Test 2 Review

Health & Healing- Aging Test
#2
1. Elder abuse is most often
"Single or repeated acts, or lack of appro-
de- fined as:
priate action, occurring within a relationship
where there is an expectation of trust, which
causes harm or distress to an older person."
(WHO, 2002)
2. Elder Abuse
- Senior over 75 years old.
Who is most likely to be Tar-
·- Senior who is lonely.
geted?
- Senior who is isolated.
- Senior who is widowed and living alone.
- Senior who is physically frail but

mentally capable.
- Senior with diminished cognitive ability.
- Senior who has to rely on others.
- Senior who has money or assets.
- Senior who is under control and influence

of the abuser.
3. Identify key indicators of
- Fear, anxiety, depression, or passiveness
physical, emotional, financial
in relation to a family member, friend, or
and sexual abuse of the
care provider.
older adult:
- Unexplained physical injuries.
Common Signs of Elder
Abuse
- Dehydration, poor nutrition, or poor
hygiene.
- Improper use of medication.
- Confusion about new legal documents,

1/
#2
such as a new will or a new mortgage.
- Sudden drop in cash flow or financial

hold- ings.
- Reluctance to speak about the situation.
4. Identify key indicators of The use of physical force that causes

physical, emotional, financial pain, discomfort or injury or that is
and sexual abuse of the excessive for, or inappropriate in, the
older adult: circumstances.
Physical Abuse · Administering or withholding medication

for inappropriate purposes.
Ex.
- Pushing, shoving.
- Hitting, slapping, poking.
- Pulling hair, biting, pinching.
- Confining or restraining a person.
- Unusual patterns of injuries.
- Unexplained injuries such as broken

bones, bruises, bumps, cuts, burns, welts,
grip marks.
5. Identify key indicators of
physical, emotional, financial - The misuse of an older person's property
and sexual abuse of the and/or funds.
older adult:
- Theft, forgery or fraud.
Financial Abuse
- Improper use of a Power of Attorney
for Property.
6.
2/
#2
Identify key indicators of Any action or behaviour that may diminish
physical, emotional, financial a person's sense of wellbeing, dignity or
and sexual abuse of the self-worth, and includes, without being lim-
older adult: ited to, threatening, insulting, intimidating
or humiliating gestures, behaviour or
Psychological/Emotional remarks, imposed social isolation including
Abuse shunning or ignoring or lack of
acknowledgement.
- Words or actions which put a person

down, are hurtful, make a person feel
unworthy.
- Not considering a person's wishes.
- Not respecting a person's belongings or

pets.
- Denying access to grandchildren or friends.

7. Identify key indicators of - Treating an older person like a child.
physical, emotional, financial
and sexual abuse of the · Any form of verbal communication of a
older adult: belittling or degrading nature which may
diminish the person's sense of well-being,
Verbal Abuse dignity or self-worth.
· This includes but is not limited to; shout-

ing, inappropriate tone of voice or manner
of speaking which is upsetting or
frightening.
8. Indicators of Physical Abuse: - Unexplained injuries.
- Unexplained bruising.
- "Accidents".
- Unkempt and signs of under/over

medication.
3/
#2
- Burn marks.
4/
#2
9. Indicators of Financial Abuse: - Unexplained or inability to pay bills.
- Refusal to spend money without "permis-

sion".
- Unexplained disappearance of
personal belongings.
- Changed POA or will.
- No spending money.
- Large bank account withdrawal.
10. Indicators of Physical/ - Depression.

Emo- tional Abuse:
- Tearfulness.
- Exclusion from family gatherings.
- No visitors/outings.
- Low self-esteem.
- Withdrawn.
- Psychosomatic complaints.
11. Indicators of Verbal Abuse: - Witnessed or overheard confrontational or

inappropriate remarks or inappropriate lan-
guage or tone of voice.
- Any form of communication of a belittling

or degrading nature which may diminish a
person's sense of well-being, dignity and
self worth.
- Sarcasm or mocking.
5/
#2
12. Identify key indicators of · Any non-consensual touching, behaviour
physical, emotional, financial or remarks of a sexual nature or sexual
and sexual abuse of the exploitation directed towards a senior by
older adult: any person.
Sexual Abuse · Any consensual or non-consensual touch-
ing, behaviour or remarks of a sexual na-
ture or sexual exploitation that is directed
towards a senior who has the inability to
give informed consent by a person in a
position of trust.
· It includes, but is not limited to: assault;

rape; sexual harassment; intercourse with-
out consent; fondling a confused senior;
inti- mately touching a senior during
bathing; ex- posing oneself to others;
inappropriate sexual comments; or any
sexual activity that occurs when one or
both parties cannot, or do not, consent.
13. Possible Indicators of - Genital infections.
Sexual Abuse:
- Frequent urinary tract infections.
- Pain, bruising, bleeding in genital areas.

