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Gerontological Nursing > Exam 2: Gero Lecture 5 > Flashcards

Exam 2: Gero Lecture 5 Flashcards

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1
Q

dry cracked itchy skin. inadequate fluid intake worsens. use super-fatted soaps and cleansers

A

xerosis

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2
Q

itchy skin. a symptom not a diagnosis. may be r/t med side effects or secondary to disease. a threat to skin integrity.

A

pruritis

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3
Q

thin fragile skin – extravasation of blood into surrounding tissue. wear long sleeves and protect from trauma.

A

purpura

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4
Q

precancerous skin lesion. from sun exposure. derm visits every 6-12 months to monitor and treat

A

actinic keratosis

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5
Q

waxy, raised, “stuck on” appearance, benign lesion. almost ALL older adults over 65 y/o

A

seborrheic keratosis

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6
Q

painful vesicular rash over a dermatome, get vaccine at age 60

A

herpes zoster

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7
Q

yeast infection, often in skin folds. keep skin clean and dry

A

candidiasis

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8
Q

where are the highest incidences reported for pressure injuries?

A

hospitalized or institutionalized older adults and vulnerable adults undergoing orthopedic procedures

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9
Q

can significantly impair recovery/rehab and impact QOL. increased risk for mortality, high prevalence of health care litigation.

A

pressure injury

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10
Q

CMS now considers pressure ulcers a __________________ adverse event and do NOT reimburse treatment for pressure ulcers acquired during admission.

A

preventable

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11
Q

key factor in maintaining health =
important factor in delaying onset and managing chronic illness =

A

adequate nutrition
adequate diet

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12
Q

what does proper nutrition include?

A

carbohydrates – 45-65%
fat – 20-35%
protein – 10-35%
vitamins and minerals – 5 servings of fruit and veggies

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13
Q

what is overweight BMI?

A

25-29.9

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14
Q

what is obese BMI?

A

30-39.9

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15
Q

what is morbid obese BMI?

A

40+

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16
Q

1/3 of 65+ are obese, the majority are…

A

women

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17
Q

a geriatric syndrome, rising incidence in acute care, LTCF, and in the community. institutionalized older adults are at high risk due to chronic disease and functional impairments. comprehensive screening and assessment is critical to identify older adults at risk.

A

malnutrition

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18
Q

increased risk of what in malnutrition?

A

infection
pressure ulcers
anemia
hip fractures
hypotension
impaired cognition
increased morbidity and mortality

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19
Q

difficulty swallowing, about 20% of those over 50 y/o, and up to 60% of LTC residents.

A

dysphagia

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20
Q

dysphagia risk factors?

A

cerebrovascular accident
Parkinson’s disease
neuromuscular disorder (als, ms, etc.)
dementia
head and neck cancer
traumatic brain injury
aspiration pneumonia
inadequate feeding technique
poor dentition

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21
Q

dysphagia symptoms?

A

difficult labored swallow
drooling
copious oral secretions
coughing choking at meals
holding or pocketing food or liquids in mouth
difficulty moving food or liquids from mouth to throat
difficulty chewing
nasal voice or hoarseness
wet gurgling voice
excessive throat clearing
food or liquid leaking from nose
prolonged eating time
pain with swallowing
unusual head or neck posturing
sensation of something stuck in throat
heartburn
chest pain
hiccups
weight loss
frequent respiratory tract infections,
–> pneumonia

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21
Q

dysphagia symptoms?

A

difficult labored swallow
drooling
copious oral secretions
coughing choking at meals
holding or pocketing food or liquids in mouth
difficulty moving food or liquids from mouth to throat
difficulty chewing
nasal voice or hoarseness
wet gurgling voice
excessive throat clearing
food or liquid leaking from nose
prolonged eating time
pain with swallowing
unusual head or neck posturing
sensation of something stuck in throat
heartburn
chest pain
hiccups
weight loss
frequent respiratory tract infections,
–> pneumonia

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22
Q

dysphagia prevention of aspiration

A

supervise all meals
seated and rested before eating
sitting up at 90 degrees
dont rush meals
alternate solids and liquids
chin-tuck swallow
thickened liquids and pureed foods
avoid sedatives – may impair cough reflex
keep suction readily available
oral care

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23
Q

PEG tubes in advanced dementia myths?

A

prevent death from inadequate intake
reduce aspiration pneumonia
improve nutritional status
provide comfort at end of life

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24
Q

PEG tubes in advanced dementia FACTS?

A

do not improve QOL
do not prolong survival in dementia
associated with increased agitation, use of restraints, and worsening pressure injuries
50% of pt die within 6 months of insertion
are associated with infection, GI symptoms and abscesses
are popular r/t convenience and labor cost

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25
Q

adequate fluid consumption and maintenance of fluid balance essential to health

A

hydration

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26
Q

what are risk factors for changes in fluid balance?

A

Physiological changes in body water content
Impaired thirst sensation
Medications
Functional impairments
Chronic illness
Emotional illness
High environmental temperatures

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27
Q

what are reasons why dehydration risk increases with age?

A

water/body ratio decreases, making you more susceptible to dehydration

requiring the need of daily care as we are less able to handle day-to-day task

needing assistance with food and fluid can significantly reduce self-hydration

increase incontinence results in the need to replenish our fluids more often

cog impair can mean that we may forget to keep ourselves hydrated

with increased age brings diminished thirst sense

the need of multiple meds can increase the onset of dehydration

increase likelihood of acute illness, can result in out body being dehydrated

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28
Q

What are the dehydration categories?

A

can drink
can’t drink
won’t drink
end of life

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29
Q

can drink =

A

able to drink
may not know whats adequate
possible cog impair
encourage and make fluids accessible

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30
Q

can’t drink =

A

physical incapable to ingest or accessing fluids
dysphagia prevention
swallow evaluation
safe drinking techniques

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31
Q

won’t drink =

A

highest risk for dehydration
able to drink but refuses
offer frequently
prevent incontinence

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32
Q

end of life =

A

terminally ill
could be any of the previous 3
refer to advanced directives with regard to hydration wishes

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33
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

many of these signs are often unreliable in older people… LOOK AT BIG PICTURE (aka the pt)

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34
Q

How is dehydration generally confirmed?

A

lab testing

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35
Q

What are hydration interventions?

A

at least 1500 mL/day (2-3 L)
water is best
offer often
make readily available
encourage with meds
provide preferred fluids
verbal reminders

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36
Q

what is urinary incontinence?

A

urge, stress, functional

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37
Q

What are urinary incontinence interventions?

A

scheduled and prompted voiding
pelvic floor muscle exercises (kegals)
thorough assessment of continence
lifestyle modifications
meds
urinary cath –> last resort

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38
Q

What meds can worsen UIs?

A

meds with anticholinergic properties and diuretics

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39
Q

What is the most common cause of sepsis in older adults?

A

UTIs

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40
Q

often asymptomatic, cog impaired may not report symptoms, and normal for older adults to be asymptomatic, uncomplicated bacteria in urine.

A

UTI

40
Q

often asymptomatic, cog impaired may not report symptoms, and normal for older adults to be asymptomatic, uncomplicated bacteria in urine.

A

UTI

41
Q

what are atypical symptoms with UTIs?

A

mental status changes
decreased appetite
incontinence

42
Q

reduction in BM freq or difficulty in forming or passing stools. 40% older adults experience (more common in women)

A

constipation

43
Q

what are complications of constipation?

A

impaction
obstruction
cog dysfunction
delirium
falls
increased morbidity and mortality
increased risk for bowel cancer

44
Q

Age related bowel changes: small intestine

A

villi become broader, shorter, and less functional; blood flow decreases. proteins fats mineral (including Ca+), vitamins (vitamin B12), and carbohydrates (lactose) are absorbed more slowly in lesser amounts.

45
Q

What are constipation interventions?

A

increase physical activity = increases motility
proper positioning = squat, lean forward
toileting regimen = normalizes bowel function, attempt BM after breakfast or dinner (gastrocolic reflex) and allow at least 10 M for a BM
increase fluid intake = at least 1.5 L per day
increase dietary fiber = know foods high in fiber

46
Q

bulk-forming (fiber)

A

psyllium (metamucil)

47
Q

emollients

A

docusate sodium

48
Q

osmotic

A

polyethylene glycol (PEG), milk of magnesia, lactulose

49
Q

stimulant

A

bisacodyl, senna

50
Q

enemas:

A

last resort
don’t use on regular basis
may alter fluid and electrolyte status
sodium phosphate enemas contraindicated in older

51
Q

bulk forming (psyllium, methylcellulose)

A

usually 1st line agents due to low cost and few AE
do not use in presence of obstruction or compromised peristaltic activity
use with caution in frail older adults, bed bound, those with swallowing probs
must be taken with adequate fluid intake to avoid obstruction in esophagus, stomach, intestines
can cause abdominal distension and flatulence

52
Q

emollients and lubes (docusate sodium and mineral oil)

A

increase moisture content of stool
insufficient evidence to recommend docusate for prevention or treatment of constipation; may alleviate straining in selected pts who undergo rectal surgery or had myocardial infarction
use with caution in frail older adult who may not have the strength to push when having a BM since soft stool can accumulate in rectal vault
the emollient laxative mineral oil should be avoided bc of risk of lipoid aspiration pneumonia

53
Q

osmotic laxatives (milk of mag, lactulose sorbitol, polyethylene glycol (PEG, miralax)

A

cause h2o retention in the colon
avoid MOM in pts with renal insufficiency since use can lead to hypermag or hyperphosphatemia
lactulose and sorbitol can cause diarrhea, abd cramps, flatulence
MiraLax associated with less bloating and flatulence
these meds can be added if bulk laxatives are ineffective

54
Q

stimulant laxatives (senna, bisacodyl)

A

stimulate colorectal motor activity
may cause cramps and electrolyte or fluid losses but when used appropriately, they are safe and effective option, especially in those with opioid induced constipation

55
Q

complication of constipation, common in incapacitated and those in institutions (increased incidence with narcotics)

A

fecal impaction

56
Q

what are CM and complications of fecal impaction?

A

malaise
urinary retention
increased temp
incontinence
cog decline
hemorrhoids
intestinal obstruction

57
Q

what is the nursing management for fecal impactions?

A

first prevent!
removal of impaction –> digital removal of hard stool from rectum, use copious lube, may take several days, don’t disimpact too much, often very painful

58
Q

What are the sleep stages?

A

NREM 75% of night –> stages 1-4
REM 25% of night
most changes in sleep begin >50 y/o
less time in stage 3-4 (stage 3-4 = feeling rested and refreshed)
more time awake or stage 1
REM critical for elders – brain replenishment

59
Q

Sleep –> aging associated with:

A

Decreased sleep efficiency & total time
Sleep disorders
Circadian rhythm responses diminished
Increase in stage one of sleep – less REM
Longer to fall asleep
Frequent awakenings
Increased napping during day
Frequency of leg movement increased

60
Q

age related changes in the body perception of light-dark cycles and circadian sleep wake rhythm

A

biorhythm and sleep

61
Q

changes in this reduce amt of deep sleep and time spent in REM sleep

A

sleep cycles

62
Q

can adversely affect cog, emotional, and physical functioning as well as quality of life

A

sleep deprivation and fragmented sleep

63
Q

Disturbed sleep in the presence of adequate opportunities and circumstances
this is a DIAGNOSIS
Difficulty falling asleep >1 month
AND impairment in daytime functioning r/t poor sleep
Primary vs. comorbid

A

insomnia

64
Q

Insomnia –> Medications and substance - Causes

A

drugs and ETOH (10-15% of insomnia)

65
Q

Sleep teachings

A

maximize comfort
bedroom is for sleep
avoid or limit naps <2 H
exercise (not b4 bedtime) and outdoor time
bedtime routine
limit tobacco, caffeine, and ETOH – in evening
manage GERD
avoid screen time just b4 bed
if cant fall asleep – go to another room until tired

66
Q

Use of sleep medications (box 17.10)

A
  1. norm changes in sleep pattern with age
  2. importance of appropriate assessment of sleep problems b4 any meds are used
  3. sleep hygiene, stimulus control, sleep restrictions and relaxation techniques
  4. avoid otc meds that contain benadryl. s/s = confusion, blurred vision, constipation, and falls
  5. AE of sleep med, also OTC meds = problems with daily function, changes in mental status, possible motor vehicle accident, increase in daytime drowsy, and increase risk of falls with only minimal improvement of sleep
  6. avoid benzos (flurazepam, triazolam, temazepam) for sleep due to long acting sedative effects
  7. if sleeping meds are prescribed, benzos receptor agonists (zolpidem, eszopiclone, zaleplon) or ramelteon are preferred; given at lowest possible dose for short term use only (2-3 weeks, never longer than 90 days) meds for sleep should be taken immediately before bedtime
  8. avoid use of alc, narcotic pain relieving meds, and antianxiety meds if taking sleep meds
  9. review all meds, include OTC, with HC provider for interactions with sleep meds
  10. using caution the day after taking sleep meds, particularly w driving and activities that require full alertness; accidents are common.
67
Q

older adults should avoid sleep aids, in general especially…

A

benzodiazepines

68
Q

OTC meds =

A

diphenhydramine (Benadryl)

69
Q

the preferred sleep RX are?

A

bensodiazepine receptor agonist (zolpidem) or melatonin receptor agonist (ramelteon)
lowest dose (start 1/2 dose)
short term
zolpidem – high ED visits for adverse drug reactions
ALWAYS REMEMBER SAFETY

70
Q

periods of no breathing while sleeping

A

sleep apnea

assess with Epworth sleepiness scale

71
Q

what are s/s of sleep apnea?

A

excessive daytime sleepiness
snorting, gasping, choking
headache, irritability
symptoms are often blamed on age

72
Q

70% of men; 56% of women >65 y/o
decline in tone of upper airway muscles
linked to heart failure, cardiac dysrhythmias, stroke, T2DM, OP and death
limit/stop ETOH and sedatives, weight loss, smoking, CPAP

A

Obstructive sleep apnea

73
Q

what are the obstructive sleep apnea risk factors?

A

increased age
increased neck circumference (not a sign in older adults)
male gender
anatomical abnormal of the upper airway
family history
excess weight
use of alc, sedatives, or tranquilizers
smoking
HTN

74
Q

Physical activity guidelines:

A

2.5 hrs weekly of moderate aerobic
muscle strengthening activities at least 2 days per week – all major muscle groups
teachings:
mod intensity aerobic
muscle strengthening
stretching
balance

75
Q

cont. movement involving large muscle groups that is sustained for a minimum of 10 M, should make your heart beat faster

A

mod intensity aerobic

76
Q

cont. movement involving large muscle groups that is sustained for a minimum of 10 M, should make your heart beat faster

A

mod intensity aerobic

77
Q

involve moving or lifting some type of resistance and work all major muscle groups

A

muscle strengthening

78
Q

therapeutic maneuver designed to elongate shortened soft tissue structures and increase flexibility

A

stretching

79
Q

improve the ability to maintain control of the body over the base of support to avoid falling

A

balance

80
Q

Know the NO’s …

A

Don’t exercise when:
SBP > 200 mm Hg
DBP > 100 mm Hg
Resting HR > 120 bpm
For 2 hrs after a big meal

81
Q

what is guidelines for exercise safety?

A

comfy loose fitting clothes
warm up
drink h2o b4, during, and after
clothes that absorb sweat
wear sunscreen if exercise outside

82
Q

what are the age related changes for feet?

A

skin becomes drier, less elastic, cooler
subQ tissue on dorsum and sides of foot thins
plantar fat pad shrinks and degenerates
toenails become brittle, thicken, less resistant to fungal infections
degenerative joint disease decreased ROM

83
Q

Thick, compacted skin often from prolonged pressure. Pad and protect area is BEST. Proper fitting shoes.

A

Corns/Calluses

84
Q

Bony deformities – great toe or fifth toe from chronic squeezing or hereditary. Custom shoes, surgery, or steroid injection.

A

Bunions

85
Q

Permanently flexed toe (clawlike). Custom shoes or surgery.

A

hammer toe

86
Q
  • Yellow, brown, opaque, brittle and thick nails. Difficult to treat – costly & limited effectiveness.
A

onchomycosis

87
Q

what is the proper foot care?

A

If DM - Must have annual foot exam by healthcare provider
Care of toenails
Best cut after bath or soaking 20-30 min – softens nails
Clip straight across
Proper fitting footwear
Orthotic shoes as needed

88
Q

¹∕₃ over 65 y/o fall each year
10% sustain serious injury

A

geriatric syndrome –> falls

89
Q

falls are a ____________ of a problem

A

symptom

90
Q

what are consequences of falls?

A

Hip fractures
Traumatic brain injury
Fallophobia –> Fear of falling causing limitations in function

91
Q

what are the fall risk assessment tools?

A

Hendrich II Fall Risk Model
Morse Fall Scale

92
Q

what are the major risk factors for falls?

A

Orthostatic hypotension
Cognitive impairment
Impaired vision and hearing
Medications
Environmental factors
Weakness and frailty

93
Q

what are fall prevention interventions?

A

Fall risk reduction programs
Fall bundles: Arm bands, signs, education, risk assessment, footwear, assisted toileting
Environmental modifications
Assistive devices
Safe client handling
Wheelchairs
Alarms/motion sensors

94
Q

device to limit movement to prevent harm

A

restraints

95
Q

consequences of restraints in older adults?

A

Do not effectively prevent falls, wandering, or removing medical equipment
Probably exacerbate the problem
Restrain-related death: Asphyxiation
Pressure ulcers, agitation, cognitive decline, depression

96
Q

Side rails?

A

Not simply a part of the bed
Type of restraint: If two full length or four half length up
Research evidence does not show side rails reduce falls or injury
Some evidence that they increase injuries!
Centers for Medicare and Medicaid (CMS): Require documentation of need for side rails

97
Q

What is restraint free care?

A

the goal for care in older
should not be used to manage behavior symp
treat underlying prob
practice with the evidence

98
Q

What is the proper documentation that is needed to be done with restraints?

A

violent pt = every 15 M
cognitive pt = every 30 M - 1H

Gerontological Nursing (26 decks)

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