AC2 Exam 1 Flashcards
Why is clinical decision making complex in older aduts?
Need for the ability to prioritize care, many different issues reside within the older adult that the RN needs to analyze
What is an ADL?
activities of daily living
toileting, bathing, dressing, feeding, continence
LAST TO GO**
What does IADL mean?
Instrumental activities of daily living
Using the telephone, shopping, housekeeping, grocery lists, laundry, handling medications, handling finances
45-50% of 85+ older adults can perform these tasks
Abnormal changes in the older adult
incontinence, obesity
What are some interventions that can prevent or decrease fall risk?
change positions slowly, move rugs/ cords,
make sure shoes hit, avoid drowsy meds
What is the Timed Up and Go Test (TUG)?
a test used to assess mobility in older adults, if the pt cant complete in 12 seconds, they are at a high fall risk
look at what the pt holds onto during the test
How do you administer the TUG test?
“When I say Go, i want you to
1. stand up from the chair
2. walk to the line on the floor at your normal pace
3. turn
4. walk back to the chair at your normal pace
5. sit back down”
What should the nurse always focus on?
Safety
How does immobility affect the overall levels of care?
Increases dependency d/t convenience (putting a brief on a pt instead of rounding q2hr and assisting to bathroom)
If a patient has a new onset of falls or increase in the number of falls, what should the nurse think?
infection or medication
A patient having multiple falls is a marker for what?
general decline, (LTC for >1year or death, 1/4 die <6mo)
What is constipation?
shitless, shitunreliable, shithurt
infrequent, incomplete, or painful evacuation of feces
What should the nurse do to assess for constipation?
perform abdominal assessment, elimination history, surgeries/ diagnosis that can cause constipation, mobility issues
What is used to help with constipation?
fiber, fluids, ambulation, enemas, laxatives
How does the nurse know when to administer a laxative?
3 days AFTER using fluids, fiber, and ambulation
When do you take a stimulant laxative?
at night
What is waters role in constipation?
brings fluid to the stool and softens it
What are some types of laxatives?
stimulant, osmotic , stool softener
Senna
stimulant laxative
Polyethylene glycol (Miralax)
osmotic
Stool softener
Docusate sodium
Types of incontinence include….
urge
stress
overflow
functional
Urge incontinence is described as…
abrupt, strong **urge **to void with moderate to large volume of leakage
What are some causes of urge incontinence?
UTI, bladder spasticity, caffeine, CNS lesions (sadie and overactive bladder)
What symptoms does a patient with stress incontinence experience?
leakage during abdominal pressure (laughing etc.)
What are some causes of stress incontinence?
pelvic muscle or ligament laxity (looseness of muscle), trauma from prostate surgery, childbearing
What are some signs a patient is experience overflow incontinence?
restriction/obstruction of flow or urine leads to distended bladder
What are some causes of overflow incontinence?
BPH, anticholinergics, TBI, diabetes, B12 deficiency, alcoholism
What is functional incontience?
pt has an inability or unwillingness to toilet
Is incontinence normal or abnormal?
abnormal regardless of age, mobility, mental status, frailty
What management techniques are used for urge incontinence?
Kegels, treat UTI, reduce bladder tone, estrogen cream, scheduled voiding
What medications will be used to relax bladder muscles (reduce the tone)?
Ipiramine, Solifenacin, Darifenacin, Oxybutin
What does Oxybutinin treat?
Urge incontinence d/t over active bladder d/t bladder spasms. Also treats post op TURP
What is atrophic vaginitis? What is it treated with?
dry vaginal and urethral epithelium , topical estrogen
as per sadies words
What management techniques are used for stress incontinence?
evaluate what medications aggravate, kegels, weight loss, treat atrophic vaginitis, insert a pessary
What management techniques will be used for overflow incontinence?
review medications, retrain the bladder, reverse the cause (improve diabetes or decrease alcohol)
What management technique is used for functional incontinence?
Remove barriers to BR use
Use pictures on BR door
Improve mobility with PT/OT
What are kegels/ pelvic floor?
helps to strengthen pelvic wall and hold in urine better, squeeze the pelvic muscles
What does oxybutynin do?
reduce tone of bladder
Topical estrogen
treatment of atrophic vaginitis
dry coocoo
Why do older adults become acutely confused (delirium) and how do we recognize and intervene appropriately?
UTIs, medications, infection, electrolyte imbalances, anemia, dehydration
How do you administer the CAM? What is it for?
a tool that asks several different questions concerning the overall presentation of the pt
Issues r/t ensuring safe use of drug therapy in an older person?
educate them on the importance of reading OTC drug labels as there may be duplicates in their daily medications
Older adults have what drug responses to medications?
They are more sensitive to some medications like opioids, so they have to take less
What is the Beers Criteria list of medications?
medications that are “inapropriate” in older adults
What is an example of an emotional or financial impact of chronic diseases?
