Chapter 15 Flashcards
(217 cards)
1
Q
occurs suddenly and often without warning
A
acute illness
2
Q
examples of acute illness
A
- stroke
- MI
- hip fracture
- infection
3
Q
- managed rather than cured
- always present but not always visible
- life long and coping can be influenced by perceived uncertainty
A
chronic illness
4
Q
chronic illness trajectory
A
- preventive phase (pre trajectory)
- definitive phase (trajectory onset)
- crisis phase
- acute phase
- stable phase
- unstable phase
- downward phase
- dying phase
5
Q
designed to stabilize physiological processes and promote recovery from acute phase
A
acute phase of illness management
6
Q
most common chronic condition in persons over 65
A
arthritis
7
Q
common chronic cardiovascular diseases
A
- htn
- coronary heart disease
- heart failure
- peripheral vascular disease
8
Q
leading cause of death and 2nd cause of disability in the US
A
cardiovascular disease
9
Q
most common chronic vascular disease of elderly
A
htn
10
Q
2nd most common chronic condition in persons over 65
A
htn
11
Q
diastolic hypertensive blood presure
A
90 and above
12
Q
systolic hypertensive blood pressure
A
above 140
13
Q
for persons older than 50, is sbp or dbp more important as a cvd risk factor?
A
sbp
14
Q
prehypertensive sbp
A
120-139
15
Q
initial drug treatment for htn
A
thiazide diuretics
16
Q
concern for pts on antihypertensive meds, especially if the pt falls
A
orthostatic hypotension
17
Q
ways to minimize risk for heart disease
A
- maintain bp of 40
- triglycerides <150
18
Q
- s/s
- develop slowly
- usually asymptomatic until an acute cardiovascular event or end organ damage has been done
A
htn
19
Q
what to do about htn
A
- screenings
- education
- prevention
20
Q
group of conditions that either completely or partially obstruct blood flow to the heart muscle
A
coronary heart disease
21
Q
racial disparity with coronary heart disease
A
african american
22
Q
s/s of coronary heart disease
A
chest pain
23
Q
do older adults always have chest pain with coronary heart disease and ischemic attacks
A
no
24
Q
direct response to ischemic damage
A
chest pain
25
chest pain with older adults...
- mild
- localized to back, abd, shoulders, one or both arms
- n&v, heartburn may be the only symptoms
- may mimic heartburn
26
complications of coronary heart disease
- angina
| - cardiac remodeling
27
increase in intensity, frequency or duration with less and less provacation
unstable angina
28
- heart enlarges and changes shape
- decrease in pumping ability
- leads to heart failure within months to years
cardiac remodeling
29
how to diagnose coronary heart disease
- ekg
- cardiac cath
- stress test
30
non-pharm management of coronary heart disease
lifestyle changes and reducing risk factors
31
pharm management of coronary heart disease
- cholesterol modifying drugs
- asa
- beta blockers
- ace inhibitors
- calcium channel blockers
32
angioplasty with or without stent placement
cardiac cath
33
what to beware of coronary heart disease
anxiety and depression
34
waht can cause anxiety and depression with coronary heart disease
- changes in functional ability
- self image
- fear of another event
35
inability of the heart to keep up with the workload
heart failure
36
compensation for heart failure
- enlargement of the ventricles
| - develop more muscle mass
37
compensation for heart failure: enlargement of ventricles
- stretches more and contracts more strongly
| - only can do this for a short amount of time
38
heart failure compensation: develop more muscle mass
- initially pumps harder
| - eventually decreases size of ventricles
39
heart failure compensation: blood vessels
- narrow to keep bp up
| - diversion of blood away from non-essential body parts
40
heart failure progression
- increased peripheral resistances
- failing heart
- neurohormonal activations
- peripheral alterations
41
left sided heart failure
- hypertension
- aortic stenosis
- valvulopathy
- myopathy
42
right sided heart failure
- ischemia
- infarction
- myopathy
43
s/s of heart failure
- shortness of breath
- coughing or wheezing
- edema
- tiredness/fatigue
- lack of appetite
- confusion/impaired thinking
- tachycardia
44
blood backing up in the pulmonary veins leads to
SOB
45
fluid build up in lungs leads to
coughing or wheezing
46
fluid build up in the body leads to
edema
47
not pumping enough blood to meet the body's need leads to
tiredness/fatigue
48
decrease in blood flow to the digestive system leads to
lack of appetite
49
changing levels of electrolytes leads to
confusion/impaired thinking
50
make up for the loss of pumping ability leads to
tachycardia
51
heart failure treatment
- early diagnosis
- treat underlying cause
- stop it from getting worse
