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NRSE-4550 Adult Care 2 > Exam One Blueprint > Flashcards

Exam One Blueprint Flashcards

1
Q

Describe why clinical decisions making is complex in older adults

A
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2
Q

What is a chronic condition

A

conditions that do not resolve within three months and complete cures are rare

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3
Q

What are geriatric syndromes

A

collection of sx not specific to one disease

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4
Q

What is a very important role a nurse plays in caring for a person with a chronic condition?

A

providing patient with proper education

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5
Q

Patients with chronic conditions often are placed on several medications. what is important for the nurse to do with these

A

-perform medication reconciliation

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6
Q

managing chronic illnesses involves more than treating medical problems such as

A

pain management, client accepting dependence, diet changes, etc

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7
Q

What is the sandwich generation?

A

when ‘middle-aged’ person has parents and children to take care of

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8
Q

Before chronic conditions develop, what is an important regimen of healthcare

A

prevention such as lifestyle changes/interventions

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9
Q

Once chronic disease occurs, patient focus shifts to?

A

managing symptoms, avoiding complications, maintaining functional status

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10
Q

What are very important challenges we must remember for our patients living with chronic illness

A

-the right to die with dignity and comfort
-psychological adjusting is hard
-self-worth may become diminished

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11
Q

Do geriatric syndromes always have a diagnosis?

A

no

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12
Q

What does it mean that geriatric syndromes are multifactorial

A

-many things cause it to happen

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13
Q

Do geriatric syndromes have high prevalence of poor outcomes in the elderly?

A

yes

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14
Q

Normal changes of the heart during old age

A

-heart muscles thicken with age
-heart rate lowers and oxygenation lowers

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15
Q

Normal changes of the arteries with age

A

-stiffen with age
-heart has to beat harder to push blood through the arteries

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16
Q

Normal changes of the lungs

A

-maximum breathing capacity declines beginning at age 40

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17
Q

Normal changes of the brain

A

-axons and neurons are lostNorm

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18
Q

al normal changes of the kidneys with age

A

kidneys gradually become less effective at removing waste from blood

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19
Q

normal changes in bladder function

A

bladder capacity declines

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20
Q

normal changes toBody fat with older age

A

weight declines, fat is redistributed to deeper organs making them more vulnerable to heart disease

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21
Q

normal changes to muscles with old age

A

muscle mass declines 22 percent in women and 23 percent in men

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22
Q

Normal changes to bones with aging

A

bone mineral is lost, especially in women

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23
Q

What steps can be taken to reduce bone loss

A

weight bearing exercises, high calcium diet

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24
Q

Normal changes to sight with old age

A

-40’s= difficulty seeing close up
-50 and up = sensitivity to glare, hard to see in little light, more difficulty detecting moving objects
-70= decline in fine details

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25
Q

Normal changes to hearing in the older adult

A

-more difficult to hear higher frequencies in the older adult
-background noise makes it harder
-declines more rapidly in men

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26
Q

Normal changes to personality in the older adult

A

-stable throughout adult life (especially if healthy)
-risk for depression and social isolation

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27
Q

What is homeostenosis?

A

the inability of the body to restore homeostasis, even after minor environmental challenges (trauma or infection)

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28
Q

Is immobility a chronic condition or geriatric syndrome?

A

geriatric syndrome

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29
Q

Examples of ADL’s

A

toileting, bathing, dressing, feeding, incontinence

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30
Q

Examples of IADL’s

A

driving, telephone, shopping, laundry, handling finances, handling medications, housekeeping

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31
Q

What two things do IADL’s require to maintain functioning

A

-physical and cognitive performance

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32
Q

Do older adults lose the ability to perform ADL’s or IADL’s first

A

IADL’s

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33
Q

One of the hardest parts of aging for the older adult includes?

A

losing independency

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34
Q

Why do healthcare workers often cause dependency in the older adult?

A

-easier to perform their tasks than allow them time to do it (autonomy)

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35
Q

What are normal mobility changes found in the older adult?

A

decline in speed due to decreased stride length

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36
Q

Falls in the community dwelling are mostly due to?

A

environmental factors and risky behaviors

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37
Q

Environmental factors that may cause falls?

A

-poor lighting
-excessive equipment
-wet floors
-loose carpets
-poorly fitting shoes
-new surroundings
-pets around feet

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38
Q

Causes of fall in hospital / LTC facilities include?

