Critical Care TB Ch. 7 Gerontological Alterations

ANS: B Collagen is the principal noncontractile protein occupying the cardiac interstitium. Because myocardial collagen content increases with age, increased myocardial collagen content renders the myocardium less compliant and may be responsible for increased loading of blood vessels.

A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction. Age-related changes in myocardial pumping ability may be evidenced by a. increased contractility. b. decreased contractility. c. decreased left ventricle afterload. d. increased cardiac output.

ANS: D Reduced drug-metabolizing capacity is caused by a decline in activity of the drug-metabolizing enzyme system, microsomal ethanol oxidizing system, and decrease in total liver blood flow. Medications that depend on the cytochrome P450 group of liver enzymes are most affected because age-associated changes cause as much as a 50% decline in enzymatic function.

A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction. Dopamine 3 mcg/kg/min has been ordered for this patient. What nursing implications should be considered when administering this drug to an older patient? a. No changes are noted in older patients with this drug. b. Drug effect is enhanced by increased receptor site action. c. Increased breakdown by liver hepatocytes occurs, increasing dosage requirements. d. Drug metabolism and detoxification are slowed, increasing the risks of drug toxicity.

ANS: C Ecchymotic areas may be seen because of decreased protective subcutaneous tissue layers, increased capillary fragility, and flattening of the capillary bed, predisposing older adults to developing ecchymoses. Medications and physiologic factors may result in an augmented bleeding tendency and appearance of ecchymotic areas; nevertheless, consideration should be given to the possibility of older adult abuse if ecchymosis is widespread or in unusual areas.

A 68-year-old patient has been admitted to the coronary care unit after an inferior myocardial infarction. When caring for this patient, the nurse will give increased attention to skin integrity because of the a. thickening of the epidermal skin layer. b. loss of sebaceous glands. c. increased fragility from loss of protective subcutaneous layers. d. decreased melanocyte production.

ANS: D Myocardial infarction in older adults is often associated with ST-segment depression rather than ST elevation. Sensation of chest pain may be altered and may be less intense and of shorter duration. Other atypical symptoms may include dyspnea, confusion, and failure to thrive, which results in unrecognized signs and symptoms of cardiac problems and delays in diagnosis and treatment.

A nurse is teaching an older patient about the signs and symptoms of a myocardial infarction. Which statement by the patient would indicate that the teaching was effective? a. The pain in my chest may last a long time. b. I will feel like I have an elephant sitting on the center of my chest. c. The chest pain will be sharp and over the center of my chest. d. The pain may not be severe and may not be in my chest.

ANS: B Respiratory muscle function is affected by skeletal muscle and peripheral muscle strength. During aging, skeletal muscle progressively atrophies, and its energy metabolism decreases, which may partially explain the declining strength of the respiratory muscles.

Age-related pulmonary changes that may affect this patient include a. increased tidal volumes. b. weakening of intercostal muscles and the diaphragm. c. improved cough reflex. d. decreased sensation of the glottis.

ANS: B Some slight memory dysfunction is common with increasing age, but a significant decline may represent a change in individual need and may be a result of acute or chronic conditions. Acute mental status changes caused by infection, metabolic imbalances, or medications are usually reversible after identification and treatment.

An older patient is admitted to the hospital with an acute onset of mental changes and recent falls. The nurse knows that the most common cause of mental changes is a. hypoxia. b. infection. c. cerebrovascular accident. d. electrolyte imbalance.

ANS: C Decrease in number and size of nephrons begins in the cortical regions and progresses toward the medullary portions of the kidney. This decrease in number of nephrons corresponds to a 20% decrease in weight of the kidneys between 40 and 80 years of age. Initially, this loss of nephrons does not appreciably alter renal function because of the large renal reserve and a simultaneous decrease in lean muscle mass.

An older patient is receiving a nephrotoxic medication. Which of the following would be a priority for the nurse to monitor? a. Electrocardiogram b. Lung sounds c. Blood pressure d. Level of consciousness

ANS: A, B, C Tricyclic antidepressants (amitriptyline and amitriptyline compounds) have strong anticholinergic effects; may lead to ataxia, impaired psychomotor function, syncope, falls; cardiac arrhythmias (QT interval changes); may produce polyuria or lead to urinary incontinence; may exacerbate chronic constipation

An older patient is started on amitriptyline to control depression. The nurse knows to monitor for (Select all that apply) a. impaired psychomotor function. b. irregular heart rate. c. polyuria. d. pulmonary edema.

ANS: B Adverse drug effects and medication interactions may be related to pharmacokinetics or the manner in which the body absorbs, distributes, metabolizes, and excretes a drug. The aging process is associated with changes in gastric acid secretion, which can alter ionization or solubility of a drug and hence its absorption. Medication distribution depends on body composition and on physiochemical drug properties. With advancing age, a patients fat content increases, lean body mass decreases, and total body water decreases, which can alter drug disposition.

An older patient is starting a new medication that is metabolized in the liver and excreted by the kidneys. Which is the best assessment to monitor the patients ability to tolerate the medication? a. Liver function tests b. Drug side effects experienced by the patient c. Kidney function tests d. Therapeutic drug levels

ANS: B Metabolism is the chemical change in a drug that renders it active or inactive. Absorption is the receptor-coupled or diffusional uptake of drug into the tissue. Distribution is the theoretic space (tissue) or body compartment into which free form of a drug distributes. Excretion is the removal of a drug through an eliminating organ, often the kidneys; some drugs are excreted in bile or feces, in saliva, or through the lungs.

Chemical changes in a drug that renders it active or inactive is known as a. absorption. b. metabolism. c. excretion. d. distribution.

ANS: A The incidence of asymptomatic cardiac dysrhythmias increases in older patients. The most common dysrhythmia is the premature ventricular contraction. Other common types are atrial fibrillation, atrial flutter, and paroxysmal supraventricular tachycardia and atrioventricular conduction disturbances. All of the other findings are abnormal.

Which of the following can be a normal assessment finding for an older patient? a. Asymptomatic dysrhythmias b. Decreased urine output c. Increased respiratory effort d. Difficulty problem solving

ANS: D Possible side effects of select NSAIDs include indomethacin: central nervous system (CNS) effects (highest of all NSAIDs); ketorolac: asymptomatic gastrointestinal conditions (ulcers); aspirin (>325 mg): asymptomatic gastrointestinal conditions (ulcers); and naproxen: gastrointestinal bleeding, renal failure, high blood pressure, and heart failure.

Which of the following nonsteroidal anti-inflammatory drugs (NSAIDs) has the side effect of renal failure, HTN, heart failure, and GI bleed in the elderly population? a. Indomethacin b. Ketorolac c. Aspirin greater than 325 mg d. Naproxen