NUR2402 Exam Revision - Exam preparation PDF

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NUR2402 – Healthy Ageing and Chronic Conditions Module 1 What is wellness? The state of being physically and emotionally healthy What does CALD stand for? Culturally and linguistically diverse Top 5 non-English speaking countries older adults have migrated from to Australia Italy Greece Germany Netherlands China Eden Alternative Domains of Wellbeing Identity – being well known. Connectedness – being loved and connected. Security – feeling safe. Autonomy – freedom to choose and a sense of control. Meaning – purpose and hope. Growth – unfolding. Joy – having contentment and delight. The estimated percentage of older adults who will be 1. 65+ years in Australia by 2051 26% 2. How many of this group will be 85+ years 20% Review the commonly used medications for older adults. Medication

Common Use

Side Effects

Donepezil

Alzeimers Disease

Lorazepam

Anxiety disorders, seizures, agitation, sedation

Nausea, insomnia, aggression, diarrhea, tiredness, muscle cramps Weakness, sleepiness, low BP, decreased effort of breathing

Ipratropium

COPD, asthma

Dry mouth,

Contraindication s Heart disease, cardiac conduction disturbances, COPD, asthma, arrythmia Allergy, respiratory failure, ataxia, glaucoma, sleep apnoea, pregnancy, breast feeding Glaucoma, GI

Diltiazem

High BP, angina

Celecoxib

Pain and inflammation, osteoarthritis, arthritis, acute pain Depression, OCD, panic disorder

Citalopram

Warfarin Losartan

Anticoagulant High BP, heart failure, diabetic kidney disease, left ventricular enlargement

cough, airway inflammation Swelling, dizziness, headaches, low BP Abdominal pain, nausea, diarrhea

obstruction

Nausea, insomnia, sexual disfunction, sweating, tiredness, shakiness Bleeding Muscle cramps, stuffy nose, cough, high potassium, anaemia

Suicidal thoughts, manic depression, low magnesium, low sodium, low potassium

SA node or AV conduction disturbances, BP below 90mm Hg Known sensitivity to sulphonamides, asthma

Pregnancy Low BP, liver problems, pregnancy, kidney impairment, decreased blood volume

Module 2 Miller's functional consequences theory? Effects of one’s action in relation to risk factors and aged related changes that influence their quality of life Why is health promotion important for older adults? Lower co-morbidities and they are educated and understand their needs and wants Explain the Transtheoretical Model of Health Promotion/Change? Pre-contemplation: Unaware/denial Contemplation: Intention to change in near future Preparation: Still not sure but more likely to change Action: Changes made but still early days Maintenance: Continued change for 12 months or more Name four packages of care available for older adults Level 1 – Basic care needs Level 2 – Low level care needs Level 3 – Intermediate care needs Level 4 - High level care needs Twelve Activities of Daily Living

Maintaining safe environment Communication Breathing Eating Elimination Wash/dress Temperature control Mobilisation Work/play Sexuality Sleep Death Two tools used to assess function ability in older adults Cognitive Assessment (MMSE) Falls Risk Assessment & Management Plan (FRAMP) What primary prevention education would the nurse give to prevent cancer? Stop smoking Wear sunscreen Avoid red meat Exercise Diet Review the commonly used medications for older adults. Medication

Common Use

Side Effects

Phenytoin

Anti-seizure

Venlafaxine XR

Anti-depressant

Amitriptyline

Major depressive disorder, anxiety disorder, ADHD, bipolar disorder

Nausea, stomach pain, loss of appetite, poor coordination, increased hair growth Loss of appetite, constipation, dry mouth, dizziness, sweating, sexual disfunction Blurred vision, dry mouth, low BP on standing, constipation, sleepiness

Rivastigmine

Alzheimer’s

Vomiting,

Contraindication s DM, decreased blood platelets, softening of bones

Allergy to gelatin

MI history, congestive heart failure, arrythmias, mania, liver disease, patients under 7 years old, breastfeeding Asthma, stomach

