Exam 1 - Study Material Flashcards

Question

Biological Theories of Aging can be classified under what 2 categories?

Answer 1

1. Stochastic 2. Non-Stochastic

Answer 2

aging occurs as a random event and occurs over time

Answer 3

aging is a predetermined and timed phenomenon – non-random

Answer 4

* Free Radical / Oxidative stress theory * Cross link or Collagen theory * Wear & Tear theory

Answer 5

* States that errors are the result of random damage from free radicals, and that over time the production of free radicals increases and the body's ability to remove them decreases. * Mitochondiral DNA is most affected by the ROS damage

Answer 6

* Describes aging as the result of accuulated damage from errors associated with corss-linked proteins. * Substances that may act as cross-linking agents include unsaturated fats, aluminum, zinc, and magnesium

Answer 7

* Proposes that cell errors are the result of "wearing out" over time because of continued use. * Cells are aggravated by the harmful effects of internal and external stressors which include pollutants and free radicals

Answer 8

1. Immunity theory 2. Neuroendocrine control or pacemaker theory

Answer 9

Presents aging as a programed accumulation of damage and decline in the function of the immune system, with damage being the result of oxidative stress.

Answer 10

* Views aging as a programmed decline in the functioning of the nervous, endocrine, and immune systems. The cells lose their ability to reproduce, called replicative senescence.

Answer 11

* Excercise on soft surfaces, using good body mechanics (wear n tear theory) * Avoid skin dryness and joint stiffening (cross-link theory) * Watch for research related to the effect of unsaturated fats and heavy metals on cell health (cross-link theory) * Avoid environmental pollutants and unecessary radiation (oxidative stress theory) * Watch for research on the use and presence of antioxidants (oxidative stress theory) * Avoid stress (oxidative stress theory) * Minimize the potential for infection; wash hands frequently, undergo immunizations, and avoid those who are ill (Immunity theory)

Answer 12

Attempts to explain and predict the behaviors, feelings, mental processes, and role changes of the aging individual

Answer 13

* Role Theory * Disengagement Theory * Activity Theory * Continuity Theory * Age Stratification Theory * Modernization Theory

Answer 14

* Proposes that the ability of an individual to adapt to changing roles over the course of life is a predictor of adjustment to personal aging * Individuals go through different stages in life with new roles in each stage. * **Successful aging inovlves completing one role to take on another.**

Answer 15

* Proposes that the natural course of aging inolves the individual slowly withdrawing from his or her former roles and activities to allow the transfer of power to yougner generations. * Transfer was viewed as necessary for social equilibrium * **Elder's withdrawl is seen as successful aging**

Answer 16

* Proposes that activity is necessary to maintain life stisfaction, positive self-concept, and being able to "stay young". * **This theory is based on the asumptiom that it is beter to be active than inactive, and better to he happy than unhappy** * **Activity is the indicator for successful aging**

Answer 17

* Proposes than an individual develops and maintains a consistent pattern of behavior, substiuting one role for a similar one as the person matures. * Late life roles, responsibilities, and activites are a refluction of a continuation of life patterns. * **Successful aging is associated with one's ability to maintain and continue previous behaviors, roles, or find suitable replacements**

Answer 18

Proposes that aging can best be understood by considering the individual as a member of an age group, with similarities to others in the group

Answer 19

* Attempts to explain the social changes that have resulted in the devaluing of both the contributions of elders and the elders themselves. * The status and value of elders is lost when their labors are no longer considered usful, kinship networks are dispersed, the infromation they hold is no longer pertinent to the society in which they life, and the culture in which they live no longer reveres them * Proposed that these changes are the result of advancing technology, urbanization, and mass education

Answer 20

* Serve as backdrop for development of one’s philosophy of care & senior programs * provide insight on factors that impact the aging process * provide information on age-related changes & pathology * nurses should educate patients * shed light on the unique ways older adults achieve healthy aging & respond to illness * may be used as a framework for addressing various issues and initiating programs

Answer 21

* Young Adulthood (20-30) * Stage – intimacy vs isolation * Middle Adulthood (30-60) * Stage – Generativity ("making your mark" on the world) vs stagnation (not doing anything) * Older Adulthood (60+) * Stage – Ego integrity (able to look back at life accomplishments) vs despair

Answer 22

* Ego Differentiation vs. Work-Role Preoccupation * Body Transcendence vs. Body Preoccupation * Ego Transcendence vs. Ego Preoccupation (looking at the end of life)

Answer 23

* Adjusting to decreasing physical strength and health * Adjusting to retirement and reduced income * Establishing an affiliation with one’s age group * Meeting civic and social obligations * Establishing satisfactory living arrangements * Adjusting to death of spouse

Answer 24

Achieving wisdom through personal transformation

Answer 25

* Vision and hearing * There is a Decline in all five senses however

Answer 26

loss of elasticity of lens causes decreased accommodation and inability to focus sharply for near vision.

