AANC Gerontological Nursing Final Exam 3 Questions with answers, Exams of Nursing

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AANC Gerontological Nursing Final Exam 3 Questions with answers Demographic Trends ✔Growth is slowing 65+ population will almost double by 2060 More ethnically diverse International migration is the largest contributor to population growth Older adults are expected to outnumber children by 2035 Carl Jung ✔Identified late life as a psychological turning inward Erikson ✔Ego Integrity vs. Despair Havighurst ✔Maximize satisfaction and happiness Neugarten ✔Successful aging dependent on personality Gerotranscendence ✔Theory of aging focused on legacy building and existential concerns Nursing principles of gerontology ✔Identify and highlight the strengths and abilities of older adults Help maximize their independence and function Minimize disability Improve or maintain quality of life Achieve a peaceful and dignified death 4 Ms ✔Medication Mentation Mobility Matters (what matters to the patient) Functional assessment ✔Systematic evaluation of the older person's level of function and self-care abilities Ability to complete ADLs and IADLs Identifies care needs and resources needed upon discharge Geriatric syndromes ✔Multiple complex health states Cannot be categorized into a specific disease category Frailty, falls, UI, delirium, pressure ulcers Goals of CGA ✔Incorporating older adult's preferences Incorporating strengths Minimizing functional decline Maximize independence Safety and managing risks Respecting the older adult's autonomy Pharmacokinetics: absorption ✔Decreased GI motility Increased gastric pH due to decreased acid production Pharmacokinetics: distribution ✔Decrease in body water Increase in body fat More common in women and individuals of lower SES Frailty Index ✔3 or more of the following Unintentional weight loss: 10 % or more Weakness: grip strength less than 20 % Slowness Exhaustion Low level of physical activity Frailty management ✔Physical activity: 3x/week for 30 to 45 minutes Nutrition: increase caloric and protein intake Sleep: age related changes ✔Decline in CNS neuropeptides Changes in the suprachiasmatic nuclei; unstable sleep wake cycles Decline in cortisol and melatonin rhythms Reduced sensitivity to light at retinal level Less time spent in deep sleep Sleep hygiene ✔Maintain regular sleep schedule Avoid caffeine and nicotine Limit fluids before bed Make your bedroom sleep friendly Avoid alcohol as sleep medication Eat a light snack before bed Exercise regularly Get a few minutes of sunlight every day Get up and leave the bed if you cannot sleep Insomnia characteristics ✔Difficulty falling asleep or staying asleep Early morning awakening Daytime sleepiness Occurs at least 3x/week for more than 1 month Treatment for insomnia ✔Cognitive behavioral therapy Mental health: age related changes ✔An older person's self concept is dependent on life experiences Personality remains stable Life satisfaction is as good or better than other age groups Risk factors for depression ✔Female, widowed or divorced African-American, Hispanic, or Asian Presence of comorbidities or overall poor health History of depression Living in rural areas Low income Depression presentation in the older adult ✔Loss of interest in activities Social withdrawal Neglect of self-care and health care regimen Vague somatic complaints: fatigue, GI upset, sleep issues, change in appetite Cognitive changes Pseudodementia Slowed speech Trouble making decisions Impaired concentration Depression pharmacological principles ✔Start low and go slow Takes 2 to 12 weeks before clinical response is seen Incorporate patient goals Pharmacological treatment for depression ✔SSRIs: preferred, less side effects SNRIs: 2nd line, minimal side effects Avoid TCAs; anticholinergic properties Self-reported pain assessment ✔Gold standard Use open ended questions Pain features Functional impact Social factors that may influence pain and treatment Assessing pain in nonverbal patients ✔Attempt to obtain self-report Assess for underlying cause of pain Observe for pain behaviors Seek input from family or caregivers PAINAD Falls Confusion and decreased cognitive function Decreased physical function New onset incontinence Decreased appetite New onset tachycardia or tachypnea Health promotion for respiratory infections ✔Immunizations Avoid crowded areas during winter months Hand hygiene Elder mistreatment assessment ✔Interview older adult and caregiver separately Ask about physical abuse, sexual abuse, financial abuse, emotional abuse, and neglect Complete physical exam Labs for anemia, dehydration, and malnutrition Toxicology screening Elder mistreatment assessment challenges ✔Chronic or acute illnesses that mask symptoms Cognitive impairment