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Nursing - Bloomberg > NUR 360: Geriatrics > Flashcards

NUR 360: Geriatrics Flashcards

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1
Q

Dry eye

A

Don’t make enough tears

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2
Q

Age-related macular degeneration

A

Dry AMD = cells under retina thin and drusen deposits accumulate. Advances slowly and sometimes can turn into Wet AMD.

Wet AMD = abnormal blood vessels grow under retina, causing blood and fluid to leak and damage macular cells. Can occur suddenly and lead to sight loss of untreated.

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3
Q

Cortical visual impairment

A

CVI is caused by neurological damage to the occipital love, due to stroke, decreased blood supply, decreased oxygenation, seizure, infection, head trauma, or other neurological disorder.

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4
Q

Congenital eye conditions

A

Present from birth

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5
Q

Retinal diseases

A

Affect any part of the retina

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6
Q

Refractive conditions

A

Can result in blurred vision.

1) MYOPIA = nearsightedness
2) HYPEROPIA = farsightedness
3) PRESBYOPIA = loss of near vision with age
4) ASTIGMATISM =irregularly shaped cornea

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7
Q

Nearsightedness

A

Myopia

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8
Q

Farsightedness

A

Hyperopia

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9
Q

Loss of near vision with age

A

Presbyopia

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10
Q

Refractive condition caused by irregular shape of the cornea

A

Astigmatism

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11
Q

Genetic disorders causing gradual destruction of photoreceptors in the retina.
Symptoms include night blindness and loss of peripheral vision.

A

Retinitis Pigmentosa

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12
Q

Cataracts

A

Lenses harden with age, and may turn cloudy.

1) Age-related cataracts
2) traumatic cataracts
3) radiation cataracts
4) congenital cataracts
5) secondary cataracts

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13
Q

Glaucoma

A

Damage to the optic nerve.

1) Primary/open-angle Glaucoma = normal drainage outflow blocked
2) Primary acute closed-angle = distance between iris and drainage system has been closed
3) Primary chronic angle closure = narrowing of space between iris and drainage system
4) Secondary Glaucoma = results from other conditions like injury or inflammation

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14
Q

Retinoblastoma

A

Rare form of cancer most commonly affecting children

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15
Q

Iatrogenic

A

Relating to illness caused by medical examination, treatment, or environment

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16
Q

3 D’s of Geriatrics

A

Dementia
Delirium
Depression

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17
Q

What are the 5 consequences of age-related changes?

A

1) Temperature dysregulation (hypothermia and hyperthermia)
2) decreased circulation
3) dehydration (decreased thirst)
4) decreased muscle and fat
5) decreased plasma volume

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18
Q

Young-Old

A

65-74 yrs

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19
Q

Mid-Old

A

75-84 yrs

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20
Q

Old-Old

A

85+ years

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21
Q

Ambulatory Care Sensitive Positions (ACSP) (7 - CAACHED)

A 
COPD
Angina
Asthma
CHF
Hypertension
Epilepsy 
Diabetes
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22
Q

Multifactorial conditions that do not fit discrete disease categories

A

Geriatric conditions

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23
Q

What are the shared risk factors of Geriatric Syndromes? (BBAM)

A
  1. Age (older adult)
  2. Baseline cognition impaired
  3. Baseline functional impairment
  4. Impaired mobility
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24
Q

Bermuda Triangle of Aging

A
  1. Polymorbidity
  2. Functional Decline
  3. Social frailty
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25
Q

Loss of muscle mass (degeneration)

= component of Frailty Syndrome

A

Sarcopenia

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26
Q

NEW LOSS of independence in self-care with deterioration in mobility & ADLs

A

Functional Decline

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27
Q

What are the 8 age-related changes? (Mind, eyes/mouth, throat, chest, shoulder, elbow, groin, legs)

A
  1. Benign forgetfulness
  2. Altered senses, appetite, and thirst
  3. Diminished pulmonary ventilation
  4. Decreased aerobic capacity
  5. Decreased muscle strength
  6. Reduced bone density
  7. Urinary incontinence
  8. Vasomotor instability
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28
Q