- lifestyle changes
52
lifestyle changes for heart failure
- low sodium diet
- low fat diet
- high potassium intake
- weight loss
- physical activity
- quit smoking
53
unmodified risk factors for CV events
- age
- gender
- heredity
- ethnicity
54
modifiable risk factors for CV events
- smoking
- stress
- obesity/diet
- physical inactivity
55
treatable risk factors for CV events
- diabetes mellitus
- htn
- hyperlipidemia
56
- build endurance, self reliance, and facilitate self care and quality of life
- begin with light activity and increase in intensity
- must be done with the supervision of a nurse of physical therapist
cardiac rehab
57
granulomatous inflammation of aorta and its brances and cranial arteries
- affects people over 50
- more common in women
giant cell (temporal) arteritis
58
s/s of giant cell (temporal) arteritis
-bruits
-fever
headache
-tenderness of scalp
-jaw pain
-tongue pain
-blurred vision/vision loss
-tinnitus
-elevated esr and crp
59
how to diagnosis giant cell (temporal) arteritis
- biopsy
- US
- MRI
- CT
60
treatment of giant cell (temporal) arteritis
corticosteroids
61
pain and stiffness in shoulder and pelvic girdle; muscles of neck, shoulders, lower back and thighs
polymyalgia rheumatica
62
when is pain greatest with polymyalgia rheumatica?
at night and early morning
63
ischemic events
- arterial disease
| - cardioempolism
64
build up of plaque in the arteries
arterial disease
65
where is arterial disease usually seen
arteries of leg
66
arterial disease can cause lack of blood flow to the:
- head
- arms
- kidneys
- stomach
67
arterial disease increases risk for:
- cad
- mi
- cva
- tia
68
late s/s of hypothyroidism
- goiter
| - slow speech and hoarse breaking voice
69
where is arterial disease usually seen
arteries of the leg
70
treatment for polymyalgia rheumatica
steroids
71
what meds are not effective on polymyalgia rheumatica
NSAIDs
72
pharmacological treatment for arterial disease
- cholesterol lowering meds
- htn meds
- dvt prophylaxis
- symptom relief meds
73
non-pharmalogical treatment of arterial disease
- angioplasty
- bypass surgery
- exercise
- diet
- prevention
74
changes to the leg with cad
- pale
- absence of leg hair
- thin skin
- shiny skin
- weak-absent pulses
- cool to touch
75
where is an embolic cva commonly formed
left side of heart
76
pain with pad
- with exertion
| - better with rest
77
pain with pvd
- with rest
| - better with movement
78
changes to leg with pvd
- deep dark color
- leg hair
- thicker skin
- pulses present
- warm to touch
79
how to diagnose cardioembolism
- neuro exam
- ct/mri
- symptoms
80
how to treat cardioembolism
- underlying cause
- symptom management
- thrombolysis
- rehabilitation
- prevention
81
symptoms of tia or stroke
- sudden weakness or numbness on one side of the body
- dimness or loss of vision in one eye
- slurred speech, loss of speech, difficulty comprehending speech
- dizziness, difficulty walking, loss of coordination, loss of balance, falls
- sudden severe headache
- difficulty swallowing
- sudden confusion
- N&V
82
main difference between cva and tia
tia symptoms begin to resolve in minutes and are totally resolved within 24 hours
83
risk factors for tia or stroke
- heart disease
- htn
- arrhythmia
- hypercholesterolemia
- diabetes
- smoking
- coagulopathies
- brain tumor
- family hx
84
progressive disease of basal ganglia and involves he dopaminergic nigrostriatal pathway
Parkinson's disease
85
is parkinsons more common in men or women
men
86
onset of parkinsons
60 years
87
possible causes of parkinsons
- genetic
- viral
- toxic
88
complication in late stages of parkinsons that can be fatal
- pressure ulcers
- pneumonia
- aspiration
- falls
89
presents the greatest risk for injury with parkinsons
falls
90
clinical signs of parkinsons disease
- tremor at rest
- muscle rigidity
- akinesia
- postural abnormalities
- sleep/wake reversal
- visual disturbances
- hypotension
- depression
- psychosis
91
parkinson med
carbidopa-levodopa
92
surgical procedures of parkinsons
- abalation
- deep brain stimulation
- transplantation
93
disorder of glucose metabiolism
diabetes mellitus
94
absolute deficiency of insulin production due to autoimmune destruction of pancreatic cells
type 1 dm
95
combination of relative insulin deficiency and insulin resistance
type 2 dm
96
these influence development of diabetes
- genetics
- lifestyle
- aging
97
risk factors for dm
- ethnicity
- increasing age
- blood pressure 140/90
- 1st degree relative with dm
- hx of impaired glucose tolerance or impaired fasting plasma glucose
- obesity
- previous gestational dm
- undesirable lipid levels
98
undesirable lipid levels
HDL- 35
| triglycerides-250
99
at risk ethnicities for dm
