Gerontological Nursing Test #1 PDF

Gerontological Nursing TEST #1 Aging in Canada Chapter 1: Increases in life expectancy have resulted in persons over the age of 65 now constituting more than 18% of the Canadian population. Racialism lowers life expectancy compared to white population, addr...

Gerontological Nursing TEST #1 Aging in Canada Chapter 1: Increases in life expectancy have resulted in persons over the age of 65 now constituting more than 18% of the Canadian population. Racialism lowers life expectancy compared to white population, addressing the importance of health/social problems throughout the lifespan not just old age. Medicare 1965 is the primary source of health insurance for older adults, especially those of low income. Acute conditions occur at lower rates and older adults, but when they do develop, they usually result in more complications and longer periods for recovery. Chronic conditions are the major health problems among older adults and contribute to the leading causes of death. Baby boomers (born 1946-1964) are changing the profile of the older population, being highly diverse, educated, have fewer children, higher incomes, and our greater users of technology than earlier generations. Chapter 2: Stochastic theories view ageing as the result of random assaults from the internal and external environment (cross-link, free radicals, lipofuscin, where and tear, evolutionary, and biogerontology theories). Non-Stochastic theories view ageing as being a complex predetermined process (apoptosis, genetic programming, mutations, autoimmune reactions, neuroendocrine, neurochemicals, radiation, nutrition, and the environment in the aging process). Chapter 6: The major roles for geological nursing include that of healer, caregiver, educator, advocate, and innovator. The formal creation of a specialty of gerontological nursing did not occur until the 1970s. Aging Population Lecture Slides: Comorbidity: the presence of multiple chronic conditions. Compression of Mortality: hypothesis that serious illness and decline can or postponed so that an extended life expectancy results in more functional/healthy years. Life Expectancy: the length of time that a person can be predicted to live. Life Span: the maximum years that a person has the potential to live. What is the human life expectancy average now compared to 1930? Life expectancy now averages 78.7 years and in 1930 the average was 59.7 years. How has the aging population (baby boomers) made an impact on health care and nursing? The current older population offered sacrifice, strength, and spirit making the country great. Older adults are currently viewed with positivism, knowledge, and concern. What is ageism? Prejudice and stereotypes solely based off an individuals age. What is the Federal Old Age Insurance Law? In 1935 the Social Security Act was the first step to significantly improving the lives of older Americans. Define chronological, functional, perceived age, and age identity. Chronological age: years lived since birth. Functional age: physical, psychological, and social function. Perceived age: how others estimate age based on appearance. Age identity: how people feel or perceive their own age. What factors influence increased life expectancy? Advancements in disease control and health technology, lower infant and child mortality rates, improved sanitation, and better living conditions. Who hypothesized Compression of Morbidity and what does it suggest? James Fries suggests if onset of serious illness/decline would be delayed, or compressed, into a few years prior to death, people could live a long life in a healthy functional state. “More years of life means little if they consist of discomfort, disability, and poor quality of life.” What are the leading causes of death for the ageing population? Diseases of the heart, malignant neoplasm, chronic lower respiratory diseases, cerebral vascular disease, Alzheimer’s, and diabetes mellitus. What makes gerontological nursing so special/difficult and complex? The diversity, chronic illnesses, multiple health conditions, risk for complications, and resources can be an issue.  Theories of Aging Lecture Slides: Describe the Stochastic theories of aging. Cross-linking: cellular division is threatened as a result of radiation or chemical reaction, which interferes with the normal process. Free radicals/Lipofuscin: oxidative metabolism, and effects of free radicals damage/replace normal process, while lipofuscin accumulation interferes interferes the normal process. Wear and tear: repetitive use, injury, or stress results in breakdown of the body. Mutation accumulation: declining force of natural selection with age. Antagonistic pleiotropy: accumulated mutant genes that have negative effects in late life may have beneficial effects in early life. Disposable soma: ageing related to use of bodies energy rather than