Exam 3 Flashcards
What is comfort?
A release from suffering, free from pain.
It is relative and everyone describes and experiences pain differently
Pain is affects comfort the most.
How many patients 65+ are affected by pain?
3 out of 5
How many patients 65+ suffer day-long bouts of pain?
1 in 4
What are the two types of pain?
Nociceptive pain
Neuropathic pain
What is Nociceptive pain?
Pain that comes from mechanical, thermal, or chemical stimuli
It can be either somatic or visceral
What is somatic pain?
Pain that is in the bone and soft tissue
It is localized/throbbing/ aching
Examples: bones, joints, muscles, connective tissue,
What is visceral pain?
It is associated with injuries or disorders to the interns organs
It can be generalized or referred.
Described as deep, cramping, pressing, aching.
Examples: heart, liver, pancreas, gut
What is neuropathic pain?
The abnormal processing of sensory stimuli from the central or nervous system. It had a sudden onset and is high intensity.
Described as sharp, stabbing, tingling, burning
What are some long term effects of unrelieved pain?
-limited mobility
-pressure ulcers
-pneumonia
-constipation
-poor appetite
-depression/hopelessness
-spiritual distress
What are general observations that show a patient is in pain?
-grimacing
-crying
-moaning
-clutching fists
-limited movement
-withdrawing
-restless
What 3 tools are used to assess pain?
1) numeric rating scale
2) visual analog scale
3) McGill pain questionnaire
What is the Numeric rating scale? And when would you use it?
Rating pain on a scale from 1-10
You would use this scale when a patient is coherent and able to answer questions
What is the visual analog scale? And when would you use it
Using “faces” or “horizontal line”
Uses this when patient is unable to communicate their pain
-Alzheimers
-stroke
-can’t respond
-they don’t understand
What is the McGill pain questionnaire?
Self reporting pain scale that consists of 78 descriptive words that are categorized into 20 groups. There is also a drawing of the body (front and back) the patient will use it to describe and pinpoint pain
Used for people who are cognitively normal or impaired. They must be able to read and hear
How do you create a patient pain management plan?
1) Identify what is causing the pain?
2) set SMART goals?
3) make sure plan is individualized
What is important to remember about medications for pain management?
1) always start slow and go slow
2) always use nonopioids before opioids
3) Adverse effects
4) medication interactions
What are different types of CAM therapy for pain?
-acupuncture
-acupressure
-aromatherapy
-biofeedback
-guided imagery
-massage
-relaxation
-heat/cold
-etc
What is the difference between acupuncture and acupressure?
Both are from Chinese culture to unblock and respite balance through invisible channels of energy “qi”
Acupuncture: putting needles under the skin
Acupressure: use of pressure points
What is Aromatherapy ?
Herbal medicine that uses scents from essential oils from plants to create psychological and emotional responses
note, do not us for someone who is experiencing upset stomach/nausea - such as people going through chemo
What two medications are CONTRAINDICATED in older adults?
propoxyphene
Pentazocine
Why: why are commonly used for pain but can have serious side effects in older adults
It can lead to CNS and cardiac toxicity, delirium, and seizures
What’s website provides evidence-based information that can assist in assist in assuring safe use of CAM therapies?
The national Center of Complementary and Integrative Health
What foods should be avoided that add to pain?
-Animal products/fat
-high-fat dairy
-egg yolk
-corn
-sugar
-junk food
-soy
-peanut oil
What is the most common medicine used for pain (opioid)
Morphine
If you come across a patient who is cry and upset, what is the first thing you should do?
Ask them what is wrong?
How long does pain have to last to be considered persistent?
3 months or longer
What are nursing comforting strategies for pain ?
Listening
Touch
Perceive
Explain
Give undivided attention
Safety statistics
1) women have a higher rate of injuries from falls
2) accidents rank the #6 leading cause of death
3) falls are the leading cause of injury related death
What is macro environment regarding safety?
Elements that are in the “larger world”
Example: weather, pollution, traffic noise, street lights, etc.
What is a micro environment regarding safety?
