NUR 305 Exam 1

cranial nerves

wilson pages 312, 313 yoost page 380

metabolic acidosis

1. can't get rid of acid -can't absorb enough bicarb to neutralize acid -hypoventilation (kuusmauls) -airway obstruction (breathing into paper bag, choking) 2. Renal Failure -Lactic Acidosis (diabetic keto acidosis) -loss of gastric juices, lower GI (diarrhea) 3. example -pH 7.33 acidic -PaCO2 30 mmHg same, decreasing -HCO3 16 mEq/L decreasing

gerontologic nursing

1. care of older adults based on the specialty body of knowledge of gerontology and nursing 2. provide care for older adults using a whole-person perspective

mixed hearing loss

1. combination of conductive and sensorineural hearing loss

Hyperphosphatemia

1. common in acute & chronic kidney disease; over-use of phos-containing laxatives 2. Rarely symptomatic: goal is to decrease dietary intake or administer meds (calcium-carbonate) to decrease absorption; dialysis if severe

care alternatives

1. Independent Living - apartments or town home living with or without meals. Social activities often available 2. Home health care - care given to older adults in their home by home health aides 3. Adult day care - Nursing care and therapy, meals and recreational activities, and social work services in a structured daytime program. 4. Residential Care - residential living with 24-hour unlicensed care. They provide assistance with ADL's, meals, social activities, housekeeping, laundry assistance and limited transportation. 5. Assisted Living - Residents must be ambulatory, able to eat independently 6. Palliative Care - relief of suffering and improve quality of living and dying. Often a stepping stone to hospice care. 7. Hospice Care - End of life care. Can be home-based or inpatient. 8. Long Term Care Facility- long-term placement due to: -Rapid patient deterioration -Caregiver inability to continue care because of stress or burnout -Alteration in or loss of the family support system 9. Relocation stress syndrome - disruption, confusion, and challenges the patient faces when moving from one environment to a new environment. -Patient becomes anxious, depressed and or disoriented to the new living situation.

sodium (Na+)

1. Normal serum sodium value 135-145 mEq/L 2. Found primarily in the extracellular fluid (ECF) 3. Necessary for: -Water distribution between the ICF and ECF to maintain fluid balance (retained, excreted or moved) -Transmission of nerve impulses, muscle contractility and acid-base balance -A loss or gain of sodium is accompanied by a loss or gain of water -The GI track absorbs sodium from foods, typically more than needed -The kidneys regulate sodium balance as well as aldosterone

extra ocular disorders

1. Hordeolum (sty) -infection of sebaceous glands in lid margin -red, swollen, circumscribed, acutely tender area develops rapidly -apply warm, moist compresses at least 4 times a day 2. Conjunctivitis -infection or inflammation of conjunctiva -ex. pinkeye 3. Keratitis -inflammation or infection of cornea caused by a variety of microorganisms or other factors -may involve conjunctiva and/or the cornea -keratoconjunctivitis: when it involves both 4. Dry eye -keratoconjunctivitis sicca -common complaint of older adults and individuals with certain systemic diseases -complain of irritation or "sand in eye" -condition worsens throughout day -caused by a decrease in quality or quantitiy of the tear film, treatment directed at underlying cause 5. strabismus -patient cannot consistently focus two eyes simultaneously on same object -eye deviates in: esotropia -out: exotropia -up: hypertopia -down: hypotropia

neurologic changes

1. In CNS, decrease in neurons, brain size, neurotransmitters 2. Slowed nerve impulse conduction 3. Decreased peripheral nerve function 4. Compromised thermoregulation 5. Decrease in deep tendon reflexes 6. Decrease in pupil size 7. Decreased ability to respond to multiple stimuli 8. in other words; things start to slow down and simple tasks take more time

hypokalemia

1. Increased loss, excessive shift from ECF to ICF, lack of intake (rare) -more dangerous to have lower level than higher level 2. S/S: Fatigue, muscle weakness, numbness, paresthesia/decreased reflexes, constipation, ileus, weak HR w/EKG changes, shallow respirations -same symptoms as hyperkalemia 3. Nursing Management: -Replace orally or via IV (must be very careful with IV replacement) -IV potassium must be done slowly, needs to be absorbed by blood vessels -Increase potassium rich foods -Monitor serum K+ level, strict monitoring of cardiac function, dietary potassium monitoring.

normal assessment findings of ears

1. Patient should be able to engage in conversation without -need for repetition of statements -Tilting "good" ear toward you -Reading lips -Excessive volume of speech -Misunderstanding your speech repeatedly 2. Alignment -Visualize a line connecting outer canthus of eye with occipital prominence -low set pinna sign of down syndrome -Top of pinna should touch line. 2. Size, shape, symmetry -Equal bilaterally 3. Skin -Fleshtone color -Intact 4. Inspect canal opening -use penlight -No discharge -No lesions

regulation of water balance

1. for proper fluid balance 2000-3000mL water intake 2. insensible water loss: invisible vaporization from lungs and skin 3. sensible perspiration is caused by exercise, fever, high environmental temp -loss of water and electrolytes in urine

hypercalcemia

1. 2/3 related to hyperparathyroidism; 1/3 related to malignancies 2. Acts as a sedative to muscles and nerves. 3. Treatment depends on severity

potassium (K)

1. 98% of the body's potassium is in the ICF -sodium is ECF, where as potassium is ICF -which is why when we draw blood sodium levels are a number in the 100s, where as a potassium value should be very low 2. Normal serum (extracellular) potassium levels: 3.5-5.0 mEq/L 3. Necessary for: -Transmission and conduction of nerve and muscle impulses -Intracellular growth -Contraction of skeletal, smooth, and cardiac muscle -Acid-base balance (potassium moves out, hydrogen moves in) -Diet is the main source of potassium intake, also small amounts from parenteral intake (TPN, medications) -if patient is on artificial nutrition, body does not do a good job of absorbing that potassium -Kidneys are the primary route for loss (about 90% of daily intake)

chronic illness (pg. 62)

1. Accounts for 70% of deaths in the U.S. 2. Older adults are at higher risk for developing chronic illnesses and related disabilities. 3. Diseases that are -Prolonged (> 6 months) -do not resolve spontaneously -irreversible -rarely cured completely -Affect the function of one or more body systems 4. Results in varying degrees of limitation in: -physical functioning -work productivity -quality of life 5. Impacts healthcare and cost 6. In addition to the patient, chronic illness impacts family members and caregivers 7. comeback may take a little longer each time... eventually not achieving baseline again after sickness as health declines -can happen over the span of months, years, decades

functional assessment tools

1. Activities of Daily Living (ADLs) -Bathing -Dressing -Toileting -Transferring -Continence -Feeding 2. Instrumental Activites of Daily Living (IADLs) -Cooking -Cleaning -Laundry -Use of telephone -Transportation -Managing Finances

nursing management

1. Acute exacerbations are often managed in the hospital 2. Other phases are managed in the home, ambulatory care settings, assisted living facilities and skilled care. 3. Nursing Care: -Health assessment -Assessment of ADL's and IADL's -Self-management -Planning care -Teaching -Assessment of patient outcomes -Collaborative care 4. patient and family/care takers must be on board with/agree with/cooperate with plan of care -must be on same page as entire health care team

