Download Healthy Aging: A Comprehensive Guide for Students and more Exams Nursing in PDF only on Docsity!
FINAL EXAM EBERSOLE & HESS
HEALTHY AGING REVISED
Types of grief anticipatory - when you know you're about to have a loss of some kind (not just death - moving, amputation, whatever) acute shadow - chronic, normal - intermittent sadness often triggered by events complicated - acute that doesn't lessen, equilibrium remains elusive - guilt, anger, ambivalence toward lost person unresolved disenfranchised - loss can't be openly mourned - eg capital punishment or relationship not socially accepted (used to be v common in era when LGBT+ not accepted) what is palliative care focus is on providing comfort and increasing QOL prevent/minimize suffering can be offered concurrently with life-prolonging/stabilizing care, or can be purely comfort-related with no curative measures taken (hospice care provides palliative care) hospice guidelines
- palliative
- 6 mo or less prognosis (can be on hospice long er than 6 months with documented decline)
- lots of misconceptions
- people can seek tx, just not for s/s related to their hospice diagnosis
- hospice meds tend to include a med for secretions (eg scopolamine), a benzo, and
morphine
- people may need education that morphine in hospice is not just for pain
- lots of services available on hospice eg music, massage, chaplain, aide grief models Kubler-Ross Disequilibrium what is a living will a type of advance directive specifically for EOL care in terminal illness for when pt becomes unable to voice their wishes includes designation of a proxy what is spiritual care assisting pts in... finding meaning, reconciliation transcendent reality strengthen their spiritual life identify and address pts in spiritual distress what is wellness
- multidimensional
- adaptation to internal/external conditions
- individualized
- is a continuum, not a condition aspects of wellness... biological environmental functional intellectual psychological
- "book smarts"
- long lasting, improves c experience
- stable c age memory problems with aging...normal? no - not expected age-related change - should be evaluated maintaining neuroplasticity... "use it or lose it" learn new things, do something outside of routine therapeutic comm c elderly
- don't use elderspeak
- be aware of ageism
- storytelling/reminiscing important health assessment in older adult
- can be complex d/t years of lived experience
- ROS may be more like "review of symptoms"
- may take multiple sessions r/t stamina what is FANCAPES fluid aeration (inc cardiovascular) nutrition communication activity pain elimination social what is SPICES sleep prandial problems incontinence confusion evident ecchymoses
skin breakdown yes I changed some of these bc this is the stupidest tool. p for "problems"? how is that a mnemonic, when there could be problems with pretty much anything? I/ADL assessment tools Katz Barthel Functional Independence Measure Blessed (dementia & I/ADLs) Cognition assessment tools MMSE mini-cog (3 words, clock drawing, repeat 3 words) Blessed (dementia & I/ADLs) FAST Global deterioration scale OARS assesses function, resource utilization in older adults OASIS assesses risk of re/hospitalization (the main home health assessment) RAI assesses QA tool for residents (of SNF/LTC) CBC results indicative of infection in older adult WBCs >10K + shift to the left Normal CBC levels RBCs 3.5- WBCs 4.5-11 (older adult, >10 + left shift = inf) Hgb 11- HCT 35- Plt 150-
pharmacodynamics: what the drug does to the body (dynamic - creates a state change in the body) Beers list identifies potentially inappropriate medications increased safety concerns in older adults issues c herbal supplements
- lots of people use them but don't always tell HCPs about them
- can have interactions c Rx meds
- 'G' herbs & increased bleeding (ginseng, garlic, ginkgo)
- SJW serotonergic normal age-related change in vision presbyopia almost 95% over 65yo need readers eye changes that can happen blepharoptosis ectropion, entropion arcus senilis dry eye cataract decreased accommodation MD: age-related/dry, or wet/neovascular POAG differences in vision c cataract, glaucoma, MD, DR cataract halos, glare, fading/yellowing of color vision, cloudy/blurry Vx glaucoma loss of peripheral vision MD loss of central vision DR black splotches in vision
age-related hearing change presbycusis types of hearing loss sensorineural (inc presbycusis) often loss of high tones first conductive (problems c ear structures, cerumen) types of hearing devices HAs - ITC, ITE, BTE, CIC, etc. cochlear implant - can be helpful if HAs don't correct enough to understand speech BUT destroy residual hearing what is: xerosis pruritus petechia, purpura, ecchymosis keratosis xerosis: dry skin pruritus: itchy skin P/P/E: pinpoint, larger, largest bleeds under the skin keratosis:
- seborrheic - benign, waxy growth
- actinic - preCA, scaly, red-pink diet & longevity
types of urinary incontinence Stress
- aka pregnancy ruins you
- can happen p TURP too
- sneeze, cough, jump - you pee a little Urge
- OMG I need to pee so bad...aaaand, sh*t, I'm peeing, wish I'd gotten to the toilet first
- Can't hold on once need to urinate hits
- Overactive bladder Functional
- my bladder works pretty well, but I have mobility problems, can't work the fasteners on my clothes, hard to sit down safely on low toilet, etc. Mixed
