Exam 1 (Maymester) for Finals Prep Flashcards
Respiratory/Lung infections in older adults. Most common is:
Pneumonia: caused by poor chest expansion, increase in mucus formation, and bronchial constriction, or HAIs as evidenced by shallow breathing, abnormal lung sounds, and sometimes fever. Pleuritic pain and lowered baseline temperature can mask s/sx.
Temperature
Know your patient’s baseline temp!! A temperature as low as 99 degrees can be a fever. Watch that your patient doesn’t become hypothermic.
Pulmonary Changes:
The trachea stiffens as we age due to cartilage calcification.
Reduced nerve endings = less sensitive gag reflex.
Lungs reduce in size and weight.
Overall reduced vital capacity.
Sarcopenia:
Decreased muscle mass/fx due to decreased grip strength and slowed mobiltiy.
Presbyopia:
Age related decrease in the eye’s ability to change shape of the lens to focus on near objects. Usually begins around age 40.
Cardiac Changes:
Sclerosis and fibrosis (heart valves increase in thickness and rigidity).
As we age, myocardial muscle loses some of its contractile strength.
BP regulation:
Regulation is key to preventing or reducing instances of orthostatic hypotension.
The best way to regulate BP is proper diet and exercise.
Immune changes:
Decreased T-cell activity leads to production of immature T-cells which leads to decreased ability to fight infection.
Orthostatic Hypotension: (safety and prevention)
Safety: Patients are at an increased risk for falls.
Prevention: Slow sitting or standing to reduce fall risk and stay hydrated
Dehydration: SATA
Assess for skin turgor, dry mucous membranes, and decreased thirst perception. Check and verify Rx’d medications (anticholinergics and antipsychotics).
Hydration:
Adequate fluid intake (3-4 L/day as tolerated) can help reduce/prevent constipation and dry skin (risk for skin tears).
Renal Changes:
Urinary incontinence can lead to social isolation and nocturia. Reduced kidney filtration means that medications are not adequately excreted, increasing risk for toxicity.
GI Changes:
Presbyesophagus: reduced strength of esophageal contractions and slower transport of food down the esophagus.
Risk for constipation. Inactivity and dehydration are big factors.
Primary and Secondary Disease Prevention
Primary: Stress management, yearly flu shots, social engagement, lifestyle teaching, cognitive stimulation, and regular immunizations
Secondary: Evidenced based screenings, annual wellness visits, personal prevention plans, and target diets (DASH).
Changes in Taste/Smell
Taste and smell are strongly linked to memory. Caused by decreased neurons sending signals to the brain. Key intervention is monitoring adequate dietary intake of your patient.
Fall Prevention:
Adequate hydration, regulated BP, and mobility aides are key to prevention.
Polypharmacy: Risks:
Taking 5+ concurrent Rx or OTCs.
Risks include Drug-drug reactions, and increase in morbidity and mortality
Polypharmacy Prevention:
Have patient “brown bag” meds/bring in the meds they take so you can cross reference any potential side effects.
Polypharmacy Complications: SATA
Multiple Providers
Presence of Chronic Illness
Taking OTCs
Iatrogenic Disturbance Pain (IDP)
Pain caused by caring for the older adult.
Herbs/OTCs and Interactions:
Garlic, Ginkgo, Ginseng, and St. John’s wort = inc risk of bleeding
Do not take with warfarin, aspirin, coumadin, etc.
Antipsychotics: Adverse Reactions:
NMS and EPS
NMS = increased temp, wbc, and heart rate
EPS = tardive dyskinesia, akathisia, and acute dystonia
Assessment of the Older Adult: Tools
SPICES = full assessment Katz = ADLs Lawton = IADLs
Effective Assessment Skills: SATA
Listen to your pt
Don’t judge/use moderated voice
Never Assume
Neurological changes:
Delirium = prob a UTI
Mini-cog assessment for neuro fx/changes
Beers Criteria
NOT a policy
A guideline for if you think a medication might be inappropriate
Nonverbal Pain cues:
Grimacing, groaning, restlessness or pacing, shallow quick breathing
Assessment of Pain:
Pain diary OLD CART (Onset, Location, Duration, Characteristics, Aggravating, Relief, Tx
Nonpharmacological tx
Heat/cold, acupuncture, acupressure, massage, TENS, activity, music, guided imagery.
Assessment priority for Narcotic tx:
Adequate dose (don’t under adminx), eval of effectiveness, repeat pain intensity scale, key is management not catch up.
Wellness (definition):
Incorporating all aspects of one’s being: Physical, Emotional, Intellectual, Social, Spiritual, Cultural, and Environmental.
Drug-food interactions
Ca2+ (like in leafy greens) interacts with Cipro, tetra, Spironolactone, and Levothyroxine.
Drug-Supplement Interactions:
CoQ 10, the 3 Gs, and St. John’s wort all = increased risk for bleeding
Drug allergies
n/v/d = side effects NOT allergic reaction.
An allergic reaction can be a severe as anaphylaxis or as mild as pruritis and swelling.
Pharmacokinetics: Absorption:
Medication is taken into the body orally, sublingually, and transdermally. Reduction of saliva, dysphagia, peristalsis, reduction in gastric acids, and delayed stomach emptying all affect abosrption.
Pharmacokinetics: Metabolism:
Biotransformation makes substances more easily eliminated from the body. Can be affected by reduction in liver mass/perfusion as well as first pass med absorption.
Pharmacokinetics: Excretion:
Most meds are excreted renally but can be excreted through sweat, bile, hair, feces, breastmilk, saliva, tears, and semen.
What is First Pass?
Active medications still on board from initial dose. Do NOT take more than prescribed more often than prescribed to prevent toxicity.
Changes is skin:
As we age, our skin thins increasing risk for bleeding and tears.
Heat Exhaustion/Stroke/Hyperthermia:
Ambient temp > 90. Goal is to get temp under 104. KEEP HYDRATED.
Sweaty, pale, tachy leads to crampy, thirsty, confused, leads to no more sweat, more tachy, and dry all over.
Hypothermia
Most deaths are older adults
Goal is temp > 90 degrees.
Risks include DM, impaired circulation, adrenal or thyroid disfunction, inadequate housing or supervision, excessive alcohol consumption, sedatives, heart meds, and antidepressants.
LEARN model: SATA
Listen to your patient Explain your perception Acknowledge their perception Recommend a comparable plan of action Negotiate a mutually acceptable plan
