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Fourth Semester > AC2 Exam 1 > Flashcards

AC2 Exam 1 Flashcards

1
Q

Why is clinical decision making complex in older aduts?

A

Need for the ability to prioritize care, many different issues reside within the older adult that the RN needs to analyze

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2
Q

What is an ADL?

A

activities of daily living
toileting, bathing, dressing, feeding, continence

LAST TO GO**

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3
Q

What does IADL mean?

A

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

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4
Q

Abnormal changes in the older adult

A

incontinence, obesity

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5
Q

What are some interventions that can prevent or decrease fall risk?

A

change positions slowly, move rugs/ cords,
make sure shoes hit, avoid drowsy meds

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6
Q

What is the Timed Up and Go Test (TUG)?

A

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

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7
Q

How do you administer the TUG test?

A

“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”

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8
Q

What should the nurse always focus on?

A

Safety

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9
Q

How does immobility affect the overall levels of care?

A

Increases dependency d/t convenience (putting a brief on a pt instead of rounding q2hr and assisting to bathroom)

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10
Q

If a patient has a new onset of falls or increase in the number of falls, what should the nurse think?

A

infection or medication

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11
Q

A patient having multiple falls is a marker for what?

A

general decline, (LTC for >1year or death, 1/4 die <6mo)

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12
Q

What is constipation?

A

shitless, shitunreliable, shithurt

infrequent, incomplete, or painful evacuation of feces

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13
Q

What should the nurse do to assess for constipation?

A

perform abdominal assessment, elimination history, surgeries/ diagnosis that can cause constipation, mobility issues

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14
Q

What is used to help with constipation?

A

fiber, fluids, ambulation, enemas, laxatives

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15
Q

How does the nurse know when to administer a laxative?

A

3 days AFTER using fluids, fiber, and ambulation

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16
Q

When do you take a stimulant laxative?

A

at night

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17
Q

What is waters role in constipation?

A

brings fluid to the stool and softens it

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18
Q

What are some types of laxatives?

A

stimulant, osmotic , stool softener

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19
Q

Senna

A

stimulant laxative

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20
Q

Polyethylene glycol (Miralax)

A

osmotic

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21
Q

Stool softener

A

Docusate sodium

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22
Q

Types of incontinence include….

A

urge
stress
overflow
functional

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23
Q

Urge incontinence is described as…

A

abrupt, strong **urge **to void with moderate to large volume of leakage

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24
Q

What are some causes of urge incontinence?

A

UTI, bladder spasticity, caffeine, CNS lesions (sadie and overactive bladder)

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25
Q

What symptoms does a patient with stress incontinence experience?

A

leakage during abdominal pressure (laughing etc.)

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26
Q

What are some causes of stress incontinence?

A

pelvic muscle or ligament laxity (looseness of muscle), trauma from prostate surgery, childbearing

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27
Q

What are some signs a patient is experience overflow incontinence?

A

restriction/obstruction of flow or urine leads to distended bladder

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28
Q

What are some causes of overflow incontinence?

A

BPH, anticholinergics, TBI, diabetes, B12 deficiency, alcoholism

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29
Q

What is functional incontience?

A

pt has an inability or unwillingness to toilet

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30
Q

Is incontinence normal or abnormal?

A

abnormal regardless of age, mobility, mental status, frailty

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31
Q

What management techniques are used for urge incontinence?

A

Kegels, treat UTI, reduce bladder tone, estrogen cream, scheduled voiding

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32
Q

What medications will be used to relax bladder muscles (reduce the tone)?

A

Ipiramine, Solifenacin, Darifenacin, Oxybutin

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33
Q

What does Oxybutinin treat?

A

Urge incontinence d/t over active bladder d/t bladder spasms. Also treats post op TURP

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34
Q

What is atrophic vaginitis? What is it treated with?

A

dry vaginal and urethral epithelium , topical estrogen

as per sadies words

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35
Q

What management techniques are used for stress incontinence?

A

evaluate what medications aggravate, kegels, weight loss, treat atrophic vaginitis, insert a pessary

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36
Q

What management techniques will be used for overflow incontinence?

A

review medications, retrain the bladder, reverse the cause (improve diabetes or decrease alcohol)

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37
Q

What management technique is used for functional incontinence?

A

Remove barriers to BR use
Use pictures on BR door
Improve mobility with PT/OT

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38
Q

What are kegels/ pelvic floor?

A

helps to strengthen pelvic wall and hold in urine better, squeeze the pelvic muscles

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39
Q

What does oxybutynin do?

A

reduce tone of bladder

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40
Q

Topical estrogen

A

treatment of atrophic vaginitis

dry coocoo

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41
Q

Why do older adults become acutely confused (delirium) and how do we recognize and intervene appropriately?

A

UTIs, medications, infection, electrolyte imbalances, anemia, dehydration

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42
Q

How do you administer the CAM? What is it for?

A

a tool that asks several different questions concerning the overall presentation of the pt

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43
Q

Issues r/t ensuring safe use of drug therapy in an older person?

A

educate them on the importance of reading OTC drug labels as there may be duplicates in their daily medications

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44
Q

Older adults have what drug responses to medications?

A

They are more sensitive to some medications like opioids, so they have to take less

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45
Q

What is the Beers Criteria list of medications?

A

medications that are “inapropriate” in older adults

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46
Q

What is an example of an emotional or financial impact of chronic diseases?

A

Difficulties within a family (mom or dad cant cook, clean, work, care for household, or provide income)

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47
Q

What emotional assessment will be done on patients with chronic disease?

A

Depression screening

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48
Q

What is compromised in patients with a chronic disease?

A

lack of self esteem, difficulty completely ADLs, family functioning, self worth, happiness

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49
Q

Management of chronic illness involves treating…?

A

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)

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50
Q

What are the nursing interventions for a patient with a chronic disease?

A

manage threats to identity, teach pt to normalize personal family life as much as possible, teach pt to carry out regimens as prescribed.

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51
Q

What are the signs and symtpoms of delirium?

A

confusion, restless, changes in LOC, hallucinations, delusions

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52
Q

How can you figure out what the patients “normal/baseline” is as the nurse?

A

ask the family

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53
Q

What are nursing interventions for delirium?

A

Provide a calming environment, resolve the cause, be cautious about what medications you give the patient

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54
Q

What is the definition of fraility in the nursing setting?

A

presence of 3 or more comorbidities, needs assistance with at least 2 ADLs, diagnosed with one or more geriatrc syndromes

55
Q

How does the nurse assess frailty when there isnt a specific tool?

A

Fall risk assessment, TUG test, nutritional assessment, urinary incontinence assessment

56
Q

What are some factors of fraility?

A

osteoporosis, chronic conditions, major surgeries

57
Q

What are comorbidities?

A

Parkinsons or Alzheimers

58
Q

What is a geriatric syndrome?

A

constipation, malnutrition

59
Q

What are the major concerns related to nutrition in the older adults?

A

being overweight but malnourished

60
Q

What are some interventions that help with appetite and increasing calories?

A

sprinkle protein powder on top

61
Q

What labs do you use to monitor the older adults nutrition?

A

Albumin and BMI

62
Q

What are the BMI ranges?

A

under 15 is malnourished
over 24.9 is overweight
over 30 is obese

63
Q

What are some diet modifications for heart disease?

A

Atherosclerosis: TLC diet (therapeutic lifestyle changes), reduced fats, increased fiber, increased soybean (plant stanol)

64
Q

What is the range for albumin?

A

3.5-5g/dL

65
Q

What are some dietary modifications for MI?

A

2-4g of sodium diet

66
Q

What are some dietary modifcations for someone with heart failure?

A

2g or less of sodium
fluid restriction of 1500cc (2L)
limit ETOH
Reduce the size of meals d/t fatigue

67
Q

What are some dietary modifications for HTN?

A

Limit ETOH
2-4g of sodium

68
Q

What are some dietary modifications for CVA?

A

inadequate nutrition (may require altered consistency diet)
low fat

69
Q

What are some dietary modifications for PNA (pneumonia)?

A

Increase fluids

70
Q

What are some dietary modifications for TB?

A

high caloric intake to prevent weight loss

71
Q

What are some dietary modifications for DM?

A

Low carb

72
Q

What are some dietary modifications for neurological disorders (MS/ Parkinsons)

A

small frequent meals
possible consistency modifciations

73
Q

What are some risk factors for BPH?

A

Increases with age, 90% of men over 80 have it, 90% of men between 70-90yr old have symptoms

74
Q

What are some expected findings of BPH?

A

Straining to urinate, hesitancy, decreased force of urine stream, frequency, incomplete emptying of bladder, post void dribbling, urgency, hematuria, nocturia

75
Q

What labs will you need for a patient with BPH?

A

Complete history, focusing on lower urinary tract symtpoms (LUTS)
UA, serum creatinine
PSA (prostate specific antigen)
Prostatism symptom complex

76
Q

What medication re establish unihibited urine flow?

A

Tamulosin

77
Q

What does tamulosin do?

A

decreases smooth muscle tone (nonselective= vasodilator)

78
Q

What are some complications/ nursing considerations for Tamulosin?

A

Hypotension, failed ejaculate. do NOT use before surgery d/t floppy iris syndrome, contraindicated with renal and liver impairment

79
Q

Monitor BP and LOC with this medication

A

Tamulosin

80
Q

When should you take tamulosin?

A

30 min after each meal

81
Q

What is a critical consideration for a 3 way catheter foley?

A

keep it patent

82
Q

What does the drainage look like each day with a 3 way cath?

A

Urine bright red (day 1), pink (day 2), to normal amber (1 week)

83
Q

What should you use for a 3 way catheter irrigation?

A

0.9% sodium chloride aka normal saline, not sterile H20

84
Q

If a pt has significant bloodloss, what lab would you monitor?

A

Hct and Hgb (H&H)

85
Q

What is the surgical treatment for BPH?

A

TURP (transurethral prostaectomy)

86
Q

What are some nursing interventions for TURP?

A

Strict I&O, stool softener, care plan and teaching (post op care and sexual dysfunction)

87
Q

What is TURP syndrome?

A

to much fluid used to wash the area around the prostate is absorbed into the blood stream, causing the patient to feel sick

88
Q

What are the s/s of TURP syndrome?

A

bradycardia, BP, confusion, N/V, H/A,d/t fluid and electrolyte imbalances

89
Q

What are some complications of TURP?

A

hemorrhage/ clot retention, displacement of catheter, bladder perforation, bladder spasm, inability to void, urethral stricture (long term), retrograde ejaculation (long term

90
Q

Lacking what vitamins make it difficult for the body to heal?

A

Vitamin D, E, A, and calcium

91
Q

What is the pathophysiology behind parkinsons disease?

A

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

92
Q

What is the etiology of Parkinsons?

A

idiopathic, post encephalitic, environmental exposure, drug induced toxic, trauma, genetic

93
Q

What is the most common etiology of Parkinsons?

A

Idiopathic (we have no clue why)

94
Q

When do parkinsons symptoms present?

A

Typically sometime after 50 or 6th decade of life. Can happen in your 30s.

95
Q

In what body systems does parkinsons present?

A

muscle movement/ coordination
autonomic system
endocrine system
brainstem
thalamic region
cerebral cortex

96
Q

What kind of disease is parkinsons?

A

systemic, treatment is multifactorial

97
Q

Hallmark symptoms of Parkinsons include…?

A

Pill roll tremor
bradykinesia
rigidity
short shuffling steps

fatigue and depression are also common complaints

98
Q

What parts of the autonomic and neuroendocrine systems does parkinsons effect?

A

digestion
temperature control
sleep wake cycle
gland secretion and hormones

99
Q

How is parkinsons disease diagnosed?

A

the process of ruling out other diseases, there is not a specific test

100
Q

Who will you work with for interprofessional colaboration with a parkinsons patient?

A

social work, spiritual help, PCP, PT, OT

101
Q

How does Parkinsons effect a patients quality of life and ADLs?

A

the patient will be tired, extra work having to eat, walk, and function daily.

102
Q

What are parkinsons patients at risk for?

A

Malnutrition and electrolyte imbalances
Fractures d/t falls
Pneumonia d/t aspiration
Increased r/f mortality and morbidity d/t the above

103
Q

What types of medications are used to treat Parkinsons?

A

Dopamine Agonists
Anticholinergics
Catechol- O- methyltransferase (COMT) Inhibitors

104
Q

When do you typically use dopamine agonists with parkinsons patients?

A

first 3-5 years

105
Q

When do you use COMT inhibitors?

A

Later in the disease process

106
Q

What is a common effect of medications used for parkinsons disease?

A

Orthostatic hypotension

107
Q

What simple nursing intervention would you implement with a parkinsons patient?

A

Raise the HOB to 30 degrees

108
Q

What are some other nursing interventions to implement with a parkinsons patient?

A

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

109
Q

How should a parkinsons patient diet change?

A

blend up foods to make it easier to eat

110
Q

What specific population are at higher risk for developing Parkinsons disease?

A

Lewybodies are developed in the brain with active combat, causing VETERANS to be at a higher risk

111
Q

What other symptoms are seen with Parkinsons patients?

A

dementia like symptoms
apathetic
dysphasia
constipation
drooling (d/t muscle weakness)

112
Q

How do COMT inhibitors work?

A

Increase duration of Sinemet by blocking an enzyme in the body which
breaks down levodopa and allows more to cross the blood brain barrier

113
Q

What effects on Parkinsons symtpoms does COMT inhibitors have?

A

NONE
instead it enhances carbidopa levidopa, lengthening beneficial effects

side effects are naseau and hypotension

114
Q

How does dopamine replace/ enhancement drugs work?

A

encourages the release of norepinephrine, stimulating the release of dopamine

115
Q

When do you take a dopamine agonist?

A

before or with levodopa

116
Q

What parkinsons medication is used as a rescue drug during off times?

A

dopamine agonist

117
Q

What is the most effective medication to treat Parkinsons disease?

A

carbidopa levodopa (Sinemet or Parcopa)
however it may speed up the disease progression

118
Q

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?

A

Carbidopa Levidopa

take 1 hour before food or 1 hours after

119
Q

What are some major concerns when caring for a patient with Parkinsons?

A

make sure they are mobile for as long as possible, difficulty swallowing (aspiration), keep HOB at 30, promote mobility

120
Q

Can you use anticholinergics (Aretane, Cogentin) in a patient with Parkinsons?

A

Yes because it control tremors and rigidity by counteracting acetecholamine, BUT it is very risky d/t anticholinergic effects (cant see, spit, poop, pee)

121
Q

Frail means what?

A

weak

122
Q

What is the difference between multiple comorbidities and multiple geriatric syndromes?

A

Comobidities are 2 or more diseases, those diseases cause the geriatric syndromes

123
Q

What do you want to pump up nutritionally for a patient?

A

Vitamin D, A , C, calcium and increase protein

124
Q

How do you combat constipation in a geriatric patient?

A

Fiber, mobility, fluid intake

125
Q

What kind of fluid do you use to irrigate a TURP?

A

it depends on the orders but usually normal saline

126
Q

You use saline when irrigating a patient with TURP, what are some adverse effects of doing so?

A

Cardiac overload, fluid retention, electrolyte imblances

127
Q

What is a common complaint of a patient with TURP syndrome?

A

HEADACHE

128
Q

If you get a clot with TURP, what do you do?

A

Flush it out

129
Q

What labs would you get for a patient with malnutrition?

A

Albumin, total protein, electrolytes, Hgb (iron)

130
Q

Bladder spasms can occur due to what?

A

Running fluid to irrigate with TURP

131
Q

What is oxytocin used for?

A

Bladder spasms

132
Q

You want to avoid mixing this when taking a dopamaine replacement drug/ COMT inhibitors.

A

high protein, limits drug absoprtion and utilization

133
Q

What can happen with some Parkinsons medication?

A

They loose their effectiveness, so patients have to take a medication holiday

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