Exam 1 Study Guide Flashcards
Respiratory:
Define bronchiectasis?
There is permanent abnormal widening of the airways due to inflammation.
Respiratory:
Define elastic recoil
The lungs ability to expand and contract
Respiratory:
Define vital capacity
Maximum amount of air that can be expelled following maximum inspiration.
Respiratory;
Define kyphosis
Curvature of the spine causing bowing of upper spine
Pneumonia IS A LEADING CAUSE OF DEATH IN OLDER ADULTS what are the contributing factors:
o Poor chest expansion and more shallow breathing
o Lowered resistance to infection
o Reduced Mobility (laying down)
o Increased mucus formation and bronchial obstruction (secretions)
o Increased incidents of hospitalization and institutionalization (long-term care) leads to increased nosocomial pneumonia.
o Changes due to aging may mask signs and symptoms:
o Pleuritic pain -less severe in older adults
o Lower Temperature -may not show fever because they tend to have lower temperature
Interventions for pneumonia:
PREVENTION IS KEY
o Encourage good fluid intake importance is to keep hydrated
o Manage bronchial secretions
o Prevent obstructions
o Preventative measures for infections if needed ask for a swallow test
o Instruction in breathing exercises
o Raise HOB at least 30 degrees (unless it is contraindicated)to help prevent pneumonia
o Educate and instruct patient to turn, cough and deep breath every two hours
o Health Promotion: Vaccines: Pneumonia and Influenza
Symptoms of pneumonia in older adults:
o Slight cough o Fatigue o Rapid respiration o Confusion * alerted LOC o Restlessness o Behavioral changes *
What are the risks due to adequate respiration of the aging adult?
o The trachea stiffens due to calcification of its cartilage. This reduces the ability to cough because it blunts the laryngeal and coughing reflexes.
o Reduced number of nerve endings may lead to a weaker gag reflex.
o The lungs become smaller in size and weight. Connective tissues needed for effective respiration and ventilation in the lungs weaken. This leads to decreased elastic recoil. Respiration then requires the use of accessory muscles. This leads to lungs being stiffed.
o Alveoli are less elastic, develop fibrous tissue, contain fewer functional capillaries and have less surface area. This reduces gas exchange.
o Loss of skeletal muscle strength in the thorax and diaphragm. This combined with the loss resilient force (tissues) that holds the thorax in slightly contracted leads to Kyphosis or a look of having a “barrel chest”.
o These changes add up to a reduction in vital capacity. = Less air exchange and more secretions remaining in the lungs.
*respirations are easier to count for the older adult
What are other age related changes in respiratory:
o Decreased response to hypoxia and hypercapnia.
o Different normal baseline temperature
o Baseline is lower, a fever may be lower for them.
Nursing considerations for repsiratory:
o Less effective gas exchange (hypoxia, )
o Easily fatigued r/t decreased respiratory efficiency
o Reduced airway clearance risk for asthma
o Increased potential for infection
Assessment for respiratory system:
o Breathing patterns
o Breath sounds
o Palpate the chest for fremitus
o Chest expansion
o Cough
o Deep breathing
o Respiratory rate
o O2 saturation
o Secretions can lead to an infection, if not able to swallow can aspirate and lead to aspiration pneumonia
o Mental status / behavioral changes will see when they get an infection, sometimes it is key.
o Pneumonia and UTI are leading causes of death in elderly they become septic
Labs to know
Other assessments to know chart:
Cardiovascular
Define physical deconditioning
Decline in cardiovascular function due to physical inactivity
Nursing considerations for cardiovascular:
o Poor peripheral circulation
o Capillary refill
o Easily fatigued
o Inadequate circulation to heart tissue
o Will damage the muscles
o Shortness of Breath
o Reduced cardiopulmonary tissue perfusion
o Hypotension
o Tachycardia
o Edema
o Dyspnea
o Delirium lack of oxygen will cause a mental status change
o Restlessness
o Pallor a little blueish due to lack of oxygen
o Memory disturbance a change, an addition to.