Difficulties within a family (mom or dad cant cook, clean, work, care for household, or provide income)
What emotional assessment will be done on patients with chronic disease?
Depression screening
What is compromised in patients with a chronic disease?
lack of self esteem, difficulty completely ADLs, family functioning, self worth, happiness
Management of chronic illness involves treating…?
chronic pain, sometimes there isnt a cure. it also involves treating more than one set of medical problems in a hollistic approach (one chronic disease can cause another)
What are the nursing interventions for a patient with a chronic disease?
manage threats to identity, teach pt to normalize personal family life as much as possible, teach pt to carry out regimens as prescribed.
What are the signs and symtpoms of delirium?
confusion, restless, changes in LOC, hallucinations, delusions
How can you figure out what the patients “normal/baseline” is as the nurse?
ask the family
What are nursing interventions for delirium?
Provide a calming environment, resolve the cause, be cautious about what medications you give the patient
What is the definition of fraility in the nursing setting?
presence of 3 or more comorbidities, needs assistance with at least 2 ADLs, diagnosed with one or more geriatrc syndromes
How does the nurse assess frailty when there isnt a specific tool?
Fall risk assessment, TUG test, nutritional assessment, urinary incontinence assessment
What are some factors of fraility?
osteoporosis, chronic conditions, major surgeries
What are comorbidities?
Parkinsons or Alzheimers
What is a geriatric syndrome?
constipation, malnutrition
What are the major concerns related to nutrition in the older adults?
being overweight but malnourished
What are some interventions that help with appetite and increasing calories?
sprinkle protein powder on top
What labs do you use to monitor the older adults nutrition?
Albumin and BMI
What are the BMI ranges?
under 15 is malnourished
over 24.9 is overweight
over 30 is obese
What are some diet modifications for heart disease?
Atherosclerosis: TLC diet (therapeutic lifestyle changes), reduced fats, increased fiber, increased soybean (plant stanol)
What is the range for albumin?
3.5-5g/dL
What are some dietary modifications for MI?
2-4g of sodium diet
What are some dietary modifcations for someone with heart failure?
2g or less of sodium
fluid restriction of 1500cc (2L)
limit ETOH
Reduce the size of meals d/t fatigue
What are some dietary modifications for HTN?
Limit ETOH
2-4g of sodium
What are some dietary modifications for CVA?
inadequate nutrition (may require altered consistency diet)
low fat
What are some dietary modifications for PNA (pneumonia)?
Increase fluids
What are some dietary modifications for TB?
high caloric intake to prevent weight loss
What are some dietary modifications for DM?
Low carb
What are some dietary modifications for neurological disorders (MS/ Parkinsons)
small frequent meals
possible consistency modifciations
What are some risk factors for BPH?
Increases with age, 90% of men over 80 have it, 90% of men between 70-90yr old have symptoms
What are some expected findings of BPH?
Straining to urinate, hesitancy, decreased force of urine stream, frequency, incomplete emptying of bladder, post void dribbling, urgency, hematuria, nocturia
What labs will you need for a patient with BPH?
Complete history, focusing on lower urinary tract symtpoms (LUTS)
UA, serum creatinine
PSA (prostate specific antigen)
Prostatism symptom complex
What medication re establish unihibited urine flow?
Tamulosin
What does tamulosin do?
decreases smooth muscle tone (nonselective= vasodilator)
What are some complications/ nursing considerations for Tamulosin?
Hypotension, failed ejaculate. do NOT use before surgery d/t floppy iris syndrome, contraindicated with renal and liver impairment
Monitor BP and LOC with this medication
Tamulosin
When should you take tamulosin?
30 min after each meal
What is a critical consideration for a 3 way catheter foley?
keep it patent
What does the drainage look like each day with a 3 way cath?
Urine bright red (day 1), pink (day 2), to normal amber (1 week)
What should you use for a 3 way catheter irrigation?
0.9% sodium chloride aka normal saline, not sterile H20
If a pt has significant bloodloss, what lab would you monitor?
Hct and Hgb (H&H)
What is the surgical treatment for BPH?
TURP (transurethral prostaectomy)
What are some nursing interventions for TURP?
Strict I&O, stool softener, care plan and teaching (post op care and sexual dysfunction)
What is TURP syndrome?
to much fluid used to wash the area around the prostate is absorbed into the blood stream, causing the patient to feel sick
What are the s/s of TURP syndrome?
bradycardia, BP, confusion, N/V, H/A,d/t fluid and electrolyte imbalances
What are some complications of TURP?
hemorrhage/ clot retention, displacement of catheter, bladder perforation, bladder spasm, inability to void, urethral stricture (long term), retrograde ejaculation (long term
Lacking what vitamins make it difficult for the body to heal?
Vitamin D, E, A, and calcium
What is the pathophysiology behind parkinsons disease?
A decrease in the amount of dopamine produced, causing cells to fire excessively. This is why there are issues with gait, shaking, tremors, postural instability
What is the etiology of Parkinsons?
idiopathic, post encephalitic, environmental exposure, drug induced toxic, trauma, genetic
What is the most common etiology of Parkinsons?