A

-bathroom seeking
-gait
-balance disorder
-dizziness

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39
Q

If there is a new onset or increased number of falls in our patient, what should the nurse question could be wrong with them?

A

-new onset of infection
-new medication side effects (such as anti-cholinergic)

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40
Q

what type of anemia is most likely to cause a fall

A

-B12

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41
Q

What electrolyte imbalance is most likely to cause a fall?

A

hyponatremia (below 120)

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42
Q

Is hyper or hypoglycemia more likely to produce afall

A

hypoglycemia

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43
Q

What medications are most likely to cause falls in the older adult

A

-anxiolytics
-sedatives
-tranquilizers
-cardiac meds
-corticosteroids
-NSAIDs
-anticholinergic drugs (such as diphenhydramine)
-hypoglycemic agents

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44
Q

Normal time for Get Up and Go Test (TUG)

A

less or equal to 11 seconds

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45
Q

Implications if the client cannot complete TUG in less than 12 seconds

A

physical therapy

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46
Q

What gait is characterized by a flexed hand + circumduction of the foot? they also have more weakness distally leading to foot drop

A

hemiplegic gait

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47
Q

What gait is characterized by universal flexion of almost every joint and small steps/shuffling? they may also have small tremors of the hands and arms.

A

Parkinson’s gait

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48
Q

What gait is characterized by a wide stand with a wide staggering quality?

A

ataxic / cerebellar

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49
Q

People with ataxic gait are more likely to fall towards what side?

A

the side of their cerebral illness

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50
Q

What is titubation?

A

when a patient with a cerebellar/ataxic gait stands still and has swaying of the trunk

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51
Q

Is the Romberg test a good indication for cerebellar / ataxic gait?

A

no

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52
Q

What is a stomping gait?

A

when a patient cannot see , so they stomp on the ground to feel vibrations in their trunk that their foot is landed

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53
Q

Is stomping gait more evident in the daytime or nighttime?

A

nighttime because in the daytime patients can typically watch their own feet

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54
Q

What is the cerebral palsy/ diplegic gait?

A

arms flexed, adduction keeping their feet together, seem to walk on tiptoes (commonly seen in children)

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55
Q

What gait happens to people with myopathy?

A

waddling gait
-pelvis drops on both sides while walking, with the head leaning the opposite way to prevent falling

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56
Q

What is the neuropathic / steppage gait?

A

-when a patient has peripheral neuropathy and foot drop
-patient takes high steps so they do not trip on their foot and fall

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57
Q

trendelenburg vs waddling gait

A

trendelenburg occurs with myopathy on one side
-pelvis drops on opposite side of hip myopathy

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58
Q

What is the cautious gait?

A

-usually occurs after a fall
-wide stance, reduced arm swing, slightly stooped posture

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59
Q

Factors to consider when assessing the home for falls?

A

-rugs, clutter, foot wear, lights, hand rails/stairs, pets, how active they are, do they live alone, comorbidities, medications

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60
Q

do the active or inactive older adults have a higher risk for falls?

A

active

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61
Q

Physical consequences of falls?

A

-hip fracture (1/4 die < 6 most after multiple falls)
-pressure ulcer
-pneumonia

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62
Q

What is constipation

A

infrequent, incomplete, or painful evacuation of feces

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63
Q

How many days constitute constipation

A

no BM in 3 days

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64
Q

With normative BS, we should hear gurgling every

A

5-10 seconds

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65
Q

how long do we listen if we do not hear BS in any quadrant

A

5 minutes

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66
Q

What are some causes of constipation in older adults

A

-drinking less water
-medications
-eating less fiber
-disease
-inactivity

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67
Q

Why does overuse of laxatives lead to constipation?

A

dependency can form

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68
Q

why are older adults more likely to eat sweets than normal food

A

decline in taste buds make sweets taste better

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69
Q

What foods should we encourage the older adult to eat to prevent constipation>

A

fiber, prunes, coffee, bran, fiber one

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70
Q

How can diabetes cause constipation?

A

neuropathy can slow down gastric motility

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71
Q

What other diseases slow down gastric motility and may lead to constipation in the older adult?

A

Hypothyroidism, MS, Parkinson’s

72
Q

Passive peristalsis can be increased by

A

-exercise such as walking and leg lifts

73
Q

What medications are likely to cause constipation in the older adult?

