NR 226- Exam 2 Study Guide

NR 226- Exam 2 Study GuidePrinciples for promoting older adult learning Make sure they are ready to learn; are they well enough to learn; sit in front of pt so they can watch your lips move & facial expression; speak slowly & in normal tone; say one idea at a time straight & to the point; give them enough time to answer; minimal distractions w/ proper lighting & comfortable settings; if tired or distracted stop teaching; invite another family to talk; audio, visual & tactile cues to help w/ learning & memory; ask for feedback to know they understand; using past experiences to connect to new learning. 2. Presentation of illness in older adults; acute care, restorative care Presentation of illness – confusion, occurrence & reasons for fall, dehydration, decreased appetite, loss of function, dizziness, incontinence Acute care – (short term hospital stay) risk for delirium, dehydration, malnutrition, nosocomial infections, urinary incontinence & falls. Restorative care - (recovering from acute illness or surgery & support of chronic conditions that effect day-to-day) stabilize chronic conditions, promote health and promote independence w/ ADL’s & IADL’s; prevent, improve, reduce or eliminate problems 3. Comparison of clinical presentation of delirium, dementia and depression; nursing implications Delirium – sudden onset; short fluctuations, worse by night & waking; abrupt progression; last hours to less than month (longer if untreated); consciousness is reduced; alertness fluctuates (lethargic or hypervigilant); attention fluctuates; orientation impaired (severity varies); forgetful; disorganized thinking (speech slow or fast); delusions & hallucinations; psychomotor movements varies; disturbed sleep (reverse). medical emergency & prompt assessment. Bedside 24/7 and ready to recognize development to report. Cognitive impairment reversed once doc identify and treat cause Dementia – slow onset & often unrecognized; long & progressively stable; slow but even progression; last moths to years; consciousness is clear; generally normal alertness; generally normal attention; orientation is normal to person but not place or time; memory impaired; thinking is impaired; misperceptions; normal psychomotor movements (may have apraxia, which is inability to perform purposeful actions); fragmented sleep. Always consider safety, physical & psychosocial needs. Enhance quality of life & maximize functional performance (cognition, mood &behavior) Depression – major life changes, can be sudden or gradual; during day, worse in morning, fluctuations w/ situation; varied progression; last at least 6 weeks or several months to years; consciousness is clear; normal alertness; attention is easily distracted; selective disorientation; sections of intact memory; thinking intact but w/ hopelessness & helplessness; intact perception(delusions & hallucinations in severe cases); varied psychomotor; disturbed sleep (wakes up early). 4. Sexuality in the older adult Changes in reproductive structure & function does not affect libido; still have desires, thoughts & actions for decades. Less activity because illness, death of partner & decreased socialization. Involves love, warmth, sharing and touching. Important role to help maintain self-esteem. understand physical changes in sexual response, provide privacy for discussion of sexuality, be nonjudgmental, ask open-ended questions. Talk about prevention of STI. Touch has many meaning and is an alternative sexual expression. 5. Health concerns; health promotion and maintenance, stroke, smoking, alcohol abuse, safety; nursing implications