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N321: Nursing Assessment of Clients > Module 12 > Flashcards

Module 12 Flashcards

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1
Q

Eriksons Stage for Infants

A

Trust v Mistrust

Attachment issues, separation and stranger anxiety

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2
Q

Eriksons Stage for Toddlers

A

Autonomy versus Shame and Doubt

Separation, disruption of routine, loss of control

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3
Q

Eriksons Stage for Preschoolers

A

Initiative v Guilt

Separation anxiety, fear of abandonment, unable to understand hospitalization (think its punishment), regression issues

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4
Q

Eriksons Stage for School Age Children

A

Industry v Inferiority

loss of control/privacy, fear of pain, bodily injury, death

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5
Q

Eriksons Stage for Adolescents

A

Identity v Role confusion

concerned with appearance, body image, loss of control/privacy, peer group

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6
Q

Is pediatrics just another 1 on 1?

A

no it involves the parents greatly and we need to educate to prevent and be an anticipatory guide for them and the Childs changes

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7
Q

Tips for Infant/Early Toddler Approach and Exam

A

Infants can be examined on bed but its better to have toddlers in the parents lap

Use comfort tools like a pacifier or bottle

talk softly and with positive encouragement

ask about any maternal health issues in pregnancy or delivery

know their birth weight

Consider the head: fontanels, trauma from birth process

consider the face: any unusual characteristics, eye coord, etc

consider feeding: type, frequency, etc

consider reflexes: rooting, sucking, palmar, moro, stepping, babinski

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8
Q

An infant gains how much weight a week

A

5-7 ounces

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9
Q

An infant grows how much a month

A

about .5 to 1 inch a month

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10
Q

Birth weight should be what by 6 months, and what by 1 year

A

double by 6 months and triple by one year

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11
Q

Tips for Toddler Exam

A

exam on lap if uncooperative

approach adult first, then acknowledge the child

call the child by name and get down on their level

they may have feeding or discipline issues

check speech development

distract them with toys, stories, let them play with equipment

reinforce what will be done and how it will feel - in simple terms

use a soft voice

praise frequently

be quick, but you may have to stop and talk to the parent and then return

minimize stress and preserve the security of the parent child relationship

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12
Q

Tips for Preschool and School Age Exam

A

gently approach but many times child open to “fun start”

allow child to verbalize

accept regressive behavior as it is normal, and reinforce to the parent that it’ll end eventually

provide play activities

provide honest and simple explanations and directions

In school age: may have some times of loneliness/boredom, isolation from peers - encourage them to make friends and participate in group/peer activities

encourage their participations

be kind yet firm

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13
Q

Tips for Adolescent Exam

A

be more forward with good eye contact and questions directed more at them as compared to the parent

be sensitive to their “awkward” stages, their anxiety and fear of changes in body image

can be searching for identity at this time

peers are the most influential group on this groups decision making

encourage verbalization of feelings - help develop coping skills

explain information honestly

maintain privacy

try to learn what they like to do, do not assume they do sports for example

be non judgmental and maybe ask questions when parents are not around

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14
Q

In what order should you do things for the physical exam in children?

A
  1. Count respirations before disturbing child
  2. Count apical heartrate
  3. measure BP
  4. measure temp (since it may need to be rectal)

*remember you may need to revisit areas and cannot go cephalocaudal

*be prepared to use pain scales like FACES FLACC or numeric

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15
Q

FLACC Pain Scale

A

you score the child based on things the infant is doing objectively that you view because the child is unable to tell you

