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older adults > midterm > Flashcards

midterm Flashcards

1
Q

primary aging

A

physiological aging related to time (senescence)

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2
Q

secondary aging

A

changes related to trauma or disease process

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3
Q

primary, secondary, tertiary prevention

A

P = vaccines, education

S = pap test

T = meds to keep chronic conditions controlled

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4
Q

biological theories

A

programmed

damage/error

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5
Q

programmed aging theories are

A
  • senescence
  • gene
  • endocrine
  • immunologic
  • nutritional
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6
Q

senescence aging

A

cells natural loss of function over time

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7
Q

gene aging

A

: life span is inherited

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8
Q

endocrine aging

A

aging is controlled by hypothalamus

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9
Q

immunologic aging

A

Decrease of T cells leads to infections

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10
Q

nutritional aging

A

diet affects aging

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11
Q

damage/error aging theories

A
  • wear & tear
  • cross-linking
  • free radicals
  • somatic mutation
  • environment
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12
Q

wear & tear aging

A

body parts wear out

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13
Q

cross-linking aging

A

DNA / proteins cross link with sugars and become stiff

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14
Q

free radicals aging

A

toxins damage cells; anti-oxidants neutralize toxins

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15
Q

somatic mutation aging

A

DNA damage (telomeres)

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16
Q

environmental aging

A

environmental toxins damage cells

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17
Q

psychosocial theories of aging

A
  • role
  • person-environment fit
  • activity
  • continuity
  • disengagement
  • age stratification
  • gero-transcendence
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18
Q

role aging

A

adaptation to different roles at late life is required

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19
Q

person-environmental fit aging

A

changes in competencies and needs due to aging influence ability to deal with environment

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20
Q

activity aging

A

active / productive life leads to life satisfaction and better health outcomes

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21
Q

continuity aging

A

continuation of life roles and habits slows aging

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22
Q

disengagement aging

A

there is a natural separation of old people from society (theory not supported currently)

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23
Q

age stratification aging

A

cohorts that age together share experiences

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24
Q

gero-transcendence aging

A

spirituality has a greater role in life and in acceptance of death

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25
Q

developmental aging theories

A
  • maslow
  • jung
  • erickson
  • peck
  • havighurts
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26
Q

maslow’s aging

A

self-actualization as a goal of aging but lower hierarchy needs must be met

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27
Q

jung aging

A

self-realisation, search for true self and spirituality

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28
Q

erickson aging

A

ego-integrity vs. despair (life satisfaction vs. unmet goals and regrets)

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29
Q

peck aging

A

new identity and new meanings beyond self-centeredness

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30
Q

havighurst aging

A

adjustment and adaptation tasks for late life changes

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31
Q

nursing theories for aging

A
  • functional consequences
  • theory of thriving
  • successful aging
  • compensation/selective optimization
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32
Q

functional consequences aging

A

aging causes functional decline

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33
Q

Theory of Thriving aging

A

harmony between environment and relationships

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34
Q

Successful Aging:

A

successful aging as a process of adaptation

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35
Q

Compensation / Selective Optimization aging

A

strategies to manage and cope with aging are required

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36
Q

presbyopia

A

Lens becomes less elastic which decreases the focusing power and causes decreased visual acuity

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37
Q

Presbycusis

A

most common form of hearing loss associated with aging

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38
Q

xerostomia

A

Reduced saliva production (dry mouth)

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39
Q

sarcopenia

A

Decrease in muscle mass, strength and endurance

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40
Q

possible causes of atypical illness presentation in older adults:

A
  1. Age-related physiologic changes
  2. Age-related loss of physiologic reserve
  3. Interactions of chronic conditions with acute illnesses
  4. Underreporting of symptoms
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41
Q

4 “I’s” Warning Red Flags:

A

Instability, Incontinence, Immobility, Intellectual impairment

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42
Q

pneumonia older adult presentation

A

Absence of the usual symptoms (cough, SOB, sputum), malaise, anorexia,
confusion, insidious onset

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43
Q

MI older adult presentation

A

Mild or no chest pain, confusion, weakness, dizziness,
SOB

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44
Q

UTI older adult presentation

A

Absence of dysuria, confusion, incontinence, anorexia

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45
Q

acute appendicitis older adult presentation

A

Diffuse abdominal pain, confusion, urinary urgency,
absence of fever or tachycardia

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46
Q

infection older adult presentation

A

Temperature normal or below normal, absence of
tachycardia, slightly elevated or normal white blood cell
count, decreased intake, confusion

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47
Q

depression older adult presentation

A

Confusion, apathy, absence of subjective feeling of
depression, somatic complaints (GI, constipation,
insomnia)

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48
Q

hypoglycemia older adult presentation

A

Light-headedness, confusion, vertigo, falls

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49
Q

hyperthyroidism older adult presentation

A

Depression, lethargy, anorexia, constipation, cardiac
symptoms

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50
Q

hypothyroidism older adult presentation

A

Confusion, agitation

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51
Q

acute abdomen older adult presentation

A

Mild discomfort, constipation, some tachypnea

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52
Q

nonspecific symptoms that may represent specific illness

A

confusion, self-neglect, falling, incontinence, apathy,
anorexia, dyspnea, fatigue

