Gero Exam 2 Flashcards
Xerosis
Dry, cracked, itchy skin
What could worsen xerosis?
Inadequate fluid intake
Nursing management(s) of xerosis
Using super-fatted soaps or cleansers
Is pruritis a symptom or diagnosis
Symptom
What is pruritis related to
Medication SEs or
Secondary to disease
Threat to skin intergrity
Purpura
Thin, fragile skin
Extravasation of blood into surrounding tissue
Nursing management(s) of purpura
Wear long-sleeves
Protect from trauma
What is the common locations of xerosis
Face
Trunk
Extremities
What is the common location of purpura
The dorsalis forearm
Actinic kerotosis
Precancerous skin lesion
What is the cause of actinic kerotosis
Sun exposure
UV light
Nursing management(s) of pt w/ actinic keratosis
Dermatology visits every 6- 12 months to monitor and treat
Seborrheic keratosis
Waxy, raised “stuck-on” appearance, benign lesion
Almost all of the older adults over 65 got this ___
Seborrheic Keratosis
Herpes Zoster
painful vesicular rash over a dermatone
What is the common location of herpes zoster
The upper back
Nursing management(s) of herpes zoster
Ask for hx of chickenpox
Pain medication
topical medication
Droplet precaution
Candidiasis
Yeast infection
What the common location(s) of candidiasis
Skinfolds
Anywhere that is warm, moist, and dark
Nursing management(s) of candidiasis
Keep skin dry and clean
Who are higher risk of candidiasis
Obese
Malnutrition
Who are at high of risk of pressure injury
Immobility and prostheses
Treatments of Pressure Injury: DIPAMOPI
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
Look at Box 13-10 for Risk factors and Prevention
Stage 1 of Pressure Ulcers
Skin: Unbroken
Inflammation : redness
Stage 2 of Pressure Ulcers
Skin is broken to epidermis or dermis
Stage 3 of Pressure Ulcers
Ulcer extends to subcutaneous fat layer
Stage 4 of Pressure Ulcers
Ulcer extends to muscle or bone
Undermining is likely
Proper nutrition includes all the essential nutrients
Carbohydrates
Fat
Protein
Vitamin adn Minerals
Proper nutrition includes all the essential nutrients
Carbohydrates
Fat
Protein
Vitamin and Minerals
How much carbohydrates should be include
45-65%
How much fats should be include
20-35%
How much proteins should be include
10-35%
How much vitamin and minerals should be include
5 serving of fruits and veggies
The higher the score in the MNA, the patient is
Normal nutritional status (12-14)
The lower the score in the MNA, the patient is
Malnourished
Overweight
> = 25
Obese
> =30
Morbid obese
> =35
Malnutrition is a _____ syndrome
geriatrics
What is the rising incidence of malnutrition does it occurs
Acute care, Long term care, and in the community
Consequences of Malnutrition
^ risk of infection, pressure ulcers, anemia, hip fractures, hypotension, impaired cognition, ^ morbidity and mortality
Dysphagia
Difficulty swallowing
Look at Box 14-17 for Symptoms of Dysphagia
Look at Box 14-16 for Risk Factors of Dysphagia
Preventions of Aspiration (Dysphagia)
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
Risk factors for changes in fluid balance
Physiological changes in body water content
Impaired thirst sensation
Medications
Functional impairments
Chronic illness
Emotional illness
High environmental temperatures
Can Drink Category
Able to drink
May not know what’s adequate
Possible cog impairment
Encourage and make fluids accessible
Won’t Drink Category
Highest risk for dehydration
Able to drink but refuses
Offer frequently
Prevent incontinence
Can’t Drink Category
Physical incapable to ingesting or accessing fluids
Dysphagia prevention
Swallow evaluation
Safe drinking techniques
End-of-life category
Terminally ill
Could be any of the previous 3
Refer to advanced directives w/ regard to hydration wishes
Signs of Dehydration
Skin turgor
Weight
Mucous membranes
Speech changes
Tachycardia
v UOP
Dark urine
Weakness
Dry axilla
Sunken eyes
What would be more reliable when looking for a pt w/ dehydration
Lab testing
How much fluids should the patient be intake
At least 1500 ml/day
Interventions for Hydration
Fluid quality (water is the best)
Offer often
Make readily available
Encourage with medications
Provide preferred fluids (no carbonated drink)
Verbal reminders
Urge Urinary Incontinence
Overactive bladder
Stress Urinary Incontinence
^ intrabdominal pressure (sneezing, coughing, laughing)
defined as leakage of some or more urine
Functional Urine
Nothing wrong w/ urinary tract
what are the 4 pharmacotherapy for constipation
bulk-forming
stimulant
osmotic
emollients
bulk-forming (fiber)
psyllium (metamucil) and methylcellulose
What is the first line of drugs for constipation
Bulk-forming due to low cost and few adverse effects
What population(s) should be bulk-forming caution?
