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FNP: 1 > Middle & Older Adult > Flashcards

Middle & Older Adult Flashcards

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1
Q

Developmental Theory for middle adults

A

generativity v. self absorption

  • helping kids becoming good adults
  • Rediscovering or developing new satisfaction with spouse.
  • Developing an affectionate but independent relationship with aging parents.
  • Reaching the peak in one’s career.
  • Achieving mature social and civic responsibility.
  • Accepting and adapting to biological changes.
  • Maintaining and developing friendships.
  • Developing leisure time activities.
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2
Q

Ages of a middle adult?

A

35-65

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3
Q

Ages of an older adult?

A

65+

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4
Q

Developmental Theory of older adult

A

Generativity v. Stagnation

- normalize their aging bodies

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5
Q

What is glaucoma?

A

a group of eye diseases that gradually result in a loss of vision by permanently damaging the optic nerve

  • usually no symptoms until vision loss has begun and it’s too late
  • genetic- look at family hx
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6
Q

Who should be screened for glaucoma?

A
  • DM
  • African Americans, 50+
  • Hispanic Americans, 65+
  • Family Hx
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7
Q

How is glaucoma diagnosed?

A

failure of one visual field

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8
Q

Total Cholesterol levels:

  • desirable
  • borderline
  • high
A

Total Cholesterol levels:

  • desirable: less than 200
  • borderline: 200-239
  • high: 240+
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9
Q

LDLs:

  • Optimal
  • Near Optimal
  • Borderline High
  • High
  • Very High
A

LDLs:

  • Optimal: less than 100
  • Near Optimal: 100-129
  • Borderline High: 130-159
  • High: 160-189
  • Very High: 190+
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10
Q

HDLs:

  • high
  • low
A

HDLs:

  • high: 60+ (Want this)
  • low: less than 40
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11
Q

Triglycerides:

  • Normal
  • Borderline High
  • High
  • Very High
A

Triglycerides:

  • Normal: less than 150
  • Borderline High: 150-199
  • High: 200-499
  • Very High: 500+
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12
Q

How often is the routine screening of triglycerides?

A

Q5 years

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13
Q

How often should your blood glucose be tested?

A
  • Once at age 45

- Q3 years from 50+

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14
Q

Fasting Blood Glucose levels

  • Normal v. Impaired
  • Diabetes v. Pre-diabetes
A
  • Normal: 70-100
  • Impaired fasting glucose: 100+
  • Pre-diabetes: 100-125
  • Diabetes: 126+
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15
Q

Who should get screened for lipid disorders?

A
  • Women 20-45: of they have increased risk for CHD
  • Women 45+: if they have increased risk for CHD
  • Men: 35+
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16
Q

Who should get tested for Type 2 diabetes?

A
  • symptomatic
  • family hx
  • asymptomatic adult with BP greater than 135/80
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17
Q

Who should be screened routinely for osteoporosis?

A

Women 60+ who are at increased risk

All women 65+

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18
Q

What is the single best predictor of osteoporosis?

A

Weight

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19
Q

How is osteoporosis screened?

A

(DEXA) Dual energy x-ray absorptiometry

- at the femoral neck

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20
Q

What increases the risk of having osteoporosis?

A

smoking
drinking
sedentary life

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21
Q

What are the goals of osteoporosis?

A
  • prevent fractures
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22
Q

What medications are considered in osteoporosis?

A

Biphosphonates: alendronate, risedronate, and ibandronate
Estrogen
Raloxifene
Calcitonin

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23
Q

How is osteoporosis treated?

A
  • Balanced diet (rich in calcium, vit. D)
  • regular exercise
  • maybe take tums before bed
  • Ca supplements are NOT given to renal patients
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24
Q

Who is at risk for Abdominal Aortic Aneurysm?

A
  • over 65
  • Male
  • Smoking (100+ cigarettes)
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25
Q

When should women be screened for abdominal aortic aneurysms?

A

Should NOT be screened

- Grade: D recc.

26
Q

When should men be screened for abdominal aortic aneurysms?

A

One-time screening for men

- age 65-75 who have ever smoked

27
Q

What happens if the abdominal aortic aneurysm is found to be 5.5cm or larger?

A

Open repair

28
Q

What happens if the abdominal aortic aneurysm is found to be 4.0-5.4 cm?

A

Periodic surveillance

29
Q

What happens if the abdominal aortic aneurysm is found to be 3.0-3.9 cm?

A

No intervention, maybe repeat ultrasound

30
Q

When should routine PSA screening occur?

A

Should not occur

- Grade: D recc.

31
Q

Who benefits from PSA screening?

A
  • men 50-70 at average risk

- men 45 and older at increased risk (FMH or African American)

32
Q

How often should PAP smears be routinely taken?

A
  • Women 21-30: Q3 years
  • Women 30-65: Q5 years
  • Women 65+: stop (esp. 3 normal neg. PAPs over 10 years)
33
Q

When should PAP smears begin?

A

3 years after sexual activity begins

34
Q

Should a PAP smear be taken after a hysterectomy?

A

No PAP if no cervix

35
Q

When should breast cancer screenings be given?

A

Women, before age 50: shared decision making

Women 50-74: mammogram every 2 years

36
Q

Who are most likely to benefit from breast cancer screening?

