hondros 163 final exam with complete solutions

Coping mechanism for elderly - Answer- Reminiscing helps them reflect on good times Fear - Answer- elderly generally do not fear death Intrinsic motivation - Answer- motivation from within homogenous - Answer- share a common historical and cultural experience heterogenous - Answer- many diverse subcultures with diff historical and cultural experiences must interact phases of greiving - Answer- shock and numbness: denial, anger, guilt searching and yearning: despair, depression, anger, guilt disorientation: depression, guilt, disorganization Reorganization: sence of release, decrease obsession with loss, renewed hope optimism teaching a pt and they become overwhelmed - Answer- break it down pain scale - Answer- 0-10 measuring fatigue - Answer- subjective chronic fatigue syndrome - Answer- pt is tired all the time regardless of sleep, signifigantly interferes with daily activities and work chronic fatigue syndrome interventions - Answer- alternate rest and activity, when planning day balance work and rest sunlight - Answer- needed for improved sleep and proper sleep patterns and the melatonin hormone intervention for poor sleep pattern - Answer- encourage outside sunlight intervention for incontinent pt up to use bathroom at night - Answer- briefs do not restrict fluids do not use catheter bedside commode can be used but more of fall risk new admit with multiple comorbidities, what do you report to physician - Answer- breathing problems primary sexual right for the elderly - Answer- two consenting adults genital discharge sign of - Answer- STD of STI intervention for dysphagia (difficult swallowing) while feeding - Answer- feed slowly, small bites, allow rest periods hypercalcemia - Answer- demenished deep tendon reflexes and muscle weekness Calcium levels - Answer- 8.5-10.5 Sodium levels - Answer- 135-145 magnesium levels - Answer- 1.5-2.5 potassium levels - Answer- 3.5-5 water soluble vitamins - Answer- b and c fat souble - Answer- adek(vit a, d, e, k) can cause toxicity and effect the liver primary prevention for flu - Answer- get flu shot Cause stress in elderly - Answer- change in routine, crime and victimization, loss of loved one, disease, injury, pain/suffering, loss of independence, financial destitution, lonliness Don't stress/fear death usually intervention to avoid stress in elderly - Answer- continuity of care food encouraged for wound healing - Answer- protein physical therapist assesment - Answer- includes: gait, pain, ROM, NOT bone density bed bound patient exercises - Answer- passive[min 2x/d pt bedbound/ or active ROM(for joint flexibility and muscle toning) cataracts - Answer- clouding of the lens of the eye, progresses over period of time and is painless no bright light they get glares glaucoma - Answer- increased intraocular pressure damages the retina and optic nerve initialy peripheral vision is affected non obvious sx so can progress before know they have it age related macular degeneration(AMD) - Answer- two kinds: dry amd & wet amd dry more common wet painful and severe if pt has poor vision - Answer- speak at eye level never approach from behind speak from doorway or loud voice exercise for osteoporosis pt - Answer- wt bearing exercises orthostatic hypotension - Answer- Decrease in blood pressure related to positional or postural changes from lying to sitting or standing positions intervention to prevent orthostatic hypotension - Answer- get pt up slowly, sit up on side of bed, dangle feet interventions for skin breakdown - Answer- turn q2hr barrier cream bladder training float heals use bed pad to pull up pt in bed diet high protein frequent incontinence care what is not always a sign/sx of DVT - Answer- swelling legs prevention of osteoporosis - Answer- adequate exercise,-strengthening exercise, adequate intake calcium, diet prevention of falls - Answer- no throw rugs, don't turn off lights polypharmacy - Answer- the prescription, administration, or use of more medications than are clinically indicated in a given patient first indicator of uTI - Answer- confusion foods high in potassium - Answer- spinach, applejuice, bananas, potatoes, tomatos canned foods high in - Answer- sodium alcoholism and elderly - Answer- hard to dx alcoholism in the elderly bc the sighs mimic aging signs pt is having trouble coping - Answer- not grooming self well interventions for relocation syndrome - Answer- continuity of care encourage verbilazation of feelings discuss reasons for move or change include older adult in care planning encourage use of familiar objects and belongings intervention for pt trying to overcome stress and cope - Answer- break it down and try to find a way to fix it interventions for pt high risk of dehydration - Answer- daily wts I&O's long term osteoporosis - Answer- can cause a pt to shrink last resort for poor sleep patterns - Answer- medication pt has roommate intervention to help with good sleep patterns - Answer- similar schedules vision screening - Answer- yearly joint commission - Answer- Establishes national patient safety goals. intervention for good oral care - Answer- fluoride toothpaste caffeine - Answer- interrupts sleep sleep patterns - Answer- sleep same time every night, consistency, read, no tv Suicide rates are _______higher_ among men than among women - Answer- likely to abuse other things alcohol, drugs etc if pt has good self esteem - Answer- in control of life and more motivated poor self esteem - Answer- less motivated, less control over life stress sx - Answer- above abd goes up below abd goes down may