Frail older people, bed-bound individual, and swallowing problems
What can bulk-forming laxatives can cause
abdominal distention and flatulence
Nursing consideration when taking bulk-forming
Must be taken w/ adequate fluid intake to avoid obstruction in esophagus, stomach, intestines
Emollients and lubricants
Docusate sodium
What is the action of emollients
^ moisture content of stool
What is emollients are used primarily for?
It is used for constipation but on specific situation (surgery)
What population(s) is caution when taking emollients
Frail older people who don’t have the strength to push
Osmotic laxatives
milk of magnesia (MOM), lactulose, polyethylene glycol (PEG), Miralax, sorbitol
Action of osmotic laxatives
Cause water retention in the colon
What population should avoid MOM
Individuals w/ renal insufficiency -> hypermagnesemia and hyperphosphatemia
What can Lactulose and sorbitol cause
Diarrhea, abdominal cramping, and flatulence
If bulk laxatives are ineffective add _____
Osmotic laxative
Stimulant laxatives
senna
bisacodyl
Action of stimulant
stimulate colorectal motor activity
What can stimulants can cause
cramping
elecctrolyte or fluid losses
Stimulant laxatives are effective and safe for people w/ _______
opioid-induced constipation
Chloride channel stimulating
Lubiprostone
Amitizal
Action of Chloride channel stimulating
stimulate ileal secretion and ^ fecal water
Chloride channel stimulating is safe, well-tolerated, and effective in _____________
Older adults w/ chronic constipation
SEs of Chloride channel stimulating
HA
ND
What is a complication of constipation
Fecal impaction
Manifestations and complications: fecal impaction
Malaise
Urinary retention
^ temp
incontinence
cognitive decline
hemorrhoids
intestinal obstruction
What is the first thing to avoid in fecal impaction
Prevent it!
Nursing management of fecal impaction
Digital removal of hard stool from rectum
Use copious lubricant
May take several days
Don’t disimpact too much
Ofter very painful
Paradoxical diarrhea
causses by leakage of fecal material around the impacted mass
may think they are having a BM
How many stages in Non-rapid eye movement?
4
What is Stage 1 of NREM
Lightest level
Between being awake and falling asleep
Stage 2 of NREM
Onset of sleep
Becoming disengaging from surroundings
Breathing and heart rate regular but temperature drops
Stage 3 and Stage 4 of NREM
“slow wave sleep”
Deepest and most restorative sleep
BP v
Breathing becomes slower
Tissue growth and repair occurs
Energy is restored
How much REM occurs
25% of the night
How long does REM recurs
every 90 mins and get longer later in the night
REM Sleep
REM key feature
Breathing ^ rate and depth
Muscle tone relaxes
When does dream occur more often
REM; 85%
Look Box 17-4 for Age-Related Sleep changes
What stages does elder spend less time on
Stage 3 and 4
Biorhythm and sleep
age related changes in the body’s perception of light-dark cycle and circadium sleep-wake rhythm
Sleep Cycle
changes in sleep cycle
v amoutn of deep sleep and time spent in REM
Insomnia is a diagnosis
True
Medications that affect sleep
SSRI
Antihypertensives
Anticholinergics
Sympathomimetic amines
Diuretics
Opiates
Cough and cold medication
Thyroid preparations
Phenytoin
Cortisone
Levodopa
Sleep teaching
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
How much moderate aerobic should pt be doing weekly?
2.5 hrs weekly
How much muscle strengthening activities should pt be doing weekly
at least 2 days
Moderate intensity aerobic activity description
continuous moving involving large muscle groups that is sustained for a minimum of 10 mins; should make your heart beat fast
Benefits of Moderate intensity aerobic activity
Improves cardiovascular functioning, strengthening heart muscle, v blood glucose and triglycerides, ^ HDL, ^ mood
Examples of Moderate intensity aerobic activity
Biking, swimming, and other waterbased activites
Muscle-strengthening description
Activities that involve moving or lifting some type of resistance and work all major groups
Benefits of muscle-strengthening
^ muscles strength, prevents sarcopenia, reduce fall risks, improves balance
Examples of muscle-strengthening
lifting weight, calisthenics, working w/ resistance bands, heavy gardening
Stretching description
therapeutic maneuver designed to elongate shortened soft tissue structures and ^ flexibility
benefit of stretching
facilities ROM around joints, prevent injury
stretching frequency
2 day/wk
Examples of Stretching
Yoga and ROM exercises
Balance exercises description
movements that improve the ability to maintain control of the body the bsae of support to avoid falling
Benefits of balance
^ lower body strength, ^ balance, helps prevent falls
Examples of balance exercises
Tai chi, yoga, standing on one foot, etc
Look at Exercise Safety Box 18.6
Don’t exercise when….
SBP > 200 mmHg
DBP > 100 mmHg
Resting HR >120
2 hr after a big meal
Feet Skin becomes:
drier, less elastic, cooler
Corns/ calluses
Thick, compacted skin often from prolonged pressure.
Nursing considerations Corns/Calluses
Pad and protect the area
Proper fitting shoes
Bunions
Bony deformities: great toe or fifth toe from chronic dquzzing or hereditory
Nursing considerations of Bunions
Custom shoes, surgery, or steroid injection
Hammer toe
Permanently flexed toe (clawlike)
Nursing considerations of hammer toe
Custom shoes or surgery
Onchomycosis
Yellow, brown, opaque, brittle, and thick nails
What foot problem is hard to treat?
Onychomycosis (costly and limited effectiveness)
Proper foot care
DM: annual foot exam
Toenails: straight across and soaking 20-30 min (softening the nails)
Proper fitting footwear
Orthotic shoes as needed
Is falls a symptom or diagnosis
Symptom
Consequences of falls
Hip fractures
Traumatic brain injury
Fallophobiia
Fallphobia
fear of falling causing limitations in function
Major risk factors of Falls
Orthostatic hypotension
Cognitive impairment
Impaired vision and hearing
Medications
Environmental factors
Weakness and fraility
Fall Prevention Interventions
Fall bundles
Environmental modifications
Assistive devices
Safe client handling
Wheelchairs
Alarm/motion sensors
Restraints and Side rails
Device to limit movement to prevent harm
Consequences of restraints in older adults
Do not effectively prevent falls, wandering, or removing medical equipment
Probably exacerbate the problem
Restrain-related dealt (asphyxiation)
Pressure ulcers, agitation, cognitive decline, depression
Preventive phase (pretrajectory)
No S and S
Definitive phase (trajectory onset)
S/S and diagnosis present
Crisis phase
Life threatening situation
Acute phase
Active illness requiring hospitialization
Stable phase
Controlled illness course/symptoms
Unstable phase
Not controlled but not requiring/desiring hospitalization
Downward phase
Progressive decline
Dying phase
Immediate weeks/days/ hours before death
Fraility
Unintentional weight loss
Self-reported exhaustion
Weak grip strength
Slow walking speed
Low activity
BP is okay if less than
150 and 90
HTN Interventions (lifestyle changes)
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)
HF etiology
damage from HTN and CHD
Ventricles enlarge and dilate
CHF Also related to
EtOH abuse
Drug abuse
Chronic hyperthyroidism
Valvular disease
Some chemotherapy medications
Radiation therapy near heart
LHF
Pump failure to body
Systolic LHF
Decreased contractility (can’t squeeze)
Diastolic LHF
Decreased filling (can’t relax)
RHF
Pump failure to lungs
The result from LHF
CHF (acute decompensated)
swelling, edema, fluids in lung (pulmonary edema)
S3 and S4 and tachycardia
Cardiovascular interventions
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
ACE and ARB
-pril and -sartan
vasodilation
Diuretics
Loop, K+ sparing, thiazdiade
Reduce fluid retention
B-blocker
-lol
Improve contractility of heart muscle
Progressive disease: over ____ yrs
10-20
What is dopamine responsible for
regulates nerve impulses for motor function
Classic Triad
Cogwheel Rigidity
Bradykinesia/Dyskinesia
Resting/Non-intention tremors
Cogwheel Rigidity
Small jerking movements when affected muscles stretched
Muscle rigidity
Bradykinesia/Dyskinesia
Difficult starting, continuing, and or coordinating movement
Shuffling
May become frozen (akinesia)
Resting/Nonintention tremors
Fine, rhythmic, purposeless tremors (disappear w/ sleep adn purposeful movements)
Pills rolling, small handwriting, low monotone voice
Autonomic Dysfunction (PD clinical signs)
Seborrhea dermatitis
Hyperhidrosis of face and neck
Heat intolerance
Postural hypotension
Constipation
Cognitive and Psychologic Dysfunction (PD- Clinical signs)
Dementia
Memory loss, lack of problem solving, v intellect
anxiety
depression
sleep/wake reversal
Visual disturbance
Psychosis
Complications of PD: Late stage
Pressure ulcers
Pneumonia
Aspiration
Falls
Parkinsonian Crisis
Major complication
precipitated by emotional stress or sudden withdrawal of meds
Manifestations of PD complications
Severe exacerbation of tremors, rigidity, and bradykinesia
Anxiety
Sweating
Tachycardia
Hyperpnea
Treatment and Interventions PD complications
Respiratory/cardiac support prn
Non-stimulating environment
Psychological supports
Restarting medications
PD interventions
Early assessment and symptom management
Surgical procedures
Drug therapy focuses on mimicking or slowing dopamine breakdown
Surgical interventions PD
Ablation
Deep brain stimulation
Stem Cell transplantation (experimental)
PD Nursing care: Exercises
- 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
PD Nursing Interventions
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
PD medications (Dopamine precursors and glutamate antagonists)
levodopa (lardopa)
carbidopa-levodopa (sinemet)
amantadine (symmetrel)
Synergistic effect PD
Levodopa converted to dopamine in brain
Carbidopa prevent conversion of dopamine in peripheral tissue
Amantadine
^ CNS response to dopamine
SEs PD medications
NVD
arrhythmias
blurred vision
darkening of sweat and urine
dyskinesia
postural hypotension
hallucinations
vivid dreams
patient with hx of should not take levodopa
TIA, angina, melanoma, narrow angle glucoma
Client Education: PD medications
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
MAOB inhibitors
Selegiline
Rasagiline
MAO of MAOB
Inhibits enzymes that inhibit and/or breakdown dopamine
MOAB is used synergistically with
Levodopa
SEs of MOABs
NV
Dizziness
Insomnia
Postural hypotension
HTN @ high doses
MOAB contraindicated w/
Prozac and Demerol
Client Education MOAB
Take @ same time each day
Report insomnia
Interventions to prevent postural hypotension
Skin exams (risk of melanoma)
Avoid foods containing tyramine
Pyridoxine foods
Pork, beef, avocado, beans, oatmeal
Dopamine Agonists PD
Bromocriptine (Parlodel)
Pramipexole (Mirapex)
Ropinirole (Requip)
Dopamine Agonists PD actions
mimic effects of dopamine in the brain
Client Education PD agonists
Same teaching as Levodopa
Don’t stop abruptly
May cause compulsive behavior
Catecholomethyltransferase Inhibitor (COMP)
Tolcapone (Tasmar)
Entacaptone (Comtan)
Action of COMT
Inhibit COMT which breaks down dopamine
Client Education COMT
Take w/ food
No EtOH or sedative
Interventions to prevent postural hypotension
Don’t stop abruptly
Report muscle control changes, jaundice, dark urine, hallunications
Anticholinergics PD
Benztropine (Cogentin)
Trihexyphenidyl (Artane)
Action of Anticholinergics
Block the excitatory action of acetylcholine
Help prevent PD symptoms of drooling, tremors, rigidity
When does anticholinergics are used
Early in disease or when Levodopa not tolerated
Anticholinergics should not be use with
Anticholinergic meds (antihistamines, TCAs)
Client Education Anticholinergies
Avoid activity which promotes fluid loss
Don’t stop abruptly
What is the goal of therapy for GERD
Prevent exacerbation of symptoms
Lifestyle and diet symptoms
Medication management
What is the most serious complication of GERD
Aspiration Pneumonia
GERD symptoms
Persistent cough, asthma exacerbations, laryngitis, intermittent chest pain
Risk factors of osteoporosis
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
OP complications
Hip fracture -> death within one year
^ incidence of other major complications
Vertebral fractures (silent)
Diagnosis of OP
DEXA scan
T-score osteopenia
-1 to -2.5
Osteoporosis
> -2.5
Interventions OP
Weight bearing and resistance training
Adequate calcium and vitamin D intake
Education about fall prevention
Pharmacological therapy to prevent bone loss
Bisphosphonates
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
What is osteoarthritis
normal soft and resilient cartilaginous lining in joint becomes thin and damaged
What is the most common symptoms of OA
Stiffness /w activity
Pain w/ activity relieved by rest
Most common locations of OA
Neck (cervical spine)
Lower back (lumbar spine)
Hips
Hands
Fingers
Thumbs
Knees
Heberden’s node
DIP distal interphalangeal joint
Heberden’s node is only in __
OA
Bouchard’s node
PIP Proximal Interphalangeal Joint
Bouchard’s node is in
OA and RA
Goal of therapy for OA
control pain and minimize disability
Non-pharmacological therapy OA
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
Pharamacological therapy OA
Acetaminophen 4x/day
NSAID- COX2 (selective NSAID)
Joint injection: intra-articular
Steroid: Inflammation
Hyaluronic Acid (Lubrication)
Acupunture
Surgical Intervention OA
Arthroscopy and Total Joint Replacement
What is RA?
