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Care of the older Adult Study Guide Lisa Campbell-Lown

Which of the following statements is true about serious chronic illnesses? The majority of annual US health care spending goes towards chronic illness What should drive decision making in palliative care? Patient goals of care Mr. R tells you that he is frightened by not knowing what happens after death. Which domain of quality of life is being affected by his serious illness? Spiritual Which statement reflects the importance of learning about palliative care as a student nurse? Future employers expect you to have education and training in palliative care services The nurse is positioning a bed-monitoring device for a client who is at risk of wandering where should the nurse place the infrared beam detector? On the wall

What is the purpose of making the client wear nonskid slippers? To prevent falls

While caring for a client with immobility the RN applies a trochanter roll after placing the client in supine position. What is the rationale behind this nursing intervention? Prevent external hip rotation A geriatric client who has a risk of falls is on a bed monitor. What should the nurse do while caring for the patient: Disconnect alarm before assisting patient out of bed The nurse caring for elderly patient who has functional impairment which action of the nurse helps to provide safe and effective care? Attaching bed rails to the patient bed The RN is teaching a student nurse about guidelines for caring for patient with restraining devise. Which statement of the student nurse indicated effective learning? I should check for symptoms of cyanosis and pallor at the site where the restraint is applied The RN is providing palliative care for a geriatric patient with functional impairment who is placed on an enclosed bed. The nurse teaches care guidelines to patient’s family member indicates the need for future teaching? I should keep the bed in high position What is a mini cog? 3 item recall and clock drawing test What is the confusion assessment method? -This tool helps RN quickly identify Delirium

What is the Braden Scale? A tool that assess sensory perception, moisture, activity, mobility, nutrition, and friction What is the BEER’s List? -A list that includes commonly prescribed meds which may cause increased risk to elderly patient What is the SPICES tool? This tool assesses: SLEEP Problems W/eating Incontinence Confusion Evidence of fall Skin Breakdown What is an example of primary prevention? Getting a flu shot What are extrinsic risk factors? Factors including rungs, poor lighting, stairs, and side rails What is Fragility? This is a general decline in physical function with unintentional weight loss, weak grip/strength, and slow walking speed What are instrumental activities of daily living? Examples are: cleaning, cooking, shopping, and paying bills What is Healthy People 2010? This health-oriented iniative has a major goal of eliminating healthcare disparity between cultural groups

Who Qualifies for Medicare? -People age 65 -People with ESRD -Diabetes -People retired from Rail Road What is Medicare Part D? -The part of Medicare that covers prescription Drugs What is the patient protection and affordable care act? It eliminates lifetime insurance gaps, provides free preventive care, provides insurance plans for patients with preexisting conditions, Allow children to stay on parents plan till age 26 What are social security benefits? These benefits are reduced if a person retires early. What are the IHI Triple Aim goals? 1. Improve pt quality /satifsication 2. Improve population health 3. Reduce healthcare cost What is interdisciplinary Team? It brings together diverse expertise to provide better-coordinated better quality care

What is care Transitions? The major goal is to reduce avoidable readmissions

What is discharge preparations checklist? This tool ensures that a pt. understands meds, who to contact if problems arise and when to follow up What is delegation? This is authority to s specific person for a specific task What is absent medication reconciliation? This is common, preventable error that occurs during transition of care What is health care power of attorney? This person makes healthcare decisions for a pt. who is unable to do so for himself What is hospice? This is appropriate referral when a pt. has a life expectancy of 6 months or less What is palliative care? This is comprehensive management of physical psychological social and spiritual needs of pt. with incurable illness What is visceral nonciorecptive pain? This type of pain usually responds well to opioid treatment Which physiologic changes in the elderly patient affects medication dosing? Reduced hepatic and renal blood flow, lower total body water, higher percentage of body fat

