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the tendency of society to explain away the problems of older adults as a function of being old rather than looking for specific medical, social or psychological causes
Number one type of elder abuse?
Neglect. The failure of an adult to provide for self the goods or services necessary to avoid physical harm, mental anguish, or mental illness or the failure of a caretaker to provide such goods or services.
Number one type of mental health problem?
I think this is substance abuse.
What do you do if an elder states they were raped?
You need to have a colleague help you to unobtrusively separate the caregiver or family member from the patient so that you can ask some direct questions without further endangering the patient. As health care providers, you are bound law to report any suspicion of elder abuse.
Older woman who is living with her 36 year old son and he is complaining to the nurse about her inability to use the bathroom and he cant take her out anymore. When the nurse leaves the room, the elder woman is fearful and cries. What type of abuse is this?
“When a family member, a caregiver, or other person behaves in a way that causes fear, mental anguish, and emotional pain or distress, the behavior can be regarded as abusive” EMOTIONAL/PSYCHOSOCIAL ABUSE
a higher level of spirituality with a lot of reflection, no drive for material benefits
Spirituality includes a system of beliefs that encompass love, compassion and respect for life. It is about our very existence; our relationships with ourselves, with others and with the universe, exploring meaning of life, connecting with others, higher power
includes specific beliefs and practices, Formalized traditions, Culturally influenced, Definite set of beliefs, rites, and or rituals, Organized means for a groups who share same belief system
Pioneers in spirituality- check all that apply;
Nightingale, Rogers, Neuman, Watson, Kolcaba
How do you get GERD?
How to decrease diverticulosis?
LOW FIBER DIET, increased fluids, anti biotic, may need surgery, low fat diet, exercise, normal weight, no smoking, don’t lay down after eating for 2-3 hrs, regular bowel, limit meds, limit NSAIDS
Early cancer stages are asymptomatic
GERD care plan-
eat small meals, stay upright after
Interpretation of decreased PO intake-
Decreased thirst and hunger due to cognitive changes or psychological conditions like depression
SNS and heart failure- know what the alpha and beta receptors do. This is a matching question with 10 parts
Alpha (vasculature): Vasoconstriction (increase BP), pupil dilation, ejaculation, contraction of bladderBeta 1(heart): increase HR, force of contraction, and conduction of AV node. Stimulate kidney to release renin. Beta 2 (lungs): bronchial dilation, vasodilation, glycogenesis, relaxation of uterine muscle.
lLeft sided Heart Failure
lLeft sided: results from CAD, HPT
lLeft sided failure can lead to right sided failure
- lManifestations of left-sided heart failure result from
- ØDecreased cardiac output: dizziness and syncope
ØPulmonary congestion: dyspnea, shortness of breath, cough, orthopnea (difficulty breathing lying flat)
lAssessment: cyanosis, breath sounds include crackles and wheezes, S3
lRight sided: results from restricted blood flow to lungs, as with acute or chronic pulmonary disease
lManifestations of right-sided heart failure result from:
- ØRight sided heart distension: distended neck veins, peripheral tissue edema seen in
- dependent tissues: feet and legs or sacrum, if bed ridden
ØGI congestion: nausea and anorexia
ØLiver engorgement: RUQ pain
- In left sided HF: cough is pink frothy sputum If only Right-sided HF will have no S&S w/lungs or SOB
Pulmonary emboli (I REMEMBER THIS ANSWER FROM SOMEWHERE BUT CANT RECALL)- An older man comes into the ER with some S/S, what is his diagnosis . I have no idea what this means so here is an explanation of a pulmonary emboli:
Pulmonary embolism is blockage in one or more arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to your lungs from another part of your body — most commonly, your legs. Pulmonary embolism is a complication of deep vein thrombosis (DVT), which is clotting in the veins farthest from the surface of the body.Pulmonary embolism can occur in otherwise healthy people. Common signs and symptoms include sudden and unexplained shortness of breath, chest pain and a cough that may bring up blood-tinged sputum.Pulmonary embolism can be life-threatening, but immediate treatment with anti-clotting medications can greatly reduce the risk of death. Taking measures to prevent blood clots in your legs also can help protect you against pulmonary embolism.