chronic, progressive, systemic inflammatory autoimmune disease
Interventions RA
Complete physical and laboratory assessment
Pharmacological therapy: Pain management, DMARDSs (Methotrexate)
Biological response modifier (-mab)
Exercise and physical therapy
Environmental modifications
Assistive devices
Look at OA vs RA chart
DM interventions
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
Thyrocalcitonin
v calcium loss from bone
Balances parathyroid hormone (PTH)
Tetraiodothyronine or Thyroxine (T4)
Produced by follicular cells if thyroid gland
T4 converted to T3 in peripheral tissues
Triiodothyronine (T3)
4-5 stronger than T4- more potent
Thyroid Stimulating Hormone (TSH)
Produced by pituitary gland
Thyroid Releasing Hormone (TRH)
Produced by hypothalmus
TRH Stimulation test
TRH injected and TSH measured to assess the function
Radioactive Iodine Uptake (RAI)
Direct test of thyroid function
Radioactive iodine absorbed by thyroid and thyroid can be visualized assess for nodules
Thyroid scan
SImilar to RAI but no Iodine. Radioactive isotopes
What is another diagnosis test for Thyroid Function
T3 and T4
What should be avoid 7 days before testing the thyroid function
Hormones, steroids, ASA, foods containing iodine
Hyperthyroidism etiologies
Grave’s disease
Toxic goiter
Women > Men
What lab values would be high and low for hyperthyroidism
Elevated T3 andT4
Low TSH
Older adults often present w/
(Hyperthyroidism)
Tachycardia
Tremors
Weight loss
Apathetic Thyrotoxicosis
Unexplained Afib
Heart failure
Constipation
Anorexia
Muscle weakness
Methimazole (Tapazole) and Proplthiouracil (PTU)
anti-thyroid agents
blocks thyroid hormone production
SSKI
Iodides
inhibit thyroid hormone secretion
Beta blockers
-olol
manage tachycardia, anxiety, and tremors
RAI (Radioactive iodine)
common for Grave disease
used alone or prior to surgery
absorbed by thyroid and radiation destroys tissue
teach radiation precaution
Thyroidectomy
Surgical removal of part or all of thyroid
Reserved by severe case or large goiter
Thyrotoxicosis
Life-threatening
Exaggeration of hyperthyroid symptoms
Treatment for Thyrotoxicosis
Cool w/ ice, v levels of TH, replace fluids and electrolytes, giveO2, stabilize cardiac function, Avoid ASA (^ TH)
Hypothyroidism
Slow onset Age 30-60
Lab values of Hypothyroidism
^TSH
v T3 and T4
Etiologies of Hypothyroidism
Chronic autoimmune thyroiditis
Radioactive treatment , surgery, medications (amiodarone), pituitary/ hypothalamic abnormality
Vague S/S Hypothyroidism
Slowed mentation
Gait disturbances
Fatigue
Weakness
Cold intolerance
Treatment of Hypothyroidism
Thyroid replacement therapy
Levothyroxine (Synthroid)
Nursing care Hypothyroidism
Prevent: chilling, constipation, skin breakdown, infection
Assess: cardiac complications, edema, tachycardia, skin
Lifelong levothyroxine therapy
Levothyroxine can cause toxicity to what medication
Digoxin
Myxedema Coma Cause(s)
Untreated or uncontrolled hypothyroidism
External stressor including surgery, trauma, infection, excessive exposure to cold temps
Manifestations of Myxedema Coma
Hypothermia, mental function rages from depression to unconscious, respiratory depression, hypotension, bradycardia
Treatments Myxedema Coma
Supportive measures and stabilization of vitals
Treat underlying cause
Thyroid hormones replacement- be slow related w/ rapid replacement
Manifestations of Prostate Cancer
Urinary complaints, retention, hematuria, back pain, cachexia, bone tenderness, lower lymphedema, adenopathy
Screening methods Prostate Cancer
Digital Rectal Exam
Prostate Specific Antigen
Adult cognition is the process of
Acquiring, storing, sharing, and using information
Neuron loss (Physiological changes)
Most pronounced in cerebral cortex
Brain atrophy (physiological changes)
Decreased weight
Dendrites atrophy (physiological changes)
Impaired synapses (impaired communication between neurons)
Changed transmission of dopamine, serotonin, and acetycholine
