Nur 116 Gero Test 1: Neurosensory, Ego Integrity, Social Integration, Sexuality Flashcards

AMP
Terms Definitions
What are the 7 steps of a positive physical approach?
Come from the front
Go slow
Get to the side
Get low (sit down)
Offer your hand
Use preferred name (ask them)
Wait for a response (before you start talking/doing)
What are the names of the 5 stages of dementia?
Level 5: Early Loss
Level 4: Moderate loss
Level 3: Middle Loss
Level 2: Severe Loss
Level 1: Profound Loss
Describe Level 5 of dementia.
Early Loss:
some word finding problems
some loss of reasoning
likes routine (doesn't like changes in routine)
fixed on time
does well with personal care & activities
may have difficulty with finances & complex tasks (driving)
may repeat stories
Describe Level 4 of dementia.
Moderate Loss:
gets tasks done but may be poor quality
makes mistakes but won't go back to fix them
problem with steps & personal care
needs guidance but can do a lot (set up help)
makes excuses & gets embarrassed easily
asks what/where/when a lot
social but content is limited & confusing sometimes
Describe Level 3 of dementia.
Middle Loss:
"Hunting & Gathering"
(takes, stores, hoards)
(touch, take, taste)
language poor & comprehension limited
responds to tone, body language, facial expression
imitates (but not always aware)
impulse control limited & says what thinking
loses ability to use tools/utensils
Describe Level 2 of dementia.
Severe Loss:
Gross Automatic Action
Constant go or down & out
paces, walks, rocks, swings, hums
not interested in food (loses wt rapidly)
enjoys rhythm & motion
can't use hands effectively
doesn't use language/understand much
repeats things (echolalia)
stops/pauses when presented with a problem
Describe Level 1 of dementia.
Profound Loss:
Stuck in Glue
Immobile & Reflexive
bed or chair bound
contractures
poor swallow/eating
sensitive to voice/touch
problems with temp regulation
limited responsiveness
returns to reflexive behavior (think newborn)
responses very slow
How do you make activities meaningful for dementia pts?
1st: Know who your person has been & what they value!
Ex: introvert/extrovert, planner/doer, follower/leader, work history, family relationships, social history, leisure background, previous daily routines/schedules, personal care habits/preferences, religious/spiritual beliefs, favorite things, stressors/hot topics, past coping skills
Neurosensory
How people interpret info from environment
What are the 2 types of intelligence?
1. Crystallized intelligence (use past learning)
This is wisdom
2. Fluid intelligence (spatial & creative intelligence)
This is thinking on your feet
What are some normal psychological aging changes?
Abilities decline in the following areas:
processing
abstract
attention
filtering
visuospatial
word finding
short term memory
flexibility
Which type of intelligence is maintained while the other declines?
Crystallized intelligence is maintained while fluid intelligence declines.
What is helpful for normal psychological aging changes?
demonstration & repetition
What type of intelligence do elders use the most?
Crystallized
How do you need to modify teaching plans for elderly because of normal psychological aging changes?
Teaching plans should be covered over a few days because the person needs time to process
(processing declines with age).
What is an example of a visuospatial task?
Wii, driving
What is an example of abstraction tasks?
Understanding the following:
"people in glass houses shouldn't throw bricks."
What physiological areas do normal neurosensory aging changes take place in the elderly?
Vision
Hearing
Taste
Smell
Pain perception
Tactile Sensation
What are the normal vision changes in the elderly adult?
(11: Famed Plantt)
Floaters
Astigmatism
Muscle tone ↓
Eyelashes ↓
Drusen
Presbyopia
Lens discoloration
Arcus Senilis
Nuclear Sclerosis
Tear production ↓
Tissue elasticity ↓
What results from a decrease # of eyelashes?
Increased risk of eye injury
(↑ eye infections)
What results from decreased tear production?
Increased risk of eye irritation
(need eye drops)
What results from increased lens discoloration?
Decreased color perception
(black looks blue)
What results from decreased tissue elasticity around the eye?
Vision decreases, increased blurring of images
(eyelids droop)
What results from decreased muscle tone of the eye?
Decreased pupil diameter
What results from presbyopia?
Difficulty reading
What results from astigmatism?
Blurred images at a distance
What results from floaters?
Interference with vision
What are floaters?
Calcium deposits in the eye
What is arcus senilis?
white/yellow ring around the cornea
What is nuclear sclerosis?
hardening of the lens
What results from Drusen?
decreased vision
What is Drusen?
