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gero > exam 2 > Flashcards

exam 2 Flashcards

1
Q

three initial approaches to gather info

A

self-report ~ if pt is competent and can give accurate info
report by proxy- from spouse, child, etc
direct observation- assessment pieces i gather

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2
Q

assessment if older adults

A

more complex, detailed, takes longer

lots of specifics, body systems wear down has more chronic illness, pt my have slower recall time

do head to toe

this begins as soon as we see them

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3
Q

what assessment piece do we begin with

A

review of pts chief complains

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4
Q

LEARN model for healthcare

A

Listen
Explain- analyze and prioritize a hypothesize
Acknowledge
Recommend
Negotiate

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5
Q

normal assessment findings of older adults

A

thin skin- tenting
low temp
high frequency hearing loss
cerumen impactations
reduced pupil responsiveness, saggy eye lids
decrease of taste, mouth dryness
slight edema
osteoarthritis
bilateral strength

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6
Q

FAN CAPES: comprehensive assessment of older adults

A

Fluids- hydration status
Aeration- o2 status at rest and activity
Nutrition- diet, can they get food and prepare it

Communication
Activity- fall risk?
Pain- do they have any? what kind?
Elimination- continent or incontinent? do they need extra assistance
Socialization- peers

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7
Q

mini mental state examination

A

looks at orientation and short term memory

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8
Q

clock drawing test

A

they draw a clock and we see if they have. good number recognition, how well they can see

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9
Q

the global deterioration scale

A

Looks at ability to perform increasingly complex task. Start simple and get harder

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10
Q

geriatric depression scale

A

assess mood and for depression

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11
Q

geriatric ability

A

Assess what they can do on own, and what they need assistance with. also assess safety

keep monitoring, things can change weekly

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12
Q

activities of daily living examples

A

Bathing , dressing, feeding, toileting, transferring oneself, feeding onself, controlling bowel and bladder function

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13
Q

instrumental activities of daily living examples

A

Ability to use telephone, travel, manage money, taking meds, packing a suitcase, prepare meals, do housework

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14
Q

OARS

A

provides info related to social and economic resources, mental and physical health, and ADLS

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15
Q

fulmer SPICES acronym

A

for cues requiring nursing action

Sleep
Problems eating
Incontinent
Confusion
Evidence of falls
Skin breakdown

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16
Q

OASIS

A

Created by government. Used to improve quality and communication for home health. Determined disbursement for home health agency

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17
Q

OASIS risk for hospitalization

A

history of falls
unintentional weight loss
multiple hospitalizations
multiple ER visits
decline in mental, emotional or behavioral status
difficulty complying with medical instructions
taking 5 or more meds
reports exhaustion

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18
Q

documentation

A

required. document everything

demonstrates quality of care
provides a way to have continuity of care between all providers

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19
Q

what group is largest user of prescription and OTC meds

A

adults over age 65

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20
Q

pharmacokinetics

A

the movement of a drug throughout body from point of its admin

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21
Q

changes in absorption in elderly

A

increased gastric pH
changes in intestinal motility (faster=less absorption, slower=increased absorption)

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22
Q

changes in metabolism in elderly

A

decreased liver function- increased amount of drug in system

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23
Q

changes in excretion in elderly

A

decreased kidney function, increased half life

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24
Q

absorption

A

amt of time between drug admin and absorption depends on bioavailability amount of drug that passes through body, route of admin

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25
Q

distribution

A

med must be transported to receptor site on the target organ to have an affect

depends on the availability of plasma protein in the form of lipoproteins, globulins, and albumin

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26
Q

what are age related changes in distribution related to

A

body composition, increased body fat, and decreased total body water

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27
Q

metabolism

A

process by which the drug modifies the chemical structure of drug
primarily occurs in liver

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28
Q

excretion

A

medications are excreted in sweat, saliva, and other secretions, as well as mainly by kidneys

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29
Q

pharmacodynamics

A

interaction between a drug and the body

decreased response to beta adrenegeric receptor stimulators and blockers, like BP meds

increased sensitivity to anticholinergics, benzodiazepines, opioid analgesics, warfarin, diltiazem, verapamil

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30
Q

chronopharmacology

A

relationship between biologic rhythms to variations in the body response to drugs

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31
Q

problems with meds and older adults

A

polypharmacyq
drug interactions
adverse effects
misuse of drugs

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32
Q

herb to avoid with antihypertensive and antivirals

A

garlic

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33
Q

herb to avoid for antidiabetics and antidepressants, antihypertesnive

A

ginko

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34
Q

common herbs to avoid in many drugs

A

St johns wort
ginseng

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35
Q

what drug can u not use with citrus juice

A

CCB

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36
Q

what drug not to use fiber

A

digoxin

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37
Q

common food to avoid for drug

A

grapefruit juice

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38
Q

polypharmacy

A

taking 5 or more meds

concern for drug interactions and adverse effects

caused by multiple conditions, multiple providers

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39
Q

mental status adverse effects

A

delirium, confusion, lethargy

CONTACT PROVIDER IMMEDIATELEY.

