NURS 525 Midterm Study Guide With
Complete Solution
Frailty - definition - ANSWER Frailty - progressive multi-system impairment
and decreased physiologic reserve resulting in increased vulnerability to
stressors.
Primary frailty is multifactorial, with sarcopenia (loss of muscle mass) being a
central component. Frailty occurs due to alterations in neuromuscular,
metabolic and immune systems causing a homeostatic decline; no underlying
pathological causative factors.
Secondary frailty is a similar dysregulation that develops due to the core
wasting processes of inflammatory and immune diseases.; results from
underlying causative factors (such as depression, CA, chronic infections, CHF)
Pre-frailty/Frailty Diagnosis - ANSWER Diagnose Frailty with at least 3 of the
following:
Weight loss (≥5% in last year)
Exhaustion - self reported
Weakness (decreased grip strength)
Slow walking speed (>6 to 7 seconds for 15 feet)
Decreased physical activity (males <383 kilocalories, kcals); females <270
kcals)
Pre-frailty is when fewer than three of these characteristics are met.
,Pathophysiology of frailty - ANSWER In frailty, the balance between the
normal reaction to stressors -- apoptosis and senescence -- or the
acceleration of either, changes mainly in these three systems:
Musculoskeletal: Decrease in skeletal muscle mass, VO2 max, strength and
exercise tolerance, thermoregulation, energy expenditure, resting metabolic
rate and muscle innervation.
Immune: There is a decrease in immunoglobulin G (IgG), IgA, interleukin 2
(IL-2) and mitogen response. There is an increase in IL-6, IL-10 and C-reactive
protein (CRP).
Neuroendocrine: decrease in growth hormone, insulin-like growth factor 1,
vitamin D, estrogen and testosterone (DHEA-S). Increase in insulin resistance,
cholecystokinin, sympathetic tone and steroid dysregulation.
Risk factors for frailty - ANSWER Physiologic: activated inflammation;
immune system dysfunction; anemia; endocrine alteration; underweight or
overweight; advanced age
Medical Illness/Comorbidity: CV disease; DM; CVA; arthritis; COPD; cognitive
impairment/cerebral changes
Socioeconomic and Psychological: females; low SES; race/ethnicity;
depression
Disability: Dependence with ADLs
ADAM questionnaire - ANSWER Assesses for presence of androgen
deficiency in aging males
Timed Up and Go (TUG) Test - ANSWER evaluates ability to get up from
armed chair and walk 10 feet and back; Normal=<10 sec
,Tinetti Assessment Tool - ANSWER Assesses gait and balance
Fulmer SPICES - ANSWER Fulmer SPICES is a framework for assessing older
adults that focuses on six common "marker conditions": sleep problems,
problems with eating and feeding, incontinence, confusion, evidence of falls,
and skin breakdown. These conditions provide a snapshot of a patient's
overall health and the quality of care. The SPICES assessment, done regularly,
can signal the need for more specific assessment and lead to the prevention
and treatment of these common conditions.
15 second FRAILTY screening tool - ANSWER Fatigue: Are you fatigued?
Resistance: Do you have difficulty walking up one flight of steps?
Aerobic: Are you unable to walk at least one block?
Illness: Do you have more than five illnesses?
Loss of weight: Have you lost more than 5% of your weight in the past 6
months?
FACIT Fatigue Scale - ANSWER Functional Assessment of Chronic Illness
Therapy: evaluates patient's perception of energy level, fatigue, and
exhaustion
KATZ Index - ANSWER assesses capability of performing ADLs
Lawton Scale - ANSWER assesses capability of performing IADLs - use of
telephone, shopping, food prep, housekeeping, laundry, transportation,
meds, finances
Pittsburgh Sleep Quality Index - ANSWER Assesses sleep patterns and
effectiveness
, Epworth Sleepiness Scale - ANSWER Screens for presence of daytime
sleepiness
Hendrich II Fall Risk Model - ANSWER provides a determination of risk for
falling based on gender, mental and emotional status, symptoms of
dizziness, and known categories of medications increasing risk.
DIAPPERS (causes of transient urinary incontinence) - ANSWER Delirium
Infection (e. g., urinary tract infection)
Atrophic urethritis or vaginitis
Pharmacology (e.g., diuretics, anticholinergics, calcium
channel blockers, narcotics, sedatives, alcohol)
Psychological disorders (especially depression)
Endocrine disorders (e.g., heart failure, uncontrolled diabetes)
Restricted mobility (e.g., hip fracture population, environmental
barriers, restraints)
Stool Impaction
TOILETED (causes of transient urinary incontinence) - ANSWER Thin, dry
vaginal and urethral epithelium
(Atrophic urethritis or vaginitis)
Obstruction (Stool Impaction/Constipation)
Infection
Limited mobility (Restricted mobility)
Complete Solution
Frailty - definition - ANSWER Frailty - progressive multi-system impairment
and decreased physiologic reserve resulting in increased vulnerability to
stressors.
