Midterm 1 Flashcards
1
Q
older adult
A
anyone over the age of 65
young old -> 65-74
middle old -> 75-84
old old -> 85+
2
Q
geriatrics
A
medical specialty focusing on the elderly
3
Q
life expectancy in canada
A
81.75 years
living over 80 -> wealth, healthy diet, education, health care
less than 60 years -> HIV/AIDS, public health, medical care, diet
4
Q
baby boomers
A
born between 1946 and 1964
4
Q
increased life expectancy
A
due to medical advancements and better treatment for chronic diseases
5
Q
changes with aging
A
- retirement (income)
- social isolation
- body appearance and function
- sense of usefulness
- sexuality
- housing and environment
- death
- elder abuse
6
Q
primary aging
A
inevitable loss of function that occurs no matter what we do
7
Q
secondary aging
A
loss of function accelerated by lifestyle and other factors
8
Q
neurological changes
A
as aging occurs organs shrink and harden
decrease in brain weight and volume, decrease in white matter, and ventricular system enlarges -> all of this is considered atrophy
brain generates fewer neurotransmitters
9
Q
integumentary and musculoskeletal changes
A
wrinkles, grey hair, age spots
muscle atrophy
loss of bone mass
fragile skin -> easily broken
misconceptions -> disables, functionally dependent, slow
10
Q
respiratory and cardiovascular changes
A
blood vessels harden and thicken -> the heart has to work harder
chest wall hardens
alveoli change
increased risk for infection -> are unable to cough forcefully to clear bacteria
increased blood pressure
11
Q
gastrointestinal and genitourinary changes
A
atrophy of kidneys and other organs
incontinence
reflux
oral hygiene
12
Q
sensory changes
A
decreased balance
worsened eye sight and hearing
presbyopia-> gradual loss of eyes ability to focus on nearby objects
13
Q
reproductive and endocrine changes
A
decreased estrogen
decreased sperm count
impacts immune system and ability to fight off infections
weight control
temp control
changes in the inflammatory response
14
Q
immune system changes
A
normal defences are decreased
change in cough reflex
15
Q
leading health challenged in older adults
A
chronic diseases -> noncommunicable (NCDs), persistent and generally slow in progression, cannot be cured
leading cause of death = cancer
2nd leading cause = heart disease
16
Q
ageism
A
discrimination based on the age of a person
society values attractiveness, energy, youth -> undervalues older persons
nurses must be aware of ageism and address it -> advocate and question negative attitudes and stereotypes
treat older adults as independent, dignified persons
17
Q
age-specific approach
A
be aware of atypical signs and symptoms
altered response and manifestations of disease
18
Q
normal defences against infection
A
normal flora (microorganisms)
body system defences -> inflammation = vascular and cellular responses
- inflammatory exudate -> fluid and leukocytes move to site of injury in response to local inflammation
- tissue repair
- histamine release
19
Q
risk of infection : susceptibility
A
age -> very young and older persons
stress
nutritional status
disease processes -> chronic illness
medical therapy-> meds that suppress the immune system
20
Q
incubation
A
first stage of infection -> pathogen enters the body, no symptoms present
21
Q
prodromal
A
second stage of infection -> mild or non specific signs/symptoms
transmission may occur between this stage and the illness stage
22
Q
illness stage
A
the third stage of infection -> specific signs and symptoms present
23
Q
convalescence
A
fourth stage of infection -> acute symptoms disappear, homeostasis returns and the body replenishes
24
localized infection
limited to a specific part of the body and has local symptoms
25
systemic infection
pathogen is distributed throughout the body
26
WBC count
high = something infectious
low= susceptible to infections
27
CRP
a protein whose levels rise in response to inflammation
28
cardinal signs of inflammation
these are local inflammation/infection S+S
heat, redness, swelling, pain, immobility, fever(sometimes)
29
S+S of systemic infection
drop in BP
increased HR and RR
altered mental status
sepsis
blood work needed -> blood cultures, lactate (>4), WBC (high or low)
30
older adult S+S of infection
may not show typical signs and symptoms
-delirium -> change in mental status
-falls
-dehydration
-decreased appetite
-loss of function/incontinence
-dizziness
31
healthcare associated infection (HAI)
also known as nosocomial (disease originating in the hospital)
