RNSG 1430 Exam V Study Guide – Weatherford College | RNSG1430 Exam V Study Guide

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RNSG 1430 Exam V Study Guide – Weatherford College Study guide Human development/ Sensory perception What determines physical characteristics? • A predetermined genetic base because of inheri... tance patterns carried on the chromosomes • Characteristics inherited from each parent are carried in gene pairs on the 23 pairs of chromosome, which carry the genetic information that determines the persons cellular differentiation, growth and function. As a result physical characteristics such as height, bone size, and eye/hair color are inherited from our family of origin. How do you treat a temper tantrum? • Let them be as long as they aren’t in danger How does a fetus develop? • The moment the ovum is fertilized by the sperm. - Pre-embryonic stage lasts for 3 weeks - The zygote implants the uterine wall has 3 distinct cell layers. - The endothelium (inner layer) which becomes the respiratory system, the digestive system, the liver, and the pancreas - The mesoderm (middle layer) becomes the skeleton, connective tissue, cartilage, muscles, circulatory, lymphoid, reproductive, and urinary systems. - The Ectoderm (outer layer) becomes the brain, spinal cord, nervous system, and outer body parts (skin, hair, and nails) • Embryonic stage occurs from the fourth to eighth week. ♣ Rapid growth and differentiation of the cell layers take place by the end of this stage, ♣ All basic organs have begun to ossify and some human features are recognizable • Fetal stage lasts form 9 weeks to birth - All body organs and systems continue to grow and develop What is the biggest influence of adolescents? • Their peers, Peer relationships What does breast milk provide to a neonate? • Protection against bacteria and viral infections via antibodies, immune-globulins, leukocytes • The high lactose content combined with limited protein, promotes an acid environment that is unsuitable for bacterial growth When is it ok to start solid foods for an infant? • When they don’t demonstrate the “tongue extrusion reflex”; - Touch the infant’s bottom lip. Their tongue will poke out. By 4-6 months this reflex goes away. This is when you can introduce solid foods. When does bonding occur? • Might occur in the first few hours after birth or later in the first few months and is necessary for later attachment. Define social isolation • The feeling of being alone. A sense of being alone and lonely as a result of having fewer meaningful relationships. What is the primary developmental task of the adolescent? • Build more/new mature relationships with peers, family members, and friends How do you teach an older adult? • Put teaching in a context that will mean something to them, like use their past occupation or hobby What is the leading cause of death in adolescents and young adults? • Motor vehicle crashes are the most common cause of mortality, often associated with the use of alcohol or drugs Menopause symptoms • Menstrual periods stop either gradually or abruptly, causing many women to experience hot flashes, mood swings, and fatigue What is ageism? • A form of prejudice like racism, in which older adults are stereotyped by characteristics found in only a few members of their group. Fundamental to ageism is the view that older people are different and will remain different. Therefore, they do not experience the same desires, needs, and concerns as other adults. What is the leading cause of cognitive impairment is old age? • Alzheimer’s disease How do you encourage reminiscence? • “Tell me about when…” • “Tell me about how you celebrated Christmas when you were young.” - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - cortisol arousal. . Consent is informed when a provider explains and the client understands 1. The reason the client needs the treatment or procedure. 2. How the treatment or procedure will benefit the client 3. The risk involved if the client chooses to receive the treatment or procedure 4. Other option to treat the problem, including not treating the problem. . Clients must consent to all care they receive in a healthcare facility “implied consent” is adequate for most aspect of nursing care. . For an invasive procedure, the client must provide written consent. . Individuals who may grant consent for another person: 1. Parent of a minor 2. Legal guardian 3. Court-specified representative 4. An individual who has durable power of attorney authority for healthcare 5. Emancipated minors (minors who are married, for example) . Nurse must: 1. Witness informed consent by ensuring that the provider gave the client the necessary information 2. Ensure that the client understood the information And it is competent to give informed consent . Have the client sign the informed consent document. . notify the provider if the client has more questions or appear not to understand any of the information. The provider is then responsible for giving clarification. . document questions the client has. Notification of the provider, reinforcement of teaching, and use of an interpreter. . nurses should refuse to practice beyond the legal scope of practice or outside of their areas of competence regardless of reason (staffing