14. Identify key indicators of The failure to provide a senior with the care
physical, emotional, financial and assistance required for health, safety
and sexual abuse of the or wellbeing, and includes failure to provide
older adult: for the necessities of life.
Neglect - Withholding care or medical attention.
- Leaving a person in an unsafe place.
- Over or under medicating.
- Not providing food or liquids.
6/
#2
- Not providing proper clothing or hygiene.
- Untreated bedsores.
- Abandonment.
15. Indicators of Neglect: - failure to provide medical attention accord-
ing to care needs.
- failure to listen and respond to

expressed needs or concerns.
- failure to provide proper nourishment

and fluids according to needs.
- failure to facilitate participation in

activities and programs of a social nature.
16. Describe how to advocate · Tell someone they trust about what is
for an older adult happening to them.
experiencing elder abuse:
· Ask others for help, and be specific
Develop a safety plan with about the type of help needed.
pt's to prevent potential
abuse and encourage them · Think ahead about what to do if someone
to... is hurting them or if they do not feel safe.
· Do the following for their protection if

they are facing possible abuse:
· Have emergency phone numbers written

in a safe place.
· Have a safe place to go, both inside

and outside the house.
· Create an emergency kit containing

money, copies of important documents, a
list of all
7/
#2
medications, and a 3-day supply of
medications, extra clothing, and assistive
devices.
· Dial 911.
17. Describe how to advocate
for an older adult · Find respite services, change the situation
experiencing elder abuse: entirely (e.g., giving the caregiver
permission to give up the role), provide
If the abuse has to do referrals to support groups, teach about
with caregiving, the the care recipient's illness, teach how to
Nurse should... use crisis hotlines, and teach anger
management strategies.
· It is the nurse's responsibility to report any

18. Identify mandatory reporting suspected abuse.
requirements for the RPN:
· Reporting elder abuse is mandatory when
Mandatory Reporting an older adult resides in a Long-Term Care
Home or a Retirement Home and elder
abuse is suspected or has occurred.
· The law requires reporting by anyone

who knows or has reasonable grounds to
sus- pect that a resident has been, or
might be, harmed by any of the following:
- improper or incompetent treatment or care,
- abuse of a resident by anyone,
- neglect of a resident by a staff member

or the owner of the home,
- illegal conduct,
- misuse or fraud involving a resident's

money, or
- misuse or fraud involving public funding

8/
#2
provided to the home (long-term
care homes
9/
#2
only).
· This obligation to report applies to every-

one except residents of the home.
Members of regulated health care
professions, social workers, and
naturopaths must report even if the
information is otherwise confidential.
· If the victim lives in their own home or in

any other setting, the law does not require
anyone to report the abuse. In some
cases, reporting might be required by
someone's employment duties, a contract
for services, or a professional code of
19. Explore online and ethics.
community resources
related to elder abuse: Senior Safety Line: Toll Free 1-866-299-1011
- 24 hours a day, 7 days a week, 150

lan- guages.
Durham Regional Police:
- Non-emergency Line; 905-579-1520

ext. 6234
Police Constable SGT Keating:
- Durham Regional Police, Senior

20. Care Across the Support Coordinator; 905-579-1520 ext.
5624
Continuum: Independence
- Home ownership
- Single room occupation (SRO)
- Condominium ownership
- Apartment dwelling
10
#2
- Shared housing/ co-housing
11
#2
- Adult lifestyle communities
- Life lease
21. Care Across the Continuum: - Public/ subsidized housing
Independent to partial - Residence with family

dependence
- Supportive housing/living
- Assisted living
-Residential facility
- Retirement
homes/residences/communities
22. Care Across the Continuum: - Extended care
Partial dependence to com- - Hospice care

plete dependence
- Complex continuing care
- Residential respite care
- Long-term care homes
- Acute care facilities
- Rehabilitation facilities
23. Residential Options in Later - Home ownership (aging in place)

