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Nursing Chronic Care > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

what physical changes does the older adult go through?

A

Integumentary
● CV/Pulmonary
● Neurological
● Gastrointestinal
● Genitourinary
● Musculoskeletal
● Endocrine
● Immunity

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2
Q

what happens to the older adults integumentary system as they age?

A

becomes thin, pale, less elastic, and get saggy

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3
Q

what happens to the older adults CV/Pulmonary system as they age?

A

the structure and function of the system declines and losses efficiency

the diaphragm becomes weaker

Lung tissues looses elasticity

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4
Q

what happens to the older adults Neurological/cognitive system as they age?

A

brain and spinal chord begin to atrophy

decreased amount of neurons and speed of neuron activity

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5
Q

what happens to the older adults Gastrointestinal system as they age?

A

The muscles in the digestive tract become stiffer, weaker, and less efficient

swallowing becomes more difficult

decreased appetite

decrease in taste

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6
Q

what happens to the older adults Genitourinary system as they age?

A

incontinence, urgency, leakage, diffuclity getting started, retention, and UTIs

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7
Q

what happens to the older adults Musculoskeletal system as they age?

A

Muscles lose overall tone, become rigid, and lose elasticity

Bones become brittle and break easily due to osteoclast/osteoblast activity

Breakdown of cartridge in joints can lead to deformity

Trank and spine shortening can lead to deformity

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8
Q

what is kyphosis?

A

exaggerated rounding of the upper back

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9
Q

what is the cause of kyphosis is older adults?

A

weakness in the spinal bones that causes them to compress or crack

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10
Q

what happens to the older adults endocrine system as they age?

A

xxx

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11
Q

what happens to the older adults immunity as they age?

A

loses the ability to protect against infections and cancer and fails to support appropriate wound healing

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12
Q

what psychosocial changes do older adults experience?

A

retirement….being used to working and now having more free time

family structure…they used to provide for the family but now they are the ones being taken care of

Death…family and friends passing

Body image…changing in how they look

Social activity…maybe they once got their social time at work but now that they are retired they loose people to talk to

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13
Q

what specific cognitive problems will an older adult face?

A

depression…delirium….dementia/Alzheimers

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14
Q

what health risks are the older adults susceptible to?

A

hypertension…high cholesterol…arthritis…diabetes..coronary artery disease…kidney disease…heart failure..depression… Alzheimer/dementia…COPD

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15
Q

how can the older adult protect themselves from the diseases they are susceptible to?

A

screenings…immunizations…injury prevention

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16
Q

what are some health screenings that the older adult would benefit from?

A

cholesterol….eye exams…hearing….fecal occult blood tests…rectal/prostate..mental health

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17
Q

how can the older adult help their immune system?

A

supplementation and immunizations

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18
Q

how can the older adult prevent injuries in their home?

A

wear their glasses…have grab bars…avoid carpets…limit usage of stairs…have ramps when entering the home

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19
Q

what should be limited in the older adults diet?

A

alcohol…refined sugars…sodium…fat

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20
Q

why should older adults limit refined sugars?

A

to avoid insulin resistance

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21
Q

what should the older adult limit to avoid high blood pressure?

A

sodium and fats

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22
Q

what is Gastroesophageal Reflux?

A

occurs when the lower esophageal sphincter is not strong enough to keep acid contents of the stomach inside this inturn causes the acid to come up into the esophagus

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23
Q

does occasional gastroesophageal Reflux cause permanent problems?

A

no

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24
Q

what does Gastroesophageal Reflux feel like?

A

burning in the upper chest sometimes patients may confuse with a heart attack

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25
Q

at what point is reflux considered GERD?

A

xxx

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26
Q

what does GERD stand for?

A

Gastroesophageal Reflux Disease

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27
Q

is GERD chronic or acute?

A

chronic

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28
Q

what tools help diagnose GERD?

A

pH monitoring of the esophagus

Endoscopy/EGD

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29
Q

what are the complications of GERD?

A

Barret epithelium and Esophageal Stricture

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30
Q

what is Barret epithelium?

A

specialized columnar epithelium replaces the normal stratified squamous epithelium of the esophagus…..which can lead to cancer

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31
Q

what is Esophageal Stricture?

A

Narrowing of the esophagus

Scar tissue forms and builds off itself eventually making it too narrow for food to pass properly

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32
Q

whose at risk for GERD?

