NURS 1016 MIDTERM SET PAPER EXAM 2025

NURS 1016 MIDTERM SET PAPER EXAM 2025 What are some strengths of older adults - -wisdom, peaceful, experienced (has knowledge and practical life skills), and have healthier past times Why is the proportion of population 65 or older steadily increasing? - -Low fertility rates and increased life expectancy Groups of old people - - young old 65-74 Middle old 75-84 Old 85+ Centenarians 100+ Supercentenarian 110+ Quality of Care - -the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge What are the attributes of health care quality - -safe, timely, effective, efficient, equitable, patient centered. Why is evidence important to nursing? - -it supports or disputes any number of situations related to nursing practice such as approving or disputing the efficacy of a treatment, using diagnostic tools, transmission of diseases, or any other scenario related to health care. Canadian Gerontological Nursing Association Standards of Practice (2020) - - Standard I: Relational care Standard II: Ethical care Standard III: Evidence informed care Standard IV: Aesthetic/ artful care Standard V: Safe care Standard VI: Socio-politically engaged care *See page 21 of first slideshow for details on each. Roles in Gerontological nursing are - -Generalist, specialist.... Implications for Gerontological Nursing and Healthy Aging - --Expertise in caring for older people can make the difference in their quality of life. This type of nursing is NUR 1016 NUR 1016 intellectually challenging as you are often caring for individuals with complex needs and health care issues. Nutrition Goals - -Safe, adequate nutrition for residents. Well-being comfort and quality of life. Respect choice and autonomy. What are some common nutrition concerns in the elderly? - -As we age there is a natural decline in: How well nutrients are absorbed, our sense of taste, smell and vision, we have a reduced thirst sensation, reduced saliva production which creates dry mouth and possible tooth loss, poor appetite and malnutrition, and cognitive issues and loss of independence. All of these things can lead to: Weight loss and general malnutrition, dehydration, bowel problems, disease complications, dysphagia, wounds or pressure ulcers, and vitamin and mineral deficiencies. Philosophy of Care when feeding elderly - -food first, medication pass nutrition supplementation program then additional oral supplements. Diet Order - -diet orders of clients may vary and could include therapeutic diets, texture orders, fluid orders or other comments. Therapeutic diets in LTC - -Regular, diabetic, renal, renal diabetic, gluten free, full fluids, clear fluids, NPO, tube feeding (tube feeding is not common) Texture order - -the texture order may include: no modification, diced, minced, minced mashed, pureed. Other comments or considerations for a diet order may include: - -allergies or intolerances, no added salt, low potassium, or any food preferences. Fluids order - -Fluid order may include: No modification, nectar thick fluids, honey thick fluids. Dysphagia - -chewing and swallowing problems. possible causes may be MS, parkinsons, alzheimers, ALS, dementia, stroke, aging, or medications. This can lead to: social isolation, withdrawal, lack of dignity, and fear of choking. Symptoms of Dysphagia - -holding food in mouth aka pocketing, inability to hold food or fluid in mouth, wet or gurgle voice, excessive chewing, coughing during or after eating or drinking, choking incident, resident complains of swallowing difficulty. (These are symptoms of....) NUR 1016 NUR 1016 Health risks of Dysphagia - -food and liquid entering the lung (aspiration), pneumonia as a result of aspiration, obstruction of airway (choking), weight loss, malnutrition, reduced quality of life. (Health risks of....) Guidelines for eating or feeding a person with dysphagia (and feeding in general) - before meal: make sure you are familiar with the residents feeding plan (positioning instructions, feeding aids, feeding methods, modifications and level of supervision), make sure their mouth is clean and clear of oral residue, excess saliva and mucous, insure the resident has their dentures, glasses or hearing aids if needed, and wash your hands as well as the residents. The environment should be calm and pleasant with minimal distractions, and turn the tv down as you can have a pleasant conversation. Avoid talking over the resident to carry on conversation with staff. For positioning make sure they are seated upright as close to 90 degrees as possible head positioned straight or slightly forward with a pillow to support neck and shoulders and always be alert. Check the tray for diet order, feed with food coming from below level of residents mouth, place food on side of mouth that is stronger for the resident. Make sure you have time to feed and do not rush. Residents may tire easily provide rest. Maintain postive attitude toward the meal regardless of your preference of the food and texture. Feed slowly with only 1/2- 1 tsp at a time and allow time to chew and swallow. Maintain a moist mouth during feeding by giving fluids in between food, and ensure mouth is clear before giving more food or liquid. DO NOT rinse food down with liquid as this increases the risk of aspiration. It may be beneficial to alternate between solids and fluids. Some residents may need encouragement to close lips around spoon or cup. If resident is holding food in mouth stimulate swallowing. We do this by presenting an empty spoon as if giving more food, touching empty spoon to residents bottom lip, gently