Answer 27

* **decreased visual acuity** * **Presbyopia (difficulty reading –up close, happens around 40 yrs old)** * decreased accommodation * reduction in pupil size & more sluggish * decreased light adaptation & night vision * increase sensitivity to glare * decreased depth perception * **yellowing of the lens**

Answer 28

* Laxity & downward shift of eyelids * Atrophy of orbital fat

Answer 29

* Vision loss due to damage to the optic nerve * **Central vision is spared, however peripheral vision is compromised.**

Answer 30

* an eye disease in which the lens becomes covered in an opaque film that affects sight, eventually causing total loss of sight * Fuzzy or cloudy images * Contrast sensitivity is decreased or lost.

Answer 31

* a gradual loss of the central part of the field of vision usually affecting both eyes that occurs especially in the elderly

Answer 32

* Loss of auditory neurons, calcification of auditory mechanisms, loss of hair cells * middle ear membranes less flexible; bones stiffen * Decrease ability to hear

Answer 33

* Make sure hearing aid is in * Shut the door to lower down background noise * Face them when talking

Answer 34

Difficulty hearing high frequency sounds

Answer 35

**Taste:** - atrophy of the tongue - diminished taste sensation - decreased saliva production - increased sensitivity to bitterness - decreased sensitivity to sweetness & salt **Smell:** - decrease in smell receptors - decreased smell acuity **Touch:** - decrease in # of touch receptors - decrease in sensitivity

Answer 36

* ↓ Moisture * Dermis thins; more fragile * Loss of subcutaneous fat * Wrinkling * Variation in pigmentation * Increased melanocytes in people of color’s skin * Nail growth slows * Less sweat gland activity

Answer 37

* Be careful when putting on IVs, especially with tearing off the tape * Advise them to use lotion * Advise them to use sunscreen

Answer 38

A common yeast infection that usually affects the vagina

Answer 39

* Also known as Shingles * a disease caused by the same virus that causes chickenpox

Answer 40

A hypertrophy that may produce nails resembling claws or a ram's horn, possibly caused by trauma or peripheral vascular disorders, but most often secondary to neglect and failure to cut the nails for extended periods of time.[

Answer 41

* the most common of all diseases of the nails in adults * Individuals who are especially susceptible include those with chronic diseases such as diabetes and circulatory problems and those with diseases that suppress the immune system * **More common in men than in women**

Answer 42

* Reduction of brain weight - 10% by 70 * Reduction in nerve cells * Slower autonomic & voluntary reflexes * Increase pain threshold * Increase in senile plaques & neurofibrillary tangles * **Decreased:** * Cerebral blood flow * Neurotransmitters * Impulse velocity

Answer 43

* Provide mental stimulation * Encourage them to be mentally active (crossword puzzles) •

Answer 44

* 40% complain of sleep problems * Decrease in total sleep time in stages 3 & 4. * Frequent awakening * Changes in circadian rhythms – more multiphasic

Answer 45

* ↓ in tone and elasticity of aorta and great vessels → Aorta & other arteries stiffen * **Heart sz. may increase slightly → slight increase in systolic BP** * Heart valves thicken & stiffen * ↓ # pacemaker cells * ↓ cardiac reserve & output * Myocardium is slower to recover its contractility * Baroreceptors which monitor B/P become less sensitive

Answer 46

* Lungs stiffen / chest wall rigid * **Total lung capacity constant** **Decreased:** * mobility of chest wall → elastic recoil of lung * cough reflex * vital capacity ↓ up to 50% by age 75 * number of alveoli → Pa02 decreases with age * number & activity of cilia **Increased:** * A-P diameter * residual volume

Answer 47

* Deep breathing exercises * Encourage them to get the flu (yearly) and pneumonia vaccines (every 5 years)

