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NURS 401 > Week 3: Health Assessment, Lab Values/Diagnostics, Geropharmacology > Flashcards

Week 3: Health Assessment, Lab Values/Diagnostics, Geropharmacology Flashcards

1
Q

Health History includes:

A
  • Demographic information
  • Past medical history
  • Current medications and dietary supplements
  • Social history
  • Functional history
  • Review of systems
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2
Q

What are factors that influence the collection of health history in older adults?

A
  • Visual and auditory acuity
  • Manual dexterity
  • Language and health fluency
  • Adequacy of translation materials
  • Availability of a trained interpreter
  • Cognitive ability and reading level
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3
Q

Review of Systems

A
  • Conducted prior to physical examination.

- Complex and time consuming

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4
Q

Why is the review of systems in older adults more complex and time consuming?

A

Because of the number of health problems present in older adults. One system often affects another system.

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5
Q

What are some limitations that may affect the ability to complete the physical assessment in an older adult?

A
  • May be difficult to complete in one setting (depending on patient’s stamina)
  • Physical and cognitive limitations may affect the ability to perform the assessment.
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6
Q

What are the two physical assessment tools used in older adults?

A

FANCAPES and SPICES

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7
Q

FANCAPES

A 
Fluids
Aeration
Nutrition 
Communication
Activity
Pain
Elimination
Socialization and social skills
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8
Q

SPICES

A 
Sleep disorders
Problems eating
Incontinence
Confusion
Evidence of falls
Skin Breakdown
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9
Q

What is the functional assessment?

A

Evaluation of person’s ability to carry out basic tasks for self-care and tasks needed to support independent living.

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10
Q

What is the functional assessment used for?

A
  • Identifying specific areas of help
  • Identifying changes in ability from one time to another
  • Provides information useful for assessing safety.
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11
Q

What tools can be used to assess activities of daily living?

A
  • Kartz Index
  • Barthel Index
  • Functional Independence Measure**
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12
Q

Functional Independence Measures assess three levels of functioning:

A
  1. Independent
  2. Assisted
  3. Unable to perform
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13
Q

What can be used to assess both function and cognition in older adults?

A

Blessed dementia scale

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14
Q

Blessed Dementia Scale

A
  • Used when assessing both function and cognition.

- Incorporates ADLs, instrumental activities of daily living, memory recall and finding ones way outdoors.

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15
Q

What are other cognitive measures assessed in older adults?

A
  • Mini mental state examination
  • Clock drawing test
  • Mini-cog
  • Global Deterioration Scale
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16
Q

Mini-Mental State Examination

A

Used to assess mental status**

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17
Q

What can be used to assess mood in older adults?

A
  • Geriatric Depression Scale

- Cornell Scale for Depression in Dementia

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18
Q

Geriatric Depression Scale**

A

….

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19
Q

Comprehensive Geriatric Assessment

A

Combines physical, functional and psychosocial components into one instrument.
Provides a basis for a detailed plan of care.

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20
Q

Outcomes and Assessment Information Set** (OASIS)

A
  • Identifies the plan for nursing care in the home.

- Aimed at preventing re-hospitalizations and ensuring safety in the home setting.

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21
Q

Resident Assessment Instrument

A

Mandated for use in all skilled nursing facilities that receive compensation from either Medicare or Medicaid.

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22
Q

Older Americans Resources and Services: Multidimensional Functional Assessment Questionnaire consists of

A
  • Social resources
  • Economic resources
  • Mental health
  • Physical health
  • ADL and IADLs
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23
Q

Hematological Testing includes what values?

A
  • RBC
  • Hgb
  • HcT
  • Iron
  • WBC
  • Platelets
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24
Q

What is the normal value of red blood cells?

A

4.4-5.8 million/mm3

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25
Q

What is the normal hemoglobin values in older adults?

A

14-18 g/dL

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26
Q

What hemoglobin values are concerning in older adults?

A

8 or less

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27
Q

What is the normal hematocrit value in older adults?

A

39-48%

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28
Q

What is the most common anemia found in older adults?

A

Anemia of chronic disease

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29
Q

Iron studies include

A
  • Serum iron
  • Ferritin
  • Total iron binding capacity
  • Transferrin
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30
Q

While anemia is not normal in the older adult, it is a common finding in

A

Frail older adults and those with chronic diseases

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31
Q

Diagnostic work up for anemia includes

A
  • CBC with differential
  • Iron studies
  • Folic acid
  • Vitamin B12
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32
Q

Normal Neutrophil Value

A

55-70%

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33
Q

Normal Eosinophil Value:

A

1-4%

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34
Q

Normal Basophils Value

A

0.5-1%

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35
Q

Normal Monocytes Value:

A

2-8%

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36
Q

Normal Lymphocyte Value:

A

20-40%

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37
Q

Neutrophils

A

Stimulated by phone if infections to fight bacteria

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38
Q

Eosinophils

A

Stimulated by allergic responses to fight antigens and parasites

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39
Q

Basophils

A

Stimulated by the presence of allergens, and transports histamine

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40
Q

Lymphocytes

A

Stimulated by the presence of viral infections.

