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Gero > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Geron (Greek)

A

Old man

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2
Q

Gerontology

A

the scientific study of the process of aging and the problems of aged persons (mental, physical, social)

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3
Q

geriatrics

A

the branch of medicine that deals with the diseases and treatments of older people

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4
Q

elite-old

A

100+ years

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5
Q

chronological age

A

the number of years lived

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6
Q

biological age

A

the age of the organs

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7
Q

psychological age

A

how old one feels

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8
Q

social age

A

ones roles and relationships

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9
Q

age is (subjective or objective)

A

SUBJECTIVE (varies with time, place, and perception)

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10
Q

nonagenarian

A

90+

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11
Q

centenarian

A

100+

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12
Q

most people 100+ are

A

female (77%)

33% have no signs of dementia

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13
Q

baby boomer

A

born between 1946-1964
“boom” after WWII
current elder population

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14
Q

fastest growing older adult age group

A

85+

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15
Q

more (men or women) live in poverty

A

women

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16
Q

two types of life tables

A

cohort (generation)

period (current)

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17
Q

cohort age

A

generational expectancy

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18
Q

period life table

A

at this time going forward how long you’re expected to live

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19
Q

most frequently used life table statistic

A

life expectancy/period (based on current age)

the average number of years of life remaining for x persons who have attained a given age

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20
Q

caring for aging population mission

A

preserve function (preventative)
enhance health
enhance quality of life
enhance dying experience (end of life care)

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21
Q

research in the aging population

A

innovation in care
provision of services
hot topics of research: dementia, reduce falls, use of restraints, pain management, delirium, end of life care

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22
Q

demand in nursing (geriatric)

A

demand in nursing is critical for gerontological nurses because there is a growing geriatric population

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23
Q

health is

A

absence of disease

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24
Q

the concept of wellness incorporates

A

all aspects of one’s being

physical, emotional, intellectual, social, spiritual, cultural, environmental

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25
Q

the wellness model suggests that

A

every person has an optimum level of functioning for each position on the wellness continuum to achieve a good and satisfactory existence

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26
Q

objectives set (elderly health)

A 
dementia
foodborne illness
infectious disease
injury prevention
oral conditions
osteoporosis
respiratory disease
sensory or communication disorders
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27
Q

primary disease prevention

A

preventing disease (teaching, stress management, social engagements, cognitive stimulation, immunizations)

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28
Q

secondary disease prevention

A

evidence-based screenings and guidelines (catching early)

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29
Q

senescence

A

condition/process of deterioration with age

latin - “to grow old”

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30
Q

cellular functioning

A

cells replicate but not exactly

become more complex, changes, more accumulation of damage every time they replicate - eventual cell death

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31
Q

error theories

A

aging is the result of accumulation of random errors in the synthesis of DNA and RNA (unpredictable)

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32
Q

wear and tear theory

A
  • breaking down results from wearing out from continued use
  • progressive decline in cellular function or increased cell death
  • cells are aggravated by internal and external stressors
  • destroyed by chemical and mechanical injuries (often done to ourselves)
  • falls under error theory
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33
Q

why do we age?

A
  • capacity is set at ~90 years
  • exact mechanisms are poorly understood
  • cellular changes = aging
  • degeneration, cell death (cellular = organism)
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34
Q

role (successful aging)

A
  • adapting/adjusting to changing roles
  • ready to fulfill new role, sense of purpose (e.g., ready to retire)
  • resistance may predict poor adjustment
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35
Q

purpose of activity

A

maintaining productive life (physical, mental)

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36
Q

disengagement

A

transferring control to younger generations (successful aging)

  • society disengages from elderly and the elderly disengages from society
  • ability to interact with society (cognitive, physical)
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37
Q

continuity

A

maintaining and continue previous behaviors and role or finding adequate replacements

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38
Q

modernization

A

older people lose power and status due to advances in technology (controversial)

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39
Q

age gratification

A

people of similar age/cohort have the most similar interests

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40
Q

Erikson

A 
developmental theory (8 stages)
- widely accepted in nursing
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41
Q

theory based interventions (evidence based practice)

A

Used to help develop interventions

  • interventions to promote healthy aging from biological theories (ch. 3 boxes)
  • used as a basis to develop policies
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42
Q

emerging majority

A

statistically, minorities are assuming the majority in number

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43
Q

health disparity

A

differences in the state of health and health outcomes between groups of persons

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44
Q

health inequity

A

excess burden of illness or the differences between the expected incidence and the prevalence and that which occurs in excess in a group