An individuals immediate surroundings that they closely interact with
Examples: furnishings, wall coverings, lighting, room temp, room sounds)
Out of Maslows hierarchy of needs which is most important regarding safety?
Physiological needs:
Shelter, air, functioning utilities, appliances, pest control
What temp should the room be kept at for older adults?
75 degrees
What is important about lighting to prevent falls
Lighting should be bright
During times of calm and relaxation, what kind of lighting is better?
Several diffused lighting sources are better than a few bright lights
What kind of lighting should be avoided and why?
Fluorescent lights as they can cause eye strain and glare
What is important about floor coverings and safety
Carpets and rugs are tripping hazards/fall risk.
Avoid clothes that lead to static electricity
What is important about furniture regarding safety ?
-appealing
-functional
-comfortable
-proper height and fit
-furniture should not be scattered
What is sensory stimulation regarding safety?
It is when you create an environment that is pleasing to the senses.
Textured walls
Soft blankets
Pictures
Plants/ flowers
Soft music
What is important about noise control and safety?
Sounds effect both emotions and physiologic
Sounds can create difficulty for older adults
Noise can be building design, landscape, paging system, street noise, animals, neighbors, etc.
Risk factors related to falls
History of falls
Female (75 and older)
Impaired vision
Gait disturbance
Postural hypotension
What percentage of adults 65+ experience a fall each year?
35%-40%
What things do older adult do that increase their risk for falls?
-dizziness
-Get up too quickly
-impared judgement
-not using or misusing mobility devises
-medications
-hypotension
-environmental hazards
-caregiver
What things can we promote patients to do to prevent falls?
-have them wear their glasses
-change positions slowly
-wear proper fitting shoes
-uses proper mobility aids
-make sure there is good lighting
What are alternative to restraints for safety?
-room by the nurses station
-one to one supervision
-alarms
-repositioning, soothing communication, touch
-frequent reality orientation
-diversions activities
What is Beers criteria?
It is an evidenced based list of medications that carry high risk for older adults and give criteria for potentially inappropriate medication use
What is biological half life?
The time it takes for half of a drug to be excreted from the body
What is Pharmaco- kinetics
4 stages meds
1) absorption
2) distribution
3) metabolism
4) excretion
What is pharmaco-dynamics ?
This is the biological and therapeutic effect of drugs at the site of action (on the target organ).
What is poly pharmacy ?
Use of multiple medications
What are the most commonly used drugs
Top 3:
-antihypertensives (for high blood pressure)
-analgesics (pain)
-antacids (reflux)
-cardiovascular agents
-sedatives
-tranquilizers
-laxatives
What is absorption
(Pharmacokinetics)
The movement of drug from the site of administration to various tissues of the body.
What route of administration is absorbed the fastest?
Injected medication
What route of administration is the most common?
Orally
What is distribution
(Pharmaco kinetics)
Movement of drug by circulatory system to intended site of action
*it can be difficult to predict due to changes in circulation, membrane permeability, body temp, and tissue structure.
What can decrease drug distribution?
Dehydration and hypoalbuminemia
What is metabolism
(Pharmaco kinetics)
The change that occurs in a drug into a more or less potent form of the drug (more soluble form or inactive form)
*renal system excretes drugs
*liver influenced drug detoxification and excretion
What conditions will decrease a drugs metabolization ?
-dehydration
-hyperthermia
-immobility
-liver disease
What is excretion
(Pharmaco kinetics)
Elimination of drug or metabolizes thru various parts of the body
Liver / kidneys
What are ways to promote drug safety ?
-avoid potentially inappropriate drugs
-review Beers criteria
-identify drugs that are high risk
-review necessity of drugs: why were they ordered? Is this the smallest dose? Any allergies? Any other drugs that may interact?
What can be an issue with suppositories in older adults?
Their decreased body temp may affect the ability to melt the suppository
What factors influence self-administration
-functional/physical limits
-cognitive limits
-educational limits
-sensory limits
-financial limits
-choice
Why is it important to monitor lab values?
-blood tests show what the medication levels are in the blood
-be sure to assess limits for older adults being able to have lab testing
What are analgesics used for?
