Chapter 28, 29,30 Flashcards
The older adult epidermis thins and renews itself every __ days compared to every __ days in children and adults.
30, 20
What change due to aging leads to a 50% reduction in rate of wound healing?
Decreased mitotic activity of cells
Describe how nail beds are affected by aging.
more rigid, thicker, and more brittle, with slowed growth
_____ wrinkles are caused by aging, ______ wrinkles are due to sun exposure.
Fine, coarse
With aging, increased lipid deposits may occur in what 2 places above the neck?
Increase lipid deposits may be found at the periphery of the cornea around the iris
What size change can occur to the lens of the eye with age?
Larger and denser
True of false: ears get bigger as we age
true- auricle gets bigger but auditory canal gets narrower
Olfactory dysfunction can reduce ______ _______
food intake
How does the tongue change with aging?
becomes smoother
At what age does the sense of taste often change?
Around age 60
What are the alveoli changes in older adult smokers?
thicker and fewer
Decreased compliance from arterial wall stiffening affects B/P by ________________________.
increasing the afterload of the left ventricle
Which increases with age, systolic or diastolic B/P?
systolic
Which ventricle usually hypertrophies with age?
left
How much does coronary artery blood flow decrease with age?
about 1/3
What causes the decrease of heart rate in aging?
Loss of pacemaker cells and bundle of His fibers
What are circulating catecholamines?
blood-borne amines derived from the amino acid tyrosine – examples include epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine – that act as hormones or neurotransmitters.
What happens to circulating catecholamines in aging?
they increase
What happens to jugular venous pulsations in aging?
increase with fluid volume excess and decrease with fluid volume deficit
Name 5 parts of the screening tool, DETERMINE.
D- Disease, E- Eating poorly, T- Tooth loss/mouth pain, E- Economic hardship, R- Reduced social contact, M- Multiple medications, I- Involuntary weight loss/gain, N- Needs assistance in health care, E- Elder above age 80
What happens to peristalsis with aging?
slows
What are important parts of the shift change assesment?
abdomen, auscultation of lungs, circulation and level of consciousness
Focused assessment: concentrates on assessing for _______________________
anticipated problems
The 4 main issues in quality hospital care include:
evidence-based medicine, quality assurance, medical ethics, and the reduction of medical error.
What are the 5 rights of delegation?
the right task, under the right circumstances, to the right person, with the right directions and communication, under the right supervision and evaluation
What are the 8 National Safety goals set by Joint Commission?
Adverse drug reactions
Catheter-associated UTI
Central line associated bloodstream infections
Injuries from falls and immobility (including delirium)
Pressure ulcers
Surgical site infections
Venous thromboembolism, if no palpable pulses notify physician if you are worried
Ventilator associated pneumonia
What is SBAR?
Situation, Background, Assessment, Recommendation
What are the 4 National Safety Interventions?
two patient identifiers, SBAR with staff communication, alarm safety, prevent infections
What is a surgical time out?
the final recapitulation and reassurance of accurate patient identity, surgical site, and planned procedure.
List 5 patient satisfaction factors.
Bedside handoff reports Purposeful hourly rounding Show respect, protect confidentiality and privacy, always introduce yourself Ask permission Use best communication practices
Upon entering a patient room, what observation should you make of tubes?
Trace tubes to insertion site and check solutions and rate
It is urgent if respiratory rate is less than __ or greater than ___.
8, 28
It is urgent if O2 sat goes below ___% despite oxygen administration.
90
Urgent: Acute change in HR of less than ___or greater than ___
50, 120
Urgent: Temperature greater than ______
39.0 C (102.0 F)
This type of pain represents an urgent situation.
uncontrolled
Urgent: Acute change in urine output less than __ ml over 4 hours
50
What does Hgb A1c test for?
blood glucose, used in diabetics or to screen for diabetes
What do hematocrit and hemoglobin test for?
bleeding and anemia
What are the 4 main labs for clotting factors?
platelets, prothrombin time (PT), partial thromboplastin time (PTT), international normalized ration (INR)
What are the 2 labs for renal function?
blood urea nitrogen (BUN)/creatinine
What is the test for ischemic cardiac changes?