What are the risks of adequate circulation related to aging adults:
o Heart valves increase in thickness and rigidity R/T sclerosis and fibrosis
o Aorta becomes dilated
o Slight ventricular hypertrophy
o Myocardial muscle loses some of its contractile strength causes a reduction in cardiac output, meaning it is less efficient with increased activity or demands on the heart. Because it is stiffening and losing its strength. Not allowing chambers to empty as they should.
o Example: more people tend to die at night or early morning. They got up and went to the bathroom = heart attack because of increased activity in the heart
o Diastolic filling and systolic emptying require more time to complete the cycle.
o Calcification and reduced elasticity of vessels. Becomes less sensitive to baroreceptors Reduces regulation of blood pressure. Reduced arterial BP leads to decreased tissue profession.
o Changes are usually gradual and become more apparent when the older adult is placed under increased activity. Consider early morning walks to restroom – increased death
Nursing assessment for cardiovascular:
o Blood Pressure (orthostatic) Lying, Sitting, Standing
o For orthostatic BP you always need a second person. As patient can fall and break hip= death
o Palpate carotid arteries
o ECG
o Exercise tolerance
Nursing interventions for cardiovascular:
o Monitor for S/S of hypotension o Encourage fluids o Hypotension, fluid drops = BP drops o Fall Precautions o Health Promotion: Medication, Diet, Exercise (as appropriate)
Cardiovascular
Define Postural (orthostatic) Hypotension
decline in systolic blood pressure of 20mm Hg or more after rising and standing for 1 minute
they stand up they hit the floor, big problem for older population
Dehydration:
o Dehydration- can cause UTI, elderly’s do not drink enough water, elderly with some cognitive impairment that can be in a wheelchair will not realize they are thirsty and not think about it. Kind of push it off. Encourage fluids every other hour unless there is a volume issue and fluids are being restricted. Think of granny how she only drinks about half a bottle of water a day
o Dehydration symptoms: orthostatic hypotension, weight loss, tachycardia, hyperthermia, weakness, nausea, anorexia, oliguria, dry mucus membranes and skin, poor skin turgor, increased thirst.
Hydration:
Hydration is important for many reasons example:
• Fluid intake can thin secretions
• Can help with hypotension, fluid drops= BP drops
• Proper hydration can help with bowel elimination
• Fluid intake can help prevent UTIs
• Hydration improves skin
Genitourinary:
Define nocturia
Voiding at least once during the night
What are urinary elimination changes related to aging:
o 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 recumbent position and increase the need to void. This is not a normal part of aging and is related to other aging issues.
o Retention of urine due to neurological inefficiencies and a weaker bladder that does not empty properly.
o Woman: fecal impaction like constipation
o Men: prostatic hypertrophy
o Reduced filtration efficiency of the kidneys affects the body’s ability to eliminate drugs and causing higher blood urea nitrogen levels.
o Incontinence Also not a normal part of aging, but usually caused by age-related physical or mental disorders. It is common but not normal
o If a man is having a UTI is is a very serious issue, try to find underlying problem.
Nursing considerations for GU:
o Potential for adverse drug reactions or toxicity because they are not clearing their systems o Pain o Risk for Infection - UTI o Risk for Falls they are up in middle of night, fall and trip its dark o Need for toileting assistance o Potential for skin breakdown o Sleep disruption o Potential for social isolation
Nursing assessment for GU
o Renal Function o Ability to void o BP for Hypotension o Fall Risk o Pain o Frequency mainly means UTI for female (urgency too) o Urgency o Constipation o Inactivity o Dehydration big cause of UTI for elderly o Indications of drug toxicity o Mental status change
- *Person in wheelchair and with cognitive issues is at higher risk for dehydration they are not likely to go and think of getting fluids on their own
GU interventions:
o Encourage fluids
o Fall Precautions watch those on blood thinners
o Monitor for drug toxicity
o Health Promotion: Bladder training and fluid intake
What is primary prevention
- healthy lifestyle behaviors -PREVENTATIVE; exercising, refraining from smoking/drinking
- stress management
- active social engagement
- cognitive stimulation
- immunizations
What is secondary prevention?
