Exam 1 Flashcards
(197 cards)
1
Q
Geron (Greek)
A
Old man
2
Q
Gerontology
A
the scientific study of the process of aging and the problems of aged persons (mental, physical, social)
3
Q
geriatrics
A
the branch of medicine that deals with the diseases and treatments of older people
4
Q
elite-old
A
100+ years
5
Q
chronological age
A
the number of years lived
6
Q
biological age
A
the age of the organs
7
Q
psychological age
A
how old one feels
8
Q
social age
A
ones roles and relationships
9
Q
age is (subjective or objective)
A
SUBJECTIVE (varies with time, place, and perception)
10
Q
nonagenarian
A
90+
11
Q
centenarian
A
100+
12
Q
most people 100+ are
A
female (77%)
33% have no signs of dementia
13
Q
baby boomer
A
born between 1946-1964
“boom” after WWII
current elder population
14
Q
fastest growing older adult age group
A
85+
15
Q
more (men or women) live in poverty
A
women
16
Q
two types of life tables
A
cohort (generation)
period (current)
17
Q
cohort age
A
generational expectancy
18
Q
period life table
A
at this time going forward how long you’re expected to live
19
Q
most frequently used life table statistic
A
life expectancy/period (based on current age)
the average number of years of life remaining for x persons who have attained a given age
20
Q
caring for aging population mission
A
preserve function (preventative)
enhance health
enhance quality of life
enhance dying experience (end of life care)
21
Q
research in the aging population
A
innovation in care
provision of services
hot topics of research: dementia, reduce falls, use of restraints, pain management, delirium, end of life care
22
Q
demand in nursing (geriatric)
A
demand in nursing is critical for gerontological nurses because there is a growing geriatric population
23
Q
health is
A
absence of disease
24
Q
the concept of wellness incorporates
A
all aspects of one’s being
physical, emotional, intellectual, social, spiritual, cultural, environmental
25
the wellness model suggests that
every person has an optimum level of functioning for each position on the wellness continuum to achieve a good and satisfactory existence
26
objectives set (elderly health)
```
dementia
foodborne illness
infectious disease
injury prevention
oral conditions
osteoporosis
respiratory disease
sensory or communication disorders
```
27
primary disease prevention
preventing disease (teaching, stress management, social engagements, cognitive stimulation, immunizations)
28
secondary disease prevention
evidence-based screenings and guidelines (catching early)
29
senescence
condition/process of deterioration with age
| latin - "to grow old"
30
cellular functioning
cells replicate but not exactly
| become more complex, changes, more accumulation of damage every time they replicate - eventual cell death
31
error theories
aging is the result of accumulation of random errors in the synthesis of DNA and RNA (unpredictable)
32
wear and tear theory
- breaking down results from wearing out from continued use
- progressive decline in cellular function or increased cell death
- cells are aggravated by internal and external stressors
- destroyed by chemical and mechanical injuries (often done to ourselves)
- falls under error theory
33
why do we age?
