midterm from quizlet Flashcards
What is SIGECAPS?
Sleep
Interest
Guilt / worthlessness
Energy
Concentration / difficulty making decisions
Appetite
Psychomotor activity
Suicidal Ideation
IS PATH WARM
Ideation
Substance abuse
Purposelessness
Anxiety
Trapped
Hopelessness
Withdrawal
Anger
Recklessness
Mood change
Depression in older adults can present as what?
May present as the onset to dementia
Depression in older adults may include a strong delusional component true or false?
True, and it is not easily treatable with antipsychotic medications
Give 5 examples of care approaches that are not helpful when caring for cognitively impaired adults
Being aggressive / domineering
Being vague with instructions / being broad
Using a singular approach to all patients
Talking down to them / diminishing their value / diminishing their abilities
Acting like we know best / Acting like they are children
Give 5 examples of nursing interventions that are informed by theories of aging
Harm reduction / quitting smoking - Environmental theory
Provision of education related to functional abilities as they age - Functional consequences theory
Encourage physical activity as tolerated - Activity theory
Encourage participation in groups of similarly aged / stage of lifed adults - Age stratification
Encourage a diet higher in fresh vegetables, fruits, fibre - nutritional theory
Preservation of function on manipulation of environment / activities of daily life
Name 4 types of dementia
Vascular dementia
Alzheimer’s disease
Lewy bodie’s diease
Frontal Temporal dementia
What is vascular dementia
Onset is slow, post-stroke
Caused by significant lack of oxygen to the brain
Progresses in steps
Alzheimer’s disease
Most common type of dementia (75%)
Cause unknown (several theories)
Reduction in brain acetylcholine
Serious head trauma
Genetic factors
Presence of plaques and tangles
Lewy body disease
Earlier occurrence of visual hallucinations (NOT in Alzheimer’s)
Faster onset than Alzheimer’s
Caused by the presence of Lewy bodies present in the brain
Frontal temporal dementia
EARLY ONSET
Causes people to have problems with speech, forgetting meaning of words
Atrophy of frontal temporal lobes
Behavioural symptoms (Dis-inhibition)
Explain what medications are typically used in the treatment of delirium, dementia, depression
Delirium - Identify underlying cause, treat accordingly. I.E antibiotics, analgesics though also antipsychotics (Haldol)
Dementia - Cholinesterase inhibitors - boosts chemical messangers
Depression - SSRI’s other antidepressants
Explain normal changes related to aging in the metabolism and urinary system
Metabolism - Increased body fat, increased metabolic diseases (type 2 diabetes, hypertension)
Urinary - Decreased kidney mass, decreased GFR, decreased BPH
Explain PIECES
P - physical
I - intellectual (Dementia)
E - emotional (Poor adjustment to changes)
C - Capabilities (Knowing limitations and strengths)
E - Environment
S - Sociocultural
Person-centered framework
Capabilities is a key addition
Name 5 communication strategies with cognitively impaired older adults
Sit in front of patient
Speak at a natural rate
Speak at eye level / make eye-contact
Use simple wording
Rephrase statements
Explain normal changes related to aging in body composition and cellular system
Body composition - Decrease in: Body mass, muscle mass, skeletal mass, body water, creatinine production
Increase in: Adipose tissues,
Decline in strength and function, increases effects level of drugs
Cellular systems - Increased: DNA damage, cell aging, senescence (WHICH MEANS AGING) fibrosis
What is Senescence
Aging
Changes in circulatory and respiratory
Circulation is reduced
Respiratory - Decreased in capacity (reduced lung elasticity), increased in residual volume
Name 5 characteristics of depression in older adults
Weight loss or lack of appetite
Decreased sleep
Somatic presentations
Resistance or aggression
Prominent cognitive problems (Such as problem solving)
How do you differentiate depression and delirium
Rule out underlying medical disorders / infections that may otherwise explain delirium
Assess onset of mood (Delirium is sudden onset and fluctuates, depression less so)
Utilize depression screening tools (PHQ9 etc)
What is delirium
Acute fluctuating syndrome of attention, cognition, awareness, sudden change
How is delirium treated
Always determine underlying cause
Nursing priorities for delirium
SAFETY (It’s step number one)
Treat pain, infection, dehydration
Ensure adequate nutrition, early mobilization
Re-orient
Explain person-centered approaches to adult care
Person-centered care is a philosophy that acknolwedges the individuality, and right to dignity of the individual
4 major elements
Person-centered focused
“If something doesn’t work, what would you do?”