Alendronate

disease, Parkinson’s disease Osteoporosis

Metformin

Type 2 DM

Glipizide

Type 2 DM

Triamterene HCTZ

High BP, swelling

Losartan HCTZ

High BP

diarrhea, weight loss, decreased appetite Constipation, abdominal pain, nausea, acid reflux

ulcer, abnormal heart rhythm

GI inflammation, hypocalcaemia, pregnancy, breastfeeding, patients under 18 years old Abdominal pain, Severe renal nausea, impairment, diarrhea metabolic acidosis Nausea, Pregnancy, diarrhea, low breastfeeding, BSL, headaches insulin dependent DM, renal insufficiency Depletion of folic Type 1 DM, type 2 acid; sodium; DM, low sodium, calcium, acidosis, high potassium, liver nausea, problems, vomiting, anaemia from low diarrhea, folic acid dizziness, fatigue, dry mouth Muscle cramps, Low BP, liver stuffy nose, high problems, kidney impairment, potassium, pregnancy, renal anaemia artery stenosis, high potassium, decreased blood volume

Module 3 Five Types of elder abuse Emotional/psychosocial Neglect Physical Financial Sexual What are the characteristics of the perpetrator of elder abuse? Hostile Stressed Shared accommodation Financial dependence Mental illness

What are the characteristics of the victim of elder abuse? Mental illness Co-dependent Not financially independent Burden of care If you suspected an older adult of being abused in a residential care facility, what action would you take? Alert facility Alert family Alert appropriate authorities Review the commonly used medications for older adults. Medication

Common Use

Side Effects

Metoclopramide

Anti-nausea, anti-vomiting

Mirtazapine

Anti-depressant

Risperidone

Schizophrenia, bipolar disorder, autism

Carbidopa / Levodopa

Parkinson’s disease

Atenolol

High BP

Tiredness, diarrhea, restlessness Increased weight, sleepiness, dizziness Movement problems, sleepiness, dizziness, sight issues, constipation, weight increase Dizziness, loss of appetite, diarrhea, dry mouth, constipation, confusion Tiredness, heart failure, dizziness, depression, SOB Vomiting, constipation, itchiness, drowsiness, light headedness Dizziness, sleepiness,

Acetaminophen / Pain, fever Codeine

Acetaminophen / Pain Hydrocodone

Contraindication s Parkinson’s disease, pregnancy, infants High cholesterol, dehydration, overweight, manic behaviour, mania DM, breast cancer, dehydration, overweight, high prolactin levels

Malignant melanoma, DM, suicidal thoughts, depression, psychotic disorders Hyperthyroidism, bradycardia, heart failure, DM Respiratory depression, acute asthma

Respiratory depression, acute

Diclofenac

Pain, inflammation

Simvastatin

Lipid lowering

Allopurinol

Gout

nausea, constipation Abdominal pain, GI bleeding, nausea, dizziness, headache, swelling

Constipation, headache, nausea Itchiness, rash

asthma 3rd trimester pregnancy, GI bleeding, inflammatory bowel disease, congestive heart failure, cerebral haemorrhage, liver insufficiency Liver disease, pregnancy, breastfeeding Dehydration, liver problems, chronic heart failure, kidney impairment

Module 4 What would be considered in the nursing assessment of an older adult when promoting safe use of medication? Cognitive capacity Barrier to compliance Side effects Cultural considerations What age related changes affect medication use in older adults? Changes to pharmacokinetics and pharmacodynamics Changes to physiology and cognition Social factors Compliance issues What factors affect behaviours related to taking medications in older adults? Motivation Cultural and psychosocial influences knowledge Physical capabilities What age related changes affect musculoskeletal wellness in older adults? Bone deterioration Minerals leave the bones quicker than they absorbed What is osteoporosis and why is it a problem in older adults? Weak, thin and fragile bones. Minor bumps or accidents cause trauma fractures What are the risk factors for falls in older adults?

Increased age Medication use Cognitive impairment Sensory deficits What is osteoarthritis? Degeneration of joints Ethel has been discharged following a fractured NOF. What would be included in the home assessment to ensure it doesn’t happen again? Hip precautions A visit home with the occupational therapist prior to D/C. Ensure the appropriate equipment to assess her with mobility Identify the risk factor of falls as it could be related to pain medications and apply appropriate interventions. What is nociceptive pain and describe the two types? Damage to body tissue and usually described as a sharp, aching or throbbing pain Somatic and visceral Explain the WHO pain ladder 1. Pain persisting or increasing --> Non opioid +/- adjuvant 2. Pain persisting or increasing --> Opioid for mild to moderate pain +/- non opioid, adjuvant 3. Freedom from pain --> +/- non-opioid and adjuvant What are the principles of pain assessment in older adults with a cognitive impairment? Reactions to stimulus Ask? Touch Facial expressions Observation What factors worsen pain in older adults? Lack of exercise Mental status Chronic conditions What factors improve pain in older adults Person's ability to communication may fluctuate Numerical rating scales as appropriate Base assessment conclusions on multiple sources of information Module 5 What can the nurse recommend to older adults to promote cognitive wellness? Problem solving Exercise

