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Nursing 212 Midterm Questions With Complete Solutions Transitional care: transitional care encopasses both the sending and the receiving aspects of the transfer Health assessments in older adults Chronic conditions in addition to acute conditions Manifestations of illness less predictable (ex UTI) Multiple possible causes of symptoms Treatments for symptoms control instead of identifying an underlying cause Cognitive impairment Often underlying illnesses not identified until advanced stage Myths and misunderstandings Types of assessment: Physical assessment Functional assessment
Mental status assessment Comprehensive geriatic assessment Environmental and safety assessment Other assessment Nursing assessment tools Purpose: to identify specific areas that need to be addressed in the nursing care plan Should be: Evidence-based Easy-to-use Interviewing older adults Preparing the physical setting Noise, lighting, comfortable furniture, privacy bathroom Establishing rapport Use formal names Explain the purpose Speak directly to the older person Maintain the modesty standards set by each culture Structuring the interview Brief interactions less than 30 minutes each
Refers to the measurement of a person's ability to fulfil responsibilities and perform self care tasks It should measure primarily: -ADLS Instrumental activities of daily living -Level of assistance needed (ie, independent, semi-independent, dependent) -Sensory function (ie, vision/hearing, etc) -Cognitive function (baseline mental status) The Katz Index of ADLs Quick 5 minute assessment of functionality Good for daily use in hospital or long-term care settings Missing assessment of cognition and mobility Assesses independence/dependence in the following areas -Bathing -Dressing -Toileting -Transferring -Continence -Feeding FANCAPES
F - Fluids A - Aeration N - Nutrition C - Communication A - Activity P - Pain E - Elimination S - Socialization 48/ Nursing assessment tool implemented in Fraser Health Authority (FHA) acute care institutions since 2012 Screening document covers 6 functional areas for older adults 70+ years, to be done within first 48 h of admission to hospital 6 functional areas are: -Bowel and bladder management -Cognitive functioning -Functional mobility -Medication management -Pain management -Nutrition and hydration mental status assessment Assessment regarding cognitive ability and mood CAM and 4ATs: delirium
Minimum data set (MDS) MDS is a toll used in fraser health to guide the home health professionals Use by many provinces to assess older adults residing in long term care facilities It is weak in its ability to measure mood or behaviour problem environmental and safety assessment -fall risk assessment -braden scale Caregiver strain index Vital to prevent potential family burnout and elder abuse 13 questions that measure strain related to care provision within employment, financial, physical social and time domains Responses to seven or more items on the index indicate a greater level of strain In what settings do these assessments apply? Any setting in which an older adult lives; -Long term care facilities -Acute care institutions -Short term rehabilitation facilities
-Private homes (where home care is coming in to support ongoing independent living by assisting with various tasks Functional decline occurs due to transitions in care Communication gaps Poor patient education, especially for caregivers and older adults Unique patient characteristics (ie, language barrier, culture, etc) Incomplete transfer of information Poor med red procedures Low staffing Pharmacokinetics how the drug is absorbed, distributed, metabolized and excreted -Absorption of oral (PO) medications can be affected by reduced gastric acid, increased gastric pH, delayed gastric emptying, and the presence of other substances (ie food) -Most PO meds are absorbed in the small intestine -It takes 5 half lives to reach steady state concentration after a drug is initiated or eliminate a drug from the body after the drug is discontinued pharmacodynamics
Low serum albumin (protein): higher concentration of medication left in the blood, higher levels of toxicity and adverse effects Altered receptor sensitivity What affects medication-taking behaviour? Motivation Knowledge about the medication Cultural and psychological influences Physical ability to remove the substance from the container and administer it Ability to swallow oral preparations Additional skills related to administer nasally, transfermally, SC and by other routes Risk factors that affect medication taking? Pathological processes and function impairment (ex dementia) Behaviours based on myths and misunderstands Communication barrier
Lack of information Inappropriate prescription practices Polypharmacy and inadequate monitoring of medications Medication non-adherence Functional consequences associated with medications in older adults Disease or polypharmacy may alter the therapeutic effects Adverse effects Anticholinergic adverse effects Altered mental status Antipsychotics in people with dementia Tardive dyskinesia and drug induced parkinsonism factors that increase older adults risks for adverse events are: Higher number of medications Malnourishment or dehydration
Can counteract the effects of cholinesterase inhibitors, and primary treatment for dementia Safer alternatives usually exist; try to advocate for them Anticholinergic adverse effects: from medications, including some medications that are widely recognized as having anticholinergic effects in the body Antipsychotic Increasingly used in LTC facilities US is restricted by FDA to prescribe antipsychotics ONLY for psychotic symptoms, not wandering, anxiety or insomnia Not similar in canada Studies confirm need for education of nursing staff to improve knowledge, attitudes and beliefs about antipsychotic use for nursing home residents Tardive Dyskinesia: Rhythmic involuntary movements of the trunk, extremities, jaw, lips, mouth or tongue Wormlike movements of the tongue, chewing, grimacing, lip smacking, jaw clenching, eye blinking, and side to side jaw
movement Can begin 3-6 months after initiation of antipsychotic use and persist after med is discontinued Tardive dyskinesia: refers to a constellation of phythemic and involuntary movements of the trunk, extremities, jaw, lips, mouth, or tongue drug induced Parkinsonism Parkinson-like symptoms such as shaking, involuntary or poorly controlled movement Many times condition is misdiagnosed as parkisnsons and the patients are started on new meds Manifestations can be reversed if the drug os stropped BEERS A list of medications known to increase the risk of delirium and other adverse reactions in older adults These medication should not be prescribed for older adults unless there is a greater benefit-risk ration for a particular situation, and then should only be used for the shortest duration Medications are safest and most therapeutic when taken or prescribed and when they are regularly reviewed goals of assessment for medications
Recommend all older adults have a list of what the are currently taking Ensure clients and caregivers understand the appropriate use of "as needed" medications Encourage nonpharmacologic approaches could manage behaviour Decrease number of medication Financial barriers :generic vs brand Interdisciplinary intervention Pharmacists role in reviewing specific actions and interactions of medications Advocate for referral to seniors clinic for complex follow up Refer to home care if assistance taking medications is required Encourage a review of medications with primary physician at every visit Social worker referral for assistance with financing medication nonadherence refers to medication-taking patterns that differ from the prescribed pattern, including missed doses, failure to fill prescriptions, or medications taken too frequently or at inappropriate times prescribing cascade adverse drug reaction mistaken as new medical condition adverse drug events
also called adverse drug reactions or adverse medication effects) are the unintended and undesired outcomes of a medication that occur in doses normally used in humans drug induced parkinsomism is the occurrence of Parkinson-like manifestations as an adverse medication effect medication reconciliation is an evidence-based intervention that has been implemented in health care settings and since 2011, considered one of the top patient safety priorities in CAnada by the canadian patient safety institute geriatric medications which are regulated by health Canada and required to be bioequivalent to their brand name counterparts in dosage from safety, purity, strength, quality, intended use, performance characteris and route of administration Clearance rate: measures the volume of blood from which the drug is eliminated per unit of time Herbs Plant components including bark, roots, leaves, seeds, flowers, fruit of trees, and extracts of these plants that are valued for their savory, aromatic, or medicinal qualities. potential inappropriate Medication
Special considerations Side effects Why the medication has been prescribed How the med is to be administered including dosage ranges Recall the 10 rights of medication administration: Drug Client Dose Route Time Documentation History and assessment Drug approach and right to refuse Right evaluation Right to education What and when are the 3 checks of Drug administration When taking meds out of cupboard When preparing Before administering it ac before meals gtt drop hs
at bedtime pc after meals gd everyday What should you do to prepare for administration of the drug: Wash hands, assemble supplies Calculate the dose (safe range) Briefly assess the patient (specific to med to be give and check: Administer drug accurately Ten rights, three checks Aseptic or sterile techniques Talk to patient (this is your ____ it is for _____ it may make you feel _______ if you experience ______ press the call bell and let us know) What is enteral? Coated, it doesn't dissolve in your stomach but only when it is in intestine Sustained realize: time release technology, aka: sustained release, controlled release, extended release What are the benefits to enteric coated and sustained release tablets