- african americans
- mexican americans
- american indians
- native hawiians
- asian americans
100
risk identification for people with diabetes
- diabetes for 10+ years
- male
- poor glucose control
- cv, retinal, or renal complications
- increased risk for amputation
101
risk factors for amputation with diabetes
- peripheral neuropathy with loss of sensation
- evidence of increased pressure
- peripheral vascular disease
- hx of ulcers
- hx of amputation
- severe nail pathology
102
what may make diagnosis of dm in older adults tricky
classic s/s may not be present in the older adult
103
how often should hemoglobin a1c be checked
quarterly
104
most frequent cause of chronic autoimmune thyroiditis; also radioiodine tx, surgery, meds, pituitary/ hypothalamic abnormality
hypothyroidism
105
lab findings for hypothyroidism
tsh >6
| t3 <4.5
106
med management of hypothyroidism
synthroid
107
hypothyroidism emergency
myxedema coma
108
patho of hypothyroidism
- hyposecretion of parathyroid
- hyposecretion of thyroid hormones
- decreased body metabolism
109
- thyroid gland
| - radioiodine treatment for hyperthyroidism
primary hypothyroidism
110
early s/s of myxedema coma
- fatigue
- apathy
- mental sluggishness
111
symptoms of tia or stroke
- sudden weakness or numbness on one side of the body
- dimness or loss of vision in one eye
- slurred speech, loss of vision in one eye
112
early s/s of hypothyroidism
- cold intolerance
- constipation
- wt gain
- bradycardia
- fatigue
- decreased sweating
- muscle cramps
- dry itchy skin
- thin, brittle fingernails
- rapid thoughts
- depression
- poor muscle tone
- female infertility
- hyperprolactinemia and galactorrhea
113
late s/s of hypothyroidism
- goiter
- slow and hoarse voice
- dry, puffy skin
- thinning of outer 3rd eyebrows
- abnormal menstrual cycles
- low temp
- infertility in women
- acute fatigue syndrome
- stress
- lowered libido
- hypotension
- carpal tunnel
- thyroid related depression
114
- main case
- thyroid gland
- radioiodine treatment of hyperthyroidism
primary hypothyroidism
115
- pituitary gland
- not secreting enough tsh
- tumor, radiation, surgery
- 5-10% of cases
secondary hypothyroidism
116
early s/s of myxedema coma
- fatigue
- apathy
- mental sluggishness
117
treatment of myxedema coma
- mechanical ventilation
- iv high doses of thyroid hormones
- iv levothyroxine
- corticosteroids
118
most common form of hyperthyroidism in older adults
graves disease
119
other causes of hyperthyroidism
- toxic goiter
- iodine ingestion
- contrast agents
- meds
120
lab findings of hyperthyroidism
- decreased tsh
| - elevated t3 and t4
121
what do beta blockers do for hyperthyroid treatment
symptom management
122
food and diet changes for hyperthyroidism
low iodine
123
surgical management for hyperthyroidism
damaging or removing the thyroid
124
radioiodine treatment for hyperthyroidism
radioactive iodine damages the thyroid
125
- medical emergency
- elevated in body temp (104)
- tachycardia
- arrhythmia
- vomiting
- diarrhea, dehydration
- coma and death
thyroid storm
126
treatment for thyroid storm
- high doses of methinazole
| - need to reduce circulating levels and production of thyroid hormones
127
small herniations or saclike outpouchings of mucosa
diverticular disease
128
movement of gastric contents, especially gastric acid, into the esophagus
GERD
129
goal of gi disorder therapy
prevent exacerbation symptoms
130
- airway and lung injury caused by inhalation of toxins and pollutants earlier in life, especially by tobacco smoke
- progressively debilitating condition characterized by exacerbations and remission of symptoms
COPD
131
- increased goblet cell number and activity (increased mucous production)
- increased mucous=decreased airway diameter
chronic bronchitis
132
lung damage and inflammation of the alveoli
emphysema
133
destruction of the alveoli walls=
decreased surface area
134
s/s of copd
- wheezing
- cough
- dyspnea on exertion
- increased phlegm production
135
how is copd diagnosed
pulmonary function tests
136
biggest barrier to copd treatment
acceptance and willingness to make lifestyle changes
137
later copd symptoms
- pursed lip breathing
- barrel chest
- air tapping
- hyperresonance
- fingernail clubbing
- pale/cyanotic nail beds
- use of accessory breathing muscles
138
complications of copd
- pneumonia
- frequent hospitalization
- impaired functional status
- home o2 therapy/bronchodilators
- non invasive respiratory support
- endotracheal intubation
139
inflammatory airway disease linked to allergenic mechanisms
- narrowing of airways
- expiratory wheezing
asthma
140
goal of asthma therapy
- reduce triggers
| - maintain quality of life
141
what is asthma influenced by?
