NR 601 Midterm Study Guide
CGA - answer*Purpose: Physical health is related to psychosocial, functional ability,
and safe environment
*Most beneficial for the vulnerable older adult
*Domains: Physical, functional, + psychological health, socioenvironmental support +
quality of life measures
*Functional health: shows how they can care for themselves day to day
Beers Criteria - answer*American Geriatric Society
*Purpose: improve medication selection; avoid dangerous medications
*Tailored for 65 and older in all settings except hospice and palliative care
*Stresses importance of de-prescribing to avoid polypharmacy and drug reactions
Health Promotion - answer*Vaccine schedules: tetanus, diphtheria, pneumococcal, flu
*CRC screening: ages 50-75
*BC screening: biennial screening ages 50-74
*Smoking cessation
*Aerobic exercise and strength training
*AAA screening
Physical Changes - answer*Lab changes can be affected by dehydration (increased
ESR due to inflammation, reduced physiological reserves due to thinner skin, less
subcutaneous tissue and fat)
*Mini nutritional assessment for obesity
Functional Domain - answer*Purpose: how the older adult cares for themselves
*Screening tools: Brody + lawton, Barthel index (both assess instrumental ADLs)
*Functional change is often the first/only sign of a new or changed disease process
Pulmonary Function Tests - answerComplete activity, understand results, FEV1 and
what it means
Asthma - answer*Chronic, inflammatory, obstructive disease
*Caused by intrinsic factors (stress) or extrinsic factors (environment)
*REVERSIBLE! hyperactivity of bronchi and bronchioles to a variety of stimuli
Intermittent asthma - answer*Intermittent symptoms less than 2 days per week
*Nighttime less than twice per month
*Normal peak expiratory flow between exacerbations
*FEV1 >80%; PFT variability ≥20%
*No daily meds
*SABA PRN < twice per week
, *Step up meds if control is not achieved
*Step down meds if controlled for 3 months
Mild Persistent Asthma - answer*Symptoms more than twice a week but not daily
*Several times at night per month
*FEV1 >80%; PFT variability 20-30%
*Daily low dose ICS; alternate LTRA, cromolyn, nedocromil, or theophylline
*Rescue: SABA PRN not to exceed 3-4 times/day
Moderate Persistent Asthma - answer*Symptoms are daily but not continual
*Night time symptoms more than ones a week but not nightly
*Exacerbations affect sleep and activity
*FEV1 60-80% predicted; PFT variability > 30%
*Daily meds: Low dose ICS + LABA or medium dose ICS + LTRA
*Rescue: SABA PRN not to exceed 3-4 times/day
Severe Persistent Asthma - answer*Continuous daily symptoms
*Frequent nighttime symptoms
*Frequent exacerbations
*Physical activities limited by asthma
*FEV1 < 60%; PFT variability > 30%
*Daily meds: low dose ICS + LABA or medium dose ICS + LTRA
*Rescue SABA PRN, not to exceed 3-4 times/day
*Consider oral steroids
COPD - answer*Gold standard: spirometry
*Levels: mild (FEV1>80%), Mod (FEV1 >50<80%), Sev (FEV1>30<50%), Ver sev
(FEV1 <30%)
*Oxygen is shown to DECREASE mortality
*Labs: CBC (evaluate eosinophil level), alpha-1-antitrypisin level
CAP - answer*Acute inflammation of acute inflammation of lung parenchyma; usually
infectious
*70-80%and of cases are over the age of 60
*S. penumoniae, gram + (40%))
*H. Influenzae, legionella
*TX: uncomplicated-azithromycin, clarithromycin, doxy
*TX: with comorbidities-resp. fluoroquinolone
OSA - answer*Temporary pause of breathing for at least 10 seconds, at least 5x/hour
*Anatomical risk factors: septal deviation, macrognathia (large/protruding jaw), tonsil
hypertrophy, obesity
*Avoid ETOH, sedatives (alters REM sleep), and narcs
*Complications: cardiac dysrhythmias
*Side effects: hypersomnolence resulting in headache
