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75 Cards in this Set
- Front
- Back
Trends in Healthcare (5)
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Health promotion (prevention)
Early diagnosis & treatment Management (living with chronic illness/disability) QOL (quality of life) EOL (coping with end of life) |
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Chronic conditions of children (definition)
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health problem that lasts over 3 months
affects normal child activities requires lots of hospitalizations / home HC / extensive medical care |
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Chronic conditions of children (list of illnesses)
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Asthma (most common!)
Diabetes Cerebral palsy Cystic Fibrosis Cancer AIDS Epilepsy Spina bifida Congenital heart problems Dental caries |
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Challenges for Chronic Children are...
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Lack of Understanding (both parent and child)
Adolescent Turmoil (adherence falls off here) Depression and Anxiety (unable to cope) Overwhelming $$$ Society (discrim, devaluing children, lack of understanding) Transition to Adult Care |
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Support for families with chronic children
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-American Family of Pediatrics
-Ronald McDonald -Air Charity Network (Angel Flights - free flights!) -Shriner's Charities -SSI (supplemental security income) -Catastrophic Illness in children Relief Fund -Disability -Fundraising |
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Chronic older adult
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-Adult onset diabetes
-Arthritis -Kidney / bladder problems -Dementia -Parkinson's -Lung disease -Cataracts -Osteoporosis -Enlarged prostate -Alzheimer's -Macular degeneration -Depression -Cardiovascular disease |
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Primary Prevention,
Secondary, Tertiary |
Primary:
protect healthy people from getting disease Secondary: After illness or risk factors are diagnosed, to halt or slow the progress of disease Tertiary: Helping people manage complicated, long-term health problems like diabetes, heart disease, cancer and chronic musculoskeletal pain |
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Health literacy
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the ability to read, understand, and effectively use basic medical instruction and information
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For the elderly, use language that is at...
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A 6th grade level.
sit at eye level, safe environment, use visual models, do teach back, bring a friend/family member, make list of concerns, write on chalkboard |
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FIRST THING YOU DO, before any teaching/learning assessment for the elderly.....
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Ask if they need glasses or hearing aids!
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ASK ME THREE Approach
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assess Health Literacy (the new vital sign)
teach so patient knows: 1) what is my main problem? 2) what exactly do i need to do? 3) why is it important for me to do this? |
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When talking with children and families...
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-Communicate attitude of CALM
-Establish trust -Encourage parents to stay with child -Designate one person as family liaison -Tell TRUTH -provide INCENTIVES, REWARDS -Assess child's nonverbals -PARENTS ARE EXPERTS on what is normal/abnormal in child |
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Nonverbal communication with kids
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-go to EYE LEVEL
-no awkward angles -SOFT voice, MODERATE pace, interrupt ONLY when/if necessary -Infants less than 6mo, touch anywhere, but do painful one last! -touch only as needed, watch your facial expressions |
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Parents of kids...
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-know normal or abnormal in kids
-having parent with child reduces PAIN in kid! -seperation = anxiety and stress for both parent and child -treat children as people -don't have parents do something painful to kids -parents shouldn't react when kid falls on face in store |
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Treat every child....
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as if they were the most special, beautiful, smartest childin the world - compliment them for something
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Guilt of parents
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parents feel guilty even if it's not their fault...
-responsible for illness/injury -causing pin -don't know enough to make a decision |
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Ages and stages of life
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Infant 1mo-12mo
Toddler 1yr - 3yr Preschool 3yr - 6yr School Age 6yr - 12yr Adolescent 12yr - 21yr Young Adult 19yr - 44yr Middle Adult 44yr - 64yr Older Adult 64yr+ Frail Older Adult is over 80yr |
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Infant growth
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0-6mo gain 1-2lb per month, increase length 1" per month
6-12mo gain 1lb per month, increase length 1/2" per month Double birth weight by 6mo & Triple birth weight by 1yr Increase length by 50% by age 1yr Head circumference growth: 1cm/month for first year |
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Infant development
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Erickson: Trust vs Mistrust (if needs are met, they learn to trust!)
