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EXAM 2 NURS 105
EMCC 2011, caring for the older adult, legal & ethic, nursing process, medication administration
50
Nursing
Undergraduate 1
10/04/2011

Additional Nursing Flashcards

 


 

Cards

Term

Reasons to study the Older Adult

in nursing practice

Definition

DUE TO THE FOLLOWING REASONS IT IS IMPARITVE TO HAVE THE COMPETENCE TO DELIVER CARE IN THE OLDER ADULT POPULATION

~The increase in the OA population. People aged 65 & older expected to represent 20% of the population.

~>than 83% cardiovascular disease deaths occure in people aged 63 & older

~25% of people aged 60 & older have diabetes

~56% of of all cancer diagnosis & 70% of cancer deaths were in people aged 65 & older

~Injury death rates in the OA are more than twice that of younger adults.

~Increasing # of OA reported in emergency hopital visits.

Term

Physiological Cardiovascular changes that

happen in aging

Definition

-arterial wall thickening & stiffening-leads to decreased compliance

-left ventricular & atrial hypertrophy

-sclerosis of atrial & mitral valves-leads to Decreased Cardiac Reserve (no change in heart rate)

 

-isolated systolic hypertension

-risk of arrythmias

-postural & diuretic induced hypertension

-syncope (dizziness)

Term

Nursing assesments & implications for

cardiovascular changes in the older adult

Definition

~Assesments~

-check heart rates, rythms, murmurs, & heart sounds

-Check BP (lying, sitting & standing) & pulse pressure

-palpate the carotid arteries &

peripheral pulses for symmetry

~Implications~

-safety to prevent falls

-Encourage & support healthy aging lifestyles

 

Term

Physiological changes in the Pulmonary

Sytem specific to the older adult

Definition

~Decreased respiratory muscle strength

~diminished ciliary & macrophage activity-leading to a drier, decreased cough reflex

~decreased response to hypoxia (deprivation of O2) leading to Hypercapnia (too much CO2 in the blood)

~Reduced pulmonary reserves- leading to dyspnea, & decreased exercise tolerance

Term

Key Pulmonary assesments

for the older adult

Definition

~Risperation rate, rythm, regularity, volume, depth, & exercise capacity

~Auscultate lung sounds in all fields

~inspect chest -obtain smoking history (include marijuana smoking history as well)

~Moniter secretions, positioning, blood gasses,

& pulse oximetry

~Assess cough

Term

Nursing Implications for the

older adult with pulmonary issues

Definition

~Keep airways open: positioning, oxygen, bronchiodilaters (as ordered)

~Incentive spirometry

~Maintain hydration & mobility

~educate on coughing techniques & smoking cessation

Term

Physiological changes in the Renal &

Genitourinary changes in the older adult

Definition

~decrease in kidney mass, GFR, decreased drug clearance

~Reduced bladder capacity, elasticity, & muscle tone

~Increased post void residuals, & nocturnal urine production

~MALES: prostate enlargement with risk of BPH


Term

Implications related to renal & genitourinary

changes in the older adult

Definition

~reduced reserves, & risk of complication in illness

~Nephrotoxic injury & adverse effects form drugs

~Risk of volume overload, reduced excretion of acid load, dehydration leading to:

-hypotremia (thiazide diuretics) hypernatremia (with fever), hyperkalemia (with potassium sparin diuretics)

~increased risk of urinary urgency, incontinence, UTI, nocturnal polyuria, & falls risk

 

Term

Nursing Care of older adults with renal

or gentitourinary changes

Definition

~Maintain drug levels: reveiw lab values, & asses for drug toxicities

~Asses for fluid electrolyte imbalnces, maintain minimums

~(for nocturnal polyuria)-Decrease fluids in evening, avoid caffeinated beverages, use prompted voiding schedules

~fall prevention -essential at night

Term

Physiological changes in Oropharyngeal &

Gastrointestinal systems specific

to the older adult

Definition

~decrease in strength of mastication, taste & thirst perceptions

~decreased gastric motility with delayed emptying

~malabsorption of carbohydrates, B12, D, folic acid, & calcium

~impaired sensation to defecate

~reduced hepatic reserve -leading to a decreased metabolism of drugs

Term

Implications of GI changes in

the older adult

Definition

~constipation is not "normal" no matter the age

~risk of chewing impairment, fluid/electrolyte imbalances, poor nutriotion

~Gastric changes -(GERD, NSAIDS induced ulcers)

~Stable liver function tests, risk of adverse drug effects

Term

Nursing assesment & care of the older adult

with changes in the GI system

Definition

~assess abdomen & bowel sounds

~assess oral cavity, chewing & swallwing, dysphagia -if aspiration assess lungs for infection & other symptoms

~moniter weight, BMI, determination of dietary intake

~assess for GERD, constipation, impaction

Term

Nursing care for older adults

with GI changes

Definition

~moniter drug levels & liver function tests, assess nutritional indicators in labs

