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FNP III - Test 1 > Module 1 > Flashcards

Module 1 Flashcards

1
Q

Durable Power of Attorney for Health Care (DPOA-HC)

A

the surrogate for decision making.

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2
Q

an individual’s wishes for medical care when they lack decision-making capability.

A

Advanced Directive

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3
Q

wishes regarding resuscitation, hospitalization, treatment goals and limits

A

living will

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4
Q

ften printed on bright pink forms and wallet cards are given to patients.

A

POLST (Physician Orders for Life-Sustaining Treatment)/MOLST (Medical)

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5
Q

patient- and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Addresses physical, intellectual, emotional, social, and spiritual needs. Facilitates patient autonomy, access to information, and choice.

A

palliative care

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6
Q

most prevalent form of dementia that is chronic and irreversible

A

alzheimers

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7
Q

gradual onset and steady decline in cognition. Short-term memory loss along with one or more of the following:
Disorientation
disturbance in executive function (planning, organizing, and abstract thinking)
Problems with ADLs
At least one common neurologic disorder (aphasia, apraxia, or agnosia)

A

Alzheimer’s disease

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8
Q

early vs late stage AD ?

A

Early stages: irritability, withdrawal, and apathy

Late stages: paranoia, hallucinations, delusions, and agitation

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9
Q

Cognitive change in the sick or hospitalized older adult. Transient waxing and waning LOC.
Presentation: acute onset and fluctuations in orientation and attention.

A

Delirium

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10
Q

State of fluid intake deprivation and/or excess fluid loss. Electrolyte imbalances may accompany (Na is the most significant)

A

Dehydration

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11
Q

serum lytes (Na <148 mEq/L), BUN/creat (ratio of 25:1 or more suggests dehydration), H/H (elevated)

A

Dehydration

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12
Q

how to tx Dehydration?

A 
pre-illness weight (kg)- current weight (kg)= Fluid deficit (L)
Oral rehydration (up to 1500mL/day)
Clysis (sub-Q fluid administration, up to 1500mL/site/day)
IV (consider Na level when selecting fluid)
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13
Q

pt education with dehydration

A

Drink 6-8 eight oz cups of water daily; reduce caffeine and alcohol intake; use sports drinks, tomato juice, or bouillon if Na deficient)

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14
Q

7 kinds of elder abuse

A

physical, sexual, psychological, financial, neglect, abandonment, and self-neglect.

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15
Q

CM and tx of elder abuse

A

CM: pressure sores, bruises, change in behavior, poor hygiene or nutritional status.

Tx: report to state adult protective services and/or police.

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16
Q

History to gather in pt w/ hx of falls?

A

hx of CAD or arrythmias, vision and hearing problems, neurologic dysfunction, lower extremity joint pain/ foot problems, medications

DDROP: diseases, drugs, recovery, onset, prodrome, and precipitants) → post-fall assessment

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17
Q

PE in pts with hx of falls?

A

Romberg test, nystagmus, CV and neuro exam, mobility, function, and strength, cognition, vision, and hearing

TUG (timed up and go test): <20 secs= low risk of falls; >30 secs=high risk of falls

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18
Q

Diagnostics for frequent fallers

A

CBC (anemia and infections), electrolytes, BUN/creat, serum glucose, stool occult blood. EKG. MRI if neuro exam positive

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19
Q

addresses the type of care a patient wants as a disease progresses.

A

5 wishes

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20
Q

unplanned loss of 10% TBW in one year

A

Frailty aka Failure to Thrive (FTT) →

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21
Q

how to tx FTT?

A

Tx: adequate protein and caloric intake (options: meals on wheels), 800 IU of Vitamin D, regular exercise

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22
Q

diagnostic labs for frequent fallers

A 
CBC
Electrolytes and BUN 
Glucose
stool occult 
EKG/ MRI if indicated
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23
Q

Dx labs for FTT?

A

CBC, CMP, BUN/creat, thyroid panel, LFT, Ca, UA, fecal occult blood

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24
Q

a five-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. For BMI, unintentional weight loss, and acute disease

A

MUST Screening Tool

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25
Q

acute care setting. 2 questions: loss of appetite and unintended weight loss

A

MST Screening Tool

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26
Q

six questions related to food in-take, weight loss, mobility, recent psychological stress or acute disease, dementia or depression, and body mass index

A

MNA-SF

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27
Q

Leading cause of death in Geriatrics

A

heart disease, cancer, unintentional injury

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28
Q

goal for elderly pts

A

maintain independence, functional and comfort

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29
Q

5 wishes

A
  • The person i want to make care decisions for me
  • The kind of medical tx i want/dont want
  • How comfortable i want to be
  • How i want people to treat me
  • What i want my loved ones to know
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30
Q

Can be delivered at ANY point of an illness
Prediction of life expectancy is inexact
Focus is on the burden of illness (not illness itself)
FAMILY unit is central focus

A

Palliative Care

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31
Q

Strategies to improve discussion of palliative care

A

providing patients with educational materials before the clinical visit, personalized messages from PCPs, and questions for the patient and family to consider to aid in the conversation

32
Q

Managing EOL constipation

A

Laxative for all pt on opioids; may need multiple classes

Methylnaltrexone (for opioid use constipation)

33
Q

Managing EOL SOB

A

May need home O2 to relieve dyspnea
Opioids (small dose) fro breathlessness
Anxiolytics
Fans + cool air, reassurance, relaxation, distraction & massage therapy (alternatives)

34
Q

Managing EOL Fatigue

A 
Educate about energy conservation
Stagger activities
Treat underlying conditions
Assess ADLs
Consider other causes (depression, medications {BBs}, etc)
35
Q

Managing EOL Nausea

A

Tx with antiemetics
Consider around the clock tx; may require multiple meds
Constipation is a side effect!!
Check for constipation with nausea

36
Q

Managing EOL Anorexia/ cachexia

A 
Small amounts of food
Try varieties of food
Tx underlying causes (nausea, constipation)
Counsel family (often more concerned about this than patient → mutual goal setting)
37
Q

Managing EOL Delirium

A

Assess for reversible causes
- Drugs, Eyes and Ears (sensory deprivation), Low-flow states (not enough O2 or blood to brain), Infections, Retention, Intracranial, Metabolic disorders

Avoid excessive stimulation
Frequent re-orientation
Family education and respite care → exhausting and hard on the family
Meds (haldol, risperidone {EXTREME caution}, olanzapine)

38
Q

Managing EOL Depression

A

Common in elderly

Psychotherapy, cognitive therapy, pharm options (BEERS list elderly, no TCAs; zoloft common and well tol in elderly)

39
Q

Managing EOL Anxiety

A

Counseling, find approach for pt and family

benzos/SSRIs

40
Q

Managing EOL communication (Palliative)

SPIKES

A 
S- setting
P- perception
I- invitation
K-knowledge
E-empathy
S-Summary
41
Q

Provides care for people/families with TERMINAL illness
Prognosis of 6 mos
Typically given at home
Belief is everyone has right to die pain free and in dignity
Provide support for family while pt is alive and after they pass

A

Hospice

42
Q

AD primary symptom:

A

short term memory loss + 1 or more of the following (disorientation, disturbance, in executive functioning, problems with ADLs + 1 or more (aphasia, apraxia, agnosia)

43
Q

most significant electrolyte imbalance in elderly

A

Na

44
Q

CM of dehydration in elderly

A

Nonspecific (confusion, lethargy, rapid weight loss, functional decline)

45
Q

PE for dehydration in eldelry

A 
Med hx: include assessment of fluid intake, functional status, weight and cognition; constipation can indicate dehydration
CV exam (orthostatics); body temp may be elevated, mucous membranes not dry until severe dehydration
Skin turgor poor assessment in elderly
46
Q

Diagnostics for dehydration in elderly

A

Lytes (Na >148), BUN/creat ratio (>25:1), osmolality, hct (elevated), hgb, glucose
Resp and GU infections are common → UA and CXR if needed

47
Q

Management for dehydration in elderly

A

Determined by severity; oral replacement preferred if a viable option
Clysis (subq admin of fluids) less costly option than IV
IV FASTEST
**after dehydration is reversed, can take weeks to months to regain functional or cognitive losses

48
Q

Labs/ dx for malnutrition

A

TSH, glucose, lytes, vit D

49
Q

Unintended Weight loss of >_____ % during 6-12 months needs further investigation

