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N352: Practice of Nursing I > Module 2 - Geriatric Nutrition, Hydration, and Mental Health > Flashcards

Module 2 - Geriatric Nutrition, Hydration, and Mental Health Flashcards

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1
Q

The ABC’s of Nutrition for the Elderly

A

Aim for fitness

Build a healthy body

Choose sensibly

(We use these to help the elderly to stay in good nutrition)

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2
Q

What is a very important factor for later ability to recover from disease and illness?

A

Lifelong eating habits

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3
Q

What are the important congressional acts to know relating to elder nutrition?

A

Omnibus Budget Reconciliation Act of 1987 (OMBRA)

Balanced Budget Act of 1997

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4
Q

What was the main purpose of the OMBRA and Balanced Budget Acts?

A

To impact nutritional standards in LTC facilities regarding BMI, weight, I/O, hydration, pressure injuries

If you cannot follow these standards there will be monetary fines and government benefits can be removed - LTC can lose their normal reimbursement amount

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5
Q

Factors that contribute to malnutrition in the elderly?

A

Normal Physiologic Changes

Oral and GI Changes - motility slows with age and they may be edentulous or using dentures

Sensory Changes - may not hear as good or smell/taste as well

Social and Economic Changes - SS reliance –> tough decisions on rent v food, etc

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6
Q

Sarcopenia (Sarcopenia Obesity)

A

Decreased lean muscle mass

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7
Q

How can sarcopenia come about?

A

Decreased Physical Activity

Sedentary Lifestyle

Decreased Nutrition

Decreased Anabolic Hormones

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8
Q

Can obesity occur alongside sarcopenia?

A

YES

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9
Q

What does the vicious cycle of Sarcopenia occur?

A

Sarcopenia –> Functional Decline –> Loss of Strength –> Additional Loss –> Increase in Morbidity and Mortality –> REPEATS FROM SARCOPENIA

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10
Q

Oral and GI Changes that contribute to Malnutrition in the Elderly

A

Xerostomia

Dysphagia

Decreased Thirst Perception

Altered Dentition

Altered Taste and Smell

Decreased Gag Reflex

Decreased Peristalsis, Gastric Secretion and Motility (Constipation)

Altered Appetite - Anorexia of the Aging

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11
Q

What contributes to Altered Appetite / Anorexia of the Aging?

A

Increase cholecystokinin and early satiety

Stomach decreases in size

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12
Q

Xerostomia

A

dry mouth

try to encourage fluids with this

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13
Q

Dysphagia

A

Difficulty swallowing

could be from something like stroke or another illness

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14
Q

Signs and Symptoms of Dysphagia in the Elderly?

A

Ask the family if they have noticed anything?

Drooling

Facial Droop, Open Mouth

Dementia, Confusion, LOC

Increased nasal or oral secretions

Weak voice; cough

Slurred speech

Recurrent Respiratory Infections

Pocketing of Food

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15
Q

What are some causes of Dysphagia in the Elderly

A

Neurologic Disorders

Muscular Disorders

Anatomical Abnormalities (like tumors)

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16
Q

What happens to intestinal absorption, motility, and blood flow with age?

A

Decreases

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17
Q

What happens to pancreas size with age and what causes it?

A

Decrease

Duct Hyperplasia and Lobular Fibrosis

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18
Q

What happens to the incidence of cholelithiasis and amount of bile with aging?

A

Cholelithiasis incidence increases but bile decreases

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19
Q

Cholelithiasis

A

Gallstones

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20
Q

What happens to liver size and flow with age?

A

Decreases

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21
Q

What happens with medication use and adverse drug reactions in the elderly?

A

Use of medication increases, and the poly-pharmacy increases the possibility of adverse drug reactions

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22
Q

What percentage of change in weight means malnutrition in the elderly?

A

Loss of 5% body weight in 1 month

or

Loss of 10% Body weight in 6 months

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23
Q

Everything ___ ___ with age!

A

slows down

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24
Q

Do older adults present in a similar way like an adult patient?

A

No

Typically an adult may present more s/s with an adult making things less obvious –> gotta be very observent

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25
Q

What are some important presentations that may appear in a geriatric patient?