genetics. Bio-gerontology: pathogens may be responsible for certain physiological changes during aging process. Describe the Non-Stochastic theories of aging. Autoimmune reactions: changes in immune function, followed with aging. Neuroendocrine/chemical: changes to the brain and endocrine glands. Radiation: radiation may induce cellular, mutations that promote aging. Apoptosis: programmed cell death that continuously occurs throughout life due to biochemical events. Programmed genetic: born with genetic program that predetermines lifespan. Error: genetic mutations cause organ declines as a result of self-perpetuating cellular mutations. Environmental: ingestion of various substances, air, pollutants, living conditions, noise levels, etc., are thought to influence how we age. What are the sociological theories of aging? Disengagement theory: the transfer of power from old to young and the process of gradual disengagement between society and the older individual. Activity theory: older person should continue middle-aged lifestyles; society should not advocate, diminishing activity, interest, and involvement. Continuity theory: personality, and basic patterns of behaviour remain unchanged as the individual ages. Subculture theory: older adults are a group with distinct norms, beliefs, expectations, habits, and issues that separate them from the rest of society. Age stratification theory: persons within similar age group generally have similar experiences, attitudes, and life transitions that offer unique shared history. What are the psychological theories of aging? Developmental task theory: challenges that must be met and adjustments that must be made in response to life experiences and continued gross. This theory follows Erikson’s stages and in order for an older adult to be satisfied as the age, they must be satisfied throughout all stages of their life (trust, autonomy, initiative, industry, identity, intimacy, generativity, and integrity). What are the nursing theories of aging? Functional consequences: promotion of wellness by addressing individuals, holistically, recognizing interconnection of body, mind, and spirits; promotes wellness and alleviates or reduces impact of negative factors, promoting positive functional consequences. Theory of thriving: everything that impacts people throughout their life must be linked to create a holistic view of aging; process of thriving is continuous and enables ageing individuals to find meaning in their life and adapt to changes. Successful aging: considers physical, mental, spiritual, well-being, and self appraisal; high level of personal control, positive affect, participation in health promoting activities will result in greater life satisfaction. Age Related Changes Chapter 4 & 5: One challenge and transition individual face as they age is changes in family roles and relationships. Retirement can be a transition, viewed both positively and negatively due to the loss of one’s rules, routines, relationships, and meaning. Changes in health, function, and appearance are significant reminders of the changes with age. Changes to body systems contribute to a higher prevalence of conditions, such as infections, hypertension, poor dental, indigestion, urinary frequency, prostatic enlargement, fractures, reduced vision, presbycusis, hypothermia/hypethermia. Chapter 32: The prevalence of disability among older adults is increasing as greater numbers of people survive once fatal conditions that leave residual disabilities. when an older person suffers from a disability, functional status rather than diagnosis, directs rehabilitative care; it is important that the person level of ADL’s/IADL independence be assessed.  Age Related Changes Lecture Slides: What are age-related changes that affect an individual? Physical Appearance: Physical changes occur first after the fourth decade of life (hair loss, grey hair, wrinkled hands, loss of tissue elasticity, subcutaneous fat, and increased skin fold thickness). By 80 years old, most adults will have lost at least 2 inches in height due to diminished stature related to reduced hydration, loss of cartilage, and thinning vertebrae. Respiratory: Trachea and rib cage become more rigid (calcification of costal cartilage and weaker thoracic muscles). An increase in residual capacity, and decrease in vital capacity occurs. Alveoli and cilia decrease/stretch, reducing the ability to cough effectively, and the AP diameter of chest increases (barrel chest). Cardiovascular System: The heart dimensions remain unchanged aging, but the heart muscle loses efficiency and contractile strength (results in reduced cardiac output, valves become thick/rigid, blood vessels reduce elasticity, oxygen is less efficient, blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output. The aorta dilates and elongates causing resistance to peripheral blood flow, left ventricular, hypertrophy, incomplete