HealthStream Regulatory Script Developmentally Appropriate Care of the Adult Patient Version: May 2007 Lesson 1: Lesson 2: Lesson 2: Lesson 3: Lesson 4: Lesson 5: Introduction Age-Specific Competencies Young Adults Middle Adults Older Adults Development and Assessment of Competencies Lesson 1: Introduction 1001 Introduction Welcome to the introductory lesson on developmentally appropriate care of the adult patient. This lesson gives the course rationale, goals, and outline. IMAGE: 1001.JPG As your partner, HealthStream strives to provide its customers with excellence in regulatory learning solutions. As new guidelines are continually issued by regulatory agencies, we work to update courses, as needed, in a timely manner. Since responsibility for complying with new guidelines remains with your organization, HealthStream encourages you to routinely check all relevant regulatory agencies directly for the latest updates for clinical/organizational guidelines. If you have concerns about any aspect of the safety or quality of patient care in your organization, be aware that you may report these concerns directly to The Joint Commission. Point 1 of 11 2 1002 Course Rationale Healthcare professionals should be committed to providing quality patient care. In order to do so, they must understand a patient’s age-specific: • Characteristics • Needs • Challenges FLASH ANIMATION: 1002.SWF/FLA Understanding these features will allow you to better meet your patient’s needs. Point 2 of 4 1003 Course Goals After completing this course, you should be able to: • Define the term “competency” • Discuss needs, characteristics, and medical care practices for the: o Young adult o Middle adult o Older adult • Explain how age-specific competencies are acquired and assessed NO IMAGE Point 3 of 4 1004 Course Outline Lesson 1 provided the course rationale and goals. FLASH ANIMATION: 1004.SWF/FLA Lesson 2 will discuss age-specific competencies. Lesson 3 will focuse on young adults. Lesson 4 will focuse on middle adults. Lesson 5 will focuse on older adults. Lesson 6 will describe development and assessment of competencies. Point 4 of 4 Lesson 2: Age-Specific Competencies 2001 Introduction & Objectives Welcome to the lesson on age-specific competencies. FLASH ANIMATION: 2001.SWF/FLA After completing this lesson, you should be able to: • Define competency • Recall age-specific competencies • Understand the importance of age-specific competencies Point 1 of 10 2002 What Is a Competency? A “competency” is a set of: • Knowledge • Skills • Abilities IMAGE: 2002.JPG This skill set allows a person to perform a task. Healthcare staff must develop and demonstrate competencies related to patient care. Point 2 of 10 2003 What Are Age-Specific Competencies? Age-specific competencies are one type of competency. IMAGE: 2003.JPG Caregivers must be able to provide care according to a patient’s: • Chronological age • Developmental age • Maturity level Point 3 of 10 2004 Why Develop Age-Specific Competencies? Age-specific competencies: • Improve the quality of patient care • Enable your facility to meet accreditation requirements IMAGE: 2004.GIF Let’s take a closer look at each of these goals. Point 4 of 10 2005 Importance of Age-Specific Competencies: Quality Patient Care At each stage of life, human beings exhibit predictable: • Characteristics • Needs • Developmental challenges • Milestones IMAGE: 2005.JPG This knowledge will allow you to provide developmentally appropriate care. This will better meet your patient’s needs. Point 5 of 10 2006 Importance of Age-Specific Competencies: The Joint Commission Standards The Joint Commission believes that age-specific competency is important. They require accredited institutions to: • Develop age-specific competencies • Evaluate competencies IMAGE: 2006.JPG Competency training and assessment must be documented. Point 6 of 10 2007 The Joint Commission Standards: Assessment of Age-Specific Competencies An employee is competent if they understand how human beings grow and develop. IMAGE: 2007.JPG They can demonstrate this knowledge by: • • • Utilizing patient data to determine a patient’s status Interpreting patient information to identify needs Providing appropriate care according to a patient’s age and developmental needs Point 7 of 10 2008 Adult Age Groups Adults can be divided into three age categories: • Young adult (ages 18 to 44) • Middle adult (ages 45 to 65) • Older adult (over age 65) IMAGE: 2008.JPG Remember, characteristics presented in this course are not absolutes. They are guidelines to consider when providing care to adult patients of different ages. Point 8 of 10 2009 Review The Joint Commission believes that age-specific care is important. However, they do not require employees to demonstrate age-specific competencies. a. True b. False MULTIPLE CHOICE INTERACTION Correct answer: B Feedback for A. Incorrect. The Joint Commission requires