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328 Cards in this Set

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IN 2010 ___ percent of the population was over age 65
13%
in 2010 ___ percent of population 65-74 & name of this cohort group
7.1%, Young Old
In 2010___ percent of population 75-84 & name of cohort group
4.1%, Middle Old
In 2010 ___ percent of population age 85-94, and name of cohort group
1.6%, Old Old
In 2010 ___ percent of population was age 95 and older & name of cohort group
0.3%, Very Old
epidemiology
The study of the distribution and determinants of diseases and injuries in human populations.
Geriatrics
From the Greek word "geras" meaning old age; the medical specialty focusing on diagnosing and treating disease of older people.
gerontology
From the Greek word "geron" meaning old man; the study of aging and health problems of older people with a holistic focus including biologic, sociologic, psychologic, spiritual, and economic issues.
homeostasis
This tendency of the body toward maintaining equilibrium.
homeostenosis
Inability of the body to restore homeostasis after even minor environmental challenges such as trauma or infection.
life expectancy
The average number of years from birth that an individual can expect to live.
life span
Biological limit to the length of life. Life span varies by species.
risk factors
Factors whose presence are associated with an increased probability that disease will develop at a later time.
senescence
Progressive deterioration of body systems that can increase the risk of mortality as an individual gets older.
stokes: progessive body system change, occurs over time
Greatest increase in people over 60 will happen in what regions in the world
developing regions
The cohort group that is expected to be the largest consumer of health care in the next three generations is known as
Baby Boomers
women compromise ___ percent of the older population in 2010
57%
In planning for the increased number and needs of the elderly in developed countries, nurses should realize that:


Greater individual wealth means that a longer life is likely.
Women outlive and outnumber men.
Aging can be delayed.
More resources should be allocated to the elderly than other age groups.
Women outlive and outnumber men.
One of the most important aspects of health care for the elderly is:

Focusing on chronic illness and disability.
Ensuring adequate housing.
Maintaining family ties.
Securing adequate income
Focusing on chronic illness and disability.
A program for the elderly that would meet one of the goals of Healthy People 2010 would focus on:

Education for safe driving.
Testing for genetic diseases.
How to get referrals to medical specialists.
Developing greater spirituality
Education for safe driving.
The leading cause of death in the elderly is:
Infectious disease.
Cancer.
Cardiovascular disease.
Complications from falls
Cardiovascular disease
When a person says “the body just falls apart when it gets old” that person is said to be subscribing to which theory of aging?
Biologic theory
Disengagement theory
Developmental theory
Continuity theory
Biological Theory
Psychologic theories of aging are characterized by what kinds of changes?

Intuitive
Functional
Role
Behavioral
Role
Medicare and Medicaid are federally funded programs. The major difference between them is that Medicare:

Only covers hospitalizations.
Is only open to those who meet certain levels of financial need.
Covers only those who have been employed.
Is generally for people 65 and older.
Is generally for people 65 and older
A common theme among all theories of aging is that:
Aging is a passive process.
Aging involves change.
Aging is feared by most people.
Aging applies to people over age 65.
Aging involves change.
Which of the following represents an appropriate generalization about the elderly:

Intellectual decline begins at about age 70.
Social Security proves an adequate level of income for most elderly.
The aging experience is unique to the individual.
Psychological changes are unavoidable.
The aging experience is unique to the individual.
A nurse is planning to conduct a health promotion program for senior citizens living at a local assisted living facility. When planning the program, which of the facts should be incorporated into the session?


Flu vaccines are recommended annually for senior citizens clients.
Flu vaccines should only be taken for immunocompromised older adults.
The use of flu vaccines in senior citizens meets the recommended levels.
Clients who take a flu vaccine will not need to have the pneumococcal vaccine
Flu vaccines are recommended annually for senior citizens clients
A nurse has been hired to plan for the educational needs of the residents in an assisted living community. When considering factors related to disability and chronic illness, which of the following factors may the nurse use to guide their decisions? Select all that apply.

The rates of disability are greater today than in the past.
The majority of senior citizens have at least one chronic health condition.
Weight reduction is needed for more than half of senior citizens.
Programming related to arthritis and respiratory disorders will be useful.
The majority of senior citizens have at least one chronic health condition.

Programming related to arthritis and respiratory disorders will be useful.
A client is at the physician’s office for an annual physical examination. During the examination, the client voices resignation about the inevitable changes in his physical condition as a result of his diabetes. Which of the following responses by the nurse is most appropriate?

“Unfortunately, the changes you are seeing associated with your diabetes are unavoidable.”
“What concerns you most?”
“Diabetes is a permanent health concern experienced by many of your peers.”
“Your own behaviors will have the greatest impact on your condition.”
Your own behaviors will have the greatest impact on your condition.”
A 62-year-old male Hispanic client had been diagnosed with heart disease. The client questions when he “got heart disease.” When planning a response, which of the following should the nurse consider?

Chronic disease may be seen in individuals well before they are diagnosed.
There is no real way to determine when the client “got sick.”
The nurse should question the client about when he became ill.
The nurse should review the client’s family history of heart disease.
The nurse should review the client’s family history of heart disease
The nurse is studying the natural history of arthritis in a group of senior citizens. When considering the impact of the disease which of the following tertiary levels of prevention will be most effective in reducing further impact of the disease?

