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NR 601 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Age related Developmental Changes:

Replicative senescence

A

Theory states that cells can replicate or divide a specific number of times. This ability tends to decrease with age.

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2
Q

Age related Developmental changes:

Oxidative damage

A

The cumulative result of the aerobic metabolism, which generates chemicals called free radicals. Free radicals may interact with other chemicals in the body and cause damage to cells.

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3
Q

Age related Developmental changes:

Telomere shortening

A

A theory that links aging to a reduction in cell division.

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4
Q

Age related Developmental changes:

Weakening of the immune response

A

Leaves older adults more vulnerable to infection and debilitating diseases.

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5
Q

Age related Physiological Changes:
Integumentary System

Loss of dermal an epidermal thickness

A

Functional change:
Loss of subcutaneous tissue and then epidermidis.

Implications:
Prone to skin breakdown and injury

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6
Q

Age related Physiological Changes:
Integumentary System

Decreased vascularity

A

Functional change:
Atrophy of sweat glands resulting in decreased sweat production, decreased body odor, decreased heat loss, dryness

Implications:
Alteration in thermoregulatory response, fluid requirements may change seasonally, loss of skin water, increase risk of heat stroke

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7
Q

Age related Physiological Changes:
Respiratory System

Decreased lung tissue elasticity

A

Functional change:
Decreased vital capacity

Implications:
Reduce overall efficiency of ventilatory exchange

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8
Q

Age related Physiological Changes:
Respiratory System

Cilia atrophy

A

Functional change:
Change in mucociliary transport

Implications:
Increased Susceptibility to infection

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9
Q

Age related Physiological Changes:
Respiratory System

Decreased respiratory muscle strength

A

Functional change:
Reduced ability to handle secretions and reduced effectiveness against noxious foreign particles. Partial inflation of lungs at rest.

Implications:
Increased risk of atelectasis

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10
Q

Age related Physiological Changes:
Cardiovascular System

Heart valves thicken and become fibrotic

A

Functional change:
Reduced stroke volume, cardiac output; may be altered

Implications:
Decreased responsiveness to stress

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11
Q

Age related Physiological Changes:
Cardiovascular System

Fibroelastic thickening of the Sinoatrial (SA) node; decreased number of pacemaker cells

A

Functional changes:
Slower heart rate

Implications:
Increased prevalence of arrhythmias

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12
Q

Age related Physiological Changes:
Cardiovascular System

Decreased Baroreceptor sensitivity (stretch receptors)

A

Functional change:
Decrease sensitivity to changes in blood pressure

Implications:
Prone to loss of balance, which increases the risk for falls

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13
Q

Age related Physiological Changes:
Gastrointestinal System

Liver become smaller

A

Functional change:

Decreased storage capacity

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14
Q

Age related Physiological Changes:
Gastrointestinal System

Decreased muscle tone

A

Functional change:
Altered mobility

Implications:
Increase risk of constipation, functional bowel syndrome, esophageal spasm, diverticular disease

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15
Q

Age related Physiological Changes:
Gastrointestinal System

Decrease basal metabolic rate (rate at which fuel is converted into energy)

A

Implications:

May need fewer calories

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16
Q

Lab results: UA

Protein

A

Normal:
0-5mg/100ml

Changes with age:
Rises slightly

Comments:
May be due to kidney changes with age, urinary tract infection, renal pathology

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17
Q

Lab results: UA

Specific gravity

A

Normal:
1.005-1.020

Changes with age:
Lower max in elderly 1.016–1.022

Comments:
Decline in nephrons impairs ability to concentrate urine

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18
Q

Lab results: Hematology

ESR

A

Normal:
Men 0–20
Women 0–30

Changes with age:
Significant increase

Comments:
Neither sensitive nor specific in aged

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19
Q

Lab results: Hematology

Iron binding

A

Normal:
Men 50–160mcg/dl
Women 230-410mcg/dl

Changes with age:
Slight decrease
Decrease

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20
Q

Lab results: Hematology

Hemoglobin

A

Normal: 
Men 13-18g/100ml
Women 12-16g

Changes with age:
Men 10-17g
Women none noted

Comments:
Anemia common in the elderly

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21
Q

Lab results: Hematology

Hematocrit

A

Normal:
Men 45-52%
Women 37-48%

Changes with age:
Men slightly decreased
Women speculated

Comments:
Decline in hematopoiesisLeu

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22
Q

Lab results: Hematology

Leukocytes

A

Normal:
4,300-10,800/mm3

Changes with age:
Drop to 3,100-9,000/mm3

Comments:
Decrease may be due to drugs or sepsis and should not be attributed immediately to age

