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Enfermeria > Session I > Flashcards

Session I Flashcards

1
Q

What is Erickson’s cognitive theory of development in the middle adulthood?

A

Generative vs. stagnation. The task is to guide next generation, accept middle age changes, adjust to needs of aging parents, and reevaluate one’s goals.

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2
Q

Levinson’s theory of cognitive development

A

Adult continue an established lifestyle or reorganize one’s life in a period of time

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3
Q

Gould’s theory

A

middle adults accept their life span as having definite boundaries and have special interest in spouse, friends and community

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4
Q

What are some adjustments of middle adulthood?

A

Career change, changes in employment, late maternity, economic security, retirement plans, spouse disenchantment, divorce, widowhood, empty-nest syndrome, generation sandwich,

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5
Q

What are some health problems middle agers face?

A

chronic illnesses, and death mainly from Malignant neoplasms, cardiovascular disease, unintentional injuries such as poisoning, falls, motor vehicle accidents, diabetes mellitus, and cerebrovascular causes. Other problems include rheumatoid arthritis, obesity, alcoholism, and depression.

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6
Q

What factors contribute to the development of illness in the

A

Smoking, alcoholism puts at risk of cancer, chronic respiratory diseases and liver disease.
Obesity can lead to atherosclerosis, high blood pressure, coronary disease , renal failure, and diabetes

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7
Q

What are some traits of the older adult?

A

> 65, females and whites are in greater proportion, increased physical or cognitive limitations, changes in roles related to aging and health status, retirement, widowhood, change in income

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8
Q

What is ageism

A

Is a prejudice against old people

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9
Q

What are some stereotypes and negative effects of ageism on older adults?

A

Being rigid, narrowed minded, unable to learn, unreliable because of memory loss, or incapable to enjoy sexual pleasure. This can contribute to feeling of boredom and uselessness

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10
Q

What are some physiological changes in older adults?

A

Aged cardiac muscles causes fluid retention in both peripheral tissues and lung causing swelling of the legs and making breathing difficult. Older adults also loss their physiologic reserve meaning they develop complications and heal slower when dealing with illness

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11
Q

How older people define health?

A

Like middle age people in how they function such as ability to remain self-reliant, to make do, and to maintain a sense of control and independence over self and environment.

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12
Q

What is Erikson’s theory of psychological development for older adult ?

A

Ego integrity vs. despair. Older adults continue to look forward and reflect and reminiscence. If successfully accomplished his task, he is optimistic and enthusiastic without regrets (ego integrity. However, If unaccomplished, he/she may despair.

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13
Q

What are some problems older people have to adjust to?

A

Pain, sleep disorders, use of devices such as canes to avoid falls, retirement, reduced income, new roles because of sick spouse, social roles to avoid isolation (associated with declining health and mortality), need for living arrangements, increased need of assistance for house chores, errands, and family role reversal with the elder becoming dependent.

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14
Q

What are some common chronic illness in older adult?

A

Hypertension, arthritis, heart disease, cancer, diabetes and sinusitis.

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15
Q

What are the leading causes of death in older adult?

A

heart disease, cancer, and stroke

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16
Q

What are some implications of healthcare in older adults?

A

Meeting continued expensive expenses, polypharmacy and use of herbal medication, special diets/equipment & medical supplies, and family involvement to cope and care for the elder

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17
Q

What are the most common diseases in African American elders?

A

heart disease, lung, prostate, & gastric cancer, and HIV

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18
Q

What the most prevalent disease in Hispanics?

A

Heart disease, stroke, unintentional injuries, and diabetes.

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19
Q

What are the most common diseases in Asian Americans?

A

Tuberculosis, stomach & liver cancer

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20
Q

What is dementia?

A

Organic, chronic disorder that progressively affect cognitive functioning.

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21
Q

What is Alzheimer’s disease?

A

It is a neurological disease that cause cognitive impairment. It affects brain cells and is characterized by patchy areas of the brain that degenerate. Over a period the person becomes confused, forgets family, and disorients in familiar surroundings

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22
Q

What is the sundowning syndrome?

