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NRSG250 > Elderly Clients > Flashcards

Elderly Clients Flashcards

1
Q

Circulatory overload and the elderly

A

it’s more common in elderly patients

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2
Q

Geriatric syndromes (def + examples)

A 
clinical conditions that cannot be attributed to disease. more common in older pts.
often related to physiologic changes of aging. But not related to other diseases like HTN or DM. keep an eye out for these, see if they can relate to another disease process. But, don't ignore these things just because they are not related to another disease process. 
Ex:
-Urine incontinence
-delirium
-falls
-pressure injuries
-functional decline
-sleep disorders
-dementia
-osteoporosis
-weight loss
-cognitive impairment (mild or occasional)
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3
Q

rapid vs gradual change

A

rapid changes in the older pt are more attributable to disease than to normal aging. must be investigated.
effects of normal aging have gradual onset, occurs slowly, body has time to adjust and adapt.

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4
Q

rapid vs gradual change

A

rapid changes in the older pt are more attributable to disease than to normal aging. must be investigated.
effects of normal aging have gradual onset, occurs slowly, body has time to adjust and adapt.

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5
Q

age-related changes are:

a. unique
b. same across patients

A

a. unique

Rationale: aging varies person to person. Each person has a unique compensatory ability.

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6
Q

why caution with chronological age

A

chrono age does not determine treatment alone. try not to make assumptions for patients based off their age.

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7
Q

what leads to decompensation?

A

changes of aging + stress + outside forces = decompensation (patient cannot rebound as fast)

  • declining physical function
  • declining reserve
  • preexisting disease
  • ageism in healthcare

For ex: after walking up a hill, we are fine, but the older person is still panting, working hard to get their O2 level back.

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8
Q

age-related changes - musculoskeletal

A

Loss of bone and muscle mass

  • Position changing more difficult
  • complications w/early ambulation post surgery (cannot walk as far)
  • delay trips to BR –> urinary/fecal incontinence
  • risk for falls –> significant injury
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9
Q

age-related changes : immune system

A

decline in immune system –> decreased protection against infection, more susceptible

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10
Q

age-related changes : neurological

A
  1. Dementia
  2. Delirium
  3. Depression
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11
Q

Dementia s/s and causes

A
  • loss of memory and cognitive ability
  • change in mood/personality (pts often get depression)
  • Alzheimer’s: most common cause of dementia, but not the only one. Cannot cure. This is a diagnosis by ruling other things out.
  • Multiple infarct/vascular dementia: chronic long term HTN or multiple small strokes causing dementia. increased pressure–>little leaks in capillaries in brain. CAN be treated.
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12
Q

Delirium s/s and causes

A
  • Decreased attention, Change in cognition, Perceptual disturbance (hallucinations, delusions)
  • person w/LATE stage dementia will also have the above things
  • short period of time (one of those rapid changes u need to pay attention to)
  • fluctuates throughout day, comes and goes, doesn’t get worse with time like dementia
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13
Q

Depression s/s, causes

A
  • people are not engaged. not enthusiastic.
  • endogenous: natural decrease in amount of neurotransmitters (serotonin, NE, dopamine).
  • exogenous: loss of friends, spouse, transitioning into retirement.
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14
Q

age-related changes: MS intervention

A

Want pts to be as active as possible even if its just sitting in chair lifting 1 lb weights because muscles will shrink. we need to keep them active.
they’ll be able to walk more comfortably and keeping muscle mass will also decrease fall risk.

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15
Q

normal lapse or dementia: forgetting a name

A

normal

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16
Q

normal lapse or dementia: not recognizing family member

A

dementia

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17
Q

normal lapse or dementia: leaving kettle on

A

normal

18
Q

normal lapse or dementia: forgetting to serve meal that was just prepared

A

dementia

19
Q

normal lapse or dementia: finding the right word

A

normal

20
Q

normal lapse or dementia: substituting inappropriate words

A

dementia

21
Q

normal lapse or dementia: forgetting date or day

A

normal

22
Q

normal lapse or dementia: getting lost in own neighborhood

A

dementia

23
Q

Frailty results from?

A

results from aging-associated decline in reserve and function across multiple physiologic systems (that isn’t addressed, or appropriately coped with)
frailness comes with vulnerability. much higher risk for injuries, different disease processes, prolonged treatment.
Find a way to engage these patients.

24
Q

frailty risk factors

A
  • dependency
  • institutionalization
  • falls
  • injuries
  • hospitalization
  • slow recovery from illness
  • increased risk of mortality
25
Q

frailty pathways (3)

A
  1. changes of aging and loss of organ reserve and function
  2. diagnosis with several chronic illnesses
  3. Existence in harmful environments
26
Q

atypical presentations of illnesses for geris

A
  • confusion/change in orientation
  • falls
  • loss of appetite
  • delirium
  • dehydration
  • atypical pain
  • dizziness
  • incontinence
  • sleep disturbances
  • failures of self care

*All these can be r/t infection: High WBC count may not be present because of declined immune response. but these things may be present.