lungs
surgical/open wounds
urinary tract
blood stream
32
endogenous
infection that occurs when some of the flora already in the body is altered
ex. enterococci, yeasts
33
exogenous
an infection that arises from microorganisms external to the individual
ex. salmonella, clostridium tetani
34
protecting patients from HAI
routine practices -> hand hygiene, proper ppe
isolation precautions
break the chain of infection
35
contact precautions
gown and gloves
36
droplet precautions
surgical mask/eye protection
37
airborne precautions
N95 mask/ eye protection
38
C diff
bacteria -> normal flora is interrupted
diarrhea
treat with antibiotics
cdiff and flu -> gown and gloves -> contact precaution
39
flu
respiratory illness
viruses - nose, throat, lungs
mild to severe
40
CVA
stroke, cerebral vascular accident
41
functional status
refers to the capacity and safe performance of ADLs and is an indicator of health or illness in older adults
42
polypharmacy
concurrent use of many medications
increase the risk for adverse reactions
43
palliative care
improving overall quality of life for persons with life-limiting illness and for their families
includes symptom management, achieving goals and expectations of illness management
44
restorative care
consists of two types of ongoing care -> continuing the convalescence from acute illness or surgery that began in acute care
-> addressing chronic conditions that affect day to day functioning
both types take place in private homes and LTC
45
cognitive impairment
is not normal in older adults and needs investigation and intervention
46
acute care settings
increases older adults risk for delirium, dehydration, malnutrition, HAI's, falls, urinary incontinence
47
pathogens
a microorganism that can cause disease
infection = entry and multiplication of a pathogen
48
communicable disease
can be transmitted from one person to another
49
gender equity
equal treatment of all, regardless of gender
no gender discrimination
50
cultural safety
recognizing power and resource distribution
awareness of institutional discrimination
be aware of personal biases
insurance doesnt often cover alternative medicine -> leads to fear of discrimination and lack of trust in health care system -> interventions are prolonged and client suffer
51
cultural humility
life long learning
interpersonal respect and reflection
self awareness -> personal and professional
52
health equity
elimination of systematic health disparities
associated with social advantage/disadvantage
53
implicit bias
unknowingly
influenced by factors from growing up
54
explicit bias
knowingly/ recognized bias
55
ethnocentrism
i'm right and you're wrong
pushing beliefs onto others
56
Trauma informed practice (TIP)
prevent -> prevent more harm and triggers
safety-> take down barriers and reduce stigma
57
4 R's of TIP
realize
recognize
respond
resist
58
6 guiding principles of TIP
safety
trust/transparency
peer support
cultural/historical/gender issues
collaboration and mutuality
empowerment, voice, choice
59
therapeutic relationships
individualized care
safety, trust, caring
good nursing care
60
the nursing process (communication)
perception
perceptual bias -> knowing the way we talk/present ourselves
reflexivity
contextual knowledge
61
the communication process
sender -> message -> channel -> receiver -> feedback
62
metacognition
body language 55%
tone 38%
actual spoken word 7%
be aware of how you are conducting yourself
63
verbal communication
written, oral, or sign language
be aware of different meanings -> may be perceived in a way you didn't intend
pacing
tone
pitch
timing
64
nonverbal communication
personal appearance
facial expression
posture
eye contact
personal space
touch, gestures, sound
can be impacted by PPE
may supplement, reinforce or undermine verbal communication
65
personal space and touch
intimate -> 0-1.5 ft
personal -> 1.5-4ft
social -> 4-12ft
public ->12+ ft
*consent* and privacy is essential for touch
66
therapeutic communication techniques
share observations
paraphrase and clarify
summarize
provide information
ineffective communication=poor outcomes, miscommunication, decreases nurse credibility
dont ask why
give false reassurance
personal opinions
defensive responses
67
active listening -> SOLER
s= sit facing pt
o= open posture
l= lean forward
e= eye contact
r= relax
68
aphasia
inability to produce/understand language
cannot speak clearly
cognitively, visually, or hearing impaired