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53
Q

goals for care for older adults

A
  • maintain self care
  • prevent complications of aging or existing conditions
  • delay decline
  • achieve highest possible quality of life
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54
Q

responsive behaviours of dementia

A

indicate unmet needs

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55
Q

protective behaviours in dementia

A

indicate the person’s attempt to protect themselves

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56
Q

person-centered care approach

A
  • treating w/ dignity & respect
  • understanding hx, culture, etc
  • looking at situations from person POV
  • providing opportunities for person to have convo w/ others
  • ensuring person has chance to try new things/participate in activities
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57
Q

gentle care philosophy

A

arrange environmental b/w person w/ dementia & physical space, programs, & other pt

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58
Q

Gentle Persuasive Approaches - teaching dementia care

A
  • body containment strategies (learning about brain changes = responsive behaviours)
  • personhood (knowing & focusing on person behaviour)
  • unmet needs & behaviour (learning how to interpret aggressive behaviour as response to unmet needs)
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59
Q

Gentle Persuasive Approaches - Body containment strategies

A
  • de-escalation, respect, person-centered, safety
  • avoid restraints
  • manipulate environment!
  • stop & go
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60
Q

what is stop & go

A

when the person is resistive to care – stop, pause and re-approach

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61
Q

Gentle Persuasive Approaches (GPA) Care Tips

A
  • Learn what makes the person happy and provide it
  • Concentrate on the person, not the task
  • Sometimes doing nothing is the best thing
  • Have one calm person interacting with the client
  • Allow personal space
  • Remember that many behaviours are time limited
  • Identify triggers and unmet needs
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62
Q

Neurogenic Reflex Grab

A
  • Person with dementia will often instinctively grab on when something comes in close contact
  • Interpreted by staff as aggressive behavior
  • pulling away reinforces the reflex and the person will simply tighten their hold
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63
Q

eden alternative

A

It utilizes children, plants and animals to fight loneliness, helplessness and boredom experienced by the elderly living in care facilities

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64
Q

The GRACE (The Geriatric Resources & Care of Elders) Model

A

support team (NP & SW) & multidisciplinary team & staged process to develop & implement an individualized plan for each pt

  • The support team then meets with the patient’s primary care provider to finalize the patient’s care plan.
  • The final step involves the support team working with the patient and his or her family or caregiver to implement the plan.
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65
Q

Guided Care Model – Chronic Care Model

A
  • involves: nurses & dr work together w/ pt w/ chronic conditions
  • nurses: in-home assessments, care planning, teach strategies.. etc
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66
Q

ACE Model of Care Principles

A
  • Care is patient-centered
  • Treatment team is interdisciplinary
  • Planning for discharge is part of care
  • Hospital environment is elder friendly
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67
Q

The Older Adults Hospitalization Reduction Strategies

A
  • Engage key stakeholders: patient, caregivers, hospital and skilled nursing staff, primary care providers, rehabilitation specialists, and home health workers.
  • Assess risk and develop a comprehensive transition plan throughout the hospitalization.
  • Enhance the safe management of medications.
  • Place an emphasis on daily communication among the multidisciplinary team focused on a coordinated transition.
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68
Q

Ten Principles of Validation

A
  1. ppl unique & treated as individuals
  2. ppl valuable, no matter how disoriented
  3. reason behind behaviour
  4. behaviour d/t brain changes, physical, social, & psychological changes
  5. can be changed only if person wants to change them
  6. accepted non-judgementally
  7. life stage has tasks, unable to complete = psych problems
  8. memory changes = restore balance by retrieving memories from past
  9. painful feelings that expressed, acknowledged & validation = diminsh
  10. empathy!!!
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69
Q

P.I.E.C.E.S. Model

A

Physical (pain/conditions = change behaviour)

intellectual (affects memory, language, self-awareness)

emotional (problems adjusting to changes)

capabilities (knowing can/can’t do)

environment (supportive to help support abilities)

social & cultural (unique social & cultural needs)

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70
Q

Teepa Snow’s Positive Approach

A

evolved to meet the complex and unique needs of individuals using effective and structured technique.

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71
Q

delirium

A

acute, fluctuating syndrome of altered attention, awareness, and cognition

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72
Q

diagnostic criteria for delirium

A

disturbance in attention (reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
tends to fluctuate

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73
Q

subtypes delirium

A

hypoactive

hyperactive

mixed

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74
Q

hypoactive delirium

A
  • most prevalent
  • “quiet delirium”
  • lethargic, drowsy, quiet, withdrawn
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75
Q

hyperactive delirium

A
  • agitated, combative
  • disoriented
  • psychotic features (hallucinations, delusions, illusions)
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76
Q

mixed delirium

A

mixed symptoms of hypo/hyper

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77
Q

delirium vs psych disorder

A
  • psychiatric disorder almost always lacks the disorientation, memory loss, and cognitive impairment found in delirious patients.
  • A history of manic illness or psychotic disorder suggests a diagnosis of psychiatric disease.
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78
Q

Delirium is misdiagnosed as depression in up to 40% of cases. (T/F)

A

TRUE

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79
Q

delirium risk factors

A
  • age
  • pre-existing cognitive dysfunction
  • taking multiple medications
  • infection
  • chronic illness/comorbidities
  • post op
  • sleep deprivation
  • so many other things..
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80
Q

are males or females at greater risk for delirium

A

MALES

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81
Q

PRISM-E underlying causes delirium

A
  • pain
  • restraint/retention
  • infection
  • sensory impairment/sleeplessness
  • medication/metabolic disturbance
  • emotions/environment
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82
Q

other causes of delirium

A
  • drug toxicity
  • substance abuse
  • dehydration
  • acute illness
  • exacerbation of chronic disease
  • elimination problems
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83
Q

suspect delirium when..

