nursing study guide !, Cheat Sheet of Nursing

Download nursing study guide ! and more Cheat Sheet Nursing in PDF only on Docsity!

Geriatrics Week 1 (Chapters 1-5)

Chapter 1: Trends and Issues in Basic Geriatric Nursing

Lesson 1.1: Understanding Aging Key Definitions  Geriatrics: Medical care of older adults, focusing on diseases and conditions of aging.  Gerontology: Study of the aging process, including social, psychological, and biological aspects.  Gerontics: Nursing care of older adults, emphasizing individualized care for their unique needs. Gerontic nursing comprises a holistic view of aging, with the goal of increasing health, providing comfort, and caring for older adults’ needs. Ageism  In the late 1960s, research began to indicate that adults of all ages are not the same. Then also, the focus of health care shifted from illness to wellness. Disability and disease were no longer considered unavoidable parts of aging. Increased medical knowledge, improved preventive health practices, and technologic advances helped more people live longer, healthier lives.  Definition: Prejudice against people based on age. It is an emotional prejudice or discrimination against people based solely on age.  Impact: Leads to discrimination and emotional separation of older adults from younger generations.  Responses: Some older adults accept discrimination passively, while others advocate for their rights.  Specializing in geriatrics is unpopular by nursing and medical students. Some health care providers erroneously believe that they are not fully using their skills when working with the aging population.

Demographic Trends  Older adults (65+) are the fastest-growing age group in the U.S.  The baby boomers are people born after World War II, between 1946 and 1964.  By 2040, over 21% of the U.S. population will be 65+ years.  Women tend to live longer than men, but life expectancy disparities among ethnic groups are declining.  Current life expectancies in terms of race are as follows: White women, about 81 years; Black women, about 77.9 years; White men, 76.1 years; and Black men, 71. years. Hispanic people in the United States have a lower mortality and higher life expectancy than both non-Hispanic White and non-Hispanic Black people. Politically Active Senior Citizen Groups Lesson 1.2: Economic and Housing Challenges Economic Status  Income: o Older men: Median income ~$34,000.

home services for older adults, elder abuse prevention, and caregiver support.  During the 1980s, Medicare instituted the diagnosis-related group (DRG) system in an attempt to contain hospital costs. Under this system, a hospital is paid a set amount based on the patient’s admitting diagnosis. If the patient is discharged in fewer days than predicted, the hospital keeps the excess money.  Medicare will pay for a maximum of 100 days in a skilled care facility after a 3-day hospital stay. After that time, the cost of care is usually the responsibility of the older person or their family unless they qualify for Medicaid.  Medicare: o Part A: Hospital insurance. Does pay deductible and copay. (Impatient hospital stays.) o Part B: Outpatient care. Only covers 80 percent after deductible. Covers ambulance transport; physical, speech, and occupational therapy (PT, OT, ST); home health services; mental health services; x-rays and lab tests; chiropractic care; medical supplies and equipment; and outpatient surgery or blood transfusions. o Part C: Medicare Advantage (private insurance options). These plans allow beneficiaries to receive their Medicare benefits through private insurance companies. The older adult enrolls in a private plan, such as a health maintenance organization (HMO) or preferred provider organization (PPO). These plans are designed to cover total costs, so that supplemental insurance coverage is not necessary. They usually also include prescription drug benefits. They do, however, limit the pool of available health care providers, and premiums and rules vary depending on the plan selected. Covers everything Medicare doesn’t cover (ex. like vision and dental). o Part D: Prescription drug coverage.  Medicaid: o For low-income individuals; covers gaps not included in Medicare. Advance Directives  Living Will: Details medical care preferences. A living will informs the physician that the individual wishes to die naturally if a terminal illness develops or if the person receives an injury that cannot be cured. Living wills prohibit the use of life-prolonging measures and equipment when the individual is near death or in a persistent vegetative state. Living wills go into effect only when two physicians agree in writing that the necessary criteria have been met.  Durable Power of Attorney: Designates someone to make healthcare decisions. A durable power of attorney for health care transfers the authority to make health care decisions to another person, called the health care agent. The agent may act only in situations in which the persons involved are unable to make such decisions for themselves.

