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NURS C475 Care of the Older Adult Study
Baby Boomers(Answer) - are aging adults born from 1946-1964. They
will reach retirement starting around 2011-2030.
Geriatrician(Answer) - a physician, board certified in geriatrics, who
specializes in the care of the elderly
Geriatrics(Answer) - The branch of medicine concerned with the
problems of aging
Gerontology(Answer) - Study of aging; broad category that includes
several areas (sociology of aging, psychology, economics of aging
Ageism(Answer) - Prejudice towards elderly
Alzheimer's(Answer) - betaamyloid plaques and neurofibrillary plaques
Age(Answer) - Old Old= 85+ years
Older Adult= 65 years of age or older
Types of Care Facilities(Answer) - Acute Care Hospital (ACH) - point
of entry into the health care system for older adults.
Acute Rehabilitation (Rehab)- may be found in several settings. Uses
the interdisciplinary team of nurses, therapists, and physicians. Goal is to
maximize independence, promote maximal function, prevent
complications, and promote quality of life within each person's strengths
and limitations. Level of intensity depends on setting and patient.
Home Health Care- For independent living home-bound adults who
require a longer period of observation or care from nurses. Can include
PT/OT, & speech therapy.
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Hospice- holistic, interdisciplinary care that helps the dying person "live
until they die." Includes palliative care and pain management and
comfort care.
Long-term Care Facility (a.k.a. nursing home)- provides 24 hr support
care to any age who have lost some or all their capacity for self-care due
to illness, disability, or dementia
Skilled Nursing Facilities (SNFs)- subacute or transitional care are for
those patients requiring more intensive nursing care than provided in
Long-term care.
Alzheimer's Care- dedicated specifically for Alzheimer and Dementia
Respite Care- provides time off for family members who are caretakers.
Care can be at adult daycare center, in the home, or in an assisted living
facility or LTC
Continuing care retirement community (CCRC)- group care in
independent living to assisted living, LTC, or skilled
Assisted Living- alternative who do not feel safe living alone, who wish
to live in a community setting, or who need some additional help with
ADLs. They each have their own apartment or room.
Foster care/Group Homes- adults who can do most ADLs but have
safety issues and require supervision with some activities.
Green House Concept- new concept of a home environment with 8-10
residents in private rooms with open kitchen and still receive assistance.
Adult Day Care- Adult day services are community based group
programs designed to meet the needs of functionally and/or cognitively
impaired adults through and individual plan of care. Less than 24 hour
five racial groups(Answer) - Caucasian/non-Hispanic whites/European
African American
Asians and Pacific Islanders
American Indians and Alaskan Natives
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Maslows Psychological Theories of Aging(Answer) - Physiological
Safety & Security
Love & Belonging
Dysarthria(Answer) - is disturbed articulation caused by disturbance in
the control of the speech muscles. This disturbance is caused by brain
lesions in motor areas in the central nervous system or the brain stem or
disruption in the coordination of information from the basal ganglia,
cerebellum, and motor neurons. Dysarthria-related lesions can be caused
by stroke, brain tumor, degenerative diseases, metabolic diseases, or
toxins. The location of the brain lesion determines the nature of the
disturbance, which can manifest in many ways, with the most severe
form being anarthria (complete inability to move the articulators for
speech). People with dysarthria may present with slurred speech,
breathiness, slow or rapid rate of speech, limited mouth or facial
movement, monotonous voice, or weak articulation. A person who has
dysarthria may be able to read, write, and gesture normally and
comprehension may remain intact
Aphasia(Answer) - is the most common language disorder in the elderly
and occurs in up to a third of the patients in an acute phase following
stroke. Aphasia is an inability to express or understand the meaning of
words due to damage in the language areas. Damage is most frequently
due to stroke in the left hemisphere, but can be due to brain tumor,
trauma, infection, dementia, or surgery. In addition to spoken language,
writing, reading, and the ability to gesture also may be impaired
Changes of aging that could affect therapeutic communication(Answer)
- Visual communication- position objects within their visual field. This
includes positioning yourself within their visual field when speaking
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with the person. This helps the person to locate the object of
conversation and to orient him or her to the topic of conversation. When
assisting elders with their care needs, it may be useful to give them a
verbal indication of the actions you are about to impart, so as to avoid
startling or scaring them needlessly. It may be necessary to assist the
person in labeling objects or to simplify what is in their visual field.
Hearing communication- Do not shout. Project voice from the
diaphragm (deepens tone). Make use of the person's other unipaired
senses. Stand in front of them if they can lip read. Speak into the good
ear. Make sure the hearing aid is turned on. Use gestures or objects to
assist communication. Limit background noise. Allow adequate time for
a response. Use short sentences and speak clearly. Enunciate words.
Write things out.
Speech Communication-individuals with speech or language difficulties
might be more anxious or self-aware. Limit distractions, make eye
contact, position yourself in front of the person. Use facial or body
language. Use written communication. Use short complete sentences.
Summarize message for accuracy. Take your time.
Satir's Basic principles for Communication(Answer) - invite, arrange,
environment, maximize communication, maximize understanding, and
follow through
Types of Hearing Aids(Answer) - BTE (Behind the ear)- 1 inch long and
worn behind the outer ear. A small tube connects with the amplification
device behind the ear and delivers amplified sound into the ear canl. The
device has an adjustable volume control and is battery powered. It is the
most common style of hearing aid. These devices are suitable for the
entire range of hearing loss.
OTE (Over the ear)- This is a new style that is very small and sits on top
of the outer ear.
ITE (in the ear)- ITEs are custom-fitted devices molded to the contour
of the outer ear. The device has an adjustable volume control and a
batter, however, both are much smaller than ones used in a BTE device.
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Some users have difficulty seeing or manipulating the control and
battery. These devices are used for mild to moderate hearing loss.
ITC (in the canal)- ITCs are tiny devices that fit into the ear canal and
are barely visable. They are customized to fit the size and shape of the
ear canal. Although cosmetically appealing, their small size is a
drawback for some individuals.
CIC (completely in the canal)- CICs are smallest type of device in the
in-the-ear class. The entire device fits within the canal. Although
cosmetically flattering, the small size is a true disadvantage because of
difficulty handling and positioning the device. This device is the most
expensive model of hearing aid.
AAC (Augmentative and Alternative Communication)(Answer) - refers
to all forms of communication that enhance or supplement speech and
writing, either, temporarily or permanently. AAC can both enhance
(augmentative) and replace (alternative) conventional forms of
expression for people who can't communicate through speech, writing,
or gestures.