shortage, lack of appropriate personnel) Question (ATI)- chapter 2 why do we refer patient with swallowing difficulties to speech pathologist? Answer- Because they teach the technique and exercises to improve function of speech, languages and swallowing. . Clinical nurse specialist- masters degree, advanced education in pharmacology and physical assessment and certification in a specialized area of practice. . Nurse educator- same as above. . Information to document 1. Assessment 2. Med admin 3. Treatments and responses 4. Client education Schedule II controlled drug has a greater risk of abuse than a schedule IV. Heroin is a schedule I and has no medical use in the U.S. . Pregnancy risk categories: A, B, C, D, X. “A” is the safest one. . Medication are organized by 1. Pharmacologic action 2. Therapeutic use. 3. Body system 4. Chemical makeup 5. Safe use during pregnancy . Side effects are expected. Adverse effects are undesired, inadvertent and unexpected dangerous effects. . Oral doses of morphine are generally higher than parenteral doses. Due to extensive first-pass effect. Therefore clients who have chronic pain, as seen with cancer, are generally given oral doses. . Document subjective data as direct quotes within quotation marks or summarize and identify the information as the client statements (the client states he fell in the shower…) . Objective data should be descriptive and should include what the nurse sees, hears, feels, and smells. Instead of “client is agitated” write “client pacing back and forth in his room, yelling loudly” . Flow charts- Show trends in V/S, blood glucose levels, pain level and other frequent assessments. . Narrative documentation- records information as a sequence of events in a story like manner. SOAP . Subjective data . Objective data . Assessment (includes a nursing dx based on the assessment). . Plan Challenges in electronic health records: 1. Learning the system 2. Know how to correct errors 3. Maintaining security Incident report: 1. Med error 2. Falls 3. Needle sticks Britt guide RNSG 1430 Exam V Study Guide Diversity Taylor Chapter 5; pgs.73-90 Hinkle Chapter 7; pgs. 95-106 Pay attention to the Boxes, Tables, Focus, Questions at end of chapter etc. Power point Characteristics of Cultural diversity in US T 74 cultural diversity: diverse groups in society, with varying racial classifications and national origins, religious affiliations, languages, physical size, gender, sexual orientation, age, disability, socioeconomic status, occupational status, and geographic location (Taylor 74) Factors inhibiting cultural sensitivity T & PP Stereotyping – assumes all members of a cultural, ethnic, racial group are the same Cultural Imposition- Belief that everyone should conform to your own belief system Cultural blindness-when one ignores the differences and acts as if they do not exist Cultural conflict-Two people aware of differences, feel threatened and respond by ridiculing the beliefs and traditions of the others to make one’s self feel more secure. Terms: Assimilation, acculturation, cultural imposition, stereotyping, cultural shock PP Race – A term related to biology. Members of a particular race share distinguishing physical features such as skin color, bone structure, or blood group. Ethnicity- A group of people that share a common and distinctive racial, national, religious, linguistic or cultural heritage. A group or individual’s conception of cultural identity, which includes learned behaviors. Enculturation – the process by which an individual learns the characteristics or traditions of their groups culture. Acculturation- The process of adapting to another culture. To acquire some of the majority group’s characteristics Assimilation- To become absorbed into another culture and to develop a new identity. Subcultures- Groups of people who have experiences different from the dominant culture and as such may not hold the same values held by the main culture. Example: Hispanics – many variations; Africans- also many variations depending on country in Africa they come from. Biculturalism- Participating and being equally comfortable in more than one culture. A person who may self-identify as a member of more than one cultural group. This person can function in two worlds. Ethnocentric- The tendency to think that their way of thinking, acting, believing is the right and proper way. The belief in the superiority of one’s own ethnic group. Cultural Imposition-The intrusive application of the majority’s or of one’s cultural view on individuals and families from different cultures. Stereotyping-The assumption that every individual from a given cultural, racial, or ethnic group are alike. Cultural Blindness- When a person ignores that differences exist and proceeds as they do not exist. How to deal with language barriers (situations) T 78: 89: To avoid misinterpretation of questions and answers, it is important to use an interpreter who understands the health care system. Sometimes a family member or friend can translate for the nurse, but such a person may be protective and not the most reliable means of transferring information, thus guidelines often discourage using family members or friends as translators. People sometimes talk more loudly to someone who does not understand