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40
Q

Beers list

A

identifies drugs that carry a higher than usual risk for adults and should be used w caution

ex- benzodiazepines, sliding scale insulin, antispasmodics, trycylic antidepressants, digoxin

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41
Q

Neuroleptic malignant syndrome

A

most common with Haldol. MED EMERGENCY
Increased temp, muscle rigidity, tachycardia

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42
Q

adverse effects for antidepressants

A

ataxia, dizziness= fall risk

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43
Q

why avoid benzodiazepines (antianxiety drugs)

A

decreased metabolism. may cause drowsiness, dizziness, ataxia, cognitive deficits, memory impairment

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44
Q

antipsychotic adverse effect

A

potential cardiac risk, neuroleptic malignant syndrome, extrapyramidal syndrome (EPS)

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45
Q

best medication assessment of older adults

A

brown bag approach- bring all of there meds in

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46
Q

pt education of meds

A
  • Provide guidance on
    • Right drug, right dose, right time
    • Easy open bottles: watch for little kids
    • Measuring and cutting devices
    • Proper storage
      Potential side effects: go over dangerous ones, may need a list
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47
Q

monitoring meds

A

assess and document changes in physical and functional status
measure blood levels
obtain baseline measures
observe for adverse effects

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48
Q

what causes constipation in older adults

A

decreased activity, pain meds, decreased hydration

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49
Q

nutritional needs in older adults

A
  • May require fewer calories= doing less activity
  • Need higher level of nutrients
  • Decreased saturated fats
  • Increased protein- for wound healing
  • Consistent fiber intake- 25g/day
    Increased Vitamin B12- increases energy
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50
Q

what causes malnutrition

A

not consuming enough nutrients,
inflammation

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51
Q

factors effecting nutritional fulfillment

A

life long eating habits
socialization
socioeconomic deprivation- more $ to eat healthy
transportation

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52
Q

Supplemental Nutrition Assistance Program (SNAP)

A

program where they can get extra money for food or food delivered to them

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53
Q

does excessive drinking increase or decrease eating

A

decrease

54
Q

where should essential nutrients come from

A

foods rather than supplements

55
Q

physiological changes affecting nutrition

A
  • Decreased movement of food in the esophagus
  • Decreased sense of smell
  • Decrease in the number of taste buds
56
Q

chronic health conditions that can decrease food intake

A
  • Gastroesophageal reflux disease (GERD)
    • Diverticular disease
      Dysphagia
57
Q

possible causes of dysphagia

A

CVA, Parkinson’s, Alzheimer’s

58
Q

what to worry about w dysphagia

A

aspiration

59
Q

interventions for dysphagia for nutrition

A

postural change- sit up
diet modification- thickeners
hand feeding
G tubes (do oral care)

60
Q

how much water should older adults have daily

A

1.5L (1500mL)

61
Q

why are older adults at more risk for dehydration

A
  • Decreased thirst
    • Decreased cognitive function
    • Decreased mobility
    • Use of medication that cause increased urination- Lasix makes them more likely to be dehydrated
62
Q

signs and symptoms of dehydration

A
  • Weight loss
  • Concentrated urine- amber colored
  • Orthostasis- blood drops in BP due to volume depletion
  • Sunken eyes
  • Rapid pulse rate
  • Longitudinal furrows in the tongue
    Confusion
63
Q

interventions for dehydration

A
  • Assess fluid intake and output
  • Make fluids accessible and consistently available
  • Allow for adequate time at meals
  • Provide a variety of fluid options
  • Monitor for fever, diarrhea, vomiting
  • Limit NPO status
  • Decrease use of diuretics

Maintain adequate documentation of intake and output

64
Q

rehydration

A

for mild to moderate - oral hydration or hypodermoclysis (infusion into subcut space)

for moderate to severe- IV therapy

monitor for F&E imbalance

65
Q

oral care

A

annual dental exams
use adaptive toothbrushes and floss if needed
maintain adequate fluids
avoid alcohol and tobacco
perform dental care- constant wear unless sleeping. use soft brush

66
Q

Aminocaproic Acid ( Amicar)

A

hemostatic agent, fibrinolysis inhibitor. For management of hemorrhage due to systemic hyperfibrinolysis or urinary fibrinolysis. Inhibits activation of plasminogen. Monitor BP, pulse, and resp status, neuro status, i&o. monitor platelet count and clotting factors. Assess for recurring bleeding

67
Q

Apixaban ( Eliquis)

A

anticoagulant, factor xa inhibitors. Prevention and treatment of embolism. Monitor for bleeding and hypersensitivity reactions. Antidote is andexanet alfa

68
Q

Rivaroxaban (Xarelto)

A

anticoagulants, antithrombotic. factor xa inhibitor Treats and prevents thromboembolic events. Monitor for bleeding. Avoid St johns wort. Antidote is andexanet alfa

69
Q

Dabigatran (Pradaxa)

A

anticoagulant, thrombin inhibitor. Prevents clot formation. Monitor for bleeding, hypersens reactions, GI upset. Reversal use idarucizumab

70
Q

urinary incontinence

A

Loss or urine controls. Interrupts daily living
often undiagnosed and underreported.

