Midterm Flashcards

Question

wear and tear theory

Answer 1

Body can be likened to a machine that is expected to function well during the period of its warranty, but that will wear out at a fairly predictable time.

Answer 2

Biochemical processes create linkages, or connections, between structures that normally are separated. This causes a buildup of collagen-like substances that leads to failure of tissues and organs.

Answer 3

They are waste products of metabolism and they can damage cells. Healthy bodies have protective mechanisms that can remove and repair damaged cells; however, these mechanisms become less effective with increased age and cellular damage becomes cumulative.

Answer 4

emphasizes the role of genes in the development of age-related changes

Answer 5

Immunosenescence, which is an age-related decline of the immune system, increases the susceptibility of older people to diseases, such as cancer and infections. The immune system may even attack healthy cells, leading to autoimmune conditions, such as rheumatoid arthritis.

Answer 6

Primary role: Identify and address modifiable factors that lead to diseases, disability, death, as well as health-promoting factors.

Answer 7

- disengagement theory - activity theory - subculture theory - age stratification theory - person environment fit theory

Answer 8

a society and older people engage in a mutually beneficial process of reciprocal withdrawal to maintain social equilibrium

Answer 9

older people remain socially and psychologically fit if they remain actively engaged in life

Answer 10

states that old people, as a group, have their own norms, expectations, beliefs and habits; therefore, they have their own subculture

Answer 11

People pass through society in cohorts that are aging socially, biologically and psychologically. New cohorts are continually being born, and each experiences a unique sense of history

Answer 12

considers the interrelationships between personal competence and the environment. (ego strength, motor skills, biologic health, cognitive capacity and sensory–perceptual capacity) -focuses on interaction between characteristics of the individual and the environment

Answer 13

Nurses can use psychological theories to address response to losses, continued emotional development, devote time and energy to life review and self-understanding.

Answer 14

physiologic needs safety and security needs love and belongingness Self-esteem Self-actualization

Answer 15

address old age within the context of the life cycle -how early life events affect future decisions and outcomes

Answer 16

identify personality types as predictive forces of successful or unsuccessful aging

Answer 17

- Selection, optimization and compensation - Socioemotional selectivity theory - Strength and vulnerability integration theory - gender related theories

Answer 18

According to this theory, older adults select certain goals and tasks while disengaging from other goals; they optimize necessary resources to achieve these goals; and they compensate by establishing new resources to substitute for lowered or lost abilities and skill

Answer 19

Proposed to explain emotional well-being during older adulthood. Older adults recognize that their time is limited, so they focus on emotional goals rather than on knowledge-seeking goals

Answer 20

Experience age-related gains as well as losses in emotion-related processes, and overall older adults maintain a positive level of emotional experience

Answer 21

- Compare and contrast male and female performance data. - Examine the nature of change in gender roles. - Study the relationship between gender role differences and social roles and social power.

Answer 22

Faith community nurses spend 50% to 100% of their time providing services to older adults, such as health education, referrals, health screenings, personal counselling, spiritual support and health advocacy

Answer 23

primary care coordinator who is responsible for implementing immediate and long-term plans as the needs of the older adult change

Answer 24

-Formal sources (agencies) - Informal sources (independent caregivers, word-of-mouth network) - Geriatric care management services

Answer 25

- pinna and the external auditory canal - Cerumen is naturally expelled, but age-related changes—such as an increased concentration of keratin, the growth of longer and thicker hair (especially in men), and thinning and drying of the skin lining the canal—can cause it to build up. - decreased sweat gland activity with age (makes cerumen drier)

Answer 26

- tympanic membrane - transmits sound energy - With increased age, collagenous tissue replaces the elastic tissue, resulting in a thinner and stiffer eardrum. - the middle ear muscles and ligaments become weaker and stiffer.

Answer 27

- Age-related changes of the inner ear include loss of hair cells, reduction of blood supply, degeneration of spiral ganglion cells and loss of neurons in the cochlear nuclei. - These degenerative changes of the cochlea and other inner ear structures are the primary cause of the age-related hearing impairment.

Answer 28

- Degenerative changes in the inner ear - Narrowing of the auditory meatus - Diminished blood supply and central nervous system changes.

Answer 29

- Increased concentration of keratin - Growth of longer and thicker hair (especially in men), and - Thinning and drying of the skin lining the canal

Answer 30

Impacted cerumen/impacted wax

Answer 31

Genetic predisposition Increased age White race Recreational or occupational exposure to noise Smoking of nicotine products Secondhand smoke Ototoxic medications Certain medical conditions (otosclerosis, diabetes, acoustic neuromas) Ototoxic environmental chemicals

Answer 32

- A hereditary disease that affects the bones in the middle ear. - This impacts the normal movement of ossicles and this disrupts the transmission of sound waves to the inner ear. - Otosclerosis primarily causes a conductive hearing loss, but some sensorineural loss may also occur. - it is difficult to hear soft and low-pitched sounds; as the hearing loss worsens, the person is likely to experience dizziness, tinnitus or balance problems.

