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108 Cards in this Set
- Front
- Back
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What are some normal GI changes
(& results from those changes) associated with aging? |
↓ muscle tone at rectal sphincters = ↑ bowel incontinence
↓ gastric secretions = ↓ digestion ↓ peristalsis = ↑ constipation & bowel impaction |
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What are some normal urinary changes (& results from those changes) associated with aging?
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↓ functioning nephrons = ↓ filtration rate
↓ blood supply to kidney = ↓ removal of wastes & ↓ concentration of urine ↓ muscle tone = ↑ residual urine ↓ tissue elasticity = ↓ bladder capacity ↓ sensation of bladder fullness = ↓ frequency of voiding ↑ size of prostate = ↑ risk of infection (urine stasis), ↓ stream of urine, & ↑ hesitancy |
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What is BPH & what are s/s of having this condition?
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Benign Prostatic Hypertrophy
nocturia frequency urgency |
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What are the common GI disease processes seen in the elderly?
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Tumors
Obstructions Constipation Diarrhea Fecal Incontinence |
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What are the common urinary/renal disease processes seen in the elderly?
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UTIs
Urinary incontinence BPH |
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Is involuntary loss of urine normal with aging?
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NO!
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What are the possible causes of urinary incontinence?
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Frequent UTIs & Neurogenic issues
(Stroke, Dementia, Parkinson's, MS) |
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At what age does BPH usually start?
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50-60 yo
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True or False: 90% of men age 80 and older have BPH.
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TRUE
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What are some risk factors for developing problems with elimination?
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"L MICE"
Lack of privacy Medication side effects Immobility Changes in diet &/or daily routine Embarrassment (think it's a part of normal aging & don't seek treatment) |
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What are the diagnostic areas to consider when assessing elimination problems in the elderly?
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Focused bowel & bladder assessment
Specifically ask about involuntary loss of urine &/or feces Individual considerations (need for privacy) UA (urinalysis) BUN (5-25) Creatinine (0.5-1.5) Cultures (stool & urine) Hemoccult |
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How many LTC residents are affected by constipation?
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50-75%
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How many older people in the community report taking laxatives?
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20%
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What does the term "slow transit" mean?
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Waste lingering in bowel for 40-72 hrs
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How long should it take for food to pass through the GI tract?
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24 hrs
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When can someone be determined to have constipation?
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When they haven't had a BM for longer than 72 hrs
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What are some medications that can cause/contribute to constipation?
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Antidepressants
antihistamines anticolenergics narcotics |
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What are the 3 "Hs" of enemas?
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Don't give...
too High too Hot too Heck of a lot! |
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When would a person be taking lactilose?
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When there is need to decrease ammonia in the body
(have liver problems) |
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What are some varieties of enemas?
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Fleets
Oil retention Soap suds Milk of Molasses |
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What is pericolace
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A laxative + stool softener in one.
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What is important to know about giving fiber to a pt you suspect of impaction?
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Don't give bulk forming laxatives!
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How much enema can you give max?
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According to book:
150-300 ml or 5-10 oz (Ms. Shimm said 2 liters in class!) |
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What can be stimulated with digital impaction removal?
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Vagal nerve
(decreases heart rate, syncope) |
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Who can perform a impaction removal (lowest level)?
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NA II
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Where is an impaction usually located?
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lower in bowel - hypoactive sounds
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Where is an obstruction usually located?
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in upper bowel - hyperactive sounds
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What are the types of Urinary Incontinence?
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Total
Overflow Functional Urge Stress (tofus) |
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Who is likely to experience total incontinence?
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Older adults
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Who is likely to experience overflow incontinence?
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People with...
enlarged prostate DM or who take... Ca channel blockers anticolinergics adrenergics |
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Who is likely to experence functional incontinence?
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frail elderly
dementia pts LTC residents |
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Who is likely to experence urge incontinence?
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Older adults
(both sexes but men are likely) |
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Who is likely to experence stress incontinence?
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Women < 60
men after prostate surgery |
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What is the cause/etiology of total incontinence?
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neuropathy prevents transmission of signals to indicate bladder fullness
independent contraction of detrusor muscle because of trauma/disease of spinal cord |
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What is the cause/etiology of overflow incontinence?
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muscles overextend/have poor tone, leading to overflow of retained urine
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What is the cause/etiology of functional incontinence?
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physical &/or psychological factors impair pt getting to the toilet
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What is the cause/etiology of urge incontinence?
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detrusor instability
weak sphincter |
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What is the cause/etiology of stress incontinence?
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weakened external sphincter/pelvic support
increased intraabdominal pressure |
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What are some s/s (characteristics) of total incontinence?
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continuous/unpredictable loss
decreased perineal sensation unaware of incontinence/bladder filling |
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What are some s/s (characteristics) of overflow incontinence?
