older adults one

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Author:
kbryant86
ID:
233240
Filename:
older adults one
Updated:
2013-09-10 08:49:38
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old people
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Description:
old peeps exam 1
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  1. Older Adults are defined as
    65+
  2. Leading causes of death in 65+
    • Heart disease
    • CA
    • COPD
    • Stroke
    • Pneumonia
  3. Comorbitity may include
    1-3
    • osteoarthritis
    • HTN
    • joint problems
  4. Geriatric syndromes
    1-11
    • delerium
    • dementia
    • vision
    • hearing
    • falls
    • malnutrition
    • incontinence
    • depression
    • sleep disorders
    • functional limitations
    • polypharmacy
  5. delerium
    vs
    dementia
    delerium= alterations in consciousness, memory loss, rapid onset, cognition fluctuates during carious periods of the day

    dementia= memory loss, language disturbance, alterations in motor activities, inabiulity to recognize familiar objects, gradual onset
  6. interventions prevent what?
    1-3
    • frailty
    • functional decline
    • geriatric syndromes
  7. impact of the geriatric syndromes
    • follow std practice based on facility
    • refrain from unnecessary interventions that may cause more harm than good
  8. cycle of frailty
    • wt loss of < 10 lbs. in one year or 5% of body wt
    • weakness as measured by grip test
    • self-reported poor stamina and exhaustion
    • inability or difficulty walking 15 ft
    • low physical activity level
  9. comprehensive geriatric assessment
    • help ID patients who are frail
    • want to do this before onset of the cycle of frailty
    • **we really focus on functional assessments in older adults
  10. cascade iatrogenesis
    the spiraling, unintended decline of health from a series of severe effects caused by medical intervention that have been used to solve previous symptoms or conditions

    side effects of Tx cause a fast decline
  11. complications associated with iatrogenesis
    • unable to walk w/o assistance
    • low cognition
    • highest in the oldest pt.s
  12. cascade iatrogenesis refers to:
    1-3
    • related sequence of 2 or more serious adverse events resulting from a diagnostic, prophylactic, or therapeutic intervention
    • an error of omission involving a reasonable clinical std
    • accidental injury occurs in hospital setting
  13. atypical presentation
    • vague presentation of illness
    • altered presentation of illness
    • non-presentation of illness
  14. change in cognitive status if a key sign of what?
    atypical presentation of UTI
  15. who is at risk for development of atypical presentations?
    • > 85 yrs
    • pt. w/ multiple comorbidies and meds
    • pt. w/ cognitive or functional impairment
  16. functional decline

    goal related to functional decline:
    • change in ADL's, etc.
    • Happens b/c of deconditioning

    goal= live as independently as possible
  17. deconditioning
    • physical change of the body
    • dec. ms mass and other changes that result from either aging or immobility or both, contribute to overall weakness
  18. steadiness vs unsteadiness in Assessment of Function
    knowing this status PRIOR to admission can help predict a decline in ADL while admitted.

    • steady= less likely
    • unsteady= more likely
  19. normal changes in aging process
    1-8
    • dec. in ms strength and aerobic capacity
    • vasomotor instability
    • baroreceptor insensitivity
    • reduced total body h@o
    • altered thirst, taste, sell, and dentition
    • reduced ventilation
    • reduced sensation
    • fragile skin
  20. in relation to decision making, remember to promote independence and autonomy in daily living
    pt.s are able to make their own decisions until proven otherwise
    • in relation to decision making, remember to promote independence and autonomy in daily living
    • pt.s are able to make their own decisions until proven otherwise
  21. # of sleep hours needed by old people
    this does NOT change with age. Still 6-10
  22. amount of deep sleep with aging
    amount in deep sleep decreases with age
  23. alcohol, caffeine, and nictoine with sleep
    • alc= disruptor of REM due to sedative effect on CNS
    • caf and nic= increase night time awakening and amount of time it takes to fall back asleep
  24. old peeps should AVOID OTC sleep aids
    old peeps should AVOID OTC sleep aids
  25. bone marrow declines, therefore so does what?
    stem cell #'s decline

    ***HOWEVER, this does not mean that Anemia is normal

    Giving erythropoietin inc. bld cell production, causeing bone pain
  26. 3 common hematologic disorders in aging
    • anemia
    • DVT= watch for coag b/c platelets get stricky as we age
    • cancer= inc. risk with age b/c # of carcinogen exposure
  27. anemia
    **common in old peeps BUT not normal
  28. severe anemia
    Dx may be neglected

    • Low H&H may lead to:
    • MI b/c of low O2
    • falls
    • confusion
  29. what treatment for severe anemia
    transfusions

    **Need to be very aware of vital signs during and afterr b/c pt. is subject to fluid overload and acute heart failure
  30. hemocrit
    # of cells in a liquid (as a %)
  31. how long can a person be on blood transfusion?
    up to 4 hours, b/c that is the shelf life of the blood bag
  32. 3 reasons DVT is common
    • abnormalities in the vessel walls
    • hypercoagulability
    • stasis of bld flow
  33. interventions for DVT
    • get pt up and moving
    • change position
    • support stockings
    • etc.
  34. anticoag agents
    • clot busters
    • heparin
    • warfarin (coumadin)= clot prevention
    • antiplatelets (ASA)
  35. PT
      vs.
    PTT
      vs.
    INR
    PT= prothrombin time= time required for clot to form after reagents have been added to bld

    PTT= partial pt= time required to forma  clot after phospholipid reagents are added (for heparin)

    • INR= international normalized rate= 1 is normal
    • ***LOOK AT THIS FOR COUMADIN dosages b/c it will increase clot time
  36. 3 types of cancer that we worry about most

    which is the leading cause of death?
    • prostate
    • breast
    • lung= leading cause
  37. always keep comorbities in mind for cancer pt.s b/c they may be causing more trouble than the cancer itself
    always keep comorbities in mind for cancer pt.s b/c they may be causing more trouble than the cancer itself
  38. Cancer is the 4th most common comorbidity 
    Cancer is the 4th most common comorbidity 
  39. top 2 leading causes of death for men and women in the US
    • 1. cardiovascular disease
    • 2. cancer
  40. this is important to do PRIOR to cancer treatment to reduce the chance of further complications associated with cancer treatment
    detect geriatric syndromes
  41. qualifications of a frail oncology pt.
    1-4
    • Any 1 of these :
    • > 85 yrs
    • dependence in > 1 ADL's
    • > 3 comorbid conditions
    • presence of > 1 geriatric syndrome
  42. 2 types of functional assessments
    • ADL
    • IADL
  43. ADL
      vs.
    IADL
    ADL= basic activities needed to get the day going (bathing, dressing, grooming, eating, mobility, toileting)

    IADL= activities needed to live Independently (paying bills, cleaning, laundry and meal preparation)
  44. what is more important indicator of cancer treatment tolerance; functional status or chronological age?
    functional status
  45. the more risk factors for frailty, the more likely to use palliative care b/c cancer treatment would be more detrimental than helpful
    the more risk factors for frailty, the more likely to use palliative care b/c cancer treatment would be more detrimental than helpful
  46.  prevention for health promotion and cancer risk reduction:

    primary
    secondary
    tertiary
    • 1. diet and exercise
    • 2. screening such as mammograms
    • 3. Tx for diagnosed pt.
  47. 3 questions to consider for cancer screening in an old person
    • Is the person going to die OF or WITH cancer?
    • Is the person at risk for the complications of cancer during his/her lifetime?
    • Is the patient able to tolerate cancer treatment? (or is palliative care better?)
  48. oral mucositis treatment
    • ice chips
    • avoid dehydration
    • oral care solutions:
    • saline, baking soda, or salt and soda solutions ONLY
    • **No alcohol solutions
  49. addiction is not to be feared when treating end of life pain
    addiction is not to be feared when treating end of life pain
  50. DNRCC
    DNR Comfort Care=pt is given care that eases the pain, including meds if needed
  51. DNRCC-Arrest
    DNR Comfort Care-Arrest=  pt receives standard care only until they die. 
  52. anxiety
    feelings are not good or bad
  53. greif
    the emotion felt after a loss
  54. mourning
    recovery period of time
  55. presbyopia
    • thickening of lens losses its elasticity
    • most common visual problem
  56. glaucoma
    • increased intraocular pressure
    • open angle is most common and fluid doesn't drain/circulate
  57. hearing question is degenerative nerve anser
    hearing question is degenerative nerve anser
  58. SPICES
    overall assessment tool
  59. BATHE
    • useful for eliciting psychosocial context
    • (mental state)
  60. LEARN
    cross culture communication
  61. Mini-Cog
    and MOCA
    cog duh

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