- evidence-based SCREENING guidelines -ex: screening an older adult for diabetes by checking BG & hgb A1c
- annual wellness visits -physical exam & labs
- personalized prevention plan - presenting a diabetic person with a diet plan
6 Psychosocial theories?
- Role
- successful aging = adapting to changing roles
- resistance may predict poor adjustment
- Activity
- successful aging = maintaining a productive life (physically & mentally); maintain involvement in activities/ hobbies that they have enjoyed all their life
- Disengagement
- successful aging = transfer control to younger generation
- society distances itself from the older adult and the older adult disengages from society
- now considered controversial
- Continuity
- successful aging = maintain & continue previous behaviors & roles or find replacements
- Age-stratification
- individuals of similar age (cohorts) have most similarities
- for example, baby boomers age similarly to other baby boomers
- Modernization
- older people lose power & status due to advances in technology, etc.
- widely challenged because older adults CAN learn new technologies, while others can feel left behind
What is health disparity?
Differences in the state of health and in health outcomes between groups of persons
What is health inequity?
Excess burden of illness or the differences between the expected incidence and prevalence. Excess burning prevalence in one group occurs higher than in another group.
What is cultural knowledge?
Knowledge means what the nurse brings to the caring situation and what the nurse learns about all older adults, their families, their communities, their behaviors, and their expectations.
What is cultural awareness?
The development of cultural proficiency with increased awareness of our own beliefs and attitudes and those commonly seen in the community of healthcare. Respect others religions
Reducing health disparities:
Cultural skills: use of communication
Unspoken Communication: handshakes, eye contact, hugs (always ask their preferences). be aware that your body language, etc, are extremely communicative
Spoken Communication: jargon, idioms, inflection (always get a professional interpreter)
*Box 4-10 (guide for working with interpreters)
Smell and taste
Define hyposmia
Decrease in smell acuity
Changes in smell and taste related to aging:
o Decrease neurons that send signal to the brain
o Difficulty distinguishing smells
o Decrease in taste secondary to change in smell acuity
Musculoskeletal
Define sarcopenia
The decline walking speed and/or grip strength related to decrease musle mass/function
Musculoskeletal changes related to aging:
o Decline in muscle fibers leads to reduced muscle mass, causing a decrease in strength and endurance.
o Decreased flexibility of joints and muscles related to changes in connective tissue
o Change of ROM = falls risk
o Tendon and ligament stiffening
o Redistribution of fat
o Narrowed intervertebral disks
o Decline in walking speed (sarcopenia)
o Increased latency/contraction of muscles
Assessment in musculoskeletal:
o Range of motion o Strength o Gross and fine motor skills o Stability o Ability to perform ADLs= when ADLs start slipping they become more dependent on other people
Nursing considerations in musuloskeletal
o Gait and balance instability o Decreased range of motion o Decreased mobility o Risk of fractures o Risk of falls o Pain o Decreased strength and endurance o Deceased activities and socialization – Risk for isolation
Interventions in musculoskeletal
o Encourage appropriate activity
o Walking for 5 min or others 20 min. It’s individualized to what they can handle, start slow and increase (depending on patient)
o Encourage and educate on good nutrition
o Consider mobility aids (walker, cane, maybe wheelchair) approach carefully bring around fall risk, this is time to do patient education and teaching.
o Fall Prevention
Polypharmcy:
oApproximately five or more medications
oIncrease risk for morbidity and mortality
oThe more prescribed medications taken, the greater the possibility of interactions
Reasons that polypharmcy occurs (SATA)
Risks
- # of providers
- Presence of chronic illness
- Use of over counter meds
- Disability that impacts a patient not taking medications
Polypharmacy prevention:
Communication between provider/nurse/pt , always ask the pt what all meds they take and have currently stopped taking.
This includes ointments, eye drops, herbs, and such……
What does box 27.1 NEUROPATHIC say?
Barriers to pain management box 27.4:
Pain cues in persons with communication difficulties
BOX 27.6 :
Persons with impaired communication skills with noncommunicative patients (Box 27-10)