A

GERD

Hiatal Hernia

Esophageal Cancer

Peptic Ulcer

Cancer of the Stomach

Diverticular Disease

Bowel Obstruction

Gastric Volvulus

Ulcerative Colitis

Chron’s Disease

Constipation - Excessive straining/laxative use

Diarrhea

Fecal impaction

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26
Q

What are some social and economic changes in the elderly that leads to malnutrition?

A

Social Isolation

Loneliness

Depression

Sedentary Lifestyle

“Food Insecurity” r/t insufficient funds

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27
Q

Why is social isolation and loneliness so prevalent in the elderly, and why does it contribute to malnutrition?

A
  1. Living location - 25% live in a rural area in the middle of nowhere and therefore it may be easier to go to a nearby gas station rather than a grocery store farther out
  2. Deaths of spouses and children moving out
  3. Caregiver may be just as old as them and not even be able to effectively care for themselves
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28
Q

How does depression contribute to malnutrition?

A

Depression and Loneliness –> Less desire to eat –> Older people are lonelier and their appetite leaves

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29
Q

How can a sedentary lifestyle for the elderly contribute to malnutrition?

A

Sitting all day or inability to ambulate may make it so people only live off candy, soda, cookies, coffee, etc

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30
Q

What is Food Insecurity ?

A

Insufficient funds makes it so a person has to choose between things (ex: rent, food, medications, etc) and may not be able to afford good nutrition

They end up making prioritization choices since they are living off of social security - which is not enough

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31
Q

How does Vitamin D dosage needs change with age?

A

Dosage needs increase

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32
Q

Who is at risk for Vitamin D deficiency?

A

People in cold climates (like BU)

Decreased Sun exposure (like BU)

Decrease in milk intake

Use of anticonvulsants and corticosteroids

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33
Q

What can occur with Vitamin D deficiency?

A

Rickets

Osteomalcia

Obesity

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34
Q

Benefits of Vitamin E?

A

Skin Health

Eye Health

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35
Q

Who is at risk for Vitamin E deficiency?

A

Users of Anticoagulants

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36
Q

Why is Vitamin B12 particularly important for the energy?

A

It is given to the elderly a lot/ added to a lot of medication regimen since it aids with memory

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37
Q

Who is at risk for Vitamin B12 deficiency?

A

Malabsorptive Disease (Crohn’s Disease)

Vegan Diet –> low protein in diet with vitamin B12

Medications that alter pH

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38
Q

What do Vitamin B12 deficiencies cause?

A

Macrocytic Anemia

Neurological Problems

Poor Memory

Depression/Irritability

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39
Q

Who is at risk for Calcium deficiency?

A

Poor dairy intake / fortified calcium foods

Excessive Caffeine and Protein

Inadequate Vitamin D

Medications like Corticosteroids, Colchine, Phenobarbital, Methotrexate, Cholestyramine

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40
Q

What do Calcium deficiencies cause?

A

Osteoporosis

Peridontal Disease

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41
Q

Who is at risk for Vitamin B6 deficiency?

A

Alcoholics

Autoimmune Disorders

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42
Q

What does Vitamin B6 deficiency cause?

A

Glossitis

Cheilosis

Depression

Confusion

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43
Q

Glossitis

A

Tongue Inflammation

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44
Q

Cheilosis

A

Inflammation of the Corner/Edges of the mouth

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45
Q

What are some things we can do to improve nutrition in the elderly?

A

be proactive

give the rights foods and amounts

encourage them

provide education

involve and speak to family members

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46
Q

How much fluid should a man have per day? A woman per day?

A

Men - 13 Cups

Women - 9 Cups

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47
Q

Who is at risk for dehydration?

A

Age

Incontinence

Polyuria

Cognitive Impairment

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48
Q

Signs and Symptoms of Dehydration

A

Tenting of the skin (stays in the same position)

Urine color is darker

Dry mucus membranes

Sunken eyes

Postural changes - orthostatic hypertension - in BP and Pulse

Confusion

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49
Q

Is tenting enough on its own to diagnose dehydration?

A

No sometimes that occurs in the elderly

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50
Q

What are some good nutritional assessment tools to use?

A

Anthropometrics

Laboratory Values

Nutritional History

Physical Exam

Screening Tools

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51
Q

What is the gold standard for nutritional assessment?

