final exam- lifespan

Biologic Clock

Programmed aging is the result of predictable cellular death

• AKA programmed cell death or apoptosis 

Immunity

Aging is the programmed accumulation of damage and decline in immune function 

• Decline in the function of the immune system 

Gene

Longevity genetic 

• Longevity associated with a genetic trait 

Wear & tear

Deterioration over time due to continued use 

Free Radicals

Result of random damage from free radicals 

• Eros are a result of random damage from free radicals; they are unpaired, unstable ions 

Dementia

• Not an inevitable outcome of aging 

• Confusion can have metabolic causes 

• Treatment: Medications, encourage self-care, routines, and

• stimulation, safety interventions (falls, wandering)

Alzheimer’s

• Progressive memory loss 

• Symptoms: forgetfulness, inattentiveness, disorganized thinking, altered level of consciousness, perceptual disturbances, sleep-wake disorders, psychomotor disturbance, and disorientation 

Depression

• Older adult at highest risk 

• Factors: Isolation, loss, change in environment, low self-esteem, medical conditions, medications

• teatment;

  • Counseling, social support, and pleasurable activities  

Immortality vs Extinction (Erikson)

Reminiscing about the past, focus on activities that bring pleasure 

Hospice

• Type of palliative care 

• Symptom relief; not curative 

• Life expectancy=/< 6 months 

• Supports the patient and family through the dying process 

• Helps the survivors through the period of bereavement 

• Settings include home, nursing facilities, or long-term care facilities. 

Mourning:Reactions

• Placing blame 

  • Common impulse after death for the survivors (e.g., for medical measures not taken, laws not enforced, unhealthy habits not changed)

  • The bereaved soemtimes blaame thee dead person, sometimes themselves, and sometimes distant others

  • Nations may blame one another for public tragedies

  • Blame is not necessarily rational

Mourning: Seeking meaning 

• Often starts with preserving memories 

• Support groups offer help when friends are unlikely to understand

• Organizations devoted to causes such as fighting cancer and banning handguns often find supporters among people who have lost a loved one to a particular circumstance

Stages of Grief (Kubler-Ross)

Denial - Anger- Bargaining- Depression- Acceptance 

Living wills

Written advance directive that details a person’s wishes to avoid, limit, or withhold medical interventions, particularly at the end of life

Power of attorney

A type of advance directive that transfers health care decision- making authority to a person designated by the patient

Physician-assisted suicide

The facilitation of suicide, where the person knowingly takes lethal drugs provided by a doctor for this purpose 

Euthanasia

Intentional act (such as the lethal injection of a drug), with the purpose of causing death 

Passive euthanasia 

A situation in which a seriously ill person is allowed to die naturally, through the cessation of medical intervention 

DNR order

A written order from a physician (sometimes initiated by a patient’s advance directive or a health care proxy’s request) that no attempt should be made to revive a patient during cardiac or respiratory arrest.

Ethical Issue

• Deciding when death occurs

  • A wide array of treatments and interventions may be used to postpone or prevent death 

  • Many life-support measures and medical interventions circumvent the diseases and organ failures that once caused death 

  • Religious advisors, doctors, lawyers, and family members disagree with one another. 

Brain death

No brainwaves, pain response, or breathing; absent voluntary movement 

Locked-in-syndrome

Cannot move except for eyes, normal brainwaves 

Coma

Deep unconscious, depressed brain reflexes, no pain response, irregular breathing 

 Vegetative state

Deep unconsciousness, cognitive functions absent; breathing and HR present; eyes may be open, but do not respond to stimuli 

Infants (grief reactions)

by 10 months, infants can respond to loss

Children (grief reaction)

anger, fear, guilt

Adolescents ( grief reaction)

grieve through academic withdrawal, regression

Young adults (grief reaction)

Rage at lost opportunities; anxiety about the future 

Bereavement

The time period when a person experiences sadness after losing a loved one involves grief and mourning

Mourning

• Outward expression of grief

• The ceremonies and behaviors that a religion or culture prescribes for people to employ in expressing their bereavement after a death  

Incomplete grief

• A situation in which circumstances interfere with the process of grieving 

• The grief process may be incomplete if mourning is cut short or if other people are distracted from their role in recovery

dysfunctional grief

• Failure to follow a predictable course of normal grieving 

• Maladaptive coping strategies 

• Expression of unresolved issues and symptoms that interfere with functioning 

• Ex: talk of suicide or actual suicide attempts

HIPAA

The Health Insurance Portability and Accountability Act (1996) enabled portability of health insurance, privacy of medical information, and coverage for preexisting conditions

PPACA

• Renamed the Affordable Care Act (ACA)

• Consumer rights and protections 

• Affordable health care coverage 

• Increase access to care 

• Quality of care that meets patient needs 

WIC

Federal grant program that provides free nutritious food, nutrition counseling, breastfeeding support, and health/social service referrals to low-income individuals at nutritional risk 

Patient/Consumer bill of rights

• Stressed the importance of the relationship between the healthcare provider and the patient 

• Stipulated that the health-care system: 

  • Is fair and meets patients’ needs

  • Gives patients a way to address problems

  • Encourages patients to take an active role in health care

Care coordination/multidisciplinary team

Managing a patient's care across multiple settings and levels using available resources to meet their health needs

Accreditation

• The process by which an institution is recognized as meeting specific, predetermined standards of care 

• A hospital that is not accredited may not be eligible to receive state or federal funding assistance 

The Joint Commission Criteria

Leading accreditation organization for hospitals in the United States. __ sets standards that define how high- quality, safe patient care should be delivered 

Cultural competence

• Awareness of acceptance of and respect for beliefs, values, traditions, and practices is different from one’s own 

• Cultural stereotyping 

• Awareness, attitude, knowledge, skill 

Cultural care/interventions

Individual’s cultural beliefs, practices, and values. It fits a person’s life, values, and system of meaning. Generated by patients themselves, not from biased assumptions.

Cultural stereotyping

Occurs when you make assumptions about a patient based on their cultural group membership rather than assessing them as an individual.

Adaptation

Sharing of resources and helping family members

Partnership

Lines of communication and participation of family members

Growth

How responsibilities are shared, among family members

Affection

Visible and invisible emotional reactions among family members 

Resolve

How time, money, and space are used for solving or preventing problems among family members. 

Preschool (Divorce)

• Regression; fears 

• Interventions 

  • Maintain house & bedtime routines

  • Reassure the love of the child 

  • Spend extra time with the child

School age (divorce)

Open grieving; feels rejected; diffculity in connentratingl fears expressing emotions

• Interventions 

  • Allow the child to love both parents, and keep them informed

  • Do not use a child as a confidant 

Adolescent ( divorce)

• Concern about one's own marriage; reassess personal values and morality; May become depressed or suicidal 

• Interventions 

  • Avoid delegating too many home responsibilities, encourage a support system/talk with a neutral party

  • Encourage the pursuit of one's own interests 

Adult (divorce)

• Increased dependence on the eldest child; expresses fears, anxieties, and anger; Inability to focus on the needs of children 

• Interventions 

  • Encourage support group/professional counseling; Refer to social or financial aid resources 

Geriatric (divcorce)

• Depression, loneliness, helplessness, bitterness 

• Increased dependence on family 

• Interventions 

  • Encourage socialization/activities of interest

Object permanence

Animism

Irreversibility

Conservation

Classification

Seriation

Stranger anxiety

Separaation anxiety

classical conditioning

Operant conditioning

Fast mapping

Overregularization