valve closures (pacemaker cells become irregular), and increased risk of posterior and postprandial (after eating) hypotension. GI system: An aging individual experiences less acute tastes sensations (atrophy), and decreases in esophageal motility, stomach pH, saliva production, esophagus and liver sizes, decreased intestinal blood flow, stomach motility/contractions, and less production of enzymes, resulting in an increased risk for aspiration, indigestion, and constipation (Normal aging does NOT cause constipation, rather the loss of sphincter tone and slower nerve impulses). Tooth loss is NOT a normal part of aging (lack of diligent dental care, teeth become more brittle/sensitive, cause gum diseases). Urinary tract: Decline of renal blood flow and filtration by approximately 50% by age 90. The kidneys become smaller causing reduced filtration, bladder capacity, tubular function, size of renal mass, nephrons, and weakening of the bladder muscles. Incontinence is NOT a normal part of aging but does occur (especially in women who have had children, when laughing/jumping). Musculoskeletal: There is a reduce in muscle mass and strength (Sarcopenia – promote exercise!), decreased reflexes/involuntary movements (muscle tremors), bone mineral/mass (Osteoporosis in older females after menopause), calcium absorption, and thinning discs/a shortening vertebrae. Nervous System: There is a decline in brain weight, cerebral blood flow, neurons, nerve fibers, and a slower response to change, which affects an individual's risk of falls, infrequent sleeping patterns, slower reaction times, and the hypothalamus is less effective in temperature regulation.  Sensory Organs: Vision - has the greatest changes and earliest changes for aging sensory organs (narrow visual field, pupil size reduced, depth perception distorted, presbyopia-inability to focus on close objects clearly). Taste, Smell – diminished atrophy to nervous system effects the ability to taste and smell (by 80 years old the sensitivity to scent is 50% less than when they were younger). Touch - reduction of tactile sensation, and reduced ability to sense pressure effects how an older person feels pain from hot or cold. Immune System: The immune system becomes depressed as T cell activity declines, cell mediated immunity declines, inflammatory defences decline (increasing an individual's ability to get infected, inflammation, swelling, cancers, reactivation of viruses in the body, etc.) What is Presbycusis and how does it impact communication with elderly clients? Presbycusis is the progressive loss of hearing, especially high-pitched noise, due to loss of functioning in middle ear. Letters S, H, P, etc., can be especially hard to hear due to their high-pitched distortion. What is orthostatic hypotension? The feeling of dizziness and unsteadiness when standing up, due to less sensitive barrel receptors. Can cause accidental falls in older adults. What happens to the aging mind (personality, intelligence, learning, attention span)? Personality: remains consistent with earlier years in absence of disease. Changes in personality may be affected by retirement, death of spouse, loss of independence, income, or disability. If large personality changes occur, it may be a pathology (not from typical aging). Memory/Intelligence: forgetfulness comes with age, but often individuals given lots of time can recall from long-term memory. Memory deficits result from a variety of factors (medications, physiological changes, lack of interest, mood, and mental illnesses). Fluid intelligence often declines (the speed of being able to complete certain tasks). Crystallized intelligence can actually increase as a person ages (knowledge accumulated throughout the lifespan). Learning: learning ability does not change (often impacted by the individual's motivation, attention, span, perceptual deficits, or illness). Older adults have a harder time changing/relearning daily habit (breaking bad habits or learning new rules). Attention Span: with ageing there is a decrease in vigilance performance, individuals are easily distracted by irrelevant information and stimuli, and they are less able to perform tasks that are complicated require simultaneous performance. What are nursing actions and interventions related to aging changes? A nurse is able to prevent dehydration (IV fluids), ensure adequate clothing and maintain room temperature (measure body temperature), encourage activities that promote health (light exercise, hygiene habits, healthy diets), ensure individuals take proper prescribed medication’s (age-adjusted dosages), observe for signs of infection/inflammation, instruct on safety measures to prevent falls and fractures. Assessment of the Older Adult Lecture Slides: What is the nursing process and what are the steps involved in the process? Nursing Process: systemic cognitive framework used to identify, diagnose, and treat human responses to health and illness. Steps (ADPIE): A = assessment - collect, organize, validate, and document data. D = diagnosis - focuses on client response to health problems (NOT a medical diagnosis). P = planning - set goals that are: specific, measurable, attainable, realistic, and timed. I = implementation - initiating planned actions or interventions. E = evaluation- collect data relating to the goals identified, continue, modify, or terminate the plan. What are the components to assessing the geriatric client? 