Gero Exam 2 Flashcards
(298 cards)
1
Q
Xerosis
A
Dry, cracked, itchy skin
2
Q
What could worsen xerosis?
A
Inadequate fluid intake
3
Q
Nursing management(s) of xerosis
A
Using super-fatted soaps or cleansers
4
Q
Is pruritis a symptom or diagnosis
A
Symptom
5
Q
What is pruritis related to
A
Medication SEs or
Secondary to disease
Threat to skin intergrity
6
Q
Purpura
A
Thin, fragile skin
Extravasation of blood into surrounding tissue
7
Q
Nursing management(s) of purpura
A
Wear long-sleeves
Protect from trauma
8
Q
What is the common locations of xerosis
A
Face
Trunk
Extremities
9
Q
What is the common location of purpura
A
The dorsalis forearm
10
Q
Actinic kerotosis
A
Precancerous skin lesion
11
Q
What is the cause of actinic kerotosis
A
Sun exposure
UV light
12
Q
Nursing management(s) of pt w/ actinic keratosis
A
Dermatology visits every 6- 12 months to monitor and treat
13
Q
Seborrheic keratosis
A
Waxy, raised “stuck-on” appearance, benign lesion
14
Q
Almost all of the older adults over 65 got this ___
A
Seborrheic Keratosis
15
Q
Herpes Zoster
A
painful vesicular rash over a dermatone
16
Q
What is the common location of herpes zoster
A
The upper back
17
Q
Nursing management(s) of herpes zoster
A
Ask for hx of chickenpox
Pain medication
topical medication
Droplet precaution
18
Q
Candidiasis
A
Yeast infection
19
Q
What the common location(s) of candidiasis
A
Skinfolds
Anywhere that is warm, moist, and dark
20
Q
Nursing management(s) of candidiasis
A
Keep skin dry and clean
21
Q
Who are higher risk of candidiasis
A
Obese
Malnutrition
22
Q
Who are at high of risk of pressure injury
A
Immobility and prostheses
23
Q
Treatments of Pressure Injury: DIPAMOPI
A
Debride
Identify and treat infection
Pack dead space lightly
Absorb excess exudate
Maintain moist would surface
Open or excise closed wound edges
Protect healing wound from infection/trauma
Insulate to maintain normal temperature
24
Q
Look at Box 13-10 for Risk factors and Prevention
A
25
Stage 1 of Pressure Ulcers
Skin: Unbroken
Inflammation : redness
26
Stage 2 of Pressure Ulcers
Skin is broken to epidermis or dermis
27
Stage 3 of Pressure Ulcers
Ulcer extends to subcutaneous fat layer
28
Stage 4 of Pressure Ulcers
Ulcer extends to muscle or bone
Undermining is likely
29
Proper nutrition includes all the essential nutrients
Carbohydrates
Fat
Protein
Vitamin adn Minerals
30
Proper nutrition includes all the essential nutrients
Carbohydrates
Fat
Protein
Vitamin and Minerals
31
How much carbohydrates should be include
45-65%
32
How much fats should be include
20-35%
33
How much proteins should be include
10-35%
34
How much vitamin and minerals should be include
5 serving of fruits and veggies
35
The higher the score in the MNA, the patient is
Normal nutritional status (12-14)
36
The lower the score in the MNA, the patient is
Malnourished
37
Overweight
>= 25
38
Obese
>=30
39
Morbid obese
>=35
40
Malnutrition is a _____ syndrome
geriatrics
41
What is the rising incidence of malnutrition does it occurs
Acute care, Long term care, and in the community
42
Consequences of Malnutrition
^ risk of infection, pressure ulcers, anemia, hip fractures, hypotension, impaired cognition, ^ morbidity and mortality
43
Dysphagia
Difficulty swallowing
44
Look at Box 14-17 for Symptoms of Dysphagia
45
Look at Box 14-16 for Risk Factors of Dysphagia
46
Preventions of Aspiration (Dysphagia)
Supervise all meals
Seated and rested before eating
Sitting up @ 90 degrees
Don't rush meals
Alternate solid and liquids
Chin-tuck swallow
Thickened liquids and pureed foods
Avoid sedatives-may impair cough reflex
Keep suction readily available
Oral care
47
Risk factors for changes in fluid balance
Physiological changes in body water content
Impaired thirst sensation
Medications
Functional impairments
Chronic illness
Emotional illness