70
Q

key component of elimination in elderly

A

being control

71
Q

why is treatment not sought in urinary incontienence

A

embarasessment, normal aging, uneducated

72
Q

stats reported of UI at home vs facility

A

> 50% of women and 25% of men living at home
50 % of women and men in a facility. Men deteriorate more quickly in long term care due to loss of independency

73
Q

risk factors for UI

A

cognitive impairment
limitations in daily activity
institutionalization
disease- diabetes
meds
stroke
obesity

74
Q

consequences of UI

A

increased risk for injury
skin breakdown
increased social isolation, shame
decreased sexual activity
loss of independence

75
Q

transient (acute) UI

A

sudden onset, persistant for 6 months or less
typically due to treatable factor like UTI

76
Q

Established (chronic) UI

A

could be sudden or gradual onset.
happens repeatedly, doesn’t just go away simply

could be stress, urge, mixed, functional, overflow

77
Q

stress UI

A

sneeze, laugh, cough. More in women

78
Q

urge UI

A

feeling like they have to all the time

79
Q

nocturia

A

wetting bed or getting up at night for bathroom

80
Q

overflow UI

A

more common in men w BPH, bladder is so full but difficulty voiding, causes leaking

81
Q

functional UI

A

inability to get to toilet

82
Q

mixed UI

A

multiple reasons cause UI

83
Q

care for UI

A

scheduled voiding
kegel exercises
lifestyle modifications- decrease caffiene, stop drinking before bed
adult briefs
anticholinergics, beta3 agonist, and antimuscarinics

84
Q

surgery for UI

A

colposuspenison
slings-Compensating for uterus not being there, puts a sling there to help bladder go back to old position. For women with hysterectomy’s

85
Q

last resort for UI

A

catheters, especially the inserted ones.

external arnt as bad

UTI can occur 48 hours after catheter insertion

86
Q

common UTI symptom in older adults

A

confusion

86
Q

most common cause of bacterial sepsis in older adults

A

UTI

87
Q

most common GI concern of older adults

A

constipation

seen more in hospitals due to narcotics and not moving as much

88
Q

s/s of fecal impaction

A

malaise, urinary retention, elevated temp, incontinence, alteration in cognitive status, fissures, hemorrhoids, intestinal blockage

89
Q

treatment of fecal impaction

A

oil retention enema or digital removal

90
Q

how to promote bowel function

A

increase fluid and fiber
promote exercise
regularity of bowel evacuation

91
Q

why should we cautiously use enemas and laxative

A

could become dependent on them, and they could cause rebounds

92
Q

what is fecal incontience often associated with

A

UI

93
Q

fecal incontinence care

A

biofeedback
surgery
meds
habit training
diet alterations
environmental manipulation
sphincter training schedules

94
Q

5 stages of sleep

A

Awake
N1- NREM
N2- NREM
N3- NREM
REM- neurotransmitters are reduced and repaired

each N stage is a deeper stage

95
Q

what sleep stage do elderly experience decreased of

A

N3, REM

96
Q

sleep architecture

A

predictable pattern of normal sleep

97
Q

Sleep disorders

A

insomnia
sleep apnea
restless leg syndrome
REM sleep behavior
circadian rhythm sleep disorder

98
Q

insomnia

A

DIFFICULTY going to sleep and staying asleep

requires that a person has difficulty falling asleep for at least 1 month and that it impairs daily functioning due to difficulty sleeping.

occurs in about half of those with dementia. can effect dementia caregivers if living at home

99
Q

promotion of sleep

A

Relaxation therapy, turn of electronics, exercise regularly, avoid caffeine, alc, tobbaco

100
Q

sleep apnea

A

a condition in which people stop breathing while sleeping followed by by arousal. Causes fragmented sleep and daytime sleepiness

risk factors are high BMI, large neck circumference

S/S- loud snoring, gasping, choking when waking, morning headaches, poor memory, personality changes

101
Q

self rating sleep scales

A

pgh sleep quality index
epworth sleepiness scale

102
Q

treatment of sleep apnea

A

depends on type

weight loss
smoking cessation
avoid alc, sedatives
avoid supine sleeping
use CPAP

103
Q

restless leg syndrome

A

a sensorimotor neurologic disorder characterized by unpleasant leg sensations that disrupt sleep

s/s= parathesia, crawling sensation, tingling, pain, burning, indescribable sensations

meds- antidepressants, neuroleptics

nonpharm- stretching, hot baths, relaxation, avoiding alc

104
Q

rapid eye movement sleep behaivor disorder

A

loss of voluntary muscle atonia during REM sleep, violent behaivors while dreaming. risk for injury

associated w parkinsons, Alzheimer, lewy body, supra-nuclear palsy

treatment-Clonazepam (benzodiazepine) be careful!!!

