Flashcards
Nursing Care of the Older Person
Cards in this deck (66)
- 1Society often views old age as?Decline, disease, disability, decrepitude or death.
(this isn't the case) - 2What are the main causes of death for older Australians?Heart Disease
Stroke
Cancer - 3What is the main contributor for burden of disease for people aged over 85 yearsDementia
- 4What is WHO's definition of active ageing?‘the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age’ allowing people to ‘realize their potential for physical, social and mental well-being throughout the life course’
- 5What is included in an age-friendly city?Outdoor spaces and buildings
Transportation and Housing
Social participation
Respect and social inclusion
Civic participation and employment
Communication and information
Community and health services - 6What is Person Centred Care?holistic care; realistic (collaborative) goal setting; interdisciplinary care.
- 7What can you do as a nurse to insure optimal age care?-Advocate on behalf of older people and challenge ageism
-Understand and integrate health, community and government resources
-Focus on person centred care - 8Define STROKEterm describing neurological changes caused by an interruption of blood supply to a part of the brain
(decrease in oxygen to a localised area=neural tissue destruction=brain damage) - 9What are the two main stroke typesIschemic and Haemorrhagic
- 10Lack of oxygen to the brain can result in irreversible brain damage after how long?5 mins
- 11what is an Ischaemic Strokeartery blocked by a blood clot
(embolic and thrombotic) - 12what is a haemorrhagic strokeArtery bursts causing a bleed
(subarachnoid and intracerebral) - 13what does TIA stand for? and what is it?Transient Ischaemic Attack
when blood supply to the brain is interrupted for a short period of time - 14TRUE or FALSE Do mini-strokes (TIA) resolve within 24 hours?TRUE
- 15What are the impacts of a strokeMobility
daily activities
relationships and family
emotional
psychological - 16FACTS1 in 6 people will have a stroke
2nd biggest killer and leading cause of disability in Australia - 17FACTstroke victims-
1/3 die within 12 months
1/3 full recovery
1/3 left with a disability - 18Non modifiable risk factors of a strokeage, sex (more in males), race and family history
- 19Modifiable risk factors for strokehypertension
hypercholesteremia
diabetes mellitus
cardiac disease
TIA
tobacco use, pill, obesity, alcohol, diet, stress - 20How do you know if someone is having a STROKE?F.A.S.T
face, arms, speech, time - 21Signs and Symptoms of STROKEweakness/numbness
vision loss
difficulty speaking/swallowing
headache/dizziness
facial droop
loss of consciousness - 22what is penumbra?zone of compromised cells that are unable to function but remain viable
- 23what is the pathophysiology of an Ischaemic strokeIschaemia>Infarction> Necrosis
- 24TRUE OR FALSE The brain doesn't depend of glucose for metabolismFALSE
totally dependant - 25NURSES ROLE in stroke managementprimary and secondary prevention of stroke
initial management
rehabilitation
discharge planning
pt education - 26Goal of acute stroke managementadequate airway and O2
stable and slightly ^ BP
serum glucose maintained
aseptic techniques - 27Required vital signs for a stroke patient2/24 GCS
4/24 vitals
continuous cardiac monitoring
BGL monitoring - 28what does ICP stand for?Intracranial pressure
- 29reasons for deterioration post strokeprogression of stroke
extension of stroke
^ICP- cerebral oedema
haemorrhagic transformation of infarcted brain
seizures - 30signs and symptoms of ^ICPdecreased level of consciousness
^ severity of headache
nausea and vomiting
cushings triad - 31Thrombolysis with Alteplase after acute ischemic strokegiven with 3-4.5 hours
- 32Recognising and responding to acute deterioration in older adultsPhysiological observations recorded at the time of admission/initial assessment or regular observation
− clear documentation of the assessment and a monitoring plan. The plan should take account of the:
◊ patient’s diagnosis
◊ presence of comorbidities
◊ agreed treatment plan. - 33what are the four steps of Recognising and responding to acute deterioration1.Awareness and utilisation of established recognition and response systems
2.Escalation of care
3. Responses to clinical deterioration
4. Communicating with patients and carers - 34what are the contexts of acute deterioration in older personsfrailty
disability
co-morbidity - 35what is frailty?Frailty syndrome: accumulation of physiological deficits which individually may be reversible but collectively can represent an intractable burden of disease
- 36what are the contributions to frailty syndrome?Chronic undernutrition
Sarcopenia
Decreased metabolic rate
Reduced energy expenditure - 37what is the Comprehensive Geriatric Assessment (CGA)CGA is an evidenced based model for the provision of co-ordinated, interdisciplinary acute medical care for older patients.
CGA is both diagnostic and therapeutic
-identifies the multiple overlapping problems of older patients - 38What are the domains of the CGAmedical
mental health
functional capacity
social circumstances
environment - 39What is the AMBER care bundle used for?help clinicians identify patients whose recovery is uncertain and, while continuing treatment, initiate discussions between clinicians, patients and families about their preferences and putting plans in place should their health deteriorate.