abnormal assessment findings of ears

1. Alignment is low set or below the visual line between outer canthus and occipital prominence (Down Syndrome) 2. Presence of clear or bloody drainage along with history of head trauma (Suspect skull fracture) -yellow or amber color of tympanic membrane 3. Foreign body- Common in children -Decreased hearing acuity -Ear pain -Presence of purulent or crusty drainage -Possible fever 4. Cauliflower ear: thickened pinna r/t repeated blunt trauma, suspected child abuse 5. Hematoma: a blood collection from trauma of contact sports, motor vehicle accident and suspected abuse in children. 6. Tophi: lesion of uric acid crystals r/t gout 7. Sebaceous cyst: nodule behind the earlobe -Painful if infected 8. Impaired Hearing during conversation -Reads lips -Requests repetition of statements -Misunderstands verbalizations -Speaks in a loud voice -Client has distortion of own speech 9. Acute otitis media (AOM) -Any age, but mostly children -Irritability -Pulling at affected ear -Fever -Decreased hearing acuity -Vomiting (infants) -Purulent drainage with relief of pain suggests perforation of the tympanic membrane 10. Acute otitis media with effusion -Middle ear has accumulation of serous fluid due to inflammation -clogged sensation in the ear -Afebrile 11. conductive hearing loss -Related to impaired air movement -Impacted cerumen (wax) -Tympanic membrane movement diminished -Middle ear otitis media or effusion -Muffled hearing 12. sensorineural hearing loss -Related to inner ear -90% of hearing loss -Deterioration of cochlear cells of the inner ear -Difficulty filtering background noise -Loss of ability to hear high pitched tones

regulation of pH

1. Buffer system- Body's response that changes strong acids into weaker ones or neutralizes them 2. Respiratory system- excretes CO2 and water which are by-products of cellular metabolism. -Quick acting response 3. Renal system (metabolic) Filters/excretes acids and conserve/reabsorbs HCO3. -Slow to respond 4. urine pH 6 -much more acidic -get rid of acids through urine output

respiratory acidosis

1. COPD, overdose, sleep apnea, asthma, sedated, retaining too much CO2 -breathing too slow -little blue around lips, fingertips -pulse ox drops 2. example -ph 7.18 acidic -PaCO2 opposite, increased -HCO3 normal

special populations

1. Chronically Ill Older Adults 2. Older Adult Women -tend to be more trusting in health care professionals -tend to be taken advantage of 3. Cognitively Impaired -declining physical health and acute illness are important factors that may influence congnition 4. Rural Older Adults -don't have easy access to medical care -may not have health insurance -may be less likely to engage in health-promoting activities 5. Homeless Older Adults -increasing 6. Frail Older Adults -usually over age 75 and has physical, cognitive, and/or mental conditions that may interfere with independently performing ADLs

age related macular degeneration

1. Common cause of irreversible central vision loss in people over age 60 2. Two forms: -Wet: most severe form -Dry: most common form 3. Slow progressive, painless vision loss -affects central vision (blind spot), so peripheral field is left -patient usually does not pick up until it is far gone, or infects both eyes 4. etiology -Related to aging process -Family history -Prolonged exposure to UV light -Cigarette smoking (causes vasoconstriction) -Poor nutrition may contribute to progression of disease 5. Pt. complains of: -Dark vision -Blurred vision -Distorted vision -Diagnostics: ophthalmoscopy 6. interprofessional care -Medications Side effects: blurred vision, eye irritation, eye pain, photosensitivity -Vitamin and mineral supplements (C and E) -Stop smoking -Use of assistive device to aid in reading and with driving -Assess psychosocial aspects -Team approach to meet desired pt. outcomes 7. health promotion -Educate the pt. about medication use Instillation Return demonstration Safety measures -Assess mobility -Avoid smoking -Maintain good health -how is patient getting to work? -Hypertension

cardiovascular changes

1. Decreased elasticity & compliance 2. Sclerosis of valves 3. Arterial wall thickening & stiffness 4. Decreased response and sensitivity to compensation mechanisms ("fight or flight") 5. Diminished reserve 6. don't have extra energy

gastrointestinal changes

1. Decreased thirst perception 2. Decreased gastrointestinal motility 3. Decrease defecation sensation 4. Decrease in olfactory and gustatory(sweet and salty) 5. Decreased absorption 6. trouble differentiating between luke warm and burning hot water

nursing strategies to improve communication and social interaction

1. Draw attention using hand movements 2. Have speaker's face in good light 3. Avoid covering mouth or face with hands 4. Avoid chewing, eating, smoking while talking 5. Face patient and maintain eye contact, speak in a normal voice using simple sentences 6. Be aware of environment. Avoid distractions 7. Ask for feedback to ensure understanding 8. Use touch when appropriate 9. good at hiding changes- read lips, facial expressions/cues -patient is intently staring 10. The nurse needs to assess all factors influencing sensory deficits that may affect communication including: -Age -Environmental factors -Back ground noise -Poor vision -Poor Hearing -Language spoken -Cultural practice not understood by the nurse -Non-verbal communication techniques

support system resources

1. Family members - preferred primary support 2. Friends, neighbors 3. Clubs, religious organizations 4. Adult day care, senior citizen centers 5. Formal systems of support: social welfare agencies, health facilities, and government support 6. You MUST ask the patient about their support system(s) -who is able to help patient at home? (today) 7. formal systems of support are not good follow throughs- offer a variety of benefits, but up to patient to take advantage

hearing aids

1. Hearing assessment by a qualified person 2. Many types 3. Place in a cool, dry area 4. Keep in a safe place 5. Remove batteries when not in use 6. Cochlear implant 7. replace batteries weekly 8. initially restrict usage to quiet listening in the home

7 tasks of patients with chronic illness

1. Preventing and managing a crisis 2. Carrying out prescribed treatment regimen -counting calories, weighing oneself, taking medications 3. Controlling symptoms -depends on comfort level 4. Reordering time (too much or too little time) 5. Adjusting to changes in course of disease 6. Preventing social Isolation 7. Attempting to normalize interactions with others

elder abuse

1. Intentional or neglectful acts by a caregiver or trusted individual that lead to, or may lead to, harm or serious risk of a vulnerable elder. 2. The term is used to describe acts of commission (abuse) or omission (neglect), that harm or threaten to harm, an older adult's health or welfare. 3. types of mistreatment -Physical abuse: use of force to threaten or physically injure a vulnerable elder. -Emotional abuse: verbal attacks, threats, rejection, isolation, or belittling acts that cause or could cause mental anguish, pain, or distress to an elder. -Sexual abuse: Sexual contact that is forced, tricked, threatened, or otherwise coerced upon another person who is unable to grant consent. indicated by STDs, bruising around genitals/breasts -Exploitation: theft, fraud, misuse or neglect of authority, and use of "undue influence" as a lever to gain control over an older person's money or property. trying to get elder to sign everything over; "thought I had more money" -Neglect: a caregiver's failure or refusal to provide for a vulnerable elder's safety, physical, or emotional needs -Abandonment: desertion of a frail or vulnerable elder by anyone with a duty of care. could be hours or days... depends on patient's condition -Self-neglect: an inability to understand the consequences of one's own actions or inactions, which lead to, or may lead to, harm or endangerment. due to no longer having the will to live 4. abuse bruises signified by: -bilateral -different phase bruises/cuts indicating happening multiple times

glaucoma (pg. 381)