what they are saying, but remember that this is a communication problem, not a hearing problem. When caring for culturally and ethnically diverse patients, it is it important to perform a transcultural assessment of communication: • What language does the patient speak during usual activities of daily living? • How well does the patient speak and write in English? • Does the patient need an interpreter? Are family members or friends available? Are there people the patient would not want to serve as an interpreter? • How does the patient prefer to be addressed? • What cultural values and beliefs of the patient may change your techniques of communication and care (such as eye contact, personal space, or social taboos)? • How does the patient’s nonverbal behavior affect the responses of members of the health care team? • What are the cultural characteristics of the patient’s communications with others? A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish and the nurse speaks only English. What should the nurse do? (Taylor 89) a) Use short words and talk more loudly b) Ask an interpreter for help c) Explain why care can’t be provided d) Provide instructions in writing Variations between ethnic groups in behavioral factors; ie space, time orientation T 79 If others do not consider a person’s personal space, that person may become uncomfortable or even angry. When providing nursing care that involves physical contact, you should know the patient’s cultural personal space preferences. For example, people of Arabic and African origin commonly sit and stand close to one another when talking, whereas people of Asian and European descent are more comfortable with some distance between themselves and others. Many people and almost all institutions in the United States value promptness and punctuality. When arriving for an appointment, doing a job, or carrying out an activity, being on time and getting the job done promptly are viewed as important. This is not true in some other cultures. For example, in some South Asian cultures, being late is considered a sign of respect. In addition, while some cultures are future oriented (including activities that promote future good health), other cultures are more concerned with the present or the past. Understanding the patient’s orientation to time is important as you communicate, for example, the need to be on time for appointments for health care procedures and when taking medications. (Taylor 79) Cultural factors that affect nursing care (apply to situations) t 85-87 box 5-4; Hinkle 101 chart 7-2 BOX 5-4
Cultural Factors that Affect Nursing Care White Family • Nuclear family is highly valued. • Elderly family members may live in a long-term care facility when they can no longer care for themselves. Folk and Traditional Health Care • Self-diagnosis of illnesses Use of over-the-counter drugs (especially vitamins and analgesics) • Dieting (especially fad diets) Extensive use of exercise and exercise facilities Values and Beliefs • Youth is valued over age Cleanliness Orderliness Attractiveness • Individualism Achievement Punctuality Nursing Considerations • Careful assessment of client’s use of over-the-counter medications (observe for signs and symptoms of toxic medication levels, especially fat-soluble vitamins) • Nutritional assessments of dietary habits African American Family • Close and supportive extended-family relationships • Strong kinship ties with nonblood relatives from church or organizational and social groups • Family unity, loyalty, and cooperation are important. • Usually matriarchal Folk and Traditional Health Care • Varies extensively and may include spiritualists, herb doctors, root doctors, conjurers, skilled elder family members, voodoo, faith healing Values and Beliefs • Present oriented Members of the African American clergy are highly respected • Frequently highly religious Nursing Considerations • Many African American families may still use various folk healing practices and home remedies for treating particular illnesses. • Special care may be necessary for the hair and skin. • Special consideration should be given to the sometimes extensive and frequently informal support networks of patients (e.g., religious and community group members who offer assistance in a time of need). Asian (Beliefs and practices vary, but most Asian cultures share some characteristics.) Family • Welfare of the family is valued above the person. Extended families are common. • A person’s lineage (ancestors) is respected. Sharing among family members is expected. Folk and Traditional Health Care • Good health is achieved through the proper balance of yin (feminine, negative, dark, cold) and yang (masculine, positive, light, warm). • An imbalance in energy is caused by an improper diet or strong emotions. • Diseases and foods are classified as hot or cold, and a proper balance between them will promote wellness (e.g., treat a cold disease with hot foods). • Many Asian health care systems use herbs, diet, and the application of hot or cold therapy. Also, many Asians believe that there are points on the body that are located on the meridians or energy pathways. If the energy flow is out of balance, treatment of the pathways may be necessary to restore the energy equilibrium.
