NUR 410 Comprehensive Final Exam ||
Complete Questions & Answers (Graded A+)
Holistic View of the Elderly-
In gerontology, it is necessary to: - ANSWER - 1. Differentiate the aging process from disease.
2. Understand the contributions of heredity, lifestyle, and environmental factors in how people age.
3. Correlate the physiologic state with psychological, social, and physical function.
Assessment of the Older Adult
- special skills for older adult assessment - ANSWER - - Is more complex
- May require a team of professionals
Special skills for older adult assessment: - Listen patiently
- Allow for pauses
- Ask questions that are not often asked
- Observe for minute details
- Use all available sources for data
- Recognize normal changes of aging from abnormal
Factors influencing the collection of the health history in older adults - ANSWER - - Visual and auditory acuity
- Cognitive ability and reading level
- Manual dexterity
- Language and health fluency
- Adequacy of translation materials
- Availability of a trained interpreter
Health History
-review of systems - ANSWER - - Conducted prior to the physical examination
- Complex and time consuming
- Because of the number of health problems, one system often affects another system
- More like a "review of symptoms"
- See Box 7-2 for best practice tips when conducting a review of systems with an older adult
Physical Assessment of an older adult - ANSWER - - May be difficult to complete in one
setting, depending on the patient's stamina
- Not like the assessment process of a younger person
- Physical and cognitive limitations may affect the ability to perform the assessment
- Considerations of common changes specific to late life assessment (Box 7-4) - Be aware of cultural rules of etiquette and taboos that influence physical assessment (Box 7-8)
Physical Assessment
- FANCAPES - ANSWER - Fluids
Aeration
Nutrition
Communication
Activity
Pain
Elimination
Socialization and social skills
SPICES - ANSWER - Sleep disorders
Problems with eating or feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown
Functional Assessment of an older adult - ANSWER - - Comprehensive
- Evaluates person's ability to carry out basic tasks for self-care and tasks needed to support independent living
- Physical performance, Psychological (cognition/mood), Social function
- Medications
- Numerous tools available that describe, screen, assess, monitor, and predict functional ability
Comprehensive Geriatric Assessment - ANSWER - - Integrated approach
- Multidisciplinary
- Combines physical, functional, and psychosocial components into one instrument
- Generally comprehensive and lengthy
- Provides a basis for a detailed, individualized plan of care
What is OARS? - ANSWER - Older Americans Resources and Services (OARS): Multidimensional Functional Assessment Questionnaire
- Social resources
- Economic resources
- Mental health
- Physical health
- ADL and IADLs
What is MDS and RAI? - ANSWER - - Minimum Data Set (MDS) and Resident Assessment Instrument (RAI) - Mandated for use in all skilled nursing facilities that receive compensation from either Medicare or Medicaid - Quality Indicators (Box 7-15)
- Incorporates 450-item Minimum Data Set
What is the OASIS C1? - ANSWER - Outcomes and Assessment Information Set (OASIS C1)
- Used in home health nursing.
- Identifies the plan for nursing care in the home.
- Aimed at preventing rehospitalizations and ensuring safety in the home setting.
- Risk for hospitalization (Box 7-17)
Goal of assessment?
Challenge here? - ANSWER - - Goal of assessment is always to assist the person to move along the wellness trajectory toward health aging, regardless of care setting or health status.
- The gerontological nurse is challenged to provide the highest level of excellence in assessment of elderly without burdening the person in the process.
- Goal of assessment?
- Is health possible with chronic disease?
- What is the focus on? - ANSWER - - Goal of assessment is always to assist patient in improving quality of life.
- Health is possible in the context of chronic disease and disability.
- Focus on function, not disability.
- Goal is person-centered care.
- Patient autonomy and decision-making integral in the process of goal setting.
- Goals include quality and evidence-based care and patient safety
Factors Influencing Aging - ANSWER - - Heredity/ genes
- Nutrition
- Physical activity
- Health status
- Life experiences
- Environment - Social relationships and support
- Stress and outlook
- Socioeconomic factors
Laboratory Findings in Older Adults- what is challenging? - ANSWER - - The older the person, the more difficult the interpretation of findings - Diligence is needed to interpret results within context of person's overall health and normal changes of aging
- While there are no differences in what is normal result in a lab finding in older compared to younger adult, deviations are more likely to occur and put person at greater risk of poor outcomes
- This is especially true with atypical presentations of illness. Hematological Testing - results affected by? - ANSWER - - Associated with blood, lymph, and their component parts
- A number of disorders in older adults can be diagnosed or monitored with hematological testing (anemia, fatigue)
- Results can be affected by dehydration, inadequate nutrition, infection, and inflammation
Values:
RBC
Hb
HcT
-elevations in hematocrit and hemoglobin? - ANSWER - Red Blood Count (RBC)
- Normal value: 4.4-5.8 million/mm3
Hemoglobin (Hb)
- Normal value: 14-18 g/dL
Hematocrit (HcT)
- Normal value: 39-48%
Caution when interpreting H&H (Box 8-2)
Elevations in hematocrit and hemoglobin levels may be the result of a pathological process but are more often an early sign of hypovolemia from malnutrition, dehydration, or severe diarrhea. The volume depletion must be corrected before an accurate interpretation can be done.
Caution when Interpreting Hgb and Hct Levels - ANSWER - (Box 8-2)
Elevated levels may be result of
- Pathological processes
- Early sign of hypovolemia from * Malnutrition * Dehydration * Severe diarrhea - Volume depletion must be corrected before accurate interpretation can be done
Decreased marrow reserves leads to prolonged recovery from depletion of red cells via hemmorrage or phlebotomy. Frequent lab draws should be done with caution.
