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1

asthma in older adult

  • restlessness and confusion - early signs of hypoxia
  • proper administration of inhalers
  • monitor for side effects - based on drug tier
  • prevent attacks
    • smoking cessation
    • identify/avoid allergens
  • prevent respiratory infection
    • influenza vaccine and pneumovax
    • good hand washing
    • avoid crowds, particularly October-March

2

diagnostics for dementia

  • thorough Hx - inattention/memory problems
    • screen for depression
    • hypothyroidism
    • vit B12 deficiency
    • syphilis
  • vascular dementia
    • lesions on CT scan 

3

normal SaO2

95%

4

symptoms of respiratory alkalosis

  • seizures
  • deep, rapid breathing
  • hyperventilation
  • tachycardia
  • decreased/normal BP
  • hypokalemia
  • numb, tingling extremities
  • lethargy & confusion
  • light headedness
  • N/V

5

emergent phase of burn management

  • immediate life threatening problems
  • lasts up to 72 hours from time of occurence
  • concerns
    • hypovolemic shock - relative shock d/t increase cap permeability - aggressive fluid resuscitation
    • edema
    • pulmonary damage - trach intubation
    • hyperkalemia - cell destruction
    • acute tubular necrosis - volume loss, K+, myoglobin - can clog renal tubules
  • how do we know we are out of this stage?
    • fluid mobilization and diuresis occurs

6

dementia overview

  • dysfunction or loss of memory, orientation, attention, language, judgment and reasoning
    • possibly personality changes and behavioral problems
  • diagnosed when 2+ functions are impaired
  • not a normal part of aging
  • 15% of older adults have dementia

7

nutritional therapy r/t burns

  • aggressive support
    • decrease mortality risk and complications
    • optimize wound healing
    • minimize effects of hypermetabolism and catabolism
  • enteral feedings if not able to PO
    • begin slowly (slowed GI motility)
    • calorie counting (30-35 kcal/kg/day)
    • nutritional supplements (vitamins)

8

abnormal PaO2 levels

  • mild: 60-79
  • moderaet: 40-59
  • severe: <40

9

stroke volume

  • amount of blood ejected with each ventricular stroke
  • 60-100 ml

10

focus of a comprehensive geriatric assessment

  • health history
    • meds (prescribed, OTC, vitamins, laxatives, herbal)
    • functional assessment (ADLs)
    • social assessment
    • advance directives
    • review of systems
  • physical exam including mental status and mood
  • evidence-based screening/assessment tools

11

biologic aging

  • senescence
  • progressive loss of function

12

pharmacological management of HF

  • ACE inhibitors
  • beta blockers
  • diuretics
  • digoxin
  • spironolactone 

13

if Mantoux or IGRA is +

  • anterior and poster CXR
  • sputum smear
    • + acid-fast bacilli indicates TB
  • sputum culture
    • definitive diagnosis for active TB

14

characteristics of delirium

  • hyper-, hypoactive or mixed
  • develops over 2-3 days
    • inability to concentrate
    • insomnia
    • loss of appetite
    • restlessness
    • confusion
  • later - agitation, misperception, misinterpretation, hallucinations 

15

unstageable pressure ulcer

  • full-thickness tissue loss
  • base of wound completely covered by slough or eschar
  • cannot determine stage of ulcer until slough or eschar is removed
    • most likely 3 or 4 underneath

16

Geriatric Depression Scale (GDS)

  • 30 items
  • "0" or "1" for each item
  • further assessment if >10
  • only a screening tool

17

reassessing restraints

  • document need
  • proper provider order and documentation
  • what does the patient need?
    • pain? toilet?
  • alternatives
    • low bed
    • bed alarm
    • activity apron
    • sitters

18

damage or error theories of aging

  • wear and tear theory - cells/tissues lose functionality
  • free radicals theory - damage to cell resulting in accumulated damage causing cells to stop functioning
    • reactive oxygen species (ROS) - most important enzyme/gene pathway responsible for development of cell aging
  • somatic DNA damage theory - DNA damage occurs continously in cells - some damage accumulates

19

contractions

excessive fibrous tissue formation causing shortening of muscle

20

Stage B HF

structural HD but w/o S/Sx of HF

21

conditions associated with depression

  • dementia
  • arthritis
  • cancer
  • heart disease
  • Parkinson's disease
  • stroke
  • thyroid disorders

22

pneumonia overview

  • acute infection of lung parenchyma
    • when defense mechanisms incompetent
    • overwhelmed virulence
  • causes
    • bacteria, virus, mycoplasma, fungi, parasites, chemicals
  • obstruction of bronchioles
    • decreased gas exchange (ventilation)
    • increased exudate

23

predisposing risk factors for delirium

  • age over 85
  • dementia
  • severe illness
  • multiple co-morbidities
  • alcoholism
  • sensory impairment
  • hx of delirium 

24

initial pH in ABG interpretation

  • acid side of normal: 7.35-7.40
  • basic side of normal: 7.41-7.45
  • compensatory mechanisms are occuring

25

hyperbaric oxygen therapy

  • stimulates angiogenesis and promotes wound healing
  • oxygen at 1.5-3X normal atmospheric pressure
  • facilitates oxygen perfusion

26

aneurysm nursing care

  • prevent rupture - early detection, prompt tx
  • conservative therapy
    • small asymptomatic 
    • risk factor modification and monitor sixe
    • drugs: beta blockers, antibiotics may slow growth
  • surgical
    • large or high risk of rupture
    • open aneurysm repair or endovascular aneurysm repair
    • complications: endoleak; growth/migration; aneurysm rupture or aortic dissection; thrombosis; infection
  • acute intervention
    • pre-op and post-op care

27

adhesions

bands of scar tissue that form between or around organs

28

implantable cardioverter-defribillator

primary prevention of sudden cardiac death to reduce mortality in nonischemic cardiomyopathy or ischemic heart disease 40 days post MI with LVEF <35% or NYHA class II-III survivial for 1+ year

29

pulmonary hypertension groups

  1. pulmonary arterial hypertension (PAH)
  2. pulmonary HTN r/t L side heart dx
    1. atrial/ventricular dx
    2. valvular dx
  3. pulmonary HTN r/t lung disease or hypoxemia
    1. COPD, interstitial lung dx
    2. sleep-dx breathing, alveolar hypoventilation
    3. chronic high altitude exposure
  4. pulmonary hTN r/t chronic thrombotic/embolic dx
    1. PE in proximal or distal pulm arteries
    2. embolization of other matter
  5. pulmonary HTN with multifactorial mechanisms
    1. chronic hemolytic anema; sarcoidosis 

30

acute phase of burn management

  • mobilization of extracellular fluid
  • diuresis
  • emotional support
  • electrolyte balance
    • sodium imbalances
      • hyponatremia - mobilization of fluids
      • hypernatremia - if fluid resuscitation occurred w/ hypertonic solution (also tube feedings and inappropriate fluid administration)
    • potassium
      • hypokalemia - fluids w/o potassium 
  • wound care

31

MMSE

mini-mental state examination

  • memory - register/recall 3 objects after 5 min
  • language - name pencil & watch; read sentence and follow directions
  • visuospatial function - copy intersecting pentagons
  • attention/calculation/executive fxn - WORLD backwards

32

signs of low perfusion

  • cool/cold skin
  • bluish color
  • delayed cap refill
  • weak/absent pulses
  • worse with activity 

33

Stage C HF recommendations

  • ACE inhibitor or ARB and beta blocker
  • diuretic for fluid overload in NYHA II-IV
  • hydral  nitrates for persistently symptomatic A.A. patients III-IV
  • aldosterone management for NYHA II-IV if createinin >30 ml/min and K+ <5.0 mEq/dL

34

pneumonia complications

  • pleurisy - inflammation of pleura
  • pleural effusions - fluid in pleural space
  • atelectasis - collapsed/airless alveoli
  • bacteremia - bacterial blood infection
  • empyema - purpulent/puss exudate in pleural cavity
  • pericarditis - inflammation of heart lining
  • meningitis - inflammation of meninges
  • sepsis - bacteria seed from lungs
  • acute respiratory failure - severe pneumonia
  • pneumothorax

35

RSV diagnosis and management

  • diagnosis: nasal swab, sputum sample, bronchi alveolar lavage
  • symptom driven supportive care
    • antipyretics
    • IV fluids - mobilize secretions
    • supplemental oxygen
  • corticosteroids and bronchodilators - for airway inflammation and bronchospasm
  • monitor for superimposed bacterial infection
  • monitor for respiratory distress/failure
  • hand washing

36

VTE risk factors

  • Virchow's triad
    • endothelial injury
    • venous stasis
    • hypercoagulability
  • female, oral contraceptive of hormone therapy use
  • smoking, family hx
  • long distance travel
  • hx of CVI, SVT, or VTE
  • bed rest

37

PHQ-2 and PHQ-9

  • screening and diagnostic
  • validated in various clinical areas with variety of patient populations
  • PHQ-2 (first two questions of PHQ-9)

38

peripheral artery disease overview

  • thickening of arterial walls resulting in progressive narrowing of arteries
  • symptoms occur at 60-75% occlusion
  • atherosclerotic (leading cause of PAD)
  • aneurysmal
  • non-atherosclerotic 

39

pathophysiologies of PVD

  • clogged = atherosclerosis
  • broken = aneurysm
  • blocked = thrombosis/embolism 

40

varicose veins

  • dilated, tortuous subcutaneous veins in saphenous vein system r/t increased venous pressure
  • primary or secondary
  • reticular veins
    • small, flat, blue-green and less tortuous
  • telangiectasias
    • spider veins
    • small visible vessels that are bluish black, purple, red

