NR 601 Week 2 Quiz Review (NR601)

NR 601 week 2 quiz review All questions will come from reading (Goroll, Kennedy), Lessons and Presentations – you should have received the PPTs Week 1 Kennedy  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.