NURS 315: Exam #3

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What is Parkinson's disease?

•progressive degeneration of neurons in the basal ganglia resulting in the reduced production of dopamine

What are defense mechanisms?

•reactions used to cope with a difficult or stressful situation

class 4 CHF

•symptoms experienced with any activity and during rest; bed rest may be required (hospice criteria is Class 4)

class 3 CHF

•symptoms experienced with less than ordinary activities; physical activity significantly limited

what are the 2 major theories that explain increased incidence of cancer in older adults?

1. biological age-related changes that impair the ability to resist diseases - logical 2. Prolonged exposure to carcinogens over the years - also logical

1. what are the main s/sx of chronic bronchitis (blue bloaters)? 2. when is dyspnea more noticeable? 3. what do they have more freq of/trouble of? 4. what episodes are common? 5. what can chronic bronchitis progress to? 6. how can you manage the secretions?

1. productive cough, SOB, wheezing 2. cold, damp weather 3. resp infections, managing those infections 4. hypoxic 5. emphysema 6. prevent airway obstruction by removing secretions via suctioning and maintaining adequate fluid intake

depression Incidence/prevalence •Depressive symptoms: ___% in community-based older adults •Major depressive disorder: -___-___% of community-based - __-___% of nursing home residents - ___-___% of acute care older adult patients •May be a ______ problem or ____ ____ in old age •_________ in older adults, _________ & ________!!!

15 6-10 12-20 11-45 lifelong, new onset underscreened, underdiagnosed, undertreated

whats the Ca minimum in an older adult? what should a well-balanced diet be rich in? why? what places strain on the joints? so whats important?

1500 mg daily protein, minerals; helps maintain structure of bones & muscles obesity; weight reduction

breast cancer •______ leading cause of cancer deaths •Risk increases with ____ •Encourage _______ _____ ______ - Older women less likely to receive _____ mammograms and breast examinations by a health care professional •Diagnosis: similar for all ages •Treatment: similar for all ages

2nd age regular breast exams yearly

hypotension •Postural or orthostatic hypotension: - Decline in systolic blood pressure of ___ mm Hg or more after _______ & ______ for __ minute •Postprandial hypotension: - similar reduction ___ hour after ______ - May also be related to taking __________ medications before eating •Both due to increased intake of ________ medications and concomitant decrease in ________ function •Consequences: - high risk of _____, ____, _______, & ______ complications

20, standing, rising, 1 1, eating antihypertensives vasoactive, physiologic falls, CVA, syncope, coronary

when do lungs mature? when does lung fxn start to decline?

20-25 35-40

Mrs. Q is a 71-year-old woman who is interested in joining a water aerobics program at the local YMCA. •Which targeted heart rate should you recommend to her? •Which target heart rate range should you tell her will be most appropriate for her?

220-71 =149 max HR 149 * 75% = 112 target HR target HR range: 97-119 bpm

how to calculate max HR? how to calculate target HR? what should target HR be? what should you teach?

220-age max HR * 75% 65-80% of max HR counting pulse

class 2 CHF

•symptoms experienced with ordinary physical activity; slight limitations may be evident

CVA •____ leading cause of death in older adults •Major cause of ________ •Risk factors - the usual culprits Types: •Ischemic - _______ - _______ or _______ •Hemorrhagic - _________ •Most common among older adults - ___________ Warning signs •Lightheadedness, dizziness, headache, _______ & ________changes, _____ _____ •Signs/symptoms depend on area of brain affected = ________ -left CVA affects ____brain •Major signs: ______, ________, _______

3rd disability blockage, thrombus, embolus rupture ischemic memory, behavioral, drop attack variable R hemiplegia, aphasia, hemianopsia

cervical cancer •Incidence/prevalence: usually occurs between ages __-__; fewer than 20% of cases in _______ women; death rate higher in older than _______ women •Signs and symptoms: endocervical ______, vaginal ______, ________, usually no _____; as progresses, urinary ________ or _______, fecal incontinence, ______ •Cervical cancer screening: continue screening if ____ or _____ found in previous screenings •Treatment/management: radium, surgery

40-49 older, younger polyps, bleeding, leukorrhea, pain, renetion, incontinence, uremia CIN2, CIN3

Although only __% of the older population is in a nursing home or other institutional setting at any given time, nearly ____ of all older women and ___ of all older men will spend some time in a long-term care facility during their lives

5 1/2, 1/3

how many liters of air should lungs be able to hold?

ovarian cancer •Increased incidence with women over age ___ •____ leading cause of cancer death, ____ leading cause of death from gynecologic malignancies •Signs and symptoms - Early: nonspecific, confused with ___ discomfort, that is, abdominal ____, ______, difficulty ______, __________ - As progresses: vaginal ________, ________, _______, presence of _______ ______ •Treatment: surgery, chemotherapy, _______ therapy, radiation

60 7th, 2nd GI, pain, bloating, eating, constipation discharge, bleeding, ascites, multiple masses hormone

cancer of vagina •Approximately half of cases occur in women over age ____ •Risk factors: ____ infection, _______ cancer, history of _______, ________ therapy in the vaginal area, women of _________ who took diethylstilbestrol (DES) during pregnancy with them (popular 1940 to 1970 and used for pregnancy complications) •Treatment: - Similar to younger women - Radiation - Topical chemotherapeutic agents -Surgery

60 HPV, cervical, smoking, radiation, mothers

macular degeneration •Most common cause of BLINDNESS in adults over the age of ___ •Damage or breakdown of the macula leading to loss of _________ ________ •Causes: - __________ macular degeneration (most common) associated with ______ - _________ macular degeneration results from injury, infection •Treatment/management: ______ therapy, _________ _________, high-intensity __________ lamps, other aids

65 central vision involutional, aging exudative laser magnifying glasses, reading

lung cancer •Most lung cancer now occurs in patients older than __ years •Higher incidence in ___, though rate in ______ is rising •Incidence and mortality rate varies in ethnic groups - Highest in _____ males, followed by ___ males, ____ females, ____ females, American Indian, Asian/Pacific Islanders, Hispanic •Incidence in ______ twice as ________ •Other known causes: exposure to _______, ___ gas,_________dusts, ________ (can be local air or water pollution by industries)

65 men, women black, white, white, black smokers, nonsmokers asbestos, coal, radioactive, chromates

OP Risk factors •Advanced age (women over ____ men over ____) •____________ •______ deficiency •_____ ____ deficiency •Small-_____, ____ women •Early _________ •_________ deficiency •Multiple __________ •_______ smoking •High ________ consumption •Prolonged _________ •Decreased __________ •Diseases or chronic use of drugs that increase bone loss (like what? _________ Commonly used in COPD?) •_____ ____ of osteoporosis

65, 80 ethnicity ca vit d framed, thin menopause estrogen pregnancies cigarette alcohol immobility exercise steroids fam hx

AGING & mental health •Depression prevalence - ___ million older Americans •Suicide - Aged ____ and above highest rate of any age group - _______ _____ _____ almost 6x general population •WHY? - Loss of ______ _____ _____ - altered ________ function and alterations in ________ ____ - _________/ ____ - demands associated with multiple _______ conditions set stage for variety of mental health problems

7 85 older white men multiple loved ones sensory, functional status discomforts/ pain chronic

DM •Recommended goal of less than ____% of HbA1c for healthy older adults •_______ ____ for patients with multiple moderate to complex illnesses, cognitive deficits, impairment in ADLs •Patients with severe impairment and complex medical illnesses: HbA1c goal of less than ____% is acceptable •Triglyceride levels below ____ mg/dL in people with diabetes •Periodically review ____-_____ of individuals who have had diabetes for a long time

7.5 Specific goals 8.5 150 self-care

tumors of vulva •Most cases diagnosed in women over ___ years •_________ is common site •Signs and symptoms: unusual _____ on vulva, may ____, be ________; or large painful, and ____-smelling fungating or ulcerating tumor; affect adjacent tissues •Treatment: radical __________; radiation therapy •Counseling: ____-___ practices, _____ _____, _____ ______

70 clitoris lump, itch, painful, foul vulvectomy self-care, body image, sexual activity

what is TIA?

•temporary or intermittent neurological event that can result from any situation that reduces cerebral circulation

Which of the following best describes the cause of a drop attack? A.Flaccidity in the legs B.Loss of consciousness C.Adverse effect of medication D.Postural hypotension

What is cholelithiasis?

•the formation or presence of gallstones in the gallbladder

what problems are the source of complaints and discomfort for older adults? what can delay the dx & tx of specific pathologies?

GI self-tx

What do Most older men have some degree of?

BPH

HLD •Risk of ____ with elevated _____ ________ increases with age •Risk increases with: - uncontrolled _____ - ____thyroidism, - _______ -________ syndrome; - use ________ & ________ diuretics •Diagnosis: - Evaluate full ____ profile, triglycerides, LDL, HDL; do not classify patient based on ____ laboratory value; obtain ________ after ___ hour fast

CAD, total cholesterol DM hypo uremia nephrotic corticosteroids, thiazide lipid one triglyceride 12

A ________ is avoidable and necessitates each nurse to be diligent in providing appropriate care to help lower this type of infection.

CAUTI

what pts are more prone to paralytic ileus?

COPD

SAFE OXYGEN ADMINISTRATION - ____ or chronic high levels of oxygen (from oxygen therapy) can contribute to a person retaining a higher amount of ____ in his or her lungs; carbon dioxide retention increases the risk of developing the serious complication of ___ _______ during oxygen therapy. - The nurse should monitor ____ and observe the patient for symptoms of carbon dioxide narcosis which may be displayed as increased ______or a ____ ______ state.

COPD, CO2, CO2 narcosis ABGs, sleeping, deep comatose

PE •Incidence is high (higher now r/t ______) •Detection and diagnosis ________ •Risk factors: ___ fractures, _____, _______, history of ________, ________, & _________ •Signs/symptoms: ________, ________, increased ________, _____ temperature elevation, ________, and elevated ________ rate •Treatment: similar to younger adults

COVID challenging hip, CHF, arrythmias, thrombosis, immobilization, malnutrition confusion, apprehension, dyspnea, slight, pneumonitis, sedimentation

Which of the following statements is true related to alcoholism and the older adult? A.Alcoholism is easily treated in the older adult. B.There is a decreased incidence of alcoholism with age. C.Health care professionals can easily detect alcoholism in an older adult. D.The long-term goal for the older adult with alcoholism is limited alcohol intake.

Parkison's disease •________ decreased and impaired function of basal ganglia - CNS can't control body movements •Exact cause unknown but many theories •More common in ____>age ____ •________ ________ !!!!!!!!! INITIAL SYMPTOMS: •____ _____ in hands •_______ •__________ •______ of PD - Face doesn't want to move •________ gait SECONDARY SYMPTOMS: •_________/dementia •______ disturbances •Decreased ________

DOPAMINE men, 50 resting tremor faint tremor drooling dysphagia mask shuffling depression sleep blinking

More tx for depression •_________ therapy •Herbs - ___ _____ _____ •Complementary/alternative (CAM) therapies - Acupressure, acupuncture, guided imagery, light therapy Good basic health practices •Help patient develop a positive ___-____ •Encourage expression of _____. •Avoid _________ feelings •Ensure that ______ ______ are met. •Offer ____

ECT st johns wort self-concept feelings minimizing physical needs hope

look for new/subtle symptoms/changes r/t neuro issues such as: •New _______ •Change in _______ •Sudden loss of ________ •New onset ________ •_____ or ________ changes •Altered ____ or change in _______ •New onset/change in ______; change in ____; ________ in extremity •Change in ___________

HA vision hearing tinnitus mood, personality LOC, cognition clumsiness, gait, tingling sensation

DM •Consensus report by American Diabetes Association and American Geriatric Society for glycemic and blood pressure goals including use of statins in older adults - Three categories * Patients who are _______ * Patients with ____ complex medical illnesses and some ________ deficits *Patients with very _________ medical conditions and significant __________ impairment - Geriatric syndromes: _________ changes, _______ impairment, increased ____ & __________ risk in diabetes, __________, _________, sensory impairment

HEALTHY few, functional complex, functional cognitive, functional, falls, fx, polypharmacy, depression

major chronic conditions of older adults •________ •High_________ •________ •_______ heart disease •________ •_______ ______ disease •______ _______ •__________ •_______ disease and other dementias •______

HTN cholesterol arthritis ischemic DM chronic kidney heart failure depression alzheimers COPD

what is syndrome x?

HTN, HLD, T2DM

urinary incontinence •Initial goal is to _____ __ _____ •Treatment goals developed based on the cause and type. •Types: - Transient: * ______, ________; caused by infection, delirium, medication reactions, excessive urine production, fecal impaction, mood disorders, inability to reach a commode or urinal * _______onset * Treatment of _____ can ________ problem - Established: * _______, _______, either ______ or _____ onset

ID the cause acute, reversible abrupt cause, reverse chronic, persistent, abrupt, gradual

what is a pressure injury?

Localized damage to the skin and/or underlying soft tissue resulting from pressure or pressure combined with shear or friction

what is epidermis?

Outer layer of skin

Routine ____ testing in men without a history of ______ _____ is not recommended.

PSA, prostate cancer

responsibilities of RNs in aging care w cancer •Ask about and sort through ____ ____ •Promote positive _______ ________ •Avoid _______ patients •Understand evidence-based risk factors •Educate on __________ measures and importance of ______ _______ leading to healthy aging •Educate patients regarding appropriate cancer _________ - ______ ________ can improve prognosis - Share _____, clarify _________, discuss ________ goals, address _______, assure decisions are _______

RF health habits alarming preventive, healthy lifestyle screening early detection facts, misconceptions, tx, questions, informed

more risks to maintaining active state •Decreased ____ - Causes: ___________ of bone; deterioration of _______, surface of joints •Increased risk for injury - Causes: _________ of bones _________) •Sensory-related changes: difficulty_________ & _________ - Causes: poorer _____, ______ •Age-related skin changes - Causes: _______ of skin; ______, loss, and change in ____ color (think social implications) •Increased difficulty with ________ - Causes: lower basal ________ _____

ROM demineralization, cartilage brittleness, OP seeing, hearing vision, hearing wrinkling, thinning, hair mobility metabolic rate

Close nursing observation can prevent and detect respiratory complications and should include checking the following: - ___ and volume - pulse (e.g., a sudden _____ can indicate _____) - blood pressure (e.g., _______ can occur with ______ ______) - temperature (e.g., not only to detect _______ but also to prevent stress on the cardiovascular and respiratory systems as they attempt to meet the body's increased oxygen demands imposed by an ________ temperature) - neck veins (e.g., for _______) - ______ of airway - coughing (e.g., ________, _____, & ________) - quality of __________ - _____ _____

RR inc, hypoxia increases, chronic hypoxia infection elevated distension patency freq, depth, productivity secretions mental status

postural drainage •Usually done by ___ in acute care but.. - Necessary to remove bronchial ______ is everybody's responsibility •Discontinue if _______, ________, _______ ______, ________ or other s/s distress •_____ hygiene and ____after

RT secretions dyspnea, palpitations, chest pain, anxiety oral, rest

Cancer of the Gallbladder •Signs and symptoms: pain in ___, ________, ___/___, weight ___, _________, weakness, constipation •Treatment: _______ •_____ prognosis

RUQ, anorexia, N/V, loss, jaundice surgery poor

whats the 7th leading COD in older adults? what incidence does it affect older adults?

T2DM 28.8%

________ cough, _____, and _____ ____ may be atypical in older adults because of age-related changes, which may cause a ________ diagnosis of pneumonia.

productive, fever, chest pain, atypical

prostatitis •Most common ____ among older men •Acute bacterial prostatitis signs and symptoms: - fever, chills, malaise (these uncommon with _______ bacterial prostatitis) - frequency, - nocturia, - ______, - bladder __________ - _______ ____ & ______ pain •Testing: - simple ___ for _____; - ____-____ with _____ secretions for __________ •Treatment: - _________ for acute; - chronic does not respond well to _______, more difficult to ____

UTI chronic dysuria obstruction lower back, perineal UA, acute clean-catch, prostatic, chronic abx abx, tx

As an RN caring for an older adult with a chronic condition has its own special challenges. Which factor should the nurse prioritize when providing care for these individuals? A.Support B.Monitoring progress C.Communicating with the health care provider D.Educating the caregiver

Assessment of chronic venous insufficiency demonstrates which of the following findings in the lower extremities? A.Pigmented and cracked appearance B.Smooth and shiny appearance C.Shiny and flat appearance D.Soft and spongy appearance

Postural and postprandial hypotension is most often related to: A.Vasoactive medications and decreased baroreceptor activity B.Antibiotics and increased cardiac output C.Antispasmodic drugs and increased levels of potassium D.Antibiotics and decreased renal function

The effects of aging on the action of insulin include which of the following? A.Insufficient release of insulin by the beta cells B.Increased tissue sensitivity to circulating insulin C.Improved ability to metabolize glucose D.Decreased glucagon production

The nurse notes a patient with Parkinson's disease is grimacing and appears restless in bed. The sheets are wrinkled and bunched up under the patient's back. The patient's legs are in an awkward position. After repositioning the patient and smoothing the sheets, the patient appears to relax and is able to sleep. Which nursing problem should the nurse prioritize in this situation? A.Pain related to poor positioning B.Discomfort due to improper care C.Anxiety due to inability to communicate D.Depression due to dependency

Which of the following breath sounds heard on auscultation would indicate an exacerbation of congestive heart failure? A.Crackles B.Vesicular C.Bronchovesicular D.Rhonchi

Which of the following roles provided by a CAM practitioner best describes the healing partnership? A.Empowerment, facilitation, and support B.Options to offer hope C.Acceptance and understanding D.High touch to relieve stress and discomfort

Which of the following statements best describes the effects of aging changes on thyroid gland activity? A.Lower basal metabolic rate B.Inability of the thyroid to meet daily needs C.Improved secretion of thyrotropin D.Increased radioactive iodine uptake

Which of the following types of skin cancers grows slowly, rarely metastasizes, and includes small, dome-shaped elevations covered by small blood vessels? A.Basal cell carcinoma B.Squamous cell carcinoma C.Melanoma D.Lymphoma

Which of the following bones are a common site for fractures in older adults as a result of a fall? Select all that apply. A.Neck of the femur B.Distal radius C.Vertebrae D.Rib E.Ankle

a, b, c

what symptom are you worried about coming first with acute appendicitis?

abd pain before vomiting

________ _______ _______ are a high risk in persons with a history of arteriosclerotic lesions, angina pectoris, myocardial infarction, and CHF.

abdominal aortic aneurysms

what is an arrythmia?

abnormal HR or rhythm

•Loose teeth can break or dislodge, leading to lung _________, ________ and _______ tooth fragments

abscesses, infections, aspirated

suicide risk Protective factors: •_______ and effective clinical care; •_______ & _______ support; •skills in _______ _______, •_______ ________, •________ ways of handling disputes; •________ & _______ beliefs that discourage suicide •Take all _______ _______ (obvious and subtle) seriously

access fam, community problem solving conflict resolution nonviolent cultural, religious suicide threats

keratosis •Also referred to as _________ or _____ keratosis •Description: _____, ______-colored lesions, usually _____ or ______ on exposed areas; cutaneous _____ with slightly _________ and ______ base •Treatment: ______ agents, acids; electrodesiccation, surgical excision •____________

actinic, solar small, light, gray, brown, horn, reddened, swollen freezing precancerous

common nursing problems r/t neuro: •Reduced ______- ______ ________ •Anxiety and/or ______; changes in ____-______ •____ •Inability to _________ •_________ •Caregiver _____ •Inability to live _________ •_____ breakdown; injury •__________; ________ issues •_____ health issues

activity; social isolation depression, self-concept pain communicate dysphagia stress independently skin constipation; voiding oral

unique challenges for older ppl w cancer •__________ stage when initially diagnosed •Multiple ______ ________ make it challenging to treat the cancer at times •Increased risk of _________, _________, & _________ when treating cancer •Survival rates ______ than younger persons for most types of cancer, even if diagnosed at same _____ •Consider this: an 80 y/o getting surgery and/or chemotherapy - ________ ______ before diagnosis important - ____ is impacted

advanced health conds complications, disability, death lower, stage functional status QOL

Guidelines for Exercise Programs for Older Adults •____-related changes affect a person's ability to exercise •Important to have ________ prior to starting a program and then monitor _______ during physical activity •Encourage program that matches _________ & _______ •Encourage to take advantage of __________ during daily routines •______ exercises throughout day to avoid _________ & _____ •Allow for periods of _____

age assessment, status interests, needs opportunities pace, fatigue, pain rest

Infections of the vulva •____-related changes cause the vulva to be more ____ and more susceptible to _______ & _________ •May also be related to _______, _______, ________, _______ ______ •Senile vulvitis - Infection associated with _______ or ________ - Other causes: _______, poor _______ practices - Symptoms: ________, _______, redness, swelling on ____ & _____ •Treatment/management: find and manage ______ _____, ____ ___, topical applications, keeping incontinent patient _____ & ____

age, fragile, irritation, infection DM, hepatitis, leukemia, pernicious anemia hypertrophy, atrophy incontinence, hygienic pruritus, blisters labia, vulva underlying cause, sitz baths, clean, dry

what is presbyopia?

age-related decrease in eye's ability to change the shape of lens to focus on near objects

what is presbycusis?