41

wound classification

  • etiology important to classify
  • depth or level of tissue destruction
    • superficial - involves epidermis
    • partial-thickness - extends into dermis
    • full-thickness - extends past dermis
      • affects subcutaneous, muscle, bone layers
  • color
    • red
    • yellow
    • black

42

diagnostic studies of influenza

  • H&P
  • clinical manifestations
  • local outbreaks
  • rapid flu test
    • nasal swab - 48 hours on onset
  • viral cultures = gold standard
    • 3-10 days for results

43

emphysema overview

  • abnormal permanent enlargement of the air spaces distal to the terminal bronchioles
  • accomipanied by destruction of their walls and w/o obvious fibrosis 

44

SVT clinical manifestations

  • palpable, firm, cordlike vein
  • surrounding area may be
    • itchy
    • tender, painful to touch
    • reddened, warm
    • extremity edema

45

influenza clinical manifestations

  • fever
  • chills
  • cough
  • sore throat
  • runny/stuffy nose
  • muscle, body aches
  • headaches
  • fatigue
  • vomiting, diarrhea (children)

46

Medicare overview

  • CMS
  • federally-funded
    • 65 or older, disabled; ESRD
  • rules change all the time
  • annual enrollment

47

chronic phase of Buerger's disease

  • thrombosis and fibrosis cause ischemia in vessel 

48

abnormal HCO3 levels

  • acidic: <22
  • basic: >26

49

RSV clinical manifestations

  • rhinorrhea
  • sore throat (pharyngitis)
  • cough
  • headache
  • fatigue
  • fever
  • wheezing

50

Morse Fall Scale

  • 0-24 = no risk
  • 25-50 = low risk
  • 51 = high risk

51

nursing care of acute arterial ishcemia

  • notify physician immediately
  • anticoagulant therapy: IV unfractionated heparin
    • possibly long-term oral anticoagulation
  • Tx option
    • surgical thrombectomy - recommended
    • percutaneous catheter - directed thrombolytic therapy
    • percutaneous mechanical thrombectomy
    • surgical bypass

52

SIG-E-CAPS

  • Sleep disturbance
  • Interests
  • Guilt
  • Energy
  • Concentration
  • Appetite change
  • Psychomotor changes
  • Suicide

53

lower extremity PAD complications

  • non healing arterial ulcers - most common over bony prominences
  • gangrene
  • uncontrolled pain and severe spreading of infection
    • indications that amputation is necessary if cannot revascularize 

54

classification of burns

  • treatment r/t severity of injury
  • severity
    • depth of burn
    • extent of burn calculated in % TBSA
    • location of burn
    • risk factors
  • based on number of tissue layers involved 

55

SaO2

  • % of hemoglobin molecules saturated with oxygen as they pass through pulmonary capillaries
  • % of oxygen bound to hemoglobin as it passes through arterial blood

56

depression treatment

  • pharmacotherapy
    • SSRI's
    • SNRI - dual inhibitors
    • adjuvant agents
  • counseling and therapy
    • anxiety; social isolation; problem solving
  • religious/spirituality interventions
  • integrative approaches
    • physical, occupational, recreational therapy
    • CAM modalities 

57

fall prevention

  • PT consult
  • toileting schedule
  • ambulatory assistive devices
  • bed/chair alarm

58

chronic illness in the older adult

  • prolonged illnesses, rarely cured
  • limits physical functioning, work productivity, and negatively affects quality of life
  • examples
    • arthritis
    • cancer
    • COPD
    • dementia
    • heart failure

59

hypercapnia

increased amount of CO2 in arterial blood

60

indicators of pulmonary damage in burns

  • burn occurred in enclosed area
  • burns of face or neck
  • singed nasal hair
  • hoarseness, voice change, dry cough, stridor
  • sooty or bloody sputum
  • labored breathing, tachypnea, hypoxemia
  • erythema and blistering of oral or pharyngeal mucosa

61

symptoms of respiratory acidosis

  • hypoventilation --> hypoxia
  • rapid, shallow respirations
  • decreased BP w/ vasodilation
  • dyspnea
  • headache
  • hyperkalemia
  • dysrthymias (increased K)
  • drowsiness, dizziness, disorientation
  • muscle weakness, hyperreflexia

62

preventive errors

  • failure to provide prophylactic treatment
  • inadequate monitoring or follow-up treatment

63

attitudes toward aging

  • aging is normal
  • aging is a date influenced by:
    • emotional/physical health
    • developmental stage (Erikson)
    • socioeconomic status - diet, resources
    • culture
    • ethnicity
  • ageism

64

how can we best care for the elderly?

  • multidisciplinary team approach w/ gerontological expertise
  • improved techniques to target risk factors and prevent complications
  • discharge planning-transitional care
    • within/across institutions, home to institution
    • challenges
      • coordination; hand-off; payment
  • communication across care continuum

65

modern biological theories of aging

  • programmed (genetic timetable)
  • damange or error theories (environmental assaults)

66

aortic dissection nursing care

  • conservative
    • pain, HR and BP control, CVD risk factor modification
  • drug
    • IV beta-blocker, calcium channel blocker; ACE inhibitor; sodium nitroprusside
  • endovascular dissection repair
  • surgical aortic resection and repair
    • emergent with acute ascending

67

New York Heart Association classification of hF

  • I - no symptoms
  • II - symptoms w/ moderate activity
  • III - symptoms w/ minimal activity
  • IV - symptoms at rest

68

diagnostic errors

  • error or delay in diagnosis
  • failure to employ indicated tests
  • use of outmoded tests or therapy
  • failure to act on results of monitoring or testing

69

sundowning

  • specific type of agitation
  • Sx occur starting in late afternoon
  • behaviors include
    • aggessiveness, yelling
    • wandering, resistance to redirect

70

depression sequelae in older people

  • under treatment
  • mistaken treatment
  • functional decline - pseudo-dementia
    • if depression is treated, dementia Sx improve
  • increased morbidity
    • poor self-management; poor compliance; poor hygiene
    • increased NCD Sx
    • poor nutrition
    • poor sleep
  • increased mortality (suicide and non-suicide)

71

clinical manifestations of aortic dissection

  • acute ascending: abrupt onset of excruciating chest/back pain radiating to shoulders and neck
  • acute descending: sharp, tearing, ripping pain in back, abdomen, legs
  • neuro deficits: altered LOC; weak/absent carotid/temporal pulses; dizziness, syncope
  • angina, MI, murmur, L side HF
  • differing UE pulses between arms
  • older adult: hypotension, vague Sx

72

burns overall

  • an injury to tissues of the body caused by heat, chemicals, electrical current, or radiation
  • resulting effects influenced by
    • temperature of burning agent
    • duration of contact time
    • type of tissue injury 

73

4 item depression screening questionnaire

  • four questions with yes/no answer
    • basically satisfied with life? 
    • life is empty?
    • afraid something bad is going to happen to you?
    • feel happy most of the time?

74

COPD overview

  • preventable and treatable
  • progressive
  • inflammation of lungs 2/2 noxious gas or particles
  • includes
    • chronic bronchitis
    • emphysema
  • 3rd leading cause of death in US
    • 4x prevalence among smokers

75

prevention of influenza

  • vaccine
    • live attenuated and inactive
    • high dose for 65+
    • contraindications
      • guillan-barre within 6 weeks
      • anaphylactic hypersensitivity to eggs
  • hand hygiene
  • cough etiquette

76

risk factors for arterial ulcers

  • heart disease
  • peripheral artery diseae
  • smoking
  • HTN
  • hyperlipidemia
  • obesity

77

normal anion gap

8-16 mEq/L

78

depth of burn

  • degrees (1st-4th
  • depth of skin destruction
    • partial thickness
    • full thickness

79

fistula formation

  • abnormal passage between
    • hollow organs
    • hollow organs and skin
  • b/c of weak tissue, cancer (tumor)

80

end of life care in HF

considered in pts with advanced, persistent HF Sx at rest despite repeat attempts to optimize pharm and nonpharm therapy, AEB by 1+ of the following:

  • 3+ hospitalizations/year
  • chronic poor QOL, inability to accomplish ADLs
  • intermitten or continuous IV support required
  • assist devices as destination therapy

81

treatment errors

  • error in performance of an operation, procedure, or test
  • error in dose or method of using drug
  • avoidable delay in treatment or in responding to abnormal test
  • inappropriate (not indicated) care

82

normal HCO3 levels

22-26 mEq/L

83

delirium overview

  • state of temporary, acute, mental confusion 
    • common, life-threatening
    • characterized by
      • disorganized thinking, difficulty concentrating, sensory misperceptions lasting 1-7 days
  • 80% in ICU
  • 15-53% post-op
  • patho is unclear
    • possibly inflammatory, cytokine effect

84

primary intention of wound repair

  • well-approximated wound margins
  • initial: 3-5 days after injury
    • migration of epitheilial cells
    • clotting makes meshwork for healing
  • granulation: 5-7 days
    • migration of fibroblasts
    • wound is fragile; collagen starting to secrete
  • maturation & scar: 7 days - months
    • remodeling of collagen; strengthening of scar

85

risk factors/complications of varicose veins

  • risk factors
    • family hx, weakness of vein structure
    • female, oral contraceptives or hormone therapy
    • tobacco, increasing age, obesity, pregnancy
    • history of VTE, occupations with long standing or sitting
  • complications
    • SVT or rupture of varicose veins 

86

characteristics of arterial ulcers

  • absent hair in extremity - decreased blood flow
  • shiny, thin skin
  • cool, white skin

87

adverse drug events (ADE)

  • injury resulting from use of a drug
  • includes harm caused by drug and harm from use of drug
  • not always from med errors

88

inherent rates of cardiac conduction system

  • SA node 60-100 BPM
  • AV node 40-60 BPM
  • ventricles 20-40 BPM
  • pacemaker cells in SA node decrease with age

