NSG 6420 Final Exam Study Guide – 450 Question with Answers
1. Over 90% of patients in long term care are older than
65
2.
The young old
... [Show More]
65-74
3.
The middle old
75-84
4.
The old old
85-99
5.
The elite old
100 or older
6.
The fastest growing subgroup??
is the old old, sometimes referred to as the advanced older adult population
7.
Physical exam
yearly
8.
Breast cancer
- self exam every month
- woman >50 mammogram Q2yrs.
9.
Cervical Cancer
- Pelvic exam with PAP Q3yrs
10.
Prostate (50 and older)
- PSA test Q year, digital exam Q year
11.
testicular cancer
Self exam every month
12.
Colorectal cancer (men and women)
- fecal occult blood test Q year
- sigmoidoscopy Q3-5 years
- colonoscopy Q 3-5 years
13.
Skin Cancer
- clinical exam yearly
14.
oral cancer
- yearly with dental checkup
15.
Oral cancer
Cancerous growths on the lips, tongue or elsewhere in the mouth.
Sores do not heal and will metastasize if not removed
16.
Bone density
- every 2 years
17.
Vision
- every year
18.
Immunizations
- tetanus diptheria (every 10 years)
- FLU (every year)
- Pneumococcal PPV those who receive 1 dose before age 65 should receive another dose at age 65 or later if at least 5 years have elapsed
- zoster vaccine
19.
Genetic Theory
- holds that life span depends to a great extent on genetic factors
- genes within the organism control "genetic clock"
- genes determine metabolic rate and cell division
- wear and tear theory
20.
Immunity Theory
- focuses on the function of the immune system (composed of the bone marrow, thymus, spleen, and lymph nodes
- decrease in thymus gland
- decrease in T cells
- nutrition plays an important role so there is a focus in vitamin supplements
- increase in autoimmunity, infection, cancer
21.
Cross linkage theory
- is a chemical reaction that produces damage to DNA and cell death
- as one ages cross links accumulates, leading to essential molecules in the cell binding together and interfering with normal cell function
22.
free radical theory
- formed during cellular metabolism, are molecules with separated high energy electrons, which can have adverse effects on adjacent molecules
- accumulation of these free radicals causes cellular death
23.
KATZ
- Bathing: only help with a single part
- Ambulation:
- Toileting
- Transfers
- Eating
- Dressing
24.
Stages of Alzheimer's: Stage 1
- independent in ADLS
- Denies presents of symptoms
- Forgets names, misplaces household items
- short term memory loss, difficulty recalling new information
- subtle changes in behavior and personality
- mild cognitive impairment
- problems with judgement
- less engaged in social relationships
- decreased sense of smell
25.
Stages of Alzheimer's Stage 2
- impairment of all cognitive function
- unable to handle finances
- disorientation to time place and event
- possible depression and agitation
- increased dependence on ADLS
- visuospatial deficits
- difficulty driving, gets lost
- incontinent
- wandering, trouble sleeping
26.
Stages of Alzheimer's Stage 3
- bedridden
- totally dependent in ADLS
- loss of facial recognition (agnosia)
- motor and verbal skills lost
- general neurologic deficit
27.
what can happen to dentures with aging
- the fit can change if the older adult loses weight, dentures are expensive so the elderly might use the ill fitting dentures anyway or try and gum their food
28.
Older adults need an increased amount of what nutrients
- Calcium
- vitamin C,D,A
-
29.
Diminished senses can lead to what?
- diminished senses of taste and smell which can cause a loss of desire for food
30.
pre albumin
-15-36 gives you a marker for the last two days shows nutrition status more sensitive goes up 1mg/DL/day
31.
Albumin
3.5-5 protein for a couple weeks
32.
total lymphocyte count
- assess the immune function, malnutrition can suppress the immune system and make to pt more susceptible to infection
- when the pt is malnourished the TLC is <1500
33.
geriatric failure to thrive
- under nutrition
- impaired physical functioning
- depression
- cognitive impairment
- drug therapy
- chronic disease
- major losses
- poor socioeconomic status
**all things to consider when screening for GFTT
34.
maintaining appropriate levels of physical activity can decrease what?