A

there is NO gold standard nor a consensus on one nutritional assessment tool, but the MNA has been validated in over 400 studies..

The lab values is what is very important

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52
Q

Anthropometrics

A

Measurement of the individual

You take Height, weight, weight history, muscle mass, and fat mass and see how it fluxuates

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53
Q

Important Lab Values for Elder Nutrition?

A

BUN

Creatinine

Serum Folate and B12

CBC - Anemia (find out why, and can tell us if they have it), MCV (elevation should be looked at), Hgb, Hct

Prealbumin - shorter half life than albumin; gives more current information on protein status

Transferrin < 180

Cholesterol <160

Albumin < 3.4 g/dL

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54
Q

What are some normal changes of aging regarding blood/cells?

A

Stem cell amount in marrow decreases

Eryropoietin administration is less effective

Lymphocyte regarding immunity is less effective

Plt Adhesiveness increases with age

Average H/H values decrease but should remain in the normal range

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55
Q

What does increased Plt adhesiveness increase the risk for?

A

Stroke Risk

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56
Q

When gathering a nutritional history it is important to do what?

A
  1. Diet Recall - ask open ended questions, include fluid/alcohol/food preparation, and cultural influences
  2. Gather food frequency (ex: how often do you snack or have meals?)
  3. Get food records for no more than the last 2 days
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57
Q

Things to Look for in a Physical Exam of Elder Nutritional Status

A

Lips, oral Mucosa, gums, tongue, teeth

angular lesions (like cheilosis)

Abdomen distention/changes

Neurological deficits

GI/GU issues like incontinence, weight fluctuation, etc
I&O

!!Difficulties Swallowing, Acid Reflux, Sensory Changes (vision, hearing, taste, smell), Appetite changes/present?, Depression influencing nutritional status

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58
Q

How can a nurse promote nutrition overall?

A

Nutritional care plan based on findings

respect food habits and preferences

Be aware of physiological factors that alter nutrition

give them some choices / substitutes

offer encouragement at meals

complaints and rejections may be evidence of an underlying problem - note these

give adequate time for eating - DO NOT RUSH THEM

encourage independence in feeding themselves instead of having us do it all

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59
Q

What are some things Nurses can do to promote proper nutrition during mealtimes?

A

Be present - use therapeutic communication (ex: eye level)

provide adaptive equipment (ex: sippy cup)

provide proper food and drink consistency based on the person (dietician assesses this)

pleasant environment (nice lighting, etc)

adequate time - no rushing

encourage socialization

give smaller more frequent meals

avoid interruptions in eating - try not to administer meds during meals

use appealing tableware and bright colors

serve food promptly and at proper temperatures

Provide for them the way you would like things!

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60
Q

How can family support be used to manage elder nutrition?

A

Request family bring in favorite meals or seasonings

Visit at meal times

Help feed them

Discuss QOL issues (palliative care, hospice, discuss end of life, etc)

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61
Q

If someone is going into palliative/end of life care what can occur with their nutrition/diet?

A

what is now important is their comfort rather than restricting something like salt

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62
Q

Ways to minimize risk for aspiration?

A

Minimize distractions

follow proper thickened liquids

sit at the same level

NEVER engage in forceful feeding

consistent feeding techniques

proper positioning (90 degrees)

do NOT try to rush. One bite at a time

watch for aspiration (make sure they can swallow)

provide oral care prior to meals

make sure individual is alert

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63
Q

Weight loss may have ___ etiology

A

unknown

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64
Q

What may be needed if a person is unable to feed themselves/swallow?

A

Have alternative feeding methods available like Tubes

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65
Q

There may be what kind of dilemmas regarding malnutrition for which you should have plans in place?

A

ethical dilemmas

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66
Q

Important things to keep in mind when someone is tube feeding?

A

Keep HOB elevated 30-90 degrees

Watch for aspiration, constipation, and dehydration

Flush the tube before eating

Help prevent diarrhea and dehydration

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67
Q

Nursing Process of Nutrition

A

Assessment (of nutrition status) –> Diagnosis (of needs) –> Set nutritional goals and focus on expected outcomes –> Planning and Implementation –> Evaluation

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68
Q

What are some physiological factors that contribute to poor nutrition?