- Leave it and come back rather than insisting
- See the world through the patient’s perspectiv
Compare primary and secondary aging
Primary aging - Physiological aging related to time
Secondary aging - Changes related to trauma or disease process
Give examples of risk factors for aging
Nutrition
Smoking
Alcohol
Sunburn
Sleep hygiene
Oral care
Social support systems
Regular medical checkups
Injury protection
Name 5 issues related to hospitalization for older adults
Increase risk for infection
Increase risk for delirium
Increase risk for falls
Physical deterioration
Increased risk for DVT
Depression
Quality of discharge planning / continuity of care
Recent hospitalization - puts people at risk for going back into the hospital
What does Hereditary mean?
passed down from parent to child
What does senescence mean?
is the process by which a cell looses its ability to divide, grow, and function. This loss of function ultimately ends in death.
What is the Hayflick limit?
Cells divide only a certain number of times and then die
What are programmed theories?
Aging has a biological timetable or internal clock
What are damage / error theories?
Aging is a result of internal and external assaults that damage cells
Random processes accumulate over time and inflict damage
Name 5 programmed theories
*Programmed Senescence
*Gene Theory
*Endocrine Theory
*Immunologic Theory
*Nutritional Theory
Name 5 Damage / Error Theories
*Wear and Tear
*Cross-linking Theory
*Free Radicals
*Somatic Mutation
*Environmental Theory
What is the Gene theory?
The gene theory states that aging is programmed due to one or more harmful genes within each organism
The gene theory suggests that human life span is an inherited trait.
What is the Endocrine theory?
Biological clocks act through hormones to control the pace of aging.
Dysfunction of the hypothalamus in regulating endocrine activity, causing age-related changes
What is the immunological theory?
The immunologic theory explains age-related decline in the immune system.
The autoimmune theory of aging stipulates that cells undergo changes and the body identifies them as foreign.
What is the nutritional theory?
Nutritional theory focuses on the idea that diet affects how one ages.
Calorie Intake Theory: Low calorie diet combined with high nutrient intake and exercise leads to metabolic efficiency and slows aging
What is the Wear and tear theory
Parts of the body eventually wear out from repeated use killing the parts and then the body.
What is the Cross-linking Theory
Some proteins in the body become cross-linked, thereby not allowing for normal metabolic activities
Connective Tissue Theory:Cell molecules from DNA and connective tissue interact with free radicals to reduce the ability of tissue to regenerate
What are Free radicals?
Free radicals cause cell damage
Free radicals are byproducts of metabolism; can increase as a result of environmental pollutants
When they accumulate, they damage cell membrane, decreasing its efficiency
What is the Environmental Theory?
A number of environmental factors are known to threaten health and may be associated with aging such as smoking, lead ingestion, arsenic poisoning.
Name the Psychosocial Theories of Aging
*Role Theory
*Person-Environment Fit Theory
*Activity Theory
*Continuity Theory
*Disengagement Theory
*Age-stratification Theory
*Selective Optimization with Compensation
*Gero-transcendence
What is the Role theory?
As people evolve through the stages in life, their roles evolve as well.
What is the person-environment fit theory?
Individuals have personal competencies that assist in dealing with the environment; i.e. ego strength, level of motor skills, individual biologic health, cognitive & sensory-perceptual capacities
What is the activity theory?
