- will help strengthen pelvic floor and reduce incontinence symptoms

Exam 1 Flashcards by Sydnie Reynolds

Interventions to prevent fall risk

clean/ organized room
adequate lighting
no carpets

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IADLS

Requires both physical & cognitive performance — 45-50% of >85 can
still do
– Using telephone, shopping, housekeeping, laundry, handling
medications, handling finances

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ADLS

The last to go, self care activities
– Toileting, bathing, dressing, feeding, continence

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Describe why clinical decision making is complex in older adults

Presence of Multiple Comorbidities
Polypharmacy
Age-Related Physiological Changes
Cognitive and Functional Decline
Social and Emotional Factors

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ADL vs IADL

ADLs are everyday activities and the last to go
IADLS require physical and cognitive performance

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TUG test

-this assesses patients mobility
-patient sits in chair and gets up and walks to designated line turns and returns to chair
-the line is 3 meters (10 feet) away from chair
-pt who takes 12 or more seconds is at high risk for falling, reduced functional mobility, and potential need for intervention

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new onset or increased number or falls

think medication or infection

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Home Assessment for falls

-Poor lighting
* Excessive equipment
* Poorly fitting shoes
* Wet floors
* Loose carpets
* Unfamiliar surroundings
-medications

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Oxybutynin

-a muscarinic antagonist (anticholinergic medication) primarily used to treat overactive bladder (OAB) by reducing bladder spasms and urinary urgency
-Increases bladder capacity and decreases urgency.
- Anticholinergic Side Effects ( dry mouth, urinary retention)

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Kegels/ Pelvic Floor

will help strengthen pelvic floor and reduce incontinence symptoms

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Topical estrogen

It helps strengthen and rejuvenate the urogenital tissues, which weaken due to estrogen decline after menopause.
Improves Urethral and Vaginal Tissue Health

Strengthens thinning vaginal and urethral tissues, reducing urinary urgency and leakage.
Increases blood flow and collagen production, improving elasticity and function.
Reduces Urge and Stress Incontinence

Helps the urethra close more effectively, reducing involuntary leakage.
Can improve overactive bladder symptoms by enhancing bladder control.
Prevents Urinary Tract Infections (UTIs)

Restores the natural vaginal microbiome, reducing harmful bacteria growth.
Enhances mucosal immunity, lowering the risk of recurrent UTIs.

-not for pts with breast cancer history

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issues associated with incontinence

fall and injuries
UTI- not fully emptying the bladder can cause infection
skin issues and infections
psychological and social impact

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Causes of Delirium

Infections (UTI, Pneumonia, sepsis)
Medication Changes (opioids, benzos, anticholinergic)
Electrolyte Imbalances (hypoatreima, dehydration)
Hypoxia, pain, sensory deprivation (hearing/vision loss)
Hospitalization (ICU, anesthesia, new environment)

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Recognize Delirium

Acute onset & fluctuating course → Sudden change in mental state, worse at night
Inattention → Difficulty focusing, easily distracted
Disorganized thinking → Rambling speech, illogical thoughts
Altered level of consciousness → Hyperactive (agitated), hypoactive (lethargic), or mixed

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Intervention & Management of Delirium

Perform lab tests → Electrolytes, kidney function, infection screening (UTI, pneumonia), oxygen levels
Review medications → Discontinue or adjust sedatives, anticholinergics, opioids
Treat infections → Start antibiotics if needed
Correct dehydration & electrolyte imbalances

Reorient & provide a familiar environment → Clocks, calendars, familiar objects
Optimize sensory input → Ensure hearing aids, glasses are used
Encourage mobility → Prevent prolonged bedrest to avoid complications
Normalize sleep-wake cycles → Avoid unnecessary nighttime disturbances
Minimize restraints & sedation → Can worsen agitation and confusion

