Holistic Care for the High-Acuity Client Flashcards
Which enteral feeding method is used for chronic tube feeds
PEG tube (Abdominal wall to stomach)
What are the 3 ENTERAL FEEDINGS
Nasogastric tube
Dobhoff tube (nose through stomach to intestine for high risk of aspiration)
PEG tube (Abdominal wall to stomach)
What additional piece of nursing care do you need to provide when pt is doing enteral feeds
regular accuchecks (only care if G is over 180)
Expected physiologic changes at the end of life
o Cardiovascular and VS changes
o Decreased efficacy of drugs
o Incontinence
o Cool, clammy skin
o Altered mental status
nursing interventions at the end of life
Pain relief
Manage comfort
* Decrease N/V, respiratory, constipation
Emotional support
* Active listening
* Educate family in dying process
* Provide family updates, involve family in care and decisions
Communicate
* Goals, advance directives
What is the preferred method of nutrition for high-acuity clients
o PO intake preferred but CONTRAINDICATED IN NEURO PATIENTS
How do you give Total Parenteral Nutrition (TPN)
Delivered via central line
IJ/Subclavian line (central line)
When should you give a pt TPN
indicated for pancreatitis/pancreas issues
when do you change tpn lines
Lines are changed every 24-72 horus
How do you assess for signs/symptoms of nutrition intolerance
HYPER/HYPOGLYCEMIA
ASPIRATION
DECREASED APPEARANCE OF HEALTH/poor healing
difference between delirium and dementia
Delirium develops quickly as opposed to dementia which develops slowly
What sx is often correlated with closeness to death
Increase in delirium days increases risk for death—those with delirium have five times the risk for death than those who do not
- Differences between palliative care, hospice, end of life care and withdrawal of care
o PALIATIVE CARE: (STILL LIVING LIFE, JUST NEED SOME EXTRA PAIN/NEURO MANAGEMENT)
Interdisciplinary approach to relieve suffering and improve quality of life
ESPECIALLY FOR DEMENTIA PTS
WHAT ARE GOALS, HELP REACH GOALS; NOT ALWAYS END OF LIFE CARE
o HOSPICE: (NO MAINTENANCE/CURATIVE DRUGS)
PROGNOSIS OF 6 MONTHS OR LESS TO LIVE (BOTH IN/OUTPATIENT ENVIRONMENT)
DOESN’T ALWAYS MEAN THEY’RE GOING OT DIE WITHIN 6 MONTHS, SOMETIMES IMPROVE AND ARE TAKEN OFF
NO MORE CURATIVE, FOCUS ON COMFORT (NO MORE CHOLESTEROL MEDS FOR CHRONIC ISSUE)
o END OF LIFE CARE: (AWAKE)
death is imminent
Can receive both hospice and palliative care at this time
Care shifts to physiological and emotional comfort and support
o WITHDRAWAL OF CARE: (NOT AWAKE)
life-supporting measures such as dialysis, ventilator support, vasopressor support, etc.
Normally accompanied with medications to sedate, relieve pain and dry secretions etc. to help ease symptoms associated with EOL
What can cause delirium
infectious process
adverse drug reactions (benzos aka: pam/olam)
metabolic conditions (UTI)
lack of sleep
Describe nurse therapeutic communication at the end of life
o ACKNOWLEDGE ISSUE w/out judgment and try to include family to remove causative force (anxiety, pain, or lack of sleep)
o CONNECT THEM TO RESOURCES by communicating needs to members of the team to orchestrate holistic care
o Communicate changes QUICKLY
o WHAT CAN WE DO BEFORE DRUGS (Pastoral care, social work, client and family education, palliative care)
What med should you avoid when trying to help an elderly, high-acuity pt sleep
BENZOS (ANTIPSYCHOTICS) CAN CAUSE DELIRIUM IN OLD PEOPLE.