- decreased risk for falls
- increased muscle strength
- increased mobility
- increased sleep
- reduced or maintained weight
- improved sense of well being and self esteem
- improved longevity
- reduces risks for diabetes, CAD, And dementia
35.
Relocation syndrome
is the physical and emotional distress that occurs after the person moves from one setting to another
S/S: sleep disturbances, GI distress, withdrawal, anger, anxiety, depression,
36.
Home modifications that can help prevent falls
- avoiding scatter rugs
- slippery floors
- avoid clutter
- installing grab bars
- using non slip bath mats
- raised toilet seats
- avoid going out on days when its raining and steps are wet
- concentrate on one activity at a time
37.
presbyopia
- farsightedness related to aging, so having frequent eye exams are important
38.
what are some things to be aware of with a decrease in the sense of touch
- decreases the awareness of body orientation
- decreased reaction time
- have problems driving
39.
what are some common drugs older adults take OTC
- analgesics
- antacids
- cold and cough preparations
- laxatives
- and herbal/nutritional supplements
40.
age related changes that can potentially affect absorption of drugs orally
- increase in gastric pH
- a decrease in gastric blood flow
- and decrease in gastric motility
- older adults do not have have major absorption difficulties because of age related changes alone
41.
Age related changes that affect drug distribution
- smaller amounts of total body water
- an increase ratio of adipose tissue to lean body mass *** can cause and increase build up of lipid soluble drugs, this leads to decreased concentration of drug in plasma but increased in tissue
- decreased albumin level
- decreased cardiac output
42.
older adult changes in drug metabolism
- decreased liver size
- decrease liver blood flow
- decrease in serum liver enzyme activity
- these changes can cause and increased plasma concentration of a drug
- monitor liver studies
- they need regular physical exams
43.
excretion of drugs as it related to aging
- usually involves the renal system
- decreased renal blood flow
- decreased GFR
- decreased creatinine clearance thus slower excretion time meaning serum drugs can become toxic
44.
normal creatinine clearance for men and women
men: 107-139
women: 87-107
- values decrease 6.5 for every decade of life after 20 YO
45.
Common adverse drug effects on the elderly
- edema
- severe N/V
- anorexia
- dehydration/acute confusion
- fatigue/weakness
- dizziness/syncope
- urinary retention/diarrhea
- constipation
- hypotension
46.
when preforming a medication assessment of an older adult what are some drugs the nurse should ask if the pt is taking
OTC's and Herbal therapies
47.
BEERS
- obtain a list of ALL medications taken on a regular basis
- highlight all medications that are part of the BEERS criteria
- collaborate with the older adult and family if changes are needed
- give verbal and written instructions
- promote adherence to drug regimen
encourage lifestyle changes to promote nonpharmacological interventions
- remind not to share or borrow drugs
48.
depression and the older adult
- is the most common mental health problem among older adults
- it increases in ocurance when the person is admitted to a nursing home/hospital
- white men ages 75-85 are most likely to commit suicide
- extreme and prolonged sadness, triggered by stressors
49.
what are some signs of depression the the older adult
- early morning insomnia
- excessive daytime sleeping
- poor appetite
- a lack of energy
- not social and unwilling to participate
-
50.
drugs for depression
SSRIS
51.
without TX what can depression result in
- worsening of medical conditions
- risk for physical illness
- alcoholism and drug abuse
- increased pain and disability
- delayed recovery from illness
- suicide
52.
dementia
- slowly progressive cognitive decline, aka chronic confusion
- Alzheimer's disease
- multi-infarct dementia (20-25%)
53.
dementia
a progressive and usually irreversible deterioration of cognitive and intellectual functions and memory without impairment in consciousness
Most common Alzheimer's
54.
delirium
- temporary state of confusion
- often seen in a setting that is unfamiliar
- types: hyperactive, hypoactive, mixed, and unclassified
55.
some of the factors that can cause delirium
- drug therapy
- electrolyte/nutritional imbalances
- infections
- fecal impaction
- surgery
- metabolic/neurologic problem
- hypoxia
- relocation syndrome
56.
how often should the older adult be in the sun
10-15 min 3-5x a week
57.
how much calcium should the older adult have
1000-1500 mg/day
58.
Baby boomers
- 1946-1966
59.
what are some psychosocial concerns for the older adult
- adjusting to physical and mental changes
- losing independence
- adjusting to income
- changes in roles
- cost of health care
- coping with loss
60.
functional aging
how old the person acts and behaves physically not their actual numeric age
61.
