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Nursing and the Aged > exam 4 > Flashcards

exam 4 Flashcards

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1
Q

Pruritus:

A

most common derm problem. caused by excessive bathing, dry heat, diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia, and certain psych probs. Tx: bath oils, lotions vitamin supplements, topical zinc oxide, antihistamines or steriods

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2
Q

Keratosis:

A

small, light-colored lesions gray or brown in color. Tx with freeing agents or acids and electrodisiccation or surgical excision ensure a more thorough removal.Monitor Keratosis closely bc it is precancerous!

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3
Q

Seborrheic Keratosis:

A

dark, wartlike projections on the skin. Sometimes, abrasive activity with a gauze pad containing oil will remove small seborrhic keratoses. Larger, raised lesions can be removed by freezing agents or by curettage and cauterization. These lesions are benign

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4
Q

basal cell carcinoma:

A

most common, grows slowly, rarely metastasizes. Risk factors: advanced age, sun exposure, UV radiation, therapeutic radiation. Growths are small, dome-shaped elevations covered by blood vessels-look like pearly moles

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5
Q

squamous cell carcinoma:

A

most often caused by sun; appear as firm, skin-colored or red nodules. The lower lip is a common site of metastasis

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6
Q

melanoma:

A

deadly if not caught early bc it metastatizes.Prognosis depends of DEPTH of melanoma, not the type.

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7
Q

pressure ulcer with ischemia

A

protect skin with Vigilon

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8
Q

Chamomile:

A

skin inflammation

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9
Q

witch hazel:

A

astringent, bruising, swelling

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10
Q

thyme oil:

A

antiseptic

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11
Q

thyme-linalol and rosewood:

A

topical acne

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12
Q

rosemary:

A

cell regeneration

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13
Q

insect bites and stings

A

basil, cinnamon, garlic, lavendar, lemon, sage, savory, and thyme:

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14
Q

peppermint oil:

A

anti-inflammatory effect and speed healing of wounds and mild burns

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15
Q

nutrition for skin:

A

zinc, mg, essential fatty acids, vits A, B B6, and E.

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16
Q

what contributes to the high prevalence of DM in older adults?

A

obesity and inactivity

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17
Q

indications of diabetes in older adults

A

orthostatis hypotension, periodontal disease, stroke, gastric hypotony, impotence, neuropathy, confusion, glaucoma, Dupuytren contracture, and infection

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18
Q

Why arent urine tests reliable in detecting diabetes in older adults?

A

The renal threshold for glucose increases with age, older thus older adults may be hyperglycemic without evidence of glycosuria.

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19
Q

What is the most effective diagnostic measure of DM in older adults?

A

glucose tolerance test; consume at least 150g of carbs for several days before the tet. older, malnoursihed individuals may be prescribed 300 g. Recent periods of inactivity, stressful illness, and inadequate dietary intake should be reported to HCP bc these situations can contribute to glucose intolerance.

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20
Q

What are medicinal considerations prior to a glucose tolerance test?

A

nicotinic acid, ethacrynic acid, estrogen, furosemide, and diuretics should not be administered before testing bc they decrease glucose tolerance
MAOIs, propranolol, and salicylates may lower blood sugar levels and interfere with testing.

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21
Q

establishing the diabetes diagnosis

A
  1. symptoms of diabetes and a random blood glucose concentration >200mg/dL
  2. Fasting blood glucose concentration >126mg/dL
  3. Blood glucose concentrations 2 hours after oral glucose intake >200mg/dL (the glucose load should be 75g anhydrous glucose dissolved in water)
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22
Q

glibenclamide
glipizide, gliclazide
glimipiride**=newer, safer, less vasoconstriction

A

sulfonylurea: stimulates insulin secretion by clocking ATP sensitive potassium channels on pancreatic beta cells. Watch for hypoglycemia
take 1/2 hour before meals

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23
Q

metformin

A

Biguanide; administer immediately after meal to avoid GI disturbance

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24
Q

Acarbose

A

alpha glucosidase inhibitor; reduces postprandial hyperglycemia. SE Flatulence.

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25
repaglinide
short-acting insulinotropic antidiabetic agent; augments endogenous insulin secretion from the pancreas in response to a meal. Take with meals
26
Rosiglitazone and pioglitazone
thiazolidinediones: can be combined with sulfonylureas, metformin, or insulin increase insulin sensitivity in target tissues, as well as decrease hepatic gluconeogenesis. DO not stimulate insulin release from pancreatic beta cells-->less risk for hypoglycemia. ASSESS FOR CARDIAC DYSFUNCTION PRIOR TO ADMINISTRATION and monitor LFTs
27
metabolic syndrome
high triglycerides, low HDL, and central obesity
28
nutritional supplements to aid in diabetic control
vit B6, folic acid, riboflavin (B2), mg, zinc, and chromium
29
herbs with hypoglycemic properties
bilberry, fenugreek, garlic, ginseng, mulberry leaves
30
What are the typical symptoms an older adult may display with hypoglycemia?
behavior disorders, convulsions, somnolence, confusion, disorientation, poor sleep, nocturnal HA, slurred speech, and unconsciousness
31
What can uncorrected hypoglycemia cause?
tachycardia, arrhythmias, MI, CVA, death
32
Manifestations of retinopathy
hemorrhage, pigment disturbances, edema, and visual disorders
33
drugs known to increase risk of hypoglycemia
beta blockers, salicylates, warfarin, sulfonamides, TCAs, and alcohol
34
What is a potential cause of hyperthyroidism in the older adult?
iodine-induced hyperthyroidism through amiodarone
35
Diagnosis of hyperthyroidism
relies on evaluation of T4, free T4, TSH, and increased uptake of radionuclide thyroid scans
36
immune senescense
age related decline in immune function
37
IgA and IgD
increase in circulation with age
38
IgM and IgD
decrease in circulation with age
39
Foods that positively impact immunity
milk, yogurt, nonfat cottage cheese, eggs, fresh fruits, vegs, nuts garlic, onions, sprouts, pure honey, unsulfured molasses
40
What is the rationale about fasting for increaed immunity?
increased macrophage activity, immunoglobulin levels, and neutrophil antibacterial activity improvement of cell-mediated immunity, ability of moncytes to kill bacteria, and NK cell activity Reductions in free radicals and antioxidant damage
41
What organs are involved in the stress response?
thymus, spleen and lymph nodes
42
cephalosporins, PCNs, fluoroquinolones, macrolides, erythromycin
nausea, gi upset
43
vancomycin
kidney toxicity
44
isoniazid
liver toxicity
45
PCNs
neutropenia, muscle inflammation, liver toxicity
46
nalidixic acid, methronidazole
convulsions
47
aminoglycosides
hearing impairments
48
tetracyclines
photophobia
49
Why are older adults at increased risk of infection?
age related changes in the immune system and high prevalence of chronic disease
50
What is a fever in the older adult?
99 degrees
51
What organisms are primarily responsible for UTI's in older adults?
E. coli (women) and Proteus (men)
52
manifestations of UTI in older adults
burning, urgency, and fever incontinence and delirium retention, hematuria Bacteriuria >105 CFU/mL confirms the diagnosis of UTI
53
What is the most common UTI among older men?
prostatitis
54
Acute bacterial prostatitis
fever, chills, and malaise frequency, nocturia, dysuria, and varying degrees of bladder obstruction secondary to an edematous, enlarged prostrate, as well as lower back and perineal pain.
55
What bug is responsible most often for oneumonia?
Streptococcus pneumoniae
56
what gram-neg bacilli may also cause pneumonia (although it is not the most common)?
Klebsiella pneumoniae
57
pneumonia presentation in the older adult
pleuritis may not be as severe as in the younger population. Instead, watch for slight cough, fatigue, and rapid respirations. Confusion, restlessness, and behavioral changes may occur as a result of cerebral hypoxia.
58
What must a nurse document related to vaccine administration?
administration of the vaccine, name of manufacturer, lot number, and expiration date.
59
What do you do if the pneumonia vaccination status is uncertain?
revaccinate; the revaccination of older adults with the pneumococcal vaccines has been shown to cause local site reactions lasting several days, but no life-threatening effects.
60
Which flu causes the most serious illness and death?
influenza A
61
Presentation of flu in older adult
fever, myalgia, sore throat, and nonproductive cough (flu destroys ciliated epithelial cells of the respiratory tract and depresses mucociliary clearance.
62
what are common complications of flu in the older adult that may contribute risk of death?
secondary pneumonia, myositis, pericarditis, Guillain-Barre syndrome, encephalitis, and a temporary loss of smell or taste.
63
What has shown to increase antibody titres in the older population following flu vaccination?
daily vitamin and mineral suypplements with enhanced antioxidants
64
who cant get the flu vaccine?
febrile conditions, egg allergies, and history of Guillain-Barre syndrome
65
What medications need to monitored for toxic reactions following flu vaccine?
carbamazepine, phenobarbital, phenytoin, theophylline, and warfarin
66
TB presentation
anorexia, weight loss, weakness night sweats may not occur d/t decreased diaphoresis with age. Fever may be absent as well. Regularly screen the older population, and retest a negative Mantoux skin test after one week to confirm a negative result.
67
streptomycin prescribed to treat TB in older adults may result in
peripheral and central nervous system damage-->hearing and disequilibrium
68
Para-aminosalicylic acid prescribed to treat TB in older adults may result in
