N300 Gero Exam #1

Patterns of beliefs, values, and perception of the meaning of life that guide choices or decision

Values-beliefs

medicare

A program added to the Social Security system that provides hospitalization insurance for the elderly and permits older Americans to purchase inexpensive coverage for doctor fees and other health expenses.

aspects of the nurse's role in caring for older adults

- advocate - educator - manager - consultant - researcher

Know the benefits of healthy gaining

- creativity and confidence are enhanced - coping ability increases - gratitude and appreciation deepen - confidence increases with less reliance on the approval of others - self-understanding and acceptance increase

Know the most common causes of disabilities in the United States

- heart disease and stroke - diabetes care - arthritis and related disorders - obesity - smoking-related illness - alcohol abuse

Be familiar with myths of aging

- • Myth: Being old means being sick - • Myth: Being old means being sick - • Myth: Health promotion is wasted on older people - • Myth: Older adults do not pull their own weight and are a drain on societal resources. - • Myth: Older people are isolated and lonely. - • Myth: Older people have no interest in sex.

The nurse notes that an older person has difficulty removing clothes in preparation for a physical assessment. On which area should the nurse focus when determining this person's ability to perform activities of daily living? 1. Bathing 2. Laundry 3. Walking 4. Housekeeping

1 Categories when determining com-petence in performing activities of daily living include bathing, dressing, toileting, transferring, continence, and feeding. Since the nurse observed the person's difficulty with dressing, additional assessment would focus on the other categories. Laundry and housekeeping are criteria within functional activities of daily living. There is no evidence to suggest that the person has difficulty walking.

7. A cognitively intact resident of a long-term care facility asks for assistance getting dressed. Shortly thereafter a taxicab driver comes to the desk to pick up the resident as requested. What action should the nurse take? 1. Locate the resident for the taxicab driver 2. Send the driver away since the resident is not per-mitted to leave the facility 3. Obtain the name, license number, and telephone number of the taxicab service 4. Ask the resident to sign an "against medical ad-vice" form before leaving the facility

1 Rationale: According to OBRA 87, a resident has the right to leave the facility. Legally, the nurse should locate the resident for the taxicab driver. The resident is permitted to leave the facility; therefore, the driver should not be sent away. Obtaining the name, license number, and telephone number of the taxicab service is not expected according to OBRA 87. The resident is not leaving against medical advice. An against-medical-advice form does not need to be signed.

3. A school of nursing is experiencing a workforce issue that will impact care provided at local hospitals. Which information best indicates that there is a work-force issue? 1. 200 applicants on a waiting list for admission 2. Seven signed agreements for clinical rotations 3. Three instructors volunteered to staff the learning lab 4. Twenty senior nursing students mentoring the freshman class

1 Rationale: Faculty shortages limit the number of stu-dents that can be admitted to nursing programs and many schools are unable to accept qualified applicants because of inadequate faculty size. U.S. nursing schools turned away 68,938 qualified applicants to undergraduate and graduate nursing programs in 2014-2015 because of an insufficient number of faculty and clinical preceptors; lack of access to clinical placements and laboratory and classroom sites; and budget constraints. A waiting list of 200 applicants indicates a workforce issue in the school of nursing. Having agree-ments for clinical rotations, staff volunteering to staff a learn-ing lab, and students serving as mentors to undergraduates does not indicate a workforce issue for this school of nursing.

3. The nurse completes a comprehensive geriatric as-sessment on an older person. On which area should the nurse focus when identifying this patient's level of independence? 1. Functional ability 2. Medical diagnoses 3. Living arrangements 4. Socioeconomic status

1 Rationale: Functional abilities should be a central focus of the comprehensive evaluation. Other more-traditional mea-sures of health, such as medical diagnosis, living arrangements, and socioeconomic status, form the basic foundation of the as-sessment to determine overall health, well-being, and the need for and intensity of social services.