1) relieve minor / moderate pain
2) administer regularly (to maintain constant blood level)
Analgesics (aspirin vs Tylenol)
Both drugs are: -NSAID (nonsteroidal anti inflammatory drugs
Aspirin:
-processed through kidneys
-can lead to kidney failure
-can cause GI bleeding
-anti inflammatory
Acetaminophen:
-processes through liver
-no anti inflammatory activity
-can cause false results in blood glucose levels
M
What is the maximum amount of acetaminophen that a person can take a day?
4000 mg
What are the signs of toxicity for analgesics ?
Dizziness
Confusion
Vomiting
Fever
Sweating
Hearing loss
Tinnitus
Burning in mouth and throat
Convulsions
Coma
What are the nursing guidelines for analgesics
1) assess pain and symptoms for underlying cause
2) explore all non pharmacological means first
3) observe for infection
What can long term aspirin use lead to?
Bleeding and delayed clotting time. Observe for anemia, bleeding, and altered hemoglobin and prothrombin time
What can a patient with diabetes who takes aspirin with sulfonylureas lead to?
Hypoglycemia
What are antacids?
-used to decreased acid secretion
-used to increase intolerance to fatty and fried foods
Nursing guidelines for anti acids
-determine underlying cause as reflux may not be issue
-always ask patients if they are taking antacids (sometimes they forget to mention them)
-antacids can interfere with other drugs, so try to avoid them
-do not give meds within 2 hours after taking antacid
What is a concern for antacids that are sodium bicarbonate
should not be given to patients in a low sodium diet
Antibiotics
-used for treating infections
Risks for excessive antibiotic use
1) leads to antibiotic resistant bacteria
2) can lead to secondary infections
3) superinfections
Nursing guidelines for antibiotics
-obtain cultures to figure out specific bacteria / virus to focus antibiotic type
-Make sure antibiotics are given completely and on a regular schedule.
(To maintain constant levels)
Antibiotic interactions
-if penicillin and high-protein-bound drugs (aspirin, phenytoin, valproate, etc) then the effects of penicillin will be reduced.
-doxycycline can be decreased by aluminum, calcium, or magnesium -based laxatives, antacids, iron preparations, phenobarbital, and alcohol
-ampicillin and carbenicillin can be decreased by antacids, chloramphenicol, erythromycin, and tetracycline
-probenecid delays the excretion of most antibiotics with the risk that their levels will accumulate in the blood and increase side effects
Anticoagulants
Used to prevent arterial and venous thrombosis (blood clots)
Used for patients with history of blood clots, strokes, coronary disorders, prophylaxis if a patient has had hip surgery and mitral valve replacement
What are the risks to older adults for anticoagulants?
It can lead to bleeding in older adults 
What are the two main types of anticoagulants?
1) Heparin
2) Warfarin (Counarin)
What is heparin?
A rapid anticoagulant.
It does not unclog existing clots, but prevents new ones
It does this by blocking the eosinophiclic response to the adrenocorticoyropic hormone and insulin
What are the long term risks of using heparin?
1) osteoporosis
2) spontaneous fractures
What is warfarin (Coumarin)?
Used for long term care
Does not unclog existing clots, but prevents new ones
What are the nursing guidelines for anticoagulants?
-PT/INR most be monitored
-anticougulats must be administered at the same time every day
-watch for signs of bleeding
-avoid vitamin k rich foods as they reduce effectiveness of anticoagulants
-mango and papaya can increase INR (international normalization ratio)
-High doses of vitamin E can increase bleeding risk
-refrain from taking herbal products as they may interfere
-avoid using aspirin as it can cause excess bleeding
What is the antidote for anticoagulation medicine?
Vitamin K
What foods are rich in vitamin K?
-asparagus
-Bacon
-Beef liver
-Cabbage
-Fish
-Cauliflower
-green leafy vegetables
What is an anticonvulsant?
Used for seizures in older adults
(seizures can I have many causes so it’s important to treat the underlying cause to eliminate the need for the anti-convulsant)
It can also be used to treat bipolar, schizophrenia, chronic neuropathic, pain, prevent migraines, and other conditions
What are the risk for anti-convulsants
Higher risk of toxicity in older adults
Nursing guidelines for anti-convulsants
-understand side effects
-Understand these can depress psycho motor activity so ensure patients have adequate physical activity
-periodic evaluation of blood levels should be completed
-Drugs can worsen any existing liver or kidney disease
-They should not be discontinued abruptly
-do not take grapefruit juice and it can increase level of toxicity
What food/drink should patients avoid if they are on anti-convulsant ?
Great fruits and grapefruit juice
What conditions can anticonvulsant‘s worsen?
Kidney/liver disease
Glaucoma
Coronary artery disease
Prostate disease
What is antidiabetic (hypoglycemic) meds for?
Antidiabetic meds fall under insulin and sulfonylureas
Dosages are adjusted based to the persons weight, diet and activity level
What is Chlorpropamide?
An antidiabetic medication with a long half-life. Thus not recommended for older adults bc it can increase risk of hypoglycemia
What is Glyburide?
An antidiabetic medication that has a long half life, so it’s not recommended for older adults. It can increase risk of hypoglycemia
What is metformin?
An antidiabetic medication that is NOT recommended for older adults bc of its risk of metabolic acidosis
What are nursing guidelines for antidiabetic meds?
-make sure patient understands proper use and proper storage of meds
-all antidiabetic meds are NOT interchangeable
-people using this med should have medication cards to alert others if they become confused
-examine injection sites regularly
-avoid alcohol bc it drastically reduces sugar
What conditions can alter antidiabetic meds?
Fever
Trauma
Prolonged diarrhea or vomiting
Altered thyroid function
Heart, kidney or liver disease
What is antihypertensive meds for?
-to reduce high blood pressure
Why are the different types of a antihypertensives?
-diuretics
-beta-blockers
-ACE-inhibitor (angiotension - converting enzyme)
-calcium channel blockers
-Alpha- blockers
What is the most common type of antihypertensive med?
Diuretics
What are diuretics and how do they work?
Diuretics are a type of antihypertensive medication
And used for hypertension and CHF
-dilated blood vessels
-blunt sodium and water retaining effects
-helps kidneys eliminate salt and water (which decrease blood volume and lower BP)
What are beta blockers and how do they work?
They are an antihypertensive medication.
Types end in “olol”
Works by stopping the effects of the sympathetic division of the nervous system that responds to stress and increases BP.
What are the side effects of beta blockers? (antihypertensives)
-dizziness
-Fainting
-Bronchospasm
-Bradycardia
-Heart failure
-SOB
-Depression
-Vivid dreams
-Hallucinations
-Sexual dysfunction
-Increase triglyceride level
-Raynaud’s phenomenon (some areas of the body feel numb or cool)
What is an angiotension-converting enzyme inhibitor? ACE inhibitor?
An antihypertensive medication
Types “pril”
-it is a well tolerated drug, so it is popular in use
-dilates arterioles by preventing the formation of angiotensin II
(Angiotensin II causes arterials to constrict and block action of ACE (the enzyme) which converts Angiotensin I to II)
Side effects if ACE inhibitors
Cough
What is a calcium channel blocker?
An antihypertensive medication
Types end in “pine”
Cause arterios to dilate by a complexity deferent mechanism
What are the side effects of CCB (calcium channel blockers)
-headache
-dizziness
-Flushing
-Fluid retention
-Problems with heart electrical system
-Bradycardia
-Heart failure
-Enlarged gums
-Constipation
What are Alpha-blockers?
An antihypertensive medication
Types: end in “osin”
Doxazosin
Prazosin
Terazosin
What are the nursing guidelines for antihypertension medication?
-Very important to take orthostatic blood pressure
-try other ways to reduce BP (weight, reduce sodium and alcohol, moderate aerobic exercise, stress management)
-get period blood work done
-do not abruptly discontinue
What are possible antihypertensive interactions?
-anti-hypertension, medicine can affect insulin and antidiabetic drugs, sedatives, diuretics
What food/drinks should you avoid while taking hypertensive?
