EXAM 1

Typically, when discussing the topic of suicide, the discussion is targeted to younger or middle-aged adults. However, older adults actually account for 20% of the suicide deaths in the United States. When assessing an older adult client, you believe that suicide might be his intent. Which of the following questions should you ask? (SATA) "Have you ever thought about killing yourself?" "Why do you think you will not be around much longer?" "How often have you had these thoughts?" "How would you kill yourself if you decided to do it?" "Do you have the implement to kill yourself?" "Have you thought of those who love you?"

-"Have you ever thought about killing yourself?" -"How often have you had these thoughts?" -"How would you kill yourself if you decided to do it?" -"Do you have the implement to kill yourself?"

Anomic Aphasia

-Able to understand and speak but may have severe word finding difficulty

SMAAST-G

-An alcohol screening assessment for older adults who may show signs of drinking problems. Older adults show different signs than younger adults so this version asks questions tailored to that population

donepezil

-Anti-Alzheimer's agent -Category C cholinergic

memantine

-Anti-Alzheimer's agent -N-methyl-D-aspartate antagonist -Category B

When discussing with an older adult client his psychiatric care, he says to you, "When I was growing up, I was taught to accept my lot in life and not to complain. I am proud of the fact that, despite my issues, I can still function independently. I do not want to be just put away." Of the factors that influence mental health care, you realize that this client is demonstrating an example of which one of the following? Settings of care Attitudes and beliefs Cultural and ethnic disparities Anxiety disorder

-Attitudes and beliefs

Individuals who are 100 to 109 years of age are known as centenarians. supercentenarians. those in between. baby boomers.

-Centenarians. Centenarians are those who are between the ages of 100 and 109 years of age, with the majority between 100 and 104 years of age. Supercentenarians are the elite who are 110 years of age or older. Those in between are born between 1915 and 1945—between baby boomers and centenarians—usually between 70 and 99 years of age. Baby boomers are the youngest of the "older generation"—born between 1946 and 1964.

Healthy People 2020 has identified emerging issues and recommendations for the aging baby boomers and those in between. Which of the following are Healthy People 2020's recommendations? (SATA) Coordinate care. Establish quantity measures. Research and analyze appropriate training to equip providers. Identify minimum levels of training for people who care for older adults.

-Coordinate care. -Research and analyze appropriate training to equip providers. -Identify minimum levels of training for people who care for older adults.

An older adult client has the following symptoms: disturbances in attention and awareness, changes in cognition, and delusional thoughts and behavior. You have watched these symptoms develop over the past couple of days. Considering what you know about cognitive impairment, you realize your client is experiencing which one of the following conditions? Dementia Delirium Lowered stress threshold Normal-pressure hydrocephalus

-Delirium

What are the 3 D's of Cognitive Impairment?

-Dementia -Delirium -Depression

Late Onset Alzheimer's (N)

-Develops after 60 years of age related to genes, lifestyle, and environment

Early Onset Alzheimer's (D)

-Develops between 30-60 years of age related to gene mutations on chromosomes 21, 14, 1

How long does it take for delirium to develop?

-Develops over a short period of time (hours to days)

Verbal Apraxia

-Disruption in the brains transmission of signals to the muscles -aphasia and apraxia usually happen together

When assessing an older adult client before noon, you smell alcohol on his breath. You suspect he is an alcoholic when you observe which of the following signs? (SATA) Good nutritional habits Excessive mood swings Family conflict Poor hygiene Irritability Maintenance of cognition

-Excessive mood swings -Family conflict -Poor hygiene -Irritability -Maintenance of cognition

Nutrition w/ Wanderers / Dementia

-Give them Finger foods!! -risk of wt. loss: lack of awareness to eat, depression, not being able to feed themselves, vision impairment, wandering, pacing -Interventions: routine schedule, food preferences, available 24 hours a day

Benzotropine

-Helps control tremor, shaking, and unsteadiness -Category C -Anti-Parkinson Agent -Anticholinergics

Dysarthria

-Impairment of the ability to articulate words -Can be caused by a weakness for incoordination of the speech muscles

When established in 1935, what effect did Social Security have by setting the retirement age at 65 years? It allowed older persons to work until they made the decision to stop. It set a time frame to describe someone as being old. It made it mandatory for all individuals to retire at 65 years of age. It made everyone realize that they could quit work at 65 years of age and live comfortably on the benefits.

-It set a time frame to describe someone as being old.

Alzheimer's Stages

-Mild: lasts 2-4 years, minor memory loss, lives at home, remembers family -Moderate: lasts 2-10 years, has trouble w/ self-care, anxiety/frustration, stops sleeping well/through the night, caregiver burnout starts -Severe: lasts 1-3 years, incontinent, pt. makes no sense, wanders, paces, inappropriate, does not recognize family

Time / Focus / Goal of Alzheimer's

-No cure -meds. won't stop decline, just by time and reduce symptoms -chart progression of disease -AVOID reality orientation -EX: Donepezil, Memantine

Which of the following therapies would not be beneficial for an older adult client with Parkinson's disease (PD)? Range-of-motion (ROM) and balance exercises Adaptive equipment for eating and self-care Facial exercises and swallowing techniques Nonparticipation in activities as a result of slowed movements and tremors

-Nonparticipation in activities as a result of slowed movements and tremors

In assessing an older adult client, you notice symptoms that include bradykinesia, a reduction in facial muscle movement, and tremors. You realize that this client possibly has which one the following conditions? Alzheimer's disease Parkinson's disease Festination disorder Anomia

-Parkinson's disease

Your client has perceptual disturbances and misinterpretations of reality. When providing care for her, you learn that she does not like bathing. When approached, she screams at you and strikes out. Which of the suggestions below might make her more comfortable? (SATA) Playing background music Using bathing terminology Singing to her Washing her hair first Keeping the room warm and low lit Bathing the least sensitive areas first

-Playing background music -Singing to her -Keeping the room warm and low lit -Bathing the least sensitive areas first

An older adult client is talking to you about his Vietnam experiences and shares that he still has flashbacks to that time. While assessing him, you notice that he is jumpy, has startle reactions, and has poor concentration. You realize these are symptoms of which of the following? Posttraumatic stress disorder (PTSD) Obsessive-compulsive disorder (OCD) Delusions Hallucinations

-Posttraumatic stress disorder (PTSD)

Fluent (wernicke's) Aphasia

-Problem finding the correct word and substituting it without realizing it

Parkinsons Symptoms

-Resting Tremor -Muscular Rigidity -Bradykinesia -Postural Instability -Shuffling gate (later onset)

You understand from an older adult client that he experienced a TIA last week. You realize that he would benefit from some education on how to prevent another TIA or stroke. You instruct him in which of the following? (SATA) Stop smoking. Maintain blood pressure at levels equal to or less than 130/85 mm Hg. Initiate an exercise program. Immediately stop all aspirin. Monitor for skin breakdown. Maintain control of diabetes.

-Stop smoking. -Maintain blood pressure at levels equal to or -less than 130/85 mm Hg. -Initiate an exercise program. -Maintain control of diabetes.

ADL's can seem like an attack when they are tasked focused (T or F)

-True -ADL's should be person focused. Utilize prior bathing routines, accept a refusal of participation, explain every step.

Anomia

-Unable to recall the names of everyday objects -aphasia and apraxia usually happen together

Global Aphasia

-Unable to understand words or speak intelligibly

Nonfluent (Broca's) Aphasia

-Understands the words but speaks slowly with minimal amount of words

carbidopa/ levodopa

-Used for Parkinson's disease -Treats S/S -Category C dopamine agonist -Test for Parkinson's. If symptoms improve its a positive response

Components to a cognitive assessment include all of the following EXCEPT differentiating among delirium, dementia, and depression. comprehensive assessment. a complete blood count (CBC). assessing for atypical presentation of illness.

-a complete blood count (CBC).

Only Definitive way to diagnose Alzheimer's

-after autopsy, brain will have neurofibrially tangles and plaques

Delirium

-an acute decline in cognitive function and attention and represents brain failure

You know your client has reached a state of wellness when (SATA) as a 91-year-old, he still enjoys going out to dinner and dancing. he bowls every week with his friends. he still likes to go with his wife to the grocery store, although he has hip pain and uses a walker. he continues to eat his green, leafy vegetables while taking Coumadin. he says to you, "I have smoked all my life, and I am not going to stop now." he says, "I am a devout Christian and believe that my God is with me always. I am not afraid of dying."

-as a 91-year-old, he still enjoys going out to dinner and dancing. -he bowls every week with his friends. -he still likes to go with his wife to the grocery store, although he has hip pain and uses a walker. -he says, "I am a devout Christian and believe that my God is with me always. I am not afraid of dying."

Dementia Symptoms

-cognitive deficits in multiple domains -progressive deterioration -cognitive impairment interferes w/ ADLs

You realize your client has suffered a hemorrhagic stroke because he: is not experiencing any arrhythmias. has no coagulation disorders. is not dehydrated or hypotensive. experiences seizures and has a depressed level of consciousness.

-experiences seizures and has a depressed level of consciousness.

An older adult client's family has made the difficult decision to place him in a nursing home. You discuss with the family about person-centered care and explain that this care (SATA) fosters abilities. focuses on the disease. enhances quality of life. offers hope. supports limitations. maintains quality of life.

-fosters abilities. -focuses on the disease. -enhances quality of life. -offers hope. -supports limitations.

You realize that an older adult client has had a transient ischemic attack (TIA) when: he has had no resolution of his symptoms. his right side remains nonfunctional. his symptoms begin to resolve within minutes. he has developed an expressive aphasia.

-his symptoms begin to resolve within minutes.

The overriding goals in caring for older adults with dementia would include all of the following EXCEPT limit opportunities for interaction. structure the environment. maintain function. create a therapeutic milieu.

-limit opportunities for interaction.

The following statements describe a mentally healthy person EXCEPT an individual who successfully adapts to life's challenges. demonstrates flexibility. sustains positive interpersonal relationships. maintains minimum resilience.

-maintains minimum resilience.

Alzheimer's

-most common type of dementia -onset is gradual/slow, irreversible -steady and progressive -Most common early Sx/Sx: forgetting newly learned info.

Alcohol abuse

-most common type of substance abuse DO -withdrawal Sx/Sx: tremor, anxiety, nausea, insomnia, tachycardia, and increased BP

Examples of interventions to promote wellness include all of the following EXCEPT influenza and pneumonia vaccinations. breast cancer screenings. psychiatric screenings. colorectal screenings.

-psychiatric screenings.

Factors that influence the aging experience include (SATA) retirement grandchildren chronic illness lack of medical care quality of care

-retirement -grandchildren -chronic illness -lack of medical care -quality of care

Geriatric Depression Scale

-used for cognitively intact or those with mild to moderate cognitive impairment -includes self report

Cornell Scale for Depression in Dementia

-used for severe cognitive impairment -includes an interview with patient and informant

Life Review Therapy

-used in elderly to go back and look / review their life -looking over years: childhood, parenthood, becoming grandparent, marriage, etc.

CAGE Alcohol Assessment

C - Cut down A - Annoyed G - Guilty E - Eye Opener

What Causes Delirium? DELIRIUM

D-Dementia E-Electrolytes (potassium) L-Lungs, liver, heart, kidney, brain I-Infection R-Rx (polypharmacy & psychotropics) I-Injury, pain, stress U-Unfamiliar environment M-Metabolic

Is depression a normal part of aging? (T or F)

False -It is the most common mental health issue and a major reasons for nursing home admittance. -Depression doubles the probability of becoming sick

What is the number one way older adults commit suicide? suffocation poisoning firearms

Firearms

Scales used for Depression screening

Geriatric Depression Scale Cornell Scale for Depression in Dementia

Wandering

a syndrome of dementia-related locomotion behavior having a frequent, repetitive, temporally disordered, spatially disoriented nature that is manifested in lapping, random, or pacing patterns, some of which are associated with eloping or getting lost unless accompanied

Physical symptoms of depression can include (SATA) chronic pain memory loss increased appetite and weight gain decreased appetite and weight loss insomnia

chronic pain memory loss decreased appetite and weight loss insomnia