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16
Q

Expected BPR for Neonates

A

B - 60/30 mmHg
P - 80-180 per minute
R - 30-50 per minute

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17
Q

Expected BPR for Infants

A

B - 96/60 mmHg
P - 80-160 per minute
R - 20-40 per minute

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18
Q

Expected BPR for Toddlers

A

B - 98/64 mmHg
P - 80 - 150 per minute
R - 20-30 per minute

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19
Q

Expected BPR School Aged Children

A

B - 106/68 mmHg
P - 75-110 per minute
R- 16-24 per minute

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20
Q

Expected BPR for Adolescents

A

B - 114/74 mmHg
P - 50-100 per minute
R - 12-20 per minute

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21
Q

Potential stress responses from children when they are unsure how to deal with articulate illness or hospitalization

A

Loss of appetite

disinterest in environment

Regressive behavior (thumb sucking, bed wetting, temper tantrum, clinging, irritability, demanding and possessive behavior)

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22
Q

The main thing to do with a pediatric assessment is …

A

help parents, and eventually the child, as they go through the developmental steps

Anticipate and Teach!!! so the parent is ready when the event occurs

Anticipatory guidance!!! is PRIMARY PREVENTION MEASURES

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23
Q

important information for SIDS

A

back to sleep

no smoking around

no sharing bed

formula/breast feeding

cereal

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24
Q

Important anticipatory guidance for parents

A

SIDS information

childproofing

getting ready for the NOs of toddlerhood

teenage rebellion/experimenting/puberty

*these are all primary prevention measures via education

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25
Q

What is Old?

A

It is an individual term per person that could mean a variety of things (not young, experiences, worn out, etc)

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26
Q

Myths about aging

A

Most elderly are sick

elderly people dont pull their weight on society

elderly people are set in their ways (you cant teach an old do new tricks)

elderly people arent mentally or physically sharp and alert

ailments caused by poor lifestyle choices such as smoking, cant be improved upon or undone

physical aging is primarily

elders dont have sex

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27
Q

Dementia is what relative to normal aging

A

not a normal part of aging

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28
Q

What is the “new Old”

A

65 to 74 is young old

75 to 84 is old

85+ is oldest old

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29
Q

2060 may be the first time in history when …

A

old people outnumber children

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30
Q

What % of elderly are in nursing homes

A

only 5%

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31
Q

What is the highest risk factor for dementia

A

Age (especially over 85)

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32
Q

What is the largest type of dementia

A

Alzheimer’s

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33
Q

Does the growth of the US population age 65 exceed that of total population under 65?

A

yes

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34
Q

greater than ___% of elderly have at least one chronic illness and __% have 2

A

80 and 77

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35
Q

Leading causes of death in the elderly are …

A

heart related diseases
cancer
cerebral vascular disease
chronic lower respiratory disease
Alzheimer’s disease
diabetes

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36
Q

Chronic diseases account for ___% of the money our nation spends on health care, yet only __% of health dollars are spent on public efforts to improve overall health

A

75% and 1%

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37
Q

The primary chronic disease in late life are:

A

HTN
Hyperlipidemia
Arthritis

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38
Q

The focus of elder care is …

A

maintenance of function, not disease cure

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39
Q

Persons with chronic diseases often…

A

continue to work and perform their usual activities

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40
Q

What is the limiter of the functional ability of elders?

A

disability from chronic diseases

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41
Q

When does prevention of chronic diseases need to occur and through what me4ans?

A

needs to occur early in adult life through screening, lifestyle changes, and medication

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42
Q

Chronic diseases do not go away, so what do they do?

A

they slowly and consistently weaken functional ability and reduce the quality of a persons life

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43
Q

The best 3 ways to care for late life is…

A

Education
Therapy
Maintenance (not cure - dont give false hope)

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44
Q

2 Chronic Disease Theories

A
  1. Corbin and Strauss Chronic Illness Trajectory 8 Steps
  2. Shifting Perspective Model
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45
Q

What is the Chronic illness trajectory

A

a chronic disease theory

it consists of 8 stages when a chronic illness starts that cycle through, never reaching wellness again, until death occurs

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46
Q

What are the 8 stages of the chronic illness trajectory

A

Pre trajectory

Trajectory onset

Crisis

Acute

Stable

unstable

Downward

Dying

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47
Q

Shifting Perspective Model

A

Chronic Disease theory that when wellness is in the foreground, that is the best time for education and to make things happen in relation to the disease - not when illness is in the foreground

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48
Q

Ageism

A

term used to describe prejudice against the older adult (incorrectly stereotyped as being different from society)

Widespread

This attitude leads to marginalization

Overtime, it will affect us all since people will make assumptions related to age and function

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49
Q

How to avoid Ageism

A

Avoid “Elder Speak” (honey, dear: similar to baby talk)

Avoid patronizing/conveying messages of dependence

Incompetence control

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50
Q

Important Types of Theories of Aging

A

Biological Theories of Aging

Sociological theories of aging

Psychological theories of aging

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51
Q

What do biological, sociological, and psychological theories of aging focus on?

A

Biological - focus on the physiological process

Sociological - focus on role changes and relationships

Psychological - focus on the developmental aspects

52
Q

What are Error (Stochastic) Theories

A

Theories of aging related to accumulated biological errors leading to aging and death

53
Q

3 Most common Error Theories

A

Wear and Tear Theory

Cross Linking Theory

Free Radical Theory

54
Q

Wear and Tear Theory

A

cell errors are the result of “wearing out”

internal and external stressors lead to these cell errors

55
Q

Cross Linking Theory

A

aging as accumulation of errors by cross linking or stiffening

56
Q

Free Radical Theory

A

Most understood and accepted error theory

Random damage from molecules in cells called free radicals

57
Q

What are Programmed Aging (Non-stochastic) Theories

A

Theories that contribute the changes of aging to being “programmed” at the cellular level

58
Q

Biological Clock Theory

A

Non Stochastic Theory

Idea that each cell is born with a limited number of replications

59
Q

How does using aging theories help nursing?

A

helps us understand the difference between aging and disease

gives a proper teaching and gives guidance for conditions and diseases

60
Q

Important Sociological theories of aging

A
  1. disengagement theory
  2. activity theory
  3. continuity theory
61
Q

Disengagement Theory

A

withdrawl from ones society and community is natural and acceptable

sociological theory of aging

62
Q

Activity Theory

A

sociological theory of aging

individuals need to stay active if they are to age successfully

promotes satisfaction and positive self concept

physical or intellectual activity

63
Q

Continuity Theory

A

sociological theory of aging

with aging, personality traits remain stable

as a person ages, they try to maintain previous habits, preferences, commitments, and beliefs

64
Q

Important Psychological Theories of Aging

A

Developmental Theories (like Erikson and Piaget)

Theory of Gerotranscendence

65
Q

Theory of Gerotranscendence

A

psychological theory of aging

as we age we tend to forget about materialistic things and start to value individuals and relationships more

66
Q

Gerontological Nursing Goals

A

We want to get them as much control back as possible (What do you want to wear today, have patience, give short directions, etc) - But do not help TOO much

It is the responsibility of the nurse to assist elders to achieve the highest level of wellness

*HELP THE OLDER ADULT FUNCTION AT THEIR HIGHEST CAPCITY

67
Q

A gerontological nursing goal is, to care and comfort ___, to cure ____, and prevent __ __ __ __ ___

A

comfort always, cure sometimes, prevent that which can be prevented

68
Q

Important ways to act when dealing with older adults

A

Have Consistency (find their normal procedure)

Be Professional (Mr, Mrs, Etc)

Be Supportive

Have Therapeutics (let them vent)

69
Q

With older adults, focus on …

A

abilities not disabilities

70
Q

What should be maximized with older adults

A

their strengths

71
Q

What should be maintained with older adults as a part of restorative nursing

A

maintain:

safe environment

COMFORT REST ACTIVITY AND MOBILITY (prevent falls and skin breakdown)

adequate nutrition

resp and circ function

skin integrity

bowel and bladder function

sensory perception

72
Q

What other things should restorative nursing do to help older adults

A

Promote social well being and psychosocial health

Enhance their self esteem

avoid elder talk and ignorance

ensure access to assistive devices

give them time

adapt environment for their function

give them some control with privacy, you asking for permission, and include them in decision making

