Geriatrics
1. HESI HINT: Confusion: not enough or too much stimulation
2. HESI HINT: decrease efficiency of heart and lungs×decrease oxygen
utilization×decrease activity tolerance.
Recommend rehab programs, exercise, and nutrition
Cardiovascular Disease: HESI HINTS
1. decreased cardiac output & dysrhythmias: syncope, falls, and TIAs
2. Respiratory
A. Lungs are less elastic, which makes it more difficult to breathe
B. Cough is not as efficient
C. They are more likely to develop chronic bronchitis, emphysema, and
pneumonia due to less efficient cough
3. GI
A. Decreased enzymes-decreased efficiency of digestive process
B. Decreased intestinal motility
C. Laxative abuse
D. Decrease in fluid intake and mobility
4. Urinary
A. Urinary output is the first sign of loss of renal integrity
B. lower specific gravity <1.001
C. Proteinuria
D. BUN >30
E. DM: fatigue, infection, sensation
F. Decreased GFR×decreased drug clearance
A. Penicillin
B. Tetracylcine
C. Digoxin
G. Decreased capacity of bladder×frequency and nocturia
H. Weakening×decreased urge and sensation to void×UTI
I. Kegel exercises: tightening and relaxing the vaginal and urinary
meatus to prevent incontinence
5. Neurologic
A. Delay in reflex responses
6. LOC, sensory, & mental
7. Endocrine
A. Decreased metabolism, aldosterone secretion, urinary output, and
glucose intolerance
B. Hypothyroidism can lead to depression
C. Thyroid dysfunction and diabetes are most common
8. Musculoskeletal
A. Decreased lean body mass and increased muscle fat
9. Hearing
A. hearing of high-pitches diminishes first
B. Presbycusis-decreased hearing acuity
I. Decreased socialization
II. Avoidance of friends and family
Iii. Decreased sensory stimulation
IV. hazardous conditions while driving
10. Pseudodementia
A. Barbituates, lithium, atropine, bromides
B. Nutrition deficiency
C. Depression
D. Metabolic disorders, hypothyroidism, anemia, and hypoglycemia
E. Speak in calm voice and avoid excitement
c
c
c
, Respiratory
1. Pneumonia
A. Increased respiratory rate
B. Irritability and restlessness
C. Fever, shaking, crackles (lungs are filled with fluid)
D. Chills, productive cough (alveoli is filled with fluid)
E. Confusion and lethargy in elderly
F. Assess ABGs
G. Deep breath, cough, suction
H. Hint: irritability and restlessness are the first signs of cerebral
hypoxia
I. provide hydration
J. Difficulty breathing×stiff lungs×hypoxia
K. Decreased breath sounds×congested lungs
2. Always give steroids last
A. Follow with oral hygiene due to risk of super-infection
3. Singulair (a leukotriene)
A. chronic asthma
4. oral suctioning is not sterile
5. Mask, gloves, and goggles for suctioning
6. Acute Respiratory Failure
A. Ph less than 7.35
B. Oxygen less than 50
C. C02 greater than 50
Neurosensory
1. Encephalitis
A. Vitals
I. Widened pulse pressure
II. Bradycardia
III. Irregular respirations
IV. Eyes do not PERRLA
V. Elevate head of the bed to 30 or 45 degrees
2. Parkinson¶s
A. Dopamine
3. Hydrocephalus
A. IICP
B. 6th nerve defect
4. Meningitis
A. 3, 4, 6, 7, 8
5. Lumber puncture
A. Measure pressure in CSF
B. Indicate neuro disorders, infections, brain, or spinal cord damage
6. EEG
A. Avoid caffeine and hair products before the test
7. IICP
A. Compresses brain structures
B. Reduces blood flow
C. Widened pulse pressure
D. Bradycardia
E. Increased temp.
F. Cheyne-stokes
G. Administer oxygen and monitor intake and output
H. Elevate head of bed 30-45 degrees
8. Seizures
A. Prodromal
c
c
c
, I. Mood changes, irritability, insomnia
9. Meniere¶s Disease
A. Salt-free diet
B. Vasodilators
C. Neuroleptics
D. Diuretics
E. Anti-histamines
F. Anti-cholingergics
G. Sedatives
H. Encourage slow movement
10. Acute closed angle glaucoma
A. Severe eye pain
B. halos
C. Pupils dilate
D. nausea and vomiting
E. Administer stool softeners, constrictive clothing, and colds
11. Detached retina
A. Sclera buckling
Cardiovascular
1. Peripheral Vascular Disease
A. Arterial
I. Arteriosclerosis & Atherosclerosis
II. Raynaud, Buerger, and Diabetes diseases
III. Smooth, shiny skin with loss of hair
IV. Thickened nails
V. pale when elevated, rubor when dependent
VI. Decreased or absent pulses (impaired perfusion)
VII. Sharp pain; intermittent claudicateion
VIII. necrotic ulcers on lateral lower legs, toes, and heels
IX. cool temperature (reduced blood supply)
X. pain is relieved when dependent
XI. numbness and tingling (impaired perfusion)
Ai
I. Anti-platelets to thin blood)
ii. anti-hypertensives
iii. anti-coagulants
iv. exercise
B. Venous
I. DVT and valvular disorders
II. Varicose veins
III. venous stasis ulcers
iv. brown pigment around ankles
v. cyanotic when dependent
vi. normal pulses
vii. ulcers on medial legs and ankles
viii. marked edema
ix. elevate extremities for relief
x. warm temperature
C. Avoid crossing legs and wearing constrictive clothing
D. Keep legs dependent if arterial, and elevated if venous
E. Compression dressing for venous
2. AAA
A. abdominal and back pain (pressure on lumbar nerves)
B. Bruit
c
c
c
1. HESI HINT: Confusion: not enough or too much stimulation
2. HESI HINT: decrease efficiency of heart and lungs×decrease oxygen
utilization×decrease activity tolerance.