U.S. Preventive Services Task Force (USPSTF)(Answer) - was
convened by the U.S. Public Health Service to systemically review the
evidence of effectiveness of clinical preventive services. The task force
is an independent panel of private-sector experts in primary care and
prevention whose mission is to evaluate the benefits of individual
services ant to create age, gender, and risk based recommendations
about services that should routinely be incorporated into primary
medical care.
Healthy People 2010(Answer) - is an initiative of the U.S. Dept. of
Health and Human Services that utilized the skills and knowledge of an
alliance of more than 350 national organizations and 250 state public
health, mental health, substance abuse, and environmental agencies to
develop a set of health care objectives designed to increase the quality
and quantity of years of healthy life of Americans and to eliminate
health disparities.
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Healthy People 2000(Answer) - reduce preventable death and disability
for Americans
Health Promotion Efforts(Answer) - of Healthy People 2010 and the
USPSTF suggest that nurses focus on to promote health and prevent
disability in the older adult (see pg 356)
Physical activity
Tobacco use
difference between ADLs and IADLs (instrumental activities of daily
living)(Answer) - Activities of daily living (ADLs): include activities of
daily life such as bathing, dressing, transferring, walking, eating, and
Instrumental activities of daily living (IADLs): Activities related to
independent living, they include meal preparation, money management,
shopping, housework, and using a telephone.
Nurses can use instruments to identify elderly individuals who benefit
from an increased level of care or add support. Fear of being advised to
leave their homes casue elderly individuals to deny difficulties. IADL
scales rely on self reporting and can difficulties when clients are not
forthcoming limitations.
•List the nutritional assessment tests to determine risk for diet-related
chronic illness(Answer) - • Serum albumin: Less than 3.5 g/dl is
associated with malnutrition and increased morbidity and mortality.
Malnutrition= serum albumin below 3.5.
• Body mass index (BMI): The Nutrition Screening Initiative suggests
that a BMI of 22-27 is considered normal. Values above or below this
range suggest over- and underweight, respectively. Unintended weight
loss is a nutritional risk that requires additional assessment. Obesity is a
problem for many older Americans, just as it is for younger adults. The
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Obesity Education Initiative of the National Heart, Lung, and Blood
Institute (2005) has provider guidelines and patient education materials
• Adult Treatment Panel (ATP III) Cholesterol Guidelines: An
unintended decrease in cholesterol to less than 150 mg/dl is a nutritional
risk (
• ADL and IADL measures: These can assess a client's ability to eat and
prepare food and to do the shopping and transportation necessary for
good nutrition.
• Dietary Reference Intakes and Recommended Daily Allowances:
These can be compared with food diaries from a 24- to 48-hour period to
assess marked deviation from these guidelines. Clients who use many
vitamin and nutritional supplements may be at risk for toxicities.
• Depression and dementia: Both are risk factors for nutritional
What are the five A's to tobacco cessation(Answer) - Ask about smoking
status at each health care visit
Advise client to quit smoking
Assess client's willingness to quit smoking at this time
Assist client to quit using counseling and pharmacotherapy
Arrange for follow-up within one week of scheduled quit date.
What are the five R's to tobacco cessation(Answer) - Relevance: Ask the
client to think about why quitting may be personally relevant for him or
Risks of smoking are identified by the client
Roadblocks or barriers to quitting are identified by the client
Repetition of this process at every clinic visit. Most people who
successfully quit smoking require multiple attempts.
I HATE FALLING risk assessment tool(Answer) - Inflammation of
joints or joint deformity
Hypotension (orthostatic blood pressure change)
Auditory and visual abnormalities
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Equilibrium problems
Foot problems
Arrhythmias, heart block, valvular disease
Leg-length discrepancy
Lack of conditioning (generalized weakness)
Nutrition (poor, weight loss)
Gait disturbance
Recommendations: Level B recommendation: Balance and
strengthening exercise programs, home safety assessment, and training
and medication monitoring and adjustment are recommended in order to
reduce fall risk.
What is the criterion for the pneumococcal vaccine?(Answer) -
Pneumococcal vaccine is given once for clients who are 65 years of age
or older. There is evidence to support one-time-only revaccination for
clients 75 years or older who have not been vaccinated in 5 or more
In most cases of elder abuse who is the perpetrator?(Answer) - Elder
Abuse may include physical, sexual psychological, and financial
exploitation, neglect, and violation of rights.
Most cases of elder abuse are perpetrated by a family member, and
reasons for the abuse include caregiver burnout and stress, financial
worries, transgenertional violence and psychopathology in the abuser.
Women and dependent elders tend to be the most vulnerable to abuse.
There are three types of assessments: Physical, Cognitive and
Functional.(Answer) - Physical assessment is assessing the patient's
physical health. It included vital signs, assessing for pain, blood pressure
problems, irregular heartbeat, abnormal breath sounds, etc. you know
these because as a nurse you are always assessing the patient. In
addition, for older adults you want to assess cognitive function.
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Functional assessment is assessing what the older adult can still for
themselves. Bathing, eating, getting dress, brushing their teeth and more
are functional abilities. Functional abilities can be altered due to physical
impairment and illness. Dr. Katz and Dr. Barthel developed ADL/IADL
indexes to measure the patient's functional abilities. You should have
noticed that ADL is used throughout the book. This is because the
ADL's can determine the patient's care plan. It determines whether they
are safe in the current environment. It impacts their ability to participate
in health promotion and disease prevention.
Cognitive- thought processing, thinking and reasoning skills. Know the
normal cognitive changes as a result of aging. Dementia is not normal.
You will need to understand the difference between delirium &
The Katz Index of ADLs(Answer) - Developed by Dr. Katz.
Distinguished between independence and dependence. Bathing, eating,
dressing, transfer, toileting, and continence
Barthel Index(Answer) - This index was designed to measure functional
levels of self-care and mobility and it rates the ability to feed and groom
oneself, bathe, go to the toilet, walk (or propel a wheelchair), climb
stairs, and control bowel and bladder.