touching outside of his or her cheek and/or providing verbal encouragement to swallow. IF resident coughs or chokes during feeding DO NOT o Why do we have texture modified diets? - -to maintain or achieve normal food intake while reducing the risk of aspiration and choking in individuals with dysphagia. Our goal is to provide the safest food consistency to maintain the best nutrition and pleasurable eating experience with the least modification. REMEMBER not everyone falls into a diet texture category perfectly. Texture Modification: Diced - -1.0 cm max. Must be easy to pickup with fingers or utensils, foods that are usually picked up do not need to be cut up like sandwiches. (not for dysphagia) We use this diet for mechanical problems with cutting food such as stroke or perceived independence. NUR 1016 NUR 1016 Texture Modification: Minced - -0.5 cm max meats and mixed dishes are moist and minced. meat requires minimal chewing We use this with problems chewing and or swallowing, or if the pt tires easily or has oral dental issues. Texture Modification: Minced/Mashed - -0.5 cm max meat is minced, vegetables are mashed, soups and desserts are blended and food is moist to facilitate swallowing. These foods require minimal chewing. We use this when there os problems chewing and or swallowing with some tongue control (you are able to move food to back of throat) Texture Modification: Pureed - -food is pureed or blended to a smooth consistency that does not require chewing. It is pureed with fluid normally found in product or with water. We use this with problems chewing and or swallowing, these pt have an inability to chew and manipulate food in mouth (they have no tongue control) Fluid consistencies - -thin fluids may be harder to control in the mouth and they may slip into the throat quickly and into the lungs (aspiration). Thick fluids are easier to control in the mouth and pass more slowly from the mouth to esophagus, reducing the risk of aspiration. There is regular, nectar thick, and honey thick. For thickened fluid diets avoid jello and frozen foods such as popsicles, ice cream, and sherbert because they melt into a thin liquid in the mouth. Regular Consistency - -no modification Nectar Thick (level 2 mildly thick) - -these fluids can be sipped from a cup and will fall off a spoon that is tipped. These types of fluids are for people with minor swallowing difficulty. Honey thick (level 3 moderately thick) - -these fluids can be eaten with a spoon but do not hold their shape on a spoon. They are too thick to be sipped from a cup. These fluids are for people with a lot of difficulty with swallowing regular fluids Aspiration - -studies suggest this is the leading cause of death in dementia patients. Properly trained feeders can reduce aspiration (you need patience and practice!) Good mouth care is essential for people at risk for aspiration. How to feed people at risk for aspiration - -Slowly with no force, small manageable bites of food. Ensure you have the resident positioned properly in an upright position and sit level with the resident. NUR 1016 NUR 1016 Development - -the sequence of physical, psychosocial and cognitive developmental changes that take place over the human lifespan. Normal Human Development - -is organized, is progressive and follows a predictable sequence across life stages Lifespan Development approach - -Aging occurs over the life span which can be up to 120 years . Aging begins at conception Course of aging varies from person to person--Influenced by genetic, social, psychological and economic factors. Types of aging - -Chronological age (# of years) Biological age (physical cond and vital organ func) Psychological age ( memory, ability to learn, skills, emotion & judgement) Social age (societal expectations and roles) Holistic Approach to Health - -an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable within the environment where they are functioning. Ageism - -Expressing prejudice toward older adults through your attitudes and behaviours Verbal and Non-verbal communication - -Listening attentively having an authentic presence nonjudgemental attitude being culturally competent clarifying giving information seeking validation keeping focus open ended questions Elderspeak - -a form of ageism where by the individual alters their speech based on the assumption that all older individuals have difficulty articulating what is being said to them Characteristics include: speaking slowly, loudly or both using a singsong voice using the pronouns we, us or our in place of you using pet names such as honey, dearie, or sweetheart Answering questions for the older person Determinants of Health - -the underlying causes of illness or wellness. there are 12 determinants of health: Income and social status NUR 1016 NUR 1016 social support networks education and literacy employment and working condition social environments physical environments personal health practices and coping skills healthy child development biology and genetic endowment health services gender and culture Principals of primary health care - -the primary health care approach is a way to build health and attend to determinants of health. This is adopted by the WHO in 1978. the 5 principles are: 1. Accessibility 2. Public participation 3. Health promotion 4. Appropriate technology 5, Intersectoral collaboration Accessibility - -the availability of health services to all Canadians regardless of their age or geographical location. Limited in rural and remote communities. Needs to be improved for minority groups and individuals who do