Little yellow deposits in the eye.
They are precursers to macular degeneration.
What is arcus senilis a sign of in young people?
Hyperlipidemia
Is arcus senilis concidered normal in the elderly?
yes
What are the 5 main causes of visual impairment/blindness in the elderly?
(CDRAG)
Cataracts
Diabetic Retinopathy
Retinal Detachment
Age-Related Macular Degeneration
Glaucoma
What is the #1 cause of blindness in the WORLD?
Cataracts
What is the #1 cause of blindness in the US?
Age-Related Macular Degeneration (ARMD)
What are scotomas?
blind spots in the central field of vision
How often should elderly get eye exams?
every other year
What are Cataracts?
opacities or yellowing of the lenses that create cloudiness/decrease vision
develop slowly & painless
What is ARMD?
Age-Related Macular Degeneration
degenerative disorder of macula which affects central vision (scotomas) & visual acuity (blurry vision)
What are some signs/symptoms of cataracts?
blurry vision
halos
glare
double vision
poor night vision
↓ color contrast
What are the 2 types of ARMD?
wet & dry
What is Glaucoma?
Optic nerve damage due to an increase in intraocular pressure
What vision changes are characteristic of Glaucoma?
Mid-peripheral vision loss
(see only in center)
What is diabetic retinopathy?
a microvasular disease of the eye occurring in Type 1 & 2 diabetes where damage to vascular system impairs transport of O2 & nutrients.
What vision changes are seen with diabetic retinopathy?
generalized blurring & focal vision loss
(spots are blurred out)
What is retinal detachment?
separation of retina from the choroids with loss of vision
(vessels detach & bleed into eye)
Feels like curtain being pulled over vision. May or may not have pain.
Name an intervention you should use with a person who has ARMD.
Sit to the side of the person
Name an intervention you should use with a person who has Glaucoma.
Sit in front of the person
What are the normal hearing changes in the elderly adult?
(4: CCNT)
Cerumen ↑
Cochlear hairs ↓
Neurons degrade
Tissue elasticity ↓/tympanic membrane thins
What results from decreased tissue elasticity/thinning of tympanic membrane of the ear?
difficulty distinguishing high pitched sounds
What results from increased cerumen production?
decreased hearing
What results from decreased cochlear hairs?
decreased hearing & balance
What results from degradation of neurons with hearing?
decreased hearing & overall hearing loss
What are some common hearing impairments?
(4: TPMD)
Tinnitus
Presbycusis
Meniere's disease
Deafness
What is presbycusis?
decreased hearing due to noise induction
What is tinnitus?
ringing in the ears with or without hearing loss
(may be due to trauma, cerumen or presbycusis)
What are some potential causes of deafness?
tumors, trauma, drugs, infection, loud noises
What is Meniere's disease?
a chronic disorder of the inner ear which causes continuous dizziness, nausea, spinning, vertigo
True or False? Ringing in the ears is active hearing loss occuring.
TRUE
What is a normal age related taste change?
decrease in # of papilla on tongue = ↓ sense of taste (hypogeusia)
What is a normal age related smell change?
decreased ability to smell
What is a normal age related pain change?
decreased perception of pain (increased pain threshold)
What is a normal age related tactile change?
decreased perception of touch, pain, joint position, temperature, vibrations
True or False? All elderly have decreased peripheral sensations.
TRUE
What temperature should the water be kept to prevent burns?
120-125 degrees
What are the normal changes of the aging neurologic system?
↓ neurons
↓ brain size/wt
↓ blood flow to brain
↓ responses/movements
↓deep tendon reflexes
↓ sensation
↓ short term memory
↑ plaques/tangles
↑ insomnia/sleep disturbances/loss of REM
↑ tremor
coordination impaired & depression more common
Risk factors causing alterations in neurosensory
sensory deficits
sensory altering meds (dilantin)
↑/↓ in environmental stimuli
chronic pain
psychosocial factors (anxiety/stress)
serious losses
difficult relationships
changes in social roles
loneliness
poverty
unplanned moves
6 drugs that can cause visual disturbances
Tamoxifen
Thioridazine
Hydroxychloroquine
Corticosteroids
Levodopa
Propranolol (beta blocker)
5 drugs that can cause a change in hearing.
