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FNP 1 > Older Adult > Flashcards

Older Adult Flashcards

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Family Nurse Practitioner (FNP) flashcards
1
Q

what is 2x more likely in the elderly?

A

adverse drug reactions

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2
Q

evidenced-based list of potentially inappropriate meds for older adults >65

A

BEERS criteria

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3
Q

7 minute tool designed to assess cognitive literacy and pillbox skills in order to optimize medication safety

A

Medi-cog

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4
Q

assists with drug discontinuation in outpatient setting. asks prescriber to consider drug indication, dose, benefits

A

good palliative geriatric practice algorithm

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5
Q

wellness visit covered during first 12 months then yearly without charge- covered by original medicare (part B) and medicare advantage plans

A

Medicare 360

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6
Q

IPPE

A

individualized preventative physical exam

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7
Q

common eye changes in elderly?

A

d/t presbyopia, eye diseases present)

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8
Q

eye exam frequency

40-45 years→
55-64 (no RF) →
>65→

A 
baseline eye exam (ophthalmologist) age 40
40-45 years→ every 2-4 years
55-64 (no RF) → every 1-3 years
>65→ every 1-2 years
Frequency increases as ages
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9
Q

tests to check elderly hearing

A

Whispered voice (behind patient): is the deficit volume or clarity related?
Finger rub near ear
Watch tick test (hold ticking watch near ear)

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10
Q

JNC 8 BP Recommendations:

A

> 60 years: LESS THAN 150/90 mmHg or less

Checked at every visit

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11
Q

Screen to check adult alcohol use

A

AUDIT

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12
Q

more detailed than cage, not as easy to interpret as Audit drinking tool

A

CARET

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13
Q

15 Q
Inpatient/ outpatient
Good for person with or without cognitive impairment
Many languages

A

Geriatric Depression Scale (GDS)

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14
Q

What test?
Have patient sit in chair, when I say go stand up and walk to line, turn around, walk (3m/10ft) back and sit back down → should be able to do in <12 secs
How well they stand, gait

A

TUG (Timed Up and Go)

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15
Q

if pt can hold 4 different positions for 10 seconds (eyes open or closed- your discretion)

A

Timed 4-Stage Balance Test:

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16
Q

Recommend to prevent falls, improve bone and muscle strength, and improve nerve health

A

Vitamin D

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17
Q

Pneumococcal Vaccine elderly considerations

A

Everyone 65 or older
get PPSV 23

Younger if immunocompromised (DM, lung disease, smoker, sickle cell)

If pt has previously had PPV13, must wait one year to receive PPSV23

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18
Q

Shingles Vaccine elderly

A

Shingrix → 2 dose series
2-6 months apart

Age 50 or older
If pt received Zostavax, revaccination with Shingrix is required

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19
Q

tetanus Vaccine elderly

A

every 10 years

Tdap if have new grandbabies (pertussis)

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20
Q

PODS

A

Plan for older drivers safety

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21
Q

SNAQ

what do the elderly need?

A

Simplified Nutritional assessment Questionnaire (SNAQ)

NEED:
K, Ca, Vit.D, B12, minerals, and dietary fiber

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22
Q

Exercise recommendations for elderly

A

2.5 hours per week of moderate aerobic exercise
Strengthening 2x/week
Activities to improve balance
Yoga, tai chi, standing on one foot and alternating

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23
Q

FRAT

A

fall risk assessment tools

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24
Q

IADL

A

instrument activities of daily living

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25
Q

More than 5 drugs per person (both prescription and nonprescription)
Higher risk of falls and changes in mental status

A

Polypharmacy

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26
Q

require 2 meds to cause interactions (erythromycin and theophylline used together are toxic)

A

SECONDARY ADE/adverse drug reaction

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27
Q

quitting meds cold turkey

A

Drug withdrawal syndrome

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28
Q

caused by benzos in older adults= higher incidence of falls

A

Tertiary ADE

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29
Q

chronic irreversible illness with gradual onset and steady decline in cognition
short -term memory loss (primary sx)
Disorientation
Disturbance in executive function (planning, organizing, abstract thinking)
Problems with ADLs
1 of 3: aphasia, apraxia, or agnosia
Day-night sleep cycles reversed
Irritability, withdrawal, and apathy in early stages

A

Alzheimers DIsease

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30
Q

acute onset with fluctuations in orientation and attention

Often seen in hospitalized older adults

A

Delirium

31
Q

often accompanied by sodium imbalance
Thirst response is diminished
Decreased renal plasma flow= decline in ability to concentrate urine (prevents body from retaining enough fluid)
Vasopressin release (usually stimulated by low fluid volume) is diminished
s/s: confusion, lethargy, rapid weight loss, and functional decline.

A

dehydration in the elderly

32
Q

labs/ tests to look for dehydration in elderly

A

BUN/creat: 25:1 or more
Na > 148
Hct elevated
PE: orthostatic bp and rise in pulse; elevated temperature

Resp and GU infections are common→ UA and CXR

33
Q

Post-falls assessment: DDROPP

A

Post-falls assessment: DDROPP

diseases, drugs, recovery, onset, prodrome, and precipitants

34
Q

STEADI

A

stopping elderly accidents, deaths, and injuries → CDC

35
Q

proggressive loss of energy, strength, and stamina leading to decreased function and physical and cognitive deterioration unexplained weight loss of 10% or more of body weight in less than one year

A

failure to thrive

36
Q

Physical signs of abuse, change in behavior or withdrawal from usual activities, checks signed by unauthorized persons, bedsores, poor hygiene or nutritional status.
In home setting report to state adult protective services; police, ombudsman

A

Elder abuse

37
Q

major physical and physiological changes that occur with aging

A

Reduction in lean body mass, increase in body fat
Decreased blood flow to liver and kidneys
Abnormalities in cardiac conduction system
Decreased gastric acid production
Decreased total body water
Increased volume distribution for fat soluble drugs, decreased distribution for water soluble drugs
Decreased vit d absorption and activation

38
Q

Major causes of elder death

A

heart disease, CVA, falls, sepsis from UTIs, HTN leading to renal failure or stroke, diabetes. Hearing and vision impairment affecting mobility.