IADLS (Instrumental Activities of Daily Living)(Answer) - more
complex activities. Laundry, shopping for groceries, using a telephone,
cooking, shopping, housekeeping, finances, taking medications,
preparing meals, fixing things around the house, lawn care,
AADLs (Advanced Activities of Daily Living)-(Answer) - social,
family, and community roles, occupation
MMSE (Mini Mental State Examination)-(Answer) - differentiate
organic from functional disorders and to measure change in cognitive
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impairment. It is not used for diagnostics. It measures orientation,
registration, attention and calculation, short-term recall, language, and
visuospatial function
Mini-Cog(Answer) - is another screening tool that can be administered
in 5 minutes or less and requires minimal training. 3 item recall, clock
drawing test (CDT)
GDS (Geriatric Depression Scale)(Answer) - a set of 30 questions to
assess for geriatric depression. A "negative" response which, depending
on the question may be a yes or no answer, is scored as one point; a
higher score indicates more symptoms of depression
SPICES(Answer) - An overall Assessment Tool of Older Adults. S is for
Sleep Disorders. P is for Problems with Bathing or Feeding, I
Incontinence, C is for Confusion, E is for Evidence of Falls, S is for Skin
CAM (Confusion Assessment Method(Answer) - is a standardized
evidence-based tool that enables non-psychiatrically trained clinicians to
identify and recognize delirium quickly and accurately in both clinical
and research settings.
CSI (Caregiver Strain Index)-(Answer) - a tool that can be used to
quickly identify families with potential caregiving concerns. Weighs out
the burdens and benefits of caregiving.
MCSI (Modified Caregiver Strain Index):(Answer) - tool that can be
used to quickly screen for caregiver strain with long-term family
caregivers. It is a 13 question tool that measures strain related to care
physiological changes that occur which make the older adult more
susceptible to adverse drug reactions.(Answer) - • Digestive system
fewer digestive enzymes and juices produced. Peristalsis decreased
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causing constipation/flatulence. Loss of teeth. Liver functions decrease.
Dysphagia often occurs. Less saliva and slower gag reflex leads to
chocking. Poor appetite due to less taste sensation.
• How to help Good oral hygiene and repair of damaged or lost teeth.
Relaxed atmosphere when eating. Avoid dry, fried or fatty foods
(difficult to digest) Offer high fiber and high protein foods. Use
seasonings to help taste. Increase fluids to help swallowing.
• Endocrine system Increased production of some hormones and
decreased production of other hormones. Immune system less effective
so get sick easier. Cold, tired, less alert due to metabolic rate decrease.
Increased blood glucose levels due to intolerance to glucose due to
intolerance to glucose. Usually occurs gradually.
• How to help: Proper exercise, rest and medical care for illness.
Balanced diet. Healthy lifestyle to decrease the effects caused by
changes in the hormones.
• Nervous system changes here affect other areas. Decrease blood flow
causes progressive loss of brain cells. Due to above, interferes
w/thinking, reacting, interpreting and remembering. Sense decreases-
longer to feel pain, less taste. May have memory loss, especially short
term. More prone to cataracts (lens become cloudy) and glaucoma
(intraocular pressure increases) Hearing loss usually gradual and more
prone to high tones.
• How to help Be patient. Proper eye and hearing caremay need
special phones for seeing numbers or hearing tones. Speak slowly and
clearly, eliminated background noise. Arrange meals attractively.
Environmental safetysmoke detectors, safety bars, etc.
• Integumentary system Most obvious effect seen here sebaceous and
sudoriferous glands less active. Circulation decreases. Skin less elastic,
itching is common, senile lentigines appear (dark yellow/brown spots).
Increased sensitivity to temperature
• How to help: Good hygiene. Frequent use of bath oils/lotions.
Decrease showers/baths to weekly. Keep injuries clean and free of
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infection. Layer clothing to help with cold. No hot water bottles/heating
• Respiratory system Muscles become weaker, rib cage becomes more
rigid, Alveoli becomes thinner and less elastic. Chronic conditions:
emphysema, bronchitis, dyspnea.
• How to help Alternate activities with periods of rest. Proper body
positioning. Sleep in semi-fowlers position. Avoid smoke-filled rooms
• Urinary system Kidneys decrease in size and become less efficient.
Loss of ability to concentrate urine causing loss of minerals and
electrolytes. Nocturia is common. Enlargement of prostate gland makes
urination difficult. Incontinence due to loss of muscle tone. Dehydration
can occur because individuals decrease intake thinking they will urinate
• How to help: Encourage fluids to decrease kidney infections. Regular
trips to the bathroom (bladder training) Drink most fluids prior to 7 pm.
• Musculoskeletal system muscles lose tone, volume and strength.
Osteoporosis occurs from mineral loss. Joints become stiff, less flexible
and sometimes painful. Movement is slower. Fine motor movements
become more difficult.
• How to help: Encourage exercise to keep muscles active (range of
motion). Diet high in protein, calcium and vitamins to slow mineral loss
and help muscle strength. Enviromental safety-grab bars, canes, etc.
Well fitting shoes. Consult w/ therapy for latest tx.
• Circulatory system Heart muscle less efficient. Vessels narrow and less
elastic. Blood flow to brain decreases due to efficieny. Blood pressure
may increase.
• How to help: Avoid strenuous activities. Moderate exercise, low
impact. Support hose to prevent blood clots. Range-of-motion exercise.
Diet low in salt/fat.
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• Changes in Cognitive Decline in information processing speed, divided
attention, sustained attention, ability to perform visuospatial tasks, and
short-term memory
• Changes in Hearing Conductive problems Sensorineural problems.
Presbycusis. Results in loss in sensitivity to pitch with high-frequency
consonants, poor word recognition
• Changes in Touch Reduction in number of receptors. Reduction in
blood flow. Results in a reduction in tactile and vibration sensations,
decreased sensitivity to warm or cold stimuli
• Changes in Vision Changes in lens, pupil, and iris. Results in poor
visual acuity, Presbyopia, increased sensitivity to light and glare.
Five Rights of Medication Administration(Answer) - • Right Drug
• Right Amount
• Right Route
• Right Time
• Right Person
Polypharmacy(Answer) - The act of taking many medications
MAP(Answer) - this means medication assistance program and it will be
mentioned in a later chapter. Make sure you understand what it is. This
is a choice you can offer your patient who cannot pay for their
Beers' List of Inappropriate drugs for Older Adults(Answer) - Make sure
you are familiar with this. Benzodiazepines are mentioned quite a bit. It
is estimated that 1/5 of clients are prescribed medications that are not
BEERS List of Medications to Avoid in the Elderly
Medication Effect
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Propoxyphene (Darvon) and combination products (Darvon with ASA,
Darvon-N, and Darvocet-N) Offers few advantages over acetaminophen,
yet has the same adverse effects as other narcotic medications.
Amitriptyline (Elavil), chlordiazepoxide-amitriptyline (Limbitrol), and
perphenazine-amytriptyline (Triavil) Strong anticholinergic and sedation
Diphenhydramine (Benadryl) May cause confusion and sedation; use in
smallest possible dose for emergency allergic reactions.
