MS1 Test 1 Review PDF

LIFE EXPECTANCY RISE IN LIFE EXPECTANCY LEADING CAUSES OF DEATH N.C for Increasing Life Expectancy - Older Generation: proportion of Americans 65 years of 1) Heart Diseases age and older has tripled in the past 1...

LIFE EXPECTANCY RISE IN LIFE EXPECTANCY LEADING CAUSES OF DEATH N.C for Increasing Life Expectancy - Older Generation: proportion of Americans 65 years of 1) Heart Diseases age and older has tripled in the past 100 years 2) Malignant Neoplasm- cancer - Promote physical activity, demote - Geriatrics: With aging population, comes a whole different 3) COPD- encourage smoking cessation sedentary/inactive lifestyle level of care to provide to geriatric population - Smoking cessation 4) Stroke-caused by HTN or HLD or clots, - Race and Gender With Greatest Expectancy: White - Low sodium Low Saturated Fat Diet women. Men take more risks. Other races have higher depriving the brain of oxygen - Educate on adherence of drug regimen incidence of disease 5) Alzheimer disease- incurable SYSTEM CHANGES IN OLDER ADULTS SYSTEM CHANGES NURSING CONSIDERATIONS Cardiovascular - Less Effective Pumping of Heart- Decreased compliance or stretch of the heart muscle decreases - Promote Diet: Low sodium Low System effectiveness of the heart Saturated Fat Diet - Decreased Cardiac Output- thickening of the Left Ventricle, known as Myocardial Hypertrophy, - For OHOTN, have the patient sit for a minute, then stand for a minute, then engulfs the ventricle and shrinks it, decreasing cardiac output walk. Also have the patient report - Fat Deposits in Arterial Wall- deposits are caused by high-fat diet and leading to HTN dizziness or lightheadedness - Slower Recovery Rate to Stress- bradycardia leads to pacemaker - OHOTN Respiratory - Breathing in and Breathing out Less Air -the max inspiratory and expiratory force decrease, and - Promote smoking cessation System lung mass decreases - Promote incentive spirometer use 10 - Amount of Air Remaining after Exhale- increased residual volume times/hour - Promote deep breathing and coughing - Smoking- most significant risk factor for lung issues exercises Integumentary - Saggy skin- as the saggy skin wrinkles and fold, there's an increased risk of skin breakdown - Turn and position, remove stickers System - Decreased SUBQ fat- causes old people to always be cold; affects body heat conversion carefully - Keep patient warm Reproductive - Sexual Activity Declines In Women- due to the loss of a partner System - Sexual Activity Decline in Men- as a result of poor health, erectile dysfunction, medications, and emotional factors - Female Sexual Changes- decreased estrogen and progesterone production during menopause; Vagina narrows, reduces secretions, elasticity, and tone - Male Sexual Changes- decreased testosterone production; less firm testes; can produce viable sperm up to 90  SYSTEM CHANGES IN OLDER ADULTS SYSTEM CHANGES NURSING CONSIDERATIONS Genitourinary System - Decreased Metabolism of Drugs- breakdown of medication slows down, increasing the risk of accumulation and toxicity of the drug - With meds start low and slow, since there is slower - Male GU Problems: benign prostatic hyperplasia (enlarged prostate gland) metabolism of drugs, that can lead to toxicity - Female GU Problems- - Involuntary peeing- urge incontinence - Peeing when you cough or sneeze- stress urinary incontinence) Gastrointestinal -Decreased Senses- decreased thirst, smell, taste, salivation - Address money and physical limitations that may System - Decreased Ability to Chew or Swallow- dysphagia can cause malnutrition interfere with food shopping and meal preparation - Decreased Stomach Secretions that Aid in Digestion- less gastric acid and - Educate on Low-fat, High-protein diet pepsin means less digestion - Delayed Motility, and