89

activity and exercise re: HF

  • individually tailored exercise progarm
    • 20-30 min 3-5x weekly
    • NYHA classes I-III
  • monitor orthostatics if on diuretics or vasodilators
    • older adults less symptomatic with BP drops and at greater risk for falls

90

normal PaO2 levels

80-100 mm Hg

91

management of asthma

  • A - adrenergics
  • S - steroids
  • T - theophylline
  • H - hydration (IV)
  • M - Mask 02
  • A - anticholinergics 

92

causes of respiratory alkalosis

  • excessive manual or mechanical ventilation
  • pulmonary embolism
  • anxiety, panic attacks
  • pregnancy
    • progesterone stimulates net respiratory drive which increases minute ventilation
    • oxygen consumption and CO2 production increase by 30% in third trimester

93

CHF diagnostic tools

  • H+P and ruling out
  • Echo
  • ECG - dysrythmia and changes with LV hypertrophy
  • CXR - heart enlargment, pulmonary congestion
  • cardiac catheterization - rule out CAD as causative factor
  • endomyocardial biposy - analyze myocardial tissue cells for myocarditis 

94

symptoms of asthma exacerbation

  • cough
  • increased mucus
  • SOB
  • wheezing, prolonged expiration
  • increased CO2 retention
  • chest tightness
  • retractions

95

lower extremity PAD overview

  • iliac, femoral, popliteal, tibial, and/or peroneal arteries
  • symptoms
    • intemritten claudication (classic)
    • shiny, taut skin; hair loss
    • diminished/absent pulses
    • elevation pallor; dependent rubor
    • paresthesia (nerve tissue ischemia)
    • rest pain - blood flow insufficient (advanced disease)
  • critical limb ischemia
    • chronic rest pain, ulceration or gangrene
    • amputation if not treated 

96

4th degree burns

  • goes down to muscle and bone
  • electrical and very severe thermal burns

97

structures of upper respiratory system

  • nose
  • pharynx
  • adenoids
  • tonsils
  • epiglottis
  • larynx
  • trachea

98

slough

moist, nonvible tissue

99

ejection fraction

  • % of blood ejected from ventricle w/ each contraction
  • normal = 60-75%

100

abnormal pH levels

  • acidic: < 7.35
  • basic: > 7.45

101

prevention of VTE

  • mobility
  • position change q2h
  • hydration
  • sequential compression devices
  • compression stockings
  • ppx anticoagulation 

102

COPD non-pharm management

  • smoking cessation
  • chest physiotherapy
  • breathing retraining
  • effective coughing
  • nutrition
    • 5-6 small, frequent meals
    • rest 30 min before
    • fluids
  • supplemental oxygen
    • o2 sat > 90% during rest, sleep, exertion OR
    • PaO2 > 60 mm Hg
    • monitored every 30-60 days

103

clinical manifestations of emphysema

  • increased CO2 retention (pink)
  • minimal cyanosis
  • purse lip breathing
  • dyspnea
  • hyperresonance on chest percussion
  • orthopneic
  • barrel chest
  • exertional dyspnea
  • prolonged expiratory time
  • speaks in short, jerky sentences
  • anxious
  • use of accessory muscles to breathe
  • thin appearance 

104

afterload

resistance against which heart has to pump

105

location of burns and impact

  • face, neck, circumferential to chest or back
    • airway (movement, swelling)
  • hands, feet, joint, eyes
    • self-care
  • ears & nose
    • infection (poor blood supply to cartilage)
  • buttocks & perineum
    • infection (proximity to stool)
  • circumferential burns to extremities
    • compartment syndrome

106

HCO3

chemical alkaline substance controlled by kidneys

107

how to assess a wound

  • measure in centimeters
  • length, width, depth
  • hands on a clock

108

Raynaud's

  • episodic vasospastic dx of small cutaneous arteries
  • risk factors:
    • female, 15-40, occupational issues, hyperhomocysteinemia
  • imbalance between vasodilation and vasoconstriction
  • Sx
    • color changes of fingers, toes, ears, nose
    • coldness, numbing, throbbing, aching pain, tingling, swelling
  • complications: punctate lesions of fingertips and gangrenous ulcers

109

physical exam for delirium

  • rule out or identify causes
  • vitals
  • respiratory
  • cardiac
  • neur
  • individualize to patient

110

what happens when blood vessels don't work?

  • arterial
    • ischemia
    • impaired cellular fxn
    • impaired healing
  • venous
    • waste buildup
    • tissue death

111

pre-hospital care of large/electrical burns, inhalation

  • TBSA > 10%
  • ABC assessment
  • do not cool for more than 10 min
  • DO NOT ICE - vasoconstriction
    • also hypothermia
  • seek medical attention

112

venous thrombosis

  • formation of thrombus and inflammation of vein
    • superficial VT - usually greater or less saphenous vein
    • DVT - mostly iliac and femoral
  • VTE - venous thromboembolism
    • spectrum of pathology from DVT to PE

113

vitamins in wound healing

  • C - capillary synthesis and colalgen production
  • B - interacts with protein, carb; fat production, metabolic rxns
  • A - epithelialization, strengthen healing process of wound

114

Stage III pressure ulcer

  • full-thickness tissue loss - through dermis, looking at subcutaneous tissue
  • no bone, tendon, muscle exposed
  • slough may be present
    • does not obscure depth of tissue loss
  • undermining or tunneling may be present

115

treatment of VTE

  • anticoagulation
    • vitamin K antagonists
    • thrombin inhibitors
    • factor Xa inhibitors
  • surgical
    • venous thrombectomy
    • vena cava interruption devices 

116

opportunistic pneumonia

  • altered immune response - AIDS
  • pneumocystis jiroveci

117

pneumonia diagnosis

  • Hx and physical exam
  • CXR
  • sputum analysis - identify underlying pathogen
  • CBC with differential (WBC > 15 w/ pneumonia)
  • pulse oximetry
  • ABGs - hypoxemia
    • patient holds onto CO2
    • respiratory acidosis

118

cardiac index

  • CO adjusted for BSA 
  • CI = CO/BSA
  • 2.5-4.0 L/min/m2

119

tertiary intention in wound repair

  • delayed primary intention (delayed suturing)
  • contamination or excessive swelling
    • incision or area of injury cannot close
  • some granulation tissue forms and then it's sutured
  • clean the wound before it's closed

120

TB induration of 10+ mm is positive in:

  • recent immigrants from high prevalence countries
  • Injection drug users
  • residents/employees of high-risk congregate settings
  • clinical conditions at higher risk
  • children < 4 yo
  • infants, children, adolescents exposed to adults in high-risk categories

121

evisceration

wound edges seprate to the extent that organs protrude

122

rehabilitation phase of burns

  • 2 weeks to 7-8 months
  • patient/caregiver participation in care
  • moisturize healed skin - eucerin, vaseline
  • education
    • antihistamine for itchiness
  • emotional support 

123

ACE inhibitors

  • inhibit angiotensin-converting enzyme
  • decrease angiotensin II levels to vasodilate
    • decrease afterload
    • limit progression of LV dysfxn
  • start low, increase gradually
  • avoid over diuresis and hypotension
    • not enough fluid for hypokinetic LV to pump out
  • check orthostatics and HR changes

124

contractility

ability of myocardial fibers to shorten and develop tension - force of contraction

125

arterial ulcers overview

  • impaired arterial blood flow (lower leg, foot)
    • ischemia, necrosis
  • extremely painful - nerves intact
  • healing is slow
  • most commonly caused by atherosclerosis
  • location
    • toes, lateral malleolus, distal lower leg, dorsum of foot
  • treatment - treat underlying cause (stent in lower extremities)

126

pulmonary changes in the older adult

  • respiratory muscles diminish in strength
  • elastic recoil of lung diminishes - do not regain shape quickly
  • chest wall compliance diminishes - how forceful lungs can be pushed
  • fewer small airways open during restful breathing
    • rely more heavily on large airways
  • diminished ciliary and macrophage activity
    • diminished immune response

127

CVI and venous leg ulcer nursing care

  • compression
  • moist dressing
  • balanced diet 
    • protein, A, C, zinc
  • antibiotics
  • skin graft
  • glycemic control in diabetics 

128

management of influenza

  • goals: relieve symptoms; prevent complications
  • treatment
    • symptom management: rest, hydration, analgesics, antipyretics
    • antiviral medications: zanamivir + tamivir
      • influenza A + B
      • pts hospitalized with influenza
  • diligent hand hygiene
  • respiratory and cough etiquette
  • droplet precautions when inpatient
  • PPE

129

mechanical restraint

  • any manual method, physical or mechanical, material, or equipment that immobilizes or reduces ability to move arms, legs, body or head freely
  • assess patient, use less restrictive measues
  • reassessed frequently; order renewals

130

physiology of malnutrition

  • physiological changes lead to lower calorie requirement
    • decrease in lean body mass
    • redistribution of fat around organs
  • changes in taste perception
    • meds, taste-bud atrophy
  • older adults need same nutrient level, but fewer calories

131

transitional care model

set of actions to ensure coordination and continuity of care as patients transfer between different locations or different levels of care within same location

132

full-thickness level of tissue involvement in burns

  • dry
  • discolored
  • no pain

133

risk factors for PAD

  • smoking (vasoconstrictor)
  • diabetes
  • hyperlipidemia
  • uncontrolled HTN
  • advanced age
  • family hx
  • obesity
  • stress
  • inflammation (elevated c-reactive protein)
  • sedentary lifestyle 

134

current therapy in Alzheimer's

  • mild-moderate Sx
    • cholinesterase inhibitors
      • donezepril; rivastigmine; galantamine
  • moderate-severe Sx
    • N-methyl-D-Aspartate (NMDA) antagonist
      • memantine 