73
Q

Tips for Communicating for Hearing & Vision Loss

A

Never assume hearing loss is because of age

face the individual, stand and sit at the same level

Gain the individuals attention

speak distinctly

pause between sentence sand phrases

remove background noises

when repeating, say things exactly the same way

74
Q

How to aid when dealing with hearing loss patients

A

do not raise the volume of your voice, speak in a lower tone

keep instructions simple

assess understanding by asking for feedback

use large print written communication

one person should speak at a time

eyeglasses should be clean and on

avoid glaring light

75
Q

How to aid when dealing with vision loss patients

A

use contrasting colors

use low vision assistive devices

use orientation strategies

have the persons attention prior to talking

speak promptly and clearly

speak normally

use appropriate lighting

76
Q

Hazards of Hospitalization (especially in older populations)

A

Decline in muscle strength

vasomotor instability

reduced bone density

diminished pulmonary ventilation

sensory deprivation

tendency for urinary incontinence

77
Q

Modifications to make for Hospitalized Elderly (since we want them to be able to leave)

A

de emphasize bed rest - they need to move

psychological considerations

actively facilitate ambulation

socialization

medication review

dietary review

interdisciplinary care and shared objectives

toileting

78
Q

What are the 3 Ds

A

Depression
Delirium
Dementia

having more or one of these can make it challenging to find what problems are with elderly patients

79
Q

3Ds: Depression

A

most often found, characterized by low mood, difficulty thinking, and somatic changes

can also be a precursor to Dementia

80
Q

3Ds: Delirium

A

an acute and sudden impairment of cognition that MAY be considered temporary

often confused with dementia

81
Q

3Ds: Dementia

A

chronic, progressive, insidious, and permanent states of cognitive impairment

82
Q

T or F: Delirium is temporary and dementia is permanent

A

True

83
Q

What do Hyperactive versus Hypoactive delirium look likie

A

Hyperactive - they got your attn (pulling tubes, etc)

Hypoactive - looks like depression (sad, withdrawn)

84
Q

Interventions to Prevent Delirium

A

Know baseline mental status

Assess any underlying mental status or sensory deficits

Attention to basic needs

medication review

understand behavior

maintain safety

minimize use of invasive equipment

environmental modifications

85
Q

What is a major thing that can cause delirium?

A

Medications! (even something like benedryl)

86
Q

How to assist Alazheimers Patients?

A

Give one direction at a time

speak slowly and with simple directions

do not force them

avoid restraints

repeat yourself as often as needed

give encouragement

praise accomplishments as activity progresses

be patient

87
Q

Sundowning

A

change in personality later in the day leading to angst and anxiety in alzheimers patients

88
Q

What sort of body contour changes occur in the elderly?

A

bony prominences show

weight distributes to waist and hips

subcutaneous tissue leave the face and arms to move to abdomen/hips

height decreases

89
Q

Important Elder changes that lead to decreases in physical endurance and activity

A

wide base gait

weight decreases from loss of lean muscle and mass sarcopenia

90
Q

Older adults differ how in total body water?

A

total body water decreases

this is unintentional weight loss NOT part of aging

91
Q

What happens to older adult temperature regulation with age?

A

Less likely to have a fever

More likely to have hypothermia

Slower metabolism

Produce less body heat

Thermoregulatory Impairment

Median body temp 96.8 (36 C)

Sweat gland diminishes in size and function

Reduced sensory input

92
Q

Causes of hypothermia in older adults

A

Decreased Activity

Hypothyroidism

Hypoglycemia

Malnutrition

(Stroke, paralysis, parkinson’s, dementia & Arthritis)

Acute Illness

Medications

93
Q

What happens to the different layers of integument in older adults

A

Epidermis
Regeneration slows
Reduced barrier protection

Dermis
A supportive layer, a 20% loss causes older skin to look more transparent and fragile.