Gentamicin (aminoglycoside antibiotic)
Antineoplastics
Loop diuretics (lasix)
Baclofen
Propranolol (beta blocker)
Several disease processes can cause alteration in pain/discomfort & neurosensory. Name some.
(VHS CDD BEEPPP)
Viral illnesses (Guillain-Barré)
Heart disease
Stroke
Cancers
Delirium
Dementia
B12 deficiencies
Endocrine disorders
Epilepsy
Presbyopia
Presbycusis
Parkinson's disease
What is cognitive dissonance?
temporary confusion that may take 1-3 days to normalize, likely to occur with stress
(moving, hospitalization, depression, losses)
What is delirium?
sudden confusion caused by an acute change in mental status
may fluctuate & include inattention, disorganized thinking & altered LOC
Usually has a definate cause
How long can delirium last?
up to 3 months
Is delirium reversible?
Often but not always
True or False? Dementia ↑ risk of Delirium & vice versa.
TRUE
What are some risk factors of Delirium?
Dementia
Advanced age
Co-morbid physical problems (pain, renal failure, malnourishment, etc. )
Causes of Delirium
(DELIRIUMS)
Drugs
Eyes/Ears
Low O2 Sats (MI/stroke/PE)
Infection (respiratory/UTI)
Retention (urine/stool)
Ictal (post seizure)
Underhydration/undernutrition
Metabolic (thyroid, hyper/hypoglycemia)
Subdural hematoma
What is the BEERS criteria?
A list of potentially inapproprate meds that should not be used in older adults
What are a few common drugs found on the BEERS list?
Demerol, Digoxin, Benadryl
What areas should you evaluate for Delirium?
Onset, duration, baseline mental status, meds, VS, O2 sat, evidence of infections, Labs, MMSE, CAM tool.
Name non-pharmacologic interventions of delirium.
Identify cause
prevent dehydration
re-orient if/when appropriate
modify environment as needed
have glasses/hearing aids available & clean
sitters/family present
have daytime activities/OOB
limit interruptions at night
put close to nurse station
avoid restraints
What is dementia?
A group of disorders characterized by...
1. decline in mental function
with
2. a decline in at least 1 other cognitive function (ex. ↓ in language, executive, visuospatial, previous functions/abilities)
What does SDAT stand for?
Senile Dementia Alzheimer's Type
What is the patho of Alzheimer's?
Gradual onset
steady decline
Characterized by neurofibrillary tangles & neuritic plaques (cause cell death) in the brain
Other changes include:
↓acetylcholine
↓ brain cells
↓ dopamine (contributes to tremors)
↓ Apo-Lipo protein E
amyloid present
brain atrophy
left brain lost first
How do we diagnose Alzheimer's?
rule out everything else
can only truly be dx on autopsy
What does MMSE stand for?
Mini Mental Status Exam
What are the limitations of the MMSE?
Person must be able to read & write
MMSE 0-9
Late, severe impairment (6-20)
MMSE 10-21
Middle, moderate impairment (2-8 yrs)
MMSE 22-28
Early, mild impairment (1-3 years from onset)
MMSE 26-30
Mild cognitive impairment
What are some symptoms common with SDAT?
Agitation &/or aggression (80%)
Depression (40%)
Psychotic symptoms such as delusions/hallucinations (20%)
(stealing/infidelity most common examples)
What are 2 interventions you can use with an agitated/aggressive Alzheimer's pt?
Distractions & exploring
What are the 4 most common types of Dementia?
Alzheimer's
Vascular
Lewy body
Frontotemporal
Describe Vascular Dementia.
Decreased blood flow to brain causes significant damage leading to cognitive impairment. Focal neurologic signs are present.
Can you have more than one type of dementia?
yes
What are some common signs of Vascular Dementia?
Focal neurologic signs of Vascular Dementia include abnormal reflexes or nerve functions. Ex. Gait difficulties, falls, mood changes, fine motor movement difficulties.
How is Vascular Dementia diagnosed?
With CT or MRI (shows evidence of TIA/CVA)
Describe Lewy Body Dementia.
Lewy bodies are found throughout the brain.
Memory impairment doesn't occur until late while progressive/fluctuating cognitive decline.
It is opposite from Alzheimer's & similar to Parkinson's Disease
What are some common signs of Lewy Body Dementia?
Fluctuating cognition
visual hallucinations
motor deficits (like Parkinson's)
sleep disturbances
syncope
falls
(Opposite from Alzheimer's)
Describe Frontotemporal Dementia.