Answer 48

* **Ht. ↓ (2-3 in.) due to loss of cartilage, thinning of vertebral disks, & curvature of spine** * **Kyphosis** * ↓ in muscle mass (up to 30%) → ↓ in muscle strengt * Bone becomes more porous and brittle * ↓ Bone mineral & mass * Loss of Ca from bone → osteoporosis

Answer 49

* Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. * **It involves symmetric joints** (if one joint is inflammed, the other one will be too). Other musculoskeletal illnesses invovle isolated or unilateral joints. * **RA pain is worse in the morning when arising.** * **RA stiffness occurs in the morning and after rest periods** * **Movement decreases pain** * **S/S: fatiuge, weakness, anorexia, Weight loss, low grade fever, lymphadenopathy.**

Answer 50

* Osteoarthritis (OA) is the most common joint disorder, which is due to aging and wear and tear on a joint. * **asymetric pain is localized and is worse usually later in the day** * **Movement increases pain**

Answer 51

A decrease in skeletal bone mass occuring when rate of bone resorption is \> than that of bone formation

Answer 52

* age \> 50 * Family history ( eg Rheumatoid Arthritis) * Obesity * Joint abnormality * History of trauma

Answer 53

* they are nodes found on people's hands with osteoarthritis * Bouchard’s nodes – proximal – closest to hand * Heberden’s nodes – distal – near fingertips

Answer 54

* Tongue atrophies, loss of papillae, teeth become brittle * Some atrophy of L & S intestine but motility of feces not largely affected **MOTILITY:** * Decreased: esophageal peristalsis & emptying * Decrease in stomach motility **ABSORPTION:** * Slower absorption of fat, Vitamins B, B12, D, Ca, & Iron **SECRETION:** * Saliva is diminshed * Decrease in digestive enzymes (HCL acid & pepsin) * Increase in biliary lipid secretion (gallstones)

Answer 55

* Tooth loss is abnormal. Causes: poor dental care, periodontal dz., poor diet. * Constipation is not normal. Other factors such as poor diet, lack of fiber & exercise are culprits.

Answer 56

* **Delayed and less thirst response ** * Blood flow to kidneys declines * Number / size of nephrons decrease * Tubular function decreases * Glomerular filtration rate decreases * Decreased ability to concentrate urine * Heightened risk of trauma, infection, etc.

Answer 57

* Bladder muscles weaken * Increase in urgency & frequency * Increase in residual urine &urinary retention * Increase in nocturia * Bladder capacity decreases * Higher rate of UTI’s * Stress incontinence more common

Answer 58

* Estrogen production decreases * Ovaries become fibrotic & atrophy * Cessation of ovulation & Menopause * Loss of capacity to reproduce * Uterine lining thins & shrinks * Atrophy of vulva, cervix, & ovaries * Vaginal wall becomes thinner, drier, & lose elasticity

Answer 59

* Decrease in testosterone production * Size & firmness of testes decreases * Decline in rate of sperm production * Prostate enlargement * Takes longer to achieve erection, smaller, less firm, but maintained longer * Erectile dysfunction increases with age

Answer 60

* Pituitary gland shrinks * Thyroid gland atrophies but function remains adequate * Reduced sensitivity to insulin * Decrease in adrenal gland secretion of glucocorticoids & steroids * Decrease in aldosterone levels * Decrease secretion of cortisol

Answer 61

* Shrinkage of thymus gland * Decreased production of thymic hormones * Less production of antibodies * Response to antigens diminishes * Vulnerable to infections, tumors, & immune diseases

Answer 62

* **S –** leep disorders * **P –** roblems with eating and feeding (P) - ain * **I –** ncontinence * **C –** onfusion * **E –** vidence of falls * **S –** kin breakdown

Answer 63

**Decrease:** * ****Hgb, Hct, & WBC (slight) * Creatinine, serum * Iron & B12 * Potassium * T cells * T3 & T4 * Protein * PO2 **Increase:** * E. Sed. Rate (slight) * B cells & Monocytes * BUN * Glucose (higher normal) * Cholesterol * Uric Acid

Answer 64

It is a thorough evaluation of a person’s ability to carry out basic tasks for self-care and tasks needed to support independent living.

Answer 65

To improve functional status and independence and enhance quality of life.

Answer 66

* The purpose of this is to get a baseline for the patient. * Should be performed on admission * Or when the patient's condition changes

Answer 67

* Communication is different, they may not be able to understand what you are saying, and or physically able to do things, mobility and reaction time, looking for age related changes * Might have to be more patient with the pts.

