1:30:19 Gerontology Exam 1 Study Guide PDF

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Gerontology Exam 1 Study Guide The Aging Adult        

65+ = older adult Gero problems do not necessarily have to be over 65 … will see chronic illness Never make assumptions about one’s overall health, functional ability, or mental status based on age Promote strengths and support weakness PATIENT’S PRIORITY COMPLAINT = PRIORITY ***** Listen to them, know bowel schedule, know their NORMALS ** Speak slowly, in normal tone NORMAL IN AGING: o Respiratory:  Harder to clear secretions  Recoil will not perform as well as before o Cardiovascular:  Heart, harder to pump, stiffness of muscles, vessels  Disorders: heart failure, stenosis, cardiomyopathy, CAD, high cholesterol  Heart muscles change to adapt to increased workload  HR will stay the same but will not increase as much with activity as in the past  Increase risk of high blood pressure  NURSING:  Include physical activity in daily routine (walking, swimming) … regular moderate physical activity = maintain healthy weight and lower heart disease risk  Healthy diet … veggies, fruits, whole grains, high fiber foods, protein (fish). Limit salt and saturated fats  Don’t smoke  Manage stress … meditation, exercise, talk therapy  Get enough sleep … 7-9 hours per night … examine sleep schedule: how do they sleep, when fall asleep, etc. o Musculoskeletal:  Weaker bones, less elasticity, hunch over  Decreased muscle mass  Joints, ligaments, cartilage are more stiff  Bones become porous  Increase risk of fractures  5 P’s Assessment: pain, pallor, Pulselessness, paresthesia, Poikilothermia  Complications: infection, compartment syndrome, blood clots, fat embolism (watch for long bone fractures, ex. femur)

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Based on age they are a fall risk **  don’t always have to have fallen before  OSTEOPOROSIS: DECREASE IN BONE DENSITY, INCREASE RISK FOR BROKEN BONES  Risk for fractures: post-menopausal women and chemotherapy patients  Watch for loose area rugs, clutter, cords, wires, oxygen tanks, children, pets, well-lit areas, access to the bathroom  Old people = more of risk to bend over and pick something up  NURSING:  Get adequate amounts of calcium … at least 1,000 mg per day … foods such as broccoli, kale, salmon, tofu  Get adequate amounts of vitamin D … at least 600 units … foods such as tuna, salmon, eggs, fortified milk, supplements  Include physical activity in daily routine … weight bearing such as walking, jogging, tennis, climbing stairs, and weight training helps build strong bones and slow bone loss  Avoid substance abuse … avoid smoking and limit alcohol o Gastrointestinal:  Slower GI, more absorption  Delayed gastric emptying  Full quicker  Constipation **  LONG TERM USE OF LAXATIVES MAY CAUSE CONSTIPATION ***  High risk of UTI  Low appetite  NURSING:  Encourage healthy diet  Encourage physical activity  constipation  Don’t ignore the urge to poop o Genitourinary:  UTI’s common, pee more/less  Weakening of pelvic floor (not normal but normal)  Weakening of bladder  Incontinence  risks are overweight, nerve damage (diabetes), medications, caffeine), inflamed prostate  NURSING:  Promote toileting schedule  regularly, such as every hour  Maintain healthy weight  Don’t smoke  Do Kegel exercises  squeeze muscles you would use to stop farting … 10-15 times at least 3 times per day  Avoid bladder irritants  pop, coffee, tea, etc.  Avoid constipation  can cause UTI **

o Neuro-Cognitive:  May be more forgetful  Memory  Thinking skills  Familiar names or words, multitask  NURSING:  Include physical activity  increases blood flow to body and brain  Eat healthy diet  Stay mentally active  read, word games, hobby, classes, instruments  Be social  Treat cardiovascular disease  Quit smoking o Integumentary:  Weaker, thinner skin, sensitive  ASSIST IN PREPARING A BATH BECAUSE THE CLIENT MAY NOT BE ABLE TO DETERMINE THE INTENSITY OF THE HEAT ***  Less elastic  More fatty tissue  Fragile  Bruise easily  Look for melanoma *** do thorough skin assessment  Skin is dry  use moisturizer after shower when they are DAMP, do not do it after they are dry  WRINKLES, AGE SPOTS, AND SMALL GROWTHS (SKIN TAGS) ARE MORE COMMON  SIGNIFICANT ON SKIN EXAM: ECCHMOSIS ON BOTH FOREARMS ***  NOT SIGNIFICANT: CHERRY HEMANGIOMAS, TENTING OF THE SKIN, NEVI ON THE NECK AND FOREHEAD  NURSING:  Provide gentle hygiene  Take precaution to hazardous exposures  sunscreen, protective clothing, check skin  Don’t smoke o Vision and hearing:  Decrease  Sensitive to glare and have trouble adapting to levels of light  Clouded vision = cataracts  Hearing may diminish  LOOK AND SPEAK TO THE CLIENT SO THAT THEY CAN SEE THE NURSES LIPS  Check for ear wax **  If they are blind  explain unit noises and physical surroundings ***  NURSING:

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Routine exams  glasses, contacts, hearing aids, corrective devices Wear earplugs around loud machinery or loud noises

 o Oral health:  Dry mouth common  Gums may pull back from your teeth  Decay and infection may be common  NURSING:  Brush and floss  Ensure dentures fit properly  Schedule regular check ups o Weight management:  Weight falls into the belly  Metabolism slows down  Gain weight  NURSING:  Encourage physical activity  Eat healthy diet  Watch portion sizes

Pharmacology  

Pharmacokinetics: the movement of a drug throughout the body from the point of administration as it is … DOES NOT WORK AS WELL AS THE BODY USED TO. OLDER ADULTS = MEDS HIT HARDER o Absorbed  Depends on: bioavailability, amount of drug that passes into the body, route of administration  Increased gastric pH  Delayed stomach emptying  Increase motility  Slowed intestinal motility o Distributed  MEDICATION MUST BE TRANSPORTED TO THE RECEPTOR SITE ON THE TARGET ORGAN TO HAVE AN EFFECT  Depends on: availability of plasma protein in the form of lipoproteins, globulins, and albumin  Increased body fat  Decreased muscle  Decreased total body water o Metabolized  Process by which the body modifies the chemical structure of the drug  PRIMARILY OCCURS IN THE LIVER  Liver activity decreased normal  mass, volume, blood flow

 Hepatic clearance of medication is decreased by 30-40% o Excreted  Medications are excreted through sweat, saliva, and other secretions  PRIMARILY OCCURS IN THE KIDNEYS  Kidney function decreases  Prolongs half-life … will be active for longer than normal drugs would … this is because of reduced Glomular filtration rates  Vancomycin = can be renally toxic  Diabetic + vancomycin = renal failure  Metformin = can be renally toxic, with contrast dyes, diabetes, etc. o DRUGS SHOULD BE RISK VS. BENEFIT FOR THE OLDER ADULT

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BEERS CRITERIA o To identify misused, unnecessary medications o Drugs to use with caution o Identify medications with high risk for side effects or adverse events o DON’T HAVE TO KNOW ALL DRUGS FOR THE TEST BUT JUST KNOW GENERAL IDEA ABOUT DRUGS WITH HIGHER RISK FOR OLDER GENERATION o Watch for organ damage, secondary issues, death o Adverse effects:  Unwanted pharmacologic effect

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Commonly include drug-induced delirium, confusion, lethargy Document carefully  NOT THE SAME AS AN “ALLERGY”

o NSAIDS  Increase risk of bleeding  Increase incidence of stomach ulcers  Increase BP o Digoxin (Lanoxin)  Can be toxic to those who’s kidneys are impaired o Diabetic Medications  Cause dangerously low blood sugars  Make sure the patient is eating ** o Muscle Relaxants  Decrease cognition and awareness  Increase risk of falls  Constipation, dry mouth, urinary problems o Antianxiety (Ex. Ativan)  Increase risk of falls  Confusion risk o Anticholinergics  DRY UP EVERYTHING **  Confusion, constipation, dry mouth, blurry vision, problems urinating o Pain Relievers (Ex. Demerol)  Increase risk of seizures  OPIOIDS IN GENERAL ARE BAD *** CONFUSION, LOC, SEIZURES *** o OTC Medications  Just because OTC does not mean risk free  Risk for confusion, blurred vision, constipation, urination, dry mouth  SHOULD NOT TAKE ANY OTC UNLESS INSTRUCTED BY A PHYSICIAN  NEED TO BE APPROVED WITH PRESCRIBED MEDICATION  Still needs to be included in polypharmacy check o Antipsychotics (Ex. Benzodiazepines)  Increased risk of stroke or death in patients with dementia  Cause tremors

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o Beta Blockers  Increased risk for orthostatic hypotension **  Increase risk for falls o Estrogen Pills or Patches  Increase risk for breast cancer, blood clots, dementia Polypharmacy o Using multiple providers, pharmacies, multiple medications at once, doubling up on medications with the same outcome o ASK THE PATIENT TO BRING IN ALL ORIGINAL PILL BOTTLES FOR EVERYTHING THEY ARE TAKING  MEDICATION ASSESSMENT  Check expiration dates, name, date filled, refills left, pills left in bottle o Consequences include:  Increased health associated cost  Increased risk for adverse reactions  Decreased functional capacity  impaired cognition, falls risk, urinary incontinence, impaired nutrition o OBTAIN A COMPLETE MED ASSESSMENT WITH EACH PATIENT ENCOUNTER Special Considerations for Older Adults o Ability to pay? o Ability to obtain refills? o Decision making skills ok? o Leftover prescription? o Obtained from other patients? o Take pills when they are already taken? o Med blood levels? o Liver and kidney functioning? o Ability to remove packaging, manipulate medication, storing? Medication Administration o Opening bottles o Use of pill cutters o Difficulty swallowing medication o Use of accurate medication measuring devices o Proper administration o Use of transdermal patch

