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gero > exam 3 > Flashcards

exam 3 Flashcards

1
Q

sentinel events

A

involves injury or death. an event that should never happen

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2
Q

why are falls the leading cause of illness and death in older population

A

they are more likely to cause other issues, such as pneuminia

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3
Q

what do falls lead to

A

hip fx
TBI
fallphobia

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4
Q

nursing sensitive quality indicator

A

Looks at what nurse could have done better, etc

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5
Q

fall risk factors

A

Often multifocal
* Intrinsic- in the person there self
* Changes in vision and hearing
Unsteady gait
* Acute or Chronic Illness
* Medication side effects
* Toileting urgency
* Extrinsic
* Environmental issues
○ Flooring
○ Handrails
○ Lighting
○ Siderail use
* Inappropriate footwear
* Inadequate assistive devices

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6
Q

factors that could lead to gait disturbances

A

arthritis
diabetes
dementia
parkinsons
stroke
alcoholism
vitamin D deficiency

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7
Q

foot derformites that could lead to falls

A

corns and bunions
overgrown toenails
uneven distribution of weight

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8
Q

orthostatic hypotension

A

from change in position, BP drops

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9
Q

postprandial hypotension

A

BP drops after meals

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10
Q

proprioception

A

bodys sense to feel that you are moving

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11
Q

what cognitive impairment increases fall risk

A

dementia and delerium

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12
Q

vision changes and falls

A

Decreased visual field
Decreased acuity
Reduced contrast sensitivity- not seeing light and dark as much, looks more grey
cataracts

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13
Q

medication that can decrease visual feils and cause imbalance that can lead to falls

A

non mitotic glaucoma meds

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14
Q

on hendrich II fall risk, what risk factors are the highest

A

confusion/disorientation
unable to rise without assistance

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15
Q

morse fall factors

A

history of falling
secondary dx
ambulatory aid
IV/hep lock
Gait
mental status

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16
Q

exercise for balance

A

tai chi or yoga

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17
Q

why can canes cause falls

A

Could cause issues if don’t know how to use properly due to false security

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18
Q

physical restraint

A

reduces ability of the patient to move

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19
Q

chemical restraint

A

can restrict/manage client behavior or movement

typically a drug/med

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20
Q

bed rails

A

all 4 being up is considered a restraint, you need a order for this.

this could increase fall risk as patients try to get around them such as a obstacle

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20
Q

what are restraints associated with

A

higher death rates
falls
nosocomial infections
incontinence
contractures
pressure ulcer
agitation/depression

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21
Q

what is temp monitoring influenced by

A

neurosensory changes
meds
economic, behavioral, environmental factors

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22
Q

hyperthermia risk factors

A

Diuretic use
insufficient fluid intake
Diabetes, Cardiac and Vascular conditions
meds

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23
Q

hypothermia risk factors

A

surgery
certain meds
inadequate housing
poor nutrition
excessive alcohol use
cardiac/resp/muscskel impairments

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24
Q

most common method of older adult suicide in men

A

guns

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25
Q

telehealth benefits

A

Reduced costs
Reduced travel
Promotes self-management
Decreased hospital readmissions

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26
Q

chronic illness trajectory- 8 phases

A
  1. Pretrajectory - Before the illness
  2. Trajectory - Signs & Symptoms present
  3. Crisis - Life-threatening situation
  4. Acute - Active illness
  5. Stable - Controlled illness
  6. Unstable - Symptoms not controlled
  7. Downward - Progressive decline - increasing disability
  8. Dying - Active decline - period preceding death
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27
Q

chronic illness

A

6 months or more
occurs and progresses slowly

2 out of 3 older americans have multiple chronic conditions

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28
Q

most common chronic illness

A

hypertension

affects more than 50% of older adults

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29
Q

consequences of chronic illness

A

physical suffering
loss
worry
grief
depression
functional impairment
increased dependence

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30
Q

goals for pts w/ chronic illness

A

maximize function and improve quality of life

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31
Q

pain

A

subjective sensation of physical, psychological, or spiritual distress

tolerance varies

32
Q

barriers to pain management

A

attitudes of healthcare workers
compliance with taking analgesic prescriptions
cost of meds
brushing it off as old age

33
Q

OLDCART

A

Onset
Location
Duration
Characteristics
aggravating factors
releiving factors
treatment

