Gerontology test 1

Chapter 23: Economic and legal issues: KEY POINTS

- A combination of social security and supplementary security income payments provides eligible persons with a regular income after 65 or earlier if disabled. - Medicare, Medicaid, and TRICARE are insurance plans for specific groups of people. - Medicaid pays for a large portion of the cost associated with nursing home care. - In order for Medicare to pay for the expenses related to long term care or home health care, strict criteria of medical necessity must be met. - Elder abuse requires a situation of caregiving; however either the care recipient or the care giver may be the perpetrator. - In most jurisdictions the nurse is required to report suspicions of abuse of the elderly and any person who in vulnerable.

Chapter 3: Care across the continuum: KEY POINTS

- A familiar and comfortable environment allows an elder to function at their highest capacity. - Culture change in nursing homes is a growing movement to develop models of person centered care and improve care outcomes and quality of life. - Relocation has variable effects, depending on the individuals personality, health, cognition, sense of control, opportunities for choice, self esteem, and preferred lifestyle.

Chapter 13: Promoting safety: KEY POINTS

- A thorough nursing assessment must include assessment of fall risk, balance, and gait; intrinsic, extrinsic, and iatrogenic factors; and post-fall assessments. - Implementation of individualized fall risk reduction interventions is one of the most important proactive considerations to preserve health and function for older adults. - Physical restraints are not appropriate for "safety" and increase injuries related to falls. - Restraint free care, fall risk reduction interventions, and a safe environment are essential to best practice care for elders. - Thermoregulatory changes, chronic illness, and medications may predispose the older adult to hypothermia and hyperthermia. Careful attention must be paid to temperature monitoring and provision of adequate heat and cooling in weather extremes. - Transportation for older adults is critical to their physical, psychological, and social health.

Chapter 24: Relationships, Roles, and Transitions: KEY POINTS

- Ability to successfully negotiate transitions depends on personal and environmental supports, timing, clarity of expectations, personality, and degree of change required. - Sexuality is love, sharing, trust, and warmth, as well as physical acts. Sexuality provides an individual with self-identity and affirmation of life. - AIDS awareness and the practice of safe sex among older adults is still lacking. - The incidence of AIDS and STDs in the older adult is rapidly increasing.

Chapter 7: Assessment and documentation for optimal care: KEY POINTS

- Assessment of the physical, cognitive, psychosocial, and environmental status is essential to meeting the specific needs of the older adult and implementing appropriate interventions. - Whether the data for an assessment tool are collected by self-report, report-by-proxy, or through nurse observation will affect the quality and quantity of the data. - Knowledge of how to use a particular gerontological assessment tool is needed to accurately administer it. - The medical and social complexity of many older adults complicates obtaining and interpreting assessment data. - Anticipate that hearing and vision may be impaired and compensation may be necessary. - For those with cognitive impairments, obtaining some assessment data from a proxy may be necessary but can only be done with the patient or legal representatives permission. - Documenting patient status and needs accurately is a key responsibility of the licensed nurse. - Nurses have a responsibility to protect patient confidentiality at all times, both in spoken communication and in the clinical record.

Chapter 2: Care of older adult

- By 2050, 1 in 5 Americans will be over 65 years old. - Older people today are healthier, better educated, and expect a higher quality of life. - Elder care is projected to be the fastest growing employment sector in the health care industry. - Older adults are the core consumers of health care, with higher rates of outpatient provider visits, hospitalizations, home care, and long-term care. - 7,128 geriatricians, one for every 2,546 older Americans. - Positive role models, a deep commitment to caring, and an appreciation of the significant contribution of a nursing model of care to the well being of older people, are motivating factors that draw nurses to the specialty.

Chapter 2: Key concepts

- Certification assures the public of nurses commitment to specialized education and qualification for the care of older adults. - All students graduating from nursing programs and all practicing nurses working with older adults should have competency in gerontological nursing. - The major changes in health care delivery and the increasing numbers of older adults have resulted in numerous revised, refined, and emergent roles for nurses in elder care.

Chapter 14: Living with chronic illness: KEY POINTS

- Declines in mortality, a growing older adult population, increasing medical expertise, and sophisticated technological developments have resulted in a great increase in the survival of the very old with multiple chronic disorders. - The effects of chronic illness range from mild to life-limiting, with each person responding to unique circumstances in a highly individualized manner. - The Chronic Illness Trajectory and the Shifting Perspectives Model of Chronic Illness offer useful frameworks to understand chronic illness and design nursing interventions. - People with chronic illness can achieve wellness, and the role of the nurse is critical in the promotion of wellness. - The goals of healthy aging include minimizing risk for disease, encouraging health promotion, and in the presence of disease, alleviating symptoms, delaying or avoiding the development of complications, and maximizing function and quality of life. - New models of cost effective care are needed that increase access and improve outcomes and quality of life for person with chronic illness. Nurses are particularly well prepared to assume major roles in chronic illness care.