- capacity is set at ~90 years
- exact mechanisms are poorly understood
- cellular changes = aging
- degeneration, cell death (cellular = organism)
34
role (successful aging)
- adapting/adjusting to changing roles
- ready to fulfill new role, sense of purpose (e.g., ready to retire)
- resistance may predict poor adjustment
35
purpose of activity
maintaining productive life (physical, mental)
36
disengagement
transferring control to younger generations (successful aging)
- society disengages from elderly and the elderly disengages from society
- ability to interact with society (cognitive, physical)
37
continuity
maintaining and continue previous behaviors and role or finding adequate replacements
38
modernization
older people lose power and status due to advances in technology (controversial)
39
age gratification
people of similar age/cohort have the most similar interests
40
Erikson
```
developmental theory (8 stages)
- widely accepted in nursing
```
41
theory based interventions (evidence based practice)
Used to help develop interventions
- interventions to promote healthy aging from biological theories (ch. 3 boxes)
- used as a basis to develop policies
42
emerging majority
statistically, minorities are assuming the majority in number
43
health disparity
differences in the state of health and health outcomes between groups of persons
44
health inequity
excess burden of illness or the differences between the expected incidence and the prevalence and that which occurs in excess in a group
(prevalence in one group is higher than the overall expected prevalence)
45
cultural awareness
development of cultural proficiency with increased awareness of our own beliefs and attitudes and this commonly seen in the community of healthcare
46
cultural knowledge
what the nurse brings (what you know) to the caring situation and what you learn about older adults and their families, community, and expectations
(what you know and learn about the patient and situation)
47
culture
shared and learned beliefs with a group of people
48
acculturation
person from minority or marginalized culture that adopts a majority culture
49
ethnicity
social differentiations based on cultural criteria
50
barriers to quality care range from those related to:
- geographic location
- age
- gender
- ethnicity
- race
- sexual orientation
(what makes them an individual/specific characteristics and situations)
51
increased risks in African Americans
```
stroke/TIA
heart disease
HTN
diabetes
diabetes-related amputation
```
52
increased risks in Mexican Americans
DM
| fewer prescriptions after MI
53
increased risk in Native Americans
DM (than whites)
54
reducing health disparities
cultural awareness
| cultural knowledge
55
self-level of cultural awareness
self-understanding; your own experiences and values (how they've shaped your perceptions)
56
cultural awareness requires the ability to
work and build a relationship with members of other cultural groups
57
cultural awareness requires recognition of
factors beyond cultural that affect members of any given group and recognize that they can affect their health, safety level, and wellbeing
58
cultural knowledge includes both
what the nurse brings to the caring situation and what the nurse learns about the older adult (what you bring in and what your learn)
59
essential cultural knowledge in the elderly
their way of life (how they think, act, and what they believe)
60
biomedical beliefs
western medical paradigm (focus on disease and abnormalities)
61
magico-religious beliefs
god or supernatural forces cause disease (good health is a blessing or reward)
62
naturalistic or holistic beliefs
health is a sign of balance/harmony (illness comes with imbalance)
63
obstacles in care of the elderly
ethnocentrism
stereotyping
ageism
64
ethnocentrism
belief that one system is superior
65
stereotyping
simplified and standardized conceptualization of a group
66
ageism
discrimination due to age
67
cultural skills
use of spoken or unspoken communication (ask/go slow)
| be aware that body language is taken differently in various cultures
68
fastest growing segment of the population
older women
69
older women
social - more likely to live alone, have friends than men
economic - lower than men (how job/educational opportunities have changed)
health - live longer than men but are sicker overall (more chronic illness, disability)
higher risk of being without insurance (death/divorce of spouse)
70
older men
most literature on aging focuses on women (more older women)
black men have the shortest statistical lifespan
we often make assumptions with social/economic status of older men
71
key to culturally and ethnically sensitive assessment
listening
72
LEARN model
Listen carefully
Explain your perceptions
Acknowledge and discuss the differences and similarities between your goals
Recommend plan of action that takes both perspectives into account
Negotiate a plan that is mutually acceptable
73
aging changes
anatomical and physiological changes that are attributed to aging
(all cells are affected by aging)
74
bronchiectasis
permanent abnormal widening of the airways due to inflammation
75
elastic recoil
the lungs ability to expand and contract
76
kyphosis
curvature of the spine bowing out of upper spine (P)
77
vital capacity
maximum amount of air that can be expelled following maximum inspiration
78
risks to adequate respiration due to aging
- the trachea stiffens due to calcification of its cartilage (reduces the ability to cough because it blunts the laryngeal and coughing reflexes)
- reduced number of nerve endings may lead to a weak gag reflex
- lungs become smaller in size and weight > connective tissues needed for effective respiration and ventilation in the lungs weaken > decreased elastic recoil > respiration then requires the use of accessory muscles (smaller = less air)
- alveoli are less elastic, develop fibrous tissue, contain fewer functional capillaries, and have less surface area (reduces gas exchange)
- loss of skeletal muscle strength in the thorax and diaphragm + loss of resilient force (tissues) that holds the thorax in slightly contracted = kyphosis/barrel chest
- reduction in vital capacity (less air exchange, more secretions remaining in the lungs)
79
age related changes
decreased response to hypoxia and hypercapnia
different normal baseline temp (may miss fever - always look at baseline)
80
nursing considerations in aging
- less effective gas exchange (hypoxia)
- easily fatigued r/t decreased respiratory efficiency
- reduced airway clearance (risk for asthma)
- increased potential for infection
81
assessment on older adult
- breathing patterns
- breath sounds
- palpate chest
- chest expansion
- cough
- deep breathing (can they breath effectively/efficiently? altered breathing pattern?)