Respiratory sleep disturbances-
Paroxysmal nocturnal dyspnea
Working with older adults-
Patient education, Information on prevention and screening, internet resources, verbal instructions not completely understood, written directions in large print, clearly written information to re-communicate what was said
Home Safety- Know what makes a home safe (only one question):
we should be able to figure this one out by now!
Geriatric syndromes (check all that apply)-
delirium, dementia, vision/hearing changes, falls, malnutrition, incontinence, depression, sleep disorders, functional limits, polypharmacy
Cascade iatrogenesis, what can we do to prevent this?
Definitive action beyond recognition and monitoring of the persons condition, Asking the right questions at the right time, Communication process must be maintained when judging the effectiveness of the selected intervention and its outcome
Change in ADL status- question about old man in nursing home not going to bingo because? (I THINK ITS DECONDITIONING OR FUNCTIONAL DECLINE)
Deconditioning: The decrease in muscle mass and other physiologic changes that result from either aging or immobility or both and contribute to overall weakness.FD: The consequence of physiological changes-the resulting inability to perform activities that ensure a person’s independence, such as rising unaided from a chair.
Drug toxicity risk in older adults-
Medical management of any illness in adults of advanced old age and/or complex illness carries a risk for untoward consequences and cascade iatrogensis. For example, treating hypertension: Drug therapy is expected to normalize blood pressure but contribute to a new onset of geriatric syndromes such as cognitive impairment or falls Older adults are prime candidates for polypharmacy- the administration of many drugs concurrently. Due to physiologic changes, older adults have altered drug absorption, distribution, metabolism, excretion, sensitivity and response. An acute illness can exacerbate these changes.
Sexuality and the older adult (BPH MAYBE? IDK?)- Study mens sexual health (one question)
Sexuality is NOT only expressed through intercourse.The need for intimacy and affection is lifelong and helps us define our identity. Sexual dysfunction is NOT an inevitable result of the aging process. Sexual satisfaction does NOT diminish with old age.Physical Changes (Women) Thinning of vaginal wall and loss of elasticity, irritation during intercourse.Less lubricationDiminished or slower orgasmic responsePhysical Changes (Men) Delayed erection and ejaculation.Erection may be less hard.Interval between ejaculations may increase.Increased ability to postpone ejaculation for longer period of time. Orgasm may be less intense.
Goal of pallatative care-x
Goal of pallatative care- Relieve suffering and improve quality of life
Priority for a dying older adult-
Relieve suffering and improve quality of life
Quality of life: this will probably be another one of those general questions.
- Exercise to improve strength, gait, balance
- Home safety measures
- Correct use of assistive devices
- Good/safe footwear
- Correct glasses/hearing devices
- Ways to minimize dizziness when changing position
- Side effects of medications
Use of incontinence briefs (story question)-
older women isn’t going to church, friends come over and notices she is leaving the conversation five times in an hour to change clothes, she says “why I use depends, so should you”…no not really
PNS control of the bladder-
Controls bladder emptying, detrusor has cholinergic receptors which respond to ACH, 2nd layer in the lining of the bladder, made of smooth muscle,
SNS control of the bladder-
Promotes bladder filling, Relaxation/storage, Stimulate SNS neurons=relaxed detrusor muscle, Beta 2 recepetors relax it, Alpha 1 receptors contract internal sphincter to let urine in
Common disorders that contribute to a UI? Not sure if this is for urinary incontinence or urge incontinence.