irritation to the GI tract, anorexia, nausea, vomiting and diarrhea-->risk for malnutrition change in gastric secretions can cause these tablets to pass through GI tract without being absorbed-check feces for undissolved tabs
69
Isoniazid prescribed to treat TB in the older adult may result in
toxic effects on peripheral and central nervous systems
70
What kills scabies?
L:inane and oral antihistamines and mild topical corticosteriods to control pruritus (rash may persist up to 1 month following treatment)
71
How do you manage the environment during a scabies outbreak?
laundry isolation during entire period of treatment. Launder all linens and previously worn clothing in hot water or dry cleaned. Seal items that cannot be laundered in plastic bags and dont use them for two weeks. Disinfect surfaces (mites can live up to three days on a surface other than the body)
72
HIV presentation in the older adult
low-grade fever, headache, sore throat, fatigue, nausea, and a rash. These symptoms may last for several months, and then the individual may be asymptomatic. Blood will test positive after 2 months.
73
first line treatment for C. diff
metronidazole | then try Vancomycin within a few days if pt is unresponsive to metronidazole.
74
How is MRSA spread
nasopharyngeal secretions and heads | Linezolid (Zyvox) and the combination of quinupristin with dalfoprestin (Synercid) are treatment options
75
VRE (Vancomycin-Resistant Enterococcus
genes present in VRE can be transferred to other gram+ organisms such as Staph aureus. Zyvox and Syncercid are the only drugs at present effective at treating VRE.
76
What is the single most important risk factor for cancer?
AGE!!!
77
What age peaks the male risk for cancer?
80-84
78
What age peaks the female risk for cancer?
85 or older
79
Why is cancer often at an advanced stage when diagnosed in an older adult?
despite having the highest rate of most cancers, older adults have the lowest rate of receiving early detection tests.
80
Why does risk of cancer increase with age?
Two Theories: 1. reduced mitochondrial activity of the cell reduces its ability to resist cancer 2. changes in the immune system (reduced T-cell activity, interleukin-2 levels, and mitogen responsiveness) impair the body's ability to recognize cancerous cells and destroy them also, prolonged exposure to carcinogens over the years-->melanomas, lung cancer
81
High fat diet increases risk of which type of cancers?
breast, colon, uterus, and prostate
82
nitrate contaminated water increases risk for which cancer?
Non-Hodgkin's lymphoma
83
Special questions to ask an older adult during examination of the thyroid gland
Before the 1950's, x-rays were used to treat acne, ringworm of the scalp, and enlarged thymus, tonsil, and adenoids. This exposure to radiation increased the risk for thyroid cancer. Ask about these treatments during the health assessment of an older adult!
84
Women at increased risk of breast cancer
BRCA1 or BRCA2 gene carriers (breast CA onset often before age 50) first period before age 12 first child after age 30 first degree relative with Breast CA or ovarian CA women whose mother took DES during pregnancy-vaginal CA
85
woman with a relative who had colon cancer
increases risk of ovarian cancer
86
What screenings does Medicare reimburse?
The sexy ones! | breast, cervical, colorectal, and prostate cancers
87
CAUTION
a mneumonic developed by the American Cancer Society in which each letter represents the first letter of a cancer warning sign - Change in bowel or bladder habits - A sore throat that does not heal - unusual bleeding or drainage - thickening or lump in the breast or elsewhere - indigestion or swallowing difficulty - obvious change in wart or mole - nagging persistent cough or hoarseness
88
Why are older adults at increased risk for surgical care?
older adults have a smaller margin of physiologic reserve and are less able to compensate for and adapt to physiologic changes. What can the nurse do? strengthen capacities pre-op maintain capacities post-op be alert for early SOI/complications
89
How many pre-op baths are recommended for the older pop?
three. one morning and night before surgery, and one the day of surgery.
90
atelectasis presentation in the older adult
decreased lung sounds and a low-grade fever. Xray may not show the condition
91
OBRA '87 requirements
HIghly stringent nursing home regulations: use of standardized assessment tool called the minimum data set (MDS) reduction of restraints and psychotropic drugs increased staffing resident rights training for nurse aids
92
MDS completion guidelines
MDS is a standardized assessment tool that must be completed on admission, whenever there is a change in resident's status, and annually
93
hierarchy of nursing facility residents' needs
Healing (illness as an opp for self discovery) holism (self care as much as possible) hygiene (basic survival need)
94
Assumption woven into the model of holism and healing
psychological, social, and spiritual well-being are of equal and sometimes greater importance than physical well-being.
95
culture change
``` home like instead of institutional environment consistent staff assignments individual care plans nurturing positive relationships staff education ``` Models developed in the culture change movement include the Pioneer Network, Wellspring, and Eden Alternative.
96
profile of the older adult greatest at risk for abuse
disabled woman, older than 75 years, who lives with a relative and is physically, socially, or financially dependant on others
97
tool for assessment of elder abuse
Elder Assessment Instrument (EAI) developed by Fulmer

Nursing and the Aged (5 decks)

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