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Older Adult Exam 2 > Older Adult Exam 2 > Flashcards

Older Adult Exam 2 Flashcards

Cardiovascular, Respiratory, Chronic pain, Integumentary, Oral, Musculoskeletal, Endocrine

1
Q

What cardiovascular changes occur with aging?

A

Decreased elasticity of blood vessels, slower heart rate response, increased risk of hypertension, and changes in heart muscle that can lead to hypertrophy or reduced contractility

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2
Q

What are some atypical presentations of cardiovascular issues in older adults?

A

Lack of chest pain, complaints of nausea, vomiting, heartburn, increased fatigue, mental status changes, dizziness, agitation, and falls.

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3
Q

Which symptoms should be assessed in cardiovascular patients to suspect cardiovascular issues?

A

Palpitations, edema, nocturnal dyspnea, nocturia, pain in lower extremities, cough, fatigue, chest pain presence/absence, shortness of breath, and syncope.

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4
Q

How does the heart compensate in heart failure (HF)?

A

By building muscle mass (hypertrophy), which temporarily increases contractility but leads to poor contractility, increased oxygen needs, poor coronary circulation, and a risk for dysrhythmias.

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5
Q

What is Acute Decompensated Heart Failure (ADHF) and how does it manifest?

A

ADHF is a severe form of HF where alveoli fill with fluid (pulmonary edema), often associated with left-sided heart failure.

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6
Q

What are the clinical characteristics of atrial fibrillation?

A

Disorganized electrical activity, increased heart rate (tachycardia), and increased risk of thrombi formation due to blood stasis.

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7
Q

What treatments are commonly used for atrial fibrillation?

A

Calcium channel blockers (Diltiazem), beta-blockers (Metoprolol), Dronedarone (multaq), Amiodarone (Cordarone, Pacerone), Digoxin (watch for toxicity).

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8
Q

What are some signs of Digoxin toxicity?

A

Visual changes, confusion, and gastrointestinal issues such as diarrhea

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9
Q

What risk factors increase the likelihood of atrial fibrillation?

A

Moderate risks include age over 75, heart failure, hypertension, low ejection fraction, and diabetes. High risks include previous stroke, TIA, embolism, mitral stenosis, and prosthetic heart valve.

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10
Q

What is the recommended drug therapy for patients with a transient ischemic attack (TIA) based on risk factors?

A

No risk: Aspirin (with an anticoagulant)
One moderate risk factor: Aspirin OR Coumadin
Any high-risk factor or multiple moderate risk factors: Coumadin

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11
Q

What is a key age-related change in the respiratory system?

A

Decreased lung elasticity and weaker respiratory muscles, leading to reduced lung capacity

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12
Q

Why is age a significant risk factor for respiratory-related mortality?

A

Older adults have weakened immune systems and are more susceptible to diseases like pneumonia and influenza.

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13
Q

How does the death rate for pneumonia and influenza change with age?

A

The death rate rises sharply in older adults.

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14
Q

Which comorbidities increase respiratory complications in older adults?

A

Diabetes, renal disease, stroke, and dementia increase the risk for complications.

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15
Q

Who is the pneumococcal vaccine recommended for?

A

All people 65 and older and adults with immunocompromised conditions or chronic illnesses.

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16
Q

When is revaccination for pneumococcal disease recommended?

A

After 5 years for those with renal failure, splenectomies, malignancy, high-dose chemo/corticosteroids, or HIV/AIDS.

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17
Q

Why is the influenza vaccine safe for older adults?

A

It does not contain live virus, so it cannot cause influenza.

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18
Q

List some common symptoms of influenza.

A

Runny nose, cough, high fever, sore throat, fatigue, headache, and muscle/joint pain.

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19
Q

What are common side effects of the influenza vaccine?

A

Sore arm, mild fever, and malaise.

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20
Q

What are key components of pulmonary rehabilitation (PR) for COPD?

