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39 Cards in this Set
- Front
- Back
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Psychosocial and developmental therory -
Erik Erickson's Stages of Psychosocial Development |
-Based upon the psychosocial conflicts throughout the lifespan; conflict of old age is ego integrity vs. despair
Stages: Intimacy vs Isolation: Early adulthood Generativity vs Stagnation: Middle age Ego vs Despair: Older adult to frail elderly |
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Psychosocial and developmental therory - Butler |
Retrospection and life review results in serenity, candor and wisdom |
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Psychosocial and developmental theory - Peck |
Expanded on Erickson -Ego differentiation vs. work role preoccupation
-Body trasndence vs. body preoccupation
-Ego trancedece vs. ego preoccupation |
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Psychosocial and developmental theory - Levinson's Seasons of Life |
-Focus on relationship of physical changes to personality
-Individual must ultimately come to terms w/ the inevitability of death |
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Psychosocial and developmental theory -
Common Threads - Developmental Tasks of aging |
-Adjust to decreasing physical strength and health
-Adjust to retirement and reduced income
-Adjust to death of a partner
-Establish affiliation with peers
-Adapt to social rules
-Establish satisfactory living arrangements |
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Physiologic theories -
Gene Theory |
One or more latent harmful genes becomes activated - organism cannot survive |
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Physiologic theories -
Error Theory |
As Cell ages, proteins contain more and more errors - "killer" gene is produced |
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Physiologic theories -
Somatic mutation theory |
-Destruction of a key gene causes cells to stop dividing
-Longevity depends upon how well the cell can repair DNA |
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Physiologic theories -
Programmed Theory |
A senescence factor accumulates in cells, acts in a dominant fashion |
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Physiologic theories -
Immunologic theory |
-Imbalance of T cells, cellular immune function decreases - autoantibodies are produced |
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Physiologic theories -
Free Radical Theory |
-Unpaired electrons are produced both intrinsically and externally
-Altered biochemical reactions result in DNA damage and cell death |
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Physiologic theories -
Cross-link theory |
Collagen molecules cross-link in tissues - produces stiffness and rigidity |
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Physiologic theories -
Stress-adaptation |
-Are related hypothermia, cardiac output decline and vital capacity result in diminished ability to cope with stress
-High degree of variability |
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End-of-life issues -
Methods of decision making for patients who cannot communicate wishes:
Appointed Person |
-makes decisions based up the patient's past wishes and values
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End-of-life issues -
Methods of decision making for patients who cannot communicate wishes:
Rational Approach |
-Makes decisions based upon what a "rational" person would do under the circumstances |
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End-of-life issues -
Methods of decision making for patients who cannot communicate wishes:
Substituted Judgement approach |
Attempts to determine what decision the patient would make if he was able |
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End-of-life issues -
Methods of decision making for patients who cannot communicate wishes:
Advanced Directives |
-Durable statements of intent based upon the pt's last written wishes
*Living wills are contracts between the pt and HCP which specify wishes for end-of-life terminal care |
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Advanced Directives, Continued....
Durable power of attorney
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authorizes another person to make decisions regarding health care when the pt is no longer able |
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Advanced Directives, Continued....
Values History |
written, videotaped, or audiotaped personal discussion
May contain Advanced directives |
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Advanced Directives, Continued....
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-Are not legally binding
-Not all states recognize AD legally
-States that do recognize them do so only when the patient is, in the opinion of the HCP, hopelessly and terminally ill |
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Advanced Directives, Continued....
DNR orders |
DNR not the same as a living will
DNR orders should not be selectively interpreted as meaning no transfer to ICU, no dialysis, etc... |
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Normal age-related changes must be differentiated form indicators of illness... |
-An increased anterior-posterior chest diameter (not just in COPD)
-Corneal ring (white ring around the iris, aka corneal arcus, senile arcus)
-Decreased skin turgor
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What are the organ systems most affected by age-related decline? |
-Neurological -Cardiovascular -Musculoskeletal -Lower Urinary
*B/c of the weakness in these 4 organ systems, the strain of illness or disease in any body system tends to manifest in one of the 4 weak ones
*In the geriatric pt, the organ system associated w/ the particular abnormality or problem is less likely to be source of sxs than in a younger adult |
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What are the predominant symptoms of illness in the Older adult? |
-Acute confusion -Depression -Falls -Incontinence -Syncope |
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Atypical disease presentations -
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-UTI may present as confusion or urinary incontinence
-MI may present as confusion
-Pneumonia may present as falling
-HF might be precipitated by mild hypothyroidism
-Mild hyperparathyroidism may produce significant congnitive dysfunction
-Mild prostate hypertrophy may result in urinary retention
-Mild glucose intolerance may result in non-ketotic coma |
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What are the two most common causes of dementia? |
#1 is Alzheimer's
#2 is Vascular dementia |
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Other dementias include |
Parkinson's Dementia
Lewy Body Disease
Pick's Disease: cognitive behavioral syndrome of frontotemporal dementia
-Subcortical dementia |
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What factors contribute to the development of pressure ulcers? |
-Moisture, advanced age, low BP, smoking, Elevated body temp, Dehydration |
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What conditions may mimic a pressure ulcer? |
-Fungal and yeast infection -Malignancy -Venous and arterial ulcers -Neuropathic ulcers |
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What scales are used for the assessment of pressure ulcers and prevention of risk? |
-Braden Scale
-Norton Scale
Both scales measure physical, mental condition, nutrition, mobility and continence
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Health Belief Model |
-Attempts to explain why people adopt healthier behaviors
Perceived susceptibility: a person's belief about the the chances of getting a condition
Perceived barriers: A person's belief about the barriers to changing a behavior
Perceived severity: A person's belief that the disease/addiction is severe and lifethreatening
Etc. |
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Abraham Maslow's Hierarchy of Needs |
-5 stages in the original model; Basic physiologic needs must be met before one can progress to the highest stage (self-actualization)
-Pyramid/triangle often used to show this model; basic needs are listed on the bottom (base), and the highest stage is at the apex of the triangle
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Jean Piaget's Stages of Cognitive Development |
-Attempts to identify cognitive development
-Last stage is "formal operational stage"; usually starts around age 11 - the older child can understand abstract ideas (abstract thinking). Logical thinking is more developed. More aware of the future. Can think in "gray" instead of "black or white" or "all or nothing" terms
-People w/ intellectual impairment remain in the "concrete" phase and never reach this "formal operational" stage |
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Sigmund Freud's Stages of Psychosexual Development |
-The last stage of this model is the "Genital stage," which starts in puberty. At this stage, genitals are seen as an important source of pleasure |
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Theory of Cultural Care Diversity |
-Madeleine Leininger
-Nursing care should be culture-specific and culturally sensitive |
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Self-Care Defecit Theory |
-Dorothea Orem
-Nurses help patients to maintain or assist them with self-care activities |
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Roy's Adaptation Model |
-Sister Calista Roy
-Promote adaptation of individuals/group by assessing behaviors/factors that affect adaptive capabilities |
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Theory of Caring |
-Jean Watson
-Caring is an important component of nursing (focus in on the person, not technology) |
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Neuman Systems Model |
-Betty Neuman
-Each person is a complete system and any changes in the "subparts" will affect the entire system; nurses help maintain stability of the system |