*Activity is necessary to maintain life satisfaction and positive self-concept:
It is better to be active than inactive
An individual is the best judge of their needs and success
What is the continuity theory?
Old age is not a separate phase of life, but rather a continuation
Individuals tend to develop and maintain a consistent pattern of behaviour, replacing one role for a similar one as one matures.
What is the disengagement theory?
talks about how old people deatch from society and become more introspective
What is the Age Stratification Theory
Age is a way of regulating behavior of a generation
What is the Selective Optimization with Compensation Theory
*Individuals develop strategies to manage and cope with losses of function that occur over time through:
optimizing existing skills / abilities, and
compensating by developing adaptations.
What is Gero-transcendence
*As people age they gain better understanding of self, shift their attention to others, and develop the importance of transcendent connections (spirituality)
What is Maslow’s hierarchy of needs?
physiological, safety, love/belonging, esteem, self-actualization
What is Havinghurst’s theory?
Havighurst’s tasks for late life:
*Adjustment to decreased strength and health
*Adjustment to retirement and reduced income
*Adjustment to loss of spouse
*Establishment of relationships with peers
*Adaptation to changing social roles
*Establishment of satisfying living arrangements
What is the functional consequences theory?
*Environmental and biopsychosocial consequences of aging impact functioning.
Name 4 goals of care for older adults as per the powerpoint
Maintaining self care
Preventing complications of aging or of existing conditions
Delaying decline
Achieving the highest possible QOL
What is Gerontology?
is the broad term used to define the study of aging and / or the aged.
Is aggression the proper term for a patient with dementia?
when describing behaviors of individuals with dementia the terms responsive and protective behaviors are preferred.
What does a responsive behaviour indicate?
An unmet need
What does a protective behaviour indicate?
The person’s attempts to protect themselves
What does the gentle care philosophy seek?
seeks to arrange an environmental fit between the person with dementing illness and the physical space, the programs, and the significant people with whom the person must interact
What are some gentle persuasive approach (GPA) to body containment strategies?
Practice personal and team de-escalation techniques that are compassionate, respectful, person-centered, safe, and self-protective.
Avoid restraints!
Manipulate the environment:
What is Stop and Go?
when the person is resistive to care - stop, pause and re-approach
What is the GPA personhood component
Personhood involves the support, respect, and trust given from one person to another in a caring relationship
The person with dementia has a unique history, the capacity for interpersonal relationships, many remaining strengths and abilities, and the need for supportive environment
GPA unmet needs and behaviours
There is a meaning behind each behavior
Most behaviors are time limited
Most responsive behaviors are the result of unmet need
Because the behavior has meaning, the person will respond to our behavior based on how they interpret it
What are 5 GPA care tips
*Learn what makes the person happy and provide it
*Concentrate on the person, not the task
*Sometimes doing nothing is the best thing
*Allow personal space
*Remember that many behaviours are time limited
What is the neurogenic reflex grab?
Person with dementia will often instinctively grab on when something comes in close contact
What is the Eden alternative
An approach to care developed by Dr. Bill Thomas.
It utilizes children, plants and animals to fight loneliness, helplessness and boredom experienced by the elderly living in care facilities
What is the GRACE (The Geriatric Resources & Care of Elders) Model
It utilizes two distinct teams: a support team and a larger multidisciplinary team, and a staged process to develop and implement an individualized plan for each patient.
What is the guided care model
The Guided Care model involves nurses who work in partnership with physicians and others in primary care to provide patient-centered, cost-effective care to patients with multiple chronic conditions.
What is the ACE model of care
Acutely ill older patients often experienced. a permanent decline in their ability to perform basic activities of daily living.
What are the ACE model of care principles
*Care is patient-centered
*Care team is interdisciplinary
*Planning for discharge is part of care
*Hospital environment is elder friendly
The Older Adults Hospitalization Reduction Strategies
Engage key stakeholders: (patient, caregivers, hospital staff)
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
What is Validation therapy?