Piaget: Sensorimotor Kohlberg: Stage 0. what i want! (moral development) Parent/Infant attachment is critical (should respond different to a stranger) LANGUAGE DEVELOPMENT is critical indicator of normal development over first year. otherwise brain/growth problems:( |
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2 month old
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-may lift head, still head lag
-primitive reflexes present -posterior fontanel closes by 2-3months -hands are often open (grasp reflex fading) -begins to follow objects -begins to smile to stimuli |
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3 month old
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-smiles in response to others
-tracks with eyes -babbles, coos -decreased head lab, holds head in place when you pull arms! -focuses on visual object and reaches -sucking to soothe -holds objects placed in hands |
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4 month old
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-flipping! (front to back, then stuck and cry)
-plays with feet -begins reaching/grasping objects -mouth to explore environment -brings hands to midline -recognizes faces, parent voice -differentiated cries! -sleeps at least 6hours -smiles, laughs, squeals -controls head WELL, bears weight on forearms, lifts chest 90 degrees -can start with cup |
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6 month old
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-rolls over! (front to back, back to front)
-dada! baba! -NO head lag when pulled! -sits with support -grasps and mouths objects -starts to self-feed -transfers small from hand to hand -rakes in small objects (object permanence) -turns to sounds -stranger anxiety -first tooth erupts! usually -lifts head, chest, upper abdomen and can bear weight on hands at 6mo, facilitates turning from abdomen to back! |
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4-6 months
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back is rounded only in lumbar area (when sitting), infant able to sit erect with good head control at 4 months!
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6-7 months old
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tripod sitting!
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7 month old
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infant bears full weight on feet by 7 months
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8 month old
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sits without support!
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9 month old
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-responds to own name
-knows "no-no", "bye-bye", "bottle" -imitates vocalizations -crawls, creeps, scoots -sits independently -may pull to a stand -shakes bangs throws drops objects -peek-a-boo, pat-a-cake -feeds self with fingers -drinking cup - interested constantly! -sleeps 6-8 hours -stranger anxiety can peak here! |
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Infant health promotion
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immunizations
hearing screening feeding sleeping on back! safety (burns, poisoning, falls, asphyxiation) prevent lead age approp toys DO NO USE WALKERS |
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Car seats
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Rear facing up to 2yrs and 30lbs, in BACK SEAT!!
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Toddler (general thoughts)
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Playing pretend, it's all about me
favorite word is "no" has stranger anxiety |
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Toddler growth
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physical growth slows
weight gain 5lb/yr height 3"/year at 2yo, head circum is 90% of adult overall head growth 1.5" during toddler years immature ab muscles and exaggerated lumbar curve |
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Toddler Development
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Erickson: Autonomy vs. Shame/Doubt (i want to do it all by myself, if I can't then i feel bad about myself)
Piaget: Sensorimotor to Preoperational Kohlberg: Punishment-Obedience language accelerates to 300 words by age 2 learning via trial/error, play, exploring expand motor skills |
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Toddler cup / bottle rule
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Get bottle away between 12-15 months
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Toddler potty training rule
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at 2yrs, toddler will have physiologic skills to go.
Not before. |
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Tooth care for infant and toddler
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Infant: rub tooth with wet wash cloth
Toddler: start brushing |
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Average age of potty training for girls, boys
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Girls: 2 years
Boys: 3 years |
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Toddler Health Promotion
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-SAFETY (curious, mobile, unaware of danger, burns, homocide due to tantrums, drowning, pedestrian, car, falls, choking, electrocution, strangulation blind curtains, firearms, bike injuries, sun)
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Preschooler (3-6) : Growth
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-Slow, steady growth
-Weight gain = 2.25kg (5lbs) per year -Height = 5 - 7.5 cm (2 - 3inches) per year -Appetite decreases -Slimmer, more agile appearance -Vital capacity increases, RR slows -Cardio maturation = participate in sustained activity -20 deciduous teeth by age 3! |
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Preschooler Development
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-Erickson: Initiative vs. Guilt
-Piaget: Preoperational -Kohlberg: Premorality -Fine and gross motor ability improve -Handedness by 3yrs -ADL (activities of daily life) by 4-5yrs >2100 words by 5yrs -Rhymes and silly words by 4yrs -Imaginative and imitative play! -Body integrity IMPORTANT (A CUT=INSIDES WILL LEAK OUT. Band aid is very important!! draw a picture on it!) -Enjoy helping adults, will try new foods if helped prepare it -Enjoy sense of accomplishment from activities (building blocks) |
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Preschooler Health Promotion
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-Need 10-12 hours sleep
-Nightmares/night terrors -Magical thinking accidents - superman can fly so they jump -Provide simple, concrete answers (no double meanings) -Gun safety, stranger awareness, good touch bad touch -Water safety -School readiness -Booster seat in car (car seat up to 40lbs) -Appropriate child care |
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Proper car seat for preschoolers?
