Exam (elaborations) NR 601 Week 2 Quiz Review (NR601)
All questions will come from reading (Goroll, Kennedy), Lessons and Presentations – you should
... [Show More] have
received the PPTs
Week 1
Kennedy
Know the physical and physiological changes in the elderly
*Appendix A pgs 643-650*
3 Primary Points 1. Reduced physiological reserve of most body systems, especially cardiac,
respiratory, and renal. 2. Reduced homeostatic mechanisms that fail to adjust regulatory systems
such as temperature control and fluid and electrolyte imbalances. 3. Impaired immunological
function: risk for infection is higher and autoimmune diseases are more prevalent.
Never be complacent and assume the issue is only age related (pg 2-3)
How aging effects Lab values in elderly
**Appendix B pgs 651- 652**
Many factors influence lab results in the elderly, including physiologic changes with aging, the
prevalence of chronic disease, changes in nutritional and fluid intake, lifestyle and activities, and
medications being taken. Biochemical individuality is important in detecting asymptomatic
abnormalities in older adults. Significant homeostatic disturbances in the same individual may
be detected through serial lab tests, even though all individual test results may lie within normal
limits of the reference interval for the entire group. Lab work can be affected by inadequate
protein stores within the body, and the elderly loose these protein stores. The serum creatinine
levels may be WNL yet indicate renal impairment in pt’s with inadequate protein stores. The
calculation of the creatinine clearance, used to estimate renal function, is significant to the
provider.
Reduced renal function, especially the GFR, affects the clearance of many drugs, and CrCl
provides an index of renal function for use in choosing renally eliminated or nephrotoxic drugs
such as digoxin, H2 blockers, lithium, and water soluble antibiotics. (pg 3-4)
How disease presents in elderly
4 factors: 1. nonpresentation of illness – underreporting of s/s r/t erroneous association of aging
with disease, disuse, and disability. The elderly basically see these changes as inevitable so they
either do not go to the doctor or if they do, they do not challenge the doctor when they are told
it is age related. 2. multiple complaints – because of the prevalence of chronic disease in the
elderly population, they may present with multiple complaints. The provider should explore the
possibility of a constellation of symptoms and signs that when analyzed may represent more
than one condition/problem. After careful exploration, depression can also be considered given
depression can manifest atypically in older adults and somatic s/s are not uncommon. 3. An
altered pattern of illness – patterns of disease may be different in the elderly. For example,
jaundice in a younger pt indicates viral hepatitis but in the elderly may indicate a malignancy or
gallbladder disease. Another example is delusions and hallucinations in a younger pt can indicate
bipolar disorder but in the elderly can indicate dementia or medication side effects.
4. Atypical, nonspecific or vague symptoms – altered presentation is common in older adults.
Since s/s may be vague and nonspecific, even a modest change in functional level or behavior
should alert the provider to carefully explore the potential for treatable conditions. For example,
an elderly pt with a UTI may only present with confusion, or one with depression may not
present with a dysphonic mood but rather agitation and psychotic features.
What exercise would you give to elderly
Page 24 give a number of available resources to educate the patient as to what type of exercise
would benefit them the most.
Metabolism
Biotransformation occurs in all body tissues but primarily in the liver, where enzymatic activity
(cytochrome P [CYP] system) alters and detoxifies the drug and prepares it for excretion. As aging
occurs, the ability of the liver to metabolize drugs does not decline similarly for all
pharmacological agents.
Even though liver size and blood flow decline with age, routine liver function tests are typically
normal IF no disease exists. Decreased liver size and blood flow can result in decreased first-pass
metabolism; drug activity for some medications is prolonged because drugs are metabolized and
eliminated more slowly.
When prescribing, know age-related pharmacokinetics and understand whether the drug
inhibits or induces CYP enzymes. Conditions of increased or decreased liver perfusion alter the
overall level of the drug that is absorbed and how it metabolizes. (pg 5)
Ch 8
Respiratory- Know which diseases are reversible and those that are not – presentation
Reversible pneumonia, bronchitis
Nonreversible COPD, pulm fibrosis, cystic fibrosis, asthma
Cardiac- know what medication are used for CHF- common meds Kennedy (pg. 214)
ACE or ARB and a BB. Possibly: diuretics (loop diuretics) if pt has edema, Digoxin if needed
There is a general consensus that ACE’s, BB, diuretics, nitrates, and CCB are helpful in tx HF with
preserved LVEF. Concurrent tx with BB and non-dihydropyridine agents is contraindicated.
Remember nitrates can cause BLE edema.
Know what medications are used post MI ACE, ARB, BB
Know the ACC/AHA guidelines and Kennedy
Presentation
Know how to read arrhythmia? (I don’t recall seeing this)
COPD Kennedy pg 205
What diagnostic tests
Spirometry (GOLD standard & required to make the dx), CXR, CT chest, pulse ox, exercise testing,
ABG, Alpha-1 antitrypsin levels, lung volumes and diffusing capacity
Education
Smoking cessation, flu and pneum vaccines, exercise, healthy diet, take medicine as directed [Show Less]