Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
103 Cards in this Set
- Front
- Back
|
Acute Pain |
Symptom of direct tissue damage or potential tissue damage. well defined time of onset that occurs suddenly; known pathology Protects form impending damage |
|
|
Persistent (Chronic) Pain |
May be symptom of or chronic disease itself lasting longer than 3-6 months. Pain continues beyond time of healing |
|
|
Faces Pain Scale |
Good for mild to moderate cognitive impairment. Verval ability or ability to point to the image |
|
|
Iowa Pain thermometer |
Moderate to severe cognitive defect or difficulty communicating |
|
|
Verbal Descriptor Scale (VDS) |
Good for any cognitive level. point to pain level or word |
|
|
Numeric Rating Scale (NRS) |
patient who can point to or state the number that reflects their current pain level |
|
|
Pain Assessment in Advanced Dementia (PAINAD) |
Breathing, vocalization, expresión, body language, consolability |
|
|
Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC) |
Facial expression, verbalization, body movement, relationships, routines, mental status change |
|
|
Complementary Pain Treatment |
warm/cold music massage spirituality and prayer environmental modifications breathing techniques |
|
|
Adjuvant Pain Treatment |
Gabapentin Duloxetine |
|
|
Interventional Pain Care |
nerve block intra-articular injection |
|
|
Analgesics for Mild Pain |
Acetaminophen (Tylenol)/APAP or topical counter stimulants Max daily dose=3,000mg healthy, 2,000mg in frail older adult Topical NSAID or lidocaine Cox-2 selective NSAIDs |
|
|
Analgesics for Moderate Pain |
Persists or increases and comfort-function-mood goal not attained--> Topical NSAIDs, Adjuvant, Opioids Codeine + APAP Tramadol (Ultram) Hydrocodone +APAP (Lortab) Weak opioids: never used alone, use with acetaminophen, complementary/alternative therapy Never stop abruptly Stool softener and laxative |
|
|
Analgesics for Severe Pain |
Persists or increases further --> cautious use of higher risk drugs: NSAIDs and ER opioids -Risk reduction strategies Short Acting: -Hydromorphone (Dilaudid) Fentanyl (Actiq) Oxycodone + Ibuprofen (Combunox) Oxymorphone (Opana) Morphine (MS Contin) Long acting: ER hydrocodone bitaratrate (ZohydroER) ER morphine (Avinza) Buprenorphine buccal film (Belbuca) - new Transdermal fentanyl (Duragesic) |
|
|
Medications to avoid in older adults |
Meperidine (Demerol) Pentazocine (Talwin) Levorphanol (Levo-Dromoran) |
|
|
Opioid ABCs |
Anti-emetics for first week Breakthrough medication Constipation management with stool softeners and/or laxatives |
|
|
Pharmacokinetics |
What the body does to the drug *Age related changes: altered absorption, distribution, metabolism, excretion Absorption: inc gastric pH, dec GI blood/motility =slowed absorption, but no affect on amount of drug ultimately absorbed. Dec topical absorption Distribution: -dec body water= inc concentration of drug -inc fat = longer duration of lipid soluble drug -dec serum protein= inc serum concentration Metabolism: dec liver size and hepatic blood flow, first pass event. = Higher blood levels and longer action renal: dec GFR= inc half life of drug and accumulation to toxic levels |
|
|
Pharmacodynamics |
What the drug does to the body -drug sensitivity increased or decreased -inc anticholinergic effects of tricyclic antidepressants -decreased response to beta-blockers -*start low and go slow |
|
|
Polypharmacy |
Duplicate drugs, similar drugs from same drug class, and drugs that are containdicated when taken together. Giving medication to treat side effects of other drugs |
|
|
Strategies to Avoid Polypharmacy |
Medication Reconciliation: review current medication list at each appointment Ask if each is still necessary Side effects Evaluate non-adherence Check Beer's |
|
|
Adverse Drug Events (ADE) |
Injury caused by medication in management of patients health and not caused by underlying condition; can occur in any health care setting--> inpatient, outpatient, long term care facility See symptoms--> look at medications as cause first Anticholinergic Side effects |
|
|
Medication Error |
Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the healthcare professional, patient, or consumer |
|
|
Anticholinergic Side Effects |
Dry mouth, blurred vision, constipation, urinary retention, tachycardia, dizziness/lightheadedness Antipsychotics Antihistamines Incontinence medications TCA's - tricyclic antidepressants Antivertigo medication |