High environmental temperatures
48
Can Drink Category
Able to drink
May not know what's adequate
Possible cog impairment
Encourage and make fluids accessible
49
Won't Drink Category
Highest risk for dehydration
Able to drink but refuses
Offer frequently
Prevent incontinence
50
Can't Drink Category
Physical incapable to ingesting or accessing fluids
Dysphagia prevention
Swallow evaluation
Safe drinking techniques
51
End-of-life category
Terminally ill
Could be any of the previous 3
Refer to advanced directives w/ regard to hydration wishes
52
Signs of Dehydration
Skin turgor
Weight
Mucous membranes
Speech changes
Tachycardia
v UOP
Dark urine
Weakness
Dry axilla
Sunken eyes
53
What would be more reliable when looking for a pt w/ dehydration
Lab testing
54
How much fluids should the patient be intake
At least 1500 ml/day
55
Interventions for Hydration
Fluid quality (water is the best)
Offer often
Make readily available
Encourage with medications
Provide preferred fluids (no carbonated drink)
Verbal reminders
56
Urge Urinary Incontinence
Overactive bladder
57
Stress Urinary Incontinence
^ intrabdominal pressure (sneezing, coughing, laughing)
defined as leakage of some or more urine
58
Functional Urine
Nothing wrong w/ urinary tract
59
what are the 4 pharmacotherapy for constipation
bulk-forming
stimulant
osmotic
emollients
60
bulk-forming (fiber)
psyllium (metamucil) and methylcellulose
61
What is the first line of drugs for constipation
Bulk-forming due to low cost and few adverse effects
62
What population(s) should be bulk-forming caution?
Frail older people, bed-bound individual, and swallowing problems
63
What can bulk-forming laxatives can cause
abdominal distention and flatulence
64
Nursing consideration when taking bulk-forming
Must be taken w/ adequate fluid intake to avoid obstruction in esophagus, stomach, intestines
65
Emollients and lubricants
Docusate sodium
66
What is the action of emollients
^ moisture content of stool
67
What is emollients are used primarily for?
It is used for constipation but on specific situation (surgery)
68
What population(s) is caution when taking emollients
Frail older people who don't have the strength to push
69
Osmotic laxatives
milk of magnesia (MOM), lactulose, polyethylene glycol (PEG), Miralax, sorbitol
70
Action of osmotic laxatives
Cause water retention in the colon
71
What population should avoid MOM
Individuals w/ renal insufficiency -> hypermagnesemia and hyperphosphatemia
72
What can Lactulose and sorbitol cause
Diarrhea, abdominal cramping, and flatulence
73
If bulk laxatives are ineffective add _____
Osmotic laxative
74
Stimulant laxatives
senna
bisacodyl
75
Action of stimulant
stimulate colorectal motor activity
76
What can stimulants can cause
cramping
elecctrolyte or fluid losses
77
Stimulant laxatives are effective and safe for people w/ _______
opioid-induced constipation
78
Chloride channel stimulating
Lubiprostone
Amitizal
79
Action of Chloride channel stimulating
stimulate ileal secretion and ^ fecal water
80
Chloride channel stimulating is safe, well-tolerated, and effective in _____________
Older adults w/ chronic constipation
81
SEs of Chloride channel stimulating
HA
ND
82
What is a complication of constipation
Fecal impaction
83
Manifestations and complications: fecal impaction
Malaise
Urinary retention
^ temp
incontinence
cognitive decline
hemorrhoids
intestinal obstruction
84
What is the first thing to avoid in fecal impaction
Prevent it!
85
Nursing management of fecal impaction
Digital removal of hard stool from rectum
Use copious lubricant
May take several days
Don't disimpact too much
Ofter very painful
86
Paradoxical diarrhea
causses by leakage of fecal material around the impacted mass
may think they are having a BM
87
How many stages in Non-rapid eye movement?