105
Q

circadian rhythm sleep disorders

A

normal sleep occurs at abnormal times

treatment is alterations in light exposure, expose to light more to keep awake, darken when need sleep

106
Q

how much activity do older adults need

A

Need a minimum of 30 minutes, 5 times a week (150 mins weekly)

107
Q

what do aquatic exercises help w

A

muscle strength, circulation, endurance

108
Q

what do yoga and tai chi help with

A

balance and flexibilty

109
Q

xerosis

A

Extremely dry, cracked, itchy skin
Associated with dehydration and environment

use creams, oils, tepid water

110
Q

pruritis

A

Itchy skin.
Often a symptom of chronic condition. Common in diabetics, renal failure, hepatic disease, iron deficiency anemia

can be aggravted by many things like detergent’s, clothing, sweating, exercise, anxiety

helpful measures include rehydration, compression, epsom salt, oatmeal

111
Q

scabies

A

Itchy skin caused by burrowing mites Contagious
Red tracks observed

treated by lotions and creams, cleanse rooms, linens, etc

112
Q

purpura

A

Appears as bruising. Blood vessels become weekend and rupture

common in dorsal forearms and hands

113
Q

skin tears

A

painful, acute, accidental wounds
common in thin, fragile skin

3 categories

avoid adhesive products, be gentle, have at risk individual wear long sleeves

114
Q

3 categories of skin tears

A

1- skin tear without tissue loss

2- skin tear with partial tissue loss

3- skin tear with complete tissue loss where epidermal flap is absent

115
Q

common causes of skin tears

A

equipment injury
patient transfers
ADLs
treatment and dressing changes

116
Q

seborrheic keratoses

A

benign growth- skin tags
common around trunk, face, neck, scalp, armpits. could be in single or multiple lesions

more common in men and dark skinned people

117
Q

actinic keratoses

A

precancerous lesion- watch closely
related to years of UV exposure

found on face, lips, hands and forearms

single or multiple rough, scaly, sandpaper like patches on an erythematous base.

early recognition and treatment is important

118
Q

herpes zoster

A

shingles
occurs along a nerve pathway or dermatone

begins w/ itching, tingling, pain

treated by oral antivirals

vaccine is available

119
Q

candidacies

A

Common in skin folds where it stays moist and dark, such as under breast, in axilla, groin area

could occur due to abx use

120
Q

whose at risk for skin cancer

A

pale or freckled skin
fair or red hair
blue eyes

121
Q

basal cell carcinoma

A

most common SC
slow growing

treatment is usually surgery with excision or mohs micrographic surgery

122
Q

squamous cell carcinoma

A

2nd most common SC

high risk for mid 60s chronic exposure to sun, like farmer

found on head, neck, hands

lesions are firm, irreg, fleshy, pink colored nodules that become red and scaly

treatment- electrodessication and curettage, mohs surgery, cryotherapy, topical 5 fluorouacil

123
Q

melanoma

A

less than 2% of skin cancers but accounts for most SC deaths

atypical, large, irreg

appears on legs and back of women and on backs of men

metastasizes quickly

124
Q

ABCDE

A

for melanoma

Asymmetry
Border irregular
Color variation
Diameter greater than size of a pencil eraser
Elevation and enlargement

125
Q

pressure injuries

A

localized damage usually over bony prominence
often occurs on sacrum, heels, greater trochanters
could also be on elbows, ankle, knees, occiput

prevention is key.

we dont restage in healing, we call it a healing stage _

126
Q

Stages of ulcers

A
  • Stage 1- Red nonblanchable area
  • Stage 2- damage to epidermis and dermis
  • Stage 3- damage to epidermis, dermis, hypodermis
  • Stage 4- into muscle, could possibly see bone
  • Unstageable- slough or eschar. We cant truly see
127
Q

prevention of pressure injury

A

skin assessments, repositioning, appropriate support devices

128
Q

skin change at end of life

A

occurs in last days or weeks of life

  • Hypoperfusion of tissues
  • Mottling - due to decreased blood flow
  • Red - Yellow - Purple area
    Becomes darker and spreads over time
129
Q

what does braden scale assess

A

sensory perception, moisture, activity, mobility, nutrition, friction or shear

The lower score the more at risk, the highest score is a 23

gero (4 decks)

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