Chapter 25: Loss, Death, and Palliative Care: KEY POINTS

- Grief is an emotional and behavioral response to loss. - One never completely resolves grief, instead, the individual incorporates the loss as part of his or her life through meaning. - Dying is a multifaceted, active process. It affects all involved.

Chapter 1: Introduction to healthy aging: KEY POINTS

- Health, history, and gender are among the major factors influencing the aging experience. - All persons, regardless of age or life and/or health situation, can be helped to achieve a higher level of awareness, which is uniquely and personally defined. - Maslow's hierarchy of needs can be used as an organizing framework for health promotion, regardless of age or situation.

Chapter 19: Cardiovascular and Respiratory disorders: KEY POINTS

- Heart disease is the most common cause of death for people in the US. - The underlying cause for the majority of cardiovascular and pulmonary disease is smoking. - Pneumonia and influenza are particularly important health problems for those over 65 and significantly more so for those who are frail, Immunocompromised, have HIV, or are otherwise decompensate. - The mortality associated with pneumonia can be minimized through the use of pneumonia and influenza vaccinations and excellent oral hygiene. - The goal of therapy for cardiac and respiratory disorders is to relieve symptoms, improve the quality of life, reduce mortality, stabilize and slow the progression of the disease, reduce the risk of exacerbation, and maximize functional capacity. - Careful attention to the early detection and prompt treatment of tuberculosis is necessary to continue in the attempt to completely eradicate this communicable disease.

Chapter 11: Rest, sleep, and activity: KEY POINTS

- Many chronic conditions interfere with the quality and quantity of sleep; rest and sleep are restorative, recuperative, and necessary for the preservation of life. - Sleep is a barometer of health and can be considered one of the vital signs. - Activity is an indication of an individuals health and wellness; inability to exercise, do physical work, or perform ADLs is one of the first indicators of decline. - Lack of physical activity increases the risk for many medical conditions experienced by elders. Exercise can be done by elders who are ambulatory, chair-bound, or bedridden and should include endurance exercises, strength, balance, and flexibility exercises. - Exercise maintains functional ability, enhances self-confidence and self sufficiency, decreases depression, improves general lifestyle, maintains mental functional capacity, and decreases the risk of medical problems. - Exercise counseling and an exercise prescription should be included in assessment of all older adults.

Chapter 22: Mental Health: KEY POINTS

- Mental health in late life is difficult to determine; it must be determined by the gratification and satisfaction that individuals feel I their particular situations. - The prevalence of mental health disorders is expected to increase significantly with the aging of the baby boomers. - Mental health disorders are underreported and under-diagnosed among older adults. Somatic complaints are often the presenting symptoms of mental health disorders, making diagnosis difficult. - The incidence of psychotic disorders with late-life onset is low among older adults. - Anxiety disorders are common in late life and reestablishing feelings of adequacy and control is the heart of crisis resolution and stress management. - Depression is the most common emotional disorder of aging and likewise the most treatable; it is usually neglected or assumed to be a condition of aging that one must "learn to live with". - An important nursing intervention is assessment of depression. - Suicide is a significant problem among older men, particularly widowers. Many come to be seen by the health care professional with physical complaints shortly before they commit suicide and assessment of depression and suicidal intent is important. - Substance abuse, particularly alcohol, and misuse of prescription drugs are often under-recognized and undertreated problems of older adults, particularly women

Chapter 18: Bone and joint problems: KEY POINTS

- Most people over 40 will have osteoarthritis at some point in their lives. - Osteoporosis is a crippling problem for many elders, especially women. Although it cannot be completely prevented, it can be minimized by early interventions: weight bearing exercise, and calcium and vitamin D intake. - The most serious outcomes of osteoporosis are fractures. - Rheumatoid arthritis produces swelling, inflammation, intense pain, and distortion of the joints. - Gout is an acute and chronic condition. One of the goals of treatment with gout is to minimize a future attack. - Individuals have found certain types of complementary and alternative interventions very helpful for joint disorders and chronic discomfort.