A

Dysphagia

Inability to feed self - dependency

Xerostomia

Poor dentition

Altered sensory perception

Constipation

Depression

Pain

Social Isolation

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69
Q

Nursing Interventions to increase Nutrition

A

Enhance eating environment

Improve taste perception (ex: seasoning)

Encourage nutrient dense foods

Saliva stimulation

Offer Frequent fluids (avoid dehydration)

Food/Liquid Consistency (dysphagia diet and texture modifications)

Offer feeding assistance

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70
Q

Mini Nutritional Assessment (MNA)

A

the most commonly used SCREENING tool for nutrition/malnutrition in the elderly

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71
Q

What things does MNA screen for

A

appetite (# of meals per day, check fluid intake)

weight loss

mobility (do they need help eating)

psychological stress

neuropsychological problems

BMI

Self view of their nutrition

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72
Q

Things to Assess for screening during the MNA?

A

Living arrangement

medications

pressure ulcers

number of meals they have

protein intake

fruits and vegetables

fluid intake

mode of feeding

self view of their nutrition

mid arm circumference

calf circumference

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73
Q

What is the role of the geriatric nurse in elder nutrition?

A

role is extremely important regarding the identification of factors that impact dietary intake , understanding the special considerations in the older adult, and implementing interventions that will help improve their overall nutrition and hydration

74
Q

____ and ___ Elders will have better outcomes

A

Nourished and Hydrated elders will have better outcomes

75
Q

What is cognitive function?

A

complicated process by which an individual perceives, registers, stores, retrieves, and uses information

76
Q

Body and ___ are inseparable

A

mind

77
Q

Most elders will not suffer significant ___ ___

A

memory impairment

78
Q

What are some physical illnesses that lead to cognitive impairment?

A

stroke

heart disease

Parkinson’s disease

endocrine disorders

cancers

epilepsy

B12 Deficiencies

chronic pain

viral illnesses

alzheimer’s

length hospitalizations

79
Q

Cognitive impairment may be associated with ___ factors

A

psychosocial

80
Q

What are some psychosocial factors that influence cognitive impairment

A

serious losses (like jobs or people)

difficult relationships

change in social roles

loneliness

poverty

unplanned moves / forced relocation

medication side effects (A BIG ONE)

depression

81
Q

Dementia

A

chronic, progressive, insidious and PERMANENT states of cognitive impairment

82
Q

Delirium

A

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

83
Q

Depression

A

most often found

characterized by low mood

difficulty thinking and somatic changes

can also be pre-cursor to dementia

84
Q

Dementia is both a ___ and ___ illness

A

chronic and terminal illness

*it isnt terminal itself, the deterioration is what brings on the terminal

85
Q

Dementia has no ___ course and no ____

A

no uniform course and no predictability

86
Q

Alzheimer’s Disease is the ___ leading cause of death in the United States? It kills more than ___ and ___ cancer combined?

A

6th leading

breast and prostate

87
Q

The biggest risk factor of Alzheimer’s Disease is ..

A

Age!!!

88
Q

How many people in the US have Alz D?

A

5 million Americans

that is 13% of seniors

89
Q

Every __ seconds someone in the US develops the disease?

A

65 seconds

90
Q

How many seniors die from Alzheimer’s or another Dementia

A

1 in 3

91
Q

Alzheimer’s treatment is very ___

A

expensive

costs 214 billion in the US in 2014

by 2050 it could rise as high as 1.2 trillion

92
Q

Namenda

A

An Alzheimer disease medication

it is crazy expensive - 30 tablets are 451 $

93
Q

What are the stages of Alzheimer’s Disease

A

Stage 1 - Normal Adult

Stage 2 - Normal Older Adult

Stage 3 - Start of Early AD

Stage 4 - Mild AD

Stage 5 - Moderate AD

Stage 6 - Moderately Severe AD

Stage 7 - Severe AD

94
Q

Stage 1 AD

A

No impairment - the normal adult

95
Q

Stage 2 AD

A

self report of memory impairment, no objective cognitive impairments are noted – normal older adult

may be aware they forget (keys lights etc)