Recommend rehab programs, exercise, and nutrition
Cardiovascular Disease: HESI HINTS
1. decreased cardiac output & dysrhythmias: syncope, falls, and TIAs
2. Respiratory
A. Lungs are less elastic, which makes it more difficult to breathe
B. Cough is not as efficient
C. They are more likely to develop chronic bronchitis, emphysema, and
pneumonia due to less efficient cough
3. GI
A. Decreased enzymes-decreased efficiency of digestive process
B. Decreased intestinal motility
C. Laxative abuse
D. Decrease in fluid intake and mobility
4. Urinary
A. Urinary output is the first sign of loss of renal integrity
B. lower specific gravity <1.001
C. Proteinuria
D. BUN >30
E. DM: fatigue, infection, sensation
F. Decreased GFR×decreased drug clearance
A. Penicillin
B. Tetracylcine
C. Digoxin
G. Decreased capacity of bladder×frequency and nocturia
H. Weakening×decreased urge and sensation to void×UTI
I. Kegel exercises: tightening and relaxing the vaginal and urinary
meatus to prevent incontinence
5. Neurologic
A. Delay in reflex responses
6. LOC, sensory, & mental
7. Endocrine
A. Decreased metabolism, aldosterone secretion, urinary output, and
glucose intolerance
B. Hypothyroidism can lead to depression
C. Thyroid dysfunction and diabetes are most common
8. Musculoskeletal
A. Decreased lean body mass and increased muscle fat
9. Hearing
A. hearing of high-pitches diminishes first
B. Presbycusis-decreased hearing acuity
I. Decreased socialization
II. Avoidance of friends and family
Iii. Decreased sensory stimulation
IV. hazardous conditions while driving
10. Pseudodementia
A. Barbituates, lithium, atropine, bromides
B. Nutrition deficiency
C. Depression
D. Metabolic disorders, hypothyroidism, anemia, and hypoglycemia
E. Speak in calm voice and avoid excitement
c
c
c
, Respiratory
1. Pneumonia
A. Increased respiratory rate
B. Irritability and restlessness
C. Fever, shaking, crackles (lungs are filled with fluid)
D. Chills, productive cough (alveoli is filled with fluid)
E. Confusion and lethargy in elderly
F. Assess ABGs
G. Deep breath, cough, suction
H. Hint: irritability and restlessness are the first signs of cerebral
hypoxia
I. provide hydration
J. Difficulty breathing×stiff lungs×hypoxia
K. Decreased breath sounds×congested lungs
2. Always give steroids last
A. Follow with oral hygiene due to risk of super-infection
3. Singulair (a leukotriene)
A. chronic asthma
4. oral suctioning is not sterile
5. Mask, gloves, and goggles for suctioning
6. Acute Respiratory Failure
A. Ph less than 7.35
B. Oxygen less than 50
C. C02 greater than 50
Neurosensory
1. Encephalitis
A. Vitals
I. Widened pulse pressure
II. Bradycardia
III. Irregular respirations
IV. Eyes do not PERRLA
V. Elevate head of the bed to 30 or 45 degrees
2. Parkinson¶s
A. Dopamine
3. Hydrocephalus
A. IICP
B. 6th nerve defect
4. Meningitis
A. 3, 4, 6, 7, 8
5. Lumber puncture
A. Measure pressure in CSF
B. Indicate neuro disorders, infections, brain, or spinal cord damage
6. EEG
A. Avoid caffeine and hair products before the test
7. IICP
A. Compresses brain structures
B. Reduces blood flow
C. Widened pulse pressure
D. Bradycardia
E. Increased temp.
F. Cheyne-stokes
G. Administer oxygen and monitor intake and output
H. Elevate head of bed 30-45 degrees
8. Seizures
A. Prodromal
c
c
c
, I. Mood changes, irritability, insomnia
9. Meniere¶s Disease
A. Salt-free diet
B. Vasodilators
C. Neuroleptics
D. Diuretics
E. Anti-histamines
F. Anti-cholingergics
G. Sedatives
H. Encourage slow movement
10. Acute closed angle glaucoma
A. Severe eye pain
B. halos
C. Pupils dilate
D. nausea and vomiting
E. Administer stool softeners, constrictive clothing, and colds
11. Detached retina
A. Sclera buckling
Cardiovascular
1. Peripheral Vascular Disease
A. Arterial
I. Arteriosclerosis & Atherosclerosis
II. Raynaud, Buerger, and Diabetes diseases
III. Smooth, shiny skin with loss of hair
IV. Thickened nails
V. pale when elevated, rubor when dependent
VI. Decreased or absent pulses (impaired perfusion)
VII. Sharp pain; intermittent claudicateion
VIII. necrotic ulcers on lateral lower legs, toes, and heels
IX. cool temperature (reduced blood supply)
X. pain is relieved when dependent
XI. numbness and tingling (impaired perfusion)
Ai
I. Anti-platelets to thin blood)
ii. anti-hypertensives
iii. anti-coagulants
iv. exercise
B. Venous
I. DVT and valvular disorders
II. Varicose veins
III. venous stasis ulcers
iv. brown pigment around ankles
v. cyanotic when dependent
vi. normal pulses
vii. ulcers on medial legs and ankles
viii. marked edema
ix. elevate extremities for relief
x. warm temperature
C. Avoid crossing legs and wearing constrictive clothing
D. Keep legs dependent if arterial, and elevated if venous
E. Compression dressing for venous
2. AAA
A. abdominal and back pain (pressure on lumbar nerves)
B. Bruit
c
c
c