|
|
Non-Adherence |
Failure to stick to the agreed upon medication regimen, including omitting medications or altering drug dosages or schedules. Most common causes: *cost of medication, side/effects/fear of side effects, complex scheduling, age-related changes, belief that medications are ineffective, cultural factors physical/functional: poor vision, manual dexterity, swallowing problems, pharmokinetics, drug tolerance Cognitive: memory problems, confusion/delirium physiologic changes: altered absorption, distribution, metabolism, excretion |
|
|
intentional Non-Adherence |
Cost of medications, side effects or fear of side effects, belief that medications are either ineffective or unnecessary, complexity of dosing regimen Strategies: education, motivational interviewing, medication review to eliminate unnecessary meds and use less expensive alternatives, change meds to better the side effects |
|
|
Unintentional Non-Adherence |
Complexity of dosing regimen, forgetfulness, cognitive impairment Strategies: medication boxes, electronic devices, text messages and phone calls, streamline mediation regimen |
|
|
Potentially Inappropriate Medications (PIMs) |
Medication used when risk>benefit, over prescribing with excessive dose or duration (Polypharmacy), poor choice of medication, dose or duration, under-prescribing clinically indicated medications |
|
|
Beer's Criteria |
used for PIMs use in older adults as guideline for healthcare professionals to help improve the safety of prescribing medications for older adults Quality of evidence PIMs PIMs due to drug-disease interactions Drugs to use with caution: anticoagulants, psychotropics/chemo drug, SIADH, hyponatremia, vasodilators, syncope |
|
|
Screening tool of Older Person's Prescriptions (STOPP) |
list of drugs by organ system which are potentially inappropriate in persons over 65 |
|
|
Screening Tool to Alert Doctors to Right Treatment (START) |
List of medications which should be considered for selected medial conditions |
|
|
PIMs |
Asthma/lung disease: avoid epinephrine, caffeine, NSAIDs--> Sudafed aspirin, NSAIDs, antacids, alcohol, antihistamines Most commonly prescribed: Propoxyphene, doxazosin, diphenhydramine, amitriptyline |
|
|
Age-related Changes of Cardiovascular Function |
dec CO and cardiac reserve, dec dispensability of vessels, dec HR and dec myocardial contrctility= affect response to stress and exercise--> HR increases more slowly and takes longer to return to resting dec HR LV thickens--> inc oxygen demand LA increase, decreased aortic dispensability and vascular tone= dec contraction and CO dec diastolic pressure inc LV end diastolic pressure, widened pulse pressure s4 heart sound fibrotic SA and A node dec pacemaker cells = less responsive |
|
|
ECG Age Related Changes |
Notched P wave Prolonged PR interval Decreased amplitude of QRS complex notched or slurred Twave |
|
|
Congestive Heart Failure (CHF) |
inability of heart to pump an efficient cardiac output Assess: BP, pitting edema LE, jugular vein pressure, heart and lung sounds, percussion for lung effusion Treatment: control precipitating factors. Low sodium, fluid restriction, rest, exercise, ACE inhibitors, diuretics, Digoxin Interventions: maximize myocardial function and assist with lifestyle modifications and emotional adjustments |
|
|
Arterial Disease |
Sudden and severe pain Chronic intermittent claudication/rest pain Hair loss distal to occlusion Thick and brittle nails thin, dry, shiny skin Pallor or reactive hyperemia (Pallor=elevated; rubor=dependent) Cool skin Severely painful ulcers on toes or upper surface of foot, metatarsal head, bony prominence No edema Diminished, weak, absent pulses |
|
|
Venous Disease |
Little or no acute pain Chronic heaviness or fullness No hair loss normal nails Normal sensation Stasis dermatitis, visible veins, mottled skin Brawny skin color, cyanotic if dependent Warm skin Pain relieved by elevation Ulcers on ankles Edema Normal pulses |
|
|
Lung volume |
Tidal volume: volume of inhaled or exhaled air= dec IR= dec ERV= dec Residual volume= inc by 25% |
|
|
Lung Capacity |
Functional Reserve Residual Capacity: inc Total lung capacity: unchanged Vital capacity: dec by 25% |
|
|
Age-Related Changes to Respiratory system |