Changes in the frontal & temporal lobes cause changes in personality, reasoning, social behavior, speech, behavior disinhibition, personal awareness, apathy, language problems.
Rare after age 75
Is Delirium acute or gradual?
Acute
Is Dementia acute or gradual?
Gradual
Is depression acute or gradual?
Can be either sudden (acute) or gradual
How long can Dementia last?
Years - up to 20 years
How long can Depression last?
Weeks to years. Normal for depression to last up to 1 year.
Describe the state of consciousness in a person with Delirium.
Disoriented
Describe the state of consciousness in a person with Dementia.
Alert
Describe the state of consciousness in a person with Depression.
Self-absorbed
Describe the behavior of a person with Delirium.
Difficulty with attention & concentration
Describe the behavior of a person with Dementia.
Personality changes, labile, easily agitated
Describe the behavior of a person with Depression.
Apathetic
feelings of worthlessness
vague somatic complaints
attention seeking behavior such as complaining
Is a person with Delirium able to follow instructions?
No, they are unable to do tasks (remember, they are disoriented)
Is a person with Dementia able to follow instructions?
Somewhat. They try to follow but progress with a gradual loss of abilities
Is a person with Depression able to follow instructions?
The are able to do tasks but they choose not to do them.
Describe the mental ability of the person with Delirium.
Fluctuating memory/orientation, disorganized thinking
Describe the mental ability of the person with Dementia.
Impaired memory, gradual loss of knowledge, language & judgment
Describe the mental ability of the person with Depression.
Selective memory loss
Is Dementia reversible?
No
What areas should you evaluate for Dementia?
History & Physical
Neuro exam
Cognitive status (AAOx3, MMSE, & Mini-Cog)
CNS/cranial nerves
Labs
CT/MRI if indicated
What is the Mini-Cog?
A test to evaluate cognitive status.
It is a good test because pts don't have to be able to read or write.
Best because of reliability, validity, sensitivity, specificity.
This is the "draw the clock" test
What do the results of the Mini Cog mean?
If the pt gets all 3 areas correct: normal (non-demented)
If the pt gets all 3 wrong: non-demented
If the pt gets the 3rd part of the test wrong, the pt may be intermediatly demented
What are some associated concerns of the person with Dementia?
Dependence in ADLs
Making Activities Meaningful
Anxiety
Spatial disorientation
elopement
resistiveness to care
food refusal
insomnia
What is elopement?
Wandering
What should you do with a resistive dementia pt?
get witness & document refusal to show you did not withhold care on purpose
What should you do with a dementia pt who refuses to eat?
Try non-verbal first: gesture to eat, then try to physically assist, can always distract & try again later
Is insomnia common with dementia?
Yes: sundowners
Name some non-pharmacologic treatments of Dementia.
***Daily Structured Activities***
(keep same staff)
No anticholinergic drugs (dry you up- dehydration- leads to delirium)
minimize prn antipsychotics
modify behavior with distraction/exploring
make environment safe
music for relaxation esp. for stressful activities
family involvement
pet therapy
approach pt at their level
What are some preventative measures for Dementia?
(thought to help, not proven)
NSAIDS (↓ hypoxia risk)
Statins (hyperlipidemia drugs)
Vit. E
Ginko biloba
What drugs are used to treat Dementia?
Cholinesterase Inhibitors
NMDA Receptor Antagonists
What does a cholinesterase inhibitor do? (patho)
prevents destruction of acetylcholine by inhibiting acetylcholinesterase (enzyme)
it slows the progression of SDAT
When is Cholinesterase drugs most effective?
In the early stages of dementia
(mild to moderate)
(the 1st 6 mon to 1 year)
What are some side effects of Cholinesterase meds?
N&V
↓ appetite
↑ bowel movements
What are the nursing implications of administering Cholinesterase meds?
Must take on a full stomach
monitor for GI distress & bleeding
esp. if pt taking NSAIDS)
dose gradually increased so results are slow
What should you know about NMDA Receptor Antagonists?
Used in moderate to severe cases
take with a full glass of water
many side effects
Is it okay for Dementia pts to take more that one kind of Dementia med?
