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Geriatric Health Assessment and Nursing Considerations, Exams of Nursing

Notre Dame College (NDC)Nursing

An overview of key considerations for assessing and caring for the geriatric population, particularly related to gastrointestinal, genitourinary, and mental health. It covers topics such as risk factors for nutritional deficits, common urinary tract infection risk factors, normal and abnormal urine findings, components of a comprehensive gi/gu assessment, lifespan considerations for the male and female reproductive systems, the nurse's role in nutritional assessment, urgent assessment findings for the heent region, the rights and principles of safe medication administration, the teaching-learning process, health literacy, the stages of grief, the physical and psychological needs of dying patients, and the principles of delegation. The information presented can be useful for nursing students and professionals working with older adult populations to provide comprehensive, patient-centered care.

Typology: Exams

2023/2024

Available from 08/13/2024

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NURS2002: Final Exam Questions with
Complete Solutions
how might older age affect GI and GU health? โœ”โœ”-risk for nutritional deficits: poor diet, living
alone, social isolation, not preparing meals, etc
-dec appetite, leading to constipation
-lots of GI effects associated with many medications
-prostate pathologies in older men that may cause obstructions
how might race/ethnicity affect GI and GU health? โœ”โœ”-certain populations at higher risk of
diseases that can affect GI/GU health
-ex: African Americans and sickle cell disease, alcoholism in Native American populations,
lactose intolerance has familial predisposition
what patients are at high risk for UTIs? โœ”โœ”-sexually active
-postmenopausal
-indwelling catheter
-diabetes
-elderly
-physical/cognitive impairment (inadequate self-care)
-women
what patients are at risk for constipation? โœ”โœ”-bed rest, immobility, post-op
-elderly
-reduced fluid
-depressed
-CNS dysfunction
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NURS2002: Final Exam Questions with

Complete Solutions

how might older age affect GI and GU health? โœ”โœ”-risk for nutritional deficits: poor diet, living alone, social isolation, not preparing meals, etc

  • dec appetite, leading to constipation
  • lots of GI effects associated with many medications
  • prostate pathologies in older men that may cause obstructions how might race/ethnicity affect GI and GU health? โœ”โœ”-certain populations at higher risk of diseases that can affect GI/GU health
  • ex: African Americans and sickle cell disease, alcoholism in Native American populations, lactose intolerance has familial predisposition what patients are at high risk for UTIs? โœ”โœ”-sexually active
  • postmenopausal
  • indwelling catheter
  • diabetes
  • elderly
  • physical/cognitive impairment (inadequate self-care)
  • women what patients are at risk for constipation? โœ”โœ”-bed rest, immobility, post-op
  • elderly
  • reduced fluid
  • depressed
  • CNS dysfunction
  • medications (ex: opioids, anticholinergics) what urine findings would require urgent assesment? โœ”โœ”-blood in the urine
  • cloudy/foamy urine
  • foul odor
  • low urine production (low GFR) what urine is considered normal? โœ”โœ”-straw yellow
  • clear, transparent
  • no sediment
  • no odor what components are included in a GI and GU health assessment? โœ”โœ”-inspection: abdomen, urine, vomit, stool
  • auscultation: listening for hyper/hypoactive/present bowel sounds
  • light palpation: abdomen (overall impression), kidneys, liver, bladder what are some lifespan considerations of the male reproductive system? โœ”โœ”-adolescents: use tanner's stages of maturation to assess,
  • older adults: dec testosterone (affect libido and sexual function), loss of muscle tone (incontinence), stool retention, dysfunction from medications, erectile dysfunction what are some lifespan considerations for the female reproductive system? โœ”โœ”-tanner staging for development
  • pregnant women: cervical changes
  • older adults: menopause, vaginal infections, UTIs, dyspareunia (genital pain before/during/after sex), diminished libido, cancers
  • older adults: dec energy expenditure, difficulty chewing/swallowing, dec in peristalsis, dec thirst, social isolation, unintentional weight loss
  • infant/children: rapid growth, need adequate nutrition what are urgent assessment findings of the head/lymphatics assessment? โœ”โœ”-"BE FAST" for stroke: balance/HA/dizziness, eye issues (blurred/loss of vision), facial drooping, arm weakness/numbness, slurred speech
  • acute head injuries and neurologic changes (stabilization of head/neck, trauma assessment)
  • neck pain (muscle tension/spasms, check for fever/headache)
  • lymphatics (fixed, irregular, hard, or rubbery mass)
  • hyperthyroidism (thyroid storm/crisis) what are urgent assessment findings of the eye assessment? โœ”โœ”-sudden vision loss
  • eye trauma/injuries
  • foreign bodies, lacerations, hyphema (blood in eye)
  • acute glaucoma what are urgent assessment findings of the ears? โœ”โœ”-outer ear foreign object
  • foul-smelling drainage
  • chronically draining ears
  • ear trauma; tympanic rupture what are urgent assessment findings of the nose, sinus, mouth, and throat? โœ”โœ”-ludwig angina: edema pushing tongue up and back (leading to airway obstruction; infection of the mouth floor)
  • aspiration
  • abrupt loss of smell
  • bacterial sinus infection

what are the risk factors related to HEENNMT and lymphatics? โœ”โœ”-medications/supplements

