NUR 356 Test #1 Review

Programmed Longevity

Biological theory of aging that states that aging follows a biological timetable.

Needs of the patient

Component of ethical decision making that deals with psychological needs and coping mechanisms.

Opportunities for Voice to be heard

Component of ethical decision making that deals with setting up family meetings; ie. palliative care meetings to inform family of all options available, including no treatment.

Patient Preferences

Component of ethical decision making that deals with what the wishes of the patient are; MOST form.

Other cardiac chnges

-10% pacemaker cells functional -Decreased AV and Left Bundle branch cells -Decreased Beta Adrenergic stimulation -Increased PR, QRS, QT Intevals -Increased Blood Pressure

Benefits of Healthy Aging

-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.

Cognitive effects of Aging

-Decreased information processing speed -Decreased attention span and multi-task ability -Decreased recollection ability -Decreased abstract and cognitive flexibility -Stable: personality and recognition (though may need cuing)

Factors that affect age

-Genetics -Physical -Social Environments

Opportunities to Improve Older Americans' Health and Quality of Life

-Healthy Lifestyles -Early detection of disease -Immunizations -Injury prevention -Self-management techniques

Where is geriatric care delivered?

-Home -Adult daycare -Skilled nursing facilities -Rehabilitation centers

Cognition Intervention Measures

-Make lists, note-taking -Repetition of activities -Keep mind stimulated -Ok to forget where, but not the what or the purpose

IOM Recommendations

-Nursing doctorates double by 2020 -Engage in lifelong learning -Leader of change increasing health

QSEN Standards for Oral Cavity

-Patient Centered Care -Teamwork and Collaboration -Evidence Based Practice -Quality Improvement -Mouth care should be given q8hr per text; but q2hr recommended- swab, npo

Goals of QSEN

-Patient-centered nursing care -Interdisciplinary team approach -Communication -Collaboration with teams

Adult-gerontological nurse practitioner or clinical nurse specialist (APRN specialization)

-RN licensure and 500 supervised clinical hours; completion of advanced pathophysiology, pharmacology, and health assessment courses.

Gerontological Nurse requirements

-RN with 2 years of practice -2000 hours of clinical practice -30 continuing ed hours in past 3 years

Best Practice Considerations for Ethnogeriatrics and Cultural Competence for Nursing Practice

-Respect -Death and dying -Gender-specific care -Modesty -Touch -Space -Pain -Medicines and Nutrition -Independence -Manners

Methods of Enhancing Communication

-Speak in soft low tone, facing the client -Don't stand over client; maintain eye-level -Look for non-verbal cues of being understood -Keep instruction short and simple; no jargon -Provide both verbal and written instructions -Don't address as "honey, sweetie" -Use their legal name, how they want to be addressed -Don't assume anything!

Global population expected to be over _________ people over age ______.

2 billion; 60

Hispanic aging population will increase from to _____ of older population

20%

1 out of every ____ U.S. residents will be age _____ or older by ________.

5; 65; 2030.

Population of ____ year-olds expected to _______ worldwide within next _____ years.

60; double; 50.

Ethnicity

A social group within the social system that claims to possess variable traits; i.e. Common religion or language.

AGNP-BC; AGCNS-BC

Adult-Gerontological Nurse Practitioner, (Clinical Nurse Specialist), Board Certified

Young Old

Ages 65-74

Middle Old

Ages 75-84

Old Old

Ages 85+

What vitamin deficiency leads to Glossodynia (burning mouth)?

B vitamins

What vitamin deficiency leads to angular cheilosis (cracking in corner of mouth)?

B vitamins, iron

Religion

Belief in a divine or superhuman power(s) to be obeyed and worshipped as the creator(s) and ruler(s) of the universe; and a system of beliefs, practices, and ethical values.

Error Aging Theories

Biological theories that emphasize environmental assaults to the human system

Practice Pearl- Postural BP

Because changes of aging cause the baroreceptors to be less efficient, it is essential to check postural blood pressures in older patients to detect postural hypotension and teach patients to prevent falls by changing positions slowly.

American Nurses Association (ANA)

Defines the scope and standards of nursing practice. Includes levels of nursing function, roles, and work setting, quality, evidence, and safety. -Each state sets nursing parameters

Power/conflict issues

Component of ethical decision making that deals with power struggle between family and clinicians

Falls can be the first sign of ________.

Cardiac conditions

Collateral circulation

Compensatory changes from which additional blood vessels develop for alternate routes for blood to flow; can effect how blockage is experienced as in MI.

Family preferences

Component of ethical decision making that deals with children possibly being the caregivers and decision makers for their mother or father.

