Term
Affected leg externally rotated
Affected leg shorter than unaffected leg
Unable to move (or very limited movement of affected leg
Pain |
|
Definition
|
|
Term
History of striking head
A fall or other event
No loss of consciousness at time of event
No immediate signs of injury
Within hours (variable time span)
Disorientation
Altered balance
Altered response
Somnolence
Lethargy |
|
Definition
|
|
Term
Intestinal obstruction
Signs
Abdominal pain
Emesis
Minimal passage of liquid feces (may be absent)
Altered bowel sounds
Hyperactive above the level of obstruction
Hypoactive below the level of obstruction
Late symptoms
Dehydration
Electrolyte imbalance
Pulmonary aspiration
Cardiac arrest
Death |
|
Definition
|
|
Term
Acute confusion and disorientation
Tachycardia
Hypotension
Tachypnea
Signs of dehydration
Fever may be absent |
|
Definition
|
|
Term
Anginal pain referred to atypical sites
Altered heart rate
Hypotension
Dyspnea
Acute confusion and disorientation
Apprehension |
|
Definition
|
|
Term
Signs
Anxiety (60% of cases)
Apprehension (“sense of impending doom”)
History of conditions or medical procedures known to have PE as a complication
Confusion, disorientation
Shortness of breath and tachypnea
Pleuritic pain
Cough with or without hemoptysis
Arrhythmias leading to hypotension and syncope |
|
Definition
|
|
Term
| ___% of PE clots start in legs, but only ___% display thrombophlebitis |
|
Definition
|
|
Term
Unexplained abdominal or lower back pain with a pulsatile mass in the abdomen
Both lateral and anterior pulsations
Onset of pain may be sudden
Later signs
Tachycardia
Hypotension |
|
Definition
| Abdominal Aortic Aneurysm |
|
|
Term
| ____% of AAAs have bruits. |
|
Definition
|
|
Term
Acute inflammation of cells within the lining of artery
Signs of temporal arteritis
Throbbing headache on the affected side
Temporal artery visibly swollen
Pain and inflammation around temporal area
Altered vision on affected side (sudden blindness, diplopia, blurring, transient field loss)
Jaw claudication (Jaw, tongue, swallowing)
Response: ER stat |
|
Definition
|
|
Term
Severe pain IN the eye
Conjunctiva redness
Excessive tearing
Extreme sensitivity to light |
|
Definition
|
|
Term
|
Definition
| Immediate referral to ER and ophthalmologist for medications to lower intraocular pressure |
|
|
Term
Involvement of eye
Scarring of cornea
Blindness
Involvement of ear
Loss of hearing
Facial scarring |
|
Definition
| Facial lesions r/t varicella zoster |
|
|
Term
| Response facial lesions varicella zoster. |
|
Definition
Prompt initiation of antiviral therapy
Corticosteroids may also be required.
Antibiotics may be needed if there is secondary infection |
|
|
Term
| Prevalence of depression in older adults. |
|
Definition
|
|
Term
| Why is there more chronic depression in older adults? |
|
Definition
|
|
Term
| Group at highest risk for suicide |
|
Definition
|
|
Term
Female gender
Lower socio-economic status
Separated, divorced, widowed
Family history of:
mood disorders
suicides
alcoholism
traumatic experience during early childhood
Are risk factors for what? |
|
Definition
|
|
Term
| An older adult comes in with suicidal comments and self neglect. What do you do? |
|
Definition
|
|
Term
| Mild chronic depression in older adults. |
|
Definition
|
|
Term
| Severe major depressive episode very responsive to ECT. |
|
Definition
| Depression c melancholic features |
|
|
Term
| This can mask symptoms of depression. |
|
Definition
|
|
Term
| How do you screen for late-life depression? |
|
Definition
| Geriatric depression scale, identify social supports, ask about mood & suicidal thoughts. |
|
|
Term
Respond to the feelings the person is having
Ask about intent to harm self |
|
Definition
|
|
Term
| Useful therapy for older adults c depression. |
|
Definition
| Reminiscence therapy; life review |
|
|
Term
| 4 Tx's for Late-life depression |
|
Definition
CBT
Interpersonal therapy
ECT
Antidepressants |
|
|
Term
| This medication should not be first-line depression treatment for older adults or anyone due to numerous side effects. |
|
Definition
|
|
Term
sedation, dry mouth, constipation, paralytic ileus, weight gain, cognitive impairment
potentiates antihypertensive drugs, causes priapism, postural hypotension & reflex tachycardia
What drug causes this and why? |
|
Definition
|
|
Term
| Antidepressant that only takes a weeks meds to OD on. |
|
Definition
|
|
Term
| This class of antidepressants is more expensive than TCAs but has less side FX. Possible side FX include excitation/jitteriness, insomnia, EPS, GI disturbances, sexual dysfunction |
|
Definition
|
|
Term
| What dietary substance can SSRIs interact with to cause overstimulation, jitteriness & insomnia. |
|
Definition
|
|
Term
| 5 common SSRIs for older adult |
|
Definition
fluoxetine (Prozac)
paroxetine (Paxil)
sertraline (Zoloft)
citalopram (Celexa)
fluvoxamine (Luvox) |
|
|
Term
| May be beneficial for pts non-responsive to SSRIs |
|
Definition
|
|
Term
| What is the best thing you can do to prevent infection? |
|
Definition
Soap and water. Soap. Water. Hot water. Just soap and water. Please. Soap and water.
:) |
|
|
Term
Enhances sleep, rapidly reduces anxiety
Lacks significant potential for orthostatic or anticholinergic symptoms |
|
Definition
|
|
Term
| A patient is non-responsive to Zoloft. What is the next course of treatment. |
|
Definition
| DC Zoloft, find a new antidepressant to try. |
|
|
Term
| Anti-manic agents in combo c antidepressants. |
|
Definition
|
|
Term
| Thyroid hormone meds in combo c anti-depressants |
|
Definition
|
|
Term
| Stimulant used c anti-depressants. |
|
Definition
| methylphenidate (Ritalin) |
|
|
Term
Headache, dizziness
Sedation or insomnia
Nervousness, anxiety
Dry mouth
Constipation, urine retention
Orthostatic hypotension
Are common side FX of what meds? |
|
Definition
|
|
Term
| Your patient was started on Zoloft three weeks ago. She has also been taking St. Johns Wort because the Zoloft wasn't working. She presents to the ER with diaphoresis, BP 170/110, n/v and muscle rigidity. What does she have? What do you do? |
|
Definition
Serotonin Syndrome
Mild-mod sx. decrease or DC drug & in 24-72 hours sx. usually resolve
Severe-close monitoring, IV fluids, seizure precautions, for hyperthermia use cooling blanket or Dantrolene Sodium (Dantrium) (eliminates excess CA in the muscles which helps decrease temp).
Benzodiazepines
Clonazepam for myoclonus (twitching/spasm)
Lorazepam for restlessness/agitation
Life threatening cases may need tx of hypo or hypertension, paralytic agents, ventilator, renal dialysis |
|
|
Term
Preservation of muscle strength
Increased aerobic capacity
Greater bone density
Greater mobility
Greater independence
Are benefits of what for the elderly (and everyone)? |
|
Definition
|
|
Term
| Inactivity leads to negative ________ balance, loss of muscle mass, _______ extraction (osteopenia/porosis) and altered lipid metabolism. |
|
Definition
|
|
Term
Disability
Institutionalization
Loss of independence
Isolation
Depression
Iatrogenic complications
Dehydration
Pneumonia
Contractures
Pressure ulcers
Constipation
Incontinence
Hypothermia |
|
Definition
| Consequences of Immbolity |
|
|
Term
| ____ of older adults fall each year. |
|
Definition
|
|
Term
| Unintentionally coming to rest on a lower area such as the ground or the floor |
|
Definition
|
|
Term
| ____ of those who fall will fall repeatedly. |
|
Definition
|
|
Term
| ___% of hospitalized patient will fall, __% of nsg home residents will fall. |
|
Definition
|
|
Term
| Leading cause of death from injury in older adults. |
|
Definition
|
|
Term
| Falls and consequences lead to ___% of nsg home admissions annually. |
|
Definition
|
|
Term
| What instrument do you use to assess fall risk? What components does this include? |
|
Definition
Hendrich II Fall Risk Model
Confusion/disorientation
Depression with symptoms
Altered elimination
Dizziness/vertigo
Male gender
Any administered antiepileptics
Any administered benzodiazepines |
|
|
Term
| Disorders affecting mobility |
|
Definition
Any orthopedic disorders
Osteoporosis
Gait disorders
Parkinson’s disease
Stroke
Arthritis
Debility |
|
|
Term
| ________ osteoporosis is associated with aging. |
|
Definition
|
|
Term
| Secondary osteoporosis is associated with _____ or _______. |
|
Definition
Diseases (hyperthyroidism, hyperparathyroidism, neoplasms, alcoholism)
Medications (corticiosterioids, phenytoin, heparin) |
|
|
Term
| How do you Dx osteoporosis |
|
Definition
|
|
Term
| Between 1 & 2.5 SDs < avg bone density of 30 year old |
|
Definition
|
|
Term
| >2.5 SDs < avg bone density of 30 yo |
|
Definition
|
|
Term
Low body weight
Low calcium intake
Estrogen deficiency
Low testosterone
Sedentary
Use of steroids
Use of anticonvulsants
Excess coffee intake
Excess alcohol intake
Current cigarette smoking
Female
Caucasian
Northern European
Advanced age
Family history
Are all risk factors for what? |
|
Definition
|
|
Term
|
Definition
| Bisphosphonates (Fosamax), Calcitonin, SERMs (Raloxifene), |
|
|
Term
| Dietary supplements Rx Osteoporosis |
|
Definition
|
|
Term
| Lifestyle Tx osteoporosis |
|
Definition
Wt. bearing exercise
Resistance training exercise |
|
|
Term
Due to joint Instability from arthritis
Due to neuropathy from diabetes
Due to vestibular disturbances
Due to medications
Orthostasis
Sedation
Extrapyramidal side effects |
|
Definition
|
|
Term
| This gait-disorder disease is caused by deficiency of Dopamine |
|
Definition
|
|
Term
| Sx parkinsonism that lead to gait problems. |
|
Definition
Bradykinesia
Resting Tremor
Rigidity
Abnormalities of posture |
|
|
Term
| Complications of parkinsons |
|
Definition
Falls
Swallowing difficulties
Risk of aspiration pneumonia
Depression
Constipation
Sleep disturbances
May be related to medications |
|
|
Term
| very common, starts in middle age. Non-crippling but slows down. Not a lot of inflammation; aches. Heberden’s nodules on most distal joint |
|
Definition
|
|
Term
|
Definition
| Low-impact exercises, warm joints, NSAIDS if inflammation |
|
|
Term
| may flare c dehdration r/t inc. uric acid. Tophii – uric acid crystal deposits |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Arthritis like conditions affecting bursa or tendons |
|
Definition
|
|
Term
|
Definition
Joint protection
Rest
Non-pharmacologic measures
Medication to reduce inflammation
Medication to relieve pain |
|
|
Term
|
Definition
|
|
Term
| Looks like stuck on skin. Not serious |
|
Definition
|
|
Term
| Skin problem CHF/edema, topical ointments. |
|
Definition
|
|
Term
| Your patient has stasis dermatitis. What do you tell them not to do? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| _______ may be accompanied by pruritis. Affects 59-85% of older adults. |
|
Definition
|
|
Term
| Prevent this skin problem by consuming adequate fluids, avoiding hot H20 & soap & perfume. |
|
Definition
|
|
Term
| Benign superficial skin lesion waxy, raised, verrucous (warty), flesh-colored or pigmented with a “stuck on” appearance. |
|
Definition
|
|
Term
| This skin condition has a risk of infection (cellulitis). |
|
Definition
|
|
Term
Chronic inflammatory eczematous dermatitis of legs
Associated with chronic venous insufficiency, edema, varicose veins, hyperpigmentation |
|
Definition
|
|
Term
| This skin problem is a reactivation of dormant prior infection with varicella. |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Why must you give antiviral meds quickly with shingles? |
|
Definition
| prevents postherpetic neuralgia (damage to the affected nerves=pain) |
|
|
Term
| Emergency shingles situation |
|
Definition
| lesions on the face – worry about scarring of eye and blindness. |
|
|
Term
| Shingles rash follows the ________ and affects only one side of the body. |
|
Definition
|
|
Term
|
Definition
|
|
Term
– dry, red. Area that’s been sun exposed.
Pre-cancerous |
|
Definition
|
|
Term
| Metastasis of non-melanomatous skin cancers. |
|
Definition
|
|
Term
| most serious non-melanomatous skin cancer & hardest to stop. Raised lesions (big pimples, often pinkish in color, ulcers on top that don’t heal. Get bigger) Can metastasize. |
|
Definition
|
|
Term
| Mean skin cancer. Can be VERY fast and happen at any age. (this means you sophia and kayley, sitting in the sun all day ;) |
|
Definition
|
|
Term
Older age
Light eyes
Light skin
Light hair
Poor ability to tan
Substantive cumulative lifetime sun exposure
These increase your risk of what kind of cancer? |
|
Definition
| Non-melanomatous skin cancers |
|
|
Term
|
Definition
Superficial spreading melanoma
Lentigo maligna
Acral lentiginous malanoma
Nodular melanoma |
|
|
Term
| ABCDs of melanoma (RAPID metasasis) |
|
Definition
Asymmetry
Border Irregularity
Color (Not uniform, multiple shades)
Diameter |
|
|
Term
| Why are older adults at increased risk of pressure ulcers? |
|
Definition
Age-related changes to epidermis, dermis & SQ tissue.
Comorbidities |
|
|
Term
| Nsg intervention to prevent pressure ulcer formation. |
|
Definition
| Always provide additional protection for skin (zinc cream, keep heels off bed, specialty mattress, frequent assessments) |
|
|
Term
| Most popular skin assessment. |
|
Definition
|
|
Term
| Basic calorie needs _____-_______. Minimum calories per day _______. |
|
Definition
|
|
Term
|
Definition
Multiple Vitmain
1500 mg Ca++
WATER |
|
|
Term
| Amt H20 older adults should have per day |
|
Definition
1500-2000 mL
6-8 eight ox glasses |
|
|
Term
| Should older adults have caffeinated beverages as part of their fluid count? |
|
Definition
|
|
Term
| Amt ETOH for older adults per day is ___ for women and ___ for men. |
|
Definition
|
|
Term
| Useful online resource for nutrition |
|
Definition
|
|
Term
Age
Common aging changes
Medications
Dependency
Functional impairments
Institutionalization
These are predisposing factors for what? |
|
Definition
|
|
Term
| Diminished water intact and pathologic fluid losses cause what type of dehydration? |
|
Definition
|
|
Term
| Greater losses of sodium than water cause this type of dehydration. |
|
Definition
|
|
Term
| Depletion of water and sodium causes this type of dehydration. |
|
Definition
|
|
Term
|
Definition
Dry mucous membranes
Oliguria/anuria
Hypotension (orthostasis)
Tachycardia
Fever
AMS
Electrolyte imbalances |
|
|
Term
Dry Skin
Constipation
Electrolyte imbalance
Thromboembolism
Peridontal sepsis
Poor clinical outcomes
Increased mortality
These are consequences of what? |
|
Definition
|
|
Term
| Interventions to prevent/treat dehydration. |
|
Definition
Make beverages accessible esp favorite beverages and limit caffeine/etoh.
Encourage drinking between meals
Encourage drinking full glass of water with meds.
Check meds
Avoid NPO status if possible. |
|
|
Term
| Your patient is incontinent in the hospital and at risk for dehydration. What should you NEVER do? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Nsg diagnoses for malnutrition. |
|
Definition
| Imbalances nutrition (more/less than body reqs) related to ..... |
|
|
Term
Sx undernutrition:
BMI < ___.
Unintentional wt loss >__% in 6 mo.
Serum albumin <___ mg/dl.
Cholesterold <____ mg |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Malnutrition risk factor treated by speech therapy. |
|
Definition
|
|
Term
| Causes malnutrition in hospital |
|
Definition
|
|
Term
| Consequences of malnutrition |
|
Definition
Delayed Recovery
Pressure Ulcer
Longer hospital stay
Increased mortality rate
Increased readmission rate |
|
|
Term
|
Definition
| [wt in lbs/ht in inches^2] x 704.5 |
|
|
Term
| What should you do if your pt has a BMI <22. |
|
Definition
| Consider adding nutritional supplementation |
|
|
Term
| What should you do if your pt has a BMI >27? |
|
Definition
| Screen for Type II DM, CVD, HTN |
|
|
Term
| What is the only correct way to confirm NG tube placement? |
|
Definition
|
|
Term
| If your patient is on a TF and has diarrhea what could be the cause? |
|
Definition
| Rate too fast, formula could be too rich, bacteria |
|
|
Term
| You come into a room and the patients HOB is 10 degrees. The patient is on a running tube feed. What do you do. |
|
Definition
| Raise HOB to at least 30 degrees. |
|
|
Term
| Injuries caused by NG tubes. |
|
Definition
Erosion of nasal mucosa
Nosebleeds
Ulceration of pharynx |
|
|
Term
| This kind of tube can have leakage, cause abscesses and cutaneous granulation |
|
Definition
|
|
Term
| What is the best position to eat in to prevent aspiration? |
|
Definition
| Avoid eating in bed or if in bed HOB 90 degrees. Chin on chest position. |
|
|
Term
| Interventions to prevent aspiration when feeding a patient at risk. |
|
Definition
Provide thickened liquids (swallow study)
If there is a strong side/good side of the mouth place food on that side.
SLOW DOWN and be patient |
|
|
Term
| Involuntary leakage of urine |
|
Definition
|
|
Term
| Urinary Incontinence is just a normal part of aging. |
|
Definition
| FALSE, it is never normal. A reason for incontinence must always be IDd |
|
|
Term
| Elderly women mostly, coughing or sneezing or laughing. Intraabdominal pressure > support given to base of bladder & neck of urethra. Usually a small amount. Obese, pregnant women at greater risk |
|
Definition
|
|
Term
| Basic Txs Stress incontinence. (exercise/dietary) |
|
Definition
| Kegel exercises, Start early! Decrease ETOH and caffeine. |
|
|
Term
| If women are perimenopausal and experiencing stress incontinence what is a simple treatment? |
|
Definition
| Estrogen cream (topical applied to vagina) |
|
|
Term
| ring that goes into vagina and supports the cervix & uterus so they don’t fall down (Tx Stress incontinence) |
|
Definition
|
|
Term
| Surgical Tx stress incontinence |
|
Definition
|
|
Term
| Oops gotta go gotta go. Excessively active bladder muscles. Urges to go. Can be overwhelming. Amt of urine lost can be large. |
|
Definition
|
|
Term
| Most common Rxs Urge incontinence |
|
Definition
| Anticholinergics: Ditropan (Oxybutynin); Probanthine |
|
|
Term
| What commonly causes bladder spasms in the hospital? |
|
Definition
|
|
Term
| Your patient is stressed out because they feel like they have to pee but they know they have a catheter in. What do you tell them? |
|
Definition
| The balloon of the catheter presses on the nerves that typically tell your bladder when it is full. This is a normal experience. |
|
|
Term
| Common causes of urge incontinence. |
|
Definition
| Bladder infection, dehydration, caffeine/ETOH |
|
|
Term
| Lifestyle Rx urge incontinence |
|
Definition
| Dilute urine & void Q2 hrs |
|
|
Term
| Bladder is never completely emptied. Tends to be constantly wet and can be high in volume. High bacterial counts in urine, chronic UTIs, high risk of ascending to kidneys, skin breakdown. Not very common |
|
Definition
|
|
Term
| Possible cause overflow incontinence |
|
Definition
| Neurological (eg diabetic damage) |
|
|
Term
| Interventions for overflow incontinence |
|
Definition
Scheduled voiding
Crede maneuver (Pressure over bladder)
Incontinence brief |
|
|
Term
| Common kind of urinary incontinence. Physically cannot get to the bathroom in time. |
|
Definition
|
|
Term
| Interventions functional urinary incontinence. |
|
Definition
| Regular schedule, bring BSC or urinal to patient frequently. |
|
|
Term
| This type of urinary incontinence is caused by meds eg. diuretics, sedatives, IVF. |
|
Definition
|
|
Term
| Best intervention iatrogenic urinary incontinence |
|
Definition
|
|
Term
| DRIP acronym for Transient (Acute) Incontinence |
|
Definition
D (Delirium, depression, dementia, dehydration)
R (Restricted mobility, retention)
I (Infection, inflammation, impaction (fecal))
P (Polyuria, pharmaceuticals) |
|
|
Term
| How long should foleys be used for? |
|
Definition
|
|
Term
|
Definition
Infection
Discomfort
Cost (Equipment/labor) |
|
|
Term
| Non-pharmacological interventions for constipation |
|
Definition
Fluids
Fiber
Exercise
Environmental manipulation
Bowel Training Program |
|
|
Term
| Complication of Constipation |
|
Definition
|
|
Term
|
Definition
Soften (Oil retention enema)
Removal (Cleansing enema, suppository, digital extraction) |
|
|
Term
Fecal impaction
Diarrhea
Inability to access toilet facilities
Weakened pelvic floor musculature
Neurologic changes affecting rectal sensation or sphincter control |
|
Definition
| Causes bowel incontinence |
|
|
Term
|
Definition
Interruption of blood flow to section of small intestine
Interruption of neurological stimulation to section of small intestine.
Cessation of peristalsis in affected section. |
|
|
Term
| Ileus is an ________. The treatment is usually ________. |
|
Definition
|
|
Term
| Signs of bowel obstruction. |
|
Definition
Abdominal pain/ distention.
Hyperactive BS above and hypoactive BS below
N/v (projectile)
Small amts brown liquid from rectum |
|
|
Term
| Complications of bowle obstruction. |
|
Definition
Electrolyte imblance
Cardiovascular collapse
Death |
|
|
Term
| Lightest level of sleep stages, easy to awaken. |
|
Definition
|
|
Term
| The amount of these sleep stages decreases or ceases with age. |
|
Definition
|
|
Term
| In stage IV of sleep the amount decreases with age but it still accounts for __% of sleep. |
|
Definition
|
|
Term
| This stage of sleep is characterized by faster breathing, relaxed muscles and dreaming. |
|
Definition
|
|
Term
| ____ sleep may be decreased in dementia. |
|
Definition
|
|
Term
| In the elderly total sleep time is ______; there are periods of subdued ______ and they have a lower ___. |
|
Definition
|
|
Term
| There is less resilience for sleep in older adults after _______ disturbances. |
|
Definition
|
|
Term
| Types of sleep disturbances (4) |
|
Definition
Insomnia
Sleep apnea (central or obstructive)
Nocturnal myoclonus
Restless leg syndrome |
|
|
Term
Difficulty falling asleep initially
Difficulty falling asleep after getting up during night
Waking early and being unable to fall back asleep |
|
Definition
|
|
Term
| Sleep assessment tool by Bysse et al. (1989() (Good assessment questions, complicated scoring ) |
|
Definition
| Pittsburgh Sleep Quality Index |
|
|
Term
| Issues to address if older adult is having trouble sleeping at night. |
|
Definition
Warm or cold
Thirst or hunger
Pain
Noise and light
Bed time rituals |
|
|
Term
| Things to avoid to get a good nights sleep |
|
Definition
Sedatives & Hypnotics
ETOH
Caffeine
Excessive Fluids
Strenuous exercise |
|
|
Term
| Repetitive cessation (>10s) of breathing during sleep. |
|
Definition
|
|
Term
| Sleep apnea causes a diminished what? |
|
Definition
|
|
Term
| Increased risk of heart attack, cardiac arrhythmias, stroke, depression, accidents are associated with what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Obstructive sleep apnea is diagnosed in ___% elderly. |
|
Definition
|
|
Term
| Male gender, obesity, enlarged tonsils/uvula, thick neck and upper airway tumors or cysts are risk factors for what? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Your patient comes into the ER and says he thinks he has narcolepsy because he is so sleepy during the day. He has headaches when he wakes up every morning and has hypertension. His wife says he snores really loudly. What is his probable diagnosis? |
|
Definition
|
|
Term
| Periodic Limb movement syndrome. Leg movements occur while asleep. This is disturbing to bed partners and treated with meds. |
|
Definition
|
|
Term
| Patient needs to move (motor restlessness). Symptoms are made worse by rest. There are associated paresthesias. Treated with medications. |
|
Definition
|
|
Term
| An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage |
|
Definition
|
|
Term
| Pain that comes from skin or close to surface of the body. Surface pain. |
|
Definition
|
|
Term
| Pain that comes from the internal organs, skeleton, abdomen etc. Deep pain |
|
Definition
|
|
Term
| Pain in an area distant from point of origin. |
|
Definition
|
|
Term
| Pain processed by a normal nervous system eg sprains, bone fractures, burns & bruises. |
|
Definition
|
|
Term
| Nociceptive pain is responsive to treatment with what drug class? |
|
Definition
|
|
Term
| Result of an injury or malfunction in the peripheral or central nervous system. e.g. post herpetic neuralgia, peripheral neuropathy |
|
Definition
|
|
Term
| Neuropathic pain is less responsive to opioids but may respond well to what? |
|
Definition
|
|
Term
Education
Cognitive/behavioral therapy
Exercise
Positioning
Neurostimulation
Chiropractic
Aroma therapy
Music therapy
Art/drama therapy
Support groups
Prayer, meditation, relaxation
Hypnosis
Biofeedback |
|
Definition
| Complementary Therapies for Pain |
|
|
Term
Pain is a natural outcome of growing old & not much can be done about it.
Pan sensitivity decreases with age.
If a resident doesn’t report pain, he does not have pain
People with dementia do not feel pain & their reports of pain are most likely not true. |
|
Definition
|
|
Term
Fear of admitting weakness
Fear of addiction
Fear of side effects
Not wanting to “trouble” staff
Fear of painful, invasive, or costly followup tests
Fear of a loss of independence. |
|
Definition
| Barriers to self report of pain |
|
|
Term
| Tool used for pain assessment in dementia patients. |
|
Definition
| PAINAD (breathing, vocalization, facial expression, body language, consolability) |
|
|
Term
| Mild pain Tx (WHO Analgesic ladder) |
|
Definition
| Non-opioid +/- adjuvant (depakote, elavil (TCA)) |
|
|
Term
|
Definition
Weak opioid (codeine) + non opioid
+/- adjuvant |
|
|
Term
| Moderate to severe pain Tx |
|
Definition
Strong opioid (morphine) +/- non opioid
+/- adjuvant |
|
|
Term
|
Definition
| Sedation, constipation, dry mouth, |
|
|
Term
Cigarette smoking or tobacco use
Excessive alcohol intake
Sedentary lifestyle
Inadequate stress/anger management
High-sodium diet
High-fat diet |
|
Definition
| Modifiable risk factors for HTN |
|
|
Term
Unmodifiable
Age, gender, heredity, ethnicity
Modifiable
Smoking, stress, obesity/diet, physical inactivity |
|
Definition
| Risk factors for Coronary Heart Disease |
|
|
Term
| Treatable aspects of coronary heart disease. |
|
Definition
Diabetes
HTN
Hyperlipidemia |
|
|
Term
Light-headedness or dizziness
Disturbances in gait and balance
Loss of appetite or unexplained weight loss
Inability to concentrate or shortened attention span
Changes in personality
Changes in grooming habits
Unusual patterns in urination or defecation
Vague discomfort, frequent bouts of anxiety
Excessive fatigue, vague pain
Withdrawal from usual sources of pleasure |
|
Definition
| Signs of Potential Coronary Heart Disease Exacerbation |
|
|
Term
Chronic cough
Insomnia
Weight loss
Nocturia
Syncope
Plus, fatigue, shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, edema, weight gain.
Delirium
Falls
Anorexia
Decreased functional capacity |
|
Definition
| Atypical signs for heart failure |
|
|
Term
|
Definition
| Intermittent Claudication |
|
|
Term
|
Definition
|
|
Term
| Its like angina of the brain |
|
Definition
|
|
Term
| Embolic CVD is secondary to what? |
|
Definition
|
|
Term
Sudden weakness or numbness (one-sided)
Dimness or loss of vision in one eye
Slurred speech, loss of speech, difficulty comprehending
Dizziness, difficulty walking, loss of coordination, loss of balance, a fall
Sudden severe headache
Difficulty swallowing
Sudden confusion
Nausea and vomiting |
|
Definition
|
|
Term
| Increased intraocular pressure |
|
Definition
|
|
Term
| Eye disorder caused by diabetes |
|
Definition
|
|
Term
| Clouding that develops in the lens of the eye. |
|
Definition
|
|
Term
| Loss of vision in the center of the eye |
|
Definition
|
|
Term
| Insufficiency with diminished or absent pedal pulses |
|
Definition
|
|
Term
| Insufficiency where edema is absent |
|
Definition
|
|
Term
| Insufficiency with thin, shiny skin |
|
Definition
|
|
Term
| Leg elevation in arterial insufficiency causes _____. |
|
Definition
|
|
Term
| Wounds are irregularly shaped and shallow in this kind of insufficiency. |
|
Definition
|
|
Term
| Pedal pulses and skin temp are normal but edema is present in this type of insufficiency. |
|
Definition
|
|
Term
| Leg elevation in this insufficiency relieves pain. |
|
Definition
|
|
Term
Fatigue
Weakness
Depression
Confusion |
|
Definition
| Hypothyroidism in older adults |
|
|
Term
Palpitations
Excessive sweating
Visual disturbances
Decreased appetite
Weight loss
Agitation
Heart failure
Angina
Edema
Tachycardia
Tremors
Confusion |
|
Definition
| Hyperthyroidism in older adults |
|
|
Term
| Why are elderly people more susceptible to GERD? |
|
Definition
| age can weaken the esophaegal sphincter. Other consequences of advanced age that can also contribute to GERD include: loss of esophageal sphincter tone, reduced saliva production, increased production of stomach acid and delayed gastric emptying. |
|
|
Term
| Best interventions for elderly c GERD. |
|
Definition
|
|
Term
| CBE every 3 years for women in 20s and 30s; Mammography yearly for women ≥40 with annual CBE; No upper age limit suggested. |
|
Definition
| Breast exam recommendations ACS |
|
|
Term
| Yearly regular Pap test beginning latest age 21. At age 30, change to every 2-3 years if had 3 normal Pap tests in a row stopping at age 65 |
|
Definition
| Pap smear recommendations |
|
|
Term
| FOBT yearly OR flexible sigmoidoscopy every 5 years OR colonoscopy every 10 years starting at age 50 and continuing until age 75 (unless a primary relative was diagnosed with colorectal cancer <60, then screen earlier) |
|
Definition
|
|
Term
| Yearly digital rectal exam (DRE) as part of yearly physical |
|
Definition
| Prostate exam recommendations |
|
|
Term
| Exercise stress testing in selected men >45 and women >55 with multiple cardiac risk factors or diabetes and discuss aspirin chemoprevention in high risk patients; no upper age limit suggested |
|
Definition
|
|
Term
| BP reading every 2 years in all adults if <120/80, otherwise yearly |
|
Definition
|
|
Term
| Routine screen (TC and HDL-C) in women >45 if at increased risk of CHD and all men >35 |
|
Definition
| Dyslipidemia recommendation |
|
|
Term
| All adults screened for obesity (BMI >30kg/m2) and offer counseling and behavioral interventions; No upper age limit sug- gested |
|
Definition
|
|
Term
| Adults ≥ 45 and repeated every 3 years with fasting blood sugar; more frequently if high risk; no upper age limit suggested |
|
Definition
| Diabetes screening recommendation |
|
|
Term
Signs
Weight loss
Fever
Cough lasting more than 3 weeks
Night sweats
General anxiety |
|
Definition
|
|
Term
| Signs: Abrupt onset fever, chills, headache, myalgias, arthralgias, malaise, respiratory symptoms |
|
Definition
|
|
Term
Signs: Rales, consolidation over involved area
Usual signs: Productive cough, fever,
Geriatric signs: tachycardia, confusion |
|
Definition
|
|
Term
|
Definition
|
|
Term
Linear distribution of vesicles
Clear fluid
Erythematous bases
Dermatomal distribution |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Influenza vaccine should be given annually, pneumococcal vaccine should be given once if given after age ___. |
|
Definition
|
|
Term
| Varicella Zoster vaccine should be given ____ after age 60. |
|
Definition
|
|
Term
| Quality of life dimensions |
|
Definition
Physical
Psychological
Social
Spiritual |
|
|
Term
Functional ability
Strength/fatigue
Sleep and rest
Nausea
Appetite
Constipation
Pain |
|
Definition
|
|
Term
Anxiety
Depression
Enjoyment/leisure
Pain distress
Happiness
Fear
Cognition/attention |
|
Definition
|
|
Term
Financial burden
Caregiver burden
Roles and relationships
Affection/sexual function
appearance |
|
Definition
|
|
Term
Hope
Suffering
Meaning of Pain
Religiosity
Transcendence |
|
Definition
|
|
Term
Regards death as a normal process
Neither speeds up death nor delays it
Provides relief from pain
Provides relief from other distressing symptoms
Integrates psychological and spiritual aspects of care
Offers a support system to patients and their fam |
|
Definition
|
|
Term
To be free from pain
To be at peace with God
To have the presence of family
To be mentally aware
To have their treatment choices followed
To have finances in order
to feel life was meaningful
To have conflicts resolved
To be able to die at home |
|
Definition
| What pts want at the end of life |
|
|
Term
| What you can do to help families of dying patient |
|
Definition
Kept me informed
Asked how I was doing
Put an arm around me when I cried
Brought me food
Knew my name
Cried with me
Put a bed for me in the room (with the patient)
Told me to hold the patient’s hand
Held my hand
Got the chaplain
Let me participate in care (of the patient)
Stayed with me after their shift was over |
|
|
Term
Comfort measures
Life expectancy of 6 months or less
Care relieves symptoms; curative care is not continued
Interdisciplinary team
Medicare |
|
Definition
|
|
Term
Comfort measures
Not related to life expectancy
Curative care as well as comfort care
Interdisciplinary team
Usual 3rd party payers of health care |
|
Definition
|
|
Term
Is in ICU with documented poor or futile prognosis
Has family support needs or communication challenges
Has a life-limiting illness and has chosen not to have life-prolonging therapy
Has unacceptable pain for a period greater than 24 hours
Has uncontrolled symptoms (e.g., nausea, vomiting)
Has unresolved psychosocial or spiritual issues |
|
Definition
| Probable Candidates for Hospice |
|
|
Term
Skin coolness
Color (cyanosis, mottling)
Temperature change
Perspiration (clammy)
Increased sleeping
Disorientation
Incontinence
Altered breathing pattern
Restlessness
Decreased intake of food and fluids
Decreased urine output |
|
Definition
|
|
Term
Withdrawal
Vision-like experiences
Restlessness
Decreased socialization
Unusual communication
Out of character statements, gestures, requests |
|
Definition
| Emotional/Spiritual Sx of Dying |
|
|
Term
Note the time of death
Report to physician
Notify family
Family may want to come to hospital
Notify the coroner if policy requires notification
Follow institution’s policy for physical care of the body
Follow institution’s policy and family wishes for transport of body to mortuary |
|
Definition
|
|
Term
| Almost ___ of all hospital beds are filled by pts >65 |
|
Definition
|
|
Term
| __% of those >75 who are functionally independent before admission are not independent on discharge. |
|
Definition
|
|
Term
| __% of hospitalized older adults are D/Cd to Nsg homes. |
|
Definition
|
|
Term
| __% of patients admitted to nsg homes remain for >1 yr. |
|
Definition
|
|
Term
| Nsg home admissions are planned to be temporary however _____ older adults admitted to nsg homes never return to their own homes. |
|
Definition
|
|
Term
| __% of hospitalized pts have adverse drug rxns |
|
Definition
|
|
Term
Functional decline
Due to interaction of aging and stress of hospitalization
Immobility
Delirium
Falls
Sleep Disturbances
Malnutrition
Pressure ulcers
Restraint use
Incontinence
Transitional mistakes |
|
Definition
| Hazards of hospitalization |
|
|
Term
Decreased vasomotor stability
Reduced muscle strength and aerobic capacity
Decreased respiratory function
Reduced bone density
Fragile skin
Urinary incontinence
Altered taste, smell, thirst, dentition
Delirium |
|
Definition
| Effects of aging and hospitalization |
|
|
Term
| Discharge planning should be begun at ________. |
|
Definition
|
|
Term
Hypotension/hypovolemia
Hypothermia
Respiratory problems
Delirium
Pain
Fluid and electrolyte imbalance
Acid-base abnormalities
Nutritional deficiencies |
|
Definition
| Early post-op complications in elderly |
|
|
Term
Reduce hazards of hospitalization and their consequences
Patient-centered care emphasizing independence
Special environment
Nurse-driven prevention protocols
Interdisciplinary team rounds
Discharge planning from day of admission |
|
Definition
| ACE (Acute Care Elderly) Units |
|
|
Term
Hospitalization
Skilled Nursing Facility (post hospitalization)
Skilled nursing care
Skilled rehabilitation
Skilled home care (post hospitalization)
Hospice care |
|
Definition
|
|
Term
Outpatient services
Physician office visits |
|
Definition
|
|
Term
| Medications are covered by what? |
|
Definition
|
|
