Adult Care Exam 3 Flashcards
(129 cards)
1
Q
How should we interview an elderly patient is abuse is suspected
A
in separate rooms, get a thorough history, complete emotional exam
2
Q
What is the role of the nurse with elder abuse?
A
report the incident to protective services
if patient is in imminent danger, consider hospital admission
3
Q
What is the difference in Alzheimer’s disease and vascular dementia?
A
with alzheimers disease, there are tangles degeneration and plaques in the neurons in the brain
with vascular dementia there is usually a lack of blood flow to the brain (like with a stroke) that causes death to the neurons
4
Q
what is so signifcant about neurons dying
A
they can’t regenerate, so when they die it causes dementia that cannot be reversed, which is progressive
5
Q
what is the first symptom of alzheimers disease
A
short term memory loss
6
Q
what stage of dementia may the person start needing assitance
A
stage 4 - need assistance with their IADLS
7
Q
what are the normal changed to the brain with aging
A
increased depth in sulci
decreased blood flow to the brain
depression more common with age
decreased REM sleep
decreased neurons with senile plaques and tangles
8
Q
what are the main IADLs
A
cooking, cleaning, transportation, laundry, managing finances
9
Q
two symptoms from these must be significantly impaired for a diagnosis
A
memory
communication and language
attention span
reasoning and judgement
visual perception
10
Q
What type of dementia is associated with a loss of communication between cells, leading to the loss of specific types of neurons?
A
dementia with Lewy Bodys and Parkinsons
11
Q
what screening tool is used for depression
A
geriatric depression scale
12
Q
what is sundowning and what do we do to help with it
A
increased confusion at night or when light is inadequate
sleeping pills may make it worse (beer’s criteria)
13
Q
How is the management of early dementia different from the management of late dementia
A
with early dementia, we can use reorientation therapy
with later stages of dementia, this can cause agitation, so we want to use validation and distraction
14
Q
What neurotransmitter is associated with AD
A
acetylcholine
15
Q
How do the cholinesterase inhibitors help with alzheimers disease
A
cholinesterase breaks down acetylcholine, so by inhibiting this enzyme, we get more acetylcholine with is associated with memory, awareness, and the ability to perform daily tasks
16
Q
is dementia a normal change in aging
A
no
17
Q
What medication is used for moderate to severe dementia
A
donepezil – cholinesterase inhibitor
18
Q
what is a major side effect of donepezil
A
GI disturbances
19
Q
What is important with the environment of a patient with alzheimers
A
consistency and structure
20
Q
What should be monitored before giving a cholinesterase inhibitor
A
heart rate- can cause bradycardia
21
Q
Which medication can be combined with others in moderate to sever AD
A
NMDA inhibitor- memantine, namenda
22
Q
what score represents depression with the GDS
A
5 or higher
23
Q
Why do we always have to look behind the behavior issue with dementia patients?
A
behavior issues usually stem from the patient trying to communicate something with us, finding the cause is important
24
Q
What is an adverse effect of leukotriene receptor antagonists?
A
depression
25
While taking theophylline, the patient should avoid which kind of diet?