135

nutritional support of wound healing

  • small, frequent meals
  • caloried beverages hourly
  • high cal, high protein
  • nutritional supplements
  • assess for food preferences
  • protein - positive nitrogen balances; collagen and immune factors
  • carbs - body will resource to protein
  • fats - fatty acids, triglycerides for cell membrane synthesis

136

delirium room

  • close observation
  • 24-hour nursing
  • 4-bed unit within ACE unit
  • restraint free
  • principles of care
    • tolerate
    • anticipate
    • don't agitate

137

collaborative wound management

  • reposition frequently
    • q2h
    • HOB 30 degrees - less pressure on sacrum
  • devices
    • alternating pressure mattresses
    • heel protectors
  • nutrition
    • imperative for wound healing
  • PT
  • pain control

138

assessment of dementia

  • interview patient and caregiver
    • functional status (ADLs, IADLs)
  • neuro exam - outpatient unless acute
  • neuroimaging - shape, positioning, volume of brain tissue
  • cognitive tests
    • MMSE
    • MoCA
  • diagnosis of exclusion 

139

precipitating risk factors for delirium

  • acute illness
  • surgery, anesthesia/sedation
  • pain
  • dehydration, NPO
  • sepsis, hypoxia
  • sleep deprivation, sleep/wake cycle disturbance
  • electrolyte disturbance
  • urinary retention/fecal impaction
  • exposure to high-risk medications
  • polypharmacy (6+)

140

cardiac conduction system

141

medical care-associated pneumonia

  • hospital associated - 48+ hrs after admission and not incubating during admission
  • ventilator associated - 48+ hrs post endotracheal intubation
  • health care associated 
    • new onset of pneumonia
    • 2+ days in acute care or long-term care setting within 90 days of infection
    • IV therapy, chemotherapy, wound care within 30 days of infection
    • attended hospital/dialysis clini

142

PaCO2

acid/gas controlled by lungs

143

red, yellow, and black concept of wound care

method of dressing selection based on wound color

144

TB induration of 15+ mm is positive in:

any person with no known risk factors for TB

145

aortic dissection

  • tear develops in inner layer of aorta
    • blood surges into middle layer
    • inner and middle layers separate
      • fatal if blood ruptures outside aortic wall
  • risk factors
    • increasing age, male
    • aortitis, trauma, CHD, connective tissue dx
    • drug use
    • hx of heart surgery, atherosclerosis, HTN
    • pregnancy

146

hypyoxemia

  • low oxygen concentration in arterial blood
  • PaO2 below 80 mm Hg
  • can lead to hypoxia if not appropriately corrected

147

COPD clinical manifestations

  • prolonged expiratory phase
  • wheezes
  • decreased breath sounds
  • barrel chest
  • tripod positioning
  • pursed lip breathing
  • cyanosis
  • polycythemia (increased Hgb)

148

structures of lower respiratory system

  • bronchi
  • bronchioles
  • alveolar ducts
  • alveoli

149

non-pharmacologic interventions for Alzheimer's

  • cognitive interventions
    • memory aids - reorientation, reminders, cues
  • environmental modifications
    • adjusted noise level, familiar objects, pictures as cues
  • changes in activity demand
    • routine, reduce complexity of activities/tasks
  • interpersonal approaches
    • simplified language, speak in context, eye contact, smiling

150

warning signs of Alzheimer's

  • memory loss affecting daily life
  • challenges in planning/problem solving
  • problems with language
  • disorientation to time and place
  • new problems with words
  • misplacing things
  • decreased or poor judgment
  • withdrawal from work or social activity
  • changes in mood or personality
  • trouble with visual/spatial relationships 

151

adverse drug reaction (ADR)

  • response to drug which is noxious and unintended and which occurs at doses normally used for prophylaxis, diagnosis, therapy, or modification of physiologic function
  • allergy - ADR mediated by immune response
  • side effect - expected/known effect of drug but is not intended therapeutic outcome

152

Alzheimer's overview

  • fatal
  • etiology unknown - environment and genetics
  • brain atrophy
    • amyloid plaques
    • neurofibrillary tangles (tau proteins twist together)
    • loss of connection between neurons
    • neuron death

153

risk factors for venous ulcers

  • obesity
  • older age
  • hx of venous disease (thromboembolism in lower legs)
  • smoking
  • occupation involving standing for long periods

154

heart failure with preserved ejection fraction (HFpEF)

  • > 50% EF
  • diastolic HF
  • borderline (41-49%) vs improved (>40%)

155

atherosclerosis

gradual thickening of intima and media layers of arterial walls that results from cholesterol and lipid deposits within vessel walls and leads to progressive narrowing of artery via plaque formation

156

confusion assessment method

  1. acute onset and fluctuating course
  2. inattention
  3. disorganized thinking
  4. altered LOC

1 +2 and 3 or 4

157

causes of metabolic alkalosis

  • excessive sodium bicarb administration
  • prolonged vomiting (vomit up acid)
  • excessive gastric suctioning

158

prevention of ADR/ADE

  • accurate med list
  • reconcile meds
  • side effects, allergies
  • assess for side effects
  • counsel patients on drug info (DICE)
  • teach-back method
  • written instructions
  • submit adverse events to appropriate department

159

nursing care of varicose veins

  • nonpharm - rest w/ limb elevation, compression, walking
  • pharm
    • venoactive drugs
    • herbal - horse chestnut seed extract and butcher's broom
  • non-invasive procedures
    • schlerotherapy, laser therapy, high-intensity pulsed-light therapy
  • surgical
    • ligation of vein, ambulatory phlebectomy, endovenous ablation

160

IGRA test

  • interferon gamma release assay (for TB)
  • positive - further diagnostic testing
  • negative - no further testing

161

logistics r/t malnutrition in oler adults

  • common reports
    • little/no appetite
    • problems with eating/swallowing
    • inadequate nutrient intake
    • fewer than 2 meals/day
  • functional limitations to purchase/prepare meals
  • transportation to buy food

162

education re: diuretics

  • time of day
  • daily weights
  • loop - K+ supplement/follow K+ levels
  • low Na diet
  • NSAIDS interfere with prostaglandin synthesis by inhibiting cyclooxygenase and antagonising diuresis
  • dizziness, lightheadedness 

163

depression symptoms among older people

  • memory problems
  • confusion
  • social withdrawal
  • loss of appetite
  • weight loss
  • vague complaints of pain
  • inability to sleep
  • irritability
  • delusions
  • hallucinations 

164

aneurysm risk factors

  • age < 60
  • male
  • tobacco
  • HTN
  • CAD
  • family hx
  • high cholesterol
  • carotid artery disease
  • previous stroke
  • overweight/obese
  • race/ethnicity 

165

primary causes of HF

  • CAD/MI
  • HTN
  • rheumatic heart disease - inflammatory disease s/p Strep
  • congenital heard disease (VSD)
  • pulmonary HTN
  • cardiomyopathy
  • valvular dx
  • myocarditis 

166

atrial fibrillation Tx

  • meds - digoxin, beta blockers, amiodarone, calcium antagonists
    • rate control is crucial
  • electrical cardioversioin
  • ablation
  • preventing stroke
    • anticoagulant and antiplatelet
    • warfarin, dibagatran, apixaban or rivaroxaban if at high risk for embolic stroke

167

formula for fluid requirements for burns

  • Parkland Baxter Burn Formula
  • 4 mL lactated ringer's solution / kg body weight / % TBSA 
    • = total fluid requirement for first 24 hrs
  • application
    • 1/2 total in first 8 hrs
    • 1/4 total in second 8 hrs
    • 1/4 total in third 8 hrs

168

7 tasks of persons with chronic illness

  1. prevent and manage crisis
  2. carry out prescribed tx regimen
  3. control symptoms
  4. reorder time (things done in the day)
  5. adjust to changes in course of disease
  6. prevent social isolation
  7. attempt to normalize interactions with others

169

Stage A HF

at high risk for HF but w/o structural HD or symptoms of HF

170

nonpharm interventions for delirium

  • multicomponent nonpharm interventions delivered by interdisciplinary team to prevent delirium
  • environmental/nursing interventions (over/under stimuli)
    • reorient, calm environment
    • room close to nurses station
    • calm environment
    • increase daytime activity
    • decrease excessive napping
    • untether and detangle patients

171

asthma overview

  • chronic inflammatory disorder of airways
  • usually reversible
  • associated with variable airflow obstruction
  • episodic - acute exacerbations w/ Sx-free periods
    • can overlap with COPD
  • hyperresponsiveness = hypersensitivity + hyperreactivity
    • hypersensitivity: increased response to low stimuli
    • hyperreactivity: stronger constriction of airway smooth muscles 

172

superficial level of tissue involvement in burns

  • painful
  • no edema
  • redness
  • blanches with pressure

173

respiratory acidosis overview

  • serum PaCO2 > 45 mEq/L
  • pH acidotic
  • causes
    • respiratory depression
    • increased CO2 levels
  • hypoventilation results in CO2 buildup
    • body tries to compensate

174

functional decline

  • mild discomfort to decreased ability to perform activities to severe, chronic pain and immobility
  • risk of falls increases with age

175

pre-hospital care of chemical burns

  • quickly remove chemical particles or powder
  • remove all contaminated clothing
  • flush with copious amounts of water 20 min - 2 hrs post exposure 

176

diagnostic studies of aneurysm

  • chest/abdominal X-rays, ECG, US, CT, MRI, angiography
  • true aneurysm
    • wall of artery forms aneurysm with at least one vessel layer intact
    • fusiform - circumferential and uniform in shape
    • saccular - pouchlike with narrow neck
  • false aneurysm
    • disruption of all arterial wall layers w/ bleeding contained by surrounding structures
      • trauma, infection, peripheral artery bypass graph surgery, arterial leakage after removal of cannula

