Hospital Care - Exam 1 Flashcards
Geriatric patients account for ____ of all in-hospital deaths
74%
What is the vicious cycle of geriatric hospital care?
Hospitalization that leads to functional loss that leads to decreased capacity to recover that leads to hospitalization
What is the greatest complication of bed rest/immobility? What does 1 day in bed equal?
loss of muscle mass and strength
1 day in bed = 3 days to recover/ regain strength
What are contributing factors to bed rest/immobility?
Difficulty transferring independently from bed
“Fall risk”
Use of restraints
Lack of access to assistive devices (e.g. cane, walker)
Attachment to external devices (e.g. IV pole, urinary catheter, oxygen tubing)
Lack of encouragement to get out of bed
What are some prevention strategies to reduce fall risk?
Assistance with ambulation and transferring
Non-slip socks / surfaces
Assistive devices and handrails
What are some ways to promote mobility while in the hospital?
Out of bed (OOB) for all meals
Ambulate 3-4 times per day
Order PT
Utilize low beds and raised toilet seats
What does being in a hospital do to an geriatric person’s psych?
feels worthless, fearful and sense of loss of control
increased risk of acute care-related delirium
What are some prevention strategies to help with psych concerns?
frequent assessment of s/s
appropriate lighting
promote orientation
hearing/vision adaptations
promote healthy sleep
promote mobility
avoid deliriogenic med and devices
What does polypharmacy lead to?
increase adverse drug reactions
increased risk of falls
prolonged use of multiple medications
What are pressure ulcers in the hospital a result of?
loss of independent ambulation and position changing
What is a highlighted prevention strategy for pressure ulcers?
maintain nutrition
Geriatric healthcare models focus on _________, _______, and _________ of specific hospital-associated complications
physical environment
processes of care
prevention
**What are the 2 examples of geriatric healthcare models?
The Hospital Elder Life Program (HELP)
Acute care for elders (ACE) units
**What is the goal of the Hospital Elder Life Program (HELP)? What is their strategy?
Prevent delirium in older hospitalized adults
Implement mobility, cognitive, sleep, and nutrition protocols on general medical wards throughout the hospital
What are the core principles of the HELP program?
quiet environments
improve cognition (with recreation activities and day visitors)
hydration and nutrition (with other people)
hearing/vision adaptations
early mobility (daily assistance with walking/exercising)
non-pharm sleep promotion (warm milk, massages, relaxing music)
**What is the goal for Acute Care for Elders model?
To prevent functional decline and improve the quality of care for older adults during acute hospitalization
The ACE model utilizes the ________ and __________. Their strategy is to develop patient goals and to ________ of hospitization
comprehensive geriatric assessment
interprofessional team-based care
prevent common complications
What things does the ACE unit promote?
good nutrition
continence
skin integrity
inclusion of patient in plan
frequent review of medical care plan
healthy sleep
mobility
orientation (clocks, calendars, group meals to increase socialization)
What are the indications for an indwelling urinary catheter?
urinary retention
urinary incontinence
monitoring input and outputs
immobilized patients
avoid overdistension in surgical patients
intravesical pharm therapy
end of life care
**What are the top 2 INAPPROPRIATE indications for catheter placement?
Urinary incontinence that has not failed other managements
Obtaining a urine specimen for testing in a patient capable for voiding spontaneously or reliably
**What is the absolute CI for indwelling urinary caths?
urethral injury
What are the relative CIs (need to consult urology) for caths?
urethral stricture
recent urinary tract sx
presence of an artifical sphincter
What are the risks for indwelling urinary catheters?
iatrogenic infections
limited mobility
bladder stones
bladder cancer with long term use
What is one of the MC causes of iatrogenic infections?
indwelling urinary catheter
What are 2 behavioral interventions that can be used as an alternative for an indwelling cath?
bladder training
scheduled/prompted toileting
What are the antimuscarinics medications? What are the MC SEs?
What are the SEs in elderly pts?
oxybutynin (Ditropan)
tolterodine (Detrol)
darifenacin (Enablex)
dry mouth and constipation
elderly: decreased cognition, dizziness, drowsiness
What is the β-3 agonist medication used as an alternative for indwelling urinary caths?
mirabegron (Myrbetriq)
What is the α-Adrenergic blockers that is used for BPH? What are the 2 SE?
tamsulosin
orthostasis, dizziness
________ is indicated for patient who have failed more conservative measures regarding urinary continence. Give some examples
surgical intervention
sling or bladder neck suspension in women
anatomic repair or prostate resection if obstructing
