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239 Cards in this Set
- Front
- Back
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What are the 7 steps of a positive physical approach?
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Come from the front
Go slow Get to the side Get low (sit down) Offer your hand Use preferred name (ask them) Wait for a response (before you start talking/doing) |
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What are the names of the 5 stages of dementia?
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Level 5: Early Loss
Level 4: Moderate loss Level 3: Middle Loss Level 2: Severe Loss Level 1: Profound Loss |
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Describe Level 5 of dementia.
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Early Loss:
some word finding problems some loss of reasoning likes routine (doesn't like changes in routine) fixed on time does well with personal care & activities may have difficulty with finances & complex tasks (driving) may repeat stories |
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Describe Level 4 of dementia.
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Moderate Loss:
gets tasks done but may be poor quality makes mistakes but won't go back to fix them problem with steps & personal care needs guidance but can do a lot (set up help) makes excuses & gets embarrassed easily asks what/where/when a lot social but content is limited & confusing sometimes |
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Describe Level 3 of dementia.
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Middle Loss:
"Hunting & Gathering" (takes, stores, hoards) (touch, take, taste) language poor & comprehension limited responds to tone, body language, facial expression imitates (but not always aware) impulse control limited & says what thinking loses ability to use tools/utensils |
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Describe Level 2 of dementia.
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Severe Loss:
Gross Automatic Action Constant go or down & out paces, walks, rocks, swings, hums not interested in food (loses wt rapidly) enjoys rhythm & motion can't use hands effectively doesn't use language/understand much repeats things (echolalia) stops/pauses when presented with a problem |
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Describe Level 1 of dementia.
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Profound Loss:
Stuck in Glue Immobile & Reflexive bed or chair bound contractures poor swallow/eating sensitive to voice/touch problems with temp regulation limited responsiveness returns to reflexive behavior (think newborn) responses very slow |
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How do you make activities meaningful for dementia pts?
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1st: Know who your person has been & what they value!
Ex: introvert/extrovert, planner/doer, follower/leader, work history, family relationships, social history, leisure background, previous daily routines/schedules, personal care habits/preferences, religious/spiritual beliefs, favorite things, stressors/hot topics, past coping skills |
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Neurosensory
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How people interpret info from environment
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What are the 2 types of intelligence?
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1. Crystallized intelligence (use past learning)
This is wisdom 2. Fluid intelligence (spatial & creative intelligence) This is thinking on your feet |
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What are some normal psychological aging changes?
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Abilities decline in the following areas:
processing abstract attention filtering visuospatial word finding short term memory flexibility |
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Which type of intelligence is maintained while the other declines?
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Crystallized intelligence is maintained while fluid intelligence declines.
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What is helpful for normal psychological aging changes?
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demonstration & repetition
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What type of intelligence do elders use the most?
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Crystallized
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How do you need to modify teaching plans for elderly because of normal psychological aging changes?
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Teaching plans should be covered over a few days because the person needs time to process
(processing declines with age). |
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What is an example of a visuospatial task?
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Wii, driving
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What is an example of abstraction tasks?
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Understanding the following:
"people in glass houses shouldn't throw bricks." |
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What physiological areas do normal neurosensory aging changes take place in the elderly?
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Vision
Hearing Taste Smell Pain perception Tactile Sensation |
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What are the normal vision changes in the elderly adult?
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(11: Famed Plantt)
Floaters Astigmatism Muscle tone ↓ Eyelashes ↓ Drusen Presbyopia Lens discoloration Arcus Senilis Nuclear Sclerosis Tear production ↓ Tissue elasticity ↓ |
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What results from a decrease # of eyelashes?
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Increased risk of eye injury
(↑ eye infections) |
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What results from decreased tear production?
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Increased risk of eye irritation
(need eye drops) |
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What results from increased lens discoloration?
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Decreased color perception
(black looks blue) |
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What results from decreased tissue elasticity around the eye?
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Vision decreases, increased blurring of images
(eyelids droop) |
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What results from decreased muscle tone of the eye?
