Midterm Flashcards
What population is the core consumer of healthcare?
Older adults
How many RN’s are certified in gerontology?
Less then 1%
Indigenous and black Canadians have a shorter lifespan by approx. ___ years?
10
How much more money is spent on adults over the age of 65 years compared to those 64 years and younger?
4 times the cost - 2700 to 12000
Define frailty
A clinically recognizable state of increased
vulnerability resulting from aging-associated decline in reserve and function
across multiple physiologic systems such that the ability to cope with
everyday or acute stressors is comprised.
What are the 5 criteria associated with a diagnosis of frailty? How many need to be met?
Meet 3 of the 5:
Low grip strength
Low energy
Decreased physical activity
Slowed walking
Unintentional weight loss
Who is at highest risk for frailty?
85+ age
Women
African-american descent
What is the number one reason for injury related death?
Falls
A fear of falling is of similar importance for older adults as a fear of crime, financial crisis, and adverse health events in healthy adults? True or false?
True
Which gender is more likely to fall?
Females (older adults)
What is successful aging?
A concept describing the quality of aging, with a goal of expanding functional years later in life
What are the 4 domains that describe healthy aging?
Avoiding disease/disability
Higher cognitive/physical function
Actively engaged in life
Psychologically well adapted later in life
The assessment of the older adult should focus on:
Social complexity
When should patient data be interpreted?
After collection and assessment, not during
What are the 3 ways that data is collected?
Self-report
Report by proxy
Direct observation
Screening determines the patients ___
Risk
What does FANCAPES stand for?
Fluids
Aeration
Nutrition
Communication
Activity
Pain
Elimination
Socialization
What does BEERS assess?
Inappropriate medication use in older adults
What are the 5 sub scales of the OARS assessment?
Social resources
Economic resources
Physical health
Mental health
ADL ability
What does SPICES stand for?
Sleep disorders
Problems with eating/feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown
What does the MMSE stand for and what does it entail?
Mini mental status exam, and it includes sentence writing, orientation questions, memory
What are you assessing for when completing an oral assessment?
Xerostomia (dry mouth), ulcers, dental carriers, oral thrush
Cranial nerves 9 & 10 are…
Glossopharyngeal and vagus - responsible for swallowing/gag
Cranial nerve 7 is the…
Facial nerve
Cranial nerves 3,4,6 are…
Oculomotor, trochlear, abducens
The cerebellum is primarily responsible for?
Coordination
What 5 aspects need to be assessed during a gait assessment?
Stride
Cadence
Step
Gait speed
Step/base width
A normal step value is?
72 cm
A normal stride value is?
144cm
A normal cadence is?
90-120 steps/minute
A normal step or base width is?
5-10 cm
What test needs to be done to assess gait speed?
TUG test (timed up and go)
A 5/5 on a strength assessment would indicate?
Normal strength
A 4+ on a reflex assessment would indicate?
Clonus
A 2+ on a reflex assessment would indicate?
A normal (brisk) response
Name the 4 cardiovascular conditions that affect older adults.
Hypertension
Coronary artery disease
Heart valve disease
Heart failure
Name at least 3 risk factors for developing cardiovascular disease
Age (over 55 in men and 65 in women), family history, smoking, obesity, inactivity, dyslipidemia, diabetes, hypertension, microalbuminuria, metabolic syndrome
What temperatures increase an older adults risk for developing cardiovascular disease?
Both high and low temperatures
What is 50% Stenosis of the Circumflex Artery?
50% moderate blockage
ECG findings in sinus tachycardia with a left bundle branch block?
Widened QRS, dominant S wave in V1
Name the common medication classes used to treat heart failure (5)
ACE inhibitors
Beta blockers
Diuretics (loop)
Electrolyte supplements
Digoxin
What is the most frequent degenerative valvular heart disease?
Aortic valve stenosis
Which tasks are appropriate to assign the UAP assisting with care? Select all that apply.
Keeping the call light within M.M’s reach
Ambulating M.M to the chair and bathroom
Assisting M.M with performing oral hygiene
Emptying the two jackson-pratt drains each shift
Obtaining routine vital signs and weight
Keeping the call light within M.M’s reach (YES)
Ambulating M.M to the chair and bathroom (YES)
Assisting M.M with performing oral hygiene (YES)
Emptying the two jackson-pratt drains each shift
Obtaining routine vital signs and weight (depends on institution and policy)
What is the 5 year survival rate of pancreatic cancer?
5-10%
What is the biggest risk factor for pancreatic cancer?
Smoking
How is pancreatic cancer treated?
Whipple procedure
State what the DELIRIUM pneumonic stands for?
Dehydration
Electrolyte imbalance
Lung, liver, heart, kidney, brain
Infection
Rx
Immobility
Untreated pain/unfamiliar environment
Metabolic disorders
What are the 4 features of the CAM?