(prevalence in one group is higher than the overall expected prevalence)

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45
Q

cultural awareness

A

development of cultural proficiency with increased awareness of our own beliefs and attitudes and this commonly seen in the community of healthcare

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46
Q

cultural knowledge

A

what the nurse brings (what you know) to the caring situation and what you learn about older adults and their families, community, and expectations
(what you know and learn about the patient and situation)

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47
Q

culture

A

shared and learned beliefs with a group of people

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48
Q

acculturation

A

person from minority or marginalized culture that adopts a majority culture

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49
Q

ethnicity

A

social differentiations based on cultural criteria

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50
Q

barriers to quality care range from those related to:

A
  • geographic location
  • age
  • gender
  • ethnicity
  • race
  • sexual orientation
    (what makes them an individual/specific characteristics and situations)
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51
Q

increased risks in African Americans

A 
stroke/TIA
heart disease
HTN
diabetes
diabetes-related amputation
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52
Q

increased risks in Mexican Americans

A

DM

fewer prescriptions after MI

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53
Q

increased risk in Native Americans

A

DM (than whites)

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54
Q

reducing health disparities

A

cultural awareness

cultural knowledge

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55
Q

self-level of cultural awareness

A

self-understanding; your own experiences and values (how they’ve shaped your perceptions)

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56
Q

cultural awareness requires the ability to

A

work and build a relationship with members of other cultural groups

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57
Q

cultural awareness requires recognition of

A

factors beyond cultural that affect members of any given group and recognize that they can affect their health, safety level, and wellbeing

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58
Q

cultural knowledge includes both

A

what the nurse brings to the caring situation and what the nurse learns about the older adult (what you bring in and what your learn)

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59
Q

essential cultural knowledge in the elderly

A

their way of life (how they think, act, and what they believe)

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60
Q

biomedical beliefs

A

western medical paradigm (focus on disease and abnormalities)

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61
Q

magico-religious beliefs

A

god or supernatural forces cause disease (good health is a blessing or reward)

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62
Q

naturalistic or holistic beliefs

A

health is a sign of balance/harmony (illness comes with imbalance)

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63
Q

obstacles in care of the elderly

A

ethnocentrism
stereotyping
ageism

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64
Q

ethnocentrism

A

belief that one system is superior

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65
Q

stereotyping

A

simplified and standardized conceptualization of a group

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66
Q

ageism

A

discrimination due to age

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67
Q

cultural skills

A

use of spoken or unspoken communication (ask/go slow)

be aware that body language is taken differently in various cultures

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68
Q

fastest growing segment of the population

A

older women

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69
Q

older women

A

social - more likely to live alone, have friends than men

economic - lower than men (how job/educational opportunities have changed)

health - live longer than men but are sicker overall (more chronic illness, disability)

higher risk of being without insurance (death/divorce of spouse)

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70
Q

older men

A

most literature on aging focuses on women (more older women)

black men have the shortest statistical lifespan

we often make assumptions with social/economic status of older men

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71
Q

key to culturally and ethnically sensitive assessment

A

listening

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72
Q

LEARN model

A

Listen carefully
Explain your perceptions
Acknowledge and discuss the differences and similarities between your goals
Recommend plan of action that takes both perspectives into account
Negotiate a plan that is mutually acceptable

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73
Q

aging changes

A

anatomical and physiological changes that are attributed to aging
(all cells are affected by aging)

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74
Q

bronchiectasis

A

permanent abnormal widening of the airways due to inflammation

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75
Q

elastic recoil

A

the lungs ability to expand and contract

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76
Q

kyphosis

A

curvature of the spine bowing out of upper spine (P)

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77
Q

vital capacity

A

maximum amount of air that can be expelled following maximum inspiration

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78
Q

risks to adequate respiration due to aging

A
  • the trachea stiffens due to calcification of its cartilage (reduces the ability to cough because it blunts the laryngeal and coughing reflexes)
  • reduced number of nerve endings may lead to a weak gag reflex
  • lungs become smaller in size and weight > connective tissues needed for effective respiration and ventilation in the lungs weaken > decreased elastic recoil > respiration then requires the use of accessory muscles (smaller = less air)
  • alveoli are less elastic, develop fibrous tissue, contain fewer functional capillaries, and have less surface area (reduces gas exchange)
  • loss of skeletal muscle strength in the thorax and diaphragm + loss of resilient force (tissues) that holds the thorax in slightly contracted = kyphosis/barrel chest
  • reduction in vital capacity (less air exchange, more secretions remaining in the lungs)
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79
Q

age related changes

A

decreased response to hypoxia and hypercapnia

different normal baseline temp (may miss fever - always look at baseline)

