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213 Cards in this Set
- Front
- Back
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how many americans die each day from injuries?
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400
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what are three examples of security threats associated with aging?
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physical vuln.
temperature vuln. natural disaster vuln. |
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what two changes lead to stress?
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cognitive and physical changes
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when is a person more vulnerable?
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when they are less physically or cognitively abe to recognize or cope with real potential hazards
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what makes elders more susceptible to temperature?
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decline in thermoregulatory responsiveness to temperature extremes as one ages
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hypertermia
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heat illness
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hypothermia
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low heat
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what causes heat stroke?
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breakdown of body's cooling system
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what are the symptoms of heat stroke? (8)
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hot and dry skin, fever (106 degrees), rapid pulse, nausea, hypotension, headache, dizziness, syncope
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how do you treat a patient suffering from heat stroke?
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move to shade, wrap in wet sheet, give fluids, call emergency
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what causes heat exhaustion?
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loss of fluid and sodium, often follows and heavy excersion and precedes heat stroke
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what are the symptoms of heat exhaustion?
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fatigue, giddiness, elevated temperature, delerium, cold and clammy skin
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how do you treat a patient with heat exhaustion?
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lie them down away from heat and elevate legs, cold fluids with 1 tsp of salt per liter, and wrap in cold, wet towels
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what causes heat syncope?
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sudden exertion or exposure to unusual heat
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what are the symptoms of heat syncope?
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dizziness, lower-than-usual blood pressure, slowed pulse, sudden fainting, cool and sweaty skin
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how do you treat a patient of heat syncope?
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get patient out of sun, head between knees, have patient drink fluids
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how is the skin of a patient with heat exhaustion?
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cold and clammy skin
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how is the skin of a patient with heat stroke?
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dry and hot
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how is the skin of a patient with heat syncope?/
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cool and sweaty
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how much should you drink to avoid hyperthermia?
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2-3 L of cool fluid
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elders should wear what kind of clothing?
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loose made of natural fibers
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what kind of baths and showers should the elderly take?
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tepid
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what is the temperature of hypothermia?
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core temp below 95 degrees F
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what are the 5 conditions that increase risk for hypothermia?
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1) thermoregulatory impairment
2) condition that decrease heat production 3)conditions that increase heat loss 4)conditions that impair central peripheral control of thermoregultion 5) drugs that interfere with thermoregulation |
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what are the 7 factors associated with low body temp?
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aging
low environmental temp thinness and malnutrition poverty living alone nocturnal/night rising orthostatic hypotension |
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what are the desired outcomes of nursing interventions reg. temp? (5)
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hands and limbs warm
body relaxed, not curled body temp >97 degrees F no shivering no complaints of cold |
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what are the 7 nursing interventions to avoid hypothermia?
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1-maintain warm ambient temperature
2-provide generous quantities of clothing 3-limit time patients sit by a cold window 4-provide a head covering when possible 5-absorbant pads for incontinent 6-provide as much exercise as poss. 7-provide hot, high-protein meail |
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what percent of Katrina victims were elderly?
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> 60%
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what is the most important environmental unit for elders?
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their neighborhood
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what is the elder equivelant to the amber alert system?
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Silver Alert System
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Violent crimes against the elderly...
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have decreased
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what is the most common crime against the elderly?
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property crime
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who is most at risk for dying in a fire?
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over 65
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fire related mortality rates are ____ x's higher in those over age 80
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3x's
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deaths from fire usually are due to _____
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smoke
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how much is spent on health care each year?
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2 trillion
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how many are uninsured?
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>46 million
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what is hte public insurance system?
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federal government purchases or provides majority of care through its insurance plans
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state governement insurance?
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medicaid
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what is the amount of benefits out of social security?
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average salary during 35 of his/her working years
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what was the average benefit in 2009?
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1044 for 49 million recipients
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what is the social security prediction in 2009?
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insolvency of medicare reserves as early as 2017 followed by insolvency of social security funds by 2037
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if you have a thrid party payer system, what do you pay?
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pay premium
co pays deductible |
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managed care system...
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monitor cos of care
control cost with prospective payment |
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Medicare part A
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entitlement insurance: automatic when you turn 65 and have paid medicare taxes for at tleast 30 quarters (10 years)
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what does medicare part A pay for?