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polypharmacy

more medications are being used than clinically needed or more pills than the patient can take
this can be noticed in new or worsening symptoms, multiple drs or pharmacists, duplicate meds, non-adherence

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How to reduce problems associated with polypharmacy

conduct regular medication reviews
use non-pharmacological alternatives if possible
deprescribing
medication regimen (combining meds or less dose)
improved communication

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Issues related to safe drug therapy in older adults

Pharmacokinetic Changes (How the Body Handles Drugs)
Pharmacodynamic Changes (How the Body Responds to Drugs)
Adverse Drug Reactions (ADRs) & Toxicity
Inappropriate Prescribing (Beers Criteria)
Medication Non-Adherence

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MOST COMMON ADVERSE EFFECTS OF DRUG-DRUG
INTERACTIONS

Confusion
Cognitive impairment
Arterial hypotension
Acute renal failure

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Aging Affects on drug therapy

Absorption: Slightly slowed gastric emptying
-Minimal impact, but may delay onset of action for some drugs
Distribution: ↑ Body fat, ↓ total body water, ↓ serum albumin Fat-soluble drugs (e.g., benzodiazepines) accumulate → prolonged effects; Water-soluble drugs (e.g., digoxin) reach higher concentrations
Metabolism (Liver): ↓ Liver enzyme activity and blood flow, Drugs metabolized by the liver (e.g., warfarin, benzodiazepines) have prolonged effects → ↑ risk of toxicity
Excretion (Kidneys): ↓ Glomerular filtration rate (GFR) and renal clearance, Drugs eliminated by the kidneys (e.g., aminoglycosides, NSAIDs, digoxin) accumulate → ↑ risk of toxicity

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Kegel

Instruct to tighten pelvic muscles as if stopping urination, hold 3-5 seconds, relax, repeat 10-15x/day

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High Risk Drug Classes In Older Adults (Beers List)

Anticholinergic (Benadryll, oxybutynin) -> Confusion, falls, urinary retention)
Benzodiazepines (lorazepam, diazepam)-> Sedation, fall risk, respiratory depression
opioids-> respiratory depression, constipation, falls
NSAIDS-> GI bleeding, kidney damage

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Medication Reconciliation

performed at every transition of care to prevent adverse drug events
-compare old/new medication lists, educate patients

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Frailty

a state of increased vulnerability to illness, falls, and functional decline

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frailty assessment

Unintentional weight loss (>10lbs in a year) Exhaustion, weakness, slow walking speed, low physical activity s/s: frequent falls, cognitive decline, poor wound healing

factors that affect frailty

age, chronic disease, medications, and social support

Impact of Chronic Disease

financial: increased healthcare costs, medications, caregiver burden emotional: depression, anxiety, and isolation

Health Literacy Principles

Use plain language, large print, teach-back method Assess understanding frequently

UTI S/S

confusion, incontinence, fever, urgency, dysuria

UTI Nursing Prevention

encourage hydration proper peri care complete bladder emptying

Benign Prostatic Hyperplasia

risk factors: aging, family, history, obesity findings: urgency, weak stream, nocturia dx: PSA test, digital rectal exam

PSA Test (BPH)

A blood test that measures the level of prostate-specific antigen (PSA) in the blood

BPH Medications

Alpha-blockers (Tamsulosin/ Flomax, Hytrin): relax bladder neck and prostate muscles -Tamsulosin (Flomax) is prostate-selective and has fewer BP effects than terazosin (Hytrin). -Watch for dizziness, orthostatic hypotension, and retrograde ejaculation. -Combination therapy with 5-ARIs (finasteride) may be needed for long-term prostate size reduction.