96
Q

Stage 3 AD

A

cognitive impairments recognized by others

anxiety

impaired performance in demanding work and social settings

Compatible with Early AD

they know they are failing, other people noticed, and anxiety starts with inability to keep up with things

97
Q

Stage 4 AD

A

withdrawal

denial of having AD

depression from reality

inability to perform ADLs and complex tasks

flattening of affect

cognitive impairment evident on exam

Mild AD

98
Q

Stage 5 AD

A

disoriented to time and place

needs assistance in clothing selection

Moderate AD

in a nursing home at this point

99
Q

Stage 6 AD

A

forgets name of spouse and other family members

personality and emotional changes

inability to perform many ADLs

agitation

Moderately Severe AD

sad and painful -calm and relaxed personality may change

100
Q

Stage 7 AD

A

loss of verbal and psychomotor skills

incontinence

needs total assistance

Severe AD

eventual failure of systems and death

101
Q

Other Types of Dementia

A

Vascular Dementia

Lewy Body Dementia

Frontotemporal Lobe Dementia

AIDS related Dementia

Trauma related Dementia

102
Q

Vascular Dementia

A

thought to be caused by cardiovascular factors

something like a stroke could cause this

103
Q

Lewy Body Dementia

A

similar to Parkinson’s disease

protein particles called Lewy bodies accumulate in the brain

104
Q

Frontotemporal Lobe Dementia

A

issues in this part of the brain leads to personality changes and atrophy of the frontal lobe

you have to rule out delirium first

105
Q

What must be ruled out to diagnose dementia?

A

Delirium must first be ruled out

it cannot be sudden severe and acute state of confusion, rather insidious and appear permanent

106
Q

Trauma Related Dementia

A

brain trauma like with athletes and foot ball players can lead to dementia later on

107
Q

Main symptoms of Dementia

A

short term memory impairment

108
Q

What is needed for a clinical diagnosis of Dementia?

A

loss of intellectual ability with impairment severe enough to interfere with social or occupational functioning

delirium must be ruled out

109
Q

Tests that should be done for checking for Dementia

A

CBC - complete blood count

TSH

Basic Metabolic Panel and LFTS

Vitamin B12

MRI or CT - checks for structural brain damage

110
Q

How should care be planned for Dementia Patients? What is the primary intervention?

A

there is no medications or technology preventing or curing dementia (but new advances are coming)

Symptomatic Nursing care is the primary intervention for dementia treatment

find ways to deal with those developing challenging behavioral and psychiatric symptoms

111
Q

Teach patients and caregivers about the effects of Dementia –> _____

A

teaching about Dementia –> promote comfort + reduce feelings of distress

112
Q

In order to give symptomatic nursing care as a primary intervention for dementia, what is required to be done?

A

Understand dementia is life limiting and a chronic illness

Caregivers need expertise (LTC and End of Life Care)

Family caregivers will need supportive care too

alleviate symptoms and teach patients and caregivers about the effects of dementia

113
Q

Persons with Dementia and their families need nursing for what reasons?

A

Promote independence and autonomy

Prevent avoidable complications

Provide comfort

Promote Quality of Life

Safety

114
Q

Do not assume what about the families of dementia patients?

A

Do not assume they understand basic care techniques

assistance and support to the families of a person with dementia are an integral part of nursing

115
Q

What things should nurses do to prepare for dementia patient care?

A

Review basic specific care like lifting, bathing, and managing inappropriate behaviors

Prepare family for the guilt, frustration, anger, depression, and other feelings that accompany the responsibility of a caregiver

assist the family with obtaining respite care (and getting them support groups)

encourage the family to network with support groups and obtain counseling as needed

116
Q

Respite Care

A

A place where a dementia patient can go for some limited time to give the family caregivers respite and rest

117
Q

How can a safe environment be promoted for Dementia Patients in the home?

A

Modify strategies used to prevent injury to toddlers to provide a safer physical environment

Tour home with caregiver to identify safety issues and develop a plan to rectify them

118
Q

As nurses we can help elderly with dementia to live …

A

full, dignified lives by showing patience, compassion, and understanding

119
Q

What really sets Delirium apart from Dementia?

