NR509 Final Chapter 27 Older Adult.pdf

▪ Hand or acial edema aer 20 gesaonal weeks is nonspecic or preeclampsia bu should be invesgaed Obseric hisory (including nomenclaure) o Gravida ▪ reers o he number o mes ha a woman has been pregnan...

▪ Hand or acial edema aer 20 gesaonal weeks is nonspecic or preeclampsia bu should be invesgaed Obseric hisory (including nomenclaure) o Gravida ▪ reers o he number o mes ha a woman has been pregnan. o Para ▪ is he number o mes ha he woman has given birh o a eus a a viable age greaer han 24 gesaonal weeks, regardless o wheher he child was born alive or sllborn. o Parody is urher broken down ino erm deliveries, preerm deliveries, aborons, sponaneous and erminaed pregnancies, living children. Pregnancy sympoms o The uerus sreches causing round ligamen pain in he lower quadrans ▪ Dexroroaon leads o greaer discomor on he righ side as well as increased righ-sided hydronephrosis Exercise and nurion recommendaons during pregnancy o Vaccinaon, screening, and laboraory esng recommendaons during pregnancy o TDAP- during 27-36 weeks o gesaon regardless o prior immunizaon o hisory o Inuenza vaccines- a any rimeser during inuenza season o Pneumococcal, meningococcal, Hep B- OK! o MMR, polio, and varicella- NOT OK DURING PREGNANCY!! ▪ Rubella ers drawn during pregnancy and immunized aer birh or non- immune o Check RH (+ or - ) and anbody ype during rs prenaal visi, a 28 weeks and delivery ▪ An-D immunoglobulin should be given o all Rh- negave women a 28 wks and again wihin 3 days o delivery o preven sensizaon i he inan i Rh-D posive Deermining gesaonal age and he expeced dae o delivery (EDD) o Preeclampsia o Ecopic pregnancy o Clinical presenaons o ecopic pregnancy range rom subacue, approximaely 80-89% go ino shock rom rupure and inraperioneal hemorrhage (10-30 cases) o Mos common clinical eaures ▪ Abdominal pain, adnexal enderness, and abnormal uerine bleeding o In more han hal here is a palpable adnexal mass ha is ypically large, xed and ill- dened a mes wih adheren omenum on small or large bowel. o In mild cases here may be a prior hx o amenorrhea or oher sympoms o pregnancy Miscarriage o Chapter 27 Older Adult Techniques o examinaon  o Assess unconal saus General survey o VSS ▪ Low weigh is a key indicaor in poor nurion Skin, hair, and nails o Eyes Ears o Mouh and eeh Neck o CV o Breas and axillae o Peripheral vascular sysem Abdomen o Female genialia and pelvic exam Male genialia and prosae o MSK—ge up and go es o Nervous sysem—assess memory and aec Cognive assessmen o Memory assessmen ▪ Serial 7s ▪ Poor perormance may resul rom delirium, he lae sages o demena, inellecual disabiliy, anxiey, or depression. Also need o consider educaonal level ▪ Spelling backwards ▪ New learning acviy ▪ 3-4 word recall- give he paen 3 words and have hem repea he words so you know hey heard hem and hen ask hem again in 5 min o recall he words. Physiologic changes associaed wih he aging process o Wih a greaer rise in SBP a widened pulse pressure oen ensues Many older aduls oen develop orhosac hypoension o Aging increases he risk o developing caaracs, glaucoma, and macular degeneraon Overclosure o he mouh may lead o maceraon o he skin a he corners or angular o cheilis Kyphosis  o Bruis may be heard in he carod areries Risk o hear ailure increases o The AV become calcied and immobile resulng in aorc senosis Decreased escular size o ED aecs abou 50% o older men can be caused rom vascular issues Diabees, HTN, dyslipidemia, and smoking can all conribue o ED o Urinary inconnence increases wih age o Forgetulness o Benign remors Pain assessmen o Screening or subsance use and abuse o Subsance use o Abuse ▪ Elder misreamen ▪ Abuse, neglec, exploiaon, or abandonmen. ▪ Prevalence is highes in aduls wih demena and depression Fall risk assessmen o Insall brigh lighng and lighweigh curains or shades. o Insall hand rails and lighs on all saircases. Pahways and walkways should be well li. o Remove iems ha cause ripping like papers, books, close, and shoes rom sairs or walkways. o Remove or secure small hrow rugs and oher rugs wih double sided ape. o Where shoes boh inside and ouside he house. Avoid bare ee and wearing slippers. o Sore medicaon saely. o Keep commonly used iems in cabines ha are easy o reach wihou using a sep sool. o Insall grab bars and nonslip mas or saey srips in bahs and showers. o Repair auly plugs and elecrical cords. o Insall smoke alarms and have a plan or escaping a re. o Secure all rearms. o Have a clinical aler device, sysem or calling a universal emergency number such as 911 or emergency conacs. 10-minue Geriaric Screener o Vision o Hearing o leg mobiliy o urinary inconnence o nurion/weigh loss o memory o depression o physical disabiliy The Join Naonal Commiee (JNC) guidelines or blood pressure o For aduls over 60 years old ▪ blood pressure arges o less han or equal o 150/90 bu noes ha i reamen resuls in SBP less han 140 and as well oleraed and wihou adverse eecs o healh or qualiy o lie, reamen does no need o be adjused.