- Usually combination of stress and urge incontinence interventions teach on bladder training, scheduled toileting, don't drink right before bedtime, kegels wear clothing that's easy to get undone, nightlights to bathroom which sleep stages increase or decrease c age 1 & 2 increase 3 & 4 decrease REM in shorter bursts hospitals & sleep 21-61% have sleep problems try to allow for 90 minute sleep cycles, cluster care what occurs during REM sleep
NTs replenished memory is transferred from short term to long term OSA frequency? can lead to? 25% older adults R side failure CVA DMii death what is first-line intervention for OSA CPAP mask exercises for OA strength balance OA - low impact, strengthen muscles that support joints strength - weights, resistance bands, Pilates, home/yard work balance - tai chi, yoga, tip toe stand, leg raises, hip extensions fall risk factors decreased visual acuity medications weakness decreased balance home safety chronic health conditions (eg PD) Extrinsic - things like clutter, rugs, etc. Intrinsic - things within like dizziness fall interventions
- trajectory onset: hey, we have symptoms, time to diagnose
- stable: we're controlling this
- unstable: we're not controlling this, actually
- acute: time to go to the hospital
- crisis: this is pretty serious, I might die
- comeback: remission, feeling better
- downward: decline, more symptoms
- dying: bucket list and last words a-fib control strategies
- rate control
- rhythm control
- prevent thromboses c blood thinners 2 kinds of CVA hemorrhagic infarct (much more common) FAST tool (not the dementia one) CVA - face arms speech time NCDs: distinction between PD and LB in PD, the movement problems come before cognitive problems in LB the cognitive problems come before the movement problems what kind of meds are contraindicated for Lewy body? typical antipsychotics s/s NGD
slow decline decline in memory and learning maybe also: attention, EF, language, perceptual motor, social fluctuating cognition hallucinations sleep and movement disturbances (without evidence of reversible causes) s/s Lewy body severe loss of ability to think (problem solving, language, numbers) fluctuating attention/alertness hallucinations - 80% disordered sleep - mostly stay in REM sleep autonomic dysregulation Decrease risk of NGDs by normal BP LDL < A1C <7% ASA81 if you have heart dz risk optimal control of HF don't smoke AD risk factors
- genetic
- age
- African American
in aging lungs, the following increase or decrease: residual capacity compliance chemoreceptor function PO2, pH, PCO cilia function cough reflex residual capacity - increases (dead space) compliance - decreases chemoreceptor function - decreases (less sensitivity to hypercapnia/hypoxia) PO2, pH, PCO2 - PO2 declines, the other two shouldn't change cilia function - decreased cough reflex - decreased Incomplete lung expansion can lead to what common finding on auscultation? atelectasis @ bilateral bases gold standard for dx COPD spirometry COPD onset is acute or insidious? insidious - long asymptomatic stage, by the time s/s appear, 50% of lung function may be lost COPD s/s wheezing, cough (primary smoker's symptom), SOB c exertion, inc phlegm late: pursed-lip breathing tripoding barrel chest c hyperresonance clubbing
COPD exacerbation
- spirometry <150mL
- worsened orthopnea/PND
- RR > asthma triggers tobacco smoke dust mites air pollution cockroaches pets mold wood/grass smoke URIs strong odors cold air asthma s/s tight chest wheezing SOB c exertion or at rest nonproductive cough relationship between asthma and OSA each can put you at risk for the other Primary cause of age-related postural/structural changes? bone Ca+ loss atrophy of cartilage and muscle By age 70, women may lose how much bone mass? 50% what affects rate of bone loss? genes estrogen levels nutritional deficiencies
persistent pain can lead to
- depression
- disturbed sleep
- decreased function
- loneliness/withdrawal
- self-medicating c ETOH/drugs causes of neuropathic pain DM CVA PVD herpes zoster degenerative disk dz older adult changes in pain perception very slight delay in sensation from periphery (inc risk for injury) slower resolution of triggered pain principles of pain management
- everyone deserves pain management
- Tx plan individualized to person's goals
- pain is what they say it is
- pharm doses may be dec by non-pharm interventions
- deal with SEs promptly
- ongoing eval of effectiveness of plan
- teach all CGs about pain plan/SE how many in nursing homes have unTx pain 65% PAINAD scale breathing - calm, or noisy/hyperventilating? vocalization - quiet, or moaning/crying? facial expression - relaxed, or frowning/grimacing?
body language - relaxed, or: tense, fidgeting, pacing, rigid, pulling away, striking out consolability - no need, or need to console/unable to console? (more or less an adapted FLACC scale) older adults mostly receive mental health care from? their PCPs long-term effects of SCZ lifespan shorter by 20-30y 2x incidence of dementia 41% of older adults c SCZ live in nursing homes assessing psychotic s/s in older adults is it bc of
- medical illness
- meds
- dementia
- mental illness did you check for visual/hearing impairment suicide & the older adult white male >85 yo highest increase in ages 50- chronic illness, uncontrolled pain, losses, crises, ETOH/drug abuse, depression, Hx attempts ETOH abuse - men or women more likely? men 4x more likely but women of any age more vulnerable to effects of etoh depression risk factors
