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What are the five most common co-morbidities for older adults?
- Type II diabetes
- Heart Disease
List some deciding factors for treatment. What is not a deciding factor?
- What the pt wants
- Co-morbid conditions and the likelihood of response to treatment, will the other conditions cause them to die soon anyway?
- Functional status and quality of life
- Age is NOT a deciding factor
T/F: Normal aging does not lead to disease; diseases accelerate common disorders of aging.
Health promotion and staying healthy is what level of prevention? What level is getting better? What level is living will and coping with illness?
primary, secondary, tertiary
What types of drugs are on the Beers list of OA and cause many ED visits each year?
Warfarin, insulin, antiplatelets, and hypoglycemics
List four vaccines recommended for OA.
- Herpes zoster to prevent shingles
- Pneumococcal vaccine to prevent lung, bloodstream and brain infection
- Flu shot
- DPT to prevent tetanus, diphtheria and pertussis
What do parts A,B,C,D cover in Medicare?
- A: Hospitalization
- B: Medical insurance
- C: Private insurance
- D: prescription drug coverage
What is medicaid?
poor people of any age
In a hospital, what needs of the OA do we treat first, unless in an Emergency situation?
the expressed need, pain, anxiety, fear
What is the largest cause of unintentional injury at home?
What is an Adverse Event?
An Adverse Event is an event in the hospital that causes harm to a pt due to medical care. Think Infections.
What three questions should the older adult learn to ask?
- What is my main problem?
- What exactly do I need to do?
- Why is it important for me to do this?
What is the nature of most nurse-client relationships?
Professional and time-limited
What are the two most common signs of illness in OA?
Confusion and falls
-ostomy vs. -otomy vs. -ectomy
- -ostomy: creation of an opening
- -otomy: cutting into or incision of
- - ectomy: excision or removal of
How long do we stop warfarin b/f sx?
What factors need to apply for consent to be legal?
- Disclosure of benefits and risks
- Pt understanding
- Voluntary and can be withdrawn at any time
What is INR and what is a normal range vs. range for most pts. What drug do we look at INRs with?
INR is used with warfarin, a vitamin K antagonist. It represents clotting time; normal clotting time is 1-1.5, with pts we want between 2-3. A lower number means blood is too think and pt needs larger dose. A higher number means blood is too thin and we need a smaller dose. Warfarin does not act in coagulation factors already made, so the effect takes a few days. INR is a ration of pts time : 1(normal clotting) can be 2-5.1:1 for therapeutic depending on who is asked.
Activated Prothromboplastin time: used for IV heparin. normal is 40. Therapeutic for pts is 40-80 seconds
What does JCAHO mandate pre-sx in the OR?
Review prodedure, mark the site, time out
Which anesthesia is deepest? Which is medium, what drugs are used for medium anesthesia?
General anesthesia results in insensate. Regional is typically a "caine" agent near a nerve, like a block or epidural.
When would we use a conscience anesthesia?
When we need to pt to participate, such as a -scopy procedure.
When assessing the respiratory system immediate post-op, what is it important to balance?
pain vs. resp depression
Describe the nursing interventions for respiratory depression immediate post-op.
Encourage slow, deep inhalations through the nose and exhalations through pursed lips (this ↑ intrathoracic pressure and prevents alveolar collapse), use incentive spirometry.
What do we look at to assess the cardiovascular system immediate post-op?
- VS, urine output, skin findings, pulse and I/O
- Also look at EBL (estimated blood loss and blood type and cross)
What position should the pt be in 0-4hr post op? Why? What is they have obstruction risk or your hear loud snoring?
- Semi-fowlers to expand the thorax
- lay on side if airway obstruction, could be the tongue
If a pt has extremity surgery of any type, what do we need to check?
Pulse for perfusion, check cap-refill too.
Sedation and Delirium are normal coming out of sx. If pt has delirium what should we check first?
O2 levels, low O2 is most common cause of waking up mean
When should we see the first urinary voiding occur post-op?
Describe pain relief 4-24 hours post-op
IV opioid x 24hr (PCA best), oral opiods x 24hr (variable strength hydrocodone with APAP, then transition to non-opioids.
Will aspirin help DVT? Why or why not?
No, aspirin is arteriole, DVT are venous
Describe 4-24 hr post op care for atelectasis and pneumonia.
- OOB to chair
- Splint to cough if ab sx
- Ambulate in 24 hours unless contraindicated
- Slow deep breathing with incentive spirometer
Describe 4-24 hr post-op care to reduce rish of DVT or PEs
- be generous with fluids
- lower leg exercises, foot pumps, foot circles, ambulation is they can
- TED or SED
- SubQ heparin or dalteparin with 25 x 1/2
Does right or left ventricular failure cause pulmonary edema?
Why is is so important to treat atelectasis?
Because w/o treatment it can turn into pneumona when microbes grow in the stagnant mucus and an infection develops.
How does sputum from the trachea differ than sputum from the lungs and bronci?
Sputum from trachea is usually think and colorless, sputum from lungs/bronchi is usually thicker and a bit yellow.
List some respiratory ND for a post-op pt.
- Ineffective airway clearance
- Ineffective breathing pattern
- Impaired gas exchange
- Risk for aspiration
- Potential complication: hypoxia, pneumonia, atelectasis
List two drains that work by negative pressure, list two that work by gravity
- Neg-pressure: JPratt, Hemovac
- Gravity: Penrose and T-tube
What does evisceration mean?
When internal organs protrude through a wound.
List three nursing management techniques for N/V.
- NPO until bowel function returns (gas)
- Be generous with anti-emetics
- Advance diet as tolerated
Described a paralytic ileus and when it is most common. What can we do about it?
- The ileus is the third portion of the small intestine. Paralytic ileus is persistent absence of bowel sounds with associated nausea and vomiting.
- Nasogastric tube, wait it out, maybe gum
List signs of blood loss we must recognize.
- Systolic drops late in blood loss
- diastolic goes up and then late goes down
- Pulse Pressure narrows (the difference between systolic/diastolic) - this is the key to identifying blood loss
- heart rate goes up due to hypovolemia
What are some tips when communicating to an OA with presbycusis?
- Face the client an use normal and low-pitched volume
- Rephrase rather than repeat because consonants are harder to hear
- In a group setting have the person sit near a wall and in the middle of the table
- Minimize the background noise
Does glaucoma cause peripheral or central vision loss? Macular degeneration (age-related macular degeneration)?
- Glaucoma: peripheral
- Macular degeneration: central
Describe the process for administering eyedrops.
Pull down on bottom of eyelid and plug puncta (corner by the nose)
Water excess or excess use of diuretics. This is hypoosmolar and causes watet to go into the cells where the concentration is higher = cells swell = CNS problems like irritability, confusion, sezures, coma. Can be fatal problems.
Describe three specific causes of hyponatremia.
- SIADH: too much ADH which holds onto fluids
- HF: the pump can't move the fluid through kidneys
- Hypoaldosteronism: aldosterone is responsible for holding onto sodium
Describe hypernatremia. Is is hyperosmolar or hypoosmolar?
Water deficit (the concentration is higher) or sodium excess. What goes out of the cell where the concentration of Na+ is higher, so it is hyperosmolar. Osmolarity is the ECF.
What are some causes of hypernatremia?
DI, hyperaldosteronism, cushing syndrome, unmanaged DM
What is the main cause of hypokalemia?
Overuse of diuretics (except potassium sparing)
What is the name of the potassium sparing diuretic?
Does hypokalemia cause metabolick alkalosis or acidosis?
Alkalosis because it causes the body to put the K+into the cells while pushing out the H+, causes an ECF drop in K+
What are some clinical manifestations of hypokalemia?
- Think CNS, Cardiac, Muscles
- CNS: fatique, weakness, n/v, paresthesis
- Cardiac: ST depression, flat T waves, U wave, V. Dys. bradycardia
- Muscle: reduced excitability of cells, paralytic ilieus (smooth muscle function) CRAMPS
Is K+ the major intra/extra cellular cation?
What is the most common cause of hyperkalemia?
Does hyperkalemia cause acidosis or alkalosis? Why?
Acidosis, because they "hyper" refers to ECF, so when it is Hyper the K+ is going out, which causes the H+ to flow in. The alkalosis/acidosis is ICF, not ECF, so it causes acidosis.
What is a high serum CO2 called? Describe it. How does the body respond?
Metabolic alkalosis is high serum CO2 (HCO3) and means the blood is very basic (high pH). The body compensates by slowing down RR (hypoventiliation) to keep more CO2 in the blood to lower the pH. This occurs from a loss of acid from vomiting/diarrhea of an increase in bicarb.
Describe metabolic acidosis.
Low serum CO2, body responds by Kussmaul RR (slow/deep respirations to dump CO2). Caused by a gain of acid (not CO2), such as in ketoacids in DM. Also osccurs due to loss of HCO3 as in renal disease
State the relationship between hyperphosphatemia and hypocalcemia in pts with renal failure.
In renal failure pts, they cannot excrete phosphate which leads to hyperphosphatemia. this etra free phosphate binds with free Ca to precipitate into tissue. this in turn leads to a lower amount of Ca i serum resulting in hypocalcemia.
What are the normal values for Hg and HCT?
List two reasons for decreased Hb and one reason for increased Hg.
- Decreased Hg: anemia, renal failure
- Increased Hg: dehydration (think concentration levels)
What is thrombcytosis?
Increase in number of plateletes, solid tumor cancers
What is thrombocytopenia?
Decrease in number of platelets due to drugs or autoimmune disorders.
What is the normal BMI?
What is normal total protein and then split that between albumin and globulin.
- Total Protein: 6-8
- Albumin: 3.5 - 5.1
- Globulin: 2.3 - 3.5
What are the normal values for total cholesterol, triglycerides, HDl, LDL and the ratio of cholesterol to HDL?
- Total Cholesterol: 200
- Triglycerides: 30 -135
- HDL: >35-40
- LDL: <130
- Ratio Chol:HDL = <4.5-6.0
What are the most common etilogies for the following abnormal blood gasses? Respiraotry acidosis, alkalosis, Metabolic acidosis, alkalosis
- Resp Acidosis: Hypoventilation
- Resp Alkalosis: Hyperventilation
- Metabolic Acidosis: Ketoacidosis from diabetes and lactic acidosis from hypoperfusion
- Metabolic Alkalosis: Vomiting
What can hyponatremia do to a person taking lithium?
Hyponatremia causes diminished lithium excretion causing lithium toxicity.
How is K+ administered?
by dilution with fusion device; never by subq, IV push, IM
Describe the EKG of hypokalemia.
ST depression or T inversion; U-wave present
Why do diabetics get ketoacidosis?
Ketoacidosis occurs when the body breaks down fat for energy since it cannot use glucose such as in a diabetic pt.
What type of respiration occurs in diabetic ketoacidosis? Describe the respiration.
Kussmauls; abnormally deep, regular and increased in rate