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Gero > Gero Exam 2 > Flashcards

Gero Exam 2 Flashcards

1
Q

Xerosis

A

Dry, cracked, itchy skin

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2
Q

What could worsen xerosis?

A

Inadequate fluid intake

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3
Q

Nursing management(s) of xerosis

A

Using super-fatted soaps or cleansers

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4
Q

Is pruritis a symptom or diagnosis

A

Symptom

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5
Q

What is pruritis related to

A

Medication SEs or
Secondary to disease

Threat to skin intergrity

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6
Q

Purpura

A

Thin, fragile skin
Extravasation of blood into surrounding tissue

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7
Q

Nursing management(s) of purpura

A

Wear long-sleeves
Protect from trauma

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8
Q

What is the common locations of xerosis

A

Face
Trunk
Extremities

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9
Q

What is the common location of purpura

A

The dorsalis forearm

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10
Q

Actinic kerotosis

A

Precancerous skin lesion

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11
Q

What is the cause of actinic kerotosis

A

Sun exposure
UV light

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12
Q

Nursing management(s) of pt w/ actinic keratosis

A

Dermatology visits every 6- 12 months to monitor and treat

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13
Q

Seborrheic keratosis

A

Waxy, raised “stuck-on” appearance, benign lesion

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14
Q

Almost all of the older adults over 65 got this ___

A

Seborrheic Keratosis

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15
Q

Herpes Zoster

A

painful vesicular rash over a dermatone

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16
Q

What is the common location of herpes zoster

A

The upper back

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17
Q

Nursing management(s) of herpes zoster

A

Ask for hx of chickenpox
Pain medication
topical medication
Droplet precaution

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18
Q

Candidiasis

A

Yeast infection

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19
Q

What the common location(s) of candidiasis

A

Skinfolds
Anywhere that is warm, moist, and dark

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20
Q

Nursing management(s) of candidiasis

A

Keep skin dry and clean

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21
Q

Who are higher risk of candidiasis

A

Obese
Malnutrition

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22
Q

Who are at high of risk of pressure injury

A

Immobility and prostheses

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23
Q

Treatments of Pressure Injury: DIPAMOPI

A

Debride
Identify and treat infection
Pack dead space lightly
Absorb excess exudate
Maintain moist would surface
Open or excise closed wound edges
Protect healing wound from infection/trauma
Insulate to maintain normal temperature

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24
Q

Look at Box 13-10 for Risk factors and Prevention

A
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25
Q

Stage 1 of Pressure Ulcers

A

Skin: Unbroken
Inflammation : redness

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26
Q

Stage 2 of Pressure Ulcers

A

Skin is broken to epidermis or dermis

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27
Q

Stage 3 of Pressure Ulcers

A

Ulcer extends to subcutaneous fat layer

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28
Q

Stage 4 of Pressure Ulcers

A

Ulcer extends to muscle or bone
Undermining is likely

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29
Q

Proper nutrition includes all the essential nutrients

A

Carbohydrates
Fat
Protein
Vitamin adn Minerals

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30
Q

Proper nutrition includes all the essential nutrients

A

Carbohydrates
Fat
Protein
Vitamin and Minerals

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31
Q

How much carbohydrates should be include

A

45-65%

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32
Q

How much fats should be include

A

20-35%

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33
Q

How much proteins should be include

A

10-35%

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34
Q

How much vitamin and minerals should be include

A

5 serving of fruits and veggies

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35
Q

The higher the score in the MNA, the patient is

A

Normal nutritional status (12-14)

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36
Q

The lower the score in the MNA, the patient is

A

Malnourished

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37
Q

Overweight

A

> = 25

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38
Q

Obese

A

> =30

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39
Q

Morbid obese

A

> =35

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40
Q

Malnutrition is a _____ syndrome

A

geriatrics

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41
Q

What is the rising incidence of malnutrition does it occurs

A

Acute care, Long term care, and in the community

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42
Q

Consequences of Malnutrition

A

^ risk of infection, pressure ulcers, anemia, hip fractures, hypotension, impaired cognition, ^ morbidity and mortality

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43
Q

Dysphagia

A

Difficulty swallowing

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44
Q

Look at Box 14-17 for Symptoms of Dysphagia

A
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45
Q

Look at Box 14-16 for Risk Factors of Dysphagia

A
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46
Q

Preventions of Aspiration (Dysphagia)

A

Supervise all meals
Seated and rested before eating
Sitting up @ 90 degrees
Don’t rush meals
Alternate solid and liquids
Chin-tuck swallow
Thickened liquids and pureed foods
Avoid sedatives-may impair cough reflex
Keep suction readily available
Oral care

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47
Q

Risk factors for changes in fluid balance

A

Physiological changes in body water content
Impaired thirst sensation
Medications
Functional impairments
Chronic illness
Emotional illness
High environmental temperatures

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48
Q

Can Drink Category

A

Able to drink
May not know what’s adequate
Possible cog impairment
Encourage and make fluids accessible

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49
Q

Won’t Drink Category

A

Highest risk for dehydration
Able to drink but refuses
Offer frequently
Prevent incontinence

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50
Q

Can’t Drink Category

A

Physical incapable to ingesting or accessing fluids
Dysphagia prevention
Swallow evaluation
Safe drinking techniques

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51
Q

End-of-life category

A

Terminally ill
Could be any of the previous 3
Refer to advanced directives w/ regard to hydration wishes

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52
Q

Signs of Dehydration

A

Skin turgor
Weight
Mucous membranes
Speech changes
Tachycardia
v UOP
Dark urine
Weakness
Dry axilla
Sunken eyes

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53
Q

What would be more reliable when looking for a pt w/ dehydration

A

Lab testing

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54
Q

How much fluids should the patient be intake

A

At least 1500 ml/day

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55
Q

Interventions for Hydration

A

Fluid quality (water is the best)
Offer often
Make readily available
Encourage with medications
Provide preferred fluids (no carbonated drink)
Verbal reminders

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56
Q

Urge Urinary Incontinence

A

Overactive bladder

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57
Q

Stress Urinary Incontinence

A

^ intrabdominal pressure (sneezing, coughing, laughing)
defined as leakage of some or more urine

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58
Q

Functional Urine

A

Nothing wrong w/ urinary tract

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59
Q

what are the 4 pharmacotherapy for constipation

A

bulk-forming
stimulant
osmotic
emollients

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60
Q

bulk-forming (fiber)

A

psyllium (metamucil) and methylcellulose

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61
Q

What is the first line of drugs for constipation

A

Bulk-forming due to low cost and few adverse effects

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62
Q

What population(s) should be bulk-forming caution?

A

Frail older people, bed-bound individual, and swallowing problems

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63
Q

What can bulk-forming laxatives can cause

A

abdominal distention and flatulence

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64
Q

Nursing consideration when taking bulk-forming

A

Must be taken w/ adequate fluid intake to avoid obstruction in esophagus, stomach, intestines

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65
Q

Emollients and lubricants

A

Docusate sodium

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66
Q

What is the action of emollients

A

^ moisture content of stool

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67
Q

What is emollients are used primarily for?

A

It is used for constipation but on specific situation (surgery)

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68
Q

What population(s) is caution when taking emollients

A

Frail older people who don’t have the strength to push

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69
Q

Osmotic laxatives

A

milk of magnesia (MOM), lactulose, polyethylene glycol (PEG), Miralax, sorbitol

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70
Q

Action of osmotic laxatives

A

Cause water retention in the colon

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71
Q

What population should avoid MOM

A

Individuals w/ renal insufficiency -> hypermagnesemia and hyperphosphatemia

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72
Q

What can Lactulose and sorbitol cause

A

Diarrhea, abdominal cramping, and flatulence

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73
Q

If bulk laxatives are ineffective add _____

A

Osmotic laxative

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74
Q

Stimulant laxatives

A

senna
bisacodyl

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75
Q

Action of stimulant

A

stimulate colorectal motor activity

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76
Q

What can stimulants can cause

A

cramping
elecctrolyte or fluid losses

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77
Q

Stimulant laxatives are effective and safe for people w/ _______

A

opioid-induced constipation

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78
Q

Chloride channel stimulating

A

Lubiprostone
Amitizal

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79
Q

Action of Chloride channel stimulating

A

stimulate ileal secretion and ^ fecal water

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80
Q

Chloride channel stimulating is safe, well-tolerated, and effective in _____________

A

Older adults w/ chronic constipation

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81
Q

SEs of Chloride channel stimulating

A

HA
ND

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82
Q

What is a complication of constipation

A

Fecal impaction

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83
Q

Manifestations and complications: fecal impaction

A

Malaise
Urinary retention
^ temp
incontinence
cognitive decline
hemorrhoids
intestinal obstruction

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84
Q

What is the first thing to avoid in fecal impaction

A

Prevent it!

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85
Q

Nursing management of fecal impaction

A

Digital removal of hard stool from rectum
Use copious lubricant
May take several days
Don’t disimpact too much
Ofter very painful

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86
Q

Paradoxical diarrhea

A

causses by leakage of fecal material around the impacted mass
may think they are having a BM

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87
Q

How many stages in Non-rapid eye movement?

A

4

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88
Q

What is Stage 1 of NREM

A

Lightest level
Between being awake and falling asleep

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89
Q

Stage 2 of NREM

A

Onset of sleep
Becoming disengaging from surroundings
Breathing and heart rate regular but temperature drops

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90
Q

Stage 3 and Stage 4 of NREM

A

“slow wave sleep”
Deepest and most restorative sleep
BP v
Breathing becomes slower
Tissue growth and repair occurs
Energy is restored

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91
Q

How much REM occurs

A

25% of the night

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92
Q

How long does REM recurs

A

every 90 mins and get longer later in the night

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93
Q

REM Sleep

A

REM key feature
Breathing ^ rate and depth
Muscle tone relaxes

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94
Q

When does dream occur more often

A

REM; 85%

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95
Q

Look Box 17-4 for Age-Related Sleep changes

A
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96
Q

What stages does elder spend less time on

A

Stage 3 and 4

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97
Q

Biorhythm and sleep

A

age related changes in the body’s perception of light-dark cycle and circadium sleep-wake rhythm

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98
Q

Sleep Cycle

A

changes in sleep cycle
v amoutn of deep sleep and time spent in REM

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99
Q

Insomnia is a diagnosis

A

True

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100
Q

Medications that affect sleep

A

SSRI
Antihypertensives
Anticholinergics
Sympathomimetic amines
Diuretics
Opiates
Cough and cold medication
Thyroid preparations
Phenytoin
Cortisone
Levodopa

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101
Q

Sleep teaching

A

Maximaze comfort
Bedroom is for 2 things
Avoid or limit nap < 2 hrs
Exercise and outdoor time
Bedtime routine
Limit tobacco, caffeine, EtOH in evening
Manage GERD
Avoid screentime
If can’t fall asleep -> go to another room until feeling sleepy

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102
Q

How much moderate aerobic should pt be doing weekly?

A

2.5 hrs weekly

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103
Q

How much muscle strengthening activities should pt be doing weekly

A

at least 2 days

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104
Q

Moderate intensity aerobic activity description

A

continuous moving involving large muscle groups that is sustained for a minimum of 10 mins; should make your heart beat fast

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105
Q

Benefits of Moderate intensity aerobic activity

A

Improves cardiovascular functioning, strengthening heart muscle, v blood glucose and triglycerides, ^ HDL, ^ mood

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106
Q

Examples of Moderate intensity aerobic activity

A

Biking, swimming, and other waterbased activites

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107
Q

Muscle-strengthening description

A

Activities that involve moving or lifting some type of resistance and work all major groups

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108
Q

Benefits of muscle-strengthening

A

^ muscles strength, prevents sarcopenia, reduce fall risks, improves balance

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109
Q

Examples of muscle-strengthening

A

lifting weight, calisthenics, working w/ resistance bands, heavy gardening

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110
Q

Stretching description

A

therapeutic maneuver designed to elongate shortened soft tissue structures and ^ flexibility

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111
Q

benefit of stretching

A

facilities ROM around joints, prevent injury

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112
Q

stretching frequency

A

2 day/wk

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113
Q

Examples of Stretching

A

Yoga and ROM exercises

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114
Q

Balance exercises description

A

movements that improve the ability to maintain control of the body the bsae of support to avoid falling

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115
Q

Benefits of balance

A

^ lower body strength, ^ balance, helps prevent falls

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116
Q

Examples of balance exercises

A

Tai chi, yoga, standing on one foot, etc

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117
Q

Look at Exercise Safety Box 18.6

A
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118
Q

Don’t exercise when….

A

SBP > 200 mmHg
DBP > 100 mmHg
Resting HR >120
2 hr after a big meal

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119
Q

Feet Skin becomes:

A

drier, less elastic, cooler

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120
Q

Corns/ calluses

A

Thick, compacted skin often from prolonged pressure.

121
Q

Nursing considerations Corns/Calluses

A

Pad and protect the area
Proper fitting shoes

122
Q

Bunions

A

Bony deformities: great toe or fifth toe from chronic dquzzing or hereditory

123
Q

Nursing considerations of Bunions

A

Custom shoes, surgery, or steroid injection

124
Q

Hammer toe

A

Permanently flexed toe (clawlike)

125
Q

Nursing considerations of hammer toe

A

Custom shoes or surgery

126
Q

Onchomycosis

A

Yellow, brown, opaque, brittle, and thick nails

127
Q

What foot problem is hard to treat?

