Exam #2 Flashcards
1
Q
What are characteristics of actinic keratosis?
A
-precancerous skin lesions
-derm visits every 6-12 months to monitor and treat
2
Q
What is seborrheic keratosis?
A
-waxy, raised,stuck on appearance
-benign
-almost all adults 65+
3
Q
Characteristics of herpes zoster?
A
-painful, vesicular rash
-over dermatome
-unilateral, un-reoccuring
4
Q
Characteristics of candidiasis?
A
-yeast infection
-in skin folds
-keep skin clean and dry
5
Q
What is the expected carb intake?
A
45-65%
6
Q
What is the expected fat intake?
A
20-35%
7
Q
What is the expected protein intake?
A
10-35%
8
Q
What is the expected vitamins and minerals intake?
A
5 servings of fruits and veggies
9
Q
How much of adults 65+ are obese?
A
1/3
10
Q
What are nursing for dysphagia patients?
A
-supervise meals
-seated and rested before eating
-sitting up at 90 degrees
-alternate solids and liquids
-avoid sedatives
-keep suction readily available
-oral care
11
Q
What falls under “can drink” criteria?
A
-may not know adequate amount of drink
-possible cog impairment
12
Q
What falls under “wont drink” criteria?
A
able to drink but refuses (highest risk for dehydration, offer fluids frequently)
13
Q
What falls under “cant drink” criteria?
A
-physically incapable of ingesting or accessing fluids
-dysphagia prevention
-swallow evaluation
-safe drinking techniques
14
Q
What are signs of dehydration?
A
Skin turgor (unreliable r/t skin changes)
Weight
Mucous membranes
Speech changes
Tachycardia
Decreased UOP
Dark urine
Weakness
Dry axilla
Sunken eyes
15
Q
What is the most reliable test for dehydration?
A
lab values
16
Q
How much fluid should be consumed in one day?
A
1500 mL/day
17
Q
What are interventions for urinary incontinence?
A
Scheduled & Prompted voiding
Pelvic floor muscle exercises (Kegels)
Thorough assessment of continence
Lifestyle Modifications
Medications
Urinary catheters – last resort
18
Q
What is the most common cause of sepsis in older adults?
A
UTI
19
Q
What are atypical symptoms of UTI?
A
-Mental status change
-Decreased appetite
-Incontinence
20
Q
Is asymptomatic, uncomplicated bacteria normal for older adults?
A
YES
21
Q
What are interventions for constipation?
A
-Increase motility
-squatting, leaning forward
-normalize bowel function
-attempt bowel movement after breakfast or dinner
-allow at least 10 mins for bowel movement
-increase fluid intake (at least 1.5L per day)
22
Q
What type of laxative is psyllium (metamucil)
A
bulk-forming
23
Q
What type of laxative is docusate sodium?
A
emolllients
24
Q
What type of laxatives are polyethylene glycol (PEG), milk of magnesia, lactulose?
A
osmotic
25
What type of laxatives are bisacodyl and senna?
stimulant
26
What type of enema is contraindicated for an older adult?
sodium phosphate
27
What type of enema is contraindicated for an older adult
sodium phosphate
28
What are manifestations of fecal impaction?
Malaise, urinary retention, increased temp, incontinence, cognitive decline, hemorrhoids, intestinal obstruction.
29
What are interventions for a fecal impaction?
1st: PREVENT
-Removal of impaction
-Digital removal of hard stool from rectum
-Use copious lubricant
-May take several days
-Don’t dis-impact too much
-Often very painful
30
What happens if there is more spent in stages 3-4 of sleep?
feeling rested and refreshed
31
What percentage of sleep is NREM?
75% (stage 1-4)
32
What percentage is REM sleep?
25%
33
What are signs and symptoms of sleep apnea?
-Excessive daytime sleepiness
-Snoring, gasping, choking
-Headache, irritability
-Symptoms often blamed on age!
34
How is sleep apnea assessed?
Epworth sleepiness scale
35
What are the dont's of exercising?
