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Adult care 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Describe why clinical decision making=complex in older adults

A

-Vague s/s w/ illness
-Tendency to disregard as “normal” in aging
-don’t complain due to concern of being a burden
-communication deficits
-multifaceted conditions

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2
Q

what are the geriatric syndromes?

A

IFFCUPD
Immobility, frailty, falls, constipation, urinary incontinence, polypharmacy, delirium

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3
Q

Difference between IADL’s and ADL’s

A

IADL= physical and cognitive performance required, first to go, higher LOC and ability needed
ADL= last to go, self care activities

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4
Q

Examples of ADL’s

A

Brushing teeth, bathing, toileting, dressing

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5
Q

Examples of IADL’s

A

Grocery shopping, managing finances/medications, housekeeping

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6
Q

How does the loss of ADL’s affect an older adult’s care?

A

It increases their dependence, which can lead to a decline in autonomy and condition

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7
Q

How does the loss of IADL’s affect an older adult’s care?

A

Loss of autonomy, independence

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8
Q

Normal aging changes for older adults

A

Decline in speed, decrease in stride, slower bowel sounds, decreased appetite/thirst, kidney function decreases, decreased bladder capacity, high frequency hearing loss, breathing capacity decreases, gray hair and wrinkles, decreased skin elasticity and strength, body fat increases in trunk

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9
Q

Abnormal aging changes for older adults

A

TUG of 12 or greater, anxiety/depression, malnutrition (dysphagia), insomnia, hypersomnia, pressure ulcers, falls, delirium

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10
Q

Interventions to prevent/decrease fall risks

A

Ensure clutter free environment, good walking shoes, proper use of assistive devices, evaluate meds for adverse effects causing immobility, treat and manage conditions causing immobility (PT)

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11
Q

Describe get up and go test (TUG)

A

Have a pt sit in a chair, stand up, walk forward 10 feet, turn around, walk back to the chair, and sit down again. This must happen in less than 12 sec. Observe gait, stride, postural stability, sway, and balance

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12
Q

What does it mean if a client cannot complete the TUG in less than 12 sec?

A

Higher risk for falling

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13
Q

What are the types of gaits?

A

Hemiplegic, parkinsonian, cerebellar/ataxic, stomping/stamping, diplegic/CP, myopathic/“waddling“, neuropathic/“steppage”, choreiform

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14
Q

Choreiform gait

A

Writhing movements, random involuntary

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15
Q

Steppage/neuropathic gait

A

Equine gait, can’t step forward without tripping because dorsi flex=weak, so have to bring knee up high and kick leg out

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16
Q

Stomping/stamping gait

A

Lack of proprioception- relies on visual cues to know that foot has hit the floor. Stomps for vibrations to be obvious through the foot, more prominent in the dark

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17
Q

myopathic/“waddling” gait

A

Pelvis not stable to bear weight when taking step-lean trunk to compensate to other side-waddling gait

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18
Q

Diplegic/CP gait

A

Extensor spasm, walking in tip toes, some circumduction and a abductor spasm keeping feet close together, arms flexed, scissors gait

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19
Q

Parkinsonian gait

A

General flexion(every joint), small shuffles, tremor associated with gait

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20
Q

Cerebellar gait

A

Broad stance, wide staggering falling forward and to one direction, trunk sways when standing still

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21
Q

hemiplegic gait

A

Hand flexed to chest(may not be if mild), unilateral circumduction of foot when walking forward, arms do not both swing/ arm does not swing normally. Flexion and extensor hypertonia, foot drop

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22
Q

How does immobility affect overall levels of care (older adult)

A

Unable to care for self, relies on family/support (a lot of pressure/burnout), loss of independence, refusal to accept need help, adherence= low, poor outcomes=high

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23
Q

Factors to consider when assessing the home for falls

A

Rugs, lights, handrails, pets (running around/under feet), alone?, appropriate footwear, gait change, activity level

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24
Q

Constipation

A

“Infrequent, incomplete, or painful evacuation of feces for three days or more”

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25
Q

Medications to help manage constipation

A

Hyperosmolar agents, prokinetic agents(not recommended for elderly)

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26
Q

Polyethylene glycol class

A

Hyperosmolar agent, non addictive

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27
Q

Stool softeners

A

Colace, docusate sodium

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28
Q

When to take a laxative

A

Last resort- do not want to use stimulants first, do not want to become dependent. Hypoactive bowel sounds, no BM within 3 days

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29
Q

Water intake and its role in constipation

A

Inc water=dec constipation, absorbs into feces, softening form; inc fluid in colon leads to inc in peristalsis

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30
Q

Stimulant (constipation)