All barbiturates, except when used to control seizures Highly addictive,
more adverse effects in the older adult.
Meperidine (Demerol) May cause confusion.
Short-acting nifedipine (Procardia and Adalat) Potential hypotension and
Clonidine (Catapres) Potential for orthostatic hypotension and CNS
adverse effects.
Mineral oil Potential for aspiration and adverse effects; other options
readily available.
Estrogens only Lack of cardioprotective effect in older women; evidence
of carcinogenic potential
Nitrofurantoin (Macrodantin) Potential for renal impairment; other
alternatives available.
Cimetadine (Tagamet) CNS effects including confusion.
Indomethacin (Indocin and Indocin SR) CNS adverse effects; other
NSAIDs available with fewer adverse effects.
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Methocarbamol (Robaxin), carisoprodol (Soma), chlorzoxaxone
(Paraflex), cyclobenzaprine (Flexeril), oxybutynin (Ditropan)
Anticholinergic effects, sedation, weakness.
Short-acting dipyridamole (Persantine) Orthostatic hypotension.
Methyldopa (Aldomet) and methyldopa-hydrochlorothiazide (Aldoril)
May cause bradycardia and exacerbate depression in older adults.
Risk Factors for Falls(Answer) - • Intrinsic risk factors- relate to the
changes associated with aging and with disorders of physical functions
needed to maintain balance. These functions include vestibular,
proprioceptive, and visual function as well as cognition and
musculoskeletal function.
• Extrinsic risk factors- are related to environmental hazards and
challenges such as poor lighting, stairs, clutter, and throw rugs. Extrinsic
factors are implicated in up to 50 % of all falls in the elderly in
community settings.
Morse Fall Scale(Answer) - An effective fall score tool
Autonomy(Answer) - the concept that each person has a right to make
independent choices and decisions
Self-Determination-(Answer) - the patient's right that is the right to
Frailty(Answer) - is the common geriatric syndrome that embodies an
elevated risk of catastrophic decline in health and function among older
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• Characteristics of Frailty include Sarcopenia (loss of muscle mass),
Osteoporosis, Muscle Weakness)
• To prevent Frailty maintain a healthy weight and diet, stay active,
Practice fall prevention, make connectionsmaintain relationships with
others, see drs regularly
Kohlman Evaluation of Living Skills (KELS)(Answer) - KELS is an
Occupational Therapy evaluation that is designed to determine a
person's ability to function in basic living skills. The administration of
the evaluation combines interview questions and tasks
What are the factors that influence the quality of life of an older
adult(Answer) - • Quality of Life is an individual's perception of his or
her position in life in the context of the culture and value system where
they live and in relation to their goals, expectations, standards and
concerns. It is a broad-ranging concept, incorporating a person's physical
health, psychological state, level of independence, social relationships,
personal beliefs and relationships to salient features in the environment.
What is the one of the most common role changes faced by the aging
person(Answer) - Changing from a parent to a grandparent
What is role reversal for the older adult?(Answer) - Role reversal is
where the children take care of the parents
List and describe the care options for the older adult(Answer) -
Independent living with help: Cooks, companions, homemaker/cleaning
serviceformal or informal.
• Family: Usually informal; may live in patient's or family member's
• Adult daycare at a facility: Part-time temporary assistance, frequently
for respite or while a family caregiver works; often used for persons
with dementia or for the frail elderly needing assistance or at risk for
social isolation. Usual discharge is to assisted living or death.
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• Adult daycare at home:Part-time respite, as above.
• Senior living complexes/continuing care/supported care retirement
communities: Full range or limited services, depending on the
community and level of assistance needed; can be progressive as needs
• Assisted living: Homelike setting with more physical and medical care
availale than in senior complexes.
• Paid caregiver homes (licensed or unlicensed): Caregivers accept one
or several non-relatives into their home to receive 24 hour assistance,
especially with BADLs, usually on a private-pay basis. In some states,
public subsidies may cover adult group/foster home care
• Extended care facilities: Skilled or intermediate care nursing home
facilities for rehabilitation or ongoing care; can be paid by Medicare,
Medicaid, or private pay, depending on financial resources. Pre-
admission screening is usually required by the state regulatory agency.
Borg Category Rating Scale(Answer) - Measures perceived exertion. It
is used to document the patient's exertion during a test, and sports
coaches use the scale to assess the intensity of training and competition.
Common signs of abuse(Answer) - • Financial exploitation
• Physical abuse
• Neglect
• Emotional abuse
Framingham Heart Study.(Answer) - • FHS is a long term,
multigenerational study, designed to identify genetic and environmental
factors influencing the development of cardiovascular and other
• Age Greater than or equal to 50 for men and 60 for women
• Hypertension
• Smoking
• Obesity
• Family History of premature CHD
• Diabetes
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• Sedentary lifestyle
• Abnormal lipid levels
Risk factors for stroke(Answer) - • High blood pressure
• Atherosclerosis
• Heart disease
• Smoking or tobacco use
• Atrial fibrillation (Afib)
• Diabetes
• Overweight or Obesity
• Blood disorders
• Excessive alcohol
• Certain medications
What are other disease processes the older adult is at risk for?(Answer) -
• Osteoporosis Age, low BMI, and failure to use estrogen replacement
are the strongest risk factors for osteoporosis development. The risk
associated with agae alone was high enough that the USPSTF
recommends routine screening for all women over the age of 65. If risk
factors, especially weight less than 70 kg ( about 154 lbs) and no
estrogen therapy, are present, the task force suggest screening women at
age 60.
• Prostate Cancer Two tests are commonly used in prostate screening:
the digital rectal exam (DRE) and the prostate-specific antigen (PSA)
blood test.
• Decreased Metabolism with age, hepatic mass and blood flow
decrease. Therefore, the hepatic metabolism of medications is reduced.
Also with age, the renal mass and renal blood flow are reduced. This
physiologic change will decrease the amount of drug that goes through
renal excretion. This can result in higher, and potentially toxic, levels of
drug in the body of the older adult
• Cardiovascular Structural changes with age: Decreased myocardial
cells, decreased aortic dispensability, decreased vascular tone. Increased
myocardial cell size, increased left ventricle wall thickness, increased
artery stiffness, increased elastin levels, increased collagen levels,
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increased left atrium sized. Functional changes: Decreased diastolic
pressure (during initial filling), decreased diastolic filling, decreased
reaction to B-adrenergic stimulus. Increased systolic pressure, increased
arterial pressure, increased wave velocity, increased left ventricular end-
diastolic pressure, elongation of muscle contraction phase, elongation of
muscle relaxation phase, elongation of ventricle relaxation. No change
with age: Ejection fraction, stroke volume, overall systolic function
Tips of medication Review(Answer) - • Current prescription medications
• Current over-the counter- and herbal medications, and frequencies
• Social drug use (i.e. alcohol, tobacco, caffeine)
• Home remedies
• Drug allergies
• Compliance assessment
• Medication administration (need for special devices, patient's mental
status, caregiver administration.