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Decreased pupil diameter
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What results from presbyopia?
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Difficulty reading
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What results from astigmatism?
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Blurred images at a distance
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What results from floaters?
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Interference with vision
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What are floaters?
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Calcium deposits in the eye
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What is arcus senilis?
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white/yellow ring around the cornea
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What is nuclear sclerosis?
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hardening of the lens
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What results from Drusen?
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decreased vision
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What is Drusen?
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Little yellow deposits in the eye.
They are precursers to macular degeneration. |
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What is arcus senilis a sign of in young people?
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Hyperlipidemia
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Is arcus senilis concidered normal in the elderly?
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yes
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What are the 5 main causes of visual impairment/blindness in the elderly?
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(CDRAG)
Cataracts Diabetic Retinopathy Retinal Detachment Age-Related Macular Degeneration Glaucoma |
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What is the #1 cause of blindness in the WORLD?
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Cataracts
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What is the #1 cause of blindness in the US?
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Age-Related Macular Degeneration (ARMD)
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What are scotomas?
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blind spots in the central field of vision
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How often should elderly get eye exams?
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every other year
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What are Cataracts?
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opacities or yellowing of the lenses that create cloudiness/decrease vision
develop slowly & painless |
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What is ARMD?
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Age-Related Macular Degeneration
degenerative disorder of macula which affects central vision (scotomas) & visual acuity (blurry vision) |
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What are some signs/symptoms of cataracts?
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blurry vision
halos glare double vision poor night vision ↓ color contrast |
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What are the 2 types of ARMD?
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wet & dry
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What is Glaucoma?
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Optic nerve damage due to an increase in intraocular pressure
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What vision changes are characteristic of Glaucoma?
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Mid-peripheral vision loss
(see only in center) |
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What is diabetic retinopathy?
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a microvasular disease of the eye occurring in Type 1 & 2 diabetes where damage to vascular system impairs transport of O2 & nutrients.
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What vision changes are seen with diabetic retinopathy?
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generalized blurring & focal vision loss
(spots are blurred out) |
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What is retinal detachment?
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separation of retina from the choroids with loss of vision
(vessels detach & bleed into eye) Feels like curtain being pulled over vision. May or may not have pain. |
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Name an intervention you should use with a person who has ARMD.
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Sit to the side of the person
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Name an intervention you should use with a person who has Glaucoma.
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Sit in front of the person
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What are the normal hearing changes in the elderly adult?
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(4: CCNT)
Cerumen ↑ Cochlear hairs ↓ Neurons degrade Tissue elasticity ↓/tympanic membrane thins |
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What results from decreased tissue elasticity/thinning of tympanic membrane of the ear?
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difficulty distinguishing high pitched sounds
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What results from increased cerumen production?
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decreased hearing
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What results from decreased cochlear hairs?
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decreased hearing & balance
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What results from degradation of neurons with hearing?
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decreased hearing & overall hearing loss
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What are some common hearing impairments?
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(4: TPMD)
Tinnitus Presbycusis Meniere's disease Deafness |
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What is presbycusis?
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decreased hearing due to noise induction
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What is tinnitus?
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ringing in the ears with or without hearing loss
(may be due to trauma, cerumen or presbycusis) |
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What are some potential causes of deafness?
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tumors, trauma, drugs, infection, loud noises
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What is Meniere's disease?
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a chronic disorder of the inner ear which causes continuous dizziness, nausea, spinning, vertigo
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True or False? Ringing in the ears is active hearing loss occuring.
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TRUE
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What is a normal age related taste change?
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decrease in # of papilla on tongue = ↓ sense of taste (hypogeusia)
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What is a normal age related smell change?
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decreased ability to smell
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What is a normal age related pain change?
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decreased perception of pain (increased pain threshold)
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What is a normal age related tactile change?
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decreased perception of touch, pain, joint position, temperature, vibrations
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True or False? All elderly have decreased peripheral sensations.
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TRUE
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What temperature should the water be kept to prevent burns?
