aging 3

pharmacokinetics

the study of movement and actions of a drug in the body

absorption

how the drug enters the bloodstream from the site of administration

distribution

how the drug enters the bloodstream from the site of administration

metabolism

how the body breaks down and chemically changes the drug

excretion

how the body eliminates the drug from the body usualy through urine or feces

pharmacodynamics

physiologic interaction between medication and the body

the older a person gets the more likely the pt willhave altered unreliable pharmacodynamics

anticholinergic side effects

• dry mo9uth

• blurred vision

• urinary retention

• constipation

• tachycardia

• confusion

• drowsiness

• increased intraocular pressure

what do you expect to see with an elevated WBC

• infection

• fever

• pain

• lymphadenopathy

lymphadenopathy

may be minimal or absent in older adults with infections so look for sudden onset of confusion or lethargy

normal INR

2-3

what to assess for with ESR

indicators of inflammation, infection, necrosis, infarction or advanced neoplasm

may be elevated in older adults secondary to chronic disease

what to look for with CRP

marker present in acute phase of inflammatory response

what does it mean when you have low albumin

used the measure nutritional status

prealbumin tells us about current nutritional stauts as the life is 2-3 days

measures half life which is representative of 3 weeks

most useful indicator of severity of illness and risk of mortality

what lab should you monitor with gout

uric acid: end product of purine metabolism

what does it mean when troponin levels elevate

acute cardiac event, noncardiac events or conditions

MI

seen within the first 3-4 hrs, peaking at 24 and lasting up to 7 days

the higher the troponin the higher the risk of death

hyperkalemia

• muscle twitching

• arrhythmias

• increased GI motility

• bradycardia

• cardiac arrest

what can be seen on the EKG with hyperkalemia

• EKG changes

• P wave flattened

• t wave large, peaked

• QRS board

• biphasic QRS-T complex

• cardiac toxicity-can lead to a cardiac arrest

SE of hypokalemia

• muscle cramping

• confusion

• fatigue

• paralytic illeus

• ECG changes

• tachycardia

• fibrillation

• sudden death

what is low K associated with

ECG changes

QT interval prolonged

t wave flattened or depressed

ST segment depressed

ginko

interacts with any anticoagulant increasing the risk for bleeding

ginseng

interacts with insulin and oral antidiabetic drugs

this may cause bg levels to be altered

st john’s wort

interacts with triptans which increase serotonergic adverse effects

serotonin syndrome and cerebral vasoconstriction

what is the effect of aging on drug distribution and labs to monitor

• reduced cardiac output and reduced circulation

• reduced body water

• increased adipose tissue

• reduced serum albumin and other plasma proteins

what is beers criteria

• potentially inappropriate medication

• drugs identified to have a higher than usual risk when used in older adults

• overwhelming benefit versus risk docummentation when prescribing theses drugs considered a standard of practice

what complications can psychoactive drugs lead to in older adults

• affect metnal fuction and affect behavior

• have higher risk for adverse events

• never to be used as a quick fix

• requires a thorough assessment

• antipsychotics when used appropriately and cautiosly can provide relief from frightening and distressing symptoms

issues associated with psychoactive meds

• malignant syndrome

• movement disorders

• acute dystonia

• akathisia

• parkinsonian symptoms

• tardive dyskinesia

what lab work do you monitor for with heparin

APTT

IV heparin use

prevention of

• stroke

• afib

• artificial heart valves

• prevention and tx of DVT

what is the brown bag method

asks the person to bring in all meds being taken including OTC, herbals, and nutraceutical or dietary supplements

ask person how they actually take meds rather than depending on label

what are drugs excreted through

kidneys

what labs need to be reviewed for older adults in regard to the excretion of med in elderly

GI absorption of mg decreases and excretion of mg by the kidneys increases

coupled with lower dietary intake can lead to hypomg

signs of hypoglycemia

harder to recognize

• dizziness

• visual disturbances

these are more common than palpations and sweating

what labs do you expect to see with anemia

hemoglobin drop

• men <13

• women <12

vitamin deficiency

CBC differential

folic acid

B12

is a PSA an expected lab for all older men with their yearly physical

no its only for certain circumstances bc it gives false positives to prostate cancer cause then to undergo aggressive screenign and tx causing more harm

• led to death

• caused bowel or bladder

symptoms of hyponatremia in elder

• high prevalence in LTC facilities

• vague symptoms -malaise, confusion, H/A or seizures

• tachycardia

• hypotension

most common chronic diseases

• heart disease

• stroke

• cancer

• diabetes

• obesity

• osteoarthritis

characteristics of frailty in older adults

• unintentional weight loss >5%

• self-report of exhaustion/fatigue

• low activity level

• low grip strength

• slow gait speed

primary prevention measure

seeking out services and education in order to prevent disease

secondary prevention measure

detecting early disease and seeking care before the disease progresses or symptoms become apparent

tertiary prevention measure

care of established disease, attempts to restore the person to their highest function, minimize the negatibe effects of disease and prevent disease-related complications

quaternary prevention

limiting disability while maintaining functional ability or reducing loss of function through adaption

effects of chronic illness on family/caregivers

• adult children begin to see their own mortality

• guilt, depression, anxiety

• providing support, love, and intamacy can lead to physical physcial and mental exhaustion, impatience, anger, and sense of futility if dying is prolonged

• everyone grieves differenct which often can hinder communication

• during final day the family may feel the need to provide intimate and personal care to the relatives’ life

• they can feel caught between trying to be present with their relative now and pushing aggressive interventions to try and save their life

• theyre faced with the task to let their loved one die

  • if fam isnt present it’ll fall on the nurse

syptoms of actively dying pt

• dyspnea

  • air hunger

  • noisy respirations

• nausea

• pain

• coolness

• restlessness

interventions for actiely dying pt

• ensure pt is comfortable

• comfort>cure

• opioids given in relief of terminal breathlessness and may be combined with lorazepam to alleviate the anxiety that opioids can trigger

• o2

• elevate HOB

• bedside fan

• minimize the need for conversation

• palliative sedation: used for comfort not to facilitate death

spiritual needs of terminally ill older adult

• Indescribable need that drives individuals throughout life to seek meaning and purpose in their existence

• The spiritual aspect of people’s lives transcends the physical and psychosocial to reach the deepest individual capacity for love, hope, and meaning

• Spirituality must be considered a significant factor to understanding healthy aging

  • There are formal spiritual assessments, but open-ended questions can also be used to begin dialogue about spiritual concerns... ASK what they need or want!

  • The caring relationship between nurses and persons nursed is the heart of nursing that touches and supports the spirit and enhances health and well-being

• Spiritual care interventions

how to nurture the spirit of the nurse

• Thinking about what gives your own life meaning, value helps develop your spiritual self and helps you offer spiritual support to patients; compassion

self- actualixation

• Self-actualization is the highest expression of one’s individual potential and implies inner motivation that has been freed to express the most unique self or the “authentic person”

characteristics of self actualization

• courage

• altruism

• humor

• self-renewal

• collective selfactualization

Courage

• Conquer fear and despair in the face of difficulty, danger, pain, or uncertainty

Altruism

• High degree of helping behaviors in many older adults

Humor

• Sustains mental well-being

• Continuous moral development

• The driving forces of morality are love and intellect

• Self-renewal

• Ongoing process as one becomes self-actualized

• Collective self-actualization

• Self-actualized person is powerful and confident

importance of intergenerational activities

• Intergenerational programs can “help older and younger people look beyond their generational stereotypes and know each other (body, mind, and spirit)”

• Nurses in the community may want to explore potential intergenerational experiences that may be of interest to their older clients