4
88
What is Stage 1 of NREM
Lightest level
Between being awake and falling asleep
89
Stage 2 of NREM
Onset of sleep
Becoming disengaging from surroundings
Breathing and heart rate regular but temperature drops
90
Stage 3 and Stage 4 of NREM
"slow wave sleep"
Deepest and most restorative sleep
BP v
Breathing becomes slower
Tissue growth and repair occurs
Energy is restored
91
How much REM occurs
25% of the night
92
How long does REM recurs
every 90 mins and get longer later in the night
93
REM Sleep
REM key feature
Breathing ^ rate and depth
Muscle tone relaxes
94
When does dream occur more often
REM; 85%
95
Look Box 17-4 for Age-Related Sleep changes
96
What stages does elder spend less time on
Stage 3 and 4
97
Biorhythm and sleep
age related changes in the body's perception of light-dark cycle and circadium sleep-wake rhythm
98
Sleep Cycle
changes in sleep cycle
v amoutn of deep sleep and time spent in REM
99
Insomnia is a diagnosis
True
100
Medications that affect sleep
SSRI
Antihypertensives
Anticholinergics
Sympathomimetic amines
Diuretics
Opiates
Cough and cold medication
Thyroid preparations
Phenytoin
Cortisone
Levodopa
101
Sleep teaching
Maximaze comfort
Bedroom is for 2 things
Avoid or limit nap < 2 hrs
Exercise and outdoor time
Bedtime routine
Limit tobacco, caffeine, EtOH in evening
Manage GERD
Avoid screentime
If can't fall asleep -> go to another room until feeling sleepy
102
How much moderate aerobic should pt be doing weekly?
2.5 hrs weekly
103
How much muscle strengthening activities should pt be doing weekly
at least 2 days
104
Moderate intensity aerobic activity description
continuous moving involving large muscle groups that is sustained for a minimum of 10 mins; should make your heart beat fast
105
Benefits of Moderate intensity aerobic activity
Improves cardiovascular functioning, strengthening heart muscle, v blood glucose and triglycerides, ^ HDL, ^ mood
106
Examples of Moderate intensity aerobic activity
Biking, swimming, and other waterbased activites
107
Muscle-strengthening description
Activities that involve moving or lifting some type of resistance and work all major groups
108
Benefits of muscle-strengthening
^ muscles strength, prevents sarcopenia, reduce fall risks, improves balance
109
Examples of muscle-strengthening
lifting weight, calisthenics, working w/ resistance bands, heavy gardening
110
Stretching description
therapeutic maneuver designed to elongate shortened soft tissue structures and ^ flexibility
111
benefit of stretching
facilities ROM around joints, prevent injury
112
stretching frequency
2 day/wk
113
Examples of Stretching
Yoga and ROM exercises
114
Balance exercises description
movements that improve the ability to maintain control of the body the bsae of support to avoid falling
115
Benefits of balance
^ lower body strength, ^ balance, helps prevent falls
116
Examples of balance exercises
Tai chi, yoga, standing on one foot, etc
117
Look at Exercise Safety Box 18.6
118
Don't exercise when....
SBP > 200 mmHg
DBP > 100 mmHg
Resting HR >120
2 hr after a big meal
119
Feet Skin becomes:
drier, less elastic, cooler
120
Corns/ calluses
Thick, compacted skin often from prolonged pressure.
121
Nursing considerations Corns/Calluses
Pad and protect the area
Proper fitting shoes
122
Bunions
Bony deformities: great toe or fifth toe from chronic dquzzing or hereditory
123
Nursing considerations of Bunions
Custom shoes, surgery, or steroid injection
124
Hammer toe
Permanently flexed toe (clawlike)
125
Nursing considerations of hammer toe
Custom shoes or surgery
126
Onchomycosis
Yellow, brown, opaque, brittle, and thick nails
127
What foot problem is hard to treat?