A

SUDDEN onset of altered behaviour

decreased ability to focus & pay attention

perceptual disturbances & impaired cognition

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84
Q

delirium is medical emergency - priorities

A
  • focus & safety
  • least restrictive measures
  • remove all tubes & drains ASAP
  • utilize haldol for agitation (produces sedation w/o amnesia)
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85
Q

test for delirium - 4AT

A
  • months of year backwards
  • asking pt day of the week
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86
Q

delirium vs dementia onset

A

del = rapid, decrease MMSE

dem = slow, decline of 2-3 MMSE points over years

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87
Q

delirium vs dementia symptoms

A

del = fluctuate over course of day

dem = relatively stable

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88
Q

delirium vs dementia duration

A

del = days to week

dem = years

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89
Q

delirium vs dementia orientation

A

del = disorientation & disturbed thinking internmittent

dem = persistent disorientation

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90
Q

delirium vs dementia LOC

A

del = fluctuates, w/ inability to concentrate

dem = alert, stable

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91
Q

delirium vs dementia sleep/wake cycle

A

del = sleep/wake cycle may be reversed

dem = sleep fragmented

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92
Q

CAM

A
  1. evidence of acute change in MS
  2. inattention, difficulty focusing attention

& either/or

  1. disorganized thinking
  2. altered LOC
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93
Q

delirium? assess

A

VS, BW, hydration, CBG, MSE, urine..

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94
Q

delirium treatment goals

A
  • nonpharm measures
  • establish routine & comfortable surroundings
  • reassurance
  • reduce sensory stim
  • rest & sleep
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95
Q

delirium prevention triad interventions

A
  1. prevent sleep deprivation
  2. monitor hydration / prevent dehydration
  3. prevent stimuli deprivation / ensure vision & hearing
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96
Q

nonpharm interventions for delirium

A
  • hydration
  • early mobilization
  • removal catheters
  • repeated reorientation
  • glasses/hearing aids
  • promote good sleep
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97
Q

nice & easy approach when working with delirium

A
  • name
  • introduce self
  • contact (firm pressure)
  • eye contact
  • explain (what ur doing BEFORE)
  • avoid arguments
  • smile (calm & reassuring)
  • you are in control (change approach if necessary)
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98
Q

dementia

A

global loss of all higher intellectual function, memory and cognitive function, accompanied by disintegration of personality and behaviour

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99
Q

is dementia a normal part of aging

A

NO

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100
Q

key features of dementia

A
  • Most types of dementia are non-reversible, chronic and progressive.
  • Symptoms occur slowly over months to years.
  • Cognition, mood, functional ability and behavior are affected.
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101
Q

dementia risk factors

A
  • age
  • genes
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102
Q

dementia symptoms

A
  • essential development of multiple cognitive deficits:
  • concentration
  • coordination
  • initiation
  • self-monitoring & self-correction
  • emotion regulation
  • inhibition
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103
Q

Behavioral and mood changes result in “Responsive behaviours”:

A

aggression, agitation, anxiety, sexual disinhibition, wandering

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104
Q

7A’s of dementia

A
  • anosognosia
  • amnesia
  • apathy
  • agnosia
  • apraxia
  • aphasia
  • altered perception & attention deficit
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105
Q

anosognosia is

A

lack of insight

  • unaware of changes
  • doesn’t recognize effects of disease
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106
Q

amnesia

A

memory loss

  • last thing learned is first thing lost
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107
Q

apathy

A

loss of initiation

  • lost ability to begin activity on own
  • will engage in convo or activity if someone else begins
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108
Q

apathy vs depression

A
  • depressed will participate if engaged by someone else
  • apathy is not choosing but rather person has lost the ability to initiate activities
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3
4
5
Perfectly
109
Q

agnosia

A

loss of recognition

  • trouble understanding meaning of what seen, heard, smell, touched
  • loss recognition of ppl that last came into their life (ex: grandchildren)
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110
Q

apraxia

A

loss of purposeful movement

  • lose ability to plan, sequence and carry out steps of particular tasks
  • trouble understanding directions
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111
Q

aphasia

A

loss of language skills

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112
Q

attention deficit

A

difficulty maintaining attention & easily distracted

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113
Q

categories of dementia

A

early: familial alzheimers, frontotemporal dementia

rapidly progressive dementia: creutzfeldt-jakob disease

later onset dementia: 4 primary types

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114
Q

primary types of dementia

A
  • alzheimers
  • vascular dementia
  • dementia with lewy bodies
  • frontotemporal dementia
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115
Q

alzheimers

A

most common, memory loss, mood/behaviour changes, damage & death of brain cells

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116
Q

vascular

A

interrupted blood supply to brain (post stroke), step progression

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117
Q

FTD

A

middle age, personality changes, impaired executive functions, mental rigidity, perseveration