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120-125 degrees
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What are the normal changes of the aging neurologic system?
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↓ neurons
↓ brain size/wt ↓ blood flow to brain ↓ responses/movements ↓deep tendon reflexes ↓ sensation ↓ short term memory ↑ plaques/tangles ↑ insomnia/sleep disturbances/loss of REM ↑ tremor coordination impaired & depression more common |
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Risk factors causing alterations in neurosensory
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sensory deficits
sensory altering meds (dilantin) ↑/↓ in environmental stimuli chronic pain psychosocial factors (anxiety/stress) serious losses difficult relationships changes in social roles loneliness poverty unplanned moves |
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6 drugs that can cause visual disturbances
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Tamoxifen
Thioridazine Hydroxychloroquine Corticosteroids Levodopa Propranolol (beta blocker) |
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5 drugs that can cause a change in hearing.
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Gentamicin (aminoglycoside antibiotic)
Antineoplastics Loop diuretics (lasix) Baclofen Propranolol (beta blocker) |
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Several disease processes can cause alteration in pain/discomfort & neurosensory. Name some.
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(VHS CDD BEEPPP)
Viral illnesses (Guillain-Barré) Heart disease Stroke Cancers Delirium Dementia B12 deficiencies Endocrine disorders Epilepsy Presbyopia Presbycusis Parkinson's disease |
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What is cognitive dissonance?
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temporary confusion that may take 1-3 days to normalize, likely to occur with stress
(moving, hospitalization, depression, losses) |
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What is delirium?
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sudden confusion caused by an acute change in mental status
may fluctuate & include inattention, disorganized thinking & altered LOC Usually has a definate cause |
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How long can delirium last?
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up to 3 months
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Is delirium reversible?
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Often but not always
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True or False? Dementia ↑ risk of Delirium & vice versa.
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TRUE
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What are some risk factors of Delirium?
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Dementia
Advanced age Co-morbid physical problems (pain, renal failure, malnourishment, etc. ) |
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Causes of Delirium
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(DELIRIUMS)
Drugs Eyes/Ears Low O2 Sats (MI/stroke/PE) Infection (respiratory/UTI) Retention (urine/stool) Ictal (post seizure) Underhydration/undernutrition Metabolic (thyroid, hyper/hypoglycemia) Subdural hematoma |
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What is the BEERS criteria?
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A list of potentially inapproprate meds that should not be used in older adults
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What are a few common drugs found on the BEERS list?
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Demerol, Digoxin, Benadryl
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What areas should you evaluate for Delirium?
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Onset, duration, baseline mental status, meds, VS, O2 sat, evidence of infections, Labs, MMSE, CAM tool.
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Name non-pharmacologic interventions of delirium.
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Identify cause
prevent dehydration re-orient if/when appropriate modify environment as needed have glasses/hearing aids available & clean sitters/family present have daytime activities/OOB limit interruptions at night put close to nurse station avoid restraints |
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What is dementia?
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A group of disorders characterized by...
1. decline in mental function with 2. a decline in at least 1 other cognitive function (ex. ↓ in language, executive, visuospatial, previous functions/abilities) |
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What does SDAT stand for?
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Senile Dementia Alzheimer's Type
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What is the patho of Alzheimer's?
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Gradual onset
steady decline Characterized by neurofibrillary tangles & neuritic plaques (cause cell death) in the brain Other changes include: ↓acetylcholine ↓ brain cells ↓ dopamine (contributes to tremors) ↓ Apo-Lipo protein E amyloid present brain atrophy left brain lost first |
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How do we diagnose Alzheimer's?
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rule out everything else
can only truly be dx on autopsy |
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What does MMSE stand for?
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Mini Mental Status Exam
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What are the limitations of the MMSE?
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Person must be able to read & write
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MMSE 0-9
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Late, severe impairment (6-20)
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MMSE 10-21
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Middle, moderate impairment (2-8 yrs)
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MMSE 22-28
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Early, mild impairment (1-3 years from onset)
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MMSE 26-30
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Mild cognitive impairment
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What are some symptoms common with SDAT?