staff to demonstrate age-specific competencies. Institutions must train and assess staff. Feedback for B. Correct. The Joint Commission requires staff to demonstrate age-specific competencies. Institutions must train and assess staff. Point 9 of 10 2010 Summary You have completed the lesson on age-specific competencies. NO IMAGE Remember: • A competency is a set of knowledge, skills, and abilities needed to perform a task. • Age-specific competencies: o Improve patient care o Allow an institution to meet accreditation requirements Point 10 of 10 Lesson 3: Young Adults 3001 Introduction & Objectives Welcome to the lesson on the young adult (ages 18 to 44). FLASH ANIMATION: 3001.SWF/FLA After completing this lesson, you should be able to: • • Describe the young adult’s: o Characteristics o Needs o Cognitive abilities Detail care practices for the young adult Point 1 of 13 3002 Physical Characteristics and Changes During the young-adult years, patients: • Reach physical and sexual maturity • Continue to experience growth of the skeletal system (until age 30) • Reach peak muscular strength (between the ages of 20 and 30) • Achieve adult lab values IMAGE: 3002.JPG Toward the end of this stage: • Physical functions slow gradually • Tissues lose some capacity to regenerate • Degenerative changes such as arthritis may develop • The skin begins to lose moisture and elasticity • The reproductive system begins to atrophy • Diseases of the reproductive system may develop Point 2 of 13 3003 Physical Characteristics and Changes: Developmentally Appropriate Care Important care practices include: • Monitoring for sexually transmitted diseases • Assessing for degenerative changes IMAGE: 3003.JPG Point 3 of 13 3004 Nutritional Needs and Related Care The nutritional needs of young adults shift from growth to maintenance. IMAGE: 3004.JPG Explain proper nutrition and diet to maintain: • Health • Normal weight Note: Nutritional needs of adults depend upon activity levels. Point 4 of 13 3005 Psychosocial and Developmental Characteristics Young adults face the primary challenge of intimacy vs. isolation. IMAGE: 3005.JPG Those who develop intimate relationships can maintain: • Friendships • A primary love relationship Those who do not, show signs of isolation: • Poor self-esteem • Withdrawal Other characteristics of the young adult are given on the next screen. Point 5 of 13 3006 Psychosocial and Developmental Characteristics: Table IMAGE: 3006.JPG Point 6 of 13 3007 Psychosocial and Developmental Challenges: Developmentally Appropriate Care Encourage the young adult patient to think realistically about commitments and challenges. These include: • Relationships • Family • Career • Community IMAGE: 3007.JPG Provide help with family planning. Provide prenatal information. Discuss changes that may be stressful. Demonstrate respect for the young adult’s personal values. Allow the young adult to verbalize concerns. Encourage questions related to fear. Help the patient explore any fears about how their condition will affect their work, relationships, or family. Point 7 of 13 3008 Cognitive Abilities Mental abilities peak during the twenties. These abilities include: • Reasoning • Creativity • Memory • Verbal skills IMAGE: 3008.JPG Young adults begin to: • Form their own opinions • Make independent decisions • Learn from life experiences Point 8 of 13 3009 Cognitive Abilities: Developmentally Appropriate Care Respect the cognitive abilities of young-adult patients. Explain all medical procedures. IMAGE: 3009.JPG Ask the patient if he or she prefers to: • Discuss the procedure • Look through written materials with you • Use other learning techniques Each patient learns differently. Adjust your explanation accordingly. Involve young-adult patients in decision-making and planning. Allow for as much self-care as possible. Point 9 of 13 3010 Safety Needs and Related Care Major causes of death among young adults are related to: • Age-specific stressors • The impact of unhealthy lifestyle choices FLASH ANIMATION: 3010.SWF/FLA To help promote safety: • Encourage the use of stress-reduction techniques • Encourage healthy lifestyle choices: o Proper nutrition and weight control o Regular exercise o Other practices for reducing long-term risk • Emphasize the importance of regular checkups and screenings • Encourage attention to safety hazards Point 10 of 13 3011 Review During some or all of the young-adult years: a. The skeletal system continues to grow. b. The skin begins to lose moisture and elasticity. c. Degenerative changes such as arthritis may develop. d. All of these are correct. MULTIPLE CHOICE INTERACTION Correct answer: D Feedback for A: Not quite. The correct answer is D. All of these physical changes take place. Feedback for B: Not quite. The correct answer is D. All of these physical changes take place. Feedback for C: Not quite. The correct answer is D. All of these