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Booster seat, up to 40lbs.
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School Age (6-12)
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-Erickson: Industry vs. Inferiority
-Piaget: Concrete operations -Kohlberg: Morality of Conventional Role Conformity (concrete thinkers, FOLLOW THE RULES!) -Increased mastery of language -Emergence of logic ( 2+3=5! 5-3=2! ) -Self-esteem development -Friendship skills established! (usually same sex) -Assume responsibility (load dishwasher) -Music is favorite form expression (trumpet/guitar) -Avid collectors! stamps! |
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School Age Health Promotion
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-20 primary teeth lost, replaced with 20 permanent!
-Reading improves language -HELMET USE -Overestimate ability and maturity -School refusal -Obesity -Regular sleep -Supervise activities -Limit TV/videogames -Media influence -Emotional support -Sex education |
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School Age Safety
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-Able to recognize danger
-Learn/get rules -Best time to learn safety/role model is parent -Peer pressure > risk taking -Pedestrian injuries -Car safety -Burns -Homocides (preteen suicide) -Fireworks/firearms -Falls from roofs/playground/trees -Sports injuries -Poisoning -Start to smoke/drugs/booze (focus on impact of bad breath, smell) |
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Adolescent Growth
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-Rapid gains in height weight (3.5-4" in one year, and weight too. girls usually grow faster. boys muscle, girls body fat)
-Development of secondary sex characteristics -Continued brain development (teens brains not fully developed til late adolescence) -BODY IMAGE IMPORTANT HERE |
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Adolescent Development
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Erickson: Identity vs. Role Diffusion
Piaget: Formal Operations Kohlberg: Higher Law and Conscience |
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Adolescent Health Promotion
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-Healthy habits
-Injury/violence prevention -Mental health -Nutrition -Sex ed -Prevent substance abuse -Address issues of fatigue -Promote physical activity -Assess/discuss risk behaviors -Violence (homicide) -Sun protection -Abstinence/contraception -STD ed -Psychosocial support/listening -Car: NO TEXTING! / SEAT BELTS! -Consequences of decisions/making good decisions |
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Adolescence : Safety
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-Drugs, alcohol, tobacco
-Teens are risk takers -Strong peer pressure -Age of REBELLION -Motor vehicle -Homocide/suicide -Bicycle/motorcycle -Drowning -Pedestrians -Guns/explosives -Assault -Sports |
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Young Adulthood Development
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-Erickson: Intimacy vs. Isolation
-Complete process of physical maturation -Adult roles, learn a trade, higher education -Understand abstract concepts, career goals, autonomy, hobbies -Adult relationships, feel empathy, intimacy skills, values, some invincibility, establish body image |
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Middle Adulthood
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Ego development: Generativity vs Self Absorption/Stagnation
Production and Care children leave home, relationships/goals change, major life changes, mid-life crisis, stuggle with new meanings/purposes |
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Aging/Care of Older Adults: Issues
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-Everyone who lives long enough gets old
-Aging and disease not synonymous -Body more fragile, mind/spirit/creativity need not decline -Aging population will transform society & HC system -More HC providers needed |
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Aging/Care of Older Adults: Misperceptions
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Older adults are just adults who are older
Care for older adults is less challenging Only need to know gerontology is one works in nursing home |
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Aging/Care of Older Adults: Differences
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-More fragile, homeostatis harder to maintain
-Body functions less efficient -Not homogenous as a group or by body system -Atypical presentation -Focus on fuction -Live with chronic conditions, co-morbidities -More complex |
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Hospitalized Elderly issues to consider
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-Physiologic changes (non-classic): pain, don't spike temps, lab counts less altered, SOB yes / but pain chest pain no. experiences pain in different ways than child and adult
-Cascade disease patterns -Inevitable decline (functional status) -Comorbid conditions |
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Aging Changes
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-Cardiovasc (decreased baroreceptor, calcification, stiffening, dilation of aortic & mitral valves)