No - should only be on 1 at a time
Aphasia
an impairment of language
common in stroke pts
2 types: expressive & receptive
Expressive aphasia
Person knows what they want to say but it doesn't come out right
Receptive aphasia
Person doesn't understand what you are telling them
Apraxia
inability to perform purposeful movement
Agraphia
loss of ability to write
Alexia
inability to grasp the meaning of written words/sentences "word blindness"
Confabulation
making up answers (unrelated to facts)
Echolalia
involuntary repetition of a word/sentence that was uttered by another person
Neologism
a word coined by the pt that is meaningful only to the pt
Nociceptive pain
from somatic (musculoskeletal) or visceral stimulation
usually signal that injury has occurred
Neuropathic pain
pain from the nerves themselves
can result from lesions in CNS
characterized as burning/tingling
not from acute injury
ex. MS, pinched nerve, sciatica
What are the 2 types of pain?
Nociceptive & Neuropathic
Cutaneous pain
from stimulated cutaneous nerves
usually a burning feeling
ex. Shingles
a type of neuropathic pain
Somatic pain
from musculoskeletal injury
ex. Bones, tendons, muscles, ligaments
pain is usually localized & specific & worsens with movement
type of Nociceptive pain
Visceral pain
from organs & their lining
usually generalized, deep, unable to be localized
ex. Twisting, tearing from spasm or cramp as with diverticulosis
type of Nociceptive pain
Referred pain
is perceived in a location other than where the pathology is occurring
ex. Gallstones cause shoulder pain
Chronic nonmalignant pain
chronic pain that occurs with or without an identifiable cause
ex. Fibromyalgia
Breakthrough pain
transient moderate to severe pain that occurs in pts with otherwise stable, baseline pain
this pain breaks through/peaks at the middle of med administration
End of dose pain
a type of breakthrough pain that peaks/breaks through at the end of med administration
Med may be inadequate to control baseline pain
What does a baseline pain assessment include?
VS
ability to move about
agitation level
appetite/eating problems
elimination habits
cognitive function
mood
Will you see an increase in VS with chronic pain?
No - body has adapted
What are the ABCDEs of Pain Assessment?
Ask/Assess (regularly & systematically)
Believe (the pt & family & what they say relieves it)
Choose (appropriate pain control)
Deliver (interventions timely, logically & coordinated)
Empower (pts/families to control their course of pain & educate)
How do you assess pain in a cognitively or verbally impaired person?
Obtain baseline info from family member (how do they act when in pain)
do frequent assessments
observe for nonverbal signs
(grimacing, guarding, moaning, tense, sad facial expression, fidgeting, perseverant verbalizations/verbal outbursts)
How would a confused/demented pt express pain?
Breathing: noisy, labored breathing, hyperventilation, Cheyne-Stokes respirations
Vocalizations: moaning, groaning, calling out, crying
Facial Expression: sad, frightened, frowning, grimacing
Body Language: tense, distressed, pacing, fidgeting, rigid, clenched fists, knees pulled up/pushing away, striking out
Consolability: distracted or reassured by voice or touch to unable to console, distract or reassure
Additional behaviors to observe for with pain assessment
Delusions & Hallucinations
What are the goals of pain management?
to relieve acute & chronic pain
use pharm & non-pharm techniques
minimize side effects
What are the key things to remember regarding pain management in the elderly?
more sensitive to opioids
start low & go slow
oral dose preferred
administer around the clock
use long acting for baseline pain with short acting for breakthrough pain
No propoxyphene (darvacet) bc of toxic buildup
use of meds with salycilates & acetaminophen limited bc too much can be toxic
What are adjuvant drugs?
meds that may relieve discomfort &/or potentate the effectiveness of pain meds
they may ↓ dose of opioid needed
they may reduce the side effects associated with high doses of opioids
List some adjuvant meds.
Antidepressants
Anticonvulsants
Antianxietys
Antipruritics
Diuretics
Topical analgesics
Muscle relaxants
Meds to dry secretions
Magic Mouthwash
What is ego integrity?
Deals with attitudes/perceptions a person holds of him/herself and their abilities/self worth
a persons self-identity
4 areas that contribute to positive life satisfaction
Good Health
Sense of control over one's life
Reciprocal social relationships
Adequate income
**Top 2 are most important to the elderly person**
Aging changes that can effect Ego Integrity
poor self concept
depression/negative feelings
loss of control
widowhood
confronting negative attitudes of aging
retirement
chronic illness/pain
alterations in body appearance
loss of body function (incontinence)
decision about driving car
death of friends/family
relocation (hospital, nursing home, family)
changes in social roles
loneliness
medication side effects
What is the top reason for elder suicide?
Incontinence
What are the risk factors for altered ego integrity?
Mainly related to aging changes
What disease processes can affect ego integrity?
All, but especially chronic, debilitating diseases or those that can lead to a loss of independence
ex. Arthritis, Ca, Amputation, Stroke
How can you diagnose an issue with ego integrity?
screen for depression
perform a focused assessment
(eye contact, speech patters, hands, body posture)
Consider the individual
(personality, happy, sad)
What is the major cause of stress in the elderly?
Relocation (hospital, nursing home, live with family, etc.)
When does stress occur?
Whenever a person is faced with a real or perceived threat, &/or when they experience a significant/life-altering change
What are the key concepts to remember regarding coping & stress in the elderly?
Different things are stressful to different people
stressors may be physical, emotional, biological, or developmental
Responses are both physical & psychological
Stress ↑ risk of physical illness
Good coping strategies can help people function in spite of high stress
Many coping/defense mechanisms are used day to day
True or False? Stress, poor coping & impaired mental health are risk factors that influence psychosocial functioning.
TRUE
What are some risk factors of stress & poor coping?
↓ economic resources
immature developmental level
unanticipated events
many daily hassles at the same time
many major life events occurring in a short time
unrealistic appraisals of situations
2 types of coping styles
Problem-focused: attempt to change ("men")
Emotion-Focused: change response/how you feel about problem ("women")
What is depression?
Low mood tone, difficulty thinking & somatic changes because of feelings of loss or guilt
True or False? S/S of depression may be emotional &/or physical.
TRUE
What are the clues to depression in the elderly adult?
Multiple somatic complaints & reports of persistent chronic pain
Why are minorities at a greater risk of depression/poor mental health?
increased segregation
poverty
poor quality education
discrimination
healthcare disparities
Why is depression under-treated & under-diagnosed in the aging?
Thought to be a normal/common part of aging (NOT TRUE!!!)
Frequently confused with other physical or social changes
What should the nurse do when a pt is sad or depressed?
Ask about suicidal intent & document
Is there a relationship between depression, suicide & alcoholism?
Yes, there is a direct relationship between these 3 things
What are some risk factors for depression?
previous suicide attempt
alcohol/substance abuse
psychiatric illness
auditory hallucinations
living alone
What do you do when a pt verbalizes suicide intent?
Immediate referral!
What is anxiety?
a state of uneasiness (mild or intense)
source is often nonspecific or unknown
At what age do experts think values and beliefs are formed by?
10 years old
What influences how a person lives & dies?
Values & Beliefs
Are values & beliefs easily changed?
No
True or False? Persons with strong values/beliefs tolerate illness better.
TRUE
What is spirituality?
A sense of what brings a person inner peace (God/higher doctrine).
It does not always include religion.
It is a source of strength & provides meaning to life.
How do you conduct a spiritual assessment?
1. Start with physical & psych history (start slow, develop rapport & trust)
2. Ask about advance directives
3. Ask about organ donation
4. Ask about spiritual/religious beliefs that may affect healthcare
(if they shut down, let them know we can assist, document so others don't bother them)
5. Observe for clues
6. Ask who should be notified in case of a change in condition
How do you support your pts spirituality?
listen actively
warm/empathetic responses
show respect
give permission to practice beliefs
put aside your own beliefs to support your pt
***make appropriate referrals to chaplain/spiritual leader***
What does the D&M diagnostic criteria of social interaction assess?
Major roles & responsibilities of an individual in family, work or social settings
True or False? Stress, poor coping & impaired mental health are risk factors that influence psychosocial functioning.
TRUE
What are some risk factors of stress & poor coping?
↓ economic resources
immature developmental level
unanticipated events
many daily hassles at the same time
many major life events occurring in a short time
unrealistic appraisals of situations
2 types of coping styles
Problem-focused: attempt to change ("men")
Emotion-Focused: change response/how you feel about problem ("women")
What is depression?
Low mood tone, difficulty thinking & somatic changes because of feelings of loss or guilt
True or False? S/S of depression may be emotional &/or physical.
TRUE
What are the clues to depression in the elderly adult?
Multiple somatic complaints & reports of persistent chronic pain
Why are minorities at a greater risk of depression/poor mental health?
increased segregation
poverty
poor quality education
discrimination
healthcare disparities
Why is depression under-treated & under-diagnosed in the aging?