9. An older client is seen sitting in a chair, staring out the window and crying. Which approach should the nurse use to comfort this client? 1. Offer a tissue and hold the client's hand 2. Cheerfully ask the client "what's wrong?" 3. Leave the client alone to maintain privacy 4. Suggest watching television as a distraction

1 Rationale: If a person cries, the nurse should offer a tis-sue, hold their hand if appropriate, and wait a few minutes. Crying can be therapeutic and offers release from persistent feelings of sadness. Asking "what's wrong" in a cheerful tone does not take the person's behavior into consideration. Leaving the person alone may exacerbate the feelings of sad-ness. Watching television is not an appropriate approach to use for a person who is obviously distressed or sad

1. The nurse desires to become certified as a gerontological nurse. What credentials does the nurse need prior to taking the certification examination? 1. Practiced as an RN for 2 years 2. Earned a master's degree in nursing 3. Employed in a skilled nursing facility 4. Completed 60 hours of continuing educatio

1 Rationale: Nurses must have practiced the equiva-lent of 2 years' full-time as a registered nurse prior to seeking certification as a gerontological nurse. A master's degree is not required. Employment in a skilled-nursing facility is not required. A minimum amount of continuing education hours is not required.

2. The nurse manager prepares an informational sheet for nursing staff regarding scope of practice. Which category should the manager include when designing this sheet? 1. Quality 2. Context 3. Teamwork 4. Environment

1 Rationale: The three elements of the scope of practice consist of quality, evidence, and safety. Context and environment are NLN competencies. Teamwork is a QSEN competency.

A resident of an assisted living facility enjoys the new apartment but is disappointed that so many females reside there alone. What does this resident's observa-tion suggest about older men? 1. They do not live as long as women 2. They tend to live with family when they age 3. They do not like to live in assisted living facilities 4. They are healthy enough to live in their own home

1 The gender differences in life expectancy may be explained by the complex interaction among biological, social, and behavioral factors. Greater male exposure to risk factors, such as tobacco, alcohol, and occupational hazards, might negatively affect male life expectancy. There is no evidence to support that older men tend to live with family when they age, dislike assisted-living facilities, or are healthy enough to live in their own homes.

The nurse prepares an educational program on healthy aging for a community group. Which segment of the population should the nurse explain as being the fastest growing in the United States? 1. Old-old 2. Young-old 3. Middle-old 4. Middle-age

1 The old-old (ages 85+) are the fastest growing segment of the population, growing at twice the rate of those ages 65 and over and four times faster than the total U.S. population. This group will triple from the current 5.7 million to over 19 million by 2060. During the next 13 years, the young-old (ages 65-74), 74 million baby boomers will retire. During the next decade, increased life expectancy will add to the number of middle-old (ages 75-84) baby boomers. Middle-age individuals are not iden-tified as being the fastest growing population segment in the United States.

6. The nurse notes that an older patient has a blood pressure of 150/90 mm Hg. Which health screening should the nurse recommend for this patient? 1. Arthritis 2. Diabetes 3. Depression 4. Cognitive function

2 Rationale: Diabetes screening is recommended every 3 years in people with a blood pressure greater than 135/80 mm Hg. The blood pressure is not used to identify health screenings for arthritis, depression, or cognitive functioning.

A comprehensive geriatric evaluation should be carried out on a regular basis, including at these times:

1. After hospitalization for an acute illness 2. When nursing home placement or a change in living status is being considered 3. After any abrupt change in physical, social, or psycho-logical function 4. Yearly for the older person with complex health needs during the annual visit for routine health maintenance with the primary healthcare provider 5. When the older patient or family would like a second opinion regarding an intervention or treatment proto-col recommended by the primary-care provider

Barriers That Can Disrupt the Communication Process

1. Fear of one's own aging 2. Fear of showing emotion or being around emotional patients 3. Fear of missing something and feeling the need to write down every detail of the encounter 4. Fear of being called on to rectify every problem verbalized by the patient 5. Lack of knowledge of the patient's culture, goals, and values 6. Unresolved issues with aging relatives in the nurse's own family that can lead to insensitivity 7. Feeling that professional distance must be maintained at all cost 8. Being overworked, or overscheduled, and lacking proper time to communicate with older patients

three underlying principles of comprehensive geriatric assessment

1. Physical, psychological, and socioeconomic factors interact in complex ways to influence the health and functional status of the older person. 2. Comprehensive evaluation of an older person's health status requires an assessment in each of these domains. The coordinated efforts of various healthcare professionals are needed to carry out the assessment. 3. Functional abilities should be a central focus of the comprehensive evaluation. Other more traditional measures of health such as medical diagnosis, nursing diagnosis, physical examination results, and laboratory findings form the basic foundation of the assessment in order to determine overall health, well-being, and the need for and intensity of social services.

