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Adult care 2 > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Describe why clinical decision making=complex in older adults

A

-Vague s/s w/ illness
-Tendency to disregard as “normal” in aging
-don’t complain due to concern of being a burden
-communication deficits
-multifaceted conditions

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2
Q

what are the geriatric syndromes?

A

IFFCUPD
Immobility, frailty, falls, constipation, urinary incontinence, polypharmacy, delirium

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3
Q

Difference between IADL’s and ADL’s

A

IADL= physical and cognitive performance required, first to go, higher LOC and ability needed
ADL= last to go, self care activities

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4
Q

Examples of ADL’s

A

Brushing teeth, bathing, toileting, dressing

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5
Q

Examples of IADL’s

A

Grocery shopping, managing finances/medications, housekeeping

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6
Q

How does the loss of ADL’s affect an older adult’s care?

A

It increases their dependence, which can lead to a decline in autonomy and condition

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7
Q

How does the loss of IADL’s affect an older adult’s care?

A

Loss of autonomy, independence

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8
Q

Normal aging changes for older adults

A

Decline in speed, decrease in stride, slower bowel sounds, decreased appetite/thirst, kidney function decreases, decreased bladder capacity, high frequency hearing loss, breathing capacity decreases, gray hair and wrinkles, decreased skin elasticity and strength, body fat increases in trunk

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9
Q

Abnormal aging changes for older adults

A

TUG of 12 or greater, anxiety/depression, malnutrition (dysphagia), insomnia, hypersomnia, pressure ulcers, falls, delirium

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10
Q

Interventions to prevent/decrease fall risks

A

Ensure clutter free environment, good walking shoes, proper use of assistive devices, evaluate meds for adverse effects causing immobility, treat and manage conditions causing immobility (PT)

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11
Q

Describe get up and go test (TUG)

A

Have a pt sit in a chair, stand up, walk forward 10 feet, turn around, walk back to the chair, and sit down again. This must happen in less than 12 sec. Observe gait, stride, postural stability, sway, and balance

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12
Q

What does it mean if a client cannot complete the TUG in less than 12 sec?

A

Higher risk for falling

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13
Q

What are the types of gaits?

A

Hemiplegic, parkinsonian, cerebellar/ataxic, stomping/stamping, diplegic/CP, myopathic/“waddling“, neuropathic/“steppage”, choreiform

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14
Q

Choreiform gait

A

Writhing movements, random involuntary

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15
Q

Steppage/neuropathic gait

A

Equine gait, can’t step forward without tripping because dorsi flex=weak, so have to bring knee up high and kick leg out

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16
Q

Stomping/stamping gait

A

Lack of proprioception- relies on visual cues to know that foot has hit the floor. Stomps for vibrations to be obvious through the foot, more prominent in the dark

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17
Q

myopathic/“waddling” gait

A

Pelvis not stable to bear weight when taking step-lean trunk to compensate to other side-waddling gait

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18
Q

Diplegic/CP gait

A

Extensor spasm, walking in tip toes, some circumduction and a abductor spasm keeping feet close together, arms flexed, scissors gait

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19
Q

Parkinsonian gait

A

General flexion(every joint), small shuffles, tremor associated with gait

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20
Q

Cerebellar gait

A

Broad stance, wide staggering falling forward and to one direction, trunk sways when standing still

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21
Q

hemiplegic gait

A

Hand flexed to chest(may not be if mild), unilateral circumduction of foot when walking forward, arms do not both swing/ arm does not swing normally. Flexion and extensor hypertonia, foot drop

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22
Q

How does immobility affect overall levels of care (older adult)

A

Unable to care for self, relies on family/support (a lot of pressure/burnout), loss of independence, refusal to accept need help, adherence= low, poor outcomes=high

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23
Q

Factors to consider when assessing the home for falls

A

Rugs, lights, handrails, pets (running around/under feet), alone?, appropriate footwear, gait change, activity level

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24
Q

Constipation

A

“Infrequent, incomplete, or painful evacuation of feces for three days or more”

