Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Gerotonlogy > Chronic Conditions Exam 2 > Flashcards

Chronic Conditions Exam 2 Flashcards

(151 cards)

Start Studying
1
Q

What is Acute Illness ?

A
  • Occurs suddenly and often without warning
  • Stroke, myocardial infarction, hip fracture, infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Chronic Illness ?

A
  • Managed rather than cured
  • Always present but not always visible
  • Most common chronic condition in persons over 65 is arthritis, followed by hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the Chronic Conditions in Adults Over 65 ?

A
  • Heart Disease
  • HTN
  • Stroke
  • Asthma
  • Chronic Bronchi or Emphysema
  • Any Cancer
  • Diabetes
  • Arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Preventive phase (pre-trajectory) ( Chronic Illness Trajectory )

A

No S/Sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Definitive phase (trajectory onset) ( Chronic Illness Trajectory )

A

S/Sx & diagnosis PRESENT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Crisis phase ( Chronic Illness Trajectory)

A

Life-threatening situation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acute phase ( Chronic Illness Trajectory)

A

Active illness requiring hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Stable phase

A

Controlled illness course/symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Unstable phase

A

Not controlled but not requiring/desiring hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Downward phase

A

Progressive decline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dying phase

A

Immediate weeks/days/hours before death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Frailty ?

A
  • Incidence increases with age
  • Normal age-related decreases in reserve capacity are depleted and not able to compensate
  • Combination of geriatric syndromes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How to Diagnose Frailty ? (5)

A
  • Unintentional weight loss
  • Self-reported exhaustion
  • Weak grip strength
  • Slow walking speed
  • Low activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HTN ( Hypertension)

A

is a complex disease with a core defect of vascular dysfunction that leads to target organ damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Is the MOST COMMON chronic condition in people > 65 yo.

A

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the Hypertension Interventions ?

A
  • Weight reduction (5-20 mmHg reduction)
  • DASH diet (8-14 mmHg reduction)
  • Lower sodium intake (2-8 mmHg reduction)
  • Increase physical activity (4-9 mmHg reduction)
  • EtOH in moderation (2-4 mmHg reduction)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Most common cause for hospitalization, re-hospitalization, and disability for those over 65 yo

A

Heart Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is Heart Failure ?

A

Heart cannot keep up with workload

Results in insufficient oxygen delivery to body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the causes of Heart Failure ?

A
  • Results from damage from hypertension and CHD
  • Ventricles ENLARGE and DILATE

Results in weaker muscle

  • Also related to :
  • EtOH abuse
  • Drug abuse
  • Chronic hyperthyroidism

-Valvular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

-What is Left sided Heart Failure ?

A

Pump Failure to lungs

  • Starling’s Law - Stretch
  • Systolic – decreased contractility – can’t squeeze
  • Diastolic – decreased filling – can’t relax
  • Think DYSPNEA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is Right sided Heart Failure ?

A

Pump Failure to body

  • Results from Left-side failure
  • Think EDEMA – but also ascites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is just Congestive Heart Failure (also Acute Decompensated) ?

A

Swelling, edema, fluid in lungs (pulmonary edema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the S/S of Congestive Heart Failure ?(4)

A
  • Tachycardia
  • S3 or S4 gallop
  • Crackles - fluid in lungs
  • Dependent edema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are Interventions for Heart failure ?(7)