  • family history
  • age
  • past medical history (conditions, surgeries, health, allergies, prescriptions, etc)
  • environmental factors (ex: smoking/tobacco use) what developmental considerations are important in the HEENT assessment of children? โœ”โœ”fontanels/dec visual acuity in infants, assessing for red eye reflex in kids what developmental considerations are important in the HEENT assessment of older adults? โœ”โœ”-bony structures more pronounced
  • skin lesions more likely
  • carefully assess for possible cancers
  • hypothyroidism
  • eye structural changes
  • vision loss
  • decreased tear production
  • diabetic retinopathy
  • cataracts
  • decreased hearing d/t age and structural changes
  • inc auditory reaction time
  • decreased olfactory sensory fibers, saliva production, and taste buds
  • loss, discoloration, and loosening of teeth
  • receding gums
  • smooth/shiny tongue, fissures what are the rights of medication administration? โœ”โœ”-right drug**
  • right reason
  • check the original orders to verify the route of administration
  • ensure that labeling is legible and clearly understood
  • follow institution medication protocols as written what question would you ask to ensure the right patient? what action would you take? โœ”โœ”-is this the right patient to receive this medication?
  • verify the identity of the patient using at least two identifiers: name and date of birth (check wristband, ask patient to state name) what question would you ask to ensure the right time? what action would you take? โœ”โœ”-is this the correct time for the medication to be administered?
  • check when the medication was last administered; if the drug is new, document when it is first given what question would you ask to ensure the right assessment data? what action would you take? โœ”โœ”-is it appropriate to administer the medication, based on the specific data collected?
  • collect appropriate assessment data related to mechanism of action and/or therapeutic effect what questions would you ask to ensure the right education? what action would you take? โœ”โœ”- is the patient familiar with the medication?
  • does the patient understand the purpose, dosing, and administration information, as well as other information specific to medication?
  • assess patient's level of knowledge, provide patient education as necessary what questions would you ask to ensure the right to refuse? what action would you take? โœ”โœ”- has the patient verbally agreed to take the medication?
  • has the patient expressed any concern with the medication?
  • acknowledge the patient's right to self-determination; provide education, then verify, document, and notify the provider about the refusal as needed

what question would you ask to ensure the right documentation? what action would you take? โœ”โœ”-has the correct documentation been completed according to facility policy?

  • complete documentation according to facility policy immediately after administering any medication
  • document and communicate to the appropriate health care provider any signs and symptoms indicative of any adverse effects what question would you ask to ensure the right response? what action would you take? โœ”โœ”- how is the patient responding to the medication?
  • monitor the patient to determine the efficacy of the drug, detect and prevent complication, and evaluate and document changes in health status
  • when applicable, assess the patient's laboratory values to detect changes
  • provide patient education, when possible, so patient is alert to adverse effects and changes in how he or she feels what are the principles used to safely prepare and administer oral medications? โœ”โœ”-use crusher, cutter, etc. depending on patients needs
  • follow five rights
  • can be capsule, pill, tablet, extended release, elixir, suspension, or syrup what are the principles used to safely prepare and administer parenteral medications? โœ”โœ”- selecting correct needle/syringe
  • using aseptic/sterile technique to prevent infection
  • careful recapping needles
  • adhering to 5 rights what are the principles used to safely prepare and administer topical medications? โœ”โœ”-should not share
  • cleaning skin thoroughly before administration to enhance absorption
  • follow specific instructions of the medication
  • subjective data: statements to the nurse, overhearing pt reporting to someone else, family and friends' report
  • verbal and nonverbal data
  • assessing for divergent strategies, manipulation, and motivation for tactics what are the common sx of violence victims? โœ”โœ”easily triggered, isolation, social withdrawal, numbing/shutting down feelings, spacing out/forgetfulness what are the risk factors that you should assess for related to mental health conditions? โœ”โœ”- exacerbating factors of violence and mental health conditions (unchangeable factors like family hx/age/gender, changeable factors like support systems/ housing/health care access/literacy, and medical issues such as parkinson disease/cancer/HIV & AIDs/other chronic conditions)
  • personal history
  • psychosocial history (support network, substance abuse, spirituality)
  • medications
  • family hx what are the appropriate health promotion measures for mental health/related violence? โœ”โœ”Important patient education topics
  • alterations in interest: life, motivation, energy, sleep, appetite; sexual behavior
  • current stressors, coping, violence
  • physical, sexual abuse; altered mood, affect
  • pervasive worry, anxiety; substance use
  • changes: behavior; self-harm; suicidal thoughts
  • memory, concentration, problem-solving abilities
  • "healthy people" health promotion goals what are the three learning domains? โœ”โœ”cognitive, psychomotor, affective

cognitive learning domain โœ”โœ”storing and recalling of new knowledge in the brain