What is AAC? (Augmentative and alternative communication) -This is an integrated group of components used by individuals to enhance communication What is the most commonly used type of hearing aide? -Behind the ear (bte) What tones becomes more difficulty to hear as one ages: -High pitched sounds What are normal changes in cognitive function in the older adult? -Decline in information processing speed, short-term memory, and ability to perform visuospatial task This Ethic group may distrust the health care system and believe they have less control over their won health? -African Americans What tool is useful for accessing how well a family caregiver is coping? -Modified Care Giver Strain Index Tool What are numeric pain scale and faces? -These 2 pain assessment tools are considered valid and reliable in the older population This is the most extensively used cognitive assessment tool? -MMSE (Mini Mental Status Exam) What are Katz Index and Barthel Index? -2 tools commonly used to Asses ADLS

What is a functional assessment? -This type of assessment focuses on the pt. abilities What 2 components of health promotion are the most widely encouraged? -Exercise and nutrition What is the leading cause of unintentional injuries? -Falls What are possible signs of elder abuse? -Can include: delays in seeking medical treatment, withdrawal, malnutrition, or frequent changes in health care providers What is recommended at age 65? -Pneumococcal vaccine What is health screening? -Form of secondary prevention goal is to detect disease at an early stage What are low-tech assistive technology devices? -Examples are: pencil grips, splints, adaptive eating utensils, and canes What is assistive technology? -This is designed to fill the patients gap in functional ability What are possible barriers to learning in older adult population? -Factors include: chronic illnesses, normal changes of aging, health disparities and issues related to cultural diversity

What level should education materials be sued by nurses working with older adults? -5th grade What are guidelines for introducing technology to older adults? -Recommendation includes: linking use of technology to individual lifestyle, using mnemonics, repeated short training sessions What is custodial care? -Refers to nonmedical assistance with ADLs What is Medicaid? -An assistance program that is jointly financed by states and federal government for low income individuals What is Medicare Part B (also part D)? -Participation in this is not mandatory and premiums must be paid and covered by the individual What is social security? -75% of poor are elderly women rely on this as their major source of income What is the “donut hole”? -This Medicare coverage gap for prescriptions drugs is schedule to be closed by 2020 What is start low go-slow? -The strategy used by prescribers to help prevent adverse drug reactions

What is ageism? -Is the term for negative attitudes towards aging or older adults? How should older adults be addressed? -Address pt. by his last name (Mr./Mrs.) What is respectful way to speak to pt. who is in a wheelchair? -Kneeling or bending to eye level What is Presbycusis? -The most common form of age related hearing loss What are 2 major types of restraints? -Chemical and physical What is a prior history of falling? -History is a major risk factor for falls What type of exercise is best for increasing muscle strength? -Resistance training What is polypharmacy? -Potential adverse outcomes of this include ADRs increased cost, and noncompliance What is risk factor for pressure ulcers? -BMI of less than 24, impaired sensations, immobility

What is functional incontinence? -This type of incontinence occurs when pt. is unable to get to bathroom due to physical or mental conditions What is Delirium? -This is acute confusional state which develops over hours or days What is reported to be a contributing factor in 40% of nursing home admissions? -Falls What is functional decline? -A new loss of independence typically associated with decreased mobility and performance of ADLS What are autonomy and independence? -As people age, their quality of life depends on their ability to maintain these 2 factors What is the health related quality of life (HRQOL) “ healthy Days Measured tool”? - This tool from the CDC measures the number of healthy days in a given month What re physical psychological, social, and spiritual well being? -The 4 distinguishers of well being

What is physical activity? -This behavioral determinant may be the primary factor for promoting optimal aging What is the single most important preventable risk factor to human health in developed countries? -Smoking What is pain? -This is what the patient says it is What is frequently used to relieve dyspnea at end of life? -Morphine 2.5-5mg by mouth every 4 hours What is “AND” (Allow Natural Death)? -This order is considered to be more descriptive and positive than DNR order What is mourning? -This is the cultural / public display of grief through ones Behavior What is initialing the conversation about end of life? -This is often biggest barrier in determining pat. Whishes for end of life care What is the rapidly increasing elderly population? - This factor will is expected to have greatest impact on health policy in US over next decades

