two years. - Coordination of senses with motor responses, sensory curiosity about the world. - Language used for demands and. cataloging. - Object permanence is development. Pre-operational Stage: Two to seven years. - Parallel play. - Symbolic thinking, use of proper syntax and grammar to express concepts. - Imagination and intuition are strong, but complex abstract thoughts are still difficult. - Conservation is developed. Concrete Operational Stage: Seven to eleven years. - Conservation: Understand both glasses can have the same amount of water. - Concepts attached to concrete situations. - Time, space, and quantity are understood and can be applied, but not as independent concepts. - Revise the direction of thoughts. - More comparative. - Can describe tasks they are not currently doing. Formal Operational Stage: Twelve and up. - Theoretical, hypothetical, and counterfactual thinking. - Abstract logic and reasoning. - Strategy and planning become possible. - Concepts learned in one context can be applied to another. - Justice and other life things. - Things might affect others. You have to complete each stage to get to the next.

Answer 32

The development of personality, thinking, behaviour, and emotions Development occurs with influence from both internal and external factors These happen together

Answer 33

Stage: Oral Age: Birth to one year Erogenous Zone: Mouth Pleasure: From feeding, using mouth, can cause healthy oral relationships. Conflict: Oral fixation if not fed well, like smoking. Stage: Anal Age: One to three years Erogenous Zone: Bowel and bladder control Pleasure: Potty training, easy going parents, not pushing it. Conflict: If parents are too pushy, turn into control freaks about things or very erratic behaviour. Stage: Phallic Age: Three to six years Erogenous Zone: Genitals Pleasure: Expose and understand the body; boys are attracted to their mothers and fear fathers so they mimic their masculine traits. It's the reverse for women. Stage: Latent Age: Six to puberty Erogenous Zone: Libido inactive Pleasure: No interest in sex or pleasure, more interested in peers and sports etc. Stage: Genital Age: Puberty to death Erogenous Zone: Maturing sexual interest Pleasure: Intimate and sexual relationships Conflict: Not able to maintain healthy monogamous relationships (sluttly behaviour)

Answer 34

Infancy- Trust vs Mistrust; meeting basic needs, present attachment to caregiver, gives trust. Early Childhood- Autonomy vs Shame and Doubt; ability to potty train at their own pace, choose own clothing, help in the kitchen, supportive, can led to self-doubt. Preschool- Initiative vs Guilt; be creative, play, interact, always saying no. School Age- Industry vs Inferiority; confidence, sports and music they like, be with friends, making them feel they have to do things. Adolescence- Identity vs Role Confusion; who we are, what do you like, supporting them, don't put them in a box. Young Adulthood- Intimacy vs Isolation; finding a romantic partner and intimate relationships. The inability to do so may result in isolation. Middle Adulthood- Generativity vs Stagnation; always moving forward. Do you feel fulfilled, support community, doing something meaningful? Becomes depressed. Maturity- Ego Integrity vs Despair; older people need to feel satisfied. Share memories. Similar to Fraud's school of thinking. Always a conflict to be resolved, positive or negative.

Answer 35

Morality is a code of conduct that guides our actions and thoughts based on our background, experiences, culture, religion, or philosophy Moral development is a gradual change in the understanding of morality As a child develops, and evolves, they apply their knowledge and understanding to making the ’right’ decisions (even when it’s inconvenient for them) Becomes less black and white

Answer 36

Premoral Stage: Child feels no obligation to follow rules. Conventional Stage: Child follows the rules set up by people in authority. Autonomous Stage: Moral judgements based on mutual respect for the rules and considers the consequences of a moral decision. Starts to consider information related to subjective intent. Moral maturity is the internalization of principles: the desire to weigh tall of the relationships and circumstances before acting or making a decision.