get dizzy interferences with good nutrition - Answer- money inability to read labels lack of access transportation physical stressors - Answer- heat, hunger, cold, noise, and trauma emotional stressors - Answer- feelings thoughts memories hypothermia sx - Answer- 95deg or lower temp mental confusion decreased pulse and respitory rate decreased body temp cool cold skin pallor or cyanosis swollen puffy face muscle stiffness fine tremors altered coordination changes in gait balance lethargy apathy irritability, hostility aggression aphasia(dysphasia) - Answer- stroke or head trauma can be cause speech pathologist receptive aphasia - Answer- difficulty understanding language expressive aphasia - Answer- unable to express themselves using language global aphasia - Answer- loses the ability both to understand language and to express using language nocturnal movement disorder - Answer- restless leg syndrome-urge to move lower extremities or nocturnal myoclonus-sudden repetitive jerking movements, kicking of lower extremities contribute to insomnia in the elderly delegate to UAP - Answer- ted hose non medicated barrier cream record I&O's causes of sex dysfunction in women - Answer- joint pain cardiac issues or fear of chronic depression discomfort during intercourse(dryness of vaginal walls increased risk for yeast infection stress, medications uterine prolapse, rectoceles,cystocele hydrocelei - Answer- scrotal swelling caused by a collection of fluid interventions to maintain sex health in elderly - Answer- sex does not decrease with age offer interventions for pain discomfort discuss sex give info STD STI example of complimentary alternative massage - Answer- geriatric massage cane use - Answer- left side weakness: hold cane on right side (strong side) cane and strong leg (right leg) will work together cane 6 in out from side of foot ( strong side) emotion focused strategies for coping - Answer- attempt to change the pt response to a special event or threat repression-remove anxious thoughts from conscience awareness denial-refuse to aknowlege when its obvious to others rationalization-create acceptable reason for unacceptable thoughts or actions intellectualization-make generalizations to avoid disturbing thoughts or feelings displacement-transfer emotions about one situation or person to another suppression-avoid thinking about projection-attributing ones own feelings to another sublimation-channeling negative energy into socially acceptable behaviors substitution- keeping so busy with activities that there is no time to think about stressors physical illness causes stress in older adult how - Answer- takes away energy to deal with new stressors pt with dementia how to help with effective coping - Answer- assess pts sleep patterns mild stress - Answer- good bc it raises mental alertness cane - Answer- hold on strong side effective outcome for pt with impaired mobility - Answer- pt remains safe and free from joint contractures assess pt coping abilility - Answer- ask what coping they have used in the past insert iv in pt get dizzy and breath rapidly - Answer- tell me your fav memory with your family, slow breathing intervention for concern about pts caregiver having caregiver strain - Answer- speak with caregiver discuss and gather infor from the caregiver supplements for osteoporosis - Answer- calcium vit D pt showing severe stress what sx display - Answer- agitated agressive relocation syndrome - Answer- pt moved from one home to another the physiologic or phychological stress that occurs problem focused coping - Answer- focusing on the problem, not denying or suppressing it, used to eliminate the problem pt transfer from bed to wheelchair - Answer- have pt help as much as possible purpose of incentive spirometer - Answer- make respirations easier ABG values - Answer- NORMAL VALUES pH = 7.35 - 7.45( l-acidosis h-alkalosis) pCO2 = 35 - 45 (respitory) Po2 = 80 - 100 HCO-39 (bicarb) = 22-26 (metabolic) ex. ph-7.25 pco2- 33 hco3-24 respitory acidosis insensible fluid loss - Answer- Occurs daily through lungs and skin--cannot be measured for accurate output pt has hyponatremia be (below 135) - Answer- encourage to drink sports drinks K+ - Answer- 3.5-5 Na+ - Answer- 135-145 Ca+ - Answer- 8.5-10.5 Mg+ - Answer- 1.5-2.5 pH - Answer- 7.35-7.45 Paco2 - Answer- 35-45 Hco3 bicarb - Answer- 22-26 hypervolemia - Answer- excess fluid volume high bp, high hr, edema hypovolemia - Answer- decrease fluid volume low bp, high hr, sunken eyes, dehydration, dry skin vit a - Answer- milk butter cheese, liver green and yellow veggies, fruits because of chronic conditions that interfere with fat absorbtion ie. gallbladder disease and cholitis Vit a deficiency is found in many pts with cholitis stroke pt watching them eat signs - Answer- drooling and coughing hypernatremia - Answer- dry mucous membranes, rubbery skin, decrease urine output pt has low sodium value-precautions - Answer- seizure precautions when stress increases the results are - Answer- decreased problem solving indecisive irratonal pt bedridden- what interventions - Answer- draw sheet to pullup in bed turn pt q2h pad bony prominences vit b12 - Answer- found in organ meats, eggs, shellfish, and dairy requires intrinsic factor from stomach for absorbtion- if inadequate absorbtion results in pernicious anemia needed for maturation on rbc's deficiency commonly seen in folacin deficiency DOES NOT AID ABSORBTION OF CALCIUM THAT IS VIT D electrolytes are excreted through - Answer- urine stool sweat emesis hypercalcemia above 45 - Answer- muscle weakness depressed reflexes