One of the most common role changes faced by aging person? - Retirement What are living options for pt. with mild to moderate dementia? - Adult day care, live at home with family member, paid caregiver, assisted living, long term care facility What is quality of life? -Control of symptoms and the ability to maintain meaningful activities / relationships has biggest impact on What is modified caregiver strain index tool? -A 13 question tool used to assess individuals of any age that have assumed the caregiver role What is the spices tool? - Used to evaluate most common problems affecting elderly What are factors assessed in Braden scale? -Sensory perception moisture activity mobility nutrition, friction shear What are potential causes of delirium in the elderly? -Fluid / electrolyte imbalance Infection CHF Meds Pain Sleep Deprivation Hypoxia

What are physical assessments and functional assessments? 2 types of assessments nurse needs to complete on elderly assessment of pt. ability to preform/ complete ADLS or care themselves and your objective exam of pt. (physical assessment) What are factors that affect medication dosing? -Decreased hepatic blood flow -Decreased renal blood flow -Urine excretion -Changes in body fat composition What is electronic health record? -Allows pt. records access to multiple providers What are low-tech assistive devices? -Ex pencils grips splints cane walker What are high tech assistive devices? -Computers, braille readers, robotic assistance What are factors that can impact learning? Decrease vision Decreased hearing Impaired cognition Side effects of meds Stress Pain Depression

What are techniques used to introduce technology to the elderly? -Techniques include making sure educations is relevant to patient lifestyle, blocking a generous amount of time to educate patient, repeating training sessions as needed, making the environment comfortable for patient, using clues, and mnemonics What is medication reconciliation? -The process of creating the most accurate list possible of all meds. Pt. is taking including drug name dosage frequency and route and comparing that list against doctors admission transfers and discharge orders with goal of providing correct meds to pt. al all transition points What is nursing informatics? -This is a combination of computer science, information science and nursing science designed to support the practice of nursing and delivery of nursing care Who are members of a multidisplanary health care team? -Doctor nurse pt/ OT speech social worker dietian What is Re-hospitalization? -Educating the pt. and family on meds, disease process and s/s to report to doctor to help not return to hospital What is the American Geriatric Society’s definition of transional care? -Actions designed to ensure the coordination and continuity of health care as pt. transitions between different locations or different levels of care with in the same location

What is addiction? -This occurs in less than 1% of pt. who use opioids for pain relief What is nociceptive pain? - This type of pain is best treated with opioids and nsaids What is neuropathic pain? -This type of pain is best treatment with tricyclic antidepressants and anticonvulsants What is power of attorney for health care? -This person chosen to make health care decisions when the pt. can no longer make them himself What interventions care decreased dyspnea in dying pt.? Morphine O2 Raise HOB Fan at BS Antianxiety meds (Ativan) Meds to dry up satiations (scopolamine) The definition of palliative vs. hospice care: Palliative care- refers to the comprehensive management of the physical psychological social spiritual and existential needs of pt. For pt. with incurable progressive illness. It focuses on achieving the best quality of life for the pt. and their families; control of pain and other symptoms and of psychological, social and spiritual problems is paramount Hospice- incorporates palliative care but is for pt. in last phases of incurable disease. Pt. must have a life expectancy of no more than 6 months to quality for hospice. Hospice uses a team approach to

address the physical emotional social and spiritual needs of pt. and family When developing the plan of care for an older adult who is hospitalized for acute illness the nurse should: -Consider the preadmission functional abilities when setting pt. goals Which information obtained by nurse to 88yr. with mild forgetfulness is most concern? - Pt. has lost 10lbs during last month Which intervention should be taken to help an older adult pt. prevent osteoporosis? -Encourage regular exercise Beers Criteria is: - A list of medications, which are considered inappropriate when given to older pt. The major components of a comprehensive nursing assessment of the older adult patient include which of these answers? -Spiritual, psychological, social functional and physical aspects During the administration of a mini mental status exam the health care provider ask the pt. to copy a simple geometric shape. This part of the exam test which of the following mental functions? -Visual comprehension and praxis

