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?
avoiding medications that make you drowsy (Benadryl)
change positions slowly
move rugs, cords, anything environmental
make sure shoes hit
PT
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)
What are some factors to consider when assessing the home for falls?
the whole person and environment as most falls are multifactorial
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
What is polypharmacy?
a patient taking around 14 or more medications
not a specific number but just know its a lot
What was the specific drug mentioned in class regarding polypharmacy?
blood pressure medications, antihistamines
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 reasons for why older adults become acutely confused (delirium)?
UTIs, medications, infection, surgery, hypoxia, dehydration
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
SCAVENGER HUNT!!!!!!!!
Go look at the CAM in D2L and know what makes it postive!
D2L will have your answer, not me :)