1. Is a group of disorders characterized by: -Increased intraocular pressure (IOP= 10-21 mm/HG) -Optic nerve atrophy -Consequences of elevated pressure -Peripheral vision loss, does have central vision -tell patient to move head left/right to see 2. Second leading cause of permanent blindness in the USA -Leading cause of blindness among African Americans -2 million people with this condition, 50% unaware 3. once diagnosed and pressure is high, the pressure under the nerve builds up and damages nerve until it gets treated or until permanent damage to eye occurs, if they find problem immediately and stop pressure with treatment it is good -blindness occurs due to noncompliant patients (blind eye patients) 4. Primary Open-Angle Glaucoma (POAG) -Most common type of glaucoma -Draining channels become clogged -Optic nerve becomes damaged -Develops slowly -No pain or pressure -L-shaped angle (canal of schlemm), aqeous humor drains slower, causing pressure build up 5. Primary Angle-closure Glaucoma (PACG) -Caused by reduction in outflow of aqueous humor -fluid rapidly builds up and can't drain -Dilatation of the pupils -Sudden, excruciating pain around the eye (emergency) -Nausea, vomiting, dizziness -Colored halos around lights -Ocular redness 6. if IOP remains elevated pt. will have permanent vision loss -fluid that keeps eyes moist, if something is clogged; builds pressure up in eye and stays there... similar to a sink; once pressure is there, damage is done, it's irreversible 7. diagnostic -History and Physical -Visual acuity measurement -Tonometry -Visual field perimetry 8. Drug therapy -Mydriasis: dilate pupils -miotics: constrict pupils 9. Surgical therapy -Laser -iridectomy (remove part of the iris) -implant 10. nursing management -Assessment: Pts. understanding of diagnosis Can pt. adhere to prescribed therapy? Assess pts. psychological condition Include the family in the assessment process -Nursing diagnoses: Disturbed visual sensory perception related to altered sensory perception and vision Anxiety and Fear related to altered self-concept -Planning: Understand the disease process Understand the importance of therapy No progression of visual impairment No post-op complications -Implications: Health promotion- early detection and treatment Address immediate reports of discomfort Encourage the pt. to follow up with the ophthalmologist Teach pt. and family about the importance of technique, frequency of therapy -Evaluation: no further loss of vision Safety Pain relief Adherence to treatment/therapy 11. health promotion -Prevent further eye deterioration -Prevent complications -Encourage pt. to adhere to treatment -Encourage pt. to maintain safe and clean environment -Assist pt. in finding resources to help manage home life -social worker sends someone to home to make sure environment is safe for patient -Provide emotional and spiritual support -Good communication with interdisciplinary team to meet desired patient outcomes

renal regulation

1. Kidneys are the primary organ for regulating fluid and electrolyte balance by responding to aldosterone and ADH. -Adjusting urine balance by regulating water balance -Regulation of electrolyte concentration by selective retention and secretion -Regulation of acid-base balance -Excretion of metabolic wastes and toxic substances

surgical therapy

1. Laser 2. Implant (IOL-intraocular lens implant)

respiratory changes

1. Lungs tissues and muscles become less elastic 2. Pulmonary function decreases 3. Vital capacity declines 4. Decrease in # and size of alveoli -leading to decreased gas exchange -lungs are not able to expand as well 5. Drier mucous membranes 6. Structural changes of the thorax (bony changes)

water content of the body

1. More important that any other nutrient for survival 2. Carries nutrients, oxygen, electrolytes and waste 3. Solvent for minerals, vitamins, glucose 4. Lubricant/cushion for joints, eyes, spinal cord 5. Maintains body temp and blood volume 6. 50% - 60% of body weight in adults -Varies with gender, body mass, and age -in older adults, body water content averages 45-50% of body weight, placing them at a higher risk for fluid-related problems -*One liter of fluid weighs 2.2 lb. (1kg)* -sudden body weight change is an indicator of fluid volume loss/gain 7. To maintain balance, adults need 2000-3000 mL/day 8. filters out other body systems

musculoskeletal changes

1. Muscle atrophy - leads to decreased expansion of organs 2. Decreased bone mineral & mass 3. Kyphosis (Hunchback) 4. Joint, ligament & tendon stiffening 5. Decreased joint mobility 6. Decrease in strength

assessment of the older adult

1. Neuro- baseline cognition and mental status. -Vital signs (orthostatic), ADL's/ IADL's, safety -social interaction can have positive effects on cognitive and physical abilities 2. Skin -thorough skin assessment is important. -Inspection should include the head, scalp, neck, trunk and limbs. -Moisture, temperature, turgor, sores, bruises, cuts 3. Respiratory -rate, pattern, breath sounds, chest expansion, cough, deep breathing, exercise capacity/intolerance, DOE (dyspnea on exertion, shortness of breath) 4. Cardiac -rate/rhythm/heart sounds, palpate carotid artery, peripheral pulses for symmetry, strength -note altered landmarks, distant heart sounds, extra heart sounds (S3 in CHF) 5. GI -abdomen size, bowel sounds, monitor weight, dietary intake, elimination patterns, fluid intake. -Assess dentition, chewing & swallowing abilities, eating habits/nutrition 6. Renal -dehydration, volume overload, electrolyte imbalances (laboratory results) and daily weight. -Ask about urinary incontinence, Stress Incontinence, abnormal urine stream, pain (UTI), urinary retention with BPH (Benign prostatic hyperplasia, enlarged prostate), nocturnal or urgent voiding -Assess medication schedule, toileting schedule, fluid intake habits -Assess functionality, mobility, symmetry and strength, fine & gross motor skills, and balance 7. Mobility -Fall risk evaluation and intervention. Physical activities. -Assess for medications that may affect bone health and muscle functioning/performance -hand rails, steps 8. use descriptors... does it itch, burn, smell 9. can usually double or triple what patient claims as alcohol intake

prevention and screening

1. Noise control 2. Use of ear protection (OSHA) 3. Hearing screening 4. Immunizations 5. Goal: Decrease advancement in hearing loss

magnnesium

1. Normal serum Mg. levels 1.5 -2.5 ( mEq/L) 2. 50% to 60% contained in bone 3. Coenzyme in metabolism of protein and carbohydrates 4. Muscle contraction/relaxation, normal neurologic function, neurotransmitter release 5. GI system and kidneys regulate absorption and excretion 6. Functions in glucose control and BP regulation

calcium (Ca)