Acutely disturbed state of mind

A

Delirium

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29
Q

Acute onset, with fluctuating disturbances in consciousness, attention, memory, thought, and perception

A

Persistent delirium

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30
Q

What are the 4 Functional Decline risk factors? (CADL)

A
  1. Age
  2. Cognitive status
  3. Depression
  4. Lifestyle (activity levels, etc)
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31
Q

Hazards of Hospitalization (12)

Heel, calf, thighs, groin, bowels, chest, throat, shoulder, hands, head, face, mind

A
  1. Pressure injuries (heel)
  2. Contractors (calf)
  3. Deep Vein Thrombosis (DVT) (thighs)
  4. Incontinence (groin)
  5. Constipation (bowels)
  6. Bronchial pneumonia (chest)
  7. Dehydration (throat)
  8. Iatrogenic complications (shoulder)
  9. Hypothermia (hands)
  10. Disabilities (head)
  11. Institutionalization (face)
  12. Isolation & Depression (mind)
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32
Q

Hyperactive delirium

A

Hallucinations, emotional instability, etc

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33
Q

8 I’s of Geriatrics (MmmAnnnS)

A
  1. Impairment - cognitive
  2. Impairment - sensory
  3. Immobility
  4. Iatrogenesis
  5. Incontinence
  6. Instability
  7. Inadequate nutrition
  8. Isolation
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34
Q

What screening tools test cognition?

A
  1. MoCA
  2. SIG E CAPS
  3. Gait speed & grip strength
  4. Clock Drawing Test (CDT)
  5. CAM (Confusion Assessment Method)
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35
Q

What are the 3 signs of Major NCDs?

A

Neurocognitive Deficits

  • Global Impairment
  • declined iADLs
  • NORMAL consciousness
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36
Q

7 A’s of Dementia

Mind, ears, eyes, nose, mouth, chest, hands

A
  1. Agnosia (mind)
  2. Amnesia (ear)
  3. Altered perception (eyes)
  4. Anosognosia (nose)
  5. Aphasia (mouth)
  6. Apathy (chest)
  7. Apraxia (hands)
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37
Q

Types of Dementia

A
  1. Alzheimer’s Disease
  2. Vascular Dementia
  3. Mixed Dementia
  4. Parkinson’s Disease
  5. Frontotemporal Dementia (FTD)
  6. Lewy Body Dementia (LBD)
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38
Q

Hemianopea

A

Hemi-neglect

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39
Q

Perseveration

A
  • Stimulus bound

- advanced dementia

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40
Q

Delirium Causes (“I WATCH DEATH”)

A

Infections

Withdrawal
Acute vascular 
Trauma
CNS pathology
Hypoxia 
Deficiencies 
Endocrine 
Acute metabolic 
Toxins, drugs
Heavy metals
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41
Q

What are the 10 Geriatric Syndromes? (DeFFFIPSSN)

A
  1. Delirium
  2. Dementia
  3. Depression
  4. Dehydration
  5. Frailty
  6. Falls
  7. Functional Decline
  8. Incontinence
  9. Pressure injuries
  10. Sarcopenia
  11. Syncope & Dizziness
  12. Nutrition & weight loss
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42
Q

Related to illness caused by medical examination or treatment

A

Iatrogenic

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43
Q

What are the four features on the CAM test?

A
  1. Mental status altered from baseline
  2. Inattention
    ONE OF THE TWO:
  3. Disorganized thinking
  4. Altered consciousness (LOC)
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44
Q

What are the 3 subtypes of delirium?

A
  1. Hyperactive
  2. Hypoactive
  3. Mixed
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45
Q

What are the 6 advantages of screening tools?

A
  1. Increases communication with colleagues (shared language)
  2. Assists clinician of patient’s abilities
  3. Documents changes over time
  4. Solves specific problems
  5. Teaches assessments
  6. Helps with discharge planning
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46
Q

What test screens for depression?

A

SIG E CAPS

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47
Q

What does SIG E CAPS stand for?

A 
Somnia 
Interest
Guilt
Energy 
Concentration
Appetite 
Psychomotor 
Suicidal ideation 
(Depressed Mood)
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48
Q

What are the 4 risk factors for falls?

