OA Module 4 (geriatric syndrome, Pain, Sleep)

When assessing an older adult client about his sleeping patterns at home, you will ask: Select all that apply. Do you have a bowel movement before going to bed? What time do you go to bed? Do you have any specific rituals at bedtime? What is the room environment? Do you experience any leg twitches in the hours before going to bed? How many times do you wake up at night?

What time do you go to bed? Do you have any specific rituals at bedtime? What is the room environment? How many times do you wake up at night?

When assessing the geriatric syndrome of a patient who reports recent intermittent problems with incontinence, which instrument would be most appropriate, according to "Try This?" A cystogram the hospital incontinence chart a bladder diary record (Urinary Incontinence Assessment: Transient Incontinence Assessment) urine volume in the catheter bag

a bladder diary record (Urinary Incontinence Assessment: Transient Incontinence Assessment)

You want to encourage your older adult client to exercise and recommend all the following EXCEPT one hour a day of moderate intensity aerobic activity. muscle strengthening activities. stretching and balance exercises. playing with the Wii game.

one hour a day of moderate intensity aerobic activity. Approximately 2 hours and 30 minutes of moderate intensity aerobic activity is recommended, not 5 to 7 hours. Muscle strengthening activities on 2 or more days that work all major muscle groups is recommended each week. Stretching and balance exercises, particularly for older people who are at risk of falling, are recommended. The Wii game system offers other possibilities for exercise at all levels and is increasingly being used in nursing homes and assisted living facilities.

PAIN: Which one of the following health problems is the most common reason for pain in older adults? Parkinson's disease osteoarthritis heart disease dyspareunia

osteoarthritis

A geriatric syndrome will most typically result from: three or more medications a diagnosis of heart disease a diagnosis of depression a change in mental status

three or more medications

Case Study Anthony Jameson is an 82-year-old man with metastatic lung cancer. He was a smoker for many years and finally quit smoking at 76 years of age. He lives at home with his younger wife, who is his primary caregiver. She is available around the clock and assists him with all of his care needs, including medication management. The couple never had children, but they have support from friends at church to provide respite care. Mr. Jameson is visited by a hospice nurse, who assists with pain and symptom management. Anthony has been experiencing increased pain and shortness of breath during the night and needs to have a pain assessment. 1. A key element in the assessment of pain is the __________ of pain as perceived by the person. 2. Which of the following pain assessment tools is used with the individual who cannot reliably express pain? a. Comprehensive Pain Assessment b. Pain Assessment in Advanced Dementia Scale (PAINAD) c. Numeric Rating Scale d. FACES Pain Scale 3. Which of the following analgesics is contraindicated in older adults? a. Tramadol b. Oxycodone c. Demerol d. Hydromorphone 4. How is opioid treatment initiated? a. Begin with as-needed doses and titrate based on need. b. Monitor for side effects weekly in hospice patients. c. Begin with the highest dose possible to control severe pain. d. Begin with around-the-clock formations unless patient exhibits addictive behavior.

1. intensity 2. Pain Assessment in Advanced Dementia Scale (PAINAD) 3. Demerol 4. Begin with as needed doses and titrate based on need The PAINAD was developed to be used with those who either cannot express or cannot reliably express their pain. It can be used by nurses, CNAs, informal caregivers, and other health care providers. The Comprehensive Pain Assessment is only possible when caring for an older adult who is cognitively intact or minimally to moderately impaired. The use of a Numeric Rating Scale requires that the person have numerical fluency, and this can never be assumed. The FACES Pain Scale was developed for use with children but is useful for adults as well. Meperidine (Demerol), used in younger adults in acute pain, is always contraindicated in older adults. If long-term management of moderate to severe pain is needed, opioids are recommended (e.g., tramadol, oxycodone, and hydromorphone). They have lower or more predictable adverse reactions, especially compared with NSAIDS. The use of opioids is always accompanied by a multipronged approach and is often the first line of approach for neuropathic pain. Opioid treatment should begin with "as-needed" doses of short-acting medications and should be titrated based on the amount needed, the response obtained, and side effects over at least a 24-hour period or around-the-clock formulations. Current recommendations are to start with the lowest anticipated effective dose, monitor response frequently, and increase dose slowly to desired effect. If a change is needed from one drug to another and the dose of active ingredient is known, then conversion resources are available so that the patient can remain pain free.