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Agitation &/or aggression (80%)
Depression (40%) Psychotic symptoms such as delusions/hallucinations (20%) (stealing/infidelity most common examples) |
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What are 2 interventions you can use with an agitated/aggressive Alzheimer's pt?
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Distractions & exploring
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What are the 4 most common types of Dementia?
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Alzheimer's
Vascular Lewy body Frontotemporal |
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Describe Vascular Dementia.
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Decreased blood flow to brain causes significant damage leading to cognitive impairment. Focal neurologic signs are present.
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Can you have more than one type of dementia?
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yes
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What are some common signs of Vascular Dementia?
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Focal neurologic signs of Vascular Dementia include abnormal reflexes or nerve functions. Ex. Gait difficulties, falls, mood changes, fine motor movement difficulties.
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How is Vascular Dementia diagnosed?
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With CT or MRI (shows evidence of TIA/CVA)
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Describe Lewy Body Dementia.
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Lewy bodies are found throughout the brain.
Memory impairment doesn't occur until late while progressive/fluctuating cognitive decline. It is opposite from Alzheimer's & similar to Parkinson's Disease |
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What are some common signs of Lewy Body Dementia?
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Fluctuating cognition
visual hallucinations motor deficits (like Parkinson's) sleep disturbances syncope falls (Opposite from Alzheimer's) |
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Describe Frontotemporal Dementia.
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Changes in the frontal & temporal lobes cause changes in personality, reasoning, social behavior, speech, behavior disinhibition, personal awareness, apathy, language problems.
Rare after age 75 |
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Is Delirium acute or gradual?
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Acute
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Is Dementia acute or gradual?
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Gradual
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Is depression acute or gradual?
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Can be either sudden (acute) or gradual
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How long can Dementia last?
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Years - up to 20 years
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How long can Depression last?
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Weeks to years. Normal for depression to last up to 1 year.
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Describe the state of consciousness in a person with Delirium.
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Disoriented
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Describe the state of consciousness in a person with Dementia.
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Alert
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Describe the state of consciousness in a person with Depression.
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Self-absorbed
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Describe the behavior of a person with Delirium.
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Difficulty with attention & concentration
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Describe the behavior of a person with Dementia.
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Personality changes, labile, easily agitated
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Describe the behavior of a person with Depression.
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Apathetic
feelings of worthlessness vague somatic complaints attention seeking behavior such as complaining |
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Is a person with Delirium able to follow instructions?
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No, they are unable to do tasks (remember, they are disoriented)
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Is a person with Dementia able to follow instructions?
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Somewhat. They try to follow but progress with a gradual loss of abilities
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Is a person with Depression able to follow instructions?
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The are able to do tasks but they choose not to do them.
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Describe the mental ability of the person with Delirium.
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Fluctuating memory/orientation, disorganized thinking
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Describe the mental ability of the person with Dementia.
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Impaired memory, gradual loss of knowledge, language & judgment
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Describe the mental ability of the person with Depression.
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Selective memory loss
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Is Dementia reversible?
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No
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What areas should you evaluate for Dementia?
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History & Physical
Neuro exam Cognitive status (AAOx3, MMSE, & Mini-Cog) CNS/cranial nerves Labs CT/MRI if indicated |
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What is the Mini-Cog?
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A test to evaluate cognitive status.
It is a good test because pts don't have to be able to read or write. Best because of reliability, validity, sensitivity, specificity. This is the "draw the clock" test |
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What do the results of the Mini Cog mean?
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If the pt gets all 3 areas correct: normal (non-demented)
If the pt gets all 3 wrong: non-demented If the pt gets the 3rd part of the test wrong, the pt may be intermediatly demented |
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What are some associated concerns of the person with Dementia?
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Dependence in ADLs
Making Activities Meaningful Anxiety Spatial disorientation elopement resistiveness to care food refusal insomnia |
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What is elopement?
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Wandering
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What should you do with a resistive dementia pt?
