Exam 2 Flashcards
acute pain
abrupt onset and lasting a short time
neuropathic pain
occurs from an abnormal processing of sensory stimuli by the central or peripheral nervous system
nociceptive pain
arises from mechanical, thermal, or chemical noxious stimuli; can be somatic or visceral
persistent pain
chronic pain that has been present for 3 months or longer
comfort
relative term; sense of physical, emotional, social, and spiritual peace and well-being
pain
unpleasant sensory and emotional experience
prevalence of pain in older adults
more than half report daily pain; difficult to determine accuracy of reported prevalence of pain in older adults; underreported due to fear of complaining; overreported due to trying to get attention
what are the different types of pain?
nociceptive and neuropathic
nociceptive pain
mechanical, thermal, and chemical
what are the different types of nociceptive pain?
somatic and visceral
somatic pain
bone or soft tissue masses; localized; throbbing, aching
visceral
disorders that cause generalized or referred pain; deep, aching
neuropathic pain
abnormal processing of sensory stimuli by central or peripheral nervous systems
what are the symptoms of neuropathic pain?
sharp, stabbing, tingling, burning, onset of high intensity
acute pain
abrupt; onset; can be severe; short duration; responses to analgesics; can develop into persistent
persistent/chronic pain
present for 3 months or longer; can be mild to severe intensity
what are the effects of unrelieved pain?
limited mobility; develop pressure ulcers; pneumonia; constipation; poor appetite resulting in malnutrition and/or dehydration
pain management
qualitative and quantitative assessment
what is included in the pain assessment?
management; open-ended questions; detailed pain history; physical; need for ongoing assessment; must ask specific questions to figure out if patient is in pain; cognitive status; cultural factors; potential barriers; pain assessment instruments
what are some pain indicators from those who are cognitively impaired?
grimacing; crying, moaning; increased vital signs; perspiration; increasing pacing, wandering, aggressive behaviors; hitting, banging on objects; splinting or guarding body parts; agitation; poorer function; change in sleeping pattern; change in appetite or intake; decreased socialization
what are some cultural factors to consider during the pain assessment?
tolerate pain without expression? dramatic expression of pain? may not acknowledge severity of discomfort
what are potential barriers when assessing pain?
knowledge deficits; inadequate pain assessment; biases or assumptions; staffing issues
what are some pain assessment instruments that can be used?
numeric rating scale; visual analog scale; mcgill pain questionaire
what are some integrative approaches to pain management?
individualize comprehensive pain management plan; identify underlying cause for pain; goals- realistic, specific, and achievable; common componnets
what are some common components that could help form an integrative approach to pain management?
complementary therapies, dietary changes, medications, comfort nursing care
what are some examples of complimentary therapies?
medications; need for nursing knowledge; patient education and counseling; acupressure; acupuncture; aromatherapy; biofeedback; chiropractic; electrical stimulation; exercises; guided imagery; heat and cold; herbal; homeopathic; hypnosis; massage; mediation; naturopathy; osteopathy; prayer; progressive relaxation; supplements; touch
what are some foods to avoid for pain? (dietary changes)
animal products; high-fat dairy products; egg yolk; beef fat; safflower; corn; sunflower; soybean; peanut oils; white flour; sugars; junk food
what are some foods to encourage for pain? (dietary changes)
green leafy vegetables; cold-water fish and fish oils; flaxseed and flaxseed oil; canola oils; walnuts; pumpkin seeds; omega-3 enhanced egg; red, purple, and blue fruits; black and green tea; red wine; chocolate and cocoa; fresh pineapple; garlic; ginger; turmeric
medication for pain in older adults
complicated; high risk of adverse effects; analgesics used appropriately and monitored closely; be slow; trial nonopioids>opioids; adjuvant medications may benefit; use narcotics carefully
what medications should you not give older adults?
meperidine; indomethacin; pentazocine; muscle relaxants
what medications should you give older adults?
acetaminophen; NSAIDs; opioids
what type of opioids can you give an older adult?
first: codeine, oxycodone, hydrocodone
severe: morphine, fentanyl patches
what are the negative opioid effects on older adults?
