NCLEX Review Gerontology

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NCLEX Review Gerontology
2014-05-28 11:34:22

Review from Kaplan tests on geri
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  1. Geri foot care
    • problems can occur from muscular or bone changes as well as from skin disorders
    • advise appropriate footwear: cotton socks, shoes 1/2 inch longer than longest toe, shoes with flexible soles and traction grids, break in new shoes gradually, ensure heel heights are safe and offer support, discard old worn shoes
    • No barefeet
    • Improve circulation in LE and feet-avoid knee high stockings, avoid sitting with knees crossed, elevate feet above hip level if feet swell
    • check feet daily for cuts, breakdown or other changes
    • report signs of foot problems to MD especially if pt is diabetic
    • Evaluate pt with PVD for adequate circulation, sensation and skin condition
    • emollient can be used if dryness is noted
  2. UTI
    • infection that begins in the urethra, bladder, ureters or bladder
    • S/S: frequent urination; urge; pain or burning on urination; nocturia; pain or tenderness over bladder; cloudy or foul smelling urine; fever; retroperitoneal pain; nausea & vomiting
    • TX: antibiotic therapy; pyridium; vaginal estrogen therapy, increase fluid intake; increase vitamin C and cranberry juice intake
    • PT Teac: empty bladder immediately after intercourse; avoid douche or powders in genital area; proper cleaning after BM
  3. Alzheimer's disease
    • manifested by global, progressive impairment of cognitive functioning, memory and personality
    • S/S: Stage 1-agitated or apathetic mood, attempts to cover up symptoms, deterioration in personal appearance, decline in recent memory inability to retain new memories, poor concentration, depression, sleep disturbances. Stage 2-bowel and bladder incontinence, confabulation, decreasing ability to understand or use language, disorientation to person place and time, failure to recongnize family members, inability to perform activities of daily living without assistance, socially unacceptable behavior. Stage 3- Severe decline in cognitive functioning, compulsive touching and examination of objects, decreased response to stimuli, deterioration in motor ability, emaciation
    • TX: Drug therapy- anticholinesterase agents: tacrine (Cognex), donepezil (Aricept) and rivastigimine (Exelon) to improve cognitive functioning. Action: cholinesterase inhibitor Adverse effects: N/D. Antipsychotic agents, such as haloperidol (Haldol) and risperidone (Risperdal) to calm agitation. Action: postsynaptic dopamine receptor blocker. Adverse effects: some sedation, orthostatic hypertension, extrapyramidal syndromes, especially with haloperidol. Benzodiazepines, such as alprazolam (Xanax), to ease anxiety. Action: CNS depression. Adverse effects: sedation, depression, light headedness, headache
    • Nursing care: protect from injury, monitor nutrition, pt to follow regular exercise routine, normal intellectual activities and social contacts; speak to pt calmly to minimize confusion; affirm the pt emotions without judgement; use orientating material like large clock and calendar in every room; provide meaningful sensory input but avoid excessive stimulation; monitor medication use and its effects; give information about community resources and support groups
  4. Dehydration
    • decreased blood flow to brain and may cause confusion and disorientation
    • indications are rapid weak pulse, rapid respirations, hypotension, weight loss, emaciation, dry mucous membranes, increased hematocrit, increased urine specific gravity
    • Care includes forcing fluids, providing isotonic IV fluids, I&O, hourly output, daily weights, monitor V/S, assess skin turgor, assessing urine specific gravity.