Exam (elaborations) NR 601 Week 2 Quiz Review

Exam (elaborations) NR 601 Week 2 Quiz Review  Know the physical and physiological changes in the elderly *Appendix A pgs 643-650* 3 Primary Points 1. Reduced physiological reserve of most body systems, especially cardiac, respiratory, and renal. 2. Reduced homeostatic mechanisms that fail to adjust regulatory systems such as temperature control and fluid and electrolyte imbalances. 3. Impaired immunological function: risk for infection is higher and autoimmune diseases are more prevalent. Never be complacent and assume the issue is only age related (pg 2-3)  How aging effects Lab values in elderly **Appendix B pgs 651- 652** Many factors influence lab results in the elderly, including physiologic changes with aging, the prevalence of chronic disease, changes in nutritional and fluid intake, lifestyle and activities, and medications being taken. Biochemical individuality is important in detecting asymptomatic abnormalities in older adults. Significant homeostatic disturbances in the same individual may be detected through serial lab tests, even though all individual test results may lie within normal limits of the reference interval for the entire group. Lab work can be affected by inadequate protein stores within the body, and the elderly loose these protein stores. The serum creatinine levels may be WNL yet indicate renal impairment in pt’s with inadequate protein stores. The calculation of the creatinine clearance, used to estimate renal function, is significant to the provider. Reduced renal function, especially the GFR, affects the clearance of many drugs, and CrCl provides an index of renal function for use in choosing renally eliminated or nephrotoxic drugs such as digoxin, H2 blockers, lithium, and water soluble antibiotics. (pg 3-4)  How disease presents in elderly 4 factors: 1. nonpresentation of illness – underreporting of s/s r/t erroneous association of aging with disease, disuse, and disability. The elderly basically see these changes as inevitable so they either do not go to the doctor or if they do, they do not challenge the doctor when they are told it is age related. 2. multiple complaints – because of the prevalence of chronic disease in the elderly population, they may present with multiple complaints. The provider should explore the possibility of a constellation of symptoms and signs that when analyzed may represent more than one condition/problem. After careful exploration, depression can also be considered given depression can manifest atypically in older adults and somatic s/s are not uncommon. 3. An altered pattern of illness – patterns of disease may be different in the elderly. For example, jaundice in a younger pt indicates viral hepatitis but in the elderly may indicate a malignancy or gallbladder disease. Another example is delusions and hallucinations in a younger pt can indicate bipolar disorder but in the elderly can indicate dementia or medication side effects. This study source was downloaded by from CourseH on :28:36 GMT -05:00 This study resource was shared via CourseH NR 601 Week 2 Quiz Review 4. Atypical, nonspecific or vague symptoms – altered presentation is common in older adults. Since s/s may be vague and nonspecific, even a modest change in functional level or behavior should alert the provider to carefully explore the potential for treatable conditions. For example, an elderly pt with a UTI may only present with confusion, or one with depression may not present with a dysphonic mood but rather agitation and psychotic features.  What exercise would you give to elderly Page 24 give a number of available resources to educate the patient as to what type of exercise would benefit them the most.  Metabolism Biotransformation occurs in all body tissues but primarily in the liver, where enzymatic activity (cytochrome P [CYP] system) alters and detoxifies the drug and prepares it for excretion. As aging occurs, the ability of the liver to metabolize drugs does not decline similarly for all pharmacological agents. Even though liver size and blood flow decline with age, routine liver function tests are typically normal IF no disease exists. Decreased liver size and blood flow can result in decreased first-pass metabolism; drug activity for some medications is prolonged because drugs are metabolized and eliminated more slowly. When prescribing, know age-related pharmacokinetics and understand whether the drug inhibits or induces CYP enzymes. Conditions of increased or decreased liver perfusion alter the overall level of the drug that is absorbed and how it metabolizes. (pg 5) Ch 8  Respiratory- Know which diseases are reversible and those that are not – presentation Reversible  pneumonia, bronchitis Nonreversible  COPD, pulm fibrosis, cystic fibrosis, asthma  Cardiac- know what medication are used for CHF- common meds Kennedy (pg. 214) ACE or ARB and a BB. Possibly: diuretics (loop diuretics) if pt has edema, Digoxin if needed There is a general consensus that ACE’s, BB, diuretics, nitrates, and CCB are helpful in tx HF with preserved LVEF. Concurrent tx with BB and non-dihydropyridine agents is contraindicated. Remember nitrates can cause BLE edema.  Know what medications are used post MI ACE, ARB, BB  Know the ACC/AHA guidelines and Kennedy Presentation  Know how to read arrhythmia? (I don’t recall seeing this) COPD  Kennedy pg 205  What diagnostic tests Spirometry (GOLD standard & required to make the dx), CXR, CT chest, pulse ox, exercise testing, ABG, Alpha-1 antitrypsin levels, lung volumes and diffusing capacity  Education Smoking cessation, flu and pneum vaccines, exercise, healthy diet, take medicine as directed This study source was downloaded by from CourseH on :28:36 GMT -05:00 This study resource was shared via CourseH  Goals of COPD Prevent/control s/s, reduce frequency and severity of exacerbations, improve health status and quality of life, improve exercise tolerance, slow progression, decrease mortality  Rx treatments – meds Beta2-agonists Short Acting = Albuterol and Levalbuterol (prn for all stages) Long Acting = Salmeterol, Formoterol, and Arformoterol (1-2 x day; must be prescribed with a SABA for relief of acute symptoms) Anticholinergics Short Acting = Ipratropium Long Acting = Tiotropium Combos = Albuterol + Ipratopium (Best option) Theophylline = use if s/s continued even with combo inhaled bronchodilators Inhaled Corticosteroids = fluticasone/salmeterol (Advair), budesonide/formoterol (Symbicort), mometasone/formoterol (Dulera)  must be used in combo with a LABA, reserve for pt’s with severe COPD FEV1 50%  Know the definition of FEV1 (Volume of air expelled in the 1st second of FVC, most reproducible and reliable), FEV1/FVC ratio (Percentage of maximum inspiration expired in 1 second), TLC (Total Lung Capacity  volume of air in the lungs at maximal inflation, normal range 80-120%, RV + VC = TLC), Goroll  How does COPD present on chest xray Impact of chronic pain? Health risk presentation? Week 2  Know how to define polypharmacy and different definitions, what is it and different definitions Kennedy Ch 8  Know the different stages of HF- not just structural but risk factors- (Kennedy) know the criteria of staging Kennedy pg 213  Know what stage the patient is – a scenario presentation will be given  Know the common finding on auscultation and physic