Hypodermis
Contains connective tissues, blood vessels, & adipose tissue
XEROSIS: DRY SKIN- Accompanied by pruritus

94
Q

What sort of things can be seen in skin and nails in older adults?

A

Skin Tags

Seborrheic Keratosis

onychomycotic nails

95
Q

What happens to hair with age

A

Loss of melanin leading to potential alopecia

96
Q

What happens to nails with age

A

thicken

brittle and flat

they can get brittle ridges (onycholysis/onychorrhexis)

97
Q

What sort of head and neck changes occur with age?

A

bones and orbits are more prevalent

great vessels may have bruits

neck shortens related to osteoporotic changes

thyroid not palpable

loss of subcutaneous tissues

98
Q

Eye changes with age

A

Decreased eyelid elasticity

conjunctiva thinner and yellow with increased infection rate

Pinguecula may develop

lacrimal gland and ducts loose fatty tissues and tears decrease

eyeballs sit deeper in sockets

cornea flattens and iris fades

increased connective tissue may cause sclerosis of sphincter muscles

pupils become smaller, sclera becomes thick and rigid

99
Q

Presbyopia

A

decrease ability to adjust near/far vision in older adults

100
Q

What sort of vision impairment occurs in the elderly

A

Presbyopia

decreased visual acuity (especially near vision) and narrowing of visual field

difficulty gazing upward and maintaining convergence, adapting to lighting changes

glaucoma

cataract

101
Q

What factors affect hearing

A

cerumen buildup and hardening

corti and the auditory nerve atrophy\

tympanic membrane thickening

tinnitus

102
Q

What sort of hearing impairments occur with age

A

decrease tone discrimination

presbycusis

decrease ability to discern consonants

decrease equilibrium due to vestibular changes

103
Q

S/S of Hearing Loss

A

need increased volume

tilting head toward person speaking

cupping hand around one ear

watching speakers lips

speaking loudly

not responding when spoken to

104
Q

tips for communicating with the hearing or vision impaired

A

Stand or sit directly in front and close to the person

Talk toward the better ear, but make sure your lips can be seen

Make sure the person pays attention and looks at your face

Speak distinctly, slowly and directly to the person

Avoid or eliminate background noise

105
Q

Smell Perception changes with age

A

decline after 60

rapid decline at age 80

cell loss from olfactory bulb and sensory cells

decrease in appetite and smell

106
Q

Changes in Mouth and teeth with age

A

Teeth Loose Enamel & Dentin

Become More Vulnerable to Caries

Incidence of Periodontal Disease increases

107
Q

How does taste perception change with age

A

very gradual decline

decreased taste from taste bud atrophy, amylase decreased amount in saliva, and accelerated with dental problems/meds/or smoking

108
Q

Decrease Taste with Age

A

Taste changes are modest

Desire increase concentration of flavor over time

have a decreased appetite from it

109
Q

Musculoskeletal system changes with age

A

Structure
Disks become thin and shortening
Slight forward bent posture

Bones
Decrease in bone density b/c resorption is more rapid than deposition

Joints, Tendons & Ligaments
Cartilage changes
Tendons may shorten

Muscles
Atrophy of muscle mass tissue

110
Q

Cardiovascular System changes with age

A

Heart: Valves & Conductivity

Blood Vessels: Arteries & Veins

111
Q

Heart changes with age

A

ATRIAL FIBRILLATION can occur from fibrosis of SA Node - Can occur from Hyperthyroidism

Pulse Pressure Widens

Blood Vessels of lower Extremities More likely to show s/s of cardiovascular Changes r/t dependent and distal position.