A

High BMI….pushes on the stomach causing pressure
Smoking
Excessive alcohol
Sleep positioning….eating and then laying flat
History of hiatal hernias….puts pressure on the stomach causing pressure
Older adult
Medications….
Sleep apnea
Pneumonia
Asthma

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33
Q

how does GERD affect your teeth?

A

the acid can erode the enamel off your teeth

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34
Q

can GERD cause bleeding of the esophagus?

A

yes

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35
Q

what kind of pneumonia can GERD cause?

A

aspiration pneumonia

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36
Q

what is aspiration pneumonia?

A

inhaling food into your lungs

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37
Q

how does acid affect your swallowing?

A

burns your throat muscles that control swallowing

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38
Q

what are the symptoms of GERD?

A

Dyspepsia….indigestion
Regurgitations
Belching
Burning chest pain
Heartburn
Coughing
Wheezing

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39
Q

what are the symptoms in history that point to GERD?

A

Heartburn or chest pain
Asthma
Hoarseness
Coughing
Wheezing
Dysphagia…trouble swallowing
Odynophagia…pain when swallowing

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40
Q

how long does GERD flare-up last?

A

20 minutes - 2 hours

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41
Q

What foods should someone with GERD avoid?

A

Peppermints
Chocolates
Alcohol
Fatty fried foods
Spicy foods
Tomatoes

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42
Q

should people with GERD eat less frequent bigger meals or more frequent smaller meals?

A

more frequent smaller meals

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43
Q

what lifestyle changes should people with GERD do?

A

Stopping smoking
limit Alcohol
Lose weight
Exercise
Avoid tight or restrictive clothing
Avoid bending over

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44
Q

what is included in musculoskeletal?

A

muscles and bones

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45
Q

what are tendons?

A

connects muscles to bones

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46
Q

what are ligaments?

A

connect bone to bone

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47
Q

what is mobility?

A

the ability to move without restrictions

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48
Q

what are some effects of decreased mobility?

A

Has physiological, psychological, and cognitive effects
Deceased bone density
Osteoporosis
Fragility fractures
Muscles atrophy
Sarcopenia
Changes in tissue tension, elasticity, and shape
Joint stiffness
Joint contractures
Foot drop
Orthostatic hypotension
Heart deconditioning
DVT
Increased risk of infection
Collapse of lungs
Bad absorption of food due to GI system not having gravity it needs to digest properly
Constipation and fecal impaction
Urinary Retention
Pressure ulcers
Dependence on others
Inability to participate in hobbies

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49
Q

what is sarcopenia?

A

the decrease in size and number of fibers in the muscle

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50
Q

what is atrophy?

A

decrease in the size of muscle fibers but not the actual number of muscle fibers

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51
Q

what should you be looking at during a mobility assessment?

A

their activity tolerance, ability to walk, balance, stamina, ability to do ADLs, and where they started what direction they are going

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52
Q

what is a mobility assessment tool?

A

a tool used to gauge the mobility of a patient….the higher the number the better

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53
Q

what is osteoporosis?

A

a disease where you lose bone density due to having overactive osteoclasts

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54
Q

do osteoclasts build bone or break down bone?

A

break down bone

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55
Q

do osteoblasts build bone or break down bone?

A

build bone

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56
Q

when is osteoporosis most common in women?

A

menopause

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57
Q

why do women experience osteoporosis more often than men?

A

because women go through menopause where their estrogen levels decrease….estrogen is responsible for telling osteoblasts to build bone

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58
Q

why are bariatric surgery patients more susceptible to getting osteoporosis?

A

because they have parts of their organs removed which lowers the rate of absorption of calcium

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59
Q

what are the modifiable risk factors for osteoporosis?

A

Nutrition… not eating calcium and vitamin D
excess body weight
being sedentary
not being in sunlight
smoking
decreased mobility
excess caffeine

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60
Q

what are the nonmodifiable risk factors for osteoporosis?

A

older age
menopause
family history
gender

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61
Q

what would change the psychosocial image of someone with osteoporosis?

A

overall decreased mobility and kyphosis that causes a deformed neck

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62
Q

what labs are monitored for someone with osteoporosis?

A

Vitamin D and calcium

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63
Q

what type of scans are used for osteoporosis?

A

Dexa scan

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64
Q

what does a Dexa scan show?

A

density of the bone

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65
Q

what should someone with osteoporosis do to help their condition?