- respiratory rate
- O2 sat
- secretions (can lead to infection - can they swallow? could they aspirate? [aspiration pneumonia])
- mental status/behavioral changes (has it changed from their baseline?)
82
leading causes of death in older adults
pneumonia
| UTI
83
contributing factors to pneumonia
poor chest expansion
lowered resistance to infection
reduced mobility (laying down)
increased mucus formation and bronchial obstruction
increased incidents of hospitalization and institutionalization (long-term care)
- nosocomial pneumonia
pleuritic chest pain and lower temp may mask s/s
84
pneumonia symptoms
- slight cough
- fatigue
- rapid respiration
- confusion (behavioral changes)
- restlessness (hard to breath = agitation)
85
pneumonia interventions
*prevention is key
- encourage good fluid intake (thins secretions + keeps them hydrated)
- manage bronchial secretions (aspiration risk?)
- preventative measures for infections
- breathing exercises
- raise HOB at least 30 degrees (raise pressure off chest) unless contraindicated
- educate and instruct patient to turn, cough, and deep breathe every 2 hours (keep from settling in the lungs)
86
physical deconditioning
decline in cardiovascular function due to physical inactivity
87
postural (orthostatic) hypotension
decline in systolic BP of 20mmHg or more after rising and standing for 1 minute
88
risk to adequate circulation due to aging
- heart valve increase in thickness and rigidity r/t sclerosis and fibrosis
- aorta becomes dilated
- slight ventricular hypertrophy
- myocardial muscle loses some of its contractile strength, causing a reduction in CO (less efficient with increased activity or demands on the heart)
- diastolic filling and systolic emptying require more time to complete the cycle
- calcification and reduced elasticity of vessels > less sensitive to baroreceptors > reduction of BP regulation > reduced arterial BP = decreased tissue perfusion
- changes are usually gradual and become more apparent when the older adult is placed under increased activity (early morning walks to restroom = increased death)
89
CV nursing considerations
poor peripheral circulation (edema, capillary refill)
easily fatigued (esp. on exertion)
inadequate circulation to heart tissue
SOB
reduced cardiopulmonary tissue perfusion
- hypotension
- tachycardia
- edema
- dyspnea
- delirium (infection, lack of O2)
- restlessness
- pallor
- memory disturbance (change)
90
CV assessment on the older adult
BP (orthostatic = lying, sitting, standing)
- 2 people to keep patient from falling
palpate carotid arteries
ECG
exercise tolerance
91
CV interventions
monitor for s/s
encourage fluids (hypotension - fluids drop)
fall precautions
health promotion: medication, diet, exercise (as appropriate)
92
presbyesophagus
age-related changes to the esophagus causing reduced strength of esophageal contractions and slower transport of food down the esophagus
93
GI issues related to aging
tongue atrophy decreases taste sensation (aspiration, inability to swallow)
- if meds sit in their mouth there will be a different uptake
- changes in how much they're eating
saliva production decreases (may make swallowing more difficult)
degenerative changes in the smooth muscle lining of the lower esophagus (presbyesophagus)
- weaker esophageal contractions
- weakness of sphincter
- decreased esophageal motility
- decreased stomach motility (med uptake, GERD) - sit them up after eating
- decreased elasticity of the stomach reduces the amount of food the stomach can accommodate (may need several small meals [too much = indigestions, aspiration = pneumonia])
- stomach has a higher pH r/t a decline in hydrochloric acid and pepsin causing increased incidence of gastric irritation in older adults
- reduced pepsin interferes with absorption of protein
- reduced hydrochloric acid interferes with absorption of calcium, iron, folic acid, and vitamin B12
- decreased sensory perception may lead to increased incidence of constipation, as can inactivity, reduced food/fluid intake, and low fiber diet)