-SBP > 200 mm Hg
-DBP > 100 mm Hg
-Resting HR > 120 bpm
-For 2 hrs after a big meal
36
When is the best time to cut toenails?
after bath or soaking 20-30 (softens nails)
-clip straight across
37
What are the assessment tools for falls?
hendrick II fall risk model
morse fall scale
38
What are major risk factors for falls?
-Orthostatic hypotension
-Cognitive impairment
-Impaired vision and hearing
-Medications
-Environmental factors
-Weakness and frailty
39
What is restraint-related death?
asphyxiation
40
How is a formal diagnosis made for frailty?
Three of the following:
-unitentional weight loss
-self reported exhaustion
-weak grip strength
-slow walking speed
-low activity
41
What is the most common chronic condition in adults 65<
HTN
42
What is a blood pressure acceptable in ages 60+?
150/90
43
What are lifestyle changes for HTN?
weight loss, decreased sodium intake, decreased EtoH intake, more exercise
44
What are etiologies of heart failure?
-damage from HTN and CHD
-ventricles enlarge and dilate
-results in weaker muscle
-EtOH, drug abuse
-chronic hyperthyroidism
-valvular
-chemo and radiation therapy near heart
45
What is left sided heart failure?
pump failure to lungs, think dyspnea (decreased systolic contractility, decreased diastolic filling)
46
What is right sided heart failure?
pump failure to rest of the body
think edema but also ascites
47
What is congestive heart failure?
swelling, edema, pulmonary edema, must remove fluid
48
What are interventions for a parkinson's patient?
-early assessment & symptom management
-surgical procedures (ablation, deep brain stimulation, and stem cell transplantation)
-drug therapy mimicking or slowing dopamine breakdown
49
What are the classic Parkinson's symptoms?
Cogwheel rigidity (muscle rigidity), bradykinesia/dyskinseia, resting/ non intentional tremors
50
What can Parkinsonian crisis be triggered by?
emotional stress or sudden withdrawal of meds
51
What are symptoms of Parkinsonian crisis?
-Severe exacerbation of tremors, rigidity, and bradykinesia
-Anxiety
-Sweating
-Tachycardia
-Hyperpnea
52
What are treatment/interventions for parkinsonian crisis?
-Respiratory/cardiac support prn
-Non-stimulating environment
-Psychological supports
-Restarting medications
53
What condition is Heberden's nodes found in?
only in osteoarthritis (head of finger)
54
What condition is Bouchard's nodes found in?
OA and Ra
55
What are exercises that can be taught to parkinson's patients?
-lift toes when walking
-widen legs when walking
-small steps when moving forward
-tight corner manipulation
-swing arms with walking to improve ROM
-carry bag to counterbalance if necessary
-facial exercises
-read aloud
-speak slowly with purpose and articulation
56
What is the client education for medications such as selegiline and rasagiline?
-same time everyday
-report insomnia
-postural hypotension prevention
-skin exams, risk of melanoma
-avoid foods containing tyramine
57
What are client education for levodopa and amantidine?
-weeks-months to take effect
-decrease protein intake
-avoid foods with pyridoxine (pork, beef, avocado, beans, oatmeal)
-teach to report increase in symptoms and cardiac side effects
58
What is the client education for tolcaone and entacapone?
-take with food
-no EtOH or sedatives
-interventions to prevent postural hypotension
-do not stop abruptly
-report muscle control changes, jaundice, dark urine, hallucinations
59
What is the client education for anticholinergics? (Benztropine (cogentin) and trihexyphenidyl (artane)?
-avoid activity which promotes fluid loss
-dont stop abruptly
60
What is the most serious complication of GERD?
aspiration pneumonia
61
When does the fastest overall loss of mineral bone density occur for women?
5 to 7 years after menopause
62
How is OP diagnosed?
dexa scan & t-score (2.5 or greater)
63
What is the USPSTF recommendation for OP screening?
women 65+ and women 60+ if high risk
64
What are interventions for OP?