A

GoLytely, Bisacodyl, Senna
Stimulates intestinal peristalsis and inc volume of water&electrolytes in intestines

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31
Q

Polyethylene glycol

A

Miralax, osmotic that draws water into intestine to inc mass of stool=peristalsis, contraindicated in HF and Bowel obstruction

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32
Q

Stool softener

A

Docusate sodium, colace
Lowers surface tension of stool to allow water in, typically for softening fecal impact ion

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33
Q

Management of Urge incontinence

A

Initial: Kegels/PFT
Treat UTI, atrophic vaginitis, meds to reduce tone of bladder, scheduled voiding for pts with cognitive deficits

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34
Q

Management of stress incontinence

A

Kegels/PFT
-tx atrophic vaginitis
-insertion of pessary
-toileting/fluid regimen
-surgery- A&P repair, bladder sling

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35
Q

Management of overflow bladder incontinence

A

Med review
-bladder retraining
-reverse cause
Improve glucose readings, reduce ETOH, catheterization

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36
Q

Management of functional incontinence

A

Remove barriers for BR use
Pictures on BR door
Improve mobility with PT/OT

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37
Q

Meds to reduce tone of bladder- Urge incontinence

A

Tricyclic agents- Imipramine
Tolterodine, darifenacin, solifenacin, oxybutynin
Scheduled voiding for pts with cognitive deficits

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38
Q

What are the concerns for oxybutynin for older adult?

A

Vasodilation(spasticity med, relaxes muscles)- orthostatic hypotension

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39
Q

Kegels/pelvic floor

A

Most notice positive change after 6 weeks, 10 times daily, tighten pelvic muscle for 10 sec then release-do this 15X (lying,sitting, standing)

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40
Q

Oxybutynin

A

Medication for BPH and overactive bladder w/ urge frequency/incontinence; decreases detrusor muscle contractions

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41
Q

Topical estrogen

A

Hormone
Tx for overactive bladder, atrophic vaginitis, stress incontinenece

42
Q

Why do older adults become acutely confused and how do we recognize and intervene appropriately?

A

Infection, medication change, trauma (hospital stressors), surgeries=#1
-short term and reversible
Assess with CAM

43
Q

How to administer CAM

A

Confusion assessment method
1. Acute onset form baseline
2a. Inattention
2b. If present, did it fluctuate?
3. Disorganized thinking (rambling, incoherent, unpredictable)
4. Altered LOC(alert,lethargic, vigilant, coma)
5. Disorientation
6. Memory impair
7. Perceptually disturbed (hallucinations and illusions)
8a. Psychomotor agitation (inc level of motor activity, restlessness,picking)
8b. Psychomotor retardation (dec level of motor activity, sluggish/slow moving, staring into space)
9. Altered sleep/wake

44
Q

What makes the CAM positive

A

Presence of 1 and 2 and either 3 or 4

45
Q

Interventions for delirium

A

Resolve cause if possible (treat infection, rehydrate, reorient, keep awake during day to sleep at night to reset sleep cycle)
-start low and go slow with medications, encourage family members to be there (easier to reorient)

46
Q

Polypharmacy

A

When a pt is on multiple medicines- or more of the same meds in diff forms- and on more than clinically needed

47
Q

Beer’s list

A

list of medications not safe for older adults
>81mg aspirin, dabigatran (inc risk bleeding), drugs that eliminate through kidney, drugs with high first pass effect, drugs with low therapeutic ranges
-Anticholinergics, opioids, antihistamines

48
Q

Ways to decrease problems of multiple drugs

A

Med rec

49
Q

What classes of drugs were mentioned in class as a major problem for older adults

A

Anticholinergics, narcotics, antihistamines

50
Q

Specific drugs mentioned in class as major problems for older adults

A

Anticholinergics
Opioids
Antihistamines

51
Q

Issues with safe drug therapy for older adults

A

Routine adherence, remembering if they took them or not, understanding dosages/ timing, obtaining refills, polypharmacy

52
Q

Interactions of normal aging and responses to drug therapy in older people

A

smaller therapeutic index, metabolism=slower–> takes less amt of drug for a therapeutic response. start low and go slow

53
Q

Frailty

A

Progressive physiological decline of multiple Body systems
Causes: older adult w/ chronic illness, loss of organ function, poverty, social isolation
3,2,1 Method

54
Q

Assessment for frailty; how to assess when there isn’t a “tool”

A

Presence of 3 or more co-morbid conditions, needs assistance with 2 ADL’s, Dx of one geriatric syndrome
Assess ADL’s and IADL’s, nutrition, and fall risk

55
Q

Co-morbid conditions criteria for frailty-LUWEPS

A

-Unplanned weight loss
-Exhaustion
-Weakness
-Poor endurance
-Slowness
-Low levels of physical -activity

56
Q

Acronyms for frailty

A

SPICES and PULSES

57
Q

SPICES- frailty

A

S-sleep disorders
P- problems with eating
I- incontinence
C- Confusion
E- Evidence of falls
S- skin breakdown

58
Q

PULSES-frailty

A

P-physical condition
U-Upper limb function
L-lower limb function
S- sensory components
E-excretory components
S-support factors

P for Physical

59
Q

Factors of frailty

A

Dependency, injury, institutionalization, falls, hospitalization, rapid decline, mortality

60
Q

Impact of chronic disease for older adults

A

Prevention=important
Once disease occurs-focus:
-Managing s/s
-avoiding complications
-avoiding acute illness
-promoting health
-maintaining functional status
-psychological adjustments to physically accommodate disabilities
-social isolation

61
Q

Assessment of pts with chronic diseases

A

-Identify specific problems
-Establish/priortize goals
- define plan of action to achieve desired outcome
-implement plan: adhere to regimens, keep illness stable, psychosocial issues
-follow up,evaluate outcomes

62
Q

Characteristics of chronic disease

A

Med conditions/health problems w/ associated s/s—>long term management
-conditions that do not resolve or for which complete cures are rare
-managing chronic illness involves more than treating med problems
-diff phases over person’s lifetime that they must adapt to
-persistent adherence to therapeutic regimens
-one chronic disease can lead to another developing
-effect more than just pt
-self-management required

63
Q

most important intervention for chronic illnesses in older adults

A

Prevention!
Diet, exercise (150minweek), no smoking, alcohol use effects physical and emotiona

64
Q

Once chronic illness occurs in older adult…

A

Managing s/s, avoiding complications, avoiding acute illness, promoting health, maintaining functional status

65
Q

Health literacy principles for older adults

A

Assess knowledge by asking them to explain their condition/ medication purpose
Ask about their perspective of illness/condition
Clear communication with explanation

66
Q

Most common s/s UTI older adults

A

Confusion, delirium, falls, sudden onset, fever, tachycardia, hypotension

67
Q

Nursing interventions to reduce reoccurrence older adult UTI

A

-Drink 2-3L fluids/day
-encourage rest and nutrition
-clean front to back
-avoid douches, scented lube, bubble baths, tight-fitting underwear, scented toilet paper
-empty bladder before and after intercourse
-do not delay urination
-cranberry juice/supplements

68
Q

Benign prostatic Hyperplasia

A

Enlarged prostate, obstructs urethra and urine flow; overflow incontinence; if persists, urine backflow in ureters and kidneys-kidney damage

69
Q

Risk factors for Benign Prostatic Hyperplasia BPH

A

-Increase in age (men >80 yrs)
-smoking, chronic alcohol use
-sedentary lifestyle, obesity
-high fat, protein, carb diet, low fiber
-DM, CV disease

70
Q

Expected findings for BPH

A

Straining to urinate
Hesitancy
Dec force of stream
Frequency
Incomplete emptying
Dribbling
Urgency
Hematuria
Nocturia (“most difficult symptom”)—> why most seek tx
-cannot start urine flow or maintain stream

71
Q

Lab tests and other diagnostics for BPH

A

PSA- rule out prostate cancer(elevated=cancer)
DRE- reveal enlarged, smooth prostate
UA- WBCs and bacteria
CBC- RBC count
BUN/creatinine- elevated=kidney damage
Transrectal US w/ needle aspiration

72
Q

Medications to re-establish uninhibited urine flow

A

Tamsulosin/Flomax, Terazosin/Hytrin, Finasteride, Sildenafil, saw palmetto

73
Q

Alpha-blocking agents for establishing uninhibited urine flow

A

Tamsulosin, Terazosin(Hytrin)

74
Q

Hytrin

A

Dec. Smooth muscle tone, relaxation of bladder and prostate gland
Complications=hypotension , dec/failed ejaculate
-Contraindicated in liver and renal impairment ; should not be used before cataract surgery

75
Q

Tamsulosin

A

Dec smooth muscle tone (non selective=vasodilation)
- Complications=hypotension, dec/failed ejaculate
-Contraindicated in liver and renal impairment
-30 min after meal, same time each day
-monitor LOC and BP
should not be used before cataract surgery

76
Q

3 way foley irrigation (BPH)

A

Ensure continuous flow, no kinks in tubing. TURP—> hemorrhage=biggest risk to evaluate for
Monitor for blood and clots-> bleeding bladder spasms=bleeding, trying to clot
Bleeding=irrigation to prevent blockage from clots

77
Q

Non-pharmacological interventions for BPH

A

Limit caffeine ETOH, table salt, spicy foods, fluids after dinner
-reg voiding schedule
- lose weight, inc exercise

78
Q

When is drug therapy started for BPH?