Onychomycosis (costly and limited effectiveness)
128
Proper foot care
DM: annual foot exam
Toenails: straight across and soaking 20-30 min (softening the nails)
Proper fitting footwear
Orthotic shoes as needed
129
Is falls a symptom or diagnosis
Symptom
130
Consequences of falls
Hip fractures
Traumatic brain injury
Fallophobiia
131
Fallphobia
fear of falling causing limitations in function
132
Major risk factors of Falls
Orthostatic hypotension
Cognitive impairment
Impaired vision and hearing
Medications
Environmental factors
Weakness and fraility
133
Fall Prevention Interventions
Fall bundles
Environmental modifications
Assistive devices
Safe client handling
Wheelchairs
Alarm/motion sensors
134
Restraints and Side rails
Device to limit movement to prevent harm
135
Consequences of restraints in older adults
Do not effectively prevent falls, wandering, or removing medical equipment
Probably exacerbate the problem
Restrain-related dealt (asphyxiation)
Pressure ulcers, agitation, cognitive decline, depression
136
Preventive phase (pretrajectory)
No S and S
137
Definitive phase (trajectory onset)
S/S and diagnosis present
138
Crisis phase
Life threatening situation
139
Acute phase
Active illness requiring hospitialization
140
Stable phase
Controlled illness course/symptoms
141
Unstable phase
Not controlled but not requiring/desiring hospitalization
142
Downward phase
Progressive decline
143
Dying phase
Immediate weeks/days/ hours before death
144
Fraility
Unintentional weight loss
Self-reported exhaustion
Weak grip strength
Slow walking speed
Low activity
145
BP is okay if less than
150 and 90
146
HTN Interventions (lifestyle changes)
Weight reduction (5-20 mmHg)
DASH diet (8-14 mmHg)
v Na+ intake (2-8 mmHg)
^ physical activity (4-9 mmHg)
EtOH in moderation (2-4 mmHg)
147
HF etiology
damage from HTN and CHD
Ventricles enlarge and dilate
148
CHF Also related to
EtOH abuse
Drug abuse
Chronic hyperthyroidism
Valvular disease
Some chemotherapy medications
Radiation therapy near heart
149
LHF
Pump failure to body
150
Systolic LHF
Decreased contractility (can't squeeze)
151
Diastolic LHF
Decreased filling (can't relax)
152
RHF
Pump failure to lungs
The result from LHF
153
CHF (acute decompensated)
swelling, edema, fluids in lung (pulmonary edema)
S3 and S4 and tachycardia
154
Cardiovascular interventions
Complete assessment of all risk factors and existing disease
Lifestyle changes
Medication regimen tailored to specific disease process and pt needs
Focus on symptom management and prevention of exacerbation of disease
155
ACE and ARB
-pril and -sartan
vasodilation
156
Diuretics
Loop, K+ sparing, thiazdiade
Reduce fluid retention
157
B-blocker
-lol
Improve contractility of heart muscle
158
Progressive disease: over ____ yrs
10-20
159
What is dopamine responsible for
regulates nerve impulses for motor function
160
Classic Triad
Cogwheel Rigidity
Bradykinesia/Dyskinesia
Resting/Non-intention tremors
161
Cogwheel Rigidity
Small jerking movements when affected muscles stretched
Muscle rigidity
162
Bradykinesia/Dyskinesia
Difficult starting, continuing, and or coordinating movement
Shuffling
May become frozen (akinesia)
163
Resting/Nonintention tremors
Fine, rhythmic, purposeless tremors (disappear w/ sleep adn purposeful movements)
Pills rolling, small handwriting, low monotone voice
164
Autonomic Dysfunction (PD clinical signs)
Seborrhea dermatitis
Hyperhidrosis of face and neck
Heat intolerance
Postural hypotension
Constipation
165
Cognitive and Psychologic Dysfunction (PD- Clinical signs)
Dementia
Memory loss, lack of problem solving, v intellect
anxiety
depression
sleep/wake reversal
Visual disturbance
Psychosis
166
Complications of PD: Late stage
Pressure ulcers
Pneumonia
Aspiration
Falls
167
Parkinsonian Crisis
Major complication
precipitated by emotional stress or sudden withdrawal of meds
168
