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Questions and Answers

What is the first step in the medication reconciliation process?

  • Compare the BPMH at all intersections of care
  • Sit down with the patient to obtain a complete medication list (correct)
  • Document discrepancies in the patient's chart
  • The prescriber uses the BPMH to write medication orders

Which of the following is NOT a nursing implication in medication reconciliation?

  • Communicating discrepancies to the interprofessional team
  • Monitoring and evaluating the effectiveness of treatments
  • Providing patient education during periods of fatigue (correct)
  • Performing a comprehensive medication assessment

How should discrepancies identified during medication reconciliation be handled?

  • Discrepancies must be documented in the patient's chart without notifications
  • Discrepancies should be ignored if the BPMH appears accurate
  • They must be communicated to the most responsible person for resolution (correct)
  • The prescriber should make unilateral decisions for changes

Which of the following best describes the 'Best Possible Medication History' (BPMH)?

<p>The complete and accurate list of a patient’s current medications (C)</p> Signup and view all the answers

When performing a medication assessment, what should a nurse ask a patient to do?

<p>Bring all medications in a bag (B)</p> Signup and view all the answers

What approach is emphasized for medication reconciliation?

<p>Team approach involving various healthcare professionals (A)</p> Signup and view all the answers

Which factor is least important when timing a patient education session?

<p>Educating immediately after medication administration (B)</p> Signup and view all the answers

Patient education should include which of the following?

<p>Use of assistive devices and memory aids (B)</p> Signup and view all the answers

Which of the following can help alleviate disability and reduce the risk of falls in older adults?

<p>Promoting healthy feet and good care (A)</p> Signup and view all the answers

What is a common characteristic of hammer toes?

<p>The toes are permanently flexed and claw-like (C)</p> Signup and view all the answers

What is polypharmacy primarily concerned with?

<p>Taking a large number of medications or contraindicated ones (A)</p> Signup and view all the answers

Which statement best defines medication reconciliation?

<p>A formal process ensuring consistent communication of medication information (A)</p> Signup and view all the answers

What increases the likelihood of adverse drug reactions in older adults?

<p>Taking multiple prescription medications (D)</p> Signup and view all the answers

What is the primary goal of falls prevention strategies for older adults?

<p>Reducing the risk of falls and associated injuries (C)</p> Signup and view all the answers

What could potentially result from polypharmacy in older adults?

<p>Adverse interactions between medications (D)</p> Signup and view all the answers

Which of the following best describes corns and calluses?

<p>They form from growths of compacted skin due to prolonged pressure. (D)</p> Signup and view all the answers

What is the primary role of nurses regarding a patient's oral health?

<p>To prioritize and maintain their oral health (B)</p> Signup and view all the answers

Which factor is NOT associated with an increased risk of dehydration in older adults?

<p>Adequate hydration habits (B)</p> Signup and view all the answers

What is the recommended daily fluid intake goal for men who are active and not frail?

<p>3.7 L (C)</p> Signup and view all the answers

Which of the following is a sign of dehydration that should be monitored?

<p>Dry axillae (D)</p> Signup and view all the answers

In the context of falls prevention, which intervention is considered ineffective?

<p>Restricting the patient's movement completely (B)</p> Signup and view all the answers

What should be a priority focus for an interprofessional team when managing a patient's hydration?

<p>Identifying and treating underlying causes of dehydration (B)</p> Signup and view all the answers

Which of the following is NOT a risk factor for dehydration?

<p>High physical activity (C)</p> Signup and view all the answers

Which dental care intervention can help maintain oral health in seniors?

<p>Daily cleaning of dentures (A)</p> Signup and view all the answers

What systemic disease can result from poor oro-dental health?

<p>Malnutrition (D)</p> Signup and view all the answers

What is the expected effect of using an ultrasonic toothbrush for elderly patients?

<p>Enhanced oral health management (D)</p> Signup and view all the answers

Flashcards

Medication Reconciliation

A process to ensure accurate medication information for a patient, especially when transferring care between different healthcare settings.

Team Approach

Medication reconciliation needs the collaboration of different healthcare professionals.

BPMH (Best Possible Medication History)

A complete and accurate list of a patient's current medications gathered from various sources.

Medication Discrepancies

Any differences found between a patient's reported medications and the medications documented or prescribed.

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Comprehensive Medication Assessment

A thorough evaluation of a patient's current medications, including prescription, over-the-counter, vitamins, and herbal remedies.

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24-hour recall

Asking the patient about all medications taken in the past 24 hours.

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Patient Education

Involves educating the patient (and their caregivers) about their medication regimen.

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Interprofessional Team

A group of healthcare professionals with diverse skills working together to provide care to a patient. Examples include doctors, nurses, pharmacists, etc.

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Emollients & Moisture Loss

Emollients can help prevent the loss of moisture in the skin.

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Sun Exposure & Sunscreen

Education on sunscreen use and avoiding sun exposure is important for health.

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Healthy Feet

Promoting foot health reduces disability, pain, and fall risk.

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Corns & Calluses

Corns and calluses are thickened skin caused by pressure.

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Hammer Toes

Hammer toes are permanently bent toes, appearing claw-like.

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Fungal Infections (Feet)

Fungal infections often appear as nail fungus or athlete's foot.

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Bunions

Bunions are bony deformities of the toes (especially big toe).

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Polypharmacy

Taking many medications, including inappropriate or duplicated ones.

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Adverse Drug Reaction (ADR)

Negative reaction arising when medications interact with other substances (foods, vitamins, etc).

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Medication Reconciliation

A process for confirming and correcting medication information to avoid errors when treatment changes.

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Oral Health Importance

Oral health is crucial for overall health; poor oral health can lead to systemic issues like malnutrition, dehydration, infections, and cardiovascular problems.

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Oral Health Interventions

Actions to improve oral health, including professional checkups, brushing/flossing, mouthwash, and using specialized tools for easier cleaning.

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Dehydration Risk Factors

Factors that increase the chance of dehydration, including age, medications (diuretics), lack of support, functional issues, cognitive decline, and illness.

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Dehydration as a Risk Factor

Dehydration itself can trigger various serious health problems such as delirium, seizures, infections, and kidney problems.

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Hydration Management

Maintaining a healthy water balance to avoid complications from abnormal fluid levels.

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Hydration Assessment

Evaluating a patient's hydration status through observation of symptoms and lab tests.

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Daily Fluid Needs

Adults need about 3.7 liters (men) or 2.7 liters (women) of fluids daily if not frail or inactive.

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Study Notes

Healthy Aging - Learning Objectives

  • Discuss assessment and interventions for nutrition, oral health, dehydration, urinary and fecal incontinence in older adults.
  • Explain age-related changes impacting rest, sleep, activity, and associated interventions.
  • Describe problems older adults experience maintaining healthy skin and feet, and associated interventions.
  • Explain how to maintain mobility and environmental safety for older adults.
  • Describe how to assess an older adult for fall risk.
  • Explore safe medication use in older adults and associated complications of improper medication use.
  • Explore the role of healthcare professionals in promoting driving safety for older adults.
  • A number of normal age-related changes affect older adults.
  • These include nutrition, oral health, hydration, urinary incontinence, and fecal incontinence.

Nutrition

  • Factors affecting nutrition in older adults include lifelong eating habits, socialization, income, transportation, and physical changes.
  • Review pages 101-105 in Ebersole & Hess' Gerontological nursing & healthy aging in Canada (3rd Ed.).
  • Health Canada has recommendations to enhance nutrition in older adults. (https://food-guide.canada.ca/en/tips-for-healthy-eating/seniors/)

Oral Health

  • Attention to a patient's oral health is a high priority for nurses.
  • Poor oral health can lead to systemic disease (malnutrition, dehydration, aspiration, joint infections, cardiovascular disease, oral pain, and poor glycemic control).
  • Interventions include using interprofessional team expertise, arranging regular oral exams by a dentist, brushing and flossing twice daily, using mouthwash daily, etc.

Hydration

  • Maintaining hydration is challenging for older adults and caregivers.
  • Dehydration often results from an insufficient fluid intake.
  • Risk factors include old age, medications, lack of adequate staffing and supervision, functional deficits, cognitive decline, comprehension, dysphagia, and illness.
  • Assessment includes paying attention to patients with vomiting, diarrhea, monitoring weight loss, malnutrition, fever, and infections.
  • Lab tests such as BUN, Sodium, Creatinine, Glucose, Bicarb & Osmolarity are important.
  • Monitor intake and output closely.
  • Hydration management promotes an adequate fluid balance to prevent complications from abnormal and undesirable fluid levels.

Urinary Incontinence

  • Urinary incontinence is the involuntary loss of urine.
  • It is very common in older adults.
  • Associated with decreased quality of life, skin irritation, infection, and falls.
  • Pressure ulcer development is also a significant concern.

Classification of Urinary Incontinence (UI)

  • Transient (Acute): short duration (less than 6 months) caused by treatable issues like UTI, constipation, increased urine production, or delirium.
  • Established (Chronic): long-term issues.
    • Urge incontinence: involuntary urine loss soon after feeling the urge to urinate.
    • Stress incontinence: involuntary urine loss during actions that increase intra-abdominal pressure, like coughing or sneezing.
    • Urge or Stress UI with high Post-void Residual incontinence: bladder does not empty normally
    • Functional incontinence: Inability to reach a toilet because of environmental barriers, physical limitations, or severe cognitive impairment.
    • Mixed incontinence: Combination of two or more types of UI, usually stress and urge.

Assessment for UI

  • The assessment should include a health history, targeted physical examination, urinalysis, and determination of postvoid residual urine.
  • Assessment should include a medical, neurological, and genitourinary history, functional assessment, cognitive assessment, psychosocial effects, strategies to manage UI, and medications.
  • A Urinary Diary should be started to track patterns, frequency, and severity of UI events in particular, for LTC setting use of CHAMMP tool is useful.

Fecal Incontinence

  • Fecal Incontinence is the continuous or recurrent passage of fecal material for at least one month.
  • Associated with, and often under-assessed and under-diagnosed in, older adults (50-65%, 33% in hospital, 50-70% have both urinary and fecal incontinence).
  • Can be transient (due to diarrhea, acute illness, or impaction) but often associated with devastating social implications.

Falls

  • A fall is an unplanned descent to the floor.
  • Leading cause of death by injury in older adults.

Common Causes of Falls

  • Multifactorial in older adults.
  • Factors include, but are not limited to, neurological conditions, sensory issues, cognitive decline, medications, musculoskeletal problems, and impending physical illness, wet floors, tripping on rugs or furniture, getting up independently

Falls Assessment

  • Assessment tools, such as Hendrich II Fall Risk Model, the Morse Fall Scale, and the Berg Balance Scale, should be used in combination with comprehensive clinical assessments to determine various risks for falls.
  • Medication use, vision, blood pressure, and balance concerns should be part of the evaluation. Neuro and cardiovascular assessments may be needed. Environmental assessments are important as well.

Interventions for Factors Affecting Healthy Aging

  • Medication reconciliation is a process by which health care providers work with older adults and families to ensure accurate and consistent medication information across all transitions of care. This can help avoid adverse drug reactions.
  • Nurses participate in med rec across all points of care.
  • Nurses should use the 3 step process: Review medication information with the patient/family. Develop the Best Possible Medication History. Compare the information for discrepancies in care.
  • Assessment to determine the patient's need for assistive devices and/or environmental modifications for easier toileting access.
  • Educate for prevention, screening for common conditions, identify risk factors, and encourage healing.
  • Ensure adequate hydration and humidification; use supe-fatted soaps/lotions/emollients and sunscreen.

Driving Safety and Falls

  • Vision changes, cognitive impairment, and medical conditions impact driving abilities.
  • Older adults with dementia have a higher risk of motor vehicle collisions (MVCs) and often have more serious consequences, both in terms of mortality and recovery time, when involved in a MVC.
  • Evaluation of visual, cognitive, and movement and strength abilities is beneficial prior to driving.

Sleep Disorders

  • Sleep disturbances are common in older adults and consist of fragmented sleep, frequent awakening, prolonged latency, reduced sleep time, frequency of daytime naps, poor quality sleep, and sleep disorders.
  • Sleep deprivation can affect cognitive function, pain, and respiratory function.
  • Common sleep disorders include insomnia, nocturia, GERD, dementia, and medications, obstructive sleep apnea, restless leg syndrome, and REM sleep behavior disorder.
  • Patients should also cultivate good sleep hygiene habits, avoid consumption of stimulants like caffeine and nicotine, and be sure to include a sleep assessment, such as checking the sleep log as part of the assessment.

Physical Activity - General

  • 60% of older adults are considered inactive.
  • Frail older adults diagnosed with conditions such as arthritis, COPD, and dementia can benefit significantly from routine physical activity.
  • Physical activity benefits include maintaining functional ability, enhancing self-confidence in older adults, decreasing depression and improving general lifestyle and maintaining mental functional capacity. It can also decrease the risk of medical problems.
  • Mobility and agility are affected by decreased strength and flexibility of muscles and joints, particularly in the legs and back.
  • The movement and range of motion in older adults is often impaired and less fluid. Muscle wasting may occur due to decreased flexibility.
  • Proactive management of persistent illnesses and the maintenance of a healthy lifestyle, and interventions to support mobility, can help to forstall the onset of mobility limitations in older adults.
  • Examples of conditions affecting physical activity include sarcopenia (loss of skeletal muscle mass, strength and function), related to aging and a marker of frailty. Gait changes such as narrower standing bases, wider side-to-side swaying, and slower responses. Agility refers to the ability of the body to change positions efficiently.

Skin

  • Common skin disorders affecting older adults can reflect systemic disorders.
  • The gerontological nurse should educate on preventive measures, screen for skin conditions and common skin disorders, and identify risk factors to facilitate interventions for healing.
  • Examples of skin conditions include xerosis (abnormal dryness), pruritus (itchy sensation), herpes zoster (shingles), and keratosis.

Feet

  • Promoting healthy feet and good care can reduce disability and pain in older adults.

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