Falls Fear/denial Risk factors for elder mistreatment in the older adult ✔Cognitive impairment Behavior problems Psychiatric illness Functional dependency Poor physical health Low income Trauma or past abuse Characteristics of perpetrators ✔Major stress Financial problems Mental or physical health problems Prior criminal history Male Exposure to abuse Depression Poor preparation for the caregiving role Prior or current substance abuse Mandated reporting ✔Professional responsibility Nurses are required to report actual or possible cases of elder mistreatment Palliative care ✔Care designed to enhance quality of life, reduce pain and suffering optimize functionality, and promote goal setting Can be delivered with life prolonging care Acute, serious or progressive,chronic illnesses Can take place across all settings Medicare part B covers some services Hospice care ✔Provides support in the last phase of a life-limiting illness Two physicians must determine that a person has 6 months of less to live Individual and their family prefers care and comfort over aggressive medical treatment Focus is on the whole person Medicare covers all services Common symptoms in the last 2 weeks of life ✔Dyspnea Pain Confusion Noisy breathing Signs of imminent death ✔Decreased urine output Cold and mottled extremities Delirium Confusion Hallucinations Cheyne-Stokes breathing Decreased LOC Terminal secretions: occur 8 to 23 hours before death Impact on the family caregiver ✔Stress Sandwich generation Grandparents caring from grandchildren Personal sacrifices Atrophy of subcutaneous tissue Senile purpura ✔Bruised, discolored areas Solar lentigo ✔Appears on sun exposed skin Light brown and uniform in color Proliferation of melanocytes Seborrheic keratosis ✔Raised, thickened papulonodular lesions Often rough in texture Dermatosis papulosa nigra ✔Multiple small dark papules on the face and neck Age related changes: gastrointestinal system ✔Dental decay Decreased saliva production Reduced chewing effectiveness Incomplete relaxation of lower esophageal sphincter Decreased motility Decreased absorption Normal BMI ✔19 to 25 Nutrition assessment ✔Food intake Functional assessment Oral assessment Abdominal assessment Changes in bowels Pain Mental health screening Medication review Access to food and food preparation Mini Nutritional Assessment (MNA) ✔Food intake Weight loss BMI Psychological stress/acute disease Neurophysiological problems Mobility Nutrition health promotion ✔Eat 1-1.2 g of protein per kg a day Increase lean meats, lentils, soybeans, and peanuts Causes of malnutrition ✔Depression Dementia Poor dentition Dysgeusia Drugs Disease Dysphagia Diarrhea Dysfunction Malnutrition interventions ✔Small frequent meals Liquid supplements are NOT meal replacements: should be provided at least 1 hour prior or after meals Incorporate preferences and provide choice Enhanced eating environment Improve taste perception, nutrient density, and feeding assistance Signs of dehydration ✔No tears or sweat Less urine, foul smelling urine Wrinkled skin Dry mouth Muscle cramps Constipation Lethargy and confusion Severe headaches Cracks or furrows in the tongue What is not a reliable sign of dehydration in older adults? ✔Skin turgor Dehydration interventions ✔Give frequent reminders to drink Provide plenty of fluids Serve juicy foods (soups, fruit) Monitor intake and output Teach to drink even if not thirsty Increased renal threshold for glucose Decreased blood flow to kidneys and GFR Inability to concentrate urine Increased risk for sodium imbalance Increased creatinine and BUN Decreased sensation of bladder fullness Atrophy of trigone Bladder capacity decreases Increased incontinence due to detrusor instability Increased post void residual Incontinence interventions ✔Avoid bladder irritants Schedule voiding regiments Pelvic floor muscle strengthening Anti-incontinence devices Medications Risk factors for BPH ✔Age over 40 Family history Obesity CAD T2DM Sedentary lifestyle ED BPH presentation ✔Difficulty starting a stream Straining to urinate Longer time needed to urinate Incomplete emptying Nocturia Overflow incontinence Dribbling after urination BPH interventions ✔Decrease alcohol, caffeine, and benadryl intake Decrease fluids 2 hours before bed Exercise and health nutrition Double voiding Avoid constipation 5-alpha reductase inhibitors Alpha-adrenergic blockers Male reproductive changes ✔Testosterone usually stays the same or declines gradually Secondary sex characteristics supported by testosterone, such as muscle mass and body and facial-hair growth, tend to diminish Ejaculation may take longer to occur, and the older man may have difficulty anticipating or delaying ejaculation. It takes longer to become sexually aroused, longer to complete intercourse, and longer