A

A condition in which an older adult with dementia becomes confused, restless and agitated after dark.

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23
Q

What is the cascade iatrogenesis?

A

A medical or nursing intervention that triggers a sequence of adverse events such as when inserting a indwelling catheter causing a UTI

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24
Q

What does the Fulmer acronym SPICES (used to identify common problems that can lead to negative outcomes) stands for?

A

S-sleep disorders, P-problems with eating or feeding, I-Incontinence, C-confusion, E-Evidence of falls, S-skin breakdown

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25
Q

What are some factor that can be mistaken for dementia?

A

Delirium (temporary state of confusion that can resolve with treatment caused by drug interactions, circulatory or metabolic problems, worsening of illness, or nutritional deficiencies) and depression. Older adults can also become confused when too many loses occurs at one time or when moved to a different environment.

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26
Q

Elder maltreatment

A

4-6% elders suffer form abuse or neglect commonly in women older than 80 years old. Poor hygiene, inadequate nutrition, untreated injuries, and lack of assistance with care needs are indicators of neglect.

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27
Q

What is Aphasia?

A

A speech disorder commonly caused by stroke that impedes speech, recall names/words, put words in proper order in a sentence, ability to understand oral directions, to read, to write, and to deal with numbers

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28
Q

What is presbycusis?

A

Hearing loss caused by ageism in which the individual can hear what people say but can’t understand what is being said. It may lead to withdrawal

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29
Q

What is Laryngectomy?

A

Surgical removal of the larynx (voice box) due to cancer

30
Q

Dysarthria

A

Slurred or difficult to understand speech due to the lack of ability to produce speech sounds correctly, maintain , maintain good breath control, and coordinate the movements of the lips, tongue, palate, and larynx. Strokes, accidents, bulbar palsy, multiple sclerosis, parkinsonism may cause dysarthria.

31
Q

How is absorption affected in elderly people?

A

Absorption is not changed but the rate may be slowed because of delayed gastric emptying and reduced splenic blood flow resulting in a delayed response. Increased pH can slow drug formulation because they need high acidity.

32
Q

How is distribution of a drug affected in elder people?

A

Increased fat provides a storage depot for lipid-soluble fast thus reducing their levels e.g. thiopental. Decreased water volume and lean body mass decreases the distribution of water-soluble drug such as ethanol, increasing the concentration and intensity of the response. Malnourished patients may have lower levels of albumin causing levels of free drug and their intensity to rise

33
Q

How is metabolism altered in elders?

A

Because a reduced hepatic blood flow & liver mass, and decrease in enzyme activity, hepatic function declines, thus causing and increase in half-life of drugs prolonging responses.

34
Q

How is excretion affected in elders?

A

It declines because reduction in renal flow, glomerular filtration rate, active tubular secretion, and number of nephrons causing drug accumulation. It is the most common of adverse drug reaction and thus creatinine levels should be clear.

35
Q

What factors underlie adverse drug interactions?

A

Polypharmacy, drug accumulation, severe illness, multiple pathologies, treatment with dangerous drugs, and nonadherence

36
Q

What are some reason for intentional nonadherence?

A

Complex regimens, awkward drug packaging, forgetfulness, side effects, low income, and failure to comprehend instructions.

37
Q

What are some common health issues that affect older adults (85-99)?

A

Decreased nutrition, hydration, & mobility, stress & loss, accidents, drug use & misuse, elder neglect & abuse, and mental/behavioral health problems

38
Q

What are some factors that contribute to poor nutrition and hydration?

A

Diminished sense of taste and smell e.g. ability to taste sweet and salt, increased consumption of fast food, soft-high calorie foods (ice cream), loneliness, tooth loss & poorly fitting dentures, low level of education and not having a female care provider

39
Q

What are some benefits of increased mobility that could help the elder?

A

Increased muscle strength/balance, mobility, sleep, sense of well-being & self-esteem, longevity,, reduced risks for diabetes, coronary artery disease, dementia and falls.