Acumassage—Technique of manipulating points along the energy pathways
Acupressure—Technique for compressing the energy pathway points
Acupuncture—Technique by which fine needles are inserted into the body at energy pathway points Values and Beliefs • Strong sense of self-respect and self-control High respect for age Respect for authority • Respect for hard work Praise of self or others is considered poor manners • Strong emphasis on harmony and the avoidance of conflict Nursing Considerations • Some members of Asian cultures may be upset by the drawing of blood for laboratory tests. They consider blood to be the body’s life force, and some do not believe that it can be regenerated. • Some members believe that it is best to die with the body intact, so they may refuse surgery except in dire circumstances. • Members of many Asian cultures seldom complain about what is bothering them. Therefore, the nurse must carefully assess the patient for pain or discomfort by observing for nonverbal signs of discomfort, such as facial grimacing or wincing and holding of the painful area. • Some Asians consider it polite to give a person the responses the person is expecting. Therefore, the client may transmit misinformation to the questioner in an effort to be respectful. • Dietary counseling may be necessary if the patient is on a salt-restricted diet because many Asian foods have a high salt content related to the use of soy sauce. Hispanic Family • Familial role is important. • Compadrazgo: special bond between a child’s parents and the child’s grandparents • Family is the primary unit of society. Folk and Traditional Health Care • Curanderas(os): folk healers who base treatments on humoral pathology—basic functions of the body are controlled by four body fluids or “humors”: 
Blood—hot and wet Yellow bile—hot and dry
Black bile—cold and dry Phlegm—cold and wet • The secret of good health is to balance hot and cold within the body; therefore, most foods, beverages, herbs, and medications are classified as hot (caliente) or cold ( fresco, frio) For example, a cold disease will be cured with a hot treatment). Values and Beliefs • Respect is given according to age (older) and sex (male). • Roman Catholic Church may be very influential. • God gives health and allows illness for a reason; therefore, many perceive illness as a punishment from God that can be cured through atonement and forgiveness. Nursing Considerations • It may be difficult to convince an asymptomatic patient that he or she is ill. • Special diet considerations are necessary if the patient believes in the hot/cold theory of treating illnesses. • Diet counseling may be necessary at times, because the usual diet of many members is high in starch. Muslim Family • The family forms the basic building block of Muslim society. The man is considered the head of the family. • Marriage forms the sole basis for sexual relations and parenthood. • Islamic law generally discourages the use of contraception, extolling the virtues of large families, but there seems to be a trend toward smaller families. Folk and Traditional Health Care • Preventive health care strategies in Muslim experience include personal hygiene, dietary measures such as the restriction in eating specific ingredients (such as pork and its byproducts, and drinking alcohol), and the avoidance of addictive habits such as smoking tobacco or overconsumption of food. • Some Muslims may perceive a sudden death or illness as a sign of punishment or a test from God. Values and Beliefs • Belief that there is no God but Allah and that Muhammad is his messenger. • Belief that God created humans and gave them their bodies as gifts to be cared for through general hygiene, diet, and exercise. • Belief that Allah will determine when they die; Death is an important part of the traditional Islamic life cycle. By tradition, family members wash the body of the deceased and bury it as soon as possible. Cremation is not allowed under Islamic law, and embalming should be avoided unless it is required by civil law. Nursing Considerations • Respect the modesty needs of both men and women: special clothing or draping may be necessary, assign health care providers of the same sex, avoid touching patients of the opposite sex, and limit eye contact. • Make accommodations for prayer needs. • Maintain bodily purity by observing their cleansing and ablution rituals. • Offer a halal diet free of alcohol and pork or pork products; make sure medications are alcohol- and pork-free. • During Ramadan, Muslims must fast from sunrise to sunset. Fasting includes abstaining from all substances, including pharmaceuticals and IV drips. However, illness is an exception. Native American (Each tribe’s beliefs and practices vary to some degree.) Family • Families are large and extended. • Grandparents are official and symbolic leaders and decision makers. • A child’s namesake may become the equivalent to another parent to the child. Folk and Traditional