80
Q

nursing considerations in aging

A
  • less effective gas exchange (hypoxia)
  • easily fatigued r/t decreased respiratory efficiency
  • reduced airway clearance (risk for asthma)
  • increased potential for infection
81
Q

assessment on older adult

A
  • breathing patterns
  • breath sounds
  • palpate chest
  • chest expansion
  • cough
  • deep breathing (can they breath effectively/efficiently? altered breathing pattern?)
  • respiratory rate
  • O2 sat
  • secretions (can lead to infection - can they swallow? could they aspirate? [aspiration pneumonia])
  • mental status/behavioral changes (has it changed from their baseline?)
82
Q

leading causes of death in older adults

A

pneumonia

UTI

83
Q

contributing factors to pneumonia

A

poor chest expansion

lowered resistance to infection

reduced mobility (laying down)

increased mucus formation and bronchial obstruction

increased incidents of hospitalization and institutionalization (long-term care)
- nosocomial pneumonia

pleuritic chest pain and lower temp may mask s/s

84
Q

pneumonia symptoms

A
  • slight cough
  • fatigue
  • rapid respiration
  • confusion (behavioral changes)
  • restlessness (hard to breath = agitation)
85
Q

pneumonia interventions

A

*prevention is key

  • encourage good fluid intake (thins secretions + keeps them hydrated)
  • manage bronchial secretions (aspiration risk?)
  • preventative measures for infections
  • breathing exercises
  • raise HOB at least 30 degrees (raise pressure off chest) unless contraindicated
  • educate and instruct patient to turn, cough, and deep breathe every 2 hours (keep from settling in the lungs)
86
Q

physical deconditioning

A

decline in cardiovascular function due to physical inactivity

87
Q

postural (orthostatic) hypotension

A

decline in systolic BP of 20mmHg or more after rising and standing for 1 minute

88
Q

risk to adequate circulation due to aging

A
  • heart valve increase in thickness and rigidity r/t sclerosis and fibrosis
  • aorta becomes dilated
  • slight ventricular hypertrophy
  • myocardial muscle loses some of its contractile strength, causing a reduction in CO (less efficient with increased activity or demands on the heart)
  • diastolic filling and systolic emptying require more time to complete the cycle
  • calcification and reduced elasticity of vessels > less sensitive to baroreceptors > reduction of BP regulation > reduced arterial BP = decreased tissue perfusion
    • changes are usually gradual and become more apparent when the older adult is placed under increased activity (early morning walks to restroom = increased death)
89
Q

CV nursing considerations

A

poor peripheral circulation (edema, capillary refill)

easily fatigued (esp. on exertion)

inadequate circulation to heart tissue

SOB

reduced cardiopulmonary tissue perfusion

  • hypotension
  • tachycardia
  • edema
  • dyspnea
  • delirium (infection, lack of O2)
  • restlessness
  • pallor
  • memory disturbance (change)
90
Q

CV assessment on the older adult

A

BP (orthostatic = lying, sitting, standing)
- 2 people to keep patient from falling

palpate carotid arteries

ECG

exercise tolerance

91
Q

CV interventions

A

monitor for s/s

encourage fluids (hypotension - fluids drop)

fall precautions

health promotion: medication, diet, exercise (as appropriate)

92
Q

presbyesophagus

A

age-related changes to the esophagus causing reduced strength of esophageal contractions and slower transport of food down the esophagus

93
Q

GI issues related to aging

A

tongue atrophy decreases taste sensation (aspiration, inability to swallow)

  • if meds sit in their mouth there will be a different uptake
  • changes in how much they’re eating

saliva production decreases (may make swallowing more difficult)

degenerative changes in the smooth muscle lining of the lower esophagus (presbyesophagus)