age-related high freq sensorineural hearing loss

The use of _______ or _______ based swab sticks (e.g., lemon-glycerin) for oral hygiene is not recommended because they can ____ the mucosa and _____ tooth enamel. _______, ______ , ______ the oral cavity with _______ will promote oral health.

alcohol, citrus dry, erode brushing, flossing, flushing, mouthwash

Good _______ and support of the _____ & _______ can prevent hyperextension and flexion of the head that can lead to impaired cerebral blood flow.

alignment, head & neck

The assessment should always include questions concerning the use of ________ _______

alternative therapies

A deterioration of a patient from _________ to _________ status can be judged a success if, without nursing intervention, that patient may have become ________ or died. Likewise, a physically and emotionally ________ death that left ________ memories for the patient's family can be a significant accomplishment. These determinants of success are different from those of acute care but are no less important.

ambulatory, wheelchair, bedridden comfortable, positive

nursing problems r/t GI problems •Weakness; reduced participation in activities - Causes: _____, ________, obesity, ________ & _______ deficiencies, ___________ •Constipation - Causes: ________ colonic peristalsis, duller ______ impulses, anorexia, obesity, hemorrhoids, lack of roughage, dehydration, habitual________ use •Diarrhea - Causes: ____, _____ ______, gastritis, ________ _____, diverticulitis, ______, fecal________, ____ feedings, _____ •Acute pain - Causes: indigestion, ________, _______, ______ •Dehydration - Causes: uncontrolled ______, ______, peritonitis, _______, ________, blood loss, insufficient ____ intake, high-_____ tube feedings •Potential for infection - Causes: ________, ________, hemorrhoids

anemia, constipation, vit, mineral, dehydration dec, neural, laxative meds, peptic ulcer, ulcerative colitis, diabetes, impaction, tube, stress constipation, hemorrhoids, flatus diabetes,infection, diarrhea, vomiting, fluid, solute DM, malnutrition

operative & postop care considerations •Use of _________ in older adults •__________ surgery discouraged •Avoid _____, _______ handling of body tissue •Prevent _________ ______ •________ anesthetics require more time to be eliminated from body •Close monitoring of _____ ______ •________, ______ postoperative observation and monitoring extremely important •Evaluation of the potential for ____ & ________ including blood loss •Assessment for ______, ____, fluid and electrolyte balance, and ________

anesthetics prolonged rough, freq pressure injuries inhaled body temp freq, close shock, hemorrhage hypoxia, UOP, infection

nursing considerations for MH conds Managing behavioral problems •Behavioral problems: actions that are _________, _________, ________, generally deviate from the ____, tend to be _______ in nature (physical or verbal _____, ________ to care, _______ actions, wandering, restlessness, suspiciousness, inappropriate _____ behavior and undressing) •Occurs in persons with altered _______ status who are incapable of thinking _________, making good ________, and ________ •Contributors to problem: illness that lowers ability to cope with change or stress, _____, environmental factors, loss of _________, insufficient _________ •First step is assessing the ______ of the behavior •Document factors associated with behavior: - Time of ____; _____ it occurred; environmental conditions; _____ present; _________ that preceded; pattern of _______; __/__ present; outcome; measures that ________ or _________ behavior •Correct _______ ____ of problem •______ factors that precipitate behavioral problem •Intervene ______

annoying, disruptive, harmful, norm, repetitive, abuse, resistance, repetitive, sexual cognitive, rationally, judgment, coping meds, independence, activity cause onset, where, ppl, activities, behavior, s/sx, helped, worsened underlying cause avoid timely

infections •_________ presentation of symptoms - _______, ___________ change in physical or mental function •Most common infection in older population: _____ - Symptoms: _______, incontinence, vague _____ ____, anorexia, ___/___ •Leading causes of infection-related deaths: ________ __________ - Symptoms: atypical;________, ________, ___________, plus typical signs

atypical abrupt, unexplained UTI confusion, abd pain, N/V bacterial pneumonia confusion, lethargy, anorexia

FEMALE reproductive system health promotion •_______ gynecologic examination with ____ ____* - Not recommended or indicated after age ___ as long as adequate ________ prior screening results which is defined as: * ___ consecutive negative cytology results or * ____ consecutive negative hrHPV test results within ___ years before stopping screening * Medicare covers ____ _____ & _____ _____ to check for cervical and vaginal cancers at no cost once every ____ months or more frequently if have certain ____ ____ * Clinical ____ ______ are also covered •Breast self-examination - This means _____ your own breasts - Recommendations for mammogram are: * Women ___ and older can switch to a mammogram every ______ ____, or choose to continue _____ mammograms. Screening should continue as long as a woman is in good health and is expected to live at least ___ more years.

annual, pap smear 65, negative 3 2, 10 pap tests, pelvic exams, 24, RF breast exams know 55, other year, yearly 10

emphysema s/sx •_________ (thin appearance) •_______ _____ •Minimal _____ but ________ on exertion •______ & ______ •Prolonged ______ time •_____ ____ ______ •Anxious •Speech in _____, _______ sentences •Use of ________ ______

anorexia barrel chest cyanosis, dyspneic fatigue, weakness expiratory purse lip breathing short, ragged accessory muscles

what are s/sx of lung abscess? whats tx?

anorexia, wt loss, fatigue, fever, chronic cough postural drainage, high protein/calorie diet

pressure injury •Tissue _______ and _______ result in _________, _________, and tissue ________ •Most common sites: _____, _____ ________, _____ ________ Predisposing factors •________ skin that damages easily •Poor ________ state •Reduced ________ •Affected by ______ & __________ conditions

anoxia, ischemia, necrosis, sloughing, ulceration sacrum, greater trochanter, ischial tuberosities fragile nutritional sensation immobile, edematous

PVD Various types commonly found in older adults •_________ •Special problems associated with______ •_______ •_______ ____ •_____

arteriosclerosis DM aneurysms varicose veins VTE

aneurysms •Advanced _______ aids in the development of aneurysms •Other causes: ______, _____ & ________ •Some seen on _______, some _________, others detected by diagnostics •________ can develop in aneurysm leading to arterial _______ or ________ of aneurysm •Most frequent type: ________ ______ aneurysm, especially if history of ________ _______, ______ pectoris, ____, ____ •Various treatments: early ________ essential; surgery

arteriosclerosis infection, trauma, syphilis inspection, palpable thrombosis, occlusion, rupture abd aorta, arteriosclerosis lesions, angina, MI, CHF intervention

__________, _________, ___________, & __________ deficiencies can threaten an older adult's vision

arteriosclerosis, DM, HTN, nutritional

risks assoc w hospitalization of older adults Useful measures to promote optimal functional independence (cont.) •Strict adherence to ______ techniques and ________ control practices •Close monitoring of ____, ___, _____ status, ____ status •___________ modifications •Assistance as necessary with ____ •Patient and family _________ •_______ _________ •Referral to appropriate resources

aseptic, infection I/O, VS, mental, skin environmental ADLs education reality orientation

Nightshade Herbs & Plants ‣ __________ ‣ Banewort ‣ Belladonna found in ________ ‣ Bittersweet (Atropine Belladonna) ‣ Brugmansia ‣ Datura ‣ Deadly _______ ‣ ______ Cherries ‣ Devil's Herb ‣ Divale ‣ Dubiosia ‣ Dwale ‣ Dwayberry ‣ Great Morel ‣ Henbane ‣ Hyoscyamus ‣ Jimson Weed ‣ Mandrake ‣ Mandragore ‣ Petunias ‣ Solanum ‣ __________

ashwanganda viagra nightshade devils tobacco

urinary incontinence assessment •____ every assessment •Medical history •_____ •______ status •________ •__________ function in lower extremities •Urinary _____ & ______ •Bladder ______ & ____ •_________ pattern •Presence of _____ ________ •Symptoms •Diet (type of ___/___ intake and amount) •________ to urinary incontinence •Refer for_________ medical evaluation!

ask meds functional cognition neuromuscular control, retention fullness, pain elimination fecal impaction food/fluid rxns comprehensive

Pieces of brittle teeth can break off, be ______, and cause _________ problems. This reinforces the importance of good ____ health and _______ ____ in late life.

aspirated, resp, oral, dental care

The first nursing intervention necessary to address problem behaviors in the older adult population is _________

assessment

urinary incontinence •Comprehensive evaluation: - Do not _____ patient has had problem ________. - Patient may be ________ to discuss topic •Interventions: ______ exercises, biofeedback, use of _______: holds vagina in place for prolapsed vagina, medications, surgery, _________ schedule, ______ method: hit abd real hard on, intermittent catheterization, improve _______, provide BSC •_______ ________ & _______ are extremely beneficial

assume, evaluated embarrassed kegel, pessary, toileting, credes, mobility positive reinforcement, encouragement

80% of older adults have what?

at least one chronic disease

What is tinea pedis?

athlete's foot; fungal infection of the foot

effects of aging on endocrine fxn •Thyroid gland ________ & _________ •Adrenal gland activity _____, reduced secretion of _____ - Results in diminished secretion of _______, __________, _________, & __________ • ____ blood levels reduced • Insufficient release of ____ by pancreas and reduced tissue ________ to circulating insulin •_______, _________, & __________ glands are at risk for dysfunction in older adults

atrophies, decreases decreases, ACTH estrogen, progesterone, androgen, glucocorticoids GH insulin, sensitivity thyroid, pancreas, adrenal

effects of aging on GI health •______ of the tongue affects ____ ____ and decreases taste ________. •Changes in taste sensation may be due to ______, ______, diseases, ______. •_____ production decreases, ________ may be difficult. •Reduction in _______ efficiency due to ________ of oral mucosa and _________ of muscles. •Presbyesophagus results in weaker esophageal _______ and weakness of the esophageal __________

atrophy, taste buds, sensation xerostomia, meds, smoking saliva, swallowing chewing, thinning, weakening contractions, sphincter

Diagnosing a thyroid condition in an older adult can be challenging due to the ________signs or symptoms that may be evident.

atypical

hearing aids •Can benefit some but not all older adults •Need for complete _________ _________ by an otologist •Purchase only by ___________ •Many not covered by _________or insurance •Variety of styles •Hearing can _______ but will not return to ______ •Difficulties with using a hearing aid: ____ ________ ________ •Education: start by wearing hearing aid for ______ periods of time each day, gradually__________ time used; avoid use in _______ environments

audiometric exam prescription medicare improve, normal all sounds amplified short, increase, noisy

nursing considerations for older adults w cancer Providing patient education •Increase _________ of measures that can ______ cancer •Understanding of _____ ______ of cancer - _________ mnemonic •____-__________ instruction •Cancer _________ tests

awareness, prevent warning signs CAUTION self-exam screening

Older adults who have asthma should be aware of which potential side effect of sympathomimetic bronchodilating nebulized drugs? A.Respiratory infection B.Cardiac arrhythmias C.Elevated serum potassium D.Peptic ulcer

Which medical problem may result in dysphagia? A.Hypertension B.GERD C.Osteoporosis D.Diverticulosis

Which of the following assessment tools is used to determine the risk of pressure ulcers? A.Folstein Scale B.Braden Scale C.Geriatric Skin Scale D.Pressure Sore Status Tool

Which of the following herbal medications may have an effect on blood clotting and must be documented in the medical record prior to any surgical procedure? A.Garlic B.Ginkgo biloba C.Black cohosh D.Rose hips

Which type of visual problem is associated with macular degeneration? A.Loss of peripheral vision B.Loss of central vision C.Perception of spots moving across the eye D.Pain with movement of the eye

Yoga, as a complementary therapy in the treatment of respiratory conditions, acts to A.Relax the diaphragm and promote breathing B.Increase deep breathing and tissue oxygenation C.Decrease the potential for apnea D.Improve elastic recoil in the lung

what is emotional homeostasis?

balance of emotions

nightshade veggies ‣ _____ _______ ‣ Datil ‣ _________ ‣ _____ peppers including ____ peppers, ________, habaneros, red pepper, cayenne, etc ‣ _______ ‣ Pimentos ‣ ________; but not _______ ‣ ______ Peppers ‣ _____ Peppers ‣ ________

banana peppers eggplant hot, chili, jalapenos paprika potatoes, sweet sweet thai tomatillos

whats the most common skin cancer in older adults?

basal cell carcinoma

CHF mgmt •____ ____: _______ bed rest discouraged; increased risk for skin ______; assist to _____ •_____ _____, ____ _____, ________, ________ •Reduction in _____ intake •Regular ____ ____ •Frequent changes of __________

bed rest, complete, breakdown, chair ACE inhibitors, beta blockers, digitalis, diuretics Na skin care positioning

tumor of scrotum •Usually _______ •Causes: ______, _______, ________, ______ •Signs and symptoms: depend on ________ _______; same as younger men •Treatment: depends on underlying cause; same as younger men •Management: _________ & _______- important

benign hydrocele, spermatocele, varicocele, hernia underlying cause education, counseling

promotion of skin health •Encourage to look ____and make _____ of appearance •Efforts to avoid ________ outcomes of aging can be fruitless and frustrating - Clarify misconceptions regarding ____________ products - Informed use of ________ to protect the skin - Accurate information about types of ________ _________ available •Nurses have best opportunity with most _______ ________ to assess the skin

best, most normal rejuvenating cosmetics cosmetic surgery direct contact

various drugs can cause or aggravate depression Antihypertensives, cardiac drugs: •______-________ •_________ •procainamide, •guanethidine, •clonidine, •reserpine, •methyldopa, •___________ Hormones: •corticotropin, •________ •___________ CNS depressants, antianxiety agents: •_______ •__________ •flurazepam, •barbiturates, •___________ Others: •__________ •L-dopa, •ranitidine, •asparaginase, •__________

beta-blockers digoxin spironolactone steroids estrogen alcohol haloperidol benzos cimetidine tamoxifen

complications of DM §Drug interactions - ___-_____, __________, ______, sulfonamides, ____, ________ - Review all medications the individual is taking - Ask about the use of ______ _____ §________ impairment §__________ §_____ §__________ arteriosclerosis §_____ §Higher risk of problems in _____ ____ ______

beta-blockers, aspirin, warfarin, TCAs, alcohol herbal remedies cognitive CAD cerebral UTIs every body system

effects of aging on vision cont. •Incidence of __________ increases with age •Communication problematic - Facial expressions and gestures may be _____ or __________. - Limitation of ___ _________ and ________ communication. - Remaining aware of current events through _________, socialization using _____ _______, playing ______ may be hampered

blindness missed, misinterpreted lip reading, written newspapers, social media, games

whats another name for chronic bronchitis? what kind of problem is it? what can it lead to?

blue bloaters inflammatory airway flow problem-tobacco use emphysema

potential nursing problems assoc w chronic conditions of older adults •Altered ____ ______ •Altered ________ intake: excess or inadequate •________ •__________ •___________ •Disruption in _____ __________ •Inability to manage _____ ________ •Insufficient _______ ______ •Insufficient _________ about condition and/or its mgmt •Low ________ for activity •Need for _______ support •_____ •Potential for ________ •Reduced ability to care for ____ •Reduced _______ •Reduced opportunities for __________ •Risk for_____ •Risk for _____ •Risk for _______ injury •_____ disturbances

body image dietary anxiety constipation dependency depression fam relationships home environment physical activity knowledge tolerance spiritual pain confusion self mobility socialization infection injury pressure sleep

healing •Mobilize the ____, ____, and ______ to control symptoms •Promote a sense of ____-_____ •Enhance the ____ •Individual can learn to ___ effectively with disease •Develop sense of ____ _____ & _______-

body, mind, spirit well-being QOL live inner peace, harmony

•Healing implies mobilization of ____, ____, and ______ to control symptoms, promote sense of ___-____, and achieve highest possible ____

body, mind, spirit, well-being, QOL

CAUTION mnemonic for cancer C-change in ______ & ______ habits A- a ______ that does not _______ U- ________ _______ or ________ T- ___________ or _____ in the breast or elsewhere I- __________ or _______ difficulty O- obvious change in a _____ or _____ N- _________ ________ _______ or __________

bowel, bladder sore, heal unusual bleeding, drainage thickening, lump ingestion, swallowing wart, mole nagging persistent cough, hoarseness

what is BRCA?

breast cancer gene; blood tests can be done to identify mutations in either one or two breast cancer susceptible genes (BRCA1 and BRCA2

It is important to ensure that older women know how to perform ____ _____ _____and that older men know how to perform ______ ____ ____

breast self exams testicular self exams

The absence of typical signs of fracture does not guarantee that a bone is not ______; therefore, close _______ _______ is essential whenever a bone has been subjected to trauma.

broken nursing observation

______ (hallux valgus) •Bony prominence over _____ _______ ____; ______ deviation of first metatarsal with ________ of great toe •More common in ________ •Treatment: possible _________

bunions 1st metatarsal head, medial, abduction women surgery

UTI cont •Signs and symptoms: - _______, ______ - ______, ________ - incontinence, - _______; - progresses to ______, •Treatment: - establish adequate urinary _______, - _________, - monitor fluid_____, force _____ as applicable • Risk for ______, especially if using ________ •________ __________common finding - Don't tx •Treatment: - _________, - avoid use of ________

buring, urgency fever, hematuria delirium retention drainage abx I/O, fluids sepsis, caths asymptomatic bacteremia prevention caths

Glycosylated hemoglobin levels monitor average blood glucose levels over what period of time? A.1 to 2 weeks B.3 to 4 weeks C.6 to 12 weeks D.12 to 20 weeks

Which of the following potential age-related changes may result in a lung abscess from aspiration of foreign material? A.Decreased elastic recoil of the lungs B.Increase in residual volume of the lung C.Decreased pharyngeal reflexes D.Increased elasticity of the alveoli

Which type of incontinence is caused by bladder neck obstructions and medications? A.Stress incontinence B.Urgency incontinence C.Overflow incontinence D.Neurogenic (reflex) incontinence

_________ (plantar keratoses) •Caused by ______ & _______, reduced ____ _______ of foot, ________ of skin, poor ______ shoes; usually appear on _____ & _______ •Massage with ______ & ____

calluses friction, irritation, fat padding, dryness, fitting, heels, soles lotions, oils

intestinal obstruction •Types - Partial or complete * Large intestine: _____ * Small intestine: _________ & _____ •Other causes: _________, _______ _____, ________, vascular problems, ________ _____ •Signs and symptoms - Small bowel obstruction (SBO): *_____ & ____-abdominal pain in ______ recurring waves * ________ - Obstructions occurring past ileum: *abdominal ______ so severe can inhibit ________, * vomiting - Obstruction of colon: *_____ abdominal pain, *altered bowel habits, *______, *sensation of need to ___________, *vomiting

cancer adhesions, hernias diverticulitis, ulcerative colitis, hypokalemia, paralytic ileus upper, mid, rhythmic, vomiting distension, respirations lower, distension, defecate

whats the 2nd leading COD in persons 65 and older? when does the probability of developing cancer dramatically increase? whats the single most important RF for cancer?

cancer w age age

Overuse of sympathomimetic bronchodilating nebulizers creates a risk of ________ _________ leading to sudden death.

cardiac arrythmias

chronic care: nursing _______ It requires knowledge and skills related to: - the management of ________ ________ problems - skilled ________ and ________ - ________ promotion of ___-___ capacity - monitoring of ____ health - a ____ of other demands.

challenge multiple medical assessment, planning individualized, self-care family variety

•RNs working with older adults need to understand the unique ________ & _____ for older patients living with chronic conditions

challenges, goals

what are the most obvious effects of aging?

changes involving skin

what does biliary tract disease consist of?

cholelithiasis & gallbladder cancer

_______ _______ can affect every aspect of life, making its impact significant for older adults. How chronic disease is managed can be the difference between a _______ life and a life controlled by _____

chronic disease satisfying disease

effect of _____ _____ on older adults is profound at times

chronic illness

glomerulonephritis •Acute and chronic: _____ may already exist when _____ develops •Signs and symptoms: very _____ and ________; fever, fatigue, nausea, vomiting, anorexia, abdominal pain, anemia, edema, arthralgias, elevated blood pressure, increased Sed Rate, oliguria, proteinuria, hematuria, headache, convulsions, paralysis, aphasia, coma, altered mental status •Diagnosis: ________ •Treatment: ______, restricted ____ & _______ diet, attention to fluid ____ •Nursing interventions: observe for medication ______, monitor for _____ ______

chronic, acute subtle, nonspecific imaging abx, Na, protein, I/O toxicity, renal failure

Chronic exposure to _______ ______, ________, ____ gas, _____ gas, and air ________ contributes to the development of lung cancer.

cigarette smoke, asbestos, coal, radon, pollutants

general interventions for CV health - avoid ______ ____ &/or ______ - failing to handle _____ effectively - ____ dose _____ (risk of ______) esp in _____ - ____ ______ _____ screening

cigarette smoke/ smoking stress low, ASA, bleeding, women C-reactive protein

emphysema 1. whats a major role in development of emphysema? 2. how do s/sx develop? 3. whats important to note about the incidence in older adults? 4. what are factors causing this disease?

cigarette smoking slowly increasing chronic bronchitis, chronic irritation, & morphologic changes in lungs

Acute glaucoma ( _________ or ______ angle) s/sx • Severe eye ____, ___/__, ______ •Rapid increase in ________ & ______of ciliary body • __________ of pupil; • vision becomes ________, • blindness will result if not corrected within a ____ •Need for early treatment to prevent blindness •Diagnosis with _________ and __________to measure IOP; gonioscopy (special non-invasive test) •Treatment: - ________ _______ ________, - __________ - _____ & ________; - iridectomy

closed, narrow pain, N/V, headache tension, edema, dilation, blurred, day ophthalmoscope, tonometry carbonic anhydrase inhibitors mannitol urea, glycerin

what is a cataract?