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118
Q

lewy dementia

A

protein deposits in nerve cells, fluctuating alertness, repeated falls, tremor, hallucinations, delusions

119
Q

alzheimers cause what kind of changes in brain

A

formation of plaques, tangles, brain shrink, inflammation

120
Q

vascular dementia is described as

A

problems in circulation of blood in brain

generally irreversible

impairment experienced related to area of brain that damaged

121
Q

Responding to BPSD: ABC Method

A

Antecedent (trigger)
Behavior
Consequence

Serves to better understand triggers and pattern of behaviors so appropriate measures can be implemented

122
Q

When can medication use be considered for dementia

A

Behaviour is dangerous, distressing, disturbing, damaging to social relationships and persistent
AND
Has not responded to consistent nonpharmacological treatment plan
OR
Requires emergency, short-term treatment to allow proper investigation of underlying problems

123
Q

Citalopram and Sertraline used for

A

irritability

124
Q

Risperidone used for

A

short-term therapy of aggression and psychosis

125
Q

quetiapine & haldol used for

A

aggressive behaviours

126
Q

trazadone used for

A

sleep aid or mild tranq

127
Q

Pharmacotherapies for BPSD

A
  • Irritability: citalopram and sertraline
  • Aggression: haldol, quetiapine, risperidone
  • Psychosis: risperidone, olanzapine, quetiapine
  • Depression : citalopram, sertraline, mirtazapine, trazadone
  • Sleep problems: trazadone, zopiclone
  • Impulsivity: carbamazepine, gabapentin
  • Hyper-sexuality: Cyproterone (Androcur)
128
Q

What antipsychotic medications are not effective for?

A
  • Aimless wandering
  • Inappropriate urination/defecation
  • Inappropriate dressing/undressing
  • Vocally repetitious behaviour (calling out)
  • Hiding/hoarding
  • Eating inedibles
  • Tugging/removing restraints
  • Pushing wheelchair bound co-resident
129
Q

sun-downing

A

increase behavioural problems that begin at dusk –> night

130
Q

precipitating factors of sundowning

A
  • End-of-day exhaustion (both mental and physical)
  • An upset in the “internal body clock,” causing a biological mix-up between day and night
  • Reduced lighting and increased shadows causing people with Alzheimer’s to misinterpret what they see, and become confused and afraid
  • Disorientation due to the inability to separate dreams from reality when sleeping
  • Not as much or no activity in the afternoon compared to the morning can lead to restlessness later in the day
131
Q

Person – Centered Communication

A
  • Focus on connecting rather than correcting
  • Guide rather than tell or control
  • Distract rather than confront
  • Avoid ‘no’ or ‘don’t’
  • Use short sentences
  • Use non-verbal expressions such as smiling, nodding, gesturing, pointing
132
Q

Pharmacological Treatment of Alzheimer’s Dementia

A

Cholinesterase Inhibitors (ChEI)

not effective treat agitation

133
Q

ChEIs Side Effects:

A

Nausea
Diarrhea
Muscle cramps
Insomnia / vivid dreams

134
Q

nursing consideration of ChEls

A

pulse, breathing, stomach discomfort, seizure risk

135
Q

Aricept (donepezil) increases the risk of two rare but potentially serious conditions:

A

muscle breakdown (rhabdomyolysis)

neuroleptic malignant syndrome (NMS)

136
Q

later life depression

A

older adults with depression will present for treatment of physical conditions, rather than for evaluation for a mood disorder. But it’s essential to assess the patient’s mood regardless of presenting symptomatology, because mood independently affects daily functioning and can impede treatment for medical comorbidities

137
Q

Depression in the Elderly

A
  • Patients often do not recognize their depression
  • Early morning awakening
  • Somatic presentations
  • Anorexia, weight loss
  • Onset or recurrence of substance abuse
  • Exaggeration of pre-morbid personality traits
138
Q

SIGECAPS

A
  • sleep disorders
  • interest decreased
  • guilt
  • energy decreased
  • concentration difficulties
  • appetite disturbances
  • psychomotor retardation/agitation
  • suicidality
139
Q

The suicide rate for older adults is two to three times higher than for the general population. (t/f)

140
Q

is path warm

A

I Ideation
S Substance Use
P Purposelessness
A Anxiety / Agitation
T Trapped
H Hopelessness / Helplessness
W Withdrawal
A Anger
R Recklessness
M Mood changes

141
Q

medication use concerns in older adults

A
  • changes related to aging: affect OA differently
  • compliance: overuse, underuse
  • polypharm
  • adverse drug reactions
  • drug interactions
142
Q

are OA biggest users of prescription & OTC

143
Q

the more drugs one is taking the greater the chance of

A

drug/drug interactions & adverse reactions

144
Q

dementia mnemonic for drugs

A

D = drugs

E = eyes & ears

M = metabolic (endocrine, electrolytes)