An approach for people with cognitive impairments and dementia
Components of the Validation Method
*Older people struggle to resolve unfinished issues. To work through these issues, they will express past conflicts in disguised forms, retreat inward, and potentially shut out the world.
*To help them resolve past issues, validation practitioners listen, showing empathy and respect so the person feels valued, not judged.
*Validation can apply to an individual or a group’s needs.
What are some validation techniques
Rephrase
*“Your wedding ring is gone”, “You think I’ve stolen it”
*“You think I am your sister. You miss her”
Utilize the visual / sense memory
*“It was a beautiful white gold ring”
*“How does she look like?”
Facilitate reminiscing
*“How did you meet your husband?”
*“What do you like the most about your sister? What don’t you like about her?”
What is the P.I.E.C.E.S model
Physical: pain and physical conditions can cause changes in behavior
Intellectual: dementia affects the person’s memory, thinking, language, self-awareness
Emotional: a person may experience problems adjusting to changes occurring in his/her life
Capabilities: knowing what the person can and can’t do will help to build on his/her strengths
Environment: a supportive environment will help the person maintain his/her abilities
Social & Cultural: each person has unique social and cultural needs that can be met only through an individualized approach
What is delirium?
Delirium is defined as an acute, fluctuating syndrome of altered attention, awareness, and cognition. It is common in older persons in the hospital and long-term care facilities and may indicate a life-threatening condition.
Name the three subtypes of delirium
Hypoactive
Hyperactive
Mixed
What is hypoactive delirium?
Most prevalent
Referred to as ‘quiet delirium”
Lethargic, drowsy, quiet and withdrawn
What is hyperactive delirium?
Agitated, combative
Disoriented
Psychotic features (hallucinations, delusions / paranoia, illusions)
What is mixed delirium?
hyper/hypo
How can you tell between delirium and a psychiatric disorder/
A psychiatric disorder almost always lacks the disorientation, memory loss, and cognitive impairment found in delirious patients.
What are some risk factors for delirium
Advanced age
Preexisting cognitive dysfunction
Taking multiple medications
Infection
Chronic illnesses & comorbidities
Recovering from surgery
Concussion
What is PRISM-E and what is it used for?
P Pain
R Restraint / Retention
I Infection
S Sensory Impairment / Sleeplessness
M Medication (new, change in dose, withdrawal) / Metabolic disturbance
E Emotions / Environment
It’s used to determine underlying causes for delirium
What else may cause delirium?
Drug toxicity or interactions
Substance abuse / misuse
Dehydration
Acute illness
Exacerbation of chronic disease
Elimination problems
Suspect Delirium When
SUDDEN onset of altered behavior (different from a baseline)
Decreased ability to focus and pay attention.
Perceptual disturbances and impaired cognition
Is Delirium a medical emergency?
Yes. Because the sudden onset of confusion can be the FIRST or ONLY sign of acute illness in the older adult, nurses must ASSUME that sudden changes are abnormal and begin investigations immediately.
Delirium medical emergency priorities
Focus and safety
Employ the least restrictive measures
Remove all tubes and drains as soon as it is possible
Utilize Haldol for psychosis / agitation - it produces sedation without causing amnesia
Is it Delirium or Dementia?
Delirium:
-Confused and inattentive
-New, acute onset
-Fluctuating course
-Reversible
-Caused by many triggers
-Sleepy or hyper alert
Sometimes preventable
Dementia:
-Confused but attentive
-No different from baseline
-Minimal fluctuation
-Irreversible
-Caused by one disease
-Alert
-Not preventable
What is the Confusion Assessment Method (CAM)
Requires the two following:
- Evidence of acute change in mental status
- Inattention, difficulty focusing attention, or keeping on track
And one of the following:
- Disorganized thinking
OR - Altered level of consciousness
Knowledge of Delirium Helps to:
Identify older adults at risk for delirium
Detect delirium promptly when it occurs
Assess causative and contributing factors
Treat underlying causes
Reduce the older adults anxiety and fear
Delirium Treatment Goals
Initiate non-pharmacological measures
Establish a routine and provide comfortable surroundings
Provide reassurance and emotional support (delirium is frightening
Reduce sensory stimulation (excess noise, etc.)