clouding of crystalline lens of eye

nursing problems r/t reproductive system •Potential for poor self-concept - Causes: _____ _____ •Discomfort - Causes: _________ •Difficulty voiding - Causes: ____, ________

sexual dysfxn vaginitis BPH, vaginitis

cataracts •_________of the lens and loss of __________ •Leading cause of _____ _______ in older adults •Risk factors: exposure to ______ ___, ___________, cigarette smoking, high ___________ consumption, eye injury Signs and symptoms •________ _______ not affected at first; as ______________ continues, vision distorted • decreased _______ vision • ___________ objects • ______ from sunlight and bright lights extremely bothersome; • nuclear sclerosis develops, lens becomes __________ or ________-_______, pupil changes color Treatment and cataract surgery •Need for surgery must be evaluated on an _________ _________ - If _________ cataract, may not need surgery - Concentrate on __________ existing visual capacity, reducing _________, using _________ measures •Types of surgery - Intracapsular extraction - Extracapsular extraction - Placement of intraocular lens

clouding, transparency low vision uv B, DM, alcohol visual acuity, opacification, night, blurred, glare yellow, yellow-brown individual basis single strengthening, limitations, safety

mind-body connection •_________ & _______ states influence physical activity •_________ can have ill effects •Activity can have positive effects on ______ & ________ •_________ activities based on unique interests - Current _______ or activities - _____ - Learn ____ hobbies or activities •Therapeutic recreation - ________ ________ with specific _____ in mind •Takes adequate ____ and much _________

cognitive, emotional immobility mood, cognition individualize current pets new structured leisure, goal time, patience

The patient's ________, __________,and ______ are largely influenced by the type of services rendered; in chronic care, most of those services will fall within the scope of _______. Perhaps this type of care, more than any other, provides an opportunity for nursing to demonstrate its facets of ________ practice and full _________ potential.

comfort, independence, QOL nursing independent leadership

varicose veins •________ problem •______, _______ nature of vein •____ pain, _______, can interfere with _____ •_______ on standing from lying position maybe •Susceptible to ____ & _________ - can lead to _______ lesions •Treatment aimed at reducing ____ - _____ & ___ affected limp - _______ - Correct use of _________ - Can_____ & _____

common dilated, tortuous dull, cramping, sleep dizziness trauma, infection, ulcerative stasis elevate, rest exercise stockings ligate, strip

Perineal herniation •____ ______ among older women •Types - _______, ________, & _______ ______ •Causes: _______ & ________ of muscles during childbirth, muscle ________ related to age •Signs and symptoms: _______ ____ pain, pelvic _______, ________ sensation, urinary and fecal ________, ________, constipation, difficult and uncomfortable _________ •Treatment of choice: ________ ______

common problem cystocele, rectocele, prolapsed uterus stretching, tearing, weakness lower back, heaviness, pulling, incontinence, retention, intercourse surgical repair

dyspareunia •______ ______ that accompanies _______ changes •More frequent in _______ women •Many gynecologic problems contribute: ______, ______ •Thorough _________ exam •Goal: achieve a _________ ____ ____

common problem, hormonal nulliparous vulvitis, vaginitis gynecologic satisfactory sex life

endometrial cancer •Not ______, but primarily affects _______ women •Incidence: higher in women with ____ onset of ______ ______, _______, personal or family history of hereditary nonpolyposis colon cancer, _____, used estrogen without _______, _____ •Signs and symptoms - ________ ________, endometrial _____ •Diagnosis: ____ ______, ______ & _______ •Treatment/management: surgery, irradiation, combination of both; early treatment can prevent spread to _____ & ____

common, older late, menstrual periods, infertile, PCOS, progesterone, uremia postmenopausal bleeding, polyps pap smear, dilation & curettage vagina, cervix

essential is... •________ for age-related changes •Public ________ •__________ for family caregivers •Creativity in suggesting _______ activities to motivate ________ •Demonstrating ______ _______ in their activities •Consider __________ needs •Learning older adult's individual ______, _________ & ________ •Avoiding ____________

compensating education education stimulating, participation sincere interest transportation interests, preferences, abilities stereotyping

Nurses cannot assume that people with long-standing incontinence have received a ________ ________ of this problem. A careful review of the medical history and interview with the patient are important to determine whether _______ testing has been done.

comprehensive evaluation, dx

nursing problems r/t urinary conditions cont. •Risk for infection - Causes: ________ urine, immobility, more ______ urine, _________ •Risk for falls - Causes: falls on urine _____ •Need for toileting assistance - Causes: _______, ________, _______ •Potential for skin breakdown; potential for social isolation - Causes: __________ •Disrupted sleep - ________, ________, ______ •Potential for social isolation - Causes: ________ over symptoms, odor, frequency, discomfort

concentrated, alkaline, catheterization puddles dementia, immobility, weakness incontinence noctura, retention, dysuria embarrassment

What is glomerulonephritis?

condition in which there is inflammation of the glomeruli, which filter blood as it passes through the kidneys

corns •_____ shaped layers of _____, ____ skin over bony prominence •________ causes discomfort; additional pressure increases ____ of corn •____ shaped corn pads and ______ wrapping toe in _____ _____ •Seek professional assistance in __________

cone, thick, dry pressure, size U, loosely, lambs wool removal

_________ & _________ _______are symptoms that may demonstrate hypoglycemia episodes in an older adult.

confusion, abnormal behavior

fecal impaction •Prevention of _______ aids in avoiding fecal impaction •A bowel _______ ______ is essential •Signs and symptoms: - distended _____; - abdominal and rectal ______; - _______ of fecal material around impaction often mistaken as ________; - _______, _____ fecal mass; - fever •Nursing interventions - Important to follow agency policy - May include ______ (oil retention); manual _______ and ________ of feces; ________ _______ •Avoid ________ or ________ patient

constipation elimination record rectum, discomfort, oozing, diarrhea, palpable, hard enemas, breaking, removal, hydrogen peroxide traumatizing, overexerting

_______ ______ is caused by the normal age-related changes of hypertrophy of the bladder muscle and thickening of the bladder.

urinary frequency

flatulence •Causes: - _________, - irregular bowel movements, - certain ____, - poor neuromuscular control of ____ _______ •_________ may occur if there is an inability to expel flatus •Treatment/management: achieving regular bowel pattern; avoiding flatus-producing _____, -_________, - sitting ______after meals •Interventions: - increased ______, - _____-_____ position, - flatus ____

constipation, foods, anal sphincter discomfort foods, meds, upright activity, knee-chest, bag

factors affecting the course of chronic care •Difficulty of sustaining treatment measures - Need for: * Periodic ______ and ________ of capacity * ________ * _________ •Factors influencing a patient's ability to manage their illness - Status of ______ may change, placing more or different _________ on the patient. - Status of ________ may change, reducing ____-____ ability. - Status of ______ may change, limiting the degree to which the patient's deficits can be __________

contact, reevaluation resources knowledge illness, demands pt, self care caregiver, compensated

whats important in reducing CVA in older adults?

controlling HTN

•Mental health indicates a capacity to _____ effectively with and manage ____ ________ in an effort to achieve _______ ________ •____ ________ give older adults an advantage in dealing with stressors •_______ & _________ may exceed physical, emotional, and social resources, contributing to mental illness •Need to promote _____ _______, detect _________ early, and minimize the impact of existing _________ problems

cope, life stressors, emotional homeostasis life experience losses, challenges mental health, problems, psychiatric

s/sx of pneumonia •Can be altered OR could be without any obvious s/s at all •Could be slight _____, ______, _____pnea, ________, ________, change in ________, ________ _____-which can be prevented by _______

cough, fatigue, tachy, confusion, restlessness, behavior, paralytic ileus, mobility

what is kyphosis?

curvature of the spine causing bowing out of upper spine

Warning signs of cancer are identified in the mnemonic CAUTION, in which the U is a reminder of which sign of cancer? A.Swallowing difficulty B.Nonhealing sores C.Lumps in the body D.Bleeding or drainage that is abnormal

Which of the following diets is encouraged for those who have a diagnosis of gout? A.Low calorie B.Low protein C.Low carbohydrate D.Low purine

Which of the following reactions, as a defense mechanism for coping with a chronic condition, demonstrates regression? A.Independently discontinuing medications B.Having a violent outburst C.Refusing to engage in self-care activities D.Abandoning self-care behaviors

what are causes of a lung abscess?

•Pneumonia •TB •Malignancy •Trauma •Aspiration

Deep Tissue Pressure Injury (DTPI) •Localized area of ____________ ____ ____ or _______ discoloration with dark ______ ___ or _______-filled _______ due to intense or prolonged pressure or shearing force. Skin may be ______ or ________

deep tissue pressure injury nonblanchable, deep red, purple wound bed, blood, blister intact, nonintact

seborrheic keratosis •Description: _____, _____-like projections •Increase in ____ & ________ with age •Various body locations •_________ lesion •________ __________ to differentiate from precancerous lesions •Treatment/management: abrasive activity with _____ pad and ____; ________ agents; curettage and _____________ procedure

dark, wart size, number benign medical evaluation gauze, oil, freezing, cauterization

what is physical deconditioning?

decline in cardiovascular function due to physical inactivity

•The incidence of major depression ________ with age, but the rate of minor depression _________ with age

declines, increases

Inactivity can result in ________, which compounds the effects of ___________.

deconditioning, sarcopenia

effects of aging on GI health cont •Esophageal and stomach motility _________ - Risk for _________ & ________ •Decreased ______ of the stomach - Reduces the amount of food accommodation at one time •Stomach has ________ pH due to declines in ____ and ______ •Decline in pepsin - Interferes with absorption of ______

decreases aspiration, ingestion elasticity higher, pepsin, HCL protein

effects of aging on GI health cont •Sensory perception _________ - May lead to _________ or incomplete _________ of the bowel •___ ____ synthesis decreases - Increase in the risk of ________ development •Pancreatic changes of fibrosis, atrophy, fatty acid deposits - Affects digestion of ____; _____ food intolerance •Liver size ________ but function should remain within normal limits; blood flow reduced due to decreased _____

decreases constipation, emptying bile salt gallstones fats, fatty decreases, CO

esophageal cancer •Incidence: ________, however, most are advanced age •Types: ________ ____ carcinoma, _____________ •Causes: poor ____ hygiene, chronic irritation from _________, _________, and other agents, Barrett's esophagus (from ____ usually) •Signs and symptoms: ______, weight_____, excessive _______, thirst, _____, anemia, chronic ________ •Diagnosis: ______ ______, _____, ________ •Treatment/management: surgical _______, _________, _______, laser therapy, photodynamic therapy

decreasing squamous cell, adenocarcinoma oral, smoking, alcohol, reflux dysphagia, loss, salivation, hiccups, bleeding barium swallow, EGD, biopsy resection, radiation, chemo

Yoga can promote _____ ______ and good _________ of tissues.

deep breathing, oxygenation

•Osteoarthritis: ________ joint disease in which there is _________ deterioration and abrasion of joint _______, with the formation of ____ ____ at the joint surfaces

degenerative, progressive, cartilage, new bone

older adult exercise program benefits •_____ or ________ some age-related effects •Cardiovascular: improve _______ intake, _______ resting blood pressure •Musculoskeletal: increase muscle ______, ________, slow rate of bone_____ •Improve body tone, circulation, appetite, digestion, elimination, respiration, immunity, sleep, self-concept •Provide opportunities for _________, _________, _________ support (__________ ___________!)

delay, prevent O2, lower strength, flexibility, loss socialization, recreation, motivational, accountability partners

Diagnosis of ovarian cancer is usually _______ because the early symptoms are often confused with ____ discomfort.

delayed, GI

GI Health Promotion •Good _____ _____ and regular _____ ______ can prevent disorders that threaten nutritional intake. •Proper nutrition enhances general health and minimizes the risk of _________ & ________ •Knowledge of the impact of ________ on GI health is important. •Utilization of natural means _____, _____, & ______) to promote bowel elimination.

dental hygiene, dental visits ingestion, constipation meds fiber, fluids, timing

whats the most freq psychiatric problem tx in older adults?

depression

Secondary symptoms of Parkinson's disease include _______, ______ disturbances, ________, ________, & __________

depression, sleep, drooling, dementia, dysphagia

nursing problems r/t visual or hearing deficits #1 •Reduced social engagement; reduced activity - Causes: sensory __________ or overload, impaired ____________ •Anxiety; risk of injury; risk of social isolation -Causes: impaired communication, altered ____-______, reduced ability to ________ self •Pain - Causes: acute _________, corneal ______, ___________retina •Communication deficit - Causes: _________ deficit •Sleep disturbances; anxiety - Causes: ___________ of environment

deprivation, comm self-concept, protect glaucoma, ulcer, detached hearing misperception

pancreatic cancer •Difficult to _____ •Diagnosed at an _______ stage •Signs and symptoms: - ______; - belching; - __/___/___; - constipation; - obstructive ________; - possible fever; - _______ pain radiating to ____, relieved by _______ _______, worsens in _______ position •Treatment/management: _______ •Generally ____ prognosis

detect advanced dyspepsia, N/V/D, jaundice, epigastric, back, leaning forward, recumbent surgery poor

arteriosclerosis •Common especially among those with ________ •Affects _____ vessels furthest from _____

diabetes smaller, heart

promoting CV health •Alterations modified by ______ & ____ •Identify and lower risks through ________ •Important practices: - Proper ____ - _______ - No ________ _______ - Manage _____ - _________ interventions

diet, lifestyle education diet exercise cigarette smoking stress proactive

CAM tx for cancer •Special _____, ___________, psychotherapy, _________ practices, _______ supplements, and _____ remedies •________ philosophies and approaches •Treatment of not just the ________, but caring for the _____ _______ •Caution with "_______ ______" CAM healthcare practitioners offer: •__________-centered care •__________ •Healing ___________ •_________ •_______ (again, caution against _____ hope) •Need to weigh ______ & ________ •Nurses need to stay current on information concerning this field; knowledge is rapidly growing

diets, acupuncture, spiritual, vitamin, herbal healing disease, whole person miracle cures relationship support partnerships comfort hope, false risks, benefits

what is dysphagia?

difficulty swallowing

arrythmias Causes: •______ ______ (most common), •_________ •acute _______ •__________ •________ syndrome, •coronary __________ Symptoms: ________, ________, ________, confusion, _______, ____tension, ______cardia, and ________ Treatment: _______, _______ drugs, ________, ________supplements, and ________ Education: modify ____, _______ cessation, decrease ______ and _______ Caution: ____ _____ can progress in absence of clinical signs and with blood levels within normal range even up to ___ weeks after drug discontinued

digitalis toxicity hypokalemia infections hemorrhage anginal insufficiency weakness, fatigue, palpitations, dizziness, hypo, brady, syncope tranquilizers, antidysrhythmics, digitalis, K, cardioversion diet, smoking, alcohol, activity dig toxicity, 2

•Urinary issues - not easily ________ by or with an older adult •Can lead to _______ detection, diagnosis and treatment •Big _______ impact - _______ impacts total body health •RN should develop ________ with patient so discussion is _________ for the older adult

discussed delayed psychosocial, negatively relationship, comfortable

aging & urinary elimination cont. •Long-acting ______ (thiazides) can cause _______ in the older adult, even if administered in ____ •Inefficient ______ control of bladder emptying and ______ bladder muscle - Retention of large volumes of urine: female—_____ ______; male—_____ - Symptoms: urinary _______, ______, ______, _____ bladder, sensation bladder has not ________ - Risk of ____ •Kidney filtration ability _______ - Affects the ability to eliminate _____ - Potential for _____

diuretics, nocturia, AM neurological, weaker fecal impaction, BPH freqm straining, dribbling, palpable, emptied UTIS decreases drugs ADR

UTIs can result from poor ______ practices, _______ problems, _________, _______, _________, arteriosclerosis, neurogenic bladders, and general ________ states.

hygeine, prostate, CAUTIs, dehydration, DM, DEBILITATED

diverticular disease •Types: __________, ________ •Causes: - chronic _______ -_______ - ______ hernia - ______ of intestinal wall muscles - low-_____, low-________ diets; - overeating - ________ during a bowel movement - _________, and irritating foods with __________ may lead to _________ •Signs and symptoms: - slight ________, - change in bowel habits - tenderness on palpation of ____ - nausea, vomiting, constipation, diarrhea, low-grade fever - _____ or _____ in stool •Treatment/management: - increase in dietary ____ intake, - weight ________, - avoidance of __________; - reduce ________, - provide _________, - relieve ________, - promote _____; - if surgery, ________ or temporary ___________

diverticulitis, diverticulosis constipation, obesity, hiatal, atrophy, fiber, residue, straining, alcohol, diverticulosis, diverticulitis bleeding, LLQ, blood, mucus fiber, reduction, constipation, infection, nutrition, discomfort, rest, resection, colostomy

Persons with varicose veins can experience ______ when rising from a lying position because blood is _______ in the lower extremities and _______circulation is reduced.

dizziness localized cerebral

mgmt of PD Medications: •________ _________ •___________ New technologies •_____ _____ stimulation •Drug infusions •____ therapy •___/___/___

dopamine agonists anticholinergics deep brain gene PT/OT/ST

pruritus •Causes: any circumstance that _____ skin (excessive _______, _____); diabetes, arteriosclerosis, hyperthyroidism, ______, liver disease, cancer, pernicious anemia, certain psychiatric problems •Potential for ____ ________ & _________ •______ recognition •Assess/correct the underlying cause •Treatment/management: - bath ____, moisturizing _________, ________; - ______ supplements, high-quality, ________-rich diet; - topical application of _____ ______; - _________, topical ________

dries, bathing, heat uremia skin breakdown, infection prompt oils, lotions, massage, vitamin, vitamin, zinc oxide, antihistamines, steroids

parkinson's pts have Increased ________, ________, _________, _____, urinary ___________/ __________

drooling, dysphagia, constipation, SOB, urgency/hesistancy

nursing problems r/t urinary conditions •Potential for adverse drug reactions - Causes: ineffective filtration of _____, wastes from blood due to loss of _______, ~50% decrease in _____ •Potential for ______ ___ - Causes: unreliable urine specimen findings due to decreased resorption of _____ from filtrate and less concentrated urine •Pain - Causes: _______, _______, ________ •Difficulty voiding - Causes: _______, _______, decreased bladder ________, _______ enlargement with age, infection, retention, calculi, strictures

drugs, nephrons, GFR missed dx glucose infection, cancer, retention urgency, frequency, capacity, prostate

xerostomia (___ ____) •Results from: - Decreased _____, some _______, Sjögren's syndrome, ______ breathing, and altered _________ •Consider the consequences of decreased saliva production in the older adult •Interventions - Saliva_________, ______ ____,_________ candy, & ____

dry mouth saliva, meds, mouth, cognition substitutes, sipping water, sugarless, gum

chronic bronchitis s/sx •_____ to ________ appearance •___________ _______ cough •_____ •_________ •Respiratory ______ •High _________ •_______ on exertion •Digital ________ •_________ •bilateral LE ______

dusky, cyanotic recurrent productive hypoxia hypercapnia acidosis hemoglobin dyspnea clubbing cardiomegaly edema

RA •Incidence/prevalence: usually develops ______ in life; more common in ______ and persons with _____ _____ •Deformities and disability begin at ____ age; peak during _____ age •Pathophysiology: synovium becomes________ and _________ with projections of synovial tissue protruding into joint cavity •Signs and symptoms: affected joints are extremely ______, ____, _______, _____, and _____ to touch; joint pain present during _____ & ________; __________ nodules over bony prominences and _______, deforming _______ ________ •Systemic symptoms: _______, _________, __________ weight_____, _______, _______

earlier, women, fam hx early, middle hypertrophied, edematous painful, swollen, red, stiff, warm rest, activity, subq, flexion contractures fatigue, malaise, weakness, loss, fever, anemia

corneal ulcer tx/mgmt •____ care effective •Cycloplegics, _________, _____, _____ •___________ will ease discomfort of photophobia •Treat underlying cause: _________, __________, ______ _____ •_________ ________

early sedatives, abx, heat sunglasses infection, abrasion, foreign body corneal transplants

d/c planning for older adults •______ & ________ discharge planning is essential •Goals: prevent _________, reduce risk for __________, and minimize ________ •Effective discharge planning particularly significant in era of abbreviated hospital stays Factors influencing postdischarge outcomes •Patients' ________ of health status and prognosis •_________ & _________ of medical conditions •Prior history of ___-_____ practices •_____ or ______ supports and resources •May be necessary to plan several sessions with patients to exchange important discharge information •Discharge plans must address _______& _________ needs •Nurse should assess and anticipate postdischarge needs as early as possible to adequately educate patient and caregivers, make referrals, suggest home preparation •_____________ geriatric team consults with staff and develops discharge plans

early, competent complications, re-hospitalization, stress perceptions number, complexity self-care fam, social fam, caregiving interdisciplinary

effects of aging on resp health •Respiratory problems develop _______; ________ to manage •Changes in upper airway paths - Nose: reduced ______ tissue support; ______ hair in nostrils - Reduced ________ secretions - Trachea ________ - Reduced ________ ______ - Weaker ____ _____

easily; difficult connective, thicker submucosal stiffens coughing reflexes gag reflex

nursing problems r/t resp risks w aging •Easily fatigued related to decreased respiratory efficiency - Causes: reduced ______ _____ of lungs during expiration •Poor airway clearance - Causes: _________ of tracheal and laryngeal cartilage •Increased potential for infection - CAUSES - decrease in ______ ____; - reduced _______ activity; - increased _______ of bronchioles & alveolar ducts; - loss of _______ muscle strength in thorax & diaphragm; - increased _______ of thoracic muscles & ribs; - increased _______ of anteroposterior chest; - less efficient _____ response

elastic recoil calcification vital capacity ciliary diameter skeletal rigidity diameter cough

nursing problems r/t resp risks w aging •Less effective gas exchange - Causes: reduced _______ ______ of lungs during expiration - _________ of lung apices and _________ of lung bases •Ineffective air exchange - Causes: increase in _______ ________ •Reduced airway clearance - Causes: decrease in __________ ______ capacity

elastic recoil hyperinflation, underinflation residual capacity max breathing

effects of aging on vision •Reduced _______ & ________ of the muscle fibers of the lens - Decreased ability to ______ (____________) •Visual ______ declines - Reduced pupil _____ - ___________ of the lens and vitreous - Loss of _____________ cells in retina •______ perception threshold decreases - Dark and light adaptation takes longer - Difficulty with vision at _____ •Increased sensitivity to________ •Distortion in ______ perception •__________ vision reduced •Produce fewer ______; eyes are _____

elasticity, stiffening focus, presbyopia acuity size opacification photoreceptor light night glare depth peripheral tears, drier

what diseases are grouped in the category of COPD? why?