A

anticholinergics and narcotics (pg 548)

74
Q

How much fiber does an older adult need a day to help prevent constipation

A

35-50 g / day

75
Q

How much water does an older adult need to help prevent constipation

A

at least 2 L / day (unless contraindicated)

76
Q

What is the ‘colon cocktail’ recommended to some older adults

A

equal parts prune juice, apple sauce, and psyllium. they should take 1-2 tablespoons daily

77
Q

Water’s role in preventing constipation

A

softens stool to make it easier to pass and prevent straining

78
Q

What should be done first when treating patients with constipation

A

lifestyle modifications and medication review

79
Q

What are examples of lifestyle modifications we can implement to prevent constipation in our patients

A

bowel retraining, regular toileting schedule, use of fiber

80
Q

Are prokinetic agents such as bethanechol and metoclopromide recommended in the elderly?

A

no

81
Q

Why should older adults not take metoclopramide

A

-potential for tardive dyskinesia and other EPS symptoms (which have to be treated with diphenhydramine)

82
Q

Why are hyperosmolar agents such as polyethylene glycol recommended in the elderly ?

A

-effective and non addictive

83
Q

What are the most physiologic treatment products for constipation?

A

bulk forming laxatives

84
Q

Example of bulk forming laxative?

A

psyllium

85
Q

Example of surfactant laxative (stool softener)

A

docusate sodium

86
Q

What are examples of osmotic laxatives

A

magnesium hydroxide, polyethylene glycol, lactulose

87
Q

What are examples of stimulant laxatives

A

bisacodyl, Senna

88
Q

If on a narcotic, what can be an adverse effect of this medication

A

opioid induced constipation

89
Q

If a patient is on a narcotic, what should be prescribed with them to prevent constipation

A

stimulant laxative

90
Q

Polyethylene glycol use puts our patient at risk for?

A

-dehydration (monitor I I’s and O’s)

91
Q

Chronic laxative use can lead to

A

fluid and electrolyte imbalances

92
Q

What two reasons make zofran a risk for causing constipation

A

-anticholinergic effects
-nauseas people typically aren’t drinking water

93
Q

Why is assessing patient transportation , food insecurity, and loneliness important?

A

may lead to poor nutrition

94
Q

If the measures of the ‘colon cocktail’ do not work, we should inform older adults to

A

take a stool softener

95
Q

Why do older adults often decrease fluid intake in the evening

A

decreased mobility, prescribed diuretics, and urinary incontinence

96
Q

Fluid restrictions in the older adult can lead to dehydration and electrolyte imbalances such as

A

sodium and potassium

97
Q

many older adults in the community are at risk for poor health due to

A

poor health literacy

98
Q

Is urinary incontinence considered a normal part of aging?

A

No

99
Q

Why is assessing for urinary incontinence in the older adult important?

A

-many are too embarrassed to admit
-major reason for LTC placement
-affects 1/3 of community - dwelling older adults

100
Q

What is urge incontinence?

A

-abrupt, strong urge to void with moderate to large amounts of leakage

101
Q

Causes of urge incontinence?

A

-UTI
-bladder spasticity
-caffeine
-CNS lesions (stroke/dementia)

102
Q

What is stress incontinence

A

instantaneous leakage during increased intraabdominal pressure

103
Q

Causes of stress incontinence

A

-pelvic muscle or ligament laxity (looseness of muscle)
-trauma from prostate surgery
-childbearing
-changes with menopause

104
Q

Stress incontinence may be brought on when a patient

A

sneezes, coughs, laughs, has obesity, is pregnancy

105
Q

What is overflow incontinence?

A

restriction of flow of urine leads to distended bladder

106
Q

Causes of overflow incontinence?

A

-atonic (lack of muscle tone) bladder
-Medications
-injury (TBI)
-impaired contractility

107
Q

What prostate condition in men regularly leads to overflow incontinence?

A

BPH (bladder outlet obstruction)

108
Q

What types of medications lead to overflow incontinence

A

anticholinergics, anesthetics

109
Q

what conditions can lead to impaired contractility and overflow incontinence

A

-b12 deficiency, diabetes, alcoholism
-stroke, MS, parkinsons

this occurs due to improper innervation of the bladder

110
Q

What is functional incontinence

A

inability or unwillingness to toilet

111
Q

Reasons that may cause functional incontinence

A

impaired cognition, environment, impaired mobility, psychological

112
Q

Incontinence and how it affects patient safety

A

causes increased risk of falls

113
Q

Incontinence and how it affects quality of life

A

may cause increased depression and social isolation (out of fear of not being able to get to a bathroom)

114
Q

When is it appropriate to catheterize a patient with incontinence

A
  1. overflow of bladder (not emptying)
  2. significant sacral wounds
  3. if on hospice
115
Q

Why should medication review be completed on those with incontinence

A

some medications cause urinary retention while others may cause frequency

116
Q

Why should we evaluate a client’s pelvic floor if they have incontinence?

