Week 3: Health Assessment, Lab Values/Diagnostics, Geropharmacology Flashcards
(149 cards)
1
Q
Health History includes:
A
- Demographic information
- Past medical history
- Current medications and dietary supplements
- Social history
- Functional history
- Review of systems
2
Q
What are factors that influence the collection of health history in older adults?
A
- Visual and auditory acuity
- Manual dexterity
- Language and health fluency
- Adequacy of translation materials
- Availability of a trained interpreter
- Cognitive ability and reading level
3
Q
Review of Systems
A
- Conducted prior to physical examination.
- Complex and time consuming
4
Q
Why is the review of systems in older adults more complex and time consuming?
A
Because of the number of health problems present in older adults. One system often affects another system.
5
Q
What are some limitations that may affect the ability to complete the physical assessment in an older adult?
A
- May be difficult to complete in one setting (depending on patient’s stamina)
- Physical and cognitive limitations may affect the ability to perform the assessment.
6
Q
What are the two physical assessment tools used in older adults?
A
FANCAPES and SPICES
7
Q
FANCAPES
A
Fluids Aeration Nutrition Communication Activity Pain Elimination Socialization and social skills
8
Q
SPICES
A
Sleep disorders Problems eating Incontinence Confusion Evidence of falls Skin Breakdown
9
Q
What is the functional assessment?
A
Evaluation of person’s ability to carry out basic tasks for self-care and tasks needed to support independent living.
10
Q
What is the functional assessment used for?
A
- Identifying specific areas of help
- Identifying changes in ability from one time to another
- Provides information useful for assessing safety.
11
Q
What tools can be used to assess activities of daily living?
A
- Kartz Index
- Barthel Index
- Functional Independence Measure**
12
Q
Functional Independence Measures assess three levels of functioning:
A
- Independent
- Assisted
- Unable to perform
13
Q
What can be used to assess both function and cognition in older adults?
A
Blessed dementia scale
14
Q
Blessed Dementia Scale
A
- Used when assessing both function and cognition.
- Incorporates ADLs, instrumental activities of daily living, memory recall and finding ones way outdoors.
15
Q
What are other cognitive measures assessed in older adults?
A
- Mini mental state examination
- Clock drawing test
- Mini-cog
- Global Deterioration Scale
16
Q
Mini-Mental State Examination
A
Used to assess mental status**
17
Q
What can be used to assess mood in older adults?
A
- Geriatric Depression Scale
- Cornell Scale for Depression in Dementia
18
Q
Geriatric Depression Scale**
A
….
19
Q
Comprehensive Geriatric Assessment
A
Combines physical, functional and psychosocial components into one instrument.
Provides a basis for a detailed plan of care.
20
Q
Outcomes and Assessment Information Set** (OASIS)
A
- Identifies the plan for nursing care in the home.
- Aimed at preventing re-hospitalizations and ensuring safety in the home setting.
21
Q
Resident Assessment Instrument
A
Mandated for use in all skilled nursing facilities that receive compensation from either Medicare or Medicaid.
22
Q
Older Americans Resources and Services: Multidimensional Functional Assessment Questionnaire consists of
A
- Social resources
- Economic resources
- Mental health
- Physical health
- ADL and IADLs
23
Q
Hematological Testing includes what values?
A
- RBC
- Hgb
- HcT
- Iron
- WBC
- Platelets
24
Q
What is the normal value of red blood cells?
A
4.4-5.8 million/mm3
25
What is the normal hemoglobin values in older adults?
14-18 g/dL
26
What hemoglobin values are concerning in older adults?
8 or less
27
What is the normal hematocrit value in older adults?
39-48%
28
What is the most common anemia found in older adults?
Anemia of chronic disease
29
Iron studies include
- Serum iron
- Ferritin
- Total iron binding capacity
- Transferrin
30
While anemia is not normal in the older adult, it is a common finding in
Frail older adults and those with chronic diseases
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Diagnostic work up for anemia includes
- CBC with differential
- Iron studies
- Folic acid
- Vitamin B12
32
Normal Neutrophil Value
55-70%
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Normal Eosinophil Value:
1-4%
34
Normal Basophils Value
0.5-1%
35
Normal Monocytes Value:
2-8%
36
Normal Lymphocyte Value:
20-40%
37
Neutrophils
Stimulated by phone if infections to fight bacteria
38
Eosinophils
Stimulated by allergic responses to fight antigens and parasites
39
Basophils
Stimulated by the presence of allergens, and transports histamine
40
Lymphocytes
Stimulated by the presence of viral infections.
| Divided into two types: T cell and B cells
41
Monocytes
- Largest of the leukocytes.
| - Become macrophages when matured which defends the body against foreign substances.