A
  1. Chronic conditions
  2. Physical and Functional impairments
  3. Medication and alcohol use
  4. Environmental hazards
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49
Q

What are the 4 risk factors for injuries due to falls? (HOAP)

A
  1. History of falls
  2. Anticoagulant medications
  3. Osteoporosis
  4. Post-surgical patients
50
Q

What does anhedonia mean?

A

Loss of interest, nothing brings pleasure

51
Q

What does BPSD stand for?

A

Behavioural and Psychological Symptoms of Dementia

52
Q

What are the 5 clusters of BPSD?

AgDAP

A
  1. Aggression
  2. Agitation
  3. Depression
  4. Apathy
  5. Psychosis
53
Q

What are the behaviour of Sundowning?

A

Aggression
Delusions
Pacing / wandering
Misunderstanding

54
Q

What are the 7 signs and symptoms of depression?

A
  1. Importuning
  2. Irritability
  3. Non-endorsement of depresses mood
  4. Lack of engagement
  5. Cognitive impairment (pseudo dementia)
  6. Psychosis (delusions)
  7. Physical symptoms (somatic complaints)
55
Q

What are the five sections in the PAINAD?

A
  1. Breathing
  2. Negative vocalizations
  3. Facial expressions
  4. Body language
  5. Consolability
56
Q

What does SOCRATES stand for and assess?

A

Asses pain:

Site
Onset
Character
Radiation
Associations 
Time
Exacerbating and Relieving Factors
Severity
57
Q

Hypodermoclysis

A

Interstitial or Subcutaneous infusion of isotonic solution over 24hrs to replenish fluids.

58
Q

Increased LOS (length of stay)

A

+9 days

59
Q

Ambulatory Care Sensitive Conditions (ACSC)

A
  1. COPD
  2. Angina
  3. Asthma
  4. CHF
  5. Hypertension
  6. Epilepsy
  7. Diabetes
60
Q

How much muscle mass is lost each day in older adults?

A

2-5%

61
Q

What are the intrinsic factors of frailty?

A
  1. Physical frailty
  2. Multi-morbidity
  3. Genetics
62
Q

What are the extrinsic factors of frailty?

A
  1. Social & physical environments

2. Lifestyle (modifiable risk factor)

63
Q

What assessment is suited to the needs of frail elderly?

A

Comprehensive Geriatric Assessment (CGA)

64
Q

How is Frailty phenotype defined?

A

Pre-defines set of 5 criteria:

  1. Walking speed
  2. Grip strength
  3. Weight loss
  4. Fatigue
  5. Activity
65
Q

Frailty index

A

Frailty as a state

66
Q

Clinical judgement tool for screening frailty that assesses ADLs and iADLs

A

Clinical Frailty Scale (CFS)

67
Q

What are the aspects of the Comprehensive Geriatric Assessment (CGA)?

A
  1. Screening
  2. Assessment
  3. Goal-directed intervention
  4. Follow-through
68
Q

What are the four domains of the Comprehensive Geriatric Assessment (CGA)?

A
  1. Physical health (comorbities, meds, etc)
  2. Functional Status (ADLs and mobility)
  3. Cognition and Mood
  4. Socioeconomic Parameters
69
Q

Failure to thrive

A

Diagnosis

70
Q

Failure to cope

A

Perception

71
Q

What are the 4 risk factors of functional Decline? (CADL)

A
  1. Cognitive status
  2. Age
  3. Depression
  4. Lifestyle factors (ie inactivity)
72
Q

What is the cascade of illness?

A
  1. Decreased muscle strength and aerobic capacity
  2. Vasomotor instability
  3. Decreased pulmonary ventilation
  4. Reduction in plasma volume
  5. Bone density loss
  6. Sensory deprivations and incontinence
73
Q

What nursing interventions can help with frailty?

A
  1. Deemphasize bedrest
  2. Remove bed rails and lower bed
  3. Moralize early
  4. Encourage hydration
  5. Increase social opportunities
74
Q

What tests screen for dementia?

A
  1. Clock drawing test
  2. MMSE
  3. MoCA
  4. Mini-Cog
75
Q

Which test screens for delirium?