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involuntary leakage due to distended bladder
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What are some s/s (characteristics) of functional incontinence?
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involuntary loss before getting to toilet
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What are some s/s (characteristics) of urge incontinence?
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sudden strong sensation of urgency then involuntary loss
frequent urination overactive bladder |
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What are some s/s (characteristics) of stress incontinence?
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involuntary loss with coughing, laughing, bending
dribbling with increased abdominal pressure urinary frequency/urgency |
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What is the normal position of the bladder/urethra?
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Normally they are at an acute angle to each other.
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How has the position of the bladder/urethra changed with stress incontinence?
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Abdominal pressure had decreased the angle between the bladder & urethra and urine escapes.
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Briefly, how can DM lead to overflow incontinence?
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Osmotic issues leads to polyurea leading to overflow
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How does Ca channel blockers lead to overflow incontinence?
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they dilate coronary arteries
(vasodilators) |
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How does adrenergics lead to overflow incontinence?
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the sphincter is constricted (increases bladder tone)
This is a med to treat high BP |
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How does anticholinergics lead to overflow incontinence?
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they decrease bladder spasms (check on this)
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What is the Crede procedure?
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a procedure to help empty a flaccid bladder by applying pressure to the suprapubic area
may bend forward &/or slightly raise knees (good for spinal injuries) |
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When is the drug prostigmine usually used?
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used with spinal injuries
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What is a common side effect with Detrol?
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confusion
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What are some medications to treat BPH in men?
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Antispasmodics
anticholinergics imipramine (tricyclic antidepressant) alpha-blockers 5 alpha reductase inhibitors |
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How does imipramine (tricyclic antidepressant), help treat BPH?
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causes bladder muscle to relax causing muscles at bladder neck to contract
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How does alpha-blockers treat BPH?
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relax muscle tissue
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What are some examples of alpha-blockers used to treat BPH?
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Hytrin
Flowmax |
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How does 5 alpha reductase inhibitors treat BPH?
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shrink the prostate
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What are some examples of 5 alpha reductase inhibitors?
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Proscar
Avodart |
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Are their some surgical interventions to treat incontinence?
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yes
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The elderly adult can expect some normal activity & exercise related changes in what body systems?
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Cardiovascular
Respiratory Neurological Musculoskeletal Hematological |
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What are some normal cardiovascular changes (& results from those changes) associated with aging?
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↓ cardiac muscle tone = ↓ oxygenation of tissues
↓ cardiac output = ↑ risk of CHF & ↓ peripheral circulation ↓ elasticity of heart muscle & vessels = ↓ venous return, ↑ dependant edema, ↑ chance of ortho hypotension & ↑ varicosities & hemorrhoids ↑ atherosclerosis = ↑ BP (HTN) hardening of valves = fibrosis of conduction system (leads to ?bradycardia? & arrhythmias |
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What are some normal respiratory changes (& results from those changes) associated with aging?
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↓ body fluids = ↓ humidifying of air
↓ airway clearance/cough = ↑ risk of aspiration/respiratory infection ↓ ciliary action = ↑ risk of aspiration & respiratory infection ↓ tissue elasticity = ↓ gas exchange, ↑ pooling of secretions in lower lungs ↓ amt of capillaries = ↓ gas exchange ↑ calcification of cartilage = ↑ rigidity of rib cage (rounded cage 1:1) ↑ A-P ratio (anterior - posterior; norm is 2:1) = ↓ elastic recoil |
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True or False: Breath sounds are clearer in base of lung lobes in the elderly.
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false, they are diminished
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What are some normal neurologic changes (& results from those changes) associated with aging?
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↓ brain cells = ↓ reflexes
↓ nerve fibers = ↓ coordination ↓ neuroreceptors = ↓ motor response & perception of stimuli |
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What are some normal musculoskeletal changes (& results from those changes) associated with aging?
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↓ bone calcium = ↑ osteoporosis & ↑ kyphosis
↓ fluid in spinal disks = ↓ height ↓ blood supply to muscles = ↓ muscle strength ↓ tissue elasticity = ↓ mobility & flexibility ↓ muscle mass = ↓ strength & ↑ risk of falls |
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What are some normal hematological changes (& results from those changes) associated with aging?
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↑ platelet adhesiveness = ↑ clots
↓ RBCs = ↑ anemia ↓ T-cells = ↓ immune system ↓ intrinsic factor = ↑ pernicious anemia |
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What are some common cardiovascular disease processes seen in the elderly?
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"Cchap"
CAD CHF HTN Anemia PVD |
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What are some common respiratory disease processes seen in the elderly?
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"Clipt"
COPD Lung cancer Influenza Pneumonia TB |
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What are some common musculoskeletal disease processes seen in the elderly?
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"Oof"
Osteoarthritis Osteoporosis Fractures |
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What are some common hematological disease processes seen in the elderly?