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23
Q

Lab results: Hematology

Lymphocytes

A

Normal:
00-2,400 T cells/mm3
50-200 B cells/mm3

Changes with age:
T-cell and B-cell levels fall

Comment:
Infection risk higher; immunization encouraged

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24
Q

Lab results: Hematology

Platelet

A

Normal:
150,000-350,000

Changes with age:
No change in number

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25
Q

Lab results: Blood chemistry

Albumin

A

Normal:
3.5-5.0

Changes with age:
Decline

Comments:
Related to decrease in liver size and enzymes; protein-energy malnutrition common

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26
Q

Lab results: Blood chemistry

Globulin

A

Normal:
2.3-3.5

Changes with age:
Slight increase

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27
Q

Lab results: Blood chemistry

Total serum protein

A

Normal:
6.0-8.4g

Changes with age:
No change

Comments:
Decrease may indicate malnutrition, infection, liver disease

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28
Q

Lab results: Blood chemistry

Blood urea nitrogen (BUN)

A

Normal:
Men 10-25mg
Women 8-20mg

Changes with age:
Increases significantly up to 69mg

Comments:
Increases significantly up to 69mg

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29
Q

Lab results: Blood chemistry

Creatinine

A

Normal:
0.6-1.5mg

Changes with age:
Increases to 1.9mg

Comments:
Related to lean body mass decrease

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30
Q

Lab results: Blood chemistry

Creatinine clearance

A

Normal:
104-124 mL/min

Changes with age:
Decreases 10%/decade after age 40 years

Comments:
Used for prescribing medications for drugs excreted by kidneys

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31
Q

Lab results: Blood chemistry

Glucose tolerance

A

Normal: 62-110mg/dL after fasting; >120mg/dL after 2hrs postprandial

Changes with age:
Slight increase of 10mg/dL/decade after 30 years of age

Comments:
Diabetes increasingly prevalent; Drugs may cause glucose intolerance

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32
Q

Lab results: Blood chemistry

Alkaline phosphatase

A

Normal:
13-39 IU/L

Changes with age:
Increased by 8-10 IU/L

Comments:
Elevations >20% usually due to disease; elevations may be found with bone abnormalities, drugs (narcotics), and eating a fatty meal

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33
Q

Atypical disease presentations:

Acute abdomen

A

Absence of symptoms or vague symptoms, Acute confusion, mild discomfort and constipation, some tachypnea and possibly vague respiratory symptoms, appendicitis pain may begin in right lower quadrant and become diffuse

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34
Q

Atypical disease presentations:

Depression

A

Anorexia, vague abdominal complaints, new onset of constipation, insomnia, hyperactivity, lack of sadness

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35
Q

Atypical disease presentations:

Hyperthyroidism

A

Hyperthyroidism presenting as “apathetic thyrotoxicosis,”i.e., fatigue and weakness; weight loss may result instead of weight gain; patient’s report palpitations, tachycardia, new onset of atrial fabulation, and heart failure may occur with undiagnosed hyperthyroidism

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36
Q

Atypical disease presentations:

Hypothyroidism

A

Hypothyroidism often presents with confusion and agitation; new onset of anorexia, weight loss, and arthralgias may occur

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37
Q

Atypical disease presentations:

Malignancy

A

New or worsening back pain secondary to metastasis from slow growing breast masses or silent masses of the bowel

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38
Q

Atypical disease presentations:

Myocardial infarction (MI)

A

Absence of chest pain.
Vague symptoms of fatigue, nausea, and a decrease in functional and cognitive status; classic presentations include dyspnea, epigastric discomfort, weakness, vomiting; history of previous cardiac failure.
Higher prevalence in females versus males. Non-Q-wave MI

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39
Q

Atypical disease presentations:

Overall infectious disease process

A

Absence of fever or low-grade fever.
Malaise.
Sepsis without usual leukocytosis and fever.
Falls, anorexia, new onset of confusion and/or alterations and change in mental status, decrease in usual functional status

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40
Q

Atypical disease presentations:

Peptic ulcer disease

A

Absence of abdominal pain, dyspepsia, early satiety
Painless, bloodless
New onset of confusion, unexplained tachycardia, and/or hypotension

