NSG 6420 Week 1 Quiz .Questions & Answers Latest.

NSG 6420 Week 1 Return to deck 1. Over 90% of patients in long term care are older than  65 2. The young old  65-74 3. the middle old  75-84 4. The old old  85-99 5. the elite old  100 or older  6. the fastest growing subgroup?? is the old old, sometimes referred to as the advanced older adult population   7. physical exam yearly  8. Breast cancer  - self exam every month - woman >50 mammogram Q2yrs. 9. Cervical Cancer  - Pelvic exam with PAP Q3yrs 10. Prostate (50 and older)  - PSA test Q year, digital exam Q year  11. testicular cancer  Self exam every month  12. Colorectal cancer (men and women)  - fecal occult blood test Q year - sigmoidoscopy Q3-5 years - colonoscopy Q 3-5 years 13. Skin Cancer  - clinical exam yearly  14. oral cancer  - yearly with dental checkup 15. Oral cancer Cancerous growths on the lips, tongue or elsewhere in the mouth. Sores do not heal and will metastasize if not removed 16. Bone density  - every 2 years  17. Vision  - every year  18. Immunnizations  - tetanus diptheria (every 10 years) - FLU (every year) - Pneumococcal PPV those who receive 1 dose before age 65 should receive another dose at age 65 or later if at least 5 years have elapsed - zoster vaccine 19. Genetic Theory  - holds that life span depends to a great extent on genetic factors - genes within the organism control "genetic clock" - genes determine metabolic rate and cell division - wear and tear theory 20. Immunity Theory  - focuses on the function of the immune system (composed of the bone marrow, thymus, spleen, and lymph nodes - decrease in thymus gland - decrease in T cells - nutrition plays an important role so there is a focus in vitamin supplements - increase in autoimmunity, infection, cancer 21. Cross linkage theory  - is a chemical reaction that produces damage to DNA and cell death - as one ages cross links accumulates, leading to essential molecules in the cell binding together and interfering with normal cell function 22. free radical theory  - formed during cellular metabolism, are molecules with separated high energy electrons, which can have adverse effects on adjacent molecules - accumulation of these free radicals causes cellular death 23. KATZ  - Bathing: only help with a single part - Ambulation: - Toileting - Transfers - Eating - Dressing 24. Stages of Alzheimer's: Stage 1 - independent in ADLS - Denies presents of symptoms - Forgets names, misplaces household items - short term memory loss, difficulty recalling new information - subtle changes in behavior and personality - mild cognitive impairment - problems with judgement - less engaged in social relationships - decreased sense of smell 25. Stages of Alzheimer's Stage 2 - impairment of all cognitive function - unable to handle finances - disorientation to time place and event - possible depression and agitation - increased dependence on ADLS - visuospatial deficits - difficulty driving, gets lost - incontinent - wandering, trouble sleeping 26. Stages of Alzheimer's Stage 3  - bedridden - totally dependent in ADLS - loss of facial recognition (agnosia) - motor and verbal skills lost - general neurologic deficit 27. what can happen to dentures with aging  - the fit can change if the older adult loses weight, dentures are expensive so the elderly might use the ill fitting dentures anyway or try and gum their food  28. Older adults need an increased amount of what nutrients  - Calcium - vitamin C,D,A - 29. Diminished senses can lead to what?  - diminished senses of taste and smell which can cause a loss of desire for food  30. pre albumin -15-36 gives you a marker for the last two days shows nutrition status more sensitive goes up 1mg/DL/day  31. Albumin  3.5-5 protein for a couple weeks  32. total lymphocyte count  - assess the immune function, malnutrition can suppress the immune system and make to pt more susceptible to infection - when the pt is malnourished the TLC is <1500 33. geriatric failure to thrive  - under nutrition - impaired physical functioning - depression - cognitive impairment - drug therapy - chronic disease - major losses - poor socioeconomic status **all things to consider when screening for GFTT 34. maintaining appropriate levels of physical activity can decrease what? - decreased risk for falls - increased muscle strength - increased mobility - increased sleep - reduced or maintained weight - improved sense of well being and self esteem - improved longevity - reduces risks for diabetes, CAD, And dementia 35. Relocation syndrome is the physical and emotional distress that occurs after the person moves from one setting to another S/S: sleep disturbances, GI distress, withdrawal, anger, anxiety, depression, 36. Home modifications that can help prevent falls  - avoiding scatter rugs - slippery floors - avoid clutter - installing grab bars - using non slip bath mats - raised toilet seats - avoid going out on days when its raining and steps are wet - concentrate on one activity at a time 37. presbyopia  - farsightedness related to aging, so having frequent eye exams are important  38. what are some things to be aware of with a decrease in the sense of touch  - decreases the awareness of body orientation - decreased reaction time - have problems driving 39. what are some common drugs older adults take OTC  - analgesics - antacids - cold