A
  • Activity – Pace to tolerance
  • Exercise
  • Medications
  • CCB are usually contraindicated!!!
  • Sodium restriction
  • Supplemental Oxygen
  • Daily weights
  • Possible fluid restriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the Cardiovascular Interventions ? (6)
- Complete assessment of all risk factors and existing disease - Lifestyle changes - Medication regimen tailored to specific disease process and patient needs - Education - Referral for financial assistance with medications if needed - Focus on symptom management and prevention of exacerbations of disease
26
What are the CV Drugs ?
- ACEI & ARB - Diuretics – Loop, Thiazide, & Potassium-Sparing - Beta Blockers
27
What Disease is considered Progressive and a Terminal Diagnosis ?
- Over 10-20 yrs - Basal ganglia (corpus striatum) and involves the dopaminergic nigrostriatal pathway - Think DOPAMINE – Dopamine is lost or inhibited - Dopamine regulates nerve impulses for MOTOR function - More common (slightly) in men than women - Onset approximately 60 years
28
What the Patho for Parkinson Disease ?
Degeneration and death of neurons of substantia nigra (in midbrain – reward, addiction, & movement - also sleep-wake cycles & firing of action potentials)
29
What are PD Clinical Signs ?
- Cogwheel Rigidity - Bradykinesia/Dyskinesia - Resting/Non-intention tremors
30
What is Cogwheel Rigidity ?
- Arms, legs, neck affected - Small jerking movements when affected muscles stretched Muscle rigidity
31
What is Bradykinesia/Dyskinesia?
- All skeletal muscles affected - Difficulty starting, continuing, and or coordinating movements - Shuffling - May become frozen (Akinesia) - absence or poverty of movement
32
What are Resting/Non-intention tremors ?
- Hands, feet, head, neck, face, lips, tongue, jaw most affected - Fine, rhythmic, purposeless tremors * Disappear with sleep and purposeful movements - Pills rolling, small handwriting, low monotone voice - Complications: falls, fractures, impaired communication, and social isolation
33
What is a Parkinsonian Crisis ?
Major complication Precipitated by emotional stress or sudden withdrawal of meds
34
What are Manifestations Parkinsonian Crisis ?(5)
- Severe exacerbation of tremors, rigidity, and bradykinesia - Anxiety - Sweating - Tachycardia -Hyperpnea
35
What are Treatment and interventions Parkinsonian Crisis ? (4)
- Respiratory/cardiac support prn - Non-stimulating environment - Psychological supports - Restarting medications
36
What are the teaching Exercises for PD ? (9)
- Lift toes when walking - Widen legs while walking - Small steps while looking forward - Tight corner manipulation - Swing arms with walking to improve balance and ROM - Carry bag to counterbalance is necessary - Facial exercises - Read aloud - Speak slowly with purpose and concentrated articulation
37
What are the Nursing Interventions for PD ? (9)
- Preservation of functional ability and quality of life - Increased independence and ADLs - Prevent complications and excess disability - Coping mechanisms - Increased socialization - Support groups for patient and family - Physical therapy and balance training - Increase strength and ROM - Occupational therapy with adaptive equipment
38
What are the Dopamine Precursors and Glutamine Antagonists ? ( First Line for PD ) (3)
Levodopa (Lardopa), carbidopa-levodopa (Sinemet), amantadine (Symmetrel)
39
What is the MOA of Dopamine Precursors and Glutamine Antagonists ?
Improves manifestations of motor dysfunction
40
Levodopa converted to dopamine............
in brain by decarboxylase
41
Carbidopa prevents conversion of dopamine........
in peripheral tissues Synergistic effect
42
Amantadine increases what ????
CNS response to dopamine
43
What are the Side Effects for Levodopa (Lardopa), carbidopa-levodopa (Sinemet), Amantadine (Symmetrel) ?
N/V/D, arrhythmias, blurred vision, darkening of sweat and urine, dyskinesias, postural hypotension, hallucinations and vivid dreams
44
Who needs to Avoid Levodopa ?
Pts with TIA, angina, melanoma, NA glaucoma
45
What is Client Education for Levodopa (Lardopa), carbidopa-levodopa (Sinemet), Amantadine (Symmetrel) ?
- Weeks to months to take effect - Decrease protein intake - High protein decreases function of meds - Avoid foods with pyridoxine Pork, beef, avocado, beans, oatmeal - Antiemetics and PPIs/H2RA prn - Interventions to decrease postural hypotension - Teach to report increases symptoms and cardiac SEs
46
What are the Monoamine oxidase B inhibitors (MAOB inhibitors) ? (2)