E = emotional (depression, grief)

N = neurological (parkinson’s, alzheimers)

T = trauma/tumor

I = infections

A = arteriosclerosis

145
Q

pharmacokinetics

A

movement & action of drug in body

146
Q

4 major pharmacokinetic processes

A

absorption, distribution, metabolism, excretion

147
Q

absorption age related changes

A
  • decreased surface area & blood flow to GI
  • decreased GI motility
  • increased pH
  • reduced salvia production
  • reduced volume of pancreatic secretions
148
Q

distribution changes

A
  • decreased albumin (risk digoxin, warfarin, diazepam)
  • increased lipoprotein (propranolol, lidocaine)
  • less body water
  • higher fat content
  • decreased muscle
149
Q

metabolism changes

A
  • reduced hepatic blood flow (CCB, BB, narcotics)
  • decline in oxidative metabolism (lorazepam etc “pams”)
150
Q

polypharm

A

use of multiple medications

151
Q

brown bag test

A

bring in all prescribed meds, OTC meds, herbal meds to appointment

152
Q

prescribing cascade

A

meds are prescribed to treat effects of other medications

153
Q

polypharm prevention “SAIL”

A

S = simplify

A = adverse effects

I = indication

L = list

154
Q

polypharm prevention “TIDE”

A

T = time

I = individualized

M = drug interactions

E = educate

155
Q

adverse drug reactions

A

unintended, unwanted, harmful effect of drug that occurs at normal drug dose

156
Q

adverse drug reactions 7X more common in OA

157
Q

adverse reaction causes

A
  • improper drug/dose selection
  • nonadherence

altered pharmacokinetics

multiple meds

multiple prescribers

158
Q

adverse reaction risk factors

A
  • over 85
  • live alone
  • lower body weight
  • HX drug reaction
  • alcohol
  • recent hospital
  • dementia
  • polypharm
  • multiple chronic disease
159
Q

adverse reaction consquence

A
  • falls
  • GI distress
  • incontinence
  • constipation
  • depression
  • anxiety
  • confusion
160
Q

acute dystonia

A

abnormal involuntary movements / slow muscle contractions

TX; benztropine, benadryl, ativan

161
Q

akathisia

A

restlessness

162
Q

NMS

A
  • extreme rigidity
  • fever
  • dizziness/fainting
  • fluctuating LOC w/ high creatinine kinase & leukocytosis
163
Q

meds commonly used in OA

A
  • benzo
  • neuroleptics
  • NSAIDs
  • tylenol
  • laxatives
  • antidepressants
  • phenytoin
  • warfarin
164
Q

meds associated with delirium

A
  • neuropsych meds
  • allergy meds
  • sedatives
  • GI meds
  • cardio meds
  • analgesics
  • corticosteroids
165
Q

inappropriate meds: beers criteria intentions

A
  • improve medication selection
  • educate clinicians
  • reduce adverse drug events
  • serve as tool for evaluating quality of care, cost, and patterns of drugs
166
Q

medication adherence challenges

A
  • lack of understanding
  • barriers to communication
  • sensory impairment: poor vision
  • cog impairment: forgetting
  • complex regimen
  • inconvenient packaging
  • adverse events
  • cost
  • social isolation
167
Q

med use & adherece nursing role

A
  • advocate & serve as pt defense against med error
  • advocate for meds to be taken with the least frequency possible
  • assess for S/E
  • education
  • simple language
  • ensure pt has glasses, hearing aids before education
  • teach regarding to negative effects
168
Q

nursing cate for chronic illness

A

preservation of function and prevention of further deterioration of health status

169
Q

chronic illness trajectory traditional model

A
  • pre traj = no sx; preventive phase
  • traj onset = sx present
  • crisis = life threatening
  • acute = active illness and complications
  • stable = sx controlled
  • unstable = sx diff control
  • downward = progressive deterioration; increase sx
  • dying
170
Q

shifting perspective model

A
  • living w/ chronic illness as ongoing shifting b/w wellness and illness
  • reflects pt-centered
  • goals: minimize risks, alleviate sx, avoid complications, max function, preserve hope
171
Q

nonfatal vs serious potentially fatal ilness

A

N = arthritis, vision impairment

S = cancer, stroke

172
Q

fraility

A

state r/t aging process in which multiple body systems gradually lose their built-in reserves

greater risk for catastrophic outcomes (falls –> death)

173
Q

OA defined as frail d/t functional decline more likely to present with ANY

A

geriatric syndrome

174
Q

geriatric syndrome progression

A

old age, functional & cognitive decline, impaired mobility —> incontinence, falls, PU —> frailty —> failure to thrive