10. An older adult without an advance directive requests no interventions should he stop breathing during the night. Which type of order should the nurse discuss with the person and healthcare provider? 1. Permit to die 2. Allow natural death 3. No extraordinary measures 4. All but cardiopulmonary resuscitation

2 Rationale: Allow natural death (AND) is a formal designation that can replace the "do not resuscitate" order in some hospitals and other healthcare facilities. AND orders describe the person's instructions for the use of feeding tubes, administration of antibiotics, use of catheters and intravenous fluids, and other methods of prolonging life. Without excep-tion, AND orders emphasize provisions for comfort mea-sures, as needed. Permit to die, no extraordinary measures, and all but cardiopulmonary resuscitation are not identified as appropriate orders to address this person's request.

7. An older person who recently retired expresses de-light in not having to get up and go to work every morning. Which theory of aging does this person's statement demonstrate to the nurse? 1. Activity 2. Continuity 3. Individualism 4. Disengagement

2 Rationale: In the continuity theory, the pace of activities may be slower and for some, the relief from time pressures and deadlines is a bounty of older age. The activity theory proposes that older adults should stay active and engaged if they are to age successfully. In the theory of individualism, the focus shifts away from the external world towards inner experiences as the older person searches for answers to life's riddles and find the essence of the true self. In the disengage-ment theory, the pattern of behavior in later life is for the older person to withdraw so that social equilibrium is maintained.

The nurse learns that an older person takes several vi-tamin and nutritional supplements every day. Which theory of aging is supported by this older person's behavior? 1. Cross-link 2. Free radical 3. Wear-and-tear 4. Somatic DNA damage

2 Rationale: In the free-radical theory, it is believed that accumulated damage caused by oxygen radicals causes cells, and eventually organs, to lose function and organ reserve. The use of antioxidants and vitamins is be-lieved to slow this damage. In the cross-link theory, it is be-lieved that an accumulation of cross-linked proteins from the binding of glucose to protein causes health problems, such as cataracts, wrinkles, and skin aging. In the wear-and-tear theory, it is believed that parts of cells and organs wear out after years of use. In the somatic DNA theory, it is believed that genetic mutations occur and accumulate with increasing age, which causes cells to deteriorate and malfunction.

The nurse notes that an older person lives alone and has been losing weight despite the absence of chronic illness that affect metabolism. Which member of the interdisciplinary team should the nurse contact to dis-cuss this person's situation? 1. Dentist 2. Social worker 3. Physical therapist 4. Geriatric physician

2 Rationale: Key members of the interdisciplinary team are the gerontological nurse, the social worker, and the geriatric physician. Since the person lives alone, a starting point would be to consult with the social worker to identify if the weight loss is related to income or other psychosocial needs. Other healthcare professionals can be included in the evaluation or consulted, depending on the needs and problems exhibited by the older person. These professionals include dentist, physical therapist and geriat-ric physician. Since the person has no chronic illnesses that affect metabolism, the physician would not be consulted for this particular problem. There is no evidence to suggest the need for dental care or care from a physical therapist.

4. During a regulatory-body survey it was determined that a skilled-nursing facility is short-staffed. Which data was used to make this clinical determination? 1. Nursing assistive personnel helping residents with meal trays 2. Delivery made of 50 indwelling urinary catheter devices to the care area 3. Residents transported to the recreation room every afternoon for a movie 4. Nursing staff turning and repositioning residents every 2 hours as needed

2 Rationale: Lower nurse-staffing levels are associated with higher rates of urinary-catheter use. Having 50 urinary-collection devices delivered to the care area indi-cates that a large number of residents have an indwelling urinary catheter. This high number is associated with a facility with insufficient care providers. Helping residents with meals indicates a sufficient number of staff to ensure for the residents' nutritional needs. Transporting staff to the recreation room indicates an adequate number of staff to ensure residents participate in activities. Having enough staff to turn and reposition residents every 2 hours helps reduce pressure-injury rates.

