Aging Adult Exam 3

What is the definition of pharmacokinetics & what are the steps?

Study of movement and actions of a drug in the body

• Absorption: how the drug enters the blood stream from teh site of administration

• Distribution: How the drug enters the blood stream from the site of administration

• Metabolism: how the body breaks down and chemically changes the drug

• Excretion: how the body eliminates the drug form teh body usually through urine or feces

What is Pharmacodynamics & when is it altered?

Physiological interaction between medication and the body

• The older a person gets the more likely it will be altered and unreliable.

What do we see with elevated WBC?

• Infection

• Fever

• Pain

• Lymphadenopathy: may not be present in older adults so look for sudden onset of confusion and lethargy

What is ESR & when might it be elevated?

ESR is an indicator of inflammation, infection, necrosis infarction or advanced neoplasm.

• May be elevated in older adult secondary to chronic disease

What is CRP?

Marker for the acute phase of an inflammatory response

Albumin is a good indicator for?

The severity of the illness and risk of mortality

What is pre albumin and albumin used for?

• Pre albumin: measures current nutritional status due to its short half life of 2-3 days

• Albumin: used for chronic nutritional status because of it s 3 week half life

What lab do we monitor with Gout?

Uric acid-the end product of purine metabolism

What do we see with a patient that has hyperkalemia?

Muscle twitching, arrhythmia, increased GI motility, bradycardia and cardiac arrest.

• EKG changes

  • P wave flattened

  • QRS broad

  • Peaked T wave

  • Biphasic QRS-T complex

• Cardiac toxicity can lead to cardiac arrest

What do we see in Hypokalemia?

Muscle cramping, fatigue, paralytic ileus, tachycardia, fibrillation, sudden death

• ECG changes

  • QT interval prolonged

  • T wave flattened or depressed

  • ST segment depressed

What is the Beers Criteria?

Drugs that are identified to have a higher than usual risk when used in older adults. A standard of practicing is noting that there is an overwhelming benefit versus risk documentation when prescribing these drugs.

What are some complications with psychoactive medications in older adults?

• Malignant syndrome

• Movement disorder

• Acute dystonia

• Akathisia

• Parkinsonian Symptoms

• Tardive Dyskinesia

What is the brown bag approach?

This is when we ask the person to bring in all medication being taken including over the counters, herbals and nutraceuticals or dietary supplements.

• You can ask how they take the medicine.

Where are drugs excreted through and primarily excreted through?

Through sweat, saliva and other secretions but primarily the Kidneys

What are the signs of hypoglycemia in an older patient?

Dizziness and visual disturbances rather than palpitations and sweating

Where is hyponatremia common?

Long term care facilities

Symptoms of hyponatremia?

Malaise, confusion, HA, seizures, tachycardia and hypotention

Psychoactive medications used correctly can result in ________ and psychoactive medications can also cause ________.

• Antipsychotics meds can provide relief form frightening and distressing symptoms

• They also can affect mental function because of the higher risk for adverse events.

Psychoactive medications should never be used for a….

“quick fix”

Psychoactive medications need what before admin?

A through assessment

What are the most common chronic diseases?

• Heart disease

• Stroke

• Cancer

• Diabetes

• Obesity

• Osteoarthritis

What are the characteristics of frailty in older adults?

• Recorded unintentional weight loss of >5%

• Self report of exhaustion

• Low activity level

• Low grip strength

• Slow gait speed

Levels of prevention

Primary: Seeking out services and education as prevention

Secondary: detect early disease and seeking care before the progresses or symptoms become apparent

Tertiary: care of established disease, restoring one to highest function, minimizing effects and preventing complications.

Quaternary: limiting disability and maintaining functional ability

Symptoms for actively dying older adults

• Dyspnea

  • Air hunger

  • Noisy respiration

• Nausea

• Pain

• Coolness

• Restlessness

What is self actualization?

the highest expression of ones most unique self or the “authentic person”

What are the characteristics of self actualized?