physical changes take place. Feedback for D: Correct. All of these physical changes take place. Point 11 of 13 3012 Review FLASH INTERACTION: 3012.SWF/FLA Psychosocial and Developmental Characteristics of the Young Adult • Establishment of personal identity • Acceptance of self • Finding a career and working up Major achievements the career ladder Major stressors • Establishing a family • Balancing roles and responsibilities at home, work, school, and in the community Most significant relationships • Spouse • Children • Coworkers • Loss of work • Loss of social relationships Greatest fears Point 12 of 13 3013 Summary You have completed the lesson on young adults. NO IMAGE Remember: • • • • • • • During the young-adult years, patients reach their physical and sexual peak. They then begin to experience degenerative changes. Physical functions slow. The nutritional needs of young adults shift to maintenance of a healthy body. Young adults work to develop intimacy. If they do not, they may show signs of isolation. Major stressors and fears are related to personal identity, career, family, and relationships. Mental abilities peak during the twenties. Young adults form their own opinions. They make independent decisions. Causes of death are related to stressors and unhealthy lifestyle choices. Consider these factors when caring for a young adult. Point 13 of 13 Lesson 4: Middle Adults 4001 Introduction & Objectives Welcome to the lesson on the middle adult (ages 45 to 65). FLASH ANIMATION: 4001.SWF/FLA After completing this lesson, you should be able to: • • Describe the middle adult’s: o Characteristics o Needs o Cognitive abilities Detail appropriate care practices for the middle adult Point 1 of 12 4002 Physical Characteristics and Changes During the middle adult stage: • Physical functions continue to slow • Basal metabolic rate [glossary] declines • Tissues continue to lose the ability to regenerate • Degenerative changes may continue • Other chronic conditions may develop • The skin continues to lose moisture and elasticity • Atrophy of the reproductive system continues IMAGE: 4002.JPG Point 2 of 12 4003 Physical Characteristics and Changes • Women typically experience menopause (may be IMAGE: 4003.JPG accompanied by depression) • Bone changes may occur (especially in women, because of menopause). These changes include: o Decalcification [glossary] and reabsorption of bone o Diminished bone density (may lead to osteoporosis) • Farsightedness tends to develop • Other senses may begin to diminish Point 3 of 12 4004 Physical Characteristics and Changes: Developmentally Appropriate Care Obesity can develop during this stage. IMAGE: 4004.JPG Emphasize the importance of checkups and screenings to: • Monitor risk factors for disease • Screen for chronic conditions Counsel women regarding menopause: • Discuss the use of estrogen • Provide tips for minimizing the risk of osteoporosis • Depression Discuss sensory changes and how these changes may affect activities such as driving. Point 4 of 12 4005 Psychosocial and Developmental Characteristics Middle adults face the primary challenge of productivity vs. stagnation. IMAGE: 4005.JPG To stay productive, middle adults may: • Reevaluate their priorities • Make new decisions Productive adults engage in tasks that nurture and nourish: • Managing a household • Raising children • Contributing to the health and welfare of future generations Those who fall into stagnation tend to be self-absorbed. Other characteristics of the middle adult are summarized on the next screen. Point 5 of 12 4006 Psychosocial and Developmental Characteristics: Table IMAGE: 4006.JPG Point 6 of 12 4007 Psychosocial and Developmental Characteristics: Developmentally Appropriate Care Middle adults may experience self-doubt and midlife crisis. IMAGE: 4007.JPG To provide encouragement: • Focus on the patient’s strengths • Acknowledge the patient’s abilities and contributions • Maintain a hopeful attitude • Be alert for signs of depression You should also: • Allow the patient to express concerns about growing children and/or aging parents • Encourage the patient to express any worries about the future • Help him or her plan for an active, healthy retirement • Encourage the patient to verbalize any fears about illness/treatment/hospitalization Point 7 of 12 4008 Cognitive Abilities The middle adult uses extensive life experience to: • Learn • Create • Solve problems IMAGE: 4008.JPG Middle adults: • Form their own opinions • Make independent decisions Point 8 of 12 4009 Cognitive Abilities: Developmentally Appropriate Care Explain all medical procedures to middle-adult patients. Provide teaching based on learning style. IMAGE: 4009.JPG Involve patients in decision-making and healthcare planning. Allow for as much self-care as possible. As with all patients, respect the middle adult’s cultural and religious beliefs. Point 9 of 12 4010 Review FLASH