Elder Mistreatment + Cancer Flashcards
Situational Theory
Result of caregiver strain/stress
Psychopathology Theory
Stems from perpetrator’s own psychological issues
Exchange Theory
Related to victim-perpetrator long term relationship and dependency
Social Learning Theory
How abuse was learned
Political Economy Theory
Focuses on challenges faced by older adults in society
Challenges with Dementia + Elder Mistreatment (2)
- patients are not able to provide a detailed history
- lack of objective assessment and policies on elder mistreatment screening and management
Risk Factors for Elder Mistreatment (7)
- functional impairment
- low SES
- lack of support
- dependency
- cognitive impairment
- social isolation
- hx of childhood trauma or abuse, substance abuse, depression, other mental health disorders
Perpetrator characteristics
- family member most of the time
- long history of conflict with the victim
- living with victim for awhile
- recent financial stress or job loss
- caregiver strain/stress
- dependency on victim
- lack of support
- low SES, poor housing
Elder Mistreatment Screening (2)
- Elder Assessment Instrument (EAI)
- Hwalek Sengstock Elder Abuse Screening Test (HS_EAST)
EAI - Elder Adult Instrument
- inpatient and outpatient
- general appearance
- evidence of dehydration
- physical and psychological indicators
HS_EAST
- self report on older history
- if positive, get a comprehensive history and physical assessment should be completed to validate possible mistreatment
poor oral hygiene is associated with increased incidence of _______
pneumonias
many medications cause dry mouth and _______ risk of _____ ______
increasing risk of dental caries
DM glucose control is ____ in the presence of periodontal disease
worsens in the presence of periodontal disease
Denture Cleaning
- don’t wear overnight
- good hygiene
- brush with liquid hand soap, dishwashing liquid, denture cleansing paste
- avoid regular toothpaste
- soak overnight in a cup of water or denture cleaner
Denture Care
- make sure they fit
- avoid sugary snacks and drinks
- avoid alcohol and tobacco
What meds dry your mouth?
Anticholinergics
Salivary stimulant
Pilocarpine
Frailty is 3 or more of the following
- unplanned weight loss
- weakness
- poor endurance and energy
- slowness
- low activity
Cascade Iatrogenesis
Initial medical interventions tat triggers a series of complicating events
Risk Factors for Cascade Iatrogenesis
- older
- more functional impairment
- higher acuity
Examples of Airborne
TB, measles, chickenpox
Examples of Droplet
PIMM - pertussis, influenza, mumps, meningitis
Examples of Contact
MRSA, pediculosis, scabies, RSV, C. diff
MRSA treatment
- Vancomycin, Linezolid
- take full length of vancomycin treatment
- showers instead of bath
- wash cloths in hot water and dryer
- sleep in a separate bed from others
The best way to decrease incidence of MRSA
Health Teaching
- avoid large crowds
- hand hygiene
- avoid contaminated surfaces
- avoid close contact with people with infectious wounds
VRE
Vancomycin - Resistant Enterococcus
= normal bacteria that live in intestinal tract –> important for digestion
Teletherapy
- don’t move nodes
- radiation of specific area
Brachytherapy
- radioactive seeds implanted
- avoid pregnant women, kids, and careful body fluids
Side Effects of Radiation
- local skin changes - discoloration, redness, peeling
- altered taste
- fatigue
- inflammatory responses that causes tissue fibrosis and scarring
- secondary cancers
Radiation Therapy teaching
- do not move markings
- good sunscreen
- prescribed lotion
- soft cotton clothing
- gentle soap and water to cleanse
- avoid direct skin exposure
- xerostomia care
- BONE more vulnerable to fracture
Cells that affect Chemo
- skin
- hair
- intestinal tissues
- spermatocytes
- blood-forming cells (immunosuppresion)
Extravasation
Key: PREVENTION
- check the IV site before administering
- flush - check for blood return
- run medication slowly
- PPE!
Side Effects of Chemo
- severe N/V (PRE MEDICATE)
- mucositis
- alopecia
- changes in cognitive function
- peripheral neuropathy
- neutropenic precaution
Neutropenic precautions
- keep door closed
- avoid fresh flowers, fresh fruit, raw foods
- PPE
- hand hygiene
- CBC and temps
- IV abx if really immunosuppressed
Oncologic Emergencies
- Sepsis
- DIC
Meds for DIC
- anticoagulants
- cryoprecipitated clotting factors
- hand hygiene
- PPE
Hypercalcemia
Occurs with bone metastasis
- fatigue
- loss of appetite
- N/V
- constipation
- polyuria
- dehydration
- severe muscle weakness
- loss of deep tendon reflexes
- paralytic ileus
- kidney stones
Hypercalcemia treatment
- hydration
- NS IV
- Dialysis to get rid of calcium
- Diuretics to get rid of calcium
Superior Vena Cava syndrome
superior vena cava compressed or obstructed by tumor growth
- Stoke’s sign (edema of face, arms, hands)
- dyspena
- erythema
- epistaxis
Superior Vena Cava syndrome treatment
- high dose radiation
- metal stent
- diuretics to help with edema
- airway is priority!
Tumor Lysis syndrome
complication of chemo
- hyperkalemia
- tall tented t waves
- flat p waves
- bradycardia
- uric acid stones
- GI hypermotility
Tumor Lysis syndrome treatment
- check electrolytes
- daily ECG
- daily potassium
- insulin (with glucose!) to help bring potassium into the cell
- K Xalate (frequent bowel mvmt)
- Allopurinol
- calcium gluconate
- check kidney function
Spinal Cord Compression
Tumors that radiate to spine
- paralysis
- weakness
Spinal Cord Compression Tx
- palliative (support brace)
- removal of lesion
- high dose radiation
- steroids