~educate on lifestyle changes & medications for GERD

~educate on normal bowel frequency, exercise, diet, laxatives recommended

~encourage community based nutritional programs

Term

Physiological changes in the Musculoskeletal

changes in the older adult

Definition

~Sarcopenia -decline in muscle strength & mass associated with aging

-increased muscle weakness & poor exercise tolerance

-lean body mass replaced by fat

-bone loss in women & men

-decreased ligament & tendon strength,

cartilage erosion, changes in stature

Term

Implications related to changes in the

musculoskeletal system in older adults

Definition

~Sarcopenia -increased risk of disability, falls,

& unstable gait

~Risk of osteipenia, ostoporosis

~limited ROM, risk of osteoarthritis

Term

Key concepts for caring for

the older adult

Definition

~Clinical assessment is essential

-look for patterns & changes from baseline for the individual older adult

~Educate & demystify the myths of aging

(often a barrier to older adults themselves)

~Exercise, diet, medication management, pain management, & falls prevention

-key concepts to assisting

older adults in "aging well"

Term

What is "person centered care"

mean when caring for an older adult?

Definition

~Focusing on the needs of the older adult, incorperating their personal beliefs, values, & thoughts -critical in delivering quality care

~Culture, environment,situation, or ethical considerations for care -developes a quality individualized plan of care for the older adult

Term

What is the SPICES assessment

used in older adult care

Definition

S is for sleep disorders -sleep affects quality of life

P is for problems with eating or feeding -could effect medications in the body, chokeing (if swallowing is an issue), nutritional state, fluid/electrolyte balances

I is for incontinenece

C is for confusion

E is for evidence of falls -fractures is the #1 killer in the older

S is for skin breakdown -may cause an infection, lenghthen stay in hospitaln spicificaly dangerous with the "antibiotic resistant" infections

Term

 causes & effects of

Sleep disorders in the older adult

Definition

~sleep effects cognative thinking -causing risk for falls

~medical conditions that effect sleep

~medications that effect sleep

~sleep is needed on a daily basis

Term

Tips on helping the older adult

with meeting thier nutritional needs

Definition

~Assess nutritional status -use diet intakes, lab values, weight, oral hygiene/dentures, chewing abilities

~Assess environment -can adult afford food? can they get to store? do they not like eating alone?

~Create visually appealing meals

~encourage eating together

~Use herbs & spices to add flavor, -older adults have fewer taste buds, they wont eat unless it taste good

~Educate OD on good food preperation techniques

Term
Incontinenece in the older adult
Definition

*INCONTINENCE IS NOT A NORMAL AGING PROCESS*

~Different types of incontinence

-Urge -do not feel need to go then can't wait

-Stress -going when they cough or sneeze

-Bowels -is there an urge sensation


~plan to toilet regulary, use least restrictive products (briefs V.S. catheter)

~Change beverages, reduce caffeine, provide cammode or urinal

Term

What puts the Older Adult at risk for

skin breakdown & pressure ulcers?

Definition

*Assesment of the skin is key to monitering skin breakdown. RN should not deligate this job*

~Decreased mobility

~decreased nutritional status

~decreased healing abilities due to medication

~skin integrity issues

Term

Medication management in the

older adult

Definition

~Know the medication~

-side effects

-potential impact on the individual older adult -drug/drug interactions

~Act~

-educate the older adult, & family caregivers about medications

-develope systems to better assist an older adult in managing their medications (reminder calls, assisted living, etc.)

~Review~

-review all medications with older adults

-report any changes in understanding or cognition to primary care provider

Term

What are the legal & ethical

roles of an RN

Definition

~mandatory reporter

 

Term

What types of drug orders are given by the

doctors for the patients

Definition

~Stat orders

~single dose orders

~standing orders

~PRN orders

Term
What is safe med administration consist of
Definition

~5 RIGHTS

~3CHECKS

Term

What are the 5 rights & 3 Checks

for safe medication administration?

Definition

~RIGHT DRUG

~RIGHT DOSE

~RIGHT TIME

~RIGHT ROUTE

~RIGHT CLIENT

~Check the 5 rights 3 times~

Term

what are the other rights for

for safe medication administration?

Definition

~ proper drug storage

~ accurate dose calculation

~ Accurtae med. dose preperation

~ Prevention & reporting of med. administration errors

~ patient teaching

~ correct transcription

Term

What are the drug routes used

to administer medication?

Definition

~Enteral -Oral, or tube

          -swallow

          -sublingual

          -buccal

~Parenteral

          -intradermal

          -SQ

          -Im

          -IV

~Topical -skin/mucous membranes

          -rectal or vaginal

          -optic

          -ophthalmic

          -intranasal

          -inhalants

Term

What are the 11 patterns in

GORDANS FUNCTIONAL HEALTH PATTERNS?

