Exam 2 Flashcards
What is Delirium
-rapid onset (within 24 hours)
-reversible
-altered level of consciousness
- could be a medical emergency
What could cause delirium?
-Coexisting factors
-Side effects for medication
-Circulatory disturbances
-dehydration
-Malnutrition
-Hyper/hypo tension
-Hyper/hypo glycemia
-Infection
-Surgery
-Stress
-Alcohol/drugs
What are some things that can happen with delirium?
-Short term memory loss
-Long term memory loss
-Inattentive
-Disoriented
-Confused
-Distorted thinking
-Incoherent speech
How do you treat delirium
-treatment depends on what is causing delirium. It is important to understand what the underlying causes and treat that.
-interventions to take during the acute stage include
-Consistency
-Minimize stimulation
-establish medical stability
-Prevent harm to self and others
-Provide support
-Set realistic expectations
What is Dementia?
-permanent
-progressive disorder
-chronic
-impaired cognitive function
What are some things that can happen with dementia ?
-memory loss
-disoriented
-altered reasoning
-lack of attention
-language
-problem solving
What are causes of dementia
Damage or injury to brain, could have several different causes.
Several types of diseases that fall under dementia.
-degenerative disease
-circulatory problems
-lack of oxygen
-infection
-trauma
-hydrocephalus
-tumor
-alcoholism
How to treat dementia?
Medication to help treat symptoms
Nursing interventions of Dementia
-consistent and structured environment
-Items that trigger memory
-Controlled environment
-be aware of wandering behavior risk
-Prevent abuse from caregivers
-Note that there are problems related to poor judgment and misperceptions
-Promote therapy and activity (occupational and expressive therapy, ferry and reality, orientation, touch, modified communication techniques)
-Physical care (monitor, eating, drinking invading, consider in ability to)
-promote respect (individuality, independence, freedom, dignity, connection)
What is the most common form of dementia?
Alzheimer’s disease
What is the main medication used for alzheimers disease?
Aricept
What is happening in the brain in Alzheimer’s?
 Characterized by two changes in the brain
1) presence of neuritic plaques *found in Alzheimer’s and Down syndrome
2) neurofibrillary tangles in cortex
-there is also a loss of degeneration of neurons and synapses and a change in neurotransmitter system.
What are causes of Alzheimer’s?
-genetics
-Environment (crop spray, minors)
-Chromosomal abnormalities (autism)
-Free radical (radiation, mercury)
-Slow acting viruses (Covid)
How does Alzheimer’s present itself in different people?
-Develop gradually and progress at different rates among different people
What are the Staging Mechanisms used for Alzheimer’s?
Staging via GDS/FAST
-GDS = condition global deterioration scale
-FAST= function assessments staging
What stage of Alzheimer’s is the suicidal rate the highest?
The beginning stage where the individual is still wear these changes are happening and they can’t stop it
Vascular Dementia
-small cerebral infractions
-cause: stroke
-rapid w/ quick progression
Frontotemporal Dementia
-neuronal atrophy affecting front lobes
-blows to the head
-wrestlers, football players, etc
Lewy Body dementia
-Subcortical pathology with Lewy body substance in cerebral cortex
-caused by protein deposits in nerve cells
-robin Williams
Creutzfeldt Jakob disease
-Rare
-death within 1 year of diagnosis
-deconstruction of neurons in cerebral cortex and overgrowth if glia
Wernickle encephalopathy
degenerative brain disorder caused by the lack of vitamin B1. It may result from: Alcohol abuse. Dietary deficiencies, Prolonged vomiting, chemo or eating disorders
-Bruce Willis
Parkinson’s disease
-unintended or uncontrollable movements
-causes: genetics, toxins, Lewy bodies
-S/S: shaking, stiffness, bradykinesia, speech problems
-Muhammad Ali, ozzy, michal J fox
AIDS
-could lead to dementia
-trauma / toxins
-Ab Lincoln, Nixon
What is a CAM therapies used to treat dementia
CAM = complementary and alternative therapies
Vitamins: B6, B12, C, E, folic acid, zinc selenium
Minerals
Herbs (ginkgo Biloba)
Theraoeutic: Thai chi
Safe environment practices for Alzheimer’s?