-Weight bearing and resistance training
-Adequate calcium and vitamin D intake
-Education about fall prevention
-Pharmacological therapy to prevent bone loss
65
What is the main teaching for biphosphonates?
upright for 30 mins after administration
66
What are interventions for OA?
-weight loss
-exercise
-physical therapy
-hot/cold therapy
-adaptive devices (cane, shoe lift, knee brace)
67
What is pharm therapy for OA?
-acetaminophen
-NSAIDs
-joint injections
-acupuncture
-surgical intervention (athroscopy, total joint replacement)
68
What is pharm therapy for RA?
-Pain management
-DMARDs (disease-modifying anti-rheumatic drugs) - methotrexate
-Biological response modifier - “-mab”
69
What is DM presentation in older adults?
dehydration, confusion (delirium), decreased visual acuity, incontinence, weight loss & anorexia, fatigue, nausea, delayed wound healing, and parasthesias
70
What is the presentation of older adults with hyperthyroidism?
-tachy
-tremors
-weight loss
-apathetic thyrotoxicosis (slowed movement and depressed affect)
71
What is the presentation of hypOthyroidism in adults?
slowed mentation, gait disturbances, fatigue, weakness, heat intolerance
72
What is treatment for hypothyrodism?
thyroid replacement therapy
(levothyroxine)
73
What is the nursing care for hypothyroidism?
-Prevent: chilling, constipation, skin breakdown, infection
-Assess: cardiac complications, edema, tachycardia, skin
-Lifelong levothyroxine therapy
-Warning: levothyroxine can cause digoxin toxicity
74
What is an important complication in hypothyroidism to watch out for?
myxedema coma
75
What are manifestations of mxyedema coma?
Hypothermia, Mental function ranges from depression to unconscious, Respiratory depression (hypoventilation), Hypotension, Bradycardia
76
What is the treatment for myxedema coma?
-Supportive measures and stabilization of vitals
-Treat underlying cause
-Thyroid hormone replacement – must be SLOW r/t toxicity with rapid replacement
77
What are screening methods for prostate cancer?
-Digital Rectal Exam
-Prostate-Specific Antigen (PSA)
-biopsy
78
What is the USPSFT recommendation for prostate cancer screening?
-men aged 55 to 69 years
-recommends against screening for ages 70 and older
79
What is care for prostate cancer?
-Active surveillance
-Watchful waiting
-Radical prostatectomy (surgical removal)
-Radiation therapy
-Hormone therapy
80
What are physiological changes in an older adult (mental)?
-Neuron loss – most pronounced in cerebral cortex
-Brain atrophy – decreased weight
-Dendrites atrophy
-Impaired synapses
-Changed transmission of dopamine, serotonin & acetylcholine
SLOWING IS NORMAL, IMPAIRMENT IS NOT
81
What are the three components of memory?
immediate recall, short term memory, and remote or long-term memory
82
What is anxiety associated with in older population?`
NOT part of normal aging process.
Excessive healthcare use
Decreased physical activity and functional status
Substance abuse
Decreased life satisfaction
Increased mortality rates
83
What are pharmacological treatments for anxiety?
Antidepressants—SSRI’s (selective serotonin uptake inhibitors) first line of treatment
Short acting benzodiazepines
Non-benzodiazepine anxiolytic agents
84
What are non-pharm treatments for anxiety?
Cognitive behavioral therapy (CBT)
Meditation
Yoga
85
What would an older adult with depression present with?
-More somatic complaints – physical symptoms
-Hypochondriasis – Constant complaining & criticism
-Decreased energy and difficulties completing ADL’s
-Social withdrawal
-Decreased libido
-Preoccupation with death
-Memory problems
-Strong association of depression with dementia
86
What are interventions for suicidal patients?
If suicide risk suspected, ask direct questions
Have you ever thought about killing yourself?
How often have you had these thoughts?
Do you have a plan to carry it out/How would you do it?
High risk patients need to be hospitalized
Moderate and low risk treated as outpatients
Adequate social support
No access to lethal means
87
What are substance abuse concerns?