Thought to be a normal/common part of aging (NOT TRUE!!!), Frequently confused with other physical or social changes
What should the nurse do when a pt is sad or depressed?
Ask about suicidal intent & document
Is there a relationship between depression, suicide & alcoholism?
Yes, there is a direct relationship between these 3 things
What are some risk factors for depression?
previous suicide attempt, alcohol/substance abuse, psychiatric illness, auditory hallucinations, living alone
What do you do when a pt verbalizes suicide intent?
Immediate referral!
What is anxiety?
a state of uneasiness (mild or intense), source is often nonspecific or unknown
At what age do experts think values and beliefs are formed by?
10 years old
What influences how a person lives & dies?
Values & Beliefs
Are values & beliefs easily changed?
No
True or False? Persons with strong values/beliefs tolerate illness better.
TRUE
What is spirituality?
A sense of what brings a person inner peace (God/higher doctrine). It does not always include religion. It is a source of strength & provides meaning to life.
How do you conduct a spiritual assessment?
1. Start with physical & psych history (start slow, develop rapport & trust) 2. Ask about advance directives 3. Ask about organ donation 4. Ask about spiritual/religious beliefs that may affect healthcare (if they shut down, let them know we can assist, document so others don't bother them) 5. Observe for clues 6. Ask who should be notified in case of a change in condition
How do you support your pts spirituality?
listen actively
warm/empathetic responses
show respect
give permission to practice beliefs
put aside your own beliefs to support your pt
***make appropriate referrals to chaplain/spiritual leader***
What does the D&M diagnostic criteria of social interaction assess?
Major roles & responsibilities of an individual in family, work or social settings
Why is it important to assess social interaction?
Roles determine our behavior, status & sense of importance. When these roles change or are lost, it is often painful & sense of identity/self is threatened. (people may grieve this loss)
What is the #1 reason for decreased sexual activity in the elderly?
Loss of a sexual partner
What are the age-related changes that affect sexuality in the elderly female?
↓ estrogen
↑ vaginal alkalinity
libido changes
What are the age-related changes that affect sexuality in the elderly male?
↓ testosterone
testes change
sperm change
libido changes
How does libido change in the elderly female & male?
Both M & F libido generally decreases.
Increase in vaginal alkalinity of the aging woman results in what changes?
↑ risk of infection
Many changes result from a woman's decrease in estrogen. What decreases?
vaginal secretions
pubic/axillary hair
size of female organs
vaginal opening
breast tissue
fullness of pubis/vulva
size of labia/clitoris
lubrication
vaginal elasticity
Many changes result from a woman's decrease in estrogen. What increases?
facial hair
fragileness of vaginal tissue
tissue irritation (decreased lubrication)
pain with intercourse
thinning of vaginal wall
LH/FSH
What age does menopause usually happen?
45-55 yo
What is Menopause?
The complete cessation of menstruation because of lack of ovarian function
What are some related concerns with menopause?
atrophic vaginitis
more frequent UTIs
incontinence
cognitive changes
vasomotor instability (hot flashes)
sleep disturbances
osteoporosis
increased cardio disease
What is atrophic vaginitis?
thinning/atrophy of the vaginal wall
What are a few treatments for menopause?
HRT (hormone replacement therapy), designer/low dose estrogens, soy products & many more (see notes)
How do the testes change with age?
decrease in firmness
What changes happen with sperm in old age?
viability decreases after age 90, number decreases dramatically with aging
What changes occur with decreased testosterone?
Decreased hair, muscle mass, rate/force of ejaculation, & seminal fluid.
Increase time needed to gain erection & increase in FSH/LH
What is erectile dysfunction/impotence?
inability to achieve or maintain an erection sufficient for sexual satisfaction
What are the causes of ED?
Vascular
Neurologic
Hormonal
Psychogenic
*Vascular the #1 cause*
What are the common disease processes that affect sexuality?
There are several (review notes) but the most common are Chronic Pain & Osteoarthritis
What is the PLISSIT model?
A tool of how to approach sexuality:
P: permission
LI: Limited Information
SS: specific suggestions
IT: Intensive Therapy
/ 239
Term:
Definition:
Definition:

Leave a Comment ({[ getComments().length ]})

Comments ({[ getComments().length ]})

{[comment.username]}

{[ comment.comment ]}

View All {[ getComments().length ]} Comments
Ask a homework question - tutors are online