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Elders > Exam 2 > Flashcards

Exam 2 Flashcards

Palliative Care, altered presentation

1
Q

Palliative Care

A

Care for patients with serious, life limiting illness

“To cloak”
To make less severe or intense, to relieve or sooth the symptoms of a disease or disorder

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2
Q

Frailty

A

State of increased vulnerability to poor resolution of homeostasis after a stressor event which increases risk of adverse outcomes.

Gradual decreases in physiological reserve occurs with aging, but in frailty decrease is accelerated & homeostatic mechanisms start to fail.

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3
Q

3 common things seen with frailty

A

Falls
Delirium
Fluctuating disability

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4
Q

Altered presentation risk factors

at greatest risk for atypical presentation

A
  • Over age 85
  • Multiple co-morbidities
  • Multiple medications
  • Cognitive or functional impairment
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5
Q

INDICATORS of frailty

A

Presence of 3 or more:

  • Self-reported exhaustion
  • Unintentional weight loss >10lbs/yr
  • Muscle weakness
  • Walking slowly
  • Low physical activity
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6
Q

Geriatric Syndromes

A

MOST COMMON:

  • Falls
  • Dehydration
  • Pain
  • Decrease in appetite
  • Dizziness
  • Loss of functional ability
  • Incontinences

Other

  • Adverse drug reactions
  • Skin breakdown
  • Sleep disorders
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7
Q

Pharmacokinetics

A

How BODY acts on DRUG

how drugs move thru body & how quickly this occurs. Gradual progressive decline in organ function affects pharmacokinetics

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8
Q

Pharmacokinetics - Elements

A
  • Absorption
  • Distribution
  • Metabolism
  • Excretion
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9
Q

.

A

.

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10
Q

Absorption

A

Movement of drug from site of administration into general circulation

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11
Q

Rate of absorption may be slowed due to:

A
  • Delayed gastric emptying
  • Reduced blood flow
  • Substances such as food & inert drug ingredients
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12
Q

Distribution

A

-Movement from plasma into cells

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13
Q

Four factor that alter distribution

A
  1. Increased % body fat
  2. Decreased lean body mass
  3. Decreased total body water
  4. Reduced concentration serum albumin
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14
Q

Metabolism

A

Hepatic metabolism declines due to:

  • reduced blood flow to liver
  • decreased liver mass, decreased enzyme activity
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15
Q

How many half-lives to eliminate a given drug

A

5 half-lives

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16
Q

Factors that effect metabolism more than age-related changes:

A
  • Diet
  • Caffeine
  • Smoking
  • Alcohol
  • Genetics/pathology
17
Q

Excretion

A

Drug accumulation due to decrease in RENAL function is most important cause of adverse drug reactions in elders

18
Q

Most important cause of adverse drug reactions in elders

A

Decreased renal function

19
Q

Index of renal function (best reflection of kindey function)

A

Creatinine Clearance

20
Q

Pharmacodynamics

A

What the DRUG does to the BODY

Interaction between chemicals introduced into body & receptors. When chemical binds to receptor therapeutic effect begins

21
Q

What changes pharmacodynamics

A

-Number and sensitivity of the receptors

22
Q

Meds that Increase receptor sensitivity

A
  • Benzos
  • CNS depressants
  • Warfarin
  • Anticholinergic
23
Q

Meds that decrease receptor sensitivity

A
  • Beta adrenergic
  • Vasodilators
  • TCAs
  • Antihypertensives
24
Q

Most common drugs for Adverse Drug Events

A 
Oral hypoglycemics
Cardiovascular
anticoagulants
diuretics
Taking > 7 meds
25
Q

Risk Factors for Adverse Drug Reaction

A
  • Polypharmacy
  • Female
  • Small Body
  • Hepatic or renal insufficiency
  • Previous ADRs
26
Q

Prescribing Cascade

A

Prescribing a drug to Tx the AE of another Rx’d drug.

-Prevent this by ALWAYS considering new S/S as consequence of current drug Tx.

27
Q

Risk Factors for Polypharmacy

A

-Multiple providers
_HCP’s lack of info about meds from other sources & pt’s non-adherence
-Elder fearful of disclosing folk remedies/other meds
-Elder not reporting self-directed changes
-Pt assume meds are indefinite
-Think same dose always appropriate
-Lack of early AE, assume wont have any AE
-Changes in habits, mental/emotional status
-Hoarding meds/insist on taking meds no longer Rx’d

28
Q

Three types of Blood draw

A
  1. Random Level
  2. Trough level- right before dose is due
  3. Peak- drawn at set time after given dose
29
Q

How often should meds be review with pt

A

At least ANNUALLY

30
Q

Functional Status

A

The capacity to safely perform daily tasks
that enable a person to live & function.
Sensitive indicator of health or illness of
an elder.

31
Q

Iatrogenic events

A

falls, fx, adverse drug reactions, nosocomial infections, use of chemical & physical restraints, diagnostic tests

32
Q

Cascade to Dependency

A

Process that leads to disability in person
who has normal aging changes and is on
bedrest in hospital.

33
Q

Deconditioning

A

Decrease in muscle mass & other
physiologic changes that result from
aging or immobility or both & contribute
to overall weakness

34
Q

Goals of a functional assessment

A

.

35
Q

Contributors to functional decline

A

.

36
Q

Long-term care

A

services & support,
formal & informal that help people function in community settings as well as possible despite long term disability or chronic illness

37
Q

Aging in Place

A

Range of services that allow older adults
to remain in one setting and receive
different levels of care as needs change.

    PACE programs (Program of All-inclusive
                                 Care for the Elderly)
38
Q

Culture change/person-centered care

A

.

Elders (5 decks)

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