A
  • Family hx of breast cancer in mom or sister
  • Previous biopsy with atypical hyperplasia
  • First childbirth after age 30
37
Q

When should colon cancer screening begin and end for men and women?

A

Begin: 50+ years for men and women
End: 75-85 years for men and women

38
Q

What are the different types of colon cancer screening tools?

A
  • Fecal Occult Blood Testing (FOBT)
  • Flexible Sigmoidoscopy
  • FOBT + Flexible Sigmoidoscopy
  • Colonoscopy
  • Double Contrast Barium Enema
39
Q

How often should the flexible sigmoidoscopy be given?

A
  • Every 5 years

- if abnormal, will need colonoscopy

40
Q

Sigmoidoscopy procedure

A

Night before: take laxatives the day before or the morning of the test to clean out your colon.

Day of:

  • You will be awake during the test, and you will probably be able to go back to work after the test.
  • Your provider will insert a thin, lighted tube into your rectum. The tube is connected to a video camera so we can look at your rectum and the lower part of your colon.
41
Q

How often should the colonoscopy be given?

A

Every 10 years

42
Q

Pros and Cons of a sigmoidoscopy

A

Pros: Cheaper than colonoscopy and back to work same day
Cons: less accurate and if abnormal, will need a colonoscopy

43
Q

Colonoscopy procedure

A

Night before: take laxatives the day before the test to clean out your colon.

Day of:

  • Will be asleep during the test
  • The provider will insert a thin tube connected to a video camera into your rectum to look at your whole colon
  • If polyps are found, they will be removed right then
  • Will miss a day of work and will need someone to drive you home
44
Q

Pros and Cons of a colonoscopy

A

Pros: most accurate test, will remove polyps on the spot
Cons: most expensive, causes more injuries, miss a day of work

45
Q

Which colon cancer screening has the greatest reduction in mortality?

A

FOBT- done annually, includes 3 specimens

46
Q

What is the recommendation grade for ovarian cancer screening?

A

Grade: D- dont

47
Q

When should ASA prophylaxis be initiated?

A

Men: 45-79
Women 55-79
- If MI risk outweighs harm of potential GI hemorrhage
- If younger, grade: D recc.

48
Q

What is osteoarthritis?

A

Pain and stiffness in one or more joints, swelling of joints, decreased mobility, nocturnal pain, and parethesias.

49
Q

Primary signs of osteoarthritis?

A
  • pain, stiffness,
  • enlargement or swelling,
  • tenderness,
  • limited range of motion,
  • muscle wasting,
  • partial dislocation
  • deformity (heberden and bouchard nodes).
50
Q

What peripheral joints are generally affected with osteoarthritis?

A

hands, wrists, knees, and feet.

51
Q

What central joints are generally affected with osteoarthritis?

A

lower cervical spine, lumbosacral spine shoulders, and hips.

52
Q

What is the conservative treatment for osteoarthritis?

A
  • rest of the involved joint
  • range of motion exercises
  • assistive devices
  • weight loss if obesity is present
  • analgesic andanti inflammatory drug therapy.
53
Q

Why would surgery be suggested?

A
  • improve joint movement
  • correct a deformity or malalignment
  • create a new joint with artificial implants
54
Q

Osteoarthritis referrals

A
  • Rheumatologist, orthopedist,
  • physical therapist, occupational therapist,
  • dietitian,
  • licensed acupuncture therapist
  • social worker
55
Q

What is Rheumatoid Arthritis?

A
  • Insidious onset beginning with general systemic manifestations of inflammation, fever, fatigue, weakness, anorexia, weight loss, and generalized aching and stiffness.
  • Gradual local manifestations of painful, tender, stiff joints.
56
Q

What are the diagnostic criteria for rheumatoid arthritis?

A

Presence of 4+ of the following, for 6 weeks:

  • Morning stiffness for longer than 1 hour
  • Arthritis of 3+ joint areas
  • Arthritis of hand joints
  • Symmetric arthritis
  • Rheumatoid nodules over extensor surfaces or bony prominences
  • Serum rheumatoid factor present in abnormal amount
  • Radiographic changes
57
Q

Delirium

A

Clouded consciousness with abrupt onset

- usually do to medication, metabolic problem, infection

58
Q

Dementia

A

Syndrome where you loose your intellectual capacity

59
Q

Delirium v. Dementia

A

Delirium- acute, reversible, corrected when underlying cause is removed
Dementia- gradual, irreversible, gradual loss of intellectual capacity

60
Q

What are some common causes of delirium?

A
  • Systemic dysfunction – hypothyroidism, Vitamin B12 deficiency, folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphillis, and HIV
  • Substance induced – polypharmacy and inappropriate prescribing of medications, alcohol abuse
61
Q

What should be screened for annually in a patient with dementia?

A

Depression- esp. with family hx or depression

Check TSH as well

62
Q

What drug therapies are used in dementia?

A
  • cholinesterase inhibitors (e.g. Aricept, Elexon, and Razaydne) these work by increasing the availability of acetylcholine in the brain
  • Memantine (Namenda) controls calcium and other internuronal messengers to preserve capacity and functionality

FNP: 1 (8 decks)

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