Exam 1 Flashcards
Interventions to prevent fall risk
clean/ organized room
adequate lighting
no carpets
IADLS
Requires both physical & cognitive performance — 45-50% of >85 can
still do
– Using telephone, shopping, housekeeping, laundry, handling
medications, handling finances
ADLS
The last to go, self care activities
– Toileting, bathing, dressing, feeding, continence
Describe why clinical decision making is complex in older adults
Presence of Multiple Comorbidities
Polypharmacy
Age-Related Physiological Changes
Cognitive and Functional Decline
Social and Emotional Factors
ADL vs IADL
ADLs are everyday activities and the last to go
IADLS require physical and cognitive performance
TUG test
-this assesses patients mobility
-patient sits in chair and gets up and walks to designated line turns and returns to chair
-the line is 3 meters (10 feet) away from chair
-pt who takes 12 or more seconds is at high risk for falling, reduced functional mobility, and potential need for intervention
new onset or increased number or falls
think medication or infection
Home Assessment for falls
-Poor lighting
* Excessive equipment
* Poorly fitting shoes
* Wet floors
* Loose carpets
* Unfamiliar surroundings
-medications
Oxybutynin
-a muscarinic antagonist (anticholinergic medication) primarily used to treat overactive bladder (OAB) by reducing bladder spasms and urinary urgency
-Increases bladder capacity and decreases urgency.
- Anticholinergic Side Effects ( dry mouth, urinary retention)
Kegels/ Pelvic Floor
- will help strengthen pelvic floor and reduce incontinence symptoms
Topical estrogen
It helps strengthen and rejuvenate the urogenital tissues, which weaken due to estrogen decline after menopause.
Improves Urethral and Vaginal Tissue Health
Strengthens thinning vaginal and urethral tissues, reducing urinary urgency and leakage.
Increases blood flow and collagen production, improving elasticity and function.
Reduces Urge and Stress Incontinence
Helps the urethra close more effectively, reducing involuntary leakage.
Can improve overactive bladder symptoms by enhancing bladder control.
Prevents Urinary Tract Infections (UTIs)
Restores the natural vaginal microbiome, reducing harmful bacteria growth.
Enhances mucosal immunity, lowering the risk of recurrent UTIs.
-not for pts with breast cancer history
issues associated with incontinence
fall and injuries
UTI- not fully emptying the bladder can cause infection
skin issues and infections
psychological and social impact
Causes of Delirium
Infections (UTI, Pneumonia, sepsis)
Medication Changes (opioids, benzos, anticholinergic)
Electrolyte Imbalances (hypoatreima, dehydration)
Hypoxia, pain, sensory deprivation (hearing/vision loss)
Hospitalization (ICU, anesthesia, new environment)
Recognize Delirium
Acute onset & fluctuating course → Sudden change in mental state, worse at night
Inattention → Difficulty focusing, easily distracted
Disorganized thinking → Rambling speech, illogical thoughts
Altered level of consciousness → Hyperactive (agitated), hypoactive (lethargic), or mixed
Intervention & Management of Delirium
Perform lab tests → Electrolytes, kidney function, infection screening (UTI, pneumonia), oxygen levels
Review medications → Discontinue or adjust sedatives, anticholinergics, opioids
Treat infections → Start antibiotics if needed
Correct dehydration & electrolyte imbalances
Reorient & provide a familiar environment → Clocks, calendars, familiar objects
Optimize sensory input → Ensure hearing aids, glasses are used
Encourage mobility → Prevent prolonged bedrest to avoid complications
Normalize sleep-wake cycles → Avoid unnecessary nighttime disturbances
Minimize restraints & sedation → Can worsen agitation and confusion
polypharmacy
more medications are being used than clinically needed or more pills than the patient can take
this can be noticed in new or worsening symptoms, multiple drs or pharmacists, duplicate meds, non-adherence
How to reduce problems associated with polypharmacy
conduct regular medication reviews
use non-pharmacological alternatives if possible
deprescribing
medication regimen (combining meds or less dose)
improved communication
Issues related to safe drug therapy in older adults
Pharmacokinetic Changes (How the Body Handles Drugs)
Pharmacodynamic Changes (How the Body Responds to Drugs)
Adverse Drug Reactions (ADRs) & Toxicity
Inappropriate Prescribing (Beers Criteria)
Medication Non-Adherence
MOST COMMON ADVERSE EFFECTS OF DRUG-DRUG
INTERACTIONS
- Confusion
- Cognitive impairment
- Arterial hypotension
- Acute renal failure
Aging Affects on drug therapy
Absorption: Slightly slowed gastric emptying
-Minimal impact, but may delay onset of action for some drugs
Distribution: ↑ Body fat, ↓ total body water, ↓ serum albumin Fat-soluble drugs (e.g., benzodiazepines) accumulate → prolonged effects; Water-soluble drugs (e.g., digoxin) reach higher concentrations
Metabolism (Liver): ↓ Liver enzyme activity and blood flow, Drugs metabolized by the liver (e.g., warfarin, benzodiazepines) have prolonged effects → ↑ risk of toxicity
Excretion (Kidneys): ↓ Glomerular filtration rate (GFR) and renal clearance, Drugs eliminated by the kidneys (e.g., aminoglycosides, NSAIDs, digoxin) accumulate → ↑ risk of toxicity
Kegel
Instruct to tighten pelvic muscles as if stopping urination, hold 3-5 seconds, relax, repeat 10-15x/day
High Risk Drug Classes In Older Adults (Beers List)
Anticholinergic (Benadryll, oxybutynin) -> Confusion, falls, urinary retention)
Benzodiazepines (lorazepam, diazepam)-> Sedation, fall risk, respiratory depression
opioids-> respiratory depression, constipation, falls
NSAIDS-> GI bleeding, kidney damage
Medication Reconciliation
performed at every transition of care to prevent adverse drug events
-compare old/new medication lists, educate patients
Frailty
a state of increased vulnerability to illness, falls, and functional decline
frailty assessment
Unintentional weight loss (>10lbs in a year)
Exhaustion, weakness, slow walking speed, low physical activity
s/s: frequent falls, cognitive decline, poor wound healing
factors that affect frailty
age, chronic disease, medications, and social support
Impact of Chronic Disease
financial: increased healthcare costs, medications, caregiver burden
emotional: depression, anxiety, and isolation
Health Literacy Principles
Use plain language, large print, teach-back method
Assess understanding frequently
UTI S/S
confusion, incontinence, fever, urgency, dysuria
UTI Nursing Prevention
encourage hydration
proper peri care
complete bladder emptying
Benign Prostatic Hyperplasia
risk factors: aging, family, history, obesity
findings: urgency, weak stream, nocturia
dx: PSA test, digital rectal exam
PSA Test (BPH)
A blood test that measures the level of prostate-specific antigen (PSA) in the blood
BPH Medications
Alpha-blockers (Tamsulosin/ Flomax, Hytrin): relax bladder neck and prostate muscles
-Tamsulosin (Flomax) is prostate-selective and has fewer BP effects than terazosin (Hytrin).
