Unintentional weight loss, weakened, exhausted, slowed physical activity are all signs of what syndrome?
Name some practices that promote wellness:
- walking (weight bearing exercise)
- good nutrition (Ca+, Vit D, Vit C, Vit A, protein)
Name some issues with nutrition in older adults:
- weight (gain/loss) - due to various issues
- loss of sense of taste
What are some nursing actions to take for constipation with older adults:
- increase fiber (35-50g per day)
- drink at least 2L fluid/daily
- alter meds - may need to give stool softeners
Name nursing actions to promote hydration in older adults
- schedule of fluids (give every couple of hours)
- decrease caffeine and alcohol
- ask about meds (diuretics, incontinence, etc..)
Why is it so important for older adults to increase mobility and stay active?
- to maintain functional fitness (ADL's)
- promotes independence, increases well-being
- increases strength and flexibility for balance
- decreases risk for falls
- increases sleep
- decreases depression
- improved longevity
- reduces risks for diabetes, CAD, dementia
The physical and emotional distress that occurs after a person moves from one setting to another
Relocation stress syndrome
How can we minimize Relocation Stress Syndrome?
- opportunities to assist in decision making
- carefully explain all procedures/routines before
- provide special keepsakes at the bedside
- ask the pt about expectations during stay
- encourage family and friends to visit often
- establish trust early
- assess pt's usual lifestyle, likes and dislikes
- avoid unnecessary room changes
- have a family member, staff member, volunteer accompany pt when leaving for procedures or therapies
Name some effects of drugs on older adults
- Distribution (more adipose tissue, liver fx decreased)
- Excretion (GFR decreased, less blood flow) leads to toxicity
What are some nursing interventions to help older adults with self admin of meds?
- directions in large print
- color coding
- set alarms
- associate med admin with event (breakfast, etc.)
The risk for older adults to take certain meds outweigh the benefits of the drugs:
When it comes to older adult mental health, name two things that are normal with aging:
- reaction time slower
- some memory loss
Why no tricyclic antidepressants for older adults?
- cholinergic properties
- increased risk for acute confusion, constipation, urinary retention
an acute state of confusion that is reversible?
What are the nursing interventions for dementia?
- reorient (not valid in late stages)
- use validation therapy (acknowledge, don't argue)
- provide a safe environment
- observe for associated behaviors (delusions, halucinations)
What are the nursing interventions in delirium?
- reorient the pt to reality
- provide a safe environment
- find the reason
- remove the cause
- STAY CALM
what are some causes of delirium?
- drug tx
- electrolyte imbalances
What are the two important things to know about elder abuse or neglect?
- we are mandatory reporters
- start with your facility (follow policy on who you report it to)
What is the best predictor that a fall will occur?
If the pt already has a history of a fall
What does the acronym SPPICES stand for?
- Sleep disorders
- Problems with eating or feeding
- Evidence of falls
- Skin breakdown
What are nursing safety priorities with elderly pts that are immobile?
- albumin and prealbumin for protein
- supervise UAP for frequent turning and repositioning Q2H
- assess skin Q8H
- Keep skin clean and dry
- avoid briefs or absorbent pads
- use pressure-relieving mattress
What are the nursing assessments for older adults receiving antipsychotic meds?
- anticholinergic effects (constipation, dry mouth, urinary retention)
- orthostatic hypotension
Common causes of OA
OA deformities of the hands that are at the distal interphalangeal joints?
OA deformities of the hands that are at the proximal interphalangeal joints?
Adverse reaction of tylenol with ETOH?
Acute liver failure
Name some non-pharmacologic tx's for OA
- heat or ice
- weight loss
- occupational, physical therapy
In gout what deposits in the joint that leads to inflammation?
What is the end product of purine metabolism?
- Uric acid
- production exceeds excretion
What are some diseases that cause secondary gout?
- Kidney disease
- Multiple myeloma
Gout caused genetically is the result of what error?
errors in purine metabolism
What is the purpose of Bisphosphonates?
prevents bone loss and increases bone density
What is osteoporosis?
- bone loss, density issue
- more bone loss than bone building
- brittle bones
What are the most common fractures in osteoporosis?
What hormone helps to keep bone density?
What is the T-score to determine osteoporosis
What is the T-score to determine osteopenia?
-1 to -2.5
What can patients do to prevent osteoporosis?
- weight bearing exercise
- increase Ca+ and Vit D
- reduce alcohol and carbonated drinks
What is osteomalacia?
- weak SOFT bone
- vitamin D deficiency
- Dilantin and fluoride preps can lead to Vit D deficiency
- On Xray Loosen's line show - not as much calcious bone
What is Paget's disease (Osteitis deformans)?
bone breaks down then rebuilds and becomes structurally disorganized which weakens the bone
What is the treatment for Paget's disease?
What areas of the body are mainly affected with Paget's disease?
- skull --> hearing loss, HA
Rehab is a ? approach
This part of the REHAB team is responsible for fine motor skills for functioning (eating, dressing, writing)
Occupational therapy (OT)
This part of the REHAB team is responsible for gross motor skills (shower, walking, transferring...)