- genetics
- environmental
- lifestyle
142
if a client has asthma, they are at a higher risk for...
lower respiratory infections
143
- med
- activates beta2 receptors in bronchial smooth muscle (vasodilation)
- bronchospasm is relieved
- histamine release inhibited
- ciliary motility increased
albuterol
144
use of albuterol
- prevention of asthma episode
- treats bronchospasm
- long term control
145
beta2-adrenergic agonists for asthma
- albuterol
- formoterol (foradil aerolizer)
- terbutaline (brethine)
146
beta2 adrenergic agonist-inhaled, long acting
formoterol (foradil aerolizer)
147
beta2 adrenergic agonists- oral, long acting
terbutaline (brethine)
148
beta2 adverse effect when alpha1 receptors are activated in the heart
tachycardia
149
activation of beta2 receptors in muscle causes:
tremors
150
beta blockers and beta2=
cancelled out
151
meds mixed with beta2 adrenergic that cause an increased risk of tachycardia and cp
MAOI's and triciycline antidepressant
152
methylxanthines
theohyline
153
causes relaxation of bronchial smooth muscle, resulting in bronchodilation
theohyline
154
normal level of theohyline
5-15
155
adverse effects of theohyline
- gi distress
- restlessness
- dysrhythmias
- seizures
156
increases adverse effects of theophyline
caffiene
157
decrease levels of theophyline
phenobarbital and phenytoin
158
increases levels of theophyline
cimitedine and cipro
159
inhaled anticholinergics
- ipratropium (atrovent)
| - tiotropium (spiriva)
160
these meds block muscanaric receptors in bronchi
- bronchodilation
- relief of bronchospasms, allergen and exercises induced asthma
inhaled anticholinergics
161
inhaled anticholinergics are contraindicated with...
peanut allergies
162
use inhaled anticholinergics cautiously with..
BPH and narrow angle glaucoma
163
glucocorticoids - inhaled
- beclomethasone (qvar)
- budesonide and formoterol (symbicort)
- budesonide (pulmicort flexhaler)
- fluticasone (flovent)
- monetasone furoate and formoterol fumarate dihydrate (dulera)
164
oral glucorticoid
prednisone
165
these meds prevent inflammation, suppress airway mucous production and promote responsiveness of beta2 receptors in the bronchial tree
glucocorticoids
166
adverse effects of glucocorticoids
- hoarseness and candidiasis
- suppression of adrenal gland function
- bone loss
- hyperglycemia and glucosria
- pud
- infection
- fluid and electrolyte imbalance
167
med interactions with glucocorticoids
- k+ depleting diuretics
- nsaids
- hypoglycemic
168
leukotriene modifiers
- montelukast (singulair)
- zileuton (zyflo)
- zafirlukast (accolate)
169
can cause liver injury and can inhibit the metabolism of warfarin ad theophyline
- zileuton (zyflo)
| - zafirlukast (accolate)
170
- prevents effects of leukotriens
| - suppresses inflammation, bronchoconstriction, airway edema, mucous production
leukotriene modifiers
171
who is more likely to get tb
residents and group living and long term care
172
infection may lie dormant and appear when person is immunocompromised
tb
173
bacterium that cause tb
- mycobacterium bovis
- africanum
- tuberculosis
174
states that cause activation of tb
- age related changes to immune system
- chemo
- hiv
- cancer
- renal failure
- diabetes
- long term steroid treatment
- poor nutritional status
175
- infects macrophages in lungs
- causes inflammation and tissue destruction
- granulomas form
- bacteria in granulomas may become dormant
tb
176
how to confirm tb
- skin test
- chest x ray
- sputum cultures
177
antimycobacterial treatment for tb
- zileuton (zyflo)
- zafirlukast (accolate)
- pyrazinamide (pza)
- ethambutol (myambutol)
- rifapentine (prifitin)
178
isoniazid only: 6-9 months, or isoniazid with rifapentine once weekly for 3 months
latent therapy for tb
179
several antimycobacterial meds must be used to treat a client who is active
-multiple meds
active tb treatment
180
adverse effects of tb meds
- peripheral neuropathy
- hepatotoxicityy
- hyperglycemia
- isoniazid
181
tb meds that inhibits metabolism of phenytoin
isoniazid
182
most common musculoskeletal disorders
- osteoporosis
- osteoarthritis
- rheumatoid arthritis
- gout
- polymyalgia rheumatica
183
for women, fastest overall loss of bone mineral density is when?
