1
Q
What are the primary characteristics of chronic illness?
A
- Permanent impairments or deviations from normal.
- Non-reversible pathologic changes.
- Residual disability.
- Special rehabilitation required.
- Need for long-term medical or nursing management.
2
Q
Describe the phases of the Chronic Illness Trajectory according to the Corbin & Strauss model.
A
- Pre-trajectory Phase: Risk factors like genetics or lifestyle put an individual at risk.
- Trajectory Onset: Noticeable symptoms appear, diagnosis begins.
- Stable Phase: Symptoms are controlled, and everyday activities are managed.
- Unstable Phase: Symptoms worsen, requiring new treatments.
- Acute Phase: Severe symptoms, necessitating hospitalization or bed rest.
- Crisis Phase: Life-threatening situation requiring emergency care.
- Comeback Phase: Recovery and adaptation to disabilities.
- Downward Phase: Worsening of condition, increased disability.
- Dying Phase: Body processes shut down, leading to death.
2
Q
List and explain the seven tasks of persons with chronic illness.
A
- Preventing and managing a crisis: Taking actions to avoid exacerbations.
- Carrying out the prescribed treatment regimen: Following medical advice to manage illness.
- Controlling symptoms: Using medications or lifestyle changes to minimize symptoms.
- Reordering time: Adjusting routines to accommodate illness.
- Adjusting to changes: Accepting the progression of disease and its impact.
- Preventing social isolation: Maintaining connections to avoid loneliness.
- Normalizing interactions with others: Attempting to live life as normally as possible.
3
Q
What factors affect adjustment to chronic illness?
A
- Suddenness, extent, and duration of lifestyle changes.
- Family and individual resources for dealing with stress.
- Stages of the individual/family life cycle.
- Previous experiences with illness or crises.
- Underlying personality characteristics.
- Unresolved anger or grief from the past.
3
Q
What are the primary types of disabilities related to aging?
A
- Sensory disabilities: Affect vision or hearing.
- Learning disabilities: Affect memory, concentration, or ability to learn.
- Communication disabilities: Affect the ability to speak or communicate effectively.
3
Q
What are the strategies for communicating with elders who have visual impairment?
A
- Ensure the person’s attention before speaking.
- Speak promptly and clearly identify yourself.
- Face the person and avoid speaking from a distance.
- Use gestures and ensure adequate lighting on your face.
- Use large, dark printing and contrasting materials.
- Avoid changing the room arrangement without explanation.
- Offer your arm when walking, and describe their surroundings.
3
Q
What are the leading causes of visual impairment in older adults?
A
- Age-related macular degeneration (AMD)
- Cataract
- Glaucoma
- Diabetic retinopathy
3
Q
Leading causes of visual impairment in older adults
Affects central vision, caused by tissue atrophy and growth of abnormal blood vessels.
A
Age-related macular degeneration (AMD)
4
Q
Leading causes of visual impairment in older adults
Clouding of the lens due to oxidative damage and fatty deposits.
A
Cataract
4
Q
Leading causes of visual impairment in older adults
Increased eye pressure leading to optic nerve damage.
A
Glaucoma
5
Q
Leading causes of visual impairment in older adults
Complication of diabetes affecting the retinal microvasculature.
A
Diabetic retinopathy
5
Q
Signs and Symptoms: Headaches, poor vision in dim lighting, sensitivity to glare, impaired peripheral vision, and a fixed and dilated pupil.
A
Glaucoma
Management: Beta blockers to lower eye pressure, laser surgery (trabeculoplasty) for some cases. Surgery is recommended only to prevent further optic nerve damage.
5
Q
What are the key risk factors for cataract development?
A
- Heredity and advancing age.
- Excessive sunlight exposure.
- Poor dietary habits, diabetes, hypertension, kidney disease.
- Eye trauma, history of alcohol intake, and tobacco use.
- A diet rich in lutein, zeaxanthin, and vitamin E can reduce cataract risk in women.
5
Q
Disease of the retinal microvasculature characterized by increased vessel permeability, leading to macular edema and lipid leakage.
A
Diabetic retinopathy
Management: Strict control of blood glucose, cholesterol, and blood pressure; laser photocoagulation; annual eye exams. Treatment with drugs may improve outcomes.
6
Q
What are the early signs of age-related macular degeneration (AMD)?