175
Q

ex of geriatric syndrome

A

falls, depression, delirium, demetia, incontinence

176
Q

SPICES geriatric syndrome screening tool

A

S = sleep disturbances

P = problems w/ eating

I = incontinence

C = confusion

E = evidence of falls

S = skin breakdown

177
Q

identifying failty

A
  • prisma 7

questions & 3 or more yes indicate increased risk of frailty

178
Q

gait speed test

A

average gait speed of longer than 5 sec to walk 4 meters = frailty

179
Q

prevention and management of frailty

A
  • early identification
  • proper tx of acute & chronic
  • promotion of activity
  • promotion of proper diet
  • falls prevention
  • avoidance of polypharm & alcohol & smoking
  • advance care planning
180
Q

failure to thrive

A
  • state of progressive functional decline, progressive apathy, loss of willingness to eat/drink
  • culminates in death
  • SHOULD NOT be considered normal aging
181
Q

4 domains critical to development of FTT

A
  • impaired physical function
  • malnutrition
  • depression
  • cognitive impairment
182
Q

FTT etiology - 11 D

A
  • diseases
  • dementia
  • delirium
  • drinking alcohol
  • drugs
  • dysphagia
  • deafness
  • depression
  • desertion by family
  • destitution
  • despair
183
Q

FTT signature consequences

A
  • weight loss
  • dehydration
  • low cholesterol & albumin
  • increased infections
  • fractures
  • pressure ulcers
  • increased mortality
184
Q

vulnerability risk red flags

A
  • repeat ER visits
  • neglect
  • lack of followup appt
  • noncompliance
  • acute deterioration in ADL
  • unexplained weight loss
  • poor grooming
  • refusal of needed assistance
  • threat of eviction
185
Q

vulnerability & ethics

A
  • actual risk vs potential risk
  • tolerable vs intolerable risk
  • decisional capacity vs incapacity
  • autonomy vs duty to intervene
186
Q

nursing prevention strategies for FTT

A
  • mobilization
  • exercise & balance training
  • mental activity
  • nutrition
  • social supports
  • ASSESSMENTS
187
Q

parkinsons

A

progressive neurodegenerative disease of basal ganglia & involves dopamine pathway

abnormal movements

188
Q

severity of PD depends on

A

degree of neuron loss & reduction of dopamine receptors

189
Q

PD men or women more effected

190
Q

risk factors PD

A
  • advance age
  • declining estrogen levels
  • decreased vit B12 & folates
  • exposure to heavy metals
191
Q

types of PD

A
  • primary or idiopathic (cause unknown)
  • secondary to other medical condition
192
Q

cardinal sx PD

A
  • rest tremor
  • rigidity
  • postural instability
  • bradykinesia
193
Q

tremors

A
  • 1st sx
  • affects jaw, facial muscles, tongue, limbs
  • disappears with movement
  • pill rolling
194
Q

rigidity

A

increased tone

195
Q

bradykinesia

A
  • slow movement
  • reduced range
  • difficulty with repetitve movements
196
Q

postural instability

A

difficulty w/ balance

197
Q

additional sx PD

A
  • mask like facial
  • muffled speech
  • depression
  • sleep disorder
  • pain
  • fatigue
  • dementia
  • writing changes
  • loss of automatic movements
198
Q

tx for PD

A
  • levodopa w/ carbidopa = 1st line tx
199
Q

levodopa

A

most effective

crosses blood-brain barrier & converted to dopamine

200
Q

dopamine agonists

A

bromocriptine, pergolide, lisuride, ropinirole, pramipexole reduce trempr

201
Q

osteoporosis

A

compromised bone strength predisposing to increased risk of fracture

202
Q

early diagnosis technique for osteoporosis

203
Q

dexa

A

best tech for assessing bone mineral density

T-score given = comparison of ur bone density to healthy 30 y/o

204
Q

t-score below -2.5 SDs indicates

A

osteoporosis

205
Q

frax

A

determines fracture probability

206
Q

factors that increase risk of osteoporosis

A
  • family hx
  • osteopenia
  • low body weight
  • diet low in calcium
  • low levels of physical activity
  • ovaries removed
  • past menopause
  • vit D deficiency
  • smoking
  • excessive caffeine intake
  • race
  • excessive alcohol
207
Q

conditions causing bone loss or fractures

A
  • rheumatoid arthritis
  • celiac disease
  • gastric bypass surgery
  • COPD
  • chronic liver failure
208
Q

tx for osteoporosis

A
  • prevent fractures
  • healthy lifestyle choice
  • balanced diet
  • adequate calcium & vit D
  • fall prevention
  • weight bearing exercises
  • resistance exercises
  • flexibility exercises
209
Q

vertebral compression fractures most common complication of osteoporosis

210
Q

gout

A

inflammatory arthritis that occurs as result of increased uric acid levels in blood which leads to accumulation of urate crystals in joints, soft tissues, kidneys

211
Q

uric acid is

A

waste product, secreted when body breaks down purines

212
Q

diagnosis of gout

A

aspirate fluid from swollen joint

213
Q

acute gout

A

painful, affects one joint

214
Q

chronic gout

A

repeated episodes of pain & inflammation may involve more than 1 joint

215
Q

risk factors gout

A
  • hyperuricemia (greater 6.8)
  • hypertension
  • diabetes
  • hyperlipidemia
  • chronic kidney disease
  • cardiovascular disease
  • metabolic syndrome
216
Q

tx for gout

A
  • rest joint
  • NSAIDs (indomethacin or naproxen)
  • glucocorticoids
217
Q

herpes zoster

A

reactivation of varicella zoster virus

remains dormant in dorsal root ganglion

218
Q

sx prior to rash (shingles)