Answer 33

build up of fluid in inner ear

Answer 34

tumor along vestibulocochlear nerve

Answer 35

abnormalities of external and middle ear interfering with sound conduction

Answer 36

abnormalities of sensory and neural structures of inner ear, usually age related or noise induced

Answer 37

in early adulthood, and by the age of 30 years for men and 50 years for women, there is some decline in hearing sensitivity at all frequencies

Answer 38

- Characterized by a reduced intensity of sounds and difficulty hearing vowels and low-pitched tones. - Occurs in one or both ears - Often there is a history of otosclerosis, perforated eardrum or other ear disease

Answer 39

- Presbycusis is the sensorineural hearing loss associated with an age-related degeneration of the auditory structures. - Usually occurs in both ears - loss of ability to hear high-pitched sounds and sibilant consonants. - words become distorted - As the hearing loss progresses, explosive consonants, such as b, d, k, p and t, also become distorted. - Background noise and environmental conditions, compound the effects of sensorineural hearing loss and can interfere with the ability to recognize words

Answer 40

- persistent sensation of ringing, roaring, blowing and buzzing - Symptom of underlying condition - Associated with hearing loss, ototoxic medications and Ménière disease - Exacerbated with caffeine, alcohol or nicotine

Answer 41

- Small amount of cerumen - Pinkish-white epithelial lining, no redness or lesions - Pearl-grey tympanic membrane, which is less translucent than in younger adults

Answer 42

every 3-12 months

Answer 43

services that improve communication for people who are hearing impaired. Auditory rehabilitation programs provide: counselling, education, amplification aids, communication methods and management of the environment.

Answer 44

- loss of accommodation - accommodation - It is the ability to focus clearly and quickly on objects at various distances. - This vision change is caused by degenerative changes in the lens and the ciliary body. - ex: the need to hold reading materials farther from the eye to focus clearly on the print.

Answer 45

- normal value is 20/20 - Visual acuity is best around age 30, after which it gradually declines. - changes in visual acuity can particularly affect night-driving competence.

Answer 46

- The ability to respond to both dim and bright light begins to decline around the age of 20 years and diminishes more markedly after age 60 - older adult requires more time to adapt to dim lighting when moving from a brighter to a darker environment - older person responds more slowly to lights, such as car or bus headlights, and requires more time to recover from exposure to glare and bright lights

Answer 47

- Glare is experienced when light is reflected from shiny surfaces, when the light is excessively bright or inappropriately focused, or when bright light originates from several sources at once - Beginning in the fifth decade, age-related changes increase a person’s sensitivity to glare and the time required to recover from glare. - these changes can significantly affect the person’s ability to read signs, see objects, drive at night and manoeuvre safely in bright environments.

Answer 48

- Functionally, the visual field is important when people engage in tasks that require a broad perception of the environment and moving objects. - Walking in crowded places and driving a vehicle are examples of activities that depend on the field of vision.

Answer 49

- Depth perception is the visual skill responsible for locating objects in three-dimensional space, judging differences in the depth of objects and observing relationships among objects in space. - Older adults experience diminished depth perception, making it more difficult to use objects effectively and manoeuvre safely in the environment.

Answer 50

- Opacification and yellowing of the lens causes an altered perception of blues, greens and violets. - darkening of blue objects and a yellowed perception of white light.

Answer 51

- Critical flicker fusion is the point at which an intermittent light source is perceived as a continuous, rather than flashing, light. - diminished critical flicker fusion causes a flashing light to appear to be continuous and it can interfere with the discernment of emergency vehicles and road construction lights, especially at night.

Answer 52

- Age-related changes of the retinal–neural pathway affect the accuracy and efficiency of visual information processing. - Thus, older adults generally need more time to process visual information, but the effects are minimal or negligible when tasks are familiar.

Answer 53

- Lifestyle factors: poor nutrition, cigarette smoking - Environmental factors: poor lighting, exposure to sunlight, wind, low humidity, warmer environmental temperatures, secondhand smoke - Chronic conditions: diabetes, hypertension, Alzheimer or Parkinson disease - Adverse medication effects: estrogen, corticosteroids, anticholinergics, β-blockers, antiparkinson agents

Answer 54

- Leading & reversible cause of visual impairment - Primary cause of avoidable blindness - the normally transparent lens becomes cloudy, transmission of light to the retina is diminished and vision is impaired - difficulty performing activities such as reading and night driving

Answer 55

- Advanced age, exposure to sunlight, smoking, diabetes, malnutrition, trauma or radiation to the eye or head, adverse effect of medications (e.g., corticosteroids) - Cigarette smoking and exposure to sunlight -most modifiable and preventable risk factor

Answer 56

Dim or blurred vision Increased sensitivity to glare, Decreased contrast sensitivity Double vision Seeing halos around bright lights* Diminished color perception

Answer 57

- Initially managed with changes in correctives lenses - Surgical removal of lens followed by implantation of an intraocular lens - Nurses Responsibility

Answer 58

Leading cause of severe vision loss in older adults

Answer 59

- Initial form: loss of central vision, faces or straight lines appear wavy, blurred vision - advanced stage: it affects central vision and significantly interferes with activities such as reading, driving, watching television, recognizing people and

Answer 60

goal is to reduce the risk of further vision loss Smoking cessation, nutrition interventions, visual rehab

Answer 61

- leading cause of blindness - aqueous humour accumulates and pushes the optic nerve into a cupped or concave shape. The resulting damage to the optic nerve causes a loss of peripheral vision. If left untreated, the damage can progress to blindness.

