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STUDY GUIDE for C475 Care of Older Adult Objective Assessment | Western Governors University - NURS C475; Exam questions are taken from the Learning Objectives under the 9 Competencies:

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STUDY GUIDE for C475 Care of Older Adult Objective Assessment | Western Governors University - NURS C475; Exam questions are taken from the Learning Objectives under the 9 Competencies: STUDY GUIDE f ... or C475 Care of Older Adult Objective Assessment Exam questions are taken from the Learning Objectives under the 9 Competencies: #1 Competency 742.1.1: Compassionate and Respectful Care of Older Adults The graduate integrates principles of compassion and respect for patients and their families into the planning and delivery of care to a diverse population of older adults and into advocacy for vulnerable older adults. This topic addresses the following learning objectives: • Recognize the impact of attitudes, values, and expectations about aging. • Describe how the RN’s personal beliefs and values may impact the care of older adults. • Articulate the concept of individualized care as the standard of practice with older adults, considering the right care, at the right time, in the right place and by the right provider of care.  Define Baby Boomers  Those born between 1946-1964; that are now reaching retirement age  What are the five racial groups listed in your text?  European Americans, African Americans, Hispanic Americans, Asian Americans, and Native Americans  How would you perform discharge teaching to an Hispanic patient  Whittemore (2007) conducted a systematic review of the literature to identify culturally competent interventions for Hispanic adults with type 2 diabetes. In reviewing 11 studies, Whittemore found that providing educational sessions and written materials, in both English and Spanish; employing bilingual Hispanic staff; including family members in an informal atmosphere in health care encounters; incorporating cultural traditions in interventions; developing culturally relevant program literature; and providing fact sheets about risk and potential poor outcomes of chronic conditions such as diabetes will increase the effectiveness of interventions. • Apply effective and respectful communication strategies in the care of older adults and their families.  List some of the changes of aging that could affect therapeutic communication  Physical: like aphasia (difficulty finding words, writing, expression), dysarthria (difficult speaking)  Psychological: Dementia, Mental disease, schizophrenia, depression, embarrassment (hearing loss, vision loss), English as a second language (cannot understand or relay message) , fear of being labeled as a complainer  Eyes: Senile miosis, difficulty adjusting to bright lights, presbyopia (accomodating near to far), decrease in acuity or depth perception, dry eyes  Ears: conduction problems, tumors, infections, foreign objects, noise pollution (hx playing in band), otoxic substances, freq, presbycuspis most common **  Note the ways to communicate or assist a patient with disabilities such as hearing deficits, vision impairments, or aphasia and dysarthria. How should you address the older adult during therapeutic communication?  Disabilities in general: Slow down, allow time for reaction, set up environment, gather supplies ahead of time, tell family members to answer only when directed, introduce your name and role, eliminate background noise (turn off tv if too loud), determine how the pt likes to be addressed (never use honey or dear), extend your hand and shake and smile, maintain eye contact, do not talk down, avoid crossing arms, do not minimize their concerns  Hearing loss: Do not use a high pitch voice or shout, stand in front of them, Sit at the side they hear best, Do not cover your face, Eliminate background noise  Visual loss: Do not startle, position yourself, provide ample lighting, be prepared if the patient states they see objects that you do not.  Language impairment: use short, uncomplicated sentences, maintain eye contact, provide an environment low in distractions, observe facial cues, paper and pen, do not correct what they say.  Know the abbreviations or acronyms, such as AAC. Know which hearing aids cover the widest range of hearing loss. See the box on Types of Hearing Aids in chapter 5. Both hearing aids and AAC will be mentioned again in Chapter 16. -AAC ‘augmented and alternative communication’, is an integrated group of components, including symbols, aids, strategies and techniques used by individuals to enhance communication. -BTE (behind the ear) is the most common and covers the widest range of hearing loss assistive device.  Make sure you understand what patients could benefit from the use of the AAC.  Deaf, Dysarthria  Understand what things can occur to make it difficult to communicate  Any barriers listed above, embarrassment, isolation, etc.  Which type of hearing aid covers the entire range of hearing loss? Behind the ear, functions on battery, easy to use.  What factors in a diverse aging population affect communication? • Support individual health goals that range from healthy activities to simply achieving comfort. • Illustrate compassionate and individualized care for older adults with chronic illness that reduces symptom burden and seeks to preserve quality of life. #2 Competency 742.1.2: Health Promotion/Maintenance and Living Environments of Older Adults The graduate evaluates the older adults' life world with special awareness of the diversity among the health status of older adults, individualizing care according to the physical, mental/cognitive, functional, and psycho-social well-being of an elder patient, along with support systems in place. *You will notice that Competencies two through five overlap one another. Some of the information for one topic may be found in another topic or another competency. Don’t become frustrated. It will all come together. This topic addresses the following learning objectives: • Identify functional and physical changes in the aging adult that would necessitate changes to the living environment. • Identify cognitive, psychological, and social changes common to the aging adult that would necessitate changes to the living environment. • Recognize steps to mitigate common physical safety issues. • Analyze the living environment of a given older adult with special awareness of the functional, physical, cognitive, psychological, and social changes of aging.  