exam 3 Flashcards
sentinel events
involves injury or death. an event that should never happen
why are falls the leading cause of illness and death in older population
they are more likely to cause other issues, such as pneuminia
what do falls lead to
hip fx
TBI
fallphobia
nursing sensitive quality indicator
Looks at what nurse could have done better, etc
fall risk factors
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
factors that could lead to gait disturbances
arthritis
diabetes
dementia
parkinsons
stroke
alcoholism
vitamin D deficiency
foot derformites that could lead to falls
corns and bunions
overgrown toenails
uneven distribution of weight
orthostatic hypotension
from change in position, BP drops
postprandial hypotension
BP drops after meals
proprioception
bodys sense to feel that you are moving
what cognitive impairment increases fall risk
dementia and delerium
vision changes and falls
Decreased visual field
Decreased acuity
Reduced contrast sensitivity- not seeing light and dark as much, looks more grey
cataracts
medication that can decrease visual feils and cause imbalance that can lead to falls
non mitotic glaucoma meds
on hendrich II fall risk, what risk factors are the highest
confusion/disorientation
unable to rise without assistance
morse fall factors
history of falling
secondary dx
ambulatory aid
IV/hep lock
Gait
mental status
exercise for balance
tai chi or yoga
why can canes cause falls
Could cause issues if don’t know how to use properly due to false security
physical restraint
reduces ability of the patient to move
chemical restraint
can restrict/manage client behavior or movement
typically a drug/med
bed rails
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
what are restraints associated with
higher death rates
falls
nosocomial infections
incontinence
contractures
pressure ulcer
agitation/depression
what is temp monitoring influenced by
neurosensory changes
meds
economic, behavioral, environmental factors
hyperthermia risk factors
Diuretic use
insufficient fluid intake
Diabetes, Cardiac and Vascular conditions
meds
hypothermia risk factors
surgery
certain meds
inadequate housing
poor nutrition
excessive alcohol use
cardiac/resp/muscskel impairments
most common method of older adult suicide in men
guns
telehealth benefits
Reduced costs
Reduced travel
Promotes self-management
Decreased hospital readmissions
chronic illness trajectory- 8 phases
- Pretrajectory - Before the illness
- Trajectory - Signs & Symptoms present
- Crisis - Life-threatening situation
- Acute - Active illness
- Stable - Controlled illness
- Unstable - Symptoms not controlled
- Downward - Progressive decline - increasing disability
- Dying - Active decline - period preceding death
chronic illness
6 months or more
occurs and progresses slowly
2 out of 3 older americans have multiple chronic conditions
most common chronic illness
hypertension
affects more than 50% of older adults
consequences of chronic illness
physical suffering
loss
worry
grief
depression
functional impairment
increased dependence
goals for pts w/ chronic illness
maximize function and improve quality of life
pain
subjective sensation of physical, psychological, or spiritual distress
tolerance varies
barriers to pain management
attitudes of healthcare workers
compliance with taking analgesic prescriptions
cost of meds
brushing it off as old age
OLDCART
Onset
Location
Duration
Characteristics
aggravating factors
releiving factors
treatment
PAINAD (Advanced Dementia)
to assess pain in dementia pts
* Negative vocalization
* Facial expression
* Body language
* Consolability
nonpharm pain management
TENS unit
acupunture
touch
distraction
relaxation, meditation and imagery
pain clinics
pharm pain management
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
leading causes of vision impairments in geriatrics
cataracts
glaucoma
diabetic retinopathy
age related macular degeneration
cataracts
clouding of lens
2 types- nuclear (most common, age related), and cortical (from UV light)
treated with surgery- replacement of intraocular lens
cataract s/s
need for more intense light when reading
cloud/blurred vision
poor night vision
glare
nursing consideration after cataract surgery
Avoid heavy lifting
Wear glasses or protective lenses Administer eye drops - keep moist to heal and prevent infection
glaucoma
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
open angle vs angle closure glaucoma
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
s/s of open angle glaucoma
headaches
increased sensitivity to glare
tired eyes
fixed, dilated pupil
frequent changes in prescriptions
poor vision in dim lightening
s/s of angle closure glaucoma
redness and pain in and around eye
severe headaches
n/v
blurred vision
screening for glaucoma
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
diabetic retinopathy
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
screening for diabetic retinopathy
annual dilated fundoscopic eye exam should occur yearly at diagnosis of type 2, and begin 5 years after diagnosis of type 1
diabetic macular edema
thickening of the center of the retina
leading cause of legal blindness
detached retina
med emergency
can occur spontaneously, after recent cataract, or injury
“curtain coming down” in vision
treated with surgery
macular degeneration
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
dry AMD vs neovascular (wet) AMD
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
macular degeneration s/s
progressive loss of central vision, blurry spots in middle of vision, increased need for bright light, dim/gray color
macular degen tx
photodynamic therapy
laser photocoagulation
anti-VEGF therapy
dry eye causes and tx
causes- antihistamines, diuretics, beta blockers, sleeping pils
tx by artificial tears, saline gel
use home humidifier
how to reduce glare
yellow-amber sunglass lenses
risk factors for hearing impairment
noise exposure
ear infections
smoking
chronic disease- diabetes, CKD
Medications- aspirin, tylenol, NSAID
conductive hearing loss
involves external and middle ear
most common cause- cerumen impaction. treated with ear canal irrigation
other causes are tumors/growths, infection, fluid, otosclerosis
sensorineural hearing loss
involves inner ear
could be presbycusis or noise induced
tinnitus
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)
interventions for hearing loss
- Hearing aids
- Cochlear implants
- Assistive devices
- When providing teaching pause and verify understanding so you know they got it
hypothyroidism
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
hyperthyroidism
may have sudden onset
caused by graves, iodine ingestion, amiodarone, levothyroxine
s/s- afib, heart failure, diarrhea, anorexia, heat intolerance
apathetic thyrotoxicosis could occur
type 1 DM vs type 2 DM
type 1=body unable to produce insulin
type 2- body doesn’t make enough insulin
How is diabetes dx
*2 FPG readings over 126 mg/dL
hgb a1c over 6.5%
non-modifiable and modifiable risk factors of dm
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
S/S DM
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
cardiovascular risk factors
poor diet
smoking
alcohol use
high cholesterol
DM care
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
hypo vs hyperglycemia
Hypoglycemia symptoms- sweating, tingling, fatigue
Hyperglycemia symptoms- thirsty, polyuria, jittery, fruity breath, confusion, warm
osteoporosis
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
foods to increase calcium
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
arthritis
most common cause of disability in US
more common in women above age 45
4 types
osteoarthritis
polymyalgia rheumatica
rheumatoid arthritis
gout
osteoarthritis
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
rheumatoid arthritis
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
polymyalgia rheumatica
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
giant cell artesis
may occur with polymyalgia rheumatica
acute inflammation of arteries in scalp of temporal area
could lead to stroke
treated by high dose steroids
gout
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
