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Gero Exam #1

Terms in this set (79)

What are some causes of the "greying" of America?
Improved healthcare, decreased child mortality rates, improved sanitation, use of vaccines and antibiotics, and an influx of immigrants
How many people aged 85 and older there expected to be by 2020?
6.6 million
What gender is more likely to live alone?
Women because they tend to outlive their husbands
What percent of older adults are home owners?
80%; but most lose their homes because they are too expensive to maintain
Why are people living longer?
Better healthcare, medical advancement, better technology
What is the biologic theory of aging?
Answers basic questions regarding physiologic process that occur in all living organisms
What is the sociologic theory of aging?
Focused on roles and relationships within in which individuals engage in later life
What is the psychologic theory of aging?
Influenced by both biology and sociology. It addresses how a person responds to the task of his or her age
What is the moral/spiritual theory of aging?
Examines how an individual seeks to explain and validate his or her existence
What is the error theory?
Based on the idea that errors occur in the synthesis of DNA which leads to systems that don't function at the right level
What is the free radical theory?
Free radicals damage cell membranes which decreases efficiency
What is the cross-linkage theory?
Some proteins become cross linked which allows waste products to accumulate in the cells
What is the wear and tear theory?
Humans are like machines, aging is the result of continuous use of the body over time
What is the Hayflick limit theory?
Normal cells divide a limited number of times therefore life expectancy is programmed
What is the immunity theory?
Changes occur in the immune system that make a person more susceptible to disease
What is the disengagement theory?
As individuals age, they withdraw from society, and society encourages this withdrawal
What is the activity/developmental task theory?
Individuals need to be active to age successfully
What is the person-environment theory?
Each individual has personal competencies that assist the person in dealing with the environment. These competencies may change with aging, thus affecting the older person's ability to interrelate with the environment
What is Maslows hierarchy of human needs?
Human motivation is viewed as a hierarchy of needs that are critical to the growth and development of all people. Individuals are viewed as active participants in life, striving for self-actualization
What is Jung's theory of individualism?
Development is viewed as occurring throughout adulthood, with self-realization as the goal of personality development. As an individual ages, he or she is capable of transforming into a more spiritual being
What is Erikson's Eight stages of Life?
All people experience eight psychosocial stages during the course of a lifetime. Each stage represents a crisis, where the goal is to integrate physical maturation and psychosocial demands. At each stage the person has the opportunity to resolve the crisis. Successful mastery prepares an individual for continued development. Individuals always have within themselves an opportunity to rework a previous psychosocial stage into a more successful outcome
What is selective optimization with Compensation theory?
Physical capacity diminishes with age. An individual who ages successfully compensates for these deficits through selection, optimization, and compensation
What theory explains all aspects of aging?
There is no one theory that does this
What population of older adults have lower health status and receive fewer services?
Racial minorities
What percent of adults 75 and older require help with ADL's?
30%
What is happening to the amount of older adults in nursing homes?
It's declining meaning the care is falling on family members
Where is the majority of elderly care provided?
The home
What is caregiver burden?
Physical, emotional, and financial stress on a family member providing care to an elderly person. Includes role reversal
What is respite?
A way to alleviate caregiver burden that can last hours, days, or weeks. It can happen in home or facilities
How is respite financed?
You have to pay out of pocket as insurance will not reimburse you
Where do older adults get their income?
Social security, assets, retirement funds, wages, and government pension (greatest to least)
What is Medicare?
The most used insurance for older adults
What are some socioeconomic changes in aging?
Increase in overall education level (possibly due to post WWII GI benefits), older men with higher incomes (women didn't work outside the home typically), many older adults use Medicare for insurance and work after retirement
What is important to realize as nurses to provide culturally competent care?
To increase awareness of our own beliefs and attitudes
What are things to consider when providing culturally competent care?
Individual vs. collective group

Time orientation

Appropriate eye contact

Touch

Decision making
What should the nurse do when providing health care to specific cultural groups?
Be knowledgable about predominant health practices of the cultural group but still individualize the care
According to Leininger, what are the 3 modes for providing culturally congruent care?
Cultural care preservation or maintenance

Cultural care accommodation or negotiation

Cultural care repatterning or restructuring
What is the LEARN model?
Listen - with sympathy and understanding to the patient's perceptions of the problem

Explain - your perceptions of the problem

Acknowledge - and discuss the differences and similarities

Recommend - treatment

Negotiate - agreement
What does ASKED stand for?
Awareness - am I aware of my personal biases and prejudices towards cultural group different than mine?

Skill - do I have the skill to conduct a cultural assessment and perform a culturally based physical assessment in a sensitive manner?

Knowledge - do I have knowledge of the patient's worldview and the field of biocultural ecology?

Encounters - how many face-to-face encounters have I had with patients form diverse cultural backgrounds?

