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50 Cards in this Set
- Front
- Back
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Kyphosis
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curvature of the spine
-caused by the collapse of the cartilage disks between the bones of the spine -can cause breathing problems especially under duress |
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thermoregulation
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OAFS are unable to regulate temperature as well
-lean body mass goes down, fat replaces muscle Fat soluble drugs differences |
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Immune system & body chages
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-immune system begins to break down
Food -lower quality nutritional food -do not enjoy the taste of food -eat less -financial concerns |
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general principles of assessment
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-chronic problems
social issues -dont want to be a burden -friends are sick or dead -spouse death (men die faster) Economic issues -fear of losing control to greedy kids |
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geriatric?
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65 and older
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mental status
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most watch tv and can name president
-some can judge day by church |
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PT HX
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-get down to eye level
-take off sunglasses -locate hearing aid, glasses, dentures -turn on lights -speak slowly, distinctly, respectfully |
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6 points to remember
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1) the pt may tire easily
2) may wear many layers of clothes and hamper assessment 3) respect privacy and modesty 4) explain all actions clearly especially to blind patients 5) Pt may deny or minimize symptoms 6) try to distinguish chronic from acute problems |
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advanced directives
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living will = full page, long time to read
advanced directions = brief order signed by doc |
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nursing homes
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-different levels of care
-primary function to convolesce pts out of the hospital -one RN can watchover many staff, not cream of the crop |
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foster care homes
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-alternative to a nursing home when specialty skills not required
-typically have hand rails and widened doors -staff are not typically medically trained -some homes designated specifically for alzheimers |
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dementia
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-more confusion
-loss of personality -cant remember caretaker |
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senility
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-still able to communicate and recognize faces
-may answer questions incorrectly -happy |
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parkinsons
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-shaking
-mentally ok |
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GI/Bowel Obstruction
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-motility slows down, more fluid is extracted
"solid biscuit" |
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vision issues
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cataracts
-hazy milk in eye -surgery may have been done glaucoma -pressure in the orbit of the eye -may be treated with cannibis |
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toxicity
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-suicide
-self medication -bad eye sight |
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environmental considerations
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-temperature regulation centers
-lose heat, don't shiver |
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emotional considerations
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-deep feelings of worthlessness & guilt
-job identity issues -extreme isolation -feelings of hopelessness -loss of energy/appetite -recurrent thoughts of death |
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suicide attempts
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-get affairs in order
-give possessions away -take unneccessary risks -increased etoh and drugs -acquistion of firearms Questions Have you ever tried to kill yourself? Have you ever thought about suicide -get cop to agree with suicide attempt, allow you to hold pt against their will |
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Trauma
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1)Osteoperosis
-increased chance of fall, bones are arthritic Muscle atrophy Visual Impairment Slowed Reflexes 2) reduced cardiac reserve -no compensation ability 3) decreased respiratory function -need ability to saturate cells with O2 4) impaired renal function |
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Head Injuries
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-brains are smaller
-coup, contrecoup injuries are more pronounced -ground level falls can be more serious |
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spinal cord injury
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higher risk
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Pain reception
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-nerve aging
-atrophied legs that wont pull on FX bone ends -no spasming |
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Hip FX
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-pt may report knee pain due to referral
-some pt's may be able to walk on a FX hip |
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Al queda targets
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go for symbols
-tall buildings |
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biological weapons
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-hannibal thew snakes onto ships
-mustard gas in WWI -designed to terrorize and injure, not neccessarily kill |
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CDC
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center for disease control
-catagorizes substances ABC |
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port of entry
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-inhalation