nausea; constipation; urinary retention; pruritus; myoclonus; irregular breathing; cognitive dysfunction; addiction
what are some considerations for pain medication on older adults?
closely observe response; aim to prevent pain, not treat after; require regular reevaluation; may need to change prescription
how should you comfort an older adult patient?
listening attentively; explaining; touching; perceiving
injury
an act that results in harm
macroenvironment
elements in the larger world that affects groups of people or entire populations
microenvironment
the immediate surroundings with which a person closely interacts
restraint
anything that restricts movement, can be physical or chemical
accidents in older adults
7th leading cause of death; unintentional falls leading to ER visit; falls is the leading cause of premature institutionalization and long-term disability for older adults
infections in older adults
altered antigen-antibody response= high prevalence of chronic disease; pneumonia and flu- 8th leading cause of death; atypical symptomatology can lead to delayed diagnosis
adverse effects and accidents related to medications in older adults
altered pharmacokinetics, self-administration problems, high volume of drugs consumed; drowsiness; dizziness; 15% of geriatric admissions to hospitals are associated with drug-related problems
what is the importance of the environment to health and wellness
promote continued development, stimulation, and satisfaction enhancing psychological well-being; assessment of environment (realistic to fulfill needs)
what is the impact of aging on environmental safety and function?
older adults need safe, functional, comfortable, personal, and normalizing environment to compensate for limitations
what are some considerations for an older adult’s environment?
lighting, temperature, colors, scents, floor coverings, furniture, sensory stimulation, noise control, bathroom hazards, and psychosocial factors
how does lighting affect the older adult?
visibility, function, orientation, mood, and behavior
what are some beneficial types of lighting?
diffuse>bright; nightlight= soft red; exposure to natural light during normal day
how does temperature affect older adults?
lower than normal; decreased natural insulation; correlates with performance; sensitive to lower temperatures
what is the recommended room temperature for the older adult?
75 degrees
what are older adults diagnosed with diabetes or cerebral atherosclerosis at risk for?
hyperthermia
what does red, yellow, or white induce?
can be stimulating and increase pulse, BP, and appetite
what does blue, brown, or earth ones induce?
can be relaxing
what does orange induce?
stimulate appetite
what does violet induce?
decrease appetite
what does green induce?
sense of well-being; master healer color
what does black and gray induce?
can be depressing
how do colors affect older adults?
identifies specific areas; caution use of patterns if the patient has cognition impairments
aromatherapy/phytomedicine
use of essential oils; pathophysiology of aromatherapy
essential oils
used in baths, compresses, rubbing, and massaging
like topical medications
produce physiological effects
carpeting
sound absorber but can cause problems
what kind of problems does carpeting have?
static electricity and cling; difficult wheelchair mobility; cleaning; odors; pests; scattered or area rugs can cause falls
what are some carpet considerations?
nonglare surface is essential; nonslip surfaces in bathrooms, kitchen, and areas leading from outdoors to indoors; avoid bold designs
what should furnishings be?
appealing, functional, and comfortable
what is a consideration for chairs?
correct height with arm rests; rocking chairs, love seats, recliners
furniture considerations
upholstery should be easy to clean; tables and bookcases should be sturdy; no obstructing pathways from bedroom to bathroom
what kind of environment should a cognitively impaired person have?
simple
how can you create an environment pleasing to senses?
textured walls and surfaces; soft blankets and spreads; pictures, wall hangings, murals, and sculptures; plants, flowers, coffee brewing, food cooking, perfumes, oils, birds and pets; soft music
what is an intervention for those who are bed bound?
sensory stimulation box
what are the effects of sound?
physiologic and emotional; can create diffulties for older adults
unwanted disharmonic or chronic noise
stressor, causes physical or emotional symptoms
what influences noise control?
design of building, landscape, and other devices
how can you avoid the use of intercoms and paging systems?
use individual pocket pagers or similar technological device
what are some bathroom safety measures?
lighting, floor surface, faucets, tubs and shower stalls, toilets, electrical appliances
what are some fire hazards toward older adults?
risk for burn injury; kitchen fires; careless use or disposal of matches/cigarettes; space heaters; fireplaces
what are some psychosocial considerations for older adults?