INTERACTION: 4010.SWF/FLA Drag and drop terms from the word bank to complete the following table of physical changes characteristic of the middle adult. System/Organ Skin Bones Reproductive system Sense Related Change Loss of moisture and elasticity Loss of density Menopause Farsightedness Point 10 of 12 4011 Review When caring for a middle-adult patient, focus on the patient’s strengths, and acknowledge the patient’s abilities and contributions. a. True b. False TRUE / FALSE INTERACTION Correct answer: A Feedback for A: Correct. Focus on the patient’s strengths. Acknowledge the patient’s abilities. Feedback for B: Incorrect. Focus on the patient’s strengths. Acknowledge the patient’s abilities. Point 11 of 12 4012 Summary You have completed the lesson on middle-adult patients. NO IMAGE Remember: • The middle adult experiences many degenerative physical changes. They may develop chronic conditions such as diabetes or cardiovascular disease. Middle adults often reevaluate their priorities and make new decisions to remain productive. If they are not productive, they may show signs of self-absorption. Major stressors and fears are related to the sandwich phenomenon. The middle adult uses extensive life experience to learn, create, and solve problems. Middle adults form their own opinions and make independent decisions. • Consider these factors when caring for a middle adult. Point 12 of 12 Lesson 5: Older Adults 5001 Introduction Welcome to the lesson on the older adult (over age 65). FLASH ANIMATION: 5001.SWF/FLA After completing this lesson, you should be able to: • Describe the older-adult patient’s: o Characteristics o Needs • Recall care practices that are appropriate for the older adult, based on: o Developmental challenges o Milestones o Characteristics o Needs Point 1 of 16 5002 Physical Characteristics and Changes Older adults experience diminished function in every system of the body. IMAGE: 5002.GIF Many of these changes are summarized in the table to the right. Point 2 of 16 5003 Physical Characteristics and Changes: Developmentally Appropriate Care Monitor the physical health of older adults closely. Encourage good health. IMAGE: 5003.JPG Ensure that immunizations are kept up-to-date. The Joint Commission’s 2007 National Patient Safety Goals includes reducing the risk of influenza and pneumococcal disease in older adults. To achieve this goal,,develop and implement protocols for: • Administration and documentation of vaccinations • Identification and management of outbreaks such as influenza and pneumococcal. Point 3 of 16 5004 Physical Characteristics and Changes: Developmentally Appropriate Care As a health care professional you should: • Encourage patients to remain as active as possible • Suggest ways of dealing with physical impairments IMAGE: 5004.JPG Finally, when examining, treating, or caring for an older adult: • • • • Provide for warmth if heat regulation is poor Have the patient change positions slowly, to compensate for decreased cardiovascular force Speak distinctly Focus light directly on objects Point 4 of 16 5005 Nutritional Needs Older adults require fewer calories than younger adults. IMAGE: 5005.GIF The nutritional status of older adults may be poor. This is due to factors such as: • Income • Overall state of health • Dental health • Changes in taste • Physical limitations, such as difficulty chewing, swallowing, etc. • Lack of transportation to and from the grocery store • Lack of appetite • Psychological factors, such as depression • Chemical dependency, such as alcoholism Point 5 of 16 5006 Nutritional Needs: Developmentally Appropriate Care Assess the nutritional status of all older-adult patients. IMAGE: 5006.JPG For older-adult patients who take care of themselves, encourage: • Healthy eating • Adequate fluid intake To help improve food intake in patients with compromised nutritional status, suggest: • Physical support while eating • Smaller, more frequent meals • Food intake appropriate for the patient’s activity level • Pureed foods • Nutritional supplements Point 6 of 16 5007 Psychosocial and Developmental Characteristics Older adults tend to be introspective. They review their lives. They face the primary challenge of ego integrity vs. despair. FLASH ANIMATION: 5007.SWF/FLA Those who achieve ego integrity display: • Wisdom and skills • Satisfaction with their lives Those who do not show signs of despair: • Remorse • A sense that life is meaningless Other characteristics of the older adult are summarized in the table on the next screen. Point 7 of 16 5008 Psychosocial and Developmental Characteristics: Table IMAGE: 5008.JPG Point 8 of 16 5009 Psychosocial and Developmental Challenges: Developmentally Appropriate Care Encourage older adults to accept the realities of aging. Also encourage them to remain as active and independent as possible. IMAGE: 5009.JPG Listen to the older-adult patient. Give patients