Manifestations of PD complications
Severe exacerbation of tremors, rigidity, and bradykinesia
Anxiety
Sweating
Tachycardia
Hyperpnea
169
Treatment and Interventions PD complications
Respiratory/cardiac support prn
Non-stimulating environment
Psychological supports
Restarting medications
170
PD interventions
Early assessment and symptom management
Surgical procedures
Drug therapy focuses on mimicking or slowing dopamine breakdown
171
Surgical interventions PD
Ablation
Deep brain stimulation
Stem Cell transplantation (experimental)
172
PD Nursing care: Exercises
- life toes when walking
- widen legs while walking
- small steps while looking forward
- tiger corner manipulation
- swing arms w/ walking to improve balance and ROM
- carry bag to counterbalance is necessary
- facial exercises
- read aloud
- speak slowly w/ purpose and concentrated articulation
173
PD Nursing Interventions
Preservation of functional ability and quality of life
^ independence and ADLs
Prevent complications and excess disability
Coping mechanisms
^ Socialization
Support groups for pt and family
Physical therapy and balance trainign
^ strength and ROM
Occupational therapy w/ adaptive equipment
174
PD medications (Dopamine precursors and glutamate antagonists)
levodopa (lardopa)
carbidopa-levodopa (sinemet)
amantadine (symmetrel)
175
Synergistic effect PD
Levodopa converted to dopamine in brain
Carbidopa prevent conversion of dopamine in peripheral tissue
176
Amantadine
^ CNS response to dopamine
177
SEs PD medications
NVD
arrhythmias
blurred vision
darkening of sweat and urine
dyskinesia
postural hypotension
hallucinations
vivid dreams
178
patient with hx of should not take levodopa
TIA, angina, melanoma, narrow angle glucoma
179
Client Education: PD medications
Weeks to months to take effect
v Protein intake
Avoid foods with pyridoxine
Antiemetics and PPIs?H2RA prn
Interventions to v postural hypotension
Teach to report increases symptoms and cardiac SEs
180
MAOB inhibitors
Selegiline
Rasagiline
181
MAO of MAOB
Inhibits enzymes that inhibit and/or breakdown dopamine
182
MOAB is used synergistically with
Levodopa
183
SEs of MOABs
NV
Dizziness
Insomnia
Postural hypotension
HTN @ high doses
184
MOAB contraindicated w/
Prozac and Demerol
185
Client Education MOAB
Take @ same time each day
Report insomnia
Interventions to prevent postural hypotension
Skin exams (risk of melanoma)
Avoid foods containing tyramine
186
Pyridoxine foods
Pork, beef, avocado, beans, oatmeal
187
Dopamine Agonists PD
Bromocriptine (Parlodel)
Pramipexole (Mirapex)
Ropinirole (Requip)
188
Dopamine Agonists PD actions
mimic effects of dopamine in the brain
189
Client Education PD agonists
Same teaching as Levodopa
Don't stop abruptly
May cause compulsive behavior
190
Catecholomethyltransferase Inhibitor (COMP)
Tolcapone (Tasmar)
Entacaptone (Comtan)
191
Action of COMT
Inhibit COMT which breaks down dopamine
192
Client Education COMT
Take w/ food
No EtOH or sedative
Interventions to prevent postural hypotension
Don't stop abruptly
Report muscle control changes, jaundice, dark urine, hallunications
193
Anticholinergics PD
Benztropine (Cogentin)
Trihexyphenidyl (Artane)
194
Action of Anticholinergics
Block the excitatory action of acetylcholine
Help prevent PD symptoms of drooling, tremors, rigidity
195
When does anticholinergics are used
Early in disease or when Levodopa not tolerated
196
Anticholinergics should not be use with
Anticholinergic meds (antihistamines, TCAs)
197
Client Education Anticholinergies
Avoid activity which promotes fluid loss
Don't stop abruptly
198
What is the goal of therapy for GERD
Prevent exacerbation of symptoms
Lifestyle and diet symptoms
Medication management
199
What is the most serious complication of GERD
Aspiration Pneumonia
200
GERD symptoms
Persistent cough, asthma exacerbations, laryngitis, intermittent chest pain
201
Risk factors of osteoporosis