A

> 5%

50
Q

Diagnostics/Screening for unintentional wt loss

A

Mini Nutritional Assessment (MNA) for undernutrition and frailty
CBC, LFTs, CMP, thyroid function tests, lytes, fecal occult blood; hgb a1c if DM is suspected
Imaging: CXR, endoscopy, gastric emptying scan, colonoscopy, EKG/echo IF INDICATED

51
Q

pharm management for unintentional wt loss

A

Dronabinol

Artificial feedings

52
Q

(fda approved cannabinoid) can help with n/v from chemo as well; megestrol typically for pt with HIV, COPD, CF, cancer → large SE profile (thromboembolic events, HTN, adrenal insufficiency)

A

Dronabinol

53
Q

Non-Pharm management for unintentional wt loss

A

Smaller meals, high protein foods
Exercise
Address underlying causes including psychosocial
Dental care, structured meal time, social meal time, assess beverage consistency

54
Q

Screening tools for unintentional weight loss

A

Mini Nutritional assessment short form
Malnutrition screening tool- (MNA)
Malnutrition universal screening tool

55
Q

asks about BMI unintentionally weight loss and acute disease

A

Malnutrition universal screening tool

56
Q

1 questions- unintentional weight loss and one about appetite

A

Malnutrition screening tool- (MNA)

57
Q

a screening tool to help identify elderly patients who are malnourished or at risk of malnutrition. (65 +) 6 questions about food intake,

A

Mini Nutritional Assessment – Short Form (MNA®-SF)

58
Q

in place to prevent long term care facilities from penalizing whistleblowers, increased funding for adult protective services, grants for LTC staff training, and civil and monetary consequences for failing to report abuse

A

Elder Justice Act (EJA)

59
Q

most common cause of elder falls

A

MOST are mechanical (trip over something)

60
Q

Post fall assessment

A

(DDROPP)
Diseases (underlying or new)
Drugs (prescribed, not prescribed, alcohol?)
Recovery (could they recover themselves or need help)
Onset (sudden or prodrome?)
Prodrome
Precipitants (acute → trip, run into something, uneven ground, new place)

61
Q

diagnostics for frequent faller

A

CBC, lytes, BUN, glucose, stool occult blood, EKG, MRI

62
Q

Multidimensional geriatric syndrome
Increased vulnerability to stressors r/t reduced capacity of multiple physiological sx
Increased risk of adverse health-related outcomes (falls, disability, hospitalization, death)

A

Frailty (FTT)

63
Q

how to dx frailty (FTT)

A

MUST meet 3 of 5 s/s

  • Poor muscle strength
  • Poor gait speed
  • Unintentional weight loss
  • Exhaustion
  • sedentary behavior
64
Q

PE for frailty (FTT)

A

Focus on organ failure, malignancy, infection
Check dentition, denture fit, gag reflex, swallowing ability
Hearing, vision, cognitive function, mood, mobility, functional status
FS: ability to perform ADLs, interact and contribute to family/community

65
Q

Labs for frailty (FTT)

A

CBC, lytes, TSH, glucose, kidney function, LFTs, Ca, UA, fecal occult
Possible CXR

66
Q

Goals of Tx for Frailty (FTT)

A

Prevent injury, hospitalizations, remediate symptoms, optimize QOL

67
Q

AD8- Dementia screen

A

USPSTF- insufficient data tro recommend for screening for dementia, ONLY done after concern for cognitive impairment

68
Q

STEADI

A

(stopping elderly accidents, deaths and injuries)

69
Q

use or misuse of multiple drugs (>5 per person or any not medically indicated), including non-prescrition

A

Polypharmacy

70
Q

Should avoid ___ drugs with dementia. H2 blockers ok but avoid in pts at high risk for delirium

A

PPIs

71
Q

Avoid Bactrim = ______ in those with decreased Cr clearance d/t hyperkalemia risk

A

ACE/ ARB

72
Q

Avoid _______ + Cipro, Bactrim, macrolides (except Zithromax) d/t bleeding risk - check IMR closely

A

Warfarin

73
Q

Avoid SSRIs, SNRIs, and ____ in those w/ h/o falls. start low and go slow

A

TCAs

74
Q

carefully monitor for _____ with tramadol, diuretics, SSRIs, SNRIs

A

hyponatremia

75
Q

who should take caution in ASA for primary prevention

A

those > 70

FNP III - Test 1 (6 decks)

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