TLC= unchanged ribs less mobile/chest compliance decreases osteoporosis and cartilage calcification--> rigid/stiff Barrel chest loss of elastic recoil Stiff alveoli= collagen weakened muscles dec SA for gas exchange dec # cilia dec IgA dec oxygen carrying capacity dec ventilatory response to hypoxia and hypercapnia *FEV1=drop to 25-30mL per year after age 30 |
|
|
Pneumonia |
Inflammation of lung parenchyma. usually associated with filling of the alveoli with fluid *Most common cause of death in older adults S/s: may be obscured by coexisting disease or chronic use of corticosteroids/anti-inflammatories *altered mental status, dehydration, failure to thrive *Prevention: early vaccination |
|
|
Prevention of Pneumonia |
*Vaccination over 6: get vaccination every 5-10 years monitor fluid status, vital signs and oxygenation, maintain a clean environment, assisting client with airway clearance cy coughing and suctioning Prevent aspiration |
|
|
Fracture |
Break or disruption in continuity of bone. trauma to bone or joint or pathologic |
|
|
Osteoporosis |
Low bone mass --> fragile, brittle bones -loss of bone mass, increased bone resorption, decreased bone formation *Spontaneous fractures or those cause by minimal trauma, loss of height, dorsal kyphosis, chronic back pain Dx: dual x-ray (DEXA) treatment: calcium/vitamin D, exersicse, antiresorptive therapy -estrogen, bisphosphonates, calcitonin |
|
|
Osteoarthritis |
Most Common type of arthritis. *Degenerative joint disease, noninflammatory disease of joints= progressive articular cartilage deterioration and formation of new bone in joint space -50-60yo onset -variable and progressive gradual onset, aching joint, pain with activity and relieved with rest, stiffness after inactivity -Crepitus, dec ROM -degeneration of joint structure--> spasms, gait changes, disuse of joints Heberden and Bouchard nodes |
|
|
Heberden Nodes |
*Osteoarthritis Bony enlargements on distal phalanges (tips of fingers) |
|
|
Bouchard Nodes |
*Osteoarthritis Nodules of proximal joints (middle knuckle) |
|
|
Rheumatoid Arthritis |
Chronic, systemic, inflammatory disease that causes joint destruction and deformitty resulting in disability; autoimmune disease -Gradual onset, repetitive courses of remission and exacerbation -Pannus: synovial fluid causing erosion of joint capsule--> decreased joint motion, deformity, ankylosis, joint immobilization -30-40yo onset painful, stiff joints, decreased range of motion, joint swelling, deformity pain 30min-6hr after waking up warm and swollen joints ulnar deviation subcutaneous nodules fatigue, malaise, anorexia, weight loss, anemia |
|
|
Gout |
Joint inflammation caused by sodium rate crystals in joint and deposits of uric acid crystals (top), usually on big toe s/s: hot, reddened, tender joints risk factors: obesity, hypertension, alcohol, diuretics, trauma, hyperlipidemia, dm, CKD, organ transplant |
|
|
Hypothyroidism |
Autoimmune, drug induced, or adverse effect of radioactive treatment= hypo functioning endocrine state that results from inadequate thyroid hormone. *Increased TSH S/s: atypical, subclinical, inconspicous, progress slowly -fatigue -cold intolerance -weight gain -muscle cramps -paresthesia -confusion Treatment: T4 replacement with Levothyroxine Serum TSH screening q5years for over 65men, women 35 |
|
|
Levothyroxine Sodium |
0.075-0.1mg/day Increased by 0.0125mg/day q2weeks or 0.025mg/day q4 weeks 1-2 months= 0.075mg/day |
|
|
Hyperthyroidism |
*Toxic Multinodal Goiter *Toxic Uninodular Goiter Decreased TRH and T3. Iodine induced S/s: tachycardia, fatigue, tremors, nervousness, enlarged palpable goiter 60% |
|
|
Subclinical hyperthyroidism:
|
suppressed TSH and normal TH--> a-fib, dec bone mineral density
|
|
|
Hypothyroidism Interventions |
Assessment: -fatigue, onset/pattern/factors, effects on ADLs, depression scale, MMSE, TSH and H/H, comorbidities, meds, weight Normal TSH= 0.5-4.0 recheck in 6 weeks explain disease, lifelong therapy work to target ADLs |
|
|
Nausea and Vomiting |
GI Symptom
Fluid replacement, sips of water q15min, semi-fowler or side lying to prevent aspiration |
|
|
Anorexia |
GI symptom monitor intake, output, weight small frequent meals |
|
|
Abdominal pain |
GI symptom IV fluid, NG tube for decompression, monitor and record vitals, monitor intake and output, completing assessment of onset, committing or diarrhea and fever and medical history |
|
|
Gas |
GI symptom belching, bloating, fullness, flatus Change dietary factors by eating slow and exercising |
|
|
Diarrhea |