Socialising Education Define dementia Chronic or persistent disorder of the mental processes, caused by brain disease or injury Define delirium Serious disturbance in mental abilities that results in confused thinking and reduced awareness of surroundings. What is Person Centred Care and why is it important when caring for older adults? Driven care practices towards a holistic model of care Focuses on the person receiving care Name 2 tools used to assess for dementia in older adults MMSE ADL's Name the 5 most common types of dementia? 1. Mixed dementia 2. Vascular dementia 3. Alzheimer's dementia 4. Lewy body dementia 5. Frontotemporal dementia 7 Stages of Alzheimer's disease 1. Normal adult 2. Age-associated 3. Mild cognitive 4. Mild dementia 5. Moderate dementia 6. Moderately severe 7. Severe dementia What is BPSD? Behavioural and Psychological Symptoms of Dementia 1. Agitation 2. Psychiatric symptoms 3. Personality changes 4. Mood disturbances Explain the PLST Model of Care Progressively Lowered Stress Threshold Understanding behaviours and planning care for person with dementia Name 2 tools used to assess for depression in older adults Geriatric Depression Scale MMSE

Review the commonly used medications for older adults. Medication

Common Use

Side Effects

Isosorbide Mononitrate

Angina, heart failure

Potassium Chloride

Prevention of low levels of potassium

Digoxin

Heart failure

Frusemide

Diuretic

Fainting, vomiting, nausea, headache, low BP on standing, blurred vision Vomiting, diarrhea, abdominal pain, GI bleeding, peptic ulcers Nausea, vomiting, diarrhea, breast enlargement Light sensitivity, ringing in ears, lightheaded on standing

Atorvastin

Abnormal lipid levels

Atropine

Metoprolol

Nitroglycerin

Joint pain, diarrhea, heartburn, nausea, muscle pain Decrease heart Dry mouth, rate large pupils, urinary retention, constipation, increased heart rate High BP, chest Insomnia, pain tiredness, abdominal discomfort, feeling faint Angina, high BP, Headache, low chest pain BP

Contraindication s Anaemia, heart attack, low BP

Acidosis, GI irritation, dehydration

AV blockage, renal disfunction, acute MI, hypokalemia DM, low magnesium, gout, low calcium, low sodium, low potassium, low chloride, heart attack Jaundice, pregnancy, breastfeeding, elevated CPK levels Glaucoma, pyloric stenosis

Hyperthyroidism, AV blockage, bradycardia, hypotension, DM, acute heart failure Anaemia, right sided MI

Module 6 What age related changes affect cardiovascular function in older adults?

Myocardial degenerative changes Arterial stiffening High peripheral resistance Name 7 risk factors for cardiovascular disease in older adults? 1. Race 2. Diet/nutrition 3. Depression 4. Hypertension 5. Increased age 6. Gender 7. Physical inactivity What is post prandial hypotension? Blood pressure drops are they eat Drop in systolic pressure of up to 20mmHg within 2 hours of meal What is orthostatic hypotension? Systolic blood pressure decreases at least 20mmHg or a diastole BP decrease of at least 10mmHg within 3 minutes of standing What age related changes affect respiratory function in older adults? Ribs and vertebrae subject to osteoporosis Mucosal bed thickens Respiratory muscles weaken Decrease in size and weight --> Flabbier Name the negative functional consequences of the respiratory agerelated changes Hypoxia Hypercapnia What would be the top 3 actions included in a health promotion plan for an adult with COPD? Smoking cessation Elimination exposure to environmental pollutions Subtle exercise What are the five stages of the transtheoretical model of health promotion you would consider when helping an older adult to stop smoking? Precontemplation Contemplation Preparation Action Maintenance What activities of daily living would be affected by an older adult with severe COPD? Breathing Sleep