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inpatient hospital stays
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to qualify for a skilled care nursing facility to be paid by medicare...
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you must be in acute care for 3 days before admission and need skilled service...max of 100 days
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does Medicare part A cover custodial nursing home care?
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NO, must be paid for out of pocket or through medicaid
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to qualify for home health care to be paid by medicare....
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must be ill enough to be considered homebound
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to qualify for hospice care to be paid by medicare....
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must have less than 6 months to live and elect to forgo traditional medical treatment for terminal illness
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inpatient psychiatric care...
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is a limited number of days in a lifetime
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When should you apply for medicare part B
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3 months before to 4 months after you turn 65
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what do most pay for medicare part B benefits?
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96.40 per month
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what does medicare part B cover?
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doctors visits and outpatient care, some preventive services
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medicare part B is created as....
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affordable purchasable voluntary insurance
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Medicare Part D
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New prescription drug coverage available jan1, 2006
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of 47 million...how many have coverage through their employer or other plans for prescriptions?
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27 million
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when does Medcare Part D begin?
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when covered medical costs reaches 2700
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the Medicare Part d covers...
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total costs of covered medications, NOT what you spend personally
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how long do medicare Part D beneficiaries remain in the "doughnut hole"?
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until out of pocket costs exceed 4350
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what is medicaid?
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healh insurance program jointly funded by federal and state gov. using tax dollars collected into general funds
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what are the majority of medicaid funds used for?
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to pay for long-term nursing home care for older and disabled adults
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How much does LTCI cost a year at age 50?
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850 per year
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how much does LTCI cost a year at age 65?
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1800 a year
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LTCI
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Long-term Care Insurance
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how much does LTCI cost a year at age 85?
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5500
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What are hte fastest growing housing option for older adults?
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residential care facilities
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what was the turning point in the way TN treats its elderly citizens?
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Long-Term Care Community Choices Act
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what is the Long-term Care Community Choices Act?
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provides home and community based care for those who need help other than traditional nursing homes
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What % of Assisted Living facitility residents are femae?
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76%
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what % of residents of Assisted living facility's will move into a nursing home?
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34%
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what % of residents in an assisted living facility will die in the facility?
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30%
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What % of residents in an assisted living facility need help with IADL's (housework)?
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91%
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What % of residents in an assisted living facility need help with IADL's (meds)?
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86%
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What % of residents in an assisted living facility need help with ADL's (bathing)?
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68%
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What % of residents in an assisted living facility need help with ADL's (dressing)?
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47%
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What % of residents in an assisted living facility need help with ADL's (toileting)?
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34%
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What % of residents in an assisted living facility need help with ADL's (transferring)?
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25%
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What % of residents in an assisted living facility need help with ADL's (eating)?
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22%
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majority of LTC (nursing homes) are...
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for profit
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the majority of residents in a LTC are over what age?
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80
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what percent of residents in LTC's are cognitively impaired?
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60%
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what percent of elders are residents of nursing homes?
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4-5%
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how many elders will be admitted in their lifetime to a LTC?
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2/5 elders
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OBRA
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omnibus budget reconciliation act
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when was OBRA passed?
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1987
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what are 4 requirements of OBRA?
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1) comprehensive resident assesments
2) more training for nurse assistants 3) elimination of restraints and meds for discipline or convenience 4) higher staff req. for nurses and social work staff |
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Who developed the Eden Alternative?
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William Thomas
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what three characteristics did Dr. Thomas find in nursing homes?
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1) loneliness
2) helplessness 3) boredom |
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what is the motto of hte Eden alternative
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"we grow People"
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what is the view of conventional nursing homes...
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emphasize the broken down and not their potential
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what is the view of the eden alternative
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look at aging as a developmental process, not decline
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what are the two local eden alternative care facilities?
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Bordeax hospital LTC unit, Nashville
community care of rutherford county |
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what are the 5 signs of frailty?
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1) unintentional weight loss
2) general feeling of exhaustion 3) weakness 4) slow walking speed 5) low levels of physical activity |
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to be considered "frail" you must have...
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two of five signs
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vulnerability is linked to...