-bed rails
-remove tripping haze adds
-close to nurses station
-good lighting
-memory items
-monitor eating / drinking
-monitor social needs
Therapeutic communication with client who is in denial of substance abuse
They must acknowledge they have a problem
What happens to caloric needs as people age
They’re caloric needs decrease, meaning they need less calories
Dysphasia
Difficulty swallowing
Transfer dysphasia
Difficulty moving (transferring) food from the mouth to the esophagus
Transport dysphasia
Difficulty with food going down (transporting) the esophagus
Delivery dysphasia
Problems with getting food from the esophagus to the stomach (being delivered)
Understand how nutritional supplements play a role in healthcare
It is important to use caution regarding vitamins, minerals, herbs, particularly in high doses… They can produce adverse effects and interact with current medication
What can too much vitamin D cause?
Calcium deposits in the kidneys and arteries
What can too much vitamin K (potassium) lead to?
Blood clots, Arrhythmias, cardiac arrest
What can too much Folic acid lead to?
Masking of vitamin B 12 deficiency, which causes dementia
What can too much calcium lead to?
-Renal calculi (kidney stones) and increased risk of cancer, as well as, imparted ability to absorb other minerals
*no more than 500mg of calcium supplements should be taken at a time.
*minimum of 1500 mg of calcium in daily diet for men and women (not taking estrogen -only 1000 for women taking estrogen)
Why is constipation More common in older adults?
-Due to slower peristalsis (constriction and relaxation of muscles in intestine)
-inactivity
-side effects of medications
-less fiber and fluid in diet
What to do FIRST when transferring client from bed to chair
Make sure they can bear weight
Anorexia Nervosa: bone density?
Much lower due to malnutrition
What is BUN level used for?
Assessing dehydration.
BUN = blood Uria nitrogen
Normal BUN level = 6-24;
BUN levels increase with dehydration = 35
What to do first when transferring a client from the bed to wheelchair
Make sure wheelchair and bed are locked
What question do you need to ask with insomnia
Do you fall asleep while driving?
What is insomnia?
Inability to fall asleep, stay asleep, or has premature waking
What is nocturnal myoclonus ?
Condition characterized by at least 5 leg jerks or movements PER HOUR during sleep
Associated with the use of tricyclic antidepressants and chronic renal failure
What is restless leg syndrome?
Neurological disorder characterized by an uncontrollable urge to move legs when one lies down
Let’s can be: uncomfortable, electrical, itching, pins and needle, pulling, creepy crawling, painful
What is sleep apnea?
A disorder in which at least 5 episodes of cessation of breathing lasting at least 10 seconds occur per hour of sleep
Accompanied by daytime sleepiness
What is sleep latency
A delay in the onset of sleep
What is the correlation between calcium and people with emphysema or difficult mobility?
The calcium in the body will increase
Breakdown of bone tissue, so extra calcium goes into the body
Why do elderly people sleep less soundly?
They spend more time in stage 1 & 2. Decline in proportion of time spent in the deeper stages 3 & 4
What are causes of insomnia?
Physical or mental illness
Environmental factors
Substance abuse
Medication
*alcohol does NOT help (no wine)
Causes for restless leg syndrome
-iron deficiency anemia
-Uremia
-Parkinson’s disease
-rheumatoid arthritis
-Diabetes
-Neurological lesions
Alterations and dopamine an iron metabolism 
-anti-depressants anti-histamines, antipsychotics alcohol and hypoglycemia can also contribute
Some ways to relive restless leg syndrome
-moving legs
-Drinking water
-Massage
-Applying heat or cold 
What are causes of sleep apnea?
-Defect in the central nervous system that affects the diaphragm
-A blockage in the upper airway that interferes with normal airflow (obstruction sleep apnea)
-Combination of both
What health conditions can affect to sleep?