TEMP RELEIF OF SYMPTOMS THAT FADE AND MAKE SX WORSE
UNLESS THEY TAKE REGULARLY
IF RX FOR SLEEP FIND SOMETHING ELSE
what makes pain worse?
anxiety. take care of that and pain may be managed
PRIORITY WITH tx DELIRIUM
IDENTIFYING THE UNDERLYING CAUSe
what pain meds are not to be used for chronic pain
Opioids
what do you give with pain meds
nausea meds
Opioids cause
constipation and respiratory depression
when do opioids start working
Onset: Usually takes about 30 to 60 minutes to start working.
Peak Effectiveness: Generally reaches peak effectiveness around 1 to 2 hours after administration.
what is expected for older adults cognition in an inpatient setting
depression, dementia, delirium, pain
When do you use sedation for high-acuity pts
on a vent, combat delirium
Newer approach to use as little as possible and only if completely necessary. goal is to have zero sedation and be on ventilator, walking and such
Name 2 COMMON SEDATION ASSESSMENT TOOLS FOR THE HIGH-ACUITY CLIENT
Richmond Agitation and Sedation Scale (RASS)
Pasero Opioid-Induced Sedation Scale (POSS)
name some HIGH-ACUITY SEDATION COMPLICATIONS
*PTSD AND BENZOS DON’T GO TOGETHER
Causes delirium, resp distress, interacts w/ PTSD meds
Keep in mind, things take a while to work so don’t stack meds that may result in overdose
EXPECTED CHANGES IN Neurological system FOR THE OLDER ADULT CLIENT
Decrease in neurotransmitter production
More permeable blood-brain barrier
Dilation of the ventricles
EXPECTED CHANGES IN Cardiovascular system FOR THE OLDER ADULT CLIENT
Decreased elasticity and increased stiffness of arterial walls
Loss of conductive tissue
Calcification of valves
EXPECTED CHANGES IN Respiratory system FOR THE OLDER ADULT CLIENT
Calcification of costal cartilage
Decreased chest wall compliance
Less oxygen carried by RBCs
Loss of lung elasticity and recoil
EXPECTED CHANGES IN Gastrointestinal system FOR THE OLDER ADULT CLIENT
Wearing of teeth
Decreased saliva production
Decreased thirst response
Decreased LES function
Decreased digestive function
Decreased absorption in GI tract
Reduction of blood flow to liver
EXPECTED CHANGES IN Genitourinary system FOR THE OLDER ADULT CLIENT
Decreased GFR
Decreased creatinine clearance
Higher risk for UTIs
Incontinence
EXPECTED CHANGES IN Integumentary system FOR THE OLDER ADULT CLIENT
Loss of elasticity of connective tissue
Decreased subcutaneous tissue
Thinning of dermal and subdermal layers
Fragile blood vessels
Reduction of lean body mass
EXPECTED CHANGES IN Musculoskeletal system FOR THE OLDER ADULT CLIENT
Decreased muscle mass
Joint stiffness
Decreased mobility
Loss of bone mass
Name some ATYPICAL PRESENTATIONS IN OLDER ADULT HIGH-ACUITY CLIENTS
COMPENSATORY MECHANISM DON’T WORK AS WELL so rapid onset of sx
older pts deteroiorate quicker
UTI’S CAUSE WEIRD SX like delirium
EARLY WARNING SIGNS MASKED BY COMORBIDITIES OR MEDS
As a patient population, older adults are more likely to have _______.
COMORBIDITIES: ASK WHAT DOCS THEY’RE SEEING AND ASK FOR CURRENT MED LIST/HX
Polypharmacy: If has multiple chronic illnesses may be on large amount of meds
Abnormal sensitivities/reactions to drugs: Certain drugs can increase the risk for delirium, hypotension, or can impair renal or hepatic function
physiologic changes: Decreased absorption
Altered liver and kidney function
Name some common acute and chronic conditions that land people in a high-acuity inpatient setting
Acute issues (trauma, stroke, aneurysm etc.)
chronic conditions (heart failure, kidney disease, diabetes, COPD)
Stress can cause what kind of complications
Delirium, GI bleed, Venous thromboembolism (VTE)