  • weaker esophageal contractions
  • weakness of sphincter
  • decreased esophageal motility
  • decreased stomach motility (med uptake, GERD) - sit them up after eating
  • decreased elasticity of the stomach reduces the amount of food the stomach can accommodate (may need several small meals [too much = indigestions, aspiration = pneumonia])
  • stomach has a higher pH r/t a decline in hydrochloric acid and pepsin causing increased incidence of gastric irritation in older adults
  • reduced pepsin interferes with absorption of protein
  • reduced hydrochloric acid interferes with absorption of calcium, iron, folic acid, and vitamin B12
  • decreased sensory perception may lead to increased incidence of constipation, as can inactivity, reduced food/fluid intake, and low fiber diet)
  • pancreas fibrosis, atrophy, and reduced pancreatic secretions may affect the digestion of fats
94
Q

GI nursing considerations

A

constipation (esp. in women can cause UTIs) (when was their last bm)

V/D

acute pain

dehydration

inactivity

insufficient nutritional intake

95
Q

GI assessment

A

abdomen (least invasive first)

  • bowel sounds
  • tenderness
  • distention

dietary intake, food, and fluids

elimination patterns

swallowing ability

chewing ability

weight (changes)

96
Q

GI interventions

A

provide food the patient likes and can tolerate

keep patient sitting up after meals (health promotion: diet)

97
Q

nocturia

A

voiding at least once during the night every/most nights

98
Q

urinary elimination changes related to aging

A

hypertrophy of the bladder muscle and thickening decreases the ability of the bladder to expand and reduces capacity (leading to urinary frequency and nocturia)

  • kidney circulation improves when a person is in a recurrent position and increases the need to void
  • this is NOT a normal part of aging (is related to other aging issues)

retention of using due to neurological inefficiencies and a weaker bladder that does not empty properly

  • women: fecal impaction
  • men: prostatic hypertrophy (can’t empty)
  • men don’t often get UTIs so it’s important to find out what caused it

reduced filtration efficiency of the kidneys affects the body’s ability to eliminate drugs and causes increased BUN

incontinence: NOT a normal part of aging (but common) [related to other physical or mental disorders/age changes]

99
Q

GU nursing considerations

A

potential for adverse drug reactions or toxicity (not clearing their system - low motility)

pain

risk for infection (UTI)

risk for falls (getting up to go to the bathroom)

need for toileting assistance

potential for skin breakdown

sleep disruption

potential for social isolation (depression = early death)

100
Q

GU assessment

A
  • renal function
  • ability to void
  • BP (hypotension)
  • fall risk
  • pain
  • frequency
  • urgency
  • constipation
  • inactivity
  • dehydration (UTI)
  • indications for drug toxicity
  • mental status change
101
Q

GU interventions

A

encourage fluids (unless contraindicated)

fall precautions

monitor for drug toxicity

health promotion: bladder training and fluid intake

102
Q

turgor

A

elasticity

103
Q

pressure injury

A

localized damage to skin and underlying soft tissue resulting from pressure, shear, and/or friction

104
Q

skin changes related to aging

A

reduced thickness of dermis

reduced vascularity of the dermis

decrease rate of epidermal turnover

degeneration of elastic fibers

increased coarseness of collagen

reduction of melanocytes

reduced blood supply (results in increased fragility of skin)

blood thinners

105
Q

skin nursing considerations

A
  • risk for skin tears
  • risk for wounds (and healing)
  • risk for infection
  • risk for pressure injury
  • bruising
  • decreased turgor
  • slow healing
  • decreased fat and muscle in the feet (unsteady gait)
106
Q

skin assessment

A 
temperature
color
lesions
bruising
turgor
signs of infection, rash
107
Q

skin interventions

A

encourage fluids (hydration improves skin)

prevention (dry skin)

educate on care

control environment temperature and humidity

108
Q

presbyopia

A

age-related decrease in the eye’s ability to change shape of the lens to focus on near objects

109
Q

vision changes related to aging

A

reduced elasticity and stiffening of the muscle fiber of the eye lens leading to presbyopia

