Lectures Flashcards
1
Q
What functional changes occur to the respiratory system as we age?
A
- Decr. exercise tolerance
- Decr. chest wall compliance
- Decr. ability to incr. RR and depth in response to hypoxia or hypercapnia
- Decr. gag and cough reflex
- Incr. air trapping
- Sarcopenia (decr. mm mass and strength)
2
Q
For an older person w emphysema:
- Possible nursing diagnoses
- Planning
- Interventions
A
Diagnoses:
- Ineffective airway clearance related to thick secretions and weak cough
- Alteration in nutrition related to breathlessness and recent low mood
- Activity intolerance related to loss of energy and breathlessness
- Anxiety related to social isolation and chronic disease
- Impaired gas exchange related to acute exacerbation of COPD
Planning:
- Immediate risks: low sats, high RR, compromised airway
- Other: may need to collab w physio, docs, social worker
post:
- Ongoing observation: RR, auscultation
- Elevate head of bed: high fowlers position
- Stagger cares/activities to minimise fatigue
- Administer meds as prescribed
- Frequent mouth care
- Needs assessment - home help, chest clinic, oxygen
- Dietitian: small frequent meals + supplements
- Oxygen as prescribed
- Advance care planning
3
Q
4 types of social support
A
- Concrete support: relates to practical acts of assistance bw people, e.g. arranging for child minding, accessing benefits
- Emotional support: compromises acts of empathy, listening and generally ‘being there’ for someone when needed. Incl. listening to trauma and grief w compassion
- Advice support: goes beyond the advice/info itself to the reassurance that goes with it, motivational interviewing and empowering processes.
- Esteem support: centers on how one person rates and informs another of their personal worth, e.g. unconditional regard, commitment and focus on positive gains.
4
Q
What information does a mental state examination tell you about a person?
A
Info about their: behaviour, thinking, mood and mental functions
at a specific point in time.
5
Q
What might cause changes to a person’s mental state?
A
- Organic changes
- drugs and alcohol
- stress
- environment
- trauma
6
Q
What does a MSE assess? Briefly describe each aspect or examples of observations.
A
- appearance: clothing, grooming, hygiene, nails, build, posture, facial expression
- interaction w interviewer: attitude to interviewer and situation e.g. friendly, cooperative, withdrawn, guarded, uncommunicative, seductive.
- behaviour/activity: motor behaviour e.g. restless, relaxed, overactive, repetitive, slowed, tremor, bizarre.
- speech: in terms of rate, vol and amount of info. e.g. slow, rapid, monotonous, loud, quiet, slurred, mute, poverty or pressure of speech.
- mood and affect: mood is what the person feels like themselves in their own words e.g. depressed, happy, suspicious. Affect is what the interviewer observes and hears, e.g. appropriate, normal, restricted, bunted, flat.
- thought
- form of thought: HOW the person is thinking. e.g. amount and rate of thought (poverty/flight of ideas), continuity of ideas (logical, loose, tangential), disturbance of language (making up words or doesn’t make sense)
- thought content: WHAT the person is thinking. E.g. obsessions, compulsions, phobias, suicidal thoughts (hx, actioned them, what are they + plan + access to means), delusions - perception: hallucination (false sensory impression or experience) can be auditory, visual, tactile, olfactory or gustatory.
- insight/judgement
- insight: person’s understanding of their situation or illness.
- judgement: ability to assess/evaluate situations, make rational decisions, understand consequences of behaviour, take responsibility - cognition
- LOC: if impaired, person could be under the influence drugs/alcohol or brain disease
- memory: immediate, recent and remote.
- orientation: time, place, person
- Concentration
7
Q
Delusions:
- what are they?
- Examples of types
A
- False beliefs that are firmly held despite objective and contradictory evidence
- delusions of persecution (convinced that someone is mistreating, conspiring against, or planning to harm you or your loved one), of reference (believes that unsuspicious occurrences refer to him or her in person, e.g. song on radio is for them), of jealousy and control. Religious, nihilistic (think you’re dead, empty, etc.), fantastic, grandiose (think you’re v powerful, famous/unrealistically inflated sense of yourself or your achievements).
8
Q
Assessment of mood disorders:
Major Depressive Disorder (MDD)
A
- pervasive and debilitating symptoms in most areas of the person’s life
- symptoms of depression can be described as alterations in 4 aspects of functioning: affective, behavioural, cognitive and physiological
- diagnosis: If 5 or more of the following features is present over a period of 2w or more and represents a change from previous functioning. At least 1 of the symptoms is either 1 or 3 below.
1. Pervasive and persistent depressed mood
2. Low self esteem
3. Markedly diminished interest or pleasure in all/most activities
4. Significant weight loss or gain
5. Insomnia or hypersomnia
6. Psychomotor agitation or retardation
7. Fatigue or loss of energy
8. Feelings of worthlessness
9. Diminished ability to think or concentrate, or indecisiveness
10. Recurrent thoughts of death or suicidal ideation
9
Q
Bipolar I vs Bipolar II
A
Bipolar I Disorder involves one or more MANIC episodes or mixed episodes (mania and depression)
Bipolar II Disorder has one or more DEPRESSIVE episodes with at least one HYPOMANIC episode
10
Q
Age related changes to the cardiovascular system
A
- Less able to adjust HR/vessel diameter when needed (circulation issues + lack of oxygenation of blood)
- Decreased exercise tolerance
- Decr. elasticity
- Fat in the myocardium
- Incompetent heart valves
- Limited responsiveness bc of beta blockers
May develop problems w
- electrical conduction (atrial fibrillation)
- Contractility (e.g. heart failure)
- postural hypotension
11
Q
The biology of ageing
- normal changes that may contribute to health issues
A
- Primary hypertension: incr. risk of atrial fibrillation
- Postural hypotension: incr. falls risk
- sarcopenia: decr. ability to fight infections e.g. pneumonia
- Slower signalling to and from the brain: impacts on balance and falls risk
- Loss of tissue elasticity: incr. pressure injury risk
- Loss of adaptive immunity: incr. risk of cancer
12
Q
Interventions for falls prevention
A
- mobility aids incl. good footwear
- exercise classes (strength training)
- environment (uncluttered, good lighting, handrails)
- Vit D supplements (mm strength and bone density)
- review of meds which may impact
13
Q
Identify risk factors + 3 nursing diagnoses, and use ADPIE to plan care for the following patient:
90y/o woman
Past hx:
- breast cancer + right mastectomy
- atrial fibrillation
- CVA
- blind right eye following retinal clot
- cellulitis right leg + arm
Lives independently w 1hr cleaning support and daughter provides frozen meals for evenings
Admitted to rest home for respite care following hosp admission due to chest inf.
Regular meds: dabigatran, digoxin, furosemide
Short-term: flucloxicillin
Slowly beginning to mobilise, feeling weak and has lost 2kg
worried abt not being able to go back home
A
Risk factors: age, level of independence, risk of pressure injury, risk of fall, risk of depression/anxiety
Diagnoses:
- Risk of falls related to reduced mobility/blindness/age.
- Risk of pressure area related to loss of tissue elasticity associated with ageing
- Risk of depression and anxiety related to being away from home and loneliness
Plan:
- Minimise risk of falls
- Minimise risk of pressure injury
- Alleviate psychological impact of being away from home
Implementation:
- Encourage appropriate footwear, mobility aids if necessary, appropriate lighting esp. at night, space clear of trip hazards
- Ensure frequent repositioning, encourage mobilisation, keep skin dry, skin care
- Connect her with family, talk to her, support services
14
Q
Pre and post-operative care:
Special considerations for patients w disabilities
A
- ?mobility devices or additional bowel mx (opiates)
- Patients w ID may have heightened anxiety/carer separation
15
Q
Case study: pre- and post-operative care
- 2 potential nursing diagnoses
- what ongoing assessments will you make over the shift?
Irene 82
surgery this morning to repair inguinal hernia
Past hx of COPD, hypertension, arthritis
Lives alone but has fam nearby
A
any 2 of:
- Risk of infection related to recent surgery
- Risk of pain due to recent surgery
- Risk of pressure injury related to alteration in skin integrity and reduced mobility
- Risk of falls related to impaired mobility
- Risk of alteration in elimination related to impaired mobility
Ongoing:
- LOC + pain scoring
- Vital signs
- fluid balance
- Pressure injury risk
- Wound assessment
- Assess for nausea and vomiting
16
Q
Pre- and post-op care:
- Initial priorities (ABCD)
- Ongoing priorities
A
- Initial
- Airway (patent/head tilt/jaw thrust)
- Breathing (adequate ventilation and oxygenation)
- Circulation (oserve vital signs trends - BP, P, T, RR, urine output)
- Drugs/drips/drains/dressings (good neurological waking, no CVA, pain management) - Ongoing
- Adequate rewarming/haemodynamic stability
- Exclude MI
- monitor for bleeding
- monitor wound drainage
- position change (pressure injury prevention)
- Fluid balance
17
Q
List the acute nursing assessments
A
- Vital signs
- AVPU and GCS
- Health hx
- EWS
- COLDSPA
- Intuition
- Inspection
- Palpation
- Auscultation
- Percussion
18
Q
Common medication errors relating to the 5 rights
A
- Wrong patient: failing to check 2 patient identifiers
- Wrong time: failing to check when last given
- Wrong/missed dose: failing to check dose against patient age/weight or calculation errors
- Wrong route: failing to administer via correct route
- Wrong drug: failing to understand the rationale
19
Q
Common factors contributing to medication errors
A
- Distraction/busyness
- Poor communication
- Inadequate documentation
- Lack of knowledge (pharmacology, poor maths)
- Unclear policy
- Poor documentation
- Failure to check allergy or ID status
- Incorrect dose (x10 errors)
- Illegal prescribing (e.g. non-approved abbreviations)
- ‘look alike/sound alike’ meds
Patient factors:
- altered metabolism/absorption
- polypharmacy
- non-adherence due to impaired vision or confusing medication regimen
- interactions w herbal/OTC meds
20
Q
Complications of IV therapy
A
- Fluid overload: will see incr. BP, HR and RR
- Air embolism: air enters circulation, most commonly with central venous access
- Needle stick injury
- Infiltration: cannula tip slips through vein, allowing meds/fluid to enter tissues
- Phlebitis: infection in the vessel wall
- Site infection: bacteria in SC tissue
21
Q
4 validity techniques to explore the extent of suicidal ideation
A
- Behavioural incident: seeking facts of event rather than opinions. e.g. asking Qs that seek factual answers such as “how many pills did you take?” and asking about the sequence of events e.g. “what did you do next?”
- Gentle assumption: use when suspect they may be hesitant to discuss a potentially embarrassing or incriminating behaviour; assume the behaviour is occurring and thus frame Q accordingly e.g. “what other ways have you thought of killing yourself?”
- Symptom amplification: use when you suspect they are about to minimise the frequency/amount of their damaging behaviours. After asking Q suggest a number set high
- Denial of the specific: after they deny a generic Q, ask a series of specific Qs to uncover a positive response. e.g. “have you thought about ways of killing yourself?” (no) “have you thought about shooting yourself?” (ans) “…overdosing?” etc.
22
Q
how do we manage suicide risk?
A
- Find/encourage doubt
- Strengthen hope/resilience
- Promote positive connections w friends/fam
- provide options for accessing support
- Treat mental illness
- Support problem-solving
- Focus on strengths
- Reduce access to means
- Monitor risk
23
Q
Risk factors for chronic respiratory disease
A
- SMOKING
- family history
- Childhood illnesses
- Occupational exposure
- allergens in the environment
24
Q
Assessment of mental state is done by…
A
- Observation: describing accurately what you see.
- Speaking with the person
- Speaking with the family/significant others
25
Q
Assessment of mood disorders: dysthymia
A
- chronic mild depression.
- Characterised by 2 years of depressed mood w persistent depressive symptoms.