Chronic conditions can interfere with sleep by producing symptoms such as nocturia, incontinence, pain, orthopnea, apnea, muscle cramps, and tremors
Cardiovascular conditions can produce nocturnal cardiac ischemia which interfere with sleep due to Dyspnea and transient angina
Diabetes due to blood glucose levels
Gastric pain and reflux
Conditions that cause someone to cough and have difficulty breathing
Muscle skeleton conditions can cause pain
Dementia has minimal stage 2 sleep or REM and no longer stage 4.
What types of medications affect sleep
-anticholinergics
-Antidepressants
-Antihypertensive
-Benzodizaoines
-beta blockers
-diuretics
-leovdopa
-steroids
-theophylline
-thyroid preparations
Hypnotics interfere with Ren and deep sleep stages and can cause daytime drowsiness

What specific drug examples affect sleep?
-Diphenhydramine HCI (Benadryl capsules)
-Nocotine (NicoDerm nicotine transdermal system)
-Fluoxetine HCI (Prozac)
-Theophylline (Theo-x Extended Release tablets)
-alprazolam (Xanax)
***many have diphenhydramine (Benadryl) as a primary ingredient
What do you do if a patient starts to fall?
Slide them down your leg and assist them to the floor
Understand how do use a cane
-make sure Cain is on strong side
-advance cain first
-step with weak / injured side
-follow with strong side
How do you do isometric exercises?
Tighten muscle then relax them
How should you assist an older adult and ambulating if they have trouble with balance?
Use a gait belt
What will the albumin levels be like for a client who has anorexia or malnutrition?
Albumin levels will be low
Normal rage = 3.4-5.4 g/dL (34-54g/L)
What can you suggest for a client who has limited hand movement
Use an adaptive device, such as a reacher
When providing hygiene care to an immobile patient, what action should you take?
-Water temperature should be 110°F/43.3°C.
-Clean from cleanest to dirtiest
-Check the bed for personal belongings when changing linens
-When shaving keep the head up
What are therapeutic ways that you can produce sleep?
-soft music
-tv
-drinking warm milk
-lemon lime soda
How often do you take dementia patients to the bathroom?
Every two hours
How to use walker
-make sure it’s the proper height
-Do not lean forward
-lift, and set it down
First step before starting exercise
Warming up
Examples of cardiovascular endurance
Aerobic exercises such as:
-Walking
-Jogging
-Cycling
-swimming
— rowing
-Tennis
-Aerobic dancing
What is cardiovascular endurance?
The ability of the heart, lungs and blood vessels to deliver oxygen to all body cells
Exercises must be performed long enough to require a continuous supply of oxygen which puts a demand on the cardiopulmonary system to reach out least 55% of its maximum heart rate
What is flexibility?
The ability to freely move muscles and joints through the range of motion
What is strength training?
Strength and endurance, and has been exercise challenge. Muscles key points are resistance and progression.
Recommendation for most adults is 8 to 12 sets at least twice a week
How do you provide oral care for an immobile patient
Turn on their side so they don’t aspirate
What is osteo-arthritis?
Degenerative joint disease in which there is a progressive deterioration and abrasion of joint Cartlidge with the formation of new bone at the joint surface
Joint inflammation
- Does not cause deformity and crippling
What are factors that contribute to fractures?
Trauma
Cancer metastasizes to the bone
Osteoporosis
Skeletal disease
What is a common site for fractures in older adults?
-Neck of the femur usually results in the fall
-Collea’ fracture a break at the distal radius (trying to stop a fall with an outstretched hand)
-Compression fracture (usually in vertebrae)
Causes / risk factors for osteoarthritis
-Excessive use of the joint
-Trauma
-Obesity
-Low vitamin D and C
-Genetic factors
What medications are used to treat osteoarthritis
-acetaminophen *first drug of choice
-Analgesics to help control pain
-rest, ice or heat, t’ai chi, aqua therapy, ultrasound, gentle massage, acupuncture, splints/brace
Diet for patients with osteoarthritis
-Freshwater fish (essential fatty acids have anti-inflammatory effects)
-Supplements :Vitamins, A, B, B6, C, E, zinc, selenium, niacinamide, calcium and magnesium
What is osteo-porosis?
Most prevalent metabolic disease of the bone.
Demineralization of the bone occurs, which is evidenced by decrease in mass and density of a skeleton
What causes osteoporosis?
-inadequate calcium intake
-Excessive calcium loss
-Poor calcium absorption
-gender (more common in women)
-Advanced age (women, over 65 men over 80)
-Ethnicity (white women from Northwest European or British Isles and Asian women)
-Obesity
-Calcium deficiency
-Vitamin D deficiency
-Small frames thin women
-Estrogen deficiency
-History of multiple pregnancies
-History of early menopause
-smoking/alcohol
-Prolonged immobility
-Decrease exercise
-Disease or chronic use of drugs that increase bone loss (corticosteroids, thyroid, hormones, anti-convalescence)
-Family history of osteoporosis
What is the skeletal structure of someone with osteoporosis?
Kyphosis and reduction in height
What kind of diet should someone eat with osteoporosis?
Diet high in protein and calcium
How do use a three point gait?
Starting from the tripod stance, swing both feet through, placing your good foot in front of the crutches. Make sure you “swing through” so that you’re giving your body the proper support when stopping.
What foods should patients with constipation eat more of
Raw vegetables
Fiber
Who do you refer patients with osteoarthritis to?
Occupational therapist
Foods high in calcium
Milk
Salmon
Broccoli
What can you use for a patient who has ostioarthritis for pain? That’s not medication
Heat and cold
Heat = soothing
Cold = numbs and reduces inflammation
What can too much calcium lead to?
Kidney stones
What should a patient eat less of if they have gout
They should eat a reduced sodium diet
Low Purine diet
Avoid: liver sardines, shrimp, turkey, bacon, kidney, brain, legumes
How can a patient who has acute dysphasia sleep/positions?
Sitting up / forward
What can a client drink at night if they have a sleep disturbance if the client desires to decrease caffeine intake?
Lemon lime soda
Who do you refer a dysphasia patient to?
Speech therapist
How do the elderly communicate / rate pain?
Typically underestimate their pain because they can’t feel it due to lack of feeling or have gotten used to it/build a tolerance
Understand different, religion, dietary restriction
Jewish = kosher diet
Muslim = no pork or alcohol, permissible meat must be blessed or killed a special way
What to do if a patient’s faith refuses life-saving treatment
Permissibility
They have right to refuse
How to set up a food tray for a patient who has a coverings and can’t see
Clock position:
describe food at hour location, matching clock
Understand about rolls and task changing in a family
Example wife gets sick, husbands now hesitate on wife’s roles
Presbycusis
Progressive hearing loss that occurs as a result of age related changes in the inner ear
Changes include loss of hair cells, decrease blood supply, reduce flexibility of basilar membrane, degeneration of spinal ganglion cells, and reduce production of endolymph
where does digestion start?
The mouth
How to speak to a patient with presbycusis
Be clear and a normal tone
Muscle skeleton changes in older adults
Muscle mass decreases
Who do you refer clients with rheumatoid arthritis who are having trouble feeding themselves?
Occupational therapist
Who do you refer a sleep Apnea patient to?
Respiratory therapist
When do we start discharge planning?
Admission
What are the physiological changes of aging?
Decreased mobility
Increase fall risk
Decrease stature
Decrease blood pressure
Decreased vision
Decrease bladder capacity
Decrease coughing flex
What should we determine first if a patient has partial hearing loss
Ask them 
What are big risk factors regarding elderly physiological changes?
Fall risks
Which patients are at a higher risk for aspiration, while eating
Stroke patients (cerebral accident)
Head/neck therapy
General anesthesia
How do you prepare a client for ambulation/how do we determine the level of strength?
We want to stand at the end of their bed and push on their feet to determine their foot strength
What can defecating cause?
Heart attack
Increase pressure on the heart if straining
What triggers the formation of vitamin D in the body
(What is a good source of vitamin D)
The sun
15 minutes per day
How does the general pattern of sexual behavior change as adults age?