A

fever, general weakness, pain, burning, tingling sensation over area of body/face

219
Q

rash

A

occurs in dermatome supplied by nerve

dermatome area of skin that mainly supplied by single spinal nerve

220
Q

blisters dry & crust within 7-10 days

221
Q

shingles pt teaching

A
  • wash hands before/after touching
  • take meds
  • wear gloves when applying cream
  • wear cotton
  • refrain from touching people
222
Q

antiviral meds

A
  • start within 72 hrs of rash appearing
  • do not kill virus but stop it from multiplying which is thought to limit severity of sx
223
Q

transmission shingles

A

only possible to those not immune to chickpox & contact with fluid from blisters may cause chickenpox

placed in isolation

224
Q

complication of shingles

A

postherpetic neuralgia = painful condition lasts more than 90 days after rash

225
Q

prevention of shingles

226
Q

arthritis

A

joint inflammation

227
Q

rheumatoid arthritis

A

autoimmune condition that causes chronic inflammation

experience painful swelling of joints & become severely deformed

228
Q

does rheumatoid arthritis affect joints symmertrically

229
Q

risk factors of osteoarthritis

A

increased age, obesity, family hx, repetitve use of joint

230
Q

osteoarthritis

A

cartilage breaks down & wears away

bone on bone = pain

231
Q

is early intervention critical with osteoarthritis

232
Q

with osteoarthritis when is it worse

A

morning d/t long period of inactivity

232
Q

pain and osteoarthritis

A
  • initially present when joint used
  • as disease progresses, pain present at rest, more joints become involved
  • joints become enlarged, unstable, deteriorate crepitus
  • range of motion reduced
233
Q

intervention for osteoarthritis

A
  • obtain tx ASAP
  • control pain
  • minimize disability
  • provide teaching
  • exercise
  • physio for OA & RA to retain joint use
  • weight loss if indicated
233
Q

information control

A

withholding info

233
Q

tx for osteoarthritis

A
  • hot/cold therapy
  • cold = acute process
  • complementary & alternative meds
  • music
  • acupuncture
234
Q

limiting options

A

not offering certain options

235
Q

impeding pts ability to act upon their wishes

A

refusal to assist, compulsory tx, imposing restrictions

236
Q

healthcare justifications

A

paternalism is acceptable because it serves to restore person autonomy

237
Q

justification for limiting autonomy

A
  • lack of capacity / competency
  • potential to harm, self
238
Q

risk assessment rules

A
  • risk management interventions are never based on convenience or gratification
  • negotiating risk ethically involves the minimal use of power to attain max benefit & min infrigement on pt liberty
  • more grave consequences - the greater obligation to intervene
239
Q

encumbered pt

A

whose judgement & decision making ability are hindered by distorting factors (brain damage), impairing emotional state (pain, grief), undue influence (manipulation) and inadequate / partial info

240
Q

unemcumbered pt

A

competent & not subjected to distorting factors

241
Q

advance directive

A

proxy (identified person to make decision) or instructional (what tx they want under what circumstance)

242
Q

what act governs sub decision makers discretion & obligation

A

representation agreement act

243
Q

best interest judgement

A
  • what would reasonable person in pts position would want?
  • considerations: current wishes, if condition likely to improve by care, whether benefit greater than risk, less restrictive care would be as beneficial
244
Q

moral distress

A

when we know what right/ethical action but can’t act on it

245
Q

consequence of moral distress

A
  • disempowering tension
  • internal conflict
  • self doubt
  • chronic stress
246
Q

ways to negotiate moral distress

A
  • recognize, acknowledge, discuss openly, affirm feelings, accept our limitations
247
Q

valid consent

A
  • voluntarily given by pt
  • fully informed
  • chance to ask qts & receive answers
248
Q

adult consent not required

A
  • emergency
  • invol psych
  • triage
  • communicable disease (TB)
249
Q

2 types of decision makers

A

formal = duly appointed person

temp = chosen by healthcare provider

250
Q

personal guardian

A

incapable adult not make representation agreement or advance directive while capable & healthcare & personal decisions need to be made

251
Q

power of attorney vs representation agreement

A

PA = money & property

RA = health care & other personal matters

252
Q

advance care planning

A

process that involves conversations, decisions, and identifying how poeple would like to be cared for

253
Q

qualify as TSDM

A
  • at least 19
  • contact w/ adult preceding 12 mon
  • no dispute w/ adult
  • be capable of giving, refusing or revoking sub consent
  • be willing to comply with duties
254
Q

green sleeve

A

important doc on fridge

255
Q

safeguards to maid

A
  • written request before 2 independent witnesses
  • 2 independent HCP
  • 10 clear days b/w request & provision of maid
  • msut be given opp to withdraw immediately before provision of maid
256
Q

end of life care

A

care provided to person in their last weeks to days of life

257
Q

end of life sub consent

A
  • personal guardian (court)
  • representative (individual)
  • advance directive
  • temp sub decision marker
258
Q

