N163 Final Exam (copy)

How can the nurse help the patient to meet the need of hydration?

Provide fluids the older adult enjoys drinking

What are some functional deficits the nurse could identify that contribute to weight loss and not meeting nutritional needs?

• medication interaction disrupting appetite

• significant arthritis making it difficult/impossible to:

  • lift pots and pans

  • ambulate

What are some age-related changes with nutrition?

• decreased saliva

• decreased mobility

• decreased nutrient absorption

• decreased digestive enzymes

• decreased stomach elasticity

How can the nurse aid the patient in achieving their nutritional goal?

Provide more frequent, smaller meals throughout the day for the geriatric population

What is an example of an age-related issue that contributes to constipation?

Reduced peristalsis

How can the nurse help the patient to reduce constipation?

Encourage a high fiber diet and more fluids

What are some micronutrients that are commonly lost or deficient in older adults?

• vitamin D

• vitamin B12

• calcium

What are some warning signs of malnutrition?

• economic hardship

• tooth loss or mouth pain

• reduced social contact

What are the labs for malnutrition?

• transferrin

• albumin

• pre-albumin

  *there is no single lab value that represents nutritional status

When does cachexia occur?

Happens at the end of life in cancer patient

When does sarcopenia occur?

Happens with prolonged immobility

What is a suspected issue in a patient with aspiration pneumonia and stroke?

Difficulty swallowing (dysphagia)

What is xerostomia and how can the nurse help?

• unusual dryness

• offer additional fluids

What information does the nurse need to collect from a patient with abdominal pain?

Elicit information about:

• duration

• location

• mode of onset

• intensity

• quality

• rhythm

What are interventions for abdominal pain?

Measures to increase comfort and provide pain relief:

• IV fluids

• NGT

• monitoring of:

  • VS

  • I&O

  • vomiting

  • diarrhea

What are some possible causes of chronic gastritis?

• ulcer

• hiatal hernia

• vitamin deficiency

• chronic alcohol use

• gastric mucosal atrophy

• achlorhydria

• peptic ulceration

What occurs in the body with chronic gastritis?

Inflammation of stomach lining that may occur repeatedly or continue over a period of time

How would the nurse manage a patient with either an ileus or intestinal obstruction?

Maintenance of hydration and promotion of comfort

What does an intestinal obstruction pain need?

bowel rest

Why do endocrine disorders in the geriatric population need to be diagnosed

Rule out changes in condition that could signal depression

What are lab tests for thyroid function?

• T4

• TSH

How does the reduced availability of sex hormones in both genders affect vascular responses to sexual arousal?

It results in less rapid and less extreme vascular responses to sexual arousal

What disease processes can affect sex?

HIV and surgeries

*use the opportunity to discuss sexuality in the older adult and ID areas of concern

What sexual changes should the nurse be aware of in the older adult?

Normal changes in aging

• ED

• menopause

• lack of period

• vaginal dryness

What should nurses examine about themselves?

They should examine their own personal beliefs about LGBT practices and ensure they do not prevent older adults from fulfilling their sexual needs

What does self-examination by nurses help with?

It allows them to enter a therapeutic relationship with older adults who are LGBT without the interference of personal feelings

*Understand one’s own bias regarding sexuality in older adults

Is pain common for geriatric populations?

It is a common experience for many older adults and needs to be addressed

What age group is the fastest growing segment of the US population?

Adults aged 85+

How can persistent intense pain harm an individual?

It can harm their mind, body, spirit, and social interactions resulting in disability and therefore constipation

What is a consideration that needs to be made for dementia patients with pain?

Persons with dementia are consistently undermedicated

Who developed the Pain Assessment in Advanced Dementia (PAINAD) scale?

Warden, Hurley, and Volicer (2003)

What is the Pain Assessment in Advanced Dementia (PAINAD) scale?

A simple, valid, and reliable tool for assessing pain

What factors are related to a patient’s pain intensity and pain distress?