Normal physical changes of older adults: General status
- fragile balance
- vulnerable
- modified pace and need for rest periods while preforming ADLS
62.
Normal physical changes of older adults: integument
- wrinkling and sagging, dryness and scaling
- balding
- moles, skin may become pale, nails thicken and become brittle and yellow
63.
Normal physical changes of older adults: musculoskeletal
- less subcu tissue, and weight
- muscle mass and strength decrease
- bone deminerization, fractures more common
- joint stiffen and are less flexible, ROM decreases
- mobility slows, posture stoops, hight decreases
64.
Normal physical changes of older adults: neurologic
- delayed response
- reflex rate decreases
- temp regulation and pain/pressure perception becomes less efficient
- loss of sensation
- decreased spatial perception, balance
- less sleep at night causing them to nap
65.
Normal physical changes of older adults: cardiopulmonary
- blood vessels become less elastic
- peripheral pulses may not be felt
- CO decreases along with HR
- clearing of the lungs becomes less efficient, decreased RR/depth
66.
Normal physical changes of older adults: Genitourinary
- less blood flow to the kidneys
- less nephron function so waste is excreted more slowly
- the F/E balance is fragile
- bladder capacity decreases so voiding becomes more frequently, incontinence or residual is common
- BPH in men
- atrophy to the woman genital tract
67.
risk factors for alzheimer's
- Advanced Age
-ApoE
- Exposure to toxins metals, and herpes virus
- head injuries
- genetics
68.
Spices Framwork
- identifies six serious "marker condition" that can lead to longer hospital stays and higher medical costs and even death
S- sleep disorders
P- problems with eating in feeding
I- incontinence
C- confusion
E- evidence of falls
S- skin breakdown
69.
seborrheic keratosis
- scaly growths that look like they are stuck on this is normal and age related "barnacles of life"
70.
seborrheic dematitis
- an inflammatory skin condition that causes flaky, white to yellowish scales to form on oily areas such as the scalp and face this is common but abnormal
71.
cherry anginoma
will bleed if cut or torn, normal age related
72.
actinic lentigines
- age spots or liver spots
- small grey brownish,appear on the wrists hands and back and arms,
- they are caused by a accumulation of melanocytes due to the excess exposure to the sun
73.
actinic purpura
a common benign skin lesion that looks similar to bruising usually appearing on the wrists hands, back, and arms, caused by sun damage to the skin normal
74.
bruising
fragile capillaries make older adults susceptible to bruising(always assess) ecchymosis is more likely in pts taking ANTICOAGULANTS or CORTICOSTEROIDS not normal
75.
arcus senilis
fat deposits around the eye it is normal and should not be mistaken for cataracts
76.
blepharitis
- common can be caused by seborrheic dermatits or an infection is abnormal
77.
what are some interventions to promote sleep
- small carb snack:to increase serotonin
- firm mattress
- exercise during the day
- avoid caffeine before bed
- eat a light dinner
- bed room should only be used for sleeping and sex
78.
stress incontinence
- loss of urine related to intra-abdominal pressure
- most common type of incontinence
- coughing sneezing laughing
- more common in females
- may cause the older adult to become more reclusive
79.
urge incontinence
- involuntary loss of urine right after getting the urge
- unable to suppress the need to urinate
- person will involuntary urinate before getting to the toilet
80.
overflow incontinence
- over distention and overflow of the bladder
- signal to empty the bladder is underactive or absent
- bladder fills and dribbling occurs
81.
Mixed incontinence
- a mixture of two types of incontinence
82.
functional urinary incontinence
- leakage of urine caused by factors other than disease of the urinary tract
- due to environmental barriers, physical limitations, cognitive problems
83.
factors contributing to urinary incontinence
Drugs: CNS depressants (opioids), Diuretics, anticholinergics,
Disease: CVA, arthritis, depression, parkinsons syndrome
Inadequate resources: they might need assistive devices, products that help with incontinence may be too costly, they may need help from a caregiver
84.