 POLST: Physician Orders for Life-Sustaining Treatment: Specific medical orders for emergency personnel. Lesson 1.3: Family Dynamics and Elder Abuse Changing Family Roles  Sandwich Generation: Middle-aged adults balancing care for their children and aging parents.  Key Issue: Loss of independence for aging parents.  Loss of independence is probably the most significant issue that aging parents and their children must face. The aging family members have spent decades making their own decisions. As independent adults, they made their own choices about where to live, what to do, and when to do it. They had control of their lives. Most independent adults do not want to ask anyone for help. Elder Abuse  Types: o Physical: Pain or injury (ex. The inappropriate use of drugs, force-feeding, and the use of physical restraints or punishment of any kind are examples of physical abuse). o Emotional: Isolation, ignoring, or verbal abuse. Emotional abuse is the most subtle and difficult to recognize type of abuse. It often includes behaviors such as isolating, ignoring, or depersonalizing an older adult. o Financial: Misuse of resources (ex. money is taken and spent by others for their own purposes. o Neglect: Failing to meet basic needs. Neglect is a passive form of abuse in which caregivers fail to provide for the needs of older persons under their care. o Abandonment: Deserting dependent older adults.  Signs: o Poor hygiene, malnutrition, unexplained injuries, or emotional withdrawal.  Reporting: Nurses are mandated reporters of suspected abuse. Responses to Abuse  It is natural to think that an older person suffering from one or more forms of abuse would complain, but this is rarely the case. Fear of being treated even worse or fear of being institutionalized or abandoned may prevent the victim from seeking help. Self-Neglect  Indicators include poor hygiene, inability to manage finances, and confusion.

o Aging follows a genetic timeline. o The programmed theory proposes that everyone has a certain biologic timeline to follow. In this theory, each individual has a genetic “program” specifying an unknown but predetermined number of cell divisions. o Includes predictable changes like menopause, graying hair, and skin changes.

2. Run-Out-of-Program Theory: o Limited genetic material "runs out" over time.
3. Rate of Living Theory: o Lifespan depends on finite breaths or heartbeats.
4. Gene Theory: o The gene theory proposes the existence of one or more harmful genes that are activated over time, resulting in the typical changes seen with aging and limiting the lifespan of the individual. o Harmful genes activate with age, causing aging and disease.
5. Error Theory: o Aging is due to accumulated environmental damage (e.g., radiation, pollution) leading to errors in cellular function.
6. Somatic Mutation Theory: o DNA damage from chemicals or radiation causes chromosomal abnormalities.
7. Free Radical Theory: o Unstable molecules (free radicals) damage cells, leading to aging. o Antioxidants may reduce free radical effects. o One free radical, named lipofuscin, has been identified to cause a buildup of fatty pigment granules, which cause age spots in older adults. o Individuals who support this theory propose that the number of free radicals can be reduced by the use of antioxidants, such as vitamins A, C, and E, carotenoids, zinc, selenium, and phytochemicals. o Free radicals: unstable molecules produced by the body during the normal processes of respiration and metabolism or after exposure to radiation and pollution o Suspected to cause cell damage and contribute to physiologic changes of aging and a variety of diseases.
8. Crosslink (Connective Tissue) Theory:

o Free radicals cause crosslinks in DNA and tissue, reducing tissue elasticity (e.g., wrinkles). o This results in skin changes typically attributed to aging, such as dryness, wrinkles, and loss of elasticity.

9. Clinker Theory: o Combines multiple theories; metabolic byproducts accumulate and damage organs.
10. Reliability Theory of Aging and Longevity o Mathematical model of system failures. o Used to describe degradation (disease) and failure (death) of human body systems o In a similar vein there is the reliability theory of aging and longevity, a complex mathematical model of system failures that was first used to describe the failure of complex electronic equipment. o It serves as a model to describe degradation (disease) and failure (death) of human body systems.
11. Wear-and-Tear Theory: o The body "wears out" due to stress and damage. Good health practices slow this process, resulting in longer and better body function. o This theory also proposes that good health maintenance practices will reduce the rate of wear and tear, resulting in longer and better body function.
12. Neuroendocrine Theory: o Aging results from less precise hormone regulation by the hypothalamus, causing body changes like decreased muscle mass. o Stimulation or inhibition of various endocrine glands by the hypothalamus initiates the release of various hormones from the pituitary and other glands, which, in turn, regulate bodily functions, including growth, reproduction, and metabolism.
13. Immunologic Theory: o The immune system weakens over time, increasing susceptibility to disease and autoimmune conditions. Lesson 2.2: Psychosocial Theories of Aging Psychosocial Theories

