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64 Cards in this Set
- Front
- Back
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Changing demographic trends |
1/8 people in US are older 12.6^ women live longer than men and more likely to live alone 50% increase in minorities by 2020 |
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Reasons people are living longer |
improvements in healtcare |
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Biologic Theory of Aging |
address factors actually triggered by the aging process. concerned with answering basic questions regarding physiologic processes. does not provide comprehensive explanation of aging process error theory free radical theory cross linkage theory wear and tear theory programmed theory (Hayflick limit) immunity theory |
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Sociologic Theory of Aging |
focused on roles of relationships that individuals engage in later life disengagement theory activity/developmental task theory continuity theory age stratification theory- cohorts age collectively and roles change and influence each other person-environment fit theory |
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Psychologic Theory of Aging |
influenced by both biology and sociology; address how a person responds to the tasks of his/her age maslows hierarchy of human needs jung's theory of individualism eriksons eight stages of life pecks expansion of Eriksons theory- seven developmental taste added to the final two stages of eriksons theory (ego vs work role, body transcendence vs body preoccupation, ego transcendence vs eco preoccupation) selective optimization with compensation |
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Moral/spiritual Theory of Aging |
examine how an individual seeks to explain and validate his or her existence |
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culture |
shared and learned beliefs, expectations, and behaviors of groups of people |
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values |
cultural beliefs about what is right and wrong |
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race |
outward expression of genetically influenced, hereditary traits- skin and eye color |
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Ethnicity |
Social differentiation of people based on group membership, shard history, common characeristics |
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Cultural Conflict |
Anxiety experienced when people interact with individuals who have beliefs, values, customs, languages, and ways o life different from own |
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Self-Assessment |
Enables nurses to be aware of strengths and weaknesses in their knowledge and skills for cross cultural caring |
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Culturally Sensitive Care |
Begins ewith an understanding of health care practices, values, beliefs or older adults and family |
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Respite |
Program to benefit caregiver with shared responsibility Most effective when used early to prevent physical and emotional exhaustion than later to treat it |
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Culture and Nursing Care |
Individual vs Collective group Time orientation Eye contact/touch Decision Making |
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Family and Nursing Care |
Changing roles, living arrangements legal Concerns (DNR) End of life Finances |
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Strategies for working with families of older adults |
Identify patient and family conduct assessment of both encourage families to plan in advance help family communication involve the older person in decisions address feelings of guilt emphasize goodness of intent of actions Nurse acts as permission giver |
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Socioeconomic factors and Nursing |
Age cohorts -roaring 20s -great depression -womens rights activates Income sources Insurance benefits -increase in overall education -men with higher wages -rely on fixed income and medicare insurance |
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Strategies for Culturally Competent Care |
Increasing awareness, knowledge, and skills are the tools needed to begin to overcome the barriers to culturally compassionate care to reduce health disparities Begins with increasing awareness of our own beliefs and attitudes and those commonly seen in the community at large and in the community of health care -Leininger's theory of cultural care diversity and universality -Explanatory model (Kleinman, Eisnberg, Good) -LEARN model -ASKED model |
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Leininger's theory of Cultural Care Diversity and Universality |
discover ways to provide culturally appropriate care to people who have different cultural perspectives from the nurse -cultural care preservation or maintenance -cultural care accommodation or negotiation -cultural care repatterining or restructuring |
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Explanatory Model (Kleinman, Eisenberg, Good) |
To provide culturally sensitive and competent care the nurse should explore the meaning of the health problem from the patients perspective |
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LEARN model |
Nurses increase cultural sensitivity and provide more culturally competent care L: listen - wit sympathy and understanding to the patients perceptions of the problem E-Explain- our perceptions of the problem A:ackknowledge- and discuss the differences and similarities R: recommend-treatment N: negotiate-agreeement |
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ASKED Model |
Awareness- aware of biases Skills: do you have the skills for assessment Knowledge: do i have the knowledge of patient world view Encounters: how many encounters have I had with this culture Desire: what is my desiire to want to be culturally compeetent |
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Medicare |
"care" for old people fed program provides health insurance for older adults Part A: hospital insurance for inpatient care and follow up care Part B: insurance to help pay for physician services and outpatient services |
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Medicare Advantage Plans |
supplements, more comprehensive, $$ |
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Medicaid |
"aid" for the poor state-administered program that uses federal funds to provide some medical expenses not covered by Medicare. Designed for people with low income and minimal assets |
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Supplement Security Income (SSI) |
fixed income to aged, disabled, poor need-based program |
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Social Security |
a federal insurance program that provides benefits to retired people and those who are unemployed or disabled earned by paying taxes and working |
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Key Legislation of Nursing Home Reform |
1983-DHHS contracted with "Suffering in Silence" -1987: OBRA passed by congreess to change medicare and medicaid decrease in overuse of antipsychotics decreased inappropriate use of restraints decreased inappropriate use of foley catheters |
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OBRA Mandates |
