Age-Related Risks

The nurse understands that the elderly client should drink at least 30 mL/kg of fluid each day with a minimum of 1500 mL/day. Mr. Rogers weighs 226 lbs (102.7 kg). How many mL of fluid should the client drink per day? (102.7kg) 30ml/kg of fluid each day

3081 [30 mL/kg = 30 mL x 102.7 kg30 x 102.7 = 3081]

The nurse sets the insulin drip to delivery how many mL/hr? (BG 312mg/dL)

4 [Blood glucose level is 312 mg/dL which means that the insulin should be infused at 4 units/hour. If the concentration of the drip is 100 units/100 mL, then for 1 unit of insulin per mL, Mr. Rogers' drip should be set at 4 mL/hr.]

Mr. Rogers lost 4 lbs (1.81 kg) in 1 month prior to his hospital admission. The nurse assesses Mr. Rogers for signs of nutritional problems. Which data is most important to report to the HCP?

- Dyspnea [Dyspnea can result from nutritional problems and may be indicative of anemia; therefore, it is the most important symptom to report]

Which laboratory finding is of most concern to the RN?

- Hemoglobin 11.2 g/dL [Normal hemoglobin for an adult male is 13.2 to 17.3 g/dL. Although lower levels are often found in older adults, 11.2 g/dL indicates anemia.]

In the older adult, the mechanism for thirst is impaired. The nurse assesses the client for common signs of extracellular fluid loss. Which of the following objective signs indicate dehydration? SELECT ALL THAT APPLY

- High creatinine levels [Creatinine levels may decrease after rehydration, which improves renal blood flow. This can be attributed to low renal blood flow due to dehydration and/or diabetic nephropathy] - Postural hypotension [Hypovolemia, which can result from dehydration, can cause a drop in systolic BP of 10 to 15 mmHg when a client changes from a lying to a standing position] - Heart rate greater than 100 bpm [Tachycardia, or an increase in heart rate, may occur with a drop in blood volume related to dehydration to help the body maintain adequate cardiac output]

The RN anticipates that the client will receive which treatment for pernicious anemia?

- Intramuscular injection of vitamin B-12 [Pernicious anemia is a deficiency of vitamin B-12 that is often caused by a lack of intrinsic factor]

The nurse understand that which symptoms are associated with diabetic peripheral nephropathy? select all that apply.

- Reduced ability to feel pain or temperature in the extremities [Peripheral neuropathy is the most common form of diabetic neuropathy affecting the ends of the nerves in the feet and legs first, followed by neuropathy affecting the hands and arms in a stocking- like pattern] -Extreme sensitivity to touch [Peripheral neuropathy is the most common form of diabetic neuropathy affecting the ends of the nerves in the feet and legs first, followed by neuropathy affecting the hands and arms] -Problems with erectile dysfunction [This is a type of diabetic autonomic neuropathy, a condition in which the nerves of nearly all body systems (autonomic system) are impaired]

Mr. Rogers is prescribed a new medication, doxazosin (Cardura) to treat his benign prostatic hyperplasia (BPH). Which of the following statements made by Mr. Rogers indicates the need for further teaching?

- This medication may cause a rise in my blood pressure [Doxazosin (Cardura) can result in a drop in blood pressure]

The RN prepares to administer the first dose of vitamin B-12 via intramuscular injection. Which technique is correct?

- Use a 1 to 1.5 inch needle [For a male client who weighs 130 to 260 lbs (59 to 118 kg), a 1 to 1½ inch needle is recommended]

Which results of the dipstick urinalysis does the RN recognize as abnormal?

-+1 ketones [Ketones are not normally found in the urine. Positive ketones can be associated with uncontrolled diabetes, malnutrition, or pregnancy.] -Scant sediment [Cloudiness or turbidity of the urine is an abnormal finding, which may be associated with an infection or with contamination of the specimen.] -Trace leukocytes [The presence of leucocytes in the urine is an abnormal finding, which may be associated with specimen contamination or with infection.]

Which recommendation by the RN may help improve mild symptoms of BPH during the "watchful waiting" period?