Grapefruits and grapefruit juice 
What are NSAIDs (Non-steroidal Anti-Inflammatory drug)
Used to relieve mild to moderate pain and inflammation.
Used after Lower risk analgesics have failed.
What are the risks to using NSAIDs
-It can cause it worsen renal failure
-can raise BP
-can exacerbate heart failure
What are nursing guidelines for NSAIDs?
-narrow therapeutic window
-toxic levels accumulate easier and with lower doses.
-observe for side effects
-ensure blood evaluations are down regularly
-be alert to how long the patient has been taking NSAID
What food or drink should be taken with NSAIDs?
Milk - to reduce GI irritation
Why are the side effects of NSAIDs?
-GI symptoms
-impaired hearing
-CNS disturbances
-Delirium (older adults)
What are cholesterol lowering drugs?
Used to lower LDL cholesterol and raise HDL (high-density lipoprotein)
What are the types of cholesterol lowering drugs?
1) Statins
2) niacin
3) bile acid resins
4) fabric acid derivatives
5) cholesterol absorption inhibitors
What is statin?
A cholesterol lowering drug
-It is typically the first treatment
-it blocks the production of cholesterol in the liver
What are the main types of Statins?
1) Rosuvastatin (crestor)
2) Atorvasatin (Lipitor)
What are the side effects of Statin
-impair liver function
-muscle pain (myopathy and breakdown of skeletal muscles)
-renal failure
-headache
-drowsiness
-dizziness
-change in bowl habits
-abdominal cramping
What are bile acid resins
Cholesterol lowering drugs
-They work in the intestine
-bind bile to prevent it from being reabsorbed not circulatory system
What are the different types of bile acid resins (cholesterol lowering drugs)
-cholestyramine
-colestipol
-colesevelam
What are the side effects to bile acid resins?
Gas
Upset stomach
Constipation
What are fibric acid derivatives?
Cholesterol lowering drug that works by enhancing the breakdown of triglyceride-rich particles and decrease secretion of certain lipoproteins and induce syntheses of HDL
What are cholesterol absorption inhibitors
Inhibiting absorption of cholesterol in the intestines
What are nursing guidelines for cholesterol lowering drugs?
-encourage lifestyle changes first
-ensure liver functions tests are ordered
-monitor for interactions
Cognitive enhancing drugs
Used to improve cognitive function
It slows the progression of cognitive decline (it does not improve function)
Types of Cholinesterase inhibitors
A cognitive enhancing drug
Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine Tartrate (Exelon)
Tacrine (Cognex)
Types of NMDA receptor antagonist
A cognitive enhancing drug
Memantine (Namenda)
What are the side effects of cognitive enhancing drugs?
Nausea
Vomiting
Diarrhea
Anorexia
Weight loss
Urinary frequency
Muscle cramps
Joint pain
Swelling
Stiffness
Fatigue
Drowsiness
Nervousness
Depression
Confusion
Change in behavior
Abnormal dreams
Difficulty falling asleep/staying asleep
Discoloration of the skin
Red scaling itchy skin
What are the nursing guidelines for cognitive drugs
-evaluate patients mental status, cognition, ADLs
-monitor for gi bleed
-have patients be reevaluated as their underlying disorder progress
-do not abruptly stop drugs
-they interact with anticholinergics, aspirin, cholinergic drugs, cholinesterase inhibitors, long term use of NSAIDs
What is Digoxin
Used to treat CHF, arterial flutter or fibrillation, supraventricular tachycardia, extrasystoles
Can also be used to reduce edema
Nursing guidelines for Dioxin
-always take pulse rate before administering
-should not exceed 0.125 mg
Risk for Dioxin
-higher risk of toxicity in older adults due to longer biological half life
What are signs of toxicity in Digoxin
Bradycardia
Diarrhea
Anorexia
Nausea
Vomiting
Abdominal pain
Delirium
Agitation
Hallucinations / halos
Headache
Restlessness
Insomnia
Nightmares
Aphasia
Ataxia
Muscle weakness and pain
Cardiac arrhythmias
High serum drug levels
What are the three types of diuretics
1) Thiazides *can deplete potassium
2) loop diuretics
3) potassium-sparing diuretics
What is a Thiazide
ASCENDING LOOP
A diuretic that inhibit sodium reabsorption in cortical diluting site of ascending loop of Henle
-increased extraction of chloride and potassium
-can deplete potassium
What are loop diuretics?