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25
Medications to help manage constipation
Hyperosmolar agents, prokinetic agents(not recommended for elderly)
26
Polyethylene glycol class
Hyperosmolar agent, non addictive
27
Stool softeners
Colace, docusate sodium
28
When to take a laxative
Last resort- do not want to use stimulants first, do not want to become dependent. Hypoactive bowel sounds, no BM within 3 days
29
Water intake and its role in constipation
Inc water=dec constipation, absorbs into feces, softening form; inc fluid in colon leads to inc in peristalsis
30
Stimulant (constipation)
GoLytely, Bisacodyl, Senna Stimulates intestinal peristalsis and inc volume of water&electrolytes in intestines
31
Polyethylene glycol
Miralax, osmotic that draws water into intestine to inc mass of stool=peristalsis, contraindicated in HF and Bowel obstruction
32
Stool softener
Docusate sodium, colace Lowers surface tension of stool to allow water in, typically for softening fecal impact ion
33
Management of Urge incontinence
Initial: Kegels/PFT Treat UTI, atrophic vaginitis, meds to reduce tone of bladder, scheduled voiding for pts with cognitive deficits
34
Management of stress incontinence
Kegels/PFT -tx atrophic vaginitis -insertion of pessary -toileting/fluid regimen -surgery- A&P repair, bladder sling
35
Management of overflow bladder incontinence
Med review -bladder retraining -reverse cause Improve glucose readings, reduce ETOH, catheterization
36
Management of functional incontinence
Remove barriers for BR use Pictures on BR door Improve mobility with PT/OT
37
Meds to reduce tone of bladder- Urge incontinence
Tricyclic agents- Imipramine Tolterodine, darifenacin, solifenacin, oxybutynin Scheduled voiding for pts with cognitive deficits
38
What are the concerns for oxybutynin for older adult?
Vasodilation(spasticity med, relaxes muscles)- orthostatic hypotension
39
Kegels/pelvic floor
Most notice positive change after 6 weeks, 10 times daily, tighten pelvic muscle for 10 sec then release-do this 15X (lying,sitting, standing)
40
Oxybutynin
Medication for BPH and overactive bladder w/ urge frequency/incontinence; decreases detrusor muscle contractions
41
Topical estrogen
Hormone Tx for overactive bladder, atrophic vaginitis, stress incontinenece
42
Why do older adults become acutely confused and how do we recognize and intervene appropriately?
Infection, medication change, trauma (hospital stressors), surgeries=#1 -short term and reversible Assess with CAM
43
How to administer CAM
Confusion assessment method 1. Acute onset form baseline 2a. Inattention 2b. If present, did it fluctuate? 3. Disorganized thinking (rambling, incoherent, unpredictable) 4. Altered LOC(alert,lethargic, vigilant, coma) 5. Disorientation 6. Memory impair 7. Perceptually disturbed (hallucinations and illusions) 8a. Psychomotor agitation (inc level of motor activity, restlessness,picking) 8b. Psychomotor retardation (dec level of motor activity, sluggish/slow moving, staring into space) 9. Altered sleep/wake
44
What makes the CAM positive
Presence of 1 and 2 and either 3 or 4
45
Interventions for delirium
Resolve cause if possible (treat infection, rehydrate, reorient, keep awake during day to sleep at night to reset sleep cycle) -start low and go slow with medications, encourage family members to be there (easier to reorient)
46
Polypharmacy
When a pt is on multiple medicines- or more of the same meds in diff forms- and on more than clinically needed
47
Beer’s list
list of medications not safe for older adults >81mg aspirin, dabigatran (inc risk bleeding), drugs that eliminate through kidney, drugs with high first pass effect, drugs with low therapeutic ranges -Anticholinergics, opioids, antihistamines
48
Ways to decrease problems of multiple drugs
Med rec
49
What classes of drugs were mentioned in class as a major problem for older adults
Anticholinergics, narcotics, antihistamines
50
Specific drugs mentioned in class as major problems for older adults
Anticholinergics Opioids Antihistamines
51
Issues with safe drug therapy for older adults
Routine adherence, remembering if they took them or not, understanding dosages/ timing, obtaining refills, polypharmacy
52
Interactions of normal aging and responses to drug therapy in older people
smaller therapeutic index, metabolism=slower--> takes less amt of drug for a therapeutic response. start low and go slow