Jury prevention
Weight reduction
Referrals for examination with a physician who specializes in arthritis conditions
Physical therapy
Physical Therapy
By the year 2050, predictions suggest people aged 65 years and older living in the United States will number approximately how many million?
87 million
Older adults frequently experience a decrease in their...?
ability to react to complex and numerous stimuli.
Women have a longer life expectancy than men, which culture lives the longest?
White females (80.5) years
Black females usually live to what age?
76.1
White males live to?
75.3
Black males live to?
69
Males tend to have at risk behaviors including...
smoking, auto accidents, alcohol, or occupational hazards (gender gap may narrow as women approach alcohol and smoking more often)
Which country has the highest life expectancy?
Japan
Morbidity is defined as...
the presence of disease
prevalence is defined as...
the RATE of presence of disease (how many get the disease)
mortality is..
the rate of death from a specific cause
Many people over 65 have comorbidities which are...
more than one illness
Leading causes of chronicity are... (4)
Hypertension, Heart Disease, Diabetes Mellitus, Respirtory disorders
Acute disease are... (give example)
Fast, short (such as the cold)
3 top killers in america are
Heart Disease, Cancer, and Cerbral Vascular Disease (Stroke {CVA})
Born in 2000/2001 is called what generation
New Silent Generation or Generation Z
1980-2000 cohort group is called
Millenial or Generation Y
1965-1979 cohort group is called
Generation X
1946-1964 cohort group is called
Baby Boomers
Last baby boomers=
1964 now 49 years old
First baby boomers
1964 now 65 years old
1925 cohort group is called
Silent Generation
1900-1924
G.I Generation
Medicare
Everyone gets age 65 and older covers hospitalization and fees
Excercise in the elderly is seen as
manual labor
World War 1
1939-1946
Korean War
1950-1953
Vietnam War
1960-1975
Why might not elders want to discuss Viet nam war?
because they were not honored
Social Security Act
1935: you pay in you get out
Fluoride in water began in what year
1947
Measles epidemic occured in
1957
Polio epedemic occured in
1934-1952
Polio immunizations started in what year
the 1950s
Primary Prevention and give examples of it
is health promotion (education, injury prevention, nutritonal assessment, exercise prescriptions, avoidance of tobacco, moderation of alcohol, limiting exposure or avoiding known carcinogens)
Secondary Prevention (example)
early dianosis and prompt TX: Screening Q's and Health Assessment, Refferal for examination, Disease Cure and aggressive treatment to limit disability and stop disease progression
Tertiary Prevention
restoration and rehabilitation: multidisciplinary rehabilitation, short term placement in rehab facility, appropriate services and aids to increase indepenence- walkers, canes, home health aid
Preventative Services provided that people should have (12)
Welcome to Medicare Physical Assessment Exam, Screening Mammogram once yearly,prostate cancer screening once yearly, Flu shot, Pneumoccoal shot, Hep B shot, Glaucoma test, Diabetes screening, Colorectal cancer screening, Cervical and Vaginal screeming (pap and pelvic exam), cardiovascular screening, bone mass measurement
Goals for healthy people 2020 4
attain high quality, longer lives, free of preventable disease, disability, injury and premature death; acheive health equity, elimate disparaties and improve the health of all groups; create social and physica environments that promote good health for all; promote quality of life, healthy development and healthy behaviors across all life stages
Myth: old means being sick... NO, only ___% are hospitalized
5%
Men or women report increased need for assistance with ADL's
women (men tend to want to do it on their own)
T/F African Americans are more likely to have limitations in ADL's
True
AAmericans with arthritis are more likely to have activity limitations T/F
True
AAmericans are more liekly to have hypertension (how much percent?)
True 60%
AAmerican and Hispanics are more likely to have diabetes T/F
True
Biological theroy fall into two groups of of theories called:
Programmed Theories and Error theories
Programmed theories defined and 3 types
Hypothesize that the bodys genetic code contain instruction for the regulation of cellular reproduction and death. 1)Programmed Longevity 2) Endocrine Theory 3) Immunological Theory
Programmed Theory
Aging is a result of the sequential switching on and off of certain genes, with senescence defined as the point int time when age associated functional deficits are manifested; telomer shortening after every mitosis, and when gone there will be no mitosis of cells
Endocrine Theory
Biological Clocks act through hormones to control the pace of aging.
Immunological Theory
A programmed decline in immune system functions leads to an icnreased vulnerability to infectious disease, aging, and eventual death. Generally accepted that healthy diet, with preventative measures can support immune function in the older person.; "fight off assaults"
Error Theories defined and 5 types
Hypothesize that environmental assaults and the body's constant need to manufacture energy and fuel metabolic activites cause toxic by-products to accumulate.
1) Wear and Tear
2)Cross-Link Theory
3) Free Radical Theory
4) Somatic DNA Damage Theory
5) Emerging Biological Theories
Wear and Tear Theory
cells and oragans have vital parts that wear out oafter year of use; see the human body as a machine
Cross-Link Theory
An accumulation of cross-linked proteins resulting from the binding of glucose (simple sugars) to protein (a process that occurs under the presence of oxygen) causes various problems.; glucose plus protein, become advanced glycation end-products (AGE), AGE are destructive to surrounding cells; diets low in glucose thought to increase longevity
Somatic DNA Damage Theory
Genetic mutations occur and accumulate with increasing age, causing cells to deteriorate and malfunction; error occurs in mitosis, mutant developed, error is perpetuated
Free Radical Theory
Free radicals are by-products of metabolism, increased production with anaerobic metabolism, free radicals destroy surrounding cells, foods high in antioxidants though to decrease free radicals
Foods thought to decrease free-radicals:
Supplements:
Vit C, E, Q10, Niacin, Melatonin
Foods thought to decrease free-radicals:
Veggies
red cabbage, spinach, red beet, brussel sprouts
Foods thought to decrease free-radicals:
Fruits
grapefruit, blackberries, pineapple, watermelons, grapes (particularly red), orange, plum, pomegranate
Foods thought to decrease free-radicals:
Nuts
walnuts, pecans, groundnuts, and hazelnuts
Foods thought to decrease free-radicals:
legumes
soy beans, pinto beans, and broad beans
Foods thought to decrease free-radicals:
dried fruits
dates, prunes, and apricots
Wear and Tear Theory
cells and oragans have vital parts that wear out oafter year of use; see the human body as a machine
Cross-Link Theory
An accumulation of cross-linked proteins resulting from the binding of glucose (simple sugars) to protein (a process that occurs under the presence of oxygen) causes various problems.; glucose plus protein, become advanced glycation end-products (AGE), AGE are destructive to surrounding cells; diets low in glucose thought to increase longevity
Somatic DNA Damage Theory
Genetic mutations occur and accumulate with increasing age, causing cells to deteriorate and malfunction; error occurs in mitosis, mutant developed, error is perpetuated
Free Radical Theory
Free radicals are by-products of metabolism, increased production with anaerobic metabolism, free radicals destroy surrounding cells, foods high in antioxidants though to decrease free radicals
Foods thought to decrease free-radicals:
Supplements:
Vit C, E, Q10, Niacin, Melatonin
Foods thought to decrease free-radicals:
Veggies
red cabbage, spinach, red beet, brussel sprouts
Foods thought to decrease free-radicals:
Fruits
grapefruit, blackberries, pineapple, watermelons, grapes (particularly red), orange, plum, pomegranate
Foods thought to decrease free-radicals:
Nuts
walnuts, pecans, groundnuts, and hazelnuts
Foods thought to decrease free-radicals:
legumes
soy beans, pinto beans, and broad beans
Foods thought to decrease free-radicals:
dried fruits
dates, prunes, and apricots
Plastic changes
modifiable changes that can be slowed
benign and superficial
wrinkles, gray hair (not damaging and you can see)
Psychological Aging theories (2)
Coping or adaptive strategies must occur for a person to age successfully
1)Jung's Theory of Individualism
2) Eriksons Developmental Theory
Jungs Theory
as a person ages the shift focus is away from the external world toward the inner experience. older person must accept past accomplishments and failures
Eriksons Theory
Theorized predetermined order of developmental and specific tasks associated with specific periods in one's life course
Eriksons Theory: Middle Age Adult
Generativity vs Stagnation: seeks satisfaction with productivity in career, family, and civic interests
Eriksons Theory: Older Adult
Integrity vs. Despair: reviwes life accomplisments, deals with loss and preparation for death
Normal changes:
Heart:
muscle thickens with age, pumping rate diminish
Normal changes:
Arteries:
tend to stiffen, heart has to beat harder to get blood through inelastic arteries
Normal changes:
Lungs:
max breathing capacity declines about 40% between ages 40-70
Normal changes:
Brain
loses some of the axons and neurons that connect with each other
Normal changes:
Kidneys
gradually become less efficient
Normal changes: Bladder
capacity declines
Normal changes: body fat
typically increases until middle age then stabilizes until late life when it begins to decline. redistributed to abdomen rather than hips.
Normal changes: muscles
muscle mass declines 22% for women an 23% for men bt 30-70, exercise can slow this
Normal Changes: Bones
bone mineral is lost and replaced throughout life but loss outpaces replacement for women at about age 35 and is accelerated by menopause
Normal Changes: sight
difficulty focusing, sensitivity to glare, greater difficulty in seeing at low levels of light and detecting moving object
normal changes: hearing
mroe difficult to hear higher frequencies declines more quickly in men
normal changes: personality
STABLE
When an elderly male client states he has pain, the nurse recognizes that:

The client probably has significant pain because many elderly clients understate and underreport pain.
Pain is probably being exaggerated because many lonely elderly clients use pain to get more attention from their families.
The loss of pain receptors that occur with aging means that the elderly have diminished capacity to experience pain.
Pain is the most frequent reason the elderly visit a healthcare provider
The client probably has significant pain because many elderly clients understate and underreport pain.
When the family of an elderly resident at the nursing home wants to file a complaint about the improper use of restraints, the nurse should suggest that they:


Call the day shift nursing supervisor.
Contact the attorney retained by the nursing home administrator.
Call the ombudsman assigned to the nursing home.
Contact the resident’s physician to verify the reasons for the use of restraints.
Call the ombudsman assigned to the nursing home.
The nurse who understands the Patient Self-Determination Act of 1990 recognizes:

Physicians and healthcare providers for the elderly must undergo annual peer reviews.
Case management for the elderly must begin within 24 hours of a hospital admission.
Medicare coverage is extended for those elderly who suffer from catastrophic conditions.
Elderly clients who are competent have the right to make informed decisions regarding health care.
Elderly clients who are competent have the right to make informed decisions regarding health care
Which of the following will the nurse want to include when planning a functional assessment of an elderly client

A social worker
Light refreshments
Forms for a durable power of attorney for health care
A chaplain
A social worker
When a nursing home uses the Minimum Data Set (MDS), the nurse is assured that:

Residents receive high quality care.
The nursing home is meeting federal regulations.
Regular dental care is being provided.
A clinical nurse specialist is available at regularly scheduled intervals
The nursing home is meeting federal regulations.
The primary purpose for documenting an adverse event, such as a fall, is to:

Record unusual occurrences.
Prevent litigation.
Improve the quality of care.
Identify the need for disciplinary action.
Improve the quality of care.
Which of the following nursing actions will help maintain safety for the elderly? Select all that apply

Encourage independence
Provide for regular ambulation
Orient to new surroundings
Ensure adequate hydratio
Provide for regular ambulation

Orient to new surroundings

Ensure adequate hydration
The nurse observes the following actions and recognizes that a breech of confidentiality is evident when a colleague:

Reports a client’s change of condition to the oncoming team when completing a change-of-shift report.
Throws unofficial lab results into the regular trash.
Faxes a client summary with a coversheet to a nursing home.
Uses the phone to confer with a physician’s nurse about a client’s change of condition.
throw unofficial lab results in the trash
When obtaining a social history from an elderly client, the nurse will ask about:

Living arrangements and family dynamics.
Problems with memory, judgment, and thought.
Acute and chronic medical problems.
Problems with hearing, vision, and speech.
Living arrangements and family dynamics
The family of an elderly client diagnosed with Alzheimer’s disease has requested a conference with members of the healthcare team to discuss the plan of care. A review of the nursing assessment reveals the client is in stable condition with minimal health problems. The family is concerned about the financial responsibility related to the hospital stay. The chief concern appears to be related to living arrangements after discharge. Which of the following members of the healthcare team should act as the leader of the team during the conference?

The physician
The social worker
The nurse
The pharmacist
the social worker
The gerontological nurse is preparing to perform an admission assessment on a new resident of the nursing home. Prior to beginning the task, which of the following factors should the nurse take into consideration? Select all that apply.