Answer 62

Advanced age; African, Latino and Asian descent; family history of glaucoma; diabetes; regular or long-term use of corticosteroids

Answer 63

- Signs & symptoms: slow onset, diminished vision in dim light, increased sensitivity to glare, decreased contrast sensitivity, diminished peripheral vision - Treatment: medical therapy with prescription eye drops

Answer 64

- Caused by a sudden complete blockage of the flow of aqueous humour. - Abrupt onset in one or both eyes - Medical emergency. - Signs & symptoms: sudden onset, intense pain, blurred vision, halos around lights, nausea and vomiting - Treatment: immediate treatment with medications, followed by surgery

Answer 65

- With increased age, the tooth enamel becomes harder and more brittle. - Teeth are less sensitive to stimuli and more susceptible to fractures. - Gradual flattening of the chewing cusps. teeth may loosen or fall out. - xerostomia (dry mouth) - Slower emptying of the stomach

Answer 66

- Presbyphagia—slowed swallowing - reduced secretion of mucus, decreased elasticity of the rectal wall and diminished perception of rectal wall distention. - diminished bile acid synthesis

Answer 67

minimum daily intake of 1-1.6 g/kg of body weight

Answer 68

25-38 g/day

Answer 69

no more than 20-30% of daily caloric intake

Answer 70

- Degenerative changes (glomerular filtration rate (GFR) - Replacement of the smooth muscle tissue in the bladder and urethra with less elastic connective tissue - Decreased blood flow - Decreased number of functioning nephrons - By age 50 GFR decreases by 50%

Answer 71

antihistamines, atypical antipsychotics and antihypertensive agents, particularly diuretics, calcium-channel blockers and angiotensin II receptor blockers

Answer 72

- Stairways between the bathroom level and the living or sleeping areas - A distance to the bathroom that is more than 40 feet - Living arrangements where several or many people share a bathroom - Small bathrooms and narrow doors and hallways that do not accommodate walkers or wheelchairs - Chair designs and bed heights that hinder mobility - Poor colour contrast, as between a white toilet and seat and light-coloured floor or walls - Public settings with poorly visible or poorly colour-contrasted signs designating gender-specific bathroom facilities - Public settings with dim lighting and out-of-the-way bathroom facilities - Very bright environments, where glare interferes with the perception of signs for bathrooms - Mirrored walls, which reflect bright lights and create glare

Answer 73

- Stroke, arthritis, dementia, delirium, depression, diabetes mellitus, metabolic syndrome, Parkinson disease, fecal impaction and chronic obstructive pulmonary disease (COPD) - pelvic floor disorders - BPH - Any acute illness or surgical intervention that temporarily limits mobility or compromises mental abilities also represents a risk factor for urinary incontinence. - Constipation and low stool frequency (i.e., fewer than three bowel movements weekly) - Obesity and smoking

Answer 74

- Impaired absorption of calcium, predisposition to hyponatremia and hyperkalemia, diminished ability to maintain fluid and electrolyte balance, and correct pH imbalances - Diminished renal function contributes to increased incidence of drug interactions and adverse medication reactions

Answer 75

- Bladder capacity is smaller, & empties incompletely - May retain residual urine post voiding predisposing older adults to UTIs - Nocturia

Answer 76

sudden leakage of urine as a result of an activity that increases abdominal pressure, such as lifting, coughing, sneezing, laughing or exercise

Answer 77

involuntary urinary leakage soon after perceiving the urge to void

Answer 78

involuntary leakage of urine with both the sensation of urgency and activities such as coughing, sneezing or exertion

Answer 79

involuntary loss of urine due to overdistention of the bladder

Answer 80

involuntary loss of control over urination due to inability to reach appropriate toileting facility

Answer 81

- Common in older adults - Common in long-term care settings - Risk factors: increased age, urinary incontinence and impaired functional or cognitive status - Catheter-associated urinary tract infections (CAUTIs), which is the single-most common cause of preventable health care–associated infections.

Answer 82

- Avoid foods and beverages that can irritate the bladder (e.g., caffeine, alcohol, artificial sweeteners and spicy and acidic foods). smoking. - Maintain ideal body weight and good physical fitness. - Take steps to prevent constipation (refer to Chapter 18, Box 18-6). - Practice pelvic muscle exercises

Answer 83

Teach about overall urinary wellness. Interventions for urinary incontinence Teach pelvic floor muscle exercise (PFME). Initiate continence training programs. Suggest environmental modifications. Use appropriate continence aids. Be knowledgeable about medications for urinary incontinence. Interventions such as asking patient to void before bedtime

Answer 84

It’s useful in the following conditions: Urge incontinence stress incontinence pelvic organ prolapse

Answer 85

- myocardial atrophy or hypertrophy, valvular thickening and stiffening, and increased amounts of connective tissue. - Changes in the tunica intima, the innermost vascular layer, contribute to the development of atherosclerosis - Changes in the tunica media, the middle layer, are associated with hypertension. - The outermost layer (the tunica externa) does not seem to be affected by age-related changes.