  • usually begins in the 40s and continues with age
  • interferes with the ability to focus

reduced pupil size, opacification of the lens, and a reduction of photoreceptors in the retina reduces visual acuity

light perception decreases leading to difficulty seeing at night

sensitivity to glare increases

distortion of colors such as blue and green

depth perception becomes distorted

peripheral vision is reduced

decreased tear production distorts light

110
Q

vision nursing considerations

A
  • blurred vision
  • decreased vision
  • need for more light to see/read
  • impaired light/dark adaption
  • decreased night vision
  • risk for falls/injury
  • risk for social isolation (unable to see, drive - can’t get meds/food/etc.)
111
Q

visual assessment

A

visual acuity under various light conditions

evaluate impact of vision limitations on driving, ambulation, social interactions, and safety

home visit assessment for environmental safety

112
Q

visual interventions

A

regular eye exams

113
Q

presbycusis

A

age-related high-frequency sensorineural hearing loss

114
Q

hearing changes related to aging

A

tympanic membrane thinning with loss of resiliency (not vibrating as well)
- inhibits communication

ossicle joint degeneration

vestibular structures atrophy (organ of Corti, cochlea)

loss of hair cells

changes in cartilage of pinna

115
Q

hearing nursing considerations

A

decreased sound conduction

risk for hearing loss (presbycusis, tinnitus, equilibrium deficits)

changes in appearance of external ear (larger and longer)

116
Q

hearing assessment

A

hearing

balance

monitor psychosocial if hearing dysfunction

evaluate safety

117
Q

hearing interventions

A

educate on hearing safety (usually once it’s gone, it’s gone)

encourage social interaction if isolated

speak in low toned voice

118
Q

hyposmia

A

decrease in smell acuity

119
Q

changes in smell and taste related to aging

A

decreases neurons that send signal to the brain

difficulty distinguishing smells

decrease in taste secondary to change in smell acuity

120
Q

sarcopenia

A

decline in walking speed and/or group strength related to decreased muscle mass/function

121
Q

mscskl changes related to aging

A

decline in muscle fibers leads to reduced muscle mass > decrease in strength and endurance

decreased flexibility of joints and muscles related to changes in connective tissue

tendon and ligament stiffening

redistribution of fat

narrowed intervertebral disks

decline in walking speed (sarcopenia)

increased latency/contraction of muscles

122
Q

mscskl nursing considerations

A
  • gait and balance instability
  • decreased range of motion
  • decreased mobility
  • risk of fractures
  • risk of falls
  • pain
  • decreased strength and endurance
  • decreased activities and socialization (risk for isolation)
123
Q

mscskl assessment

A

range of motion

strength

gross and fine motor skills

stability

ability to perform ADLs

124
Q

mscskl interventions

A

encourage appropriate activity

encourage and educate on good nutrition

consider mobility aids

fall prevention

125
Q

endocrine changes related to aging

A

thyroid gland strophes leading to a decrease in activity

reduced/insufficient release of insulin (T2 DM)

reduction in sensitivity to insulin (resistance)

decreased adrenocorticotropic hormone secretion leading to reduced estrogen and progesterone secretions (can be supplemented based on patient preference)

126
Q

endocrine nursing considerations

A

risk for developing T2 DM

risk for hypoglycemia (quicker to kill)

decreased ability to respond to physiological changes/stressors

risk for medication safety issues

127
Q

endocrine assessment

A

monitor lab values

  • A1C (glycated hemoglobin)
  • Thyroid panel
128
Q

endocrine interventions

A

educate and encourage balanced nutrition

educate on medications

129
Q

immune system changes related to aging

A

T-cell activity declines

more immature T-cells present

thyme mass decreases
- leads to immature T-cells

cell-mediated immunity declines
- reduces ability to fight infection

lower body temperature

ability to respond to cold temps decrease
- r/t inefficient vasoconstriction, reduced peripheral circulation, decreased CO, reduced muscle mass, and reduced subcutaneous tissue

130
Q

immune nursing considerations

A

risk for infection (s/s)

lower response to immunizations

131
Q

immune assessment

A

s/s of infection

labs

box 24-1

132
Q

immune interventions

A

standard precautions

immunizations

education: diet, activity, stress, rest

133
Q

nervous system changes related to aging

A

atrophy of the brain and spinal cord r/t loss of nerve cell mass (dementia)

decline in nerve cells

reduced nerve conduction

slowed central processing

approximately 20% reduction in cerebral blood flow

decreased peripheral nerve function (decreased sensation)

decreased cranial nerves

134
Q

NS nursing considerations

A

delayed response time to stimuli and in reflexes

risk for falls/injury

decreased taste and smell

dulled tactile sensation

risk of cognitive impairment

pain

reduced activity

social isolation

restricted mobility

risk for CVA (narrowed blood vessels, atrophy, less circulation, occlusion)

