NR601 Midterm Exam
Rule of fourths ANS: this rule clarifies that changes often attributed to normal aging by the general
public. Caused by
- disease
-disuse
-misuse
-physiology.
Disease-related disability: could manifest as decreased exercise tolerance in chronic smoker with chronic
lung disease.
Disuse-related disability: SOB on minimal exertion in sedentary older persons.
Misuse-realated disability: knee arthritis in a former football player
disability related to physiolgic aging: trouble reading fine print in a 50 year old.
Functional reserve ANS: all body systems tend to have functional ability and move what is used during
everyday activities.
Nocturia ANS: almost ubiquitous in older persons, largely because of changes in bladder physiology
(decreased capacity and increased residual volume) combined with altered control of fluid excretion
(related to low nighttime antidiuretic hormone levels and increased nighttime natriuretic polypeptide
levels).
Vistable housing ANS: includes these three basic features
- at least one no-step entrance
,- doors and hallways that are wide enough to navigate through in a wheelchair or walker
- bathroom on the first floor big enough to get into a wheelchair and close the door.
Activity versus disengagement ANS: Disengagement theory: who posited that letting go of the trappings
of earlier life was the key to successful aging.
Activity theory: who believed that staying active and engaged was the key to healthy living.
Iatrogenic disease ANS: illness caused by medical interventions, is one of the most common medical
problems of older persons.
The majority of persons > 65 years old take 5 or more medications.
At least 2/3 of persons > 65 years have a significant decline in renal function, making them vulnerable
for AKI
Deliberate medicine ANS: a philosophy and approach that applies the prince of beneficence (first do not
harm).
Interprofessional nature of geriatric care ANS: 1. The 2008 institute of medic report, Retooling for an
aging America: building the health care workforce
- emphasized the importance of training all healthcare professionals in the skills needed to work
effectively in teams and calls for the implementation of new geriatric care models that use inter
professional teams.
2. The affordable care act
- holds clinicians and hospitals accountable not only for treating patients once they get sick but also for
helping to keep them out of the hospital and ER.
,3. The patient centered medical home.
- focuses on use of interpforessional teams to provided improved continuity, comprehensiveness, and
coordination of care.
Health promotion ANS: the science and art of helping people change their lifestyle to move forward to a
state of optimal health. Defined as balance of physical, emotional, social, spiritual, and intellectual
health.
Immunizations ANS: the target percentage for 2020 as set in Healthy people 2020 is 90% adherence for
non institutionalized adults aged > 65 years.
The second shingles vaccination, Shingri was approved in January 2018. This varicella recombinant
vaccine is strongly recommended for all adults over age 65, even those who have previously received
Zostavax.
The vaccination is recommended even if the patient is unsure about having chickenpox in the past..
if a person received the pneumovax before turning 65, it should be repeated once after the age of 65
years.
Prevnar is now only recommended for high-risk persons such as those with asplenia or cochlear impacts.
Tobacco use ANS: when cessation interventions are tailed to older adults, their rate of smoking
cessation equals that of younger people.
The most effective smoking cessation approach uses a combination of behavior approaches and
pharmacotherapy.
, Pharmacologic interventions for smoking cessation include seven first-line medications (five nicotine
and two non nicotine). Buproprion SR, nicotine replacement therapy (NRT) with gum, inhaler, lozenge,
nasal spray, or patch, and varenicline (Chantix).
Screening for alcohol use/abuse ANS: the most commonly used and reliable screening instrument for
alcohol use disorders is the CAGE self-report quisonaiire.
Other measures include the 25 question michagan Alcohol Screening Test (MAST).
Bone health ANS: Bone mineral density (BMD) testing screens for osteoporosis and when used in
conjunction with the fracture risk assessment tool (FRAX) predicts future fracture risk.
T-Scores reflect bone density in the lumbar spine (L1-L4), radius (one-third), and femoral neck/femur.
The USPSTF recommends BMD testing at least once in women over age 65 and above the
postmenopausal women younger than age 65 who are at increased risk for osteoporosis fractures
(previous trauma fracture, history of hyperparathyroidism, use of medications that reduce bone
density).
Recommend BMD testing for all men older than age 70 and in men age 50-70 when risk factors are
present.
Repeat or serial testing is done every 1-3 years after initiation of a bisphoshonate to gauge effectiveness
of treatment, looking for improvement in bone density.
Calcium and vitamin d ANS: When calcium from diet is inadequate, calcium supplementation, spread
through out the day, for a total intake of 1200-1500 mg is recommended.
the safe upper limit of total calcium intake is 2500 mg per day. Calcium citrate is better absorbed than
calcium carbonate and does not need to be taken with food.