speak a different language
unresponsive
69
cognitive changes
structural and physiological changes within the brain are normal with aging
disorientation, loss of language, poor judgment, are NOT normal changes with aging -> something is wrong
70
3 Ds
dementia
delirium
depression
71
Delirium
an acute, reversible state of disorientation, inattention, and confusion
rapid onset -> hrs-days
MEDICAL EMERGENCY
72
S+S of delirium
days/nights mixed up
visual hallucinations
more alert/more tired
different behaviour/personality
older persons tend to experience hypoactive delirium -> might seem like depression
73
CAM+
if a client is CAM+ they have delirium
if the client is CAM+ complete PRISME
74
causes of delirium
infection, low sodium, dehydration, nausea, constipation
75
management of delirium
find and treat underlying cause
include family
keep routine simple
encourage healthy eating/drinking
dont argue with pt
76
dementia
broad term for a set of symptoms that affect the brain
gradual deterioation
umbrella term for memory loss and other thinking abilities
77
warning signs of dementia
impaired judgment
problems with language
memory loss affecting day to day activities (ADLs)
disoriented to time and place
78
Alzheimers disease
cause = genetics, lifestyle, environmental factors
gradual decline
decreased cognitive function
79
vascular dementia
cause = stroke, TIA, blood supply issue
rapid decline
decreased cognitive function following a stroke of TIA
CT or MRI for diagnosis
80
lewy body
cause = abnormal build up of proteins
gradual decline
common in men and those with parkinsons
81
mini-mental (MMSE)
score of 23 or less = cognitive impairment
determine dementia
82
depression
mood disorder characterized by feeling of sadness or despair -> longer than 2 weeks
not a normal part of aging
83
S+S of depression
loses interest
sleep changes
change in ADL's
lethargy
suicide ideation
84
GDS
geriatric depression scale
85
depression management
diet
exercise
manage stress
medications
86
the nursing process (ADPIE)
assessment
diagnosis
planning
implementation
evaluation
87
assessment
supplement, confirm, or refute data obtained from hx
confirm/identify nursing diagnosis
make judgments about health status and management
look at chart/my days/ nursing documentation
pt specific needs
family history
88
types if assessments
interview
emergency/primary assessment
focused assessment
H2T assessment
88
subjective data
feelings, perceptions, self report
89
primary data sources
client
89
objective data
observations, measurements, verifiable facts
90
secondary data sources
family, physician, allied health, chart
91
tertiary data sources
nurse experience, literature
92
primary assessment
- QPA and POCRA (ABCDE)
- first assessment you do when you meet a client
- is repeated whenever you suspect or recognize a change in the clients status -> or they are becoming unstable
93
Safety assessments
-POCRA
-infection control practices
-falls preventions -> call button in reach, bed at correct height, declutter room
- scope of practice
94
Inspection
- visual check
-ensure all surfaces can be viewed
- look for size, symmetry, colour, position, abnormalities
-compare both sides
95
auscultation
- use stethoscope
- identify sounds -> normal or abnormal
- determine characteristics of the sounds -> frequency, loudness, quality
96
palpation
get consent first
- touch
-assess for tenderness, distension, masses
- tender areas are palpated last
97
diagnose
support the diagnosis through assessment findings
consider risk factors, etiology, definition of the label of the diagnosis and the diagnostic label
98
nursing diagnosis
a clinical judgment about client responses to an actual or potential health problem
99
medical diagnosis
the identification of a disease or condition on the basis of specific evaluation of S+S
100
collaborative problem
an actual or potential complication that nurses monitor to detect a change in client status
101
plan
goals and outcome are created that directly impact client care
set priorities
select nursing interventions
write plan of care
establish client centred goals/outcomes
102
implementation
carrying out or delegating nursing interventions
treat symptoms
promote health
facilitate coping
103
TID
three times a day
104
evaluation
reassess
evaluate
determine if outcomes have been met
continue, modify, or terminate plan of care
105
avoiding errors
CRITICALLY THINK
do i understand the data?
do i need guidance?
have i considered other diagnoses?