What are the five A’s to tobacco cessation?  What are the Five R’s to tobacco cessation?  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.  What is the criterion for the pneumococcal vaccine?  Pneumococcal vaccine is given once for clients who are 65 years of age or older. There is evidence to support one-time-only revaccination for clients 75 years or older who have not been vaccinated in 5 or more years.  In most cases of elder abuse who is the perpetrator?  Most cases of elder abuse are perpetrated by a family member, and reasons for the abuse include caregiver burnout and stress, financial worries, transgenerational violence, and psychopathology in the abuser. Women and dependent elders tend to be the most vulnerable to abuse.  What 5 areas do Healthy People 2010 and the USPSTF suggest that nurses focus on to promote health & prevent disability in the older adult? (see page 356 in text)  Physical activity  Nutrition  Tobacco use  Safety  Immunization  Describe the difference between ADLs and IADLs (instrumental activities of daily living)  ADL: Include bathing, dressing, grooming, showering, and toileting activities.  IADL: Activities related to independent living; they include meal preparation, money management, shopping, housework, and using a telephone.  Tools of ADL/IADL can be used to determine functional ability of a pt and how much they need to depend on others to live alone or with some assistance.  List the nutritional assessment tests to determine risk for diet-related chronic illness (see text page 359)  DETERMINE Your Nutritional Health Checklist: A tool created by the Nutrition Screening Initiative, a collaborative project of health, medical, and aging organizations. The nutrition checklist can be ordered from the initiative’s Web site for a nominal fee.  • Serum albumin: Less than 3.5 g/dl is associated with malnutrition and increased morbidity and mortality.  • Body mass index (BMI): The Nutrition Screening Initiative suggests that a BMI of 22–27 is considered normal. Values above or below this range suggest over- and underweight, respectively. Unintended weight loss is a nutritional risk that requires additional assessment. Obesity is a problem for many older Americans, just as it is for younger adults. The Obesity Education Initiative of the National Heart, Lung, and Blood Institute (2005) has provider guidelines and patient education materials  • Adult Treatment Panel (ATP III) Cholesterol Guidelines: An unintended decrease in cholesterol to less than 150 mg/dl is a nutritional risk  • ADL and IADL measures: These can assess a client’s ability to eat and prepare food and to do the shopping and transportation necessary for good nutrition.  • Dietary Reference Intakes and Recommended Daily Allowances: These can be compared with food diaries from a 24- to 48-hour period to assess marked deviation from these guidelines. Clients who use many vitamin and nutritional supplements may be at risk for toxicities.  • Depression and dementia: Both are risk factors for nutritional compromise.  Review the USPSTF Screening Recommendations for Older Adults, Table 12-1 on page 376 in text.  Immunizations:  Annual flu vaccine  Pneumococcal vaccine once after age 65 and onetime revaccination for clients over age 75 who’ve not been vaccinated in 5 years  Td vaccine every 10 years  Review the I HATE FALLING risk assessment tool, Box 12-4 on page 361. What can the nurse recommend to reduce risk of falling?  Inflammation of joints or joint deformity  Hypotension (orthostatic blood pressure change)  Auditory and visual abnormalities  Tremor  Equilibrium problems  Foot problems  Arrhythmias, heart block, valvular disease  Leg-length discrepancy  Lack of conditioning (generalized weakness)  Illness  Nutrition (poor, weight loss)  Gait disturbance  Balance and strengthening exercises, home safety modifications, and elimination of high-risk medications have been the focus of fall-risk prevention strategies. There are strong data to support the effectiveness of balance and strengthening exercises for fall reduction, as well as research to support physiologic and environmental risk factor reduction. PREVENTION is key. #3 Competency 742.1.3: Health Needs of Older Adults The graduate effectively collaborates with patients, families and inter-professional team members in planning primary, secondary, tertiary and end-of-life care that addresses older adults' physical, mental, psychosocial and spiritual needs and preferences and responses to changes in health status and related treatments. This topic addresses the following learning objectives: • Identify how the physiological changes of aging affect the organs involved in absorption and excretion of medications • Recognize functional changes and mobility issues that may threaten independence in the older adult. • Identify factors that may contribute to alterations in nutrition, metabolism, and elimination in older adults. • Recognize the signs and symptoms of geriatric syndromes and the subsequent frailty that may result. • Apply knowledge of the aging process and associated risk factors; skills in history-taking and assessment; and respect for the dignity of older adults in a comprehensive, individualized assessment. • Identify and use valid and reliable standardized tools of functional assessment in older adults. • Identify and use valid and reliable standardized tools of cognitive assessment in older adults. • Observe for risks or the presence of the five most common geriatric syndromes (pressure ulcers, incontinence, falls, functional decline, and delirium, including hypokinetic delirium). • Compare specified theories of aging, including the genetic theory. • Describe how to use evidence-based assessment tools and methods to conduct a comprehensive assessment of an older adult. • Promote quality outcomes through the application of evidence-based practices specific to the care needs of older adults. ***************************************CONTINUED***************************** [Show More]

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