Chronic Illness      

Account for 70% of deaths in the United States Occur and progress slowly Level of impairment varies greatly 2/3 older Americans have multiple chronic conditions CONSEQUENCES: PHYSICAL SUFFERING, LOSS, WORRY, GRIEF, DEPRESSION, FUNCTIONAL IMPAIRMENT, INCREASED DEPENDENCE * Levels of Prevention:

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o Primary: measures that prevent the occurrence of specific disease  Ex. diet, exercise, immunization o Secondary: actions aimed at early detection of disease that can lead to interventions to prevent progression  Ex. colonoscopy, gynecological exams, annual screenings o Tertiary: activities that limit disease progression or the return to patient optimal function  Ex. rehab  Ex. ADL at 50% after stroke occurred, this is new normal  Promote new baseline Nursing: o Conduct history and physical assessment o Focus should be patient priority problem/complaint o Need to be PATIENT ADVOCATE ** o Educate the patient and caregiver **** o Do not talk over the patient o Symptom management  #1 indicator of readmission to hospital Hypertension: o Prevention and management is critical o Most diagnosed during routine screening o Most common complication is end-organ damage o Higher risk for CHD, atrial fib, HF, MI o Mediations:  GO LOW AND GO SLOW  Watch for orthostatic hypotension  major problem  Diuretics: watch for patient with bladder issues  Beta blockers: SA node dysfunction is common

High Cholesterol: o “The Silent Killer” o Cholesterol levels increase with age o Increase in the LDL

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o High LDL and low HDL = CHD risk ** o Treatment = statins in 6 months … decrease mortality and morbidity o Medications:  Aspirin: great benefit in elderly with CAD  ACE inhibitor and Beta Blockers: effective for post-MI  start low go slow Arthritis: o Most common cause of disability o More common in women o Increase after age 45 o Associated with pain and limited motility o Related to:  Osteoarthritis  Polymyalgia  Rheumatoid arthritis  Gout Coronary/Ischemic Heart Disease: o Develops mostly from atherosclerosis and HTN o Causes:  Exposure to smoke and pollutants  Diabetes  Genetics o CHD can result in MI  increase mortality o In women and older adults, S/S more likely to be mild  WATCH OUT FOR “FLU-LIKE ABDOMINAL SYMPTOMS” Diabetes: o S/S: polyuria, polyphagia, polydipsia ** o Hyperglycemia is well tolerated in older adults o Hypoglycemia = where problems mostly come from **** o WATCH FOR DEHYDRATION, CONFUSION, DELIRIUM, INCONTINENCE o Vague S/S: fatigue, nausea, delayed wound healing, paresthesia

Chronic Kidney Disease: o Defined as one of the following:  Kidney damage  Abnormalities, blood, urine, imaging tests showing damage  Low Glomular filtration rate (GFR)

 Less than 60 mL/min for 3+ months o Causes: diabetes, HTN o Frequently asymptomatic

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Heart Failure: o Heart muscle is damaged, malfunctioning, and can no longer pump effectively o Causes: HTN, anemia, metabolic disease, infection o S/S:  Fatigue, SOB, weight gain, swelling, dyspnea  May present with delirium, falling, insomnia, nocturia, dizziness, syncope, malaise Depression: o #1 REASON FOR LONG TERM CARE PLACEMENT *** o Mood disorder having cognitive, affective, physical manifestations  Primary: lack of neurotransmitters  Secondary: situational, illness, loss o Geriatric Depression Scale used  used to assess o Treatment: drug therapy and psychotherapy Alzheimer’s Disease and Dementia: o 6th leading cause of death in the US o NOT A NORMAL PART OF AGING ******** o S/S:  Memory loss  Impaired thinking  Inability to find words  Problems with judgement  Specific behaviors Chronic Obstructive Pulmonary Disease (COPD) o Umbrella term that includes conditions that impair airflow o ASTHMA o CHRONIC BRONCHITIS  inflammation and mucus o EMPHYSEMA  alveolar trapping o Arise from tobacco use or exposure to pollutants earlier in life o Airway obstruction is worse with expiration ****** o S/S: dyspnea and wheezing o Watch for oral thrush  need to wash mouth out after taking inhaled medication  can lead to malnutrition, lack of appetite, and dehydration o Inhaled medication  may not be taking full dose, utilize cost, poor/lack of education on proper use, makes them feel jittery/anxious/irritable ****** o EDUCATE

o Risk for infection, pneumonia, retained secretions, decreased recoil, immune system depression o Management with medications: inhaled steroids o Educate on utilization of inhalers o Assess medication administration o Assess medication compliance o Inhaled steroids = good meds for COPD because less risk for systemic effects  Decreased need for albuterol o DO NOT GIVE TONS OF OXYGEN = CANNOT TOLERATE. ALSO A LUNG PROBLEM NOT AN OXYGEN PROBLEM o If sat is low = give nonrebreather mask with the thing all the way up = allows to rebreathe CO2 … short fix *...