1. Normal serum calcium level 9.0-10.5mg/dl 2. Requires vitamin D to be absorbed -calcium supplement usually goes along with vitamin D supplement 3. Regulated by parathyroid hormone & calcitonin 4. Necessary for: -Transmission of nerve impulses and neuromuscular activity -Blood Clotting -Formation of teeth and bone -Myocardial and muscle contractions -functions as a sedative, but magnesium more so

phosphate

1. Normal serum phosphorus levels range from 2.5- 4.5 mg/dl 2. Essential to function of muscle, red blood cells, and nervous system 3. Deposited with calcium for bone and tooth structure 4. Involved in acid-base buffering system, ATP production, and cellular uptake of glucose. 5. Regulated by Parathyroid hormone; excreted by the kidneys 6. Found in dairy products

prevention of chronic illness

1. Preventive health behaviors are voluntary actions taken by an individual or group to decrease the potential threat of illness 2. Primary - protection to prevent occurrence of disease (proper diet, proper exercise, immunizations, communication, social interaction) 3. Secondary - action aimed at early detection to prevent disease progression, screenings (vision, hearing, breast exam, pap, colon cancer screening) 4. Tertiary - activities that limit disease progression such as rehabilitation, dietary/exercise modifications, support groups, medicare/medicaid, polypharmacy (use of multiple meds by a person with more than 1 health problem) -The Patient Self-Determination Act of 1991 mandates advance directives be available on admission to health care facilities.

kidneys (JG cells)

1. Primary organ for fluid and electrolyte balance 2. Sense low Na or low volume 3. Release of renin 4. Converts angiotensin to angiotensin I which converts to angiotensin II (active form) -increasing blood flow -retaining sodium and water -tightens arteries, increasing fluid volume and pulse 5. Stimulated aldosterone release 6. activation of system could cause fluid volume overload

genitourinary changes

1. Reduced bladder size, elasticity, muscle tone 2. Weakened urinary sphincter 3. Stress Incontinence 4. Decreased or delayed perception of voiding signal 5. Increased nocturnal urine production -due to hormonal changes -leads to lack of sleep -risk for falls 6. In males, benign prostatic hypertrophy -males tend to not talk about urine problems

Heart (ANP) regulation

1. Senses excess fluid volume via receptors in the right atria 2. Stimulates secretions of ANP, BNP 3. Suppresses RAAS, Inhibits ADH 4. Increases Na excretion 5. Dilates blood vessels 6. ANP: atrial natriuretic peptide 7. BNP: brain natriuretic peptide -checked for patients with fluid overload

communication

1. Speech Reading -Also called, Lip Reading -Helps with spoken word 2. Sign Language -uses gestures and facial features -It is not universal (ASL) 3. Assistive Learning Devices -text-telephone alerting system -Trained dogs 4. Speak normally and slowly directly into the patient's better ear. Do not exaggerate facial expressions. Do not overenunciate. Use simple sentences; rephrase sentences; use different words. Write out names or difficult words. Avoid shouting.

sighted guide technique

1. Stand slightly in front and to one side of the patient. Offer an elbow for the patient to hold. Serve as the guide, walking slightly ahead of the patient with the patient holding the back of your arm. -As you walk, describe the environment to help orient the patient.

electrolytes

1. Substances whose molecules split into ions when placed into water 2. Electrolytes move in and out of intracellular and extracellular fluid 3. Ions possess electrical charges: -Cations have a (+) charge -Anions have a (-) charge 4. Expressed as milliequivalents (mEq) 5. Fluids and electrolytes are CONSTANTLY in motion

normal assessment findings of eyes

1. Test Visual Acuity Distance Vision: Snellen Eye Chart (big E) Patient will stand or sit 20 feet from eye chart posted on wall -Test the uncovered eye by asking the patient to read the line of letters aloud -Identify which line was identified by patient completely & correctly. Record measurement. -Client tested with or without corrective lenses (glasses or contacts) -Patient should read without hesitation 20/30 measurement means that patient reads at 20 feet what a person with normal vision reads at 30 feet Test for near vision -Test 1 eye at a time as in Distance Vision -Have the patient read a Jaeger or Rosenbaum card at a distance of 14", normal distance for reading a book -Record the line that the client read completely 2. Inspection of External Eye Structures -Skin: intact and color the same as the face -Eyelashes evenly distributed -Upper eyelid covers part of iris, not pupil -Lower eyelid covers bottom edge of iris -Blinking at normal frequency of 20/min: Bilateral, Involuntary -Palpebral fissures equal bilaterally Asians have slanted palpebral fissure For African Americans more protrusion of eyeball is acceptable 3. Inspection of conjunctivae -Client is sitting; ask client to look upward -Wash hands then don non-sterile exam gloves -Hold skin below the lower lid down gently to expose the conjunctiva Repeat on opposite eye -Color: pink is normal -Moist mucosa -No lesions 4. inspection of Sclera: should be white and clear -patients with dark complexion may have darker shade -patients with light complexion may have a yellow tint 5. Iris -Round shape -Color: usually the same, different color in each eye in some individuals (genetic cause) 6. Cornea: aim penlight from lateral side -Cornea normally is clear and shiny -Corneal light reflex for symmetry Ask patient to stare ahead with both eyes open, Shine penlight at patient's bridge of nose, Reflection of light should be symmetric on both corneas 7. Pupils -Size in room light, assess size in mm (Normal is 2-6mm, Equal bilaterally) When inspecting the pupils of a patient with dark brown irises, the nurse can dim the overhead lighting to better visualize the pupillary reaction to light -Shape (round, equal bilaterally) -Reaction to light (shining a penlight from the lateral side, observe constriction of the pupil, Repeat for other eye) -Consensual reaction (tested at the same time as reaction to light. Light directed to 1 eye should cause a constriction in the opposite eye as well) -Accommodation (Pupils Dilate when focusing on a Distant object, Pupils Constrict when focusing on a Close object) Pupils Equal Round Reactive to Light (directly and consensually) Accommodation

abnormal assessment of eyes

1. Testing distance visual acuity with Snellen chart -Client leaning forward -Squinting -hesitancy -Acuity > 20/200: legally blind 2. Testing for near vision -Does the client need to hold card farther away than 14" to read it clearly? 3. Ptosis: Upper lid of eye covering part of the pupil 4. Exopthalmos: sclera visible above upper lid (hyperthyroidism) 5. Eyelids -Edema -Lesions -Nodules -Crusting and/or discharge (infection) 6. Conjunctivae -Redness -Congestion/ edema -Subconjunctival hemmorrhage: defined area of redness. 7. Sclerae -Yellowing indicates jaundice (liver impairment) 8. Assymetric corneal light reflex- indicates weakness in extraocular muscle 9. Nystagmus: involuntary movement of the eyeball -Horizontal -Veritical -Rotary -Mixed -Congenital or Acquired from trauma to brain 10. Pupils -Mydriasis: pupil size > 6mm that does not constrict further. Dilation of pupil. -Miosis: constriction of the pupil <2mm -Unequal pupil size may indicate: Trauma, Eye surgery, Congenital abnormalities -Reaction to light Slowed, Unequal bilaterally -Loss of accommodation 11. Cornea -Corneal arcus: white ring around corneal edge -Common in patients > age 60 -Sign of hyperlipidemia -Opacity of cornea 12. Iris -Missing piece of iris Check patient's history: may have had a surgical iridectomy done to correct glaucoma