1. Patient Interview: used to collect subjective data, consists of: biographical data, family history, health history (medications as well), social and leisure activities, religious/spiritual profile, and psychological/cognitive assessment. 2. Physical Assessment: used to collect objective data, this is a head-to-toe assessment of normal aging verse pathology (sensory changes, GI system, skin lesions, wrinkles, dehydration). 3. Functional Screening Assessment: how the person manages day-to-day ADL’s (feeding, toileting, grooming, dressing, bathing, and walking/transferring) and IADL’s (managing finances, handling transportation, shopping, preparing meals, using the telephone/communication devices, managing meds, housework/house maintenance). What is PIECES and what does it include? A practical, effective approach to change and continuous improvement. Provides a framework for understanding multiple causes and how they relate to the client. P = physical, I = intellectual, E = emotional, C = capabilities, E = environment, S = social. Maintaining Functional Health Status Chapter 7: holistic gerontological care integrates, the biological, psychological, social, and spiritual dimensions of an individual. Considers physiological balance, the connection of the individual with self, others, the culture and the environment, and the degree to which the person is achieving gratification. Chapter 10: Supportive/Preventive services assist independent people who reside in the community to maintain their self-care, and avoid physical, emotional, social, and spiritual problems. Partial/Interment services provide help to person with a partial limitation in their self- care capacity or who have a therapeutic demand that requires occasional assistance. Complete/Continuous care services assistance to individuals who need 24 hour assistance or supervision. Chapter 33 & 34: Older adults are significant users of acute care services, but often have a smaller margin of physiological reserve than younger patients, and are less able to compensate and adapt to changes, increasing their risks of complications, infections, hospitalization, falls, pressure ulcers, and hyper/hypothermia. Long-term care developed without a clear vision for the unique purpose, function, and nursing rules associated with this segment of care, as a result, less than ideal conditions developed for the older adults. A greater understanding of unique aspects of long-term care and the culture change movement have brought about significant improvements to the model of the long- term care services, and it continues to develop and improve. Maintaining Functional Health Status Lecture Slides: What are some supportive and preventative services for aging individuals? Preventive Services: services provided by the community for individuals with the capacity for independent self-care. Partial/Intermittent Care Services: services provided by communities and institutions for individuals with partial limitations in self-care, therapeutic demands that require occasional assistance, or both.  Complete/Continuous Services: services provided by institutions for individuals with partial or total limitations in self-care capacity and therapeutic demands that require regular assistance. What is the holistic health model of care? It is the nurse's job to provide growth towards wholeness, promoting recovery and learning from an illness, maximizing quality of life when one has an incurable illness or disability, and providing peace, comfort, and dignity as death is approached. In holistic care, the goal is not to treat disease but to serve the needs of the person through healing of the body, mind, and spirit. How can nurses meet the holistic needs of the client? The assessment process considers patients effectiveness in meeting needs related to health promotion and health challenges. If the individual is successful in fulfilling needs, there is no need for nursing intervention. When the older adult does not have the requisites to meet needs independently, nursing interventions are needed. (education, counselling, coaching, monitoring, therapies, etc.) Acute Care & Long-Term Care Lecture Slides: Latrogenic complications: complications inadvertently caused by practitioners or by medical treatments/procedures. Nosocomial infections: hospital-acquired infections.