• Culture

• Past pain experiences

• Individual attributes

• Pain threshold

What is a fracture?

A break or disruption in the continuity of the bone

Why do fractures occur?

• Trauma to a bone or joint

• Result of pathological processes of bone fragility

  • osteoporosis

  • neoplasms

What are complications of hip fractures generally related to?

Immobility

What fracture is the most debilitating?

Hip fractures

*put pt at greatest risk of functional decline

What happens in gout?

Excessive production or decreased urinary excretion of uric acid

Describe the onset of gout.

It is sudden and manifested by an acute attack of pain in one of more joints

In the acute phase, what is the goal of nursing management?

Relieve pain

With gout, what should a patient avoid in their diet?

• purines

• alcohol

What are some common foot problems patients complain of?

• hammertoes

• bunions

• corns

What are the overall goals for mobility for patients with foot problems?

• keep as functional as possible

• education

• pain control

• preventing injury

What are some normal age-related changes of the heart?

• size of atrium increases

• HR decreases

• aortic distensibility

• vascular tone decreases

• left-ventricular wall thickening

What lifestyle changes minimize cardiac issues?

• walking for older adults

• maintain healthy body weight

• manage stress

• reducing fat content

• cessation of smoking

  • Asking

  • Advising

  • Assessing

  • Assisting

  • Arranging

What are signs and symptoms of CAD?

• atypical due to neuropathy

• present later due to not wanting to seek medical attention

• can result in HF due to delay in care

Where is valvular disease most common?

mitral and aortic valves

*treat HF and A-fib if present

Why are prophylactic antibiotics given before invasive procedures for valvular disease?

prevents endocarditis

*surgical repair or replacement may be necessary

What is the most common cause of death in the US?

cardiovascular disease

What are modifiable risk factors of CAD?

• obesity

• sedentary lifestyle

What are non-modifiable risk factors of CAD?

• age

• sex

Why could symptoms of angina or MI be vague and atypical?

neuropathies and changes in pain recognition

What is the treatment for MI?

• Morphine

• Oxygen

• Nitroglycerin

• Aspirin

What are primary causes of HTN?

• family hx, age, race, diet, smoking, stress, alcohol, drug consumption, lack of physical activity, hormonal intake

What are secondary causes of HTN?

underlying disease (hyperthyroidism)

What are you at risk of with orthostatic hypotension?

syncope and falls

What are s/s of orthostatic hypotension?

• dizziness with position changes

  • results from decreased sensitivity of baroreceptors

What education do you give a patient with orthostatic hypotension?

Patient education on position changes

What should the nurse do for atrial fibrillation in the geriatric pop?

• control the underlying disease

• slow HR and/or convert rhythm to NSR

• prevent stroke

Why are oral anticoagulants prescribed for a-fib?

Reduce thrombotic events

*need for anticoagulation significantly increases risk of harm in even of fall

What does the nurse do in the event of syncope?

• Administer O2

• Monitor O2 saturation

• Assist in ID of cause of syncope

• Implement measures to avoid constipation

  • straining can lead to secondary episodes of syncope

When do symptoms appear for peripheral artery disease (PAD)?

when the artery is unable to supply the tissues with adequate oxygenated blood flow

• *requires impeccable foot care

What are common disorders associated with chronic venous insufficiency?

• varicose veins

• venous ulceration

• DVT

  *requires impeccable foot care

What is the leading cause of hospitalization in the older adult pop?

HF

What should the nurse assess and monitor for HF?

• Assess BP, apical pulse, HR, heart sounds, lung sounds, peripheral edema, I&O, daily weights, electrolytes

What is the primary treatment for HF?

• Diuretics

  • Monitor electrolytes, BMP, VS

What should the nurse do for anemia?

• instruct on diet and food selection

• monitor for side effects of meds

• assess income for food purchases

• instruct on maintaining activity and rest balance

• test stool for occult blood

What is an early sign of respiratory problems?

