Hospital Care - Exam 1

Question 1

Geriatric patients account for ____ of all in-hospital deaths

Answer 1

74%

Question 2

What is the vicious cycle of geriatric hospital care?

Answer 2

Hospitalization that leads to functional loss that leads to decreased capacity to recover that leads to hospitalization

Question 3

What is the greatest complication of bed rest/immobility? What does 1 day in bed equal?

Answer 3

loss of muscle mass and strength

1 day in bed = 3 days to recover/ regain strength

Question 4

What are contributing factors to bed rest/immobility?

Answer 4

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

Question 5

What are some prevention strategies to reduce fall risk?

Answer 5

Assistance with ambulation and transferring

Non-slip socks / surfaces

Assistive devices and handrails

Question 6

What are some ways to promote mobility while in the hospital?

Answer 6

Out of bed (OOB) for all meals

Ambulate 3-4 times per day

Order PT

Utilize low beds and raised toilet seats

Question 7

What does being in a hospital do to an geriatric person’s psych?

Answer 7

feels worthless, fearful and sense of loss of control

increased risk of acute care-related delirium

Question 8

What are some prevention strategies to help with psych concerns?

Answer 8

frequent assessment of s/s

appropriate lighting

promote orientation

hearing/vision adaptations

promote healthy sleep

promote mobility

avoid deliriogenic med and devices

Question 9

What does polypharmacy lead to?

Answer 9

increase adverse drug reactions

increased risk of falls

prolonged use of multiple medications

Question 10

What are pressure ulcers in the hospital a result of?

Answer 10

loss of independent ambulation and position changing

Question 11

What is a highlighted prevention strategy for pressure ulcers?

Answer 11

maintain nutrition

Question 12

Geriatric healthcare models focus on _________, _______, and _________ of specific hospital-associated complications

Answer 12

physical environment

processes of care

prevention

Question 13

**What are the 2 examples of geriatric healthcare models?

Answer 13

The Hospital Elder Life Program (HELP)

Acute care for elders (ACE) units

Question 14

**What is the goal of the Hospital Elder Life Program (HELP)? What is their strategy?

Answer 14

Prevent delirium in older hospitalized adults

Implement mobility, cognitive, sleep, and nutrition protocols on general medical wards throughout the hospital

Question 15

What are the core principles of the HELP program?

Answer 15

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)

Question 16

**What is the goal for Acute Care for Elders model?

Answer 16

To prevent functional decline and improve the quality of care for older adults during acute hospitalization

Question 17

The ACE model utilizes the ________ and __________. Their strategy is to develop patient goals and to ________ of hospitization

Answer 17

comprehensive geriatric assessment

interprofessional team-based care

prevent common complications

Question 18

What things does the ACE unit promote?

Answer 18

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)

Question 19

What are the indications for an indwelling urinary catheter?

Answer 19

urinary retention

urinary incontinence

monitoring input and outputs

immobilized patients

avoid overdistension in surgical patients

intravesical pharm therapy

end of life care

Question 20

**What are the top 2 INAPPROPRIATE indications for catheter placement?

Answer 20

Urinary incontinence that has not failed other managements

Obtaining a urine specimen for testing in a patient capable for voiding spontaneously or reliably

Question 21

**What is the absolute CI for indwelling urinary caths?

Answer 21

urethral injury

Question 22

What are the relative CIs (need to consult urology) for caths?

Answer 22

urethral stricture

recent urinary tract sx

presence of an artifical sphincter

Question 23

What are the risks for indwelling urinary catheters?

Answer 23

iatrogenic infections

limited mobility

bladder stones

bladder cancer with long term use

Question 24

What is one of the MC causes of iatrogenic infections?

Answer 24

indwelling urinary catheter

Question 25

What are 2 behavioral interventions that can be used as an alternative for an indwelling cath?

Answer 25

bladder training

scheduled/prompted toileting

Question 26

What are the antimuscarinics medications? What are the MC SEs?
What are the SEs in elderly pts?

Answer 26

oxybutynin (Ditropan)
tolterodine (Detrol)
darifenacin (Enablex)

dry mouth and constipation

elderly: decreased cognition, dizziness, drowsiness

Question 27

What is the β-3 agonist medication used as an alternative for indwelling urinary caths?

Answer 27

mirabegron (Myrbetriq)

Question 28

What is the α-Adrenergic blockers that is used for BPH? What are the 2 SE?

Answer 28

tamsulosin

orthostasis, dizziness

Question 29

________ is indicated for patient who have failed more conservative measures regarding urinary continence. Give some examples

Answer 29

surgical intervention

sling or bladder neck suspension in women

anatomic repair or prostate resection if obstructing