the opportunity to express their: • Feelings about life accomplishments • Grief concerning the death of family and friends • Fears and concerns Finally, help guard against depression and isolation by encouraging: • Social activities • A positive attitude • Sense of humor Point 9 of 16 5010 Cognitive Abilities Older adults may remain active learners and thinkers. IMAGE: 5010.JPG However, many older adults eventually experience significant declines in: • Memory • Learning • Communication skills Point 10 of 16 5011 Cognitive Abilities: Developmentally Appropriate Care Involve competent older-adult patients in decision-making and healthcare planning. IMAGE: 5011.JPG Allow for as much self-care as possible. Encourage the completion of advance directives [glossary]. For those with a limited ability to understand: • Involve a designated healthcare representative • Present information slowly • Keep sessions short • Avoid distractions • Use large print materials and simple pictures or drawings Preserve patient dignity. Promote autonomy. This should be done even in patients with dementia. Point 11 of 16 5012 Safety Needs and Related Care Patients in this age group have increased safety needs: • Older adults are at increased risk for falls. They also are more likely to be injured in a fall. • Sensory changes may put drivers at increased risk. • Confused patients may be unable to recognize dangers. IMAGE: 5012.JPG Related healthcare practices include: • Assess patients for fall risk • Assess patients for confusion • Discuss how sensory changes can affect activities • Suggest environmental changes to help prevent falls Point 12 of 16 5013 Medical Needs and Related Care Older adults may take many medications. IMAGE: 5013.JPG Provide aids (dose calendars, daily pillboxes, etc.) to help the patient remember to take their medications. Age-related changes can affect drug absorption, metabolism, and excretion. Medications can have unexpected and unpredictable effects. Therefore, dosages should follow the “start low, go slow” rule. Point 13 of 16 5014 Review Older adults should avoid physical activity as much as possible. a. True b. False TRUE / FALSE INTERACTION Correct answer: B Feedback for A: Incorrect. This statement is false. Older adults should remain as active as possible. Feedback for B: Correct. Older adults should remain as active as possible. Point 14 of 16 5015 Review Older adults who fail to achieve ego integrity tend to display: a. Despair b. A sense that life is meaningless c. Remorse about ways in which they could have lived life differently d. All of these MULTIPLE CHOICE INTERACTION Correct answer: D Feedback for A: Not quite. The correct answer is D. Older adults who do not achieve ego integrity show signs of despair and remorse. Feedback for B: Not quite. The correct answer is D. Older adults who do not achieve ego integrity show signs of despair and remorse. Feedback for C: Not quite. The correct answer is D. Older adults who do not achieve ego integrity show signs of despair and remorse. Feedback for D: Correct. Older adults who do not achieve ego integrity show signs of despair and remorse. Point 15 of 16 5016 Summary You have completed the lesson on older adults. NO IMAGE Remember: • Older adults experience diminished function in every system of the body. • Older adults require fewer calories than younger adults. However, they may not maintain adequate dietary intake. • Older adults tend to be introspective. They face the challenge of ego integrity vs. despair. • Major stressors and fears for the older adult are related to new roles, decline, decreasing independence, dealing with death, security, and status. • Many older adults will experience declines in memory, learning, and communication skills. • Safety issues for older adults are related to fall risk, sensory changes, and confusion. • Older adults may take many medications. They may have unexpected and unpredictable effects. • Consider these factors when caring for the older adult. Point 16 of 16 Lesson 6: Development and Assessment of Competencies 6001 Introduction & Objectives Welcome to the lesson on development and assessment of agespecific competencies. FLASH ANIMATION: 6001.SWF/FLA After completing this lesson, you should be able to: • Detail the facilities requirements concerning age-specific competencies • Describe methods used to assess age-specific competencies Point 1 of 9 6002 Developing Age-Specific Competencies Your facility must: • Define age-specific competencies • Educate and train staff members • Assess employee competencies FLASH ANIMATION: 6002.SWF/FLA Let’s take a closer look at each responsibility. Point 2 of 9 6003 Defining Age-Specific Competencies Each healthcare facility must define the exact competencies to be achieved by its employees. FLASH ANIMATION: 6003.SWF/FLA Exact definitions are important. All employees need a clear idea of the knowledge and skills