-Misuse of prescription and OTC medications
-Polypharmacy effects exacerbated with alcohol use
-Inappropriate prescribing and ineffective monitoring of controlled substances
88
How is delirium assessed/diagnosed?
-Confusion Assessment Method (CAM & CAM-ICU)
-Documentation should focus on specific indicators of altered mental status rather than “confused”
-Will lead to more appropriate prevention, detection, and treatment to prevent negative outcomes
89
What are risk factors for delirium?
acute illness, infections, medications, invasive equipment, metabolic disturbances, dehydration, alcohol or drug abuse, sensory impairments, unrelieved pain, surgery, hip fracture, cognitive impairment
90
What are ways to prevent delirium?
* Know baseline mental status, functional abilities, living conditions, medications taken, alcohol use.
* Assess mental status using Mini-Mental State Exam-2 Confusion Assessment Method, or NEECHAM Confusion
Scale, and document.
* Correct underlying physiological alterations.
* Compensate for sensory deficits (e.g., hearing aids, glasses, dentures).
* Encourage fluid intake (make sure fluids are accessible).
* Avoid long periods of giving nothing orally.
* Explain all actions with clear and consistent communication.
* Avoid multiple medications, and avoid problematic medications (see Beers Criteria).
* Be vigilant for drug reactions or interactions; consider onset of new symptoms as an adverse reaction to medications.
* Avoid use of sleeping medications; use music, warm milk, or noncaffeinated herbal tea to alleviate discomfort.
* Attempt to find out why behavior is occurring rather than simply medicating for it (e.g., need to toilet, pain, fear, hunger, thirst).
* Avoid excessive bed rest; institute early mobilization.
* Encourage participation in care for activities of daily living (ADLs).
* Minimize the use of catheters, restraints, or immobilizing devices.
* Use least restrictive devices (mitts instead of wrist restraints, reclining geri-chairs with tray instead of vest restraints).
* Hide tubes (stockinette over intravenous [IV] line), or use intermittent fluid administration.
* Activate bed and chair alarms.
* Place the patient near the nursing station for close observation.
* Assess and treat pain.
* Pay attention to environmental noise, light, temperature.
* Normalize the environment (provide familiar items, routines, clocks, calendars).
* Minimize the number of room changes and interfacility transfers.
* Do not place a delirious patient in the room with another delirious patient.
* Have family, volunteer, or paid caregiver stay with the patient.
91
What is aphasia?
partial or total loss of the ability to articulate ideas or comprehend spoken or written language
92
What is apraxia?
partial or total loss of the ability to perform coordinated movements or manipulate objects in the absence of motor or sensory impairment
93
What is agnosia?
loss of the ability to interpret sensory stimuli, such as sounds or images
94
What is Lewy body dementia?
a disease associated with abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, affect chemicals in the brain whose changes, in turn, can lead to problems with thinking, movement, behavior, and mood.
95
What is frontotemporal dementia?
the result of damage to neurons in the frontal and temporal lobes of the brain.
96
What is vascular dementia?
a common form of dementia caused by an impaired supply of blood to the brain, such as may be caused by a series of small strokes.
97
What are the two types of Alzheimers?
early onset and late onset
98
What is early onset alzheimers?
(between ages 30-60)
-Affects about 5% of persons with AD
-Results from genetic mutations of three genes
-Genetic testing available for at risk individuals
99
What is late onset Alzheimers?
After age 60
-Does not run in families
-Probable combination of lifestyle, environmental factors, and genetic mutation
100
What are pharm interventions for AD patients?
Cholinesterase inhibitors (CI)
Directed toward symptom management
Does not affect neuronal decline
101
What are interventions for Alzheimer's patients?
-bright light therapy
-animal-assisted therapy
-activities and exercise
-validation therapy
-distraction
-social contact
-distraction
-reminisence activities
-sensory stimulation
-environmental modifications
102
What are nursing interventions for dementia?