Rule of fourths ANS: this rule clarifies that changes often attributed to normal aging by the general
public. Caused by
- disease
-disuse
-misuse
-physiology.
Disease-related disability: could manifest as decreased exercise tolerance in chronic smoker with chronic
lung disease.
Disuse-related disability: SOB on minimal exertion in sedentary older persons.
Misuse-realated disability: knee arthritis in a former football player
disability related to physiolgic aging: trouble reading fine print in a 50 year old.
Functional reserve ANS: all body systems tend to have functional ability and move what is used during
everyday activities.
Nocturia ANS: almost ubiquitous in older persons, largely because of changes in bladder physiology
(decreased capacity and increased residual volume) combined with altered control of fluid excretion
(related to low nighttime antidiuretic hormone levels and increased nighttime natriuretic polypeptide
levels).
Vistable housing ANS: includes these three basic features
- at least one no-step entrance
,- doors and hallways that are wide enough to navigate through in a wheelchair or walker
- bathroom on the first floor big enough to get into a wheelchair and close the door.
Activity versus disengagement ANS: Disengagement theory: who posited that letting go of the trappings
of earlier life was the key to successful aging.
Activity theory: who believed that staying active and engaged was the key to healthy living.
Iatrogenic disease ANS: illness caused by medical interventions, is one of the most common medical
problems of older persons.
The majority of persons > 65 years old take 5 or more medications.
At least 2/3 of persons > 65 years have a significant decline in renal function, making them vulnerable
for AKI
Deliberate medicine ANS: a philosophy and approach that applies the prince of beneficence (first do not
harm).
Interprofessional nature of geriatric care ANS: 1. The 2008 institute of medic report, Retooling for an
aging America: building the health care workforce
- emphasized the importance of training all healthcare professionals in the skills needed to work
effectively in teams and calls for the implementation of new geriatric care models that use inter
professional teams.
2. The affordable care act
- holds clinicians and hospitals accountable not only for treating patients once they get sick but also for
helping to keep them out of the hospital and ER.
,3. The patient centered medical home.
- focuses on use of interpforessional teams to provided improved continuity, comprehensiveness, and
coordination of care.
Health promotion ANS: the science and art of helping people change their lifestyle to move forward to a
state of optimal health. Defined as balance of physical, emotional, social, spiritual, and intellectual
health.
Immunizations ANS: the target percentage for 2020 as set in Healthy people 2020 is 90% adherence for
non institutionalized adults aged > 65 years.
The second shingles vaccination, Shingri was approved in January 2018. This varicella recombinant
vaccine is strongly recommended for all adults over age 65, even those who have previously received
Zostavax.
The vaccination is recommended even if the patient is unsure about having chickenpox in the past..
if a person received the pneumovax before turning 65, it should be repeated once after the age of 65
years.
Prevnar is now only recommended for high-risk persons such as those with asplenia or cochlear impacts.
Tobacco use ANS: when cessation interventions are tailed to older adults, their rate of smoking
cessation equals that of younger people.
The most effective smoking cessation approach uses a combination of behavior approaches and
pharmacotherapy.
, Pharmacologic interventions for smoking cessation include seven first-line medications (five nicotine
and two non nicotine). Buproprion SR, nicotine replacement therapy (NRT) with gum, inhaler, lozenge,
nasal spray, or patch, and varenicline (Chantix).
Screening for alcohol use/abuse ANS: the most commonly used and reliable screening instrument for
alcohol use disorders is the CAGE self-report quisonaiire.
Other measures include the 25 question michagan Alcohol Screening Test (MAST).
Bone health ANS: Bone mineral density (BMD) testing screens for osteoporosis and when used in
conjunction with the fracture risk assessment tool (FRAX) predicts future fracture risk.
T-Scores reflect bone density in the lumbar spine (L1-L4), radius (one-third), and femoral neck/femur.
The USPSTF recommends BMD testing at least once in women over age 65 and above the
postmenopausal women younger than age 65 who are at increased risk for osteoporosis fractures
(previous trauma fracture, history of hyperparathyroidism, use of medications that reduce bone
density).
Recommend BMD testing for all men older than age 70 and in men age 50-70 when risk factors are
present.
Repeat or serial testing is done every 1-3 years after initiation of a bisphoshonate to gauge effectiveness
of treatment, looking for improvement in bone density.
Calcium and vitamin d ANS: When calcium from diet is inadequate, calcium supplementation, spread
through out the day, for a total intake of 1200-1500 mg is recommended.
the safe upper limit of total calcium intake is 2500 mg per day. Calcium citrate is better absorbed than
calcium carbonate and does not need to be taken with food.