Health Care • Medicine men (shaman) are heavily used. • Heavy use of herbs and psychological treatments, ceremonies, fasting, meditation, heat, and massages Values and Beliefs • Present oriented. Taught to live in the present and not to be concerned about the future. This time consciousness emphasizes finishing current business before doing something else. • High respect for age • Great value is placed on working together and sharing resources. • Failure to achieve a personal goal frequently is believed to be the result of competition. • High respect is given to a person who gives to others. The accumulation of money and goods often is frowned on. • Some Native Americans practice the Peyotist religion, in which the consumption of peyote, an intoxicating drug derived from mescal cacti, is part of the service. Peyote is legal if used for this purpose. It is classified as a hallucinogenic drug. Nursing Considerations • The family is expected to be part of the nursing care plan. • Note taking often is taboo. It is considered an insult to the speaker because the listener is not paying full attention to the conversation. Good memory skills often are required by the nurse. • Indirect eye contact is acceptable and sometimes preferred. • It often is considered rude or impolite to indicate that you are not clearly hearing what they are saying. • A low tone of voice often is considered respectful. • A Native American patient may expect the caregiver to deduce the problem through instinct instead of asking many questions and history taking. If this is the case, it may help to use declarative sentences rather than direct questioning. • Hawaiian Family • Familial role is important. • Ohana, or extended families, are jointly involved in childrearing. • Hierarchy of family structure—each gender and age have specific duties. • Closely knit families in small, isolated communities Folk and Traditional Health Care • Kahuna La’au Lapa’au is the ancient Hawaiian medical practitioner. • View patient’s illness as part of the whole. • Relationships among the physical, psychological, and spiritual • Emphasis on preventive medicine • Treatment uses more than 300 medicinal plants and minerals Values and Beliefs • Aloha: a deep love, respect, and affection between people and the land • Christian God replaced the myriad of Hawaiian gods. • Lifestyle more revered than compliance with health care issues • Present oriented, less initiative and drive rather than direction and achievement • Death seen as part of life and not feared Nursing Considerations • Many Hawaiians may still use folk healing practices and home remedies. • Special consideration given to the extensive family network during hospitalization • Acceptance from health care practitioners of current health practices and lifestyle Appalachian Family • Intense interpersonal relations • Family is cohesive, and several generations often live close to each other. • Elderly are respected as providers. • Tend to live in rural, isolated areas Folk and Traditional Health Care • “Granny” woman, or folk healer, provides care and may be consulted even if receiving traditional care. • Various herbs, such as foxglove and yellow root, are used for common illnesses such as malaise, chest discomfort, heart problems, and upper respiratory infections. • Elderly may have had only limited contact with health care providers and may be skeptical of modern health care. Values and Beliefs • Independence and self-determination • Isolation is accepted as a way of life. • Person oriented • May be fatalistic about losses and death • Belief in a divine existence rather than attending a particular church Nursing Considerations • Treat each person with regard for personal dignity. • Allow family members to remain with patient as support system. • Accept the person’s current health practices and lifestyle. • Allow patients to make decisions about care. (Taylor 85-86) CHART 7-2 Prohibited Foods and Beverages of Selected Religious Groups Hinduism All meats Animal shortenings/fats Islam Pork Alcoholic products and beverages (including extracts, such as vanilla and lemon) Animal shortenings Gelatin made from pork, marshmallow, and other confections made with gelatin Note: Halal is lawful food that may be consumed according to tenets of the Koran, whereas Haram is food that is unlawful to consume. Judaism Pork Predatory fowl Shellfish and scavenger fish (e.g., shrimp, crab, lobster, escargot, catfish). Fish with fins and scales are permissible. Mixing milk and meat dishes at same meal Blood by ingestion (e.g., blood sausage, raw meat). Note: Packaged foods will contain labels identifying kosher (“properly preserved” or “fitting”) and pareve (made without meat or milk) items. Mormonism (Church of Jesus Christ of Latter-Day Saints) Alcohol Beverages containing caffeine stimulants (coffee, tea, colas, and selected carbonated soft drinks) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1. a. A newborn with a heart rate less than 100 bpm, irregular respiratory effort, normal muscle tone, weak cry, and bluish tint to the skin scores a 5 on the APGAR chart. 