-Avoid sources of caffeine [Caffeine may stimulate an overactive bladder and irritate an already enlarged prostate]

The nurse reports the abnormal findings to the HCP, who orders a urinalysis and urine for culture and sensitivity. The nurse obtains a clean catch specimen and sends it to the lab for analysis. The lab report states that there is greater than 100,000 E. coli bacteria, and Mr. Rogers is diagnosed with a UTI. Nearly half of all men over the age of 75 suffer from benign prostatic hyperplasia (BPH), also called benign prostatic hypertrophy. The HCP prescribes an oral antibiotic to treat the UTI and recommends the conservative "watchful waiting" approach for managing the BPH. The RN understands that which symptoms are commonly associated with BPH?

-Bladder distention [Enlargement of the prostate can cause obstruction, preventing emptying of the bladder and resulting in bladder distention] -Frequent stopping and starting of urinary stream [Enlargement of the prostate causes obstructive symptoms such as difficulty maintaining a steady stream of urine] -Straining while urinating [Enlargement of the prostate causes obstruction, making it difficult to urinate without straining] -Dribbling at the end of urination [Enlargement of the prostate may cause an obstruction, making it difficult to end the urinary stream, resulting in dribbling]

Which other symptoms should the nurse expect to find in a client with a diagnosis of diabetic retinopathy? Select all that apply.

-Loss of vision [Micro aneurysms and edema can lead to increased intraocular pressure, retinal detachment and glaucoma, which can all cause loss of vision.] -Reports of floaters [Small micro aneurysms protrude from the vessel walls, causing the client to see red and black spots or lines described as floaters.] -Difficulty with color perception [Macular edema associated with diabetic retinopathy can cause impaired hue discrimination resulting in impaired color perception.]

The RN considers which pharmacological age-related principle(s) when administering medications or monitoring the effects of medications in the elderly client? SELECT ALL THAT APPLY

-Decreased cardiac output increases the risk for adverse drug reactions [Decreasing cardiac function is responsible for about 50% of blood flow to the kidneys, leading to reduced kidney efficiency. Drugs are not filtered as quickly from the bloodstream, which increases their half-life and leads to toxicity] -Drug administered intravenously have a faster absorption rate than oral drug [Decreased gastric blood flow and motility in the elderly can slow oral drug absorption] - Dehydration can decrease the half-life of drugs[Dehydration leads to a delay in the filtration process of drugs. The extended biological half-life of drugs in the older adult increases the risk of adverse reactions]

The nurse suspects that Mr. Rogers is dehydrated and encourages him to increase his oral intake of fluids, especially during his treatment for a UTI. Along with clinical manifestations, which common laboratory findings indicate dehydration? SELECT ALL THAT APPLY

-Elevated hemoglobin and hematocrit [No single laboratory test result confirms or rules out dehydration. Instead it is determined by laboratory findings with clinical manifestations. Common findings are elevated hemoglobin and hematocrit levels from hemo concentration (an increase in the number of red blood cells/plasma). In the case of dehydration, BUN would be elevated] -Increased serum osmolarity [During dehydration, increased levels of sodium, BUN or glucose in the blood can increase the serum osmolarity] -Increased serum glucose [Urine specific gravity is a measure of the concentration of dissolved substances or solutes (urea and sodium). The specific gravity of water is 1.000. An increase in urine specific gravity is caused by dehydration] - Increased urine specific gravity [Increased amounts of solutes, such as glucose or protein, can also increase specific gravity of the urine]

The nurse understands that which information is correct regarding the prescribed insulin?

-Glargine (Lantus) does not have a peak interval [Glargine (Lantus), long-acting insulin, has an onset of 1 to 2 hours, has no pronounced peak, and has a duration of 24+ hours. ]

What conditions, other than hyperglycemia, might Mr. Rogers have? Select all that apply.

-Glycosuria [When blood glucose levels exceed the renal threshold, the glucose spills into the urine, causing glycosuria.] -Ketonuria [The lack of glucose in cells results in fat breakdown by the liver, and ketonuria results from the excretion of ketones in the urine.] -Osmotic diuresis [Glucose is an osmotically active particle, and lack of glucose results in cellular dehydration.]

Which of the following results can affect drug distribution and influence drug-to-drug interactions?

-Low serum albumin levels [Serum albumin levels can affect the binding of drugs. Low levels of albumin can result in toxic effects, especially in the elderly]

The nurse creates Mr. Rogers' care plan and records a nursing diagnosis for knowledge deficit related to signs and symptoms of hypoglycemia. Which of the following teaching points should be included in this plan of care? SELECT ALL THAT APPLY

-Notify the HCP if there is headache or irritability [Headache and irritability are symptoms of hypoglycemia, so these should be reported. Hypoglycemia can be dangerous when blood glucose levels are below 50 mg/dL in adults because it can cause irreversible damage to the cerebral cortex. The brain cannot burn anything other than glucose. A prn prescription for parenteral glucose or a carbohydrate meal is usually given] -Report excessive hunger and/or weakness [Excessive hunger and weakness are a sign of hypoglycemia, which can be a result of not eating or an indication of a side effect of insulin or oral hypoglycemic agents. These symptoms should be reported. A prn prescription for parenteral glucose or a carbohydrate meal is usually given] -Report cold and clammy skin [Hypoglycemia causes autonomic nervous system symptoms such as nervousness, sweating, irregular heart rhythm, tremor, and hunger, and these symptoms should be reported]

Based on the information gathered during the nurse's assessment, the HCP prescribes low doses of regular insulin by continuous IV infusion. In addition to the insulin, which of the following immediate measures would be indicated in the treatment of Mr. Rogers? Select all that apply.

-Potassium supplements [Ketones accumulate, which produces a drop in blood pH and increases the number of hydrogen ions in the blood, resulting in acidosis. The body attempts to buffer the acidic hydrogen ions by exchanging them with intracellular potassium ions. Potassium supplements are given to restore normal potassium levels.] -Sodium bicarbonate [The sodium bicarbonate is administered to correct the metabolic acidosis.] -0.9% normal saline [Fluids are used to correct profound dehydration and hyper osmolarity.]

The pharmacist delivers Mr. Rogers' dose of ampicillin (omnipen) in a 100ml bag of 0.9% normal saline. In order to deliver the medication over 30 minutes, the nurse sets the pump at how many ml/hr?

200 [100 mL to be delivered over thirty minutes is given at 200 mL/hr]

With the understanding that Mr. Rogers' eating habits lack consistency, which physiological facts about he client's nutrition are most concerning to the nurse? Select all the apply.

-The stage II non-healing ulcer on the client's right heel could require amputation. [Extra protein is needed for healing wounds and restoring losses. Extensive tissue destruction, such as that which occurs with burns, pressure sores, and diabetic ulcers requires a large protein increase for the healing and grafting processes. Older adults with diabetes mellitus II (DM) also demonstrate poor wound healing.] -Dehydration exacerbated by lack of nutrition. [Approximately 19% of total water intake comes from food. Uncontrolled diabetes mellitus causes an excess loss of water through urine as a result of high blood glucose levels. In such cases, the replacement of lost water and electrolytes is vital to prevent dehydration.] -Lack of appetite and not wanting to eat alone could lead to malnutrition. [Many of the health problems of older adults result from general aging and states of malnutrition caused by poor food habits, such as a lack of appetite, or loneliness and not wanting to eat alone.] -The development of hypoglycemia could be life-threatening. [This is a concern to the nurse.]

The RN understands that which physiological age-related change is often responsible for dehydration in the elderly

-Thirst decreases, contributing to less fluid intake [Older adults have a higher baseline osmolality and, thus, a higher osmotic operating point for thirst sensation. As the thirst mechanism decreases, the elderly individuals are more likely to take in fewer fluids. Urine output rises from osmotic diuresis]

The nurse is developes a plan of care to prevent Mr. Rogers' feet from further skin breakdown. Which actions will help maintain skin integrity? Select all that apply.

