Exam 3 Study guide Flashcards
Define the categories of abnormal blood pressure
Normal systolic > 120 and diastolic > 80
Pre HTN/Elevated 120-129 and > 80
HTN stage 1 130-139 and 80-89
HTN stage 2 140 > greater or equal to 90 or higher
Hypertension crisis higher than 180 and higher than 120
Discuss risk factors for hypertension
Stress High salt diet Obesity Physical inactivity Poor diet habits Low K diet Age Men vs women African american Family HX Smoking Too much alcohol Sleep apnea
Correlate clinical manifestations of hypertension to pathophysiological processes
Damaged blood vessels
Inflammation in the endothelium causes atherosclertoic disease which contributes to MO, CVA and chronic kidney disease
Describe the diagnostic results used to support the diagnosis of hypertension
urinalysis -protein in the urine specifically albumin
Urine Test- Protein and creatinine BMP CMP has albumin Lipid profile EKG ECG
Describe the lifestyle modifications and medication therapy for hypertension
Dietary-dash diet Limit sodium Psychical activity Consume alcohol in moderation 8-10 servings of veggies and fruit Arugula - has nitric oxide which vasodilates Baked chicken (usually the healthier option) over foods that are high in sodium such as ham Wheat bread over White bread
Create a care plan for care of the patient with hypertension
Obtain blood pressure
Educate pt and family on S/S of SEVERE HTN ONLY - increased bp, anxiety, early morning HA, irregular heart rhythm, buzzing in ear, chest pain, muscle tremors and vision changes.
Educate on importance of taking medication
Cluster care to provide rest between activities
Monitor Is and Os
Discuss the management of hypertension among older adults
Exercise 150 min a week Limit alcohol 1 drink women 2 drink men Eat mostly plants Fresh food rich in potassium Consider less rigid bp control - lower target can increase risk for orthostatic hypotension/fall risk
Describe hypertensive crises and their management
Emergency- life threatening requiring immediate TX to prevent organ damage
Use of IV vasodilators to gradually decrease BP
HTN urgency- BP elevated but no evidence of organ damage
Fast acting antihypertensive PO med recommended
Identify factors affecting movement and alignment
Developmental Physical health Mental health Lifestyle Attitude and values Fatigue and stress External factors
Discuss movement and alignment changes related to older adults
Loss of muscle tone
Increased convexity in the thoracic spine from disk shrinkage and decreased height
Subcutaneous fat loss
Arthritic joint changes may be present
Differentiate isotonic, isometric and isokinetic exercises
Isotonic
Muscle shortening and deactivate movement - fixed resistance
Examples include ADLs, swimming and jogging
Weights resistance
Isometric
Muscle contraction without shortening
Examples include yoga, planks
Isokinetic
Muscle contraction (lengthening) with resistance - speed is the same throughout arch of movement
Examples include weight training - varied resistance
Swimming, jogging
Compare the effects of exercise and immobility on the body
Immobility Increase C.O Increase risk for orthostatic hypotension Blood clots Decreased muscle strength Pressure sores Depression Resp issues Slower metabolism and decreased appetite and bowel movements Exercises Increased strength Endurance Improved appetite Improved respiratory and bowel function
Create a care plan for a patient with activity intolerance
Monitor vitals during and after activity
Encourage alternating activity and rest
Have pt perform return demonstration collab with PT
Educate pt about underlying condition if appropriate
What are the three postural reflexes?