they are expected to have. Your facility competencies may differ slightly from those presented in this course. Point 3 of 9 6004 Defining Age-Specific Competencies: Documentation Age-specific competencies may be documented in: • Position or job descriptions • Addenda to position or job descriptions • Unit or departmental policies • Departmental scope-of-service documents • Peer review standards • Contracts between employers and provider groups FLASH ANIMATION: 6003.SWF/FLA Ask your supervisor where to find documentation if needed. Point 4 of 9 6005 Education Your facility also should offer training: • Orientation programs • In-services • Videos and other self-learning materials • Computer-based programs • Hospital-wide education programs FLASH ANIMATION: 6005.SWF/FLA Completion should be documented in your employee record. Point 5 of 9 6006 Assessment Your facility also must assess age-specific competencies. Specific criteria must be used. FLASH ANIMATION: 6006.SWF/FLA Point 6 of 9 6007 Assessment Assessment methods may include: • • • • • Direct observation Return demonstration Medical record review Peer evaluation Patient satisfaction survey Click on each method to learn more. CLICK TO REVEAL Direct observation A supervisor watches a staff member provide care to a patient. Developmentally-appropriate care (or lack of) is noted by the supervisor. Return demonstration A staff member observes a supervisor teach the proper way to care for a patient. The staff member then demonstrates the care procedure. This shows that he or she has acquired the competency. Medical record review A supervisor checks the medical records of patients. Developmentally-appropriate care (or lack of) is noted. Peer evaluation Coworkers assess the knowledge and ability of a staff member. They are in the best position to view performance on an ongoing basis. Surveys Surveys provide information about patient perceptions of the quality of age-specific care. Point 7 of 9 6008 Review The direct observation method is used to assess age-specific competencies. A supervisor watches as a staff member provides care or services to a patient of a particular age group. a. True b. False TRUE / FALSE INTERACTION Correct answer: A Feedback for A: Correct. A supervisor watches as a staff member provides care or services to a patient. Feedback for B: Incorrect. This statement is true. In direct observation, a supervisor watches as a staff member provides care or services to a patient. Point 8 of 9 6009 Summary You have completed the lesson on acquisition of age-specific competencies. NO IMAGE Remember: • Your facility must define age-specific competencies. Age-specific competencies may be documented in a variety of places. Your facility must provide education and training. It must be documented. Your facility is responsible for assessing age-specific competencies. Point 9 of 9 [Developmentally Appropriate Care of the Adult Patient] Course Glossary # Term Assess Psychosocial Cognitive Basal metabolic rate (BMR) Decalcification Advance directive Definition To determine the importance, size, or value of through official evaluation "Psychological + social" - the emotional portions of thought plus the relationship to human society, life and community A term that describes the process people use for remembering, reasoning, understanding, problem solving, evaluating and using judgment. A measurement of the energy required to keep the body functioning at rest Loss of calcium from bones or teeth Written document that describes how you want medical decisions to be made if you lose the ability to make decisions for yourself [Developmentally Appropriate Care of the Adult Patient] Pre-Assessment 1. Jill Smith is a 27-year-old accountant. She recently married. She is considering starting a family, but also enjoys her work. She wonders how a new baby would affect her marriage. She is also concerned about her friendships with non-mothers. You should: a. Encourage her to pursue both family and career, while she is still young and energetic b. Advise her to establish her career more firmly before having children c. Encourage her to think realistically about the commitments and challenges related to relationships, family, and career d. Reassure her that children will not affect her other relationships or her ability to pursue her career Correct answer: C Rationale: Balancing roles and responsibilities can be a major stressor for young adults. Encourage patients in this age group to think realistically about the challenges and commitments of relationships, family, and career. 