Esophageal and Stomach Emptying- food takes longer to digest because it moves through GI tract slower - Require Fewer Calories- due to changes in body mass and sedentary lifestyles Musculoskeletal - Fracture and Fall Risk- due to decreased bone density, decreased muscle - Fracture Risk: perform weight bearing exercises like System strength/size, and deterioration of joint cartilage walking and lifting weight (10lb limit). Increase vitamin D and calcium intake - Fall Risk: bed alarm, bed in lowest position, 3/4 side rails up, non skid socks, educate on and respond to call bells, place pt near nurses station, keep frequently used items close to patient Nervous System - Risk for Falls and Driving Accidents Due to- loss of brain mass, diminished - Fall Risk: bed alarm, bed in lowest position, 3/4 side reaction time, increased confusion and poor balance r/t poor cerebral function rails up, non skid socks, educate on and respond to call bells, place pt near nurses station, keep frequently used items close to patient Senses - 5 Sense: all decrease; can lead to hearing aids, reading classes etc Sleep - Factors that Cause Poor Sleep- respiratory problems (obstructive sleep - Fall Risk: bed alarm, bed in lowest position, 3/4 side apnea), restless leg syndrome, nocturia, pain, dementia rails up, non skid socks, educate on and respond to call bells, place pt near nurses station, keep frequently used items close to patient  DELIRIUM VS DEMENTIA DELIRIUM DEMENTIA - Definition: ACUTE medical emergency, confused state that begins with - Onset- symptom onset subtle, progresses slowly disorientation. Must be treated IMMEDIATELY or can progress to changes in - Alzheirmers is the Most Common Dementia- accounts for 70% of dementia, LOC, dementia, irreversible brain damage, and sometimes death 6th leading cause of death - Causes- drugs, infection, withdrawal, insomnia, head trauma - Risk factors- environmental toxins, head injury, viral infections, age, genetics, - Nursing Considerations- treat cause of delirium, reorient pt frequently, use race, gender calm voice and music MILD ALZHEIMER’S (EARLY STAGE) MODERATE ALZHEIMER'S (MIDDLE STAGE) - No Impairment/ Mild Cognitive Decline- normal function with forgetfulness of - Clear-cut Cognitive Deficiencies- withdrawn, memory loss, limited knowledge everyday objects (glasses, phone, keys) of recent events. Difficulty with planning and organizing (paying bills or - Not Obvious- not evident to provider, friends or coworkers managing money). SEVERE ALZHEIMER'S (LATE STAGE) VERY SEVERE - Physical Impairment- incontinence, wandering behaviors, assistance with - Severe Physical and Cognitive Impairment- can't respond to stimuli, speak, ADLs, disturbed sleep patterns control movement (ataxia), or eat; remains incontinent - Loss of Awareness- of recent events, surroundings, and personal history (but can recall name) - Personality changes- delusions, and hallucinations  NURSING INTERVENTIONS FOR ALZHIEMERS SCHEDULING PATIENT SAFETY IN THE HOSPITAL - Toileting, Walk and Sleep schedule- to reduce wandering behaviors; ensure - Place Patient Near the Nurses Station- for frequent monitoring proper hygiene to prevent infection -Keep Patient From Safety Risks- keep patient away from stairs, elevators, - Turning Schedules- to prevent skin breakdown; ensure proper hygiene to exits prevent infection PATIENT SAFETY AT HOME: Prevent Falls MONITOR DIET - Remove floor rugs and clutter - Offer finger food or snacks if patient can’t sit for a long time - Secure electrical cords to baseboards, - Monitor I&Os - Good lighting - Install handrails (stairs and bathroom) and Shower chair - Mark stair edges with colored tape AVOID OVERSTIMULATION - Place mattress on floor - Keep Structured Environment - Initiate exercise program to improve mobility, - Introduce