Answer 68

* # of conditions on problem list correlates with degree of functional status * Objective indicators of health are the best indicators of a person’s ability. * Severity of disease determines the presence of functional impairment * All problems of elderly are related to a result of “aging or having lived a long life.”

Answer 69

* Physical Functioning * Cognitive Status * Psychological Status * Social Functioning / Support * Environmental Characteristics

Answer 70

It is an acronym that assess basic functions * **Fluids** * **Aeration** * **Nutrition** * **Communication** * **Activity** * **Pain** * **Elimination** * **Social skills**

Answer 71

* Evalue client's current state of hydration * Assess client's ability to obtain adequate fluids independently, to express thirst, to awallow effectively, and to evalue medications that affect intake an output

Answer 72

* This section refers to the adequacy of oxygen exchange * You observe fro RR, depth of respirations at rest and during activity * Evaluate breath sounds and medications that may affect breathing * Determine O2 saturation level

Answer 73

* Examine mechanical and psychological factors in addition to the type and amaount of food consumed. * Assess ability to bite, chew, swallow, dentures, and condition of gums and teeth * Assess diet, medical restrictions, economic resources, and living conditions

Answer 74

* Assess the client's ability to send and receive verbal and nonverbal information * Determine sight and sound acuity, adequate function of tongue, teeth, pharynx and larynx. * Determine client's ability to red, write, and understand spoken language

Answer 75

* Asses the client's ability to ambulate, eat, toliet, dress, and groom * Coordination, balance, finger dexterity, grip strength, and other abilities are necessary in daily life should also be assessed.

Answer 76

* Assess for physical, mental, and spiritual pain * Gather infromation about any recent losses or anxiety

Answer 77

* Bladder and bowel elimination are asseessed * Examine for any urinary dribbling, incontinence, use of protective garments, or medications that affect voiding and intestinal peristalsis * **Don't use complex words when talking about bowel and bladder functioning**

Answer 78

* Asess the client's ablity to negotiate in society, to give and receive love and friendship, and to feel self-worth * This assessment focuses on the individual's ability to deal with loss and to interact with other people in give-and-take situations

Answer 79

* Eating * Bathing * Dressing * Toileting * Transferring * Urine & Bowel Continence

Answer 80

* Telephone Use * Shopping * Food Preparation * Housework * Transportation * Medication Use * Money Management

Answer 81

* Folstein Mini-Mental Status Exam * The Mini Cog * Clock Drawing * Time & Change Test

Answer 82

* Orientation * Registration * Attention and Calculation * Recall * Language

Answer 83

* Instruct pt. to listen carefully to and remember 3 unrelated words and then to repeat the words. * Instruct pt. to draw face of a clock on a blank sheet of paper or on a sheet with the clock circle already drawn. After pt. puts numbers on clock face, ask him/her to draw hands of clock to read a specific time (11:10). * Ask pt. to repeat the 3 previously stated words.

Answer 84

* Tell time on clock with hands set to 11:10. * Count out one dollar in change (provide 3 quarters, 7 dimes, & 7 nickels)

Answer 85

* Geriatric Depression Scale * Spiritual Assessment (Jarel Spiritual Well-Being Scale & Stoll’s Guidelines for Spiritual Assessment)

Answer 86

* I am satisfied that I can turn to my family for help when something is troubling me. * I am satisfied with the way my family talks over things with me and shares problems with me. * I am satisfied that my family accepts and supports my wishes to take on new activities or directions. * I am satisfied with the way my family expresses affection and responds to my emotions, such as anger, sorrow or love. * I am satisfied with the way my family and I share time together. ## Footnote **Responses: Always, Some of the time, Hardly ever**

Answer 87

* It assess the availability & relationship with family, relatives, & friends It lalso looks at : * employment, * Income & assets, * expenses, * financial resources, & * medical insurance

Answer 88

* It is an assessment required by CMS (Centers for Medicare & Medicaid Services) for all residents of Medicare/Medicaid approved N.H. & SNF * **Required within 14 days of admission, major “permanent”** change in condition, quarterly (selected items), & annually * Resident Assessment Protocols * **Assists with care planning**

Answer 89

* Care Planning * Quality Improvement * Reimbursement – Medicare * Coordination * Delegation * Attestation of accuracy for some parts

Answer 90

**Patients with:** * Fx hip * Stroke * Severe arthritis * Paraplegia/Tetraplegia * Children following heart surgery (back of the head)