- 40what does AMBER care bundle stand for?A- assessment
M- management
B- best practice
E- engagement
R- recovery uncertain - 41Definition of a wounda break in the epithelial integrity of the skin
the disruption could be deeper, extending into the dermis, subcutaneous fat, fascia, muscle or even the bone’1 - 42what are the phases of wound healing1. haemostasis/inflammatory (0-10)
2. proliferative (1-30)
3. remodelling (10-300) - 43types of wound closureprimary
delayed primary (due to inflammation etc)
secondary
skin graft
flap repair - 44Local factors affecting wound healingnecrotic burden
wound temp
wound exudate
wound moisture - 45systematic factors affecting wound healing?underlying disease e.g.. diabetes
oedema
sepsis
stress
medications
smoking
obesity - 46Wound assessmentWound history
Medications
Type: acute/chronic
Stage:
location
pain assessment
infection
characteristics - 47Skin Tear ManagementAttempt to replace tissue if viable e.g. roll back skin, use moistened cotton bud and gently syringe with saline
Dress with non-adherent dressing e.g. Mepitel or Mepilex range of products which can be left intact for 5 days, mark direction for removal
If non-healing, refer to GP, Wound CNC, Plastics/Surgical Team for further advice - 48What is a pressure injury?A pressure injury (PI) is a “localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.”
- 49Leg ulcer treatmentDirect management
Venous = compression, surgery
Arterial = re-purfusion
Vasculitic = treat underlying condition
Neoplastic = treat according to lesion - 50What are the factors of Wound management-Patient position for delivery of care
-Dressing Schedule, e.g. the dressing type, amount of wound exudate
-Treatment objective/goal of wound care
-Pain score/analgesic use
-Cleansing Solution and techniques for cleaning the wound
-Surrounding Skin Care, e.g. moisturiser, barrier wipes - 51Types of dressingsPrimary Dressing, e.g. hydrofibre, gel, foam, silicone product
Secondary Dressing e.g. foam, gauze, super-absorbant pads
Fixation/Retention e.g. tapes, stockingette, bandage, velband/softban - 52Define Dementia“Dementia is the term used to describe the symptoms of a large group of illnesses which cause a progressive decline in a person’s functioning. It is a broad term used to describe a loss of memory, intellect, rationality, social skills and what would be considered normal emotional reactions.” There are a variety of causes. The most common cause of dementia is Alzheimer’s disease
- 53FACTS- DEMENTIADementia is NOT a normal part of ageing.
However, the longer a person lives, the more likely they are to develop dementia.
Dementia is more common after the age of 65 years.
The risk is one person in four over the age of 85 years. - 54Normal brain functions and partsFrontal lobe – Planning, organisation and decision-making. Social behaviour and starting and stopping tasks.
Temporal lobe – Memory of what is read, seen or heard.
Parietal lobe – Language, speech, reading, maths, spatial awareness, recognition and naming.
Occipital lobe - Vision
Cerebellum – Balance, coordination of voluntary movement
Brain stem – Breathing, heart rate, swallowing, reflexes, temperature, blood pressure, etc. - 55Common causes of dementiaAlzheimer’s disease (50%-70% of cases)
Vascular dementia
Dementia with Lewy bodies
Fronto Temporal Lobar Degeneration - 56Rare causes of dementiaParkinson’s disease
Alcohol related dementia (Korsakoff’s syndrome)
Creutzfeldt-Jacob disease (mad cow disease)
AIDS related dementia
Huntington’s disease - 57List the therapeutic approaches to communication with people with dementiareality therapy
reminisce therapy
validation therapy - 58Risk factors for incontinenceage
obesity
pregnancy, child birth
UTI
Diabetes
dementia/cognitive impairment
menopause
chronic illness
mobility impairment - 59Types of urinary incontinence1. stress
2. urinary
3. mixed (1+2)
4. nocturnal enuresis
5. continuous leakage
6. overactive bladder
7. functional - 60management of incontinencedetermine the cause and reverse where possible.
Voiding and defecation diaries
Bladder and bowel training
Pelvic floor muscle exercises
Prompted toileting.
Dietary modifications.
Pharmacological management
Continence aids and appliances - 61Aetiology of constipation in older persons.Cardiac disorders.-Congestive cardiac failure
Dietary causes- Low fibre in diet, fluid depletion.
Endocrine and metabolic- Diabetes mellitus, hypothyroidism etc.
Myopathic disorders-Amyloidosis, systemic sclerosis.
Neurological.-Dementia, depression, autonomic neuropathy etc
Gastrointestinal disorders-Anal fissure, external compression (e.g. from a tumour), diverticular disease, strictures, (inflammatory, post diverticulitis, post ischaemic, post-radiotherapy)
General- Bedridden status. - 62Medications associated with constipationAnticholinergics , Antidepressants, Antihistamines, Anticonvulsants Antipsychotics, Calcium-channel blockers
Clonidine (Catapress), Diuretics, Iron, Levodopa, NSAIDS, Opioid,
Psychotrophics - 63What are the ethical principles?autonomy- consent, confidentially
beneficence- relevant skills
non-maleficence- relevant skills
justice- respect law and rules - 64What is an advance directiveA person with capacity indicates wishes re treatment – relevant for possible future time when no longer competent
- 65What is a substituted decision makerA SDM is an authorised representative for a person who lacks capacity
Nominated
Appointed - 66Palliative care definition(WHO)Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
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- Nursing care of the older person study notes
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