Test 2: Older Adults pt 2 Flashcards
describe coronary artery disease
leading cause of death in older people
High LDL, low HDL
blood flow to myocardium; endothelial dysfunction
increase in systolic HTN and arterial dysfunction
L ventricle hypertrophy
increase in leukocyte and platelet adherence and migration
what is heart failure
cardiac output cannot meet metabolic needs
structural and functional defect
most common cause = ischemic L ventricular dysfunction secondary to CAD and HTN
S&S
- peripheral edema
- jugular vein distension
- hypoxia
- dyspnea
- cyanosis
- angina
what is pneumonia
acute lung inflammation
exudate accumulates in small brinchioles and alveoli
body inflammatory response then causes swelling; vicious cycle
2nd leading type of hospital acquired infections
S&S of pneumonia and diagnosis
fever
productive cough with sputum porduced
dyspnea
tachycardia
tachypnea
hypoxemia
high white blood cells + culture
chest x ray = diagnosis
older adults have atypical signs (change in mental status, anorexia, decreased activity tolerance, falls, incontinence, elevated HR, etc
characteristics of UTI
2nd most common infection
body is sterile except for distal portion of urethra; this is where infection usually starts
urinary retention is primary contributor
S&S of UTI
pain with urination
increase frequency/urge
hematuria but not necessarily in elderly
older adults often have no/atypical S&S
what is sepsis
life threatening
body’s response to infection actually injures body’s own tissue
hypotension, fever, elevated HR
high mortality
survivors = often PICS
dehydration implications with older adults/pathophysiology
directly increase in rate of mortality
decreased thirst mechanism with age
reduction in total body fluid and mm
decreased renal function = concentrated urine; body can’t retain fluid
hyper, iso, and hypo tonic meaning
hypertonic = greater loss of water than Na
isotonic = equal loss of water and Na
hypotonic = greater loss of Na than water
symptoms of dehydration
confusion
lethargy
rapid weight loss
functional decline
what is diabetes
metabolic; inadequate insulin (regulates glucose)
type 2 = metabolic
ideal control = diet, exercise, weight control
usually controlled with meds though
uncontrolled = neuropathy, impaired wound healing, renal disease, and visual problems
management in acute settings
85+ more likely to be hospitalized
more vulnerable to iatrogenic affects (delerium, pneumonia, dehydration, loss of control, pressure injuries, mobility decline, anxiety, depression, malnutrition, etc)
American Association of Critical Care Nurses developed initiative to reduce adverse events in acute care
IPR setting management
multidisciplinary
pt must be determined to have significant rehab potential and pt must meet certain criteria
required 3 hours therapy/day at least 5 days/week
trial admission not permitted
reimbursement higher from MC bc of level of care provided
60% of the pts at these facilities must be CMS-13 diagnostic category
skilled nursing setting management
certified by CMS to provide MC reimbursable short term skilled nursing and therapy
more pts have lower functional level and there is no 60% rule
usually require longer length of stay
changes in other settings means that more who don’t need as intense therapy are admitted as well (i.e. total joints)
goal = return home
long term care setting management
some cases after SNF benefit is exhausted
no regular or skilled intervention provided under long term care benefits
MC doesnt cover cost but some private insurances will
periodic screens provided with rehab team
if screen is done and pt is appropriate for therapy services are paid under MC (part B)
goal may just be improve function
home health setting management
homebound criteria = need of aide support OR have a condition that leaving the home is medically contraindicated
if pt meets one of the conditions, then they must also meet 2 criteria: must exist a normal inability to leave home AND leaving home must require very taxing effort
can do home under MC part B if pt isnt homebound but travel time is not reimbursable
initial home health visit can take 90 min
end of life care setting management
QOL focus
PT = be more comfortable and preserve function
palliative care = focus on chronically ill but not terminally ill
- may be months
- reimbursed through pts reg insurance
- all hospice pts receive palliative care but not all palliative care receive hospice
documentation = must include need for skilled PT to prevent decline vs ability of a family member or nurse to provide this
to qualify = hospice physician and PCP must assure there is a terminal condition with life expectancy less than 6 months
pt needs to confirm they are willing to do comfort based care and no longer seeking treatment
hospice begins with 2 initial 90 day periods followed by unlimited 60 day periods
aerobic functional measures
6 min walk test
2 min walk test (for more severe pt)
2 min step test (# steps in 2 min)
seated step test (if pt can’t stand)
mobility functional measures
elderly mobility scale
TUG and TUG cog
gait speed (10mWT)
4 square step test (step/direction change)
DGI
FGA
balance functional measurs
functional reach
SLS test
Rhomberg
M-CTSIB
Berg balance
Fullerton Adv Balance Scale (high functioning older adults)
STEADI
self report functional measures
Activities specific balance confidence scale
falls efficacy scale(fear of falling); highest score is 100; over 70 is fall risk
posture functional measures
plumb line observation
inclinometer for kyphosis
occiput to wall
tragus to wall
components of exercise prescription
warm up/cool down
overload - for adaptation
specificity
progression
recovery
frequency
intensity
duration
speed
mode
purpose of warm up/general guidelines
5-10 min either passive, general, or specific
increases BF, mm viscosity, speed of nn impulses, and flexibility
reduces injury
cool down general guidelines
5-10 min
gradual tapering
prevents pooling of blood, decreases light headedness, fainting, and abnormal heart rhythm
promotes removal of waste products
parameters for aerobic/endurance training
mean intensity = 66-73% with 40-50 min for 3-4 days/week appears most effective
ACSM recommends 60-80% HRR with daily goal of 30 min and can be done in 10 min increments
use HR or RPE scale, 6-20 Borg scale work at 13-16
balance training Rx recs
daily for older
reactive and anticipatroy
reduce BOS
alter COG
multidirectional stepping more effective than walking
power based ballistic concentric mm contractions more effective than strength
obstacle train
10-15 min
flexibility Rx recs
10-30 sec but preferably 60 sec for older adults, 2-3 times each mm
5 days per week min
5 min per week per mm
proper alignment is crucial
static flex = hold; goal to increase flexibility
dynamic flex = good for warm up/used for breathing
older adults = move tendon end first followed by mm
mild discomfort is okay but do not want pain
gait exercise Rx
5-7 days per week
challenge limits
change speed, surfaces, environment
heel walking, toe walking, braiding, tandem, etc
strength exercise Rx recs
60-80% 1RM
2-4 sets for each mm group
speed should be slow/steady
2-3 days per week and give mm groups time to recover (48 hours)
power training exercise Rx
low intesity high reps = power
low reps high intensity = strength
power is a better predictor of function than strength
30-60% 1RM 3-6 reps, 1-3 sets
cardio/pulm exercise benefits
heart pumps more effectively
resting and exercise HR decreases
decreased resting BP
increased VO2 max
respiratory rate is lower at rest
MSK benefits of exercise
increase insulin actin
increase strength/endurance
increase power in type I and II fibers
reduce body fat
neuromuscular benefits of exercise
increased postural and NM control
increase speed of mvmt
increased contractile time
improved rxn time
mental health benefits of exercise
improved cognitive function
increased self respect
decreased anxiety/depression
barriers to exercise
lack of time/knowledge/energy
dont like being alone
travel
older age
cognitive decline
boring
neg attitude
decreased self efficacy
pain
things to note in regard to wellness in older adults
factors associated with physical, psychological, and social health
PTs can promote with edu backgroun, lengthy pt contact, and pt trust
exercise is single most important health promoting activity for older adults
current rec = 150 min per week mod to intense aerobic ex and strengthening major mm