A

Onychomycosis (costly and limited effectiveness)

128
Q

Proper foot care

A

DM: annual foot exam
Toenails: straight across and soaking 20-30 min (softening the nails)
Proper fitting footwear
Orthotic shoes as needed

129
Q

Is falls a symptom or diagnosis

A

Symptom

130
Q

Consequences of falls

A

Hip fractures
Traumatic brain injury
Fallophobiia

131
Q

Fallphobia

A

fear of falling causing limitations in function

132
Q

Major risk factors of Falls

A

Orthostatic hypotension
Cognitive impairment
Impaired vision and hearing
Medications
Environmental factors
Weakness and fraility

133
Q

Fall Prevention Interventions

A

Fall bundles
Environmental modifications
Assistive devices
Safe client handling
Wheelchairs
Alarm/motion sensors

134
Q

Restraints and Side rails

A

Device to limit movement to prevent harm

135
Q

Consequences of restraints in older adults

A

Do not effectively prevent falls, wandering, or removing medical equipment
Probably exacerbate the problem
Restrain-related dealt (asphyxiation)
Pressure ulcers, agitation, cognitive decline, depression

136
Q

Preventive phase (pretrajectory)

A

No S and S

137
Q

Definitive phase (trajectory onset)

A

S/S and diagnosis present

138
Q

Crisis phase

A

Life threatening situation

139
Q

Acute phase

A

Active illness requiring hospitialization

140
Q

Stable phase

A

Controlled illness course/symptoms

141
Q

Unstable phase

A

Not controlled but not requiring/desiring hospitalization

142
Q

Downward phase

A

Progressive decline

143
Q

Dying phase

A

Immediate weeks/days/ hours before death

144
Q

Fraility

A

Unintentional weight loss
Self-reported exhaustion
Weak grip strength
Slow walking speed
Low activity

145
Q

BP is okay if less than

A

150 and 90

146
Q

HTN Interventions (lifestyle changes)

A

Weight reduction (5-20 mmHg)
DASH diet (8-14 mmHg)
v Na+ intake (2-8 mmHg)
^ physical activity (4-9 mmHg)
EtOH in moderation (2-4 mmHg)

147
Q

HF etiology

A

damage from HTN and CHD
Ventricles enlarge and dilate

148
Q

CHF Also related to

A

EtOH abuse
Drug abuse
Chronic hyperthyroidism
Valvular disease
Some chemotherapy medications
Radiation therapy near heart

149
Q

LHF

A

Pump failure to body

150
Q

Systolic LHF

A

Decreased contractility (can’t squeeze)

151
Q

Diastolic LHF

A

Decreased filling (can’t relax)

152
Q

RHF

A

Pump failure to lungs
The result from LHF

153
Q

CHF (acute decompensated)

A

swelling, edema, fluids in lung (pulmonary edema)
S3 and S4 and tachycardia

154
Q

Cardiovascular interventions

A

Complete assessment of all risk factors and existing disease
Lifestyle changes
Medication regimen tailored to specific disease process and pt needs
Focus on symptom management and prevention of exacerbation of disease

155
Q

ACE and ARB

A

-pril and -sartan
vasodilation

156
Q

Diuretics

A

Loop, K+ sparing, thiazdiade
Reduce fluid retention

157
Q

B-blocker

A

-lol
Improve contractility of heart muscle

158
Q

Progressive disease: over ____ yrs

A

10-20

159
Q

What is dopamine responsible for

A

regulates nerve impulses for motor function

160
Q

Classic Triad

A

Cogwheel Rigidity
Bradykinesia/Dyskinesia
Resting/Non-intention tremors

161
Q

Cogwheel Rigidity

A

Small jerking movements when affected muscles stretched
Muscle rigidity

162
Q

Bradykinesia/Dyskinesia

A

Difficult starting, continuing, and or coordinating movement
Shuffling
May become frozen (akinesia)

163
Q

Resting/Nonintention tremors

A

Fine, rhythmic, purposeless tremors (disappear w/ sleep adn purposeful movements)
Pills rolling, small handwriting, low monotone voice

164
Q

Autonomic Dysfunction (PD clinical signs)

A

Seborrhea dermatitis
Hyperhidrosis of face and neck
Heat intolerance
Postural hypotension
Constipation

165
Q

Cognitive and Psychologic Dysfunction (PD- Clinical signs)

A

Dementia
Memory loss, lack of problem solving, v intellect
anxiety
depression
sleep/wake reversal
Visual disturbance
Psychosis

166
Q

Complications of PD: Late stage

A

Pressure ulcers
Pneumonia
Aspiration
Falls

167
Q

Parkinsonian Crisis

A

Major complication
precipitated by emotional stress or sudden withdrawal of meds

168
Q

Manifestations of PD complications

A

Severe exacerbation of tremors, rigidity, and bradykinesia
Anxiety
Sweating
Tachycardia
Hyperpnea

169
Q

Treatment and Interventions PD complications

A

Respiratory/cardiac support prn
Non-stimulating environment
Psychological supports
Restarting medications

170
Q

PD interventions

A

Early assessment and symptom management
Surgical procedures
Drug therapy focuses on mimicking or slowing dopamine breakdown

171
Q

Surgical interventions PD

A

Ablation
Deep brain stimulation
Stem Cell transplantation (experimental)

172
Q

PD Nursing care: Exercises

A
  • life toes when walking
  • widen legs while walking
  • small steps while looking forward
  • tiger corner manipulation
  • swing arms w/ walking to improve balance and ROM
  • carry bag to counterbalance is necessary
  • facial exercises
  • read aloud
  • speak slowly w/ purpose and concentrated articulation
173
Q

PD Nursing Interventions

A

Preservation of functional ability and quality of life
^ independence and ADLs
Prevent complications and excess disability
Coping mechanisms
^ Socialization
Support groups for pt and family
Physical therapy and balance trainign
^ strength and ROM
Occupational therapy w/ adaptive equipment

174
Q

PD medications (Dopamine precursors and glutamate antagonists)

A

levodopa (lardopa)
carbidopa-levodopa (sinemet)
amantadine (symmetrel)

175
Q

Synergistic effect PD

A

Levodopa converted to dopamine in brain
Carbidopa prevent conversion of dopamine in peripheral tissue

176
Q

Amantadine

A

^ CNS response to dopamine

177
Q

SEs PD medications

A

NVD
arrhythmias
blurred vision
darkening of sweat and urine
dyskinesia
postural hypotension
hallucinations
vivid dreams

178
Q

patient with hx of should not take levodopa

A

TIA, angina, melanoma, narrow angle glucoma

179
Q

Client Education: PD medications

A

Weeks to months to take effect
v Protein intake
Avoid foods with pyridoxine
Antiemetics and PPIs?H2RA prn
Interventions to v postural hypotension
Teach to report increases symptoms and cardiac SEs

180
Q

MAOB inhibitors

A

Selegiline
Rasagiline

181
Q

MAO of MAOB

A

Inhibits enzymes that inhibit and/or breakdown dopamine

182
Q

MOAB is used synergistically with

A

Levodopa

183
Q

SEs of MOABs

A

NV
Dizziness
Insomnia
Postural hypotension
HTN @ high doses

184
Q

MOAB contraindicated w/

A

Prozac and Demerol

185
Q

Client Education MOAB

A

Take @ same time each day
Report insomnia
Interventions to prevent postural hypotension
Skin exams (risk of melanoma)
Avoid foods containing tyramine

186
Q

Pyridoxine foods

A

Pork, beef, avocado, beans, oatmeal

187
Q

Dopamine Agonists PD

A

Bromocriptine (Parlodel)
Pramipexole (Mirapex)
Ropinirole (Requip)

188
Q

Dopamine Agonists PD actions

A

mimic effects of dopamine in the brain

189
Q

Client Education PD agonists

A

Same teaching as Levodopa
Don’t stop abruptly
May cause compulsive behavior

190
Q

Catecholomethyltransferase Inhibitor (COMP)

A

Tolcapone (Tasmar)
Entacaptone (Comtan)

191
Q

Action of COMT

A

Inhibit COMT which breaks down dopamine

192
Q

Client Education COMT

A

Take w/ food
No EtOH or sedative
Interventions to prevent postural hypotension
Don’t stop abruptly
Report muscle control changes, jaundice, dark urine, hallunications

193
Q

Anticholinergics PD

A

Benztropine (Cogentin)
Trihexyphenidyl (Artane)

194
Q

Action of Anticholinergics

A

Block the excitatory action of acetylcholine
Help prevent PD symptoms of drooling, tremors, rigidity

195
Q

When does anticholinergics are used

A

Early in disease or when Levodopa not tolerated

196
Q

Anticholinergics should not be use with

A

Anticholinergic meds (antihistamines, TCAs)

197
Q

Client Education Anticholinergies

A

Avoid activity which promotes fluid loss
Don’t stop abruptly

198
Q

What is the goal of therapy for GERD

A

Prevent exacerbation of symptoms
Lifestyle and diet symptoms
Medication management

199
Q

What is the most serious complication of GERD

A

Aspiration Pneumonia

200
Q

GERD symptoms

A

Persistent cough, asthma exacerbations, laryngitis, intermittent chest pain

201
Q

Risk factors of osteoporosis

A

Female
NE ancestry
Advanced age
Family hx of osteoporosis
Low body weight
Low calcium intake
Estrogen deficiency
Low testosterone
Inadequate exercise or activity
Use of steroids or anticonvulsants
Excess coffee or alcohol intake

202
Q

OP complications

A

Hip fracture -> death within one year
^ incidence of other major complications
Vertebral fractures (silent)

203
Q

Diagnosis of OP

A

DEXA scan

204
Q

T-score osteopenia

A

-1 to -2.5

205
Q

Osteoporosis

A

> -2.5

206
Q

Interventions OP

A

Weight bearing and resistance training
Adequate calcium and vitamin D intake
Education about fall prevention
Pharmacological therapy to prevent bone loss

207
Q

Bisphosphonates

A

Prevent bone loss
should be taken w/ a full glass of H20 in the morning or an empty stomach
Must disslve in the acidic environment
Upright for 30 min

208
Q

What is osteoarthritis

A

normal soft and resilient cartilaginous lining in joint becomes thin and damaged

209
Q

What is the most common symptoms of OA

A

Stiffness /w activity
Pain w/ activity relieved by rest

210
Q

Most common locations of OA

A

Neck (cervical spine)
Lower back (lumbar spine)
Hips
Hands
Fingers
Thumbs
Knees

211
Q

Heberden’s node

A

DIP distal interphalangeal joint

212
Q

Heberden’s node is only in __

A

OA

213
Q

Bouchard’s node

A

PIP Proximal Interphalangeal Joint

214
Q

Bouchard’s node is in

A

OA and RA

215
Q

Goal of therapy for OA

A

control pain and minimize disability

216
Q

Non-pharmacological therapy OA

A

Weight loss (1 lb= 4 lbs of pressure)
Exercise “motion is the lotion”
-> strength and flexibility (support the joints)
-> water exercise
Physical therapy
Hot/Cold therapy
Adaptive devices
-> cane, shoe lift, and knee brace

217
Q

Pharamacological therapy OA

A

Acetaminophen 4x/day
NSAID- COX2 (selective NSAID)
Joint injection: intra-articular
Steroid: Inflammation
Hyaluronic Acid (Lubrication)
Acupunture

218
Q

Surgical Intervention OA

A

Arthroscopy and Total Joint Replacement

219
Q

What is RA?

A

chronic, progressive, systemic inflammatory autoimmune disease

220
Q

Interventions RA

A

Complete physical and laboratory assessment
Pharmacological therapy: Pain management, DMARDSs (Methotrexate)
Biological response modifier (-mab)
Exercise and physical therapy
Environmental modifications
Assistive devices

221
Q

Look at OA vs RA chart

A
222
Q

DM interventions

A

Screening and early identification of disease
Prevent complications
Assessment of end organ status
Medical management
Assessment of self care ability
Nutrition
Exercise
Close monitoring of residents in LTC environment

223
Q

Thyrocalcitonin

A

v calcium loss from bone
Balances parathyroid hormone (PTH)

224
Q

Tetraiodothyronine or Thyroxine (T4)

A

Produced by follicular cells if thyroid gland
T4 converted to T3 in peripheral tissues

225
Q

Triiodothyronine (T3)

A

4-5 stronger than T4- more potent

226
Q

Thyroid Stimulating Hormone (TSH)

A

Produced by pituitary gland

227
Q

Thyroid Releasing Hormone (TRH)

A

Produced by hypothalmus

228
Q

TRH Stimulation test

A

TRH injected and TSH measured to assess the function

229
Q

Radioactive Iodine Uptake (RAI)

A

Direct test of thyroid function
Radioactive iodine absorbed by thyroid and thyroid can be visualized assess for nodules

230
Q

Thyroid scan

A

SImilar to RAI but no Iodine. Radioactive isotopes

231
Q

What is another diagnosis test for Thyroid Function

A

T3 and T4

232
Q

What should be avoid 7 days before testing the thyroid function

A

Hormones, steroids, ASA, foods containing iodine

233
Q

Hyperthyroidism etiologies

A

Grave’s disease
Toxic goiter
Women > Men

234
Q

What lab values would be high and low for hyperthyroidism

A

Elevated T3 andT4
Low TSH

235
Q

Older adults often present w/
(Hyperthyroidism)

A

Tachycardia
Tremors
Weight loss
Apathetic Thyrotoxicosis
Unexplained Afib
Heart failure
Constipation
Anorexia
Muscle weakness

236
Q

Methimazole (Tapazole) and Proplthiouracil (PTU)

A

anti-thyroid agents
blocks thyroid hormone production

237
Q

SSKI

A

Iodides
inhibit thyroid hormone secretion

238
Q

Beta blockers

A

-olol
manage tachycardia, anxiety, and tremors

239
Q

RAI (Radioactive iodine)

A

common for Grave disease
used alone or prior to surgery
absorbed by thyroid and radiation destroys tissue
teach radiation precaution

240
Q

Thyroidectomy

A

Surgical removal of part or all of thyroid
Reserved by severe case or large goiter

241
Q

Thyrotoxicosis

A

Life-threatening
Exaggeration of hyperthyroid symptoms

242
Q

Treatment for Thyrotoxicosis

A

Cool w/ ice, v levels of TH, replace fluids and electrolytes, giveO2, stabilize cardiac function, Avoid ASA (^ TH)

243
Q

Hypothyroidism

A

Slow onset Age 30-60

244
Q

Lab values of Hypothyroidism

A

^TSH
v T3 and T4

245
Q

Etiologies of Hypothyroidism

A

Chronic autoimmune thyroiditis
Radioactive treatment , surgery, medications (amiodarone), pituitary/ hypothalamic abnormality

246
Q

Vague S/S Hypothyroidism

A

Slowed mentation
Gait disturbances
Fatigue
Weakness
Cold intolerance

247
Q

Treatment of Hypothyroidism

A

Thyroid replacement therapy
Levothyroxine (Synthroid)

248
Q

Nursing care Hypothyroidism

A

Prevent: chilling, constipation, skin breakdown, infection
Assess: cardiac complications, edema, tachycardia, skin
Lifelong levothyroxine therapy

249
Q

Levothyroxine can cause toxicity to what medication

A

Digoxin

250
Q

Myxedema Coma Cause(s)

A

Untreated or uncontrolled hypothyroidism
External stressor including surgery, trauma, infection, excessive exposure to cold temps

251
Q

Manifestations of Myxedema Coma

A

Hypothermia, mental function rages from depression to unconscious, respiratory depression, hypotension, bradycardia

252
Q

Treatments Myxedema Coma

A

Supportive measures and stabilization of vitals
Treat underlying cause
Thyroid hormones replacement- be slow related w/ rapid replacement

253
Q

Manifestations of Prostate Cancer

A

Urinary complaints, retention, hematuria, back pain, cachexia, bone tenderness, lower lymphedema, adenopathy

254
Q

Screening methods Prostate Cancer

A

Digital Rectal Exam
Prostate Specific Antigen

255
Q

Adult cognition is the process of

A

Acquiring, storing, sharing, and using information

256
Q

Neuron loss (Physiological changes)

A

Most pronounced in cerebral cortex

257
Q

Brain atrophy (physiological changes)

A

Decreased weight

258
Q

Dendrites atrophy (physiological changes)

A

Impaired synapses (impaired communication between neurons)
Changed transmission of dopamine, serotonin, and acetycholine

259
Q

Slowing is _____

A

Normal

260
Q

Impairment is ___________

A

Not Normal

261
Q

Three components of Memory

A

Immediate Recall
Short-term memory
Remote or long-term memory

262
Q

Immediate Recall

A

Remember stuff from min- hr ago

263
Q

Short-term memory

A

Few weeks back

264
Q

Remote or long-term memory

A

Back to middle age or childhood

265
Q

Memory retrieval

A

Recall of newly encountered information decreases w/ age
Memory declines noted for complex tasks and strategies

266
Q

Basic intelligence remains _______ with increasing years

A

Unchanged

267
Q

Cognitive Assessment

A

Focused assessment:
Complete assessment (laboratory workup), stress, medications, organ dysfunction

268
Q

Common mental disorders in late life are

A

Depression & anxiety
Mood disorders
Alcohol abuse and dependence

269
Q

Health Promotion: Assessment Mental Health

A

Risk factors of life transition, loss, and loss of social support
Hx of ability to cope w/ stress and life events
Assessment of cognitive function and/ or impairment
Assessment of substance abuse and suicide risk

270
Q

Health Promotion: Interventions

A

Enhancing characteristics of hardiness, resilience, and resourcefulness
Enhancing functional status and independence
Promoting a sense of control
Fostering social support and relationships
Education regarding available resources

271
Q

Factors influencing mental health care:

A

Attitudes and Beliefs: stigma and myth
Availability and Adequacy of Mental Health Care: access and ability to pay
Cultural and Ethnic Disparities:: poverty, language, and cultural understanding

272
Q

What factors contribute to the development of anxiety disorders?