- pancreas fibrosis, atrophy, and reduced pancreatic secretions may affect the digestion of fats
94
GI nursing considerations
constipation (esp. in women can cause UTIs) (when was their last bm)
V/D
acute pain
dehydration
inactivity
insufficient nutritional intake
95
GI assessment
abdomen (least invasive first)
- bowel sounds
- tenderness
- distention
dietary intake, food, and fluids
elimination patterns
swallowing ability
chewing ability
weight (changes)
96
GI interventions
provide food the patient likes and can tolerate
keep patient sitting up after meals (health promotion: diet)
97
nocturia
voiding at least once during the night every/most nights
98
urinary elimination changes related to aging
hypertrophy of the bladder muscle and thickening decreases the ability of the bladder to expand and reduces capacity (leading to urinary frequency and nocturia)
- kidney circulation improves when a person is in a recurrent position and increases the need to void
- this is NOT a normal part of aging (is related to other aging issues)
retention of using due to neurological inefficiencies and a weaker bladder that does not empty properly
- women: fecal impaction
- men: prostatic hypertrophy (can't empty)
* men don't often get UTIs so it's important to find out what caused it
reduced filtration efficiency of the kidneys affects the body's ability to eliminate drugs and causes increased BUN
incontinence: NOT a normal part of aging (but common) [related to other physical or mental disorders/age changes]
99
GU nursing considerations
potential for adverse drug reactions or toxicity (not clearing their system - low motility)
pain
risk for infection (UTI)
risk for falls (getting up to go to the bathroom)
need for toileting assistance
potential for skin breakdown
sleep disruption
potential for social isolation (depression = early death)
100
GU assessment
- renal function
- ability to void
- BP (hypotension)
- fall risk
- pain
- frequency
- urgency
- constipation
- inactivity
- dehydration (UTI)
- indications for drug toxicity
- mental status change
101
GU interventions
encourage fluids (unless contraindicated)
fall precautions
monitor for drug toxicity
health promotion: bladder training and fluid intake
102
turgor
elasticity
103
pressure injury
localized damage to skin and underlying soft tissue resulting from pressure, shear, and/or friction
104
skin changes related to aging
reduced thickness of dermis
reduced vascularity of the dermis
decrease rate of epidermal turnover
degeneration of elastic fibers
increased coarseness of collagen
reduction of melanocytes
reduced blood supply (results in increased fragility of skin)
blood thinners
105
skin nursing considerations
- risk for skin tears
- risk for wounds (and healing)
- risk for infection
- risk for pressure injury
- bruising
- decreased turgor
- slow healing
- decreased fat and muscle in the feet (unsteady gait)
106
skin assessment
```
temperature
color
lesions
bruising
turgor
signs of infection, rash
```
107
skin interventions
encourage fluids (hydration improves skin)
prevention (dry skin)
educate on care
control environment temperature and humidity
108
presbyopia
age-related decrease in the eye's ability to change shape of the lens to focus on near objects
109
vision changes related to aging
reduced elasticity and stiffening of the muscle fiber of the eye lens leading to presbyopia
- usually begins in the 40s and continues with age
- interferes with the ability to focus
reduced pupil size, opacification of the lens, and a reduction of photoreceptors in the retina reduces visual acuity
light perception decreases leading to difficulty seeing at night
sensitivity to glare increases
distortion of colors such as blue and green
depth perception becomes distorted
peripheral vision is reduced
decreased tear production distorts light
110
vision nursing considerations
- blurred vision
- decreased vision
- need for more light to see/read
- impaired light/dark adaption
- decreased night vision
- risk for falls/injury
- risk for social isolation (unable to see, drive - can't get meds/food/etc.)