feelings and behavior influenced by their environment; need for own space; need for privacy and personal space; adjustment to new living environments; memory triggering cues are gone; reactions to loss; routine changes; enhance institutional environment
how can we provide privacy and personal space?
define specific areas and possessions of individual; provide privacy area for periods of solitude; request permission to enter personal space; allow maximum control over one’s space
what are some reactions to loss?
depression, regression, humiliation, and anger
what are some ways to enhance institutional environments?
attractive décor; inclusion of personal possessions; respect and privacy and personal territory; recognition of individuality; allowance of maximum control over activities and decision-making; environmental modifications to compensate for deficits; respect, individuality, sensitivity
what are the problem of falls?
25% 65 or older experience a fall each year; 1 in 5 results in serious injury; leading cause of fatal and nonfatal injuries in the older population; can lead to development of post-fall syndrome
post fall-syndrome
results in unnecessary dependency, loss of function, decreased socialization, poor quality of life
risk factors of falls
age-related changes; improper use of mobility aids; medications; unsafe clothing; disease-related symptoms; environmental hazards; distractions; caregiver-related factors
how to prevent falls
active program to prevent falls beneficial in facility and community; regular, careful inspection of environment and prompt corrections of hazards; proper assessment of each individual; proper orientation to new environment and reinforce safe practices
what is test to assess an older adult for fall risks?
hendrich II fall risk model
nursing assessment of falls
keep immobile until full examination; fractures may not be easily identified initially; may affect location other than area of direct impact; must include psychological assessment; monitor individual for late-appearing signs and/or symptoms; offer suggestions for preventing future falls while encouraging maximum activity
risks associated with restraints
anything the restricts freedom of movement- chemical or physical; can increase fear and worsen behavior symptoms; nonuse of restraints is standard for gerontological nursing; conduct thorough assessment
what are some serious complications with restraints?
aspiration, circulatory obstruction, cardiac stress, skin tears and ulcers, anorexia, dehydration, constipation, incontinence, fractures, dislocations
what are some alternatives to restraints?
placing patient in rooms near nursing station; 1:1 observation; electronic devices to alert staff to movement; comfort measures; frequent reality orientation and reassurance; diversional activities; close observation and documentation of responses are essential
interventions to reduce intrinsic risks to safety
prevention of injury is essential; reducing hydration and nutritional risks; addressing risks associated with sensory deficits; addressing risks associated with mobility limitations; monitoring body temp; preventing infection; suggestive sensible clothing; using medications cautiously; avoiding crime; promoting safe driving; promoting early detection; addressing risks associated with functional impairment
beers criteria
originally developed by a group headed by Dr. Mark H. Beers, listing of drugs that carry high risks for older adults and criteria for potentially inappropriate medication use in older adults
biological half-life
the time necessary for half of a drug to be excreted from the body
pharmacokinetics
refers to the absorption, distribution, metabolism, and excretion of drugs
pharmacodynamics
refers to the biologic and therapeutic effects of drugs at the site of action or on the target organ
polypharmacy
use of multiple medications
what are the effects of aging on medication use?
special challenges due to number of drugs commonly used; age-related affect; increased risk for adverse reactions
what are the most common medications for older adults?
cardiovascular agents, antihypertensive, analgesics, antarthritic agents, sedatives, tranquilizers, laxatives, and antacids
why is polypharmacy relevant to older adults?
high prevalence of health conditions = large use of medications
what are some factors altering absorption?
route of administration; concentration and solubility of drug; diseases and symptoms
what measures do you maximize for absorptions?
exercise; heat; massage; preventing dehydration, hypothermia, hypotension; interactions with other medications, use most effective route
what are some factors altering absorption?
route of administration; concentration and solubility of drug; diseases and symptoms
what are some considerations with distribution for the older adult?
changes in circulation; membrane permeability; body temp; tissue structure
what can decrease drug distribution and lead to toxicity?
dehydration and hypoalbuminemia
what are some conditions that decrease the metabolism of drugs?
dehydration, hyperthermia, immobility, and liver disease
extended biological half-life
close evaluation of drug clearance
what are some general factors regarding adverse reaction in older adults?
