FINAL Flashcards

Question

meds that can contribute UTI

Answer 1

-ANTICHOLINERGICS -antihistamines -antimuscarinics -antispasmodics -antipsychotics -antiparkinson -muscle relaxers -tricyclic antidepressants -diuretics -sedative hypnotics -benzos -opioids -alpha agonist- sphincter constriction -alpha antagonist- sphincter relaxation -CCB- decrease bladder contraction

Answer 2

-URGE -anticholinergics- oxybutynin, tolterodine -> S/E: dry eyes and mouth, constipation, headache, dizziness, orthostatic BP, confusion -estrogen -beta 3 agonist (mirabegron) -bladder retraining -fluid management -timed voids -STRESS -pelvic floor muscle exercise -surgery -OVERFLOW -relief of obstruction -alpha blockers- BPH - tamsulosin -catheter for 3-4 weeks if retention -> alpha blocker -cognitive impairment -prompted voiding -habit training -bladder retraining -fluid intake

Answer 3

-RF- maceration, immobility, incontinence, decrease perfusion, age, AMS, low albumin, dry skin, low wt, poor nutrition, hx of ulcer, fracture -MC- sacrum, heels, trochanteric -MC- orthopedics and ICU -intense full careful skin exam prior to admission -> document -high protein diet -> healing

Answer 4

-STAGE 1: -non-blanchable red -pain, firm/soft, warm/cool -STAGE 2: PARTIAL THICKNESS: -partial loss of dermis -shallow -> intact or open -serum or serosanginous filled blister -no sloughing or bruising -STAGE 3: FULL THICKNESS SKIN: -subcutaneous tissue visible (not bone, tendon muscle) -slough present but doesnt obscure -can be shallow- nose, ear, occiput (head), malleolus- no adipose -STAGE 4: FULL THICKNESS TISSUE: -exposed bone, tendon, muscle -slough or eschar -undermining and tunneling -osteomyelitis/osteitis -UNSTAGEABLE/UNCLASSIFIED: -full tissue loss obscured by slough -slough- yellow, tan, gray, green, brown -eschar- tan, brown, black -dont remove eschar if stable -SUSPECTED DEEP TISSUE INJURY: -purple or maroon -blood filled blister -painful, firm, mushy, boggy, warm/cool -thin blister, thin eschar can evolve

Answer 5

-heels- moisturize, hydrocolloid dressing over reactive hyperemia, socks, pillow, cornstarch -turn every 2 hours -foam mattress overlay, static flotation overlay (air or water), gel mattress, alternating air mattress overlay, low-air-loss bed, air-fluidized bed -nutrition -debridement -surgery -wet to dry saline dressing

Answer 6

-3+: -wt loss- >10lb in year or >5% -exhaustion -activity low- depends on kcal -kinetic slowdown (slow walking)- depends on ht -strength loss (grip, weakness)- depends on BMI -latent phase- not apparent in absense of stressors -early stages of weakness, slow gait, physical activity -end-stage- high risk short term mortality -adverse outcomes- falls, fractures, hospitalization, chemo, surgery, hemodialysis, disability, dependency, mortality -frality is midpoint btwn independence and death

Answer 7

-ADLs and IADLs -identify stressors- extremes of heat/cold, depression, meds, surgery, hospital, illness -check wt - >10lb in year or >5% -labs- albumin, vit D, B12, folate, magnesium, ca, TSH, CBC, phosphate -aerobics, strength training with weights!!!, and flexibility+balance -low fats, low Na, high Ca, high fiber -low alcohol, high vitamins

Answer 8

-weak appetite nutrition in peril -wt loss -appetite low -nutrition -inactivity -psych (depression, dehydration, immune, low cholesterol) -worsening of physical frailty -> compounded by cognitive impairment and/or functional disability -closer to full dependence and death -4 syndromes predictive of ADR in FTT -> impaired physical function, malnutrition, depression, cognitive impairment

Answer 9

-patronizing ageism- infatilization -neglect- no food, meds, care -financial abuse -risks for elder- chronic disorder, functional impairment, AMS, social isolation -risk for caregiver- substance abuse, psychiatric disorder, hx of violence, stress, dependence on victim -many ED visits for exacerbations of a chronic ds despite care plan resources -refusal of at home care or to leave pt -refer to services for pt and caregiver, money management program, helplines, shelters, teams to coordinate -Adult day care, respite programs, and home health care

Answer 10

-use combo products -any sx in elderly is a SE until proved otherwise -ABSORPTION -decrease HCL, high pH, longer gastric emptying-> decrease absorption -loss of fat -> topicals increased -METABOLISM -long term exposure to environment toxin, alcohol, health, nutrition -decrease liver mass, kidneys -> dec metabolism -low protein levels -> inc serum drugs -idiosyncratic rxn -EXCRETION -decrease nephrons -> GFR -> longer drug half life -more SE, toxicity -DISTRIBUTION -decrease CO and circulation