Educational level
Reading level
Ethnic background
Cultural beliefs
Educational level

Reading level

Ethnic background

Cultural beliefs
The nurse is caring for a 80-year-old African-American male who is admitted to the hospital for management of hypertension and diabetes. As the nurse is administering the morning medications, the client states he is concerned about his medications. He states, “My people might not react to this medication as well as other races.” Which of the following principles should guide the nurse’s actions in this matter:

Different races may react to medications differently.
The client’s physician has ordered this medication so that ensures this potential factor has been taken into consideration.
Medications will impact the races in the same manner.
The client is older and may be confused
Different races may react to medications differently
comprehensive geriatric evaluation
An interdisciplinary approach to assessment of the older person using a biopsychosocial functional model that systematically collects data from a multidimensional, complex base and focuses the plan of care on issues of greatest concern to patients and families.
functional assessment
A comprehensive evaluation of physical and cognitive abilities required to maintain independence; includes objective measures of physical health, activities of daily living (ADLs), instrumental activities of daily living (IADLs), and psychological and social function.
interdisciplinary education
An educational process that encourages the integration of different perspectives on a defined subject. The goal is to expose students to a shared knowledge base so they gain a basic understanding of core concepts, principles, and contributions of a variety of disciplines.
interdisciplinary teams
A group of people from different disciplines who assess and plan care in a collaborative manner. A common goal is established and each discipline works to achieve that goal.
key members of interdisciplinary teams
gerontological nurse, social worker, geriatric physician, consultations etc
health history
instructions prior to data collection (bring in meds, dates of hospitalizations, procedures etc), emphasis on past history (falls, fractures, acute and chornic med problems), disease prevention (vaccinations, cancer screening)
health history sections
evaluation of environment, accuracy of health history, social history, psychological history, home enivironment, culture and education
emphasis in health history includes...
social supports, finances, driving status, family input (perception of memory), ROS (dentition, taste, smell, nutrition, hearing, vision, bowel/bladder function, perception of memory)
potential problems that can occur with health history
communication difficulties, underreporting of symptoms, vague or nonspecific complaints, multiple complaints, lack of time (min 1hr)
social history key elements
occupational history, family history, present and former marital status
Social history include quality of relationships
identification of family members, living arragements, family dynamics, family and caregiver expectations, economic status, adequacy of health insurance, social activities and hobbies, mode of transportation, community involvement and support
Psychological History include
history of past mental illness or related tx, current and past stress and coping mechanisms, current and past alcohol and drug abuse, meds taken for anxiety, insomnia, or depression, impaired memory, judgement, or thought processing, personality changes, feelings of hopelessness or suicidal ideation, feelings of appropriate emotions related to present life and health situation
Geriatric Depression Scale (GDS)
A score of greater than 5 responses in bold is suggestive of depression
The Mini-Cog
Consists of three item recalls and a clock drawing test (CDT)
One point for each recalled word after the CDT.
1) state three words
2) draw clock with circle already drawn. then the lines to a specific time.
3) then state 3 words again
If no items remembered they are demented. If 1-2 words recalled is based on CDT, if abnormal clock, CDT abnormal, and if normal clock CDT normal. If 3 items recalled non-demented
Home Environment considerations
Stairs, bathing and toileting, meds, predetermined wishes, nutrition and cooking, falls, smoke detectors, emergency numbers, temp of home, temp of water (hot below 120), safety in neighborhood, financial
Culturally Sensitive Assessments: Consider
educational levels, language barriers, reading levels, cultural backgrounds, use of instruments (potential for cultural biases, use caution drawing conclusions), use cultural nonbias instruments
Minimum Data Set (MDS)
required for all residents in facilities receiving medicaid or Medicare funds.
The Omnibus Budget Reconciliation Act of 1987
mantes that all resident of facilities that colloect fund from medicare or medicaid be assessed using the MDS
MDS consists of screening clinical, and functional measures. 3 things are used with it....
RAPS, RUGS, RAI
RAPS
Resident Assessment Protocols: problem oriented guidelines, elicits triggering information
RAP triggers
Delirium, Cognitive loss/dementia, visual function, communication, ADL function loss, Urinary incontinence (use of indwelling catheter), psychosocial well-being, mood state, behavioral symptoms, activities, falls, nutritional status, feeding tubes, dehydration/fluid maintenance, oral/dental care, pressure ulcers, psychotropic drug use, physical restraints
RUGS
Resident Utilization Guidelines: determine the reimbursement the facility will recieve
RAI
Resident Assessment Instrument: identifies medical problems and describes each older person's functional ability in a comprehensive standardized format.
HIPPA
Health Insurance Portability and Accountability Act (1996): protects patient health information, and Health care providers are required to comply with privacy rules
Confidentiality
only the right people can see protected information
integrity
the information is supposed to be without alteration or destruction
availability
the right people can see it when needed
Information considered confidential
identifying, past present future illness, documentation regarding healthcare, payment info
PSA
Patient Self Determination Act: informed consent for healthcare and research protocols. Assessment to ensure capacity for consent-decisional capacity is an ongoing process (exam and experimental procedures)
Living Will
Legal Document, makes wishes regarding life prolonging medical txs, also called advance directive, health care directive, or physicians directive
Healthcare Proxy
legal document which designates a person to makes health care decisions
Surrogate decision makers
someone with legal ability to make decisions, durable power of attorney
restorative care
is to help individuals regain maximal functional status and to enhance quality of life through promotion of independence and self-care: Home care, rehab, extended care facilities
home-care
the provision of medically related professional and paraprofessional services and equipment to clients and families in their homes for health maintenance, education, illness prevention, diagnosis, and tx of disease, palliation, and rehabilitation. health promotion and education are traditionally the primary objectives of home care.
home care services
wound care, respiratory care, vitals, elimination, nutrition, rehabilitation, meds, intravenous therapy, laboratory studies
Rehabilitation
restores a person to the fullest physical, mental, social, vocational, and economic potential possible. Learn to function with limitations of their disease.
rehabilitation services
include physical, occupational, and speech therapy, and social services
extended care facilities
provides intermediate medical, nursing or custodial care for clients recovering from acute illness or client with chronic illnesses or disabilities
Skilled nursing facility
offers skilled care from a licensed nursing staff.
Continuing Facilities
variety of health, personal, and social services for disabled who were never functionally independent or suffer a terminal disease: nursing centers/facilities, assisted living, respite care, adult day care, hospice
nursing facilities/centers
5% of 65 yrs and older live here, provides 24 hr intermediate and custodial care.
assisted living
attractive long-term care setting with a homier environment and greater resident autonomy, nurses services not directly available
respite care
service that provides short-term relief or time off for persons providing home care to an ill, disabled, or fragile older adult
adult day care
avoid delay admission to nursing center, variety of health services, 5 days a week usually
hospice
system of family centered care that allows clients to live and remain at home with comfort, independence, and dignity while easing the pains of terminal illness
women expected to live ____ mores years after age 65, compared to men with ___
19.4, 16.4
most frequently occurring chronic conditions were....
hyp, arthritis, heart disease, cancer, and diabetes
ageism
discrimination against people because of increasing age
special learning/teaching strategies
sit facing, speak slow, varify readiness to learn, tone of voice low, one idea at a time, emphasize concrete rather than abstract material, use audio visual tactile cues, environmental distractions to a minimum
reality orientation
is a communication technique that makes an older adult more aware of time, place, and person
validation therapy
is an alternative approach to communication with a confused older. it accepts the time and place as stated by the confused older adult
reminiscence
is recalling the past
IADL
telephone, shopping, doing laundry, cleaning the home or apartment, and driving and automobile, preparing meals
alcohol abuse
Use of alcoholic beverages to excess despite problems resulting from continued use
alcohol dependence
Craving or reliance on alcohol despite problems resulting from continued use.
anxiety
a stage of apprehension, uneasiness, distress
cognitive function
The ability to think, reason, remember, and communicate
competence
A legal determination of the match between an individual's cognitive abilities and environmental demands.
coping mechanisms
Methods used by individuals to adjust or accept to a threat or challenge
dysthymia
Chronic feelings of sadness and lack of enjoyment in life.
flat effect
Lack of facial expression or emotional response
hallucination
Sensory perceptions that occur without the appropriate stimulation of the corresponding sensory organ, such as seeing people who are not present
personality
A set of personal characteristics, attitudes, and beliefs that influence how an older person interacts with the world
pseudodementia
A state of cognitive impairment caused by depression or another condition when evidence of an organic disorder is lacking
seasonal affective disorder
A depression that occurs in the fall and spring months in older persons who have normal mental health during the rest of the year
stress
An internal or external event that creates a nonspecific response in the older person
What is the greatest threat to the mental well being of the elderly?