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get witness & document refusal to show you did not withhold care on purpose
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What should you do with a dementia pt who refuses to eat?
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Try non-verbal first: gesture to eat, then try to physically assist, can always distract & try again later
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Is insomnia common with dementia?
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Yes: sundowners
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Name some non-pharmacologic treatments of Dementia.
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***Daily Structured Activities***
(keep same staff) No anticholinergic drugs (dry you up- dehydration- leads to delirium) minimize prn antipsychotics modify behavior with distraction/exploring make environment safe music for relaxation esp. for stressful activities family involvement pet therapy approach pt at their level |
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What are some preventative measures for Dementia?
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(thought to help, not proven)
NSAIDS (↓ hypoxia risk) Statins (hyperlipidemia drugs) Vit. E Ginko biloba |
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What drugs are used to treat Dementia?
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Cholinesterase Inhibitors
NMDA Receptor Antagonists |
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What does a cholinesterase inhibitor do? (patho)
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prevents destruction of acetylcholine by inhibiting acetylcholinesterase (enzyme)
it slows the progression of SDAT |
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When is Cholinesterase drugs most effective?
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In the early stages of dementia
(mild to moderate) (the 1st 6 mon to 1 year) |
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What are some side effects of Cholinesterase meds?
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N&V
↓ appetite ↑ bowel movements |
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What are the nursing implications of administering Cholinesterase meds?
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Must take on a full stomach
monitor for GI distress & bleeding esp. if pt taking NSAIDS) dose gradually increased so results are slow |
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What should you know about NMDA Receptor Antagonists?
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Used in moderate to severe cases
take with a full glass of water many side effects |
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Is it okay for Dementia pts to take more that one kind of Dementia med?
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No - should only be on 1 at a time
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Aphasia
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an impairment of language
common in stroke pts 2 types: expressive & receptive |
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Expressive aphasia
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Person knows what they want to say but it doesn't come out right
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Receptive aphasia
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Person doesn't understand what you are telling them
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Apraxia
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inability to perform purposeful movement
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Agraphia
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loss of ability to write
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Alexia
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inability to grasp the meaning of written words/sentences "word blindness"
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Confabulation
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making up answers (unrelated to facts)
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Echolalia
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involuntary repetition of a word/sentence that was uttered by another person
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Neologism
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a word coined by the pt that is meaningful only to the pt
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Nociceptive pain
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from somatic (musculoskeletal) or visceral stimulation
usually signal that injury has occurred |
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Neuropathic pain
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pain from the nerves themselves
can result from lesions in CNS characterized as burning/tingling not from acute injury ex. MS, pinched nerve, sciatica |
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What are the 2 types of pain?
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Nociceptive & Neuropathic
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Cutaneous pain
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from stimulated cutaneous nerves
usually a burning feeling ex. Shingles a type of neuropathic pain |
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Somatic pain
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from musculoskeletal injury
ex. Bones, tendons, muscles, ligaments pain is usually localized & specific & worsens with movement type of Nociceptive pain |
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Visceral pain
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from organs & their lining
usually generalized, deep, unable to be localized ex. Twisting, tearing from spasm or cramp as with diverticulosis type of Nociceptive pain |
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Referred pain
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is perceived in a location other than where the pathology is occurring
ex. Gallstones cause shoulder pain |
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Chronic nonmalignant pain
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chronic pain that occurs with or without an identifiable cause
ex. Fibromyalgia |
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Breakthrough pain
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transient moderate to severe pain that occurs in pts with otherwise stable, baseline pain
this pain breaks through/peaks at the middle of med administration |
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End of dose pain
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a type of breakthrough pain that peaks/breaks through at the end of med administration
Med may be inadequate to control baseline pain |
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What does a baseline pain assessment include?
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VS
ability to move about agitation level appetite/eating problems elimination habits cognitive function mood |
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Will you see an increase in VS with chronic pain?
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No - body has adapted
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What are the ABCDEs of Pain Assessment?
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Ask/Assess (regularly & systematically)
Believe (the pt & family & what they say relieves it) Choose (appropriate pain control) Deliver (interventions timely, logically & coordinated) Empower (pts/families to control their course of pain & educate) |
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How do you assess pain in a cognitively or verbally impaired person?
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Obtain baseline info from family member (how do they act when in pain)
do frequent assessments observe for nonverbal signs (grimacing, guarding, moaning, tense, sad facial expression, fidgeting, perseverant verbalizations/verbal outbursts) |
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How would a confused/demented pt express pain?
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Breathing: noisy, labored breathing, hyperventilation, Cheyne-Stokes respirations
Vocalizations: moaning, groaning, calling out, crying Facial Expression: sad, frightened, frowning, grimacing Body Language: tense, distressed, pacing, fidgeting, rigid, clenched fists, knees pulled up/pushing away, striking out Consolability: distracted or reassured by voice or touch to unable to console, distract or reassure |
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Additional behaviors to observe for with pain assessment
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Delusions & Hallucinations
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What are the goals of pain management?
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to relieve acute & chronic pain
use pharm & non-pharm techniques minimize side effects |
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What are the key things to remember regarding pain management in the elderly?
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more sensitive to opioids
start low & go slow oral dose preferred administer around the clock use long acting for baseline pain with short acting for breakthrough pain No propoxyphene (darvacet) bc of toxic buildup use of meds with salycilates & acetaminophen limited bc too much can be toxic |
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What are adjuvant drugs?
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meds that may relieve discomfort &/or potentate the effectiveness of pain meds
they may ↓ dose of opioid needed they may reduce the side effects associated with high doses of opioids |
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List some adjuvant meds.
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Antidepressants
Anticonvulsants Antianxietys Antipruritics Diuretics Topical analgesics Muscle relaxants Meds to dry secretions Magic Mouthwash |
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What is ego integrity?
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Deals with attitudes/perceptions a person holds of him/herself and their abilities/self worth
a persons self-identity |
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4 areas that contribute to positive life satisfaction
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Good Health
Sense of control over one's life Reciprocal social relationships Adequate income **Top 2 are most important to the elderly person** |
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Aging changes that can effect Ego Integrity
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poor self concept
depression/negative feelings loss of control widowhood confronting negative attitudes of aging retirement chronic illness/pain alterations in body appearance loss of body function (incontinence) decision about driving car death of friends/family relocation (hospital, nursing home, family) changes in social roles loneliness medication side effects |
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What is the top reason for elder suicide?
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Incontinence
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What are the risk factors for altered ego integrity?
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Mainly related to aging changes
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What disease processes can affect ego integrity?
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All, but especially chronic, debilitating diseases or those that can lead to a loss of independence
ex. Arthritis, Ca, Amputation, Stroke |
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How can you diagnose an issue with ego integrity?
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screen for depression
perform a focused assessment (eye contact, speech patters, hands, body posture) Consider the individual (personality, happy, sad) |
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What is the major cause of stress in the elderly?
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Relocation (hospital, nursing home, live with family, etc.)
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When does stress occur?
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Whenever a person is faced with a real or perceived threat, &/or when they experience a significant/life-altering change
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What are the key concepts to remember regarding coping & stress in the elderly?
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Different things are stressful to different people
stressors may be physical, emotional, biological, or developmental Responses are both physical & psychological Stress ↑ risk of physical illness Good coping strategies can help people function in spite of high stress Many coping/defense mechanisms are used day to day |
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True or False? Stress, poor coping & impaired mental health are risk factors that influence psychosocial functioning.
