Acute Care Exam 1: Common Problems in the Older Adult Exam 47 Questions with Verified Answers
What is gerontology? - CORRECT ANSWER Study of all
... [Show More] aspects of aging and its consequences
What is ageism? - CORRECT ANSWER When older adults are stereotyped
Dependence
Frailty
Poor
Always lonely
Memory loss
Cannot drive
What is gerontologic nursing? - CORRECT ANSWER Specialized nursing with knowledge of illness and health of the aging
Starts at age 65
What is young old? - CORRECT ANSWER 65-74 yo
What is middle old? - CORRECT ANSWER 75-84 yo
What is old old? - CORRECT ANSWER 85-99 yo→ Growing the fastest
What is elite old? - CORRECT ANSWER 100+ yo
What are the most common health conditions? - CORRECT ANSWER Diabetes
HTN
Heart disease
Cancer
What diseases cause the most mortality? - CORRECT ANSWER Heart disease
Cancer
Stroke
Chronic lower respiratory disorders (COPD)
Alzheimer's
What can be done to improve cognition and QOL? - CORRECT ANSWER Socializing
Maintain and manage chronic conditions
Maintain healthy weight (eliminate salt and fat)
Engage in physical activity
What occurs to the body as it ages? - CORRECT ANSWER Decreased adaptability
Many physiologic changes (body systems impacted)
Impaired stress response (can worsen at hospitals)
Greater risk for functional decline (ADLs)
Critical care nurses must consider all physiologic and psychologic factors to provide the best care
What is involved in adjusting to changes of aging? - CORRECT ANSWER Ageism
Transitions
Rest more
Curtail driving
Cane/walker for mobility
Diet/nutritional changes→ More fiber, dentition, finances
What are health promoting behaviors? - CORRECT ANSWER Vaccinations
Influenza
Pneumococcal
Tetanus (booster every 10 yr)
Shingles shot
Seat belts
Moderate alcohol or not at all
No smoking (no smoking in bed)
Smoke detectors/sprinklers in home
Sun exposure for 10-15 mins 2-3x/week or vitamin supplement
Herbs, supplements (as prescribed)
Herb and drug effects
Vitamin D and calcium
Hazard-free environment→ No scatter rugs, waxed floors
Stress management
What is malnutrition? - CORRECT ANSWER Diminished sense of taste, smell (may be adding a lot of salt and sugar→ educate)
Inappropriate/unbalanced foods → educate
Ex: Lots of desserts/sweets → tooth decay, obesity
Tooth decay, tooth loss, poorly fitting dentures
Reduced income
Chronic disease, fatigue
Decreased ability to perform ADLs
"Fast food" consumption that leads to obesity (convenient, no prep, cheaper)
Trouble carrying heavy groceries
Food banks
Food stamps
Loneliness
Decreased hydration (vomiting, diarrhea, dry mucous membranes, dark urine)
What is Geriatric Failure to Thrive (GFTT)? - CORRECT ANSWER Undernutrition
Impaired physical functioning
Depression
Cognitive impairment
What are benefits to regular exercise? - CORRECT ANSWER Prevents cardiac disease and DM
Improves sleep
Maintenance of weight
Fewer depression symptoms
Improved longevity
What is the goal for homebound pt who has decreased mobility? - CORRECT ANSWER Goal is to do ADLs
What is the goal for non-homebound pt who has decreased mobility? - CORRECT ANSWER Encourage activity (walking)
What can cause stress and loss? - CORRECT ANSWER Rapid environmental changes
Changes in lifestyle
Acute or chronic illness
Loss of significant other
Financial hardship (cannot pay for groceries, health maintenance)
Relocation
What can cause accidents? - CORRECT ANSWER Common in older adults
Falls most common
Motor vehicle crashes increase with aging, chronic disease (Alzheimer's or arthritis)
What is the assessment for fall risk? - CORRECT ANSWER Observation (gait, footwear, assistive devices)
PMHx (fall hx, neuropathy)
Fall Risk
Get Up and Go Test
What can cause a pt to become a fall risk? - CORRECT ANSWER Generalized weakness
Drug assessment (pain meds, diuretics)
Urinary incontinence
Communication/visual impairment (are they using assistive devices? are they updating them as needed?)
Alcohol/substance abuse
Hazard free environment
How do you improve driving safety? - CORRECT ANSWER Assess any physical/mental deficits
Consult with provider to treat health problems
Wear glasses/hearing aids
Encourage driving refresher classes
Avoid high-risk locations and conditions
What cause drug use/misuse? - CORRECT ANSWER Polymedicine or polypharmacy (use of multiple drugs)
Intolerance to standard drug dosages
Drugs prescribed for too long period of time
Physiologic changes affect absorption, distribution, metabolism, excretion
"Start low and go slow" policy
Drug-drug, drug-food interactions
What are the effects of drugs? - CORRECT ANSWER Often intolerant of standard doses
Age-related changes:
Affect absorption (decreased GI motility)
Affect distribution (decreased body water)
Affect metabolism→ Reduce liver blood flow and serum enzyme activity
Affect excretion (decreased GFR, kidney function)
Changes in kidneys result in high plasma drug concentrations→ Creatinine Clearance Test
What can cause issues with self-administration of drugs? - CORRECT ANSWER Poor communication with physician
Take OTC drugs that interact with prescribed drugs
Make errors→ Forget to take (use pill box, alarm)
Discontinue drug therapy
Fear of dependency/cost
Side effects
Use leftover drugs from previous illness
Borrow from others
What drugs are included in Beers criteria? - CORRECT ANSWER Meperidine (Demerol)
Cyclobenzaprine (Flexeril)
Digoxin (Lanoxin) (Should not exceed 0.125 mg daily except for atrial fibrillation)
Ticlopidine (Ticlid)
Fluoxetine (Prozac)
Amitriptyline (Elavil)
Diazepam (Valium)
Promethazine (Phenergan)
Ketorolac (Toradol)
Short-acting nifedipine (e.g., Procardia)
Ferrous sulfate (Iron) (Should not exceed 325 mg daily)
Chlorpropamide (Diabinese)
Diphenhydramine (Benadryl)
What can cause safe use of meds? - CORRECT ANSWER Know the name, amount, type, frequency, purpose, and side effects of prescription/non-prescription meds
Bring all meds to every MD visit
Use a single pharmacy
Assess client's ability to self-administer (vision, judgment, memory etc.)
Simplify regimen as much as possible
What is legal competence? - CORRECT ANSWER 18 yr or older
Pregnant or married minor
Legally emancipated
Not declared incompetent by a court of law
What is clinical competence? - CORRECT ANSWER Person is legally competent; can make clinical decisions
What is depression? - CORRECT ANSWER Mood disorder having cognitive, affective, physical manifestations
Primary: Lack of neurotransmitters
Secondary or situational: Illness or loss
Depression, delirium, dementia
Increased risk of suicide
May lead to alcohol and drug abuse
Risk for physical illness
Sleeping more, not eating
Geriatric Depression Scale used for assessment (GDS-SF)
Primary treatment includes drug therapy (SSRIs are drug of choice→ 2-3 weeks before they work), psychotherapy
What is alcohol use/abuse? - CORRECT ANSWER Increase risk for falls, other accidents
Affects mood, cognitive ability→ Isolation, depression, delirium can result
Lead to complications of chronic diseases→ DM, HTN, GERD
Recommend no more than 1 drink/day for people over 65
What is the CAGE test for alcohol abuse? - CORRECT ANSWER Cut down--Have you ever tried to cut down on drinking?
Annoying--Have people annoyed you about stopping drinking?
Guilt--Have you ever felt guilty about drinking?
Eye opener--Have you had a drink this morning?