A

Acute

Sudden

MAY be temporary

120
Q

Etiologies for Delirium

A

disturbances in neurotransmission in the brain which control cognition, behavior and mood

cholinergic failure

poor cerebral blood flow

complication of illness

drug or substances effect on the brain

general anesthesia

121
Q

What is the biggest concern with detection for Delirium?

A

it is often just seen as CONFUSION (which is sometimes seen as normal in the elderly BUT it IS NOT)

delirium over dementia is difficult to determine

it IS an medical emergency

causes acute, distress, sometimes fearful

122
Q

Potential (Specific) things/ Diagnoses that cause Delirium

A

CNS infections

Hypothyroidism

B12 Deficiency

CNS masses (neoplasms and subdermal hematomas)

medication side effects

123
Q

The Yale Delirium Prevention trial demonstrated the effectiveness of what?`

A

Orientation and therapeutic activities alleviate cog impairment

early mobilization prevents later immobilization

non pharm approaches minimize psychoactive drug use and effects

you can intervene to prevent sleep deprivation

communication methods and adaptive equipment helps with vision and hearing issues

EARLY INTERVENTION FOR VOLUME DEPLETION

124
Q

Volume depletion causes …

A

confusion/delirium so make sure to offer enough fluids so it doesn’t get worse

125
Q

What are the consequences of delirium?

A

significant distress

associated with high morbidity during hospitalization

functional decline

post op complications

increased length of stay

low rate of recovery to prior level of functioning

potential institutionalization

126
Q

Types of Delirium

A

Hypoactive

Hyperactive

127
Q

Hypoactive Delirium

A

Quiet

“Pleasantly confused”

lethargic

inactive

withdrawn

limited, slow and wavering vocalizations

128
Q

Hyperactive Delirium

A

heightened alertness

easily distracted

hallucinations

delusions

agitated

aggressive

fast and / or loud speech

wandering

repetitive movements

removing tubes

attempting to get out of bed

129
Q

What is the scarier type of Delirium

A

hyperactive

130
Q

What is the main symptom of both hypo and hyperactive delirium?

A

Patient is NOT acting like themselves

131
Q

Nursing Interventions for Delirium

A

Reassess cognition using established tools

make sure basic needs are met (NUMBER 1 PRIORITY)

review medications

understand behavior, determine root cause

maintain safety with MINIMAL restraints!!

lessen invasive procedures

modify the environment

family involvement

132
Q

___ can be a precursor to dementia

A

Depression

133
Q

What are some common vents that require psychological adjustments and could lead to depression

A

widowhood

confronting negative attitudes of aging

retirement

chronic illness

functional impairments

decisions about driving a car

death of friends and family

relocation from home to assisted living

134
Q

More events needing coping and adaptation occur when …

A

a person lives longer

135
Q

What subgroups of risk factors for depression exist?

A

High levels of stress and poor coping

Impaired mental health - previous depression

(and substance abuse)

136
Q

What are some risk factors for high levels of stress and poor coping?

A

diminished economic resources

immature developmental level

unanticipated events, such as the death of a spouse

many daily hassles at the same time in one day

many major life events occurring in a short period of time

unrealistic appraisals of situations

137
Q

Depression may be associated with …

A

stroke

heart disease

Parkinson’s disease

endocrine disorders (diabetes)

cancers

epilepsy

B12 deficiency

chronic pain

viral illness

serious losses

138
Q

What things/changes relate back to depression in the elderly?

A

difficult relationships

changes in social roles

retirement

widowhood

loneliness

poverty

unplanned moves

medication side effects

age related changes!

139
Q

Depression risk can be decreased through …

A

Nonpharmacological interventions and pharmacological interventions

140
Q

Nonpharmacological Interventions for Depression

A

Light therapy for seasonal affective disorder (SAD)

electroconvulsive therapy (ECT) (Not used too much anymore)

alcoholics anonymous / support groups

141
Q

Pharmacological Interventions

A

antidepressants

mood stabilizers

antianxiety drugs

142
Q

Nursing Interventions for Depression

A

ID stressors and rate elder stress levels

Education of elder and family about stress theory and stress cycle

ID successful coping mechanisms used in the past

assist in examining current coping mechanisms and behaviors

alter or eliminate negative or maladaptive mechanisms

reinforce and strengthen positive coping mechanisms

investigate community resources, support groups, stress reduction clinics, and other stress relievers

initiate suicide self restraint contracts

encourage appropriate self care behaviors

ID and encourage effective coping strategies

encouraging hopeful attitudes

143
Q

How can health aging, social interaction, education, and problem solving be fostered?