53
Frailty
Progressive physiological decline of multiple Body systems Causes: older adult w/ chronic illness, loss of organ function, poverty, social isolation 3,2,1 Method
54
Assessment for frailty; how to assess when there isn’t a “tool”
Presence of 3 or more co-morbid conditions, needs assistance with 2 ADL’s, Dx of one geriatric syndrome Assess ADL’s and IADL’s, nutrition, and fall risk
55
Co-morbid conditions criteria for frailty-LUWEPS
-Unplanned weight loss -Exhaustion -Weakness -Poor endurance -Slowness -Low levels of physical -activity
56
Acronyms for frailty
SPICES and PULSES
57
SPICES- frailty
S-sleep disorders P- problems with eating I- incontinence C- Confusion E- Evidence of falls S- skin breakdown
58
PULSES-frailty
P-physical condition U-Upper limb function L-lower limb function S- sensory components E-excretory components S-support factors | P for Physical
59
Factors of frailty
Dependency, injury, institutionalization, falls, hospitalization, rapid decline, mortality
60
Impact of chronic disease for older adults
Prevention=important Once disease occurs-focus: -Managing s/s -avoiding complications -avoiding acute illness -promoting health -maintaining functional status -psychological adjustments to physically accommodate disabilities -social isolation
61
Assessment of pts with chronic diseases
-Identify specific problems -Establish/priortize goals - define plan of action to achieve desired outcome -implement plan: adhere to regimens, keep illness stable, psychosocial issues -follow up,evaluate outcomes
62
Characteristics of chronic disease
Med conditions/health problems w/ associated s/s—>long term management -conditions that do not resolve or for which complete cures are rare -managing chronic illness involves more than treating med problems -diff phases over person’s lifetime that they must adapt to -persistent adherence to therapeutic regimens -one chronic disease can lead to another developing -effect more than just pt -self-management required
63
most important intervention for chronic illnesses in older adults
Prevention! Diet, exercise (150minweek), no smoking, alcohol use effects physical and emotiona
64
Once chronic illness occurs in older adult…
Managing s/s, avoiding complications, avoiding acute illness, promoting health, maintaining functional status
65
Health literacy principles for older adults
Assess knowledge by asking them to explain their condition/ medication purpose Ask about their perspective of illness/condition Clear communication with explanation
66
Most common s/s UTI older adults
Confusion, delirium, falls, sudden onset, fever, tachycardia, hypotension
67
Nursing interventions to reduce reoccurrence older adult UTI
-Drink 2-3L fluids/day -encourage rest and nutrition -clean front to back -avoid douches, scented lube, bubble baths, tight-fitting underwear, scented toilet paper -empty bladder before and after intercourse -do not delay urination -cranberry juice/supplements
68
Benign prostatic Hyperplasia
Enlarged prostate, obstructs urethra and urine flow; overflow incontinence; if persists, urine backflow in ureters and kidneys-kidney damage
69
Risk factors for Benign Prostatic Hyperplasia BPH
-Increase in age (men >80 yrs) -smoking, chronic alcohol use -sedentary lifestyle, obesity -high fat, protein, carb diet, low fiber -DM, CV disease
70
Expected findings for BPH
Straining to urinate Hesitancy Dec force of stream Frequency Incomplete emptying Dribbling Urgency Hematuria Nocturia (“most difficult symptom”)—> why most seek tx -cannot start urine flow or maintain stream
71
Lab tests and other diagnostics for BPH
PSA- rule out prostate cancer(elevated=cancer) DRE- reveal enlarged, smooth prostate UA- WBCs and bacteria CBC- RBC count BUN/creatinine- elevated=kidney damage Transrectal US w/ needle aspiration
72
Medications to re-establish uninhibited urine flow
Tamsulosin/Flomax, Terazosin/Hytrin, Finasteride, Sildenafil, saw palmetto
73
Alpha-blocking agents for establishing uninhibited urine flow
Tamsulosin, Terazosin(Hytrin)
74
Hytrin
Dec. Smooth muscle tone, relaxation of bladder and prostate gland Complications=hypotension , dec/failed ejaculate -Contraindicated in liver and renal impairment ; should not be used before cataract surgery
75
Tamsulosin