Medication Adherence(Answer) - Direct and indirect methods of
assessing medication adherence can be utilized to identify elderly people
having difficulty in adhering to prescribed regimens. Health care
professionals can monitor blood levels and/or urine assays for drug
metabolites or marker compounds. Indirect methods of assessing
adherence include patient interviews, pill counts, refill records,
medication organizers, and measurement of health outcomes.
Falls & Safety(Answer) - • Falls are the leading cause of unintentional
injury death in older adults in this country. Elderly adults are susceptible
to falls as a result of postural instability, decreased muscle strength, gait
disturbances and decreased propriocepton, visual and or cognitive
impairment, and polypharmacy. Environmental conditions that
contribute to falls are slippery surfaces, stairs, irregular surfaces, poor
lighting, incorrect footwear, and obstacles in the pathway.
Types of restraints(Answer) - • Physical
• Chemical
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Alternatives techniques to restraints(Answer) - • Personal strengthening
and rehabilitation program
• Use of personal assistance devices such as hearing aids, visual aids,
and mobility devices
• Use of positioning devices such as body and seat cushions or padded
• Safer physical environment design, including removal of obstacles that
impede movement, placement of objects and furniture in familiar places,
lower beds, and adequate lighting
• Regular attention to physical and personal needs, including toileting,
thirst, hunger, socialization, and activities adapted to current ability and
former interests
• Design of physical environment for close observation by staff
• Efforts to increase staff awareness of a person's individual needs,
including assignment of staff particularly to the person, in an effort to
improve function and decrease difficult behaviors
• Living environment designed to promote relaxation and comfort,
minimize noise, provide soothing music, and maintain appropriate
• Provision of massage, art, movement activities, and complementary
therapies (e.g. Healing Touch, energy work)
• Use of bed, chair, and door alarms to alert to the need for assistance
What are some of the preventive care services covered under
Medicare(Answer) - • Abdominal aortic aneurysm screening
• Alcohol misuse screenings & counseling
• Bone mass measurements (bone density)
• Cardiovascular disease screenings
• Cervical and vaginal cancer screening
• Colorectal cancer screening
• Depression screenings
• Diabetes screenings
• Obesity screenings
• Prostate screenings
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• STI screenings and counseling
• Shots: Flu, Hep B, Pneumococcal
• Tobacco cessation
health contract(Answer) - • The client is helped to choose an appropriate
behavior change goal and to create and implement a plan to accomplish
that goal. The statement of the goal and the plan of action are then
written into a contract format.
Health promotion vs. health screening.(Answer) - • Health promotion
are activities in which an individual is able to proactively engage in
order to advance or improve his or her health
• Health screening
Three types of prevention(Answer) - • Primary prevention are activities
that are designed to prevent disease from occurring, such as
immunization against pneumonia or influenza.
• Secondary prevention are efforts are directed toward early detection
and management of disease, such as the use of colonoscopy to detect
small, cancerous polyps
• Tertiary prevention are efforts used to manage clinical disease in order
to prevent them from progressing or to avoid complications of the
disease, as is done when beta blockers are used to help remodel the heart
in congestive heart failure.
Chronic disease self-management program (CDSMP)(Answer) - • Is a
17 hr course for patients with chronic disease taught by trained lay
people. The course goal is to improve symptom management, maintain
and adhere to their medication regimens. The effectiveness of the
intervention is, at least in the improved self-efficacy of clients who pay
for the program. Clients come to believe that they can manage their
illness and prevent disabilities. Five key elements of self-management
programs are: problem solving, decision making, resource utilization,
care professional/client partnership and take
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Risks for a sedentary life style(Answer) - Lack of physical activity has
clearly been shown to be a risk factor for cardiovascular disease and
other conditions:
• Less active, less fit persons have a greater risk of developing high
blood pressure.
• Studies indicate that physically active people are less likely to develop
coronary heart disease than those who are inactive--even after the
researchers accounted for smoking, alcohol use, and diet.
• Lack of physical activity can contribute to feelings of anxiety and
• Physical inactivity may increase the risk of certain cancers.
• Physically active overweight or obese people significantly reduced
their risk for disease with physical activity.
• Inactivity tends to increase with age.
• Women are more likely to lead sedentary lifestyles than men.
• Non-Hispanic white adults are more likely to engage in physical
activity than Hispanic and non-Hispanic black adults
Four leading causes of death in the US(Answer) - 1. Heart disease
2. Cancer
3. Chronic lower respiratory diseases
4. Stroke
5. Accidents
6. Alzheimer's
7. Diabetes
8. Kidney Failure
9. Influenza & Pneumonia
10. Suicide
Risks for poor nutrition(Answer) - Multiple chronic illness, may have
tooth or mouth problems that may interfere with their ability to eat, may
be socially isolated, may have economic hardship, may be taking
medications that can cause changes in appetite or gastrointestinal
symptoms, and may need assistance with self-care
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• Depression and dementia are both risk factors for nutritional
Center for Science in the Public Interest (CPSI(Answer) - premier
educational and advocacy organization for promoting better nutritional
habits in the United States.
Malnutrition lab values(Answer) - Serum Prealbumin <15 mg/dl—best
marker for malnutrition
• Serum Albumin <3.4 mg/dl
• Serum Transferrin <200 mg/dl
• Total Lymphocyte Count < 1500/mm3
General guidelines to dietary counseling.(Answer) - • Limit alcohol to
one drink a day for women, two daily for men
• Limit fat and cholesterol
• Maintain a balanced caloric intake
• Ensure adequate daily calcium, especially for women
• Older adults should consume vitamin B12 in crystalline form, which
can be derived from fortified cereals and supplements
• Older adults who have minimal exposure to sunlight or who have dark
skin need supplemental vitamin D. Daily vitamin D intake should be
400-600 IU and can be derived from fortified foods or supplements.
