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44 Cards in this Set

  • Front
  • Back
baseline vulnerability
-age
-physical health
-frailty
-sensory loss
-cognition (chronic dementia, acute mental status)
predictive model of delirium
acute confusion=delirium
-looking at "insults" that health system does which increase problem(s)
-also predisposing factors: Vulnerability
-Precipitating Factors: Insults
consequences of restrive devices
-immobility: we want to improve not decrease this.
-psychological
-injuries
physical consequences of immobility
-pressure ulcers
-incontinence
-muscle atrophy
-bone loss
psychological consequences of restraints
-agitation
-confusion
-loss of dignity
Injuries ass. with restraints
-asphyxiation
-entrapment
-falls
specific approaches to fall/injury prevention
-assess behavioral and functional changes
-evaluate fall risk
-orient and inform
-facilitate observation: increase time OOB
-distract: glove over IV
-offer activities
-promote mobility
-exercise
-improve ability to get out of bed safely (lighting)
-maintain continence
-promote comfort
-provide reminders (alarms, signs)
-Reduce injury/entrapment risk (hip pads, low ht bed, impact mat)
definition of siderails as restraints
"restricts the pt's movement and the pt cannot remove it"
hartford institute mission
-to set a national agenda and shape the quality of health care for elderly
-promote geriatric nursing excellence
-promote competence in geriatric practice for all nurses
-influence both individual nurses and the systems they work in.
falls in old people
-common
-high morbidity, mortality
-many causes and risk factors
-potentially preventable
causes of falls
-multiple causes usually involved
-frequently not observed
-poor recall of event
-different ways to categorize cause:
1. primary or precipitating cuase
2. all contributing causes
3. other risk factors
clinical approach to the faller
-assess and treat any injury
-determine cause (history, physical, lab)
-prevent recurrence: trt cause/illness, reduce risk factors, adaptive behaviors (slow rise, cane)
basic falls risk assessment
-falls history
-med review
-focused physical exam
-functional & cog status
-environ survey
falls history
-circumstances
-major medical problems
-drugs: esp. cardiac, diuretic, psychoactive
physical exam: key aspects
VS: postural pulse/BP, temp
HEENT: vision, hearing, nystagmus
Neck: ROM, motion-induced vertigo, bruit
Card/Pulm: CHF, arrhythmia, murmur
Ectrems: arthritis, ROM, deformities, feet
Neuro: altered MS, gait/balance, weakness, focal finding, tremor, rigidity, peripheral neuropathy
reduce fall risk
-reduce use of psychoactive drugs
--treatment of pain
-improve sleep
-bed height
-lighting
-skid-proof floor/socks
-provide "transfer enabler" or safe "short" rail
-promote continence (siderail=barrier for confused elder)
-impact mat
-increase surveillance: bed alarms
Diarrhea assessment
History: onset, frequency, character, consistency, medication hisotry, dietary history
Physical: VS, ht, wt, skin turgor, abdomen, rectum
Causes of diarrhea
-motility disturbances
-decreased fluid absorption
-increased fluid secretion
Motility disturbances
-irritable bowel syndrome
-gastrectomy
-diabetic enteropathy
decreased fluid absorption
-oral intake of laxatives
-malabsorption syndrome
-mucosal damage
increased fluid secretion: most common
-infections: clostridium difficile
-drugs
-foods
Clostridium difficile (C.Diff)
-a common cause of diarrhea in frail elders.
-elders on antibiotics especially susceptible
-highly infectious
nursing interventions for diarrhea
-treat and identify the cause BEFORE treating the symptoms
-handwashing
-contact isolation
-antibiotics
-fluid repletion
antidiarrheal agents
-anticholinergics (imodium, lomotil)
-Demulcents (pepto)
-Narcotics
Constipation: definition
-frequency <3 bowel movements a week
-individualized
-NOT associated with aging
clinical manifestations of constipation
-abd bloating, distention, pain
-hard dry stool
-headache
-nausea
-hemorrhois
-valsalva maneuver
-diverticulosis
-fecal impaction
causes of constipation
-dietary related
-colonic disorders
-medication related
-neurologic disorders
Nursing interventions: constipation
-treatment depends on symptoms and assessemnt
-dietary teaching
-exercise
-position during bowel movement
Laxative choices
-bulk (metamucil, fibercon)
-osmotic/saline (mag citrate, lactulose, MOM)
-emollient (colace, mineral oil)
-stimulant/irritant (ex-lax, senacot)
-suppositories
-enemas
nursing assessement: UTI
-atypical presentation in elderly: non-specific S&S such as change in functional status, fatigue, anorexia, nausea, vomiting, MENTAL STATUS CHANGES, hypothermia, afebrile
-Typical presentation: frequency, urgency, suprapubic or low back pain, burning, fever and malaise
risk factors in elderly women for UTI
-use of pessary
-atrophic vaginitis
-short urethra
-cystocele
-catheterized
-immobility, incontinence
-bladder stones
risk factors in elderly men for UTI
-prostate enlargement
-lack of circumcision
-catheterized
-immobility, incontinence
-bladder stones
Interventions: UTI
-monitor adverse effects of antibiotics
-fluids
-avoid catheterization
-handwashing
-I/O
Pt teaching: UTI
-teaching perineal hygiene
-avoid caffeine, chocolate, alcohol
-pain managment
-antibiotic teaching
-avoid bubble baths
Urinary Incontinence
-15-30% community dwelling older adults
-women>men
-at least 50% of NH residents
-defined as the involuntary loss of urine
-adverse effects: social isolation, skin breakdown, depression, falls, high economic costs
types of urinary incontinence (UI)
-acute reversible
-persistent
Acute/transient incontinence: UI
D-delirium/confusion
I-infection
A-atrophic vaginitis
P-pharamaceuticals
P-polyuria
R-restricted mobility
S-stool impaction
Chronic UI
U-urge
F-functional
O-overflow
S-stress
urge incontinence
involuntary loss of urine ass with sensation to void (urgency)
Symptom: i go before i can get to the bathroom
mechanism: bladder involuntary contracts, sphincter involuntary relaxes
causes: CNS or Local
Functional incontinence
definition: chronic physical or cognitive impairments
symptom: i can't get to the bathroom
Mech: inability to toilet self
Causes: severe dementia, arthritis, hip fracture
Overflow incontinence
Def: involuntary loss of urine ass with over-distention of the bladder
symp: I just go a little bit. I am always leaking
Mech: bladder fails to contract & spincter fails to relax until overcome by pressure
causes: outlet obstruction, hypotonic bladder
stress incontinence
Def: sphincter failure ass with increased abdominal pressure
symp: i lose it when i cough or sneeze
mech: involuntary relaxation of sphicter due to sphincter damage
causes: pelvic surgery
Behavioral treatment for UI
-biofeedback
-kegels
-toileting program
drug therapy treatment & other: UI
-look at current drug regimen
-drugs for urge UI, for stress UI, overflow UI
-Glycemic control
other:
-surgery
-absorptive products
-PESSARY-inserted into vagina or rectum, used to treat stress UI