  • prevent TIA - always looking for s/s (face drooping, weakness in extremities/one side, gaze/pupil reaction, speech)
  • run a neuro - equal grip strength/evenly able to hold up arms, dilated pupils/PERRLA/sluggish reaction
135
Q

NS assessment

A

cognition

independence

ability to perform ADLs

136
Q

NS interventions

A

encourage and educate on use of assistive devices

fall prevention

137
Q

reproductive changes related to aging

A

hormonal changes

  • women: estrogen decreases (menopause)
  • men: testosterone and sperm count decreases
138
Q

reproductive assessment

A

changes in hormones (labs)

139
Q

reproductive interventions

A

educate on STD prevention

hormone changes

140
Q

muscle twitching intervention

A

metabolic panel

141
Q

hyperkalemia

A

> 5 mEq/L

may be caused by potassium sparing diuretics (Lasix)

assess BP edema

142
Q

hyponatremia

A

< 135

143
Q

hypernatremia

A

> 148

144
Q

pharmacokinetics

A

the way the body uses medications

145
Q

absorption

A

how the medication is taken into the body

route: oral, sublingual, transdermal

146
Q

distribution

A

how the medication is dispersed throughout the body

147
Q

metabolism

A

how the medication is broken down

148
Q

excretion

A

how the medication is removed from the body

149
Q

age-related changes to absorption

A
  • thinning skin
  • reduction of saliva (anticholinergic)
  • difficulty swallowing (meds breaking down on tongue)
  • slowed motility (not normal, but common)
  • reduction in gastric emptying
  • delayed stomach emptying
150
Q

systemic circulation

A

transportation to target cell receptors

151
Q

high blood flow target organs (distribution)

A

brain, kidneys, liver

rapid reception = increased concentrations of medications

*most medications are cleared through the renal system

152
Q

low blood flow target organs (distribution)

A

skin, muscles, fat

  • lower concentrations of medications
153
Q

age related changes to distribution

A

less body water

increased body fat

decreased availability of plasma proteins

common:

  • PVD (circulatory)
  • chronic illness
  • acute illness
154
Q

metabolism takes place mainly in the

A

liver (liver toxicity)

155
Q

biotransformation

A

transforms substances making them more easily eliminated from the body

156
Q

age related changes to metabolism

A

reduction of liver mass
reduction of liver perfusion (30-40%)
reduced the amount of medication metabolized during the first pass

157
Q

excretion occurs

A

as metabolites or unchanged

through: lungs, sweat, bile, feces, breast milk, hail, saliva, tears, semen, and urine (the renal system)

158
Q

age related changes to excretion

A

reduction of GFR (~1%/year after 20yo)

prolonged medication half-life

159
Q

pharmacodynamics

A

physiological interactions between a medication and the body

ex. chemical compounds and cell receptors

160
Q

age related changes to pharmacodynamics

*help patient move

A

reduction in baroreceptor reflex response
- increased susceptibility to orthostatic hypotension

decreased responsiveness in the a-adrenergic system (bronchodilators)
- decreased sensitivity to B-agonist

decreased thirst sensation (dehydration - medications that cause increased excretion)

161
Q

polypharmacy

A

approx 5 or more medications

substantial problem in older adults

162
Q

increase risk for morbidity and mortality (poly pharmacy)

A
  • number of providers
  • presence of chronic illness
  • OTC meds
  • disabilities that may impact how they take their meds

*the more prescribed meds taken, the greater possibility of interactions (specialists don’t always look at other meds)

163
Q

medication-food (calcium in dairy)

A

milk binds with some receptors that a lot of medications need (best to take meds with water)

levothyroxine
tetracycline
ciprofloxacin
spironolactone

increase potassium

164
Q

med-food: green leafy vegetables

A

full of vitamin k
- decrease anticoagulant effects

warfarin
Coumadin
heparin

165
Q

adverse

A

unintended consequence

166
Q

beers criteria

A
  • potential inappropriate
  • potentially inappropriate for older adults w/ certain conditions
  • should only be taken with caution
  • avoid
  • not meant to be policy
167
Q

psychoactive medications

A

older adult: depression, anxiety, bipolar, dementia

use only after non-pharmacological approaches found ineffective

look for changes (especially thermal)

168
Q

antipsychotics

A

affect hypothalamic and thermoregulatory pathways

known for side effects - watch your patient closely
neuroleptic malignant syndrome, sedation, hypotension, EPSEs

169
Q

typical antipsychotic

A

haloperidol (never use with dementia with Lewy bodies)