CGA - answer*Purpose: Physical health is related to psychosocial, functional ability,
and safe environment
*Most beneficial for the vulnerable older adult
*Domains: Physical, functional, + psychological health, socioenvironmental support +
quality of life measures
*Functional health: shows how they can care for themselves day to day
Beers Criteria - answer*American Geriatric Society
*Purpose: improve medication selection; avoid dangerous medications
*Tailored for 65 and older in all settings except hospice and palliative care
*Stresses importance of de-prescribing to avoid polypharmacy and drug reactions
Health Promotion - answer*Vaccine schedules: tetanus, diphtheria, pneumococcal, flu
*CRC screening: ages 50-75
*BC screening: biennial screening ages 50-74
*Smoking cessation
*Aerobic exercise and strength training
*AAA screening
Physical Changes - answer*Lab changes can be affected by dehydration (increased
ESR due to inflammation, reduced physiological reserves due to thinner skin, less
subcutaneous tissue and fat)
*Mini nutritional assessment for obesity
Functional Domain - answer*Purpose: how the older adult cares for themselves
*Screening tools: Brody + lawton, Barthel index (both assess instrumental ADLs)
*Functional change is often the first/only sign of a new or changed disease process
Pulmonary Function Tests - answerComplete activity, understand results, FEV1 and
what it means
Asthma - answer*Chronic, inflammatory, obstructive disease
*Caused by intrinsic factors (stress) or extrinsic factors (environment)
*REVERSIBLE! hyperactivity of bronchi and bronchioles to a variety of stimuli
Intermittent asthma - answer*Intermittent symptoms less than 2 days per week
*Nighttime less than twice per month
*Normal peak expiratory flow between exacerbations
*FEV1 >80%; PFT variability ≥20%
*No daily meds
*SABA PRN < twice per week
, *Step up meds if control is not achieved
*Step down meds if controlled for 3 months
Mild Persistent Asthma - answer*Symptoms more than twice a week but not daily
*Several times at night per month
*FEV1 >80%; PFT variability 20-30%
*Daily low dose ICS; alternate LTRA, cromolyn, nedocromil, or theophylline
*Rescue: SABA PRN not to exceed 3-4 times/day
Moderate Persistent Asthma - answer*Symptoms are daily but not continual
*Night time symptoms more than ones a week but not nightly
*Exacerbations affect sleep and activity
*FEV1 60-80% predicted; PFT variability > 30%
*Daily meds: Low dose ICS + LABA or medium dose ICS + LTRA
*Rescue: SABA PRN not to exceed 3-4 times/day
Severe Persistent Asthma - answer*Continuous daily symptoms
*Frequent nighttime symptoms
*Frequent exacerbations
*Physical activities limited by asthma
*FEV1 < 60%; PFT variability > 30%
*Daily meds: low dose ICS + LABA or medium dose ICS + LTRA
*Rescue SABA PRN, not to exceed 3-4 times/day
*Consider oral steroids
COPD - answer*Gold standard: spirometry
*Levels: mild (FEV1>80%), Mod (FEV1 >50<80%), Sev (FEV1>30<50%), Ver sev
(FEV1 <30%)
*Oxygen is shown to DECREASE mortality
*Labs: CBC (evaluate eosinophil level), alpha-1-antitrypisin level
CAP - answer*Acute inflammation of acute inflammation of lung parenchyma; usually
infectious
*70-80%and of cases are over the age of 60
*S. penumoniae, gram + (40%))
*H. Influenzae, legionella
*TX: uncomplicated-azithromycin, clarithromycin, doxy
*TX: with comorbidities-resp. fluoroquinolone
OSA - answer*Temporary pause of breathing for at least 10 seconds, at least 5x/hour
*Anatomical risk factors: septal deviation, macrognathia (large/protruding jaw), tonsil
hypertrophy, obesity
*Avoid ETOH, sedatives (alters REM sleep), and narcs
*Complications: cardiac dysrhythmias
*Side effects: hypersomnolence resulting in headache