Courage, altruism, humor, self renewal and collective self actualization

What is courage?

conquering fear and despair in difficulty, danger, pain or uncertainty

What is altruism?

high degree of helping behavior in many older adults

What is humor?

Continuous moral development

What are the driving forces of Morality?

Love and intellect

What is self renewal?

Ongoing process as one become self actualized

A self actualized person is….

Powerful and confident

What do intergenerational programs do?

Help older and younger people look beyond there generational stereotypes and know each other (body, mind and spirit)

When are people the most in touch with their inner psychological life?

When you are old

Anticholinergic Side Effects

Cognitive decline, urinary retention, blurry vision, tachycardia

Normal INR value

2-3

What does a elevated troponin level indicate? What are the values? What is the risk of a high troponin?

Indicates: acute cardiac event, non cardiac event or conditions

• Also can be a strong indicator of acute myocardial infarction

• Seen within the first 3-4 hours, peaking at 24 and lasting for 7 days

• The higher troponin the higher risk of death

What does Ginko interact with and cause?

Interacts with anticoagulants and increases the risk for bleeding

What does Ginseng interact with and result in?

Ginseng interacts with insulin and oral antidiabetic drugs which may cause blood glucose levels to be altered.

What does St.John wort used for, interact with and cause?

St Johns wort is used for depression and interacts with triptans which may increase serotonergic adverse effects, serotonin syndrome and cerebral vasoconstriction.

What causes from aging effect distribution in pharmacokinetics?

• Reduced cardiac output and reduced circulation

• Reduced body water

• Increased adipose tissue

• Reduced serum albumin and other plasma proteins

What is IV heparin given for? what lab work do we use to monitor?

Heparin is giving for: the prevention of stroke, afib, artificial heart valves and prevention and treatment of DVT

• APTT is used to monitor

Is PSA an expected lab for all older men with their yearly physical?

No it is only used for some circumstances because it gave so many false positive to prostate cancer and many men then went under aggressive treatment and screening that lead to death or bowel or bladder incontinence.

How are adult children affected by a family member chronic illness?

• They begin to see their own mortality

• They will feel caught between trying to be present with their relatives now and pushing aggressive intervention to try and save their life.

• They are faced with the task to let their loved one die

  • If they dont make the decision the nurse will

What might the family feel during their final days with a family member that has a chronic illness?

They might feel the need to provide intimate and personal care to the relative life.

Because everyone in a family grieves differently this may affect affect the familys…

communication

When is guilt, depression and anxiety more common in familys of patients with a chronic illness?

When aggressive measures were taken that prolonged the natural death

What is our most important intervention for an actively dying older adult?

• First and foremost make sure the patient is comfortable

  • Comfort>cure

What do we give actively dying patients to relieve terminal breathlessness?

Opioids that are combined with lorazepam to alleviate the anxiety that opioids can trigger.

What is palliative sedation?

Used for comfort not to facilitate death

What are some comfort measures for actively dying older adults?

• Oxygen

• Elevate the head of the bed

• Use of bedside fan

• Minimize the need for conversation

What is an interacting drug class with anticholinerigics?

other anticholinergics or sedatives/hypnotics

Who is and isnt effected by anticholinergics?

Younger patients may not have any severe reaction but older clients will.

What meds cause an increase in WBC?

Allopurinol, aspirin, heparin and steroids

PT, INR and aPTT is used to monitor what?

PT & INR: monitor warfarin

• INR >7 give Vit K

aPTT: monitor heparin

• Agonist is protamine sulfate

If someones albumin levels are low and they are bed bound what are we looking for?

Bed sores because they are at risk for skin breakdown

What are the symptoms of gout?

Joint pain of elbow and hip and other joints

What are the high purine foods that would trigger gout?

alcohol and shell fish

What med is given for gout? What can it cause and what do we monitor?

Allopurinol is given

• Can cause an increase in WBC

• Monitor for renal failure and leukemia

How much IV potassium can you give at one time for hypokalemia? (IV and PO)

• 10 mEq, slow over an extended period of time, if it burns you can dilute it with NS

• Only give supplement every few hours

Symptoms of low magnesium

Muscle aches and cramps

What do you give to treat hyperkalemia?

