WGU Care of the Older Adult - C475

WGU Care of the Older Adult - C475 Healthy People 2010 Ans: develop a set of health care objectives designed to increase the quality and quantity of years of healthy life of Americans and to eliminate health disparities barriers to physical activity Ans: lack of access to safe areas to exercise, pain, fatigue, and impairment in sensory function and mobility risks for poor nutrition Ans: multiple chronic illnesses, may have tooth or mouth problems that may interfere with their ability to eat, may be socially isolated, may have economic hardship, may be taking multiple medications that can cause changes in appetite or gastrointestinal symptoms, and may need assistance with self-care falls Ans: leading cause of unintentional injury death in older adults in this country Polypharmacy Ans: the taking of multiple drugs concurrently, whether prescribed or OTC tetnus shot Ans: recommended re-vaccination after 10 years in the elderly Mini Mental State Examination Ans: This exam test the elderlys orientation, registration, attention and calculation, recall(memory) and visou spatial skills. If the patient score less than twenty indicates cognitive impairment. Aids in detecting dementia CAGE questionnaire Ans: • Cut down: Refers to attempts by the client to cut down on drinking • Annoyance: Related to suggestions by friends or family to cut down on drinking • Guilt: Relates to client guilt about drinking • Eye opener: Relates to the need for a drink in the morning to get going Elder abuse reporting Ans: may include physical, sexual, psychological, and financial exploitation, neglect, and violation of rights Report to adult protective service In nursing homes and assisted living facilities must be reported to the Long-Term Care Ombudsman Program in most states. Modified Caregiver Strain Index Ans: tool that can be used to quickly screen for caregiver strain with long-term family caregivers. It is a 13-question tool that measures strain related to care provision Reciprocity Ans: ability to be true to one's self while respecting and supporting the values and views of another Patient Self-Determination Act of 1990 Ans: this law requires that patients are provided the opportunity to express their preferences regarding lifesaving or life-sustaining care on entering any health care service, including hospitals, long-term care centers, and home care agencies. The law also requires that adequate information be supplied to the patient so that he or she can make informed decisions regarding self-determination advanced directives Ans: Decisions regarding life-saving or life-sustaining care are recorded in legal documents known as__________ living will Ans: alternative documents that direct preferences for end-of-life care issues, providing an "if...then..." plan autonomy Ans: independent; not controlled by others; self-governing self-determination Ans: The patient right that is the right to decide healthy aging Ans: the ability to maintain three key behaviors: low risk of disease and disease-related disability, high mental and physical function, and active engagement of life vaccination recommendations Ans: annual flu pneumonia, revaccination after 5 years if 75 or older Boosters for tetanus every 10 years Framingham Heart Study Ans: risk factors associated with coronary heart disease: Age greater than or equal to 50 for men and 60 for women • Hypertension • Smoking • Obesity • Family history of premature CHD • Diabetes (considered to be a CHD risk-equivalent, i.e., carries the same risk of a coronary event as known CHD) • Sedentary lifestyle • Abnormal lipid levels Dementia screening Ans: The Mini Mental State Examination (MMSE) Smoking cessation Ans: The 5 As Ask about smoking status at each health care visit. Advise client to quit smoking. Assess client's willingness to quit smoking at this time. Assist client to quit using counseling and pharmacotherapy. Arrange for follow-up within one week of scheduled quit date. The 5 Rs Relevance: Ask the client to think about why quitting may be personally relevant for him or her. Risks of smoking are identified by the client. Rewards of quitting are identified by the client. Roadblocks or barriers to quitting are identified by the client. Repetition of this process at every clinic visit. Most people who successfully quit smoking require multiple attempts. Elder abuse - signs of Ans: Bruises Broken bones Burns Abrasions Pressure marks Hearing odd explanations for injuries -- "Oh, she ran into a wall." Barriers to physical activity Ans: Barriers to physical exercise that have been identified by the elderly include lack of access to safe areas to exercise, pain, fatigue, and impairment in sensory function and mobility. Depression screening Ans: Geriatric depression scale Functional assessment Ans: ADL and instrumental activities of daily living (IADLs) . ADL index can be used to determine a patient's care plan. Determines wheter patient's are safe in their current environment. Three types of assessments Ans: Physical, functional and cognitive What is NOT a normal sign of aging? Ans: Dementia Cognitive assessment measures - Ans: thought processing, thinking, reasoning skills CAM Ans: the confusion assessment method; used to diagnose delerium Symptoms of delirium Ans: disorientation to time and place, altered attention, impaired memory, mood swings, poor judgment, altered level of consciousness, and a decreased Mini Mental State Examination (MMSE) score. CDT Ans: Clock drawing test; screens for mild cognitive impairment SPICES (fulmer) Ans: S is for Sleep Disorders P is for Problems with Eating or Feeding I is for Incontinence C is for Confusion E is for Evidence of Falls S is for Skin Breakdown an instrument for obtaining the information necessary to prevent health alterations in the older adult patient Differences between delirium and dementia Ans: Some differences between the symptoms of delirium and dementia include: Onset. The onset of delirium occurs within a short time, while dementia usually begins with relatively minor symptoms that gradually worsen over time. Attention. The ability to stay focused or maintain attention is significantly impaired with delirium. A person in the early stages of dementia remains generally alert. Fluctuation. The appearance of delirium symptoms can fluctuate significantly and frequently throughout the day. While people with dementia have better and worse times of day, their memory and thinking skills stay at a fairly constant level during the course of a day. Mini-Cog evaluation Ans: assessment tool for dementia susceptible to polypharmacy Ans: multiple comorbid conditions for acute and chronic health conditions; take meds to treat side effects also, take OTC meds, if dementia don't know what they are taking/take wrong meds BEERS Ans: list of inappropriate drugs for older adults Common drugs alter lab results Ans: isoniazid levodopa morphine vitamin c penicillin G MAP Ans: medication assistance program - cannot afford to pay for meds kohlman evaluation of living skills Ans: The Kohlman Evaluation of Living Skills (KELS) is an occupational therapy evaluation that is designed to determinea person's ability to function in basic living skills. The administration of the evaluation combines questions and tasks. Borg category scale Ans: Perceived Exertion (Borg Rating of Perceived Exertion Scale) The Borg Rating of Perceived Exertion (RPE) is a way of measuring physical activity intensity level. Perceived exertion is how hard you feel like your body is working Risks for falls - intrinsic Ans: LE weakness, dizziness, psychoactive meds, poor visions, probs with feet/shoes, home hazards Most falls occur Ans: During usual activities such as walking. Indoor falls occur most often in the bathroom, bedroom, and kitchen. About 10% of falls occur on stairs, with descent being more hazardous than ascent. The first and last steps are the most dangerous. Common sites of outdoor falls are curbs and steps. bailey bulls eyes Ans: The goal of the bull's-eye is for people to consume the nutritious foods that are listed in the center of it. Risk for falls - extrinsic Ans: environmental hazards and challenges such as: • Poor lighting • Poor color distinction • Cluttered environment • Unfamiliar environment • Stairs • Throw rugs • Unsuitable footwear • Restraints • Side rails Four leading causes of death Ans: cancer • diabetes • coronary heart disease • cerebral vascular accidents Medicare preventative services Ans: One time "Welcome to Medicare Physical • Cardiovascular screening every 5 years • Cervical cancer screening every 2 years • Colorectal cancer: annually for fecal occult blood test; every 4 years for sigmoidoscopy or barium enema • Densitometry: covered every 2 years • Diabetes screening annually • Mammogram covered annually • Prostate cancer covered annually • Smoking Cessation: Two quit attempts annually • Immunization: Influenza vaccination covered annually; pneumococcal vaccination covered one time, revaccination after 5 years dependent on risk. Malnutrition Ans: serum albumin Medicare Ans: federal health insurance for people 65 years+, people with end stage real disease, or disable lou gehrig's disease (ALS) Medicaid Ans: children's health insurance program, military personal, veterans, American Indians/ Alaska Natives the poor - person with disabilities, low income woman, children beneficiary must qualify by demonstrating a level of a need usually based on low income and personal assets or excessive medical expenses Medicare part a Ans: Helps cover inpatient care in hospitals Most people don't pay for it Starts 1st day of the month you turn age 65 Provides medical expense insurance (hospital stay) to persons over 65 years old or anyone with chronic kidney disease or with disability receiving Social Security Disability benefits for more than 24 months. Medicare part b Ans: Medical insurance for Medical Services: a) medical services by practitioners-doctors, etc. b) outpatient services c) medical supplies d) many services not covered by Medicare Part A. Problems with patient transfers/why are pts readmitted to hospital Ans: No follow-up care; Not understanding discharge instructions; Medication issues; Lack of timely follow-up appointment; Unmet post-discharge needs; Poor communication with PCP; Mostly preventable care transition categories Ans: Medication management; Transition planning; Patient and Family Engagement or education; Information Transfer; Follow Up Care; Healthcare Provider Engagement; Shared accountability across providers and organizations interdisciplinary team Ans: MD, nurse, SW, therapy, dietary, dentist, pharmacist, PA, NP Role of nurses in transition of care Ans: Bedside nurses assess patients, design and implement care plans, and educate them about medications, self-care, activity, diet restrictions, and important symptoms or red flags to look for - all in preparation for discharge.