Anxiety
Depression
Alcoholism
Pain
depression
The primary goal of treatment of depression in the elderly is:

Prompt prescription of appropriate antidepressants.
Improving their quality of life.
Helping them cope with life stressors.
Improving their affect.
improving their quality of life
Which of the following interventions might the nurse use to prevent loneliness in a newly admitted resident of a nursing home?

Provide group learning activities.
Allow residents to wander the halls to get acquainted.
Provide one-to-one contact with the resident.
Share a daily listing of activities and invite the resident to participate.
provide one to one contact with the resident
Which of the following might cause the nurse to suspect elder abuse when making a home visit?

The temperature in the house is 78 degrees.
There is only peanut butter and jelly in the refrigerator.
There is a bruise on the client’s right leg that she says she got from bumping into a table.
The client is wrapped in a large wool shawl
their is only peanut butter and jelly in the refridgerator
When the nurse suspects that a medication an elderly client is taking is causing signs of depression, the nurse should:

Discuss the reasons for the depression with the client’s family.
Suggest that the client stop the medication to see if symptoms subside.
Consult with the physician about a possible change in medication.
Ask the client for suggestions about activities that would lift the depression.
consult with a physician about a possible change in the medication
One of the most common reasons that depression is misunderstood in the elderly is the belief that:

The elderly have come to terms with the inevitability of their death.
The elderly have relatively stable mental health due to their maturity.
The elderly have less need for companionship as they age.
Depression is to be expected as part of aging and declining health
The elderly have relatively stable mental health due to their maturity.
When providing care for an elderly alcoholic client the nurse recognizes that:

Elderly males are the group most likely to respond to treatment.
Physicians are more likely to detect this problem than any other group of healthcare providers.
Treatment programs are significantly less successful with the elderly.
Alcoholism often arises as a coping mechanism to deal with loss, depression, or anxiety
Alcoholism often arises as a coping mechanism to deal with loss, depression, or anxiety
The elderly spouse who provides home care for a loved one with accelerating Alzheimer’s disease has begun to say that the stress is getting overwhelming and it may be hard to “keep going.” What intervention might the nurse suggest to deal with this problem?

Initiate contact with an area long-term-care facility to place the Alzheimer’s client.
A low dose sleeping preparation may help the spouse to feel more rested.
A support group may help with coping strategies and to relieve some tension.
Keep a journal to record thoughts and feelings to help sort them out later.
A support group may help with coping strategies and to relieve some tension
The most commonly used classification of medications used to treat depression in the elderly is:

Monoamine oxidase inhibitors (MAOIs).
Tricyclic antidepressants.
Selective serotonin reuptake inhibitors (SSRIs).
Thiazides.
Selective serotonin reuptake inhibitors (SSRIs)
When an elderly resident of a nursing home is flat of affect, the nurse is likely to observe:

Erratic behavior.
Dull eyes and no smile.
Slurred speech and many gestures.
Decreased appetite.
Dull eyes and no smile
A nurse working in a mental health facility is conducting an educational program to discuss psychological health of the elderly. When the nurse mentions the large percentage of the elderly population who have mental health issues a participant questions the statement reporting that she does not see a large elder population at the facility. What factors can best explain this phenomenon? Select all that apply.

The mental health problems of the elderly rarely need inpatient services.
The elderly do not benefit as much as younger individuals from inpatient services.
The elderly are at an increased risk for misdiagnosis of mental health problems.
There is suspected under reporting and treatment of mental health problems in the elderly
The elderly are at an increased risk for misdiagnosis of mental health problems.

There is suspected under reporting and treatment of mental health problems in the elderly
The nurse is reviewing a grouping of clients admitted with depression whose cases will be reviewed during the staffing conference. When considering the potential outcomes, which of the following clients will likely have a more positive health outcome?

A 66-year-old African-American male with a high school education
A 67-year-old retired Caucasian physician
A 66-year-old Hispanic immigrant with a trade school education
A 68-year-old African-American female with a 10th grade education
A 67-year-old retired Caucasian physician
A resident at the assisted living facility reports fear of experiencing cognitive impairments. When questioned, he reports he has not noticed changes yet but is still concerned. What information can the nurse provide to the individual?

Significant memory impairment is an anticipated occurrence of aging.
Difficulty remembering names may result with aging.
There is little that can be done to reduce the occurrence of the cognitive changes associated with aging.
Memory tools are not successful to use to compensate for the mental changes such as forgetting things.
Difficulty remembering names may result with aging
The nurse has performed an assessment of the cognitive function of a recently admitted long-term-care facility resident. The nurse notes some changes. Which of the following factors may be implicated as potential causes for the changes? Select all that apply.