SPEAK EOL decisions

A

s = sub decision maker
p = preferred tx option
e = expressed wishes
a = advance directives
k = knowledge of benefits & tx prognosis

259
Q

MOST

A

m3 = full medical tx
m2 = transfer only when comfort measures can’t be achieved
m1 = comfort measures only
c2 = intubation
c1 = no intubation

260
Q

goals of palliative care

A

prevent & relieve suffering, enhance quality of life, optimize function, assist within decision making, provide opportunities for personal growth

261
Q

spirituality and dying

A

important resource for addressing distress when facing death

262
Q

assessing spiritual needs

A

asking about meaning in life, personal strengths & connectedness with higher self & explore how these values can influence decisions regarding health care choices and self care

263
Q

spiritual needs in dying process

A
  • need for relief from loneliness & isolation
  • need to feel useful
  • need to express anger
  • need for comfort in anxiety and fear
  • need to allevaite depression and find meaning in experience
264
Q

spiritual work of dying process

A
  • remembering r/t to reminiscence or a life review through which one can recognize the goodness of life
  • reassessing is act of redefining personal worth
  • reconciling means healing damaged or broken relationships
  • reuniting refers to combining the material and spiritual elements of person & world
265
Q

pron of death

A
  • no apical for 1 min
  • no spontaneous resp for 1 min
  • pupils dilated & fixed
266
Q

death charting elements

A
  • events leading to death
  • time resp ceased
  • criteria to pronounce death
  • death at ___
  • time physician notified
  • time family notified
267
Q

good death

A
  • pain/sx management
  • avoiding prolonged dying process
  • clear communication about decisions
  • adequate prep for death
  • feeling sense of control
  • finding spiritual or emotional sense of completion
  • affirming pt as unique and worthy
  • not being alone
268
Q

approaching death sx

A
  • decreased LOC
  • muscle relaxation/inability yo swallow
  • restlessness
  • congestion
  • breathing laboured
  • moaning likfe sounds
  • incontienence
269
Q

palliative discomfort

A
  • pain
  • delirium
  • anxiety/depression
  • dyspnea
  • N & V
  • dehydration
  • diarrhea
  • incontinence
  • inability to perform ADLs
270
Q

nursing interventions for dying

A
  • ongoing assessment
  • pain control
  • reduce air hunger
  • skin & mucous membrane care
  • choices
  • TR
  • grooming
  • spirituality needs
  • communication
271
Q

BATHE communication

A

B = background info

A = affect

T = trouble

H = handling things

E = empathy

272
Q

mourning vs grief

A

G = individual response to loss

M = active & evolving process

273
Q

acute grief

A

CRISIS!

somatic & psychological sx of distress that occur in waves lasting varying periods of time

274
Q

anticipatory grief

A

response to a real or perceived loss before it occurs

275
Q

ambiguous loss

A

type of loss that happens when a person with dementia is physically present, but at time psych absent

276
Q

disenfranchised grief

A

person whose loss can’t be openly acknowledged or publicly mourned experiences

277
Q

chronic / dysfunctional grief

A

pathologic chronic grief begins with normal grief but obstacles interfere with normal evolution towards adjustment, towards the reestablishment of equilibrium

278
Q

risk for dysfunctional grief

A
  • dependency
  • unexpected loss
  • inadequate coping
  • lack of support
  • mental illness
  • substance use
279
Q

5 R’s of spirituality

A

reason & reflection on meaning of life

religion

ritual practices

relationships

restoration = positive impact & influence spirituality

280
Q

spiritual care interventions

A
  • being with
  • doing for
  • looking inward
  • looking outward
281
Q

being with

A
  • listening
  • offering self/being present
  • conveying acceptance, recognition
  • meeting persons at their level
  • creating trust
282
Q

doing for

A
  • holding hands/ tender touch
  • exploring concerns
  • making connections with other supports
283
Q

looking inward

A

acknowledging spiritual dimension

  • assessing spiritual needs
  • developing a deeper understanding of cultural/religious views
  • facilitating expression of thoughts r/t existential issues
  • helping to make sense and derive meaning from experiences
  • encouraging grieving over losses
284
Q

looking outward

A
  • referring to pastoral care
  • encouraging & affirming value of being part of religioud community
  • teaching lifestyle alteration focused on self care
  • encouraging prayer
  • helping find joyful & pleasurable activities
285
Q

spirituality and dementia

A

memory may be lost, needs continue and remain strong

286
Q

types of elder abuse

A
  • physical
  • sexual
  • emotional
  • medical
  • financial
  • neglect
  • abandonment
287
Q

what is most common type of abuse

288
Q

risk factors of elder abuse

A

advance age (80)

women

disability

dementia

depression

social isolation

289
Q

types of abuse by nurses

A
  • embarrassing or offensive comments
  • yelling/swearing
  • deliberate ignore care needs
  • roughness
  • hitting
  • sexual
  • taking values
290
Q

nurses strategies to help prevent abuse

A
  • know triggers
  • know how to manage pt who demonstrate aggressive behvaiour
  • learn about other cultural values
  • communication skills
  • peer support activities
  • obtaining support from management

older adults (3 decks)

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