Desire - what is my genuine desire to "want to be" culturally competent?
What does Medicare part A cover?
"hospital insurance"

Home health care & equipment, hospice, hospital stay, mental health inpatient stay, skilled nursing, blood transfusions

Pays for more acute things

Does not pay for stay in a nursing home
What does Medicare part B cover?
"medical insurance"

Home health care & equipment, medical and other services (physician fees), outpatient mental health, outpatient hospital services (physical therapy)

Extra supplemental insurance that people can pay for

Very confusing and expensive
How is Medicaid funded?
Federally; its for low income individuals and based on income
What is OBRA?
Omnibus Budget Reconciliation Act of 1987; lead to dramatic changes to all Medicare and Medicaid certified nursing homes
How often do physician evaluations need to happen as the result of OBRA?
On admission, at 30 days, at 90 days, with change in condition, and annually
What are the minimum nursing staffing levels as the result of OBRA?
Licensed nursing services 24 hours/day, 7 days/week. RN must be on duty 8 hours/day, 7 days/week
What are social worker requirements as a result of OBRA?
Professional social worker is required in facilities with over 120 beds
What are the conditions under which a resident can be discharged as a result of OBRA?
The facility cannot meet the residents' needs

Their stay is no longer required for their medical condition

They fail to pay for their care as agreed to

The facility ceases to operate
What must be maintained or improved with the use of antipsychotics, benzos, anxiolytics, sedatives, and hypnotics as a result of OBRA?
The resident's functional status; non-drug interventions must be documented and medications can't be sued for environmental control
When is it okay to put a resident in physical restraints as a result of OBRA?
Only if they have a specified medical condition and have a physician order
When can chemical restraints be used thanks to OBRA?
Antipsychotics must have an appropriate psych diagnosis before use
How much of a dose reduction should you start with?
25%
What is done for a urinary incontinent resident thanks to OBRA?
Bladder training programs NOT chronic catheters. Behavioral approaches are the preferred intervention
What is the standard annual survey?
Mandatory, unannounced survey that makes sure the facilities are meeting the OBRA requirements
Who makes up a state survey team?
Interdisciplinary teams: at least 1 RN
What is an extended survey?
Follow-up of deficiencies or self-reported issues
What are F-tags?
F-tags are federal regulations that govern long term care facilities and are sanctioned by state DHHS
Where are survey results posted?
Survey results and violations are posted on internet to increase accountability
What should you take into account when giving a physical exam to an older adult?
Emphasis on musculoskeletal and skin exam

Monitor for fatigue during exam

Provide comfort and modesty

Palpate painful areas last
What is different about an adult vs geriatric patient assessment?
Slower

Delirium assessment

Functional assessment (how much help do they need?)
What factors should you take into account when collecting a health history on an older adult?
• Visual deficit
• Hearing deficit
• Anxiety
• Reduced energy level
• Pain
• Multiple and interrelated problems
• Tendency to reminisce
How do older adults atypically present with UTI's?
Dysuria is often absent; frequency, urgency, nocturia sometimes present. Incontinence, delirium, falls, and anorexia are other signs
How do older adults atypically present with MI's?
Sometimes NO chest pain; or atypical pain location such as in jaw, neck, shoulder, epigastric area
How do older adults atypically present with Pneumonia?
Cough may be productive, dry, or absent; chills and fever and/or elevated WBCs may also be present
What are the basic ADL's?
• Bathing
• Dressing
• Grooming
• Eating
• Continence
• Transferring
What are the basic IADL's?
• Meal preparation
• Shopping
• Medication administration
• Housework
• Transpiration
• Accounting
What is the primary goal of acute care nurses within the older adult population?
To maximize older adults independence by enhancing function and decreasing the likelihood of institutionalization
Is a functional assessment affected by the environment in which the tool is administered?
Yes
What are age related changes affecting vision?
• Floaters and flashers
• Dry eyes
• Presbyopia: a diminished ability to focus clearly on close objects
• Ectropion: the turning outward of the lower eye lid
• Entropion: the turning inward of the lower eye lid
• Blepharitis: chronic inflammation of the eyelid margins
• Glaucoma: increase in intraocular pressure that is the second leading cause of blindness in the US (first leading cause of blindness among Blacks)
• Cataracts: a clouding of the normally clear and transparent lens of the eye (most common disorder found in the aging adult)
• Diabetic retinopathy: altered circulation to the eye that may result in retinal edema, degeneration, or detachment
What are age related changes affecting hearing?
• Pruritus: itching within the external auditory canal related to age-related atrophic changes in the skin
• Cerumen impaction: dry earwax gets stuck in the ear canal. This is a reversible, often overlooked, cause of conductive hearing loss
• Tinnitus: chronic combination of both conductive and sensorineural hearing loss; it is a subjective sensation of noise in the ear, defined as a ringing, buzzing or hissing sound
• Hearing loss: approximately 17% or 36 million American adults report some degree of hearing loss. Hearing loss is NOT a normal part of the aging process and should be evaluated in order to have proper treatment
• Presbycusis: sensorineural hearing loss, most common form of hearing loss in older adults. Affects more men than women
Should dizziness and imbalance be considered normal parts of aging?
NO
What is Meniere disease?
Caused by pressure within the labyrinth of the inner ear. Three major characteristics are: vertigo, tinnitus, and hearing loss
What is xerostomia?
Dry mouth
What are nursing interventions for vision impairments?
Microscopes, large print medications, assistance with ADLS, and descriptive instructions
What are nursing interventions for hearing impairments?
• Lower your tone of voice
• Looking directly at the patient
• Slowing down
• Removing background noise
Is hospice covered by Medicare part A?
Yes
What does STEADI stand for?
Stopping Elderly Accidents, Death and Injury; fall risk checklist from the CDC
What is the Barthel Index?
Measures how well the person can perform ADLs
What is the difference between aging changes vs aging problems?
Aging changes affect everyone universally no matter what while aging problems are not the direct result of aging, rather issues that tend to cluster late in life
What is an example of an aging change?
Decreased immune system
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