2. The nurse records an APGAR score of 4 for a newborn. What would be the priority intervention for this newborn? a) No interventions are necessary; this is a normal score. b) Provide respiratory assistance. c) Perform CPR. d) Wait 5 minutes and repeat the scoring process. 2. b. A newborn who scores a 4 on the APGAR chart requires special assistance such as respiratory assistance. Normal APGAR scores are 7 to 10. Neonates who score between 4 and 6 require special assistance, and those who score below 4 are in need of life-saving support. 3. A school nurse is preparing a talk on safety issues for parents of school-aged children to present at a parent–teacher meeting. Which topics should the nurse include based on the age of the children? Select all that apply. a) Child-proofing the home b) Choosing a car seat c) Teaching pedestrian traffic safety d) Providing swimming lessons and water safety rules e) Discussing alcohol and drug consumption related to motor vehicle safety f) Teaching child how to “stop, drop, and roll” 3. c, d, f. Important safety topics for school-aged children include pedestrian traffic safety, water safety, and fire safety. Childproofing a home would be appropriate for parents of a toddler, choosing a car seat would be an appropriate topic for parents of an infant or toddler, and teaching drug and alcohol as it relates to motor vehicle safety would be a more appropriate topic for parents of adolescents. 4. The nurse encourages parents of hospitalized infants and toddlers to stay with their child to help decrease what potential problem? a) Problems with attachment b) Separation anxiety c) Risk for injury d) Failure to thrive 4. b. Separation anxiety, with crying initially and then appearing depressed, is common during late infancy in infants who are hospitalized. 5. A nurse is teaching parents of toddlers how to spend quality time with their children. Which activity would be developmentally appropriate for this age group? a) Playing video games b) Playing peek-a-boo c) Playing in a sand box d) Playing board games 5. c. Playing in a sand box with toys that emphasize gross motor skills and creativity is a developmentally appropriate activity for a toddler. Video games are appropriate for school-aged children and adolescents, but should be monitored. Playing peek-a-boo is developmentally appropriate for an infant, and playing board games usually begins with preschool and older children. 7. A high school nurse is counseling parents of teenagers who are beginning high school. Which issues would be priority topics of discussion for this age group? Select all that apply. a) The influence of peer groups b) Bullying c) Water safety d) Eating disorders e) Risk taking behavior f) Immunizations 7. a, b, d, e. Appropriate topics of discussion for parents of adolescents include peer groups, bullying, eating disorders, and risk-taking behaviors. Immunizations would be appropriate for parents of children from infants to school-age, and water safety should be taught in the preschool years. 8. A nurse working with adolescents in a group home discusses the developmental tasks appropriate for adolescents with the staff. What is an example of a primary developmental task of the adolescent? a) Working hard to succeed in school b) Spending time developing relationships with peers c) Developing athletic activities and skills d) Accepting the decisions of parents 8. b. Adolescence is a time to establish more mature relationships with both boys and girls of the same age. 9. Following assessment of an obese adolescent, a nurse considers nursing diagnoses for the patient. Which diagnosis would be most appropriate? a) Risk for injury b) Risk for delayed development c) Social isolation d) Disturbed body image 9. d. Adolescents who are obese are at high risk for a disturbed body image. Risk for injury would be appropriate for a risk taker, a risk factor for delayed development may be ADHD, and social isolation may occur with low self-esteem. 10. A nurse is teaching new mothers about infant care and safety. What would the nurse accurately include as a teaching point? a) Keep infants younger than 6 months out of direct sunlight. b) Use honey instead of sugar in homemade baby food. c) Place the baby on his or her stomach for sleeping. d) Keep crib rails down at all times. 10. a. Nurses should teach parents to keep infants younger than 6 months out of direct sunlight and cover them with protective clothing and hats. The nurse should also teach parents not to add honey or sugar to homemade baby food, to place the baby on the back for sleeping to prevent SIDS, and to keep the crib rails up at all times. 