Changes Gradually - Add difficult door locks and alarms - Keep Noise and Clutter to a Minimum - Lock cleaning supplies, water heater, and thermostat - Avoid Crowds MEMORY TRAINING REDUCE AGITATION - Reminisce of the patients past - Calm, redirecting statements - Use memory techniques, such as making lists - Distract patient with music therapy - Stimulate memory by repeating the client’s last statement. EARLY STAGE ORIENTATION LATE STAGE THERAPY - Easily viewed clock and single-day calendar - Acknowledge the patient’s feelings, don’t argue with them - Pictures of family and pets - Caution repetitive actions or ideas - Frequent reorientation to time, place, and person - Promote self-care as long as possible, - Promote consistency with routine and place commonly used objects in the same - Assist with ADLs when necessary location - Speak directly to the client in short, concise sentences.  INTRO TO FLUIDS AND ELECTROLYTES FLUID MAKEUP IN THE BODY N.C WHEN TAKING OFF FLUID - How much of the Adult body is made up of fluid: 60% - Monitor BP- severe drop in B/P if fluid taken off too quick - Intracellular fluid- 2/3 of body fluid; within the cell membrane - 1 Liter at a Time- severe drop in B/P if fluid taken off too quick - Extracellular Fluid- 1/3 of body fluids; outside the cell membrane; Further - Osmotic diuretics- may be needed if fluid is in the tissues like in burns or divided into parts cerebral edema. Osmotic diuretics suck the fluid from the tissue, into the - Intravascular fluids- liquid part of the blood vasculature (blood vessels). Then lasix can be given to pee out the fluid - Interstitial fluid- located between the cells and outside of the blood vessels - Transcellular Body Fluids- secreted by epithelial cells (cerebrospinal, pleural, peritoneal, and synovial) LABS TO MONITOR F/E ALDOSTERONE AND ALBUMIN - CBC: complete blood count; WBC, RBC, PLT, Hgb, Hct - Aldosterone Function: aldosterone makes the kidneys retain Na while - Low H&H can indicate blood loss Excreting K+ - CBC with differential= CBC with types of WBC (neutrophils, basophils) - Where sodium goes, water flows, so some water will be retained with the - BMP (basic metabolic panel)= kidney function, electrolytes and CO2 sodium - BUN and creatinine: waste products that are excreted by the kidneys. - High Aldosterone Levels- high Na and H2O, Low K (Cushing’s signs) BUN is more sensitive to fluid imbalances. Cr indicates severe imbalance - Low Aldosterone Levels- low Na and H2O, high K (Addison's signs) - High BUN= dehydration - High BUN and Creatinine= kidney failure - Albumin Function: produced by the liver, albumin keeps water in the blood vessels, rather than it leaking into the tissue and causing edema - Low Albumin Levels: less fluid is in the blood vessels, more fluid is in the tissues, causing edema GERONTOLOGIC CONSIDERATIONS - Medications- meds that affect renal and cardiac function increases risk of F/E imbalance. Old people are more likely to be on these meds as they have decreased cardiac and renal function - EX. if an older pt needs a blood transfusion, they may be put on lasix to prevent fluid overload - Dehydration- common - Delirium- caused by fluid imbalance - Fluid Makeup- decreases to 55% in older adults - Older People are More at Risk for F/F Imbalances Due To: - Loss of SUBQ tissue - Impaired excretion and reabsorption of the kidneys - Loss of muscle mass: muscle tissue holds more body water - Diminished thirst reflex  FLUID VOLUME DEFICIT/FVD/HYPOVOLEMIA DEHYDRATION vs FVD - Dehydration- loss of water alone (not electrolytes) with increased sodium levels; not FVD - FVD- lack of both water and electrolytes, causing a decrease in circulating blood volume - Aldosterone Function: aldosterone makes the kidneys retain Na and some H2O, while Excreting K+ - Albumin Function: produced by the liver, albumin keeps water in the blood vessels, rather than it leaking into the tissue and causing edema WAYS TO LOSE FLUID - GI Losses (through mouth or anus): vomiting, breathing (insensible losses) NG tube suctioning, diarrhea - Skin Losses: diaphoresis (sweating), heat stroke, burns - Renal Losses (peeing): diuretics, diabetes insipidus, kidney disease, addison's/adrenal insufficiency, low aldosterone - DI- loss of antidiuretic hormone, making you pee more since there's nothing to stop you from peeing - Kidney Disease: the kidneys fail to reabsorb fluids into the bloodstream and now excrete them - Addison's Disease and Low Aldosterone- Addison's disease is low cortisol and aldosterone. Less aldosterone means less Na and H2O is retained - Third Spacing/Fluid Shift from Vasculature or Organs into Interstitial Space: peritonitis, bowel obstruction, ascites, burn - Additional Causes: hemorrhage, NPO, poor PO intake FLUID VOLUME EXCESS/FVE - FVE: an excess of water and electrolytes in the extracellular fluid WAYS TO RETAIN FLUID COMPLICATIONS ASSOCIATED WITH FVE - Heart Failure: heart is less effective at pumping blood, causing poor circulation - Left sided Heart Failure: fluid overload in lungs; SOB, dyspnea and fluid retention by the kidneys - Right Sided HF: fluid overload in rest of the body; swollen legs and abdomen - Kidney Injury: the kidneys cannot properly excrete fluid - Congestive HF: (CHF)- both sides of the heart - Hyperaldosteronism: more aldosterone means more Na and H2O is retained - Pulmonary Edema: coughing up foamy pink secretions - Altered Intake- excessive salt or fluid consumption, excessive corticosteroid use NURSING CONSIDERATIONS FOR ALL FLUID AND KIDNEY ISSUES - I&Os - Normal Urine Output= 30 mL/hr or 720 mL/day - Low Urine Output= 2,000 mL/day - Daily Weights - 1 additional kg = 1000mL retained fluid (2.2 lbs=1,000 mL) - Notify HCP of a 1-2 lbs gain in 24 hours or 3lb gain in 1 week - Monitor BP & HR - Monitor BUN and Creatinine: Kidneys play a role in F/E balance since they monitor the excretion and reabsorption of F/E  SYMPTOMS OF FVD AND FVE THE S/S FVD FVE - HOTN and Tachycardia with Thready Pulse- less fluid is being - HTN and Tachycardia with Bounding Pulse: more fluid is being pumped so the heart works harder to get more fluid circulated pumped so the heart works harder to get more fluid circulated Vital Signs - Hyperthermia- body is compensating, less water to sweat and cool body, less blood to warm body - Increased RR- less blood is oxygenating the lung muscles, lungs - Increased RR- excess fluid can build up in the lungs, making it harder to compensate by breathing faster breathe - confused, thirsty, low weight - restlessness, confusion, increased weight, Appearance - poor skin turgor, flattened neck veins, sunken eyes - edema, distended neck veins (JVD), crackles (alveoli filled with fluid) - low urine output/oliguria - increased urine output/polyuria, - Increased Hgb & Hct- due to the less fluid to dilute the H&H - Decreased Hgb & Hct- due to hemodilution - Increased BUN (Blood Urea Nitrogen)- less fluid is getting to - Decreased BUN: more fluid is getting to kidneys more urea is filtered kidneys, less urea is filtered out of the blood and excreted through out of blood and excreted urine Labs - Increased Urine Specific Gravity & Osmolality: specific gravity is - Decreased Urine Specific Gravity & Osmolality: specific gravity is the the weight of the pee. Solutes make pee heavier. Specific gravity weight of the pee. Solutes make pee heavier. Specific gravity decreases increases due to the less fluid that would dilute urine due to more fluid that dilutes urine - IV fluids - Semi-Fowlers Position: promote lung expansion - T/P: edema causes skin to stretch out, saggy skin easily