A

S/s affect QOL or significant outlet obstruction present (Tamsulosin=safer)
-prevent permanent bladder dysfunction and renal insufficiency

79
Q

What are the concerns r/t nutrition in older adult?

A

Low sodium, dec absorption of mult vitamins, inc risk for osteoporosis, dec lean muscle mass, caloric intake, weight loss, malnutrition, dehydration

80
Q

Interventions to help w/ older adult appetite?

A

List foods they enjoy, flavored with salt or sweet

81
Q

What labs do we use to monitor the older adult’s nutrition?

A

CMP, BMP,CBC

82
Q

Hallmark symptoms- Parkinson’s disease

A

Tremor, Parkinsonian gait(shuffling steps, flexed joints, tremor), stooped posture, forward tilt of trunk, mask-like face, drooling, rigidity, pill roll tremor, bradykinesia

83
Q

How/when do Parkinson’s disease s/s present?

A

Early 60s-80s
Progression over 20 years

84
Q

What gaits are present? (Parkinson’s)

A

parkinsonian (propulsive) gait, bradykinesia, freeze periods

85
Q

How does gait and s/s affect the PD patient’s QOL?

A

Decrease in independence, mobility, and functionality—> overall health decline

86
Q

Major concerns with caring for the PD patient in all stages of the disease

A

Safety, medication adherence/education, independence, nutrition, frailty

87
Q

Interventions that the nurse should use for caring for Parkinson’s pts

A

-Daily exercise, ROM, postural exercise
-Warm baths
-Environmental modifications for self care
-Inc fluids, moderate fiber foods, regular bowel program
-monitor weight, extra feedings, high calorie, high protein diet
-monitor skin (inc risk for melanoma)
-family teaching

88
Q

Challenges with medication management (Parkinson’s)

A

Levodopa- more side effects over time- side effects
Sinemet/Parcopa(levodopa-carbidopa)-cant eat within 2 hrs
Protein heavy meals limits drug absorption and utilization
Best absorbed on empty stomach (1 hr before OR 2 hrs after)

89
Q

Medication Classes (Parkinson’s)

A

Anticholinergics(artane, Cogentin)
Dopamine Agonists
Catechol-O-Methyltransfrese (COMT) Inhibitors

90
Q

Dopamine replacement/ enhancement drugs (Parkinson’s)

A

Levodopa, Sinemet/Parcopa (Levodopa & Carbidopa Combined)
Used BEFORE or WITH Levodopa
High risk of hypotension and dec LOC
“Rescue” drug for off times

91
Q

COMT inhibitors (Parkinson’s)

A

Inc duration of Sinemet-blocks enzyme breaks down levodopa
NO effect on PD symptoms ALONE
N/hypotension=S/E
entacapone, tolcapone

92
Q

Interventions to decrease postural hypotension

A

Ankle pumps, HOB elevated, dec contributing medications, pressure stockings, teaching pt to get up/change position slowly

93
Q

Artane/Cogentin

A

anticholinergic
Help control tremor and rigidity by counteracting acetylcholine (blocks cholinergic receptors)
Very risky- urinary retention, dry mouth, blurred vision, constipation

94
Q

What is the ARMOR scale?

A

Used on LTC pt, improve med adherence and reduce ADEs (adverse drug events)

95
Q

ARMOR

A

Assess, Review, Minimize, Optimize, Reassess

96
Q

What is the A in armor?

A

Assess:
What meds they are on

97
Q

R in ARMOR

A

Review:
Drug-drug, drug-disease, and adverse drug reactions

98
Q

M in ARMOR

A

Minimize:
Number of meds according to functional status rather than evidence-based medicine

99
Q

O in ARMOR

A

Optimize:
For renal/hepatic clearance,PT/PTT,etc

100
Q

Second R in ARMOR?

A

Reassess:
Functional/cognitive status in 1 week and as needed
-clinical status and medication compliance

101
Q

Finasteride

A

dec the breakdown of testosterone->shrinks prostate (Tx for BPH)
S/E: dec libido, gynecomastia, impotence, ORTHOSTATIC HYPOTENSION, caution with liver disease pts

102
Q

Tamsulosin

A

alpha blocker
Relaxes smooth muscles
S/E: hypotension, dizziness, nasal congestion, sleepiness, faintness, problems with ejaculation, floppy iris syndrome
Contraindicated in severe liver failure
Take after meals

Adult care 2 (4 decks)

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