A

weak pelvic floor muscles may lead to stress incontinence

117
Q

What is pelvic floor therapy?

A

-exercises to strengthen pelvic floor muscles and open urethra

118
Q

For a better understanding of their incontinence, what may patients be instructed to do to generate solutions

A

-3 day voiding diary

119
Q

Why is postvoid residual volume used to determine incontinence

A

-uses catheter or ultrasound to confirm urine left in the bladder after attempting to pee

120
Q

What labs may be evaluated to generate solutions for incontinence

A

-UA, BUN, Cr, WBC

121
Q

Post void residual will be low in what type of incontinence

A

-urge incontinence

122
Q

Post void residual will be high in what type of incontinence?

A

-overflow incontinence

123
Q

Treatment for urge incontinent includes

A

-initial therapy Kegels / PFT
-treat UTI
-Medications
-scheduled toileting for cognitive defects

124
Q

Atrophic vaginitis, a common cause of urge incontinence, is treated with

A

estrogen cream

125
Q

Our main concern for our patients on topical estrogen cream is

A

-applying it properly (2-3 days a week) to prevent systemic effects

126
Q

Other medications to treat urge incontinence include

A

-tricyclic agents (imipramine)
-tolterodine tartrate, Darifenacin, Solifenacin, or Oxybutynin

127
Q

Imipramine, a tricyclic agent used to treat urge incontinence, puts the patient at risk for

A

postural hypotension

128
Q

How does oxybutynin work?

A

relaxes bladder muscles

129
Q

Oxybutynin puts our patient at risk for

A

-anticholinergic affects
-slow reaction times
-orthostatic hypotension

130
Q

Treatment for stress incontinence includes

A

-evaluating medications that may aggravate
-Kegels/PFT
-treat atrophic vaginitis
-weight loss
-insertion of pessary
-toileting and fluid regimen
-surgery

131
Q

What is a pessary?

A

-a device inserted into the vagina to support your pelvic organs

132
Q

Why is surgery sometimes needed to treat stress incontinence

A

bladder tips back into pelvis after hysterectomy

133
Q

Treatment for overflow incontinence

A

-medication review
-bladder retraining
-improve glucose readings (diabetics)
-reduce ethanol / alcohol intake

134
Q

How to treat functional incontinence

A

-remove barriers to BR use
-use pictures on BR door
-improve mobility with PT / OT

135
Q

Tamsulosin, used to treat BPH and overflow, puts the patient at risk for?

A

-hypotension and falls

136
Q

How does tamsulosin work?

A

by dilating the urethra

137
Q

How do Kegel/ pelvic floor exercises help reduce incontinence

A

-strengthen the pelvic floor muscles

138
Q

How should we educate our patients to perform kegal exercises?

A

-tighten pelvic muscles for a slow count of 10 and then relax for a slow count of ten
-perform 15 reps while laying, sitting, and standing
-finish with 10 rapid contractions
-repeat 10 times a day

139
Q

what is the most common reason older adults become delirious and why?

A

-surgery because they do not process anesthesia as fast (most commonly cardiac)

140
Q

Other causes for delirium include?

A

-infection (UTI)
-hypoxia (not enough oxygen getting to brain)
-hypoperfusion (less oxygenation)
-trauma
-pain
-hypo/hypernatremia
-dehydration
-restraints
-medications
-constipation

141
Q

How does cholinergic deficiency cause delirium?

A

-decreased acetylcholine

142
Q

How does dopaminergic excess cause delirium

A

-increased amounts of dopamine

143
Q

What medications commonly cause delirium?

A

-anticholinergics
-benzodiazepines
-narcotics (specifically meperidine or codeine)

144
Q

Delirium can be treated by resolving the cause of it. Give examples:

A

-treating hypovolemia with fluids
-treating UTI / infections
-getting patients out of bed during the day so they sleep at night

145
Q

Symptoms of delirium

A

-confusion
-inattention
-restlessness
-hallucinations
-change in level of consciousness
-incoherence
-anxiety
-illusions
-delusions
-fear
-excitement

146
Q

How do we assess for delirium?