111
visual assessment
visual acuity under various light conditions
evaluate impact of vision limitations on driving, ambulation, social interactions, and safety
home visit assessment for environmental safety
112
visual interventions
regular eye exams
113
presbycusis
age-related high-frequency sensorineural hearing loss
114
hearing changes related to aging
tympanic membrane thinning with loss of resiliency (not vibrating as well)
- inhibits communication
ossicle joint degeneration
vestibular structures atrophy (organ of Corti, cochlea)
loss of hair cells
changes in cartilage of pinna
115
hearing nursing considerations
decreased sound conduction
risk for hearing loss (presbycusis, tinnitus, equilibrium deficits)
changes in appearance of external ear (larger and longer)
116
hearing assessment
hearing
balance
monitor psychosocial if hearing dysfunction
evaluate safety
117
hearing interventions
educate on hearing safety (usually once it's gone, it's gone)
encourage social interaction if isolated
speak in low toned voice
118
hyposmia
decrease in smell acuity
119
changes in smell and taste related to aging
decreases neurons that send signal to the brain
difficulty distinguishing smells
decrease in taste secondary to change in smell acuity
120
sarcopenia
decline in walking speed and/or group strength related to decreased muscle mass/function
121
mscskl changes related to aging
decline in muscle fibers leads to reduced muscle mass > decrease in strength and endurance
decreased flexibility of joints and muscles related to changes in connective tissue
tendon and ligament stiffening
redistribution of fat
narrowed intervertebral disks
decline in walking speed (sarcopenia)
increased latency/contraction of muscles
122
mscskl nursing considerations
- gait and balance instability
- decreased range of motion
- decreased mobility
- risk of fractures
- risk of falls
- pain
- decreased strength and endurance
- decreased activities and socialization (risk for isolation)
123
mscskl assessment
range of motion
strength
gross and fine motor skills
stability
ability to perform ADLs
124
mscskl interventions
encourage appropriate activity
encourage and educate on good nutrition
consider mobility aids
fall prevention
125
endocrine changes related to aging
thyroid gland strophes leading to a decrease in activity
reduced/insufficient release of insulin (T2 DM)
reduction in sensitivity to insulin (resistance)
decreased adrenocorticotropic hormone secretion leading to reduced estrogen and progesterone secretions (can be supplemented based on patient preference)
126
endocrine nursing considerations
risk for developing T2 DM
risk for hypoglycemia (quicker to kill)
decreased ability to respond to physiological changes/stressors
risk for medication safety issues
127
endocrine assessment
monitor lab values
- A1C (glycated hemoglobin)
- Thyroid panel
128
endocrine interventions
educate and encourage balanced nutrition
educate on medications
129
immune system changes related to aging
T-cell activity declines
more immature T-cells present
thyme mass decreases
- leads to immature T-cells
cell-mediated immunity declines
- reduces ability to fight infection
lower body temperature
ability to respond to cold temps decrease
- r/t inefficient vasoconstriction, reduced peripheral circulation, decreased CO, reduced muscle mass, and reduced subcutaneous tissue
130
immune nursing considerations
risk for infection (s/s)
lower response to immunizations
131
immune assessment
s/s of infection
labs
box 24-1
132
immune interventions
standard precautions
immunizations
education: diet, activity, stress, rest
133
nervous system changes related to aging
atrophy of the brain and spinal cord r/t loss of nerve cell mass (dementia)
decline in nerve cells
reduced nerve conduction
slowed central processing
approximately 20% reduction in cerebral blood flow
decreased peripheral nerve function (decreased sensation)
decreased cranial nerves
134
NS nursing considerations
delayed response time to stimuli and in reflexes
risk for falls/injury
decreased taste and smell
dulled tactile sensation
risk of cognitive impairment
pain
reduced activity
social isolation
restricted mobility
