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Gerontological Nursi
Nursing 10006, Gerontological
| question | answer |
|---|---|
| Geriatric | Medical focus is pathologic, physiologic, diagnosis and management |
| Gerontology | Broader scope looks at problems of the older adult, the process of getting old and adaptation |
| What is old? | Subjective data, Functional abilities and objective data. |
| Demographics | Cultural Diversity will be the hallmark of the 21st century. |
| Upward extention famlies | Older adults dependent on children for care more common in whites |
| Downward extention | grandchildren are dependent on older adults ..more common in blacks |
| Demographic implications | Social security, Health care providers, Research, Leisure activities, Home health care 85 year olds are the fastest growing group, white women live longest |
| Agesim | attitudes that discriminate on the basis of age |
| Theories on ageing | Biological, Sociological, Psychological and Nursing functional consequence theory on aging |
| Biological theory | Biological theorist attempt to explain the physical process of aging |
| Sociological theory | looks at the relationship between society and older adults |
| Disengagement theory | 1st theory on aging 1950's Principle that older adults gradually seperate from society and that society seperates from the older adult |
| Activity theory | The more an older adult keeps active the more active they will remain |
| Psychological theory | Focus is on behavior, life experances, personality, and how we handle life events |
| Functional Consequence theory | Postulates that the older adults experiences functional consequences because of age related changes and additional risk factors |
| 4 concepts central to Functional Consequence theory of ageing and Nursing | Nursing, Health, Person and Enviroment |
| Psychososial Functioning Age Related Changes | Stereotyping the aged, Retirement, Widowhood, Death of friends, Relocation, Chronic illness. |
| Stress | individual meaning...Difference between demands and your ability to meet the demands |
| Coping | the process used to manage stressfull events |
| Psycosocal Assesment | Will include: Cognitive function, Affective function, Contact with reality and Sociocultural Supports |
| Risk factors of Depression in the older adult | Physical disorders, Medications, Substance abuse, Social, cultural and demographic factors |
| Signs and symptoms of depression | sleep changes, appetite changes, loss of interest, fatigue, anxiety, low esteem, sucidal thoughts |
| Elder abuse and neglect | Infliction upon an adult of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish |
| Neglect | Failure of an adult caretaker to provide services necessary to avoid physical harm, mental anguish or mental illness |
| Exploitation | Unlawfull or improper act of a caregiver using an adult or his resources for monitary or personal gain |
| Cognitive Functioning in older adults | The mental process of knowledge being aquired and used |
| Delirium | Reversible dysfunctional cerbral cortex, which is manifested by a wide varity of neuro-psychatric abnormalities |
| Dementia | Chronic, progressive, acquired brain syndrome, with gradual onset of decline in memory and other cognitive functions sufficent to life |
| causes of delirium | Neurologic, systemic and psychriatric |
| Alzheimers diease | a progressive irreversible brain disorder that is characterized by gradual deterioration of memory, cognitive function, reasoning, language and eventually physical functioning and death |
| Etiology of alzheimers disease | cell damage and inflammation in the brain, deficiency of neurotransmitters: acetycholine and serotonin, Tau-a protein (organizes nerve centers), ApoE gene |
| Stages of alzheimers disease | First stage, Second stage and third stage |
| alzheimers disease: First stage | forgetfullness, impairment in judgement, increasing inability to handle routine tasks, lack of spontaneity, lessening of initiative, disorientation of time and place, depression and terror |
| alzheimers disease: Second stage | wandering and preservation, increasing disorientation, increasing forgetfullness, agitation, restlessness, especially at night, develop an inability to attach meaning to their sensory perceptions, inability to think abstractly, muscle twitching, seizure |
| alzheimers disease: third stage | disorientation, complete dependence, develop an inability to recognize self and others, speech impairment to muteness, morbid need to put everything in their mouths, necessity to touch everything in sight, become emaciated, complete loss of all body funct |
| Aricept | increases concentration of acetycholine |
| Exelon | increases concentration of acetycholine |
| Cognex | blocks chemicals that destroy acetycholine |
| MMSE | Folstein's Mini mental State Examination...most widely used |
| Katz | index of ADL's functioning |
| IADL | instrumental activities of daily living...essential for acessing the function in the community |
| PULSES | P=physical, U= Upper limb function, L= Lower limb function, S= sensory, E= elimination, S= support factors |
| Barthel Index | Assesses the need for long term facility |
| Automony | the personal freedom to direct ones own life as long as it does not infringe on the rights of others |
| Competency | Legal term that refers to the ability to fulfill ones role and handle ones affairs in an adequate manner |