2. Amy Peters is a 24-year-old college graduate looking for a job. She dates casually, but has never been in a serious relationship. She has no children. Jane Joseph is a 52-year-old stay-at-home mother of three. Her youngest child recently started college. Which of the following statements reflect best practices for BOTH patients? a. Explain all necessary medical procedures to Jane, including the rationale for each procedure. Discuss Amy’s treatment with her parents. b. Screen Jane for depression related to mental and physical decline. Screen Amy for depression related to midlife crisis. c. Monitor Jane for risk factors related to conditions such as cancer, heart disease, and diabetes. Monitor Amy for sexually transmitted diseases. d. Acknowledge Jane’s abilities and contributions. Give Amy the opportunity to express feelings related to life achievements. Correct answer: C Rationale: Monitor middle adults for risk factors. Monitor young adults for sexually transmitted diseases. 3. The primary psychosocial challenge for older adults is: a. Intimacy vs. isolation b. Productivity vs. stagnation c. Ego integrity vs. despair d. Dependence vs. independence Correct answer: C Rationale: The primary challenge for older adults is ego integrity vs. despair. Those who achieve ego integrity display wisdom, skills, and satisfaction with their lives. Those who fail to achieve ego integrity display signs of despair: remorse about what might have been, and a sense that life is meaningless. 4. Medication dosages for older adults should follow the: a. “Start low, go slow” rule b. “Aim high, retry” rule c. “Stop and drop” rule d. “Wait and watch” rule Correct answer: A Rationale: Age-related changes can affect drug absorption, metabolism, and excretion. In some cases, medications can have unexpected and unpredictable effects on older patients. To help guard against this, medication dosages should follow the “start low, go slow” rule. 5. Each healthcare facility is responsible for defining and describing the exact competencies to be achieved by its employees. All of the following statements are true EXCEPT: a. Exact definitions are important so that all employees have a clear idea of the knowledge and skills they need to provide quality, ageappropriate care. b. Descriptions of age-specific competencies are often documented in job descriptions or unit/departmental policies. c. Once a facility has defined and documented its competency expectations, it has no further responsibilities with regard to the age-specific competencies of its employees. d. Clear definitions and descriptions provide reliable guidelines for patient care, but do not give hard-and-fast rules. Correct answer: C Rationale: In addition to defining age-specific competencies, facilities are responsible for training and assessing their employees with regard to established competencies. 6. The term “competency” refers to a set of knowledge, skills, and abilities that allow a person to perform a specific task. a. True b. False Correct answer: A Rationale: This is an accurate definition of competency. 7. You are evaluating an institution’s compliance with The Joint Commission’s National Patient Safety Goals. The institution has initiated a program to increase flu and pneumococcus vaccination program among older adults. They also have methods in place to document how many older patients are vaccinated. To be fully compliant, they also need to: a. Develop protocols to vaccinate middle adults as well b. Develop protocols to vaccinate older patients against Rubella as well c. Develop protocols to identify and manage influenza and pneumococcus outbreaks d. No other measures are needed. The institution is fully compliant. Correct answer: C Rationale: The Joint Commission also expects accredited institutions to identify and manage influenza and pneumococcus outbreaks. 8. Developmentally-appropriate care uses age as a guideline for providing patient care. This is an advantage because care is standardized by age. A 30-year-old man with Down syndrome will receive the same care as a 30-year-old man without Down syndrome. a. True b. False Correct answer: B Rationale: Age is used only as a guideline. Care must also depend on other factors. In this example, the developmental stage of the patient with Down syndrome must be considered. The two patients will have different characteristics and needs. Each must be addressed appropriately. 9. Rich is 30-years-old. He is living with his parents while attending graduate school. Chris is a 30-year-old student who lives off campus and has a full-time job. You should challenge the personal values of ____ in order to encourage his independence. a. Chris b. Rich c. Both Chris and Rich d. Neither Chris or Rich Correct answer: D Rationale: Never challenge the personal views of a patient. 10. When caring for a menopausal woman: a. Discuss the use of estrogen b. Provide tips for minimizing the risk of osteoporosis c. Screen for depression d. All of these should be done e. None of these are necessary at this stage Correct answer: D Rationale: Menopausal women need information about the use of estrogen. Because bone changes take place after menopause, they also need information about osteoporosis. Finally, menopause can be accompanied by depression. 