Slowing is _____
Normal
Impairment is ___________
Not Normal
Three components of Memory
Immediate Recall
Short-term memory
Remote or long-term memory
Immediate Recall
Remember stuff from min- hr ago
Short-term memory
Few weeks back
Remote or long-term memory
Back to middle age or childhood
Memory retrieval
Recall of newly encountered information decreases w/ age
Memory declines noted for complex tasks and strategies
Basic intelligence remains _______ with increasing years
Unchanged
Cognitive Assessment
Focused assessment:
Complete assessment (laboratory workup), stress, medications, organ dysfunction
Common mental disorders in late life are
Depression & anxiety
Mood disorders
Alcohol abuse and dependence
Health Promotion: Assessment Mental Health
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
Health Promotion: Interventions
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
Factors influencing mental health care:
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
What factors contribute to the development of anxiety disorders?
Life events and stressors
Anxiety disorder is associated w/
Excessive healthcare use
Decreased physical activity and functional status
Substance abuse
Decreased life satisfaction
Increased mortality rates
Anxiety Health Promotion: Assessment
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)
Anxiety Health Promotion: Interventions
Treatment choices depend on symptoms, specific anxiety diagnosis, comorbid medical conditions, and current medications
SSRI
Antidepressants and Anxiety
First line of treatment
Short-acting benzodiazepines
sedating
It would take while to be effective
Therapeutic relationship between patient and healthcare provider is the foundation of any intervention
True
Non-pharmacological interventions for anxiety
CBT
Mediation
Yoga
Depression is associated w/
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
Etiology- multifactorial for anxiety
Health and chronic conditions
Gender
Developmental needs
Socioeconomics
Environment
Personality
Losses
Functional decline
Presentation of Depression in Elders
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
Depression Assessment
Depression screening scale, H&P, functional and cognitive assessment, medication review, laboratory analysis, comorbid conditions
Interventions of Depression
Combination of pharmacologic therapy and psychotherapy and counseling
ECT Therapy
Efficacy rates ranging from 60-80%
Safe therapy for older adult @ risk of harm, suicidal ideation, psychotic depression, severe malnutrition
Depression screening is important for all older adults
True
Intervention Suicide
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
Myxedema Coma Causes
untreated or uncontrolled hypothyroidism
external stressors
manifestations of myxedema coma
hypothermia
mental function range from depression to unconscious
respiratory depression
hypotension
bradycardia
treatment myxedema coma
supportive measures and stabilization of vitals
treat underlying cause
thyroid hormone replacement (be slow rt toxicty w/ rapid replacement)
Drugs for AD
Cholinesterase inhibitors
Cholinesterase inhibitors
Donepezil, galamantamine, rivastigmine
Nursing managment of cholinesterase inhibitors
Take w/ food (due to GI distress)
IV: start with low dose and titrate up
PLST: Stressors Triggering
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)
Need-Driven Dementia-Compromising Behavior(NDDH)
What is it?
framework for the study and understanding behavioral symptoms of dementia has a meaning
DM Presentation in Older adults
Weight loss and Anorexia
Dehydration
Confusion, delirium
Decreased visual acuity
Fatigue, nausea
Delayed wounding healing
Paresthesia
Incontinence
^ risk of amputation diabetes
Hx of amputation
Hx of ulcers
PVD
Severe Nail pathology
Peripheral neuropathy w/ loss of sensation
^ pressure (redness, bony deformities)
What medication cause hypothyroidism
Amiodarone