-Use heel protectors [Heel protectors can help take pressure off the heels. Check heels for erythema, blisters, or breaks in skin integrity] -Use special mattress or foot cradles [Pressure on infected or open wounds on the feet can be eliminated by the addition of a soft care mattress or use of a foot cradle] -Apply skin moisturizers to prevent cracking [Foot deformities are common in diabetic neuropathy and may lead to callus formation, ulceration, and increased areas of pressure] -Instruct the client to wear clean white socks [Clean white socks should be worn with shoes that fit properly]

Mr. Rogers is prescribed ampicillin (Principen) one gram every six hours for his urinary tract infection. He develops a maculopapular rash on his torso. The nurse notifies the HCP and the ampicillin (Principen) is discontinued. Which antimicrobial medications are safe alternatives for clients with penicillin allergies?

-Vancomycin (Vancocin) [IV vancomycin (Vancocin) is indicated for serious infections with susceptible organisms in clients who are allergic to penicillins.] -Clindamycin (Cleocin) [Clindamycin (Cleocin) is indicated for serious infections with susceptible organisms in clients who are allergic to penicillins] -Erythromycin (Erythrocin) [Erythromycin (Erythrocin) is one of the drugs that is indicated for serious infections with susceptible organisms in clients who are allergic to penicillin.]

When using an 8-ounce drinking glass, the client should drink how many glasses per day to ingest 3081 mL in 1 day?

13 30 mL = 1 ounce 8 ounces x 30 mL = 240 mL/glass 3081 mL per day ÷ 240 mL/glass = 12.8 glasses Round to 13 glasses

Which lab value needs to be reported immediately?

Arterial PH 7.05 [An arterial pH below 7.35 indicates an abnormal blood gas and indicates a shift to an acidotic state. This is an emergency situation.]

Prior to changing the dressing on Mr. Rogers' right heel ulcer, the nurse should first take which actions?

Inspect the feet carefully for temperature, sensation, and drainage. [An inspection must be done by the nurse to assess for drainage in case a culture/sensitivity needs to be done to rule out the possibility of infection. Peripheral neuropathy may begin with nerve irritation and pain that progresses to the loss of sensation to fine touch. Diabetic clients may often ignore or be unaware of irritation or injury to their feet.]

which information about the client is of most concern to the nurse?

Reports a new onset of blurry vision. [Blurry vision can indicate cataracts, glaucoma, optic nerve damage or diabetic retinopathy. ]

Mr. Rogers is placed on an EKG monitor because of a concern about hypokalemia. Which pattern should the nurse report immediately to the HCP?

ST depression and "U" waves. [After insulin therapy, hypokalemia is expected because the potassium shifts back into the cell. Hypokalemia is a serum potassium level less than 3.5 mEq/L and can be life threatening. Flat or inverted T waves or increased "U" waves can occur with hypokalemia.]

The RN understands that which concept is important when addressing the client's physiological and psychosocial needs?

The client's diabetes mellitus should not present a problem for community dining [The client should be able to order or select dishes on his diabetic meal plan from the community dining center. A special dietary need will not typically prevent a client from enjoying the social benefits of a community dining experience]

Mr. Rogers tells the nurse that he likes to take warm baths because it helps his joints feel better. The nurse is concerned that peripheral neuropathy may cause him to unintentionally burn himself when he is discharged to the assisted living facility. Which instruction related to bath safety is best?

Use a bath thermometer to ensure that the temperature is below 102 degrees F [Use of an unbreakable thermometer to ensure temperature is below 102° F (38.8° C) will help prevent burns for the client with peripheral neuropathy.]

The nurse asks Mr. Rogers additional questions related to his urinary symptoms. Mr. Rogers reports mild pain with urination and his temperature is 98° F (36.6° C). The nurse reports the foul smelling urine to the HCP who prescribes a random dipstick urinalysis test. The RN should instruct the client to take which action when collecting a urine sample?

Wipe the genital area clean [This step helps prevent contamination of the sample from the skin]

Which response by the client is of most concern to the RN?

my urine had a foul smell this morning [New onset of a foul smell in the urine could be a sign of UTI and should be investigated further. Bladder (cystitis) and kidney (pyelonephritis) infections are common problems in clients with diabetes.]

The nurse notes that Mr. Rogers takes PO gabapentin (Neurontin) every day when he is at home to treat his peripheral neuropathy. It is most important for the client to report which potential adverse or side effect associated with gabapentin (neurontin)?

tarry stool [A tarry or black stool may be an indication of a gastrointestinal bleed, a potentially life-threatening complication.]