The nurse visits the home of an older patient with chronic lung disease. Which observation indicates that the patient is not engaged in health improvement activities? 1. Prepares pasta for dinner 2. Walks a pet dog twice a day 3. Talks with family once a week 4. Sleeps in a recliner in the living room

2 Rationale: One myth of aging is health promotion is wasted on older people. The fact is that it is never too late to begin good lifestyle habits, such as eating a healthy diet and engaging in exercise. Walking the pet dog twice a day indicates that the person is engaged in a health-improvement activity. Pasta is high in carbohydrates which would have an adverse effect on weight and overall health. Talking with family may fill a psychosocial need; however, does not indicate engagement in a health-improvement ac-tivity. Sleeping in a recliner in the living room may help re-spiratory function; however, does not indicate engagement in a health-improvement activity.

An older person states that "it's just a matter of time" before a knee and hip replacement will be needed. Which theory of aging is this older person describing to the nurse? 1. Endocrine 2. Wear and tear 3. Immunological 4. Programmed longevity

2 Rationale: People who subscribe to the wear-and-tear theory believe that the human body is similar to a machine and parts wear out after years of use. In the endocrine theory, the biological clock acts through hormones to control the pace of aging. People who follow this theory would use various natural and synthetic hormones to slow the aging process. In the immunological theory, immune function slowly declines, which increases vulnerability to diseases, aging, and death. People who follow this theory follow a healthy diet and use preventive measures to support immune function. In the programmed-longevity theory, aging occurs because of gene changes. People who follow this theory are interested in genetic theories of aging.

7. An older client on a fixed income receiving Medicare plans to move into a skilled-nursing facility. How should the nurse respond to a question from the client regarding his/her decision? 1. "Now that you are 65, you are automatically quali-fied for admission." 2. "That's a good decision since Medicare will cover the cost of your room." 3. "In the long-term, you will need to pay for the room until you qualify to receive Medicaid." 4. "I'm not sure if you need to go to this type of place since many people are really ill."

3 Rationale: A resident with a musculoskeletal structural disorder, such as severe kyphoscoliosis, who does not want to participate in community outings more than likely is experiencing a disturbance in body image. There is no evidence to suggest the resident is unable

The nurse plans an educational wellness program for a group of older adults residing in the community. On which topic should the nurse focus the majority of the information? 1. Benefits of remaining socially active 2. Managing Alzheimer's disease symptoms 3. Managing heart failure symptoms 4. Benefits of treating depression with medications

3 Five chronic diseases—heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes—cause more than two-thirds of all deaths each year. To help reduce the incidence of death from heart disease and stroke, and possible adverse effects from diabetes, the nurse should focus the majority of in-formation on blood pressure control. Although socializa-tion, cognitive activities, and socioeconomic support are useful topics for senior community members, the topic that has the greatest impact on wellness is blood pressure control.

The nurse visits the home of an older person recover-ing from an exacerbation of a chronic illness. Which observation indicates to the nurse that the person has dispelled the myth that older people cannot learn new things? 1. Preparing a shopping list 2. Planning to meet friends for lunch 3. Researching medications on the Internet 4. Scheduling an ophthalmologic examination

3 One common myth about older people is being set in familiar ways and having the inability to learn new things. Researching medications on the internet dispels this myth. Preparing a shopping list demonstrates engagement in everyday-life activities. Meeting friends for lunch indicates interest in socialization. Scheduling a health appointment indicates interest in health-promotion activities.

