NUR 2092 FINAL EXAM STUDY GUIDE
1. Geriatrics: functional assessment-what is being tested, best approach to testing;
caregiver concerns; IADLs, ADLs; disability concerns; tools to assess
What is being tested -Identify strengths
-Identify limitations – so interventions can be recognized
-Independence and prevention of functional decline
Best approach to testing
Caregiver concerns -Decrease in attention, memory, orientation, language, planning
and making decisions
-Depression is not a normal change
-Persistent depression – is concerning if it interferes with
ADL’s
-Eating
IADLs Instrumental activities of daily living
-measures functional abilities necessary for independent
community living
-includes shopping, meal preparation, house-keeping, laundry,
managing finances, taking medications, and using transportation
ADLs Activities of daily living
-tasks necessary for self-care
-measure domains of eating/feeding, bathing, grooming,
dressing, toileting, walking, using stairs, and transferring
Disability concerns
Tools to assess -Katz Activities of Daily Living
-The Lawton Instrumental Activities of Daily Living Scale
-Hospital Admission Risk Profile
-Geriatric Depression Scale (short form)
-Inspect for lesions and moles – irregular shapes, change in size
or color
-Check for pressure ulcers especially sacrum, heels &
trochanters
-Clubbing – cardiac or pulmonary disorder
-Pitting/transverse groves – peripheral vascular disease, arterial
insufficiency, or diabetes
-Brittleness – decreased vascular supply
-Yellow or brown nails – fungal infection
-Look for limited range of motion – arthritis or muscle
weakness causing pain and discomfort
-While assessing range of motion – watch for reports of pain,
dizziness, jerky or abnormal movements: may indicate fractured
vertebrae, Parkinson’s disease, transient ischemic attack, or
stroke
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, -Look for facial symmetry (asymmetry may indicate a stroke)
-Bowel sounds; Look for hernias, pulsatile masses
-Evaluate muscles for atrophy, tremors, and involuntary
movements
-Note warmth, swelling, tenderness, crepitus and deformities
2. Cultural assessment: culturally competent care; definition of ethnicity; spirituality;
concepts such as assimilation, acculturation, etc.
Culturally competent -Know self, understand own heritage
care -Identify meaning of health to someone else
-Understand health care delivery system
-Gain knowledge re social backgrounds of clients
-Be familiar with language, resources for interpreters, resources
within community
Ethnicity Associated with culture; awareness of belonging to a group in
which certain characteristics differentiate from one group to
another
-Includes nationality, regional culture, language, ancestry
-Ex: Egyptian, Swedish, Mexican, Jewish, etc.
Spirituality -Borne out of each person’s unique life experience and his or
her personal effort to find purpose and meaning in life.
-Comes from person’s life experiences
-Attempt to find meaning and purpose of life
-More abstract
-Relationship of self and something larger
Ethnocentrism To believe one’s own beliefs or way of life is ‘superior’; will
interfere with collection and interpretation of data, your
development of a plan of care may be skewed; must be aware of
your own biases
Acculturation Adapting to and acquiring another culture
Assimilation Developing new cultural identity and becoming like the
dominant culture
Biculturalism Divided loyalty, identifies with two cultures
3. Therapeutic communication: examples of effective and ineffective techniques e.g.
clarification, reflection, blaming, etc.
Therapeutic The face-to-face process of interacting that focuses on advancing the
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,communication physical and emotional well-being of a patient. Nurses use therapeutic
s communication techniques to provide support and information to
patients.
Examples of -Open ended questions: tell me about, how are you doing today
Therapeutic -Closed ended questions: do you have pain
communication -Facilitation: nodding yes, uh-huhh
s -Encourages client to say more; shows person you are interested
-Reflection: echoes words, repeat part of what was said
-Clarification: summarize, simplify
-Useful when patient’s word choice is ambiguous and confusing
-Silence: Communication that client has time to think; silence can be
uncomfortable; provides you w/ chance to observe client and note
nonverbal cues
-Empathy: Names a feeling and allows its expression
-Consider your body language; consider cultural differences
Barriers to -Lack of interest or attention/lack of respect
communication -Physical barriers: a curtain, a door, a computer, a monitor, pain, room
temperature
-The patient’s inability to hear you, hearing deficit, or language barrier
-Language/ use of jargon, or speaking above someone’s educational
level
-Safety: fear
-Psychological barriers: embarrassment, disbelief, shock, anger, fear,
grief, fatigue, hostility
10 Traps of 1. Providing false assurance or reassurance
Interviewing 2. Giving unwanted advice
3. Using authority
4. Using avoidance language
5. Distancing
6. Using professional jargon
7. Using leading or biased questions
8. Talking too much
9. Interrupting
10. Using “why” questions
-Advising, defending, disagreeing, disapproval, giving approval,
reassuring, requesting an explanating
4. General survey – what is included?
General -Begins with first contact
Survey -General impression of client (age, sex, loc, skin color, facial features)
-Physical appearance/hygiene (facial expression, speech, dress, hygiene)
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, -Body structure (stature, nutrition, symmetry, posture, position, body
build)
-Body movement (gait, range of motion, assistive devices, involuntary,
movements)
-Emotional and mental status and behavior (mood/affect, speech,
appropriate behavior for setting)
Temperature Normal range: 97.8°F to 99.1°F/average 98.6°F
Heart rate Normal: 50-90 beats per minute.
-Bradycardia: A resting heart rate less than 50 beats/min
-Tachycardia: A more rapid heartbeat, defined as over 95 beats/min or
over 100 beats/min.
Respiratory Normal: 10-20 breaths per minute; relaxed, regular, automatic, and silent
rate
Blood Normal: 90/60 mm/Hg to 120/80 mm/Hg.
pressure
5. Nutrition: Dietary assessment; abnormal eating patterns
Dietary An in-depth evaluation of both objective and subjective data related to an
assessment individual's food and nutrient intake, lifestyle, and medical history. Once
the data on an individual is collected and organized, the practitioner can
assess and evaluate the nutritional status of that person.
Food and fluid intake (24 hour recall is always the first thing done)
Nutritional status and risk factors
Anthropometric measurements, biochemical tests, and nutrition-
focused questions
Swallowing assessment prn
Ask questions about nutritional health (ex: what are the important
components of a healthy diet, what are the risk factors for poor diet,
any questions about weight loss/gain?)
*Nutritional status: refers to the degree of balance between nutrient intake
and nutrient requirements (over nutrition, undernutrition, weight loss
problems, weight gain problems, difficulty chewing/swallowing, obesity,
anorexia nervosa, binge eating, bulimia)
Abnormal -Overnutrition: overweight or obesity; can lead to obesity and risk factor
eating patterns for: heart disease, hypertension, type 2 diabetes, stroke, gallbladder
disease, sleep apnea, certain cancers, osteoarthritis
-Undernutrition: occurs when nutritional reserves are depleted or when
nutrient intake is inadequate to meet day-to-day needs or added metabolic
demands; risk for: impaired growth and development, lowered resistance
to infection and disease, delayed wound healing, longer hospital stays,
higher health care cost
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