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Anemia
Leukemia |
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What disorders fall under COPD?
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Asthma
Bronchitis Emphysema (ABE has COPD) |
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How do we test for TB in the elderly?
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2 step method b/c they may have a delayed immune system reaction
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What is the peak age of lung cancer?
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55-65
more common in men |
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What is PVD and what can it result in?
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Peripheral Vascular Disease
Narrowing of peripheral vessels. May cause gangrene & decreased renal function |
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What is CVD?
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Coronary Valve Disease
Inefficient valves may contribute to little clots. Pt may be on plavix, aspirin, coumadin. |
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What is important to know about CAD?
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leads to inadequate O2 & nutrients which can lead to necrosis of heart muscle
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What is the new prehypertensive BP parameters?
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120-140/80-90
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What is the normal BP in the older adult?
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Normal to have an increased systolic pressure (over 140)
NOT normal to have an increase in diastolic pressure. |
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What are some pathologic BP changes in the older adult?
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Uncontrolled increase in systolic BP can increase risk for MI &/or stroke, an increase in diastolic pressure (not normal) could increase intravascular resistance, decrease cardiac output & stroke volume.
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What part of the US is considered the "stroke belt?"
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The south
(we like fried foods and salt) |
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Name some cardiac diagnostic studies.
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"cmeed"
Cholesterol (<200) Myocardial proteins (troponin) Enzymes EKG Digioxin level (0.5-2) |
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Name some hematologic diagnostic studies.
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CBC
RBC H&H |
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Name some coagulation diagnostic studies.
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PT (11-15)
PTT (60-70) APTT (20-35) Platelets (150-400) |
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Name some electrolyte diagnostic studies.
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K (3.5-5.3)
Na (135-145) Cl (95-105) CO2 (22-30) BUN (5-25) Cr (0.5-1.5) Glucose (70-110) Uric acid |
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Name some respiratory diagnostic studies.
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Respiratory function tests
Chest x-ray Theophyline level (bronchodilator med) (5-20 norm; 5-18 elder) |
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Name some neuromuscular diagnostic studies.
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Cat scan
Ca MRI |
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Describe sleep stage 1.
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Non-rapid eye sleep
lightest level easily aroused vital signs slowed |
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Describe sleep stage 2.
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Non-Rem
sound sleep arousal still easy body functions still slowing |
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Describe sleep stage 3.
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Non-Rem
initial deep sleep difficult to arouse muscles completely relaxed |
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Describe sleep stage 4.
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Non-Rem
deepest stage very difficult to arouse physiological restoration release of growth hormone, prolactin & TSH |
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Describe sleep stage 5.
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Rem
automatic rapid eye movement fluctuating vital signs loss of skeletal muscle tone most difficult to arouse "Dream sleep," psychological/mental restoration |
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What myocardial proteins indicate a MI?
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Troponin I & Troponin T
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What bronchodilator should you test for when evaluating respiratory problems?
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Theophylline levels (SE: tachycardia)
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When do activity & exercise alterations occur in the older adult?
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When demands are increased on the heart & lungs
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What stages of sleep do people get less of as they age?
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Stages 4 & 5
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What are some examples of abnormal sleep behaviors?
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Restless leg syndrome
sleep walking sleep terrors |
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How much sleep does the elderly person need at night?
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6-10 hrs
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Is daytime napping good or bad for the elderly adult?
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In excess, it is bad - it can further disrupt circadian rhythms.
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How often does REM sleep occur?
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about q 90-120 minutes
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What happens when a person has sleep apnea?
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partial or complete collapse of the airway leads to hypoxia.
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What medical problems can sleep apnea cause?
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Sudden death
Angina Increased BP |
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What cardiovascular & respiratory diseases can cause disturbance with sleep & rest?
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CHF, COPD
(cause orthopnea & SOB) |
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What GI diseases can cause disturbance with sleep & rest?
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GERD (dyspepsia)
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What neuromusculoskeletal problems can cause disturbance with sleep & rest?
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Osteoarthritis
(causes pain & is 1/3 reason for sleep disruption) any disorders that cause pain |
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What genitourinary problems can cause disturbance with sleep & rest?
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Urinary frequency
nocturia incontinence BPH |
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What are some other general disorders that can cause problems with sleep & rest?
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Sleep apnea
depression anxiety dementia (wondering/walking at night) |
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What are some risk factors that increase the risk of disturbed sleep & rest?
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"mud peep"
Medications Use of alcohol/tobacco/caffeine Diet (late night eating, obesity) Psychological stress Environmental changes Exercise (late night) Physical inactivity (obesity) |
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What is sleep hygiene?
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The maintenance of habits conducive to sound sleep and rest
(for good SH, naps should be limited, exercise, proper nutrition, caffeine, alcohol, nicotine, worrying, etc, minimized before sleeping) |