They are responsible for the subconscious maintenance of the body’s posture when movement and position are altered
Righting reactions
A reflex that corrects the orientation of the body when it is taken out of its normal upright position
Placing reactions
Eliciting the placing reaction is the dangling leg posture
When baby moves their leg up, their arm on the same side moves up as well
Equilibrium reactions
The last of the motor reflexes to mature
Multidirectional range of movements
Identify factors affecting urinary elimination
Age
Diet
Exercise
Medication
Discuss urinary elimination changes related to older adults
Bladder muscles weaken
For women, urethra shortens and becomes thinner
Prostate problems for men
Describe characteristics of normal and abnormal urine
Normal
clear/ pale yellow color Slightly aromatic/ ammonia odor Specific gravity 1.001-1.035 Abnormal red-red/brown color Cloudy Veggies can change smell acetone/fruity odor
Create a care plan for a patient with impaired urinary elimination, urinary retention and urinary incontinence
For urinary retention
Assess pt bladder fullness
Encourage fluids
Monitor Is and Os
Monitor for s/s of UTI
Lower: symptoms in bladder, cystitis,
Upper: pyelonephritis, fever- only in upper, N/V, CVA tenderness, systemic symptoms - kidneys symptoms
For urinary incontinence
Assess impairments that can hinder ability to get to the bathroom
Encourage avoiding caffeine, alcohol and carbonated drinks
Assess signs of infection
Assess bladder distention
Develop voiding schedule
Assess for skin breakdown
Monitor for signs of UTI
Lower: symptoms in bladder, cystitis, frequent urination with pain (dysuria), dark, cloudy tinged
Upper: pyelonephritis, fever- only in upper, N/V, CVA tenderness, systemic symptoms; high temperature i.e. fever, can see symptoms of lower UTI can be seen in upper UTI
Urinary Terms some definition
anuria - 24 hour urine output is less than 50 mL
Dysuria - pain or difficulty peeing
Frequency- increase in voiding
Glycosuria - presence of glucose in the urine
Nocturia - night time peeing
Oliguria - 24 hour urine output is less than 400 mL
Polyuria- excessive peeing
Proteinuria- protein in urine
Pyuria - pus in urine
Urgency - strong desire to void
Stress incontinence- loss of urine that happens with increased abdominal pressure (sneeze and laughing)
Reflex incontinence- emptying bladder without sensation to void
Functional incontinence- involuntary/ unpredictable passage of urine
Incontinence- uncontrolled loss of urine or feces
Urge incontinence- involuntary passage of urine happens after strong urgency to void
Overflow incontinence- involuntary loss due to overdistention and overflow of bladder
UroSepsis: infection in the blood caused by bacteria that can from urine
150-250 mL - gets urge
Normal production 1000-2000mL
600-100 mL - retention
If 100 mL left in bladder need to investigate
Should measure within 15 minutes of voiding - bladder ultrasound first-
Identify factors affecting bowel elimination
Age
Diet
Exercise
Medication
Discuss bowel elimination changes related to older adults
Muscle tone in the bowel and abdominal muscles weaken Prostate problems for men Malabsorption Slower metabolism can cause constipation Describe characteristics of normal and abnormal stool Normal Brown color Pungent odor Soft, formed consistency Daily or 2-3x a week 150g/day Resembles diameter of rectum shape Abnormal White, clay, black, red or pale color Noxious odor Liquid or hard consistency narrow/ pencil shaped
Create a care plan for a patient with constipation and diarrhea
For constipation
laxatives/enema Increase fiber Food high in fiber; cereals with raisin bran Encourage fluid intake Exercise regularly Establish regular time to defecate digital removal of stool Anti-diarrheals PO glucose and electrolytes Endoscopy and colonoscopy Change diet Decrease use of straws
Systemic Circulation
Right Side -Deoxygenated Blood Superior/Inferior Vena Cava Right Atrium Tricuspid Valve Right Ventricle Pulmonic Valve Pulmonary Artery *Deoxygenated blood goes to the lungs* Left Side-Oxygenated Blood Pulmonary Vein Left Atrium Bicuspid/Mitral Valve Left Ventricle Aortic Valve Aorta *Oxygenated Blood goes to the body*
Ventilation is the moving of air in the lungs
Respiration is the exchange of o2 and Co2 between the atmospheric air in the alveoli and blood in the pulmonary capillaries
Diffusion is the movement of solute from higher to lower concentration