27
Q

an elderly pt is presenting differently from their normal, saying inappropriate words etc. what do you expect an order for?

A

get a UA and CXR because those are the most common infections.
Rationale: abnormal illness presentation in elderly.

28
Q

Caring for patients with frailty

A

honor pt preferences, even if it doesn’t make sense to you. if they don’t want an xray, ask Dr. if there’s a different way to get the info you need.
Reflect needs/wishes of pt/family.
Talk to the family/pt about choosing less aggressive care. Educate on options.
Be consistent with accepted public policy.
Consider risk vs benefit of treatment

29
Q

markers of poor quality care

A

Development of pressure ulcers.
Use of physical restraints.
Frequent tx with antipsychotics for behavior control. (Haldol)
Tx carried out with little chance of success.

30
Q

Ageism

A

characterization of old people. allows younger people to see elders as “others”, separates young from the old “i’m not like them”.

31
Q

ageism in healthcare examples

A
  • ignoring some symptoms as “getting old” (ie should always investigate urine incontinence as potential uti, not just being old)
  • offering/withholding certain treatments
  • assumption that each older person has all stereotypical problems ie incontinence, senility, hearing loss.

*there are also patient’s ageism toward themselves “i wont tell the doctor, thats just cause im old”

32
Q

Chronic care nursing goals:

A
  1. help clients set realistic goals and expectations
  2. encourage verbalization of feelings
  3. maintain/improve self care capacity
  4. manage disease effectively
  5. boost body’s healing abilities
  6. prevent complications
  7. delay deterioration and decline
  8. achieve highest possible QOL
  9. die with comfort, dignity
33
Q

gern nurse role

A
  • challenge myths/stereotypes about aging
  • distinguish healthy aging from disease
  • examine factors of healthy aging
  • develop strategies to promote and maintain health
  • refine concept of health
34
Q

problem with many prescribed meds?

A

The more meds, the higher the risk for noncompliance (whether intentional or unintentional), adverse drug rxns, and drug drug interactions.

35
Q

considerations with meds and the elderly and pharmacokinetics

A

the body process meds different when older. be extra vigilant watching for side effects and adverse rxns in older pts.
-absorption: thinner skin, GI problems
-distribution: blood flow, heart failure, etc
-metabolism: liver decline, liver failure
-excretion: kidney decline
etc etc. Changes in all areas of pharmacokinetics: meds may not work as expected.

36
Q

inappropriate meds for elderly examples, criteria

A

Beer’s criteria for potentially inappropriate med use with elderly.
Long acting benzos, anticholinergics, NSAIDs, and others.
Long term use of drugs that should be short term: antihistamines, short acting benzos, oral antibiotics.
Meds prescribed over dosage limits.

37
Q

What would you do if an elderly pt had unsafe prescription?

A

?
Talk to the prescriber with SBAR - Cite Beer’s, maybe consult with pharmacist about a good recommendation before talking to prescriber, then suggest a different med, safer med.

38
Q

appropriate prescribing meds for elderly, when to reduce dose

A

Drugs should only be used for clear diagnoses, symptoms.
Reduced dosages:
-Weight is less than avg
-Liver/renal function decreased

39
Q

how to assess side effects of one drug, how NOT to

A

One drug should not be prescribed to treat side effects of another. Better to change the offending drug, decrease dose to decrease side effects.

40
Q

Preventing polypharmacy

A

-use same pharmacy for all meds
-bring med list to doctor EVERY TIME
-notify all prescribing clinicians of ALL drugs used
-obtain complete history of drugs used INCLUDING:
a. prescribed meds
b. OTC meds
c. vitamins
d. dietary supps
e. herbal supps
Brown bag method: Bring all meds, vitamins, supps in a brown bag. Take them out one by one and ask pt about the med, how they take it, why, see if there’s side effect, if it can be unprescribed, etc.

41
Q

adverse drug rxns with elderly

A

Look for rapid, sudden changes that happen in the elderly. Always consider medications as a cause.

  • difficulty with ADLs
  • cognitive changes
  • falls
  • anorexia, nausea
  • weight change
42
Q

How to increase med adherence with elderly pts

A

*Assess adherence initially and ongoingly. (Brown bag assessment): Make sure there’s no resolvable reason for non compliance.

  1. Reduce impact of side effects (naturally if possible.)
    - adequate fiber/fluids
    - schedule diuretics appropriately (morning, not night)
    - liquids/lozenges for dry mouth (anticholinergic side effects)
  2. assure financial access to meds
  3. Ask client what they would prefer.

NRSG250 (11 decks)

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