A pt. with history of depression who experiences memory lapses and work finding difficulty is diagnosed with pseudo demtia. Which of these represents a chararistis of psuedo demetia? -Cognitive impairments are reversible A patient diagnosis with delirium sees the IV tubing and believes it to be a snake. How should behavior be documented? -Illusion Rn providing care for patient diagnosed with mild cognitive impairment. Which of thee would be most effective intervention for this pt.? - Frequent reorientation Patient diagnosed with dementia is prescribed a med that inhibits acetyhlecholinesterase. How does med benefit pt? -Acetylcholine is needed for memory and problem solving When planning care for pt. diagnosed with Alzheimer’s which of these interventions is most therapeutic? -Encouraging both verbal and nonverbal communication The provider is assessing elderly pt. who is disoriented to time and place. Which additional finding would support a diagnosis of delirium? Sudden onset of symptoms Attention is impaired Often linked to identifiable cause Rambling and incoherent speech

A pt. with diagnosis of Alzheimer’s disease is admitted to along term care facility. Which of the following assessment findings will the health care provider anticipate? Amnesia Agnosia Aphasia Which of the following if assessed in patient will health care provider identify as a risk factor for the development of delirium? -Organ failure -Sleep deprivation -Infections -Administration of opioids A patient diagnosed with dementia often becomes agitated and has angry outburst which of the following interventions will the health care provider implement when caring for htis patient? -Ensure the safety of patient and staff -Utilize distraction when agitation occurs -Move the patient to a quiet environment The major impact of the physiological changes that occur with aging is: Reduced physiological reserve Reduced homeostatic mechanisms Impaired immunological response The strong evidence regarding normal physiological aging is available: Longitudinal studies All of the following are true about lab values in older adults except: -Abnormal findings are often due to physiological aging

Polypharmacy is best described as taking: -A single med if there is a not a clear indication for its use Hospice care differs from palliative care in that: -Hospice supports patients and families through both the dying and bereavement process Evidence reflects the primary obstacles to implementing palliative care in the long term care setting includes the following: -Inadequate communication between decision makers -Failure to recognize futile treatments -Lack of advance directives The prevalent symptom in end of life care: -Pain -Dyspnea -Delirium The highest level of evidence to support interventions at the end of life is with: -Opioids for dyspnea The highest level of evidence with use of adjuvant analgesics is with: -Neuropathic pain patient are candidates for adjuvant analgesia The following are true about chronic disease and illness: - Chronic disease is defined as a condition that requires both modification the pt. along with interaction with provider - The meaning of chronic illness includes experience of pt and family and provider - Chronic conditions

The highest number of people with multiple chronic conditions are those that are: -Over age 85 All define frailty: Slow walking speed Self reported exhaustion Weight loss greater than 10pounds in past year (unintentional)

Health consequences of obesity: High BP CAD Sleep Apnea Fluid balance in elderly: Total body water decreased with age Thirst response decreases as pt. ages African Americans have higher rates of dehydration than whites Distinguishing delirium from dementia can be problematic since they may coexists the primary consideration in the differential is: -Rapid change and fluctuation course of cognitive function What is relative functional decline are older adults: Some indivduals of “ old age” but have maintained an active and healthy lifestyle Timing of the get up and go test should take less than: 16 seconds

A validation toll for assessing cognitive function specific to dementia is: -Mini Cog The medical outcome study short form 36 remains the Gold standard quality of life instrument it measures: -Physical mental and social domains Strength building is the primary intervention for preventing what medical condition the gradual loss of muscle with age? -Sarcopenia (loss of muscle) Among military, what medical condition can be a result of retirement and having more time to dwell on war experiences or with common changes occurring with age? - Late Onset Stress Symptomology (LOSS)

What assessment tool can be used to determine activities of daily living (ADLS) independence in older adults? -The Katz Index The purpose of which is to identify drugs to avoid in older adults and improve medi...