106
pain
pain is NOT normal with aging
most common reason people will seek medical care
its the 6th vitial sign
an activation of the nervous system
purpose = defence
107
older adults experiencing pain
may have atypical presentation
pain or pain treatments can have increased negative effects
108
nociception
perception or sensation of pain
transduction
transmission
perception
modulation
109
transduction
first phase -> injury and response initiation
damages cells -> chemical release -> nociceptor activation (sensory nerve cells)
110
transmission
second phase -> pain moves from the PNS to the CNS
pain-sensitizing/inflammatory substances spread the message via nerve fibres -> transmission of pain in the dorsal horn -> transmitted through the spinothalamic tract to the brain
111
nociceptors
sensory nerve cells that react to noxious stimuli by sending signals to the spinal cord and brain
112
A-delta fibres
a fibre in a peripheral nerve
myelinated, sharp, well localized, short in duration
113
C fibers
unmyelinated, dull, aching, diffuse nature, slow onset, relatively long duration
114
perception
the third phase-> conscious awareness of pain and interpretation
pain interpretation (intensity, location, character, quality) -> somatosensory cortex (location and intensity)-> association cortex (how do we feel about the pain -> limbic system)
115
modulation
fourth phase -> altered signals and response
pain increased or decreases
body reacts
116
mobility
ROM -> passive or active
gait (how they walk)
exercise
activity tolerance
117
proprioception
awareness of body position and its parts
proprioceptors are in muscles, bones, joints
118
balance
controlled by the cerebellum and inner ear
119
skeletal system
206 bones
support
protection
movement
mineral storage
hematopoiesis
characterized by shape
long -> femur
short -> carpels
flat -> sternum
irregular -> vertebrae
120
joints
connections between bones
121
synarthortic joint
bone on bone
122
cartilaginous joint
joints with little movement, cartilage found in between bones
123
fibrous joint
a joint where 2 bony surfaces meet with a ligament
124
synovial joint
freely moving joint covered by articular cartilage and connected by ligaments
125
ligament
fibrous tissue that connects bones and cartilage/ bones and bones
126
tendon
fibrous bands of tissue that connect bone to muscle
127
cartilage
supporting connective tissue, used for shock absorption
128
skeletal muscles
made from fibres that contract when stimulated by nerve impulses that travel from one nerve to the muscle across the neuromuscular junction
functions -> moving, stabilizing, posture, heat, circulation, organ protection
129
Isotonic contraction
muscles contract and change length
130
acute pain
sudden and typically resolves
cause = injury, illness, trauma, surgery, infection
131
chronic pain
lasts over 3 months and often not resolved
cause = illness or injury, cancer, RA, OA
vitals may appear in normal ranges as the body has adapted to the pain
132
nociceptive pain
somatic -> bones, joints, connective tissues, muscles
visceral -> organs- heart, liver, pancreas, gut
133
neuropathic pain
deafferentation
sympathetic maintained
peripheral
caused by damage of dysfunction of the nervous system
is often burning or shooting pain, tingling, electrical, or prickling
not localized
usually chronic
134
somatic pain
nociceptive pain
superficial burn, tibia fracture, arthritis
described well -> throbbing, sharp, achy
localized
135
visceral pain
nociceptive pain
myocardial infarction (MI), appendicitis, menstrual cramps
not as easy to describe -> may radiate
not localized
136
deafferentation pain
neuropathic pain
spinal cord injury, shingles, phantom limb pain, spinal tumor
injury to the CNS or PNS
137
sympathetic pain
neuropathic pain
raynaud's disease, complex neuropathic pain (CRPS)
disregualtion of the ANS
138
peripheral pain
neuropathic pain
diabetic neuropathy, trigeminal neuralgia
injury to the peripheral nerves
139
non-pharmacological intervention
cold/heat
massage
positioning
visualization/imagery
distraction
prayer
relaxation techniques
deep breathing
140
pharmacological interventions
non-opioids -> mild to moderate pain (tylenol)
NSAID -> mild to moderate pain (advil)
opioids -> moderate to severe pain (codeine, morphine, hydromorphone)
co-analgesics -> not initially intended for pain (anticonvulsants, corticosteriods)
141
tolerance
opioid use-> stimulation of opioid receptors in brain -> upregulation of opioid receptors-> receptors demand more opioids
142
withdrawal
72 hours physical symptoms at their peak
1 week symptoms start to lessen
2 weeks psychological and emotional symptoms
1 month cravings and depression
143
osteoarthritis
chronic disease that commonly affects hips and knees, causes lots of main and impacts mobility
wear and tear on the joint
most common type of arthritis
progressive breakdown of cartilage and underlying bone
x-ray or mri
NSAIDS or non opioid
mobility aids
surgery
144
osteoporosis
a chronic disease that is primarily age associated
major impact on mobility and safety and increases risks for fracture
porous bones = decreased bone mass
dual energy x-ray (bone density)
medications
vitamins/minerals
physiotherapy
145
pathological fracture
an injury that occurs from a chronic condition that weakens bones
causes = osteoporosis, cancer
x-ray
surgery
pain control
palliative care
146
rheumatoid arthritis
an autoimmune disorder that affects joints
occurs in hands and affects independence with ADLs
injury to the joint lining
147
OPQRSTUV (pain assessment)
onset
precipitating/palliating
quality/quantity
region/radiation
severity
timing
understanding of the pain and impact on ADLs
values of the pt
