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Promoting Optimal Function and Pt Safety in Older Adults
From Slides
26
Nursing
Undergraduate 1
04/06/2012

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Term
Identify Q/S measures relevant to the care of OA:
Definition
- Reduce r/o falls
- Reduce r/o skin tears
- Reduce r/o PU
Term
What immune system changes occur with aging?
Definition
-- LESS efficient at responding to new antigens [fewer niave T cells]
--Inability of immune cells to DIVIDE indefinitely
--Poor cell SIGNALLING [Ca2+ deficiency]
--Less able to fight infection
--Reactivation of LATENT infectious diseases
--Antibody response to VACCINES is slower and weaker so vaccinations less protective
Term
Ns actions to prevent PRESSURE ULCERS in OA:
Definition
- Assess skin and nutrition
- Prevent Friction
- POSITIONING: HOB 30 Degress OR LESS, avoid trochanter, keep bones apart, individualize repositioning time table
- PU reducing devices
- Evaluate/Doc intervention effectiveness
- provide education
- Bathing and pericare
Term
What are R/F for falls in OA?
Definition
-- advanced age
-- acute/chronic health conditions
--use of assistive devices
--altered mental status
--alt/ b/b fxn
--Cognitive and sensory impairments ESP BALANCE
--altered PROPRIOCEPTION
--Recent care site transition
--Medications (effect senses/hypotension/fluid balance)
--Delirium/depression/dementia, etc
Term
What are adverse outcomes from falls in OA?
Definition
- Fractures
- TMI
- Loss independence
- Decreased quality of life
- fear of falls
- DEATH
Term
What are the effects of aging on drug metabolism?
Definition
- Decrease in body WATER -> serum levels of water sol. drugs GOES UP
- Increased body fat increases half life of fat soluble drugs.
- Variable changes in first pass metabolism due to decreased hepatic blood flow
- Cytochrome P450=decreased drug clearance and INCREASED half life
Term
What are the demographics r/t aging and medication use?
Definition
--40% of prescriptions in US are for OA (>65)
--SNF means 4-6 meds per day
--AMBULATORY US ELDERS: 44% Men/57% of women taking 5+ medications, 12% taking 10, 47/57% taking vitamins and minerals, 11/14% taking CAM therapies
Term
What are common drug related problems in the elderly?
Definition
- **UNDERTREATMENT
-**Inappropriate prescribing
- **Adverse Drug Events
- Adherence
Term
What are some medications that are NOT appropriate for OA?
Definition
--ESP Anticholinergics (anti rest and digest...)
-- Benadryl
--Cyclobenaprine
Term
What is the difference between lab values and medication administration?
Definition
Term
How prevalent is complimentary and alternative medicine use in OA?
Definition
7%-11% of OA use CAM
Term
What are major interactions btw natural products and drugs commonly used by OA?
Definition
Warfarin, NSAIDS and ASA: garlic, ginko, gensing
--Cytochrome P450 3A4 metabolized drugs and St. John's Wart
-- Levothyroxine and Calcium must be staggered.
Term
What is the Ns' role in the older adults' adherence to medication regimen?
Definition
- Thorough Hx
- Start LOW go SLOW
- Consider nonpharmacologic approaches
- Streamline meds eliminate unecessary duplicates
- Provide info to pt AND family
Term
What are the atypical ways that OA present with INFECTION?
Definition
--ABSENCE of fever/afebrile
--Changes in MENTAL STATUS
--Decline in functional status
--Weight loss/Appetite loss
--New ONSET falls or incontinence
Term
Ns actions to prevent SKIN TEARS in OA (r/f what?):
Definition
Risk for cellulitis!!
-- Moisturize skin 2x daily
--Sleeves/Pants
-- Paper tape/non-tape options
--adequate lighting, hydration and nutrition
Term
Name some drugs that increase risk of falls?
Definition
Digoxin
Diuretics (makes them have to pee)
Anticholinergics
Term
What should you do if there IS a fall?
Definition
- Take their BP (assess!)
- Notify/communicate RE the fall
- Monitor and reassess
- DOCUMENT
Term
What is NOT impaired in drug metabolism in OA?
Definition
- Absorption is not impaired
Term
What is a good marker for GFR Cr serum or Cr clearance?
Definition
Cr CLEARANCE
Term
In what direction does the Cr-Gault equation estimate Cr Clearance in frail elders (AGE-WGT-GENDER)?
Definition
Can OVER estimate Cr Clearance.
Term
Alcohol effects are _______ in older adults (weaker/stonger)?
Definition
STRONGER, also ACEI's, Opiates, benzodiazapines, theophyllines)
Term
T/F Many of the sx of ADE are very similar to the common signs of aging?
Definition
TRUE
Term
What are the goals for Pt safety measures?
Definition
1. Improve INDIVIDUAL pt care
2. Improve population level health
3. Decrease unnecessary costs
Term
What are the four steps in developing a Root Cause Analysis?
Definition
1. Identify a problem statement
2. Identify a list of causes for each branch of the fish
3. Indicate RELATIONSHIPS btw causal chains
4. Develop causal statements.
Term
What other changes impact immunity in OA?
Definition
- Impaired SKIN integrity
- RESPIRATORY: Weak respiratory muscles/decreased chest expansion/poor ability to cough/decreased effectiveness of tracheobronch cilia/increased residual vol
- Increased risk ASPIRATION
- Weak BLADDER and residual volume
- Presence of chronic conditions can exacerbate infection
Term
What are the overall immune changes with OA given the decreased immune response and other factors?
Definition
- Less able to fight infection (they last longer)
- Reactivation of latent infectious diseases (Like TB)
- Antibody response to vaccines is slower and therefore less protective
...AT INCREASED RISK OF INFECTIOUS DISEASE WITH AGE.
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