GI symptoms Maintain adequate fluid and electrolyte balance, assess for complications oral or parenteral therapy avoid gas forming foods: veggies, spices, milk products BRAT: bananas, rice, applesauce toast |
|
|
Constipation |
GI symptom Increase fluid intake and fiber, exercise, toilet routine |
|
|
Constipation |
GI symptom Increase fluid intake and fiber, exercise, toilet routine |
|
|
Fecal incontinence |
GI symptom Education and bowel control |
|
|
Gingivitis and Peridontitis |
Inflammation of gums and spreading of inflammation to underlying tissue, bones, root tf teeth-> tooth loss cause: long term Phenytoin (Dilantin) Candida albicans: thruh Promote oral hygiene, preventative dental care, nutritional status |
|
|
Hiatal Hernia |
GI disorder cause of reflux esophagitis, part of stomach protrudes through diaphragm asymptomatic, heartburn, gastric regurgitation, dysphagia, indigestion with supine, overeating, exercise or change in position |
|
|
Vitamin B12 deficiency |
GI disorder age related change in small intestine - atrophy and thinning of villi, decreased epithelial cells--> decreased absorption of fat and it b12 *Pernicious anemia parasthesia |
|
|
Gastritis |
GI disorder inflammation of gastric mucosa ant-acids, small frequent meals, calm environment |
|
|
Peptic Ulcer Disease |
ulceratie condition caused by erosion of GI mucosa from hydrochloric acid and pepsin in stomach or duodenum *H pylori NSAIDs, warfarin, SSRI, bisphoshonates gastric: HCl acid reduced, increased diffusion of acid into tissue *gnawing/burning pain in epigastric region. eating=relief duodenal: increased rate of acid secretion, emptying rate into duodenum *exacerbation and remission, food=relief 2-4 hours after/immediately relieved by food or antacids *burning or cramp radiating to back; heartburn interventions: dietary modifications, smoking cessation, avoid irritants, reduce stress H2 receptor antagonists: interfere with warfarin, theophylline, phenytoin |
|
|
Enteritis |
inflammatory process of stomach or small intestine ---> food poisoning hdydration and clear liquids |
|
|
Diverticula |
saclike protrusion in mucosa along GI by herniation through separation in muscle fibers constipation, diarrhea, LEFT sided LOWER abdomen pain high fiver foods: beans, whole grains, brown rice, apples, bananas, pears, broccoli, carrots, corn, squash |
|
|
Hemorrhoids |
dilation of veins in mucous inside rectum prevent and eliminate constipation |
|
|
Age related changes in Skin |
Epidermis: decreased replacement of stratum corner, loss of elasticity, thinning--> more moisture escapes,delay healing, inc skin tears dermis: thinning, dec sweat glands, blood vessels and nerve endings, collagen stiffens subq fat: dec fat, redistributed to abdomen and thighs, breast atrophy, wringing and sagging/temp control dec eccrine sweat glands dec aprocrine sweat glands in axilla, scalp, face, genitals= dec sweating and thermoregulation thin hair nails= thick, brittle, ridges *xerosis, laxity, wrinkling, uneven pigmentation, easy tearing, purpura, neoplasia |
|
|
Cherry angioma |
Benign skin growth 30yo Bright red superficial vascular lesion on trunk |
|
|
Seborrheic keratosis |
Benign skin growth older adults, stuck on appearance elevated and greasy |
|
|
Acrochordons (skin Tags) |
benign neck, axilla, eyelid, groin |
|
|
Seborrheic Dermatitis |
inflammatory condition chronic inflammation of skin on scalp, ear canals, eyebrows, eyelashes, nasolabial fold, axilla, breast, chest, groin--> scaling zinz pyrithione, selenium sulfide, ketoconazole shampoo hydrocortisone elidel steroid for face |
|
|
Intertrigo |
inflammatory/seborrheic friction on skin of axilla, breast, abdominal fold in obese and diabetics moisture management, weight loss, hydrocortisone |
|
|
Psoriasis |
inflammatory autoimmune, onset early with cycle and remission and relapse pink plaques with white/silver calls nails yellow/brown, pitting treat: steroid cream, coal tar, Dovonex, Tazorac, UV therapy |
|
|
Pruritis |
inflammatory intense itching by xerosis (dry skin), heat, detergent, stress, liver or kidney failure, hypothyroidism treat: emollients: lubriderm, cetaphinl decrease bathing antihistamine |
|
|
Actinic Keratosis |
pre-malignant skin growth sun damage to hands scalp ears face arms rough surfaces and cutaneous horns |
|
|
Basal cell carcinoma |
malignant caner *most common skin cancer, usually far skinned pearly, doughnut, blue-blakc noodle, red scaly macule |
|
|
squamous cell carcinoma |