and cough preparations - laxatives - and herbal/nutritional supplements 40. age related changes that can potentially affect absorption of drugs orally  - increase in gastric pH - a decrease in gastric blood flow - and decrease in gastric motility - older adults do not have have major absorption difficulties because of age related changes alone 41. Age related changes that affect drug distribution  - smaller amounts of total body water - an increase ratio of adipose tissue to lean body mass *** can cause and increase build up of lipid soluble drugs, this leads to decreased concentration of drug in plasma but increased in tissue - decreased albumin level - decreased cardiac output 42. older adult changes in drug metabolism  - decreased liver size - decrease liver blood flow - decrease in serum liver enzyme activity - these changes can cause and increased plasma concentration of a drug - monitor liver studies - they need regular physical exams 43. excretion of drugs as it related to aging  - usually involves the renal system - decreased renal blood flow - decreased GFR - decreased creatinine clearance thus slower excretion time meaning serum drugs can become toxic 44. normal creatinine clearance for men and women  men: 107-139 women: 87-107 - values decrease 6.5 for every decade of life after 20 YO 45. Common adverse drug effects on the elderly  - edema - severe N/V - anorexia - dehydration/acute confusion - fatigue/weakness - dizziness/syncope - urinary retention/diarrhea - constipation - hypotension 46. when preforming a medication assessment of an older adult what are some drugs the nurse should ask if the pt is taking  OTC's and Herbal therapies 47. BEERS - obtain a list of ALL medications taken on a regular basis - highlight all medications that are part of the BEERS criteria - collaborate with the older adult and family if changes are needed - give verbal and written instructions - promote adherence to drug regimen encourage lifestyle changes to promote nonpharmacological interventions - remind not to share or borrow drugs 48. depression and the older adult  - is the most common mental health problem among older adults - it increases in ocurance when the person is admitted to a nursing home/hospital - white men ages 75-85 are most likely to commit suicide - extreme and prolonged sadness, triggered by stressors 49. what are some signs of depression the the older adult  - early morning insomnia - excessive daytime sleeping - poor appetite - a lack of energy - not social and unwilling to participate - 50. drugs for depression  SSRIS 51. without TX what can depression result in  - worsening of medical conditions - risk for physical illness - alcoholism and drug abuse - increased pain and disability - delayed recovery from illness - suicide 52. dementia  - slowly progressive cognitive decline, aka chronic confusion - Alzheimer's disease - multi-infarct dementia (20-25%) 53. dementia a progressive and usually irreversible deterioration of cognitive and intellectual functions and memory without impairment in consciousness Most common Alzheimer's 54. delirium  - temporary state of confusion - often seen in a setting that is unfamiliar - types: hyperactive, hypoactive, mixed, and unclassified 55. some of the factors that can cause delirium  - drug therapy - electrolyte/nutritional imbalances - infections - fecal impaction - surgery - metabolic/neurologic problem - hypoxia - relocation syndrome 56. how often should the older adult be in the sun  10-15 min 3-5x a week  57. how much calcium should the older adult have  mg/day  58. Baby boomers  - 59. what are some psychosocial concerns for the older adult  - adjusting to physical and mental changes - losing independence - adjusting to income - changes in roles - cost of health care - coping with loss 60. functional aging  how old the person acts and behaves physically not their actual numeric age  61. Normal physical changes of older adults: General status  - fragile balance - vulnerable - modified pace and need for rest periods while preforming ADLS 62. Normal physical changes of older adults: integument - wrinkling and sagging, dryness and scaling - balding - moles, skin may become pale, nails thicken and become brittle and yellow 63. Normal physical changes of older adults: musculoskeletal  - less subcu tissue, and weight - muscle mass and strength decrease - bone deminerization, fractures more common - joint stiffen and are less flexible, ROM decreases - mobility slows, posture stoops, hight decreases 64. Normal physical changes of older adults: neurologic  - delayed response - reflex rate decreases - temp regulation and pain/pressure perception becomes less efficient - loss of sensation - decreased spatial perception, balance - less sleep at night causing them to nap 65. Normal physical changes of older adults: cardiopulmonary  - blood vessels become less elastic - peripheral pulses may not be felt - CO decreases along with HR - clearing of the lungs becomes less efficient, decreased RR/depth 66. Normal physical changes of older adults: Genitourinary  - less blood flow to the kidneys - less nephron function so waste is excreted more slowly - the F/E balance is fragile - bladder capacity decreases so voiding becomes more frequently, incontinence or residual is common - BPH in men - atrophy to the woman genital tract 67.