42
What is the normal platelet value?
150,000-400,000/mm3
43
Platelets and aging
Platelet count does not change with aging.
| However, an increase in coagulation enzymes can lead to hyper-coagulability in the older adult.
44
Erythrocytes Sedimentation Rate
Indicator of inflammation, infection, necrosis, infarction or advanced neoplasm.
45
Erythrocytes Sedimentation Rate in older adults
May be slightly elevated secondary to chronic disease
46
C-Reactive Protein
- Produced during the acute phase of inflammation.
| - Useful indicator for cardiac events and the course of other diseases.
47
B Vitamins include
Vitamin B12 and Folic Acid
48
Folic Acid
Important for normal function of RBC’s and WBC’s
49
Vitamin B12 is important for
Normal development of RBC’s, neurological function and DNA synthesis
50
Vitamin D
Deficiencies reduce the absorption of calcium into the bone.
51
Electrolytes
- Maintain a balance between intracellular and extracellular movement.
- Regulates hydration, blood pH and are critical for nerve and muscle function.
52
Most common electrolytes include
- sodium and chloride
- potassium
- glucose
53
Hyponatremia Levels
< 130
54
Hypernatremia Levels
>145
55
What are 3 categories of hyponatremia?
1. Decreased extracellular fluid (diarrhea, renal salt loss)
2. Increased ECF (heart failure)
3. Normal ECF (SIADH)
56
Hypernatremia is most often caused by what?
Free water loss (vomiting, diarrhea, dehydration)
57
Hypernatremia is associated with what symptoms?
- Lethargy
- Irritability
- Weakness
58
Hypokalemia Symptoms include
- Muscle weakness
- Cramping
- Confusion
- Fatigue
- Paralytic Ileus
- Atrial and ventricular ectopy
- Tachycardia
- Fibrillation
- Sudden death
59
Hypokalemia is associated with
ECG changes such as:
QT interval prolonged
T wave flattened or depressed
ST segment depressed
60
Hyperkalemia Symptoms include
- Impaired muscle activity
- Weakness
- Muscle pains/cramps
- Increased GI motility
- Bradycardia
- Cardiac arrest
61
Hyperkalemia is associated with
-EKG changes
62
What EKG changes are associated with hyperkalemia?
- Flattened P Wave
- Large T wave, peaked
- QRS broad
- Biphasic QRS-T complex
63
Glycosylated Hb (HgbA1C)
Provides a snapshot of blood glucose over the last 120 days.
64
In nondiabetics, HgbA1C should be what?
< 5.7%
65
What HgbA1C level is considered good diabetic control in diabetic patients?
< 7%
66
What is considered to be a fair control of glucose in diabetic patients?
8-9%
67
What HgbA1C level is considered poor control of glucose in diabetics?
> 9%
68
Uric Acid
End product of purine metabolism.
69
Uric Acid Levels are used for
- Diagnosis and treatment of gout.
| - Evaluation of renal failure and leukemia.
70
Prostate-Specific Antigen
Primary screening tool for prostate cancer.
71
Serum Albumin
Most often used to measure nutritional status.
| Most useful as indicator of severity of illness and risk of mortality.
72
Serum Albumin measures what?
The half-life. Which is representative of about 3 weeks.
73
Prealbumin
May be more informative of current nutritional status as the half life is 2-3 days.
74
BUN
Measurement of nitrogen portion of urea.
| Used as gross measurement for renal functioning.
75
Normal BUN Values:
10-20 mg/dL
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Creatinine
- Key component in determining eGFR.
- Used to diagnose and monitor renal function.
- More accurate reflection of renal health than BUN.
77
Anticoagulant Monitoring includes
- Prothrombin Time
- Partial Tromboplastin Time
- INR
78
Normal Digoxin Values:
0.9-2 night/mL
79
Signs of Digoxin Toxicity
- Halovision
- N/V
- Headaches
- Flu-like symptoms (weak, achy)
Look up more!!
80
Normal INR value
2-3
81
Table 8-4 on page 97: Specific INR values
*NEED TO KNOW*
82
What values can indicated digoxin toxicity?
...
83
Thyroid Panels
Includes TSH, T3 and T4.
84
What are thyroid panels used for?
Used to diagnose or monitor thyroid disorders and their treatment.
85
If goiter is present,
A thyroid scan may be necessary.
86
Pharmacokinetics
Study of the movement and actions of a drug in the body.
| Absorption, Distribution, Metabolism and Excretion
87
Absorption depends on:
- Route of administration
- Bioavailability
- Amount of drug that passes through absorbing surfaces in the body.
88
Distribution
-Once absorbed, systemic circulation transports drug to receptor site on target organ.
89
Distribution to organs with lower blood flow occurs
More slowly and results in lower concentrations.
90
Distribution depends on:
availability of plasma protein in the form of lipoprotein, globulins, and especially albumin.
91
Excretion
Drugs and their metabolites are excreted in sweat, saliva and other secretions but primarily through the kidneys.
92
Renal drug excretion occurs when
Drug is passed through kidney.
93
Renal drug excretion involves
- glomerular filtration
- active tubular secretion
- passive tubular reabsorption
94
What is an important consideration in older adults to prevent drug toxicity?
Assessment of creatinine clearance rates
95
Pharmacodynamics
Physiological interaction between medication and the body.
96
The older a person gets, the more likely he/she will have altered and unreliable
Pharmacodynamics
97
Polypharmacy
Taking multiple medications at same time. Approx. 5 or more.
98
Taking more than five medications at a time can increase the risk for:
- Frailty, disability
- Death
- Falls
- Medication interactions
- Adverse events
99
Types of medication reactions include
- Medication-herb/supplement interactions (Table 9-1)
- Medication-food interactions (Table 9-2)
- Medication-medication interactions
100
Medications via Enteral Feeding Tubes: Possible Outcomes
- Occluded tube
- Reduced drug effect
- Drug toxicity
- Patient harm
- Patient death
101
The three most common medication errors
- Incompatible route
- Improper preparation
- Improper administration
102
Adverse Drug Reactions or Events
Occurs when there is a noxious response to a medication.
103
Drugs that increase the concern for adverse drug reactions include
```
Corticosteroids
Anticoagulants
Sedative hypnotics
Immunosuppressants
Chemotherapeutic agents
```
104
To minimize the likelihood of ADRs:
“Start low and go slow”
105
“Beer’s Criteria”
- Potentially inappropriate medication.
- Drugs identified to have a higher than usual risk when used in older adults (Box 9-7).
- Overwhelming benefit versus risk documentation when prescribing these drugs considered a standard of practice.
106
Psychoactive Medications
Affect mental function, which in turn can affect behavior.
107
Medications with psychoactive properties have a higher risk for
Adverse events.
108
Psychoactive Medications requires
Thorough assessment.
| Should never be used as a quick fix.
109
Antipsychotics, when used appropriately and cautiously, can be used to provide
Relief from frightening and distressing symptoms
110
Issues Associated with Psychoactive Medications include
Malignant syndrome
| Movement disorders
111
Movement disorders include
Acute dystonia
Akathisia
Parkinsonism Symptoms
Tardive dyskinesia
112
Nursing Implications for safe medication administration in geriatric patients
1. Ensure medication is used appropriately, effectively, and safely.
2. Monitor for signs and symptoms of ADRs.
3. Prompt recognition of changes in patient status that can affect drug regimen.
4. Patient and family education on purpose and side effects of all medications to enhance safe compliance with drug therapy.
113
The brown bag approach
- Asks the person to bring in all medications being taken, including over the counters, herbals, or dietary supplements.
- Ask how medication is taken rather than depending on label.
114
The most common intervention to promote medication adherence is
Education
115
Promotion of healthy aging related to medication use includes:
```
Key persons
Environment
Timing
Communication
Reinforce teaching
```
116
Medication Education in Geriatric Patient’s
- Assess readiness to learn, ability to comprehend and functional capacity to incorporate lifestyle adaptations for medication management.
- Pamphlet and booklets written in lay terms and in appropriate language and reading level should be available.