• Include adequate whole grains, fruits, and vegetables
• Drink adequate water
Alcohol abuse(Answer) - • The prevalence of alcohol abuse by
community-dwelling elderly in the United States is largely unknown, but
6% to 11 % of elderly adults admitted to hospitals are found to have
problems with alcohol
• CAGE Questionnaire is a self report screening instrument that is easy
and quick to administer. It asks four yes/no questions. Cut down,
Annoyance, Guilt, Eye opener
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Assistive technology(Answer) - • any item, piece of equipment or
product system, whether acquired commercially off the shelf, modified,
or customized, that is used to increase, maintain or improve functional
capabilities of individuals with disabilities
• These devices include the entire range of supportive tools and
equipment, from adapted spoons to wheelchairs and computer systems
for environment control.
• There is a loss of strength, balance, visual and auditory, cognitive,
and/or memory changes that occur as we age. Assistive technology is
designed to help us with these losses & bridge the gap between
capabilities and care needs.
• It is anything that can enhance the function of some physical or mental
ability that is impaired. It can be a cane, walker, glassed, hearing aids,
wheelchair, bath bench, elevated toilet seat. All of this is assistive
technology. It is filling the functional gap.
Common Applications of Assistive Technology(Answer) - 1. Position
and mobility (wheelchairs, walkers...)
2. Environmental access and control (ramps, automatic doors...)
3. Self-care (aids for hygiene and grooming)
4. Sensory impairment (aids for speech, hearing or sight)
5. Cognitive Impairment (clocks, calendars)
6. Social interaction and recreation (computer software, drawing,
puzzles, computer games)
6. Computer-related technology (speech recognition)
Guidelines for Introducing Technology and Teaching the Elderly About
Its Use(Answer) - • The use of technology must be perceived as needed
and meaningful, and must be linked to the lifestyle of the person.
• •Cautions and disbelief in one's capability may be an obstacle in
accepting new technology and must be considered when creating the
learning environment.
• A generous amount of time as well as repeated short training sessions
should be allowed. 1112
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•More stress should be placed on the practical application of the device
than on its technical features.
• Only selective, central facts should be presented.
• Sessions should be held in the home or natural meeting places of the
• The instructor should be well known by the elderly or introduced well
in advance of the training.
• The attitudes of the instructors toward the aged must be positive and
Robotic Assistance(Answer) - • Intelligent reminding: many older adults
have to give up independent living because of memory loss. They forget
to visit the restroom, to take medicine, to drink, or to see the doctor. One
project explores the effectiveness of a robotic reminder, which follows
people around, so they can't become lost.
• Tele-presence: Professional caregivers can use the robot to establish a
"tele-presence" and interact directly with remote care recipients. This
makes many doctor visits unnecessary.
• Data collection and surveillance: Robots can be used for a wide range
of emergency conditions that can be avoided with systematic data
collection (e.g. certain types of heart failures).
• Mobile manipulation: A semi-intelligent mobile manipulator integrates
robotic strength with person's senses and intellect. This mobile
manipulation can overcome barriers in handling objects (i.e refrigerator,
laundry and microwave) that currently force older adults to move into
assisted-living facilities. This technology could be used for any person
dealing with function problems, such as arthritis, as the main reason for
giving up independent living.
• Social interaction deprivation: This affects a huge number of elderly
people who are forced to live alone. This project seeks to explore
whether robots can take over certain social functions for these older
The Patient Protection and Affordable Care Act(Answer) - 1. Eliminate
lifetime limits for health insurance coverage for essential services
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2. Eliminate the ability of insurance companies to rescind coverage
3. Free Preventative care
4. Development of a prevention and public health fund.
5. Increase access to affordable care, including a provision for
6. Quality improvement and risk reduction
The Independence at Home Demonstration(Answer) - NP's worked with
patients to help them experience a higher level of independence through
better management of their chronic illnesses
Provisions that have already taken effect:
1. Improved drug discounts for Medicare recipients
2. Coverage for young adults through parental health insurance until age
3. Expanding coverage for early retirees
4. National preexisting-condition insurance plan to assist those
individuals without coverage for at least 6 months due to a prior
5. 2012 mandate The US Supreme Court upheld provisions to expand
Medicaid and Medicare coverage
a. The Medicare expansion program requires participating states to
expand coverage to most individuals under the age of 65 with income
below poverty levels outlined in the Act.
6. The intent of PPACA in terms of Medicare is to reduce overall cost
while maintaining coverage to those entitled to Medicare.
7. A national Medicare pilot program will be developed to provide
Medicare recipients with more options for long-term care, including
primary care services in their homes rather than institutional care.
8. Increase services that will impact the older population include
providing wellness and prevention programs at no cost to the individual
and prescription drug discounts.
Medicare(Answer) - o 65 or over who have paid into the Social Security
system, the railroad fund, or are diagnosed with end stage renal disease
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Medicare Parts A, B, C, and D(Answer) - Part A: Blood, home health
services, hospice, inpatient hospital care, SNF care (for transitional care)
{Think mainly hospital costs}
Part B: Doctor and other healthcare provider services, outpatient care,
durable medical equipment, mental health services, some home care
services, some screening and preventive services, laboratory services
{Think mainly Dr related}
*A & B are the traditional plan
Part C: ADVANTAGE PLAN {for the healthier older adult} All
covered benefits included in Traditional Medicare Parts A and B, except
May cover additional benefits such as dental, vision, and health and
Part D: Drugs... Multiple plans are offered from which a beneficiary can
Plans vary in prescriptions covered, deductible, premium, and
Medicaid(Answer) - o Financed by state and federal governments,
administered by state
1. Health insurance for low-income families and people with disabilities
2. Long-term care (LTC) for older Americans and persons with
3. Supplemental coverage for low-income Medicare beneficiaries for
services not covered by Medicare
What are you going to be?(Answer) - A GREAT NURSE!
Healthwise(Answer) - The best known older adult medical self-care
program is Healthwise, located in Boise, Idaho.
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Social Security(Answer) - Is "retirement income", based on work history
SSI (Supplemental Security Income)(Answer) - Additional monthly
check for those at poverty level
International Classification of Impairment, Disability and Handicap
(ICIDH)(Answer) - cover those expenses of long-term care that are not
covered by traditional health insurance or Medicare.
Long-term Care(Answer) - cover those expenses of long-term care that
are not covered by traditional health insurance or Medicare.
Triple Aim of healthcare reform(Answer) - The IHI Triple Aim is a
framework developed by the Institute for Healthcare Improvement that
describes an approach to optimizing health system performance. It is
IHI's belief that new designs must be developed to simultaneously
pursue three dimensions, which we call the "Triple Aim":
• Improving the patient experience of care (including quality and
• Improving the health of populations; and
• Reducing the per capita cost of health care.