40
Q

What is the relocation stress syndrome?

A

Is a physical (sleep disturbances, GI distress)and emotional distress (withdrawal, anxiety, anger, and depression) that occurs after the person moves from one setting to another.

41
Q

What are some factor that increase stress in the old adult?

A

Illness, financial hardships, relocation. loss of significant others, changes in life style from physical impairment, and rapid environmental changes

42
Q

What is frailty?

A

Is a clinical syndrome in which the older adult has unintentional weight loss, weakens and exhaustion, and slowed physical activity including walking.

43
Q

What are some nursing interventions to help overcome fallophobia (fear of falling) and presbyopia (farsightedness that worsens with age) in older adults?

A

install handrails, grab bars, raised toilet seats, slip-proof pads for rugs, adequate lighting; avoid scatter rugs, slippery floors & clutter, wet & icy steps/walkways. Encourage to look down, have frequent eye examinations to update glasses and use drug therapy or surgery to overcome glaucoma or cataracts. Use visual, hearing or assistive devices (walker, cane) if necessary. Tai chai can help with balance and functional mobility.

44
Q

What is the difference between polymedicine and polypharmacy?

A

Polypharmacy is the unnecessary use of multiple drugs that involve duplicate drug therapy and high dose medication and drugs prescribed for too long a period of time. Polymedicine, is the use of many drugs to treat multiple problems.

45
Q

What is the difference between legally and clinically competent?

A

A legally competent person is 18 year, pregnant, married, or emancipated (free) self-supported who might not be able to make clinical decision but with a guardian. A decisional capacity depends on ability to identify problems, recognize options, make decisions and their rationale.

46
Q

What’s the difference between primary and secondary Depression?

A

Primary depression is cause by the lack of neurotransmitters such as serotonin and norepinephrine whereas secondary depression is caused by illness or loss such as stroke, arthritis, and cardiac disease.

47
Q

What is the difference between dementia and delirium?

A

Dementia is a slowly progressive cognitive decline referred as chronic confusion. Delirium is an acute short-term , and reversible state of confusion

48
Q

What are some factors that may cause delirium and how can a nurse intervene?

A

Drug therapy electrolyte imbalance, infections esp. UTI, pneumonia, surgery, hypoxia, fecal impaction, relocation, major loss, nutritional deficiencies, neurological disorder such as tumors, circulatory, renal, and pulmonary disorders. A nurse can provide a stuffed animal, soothing music, and use a soft voice.

49
Q

What are some signs of neglect and physical abuse?

A

Neglect: pressure ulcers, dehydration, or malnutrition, urine burns, excessive body odors and listlessness.
Abuse: bruise in clusters and regular patterns, burns on buttocks or the soles of the feet, unusual hair loss, multiple injuries or fractures.

50
Q

What are some nurse interventions for sleep, nutrition, and incontinence?

A

Give pain medication and dim lights before bed time, keep patients awake during the day, postpone treatment to early morning or waking hours, keep conversations quiet, place a sign on the door; Coordinate a plan of care with a dietitian speech-language and if no restrictions encourage family to bring food; place the patient on a toileting schedule or a bowel/bladder program.

51
Q

What are some nursing interventions a nurse would use to prevent falls?

A

Call bell, patient care articles, objects within reach, use a walker, cane, clean spills & clutter,, remind to wear hearing aid, glasses, arrange furniture, observe drug side effects, raise handrail, lower beds and lock them

52
Q

What is glaucoma?

A

visual field loss secondary to optic nerve damage that can result in permanent blindness. The most common type is open angle glaucoma (POAG). Black people with elevated IOP, history of POAG and elder are at high risk.

53
Q

What do you use to treat glaucoma?

A

Glaucoma is preferentially treated with topical administration of first line defense such as Beta-blockers (Timolol..), alpha2-adrenergic agonist (Brimonidine-long term), and prostaglandin analogs (Latanoprost). Second line Agents include cholinergic drugs: Pilocarpine, and carbonic anhydrase inhibitors: dorzolimide

54
Q

What are some side effects of beta blockers?

