Rest (sleep), Aging, & Death

Question 1

Patients w/ depression are often associated w/ which of the follow sleep disorders (insomnia, narcolepsy, obstructive sleep apnea, & restless leg syndrome)

Answer 1

Insomnia

Question 2

Identify this key term:

• rhythm that completes a full cycle every 24 hours

Answer 2

Circadian Rhythm (diurnal rhythm)

Question 3

What is a natural chemical produced at night that decreases wakefulness and promotes sleep by regulating circadian rhythm

Answer 3

Melatonin

Question 4

What is the condition in which patients are unable to lie still and report experiencing unpleasant creeping, crawling, or tingling sensations in the legs

Answer 4

Restless Legs Syndrome (RLS):

Question 5

What stages are “light sleep” and take up b/w 5-50% of sleep.

Answer 5

Stage I and II

Question 6

What stages of sleep are “deep-sleep” states and take up 10% of sleep.

Answer 6

Stages III and IV

Question 7

Which stage of sleep does “delta sleep” occur in?

Answer 7

Stage III and IV

Question 8

What happens to

Pulse, RR, BP, Temperature, metabolic rate, skeletal muscle tone and deep tendon reflexes during REM sleep?

Answer 8

Increase in Pulse, RR, BP, Temperature, metabolic rate

Decrease in skeletal muscle tone and deep tendon reflexes

Question 9

Describe the order of a sleep cycle.

Answer 9

Wakefulness ⇢ Stage I ⇢ II ⇢ III ⇢ IV ⇢ III ⇢ II ⇢ REM ⇢ II ⇢ III ⇢ IV ⇢ III ⇢ II ⇢ REM

Stage I becomes replaced by REM

Question 10

What is the general pattern of recommended hours of sleep as you age?

Answer 10

It decreases

Question 11

What age is considered middle ages?

What ages are considered old age?

What is the range for the 3 subclasses of old age?

Answer 11

• middle: 40 to 65 years old
• old age: 65+
  
  • Young old: 65-75
  • Middle: 75-85
  • Old old: 85+

Question 12

What visual acuity changes are possibly seen in middle adult?

Answer 12

presbyopia

(A gradual, age-related loss of the eyes’ ability to focus actively on nearby objects.)

Question 13

What auditory acuity diminishes in middle age?

High-pitched or Low-pitched sounds?

Answer 13

High-pitched

(e.g., woman’s voice, bird chirp, child’s squeal)

Question 14

Is cognitive function decreased in middle ages?

Why might it take slightly longer for middle age adults to respond?

Answer 14

No, response times may be longer due to a longer search through more memories and to a desire to think a problem through before responding.

Question 15

What are leading causes of death in middle adult hood?

(3/6)

Answer 15

1. Malignant neoplasms (cancer)
2. Cardiovascular disease
3. Unintentional injury including poisoning, motor vehicle accidents, and falls
4. Diabetes mellitus
5. Chronic lower respiratory disease (e.g., COPD, emphysema, bronchitis, & asthma)
6. Cerebrovascular (blood flow to the brain) causes (e.g., stroke)

Question 16

What are major health problems for middle adults?

Answer 16

1. Rheumatoid arthritis
2. Obesity
3. Alcoholism
4. Depression

Question 17

What changes occur in short and long-term memory for Older Adults?

Answer 17

Mild short-term memory loss is common

(can be remedied by notes, reminders, calendars, etc)

Long-term memory is intact

Question 18

What are the causes of accidental Injuries in Older Adults.

(Name: 3/7)

consider physiological changes

Answer 18

1. Changes in vision and hearing
2. Loss of mass and strength of muscles
3. Slower reflexes and reaction time
4. Decreased sensory ability
5. Combined effects of chronic illness and medications
6. Economic factors
7. Falls are the most common cause of injuries and hospital admission in older adults

Question 19

___ is a series of adverse events triggered by an initial medical or nursing intervention initiating a downward decline.

Answer 19

Cascade iatrogenesis

Question 20

Swallowing difficulty can lead to ___.

Answer 20

aspiration

Question 21

risk of fractures are increased in which gender?

What time in their lives is this further increased?

Answer 21

Females (due to loss of calcium in bones)

Post-menopause

Question 22

What type of loss is described?

“can be recognized by others as well as by the person sustaining the loss”

e.g., loss of a limb, a child, a valued object such as money, and a job.

Answer 22

Actual Loss

Question 23

What type of loss is described?

“is felt by person but intangible to others”

e.g., loss of financial independence, youth, social standing

Answer 23

Perceived loss

Question 24

What type of loss is described?

occurs when a person displays loss and grief behaviors for a loss that has yet to take place

e.g., awaiting passing of a family member

Answer 24

Anticipatory loss

Question 25

What characteristic may be a normal finding with an older adults toenails?

Answer 25

Become thicker and yellowish tint to the nails beds

Question 26

Exposure to the sun over the years can cause a patient’s skin to be more ___.

Answer 26

Pigmented

your skin increases its production of the brown pigment called melanin to protect itself from the damaging effects of the sun.

Question 27

What happens to the bladder capacity of older adults?

Answer 27

↓ capacity = ↑ voiding (urination)

Question 28

What is the most common degenerative neurological illness and cause of cognitive impairment in older adults?

Answer 28

Alzheimer disease

Question 29

Which problem is described commonly seen in patients with dementia?

“an older adult habitually becomes confused, restless, and agitated after dark”

Answer 29

sundowning syndrome

Question 30

What are two types of advance directives?

Answer 30

1. Living will
2. Durable healthcare power of attorney or proxy.

Question 31

What code is this?

Medical order, no CPR in event that heart or breathing stops

sometimes called No Code or Allow Natural Death (AND)

Answer 31

DNR (Do Not Resuscitate)

Question 32

What is being described?

“indicates that the goal of treatment is a comfortable, dignified death and that further life-sustaining measures are no longer indicated.”

Answer 32

Comfort Care Only

Question 33

What is terminal weaning?

Answer 33

Withdrawal from mechanical ventilation

Question 34

What is the difference between active and passive euthanasia?

Answer 34

Active euthanasia is actively inducing death in a patient.

Passive euthanasia is not doing anything (withdrawing medical treatment) to cause death.

Question 35

Placing the body in the correct anatomical position should be done post-mortem for what reason?

Answer 35

Important to begin soon after death to avoid contractures due to rigor mortis.

Question 36

The circadian biological clock is regulated by?

Answer 36

Suprachiasmatic Nucleus (SCN), a group of cells within the hypothalamus

Question 37

Which sleep disorder is often associated with cataplexy?

How long can it last for?

Answer 37

Narcolepsy

seconds to 2 minutes

Question 38

sudden loss of muscle tone while a person is awake leads to weakness and a loss of voluntary muscle control.

Answer 38

Cataplexy

Question 39

Once a persons narcolepsy has ceased due to medications, what would be the next step for the medications?

Answer 39

Continue on, d/c would lead to relapse in narcolepsy

Question 40

Methylphenidate, Modafinil

are you to treat which sleep disorder?

Answer 40

Narcolepsy

Question 41

What vital sign changes do we see during obstructive sleep apnea (OSA)?

What are the long term effects of OSA

Answer 41

• ↑ HR & BP, ↓ SpO2
• Can lead to CV disease (heart is working harder trying to get adequate oxygen)
• Fatigue
• Depression