IV insulin

What can cause abnormally high potassium levels?

If the blood sample is in the cart for too long

If you are treating hypokalemia and giving more potassium is not working what does that mean?

Magnesium is low and you need to give more.

What is the issue with administering topical medications to older adults?

They have lost subcutaneous tissue so the medication may not absorb correctly

• Lidocaine, nicotine and fentanyl

  • Given to a lower body mass could cause more sedation

What is a common drug that falls under the beers criteria?

Diphenhydramine (bendryl)

When should Ginko be stopped?

36 hours before surgery

Malignant syndrome signs and symptoms, what do we do with these patients?

High fever, rigidity, altered mental status and autonomic instability

• refer them to the hospital because it is emergent

What is acute dystonia look like?

slow continuous movement of the muscle like tongue twitching

What is tartive dyskinesia?

• When does it show up?

• Does it ever cure?

Repetitive and progressive

• 3-6 months after antipsychotic use

• Cannot cure once it is developed

What is parkinsonian symptoms?

Akinesia and rigidity

What is akathisia? who has it?

• Compulsion to be in motion, sense of restlessness

• People who have been on antipsychotics long term for: schizophrenia and bipolar

What is an example of an intergenerational activity?

Daycares being apart of a nursing home

What are some interventions for assisting in polypharmacy for older adults?

• Safety with medication

• Look for adverse drug reactions

• Teach family side effects

  • Helps with medication compliance

What labs should be reviewed for older adult in regard to the excretion of medication in older adults?

• Magnesium: GI adsorption decreases and kidney excretion increases coupled with low dietary intake results in hypomagnesemia

• Creatinine

  • Important to prevent toxicity

  • Normal: 1.2 or less

  • GFR

Adverse drug reactions for Lispro and Aspart

• Hypoglycemia

• Injection site reactions

• Allergic reaction

• Weight gain

Adverse drug reactions for lisinopril

• Dry cough

• Hyperkalemia

• Decreased renal function

• Hypotension

• Angioedema

• Dizziness

• Headache

• Fatigue

• Nausea

Lisinopril should be used with caution when?

In pregnancy because it can cause fetal harm

What needs to be monitored closely on lisinopril?

Potassium (because it is potassium sparing) and renal function

What can cause a false PSA?

a digital rectal exam

What can cause hyponatremia in older adults?

Antidiuretic and diuretics

What is the McGree criteria?

A set of standardized definitions used to identify health care associated infection in long term care facilities

An increase in population is often though to be a ________ when it should be thought as an __________ to society.

• Problem

• Enrichment to society

What is a legacy?

When ones tangible and intangible assets are transferred to another is a symbol of morality.

What is a collective legacy?

Legacies expressed through other people

What is a living legacy?

legacies that people leave behind are important to families

Personal possessions

People have things that provide meaning from patient to patient

What is impact and functional disruption?

Assisting in daily routines to maintain dignity

What can a nurse do to help spousal grieving?

• Active listeners

• Reframe memories: like celebrating a birthday

• Create new memories

• Help with funeral arrangements

• Encourage adaptation: new routines

What should the nurse do if a family have three siblings for a parent that are all durable power of attorneys?

Communicate with all of them incase they are not communicating themselves.

What should a nurse perform for a widowed older adult?

Greif assessment and try to learn prior coping skills

When do we see hope in death?

When death relieves symptoms

What is promoting equilibrium for a family?

Using nursing interventions that help the family cope with the loss while being

aware of traditions and values

What is the ANA stances on physician assisted suicide?

Against

When can a patient be placed on hospice?

Two MD’s have to agree that they have 6 months or left of life

What is palliative care? Can you still receive treatment?

Palliative care is focused on the quality of life.

• You can still receive treatment

What is important for a family to do towards the end of a patient death?

Give the patient permission to go

Should a nurse give a foley and oxygen for an actively dying client?

Only if a family wants it.

What drug is often given to an actively dying client?

Sublingual dilaudid

What is kennedy sacral?

Skin breakdown during actively dying