A

travel with senior citizens groups

outsides activities

taking classes

elder hostels

volunteer work

regular exercise

hobbies and crafts

increased family involvement

144
Q

What things must be maintained and promoted as a client regresses?

A

Individuality

Independence

Freedom

Dignity

Connection

145
Q

How to maintain and promote Individuality

A

learn the personal history and uniqueness of the patient and incorporate it into nursing care

146
Q

How to maintain and promote Independence

A

even if it takes 3x longer to guide patients through dressing than it would to dress them, they should be afforded every opportunity for self care!

147
Q

How to maintain and promote Freedom

A

major freedoms become limited so minor choices made by the client become especially important

148
Q

How to maintain and promote Dignity

A

clients should be afforded the respect given to any adult including attractive clothing, good grooming, adult hairstyles, use of their names, privacy, and individuality

149
Q

How to maintain and promote Connection

A

value the client as someone who is a member of a family, community, and universe.

Interaction and connection with other people and nature recognition and respect for the spiritual beings that live within the altered body and mind

150
Q

How to help older patients with cognitive decline deal with anxiety?

A

plan specific interventions to minimize stress level

enhance feelings of trust and safety

promote self control by providing a daily routine with few variations to provide stability

diversional activities like music therapies, reminiscence, structure sensory stimulation, snoelezen room

151
Q

What are some risk factors for Elopement of older patients?

A

severe cog impairment

exhibit more than one challenging behavior (ex: combative with care, not eating or drinking, abnormal behavior)

spend long periods alone (isolation)

in a darkened or unfamiliar environment

boredom (keep preoccupied)

stress and tension ( and stress increases with cog decline)

lack of control

lack of exercise

nocturnal delirium

don’t leave cues like keys around for them to use

152
Q

Nocturnal Delirium

A

at night a cognitively declining patient cannot sleep and become confused and try to get away/ elope from where they are

153
Q

What is common to middle and late stages of dementia?

A

Resistance to Care

154
Q

The major reason for institutionalization and use of psychotropic drugs is …

A

resistance to care

155
Q

Alternative strategies to drugs when a patient is resistant to care?

A

responding with a relaxed and smiling manner

“time out” with a pleasant distraction (disengage let them listen to music or ATV then re-approach once settled)

156
Q

Why is insomnia very prevalent in cognitive decline?

A

death of suprachiasmatic nucleus –> death and loss of regulation of circadian rhythms

157
Q

What is evident several months before AD diagnosis?

A

insomnia

158
Q

Strategies to deal with the Difficulty of insomnia for caregivers?

A

Establish sleep hygiene –> very cut and dry sleep schedule

eliminate stimulation prior to bedtime

159
Q

Symptoms of Caregiver Stress

A

Denial
Anger
Social Withdrawal
Anxiety
Depression
Exhaustion
Sleeplessness
Irritability
Lack of Concentration
Health Problems

160
Q

Tips for Caregivers to prevent burnout/stress

A

Knowing available resources (adult day programs, visiting nurses, meal deliveries, etc)

Get Help (social support of those going through something similar)

Use relaxation techniques (visualization, meditation, breathing exercises)

Get moving and Physical Activity (do what you enjoy)

Time for You

Become an educated caregiver

take care of yourself !!!!

161
Q

When planning care for patients with dementia it is important to understand what regarding the disease?

A

Dementia is a family disease

Dementia is a public health problem (more are getting it and caregiving needs are required by informal family and friends or Medicare and Medicaid providers)

162
Q

Adult Day Centers

A

almost like an adult day care that gives the clients opportunities to be social and participate in activities in a social environment

163
Q

What things does adult day centers provide?