A

prevention of falls
improving nutrition
managing risk factors under their control

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66
Q

What nutritional interventions would someone with osteoporosis need to do?

A

intake of more calcium, vitamin D, and fiber

limit alcohol

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67
Q

what foods are high in calcium

A

milk, yogurt, cheese, leafy greens, broccoli

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68
Q

what activities would someone with osteoporosis need to do?

A

light exercising and strengthing abdominals

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69
Q

what drug therapy options do we have for osteoporosis?

A

HRT…Teriparatide
Calcium supplement
Biphosphonate

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70
Q

In what order should the drug therapies be done for osteoporosis?

A

Start with the hormone and then go on the medication

71
Q

what is teriparatide?

A

a synthetic form a parathyroid hormone that helps your body to form new bone, increase bone mineral density and bone strength

72
Q

what is biphosphonate?

A

a medication that is absorbed by the osteoclasts….once absorbed it slows down their activity

73
Q

what is the recommended intake of vitamin D?

A

400 to 1000 international units per day

74
Q

what is the recommended intake of calcium?

A

1000mg per day

75
Q

what is osteoarthritis/degenerative joint disease?

A

wearing down of cartilage in the joint

76
Q

why is the wearing down of cartilage a bad thing?

A

because it narrows the joint space preventing the joint from moving in a complete ROM that is pain-free

77
Q

what can occur in the joint after cartilage is worn down?

A

bone spurs

78
Q

what are the risk factors for osteoarthritis / degenerative joint disease?

A

older age….being a woman..obesity…occupation…deformities

79
Q

where does osteoarthritis / degenerative joint disease most commonly occur?

A

knee, hip, and back are the most common but it can be seen in the fingers

80
Q

in a patient with osteoarthritis / degenerative joint disease does join stiffness get better throughout the day?

A

yes

81
Q

what should be encouraged in patients with osteoarthritis / degenerative joint disease to help with pain?

A

movement

82
Q

what psychosocial factors must be considered in patients with osteoarthritis / degenerative joint disease?

A

Can interfere with the patient’s quality of life

Body image

Self-esteem

83
Q

can lab work be done for a diagnosis of osteoarthritis / degenerative joint disease?

A

no lab will show osteoarthritis / degenerative joint disease but it will be done to rule out other diseases

84
Q

what imaging can be done to diagnose someone with osteoarthritis / degenerative joint disease?

A

X-rays and MRIs

85
Q

what nonpharmacological interventions can be done to help those with osteoarthritis / degenerative joint disease?

A

rest, strength training, cardio, PT/OT, assistive equipment

86
Q

what pharmacological interventions can be done to help those with osteoarthritis / degenerative joint disease?

A

Acetaminophen, NSAIDs, tramadol, and opioids

87
Q

what should a nurse be doing for a patient post-surgery for a patient with osteoarthritis / degenerative joint disease?

A

pain management….monitoring for blood loss…monitoring for DVT and VTE….monitoring for infection….teaching patient about signs and symptoms

88
Q

what should patients who have had hip surgery avoid?

A

hip adduction

89
Q

what is Parkinson’s disease?

A

a progressive neurogenerative disease that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination

90
Q

what happens inside of the brain that causes Parkinson’s?

A

a decrease in dopamine which leads to no control of voluntary muscles and loss of function of the autonomic nervous system

91
Q

what are the risk factors for Parkinson’s?

A

there are no known risk factors but its thought to be exposure to metals and pesticides

92
Q

what are the characteristics of Parkinson’s?

A

Tremors……. bradykinesia/slow movements…aconesia/no movements….postural instability….risk of falls…shuffling feet…slow rising…..muscle rigidity…stooped posture…drooling…incontinence…slow speech

93
Q

what psychosocial effects can someone with Parkinson’s have?`

A

mood swings…..decreased social participation…needing a caregiver

94
Q

what should the plan be to help those with Parkinson’s

A

improve mobility….manage cognitive function…keep abilities for as long as possible…encourage exercise…monitor swallowing…possible thickened liquids…encouraging communication…. increase fluids… education to those that will be around the patient

95
Q

what medications are used for Parkinson’s?

A

Carbidopa levodopa

96
Q

how does carbidopa levodopa work?

A

stimulates dopamine production

97
Q

what should you do with fluid intake when taking carbidopa levodopa?

A

increase fluid intake

98
Q

what is systole?

A

contraction of the heart

99
Q

what is diastole?