177

community acquired pneumonia

  • not hospitalized or in long-term care facility w/in 14 days of onset
  • CURB65 scale or PORT pneumonia severity index

178

non-pharm management of HF

  • diet
    • 2g Na (less if more severe HF)
    • low fat/ cholesterol if CAD
  • fluid management
    • <2L/day if hyponatremia
    • thirst decreases with age
  • advance HF/cardiac cachexia
    • caloric and nutritional supplements

179

aneurysm complications

  • rupture
  • Sx:
    • severe back pain, Grey Turner's sign (back or flank ecchymosis, anxious
  • 90% die from massive hemorrhage
  • if patient is in hospital
    • hypovolemic shock
    • simultaneous resuscitation and surgical repair 

180

pulmonary injury and management in burns

  • upper airway
  • inhalation below glottis
  • carbon monoxide poisoning
  • restrictive defects
  • intubation within 1-2 hours of inhalation injury 

181

types of errors

  • diagnostic
  • treatment
  • preventative
  • other

182

susceptible areas for pressure ulcers

  • sacrum
  • scapula
  • occiput
  • heels
  • elbow
  • hips
  • ears (device-related)

183

yellow wound dressings

  • hydrocolloid - duoderm

184

influenza in older adult

  • at greatest risk for complications
  • 80-90% of flu-related deaths
  • 50-70% of flu-related hospitalizations
  • prevention
    • vaccine (standard or high dose)
    • good health habits
    • seek medical advice quickly whe Sx present

185

skin changes with aging

  • loss of elastin, collagen, and subcutaneous fat
  • thinning of dermis and epidermis
  • fewer sweat and sebaceous glands
  • slowed healing times
  • less resistance to tearing/shearing injuries
    • b/c skin not as taut

186

arterial blood gases

  • diagnostic testing
  • measured to determine
    • oxygenation status
    • acid-base balance
  • obtained by
    • arterial puncture
    • arterial catheter (more precise BP reading)

187

aspiration pneumonia

can be CAP or MCAP - vomit, food, water

188

symptoms of metabolic acidosis

  • headache
  • decreased BP
  • hyperkalemia
  • muscle twitching
  • warm, flushed skin (vasodilation)
  • nausea, vomiting
  • decreased muscle tone, decreased reflexes (confusion, increased drowsiness)
  • Kussmaul respirations (compensatory hyperventilation)

189

post-thrombotic syndrome (PTS)

  • complication resulting from chronic venous HTN caused by valvular destruction, stiff noncompliant wall, persistent venous obstruction
  • Sx
    • pain, aching, heaviness, swelling
    • cramps, itching, tingling
  • Signs
    • persistent edema, increased pigmentation, eczema
    • secondary varicosities and lipodermatosclerosis 

190

assessment hx for delirium

  • family members and caretakers
    • when did confusion begin
    • condition change over 24 hrs
    • changes in thought processes or thinking or ability to maintain attention?
    • hx of mental illness and/or cognitive impairment?
    • sudden decline or change in physical health/function
    • has there been new prescription or OTC meds added?
    • change in alertness and/or sleep pattern?

191

signs and symptoms of pulmonary HTN

  • elevated mean pulmonary artery pressure > 25 mm HG
    • normal = 9-12
  • SOB on exertion
  • fatigue
  • ascites
  • peripheral edema
  • nausea
  • loss of appetite
  • syncope
    • R side can't get blood to L side to accomodate body

192

black wound treatment

  • sharp or chemical debridement of eschar/slough
  • wound vac

193

3rd degree burns

  • complete destruction of epidermis and dermis
    • further into subcutaneous tissue
    • muscle and bone may be involved
  • full-thickness tissue lost - skin cannot regenerate
    • requires grafting
  • appears dry and leathery
  • insensitive to pain immediatley after injury b/c of level of tissue destruction 
  • fluid loss and infection are complications

194

pneumonia management

  • abx
  • repeat CXR
  • symptom driven management
    • rest, antipyretics, analgesics (chest pain), oxygen
  • antivirals for influenza pneumonia
  • hydration - mobilize secretions
  • nutrition - hypermetabolic state
  • pulmonary toileting - cough, deep breath, spirometry
  • early ambulation - expand lungs

195

general principles of care

  • safety
  • structure living environment to maximize abilities
  • monitor general health
    • confusion is often first sign of health problem 
  • pain - rely on other cues
    • vocalization, agitation, withdrawal
  • eating/swalloing - thickened food
  • oral - inspect mouth (may cheek food)
  • infection prevention (UTI, pneumonia)
  • elimination - urinary/fecal incontinence, constipation

196

"other" errors

  • failure of communication
  • equipment failure

197

active vs latent TB

198

partial-thickness level of tissue involvement in burns

  • blistered
  • moist
  • painful

199

falls

  • sleep impairment
    • moving during dark hours; residual sleep med effects
  • vision impairment
  • balance, gait, mobility impairment
  • environmental hazards
  • physical restraints
  • medications

200

acute phase of Buerger's disease

  • inflammatory thrombus forms and blocks vessels
  • over time, thrombus becomes more organized and inflammation subsides 

201

nursing care of Raynaud's

  • diagnosis - persistent Sx for 2+ years
  • Tx
    • loose, warm clothing; avoid temp extremes
    • avoid caffeine, nicotine, vasoconstriction drugs
    • stress management strategies
  • drug therapy: nifedipine
  • prompt tx for ulceration and/or critical ischemia 

202

hemodynamic status in acute heart failure

203

risk factors for dementia

  • nonmodifiable
    • aging
    • genetic predisposition
    • family hx
    • traumatic brain injury
  • modifiable
    • diabetes
    • smoking
    • HTN
    • cardiovascular risk 

204

cardioversion and defibrillation

  • treat tachydysrhythmias via electrical current to depolarize myocardial cells
  • timing is different
  • cardioversion - electrical current synchronized with patient's electrical events
  • defibrillation - delivery is immediate and unsynchronized
  • delivered externally through skin with paddles or pads

205

wound care of acute phase of burns

  • diligent sterile technique
  • skin grafting

206

pH revisited in steps to ABG interpretation

  • uncompensated: no attempt to correct acid-base imbalance; pH abnormal
  • partially compensated: attempt to correct acid-base balance; pH abnormal
  • compensated: corrected acid-base balance; pH normal

207

psychological implications of wound

  • distress at sight of wound
  • fear of scarring
  • drainage/odor can cause distress
  • discuss concerns
  • pain management
    • pharmacological treatment during dressing changes

208

ABC involvement of burns

  • A
    • tongue, nose, throat involvement
    • patency
    • swelling
    • singed nasal hair
    • dark oral or nasal membranes
  • B
    • chest symmetrically rising and falling
  • C
    • pulses - elevate limb above heart to reduce swelling and pain 

209

Stage I pressure ulcers

  • intact skin
  • non-blanchable erythema
  • may be painful, warm or cool
  • darker skin
    • may not have visible blanching
    • color may be different from surrounding areas
  • compare to surrounding skin

210

cautions r/t depression in elderly

  • fragmented care
    • PCP and homecare included
  • symptomatic Tx (avoid - treat underlying cause)
    • benzos and hypnotics are high risk
    • anticholinergic side effects; sedation; increase in falls
  • pharmacotherapy alone
    • social concerns remain unaddressed with drug therapy alone

211

mechanical circulatory support

  • cardiac assistive device
  • ventricular assist devices (VADs)
    • circulate as much blood/min as heart
    • each supports one ventricle 

212

DVT clinical manifestations

  • unilateral leg pain, edema, tenderness
  • warm skin, erythema
  • paresthesias
  • systemic fever

213

risk factors for poor prognosis burn recovery

  • CV - arrhythmias, MI
  • Resp - impaired gas exchange, inhalation damage, underlying lung dx
  • Renal - ischemia
  • Diabetes - delayed healing
  • PV dx
  • Alcoholism
  • Malnutrition 

214

cardiac resynchronization therapy

for LVEF <35%, sinus rhythm, left bundle-branch block with a QRS duration of 150+ ms, NYHA II, III, or ambulatory IV Sx

215

goals to wound treatment

  • no deterioration/worsening
  • reduce/eliminate factors contributing to pressure ulcer risk
  • prevent infection
  • healing
  • no recurrence
  • keep wound moist!

216

complications of hospitalizations for older adults

  • malnutrition (no reserves)
  • falls
  • restraint use
  • infection
  • functional decline
  • adverse drug effects
  • death

217

factors that delay wound healing

  • adhesions
  • contractions
  • dehiscence
  • evisceration
  • excess granulation tissue
  • fistula formation
  • infection
  • hemorrhage
  • hypertrophic scars
  • keloid formation

218

1st degree burns

  • involves only epidermis
  • pink, dry, red, painful
  • relieved by cooling
  • no blistering; actual tissue damage is minimal
  • sunburn
  • not calculated in TBSA

219

pre-hospital care of inhalation injuries

  • close observation of respiratory distress
  • if carbon monoxide is suspected, treat with 100% humidified O2 en route to hospital 

220

triggers of asthma

  • hypersensitivity
  • URI
  • exercise
  • air pollutants
  • respiratory infections
  • GERD

221

defibrillator safety

  • conductive agents to avoid burns
  • remove transdermal med patches
  • no touching patient, bed frame, or device or object touching patient
  • do not stand in liquids and patient should not be lying in liquids

222

thrombosis/embolism

  • thrombosis: complete blockage of blood vessel from platelets and/or fibrin
  • embolism: dislodged mass that traveled through bloodstream to cause blockage 

223

steps to ABG interpretation

  1. PaO2 + SaO2: hypoxemia? SaO2 > 95%?
  2. pH - acidic or alkaline
  3. PaCO2 - respiratory acidosis, alkalosis, or normalcy
  4. HCO3 - metabolic acidosis, alkalosis, or normalcy
  5. pH - compensated, partially compensated, uncompensated?