It doesn’t, it stays consistent throughout life
Andropause
-decline in testosterone in men
-Happens naturally as men age, but does not happen every man
What are the effects of Andropause?
-ED
-enlarged breast
-Shrinking testes
-Decree sex drive
-Decrease muscle mass
-Lower energy/stamina
What are treatments for Andropause
Hormone replacement therapy (HRT)
What is menopause?
A permanent cessation of Minnis for at least one year 
When does post menopause start?
12 months after the last cycle
What are causes of menopause?
-estrogen levels fall
-Reduce number of ovarian follicles, lose their ability to respond to gonadotropic hormone stimulation
What creates estrogen before an after menopause?
Before menopause = estradiol (produced by ovaries)
After menopause = conversion of androstenedione to estrogen in skin and adipose tissue
What is dyspareunia?
Painful intercourse
Effects of menopause on the physical body
-no more period
-dyspareunia
-Vaginal drying
-Decreased wall expansion
-Sending a vaginal walls
-labia majora does not separate
-Decrease estrogen
-Hot flashes
Affects on emotions for women going through menopause
-Decree sex drive
-Mood swing
-Emotional distress
-Fatigue
-Depression
-Fuzzy, thinking/memory problems
-Anxiety, restlessness, panic disorder
Treatments for menopause
-hormone replacement therapy (HRT)
However, Estrogen and progesterone can increased heart risk. If started within the first year of menopause, and the chance of having a heart attack decreases.
How to help manage symptoms of menopause without medication treatment
-Diet
*food rich in plant estrogen: apples, beans, carrots, celery, nuts, seeds, soy products)
*food rich in boron to increase estrogen retention: asparagus, beans, broccoli, cabbage, peaches, prunes, strawberries, tomatoes
-Exercise
-Meditation
-sleep
-Stress management
-Vaginal moisturizing (Saint johns wort oil)
-Vitamins to minerals
Erectile dysfunction causes
-diabetes (#1 cause )
-Andropause
-Alcoholism
-Hypertension
-The reduction of testosterone
Medication that can have an adverse effect on sex life
-anti-depressants
-Antihypertensive
-Sedatives
-ACE inhibitors
-anxiety/benzodiazepines
-anticholinergic
-antihistamine
What is the Harris Benedict equation? Also known as resting energy expenditure.
Determines resting caloric need takes into account, age, height, weight, and gender
Recommended amount of water for hydration
1500 mL of water
* help prevent UTI
* this is harder in elderly because they are more incontinent. Don’t want to drink as much at night.
What are the stages of sleep?
Stage 1: start to nod off
Stage 2: deeper stage of relaxation
Stage 3: early phase of deep sleep
Stage 4: deep sleep and relaxation
REM: rapid eye movement
What medicine should you not give when promoting rest and sleep?
Benadryl (Disphenhydranine)
What is crystallized intelligence?
-knowledge that has been accumulated over someone’s lifetime
-Comes from the dominant hemisphere of the brain
What is fluid intelligence?
-Involves new information coming from the non-dominant hemisphere
-Controls emotions
-Retention of non-intellectual information
-creative capacities
-Spatial perception
-Aesthetic appreciation
Prebyescophagus
Decrease intensity of propulsive waves and increased frequency of non-propulsive waves in the esophagus
Presbyopia
Inability to focus for accommodate properly, to do reduced elasticity of the eye lends
How to calculate max heart rate
220 minus age
How to calculate target heart rate
Max HR x 75%
What causes rheumatoid arthritis?
Auto immune disorder
What is gout?
Metabolic disorder in which too much uric acid crystallizes and deposits into joints
What does agnostic mean?
Person who claims not to know with clarity, weather, God exist or not
What does atheist mean?
A person who does not believe in God
What is religion?
Human created structures, rituals symbolism in rules for relating to God/higher power
What is spirituality?
Relationship and feeling with things that are transcending the physical world
What is spiritual distress?
A state in which ones relationship to God or other higher power is disrupted are at risk for been disrupted, or spiritual needs, cannot be for filled