Recent medication changes
Exacerbation of multiple sclerosis
The addition of a roommate for the resident
The recent death of a close friend
Recent medication changes

Exacerbation of multiple sclerosis
When an elderly person agrees with a physician that a do not resuscitate (DNR) order is appropriate, that person is said to be:

Lacking decisional capacity.
In need of a living will.
Giving assent.
Competent.
competent
The cohort that is expected to be the largest consumers of health care in the next three decades is known as the:

War generation.
Generation X.
Sandwich generation.
Baby boomers.
Baby Boomers
agnosia
Inability to recognize familiar objects.
Alzheimer's Disease (AD)
A type of dementia of unknown cause with symptoms that show a gradual onset and relentless progression. AD involves a sufficient loss of intellectual ability to interfere with social or occupational functioning, memory loss, possible personality change, and impairments in abstract thinking, judgment, spatial orientation, and/or language. Histopathology reveals characteristic senile plaques and neurofibrillary tangles
anhedonia
Loss of pleasure from activities that were once enjoyable
anomia
A severe problem with word finding and/or retrieval
apraxia
Inability to initiate purposeful motor functions and/or use objects properly in the absence of known physical problems.
chorea
Involuntary twitching of the limbs or facial muscles
Delirium
Potentially reversible acute onset confusional state.
Delusions
A fixed or false belief that is firmly held despite convincing evidence to the contrary.
Dementia
Acquired, progressive state of long duration (months to years) of decreased mental ability that impairs daily activities in a previously alert individual
dementia with Lewy Bodies (DLB)
Also called diffuse Lewy body disease; a type of dementia characterized by a fluctuating course of cognitive impairment that includes episodic confusion and lucid intervals similar to delirium and (1) visual and/or auditory hallucinations resulting in paranoid delusions, (2) mild extrapyramidal symptoms or adverse extrapyramidal response to standard doses of neuroleptics, or (3) repeated, unexplained falls; histopathology reveals presence of Lewy bodies.
dystonia
Involuntary muscle contractions that force certain parts of the body into abnormal and sometimes painful movements or positions
epilepsy
A chronic condition produced by temporary changes in the electrical function of the brain causing reoccurring and unprovoked seizures that affect awareness, movement, or sensation.
executive function
Ability to plan and think abstractly; loss of executive function is detected when persons with dementia interpret proverbs literally versus their abstract meaning
frontotemporal dementia
A type of dementia characterized by a symptoms of altered personality similar to changes induced by damage of frontal lobes by other causes (injury, stroke); include behavioral disinhibition, loss of social or personal awareness, or disengagement with apathy
multiple sclerosis (MS)
A chronic disabling disease that affects the central nervous system causing numbness, weakness, paralysis, or loss of vision.
Parkinson's Diease (PD)
A chronic, progressive neurological disorder in which a syndrome consisting of variable combinations of tremor, rigidity, and extreme slowness in movement occur without evidence of more widespread neurological involvement.
parkinsonism
A neurological syndrome characterized by tremor, rigidity, and instability when walking.
Picks Disease
A type of dementia that is a subtype of a frontotemporal dementia and characterized by Pick bodies inside nerve cells and ballooned nerve cells.
spatial disorientation
Misperception of immediate surroundings such as the inability to distinguish a two-dimensional object from a three-dimensional object or not knowing where one is in relation to the environment; leads to getting lost.
vascular dementia
A type of dementia caused by multiple small and/or large brain infarcts or a small strategically placed stroke and is characterized by an abrupt onset, focal neurological findings, low-density areas, and/or presence of multiple strokes in CT or MRI scans.
Which of the following statements accurately describes Alzheimer’s disease (AD)?

Alzheimer’s disease is a form of dementia, with reversible manifestations of memory loss and altered cognition.
Alzheimer’s disease is a form of dementia that begins with memory loss, which is immediately noticeable.
Alzheimer’s disease results from complex interactions between genetic and environmental factors.
Alzheimer’s disease is a rapid progressive degenerative neurologic disease, which causes brain degeneration without inflammation.
Alzheimer’s disease results from complex interactions between genetic and environmental factors.
The gerontology nurse practitioner should rule out (R/O) which symptom before the diagnosis of dementia is made?

History of seizures
History of head injury
History of schizophrenia
History of delirium
History of delirium
The definitive medical diagnosis of Alzheimer’s disease (AD) is confirmed by:

Histopathological findings.
History and physical examination.
Neuropsychological testing.
Combing estimates of genetic and environmental risk factors.
Histopathological findings
Which of the following statements is accurate pertaining to frontotemporal dementia? Frontotemporal dementia:

Includes Lewy bodies, and is diagnosed on the basis of personality changes.
Is an abrupt onset dementia with abnormal reflexes and emotional instability.
Includes Pick’s disease, and is diagnosed on the basis of personality changes and the presence of frontal brain atrophy.
Includes both Lewy and Pick’s bodies inside nerve cells, and behavioral disinhibition.
Includes Pick’s disease, and is diagnosed on the basis of personality changes and the presence of frontal brain atrophy.
Which drug received approval from the Food and Drug Administration (FDA) in 2003 for use in persons with moderate to severe dementia?

Donepezil hcl (Aricept)
Rivastigmine tartrate (Exelon)
Galantamine (Reminyl)
Memantine (Namenda)
Memantine (Namenda)
Parkinson’s disease (PD) is referred to as an extrapyramidal syndrome because it manifests which of the following clinical symptoms?

Tremor, bradykinesia
Diarrhea, sweating
Constipation, hypotension
Somnolence and poor gait
Tremor, bradykinesia
Which of the following drugs would the nurse anticipate being ordered for an elderly client with Parkinson’s disease (PD)?

Carbidopa/Levodopa (Sinemet)
Memantine (Namenda)
Clopidogrel (Plavix)
Lioresal (Baclofen)
Carbidopa/Levodopa (Sinemet)
Nurses who administer Sinemet as prescribed for the elderly should incorporate timing of the administration of Sinemet into the client’s care plan and:

Give Sinemet 30 minutes after meals.
Give Sinemet 30 minutes before meals.
Give Sinemet 1 hour before meals.
Give Sinemet with meals, followed by a glass of water.
Give Sinemet 1 hour before meals
The pathology of a stroke typically is not caused by which of the following?