high protein decreases the duration of action
alcohol and caffiene should be avoided
26
benign vs malignant
benign does not invade surrounding tissues, however its issues will arise from compressing surrounding tissues
malignant invades surrounding tissues
27
28
what are the most common risk factors of cancer
advancing age, smoking, genetics, viruses, radiation, tobacco, hormonal agents, immunosuppressants
29
When does primary cancer prevention start
everyday practice, before cancer
30
what is involved in primary cancer prevention
sunscreen, healthy living, vaccinations
31
what is secondary cancer prevention
self examinations, screening -- when cancer suspected
32
what is tertiary cancer prevention
when pt has cancer- - surgery and chemo
33
what are the signs and symptoms of cancer - CAUTION
Changes in bowel or bladder
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoaresness
34
what is a drug that can be used to prevent cancer and what is the mechanism of action and side effects
tamoxifen is used to decrease the risk of breast cancer in high-risk individuals by blocking the effects of estrogen which can cause hot flashes, nausea, vaginal dryness, and fatigue
35
guidelines for cancer screening
breast cancer by 40 and then annual
gyn cancer -- pap >21 every 3 years
colorectal -- colonoscopy after 50, every 10
prostate DRE >50
36
what are nursing interventions for radiation
examine skin, no lotions, powders, ointments
make sure pt does not remove markings (lined up with machine and cancer)
site of radiation = site of effects
37
what should the nurse do if a patient's radioactive seed falls out
do not touch it with bare hands, use tongs or forceps to dispose properly
38
how should the nurse care for the patient undergoing radiation
cluster care, 6 ft away unless performing direct care, private room with sign, badge that detects exposure
39
how long should the patient be isolated if the half life is 8 days
8 days
40
if the person prepares the chemo
they are not the one that administers the chemo
41
what is tumor lysis syndrome
cells are killed and explode, which leaves their contents in the circulating blood which can cause electrolyte imbalances and acute kidney injury
42
which electrolytes should be monitored with tumor lysis syndrome
Potassium (high)
Phosphorus (high)
Uric acid (high)
Calcium (low; secondary to high phosphorus)
43
what is chemo brian
congitive impairment
44
what intervention can be done for alopecia
keep scalp moist, use mild shampoos
look better feel better program
scalp hypotheria
45
what can be done to prevent oral mucositis
teach regimen to inspect mouth 3-4 times daily, use plain water or salt water to rinse
use a soft toothbrush
avoid alcohol or lemon gylcerin swabs
46
what can be done to treat chemo diarrhea
change diet to decrease bulk, use clear mild juices, soup
no caffiene, plenty of fluids, low bulk
47
why is allopurinol given for tumor lysis syndrome
allopurinol helps to block the production of uric acid which would crystalize and cause problems in the kidneys
48
what teaching is taught with allopurinol
increase fluids, want output 150ml/hr minimum, given 2-4 days before chemo
49
how is the onset of oseoarthritis desscribed
slow progressive onset
50
what is another name for osteoarthritis
wear and tear
51
what are signs of osteoarthritis
herberdens and bouchard nodules on the finger joints, morning stiffness last less than 1 hour, crepitus (from floating bone fragments in joints), joint effusions
52
what is primary v secondary osteoarthritis
primary is caused by aging and genetics
secondary is related to join trauma from metabolic diseases and DM
53
what improves the pain in osteoarthritis
rest improves, activity makes it worse
54
what are the meds used to treat osteoarthritis
acetaminophen
corticosteroid injections
lidocaine pathches
rest and exercise
heat and cold
weight control
55
What is the surgery associated with osteoarthritis
total joint arthroplasty
56
what are the pre op instructions for a total joint replacement
assess mobility issues
dc Rx that increases risk for clotting and bleeding one week before surgery
57
post op joint replacement
prevent hip dislocation -- no bending greater than 90 degrees, no adduction of the hip, no crossing the legs, do not twist body when standing
keep heels off the bed
orthostatic hypotension management
manage pain
monitor DVT
58
rhematoid arthritis is caused by
autoimmune destruction of synovial joints
59
what are the signs and symptoms of rheumatoid arthritis
morning stiffness lasting more than 1 hour
fever, weakness, fatigue, paresthesia
ulnar defiation and boutineere deformity
osteoporosis, anemia, weight loss, peripheral neuropathy
60
what are the syndromes associated with rheumatoid arthritis
sjogrens sydrome,
feltys syndrome
caplans syndrome
61
what is sjogrens syndrome
dry eyes, dry mouth, dry cooch
62
felty sydrome
hepatomegaly and leukopenia
63
caplans syndrome
rheumatoid nodules in the lungs
64
What labs are done on a patient with rheumatoid arthritis
rheumatoid factor (RF)
ESR and CRP -- inflammatory markers
ANA- antinuclear antibody
65
what are risk factors for rheumatoid arthritis
women over men
onset in 40s
family hx
smoking
environmental exposure
obesity
66