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TRUE
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What are some risk factors of stress & poor coping?
|
↓ economic resources
immature developmental level unanticipated events many daily hassles at the same time many major life events occurring in a short time unrealistic appraisals of situations |
|
|
2 types of coping styles
|
Problem-focused: attempt to change ("men")
Emotion-Focused: change response/how you feel about problem ("women") |
|
|
What is depression?
|
Low mood tone, difficulty thinking & somatic changes because of feelings of loss or guilt
|
|
|
True or False? S/S of depression may be emotional &/or physical.
|
TRUE
|
|
|
What are the clues to depression in the elderly adult?
|
Multiple somatic complaints & reports of persistent chronic pain
|
|
|
Why are minorities at a greater risk of depression/poor mental health?
|
increased segregation
poverty poor quality education discrimination healthcare disparities |
|
|
Why is depression under-treated & under-diagnosed in the aging?
|
Thought to be a normal/common part of aging (NOT TRUE!!!)
Frequently confused with other physical or social changes |
|
|
What should the nurse do when a pt is sad or depressed?
|
Ask about suicidal intent & document
|
|
|
Is there a relationship between depression, suicide & alcoholism?
|
Yes, there is a direct relationship between these 3 things
|
|
|
What are some risk factors for depression?
|
previous suicide attempt
alcohol/substance abuse psychiatric illness auditory hallucinations living alone |
|
|
What do you do when a pt verbalizes suicide intent?
|
Immediate referral!
|
|
|
What is anxiety?
|
a state of uneasiness (mild or intense)
source is often nonspecific or unknown |
|
|
At what age do experts think values and beliefs are formed by?
|
10 years old
|
|
|
What influences how a person lives & dies?
|
Values & Beliefs
|
|
|
Are values & beliefs easily changed?
|
No
|
|
|
True or False? Persons with strong values/beliefs tolerate illness better.
|
TRUE
|
|
|
What is spirituality?
|
A sense of what brings a person inner peace (God/higher doctrine).
It does not always include religion. It is a source of strength & provides meaning to life. |
|
|
How do you conduct a spiritual assessment?
|
1. Start with physical & psych history (start slow, develop rapport & trust)
2. Ask about advance directives 3. Ask about organ donation 4. Ask about spiritual/religious beliefs that may affect healthcare (if they shut down, let them know we can assist, document so others don't bother them) 5. Observe for clues 6. Ask who should be notified in case of a change in condition |
|
|
How do you support your pts spirituality?
|
listen actively
warm/empathetic responses show respect give permission to practice beliefs put aside your own beliefs to support your pt ***make appropriate referrals to chaplain/spiritual leader*** |
|
|
What does the D&M diagnostic criteria of social interaction assess?
|
Major roles & responsibilities of an individual in family, work or social settings
|
|
|
True or False? Stress, poor coping & impaired mental health are risk factors that influence psychosocial functioning.
|
TRUE
|
|
|
What are some risk factors of stress & poor coping?
|
↓ economic resources
immature developmental level unanticipated events many daily hassles at the same time many major life events occurring in a short time unrealistic appraisals of situations |
|
|
2 types of coping styles
|
Problem-focused: attempt to change ("men")
Emotion-Focused: change response/how you feel about problem ("women") |
|
|
What is depression?
|
Low mood tone, difficulty thinking & somatic changes because of feelings of loss or guilt
|
|
|
True or False? S/S of depression may be emotional &/or physical.
|
TRUE
|
|
|
What are the clues to depression in the elderly adult?
|
Multiple somatic complaints & reports of persistent chronic pain
|
|
|
Why are minorities at a greater risk of depression/poor mental health?
|
increased segregation
poverty poor quality education discrimination healthcare disparities |
|
|
Why is depression under-treated & under-diagnosed in the aging?
|
Thought to be a normal/common part of aging (NOT TRUE!!!), Frequently confused with other physical or social changes
|
|
|
What should the nurse do when a pt is sad or depressed?
|
Ask about suicidal intent & document
|
|
|
Is there a relationship between depression, suicide & alcoholism?
|
Yes, there is a direct relationship between these 3 things
|
|
|
What are some risk factors for depression?
|
previous suicide attempt, alcohol/substance abuse, psychiatric illness, auditory hallucinations, living alone
|
|
|
What do you do when a pt verbalizes suicide intent?
|
Immediate referral!
|
|
|
What is anxiety?
|
a state of uneasiness (mild or intense), source is often nonspecific or unknown
|
|
|
At what age do experts think values and beliefs are formed by?