39
Q

What is important to know about incontinence in women?

A

Not normal at any age

40
Q

non-pharma plans for urge incontinence

pharma

A

PT, OT, decrease fluids, weight loss, management of constipation

Anticholinergic meds (avoid in elderly), B-adrenergic agonists, intravaginal estrogen, Botox

41
Q

when to refer urge incontinence to urology

A

Failure or intolerance of non-surgical treatments

Surgical: sacral nerve stimulator

42
Q

when to refer Stress incontinence to urology

A

Failure or intolerance of non-surgical treatments. Suprapubic catheter

43
Q

when to refer overflow incontinence to urology

A

Failure or intolerance of non-surgical treatments. Suprapubic cath

44
Q

non-pharma plans for stress incontinence

pharma

A

Smoking cessation, weight loss, decrease fluids, PT, OT, pessary, urethral plugs

A-adrenergic agonists
Duloxetine

45
Q

non-pharma plans for mixed incontinence

pharma

A

Treat using combo of treatments for urge/ stress w/ focus on most dominant symptom

46
Q

non-pharma plans for mixed incontinence

pharma

A

identify and relieve obstruction. Self or assisted intermittent cath, indwelling cath

a-adrenergic antagonists or blockers

47
Q

what kind of incontinence to refer to urology

A

incontinence that is associated with hematuria or an infection that is not responsive to treatment

48
Q

what is urinary incontinence in men usually due to

A

BPH

49
Q

what is urinary incontinence in men usually due to

A

decreased activity, medications (pain, depression, etc), diabetic neuropathy, etc.

50
Q

clasts break down the bone (bone resorption>bone formation)

A

osteoporosis

51
Q

BMD higher than 1 SD below the young adult mean

A

Normal BMD

52
Q

BMD between 1 and 2.5 SD below the young adult mean

A

Osteopenia (or low bone mass)

53
Q

BMD lower than 2.5 SD below the young adult mean

A

Osteoporosis

(WHO p1002):

54
Q

BMD lower than 2.5 SD below young adult mean and the presence of one for more fragility fractures

A

Established (or severe) osteoporosis

55
Q

USPSTF osteoporosis screening recommendations for women > 65

A

B

56
Q

USPSTF osteoporosis screening recommendations for postmenopausal women younger than 65 at increased risk

A

B

57
Q

USPSTF osteoporosis screening recommendations for men

A

I

58
Q

only FDA approved for prevention of osteoporosis

A

Hormone Therapy

59
Q

Osteoporosis risk factors

A

Advanced age
Female gender- post menopause ( decreased estrogen)
Prior osteoporotic fracture
Femoral neck BMD
Low BMI
Oral glucocorticoid use (5mg prednisone/day for 3 or more months-ever)
rheumatoid arthritis
Secondary osteoporosis- glucocorticoid treatments most common cause of 2ndary
Parental hx of hip fracture
Current smoking
More than 3 alcoholic drinks/day

60
Q

foods high in calcium

A

Broccoli, green leafy vegetables

61
Q

osteoporosis lifestyle modifications

A

Nutritional supplements, increase physical activity, stop smoking, limit alcohol and caffeine. Calcium and Vitamin D supplements

62
Q

meds used to tx osteoporosis

A

Bisphosphonates

RANKL Ab, estrogen replacement, SERMs

63
Q

vision changes associated with aging

A

Decreased visual acuity (presbyopia).
Structural changes within the eyes,
floaters, reduced peripheral vision

64
Q

vision changes associated with pathology

A

Cataracts,
Glaucoma,
Macular degeneration,
Retinopathy

65
Q

elderly hearing changes

A

Presbycusis (age related hearing loss), tinnitus, ear wax (produce more as you age)

66
Q

elderly touch/ pain changes

A

Diminished ability to feel injury, pressure. Clumsiness, difficulty with tasks
(reduced brain weight,
decreased conduction speed along nerves related to loss of myelin sheath, decreased circulation, and slowed waste removal)

67
Q

elderly proprioception changes

A

Decreased conduction speed along nerves related to loss of myelin sheath -> Difficulty with balance, falls, decreased willingness to leave
familiar surroundings

68
Q

elderly smell changes

A

Decreased number of nerve endings and mucus production in the nose -> Decreased enjoyment of pleasant smells & taste, decreased ability to smell dangerous odors such as gas or smoke

69
Q

elderly taste changes

A

Decline in the number of taste buds, & Remaining taste buds shrink. Taste sensitivity declines. Decreased saliva production

70
Q 
risk factors include age, diabetes, smoking, alcohol use, UV light exposure
Symptoms:
cloudy/blurry vision
Faded colors
Glare, possibly halo around lights
Decreased night vision
Double vision or multiple images in one eye
Frequent prescription changes
A

cataracts

71
Q

Presentation of Infections in the Elderly

A 
Absence of fever
Sepsis without usual leukocytosis and fever
Falls
Decreased appetite or fluid intake
Confusion
Change in functional status
72
Q

cognitive screenings for elderly

A

Mocha, MiniCog

73
Q

Erikson stage for elderly

A

Integrity vs. despair

Reflection on life, did they accomplish what they wanted, was life what they thought it would be? Was life productive and happy (Integrity( or not? (despair/depression).

74
Q

what can happen with continuous wearing of dentures-

A

oral stomatitis

FNP 1 (18 decks)

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