Chapter 6: Social, psychological, spiritual, and cognitive aspects of aging: KEY POINTS

- Normal aging involves a gradual process of biopsychosocial change over the course of time. - Life span development theorists tend to study the total life course of cohort groups to determine the influence of major historical events on their development. - The impact of gender, culture, and cohort must always be considered when discussing the validity of biopsychosocial theories. - Spirituality must be considered a significant factor in understanding healthy aging. - Late adulthood is no longer seen as a period of when growth ceases and cognitive development halts; rather it is seen as a life stage programmed for plasticity and the development of unique capacities. - Cognitive stimulation and attention to brain health is just as important as attention to physical health. - Learning in late life can be enhanced by utilizing principles of geragogy and adapting teaching strategies to minimize barriers such as hearing and vision impairment and low literacy.

Chapter 21: Cognitive impairment: KEY POINTS

- Nurses must advocate for thorough assessment of any elder who appears to be experiencing cognitive decline and inability to function in important aspects of life. - Delirium is sometimes the result of physiological imbalance, characterized by fluctuating levels of consciousness and frequent misperceptions and illusions; it often goes unrecognized and is attributed to age or dementia. - People with dementia are more susceptible to delirium. - Medications and pain are frequently the causes of delirious states in older people. - Irreversible dementias follow a pattern of inevitable decline accompanied by decreased intellectual function, personality changes, and impaired judgment. The most common of these is Alzheimer's disease. - Alzheimer's disease has no found cause or cure, evidences suggests the disease starts many years before symptoms appear; some medications slow the progress of the dementia for a time. - Individuals with cognitive impairment respond best to calmness and patience, adaptions of communication techniques, and environments and relationships that enhance function, support limitations, ensure safety, and provide opportunities for a meaningful quality of life. -Cognitively impaired people may be unable to express their feelings and needs in ways that are easily understood, the gerontological nurse must always try to understand the world from their perspective. - Families provide most of the care for persons with dementia, and while many gain satisfaction from this, they experience more adverse consequences than caregivers of other older adults. - Comprehensive interventions for both the person with dementia and the caregiver should begin early in the disease and continue throughout the trajectory.

Chapter 5: Theories of aging and physical changes: KEY POINTS

- Physiological aging begins at birth and is universal, progressive, and intrinsic. - Many of the normal changes with aging may be misinterpreted as being pathological, and some pathological conditions may be mistaken for normal changes of aging. - Careful assessment of individual aging changes, life style, and desires is fundamental to caring and the promotion of health in later life. - The nurse cannot rely on the typical signs of infection in the older adult but must use a more holistic approach.

Chapter 8: Safe medication use: KEY POINTS

- Polypharmacy is one of the most serious problems of elders today, and this is usually the first are to investigate when adverse events occur. - Nurses must consider the occurrence of a possible adverse medication effect immediately if a change in the persons condition is observed, including mental status changes. - Chronotherapy that uses biorhythms of the body for the most effective medication therapy has the potential to decrease dose, frequency, and cost of medication regimens and to improve adherence to drug therapy. - Psychotropic medications should reduce distress, clearer thinking, and more appropriate behavior. - It is always expected that pharmacological approaches augment rather than replace nonpharmacologic approaches. - The Omnibus Budget Reconciliation Act (OBRA) restricts the use of psychotropic drugs in long term care settings unless they are truly needed for specific disorders and to maintain or improve function. - Anytime a behavior change is noted in a person, reversible causes must be sought and treated before medications are used.

Chapter 4: Culture and aging: KEY POINTS

- Research has reveled significant and persistent inequities in the outcomes of health for persons from minority groups, with the members of these groups bearing the burden of morbidity and mortality in most areas. - Negative stereotyping is never appropriate. - Cultural awareness, knowledge, and skills are necessary to increase cultural competence. - Many elders hold health beliefs that are different from those of the biomedical or western medicine used by most health care professionals in the US. - Lack of awareness of the elders health belief system has the potential to produce conflict in the nursing situation. - Kleinmans explanatory model and the LEARN model provide a useful framework for working with elders of any ethnicity or background.

Chapter 17: Metabolic disorders: KEY POINTS

- Signs and symptoms of endocrine disorders in the older adult may be vague or suggestive of other medical conditions or considered as part of "old age" rather than the usual and expected symptoms. For example: polyuria, polydipsia, and polyphagia in an older adult with hyperglycemia are unusual. - Although thyroid disorders only affect a small number of persons, the incidence increases with age and is potentially life threatening. - Consideration of the persons life expectancy and the risks and benefits of treatment are taken into account when determining the appropriate level of glycemic control in the older adult with DM. - Management of diabetes is a comprehensive team effort and should include the elder as much as he or she can realistically participate. If this isn't possible, the caregiver, if not the nurse, will need to ensure that the medical regimen is effective. - Caring for persons with DM includes working with them to reduce their risk for cardiovascular diseases. - Preventive foot care is essential for prevention of the possibility of future foot problems. - Any time a person is being evaluated for depression, atrial fibrillation, dementia or confusion, the assessment should include consideration of a thyroid disturbance. - Very low doses of thyroid replacement are usually adequate in older adults. When dose changes are necessary, they must be made very slowly.