Hemorrhage into the brain
An embolus or thrombus that occludes an artery
Rupture of an extracerebral artery causing subarachnoid hemorrhage
Damage to the cerebrum and myelin sheath
Damage to the cerebrum and myelin sheath
A 70-year-old female presented to the emergency room with slurred speech and weakness of left upper and lower extremities, which started 30 minutes ago. Stat CT scan reveals evidence of acute ischemic stroke. Barring contraindication, which of the following treatment modalities should be considered?

Packed Red Blood Cells (PRBC) followed by furosemide (Lasix)
25% albumin followed by 0.9% sodium chloride
Recombinant tissue plasminogen activator (rt-PA)
Heparin infusion alternating with Coumadin (Warfarin)
Recombinant tissue plasminogen activator (rt-PA)
During assessment of an elderly client with history of seizure disorder the nurse would include specific questions regarding which of the following? Select all that apply.

Age of seizure onset
Frequency and types of attacks
Anti-seizure medication name, dosage, and frequency
Client’s height
Age of seizure onset
Frequency and types of attacks
Anti-seizure medication name, dosage, and frequency
Which of the following would the nurse implement first if a client is found having a tonic-clonic seizure?

Open the airway using the head-tilt-chin lift method.
Provide oxygen immediately.
Protect the client from injury.
Place the client on his or her back
Protect the client from injury.
The nurse observes an elderly client exhibit stiffening of the muscles and loss of consciousness followed by a period of rhythmic jerking of the extremities. How should the nurse properly record this on the chart?

Client appears to have had a myoclonic seizure.
Client appears to have had an absence seizure.
Client appears to have experienced an atonic seizure.
Client appears to have had a tonic-clonic seizure
Client appears to have had a tonic-clonic seizure.
When planning client and family education regarding seizures, the nurse should include which of the following? Select all that apply.

Providing client and family with audiovisual aids for ongoing review.
Teaching how to identify and avoid precipitating factors for seizures.
Stressing the need to take medication as prescribed.
Instructing family member to place a spoon in the client’s mouth during a seizure.
Providing client and family with audiovisual aids for ongoing review.

Teaching how to identify and avoid precipitating factors for seizures.

Stressing the need to take medication as prescribed.
After a fall an elderly client sustains a brain injury involving the frontal lobe. For which of the following deficits should the nurse assess the client?

Inability to recognize the taste of coffee
Inability to perform a simple math problem
Inability to recall a two-digit number told to the client 5 minutes ago
Inability to recognize a common eating utensil
Inability to perform a simple math problem
A 75-year-old female is diagnosed with early Alzheimer’s disease (AD). Which of the following should the nurse incorporate in her plan of care for the client? Select all that apply.

Discussions with the client about desired treatment modalities
Providing information on available community services
Need to consider selection of a healthcare proxy
Need for inevitable placement in a nursing home
Discussions with the client about desired treatment modalities

Providing information on available community services

Need to consider selection of a healthcare proxy
The nurse implements which of the following strategies to assist the client with Alzheimer’s disease (AD) to participate in dressing?

Encourages the client to tie sneakers
Hands the client a jogging suit to wear
Encourages the client to select and remove clothes from the closet
Provides no verbal cues
Hands the client a jogging suit to wear
A client with Alzheimer’s disease (AD) frequently wanders during the night due to insomnia. Which of the following strategies may assist with modification?

Scheduled daytime naps
A cup of hot tea prior to bedtime
Comfortable bedding and a quiet environment
Brief exercise activity prior to bedtime
Comfortable bedding and a quiet environment
An elderly client recently diagnosed with atrial fibrillation presents to the emergency room with an embolic stroke. The client is started on a continuous heparin drip and oral warfarin (Coumadin) therapy. When should the nurse suggest to the physician that the continuous heparin drip be discontinued?

When the stroke symptoms resolve
When the INR is 2.5
When the PTT is within normal limits
When the PTT is within therapeutic range
When the INR is 2.5
The nurse determines that which one of the following statements is accurate?