emphysema, chronic bronchitis, asthma because of their common outcome of obstructing airflow

risks to maintaining active state •Difficulty _________ in activity and exercise - Causes: decreased ____ •____ - Causes: reduced _______ capacity and efficiency •Decreased ________ tissue perfusion - Causes: delayed _______ diffusion •Increased ________, decreased _______, and/or reduced muscle ________ with activity - Causes: decrease in muscle ____, _______, & _____

engaging CO SOB breathing peripheral O2 fatigue, stamina, strength mass, strength, mvmts

whos the pt in chronic care?

entire fam

What are melanocytes?

epidermal cells that give skin its color

Nutrients beneficial to vision #1 •________ ________ _______: important to healthy retinal function •Flavonoid: improves ______ vision and adaptation to ____; promotes visual ______; improves capillary integrity to reduce ___________ risk in diabetic ___________ •Vitamin A: maintains healthy _____ & ______ in retina •Vitamin B complex: may prevent elevated levels of __________, associated with vascular problems affecting retina •Vitamin C: promotes normal vision; supplementation may reduce risk of __________ •Vitamin E: may aid in preventing _________; supplementation in large doses can prevent ______ _________ •Selenium: may aid in preventing __________; supplementation with ____ ___ can reduce visual loss in macular degeneration •Zinc: promotes normal visual capacity and adaptation to ____; supplementation can reduce visual loss in macular degeneration; deficiency can facilitate __________ development

essential fatty acids night, dark acuity, hemorrhage, retinopathy rods, cones homocysteine cataracts cataracts, macular degeneration cataracts, vit E dark cataract

involuntary loss of urine that can have an abrupt or sudden onset and is chronic

established incontinence

neuroendocrine aging includes decreased production of what?

estrogen, testosterone in men, adrenal fxn, GH insulin-like growth factor

vaginitis •Treatment: local _______ in suppository or cream; ____ or gentian violet douches (typically douching is not recommended as it predisposes for ___ because of change in vaginal pH) •Nursing interventions - Avoid use of ______ soaps and sprays or unprescribed ______. - Wear _____ underwear. - Keep genital area ____ & ____ - Use ________during intercourse.

estrogens, zinc, UTI perfumed, douches cotton clean, dry lubricants

hyperthyroidism •Secretion of ________ amounts of thyroid hormone •Incidence/prevalence: affects _______; less prevalent than _________ •Causes: use of __________ •Diagnosis: relies on evaluation of __, ____ ___, _____, increased uptake of radionuclide thyroid scans Symptoms: • diaphoresis • ______cardia, ________, _______tension • tremor, ________, • stare, ____ ____, • _________, •nervousness, confusion, • ______ intolerance, • increased _______, • proximal muscle weakness, •_________ • Can present with ______ symptoms in older adults

excess women, hypothyroidism amiodarone T4, free T4, TSH tachy, palpitations, hyper, diarrhea, lid lag, insomnia, heat, hunger, hyperreflexia atypical

DM Exercise & Nutrition §Health benefits of regular ______; effect on ____ & ________levels §Need to monitor the level of_______ as it relates to blood glucose levels §Maintain ________ daily intake of food; can be impacted by ________ factors §Diet high in ______ _______, _________ §Supplements: vitamin ___, ______ _____, ________, _______, _____, _________

exercise, BG, triglyceride activity consistent, psychosocial complex carbs, fibers B6, folic acid, RIBOFLAVIN, MAG, Zn, CHROMIUM

pneumonia •Related to: •Poor chest _______, _______ breathing •Lower resistance to ________ •High prevalence of respiratory diseases promoting ______ formation and subsequent bronchial __________ •High incidence of conditions causing reduced _____ and even _________ •Greater likelihood of developing ________ ________

expansion, shallow infection mucus, obstruction mobility, debilitation nosocomial pneumonia

measures to compensate for visual deficits in older adults •_____ person when speaking -> •Use several ____ _________ lights not a _______ __________one -> •Avoid _________ from windows with _______ curtains or _________ windows -> •Use ________ print reading material -> •Place __________ _____ items within visual field -> •Avoid use of ___-____ colors; use ________ ones -> •Use ___________ colors on doorways and stairs and for changes in levels -> •Identify personal belongings and differentiate room and wheelchair with unique _______ rather than letters or numbers

face soft, indirect, single, glaring glare, sheer, stained large freq used low-tone, bright contrasting design

drop attack is a ____ caused by a complete _______ _______ in the ____, without an alteration in ___________

fall, muscular flaccidity, legs, consciousness

The most important goal to facilitate physiologic balance of an older client who has risk of injury related to urinary incontinence is to be free from _____ related to_______ ______(e.g., falls on _____ _____).

falls, escaped urine; urine puddles

fx •Fracture should be suspected when an older adult ____ or has ________ to their bones •Signs and symptoms: ____, change in ______ or ______ of limb, abnormal or restricted _____, ______, ______ of surrounding tissue, discoloration of tissues, _____ fracture •________ of signs or symptoms does not rule out fracture; ______ signs or symptoms may appear later •_________ of the injured site during transport for evaluation essential •Nursing __________ essential

falls, trauma pain, shape, length, motion, edema, spasm, open absence, overt immobility observation

Choosing an exercise program for an older adult can be achieved by identifying common activities that older adults enjoy and implementing a program based on your findings from the literature.

false

Older adults have the highest rate for any age group of receiving early detection tests for cancer.

false

•Benign prostatic hyperplasia is a rare occurrence in otherwise healthy older men.

false

What is pseudodementia?

false appearance of dementia that occurs when persons demonstrate cognitive deficits secondary to being depressed

Is the following statement true or false? Cerebral blood flow decreases by 50% in older adults.

false, by 20%

Is the following statement true or false? •The rate of completed suicide among older persons is the lowest of any age group in the United States

false, highest

•It's okay for your patient to purchase a hearing aid from a catalog if he or she is having financial difficulties.

false, needs a prescription and complete hearing exam by otologist

Is the following statement true or false? Systemic symptoms often accompany osteoarthritis

false, occur w RA

Routine digital examinations are usually performed after an older gentleman begins to exhibit signs of prostate cancer.

false, should be regularly assessed

There are various medications that can be utilized as a first step to correct a digestion or bowel problem.

false, try natural means first

•Chronic condition care activities should be focused down a curative path

false; Because patients cannot eliminate their disease, care measures focus on helping patients effectively live in harmony with, rather than cure, the condition.

Normal age-related changes do not cause intercourse to be uncomfortable for older women.

false; There are several changes in the female reproductive system that increase the risk of uncomfortable conditions and interfere with satisfying sexual experiences.

mgmt of HLD •Has a _______ tendency - be aware •Treat with: - Lifestyle changes - ____ & ____ - Meds - _____ , _________

familial diet, lifestyle statins, fibrates

depression s/sx Most common: •__________ •________ •anorexia, weight _____ •_________ •lack of _______ in activities previously enjoyed, •decreased interest in _____ •May express self-________, _____, apathy, remorse, __________, _________, feelings of being a _________ •Problems with personal relationships and social interactions •Changes in _____ and psychomotor activity •________ neglect •Physical complaints: can include ________ & _________ •Altered cognition - Can mimic __________

fatigue insomnia loss constipation interest sex depreciation, guilt, hopelessness, helplessness, burden sleep hygiene HA, indigestion dementia

nursing problems r/t MSK problems & their causes •Difficulty engaging in activities, exercise, and mobility - Causes: muscle _____, ____, deformity, ______, ______ •Anxiety - Causes: ____, fear of _______ •Constipation, urinary retention - Causes:_______ or ________ from pain or disability •Pain (acute, chronic) - Causes: _______, contracture, spasms, _______ •Fear - Causes: change or loss of ______ or __________ •Difficulty performing ADLs and/or IADLs - Causes: ______, contracture, ____, impaired ____ •Increased risk of injury - Causes: _____ gait, pain, improper use of _____ •Powerlessness - Causes: dependence in ____ and/or _____

fatigue, pain, spasms, atrophy pain, injury inactivity, immobility fx, arthritis fxn, appearance arthritis, pain, ROM unsteady, heat ADLS, IADLS

Changes in the renal threshold for glucose cause older adults to be ________ without having any evidence of _______.

hyperglycemia, glycosuria

preop considerations •Sensitivity to ____ of older adults •Understanding of how surgical procedures have advanced - Better ________ tools; Improved therapeutic measures; Increased _________ concerning older adults •__________ and support •Patient education Preoperative preparation •Types of reactions to ________ •______ of and _________ of surgery •Routine ________ ____ procedures •Expected ____ and management •_________, _______, & ___ _______ exercises •Review of _______ - Patient may not have informed health care provider of all medications, OTC, or herbal preparations •Preoperative screening completed •Provide appropriate _________ if needed •Promote _________ control •Ensure _________ _______ has been obtained

fears dx, knowledge reassurance anesthesia length, description recovery room pain turning, coughing, & deep breathing meds screening infection informed consent

what are the most common sites of fx in older adults?

femur, distal radius, vertebrae

dental problems •Importance of dental care throughout the lifetime - Consider _______ limitations - Encourage regular ____ ____ •Poor dentition can restrict food intake and lead to: -________ - __________ •Impact on ________ & _________ •_________ disease predisposes to systemic infection •Underlying causes: altered _____ sensation, poor diet, deficiencies of vitamin ___ complex and ____, _______ imbalances, hyperparathyroidism, diabetes, __________ (soft bones), _______ disease, ______ •Phenytoin: ________; antihistamines, antipsychotics: severe ____ mouth •Aging process: tooth _____, ____ absorption, loss of tooth _______ •Lesions: benign neoplastic, malignant, moniliasis •__________ disease •Dental ______

financial dental care constipation malnourishment appearance, socialization periodontal taste, B, Ca, hormonal, osteomalacia, cushings, syphilis gingivitis, dry decay, root, enamel periodontal caries

DM monitoring •May require multiple ______-______ each day to monitor blood glucose level; •_________ ________ __________ (CGM), used by type 1 patients, may be useful in type 2 patients on insulin with ________ episodes •Infrared device and other noninvasive to minimally invasive devices are under research •HbA1c test measures the amount of glycosylated hemoglobin in the blood - Used to monitor _________- of disease control - _______ of blood glucose control over __-__-week period - Normal range between __-__% - Goal: ________ and could be <____% or <____% •Performed ________

finger-pricks continuous glucose monitoring, hypoglycemia effectiveness average, 6-12 4-6 individualized, 7.5, 8.5 quarterly

_____ _____ for older adults with coronary artery disease can improve cardiac ______ ______, reduce ______ episodes, decrease the risk of _______, and promote a sense of ___-____ and ______ over the condition.

fitness programs functional capacity, ischemic, complications, well-being, control

What is Dupuytren's contracture? whos at risk?

fixed flexion of the hands due to a thickening of the fibrous tissue under the skin of the palm and fingers a risk for persons with diabetes mellitus

effects of aging on the skin •_________ of the dermal-epidermal junction •Reduced ________ & _______ of the dermis •Decreased rate of epidermal ________ •Degeneration of _____ fibers •Increased __________ of collagen •Reduction in ________ •Increased _________ of the skin •Changes potentially affecting _____ ______, ____-_______, reactions from others, socialization, and other psychosocial factors

flattening thickness, vascularity turnover elastic coarseness melanocytes fragility body image, self-concept

Most ___ deaths occur in older adults •Flu __ most frequent •Flu __ less severe •Age related changes increase __________ •S/S: _____, ________, ____ throat, __________ cough. MAY NOT BE _________ IN OLDER ADULTS •Risk higher for developing ________ infection (like _______) especially if underlying chronic respiratory, cardiac, or metabolic disease

flu a b susceptibility fever, myalgia, sore, nonproductive, evident secondary, pneumonia

urinary system health promotion Assess, assess, assess •Adequate ____ intake •Maintenance of ______ urine •Avoidance of ______ •Avoid ______ •Frequent ______ •Enhance _______ and prevent _________

fluid acidic catheters inactivity toileting voiding, retention

effects of aging on resp health external changes: •Reduction in body ____/reduced ____ intake •Altered ____ sensation •Different norms for ____ ____ •_____ or _____ teeth; fragments can be __________ •_______ sphincters and ______ gastric motility •Impaired _______ and/or _______ •Medication adverse effects

fluid, fluid pain body temps loose, brittle, aspirated relaxed, slower mobility, inactivity

podiatric conds •_____ ________ are a common occurrence •Referral to podiatrist necessary for treatment •Education r/t proper ____ ____, importance of seeking professional care for problems •Nursing interventions - Offer _____ _______ if not contraindicated - Effectively identify and seek treatment to improve _______ & ________

foot problems foot care foot massage mobility, independence

detached retina •_________ displacement of the retina Signs and symptoms •Gradual or sudden: - perception of _______ moving across eye - blurred vision -flashes of ______ - feeling that a ________ is developing over eye - _______ areas of vision progress to complete _____ of vision •______ __________ to prevent continued damage and eventual blindness •Treatment/management: - initially, _____ _____ & _____ ________ - surgery (electrodiathermy, cryosurgery, scleral buckling, photocoagulation)

forward spots light coating blank, loss prompt tx bed rest, eye patches

Age-related changes cause the vulva to be more _____ and more easily susceptible to _______ & _______

fragile irritation, infection

proper nutrition for CV health diet & wt •NO ______ _____; LIMIT _____ ____ •_____ ____ & _____ GOOD •_____-____ cals/day •__________ and ______-___oils GOOD •_____-____ ______ ____ like in ___ GOOD •_______, _______ foods, ____ ____ - NEED TO LIMIT •_________ - LIMIT control ________ ________, effective _____ mgmt

fried foods, animal fats complex carbs, fiber 1300-1400 monounsaturated, omega 6 omega 3 fatty acids, fish sugar, processed, red meat alcohol cholesterol exercise, stress

tumor of penis •Incidence: ____ •Signs and symptoms: _______ _____, _______ growth; may be misdiagnosed as _____ •Diagnosis: _______ •Treatment: ______, local ______ for small lesions, partial or total penile _________ for extensive lesions

rare painless lesion, wartlike, chancre biopsy irradiation, excision, amputation

providing encouragement •Respiratory problems: _______ and produce _______ •Understanding of _______ process and management •Promote self-care but consider - Can they use _____ correctly or from a functional standpoint? •Need for psychological support and ________ •Encouragement to meet _______ of chronic disease •Ventilated patients - _______-, _________, ______ needs of those ventilator dependent

frightening, anxiety disease inhaler reassurance demands physical, emotional, social

stage 3 pressure injury •A ____ ________ of skin is lost extending through the ________ and exposing the _________ tissues; presents as a ____ ________with or without ________ and undermining adjacent tissue.

full thickness epidermis, subq deep crater, tunneling

stage 4 pressure injury •A _____ _______ of skin and _________ tissue is lost, exposing _______, ______ or both; presents as a deep crater that may include _______ tissue, ______, or _______. ________ and undermining often present

full thickness, subq muscle, bone necrotic, slough, eschar tunneling

unstageable pressure injury •___-_______ loss of tissue with base covered by _____ &/or ____. Stage cannot be determined until ____ or ________ is removed to expose _____ and actual _______ of wound

full-thickness eschar, slough slough, eschar base, depth

loss of voluntary control of urine due to disabilities that prevent independent toileting, sedation, inaccessible bathroom, medications that impair cognition, or any other factor interfering with the ability to reach a bathroom

functional incontinence

risks assoc w hospitalization of older adults •Decreased ______ ____ •_________ infections •________ complications •Delirium, _____, _________ _______, _________, incontinence, constipation, and loss of ________ _______ Useful measures to promote optimal functional independence •Careful assessment to identify _______& _____ •Early _________ ______ (day of admission!) •Encouragement of __________ •Monitoring of medications •Frequent _________, _________, & ____ _______, _________ •Prevention of complications •Avoidance of _________ _________ if possible

functional status nosocomial iatrogenic falls, pressure injury, dehydration, functional independence problems, risks discharge planning independence repositioning, coughing & deep breathing, toileting urinary catheterization

What is onychomycosis?

fungal infection of the nail or nail bed

podiatric infections •Onychomycosis: _____ infection of ____ or ____ ___; treatment: ________ preparations •Tinea pedis: _______ _____; ______ infection of foot; breaks in skin can lead to ________ infections

fungal, anil, nail beds, antifungal athletes foot; fungal, bacterial

Many older adults who have lived independently in their homes prior to hospitalization are not discharged with the same level of _______ and may require ______ _____ transfer.

fxn nursing home

what is flatus?

gas in intestinal tract

effects of aging on GI health cont •Decline in hydrochloric acid - Increase in the incidence of ____ ________ - Interferes with absorption of ___, ___, ____ ___, & ____ ___ •Fewer cells on absorbing surface of intestinal wall impact the absorption of ______, _____, ___, ____, & vitamin __, ___ & ___ •______ peristalsis, inactivity, reduced food/fluid intake, drugs, and low-____ diet - Increase risk of __________

gastric irritation Ca, Fe, folic acid, Vit B12 dextrose, xylose, Ca, Fe, B, B12, D slower, fiber constipation

SAFE O2 ADMINISTRATION - The nurse should check the ___ frequently to ensure that it is set at the prescribed level and check the oxygen flow for any interruption or blockage from an _____ tank, _____ tubing, or other problems. - The nurse should evaluate and recommend the method of administration that will be most effective for the individual patient. Older patients who breathe by ____ or have poor control in keeping their lips _______ most of the time may not receive the full benefit of a ____ _____. An _______ person whose facial structure does not allow for a tight seal of a face mask may lose a significant portion of oxygen through _______. A patient who is _______ & _______ inside an oxygen tent may spend oxygen for emotional stress and not gain full therapeutic benefit. - The patient's nasal passages should be regularly ______ to maintain _______. Indications of insufficient oxygenation must be closely monitored; some older persons will not become _______ when hypoxic, so the nurse must evaluate other signs.

gauge empty, kinked mouth, sealed, nasal cannula emancipated leakage insecure, anxious cleaned, patency cyanotic

What's the second leading cause of blindness in older adults?

glaucoma

T2DM §______ ________ §Contributors to diabetes: _______, inactivity, increased amount of ___ tissue, ___-____ _______ with diabetes §Physiologic deterioration of glucose tolerance no longer considered a risk factor Diagnosis §Early diagnosis often difficult. §Classic symptoms may be ______ Screening §______ ____ recommended every ___ years for persons over ___ years of age. §Screen with ________ ____ and/or ______; if levels out of range, then ________ __________ _____ §_______ _________ _____ is the most effective test. §To avoid _____-_________ results, more than one test should be performed, lab tests may be misleading.

glucose intolerance obesity, fat, first degree relative absent fasting BG, 3, 45 fasting BG, HbA1C, glucose tolerance test glucose tolerance test false-positive

what does every aspect of ADLS depend on?

good neurologic status

hyperthyroidism •Depends on cause - ________ ________ (autoimmune disorder): ________ medications or ________ ______ - _____ _______ ______: surgery •Medications: _________, _________ •Need special monitoring when experiencing an ______ illness, surgery, or trauma, can precipitate extreme __________; may require hospitalization

graves disease, antithyroid, radioactive iodine toxic multinodular goiter methimazole, PTU acute thyrotoxicosis

venous stasis ulcers •Use ______ to promote circulation and reduce _______ •Use _______ _____ to prevent pressure on ulcer. •Avoid ____ socks •Control ____ with meds •Change _______ as prescribed. •Exercising: - ______ - _________ - stationary _________ - _________ of feet.

gravity, edema overbed cradle tight pain dressing walking swimming bicycling dorsiflexion

hiatal hernia •Incidence: affects about ___ of people over age 50 •Causes: believed to be ____ ____ diet;_________ •Types - ______ (axial) * Most _______ type * Common with ______ - ________ (paraesophageal) •Signs and symptoms: ________, ________, _________, vomiting, regurgitation, pain, _________; sometimes mistaken for ____ •Diagnosis confirmed with _____ ______, ____ •Treatment/management: weight _______, _____ diet, frequent _____ meals, discourage bedtime ______, sleep in partly _______ position, ___ _______ & ____

half low fiber, obesity sliding common GERD rolling heartburn, dysphagia, belching, bleeding; MI barium swallow, EGD reduction, bland, small, eating, recumbent, H2 blockers, PPIs