Care Transitions 4 conceptual Domains/Pillars(Answer) - 1. Medication
self management
2. Use patient-centered health record
3. HCP/Specialist
4. Knowledge of red flags
Transitional Care Models & Programs(Answer) - BOOST
Care Transition Intervention
Transitional Care Model
BOOST(Answer) - The Better Outcomes for Older Adults through Safe
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An intervention that includes predischarge and postdischarge
interventions to (1) reduce 30-day hospital readmission rates for older
adults, (2) improve patient satisfaction, (3) identify high-risk patients to
prevent adverse events, (4) improve communication between providers
and patients, and (5) better prepare the patient and family for discharge
Care Transition Intervention(Answer) - Developed by Eric Coleman.
Patient-centered 4-week intervention program designed to improve
quality of care and contain costs for patients with complex care needs as
they transition across care settings. It is based on four pillars: (1)
assistance with self-management of medications, (2) a patient-centered
medical record that is kept by the patient, (3) timely follow-up with
primary physician or specialist, and (4) a list of signs and symptoms that
could indicate worsening of the condition.
Main Feature: Transistional Coaching
Transitional Care Model(Answer) - Nurse-led model that follows the
patient from hospital to home. The nurse acts as the main care manager,
who consults with the patient in hospital, at home within 24 hours of
discharge, accompanies the patient to post-discharge follow-up visits,
and provides weekly home visits and ongoing telephone support for an
average of 2 months.
*TCM was developed to address the needs of elders with complex needs
after discharge from the hospital
Community-Based Care Programs(Answer) - To provide choices and
informed decision making for older adults, it is imperative that nurses
have the knowledge to assist the older adult through improved
awareness of community services, availability of services, access points,
eligibility for service, and affordability of quality care for older adults
Poor outcomes to Transitional Care(Answer) - (1) inadequate education
to patients and their families about care management,
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(2) poor communication between patients and care providers,
(3) inadequate assessment at point of care,
(4) medication discrepancies,
(5) lack of follow-up care,
(6) health literacy issues,
(7) lack of support systems, and
(8) cultural barriers
Nursing Responsibilities in Transitional Care(Answer) - Detailed
Current medications
Level of independence
Recent diagnostic testing
Primary care practitioner notification upon discharge and admission to
the receiving facility
Aims for Improvement(Answer) - Safe: Avoiding injuries to patients
from the care that is intended to help them.
Effective: Providing services based on scientific knowledge to all who
could benefit, and refraining from providing services to those not likely
to benefit.
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Patient centered: Providing care that is respectful of and responsive to
individual patient preferences, needs, and values, and ensuring that
patient values guide all clinical decisions.
Timely: Reducing waits and sometimes harmful delays for both those
who receive and those who give care.
Efficient: Avoiding waste, including waste of equipment, supplies,
ideas, and energy.
Equitable: Providing care that does not vary in quality because of
personal characteristics such as gender, ethnicity, geographic location,
and socioeconomic status
Patient Protection and Affordable Care Act (PPACA)(Answer) - provide
affordable health care to enhance quality of life for all Americans.
Interdisciplinary Team(Answer) - Bring together diverse skills and
expertise to provide more effective, better coordinate, and better quality
services for clients
Multidisciplinary teams(Answer) - Function as a group (multiple) of
professionals who work loosely in the same area or with the same client.
Communicating Bad News(Answer) - EPEC Project Module 2 presents
a 6-step approach to communicating bad news.
1. Get started: Plan what to say, confirm medical facts, create a
conducive environment, determine who else the patient would like
present, and allocate adequate time.
2. Find out what the patient knows: Assess his or her ability to
comprehend bad news.
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3. Find out how much the patient wants to know: Recognize and support
patient preference to decline information and to designate someone else
to communicate on his or her behalf; accommodate cultural, religious,
and socioeconomic influences.
4. Share information: Say it, then stop. Pause frequently, check for
understanding, and use silence and body language; avoid vagueness,
jargon, and euphemisms.
5. Respond to feelings: Expect affective, cognitive, and fight-flight
responses; be prepared for strong emotions and a broad range of
reactions. Give time to react; listen, and encourage description of
feelings. Use nonverbal communication of touch and eye contact.
6. Plan/follow-up: Provide additional tests, symptom treatment, and
referrals as needed. Discuss potential sources of support; assess the
safety of the patient and home supports before he or she leaves. Repeat
the news at future visits.
Hospice Care(Answer) - Life expectancy of less than 6 months.
• Hospice provides care and support for persons in the last phases of
incurable disease so they may live as fully and comfortable as possible
• Palliative Care philosophy of whole person care for those persons with
life-limiting illnesses who are not yet eligible for hospice support
Respite Care(Answer) - "respite" means to take a break.
Short term intermittent care for person with chronic/debilitating care for
person with chronic/debilitating conditions.
For a care giver who is providing 24/7 care to anyone with continuous
care needs, respite could mean taking the loved one to an agency over
the weekend so that the caregiver can take a break from care giving, or
having someone else come in to relieve the caregiver.
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Advanced Directives(Answer) - helps an individual identify their
personal wishes in a legal manner and to share that information with the
people around them, including medical personnel.
Living Will(Answer) - alternative documents that direct preferences for
end-of -life care issues, providing an "if...then..." plan
DNR (Do Not Resuscitate)(Answer) - life-prolonging procedures
declaration are all legally recognized documents for indicating one's
health care wishes. Do not resuscitate implies taking something away, or
not doing something for the patient (i.e., resuscitation).
AND (Allow Natural Death)(Answer) - Considered a more descriptive
and more positive order than a DNR.
Its focus is on allowing death as nature takes its course at the end of an
AND provides for comfort measures so that even with the withdrawal of
artificially supplied nutrition and hydration, the dying process would
occur as comfortably as possible
What are the signs of impending death?(Answer) - 1. Loss of appetite
2. Excessive fatigue and sleep
3. Increased physical weakness
4. Mental confusion or disorientation
5. Labored breathing
6. Social withdrawal
7. Changes in urination
8. Swelling in the feet and ankles
9. Coolness in the tips of fingers and toes
10. Mottled veins
Pain(Answer) - Neuropathic pain Injury to peripheral nerves or central
nervous system. May be described as shooting, stabbing, burning, or
shock-like. May be constant or intermittent. Less responsive to opioids;
responds best to anticonvulsants or tricyclic antidepressants.