Incidence of epilepsy decreases with advanced age.
Epilepsy is two or more unprovoked seizures.
People under 65 are twice as likely to develop new-onset epilepsy when compared to adult age groups over 75.
Antiepileptic medications act the same regardless of age category.
Epilepsy is two or more unprovoked seizures.
Frontal lobe functions
Broca's (language) area, motor function, judgement, problem solving, impulse control, reasoning, memory, and executive function.
temporal lobes
are responsible for language (wernickes area), memory, hearing, perception, and recognition.
occipital lobes
visual info
parietal lobes
integrate sensory information such as taste, pain, and temp
neurotransmitters influence
influence memory and cognition, mood and motor function, also control hypothalamic-pituitary-adrenal axis which integrates endocrine, immune and nervous system.
peripheral nervous system consists of 4 parts
cranial nerves, spinal nerves, somatic and autonomic nervous system, and reflex arc
somatic system is the link between...
the brain and the spinal cord to the muscles and sensory receptors. responsible for movement and receiving messages
autonomic nervous system
maintains homeostasis within the body and is divided into the parasympathetic and sympathetic nervous system
central nervous system includes 6 parts...
cerebral cortex, basal ganglia, diencephalon, cerebellum, and spinal cord.
changes in CNS:
brain
decreases in size and weight
changes in CNS:
neurons
decreased number of neurons/neuronal death with accumulation of senile plaques and neurofibrillary triangles
changes in CNS:
vessels
my be affected by atherosclerosis, vulnerable to clots or rupture resulting in strokes.
changes in CNS:
neurotransmitters
level decreases and chemical receptors decline in number
changes in CNS:
endocrine
mean increase in glucocorticoids, puts body in chronic stress condition
changes in PNS:
cells
in spinal cord decline and narrowing of interior vertebral bodies put pressure on spinal cord
changes in PNS:
feet
bilateral loss of vibratory sense in the feet, not advanced to knewws
PNS changes: achilles
reflex may be absent, but quad reflex should be intact
PNS changes: autonomic system
slow response to drop in bp, thermoregulation affected
PNS changes: neurological conditions
memory, movement, seizure disorders, and stroke.
conditions of CNS
cognitive ability: consciousness, appearance and behavior, speech and language, mood (depression or anxiety) and affect, perception and thought content, and insight and judgement
Depression, specific clue to it and scale used
apathy and GDS, may be as high as 50% in population and meet DSM IV criteria= 10-20%
Delirium definition and scale used
acute disorder of cognition that affects functional independence. may be reversible . Confusion Assessment Method (CAM)
delirium occurs in ___- ___% of older adults
14-80%
Etiology of delirium
acute illness, infection, metabolic disturbances, alcohol or drug abuse, sensory impairments, surgery, hip fracture
DSM IV classification of delirum
disturbance with decreased ability to focus, sustain or shift attention
changes in cognition and perception
changes throughout the day
Assessment of delirium
MMSE, CAM, NEECHAM confusion scale
consequences of delirium
high morbidity and mortality, decline in ADL/IADL, increase length of hospitalization, increase in readmissions, increased outpatient services, increased institutionalization
Delirium manifestations
confusion, sleep-wake disturbance, altered psychomotor behavior, disruptive vocalization, disorientation to time, place, person, hallucinations or delusions, subtypes (hyperactive, hypoactive, mixed)
Delirium interventions
preventions: quiet environment, exercise, visual, hearing, assure hydration
care: safety and stabilization.
Dementia
syndrome whose signs and symptoms may be the results of several acquired progressive, life-limiting disorder that erase memory and the person's usual way of being in the world- with no uniform course and no predictability
DSM IV- Dementia must include a decline in memory and in at least one of the following cognitive abilities
Ability to generate coherent speech and understand spoken/written language; ability to recognize or identify objects; ability to execute motor activities; ability to think abstractly, make sound judgements and carry out complex tasks- severe enough to interfere with daily life.
the greatest risk factor for developing dementia is:
older age
types of dementia
Alzheimers disease (DAT)
Vascular Dementia
Lewy Body Dementia
Frontotemporal Dementia
incidence of DAT is ___% of individuals over 85 years
42%
Neuropathological criteria includes presence of 2 things
(with also one more thing...)
neuritic plaques
neurofibrillary triangles- start to get smaller and tighter in the brain
decreased acetylcholine in brain (a neurotransmitter)
brain shows with DAT
cortical atrophy, and decrease in size and weight (less cortical activity)
DSM DAT
1. Impaired short/long term memory
2. At least one of the following
a.aphasia
b.apraxia
c. agnosia
d. disturbance in executive functions (planning, organizing, sequencing, abstract reasoning)IADL's
aphasia (2 types)
Motor- inability to speak
receptive- receive sensory input (decreased ability to understand the spoken word)
Apraxia
inappropriate/uncoordinated movement
agnosia
inability to recognize objects (sterognosis)
stage one DAT
Mild
onset: 1-3 yr, progressive, insidious, and subtle
(people around might notice/blaming bc they don't realize)
stage 2 DAT
progression to confusion much of the time
onset: 2-10 yrs
stage 3 DAT
extrapyramidal manifestations (beginning)
Apraxia: abnormal mvt
Repetitive Motions
Echolalia: repeating stories
Stage 4 DAT
Advanced stage-terminal stage
can lose up to 50% of brain here
can become vegetative
death from something else
Decorticate Positioning-indicates lesion near cerebral hemispheres: upper arms adducted to sides, elbows fingers wrist flexed, internal rotation of legs, feet plantar flexed. (sometimes people don't reach this)
Developmentally disabled elders have an increase of
DAT (down syndrome)
Nursing interventions that are preventative=
reading, less TV, elderhostel, book clubs, library, volunteer activities, religious activities
Gingko Biloba
OTC to improve memory, improve blood flow to brain
Vit E
antioxidant theorized to help delay the development of AD
Parkinsons Disease (PD)
chronic, progressive, neurological disorder in which idiopathic parkinsonism appears without other widespread neurological symptoms, such as cognitive impairment. Considered an extrapyramidal syndrome
pathology of PD
loss of dopaminergic cells situated deep in the brain in the substantia nigra
Levodopa
med for PD which is the metabolic precursor of dopamine provides symptomatic relief of symptoms (particularly bradykinesia)
Sinemet
to maximize absorpotion and facilitate movement across the blood brain barrier, should be taken on an empty stomach (for PD)
PD at rest
non intentional tremor
flexor and extensor are both contracted
may get better with purposeful movement
rhythmic tremor- pill rolling (hands and fingers)
PD postural abnormalities
disorder of equilibrium
postural fixation
flexion of head and neck
disorder or righting-cannot stand up right
Stroke
Brain attack, CVA - lack of blood in brain
TIA
Transient Ischemic Attack, decreased blood supply to tissue but it comes back- no perminant or lasting damage
hemiplegia
contralateral and total paralysis
hemiparesis
contralateral and partial paralysis
Motor aphasia- stroke
unable to speak or write
NIH stroke scale
used to gauge degree of cerebral infarction by determining level of consciousness- higher the score the worse- lower the score the worse
seizures
abrupt release of chemical activity in the brain
epilepsy
two or more unprovoked seizures, incidence increases with age
seizures classified as
generalized, partial (focal), or unclassified
6 types of generalized
tonic-clonic (grand mal)
Absence seizures
Myoclonic
Tonic
Clonic
Atonic Seizure
Tonic-Clonic
2-5 min with rigidity and stiffening of muscles and loss of consciousness- first phase
to rhythmic jerking (flexion) of extremities
Absence (petit mal)
common in child, brief loss of attention with no loss of consciousness
Myoclonic
last a few seconds: rhythmic jerking of muscles
Tonic
like first phase of Tonic clonic (extension and stiffening)
Clonic
like second phase of clonic tonic (flexion and rhythmic jerking)- involves repetitive motor activity (lip smacking)
Atonic
sudden loss of muscle tone
Partial seizures
1-3 min only in one hemisphere of the brain and are either complex or simple, older person remains conscious and often feels an aura
if seizure last more than 10 min, or successive more than 30
go to ER
multiple sclerosis (MS)
CNS disease affecting the myelin sheath of the brain and spinal cord. over time message cannot be transmitted smoothly leading to muscle weakness, incoordination, visual problems, parathesias, and memory and cognition disturbances.