risk for CVA (narrowed blood vessels, atrophy, less circulation, occlusion)
- prevent TIA - always looking for s/s (face drooping, weakness in extremities/one side, gaze/pupil reaction, speech)
- run a neuro - equal grip strength/evenly able to hold up arms, dilated pupils/PERRLA/sluggish reaction
135
NS assessment
cognition
independence
ability to perform ADLs
136
NS interventions
encourage and educate on use of assistive devices
fall prevention
137
reproductive changes related to aging
hormonal changes
- women: estrogen decreases (menopause)
- men: testosterone and sperm count decreases
138
reproductive assessment
changes in hormones (labs)
139
reproductive interventions
educate on STD prevention
hormone changes
140
muscle twitching intervention
metabolic panel
141
hyperkalemia
>5 mEq/L
may be caused by potassium sparing diuretics (Lasix)
assess BP edema
142
hyponatremia
< 135
143
hypernatremia
> 148
144
pharmacokinetics
the way the body uses medications
145
absorption
how the medication is taken into the body
route: oral, sublingual, transdermal
146
distribution
how the medication is dispersed throughout the body
147
metabolism
how the medication is broken down
148
excretion
how the medication is removed from the body
149
age-related changes to absorption
- thinning skin
- reduction of saliva (anticholinergic)
- difficulty swallowing (meds breaking down on tongue)
- slowed motility (not normal, but common)
- reduction in gastric emptying
- delayed stomach emptying
150
systemic circulation
transportation to target cell receptors
151
high blood flow target organs (distribution)
brain, kidneys, liver
rapid reception = increased concentrations of medications
*most medications are cleared through the renal system
152
low blood flow target organs (distribution)
skin, muscles, fat
- lower concentrations of medications
153
age related changes to distribution
less body water
increased body fat
decreased availability of plasma proteins
common:
- PVD (circulatory)
- chronic illness
- acute illness
154
metabolism takes place mainly in the
liver (liver toxicity)
155
biotransformation
transforms substances making them more easily eliminated from the body
156
age related changes to metabolism
reduction of liver mass
reduction of liver perfusion (30-40%)
reduced the amount of medication metabolized during the first pass
157
excretion occurs
as metabolites or unchanged
through: lungs, sweat, bile, feces, breast milk, hail, saliva, tears, semen, and urine (the renal system)
158
age related changes to excretion
reduction of GFR (~1%/year after 20yo)
prolonged medication half-life
159
pharmacodynamics
physiological interactions between a medication and the body
| ex. chemical compounds and cell receptors
160
age related changes to pharmacodynamics
*help patient move
reduction in baroreceptor reflex response
- increased susceptibility to orthostatic hypotension
decreased responsiveness in the a-adrenergic system (bronchodilators)
- decreased sensitivity to B-agonist
decreased thirst sensation (dehydration - medications that cause increased excretion)
161
polypharmacy
approx 5 or more medications
substantial problem in older adults
162
increase risk for morbidity and mortality (poly pharmacy)
- number of providers
- presence of chronic illness
- OTC meds
- disabilities that may impact how they take their meds
*the more prescribed meds taken, the greater possibility of interactions (specialists don't always look at other meds)
163
medication-food (calcium in dairy)
milk binds with some receptors that a lot of medications need (best to take meds with water)
levothyroxine
tetracycline
ciprofloxacin
spironolactone
increase potassium
164
med-food: green leafy vegetables
full of vitamin k
- decrease anticoagulant effects
warfarin
Coumadin
heparin
165
adverse
unintended consequence
166
beers criteria
- potential inappropriate
- potentially inappropriate for older adults w/ certain conditions
- should only be taken with caution
- avoid
- not meant to be policy
167
psychoactive medications
older adult: depression, anxiety, bipolar, dementia
use only after non-pharmacological approaches found ineffective
look for changes (especially thermal)
168
antipsychotics
affect hypothalamic and thermoregulatory pathways