Answer 91

* Friction * Shear forces * Incontinence, perspiration, urine, feces, drainage * Blood or serum concentrations

Answer 92

* Reduce the incidence of pressure ulcers/improve quality * Identify who is and who is not at risk * Plan care based on risk factors and level of severity of risk factors * Avoid unnecessary expensive care * Improve quality of care and decrease costs

Answer 93

* Pressure ulcers develop in the e**arly days & hours following admission** * Study of support surfaces….5 of 20 developed ulcers in one day * **Risk assessment should be done on admission for both prevention and treatment** * Skin assessment must be done on admission or hospitals can be penalized

Answer 94

**Risk for pressure ulcer development based on score:** * 15-18 Mild Risk * 13-14 Moderate Risk * 10-12 High Risk * 9 or less Very High Risk

Answer 95

* Turning reminders at night for some * Maximal remobilization * Protect heels—for some * Manage moisture, nutrition and friction and shear * High density foam mattress and chair cushions * \* If other major risk factors present, advance to next level of risk

Answer 96

* High density foam replacement mattress * Turning schedule (2, 3, or 4 hour) when in bed with 30 degree rule * Maximal remobilization * Protect heels through elevation * Manage moisture, nutrition and friction and shear * \* If other major risk factors present, advance to next level of risk

Answer 97

* High density foam replacement mattresses * Turn 2, 3 or 4 hour, 30 degree rule with foam wedges or pillows * Supplement with small shifts if necessary * Maximal remobilization * **Protect heels** * Manage moisture, nutrition and friction and shear

Answer 98

* Increase protein intake * Increase calorie intake to spare protein * Supplement with commercial product when meals are missed * Supplement with Multi-Vitamins (esp A, C, E) * Act quickly to alleviate deficits * Consult a dietitian

Answer 99

* Toilet at regular intervals * Use commercial moisture barrier * Use absorbent pads that wick and hold moisture…take off at intervals to let skin breathe * Address causes of incontinence * Provide plenty of water

Answer 100

* **Elevate HOB no more than 30o** * Use trapeze when indicated * Use lift sheet and friction reducing devices to move patients * **Protect elbows and heels if being exposed to friction** * Watch for friction from assistive devices, casts, bedrails, etc.

Answer 101

* Unintentionally coming to rest on a lower area such as the ground or floor * Inadvertently coming to rest on the ground, floor or other lower level, excluding change in position to rest in furniture, wall or other objects

Answer 102

* **Older adults are at greatest risk for falls** * Falls and/or their consequences can be fatal * The cost of falls is high and is expected to increase * Hospitals and Healthcare Professionals are responsible for fall prevention * Rate of falls in the hospital setting is used as a Nursing Quality Indicator

Answer 103

**Times of highest risk:** * Acute Illness * Exacerbation of chronic illness **The risk of falls increases with the number of risk factors** **Risk factors are categorized as:** * Intrinsic * Extrinsic **Most falls occur from a combination of intrinsic and extrinsic risk factors**

Answer 104

**Conditions that are:** * High cost and/or high volume * Result in the assignment of a case to a DRG that has a higher payment when presented as a secondary diagnosis * **_Could have reasonably been prevented through the application of Evidenced Based guidelines -- Such as falls_**

Answer 105

* Reduced vision * Unsteady gait * Cognitive impairment * Foot deformities * Hypotension * Acute and Chronic Illness * Effect of Medications

Answer 106

**Foot Deformities can cause unsteady gait:** * Neglect of corns, bunions and overgrown nails **Other Causes of foot problems:** * Loss of fat cushioning related to aging * DM- ulcers, neuropathy * Poor fitting shoes **As part of the head to toe assessment- inspect feet (top and bottom) and foot wear**

Answer 107

* Lack of support equipment by bathtubs and toilets * Height of beds * Condition of floors * Poor lighting * Inappropriate footwear * Improper use of assistive devices * Inadequate assistive devices

Answer 108

**Instruct older adults/caregivers on proper foot care:** * Wash and thoroughly dry feet daily * Trim toenails regularly * Check top and bottom of feet as well as in between toes daily * Report decreased sensation, tingling, etc to healthcare provider * Wear properly fitting shoes and socks

Answer 109

* It is a sudden drop in blood pressure after eating caused by increased blood flow to the digestive tract with failure of circulatory compensation. * More common in the elderly and those with DM and Parkinson’s disease

Answer 110

1. Hip fractures 2. Traumatic brain injury 3. Fallophobia

Answer 111

* Mortality * Limitations in mobility * Decline in bone mineral density, lean body mass, strength * Decreased quality of life * Persistent pain * Depression * Only ½ of patients with hip fractures recover to their pre-fracture ambulation status within 1 yr.