Case Study with Answers William Quinn is a 70-year-old man who lives in an apartment complex designated for adults older than 55 years of age. He is a recent widower and enjoys an active lifestyle, including gardening, walking, and traveling. After his wife of 22 years recently passed away, he decided to sell his home in the country and move into the new apartment complex, which allows him more access to his family, shopping, and church. He is also hoping to meet more singles his age who he can travel with and plans to join the walking club at the complex. The apartment complex is very close to a series of multipurpose trails. 1. Which of the following statements are true regarding physical activity for older adults? (Select all that apply.) a. Older people are less likely to receive exercise counseling from their primary care provider. b. As little as 10 minutes of exercise can provide health benefits. c. Extremely frail individuals should engage in strength and balance training. d. Exercise must be performed for 60 minutes per day. e. People over the age of 70 are too old to begin a fitness program.

A, B, C The nurse should be knowledgeable about recommended physical activity guidelines, educate individuals about the importance of exercise and physical activity, and provide suggestions on ways to incorporate exercise into daily routines. Many older people mistakenly believe that they are too old to begin a fitness program. Older people are less likely to receive exercise counseling from their primary care providers than younger individuals. Recommendations for all adults are participation in 30 minutes of moderate-intensity physical activity for 5 or more days of the week. People do not have to be active for 30 minutes at a time but can accumulate 30 minutes over 24 hours. As little as 10 minutes of exercise has health benefits and three 10-minute bouts of activity have the same fitness effects as one 30-minute bout. Extremely frail individuals may not be able to engage in aerobic activities and should begin with strength and balance training before engaging in as little as 5 minutes of aerobic training.

Pain can be which of the following? Select all that apply. Acute Idiopathic Nociceptive Pathologic Adjuvant Persistent

Acute Idiopathic Nociceptive Persistent Pain is either acute or persistent and is otherwise known as chronic. Acute physical pain is temporary and includes postoperative, procedural, and traumatic pain. Pain is idiopathic. Although a causative factor might not be found, the client can and does still experience pain. Pain is nociceptive and is caused when special nerve endings—called nociceptors—are irritated. Persistent or chronic pain is moderate to severe and present in approximately 50% of those older than 65 years of age. The most common persistent pain is noncancerous and musculoskeletal in nature and is from arthritis and degenerative spinal conditions. Pathologic pain is first classified as that which is related to cancerous or noncancerous conditions. Adjuvant is a drug that has a primary use other than for pain, but it is also used to enhance the effects of traditional pain medication.

Normal aging changes that would influence an older client's experience of pain would include all of the following EXCEPT Decreased tactile sensation. Delayed reaction time. Degenerative spine conditions. Increased sensitivity to pain. All of the above are normal aging changes that would influence an older client's experience of pain.

All of the above are normal aging changes that would influence an older client's experience of pain.

When taking care of an older adult client, you realize when assessing his pain level that all of the following considerations would apply EXCEPT He might not be able to express pain. He might be depressed. Sedation will affect how he expresses his pain. You will have to take his culture into consideration. Because he is older, he does not feel pain as much.

Because he is older, he does not feel pain as much. SHOULD assess for... - that he may not be able to express pain - he may be despressed - sedation affects expression of pain - take culture into consideration

3. Before beginning an exercise program, which of the following interventions should be encouraged and taught to the individual? (Select all that apply.) a. Assume that the doctor will approve the program. b. Collaborate with the person to set general goals. c. Assess barriers to exercise and provide tips on how to overcome them. d. Design a program that can be used at home or elsewhere. e. Provide self-monitoring methods to visualize progress.

C, D, E Before beginning any exercise program, the individual should check with his or her physician to be screened. Short- and long-term goals should be specific and achievable and should match perceived needs, health, cognitive abilities, culture, gender, and interests. Barriers to exercise should be assessed and the person should be provided tips on how to overcome them. The program should be designed for use at home or elsewhere. The individual should be provided with self-monitoring methods to assist in visualizing progress.

Regular recurrence of certain phenomena linked to the 24-hour day by time cues, defines which one of the following? Non-rapid eye movement Circadian rhythm Obstructive sleep apnea Insomnia

Circadian rhythm The circadian sleep-wake rhythm, which is the regular recurrence of certain phenomena in cycles of approximately 24 hours, is the most important biorhythm, second only to body temperature, pulse, blood pressure, and hormonal levels. Four stages of non-rapid eye movement and a fifth stage of rapid eye movement occur with sleep. The obstruction of the upper airway causes obstructive sleep apnea and is the most common of the sleep apneas. Insomnia is defined as "a complaint of disturbed sleep in the presence of an adequate opportunity and circumstance for sleep."