Selegiline (Eldepryl), rasagiline (Azilect)
47
What is the MOA for Selegiline (Eldepryl), rasagiline (Azilect) ?
- Inhibits enzymes that inhibit and/or breakdown dopamine - Often used synergistically with Levodopa
48
What are the Side Effects for Selegiline (Eldepryl), rasagiline (Azilect) ?
N/V, dizziness, insomnia, postural hypotension, HTN at high doses
49
What is the Client Education or Selegiline (Eldepryl), rasagiline (Azilect) ?
- Take at same time each day - Report insomnia - Interventions to prevent postural hypotension - Skin exams – risk of melanoma - Avoid foods containing Tyramine
50
What is Contraindicated for Selegiline (Eldepryl), rasagiline (Azilect) ?
Prozac and Demerol
51
What are the Dopamine Agonists ? (3)
Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip)
52
What is the MOA for Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip) ?
- Mimic effects of dopamine in brain - Often used synergistically with Levodopa
53
What are the SE for Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip ?
Similar to Levodopa
54
What is the Client Education for Bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip) ?
- Same teaching as Levodopa - Don’t stop abruptly - May cause compulsive behavior
55
What are the Catechol-O-Methyltransferase (COMT) Inhibitors ?
Tolcapone (Tasmar), entacapone (Comtan)
56
What is the MOA of Tolcapone (Tasmar), entacapone (Comtan) ?
- Inhibit COMT, which breaks down dopamine - Used synergistically with Levodopa/Sinemet
57
What are the Nursing Considerations for Tolcapone (Tasmar), entacapone (Comtan) ?
- Monitor LFTs - Interacts with warfarin, so monitor INR closely - Not to be used with MAOBIs
58
What is the Client Education for Tolcapone (Tasmar), entacapone (Comtan) ?
- Take with food - No ETOH or sedatives - Interventions to prevent postural hypotension - Don’t stop abruptly - Report muscle control changes, jaundice, dark urine, hallucinations
59
What are the Anticholinergics in relation to PD ?
Benztropine (Cogentin), Trihexyphenidyl (Artane)
60
What is the MOA of Benztropine (Cogentin), Trihexyphenidyl (Artane) ?
Block the excitatory action of acetylcholine
61
What are the Nursing Considerations for Benztropine (Cogentin), Trihexyphenidyl ?
- Used early in disease or when Levodopa not tolerated - Help prevent PD symptoms of drooling, tremors, rigidity
62
What the Anticholinergic Side Effects ?
- Can’t… SEE - Can’t… PEE - Can’t… SPIT - Can’t … POOP Assess for glaucoma S/S and photophobia
63
What is the Client Education for Benztropine (Cogentin), Trihexyphenidyl ?
- Avoid activity which promotes fluid loss - Don’t stop abruptly
64
What is GERD ?
- Movement of gastric contents, especially gastric acid, into the esophagus - Lower esophageal spincter (LES) relaxes too much
65
What the Older adult Symptoms for GERD ?
- Persistent cough - Asthma exacerbations - Laryngitis - Intermittent chest pain
66
Goal of therapy of GERD is to Prevent what ?
Exacerbation of Symptoms
67
What is the Most serious Complication for GERD ?
Aspiration Pneumonia
68
How do we prevent GERD Exacerbations ?
Lifestyle and diet changes ( Sit up after eating, Elevated HOB while sleeping and weight loss ) Medication management – PPI’s
69
What are the Musculoskeletal Disorders ?
Osteoporosis Osteoarthritis Rheumatoid arthritis
70
What are Osteoporosis Risk Factors ( Non- Modifiable ) ?
- Female gender - Northern European ancestry - Advanced age - Family history of osteoporosis
71
What are Osteoporosis Risk Factors ( Modifiable ) ?
- Low body weight (underweight) - Low calcium intake - Estrogen deficiency - Low testosterone - Inadequate exercise or activity - Use of steroids or anticonvulsants - Excess coffee or alcohol intake - Current cigarette smoking
72
For women, fastest overall loss of bone mineral density is 5 to 7 years immediately after what ?
Menopause
73
What are the complications of Osteoporosis ?
- Most serious health consequence of osteoporosis is morbidity and mortality resulting from falls - 20-24% of adults with hip fractures die within one year - One in five will require long term care - Only 15% will be able to walk unassisted six months post fracture - Women with osteoporotic fractures have increased incidence of other major complications - Vertebral fractures often not recognized - Silent - Several new treatment options available – kyphoplasty/vertebroplasty
74
When should women get screened for Osteoporosis ?
65 and Older
75
What are the Interventions for Osteoporosis ?