middle ear

1. air space located in temporal bone 2. normally closed, opened with movement of jaw -yawning or swallowing 3. when eustachian tube remains open, referred to as patulous -person can hear one's own voice (autophony) 4. contains 3 smallest bones in body -malleus, incus, stapes (ossicles)

cataracts

1. an increasing cloudiness or opacity of the natural crystalline lens caused by oxidative damage to the lens solubility, usually as a result of aging. 2. Can affect one eye or both 3. Other contributing factors: -Trauma -Diabetes -UV light exposure -Certain drugs -Congenital factors (Rubella) -Leading cause of blindness in remote areas 4. think of onion...little tissue that starts to grow, gets bigger and bigger until it begins to cover whole eye -remove piece of flesh and patient can see again 5. caught early enough if seeing physician regularly 6. clinical manifestations -Onset is gradual -Headlights looks like starbursts -Difficulty reading street signs at night -Glare is bothersome -Progressive reading difficulty even with glasses -Painless progressive loss of vision that happens with aging 7. nonsurgical therapies -Adjust the pt. eyewear prescription -Increase the amount of lighting to read -Encourage pt. to adjust their lifestyle around visual changes -Stop nighttime driving -When palliative measures fail to work/Surgical therapy -Pt. becomes a good candidate for surgery -the longer you live the most likely everyone will develop cataracts 8. preoperative phase -History and Physical -Done as outpatient -Anti-inflammatory meds. given to reduce inflammation -Dilating drops given (Mydriatic) -Anticholinergic drugs given to produce paralysis -Antianxiety meds given before anesthesia -most times don't put patient completely asleep -Avoid activities such as: bending, coughing, stooping, lifting, no valsalva maneuver -reassure patient education... do they know what cataracts are, is it one eye or both eyes -make sure patient wears dark glasses after surgery to protect eye(s) 9. post-op care -Assess pain level -Instill eye drops -Apply dressing and eye patch/shield -Assess for s/s of infection -Assess the un-operated eye -Assist the pt. -not your job to take eye patch off... lift patch up, instill eye drops, put patch back in place -can add tape to patch, don't need order -look for drainage, inflammation 10. Signs of potential complications: -Nausea -Vomiting -Restlessness- may be related to Increased Intraocular Pressure due to a ruptured vessel -seldom pain... if patient complains of pain there is a problem 11. nursing management -Assessment: Un-operated eye Level of knowledge -Nursing Diagnosis: Self care deficits related to visual deficit -Planning: Well informed pt. Understanding post-op instructions Maintain level of comfort Free of infections -Implementation: Encourage pt. to maintain healthy lifestyle Provide information, support, and reassurance (minimal sedation) Include caregivers in the discharge planning Modify the home environment for safety issues -Evaluation: Pain free Improved vision (not right away) Can the pt. take care of themself?

external ear (pg. 360)

1. auricle (pinna), external auditory canal, tympanic membrane (TM) 2. 1/3 of canal contains fine hair (cilia), sebaceous (oil) glands, ceruminous (wax) glands -oil and wax lubricate canal, keep it free from debris, kill bacteria 2. distal 2/3 lined with epithelium over the bone -very sensitive 3. collects and trasmits sound wave to the TM (eardrum)

kidney studies

1. bun urea nitrogen 2. creatinine

polypharmacy

1. The administration of many drugs together and/or the administration of excessive medications 2. Older adults take longer to metabolize and excrete medications due to decreased renal and liver function 3. Lack of knowledge by patients and/or caregivers 4. Over prescription by providers 5. This can be life threatening 6. Assessment: -Medical diagnosis and self-diagnosis of health problems -Known drug allergies -History of previous adverse drug reactions -All prescribed medications taken -All OTC medications taken -All non-traditional meds taken -Length of time each medication has been taken -Actual amounts of each medication taken and how often -Reason for taking med and any adverse effects -Any problem taking med in its prescribed form 7. Common causes of medication errors in the older adult: -Poor eyesight -Forgetting to take medication -Use of non-prescription over the counter drugs -Use of medications prescribed to someone else -Lack of financial resources to obtain prescription drugs -Failure to understand instructions -Failure to understand importance of prescribed drugs -Refusal to take medications because of undesirable side effects 8. BEERS criteria -Identifies medications as potentially inappropriate for use in the older adult population. -There are medications that are either ineffective or pose unnecessary high risks for older person when safer alternatives are available. -Certain medications should not be used in older persons known to have specific medical conditions.

acid-base balance

1. The body's mechanism to balance acids (produced during metabolism) and the bases that neutralize and promote waste excretion 2. Problems such as diabetes, chronic obstructive pulmonary disease (COPD), kidney disease often result in imbalances 3. Imbalance is not a disease, but is a symptom of an underlying health problem 4. pH -Acid or Base -7.35-7.45 -alkaline >7.45 -acidic <7.35 5. CO2 -Carbon Dioxide (acidid) -managed by resp system -35-45 6. HCO3 -Bicarbonate (base) -helps to neutralize -managed by renal system -22-26

uncorrectable visual impairment

1. Total blindness -no usable vision and cannot see the light 2. Functional blindness -some light perception, no usable vision -This pt. is considered legally blind

assessment of nutritional status

1. What affects an older adult's nutritional status? -Sensory deficits -Diminished taste and smell -Loss of teeth, dysphagia -Sedentary lifestyle (little or no physical activity) and living alone -Social isolation, and depression -Functional limitations, transportation -Medications -Limited income -Chronic illnesses 2. Patient history including diet history 3. Physical exam including skin turgor, muscle wasting, hydration, dentition, chewing & swallowing 4. Anthropometric measurements (height, weight, body mass index, body fat and muscle mass measurement) 5. Laboratory Values (Albumin, CBC, serum folate, transferrin, pre albumin, vitamin B12, cholesterol) 6. Monitor weight, keep a diary with: dietary intake, fluid intake, elimination patterns 7. Refer to a dietition 8. Provide nutritious snacks (small frequent meals) 9. Provide conducive environment for meals 10. Ask about food preferences (not always the best indicator)

culturally competent care

1. When caring for a patient from another culture its important for the nurse to develop an understanding of his or her own culture and feelings. -making sure you address the needs of this patient at that given time -don't assume patient's beliefs, rather ask 2. Ethnogeriatrics - providing ethically competent care to older adults -assume that ethnicity and culture are important to older adults and their families unless they tell you otherwise during an assessment

warning signs of elder abuse

1. Withdrawal from normal activities 2. Frequent minor injuries, bruises, abrasions, welts, burns, pressure and slap marks 3. Bruises around breasts, genital areas, or unexplained sexually transmitted diseases 4. Sudden changes in finances and accounts, altered wills, trusts, or unusual bank withdrawals 5. Untreated bed sores, need for medical or dental care, unclean appearance, poor hygiene, weight loss.

ageism

1. a negative attitude based on age -Leads to discrimination and disparities in care 2. The nurse may have expectations, and fears about growing older -Ageism often leads to poorer health care for older individuals.