Answer 37

This is not considered useful as it was only studied in young boys. Stage One: Punishment and obedience orientation. It is okay to do what you do if you don't get caught. Stage Two: Instrumental. Relativist orientation, it feels good, do it. Stage Three: Good boy, nice girl. Do it for me. (He should do it because he loves his wife. Stage Four: Law and order orientation. Do your duty. (Saving a human life is more important than protecting property) Stage Five: Social contract orientation. It is the consensus of thoughtful men. (Society has a right to insure its own survival. I couldn't hold my head up in public if I let her die) Stage Six: Universal ethical principles. What if everybody did that?

Answer 38

People are motivated to meet certain needs Generally, people need to meet the lower needs before they can attend to the higher needs However, the needs/levels are not rigid The most basic need is physical survival Original hierarchy included 5 levels of needs, but has been updated to include 8 levels Cannot meet needs higher without the bottom meet. Bottom Physiological needs- air, water, food, shelter... Safety needs- person security, employment... Love and belonging- friendship, family, intimacy... Esteem- respect, status, freedom... Self-actualization- desire to become the most one can be. Top

Answer 39

Bottom: Basic needs; (Deficiency needs) Physiological needs Safety needs Belonging and love needs Esteem Ongoing needs; (Growth needs) Cognitive needs Aesthetic needs Self actualization Transcendence Top

Answer 40

Understanding the process of human development can: Help us to plan patient/client care Help us to assess and treat a person’s response to illness Provide a framework for examining, describing, and appreciating human development Understand growth and development and processes in which sociocultural, biological, and physiological forces interact with eachother over time

Answer 41

The exchange of information between individuals through a system of signs, symbols, speech, and behaviour Communication is the most important ability of human beings (Boscart et al., 2023) Allows us to express thoughts, feelings, likes, dislikes Verbal and nonverbal Communication is an essential skill for nurses We must ensure the messages we send are interpreted as we intended; conversely, we must ensure that we clearly understand and interpret the messages sent from others Communication can be impacted by a variety of factors: Personal/perceptual biases Use of non-therapeutic techniques Alterations in sensory and neurological functions The ‘normal’ aging process can affect communication Communication involves numerous techniques and strategies that must be consciously practiced in order to ensure effective therapeutic nurse client relationships Meaningful communication and active involvement in society can contribute to: Healthy aging Improving longevity Improving the older person’s response to interventions Maintaining optimal function

Answer 42

Standard Statement 1: Therapeutic Communication Nurses use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-client relationship. Basic therapeutic communication strategies are applicable when communicating with older persons Attentive listening Authentic presence Nonjudgemental attitude Cultural competence Clarifying Providing information Seeking validation of understanding Keeping focus Using open-ended questions

Answer 43

Ageism A term used to describe prejudice expressed toward older persons through attitudes and behaviours Found cross-culturally, but prevalent in the Western world Elderspeak A common speech style used when talking to older persons that presupposes their dependence, incompetence and control by the speaker Includes baby talk, using terms or petnames like ‘honey’ and ‘dear’, and speaking louder and more slowly

Answer 44

Can be an important component of communication Tells us a great deal about the person Important part of the assessment process It takes time, and patience It is a gift and an honour to hear someone’s story They are hoping that you are listening and interpreting their story ‘correctly’ Constructed through reminiscence, journaling, life review, or guided autobiography

Answer 45

A critical analysis of a person’s past life, with the goal of facilitating integrity Often occurs as an internal review of memories, therefore, it is often a very personal and private reflection Considered more of a formal therapeutic technique than reminiscence – meant to guide a person through their life in chronological order

Answer 46

Any recall of the past Considered the most important psychological task in older age May enhance socialization and connectedness with others Can cultivate: 1) a sense of security through the recounting of comforting memories 2) a sense of belonging through sharing 3) self-esteem through the confirmation of uniqueness

Answer 47

Ensure you have the persons attention. Do not approach from behind or startle Face the person and sit or stand at eye level Ensure the person has any sensory aids in place Speak slowly and articulate in a normal tone of voice Rephrase as opposed to repeat information Speak towards the unaffected ear (when appropriate) Ensure that others team members are aware of the hearing impairment (documented in the plan of care)