Life:
- Social housing
Independent living options
- Life lease
- Adult style communities
12 /
#2
- Shared housing
- Cohabitation
24. Residential Options in Later Broad term for non-medical, community

Life: based residential settings that house adults
and provide services such as meals, med
Assisted living options supervision and assistance with ADL's
25. Residential Options in Later - Nursing homes, special care homes

Life: and personal care homes
Long Term care homes - LTC homes and provide assistance to

those unable to perform ADL's anymore.
Most common reason client enter these
facilities
- More than 2/3 are cognitively impaired.
- LTC homes are highly regulated, with

laws, regulations and standards varying
across the provinces
- Public and many health care providers

hold negative view
- Institution vs. Person Centered Care
26. Current issues in LTC 4,500 senior citizens are stuck in

hospital beds
Lack of ALC beds in Ontario
Bottle necks
Privately owned and operated LTC centers.
Less supports than nursing homes
13 /
#2
29.
27. Acute Care Hospitalization

of the Older Adult:
Hospital
28. Risks for
Hospitalization: Delirium
#1
14 /
#2
Cost to client or family
Interventions:
Extensive wait lists for a nursing
home bed • Make sure client has glasses and
hearing aid in and turned on
- Age-related changes coupled • Try to spend some time with client
with chronic conditions increase or arrange for family to be present
risks for seniors • Orientate patient to environment within 1st
hour of admission
- Get discharged quickly (sicker)
- Hospitalization, whether for

planned surgery or acute
illness, can be traumatic
to an older adult, physically,
psychologically, emotionally,
spiritually
Could be related to:
new
environment
sensory
deprivation
adverse drug
reactions
inaccessible eyeglasses and

hearing aid
altered cognition or level of

consciousness
related to excess stimuli or

physiological dis- turbance
15 /
#2
Risks for Hospitalization: presence of equipment or supplies
Risk for Falls # 2 chemical or physical restraints
failure to use bed rails
effects of medications
lack of assistance / dizziness
orthostatic hypotension
weakness, fatigue related to bed rest
unfamiliar environment
altered cognition or level of consciousness
Interventions:
• Ensure unused equipment is cleared or

out of the way of client, remove barriers
• Due diligence when clients are chemically
or physically restrained. Use only in
extreme measures
• Use bedrails
30. Risks for age-related changes to skin
Hospitalization: immobilization
Pressure Ulcers # 3 shearing forces
sedation
pain
weakness
16 /
#2
debilitating condition
lack of assistance
Interventions:
• Will do ROM exercises with patient q4h

• Thoroughly access patients skin at begin-
ning and end of shift
• Reposition patient q2H
• Physiotherapist to assess patients mobility
• Walk with patient for 10 mins 2 times
per shift
• Look into pressure release mattresses
• Use Braden scale once per
31. Risks for week age-related change in thirst
Hospitalization: nausea, vomiting
Dehydration # 4 sedation
altered cognition or level of consciousness
inaccessible fluids
lack of assistance
Interventions:
• Offer fluid every hour popsicles

between meals
• Provide extra fluids with meals juice,
soup, ice cream water on trays
• Always report intake and output
document colour of urine
• During oral care check for dry mucous
membranes and to promote interest in
drinking
17 /
#2
• Assess skin daily for poor skin turgor
• Place signs in patients room as a
reminder to drinks
• Inquire as to patients preferences on
their beverages
32. Risks for diuresis (increased urine output)
Hospitalization: sedation
Incontinence # 5 weakness
inaccessible bedpan or commode
indwelling catheterization
lack of assistance
Interventions:
• Assist patient to washroom q2H during

day and q4h during the night
• Ensure call bell is within reach q2h
• Provide peri care bid
• Educate patient on pelvis floor exercises
• Will guide patient to perform PFME's bid
30 contractions
• Record urinary output for patterns
• Record BM patterns
• Assess brief q1h for skin
breakdown Age-related changes to
33. Risks for GI system Effects of medications
Hospitalization: Effects of surgery
Constipation # 6 Dietary modifications
18 /
#2
Reduced activity
Poor positioning during defecation
Inaccessible commode, bedpan
Lack of toileting assistance
Interventions:
• Help patient go for a walk around

nursing home bid
• Toilet patient every 2 hours or as needed
• Reposition patient into fowlers
position when using a bed pan
• Ask doctor to order a stool softener or
fiber supplement
• Offer 250 ml of water q2h
34. Risks for Hospitalization: unnecessary restrictions
Loss of Functional Indepen- insufficient time for self-care

dence # 7
knowledge deficit
immobility
development of complications
failure to ambulate, mobilize early
Interventions:
• Perform ROM q2h by the end of shift