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frailty
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what is one of the most uncrecognized or underreported social problems?
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elder mistreatment
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what are the 4 types of elder mistreatment?
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physical abuse
sexual abuse financial or material abuse or exploit. emotional or psychological abuse |
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edler abuse requires 3 things
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an abuser
an elder and context of care-giving |
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good nursing care begins with...
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assessment
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frail elders benefit the most from....
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comprehensive assesment
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reporting of elder abuse is...
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mandatory
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APS
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adult protective services
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nurses are required to do what in most states?
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report elder abuse
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what are 3 ways to prevent elder abuse?
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provide respite for caregiver
daycare counseling |
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feelings of security as one ages are strongly influenced by....
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cognitive capabilities and ability to problem solve
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Power of Autorney
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one person designates another person to act on his or her behalf
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general power of auttorney
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usually has right to make financial dcisions, pay bills, but not make decisions related to health care
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durable power of attorney
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has rights to make health related decisions for person when they are unable to make them for themselves; also called a health care surrogate
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how many medigap policies are there?
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10
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guardians and conservators
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individuals, agencies, or corporations who have been appointed by court to have care, custody and control of disabled person and manage his or her personal financial affiars or both
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conservator
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person appointed to control finances
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guardian
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person appointed to be responsible for the person
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when was HIPAA passed?
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1996
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HIPAA
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reduced allowable methods of hiding or transferring monies before needing or entering long-term care
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what is the first sign to physical frailty
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mental frailty
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most elder abuse is from....
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spouse, or adult children
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where does most elder abuse occur?
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in the home
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patients with what two diagnoses are most commonly abused
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depression and dementia
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one study showed that half of elders that complain of constipation moved their bowels ...
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at least once a day
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What is the health professionals definition of constipation?
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fewer than 3 BM's a week, hard stools, difficulty with evacuation
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what is the most common GI complaint?
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constipation
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what % of edlers in community based programs report laxative use?
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60%
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what % of elders in LTC's use laxatives every day?
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74%
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what may be the only signs of constipation in dementia patients? (4)
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confusion, increased agitation, incontinence, unexplainable falls
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constipation is a common problem of many ________ illness'
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neurological
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what is the 1st intervention for constipation?
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examin meds and chonge those that could cause constipation
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what are the 3 non-pharm interventions for constipation?
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fluid/fiber
exercise (walking 20-30 minutes daily) environmental manipulation |
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what kind of enemas should not be used?
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soapsud or phosphate
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what kind of enema should be used?
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normal saline or tap water (temp of 105 degrees)
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what is a major complication of constipation?
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fecal impaction
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fecal impaction requires..
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digital removal of impacted stool from rectum with use of lubrcation containing lidocaine jelly
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bowel incontinence
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inability to control passage of stool or gas via anus or involuntary loss of stool from rectum at inappropriate times
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what % of community dwelling elders have bowel incontinence?
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3-4%
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what % of institutionalized elders have bowel incontinence
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16-60%
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nurses must always provide immaculate....to persons with incontinence...
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skin care
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bladder function requires what 3 things?
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intact brain and spinal cord
competent bladder active sphincters |
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what is common RE bladder function
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nocturnal frequency
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in the elderly the warning period between desire to void and actual voiding is..
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shortened
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what is one of the most prevalent bladder function symptoms encountered?
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urinary incontinence
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stress incontinence is caused by what 6 things?
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obestiy
estrogen deficiency pelvic floor muscle weakness radiation or prostrate surgery urethral sphincter weakness drugs |
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urge incontinence is caused by what 6 things?
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stroke
dementia parkinsonism UTI detrusor overactivity or instability drugs |
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overflow incontincence is caused by what 5 things?
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fecal impaction
enlarged prostate diabetic neuropathy severe pelvic prolapse drugs |
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function incontinence is caused by what 7 things?
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mobility limitations
cognitive impairment depression bipolar/schizo disorders ext. factors: restraings/inattention drugs environment barriers |
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Iatrogenic incontinence is caused by what 4 things?
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extracellular fluid compartment: CHF
chronic venous insufficiency metabolic states:glycosuria/calcemia drugs |
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what is the most common infection in LTC residents?
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UTI
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what are the symptoms for a UTI in the elderly?