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• Somatic pain Tissue injury resulting in stimulation of afferent nerve
endings. The skeletal system, soft tissue, joints, skin, or connective
tissue. The patient typically can localize the pain, may be able to point
with finger to area.
• Visceral Pain Activation of nociceptors. Internal organs. Patient often
unable to localize; may use an open hand to show area affected, because
pain my be diffuse. May describe as deep, aching, cramping, or
sensation of pressure. Very responsive to opioid therapy.
Stages of Grief(Answer) - 1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
"5 Wishes"(Answer) - • Is a movement that encourages people to
provide more specific instructions than those offered by a living will.
1. The person chosen to make decisions when the individual can no
longer make them for himself or herselfa durable power of attorney
for health care
2. The kind of treatment the person wants or does not wanta living
3. How comfortable the person wants to be
4. How the person wants to be treated by others
5. What the person wants his or her loved ones to know
End of Life SOB(Answer) - The low-dose opioid initiated for pain
would also help with his shortness of breath; supplemental oxygen may
also be of benefit. Morphine 5 mg q 4 hr
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Health Related Quality of Life (HRQL)(Answer) - A term the CDC has
focused on measuring by using an instrument that assesses the number
of healthy days an individual has in a given month
Functional incontinence(Answer) - problems from factors external to the
lower urinary tract such as cognitive impairments, physical disabilities,
and environmental barriers
Functional decline(Answer) - scientific evidence supports the fact that
functional disability is not caused by aging, per se, but results from
illnesses and diseases that are related to unhealthy lifestyle decisions. Up
to 70% of the physical disabilities associated with the aging process
results from illness and diseases that are related to unhealthy lifestyle
Dementia(Answer) - chronic and progressive illness characterized by
behavioral and cognitive changes that affect memory, problem solving,
judgement, and speech and that cause deficits in functional abilities.
Reciprocity(Answer) - ability to be true to one's self while respecting
and supporting the values and views of another.
Self-care(Answer) - Assistive devices for self-care include such items as
robotics, electric feeders, adapted utensils, specially designed toilet
seats, and aids for tooth brushing, washing, dressing, and grooming. An
emergency response system (ERS) can increase the safety of an
individual who requires assistance with self-care activities.
Sensor-based Monitoring(Answer) - the goal of this system is to enable
older adults with disabilities to remain in their own homes for as long as
possible. The system is composed of unobtrusive and low-cost sensors
(no cameras or microphones) that detect movement and pressure.
Most common form of assessment in rehabilitation(Answer) - Uniform
Data System for Medical Rehabilitation (UDSMR)
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• Functional Independence Measure (FIM
The National Gerontological Nursing Association(Answer) - It is the
first and only nursing specialty organization dedicated to helping realize
the full potential of Gerontological nurse. The organization is composed
of a growing, dynamic, and dedicated group of professionals who share
ideas and information that improve the quality of nursing care for older
A theory of behavior change(Answer) - Attempts to explain the
processes underlying the learning of new health behaviors. The two most
widely cited theories of behavior change are social cognitive theory, and
stages of change. Other theories that have marshaled support are health
locus of control health belief model, reasoned action, community
empowerment, and community-oriented primary care.
Health Literacy(Answer) - degree to which individuals have the capacity
to obtain, process, and understand basic health information and services
needed to make appropriate health decisions
Advocacy(Answer) - refers to loyalty and a championing of the needs
and interests of others, requiring the nurse to educate patients and their
families so that they know their rights, are fully informed, and are able
to access all the benefits they are entitled to.
Canadian Occupational Performance Measure (COPM)(Answer) - this
tool is designed to detect changes in self-perception of occupational
performance over time
Nonadherence(Answer) - NCPIE has noted that non-adherance can take
a variety of forms, including not having a prescription filled; taking an
incorrect dose; taking a medication at the wrong time; forgetting to take
doses; or stopping therapy too soon due to the costs, a logical decision,
or side effects unknown to the physician.
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Nursing informatics(Answer) - nursing informatics is a combination of
computer science, information science and nursing science, designed to
assist in the management and processing of nursing data, information
and knowledge to support the practice of nursing and the delivery of
nursing care.
Pharmacokinetics(Answer) - is the time course by which the body
absorbs distributes, metabolizes, and excretes drugs. In other words,
pharmacokinetics speaks to how drugs move through the body and how
quickly this occurs.
International Classification of Impairment Disability and Handicap
(ICIDH)(Answer) - It suggests relationships among impairment,
disability, and handicap. In attempting to move away from a disease
perspective and towards a health perspective, the WHO discontinued
using the term handicap and made definitional changes, creating a new
International Classification of Functioning, Disability, and Health in
Moderate exercise(Answer) - Moderate exercise is defined as 30 or more
minutes of brisk walking on 5 or more days per week. Tai chi and yoga
are helpful for improving balance and flexibility. Modified exercises,
such as armchair exercises, can be helpful the frail elderly or those with
mobility restrictions. Sporadic, vigorous exercise should be discouraged.
Healthy aging(Answer) - the ability to maintain three key behaviors:
1. Low risk of disease and disease related disability
2. High mental and physical function
3. Active engagement of life
Veracity(Answer) - means truthfulness and refers to telling the truth, or
at the very least, not misleading or deceiving patients or their families.
Active Aging(Answer) - The term active aging was adopted by the
WHO in the late 1990s to allow inclusion of additional factors related to
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healthy aging. The active aging approach is based on the human rights of
older people and the United Nations' principles of independence,
participation, dignity, care, and self-fulfillment.
Adherence in Low-literacy patients(Answer) - patients with low literacy
can be taught to color code their bottles with colored tape or to use an
organizer that separates daily doses into morning, noon, evening, and
Barriers to Older Adult's Learning(Answer) - Theses include chronic
illnesses, normal aging changes occurring with advancing age, health
disparities, and other factors that may accompany cultural diversity.
• Reduced vision
• Reduced hearing
• Impaired cognitive function
• Depression
• Stress
• Chronic illnesses
• Dementia
Healthy People 2010(Answer) - develop a set of health care objectives
designed to increase the quality and quantity of years of healthy life of
Americans and to eliminate health disparities
Primary prevention(Answer) - activities designed to completely prevent
a disease from occurring, such as immunization against pneumonia or
Secondary prevention(Answer) - directed toward early detection and
management of disease, such as the use of colonoscopy to detect small,
cancerous polyp
tertiary prevention(Answer) - efforts are those used to manage clinical
diseases in order to prevent them from progressing or to avoid
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