A

Relaxation of the heart

100
Q

when do you hear the S1 heart sound?

A

during systole

101
Q

when do you hear the s2 heart sound?

A

during diastole

102
Q

what is cardiac output?

A

The volume of blood put out in one minute by the heart

103
Q

what is the equation for CO?

A

Stroke volume x HR

104
Q

when HR increases what happens to the CO?

A

it increases

105
Q

what is stroke volume?

A

the volume of blood pumped out after each contraction

106
Q

what is perfusion?

A

the flow of blood through vessels to deliver nutrients and oxygen to your cells

107
Q

what is atherosclerosis?

A

The build-up of fats, cholesterol, and other substances in and on the artery walls

108
Q

what are the non modifiable risk factors for atherosclerosis?

A

heredity…genetics
ethnicity…blacks
age…60+
Sex..men

109
Q

what are modifiable risk factors for artheroslerosis?

A

elevated lipid levels….keep fat consumption between 25-30%
diabetes…high glucose levels cause damage to vessels and nerves that control the heart
obesity…
sedentary lifestyle
smoking
hypertension

110
Q

can someone be diagnosed with one reading being hypertensive?

A

no you need 2 readings on 2 separate occasions so 4 total readings showing hypertension

110
Q

what is hypertension?

A

blood pressure above 120/80

111
Q

what does chronic hypertension cause?

A

MI, stroke, damage to heart, brain, kidney, and eyes

112
Q

what is essential/primary hypertension?

A

not caused by an existing health problem

related to modifiable and nonmodifiable health factors

113
Q

what are the causes of essential/primary hypertension?

A

family history
ethnicity
fat consumption
weight
diet
high sodium, caffeine, alcohol
low potassium, magnesium, and calcium???
stress

114
Q

what is secondary hypertension?

A

caused by kidney disease, cushions disease, after pregnancy, drugs, birth control, corticosteroids

115
Q

what would you be looking for in a history for someone who has hypertension?

A

symptoms
modifiable/nonmodifiable risk factors
past drug/smoking/alcohol use
family history

116
Q

what would you be looking for in a physical assessment for someone who has hypertension?

A

headaches
facial flushing
dizziness
fainting

117
Q

what would you be looking for in a psychosocial assessment for someone who has hypertension?

A

whit coat syndrome
anxiety
stress

118
Q

what labs would be looked at for hypertension?

A

no direct labs will show

119
Q

what diagnostic tests will you use to determine if someone has hypertension?

A

EKG to look at damage

Only BP will show hypertension

120
Q

what lifestyle modifications would help someone with hypertension?

A

diet modifications
loosing weight
exercise
quitting smoking
decrease stress
lower sodium, sugary drinks, alcohol
DASH diet

121
Q

what is on the dash diet?

A

Fat free
Vegetables and fruits
Lower saturated fats
Rich in potassium, magnesium, and calcium

122
Q

what is heart failure?

A

occurs when the body can not pump enough blood through the body

123
Q

why is heart failure bad?

A

your blood begins to pool up and clot

124
Q

what is left-sided HF?

A

the left side of your heart is failing to bring oxygenated blood into your heart

125
Q

what does left-sided HF cause?

A

hypertension
coronary artery disease
valve disease

126
Q

what part of the body gets congested in left-sided HF?

A

the lungs

127
Q

what additional S sound will be heard in patients with left-sided HF?

A

S3

128
Q

can left-sided HF cause right-sided HF?

A

yes

129
Q

what are the symptoms of left-sided HF?

A

pulmonary congestion…crackles… wheezing…cough..blood sputum..tachypnea

restlessness, confusion, orthopnea, tachycardia, exertional dyspnea, fatigue, cyanosis, and Paroxysmal nocturnal dyspnea

130
Q

what is Paroxysmal nocturnal dyspnea?

A

a sensation of shortness of breath that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position

131
Q

what is orthopnea?

A

shortness of breath that occurs while lying flat and is relieved by sitting or standing

132
Q

what is exertional dyspnea?

A

the sensation of running out of the air and of not being able to breathe fast or deeply enough during physical activity

133
Q

what is cyanosis?

A

bluish color in the skin, lips, and nail beds caused by a shortage of oxygen in the blood.

134
Q

what happens in right-sided HF?

A

your heart is unable to empty completely

135
Q

what can right-sided HF cause?

A

left-sided HF

MI

Pulmonary hypertension

136
Q

where is fluid backing up in left-sided HF?

