Test 2: Older Adults pt 2 Flashcards
describe coronary artery disease
leading cause of death in older people
High LDL, low HDL
blood flow to myocardium; endothelial dysfunction
increase in systolic HTN and arterial dysfunction
L ventricle hypertrophy
increase in leukocyte and platelet adherence and migration
what is heart failure
cardiac output cannot meet metabolic needs
structural and functional defect
most common cause = ischemic L ventricular dysfunction secondary to CAD and HTN
S&S
- peripheral edema
- jugular vein distension
- hypoxia
- dyspnea
- cyanosis
- angina
what is pneumonia
acute lung inflammation
exudate accumulates in small brinchioles and alveoli
body inflammatory response then causes swelling; vicious cycle
2nd leading type of hospital acquired infections
S&S of pneumonia and diagnosis
fever
productive cough with sputum porduced
dyspnea
tachycardia
tachypnea
hypoxemia
high white blood cells + culture
chest x ray = diagnosis
older adults have atypical signs (change in mental status, anorexia, decreased activity tolerance, falls, incontinence, elevated HR, etc
characteristics of UTI
2nd most common infection
body is sterile except for distal portion of urethra; this is where infection usually starts
urinary retention is primary contributor
S&S of UTI
pain with urination
increase frequency/urge
hematuria but not necessarily in elderly
older adults often have no/atypical S&S
what is sepsis
life threatening
body’s response to infection actually injures body’s own tissue
hypotension, fever, elevated HR
high mortality
survivors = often PICS
dehydration implications with older adults/pathophysiology
directly increase in rate of mortality
decreased thirst mechanism with age
reduction in total body fluid and mm
decreased renal function = concentrated urine; body can’t retain fluid
hyper, iso, and hypo tonic meaning
hypertonic = greater loss of water than Na
isotonic = equal loss of water and Na
hypotonic = greater loss of Na than water
symptoms of dehydration
confusion
lethargy
rapid weight loss
functional decline
what is diabetes
metabolic; inadequate insulin (regulates glucose)
type 2 = metabolic
ideal control = diet, exercise, weight control
usually controlled with meds though
uncontrolled = neuropathy, impaired wound healing, renal disease, and visual problems
management in acute settings
85+ more likely to be hospitalized
more vulnerable to iatrogenic affects (delerium, pneumonia, dehydration, loss of control, pressure injuries, mobility decline, anxiety, depression, malnutrition, etc)
American Association of Critical Care Nurses developed initiative to reduce adverse events in acute care
IPR setting management
multidisciplinary
pt must be determined to have significant rehab potential and pt must meet certain criteria
required 3 hours therapy/day at least 5 days/week
trial admission not permitted
reimbursement higher from MC bc of level of care provided
60% of the pts at these facilities must be CMS-13 diagnostic category
skilled nursing setting management
certified by CMS to provide MC reimbursable short term skilled nursing and therapy
more pts have lower functional level and there is no 60% rule
usually require longer length of stay
changes in other settings means that more who don’t need as intense therapy are admitted as well (i.e. total joints)
goal = return home
long term care setting management
some cases after SNF benefit is exhausted
no regular or skilled intervention provided under long term care benefits
MC doesnt cover cost but some private insurances will
periodic screens provided with rehab team
if screen is done and pt is appropriate for therapy services are paid under MC (part B)
goal may just be improve function