what meds are used for rheumatoid arthritis
methotrexate- DMARDs
NSAIDs- inflammation
oral corticosteroid - prednisone
biologic agent - etanercept, infliximab
67
what are some risks with DMARDs
immunosuppression- monitor infection, bleeding, anemia
68
what are non pharmaological treatments for RA
fish oil, plant oil, tai chi
69
what are symptoms of a hip fracture
affected leg appears shorter and toe is pointed outward
patient is unable to bear weight after a fall
severe pain in groin, hip area
70
what is the treatment of choice for a hip fracture
open reduction internal fixation
71
what is osteoporosis
the buildup of bones (osteoblast) activity is less than the breaking down (osteoclast) activity
72
what is the first sign of osteoporosis
fracture
73
primary v secondary osteoporosis
primary is postmenopausal men and women (testosterone builds bone up and estrogen keeps it from breaking down) these hormones are decreased with age
secondary is from long term drug therapy (corticosteroids) or immobility
74
astronauts are prone to which class of osteoporosis and why
secondary osteoporosis because they do not do weight bearing exercisesq
75
what type of osteoporosis happens to a single area and why
regional osteoporosis on an injured joint because bone loss occurs when the bone is immobilized
76
what are dietary causes of osteoporosis
caffiene -- which causes calcium to be lost in the urine
low calcium and vitamin d intake
high phosphorus intake
carbonated beverages
protein def
excessive alcohol and tobacco use
77
what is the golden standard for checking osteoporosis
DEXA scan (dual x ray absorptiometry)
78
t score vs z score
t score is when the bone density in a DEXA scan is compared with a healthy person of the same gender
z score is when it is compared with someone the same age and gender
79
osteopenia is when the bone mass is less and defined by a DEXA of...
(-1)-(-2.5)
80
osteoporosis is a DEXA
score of <-2.5
81
what are meds for osteoporosis
biphosphates
vit d and calcium supplements
estrogen agonist
monoclonal antibodies
82
what are considerations for biphosphates (dronates)
sit up for 30 minutes after taking them, should be taken in the am
we check DEXA every 3 years and if the results are improving, then the treatment is continued
83
what is gout
excess uric acid levels in the blood causes crystallization , causes pain mainly in the great toes
84
what are the stages of gout
asymptomatic hyperuricemia
acute gouty arthritis
chronic gout
85
how do we diagnose gout
serum uric acid greater than 6.5
arthrocentesis -- aspriate of joint
86
what are the meds for acute gout
colchine - anti inflammatory
corticosteroids
NSAIDS
87
what meds are used for chronic gout
allopurinol - block uric acid
febuxostat - block xanthine into uric acid
probenecid - increases secretion of renal dysfunction
88
what foods should the patient with gout avoid
foods high in purine -- red meats, shellfish, oils fish with bones
89
What are the 3 types of anemia
microcytic
normocytic
macrocytic
90
what is an example of microcytic anemia
irone deficient anemia
91
what is the goal with iron deficient anemia
find the cause- check the GI first
92
what do the iron studies look like with iron deficient anemia
low serum fe with high total binding capacity
the high TIBC represents where the body is trying to bind up any iron that is available
93
what are signs of iron deficient anemia
at first: fatigue, SOB, weakness, pale earlobes, palms and conjunctiva
after a while: brittle fingernails, sore cracked corner of mouth, red tongue
94
what are signs of iron deficient anemia in elderly
confusion, disorientation, memory loss
95
what do we have to know before treating anemia
the cause
96
what medication is used for iron deficient anemia and pt teaching
ferrous sulfate taken without food unless not tolerated
take it with vitamin c for better absorption
will stain teeth
take 325 mg for 6-12 months
97
what does the stool do when taking ferrous sulfate
turn dark green or black -- pt may think they are rebleeding, important education point
98
what are types of normocytic anemia
anemia of chronic disease
hemolytic anemia
aplastic anemia
99
what are the causes of anemia of chronic disease
malnutrition- no folic acid and vitamin c
chronic infection
cancer
renal insufficiency - can't make erythropoietin
chronic liver disease- decreased iron stores
100
what inhibits iron absorption
coffee, tea, milk, cereal, dietary fiber, carbonated beverages, dietary supplements, antacids
101
what are macrocytic anemias
pernicious anemia and folate deficiency
102
what causes b12 deficiency
lack of intrinsic factor in the stomach from smoking alcohol autoimmune or gastrectomy
103
what are signs and symptoms of pernicious anemia
beefy red tongue, infections, mood swings, hgb 7-8, weakness, paresthesia, weight loss, mouth sores, abdominal pain
104
what are signs of folate deficiency and what is the treatment
scales and fissures in the mouth, stomatitis, dysphagia, flatulence, watery diarrhea
treat with folic acid, which can cause urine dark yellow and mask B12 deficiency
105
what are the 4 types of leukemia
acute lymphocytic leukemia
acute myelogenous leukemia
chronic lymphocytic leukemia
chronic myelogenous leukemia
106
What is the patho behind CLL?