signs and symptoms differ in older adults; adverse reaction may take longer to become apparent; may be demonstrated even after medication discontinued; may develop suddenly, even after long-term use
what is an early adverse reaction?
mental dysfunction
what are some drugs that cause mental dysfunction?
codeine, digitalis, methyldopa, phenobarbital, L-dopa, diazepam, various diuretics
mental dysfunction can arise from medication that promotes…
hypoglycemia, acidosis, fluid and electrolyte imbalances, temperature elevations, increased intracranial pressure, reduced cerebral circulation
how to avoid potentially inappropriate drugs
identification of drugs that carry high risks for older adults; major drugs of concern; widely accepted in geriatric care; centers for medicare and medicaid services adopted for use in nursing home surveys; joint commission adopted criteria as potential sentinel event in hospitals
what are some major drugs of concern for older adults?
anticholinergics, tricyclic antidepressants, antipsychotics, barbiturates, benzodiazepines
how to check the scope of drug use and significant adverse reactions for older adults
ensure drugs are selectively and cautiously used
what is the most common route to administer drugs?
oral; problems can interfere with the process
suppository form
due to lower body temperature may take longer to melt
what can reduce the rate of absorption for IM and SC injecgtions?
immobile limb
patient teaching for self-medication
assess for risk of medication errors; plan interventions to minimize risks
what factors interfere with safe administration?
function limitations; cognitive limitation; educational limitations; sensory limitations; financial limitations; choice
anorexia
lack of appetite
cholelithiasis
the formation or presence of gallstones in the gallbladder
diverticulitis
inflammation or infection of the pouches of intestinal mucosa
dysphagia
difficulty swallowing
esophageal dysphagia
difficulty with the transfer of food down the esophagus
fecal incontinence
involuntary passage of stool
flatus
gas in intestinal tract
gingivitis
inflammation of the gums surrounding the teeth
hiatal hernia
portion of the stomach protrudes through an opening in the diaphragm
oropharyngeal dysphagia
difficulty transferring food bolus or liquid from mouth into pharynx and esophagus
periodontal disease
inflammation of the gums extending to the underlying tissues, roots of teeth, and bone
presbyesophagus
age-related changes to esophagus causing reduced strength of esophageal contraction, slower transport of food down the esophagus
what are the effects of aging on GI health?
atrophy of the tongue affects taste buds and decreases taste sensation; changes in taste sensation may be due to xerostomia, medication, diseases, smoking; saliva production decreases, swallowing may be difficult; reduction in chewing efficiency due to thinning of oral mucosa and weakening of the muscles; presbyesophagus results in weaker esophageal contractions and weakness of the esophageal sphincter; esophageal and stomach motility decreases; decreased elasticity of the stomach; stomach has higher pH due to declines in HCl acid and pepsin; decline in pepsin; decline in HCl acid; fewer cells on absorbing surface of intestinal wall impact the absorption; slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet; sensory perception decreases; bile salt synthesis decreases; pancreatic changes of fibrosis, atrophy, fatty acids deposits; liver size decreased
what happens if the esophageal and stomach motility decreases?
risk for aspiration and indigestion
what happens if there is a decreased elasticity of the stomach
reduces the amount of food accommodation at one time
what does the decline in pepsin interfere with?
absorption of protein
what happens if there is a decline in HCl acid?
increase in incidence of gastric irritation; interferes with absorption of calcium, iron, folic acid, and vitamin B12
what happens if there is slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet?
increase risk of constipation
what happens if sensory perception decreases?
may lead to constipation or incomplete emptying of the bowel
what happens if the bile salt synthesis decreases?
increase in the risk of gallstone development
what happens if pancreatic changes of fibrosis, atrophy, fatty acid deposits?
affects digestion of fats; fatty food intolerance
what can an older adult do to promote GI health?
good hygiene, proper nutrition, knowledge of the impact of medication, utilization of natural means
what are some nursing problems related to GI problems?
weakness- reduced participation in activities; constipation; diarrhea; acute pain; dehydration; potential for infection; insufficient nutritional intake; weight gain; oral pain, poor dental status, insufficient food intake
what could cause weakness?