o Support patients in maintaining social connections and engaging in purposeful activities.

2. Developmental Tasks: o Assist aging individuals with adjusting to physical changes, retirement, and loss. o Recognize the emotional challenges of aging, such as fear of dependency.
3. Education and Advocacy: o Educate patients about managing aging-related conditions (e.g., arthritis, osteoporosis). o Advocate for environments that support healthy aging.

Chapter 3: Physiologic Changes

Lesson 3.1: The Integumentary System Expected Age-Related Changes  The function of sweat glands decreases; thus the amount of perspiration also decreases. This results in heat intolerance, because the body’s cooling system through evaporation is less efficient (heat intolerance).  Senile lentigo: These areas are often referred to as age spots or liver spots and are most often seen on those body areas that are most exposed to sunlight. Seen as brown spots.  Seborrheic keratosis: skin growths/is slightly raised, wart-like macules with distinct edges appear. These lesions, ranging in color from light tan to black, are most often observed on the upper half of the body; they may cause discomfort and itching.  Cutaneous papilloma or skin tags  Crow’s feet or wrinkles  Faded or gray hair color  Hair distribution patterns change (decreases growth over time)  Fingernails grow more slowly  Toenails become thicker (sometimes have yellow toenails)  Xerosis (dry skin)  Senile purpura - Capillary walls become increasingly fragile with age and may hemorrhage, leading to senile purpura: red, purple, or brown areas commonly seen on the legs and arms. Can be due to unproper handling of the patient. Common Disorders

 Skin cancers (melanoma, basal cell carcinoma, squamous cell carcinoma).  Pressure injuries, fungal infections, and herpes zoster.  Inflammation and infection  Rosacea (appears as redness, dilated superficial blood vessels, and small “pimples” on the nose and center of the face)  Contact, allergic, and seborrheic dermatitis (unsightly skin condition characterized by yellow, waxy crusts that can be either dry or moist)  Herpes zoster  Fungal, yeast, and bacterial infections  Infestation with scabies (mite that grows under the skin)  Hypothermia due to reduced subcutaneous fat. The decrease in subcutaneous tissue reduces the older adult’s ability to regulate body temperature. Lesson 3.2: The Musculoskeletal System Age-Related Changes  Bones: Decreased calcium, risk of fractures, and loss of height.  It is also necessary to apply stress to the long bones to keep the minerals in the bones. This needed stress is best provided by weight-bearing activities, such as standing and walking.  Calcium is necessary for bone strength, muscle contraction, myocardial contraction, blood clotting, and neuronal activity.  Weight bearing activity is needed to keep the bones strong. (You gotta move that ass).  Muscles: Reduced mass, tone, and blood supply.  As a person ages, muscle mass decreases, and the proportion of body weight resulting from fatty, or adipose, tissue increases.  Joints: Decreased elasticity and fluid in intervertebral disks. Common Disorders  Osteoporosis: Increased fracture risk.  Menopausal hormone therapy (MHT) has beneficial effects on bone density but also carries an increased risk for heart attack, blood clots, stroke, and breast cancer.  Arthritis: Osteoarthritis, rheumatoid arthritis, bursitis (inflammation of the bursa and the surrounding fibrous tissue), gouty arthritis (elevated levels of uric acid in the body).  Osteoarthritis is not considered a normal change of aging; however, the incidence of osteoarthritis increases with age.