1: acute onset/fluctuating course
2: inattention
3: disorganized thinking
4: altered LOC
The delirium index assesses the same things as the CAM except for?
Sleep/wake cycle
Symptoms of delirium
Disorganized thinking, disorientation, anxiety, agitation, delusional thinking, poor executive function and recall
What % of delirium cases are misdiagnosed?
70%
What is the term that is wrongfully used by police to detain racialized groups experiencing delirium?
Excited delirium
What are the 3 types of delirium?
Hypoactive, hyperactive, mixed
How many controlled acts are there?
14
4 most common drug classes that induce delirum?
Antidepressants, anticonvulsants, benzos, opiates
For each behavior listed, specify whether it is associated with
delirium (DL) or dementia (DM).
______ a. Gradual and insidious onset
______ b. Hallucinations or delusions
______ c. A sudden, acute onset of symptoms
______ d. Progressive functional impairment
______ e. Personality changes with emotional lability
______ f. Incoherent interactions with others
______ g. Possible wandering behavior
______ h. Lucid at times, but often worsens at night
Delirium: b,c,f,h
Dementia: a,d,e,g
Several diagnostic tests are ordered. From the tests listed, select
those which would be used to help diagnose the type of dementia.
Toxicology screen
Electrocardiogram
Electroencephalogram
Complete metabolic panel
Complete blood count with differential
Thyroid function tests
Colonoscopy
Rapid plasma reagin (RPR) test
Serum B12 and folate levels
Bleeding times
Liver function tests
Vision and hearing evaluation
Magnetic resonance imaging (MRI)
Urinalysis
Toxicology screen
Electrocardiogram
Electroencephalogram
Complete metabolic panel
Complete blood count with differential
Thyroid function tests
x Colonoscopy
Rapid plasma reagin (RPR) test
Serum B12 and folate levels
x Bleeding times
Liver function tests
Vision and hearing evaluation
Magnetic resonance imaging (MRI)
Urinalysis
What do you need to teach about donepezil? Select all that apply.
a) “The best time to take donepezil is in the morning.”
b) “Swallow each tablet whole. Drink a glass of water afterward.”
c) “Notify the provider if you have trouble urinating or muscle weakness.”
d) “You may have some nausea. Taking the medication with food may help.”
e) “Keep the tablet in the blister pack until you are ready to take the medicine.”
Correct answers are: a, c, d, e
This tablet dissolves under the tongue
Taking in the morning lessens insomnia
Define dementia
Umbrella term for loss of cognitive functioning that interferes with daily life and activities
Name the different types of rare dementias
Lewy body
Posterior corticoid atrophy
Primary progressive aphasia
Familial AD
Frontotemporal lobe dementia
Young onset alzheimers disease
Explain the neuroanatomic changes that occur in a person with alzheimers
Destruction of proteins of nerve cells of cerebral cortex by diffuse infiltration with neurofibrillary tangles and plaques (non functional tissue)
What does Donepezil treat?
Alzeheimers, manages symptoms and slows progression but does not prevent/cure AD
What are the 3 newest risk factors for dementia?
Excessive alcohol consumption, pollution, traumatic brain injury
Those ___ and older use the most OTC/perscription medications in Canada
65+
What % of older adults are taking more then 5 medications?
33%
What are the 4 stages of pharmacokinetics?
Absorption
Distribution
Metabolism
Excretion
Define chronopharmacology
Relationship of biological rhythms to variations in the body’s response to medications
Name 4 common medication issues in older adults?
Polypharmacy
Medication interactions
Misuse of medications
Adverse drug reaction
How do anticholinergic medications work?
Compete for the acetylcholine receptor sites within the cholinergic system - preventing the effects of cholinergic neurotransmission in the CNS and peripheral tissue
What are common side effects of anticholinergic medications?
Blurred vision/dry eyes
Dry mouth
Constipation
Skin flushing/overheating, unable to sweat
Drowsiness, dizziness, confusion, hallucinations
Rapid heart rate
Urinary retention
True or false: SSRIS are a good alternative for antidepressants over other antidepressant medications?
True - SSRIS have lower anticholinergic effects compared to older anti-depressants, although they still come with their own risks (hyponatremia)
Multimorbidity can be defined as:
2 or more long term conditions that increase with age
Acetylcholinesterase inhibitors have what function?
Inhibit cholinesterase enzyme from breaking down acetylcholine, increasing the level of duration and level of NT action which improves mental function
How does diffuse lewy body dementia present?
Parkinson’s like symptoms
Posterior corticoid atrophy affects:
Visual and spatial perception
Primary progressive aphasia affects:
Mainly language skills
Familial AD can occur as young as:
30 years
Frontotemporal lobe dementia affects:
Behaviour, personality, language
_______ testing is done to determine degree of cognitive impairment
Neuropsychological