What is neglect? - CORRECT ANSWER Failure to provide basic needs
Pressure ulcers
Contractures
Dehydration
Malnutrition
Urine burns
Excessive body odor
What is emotional abuse? - CORRECT ANSWER Intimidation, humiliation
What is financial abuse? - CORRECT ANSWER Unauthorized use of pts money whether for profit or gain
What is physical/sexual abuse? - CORRECT ANSWER Hitting, biting, burns, restraining, molesting, unusual hair loss, sedating
What is SPICES? - CORRECT ANSWER Focus on the special health care issues seen in the older population
Six conditions that lead to:
Longer hospital stays
Higher medical cost
Death
Sleep disorders
Problems with eating/feeding
Incontinence
Confusion and falls
Skin breakdown
What are the causes sleep disorders? - CORRECT ANSWER Common in older hospitalized adults
Adequate rest is important for healing
Attempt to keep patients awake during the day to prevent insomnia
Identify contributing factors to insomnia (medication, caffeine)
Postpone tx if possible to waking hours
Environmental factors
Manage the patient's pain by giving pain medication before bedtime
What are problems with eating/feeding? - CORRECT ANSWER Perform nutritional screenings on the 1st day of pt admission (baseline)
Nutritional hx, wt, ht, and BMI, albumin, prealbumin
Collaborate with the RD about the patient's nutritional status
Consider cultural preferences and determine what foods the patient likes
Manage symptoms→ Pain and N/V
What causes incontinence? - CORRECT ANSWER Caused by many factors→ Acute or chronic disease, ADL ability, and available staff
Assess the pt to identify causes
Place the pt on a toileting schedule or a bowel or bladder training program
What can prevent confusion and falls? - CORRECT ANSWER Avoiding multiple drugs and promoting adequate sleep can help prevent acute confusion
Reorient pt to reality as much as needed
Most common accident among older patients in a hospital or NH setting is falling
Nocturia: Pts forget to ask for assistance and subsequently fall as a result of disorientation in the darkness in an unfamiliar environment
What are risk factors for falls? - CORRECT ANSWER History of falls
Advanced age (>80 years)
Multiple illnesses
Generalized weakness or decreased mobility
Gait and postural instability
Disorientation or confusion
Use of drugs that can cause increased confusion, mobility limitations, or orthostatic hypotension
Urinary incontinence
Communication impairments
Major visual impairment or visual impairment without correction
Alcohol or other substance abuse
Location of patient's room away from the nurses' station (in the hospital or nursing home)
Change of shift or mealtime (in the hospital or nursing home)
What causes skin breakdown? - CORRECT ANSWER Skin breakdown (esp. pressure ulcers) is a major problem among older adults in hospitals and nursing homes
Prevent agency-associated pressure ulcers by using evidence-based interventions
Turning, gentle touch
Skin tears are also common (especially the old-old group and those who are on chronic steroid therapy)
Use a gentle touch
Report any open areas
Use the Braden scale
Report and document
Nutrition support (albumin, prealbumin)
Skin protective creams
What are chemical restraints? - CORRECT ANSWER Antipsychotics
Antianxiety drugs
Antidepressants
Sedative-hypnotics
What is important to know for physical restraints? - CORRECT ANSWER Used when chemical restraints and restraint alternatives fail
Check pt q30-60mins
Release restraints q2hr for turning, toileting and repositioning
What are restraint alternatives? - CORRECT ANSWER If the patient is acutely confused, reorient him or her to reality as often as possible.
If the patient has dementia, use validation to reaffirm his or her feelings and concerns.
Check the patient often, at least every hour.
If the patient pulls tubes and lines, cover them with roller gauze or another protective device; be sure that IV insertion sites are visible for assessment.
Keep the patient busy, with an activity, pillow or apron, puzzle, or art project.
Provide soft, calming music.
Place the patient in an area where he or she can be supervised. (If the patient is agitated, do not place him or her in a noisy area.)
Turn off the television if the patient is agitated.
Ask a family member or friend to stay with the patient at night.
Help the patient to toilet every 2 to 3 hours, including during the night.
Be sure that the patient's needs for food, fluids, and comfort are met.
If agency policy allows, provide the patient with a pet visit.
Provide familiar objects or cherished items that the patient can touch.
Document the use of all alternative interventions.
If a restraint is applied, use the least restrictive device (e.g., mitts rather than wrist restraints, a roller belt rather than a vest). [Show Less]