A

Life events and stressors

273
Q

Anxiety disorder is associated w/

A

Excessive healthcare use
Decreased physical activity and functional status
Substance abuse
Decreased life satisfaction
Increased mortality rates

274
Q

Anxiety Health Promotion: Assessment

A

Difficult to diagnose in older adults
Denial
Coexisting medical conditions can mimic anxiety
Common side effects of certain drugs
Drug and alcohol withdrawal also cause anxiety symptoms
Generalized Anxiety Disorder (assessment tool)

275
Q

Anxiety Health Promotion: Interventions

A

Treatment choices depend on symptoms, specific anxiety diagnosis, comorbid medical conditions, and current medications

276
Q

SSRI

A

Antidepressants and Anxiety
First line of treatment

277
Q

Short-acting benzodiazepines

A

sedating
It would take while to be effective

278
Q

Therapeutic relationship between patient and healthcare provider is the foundation of any intervention

A

True

279
Q

Non-pharmacological interventions for anxiety

A

CBT
Mediation
Yoga

280
Q

Depression is associated w/

A

Increased disability
Delayed recovery from illness and surgery
Excessive use of health services
Cognitive impairment
Decreased quality of life
Increased suicide and non-suicide-related death

281
Q

Etiology- multifactorial for anxiety

A

Health and chronic conditions
Gender
Developmental needs
Socioeconomics
Environment
Personality
Losses
Functional decline

282
Q

Presentation of Depression in Elders

A

Comorbid medical conditions strongly related to depression in older people
More somatic complaints – physical symptoms
Hypochondriasis – Constant complaining & criticism
Decreased energy and difficulties completing ADLs
Social withdrawal
Decreased libido
Preoccupation with death
Memory problems
Strong association of depression with dementia

283
Q

Depression Assessment

A

Depression screening scale, H&P, functional and cognitive assessment, medication review, laboratory analysis, comorbid conditions

284
Q

Interventions of Depression

A

Combination of pharmacologic therapy and psychotherapy and counseling

285
Q

ECT Therapy

A

Efficacy rates ranging from 60-80%
Safe therapy for older adult @ risk of harm, suicidal ideation, psychotic depression, severe malnutrition

286
Q

Depression screening is important for all older adults

A

True

287
Q

Intervention Suicide

A

If suicide risk suspected, ask direct questions
-Have you ever thought about killing yourself?
-How often have you had these thoughts?
-Do you have a plan to carry it out/How would you do it?
High risk patients need to be hospitalized
Moderate and low risk treated as outpatients
Adequate social support
No access to lethal means

288
Q

Myxedema Coma Causes

A

untreated or uncontrolled hypothyroidism
external stressors

289
Q

manifestations of myxedema coma

A

hypothermia
mental function range from depression to unconscious
respiratory depression
hypotension
bradycardia

290
Q

treatment myxedema coma

A

supportive measures and stabilization of vitals
treat underlying cause
thyroid hormone replacement (be slow rt toxicty w/ rapid replacement)

291
Q

Drugs for AD

A

Cholinesterase inhibitors

292
Q

Cholinesterase inhibitors

A

Donepezil, galamantamine, rivastigmine

293
Q

Nursing managment of cholinesterase inhibitors

A

Take w/ food (due to GI distress)
IV: start with low dose and titrate up

294
Q

PLST: Stressors Triggering

A

Fatigue
Change in behaviors
Misleading stimuli or inappropriate stimulus levels
Internal or external demands to perform beyond abilities
Physical stressors (pain, discomfort, acute illness, and depression)

295
Q

Need-Driven Dementia-Compromising Behavior(NDDH)
What is it?

A

framework for the study and understanding behavioral symptoms of dementia has a meaning

296
Q

DM Presentation in Older adults

A

Weight loss and Anorexia
Dehydration
Confusion, delirium
Decreased visual acuity
Fatigue, nausea
Delayed wounding healing
Paresthesia
Incontinence

297
Q

^ risk of amputation diabetes

A

Hx of amputation
Hx of ulcers
PVD
Severe Nail pathology
Peripheral neuropathy w/ loss of sensation
^ pressure (redness, bony deformities)

298
Q

What medication cause hypothyroidism

A

Amiodarone

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