Female
NE ancestry
Advanced age
Family hx of osteoporosis
Low body weight
Low calcium intake
Estrogen deficiency
Low testosterone
Inadequate exercise or activity
Use of steroids or anticonvulsants
Excess coffee or alcohol intake
202
OP complications
Hip fracture -> death within one year
^ incidence of other major complications
Vertebral fractures (silent)
203
Diagnosis of OP
DEXA scan
204
T-score osteopenia
-1 to -2.5
205
Osteoporosis
> -2.5
206
Interventions OP
Weight bearing and resistance training
Adequate calcium and vitamin D intake
Education about fall prevention
Pharmacological therapy to prevent bone loss
207
Bisphosphonates
Prevent bone loss
should be taken w/ a full glass of H20 in the morning or an empty stomach
Must disslve in the acidic environment
Upright for 30 min
208
What is osteoarthritis
normal soft and resilient cartilaginous lining in joint becomes thin and damaged
209
What is the most common symptoms of OA
Stiffness /w activity
Pain w/ activity relieved by rest
210
Most common locations of OA
Neck (cervical spine)
Lower back (lumbar spine)
Hips
Hands
Fingers
Thumbs
Knees
211
Heberden's node
DIP distal interphalangeal joint
212
Heberden's node is only in __
OA
213
Bouchard's node
PIP Proximal Interphalangeal Joint
214
Bouchard's node is in
OA and RA
215
Goal of therapy for OA
control pain and minimize disability
216
Non-pharmacological therapy OA
Weight loss (1 lb= 4 lbs of pressure)
Exercise "motion is the lotion"
-> strength and flexibility (support the joints)
-> water exercise
Physical therapy
Hot/Cold therapy
Adaptive devices
-> cane, shoe lift, and knee brace
217
Pharamacological therapy OA
Acetaminophen 4x/day
NSAID- COX2 (selective NSAID)
Joint injection: intra-articular
Steroid: Inflammation
Hyaluronic Acid (Lubrication)
Acupunture
218
Surgical Intervention OA
Arthroscopy and Total Joint Replacement
219
What is RA?
chronic, progressive, systemic inflammatory autoimmune disease
220
Interventions RA
Complete physical and laboratory assessment
Pharmacological therapy: Pain management, DMARDSs (Methotrexate)
Biological response modifier (-mab)
Exercise and physical therapy
Environmental modifications
Assistive devices
221
Look at OA vs RA chart
222
DM interventions
Screening and early identification of disease
Prevent complications
Assessment of end organ status
Medical management
Assessment of self care ability
Nutrition
Exercise
Close monitoring of residents in LTC environment
223
Thyrocalcitonin
v calcium loss from bone
Balances parathyroid hormone (PTH)
224
Tetraiodothyronine or Thyroxine (T4)
Produced by follicular cells if thyroid gland
T4 converted to T3 in peripheral tissues
225
Triiodothyronine (T3)
4-5 stronger than T4- more potent
226
Thyroid Stimulating Hormone (TSH)
Produced by pituitary gland
227
Thyroid Releasing Hormone (TRH)
Produced by hypothalmus
228
TRH Stimulation test
TRH injected and TSH measured to assess the function
229
Radioactive Iodine Uptake (RAI)
Direct test of thyroid function
Radioactive iodine absorbed by thyroid and thyroid can be visualized assess for nodules
230
Thyroid scan
SImilar to RAI but no Iodine. Radioactive isotopes
231
What is another diagnosis test for Thyroid Function
T3 and T4
232
What should be avoid 7 days before testing the thyroid function
Hormones, steroids, ASA, foods containing iodine
233
Hyperthyroidism etiologies
Grave's disease
Toxic goiter
Women > Men
234
What lab values would be high and low for hyperthyroidism
Elevated T3 andT4
Low TSH
235
Older adults often present w/
(Hyperthyroidism)
Tachycardia
Tremors
Weight loss
Apathetic Thyrotoxicosis
Unexplained Afib
Heart failure
Constipation
Anorexia
Muscle weakness
236
Methimazole (Tapazole) and Proplthiouracil (PTU)
anti-thyroid agents
blocks thyroid hormone production
237
SSKI
Iodides
inhibit thyroid hormone secretion
238
Beta blockers
-olol