 Chronic obstructive pulmonary disease (COPD) o Emphysema, and chronic bronchitis  Asthma  Influenza  Coronavirus disease (COVID-19)  Pneumonia  Tuberculosis - The symptoms of TB include cough, night sweats, fever, dyspnea, chest pain, anorexia, and weight loss. The cough may be nonproductive or productive. The sputum may be green or yellow; with hemoptysis, the presence of blood may impart a rusty color.  Lung cancer Lesson 3.4: The Cardiovascular System Age-Related Changes  Occlusion of the coronary arteries decreases the nutrient and oxygen flow to the myocardium. Total oxygen deprivation results in myocardial tissue necrosis, which is irreversible.  Reduced cardiac muscle tone, thicker heart walls, and fewer pacemaker cells.  Increased risk of atherosclerosis and decreased elasticity of vessels. Common Disorders  Coronary artery disease, arrhythmias, heart failure, varicose veins.

The Hematopoietic and Lymphatic Systems

Common Disorders

Age-Related Changes  Fewer functional nephrons, decreased bladder muscle tone.  Increased nocturnal urine production and risk of incontinence. Common Disorders  Chronic kidney disease, urinary tract infections (UTIs). Lesson 3.7: The Nervous System Age-Related Changes  Fewer neurons, slower reflexes, and reduced nerve function. Common Disorders  Alzheimer’s disease, strokes (ischemic and hemorrhagic), Parkinson’s disease. Lesson 3.8: The Special Senses

Age-Related Changes  Eyes: Presbyopia, fewer tears, discoloration of the lens.  Ears: Presbycusis (age-related hearing loss), reduced elasticity.  Taste and Smell: Decreased sensitivity. Common Disorders  Cataracts, glaucoma, macular degeneration, and Ménière’s disease.  Blepharitis, a chronic inflammation of the eyelids caused by bacteria and oily flakes at the base of the eyelid, is one of the most common disorders of the eye.  Symptoms of blepharitis include burning, itching, and sensitivity to light.  Discomfort is often worse on awakening. Blepharitis can be caused by Staphylococcus bacteria, by sebaceous gland dysfunction, or in conjunction with skin conditions, such as seborrhea or rosacea.

Chapter 4: Health Promotion, Health Maintenance, and Home Health Considerations

Lesson 4.1: Recommended Health Maintenance Practices Dietary Recommendations  Emphasize a well-balanced, plant-based diet.  Adjust caloric intake to account for reduced metabolic rate in aging.  Educate older adults on reading food labels, especially for conditions like low sodium diets. Exercise  Benefits include flexibility, muscle maintenance, glucose control, weight management, and overall well-being.  30 minutes of continuous activity is recommended daily but doesn’t need to be aerobic. Tobacco and Alcohol Use  Smoking cessation aids are available; quitting improves health at any age.  Even the body of an older person can repair damage once smoking is discontinued.  Alcohol use disorder is common due to stress-coping mechanisms; monitor for abuse.  A physician recommend a glass of wine or beer to an older adult as an appetite enhancer.  Moderate use: o For women: 1 drink per day. o For men 2 drinks per day. o A beer is 12 oz, wine is 5 oz, and a distilled spirit is 1.5 oz.

Physical and Dental Exams  Annual physical exams can detect problems early and manage chronic conditions.  Physical examinations in older adults should include evaluations of height and weight, blood pressure, and a rectal examination.  Regular dental visits (at least yearly) help prevent oral cancers and address dry mouth.  Poor fit is a major reason why some older adults fail to wear their dentures regularly. This contributes to problems with nutrition and digestion. Should be cleaned at least once a day.  Evaluation of joints, feet, and gait should be part of the physical examination. Problems with the knees and shoulder joints can cause pain, activity limitations, poor sleep, and decreased overall function.  Vision should be checked yearly to monitor for glaucoma or other eye problems. Refractive examinations can detect the need for a change in eyeglass prescription.  Hearing examinations need not be done annually unless a problem is suspected. When signs of diminished hearing are present, audiometric testing is appropriate.  Blood tests for hypothyroidism or diabetes, electrocardiograms, and other diagnostic tests are not routinely part of the physical examination. In the absence of heart disease, blood cholesterol screening should be done every 4 to 6 years (CDC, 2021).