34
Q

PAINAD (Advanced Dementia)

A

to assess pain in dementia pts
* Negative vocalization
* Facial expression
* Body language
* Consolability

35
Q

nonpharm pain management

A

TENS unit
acupunture
touch
distraction
relaxation, meditation and imagery
pain clinics

36
Q

pharm pain management

A

tylenol is first line approach. NSAIDs have higher risk of adverse effects

opioids- use w caution. monitor safety

adjuvant- increases effectiveness of analgesics. affective for neuropathic pain

37
Q

leading causes of vision impairments in geriatrics

A

cataracts
glaucoma
diabetic retinopathy
age related macular degeneration

38
Q

cataracts

A

clouding of lens
2 types- nuclear (most common, age related), and cortical (from UV light)

treated with surgery- replacement of intraocular lens

39
Q

cataract s/s

A

need for more intense light when reading
cloud/blurred vision
poor night vision
glare

40
Q

nursing consideration after cataract surgery

A

Avoid heavy lifting
Wear glasses or protective lenses Administer eye drops - keep moist to heal and prevent infection

41
Q

glaucoma

A

Increased pressure within the eye leads to Optic Nerve damage

2 main types- open angle, angle closure

treated by meds or eye drops to lower pressure, laser surgery

42
Q

open angle vs angle closure glaucoma

A

open angle- most common, effects peripheral vision first. develops slowly and is treatable.
high risk groups- htn, diabetes, family hx, corticosteroid use

angle closure- aqueous humor doesnt drain, increases pressure. medical emergency. can lead to blindness in days
more common in those with smaller eyes

43
Q

s/s of open angle glaucoma

A

headaches
increased sensitivity to glare
tired eyes
fixed, dilated pupil
frequent changes in prescriptions
poor vision in dim lightening

43
Q

s/s of angle closure glaucoma

A

redness and pain in and around eye
severe headaches
n/v
blurred vision

44
Q

screening for glaucoma

A

annual eye exam in those 65 and above

eye exam for those with controlled glaucoma every 6 months

annual eye exam for those with family hx at age 40

45
Q

diabetic retinopathy

A

leading cause of blindness in US

Complication of diabetes
blood and lipid leakage leads to macular edema and hard exudate

has no symptoms in early stage

*must have strict blood glucose control to reduce progression
Possible laser treatment can reduce vision loss

46
Q

screening for diabetic retinopathy

A

annual dilated fundoscopic eye exam should occur yearly at diagnosis of type 2, and begin 5 years after diagnosis of type 1

47
Q

diabetic macular edema

A

thickening of the center of the retina

leading cause of legal blindness

48
Q

detached retina

A

med emergency

can occur spontaneously, after recent cataract, or injury

“curtain coming down” in vision

treated with surgery

49
Q

macular degeneration

A

Leading cause of vision loss in 60 years and older

damage to CENTRAL PART OF RETINA

2 types: dry age related, neovascular (wet)

age is greatest risk factor

causes progressive loss of central vision, leaving only peripheral intact. screen with amsler grid

50
Q

dry AMD vs neovascular (wet) AMD

A

dry- more common. occurs more slowly, no leakage from vessels

neovascular- abnormal blood vessels behind retina start to grow under the macula. rapid, severe loss of central vision. may lead to legal blindness in 2 years

51
Q

macular degeneration s/s

A

progressive loss of central vision, blurry spots in middle of vision, increased need for bright light, dim/gray color

52
Q

macular degen tx

A

photodynamic therapy
laser photocoagulation
anti-VEGF therapy

53
Q

dry eye causes and tx

A

causes- antihistamines, diuretics, beta blockers, sleeping pils

tx by artificial tears, saline gel
use home humidifier

54
Q

how to reduce glare

A

yellow-amber sunglass lenses

55
Q

risk factors for hearing impairment

A

noise exposure
ear infections
smoking
chronic disease- diabetes, CKD
Medications- aspirin, tylenol, NSAID

56
Q

conductive hearing loss

A

involves external and middle ear

most common cause- cerumen impaction. treated with ear canal irrigation
other causes are tumors/growths, infection, fluid, otosclerosis

57
Q

sensorineural hearing loss

A

involves inner ear
could be presbycusis or noise induced

58
Q

tinnitus

A

ringing in ear
occurs when no external sound is present
may be constant or intermittent

risk factors- caffeine, cigarettes, fatigue, stress, meds (salicylates, NSAID, tylenol)