Dec smooth muscle tone (non selective=vasodilation) - Complications=hypotension, dec/failed ejaculate -Contraindicated in liver and renal impairment -30 min after meal, same time each day -monitor LOC and BP should not be used before cataract surgery
76
3 way foley irrigation (BPH)
Ensure continuous flow, no kinks in tubing. TURP—> hemorrhage=biggest risk to evaluate for Monitor for blood and clots-> bleeding bladder spasms=bleeding, trying to clot Bleeding=irrigation to prevent blockage from clots
77
Non-pharmacological interventions for BPH
Limit caffeine ETOH, table salt, spicy foods, fluids after dinner -reg voiding schedule - lose weight, inc exercise
78
When is drug therapy started for BPH?
S/s affect QOL or significant outlet obstruction present (Tamsulosin=safer) -prevent permanent bladder dysfunction and renal insufficiency
79
What are the concerns r/t nutrition in older adult?
Low sodium, dec absorption of mult vitamins, inc risk for osteoporosis, dec lean muscle mass, caloric intake, weight loss, malnutrition, dehydration
80
Interventions to help w/ older adult appetite?
List foods they enjoy, flavored with salt or sweet
81
What labs do we use to monitor the older adult’s nutrition?
CMP, BMP,CBC
82
Hallmark symptoms- Parkinson’s disease
Tremor, Parkinsonian gait(shuffling steps, flexed joints, tremor), stooped posture, forward tilt of trunk, mask-like face, drooling, rigidity, pill roll tremor, bradykinesia
83
How/when do Parkinson’s disease s/s present?
Early 60s-80s Progression over 20 years
84
What gaits are present? (Parkinson’s)
parkinsonian (propulsive) gait, bradykinesia, freeze periods
85
How does gait and s/s affect the PD patient’s QOL?
Decrease in independence, mobility, and functionality—> overall health decline
86
Major concerns with caring for the PD patient in all stages of the disease
Safety, medication adherence/education, independence, nutrition, frailty
87
Interventions that the nurse should use for caring for Parkinson’s pts
-Daily exercise, ROM, postural exercise -Warm baths -Environmental modifications for self care -Inc fluids, moderate fiber foods, regular bowel program -monitor weight, extra feedings, high calorie, high protein diet -monitor skin (inc risk for melanoma) -family teaching
88
Challenges with medication management (Parkinson’s)
Levodopa- more side effects over time- side effects Sinemet/Parcopa(levodopa-carbidopa)-cant eat within 2 hrs Protein heavy meals limits drug absorption and utilization Best absorbed on empty stomach (1 hr before OR 2 hrs after)
89
Medication Classes (Parkinson’s)
Anticholinergics(artane, Cogentin) Dopamine Agonists Catechol-O-Methyltransfrese (COMT) Inhibitors
90
Dopamine replacement/ enhancement drugs (Parkinson’s)
Levodopa, Sinemet/Parcopa (Levodopa & Carbidopa Combined) Used BEFORE or WITH Levodopa High risk of hypotension and dec LOC “Rescue” drug for off times
91
COMT inhibitors (Parkinson’s)
Inc duration of Sinemet-blocks enzyme breaks down levodopa NO effect on PD symptoms ALONE N/hypotension=S/E entacapone, tolcapone
92
Interventions to decrease postural hypotension
Ankle pumps, HOB elevated, dec contributing medications, pressure stockings, teaching pt to get up/change position slowly
93
Artane/Cogentin
anticholinergic Help control tremor and rigidity by counteracting acetylcholine (blocks cholinergic receptors) Very risky- urinary retention, dry mouth, blurred vision, constipation
94
What is the ARMOR scale?
Used on LTC pt, improve med adherence and reduce ADEs (adverse drug events)
95
ARMOR
Assess, Review, Minimize, Optimize, Reassess
96
What is the A in armor?
Assess: What meds they are on
97
R in ARMOR
Review: Drug-drug, drug-disease, and adverse drug reactions
98
M in ARMOR
Minimize: Number of meds according to functional status rather than evidence-based medicine
99
O in ARMOR
Optimize: For renal/hepatic clearance,PT/PTT,etc
100
Second R in ARMOR?
Reassess: Functional/cognitive status in 1 week and as needed -clinical status and medication compliance
101
Finasteride
dec the breakdown of testosterone->shrinks prostate (Tx for BPH) S/E: dec libido, gynecomastia, impotence, ORTHOSTATIC HYPOTENSION, caution with liver disease pts
102
Tamsulosin
alpha blocker Relaxes smooth muscles S/E: hypotension, dizziness, nasal congestion, sleepiness, faintness, problems with ejaculation, floppy iris syndrome Contraindicated in severe liver failure Take after meals

Adult care 2 (5 decks)

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