Chapter 15: Pain and comfort: KEY POINTS

- The absence of expressed pain does not necessarily imply comfort. Comfort is a state of ease and satisfaction of body needs, self worth, as well as freedom from pain and anxiety. - The experience of pain is not limited to that which is of physical origin. Pain related to psychological or spiritual factors can have the same effect and is often combined with that arising from physical causes. - Assessment of pain is influenced by many misconceptions, myths, and stereotypes about pain. Inadequate treatment of pain is a major concern for older adults in care settings today. - Culture, ethnicity, family, and individual characteristics all influence ones tolerance and expression of pain as well as the acceptance of relief interventions. - Older people with various degrees of cognitive impairment may demonstrate pain by increased levels of confusion, restlessness, or withdrawal. - It hasn't been show that pain sensitivity and perception decrease with age or changes in cognitive status.

Chapter 12: Promoting healthy skin and feet: KEY POINTS

- The skin is the largest organ of the body and has multiple roles in maintaining ones health. - Maintaining adequate oral hydration and skin lubricant will reduce the incidence of xerosis and other skin problems. - The best way to minimize the risk of skin cancer is to avoid prolonged sun exposure. - Mobility is fundamental to independence; therefore care of the feet and toenails is an important area for the gero nurse.

Chapter 20: Neurological disorders: KEY POINTS

- There are a number of thing that an individual can do to reduce their risk for cerebrovascular disease. - Ischemic strokes are the result of temporary loss of oxygen to the brain resulting in damage to this tissue. - Hemorrhagic strokes are less common than ischemic strokes but much more deadly and result from a rupture in a blood vessel in the brain. - For the best outcomes, immediate treatment is required; persons need to learn the signs and symptoms and how to activate the emergency response system. - Correct diagnosis of the type of stroke is necessary before treatment can begin. - Parkinsons disease is progressive and incurable at this time. - Parkinsons disease is a disorder that affects voluntary control of movement. - The signs and symptoms of Parkinsons disease initially may be mistaken for other common disorders seen in older adults. - Neurological disorders frequently affect ones ability to speak in a way that is understandable to others. - Working with people who have neurological disorders requires a team approach that includes professionals, the patient, and significant others.

Chapter 10: Elimination: KEY POINTS

- Urinary incontinence is not a part of normal aging. urinary incontinence is a symptom of an underlying problem and calls for a thorough assessment. - Urinary incontinence can be minimized or cured, and there are many therapeutic modalities available for treatment of UI that nurses can implement. - Health promotion teaching, identification of risk factors, comprehensive assessments of UI, education of informal and formal caregivers, and use of evidence based interventions are basic continence competencies for nurses. - A number of interventions for urinary incontinence are applicable to the management of bowel incontinence.

Chapter 16: Diseases affecting vision and hearing: KEY POINTS

- Vision loss from eye disease is a global concern and preventive interventions, early detection, and treatment of eye diseases is an important priority for nurses and other health care professionals. - The major diseases affecting vision are glaucoma, cataracts, macular degeneration, and diabetic retinopathy. - Ear damage and hearing impairment are increasing due to the aging of the population and increased exposure to loud noises such as blast exposure in combat situations among military personnel. - 2 types of hearing impairment= sensorineural and conductive hearing loss. - Tinnitus is a common condition among older people and can interfere with hearing, as well as become extremely irritating. It is characterized by ringing in the ear and may also manifest as buzzing, hissing, whistling, clicking, pulsating, or swishing sounds.

Chapter 9: Nutrition and hydration: KEY POINTS

- reduced calorie intake based on decreased caloric requirements. - Protein caloric malnutrition is the most common form of malnutrition in older adults. - Dental health of older adults is a basic need that is increasingly neglected. - Poor oral health is a risk for dehydration, malnutrition, and aspiration pneumonia. - Age related changes in the thirst mechanism, decrease in total body water (TBW), and decreased kidney function increases the risk for dehydration in older adults. - Dysphagia is a serious problem and contributes to weight loss, malnutrition, dehydration, aspiration pneumonia, and death.

Chapter 1: Maslow's Hierarchy of Needs

BOTTOM TO TOP: ----- biological and physiological integrity. ---- safety and security. --- belonging and attachment. -- self esteem and self efficacy. - self actualization and transcendence.