Erectile Dysfunction •Problem affecting nearly ____ of men over ____ years •Incidence ________ with age •Not ______ _____; due to _______, ____ abuse, _______, dyslipidemia, _____, __________, _______ ______, _____ failure, _____, _______ conditions, psychological factors, _________, ________, ________, ______, ________, tranquilizers •Signs and symptoms: inability to ________ & ______ an _______ for intercourse •Treatment/management - Oral erectile agents (______ citrate, vardenafil HCl, tadalafil), drugs ______ into penis, ______ ________, vacuum pump devices, surgical implantation of devices, penile artery reconstruction - Monitor for _____ to medication - Ensure no_________ for erectile drug before administering

half, 70 increases normal aging, alcohol, drug, HTN, DM, hypogonadism, Multiple sclerosis, renal, SCI, thyroid, anticholinergics, antidepressants, antihypertensives, digoxin, sedatives sustain, achieve, erection Sildenafil, injected, penile implants ADR contraindications

_________ ________ (digiti flexus) •_________ at metatarsophalangeal joint with ______ •Often ____ formation at _________ interphalangeal joint •________ to area results in discomfort •Treatment: _______, ________

hammer toe hyperextension, flexion corn, proximal pressure orthotics, surgery

nursing interventions after fx to prevent complications •Remember older adults ____ more slowly •Risk of ________ greater: ________, _________ formation, ________ injuries, renal calculi, fecal _______, _________ •Need _____ ______ & _______ exercises, _________ & _____ exercises, frequent ________ & ________ changes •Encourage _____, good ________ •Maintain correct body _________ •Prevent _______ ________ •________ as early as possible •__________ & __________ essential •Progress in _____ ____

heal complications, pneumonia, thrombus, pressure. impaction, contractures deep-breathing, coughing, isometric, ROM, turning, positioning fluids, nutrition pressure injuries mobilize explanation, reassurance small steps

what is the #1 goal for chronic care?

healing

nurses role in chronic care •Facilitate the _______ process •Guide individuals to achieve their maximum_______ and highest attainable ____ •Create a therapeutic ____ & ________ environment •Educate, _______, reinforce, _______, _______, and remove _________

healing potential, QOL human, physical empower, affirm, validate, barriers

pressure injury •Longer ______ periods •Most important nursing measure: _________ - Encourage _____, ___________ immobile individuals; prevent __________ activities; use of ______; keep beds ________-free; use of medical devices; proper _______; good skin care - In very ill patients - remember _______ ______ _______ can occur despite every effort to prevent Signs: •________; _________; __________; ____ ______ damage Tools: •________ scale, Norton scale, Pressure Sore Status Tool

healing prevention activity, repositioning, shearing, devices, wrinkle, nutrition terminal skin failure hyperemia, ischemia, necrosis, deep tissue braden

•Dysfunction of the neurologic system has a ripple effect on other systems and can profoundly affect _____, ______, ________, & general ____-____

health, safety, normalcy, well-being

general nursing considerations for skin conditions #2 Using Alternative Therapies •______ and other _____ products •_________ ____ •Homeopathic and naturopathic remedies • __________ •Biofeedback •Guided imagery •_________ exercises •_________ supplements

herbs, plant essential oils acupuncture relaxation nutritional

what does metabolic syndrome consist of? Occurring together can increase the risk of developing?

high triglycerides, low high-density lipoprotein, elevated fasting BG, HTN, & central obesity DM, CVA, CAD

•Goal is to maintain a ____ ______, _______ life, and not be controlled by the _________

high-quality satisfying, disease

The manner in which a chronic condition is managed can make the difference between a ____-_______, _______ life and one in which the person is a prisoner to a ______.

high-quality, satisfying, disease

incidence of chronic disease is what? most adults have at least?

higher w advancing age, two

Most families seek assisted living or nursing home care after having attempted caregiving of their elder relative at _____, not as a ___ ____. By the time they seek such assistance, their physical, emotional, and socioeconomic resources can be significantly _________, and they may require special ________ and ________from nurses.

home, first choice depleted support, assistance

Acute care and the older adult population •Higher rates of __________ •________ length of stay •Age-related changes increase the risk of _______, _________, & ________ •Technology has improved care and options •Older adults have ______ care needs while hospitalized

hospitalization longer injuries, infections, complications unique

•When determining how to approach your older adult patient concerning their urinary needs, a good guideline is to consider what?

how you would like to be treated if you were the patient.

Nightshade Fruits ‣ Garden ________ ‣ _____ berries aka _____ berries ‣ __________ ‣ Jerusalem ________ ‣ Pepino ‣ _________ ‣ Tamarillo ‣ ___________

huckleberry goji, wolf gooseberries cherries sunberry tomatoes

infection prevention in older adults •Promoting good _________ & _______ status •Monitoring ___, _________ status, general health status •Maintaining intact ___ & ___ •Avoiding _________ •Ensuring __________ & _________ vaccines •Maintaining a _____ environment •Restricting _________ with infected persons •_______ foods properly •Preventing ________ •Adhering to ______-_________ practices

hydration, nutritional VS, mental skin, mm immobility pneumococcal, influenza clean contact storing injuries infection-control

aging and urinary elimination •________ & ________ of the bladder muscle - Decreases bladder ability to ____ - Reduces _______ capacity * Daytime urinary ______ * _________ •Kidney function can improve when in _______ position, voiding may be required after ______ ____ during night •Changes in cortical control of micturition - Contributes to ________ - Related to_________

hypertrophy, thickening expand storage frequency nocturia recumbent, lying down nocturia dementia

indications of ineffective tissue perfusion •_____tension •_____ cardia •Decreased ____ quality •_________: anaerobic activity (inc need for O2 upon exertion) •_____ •Loss of____ on extremities •Tissue ________ •Stasis ________ •________ •Increased _______ •_____ •_______ of skin •________ •Decreased _____ •________ •__________ •________ disturbance

hypo tachy pulse claudication edema hair necrosis ulcers dyspnea respirations pallor coolness cyanosis UOP delirium restlessness memory

Older adults may demonstrate restlessness as the primary symptom of __________ after surgery

hypoxia

_________ is a difficult life situation

illness

nursing problems r/t MSK problems & their causes •Difficulty in conducting self-care activities - Causes: ________, _____, deformity •Decreased self-image - Causes: change in body structure or ______, pain, immobility, increased ________ •Sexual dysfunction - Causes: ____, ______, ________ difficulties, altered ____ ____ •Difficulty sleeping - Causes: ____, _____, _____ •Difficulty interacting with others; increased social isolation - Causes: change in body structure or function, altered ____-_____, ____ •Reduced social contact - Causes: immobility, pain, __________

immobility, pain fxn, dependency pain, fatigue, positioning, body image pain, spasms, cramps self-concept, pain disfigurement

what should you never give for "suspected diarrhea"? What should you do before giving it?

imodium digitally checking for a fecal impaction

nursing considerations for MH conds Monitoring meds •May bring significant _________ •Potential for adverse effects: anorexia, ________, _____, incontinence, anemia, _______, sleep disturbances, confusion •Use the______ possible doses •Complement other forms of treatment Promote a positive self-concept •People need to feel their lives have had _______ and that there is _____ •Take ________ in the lives and accomplishments of the older adult •Promote self_______ •_____ ____, ____ _____, and _______ of life events may assist in the sense of worth (sound familiar?!?) •Encourage ________ in relevant activities •Ensure _________ in meaningful social interactions •Have opportunities to do for ________ •Exercise maximum amount of ______ over own life as possible •Maintain ________ & _________ practices •Be __________ as individuals

improvement constipation, falls, lethargy lowest meaning, hope interest life review, oral hx, scrapbook participation engagement others control religious, cultural respected

chronic constipation •Contributing or causative factors: - _______ lifestyle; - low ____ and low _____ intake; - depression; - _______ abuse; - medications (_______, sedatives, _______ _______ gels); - _____ sensations to need for bowel elimination; - failure to allow _______ ____ for complete emptying of bowels •Interventions to promote bowel elimination: - high-____ diet, - _____, - regular ______; - specific foods individual responds to; - regular schedule •Need for education - Safe use of ________ •Use of an _______ ______ •May require medical evaluation

inactive, fiber, fluid, laxative, opiates, aluminum hydroxide, dulled sufficient time fiber, fluids, activity laxatives elimination chart

what is substance abuse?

inappropriate or excessive use of alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics, anxiolytics, stimulants, tobacco, and other or unknown substances that result in disorders

women have special risks with cancer •Especially with ________ ___ •Age at onset of ______ & ________ can be important to know •Age at _____ of ____ _____ can be important to know •_____ ________ _________ with breast or ovarian cancer •If mother took ____________ during pregnancy - Popular during time ______ ________ getting pregnant •Relatives with ______ cancer increase risk for ________ cancer •Excess ________ and/or long-term ________ _________ increase risks

inc age menses, menopause birth, 1st child first degree relative diethylstilbestrol (DES) baby boomers colon, ovarian estrogen, hormonal replacement

prostate cancer •_________ incidence with age, median age ____ •________disease progression •Signs and symptoms: ____ pain, _______, _________, weight ____ •Diagnosis - Detected by _______ ______ ______, ____, _______ •Treatment/management - _____ should be followed closely - If no metastasis: _______, _______, radical __________ - __________ - Palliative treatment: irradiation, ________ surgery, chemotherapy, ________, hormone therapy

increased, 66 asymptomatic back, anemia, weakness, loss digital rectal exam, PSA, biopsy BPH monitoring, irradiation, prostatectomy hormones transurethral, orchiectomy

CVD & Women •Prevalence _______ with age - 70% of women ___ years and older - Leading ____for women •Guide women about not _________ symptoms •Symptoms less _____ in women than men; leads to _____ in seeking treatment •Ask about _______ _____ during routine assessments

increases 65 COD ignoring evident, delay specific s/sx

dysphagia •Incidence of swallowing difficulties _________with age •Causes - _____, ______, and structural disorders •Types - Oropharyngeal - Esophageal •Symptoms - Mild (________ dysphagia with certain foods) to complete inability to _______ •Nursing assessment - Onset - Accompanying ________ - Triggered by _____ or ______ - ________ or _______ at each meal •Referral to ____ •Major goals: - Prevention of __________ - Promotion of adequate _________ status

increases GERD, CVA occasional, swallow s/sx solids, liquids intermittent, present ST aspiration nutritional

intestinal obstruction •Nursing assessment - Review _________ thoroughly - Careful attention to _____ ____ •Treatment/management - _______ intervention is extremely important - Medical management: _____, _______ evaluation, intestinal _______ - Surgical management

s/sx bowel sounds timely xrays, blood, intubation

CHF •Incidence ________ with age •Leading cause of _________ •Complication of ________ heart disease •______ responsible for most cases •Other risk factors: - DM, dyslipidemia, sleep-disordered breathing, anemia, CKD, use of illicit drugs, sedentary lifestyle, psychological stress •Symptoms: _______ on _______, _________, _________, ________ at night, agitation, depression, ________, wheezing, weight _____, bilateral ______ _____, moist _______ lungs

increases hospitalization atherosclerotic CAD dyspnea, exertion, confusion, insomnia, wandering, orthopnea, gain, ankle edema, crackles

Cholelithiasis •Incidence ________ with age •Signs and symptoms: ____, often following ______ •Treatment: _____ _______treatment, _____, standard surgical procedures •Management: monitor for _______, _______, _______

increases pain, meals rotary lithotrite, ESWL obstruction, inflammation, infection

HTN •Incidence and prevalence _______ with advancing age •Most ________ cardiovascular disease of older adult •Various causes: - ________ associated with aging, - _________, ________ - ____ disease, -_______, - _______ deficiency •Be mindful of ___ readings - might not be exactly what you think in older adults; SBP> ___ & DBP> ____ •Good data on the impact of ____ ____, even just 5#, on BP

increases prevalent vasoconstriction hyperthyroidism, parkinsons pagets anemia thiamine BP, 140, 90 wt loss

bladder cancer •Incidence: _______ with age, 90% of cases are over age ____ years; _____ 3x more than _____ •Risk factors: chronic irritation of bladder, exposure to dyes, ________ _______ •Signs and symptoms: resemble ____; frequency, urgency, dysuria, _______ _______ •Diagnosis: standard measures including cystoscopy •Treatment: surgery, radiation, immunotherapy, chemotherapy •Observation for signs of metastasis: _____ or ____ ____

increases, 55, men, women cigarette smoking UTI, painless hematuria pelvic or back pain

stomach cancer •Incidence: ______ with age, average of ___ years •Prevalence: ____; _______ ______; _____ socioeconomic groups; African American, Hispanic, and Asian/Pacific Islander individuals •Signs and symptoms: _______, _______ pain, weight ____, _______; may be ___________ •Diagnosis: ______ ________, _________ with biopsy •Treatment/management: ______ •Prevention: diet low in ____ _____ and high in ___________

increases, 68 men, cigarette smokers, poor anorexia, epigastric, loss, anemia, insidious barium swallow, gastroscopy surgery red meats, antioxidants

VTE •________ incidence among older adults •High risk: restricted to ____ ____, recent _____ & _____ •Signs and symptoms depend on location, can include ____, _______ over affected area, _____ swelling, cyanosis, aching, ________ of superficial veins, _______ •Treatment depends on location, can include _______, surgery, elastic _______, bandages, and ________ of extremities

increasing bed rest, surgery, fx edema, warmth, pain, engorgement, tenderness anticoagulants, stockings, elevation

A primary goal of nursing interventions for older adults with a musculoskeletal disorder is to promote __________

independence

•Cognitive function in later life is highly ___________ •Incidence MH issues rising among older adults - ___ in ___ experience some mental disorder: depression, anxiety disorders, substance use disorders, dementia - Expected to be ___ million by 2030 - ____rds of older adults do not seek treatment for MH issues

individualized 1, 4 15 2/3

DM Management §Glycemic goals: ___________ - Fasting plasma glucose of __-__ mg/dL - Postprandial glucose of <____ mg/dL - HbA1c of <____% - Example: patients we saw in LTC or Memory Care? A1C <____% OK! Management through _______ ________ §Overview of disease process §_______ §_________ & ________ §Medications §Monitoring §Recognizing ________ & __________ §Recognition of ___________ §Presentation of complications

individualized 90-140 180 7.5 8.5 pt education nutrition activity, exercise hypoglycemia, hyperglycemia symptoms

•Gerontological nurses should suspect an _______ when there is any abrupt, unexplained change in physical or mental function in the older adult.

infection

resp health promotion •Prevention of ________ •_______ & ________ vaccines important •Avoiding exposure to people with ________ ___________ •________ cessation •_________ is a major threat •Caution with ___-_______ of respiratory issues •Review of ________ •Encourage healthy ___ cavity •_____ ________ exercises

infection influenza, pneumonia resp infection smoking immobility self-tx meds oral deep breathing

nursing problems r/t reproductive system •Dyspareunia - Causes:________ , pain, altered structures, _________ •Inability to engage in _________ ____ - Causes: infection, pain, altered structures, embarrassment •Potential for infection - Causes: more ________ & ________ vaginal canal, _____

infection, embarrassment satisfying sex alkaline, fragile BPH

promoting hearing •Good care of ears throughout the lifetime •Prompt/complete treatment of _________ •Prevention of _______ to ear •Regular __________ exams •Assessment for _________ __________ - _________ •Education - Environmental _____; protection from exposure - wear _____ _________!

infections trauma audiometric impacted cerumen irrigation noise, noise proetctors

What is gingivitis?

inflammation of gums surrounding the teeth

corneal ulcer •__________ of the cornea accompanied by a loss of _________ •Predisposition factors: - ______ states, - _______, - dietary deficiencies, - lowered ________, - ____ •May _____ or _________, leading to destruction of cornea and__________ •Signs and symptoms: - affected eye may appear __________, - increased _________,_ - ____, - ___________

inflammation, substance febrile, irritation, resistance, CVA scar, perforate, blindness bloodshot, lacrimation, pain, photophobia

gout Pathophysiology •________ disorder in which excess _____ ____ accumulates in the blood, uric acid crystals deposit in and around _____ Signs and symptoms •Severe ______ & _______ of joint and ______, _______, _______ of surrounding tissue; •during acute attack, pain can be _______ •unable to ____ _____ or have anything ____/______ affected joint; •attacks can last ____ to _____ •periods of _________

metabolic, uric acid, joints pain, tenderness, warmth, swelling, redness severe bear wt, rest/touch weeks, mo remission

nursing care of older adults w asthma •Remember it's an _________ process with high risk for _____ problems and _________ •High rates of ________ •Assess for causative factors - ____________! - (e.g., ________, ______ breathing, and _______ ________ infections) and educate the patient regarding early _______ of and prompt _______ to an asthma attack when it does occur. •Assess for effective/correct use of _______ and/or _______ •__________ - can cause _________ ________!

inflammatory, cardiac, bronchiectasis mortality educate emotions, mouth, chronic resp recognition, attn nebulizer, inhaler bronchodilator, cardiac dysrhythmias

overall CV nursing considerations •Keep patient _________ •____________!!!!! •Good ___ care - prevent/eliminate sources of ________ •Maintain ____ _____ •Assess vital signs - keep ___ acceptable range •Carefully administer ____ •Potential for ____ stimulation exists •_____ rate of drug detoxification = toxicity •Consideration of impact of cv function on _________ •_______ expectations on any restrictions and lifestyle changes

informed prevention skin, pressure fluid balance BP O2 vagal slower sexuality realistic

acute appendicitis •________ in older adults •_______ presentation: minimal or _______ pain, minimal _____, absent _________ •Potential for a _____ in diagnosis •Potential for greater ________ & _______ •Treatment/management: prompt ______

infrequent atypical, referred, fever, leukocytosis delay implications, mortality surgery

_______ ________(onychocryptosis) •As nail grows, edge cuts into tissue, leading to _________ •Treatment: _____ & _______ ____, podiatrist _______ of ingrown portion and _______ of area

ingrown nails inflammation soaks, topical abx removal, cleaning

The effective use of ______ requires the ability of the user to manipulate the ______ and coordinate the _____ with inhalation—tasks that may be difficult for some older persons.

inhaler, apparatus, spray

Paranoia •Need to explore mechanisms to reduce ________ & _________ - Believes food is ______; _____ deprivation; health care provider is trying to ____ them Interventions •__________ & _____ are used when other interventions unsuccessful Treatment/management •_____, _____ explanations and approaches are beneficial •At no time should _______ be supported

insecurity, misperception poisoned, sleep, hurt psychotherapy, meds honest, basic delusions

Symptoms of gastric cancer can be _______ and easily mistaken for ________

insidious, indigestion

fecal incontinence •__________ defecation •Inability to _______ _______ the passage of stool •Most often associated with ______ _________ - First step: assess for ________ •Other causes: - decreased ______ strength, - impaired automaticity of puborectal and external ____ _________, - loss of _______ control, - reduced reservoir ________ •Diagnosis: proctosigmoidoscopy, proctography, anorectal manometry •Treatment/management: - bowel _______, - drugs, - surgery, - _________

involuntary voluntarily control fecal impaction impaction contractile, anal sphincter, cortical, capacity retraining, biofeedback

What is mixed incontinence?

involuntary loss of urine due to a combination of factors

What is fecal incontinence?

involuntary passage of stool

what are mongolian spots? where are they found? whos it more prevalent in?

irregular, dark areas (resembling bruises) may be found on buttocks, lower back, and to lesser extent on arms, abdomen, and thighs; more prevalent in persons of African, Asian, or Native American backgrounds

promotion of skin health •Avoid agents________ to the skin •Good skin _________ & _________ •Promote _______ •Hydration using bath ____, ______, & _______ •Avoid excessive ________ •Early treatment of _______ and skin _____ •Avoid exposure to ____ ____ - use ____-_____: at least SPF ___ and apply liberally and often - Wear __________ - protect eyes from ocular skin cancers - Skin damage can occur on __________ days

irritating nutrition, hydration activity oils, lotion, massage bathing pruritus, lesions UV rays sun-screen, 15 sunglasses overcast

CAD •________ heart disease •Prevalence________ with age •Most persons ___ years or older have some form •Presentation: - ______ * can be _____ and merely vague ________ * Coughing, ______, _______with exertion, _______ * Treat with _____ with caution - Myocardial Infarction (MI) * Seen usually with hx of____ & _________ * Dx can be _______- those atypical symptoms again * Can see ______, progresses to ________, ____ death

ischemic increases 70 angina atypical, discomfort syncope, sweating, confusion nitro HTN, atherosclerosis delayed anuria, arrythmias, v fib

what is pruritus? what is turgor?

itching elasticity

renal calculi (_____ ________) •Causes: ________, ______, changes in ____ or concentration of urine, chronic ________, dehydration, excessive elimination of ____ ____, _________ •Signs and symptoms: ___, ________, symptoms of ____, ___ _____ •Nursing interventions: prevent _______ ______, provide ample _______, facilitate prompt treatment for ____ •Diagnosis: imaging •Treatment: depends - fluid ____ important, treat ____, restrict ____ & _______ in diet

kidney stones immobility, infection, pH, diarrhea, uric acid, hypercalcemia pain, hematuria, UTI, GI upset urinary stasis, fluids, UTIs I/O, pain, Na, protein

stage 2 pressure injury o______-_________ loss of skin layers involving epidermis that presents clinically as _______ or _____/_______ blister, or open _____ ____

partial-thickness intact, open/ruptured shallow crater

OP •May cause _______, _____ pain, and _________ •Often ________, detected by ____ •Diagnosis - ____ _______ via DEXA, P-DEXA, DPA •Treatment/management: depends on underlying cause - Medications: ____ supplements, ____ ___ supplements, ______, synthetic ______, __________ - Diet: rich in ______ & ____ - ______, ____-_____ - Exercise - ______ _______ most important and best Nursing management •Advise against ____ _______, ________, and similar activities •Individuals providing care must be _____ to avoid _______ •_____ exercises and ________ important

kyphosis, spinal, fx asymptomatic, xray bone density Ca, vit D, SERMS, calcitonin, bisphosphonates Ca, protein braces, bed-board wt bearing heavy lifting, jumping gentle, fx ROM, ambulation

what is anorexia?

lack of appetite

factors affecting the course of chronic care •Defense mechanisms and implications - Reactions to _______ changes, _______, and _________ - Reactions as defense mechanisms: * _______: making statements or taking actions that are not ______ with the ________ of the illness (e.g., abandoning a special diet, discontinuing medications independently, committing to responsibilities that cannot be _________) * ______: acting in a hostile manner, having violent outbursts *_________: making statements regarding the __________ of a situation, refusing to engage in self-care activities, _________, questioning the _______ of life * ____________: becoming increasingly _______ unnecessarily, abandoning self-care behaviors - Avoid _______ and help individual ____ through it (e.g., by providing an opportunity to ___ frustrations and offering _____from the routines of care by doing for the patient until he or she feels psychologically able to resume self-care).

lifestyle, frustrations, losses denial, consistent, realities, fulfilled anger depression, hopelessness, withdrawing, purpose regression, dependent reacting, work, vent, respite

anxiety Causes: •Adjustments to physical, emotional, and socioeconomic ______ in old age; •new _______ frequently encountered with aging Clinical manifestations: •_______ complaints, •rigidity in _________ & _______ •_________, fatigue, •________, restlessness, •_____-______, pacing, fantasizing, confusion, •increased ________; •increase in ___, ____, ____, psychomotor activity, •frequency of ________; change in ______; •intensively involved with _____ task; •difficulty ___________ on activity at hand

limitations problems somatic thinking, behavior insomnia hostility chain-smoking dependency BP, RR, pulse voiding, appetite minor concentrating

whats a chronic condition?

long-term dysfxn or pathology

what are mental health myths about aging?

loss of cognitive fxn is a normal part of aging pathological signs are considered normal

mgmt of gout •____ ____ diet •Medications - Acute attacks: _______, _______ - Long term: ________, _______, _________, _________ •AVOID _________ & _____ ______ •Dietary supplements: - _____ ___, ______ _____ •Nursing interventions - Monitor and Treat _____! - Encourage ______ intake

low purine •Colchicine, phenylbutazone •cochicine, allopurinol, probenecid, indomethacin alcohol, thiazide diuretics vit E, folic acid pain fluid

what is cataracts the leading cause of in older adults?

low vision

Aspiration of foreign material can also cause a ______ _____; this may be a particular risk to aged persons who have ________ _______ ________

lung abscess dec pharyngeal reflexes

whats the most common cause of blindness in adults > 65 y?

macular degneration

hearing deficits •Incidence/prevalence: _________ of older adults, higher in _____ Causes: •exposure to _____ _______, •recurrent ______ _________, •trauma, •_______ medications, •__________ •tumors of ____________ •_____ thyroidism, •___________ •psychogenic factors

majority, men loud noise otitis media ototoxic DM nasopharynx hypo syphilis

suicide gestures •_______ misuse •Self-_________ •Activities that oppose a ________ ___ •Activities that threaten a ________ _______ •Subjecting oneself to ________ risks

med starvation therapeutic need medical problem unnecessary

_______ _______ has helped many people survive illnesses that once would have killed them; greater numbers of people are reaching old age, in which the incidence of ______ _______ is higher.

medical technology chronic disease

who is parkinsons more common in? what's the thing that differentiates them from a different disease?

men > 50 y resting tremor

_______ _______ is as vital to an individual's physical well-being as physical activity. Likewise, physical activity can improve _____ & ________

mental stimulation mood, cognition

melanoma •Tends to more easily ___________ •Rising __________ in the United States •Risk factors: ____ exposure; ____-skinned individuals; ____ Classifications •Lentigo maligna melanoma •Superficial spreading melanoma •Nodular melanoma •Acral lentiginous melanoma •Evaluation and treatment: _____ & ________; some physicians recommend removal of palpably enlarged _________ ________ •Prognosis: depends on _____ rather than ____ of melanoma •Teach older adults to _____ themselves, seek evaluation of _________ _______ •_____ ________ improves prognosis

metastasize incidence sun, fair, age biopsy, excision; lymph nodes depth, type inspect, suspicious lesions early detection

more risks to maintaining active state •Higher prevalence of living with multiple chronic illnesses can result in - Increased difficulty with ________ and __________ in exercise or other activities - Potential for chronic ____ related to chronic disease •Reduced income can result in - Decreased _______ resources to pay for exercise programs and social activities - Potential for chronic low ____-______ related to decreased income - Reduced ___ _______ related to fewer funds available for transportation, entertainment, and leisure pursuits

mobilization, engagement pain financial self-esteem social contact

dysphagia care plan •Dietary _________ •Eat in an ________ position •Ingest _____ bites in ________ manner •________ cues •Easily accessible ______ machine •Monitor food _____ and ______

modifications upright small, unhurried verbal suction intake, wt

surgical care •______ adults of advanced age are undergoing surgical procedures. •Independent _______ status and ____ can be improved. •____-_______ changes alter normal surgical procedures in this population. •No longer denied benefit of surgery based on ____ alone. •Successful surgery can provide more _________ years. Special risks for older adults •Smaller margin of ________ reserve •Less ability to _____ to physiologic changes •Age changes can cause greater risk of _________ •Proactive ___________ of capacities

more functional, QOL age-related age functional physiologic adapt complications strengthening

basal cell carcinoma •____ _______ form •Grows _________ •Rarely ___________ •Risk factors: advanced age, exposure to ____, ________ radiation, therapeutic radiation •Description of appearance: usually on _____; small, ______ -shaped elevations covered by small _____ _____

most common slowly metastasizes sun, UV face, dome, BVs

UTI •______ ______ infection, increased ________ with age •Organisms responsible: women—___ ____; men—______ •Foreign body predisposes to infection (like a ______) •Other causes: - poor ______, improper hygiene after ____ _______, - low ____ intake or excessive fluid ____, - _________ changes, - ________ state, - ________ bladders, __________, _______ •_______: single most common type of healthcare-associated infection

most common, prevalence e.coli, proteus cath hygiene, BM fluid, loss hormonal debilitated neurogenic, arteriosclerosis, DM CAUTIs

complementary therapies •Some herbs affect respiratory health. - Mucus-secreting effects: _____, _____ extract, ______, ______ leaf, slippery ____ - Expectorants: lobelia, ________, _________ root •Aromatherapy may prove helpful: _______, _______, _______, _____ •Assess for interactions with other _________. •____, _____ foods open airways. •Avoid_____-______ foods. •_________, _________, _____, Rolfing, and massage.

mullein, gingko, peppermint, plantain, elm eucalyptus, licorice lavender, lemon, eucalyptus, pine meds hot, spicy mucus-forming acupuncture, acupressure, yoga

effects of aging on hearing •Communication problematic - Changes may ___________ impact communication - Age-related sensorineural hearing loss (____________) - impacted ___________ •____-____________ of limitation and avoid interactions leading to social isolation •Underlying cause determined by ___________ exam by specialist

negatively presbycusis cerumen self-conscious audiometric

loss of control of voiding due to inability to sense the urge to void or control urine flow

neurogenic (reflex) incontinence

One way to promote dietary compliance is to classify foods for the patient as those that should "_____ ___ _____," "eaten ________," or "eaten as _______."

never be eaten, occasionally, desired

what is goiter?

nonmalignant swelling of thyroid gland

_________ ________ can be a useless expenditure of _____ and can be _______ to an older adult.

nonproductive coughing, energy, stressful

general nursing considerations for skin conditions #1 Promoting ______ •Reassure visitors regarding the safety of ________ •Provide instructions for any special __________ •Older adults have normal _____ & _______, including social __________ & _________ •Preventing _______: avoid excess ____ ________, use ______, ________ products

normalcy contact precautions needs, feelings, interaction, contact wrinkles, sun exposure, sunscreen, topical

Needs of suicidal older adults •Close _______ •Careful ________ •____ therapy •Treatment of underlying ________ • Environmental _____ • Nurses' willingness to ______ and discuss _____ & ______ related to suicide

observation protection prompt depression safety listen, thoughts, feelings

nursing problems r/t GI Problems cont •Insufficient nutritional intake - Causes: intestinal _______, ________, ___/___, poor ______ status, altered _____ sensations, ______ •Weight gain - Causes: altered taste sensations, _____ preferences, ________, lack of __________ to eat well •Oral pain; poor dental status; insufficient food intake - Causes: ________, cancer, ________, periodontal disease, _____ teeth, poorly fitting ________, dehydration, malnutrition, ____ mouth

obstruction, anorexia, N/V, dental, taste, constipation ethnic, inactivity, motivation DM, gingivitis, jagged, dentures, dry

influenza prevention _________ IS BEST COURSE OF ACTION •______ _____ - Contraindicated when ____ OR if hx of _____ - Can give with allergy to ____ but must ______ closely •Avoid those with known or suspected ____

prevention annual vaccine febrile, GBS eggs, monitor flu

hearing aid care •Turn aid ____ or remove ________ when not being worn. Store in ____, ________ container. •Clean at least _______. Wipe it off and use ______, ____ ______, or pick to clean channel. Do not use ________, can cause ________ & ________. Avoid having _________, _______ or other chemicals come in contact with aid. •Protect the aid from exposure to extreme _____ (e.g., _______ ______), _____ weather, or _________ •When changing battery, ____ ____ first. •Keep several new ________ available. Typically, a battery will last about ____ hours.

off, battery, safe, padded weekly toothpick, pipe cleaner alcohol, drying, cracking hairspray, ge;s heat, hair dryers, cold, moisture turn off batteries 80

Chronic glaucoma (____ angle) •_____ ________ form •________ is important for early detection •Signs and symptoms: - ______ vision becomes slowly impaired - Frequent changing of __________ - as progresses, ______ vision affected - _______ feeling in eyes, - headaches, _____ vision, seeing _________ around ________, ________ appearance to cornea - iris _______ & _________ - may affect one or both eyes •Diagnosis with ophthalmoscope and tonometry to measure IOP; gonioscopy •Treatment/management: - _______ & ______ _______ ________ - surgery; laser trabeculoplasty •Vision lost cannot be __________ •Care and prevention of complications - Avoiding situations or activities that_______ ____ - Avoid ___________ ____ - Careful monitoring of all ____ - Carry _____ or wear________ - Avoid ______ & _________ of the eyes •Patient ____________ can be challenging

open most common screening peripheral glasses central tired misty, halos, lights, cloudy dilated, fixed miotic & carbonic anhydrase inhibitors restored inc IOP emotional stress meds card, bracelet abuse, overuse compliance

glaucoma •Damage to the ______ _____ from above normal ________ ________ (___) •Second leading cause of ___________ in older adults •Incidence: occurs in people over ___, increases in prevalence with ___ •Causes: - exact cause unknown; - associated with increased ____ of lens, iritis, allergy, endocrine imbalance, emotional instability, ______ ________; drugs with ___________ properties can exacerbate glaucoma •Types: acute, chronic

optic nerve, intraocular pressure (IOP) BLINDNESS 40, age size fam hx, anticholinergic

DM •Some require only _____ _________ agents •Some require ______ therapy •_______ _____ _______ should not be long-term - Closely _______ individuals - Reevaluate in __ ____ •______-______ ________ regimens - Similar to body's natural action Patient self-care •Ability to handle a ______ and ____ of insulin (think about _______) •Ability to read _________ on an insulin syringe •Appropriate ________, motor skills, function, level of _________ system impairment to understand and follow directions • ________ without being _________ •_______-_________ and use of glucose monitor • _________! •Consider ________ hands, impaired _________, ______ deficits - insulin could be a recipe for disaster

oral hypoglycemic insulin sliding scale insulin monitor 1 week basal-bolus insulin syringe, vial, arthritis calibrations cognition, sensory hyperglycemic, glycosuric finger-prick hypoglycemia arthritic, cognition, visual

DM •Indications of diabetes can include __________ _______, ________ disease, ________, gastric hypotony, impotence, neuropathy, confusion, _________, __________ _________, _________ •Criteria for diagnosis usually established if one of following exists: - Symptoms of diabetes and random blood glucose concentration ≥____ mg/dL - HbA1c≥_____% - Fasting blood glucose concentration ≥ ____ mg/dL - Blood glucose concentrations 2 hrs after oral glucose intake ≥____ mg/dL during oral glucose tolerance test •Results usually confirmed by _____ _______ on _______ ___

orthostatic htn, periodontal, CVA, glaucoma, dupuytren's contracture, infection 200 6.5 126 200 repeat testing, different day

whats the leading cause of physical disability in older adults?

osteoarthritis

Although _______ cancer is less common than _______ or ______ cancer, it is more deadly when it does occur.

ovarian endometrial, cervical

what may contribute to diverticulitis in the patient with diverticulosis?

overeating, straining during a BM, ETOH, irritating foods

involuntary loss of urine due to an excessive accumulation of urine in the bladder

overflow incontinence

provide support to pt & fam with cancer •Diagnosis may be ________ & _______ •Fear •_____ of treatment •Change in plans and _______ pursuits •Need strong ________ •Assess patient's __________, clarify __________, offer __________ •Provide ample opportunity to ______ _________ •Include ______ & _______ ______ in process •Recommend local ________ _______ •May experience variety of _________ •Essential to remain _______ to emotional and spiritual status •Constant changing of _____, strongly encourage regular _________ and ________ of plan of care •Important to have a _____! Ok to discuss and in fact should review ________ ________

overwhelming, stressful cost future support understanding, misconceptions, explanations express feelings fam, significant others support groups rxns sensitive needs, reassessment, adjustment plan, advanced directives

resp health promotion Consider impact of environmental factors •Outdoor pollutants: - ____ - ________ _____ - _________ oxide- ________ gas-lives in ambient air •Indoor pollutants: - _______ or ______ building materials, - ______ dander, - _______ smoke •Improve indoor air: - ___ _____ in heating and AC systems; - regular _________ - ___-_____ furnishings; - stop cigarette smoking ________ - open ______ to air out rooms - consider _____ count! - ______ houseplants

ozone carbon monoxide nitrogen, greenhouse synthetic, plastic animal cigarette air filters vacuuming damp-dusting indoors windows, pollen green

general nursing considerations for MSK •Manage ____ which impacts ________ and ____ •Prevent _____ •Promote ________ •_________

pain, independence, QOL injury independence educate

What is dyspareunia?

painful intercourse

what is hemiplegia?

paralysis of one side of the body

special problems assoc w DM •High risk for _______ _______ problems •Arterial insufficiency - ______ pain: _________ ________ - Arterial pulses: _____ or difficult to _____ - Skin discoloration, ________, & ________ •Assessment: palpate _____ and skin ______ •Treatment selected based on extent of disease: _____, ______, _______ •Treatments today are much different from past •Remember - must pay attention to ____- inspect ____

peripheral vascular resting, intermittent claudication absent, palpate ulcerations, gangrene pulses, temp walking, analgesics, surgery feet, daily

Caregivers should be prepared for the __________ ________ that often occur in individuals who have neurologic disorders; caregivers may benefit from _______ _______ also.

personality changes nursing support

Guidelines for Exercise Programs for Older Adults - Ensure that a recent ______ _______ has been done to detect conditions that could affect or be affected by an exercise program (e.g., heart disease and diabetes). If health conditions are present, consult with the physician as to ________ or ________ to the exercise program. - Assess the older adult's _______ activity level, _____, muscle _______ & _____, and response to physical activity. In collaboration with the patient, develop an exercise program that recognizes _______, ________, _________, and ________ potential. - Emphasize exercises that focus on good _______ & _______ (e.g., ____ weights and high ________). Keep resistance exercises at a ____ level and avoid ________ exercises. - Determine the training _____ and evaluate _____ during exercise to ensure that the rate stays within a safe range. - To determine an age-adjusted training heart rate, subtract the person's age from ____ and multiply that answer by ____%. This calculates the _______ rate that will provide vascular and other benefits without causing deleterious effects. -The ______ heart rate can serve as the lower level and the _______ heart rate as the upper level for a safe heart rate range during exercise. - Monitor _____ during exercise and reduce ________ & _______ of exercise if heart rate is more than _____ beats above the target heart rate. - Consult the physician as to the appropriateness of the exercise program for persons who have a resting heart rate exceeding _____ beats per minute. - Advise the older adult to wear proper-fitting ______-absorbing shoes with _______ soles. - Encourage _____-___ exercises (e.g., gentle _________ & ________) for at least ___ minutes before the person engages in the full exercise program. - Provide for a period of ________ down after exercises. Begin with a conservative exercise program and gradually increase activity. Monitor vital signs and symptoms at various activity levels. Note _________, significant changes in ____, ________, _____, fatigue, angina, and ___________ ___________

physical exam modifications, restrictions current, ROM, strength, tone interests, capacities, limitations, realistic speed, rhythm, low, reps low, isometric HR, HR 220 70 max resting training pulse intensity, length 10 100 shock, traction warm-up stretching, flexing 10 cooling arrythmias, blood pressure, dyspnea, shortness of breath, intermittent claudication

MSK health promotion •Educate and promote ______ _______ in all age groups - _____ the exercise program for the older adult - Exercise programs should address: * ____ _______ - aerobic, reach at least ___% of maximum HR, ________ intensity at least ___ _____ ___ days a week (must adjust based on health condition) * Flexibility: gentle ______ __-__ minutes before and after exercise and stretch major muscle groups at least ____ a week * Strength training: resistance with progression - set of __-___ repetitions at least __x week •Educate on the ____-____ connection •Prevent __________ •Educate on adequate _________

physical exercise tailor CV endurance, 55, moderate, 30 min 5 stretching, 5-10, twice 8-12, 2 mind-body inactivity nutrition

whats another name for emphysema? what kind of problem is it? whats one major cause?

pink puffers inc CO2 problem=s/sx develop slowly chronic bronchitis

pneumonia education •Report suspicious symptoms •_________ ________recommended for age 65 and up - CDC has guidelines for recommended valents and vaccines for older adults

pneumococcal vaccines

whats the leading COD in older adults?

pneumonia

postop complications •Respiratory: ________, _____, _________ •Cardiovascular: ________, ________, myocardial infarction, arrhythmias, cerebrovascular accident, coronary occlusion, cardiac failure •Skin: _________ _________ •Renal failure (drug-induced): __________, _________, aminoglycosides, cephalosporins, ampicillin, neuromuscular-blocking agents •_________ •________ _____, accompanied by fever, dehydration, abdominal tenderness, distention •Others: fluid and electrolyte imbalance; __________; wound dehiscence, wound evisceration, joint ________, _________, acute _________ states

pneumonia, PE, atelectasis embolus, thrombus pressure injuries cimetidine, digoxin delirium paralytic ileus malnutrition, stiffness, contractures, confusional

what is hiatal hernia?

portion of the stomach protrudes through an opening in the diaphragm

Poor _______ results in discomfort and pain that can be remedied by altering the patient's ________, making ____ ____ the most appropriate nursing diagnosis associated with _____ ________ in the older client.

positioning position acute pain patients positioning

vaginitis •Occurs in ________ women •Related to reduction in _______ & ________ tissue, ________ & _______ of vaginal canal, decreased _______, fewer vaginal ________, more _________ vaginal pH •Increased vaginal ________increases the risk of irritation leading to vaginitis •Signs and symptoms: soreness, _______, _______, ______ vagina; ____, ____, or _____ foul-smelling vaginal discharge; bleeding, adhesions

postmenopausal collagen, adipose, shortening, narrowing, elasticity, secretions, alkaline fragility pruritus, burning, reddened, clear, brown, white

tx/mgmt of emphysema •________ ________ •________________ •Low _____ •Breathing __________ •LOW _______ level to stimulate __________ •Encourage good _____ intake •Prevent __________ EDUCATE: The patient must learn to ____ activities, avoid extremely ____ weather, administer _________ correctly, and recognize symptoms of _________.

postural drainage bronchodilators stress exercises O2, breathing fluid infection pace, cold, meds, infection

promoting vision •Routine examinations including tonometry (________ check for ________) by ophthalmologist •Early detection and treatment of problems •Consideration of ________ ability to receive treatment; community resources, Medicare •Prompt evaluation of symptoms that may indicate a visual problem: - ______ or _______ in eye - ________ or _________ vision - _________ of conjunctiva - _______, headaches, any change in vision •Variety of disorders can cause damage to retina: - ___________; __________ nutritional deficiencies, ___________ can lead to visual impairment

pressure, glaucoma financial burning, pain blurred, double redness spots arteriosclerosis, DM HTN

osteoporosis •Most ________ _______ _______ of the bone •Incidence: primarily adults in _______ to _______ life •Potential causes: - Inadequate ______ intake, excessive _______ loss, poor _______ absorption -________ or _______ - Reduction in _______ ____ hormones - Diet - other _____

prevalent metabolic disease middle, later Ca x3 inactivity, immobility anabolic sex hormones drugs