A

counseling

health services

nutrition - from dieticians

personal care

activities

behavioral management - with trained staff

164
Q

In Home Health Care

A

Includes a wide range of services provided in the home rather than in a hospital

it allows a client to stay in familiar environment and is of great assistance to caregiver

165
Q

Types of In Home Health Care Services

A

Companion services - let the families go out

Personal care services - helps with grooming

Homemakers - help with chores around the home and take a load off the caregiver

Skilled care - nursing care like med management and wound care

166
Q

Residential Facilities (LTC)

A

Provide a communal living environment for those who need a higher level of care that can be provided at home

167
Q

Types of Residential Facilities

A

Retirement housing

assisted living

nursing home / skilled nursing facility / LTC

Alzheimer’s Special Care Units / Memory Care Units

Continuing care retirement communities

168
Q

Retirement Housing

A

residential facility

appropriate for those with early stage AD who are still able to care for themselves independently

client may be able to live alone safe, but difficulty managing an entire house

limited supervision is provided and some offer opportunities for social activities, transportation, and other amenities

almost like living in a hotel (call bell available) - supervision but mostly on their own !!

169
Q

Assisted Living

A

residential facility

bridges the gap between independent living and living in a nursing home

provides housing, meals, supportive services, and health care

Resident may choose which services they receive from facilities such as bathing, dressing, eating, or medication reminders

May or may not provide services specifically for dementia

all services are available - or they choose just services needed

Staff MAY OR MAY NOT be specifically trained for dementia

170
Q

Nursing Home / LTC Unit

A

residential facility

provides around the clock care and long term medical treatment giving services addressing issues like nutrition, care planning, recreation, spirituality, and medical care

staff may OR may not have experience or training with caring for dementia clients

always a physician here and nurses and aides

24/7 care

everything is included in the care here

171
Q

Alzheimer’s Special Care Units / Memory Care Units

A

SCUs are residential facilities designed to meet the specific needs of individuals with AD and other dementias

Can take many forms and exist at various levels of residential care

a cluster setting in which clients with dementia are groups together on a floor or unit - DONT WANT TO PUT THEM WITH SOMETHING LIKE THE REHAB FLOOT SINCE THE REHAB COULD BE DISTRACTED AND ALZ ARE ANXIOUS

staff has extensive training in dementia care, specialized activities are provided and staff can care for behavioral needs of residents - VERY SPECIALIZED STAFF

172
Q

Continuing Care Retirement Communities (CCRI)

A

Residential facility providing different levels of care (independent, assisted living, and nursing home) based on individual needs

Client is able to move throughout the different levels of care within community if their needs change (changes from rehab to Nursing home to LTC, etc ,etc)

payment includes and initial entry fee (ex: 250-500 thousand) w/ subsequent monthly fees or payment based solely on fees - very expensive out of pocket

commonly has a waiting list

guaranteed care until end of life

173
Q

Respite Care

A

respite care provides caregivers a temporary rest from caregiving, while the person with AD continues to receive care in a safe environment

it gives caregivers the chance to spend time with friends/families or to just relax - important to prevent burn out, gives break, etc

Provided comfort and peace of mind knowing that the client is spending time with another caring individual

174
Q

Forms of Respite Care

A

In Home Health Care Services

Adult Day Centers

Residential Facilities

(sometimes done out of homes)

175
Q

Hospice Care

A

focuses on comfort and dignity at the end of life

primary purpose is to manage pain and other symptoms during the last six months of life

provided at home or in a nursing facility

gives counseling about the emotional and spiritual impact of the end of life and gives grief support to family

176
Q

Medical Care in Hospice Care focuses on …

A

Symptom Management

Less chemo, anitbiotics, and dialysis - more giving them comfort and what they want in diet

177
Q

Hospice care is for the estimated last ___ months of live

A

6 months of life (may not be exact)

178
Q

Hospice may require what to give caregivers relief?

A

some respite care too for the client

179
Q

Hospice focuses on ___ and ___ of the client

A

comfort and dignity

180
Q

What things should be asked when deciding where a loved one goes?

A

Patient choice on where to go

Family involvement as it is a team approach decision

Interdisciplinary Team - makes recommendations to help make choices

The important points to keep in mind are dignity, comfort, and safety

181
Q

What are the 3 most important points of Geriatric Care?

A

Dignity (#1; Always at the forefront)

Safety

Comfort

N352: Practice of Nursing I (14 decks)

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