These are for Urinary Incontinence Alzheimer’s Disease Bladder cancerBladder spasms DepressionLarge prostate in men Urinary tract problemsSpinal cord injuries Weakness of the sphincterNervous system conditions, such as multiple sclerosis or strokeNerve or muscle damage after radiation treatment to the pelvis
These are for Urge Incontinence diabetes, Alzheimer's disease, Parkinson's disease, multiple sclerosis, or stroke.Inflammatory: Acute or chronic cystitis (bacterial, post-radiation, etc.); estrogen deficiency in women
What is in the dermal layer of the skin?-
Blood vessels, sensory nerves, primary source of nutrition, CT by the way of epidermis and sub q.
Compounding risk of incontinence-
Impaired skin, DM, immobility, vascular disease, slower healing process, activity (increases skin breakdown), mobility, friction and shear
What happens during the vascular stage of inflammation?-
increased permeability of the microvasculature, Vasodilatation of arterioles opens up the capillary beds which leads to: Redness and Warmth, Edema- area becomes congested, protein-rich exudate in interstitial space, increased blood constituents ( RBCs, WBCs, platelets, clotting factors this leads to decreased blood volume: All of this leads to blood clotting as well as pain, swelling, and impaired function. Pain occurs bc the edema puts pressure on the nerves.
What are the first signs in an older adult with a UTI?-
Change in attitude/Mentation/Confusion
When a women dribbles piss when she sneezes it is?
Social IsolationSome older adults stop socializing outside their homes due to incontinency issues.Depression can result from the isolation.
Problems related to alcohol use?
Interaction with prescribed and OTC drugs
Age related changes and alcohol (check all that apply)-
Decreased body water (increases etoh effect, and increase blood alcohol level), increased sensitivity and decreased tolerance to etoh, decrease in metabolism of etoh in the GI, cognitive impairments
Barriers to identification (check all that apply) – detailed in study guide sent by JL
Ageism: the tendency of society to explain away the problems of older adults as a function of being old rather than looking for specific medical, social or psychological causes. Lack of Awareness: Older adults are more likely to deny or not recognize the signs of substance abuse, which carries a greater stigma for people age 60 and older. Families and professional caregivers share this lack of awareness.Healthcare provider´s behaviors: There is a low index of suspicion for the problem despite its frequency. Comorbidity: Comorbid conditions not only can complicate a diagnosis, but can sway a provider away from encouraging older patients to pursue treatment for substance abuse problems.Enabling by professionals family and attitudes.
Which of the following is NOT a good treatment for substance abuse?
Correct answers include cognitive/behavioral, individual/counseling, medical/psychiatric.
Definition of alcoholism (true or false)-
Alcoholism is a chronic, often progressive, and potentially fatal disease that includes problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect (physical dependence), or having withdrawal symptoms when you rapidly decrease or stop drinking. If you have alcoholism, you can't consistently predict how much you'll drink, how long you'll drink, or what consequences will occur from your drinking
Practical problems and substance abuse-
Impaired self-care, Reduced coping skills,Decreased economic security or new poverty status due to: Loss of income; Increased health care costs, Dislocation: Move to new housing or family moves away; Homelessness; Inadequate housing
Medical problems and substance abuse-
Physical distress, Chronic pain, Physical disabilities and handicapping conditions, Insomnia, Sensory deficits (hearing, sight), Reduced mobility, Cognitive impairment and change. Discussing life changes with patients can help them to develop insight into the causes of their substance abuse problems. For example, while discussing pain or insomnia with a patient, the drinking problem often emerges naturally as a topic of discussion.
Emotional and social life changes-
Bereavement and sadness, Loss of: Friends; Family members; Social status; Occupation and sense of professional identity; Hopes for the future; Ability to function, Consequent sense of being a “nonperson”, Social isolation and loneliness, Reduced self-regard or self-esteem, Family conflict and estrangement, Problems in managing leisure time/boredom, Loss of physical attractiveness (esp. for women). A number of interrelated emotional, social, medical, spiritual, and practical problems or changes characterize the older adult’s experiences. Some of these can precipitate abuse of alcohol or other drugs. Those that initiate, sustain, or interact with the substance abuse problem provide the focus of a holistic treatment approach tailored to the needs of the individual.