-Watch for dizziness, orthostatic hypotension, and retrograde ejaculation.
-Combination therapy with 5-ARIs (finasteride) may be needed for long-term prostate size reduction.
3 Way Foley Irrigation
Used post-TURP to prevent clotting
-to continuously flush the bladder with sterile fluid, typically saline, through a special catheter with three lumens, allowing for simultaneous drainage of urine while preventing the buildup of blood clots or debris that can occur after prostate surgery or procedures like a Transurethral Resection of the Prostate (TURP) where tissue fragments may be present
Parkinson’s Disease Hallmark Symptoms
bradykinesia (slow movement), resting tremors, rigidity, postural instability
Parkinson Gaits
shuffling**
festinating
freezing episodes
Parkinsons Affecting QOL
difficulty eating, dressing, swallowing, increased fall risk
Nursing Interventions for Parkinsons Disease
Encourage exercise , fall prevention, nutrition support, speech therapy
monitor for dysphagia, aspiration risk, orthostatic hypotension
Parkinsons Medication
Levodopa/ Carbidopa (Sinemet): Dopamine replacement
side effects: dyskinesia (jerky movements), hallucinations
COMT Inhibitors (Entacapone) Prolongs Levodopa action
What are 6 examples of IADLs?
using telephone, shopping, housekeeping, laundry, handling meds, handling finances
The TUG test should take less than _______________ to complete; any longer and the patient is considered high-risk of falling
12 seconds
orthostatic hypotension is defined as a reduction of greater than ____________ mm Hg systolic or ________________ mm Hg diastolic blood pressure, ________ minutes after changing from lying to standing position
20; 10; 3
What is a considered a renal dose?
half of a normal dose
What criteria are considered to be used for diagnosis of frailty (6 total criteria; 3 of these to be considered frail)
unplanned weight loss, exhaustion, weakness, poor endurance, slowness, and low levels of physical activity
Tamsulosin should be taken _____________ which Doxazosin should be taken ________________
30 mins after meal; same time each day
_____________ decreases how much ____________ is converted to dopamine, allowing for more drug availability and less side effects
carbidopa; levodopa
Levodopa is best absorbed on an empty stomach so it should be taken _________ before or _____________ after a meal; protein intake should be _____________
1 hour; 2 hours; limited
What are the 4 side effects of anticholinergics?
urinary retention, dry mouth, blurred vision, and constipation
What are 2 adverse effects of dopamine agonists?
hypotension and decreased LOC
dopamine agonists
these Parkinson’s drugs stimulate the production of dopamine or they stimulate the dopamine receptors in the brain by acting like dopamine; can be used as rescue drugs for off times
3 way Foley irrigation colors
day 1- bright red
day 2- pink
day 7- amber
What are the 2 side effects of COMT inhibitors?
nausea and hypotension
foods with ____________ should not be consumed when taking MAOIs
tyramine
delirium is assessed using
confusion assessment method
4 components of med list
name, dose, frequency, route
BPH causes what incontinence
overflow
What scale is used for polypharmacy
armor scale
Armor Scale
Assess
Review
Minimize
Optimize
Reassess
Couda
Catheter used for urinary in men with BPH
this is considered the most difficult symptom of BPH
nocturia
These 2 meds are alpha1-adrenergic antagonists that decrease smoot muscle tone to help treat BPH
Tamsulosin and Doxazosin
___________ and __________ should be monitored when taking alpha1-adrenergic antagonists (BPH Medication)
BP and LOC
the use of alpha1-adrenergic antagonists is contraindicated with __________________
renal and liver impairment
finasteride should not be taken with __________________
liver impairment
________________ should not handle finasteride due to possible absorption
pregnant women
when taking finasteride, the man cannot ________________ until 1 month after use
donate blood
it could take _______________ to see benefit from taking finasteride
6 months
This is a phosphodiesterase-5 inhibitor used to treat BPH
Sildenafil (Viagra)
sildenafil (Viagra) can cause ________________ and can affect ______________
MI/sudden death; hearing
when taking Sildenafil, no NTG/QT prolongation/grapefruit juice/PDE5 inhibitors due to the risk of ________________
fatal hypotension
this is an OTC herb that is commonly used to treat BPH but has not been proven to work
Saw palmetto
this is a common finding after TURP
hematuria
this is a tense resistance, creating stop and go movements
Cogwheel rigidity