112
Q

How to promote heart health early in life (when you should)

A

Engage in regular exercise

Eat a low-fat, low-cholesterol, balanced diet

Maintain control of diabetes

Do not smoke; avoid exposure to smoke

Avoid environmental pollutants

Practice stress management

Minimize sodium intake

Maintain ideal body weight

113
Q

What determines respiratory system changes with age

A

musculoskeletal and nervous system (loss of elastic recoil, stiffening chest wall, gas exchange changes, resistance to flow)

114
Q

Why does risk of infection of the resp system increase with age?

A

less responsive cilia

diminished cough reflex

115
Q

If you have trouble auscultating an older patient you should ..

A

start at the bases and move up

116
Q

Respiratory Changes seen with age

A

Airways:
Nose
Trachea & Larynx

Chest Wall and Lung:
Limited Chest Expansion
“Senile Emphysema”
Alveolar Duct Ectasia

Oxygen Exchange:
Chemoreceptors Altered
↓ PO²

117
Q

How to promote lung capacity

A

Obtain pneumonia immunization

Obtain annual influenza immunization

Avoid exposure to smoke and pollutants

Do not smoke

Avoid persons with respiratory illnesses

Seek prompt treatment of respiratory
infections

Wash hands frequently

Eat meals in relaxed atmosphere

Practice thorough oral hygiene

Exercise Deep Breathing/Laughing

118
Q

Renal and Urological System changes with age

A

Kidneys:
Loss of Nephrons
↓Kidney Mass

Renal Vessels:
↓ Renal Blood Flow

Ureters, Bladder & Urethra:
↓Tone & Elasticity
↓Bladder Holding Capacity
Urgency & Frequency Increases
Nocturia

Glomerular Filtration Rate:
Linear Decline

119
Q

Endocrine System changes with age

A

Thyroid Gland:
Incidence of Hypothyroidism
↓Serum T3 ? From increase TSH
Usually Requires Lower doses of Thyroid Replacement

Parathyroid Gland:
Changes in PTH may be cause of Alterations in Calcium Homeostasis/Bone loss

Endocrine Pancreas:
Secretion does NOT decrease/Tissues may develop ↓ sensitivity to insulin.

120
Q

Digestive System changes with age

A

Esophagus:
Contractions Increase
Propulsion is Decreased

Stomach:
↓ Motility
GERD r/t decrease in resting pressure of esophageal sphincter-INCREASE risk for Aspiration
Reduction Secretion of Bicarbonate & Gastric Mucous

121
Q

How to promote healthy digestion

A

Practice good oral hygiene

Wear properly fitting dentures

Yearly dental checks!

Seek prompt treatment of dental caries
and periodontal disease

Eat meals in relaxed atmosphere

Maintain adequate intake of fluids

Respond promptly to urge to defecate

Eat balanced diet

Avoid prolonged periods of immobility

122
Q

Decrease occurs for what neurotransmitters with age

A

Decreased Catecholamines
Decrease Serotonin
Decrease Choline Acetylase
Increase Monoamine Oxidase (MAO)

123
Q

Changes of the Reproductive System with age

A

The Female Reproductive System:
↓Estradiol
↓Estrone
Breast Size Decreases
Breast Lumps more evident
Menopause
Cessation of Menses, Atrophy of ovaries

The Male Reproductive System:
BPH (Benign Prostatic Hypertrophy)
Dribbling/Difficulty Initiating urinary stream
May see an increase in fatty tissue (Breast)

124
Q

Changes of the Immune System with Age?

A

decrease in T cell function

decrease in response to foreign antigen

also larger system changes like skin lungs and GU

125
Q

Male Gait in elderly

A

smaller steps

wider base

126
Q

Female gait in elderly

A

waddling gait

bowing of legs

127
Q

Changes in sleep with age

A

Interrupted REM Episodes

Increased Total Daily Sleep

Increased Awakening after Sleep Onset
(Wake up feeling tired)

N321: Nursing Assessment of Clients (18 decks)

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