Chapter 6: Types of aging

Chronological age: - measured by number of years lived. Biological age: - predicted by persons physical condition and how well vital organs are functioning. Psychological age: - expressed through a person ability and control of memory, learning capacity, skills, emotions, and judgment.

Chapter 6: Sociological theories of aging

DISENGAGEMENT THEORY: - aging is inevitable, mutual withdrawal, resulting in decreased interaction. ACTIVITY THEORY: - remaining as active as possible in the pursuits of middle age is the ideal in later life. CONTINUITY THEORY: - life satisfaction with engagement or disengagement depends on personality traits. - personality traits remain quite stable; personality influences role activity and ones level of interest in a role; personality influences life satisfaction regardless of role activity. AGE STRATIFICATION THEORY: - helps understand the role, reactions, and the adaptions of older adults. SOCIAL EXCHANGE THEORY: - based on consideration of the cost benefit model of social participation. MODERNIZATION THEORY: - explains social changes that result in devaluing of both the contribution of elders and the elders themselves. SYMBOLIC INTERACTION THEORY: - focus on the interaction between the older adult and their social world.

Chapter 5: Biological theories of aging

ERROR THEORIES: - aging as a result of an accumulation of errors in the synthesis of cellular DNA and RNA; with each replication, more errors occur, until the cell is no longer able to function. - WEAR AND TEAR THEORY: --- cell errors are the result of "wearing out" over time because of continued use and trauma. - CROSS LINK THEORY: --- aging by accumulation of errors by cross linking or the stiffening of proteins in the cell. - OXIDATIVE STRESS THEORY: --- free radical theory; damaged caused by free radicals occurs faster than the cells can repair themselves. PROGRAMMED AGING (NONSTOCHASTIC THEORIES) - aging changes are predetermined at the cellular level. - NEUROENDOCRINE IMMUNOLOGICAL THEORY: --- programmed deaths of immune cells from free radicals.

Chapter 5: Physical changes that accompany aging

INTEGUMENT: - dryness, thinning, decreased elasticity, skin tears, purpura, xerosis, color change, texture change. HAIR & NAILS: - hair on head thins, ear eyes nose and eyebrow hairs increase and thicken. - nails become harder, thicker, more brittle, dull, opaque, and change shape; nail growth slows as well as blood supply. MUSCULOSKELETAL: - ligaments, tendons, and joints become dry, hardened, and less flexible; muscle tissue mass decreases; reduced bone marrow density. - sarcopenia= age related changes to muscles. CARDIOVASCULAR: - myocardial and blood vessel stiffening, decreased responsiveness to changes in CV demand; left ventricle wall thickens; decreased blood flow. RESPIRATORY: - Loss of elasticity resulting in stiffening of the chest wall, inefficiency in gas exchange, and increased resistance to air flow. RENAL: - decreased blood flow, GFR, and ability to regulate body fluids; kidneys decrease in size and function, usually at the top (kidney cortex). ENDOCRINE: - glands atrophy and decrease their rate of secretion, decreased sensitivity to insulin, increased incidence of hypothyroidism, thyroid fibrosis and inflammation occurs. REPRODUCTIVE: - females lose ability to procreate, men have decreased testosterone levels and have erectile changes. DIGESTIVE: - decrease enamel and dentin (dental caries), xerostomia, edentulous, decreased appetite, weight loss, GERD, more susceptible to peptic ulcer disease, stomach delays emptying time, nutrient absorption is affected, peristalsis is slowed, and increased incidence of gallstones. NEUROLOGIC: - # of neurons decreases, dendrites appear to be "warn out", decrease in brain weight and size, sleep disturbances, increased risk for injury, tactile sensitivity decreases, altered proprioception. SENSORY: - presbyopia (decrease in near vision), dry eyes, more rigid and thickened lens, color perception decreases, light scattering increases, presbycusis (loss of ability to hear high frequency sounds).

Chapter 6: Psychological theories of aging

Jung's theories of personality: - a personality is either extroverted and oriented toward the external world or introverted and oriented toward the subjective inner world of the individual. - Aging results in the movement from extraversion to introversion. Developmental theories: - ego differentiation versus work role preoccupation. - body transcendence versus body preoccupation. - ego transcendence versus ego preoccupation. Theory of Gerotranscendence: - a high degree of life satisfaction; midlife patterns and ideals are no longer prime motivators; complex and active coping patterns. - A greater need for solitary philosophizing, meditation, and solitude; social activities are not essential to well being; satisfaction with self selected social activities; less concern with body image and material possessions. - Decreased fear of death; affinity with past and future generations; decreased self centeredness and increased altruism.