| known for side effects - watch your patient closely
neuroleptic malignant syndrome, sedation, hypotension, EPSEs
169
typical antipsychotic
haloperidol (never use with dementia with Lewy bodies)
170
atypical antipsychotic
seroquel
171
extrapyramidal and anticholinergic side effects (EPSEs) (antipsychotics)
movement
drying
atypical tend to produce less EPS symptoms
172
EPS
acute dystonia
- oculogyric crisis: eyes fixed in position
akathisia
parkinsonian symptoms
tardive dyskinesia
173
promoting healthy aging: assessment
"brown bag" (to bring meds in)
discuss each med
stop/start tool
174
herbs and supplement regulation
- regulated by dietary supplement health and education act
- herbal manufacturers label herbs as foods (NOT FDA regulated)
- good manufacturing practices required since 2007 (prep and storage, product ID, purity, strength, composition)
175
CoQ 10
Use: for people who can't use statins
Caution: DO NOT TAKE WITH WARFARIN
Adverse reactions: elevated liver function tests, mild GI upset
176
garlic
Use: decreased blood clots and reduced total serum cholesterol and LDLs
Caution: with use of anticoagulants
Adverse reactions: severe allergic reactions, increased flatulence, and upper GI irritation with nausea and heartburn
177
ginkgo biloba
Use: cognitive function, memory
Caution: with use of anticoagulants
Adverse reactions: BLEEDING
178
St. John's wort
Use: mild or moderate depression, anxiety, pain
Caution: warfarin, contraindicated with other antidepressants (esp. SSRIs)
Adverse reactions: SEROTONIN SYNDROME, photosensitivity
179
melatonin
Use: promote sleep
Caution: when taking other meds that can cause drowsiness
Adverse reactions: headache, nausea
180
ginseng
Use: promotes overall wellbeing and immunity
Caution: with use of anticoagulants
Adverse reactions: box 10-1
181
glucosamine and chondroitin sulfate
Use: support cartilage and connective tissue (has anti-inflammatory effects)
Caution: with allergies, diabetes, asthma
Adverse reactions: nausea, GI upset
182
dietary supplements for hypertension
```
coenzyme Q10
fish oil
garlic
green tea
melatonin
```
183
dietary supplements for HIV
SJW
184
dietary supplements for GI disorders
psyllium
milk thistle
probiotics
185
dietary supplements for cancer
calcium (colorectal)
fish oil (endometrial)
garlic (colorectal, prostate)
ginseng (breast, stomach, liver, lung, ovarian)
186
dietary supplements for Alzheimer's
ginkgo
187
diabetes and herbal treatment
- herbs have been used to manage diabetes since before the 1921 discovery of insulin
- some of the 400 plants that affect blood glucose are still used
- there is not enough evidence to support the use of herbal supplements for treating diabetes
- cinnamon (requires a lot - biggest problem is people like to add sugar)
188
pain
an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described as such
189
pain is
what the patient says it is
multidimensional, sensory, psychosocial, emotional, personal, and spiritual
categorized as acute or chronic/persistent
190
pain is reported by more
men than women
191
decrease in density of both myelinated and unmyelinated nerve fibers
delaying sensation of pain from the periphery and there is slower resolution once triggered
192
pain with cognitive impairments in older adults
- consistently untreated or undertreated
- receive less meds, even when they experience the same acutely painful events
- providing comfort (careful observation of behavior, watch for changes/pain cues, give attention to caregiver)
193
iatrogenic disturbances pain (IDP)
be aware of pain that can be caused by those caring for the older adult (moving them, turning, etc.)
194
pain assessment
- pain diary
- OLD CART
- coexisting depression and anxiety
195
non-pharmacological pain interventions
```
heat/cold
TENS
acupuncture/acupressure
relaxation, meditation, guided imagery
music
activity
cognitive-behavioral therapy
```
196
pharmacological pain interventions
- erase the "memory of pain"
- ATC
- PRN for breakthrough pain
- start low, go slow, but go
- pain control choices: non-opioid, opioid, other
197
pain effectiveness evaluation
- qualitatively measured (repeat intensity scale)
- qualitative observations
- adjust interventions