PROXIMAL PORTION OF ASCENDING LOOO
A diuretic that Inhibits reabsorption of sodium and chloride at the proximal portion of the ascending loop of Henle
What are potassium sparing diuretics
DISTAL
Antagonized aldosterone in the distal tubule, causing water and sodium, but not potassium to be excreted
What are the risks for diuretics ?
Potential for fluid and electrolyte imbalance
Nursing guidelines for diuretics
-plan to administer them on a schedule that least intersects with patients schedule
-monitor I/O
-monitor/educate for signs of a fluid and electrolyte imbalance
-monitor hearing
-they can worse. Liver disease, rental disease, gout, and pancreatitis and raise blood glucose levels
Signs of fluid overload and electrolyte imbalance
Dry oral cavity
confusion
thirst
weakness
lethargy
drowsiness
Restlessness
Muscle cramps
Muscular fatigue
Hypotension
Reduced urinary output
Slow pulse
GI disturbances
What is a laxative drug?
Help a person pass poop
What are the different types of laxatives?
1) bulk forms
2) stool softeners
3) osmotics
4) stimulants
5) Lubricants
What are nursing guidelines for laxatives?
-recognize that constipation is a common geriatric risk
-assess carefully constipation before going right to laxative
-laxatives can have strong side effects and can interact with other drugs
-MUST drink with lots of water
What must a patient take when they are taking laxatives?
Lots of water!!!
What is a bulk former?
A laxative
It absorbs fluid in the intestines to create extra bulk.
It distends the intestine to help increase peristalsis
Takes 12-24 hours to work
What is a stool softener?
Laxative
Collects fluid in the stool to make mass softer and easier to move
Takes 24-48 hours
What is an Osmotics
Laxative
Pulls fluid into the colon
Causes bowl direction to increase peristalsis
Takes 1-4 hours to take effects
***contraindicated when there is a risk of fecal impaction
What is a stimulant?
Laxative
Irritate smooth muscle of intestines and pulls fluid into colon, causing peristalsis
-takes 6-10 hours
-can cause cramping and exceeding fluid evacuation
What is a lubricant ?
A laxative
It coasts decal material to facilitate passage
6-8 hours
Not recommended for older adults
What are different types psychoactive drugs?
1) Antianxiety
2) Antidepressants
3) Antipsychotics
4) sedatives / Hypnotics
What is an antianxiety drug ?
Used for disorders found in diagnostic and statistical manual of mental disorders
What are the two types of antianxiety drugs?
Short-acting benzodiazepine
Long-acting benzodiazepine
Benzodiazepines are on the BEERS list
What are short-acting Benzodiazepines?
-Alprazolam
-Estazolam
-Lorazepam
-Oxazepam
-Temazepam
What are long term benzodiazepines?
-Chlordiazepoxide
-Clonazepam
-Diazepam
-Flurazepam
-Quazepam
What are the side effects of benzodiazepines?
Dizziness
Unsteady gait
Drowsiness
Slurred speech
Confusion
Abdominal or stomach cramps
Increased heart rate
Increased perspiration
Sensitivity to light
Seizures
Hallucinations
Insomnia
Irritability
Nervousness
What are nursing guidelines for antianxiety meds
-exhaust all options before drugs
-make sure patients move slow and steady, avoid operating heavy machinery
-promote diet to help move food as antianxiety can cause constipation
-avoid alcohol and limit caffeine
-may take several days before meds take effect
What food/drink should be avoided when taking antianxiety?
Grapefruit / grapefruit juice
What are antidepressants?