- Weight bearing and resistance training - Adequate calcium and vitamin D intake - Education about fall prevention - Pharmacological therapy to prevent bone loss
76
What is the Safety Alert for Bisphosphonates ?
Oral Meds must be taken on an empty stomach ( when first awake ) with a full glass of water, and the person must remain in an upright position for at least 30 minutes and not eat or drink for at least 30 minutes.
77
What is Osteoarthritis ( OA) ?
- Normal soft and resilient cartilaginous lining in joint becomes thin and damaged - Joint space narrows and bones of joint rub together, causing joint destruction - Diagnosis is made clinically
78
What is the Most common Symptom for OA ?
- Stiffness with activity and pain with activity relieved by rest
79
What are the Most common Locations for OA ?(7)
Neck – cervical spine Lower back – lumbar spine Hips Hands Fingers Thumbs Knees
80
What are the OA Deformities ? ( If you see these you know for a fact this person has OA )
- Heberden’s node – DIP – Distal Interphalangeal Joint - Bouchard’s node – PIP – Proximal Interphalangeal Joint
81
What are the OA Interventions ? ( Non- pharmalogical therapy )
- Weight loss can help – One pound of weight places four pounds of pressure on knees - Exercise - “Motion is the Lotion” Strength and flexibility – support the joints Water exercise - Physical therapy - Hot/Cold therapy – patient preference - Adaptive devices Cane – Relieves hip pressure by 60% Shoe lift for back pain Knee brace for stability
82
What are the OA Interventions ? ( Pharmalogical therapy )
- Acetaminophen – 4 Gram MAX/day - NSAIDs - COX2 (selective NSAID) - Joint injections – Intra-articular Steroids - Inflammation Hyaluronic Acid - Lubrication - Acupuncture - Surgical intervention – Knee/Hip Arthroscopy Total Joint Replacement
83
What is Rheumatoid Arthritis ( RA) ?
-Chronic, progressive, systemic inflammatory autoimmune disease - Primarily synovial joints - Inflammation destroys surrounding cartilage & eventually bone
84
What is Systemic RA ?
can affect any organ system i.e. vasculitis, anemia, splenomegaly, pulmonary nodules, pericarditis
85
The Focus of research for RA includes what ?
- Genetic factors - Environmental triggers in genetically vulnerable population - Hormonal triggers
86
What are Rheumatoid Arthritis interventions ? (4)
- Complete physical and laboratory assessment - Exercise and physical therapy - Environmental modifications - Assistive devices
87
What are Rheumatoid Arthritis interventions ? ( Pharmacological Therapy )
Pain management DMARDs (disease-modifying anti-rheumatic drugs) - methotrexate Biological response modifier - “-mab”
88
Difference between is OA and RA ? ( Osteoarthritis )
- Older adults - May be unilateral - Knee, hip, spine, hand - DIP & PIP - Usually NO MCP - Shorter period of morning stiffness - Pain with activity
89
Difference between is OA and RA ? ( Rheumatoid Arthritis )
- Women > Men - Symmetrical – hands & feet common - MCP & PIP - Usually NO DIP - Prolonged morning stiffness > 30 min - Pain > with inactivity
90
What are the Endocrine Chronic Conditions ?
- Diabetes Mellitus – altered presentation - Hyperthyroid - Hypothyroid
91
What is Diabetes Mellitus ( DM) ?
Disorder of glucose metabolism
92
What is Type 1 Diabetes ?
Absolute deficiency of insulin production due to autoimmune destruction of pancreatic β cells
92
What is Type 2 Diabetes ?
- Combination of relative insulin deficiency and insulin resistance - Genetics, lifestyle, and aging influence development of diabetes
93
How does DM present in Older pts ?
- Dehydration - Confusion, delirium - Decreased visual acuity - Incontinence - Weight loss & anorexia (polyphagia in younger) - Fatigue, nausea - Delayed wound healing - Paresthesias
94
What is the risk for Amputation in DM pts ?
- Peripheral neuropathy with loss of sensation - Evidence of increased pressure (redness, bony deformity) - Peripheral vascular disease (diminished or absent pedal pulses) - History of ulcers - History of amputation - Severe nail pathology
95
What are the Interventions for DM ?
- Screening and early identification of diabetes - Prevent complications - Assessment of end organ status - Assessment of self-care ability - Nutrition - Exercise - Close monitoring of residents in long-term care environment
95
What are the Interventions for DM ?(7)
- Screening and early identification of diabetes - Prevent complications - Assessment of end organ status - Assessment of self-care ability - Nutrition - Exercise - Close monitoring of residents in long-term care environment