Answer 11

-type A- expected exaggerated physiologic effects of drug -type B- less common -> idiosyncratic effects, ex. anaphylaxis, dyscarias, toxicity -polypharmacy is primary reason for ADRs -> DDIs -ask open ended questions about ADRs at follow up and annuals

Answer 12

-antipsychotics in pts with parkinsons complicated by psychosis -> quetiapine, clozapine, pimavanserin can be used with caution -AVOID rivaroxaban and dabigatranbc of higher bleeding risk than warfarin and other direct oral anticoagulants -AVOID tramadol -> hyponatremia from SIADH secretion -AVOID opioids with benzos or gabapentinoids -> respiratory depression -Bupropion, pseudoephedrine, vasodilators, and caffeine are removed from the list -> good! -For pts with dementia, histamine H2 receptor antagonists removed -> need an alt to PPI which cause c diff and fracture

Answer 13

-nonbenzo sedative hypnotics -> zolpidem, eszopiclone, zaleplon -> AVOID in delirium -alpha blockers and clonidine -> orthostatic hypotension risk -AVOID digoxin- not the best for afib or HF -sliding scale insulin -> hypoglycemia risk -AVOID metoclopramide for longer than 12 weeks

Answer 14

-brown bag review- have them bring the bottles in -interprofessional care- diff people rx same med -identify prescribing cascade -harm vs benefit -discontinue regimen -combo products or long acting form for pts taking >5 meds -> less pill burden -observed therapy- watch them take it -non pharm therapy

Answer 15

-test thought and communication -mental status exam -attention, memory, reasoning, reality orientation, language -state the nature of procedure, reasons for procedure, alternatives, and risks back to you in their own words -take in info, understand, make informed decision -independence -mental skills for ADLs -Ability to use logic and calculate -Ability and “flexibility” to turn attention from 1 task to another -Executive functions -competence is a legal term- judge

Answer 16

-nature of procedure -reason for procedure or consequence of not -consequences of doing procedure -risks -alternatives- offer coordinated, symptom-directed services such as palliative care early in the disease process -> Curative to palliative options -be able to express an opinion -demonstrate reasoning process for the choice they made -need a witness -document -power of attorney - documented legal gaurdian -dont use negative terminology

Answer 17

-eval without meds -fully awake -try multiple times -sit pt up -eval with family member present -maintain communication with family

Answer 18

-to patient - make sure pt understands -to subspecialist - what are the harm and benefits -to health care team - what else can be offer to pt -make sure pt wants to know prognosis or not -be realistic -explain quality of life with treatments -Conflicts may arise when pt. wants ‘medically futile’ Rx -> tx that does no good

Answer 19

-DNR- CPR, IV fluid or nutrition -DNI- intubate -living will- removes burden from family, friends, physician -health care proxy- 2 witness, legal document -durable power of attorney- signed, dated, witness, notarized, copied, distributed -> for finances -> best to choose 2 diff people (1 for health and 1 for finance) - legal doc -palliative care- still get antibx, nutrition, pain meds, radiation -> sign and witnessed in the living will (pt can change their mind) -organ donation -life sustaining equipment- dialysis, ventilator

Answer 20

-signed by PA or doctor in collab with pt or health care proxy -usually less than a year to live, terminal, incapacitate -1. Prepare for discussion-Understand pts health status, prognosis & ability to consent * Retrieve completed Advance Directives * Determine decision-maker & PHL legal requirements -2. Determine what pt/family know -3. Explore goals, hopes and expectations -4. Suggest realistic goals -5. Respond empathetically -6. Use MOLST to guide choices & finalize pt wishes * Shared, informed medical decision-making and conflict resolution -7. Complete and sign MOLST * Follow PHL and document conversation -8. Review and revise periodically

Answer 21

PALLIATIVE -can be anytime (not terminal) -can be alongside curative or life prolonging tx HOSPICE -terminal -6mo or less -no curative tx -usually at home

Answer 22

-physician, NP, or PA must identify & notify a person from highest priority who is reasonably available, willing, & competent to serve as surrogate decision-maker -person can designate any other person on list to be surrogate, provided no one in a class higher in priority than the person designated objects -pts guardian authorized to decide about health care under Mental Hygiene Law Article 81 -spouse, if not legally separated from pt, or domestic partner -Pts son or daughter, age 18+ -Pts parent -Pts brother or sister, age 18+ -Pts actively involved close friend, age 18+

FINAL Flashcards

(46 cards)