Interventions for incontinence
1. behavior techniques: kegal's, electric stimulation, bladder training
2. catheterization
3. drugs: estrogen, anticholinergics, antispasmodics, tricyclic antidepressants
85.
describe some sleep changes in the older adult
- need 5-7 hrs of sleep
- decreased stage IV of sleep
- REM sleep is shortened
86.
things to be aware of when implementing pain interventions and the elderly
- avoid the use of Demerol, codine, indocine
- use non pharmacological measures
- Faces pain scale is a good indicator of pain
- Avoid IM injections
- recommended to use acetaminophen because it does not rely on renal function
87.
Iron deficiency anemai
Microcytic and hypochromic
88.
ACD
Normocytic and normochromic
89.
ACD
Hallmark is disregulation of iron homeostasis. Lab: ferritin level
90.
GINA Bill
protection of genetics
91.
Physiological changes of aging
Reduced physiological reserve, reduced homeostatic mechanisms, and impaired immunological function
92.
X-linked Dominant
Women will transmit mutation to 50% of all offspring
93.
Autosomal Recessive
Two gene mutations for offspring to have disease. One gene to be a carrier.
94.
Dysmorphology
Genetic and abnormal features such as Down's Syndrome.
95.
First Step for family genome assessment?
Family history
96.
Health History includes?
chief compliant, HPI, past medical hx, meds., habits, social hx, family hx, and ROS
97.
Biotransformation(metabolism)
CYP enzyme activity in the liver can induce and inhibit drugs.
98.
First symptoms of HIV?
fever, sore throat, and HA,
99.
Cardiovascular risk factors
HTN, smoking, obesity, physical inactivity, dyslipidemia, DM, microalbuminuria, age (>55 men, >65 women), family hx
100.
Blood sugar screening
Start at 45 years old and Q 3yr. if no risk
101.
S1
beginning of systole closure of mitral and tricuspid valve
102.
S2
closure of aorta and pulmonary valves
103.
S3
Ventricular overload and/or systolic dysfunction -may be normal in children and pregnancy. CHF or heart failure, early diastole, "ventricular gallop". Always abnormal if occurs after age 35 yo.
104.
S4
LVH, Poor diastolic function, found in poorly controlled HTN or recurrent myocardial ischemia. In healthy elderly pt. (normal), Also known as "atrial kick"- late diastole, atria has to squeeze harder to overcome resistance of a stiff left ventricle, best heard at Apex with Bell
105.
Posterior drawer test
Positive indicates PCL deficient knee
106.
Systolic Murmurs
benign or pathologic MR PASS wins MVP , Mitral regurg, aortic stenosis, mitral valve prolapse
107.
Diastolic Murmurs
• Mitral Stenosis
• Aortic regurg
108.
Murmur Red Flags
Murmur PLUS :
afib , syncope , heart failure , angina
109.
Signs of Aortic Stenosis
Systolic murmur.
Weakened pulse.
Left ventricular hypertrophy.
110.
mitral valve prolapse (MVP)
pathological condition that occurs when leaflets of mitral valve bulge into atrium and permit backflow of blood into atrium. Mid-Systolic CLICK
111.
Most common oral precancerous lesion?
leukoplakia
112.
• Frozen Shoulder (Adhesive Capsulitis)
o Contracted and thickened joint capsule w/ little synovial fluid
o Chronic inflammation w/ contracted inelastic rotator cuff muscles
o Generalized pain w/ motions (active and passive) resulting in resistance of movement
113.
MVP sxs
palpitations, lightheadedness, dypsnea, syncope, anxiety
114.
Moderate-intensity statin therapy
Atorvastatin 10-20 mg
Rosuvastatin 5-10 mg
Simvastatin 20-40 mg
Pravastatin 40-80 mg
Lovastatin 40-80 mg
Fluvastatin 80 mg
Pitavastatin 2-4 mg
115.
Moderate to high intensity statin therapy
Cardiovascular disease
LDL >190
Diabetes ages 40-70yo
Est. 10-year risk >7.5%, ages 40-75
116.
Most accurate diagnosis for pancreatitis?
Lipase
117.
When is Niacin used?
In combo with other meds for tx of triglycerides.
118.