-Address Safety
-Structure daily living to maximize abilities
-Monitor general health
-Support advance care planning and directives
-Educate and support caregivers
103
What are nursing interventions for wandering in AD?
Music, exercise, refreshments, social interaction
Camouflage doorways, enclosed areas for walking, electronic bracelets,
104
What are common medications given to Alzheimer patients?
Donezepil (Aricept) , Rivastigmine (Exelon) , and Galantamine (Razadyne)
105
What is the preventitive phase of chronic illness?
No S/Sx
106
What is the definitive phase?
S/Sx & diagnosis PRESENT
107
What is the crisis phase?
Life-threatening situation
108
What is the acute phase?
Active illness requiring hospitalization
109
What is the stable phase?
Controlled illness course/symptoms
110
What is the unstable phase?
Not controlled but not requiring/desiring hospitalization
111
What is the downward phase?
Progressive decline
112
What is the presentation of GERD in older adults?
Persistent cough, Asthma exacerbations, Laryngitis, Intermittent chest pain
113
What is the medication for patients with GERD?
PPI
114
What are characteristics of osteoarthritis?
older adults, may be unilateral (knee, spine, hip, hand), shorter period of morning stiffness, and pain with ACTIVITY
115
What are characteristics of rheumatoid arthritis?
women>men, symmetrical (hands and feet common), prolonged morning stiffness > 30 mins, pain increases with inactivity
116
What are interventions for callused feet?
pad and protect area, proper fitting shoes
117
What are interventions for bunions?
custom shoes, surgery, or steroid injections
118
What are interventions for hammer toe?
custom shoes or surgery
119
What are interventions for Onchymosis?
difficult to treat-costly and ineffective
120
What are the three top chronic illnesses in older adults?
1. HTN
2. high cholesterol
3. arthritis
121
What is apathetic thyrotoxicosis?
slowed movement and depressed affect
122
Pre-op thyroidectomy care?
1. give antithyroid medication called lugol's solution
-it's potassium iodine & iodide used to decrease thyroid gland perfusion & decrease T3, T4 production
-as gland is cut, TH is released. Bc of this, person has a high risk of having a thyroid storm or thyrotoxicosis which can be life-threatening
2. Want to promote reduction of anxiety to reduce risk of thyroid storm
123
Post-op thyroidectomy care?
1. person is at high risk for developing respiratory or airway complications due to airway edema so need to continuously be assessing airway & resp. status
2. HOB should ALWAYS be up after surgery, head supported by pillows
3. Pt will have difficulty speaking or have a hoarse voice after surgery; pt needs to rest voice
4. There should be a trach tray available by the bedside in case of airway occlusion
5. Teach pt to reduce calorie intake
-bc of manifestations of hyperthyroidism, person probably needed extra calories to maintain a healthy body weight; now they will have either a normal or low metabolic rate
6. Maintain adequate dietary intake of iodine
7. Avoid high temps bc it can cause person to have more signs of hyperthyroidism even after surgery; person is very sensitive to heat
124
What are interventions for wandering?
1. face person and make eye contact
2. gently touch person's arm, shoulders, back, or waist if they won't move away from door
3. call person by formal name
4. listen to what the person is communicating verbally & nonverbally
5. identify agenda/plan of action and emotional needs being expressed
6. respond to feelings, staying calm
7. repeat specific words/phrases
8. if repetition fails to distract the person and increases distress, stop talking
9. redirect person toward facility or home at intervals
10. if redirection fails, continue to walk but allowing person control by ensuring safety
11. have a backup person
12. have someone call for help if unable to redirect
125
What is the BMI for overweight?
25 to 29.9
126
What is the BMI for obese?
greater than or equal to 30
127
What is the BMI for morbidly obese?
over 40
128
What are facts about PEG tubes in advanced dementia?
-not QOL improvement
-no prolong survival
-associated w increased agitation, use of restraints, and worsening pressure injuries
-50% of patients die within 6 momths of insertion
-associated with GI symptoms and abscess
129
What are risk factors for fluid changes in older adults?