170
Q

atypical antipsychotic

A

seroquel

171
Q

extrapyramidal and anticholinergic side effects (EPSEs) (antipsychotics)

A

movement
drying
atypical tend to produce less EPS symptoms

172
Q

EPS

A

acute dystonia
- oculogyric crisis: eyes fixed in position

akathisia

parkinsonian symptoms

tardive dyskinesia

173
Q

promoting healthy aging: assessment

A

“brown bag” (to bring meds in)
discuss each med
stop/start tool

174
Q

herbs and supplement regulation

A
  • regulated by dietary supplement health and education act
  • herbal manufacturers label herbs as foods (NOT FDA regulated)
  • good manufacturing practices required since 2007 (prep and storage, product ID, purity, strength, composition)
175
Q

CoQ 10

A

Use: for people who can’t use statins
Caution: DO NOT TAKE WITH WARFARIN
Adverse reactions: elevated liver function tests, mild GI upset

176
Q

garlic

A

Use: decreased blood clots and reduced total serum cholesterol and LDLs
Caution: with use of anticoagulants
Adverse reactions: severe allergic reactions, increased flatulence, and upper GI irritation with nausea and heartburn

177
Q

ginkgo biloba

A

Use: cognitive function, memory
Caution: with use of anticoagulants
Adverse reactions: BLEEDING

178
Q

St. John’s wort

A

Use: mild or moderate depression, anxiety, pain
Caution: warfarin, contraindicated with other antidepressants (esp. SSRIs)
Adverse reactions: SEROTONIN SYNDROME, photosensitivity

179
Q

melatonin

A

Use: promote sleep
Caution: when taking other meds that can cause drowsiness
Adverse reactions: headache, nausea

180
Q

ginseng

A

Use: promotes overall wellbeing and immunity
Caution: with use of anticoagulants
Adverse reactions: box 10-1

181
Q

glucosamine and chondroitin sulfate

A

Use: support cartilage and connective tissue (has anti-inflammatory effects)
Caution: with allergies, diabetes, asthma
Adverse reactions: nausea, GI upset

182
Q

dietary supplements for hypertension

A 
coenzyme Q10
fish oil
garlic
green tea
melatonin
183
Q

dietary supplements for HIV

A

SJW

184
Q

dietary supplements for GI disorders

A

psyllium
milk thistle
probiotics

185
Q

dietary supplements for cancer

A

calcium (colorectal)
fish oil (endometrial)
garlic (colorectal, prostate)
ginseng (breast, stomach, liver, lung, ovarian)

186
Q

dietary supplements for Alzheimer’s

A

ginkgo

187
Q

diabetes and herbal treatment

A
  • herbs have been used to manage diabetes since before the 1921 discovery of insulin
  • some of the 400 plants that affect blood glucose are still used
  • there is not enough evidence to support the use of herbal supplements for treating diabetes
  • cinnamon (requires a lot - biggest problem is people like to add sugar)
188
Q

pain

A

an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described as such

189
Q

pain is

A

what the patient says it is

multidimensional, sensory, psychosocial, emotional, personal, and spiritual

categorized as acute or chronic/persistent

190
Q

pain is reported by more

A

men than women

191
Q

decrease in density of both myelinated and unmyelinated nerve fibers

A

delaying sensation of pain from the periphery and there is slower resolution once triggered

192
Q

pain with cognitive impairments in older adults

A
  • consistently untreated or undertreated
  • receive less meds, even when they experience the same acutely painful events
  • providing comfort (careful observation of behavior, watch for changes/pain cues, give attention to caregiver)
193
Q

iatrogenic disturbances pain (IDP)

A

be aware of pain that can be caused by those caring for the older adult (moving them, turning, etc.)

194
Q

pain assessment

A
  • pain diary
  • OLD CART
  • coexisting depression and anxiety
195
Q

non-pharmacological pain interventions

A 
heat/cold
TENS
acupuncture/acupressure
relaxation, meditation, guided imagery
music
activity
cognitive-behavioral therapy
196
Q

pharmacological pain interventions

A
  • erase the “memory of pain”
  • ATC
  • PRN for breakthrough pain
  • start low, go slow, but go
  • pain control choices: non-opioid, opioid, other
197
Q

pain effectiveness evaluation

A
  • qualitatively measured (repeat intensity scale)
  • qualitative observations
  • adjust interventions

Gero (3 decks)

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