Term
| Identify Q/S measures relevant to the care of OA: |
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Definition
- Reduce r/o falls
- Reduce r/o skin tears
- Reduce r/o PU |
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Term
| What immune system changes occur with aging? |
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Definition
-- LESS efficient at responding to new antigens [fewer niave T cells]
--Inability of immune cells to DIVIDE indefinitely
--Poor cell SIGNALLING [Ca2+ deficiency]
--Less able to fight infection
--Reactivation of LATENT infectious diseases
--Antibody response to VACCINES is slower and weaker so vaccinations less protective |
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Term
| Ns actions to prevent PRESSURE ULCERS in OA: |
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Definition
- Assess skin and nutrition
- Prevent Friction
- POSITIONING: HOB 30 Degress OR LESS, avoid trochanter, keep bones apart, individualize repositioning time table
- PU reducing devices
- Evaluate/Doc intervention effectiveness
- provide education
- Bathing and pericare |
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Term
| What are R/F for falls in OA? |
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Definition
-- advanced age
-- acute/chronic health conditions
--use of assistive devices
--altered mental status
--alt/ b/b fxn
--Cognitive and sensory impairments ESP BALANCE
--altered PROPRIOCEPTION
--Recent care site transition
--Medications (effect senses/hypotension/fluid balance)
--Delirium/depression/dementia, etc |
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Term
| What are adverse outcomes from falls in OA? |
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Definition
- Fractures
- TMI
- Loss independence
- Decreased quality of life
- fear of falls
- DEATH |
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Term
| What are the effects of aging on drug metabolism? |
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Definition
- Decrease in body WATER -> serum levels of water sol. drugs GOES UP
- Increased body fat increases half life of fat soluble drugs.
- Variable changes in first pass metabolism due to decreased hepatic blood flow
- Cytochrome P450=decreased drug clearance and INCREASED half life |
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Term
| What are the demographics r/t aging and medication use? |
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Definition
--40% of prescriptions in US are for OA (>65)
--SNF means 4-6 meds per day
--AMBULATORY US ELDERS: 44% Men/57% of women taking 5+ medications, 12% taking 10, 47/57% taking vitamins and minerals, 11/14% taking CAM therapies |
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Term
| What are common drug related problems in the elderly? |
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Definition
- **UNDERTREATMENT
-**Inappropriate prescribing
- **Adverse Drug Events
- Adherence |
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Term
| What are some medications that are NOT appropriate for OA? |
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Definition
--ESP Anticholinergics (anti rest and digest...)
-- Benadryl
--Cyclobenaprine |
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Term
| What is the difference between lab values and medication administration? |
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Definition
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Term
| How prevalent is complimentary and alternative medicine use in OA? |
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Definition
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Term
| What are major interactions btw natural products and drugs commonly used by OA? |
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Definition
Warfarin, NSAIDS and ASA: garlic, ginko, gensing
--Cytochrome P450 3A4 metabolized drugs and St. John's Wart
-- Levothyroxine and Calcium must be staggered. |
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Term
| What is the Ns' role in the older adults' adherence to medication regimen? |
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Definition
- Thorough Hx
- Start LOW go SLOW
- Consider nonpharmacologic approaches
- Streamline meds eliminate unecessary duplicates
- Provide info to pt AND family |
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Term
| What are the atypical ways that OA present with INFECTION? |
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Definition
--ABSENCE of fever/afebrile
--Changes in MENTAL STATUS
--Decline in functional status
--Weight loss/Appetite loss
--New ONSET falls or incontinence |
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Term
| Ns actions to prevent SKIN TEARS in OA (r/f what?): |
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Definition
Risk for cellulitis!!
-- Moisturize skin 2x daily
--Sleeves/Pants
-- Paper tape/non-tape options
--adequate lighting, hydration and nutrition |
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Term
| Name some drugs that increase risk of falls? |
|
Definition
Digoxin
Diuretics (makes them have to pee)
Anticholinergics |
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Term
| What should you do if there IS a fall? |
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Definition
- Take their BP (assess!)
- Notify/communicate RE the fall
- Monitor and reassess
- DOCUMENT |
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Term
| What is NOT impaired in drug metabolism in OA? |
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Definition
| - Absorption is not impaired |
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Term
| What is a good marker for GFR Cr serum or Cr clearance? |
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Definition
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Term
| In what direction does the Cr-Gault equation estimate Cr Clearance in frail elders (AGE-WGT-GENDER)? |
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Definition
| Can OVER estimate Cr Clearance. |
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Term
| Alcohol effects are _______ in older adults (weaker/stonger)? |
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Definition
| STRONGER, also ACEI's, Opiates, benzodiazapines, theophyllines) |
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Term
| T/F Many of the sx of ADE are very similar to the common signs of aging? |
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Definition
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Term
| What are the goals for Pt safety measures? |
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Definition
1. Improve INDIVIDUAL pt care
2. Improve population level health
3. Decrease unnecessary costs |
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Term
| What are the four steps in developing a Root Cause Analysis? |
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Definition
1. Identify a problem statement
2. Identify a list of causes for each branch of the fish
3. Indicate RELATIONSHIPS btw causal chains
4. Develop causal statements. |
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Term
| What other changes impact immunity in OA? |
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Definition
- Impaired SKIN integrity
- RESPIRATORY: Weak respiratory muscles/decreased chest expansion/poor ability to cough/decreased effectiveness of tracheobronch cilia/increased residual vol
- Increased risk ASPIRATION
- Weak BLADDER and residual volume
- Presence of chronic conditions can exacerbate infection |
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Term
| What are the overall immune changes with OA given the decreased immune response and other factors? |
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Definition
- Less able to fight infection (they last longer)
- Reactivation of latent infectious diseases (Like TB)
- Antibody response to vaccines is slower and therefore less protective
...AT INCREASED RISK OF INFECTIOUS DISEASE WITH AGE. |
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