10. During an activity in the recreation room the nurse notes a resident staring with a puzzled expression after instructions for a group activity are given. What should the nurse do to assist this resident? 1. Talk louder in the future 2. Lower the room lights 3. Repeat the information after making eye contact 4. Hold the resident's hand

3 Rationale: A puzzled look may mean the person cannot hear but is ashamed to interrupt. Because of the puzzled look, the nurse should repeat the information about the activity. Talking louder can be disturbing. There is no reason to lower the lighting in the room. The resident is not demonstrating an emotion issue, so holding the hand is not appropriate at this time.

8. The nurse plans care for an older patient recovering from an exacerbation of a chronic illness. Which inter-vention best supports this patient's autonomy? 1. Assess for pain level every 4 hours 2. Encourage to perform active range of motion twice a day 3. Coordinate time of day to provide hygienic care 4. Ambulate down the hall to have meals in the dining room with other clients

3 Rationale: The ethical principle of autonomy is to re-spect people's needs for self-determination, freedom, and rights. Coordinating the time of day to provide hygienic care with the person supports the principle of autonomy. Assessing for pain, encouraging range of motion, and ambulation supports the ethical principles of beneficence and nonmaleficence.

Patterns of exercise and daily activity. Includes leisure and recreation

Activity-exercise

6. The nurse notes that a resident of an assisted-living facility has severe kyphoscoliosis and rarely partici-pates on community outings. Which nursing diagnosis should the nurse use to guide this resident's care needs? 1. Insufficient coping 2. Impaired activity tolerance 3. Diminished cognitive status 4. Altered body image

4 Rationale: A resident with a musculoskeletal structural disorder, such as severe kyphoscoliosis, who does not want to participate in community outings more than likely is experiencing a disturbance in body image. There is no evidence to suggest the resident is unable

8. The nurse notes that laboratory data for a person who is not a resident of the skilled facility was accidentally faxed to the care area. What should the nurse do with this information? 1. Throw it in the trash 2. Place it in biohazard trash 3. File in the reusable paper pile 4. Destroy it with a paper shredder

4 Rationale: Fax machines should be used only when it is understood that the authorized provider is the only receiver or that the authorized receiver will "stand by" a shared fax machine to receive confidential information. Sending the information to the wrong receiver constitutes a breech in confidentiality. Throwing the data in the trash, biohazard trash, or using it as recycled paper compounds the breech and should not be done. The data should the destroyed with a paper shredder.

An adult daughter is concerned about an her 85-year-old mother's disinterest in activities since retiring from a full-time teaching position. Which theory of aging should the nurse use to help explain this older person's behavior? 1. Activity 2. Continuity 3. Developmental 4. Disengagement

4 Rationale: In the disengagement theory, it is believed that older people and society engage in a mutual and reciprocal withdrawal so that when death occurs, neither parties are harmed and social equilibrium is maintained. In the activity theory, it is proposed that older people stay active and engaged to ensure successful aging. In the continuity theory, it is believed that successful aging involves maintaining or continuing previous values, habits, preferences, family ties, and other connections that have formed the underlying structure of the person's life. In the developmental theory, the task of the older adult is ego integrity versus despair. If the ego is intact, the older person will approach death without regrets. If failures or disappointments have occurred, this stage of development will be difficult to achieve because despair interferes with the acceptance of eventual death.

The nurse schedules an interdisciplinary team meet-ing for an older person with new pressure injuries on the sacrum and left heel. Which team member should the nurse ensure is present before the meet-ing begins? 1. Dietician 2. Social worker 3. Physical therapist 4. Geriatric physician

4 Rationale: Key members of the interdisciplinary team are the gerontological nurse, the social worker, and the geriatric physician. Since the person lives alone, a starting point would be to consult with the social worker to identify if the weight loss is related to income or other psychosocial needs. Other healthcare professionals can be included in the evaluation or consulted, depending on the needs and problems exhibited by the older person. These professionals include dentist, physical therapist and geriat-ric physician. Since the person has no chronic illnesses that affect metabolism, the physician would not be consulted for this particular problem. There is no evidence to suggest the need for dental care or care from a physical therapist.