tears Tx - Monitor lung sounds for crackles - Implement fluid and sodium restrictions ELECTROLYTES ELECTROLYTE AND FUNCTION NORMAL LEVELS Sodium: -NAtermia. maintains B/P, blood volume, and pH balance 135-145 Chloride: -CHLORemia. Sodium and chloride go hand and hand and have the same causes and effects 97-107 Potassium: -Kalemia. Contracts heart and muscle tissue by conducting nerve impulses 3.5-5 Calcium: -CAlcemia. Promotes blood clotting and depolarizes/relaxes muscle cells 8.6-10.2 - Ca and Phosphate affect each other in opposite ways Magnesium: -MAGnesemia. Depolarizes/relaxes muscle cells in the heart, uterus, and DTR 1.2-2.3  SODIUM maintains B/P and blood volume HYPONATREMIA- BRAIN CHANGES HYPERNATREMIA- BRAIN CHANGES Na LEVELS - < 135 - > 145 Where water goes, sodium flows Gain of Sodium: -Hypovolemic Hyponatremia: loss of sodium and water - Increased Dietary intake - Diaphoresis- more loss of Na than H2O - NG tube feedings without enough water - Decreased salt intake - Increased aldosterone with Cushing's, CAUSES - Diuretics - Diarrhea Loss of Water to Dilute Sodium - Drains - NPO - Hypervolemic Hyponatremia: excess water dilutes sodium levels - Heat stroke: more loss of H2O than Na. - Decreased Aldosterone with Addisons - Burns: water evaporates through the burned skin - SIADH: pee less - Diabetes insipidus: pee more APPEARANCE - Confusion, lethargic, less salivation, nausea, poor skin turgor, - Restless, irritable, thirsty, n/v, anorexia, flushed with rosy cheeks cramping VS (Vital Signs) - HOTN with hypovolemia, tachycardia - HTN, hyperthermia - AMS: confusion, headache, lethargic - AMS NEURO - Seizures: brain swells due to fluid shift into the brain (water - Seizures: brain swells due to fluid shift out of the brain (water moves CHANGES moves from high solute to low solute) from high solute to low solute) - Implement seizure precautions- oxygen, mask, suction, - Implement seizure precautions- oxygen, mask, suction, padded padded side rails side rails - Coma - Coma SALTS: 0.9% normal saline, LR, NaCl Hypotonic Fluids:0.45% saline ADMIN - Electrolyte changes must be made slowly to reduce the risk - Electrolyte changes must be made slowly to reduce the risk cerebral edema due to solute changes cerebral edema due to solute changes For SIADH: admin diuretics since H2O is high Diet: foods high in sodium Diet: foods low in sodium. N.C Monitor: I&Os, daily weights, VS, levels of consciousness (LOC) Monitor: I&Os, daily weights, VS, levels of consciousness (LOC) Implement: seizure precautions Implement: seizure precautions  POTASSIUM: contracts heart and muscle tissue by conducting nerve impulses HYPOKALEMIA HYPERKALEMIA EKG changes, low & slow because of less contraction of muscles. EKG changes, tight & contracted because of more contraction of the muscles K LEVELS - < 3.5 - > 5.0 - Lasix or Furosemide: potassium wasting diuretics - Spironolactone: potassium sparing diuretic - Diarrhea, ileostomy, intestinal suctioning - ACE inhibitors CAUSES - Increased aldosterone with Cushing's: holds more Na and H2O, - Decreased aldosterone with Addison's: lose Na and H2O, hold more K lose K - Drains - Excessive dietary intake - Poor dietary intake - Acidosis - Alkalosis Less Nerve Conduction/Muscle Contraction More Nerve Conduction: - Fatigue - Restlessness APPEARANCE - Muscle weakness - Muscle weakness - Paraesthesias (tingling) - Paraesthesias (tingling) - DIMINISHED DTR - HYPERACTIVE DTR - Decreased bowel motility, paralytic ileus, constipation - Hyperactive bowel motility, diarrhea - *** Diarrhea CAUSES hypokalemia, constipation is a RESULT of hypokalemia EKG - ST DEPRESSION, FLAT T WAVES; less contraction of - PEAKED T WAVES, V FIB: more contraction of heart muscles heart muscles POTASSIUM: PO or IV piggyback. Run IV for 1 hour since it - IV calcium