Idiopathic (we have no clue why)
When do parkinsons symptoms present?
Typically sometime after 50 or 6th decade of life. Can happen in your 30s.
In what body systems does parkinsons present?
muscle movement/ coordination
autonomic system
endocrine system
brainstem
thalamic region
cerebral cortex
What kind of disease is parkinsons?
systemic, treatment is multifactorial
Hallmark symptoms of Parkinsons include…?
Pill roll tremor
bradykinesia
rigidity
short shuffling steps
fatigue and depression are also common complaints
What parts of the autonomic and neuroendocrine systems does parkinsons effect?
digestion
temperature control
sleep wake cycle
gland secretion and hormones
How is parkinsons disease diagnosed?
the process of ruling out other diseases, there is not a specific test
Who will you work with for interprofessional colaboration with a parkinsons patient?
social work, spiritual help, PCP, PT, OT
How does Parkinsons effect a patients quality of life and ADLs?
the patient will be tired, extra work having to eat, walk, and function daily.
What are parkinsons patients at risk for?
Malnutrition and electrolyte imbalances
Fractures d/t falls
Pneumonia d/t aspiration
Increased r/f mortality and morbidity d/t the above
What types of medications are used to treat Parkinsons?
Dopamine Agonists
Anticholinergics
Catechol- O- methyltransferase (COMT) Inhibitors
When do you typically use dopamine agonists with parkinsons patients?
first 3-5 years
When do you use COMT inhibitors?
Later in the disease process
What is a common effect of medications used for parkinsons disease?
Orthostatic hypotension
What simple nursing intervention would you implement with a parkinsons patient?
Raise the HOB to 30 degrees
What are some other nursing interventions to implement with a parkinsons patient?
daily and postural excercise
ROM
wide based gait, heel to toe, march to music
environmental modifications (move rugs, cords, etc)
bowel program (increase fiber, fluids)
nutrition monitor (manage weight)
monitor skin
How should a parkinsons patient diet change?
blend up foods to make it easier to eat
What specific population are at higher risk for developing Parkinsons disease?
Lewybodies are developed in the brain with active combat, causing VETERANS to be at a higher risk
What other symptoms are seen with Parkinsons patients?
dementia like symptoms
apathetic
dysphasia
constipation
drooling (d/t muscle weakness)
How do COMT inhibitors work?
Increase duration of Sinemet by blocking an enzyme in the body which
breaks down levodopa and allows more to cross the blood brain barrier
What effects on Parkinsons symtpoms does COMT inhibitors have?
NONE
instead it enhances carbidopa levidopa, lengthening beneficial effects
side effects are naseau and hypotension
How does dopamine replace/ enhancement drugs work?
encourages the release of norepinephrine, stimulating the release of dopamine
When do you take a dopamine agonist?
before or with levodopa
What parkinsons medication is used as a rescue drug during off times?
dopamine agonist
What is the most effective medication to treat Parkinsons disease?
carbidopa levodopa (Sinemet or Parcopa)
however it may speed up the disease progression
What medication has an increase of Parkinson’s side effects over time, include nausea, hypotension, bradykinesia, dry mouth and is best absorbed on an empty stomach?
Carbidopa Levidopa
take 1 hour before food or 1 hours after
What are some major concerns when caring for a patient with Parkinsons?
make sure they are mobile for as long as possible, difficulty swallowing (aspiration), keep HOB at 30, promote mobility
Can you use anticholinergics (Aretane, Cogentin) in a patient with Parkinsons?
Yes because it control tremors and rigidity by counteracting acetecholamine, BUT it is very risky d/t anticholinergic effects (cant see, spit, poop, pee)
Frail means what?
weak
What is the difference between multiple comorbidities and multiple geriatric syndromes?
Comobidities are 2 or more diseases, those diseases cause the geriatric syndromes
What do you want to pump up nutritionally for a patient?
Vitamin D, A , C, calcium and increase protein
How do you combat constipation in a geriatric patient?
Fiber, mobility, fluid intake
What kind of fluid do you use to irrigate a TURP?
it depends on the orders but usually normal saline
You use saline when irrigating a patient with TURP, what are some adverse effects of doing so?
Cardiac overload, fluid retention, electrolyte imblances
What is a common complaint of a patient with TURP syndrome?
HEADACHE
If you get a clot with TURP, what do you do?
Flush it out
What labs would you get for a patient with malnutrition?
Albumin, total protein, electrolytes, Hgb (iron)
Bladder spasms can occur due to what?
Running fluid to irrigate with TURP
What is oxytocin used for?
Bladder spasms
You want to avoid mixing this when taking a dopamaine replacement drug/ COMT inhibitors.
high protein, limits drug absoprtion and utilization
What can happen with some Parkinsons medication?
They loose their effectiveness, so patients have to take a medication holiday