5. The nurse reviews information collected after complet-ing a comprehensive assessment with an older person. For which reason should the nurse recommend lipid-disorder screening for this patient? 1. Over the age of 65 2. Body mass index 28.5 3. Blood pressure 140/90 mm Hg 4. Diagnosed with peripheral-artery disease

4 Rationale: Lipid-disorder screening is recommended every five years or more often in older people with peripheral-artery disease. Bone-mineral density, herpes zoster immunization, pneumonia immunization, tetanus booster, abdominal aortic aneurysm screening, sigmoid-oscopy/colonoscopy, and mammography/clinical breast exam are recommended screenings for persons over the age of 65. Height and weight are measured annually to ad-dress obesity. Diabetes screening should be recommended every 3 years in people with a blood pressure greater than 135/80 mm Hg.

4. During a comprehensive geriatric assessment the nurse learns that an older person has not been taking prescribed medications for several months. Which aspect of the assessment should the nurse focus to identify the reason for medication nonadherence? 1. Functional ability 2. Medical diagnoses 3. Nutritional status 4. Socioeconomic status

4 Rationale: Since the older person has not taken medi-cation for several months, it is likely to be because of a finan-cial/socioeconomic issue. This is the area in which the nurse should focus first to determine the reason for medication nonadherence. The reason why the medications have not been taken for several months is unlikely to be because of functional ability, medical diagnoses, or psychological status.

5. The nurse identifies the diagnosis of Insufficient cop-ing strategies for an older client. What functional health pattern data did the nurse use to determine this diagnosis? 1. Parish council voted to replace the current pastor 2. Best friend moving to a senior community in an-other state 3. Community golf course raised the rates for a round of golf 4. Alcohol consumption increased since son was incarcerated

4 Rationale: The functional-health pattern of coping-stress tolerance addresses the behavior patterns of coping with stressful events and level of effectiveness of coping strategies. Ingesting more alcohol since a son was incarcerated indicates the person is having difficulty with this functional-health pattern. Replacing a parish pastor would affect the values-beliefs functional-health pattern. A best friend moving to another state would affect the roles-relationships functional-health pattern. Learning that it costs more to play a round of golf would affect the activity-exercise functional-health pattern.

9. An adult daughter says that the patient has been asked repeatedly to complete an advance directive; however, has neglected to do so. What should the nurse do first to facilitate this patient completing an advance directive? 1. Determine if an attorney has been identified 2. Obtain a copy of the patient's Last Will and Testament 3. Ascertain the patient's religious belief surrounding death and dying 4. Assess the older adult's attitudes about advance directives

4 Rationale: There are a variety of reasons why an older person may not have an advance directive. The first thing, though, for the nurse to do is to determine if there are any physical reasons why the directive has not been completed. They may have poor eyesight, cognitive impairment, hear-ing disorder, or challenges with writing. An attorney does not need to be identified for the person to complete an ad-vance directive. The Last Will and Testament is not required for completing an advance directive. Religious beliefs may be hindering the person's completion an advance directive and this could be assessed; however, it would not be as-sessed first. Physical reasons for not completing the advance directive should be assessed first

medicaid

A federal and state assistance program that pays for health care services for people who cannot afford them.

To respect patients' needs for self-determination, freedom, and patient rights

Autonomy.

To do good and not harm patients.

Beneficence/nonmaleficence.

Patterns of thinking and ways of perceiving the world and current events

Cognitive-perceptual

Patterns of coping with stressful events and level of effectiveness of coping strategies

Coping-stress tolerance

- emphasizes environmental assaults to the human system hypothesize that environmental assaults and the body's constant need to manufacture energy and fuel metabolic activities cause toxic by-products to accumulate. These toxic by-products may eventually impair normal body function and cellular repair

ERROR THEORIES

Patterns of excretory function and elimination of waste (e.g., bowel, bladder)

Elimination

Eight stages of life - the older adults, integrity vs. despair

Erikson's Developmental theory

The older individual's perceived health and well-being along with self-management strategies

Health perception-health management

theory that states that as a person ages, the shift of focus goes from extroversion to introversion

Jung's theory of individualism

To be fair and distribute scarce resources equally to all in need.