1. A nurse caring for adults in a physician’s office notes that some patients age more rapidly that other patients of the same age. The nurse researches aging theories that attempt to describe how and why aging occurs. Which statements apply to the immunity theory of aging? Select all that apply. a) Chemical reactions in the body produce damage to the DNA. b) Free radicals have adverse effects on adjacent molecules. c) Decrease in size and function of the thymus causes infections. d) There is much interest in the role of vitamin supplementation. e) Lifespan depends on a great extent to genetic factors. f) Organisms wear out from increased metabolic functioning. 1. c, d. The immunity theory of aging focuses on the functions of the immune system and states that the immune response declines steadily after younger adulthood as the thymus loses size and function, causing more infections. There is much interest in vitamin supplements (such as vitamin E) to improve immune function. In the cross-linkage theory, cross-linkage is a chemical reaction that produces damage to the DNA and cell death. The free radical theory states that free radicals, formed during cellular metabolism, are molecules with separated high-energy electrons, which can have adverse effects on adjacent molecules. The genetic theory of aging holds that lifespan depends to a great extent on genetic factors. According to the wear-and-tear theory, organisms wear out from increased metabolic functioning, and cells become exhausted from continual energy depletion from adapting to stressors. 2. A nurse caring for older adults in a long-term care facility knows that several physical changes occur in the aging adult. Which characteristics best describe these changes? Select all that apply. a) Fatty tissue is redistributed. b) The skin is drier and wrinkles appear. c) Cardiac output increases. d) Muscle mass increases. e) Hormone production increases. f) Visual and hearing acuity diminishes. 2. a, b, f. Physical changes occurring with aging include these: fatty tissue is redistributed, the skin is drier and wrinkles appear, and visual and hearing acuity diminishes. Cardiac output decreases, muscle mass decreases, and hormone production decreases, causing menopause or andropause. 4. Which of the following nursing diagnoses would be appropriate for many middle adults? a) Risk for Imbalanced Nutrition: Less Than Body Requirements b) Delayed Growth and Development c) Self-Care Deficit d) Caregiver Role Strain 4. d. Many middle adults help care for aging parents and have concerns about their own health and ability to continue to care for an older family member. Caregivers often face 24-hour care responsibilities for extended periods of time, which creates physical and emotional problems for the caregiver. 5. An experienced nurse tells a younger nurse who is working in a retirement home that older adults are different and do not have the same desires, needs, and concerns as other age groups. The nurse also comments that most older adults have “outlived their usefulness.” What is the term for this type of prejudice? a) Harassment b) Whistle blowing c) Racism d) Ageism 5. d. Ageism is a form of prejudice in which older adults are stereotyped by characteristics found in only a few members of their age group. Harassment occurs when a dominant person takes advantage of or overpowers a less dominant person (may involve sexual harassment or power struggles). Whistle blowing involves reporting illegal or unethical behavior in the workplace. Racism is prejudice against other races and ethnic groups. 6. A nurse who is caring for older adults in a senior daycare center documents findings as related to which normal aging process? Select all that apply. a) A patient’s increased skin elasticity causes wrinkles on the face and arms. b) Exposure to sun over the years causes a patient’s skin to be pigmented. c) A patient’s toenails have become thinner with a bluish tint to the nail beds. d) A patient experiences a hip fracture due to porous and brittle bones. e) Fragile blood vessels in the dermis allow for more easy bruising of a patient’s forearm. f) Increased bladder capacity causes decreased voiding in an older patient. 6. b, d, e. Exposure to sun over the years can cause a patient’s skin to be pigmented. Bone demineralization occurs with aging, causing bones to become porous and brittle, making fractures more common. The blood vessels in the dermis become more fragile, causing an increase in bruising and purpura. Wrinkling and sagging of skin occur with decreased skin elasticity. A patient’s toenails may become thicker, with a yellowish tint to the nail beds. Bladder capacity decreases by 50%, making voiding more frequent; two or three times a night is usual. 7. A nursing instructor teaching classes in gerontology to nursing students discusses myths related to the aging of adults. Which statement is a myth about older adults? a) Most older adults live in their own homes. b) Healthy older adults enjoy sexual activity. c) Old age means mental deterioration. d) Older adults want to be attractive to others. 