Primary frailty is multifactorial, with sarcopenia (loss of muscle mass) being a
central component. Frailty occurs due to alterations in neuromuscular,
metabolic and immune systems causing a homeostatic decline; no underlying
pathological causative factors.
Secondary frailty is a similar dysregulation that develops due to the core
wasting processes of inflammatory and immune diseases.; results from
underlying causative factors (such as depression, CA, chronic infections, CHF)
Pre-frailty/Frailty Diagnosis - ANSWER Diagnose Frailty with at least 3 of the
following:
Weight loss (≥5% in last year)
Exhaustion - self reported
Weakness (decreased grip strength)
Slow walking speed (>6 to 7 seconds for 15 feet)
Decreased physical activity (males <383 kilocalories, kcals); females <270
kcals)
Pre-frailty is when fewer than three of these characteristics are met.
,Pathophysiology of frailty - ANSWER In frailty, the balance between the
normal reaction to stressors -- apoptosis and senescence -- or the
acceleration of either, changes mainly in these three systems:
Musculoskeletal: Decrease in skeletal muscle mass, VO2 max, strength and
exercise tolerance, thermoregulation, energy expenditure, resting metabolic
rate and muscle innervation.
Immune: There is a decrease in immunoglobulin G (IgG), IgA, interleukin 2
(IL-2) and mitogen response. There is an increase in IL-6, IL-10 and C-reactive
protein (CRP).
Neuroendocrine: decrease in growth hormone, insulin-like growth factor 1,
vitamin D, estrogen and testosterone (DHEA-S). Increase in insulin resistance,
cholecystokinin, sympathetic tone and steroid dysregulation.
Risk factors for frailty - ANSWER Physiologic: activated inflammation;
immune system dysfunction; anemia; endocrine alteration; underweight or
overweight; advanced age
Medical Illness/Comorbidity: CV disease; DM; CVA; arthritis; COPD; cognitive
impairment/cerebral changes
Socioeconomic and Psychological: females; low SES; race/ethnicity;
depression
Disability: Dependence with ADLs
ADAM questionnaire - ANSWER Assesses for presence of androgen
deficiency in aging males
Timed Up and Go (TUG) Test - ANSWER evaluates ability to get up from
armed chair and walk 10 feet and back; Normal=<10 sec
,Tinetti Assessment Tool - ANSWER Assesses gait and balance
Fulmer SPICES - ANSWER Fulmer SPICES is a framework for assessing older
adults that focuses on six common "marker conditions": sleep problems,
problems with eating and feeding, incontinence, confusion, evidence of falls,
and skin breakdown. These conditions provide a snapshot of a patient's
overall health and the quality of care. The SPICES assessment, done regularly,
can signal the need for more specific assessment and lead to the prevention
and treatment of these common conditions.
15 second FRAILTY screening tool - ANSWER Fatigue: Are you fatigued?
Resistance: Do you have difficulty walking up one flight of steps?
Aerobic: Are you unable to walk at least one block?
Illness: Do you have more than five illnesses?
Loss of weight: Have you lost more than 5% of your weight in the past 6
months?
FACIT Fatigue Scale - ANSWER Functional Assessment of Chronic Illness
Therapy: evaluates patient's perception of energy level, fatigue, and
exhaustion
KATZ Index - ANSWER assesses capability of performing ADLs
Lawton Scale - ANSWER assesses capability of performing IADLs - use of
telephone, shopping, food prep, housekeeping, laundry, transportation,
meds, finances
Pittsburgh Sleep Quality Index - ANSWER Assesses sleep patterns and
effectiveness
, Epworth Sleepiness Scale - ANSWER Screens for presence of daytime
sleepiness
Hendrich II Fall Risk Model - ANSWER provides a determination of risk for
falling based on gender, mental and emotional status, symptoms of
dizziness, and known categories of medications increasing risk.
DIAPPERS (causes of transient urinary incontinence) - ANSWER Delirium
Infection (e. g., urinary tract infection)
Atrophic urethritis or vaginitis
Pharmacology (e.g., diuretics, anticholinergics, calcium
channel blockers, narcotics, sedatives, alcohol)
Psychological disorders (especially depression)
Endocrine disorders (e.g., heart failure, uncontrolled diabetes)
Restricted mobility (e.g., hip fracture population, environmental
barriers, restraints)
Stool Impaction
TOILETED (causes of transient urinary incontinence) - ANSWER Thin, dry
vaginal and urethral epithelium
(Atrophic urethritis or vaginitis)
Obstruction (Stool Impaction/Constipation)
Infection
Limited mobility (Restricted mobility)