Divided into two types: T cell and B cells

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41
Q

Monocytes

A
  • Largest of the leukocytes.

- Become macrophages when matured which defends the body against foreign substances.

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42
Q

What is the normal platelet value?

A

150,000-400,000/mm3

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43
Q

Platelets and aging

A

Platelet count does not change with aging.

However, an increase in coagulation enzymes can lead to hyper-coagulability in the older adult.

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44
Q

Erythrocytes Sedimentation Rate

A

Indicator of inflammation, infection, necrosis, infarction or advanced neoplasm.

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45
Q

Erythrocytes Sedimentation Rate in older adults

A

May be slightly elevated secondary to chronic disease

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46
Q

C-Reactive Protein

A
  • Produced during the acute phase of inflammation.

- Useful indicator for cardiac events and the course of other diseases.

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47
Q

B Vitamins include

A

Vitamin B12 and Folic Acid

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48
Q

Folic Acid

A

Important for normal function of RBC’s and WBC’s

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49
Q

Vitamin B12 is important for

A

Normal development of RBC’s, neurological function and DNA synthesis

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50
Q

Vitamin D

A

Deficiencies reduce the absorption of calcium into the bone.

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51
Q

Electrolytes

A
  • Maintain a balance between intracellular and extracellular movement.
  • Regulates hydration, blood pH and are critical for nerve and muscle function.
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52
Q

Most common electrolytes include

A
  • sodium and chloride
  • potassium
  • glucose
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53
Q

Hyponatremia Levels

A

< 130

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54
Q

Hypernatremia Levels

A

> 145

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55
Q

What are 3 categories of hyponatremia?

A
  1. Decreased extracellular fluid (diarrhea, renal salt loss)
  2. Increased ECF (heart failure)
  3. Normal ECF (SIADH)
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56
Q

Hypernatremia is most often caused by what?

A

Free water loss (vomiting, diarrhea, dehydration)

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57
Q

Hypernatremia is associated with what symptoms?

A
  • Lethargy
  • Irritability
  • Weakness
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58
Q

Hypokalemia Symptoms include

A
  • Muscle weakness
  • Cramping
  • Confusion
  • Fatigue
  • Paralytic Ileus
  • Atrial and ventricular ectopy
  • Tachycardia
  • Fibrillation
  • Sudden death
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59
Q

Hypokalemia is associated with

A

ECG changes such as:
QT interval prolonged
T wave flattened or depressed
ST segment depressed

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60
Q

Hyperkalemia Symptoms include

A
  • Impaired muscle activity
  • Weakness
  • Muscle pains/cramps
  • Increased GI motility
  • Bradycardia
  • Cardiac arrest
61
Q

Hyperkalemia is associated with

A

-EKG changes

62
Q

What EKG changes are associated with hyperkalemia?

A
  • Flattened P Wave
  • Large T wave, peaked
  • QRS broad
  • Biphasic QRS-T complex
63
Q

Glycosylated Hb (HgbA1C)

A

Provides a snapshot of blood glucose over the last 120 days.

64
Q

In nondiabetics, HgbA1C should be what?

65
Q

What HgbA1C level is considered good diabetic control in diabetic patients?

66
Q

What is considered to be a fair control of glucose in diabetic patients?

67
Q

What HgbA1C level is considered poor control of glucose in diabetics?

68
Q

Uric Acid

A

End product of purine metabolism.

69
Q

Uric Acid Levels are used for

A
  • Diagnosis and treatment of gout.

- Evaluation of renal failure and leukemia.

70
Q

Prostate-Specific Antigen

A

Primary screening tool for prostate cancer.

71
Q

Serum Albumin

A

Most often used to measure nutritional status.

Most useful as indicator of severity of illness and risk of mortality.

72
Q

Serum Albumin measures what?

A

The half-life. Which is representative of about 3 weeks.

73
Q

Prealbumin

A

May be more informative of current nutritional status as the half life is 2-3 days.

74
Q

BUN

A

Measurement of nitrogen portion of urea.

Used as gross measurement for renal functioning.

75
Q

Normal BUN Values:

A

10-20 mg/dL

76
Q

Creatinine

A
  • Key component in determining eGFR.
  • Used to diagnose and monitor renal function.
  • More accurate reflection of renal health than BUN.
77
Q

Anticoagulant Monitoring includes

A
  • Prothrombin Time
  • Partial Tromboplastin Time
  • INR
78
Q

Normal Digoxin Values:

A

0.9-2 night/mL

79
Q

Signs of Digoxin Toxicity

A
  • Halovision
  • N/V
  • Headaches
  • Flu-like symptoms (weak, achy)

Look up more!!