Grave's disease
--autoimmune disorder- IgG Abs against thyroid TSH receptor = overproduction of thyroid hormones
--characterized by diffuse, toxic hyperplasia
--80% of all hyperthyroidism
--lab results: TSH up, FT4 up
--do thyroid antibody tests- positive for thyroid stimulating antibody
--see exothalamus (bulging eyes) in 25% of patients
--treated w/ meds, radioactive iodine, surgery
--common in N. America- affects 0.4% of population
--5:1 female to male ratio
119.
H. pylori gastritis: treatment
Triple therapy for 10-14 days:
1. PPI
2. amoxicillin
3. clarithromycin or metronidazol
120.
Anterior Drawer Test
ACL
121.
Presbycusis
high frequency hearing loss due to destruction of hair cells at the cochlear base (preserved low-frequency hearing at apex). Normal with aging.
122.
How often do you check PSA levels?
Every 2 years if <2.5 and every year if >2.5
123.
Tinea Capitis Treatment
• Topical therapy is ineffective
• Use micronized griseofluvin 20 to 25 mg/kg/day in divided doses with milk or food until clinically cured, generally 2 to 4 months
124.
Keratitis
-Cause by bacteria, viruses, fungi or parasites
-Increased risk of bacterial keratitis (BK) with extended wear contact lens
-gray infiltrates
Herpes keratitis: acute onset of pain, blurred vision in one eye, fernlike lines in the corneal surface
-Immediate refferal
125.
Bacterial conjunctivits
•usually bilateral
•conjunctivalinjection
•mucoPURULENTdischarge
•associated URI
•lid crusting (more crusty than w viral)
•resolves spontaneously within 1-2 weeks
•highly contagious
126.
Allergic conjunctivitis
Itchy, watery thin, clear discharge, hx of allergies
127.
Viral conjunctivitis
foreign body or gritty, mucoid discharge, palpable nodes
128.
Amaurosis fugax
**monocular, transient loss of vision from ischemia of the retina.
**Warning sign of impending stroke
Immediately referred
129.
Most common cause of eye redness?
conjunctivitis
130.
Warnings for eye redness
Pain, decreased vision, profuse discharge, corneal defect grossly visible
131.
clinical manifestations of UTI
10% asymptomatic
dysuria (difficulty urinating)
urinary frequency
suprapubic/ lower back discomfort related to bladder spasm
cloudy urine
leukocyte 3-4, nitrates
foul smelling urine
urgency
elderly = more non-specific
confusion, diffuse abdominal pain
132.
Isolated Systolic HTN in elderly
Caused by loss of recoil in the arteries (atherosclerosis), which increases PVR. Increased pulse pressure, >150/<90
133.
Screen for lipids
Men: age 35 years or older; age 20-35 if risk of heart dz
Women: age 45 years or older; age 20-45 years if risk of heart dz (HTN, family hx of , or stroke)
134.
Mitral Stenosis
Rheumatic fever
*Mitral valve thickened*
Rise in left atrial pressure to maintain normal cardiac output
Murmur
Asymptomatic: pregnancy, arrhythmia
Dyspnea and fatigue
Right sided heart failure
135.
Hypertensive reinopathy
copper and silver wire artioles
136.
Diabetic reinopathy
microaneurysms, cotton wool spots
137.
cerumen impaction
excessive buildup of wax in the ear that often reduces hearing acuity, especially in older persons
138.
Atopic disorders mediated by IgE with a histamine response. Histamine response is:
Bronchospasm, vascular permability, and vasocdilation
139.
CURB 65
C confusion
U BUN greater than 20 (dehydration)
R respirations greater than 30
B sbp <90 dbp < 60 (septic shock)
>65 yrs old
140.
Which findings are not considered normal age related?
dizziness, and problems with balance
141.
Common skin cancer found on the nose?
-tip of nose and nasopharyngeal area- Squamous Cell carcinoma
-lesion that won't heal, ulceration, or a "button" on tip of nose - Basal Cell carcinoma
142.
Centor criteria for GABHS bacterial pharyngitis
Fever
Absence of cough
Cervical anterior lymphadenopathy
Tonsillar exudates
143.
What are the signs and symptoms of Impingement syndrome?
diffuse pain around acromion, point tenderness in subacromial space, increased pain with overhead activities, posterior capsule tightness, a (+) Hawkins-Kennedy Test
144.
Ischemic Heart Disease
-Poor blood supply to the heart muscle
-Atherosclerosis
-Coronary Artery Disease
Chest pain
Women and elderly usually delay tx
145.