Perfusion is the blood from the left side of the heart, through systemic circulation, oxygenated cappliary blood passes through body tissue
Internal respiration is the exchange of oxygen and carbon dioxide between the circulating blood and body tissues
Describe common alterations in cardiopulmonary function and oxygenation
Arrhythmia
P and T waves abnormal
Hypoxia
Identify factors affecting cardiopulmonary function and oxygenation
Hyperventilation
Hypoventilation
Hypoxia
Decrease H&H
Conditions affecting chest wall movement
COPD
Discuss changes in cardiopulmonary function and oxygenation related to older adults
Previous smoker
Other conditions
Decrease mobility
Create a care plan for a patient with ineffective airway clearance, ineffective breathing pattern and impaired gas exchange
Ineffective airway clearance Elevate head of bed during and after meals Encourage coughing and deep breathing Possible aspiration precautions Monitor sputum Assess and monitor respiratory status Perform chest physiotherapy if needed Provide exercise and activity Suction pt airway as needed Monitor ABG Ineffective breathing pattern Impaired gas exchange Assist ADLs Auscultate breath sounds Monitor respiratory status Monitor signs of respiratory problems Perform chest physiotherapy Limit agitation Encourage incentive spirometry Monitor ABG Maintain airway Afterload, Preload, Stroke Volume Afterload- resistance of blood from L. ventricle Preload- amount of blood at end of ventricular diastole Stroke volume- amount of blood pumped out ventricle w each beat/contraction Differentiate types of oxygen delivery systems Regular nasal cannula mustache/ pendant cannula Simple face mask Partial rebreather with reservoir bag Non rebreather with reservoir bag High flow nasal cannula Venturi mask Regular nasal cannula O2 1-6 L/min 24%-44% Mustache or Pendent cannula o2 3x-4x more than regular cannula with same flow rate No humidifier Simple face mask o2 5-8 L/min 40%-60% Partial rebreather with reservoir bag 02 8-11 L/min 50%-75% Non Rebreather with reservoir bag o2 10-15 L/min 80%-95% High flow nasal cannula o2 Max flow 60 L/min 10 L/min-65% 15 L/min-90% Humidifier Venturi mask o2 Deliver precise, high flow rates Masks available of 24%, 28%, 31%, 35%, 40%, 60% Which o2 methods are low flow? Regular cannula Mustache or pendant cannula Simple face mask Partial rebreather Non Rebreather Which o2 methods are high flow? High flow nasal cannula Venturi mask Which o2 methods are used with a humidifier? Regular nasal cannula Simple face mask High flow nasal cannula
Skin Integrity & Wound Care
Identify factors affecting skin integrity
Age Broken skin Dehydration Dry skin Poor circulation Reduced mobility Malnourished Medication Decreased sensation
Discuss changes in skin related to older adults
subQ/dermal tissues are thin Increase risk of injury Decreased insulation Decrease elasticity Decreased sensation to pain Skin is dry and have itching Cell renewal is shorter/healing time is delayed Hair turns white/grey Decrease pigmentation Wrinkles
Identify wounds based on accepted classification system
Status of skin integrity Cause of the wound Severity of tissue injury Partial involving epidermis Full thickness-both layers of skin Cleanliness of wound Car accident/ sitting in dirt Descriptive qualities
What does it look/smell like
Discuss the normal process of wound healing
Injury occurs
Hemostasis
Blood flow stopped
Platelet aggregation
Inflammation
Neutrophils secrete chemicals to kill bacteria
Macrophages engulf debris
Proliferation
Fibroblasts secrete collagen
Epidermal cells migrate from the wound edge
Granulation tissue is formed
Remodeling/ Maturation
Wound contracts increasing tissue integrity
Fibroblasts secrete collagen to strengthen wound
Identify factors affecting wound healing
Local: infections, trauma, necrosis, dehydration, edema
Systemic: age, circulation, nutritional status, general health,
immunosuppressant, adherence to drugs
Discuss common wound complications
Hemorrhage Infection Dehiscence Splitting or bursting open of a wound Evisceration Being cut further Primary intention: open wound, closed surgically with staples Secondary intention: kept clean, left alone to let tissue repair, inside heals first Tertiary Intention: wound left open for a period of time, make sure no infection then surgically close with staples. Identify factors involved in pressure injury Aging skin Chronic illness Immobility Malnutrition Fecal and urinary incontinence Altered level of consciousness Spinal cord injuries Brian injuries Neuromuscular disorders Can a stage be reversed? No What is slough? yellow/white material in the wound bed Eschar Dead tissue/dry Undermining Occurs when tissue under wound edges becomes eroded Tunneling A wound that has progressed to form passageways under the skin