80
Q

Normal INR value

81
Q

Table 8-4 on page 97: Specific INR values

A

NEED TO KNOW

82
Q

What values can indicated digoxin toxicity?

83
Q

Thyroid Panels

A

Includes TSH, T3 and T4.

84
Q

What are thyroid panels used for?

A

Used to diagnose or monitor thyroid disorders and their treatment.

85
Q

If goiter is present,

A

A thyroid scan may be necessary.

86
Q

Pharmacokinetics

A

Study of the movement and actions of a drug in the body.

Absorption, Distribution, Metabolism and Excretion

87
Q

Absorption depends on:

A
  • Route of administration
  • Bioavailability
  • Amount of drug that passes through absorbing surfaces in the body.
88
Q

Distribution

A

-Once absorbed, systemic circulation transports drug to receptor site on target organ.

89
Q

Distribution to organs with lower blood flow occurs

A

More slowly and results in lower concentrations.

90
Q

Distribution depends on:

A

availability of plasma protein in the form of lipoprotein, globulins, and especially albumin.

91
Q

Excretion

A

Drugs and their metabolites are excreted in sweat, saliva and other secretions but primarily through the kidneys.

92
Q

Renal drug excretion occurs when

A

Drug is passed through kidney.

93
Q

Renal drug excretion involves

A
  • glomerular filtration
  • active tubular secretion
  • passive tubular reabsorption
94
Q

What is an important consideration in older adults to prevent drug toxicity?

A

Assessment of creatinine clearance rates

95
Q

Pharmacodynamics

A

Physiological interaction between medication and the body.

96
Q

The older a person gets, the more likely he/she will have altered and unreliable

A

Pharmacodynamics

97
Q

Polypharmacy

A

Taking multiple medications at same time. Approx. 5 or more.

98
Q

Taking more than five medications at a time can increase the risk for:

A
  • Frailty, disability
  • Death
  • Falls
  • Medication interactions
  • Adverse events
99
Q

Types of medication reactions include

A
  • Medication-herb/supplement interactions (Table 9-1)
  • Medication-food interactions (Table 9-2)
  • Medication-medication interactions
100
Q

Medications via Enteral Feeding Tubes: Possible Outcomes

A
  • Occluded tube
  • Reduced drug effect
  • Drug toxicity
  • Patient harm
  • Patient death
101
Q

The three most common medication errors

A
  • Incompatible route
  • Improper preparation
  • Improper administration
102
Q

Adverse Drug Reactions or Events

A

Occurs when there is a noxious response to a medication.

103
Q

Drugs that increase the concern for adverse drug reactions include

A 
Corticosteroids
Anticoagulants
Sedative hypnotics
Immunosuppressants 
Chemotherapeutic agents
104
Q

To minimize the likelihood of ADRs:

A

“Start low and go slow”

105
Q

“Beer’s Criteria”

A
  • Potentially inappropriate medication.
  • Drugs identified to have a higher than usual risk when used in older adults (Box 9-7).
  • Overwhelming benefit versus risk documentation when prescribing these drugs considered a standard of practice.
106
Q

Psychoactive Medications

A

Affect mental function, which in turn can affect behavior.

107
Q

Medications with psychoactive properties have a higher risk for

A

Adverse events.

108
Q

Psychoactive Medications requires

A

Thorough assessment.

Should never be used as a quick fix.

109
Q

Antipsychotics, when used appropriately and cautiously, can be used to provide

A

Relief from frightening and distressing symptoms

110
Q

Issues Associated with Psychoactive Medications include

A

Malignant syndrome

Movement disorders

111
Q

Movement disorders include

A

Acute dystonia
Akathisia
Parkinsonism Symptoms
Tardive dyskinesia

112
Q

Nursing Implications for safe medication administration in geriatric patients

A
  1. Ensure medication is used appropriately, effectively, and safely.
  2. Monitor for signs and symptoms of ADRs.
  3. Prompt recognition of changes in patient status that can affect drug regimen.
  4. Patient and family education on purpose and side effects of all medications to enhance safe compliance with drug therapy.
113
Q

The brown bag approach

A
  • Asks the person to bring in all medications being taken, including over the counters, herbals, or dietary supplements.
  • Ask how medication is taken rather than depending on label.
114
Q

The most common intervention to promote medication adherence is

115
Q

Promotion of healthy aging related to medication use includes:

A 
Key persons
Environment
Timing
Communication
Reinforce teaching
116
Q

Medication Education in Geriatric Patient’s

A
  • Assess readiness to learn, ability to comprehend and functional capacity to incorporate lifestyle adaptations for medication management.
  • Pamphlet and booklets written in lay terms and in appropriate language and reading level should be available.
117
Q

Teas

A
  • Are both foods and herbs.
  • May have beneficial antioxidant properties.
  • Consumption of more than recommended amounts of certain teas may cause illness or death.
118
Q

Chamomile

A
  • Usually taken in tea form.
  • Primary uses: anti-inflammatory and antispasmodic.
  • Promotes sleep and reduces anxiety.
119
Q

Echinacea

A

-Shown to be effective for the prevention of upper respiratory infections or decreasing their duration by 1-2 days.

