midterm quiz - physical assessment Flashcards
It is based on technical competence in physical assessment, knowledge of the normal changes and disease associated with aging, as well as good communication skills.
Physical assessment of Older Adult
reviews each body system by first taking a history and then conducting a physical examination.
Physical assessment with a “systems” approach
can occur at all ages, these diseases are associated with people in their older years, and comprehensive assessment will include taking a cardiac history and performing a physical examination.
Diseases of Circulatory system
occurs when urine leaks as pressure is put on the bladder, such as during exercise, coughing, sneezing, laughing, or lifting heavy objects.
Stress incontinence
happens when people have a sudden need to urinate and cannot hold their urine long enough to get to the toilet.
Urge incontinence
happens when small amounts of urine leak from a bladder that is always full.
Overflow incontinence
occurs in many older people who have normal bladder control.
Functional incontinence
In conducting a comprehensive assessment with an older adult, asking about sexual function is inappropriate. Be sensitive and respectful of privacy because this is clearly a very personal area of human function. TRUE OR FALSE
FALSE (asking about sexual function is appropriate.
Age-related changes for men include increase in the speed and duration of erection, in women there is a decrease in vaginal lubrication. TRUE OR FALSE
FALSE (Age-related changes for men include DECREASE in the speed and duration of erection)
Age-related diseases such as Alzheimer’s disease and Parkinson’s disease and other health problems such as stroke can lead to cognitive changes including…
memory loss, lack of spatial orientation, agnosia, apraxia, dysphagia, aphasia and delirium.
The most common disease of dementia
Alzheimer’s disease
The most common disease of dementia
Alzheimer’s disease
Most common musculoskeletal health problems
osteoarthritis, osteoporosis
Commonly used assessment tool for the risk of falls is the
Morse Fall Scale
What is >45 and higher in morse fall risk assessment chart?
High Risk
What is 25-45 in Morse fall risk assessment chart?
Moderate risk
What is 1-24 in morse fall risk assessment chart?
low risk
What is 0 in morse fall risk assessment chart?
no risk malamang
provides a quick assessment of an older person’s mobility and overall function.
Up and Go test
The nurse should measure a distance of 10 feet from the person’s chair and ask him or her to rise, walk to the line, turn, walk back, and sit down. An average time to do this is 10 seconds. Greater than 10 seconds may indicate functional problems with ambulation TRUE OR FALSE
TRUE
The other senses are smell, taste and touch. Taste and smell are interrelated. TRUE OR FALSE
TRUE
Older adults with decreased mobility and extended bed rest are at low risk for skin damage and breakdown. TRUE OR FALSE
FALSE (high risk malamang)
usually understood in relation to the qualities of attention, memory, language, and executive capacity
Cognitive function
Cognitive Assessment tools
Mini Mental State Examination (MMSE)
is a permanent progressive decline in cognitive function
Dementia
is the most common form of dementia.
Alzheimer’s disease
is possible only on autopsy with Dementia.
Definitive diagnosis
is possible only on autopsy with Dementia.
Definitive diagnosis
Standardized psychological assessment tool. Performing this assessment requires little time and only a pencil and blank sheet of paper
Scoring of this tool is simple and self-explanatory
Mini Mental State Examination (MMSE)
The MMSE can be used to assess 6 areas of mental abilities, including:
-orientation to time and place — knowing the date and where you are
-attention / concentration
-short-term memory (recall)
-language skills
-visuospatial abilities —
visual and spatial relationships between objects
-ability to understand and follow instructions
the MMSE test consists of a series of tasks such as:
-memorizing a few objects and then repeating the list back later
-copying a drawing
-writing a short sentence that is grammatically correct, such as “The dog sat on the floor”
-correctly identifying the current day of the week, followed by the date, the month, the season and the year
-correctly identifying where you are
scores of 26 or higher in MMSE Score being traditionally considered
normal
Scores less than 9 in MMSE Score generally indicate
severe impairment
scores between 10 and 20 in MMSE Score indicate
moderate dementia
score in the 19 to 24 range in MMSE Score
People with early stage Alzheimer’s disease
Fulmer SPICES
Sleep disorders
Problems with eating or feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown
