Module 3 Guided Questions with Answers Latest Update 2024 Test, Exams of Nursing

Download Module 3 Guided Questions with Answers Latest Update 2024 Test and more Exams Nursing in PDF only on Docsity! Module 3 Guided Questions with Answers Latest Update 2024 Test Lesson 1: Geriatrics for the PCP 1. What are the physiologic changes of aging? What kinds of problems are caused by these changes? • Vision : Presbyopia is caused by loss of elasticity of the lenses. Close vision is markedly affected. Onset is during early to mid-40s. Can be remedied with “reading glasses” or bifocal lenses. Cornea less sensitive to touch. Arcos senile, cataracts, and glaucoma are more common. Annual eye exams, Assess ability to read (driving, Rx bottles) Arcos Senile- check lipids • Hearing : Presbycusis (Sensor neural Hearing Loss) Screen with audio scope or whisper test. Refer to audiology if failed. Higher risk for cerumen impaction. Be aware of temp. hearing loss inducing meds: ASA, Lasix • Mouth : Receding gums and xerostomia (dry mouth) Decreased sensitivity of taste buds results in decreased appetite. Dentures- do they fit? Leukoplakia- check bottom lip, chelates, glossaries • Neck : probably is not supple, masses are likely cancer. Check thyroid and TSH level, check Carotids • Chest : BP 𝖳 r/t 𝖳 vascular resistance. Baroreceptors less sensitive to changes Page 1 of 20 in position. Decreased sensitivity of the autonomic nervous system. Blunted BP response. Decrease in maximum heart rate. Higher risk of orthostatic hypotension. S4 heart sound a “normal finding” in the elderly if not associated with heart disease. The left ventricle hypertrophies with aging (up to 10% of thickness). ↓ Cough reflex, ↓ mobility= risk for PNA • Extremities : Edema- does it resolve at night? Discoloration of lower extremities r/t chronic edema. Assess pulses, Heber den nodes, foot abnormalities 𝖳 risk of falls. • Abdomen/GI : Decreased efficiency in absorbing some vitamins and minerals by the small intestines. Delayed gastric emptying. Higher risk of gastritis and GI damage from decreased production of prostaglandins. Diverticula common. Large bowel (colon) transit time is slower. Constipation more common. Increased risk of colon cancer (age greater than 50 years is strongest risk factor). Fecal incontinence common due to drug side effects, underlying disease, and/or neurogenic disorders. Fecal impaction may lead to small amount of runny soft stool. Laxative abuse more common. • GU/reproductive : Starting at the age of 40 years, the GFR starts to decrease. By age 70, up to 30% of renal function is lost. Renal clearance of drugs is less efficient. The serum creatinine is a less reliable indicator of renal function in the elderly due to the decrease in muscle mass, creating production, and creatinine clearance. Serum creatinine can be in the normal range even if renal function is markedly reduced. Risk for UTI 𝖳 r/t prostatic enlargement, atrophic vagina, constipation, mobility issues. Remember early sign of UTI in geriatrics is confusion! Ask about sexual activity, may need pharmacological support, and may need STD education. • MSK : Kyphosis: Compression fractures of vertebrae (a sign of osteoporosis). Deterioration of articular cartilages common after age of 40. Stiffness in the morning. Osteoarthritis very common. Muscle mass and muscle strength markedly decrease, with more muscle loss on the legs compared with the arms. Osteoporosis and osteopenia common. Slower healing of fractures due to decrease in the number of osteoblasts. Bone resorption is more rapid than bone deposition in women compared with men (4:1). Remember to observe for symmetry in changes. Sarcopenia- age Page 2 of 20 2. How do the changes impact the function of the elder? (Source: Kaplan & Shaddock’s Psych Book p. 1336) Page 5 of 20 3. How is function assessed by the PCP? Why is function important? • The geriatric assessment begins with a review of the two key divisions of functional ability: activities of daily living (ADL) and instrumental activities of daily living (IADL). o ADL are self-care activities that a person performs daily (e.g., eating, dressing, bathing, transferring between the bed and a chair, using the toilet, controlling bladder and bowel functions). o IADL are activities that are needed to live independently (e.g., doing housework, preparing meals, taking medications properly, managing finances, using a telephone). o Two instruments for assessing ADL and IADL include the Katz ADL scale and the Lawton IADL scale o Deficits in ADL and IADL can signal the need for more in-depth evaluation of the patient's socioenvironmental circumstances and the need for additional assistance. o Mental status should be a part of the functional assessment. Dementia = significant decline in 2 or more areas of cognitive functioning. Dementia is major cause of loss of ADL/IADL function. Screening is Holstein MMSE, MCOA, or Mini Cog. • The degree of functional competence in their everyday behaviors is an important consideration in formulating a treatment plan for these pts. 4. What are the geriatric syndromes? How are they managed? (Primary Care textbook, p 87- 93) • Polypharmacy o Definition: Use or misuse of multiple drugs (>5), both prescription and OTC o Mgmt ▪ Review all meds at each pt. contact Page 6 of 20 ▪ Maintain good communication w consultant ▪ Use tools to evaluate use of drugs (i.e. Beers list; and I don’t mean Budweiser, Miller, or Corona ;) ▪ Encourage pt. to carry an up-to-date list of their meds ▪ Determine drug risk/benefit ration when considering use of any new drug (“start low and go slow”) • Cognitive impairment (See NCD tx) • Dehydration o Definition: a state of fluid intake deprivation and/or excess fluid loss Page 7 of 20 Syndromes is frequent testing at an eye doctor and the use of prescription glasses or bifocals, when prescribed • Sleeping