96
What are the Meds for DM ?
- SGLT2 Inhibitors – Sodium Glucose Transport 2 Inhibitors - Biguanides - Sulfonylureas
97
SGLT2 Inhibitors – Sodium Glucose Transport 2 Inhibitors
-glifozin Prevents reabsorption of glucose ( and sodium) “Pee out glucose”
98
What are Biguanides ?
- Metformin - Increases uptake of glucose by muscles (increases insulin sensitivity of body tissue) and reduces gluconeogenesis
99
Nursing Considerations for Sulfonylureas ?
- Don’t use in older adults!! - Long ½ life and risk for hypoglycemia
99
Hypothalamic- Pituitary- Thyroid Axis( Whats the the order ? )
Negative Feedback System Hypothalmus → Thyrotropin Releasing Hormone → Ant Pituitary to Increase Thyroid Stimulating Hormone →Thyroid Gland to produce T3 and T4
100
What are the Diagnostic Studies of Thyroid Function ?
- Serum levels of TSH, T3, T4 & Free T4 - Thyrotropin-releasing hormone stimulation test (TRH) - Radioactive Iodine uptake (RAI) - Thyroid scan
101
What is the Thyrotropin-releasing hormone stimulation test (TRH) ?
TRH injected and TSH measured to assess thyroid function
102
What is the Radioactive Iodine uptake (RAI) ?
- Direct test of thyroid function - Radioactive iodine absorbed by thyroid and thyroid can be visualized assessing for nodules
103
What is a Thyroid Scan ?
Similar to RAI, but iodine not used. Radioactive isotopes given orally and taken up by thyroid and visualized on scan
104
What does T4 Indicate ?
- Generally bound to proteins - Free T4 measures T4 not bound to proteins therefore active - Released by thyroid gland
105
What does T3 Indicate ?
- Monitor the effectiveness of thyroid replacement therapy
106
What should be Avoided for T3 and T4 testing ?
Hormones, steroids, ASA, foods containing iodine should be avoided for 7 days before testing.
107
What is Hyperthyroidism ?
- increased T3 and T4 hormones which increases the metabolic rate - Most severe form thyrotoxicosis
108
What causes Hyperthyroidism ?
- Autoimmune disorder (Grave’s disease) *most common - Multinodular goiter (Toxic goiter) - Women affected more often, 5-7:1
109
What is the Pathophysiology of Hyperthyroidism ?
- Increased circulating thyroid hormones (TH) - Metabolic rate increases - Heightened sympathetic nervous system - Heightened sensitivity to catecholamines - Manifestations of hyperthyroidism
110
Hyperthyroidism In Relation to Older Adults ?
- Onset often abrupt - Graves disease most common form in older adults - Also caused by toxic goiter, iodine ingestion or iodine-containing foods, contrast agents, & medications
111
Thyroxine increases myocardial oxygen consumption which can cause what ? ( hyperthyroidism )
- Increases risk for Afib and angina in person with CHD - Can cause heart failure - Most common complication – AFIB – 27% of older adults with hyperthyroidism
112
How does Hyperthyroidism Present in the Older Population ?
- Tachycardia - Tremors - Weight loss - Apathetic Thyrotoxicosis – slowed movement and depressed affect
113
What is a Thyroidectomy ?
- Surgical removal of part or all of thyroid - Reserved for severe case or large goiters
114
What is the Pre- Op care for a Thyroidectomy ?
- Give antithyroid medications - Lugol’s solution (potassium iodide and iodine) given 10 days before to decrease thyroid hormone production - Promote reduction of anxiety to reduce risk of thyroid storm
115
What is the Post-Op care for a Thyroidectomy ?
- HOB up Semi-Fowler’s - Check dressing – esp back of the neck - Assess resp status/distress due to risk of airway edema - Trach tray, oxygen and suction at bedside - Rest voice - hoarseness with nerve injury - Observe for tetany – Chvostek’s and Trousseau’s sign – indicator of damage or removal of parathyroid glands – resulting in hypocalcemia
116
What is Chvostek's sign?
Push the cheek and it spasms (low calcium)
117
What is Trousseau's sign?
BP cuff inflated and causes a carpal spasm.
118
What is Thyroid Storm ( thyrotoxicosis ) ?
Life-threatening condition Exaggeration of hyperthyroid symptoms Hyperthermia 102-106 F Tachycardia (130+) HTN Abd pain, N/V/D, agitation, anxiety, psychosis, delirium, seizures, dehydration
119
What are the S/S of a Thyroid Storm ?
- Hyperthermia 102-106 F - Tachycardia (130+) - HTN - Abd pain, N/V/D, agitation, anxiety, psychosis, delirium, seizures, dehydration
120
How do we treat a Thyroid Storm ?
Cooling with ice, reducing levels of TH, replacement of fluids and electrolytes, give oxygen, stabilize cardiac function. Avoid ASA (increases TH)
121
What is hypothyroidism?