Contextual factors

Component of ethical decision making that deals with factors relating to their plan of care; ie, culture, socioeconomic factors.

Decision-making capabiliy

Component of ethical decision making that deals with mental status of patient- Do they have a Guardian of HCPOA? Have they been determined incompetent by a judge? Are they receiving medications to alter ability to think?

Assessment

Component of ethical decision making that deals with patient condition and plan of care.

Medicare Part A

Covers hospitalizations

Medicare Part B

Covers medical coverage- doctor visits

Cross-Cultural Communication

Cultural competence standard for knowledge of verbal and nonverbal communication skills.

Evidence-Based Practice and Research

Cultural competence standard for research-based practice that will be effective in multi-cultural populations.

Policy Development

Cultural competence standard for the development of knowledge and skills to establish comprehensive policies in both the pubic and private sectors.

Cross-Cultural Leadership

Cultural competence standard for the development of knowledge and skills to influence others to achieve cultural competent care.

Social Justice

Cultural competence standard that promotes social justice for all.

Patient Advocacy and Empowerment

Cultural competence standard to advocate for the inclusion of patient's cultural beliefs and practices in all facets of health care.

Knowledge of Cultures

Cultural competence standard to develop understanding of the perspectives, traditions, and so forth of the communities of the population they care for.

Multicultural Workforce

Cultural competence standard to engage in efforts to ensure a multicultural workforce.

Education and Training in Culturally Competent Care

Cultural competence standard to have educational preparation to provide culturally competent care.

Cultural Competence in Healthcare Systems

Cultural competence standard to provide the structure and resources necessary to meet the cultural and language needs of patients.

Critical Reflection

Cultural competence standard to understand one's own values, beliefs, and cultural heritage to have awareness of how these attributes affect culturally congruent care.

Culturally Competent Practice

Cultural competence standard to use cross-cultural knowledge and culturally sensitive skills in implementing care.

Myth: Health promotion is wasted on older people.

Truth: Never too late to start good lifestyle habits; there are still some outcomes that are at least partially reversible if bad habits are stopped.

Myth: Most people are set in their ways and cannot learn new things or take up new activities.

Truth: Older people should be challenged to stay mentally active; healthy older adults find hobbies they enjoy to give life meaning and pleasure.

National Institutes on Aging

Developed by Congress in 1974 as part of NIH to have a focus on gerontology health promotion and maintaining function through research.

Disease signs and symptoms may present ________ in the elderly; they may be ________.

Differently; masked

Cardiac output _________.

Declines from 5L to down to 3.5L.

Myth: Older adults do not pull their own weight and are a drain on societal resources.

Truth: Older people support society and their families; some work, volunteer, and mentor.

Secondary Prevention

Early Diagnosis and Prompt Treatment; examples are: -Screening questions and health assessment -Referral for examination and testing -Disease cure and aggressive treatment to limit disability and stop disease progression

Division of Geriatric Nursing Practice

Established by ANA in 1966; 1970 statement on the scope of gerontological nursing practice developed to address health promotion; name changed in 1976 to emphasize health in addition to diseases of old age.

Myth: Older people have no interest in sex.

Truth: Sexual activity does decrease, but the human need for affection and physical contact continues throughout life.

Justice

Fair distribution of scarce resources to all in need.

Geriatrics

Field of medicine involving health and disease later in life and after the care of older people including their caregivers.

Primary Prevention

Health Promotion; examples include: -Education about healthy lifestyle -Injury prevention -Nutritional assessment and guidance -Exercise Rx as appropriate -Avoidance of tobacco -Alcohol moderation -Limiting exposure/ avoiding carcinogens

Culturally competent care

Health needs individualized and specific to the patient in a culturally-appropriate context.

Leading cause of death for Americans over 65 is:

Heart disease

Gerontology

Holistic study of aging processes and individuals throughout the lifespan.

Practice Pearl- Cardiac Risk Factors

Identification of cardiac risk factors including smoking, dyslipidemia, obesity, and diabetes mellitus is crucial in treating older adults with hypertension.

Practice Pearl- Systolic BP

If left uncontrolled, high systolic pressure can lead to stroke, myorcardial infarction, heart failure, kidney damage, blindness, or other conditions. Although it cannot be cured once it has developed, isolated systolic hypertension, ISH, can be controlled. Progressive physical activity can reduce vascular wall stiffness and reduce systolic hypertension. Nurses can help patients understand the importance of remaining active in their later years.

Myocardial Hypertrophy

Increase of muscle cells in myocardium.

Left ventricular wall in elderly ________ with age.

Increases by up to 25%

QSEN

Its goal is to prepare future nurses with knowledge, skills, attitudes to increase safety and quality in healthcare setting.