whatever lines up with pH is deficient - other system is compensatory 

224

Stage II pressure ulcer

  • partial thickness loss - epidermis, part of dermis
  • shallow, open ulcer
  • red-pink wound bed
  • no slough present
  • intact serum-filled blister or open/ruptured blister

225

chronic venous insufficiency (CVI) and venous leg ulcers

  • leg veins and valves fail to keep blood moving forward
  • CVI leads to ulcers
  • risk factors
    • old age, women
    • varicose veins, post-thrombotic syndrome
  • clinical manifestations
    • leathery brownish skin, edema
    • eczema and itching
  • ulcers: medial malleolus, painful in dependent position
    • complications: infection, osteomyelitis, malignant changes

226

TB induration of 5+ mm is positive in:

  • HIV
  • recent contact with TB
  • fibrotic changes on chest radiograph consistent with prior TB
  • organ transplants
  • immunosuppressed

227

prevention management of TB

  • BCG vaccine - strain of mycobacterium bovis
    • in areas of high TB prevalence
  • not in US b/c
    • low risk of infection
    • potential interference with TB skin test 
    • variable effectiveness 

228

drug therapy for burns

  • opioid analgesics (IV best)
    • oral has slower absorption rate (esp w/ slow GI)
  • sedation
  • tetanus immunization
    • tetanus toxoid r/t burns that can contaminate wound
  • antimicrobial agents
    • topical - silver sulfadiazine
    • systemic - utilized if diagnosis of sepsis is made
      • sepsis = primary cause of death in burn patients
  • anticoagulants
  • GI prophylaxis

229

diuretics

  • decrease sodium reabsorption, enhance sodium and water excretion
  • decrease preload
  • loop diuretics
    • furosemide

230

deep tissue injury (DTI)

  • purple or maroon localized area
    • discolored intact skin
    • blood filled blister
  • caused by damage to underlying tissue
  • differentiate from bruise or ecchymosis
    • DTI is pressure-related
  • don't know how deep the level of damage is
  • can be soft, boggy, mushy, warmer or cooler than surrounding tissue

231

symptoms of L side HF

  • paroxysmal noctural dyspnea
  • elevated pulmonary capillary wedge pressure
  • pulmonary congestion
    • cough, crackles, wheeze, blood-tinged sputum, tachypnea
  • restlessness
  • confusion
  • orthopnea
  • tachycardia
  • exertional dyspnea
  • fatigue
  • cyanosis

232

dehisence

  • separation and disruption of previously joined wound edges
  • causes
    • infection
    • weak granulation tissue
    • obesity (low vascularization)
    • fluid pockets

233

influenza overview

  • highly contagious
  • mild to severe
  • types: A, B, C
    • subtypes of A: H, N
    • B, C: no subtypes
  • most comon complication - pneumonia
  • season: September to April
    • peaks November to March

234

heart failure with reduced ejection fraction (HFrEF)

  • < 40%
  • systolic HF

235

chemical restraint

drug/med not used as standard treatment for medical or psychiatric condition that results in restricting freedom of movement

236

changing behavior in dementia and delirium - agitation

  • excessive motor or verbal activity
    • threatening; screaming; wandering; assaulting
  • estimates range 55-95% of elders with dementia experience agitation
  • increases caregiver stress
  • inpatient, majority of care rests on nursing staff

237

nursing strategies for delirium

  • remain calm
  • avoid confrontation
  • assess for causes - start with basics
    • pain - headache, reflux, arthritis pain
    • GI discomfort - constipation, diarrhea
    • confusion r/t impaired hearing or vision
    • needs - voiding, hunger, thirst

238

management of latent TB

  • prevention of active infection
  • one drug therapy
    • 6-9 month isoniazid

239

COPD pathophysiology

240

pneumonia prevention

  • pneumococcal vaccine
  • indicated for
    • 65+
    • immunosuppression 2-64 yo
    • asthma, smoke 19-64 yo
    • nursing homes, long term care facilities 

241

TB tuberculin/Mantoux skin test

  • inject tuberculin - read 48-72 hrs after
  • positive = further diagnostic testing
  • negative = no further testing

242

programmed (genetic) theories of aging

  • programmed longevity - switching certain genes on/off
  • endocrine theory - biological clocks acting through hormones
    • control pace of aging
    • insulin/IGF-1 signaling patway (key role in hormonal regulation of aging)
  • immunological theory - immune system decline
    • antibodies lose effectiveness
    • dysregulated immune response (CV, inflammation, Alzheimer's, cancer)

243

symptoms of R side HF

  • fatigue
  • increased peripheral venous pressure
  • ascites
  • enlarged liver/spleen
  • may be 2/2 chronic pulm problems
  • JVD
  • anorexia, GI distress
  • weight gain
  • dependent edema 

244

purpose of skin

  • temperature regulation
  • barrier against pathogens
  • largest organ in body

245

causes of metabolic acidosis

  • diabetic ketoacidosis
  • lactic acidosis
  • diarrhea - defacate alkaline material
  • renal failure (K+ buildup, inadequate H+ excretion)
  • aspirin overdose

246

second intention wound repair

  • more irregular wound margins
  • more extensive tissue loss
  • edges not neatly brought together
    • inflammation greater; more tissue damage

247

venous ulcers overview

  • pulling/leaking of fluid into surrounding tissue
    • caused by prolonged venous hypertension in lower extremities
  • located on inner/outer aspect of lower leg below ankle
  • shallow
  • irregularly shaped w/ sharp borders
  • beefy red wound bed
  • surround areas - hyperpigmentation, scaly skin, edema
  • classified as partial or full-thickness

248

symptoms of pneumonia

  • cough
  • fever
  • chills
  • tachycardia
  • tachypnea
  • dyspnea
  • pleural pain
  • malaise
  • respiratory distress
  • decreased breath sounds

249

diagnosing dementia

  • abrupt or gradual, depending on cause
    • commonly gradual, progressive decline
  • 2 most common
    • neurodegenerative - Alzheimer's
    • vascular dementia (multi-infarct)
      • from ischemia 

250

prevention of chronic illness

  • primary
    • measures to prevent disease - diet, exercise, immunizations
  • secondary
    • early detection to prevent disease progressio - screening
  • tertiary
    • activities to limit disease progression - rehab

251

cardiac output

  • volume of blood ejected by the ventricle into the systemic circulation each minute 
  • stroke volume x HR
  • normal = 4-8 L/min

252

sexual activity and older men

  • erectile dysfunction
  • decreased mechanical sensitivity
  • climaxing too quickly
  • inability to climax
  • performance anxiety
  • lack of sexual interest

253

gerontological models of care

  • Acute Care for the Elderly (ACE)
  • Programs fo All-Inclusive Care to Elderly (PACE)
    • Living Independently for Elders (LIFE)
  • Hospital Elder Life Program (HELP)
  • Nurses Improving Care to Health system Elders (NICHE)

254

Medicare coverage

  • Part A - hospital
    • inpatient, skilled nursing facility, hospice, short term home health care
  • Part B - medical insurance
    • outpatient, preventive, rehab, home health care
  • Part C - Medicare Advantage Plans
    • A + B through private insurance
  • Part D - prescription drug
    • Medicare Modernization Act of 2003

255

chronic illness phase trajectory

256

red wound dressings

  • OpSite
  • Tegaderm

257

signs and symptoms/prevention of infection in older adults

  • cognitive changes (1st sign in elderly)
  • +/- fever (may actually be lower)
  • pain
  • prevention
    • standard precautions
    • remove catheters, IVs ASAP

258

depression in older people

  • very common comorbid condition
    • 1 in 5 (underdiagnosed - not screened)
  • often atypical presentation
    • not classically "depressed"
  • common presentation
    • persistent and vague complaints
    • help-seeking
    • moving in a slower manner
    • demanding behavior (anxiety)

259

ventilation vs perfusion

  • ventilation (V) - occurs via inspiration and expiration
    • movement of air in and out of lungs (4-5 L/min)
  • perfusion (Q) - blood flow to capillaries
  • normal V/Q ratio = 1
  • V/Q mismatch
    • pulmonary embolism (perfusion); elasticity (ventilation); blockage - tumor, mucus (ventilation)
  • shunt
    • blood shunted - poor perfusion or ventilation depending on mismatch

260

factors complicating nutrition

  • chronic illnesses
    • depression
    • stroke (dysphagia)
  • poor oral health
  • meds
    • cause xerostomia (dry mouth) - antidepressants, antiHTN, bronchodilators, diuretics
    • altered taste
    • decreased appetite

261

management of active TB

  • TB precautions
  • drug therapy
    • isoniazid, rifampin, pryazinamide, ethambutol
  • side effects - non viral hepatitis
  • baseline liver fxn tests and intermittent monitoring during drug therapy
  • 4.5-9 month tx course
    • drug resistance; compliance is crucial
  • education

262

overall goals in older adult care

  • to minimize loss of independence associated with functional decline and illness
  • to optimize management of chronic and acute disease processes

263

DSM-5 criteria for major depressive episode

  • depressed mood *
  • loss of interest/pleasure in hobbies/activities *
  • appetite/weight changes
  • decreased energy, fatigue
  • difficulty concentrating, remembering, making decisions
  • sleep disturbances
  • thoughts of suicide/death
  • psychomotor agitation/retardation
  • restlessness or irritability
  • feelings of worthlessness or excessive or inappropriate guilt

264

wound care of burns

  • surgical debridement
    • escharotomy - allow tissue to breathe
    • fasciotomy - to relieve tension
    • life threatening if left untreated
  • open method
    • antimicrobial ointment 
    • no dressing
  • closed method (multiple dressing changes)
    • sterile gauze impregnated with or laid over antimicrobial
  • PPE
  • sterile changes w/ new dressings
  • primary goals: permanent skin coverage
  • complication: infection --> sepsis 

