Exam 1 (Maymester) for Finals Prep

Question 1

Respiratory/Lung infections in older adults. Most common is:

Answer 1

Pneumonia: caused by poor chest expansion, increase in mucus formation, and bronchial constriction, or HAIs as evidenced by shallow breathing, abnormal lung sounds, and sometimes fever. Pleuritic pain and lowered baseline temperature can mask s/sx.

Question 2

Temperature

Answer 2

Know your patient’s baseline temp!! A temperature as low as 99 degrees can be a fever. Watch that your patient doesn’t become hypothermic.

Question 3

Pulmonary Changes:

Answer 3

The trachea stiffens as we age due to cartilage calcification.
Reduced nerve endings = less sensitive gag reflex.
Lungs reduce in size and weight.
Overall reduced vital capacity.

Question 4

Sarcopenia:

Answer 4

Decreased muscle mass/fx due to decreased grip strength and slowed mobiltiy.

Question 5

Presbyopia:

Answer 5

Age related decrease in the eye’s ability to change shape of the lens to focus on near objects. Usually begins around age 40.

Question 6

Cardiac Changes:

Answer 6

Sclerosis and fibrosis (heart valves increase in thickness and rigidity).
As we age, myocardial muscle loses some of its contractile strength.

Question 7

BP regulation:

Answer 7

Regulation is key to preventing or reducing instances of orthostatic hypotension.
The best way to regulate BP is proper diet and exercise.

Question 8

Immune changes:

Answer 8

Decreased T-cell activity leads to production of immature T-cells which leads to decreased ability to fight infection.

Question 9

Orthostatic Hypotension: (safety and prevention)

Answer 9

Safety: Patients are at an increased risk for falls.
Prevention: Slow sitting or standing to reduce fall risk and stay hydrated

Question 10

Dehydration: SATA

Answer 10

Assess for skin turgor, dry mucous membranes, and decreased thirst perception. Check and verify Rx’d medications (anticholinergics and antipsychotics).

Question 11

Hydration:

Answer 11

Adequate fluid intake (3-4 L/day as tolerated) can help reduce/prevent constipation and dry skin (risk for skin tears).

Question 12

Renal Changes:

Answer 12

Urinary incontinence can lead to social isolation and nocturia. Reduced kidney filtration means that medications are not adequately excreted, increasing risk for toxicity.

Question 13

GI Changes:

Answer 13

Presbyesophagus: reduced strength of esophageal contractions and slower transport of food down the esophagus.

Risk for constipation. Inactivity and dehydration are big factors.

Question 14

Primary and Secondary Disease Prevention

Answer 14

Primary: Stress management, yearly flu shots, social engagement, lifestyle teaching, cognitive stimulation, and regular immunizations

Secondary: Evidenced based screenings, annual wellness visits, personal prevention plans, and target diets (DASH).

Question 15

Changes in Taste/Smell

Answer 15

Taste and smell are strongly linked to memory. Caused by decreased neurons sending signals to the brain. Key intervention is monitoring adequate dietary intake of your patient.

Question 16

Fall Prevention:

Answer 16

Adequate hydration, regulated BP, and mobility aides are key to prevention.

Question 17

Polypharmacy: Risks:

Answer 17

Taking 5+ concurrent Rx or OTCs.

Risks include Drug-drug reactions, and increase in morbidity and mortality

Question 18

Polypharmacy Prevention:

Answer 18

Have patient “brown bag” meds/bring in the meds they take so you can cross reference any potential side effects.

Question 19

Polypharmacy Complications: SATA

Answer 19

Multiple Providers
Presence of Chronic Illness
Taking OTCs

Question 20

Iatrogenic Disturbance Pain (IDP)

Answer 20

Pain caused by caring for the older adult.

Question 21

Herbs/OTCs and Interactions:

Answer 21

Garlic, Ginkgo, Ginseng, and St. John’s wort = inc risk of bleeding
Do not take with warfarin, aspirin, coumadin, etc.

Question 22

Antipsychotics: Adverse Reactions:

Answer 22

NMS and EPS
NMS = increased temp, wbc, and heart rate
EPS = tardive dyskinesia, akathisia, and acute dystonia

Question 23

Assessment of the Older Adult: Tools

Answer 23

SPICES = full assessment
Katz = ADLs
Lawton = IADLs

Question 24

Effective Assessment Skills: SATA

Answer 24

Listen to your pt
Don’t judge/use moderated voice
Never Assume

Question 25

Neurological changes:

Answer 25

Delirium = prob a UTI | Mini-cog assessment for neuro fx/changes

Question 26

Beers Criteria

Answer 26

NOT a policy | A guideline for if you think a medication might be inappropriate

Question 27

Nonverbal Pain cues:

Answer 27

Grimacing, groaning, restlessness or pacing, shallow quick breathing

Question 28

Assessment of Pain:

Answer 28

``` Pain diary OLD CART (Onset, Location, Duration, Characteristics, Aggravating, Relief, Tx ```

Question 29

Nonpharmacological tx

Answer 29

Heat/cold, acupuncture, acupressure, massage, TENS, activity, music, guided imagery.

Question 30

Assessment priority for Narcotic tx:

Answer 30

Adequate dose (don't under adminx), eval of effectiveness, repeat pain intensity scale, key is management not catch up.

Question 31

Wellness (definition):

Answer 31

Incorporating all aspects of one's being: Physical, Emotional, Intellectual, Social, Spiritual, Cultural, and Environmental.

Question 32

Drug-food interactions

Answer 32

Ca2+ (like in leafy greens) interacts with Cipro, tetra, Spironolactone, and Levothyroxine.

Question 33

Drug-Supplement Interactions:

Answer 33

CoQ 10, the 3 Gs, and St. John's wort all = increased risk for bleeding

Question 34

Drug allergies

Answer 34

n/v/d = side effects NOT allergic reaction. | An allergic reaction can be a severe as anaphylaxis or as mild as pruritis and swelling.

Question 35

Pharmacokinetics: Absorption:

Answer 35

Medication is taken into the body orally, sublingually, and transdermally. Reduction of saliva, dysphagia, peristalsis, reduction in gastric acids, and delayed stomach emptying all affect abosrption.

Question 36

Pharmacokinetics: Metabolism:

Answer 36

Biotransformation makes substances more easily eliminated from the body. Can be affected by reduction in liver mass/perfusion as well as first pass med absorption.

Question 37

Pharmacokinetics: Excretion:

Answer 37

Most meds are excreted renally but can be excreted through sweat, bile, hair, feces, breastmilk, saliva, tears, and semen.

Question 38

What is First Pass?

Answer 38

Active medications still on board from initial dose. Do NOT take more than prescribed more often than prescribed to prevent toxicity.

Question 39

Changes is skin:

Answer 39

As we age, our skin thins increasing risk for bleeding and tears.

Question 40

Heat Exhaustion/Stroke/Hyperthermia:

Answer 40

Ambient temp > 90. Goal is to get temp under 104. KEEP HYDRATED. Sweaty, pale, tachy leads to crampy, thirsty, confused, leads to no more sweat, more tachy, and dry all over.

Question 41

Hypothermia

Answer 41

Most deaths are older adults Goal is temp > 90 degrees. Risks include DM, impaired circulation, adrenal or thyroid disfunction, inadequate housing or supervision, excessive alcohol consumption, sedatives, heart meds, and antidepressants.

Question 42

LEARN model: SATA

Answer 42

``` Listen to your patient Explain your perception Acknowledge their perception Recommend a comparable plan of action Negotiate a mutually acceptable plan ```