A

Exercise training, smoking cessation, nutrition counseling, and education.

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21
Q

What are critical COVID-19 prevention strategies for older adults?

A

Limiting interactions, using masks, getting vaccinated, frequent hand washing, and seeking medical advice if symptoms occur.

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22
Q

How should a patient with pneumonia be positioned to prevent aspiration?

A

Elevate the head of the bed 30-45 degrees and ensure proper positioning for meals.

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23
Q

What are important aspects of COPD management in nursing?

A

Oxygen therapy, promoting activity tolerance, monitoring, mucolytic therapy, and teaching effective coughing techniques.

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24
Q

Name some common respiratory diseases in older adults.

A

Pneumonia, chronic bronchitis, emphysema, respiratory infections, COPD, COVID-19, and influenza.

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25
Q

What should be included in a respiratory assessment?

A

Vital signs, lung auscultation, checking for tachypnea, tachycardia, cyanosis, and accessory muscle use.

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26
Q

What is community-acquired pneumonia (CAP)?

A

Pneumonia acquired outside of healthcare settings; treated at home or hospitalized based on severity.

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27
Q

What is healthcare-associated pneumonia (HCAP)?

A

Pneumonia linked to nursing homes or healthcare facilities; often requires empiric antibiotic therapy.

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28
Q

What treatments are commonly used for pneumonia?

A

Antibiotics, chest percussion, beta-agonist inhalers, oxygen, rehydration, and breathing treatments.

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29
Q

Describe aspiration pneumonia.

A

It results from inhaling secretions into the lower airways, often in those with impaired swallowing or consciousness.

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30
Q

What does the CURB-65 score assess in pneumonia patients?

A

It evaluates the severity and need for hospitalization based on confusion, uremia, respiratory rate, BP, and age (65+).

31
Q

How is pain defined in the older adult?

A

Pain is a subjective experience; it exists whenever the person experiencing it says it does

32
Q

What are some consequences of untreated or poorly managed pain in older adults?

A

Fear of hastening death by analgesics, requests for assisted suicide, use of placebos, and increased risk of depression, sleep disturbances, decreased mobility, and social role dysfunction.

33
Q

What are some cautions to consider when treating pain in older adults?

A

Older adults metabolize drugs more slowly, have higher risk of GI bleeding with NSAIDs, face potential drug interactions, and may experience worsened cognitive impairment and ataxia with analgesics.

34
Q

What characterizes acute pain?

A

Quick onset, often after surgery, trauma, or post-op procedures, and usually resolves with healing.

35
Q

What characterizes chronic pain?

A

Persistent, lasting over 3 months, may start as acute but continues past normal recovery, marked by fatigue, decreased physical activity, and social withdrawal.

36
Q

What are key components of a pain assessment?

A

Onset, duration, associated symptoms, factors increasing/relieving pain, pattern, location, intensity, and quality.

37
Q

What should be considered when assessing pain in patients with dementia?

A

Use observations and nonverbal cues such as changes in behavior or facial expressions to gauge pain level.

38
Q

What are some types of nonopioid pain medications?

A

Aspirin, acetaminophen, NSAIDs (e.g., ibuprofen, diclofenac, naproxen).

39
Q

What are side effects associated with NSAIDs?

A

GI problems, renal insufficiency, and hypertension.

40
Q

What are commonly used opioid medications?

A

Morphine, oxycodone, and codeine (pure agonists, with no analgesic ceiling).

41
Q

Which opioids should be avoided in older adults?

A

Meperidine (Demerol) and propoxyphene (Darvocet), due to increased risks and adverse effects.

42
Q

What are the side effects of Opioids?

A
  1. Constipation
  2. Nausea, and vomiting
  3. Sedation
  4. Respiratory depression
  5. Pruritis
43
Q

What is adjuvant therapy, and give examples?

