older adults - final exam

Question 1

more than 80% of older adults have

Answer 1

chronic medical conditions resulting in pain
osteoarthritis
PVD

Question 2

pain is associated wih

Answer 2

depression
sleep disturbances
dereased socialization
isolation
slowed GI = constipation
immune impaired
functional loss
increasing dependency

Question 3

untreated pain can potentially cause

Answer 3

tachycardia
increased myocardial oxygen consumption
delirium
immobility
splinting
atelectasis
pneumonia

Question 4

characteristics of acute pain

Answer 4

fron injury, surgery or tissue damage
autonomic activity ass. = tachycardia, diaphoresis
time limited
subsides with healing

Question 5

characteristics of chronic pain

Answer 5

more than 3-6 months
may or may not be from a disease
no autonomic activity
ass. w/ functional loss, disability, mood and behavior changes
reduced quality of life
treatment may be complicated by other diseases

Question 6

pain scale that is more valid in older pop

Answer 6

verbal description

Question 7

The ACCM recommends

Answer 7

using the numeric rating scale in the ICU

Question 8

tylenol products potentially cause

Answer 8

liver damage

Question 9

indicates the use of more medication than is clinically indicated 5+ drugs

Answer 9

polypharmacy

Question 10

takes _ to _ prescriptions and _ OTC drugs at a time

Answer 10

4-5; 2

Question 11

fills _ to _ prescriptions/yeart

Answer 11

12-17

Question 12

main source of income is

Answer 12

social security

Question 13

average spent for meds

Answer 13

$955

Question 14

ambulatory

Answer 14

2-4 pres. drugs

Question 15

in long term care

Answer 15

2-20 pres. drugs

Question 16

_% of population takes _% of the prescription medication

Answer 16

13; 30

Question 17

physician factors that lead to polypharmacy

Answer 17

presuming pt. expects. pres. med
no med. review
no investigation of clinicals setting
complex, unclear instructions
automatic refills
lack of knowledge of geriaric clinical pharmacology

Question 18

patient factors leading to poly pharmacy

Answer 18

multiple doctors
hoarding/sharing
inaccurate reporting of all meds
assuming med. is indefinite
changes in daily routine
declining cognition, funds, function, living alone

Question 19

preventing polypharmacy

Answer 19

written instructions
sensitivity to lack of funds - MSW referrral
brown bag exam every visit
pill boxes

Question 20

5th leading cause of death

Answer 20

adverse drug reactions

Question 21

falls from

Answer 21

orthostatic hypotension

Question 22

changes in body drug distribution

Answer 22

higher percentage of fat
decreased total body water
decreased plasma albumin concentration

Question 23

absorption changes

Answer 23

delayed gastric emptying
decreased gastric acidity
decreased splanchic blood flow
mucosal edema
disease

Question 24

changes in body composition changes

Answer 24

serum concenration of water-soluble drugs

Question 25

change in fat mass affects

Answer 25

concentration of fat-soluble medications

Question 26

drug clearance changes

Answer 26

altered liver metabolism | decreased renal excretion of drugs

Question 27

decreased baroreceptor responses cause increased susceptibility to

Answer 27

positional changes | volume changes

Question 28

anticholinergic problems

Answer 28

``` confusion orthostatic hypo. dry mouth blurred vision urinary retention ```

Question 29

these meds cause anticholinergic effects

Answer 29

TCAs

Question 30

effects of antiemetics

Answer 30

``` confusion ortho. hypo blurred viision falls dry mouth urinary retention ```

Question 31

% in hospital from iatrogenic complications

Answer 31

36%

Question 32

geriatric syndromes

Answer 32

``` pain falls polypharmacy incontinence pressure ulcers cognitive impairment/delirium ```

Question 33

fastest growing segment of US pop

Answer 33

old old 85 +

Question 34

frailty is 3 or more of the following

Answer 34

``` unplanned weight loss (10lb in last yr) weakness (dec. grip strngth) poor endurance and energy slowness low activity ```

Question 35

risks of frailty

Answer 35

``` dependency institutionalization falls injuries hospitalizations slow recovery from illness mortality ```

Question 36

this alone can start the geriatric cascade

Answer 36

hospitalization

Question 37

fear starts the downward spiral.....

Answer 37

fear - overly cautious - dec. activiy levels - muscle weakness - loss of mobility - loss of independence - social isolation and depression

Question 38

to prevent the cascade

Answer 38

identify frail pts know the indicators of frailty & increased risk for poor outcomes assess functional status before & during observe for delirium be aware of atypical disease presentation

Question 39

end stage frailty

Answer 39

Irreversible hospice care comfort & dignity

Question 40

respect for autonomy is the basis for

Answer 40

informed consent

Question 41

beneficence conflict when

Answer 41

pt. disagrees w/ treatment recommendations

Question 42

actions that serve the best interests of patients

Answer 42

beneficence

Question 43

first do no harm; must be balanced w/ beneficence

Answer 43

non-maleficence

Question 44

ageism or stereotyping is a form of

Answer 44

unethical thinking

Question 45

percent of informal caregivers are

Answer 45

women

Question 46

_ rely on families and friends for support/assistance

Answer 46

75%

Question 47

families provide _% of caregiving

Answer 47

families

Question 48

3 stages of caregiver burnout

Answer 48

frustration isolation despair

Question 49

provides for managemen of assets in case of disability (only for financial matters)

Answer 49

statutory durable power of attorney

Question 50

authorizes an agent to make health care decisions in the event of incapacity

Answer 50

medical power of attorney

Question 51

expresses the desire of grantor not to be kept alive by extraordinary means when grantor has been diagnosed w/ a terminal condition

Answer 51

advanced directive

Question 52

the legal means to care for a person and/or his estate when he can't do so for himself

Answer 52

guardianship

Question 53

assisting w/ suicide or ending life by request

Answer 53

active euthanasia

Question 54

speeding death by treatment to prevent suffering or disease extension

Answer 54

double effect

Question 55

allowing death by forgoing extraordinary measures

Answer 55

passive euthanasia

Question 56

view death as inevitable and natural part of life cycle

Answer 56

death-accepting

Question 57

refuse to believe that death would take anything away and believe it could be overcome

Answer 57

death-defying

Question 58

refuse to confront death, believe that death is antithetical to living and that is not a natural part of human existence

Answer 58

deth-denying

Question 59

the process of psychological, social and somatic reactions to the perception of loss

Answer 59

grief

Question 60

cultural response to loss

Answer 60

mourning

Question 61

the state of having suffered a loss

Answer 61

bereavement

Question 62

the ability to comprehend info, consider options, evaluate risks, make a decision and communicate that decision

Answer 62

capacity

Question 63

only be decided judicially

Answer 63

competence

Question 64

pain management physical suffering can always be alleviated mot resricted to those who are dying or those enrolled in hospice programs

Answer 64

palliative care

Question 65

medieval concept of hospitality care for patients at home replaces medicare coverage for the terminal illness can be provided in nursing home or inpatient setting

Answer 65

hospice

Question 66

resources for caregivers

Answer 66

``` adult day care respite programs caregiver support groups community mental health services organizational resources by type of disease or illness ```