120
Q

Adverse reactions of Echincacea

A 
Fever
Sore throat
Diarrhea
N/V
Abdominal pain
Dry eyes
121
Q

Who should use echinacea with caution?

A

Persons with HIV or autoimmune diseases

122
Q

Garlic

A

Composed of more than 200 chemicals.

Primary active ingredient is sulfur called allicin.

123
Q

What are the reported benefits of garlic?

A
  • Decreased blood clots

- Reduced total serum cholesterol and low-density lipoprotein.

124
Q

What are possible adverse reactions of garlic?

A
  • Severe allergic reactions
  • Increased flatulence
  • GI irritation w/ nausea and heartburn
125
Q

Ginkgo Biloba

A
  • May benefit cognitive function in dementia.
  • There is no scientific evidence that ginkgo impacted cognitive impairment, memory, attention, language, visual-spatial ability, executive functions, or reduced prevalence of dementia and Alzheimer’s disease.
126
Q

Gingko Biloba Side Effects

127
Q

Ginseng

A

Improves well-being and helps with stress adaptation.
Enhances Immunity
Decreases cellular oxidation

128
Q

Ginseng: Possible Side Effects

129
Q

Glucosamine and Chondroitin Sulfate

A
  • Support cartilage and connective tissue

- Typically used in osteoarthritis d/t mild anti-inflammatory effects.

130
Q

Glucosamine and Chondroitin Sulfate should be used with caution in persons with

A

Diabetes
Shellfish allergies
Asthma

131
Q

Hawthorn

A
  • Use in the treatment of heart disease, digestive and kidney problems.
  • Reported to increase CO
  • Antispasmodic and antianxiety effects.
  • Anti-inflammatory, reduces lipids and has diuretic and sedating effects.
132
Q

Melatonin

A
  • Used as an alternative or adjuvant to sleep medications to promote sleep.
  • May be helpful with jet lag
133
Q

Melatonin should be used with caution in persons

A

Taking other medications that can cause drowsiness

134
Q

Red Yeast Rice

A

Chemical equivalent and as effective as statins and may be potential alternative for patients who cannot tolerate statins.

135
Q

With Red Yeast Rice, be aware of a contaminant

A

“Citinin” which can cause kidney failure.

136
Q

St. John’s Wort

A

Used to treat mild or moderate depression and seasonal affective disorder, anxiety, pain.

137
Q

St. John’s Wort is contraindicated with

A

-With other antidepressant use, especially selective serotonin reuptake inhibitors (SSRIs).

138
Q

How long after discontinuing St. John’s Wort before you can begin taking an antidepressant?

A

Wait 2 weeks after discontinuing

139
Q

Saw Palmetto

A

Offers mild to modest symptom improvement for BPH.

Don’t use with other drugs used to treat BPH or prostate cancer.

140
Q

What herbs and supplements can be used to treat hypertension?

A
  1. Hawthorn

2. Dietary calcium

141
Q

Dietary Calcium and HTN

A

Dietary calcium in enriched low-fat dairy products taken 3x daily and may lower BP in moderate HTN

142
Q

Popular herbals for GI disorders include

A
  • Psyllium
  • Calcium
  • Cranberry
  • Probiotics.
143
Q

Chronic alcohol-induce and fulminate hepatitis have both been positively affected by the use of

A

Milk thistle

144
Q

What herbs and supplements can be used to treat Alzheimer’s?

A

-Gingko (because it increases blood supply to brain and improves memory and attention).

145
Q

According to Alzheimer’s Association, what can decrease the risk for cognitive decline?

A
  • Moderate physical activity
  • Drinking tea one to four times a day
  • Maintaining normal serum vitamin D levels
146
Q

What are herbs that can affect bleeding and clotting time?

A

Ginger
Garlic
Ginkgo
Ginseng

147
Q

Interventions for Gerontological Nursing include

A
  1. Education
  2. Check for side effects, adverse reactions and interactions among herbs, supplements, medications, foods and illness.
  3. Urge discontinuance of possibly harmful products.
  4. Provide relevant information and correct use of product as indicated.
148
Q

Add notes from weekly review PowerPoint

149
Q

Things need to know for exam 1 are on slide 89 of week 3 PowerPoint

NURS 401 (26 decks)

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