Unstageable
Base of wound not visible
Full thickness tissue loss
Completely obscured by necrotic tissue
Stage 1
Skin is intact
Nonblanchable
Stage 2
Shallow, open ulcer
Can be a blister with fluid
Particle thickness loss of epidermis with exposed dermis
red/ pink wound bed
Stage 3
Full thickness skin loss May see subcutaneous fat Sloughing may be present- yellow tissue Eschar may be present-dead tissue Possible undermining and tunneling
Stage 4
Full thickness skin and tissue loss
Exposed bone, tendon or muscle
Possible slough or eschar
Often undermining and tunneling
Braden Scale: Be able to diagnosis patients risk for pressure ulcer based on this scale
Low risk 23-19 ? Moderate risk 18-15 ? High risk 14-10? Very high 9 or below (lower score is higher risk)
Classify pain according to duration, location and etiology
Etiology Nociceptive Normal pain process Occurs from actual injury Most common Neuropathic Caused by lesion or disease of nerves Exact cause unknown Burning Stabbing Intractable Persistent and resistant Phantom Occurs with amputations Absence of pain receptors and nerves Psychogenic No physical cause can be identified Feelings of pain are just as intense as psychical pain Duration Either acute or chronic Acute-quick onset, protective, ANS activation Chronic- lasts longer than expected, lasts at least 6 months, variable, stigmatizing Acute example broken bone, pulled muscle, a cut Chronic example nerve damage, lower back pain, arththiris Location Cutaneous Superficial Somatic Deep Tendons Bones Well localized Visceral Occurs in organs Referred Pain is perceived at a site other than the original location
Pain management
- Patient Controlled Analgesia-drug (PCA): used after surgery/burns, administered IV. Patient is in control and can self administer by pushing a button
- Anesthesia-Local infiltration of anesthetic medication to induce a loss of sensation. Brief surgical procedures-removing a mole/lesion, suturing a wound
- Analgesics-creams, ointments, patches. Education important on placement
- Regional Anesthesia-injection or infusion of local anesthetics to block a group of sensory nerve fibers. - also block motor and autonomic functions
- Perineural Local Anesthetic-Type of regional anesthesia-infusion of local anesthetics infused through an unsutured catheter that is inserted near a nerve or group of nerves. Usually left in place for 48 hours. Continuous or intermittent infusion. On-Q pump.
- Epidural Analgesia-Type of Regional Anesthesia-Opioids or combination of anesthetics are administered into epidural space. Inserted by anesthesiologist or Nurse Anesthetists. Patients can self administer demand doses.
Identify factors affecting the pain experience
Culture
Ethnic variables Family, sex, age Religious beliefs Environmental Support system Past pain experiences Anxiety and stressors Fatigue
Discuss the pain experience of the older adults
The concentration of water soluble drugs (morphine) in the body is
increased. The volume of distribution for fat soluble drugs also increases
(fentanyl). This is because with aging, there is a decrease in muscle
mass, body fat increases, and body water percentage decreases.
Older adults often eat poorly, without an adequate protein intake, which
can lower serum albumin level. Many drugs are highly protein bound.
Low albumin can cause the active form of the drug to be more available,
increasing side effects and toxicity.
Liver and renal function naturally start to decline with age, which can
reduce the metabolism and excretion of drugs. Can cause a greater
peak and longer duration of analgesics.
Age related skin changes, such as thinning of the skin and loss of elasticity can affect the absorption rate of topical medications.
Create a care plan for a patient with acute and chronic pain
Acute pain Give meds Educate pt and family about meds Express importance of pain reporting Establish acceptable pain level Assess for nonverbal pain cues Assess pain characteristics, severity, location, onset, type, factors and duration Chronic pain Give meds Promote nonpharmacologic relief Same as above Transduction Activate pain receptors Transmission Sent to brain Perception Realizing its hot/awareness characteristic Modulation How to fix pain