Physiological changes in body water content
Impaired thirst sensation
Medications
Functional impairments
Chronic illness
Emotional illness
High environmental temperatures
130
What are characteristics of bulk forming laxatives? (psyllium, metamucil)
1. first line agent (low cost & less adverse effects)
2. do not use in prescense of obstruction or altered peristalsis function
3. caution with frail older people, bedbound, and swallowing problems
4. must be taken with adequate fluids
5. can cause abdominal distention and flatulence
131
What are characteristics of emollient laxatives?
(docusate sodium)
1. increase stool moisture content
2. use in caution with frail older people that may not be able to "push" bc stool can accumulate in rectal vault
3. avoid mineral oil
4. used mostly in specific situations like prevention of constipation after surgery
132
What are characteristics of osmotic laxatives? (milk of mag, polyethylene glycol, and lactulose)
c
133
What are characteristics of stimulant laxatives? (senna, bisacodyl)
1. stimulate colorectal motor activity
2. may cause f&e losses and cramping but safe and effective when used appropriately
134
What are the bulk-forming laxatives?
psyllium, metamucil
135
What are the emollient laxatives?
docusate sodium
136
What are the osmotic laxatives/
MOM, lactulose, polyethylene glycol, miralax
137
What are the stimulant laxatives?
senna, bisacodyl
138
What constitutes and insomnia diagnosis?
difficulty falling asleep > 1 month
AND impairment in daytime functioning r/t poor sleep
139
What are preferred prescriptions to help with sleep?
zoldipem and ramelteon
-lowest dose and short term
140
What are autonomic symptoms of PD?
Seborrhea (seb-o-REE-ik) dermatitis
Hyperhydrosis of face and neck
Heat intolerance
Postural hypotension
Constipation
141
What does levodopa and amantidine do?
improves manifestations of motor dysfunction
142
What do sellegiline and rasaligine do?
inhibits enzymes that inhibit or breakdown dopamine
143
What do bromocriptine, pramipexole, and ropinirole do?
mimick effect of dopamine in brain
144
What is client education for bromocriptine, pramipexole, and ropinirole?
do not stop abruptly
may cause compulsive behavior
145
What do tolcapone and entacapone do?
Inhibit COMT, which breaks down dopamine
146
What do the anticholinergics do? (cogentine, artane)
blocks excitatory action of acetylcholine
147
What are intervenions for thyrotoxicosis?
Cool with ice, ↓ levels of TH, replace fluids & electrolytes, give O2, stabilize cardiac function. Avoid ASA (increases TH)
148
What are lab tests for dehydration?
-blood urea nitrogen (BUN)/creatinine ratio, serum sodium level, serum and urine osmolarity, and specific gravity
149
What are the manifestations of prostate cancer?
-General urinary complaints, retention, hematuria, back pain
-Cachexia, bone tenderness, lower lymphedema, adenopathy
150
What are causes of hypothyroidism?
1. Genetic/congenital
2. tx for hyperthyroidism
3. thyroiditis
4. iodine deficiency
5. decreased TH produced
6. Can be caused by medications such as amiodarone, anabolic steroids, lithium, phenytoin, beta blockers
151
What are causes of hyperthyroidism?
1. Autoimmune disorder: Graves disease is the most common
2. Multinodular goiter (toxic goiter)
3. Women are affected more, 5-7:1
152
What can malnutrition lead to?
Increased risk of infection, pressure ulcers, anemia, hip fractures, hypotension, impaired cognition and increased morbidity and mortality
153
What are complications of constipations?
Impaction, obstruction, cognitive dysfunction, delirium, falls, increased morbidity & mortality
Increased risk for bowel cancer
154
What is the cause of sleep apnea?
decline in tone of upper airway muscles
155
What is sleep apnea linked to?
heart failure, dysrhythmias, stroke, T2DM, OP and death
156
What are things to combat sleep apnea?
Limit/stop ETOH & sedatives, weight loss, smoking, CPAP
157
What is the most common cause for hospitalization, re-hospitalization, and disability for those over 65?
HF