A change in mental status including subtle increases in forgetfulness and irritability

Why are older adults at increased risk for respiratory infection?

Decreased immunoglobulin A (IgA) in the nasal respiratory mucosal surface that neutralizes viruses

What is emphysema characterized by?

Progressive airflow limitation that is not fully reversible where lung tissue becomes abnormally inflamed

What are findings of emphysema?

• tripod position

• barrel chest

• retractions

What is chronic bronchitis characterized by?

Excessive mucus production with chronic recurrent cough on most days for a minimum of 3 months of the year for at least 2 consecutive years in a patient whom other causes have been ruled out

What are the typical findings of chronic bronchitis?

• persistent cough

• dyspnea on exertion

• purulent sputum

• cyanosis

• crackles on auscultation

• tachycardia

• pedal edema

What happens with sleep apnea?

Partial awakening with a startled response of snorts and gasps which move tongue and soft palate and relieve obstruction

What system can sleep apnea have chronic effects on?

Cardiovascular

What is required for sleep apnea?

nasal continuous positive airway pressure (CPAP)

What can the nurse do for a patient with cancer?

• provide relief of pain, emotional support, counseling, and discussion of options

• provide factual info

• provide education and reassurance

• monitor VS

• support patient and family in decisions

What are 7 warning signs of cancer?

• Change in bowel or bladder habits

• A sore that does not heal

• Unusual bleeding or discharge

• Thickening or lump in breast or elsewhere

• Indigestion or difficulty swallowing

• Obvious change in a wart or mole

• Nagging cough or hoarseness

What should the nurse do about abuse?

• look for signs of abuse

  • patient may be fearful or hesitant to talk in front of the abuser

• act as a mandated reporters

Why are older adults more vulnerable to infections?

Physiological changes in the immune system and underlying chronic disease

*increased risk of infection: acute care setting

What are things to know as a nurse related to transferring patients to a higher level of care?

• If the facility cannot meet the resident’s needs, it has the right to transfer them elsewhere

• COVID-19 has impacted the geriatric population due to immunosenescence

What are two different types of care?

• respite care for individuals that need a minimum level of assistance, temporarily

• Needs some assistance, but can do most ADL/s independently

What is the priority for chronic disease in adults?

• Consider the chronic disease’s impacts on the present acute scenario and implement interventions accordingly

• Goals of care based on family and patient wishes

What does nursing care need to focus on in chronic disease?

• increased functional ability

• prevent complications

• promote the highest quality of life

• provide comfort and dignity in dying

What is the key role for the nursing care for chronic disease?

Help patient achieve optimal physical and psychosocial health

When do caregivers report role strain or stress?

The patient does not recognize family members or does not remember previous relationships because of cognitive changes

What should the nurse highlight for the caregiver?

• get to know the caregiver

• provide info about illness

• reassure that feelings of frustration or helplessness are not unusual

• referral to social worker

• respite services

What are some points about functional status?

• changes in functioning = family makes decisions about patient’s:

  • living situation

  • arrange for social services

  • healthcare

  • caregiving

  • advanced directive

• At this point it is appropriate to execute general power of attorney:

  • appoints someone to act as an agent for legal, financial, and health matters when the person is no longer able to do so

What are some facts about the 85+ pop?

• fastest growing segment of pop

• at risk for increase in chronic disease

• decrease ability to perform ADLs

• Increased expenses for assistance, assistance devices, meds

• lowest annual income of all older americans

  • 10% live in poverty

• social security is primary source of income

What is medicare?

federal health insurance program for persons older than 65 or persons of any age who are disabled or who have chronic kidney disease.

• Know what is covered under Medicare

What is covered by Medicare A?

• Mental health inpatient stays

• home health

• inpatient hospital stays

How is medicaid funded?

State funded for low income

How is medicare funded?

federally funded for those over 65 and with disabilities