Answer 86

Cardiovascular disease/heart disease Atherosclerosis Physical inactivity/physical deconditioning Tobacco smoking and secondhand smoke Dietary habits Obesity/abdominal obesity Hypertension Lipid disorders/dyslipidemias Metabolic syndrome/insulin-resistance syndrome Psychosocial factors (stress, anxiety, depression, social isolation, poor social supports) Heredity and socioeconomic factors Women & minority groups: African American women have higher risk for developing cardiovascular dysfunction

Answer 87

healthy older adults do not experience any decline in cardiac output.

Answer 88

- pulse rate for healthy older adults is slightly lower than that for younger adults -harmless ventricular and supraventricular arrhythmias - Atrial fibrillation commonly occurs in older adults, but this is associated with pathologic conditions (e.g., hypertension, coronary artery disease) rather than with age-related changes. - age-related increase in systolic blood pressure from ages 30 to 40 years.

Answer 89

- The maximum heart rate achieved during exercise is markedly decreased, and oxygen consumption decline in older adults. - Most of this decline is attributable to physical deconditioning and other risk factors, rather than to age-related changes alone.

Answer 90

- reduce cerebral blood flow to some extent in healthy older adults - Increased dilation of the veins, along with decreased efficiency of the valves, lead to impaired venous return from the lower extremities.

Answer 91

Reduction in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg when assuming a standing position after being recumbent for at least 5 minutes

Answer 92

Reduction of systolic blood pressure—drop of 20 mmHg in a supine/sitting position within 120 minutes after eating a meal

Answer 93

the phenomenon of elevated systolic blood pressure readings that result from the inability of the external cuff to compress the arteries in older people with arteriosclerosis

Answer 94

Hypertension Lipid disorders Smoking cessation Obesity, physical inactivity, dietary habits

Answer 95

These interventions address specific risk factors, such as smoking, hypertension, obesity and lipid disorders as well as preventive measures, such as optimal levels of physical activity, heart-healthy dietary patterns and stress-reduction actions.

Answer 96

- Diminished blood flow to the nose - Thicker mucus - Stiffening of trachea - Blunted cough and laryngeal reflexes - Atrophy of laryngeal nerve endings

Answer 97

- Ribs and vertebrae become osteoporotic - Costal cartilage calcifies - Respiratory muscles weaken - Structural changes - Kyphosis: curvature of spine - Shortened thorax - Increased anteroposterior diameter of the chest - Chest wall stiffens

Answer 98

- Lungs become smaller and flaccid. - Pulmonary artery becomes wider, thicker and less elastic. - Diminished capillaries - Decrease in capillary blood volume - Mucosal bed thickens gas exchange is compromised in the lower lung regions

Answer 99

Age-related alteration of T cells contribute to increased prevalence of lung diseases.

Answer 100

Firefighters Miners Traffic controllers Shipyard workers Rubber workers Aluminum workers Iron and steel foundry workers Tunnel and street repair orkers Asbestos workers Quarry workers Farmers, agricultural workers, grain handlers Construction workers Paper mill workers Workers exposed to the following: dust, fumes, gases, nickel, arsenic, beryllium, chromium or radiation

Answer 101

- Obesity or chronic illness bedrest - Kyphosis - associated with poor posture and shallow breathing patterns - Lack of vaccinations - Medications - sedatives and anti-cholinergic medications

Answer 102

increases the risk of pneumonia

Answer 103

Overcrowded areas Smoking Diabetes Malnutrition Debilitating conditions

Answer 104

- Chronic obstructive pulmonary disease (COPD): chronic airflow obstruction interfering with breathing - Risk factors: exposure to secondary smoke and other air pollutants, increased age, genetic predisposition, low socioeconomic status and history of significant childhood respiratory disease. - Common manifestations: cough, dyspnea, wheezing and sputum production - Health promotion: participation in self-management programs

Answer 105

-rate of epidermal turnover gradually decreases. - Beginning around the age of 25 years, the number of active melanocytes decreases -Moisture content of the outer epidermal layer decreases. -flattening of the dermal-epidermal junction and diminishing the surface area between the epidermis and dermis slows the transfer of nutrients and oxygen between the dermis and epidermis.

Answer 106

- dermal thickness gradually diminishes - The dermal vascular bed decreases and this contributes to the atrophy and fibrosis of hair bulbs, sweat and sebaceous glands.

Answer 107

-With increased age, atrophy of subcutaneous tissue , particularly in the plantar foot surface and in sun-exposed areas of the hands, face and lower legs takes place. - This increased body fat is more pronounced in women than in men and is most noticeable in the waists of men and the thighs of women. - Age-related changes also affect the cutaneous nerves responsible for sensations of pressure, vibration and light touch.

Answer 108

-Both eccrine and apocrine glands decrease in number and functional ability with increased age. -sebaceous glands increase in size but produce less sebum.

Answer 109

- Nail growth begins to slow in early adulthood - Nails of older adults gradually become thinner, fragile, brittle and more prone to splitting. - In appearance, the older nail is dull, opaque, longitudinally striated, and yellow or grey.