Physical therapy (PT)
This part of the REHAB team is responsible for helping the patient to find jobs or college opportunities
This part of the REHAB team is responsible for dysphagia (swallowing) or dysphasia (speaking), language
This part of the REHAB team is responsible for overseeing the orders
Physiatrist (MD, NP, PA)
This part of the REHAB team is responsible for dealing with emotional support (disability, grief...)
This part of the REHAB team is responsible for placements, outside resources, financial, relocation...
Social worker/Case Manager
This part of the REHAB team is responsible for management of care, advocate, team unifier
This part of the REHAB team is responsible for adjusting diet according to issues, education
This part of the REHAB team is responsible for meds reconciliation, med safety
This part of the REHAB team is responsible for spiritual support
This part of the REHAB team is responsible for adaptive devices, fitting equipment
Rehab, as well as any discipline in medicine is ? oriented?
Rehab is ? dependent on the patients ability and disability?
What is the goal of rehab?
getting the patient to a FUNCTIONAL level
When v/s change how much? do we stop what we are doing an activity
- BP up or down by 20
- HR up by 20
- O2 sat drops
- Respirations increase or decrease
If pt is SOB they must do what in order for you to chart it and why?
patient must say "I'm SOB" because that is subjective - you cannot determine by looking at someone. You can document sternal retractions...
When is it a good time to get v/s on a pt in rehab?
- BEFORE, during and after an activity.
- Must have a baseline, hence the before v/s
How is orthostatic hypotension indicated?
- a drop of more than 20 mmHg systolic
- a drop of 10 mmHg in diastolic
How can we conserve energy in pts with COPD
- rest periods
- encourage tiring activities in the morning or when pt feels best
- break projects into smaller parts
What is one of the biggest signs that impending death is near?
The patient stops eating or drinking
What is one of the most important questions to ask a patient that has a terminal illness?
Where do you want to die?
A durable power of attorney for healthcare measures
To have decision-making ability a patient must be able to do what?
- Receive info (but not necessarily oriented x4)
- Evaluate, deliberate, and mentally manipulate info
- Communicate a treatment preference
What is Part 2 of the advanced directive?
The Living Will portion
Part 1 is the designation of an "agent"
What is the recommended document that follows patient across healthcare settings?
POLST (Provider Orders for Life-Sustaining Treatment)
Hospice is about the quality of life left and relief of ?
What is the difference between hospice and palliative care?
hospice - provider determines the pt has 6 mo or less to live
palliative care can be at any stage of illness
What is the main thing to do with family regarding EOL?
educate on s/s of death
Name important s/s of approaching death:
- cold extremities (don't use heat)
- sleeping increases - let them sleep
- stop eating and drinking - do not force them
- incontinence - keep them dry
- secretions - turn on their side (sometimes anticholinergics used)
- breathing - Cheyne Stokes
- disorientation - speak softly, encourage family to reminisce
- restlessness - use aromatherapy, music, healing touch, etc.
What is Cheyne Stokes breathing?
periods of rapid breathing and apnea
Name the interventions to provide a peaceful death:
- Pt's needs and preferences met
- Control of symptoms of distress
- Meaningful interactions with family
- A peaceful death
What is a nursing priority to offer a pt with dyspnea that is near death?
- A fan circulating air may be desired
Name some psychosocial interventions for care of the dying patient and the family:
- offer physical and emotional support (be with the pt)
- respect cultural preferences
- be realistic
- encourage reminiscence
- promote spirituality
- avoid explanations of the loss
- communicate with the pt
- provide referrals to bereavement specialists
- educate about physical signs of death
- ensure pt is receiving palliative care, with an emphasis on symptom management
Name some basic beliefs of Death for Christianity
- Catholic - sacrament of the sick
- believe in afterlife once the soul has left the body
Name some basic beliefs of Death for Judaism
- dying person encouraged to recite the confessional "Shema"
- pt should not be left alone
- body deserves reverence and respect
- body should not be left unattended until the funeral (preferred within 24H)
- autopsies not allowed by Orthodox Jews
- body should not be embalmed, displayed, or cremated
Name some basic beliefs of Death for Islam
- death is seen as the beginning of a new and better life
- God has prescribed an appointed time of death for everyone
- Qur'an encourages humans to seek treatment and not to refuse
- upon death, the eyelids are to be closed and the body should be covered
- someone from the pt's mosque perform rituals of bathing and wrapping the body in cloth
What is the meaning of spirituality?
whatever gives the ultimate meaning or purpose to ones life
Before post mortem care what should the nurse ensure?
- Family gets time alone with pt
- Know the organ donor status (do not remove tubes, etc. and notify the Organ Team)
What precludes a pt from being an organ donor?
- Metastatic Cancer - except cornea if no eye involvement
- may be contraindicated in diabetics and HTN
Name three things the nurse will do regarding the pronouncement of death:
- time of death
- call the family
- call the provider