Difficulties- Warning Signs: Difficulty concentrating during the day, drowsiness, persistent insomnia. Solutions: An overnight stay in an observational sleep lab is the best way to get a comprehensive diagnosis of sleep patterns, which can then be cross-examined by a doctor against current medications and patient lifestyles to determine if sleep medication is an appropriate solution. • Hearing Loss / Presbycusis- Warning Signs: Difficulty following or contributing to a conversation, frequent requests for words to be repeated, lack of reaction to sounds in the immediate area. Solutions: An examination is necessary to determine if the cause is, in fact, Something serious and not an easily remedied condition such as impacted earwax. If a serious issue is discovered, a hearing aid may be prescribed to assist the user’s natural hearing capability. Mental Function: • Dementia- Warning Signs: Strange or unusual declarations, confusion, inability to remember short-term events. Solutions: see neurocognitive disorders below. • Depression- Warning Signs: Withdrawing from social activities, a preoccupation with death or dying, and a general lack of energy or enthusiasm. Solutions: see neurocognitive disorders below. • Paranoia / Psychosis- Warning Signs: Frequent accusations of misdeeds such as stealing or attempting to inflict harm, an overwhelming feeling of being watched, experiencing sights and sounds that aren’t present. Solutions: Anti-psychotic medication can be very effective in controlling the disruptive properties of these syndromes • Substance Abuse- Warning Signs: Consciously taking more pills than prescribed, frequent alcohol drinking, and disproportionately negative reactions when an addictive substance is controlled or taken away. Solutions: Just as their younger counterparts might turn to others for help, group therapy has been shown to assist elderly substance abusers with regaining sobriety and responsible medication handling. 6. How is a functional assessment performed in the primary care visit? • Musculoskeletal and foot assessment; mobility • Activities of daily living- Katz ADL scale • Instrumental activities of daily living- Lawton IADL scale • Mental status- Holstein MMSE, MCOA, or Mini Cog, & Clock test *Geriatric Depression Scale or Patient Health Questionnaire (PHQ2)* Page 10 of 20 Lesson 2: Neurocognitive Disorders 1. What cognitive changes are seen in the elderly patient? • Regarding neurocognitive domains, NORMAL changes with aging are: o Attention: slow decline with age seen in selective attention, divided attention, & working memory o Executive function: decline with age especially after age 70 o Memory: episodic memory shows lifelong declines while semantic memory shows late life decline; unlike declarative memory, no declarative memory remains unchanged across the lifespan o Language: overall language ability remains intact with aging; vocabulary remains stable and even improves over time o Visuospatial Abilities: visual construction skills decline overtime, in contrast, visuospatial abilities remain intact Page 11 of 20 o Processing speed: fluid ability begins to decline in the 3rd decade of life and continues throughout the lifespan 2. What are neurocognitive disorders? • NCD Defined: o formerly known as dementia o A reduction or impairment of multiple cognitive abilities, including memory, sufficient to interfere with self- maintenance, work, or social relationships o Progressive & disabling episodic memory shows lifelong declines while o NOT an inherent aspect of aging o Different from normal cognitive lapses • DSMV Criteria: Major vs Minor Cognitive Disorder o Major NCD ▪ Cognitive deficits interfere w independence in AD activities (minimally requiring asset w complex IADLs) ▪ Cognitive deficits do NOT occur exclusively in the context of a delirium ▪ Cognitive decline is not better explained by a mental disorder (i.e. major depressive disorder, schizophrenia) o Minor NCD (AKA mild cognitive impairment) ▪ Memory problem w/o deficits in other domains ▪ NO fan impairment ▪ 10-12%/yr. progress to dementia • Ds NCD o Examination of neuron, mental, & fan status using screening tools ▪ Cognitive screening tools ➢ Holstein MMSE ➢ Mini-cog ➢ MOCA ➢ SLUMS ➢ Clock Test ▪ Fan screening tools ➢ Lawton IADL Scale ➢ Katz (Basic ADLs) ➢ KELS Evaluation (independent living status) o Laboratory testing ▪ CBC, Blood chemistries, LFTs, renal fan tests, other Page 12 of 20 mental exam MMSE, min- cog, ACE-R, Beck depression, ADL self-performance, Index of social engagement) TX thorough health, drug, medical history, family interview, refer to neurologist, MRI of brain preferred image testing • Depression- disturbance in cognitive, emotional behavior, somatic regulations, depressed mood and loss of interest or pleasure are major symptoms, (depressed mood for 2 weeks or longer, anhedonia, decreased/increased appetite, weight loss or gain, sleep disorder, Page 15 of 20 psychomotor agitation or retardation, fatigue, loss of energy, feeling of worthlessness(poor self-image), inappropriate guilt, recurrent thoughts of death(suicide), difficulty thinking or concentrating/indecisiveness Ds labs CBC, TSH, Vat B12 TX rule out other disease refer psychotherapy ,first line SSRI Page 16 of 20 ~ Delirium ® Acute © Reversible * Consciousness: fluctuating © Decreased awareness of self * Perceptions: illusions, hallucinations common © Speech: slow, incoherent e Disorientation: time, others © Cognitive dysfunction IIness, med. toxicity: often Diurnal disruptions ® Outcome: excellent if corrected early Page 17 of 20 Delirium vs. Dementia Gradual Irreversible Consciousness: rarely alters Decreased awareness of self Perceptions: Hallucinations not common Speech: repetitive difficulty finding words Disorientation: time, person, place Memory impairment Illness, med. toxicity: rarely Diurnal disruptions Qutcome: poor