2nd leading cause of death for Americans over 65 is:

Malignant neoplasms

Practice Pearl- Female CV Symptoms

Many older women will complain of vague symptoms when having a myocardial infarction, including fatigue, sleep disturbances, and epigastric pain. Be sure to refer older patients with any of these complaints for medical evaluation and teach them to report such symptoms. Also true of diabetics.

Medicare Part C

Medicare Advantage programs- PPO's, HMO's

Medicare Part D

Medication coverage- Rx's

Competing interests

Most challenging component of ethical decision making that deals with the interests of family, healthcare team, on futile utilization of scarce resources.

Medicare

National health insurance through federal government for Americans aged 65 or older, or younger than 65 and disabled, or people with ESRD on dialysis.

Practice Pearl- Atrial Fibrillation

New-onset atrial fibrillation and other arrhythmias may signal the onset of serious underlying illness such as hyperthyroidism, electrolyte disturbances, or myocardial infarction. All older patients with complaints of "skipped beats" or "fluttering in the chest" should be referred for medical evaluation.

What vitamin deficiency leads to Glossitis (tongue inflammation)?

Niacin, folic acid, B6, B12

What vitamin deficiency leads to Stomatitis?

Niancin, folic acid, B12

Culturally appropriate

Nurse applies cultural background knowledge to care situation.

Cultural competence

Nurse is aware of culturally-sensitive needs of a patient and makes them available.

Heritage inconsistency

Observance of the beliefs and practices of one's acculturated belief system; includes the determination of one's cultural, ethnic, and religious background.

Practice Pearl- Kidney Disease

Older patients with chronic kidney disease or diabetes should be aggressively treated because of additional risk. Their blood pressure goal is below 130/80 mmHg.

Compensation

Phenomena during which other body system changes can affect the cardiovascular system. Systems are interrelated; cardiovascular affects neurological and endocrine systems.

Healthy People 2020

Prevention agenda for the United States; establishes quality measures by identifying levels of training for people who care for older adults; aims to achieve health equity, eliminate disparities, and improve the health of all groups.

Socialization

Process of being raised within a culture and acquiring the characteristics of that group.

Gerontologists

Professionals studying gerontology or the aging process

Primary goal of Gerontological Nursing

Provide high quality care to older adults.

Erikson's Developmental Theory

Psychological theory that includes the 8 stages of life- the older adult deals with integrity vs. despair.

Jung's Theory of Individualism

Psychological theory that states as a person ages, focus goes from extroversion to introversion.

RN-BC

Registered Nurse, Board Certified: Gerontological Nurse

Resting heart with aging __________.

Remains the same.

Tertiary Prevention

Restoration and Rehabilitation; examples include: -Multidisciplinary rehabilitation -Short term placement in rehab or home rehab -Appropriate services and aids to increase independence

Culturally appropriate services

Services relating to specific cultural needs provided by healthcare professionals.

Continuity Theory

Sociological theory that states that aging involves maintaining previous values and habits.

Activity Theory

Sociological theory that states that older adults stay active and engaged to enjoy old age.

Disengagement Theory

Sociological theory that states that older people and society engage in a mutual ad reciprocal withdrawal.

Changes in valve rings lead to ________ or _________.

Stenosis, incompetence.

Heart valves ________ due _____________ and ________.

Stiffen; fibrosis, calcification.

Culture

The language, thoughts, beliefs, values, and institutions of racial, ethnic, religious, or social groups.

Practice Pearl- Older heart and stress

The older heart cannot respond to stressful stimuli as well as the younger heart. Caution your sedentary older patients not to engage in stressful activities like vigorous shoveling of snow or heavy yard work without engaging in gradual exercise program to build fitness.

National CLAS Standards

These are intended to advance health equity, improve quality, and help eliminate health disparities by establishing a blueprint for individuals as well as health and health care organizations to implement culturally and linguistically appropriate services.

Beneficience

To do good, to benefit others.

Nonmaleficence

To do no harm.

Gerontology Nurse Role

To provide care to people while respecting rights.

Autonomy

To respect patients' freedom, self-determination, and rights.

African-American elderly will _____ by _____.

Triple; 2030

Myth: Being old means being sick.

Truth: Many older adults function well with chronic conditions; fewer than 5% require skilled facility care.

Myth: Older people are isolated and lonely.

Truth: Many older people join clubs and volunteer to stay active and connected.

What vitamin deficiency leads to Xerostomia (dry mouth)?

Vitamin A, Vitamin B12

What vitamin deficiency leads to bleeding gums?

Vitamin C, Vitamin K

Leuokoplakia

White patches, oral thrush