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Gero > Exam 2 updated > Flashcards

Exam 2 updated Flashcards

1
Q

What are manifestations of fecal impaction?

A

Malaise, urinary retention, increased temp, incontinence, cognitive decline, hemorrhoids, intestinal obstruction.

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2
Q

What are etiologies of heart failure?

A

-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

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3
Q

What are symptoms of Parkinsonian crisis?

A

-Severe exacerbation of tremors, rigidity, and bradykinesia
-Anxiety
-Sweating
-Tachycardia
-Hyperpnea

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4
Q

What condition is Heberden’s nodes found in?

A

only in osteoarthritis (head of finger)

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5
Q

What condition is Bouchard’s nodes found in?

A

OA and Ra

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6
Q

What is the client education for medications such as selegiline and rasagiline?

A

-same time everyday
-report insomnia
-postural hypotension prevention
-skin exams, risk of melanoma
-avoid foods containing tyramine

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7
Q

What are client education for levodopa and amantidine?

A

-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

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8
Q

What is the client education for tolcaone and entacapone?

A

-take with food
-no EtOH or sedatives
-interventions to prevent postural hypotension
-do not stop abruptly
-report muscle control changes, jaundice, dark urine, hallucinations

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9
Q

What is the client education for anticholinergics? (Benztropine (cogentin) and trihexyphenidyl (artane)?

A

-avoid activity which promotes fluid loss
-dont stop abruptly

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10
Q

How is OP diagnosed?

A

dexa scan & t-score (2.5 or greater)

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11
Q

What are interventions for OP?

A

-Weight bearing and resistance training
-Adequate calcium and vitamin D intake
-Education about fall prevention
-Pharmacological therapy to prevent bone loss

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12
Q

What are interventions for OA?

A

-weight loss
-exercise
-physical therapy
-hot/cold therapy
-adaptive devices (cane, shoe lift, knee brace)

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13
Q

What is pharm therapy for OA?

A

-acetaminophen
-NSAIDs
-joint injections
-acupuncture
-surgical intervention (athroscopy, total joint replacement)

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14
Q

What is pharm therapy for RA?

A

-Pain management
-DMARDs (disease-modifying anti-rheumatic drugs) - methotrexate
-Biological response modifier - “-mab”

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15
Q

What is the presentation of older adults with hyperthyroidism?

A

-tachy
-tremors
-weight loss
-apathetic thyrotoxicosis (slowed movement and depressed affect)

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16
Q

What is the nursing care for hypothyroidism?

A

-Prevent: chilling, constipation, skin breakdown, infection
-Assess: cardiac complications, edema, tachycardia, skin
-Lifelong levothyroxine therapy
-Warning: levothyroxine can cause digoxin toxicity

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17
Q

How is delirium assessed/diagnosed?

A

-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

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18
Q

What are ways to prevent delirium?

A
  • 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.
19
Q

What is aphasia?

A

partial or total loss of the ability to articulate ideas or comprehend spoken or written language

20
Q

What is apraxia?

A

partial or total loss of the ability to perform coordinated movements or manipulate objects in the absence of motor or sensory impairment

21
Q

What is agnosia?

A

loss of the ability to interpret sensory stimuli, such as sounds or images

22
Q

What are nursing interventions for wandering in AD?

A

Music, exercise, refreshments, social interaction
Camouflage doorways, enclosed areas for walking, electronic bracelets,

23
Q

What is apathetic thyrotoxicosis?

A

slowed movement and depressed affect

24
Q

Pre-op thyroidectomy care?

A
  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
25
Q

Post-op thyroidectomy care?

A
  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
26
Q

What are interventions for wandering?

A
  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
27
Q

What are characteristics of bulk forming laxatives? (psyllium, metamucil)

A
  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
28
Q

What are characteristics of emollient laxatives?
(docusate sodium)

A
  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
29
Q

What are characteristics of osmotic laxatives? (milk of mag, polyethylene glycol, and lactulose)

A

Cause water retention in the colon
Avoid MOM in individuals with renal insufficiency since use can lead to hypermagnesemia or hyperphosphatemia
Lactulose and sorbitol can cause diarrhea, abdominal cramping, and flatulence.

30
Q

What are characteristics of stimulant laxatives? (senna, bisacodyl)

A
  1. stimulate colorectal motor activity
  2. may cause f&e losses and cramping but safe and effective when used appropriately
31
Q

What is the emollient laxative?

A

docusate sodium

32
Q

What are the osmotic laxatives?

A

MOM, lactulose, polyethylene glycol, miralax

33
Q

What are the stimulant laxatives?

A

senna, bisacodyl

34
Q

What are preferred prescriptions to help with sleep?

A

zoldipem and ramelteon
-lowest dose and short term

35
Q

What are autonomic symptoms of PD?

A

Seborrhea (seb-o-REE-ik) dermatitis
Hyperhydrosis of face and neck
Heat intolerance
Postural hypotension
Constipation

36
Q

What does levodopa and amantidine do?

A

improves manifestations of motor dysfunction

37
Q

What do sellegiline and rasaligine do?

A

inhibits enzymes that inhibit or breakdown dopamine

38
Q

What do bromocriptine, pramipexole, and ropinirole do?

A

mimick effect of dopamine in brain

39
Q

What do tolcapone and entacapone do?

A

Inhibit COMT, which breaks down dopamine

40
Q

What do the anticholinergics do? (cogentine, artane)

A

blocks excitatory action of acetylcholine

41
Q

What are intervenions for thyrotoxicosis?

A

Cool with ice, ↓ levels of TH, replace fluids & electrolytes, give O2, stabilize cardiac function. Avoid ASA (increases TH)

42
Q

What are the manifestations of prostate cancer?

A

-General urinary complaints, retention, hematuria, back pain

-Cachexia, bone tenderness, lower lymphedema, adenopathy

43
Q

What are causes of hyperthyroidism?

A
  1. Autoimmune disorder: Graves disease is the most common
  2. Multinodular goiter (toxic goiter)
44
Q

What are causes of hypothyroidism?

A
  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

Gero (5 decks)

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