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Unintentional weight loss, weakened, exhausted, slowed physical activity are all signs of what syndrome?
Geriatric syndrome
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Name some practices that promote wellness:
- walking (weight bearing exercise)
- good nutrition (Ca+, Vit D, Vit C, Vit A, protein)
- Vaccines
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Name some issues with nutrition in older adults:
- weight (gain/loss) - due to various issues
- loss of sense of taste
- constipation
- dehydration
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What are some nursing actions to take for constipation with older adults:
- increase fiber (35-50g per day)
- drink at least 2L fluid/daily
- exercise
- alter meds - may need to give stool softeners
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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..)
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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
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The physical and emotional distress that occurs after a person moves from one setting to another
Relocation stress syndrome
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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
- reorient
- 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
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Name some effects of drugs on older adults
- Distribution (more adipose tissue, liver fx decreased)
- Excretion (GFR decreased, less blood flow) leads to toxicity
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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.)
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The risk for older adults to take certain meds outweigh the benefits of the drugs:
BEERS criteria
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When it comes to older adult mental health, name two things that are normal with aging:
- reaction time slower
- some memory loss
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Why no tricyclic antidepressants for older adults?
- cholinergic properties
- increased risk for acute confusion, constipation, urinary retention
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an acute state of confusion that is reversible?
delirium
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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)
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What are the nursing interventions in delirium?
- reorient the pt to reality
- provide a safe environment
- find the reason
- remove the cause
- STAY CALM
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what are some causes of delirium?
- relocation
- drug tx
- electrolyte imbalances
- surgery
- hypoglycemia
- hypoxemia
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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)
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What is the best predictor that a fall will occur?
If the pt already has a history of a fall
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What does the acronym SPPICES stand for?
- Sleep disorders
- Problems with eating or feeding
- Pain
- Incontinence
- Confusion
- Evidence of falls
- Skin breakdown
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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
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What are the nursing assessments for older adults receiving antipsychotic meds?
- anticholinergic effects (constipation, dry mouth, urinary retention)
- orthostatic hypotension
- parkinsonism
- restlessness
- hyperglycemia
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Common causes of OA
- obesity
- trauma
- genetic
- aging
- occupation
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OA deformities of the hands that are at the distal interphalangeal joints?
Heberden's Nodes
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OA deformities of the hands that are at the proximal interphalangeal joints?
Bouchard's Nodes
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Adverse reaction of tylenol with ETOH?
Acute liver failure
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Name some non-pharmacologic tx's for OA
- heat or ice
- glucosamine/chondroitin
- weight loss
- occupational, physical therapy
- antioxidents
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In gout what deposits in the joint that leads to inflammation?
Urate crystals
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What is the end product of purine metabolism?
- Uric acid
- production exceeds excretion
-
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What are some diseases that cause secondary gout?
- Kidney disease
- Multiple myeloma
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Gout caused genetically is the result of what error?
errors in purine metabolism
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What is the purpose of Bisphosphonates?
prevents bone loss and increases bone density
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What is osteoporosis?
- bone loss, density issue
- more bone loss than bone building
- brittle bones
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What are the most common fractures in osteoporosis?
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What hormone helps to keep bone density?
estrogen
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What is the T-score to determine osteoporosis
<-2.5
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What is the T-score to determine osteopenia?
-1 to -2.5
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What can patients do to prevent osteoporosis?
- weight bearing exercise
- increase Ca+ and Vit D
- sunlight
- reduce alcohol and carbonated drinks
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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
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What is Paget's disease (Osteitis deformans)?
bone breaks down then rebuilds and becomes structurally disorganized which weakens the bone
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What is the treatment for Paget's disease?
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What areas of the body are mainly affected with Paget's disease?
- skull --> hearing loss, HA
- pelvis
- legs
- vertebrae
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Rehab is a ? approach
TEAM
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This part of the REHAB team is responsible for fine motor skills for functioning (eating, dressing, writing)
Occupational therapy (OT)
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This part of the REHAB team is responsible for gross motor skills (shower, walking, transferring...)
Physical therapy (PT)
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This part of the REHAB team is responsible for helping the patient to find jobs or college opportunities
Vocational counselor
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This part of the REHAB team is responsible for dysphagia (swallowing) or dysphasia (speaking), language
Speech therapy
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This part of the REHAB team is responsible for overseeing the orders
Physiatrist (MD, NP, PA)
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This part of the REHAB team is responsible for dealing with emotional support (disability, grief...)
Psychologist
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This part of the REHAB team is responsible for placements, outside resources, financial, relocation...
Social worker/Case Manager
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This part of the REHAB team is responsible for management of care, advocate, team unifier
Nurse
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This part of the REHAB team is responsible for adjusting diet according to issues, education
Nutritionist
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This part of the REHAB team is responsible for meds reconciliation, med safety
Pharmacist
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This part of the REHAB team is responsible for spiritual support
Clergy
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This part of the REHAB team is responsible for adaptive devices, fitting equipment
Biomed
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Rehab, as well as any discipline in medicine is ? oriented?
GOAL
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Rehab is ? dependent on the patients ability and disability?
INDIVIDUALIZED
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What is the goal of rehab?
getting the patient to a FUNCTIONAL level
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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
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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...
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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
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How is orthostatic hypotension indicated?
- a drop of more than 20 mmHg systolic
- OR
- a drop of 10 mmHg in diastolic
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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
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What is one of the biggest signs that impending death is near?
The patient stops eating or drinking
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What is one of the most important questions to ask a patient that has a terminal illness?
Where do you want to die?
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A durable power of attorney for healthcare measures
Advanced directive
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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
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What is Part 2 of the advanced directive?
The Living Will portion
Part 1 is the designation of an "agent"
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What is the recommended document that follows patient across healthcare settings?
POLST (Provider Orders for Life-Sustaining Treatment)
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Hospice is about the quality of life left and relief of ?
symptoms
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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
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What is the main thing to do with family regarding EOL?
educate on s/s of death
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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.
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What is Cheyne Stokes breathing?
periods of rapid breathing and apnea
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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
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What is a nursing priority to offer a pt with dyspnea that is near death?
- Oxygen
- A fan circulating air may be desired
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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
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Name some basic beliefs of Death for Christianity
- Catholic - sacrament of the sick
- believe in afterlife once the soul has left the body
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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
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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
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What is the meaning of spirituality?
whatever gives the ultimate meaning or purpose to ones life
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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)
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What precludes a pt from being an organ donor?
- HIV
- TB
- Malaria
- Metastatic Cancer - except cornea if no eye involvement
- may be contraindicated in diabetics and HTN
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Name three things the nurse will do regarding the pronouncement of death:
- time of death
- call the family
- call the provider
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