Podcast
Questions and Answers
What is the first step in the medication reconciliation process?
What is the first step in the medication reconciliation process?
Which of the following is NOT a nursing implication in medication reconciliation?
Which of the following is NOT a nursing implication in medication reconciliation?
How should discrepancies identified during medication reconciliation be handled?
How should discrepancies identified during medication reconciliation be handled?
Which of the following best describes the 'Best Possible Medication History' (BPMH)?
Which of the following best describes the 'Best Possible Medication History' (BPMH)?
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When performing a medication assessment, what should a nurse ask a patient to do?
When performing a medication assessment, what should a nurse ask a patient to do?
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What approach is emphasized for medication reconciliation?
What approach is emphasized for medication reconciliation?
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Which factor is least important when timing a patient education session?
Which factor is least important when timing a patient education session?
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Patient education should include which of the following?
Patient education should include which of the following?
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Which of the following can help alleviate disability and reduce the risk of falls in older adults?
Which of the following can help alleviate disability and reduce the risk of falls in older adults?
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What is a common characteristic of hammer toes?
What is a common characteristic of hammer toes?
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What is polypharmacy primarily concerned with?
What is polypharmacy primarily concerned with?
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Which statement best defines medication reconciliation?
Which statement best defines medication reconciliation?
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What increases the likelihood of adverse drug reactions in older adults?
What increases the likelihood of adverse drug reactions in older adults?
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What is the primary goal of falls prevention strategies for older adults?
What is the primary goal of falls prevention strategies for older adults?
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What could potentially result from polypharmacy in older adults?
What could potentially result from polypharmacy in older adults?
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Which of the following best describes corns and calluses?
Which of the following best describes corns and calluses?
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What is the primary role of nurses regarding a patient's oral health?
What is the primary role of nurses regarding a patient's oral health?
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Which factor is NOT associated with an increased risk of dehydration in older adults?
Which factor is NOT associated with an increased risk of dehydration in older adults?
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What is the recommended daily fluid intake goal for men who are active and not frail?
What is the recommended daily fluid intake goal for men who are active and not frail?
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Which of the following is a sign of dehydration that should be monitored?
Which of the following is a sign of dehydration that should be monitored?
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In the context of falls prevention, which intervention is considered ineffective?
In the context of falls prevention, which intervention is considered ineffective?
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What should be a priority focus for an interprofessional team when managing a patient's hydration?
What should be a priority focus for an interprofessional team when managing a patient's hydration?
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Which of the following is NOT a risk factor for dehydration?
Which of the following is NOT a risk factor for dehydration?
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Which dental care intervention can help maintain oral health in seniors?
Which dental care intervention can help maintain oral health in seniors?
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What systemic disease can result from poor oro-dental health?
What systemic disease can result from poor oro-dental health?
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What is the expected effect of using an ultrasonic toothbrush for elderly patients?
What is the expected effect of using an ultrasonic toothbrush for elderly patients?
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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.
Normal Age Related Changes
- 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.
Age-Related Changes in Mobility - Physical Activity
- 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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