A
- Blurred vision and difficulty reading or driving.
- Increased need for bright light.
- Colors appear dim or gray.
- Blurry spot in the center of vision.
- Wavy lines seen on an Amsler grid.
7
Q
What are the common communication strategies for older adults with hearing impairment?
A
- Face the person and speak at eye level.
- Gain their attention before speaking.
- Determine which ear has better hearing and adjust position.
- Use nonverbal cues like gestures and written material.
- Avoid speaking from a distance or turning away.
- Articulate clearly and use a moderate speed.
- Lower the tone of your voice.
- Reduce background noise and ensure proper lighting.
8
Q
Primary types of dementia:
15% of dementias, often follows a stroke, confirmed by brain scans.
A
Vascular dementia
8
Q
It diminishes quality of life and is associated with decreased function, miscommunication, depression, falls, loss of self-esteem, safety risks, and cognitive decline.
A
Hearing loss
Inadequate communication with hearing-impaired older adults can lead to misdiagnosis and poor adherence to medical regimens.
9
Q
What are the two major types of hearing loss, and how do they differ?
A
- Sensorineural hearing loss
- Conductive hearing loss
9
Q
Major type of hearing loss
Results from damage to the inner ear or neural pathways. This type is commonly caused by age-related degeneration (presbycusis), affecting speech understanding, particularly in noisy environments.
A
Sensorineural hearing loss
9
Q
What strategies can nurses use when communicating with patients experiencing delirium?
A
- Speak slowly and calmly.
- Make eye contact and get down to the patient’s level.
- Explain all actions clearly.
- Use simple, familiar words and one-step directions.
- Provide reassurance and a calm, structured environment.
- Use nonverbal communication when necessary.
- Repeat information if needed and allow time for responses.
- Ensure safety and provide consistency in caregivers.
9
Q
Major type of hearing loss
Results from abnormalities in the external or middle ear that prevent sound transmission, caused by issues like infections, fluid accumulation, or earwax build-up.
A
Conductive hearing loss
9
Q
It is the perception of sound in one or both ears or the head without any external sound. It can manifest as ringing, buzzing, hissing, whistling, clicking, or pulsating sounds. The intensity can vary, and it is often more pronounced at night or in quiet environments.
A
Tinnitus
10
Q
It is an acute, reversible state of confusion with sudden onset, often due to underlying causes like infections, medications, electrolyte imbalances, or sensory impairment. Risk factors include immobility, cognitive impairment, sensory deficits, use of restraints, malnutrition, dehydration, and surgery.
A
Delirium
10
# **Three clinical subtypes of delirium**
Characterized by reduced activity, lethargy, passivity, and limited vocalization.
Hypoactive
10
What are the three clinical subtypes of delirium?
1. Hypoactive
2. Hyperactive
3. Mixed
11
# **Three clinical subtypes of delirium**
Characterized by increased psychomotor activity, agitation, hallucinations, and aggression.
Hyperactive
12
# **Three clinical subtypes of delirium**
Fluctuations between hypoactivity and hyperactivity
Mixed
13
How can chronic confusion (dementia) be distinguished from acute confusion (delirium) in terms of:
1. Onset
2. Course
3. Duration
4. Counsiousness
5. Attention
* **Onset**: Delirium has a sudden onset, while dementia has a slow, progressive onset.
* **Course**: Delirium fluctuates and worsens at night, while dementia progresses steadily.
* **Duration**: Delirium lasts hours to weeks; dementia lasts years.
* **Consciousness**: Delirium often involves altered consciousness, while dementia usually maintains clear consciousness.
* **Attention**: Delirium presents disordered, fluctuating attention, while attention in dementia is generally intact.
14
What are the main warning signs of dementia?
* Memory loss.
* Difficulty performing familiar tasks.
* Problems with language.
* Disorientation to time and place.
* Poor or decreased judgment.
* Difficulty with abstract thinking.
* Misplacing things frequently.
* Changes in mood or behavior.
* Changes in personality.
* Loss of initiative.
15
What are the primary types of dementia?
1. Alzheimer’s disease
2. Vascular dementia
3. Mixed dementia
4. Frontotemporal dementia
15
# **Primary types of dementia:**
50-80% of all dementias, memory problems are the earliest signs.