Eating Work Sex Module 7 Name 5 risks that affect hearing in older adults Male gender Increased age Genetic predisposition Exposure to noise Impacted cerumen Smoking What is presbycusis? Loss of hearing that gradually occurs in most individuals as they grow older What are the age related changes that affect sight in older adults? Relaxation of lower eyelid Loss of orbital fat Decreased elasticity of eyelid muscles What are the 4 most common conditions that affect sight in older adults? 1. Diabetic retinopathy 2. Cataracts 3. Glaucoma 4. Aged related macular degeneration What is depth perception and how might it affect an older adult? Visual ability to perceive the world in 3D and the distance of an object Declines with age Name the age-related changes that affect the skin in older adults Decrease rate of epidermal proliferation Decrease moisture Decrease sweat and sebaceous glands Arterial leg ulcer No hair Relieves pain when lowering No foot or leg pulses Venous leg ulcer Relieves pain when raised Foot and leg pulses What 5 areas does the Braden Scale assess? Activity Mobility Sensory perception Moisture

Friction and shearing Nutrition Module 8 What age related changes affect digestive, nutrition and hydration wellness in older adults? Less effective chewing Low sense of smell and taste Daily intake What 6 areas are assessed when using the Mini Nutritional Assessment tool? 1. Food intake 2. Weight loss 3. Mobility 4. Psychological stress 5. Neuropsychological problems 6. BMI What are the 5 age related changes that affect urinary wellness in older adults? 1. Cognitive ability 2. Functional status 3. Mobility 4. Postural sway 5. Medications How much urine can older adults generally store in their bladder? 300-450ml Maximum 500ml Changes to each person What environmental factors contribute to incontinence in older adults? Cognition Accessibility Ability to voluntarily control Urge to void Accessibility to toilets What may lead you to suspect an older adult, previously healthy, may have developed type II diabetes? Blurred vision Itching Skin infections Cuts that heal slowly Tired and lethargic 6 interventions that would be included in a health promotion plan for an older adult with type II diabetes

Quit smoking Exercise Nutrition Medication No alcohol Education Name 5 categories of urinary incontinence? Stress incontinence - Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy. Urge incontinence. Overflow incontinence. Functional incontinence. Mixed incontinence. What factors increase the risk of dehydration in older adults? Health conditions Intake behaviours Medications Module 9 Explain Palliative Care An approach that improves the quality of life of patients and their families facing the problem associated with life threatening illness, through the prevention and relief of suffering What would you say to patients and families during the final stages of life? Tell me more about? What questions do you have? What are you most concerned about? How are you today? Name 9 medications commonly used during end of life care 1. Morphine 2. Hydro morphine 3. Haloperidol 4. Midazolam 5. Metoclopramide 6. Hyoscine 7. Clonazepam 8. Hyoscine butyl bromide 9. Fentanyl Name 7 common symptoms that often need to be managed during Palliative Care? 1. Pain 2. Breathlessness

3. Anxiety 4. Agitation/restlessness 5. Hallucinations 6. Dysphagia 7. Nausea 8. Vomiting 9. Respiratory symptoms What 4 physiological changes would lead you to believe death was imminent? 1. Changes in respiration 2. Hypotension and tachycardia 3. Change in responsiveness 4. Uncharacteristic restlessness Name 7 supportive interventions for relationship building during end of life care 1. Presence 2. Touch 3. Recognition of autonomy 4. Compassion 5. Honesty 6. Expert communication 7. Assisting in transcendence What is the Liverpool Care Pathway? What benefits does it offer? Covering palliative care options for patients in the final days or hours of life Pathway for the dying patient Supporting quality care in the last hours or days of life

QUIZ The planning and implementing of nursing care for an older adult often differ from those of younger adults in that: A. The elderly patient has different and less commonly identified nursing diagnosis B. The elderly patient's desired outcome of care often is functional independence in a safe environment C. Standardised care plans can be used more frequently D. Most older adults require institutionalised care for a short time following an acute illness A contributing factor to malnutrition in the older adult that the nurse specifically addresses during the assessment of the patient's nutritional status is whether the patient: A. Eats only meals prepared by others B. Has access to a grocery store C. Has an increased oral sensitivity to spices D. Responds to advertising for junk food B. Has access to a grocery store In planning care for elderly patients with chronic illnesses, the nurse recognises that management of chronic illness requires: A. Adjusting to changes in the course of the disease B. Restricting social interactions outside the home C. Frequent hospitalisations for treatment of acute episodes of the illness D. Institutionalisation in long-term care facilities In caring for the older adult patient, the nurse recognises that the complexity of care of an older person with multiple health problems is complicated by the fact that: A. A medication indicated to treat one illness or symptom may result in a cascade of health problems as it affects other functions B. Elderly patients focus on their symptoms and frequently use unnecessary health resources C. Elderly men have access to fewer resources and, as a result, tend to under-report symptoms of illness D. Because most elderly patients develop cognitive impairment, they ar...