A
  1. CAM (Confusion Assessment Method)

2. Delirium Rating Scale

76
Q

What are normal age-related memory changes?

A
  1. Increase in processing time
  2. Increased emphasis on relevance
  3. Increased distractibility
77
Q

What are symptoms associated with Alzeihmer’s Disease?

A
  1. Aphasia
  2. Agnosis
  3. Apraxia
  4. Short term memory loss
78
Q

What type of dementia is early onset?

A

Frontotemporal (FTD)

79
Q

What type of dementia results in vivid hallucinations, autonomic system fluctuations, and changes in attention and alertness?

A

Lewy Body Dementia (LBD)

80
Q

What are the 3 components of the Mini-Cog Screening test?

A
  1. Registration of words
  2. Clock Drawing Test
  3. Word Recall
81
Q

If a patient is only able to recall 1-2 words in the Mini-Cog screening test, and has an abnormal clock drawing test, what does this indicate?

A

Possible dementia

82
Q

What are preventions of delirium?

A
  1. Sleep
  2. Mobilize
  3. Perceptual aids
  4. Hydration
  5. Orientation (to date, time, etc)
  6. Minimize drug use
  7. Routine
83
Q

What is the #1 risk factor for falls that increases the risk by 4x?

A

Lower extremity weakness

84
Q

What are the 3 risk factors of delirium?

A
  1. Cognitive impairment
  2. Opioid use
  3. Sever pain
85
Q

Temporary pain often caused by procedures such as surgery. Responds well to analgesics.

A

Acute pain

86
Q

Pain that is present for longer, often caused by disease and more common in older adults.

A

Persistent pain

87
Q

What are 2 causes of dehydration in older adults?

A
  1. Inadequate fluid intake

2. Excessive fluid loss

88
Q

What are 5 age-related changes that lead to dehydration?

A
  1. Decreased total body water (TBW)
  2. Decreased thirst sensation
  3. Decreased ability to sweat
  4. Aging kidneys
  5. Decreased muscle mass with increased fat (thus decreased water storage)
89
Q

What would a nurse assess in the skin for dehydration?

A

Skin turgor and elasticity

90
Q

What blood assessments indicate dehydration?

A
  1. Na/K levels
  2. Urea and creatinine levels
  3. Albumin levels
91
Q

What vitals indicate the possibility of dehydration?

A
  1. HR increased (tachycardia)
  2. BP decreased (hypotension)
  3. Incontinence/decreased urine output
  4. Dizziness
  5. Neuro impairment
  6. High fever
  7. Diarrhea
92
Q

What drugs increase dehydration?

A
  1. Diuretics
  2. Laxatives
  3. Psychotropics
93
Q

What are some risk factors for dehydration? (12)

A
  1. Decreased muscle mass with increase fat mass (TBW storage)
  2. Decreased thirst sensation
  3. Decreased rental function
  4. Older age (85+) & female
  5. Frailty
  6. Dementia or Functional Decline
  7. Fear of incontinence (decreased intake)
  8. Decreased mobility and isolation
  9. Decreased swallowing efficiency
  10. Diabetes
  11. Malnutrition
  12. Laxatives and diuretics
94
Q

What are some consequences of dehydration? (11)

A
  1. Constipation/ bowel obstruction (obstipation)
  2. Impaired cognition
  3. Falling
  4. Hyperthermia
  5. Glycemic control
  6. Orthostatic hypotension
  7. Salivary dysfunction
  8. UTI
  9. Kidney stones
  10. CHD (coronary heart disease)
  11. Pressure ulcers
95
Q

What are the 4 causes of inadequate fluid intake?

A
  1. Can drink (unaware of adequate intake)
  2. Can’t drink
  3. Won’t drink (bad habits or fear of incontinence)
  4. End of life
96
Q

What are 3 mechanisms of urinary incontinence?

A
  1. Urethra pressure is greater than bladder pressure
  2. Dretrusor muscle no longer voluntary
  3. Inability to suppress voiding urge
97
Q

What are age-related changes associated with urinary incontinence?