117
Teas
- Are both foods and herbs.
- May have beneficial antioxidant properties.
- Consumption of more than recommended amounts of certain teas may cause illness or death.
118
Chamomile
- Usually taken in tea form.
- Primary uses: anti-inflammatory and antispasmodic.
- Promotes sleep and reduces anxiety.
119
Echinacea
-Shown to be effective for the prevention of upper respiratory infections or decreasing their duration by 1-2 days.
120
Adverse reactions of Echincacea
```
Fever
Sore throat
Diarrhea
N/V
Abdominal pain
Dry eyes
```
121
Who should use echinacea with caution?
Persons with HIV or autoimmune diseases
122
Garlic
Composed of more than 200 chemicals.
| Primary active ingredient is sulfur called allicin.
123
What are the reported benefits of garlic?
- Decreased blood clots
| - Reduced total serum cholesterol and low-density lipoprotein.
124
What are possible adverse reactions of garlic?
- Severe allergic reactions
- Increased flatulence
- GI irritation w/ nausea and heartburn
125
Ginkgo Biloba
- May benefit cognitive function in dementia.
- There is no scientific evidence that ginkgo impacted cognitive impairment, memory, attention, language, visual-spatial ability, executive functions, or reduced prevalence of dementia and Alzheimer’s disease.
126
Gingko Biloba Side Effects
Bleeding
127
Ginseng
Improves well-being and helps with stress adaptation.
Enhances Immunity
Decreases cellular oxidation
128
Ginseng: Possible Side Effects
Box 10-1
129
Glucosamine and Chondroitin Sulfate
- Support cartilage and connective tissue
| - Typically used in osteoarthritis d/t mild anti-inflammatory effects.
130
Glucosamine and Chondroitin Sulfate should be used with caution in persons with
Diabetes
Shellfish allergies
Asthma
131
Hawthorn
- Use in the treatment of heart disease, digestive and kidney problems.
- Reported to increase CO
- Antispasmodic and antianxiety effects.
- Anti-inflammatory, reduces lipids and has diuretic and sedating effects.
132
Melatonin
- Used as an alternative or adjuvant to sleep medications to promote sleep.
- May be helpful with jet lag
133
Melatonin should be used with caution in persons
Taking other medications that can cause drowsiness
134
Red Yeast Rice
Chemical equivalent and as effective as statins and may be potential alternative for patients who cannot tolerate statins.
135
With Red Yeast Rice, be aware of a contaminant
“Citinin” which can cause kidney failure.
136
St. John’s Wort
Used to treat mild or moderate depression and seasonal affective disorder, anxiety, pain.
137
St. John’s Wort is contraindicated with
-With other antidepressant use, especially selective serotonin reuptake inhibitors (SSRIs).
138
How long after discontinuing St. John’s Wort before you can begin taking an antidepressant?
Wait 2 weeks after discontinuing
139
Saw Palmetto
Offers mild to modest symptom improvement for BPH.
| Don’t use with other drugs used to treat BPH or prostate cancer.
140
What herbs and supplements can be used to treat hypertension?
1. Hawthorn
| 2. Dietary calcium
141
Dietary Calcium and HTN
Dietary calcium in enriched low-fat dairy products taken 3x daily and may lower BP in moderate HTN
142
Popular herbals for GI disorders include
- Psyllium
- Calcium
- Cranberry
- Probiotics.
143
Chronic alcohol-induce and fulminate hepatitis have both been positively affected by the use of
Milk thistle
144
What herbs and supplements can be used to treat Alzheimer’s?
-Gingko (because it increases blood supply to brain and improves memory and attention).
145
According to Alzheimer’s Association, what can decrease the risk for cognitive decline?
- Moderate physical activity
- Drinking tea one to four times a day
- Maintaining normal serum vitamin D levels
146
What are herbs that can affect bleeding and clotting time?
Ginger
Garlic
Ginkgo
Ginseng
147
Interventions for Gerontological Nursing include
1. Education
2. Check for side effects, adverse reactions and interactions among herbs, supplements, medications, foods and illness.
3. Urge discontinuance of possibly harmful products.
4. Provide relevant information and correct use of product as indicated.
148
Add notes from weekly review PowerPoint
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149
Things need to know for exam 1 are on slide 89 of week 3 PowerPoint
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