Final Lecture #2

Question 1

CV CMs

Answer 1

 Decreased CV reserve and output
 Decrease in HR
 HR 40-100 BPM
 Slow recovery from tachycardia
 Fatigue, SOB increased premature or ectopic beats
 Risk of valvular dysfunction and systolic murmurs
 Extra heart sounds common: s4 (not s3 which is always abnormal)
 Risk of postural and diuretic induced hypotension
 Increased SBP, pulse pressure, peripheral resistance
 Risk of carotid artery buckling, JVD
 Strong arterial pulses; diminished peripheral pulses; cool extremities
 Risk of inflamed varicosities

Question 2

resp CM

Answer 2

 Kyphosis: barrel shaped
 RR: 12-24 breaths/M
 Decreased respiratory excursion and chest/lung expansion with less effective exhalation and increased residual volume
 Diminished breath sounds particularly at lung bases
 Decreased cough, deep breathing, mucus/foreign matter clearance (risk of infection and asthma)
 Altered pulmonary function
 Lower maximal expiratory flow (FEV, FEV1/FVC1)
 Reduced vital capacity
 Unchanged total lung capacity, dyspnea on exertion, decreased exercise tolerance
 PO2, SpO2 decreased, decreased capacity to maintain acid-base balance

Question 3

GI CM

Answer 3

 Impaired digestive ability with possible food intolerances
 Risk of dehydration
 Electrolyte imbalances
 Poor nutritional intake PO
 Risk of gingivitis
 Tooth loss with chewing
 Impaired perception of taste and smell
 Risk of dysphagia, hiatal hernia, aspiration
 Delayed emptying of stomach
 GERD
 Decreased absorption of fat, carbs, protein, vit. B12, iron, folate, Ca+ and Vit. D
 Constipation
 Flatulence risk of fecal impaction
 Risk of AE drug reactions
 Cholecystolithiasis

Question 4

GU CM

Answer 4

 Risk of renal complications in illness
 Risk of dehydration
 Reduced excretion of acid load
 Risk of postural hypotension
 Decreased drug clearance
 Risk of nephrotoxic injury by drugs

Question 5

Skin CM

Answer 5

 Cool pale-dry skin
 Increased fragility, wrinkling, tenting, sagging
 Decreased elasticity, turgor, wound healing, and perspiration with reduced ability to maintain temp
 Risk of skin tears, ecchymosis, dermatitis, pressure ulcers, dehydration
 Increased senile lentigines, neoplasms
 Decreased sensation with risk of injury
 Decreased fat, muscle tone of feet affected ambulation
 Graying, dry, thin hair with facial hair alteration in men/women
 Thick brittle easily split nails with slow growth and risk of fungal infections

Question 6

MS CM

Answer 6

 Kyphosis, height loss, gait, and balance instability common
 Risk of osteoporosis and FX, osteoarthritis
 Reduced extremity fat
 Decreased total body water
 Risk of fluid imbalances
 Decreased muscle strength, slowed DTR/reaction times
 Decreased endurance joint stiffness with
 Decreased mobility, risk of injury, joint subluxation, crepitus and pain on ROM

Question 7

endocrine changes

Answer 7

 Reduced insulin secretion
 Increased insulin resistance
 Mineral metabolism affected by decreased vit. D synthesis, altered parathyroid hormone activity
 Estrogen declines in post-menopausal women with increased bone osteoclast activity
 Fluid/electrolyte balance affected by decreased rein-angiotensin aldosterone activity
 Increased arterial natriuretic hormone
 Body composition affected by decreased growth hormone
 Alter glucocorticoid and testosterone activity
 Decreased adrenal functional reserve and hormonal response

Question 8

immune changes

Answer 8

 Risk of infection
 Fewer antibodies made against bacteria/viruses
 Lower response to immunizations
 Immunocompromised (chronically)

Question 9

nervous changes

Answer 9

 Decreased in neurons, brain size, neurotransmitters
 Slow nerve impulse
 Conduction
 Decreased peripheral nerve function

Question 10

reproductive changes

Answer 10

 Perineal muscle weakness
 Decreased testosterone and estrogen
 Libido doesn’t change
 Vaginal wall thinning

Question 11

Hyponatremia (serum Na+ <135) symptoms?

Answer 11

 Hypotension
 Tachycardia
 Hyperthermia
 Nausea
 Malaise
 Lethargy
 Somnolence
 Confusion
 Poor skin turgor
 Increased thirst
 Muscle twitching
 Abdominal cramps
 HA
 Seizure
 Coma
 Elevated BUN and HCT

Question 12

Hypernatremia (serum Na+ >148) symptoms?

Answer 12

 Orthostatic hypotension
 Increased thirst
 Poor skin turgor
 Dry mucus membranes
 Weight loss
 Oliguria
 Lethargy
 Hyperthermia
 Elevated BUN, HCT, and creatinine

Question 13

Hyperkalemia (serum K+ >0.5) symptoms?

Answer 13

 Diarrhea
 CV dysrhythmias/arrest
 ECG abnormalities
 Irritability apathy
 Confusion
 Muscle weakness
 Areflexia
 Paresthesia

Question 14

UTI CM

Answer 14

 Dysuria
 Flank or suprapubic pain
 Hematuria
 Urinary frequency/urgency
 Cloudy/malodorous urine
 Anorexia
 Confusion
 Nocturia
 Enuresis

Question 15

FVO CM

Answer 15

 Weight gain >2%
 Input greater than output
 Bounding pulse
 Tachycardia
 Increased BP and CVP
 Distended neck/peripheral veins
 Crackles
 Dyspnea
 SOB
 Confusion

Question 16

dehydration CM

Answer 16

 Orthostatic hypotension
 Weight loss
 Tachycardia
 Hyperthermia
 Weakness
 Nausea
 Anorexia
 Oliguria
 Dry mucous membranes and skin
 Poor skin turgor
 Increased thirst

Question 17

Electrolyte labs that need to be obtained:

Answer 17

 Na+: decreased LTC (low intake, altered ADH, and increased H2O)
 K+
 Ca+: decreased (increased bone resorption, vitamin D)
 Glucose: low is most dangerous, insulin, malnutrition
 Albumin: decreased (prealbumin: acute malnutrition)
 PSA: limited use (>75 and high risk)

Question 18

Labs to obtain?

Answer 18

 RBC: production decreased (speed/marrow reserve)
 H/H: change with nutrition and fluid status
 WBC: change may be absent or delayed w/ infection; immunity aging theory
 ESR: decreased
 Vitamin B/C: short term malnutrition
 Vitamins A/E/B12/K: long term malnutrition
 Vitamin D: decreased

Question 19

taste and smell?

Answer 19

 Hyposmia: decrease in smell acuity
 Decrease neurons that send signal to the brain
 Difficulty distinguishing smells
 Decreased in taste secondary to change in smell acuity

Question 20

creatinine

Answer 20

more accurate measure of renal function and used to diagnose and monitor renal insufficiency.

Question 21

Cockcroft- Gault Equation

Answer 21

estimates renal function, formally used to dose possible toxic drugs, no longer recommended for pt use, should only be used for research purposes.