EKG
What is stasis dermatitis?
skin inflammation in the lower legs caused by blood/fluid pooling in the veins of the leg
What is Herpes zoster?
Shingles: reactivation of the chickenpox virus which affects the nerves.
Define ectropion.
an eyelid, typically the lower lid, that turns out leaving the inner eyelid surface exposed and prone to irritation
Define entropion.
eyelid that turns inward so that eyelashes and skin rub against the eye surface, causing irritation and discomfort
What are Bouchard nodes?
hard, nontender bony growths or gelatinous cysts on the proximal interphalangeal joints. A sign of osteoarthritis.
What are Heberden nodes?
hard, nontender bony growths on the distal intraphalangeal joint (end of the fingers or toes)
What does the Morse scale assess for?
Fall risk
What is the costovertebral angle?
the acute angle formed on either side of the human back between the twelfth rib and the vertebral column.
How long must a central line be in prior to a bloodstream infection for it to be deemed a central-line associated infection?
2 days
Define surgical infection.
infection that occurs 30-90 days after the operative procedure with purulent drainage
Define dehiscence.
separations of the side of a suture, especially when tissues protrude
What is VAP?
Ventilator associated pneumonia (VAP)- hospital-acquired pneumonia which occurs in patients who are receiving mechanical ventilation. Fever, Leukopenia (WBC count
What are the signs of ventilator associated pneumonia in patients over 70?
Altered mental status with no other recognized cause and at least two of the following:
new onset of increased respiratory secretions, New onset or worsening cough, dyspnea, or tachypnea
What are the common signs of systemic infection (sepsis)?
documented or suspected infection, heart rate greater than 90 beats/min, temperature less than 36C or greater than 38.3C, respiratory rate more than 20 breaths per minute or PaCO2 less than 32 mmhg, altered mental status
What are the 5 P’s of nurses’ rounds?
Pain, Personal needs, Position, Placement (of essential items like call light, phone), and Prevent Falls
Define ptosis.
drooping upper eyelid
Enlarged bones or tissue could be a sign of __________.
acromegaly
“Moon face” could be a sign of __________.
Cushing syndrome
Weak blink could mean
damage to CN V or VII
What is malocclusion?
imperfect positioning of the teeth when the jaws are closed.
tongue that deviates to one side could be a sign of
stroke or damage to CN XII (hypoglossal)
What could it indicate if the iris looks pushed forward?
glaucoma
What 2 findings in an eye assessment are urgent?
white pupil reflex(leukocoria) and lack of red reflex
What assessment can be done for Vestibulocochlear nerve VIII?
ability to repeat whispered words
What indicates a positive Rinne test?
positive for hearing loss if bone conduction longer or the same as air conduction
Define obtunded.
deadened or dulled
What is decorticate rigidity?
arms flexed, or bent inward on the chest, the hands are clenched into fists, and the legs extended and feet turned inward
What is a possible abnormal finding about the liver that could be observed in an abdominal assessment?
Liver is palpable below rib
What is a possible abnormal finding about the spleen that could be observed in an abdominal assessment?
Spleen that deviated downward or medially
What do you assess for on heels?
blanching
What could hyperresonance in the chest be a sign of?
COPD
lack of coordination is called _______________________
adiadochokinesia
What is a stereognosis test?
ability to perceive the form of solid objects by touch
What is the Braden scale? What factors does it score?
Scores patients from a 1-4 in six subscales based on:
sensory perception, moisture, activity, mobility, nutrition, and friction
What Braden scale score range indicates no risk? What score indicates high risk?
19 and above indicates no risk. 10 and below indicate high risk.
What is the safety alert for serum potassium levels
Serum potassium levels may affect neural or cardiac cell conduction, leading to arrhythmias and potentially to cardiac arrest. Potassium must be maintained within normal limits and abnormalities must be corrected promptly.