Chronic stable angina
chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms
Pain can last for 5-15 minutes, subsiding when the precipitating factor is removed. Pain at rest is unusual. Controlled well with medication
146.
Prinzmetal angina
• Vasospasm causes decreased blood flow through atherosclerotic vessels
• This form of attack frequently occurs at rest with ST-segment elevation on ECG
• Treat with calcium channel blockers
147.
Unstable Angina
- incomplete thrombosis
- reversible injury, no necrosis
- ST depression on ECG
- chest pain at rest
- relieved by nitro
- high risk for MI
148.
Nephrolithiasis
Kidney stones
-Acute onset
-severe colickly flank pain
-usually unilateral
-radiates to ipsilateral groin
-hematuria
-n/v
-difficulty finding a comfortable position.
149.
pyelonephritis
inflammation of the renal pelvis and the kidney. One of the most common types of kidney disease. It may be the result of a lower urinary tract infection that moved up to the kidney by way of the ureters. There may be large quantities of WBC's and bacteria in the urine. Blood (hematuria) may even be present in the urine in this condition. can occur with any untreated or persistent case of cystitis. Fever
150.
Gross hematuria + flank pain + palpable mass
RCC
151.
BPH
asymmetric enlargement and a firm, smooth, nontender gland
-LUTS
152.
Proteinuria
parenchymal disease of the kidney
-diabetic neuropathy
-nephritic syndrome
-autoimmune dz
-multiple myeloma
-acute inflammation
painless
153.
stress urinary incontinence (SUI)
involuntary discharge of urine at the time of cough, sneeze, and/or strained exercise
154.
#1 compliant of OA?
Hip pain
155.
20yo female with pain, tenderness, decrease ROM at neck, shoulder, and medial knee:
fibromyalgia
156.
Ligament injury, "give-away", "pop"
Drawer test, ACL, PCL, MCL
157.
De Quervain's tendonistis
irritation of the tendon located on the radial side of wrist, near thumb.
158.
Osteoarthritis
-progressive deterioration of articular cartilage
-causes bone buildup and the loss of articular cartilage in peripheral and axial joints
-affects weight-bearing joints and joints that receive the greatest stress, such as hips, knees, lower vertebral column, and hands
Assessment:
morning stiffness <30min
-pt experiences joint pain that diminishes after rest and intensifies after activity, noted early in the disease process
-as disease progresses, pain occurs with slight motion or even at rest
-symptoms are aggravated by temp. change and climate humidity
-joint swelling, crepitus, limited ROM
-difficulty getting up after prolonged sitting
-skeletal muscle disuse atrophy
-compression of the spine as manifested by radiating pain, stiffness, and muscle spasm in one or both extremities
159.
Differential diagnosis for knee pain?
chrondromalacia patella, infection of the joint, patellar buristis
160.
Ottawa ankle rules (5 things)
*No Age cut off*
- tenderness at posterior edge of either malleolus
- 5th Metatarsal tenderness
- Navicular tenderness
- Unable to bear weight
161.
Systemic Lupus Erythematosus (SLE)
Chronic autoimmune inflammatory disease of collagen in skin, joints, and internal organs.
- pos ANA
-macular rash
-women, younger
-increase ESR and CRP
162.
Rotator Cuff Muscles (shoulder joint stabilizer)
SITS
S: Supraspinatus- abductor
I: Infraspinatus- lateral rotator
T: Teres Minor- lateral rotator
S: Subscapularis- medial rotator
163.
subacromial bursitis
• inflammation and swelling of subacromial bursa over the shoulder cause limited ROM and pain with motion
• localized swelling under deltoid muscle may increase by partial passive abduction of the arm
• caused by direct trauma, strain during sports, local or systemic inflammatory process, or repetitive motion with injury
• Urgent
164.
back pain: red flags
• Urinary incontinence
• over 50, under 20
• B symptoms
• Hx of cancer
• IV drug use
• hx of corticosteroids
• hx significant trauma
• neuro deficits
• pain worse lying down/night (*cancer*)
• features of caudal equine
165.
Subarachnoid hemorrhage (SAH)
• Most often caused by trauma.
• Sx: 25-50% have classic "thunderclap" headache, "the worst headache of my life"
166. [Show Less]