not speak french or english Public Participation - -active partners in making decisions about their health care and health of their communities. Involves including older individuals in identification of health needs in the community. Results in flexible, responsive health care. Use of different community programs that allow individuals to become involved, and provide input related to health care needs, organization, and services. Health Promotion - -the process of enabling people to increase control over and to improve their health. This addresses the determinants of health and includes health education, public education, nutrition, sanitation, prevention and control of diseases. Appropriate Technology - -includes methods of care, service delivery, procedures, and equipment that are socially acceptable and affordable. Intersectoral collaboration - -recognizes that health and well being are linked to both economic and social policy. It means being the experts in the health sector; working with experts in other sectors. Health care professionals from various disciplines collaborate and function independently to meet the needs of canadians. NUR 1016 NUR 1016 Implications for Gerontological Nursing and Health Aging - -It is the responsibility of the nurse to assist older persons to achieve the highest level of wellness possible, The nurse assesses and. can help explore the underlying situation that may be interfering with the achievement of wellness and work with the person to develop appropriate plans. The nurse and the older person collaboratively implement interventions to achieve goals and evaluate effectiveness. Interprofessional collaboration and intersectoral collaboration are important parts of gerontological nursing. By incorporating the principles of primary health care in their practice, nurses can improve older adults access to health promotion and health care services. Intersectoral collaboration and public participation are required to promote health and prevent disability Biological theories of Aging - -Error (stochastic) theories, programmed aging (nonstochastic) theories. Error (stochastic) theories - -Aging as a result of an accumukation of errors in the synthesis of dna and rna, which are the basic building blocks of the cell. Ex: wear and tear theory, cross link theory, and oxidative stress theory. Wear and Tear theory - -cell errors result from the result of "wearing out" over time due to trauma and repeated use. Cross link theory - -cell errors result from the cross-linking, otherwise known as stiffening of proteins in the cell. Proteins bind with glucose in the presence of oxygen, causing the proteins to become stiff or thick. Oxidative Stress (free radical theory) - -This is the most understood and accepted theory of aging, cell errors result from damage to molecules (free radicals) in the cells. Exposure to the environment pollutants such as pesticides, smog, radiation increases the production of free radicals and increases damage to cells. Programmed Aging (nonstochastic) theories - -aging is thought to be predetermined at a cellular level. Cells have a natural life expectancy. This brings us the Neuroendocrine-Immunological theory. Neuroendocrine-Immunological theory - -based on changes in the neuroendocrine and immune systems. Emphasis is on the programmed deaths of the immune cells from damage caused by the increase of free radicals as aging progresses. Genetic research has shown that telomeres shorten with each cellular reproduction until the telomere disappears. At the same time as the telomeres are shortening and disappear the cell produces more progerin, which can interfere with the telomeres and shorten their life. What is important about cells during aging? - -During aging the number of cells decrease lean body mass is reduced, but fat tissue increases until 60s NUR 1016 NUR 1016 total body fat increases intracellular fluid decreases. This means the less total body fluid creates a risk of dehydration in older adults. Signs of dehydration in elders. - -dry mouth, tiredness, dark urine, dizziness, and fainting Age related changes - -graying and thinning of hair/balding ectropion (eyelids turn outward) Elongation of earlobes growth of facial hair in women diminished muscle mass and skinfold thickness decreased height wrinkling of skin deepening of hollows of axillae & intercostal & supraclavicular spaces Narrower gait in women, wider gait in men thicker hair in ears and nose Skin - -Made up of three layers: epidermis, dermis and hypodermis Epidermis damage in aging - -Thins making blood vessels and bruises much more visible, cell renewal time increases, the number of melanocytes in the epidermis decreases. Dermis damage in aging - -many signs of aging are a result of changes to the dermis loses about 20% of thickness with aging dermal blood vessels are reduced Collagen synthesis decreases Hypodermis damage in aging - -Some areas atrophy, fat decreases. Vitamin D - -Sunshine vitamin because when skin is exposed to sunlight vit D is produced and absorbed into the skin. Important for calcium absorption and osteoporosis prevention. hen there is a deficiency there is a risk for many chronic diseases and illnesses. Supplementation is recommended in areas where there is limited access to sunlight in the winter, such as Canada. Osteoporosis Canada (2017) recommends daily supplements of at least 800 IU per day for people over 50. Promoting Healthy Skin While Aging - -Avoid excessive exposure to UV light Apply moisturizer to damp skin after bathing Avoid use of drying soaps, instead use low pH