|
10 years old
|
|
|
What influences how a person lives & dies?
|
Values & Beliefs
|
|
|
Are values & beliefs easily changed?
|
No
|
|
|
True or False? Persons with strong values/beliefs tolerate illness better.
|
TRUE
|
|
|
What is spirituality?
|
A sense of what brings a person inner peace (God/higher doctrine). It does not always include religion. It is a source of strength & provides meaning to life.
|
|
|
How do you conduct a spiritual assessment?
|
1. Start with physical & psych history (start slow, develop rapport & trust) 2. Ask about advance directives 3. Ask about organ donation 4. Ask about spiritual/religious beliefs that may affect healthcare (if they shut down, let them know we can assist, document so others don't bother them) 5. Observe for clues 6. Ask who should be notified in case of a change in condition
|
|
|
How do you support your pts spirituality?
|
listen actively
warm/empathetic responses show respect give permission to practice beliefs put aside your own beliefs to support your pt ***make appropriate referrals to chaplain/spiritual leader*** |
|
|
What does the D&M diagnostic criteria of social interaction assess?
|
Major roles & responsibilities of an individual in family, work or social settings
|
|
|
Why is it important to assess social interaction?
|
Roles determine our behavior, status & sense of importance. When these roles change or are lost, it is often painful & sense of identity/self is threatened. (people may grieve this loss)
|
|
|
What is the #1 reason for decreased sexual activity in the elderly?
|
Loss of a sexual partner
|
|
|
What are the age-related changes that affect sexuality in the elderly female?
|
↓ estrogen
↑ vaginal alkalinity libido changes |
|
|
What are the age-related changes that affect sexuality in the elderly male?
|
↓ testosterone
testes change sperm change libido changes |
|
|
How does libido change in the elderly female & male?
|
Both M & F libido generally decreases.
|
|
|
Increase in vaginal alkalinity of the aging woman results in what changes?
|
↑ risk of infection
|
|
|
Many changes result from a woman's decrease in estrogen. What decreases?
|
vaginal secretions
pubic/axillary hair size of female organs vaginal opening breast tissue fullness of pubis/vulva size of labia/clitoris lubrication vaginal elasticity |
|
|
Many changes result from a woman's decrease in estrogen. What increases?
|
facial hair
fragileness of vaginal tissue tissue irritation (decreased lubrication) pain with intercourse thinning of vaginal wall LH/FSH |
|
|
What age does menopause usually happen?
|
45-55 yo
|
|
|
What is Menopause?
|
The complete cessation of menstruation because of lack of ovarian function
|
|
|
What are some related concerns with menopause?
|
atrophic vaginitis
more frequent UTIs incontinence cognitive changes vasomotor instability (hot flashes) sleep disturbances osteoporosis increased cardio disease |
|
|
What is atrophic vaginitis?
|
thinning/atrophy of the vaginal wall
|
|
|
What are a few treatments for menopause?
|
HRT (hormone replacement therapy), designer/low dose estrogens, soy products & many more (see notes)
|
|
|
How do the testes change with age?
|
decrease in firmness
|
|
|
What changes happen with sperm in old age?
|
viability decreases after age 90, number decreases dramatically with aging
|
|
|
What changes occur with decreased testosterone?
|
Decreased hair, muscle mass, rate/force of ejaculation, & seminal fluid.
Increase time needed to gain erection & increase in FSH/LH |
|
|
What is erectile dysfunction/impotence?
|
inability to achieve or maintain an erection sufficient for sexual satisfaction
|
|
|
What are the causes of ED?
|
Vascular
Neurologic Hormonal Psychogenic *Vascular the #1 cause* |
|
|
What are the common disease processes that affect sexuality?
|
There are several (review notes) but the most common are Chronic Pain & Osteoarthritis
|
|
|
What is the PLISSIT model?
|
A tool of how to approach sexuality:
P: permission LI: Limited Information SS: specific suggestions IT: Intensive Therapy |