7. c. Although response time may be longer, intelligence does not normally decrease because of aging. Most older adults own their own homes, and although sexual activity may be less frequent, the ability to perform and enjoy sexual activity lasts well into the 90s in healthy older adults. Older adults want to be attractive to others. 8. What is the leading cause of cognitive impairment in old age? a) Stroke b) Malnutrition c) Alzheimer disease d) Loss of cardiac reserve 8. c. Alzheimer disease is the most common degenerative neurologic illness and the most common cause of cognitive impairment. It is irreversible, progressing from deficits in memory and thinking skills to an inability to perform even the simplest of tasks. 9. A nurse is caring for an 80-year-old female patient who is living in a long-term care facility. To help this patient adapt to her present circumstances, the nurse is using reminiscence as therapy. Which question would encourage reminiscence? a) “Tell me about how you celebrated Christmas when you were young.” b) “Tell me how you plan to spend your time this weekend.” c) “Did you enjoy the choral group that performed here yesterday? d) “Why don’t you want to talk about your feelings?” 9. a. Asking questions about events in the past can encourage the older adult to relive and restructure life experiences. 10. Following a fall that left an elderly male patient temporarily bedridden, the nurse is using the SPICES assessment tool to evaluate him for cascade iatrogenesis. Which are correct aspects of this tool? Select all that apply. a) S – Senility b) P – Problems with feeding c) I – Irritableness d) C – Confusion e) E – Edema of the legs f) S – Skin breakdown 10. b, d, f. The SPICES acronym is used to identify common problems in older adults and stands for: S – Sleep disorders P – Problems with eating or feeding I – Incontinence C – Confusion E – Evidence of falls S – Skin breakdown 4/3/2017 Taylor chapter 17-19 Pg371 – Genetic heredity • 23 pairs of chromosomes o Where risk factors for many things come from Don’t get bogged down in pages about specific people and age groups. • Erikson is the one that nursing follows the most. Pg387 – cephalocaudal (from head to tail) • How humans develop • Embryotic stage Neonate stage – birth to 28 days • Hole in heart must close up o If not closed, heart murmurs • Best to breastfeed neonate if possible o Colostrum in excretion and good for immunity boost o 1st month is most important • Pg391 – bonding o Important during first few hours Infant – 1 month to 1 year • Birth weight usually triples by 1 year • OK to introduce solid foods when tongue extrusion reflex stops o Stops 4-6 months o Introduce foods 1 at a time ♣ To understand reactions if they appear ♣ Pg395 •- - - - - - - - - - - - - - - - - - - - - - - - - - o Need for sleep is near triple to that when growing stops ♣ Sleep releases growth hormone • 2 “jobs” other than sleep, growth, and life o Development of more mature relationships ♣ Notice of opposite sex ♣ Can lead to pregnancies at an early age o Regardless of what you tell them as a parent, they copy others ♣ If you smoke, they smoke ♣ If friends do things, they do things Aging adult Chapter 19 • Physiological for women o Pg421 - Menopause o If woman states they have had hysterectomy, did they have complete? ♣ Removes all estrogen and progesterone development • Pg423 – Middle adults continue eating habits and reduce activity o Increase in obesity o Increase in diabetes o Pg 425 – Ageism ♣ Form of prejudice ♣ Stereotypes • Can’t drive, can’t function in society, grumpy, deaf, etc. • “Don’t feel pain as much” but truthfully, they just report pain less ♣ AARP only group more powerful than AMA (side note) o Feel more pain, report less o If they can’t hear you, check ears for wax build-up. o Pg429 – reminiscence can be used as a therapy to get patients to open up and talk about things in the past ♣ Open ended questions to dig deeper ♣ Older women – the closer to death they are, they will recall any child they lost at early ages (abortion, early death, etc.) o Pg 431 – social isolation ♣ Sense of being alone and having fewer friends • Isolate themselves due to changes with social status o Diminished senses, friends dying o Support groups ♣ Meals on wheels ♣ Community centers o Pg435 – risk of accidental injuries (bottom right section on page) Look at this section in depth ♣ Falls are most common cause • Throw rugs and wires o Dementia, depression, and delirium ♣ Alzheimer’s is most common • Increased age in today’s time • Biggest risk factor is old age o (MYTH) Old age decreases cognitive ability. o Growing at large rate due to Baby Boomers reaching that age now. o Pg439 – promoting health in older adults ♣ Slow down and wait for response • If the idea or concept is not appealing to them, they will ignore it. ♣ Fall risk • Remove throw rugs to lessen fall risk • Night light ♣ Weakened immune system • BPH – ask if they have trouble initiating stream [Show More]

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