there are immature lymphocytes developing irregularly and crowding the bone marrow, these cells do not develop antibodies like they are supposed to (b cells are helper cells)
107
where do the b cells go
they don't die, they congregate in the spleen and liver which causes organ enlargement
108
what are the b symptoms
fever, night sweats, unintentional weight loss, and infections
109
what are the signs and symptoms of chronic lymphocytic leukemia
weak, fatigue, lymphadenopathy, anemia, thrombocytopenia, enlarged spleen, elevated WBC
110
acute myeloid leukemia is characterized by
immature myeloblasts in the bone marrow (these are supposed to be the clean upper cells)
111
what are symptoms of acute myeloid leukemia
fever and infection from neutropenia, weakness and fatigue from anemia, bleeding from thrombocytopenia, engorgement of spleen and liver, gum hyperplasia, bone pain
112
why does AML cause gum hyperplasia
these cells invade other tissues causing overgrowth and thickening and the gums are a common site for this
113
how is AML treated
bone marrow aspiration -- excessive immature blast cells are sitting in the marrow
114
what med is given for AML
cytarabine
hydroxyurea in elderly for increased QOL
bone marrow transplant
115
what is the diagnostic marker in CML
Philadelphia chromosome
116
what happens in chronic myelogenous leukemia
overproduction of abnormal myeloids, which causes bone marrow and organs to enlarge
117
what is the only known cause of chronic myelogenous leukemia
ionizing radiation
118
what are symptoms of chronic myelogenous leukemia
fatigue, weakness, anorexia, weight loss, splenomegaly (more prominent and painful)
119
what is the treatment of CML
hydroxyurea
120
what is the goal of treatment of CML
induce remission and control the proliferation of WBC
121
nursing care of patients with leukemia
manage mucositis
control pain
risk of dehydration
weakness and fatigue
rest between activities
assist with self care
anxiety
hospice home health
122
What is the big difference between hodgkins and non hodgkins lymphoma
hodgkins has REED STERNBERG cells
123
What are some causes of hodgkins lymphoma
epstein barr virus (mono)
agent orange
immunosuppression
124
what are the signs of hodgkins lymphoma
enlargement of the lymph nodes moves from axillary inguinal and retroperiotoneal
asymptomatic unless pressure of lymph nodes produces symptoms
B symptoms (without chills)
125
how is hodgkins lymphoma diagnosed
lymph node biopsy
pet scan, ct, cxr
126
what is the treatment of hodgkins lymphoma
radiotherapy, cure rate of 80%
late: chemo, radiotherapy, 80% can be put in remission
127
how is non hodgkins lymphoma different
begins with one node and spreads throughout body to bone cns and gi tract
lymphoid cells are replaced with diseased cells, resulting in infection and immune def
128
is hodgkins or non hodgkins worse
non hodgkins has a poorer prognosis
129