A

Medications developed for other purposes but effective for pain, like:
1. Corticosteroids (Dexamethasone (Decadron), Methylprednisolone (Medrol)
2. Anti-seizure drugs (e.g., gabapentin, pregabalin).
3. Antidepressants Amitriptyline (Elavil)
Imipramine (Tofranil)
4. GABA receptor agonists
Baclofen (Lioresal)

44
Q

Why are nonpharmacological approaches used in pain management for older adults?

A

They reduce the required dose of analgesics and minimize side effects.

45
Q

Name some types of nonpharmacological pain treatments.

A

TENS (transcutaneous electrical nerve stimulation), acupuncture, and heat/cold therapy.

46
Q

What are some normal changes in skin thickness and elasticity with aging?

A

Decreased thickness and elasticity, with reduced moisture leading to a dry, rough appearance.

47
Q

What changes occur in the epidermis with aging?

A

Scattered pigmented areas, including nevi (moles), age spots (“liver spots”), and larger freckles.

48
Q

What dermal changes are associated with aging?

A

Decreased thickness and function, reduced elastin quality (wrinkling, sagging), less organized collagen (loss of turgor), reduced vascularity (paler complexion), and fragile capillaries (senile purpura).

49
Q

What changes occur in subcutaneous tissues with aging?

A

Thinning in the face, neck, and lower legs, visible veins in exposed areas, increased body fat in the abdomen and thighs, and tissue hypertrophy in some areas.

50
Q

What is the main risk factor for premature aging and decreased immune function in skin?

A

Sun damage, especially from ultraviolet B (UVB) exposure.

51
Q

What are some skin conditions associated with intense, intermittent UV exposure?

A

Basal cell carcinoma and malignant melanoma.

52
Q

Which skin conditions are associated with chronic sun exposure?

A

Squamous cell carcinoma, photoaging, and actinic keratosis.

53
Q

What are the “ABCDEs” of skin cancer?

A

Asymmetry: Uneven halves
Border: Irregular edges
Color: Variation in color
Diameter: Larger than 6 mm
Evolving: Changes in size, shape, or symptoms.

54
Q

What distinguishes benign from malignant skin lesions?

A

Benign lesions stay localized, while malignant lesions can spread to other parts of the body and may be life-threatening.

55
Q

What are some nursing management principles for pressure ulcers?

A

Promote mobility, assess and stage the wound, debride necrotic tissue, cleanse the area, turn every 2 hours, and avoid prolonged sitting.

56
Q

What is stage 1 pressure ulcer?

A

Non-blanchable erythema of intact skin

57
Q

What is stage 2 of pressure ulcer?

A

Partial thickness skin loss involving dermis or epidermis

58
Q

What is stage 3 of pressure ulcers?

A

Full thickness skin loss with damage to subcutaneous tissue

59
Q

What is stage 4 of pressure ulcers?

A

Full thickness loss with tissue necrosis and possible exposure of bone

60
Q

What is the unstageable stage of pressure ulcer?

A

Ulcers covered by slough or eschar.

61
Q

What tool is used to assess pressure ulcer risk?

A

The Braden Scale, which evaluates mobility, sensory perception, skin moisture, friction, shear, and nutrition.

62
Q

What causes cellulitis in older adults?

A

Bacteria, typically Staphylococcus aureus or streptococci, entering a break in the skin.

63
Q

Where does cellulitis commonly occur, and what are its symptoms?

A

Common on the face, legs, and arms, with symptoms like redness, warmth, and tenderness.

64
Q

How is cellulitis treated?

A

With antibiotics, administered orally or intravenously.

65
Q

What are some normal musculoskeletal changes associated with aging?

A

Increased complaints of musculoskeletal pain, joint limitations, limited mobility, and impaired ability to perform ADLs.

66
Q

What are normal skeletal changes associated with aging?

A

Bones become stiffer, weaker, and more brittle; postural changes; loss of height; disproportionate size of long bones in the arms and legs; and kyphosis.

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Older Adult Exam 2 (1 decks)

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