3 Way Foley Irrigation

Used post-TURP to prevent clotting -to continuously flush the bladder with sterile fluid, typically saline, through a special catheter with three lumens, allowing for simultaneous drainage of urine while preventing the buildup of blood clots or debris that can occur after prostate surgery or procedures like a Transurethral Resection of the Prostate (TURP) where tissue fragments may be present

Parkinson's Disease Hallmark Symptoms

bradykinesia (slow movement), resting tremors, rigidity, postural instability

Parkinson Gaits

shuffling** festinating freezing episodes

Parkinsons Affecting QOL

difficulty eating, dressing, swallowing, increased fall risk

Nursing Interventions for Parkinsons Disease

Encourage exercise , fall prevention, nutrition support, speech therapy monitor for dysphagia, aspiration risk, orthostatic hypotension

Parkinsons Medication

Levodopa/ Carbidopa (Sinemet): Dopamine replacement side effects: dyskinesia (jerky movements), hallucinations COMT Inhibitors (Entacapone) Prolongs Levodopa action

What are 6 examples of IADLs?

using telephone, shopping, housekeeping, laundry, handling meds, handling finances

The TUG test should take less than _______________ to complete; any longer and the patient is considered high-risk of falling

12 seconds

orthostatic hypotension is defined as a reduction of greater than ____________ mm Hg systolic or ________________ mm Hg diastolic blood pressure, ________ minutes after changing from lying to standing position

20; 10; 3

What is a considered a renal dose?

half of a normal dose

What criteria are considered to be used for diagnosis of frailty (6 total criteria; 3 of these to be considered frail)

unplanned weight loss, exhaustion, weakness, poor endurance, slowness, and low levels of physical activity

Tamsulosin should be taken _____________ which Doxazosin should be taken ________________

30 mins after meal; same time each day

_____________ decreases how much ____________ is converted to dopamine, allowing for more drug availability and less side effects

carbidopa; levodopa

Levodopa is best absorbed on an empty stomach so it should be taken _________ before or _____________ after a meal; protein intake should be _____________

1 hour; 2 hours; limited

What are the 4 side effects of anticholinergics?

urinary retention, dry mouth, blurred vision, and constipation

What are 2 adverse effects of dopamine agonists?

hypotension and decreased LOC

dopamine agonists

these Parkinson's drugs stimulate the production of dopamine or they stimulate the dopamine receptors in the brain by acting like dopamine; can be used as rescue drugs for off times

3 way Foley irrigation colors

day 1- bright red day 2- pink day 7- amber

What are the 2 side effects of COMT inhibitors?

nausea and hypotension

foods with ____________ should not be consumed when taking MAOIs

tyramine

delirium is assessed using

confusion assessment method

4 components of med list

name, dose, frequency, route

BPH causes what incontinence

overflow

What scale is used for polypharmacy

armor scale

Armor Scale

Assess Review Minimize Optimize Reassess

Couda

Catheter used for urinary in men with BPH

this is considered the most difficult symptom of BPH

nocturia

These 2 meds are alpha1-adrenergic antagonists that decrease smoot muscle tone to help treat BPH

Tamsulosin and Doxazosin

___________ and __________ should be monitored when taking alpha1-adrenergic antagonists (BPH Medication)

BP and LOC

the use of alpha1-adrenergic antagonists is contraindicated with __________________

renal and liver impairment

finasteride should not be taken with __________________

liver impairment

________________ should not handle finasteride due to possible absorption

pregnant women

when taking finasteride, the man cannot ________________ until 1 month after use

donate blood

it could take _______________ to see benefit from taking finasteride

6 months

This is a phosphodiesterase-5 inhibitor used to treat BPH

Sildenafil (Viagra)

sildenafil (Viagra) can cause ________________ and can affect ______________

MI/sudden death; hearing

when taking Sildenafil, no NTG/QT prolongation/grapefruit juice/PDE5 inhibitors due to the risk of ________________

fatal hypotension

this is an OTC herb that is commonly used to treat BPH but has not been proven to work

Saw palmetto

this is a common finding after TURP

hematuria

this is a tense resistance, creating stop and go movements

Cogwheel rigidity

Exam 1 Flashcards

(73 cards)