Definition

1) Health perception & health management

2) Nutritional Metabolic pattern

3) Elimination pattern

4) Activity & exercise pattern

5) Cognative-Perceptual pattern

6) Sleep rest pattern

7) Self-perception-Self-concept pattern

8) Role-relationship pattern

9) Sexuality & Reproduction pattern

10) Coping-stress pattern

11) Value Belief pattern

Term

What is malpractice

What is Negligence

Definition

-An error that causes a consenquence, acting incorrectly

-Do something wrong to make a mistake

(RN is equally responsible for error made by DR.)

-The failure to act

Term

What is informed consent and who

is responsible for getting informed

consent from patient?

Definition

-Gives the patient the information needed to make a decision regarding their health care

-It is the providers responsibility to expalin medical proceedures to the patient

-RN CAN witness the signiture of a client, but CAN NOT witness the proceedure

Term

What is assult

what is battery

Definition

-Any kind of threat

Physical injury

-restraint of any kind

-the action of the threat (including any restraints)

Term

What are the 3 types of

nursing diagnosis?

Definition

1) ONE PART

- wellness diagnosis or syndrom diagnosis

2) TWO PART (problem R/T cause)

-Risk diagnosis or possible nursing diagnosis

3) THREE PART (problem R/T cause AEB S&S

-actual diagnosis

Term

Expected Outcomes

A PROMPT

Definition

*Goals made by RN & PT*

A adress the nursing diagnosis

P patient centered involve PT in the process of goals & achievment

R realistic & obtainable create goals that are realistic to the individual & his/her diagnosis

O one behavior only ask PT to acomplish 1 activity at a time so the acomplishments can be identified

M measurable use sources of measurment (distance, weight, temp.)

T time frame implement a time frame the goal is to be obtained

Term
What are the 4 types of medication orders?
Definition

1) Stat-now, immediatly

2) single dose

3) standing-most common order

4) PRN-pain management

-better if reason why is indicated

-can only administer for indicated use

-assess pain prior to administering and again after (time frame to assess after adminstration depends on the route)

Term

What are the 7 parts to a

medication order?

Definition

1) Name of PT

2) Date & time

3)name of drug

4) dose of drug

5) Route of administration

6) Time/frequency (what type of order is it)

7) Signiture of Dr

Term

Whats important in documentation

of med. administration?

Definition

-Document immediatly after med. administration to PT (at the bedside if possible)

- It is a legal document

- Document if PT refuses to take med.

Term

What is the role of the RN if a PT

refuses a particular med?

Definition

-Educate PT on the importance of the medication and the possible results if med. is not taken

- If PT insists on refusal, DOCUMENT

- When many meds are scheduled. put meds in sequential order

Term
General Med administration rules
Definition

~NEVER administer meds you havnt prepared yourself

~Do not take verbal orders, only written orders

~Never leave med with a PT to take later

~If Pt qustions med., double check the order

~ WHEN IN DOUBT, hold the med

~label all syringes

Term

What are the 3 drug routes for

medication administration?

Definition

1) Enteral -swallow, sublingual, buccal

2) Parenteral -intradermal, sub-Q, intramuscular, intravenus

3) Topical -skin, mucous membrane (rectal, vaginal, otic, opthalmic, internasal, inhalants)

Term

Things to remeber with administering

meds. the Enteral route

 

Definition

~ give PT plenty of water (unless otherwise contraindicated)

~ GI complications will effect drug absorption

~ If PT vomits-check vomit for intact pill. Just because med maybe disolved does not mean it has necessarily been absorbed

Term

Things to remember when administering

meds. subligual

Definition

~ have Pt sip small amout of water prior to administering

~SL is a quick acting route

~ Smoking causes vasoconstriction and severly affects the absorption of SL meds

~ DO NOT give to uncounciess PT's

Term

Things to remeber when administering

meds topically

Definition

~ Topical route can give a systemic effect or local effect

~ Asses PT to be sure other topical patches are off

~Asses are med is being applied first

 

Term

Things to remember when administering

meds Rectally (enemas, suppository, ointments)

Definition

~ DO NOT use in cardiac PT's

~Administer w Pt lying on left side (if possible)

~give enemas with PT lying down (not on comode)

~do not deligate enemas-requires assessment prior to, very invasive, & its a medication

~place recatl meds on the side of the rectal wall

 

Term

things to remember when administering

inhalants

Definition

~ASSESSMENT is key to all inhalants

~ Osculate lung sounds prior to administering med

~ lung sounds typically sound worst after med has been administered

~ direct the PT to take a deep breath prior to using puffers

Term

Things to remember when administering

meds Intramuscular

Definition

*never use dorsogluteal site for IM route*

~ drugs absorb rapidly in skeletal muscle do to its high vascular state

~3 IM sites used

1)deltoid-primarily for vaccines

2)ventrogluteal-first choice, good for large volume of med

3)vastus lateralis-used with pediatrics, good location for self administration

 

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