manage tachycardia, anxiety, and tremors
239
RAI (Radioactive iodine)
common for Grave disease
used alone or prior to surgery
absorbed by thyroid and radiation destroys tissue
teach radiation precaution
240
Thyroidectomy
Surgical removal of part or all of thyroid
Reserved by severe case or large goiter
241
Thyrotoxicosis
Life-threatening
Exaggeration of hyperthyroid symptoms
242
Treatment for Thyrotoxicosis
Cool w/ ice, v levels of TH, replace fluids and electrolytes, giveO2, stabilize cardiac function, Avoid ASA (^ TH)
243
Hypothyroidism
Slow onset Age 30-60
244
Lab values of Hypothyroidism
^TSH
v T3 and T4
245
Etiologies of Hypothyroidism
Chronic autoimmune thyroiditis
Radioactive treatment , surgery, medications (amiodarone), pituitary/ hypothalamic abnormality
246
Vague S/S Hypothyroidism
Slowed mentation
Gait disturbances
Fatigue
Weakness
Cold intolerance
247
Treatment of Hypothyroidism
Thyroid replacement therapy
Levothyroxine (Synthroid)
248
Nursing care Hypothyroidism
Prevent: chilling, constipation, skin breakdown, infection
Assess: cardiac complications, edema, tachycardia, skin
Lifelong levothyroxine therapy
249
Levothyroxine can cause toxicity to what medication
Digoxin
250
Myxedema Coma Cause(s)
Untreated or uncontrolled hypothyroidism
External stressor including surgery, trauma, infection, excessive exposure to cold temps
251
Manifestations of Myxedema Coma
Hypothermia, mental function rages from depression to unconscious, respiratory depression, hypotension, bradycardia
252
Treatments Myxedema Coma
Supportive measures and stabilization of vitals
Treat underlying cause
Thyroid hormones replacement- be slow related w/ rapid replacement
253
Manifestations of Prostate Cancer
Urinary complaints, retention, hematuria, back pain, cachexia, bone tenderness, lower lymphedema, adenopathy
254
Screening methods Prostate Cancer
Digital Rectal Exam
Prostate Specific Antigen
255
Adult cognition is the process of
Acquiring, storing, sharing, and using information
256
Neuron loss (Physiological changes)
Most pronounced in cerebral cortex
257
Brain atrophy (physiological changes)
Decreased weight
258
Dendrites atrophy (physiological changes)
Impaired synapses (impaired communication between neurons)
Changed transmission of dopamine, serotonin, and acetycholine
259
Slowing is _____
Normal
260
Impairment is ___________
Not Normal
261
Three components of Memory
Immediate Recall
Short-term memory
Remote or long-term memory
262
Immediate Recall
Remember stuff from min- hr ago
263
Short-term memory
Few weeks back
264
Remote or long-term memory
Back to middle age or childhood
265
Memory retrieval
Recall of newly encountered information decreases w/ age
Memory declines noted for complex tasks and strategies
266
Basic intelligence remains _______ with increasing years
Unchanged
267
Cognitive Assessment
Focused assessment:
Complete assessment (laboratory workup), stress, medications, organ dysfunction
268
Common mental disorders in late life are
Depression & anxiety
Mood disorders
Alcohol abuse and dependence
269
Health Promotion: Assessment Mental Health
Risk factors of life transition, loss, and loss of social support
Hx of ability to cope w/ stress and life events
Assessment of cognitive function and/ or impairment
Assessment of substance abuse and suicide risk
270
Health Promotion: Interventions
Enhancing characteristics of hardiness, resilience, and resourcefulness
Enhancing functional status and independence
Promoting a sense of control
Fostering social support and relationships
Education regarding available resources
271
Factors influencing mental health care:
Attitudes and Beliefs: stigma and myth
Availability and Adequacy of Mental Health Care: access and ability to pay
Cultural and Ethnic Disparities:: poverty, language, and cultural understanding
272
What factors contribute to the development of anxiety disorders?