gluconate will burn when going in - IV sodium bicarb ADMIN - NEVER CRUSH K+ PILL - IV regular insulin with dextrose: insulin promotes K movement into - NEVER IV PUSH K+ cells and out of the blood - K+ cannot be given if the patient isn’t peeing. NO PEE NO - Kayexalate (sodium polystyrene) K. - Lasix Diet: high in potassium Diet: low in potassium. NO SALT SUBSTITUTE. Salt substitute (Mrs. dash) N.C contains potassium Monitor: I&Os, EKG, BS, DTRs Monitor: I&Os, EKG, BS, DTRs Implement: tele monitor Implement: tele monitor  CALCIUM CONTROL Calcium: promotes clotting and relaxation/depolarization of muscles Calcium Levels Control: controlled by parathyroid hormone and calcitonin. Vitamin D: needed for the absorption of calcium. Calcium and Phosphate Relationship: work in opposite ways. High phosphorus means low calcium and vice versa PTH: released when Ca is low. Signals the bone and kidneys Calcitonin: released when Ca is high. Signals bone & kidneys - Bone- releases Ca from bones into the bloodstream - Bones- stops the release of calcium from the bones - Kidneys- enhances reabsorption of calcium from urine, back into - Kidneys- stimulates calcium excretion in urine, reduces reabsorption bloodstream, preventing loss  CALCIUM Promotes clotting and relaxation/depolarization of muscles HYPOCALCEMIA HYPERCALCEMIA bones, blood clotting, beats. Less calcium, less relaxation & clotting stones, moans, and groans. More calcium, more relaxation & clotting LEVELS - < 8.6 - > 10.2 - Hypoparathyroidism: when PTH is removed during thyroidectomy - Hyperparathyroidism, - Low Vitamin D Intake - Osteoporosis: bone breakdown releases Ca into blood CAUSES - Kidney injury, pancreatitis, laxatives - Excessive Vitamin D - Diuretic, corticosteroids - Lithium: causes low phosphate which causes calcium to increase. EKG - Prolonged QT interval - Shortened QT interval Less Muscle Relaxation: More Muscle Relaxation: APPEARANCE - Tetany (twitching), Paresthesia (tingling) - Fatigue - Charley horses - Muscle weakness, - Hyperactive DTR - Hypoactive DTRs - Diarrhea, cramps - Nausea, cramps, severe constipation, polyuria - Seizures - Kidney stone formation (renal calculi) - Dyspnea due to laryngospasm - Bone pain - OSTEOPOROSIS since Ca is being taken out of the bone to increase sermon levels CLINICAL Positive Trousseau Sign- hand flexion when BP cuff is inflated SIGNS Positive Chvostek Sign- twitching of facial nerve ADMIN - IV calcium gluconate - PO Ca and dietary Ca: cheese, spinach, milk collards greens - Dietary Calcium Restrictions N.C - Seizure precautions - Hypercalcemia has a high mortality rate. Prevent hypercalcemia - Exercises to decrease bone calcium loss - Fall precautions and fracture risk r/t osteoporosis cause - Low stimuli - Fall precautions and fracture risk r/t osteoporosis symptom - Monitor DTR and airway for laryngospasm  MAGNESIUM Depolarizes/relaxes muscle cells in the heart, uterus, and DTR HYPOMAGNESEMIA HYPERMAGNESEMIA less magnesium means less relaxation more magnesium means more relaxation LEVELS - < 1.3 - > 2.3 CAUSES - Alcoholism - Kidney injury, diabetic ketoacidosis, e - GI losses - Excessive Mag intake - Limited Mag intake - Extensive soft tissue injury - Loop or thiazide diuretic, hypokalemia, - Hypocalcemia APPEARANCE Less Relaxation: More Relaxation: - Tetany (twitching), paresthesia (tingling), - Muscle weakness, - Irritability - Drowsiness, lethargic - Charley horses - Depressed RR (depressed skeletal muscle) - Hyperactive DTR - Hypoactive DTRs - Chvostek and Trousseau signs EKG - Cardiac Arrest - Dysthymia, Cardiac Arrest ADMIN - Mag Sulfate IV - IV calcium gluconate - PO Mag - Loop diuretics - NaCl, LR N.C - Seizure Precautions - Monitor: I&Os, VS, EKG, DTRs - Monitor: I&Os, VS, EKG, DTRs - Implement: tele monitor - Implement: tele monitor