A type of psychoactive drug
To help with depression
Types of antidepressants
-alpha-adrenoceptors
-Dopamine reuptake blocking compounds
-monoamine oxidase inhibitors
-serotonin antagonists
-selective serotonin norepinephrine reuptake inhibitors
-selective serotonin reuptake inhibitors (SSRI)
-tricyclic antidepressants
What is the best antidepressant for older adults
SSRIs (selective serotonin reuptake inhibitors)
They are well tolerated in older adults
What are the tricyclic antidepressants side effects
-Cardiotoxicity
-orthostatic hypotension
-anticholinergic effects
-arrhythmias
What are the nursing guidelines for antidepressants
-assess factors contributing to depression (causes could be finances, grief counseling, joining a group, etc)
-try therapies along with antidepressants
-start with lowest dose
-several weeks of therapy should be tried first
-observe for side effects
-must be discontinued gradually
What are the side effects of antidepressants?
Diaphoresis
Urinary retention
Indigestion
Constipation
Hypotension
Blurred vision
Difficulty voiding
Increased appetite
Weight gain
Photosensitivity
Fluctuating blood glucose levels
Dizziness
Drowsiness
Confusion
Dryness if the mouth
What are antipsychotics
A psychoactive drug
Used to treat delirium, agitation, psychosis due to Alzheimer, schizophrenia
Helps control symptoms
Can help improve quality of life and functions
What are the two major classes of antipsychotics?
1) first generation (conventional / typical) agents
2) second generation (atypical) agents
Second generation vs first generation
2nd gen have a lower risk of adverse effects and greater tolerability
However
They have separate side effects for older adults
What are the side effects of 2nd gen antipsychotics?
Hypotension
Sedation
Falls
Increase cerebrovascular adverse events
Mortality
When should 2nd gen antipsychotics be used for the elderly population?
BLACK BOX WARNING
-only for schizophrenia
What are the nursing guidelines for antipsychotics?
-physical and mental health evaluation must be complete first
-try to use other methods first (last result)
-should be used to treat specific disorders - do not use to manage behavior (if it is, can be considered a restraint)
-use lowest dose possible! It had a longer 1/2 life
-gradual weaning
Side effects for antipsychotics
Dry mouth
Constipation
Urinary retention
Blurred vision
Insomnia
Restlessness
Fever
Confusion
Disorientation
Hallucinations
Agitation
Picking behavior
Tardive dyskinesia
Parkinsonism
Akinesia
Dystonia
Falls due to hypotensives and sedative
Constipation
What can you not take with Warfarim?
Ginger Root
What is Lisinopril and what is it used for?
ACE Inhibitor
Used to treat hypertension by lowering blood pressure)
What do we use if we are worried about a patient falling when we are waking with them?
Gait belt
What can you not take with Coumadin?
Gingko Biloba
Bc it is a blood thinner
What drug do you use to lower cholesterol (aka hyperlymphedema)
Statin
What level of Dioxin is considered toxic in older adults?
Anything over 0.125 mg
What are the best meds to take for osteoporosis
Estrogen
What is a sign of end of life
Diaphoresis (sweating)
What is not a factor in coping and adapting to stress of illness/ disease?
CAM therapies
It is affective to start, but not long term
Quiz question: what should we avoid to prevent falls
Broken stairs
Dim lights
Throw rugs
A patient who is taking beta blockers used for hypertension, how do we want them to move?
Have them move slowly
When do we complete a fall risk assessment?
On admission
If a patient keeps coming back to the hospital what to we want to prevent?
Injury!!
Why do they keep coming back?
Falls, adverse to drugs? Infection? Environment?
What negative thing can Ginseng cause?
Hypertension
If a nurse is visiting an obese client with hypertension, what should we make sure he is not taking?
St. John. Worths.
It can exasperate hypertension
If a parent is having trouble taking meds at night what should we do when administering them?
Stay with them the whole time to make sure they got it down
Why does drug toxixity occur in elderly?
They are taking their meds incorrectly.
When discharging a patient we want to make sure of what? Regarding meds
All their meds are reviewed with ALL providers.
How often should older patients review their meds with the doc?
At least once per year, or at every doc appt