Promote rest and sleep
Promote orientation, calendar, clock, eye glasses, hearing aids etc.
Ensure adequate nutrition and fluids
Delirium Prevention Triad Interventions
- Prevent sleep deprivation
- Monitor hydration / prevent dehydration
- Prevent stimuli deprivation / Ensure vision and hearing
What is the NICE & EASY approach
NICE:
-Name: use preferred name
-Introduce yourself every time
-Contact: apply firm pressure
-Eye Contact
EASY:
-Explain what you are doing BEFORE you do it
-Avoid Arguments: try later if resistance interferes
-Smile: remain calm and reassuring
-You are in control: change your approach if necessary
What is mild neurocognitive disorder?
Mild Cognitive Impairment (MCI) involves cognitive decline beyond that normally expected in a person of the same age with preservation of function.
This is not a normal part of aging
What are some common symptoms of MCI
Neglect of personal hygiene
Becomes impulsive
Becomes easily distracted
Forget important events
Experience difficulty with abstract thinking
Is dementia a normal part of aging?
no
What are some key features of dementia
*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.
What are some diagnostic features dementia?
The cognitive deficits must be sufficiently severe to cause impairment in occupational or social functioning, and must represent a decline from a previously higher level of functioning.
Neurocognitive disorders, delirium and depression can co-exist.
Older adults with major neurocognitive disorder are at increased risk for delirium.
What are the 7As of dementia?
1.Anosognosia (from Greek: without knowledge of disease)
2.Amnesia (from Greek amnestia - oblivion)
3.Apathy (from Greek without feelings)
4.Agnosia (from Greek: without knowledge)
5.Apraxia (from Greek: without action):
6.Aphasia (from Greek without speech)
7.Altered Perception & Attention Deficit
Define Anosognosia
*The person is unaware of the changes caused by the disease process.
*The person does not recognize the effects of the disease on their daily functioning.
Define amnesia
*Loss of sensory memory, short-term memory, habitual memory.
The person may forget and not remember later, especially things that happened more recently
Define apathy
*The person has lost the ability to begin an activity on their own
*The part of the brain controlling initiation of activity is damaged
What is the difference between apathy and depression
*Apathy is sometimes interpreted as a symptom of depression.
*The difference is that the depressed person will participate if engaged by someone else.
What is agnosia
*Loss of recognition crosses all senses
*The person has trouble understanding the meaning of what is seen, heard, smelled, touched, and tasted.
*The person may not recognize familiar faces or objects
What is apraxia
*The person loses the ability to plan, sequence and carry out the steps of particular tasks even though the person is physically capable of performing the activity
*Every task has an order and the person loses the ability to organize the sequence
*The person knows what they want to do but is unable to execute the task
Define Aphasia
*The person may have difficulty expressing themselves and understanding of what is said.
*These losses are unique to that person.
Loss of language
What is altered pereception in dementia
Loss of depth perception
Misperception (delusions / illusions)
Hallucinations
what Alzheimer’s is
*the most common; memory loss and mood and behavior progressive changes; characterized by neuritic (senile) plaques and neurofibrillary tangles in the brain
What is the ABC method of BPSD (behavioural and psychological symptoms of dementia)
Antecendent (trigger)
Behaviour
Consequence
What is sun-downing?
Increases in behavioral problems that begin at dusk and last into the night
What factors precipitate sun-downing?
*End-of-day exhaustion (both mental and physical)
*An upset in the “internal body clock”
*Reduced lighting and increased shadows causing people with Alzheimer’s to misinterpret what they see
*Disorientation due to the inability to separate dreams from reality when sleeping
Little activity during the day