malignant epidermis thick, adherent scale with soft and moveable tumor and well defined border center ulcerated or crusted, base inflamed, red, bleeds easy |
|
|
Melanoma |
Malignant cancer early detection is key!!! halmark: irregularly shaped nevus, papule, or plaque that has undergone change in color |
|
|
ABCDEs of Melanoma |
Asymmetry Border irregularity Color variation Diameter >6mm Evolution/elevation/enlargement |
|
|
Furuncle |
Red, swollen, hard tender puss filled lesion acute localized bacterial infection *warm compresses *TOPICAL antibiotic |
|
|
Cellulitis |
larger area of red, warm, edematous skin *ORAL antibiotics |
|
|
Candida Albicans |
normal flora--> overgrowth = infection -erythemous, satellite lesions, malodor antifungals BID x 14 days --> topical cream |
|
|
Herpes Zoster |
shingles- reactivation of varicella zoster (chickenpox) Prevention: Zostavax vaccinnation (50+) s/s: prodrome tingling, burning, itching, maculopapular rash, vesicles antiviral treatment |
|
|
Norton Scale |
Pressure ulcer assessment scale using 5 assessment categories score of <16 = at risk for pressure ulcer |
|
|
Braden Scale |
Pressure ulcer assessment; assesses sensory perception rather than mental status score<18 = high risk for skin breakdown at risk= 15-18 moderate risk= 13-14 high risk= 10-12 every risk = 9 |
|
|
Stage I Pressure Ulcer |
Red and intact, lightly pigmented and blanch, dark skin will not blanch treatment: preventative, film or hydrocolloid |
|
|
Stage II Pressure Ulcer |
Partial-thickness skin erosion. Loss of EPIDERMIS OR DERMIS. Shallow or open blister; red-pink wound bed treatment: prevent, assess for infection, debride necrotic tissue, conduct nutritional assessment, provide nutritional supply -film -hydrocolloid, hydrogel, foam, honey, collagen matrix, wet to moist dressing infected--> topical antiseptic and wet to dry dressing |
|
|
Stage III Pressure Ulcer |
Full-thickness extending to SUBCUTANEOUS tissue; resembling a crater. may see subcutaneous fat but NO muscle, bone, or tendons treatment: prevent, assess infecton, decried, nutrition assessment film if clean -hydrocolloid, hydrogel, foam, honey, collagen-matrix, wet to moist dressing infected--> topical antiseptic wet to dry dressing |
|
|
Stage IV Pressure Ulcer |
FULL thickness involving ALL skin layers, exposing MUSCLE, TENDON, OR BONE. may slough off or eschar treatment: clean: hydrogen, hydrocolloid past or wafer, collagen matrix or wet to moist dressing infected- manage topically with antiseptic and wet to dry dressing until resolved, bno longer than 5 days |
|
|
Unstageable |
Unable to determine depth, covered with eschar |
|
|
Sexual Age Related Changes |
Reduced availability of sex hormones--> less rapid and less extreme vascular response to sexual arousal |
|
|
Age Related changes in older Men |
Less firm erection, shorter, less forceful ADAM: androgen decline in aging male Erectile dysfunction: inability to develop and maintain an erection long enough for sexual intercourse |
|
|
Age Related Changes in older Women |
Usually no difficulty maintaining sexual function in older age; infrequency due to lack of desire menopause: atrophic vaginitis, decreased lubrication, thinning of wall Loss of hormones Dyspareunia: painful intercourse |
|
|
Being aware that older adult clients often present with non-classic symptoms of type 2 DM, the nurse is particularly suspicious of a client reporting: |
Recent problems reading an infected sore on his toe that won't heal |
|
|
A 66 r old is being evaluated for an underachieve thyroid gland. the diagnosis of hypothyroidism is supported when the nursing assessment notes: |
Client reported that "I always wear a sweater" *cold intolerance |
|
|
Which of the following is a common complication of long term treatment for RA? |
Infection *prednisone and anti-inflammatories |
|
|
This part of the mouth may atrophy with age, which leads to inability to discriminate among flavors, especially salty and sweet |
Taste buds |
|
|
"lack of appetite." in the older adult is not an eating disorder of psychological significance |
Anorexia |
|
|
A major cause of reflux; occurs when part of the stomach protrudes through an opening of the diaphragm |
Hiatal hernia |
|
|
Inflammatory process of stomach or small intestine, can be caused by bacteria, viruses, medications, radiation, ingestion of irritating foods, or allergic reactions; symptoms include abdominal cramping, profuse diarrhea, vomiting |
Enteritites |