Answer 112

It is damage to the brain as the result from a violent blow or jolt to the head Factors placing the older adult at risk: * Comorbid conditions * Use of Aspirin, Anticoagulants * Age related brain changes

Answer 113

* Low grade headache * Memory loss * Trouble with daily tasks * Fatigue * Change in sleep pattern * Blurred vision * Mood changes

Answer 114

* Severe headache that gets worse * Repeated vomiting or nausea * Seizures * Dilation of one or both pupils * Weakness * Confusion, restlessness, agitation

Answer 115

* It is the fear of falling * _Falls_ lead _to loss of confidence_ which _reduces physical activity_ which _increases dependency_ and leads to _social withdrawal_.

Answer 116

* Purpose is to identify the underlying cause, implement risk reduction programs and prevent future falls **Postfall Assessment:** * Assess for any obvious injuries and provide appropriate care * Physical Exam including vital signs * Notify MD * Description and circumstances of the fall from the patient or witness * Associated Symptoms that occurred with fall * Medication Review * Environmental Assessment

Answer 117

1. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling. 2. Decide if you're hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse. 3. If you think you can get up safely without help, roll over onto your side. 4. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair. 5. Put your hands on the chair seat and slide one foot forward so that it is flat on the floor. Keep the other leg bent so the knee is on the floor. 6. From this kneeling position, slowly rise and turn your body to sit in the chair.

Answer 118

* Broadens patient’s base of support * Improves balance and stability * Redistributes weight from lower extremities to: alleviate joint pain, compensate for weakness or injury

Answer 119

* Improve independent mobility * Reduce disability * Delay functional decline * Decrease the burden of care

Answer 120

* Advance cane/walker with affected leg, then move the unaffected leg forward * Posture should be upright without leaning forward

Answer 121

* Walking up stairs- place cane on unaffected side and lead with unaffected leg * Moving cane with affected leg step up (keep cane in line with affected leg) * Healthcare provider remains behind patient

Answer 122

* place cane on unaffected side. Place cane on lower step. * Step with affected leg first, then unaffected leg * Healthcare provider remains in front of patient

Answer 123

It is a system of ethical principles and legal mandates which govern the behavior of professional nursing practitioners to further the goal of promotion and protection of the health, safety, and welfare of the public

Answer 124

binding rules of conduct enforced by authority.

Answer 125

Examines values, choices, and actions to determine right and wrong. –Values: strongly held personal and professional beliefs about worth and importance of human beings upon which choices are made and actions taken.

Answer 126

* recognizing conflicts in values and beliefs * mediating, negotiating, clarifying, explaining, intervening (important to determine competency of elder’s understanding) * assuring respect, equality/fairness and right of human dignity toward others without discrimination * serving as a liaison between patient receiving health care and the health care system;

Answer 127

A legal term used to indicate a person has decision-making capacity

Answer 128

**To determine decisional ability of a person:** * have an “ordinary” conversation * observe person’s behavior * talk with family, friends or staff

Answer 129

Discuss interactions between you and individuals whom you have interviewed, assessed their functional capacity and/or their nutritional status (identify age, gender, psycho-social being)

Answer 130

**Employment vs. Retirement:** * (Medicare A and B; Social Security; Pension funds; Medicaid) **Living accommodations:** * Independent /alone or with spouse or child; assisted-living facility; LTC/nursing home; CCRC/senior residential community (rental vs. “life-care”); use of day care facility **Driving:** * continuing licensure vs. cessation **Polypharmacy:** * prescriptive; OTC **Nutrition (adequate vs. inadequate)** * Dehydration **Financial management:** * cash; credit card/s; * bank account/s; investments; property ownership…Vulnerability to fraud/scams **Healthcare resources:** * availability; accessibility **Healthcare insurance:** * no coverage; Medicaid; Medicare; MCO/HMO; PPO; supplemental health insurance; Long Term Care insurance. “Fee for Service” as a choice for whom?