| OBRA | Omnibus Budget Reconsilation Act (1980) |
| OBRA requirements | RIA, MDS, RAPS, Nurses aide training, Limiting the use of physical and chemical restraints, residents rights and PSDA |
| PSDA | Patient Self Determining Act... Living wills, advance directives DPOA, the righht to refuse treatment and the right to be informed of medical care decisions |
| Medicare | age 65 and older, under 65 with certain disabilities, those with end stage renal disease |
| Medicaid | welfare |
| Respiratory function risk factors: | smoking, enviromental factors, kyphosis, immune response, Obesity, medications, immobility, cardiac problems and surgery |
| Respiratory function: Psysiologic effects of smoking | Bronchoconstriction, mucosa inflammation and decreased cillary action |
| Respiratory function:Negative Functional effects of smoking | Increase use of accessory muscles, increased energy expanded for respirations, decreased gas exchange, diminished cough reflex, decreased gag reflex, increased susceptibility to infections |
| Respiratory: physical assessment | A-P diameter, appearance, percussion, ascultation |
| COPD | Chronic Obstructive pulmonary Diease |
| Respiratory function:Pneumonia | Infection of the pulmonary tissue, pathogens penitrate the airway causing the mucosa to inflame and increased edema. increasing stiffness to the lung decreasing vital capacity |
| Respiratory function: S/S pneumonia | confusion, fatigue, decreased appetite, dehydration, headache, increased respiratory rate, adventitious lung sounds |
| Respiratory function: Influenza | acute contagious viral respiratory infection |
| Respiratory function: S/S Influenza | muscle aches, headache, fatigue, cough, sore throat and rhinorreha |
| Respiratory function: Tubrculosis | older adults increase susceptibitity than younger it can be dormant for many years and reactivate |
| Age related changes: Urinary elimination | kidneys ( decrease filtration 50% less nephrons), renal tubules, urinary muscles and neurologic control |
| Age related changes: Urinary elimination-Risk factors | Diease ( Diabetes, UTI, BPH), Medications, Enviroment ( proximity to bathroom), Psycholosocial (lack of privacy shame), Catheters |
| Age related changes: Urinary elimination-Functional Consequences | Negative- decline in homestatic mechanisms, delayed excretion of water soluable medications, diminished bladder capicity, urinary urgency and frequency, nocturea, chronic residual urine |
| Incontinence | a condition in which there is an involuntary loss of urine |
| Urge incontinence | inability to hold urine, exacerbated by fluid limiting and frequent urination |
| Stress Incontinence | occurs due to increases abdominal pressure, lack of estrogen, vaginal deliveries, prostatic enlargement |
| Overflow Incontinence | over distention due to fecal impaction, diabetic neuropathy, prostatic hypertrophy, bladder cancer. |
| Age related changes: Mobility and Safety | Aging bones, muscle deterioration, joint and connective tissue degeneration, neurological |
| Age related changes: Mobility and Safety-Risk factors | age related changes, osteoporosis, osteopenia, parkinson's disease, medications, environmental, restraints (physical or chemical) |
| Osteoporosis | osteoporosis - bone mass loss occurs gradually increased after menopause. |
| Osteoporsis: Risk factors | small bones, obesity, genetic, lack of exercise especially weight bearing, smoking, live in the north, decreased calcium intake, decreased Vit. D intake |
| Calcium requirements | 60 year old- 1500 mgs daily |
| Parkinsons Diease | Chronic progressive disease, average age of onset 65, imbalance of 2 neurotransmitters( dopamine and acetycholine), causes classic S/S, of unknown etiology ( possible- trauma to midbrain, strokes, toxins and atherosclerosis) |
| Parkinsons Diease: Clinical manifestations- Bradykinesia | sloweness of movement, masklike expression, drooling, soft voice low volume, slow shuffling gait, stooped posture, handwriting becomes small ( micrographia) |
| Parkinsons Diease: Clinical manifestations- Tremor | Coarse, 3-4 second pill rolling, tremor in the hand and arms at rest, appears with intentional movements, tremor may affect only one arm |
| Parkinsons Diease: Clinical manifestations- Rigidity | increased muscle tone, resistance to passive movements, limb has a cogwheel or ratchet like response to passive movement |
| Parkinsons Diease: Clinical manifestations- Autonomic disfunction | Excessive perspiration, Seborrhea, Constipation, Urine hesitancy or retention, Heat intolerance |
| Classis S/S Parkinsons Diease | Bradykinesia, Tremor, Rigidity, Autonomic dysfunction |
| AntiParkinsons agents: | Edilpril, Tasmar and Comptin- balance neurotransmitters. First drug of choice Sinemet (attempts to provide dopamine to the brain) |
| Pharmokinetics | how drugs are absorbed, processed and distributed to the body |
| Medications: age related changes | sense of thirst is decreased, total body fluids decreased, decreased circulation, decreased gastric acids |
| Medications: age related changes-Polypharmacy | multiple health problems, multiple health care providers, poor guidelines for psycotropic drug use, medication sharing, hoarding of unused medications and home remodies |
| Medications: common S/S drug overdose | mental changes, CNS changes, GI disturbances and sexual response |
| osteopenia | first early stage is mild bone loss. |
Created by:
Denise
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