- thyroid horome deficiency, low T3 and T4 levels which decreases the metabolic rate - AKA Myxedema in adults & Cretinism in infants Women affected more often 5:1 - Ages 30-60
122
What are the Primary causes of Hypothyroidism ?
Genetic/congenital, tx for hyperthyroidism, thyroiditis, iodine deficiency, decrease TH produced
123
What are the Secondary causes of Hypothyroidism ?
Pituitary TSH deficiency or peripheral resistance to thyroid hormones
124
What the Meds for Hypothyroidism ?
Amiodarone, anabolic steroids, lithium, phenytoin, beta blockers
125
What is Hashimoto's Thyroiditis ?
Chronic autoimmune thyroiditis Genetic link
126
What is the Patho of Hashimoto's Thyroiditis ?
Autoantibodies attack thyroid tissue>thyroid becomes fibrous>function of thyroid decreases>low T3 T4>goiter development>signs of hypothyroidism
127
What are the S/S of Hashimoto's Thyroiditis ?
- Hypothyroidism - Sore throat, malaise
127
How do we Treat Hashimoto's Thyroiditis ?
- Goal: decrease size of thyroid and prevent hypothyroidism - Thyroid hormone replacement Giving Synthroid decreases size of gland by reducing its activity
128
How to Diagnose Hashimoto's Thyroiditis ?
With T3, T4, TSH, Antithyroid hormones
129
Hypothyroidism In Relation to Older Adults ?
- Most frequent cause chronic autoimmune thyroiditis - Also radioiodine treatment, surgery, medications (Amiodarone), pituitary/hypothalamic abnormality
130
How does Hypothyroidism Present in Older Adults ? (5)
- Slowed mentation - Gait disturbances - Fatigue - Weakness - Heat intolerance COLD intolerance
130
How to Diagnose Hypothyroidism ?
TSH, T3, T4, FT4 PE( Pulmonary Embolism ) and hx; Cardiac studies to assess for complications
131
How to Treat Hypothyroidism ?
Thyroid replacement therapy Levothyroxine (Synthroid) ( Most Common )
132
Levothyroxine (Synthroid) is the MOA ?
Synthetic T4 (converted to T3 in tissues)
133
What are SE of Levothyroxine (Synthroid) ?
- All those signs of HYPERTHYROIDISM - Dysrhythmias, CHF, HTN, angina, seizures
134
What are the Nursing Considerations for Levothyroxine (Synthroid) ?
- Assess for bleeding in pts on anticoagulants (potentiates action) - Hyperglycemia (need for increased DM treatments) - NOT used as a wt loss med - Long half-life - Give on empty stomach
135
What is the myxedma coma?
Rare & Life-threatening complication with HIGH mortality rate
136
What are the causes for myxedma coma ?
- Untreated or uncontrolled hypothyroidism - External stressors including surgery, trauma, infection, excessive exposure to cold temps
137
What are the Manifestations of Myexdema Coma ?
Hypothermia, Mental function ranges from depression to unconscious, Respiratory depression (hypoventilation), Hypotension, Bradycardia
138
What are the treatments for Myxedema Coma ?
- Supportive measures and stabilization of vitals - Treat underlying cause - Thyroid hormone replacement – must be slow r/t toxicity with rapid replacement - PO or IV
139
What are the Brochodilators for Respiratory ?
Albuterol Formoterol Salmeterol
140
What are the Inhaled corticosteroids (ICS) ?
Budesonide Mometasone Fluticasone
141
What are the Oral Steroids ?
Prednisone
142
What are the anticholinergics?
Short Acting Muscarinic Antagonists (SAMA) - Ipratropium Long Acting Muscarinic Antagonists (LAMA) - Tiotropium
143
A client has been diagnosed with hyperthyroidism. What lab result would the nurse least expect to be elevated? A. T4 B. T3 C. Free T4 D. TSH
D. TSH
144
A client with severe thyrotoxicosis has a temperature of 104 F. What medication or treatment is least appropriate to suppress the temperature? A. Aspirin B. Tylenol C. Cooling blanket D. Intravascular cooling system
A. Aspirin
145
A client has been admitted to the ICU in myxedema coma. What client description does the nurse most expect? A. Young man with abdominal pain B. Middle-aged man with skeletal trauma C. Middle-aged woman in summer D. Elderly woman during winter
D. Elderly woman during winter
146
The nurse evaluates that female client recently diagnosed with hypothyroidism understands the prescribed therapy with levothyroxine (Synthroid) when the client states A. “I should be able to become pregnant in a couple of months.” B. “This medications will help me lose all this extra weight.” C. “I should call the doctor for nervousness or an increased pulse.” D. “This medication should be taken with food, preferably dairy.”
C. “I should call the doctor for nervousness or an increased pulse.”

Gerotonlogy (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions