Care of Aging Adult II part 5

Question 1

What are the side effects and the reason anticholinergic medications can be inappropriate for adult use?

Answer 1

Side effects: 
blurred vision
confusion
tachycardia
urinary retention
constipation
can complicate pre-existing conditions

Question 2

If a medication says XL or LA what does this mean?

Answer 2

it must be swallowed whole and never crushed or broken in half

Question 3

What are some ways to decrease side effects of OAB medication (oxybutynin and tolterodine)?

Answer 3

• use long acting medications
• meds that do not cross BBB
• selective drug therapy

Question 4

What are some ways to minimize adverse effects of anticholinergic medications (OAB).

Answer 4

• xerostomia (dry mouth): sipping fluids, sugar-free gum, saliva substitute, alcohol free mouth wash.
• Blurred vision: avoid hazardous activities
• photophobia: sunglasses
• urinary retention: void before taking anticholinergic’s
• constipation: increase fiber and fluids, laxative if severe
• hyperthermia: avoid vigorous exercise in warm climate
• tachycardia: monitor pulse

Question 5

What medications can anticholinergics have an adverse reaction to?

Answer 5

antihistamines
tricyclic antidepressants
phenothiazines

Question 6

Explain acute toxicity to medications?

Answer 6

• hallucinations and delirium
• skin becomes hot, dry, and flushed
• differentiate muscarinic antagonist poisoning from psychosis
• Tx: limit absorption (charcoal)

Question 7

Define diarrhea

Answer 7

-increased frequency of >3 per day
-liquid consistency
-

Question 8

Define acute, persistent, and chronic diarrhea.

Answer 8

• acute < 14 days
• persistent > 14 days
• chronic > 30 days

Question 9

What is the primary cause of diarrhea?

Answer 9

ingestion of an organism

Question 10

What is the pathophysiology of diarrhea?

Answer 10

viral 
bacterial
laxative misuse 
medications 
food intolerance

Question 11

How can C.diff be treated?

Answer 11

• lactobacillus for prevention
• Tx: oral vancomycin or fidaxomicin, Metronidazole option if unable to tolerate Vancomycin, fecal microbiota transplantation

Question 12

Clinical manifestations Upper GI

Answer 12

• large volume watery stools, cramping, peri-umbilical pain
• possible fever
• nausea/ vomiting

Question 13

Clinical manifestations Lower GI.

Answer 13

• fever, bloody diarrhea - small volume
• luekocytes, blood, and mucus may be present in stool
• stool cultures

Question 14

Physiologic manifestations of diarrhea.

Answer 14

• lethargy, sunken eyeballs, fever, malnutrition
• pallor, dry mucous membranes, poor skin turgor, perianal irritation
• soft to liquid stools
• abdominal distention
• hyperactive bowel sounds, pus, blood, mucus, or fat in stools, fecal impaction
• decreased output, concentrated urine

Question 15

What are some complications of diarrhea?

Answer 15

• dehydration: esp. in older adult
• electrolyte abnormalities: low potassium, low bicarbonate
• skin care issues: irritant dermatitis

Question 16

How can we manage diarrhea?

Answer 16

determine cause 
control symptoms 
prevent complications 
infection control - prevent spread 
medications if appropriate 
replacing fluid and electrolytes 
protecting skin

Question 17

What is the nursing diagnosis for diarrhea?

Answer 17

fluid imbalance

electrolyte imbalance