Answer 110

-About half of adults at the age of 50 years have greying hair -By the age of 50 years, about 60% of men have a noticeable degree of baldness -Progressive loss of body hair, initially in the trunk, then in the pubic area and axillae.

Answer 111

- genetics (People with fair skin, light hair and light eyes are more sensitive to the effects of ultraviolet radiation) -Smoking, sun exposure, emotional stress, and substance or alcohol abuse are the health behaviours and environmental factors that significantly affect skin wellness. -Exposure to ultraviolet radiation is the most significant environmental factor. - medication

Answer 112

- More wrinkles - Greyish discolouration - Diminished ability to protect against ultraviolet radiation damage - Increased risk of skin cancer

Answer 113

- Common adverse medication effects involving the skin include pruritus, dermatoses and photosensitivity reactions. - Medications that commonly cause dermatitis include antibiotics, nonsteroidal anti-inflammatory drugs, anti-convulsants, and antihypertensive agent - Photosensitivity is an adverse medication effect that causes an intensified response to ultraviolet radiation. - Amiodarone, furosemide, naproxen, phenothiazines, sulfonamides, tetracyclines, and thiazides are examples of medications that can cause photosensitivity reactions. -St. John’s wort and other herbal preparations may also increase the risk of photosensitivity.

Answer 114

-abnormal growth of skin cells - Age-related changes and long-term sun exposure - Main 2 types of cancer: Basal cell carcinoma & Squamous cell carcinoma - Melanoma: originates in the melanocytes, is the most serious type of skin cancer and the one most likely to be fatal

Answer 115

1. No skin loss, with an average of 10 days to heal 2. Partial thickness (i.e., epidermis separated from the dermis), with an average of 14 days to heal 3. Full thickness (i.e., both epidermis and dermis separated from underlying tissue), with an average of 21 days to heal

Answer 116

- Include adequate amounts of fluid in the daily diet. - Use humidifiers to maintain environmental humidity levels of 40% to 60%. - Apply moisturizing lotions twice daily or as needed. - Use moisturizing lotions immediately after bathing, when the skin is still moist. - Avoid massaging over bony prominences when applying lotions. - Avoid skin care products that contain perfumes or isopropyl alcohol. - Avoid multiple-ingredient preparations because unnecessary additives may cause allergic responses. - Inspect skin monthly for suspicious-looking changes.

Answer 117

When bathing or showering, use soap sparingly or use a mild, unscented soap (e.g., Dove, Tone, Basis, Aveeno). Maintain water temperatures for bathing at about 32°C to 37°C. Rinse well after using soap. Whirlpool baths stimulate circulation, but moderate temperatures should be maintained. Apply emollient moisturizing products after bathing, rather than using them in the bath water, to minimize the risk for falls on oily surfaces and to maximize the benefits of the emollient. Use emollient products containing petrolatum or mineral oil (e.g., Keri, Eucerin, Aquaphor, Vaseline). If you use bath oils, take extra safety precautions to prevent slipping. If moisturizing products are applied to the feet, wear nonskid slippers or socks before walking. Dry your skin thoroughly, particularly between your toes and in other areas where your skin rubs together. When drying your skin, use gentle, patting motions rather than harsh, rubbing motions. Include adequate amounts of fluids and vitamins in the daily diet Obtain regular podiatric care.

Answer 118

Wear wide-brimmed hats, sun visors, sunglasses and light-coloured clothing when exposed to the sun. Wear clothing made of cotton, rather than polyester fabrics, because ultraviolet rays can penetrate polyester. Apply sunscreen products liberally beginning 1 hour before sun exposure and reapplying at frequent intervals. Use sunscreen lotions with an SPF of 30. Avoid exposure to the sun between 10:00 AM and 4:00 PM. Protect yourself from ultraviolet rays even on cloudy days and when you are in the water (lake, pool, ocean). Artificial tanning booths use ultraviolet type A rays, which have been found to cause damage and increase the risk for skin cancers.

Answer 119

avoiding too much exposure to sunlight and using a sunscreen and other protective measures when exposure to sunlight is unavoidable.

Answer 120

Sleep Quantity: Sleep efficiency decreases in older people Sleep Quality: Longer time to fall asleep, more frequent arousals.

Answer 121

- Anxiety, boredom and social isolation - Noise, lack of privacy, temperature of room, light and hot or humid conditions - Chronic conditions, nocturia, obstructive sleep apnea - Restless leg syndrome: - Periodic limb movements during sleep (PLMS), - Adverse effects of medications, caffeine and alcohol

Answer 122

- Longer time needed to fall asleep - Frequent arousals during night - More time in bed to achieve same quantity of sleep - Diminished quality of sleep (less dreaming and deep sleep)

Answer 123

-Insomnia -Excessive daytime sleepiness -Obstructive sleep apnea

Answer 124

- Establish a bedtime ritual that is effective for you, and try to follow it every night. - Maintain the same daily schedule for waking, resting and sleeping. - Take a warm, relaxing bath in the afternoon or early evening. - After 1:00 PM, avoid foods, beverages and medications that contain caffeine or stimulants (e.g., tea, cocoa, coffee, chocolate, sugar, refined carbohydrates, and some over-the-counter pain relievers and cold preparations). - Pre-bedtime foods that promote sleep include milk (warm), chamomile tea and a light snack of complex carbohydrates (e.g., whole grains). - Use one or more of the following relaxation methods: imagery, meditation, deep breathing, progressive relaxation, soothing music, body or foot massage, rocking in a chair, reading non stimulating materials or watching non stimulating television. - Perform daily moderate aerobic exercise, preferably before the late afternoon, but avoid vigorous exercise in the evening. - Ensure adequate intake of the following nutrients: zinc, calcium, magnesium, manganese, vitamin C and vitamin B complex.