Hematological Testing:
Complete Questions & Answers (Graded A+)
Holistic View of the Elderly-
In gerontology, it is necessary to: - ANSWER - 1. Differentiate the aging process from disease.
2. Understand the contributions of heredity, lifestyle, and environmental factors in how people age.
3. Correlate the physiologic state with psychological, social, and physical function.
Assessment of the Older Adult
- special skills for older adult assessment - ANSWER - - Is more complex
- May require a team of professionals
Special skills for older adult assessment: - Listen patiently
- Allow for pauses
- Ask questions that are not often asked
- Observe for minute details
- Use all available sources for data
- Recognize normal changes of aging from abnormal
Factors influencing the collection of the health history in older adults - ANSWER - - Visual and auditory acuity
- Cognitive ability and reading level
- Manual dexterity
- Language and health fluency
- Adequacy of translation materials
- Availability of a trained interpreter
Health History
-review of systems - ANSWER - - Conducted prior to the physical examination
- Complex and time consuming
- Because of the number of health problems, one system often affects another system
- More like a "review of symptoms"
- See Box 7-2 for best practice tips when conducting a review of systems with an older adult
Physical Assessment of an older adult - ANSWER - - May be difficult to complete in one
setting, depending on the patient's stamina
- Not like the assessment process of a younger person
- Physical and cognitive limitations may affect the ability to perform the assessment
- Considerations of common changes specific to late life assessment (Box 7-4) - Be aware of cultural rules of etiquette and taboos that influence physical assessment (Box 7-8)
Physical Assessment
- FANCAPES - ANSWER - Fluids
Aeration
Nutrition
Communication
Activity
Pain
Elimination
Socialization and social skills
SPICES - ANSWER - Sleep disorders
Problems with eating or feeding
Incontinence
Confusion
Evidence of falls
Skin breakdown
Functional Assessment of an older adult - ANSWER - - Comprehensive
- Evaluates person's ability to carry out basic tasks for self-care and tasks needed to support independent living
- Physical performance, Psychological (cognition/mood), Social function
- Medications
- Numerous tools available that describe, screen, assess, monitor, and predict functional ability
Comprehensive Geriatric Assessment - ANSWER - - Integrated approach
- Multidisciplinary
- Combines physical, functional, and psychosocial components into one instrument
- Generally comprehensive and lengthy
- Provides a basis for a detailed, individualized plan of care
What is OARS? - ANSWER - Older Americans Resources and Services (OARS): Multidimensional Functional Assessment Questionnaire
- Social resources
- Economic resources
- Mental health
- Physical health
- ADL and IADLs
What is MDS and RAI? - ANSWER - - Minimum Data Set (MDS) and Resident Assessment Instrument (RAI) - Mandated for use in all skilled nursing facilities that receive compensation from either Medicare or Medicaid - Quality Indicators (Box 7-15)
- Incorporates 450-item Minimum Data Set
What is the OASIS C1? - ANSWER - Outcomes and Assessment Information Set (OASIS C1)
- Used in home health nursing.
- Identifies the plan for nursing care in the home.
- Aimed at preventing rehospitalizations and ensuring safety in the home setting.
- Risk for hospitalization (Box 7-17)
Goal of assessment?
Challenge here? - ANSWER - - Goal of assessment is always to assist the person to move along the wellness trajectory toward health aging, regardless of care setting or health status.
- The gerontological nurse is challenged to provide the highest level of excellence in assessment of elderly without burdening the person in the process.
- Goal of assessment?
- Is health possible with chronic disease?
- What is the focus on? - ANSWER - - Goal of assessment is always to assist patient in improving quality of life.
- Health is possible in the context of chronic disease and disability.
- Focus on function, not disability.
- Goal is person-centered care.
- Patient autonomy and decision-making integral in the process of goal setting.
- Goals include quality and evidence-based care and patient safety
Factors Influencing Aging - ANSWER - - Heredity/ genes
- Nutrition
- Physical activity
- Health status
- Life experiences
- Environment - Social relationships and support
- Stress and outlook
- Socioeconomic factors
Laboratory Findings in Older Adults- what is challenging? - ANSWER - - The older the person, the more difficult the interpretation of findings - Diligence is needed to interpret results within context of person's overall health and normal changes of aging
- While there are no differences in what is normal result in a lab finding in older compared to younger adult, deviations are more likely to occur and put person at greater risk of poor outcomes
- This is especially true with atypical presentations of illness. Hematological Testing - results affected by? - ANSWER - - Associated with blood, lymph, and their component parts
- A number of disorders in older adults can be diagnosed or monitored with hematological testing (anemia, fatigue)
- Results can be affected by dehydration, inadequate nutrition, infection, and inflammation
Values:
RBC
Hb
HcT
-elevations in hematocrit and hemoglobin? - ANSWER - Red Blood Count (RBC)
- Normal value: 4.4-5.8 million/mm3
Hemoglobin (Hb)
- Normal value: 14-18 g/dL
Hematocrit (HcT)
- Normal value: 39-48%
Caution when interpreting H&H (Box 8-2)
Elevations in hematocrit and hemoglobin levels may be the result of a pathological process but are more often an early sign of hypovolemia from malnutrition, dehydration, or severe diarrhea. The volume depletion must be corrected before an accurate interpretation can be done.
Caution when Interpreting Hgb and Hct Levels - ANSWER - (Box 8-2)
Elevated levels may be result of
- Pathological processes
- Early sign of hypovolemia from * Malnutrition * Dehydration * Severe diarrhea - Volume depletion must be corrected before accurate interpretation can be done
Decreased marrow reserves leads to prolonged recovery from depletion of red cells via hemmorrage or phlebotomy. Frequent lab draws should be done with caution.
Hematological Testing:
