Asphyxiation & Medication for Older Adults

Safety Key Terms

• Asphyxiation: Suffocation where air does not reach the lungs, causing breathing to stop, common causes include drowning, choking, or gas poisoning.
• Bioterrorism: Deliberate spread of organisms into a community, causing widespread illness, fear, and panic.
• Bullying: Aggression (direct or indirect) that includes hostile physical, verbal, psychological, and/or relational behaviors.
• Chemical Emergency: Release of a chemical compound, deliberate or unintentional, with the potential to harm people's health.
• Biotoxins: Poisons originating from plants or animals.
• Blister agents/vesicants: Chemicals severely blistering eyes, respiratory tract, and skin upon contact.
• Blood agents: Poisons absorbed into the bloodstream.
• Caustics (acids): Chemicals burning/corroding skin, eyes, and mucous membranes on contact.
• Choking/lung/pulmonary agents: Chemicals causing severe irritation/swelling of the respiratory tract.
• Incapacitating agents: Drugs affecting the ability to think clearly or causing altered consciousness
• Long-acting anticoagulants: Poisons preventing blood clotting, leading to bleeding.
• Metals: Agents consisting of metallic poisons.
• Nerve agents: Highly poisonous chemicals preventing the normal function of the nervous system.
• Organic solvents: Agents that damage tissues by dissolving fats and oils.
• Riot control agents/tear gas: Irritating agents used by law enforcement for protection or crowd control.
• Toxic alcohols: Poisonous alcohols damaging the heart, kidneys, and nervous system.
• Vomiting agents: Chemicals causing nausea and vomiting.
• Culture of Safety: Organizational environment emphasizing safety over goals via collective commitment.
• Cyber Terror: Using high technology to disable or delete critical infrastructure data or information.
• Disaster: A tragic event of great magnitude requiring a response from people outside the involved community.
• Elder Abuse: Physical, sexual, psychological abuse, neglect or financial exploitation.
• Intersectionality: Overlap of race, sex, gender, class, and other characteristics, leading to increased discrimination.
• Intimate Partner Violence: Physical/sexual violence, stalking, and/or psychological aggression by current or former partners.
• Nuclear Terrorism: Intentionally introducing radioactive materials into the environment to cause injury/death.
• Poison Control Centers: Checklist for poison proofing a home and lists of toxic household items.
• Restraints: Physical devices or chemical means limiting patient freedom/movement, not removable by the patient.
• Safety: Freedom from danger, harm, or risk, which is a concern for all nursing care.
• Safety Event Report: Completion is required after an accident/incident compromising safety in a healthcare facility.
• Sentinel Event: Unexpected occurrence involving death/serious injury, physically or psychologically.

Improving Safety

• Fall prevention includes installing grab bars, removing hazards, and using non-slip socks/mats
• Installing grab bars is a major risk intervention for older adults.
• Medication safety includes reconciliation and electronic prescriptions to prevent errors/drug interactions.
• Hand hygiene and sanitizer use reduces infections at home/in health care.
• Infection control includes proper wound care, surface disinfection, and PPE, which lowers risk.

Safety Risk Assessment

• Fall risk includes history/weakness/dizziness/impaired mobility, or medications impacting balance.
• Medication safety is the risk of overdose
• Cognitive impairment (dementia, confusion, delirium) increases injury risk.
• Skin integrity risk is the risk of pressure ulcers in immobilized patients.
• Infection risk includes immunosuppression, surgical wounds, and/or poor hygiene.
• Trip hazards like clutter, loose rugs, and/or wet floors increase fall risk.
• Fire safety risk is identified as using oxygen near open flames.
• Inadequate lighting can cause poor visibility increases risk of fall
• Infection control is the lack of hygiene, equipment contamination, and/or improper PPE.

Team Collaboration

• Working with OT/PT therapists is important for fall prevention strategies, mobility aids, or home modifications.
• Coordinating with a pharmacist is important to review medications for interactions/proper dosing/patient education.
• Communicating with physicians is important to rapport safety concerns, pain management needs, and patient condition.
• Educating patients/families regarding medication use, infection control, and home safety practices is very important.
• Social workers/case managers can arrange home health services, medical equipment, and community resources.
• Infection control teams implement hygiene/PPE/sanitation protocols

Factors of Safety in Healthcare

• Acknowledgement of healthcare's high-risk nature, committing to safe operations.
• Blame environment isn't maintained, protecting/expecting reporting.
• Teamwork/collaboration are promoted to prevent/seek solutions for safety issues.
• Organization commits resources addressing actual/potential safety issues through a systems-based perspective.

Developmental Stages & Teaching Tips

• Stress and domestic violence increases accidental injuries during adulthood.
• Motor vehicle accidents, industrial accidents, and substance abuse accidents increases deaths due to the adult risk factors.
• Practice stress reduction techniques, enroll in defensive driving, evaluate safety hazards, moderate alcohol consumption, avoidance of any illegal drugs.
• The utilization of safety equipment and options/referrals to those experiencing intimate partner violence helps to improve safety during adulthood.
• Decrease accidents, increase collaboration between health workers/families, and modify environment so as to help ensure a safe environment for all.

Fall Risk Factors

• Modifiable Fall Risk Factors include poor gait/balance, strength, impaired vision, feet/shoe issues, depression/osteoporosis, medications, orthostatic hypotension, home hazards, and Vitamin D deficiency.
• Intrinsic Fall Risk Factors include advanced age, previous falls, weakness, balance issues, poor vision, hypotension, comorbidities, Vitamin D deficiencies, and fear of falling.
• Extrinsic Fall Risk Factors include lack of handrails, poor stair design, no grab bars, dim lighting, slippery surfaces, obstacles, medications, improper use of assistive devices.
• Older adults struggle with medication discharge because confusion, vision decline, polypharmacy, and drug effects of aging

Safety and Security

• Absence of stairway gate or supervision increases fall risk, look out for difficulty in difficulty with gait, modifiable factors, and unsafe home environment
• Access to dangerous products increases the risk of poisoning.

Safe Outcomes

• Identifying unsafe situations/potential hazards, demonstrating fall/accident prevention, establishing safety with family, and demonstrating familiarity.
• Correct identification of an unsafe environment. Implementation of safety and the usage of safety information should be incorporated into the daily living.

Restraints

• Include type, alternatives tried, notifications, and duration. Must be checked every hour and have a new order after an assessment.
• Complete risk assessments, indicate risk on the door and cart, bed in low position with wheels locked, leave a call bell, answer calls always, eliminate hazards, footwear should be nonskid, reposition the patient as needed, and use alternative strategies when necessary.

Asepsis & Infection Control

• Aerobic requires oxygen while anaerobic does not. Antibiotics treat bacterial infections. -Airborne transmission occurs through air while droplet transmissions occurs through fluid from infected.
• Asepsis prevents infection, breaking the chain. Disinfection destroys all pathogenic organisms except spores. Sterilization destroys all microorganisms.
• Bacteria are categorized by shape (cocci, bacilli, spirochetes) & Gram stain reaction (positive/negative). Viruses are the smallest.
• Bundles are 3-5 evidence-based practices together to improve patient outcomes. Iatrogenic results are due to a treatment or diagnostic procedure.
• Contact (direct & indirect): proximity between host and infected, physical touching, or intermediaries.
• HAIs (healthcare-associated infections) develop from medical care in various settings, exogenous or endogenous.
• Infection results from pathogens. Isolation limits the spread of infection w/ protective procedures for hospital personnel, patients, and visitors
• Medical asepsis includes clean techniques to reduce microorganisms. Surgical asepsis uses sterile techniques and area rendering and keeping free of microorganisms.
• Hand rubs before and after patient, after coming into contact with body fluids, but only when hands are visibly soiled. Wash if visibly soiled
• Standard requires precautions for all hospitalized patients, applies to blood, fluids, and coughing etiquette. Transmission bases on airborne.contact for the patients

Nursing Process with Infections

• Assessment gathers history, risk factors, and understanding of hygiene/wounds/devices.
• Diagnosis identifies infection risk or impaired skin integrity.
• Planning involves individualized care plans focusing on hygiene/isolation/wound care.
• Implementation focuses on hand hygiene, PPE, antibiotics, aseptic techniques, and patient education.
• Evaluation monitors infection signs and gauges patient adherence.

Asepsis & Precautions

• Medical asepsis reduces microorganisms via hand hygiene (soap/water or alcohol), PPE, cleaning/disinfecting, and isolation.
• Surgical asepsis eliminates microorganisms, includes sterile field maintenance, proper hand asepsis/PPE, and aseptic wound care.
• Standard applies to all patients. Transmission is based on the mode of transmission (contact, droplet, airborne).
• Contact uses gloves/gown and limits patient transport. Droplet uses masks with patient transfer. Airborne uses N95 with negative pressure.

Nursing Interventions for Infection Prevention

• Always follow standard precautions for all patients. This includes performing hand hygiene, using PPE, practice cough etiquette, and safe use.
• Perform airborne, droplet, and contact transmission-based precautions when needed. Don gear before entering and taking gear off when leaving transmission-based precaution area Additional Notes:
• Number/virulence of organisms, host immune competence, and contact length influence disease potential, and the skin has defenses.
• Infection progresses through incubation, prodromal, acute, and convalescent stages. Use antimicrobial only on antibiotic infections, and antivirals only on viruses.
• Alcohol-based hand rubs are to be used before and after every patient contact.

Mobility Key Terms

• Active exercise: The patient independently moves through their full range of motion.
• Active-assistive exercise: The nurse may provide minimal assistance if the patient cannot do the exercise independently.
• Activities of daily living (ADLs): Eating, bathing, dressing, and toileting.
• Aerobic Exercise: Sustained muscle movements which will increase blood flow, heart rate, and metabolic demand for cardiovascular conditioning.
• Atrophy: Leads to decreased muscle size. Contractures: Permanent contraction of a muscle.
• Ergonomics: Designing equipment and work tasks to conform to the capability of workers.
• Flaccidity: Decreased muscle tone resulting from disuse or neuron impairment. Fracture: A break in the bone.
• Instrumental activities of daily living (IADLs): Housekeeping, meal preparation and finances.
• Isokinetic exercise: Involves muscle contractions with resistance. Isometric exercise: Contraction and no shortening of the muscle.
• Isotonic exercise: Muscle shortening and active movement. Paralysis: Absence of strength secondary to neuron impairment.
• Paresis: Impaired muscle strength/weakness. Passive exercise: Patient unable to move independently and the nurse moves the joint.
• Range of motion (ROM): Maximum degree of movement of which a joint is normally capable.
• Safe patient handling and mobility (SPHM): Ergonomics applied to activities associated with direct patient care.
• Spasticity: Increased tone that interferes with movement.

Exercise, Strength, and Tonus

• Strength/endurance exercise: Muscle building through weight training.
• Stretching exercise: Movement allowing joints and muscles to stretch through their ROM.
• Tonus: State of constant slight contraction in a muscle.

Exercise vs Immobility

• Exercise: Increases cardiovascular health, increases muscle strength, enhances flexibility, boosts immune function, produces healthy metabolism, improves bone density, improves mental health, makes you feel better, enhances cognitive functions.
• Immobility: Muscle atrophy, joint stiffness, poor circulation, increased risk of blood clots, pressure ulcers and respiratory complications, increased weight gain, mental health, sleep disturbances.

Nursing Process for Mobility

• Assess current mobility and potential barriers. Implement the plan that is specific to realistic mobility goals. Encourage safe practices and educate patients on the process that is needed to improve safety. Monitor the mobility progress often.

Good Mechanics

• To have proper body mechanics, one must use legs to lift, legs should be bent at the knee and keep it close to the body. Always maintain the base for support.
• There should be a lift term. Know your teammate's and your limits.

Additional Mobility Notes

• Motion can be as simple as extending muscles, or as complex as skiing. Maintenance of posture: Skeletal muscle contractions hold the body in place.
• Support: Skeletal muscle contractions support tissue in the pelvic cavity. Heat production: Maintain body temperature.

Congenital Abnormalities & Nursing Responsibility

• Early detection and referral for such problems. Provide counseling that educates with support.
• Constant attention positioning transfers and use of safe practices helps create a better outcome. Regular exercise benefits the body through cardiovascular and better breathing:
• Increase efficiency of the heart. Decrease heat rate of the blood. This requires that patient do exercises to obtain maximal amount of O2 levels

Nursing and Musculosketal

• Be in collaboration with the health care team to find optimal capacity. Safe, correct and correct in the exercise to not create any potential problems with the comorbodities.

Outcomes of Musculosketal Function

• Increased energy levels.
• Increased bone density. The health care worker should first examine the following. There should be attention to detail when you can.
• Patient ability at rest. The ability to perform. The response. Vital signs immediately.

Additional Nursing Considerations

• Assess patient for any braces and know if they are allowed. Always assess patient capability and that they are understanding the instructions by staff.
• Assessment the area that there will be movement (removes any obstacle). To safely guide with a movement, you should use an already established test.
• After the patient's assessment there should be general movement and alignment. There should be functioning and structure. The patient should be able to endurance properly

Adult Mobility

• Adults stand, sit erect, are balanced and coordinated. Pregnant adults have a shifted gravity due to the developing fetus.
• One should access activity balance and note down any illnesses. For interventions, do it by following the instructions of a fitness counselor.

Older Adult Mobility

• To increase and reduce the risk of falls, there should be a focus on general easy access alignment. Check joints and what their function is, and what and tone the muscle is. Importance of exercise and D-enriched diet should be emphasized.

Mobility Body Systems

• With exercise, heart efficiency, oxygen flow, and other factors will increase. With immobility, increased cardiac workload, risk for thrombosis, and venous thrombosis should be anticipated.

Body Checklist

• Straight alignment and proper body movement and function. The patient should also know if something is bothering them or if it comes across as being different.

Safety

• If something doesn't feel right at any time, you should stop, assess and call medical services. Never assume what is going on (always call medical services).
• When in acute, you may have altered mental status and will require more assistance and services. To improve the way you live, you should always try to implement as more exercise as possible at all times.

Key Terms for Comfort and Pain Management

• Acute Pain: Rapid onset, varies in intensity, protective nature.
• Addiction: Chronic relapsing brain disease; compulsive drug seeking/use.
• Adjuvant: Analgesics (anticonvulsants, antidepressants, drugs) used with primary pain.
• Analgesic: Relieves pain, reduces perception and alters responses.
• Breakthrough Pain: Temporary moderate/severe flare-up when persistent pain is medicated.
• Chronic Pain: Maladaptive, lasts/reoccurs more than 3 months.
• Cutaneous Pain: Superficial, involves skin/subcutaneous tissue.
• Endorphins: (opioid neuromodulator) CNS pathway, pain-blocking, prolonged analgesic & euphoria.
• Enkephalins: (opioid neuromodulator) brain/spinal cord, reduces less potent than endorphins, and it reduces pain.
• Exacerbation: Symptoms that are reappearing, contains chronic and acute pain symptoms
• Gate Control Theory: Most of the practical model concerning the concept of pain.
• Intractable: Pain resists therapy, persists despite interventions.
• Modulation: Sensation of pain, inhibition/modification.
• Neuromodulators: Endogenous opioid compounds, spinal cord/brain, analgesic, alters pain -Neuropathic Pain: caused by a legion or disease the central somatic sensory nervous system
• Neurotransmitters: Excites or inhibit target nerve cells, which either excite or inhibits some certain nerves.
• Nociceptive Pain: damage to nonneural tissue which presents as normal pain
• Opioid side effects include respiratory, tolerance, dependence, nausea and vomiting.
• Opioid assessment tools, to test induced sedations and can also include pasero opioid induced scales
• Analgesics controlled substances Morphine, codeine, hydro morphine

Describing Quality

• Sharp is stabbing and intense. Dull is annoying rather than sharp
• Diffuse covers a wide range, which the area is not. Shifting goes to one and another.

Pain Responses

• Physiologically (involuntarily) occurs, HR, BP, and RR.
• Behavior (voluntary) responses occur, guarding or protecting the area.

Modulation (contributing factors)

• Enhancing the transfer and making and contribute to sensation. There is somatic origin, that involves vessels, nerves and muscles.
• Cutaneous involves the skin and tissues. Referral is when pain is actually felt and is more and more of a contributing factor.
• The assessment has a look to to it via the form test

Physical Dependency

• Physiological condition leading to withdraw, if the drug is stopped. Tolerance with a drug. When the body has a low tolerance one will have to make the person have access to the pain:
• Make sure that there is low to no cost for everything
• Openly talk about what they are feeling and ensure their satisfaction and what can fix it and work for them.
• Try and include other strategies such like heat and massage.
• It is important to get communication going and you must always ask how they may assist you as people working in the area.
• Talk and take action toward relieving pain so that it is always a win win
• Work on what is making them feel well. Have them be able to tell you if they can.

Hygiene

• Key Terms:
• Alopecia: Absence or absence of hair.
• Caries: Teeth decay with all its foundations and cavities.
• Cerumen: Build up the canal, it is all the wax that has built up. It is what causes dryness
• Cheilosis: Ulceration and dry scalping at the fissures at the base of the mouth.
• Gingivitis: The gingiva itself is in fact inflamed in some sort of fashion.
• Glossitis: inflammation in the tongue due to deficiencies and an abundance of folic acid too.
• Pediculosis: This is an infestation of the lice.
• Plaque: an invisible destructor.
• Stomatitis: Inflammation of the oral mucosa. The factors that may affect it
• Cultural beliefs: The many differences all around. Physical limitations (any factors of paralysis)

General Hygiene

• Mental can lead to neglect and lack of resources, and in fact can hinder ones from getting proper care.
• Assess those you are caring for and take the care to look over their body for any lesions. It can also become more and more difficult.
• The goal is to maintain skin integrity and the patients as needed.

Types of Baths

• One can use all sorts of traditional baths that go on a frequent basis. The patient's privacy needs to always be respected and water will become too contaminated over time.
• Disposable cloths are used to clean and reduce bacteria, therefore prevent skin breakdowns and infections. CHG baths are recommended when the CHG level is at 2 %.

Tips for Hygiene

• Clean to the front in order to prevent any UTIs and take use mild soaps. In the acute areas, a check will help to prevent bacteria accumulation on the skin integrity
• Look over the skin in case there are any conditions. Educate the patient about hygiene and prevent from any breakdown in the systems.

Nursing Interventions

• Provide CHG wash, routine assess for lice or scalp, and to ensure everything is clean. Evaluate at all high risk area of redness and keep everything clean.
• When maceration excess is present, be sure to get rid of the area. It can require barrier creams that can be created.
• If mucosa is inflamed, give saline rinses and easy food.

General Rules to Follow

Incorporate them in all other other systemic areas. You should know to cause problems. Take into consideration the other mechanical devices. Assess physical areas. Clean skin

Values, Ethics and Advocacy

Key terms:

• Advocacy: The protection and support of another`s rights.
• Autonomy: Respect the rights of patients or their surrogates to make healthcare
• Beneficence: Benefit the patience, and balance; benefits against risks and harms care
• Based Approach: directs attention to the specific situations of individual patients viewed within the context of their life narrative set of principles that reflect the primary goals and obligations.

Different Key Terms

• Conscientious Objection: the refusal to participate in certain types of treatment and care based on the fact that these activities violate the nurse's personal and professional ethical beliefs and standards
• Ethical Dilemma: arise when attempted adherence to basic ethical principles results in two conflicting courses of action Ethics: a systematic study of principles of right and wrong conduct, virtue and vice, and good and evil as relate to conduct and human flourishing

Virtues and Malpractices

• Altruism: Concern for the safety and well being of others.
• Compassionate: Providing empathetic and patient-centered care. -Malpractice and neglience happens by, nurses are legally accountable for providing competent care; failure to meet standards can result in legal action:

Values and Ethics

• Be with people who respect your patient and have good judgement. The assessment should be accurate.
• Make time for other people. Create an environment that facilitates people
• Code of ethics for nurses and the rules the govern the people in the place. The ANA code has codes of ethics and what and where are your sources. The ethical problems can include any mental health issues.

Nursing Ethics

• Nurses must always be committed and trustworthy as well as reliable. Keep every professional ethical and treat all with care. Take into consideration that any action does affect and does have a play of effect on others health.
• All patients should have treatment as fairly to ensure everybody has equal care. This is how you should act or care and what can you do about it.
• Don't cause any harm and respect the limitations to make sure there are no negligence, also stay safe by preventing all harms. It is always important to stay updated and knowledgeable to ensure the best ethical care.

Pharmacology and Medication

• ADME is the way that drugs are absorbed, distributed, metabolism, and excreted. Absorption is the way that the drug moves. After the drug becomes absorbed its distributed through the body so that they can take action properly all throughout. This is the process of removing them from the body.
• Pharmacotherapeutics is a therapeutic use. Adverse occurs and is the most serious of all the allergic effects. Bioavality is where the body can use and do its functions properly
• Pharmacodynamics are the way drugs act in target, which lead to some alteration. Pharmacokinetics is all to do in relation to the body's relation. Placebo is an inactive substance. Synergistic effect is a combined result.
• Trade name is protected. Trough level is when the drug is is the lowest. Is when its self setting and easy.

Tips for Medication

• Easy to set up as an injection. Subcutaneous to be a part of long term use of the drug, which you do not have to keep coming in on a day to day basis.
• The best thing to do is educate your patient and if they have a good understanding that they need to take those medications. Remember that there are both types of drugs, there is OTC and any other. Always have something to follow by and make the day by day easier.

Medication Dosage

• Stat will be made and given on the spot. All patients shall be assessed and documented fully. Ensure that the patient understands and can swallow. If not, you should not leave the area and give them time to swallow carefully

• Follow and take the medication is the best thing you can do. Make the decision to take to medication is key.

• As nurses, we should monitor vital signs. Always maintain the patient and educate the patients on why in fact they need to continue to take the medication. Always have the patient be your main priority at all times.

• If in any way a change needs to be adjusted, we will. The amount we give depends per diagnosis.

  You must always ensure that you are giving them what they need, not what you want.