Omnibus Budget Reconciliation Act of 1987 Provision of service requirements for nursing facilities, survey and certification process, enforcement mechanisms and sanctions -quality of life and preservation of human rights and due process -survey process focusing on outcomes of residential care and sanctions to enforce complience |
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OBRA Mandate Components |
1. Provision of service requirements 2. Survey and Certification processes 3. Enforcement mechanisms and sanctions |
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Provision of Service Requirements for nursing facility |
Minimum Data Set (MDS 3.0) - comprehensive care plan, reviewed quarterly -background, activity, cognition, physical functioning pssychosocial status |
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Nursing Home Enforcements |
-minimal nurse staffing levels (LPN 24/7, RN 8hr/7) -required and approved nursing aid programs and competency (6 hour inservice -social worker services -provisions of discharge -Unnecessary drug use- antipsychotics, bentos, anxiolytics/sedatives -physical restraints -chemical restraints (gradual dose reductions -Urinary incontinence |
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Key Components of Geriatric Specific Nursing Assessment |
*physical and psychosocial aspects of aging -modify environment, consider energy level and adaptability, observe opportunity for demonstrating assets and capabilities Assessment of disease/disability and effects on functional status |
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Health History Interview of Older Adults |
Visual Deficit Hearing Pain Anxiety, reduced energy level, multiple and interrelated health problems, tendency to reminisce |
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Atypical Presentation of Illness in the older Adult |
Diminished physiologic reserve: blunted or atypical signs or symptoms of illness -dry cough with pneumonia -no chest pain with MI hyperthyroidism: slow, lethargic, weak, atrial fi Delirium is common but not normal UTI: dysuria absent |
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Baseline Functional Status |
Important to know b/c older adults move between health care settings -improving may delay onset of impairment |
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Change in functional status |
sign of illness or complication of illness |
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Functional Assessment |
measure of older adults ability to perform basic self-care tasks or ADLs and tasks that require more complex activities for independent living |
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Katz Index of ADLs |
determine results of treatment and prognosis in older and chronicley ill people. ranks adequacy in bathing dressing toiling transferring continence and feeding -order reflects natural progression in loss and restoration of function -describbes functional level at specific point in timing measures effects of treatment |
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Barthel Index |
Rates self-care abilities in feeding, moving, toiling, bathing, walking, propelling wheelchir, stairs, dressing, continence -most appropriate in rehb |
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Philadelphia Geriatric Center Instumental ADL Scale |
measures complex activities - telephone, shopping, prepping food, housekeeping, laundry |
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Importance of Functional Assessment |
capacity to carry out basic self-care activities that ensure overall health and well being progress and promotes communication Goal of nurse: maximize older adults independence by enhancing function and decrease institutionalization |
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Vision Age-Related Changes Affecting Senses |
Ptosis: eyelds lose tone and become lax conjunctiva things and yellows Arcus senilis: cornea yellos and develops fat pupil decreases lense - dense and rigit floaters and flashers dry eyes |
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Presbyopia |
most common complaint of older adults Diminished ability to focus clearly on close objects Lens loses ability to focus on close objects decreased accomodation |
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Blepharitis |
Chronic inflammation of eyelid margins |
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Cataract |
opacity of the lens and requires surgery
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Glaucoma |
Increased IOP requiring liflong medication treatment |
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Retinal Detachment |
Requires immediate attention |
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Age Related Hearing Loss |
Affects communication and may lead to depression, social isolation, loss of self-esteem -larger auricle and loss of skin elasticity -elongated lobule -coarse wire like hairs -narrowed auditory canal -cerumen gland atrophy with dry cerumen |
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Balance Decline |
decreased sensory input, slowed motor responses, musculoskeletal limitations |
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Pruritus |
Itching within the external auditory canal from atrophic changes in epithelial and epidermal sebaceous glands resulting in dryness |
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Cerumen impaction |
prevention and torment is a very important nursing intervention |
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Presbycuis |
Sensorineural hearing loss Difficulty hearing high pitched tones and conversational speech |
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Vertigo |
Chronic and annoying, proper safety measures and reducing dizziness facilites daily functioning |
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Meniere Disease |
caused by pressure within the labyrinth of inner ear resulting from excessive endolymphatic fluid that causes swelling in the cochlea -severe vertigo with tinnitus and low frequency hearing loss |
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Age Related Taste and Smell Loss |
risk for injury especially in affected limbs decreased density of cutaneous receptors CVA, PVD, diabetic neuropathy |
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Xerostomia |
Dry mouth Pain in oral mucosa, gums, and tongue leading to alterations in tase |
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Fall Precautions |
Set of measures to reduce risk of fall -modify environment -place sign outside door -fall mats -low beds -hourly rounding and keep older person close to nurse -frequent toiling and prior to pain med -bed and chair alarms |
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Nurses role in Promotion of Safety |
Conduct individualized safety assessment- identify age-related risk factors Safety and freedom fromm harm= essential to well being |
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Fall Interventions |
Exercise Define bed perimeters and call light Safe transfers safe environments- night lights, remove clutter |
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Open fracture |
apply pressure to stop bleeding, place sterile dressing, immobilize leg |
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Interventions for vision loss |
organize environment, click method of eating, assisting ambulation with sighted guide |
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Interventions for hearing loss |
focus on aural rehabilitation and facilitation of communication |