265

heart failure definition

  • inabiity of the heart to pump sufficiently to meet the metabolic needs of the body
  • left, right, or both sides

266

lower extremity PAD diagnostic studies

  • assess blood flow
    • doppler
      • segmental BPs
      • angiography
    • magnetic resonance angiography
  • ankle brachial index (ABI)
    • ratio of BP in lower extremity to BP in upper extremity
    • <1.00 - 1.40 = normal ABI

267

Stage C HF

structural heart disease with prior or current Sx of HF

268

Sx of Alzheimer's

  • aphasia - impairment in language
  • apraxia - inability to perform a previously learned task
    • willing and physically capable but cannot do it
  • agnosia - inability to recognize familiar people, objects, shapes, sounds, smells
    • will drive and get lost
  • loss of executive fxn
    • planning, problem solving, reasoning, multi-tasking 

269

wound hemorrhage

  • internal or external bleeding from
    • suture failure
    • coagulopathies
    • erosion of blood vessel

270

clinical manifestations of varicose veins

  • heavy, achy feeling following prolonged sitting or standing period that is relieved by walking or limb elevation
  • pressure, itching, burning, tingling, or cramp-like leg sensation
  • swelling, restless, tired legs, fatigue, nocturnal leg cramps
  • cosmetic disfiguration 

271

RSV overview

  • respiratory syncytial virus
  • healthy people: mild, cold-like Sx
  • children, older adults: significant and serious
    • morbidity and mortality
  • can present as URI and lead to LRI
  • October-March
  • high risk populations - immunocompromised, cardiopulmonary, long-term care facilities
  • severe respiratory distress and respiratory failure

272

anion gap

quantity of anions not balanced by cations

273

patient education re: HF

  • daily weights
    • 2-3+ lbs/day for 2 days
    • 5+ lbs in one week
  • action plan if Sx change
  • how to take meds; reasons
  • read food label for Na serving

274

excess granulation tissue

  • may protrude about surface of healing wound
  • aka profound flesh
  • typically cut off, cauterized

275

Stage B HF recommendations

  • evidence of LV dysfxn but no Sx
  • prior Hx of MI, HTN, L ventricular hypertrophy, valvular dx
  • benefit from ACE inhibitor, beta blocker

276

normal PaCO2 levels

35-45 mm Hg

277

beta blockers

  • decrease sympathetic stimulation
    • Beta1, Beta2, or Alpha1 depending on agent
  • metorpolol ER, bisoprolol, carvedilol
  • check orthostatics and HR changes

278

eschar

dry, nonviable tissue

279

disability assessment

  • past/present injuries
  • hearing + vision
  • nutritional patterns (clues to musculoskeletal system)
  • activity/exercise - limitations r/t pain
  • sleep-rest patterns - pain interferes
  • pain

280

care of emergent phase of burns

  • airway management
    • intubation b/c of massive fluid resuscitation
    • need to secure airway, even without burn to airway
  • ABGs
  • fluid therapy - Parkland's Formula
  • pain and anxiety management
  • drug therapy
  • PT - bedside
  • nutritional therapy
  • wound care

281

COPD exacerbation tx

  • short acting bronchodilators PRN
  • corticosteroids
  • antibiotics
  • supplemental oxygen

282

signs of normal perfusion

  • warm hands/feet
  • brisk cap refill
  • easily palpable pulses
  • good skin color

283

characteristics of depression in older people

  • onset coincides with life changes, often abrupt
  • can wax and wane, ongoing for months/years
  • thinking intact but with apathy, slow r/t fatigue
  • may deny depression, but express feelings of guilt
  • withdrawn and hypoactive
  • disturbed sleep-wake cycle 

284

2nd degree burns

  • deep epidermal layers and upper dermis layers
    • deep partial-thickness
  • blisters, severe pain, swelling, scarring
    • can weep
  • usually heals without surgical interventions

285

inflammatory response of wounds

  • sequential reaction to cell injury
  • neutralizes and dilutes inflammatory agent
  • phagocytosis removes necrotic material
  • establishes healing environment

286

metabolic acidosis overview

  • serum HCO3 less than 22 mEq/L
  • pH acidotic
  • buildup of hydrogen ions in body

287

causes of HF

  • left
    • HTN
      CAD
  • right
    • pulmonary HTN

288

pressure ulcer overview

  • classifications
    • I - IV
    • suspected deep tissue injury (DTI)
    • unstageable
  • locations
    • ears
    • bony prominences

289

aortic aneurysm

  • aorta - largest artery
  • aneurysm: permanent, localized outpouching or dilation of vessel wall
  • 75% occur in abdominal aorta and 25% in thoracic aorta
  • abdominal aorta >3cm = aneurysmal
    • larger = greater risk of rupture
  • causes
    • degenerative, congential, mechanical, inflammatory, infections

290

phases of burn management

  • pre-hospital
  • 3 phases
    • emergent (resuscitative)
    • acute (wound healing)
    • rehabilitative (restorative)

291

diabetic ulcers

  • poor wound healing + lack of sensation + poor motor = ulcers
  • partial or full thickness
  • usually regular wound edges
  • not a lot of drainage
  • common sites
    • metatarsal head
    • plantar surface of hood
    • under the heel

292

aortic dissection diagnosis

  • ECG, CXR, CT, TEE, MRI
  • complications
    • cardiac tamponade
      • life threatening (descending)
      • blood leaks into pericardial sac
      • manifestations: hypotension, narrowed pulse pressure, JVD, muffled heart sounds, pulsus paradoxus
    • aortic rupture - hemorrhage, exsanguination, death
    • occlusion of blood supply to vital organs 

293

pathophysiology of burns - fluid and electrolyte shifts

  • potassium is key in this stage
  • also water and sodium
    • fluid resuscitation - fluid moving to interstitial space 

294

abnormal PaCO2 levels

  • acidic: >45
  • basic: <35

295

treatment of pressure ulcers

  • based on stage, size, location, amount of exudate
  • may need debridement, cleansing, dressing, relief of pressure
  • clean with noncytotoxic solution
    • no Dakiin's, acetic acid, povidone-iodine, hydrogen peroxide
  • dressing - slightly moist (no wet to dry)
    • pulls out bad tissue but maintains granulation

296

wound regeneration

replacement of lost cells with the same type of tissue

297

Stage IV pressure ulcer

  • full-thickness tissue loss
  • bone, tendone, muscle exposed
  • often includes tunneling and undermining

298

types of ulcers

  • depends on etiology
  • vascular
    • venous
    • arterial
    • pressure
  • diabetic
    • ischemic (2/2 diabetes)
    • neuropathic

299

clinical manifestations of chronic bronchitis

  • dusty, cyanotic
  • recurrent cough + sputum production
  • hypoxia
  • hypercapnia (increased pCO2)
  • respiratory acidosis
  • increased Hgb
  • increased RR
  • exertional dyspnea
  • increased incidence in heavy cigarette smokers
  • digital clubbing
  • cardiac enlargement
  • accessory muscle use
  • leads to R-side HF

300

metabolic alkalosis

  • serum HCO3 greater than 26 mEq/L
  • pH alkaline

301

sexual activity and aging

  • important element to most elderly
  • gender differences in incidence of intercourse and masturbation
  • physical illness directly/indirectly affects sexual function
  • psychological illness affects
  • medications
  • modifiable health behaviors associated with erectile dysfunction in men

302

8 standards of good gerontology care

  • frequent observation
  • attention to meals and eating
  • early and frequent mobilization
  • cognitive stimulation
  • sleep protection and promotion
  • pain management
  • discharge planning
  • family engagement

303

tobacco/alcohol/OTC meds re: HF

  • quitting smoking is critical
  • alcohol
    • can worsen failure
    • increse dysrhythmias
  • OTC meds
    • nothing w.o MD approval

304

causes of resiratory acidosis

  • respiratory depression
    • over-sedation
    • myasthenia gravis (can't take deep breaths)
  • increased levels of CO2
    • acute: arrest, pneumothorax, pneumonia
    • chronic: emphysema, chronic bronchitis

305

Beers criteria

  • criteria for potentially inappropriate medications in elderly
  • American Geriatrics Society
  • examples
    • sliding scale insulin
    • benadryl
    • steroids
    • aspirin > 325 mg/day
    • alprazolam/lorazepam
    • haldoperidol 

306

Stage D HF recommendations

  • advanced or refractory HF
  • symptomatic despite tx
  • considered for transplant
  • hospice for end of life care

307

disability definition

  • difficulty/dependency in carrying out activities essential to independent living, including essential roles, tasks needed for self-care and living independently at home, and desired activities important to QOL
  • needing assistancein >1 ADL (eating, dressing, bathing, getting out of bed)

308

nursing care of Buerger's disease

  • diagnosis of exclusion based on age of onset, Hx, clinical Sx, ruling out other diseases
  • nonpharm Tx
    • complete cessation of smoking tobacco/marijuana
    • avoid limb exposure to cold, avoid trauma
  • pharm tx
    • antibiotics for ulcers and analgesics for pain
    • IV iloprost may be promising
  • surgical tx
    • sympathectomy, spinal cord stimulator, bypass surgery, amputation 

309

COPD drug therapy

  • bronchodilators
    • B2-adrenergic agonists
    • anticholinergics
    • methylxanthines
  • inhaled corticosteroid therapy
  • long acting anticholinergics (Tiotropium/Spiriva)
  • antibiotic therapy (azithromycin)
  • phosphodiesterase inhibitor (roflumilast) - decrease likelihood of exacerbation
  • combivent respimat (ipratropium and albuterol)

310

what do blood vessels do?