anemia, constipation, obesity, vitamin and mineral deficiencies, dehydration
what could cause constipation?
decreased colonic peristalsis, duller neural impulses, anorexia, obesity, hemorrhoids, lack of roughage, dehydration, ahbitual laxative use
what could cause diarrhea?
medications, peptic ulcer, gastritis, ulcerative colitis, diverticulitis, diabetes, fecal impaction, tube feedings, stress
what could cause acute pain?
indigestion, constipation, hemorrhoids, flatus
what could cause dehydration?
uncontrolled diabetes, infection, peritonitis, diarrhea, vomiting, blood loss, insufficient fluid intake, high-solute tube feedings
what could cause potential for infection?
diabetes, malnutrition, hemorrhoids
what could cause insufficient nutritional intake?
intestinal obstruction, anorexia, nausea, vomiting, poor dental status, altered taste sensation, constipation
what could cause weight gain?
altered taste sensations, ethnic preferences, inactivity, lack of motivation to eat well
what could cause oral pain, poor dental status, insufficient food intake?
diabetes, cancer, gingivitis, periodontal disease, jagged teeth, poorly fitting dentures, dehydration, malnutrition, dry mouth
what does dry mouth (xerostomia) result from?
decreased saliva, some medications, Sjorgen’s syndrome, mouth breathing, and altered cognition
what are some interventions of xerostomia?
saliva substitutes, sipping water, sugarless candy, and gum
what are underlying dental problems?
altered taste sensation, poor diet, deficiencies of vitamin B complex and calcium, hormonal imbalances, hyperparathyroidism, diabetes, osteomalacia, cushing’s disease, syphilis
what is the phenytoin of dental problems?
gingivitis, antihistamines, antipsychotics, severe dry mouth
aging process of dental
tooth decay, root absorption, loss of tooth enamel
what are the causes of dysphagia?
GERD, stroke, and structural disorders
what are the different types of dysphagia?
oropharyngeal and esophageal
what are the symptoms of dysphagia?
mild to complete inability to swallow
what is the nursing assessment of dysphagia?
onset, accompanying symptoms, triggered by solids or liquids, intermittent or present at each meal
what are the major goals of dysphagia?
prevention of aspiration; promotion of adequate nutritional status
what is the nursing care plan of dysphagia?
dietary modification; eat in an upright position; ingest small bites in unhurried manner; verbal cues; easily accessible suction machine; monitor food intake and weight
what are the causes of hiatal hernia?
believed to be a low-fiber diet
what are the different types of hiatal hernias?
sliding, rolling
signs and symptoms of hiatal hernia
heartburn, dysphagia, belching, vomiting, regurgitation, pain, bleeding; sometimes mistaken for a heart attack
how is a hiatal hernia diagnosed?
barium swallow, esophagoscopy
what is the treatment/management of a hiatal hernia?
weight reduction, bland diet, frequent small meals, discourage bedtime eating, sleep in partly recumbent position, H2 blockers and proton pump inhibitors
what are the different types of esophageal cancer?
squamous cell carcinoma, adenocarcinoma
what are the causes of esophageal cancer?
poor oral hygiene, chronic irritation from tobacco, alcohol, and other agents, barrett’s esophagus
signs and symptoms of esophageal cancer
dysphagia, weight loss, excessive salivation, thirst, hiccups, anemia, chronic bleeding
how to diagnose esophageal cancer?
barium swallow, esophagoscopy, biopsy
what is the treatment/management of esophageal cancer?
surgical resection, radiation, chemotherapy, laser therapy, photodynamic therapy
what are the causes of peptic ulcer disease?
stress, diet, genetic predisposition, COPD, certain medications that can increase gastric secretions and reduce resistance of mucosa
what are the risk factors from a peptic ulcer disease?
smoking, heavy alcohol use, caffeine, stress, H. pylori infection
signs and symptoms of peptic ulcer disease
pain, bleeding, obstruction, perforation
what are some complications associated with peptic ulcer disease?