A
  1. Decreased bladder capacity
  2. Decreased # of nephrons
  3. Change in renal threshold
  4. Decreased muscle tone of urethra
  5. Decreased sensation
  6. Decreased speed of detrusor muscle contraction
  7. Decreased sphincter resistance
  8. Decreased urinary flow rate
  9. Increased urinary frequency
  10. Increased post-void residual volumes
  11. Increased tract obstruction (prostate enlargement)
98
Q

DRIP of urinary incontinence

A

Delirium / confusión
Restricted mobility, retention
Infection, inflammation, impact(fecal)
Polyuria, pharmaceuticals

99
Q

What are contributing factors to urinary incontinence?

A
  1. Undiluted urine
  2. Caffeine
  3. Alcohol
  4. Constipation
  5. Meds
  6. Obesity
  7. Mobility
  8. Environment
100
Q

Loss of memory

A

Amnesia

101
Q

Loss of language

A

Aphasia

102
Q

Loss of recognition

A

Agnosia

103
Q

Loss of purposeful movement

A

Apraxia

104
Q

Loss of ability to realize there is anything wrong

A

Anosognosia

105
Q

Misinterpretation of sensory information

A

Altered perception

106
Q

Loss of drive or initiative

A

Apathy

107
Q

What are the 7 A’s of Dementia?

A
  1. Agnosia (mind)
  2. Amnesia (ear)
  3. Altered perception (eyes)
  4. Anosognosia (nose)
  5. Aphasia (mouth)
  6. Apathy (chest)
  7. Apraxia (hands)
108
Q

What are the 3 categories of restraints?

A
  1. Physical
  2. Environmental
  3. Chemical
109
Q

What tests screen for functional decline?

A
  1. Katz index

2. Timed Up and Go (TUG)

110
Q

High press environment

A

Increase stimulation

111
Q

What are the 5 behavioural and psychological symptoms of dementia (major neurocognitive disorder)?

A
  1. Aggression
  2. Agitation
  3. Depression
  4. Apathy
  5. Psychosis
112
Q

NHS Fall Assessment

A
  1. Sex
  2. Age
  3. Gait
  4. Sensory deficits
  5. Mobility
  6. Fall history
  7. Medication
  8. Medical history
  9. Home environment
113
Q

Comprehensive Fall Risk Assessment

A
  1. Cognitive/neurological assessment
  2. Sense assessment (vision, hearing, vestibular)
  3. Cardiac assessment (orthostatic hypotension)
  4. Gait and balance assessment
  5. Osteoporosis risk assessment
  6. Medication review
  7. Fall history
  8. Fear of falling assessment
114
Q

What are the 4 age-related changes for falls? (FORI)

A
  1. Fall risk
  2. Orthostatic hypotension
  3. Reduced stepping height
  4. Impaired reaction time
115
Q

Screening and assessment tools for dehydration (DEHYDRATIONS)

A 
Drugs
End of life
High fever
Yellow urine darkens 
Dizziness
Reduced oral intake 
Axillae dry 
Tachycardia 
Incontinence (fear of)
Oral problems 
Neurological impairment 
Sunken eyes
116
Q

Which dementia test also screens for executive functioning?

A

MoCA

117
Q

Which dementia test also screens for executive functioning?

A

MoCA

118
Q

What are 3 reasons to use restraints on a patient?

A
  1. To prevent harm (from yourself or the patient)
  2. To enhance the patient’s freedom or enjoyment of life
  3. If authorized in plan of treatment by patient or SDM
119
Q

What are the 4 types of depression?

A
  1. Psychotic depression
  2. MDD
  3. Persistent Depression (not quite MDD but lasts for 2+ years)
  4. Adjustment Disorder (hard time coping)
120
Q

What are the 9 stages of the Frailty Index?

A
  1. Very fit
  2. Well
  3. Managing well (medical problems well controlled)
  4. Vulnerable (symptoms limit activity but still independent)
  5. Mildly Frail (help with iADLs)
  6. Moderately Frail (help with bathing)
  7. Severely Frail (completely dependent but stable)
  8. Very Severely Frail (could not recover from any illness)
  9. Terminally ill

Nursing - Bloomberg (52 decks)

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