Life events and stressors
273
Anxiety disorder is associated w/
Excessive healthcare use
Decreased physical activity and functional status
Substance abuse
Decreased life satisfaction
Increased mortality rates
274
Anxiety Health Promotion: Assessment
Difficult to diagnose in older adults
Denial
Coexisting medical conditions can mimic anxiety
Common side effects of certain drugs
Drug and alcohol withdrawal also cause anxiety symptoms
Generalized Anxiety Disorder (assessment tool)
275
Anxiety Health Promotion: Interventions
Treatment choices depend on symptoms, specific anxiety diagnosis, comorbid medical conditions, and current medications
276
SSRI
Antidepressants and Anxiety
First line of treatment
277
Short-acting benzodiazepines
sedating
It would take while to be effective
278
Therapeutic relationship between patient and healthcare provider is the foundation of any intervention
True
279
Non-pharmacological interventions for anxiety
CBT
Mediation
Yoga
280
Depression is associated w/
Increased disability
Delayed recovery from illness and surgery
Excessive use of health services
Cognitive impairment
Decreased quality of life
Increased suicide and non-suicide-related death
281
Etiology- multifactorial for anxiety
Health and chronic conditions
Gender
Developmental needs
Socioeconomics
Environment
Personality
Losses
Functional decline
282
Presentation of Depression in Elders
Comorbid medical conditions strongly related to depression in older people
More somatic complaints – physical symptoms
Hypochondriasis – Constant complaining & criticism
Decreased energy and difficulties completing ADLs
Social withdrawal
Decreased libido
Preoccupation with death
Memory problems
Strong association of depression with dementia
283
Depression Assessment
Depression screening scale, H&P, functional and cognitive assessment, medication review, laboratory analysis, comorbid conditions
284
Interventions of Depression
Combination of pharmacologic therapy and psychotherapy and counseling
285
ECT Therapy
Efficacy rates ranging from 60-80%
Safe therapy for older adult @ risk of harm, suicidal ideation, psychotic depression, severe malnutrition
286
Depression screening is important for all older adults
True
287
Intervention Suicide
If suicide risk suspected, ask direct questions
-Have you ever thought about killing yourself?
-How often have you had these thoughts?
-Do you have a plan to carry it out/How would you do it?
High risk patients need to be hospitalized
Moderate and low risk treated as outpatients
Adequate social support
No access to lethal means
288
Myxedema Coma Causes
untreated or uncontrolled hypothyroidism
external stressors
289
manifestations of myxedema coma
hypothermia
mental function range from depression to unconscious
respiratory depression
hypotension
bradycardia
290
treatment myxedema coma
supportive measures and stabilization of vitals
treat underlying cause
thyroid hormone replacement (be slow rt toxicty w/ rapid replacement)
291
Drugs for AD
Cholinesterase inhibitors
292
Cholinesterase inhibitors
Donepezil, galamantamine, rivastigmine
293
Nursing managment of cholinesterase inhibitors
Take w/ food (due to GI distress)
IV: start with low dose and titrate up
294
PLST: Stressors Triggering
Fatigue
Change in behaviors
Misleading stimuli or inappropriate stimulus levels
Internal or external demands to perform beyond abilities
Physical stressors (pain, discomfort, acute illness, and depression)
295
Need-Driven Dementia-Compromising Behavior(NDDH)
What is it?
framework for the study and understanding behavioral symptoms of dementia has a meaning
296
DM Presentation in Older adults
Weight loss and Anorexia
Dehydration
Confusion, delirium
Decreased visual acuity
Fatigue, nausea
Delayed wounding healing
Paresthesia
Incontinence
297
^ risk of amputation diabetes
Hx of amputation
Hx of ulcers
PVD
Severe Nail pathology
Peripheral neuropathy w/ loss of sensation
^ pressure (redness, bony deformities)
298
What medication cause hypothyroidism
Amiodarone