59
Q

interventions for hearing loss

A
  • Hearing aids
  • Cochlear implants
  • Assistive devices
  • When providing teaching pause and verify understanding so you know they got it
60
Q

hypothyroidism

A

most common thyroid disorder in elderly. slow onset

s/s-gait disturbance, fatigue, cold intolerance, constipation

treatment is to slowly replace thyroxine

myxedema coma could occur

61
Q

hyperthyroidism

A

may have sudden onset
caused by graves, iodine ingestion, amiodarone, levothyroxine

s/s- afib, heart failure, diarrhea, anorexia, heat intolerance

apathetic thyrotoxicosis could occur

62
Q

type 1 DM vs type 2 DM

A

type 1=body unable to produce insulin

type 2- body doesn’t make enough insulin

63
Q

How is diabetes dx

A

*2 FPG readings over 126 mg/dL
hgb a1c over 6.5%

64
Q

non-modifiable and modifiable risk factors of dm

A

Nonmodifiable - 45 age and above, 1st degree relative, previous gestational diabetes, hx of cardiovascular disease, atypical antipsychotics and glucocorticoids

Modifiable- high BP, overweight, undesirable lipid counts, inactivity

65
Q

S/S DM

A

May be difficult to diagnose in the elderly
Signs & Symptoms
* 3 Ps
○ Polyuria
○ Polydipsia
Polyphagia- cells think they are starving
Early warnings
Dehydration- urinating more trying to get rid of extra sugar
* Confusion
Vague symptoms
* Fatigue
* Nausea
* Delayed wound healing
* Paresthesia- numbness and tingling

66
Q

cardiovascular risk factors

A

poor diet
smoking
alcohol use
high cholesterol

67
Q

DM care

A

Goal is self-management

Medications
* Insulin
* Metformin (first line therapy)
Foot care
monitor for signs & Symptoms of hyper and hypoglycemia
Appropriate diet
* decreased carbohydrates- crackers, potatoes, sugary items, pasta, white rice, corn, bread
Daily exercise- needs to be on a consistent basis

68
Q

hypo vs hyperglycemia

A

Hypoglycemia symptoms- sweating, tingling, fatigue
Hyperglycemia symptoms- thirsty, polyuria, jittery, fruity breath, confusion, warm

69
Q

osteoporosis

A

Loss of bone density
Diagnosed by DEXA scan
*teaching
* Increase weight-bearing activities
* Increase calcium intake
* Stop smoking
* Encourage home safety
○ Decrease throw rugs and clutter
* Medications- calcium, vitamin D

70
Q

foods to increase calcium

A

dairy, Chinese garbage, tofu, soy milk, OJ, cheese pizza, green leafy veggies, tortilla , cooked soy beans, salmon, almonds, breads and cereals that are fortified with calcium

71
Q

arthritis

A

most common cause of disability in US
more common in women above age 45

4 types
osteoarthritis
polymyalgia rheumatica
rheumatoid arthritis
gout

72
Q

osteoarthritis

A

Most common type of arthritis
Degenerative joint disorder
Causes stiffness and pain which is relieved within 20 mins of movement
* Bone spurs
* Joint instability
* Narrowing joint spaces
* Crepitus
Common locations= Knee, Hands, Hips, Feet

73
Q

rheumatoid arthritis

A

Chronic, systemic, inflammatory joint disease
Autoimmune disease
Occurs in small joints
* wrist, knee, ankle, and hand

Symptoms
* Generalized fatigue
* Malaise
* Unexplained fever
May lead to systemic problems

74
Q

polymyalgia rheumatica

A

common inflammatory disease with unknown cause
develops slowly

see stiffening and pain begining in upper body, pain, low grade fever
pain is worse at night and in early morning
usually no joint inflammation

75
Q

giant cell artesis

A

may occur with polymyalgia rheumatica
acute inflammation of arteries in scalp of temporal area

could lead to stroke

treated by high dose steroids

76
Q

gout

A

Inflammatory arthritis
*Accumulation of uric acid crystals
Risk factors
* Alcohol use
* High blood pressure
* Diet high in purine (Meats, Anchovies, Sardines, Alcohol)
Treatment
* Avoid high purine foods and beverages
* Corticosteroids
* Colchicine

gero (4 decks)

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