A

CAM (confusion assessment method)

147
Q

How to interpret results from the CAM

A

to be positive, the patient must display signs of
-section 1 and 2 + 3 OR 4

section 1: acute onset and fluctuations
section 2: inattention
section 3: disorganized thinking
section 4: altered LOC

148
Q

Why is it important to have family at the bedside and maintain consistent caregivers for patients experiencing delirium?

A

-provides therapeutic environment
-makes it easier to re-orient them

149
Q

What may be administered to our delirious patients to promote adequate sleep?

A

low dose trazodone

150
Q

What is polypharmacy?

A

when patients are on more meds than are clinically necessary

151
Q

Polypharmacy includes both

A

prescription and OTC drugs

152
Q

80% of older adults age 65-79 are on ____ medications/day

A

14

153
Q

80% of older adults greater than 80 are on ___ medications/day

A

18

154
Q

What are cues nurses should recognize that our patient is apart of polypharmacy

A
  • multiple forms of the same medicine
  • medication no longer needed clinically
  • more drugs than the patient can physically take (high pill burden)
155
Q

What categories of medications are often stacked and lead to polypharmacy

A

-BP and diabetic meds

156
Q

The risk of medication errors increases when

A

patients are transferred in care (ex: hospital –> LTC )

157
Q

When should medication reconciliations be completed

A
  1. each admission and discharge of acute care
  2. each provider visit
  3. by pharmacist, etc
158
Q

Why are medication reconciliation sometimes inaccurate?

A

-personal patient lists aren’t updated/ patients unable to communicate correctly
-illegibility of MAR’s on transfer
-same pharmacies aren’t used

159
Q

How many chronic conditions increases patient risk for MRP and ADE

A

6

160
Q

How many doses of drugs/ day puts patient at risk for MRP and ADE

A

12

161
Q

How many medications put patient at risk for MRPs and ADEs

A

9

162
Q

Having a low body weight or BMI increases or decrease the risk for an ADE?

A

increases

163
Q

Having a previous adverse drug reaction means?

A

the patient is more at risk of having another

164
Q

What age is a risk factor for MRPs and ADEs

A

85 or older

165
Q

Our patient is at risk for MRPs and ADEs if their creatinine clearance is an estimated

A

< 50 mL/min

166
Q

Most common adverse effects of drug-drug interactions?

A

-confusion
-cognitive impairment
-arterial hypotension
-acute renal failure

167
Q

What drugs have a high potential for severe ADE’s?

A

-amitriptyline
-chlorpropramide
-Digoxin > 0.125 mg/ day
-Disopyramide
-GI antispasmodics
-meperidine
-methyldopa
-pentazocine
-ticlopidine

168
Q

What drugs have a high potential for less severe ADE’s

A

-antihistamines
-dipyridamole
-ergot mesylates
-indomethacin
-meperidine, oral
-muscle relaxants

169
Q

How is absorption of medications affected in the older adult?

A

-gastric pH increases, GI motility decreases, and gastric blood flow decreases

170
Q

How is drug distribution affected in the older adult?

A

-small amounts of total body water and increased fat
-decreased albumin level

171
Q

Lipid soluble drugs and the older adult

A

-more body fat allows for the medication to stay in the body longer = toxicity

172
Q

Highly protein bound drugs and the older adult

A

-less protein = less inactivation of the drug
-may lead to toxicity in the older adult

173
Q

Decreased GFR and Creatinine clearance in the older adult increases their risk of ?

A

-toxicity due to slir ow excretion of drugs

174
Q

Drugs with a high first-past metabolism and their effect on the elderly

A

-decreased hepatic blood flow = decreased ability to inactivate drug –> increased bioavailability and risk for toxicity

175
Q

How can we ensure safe use of drug therapy in the older adult

A

-performing medication reconciliations at the correct time and with accuracy
-ensure they are using mechanisms to properly take their medications
-monitor creatinine clearance, GFR, and drug levels if needed

176
Q
A
177
Q

Popular anticholinergic drugs seen on the Beer’s list that may cause ADE’s in the elderly?

A

First generation antihistlamines
-diphenhydramine
-promethazine
-dimenhydrinate
Antiparkinsonian Agents
-benztropine
Antispasmodics
-atropine
-scopolamine
TCA
-amitriptyline

NRSE-4550 Adult Care 2 (2 decks)

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