Alzheimer’s disease
15
# **Primary types of dementia:**
10-15% of cases, a combination of Alzheimer’s and vascular dementia.
Mixed dementia
16
# **Primary types of dementia:**
5-10%, begins with personality changes like depression, disinhibition, and poor judgment.
Frontotemporal dementia
17
What are the pharmacologic treatments used for dementia?
1. Acetylcholinesterase inhibitors
2. NMDA receptor antagonist: Memantine (Abixa)
18
# **Pharmacologic treatments used for dementia**
* Tacrine (Cognex)
* Donepezil (Aricept)
* Rivastigmine (Exelon)
* Galantamine (Reminyl)
Acetylcholinesterase inhibitors:
18
What are the non-pharmacologic interventions used in dementia care?
1. **Education and support**: Educating the family on realistic expectations and long-term planning.
2. **Maintaining physical health**: Regular physical therapy, exercise, immunizations, and self-care.
3. **Behavioral strategies**: Structured routines, safety measures, and cognitive stimulation.
4. **Support groups**: Resources for families and caregivers, helping them manage stress and provide better care.
19
What are the main goals of care in dementia management?
* Slow the progressive deterioration.
* Maintain current capabilities.
* Delay nursing home placement or total dependence.
* Provide physical, emotional, and cognitive support.
* Implement long-term planning and daily management strategies.
* Offer support to family and caregivers through education and counseling.
19
What nursing interventions can improve the quality of life for older adults with chronic vision or hearing impairments?
1. **Adapt the environment**: Improve lighting, reduce glare, ensure clear auditory signals, and label important objects.
2. **Facilitate communication**: Speak clearly and face the patient, use large-print materials, and assist with hearing aids.
3. **Promote independence**: Encourage the use of assistive devices like magnifying glasses, talking clocks, or hearing amplifiers.
4. **Provide health teaching**: Educate patients about self-care strategies, such as protecting eyes from UV light and managing conditions like diabetes that affect vision.
19
What strategies can help promote hearing and vision health in older adults?
1. **Regular screening**: Annual eye exams for those over 65, hearing assessments for those at risk.
2. **Prevention**: Use of sunglasses to prevent cataracts, managing blood glucose to prevent diabetic retinopathy.
3. **Education**: Teach patients about environmental adaptations to enhance hearing and vision, such as reducing background noise and increasing lighting.
4. **Assistive devices**: Promote the use of hearing aids, glasses, and low-vision aids.
19
# **Pharmacologic treatments used for dementia**
These medications aim to slow the progression of dementia and manage behavioral symptoms.
NMDA receptor antagonist: Memantine (Abixa).
19
What are the main nonpharmacological interventions to manage delirium?
1. **Promote sleep and rest**: Reduce noise and distractions, encourage sleep hygiene.
2. **Reorient the patient**: Use familiar objects and discuss current events to help maintain mental stimulation.
3. **Ensure proper nutrition and hydration**: Feed and hydrate the patient regularly.
4. **Create a calm environment**: Minimize chaos and provide consistent, reassuring care.
5. **Encourage physical activity**: Assist the patient in getting out of bed and moving around when safe.
20
What communication strategies can help when interacting with individuals experiencing cognitive impairment?
1. **Simplification strategies**: Give one-step directions, speak slowly, and reduce distractions.
2. **Facilitation strategies**: Establish common ground, allow the person to choose topics, and use humor.
3. **Comprehension strategies**: Identify time confusion, find a common theme, and recognize hidden meanings.
4. **Supportive strategies**: Introduce yourself, explain why you’re there, and use multiple methods (gestures, touch) to communicate.
20
What are the clinical signs and symptoms of delirium?
* Acute onset of confusion and disorientation.
* Fluctuating levels of consciousness.
* Disorganized thinking, difficulty concentrating.
* Inattention or hypervigilance.
* Agitation or lethargy, mood swings.
* Hallucinations or delusions.
* Sleep-wake disturbances.
20
What are some key considerations when assessing and planning care for a patient with delirium?
1. **Assessment**: Consider factors like infection, medications, electrolyte imbalance, pain, sleep disturbance, and sensory impairments.
2. **Diagnosis**: Use appropriate nursing diagnoses like acute confusion, risk for injury, and impaired communication.
3. **Planning and Implementation**: Establish therapeutic relationships, review medications, provide a quiet environment, and address sensory deficits (e.g., glasses, hearing aids).
20
What are the expected outcomes for patients experiencing delirium?
* The patient will be free from injury.
* Symptoms of delirium will be resolved.
* Underlying causes of delirium (e.g., infections, medications) will be corrected.
* The patient will cooperate with a rehabilitation program and be discharged appropriately (home or facility).
20
What are the key goals of managing chronic illness in older adults?
* Minimize disease progression and symptoms.
* Promote self-care and independence.
* Maximize function and quality of life.
* Prevent or delay complications.
* Ensure continuity of care and support for caregivers.
21
What are the pharmacological interventions used to manage delirium?
1. Antipsychotic drugs
2. Benzodiazepines
21
What are the common consequences of untreated hearing loss in older adults?
1. **Social isolation**: Difficulty hearing leads to withdrawal from social activities.
2. **Depression**: Loss of communication can result in feelings of loneliness and sadness.
3. **Cognitive decline**: Studies show that untreated hearing loss may accelerate cognitive impairment.
4. **Safety risks**: Inability to hear alarms, sirens, or warnings can lead to accidents or injuries.
21
What are the goals of healthy aging in older adults with chronic illnesses?
* Minimize the risk for disease progression and complications.
* Alleviate symptoms and improve overall function.
* Maximize quality of life through appropriate care and interventions.
* Support self-care and promote independence for as long as possible.
21
# **Pharmacological interventions used to manage delirium:**
Used to treat agitation, hallucinations, and improve sensory disturbances.
* Haloperidol (Haldol®)
* Risperidone (Risperdal®)
* Olanzapine (Zyprexa®)
* Quetiapine (Seroquel®)
Antipsychotic drugs
21
# **Pharmacological interventions used to manage delirium:**
Primarily used when delirium is due to alcohol or sedative withdrawal
Benzodiazepines
21
An age-related sensorineural hearing loss, the most common form in older adults. It typically affects high-pitched sounds and speech discrimination, particularly in noisy environments. Individuals may struggle to understand conversations, particularly those involving women's or children's voices.
Presbycusis
22
Measures taken to prevent the occurrence of disease, such as proper diet, exercise, and immunizations.
Primary prevention
22
What are some environmental adjustments that can help visually impaired older adults maintain independence?
* Ensure adequate lighting and reduce glare.
* Use high-contrast colors for furniture, walls, and printed materials.
* Label personal items with large, dark print.
* Avoid rearranging furniture or changing familiar settings without explaining it first.
22
Early detection of disease, followed by interventions to prevent the progression, such as screenings and regular health checkups.
Secondary prevention
23
What are the common concerns in the care of persons with dementia, and how can nurses respond to them?
* **Safety**: Implement fall prevention strategies, adjust the environment, and monitor wandering.
* **Communication**: Use simple, clear language and support comprehension with gestures.
* **Behavioral changes**: Address agitation, aggression, or confusion with calmness and patience.
* **Nutrition**: Monitor weight loss and difficulty eating, and provide assistance as needed.
* **Sleep disturbances**: Encourage a regular sleep schedule, reduce daytime naps, and create a calming bedtime routine.
24
What nursing interventions can be applied to manage patients in the unstable phase of chronic illness?
* Provide guidance and support to patients and caregivers.
* Reinforce teaching about managing symptoms and adjusting treatments.
* Monitor for changes in symptoms and offer emotional support during periods of uncertainty.
* Collaborate with healthcare providers to adjust medication regimens and interventions.
24
What are the primary nursing interventions for managing the downward phase of chronic illness?
1. Provide home care and community-based support to help the patient and family adjust to worsening conditions.
2. Assist in developing new management strategies for deteriorating health.
3. Encourage discussions on end-of-life preferences and planning.
4. Support the family in making necessary lifestyle adjustments to accommodate the patient's declining condition.
24
What are the key goals of nursing care during the dying phase of chronic illness?
1. Provide direct, compassionate care focused on comfort.
2. Collaborate with hospice teams to manage symptoms and pain relief.
3. Offer emotional and psychological support to the patient and their family.
4. Ensure the patient's end-of-life preferences are respected and followed.
5. Help the family with closure and bereavement support.
GERIATRICS NURSING
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