Answer 125

-Do not drink alcohol before bedtime because it may cause early-morning awakening. If you use alcohol, use only in small amounts. -Do not smoke cigarettes in the evening because nicotine is a stimulant. -If your bedtime is temporarily changed, try to keep your waking time as close to the usual time as possible, and avoid staying in bed beyond your usual waking time. -Do not use your bed for reading or other activities not associated with sleeping. -If you awaken during the night and cannot return to sleep, get out of bed after 30 minutes and engage in a nonstimulating activity, such as reading, in another room. -Arise at your usual time, even if you have not slept well.

Answer 126

refers to the several years before menopause when women begin experiencing manifestations of approaching menopause (e.g., changes in menstrual cycles, vasomotor symptoms, vaginal dryness).

Answer 127

begins 12 months after a woman’s last menstrual cycle.

Answer 128

-Diminished estrogen levels breasts become more pendulous and have more fat and less mammary tissue. -Vaginal dryness diminished quantity of pubic hair and atrophy of sexual organs. -About 75% to 80% of all menopausal women experience hot flashes -increased risk for osteoporosis, cardiovascular disease, Alzheimer disease and metabolic dysfunction, depression

Answer 129

-Production of viable sperm gradually diminishes -Andropause (or male menopause) is the age-related decline in testosterone in men that begins around the age of 30 years -low serum testosterone levels are associated with increased risk for pathologic conditions, such as anemia, diabetes and osteoporosis

Answer 130

-Pain, cancer, diabetes, cardiovascular disease, obstructive sleep apnea -Prevalence of erectile dysfunction in men with diabetes is 50% or more -Women with diabetes or metabolic syndrome also have a high prevalence of sexual dysfunction, such as problems with orgasm or lubrication -Depression is strongly associated with sexual dysfunction

Answer 131

Prostatic hyperplasia Urethritis & Vaginitis

Answer 132

-Reproductive ability: ceases in women and diminishes in men Response to sexual stimulation: slower and less intense -Regularly engaging in sexual activity helps older adults respond to sexual stimulation. -Any major changes in response to sexual stimulation are associated with risk factors rather than aging -Sexual interest and activity: older adults do not lose their interest in or capacity for sexual activity because of age-related changes, -Sexual dysfunction in men and women: Erectile dysfunction, defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual function in men.

Answer 133

-Older adults are likely to be diagnosed at a later stage -Older adults have a shorter interval before progression to AIDS, particularly if HIV was diagnosed after the age of 60 years. -increased risk for dying due to AIDS -Older adults with HIV/AIDS have high rates of depression. more likely to have less social support due to ageism, living alone, perceived stigma and nondisclosure of HIV status. -Caregivers of people with HIV/AIDS experience significant levels of stress,

Answer 134

a normal process that involves the development and use of complementary and alternative neural circuits to achieve a cognitive goal.

Answer 135

heterogeneous syndrome characterized by cognitive functionthat is impaired beyond “normal aging” but does not meet thecriteria for mild dementia.

Answer 136

the phenomenon of older adults suffering significant losses of health, cognition and social functioning but reporting high levels of well-being and positive emotions

Answer 137

-degenerative brain changes -decreased reaction time -slower processing of information -Decreased cerebral blood flow and volume -Reduced brain weight, enlarged ventricles and wider sulci, loss and shrinkage of neurons, reduced neurotransmitters or their binding sites -Current research emphasizes that brain maturation and associated cognitive abilities continue to develop throughout adulthood and can be improved even in older adults

Answer 138

-myths about aging and cognition -decreased vision and hearing -adverse effects of alcohol and medication (anticholinergics) -diseases (dementia, depression) -Nutritional deficiencies (low levels of β-carotene, and vitamins B, C and D) -mental health (stress) -Occupational, environmental exposure (secondhand smoke) -Diminished brain volume and loss of white matter (caused by pathological processes like diabetes/hypertension)

Answer 139

-Capacity to solve new problems, adapt to new situations, and think abstractly and logically. -It involves reasoning, pattern recognition, and the ability to manipulate informatio -Characterized by the ability to handle unfamiliar tasks and find solutions to problems -Peak in early adulthood and then gradually decline with age -Fluid intelligence involves tackling new, abstract, and unfamiliar tasks

Answer 140

-Knowledge and skills that a person has acquired over their lifetime through learning and experience -Focuses on vocabulary, information, and verbal comprehension -person's ability to use their accumulated knowledge and expertise to solve problems and make decisions -It is the result of years of learning, education, and experience -Crystallized intelligence continues to develop during adulthood because of accumulated experiences and learning -does not decline with age, and it may even increase

Answer 141

short duration, small capacity

Answer 142

longer duration, important for retrieval and storage

Answer 143

-Both types of memory decline equally but older adults have a larger store of information about events of long ago -memory skills in older adults are better when the information is highly interesting, emotionally positive or personally relevant.