Justice

Patterns of food and fluid consumption relative to metabolic need and nutrient supply

Nutritional-metabolic

Patterns of engagement with others, ability to form and maintain meaningful relationships, assumed roles

Roles-relationships

Patterns of viewing and valuing self (body image and psychological state, self-image, etc.)

Self-perception-self-concept

Patterns of sexuality and satisfaction with present level of interaction with sexual partners

Sexuality-reproductive

Patterns of sleep, rest, and relaxation

Sleep-rest

Factors to Consider When Assessing the Home

Stairs Bathing and Toileting Medications Advance Directives Nutrition and Cooking Falls Smoke/Carbon Monoxide Detectors Emergency Numbers Temperature of Home Temperature of Water Safety of the Neighborhood Financial

T/F Modifiable changes of aging can be slowed by a healthy lifestyle

True

older adults stay active and engages to enjoy old age

activity theory

aging involves maintaining previous values and habits

continuity theory

the older adult person and society engage in a mutual and reciprocal withdrawl

disengagement theory

Biological aging theories

falls into 2 categories: 1. programmed theories - Programmed theories assert that aging follows a biological timetable and may represent a continuation of the cycle that regulates childhood growth and development. 2. error theories - The error theories emphasize environ-mental assaults to the human system that gradually cause things to go wrong.

The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to

meet the challenge of preparing future nurses who will have the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work

Aging follows a biological timetable Aging is the result of the sequential switching on and off of certain genes, with senescence defined as the point in time when age-associated functional deficits are manifested. Persons who endorse this theory are interested in studying the human genome and genetic theories of aging.

programmed theories

secondary prevention

trying to detect a disease early and prevent it from getting worse -focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status -examples: communicable disease screening and case finding; early detection and treatment of diabetes; exercise programs for older adult clients who are frail

tertiary prevention

trying to improve your quality of life and reduce the symptoms of a disease you already have. -aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -examples: prevention of pressure ulcers as complication of a spinal cord injury; promoting independence for the client who has traumatic brain injury

primary prevention

trying to prevent yourself from getting a disease ; improving the overall health of the population Actions that change overall background conditions to prevent some unwanted event or circumstance, such as injury, disease, or abuses

Difficulties in Obtaining Health Histories

• Communication difficulties. Decreased hearing or vision, slow speech, and use of English as a second language have an effect on communication. • Underreporting of symptoms. Fear of being labeled as a complainer, fear of institutionalization, and fear of serious illness and need for further testing can influence symptom reporting. • Vague or nonspecific complaints. These may be associated with cognitive impairment, drug or alcohol use or abuse, or atypical presentation of disease. • Multiple complaints. Associated "masked" depression, presence of multiple chronic illnesses, and social isolation are often an older person's cry for help. • Lack of time. New patients scheduled for geriatric assessment should have the minimum of a 1-hour appointment with the gerontological nurse. Shorter appointments will result in a hurried interview with missed information.

HIPAA standards include:

• Confidentiality—Only the right people can see pro-tected information. • Integrity—The information is supposed to be without alteration or destruction. • Availability—The right people can see it when needed. • The information is protected against reasonably antici-pated threats and hazards to its security or integrity. • The information is protected against reasonably antici-pated uses and disclosures not permitted by privacy rules. • The provider will ensure compliance by the agency workforce.

Barriers to the completion of an advance directive include the following:

• Inability to speak English • Family/healthcare provider attitudes and preferences • Religious or ethnic beliefs • Poor eyesight, cognitive impairment, and/or hearing deficit • Standardized forms that are too technical or print that is too small to read • Procrastination • Dependence on family for all decisions • Lack of knowledge about advance directives • Belief a lawyer is necessary • Fear of being written off or signing life away • Acceptance of the will of God

Key elements of the social history include the following:

• Past occupation and retirement status • Family history (helpful to construct a family genogram) • Present and former marital status, including quality of the relationship(s) • Identification of family members, with designation of level of involvement and place of residence • Living arrangements • Family dynamics • Family and caregiver expectations • Economic status, adequacy of health insurance • Social activities and hobbies • Mode of transportation • Community involvement and support • Religious involvement and spiritualit