constipation, diarrhea, dehydration, peritonitis, hemorrhage, shock
signs and symptoms of cancer in the stomach
anorexia, epigastric pain, weight loss, anemia; may be insidious
treatment/management of cancer in the stomach
surgery
how to prevent cancer in the stomach
diet in low in red meats and high in antioxidants
causes of diverticulitis
chronic constipation, obesity, hiatal hernia, atrophy of intestinal wall muscles, low-fiber, low-residue diets; overeating, straining during a bowel movement, alcohol, and irritating foods with diverticulosis may lead to diverticulitis
signs and symptoms of diverticulitis
slight bleeding, change in bowel habits, tenderness on palpation of lower left quadrant, nausea, vomiting, constipation, diarrhea, low-grade fever, blood or mucus in the stool
treatment/management of diverticulitis
increase in dietary fiber intake, weight reduction, avoidance of constipation; reduce infection, provide nutrition, relieve discomfort, promote rest; if surgery, resection or temporary colostomy
signs and symptoms of colorectal cancer
rectal bleeding, bloody stools; change in bowel pattern; feeling of incomplete emptying of bowel; anorexia; nausea; abdominal discomfort; weakness, fatigue; unexplained weight loss; anemia
treatment/management of colorectal cancer
surgical resection with anastomosis or colostomy
contributing or causative factors of chronic constipation
inactive lifestyle; low fiber and low fluid intake; depression; laxative abuse; medications; dulled sensations to need for bowel elimination; failure to allow sufficient time for complete emptying of bowels
interventions to promote bowel elimination
high-fiber diet, fluids, regular activity; specific foods individual responds to; regular schedule; rocking trunk of body
patient education for chronic constipation
safe use of laxatives; use of elimination chart
causes of flatulence
constipation, irregular bowel movements, certain foods, poor neuromuscular control of anal sphincter
treatment/management of flatulence
achieving regular bowel pattern; avoiding flatus-producing foods, medications, sitting upright after meals
interventions for flatulence
increased activity, knee-chest position, flatus bag
what are the different types of intestinal obstruction
partial or complete
causes of intestinal obstruction
diverticulitis, ulcerative colitis, hypokalemia, vascular problems, paralytic ileus
signs and symptoms of a small bowel obstruction
upper and mid-abdominal pain in rhythmic recurring waves, vomiting
signs and symptoms of obstructions occurring past ileum
abdominal distention so severe can inhibit respirations, vomiting
signs and symptoms of obstruction of colon
lower abdominal pain, altered bowel habits, distension, sensation of need to defecate, vomitting
nursing assessment of intestinal obstruction
review symptoms thoroughly; careful attention to bowel sounds
treatment/management of intestinal obstruction
timely intervention is extremely important; medical management- x-rays, blood evaluation, intestinal intubation; surgical management
signs and symptoms of fecal impaction
distended rectum, abdominal and rectal discomfort, oozing of fecal material around impaction often mistaking as diarrhea; palpable, hard fecal mass; fever
nursing interventions of fecal impaction
important to follow agency policy; may include enema (oil retention); manual breaking and removal of feces; hydrogen peroxide; avoid traumatizing or overexerting patient
causes of fecal incontinence
decreased contractile strength, impaired automaticity of puborectal and external anal sphincter, loss of cortical control, reduced reservoir capacity
treatment/management of fecal incontinence
bowel retraining, drugs, surgery, biofeedback
atypical presentation of acute appendicitis
minimal or referred pain, minimal fever, absent leukocytosis
treatment/management of acute appendicitis
prompt surgery
signs and symptoms of cancer of the pancreas
dyspepsia; belching; nausea; vomiting; diarrhea; constipation; obstructive jaundice; possible fever; epigastric pain radiating to back, relieved by leaning forward, worsens in recumbent position
treatment/management of cancer of the pancreas
surgery
signs and symptoms of choleithiasis
pain, often following meals
treatment of chloeithiasis
rotary lithotrite treatment, extracorporeal shock wave lithotripsy, standard surgical procedures
management of chloeithiasis
monitor for obstruction, inflammation, infection
signs and symptoms for cancer of the gallbladder
pain in the upper right quadrant, anorexia, nausea, vomiting, weight loss, jaundice, weakness, constipation
treatment for cancer of the gallbladder
surgery