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41
Q

Atypical disease presentations:

Pneumonia

A

Absence of fever; mild coughing without copious sputum, especially in dehydrated patients; tachycardia and tachypnea; anorexia and malaise are coming; alteration and cognition

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42
Q

Atypical disease presentations:

Pulmonary edema

A

Lack of paroxysmal nocturnal dyspnea or coughing; insidious onset with changes in function, food or fluid intake, or confusion

43
Q

Atypical disease presentations:

Tuberculosis (TB)

A

Hepatosplenomegaly, abnormalities and liver function tests and anemia

44
Q

Atypical disease presentations:

Urinary tract infection

A

Absence of fever, worsening mental or functional status, dizziness, anorexia, fatigue, weakness

45
Q

Geriatric syndromes:

SPICES

A 
S: sleep disturbances
P: Problems with eating or feeding
I: incontinence
C: confusion
E: evidence of falls 
46
Q

Geriatric syndromes

A

Early detection and correction of problems such as sensory deficits, confusion, and gait/balance issues can increase independence and longevity among the elderly

47
Q

Geriatric syndromes:

Confusion (Delirium)

A

A state of unclear thinking caused by delirium and dementia

Delirium is a state of mental confusion that develop suddenly and can fluctuate over time

D: drugs
E: electrolyte imbalance
L: lack of drugs (withdrawal, uncontrolled pain)
I: infection (often UTI)
R: reduce sensory input (vision or hearing loss)
I: intracranial (CVA or subdural)
U: urinary retention or fecal impaction
M: myocardial/pulmonary
48
Q

Categories of aging:

Ranges

A

Young-old: 65-74 years
Old: 75-84 years
Oldest-old: 85 years and older

49
Q

Categories of aging:

Dermatological psoriasis

A

Younger adults:
Late teens to 20s
A regular course which tends to generalize hereditary factors

Older adults:
50s: Males
60s: Females
Sporadic onset

50
Q

Categories of aging:

Gastrointestinal
IBD, UC, CD

A

Younger adults:
20-40 years old
Right lower UC

Older adults:
> 60-75 years old a second peak occurs
more often older women
proctitis
Left-sided UC
higher rates of anemia
may present as chronic diarrhea
fistula development
increased cases of associated malnutrition
extraintestinal manifestations include arthritis spondylitis, Uveitis, and erythema nodosum, 
More comorbid conditions
may be confused with other forms of colitis
51
Q

Categories of aging:

Malignancy

A

Younger adults:
20-30 years old

Older adults:
>50 years old

52
Q

Categories of aging:

Hodgkin’s lymphoma

A

Younger adults:
Possible infectious ideology

Older adults:
Increased mortality

53
Q

Categories of aging:

Neurodegenerative myasthenia gravis

A

Young adults:
Women 20-40 years old
More thymus abnormalities

Older adults: 
Men 50-70 years old
Woman 70 years old
Dysphonia
More frequent ocular form MG
Increased rate of ACHR seropositivity
54
Q

Exercise in older adults:

Sleep and flexibility

A

To maintain the flexibility necessary for a regular physical activity in daily life, older adults should perform activities that maintain or increase flexibility on at least 2 days each week for at least 10 minutes each day

55
Q

Exercise recommendations for specific diagnosis:

Osteoarthritis

A

Walking, aquatic activities, tai chi, resistant exercises, cycling

Vary type and intensity to avoid over stressing joints; heated pool

56
Q

Exercise recommendations for specific diagnosis:

Coronary artery disease

A

Walking, treadmill walking, cycle ergometry

Supervised program with BP and HR monitoring

57
Q

Exercise recommendations for specific diagnosis:

Congestive heart failure

A

Walking, treadmill walking, cycle ergometry

Individualized to client; supervised program

58
Q

Exercise recommendations for specific diagnosis:

Type 2 diabetes mellitus

A

Resistive, aerobic, aquatic, recreational activities

Proper shoe fit; may need insulin reduction if insulin dependent

59
Q

Exercise recommendations for specific diagnosis:

Anxiety disorder

A

Walking, biking, weightlifting

If able to do high intensity exercise, this benefits anxiety

60
Q

Exercise recommendations for specific diagnosis:

Depression

A

Walking, cycling, recreational activities

Group participation helpful to keep patient engaged

61
Q

Exercise recommendations for specific diagnosis:

Fibromyalgia

A

Aerobic, aquatic therapy, strengthening, tai chi, Pilates

Heated pool, gentle stretches, counsel about possible increased pain initially

62
Q

Exercise recommendations for specific diagnosis:

Chronic obstructive pulmonary disease

A

Cycle ergometer, treadmill walking: individualize

Supervised program-consider pulmonary rehab program

63
Q

Exercise recommendations for specific diagnosis:

Chronic venous insufficiency

A

Walking, standing exercises

Supervised programs

64
Q

Exercise recommendations for specific diagnosis:

Osteoporosis

A

Weight-bearing exercises, weight training

Assess balance and risk for falls before beginning

65
Q

Exercise recommendations for specific diagnosis:

Parkinson’s disease

A

Walking, treadmill walking, stationary bike, dancing, tai chi, Pilates, boxing

Assess balance and risk for falls before beginning; American Parkinson’s disease Association resource

66
Q

Exercise recommendations for specific diagnosis:

Peripheral artery disease

A

Lower extremity exercises, treadmill walking, walking

Very short intervals initially, progress as tolerated

67
Q

Exercise recommendations for specific diagnosis:

Age related sleep disorders

A

Tai chi, walking, aquatic therapy, biking

Assess balance and risk for falls before beginning

68
Q

Exercise recommendations for specific diagnosis:

Dementia

A

Walking, recreational activities

Provide safe environment, assess fall risk and ability to participate

Testing prior to exercise initiation

Recommended testing prior to exercise initiation

69
Q

Recommended testing prior to exercise initiation

A

Assess balance and risk for falls

70
Q

Barriers to exercise

A

Lack of time, perceived need for equipment, perceived barrier to begin exercise/physical activity, disability or functional limitation, unsafe neighborhood or weather conditions, no park or walking trails, depression, high body mass index, lack of motivation, enter personal loss or significant life event, ignorance of what to do

71
Q

 patient facilitators to exercise

A

Social support, positive self-efficacy, Motivation to engage in physical activity, good health, no functional limitations, frequent contact with prescriber, regular schedule, plan program, satisfaction with program, insurance incentive, improvement in mobility or health condition, staff

72
Q

Contraindications to exercise

A

Unstable angina, uncompensated heart failure, severe anemia, and controlled blood glucose, and stable aortic aneurysm, uncontrolled hypertension or tachycardia, severe dehydration or heat stroke, low oxygen saturation

73
Q

Health promotion: immunizations

Influenza

A

Recommended annually for all adults over 50 years old Unless contra indicated. Patients with a severe egg allergy or severe reaction to the influenza vaccination in the past with prior history of Guillain-Barré syndrome to talk to the healthcare provider before getting the vaccination



74
Q

Health promotion: immunizations

Tetanus-diphtheria toxoids with pertussis vaccination (Tdap)

A

Once in a lifetime booster to adult then TD booster every 10 years

75
Q

Health promotion: immunizations

Pneumococcal vaccination

A

PCV 13 at the age of 65

PPSV23 12months after PVC 13

76
Q

Health promotion: immunizations

Hepatitis B

A

Recommended for a high-risk person(I.e. Drug users, sexually active with multiple partners, living with someone with chronic happy, patients less than 60 years old with diabetes, and all desiring protection from Hep B)

The initial dose is given followed one month later by second dose then their dose is given for six months after the second

77
Q

Health promotion: immunizations

Shingrix (zoster)

A

Administered and two doses

Second dose is given 2 to 6 months after initial dose

Persons who have had zostavax immunizations with shingrix

78
Q

Recommended health screenings:

Hearing loss

A

Greater than 50 years old

79
Q

Recommended health screenings:

HIV

A

15-65 years old

80
Q

Recommended health screenings:

Alcohol Misuse

A

Greater than 18 years old

81
Q

Recommended health screenings:

Tobacco abuse and depression

A

All adults

82
Q

Recommended health screenings:

Hypertension

A

Greater than 18 years old

83
Q

Recommended health screenings:

Abnormal blood glucose

A

40-70 years old who are overweight or obese

84
Q

Recommended health screenings:

Low-moderate dose statin for prevention of CVD without history of CVD or ischemic stroke

A

Who all is met:
40-75 years old
One or more risk factor for CVD (Dyslipidemia, diabetes, hypertension, or smoking)
Calculated 10 year risk of cardiovascular event of 10% or greater

85
Q

Recommended health screenings:

Abdominal aortic aneurysm

A

One time but ultrasound in men aged 65 to 75 years old who have ever smoked

86
Q

Recommended health screenings:

Obesity

A

All adults, refers BMI is greater than 30 or higher to intensive multi component behavioral interventions

87
Q

Recommended health screenings:

Mammogram

A

Biennial for women age 50 to 74 years old

88
Q

Recommended health screenings:

Visual acuity

A

Older adults

89
Q

Recommended health screenings:

Osteoporosis

A

Women age 65 and older
Younger women whose fraction race is equal to or greater than that of a 65-year-old white woman who has no additional risk factors

90
Q

Recommended health screenings:

Prostate cancer

A

Older men

91
Q

Recommended health screenings:

Cognitive impairment

A

Older adults

92
Q

Recommended health screenings:

Colorectal cancer

A

Starting at age 50 and continuing until age 75

93
Q

Risks related to travel

A

Patients with chronic disease that as well managed at home may decompensate and foreign environments because of heat, humidity, altitude, fatigue, changes in diet, and exposure to infectious diseases.

Fever is not always reliable indication of illness and older adults

Seroconversion rates decrease with age, rendering some vaccines less effective for older travelers

94
Q

Immunizations for travel

A

All immunizations should be current: influenza, pneumococcal, TD/Tdap, zoster, and for some hepatitis B vaccination.

Yellow fever and herpes Oster are the only life virus vaccines that people over the age 50 receive.

A man response can be impaired if live virus vaccines are given within a 28 to 30 day interval from each other

If a patient is required to have a yellow fever vaccine for travel, they can’t enter a yellow fever county until 10 days after receiving the yellow fever vaccine.

The most common vaccine used for protecting travelers are hepatitis A, hepatitis B, typhoid fever, yellow fever, adult booster polio, Japanese encephalitis, meningococcal, and rabies

95
Q

Comprehensive geriatric assessment:

Purpose

A

Physical health is related to psychosocial, functional ability and safe environment

Most beneficial for the vulnerable, older adult

96
Q

Comprehensive geriatric assessment:

Domain #1

A

Physical health

History taking, physical exam, diagnostics, nutritional assessment, medication review

(Cc, HPI, past history, family and social history, and ROS)

97
Q

Comprehensive geriatric assessment:

Domain #2

A

Functional health

ADLs, instrumental activities of daily living, sensory assessment (hearing, vision) can I gait and balance

Purpose determines how the older adult can care for themselves on a day-to-day basis

Any change in function is often the first and only sign of a new or changed disease process

(The Katz activities of daily living scale)

98
Q

Comprehensive geriatric assessment:

Domain # 3

A

Psychological health

Cognitive disorders (delirium, dementia, mild cognitive impairment), Affective disorders (depression, anxiety), Spiritual well-being

(MMSE, Montreal cognitive assessment (MoCA), and St. Louis University mental status examination (SLUMS))

99
Q

Comprehensive geriatric assessment:

Domain #4

A

Socioenvironmental support and quality of life measures

Socioenvironmental: social network and support (The medical outcomes study—short-form 36)

Supports: A living situation, environmental safety, economic resource (lubben social network scale)

Quality of life measures: physical conditions, social conditions, environmental conditions, personal resources (mental health, life perspective), Preferences for care
(The medical outcomes study— short-form 36)

100
Q

Beers criteria: Purpose

A

Go to use for medical management of geriatric patients

List of potentially inappropriate medication‘s for the elderly-listed by drug category and diagnosis

List alternative drugs that can be used safely in older adults

Drug to drug interactions listed, dosage for kidney impairment graded as high, medium, or low to assist with decision-making

101
Q

Polypharmacy: Multiple definitions

A

Prescribing many drugs, prescribing five or more drugs, prescribing potentially inappropriate medication‘s

The use of multiple pharmacies (providers and self-prescribers)

Provider should routinely evaluate medication appropriateness to avoid the risk of polypharmacy

102
Q

Polypharmacy: Prevention strategies

A

Have new patients bring in all medications to their first visit

Review meds list at every visit

Ask if any other provider has changed or added any medication‘s

Update med list at every visit

103
Q

Polypharmacy: Screening tools

A

Three available tools to evaluate patients prescriptions

STOPP- screening tool of older persons potentially inappropriate prescriptions

MAI- medication appropriateness index

ARMOR- assess, review, minimize, optimize, reassess

NR 601 (4 decks)

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