Med Surg Age Related Diseases Flashcards
Early Adulthood (20-40 years)
maximal body functioning, high risk grounds (breast and testicular cancer, skin, drug use, endocrine), leading cause of death: MVA, homicide suicide, injuries)
What age group affects intimacy and isolation?
Early adult hood, 30s
Middle Adulthood 40-64 years
slight decrease in resp. capacity and cardiac fx, hair and skin changes, menopause in women, decreased testosterone and sperm, HTN, CV, diabetes, arthritis
What age group affects generativity vs stagnation?
middle adult hood 40-64 yr.
Late adulthood 65 years old
CV, COPD, Lung and colorectal cancer, pneumonia, multiple chronic illnesses, and polypharmacy
Which age group is affected by integrity vs despair
late adulthood 65 years
1 killer in the US of elderly
coronary artery disease
silent killer illness of the elderly
HTN
What disease is very common in the elderly? Hint* these get inflamed, bleed, cause acute abdominal pain.
Diverticular disease
What should you always check for in an elderly patient’s skin, especially in the sacrum area?
Pressure sores
In this disease, a simple headache may lead to blindness
Temporal arthritis/ polymyalgia rheumatica
You are caring for Betsy a 75 year old patient admitted in the ED. What are common labs you expect ordered?
CBC, chem panel, TSH, UA, Vit B12/Folate, RPR/VDRL, ESR, LFTs, head CT or MRI
What is included in a basic chem panel and what does it evaluate?
BUN, CO2, Creatinine, Glucose, Cl, K, Na. Evaluates kidney function, blood acid/base balance, and blood sugar levels
High / Low levels of TSH may indicate what?
High: hypothyroidism. Low: hyperthyroidism
Why is vitamin B12 and folate important?
Both help the body produce RBC. Vit B12 is vital for an important nervous system. Folate important for brain function.
What are RPR and VDRL lab tests used to test ?
Syphilis
What is an erythrocyte sedimentation rate (ESR) lab test?
Measures how much inflammation is in the body. Usually ordered for someone with unexplained fevers, some types of arthritis, and unexplained symptoms/. Helps monitor inflammatory diseases or cancer.
Why are liver function tests (LFT)ordered? Give 2 common tests ordered
Helps detect inflammation and damage to the liver. How well the liver is working. ALT, AST, PT, INR, albumin, and bilirubin
You are discussing with the UAP common ADLs that elderly patients need assistance with. What are basic ADLs you should discuss using the Katz’s modified scale
eating, bathing, dressing, transfer, continence, toileting, grooming, ambulation
True or False, urinary incontinence is a physiological aging change
FALSE
True or False, urinary incontinence is a symptom that can be improved not cured
TRUE
Would you expect a patient with urinary incontinence to be managed by his or her primary care doctor or a urologist?
Primary care doc
Why is urinary incontinence a neglected problem in the elderly?
patient embarrassment about problem, patient feels under appreciated, underevaluation by health care provider. These all lead to pressure sores and premature institutionalization
Acute Etiologies of urinary incontinence include : *hint: think DRIP mnemonic
D- Delirium ( acute disease, postoperative) and Drugs ( anticholinergics, psychotropics, diuretics, ETOH, anti-HTN). R- Restricted mobility (DJD, o-HTN, gait disorders, restraints) and Retention of urine w/overflow (drugs, BPH). Infection (urinary tract or systemic), Illness, Impaction and Injury to brain (stroke) and Polyuria (CHF and DM)
Chronic etiologies of female GU etiologies:
weak pelvic floor muscles (s/p childbirth, menopause), cystourethrocele, hypermobile bladder neck, idiopathic destrusor underactivity, bladder tumor/stones
Chronic etiologies of male GU etiologies
BPH, bladder tumor/stones, prostate surgery/irradiation
Chronic GU etiologies for male and females
parkinsonism, stroke, dementia, depression, nph, cerebral/spinal cord tumor/lesion, autonomic neuropathy (DM, ETOH, pernicious anemia)
_____ of community-dwelling elderly fall w/ significant morbidity and mortality
one-third
_______ of institutionalized patients suffer from falls
two-thirds
___-___ % of falls result in _______ injuries with 5-10% resulting in fractures
30-40% of falls result in soft-tissues injuries with 5-10% resulting in fractures
Although not often, falls can cause _____ hematomas
subdural hematomas
Fall etiologies * hint: think IJUMPD
I-Incoordination/Ataxia, J-joint stiffness/spasm , U-Unsafe environments, M- Muscle weakness, D- dizziness/vertigo
Incoordination Ataxia
dementia, neurosyphilis, pernicious anemia, vestibular disease