A

Heart block, bradycardia, bronchospasm as well as hypotension

55
Q

What are some side effects of prostaglandin analogs (Latanoprost)?

A

Brown pigmentation in the iris and eyelid

56
Q

What are some side effects of Alpha2–Adrenergic Agonist?

A

Headache, dry mouth, altered taste, conjunctivitis, lid reactions, pruritus

57
Q

What are some side effects of cholinergic drugs?

A

Miosis and blurred vision

58
Q

What are some side effects of carbonic anhydrase inhibitors?

A

Ocular stinging, bitter taste, conjunctivitis, lid reactions.

59
Q

What is myopia?

A

Nearsightedness. Near distance vision is poor because the eye overbends the light and the images converge in front of the retina

60
Q

What is Astigmatism?

A

a refractive error caused by unevenly curved surfaces on or in the eye especially in the cornea distorting vision

61
Q

What is the difference between miosis and mydriasis?

A

Miosis-pupillary constriction. Mydriasis- pupillary dilation

62
Q

What are some structural changes in older people?

A

Decrease eye muscle tone that reduces the ability to keep gaze focused on single object. Ectropion (lower of the lid away from the eye) which causes dry-eye. The cornea flattens causing astigmatism and blurred vision. Inability to dilate of the iris which leads to difficulty in adapting to dark environment. ARCUS SENILIS-an opaque, bluish white ring within the outer edge of the cornea caused by fat deposits; it does not affect vision.

63
Q

What are some functional changes of the eye in elders?

A

Color perception especially green, blue, violet decreases. Near point vision increases and far point vision decreases. v

64
Q

What are some factors that can be used to assess patients for eye and vision problems?

A

AGE- Cataract and glaucoma increases with age. Presbyopia starts at 40. GENDER- retinal detachments are common in in men and dry-eye syndrome in women. OCCUPATION- eyestrain is common in computer programming workers. HEALTH- injuries, surgeries (laser also). DRUGS- Decongestants and antihistamines cause dry eyes and increase intraocular pressure. (IOP), Other dugs may cause pruritus and photophobia.

65
Q

Cataract

A

It is an increased in density in the lens because dried proteins form crystals and fiber compress giving an opaque appearance and causing image distortion (blurred vision, decreased color perception, double vision, & absent red reflex) and difficulty with ADLs. 22 million people has it in USA. It is expected in elder over 70 years, but it can be caused by trauma, exposure to toxic agents, UV, X-rays light, diseases (DM, hypothyroidism, intraocular disease), eye disorders, genetics (down syndrome) and some drugs ( corticosteroids, beta-blockers, miotic drugs)

66
Q

What is phacoemulsification?

A

is the removal of the lens by suction after it has been broken down with high-frequency waves inserting a probe. It gets replaced with a small, clear, plastic lens called the intraocular lens (IOL)

67
Q

What is macular degeneration?

A

Is the deterioration of the macula (are of central vision) and can be age related (AMD) or exudative.

68
Q

Dry AMD

A

is caused by the gradual blockage of retinal capillaries which allows retinal cells in the macula to become ischemic and necrotic. Rod and cone photoreceptors die. Central vision declines causing mild blurring and distortion. Smoking, HTN, female gender, short stature, family history, and a long-term diet poor in carotene and vitamin A. It has no cure but we can slow the progression by increasing intake of antioxidants, vitamin B12, and the carotenoids (lutein & zeaxanthin). Some drugs to be used are Bevacizumab (Avastin) or Ranibizumab (Lucentis)

69
Q

Wet AMD

A

The growth of new blood vessels in the macula, which have thin walls and leak blood and fluid.
Exudative macular degeneration is another type AMD and can occur at any age in one or both eyes.

70
Q

What is a retinal hole?

A

break in retina caused by trauma and aging

Enfermeria (9 decks)

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