Which symptoms would be most common in an older adults with insomnia? Hypertension and agitation Rapid respirations and anxiety Confusion and irritability Decreased temperature and talkativeness

Confusion and irritability

The medical syndrome of "frailty" will typically result in which of the following? (Select all that apply) Falls A sudden weight gain Worsening of hospital outcomes Disability and mortality

Falls Worsening of hospital outcomes Disability and mortality Why does it matter if someone has the syndrome of frailty? o More prone to falls. o More prone to disability, hospitalizations, to institutionalization. o At a greater risk for mortality. Formalized phenotype of frailty o Chronic fatigue o Weakness o Weight loss - weight loss of 10 pounds or more within one month o Slowed walking speed o Low activity

Most common conditions referred to as "Geriatric syndrome" o Falls and gait abnormalities o Frailty o Hypokalemia o Surgery o Delirium o Diabetes o Urinary incontinence o Sleep disorders o Pressure ulcers o Adequate walking routine

Falls and gait abnormalities Frailty Delirium Urinary incontinence Sleep disorders Pressure ulcers

As a nurse caring for a cognitively impaired older adult client, you need to observe for which of the following? Select all that apply. Increased confusion Agitation Aggression Decreased passivity Pointing to a grimacing face or crying Staring off into space

Increased confusion Agitation Aggression Pointing to a grimacing face or crying

According to research evidence, the pain experience in older adults is best characterized by which statement? Pain is a normal part of aging. The ability to feel pain diminishes with age. Pain is expected and well-tolerated with age. Many older adults have pain that is untreated.

Many older adults have pain that is untreated.

To assess pain in a non-verbal older adult, which one of the following assessment scales is most frequently commended? Numeric rating scale Simple descriptive rating scale Older Adult Faces Pain Scale PAINAD scale

Older Adult Faces Pain Scale Nonverbal: Objective pain behaviors/indicators [facial expressions, verbalizations, body mvmts., change in interpersonal interactions, change in activity patterns, mental status change] BPSD: Behavioral and Psychiatric symptoms of Dementia - assess pain in dementia pts. PAINAD - assesses pain in advanced dementia PACSLAC - Pain Assessment Checklist for Seniors with Limited ability to communicate

SLEEP Which one of the following interventions is best for promoting sleep in an older adult living at home with poor sleep? Increased daytime napping Watching TV in bed until falling asleep Diphenhydramine (Benadyl) 25 mg before bed Relaxation exercises

Relaxation exercises

As a nurse, you know that sleep and rest are physiological and mental necessities for survival. Which of the following statements is incorrect about rest and sleep? Sleep is a basic need. Sleep occupies half of our lives. Rest occurs with sleep. Deprivation of sleep may adversely affect older adults.

Sleep occupies half of our lives. Sleep occupies 1/3 of our lives Sleep occupies approximately one third of our lives and is a vital function and basic need. Sleep is a basic need and is an extension of rest, both of which are physiological and mental necessities for survival. Rest occurs with sleep in sustained unbroken periods. Sleep deprivation and fragmentation of sleep in older adults may adversely affect cognitive, emotional, and physical functioning, as well as the quality of life.

The best gerontological nursing care is that in which Nursing is provided in a judgmental manner. The goal of comfort is to lessen pain as much as possible. Undertreatment of pain may be caused by a nurse's own definitions of pain. The key person in the assessment of pain is the nurse

The key person in the assessment of pain in The nurse is the key person in the assessment of the level of comfort in persons receiving care and is usually the most attuned to the needs of patients. The best care is given in a nonjudgmental manner. The goal of comfort is not to simply lessen pain, but it is also to relieve it and to prevent it from reoccurring. The reasons for undertreating pain include the nurse's own definition of pain and his or her expectations of how his or her own pain is expressed.

For an older adult client who is having trouble sleeping at night, you would implement all the following EXCEPT sleep restriction therapy. relaxation therapy. soft music. administration of a sedative.

administration of a sedative. Sedatives and hypnotics should be avoided. Restriction of sleep during the day will assist the client in sleeping at night because he or she will be tired. Relaxation therapy might calm a client enough to enable him or her to sleep. Soft music is a type of relaxation therapy that might help sooth a client.

2. What type of physical activity is recommended for individuals with arthritis or mobility limitations? a. Yoga b. Dancing c. Biking d. Swimming

d. Swimming The high prevalence of joint diseases, such as osteoarthritis, may hamper successful performance of aerobic exercises that cause joint impact. Muscle-strengthening exercises without weight bearing provide more joint stability. Swimming is a low-risk activity that provides aerobic benefit, and water-based exercises are particularly beneficial for individuals with arthritis or other mobility limitations. Biking and dancing are activities aimed at improving cardiovascular fitness. Yoga is useful for flexibility.