Joint stiffness/ Spasm
DJD, kyphosis, scoliosis, contractures, parkinsonism
Unsafe environment
poor vision, dim lights, loose rugs, ,slippery floors, sidewalk cracks
Muscle weakness
osteomalacia,peripheral neuritis
Dizziness/vertigo
simple loss of vestibular function
Common medications that cause falls
sedatives, tranquilizers, antiseizure medications, anti-HTN, diuretics, antidepressants
Risk factors for falls
decreased mobility, poor balance, impaired function, decreased vision, hearing loss, back and neck stiffness, hip and knee weakness, orth-HTN, alt. mental status, depression, polypharmacy, multiple recent falls
Soft tissue injures, fractures subdural hematomas, post fall syndrome
complications of falls
Post fall syndrome
syndrome that develops after falls where the patient develops a lack of confidence and anxiety about further falls, which leads to immobility with risks of urinary incontinence, pressure sores, pneumonia, loss of independence, and eventually death
Ways to prevent falls at home and hospital include:
adequate lighting, paint the edges of stairs a bright color, place a bell on any cats ( they move quick and can get under foot), wear proper foot support ( nonslippery materials, bed low and locked, possessions within reach, call light within reach, bed alarm
Common sensory deficits for the elderly include
vision- glaucoma, macular degeneration, cataracts. Hearing- presbycubis
cataracts
an abnormal progressive clouding or opacity of the lens of the eye
glaucoma
increase in intraocular pressure. Can be chronic or acute in onset. Chronic usually asymptomatic. Acute is accompanied by redness, pain in and around the eye, severe headache, n & v, blurring vision
Macular degeneration
painless eye condition that generally leads to the gradual loss of central vision but can sometimes cause a rapid reduction in vision
Nursing interventions for vision problems
encourage social interaction, describe environment verbally to visually impaired to increase orientation and decrease confusion, arrange for glasses prn, Make it easier for them ( large print books, bright colors, recorded books, lighted mirror), use artificial tears and don’t rub or pick at eye (risk of infection), and encourage regular eye exams
Diminished eyesight results in:
loss of independence (driving, adls), lack of stimulation, inability to read, fear of blindness
Presbycusis
age-related decrease in hearing acuity, auditory threshold, pitch and tone discrimination, and speech intelligibility (ability to understand another person’s speech)
Nursing interventions for hearing impaired
provide auditory cues to supplement loss of sensory input, supply written materials, directly face hearing-impaired so they can read lips and interpret facial expressions, decrease background noise, hearing aids prn, LOWER YOUR TONE
Presbycusis can lead to :
decreased socialization, avoidance of friends and family, decreased sensory stimulation, and hazardous conditions when driving
This disease involves an altered level of consciousness, usually acute onset, and superimposed over demential
Delirium
True or false, delirium is most often caused by a treatable illness, but still results in 30 mortality
TRUE
True or false, Delirium is not a medical emergency
FALSE
Difference between a demented patient and a demented patient with delirium answering questions
D- responds to questions inappropriately. D & D- ignore questions
This disease is usually acquired, causes progressive intellectual impairment but with clear consciousness
Dementia
What are 3 changes that occur in patient with Dementia
loss of memory; changes in cognition, language, visulospatial skills, personality; and must impact social or occupational functioning
Alzheimer’s dementia, multi-infarct dementia, pick’s dementia, and subcorical dementia (AIDS, amyotrophic lateral sclerosis) are all ?..?
irreversible etiologies of dementia
What is a key role of the nurse in caring for a patient with Dementia?
complete assessment to rule out other possible causes of a particular behavior
Possible causes of pseudo-dementia (reversible) include
drug side effects, depression, nutritional deficits, metabolic disorders ( hypothyroidism, anemia, hypoglycemia)
Nursing interventions for patients with dementia
keep client functioning and actively involved in social and family activities, ritualistic schedule, keep calendar and clocks with correct date and time around, encourage family to bring pictures from home, admin drugs to reduce emotional lability, agitation, and irritability, speak in slow calm voice, provide support for family and long-term caregivers