OA •________ deterioration of joint cartilage with the formation of _____ _____ at the joint surface •Incidence - Affects most persons over age ____ - Affects _______ more •Pathophysiology: disequilibrium between _________ & ________ elements leads to lack of _________ necessary to maintain ________ •Causes: ______ ____ of joint, _____, _________, low vitamin ___, ___ levels, ___________ factors

progressive, new bone 55 women destructive, synthetic, homeostasis, cartilage excessive use, trauma, obesity, D, C, genetic

nursing care of CVA •_____ medical care - stroke time = _____ time During acute phase: •________ •Hydration/nutrition •Vital signs and _____ _____ •Prevent complications that come from __________ •Unconscious patients - frequent _______, _______ & ________ care, care of _____, ____ care, _____, good ____ care Nursing interventions •____ to the patient and education, even during ______ activities •Speak ________ & _________ •Control the environment - ____, ______ •Provide ________ care

prompt, brain airway neuro checks immobility turning, bladder, bowel, eyes, oral, ROM, skin talk, routine slowly, distinctly nosie, clutter consistent

whats the most common UTI among older men?

prostatis

maximizing benefits of chronic care •Select an appropriate _______ that is a ___________ _________ - In addition to ________ in treating the specific condition, the physician should have a style with which the patient is _________ because the relationship will be ____ ____. -> •Use a ____ _____ ___ to offer ________ and positive reinforcement, support, encouragement, and assistance -> Using a chronic care coach COACHING: •________: Schedule regular telephone or face-to-face ________ to check on the patient's status. •________: Be ______ to comments, mood, body language, energy, general status, presence of symptoms, compliance. •_________: _______ care plan and actions, ________ patient's efforts and accomplishments. •________: Ask ______, ________ observations, _______ misconceptions, _______ information. •______: Offer assistance when _____-_____ capacity is diminished; ____ and ________ resources. •_______: ______ patient to comply with care plan, build on _______ experiences and accomplishments; offer _____ •________: Provide ________, ________, ________ •_________: Assist in setting _______ goals, developing ___, _________, seeking resources, and making ___________.

provider, knowledgeable specialist expertise, comfortable, long term chronic care coach, feedback contact x2 observe, attentive affirm, reinforce, recognize clarify, questions, validate, correct, reinforce help, self-care, locate, negotiate inspir, encourage positive, hope nurture, education, information, support guide, realistic, plans, prioritizing, decisions

whats the most common dermatologic problem among older adults?

pruritus

nursing interventions for PD •Provide ________ support •_________! Including caregivers/family •DO NOT ASSUME PATIENT IS _________ _________!!! •Assure the goal is maximum level of __________ •Warm: Active and passive ____ exercises; warm _____ & __________ •Encourage ________ and ______ ________

psychological educate cognitively impaired independence ROM, baths, massage comm, mental stimulation

tx of depression •_________ •Antidepressants - ____: escitalopram, fluvoxamine, fluoxetine, paroxetine, sertraline - ______ compounds: amoxapine, desipramine HCl, doxepin HCl, imipramine pamoate, nortriptyline HCl - _______: phenelzine, tranylcypromine Nursing Guidelines for Antidepressants •Begin with ________ dose and frequency •________ common during initial treatment; ____ precautions necessary •Usually requires __ ____ of therapy before therapeutic effects noted •_______ administration preferred •Be alert for __________ symptoms (cyclic compounds) •Potential adverse events: ___ mouth, diaphoresis, urinary ________, indigestion, constipation, ____tension, blurred vision, drowsiness, increased appetite, weight ____, photosensitivity, fluctuating ____ levels •Ensure older adults and caregivers understand _______, intended effects, and ____ to drugs; instruct about drug-drug and drug-food interactions

psychotherapy SSRIS cyclic MAOIS lowest sedation, fall 1 mo bedtime anticholinergic dry, retention, hypo, gain, BG dosage, ADR

who should validate care plan priorities and goals?

pt and fam caregivers

what can be challenging regarding the tx for glaucoma w older adult population?

pt compliance

DM drug therapy •Goals: _____-________care, _______, ____, preferences, abilities, living conditions; avoidance of _________ •Biguanide: _______ - ____-____ drug - Do not use if _____ disease, ______ disease, _________, severe _____, severe peripheral vascular disease, severe _____ - Adverse effects: ___/___/___, ____ ____ - Administer with ________ •Sulfonylurea drugs: ______, _________, _________ - _________ and gliclazide no longer available in U.S. -__________ & __________ on Beers Criteria List

pt-centered, HBA1C, BG, hypoglycemia metformin first-line renal, liver, alcoholism, CHF, COPD N/V/D, abd pain meals glipizide, glimepiride, glyburide glipizide glimepiride, glyburide

inactivity & deconditioning •Physiologic changes: - reduced _____, muscle ______, _____, and _________; - increased cardiac ________; - decreased ________capacity, chest _______ and ________ - _________ of bones, increased ease of _________; - slower GI ________ and _________ and ___________ circulation •Increased risk of complications: - __________ ________, ________ _________ (slow developing chronic pulmonary disorder usually in _________ patients), - _______ injuries, - poor ________, - obesity, _________, - fecal impaction, - incontinence, kidney stones, - ____, - joint _________, limited ___ •Changes in mood and self-concept: - increased feelings of ___________, ________; - perception of self as ________, ____ •Increased __________ •Reduced opportunities for ___________

pulse rate, strength, tone, endurance, workload, aerobic, expansion, ventilation, demineralization, fx, motility, metabolism, lymphatic postural htn, hypostatic pneumonia, bedbound, pressure, appetite, constipation, UTI, stiffness, ROM helplessness, depression, incapable.,frail dependency socialization

MALE reproductive system health promotion •Men - Prostatic hypertrophy examined every ___ ____ - _________ self-examination - usually stops in older adults •Complete history and physical examination •Routine ____ testing is no longer recommended in men without a history of _____ _____

q6mo testicular PSA, prostate cancer

Most of the chronic conditions that are common in older adults can significantly affect the

quality of daily life

suicide risk •VERY _____ and VERY ______ RISK! •Incidence/prevalence - Highest for all males among aged ___ and older - Highest for all females among aged ____ and older Risk factors: •________ ______ and/or ____ _____ of suicide, •history of _______ and/or _______ ____ •___________ •________ to accessing mental health treatment, •_________ illness, •easy access to ______ methods, •__________ to seek help

real, serious 75 75 previous attempt, fam hx alcohol, substance abuse isolation barriers physical lethal unwillingness

stage 1 pressure injury o Persistent area of skin ______ (without _______ in skin) does not disappear when _________ is relieved; usually over _____ ________.

redness break pressure bony prominence

•Benefits of _______ _______ are many! Physical, psychological, social •Many health problems can be avoided when maintaining an _______ ________ •But, remaining active and/or physical activity can be challenging in late life due to: - Effects of _______ - Common ______ ________ problems •Important for the RN to educate on the importance of _______ ________ and to identify ways older adults can ________ ________

regular activity active state aging chronic health remaining active, remain active

_______ _______ can decrease or limit the age-related functional declines that aging people can experience.

regular exercise

exercise for CV health •_______ exercise versus _____ of activity •______ ________ is related to functional decline •Recommendation: - ___ ____of _____ physical activity at least ___ days per week or - ____ ____ of _______ exercise at least ___ days per week •_______ exercise, ____, ________ exercises, _______ exercises, and ___ ___ - all enhance ________

regulat, spurts physical deconditioning 30 min, moderate, 5 20 min, vigorous, 3 aerobic, yoga, strengthening, balance, tai chi, circulation

If unconscious from CVA- focus when conscious and stable is __________ •Use objects _______ to patient. •Keep ______ or sign showing ____ & _____ •Supply _______ stimulation. •Provide frequent ________ _________ •Expect and accept _____ & ________ •Promote activities that reduce patients' ____ of CVA

rehab familiar calendar, day, date sensory positive feedback errors & failures risk

aging & urinary elimination cont •Reduced _____ function - High ___ levels •Decreased _____ function - Concentration of urine changes in response to ____ and/or ____ excess/depletion •Increase in renal threshold for _____ - False-____ results for _______ in the urine without ________ •_________ is not a normal occurrence with advancing age

renal BUN tubular water, Na glucose negative, glucose, s/sx incontinence

•________ system problems may be difficult topics for older adults to discuss •Reproductive health can affect _____ ______ •Need for _________ & _____ ______ •Promotion of satisfying ______ _______ •Need for education about ______ changes and _____ _______measures

reproductive overall health detection, early prevention sexual activity aging changes, health promotion

amount of air remaining in lungs after fully exhaling

residual volume

emergency care •Occurrence is often because of age-related changes that lower ________ and increase the risk of _______ & ______ •_________ presentation of disease that complicates diagnosis •More difficult to ____ & ________ •Greater risk of __________ & _____ Goals guiding nursing actions •Maintain life functions (this is why ________ _____ are so important!) •Prevent and treat ____ •Control _________ •Prevent _________ •Keep patient physically and psychologically ____________ •Observe and record signs, treatments, and responses •Assess for __________ factors

resistance, injury, illness atypical tx, stabilize complications, death advanced directives shock bleeding complications comfortable causative

factor responsible for the high risk of infection in older adults Age-related changes: •decreased ________ activity; •reduced ability to expel _______ from lungs; •weaker ________ muscles facilitating _________ _________; •prostatic hypertrophy; •increased _________ of vaginal secretions; •increased _________ of the skin and mucous membrane •High prevalence of _______ disease •___________ •Greater likelihood of _________, _______ _______ use, invasive procedures, hospitalization, and institutionalization

resp secretions bladder, urinary retention alkalinity fragility chronic immobility malnutrition, urinary cath

RA Treatment/management •_____, limb support, ____ exercises, ______ _____, ____, gentle _________ •Medications: ________, ______ agents, ________ drugs, ________, ______________ drugs; •must know potential ___ _____ & ________ with other drugs •Surgery Nursing interventions •If rheumatic heart disease: eliminate "________" foods from diet •____ ____ & ______ may improve symptoms •Patient education to include disease and treatment info, medications, how to identify side effects, exercise, use of assistive devices, ways to avoid and reduce pain, need for continued medical supervision •Advise consulting with nurse or physician before investing in ______ ____ or ______for arthritis

rest, ROM, assistive devices, heat, massage analgesics, NSAIDS, DMARDS, steroids, immunosuppressive side effects, interactions nightshade green tea, ginger quick cure, relief

Instead of demonstrating cyanosis, older adults with hypoxia can become _____, _______ & _______

restless, irritable, dyspneic

operative & postop considerations •________ may be sign of hypoxia, not _____ •Strict documentation of _____ •Prevent _________ •Relief of ____ is essential •Attention to _________status •Maintaining regular ______ & ______ elimination •Keeping joints ______ •Monitor for ________ _________ •Interventions to promote _________ and prevent postoperative complications

restlessness, pain I/O infection pain nutritional bowel, bladder mobile resp depression mobilization

lung cancer •May have lung cancer long before ________ develop •High-risk individuals should be _________ regularly - ________, those exposed to know _______ -______ ___ based on risks •Symptoms: _______, _______, _____ ____, fatigue, ________, _______, and _____ respiratory infections •Diagnosis confirmed through __________, ______ •Treatment: surgery, _____, ______

s/sx screened smokers, carcinogens, chest CT coughing, dyspnea, chest pain, anorexia, wheezing, upper bronchoscopy, biopsy chemo, radiation

general nursing considerations for resp conditions •Recognize _________; report changes in character of _______ •Prevent ________ •Beware at higher risk for ______ impairments and greater risk of _____ •Ensure safe use of ______ (ANY setting) - Be _______ with use - Be aware of ____ narcosis * _________, muscle _______, _____ defects, profuse ______, _______ leading to progressive ________ _______, cerebral _________ - Keep an eye on ____

s/sx; sputum complications balance, falls O2 prudent CO2 confusion, twitching, visual, perspiration, htn, circulatory failure, depression ABGS

what are the most common sites for pressure injury?

sacrum, greater trochanter, ischial tuberosities

detached retina nursing interventions •Help patient feel as _____ as possible •Frequent _____, _________, ________stimuli •Easy access to ____ _____ •Minimize _______, enhance psychological comfort •Avoid physical and emotional ________ •Emphasize importance of periodic ___________

safe checks, comm, verbal call light anxiety stress exams

promoting MH in older adults •Mental health implies ________ & ________ life •No single profile for mental health •Assessment should be __________ & ________ •Good mental health practices throughout a lifetime promote mental health in later life •Need to maintain satisfying ________ & _______ with aging important •Need opportunities to sense _____ as a member of society and have ___-___ reinforced •Security to meet basic human needs important (physical, mental, financial, etc) •__________ and assistance through stressful situations important (family, friends, neighbors) •__________ with others important •Maintain optimum _________ health important (relative to each individual) •Strengthen patient's ________ to manage condition as can Eliminate or minimize limitations imposed by condition •Act for or do for the patient only when __________ ________ •Assess symptoms as they may be "_______" reactions to life circumstances •Address the ______ of the problem rather than effects/symptoms alone •Need for accurate and astute assessment by the RN

satisfaction, interest obj, unbiased interests, activities value, self-worth support connection physical capacity absolutely necessary normal cause

Measures to promote bowel elimination include _______ a regular time for this function, incorporating high-____foods into the diet, and _______ the trunk from ____ to ____ and _____ & ____ while sitting on the toilet.

scheduling, fiber, rocking, side, side, back, forth

assessment of depression •Crucial to _____ and avoid _________ •Should be ________ during all routine health visits •There are short/brief assessment tools •Can have ______ presentation of symptoms •Always assess ________ of life events and/or serious or terminal _______ with depression •Always assess _________ ________ •_______ _______ can hasten recovery

screen, misdx screened atypical relationship, illness underlying problem prompt tx

promoting productive coughing •Coughing is important in removal of _________ •_________ coughing is useless and stressful. •Measures to promote productive cough. - ____ ____ to increase secretions (consider _____ & ____ ____ if needed) - _______ exercises - Use of _________ - _________ - Increase _____ intake if not contraindicated •Good _________ & ____ _____ are essential.

secretions nonproductive hard candy, swallow, sugar free breathing humidifier expectorants fluid handwashing, oral hygiene

overall goals for chronic care •Maintain or improve ___-___ capacity •Manage the _____ effectively •Boost the body's _______ abilities •Prevent _________ •Delay _______ & _____ •Achieve the highest possible ___ •Die with ________ & _______

self-care disease healing complications deterioration, decline QOL comfort, dignity

assessment of chronic care needs •Assessment and reassessment of _____ and __________ abilities - Individual - Family/caregiver * The family is the ______ •Care needs must be _________ & _________ with the patient and family members to develop ____ for care •Assessment should include _______ of chronic condition on total ___ of older adult •Understand that physical or mental status will ________ over time

self-care, caregiving pt reviewed, validated, goals impact, life decline

Whereas the primary goals of acute care are to diagnose, treat, and cure, in chronic care, the goals are to maintain or improve ____-____ capacity, _______ the condition effectively, boost the body's ________ abilities, prevent _________, delay _________ and _____ when it is unavoidable, achieve the highest possible ____, and die with _______ & ______

self-care, manage, healing, complications, deterioration, decline, QOL, comfort, dignity

promotion of skin health •Encourage ____-________ of entire body on a regular basis Detect abnormalities •A: __________ •B: ______ _______ •C: _____ •D: __________ •E: _________ in height AND NOW WE ADD: •Change in ________ (itchiness, tenderness, pain) •___________ tendency

self-inspection asymmetry border irregularity color diameter elevation feeling bleeding

general nursing considerations for urinary conditions •Need - Need for ________ while discussing urinary problems with the older adult. •Consider - Consider____ & ______ toward urinary incontinence. •Provide - Provide ________ and ________ expectations. •Involve - Involve all members of the health care team - __________ •Use - Use _________ •Maintain - Maintain ______

sensitivity fear, anxiety education, realistic interdisciplinary discretion dignity

paranoia •Occurs for multiple reasons - _______ losses, may cause environment to be ___________ - Illness, disability, living alone, and limited budget promote _________ - _______ within society sends negative message about aging - Victims of _____ and unscrupulous practices •Conditions affecting _________ ____ can contribute - Chronic conditions become ____ - ____ to medications

sensory, misperceived insecurity ageism crime physical health acute ADR

_______ ___ meals throughout the day, rather than _____ ____ ones, not only are beneficial in the management of hiatal hernia but also have advantages for the gastrointestinal health of all older adults.

several small, 3 large

nursing problems r/t reproductive system •Anxiety - Causes: _____ ______, ____, _________ over symptoms or treatments •Pain - Causes: ______, cancer, prostatic ______, ________ •Risk of reduced _________ - Causes: infection, cancer

sexual dysfxn, pain, embarrassment infection, enlargement, vaginitis independence

Is the following statement true or false? Signs and symptoms of a transient ischemic attack can last for several days and complete recovery is usual within 1 week.

signs can last from minutes to hours, and complete recovery is usual within a day.

effects of aging on MSK fxn •Decline in ____ & _______ of muscle fibers and reduction in muscle ____ - Decreased body _______ - _____ strength endurance declines •Connective tissue changes - Reduced ________ of joints and muscles •Sarcopenia - Decline in ______ _____ or ____ _______ - Causes: disease, ______, decreased ________ intake, poor ____ ____ to muscle, decline in _______, increase in _________ ________ - Can lead to ________ •Psychosocial factors impact activity - Loss of spouse and/or friends, _______, _______ limitations, poor health, need for relocation to ______ home, ________, or a facility

size, number, mass strength grip flexibility walking speed, grip strength immobility, caloric, blood flow, hormones, proinflammatory cytokines disability retirement, financial, smaller, apt

effects of aging on resp health Changes in lungs •Reduced ___ & ___ •Weaker ______ _____ •Alveoli less ________ •Development of _____ and/or _____ ____ •Reduction in ____ _____ •Increased _______ volume

size, wt elastic recoil elastic kyphosis, barrel chest vital capacity residual

whats the largest organ of the body? what can it be a part of in severly ill older adults?

skin (external) multi-organ failure

The risk of ____ _____ is high in persons with CHF because of the presence of _____ and poor ________ of the tissues. The ______ of older skin compounds this risk.

skin breakdown edema, nutrition fragility

what is photoaging (solar elastosis)?

skin changes from exposure to UV rays

Special attention must be taken when caring for older adults as they have a heightened risk for ____ ______

skin tears

what is bradykinesia?

slow movement

BPH •Signs and symptoms - _____ progression; _______, decreased ______ of urinary stream, _______, ________; _______, poor ________, ________ incontinence, _________ - As progresses: urinary _______, increased risk of ____ •Men ________ OR _________to seek medical treatment - May result in _____ _____ •Treatment - Prostatic ______; urinary _______; avoidance of _______, _________, & _________ agents - Transurethral surgery * Realistic explanation of risk/benefit * Not a _____ ____

slow, hesitancy, force, freq, nocturia, dribbling, control, overflow, bleeding retention, UTI reluctant, embarrassed kidney damage massage, antiseptics, diuretics, anticholinergics, antiarrhythmic quick fix

what is keratosis?

small, light-colored benign lesions on epidermis

problems of cervix •Aging changes: - Becomes ______; endocervical epithelium _______ •Endocervical glands can seal over leading to formation of ______ ______ - Secretions can _______; _____ and a palpable _______ _____ may be evident •Regular gynecologic examinations to check cervix _______ are very important - However, this is NOT the recommendation of American College of Gyn/OB (ACOG) for women over age ____ - Understand routine well women exams are NOT indicated in older women without specific _______ and/or ____ and/or _____ ____

smaller, atrophies nabothian cysts accumulate, fever, tender mass patency 65 s/sx, risks, prior hx

substance abuse tx/mgmt •Long-term goal is __________ •Patient must _______ the problem and take __________ •_______ involvement in the treatment plan •_____ monitoring •Alcoholism treatment programs for older adults are ____ - ____

sobriety acknowledge, responsibility fam med rare AA

pt care for hearing deficits •Impaired hearing associated with ____ ______, __________, risk of _________, higher __________ rate •Encourage __________ testing - Problem may not be ___-_____ and could be readily_________ •Learning to _____ with a hearing deficit •Physical, emotional, and social health can be seriously affected •Nursing interventions: alert _________ to help in emergencies, locate individuals close to ________ ________, provide ________information

social isolation, depression, dementia, mortality audiometric age-related, treatable live neighbor, nursing station, written

effects of aging on male reproductive system •Reduction in _____ count related to: - ________ epithelium of the seminal vesicles - Replacement of muscle tissue with _____ tissue - Decreased capacity to ______ fluids •Seminiferous tubule changes - Increased ______, epithelium _____, _______ of the basement membrane, and _________ of the lumen

sperm thinner connective retain fibrosis, thinning, thickening, narrowing

female cancers in older adults •ANY _______ or ________ after menopause is suspicious for cancer and should be evaluated taking into consideration the age and general health status of the patient •Menopause is defined as no _________ or ________ for ___ consecutive months •Choosing Wisely - important considerations in aging adults

spotting, bleeding spotting, bleeding, 12

•A chronic care coach can be a _____, _____, ______ or someone with a similar ________ who ____ about and has regular ________ with the patient

spouse, child, friend, condition, cares, contact

Plantar fasciitis •Often mistaken for _____ •Inflammation of ______ at _____ attachment •Symptom: ____, usually after ____ •Treatment: ______ exercising foot, ____ _____, wearing _______ in heel, ____ heels on shoes, _______-made orthotics

spur band, heel pain, rest stretch, ice pack, cushions, 2 in, custom

vascular lesion tx/mgmt •Need special attention to facilitate healing of _______ ________ •Control ________ and remove _______ tissue •Good _________ •Interventions to enhance _______ _______ •Avoid situations that promote ______ _________ •_________ legs several times a day •Prevent interferences to ________ •_______ support stockings •Surgery

stasis ulcers infection, necrotic nutrition venous return stasis dermatitis elevate circulation elastic

general nursing considerations for visual & hearing •Attention to __________ of all senses on a daily basis •Interventions to compensate for visual changes and limitations •Interventions for those with a hearing issue •______ as a means of sensory stimulation as well as expressions of ______ & _____

stimulation touch warm, caring

An annual ____ ______ ________ and _______ ______ _______ are recommended because they can detect many cancers of the large bowel and rectum. In addition, a flexible ________ every ___ years or a ________ every ___ years is advised as an important means to detect colorectal cancer. Risk factors may warrant more frequent screening.