Answer 48

Ensure you have the person’s attention before you begin speaking Clearly identify yourself and others with you Speak normally, but not from a distance Do not lower or raise your voice Use the analogy of a clock face to help locate objects Do not change room arrangement Ensure the person has their glasses/visual aid prior to initiating communication

Answer 49

Persons with neurological disturbance may experience impaired verbal communication arising from: 1) reception: impaired by anxiety or related to a specific disorder, hearing deficits, or altered level of consciousness 2) perception: distorted by stroke, dementia, delirium 3) articulation: hampered by mechanical difficulties such as dysarthria, respiratory disease, cerebral infarction

Answer 50

A communication disorder that can affect a person’s ability to use and understand spoken or written words Can affect a person in more than one way: speaking, understanding, reading, writing, gesturing Involving a Speech Language Pathologist (SLP) is imperative to develop a plan of care Alternative or augmentative speech aids may be used Alphabet or picture boards Electronic boards and computers (can be voice activated) Explain situations, treatments, or anything else that is pertinent to the person Treat the person as a person (adult) Be patient, allow time for communication, provide a quiet environment Speak naturally and slowly, ask one question at a time (consider using close-ended questions) Include the person in social gatherings and conversations Ensure the person has access to sensory aids Use visual cues, objects, pictures, gestures, and touch in conjunction with words when appropriate Encourage all speech, give the person the opportunity to complete their thoughts and struggle with words Do not be too quick to finish their sentences or assume what they are trying to communicate Use any augmentative devices available Minimize external noise when communicating (e.g., radio, TV)

Answer 51

A speech disorder caused by weakness or incoordination of the muscles used for speech Impairment in the ability to articulate words as a result of damage to the speech mechanism controlled by either the central or peripheral nervous system Pay attention to the person speaking, and watch them as they talk Allow more time for conversation, and provide a quiet environment Be honest, and let the person know if you have difficulty understanding – don’t pretend to understand If the person’s speech is very difficult to understand, repeat back what they said to ensure you understood Ask the person how you can best support them (e.g., guessing, finishing sentences, or writing)

Answer 52

Cognitive impairment that affects memory, speech, and communication Individuals may have difficulty expressing their ‘personhood’ in a way that is easily understood by others Communication requires special skills and patience Anomia (difficulty with word finding) Difficulty expressing thoughts and emotions Difficulty with expressive and receptive communication Limits with verbalization may occur in later stages Do not assume that they can not understand you Continue to communicate with them – verbal and non-verbal Learn about the person Ask questions and provide time for response Meet the person where they are at Recognize and respond to feelings, thoughts, behaviours Provide care and connect with respect and dignity

Answer 53

Description- A detailed description of the situation What happened? When and where did it happen? Who was present? What did you and the other people do? What was the outcome of the situation? Why were you there? What did you want to happen? Feelings- Exploration of the thoughts and feelings during the experience and how they may have impacted the experience What were you feeling during the situation? What were you feeling before and after the situation? What do you think other people feel about the situation now? What do you think about the situation now? Evaluation- Evaluate what worked and what did not work in the situation (trying to be as objective as possible) Focus on the positive and negative aspects of the situation What was good and bad about the experience? What went well? What did not go well? What did you and other people contribute to the situation (positively or negatively)? Analysis- An opportunity to make sense of what happened – looking for meaning in the situation What did things go well? Why didn’t things go well? What sense can I make of the situation? What knowledge – my own or others – can help me understand the situation? Conclusion- Make conclusions about what happened Summarize learning and highlight what could improve the outcome in the future What did I learn from this situation? How could this have been a more positive situation for everyone involved? What skills do I need to develop for me to handle a situation like this better? What else could I have done? Action Plan- Plan for what you would do differently in a similar/related situation in the future Plan not only what you would do differently, but how you would do it differently If I had to do the same thing again, what would I do differently? How will I develop the required skills I need? How can I make sure that I can act differently next time?