fluid volume deficit

1. abnormal loss of body fluids, inadequate fluid intake, plasma or interstitial fluid shift 2. due to -Diarrhea/vomiting -Wound drainage -Hemorrhage (escape of blood from a ruptured blood vessel) -Fever with diaphoresis -Inadequate fluid intake -Overuse of diuretics -Third-spacing of fluid -Diabetes Insipidus (putting out as much as taking in) 2. dehydration: loss of pure water without corresponding loss of Na 3. treatment -replace water and electrolytes with Ringer's lactate solution -must identify underlying cause -Monitor vital signs -Monitor strict intake and output -Monitor laboratory results -Monitor daily weight 4. clinical manifestations -Thirst, dry mucous membranes -Poor skin turgor, cool and clammy -Postural Hypotension -Decreased urinary output -Increased respiratory and heart rates -Weakness, dizziness -Weight loss -Restless, drowsy, confusion -Seizures, coma 5. laboratory data -Urine specific gravity >1.025 indicated concentrated urine -Increased hematocrit -BUN elevated -Serum Sodium elevated -Serum Potassium elevated -increased lab values due to fluid being more concentrated -falsely high or actually high

conductive hearing loss

1. conditions that impair the transmission of sounds into inner ear -cerumen -Otosclerosis: hereditary autosomal dominant disease. most common cause of hearing loss in young adults. good hearing by bone conduction (vibrations), but poor hearing by air conduction -hear better in noisy environment - speaks softly because hearing his or her own voice (which is conducted by bone) seems loud 2. obstruction from cerumen -in older person cerumen becomes dense and dries, hair in the ear becomes thicker and coarser -Cilia entraps the cerumen -Causing discomfort and decreased hearing -do not attempt to remove -symptoms include hearing loss, otalgia, tinnitus, vertigo 3. infection -external otitis: inflammation or infection of epithelium of the auricle and ear canal, ear pain is first sign (swimming, or shower) -picking the ear -bacteria or fungi -Ear pain, Some drainage or none, may have fever 4. trauma -ruptured ear drum -due to cleaning ears, infection, laceration

gerontologic considerations

1. decrease in renal blood flow, loss of ability to concentrate urine and conserve water 2. loss of sub q tissue and thinning of dermis lead to increased moisture lost through skin and inability to respond quickly to heat or cold 3. Hormonal changes lead to decrease in ADH and ANP. 4. Reduced thirst mechanism results in decreased fluid intake

Hypophosphatemia

1. decreased absorption, increased excretion or ECF to ICF fluid shifts 2. Cellular function (ATP) impairment and decreased O2 delivery 3. Mild- moderate asymptomatic with sudden onset of symptoms when severe. 4. Severe- often fatal due to cellular function (CNS depression, resp./heart failure)

neurological problems

1. dementia -Permanent loss or decline in memory and other cognitive abilities -Caused by various diseases that result in damaged brain cells -Can affect mood, personality, and abilities 2. delirium -due to changes in environment, new meds -Sudden, fluctuating, usually reversible cognitive disorder -Early diagnosis is critical -Detection can be difficult -Urinary tract infection are the most common cause

fluid spacing

1. distribution of body water 2. first spacing: normal distribution 3. second spacing: abnormal accumulation of interstitial fluid -edema 4. third spacing: excess fluid collects in the nonfunctional area between cells -ascites: fluid leaking into abdominal cavity -edema associated with burns 5. when patient has fluid issues; find out what is normal for them -patient usually has edema, but today can't get shoes on -"is this swelling normal for you; more or less?" -equal bilaterally, could be swelling due to injury/condition

nursing interventions for blind patient

1. don't talk louder and slower 2. always introduce self from distance, tell patient what you are doing exactly, tell patient when leaving 3. dont know patient's level of independence 4. explain food like clock, no garnish 5. recommend sign behind bed, saying patient is visually blind 6. good to acknowledge patient feelings 7. Intermediate Union helps blind students

hypocalcemia

1. due to removal or injury of parathyroid glands (surgery/radiation); sudden rise in pH (alkalosis) 2. Acts as a stimulant to muscles and nerves (spastic, hyper reflexive, seizures). Tetany (intermittent muscular spasms), Trousseaus sign 3. Treatment depending on severity/cause. -Mild: increase dietary intake -severe: IV calcium gluconate or restoration of pH balance 4. Chvostek sign: a clinical sign of existing nerve hyperexcitability (tetany) seen in hypocalcemia. It refers to an abnormal reaction to the stimulation of the facial nerve. 5. Trousseau's sign: An indication of latent tetany in which carpal spasm occurs when the upper arm is compressed, as by a blood pressure cuff.

fluid volume excess (over hydration)

1. excess intake of fluids, abnormal or retention of fluids (heart/renal failure) -weight gain 2. treatment -diuretics and fluid restriction -sometimes also need Na restrictions -Monitor strict intake and output -Daily Weights -Monitor vital signs -Assess for edema -Auscultate lung fields -Monitor laboratory results -Assess for neurologic changes 3. due to -Excessive administration of isotonic/hypotonic fluids -Heart failure -Renal failure -Cirrhosis -Syndrome of inappropriate anti-diuretic hormone (SIADH) -Cushings Syndrome (too much cortisol) -Long-term steroid use 4. clincal manifestations -Weight gain -Headache -Peripheral edema (dependent areas) -Bounding pulse, S3 heart sound -hypertension -Dyspnea, crackles, cough, pulmonary edema (excess fluid in lungs) -Jugular vein distention (JVD) -Muscle spasms -later signs of Confusion, lethargy, Seizures, coma 5. laboratory data -Urine specific gravity <1.010 indicated dilute urine -Decreased hematocrit -BUN decreased -Serum Sodium decreased -Serum Potassium decreased (diuretic use) hypokalemia -Serum Potassium increased (potassium sparing diuretics) hyperkalemia

hypernatremia

1. excessive Na+ intake, excessive water loss, inadequate water intake 2. S/S: Extreme thirst, dry mouth, hot/dry/flushed skin, weight loss, generalized weakness, muscle cramps, agitation, seizures, lethargy 3. Nursing Management: -If water deficit replace with oral or 0.9% NS -If Na+ excess, dilute serum with sodium free IVF. Reduce dietary sodium intake. -Monitor serum Na+ level, strict I/O, dietary sodium restriction 4. very sensitive to small changes -significant changes in sodium leads to significant changes in water balance -IV sodium must be done at a slow rate

hyponatremia

1. excessive Na+ loss, inadequate Na+ intake, excessive water intake, inadequate absorption -some patients live at higher/lower level with certain lab values 2. S/S: Irritable, dizziness, headache, confusion, fatigue, muscle weakness, dry mucous membranes, cool, clammy skin. 3. Nursing management: -If related to excessive loss, replace fluids with sodium containing fluids. -If related to fluid excess, fluid restriction (500mL < last 24-hour urine output), loop diuretics -Monitor serum Na+ levels, strict I/O, fluid restriction

external eye structures (pg. 351, 353, 354)

1. eyebrows 2. eyelids -blinking of the upper eyelid distributes tears over anterior surface of eyeball and nourishes surface cells -eyelids open by action of CN III and close by CN VII 3. lacrimal system -Lacrimal gland: in lateral upper lids, provides tears -Lacrimal puncta and sac: on medial aspect of both lids; drains tears from eye into nasolacrimal duct -Tears flow from upper, lateral aspect of the eye across to the lacrimal ducts on the medial eye -postmenopausal patients tend to have dry lacrimal glands 4. conjunctiva -lining of the sclera and eyelids 5. cornea -covers the pupil and iris -is transparent -rich sensory nerve supply -avascular (no vessels) 6. sclera -white of eye 7. extraocular muscles 8. Palpebral fissure: opening between eyelids -distance between the upper and lower lids on the medial or innermost part

blood chemistry

1. glucose -60-110 mg/dL -energy source for the body; a steady supply must be available for use, and a relatively constant level of glucose must be maintained in the blood. 2. calcium -8.5-10.5 mg/dL -one of the most important minerals in the body; it is essential for the proper functioning of muscles, nerves, and the heart and is required in blood clotting and in the formation of bones. 3. sodium -135-145 mEq/L -vital to normal body processes, including nerve and muscle function 4. potassium -3.5-4.5 mEq/L -vital to cell metabolism and muscle function 5. carbon dioxide -35-45 - helps to maintain the body's acid-base balance (pH) 6. chloride -95-105 mEq/L -helps to regulate the amount of fluid in the body and maintain the acid-base balance 7. bun urea nitrogen (bun) -10-20 mg/dL -waste product filtered out of the blood by the kidneys; conditions that affect the kidney have the potential to affect the amount of urea in the blood. 8. creatinine -females: 0.5-1.1 mg/dL -waste product produced in the muscles; it is filtered out of the blood by the kidneys so blood levels are a good indication of how well the kidneys are working. -males: 0.6-1.3 mg/dL

prebycusis

1. hearing loss due to aging 2. can be a result of noise exposure, systemic diseases, poor nutrition, ototoxic drugs, pollution exposure over life span 3. accumulation of dry cerumen in external canal 4. tinnitus: ringing in the ears

Hyperkalemia

1. impaired renal excretion, excessive shift from ICF to ECF -not often r/t increased intake, usually due to kidneys not being able to get rid of excess potassium 2. S/S: Fatigue, irritability, muscles weakness/cramps, paresthesia/decreased reflexes, abdominal cramping/d/v, irregular heart rate, arrhythmias, EKG changes. 3. Nursing Management: -Eliminate intake of potassium (as much as possible) -Increase potassium elimination: Renal (loop/thiazide diuretics, dialysis). -GI: -Administer Kayexalate -Monitor serum K+ level, strict monitoring of cardiac function, dietary potassium restriction

sensorineural hearing loss

1. impairment of function of the inner ear -noise -trauma over time -systemic infections 2. ototoxic substances -Salicylates (ASA) (aspirin) -Loop diuretics (Furosemide, Bumetanide) -Chemotherapeutic drugs -Industrial chemicals -Tinnitus and Disequilibrium 3. BPPV -benign paroxysmal positional vertigo -free-floating debris in the semi-circular canal causes vertigo with specific head movement -rolling over in bed -changing position (from lying to sitting) -Nystagmus, Lightheadedness, vertigo 4. presbycusis -Decline in word recognition ability (vowels heard better than some consonants) -Pt. may experience confusion and embarrasment

Hypomagnesemia

1. insufficient intake increased gastric/renal losses; prolonged parenteral nutrition. 2. Clinically mimics hypocalcemia (muscle cramps, hyper-reflexive muscles), cardiac dysrhythmias (Torsades de pointes) 3. Treatment depends on cause. -Increase supplements/dietary intake/IV replacement.

composition of body fluids

1. intracellular -2/3 of body fluid -Located within the cells of the body 2. extracellular -1/3 of body fluid -Intravascular (blood plasma; blood vessels) directly influenced by intake or elimination of fluid in the body. -Interstitial: outside the blood vessels between the cells -Transcellular: lymph, cerebrospinal fluid, peritoneal, abdominal 3. solutes: solid particles -solvent: liquid in which a solute is dissolved to form a solution -ex. sugar, potassium, etc. is the solute, plasma is the solvent, solution is blood 4. electrolytes

internal eye structures

1. iris -is a muscular membrane responsible for constriction and dilation -colored part of eye 2. lens -biconvex structure located behind iris -bends light rays allowing rays to fall onto retina 3. ciliary body -Allows the lens to change shape; near and far vision -Maintains intraoccular pressure 4. retina -light reflected from an object in the field of vision passes through the transparent structures of the eye and is refracted (bent) so that a clear image can fall on the retina -is an extension of the CNS -Contains photoreceptor cells -Macula is densely packed with rods -innermost layer of the eye that extends and forms optic nerve 5. pupil -allows light into eye to retina -constricts and dilates to control amount of light that enters the eye -worry if there is no pupillary response, or if dilated/fixed, NOT if it is simply a slower response

subjective data of auditory system

1. many problems related to ear may result from childhood illnesses or problems of adjacent organs -a careful assessment of past health problems is important -some congenital hearing loss is hereditary 2. amount and frequency of aspirin use are important because tinnitus can result from high aspirin intake 3. note onset of hearing loss -sudden or gradual -who noted onset 4. ear pain: otalgia -assessment of clenching or grinding of the teeth helps differentiate problems of the ear from referred pain of the TMJ 5. review of patient's activity exercise pattern is essential when assessing for equilibrium problems 6. find out if patient has tried any techniques to modify tinnitus -having fan on, using white noise devices 7. if pain is present, ask patient to describe pain 8. presence of drainage (otorrhea) 9. history of teeth grinding 10. treatments used for relief -home remedies such as hot oil in the ear 11. note patient's ability to pay attention and follow directions -problems with these tasks may be an early indicator of hearing loss 12. denial is a common response to a hearing problem

osmolality

1. measures concentration of fluids (plasma, urine) 2. Increase (becomes more concentrated, as in dehydration) -stimulation of the posterior pituitary increases thirst and secretes ADH. -ADH works on the distal tubules and collecting ducts of the kidney to reabsorb more water and less urine is produced 3. Decrease (less concentrations in over hydration) -the pituitary stops producing as much ADH. -ex. mixing koolaid into water: the more water, the less concentrated

legal and ethical issues

1. medicare -Federally funded health care for individuals over the age of 65 years old -Those under 65 year old who are disabled -Drug coverage can be added -Part A covers skilled care & hospitalization -Part B covers outpatient care, PCP and home health. -part C must pay premium -part D prescription coverage -doesn't cover long term care, dental, hearing aids, glasses 2. medicaid -Low income -Financial aid for health care coverage (state-based) -Eligibility is based on income -Covers long-term care and home health care. 3. insurance doesn't pay coverage within 30 day readmission 4. Legal concerns regarding advanced directives (will), estate planning, taxation issues, and appeal for denied services are often a concern for the older adult. 4. Legal aid is available to low income older adults: Title III of the Older Americans Act -The Patient Self-Determination Act of 1991 mandates advance directives be available on admission to health care facilities. -older adults are denied service because of their lack of ability to pay

active transport

1. molecules move against concentration gradient -energy required from ATP

trauma

1. most common ocular injuries occur in the home due to gardening, power tool use, home repair work 2. morgan lens may be used to provide continuous irrigation of an injured eye 3. enucleation: removal of the eye -primary indication for blind, painful eye -results from glaucoma, infection, or trauma

diffusion

1. movement of molecules from an area of high concentration to low concentration 2. net movement stops when concentration is equal in both areas 3. simple diffusion requires no external energy 4. facilitated diffusion involves use of protein carrier in the cell membrane from an area of high to low concentration -requires no energy

osmosis

1. movement of water down a concentration gradient across semipermeable membrane 2. higher concentration=greater osmotic pressure 2. requires no outside energy

interpreting acid base

1. pH - normal, high (basic/alkaline) or low (acidic) 2. CO2- direction -Opposite of pH = respiratory problem 3. HCO3 direction -Same as pH = metabolic problem

respiratory alkalosis

1. panic/anxiety attack, asthmatic patient -breathing too fast -Hyperventilating -removing too much CO2 2. must slow breathing down -sedation -may cause him/herself to pass out -intubate 3. Example -pH 7.64 alkalotic -PaCO2 27 mmHg opposite, decreasing -HCO3 24 mEq/L normal

coagulation studies

1. platelets (thrombocytes) -150,000-450,000 -involved in clotting 2. prothrombin time (PT) -11-13 seconds -how long it takes blood to clot 3. international normalized ratio (INR) (based on the ratio of the patient's prothrombin time and the normal mean prothrombin time) -0.8-1.1 not on coagulant therapy -2.0-3.0 prophylaxis or treatment of venoud thrombosis -3.0-4.0 prosthetic cardiac valve replacement 4. activated partial thromboplastin time (APTT) -30-40 seconds 5. fibrinogen -200-400

objective data of auditory system

1. posturing of the head and appropriateness of responses -does patient ask certain words to be repeated -does patient intently watch examiner but miss comments when not looking at examiner -is patient lip reading?

inner ear

1. receptor organ for hearing is the cochlea, which is a coiled structure 2. functions in hearing and balance 3. vertigo: sense that the person or objects around the person are moving or spinning and is usually stimulated by movement of head -may be accused of acting intoxicated 4. dizziness is a sensation of being off-balance that occurs when standing or walking 5. nystagmus is an abnormal eye movement that may be observed as a twitching of the eyeball -described as blurring of vision with head or eye movement 6. try to categorize symptoms related to balance and separate them from symptoms related to hearing loss or tinnitus

complete blood count

1. red blood cells (erythrocytes) -male: 4.7-6.1 -female: 4.2-5.4 2. hemoglobin (oxygen transporter) -male: 14-17 -female: 12-16 3. hematocrit (% of RBCs in whole blood) -male: 41-51 -female: 36-47 4. white blood cell count (leukocytes) -5,000-10,000

correctable refractive errors

1. refraction is the ability of the eye to bend light rays so that they fall on the retina -when light does not focus properly it is called a refractive error 2. myopia: nearsightedness 3. hyperopia: farsightedness 4. astigmatism -uneven curvature of cornea -results in visual distortion 5. presbyopia -loss of accommodation -inability to focus on near objects -due to lens becoming inflexible 6. nonsurgical corrections -glasses -contact lenses

renin-angiotensin-aldosterone system

1. regulates blood pressure and body fluids through vasoconstriction and excretion or reabsorption of sodium.

metabolic alkalosis

1. retaining too much bicarb, due to excreting too much acid -vomiting, diarrhea, NG tube (getting rid of too much acid too quickly) -upper GI loss (vomiting, GI suctioning) 2. example -pH 7.48 alkalotic -PaCO2 51 mmHg same, increasing -HCO3 35 mEq/L increasing

antidiuretic hormone (ADH)

1. secreted through the pituitary gland maintains serum osmolality by controlling the amount of water excreted in the urine -makes kidneys and renal tubules more permeable to water, increasing water reabsorption and decreasing excretion

gastrointestinal regulation

1. secrets 8000 mL each day, reabsorbing most -small amount eliminated in feces -diarrhea and vomiting prevent GI reabsorption, potentially leading to significant fluid and electrolyte loss

assessment of skin turgor

1. should take 20-30 seconds to return back to normal at very most

integumentary changes

1. skin -Less elasticity, wrinkles -Loss extremity fat; thin skin -Dry, fragile skin, pruritus (severe itching) -Increased lesions, skin cancer (50% of older adults) -older adults not raised to put on sunscreen 2. Hair -Hair Loss -Hair becomes sparse and gray -Decreased hair on arms and legs 3. Nails -Nails grow slower -Become thicker with ridges 4. feet -years of use -disease, poor circulation -ill-fitting shoes due to only having a few pairs of shoes over long period of time -bunions, corns, dry skin, fungus, spurs, hammertoes -fungus due to lack of reach -esp. diabetics

homeostasis

1. state of equilibrium in the internal body 2. How the body maintains fluids which are in constant motion transporting nutrients, electrolytes, and oxygen to cells and carrying waste products away from cells. 3. Naturally maintained by adaptive responses

aging

1. the process of growing old of maturing 2. In the older adult successful aging means different things to different people -Number of years one lives -Years that one lives independently, positively adapting and participating in activities and socializing with friends and loved ones -Financially secure, having basic needs met, feeling useful, having opportunities -Respect, joy and happiness

lipid profile

1. total cholesterol (mg/dL) -<200 2. HDL (mg/dL) -good cholesterol -males >45 -females >55 3. LDL (mg/dL) - <130 -borderline high: 130-150 -high risk: >159 4. triglycerides (mg/dL) - <150 desirable

Hypermagnesemia

1. typically only increased intake (nuts, spinach, bananas), combined w/ renal trouble. -relaxes muscles (including heart, diaphragm) -small changes in magnesium level can result in huge difference 2. Muscle weakness, diminished reflexes, vomiting, lethargy. Can lead to respiratory arrest. 3. Decrease intake and increase fluids. -Possible diuretics and dialysis.

sensory changes

1. visual changes -Decreased color and depth perception -Decreased pupillary response and ability to adjust to night vision -Floaters, cataracts, glaucoma -Presbyopia: loss of focus and accommodation -Conjunctivitis; Dry eyes -Age-related macular degeneration 2. auditory changes -1/3 of adults over 60 have decrease hearing acuity. -Impacts socialization, relationships, cognitive impairment -common problems include conductive hearing loss and tinnitus (ringing in ears) -excess wax build up 3. sensory deficits can have effect on -Communication -Perceptions -Behaviors -Moods -Mobility -Personality 4. sensory deficits can cause -Falls -Injury -Disorientation -Social Isolation

young-old adult

65 to 74 years of age

old old adult

85 years of age and older

overall assessment tool

S = Sleep disorders P = Problems with eating or feeding I = Incontinence C = Confusion E = Evidence of falls S = skin breakdown

the older adult

those 65 years of age and older