test 4 Flashcards
leading cause of cardiac deaths
stroke and heart disease
most common chronic disease
htn
common htn complications
end organ damage
stroke
cardiac disease
renal insufficiency
right sided hf symptoms
lower extremity edema
weight gain
left sided HF s/s
SOB
dyspnea
congested sounded lungs
symptom control of HF
o2
limit salt
controlled fluid balance
elevate HOB, limit exertion
what problems often accompany COPD
asthma
bronchitis
emphysema
exacerbation of COPD
increase in symptoms. sputum may increase. symptoms vary
decrease in functional status
ischemic cva
Most common
Blood supply to brain interrupted due to blockage
main causes- arterial disease, cardioembolism, hematologic disorders, systemic hypo-perfusion
hemorrhage cva
Increased risk of life threatening event compared to ischemic
Primarily caused by uncontrolled HTN
may see seizures and decreased LOC
TIA
Mimic symptoms of a CVA
Symptoms begin to resolve in minutes
Do you lose cognition with stroke
no, you may loose function but not cognition
FAST stroke
Face
Arm
Speech
Time
most common neurodegenerative disorders
alzheimers and parkinsons
alzheimers disease
Memory loss
Impaired thinking
inability to find words
Decreased judgment
Altered behavior
pharm therapy to help slow alzheimers
cholinesterase inhibitors
NMDA antagonist
fluent aphasia vs nonfluent aphasia
fluent- person speaks easy but content doesnt make sense
nonfluent- speaks slowly and uses minimal words
dysarthria
impairment in ability to articulate words. Caused by weakness or incoordination of speech
common s/s of anxiety
Agitation
Irritability
Pacing
Sweating
Difficulty sleeping
Stomach issues
barriers to access to mental health care in elderly
Shortage of trained personnel
Limited availability and access
Lack of staff training
Inadequate Medicaid and Medicare reimbursement
treatment for anxiety in older adults
cognitive behavior therapy
SSRI
Use benzodiazepines cautiously
four major symptom clusters of ptsd
reexperiencing
avoidance
persistent negative alterations in cognition and mood
alterations in arousal and receptivity
s/s of depression in elderly
insomnia
loss of appetite
pain
loss of interest
treatment of depression in elderly
Social Support
Cognitive Behavioral Therapy
Exercise
Medications
most common substance abuse form in older adults
alcohol
educate on increased blood alcohol levels due to decreased liver function
delirium causes
severe illness
procedures
medications
restraints
types of delerium
Hyperactive
○ Increased activity levels
Hypoactive
○ Decreased activity levels
Mixed
○ Periods of excitability and lethargy
delerium
sudden onset, decreased consciousness
3 Ds of cognitive impairment
dementia
delirium
depression
dementia
steady cognitive decline. often occurs slow over years unless due to vascular
focus on communication, behavior, relationships
focus on pt needs
maximize ability to make own choice
do meaningful activities like reminiscing
wandering patient interventions
Patient redirection
Provide activities during normal wandering times
Utilize visual cues for reorientation
Locked units
ensure safety
if these pts do it often it can become predictable on the time of day they do it. keep them entertained during this time.
what are dementia pts at risk for
weight loss and inadequate nutrition
who is at economic risk for retirement
women
disabled
those who lack access education or hold low paying jobs
those not eligible for social security
immigrants
key to retirement
planning
pay attention to finances and resources
death of a spouse
often a loss of identity
significant impact on well being: physical, psychosocial, social, economic
fictive kin
not blood family, but people that are close that may help out, such as someone from church
do siblings become closer or more distant with age
closer
the strongest bond is between sisters
intimacy and older adults
more than just a physical act.
Feelings of connectedness, belonging, commitment, acceptance
importance at all stages in life
what is sexual health influenced by
culture
changes with aging
expectations
activity level
most prevalent sexual problem in men
erectile dysfunction
age group that HIV is at greatest risk
females 60 and over
increasing occurence in elderly
why is HIV hard to dx
s/s are common to many other diseases in elder population
PLISSIT model
a way to start sexual health convo
Permission
Limited Info
Specific Suggestions
Intensive Therapy
who is most prone to negative impact from caregiving
spouses
this is due to they are less likely to receive assistance from others
types of elder abuse
physical, psychological, medical, financial, or sexual
what is abuse
when harm is inflicted intentionally
who is more at risk for elder abuse
the older and more frail you are the more at risk
neglect
failure of a action. Can be by caregiver or self,
it is typically unintentional if from caregiver, but could be deliberate.
self neglect may be due to many reasons
signs of medical neglect
delay in seeking healthcare
signs of neglect
weight loss
inappropriate clothing
signs of psychological abuse
agressive behaviors
patient not allowed to talk
mandatory reporting
nurses must report all abuse or if its suspected
anticipatory grief
grief before loss occurs
acute grief
a crisis characterized by periods of functional disruption
shadow grief
occurs over months as intense pain of the moment lessens
complicated grief
grief that does not lessen over time or bears traumatic memories
disenfranchised grief
when grief cannot be expresses. may lead to reckless behavior
effective coping
maintains composure
use good judgement
optimistic attitude while accepting loss
ineffective coping
pessimistic attitude
demanding
emotional extremes
feelings of guilt
six Cs for helping patient and families navigate the dying process
Care- managing common problems like pain
Control- person centered actions
Composure- address sadness, have moments of relief
Communication- pt express wishes, provide info to family
Continuity- assist to maintain as normal life as possible when dying
Closure- reconciliation and transcendence
best practices when approaching death
Ensure patient comfort with warm blankets and socks
Provide opportunity for increased rest
Change beddings as needed
Play soothing music and use dim lights
Respect the patient’s diminishing appetite
Explain decrease in urine output to family
Reposition patient as needed to ease breathing
goal of palliative care
comfort
durable POA
Provides information on matters pertaining to care
living will
Represents the patient’s wishes specific to a terminal illness
medical POA
Rights and responsibilities to make health-related decisions if the patient is unable