Answer 144

refers to self-knowledge and perceptions about memory, cognitive function and development of memory. Metamemory is important in everyday activities because if people know what they can remember and how much effort they will need to remember certain things, they can plan efficient and effective strategies for remembering.

Answer 145

-Age-related declines in some cognitive skills begin around the age of 40 -Age-related cognitive changes generally occur at a slow linear rate; any major or rapid changes are due to pathologic processes. -Many studies suggest that cognitive function is increasing in successive cohorts of older adults -Pathologic processes, such as those related to inflammatory processes and cardiovascular diseases, are associated with greater degrees of cognitive impairment.

Answer 146

-Skills that stay the same: improve wisdom, creativity, common sense, coordination of facts and ideas, and breadth of knowledge and experience -Skills that decline slightly and gradually: Calculation, word fluency, verbal comprehension, inductive reasoning -Word finding may be more difficult but total vocabulary increases. -Remote memory remains intact and holds a large store of information about the past.

Answer 147

anxiety, depression, diminished sensory input, poor health, negative beliefs, ageist attitudes, pathologic processes (e.g., dementia)

Answer 148

good nutrition, physical exercise, mental stimulation, challenging leisure activities, strong social networks, and activities that provide a sense of control and mastery

Answer 149

Eat foods high in antioxidants omega-3 fatty acids limit salt, cholesterol and saturated fat. Maintain a healthy weight. Engage in regular physical activity, Engage in new learning experiences that are appealing and challenging. Practice body–mind activities Participate in leisure activities, such as dancing, playing board games Choose activities in which there is a sense of control and mastery, such as playing computer games or learning a new skill. Maintain strong and frequent social relationships Encouraging participation in mentally stimulating activities

Answer 150

-Techniques, such as relaxation, imagery and meditation. -Mindfulness (also called mindfulness meditation), -Self-help books describe techniques for meditation, mindfulness and relaxation as ways of maintaining or improving cognitive function and opening the mind to new learning.

Answer 151

- rapid onset -Course (duration) short - diurnal fluctuations – worse at night, in dark - Duration - hours to < 1 month -Possible Causes: Infections, serious illness, fever, lack of vitamins, seizures, lack of oxygen, head injury, medications, alcohol, advanced age, dementia, depression, functional dependency, polypharmacy, surgery, and physical restraints After surgery, falls

Answer 152

Longer hospital stays Increase mortality Increase dependency Short/long-term functional impairment Higher rates of permanent residency in long-term facilities

Answer 153

delirium is diagnosed on the basis of a four-point algorithm 1. Acute onset or fluctuating course: 2. Inattention 3. Disorganized thinking 4. Altered level of consciousness

Answer 154

Provision of aids to orientation (e.g., clock, watch, calendar) and aids to improve sensory function (e.g., eyeglasses, hearing aids) Frequent verbal orientation and reminders about daily events Environmental modification (e.g., noise reduction, familiar objects) Psychological support (e.g., cognitive and social stimulation) Identification of adverse medication effects Promotion of physiologic stability (e.g., low-dose oxygenation, maintenance of fluid and electrolyte balance) Adequate pain management Promotion of normal sleep–wake pattern Maintenance of optimal bowel and bladder function Physical activity (e.g., ambulation, physical therapy, occupational therapy) Provision of cognitively stimulating activities Encouragement of family and support people to be with the person

Answer 155

a group of diseases. a group of brain disorders characterized by a gradual decline in cognitive abilities (e.g., memory, understanding, judgment, decision-making, communication) and changes in personality and behaviour. Two or more types of dementia can develop at the same time or sequentially.

Answer 156

-Insidious onset -Progressive over 5-10 years -60-80% of all dementias Memory loss that disrupts daily life -Challenges in planning or solving problems -Difficulty completing familiar tasks at home, at work or at leisure -Confusion with time and place -Trouble understanding visual images and spatial relationships -Changes in language or writing skills -Misplacing things and losing the ability to retrace steps -Impaired judgment -Withdrawal from work or social activities -Changes in mood and personality

Answer 157

-abrupt onset -history of vascular risks (stroke, hypertension) -improvement possible depending on causative factors -based on the area of the brain that's affected -aphasia, memory impairment, apathy, depression, emotional lability, sensory motor deficits (gait, hemiparesis, incontinence)

Answer 158

-Insidious onset with progressive decline in cognitive behavioural and motor symptoms -manifests similar to parkinsons -significant cognitive impairment -fluctuating levels of cognition -parkinsonisms -hallucinations, sleep disturbances -loss of postural stability -sensitive to neuroleptic medications and anticholinergics -may decompensate rapidly with other comorbid conditions

