MT 1 (week 1-4) Flashcards
Types of language barriers (4)
Proficiency
Technical
Cultural
Physical
SDM
Substitute decision maker
- person you can choose to make you healthcare decisions for you when you can’t
Biological theories of aging define aging as:
Progressive loss of function
Some biological theories of aging (3)
Free radical
- oxidation alters cell function, causing aging
Cross link
- molecules reaction with chemicals that cause cell instability
Immunological-autoimmunological
- alteration of T and B cells lead to loss of capacity to self regenerate. Normal cells recognized as foreign
Social theories of aging (4)
Disengagement theory
- withdrawment from society is natural in old age
Activity theory
- older people must remain active to enjoy older age
Continuity theory
- old people make choices to maintain internal structures like beliefs
Gerotranscendnece
- as people age, they develop new views of life
- progression toward wisdom
Frail elderly
Loss of ADL function and weight loss
Need both to happen to be considered frail
Most old people are living with;
Comorbid conditions
Most important adjustment of getting older
Finding ways to maintain QOL
Biggest indicator of health or illness in older persons
Capacity and safe performance of ADLs
Changes that are not normal with aging
Disorientation, loss of language skills, loss of math abilities, poor judgement
Conditions affecting cognition
Delirium dementia depression
Delirium
Acute state of confusion, sudden onset
Dementia
Generalized impairment of intellectual functioning
Gradual deterioration
Depression
Mood disturbance
Feeling of sadness and despair
Psychosocial changes in old age
Retirement
Social isolation
Abuse
Sexuality
Housing and environment changes
Death
Restorative care addresses:
Chronic conditions that affect daily functioning
Aim to regain ADL independence
Palliative care is for
Improving QOL for Peeople with life limiting illness and their families
Gerontology
Study of biological, social, and psychological aspects of aging
Senescence
Decline in old age
Ageism
Stereotyping due to age
How can old age be defined?
Chronologically
Social roles
- grandparent, retired
Functional age
Cohort
Group of people who experience the same event at the same time
Age cohort - people born during a specific time period
Generation
Family processes
Similar to cohort, but not time bound - family bound
Family
Two or more people who depend on one another for support
Current trends in family
Divorce, LGBT
Grandparents
Family forms
Blended, extended, solo, step, nuclear
Resiliency
Coping under stress that enables the family to flourish
Calgary family assessment model (CFAM)
Strength focused model that guides nurses in the completion of family assessment
- structural, developmental, functional assessments
CFAM assessments with examples
Structural
- fam comp
- race
Developmental
- stages, tasks
Function
- ADLs
- problem solving
Structural assessment tools
Ecomap
- has connecting lines
Genogram
- family tree
ADE
Adverse drug events
Adverse drug event
Unexpected excessive response to a med that results in:
- harm
- hospital admission
- death
Types of adverse drug events (6)
Adverse drug reaction
Dose related reaction
Drug/drug interaction
Drug/food interaction
Hypersensitivity
Idiosyncratic reaction
Adverse drug reaction
Caused by process in patients body
May or may not be caused by medication errors
Types of med errors (4)
Near miss
- no harm, didn’t reach patient
No harm event
- reaches patient, no harm
Med error
- causes harm
Critical incident
- serious harm
Dose related (toxic) reactions
May be relegated to age, renal/hepatic impairment, underlying illness
Discontinue temporarily
- can provide antidote if needed
Review all meds in Px history
Assess for S/S of toxicity
Report LAB VALUES
Drug drug interactions (4)
Pharmacokinetics and pharmacodynamics of one drug can affect another
Potentiation
Interference
Displacement
Antagonsim
Pharmacokinetics
What the Body does to the drug
Absorption, distribution, metabolism, excretion
Pharmacodynamics
What the drug does to the body
Check a and physiological changes the drug causes
Drug effect
Potentiation
Type of drug/drug interaction
Drugs with similar actions can cause additive effects
Eg. warfarin and ASA can cases excessive bleeding
1+1=3 type deal
Interference
Type of drug/drug interaction
One drug accelerates or slows the metabolism/excretion of another
Can lead to drug being in the body too long even if the dose is right
Potential for serious toxic effects
Displacement
Type of drug/drug reaction
Two drugs compete for protein binding sites
Displaced drug is active for longer
- same effect as taking a higher dose
Antagonsim
Type of drug/drug reaction
One drug decreases the effectiveness of another due to opposite effects
Inhibitors and inducers
A drug that inhibits and enzymes can cause slow metabolism of a drug metabolized by that enzyme
Opposite for inducers.
A drug that stimulates production of an enzyme will metabolize a drug faster
Nursing responsibilities in drug/drug interactions
Check lab values for drug levels
Assess Px for drug effects
Check Davis
Drug/food interactions
Food can alter absorption/metabolism of medications
Diets can alter the bacterial flora of SI, can affect metabolism
MAOs
Monoamine oxidase inhibitor
Drug/food interaction example
Iron taken with acidic food can cause increase absorption
Hypersensitivity
Can be allergic or non allergic
- includes anaphylaxis
Non allergic reactions usually include
- glomerulonephritis, neutropenia
Ex. SJS, Toxic epidermal necrolysis
Nursing responsibilities with hypersensitivity
Stay with Px
Maintain IV access
Ensure access to resus equipment
Access ABCs
Notify MD/NP
Idiosyncratic reactions
May be caused by pharmacogenetic differences in drug metabolizing enzymes
Unrelated to dose
Unpredictable
Drug prone to idiosyncratic reactions
ASA!!!
S/S of an adverse drug event
Changes in:
- resps
- HR
- BP
- mental status
Occurrence of:
- seizures
- anaphylaxis
- fever
Rash
Phases of drug activity (table flow chart)
Dose of drug
- administration
Pharmaceutical phase 1
- dissolution of drug
- now available for absorption
Pharmacokinetics phase 2
- absorption/dist/metabolism/excretion
- drug now available for action
Pharmacodynamic phase 3
- drug receptor interaction
Effect
Fastest vs slowest oral preparations of drugs
Fast
- liquids, powders
Slowest
- EC tablets
- other tablets
First pass effect
Some routes make the drug pass through the liver before the site of action, rendering some of it useless
Route that have first pass effect
Oral, portal venous, pr, hepatic arterial
Onset of action
From time drug was administered until it starts to work
Duration of action
Visible effect period of drug activity
Problematic meds in older adults
Analgesics (NSAIDS)
Anticoagulants
Anitcholinergics
Antidepressants
Antihypertensives
Sedatives
More than not lmao
Older adult considerations with taking drugs
Polypharmacy
Self prescribing
Over the counter stuff
Misuse
Noncompliance