Answer 131

Individuals who clearly lack capacity to decide for themselves, as manifested in “dementia” or in situations of “disorientation” or “delusions” whether transitory or irreversible * should have a surrogate decision-maker * even if person might be seriously incapacitated in decision-making, he/she might retain ability to designate an appropriate surrogate; allow him/her this choice to name the surrogate person

Answer 132

It is defined by state law

Answer 133

* Physical abuse (force with body injury) * Sexual abuse * Emotional/psychological abuse * Financial exploitation * Neglect “passive abuse” or Self-neglect

Answer 134

* Vision and hearing problems * Decubiti; Unexplained bruises, burns, skin tears * Pain: What ways can be used as determinants? * Mobility vs. restraints (physical, drug/s) * Nutritional status; thirst and dehydration * Urinary and/or bowel incontinence * Over-medication or under-medication * Infection (URI, UTI; others?) * Poor personal hygiene; clothing appearance * Residential appearance (interior) * Social withdrawal; loneliness; despair; anger/hostility; fear

Answer 135

* escalating medical costs; scarce public resources * increasing use of high technology for procedures/treatments * rationing of health care: decisions made by society vs. medical professionals * State law and the court system

Answer 136

* Ensures rights of individual/client/patient to “author or execute” written and signed instructions about his/her wishes for medical treatment in the event of becoming “incapacitated” and appropriately witnessed. * Requires health care facilities receiving Medicare funds to provide information about Advance Directives to patients on admission.

Answer 137

written statement that directs health care providers concerning consent or refusal of treatment when the individual patient does not possess decision-making capacity.

Answer 138

document that establishes a written mechanism for an individual to specify wishes about withdrawing or forgoing life-sustaining treatment (treatment that only prolongs or delays the process of dying

Answer 139

* Oral revocation * Destroying the document * Amending document in writing

Answer 140

* that each hospital provides adult patients information to initiate Advance Directives; unless patient * has a valid document that is available to physician or on patient’s chart

Answer 141

* may use a Healthcare Proxy (surrogate) or * decisions can be made through state “guardianship” laws

Answer 142

individuals, agencies or corporations appointed by the court to have care, custody, and control of a legally disabled person (not medically disabled; cite examples).

Answer 143

* Manage his/her personal and/or financial business * Make provisions for one’s physical health and safety, such as health care, food, shelter, personal hygiene (partial dependency) _vs._ “total dependency” person unable to meet basic needs for survival and manage his/her environment * Consider high risk for exploitation

Answer 144

Any patient with a “lethal/deadly” disease or condition.

Answer 145

nnot considered suicide by ethical standards; courts have ruled these practices as legally acceptable.

Answer 146

* do not perform endotracheal intubation in event of cardiac arrest or respiratory failure; * do not resuscitate by chemical/drug, electrical or manual means; * do not contact “code team”; all other medical care will be provided unless ordered otherwise

Answer 147

It is the willingness to modify one’s own culture as a result of contact with another culture. An individual’s adaptation to customs, values, beliefs, and behaviors of a new country.

Answer 148

willingness of a person emigrating to a new culture to gradually adopt and incorporate characteristics of the prevailing culture

Answer 149

conscious process of demonstrating knowledge and understanding of a _client’s_ _culture_ to recognize, accept, respect cultural differences; be able to incorporate these cultural beliefs and practices about wellness and illness into the delivery of care; and adapt interventions to be congruent with the client’s culture

Answer 150

knowledge and fundamental ability to manage illness as well as navigate the health care system

Answer 151

A systematic appraisal or examination of individuals, groups, and communities about their cultural beliefs, values, and practices to determine explicit needs and intervention practices.

Answer 152

How members of a group perceive themselves and how they are perceived by others; associations due to customs, and cultural patterns, rather than biological origins; a shared kinship.

Answer 153

generally defined as a biological factor of discrete group whose members share distinctive genetic, biological, and other factors from a common or claimed or ancestor.

Answer 154

“situations and feelings of passive betweeness when people exist between two different cultures and do not yet perceive themselves as centrally belonging to either one.”

Answer 155

universal tendency of persons to think that their ways of thinking, believing and behaving are the only right, proper and natural ways.

Answer 156

* It embodies beliefs, values and treatment approaches of a particular cultural group that are products of cultural development. * It ses a holistic approach of family and support systems. When folk healing is not effective, person may turn to Western health care (scientific).