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changes in mental status, decreased appetite, abdominal pain, new onset of incontinence, respiratory distress
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asymptomatic bacteriuria is considered....
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a benign condition in oder people and should not be treated with antibiotics
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urine cultures should not be performed in....
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patients who are assymptomatic
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about 1/3 of a persons lifetime is spent in....
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sleep and rest activities
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circadian rhythm completes every...
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24 hours
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insomnia is most common in....
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women
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nocturnal myoclonus
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periodic limb movement
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what % of community based elders have nocturnal myoclonus?
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45%
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what is the second most common underlying cause of death in the US?
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combo of lack of physial activity and porr diet
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what is the most common oral health problem?
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dental carries
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what is the major cause of tooth loss?
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accumulation of bacterial plaque on teeth
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periodontitis can be a serious infection linked to....
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diabetes complications, heart disease, resp. disease, tooth loss
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there is a direct relationship between....and periodontal disease?
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CV disease
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oral cancer is more common in ___ men then in _____
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black men than white men
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oral cancer is twice as more likely to occur in _____ then _____
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men than women
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what are the 3 major risks factors for oral cancer?
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tobacco use
alcohol use exposure to UV light (esp in lip cancer) |
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federal regs mandate what kind of annual exam for skilled nursing facilities?
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oral
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how do you cut toenails?
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strait across and even with top of toe
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when is it best to cut toenails?
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after soaking them in warm water or after a bath or shower
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how often should skin be exposed for adequate vitamin D?
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15 minutes a day, 3 days a week
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what is the most common skin problem?
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xerosis
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xerosis
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dry skin
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pruiritis
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itching
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herpes zoster
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shingles
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actinic keratosis
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precancerous lesion for squamous cell carcinoma
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what is the second most common skin cancer?
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actinic keratosis
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what is a major cause of actinic keratosis?
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sun exposure
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what is the most common skin cancer?
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basal cell carcinoma
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BCC is precipitated by...
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chronic sun exposure
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what cancer is increasing more rapidly than others in the last 10 years?
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melanoma
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melanoma...
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metastases quickly and often originates in a mole
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nevus
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precancerous lesion (mole)
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a total body skin exam should be part of...
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yearly assemsment
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70% of pressure ulcers occur in...
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elders over age 70
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where are pressure ulcers most frequently seen?
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posterior aspects, especially sacrum
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what are two assessments for pressure ulcers?
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braden scale
norton scale |
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what is the most common assessment for pressure ulcers?
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braden scale
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what 6 things does the braden scale test?
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sensory preception
skin moisture activity mobility friction and shearing nutritional status |
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braden scale rates each category how?
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1-4
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what is the max possible score in the braden scale?
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24
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what is the most neglected of all sense?
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touch
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touch is ___ stronger than verbal or emotional contact
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10X
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procedural touch
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task oriented
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social zone
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hands
arms shoulders back |
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consent zone
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mouth
wrists feet |
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vulnerable zone
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face
neck front of body |
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intimate zone
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genitalia
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what kind of sexual dysfunction is more common?
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psychological
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Impotence is now called
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erectile dysfunction
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1/3 of ED is a complication of....
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diabetes
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married spouses in nursing homes...
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federal law requires they be allowed to share a room if they'd like
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50 and older account for what % of AIDs cases in the US?
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12-15%
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what % of physicians don't asses HIV risks in the older population?
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40%
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Elders are often misdiagnoes as having __________ instead of AIDs
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Alzheimers disease (AD)
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friendship
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often a significant source of support in late life
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what % of elders have living family members?
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94%
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what % of elders reporrt weekly contact with at least one of their children?
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80%
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what % of elders have 3 or more grandchildren?
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80%
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what % of elders are great-grandparents
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50%
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what % of elders have at least 1 sibling?
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80%
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family members provide _____ of care for older adults in USA
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80%
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what % of caregivers are men?
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39%
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what was the economic value of family care giving in 2000?
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257 billion
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|
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family assessment
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comprehensive assessment of elder including family
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what % of men and women are divorced at 65?
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11.5 % women
9.2% men |
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what % of first marriages end in divorce?
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50%
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what % of remarriages end in divorce?
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60%
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