5 years after menopause
184
nonmodifiable risk factors for osteoporosis
- female
- caucasian
- Northern European ancestry
- advanced age
- family hx
185
modifiable risk factors for osteoporosis
- low body weight
- low calcium intakee
- estrogen deficiency
- low testosterone
- inadequate exercise or activity
- use of steroids or anticonvulsants
- excess coffee or alcohol
- current cigarette smokingg
186
promotion of bone health begins...
teen years
187
- normal soft and resilient cartilaginous lining in joint becomes thin and damaged
- joint space narrows and bones of joint rub together, causing joint destruction
osteoarthritis
188
most common symptoms of osteoarthritis
- stiffness with activity
| - pain with activity relieved by rest
189
non pharmacological therapy for osteoarthritis
- exercise
| - physical therapy
190
pharmacological therapy for osteoarthritis
- tylenol
| - nsaids
191
other osteoarthritis therapies
- acupuncture
| - surgical intervention
192
- chronic systemic inflammatory joint disorder
| - autoimmune disease where inflammation of joint lining destroys surrounding cartilage and eventually bone as well
rheumatoid arthritis
193
focus of RA research
- genetic factors
- environmental triggers
- hormonal triggerss
194
pharmacological therapy for RA
- pain management
- dmard's
- biological response modifier
195
acute and/or chronic inflammatory disease caused by accumulation of uric acid in blood and synovial fluid
gout
196
gout is associated with which diet
high purine diet
197
most common gout site
great toe joint
198
treatment of gout
- pain management
| - low purine diet
199
purine foods
- meat, poultry, fish
- fat
- alcohol
- caffeine
- high fructose corn syrup
200
BPH at risk population
- african americans
| - hispanics with a family hx
201
symptoms of BPH
- frequency
- urgency
- nocturia
- weak stream
- incomplete emptying
202
symptom management of bph
- avoidance of caffeine
- meds
- surgical treatment
203
bph meds
| -5-alpha reductase inhibitors
- finasteride (proscar)
| - dutasterride (avodart)
204
med that decreases usable testosterone, and causes reduction in prostate size
-also increases hair growth
5-alpha reductase inhibitors
205
adverse and contraindications with 5-alpha reductase inhibitors
- pregnancy category x
- liver disease
- decreased libido and ejaculate volume
- gynecomastia
- orthostatic hypotension
206
alpha 1 adrenergic antagonists
- tamsulosin (flowmax)
- alfuzosin (uroxatral)
- terazosin
- doxazosin (cardura)
207
relaxes smooth muscle of bladder neck and prostate
| -also lowers bp
alpha 1 adrenergic antagonists
208
adverse effects of alpha 1 adrenergic antagonists
- hypotension
- failure to ejaculate
- decreased volume of ejaculate
209
use cautiously in clients with renal impairment
silodosin
210
med/food interactions with alpha 1 adrenergic antagonistss
- cimetidine
- antihypertension, nitroglycerine
- erythromycin and hiv meds
211
tamulosin timing
30 mins after meal
212
silodosin timing
with same meal each day
213
alfuzosin timing
right after meal
214
doxazosin timing
same time each day
215
coping with chronic health problem factors
- gender
- sexuality
- fatigue
- grieving
- family
- locating care
- prevention of iatrogenic complications
216
most common chronic condition in persons over 65
HTN
217
this could be a symptom of a chronic illness, a side effect of a med, a symptom of depression, or all of these
fatigue