Answer 159

-Early and progressive changes in behaviour, motor abilities, and/or speech language skills -memory impairments occur later

Answer 160

Research showing persons with dementia are aware of deficits

Answer 161

Agitation Psychiatric symptoms (delusions, hallucinations) Personality changes Mood disturbances Aberrant motor movements Changes in sleep, eating and appetite Hypersexual behaviour

Answer 162

Modify the environment to compensate as much as possible for sensory deficits and other functional impairments. Use clocks, calendars, daily newspapers and simple written cues for orientation (e.g., day, date, names, place, events). Use simple pictures, written cues or colour codes for identifying items and places (e.g., toilet, bedroom). Use simple written cues to clarify directions for operating radios, televisions, appliances and thermostats (e.g., on, off, directional arrows). Place pictures of familiar people in highly visible places, but use nonglossy pictures and nonglare glass in picture frames. Turn lights on as soon as, or before, it gets dark. Use nightlights, or leave dim lights on during the night. Provide adequate environmental stimuli while avoiding overstimulation.

Answer 163

Keep all activities as simple and routine as possible. Establish routines that allow for maximum independence and the least amount of frustration. Lay out one set of clothing in the order in which the items are to be donned. Arrange personal care items, such as grooming and hygiene aids, in a visible and uncluttered place, in the order in which the items are to be used. Leave a toothbrush on the bathroom sink with toothpaste already on it. Establish an individualized toileting plan that allows for maximum independence but minimal risk for incontinence episodes. Offer finger foods and nutritious snacks if the person will not sit at the table to eat a meal.

Answer 164

Adapt your level of communication to the abilities of the person with dementia. Simplify sentences Present only one idea at a time. Allow enough time for processing. Avoid infantilization Assist with word finding Avoid shaming the person ( Paraphrase what the person says, and ask for clarification about the meaning. repeat the statement using the same words, or simplify the wording. Do not argue with the person, unless it is a matter of safety. Avoid complex or sarcastic humour. Use positive statements Involve the person with decisions to the best of his or her ability by offering simple and concrete choices Do not ask questions that you know the person cannot answer correctly. Do no Listen to the feelings the person is trying to express and respond to the feelings, rather than the statement

Answer 165

Attract and maintain the person’s attention (e.g., through eye contact, pleasant facial expressions). Use a relaxed and smiling approach. Reinforce verbal communication with appropriate nonverbal communication (e.g., demonstrate what you are asking the person to do). Use simple pictures rather than written cues. Use appropriate touch for communication unless the person responds negatively to touch. Be aware of your own nonverbal communication. Closely observe all nonverbal cues exhibited by the person Assume that all nonverbal expressions of the person with dementia are attempts to communicate needs or feelings.

Answer 166

-depressed mood and/or loss of interest or pleasure -at least five of the following signs and symptoms: -weight loss, appetite change, sleep disturbances, observable psychomotor agitation or retardation (i.e., slowness), fatigue or loss of energy, feeling worthless or excessively guilty, cognitive impairment, and recurrent thoughts of death or suicide - noticeably interferes with usual functioning and is associated with significantly diminished quality of life

Answer 167

Same signs and symptoms as major depression but not as severe

Answer 168

onset of depression after age 65 Often unrecognized and undertreated. Older adults are less likely to admit to depression to health care professionals. Causative factors are more complex Depression often occurs with other conditions. Associated with more serious consequences

Answer 169

-Psychosocial theories focus on the impact of loss, as well as the buffering effects of social supports and the social network in protecting against depression. -Learned helplessness theory: Deficit in the following four areas: cognitive, motivational, self-esteem and affective-somatic. -Depression occurs when people expect bad things to happen, believe they can do nothing to prevent them -can help identify factors that protect older adults from depression -The learned helplessness theory supports the use of nursing interventions directed toward improving self-efficacy and a sense of control over one’s environment.

Answer 170

-Depression is caused not by adverse events, but by distorted perceptions, which impair one’s ability to appraise oneself and the event in a constructive manner. -Cognitive triad: self-image, their environment or experiences, and their future -Depressed people judge these three realms as lacking some features that are necessary for happiness

Answer 171

Female sex Personal or family history of depression Loss of significant relationships Loneliness Chronic stress Recent social stressors Stressful social environment Loss of meaningful social interaction Lack of social supports Loss of significant roles Current or previous experiences of abuse or neglect Being a caregiver (including assuming primary care of a grandchild). Adverse medication effects can cause a depressive syndrome alcohol

Answer 172

Loss of appetite Weight loss Digestive system complaints, particularly dysphagia, flatulence, constipation, stomach distress or early satiety Insomnia, hypersomnia, frequent awakening, early-morning awakening and other sleep disturbances Fatigue, loss of energy Pain, discomfort, dyspnea, general malaise Slowed or increased psycho-motor activities Loss of libido or other problems with sexual function Slowed body movements and slowed verbal responses Feeling extremely fatigued and having little or no energy Psychomotor agitation

Answer 173

-Often overlooked; less attention in older population -Major public health concern -Suicidal events unreported -Suicide rates and mechanisms vary by gender and ethnicity. -Suicide rates higher for men than for women

Midterm Flashcards

(198 cards)