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43 Cards in this Set
- Front
- Back
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Effects of chronic pain
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decreased socialization, impaired ambulation, increased health care utilization/costs
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Common causes of chronic pain
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DJD (osteoarthritis), polymyalgia rheumatica, PVD, peripheral neuropathy, cancer or terminal pain, often undertreated, patients with delayed sensation
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Asess pain
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pain scale, culture and gender influence
older adults unable to complete scale may evidence pain by vocalizations and disruptive behaviors |
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Barriers to pain relief
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believe elders experience lss pain
variety of terms belief elders cannot tolerate opiods assess instruments not used misinterpretation of cognitively impaired person's behavior |
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Problems with pain in cognitive impaired older adults
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CI not associated with decreased pain but with decreased ability to report pain
CI may not be able to identify or communicate pain CI who has recent behavior change should be evaluated for pain Reports from caregivers are important |
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Adverse consequences of pain
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decreased quality of life
depression decrease socialization sleep disturbance impaired ambulation suicidal ideation decreased appetite increased healthcare utilization |
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Strategies in treating pain in older adults
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assess for evidence of chronic pain
persistent or reoccurring pain is a problem identify conditions that require specific interventions diary regular reassessment |
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Nonpharmacological pain treatment
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cognitive programs, imagery, relaxation, biofeedback, hypnosis, discourage abnormal behavior, provide positive feedback
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Nonpharmacologic pain treatment examples
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exercise, acupuncture, TCNS, distraction, physical methods (heat, cold, massage), relaxation, alternative/complementary therapies, spiritual healing, naturopathic, homeopathic
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Palliative care
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total care of patients whose disease is not responsive to curative treatment
control of pain and other symptoms as well as addressing holistic person promote wellbeing at end of life |
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If older adult is restless
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may need to use bathroom
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Iatrogenesis
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hazard of hospitazliation
injury or illness acquired in hospital or by healthcare provider increases morbidity and mortality |
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Nursigenic
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injury or illness or harm to the patient coming fromt he nurse
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Examples of iatrogens
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adverse drug reactions, complications to procedures, nosocomial complications, HAI's, Geri syndromes, falls or other injuries from environment
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Geri syndrome
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fall, UTI, delirium
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Iatrogenic effects highest amont
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over 65 years old
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The older a patient with a higher number of diseases increases...?
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adverse drug effects/reactions
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Presentation of drug reactions in adults
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atypical: often missed and more vague (such as confusion or change in behavior)
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Give ativan or haldol?
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ativan: shorter 1/2 life
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Polypharmacy
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prevalent in elders, increases risk of drug-drug interactions, predictor of hospitalizations (or nursing home or death), can cause hypoglycemia, pneumonia, fractures, or immobility
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Definition polypharmacy
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use of more than one chemical agent to effect a therapeutic endpoint
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5th leading cause of death in older adults
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misuse of drugs
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Adverse reactions to drugs common in older adults
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side effects, changes in pharmacokinetics, falls, hepatic toxicity, renal toxicity, drug-drug interactions
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Beers Criteria
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identify inappropriate meds including psychotropic meds in frail elderly
based on potential risks and benefits of meds |
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high risk meds to avoid
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coumadin
anti hypertension meds BZD's sedatives/hypnotics anticholinergics |
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Watch for what with anti HTN meds
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watch for orthostatic hypotension
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Anticholinergic effects
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increased thirst, tachy, urinary retention, hallucination, seizures, agitation
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Other high risk meds
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antihistamines, NSAIDS, some opiates, persantine, digoxin over 0.125, tigan/phenergan, norpace, diabenase
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What antihistamines are ok with older age
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zyrtec and claratin
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No dose of digoxin over
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0.125
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risk factors for noncompliance/ adverse drug rxn
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change in cognition, living alone, no social support, depression, decline in function
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Strategy for increasing compliance
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help, identify risk factors, identify strategies, how to pay, minimize expenses, support systems, bill boxes, prepared meds, calls or reminds, pill counts
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Factors that reduce compliance
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multiple meds, frequent dosing schedule, complicated instructions
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Digoxin
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s/e
clearance delayed due to decreased CR Cl Low K+, Mg, and high Ca may potentiate toxicity serum levels often not helpful ECG reading |
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Thiazides
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low K and Na--> delirium or arrhythimas
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K+ sparing diuretics
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elevated K
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ACE inhibitors
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elevated K
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BBlockers
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mask s/s hypoglycemia, depression
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BZDs
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used for anxiety, insomina, agitation
avoid long term use |
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NSAIDS
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gastritis, GI bleed, often asymptomatic until bleed
may increase digoxin levels |
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pseudoephedrine
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increased BP
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restoril
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insomnia
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Cockcroft- Gault equation
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renal clearance test
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