  • deliver oxygen
  • deliver nutrients
  • circulate lymphocytes
  • remove waste
  • regulate blood flow and pressure

311

COPD at risk populations

  • smokers
  • occupational chemicals + dust
  • air pollution
  • infection 

312

TB overview

  • infectious disease
    • mycobacterium tuberculosis
      • gram +, acid-fast bacilli
    • aerophilic
  • re-emerged after 1980s
  • at risk populations
  • transmitted via airbone droplets

313

Lund-Browder chart

  • more accurate assessment of extent of burn
  • takes body surface area into account

314

collaborative interventions for disability

  • dietician
  • PT/OT
  • cardiac/pulm rehab
  • pain management

315

atrial fibrillation

  • atria quiver instead of beating effectively
  • blood not pumped completely out of atria
    • may pool and clot
  • risk factors
    • increasing age
    • HD (HTN, prior MI)
    • hyperthyroidism
    • caffeine, tobacco, alcohol
    • sleep apnea
  • can cause stroke - 15% strokes occur in AF

316

phlebitis

  • inflammation of walls of small cannulated veins of hands or arms
  • risk factors - mechanical irritation, infusion of irritating meds, catheter location
  • Sx - pain, tenderness, warmth, erythema, swelling, palpable cord
  • nursing care
    • remove catheter
    • elevate extremity if edematous
    • apply warm moist heat 
    • oral/topical NSAIDs

317

preload

volume of blood in ventricles before contraction

318

causes of disability

  • changes in balance
  • bone remodeling
    • osteopenia, osteoporosis
  • loss of motor neurons
  • tendons/ligaments less flexible

319

sexual activity and older women

  • postmenopausal 
    • vaginal dryness
    • dyspareunia (painful intercourse)
    • decreased clitoral sensation, orgasmic intensity/frequency
    • pain
    • decreased arousal
    • lack of sexual interest

320

gerontologic considerations r/t burns

  • mobility
  • memory
  • delirium onset
  • reduction of subcutaneous tissue
  • decreased vascularity
  • comorbidities
  • self care deficit 

321

compensation - respiratory/metabolic acidosis/alkalosis

322

chronic bronchitis overview

  • presence of chronic productive cough for 3 mo in each of 2 consecutive yeras
  • other cause of chronic cough rules out
  • chronic inflammation of bronchioles
    • irritation
  • smoking = main cause 

323

pre-hospital care of small thermal burns

  • < 10% TBSA
  • cover with clean, cool, tap water dampened towel
  • cooling injured site within 1 minute helps minimize depth of injury

324

respiratory alkalosis overview

  • serum PaCO2 less than 35 mEq/L
  • pH alkaline
  • hypoventilation - fall of CO2

325

side effects of anticholinergics

  • blind as a bat
  • mad as a hatter
  • red as a beet
  • hot as Hades
  • dry as a bone
  • bowel and bladder lose their tone
  • the heart runs alone 

326

digoxin

  • + inotrope - inhibitory effects on sympathetic nervous system
  • symptoms despite standard HF therapy
  • HF with atrial fibrillation
  • 0.125 mg/day
    • serum < 1.0 ng/ml
  • toxicity - N/V, tachy and brady arrhythmias, halo effect
  • antidote - digibind 

327

Stage A HF recommendations

  • control BP, lipids
  • control obesity, diabetes, tobacco, cardiotoxic drugs
  • ACE inhibitors or ARB for HTN/DM

328

hypoxia

reduction of oxygen supply at tissue level

329

intermittent claudication

  • ischemic muscle pain occuring during exercise and relieved by rest
  • good collateral circulation may mean no pain
  • location of pain gives clue to where blockage(s) are

330

infection in older adults

  • hospital-acquired infections 2-3x higher in older than younger patients
  • risk r/t comorbidities, impaired immune fxn, catheters
  • common HAI
    • pneumonia
    • UTI
    • skin infections

331

clock draw and mini cog

  • clock
    • tests executive function
    • draw clock; set to 11:10
  • mini cog
    • clock draw
    • 3 item recall

332

frailty

  • shrinking - weight loss (unintentional > 10 lbs w/o trying in one year)
    • sarcopenia (loss of muscle mass)
  • weakness (grip strength)
  • poor endurance (exhaustion)
  • slowness (walking time/15 ft - 6-7 sec depending on gender/height)
  • low activity: kcals/weeks
    • male < 383 kcal/week
    • females < 270 kcal/week
  • > 3 of the above = frailty phenotype

333

Rule of Nines

initial assessment to determine extent of burn

334

thromboangitis obliterans (Buerger's disease)

  • non-atherosclerotic, segmental, recurrent inflammatory disorder
  • risk factors: male < 45 yo, tobacco or marijuana use, chronic periodontal infection, w/o other CVD risk factors
  • acute/chronic phases
  • symptoms
    • intermittent claudication of hands/feet; rest pain
    • ishcemia ulcerations; temp/color changes of limbs
    • paresthesia; cold sensitivity; superficial vein thrombosis

335

asthma diagnostics

  • detailed hx and physical
  • peak flow monitoring/PEFR
    • peak expiratory flow rate
    • trend throughout disease
  • pulmonary function tests
    • spirometry
  • CXR
  • ABGs

336

clinical manifestations of aneurysm

  • thoracic aortic aneurysms - often asymptomatic
    • deep, diffuse chest pain; angina
    • hoarseness; dysphagia
    • JVD; edema
  • abdominal aortic aneurysms - often asymptomatic and found via routine physical examinations or incidental
    • pulsatile mass in periumbilical area slightly left to midline
    • bruits, back pain, epigastric discomfort and altered bowel elimination
    • blue toe syndrome 

337

adequate urine output in emergent phase of burn recovery

0.5 ml/kg/hr

338

Stage D HF

refractory HF requiring specialized interventions

339

acute arterial ischemia overview

  • sudden interruption in arterial blood supply to tissue, organ, or extremity
  • caused by embolism, thrombus, trauma
  • clinical manifestations - 6 Ps
    • pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia
  • requires immediate intervention

340

LGBT aging

  • 3 million LGBT elders in US
  • unique economic and health disparities
  • lifetime of stressors r/t discrimination
  • less open about sexuality
  • social isolation

341

wound infection

  • colonizatio nof microorganisms that delay wound healing or destroy tissue
  • patients at increased risk
    • necrotic tissue
    • decreased blood supply
    • high sugar
    • impaired immune function

342

asthma-COPD overlap syndrome

  • persistent airflow limitation
  • shares several features of asthma and COPD

343

Medicaid

  • created by Social Security Amendments of 1965
  • state administered program
    • each sets own guidelines
    • eligibility and services vary by state
  • available to
    • ceratin low-income individuals and families
    • must fit eligibility recognized by federal and state law

344

symptoms of metabolic acidosis

  • restlessness followed by lethargy
  • dysrhythmias (tachycardia)
  • compensatory hypoventilation
  • confusion (decreased LOC, dizzy, irritable)
  • nausea, vomiting, diarreha
  • tremors, muscle cramps, tingling of fingers/toes
  • hypokalemia 

345

Braden Scale

  • sensory perception
  • moisture
  • activity
  • mobility
  • nutrition
  • friction & shear
  • assess q24h

346

strategies to prevent/manage malnutrition

  • make meals social/pleasant
  • home-delivered meals
  • food stamps 
  • dietary consult
  • enteral/parenteral nutrition may be necessary
    • check advance direction/patient/family

347

cognitive changes with healthy aging

  • not severe enough to interfere with everyday function
  • misplacing objects
  • forgetting acquaintance's name momentarily
  • occasional word-finding difficulty
  • slowed intellectual response time
  • limited selective attention

348

nursing assessment for depression

  • assess every elder patient - all at risk as we age
  • structured assessments - use validated tools
  • don't worry about over-identification
    • better to refer than to assume it's loss/normal grief
  • overcome generational misconceptions
    • tx is effective, so reach out
    • cognitive behavioral tx and pharm tx is effective 

349

lower extremity PAD nursing care

  • nonpharm
    • education on risk factor modification, exercise, diet modification, tobacco cessation
  • pharm
    • antiplatelet (aspirin)
    • cilostazol and pentoxifylline for intermittent claudication
  • interventional radiology catheter
    • percutaneous transluinal angioplasty (PTA), stents, atherectomy, cryoplasty
  • surgery - revascularization is optimal
    • peripheral artery bypass graft, endarterectomy, patch graft angioplasty, amputation

350

normal pH levels

7.35-7.45

351

hospitalized elders with malnutrition are at risk for

  • poor wound healing
  • pressure ulcers
  • infection
  • decreased muscle strength
  • post-op complications
  • increased risk of mortality

352

genetic markers in Alzheimer's

  • early onset familial (<60 yo), 5% of cases
  • mutations in
    • amyloid precursor protein on chromosome 21
    • presenlin-1 on 14 
    • presenlin 2 on 1
  • late onset sporadic (>60 yo)
    • apolipoprotein E on chromosome 19

353

symptoms of TB

  • progressive fatigue
  • malaise
  • anorexia
  • weight loss
  • chronic productive cough
  • night sweats
  • hemoptysis (late stage)
  • pleuritic chest pain
  • low grade temp (late afternoon)

354

types of burn injury

  • thermal
  • chemical - acid
  • smoke & inhalation injury
  • electric 
  • cold thermal injury - frostbite
    • mostly epidermis and dermis involvement

355

peripheral vascular and diabetic foot care

  • wash feet daily with mild soap and water
  • pat dry
  • examine daily
  • toenail care
  • guard against frostbite
  • wear clean absorbent socks
  • avoid circulation-restrictive socks or shoes
  • avoid prolonged sitting, standing, crossing legs
  • report skin infections or non-healing sores