Answer 157

1. Examine personal culture 2. Get familiar with client culture 3. Identify adaptations made by client 4. Modify the client teaching based on data from earlier steps

Answer 158

* **Observe** interactions between client and family members and among family members. * Who makes the decisions? How are decisions made? * **Consider** communication abilities & primary language: verbal, non-verbal; etiquette of interaction-acceptable, nonacceptable. * ** Explore** customs or taboos to clarify beliefs and practices that may restrict care or treatment. * **Determine** importance of time and time periods to client and family. * **Be aware** of cues for interaction: respect is key behavior. Know correct way to address the persons.

Answer 159

* If client speaks foreign language, whenever possible the client’s primary language should be used. * Use of family or friends for translation of communication is _not_ recommended; use professionally trained interpreters. Family or friends: * May choose to omit portions of content they believe to be unnecessary or unacceptable * Presence with client may inhibit communication & violate confidentiality.

Answer 160

1. **American Indians/Native Americans/Eskimos:** unique to the U.S. 2. **Asian/Pacific Islanders**: composed mainly of people from Korea, Viet Nam, Laos, Thailand, Cambodia, Taiwan, Japan, China, Philippines, India, Pakistan 3. **Blacks:** origins are mainly from Africa and Caribbean Islands. 4. **Hispanics:** Mexicans, Puerto Ricans, Central and South Americans, Cubans.

Answer 161

* The centrality of the family and extended family is single most important source of social support * **Heavy reliance on family has been linked to Hispanics’ low use of health care services** * May view physical illness as an act of God; something to be endured; mental illness as an enemy’s hex or witchcraft from envy or vengeance; remains a stigma and not discussed with strangers; genetic defects attributed to God’s will; mother’s failure to care for herself or a hex

Answer 162

**Verbal:** * Consider loudness as rude; requests should be in non-confrontational tone of voice * Converse in warm, respectful manner * Communicate serious/terminal illness with patient and family together **Nonverbal:** * Direct eye contact may interpret as intimidation or “evil eye” from authority and opposite gender * Personal space: prefer to keep appropriate social distance * Silence may indicate disapproval, disappointment or anger; politeness or not understanding * Gestures: handshake appropriate between strangers * Touch: enjoy touching family members, friends but not by strangers * Time: usually focused on here and now; leave the future in God’s hands * Modesty greatly valued * Privacy: usually share info about illness with selected family/extended members. Do not share problems/conflicts outside the family * Self-care: expect hospital staff to give help or will wait for family member to help * Self-care management: may self-treat, especially if uninsured or questionable legal status * Special clothing includes crucifixes, religious medals, amulets. Clinicians should handle with respect

Answer 163

* Their strong religious values and beliefs (inner strength from their trust in God) may extend to feelings about health promotion and illness. “What happens is God’s will”. * May have folk practice beliefs about spirits in the world: animate or inanimate objects which have good or evil spirits (religious priests, witch doctor or medicine man have power to release hostile spirits). May use faith and “root healers” (herbalists) with biomedical resources

Answer 164

**Buddhism:** “all existence is suffering”; pattern of authority is inferior to superior; man in harmony with universe; ancestor worship. **Hinduism:** Dharma, traditional law of morality and ethics that establishes norms and expectations; roles/ceremonies based on caste system, focus on birth, marriage, death. **Muslim:** Islam religion guides and governs all aspects of life; reading of the Quran; prayer highest form of worship; communicate with Allah. Do not expect Muslim leader (imam) to visit patient; summoned after death.

Answer 165

* Male authority and dominance * Strong family ties * Respect for parents, elders, teachers and other authority figures * Personal behaviors are a result of a sense of pride

Answer 166

* Older generation tend to have more difficulty adapting to acculturation; children usually adapt more quickly * Medical practices differ significantly from Western scientific medicine * Tend to seek health care only when seriously ill; “crisis oriented” (especially immigrants)

Answer 167

* Spiritual attachment to land and harmony with nature * Intimacy of religion and medicine; varies by individuals and with practices/rituals * **Strong ties to extended family network, including entire tribe** * Elders view children as assets, not liabilities; children given much freedom to learn from their decisions and live with the consequences of their actions * nBelief that supernatural powers exist in animate and inanimate objects nDesire to remain Native American and avoid acculturation, especially elders nLack materialism and desire to share with others

Answer 168

**Women expected to act in submissive role:** * Preservation of female chastity * Fidelity prohibits adult males to be alone with female, except with spouse * Females omit handshakes; touching in marriage only

Exam 1 - Study Material Flashcards

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