• Instruct patient how to do proper hygiene
by the end of the day
• Encourage patient to be as independent
as possible by the end of the shift
• Instruct patient how to use assistive devices
19 /
#2
#9
35. Risks for
Hospitalization:
Malnutrition # 8
36. Risks for
Hospitalization: Infection
20 /
#2
during the shift preferences
• Identify what the patient • Teach patient about good nutrition
can or cannot do on their • Speak to a doctor about obtaining an
own in the beginning of the order for a medication to stimulate appetite
shift • Speak to a doctor about initiating an
enteral feed
NPO for tests
Elderly are at high risk of infection in
stress of surgery increases hospital due to:
nutritional needs
decreased immunity
decreased absorption of iron,
B12, calcium due to
aging process
nausea/
vomiting
unappetizing
food
selections
sedation
weakness
altered level of
consciousness/cognition
lack of assistance with meal
tray Interventions:
• Ask family to bring in from

home
• Ask patient about food
21 /
#2
decreased respiratory activity
decreased ability to expel secretions from

lungs
urinary retention ( weaker bladder muscles

- medication effects)
prostatic hypertrophy in males
increased alkalinity of vaginal secretions in

females
fragility of skin and mucous membranes
increased chronic disease
immobility
malnutrition, unintentional weight loss
decreased serum albumin levels
nosocomial infections
Interventions:
• Iatrogenic --> infection result of an

intervention
• Don't contaminate sterility, hand hygiene
37. Risks for weakness
Hospitalization: pneumonia
Immobility # 10 deep vein thrombosis
loss of previous function
22 /
#2
Interventions:
• ROM
• Drinking lots of water
• Get them walking
38. Risks for Serious problem for hospitalized older
Hospitalization: adults loss of interest/pleasure
Depression # 11 weight loss
insomnia
fatigue
Interventions:
• Can look like failure to thrive

• Not eating or interacting
• Psychiatrist or psychologist consult
• Speak to family
increased monitoring during the night (eg.

VS, IV)
39. Risks for
rounds (flash light every hour)
Hospitalization:
turning and repositioning q 2 h
Insomnia # 12
physical discomfort (pain, urinary
frequency, respiratory difficulties)
effect of meds (caffeine in Tylenol with

codeine, diuretics)
depression
anxiety
23 /
#2
Interventions:
• No pain
• No caffeine
• Review meds
• Diuretics
• Stimulants
40. Key Concepts in Death & An individual's response to a loss

Dy- ing:
Grief
41. Key Concepts in Death & An active and evolving process that
Dy- ing: includes behaviours through which the
experience of loss is incorporated into one's
Mourning life
-Strongly influenced by social & cultural

norms
42. Types of Grief:
A response to a loss before it occurs
Anticipatory Grief
Behaviours may include preoccupation with
the loss, unusually detailed planning, or a
sudden change in attitude toward the thing,
part or person to be lost
>Sociological Death
>Psychological Death
43. Sociological Death Premature withdrawal of others from the dy-

ing person
44. Psychological Death Withdrawal of the dying person for others or
environment
45. Types of Grief
Grief: Acute
24 /
#2
- Is a crisis with
somatic and
psychologi-
cal symptoms of
distress occurring in
waves lasting
various periods of
time
25 /
#2
- May include feelings of self-blame or guilt
and manifest as hostility or anger towards
friends or depression or withdrawal
- Difficult to accomplish ADL's and daily living

(meet responsibilities)
- Acute signs eventually diminish

46. Types of Grief: Lingering Grief OR Shadow Grief - resur-
faces from time to time but does not persist
Persistent Grief
Pathological Grief Persists
>AKA: Impaired, dysfunctional or maladap-

tive grief
>Begins with normal grief responses but ad-

justment is blocked, memories resist being
reframed.
>Recurrent acute grief over and over
>Signs may include irrational and excessive

anger, insomnia, depression
>Loved ones dealing with suicide
>Often requires professional intervention
47. Types of Grief: Is an experience of the person whose loss

cannot be openly acknowledged or publically
Disenfranchised Grief mourned
e.g.: hidden or secret relationships , extra-

marital affairs, losses not deemed worthy like
a loss of a pet
48.
26 /
#2
Needs of the dying and Care
their families
Control
Weismans 6 C's approach
Composure
Communication
Continuity
Closure
49. Hospice Palliative Care Term used to describe care based on the
principles and norms of hospice and pallia-
tive care.
Hospice Palliative Care is the whole-person

health care that aims to relieve suffering
and improve the quality of living and dying
Canadian competencies for Hospice