-food and water source contamination |
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anthrax
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-white powder
-cutaneous = outdoors rare, S/S after 7 days local tissue damage -Inhalation = deadly Early Stage = common cold Middle Stage = severe respiratory distress Late Stage = death within 36 hours |
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Botulism
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-bacterial toxin
-kills via respiratory paralysis -food and wound bourne -airborn S/S 12-36 hours -N -blurred vision -respiratory distress -difficulty swallowing |
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infant botulism
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incubate poison in bowels
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plague
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-fever, extreme weakness, SOB, bloody sputum
-bacteria found in rodents -transferred via respiratory droplets |
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ricin
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-castor beans
-contact or ingestion -no antidote or antibiotic S/S 8 HRS, 36-72 Fatal -weakness -fever -vomiting -cough |
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small pox
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-disease ends with blindness, scarring
-1980 declared extinct -incubation period 12 days -airborn droplet or bodily fluids (spread by caretakers) S/S -high fever -fatigue -back ache 2-3 days -lesions Mortality 35% -vaccines available but not currently adminstered |
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gerontology and facts
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"the study of the problems of all aspects of aging"
-5 to 10% of each decade of life after 30 (body malfunction) systems affected -respiratory -CV -renal -nervous -musculoskeletal |
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Respiratory changes
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75 y/o
-vital capacity decrease by 50% -maximum breathing capacity decrease by 60% -maximum work rate and max O2 uptake decrease by 70% -arterial O2 decrease while Co2 stays the same |
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CV system changes
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due to both atherosclerotic CAD and non-ischemic pysiological changes
between 30 and 80 -CO decreases 30% -increase PVR -myocardial hypertrophy, CAD, hyperdynamic changes predispose geriatric patient to dysrhythmias electrical conduction changes -chronic A fib -sick sinus syndrome -brady and heart block |
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Renal system changes
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30-80 y/o
-renal blood flow falls 50% -decrease filtration rate 8ml/min per decade -renal concentrating ability -sodium conservation -free water clearance -glomerular filtartion -renal plasma flow -hepatic blood flow decrease |
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Nervous System changes
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30-70
-10% brain reduction -decreased cerebral blood flow -changes in CNS -velocity of nerve conduction -electrolyte imba |
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Musculoskeletal system changes
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muscles shrink, calcify, disks thin
-osteoperosis -decrease in total muscle mass -decrease height 2-3" -widening and weakening of bones |
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Fall prevention strategies
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1) use assistive devices (walker, cane)
2) remove scatter rugs and secure loose carpet 3) remove items that may cause tripping 4) provide and use handrails 5) ensure adequate lighting 6) remove clutter from the environment 7) arrange furniture for walking ease 8) using non-slip decals for the bathtub or shower 9) providing handrails on bathtubs showers or commodes |
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other physiological changes
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65 y/o
-lean body mass decreases by 25% affecting dosage and frequency of admin for FAT SOLUBLE DRUGS (more drug per weight of metabolically active tissue and larger reservoir for buildup of the drug) -increase concentration of water soluble drugs (as there is less water) |
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bacterial pneumonia
T & T |
leading cause of death in geriatric age group, often fatal in frail adults
-more suseptible to developing bacteria -the usual clinical picture of fever, productive cough, pleurisy and signs of pulmonary congestion is often absent possible S/S -altered mental status -cough -fever (sometimes) -SOB -tachycardia -tachypnea |
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COPD
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bronchitis, emphysema, asthma
S/S -extreme anxiety -cyanosis -wheezing -abnormal or diminished breathsounds -paradoxical movement -JVD -decreased O2 sats |
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Pulmonary Embolism
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associated with venous stasis, heart failure, COPD, malignancy, immobilization
-most form from in the veins of the legs S/S -L ventricular failure with sudden tachypnea -unexplained tachycardia -a fib -calf discomfort without tenderness, mild calf and ankle increased warmth, dilation of superficial veins in one foot or leg -P.E. can cause CHF to develop TX -immobilize and elevate an affected extremity -IV |
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MI
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Cx Pn less reported after 70, only 45% after 80 y/o
-mortality doubles after 70 6 common factors 1) previous MI 2) angina 3) diabetes 4) hypertension 5) cholesterol 6) smoking |
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silent MI
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atypical complaint
-fatigue -breathlesness -nausea -ABD pn |
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heart failure
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S/S
-dyspnea -fatigue (left sided heart failure sign) -orthopnea -dry, hacking cough progressing to productive cough with frothy sputum -dependent edema caused by right sided heart failure -nocturia -anorexia, hepatomegaly, ascities TX -intubation/IV -fuersamide -nitro -morphine |
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dysrhythmias
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most commonly caused by hypertensive heart disease
-PVCs are common in adults over 80 -A-fib is the most common dysrhythmia |