cleansers Always use sunscreens, pay special attention to face, ears, neck and hands. Wear a broad rimmed hat when in the sunshine Keep well hydrated: drink 1.5 L per day, use a humidifier in the winter. NUR 1016 NUR 1016 Hair and aging - -Men and women in all racial groups have less hair ass they age and it turns grey or white. Older women develop chin lip and facial hair By age of 50 many men have some degree of baldness. The amount of hair in the ears, nose, and eyebrows of older men increases and stiffens Baldness begins usually with a receding hairline. Nails and Aging - -Nails become harder and thicker, more brittle, dull and opaque (harder to cut). Change shape, becoming at times flat or concave instead of convex. The blood supply and nails grow slower. Ensure you cut toenails straight across to avoid ingrown toenails. Ingrown toenail makes patient at higher risk for fungal infections. Musculo Skeletal System and Aging - -Experience damage to the structure, posture and body composition. Vertebral discs become thin, causing shortening of the trunk this can occur as early as age 50. From ages 20-70 height decreases by 2 inches. Bone strength decreases. May experience stooped appearance from kyphosis. Age related changes to muscles are known as sarcopenia. Reduced bone mineral density (BMD) Slower response changes in balances, this equals an increased risk for falls. Alteration in body shape and weight loss occur as lean body mass declines and body water is lost. Muscle strength declines, some muscle atrophy. Sarcopenia - -decrease in muscle mass and weakness in older adults-- increases fatigue, frailty and disabilities. Major risk factor for falling, daily activities are more difficult and independence is compromised. Heart damage by aging - -Presbycardia Heart loses its efficiency and contractile strength, resulting in lower cardiac output in times of physiologic stress: it takes longer for the heart to accelerate and then return to a resting state. The changes associated with disease are not a part of normal aging. Most older adults tire more quickly than the young and endurance declines with age. Presbycardia - -age related changes of the heart. Blood vessel damage and aging - -Development of atherosclerosis. NUR 1016 NUR 1016 Most significant change is decreased elasticity and recoil. Blood supply to various organs decreases, but change in flow to coronary arteries and brain is minimal. There is decreased perfusion of the liver and kidneys. - Implications for medications. Modifiable risk factors - -smoking, eating healthy, maintaining healthy weight, physical activity, coping with stress, limit sodium intake, limit saturated and trans fats. Non-Modifiable Risk Factors - -family history, gender (men are more likely to have CVD), ethnic origin and age. Thermoregulation in older adults - -slower circulation, including decreased vasoconstrictor responses. Reduced function of thermoregulatory capacity of the skin (including decreased or absent sweating) Reduced heat production (associated with slower metabolic and physical activity) Decreased shivering response Reduced perception of environmental temp are seen among older adults. Normal Age related changes in the respiratory system - -Loss of elastic recoil stiffening of the chest wall inefficiency in gas exchange increased resistance to air flow less lung expansion insufficient inflation decreased ability to expel foreign or accumulated matter lungs exhale less effectively max breathing capacity decreases: high risk for respiratory infections, like pneumonia, especially when immobile; endurance training can produce an increase in lung capacity of older adults Promoting healthy lungs - --Drink 1.5 - 2 L of water daily - Eat a well balanced diet - Wash hands frequently with soap and water - Practice thorough oral hygiene - Obtain pneumonia vax - Obtain annual influenza vx - Avoid exposure to smoke and pollutants - Do not smoke and stop smoking - Avoid persons with respiratory illnesses - Seek prompt treatment of respiratory infections Normal Age Related Changes to the Renal System - -blood flow through the kidneys decreases loss of as many as 50% of the nephrons Decrease in size and func in the kidney cortex NUR 1016 NUR 1016 urine creatinine declines due to reduced lean muscle mass Normal Age related changes to the endocrine system - -Pancreas - tissues of the body often develop decreased sensitivity to insulin--older persons ability to metabolize glucose is reduced (this is diabetes) we do not know why this happens Thyroid gland - some atrophy, fibrosis, and inflammation occur - Overall, thyroid function remains adequate - Increases incidence of hypothyroidism Hormonal Regulation - -physiological mechanisms that regulate the secretion and action of hormones associated with the endocrine system. Hormonal Regulation and Older Adult - -with aging glands become smaller with reduced hormone production. fragility risk for dehydration Normal Age Related Changes to the Gastrointestinal: Mouth - -teeth eventually lose enamel and dentin and become more vulnerable ot cavities, the roots become more brittle and break more easily. Gums are more susceptible to periodontal disease; bones that support teeth decrease in density and height = teeth loss Taste buds decline in number salivatory ssecretion lessens and is thicker Xerotomia common Normal Age Related Changes to the Gastrointestinal: Esophagus - -esophageal emptying is slower which can be uncomfortable because food remains in the esophagus longer. Aspiration is a risk because of a weaker gag reflex and delayed esopha