Pallia- tive Care Nursing
50. Palliative Care Units Vs In hospital provides symptom relief and com-
Hos- pices fort
Stays are limited to 15 days
Hospital bed $1,200 to $1,500 a
day
Residential Hospice is a standalone institu-

tion that can keep residents longer usually
around 3 months and provide bereavement
care
Provides a homelike experience costing

51. A Good Death $493:00/ day
27 /
#2
Consider concepts discussed during the
last week:
Advance Directives
Living-Dying Interval
Anticipatory Grief
A good death is (Leung et al., 2010):
Free from avoidable distress and suffering

for
patient, family and caregivers;
In general accord with patient's and family's

wishes; and
Reasonably consistent with clinical,

cultural, and ethical standards (RNAO
BPG)
52. Signs & Symptoms Near the
End of Life? How you can Sleeping
help:
May sleep for longer periods
What's Happening?
May tire easily
53. Signs & Symptoms Near the
End of Life? How you can Bring books or projects to keep you occupied
help:
Keep conversations to periods of alertness
What do I do?
Avoid over stimulation
54. Confusion and Forgetful-
ness: Delirium Fatigue, pain and spread of disease may
cause symptoms
What is Happening?
These symptoms can be caused by side
effects of medication and changes in body
chemistry
28 /
#2
29 /
#2
55. Confusion and Speak in a calm, reassuring voice, reminding
Forgetful- ness: Delirium them who they are
What do I do? Remember client is not doing this on pur-
pose, avoid arguing with dying client
30 /

Test 2 Review

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Test 2 Review

Uploaded by

Copyright:

Available Formats

Health & Healing- Aging Test

- Senior who is widowed and living alone.

- Senior who is physically frail but

- Senior with diminished cognitive ability.

- Senior who has to rely on others.

- Senior who has money or assets.

- Senior who is under control and influence

- Improper use of medication.

- Confusion about new legal documents,

- Sudden drop in cash flow or financial

- Reluctance to speak about the situation.

4. Identify key indicators of The use of physical force that causes

Physical Abuse · Administering or withholding medication

- Hitting, slapping, poking.

- Pulling hair, biting, pinching.

- Confining or restraining a person.

- Unusual patterns of injuries.

- Unexplained injuries such as broken

- Words or actions which put a person

- Not considering a person's wishes.

- Not respecting a person's belongings or

- Denying access to grandchildren or friends.

· This includes but is not limited to; shout-

8. Indicators of Physical Abuse: - Unexplained injuries.

- Unkempt and signs of under/over

- Refusal to spend money without "permis-

- Changed POA or will.

- Large bank account withdrawal.

10. Indicators of Physical/ - Depression.

- Exclusion from family gatherings.

11. Indicators of Verbal Abuse: - Witnessed or overheard confrontational or

- Any form of communication of a belittling

· It includes, but is not limited to: assault;

- Pain, bruising, bleeding in genital areas.

Neglect - Withholding care or medical attention.

- Leaving a person in an unsafe place.

- Over or under medicating.

- Not providing food or liquids.

- Not providing proper clothing or hygiene.

- failure to listen and respond to

- failure to provide proper nourishment

- failure to facilitate participation in

· Do the following for their protection if

· Have emergency phone numbers written

· Have a safe place to go, both inside

· Create an emergency kit containing

· It is the nurse's responsibility to report any

· The law requires reporting by anyone

- improper or incompetent treatment or care,

- abuse of a resident by anyone,

- neglect of a resident by a staff member

- misuse or fraud involving a resident's

- misuse or fraud involving public funding

· This obligation to report applies to every-

· If the victim lives in their own home or in

- 24 hours a day, 7 days a week, 150

Durham Regional Police:

- Non-emergency Line; 905-579-1520

Police Constable SGT Keating:

- Durham Regional Police, Senior

- Single room occupation (SRO)

- Shared housing/ co-housing