stool occult blood, digital rectal exam sigmoidoscopy, 5 colonoscopy, 10

involuntary loss of urine when pressure is placed on the pelvic floor (e.g., from laughing, sneezing, or coughing)

stress incontinence

PUD •Causes: ____, ____, genetic predisposition, _____, certain medications that can _______ gastric secretions and reduce _________ of mucosa •Risk factors: _________, heavy ________ use, _______, _____, ______ infection •Signs and symptoms: ___, _______, _________, _________ •Diagnostic, therapeutic measures: similar to younger adults •Be alert to complications associated with peptic ulcer: __________, ________, _________, ________, __________, _____

stress, diet, COPD, inc, resistance smoking, alcohol, caffeine, stress, H. pylori pain, bleeding, obstruction, perforation constipation, diarrhea, dehydration, peritonitis, hemorrhage, shock

People who are unable to participate in an aggressive exercise program can _____ and _______ movements during routine activities to promote joint _______ &__________.

stretch, exaggerate mobility, circulation

whats the 3rd leading COD in older adults? what type is most common in older adults? what are the major signs?

stroke ischemic hemiplegia, aphasia, hemianopsia

what is CVA?

stroke, interruption in blood supply to brain

_________ in chronic care are measured differently from those in acute care.

successes

whats a drop attack?

suddenly legs are flaccid and you go down r/t CVA

what drugs especially pose a hypoglycemia risk with DM?

sulfonylureas, insulin

what are some contributing factors for squamous cell carcinoma? what are common locations? whats the description of the appearance?

sun exposure, exposure to hydrocarbons, arsenic, radiation lower lip, scar tissue firm, skin-colored or red nodules

With age, the teeth experience a wearing down on the _______, decrease in the ____ and ______ of pulp, increased __________, varying degrees of root absorption, and a loss of ______.

surfaces, size, volume, brittleness, enamel

conventional tx for cancer •Plan of treatment depends on the specific cancer - ______, ________, __________, & ________ therapy •_________ risks for older adults - Higher risk of ________and __________ from surgery - __________& ________ of cytotoxic drugs •Impact of _________ ____

surgery, chemo, radiation, biologic unique mortality, complications pharmacokinetics, pharmacodynamics advanced age

whats the #1 symptom of CVD in women?

syncope

OA •Signs and symptoms: not accompanied by _________ symptoms; _____ joints may develop _____ _______ (__________ nodes); uncomfortable during _____ ______ and periods of ______ ______ •Treatment/management - Pain: analgesics (_________) #1 med for pain - ____, ___ or ____, ___ ____, aquatherapy, ultrasound, gentle massage, acupuncture, splints, braces, canes - Maintain proper body ________; use good ____ _____ - Diet/nutrition: essential _____ _____; vitamins __, ___, ___, ___, & ___, ___, ________, ____, _____ •Treatment/management (cont.) - _____ _________ - ________ assistance - ___/___ - __________ •Nursing interventions - Ensure patient and caregivers understand _______ and adhere to ____ ___ ____

systemic; distal, bony nodules (heberdens); damp weather, extended use acetaminophen rest, heat, ice alignment, body mechanics fatty acids, A, B, B6, C, E Zn, selenium, Ca, Mag wt reduction household OT/PT arthroplasty instructions, plan of care

TIA •_________ or ________ reduction in ________ •Caused by anything that reduces ______ ________ S/S •__________! •Body - _________, __________ •Communication - ________ •ENT - ________ loss of vision; diplopia; ________; ________ •GI - n/v •USUALLY RECOVERY WITHIN ___ _____!!!! •Treatment - correct the problem •The more TIAs they have - the GREATER THE RISK OF _____!!!

temp, intermittent cerebral circulation transient hemiparesis, hemianesthesia aphasia unilateral, vertigo, dysphagia 1 day CVA

effects of aging on male reproductive system •Atrophy of the _______ and reduction in testicular _____ •Ejaculation fluid contains less ____ ____ •________ stays the same or decreases slightly •More time required to achieve an ________ •Enlargement of the prostate gland - Most often ______, increased risk for _________

testes, mass live sperm testosterone erection benign, malignancy

whats goal #2 for chronic care?

the nurses role

effects of aging on CV health •Heart valves become _____ & ____ •Aorta becomes _______ • myocardial muscle less ______ • ________, reduced __________ of vessels • less sensitive to _______ regulation of BP • any # of conditions alter tissue _________ • poor ________ _______ • easily _________ • inadequate _______ to heart tissue • reduced __________ tissue perfusion

thicker, rigid dilated efficient calcification, elasticity baroreceptor perfusion peripheral circulation fatigued circulation cardiopulmonary

colorectal cancer •_____ most common malignancy in the United States •Signs and symptoms: - rectal _______, _______ stools; - change in bowel pattern; - feeling of _________ emptying of bowel; - anorexia; nausea; abdominal discomfort; - weakness, ________; - unexplained weight _____; - _____ •Diagnosis and diagnostic tests: -______ ______ ______, - _____ ______ _____ testing, - _______ with biopsy and ____ colonography •Treatment/management: - surgical ______ with anastomosis or __________ •Impact of a _________ on an older adult •USPSTF: screening recommended until age ____ - decision to screen for colorectal cancer in adults aged ___-___ years should be an individual one, taking into account patient's overall health and prior screening history

third bleeding, bloody incomplete, fatigue, loss, anemia digital rectal exam, fecal occult blood, colonoscopy, CT resection, colostomy colostomy 75 76-85

Many cancers can be prevented by healthy lifestyle practices that minimize risks •Avoid the use of and exposure ______ products. •Limit exposure to the ____. •Eat a diet rich in ____, ______, & _______ •Limit intake of ____ _____, _____, _____ foods, & _______, ______, or _______ foods. •Maintain _____ within an ideal range. •________ and be physically ______. •Protect against exposure to known ____________. •Limit ________ consumption. •Discuss prevention with your physician if _______ _______ increases the risk of cancer.

tobacco sun fiber, fruits, veggies red meats, fats, fried, pickled, smoked, cured wt exercise, active carcinogens alcohol fam hx

modifiable RF & preventive measure that can lead to neuro issues: •________ use - ________ cessation •_______ - healthy _____, m/t healthy weight •High __________- healthy diet •_______ - manage appropriately •________ or _____ abuse - avoid •____ -_____ ____! - neurosyphilis •Ineffective ______ management - identify ways to manage stress •_______ in diagnosis/treatment - seek ______ medical care, manage ________ •Unsafe actions - ____ prevention; prompt treatment of __________

tobacco, smoking obesity, diet cholesterol HTN drug, alcohol STIS-safe sex stress delay prompt, infections fall, infections

Treatment for atrophic vaginitis could include _______ ______ creams and ______ ______ _____

topical estrogen, estrogen replacement therapy

maximum volume that lungs can expand during fullest inspiration

total lung capacity

involuntary loss of urine that is acute in onset and usually reversible

transient incontinence

Fx •Contributing fractures: _____, _______ metastasis to bone, ________, etc. •Common sites: _____, _____ _____, ________ •______ bones fracture more easily and heal at a _____ rate - Potential for complications associated with ________ •Interventions aimed at __________ - Caution against ______ &/or ______ activities - Postural hypotension - _______!!! - Proper ______ & ________ devices

trauma, cancer, osteoporosis femur, distal radius, vertebrae brittle, slower immobility prevention unsafe, risky falls shoes, assistive

what are characteristic of Parkinson's disease?

tremors, shuffling gait

promote optimum care for cancer pts •Choice of _____ facility •______ _______ through the National Cancer Institute (NCI) •Care after ________ & _______ with knowledge of the increased risks related to ____-related changes •Knowledge of common age-related risk factors that increase likelihood for certain conditions •Prevention of ___________ •Assure patients that _____ can be managed - Regularly assess for ____ and develop plans for _________/_____

tx clinical trials chemo, radiation, age complications pain pain, prevention/mgmt

tumor of testes •Incidence: ______ in older men, usually ______ when does occur •Signs and symptoms: testicular ________, _____ & _______ of ________ •Treatment: chemotherapy, irradiation, __________ •Management: assess patient's knowledge of _________ ____ _____

uncommon, malignant enlargement, pain, enlargement, breasts orchiectomy testicular self-exam

anxiety Treatment/management •Depends on _________ _____ •Look for recent ______ or new _________ •Review consumption of _____, _______, ________, ____ drugs Nursing interventions •Medications, biofeedback, guided imagery, relaxation therapy, psychological therapy •Control environmental _____ •Plan interventions specific to ________ ___ •Allow adequate ____ for conversations, procedures, other activities •________ and _______ patients' decisions over matters affecting their lives •________ patients for all anticipated activities •Provide _____, ______, & _______ explanations •Control ________ & _______ of persons with whom patients must interact •Adhere to ________ •Keep and use _______ objects •Prevent __________ of the senses

underlying cause changes, stresses alcohol, nicotine, caffeine, OTC stimuli underlying cause time encourage, respect prepare thorough, honest, basic number, variety routines familiar overstimulation

substance abuse •Often a problem that goes ________ in the older adult •Threatens physical, emotional, and social health •Potential for ____ consequences •Increases risk for _____, decreased _____, _____, and self-________ •_______ abuser versus _________ abuser •Health care professional __________ •Substance abusers come in many forms •Can cause medical problems: GI _______, _____tension, muscle ________, _______ _______, susceptibility to _________

unnoticed ADR falls, cognition, abuse, neglect chronic, situational stereotyping bleeding, hyper, weakness, peripheral neuropathy, infections

_______ ____ can significantly affect an older person's independence and quality of life.

unrelieved pain

•Symptoms of age-related changes in the cardiovascular system become most apparent when the older adult is faced with ______ ________ _______; such as ________ activity or ________

unusual physiological stress heightened, infection

involuntary loss of urine due to irritation or spasms of the bladder wall that cause a sudden elimination of urine

urgency incontinence

effects of aging on female reproductive system •_____ & ________ decrease in size. •Endometrium continues to respond to ________ stimulation. •Fallopian tubes become ______ & _________. •Breasts ____ and are less _____. •Some _______ of nipples related to ________ & ________ changes. •_____ ____ ______ develop on breasts from _________ & ________ of terminal ducts.

uterus, ovaries hormonal shorter, straighter sag, firm retraction, shrinkage, fibrotic firm linear strands, fibrosis, calcification

alcohol use or misuse •May manifest in _______ of ways, can be ______ or confused with other disorders Possible indications of alcohol abuse: •drinking to _____ ____ or improve ____ •_______or _______ consuming alcoholic beverages; •memory _________ •_________; •confusion; •social _______ & ___________ •disrupted _________ •arrests for _____ offenses; •Anxiety and/or irritability; •_________ and/or mood swings; •lack of _______ or energy; •injuries, _____, clumsiness •insomnia; •____distress •Symptoms can develop secondary to complications from alcoholism: ________, _________, ______ infections •Screening tools exist •Criteria for diagnosing alcoholism - Drinks _____ of whiskey per day or equivalent in _____ or _____ - Alcoholic _________ - Blood alcohol level >___ mg/___ mL - ___________ syndrome - Continued drinking despite ______ or _________

variety, subtle calm nerves, mood gulping, rapidly blackouts malnutrition isolation, withdrawal relationships minor depression motivation falls GI alcoholism, cirrhosis, chronic fifth, wine, beer blackouts 150/100 withdrawal advice, problems

hearing deficits Inner ear problems caused by •________ disorders •________ infections •_________ Middle ear •___________ ________: ___-_______ ______ _____, ear injury, medications, cardiovascular disease •Treatment: correcting underlying problem, medications, ______ strategies, alternative therapies Infections •______ _____ infections less common in older adults •Usually accompany more serious disorders, e.g., ______, ______ External ear •_________, furunculosis, _________ _________, cysts, neoplasms

vascular viral presbycusis otosclerosis tinnitus, age-related hearing loss coping middle ear tumors, DM dermatoses, cerumen impaction

DM care plan goals •________ ________ of diabetes and management. •Demonstrate proper technique for administration of _______ _____ •Demonstrate correct method of ____ testing. •Be free from signs of _________ & _________. •Describe signs and symptoms of hypoglycemia and _______ shock. •Adapt management of diabetes to __________ •Maintain _____ at appropriate level or _____ specified amount. •Engage in regular ________ program. •Be free from _______; be free from _______; be free from _____ ________ impairment. •Be free from _________ associated with diabetes. Be able to ______/____ with disease to enjoy a quality of life

verbalize understanding antidiabetic meds BG hypoglycemia, hyperglycemia insulin lifestyle wt, lose exercise injury, infection, skin integrity complications manage/cope

•Good _____ & ______ are often taken for granted. -> •Protection from _____ is important. -> •Ability to hear and see facilitates accurate _________ of the environment. -> •Sensory function is essential to ___________. -> •______ ________, sharing of ________, exchange of __________ are more complete when vision and hearing are intact. -> •Through communication, people share_____ & ________, derive feelings of _________, validate _________, and maintain a link with ________.

vision, hearing harm perception communication social interaction, experiences, feelings joys, burdens normalcy, perceptions reality

maximum amount of air that can be expelled following maximum inspiration

vital capacity

what are increased and decreased resp in older adults?

vital capacity reduced; inc residual volume

effects of aging on female reproductive system •Hormonal changes - _____ atrophies - _________ of the labia - Loss of _____ ___ & ____ •Vaginal changes - Epithelium ____ - Environment becomes ____, more ______ •what atrophies?

vulva flattening subq fat, hair thins drier, alkaline Cervix, uterus, fallopian tubes, and ovaries

vascular lesions •Age-related change: _______ vein walls - Reduce ability of veins to respond to increased _____ _______ - _______ and hereditary factors compound problem Pathophysiology •_________ veins •Lower extremity _______ •________, ________, _________ appearance •Can result in ______ ____________ Stasis dermatitis •_________ condition associated with _____ ______ ___________ •Signs/symptoms: subsequent __________, __________, other trauma •Potential for ______ __________ formation

weaken venous pressure obesity varicose edema pigmented, cracked, exudative stasis dermatitis inflammatory, chronic venous insufficiency scratching, irritation stasis ulcer

What is hemiparesis?

weakness on one side of the body

4 M's framework

what matters, meds, mobility, mentation

hypothyroidism •Subnormal concentration of thyroid hormone •Prevalence: more common in ____ •Primary versus secondary hypothyroidism - Primary: ________ _________ destroys thyroid; low free ___ or free T4 index with elevated ____ - Secondary: insufficient pituitary secretion of ___; low free __ or free T4 and low ____ Signs and symptoms •Can be easily ________ or attributed to other conditions •_______, weakness, ______; •_________, disinterest in activities; • anorexia, weight ____, ______ face; • impaired ________; •________ & ________ edema; • _________; • _____ intolerance; • myalgia, paresthesia, ataxia; • dry skin, ________ hair •Treatment: __________, recheck TSH level in ___ weeks to evaluate dosage •Nursing interventions: support treatment plan, assist with management of symptoms; thyroid replacement will likely be a _________ requirement

women disease process, T4, TSH TSH, T4, TSH missed fatigue, lethargy, depression, gain, puffy, hearing, periorbital, peripheral, constipation, cold, coarse levothyroxine, 6 lifetime

effects of aging on NS •Decreased brain ____ and ________ of the brain & spinal cord •Slower nerve conduction which leads to: - slower ______ & ______ ____ - Weaker ________ •Ability to ________ declines with age •Cerebral blood flow decreases by about ___% •Delay in time required to perform tasks b/c _______ __________ slowing •Dulling of ______ sensation d/t decrease in neurons •Dulling of _____ & ______ d/t less functioning CNS •Intellectual performance MAINTAINED UNTIL AT LEAST AGE ____!!

wt, atrophy response, rxn times reflexes compensate 20 central processing tactile taste, smell 80

Maintaining _____ & ________ levels within their ideal range, avoiding ______ ______, effectively managing _____, ______ safely, and controlling _________ can prevent some neurologic conditions.

wt, cholesterol cigarette smoking stress, driving, infections

complications of DM •At greater risk for developing than _______ adults Hypoglycemia •Greater threat than _________ •Atypical symptoms: _______ disorders, _______, somnolence, _________, disorientation, poor sleep patterns, ________ _______, ________ speech, _________ •Uncorrected hypoglycemia: ________, __________, ____, _____, death Peripheral vascular disease •Symptoms: may range from ________ & ____ pulses to ________ & _________ •Education on proper ____ ____ Diabetic retinopathy •Signs and symptoms: _________, ________ disturbances, _______, visual disorders •Many taking ____________ experience hypoglycemia

younger ketoacidosis behavior, convulsions, confusion, nocturnal HA, slurred, unconscious tachy, arrythmias, MIs, CVAs numbness, weak, infection, gangrene foot care hemorrhage, pigment, edema sulfonylureas

what is esophageal dysphagia?

• difficulty with the transfer of food down the esophagus

max HR for 70 y/o target HR for 70 y/o target HR range

•220 - 70 = 150 maximum HR •150 x 75% = 112 target HR •Target HR range would be between 97 and 120 - dependent on each patient

what is dysarthria?

•difficulty forming words associated with poor muscular control due to damage to the central or peripheral nervous system

What is oropharyngeal dysphagia?

•difficulty transferring food bolus or liquid from mouth into pharynx and esophagus

what are problems that can challenge emotional homeostasis?

•Illness •Death •Retirement •increased vulnerability •social isolation •sensory deficits •greater awareness of own mortality •increased risk of institutionalization (like LTC!) •dependency

what are potential causes of arrhythmias in the older adult population?

•digitalis toxicity (most common), Hypokalemia, acute infections, hemorrhage, anginal syndrome and coronary insufficiency

what is glaucoma?

•eye disease involving increased intraocular pressure

what are some non pulmonary complications of influenza?

•Myositis •Pericarditis •Guillain-Barre syndrome •Encephalitis •Temporary loss of taste or smell

general nursing considerations regarding CVA

•Promote independence •Be patient and encouraging! •Prevent injury •Prevent complications

what is COPD?

•group of diseases including asthma, chronic bronchitis, and emphysema

What is atherosclerosis?

•hardening and narrowing of arteries due to plaque buildup in vessel walls

What is erectile dysfunction?

•impotence problems in achieving or sustaining an erection for intercourse

what pathogens is pneumonia caused by?

•Strep pneumoniae, •Klebsiella pneumoniae, •Legionella pneumophilia, •Haemophilus influenzae

what is periodontal disease?

•inflammation of the gums extending to the underlying tissues, roots of teeth, and bone

What is diverticulitis?

•inflammation or infection of the pouches of intestinal mucosa

What is macular degeneration?

•loss of central vision due to the development of drusen deposits in the retinal pigmented epithelium

what is elastic recoil?

•lungs' ability to expand and contract

what is BPH?

•nonmalignant enlargement of the prostate gland that commonly occurs with age

what is homans sign?

•pain when the affected leg is dorsiflexed, can be associated with deep phlebitis of the leg

What is bronchiectasis?

•permanent abnormal widening of the airways due to inflammation

what is fremitus?

•a vibration felt during palpation of chest

what is presbyesophagus?

•age-related changes to esophagus causing reduced strength of esophageal contractions, slower transport of food down esophagus

What is osteoporosis?

•bone condition characterized by low bone density and porous bones

class I CHF

•cardiac disease without physical limitation

what is CAM?

•complementary and alternative medicine therapies; those therapies that fall outside of mainstream Western medical practices; includes alternative medical systems, mind-body interventions, manipulative and body-based methods, biologically based therapies, and energy therapies

what is iatrogenic complications?

•complications inadvertently caused by practitioners or by medical treatments or procedures

what is HTN?

•consistent blood pressure reading ≥130 systolic and ≥90 diastolic

what is postural (orthostatic) htn?

•decline in systolic blood pressure of 20 mm Hg or more after rising and standing for 1 minute

what is sarcopenia?

•decline in walking speed or grip strength associated with an age-related decrease in muscle mass and/or function

what is hemianopsia?

•decreased vision or blindness in half of one eye or the same half of both eyes

what is dysphasia?

•difficulty expressing or comprehending verbal or written language due to brain lesion or injury

what is nocturia?

•voiding at least once during the night

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NURS 315: Exam #3

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