before sexual arousal can occur again Female reproductive changes ✔Depletion of estrogen, once menopause is complete Vaginal tissues thin and become less elastic The vaginal canal shortens There is less vaginal lubrication, potentially making intercourse more painful. The cervix, urethra, and trigone of the bladder also atrophy Androgens are no longer opposed by estrogen, may result in coarsening of the skin and an increase in facial hair. It takes longer for the older woman to become sexually aroused and to produce vaginal lubrication. PLISSIT model ✔Permission Limited information Specific suggestions Intensive therapy Challenges to sexual intimacy ✔Chronic pain and OA Cardiac disease Diabetes Medications Dyspareunia ED Age related changes: cognitive (physical) ✔Decreased weight and volume of brain Decline in grey and white matter Decreased vascular perfusion Decline in grey matter ✔Most prominent in the prefrontal cortex Associated with neuronal death Impacts executive function and working memory Risk factors for PD ✔Exposure to environmental toxins Genetic predisposition Antipsychotic medications Brain injuries Male > female PD manifestations ✔Stooped posture Weakness and fatigue Masklike facial expression Slow shuffling and widened gait Uncoordinated movements 4 classic symptoms of PD ✔Resting tremors Muscle rigidity Bradykinesia Impaired balance PD interventions ✔Fall precautions Short, deliberate steps Treat pain Aspiration precautions Speech therapy HOB elevated PT/OT Encourage self care Fluids OOB Stool softeners Toileting schedule Medications for PD ✔Anticholinergic medications Dopamine receptor agonists Carbidopa/Levodopa Risk factors for stroke ✔HTN, heart disease, DM Smoking, ETOH, illicit drug use Obesity and sedentary lifestyle Hyperlipidemia Age over 55 Male (women are more likely to die) African-American Symptoms of hemorrhagic stroke ✔Thunderclap headache Neck stiffness Photophobia Focal neuro deficit Seizures Loss of consciousness Symptoms of ischemic stroke ✔Facial drooping Arm weakness/numbness Speech difficulties Unilateral weakness Decreased sensation Visual disturbances Swallowing difficulties Exclusion criteria for tPA ✔Active bleeding Recent anticoagulants (PT > 15 seconds, INR > 1.7) Recent MI BP > 185/110 CVA nursing interventions ✔Monitor LOC, neurological changes, GCS Oxygenation and perfusion DVT prevention VS monitoring and BP maintenance Dysphagia and aspiration precautions Glucose management Fall precautions CVA long term complications ✔Motor and/or sensory weakness Paralysis Hemispatial neglect Speech disorders Arcus senilis Thickening of the lens Increased opacity and yellowing of the lens Hardening and decreased pliability of the lens Decreased pupil diameter Delayed pupillary reaction Increased light sensitivity Gradual decrease in acuity and depth perception Age related changes: hearing ✔Auricle wrinkles and sags Decreased activity of ceruminous and apocrine glands Atrophy of organ of Corti and cochlear neurons Loss of sensory hair cells Age related changes: taste and smell ✔Decrease in number and function of taste buds Decrease in saliva production Decrease in olfactory sense Reduced number of sensory cells and neurotransmitters of olfactory mucosa Cataracts ✔Leading cause of blindness in the world Slow and painless development May be unilateral or bilateral Opacities form and cloud the lens Decreased amount of light able to reach the retina Risk factors for cataracts ✔Increased age Smoking Alcohol Obesity Diabetes, hyperlipidemia, HTN Trauma to the eye or history of previous eye surgery Exposure to the sun and UVB rays Long term corticosteroids Caucasian race Symptoms of cataracts ✔Blurry vision Glare Halo around objects Double vision Difficulty seeing contrasting colors Poor night vision ARMD (age related macular degeneration) ✔Degenerative disorder of the macula Affects both central vision and visual acuity Dry ARMD ✔Atrophy Retinal pigment degeneration Drusen Most common form No treatment Wet ARMD ✔Severe vision loss Blood or serum leaks from newly formed blood vessels beneath the retina Straight lines appear crooked or wavy ARMD risk factors ✔Above age 60 Cigarette smoking Family history Increased exposure to UV light Caucasian race and light colored eyes HTN or CV disease Lack of dietary intake of antioxidants and zinc Glaucoma ✔Result of optic nerve damage Due to an increase in IOP Second most common cause of blindness Open angle glaucoma ✔Drainage of aqueous humor is slowed Fluid builds up and causes increased IOP Results in peripheral vision loss Vision loss is painless and gradual Angle closure glaucoma ✔Angle of the iris obstructs drainage of the aqueous humor May occur suddenly due to trauma or infection Unilateral headache, visual blurring, nausea and vomiting, photophobia