-Respiratory (decreased ciliary & cough reflex, alveoli less elastic) -Genitourinary(decreased GFR, reduced bladder elasticity/tone/capacity) -Integumentary (decreased subcut fat, capillary fragile) -GI (decreased thirst sensation, decreased esoph motility) -Musculoskel (tendon/ligament stiffens, narrowed intervertebral disks) -Sensory (decreased periph vision, hearing) -Endocrine (reduced insulin, decreased Vit D synthesis) -Nervous (decrease in neurons & NTs, slowed nerve impulses) -Cognition (stable crystallized intelligence, some decline in multitasking, increased time to learn/process new, some decline in retrieving info) |
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Cascade Disease Patterns:
Elderly client diagnosed with hypertension |
Educate individual re diet and exercise
participation in health promotion activities |
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Cascade Disease Patterns:
Started on antihypertensive therapy |
Educate about orthostasis and importance of dangling/leg exercises when getting up
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Orthostasis
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head rush or dizzy spell, is a form of hypotension in which a person's blood pressure suddenly falls when standing up or stretching. In medical terms, it is defined as a fall in systolic blood pressure of at least 20 mm Hg or diastolic blood pressure of at least 10 mm Hg when a person assumes a standing position.
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Cascade Disease Patterns:
Syncopal episode with fall |
Acute care interventions
referral for home health assessment of home for safety issues |
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Cascade Disease Patterns:
Fall with hip fracture; arthroplasty |
Acute care interventions and rehabilitation
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Cascade Disease Patterns:
Deconditioning and inactivity, Immobility and skin breakdown |
Rehabilitation
mobility activities |
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Challenges to Independence in Older Adult
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Physical and cognitive decline
Role changes/transitions/reversals -Retirement / economic decline: The effect of Social Security on the economic well-being of older adults -Health decline -Loss of spouse/friends -Driving privileges |
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Support for independent living in the community
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Social security and Medicare
-Part A: Hospitalization -Part B: Medical insurance -Part C: Private insurance (A&B) -Part D: Prescription drug coverage Medicaid -State Children’s Health Insurance Plans (S-CHIPS) The community |
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Nursing Issues in Caring for the Elderly
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Attend to primary expressed need first
-Pain -Fear -Anxiety Unless it’s a real emergency -time = worse outcome -deal with both at once |
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Goal of Elderly Care
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STABILIZE or CURE underlying condition, maintain QOL, preserve functional status
Recalibrate your pace as RN, be patient, don’t rush, provide encouragement -adjust to their Motor abilities -adjust to their Cognitive abilities |
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Elderly Assessment Tools
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FIM (functional independence measure) used in rehab
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Health promotion for Elderly
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POLYPHARMACY
AGEISM Physical activity Nutrition Tobacco Falls Immunizations |
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Older Adult issues / health realities
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-Lose sense of taste
-On crazy diets from comorbidities -Thirst reflex diminishes -GI slows -Dentitia (lose weight and dentures don't fit) -Do dietary recall for a week! -At risk for aspiration -GERD (a reason they could lose weight) |
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What to do/reference with Polypharmacy?
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BEERS CRITERIA (a list of PIMS - potentially inappropriate medications) for the elderly. A PDF document online
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why elderly don't adhere to meds?
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Decreased motor skills
Forgetful Finances -find out real problem, ask them |
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Elderly immunizations
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Herpes
Flu Pneumovac |
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Safety for Elderly
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-Unintentional injury at home (falls, struck by something, motor injury, cutting/piercing, animal/insect, fire/burns)
-Unintentional injury in hospital (aspiration/pressure ulcers/patient falls/UTI/hospital acquired infection) -Adverse events (harm to P due to medical care=infections) -Never events (serious events that should never occur in health care setting) |
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Geriatric syndromes
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-Delirium
-Fall Risk -Incontinence -Pressure ulcers -Sleep disturbances -Depression -Nutrition/weight loss -Polypharmacy Also: Agism, Successful Aging |
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Successful Aging: what do patients want?
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1) Stay healthy
2) Live well and cope with illness and disability 3) Cope with End of Life |