- Includes: tearfulness. anxiety, low mood, lack of energy/interest, irritability, sleep disturbances
26
Q
Etiology of mood disorders
A
- Genetics: mainly contributes to bipolar disorder
- Neurochemical: factors such as decreases in serotonin, noradrenaline and dopamine
- Psychosocial: stressful life events bc they cause disequilibrium in hormonal and neurophysiological systems
27
Q
How do we go about providing care to a person experiencing a depressive episode?
A
- Build a relationship
- Active listening
- Open questioning
- Antidepressants (most commonly SSRI’s. can take 3-8w to work)
- ECT: used when drug treatment has failed or adverse reaction to meds
Remember - Reassess for changes/assess for suicidality
- spend time w people who are withdrawn
- focus on their strengths
- involve them in activities where they can achieve something
28
Q
Assessment of mood disorders: bipolar affective disorder
A
- episodes of mania w a depressive disorder is called bipolar disorder
- a cycling bw depression-normal mood and mania over periods of time from days to months
29
Q
Mania vs hypomania vs cyclothymia
A
- Mania: excessive elation or irritability, inflated self esteem, hyperactivity, agitation, accelerated thinking and speaking and flight of ideas.
- Hypomania: milder form or mania, NEVER accompanied by psychotic features (delusions or hallucinations). no significant impairment in social/occupational functioning.
- cyclothymia: chronic instability of mood, with mild depression and mild manic symptoms
30
Q
Providing care for people experiencing a manic episode
A
- Calm, supportive tone
- work in collaboration
- set limits
- do not argue or engage in debate. reinforce reality
- respond to legitimate complaints
- psychotherapy: CBT
- mood stabilisers e.g. lithium
- hospitalisation (risk to self or others)
31
Q
Practical advice for people experiencing mood disorders
A
- Recommend maintaining regularly daily routine
- avoid alcohol
- regular medication
- healthy sleep patterns
- offer dietary advice
- help w weight management for those on long-term antipsychotics (e.g. healthy eating resources or referral to community mental health weight loss/exercise programs)
- Consider Hep B vaccine and contraceptive planning against future risky sexual behaviours
32
Q
Risk factors for cardiovascular conditions
A
- obesity
- smoking
- physical activity
- diabetes
- hypertension
- hyperlipidemia
- oral contraceptives
- gender
- age related changes
- family history
33
Q
Components of end of bed-o-gram
A
- Colour
- pale (?shock) or
- red (?high BP or sepsis) - Peripheral perfusion
- cold or
- warm
- urine output - Skin
- clammy and sweaty or
- dry and cold - Speech
- managing full sentences
- keeping eyes open
34
Q
Assessment for cardiovascular conditions
A
Health hx
Physical assessment
Lab and diagnostic tests
35
Q
Polypharmacy in the elder adult: medication considerations
A
- overdose on OTC preparations e.g. deep heat
- prescribing cascade: meds prescribed by different teams to manage side effects from others
- Cognitive changes may incr. the likelihood of medication omissions
- Health literacy: our jargon
- need for medicines reconciliation at points of care transition (i.e. what they are currently taking)
36
Q
Mental health considerations in the elderly
A
- Social connectedness is important for ongoing resilience and mental health
- decr. production of neurotransmitters impacts memory and mood
- Decline in cognition is an important predictor of mortality in older adults
- depression or anxiety can have very physical manifestations e.g.sleep, appetite, motivation
- impact of the loss of peers
37
Q
What does a nutritional assessment include?
A
- social factors (income)
- cognitive (mood and appetite)
- dentition and manual dexterity
- food preferences
- weight
- bladder and bowel habits
- limiting processed food / alcohol
- hydration
- degree of sarcopenia (muscle loss)
- essential vitamins/nutrients
38
Q
Special considerations for older adults having surgery
A
- less physiological reserve
- multimorbidities (renal failure/reduced GI motility)
- polypharmacy
- mobility issues
- pre-operative state (?dehydrated, malnourished)
- risk of pressure injury/blood clots