  • ex: lecture, panel, discovery, written materials psychomotor learning domain โœ”โœ”learning a physical skill
  • ex: demonstration, discovery, printed materials affective learning domain โœ”โœ”changing attitudes, values, and feelings
  • ex: role modeling, discussion, audiovisual materials what is the teaching-learning process? โœ”โœ”-assess learning needs and learning readiness
  • diagnose the patient's learning needs
  • develop learning outcomes
  • develop a teaching plan
  • implement teaching plan and strategies
  • evaluate learning; revise the plan if the learner outcome is not met
  • document the teaching-learning process what does TEACH stand for? โœ”โœ”T: tune into the patient E: edit patient information A: act on every teaching moment C: clarify often H: honor the patient as a partner in the education process what are some lifespan considerations that you need to keep in mind when teaching your patients? โœ”โœ”-older adults: identifying learning barriers, allowing extra time, planning short teaching sessions, accommodating for sensory deficits, reducing environmental distractions
  • infants/toddlers/preschoolers: learning directed towards parents

what is bereavement? โœ”โœ”a state of grieving due to loss of a loved one what are Engel's six stages of grief? โœ”โœ”1) shock and disbelief (no, not me)

  1. developing awareness (why me?)
  2. restitution (rituals surrounding the loss)
  3. resolving the loss (dealing with the void left by the loss)
  4. idealization (exaggeration of the good qualities of the person or object, followed by acceptance of the loss)
  5. outcome (dealing with loss as a common life occurrence) what are the Kubler-Ross stages of grief? โœ”โœ”1) denial and isolation
  6. anger
  7. bargaining
  8. depression
  9. acceptance what is dysfunctional grief? โœ”โœ”abnormal or distorted grief that may be either unresolved or inhibited what are signs of impending death? โœ”โœ”-difficulty talking or swallowing
  • nausea, flatus, abdominal distention
  • urinary or bowel incontinence or constipation
  • loss of movement, sensation, reflexes
  • decreasing body temperature with cold or clammy skin
  • weak, slow, or irregular pulse
  • decreased blood pressure
  • noisy, irregular, or cheyne-stokes respirations
  • restlessness or agitation
  • cooling, mottling, and cyanosis of the extremities and dependent areas what are Kubler-Ross' five stages of dying? โœ”โœ”1) denial: pt denies the reality of death, represses what's discussed
  1. anger: pt expresses rage and hostility (why me?)
  2. bargaining: pt tries to barter for more time (put personal affairs in order, make wills, fulfill last wishes)
  3. depression: pt goes through period of grief; crying, not speaking much
  4. acceptance: pt feels tranquil; accepts the reality of death and is prepared to die what are the physiologic needs of the dying patient? โœ”โœ”physical needs
  • hygiene
  • pain control
  • nutritional needs what are the psychological factors of the dying patient? โœ”โœ”-pt needs control over fear of the unknown
  • pain
  • separation
  • leaving loved ones
  • loss of dignity
  • loss of control
  • unfinished business
  • isolation what are the spiritual needs of the dying patient? โœ”โœ”patient needs meaning and purpose, love and relatedness, forgiveness and hope
  • taking vital signs
  • measuring I & O
  • client transfers
  • ambulation
  • postmortem care
  • bathing, feeding, gastrostomy feedings
  • attending to safety
  • weighing
  • simple dressing changes
  • suctioning of chronic tracheostomies
  • basic life support (CPR) what cannot be delegated to UAPs? โœ”โœ”-assessment
  • interpreting data
  • making a nursing diagnosis
  • creating a nursing care plan
  • evaluating care effectiveness
  • care of invasive lines
  • administering parenteral medications
  • inserting NG tubes
  • client education
  • performing triage
  • giving telephone advice the RN can delegate ________ and supervise appropriately; however, the _________________ cannot be delegated. โœ”โœ”the RN can delegate individual components of care and supervise appropriately; however, the main functions of assessment, planning, evaluation, and nursing judgement cannot be delegated.

what must the nurse do before delegating? โœ”โœ”must assess basic care activities

  • activities of daily living (ADLs) and assistive devices
  • nutrition and oral hydration
  • elimination
  • personal hygiene
  • mobility/immobility
  • rest and sleep
  • non-pharmacological comfort interventions how does prioritization figure into delegation? โœ”โœ”-prioritizing is "deciding which needs or problems require immediate action and which ones could be delayed until a later time because they are not urgent"
  • if nurse has some tasks that are more of a priority for them to carry out, the nurse can delegate other tasks of less priority to the appropriate personnel what does DAR stand for? โœ”โœ”data, action, response