A

lungs

137
Q

where is fluid backing up in right-sided HF?

A

the body

138
Q

what are some symptoms of right-sided HF?

A

fatigue, ascites, enlarged liver/spleen, distended jugular veins, weight gain, dependent edema, anorexia, complaints of GI distress

139
Q

what is ascites?

A

fluid build up in the abdomen

140
Q

what is dependent edema?

A

specific to parts of the body that are influenced by gravity, such as your legs, feet, or arms

141
Q

what are questions would you ask someone when gathering a history on a patient with HF?

A

family history, activity level, SOB, previous heart problems, smoking, stress, diet, salt/fat/caffeine/alcohol consumption, drugs, weight fluctuations, sleeping with extra pillows or recliners

142
Q

what are you looking for in a physical assessment of a patient with HF?

A

listening to the apical pulse for one minute….listening for dysrhythmias

143
Q

what would you listen for in a left-sided HF patient?

A

listen to the lungs for crackles and wheezes

listen to the heart for s3 sound

144
Q

how much weight can someone gain before they notice they have pitting edema?

A

10-15lbs

144
Q

what psychosocial symptoms may someone with HF have?

A

depression and anxiety

145
Q

what labs will be run to help diagnose someone with HF?

A

potassium, calcium, sodium, magnesium, BNP, cholesterol, lipids, hemoglobin A1C

146
Q

what diagnostic tests will help diagnose someone with HF?

A

Echocardiogram, chest x ray, and ekg

147
Q

what interventions will be done for the lungs in a HF patient?

A

keeping them above 92%…..patients with HF will have a lower-than-normal S`PO2

elevating HOB

coughing, deep breathing, incentive spirometry

148
Q

what interventions will be done for the Heart in a HF patient?

A

Improve CO

Fluid restriction

Daily weights

149
Q

what non pharmacological actions will increase blood flow in patients with HF

A

Ted hose, SCD, exercise/movement

150
Q

what is cognition?

A

ability to reason and have a higher level of thinking

150
Q

what factors impair cognition?

A

old age, brain trauma, toxins, substance abuse, down syndrome, depression, long term steroid abuse, low sodium

151
Q

why does old age affect cognition?

A

The decrease of ACH

152
Q

what are symptoms of inadequate cognition?

A

short term memory loss, long term memory loss, disoriented, impaired reasoning/decision making, inappropriate emotions, impaired language, delusions, hallucinations

153
Q

what are hallucinations?

A

seeing things that are not there

154
Q

what are delusions?

A

thinking things that are not true

155
Q

what should you do when assessing for the patient’s state of cognition?

A

ask AAO questions….mini cognition test….MRI…O2 levels

156
Q

what is involved in the mini cognition test?

A

give the patient words to remember….then have them draw a clock with a specific time….then have them recall the words

157
Q

what interventions should you do for someone with inadequate cognition?

A

make their environment safe….clear their area for tripping hazards…keep tubing to a minimum….remind them who you are frequently…orient them to where they are and why

158
Q

how can you prevent problems with cognition?

A

avoid trauma to the head….avoid toxins….watch their meds and don’t combine certain meds…mental and social activities to promote brain activity…quit smoking…good sleep….treat mental illness…some impairment in cognition is normal with age

159
Q

what is delirium?

A

an acute condition that affects cognition rapidly usually caused by infections or medications

160
Q

is delirium curable?

A

yes

161
Q

what are the main causes of delirium?

A

infection, medications, and prolonged hospital stays

162
Q

can symptoms fluctuate in someone with delirium?

A

yes

163
Q

What interventions can a nurse do to help a patient with delirium?

A

safe environment…reorient the patient every hour…reintroduce yourself…calm environment….sensory aids on like glasses or hearing aids….calm voice

164
Q

what is Dementia?

A

a chronic progressive disease that affects cognition especially short/long term memory loss

165
Q

is dementia curable?

A

no

166
Q

is there fluctuation in symptoms for dementia?

A

no

167
Q

what is the pathophysiology behind dementia?

A

patients have decreased amount of the neurotransmitter ACH

168
Q

can dementia progression be stopped with medication?

A

no progression can not be stopped only slowed down

169
Q

what interventions can be done to help with dementia?

A

support cognitive function by doing things that will challenge their mind……have them to everything that they can…good nutrition…simple instructions…having understanding family members

170
Q
A

Nursing Chronic Care (4 decks)

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