11. Which of the following patients is most likely to experience the sandwich phenomenon? a. A 23-year-old woman b. A 45-year-old woman c. A 69-year-old woman d. All of these Correct answer: B Rationale: Middle adults typically experience the sandwich phenomenon. They are often caring for their children and aging parents at the same time. Final Exam 1. The term “competency” refers to a set of knowledge, skills, and abilities that allow a person to perform a specific task. a. True b. False Correct answer: A Rationale: This is an accurate definition of competency. 2. Age-specific competencies are assessed for accreditation by The Joint Commission. Each employee must be able to: a. Determine a patient’s status by assessing patient data b. Identify an individual patient’s needs by interpreting patient information c. Provide care appropriate to a patient’s age and developmental needs d. All of these abilities must be demonstrated e. None of these abilities must be demonstrated Correct answer: D Rationale: To be considered competent under The Joint Commission standards, an employee must demonstrate all of these abilities. 3. The sandwich phenomenon and empty nest syndrome are most common among: a. Young adults b. Middle adults c. Older adults d. All of these e. None of these Correct answer: B Rationale: The sandwich phenomenon describes caring for both growing children and aging parents. Empty nest syndrome describes parental feelings of depression after children leave home. Both are most common among middle adults. 4. Older adults rarely have problems related to inadequate dietary intake. a. True b. False Correct answer: B Rationale: Although older adults require fewer calories, their nutritional status is often poor, due to inadequate income, overall state of health, dental health, changes in taste, and other factors. 5. Developmentally appropriate care uses age as a guideline. Other factors don’t need to be taken into account. a. True b. False Correct answer: False Rationale: Age is used as a guideline, not a rule. Other factors need to be considered when caring for a patient. 6. Learning styles differ from patient to patient. Even individuals among a single age group differ. a. True b. False Correct answer: A Rationale: Learning styles differ from person to person. 7. Which of the following statements is (are) true? a. The middle years can be a time of doubt. b. The middle years can be a time of crisis. c. The middle years can be a time of nurturing. d. All of the above e. None of the above Correct answer: D Rationale: All of these can characterize the middle years. 8. When caring for patients, you must consider: a. Chronological age b. Developmental age c. Maturity level d. All of the above e. None of the above Correct answer: D Rationale: All of these factors are important to consider. 9. One the Joint Commission’s National Patient Safety Goals is to reduce the risk of influenza in: a. Young adults b. Middle adults c. Older adults d. All adults Correct answer: C Rationale: The Joint Commission requires accredited institutions to reduce the risk of influenza in older adults. 10. Age-related changes can affect drug absorption, metabolism, and excretion. However, these changes are predictable. a. True b. False Correct answer: B Rationale: Drug effects in older patients are unpredictable. 11. Which assessment method gathers information about patient perceptions about the quality of age-specific care? a. Direct observation b. Medical record review c. Peer evaluation d. Surveys Correct answer: D Rationale: Patient surveys collect information about the patient’s perceptions of care. 12. Monitoring for sexually transmitted diseases is an important care practice for the ____ patient. a. Young adult b. Middle adult c. All adults d. Both A and B Correct answer: A Rationale: Young adults should be monitored for sexually transmitted diseases. 13. The primary psychosocial challenge for the older adult is a. Ego integrity vs. despair b. Intimacy vs. isolation c. Productivity vs. stagnation d. Independence vs. dependency Correct answer: A Rationale: Older adults face the challenge of ego integrity versus despair. 14. Which of the following patients is most likely to experience the sandwich phenomenon? e. A 23-year-old woman f. A 45-year-old woman g. A 69-year-old woman h. All of these Correct answer: B Rationale: Middle adults typically experience the sandwich phenomenon. They are often caring for their children and aging parents at the same time. 15. Which of the following statements is NOT true? a. It is important to encourage stress reduction among young adults b. Unhealthy lifestyle choices are a major safety risk for young adults c. Older adults are at increased risk for falls d. Confused older adults recognize dangers but are unable to avoid them Correct answer: D Rationale: Confused adults often do not recognize dangers.