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Unit C N104
| Question | Answer |
|---|---|
| Middle age, age range? | 40-65 years |
| Middle age psychosocial concepts (tasks) | -Assume civic and social responsibility -Relationship with spouse/significant other (has more time with spouse which can be good or bad) -Accept/adjust to physical changes -Assist children with growth and development (establish next generation) |
| Middle age psychosocial concepts (tasks) cont. | -Assist aging parents -Establish standard of living -Develop leisure time activities -Can be a time of stress, mid-life crisis, and divorce |
| Middle age Psychosocial Development Erikson's stage? | Generativity vs Stagnation-concern for establishing & guiding next generation (less focus on self, more on community) -Welfare of mankind equal to concern of providing for self |
| Generativity | Positive side: charitable & altruistic actions (ex-volunteering, political, church fundraising) |
| Stagnation | -Unable to expand interests, suffer sense of BOREDOM & IMPOVERISHMENT -Difficulty accepting aging body, become WITHDRAWN & ISOLATED -Preoccupied with self (self-centered) -Regression to earlier phases of life -Extramarital affairs -Mid-life crisis |
| More Middle Age Psychosocial Development | -Look and feel older -Enjoy freedom & independence of middle age -Focus shifts from inner self and being to others and doing -Religious and philosophical concerns become important |
| Middle Age Physiological Changes -Normal APPEARANCE Changes | -Thinning, gray hair -Less skin turgor, moisture -Less subcut fat-leads to wrinkles -Nose and ears still growing -Fatty tissues redistribute (from periphery to central; goes into deep tissues and abdominal region) |
| Middle Age Physiological Changes -Normal MUSCULOSKELETAL changes | -Muscle bulk decreases around age 60 -Muscle growth continues in proportion to use -Intervertebral disc thinning (decrease in height about 1") -Calcium loss from bones (more common in post-menopause women. Need to start supplementing Ca @ 35) |
| Middle Age Physiological Changes -Normal CARDIOVASCULAR System | Blood vessels lose elasticity and become thicker (heart muscle walls thicken) -Increase in blood pressure is normal *but HTN is NOT normal, it's a disease! |
| Middle Age Physiological Changes -Normal METABOLISM changes | Slows, leading to weight gain |
| Middle Age Physiological Changes -Normal GASTROINTESTINAL changes | -Decrease in tone of large intestine (may lead to constipation). Too much water gets pulled out because of slowed peristalsis |
| Middle Age Physiological Changes -Normal SENSORY PERCEPTION changes | Visual acuity declines often by late 40's-PRESBYOPIA (need for reading glasses) -Auditory acuity declines (especially high frequency sounds-called PRESBYCUSIS; more common in men, talk lower) -Taste sensations diminish (can be a factor in malnourishment |
| Middle Age Physiological Changes -Normal URINARY system changes | -Nephron units lost (Bladder capacity declines, urine more dilute with more water content) -Glomerular filtration rate decreases -Increased urgency, dribbling, and frequency |
| Middle Age Physiological Changes -Normal SEXUALITY changes | -Hormonal changes take place -Menopause (estrogen drops, disruption of menses) -Climacteric (later 40's-early 50's, decreased HGH & testosterone. Depression, osteoporosis, sexual dysfunction. |
| Middle Age Cognitive Development | -Reaction time, memory, perception, learning, problem solving and creativity CHANGE VERY LITTLE -Longer reaction time during LATTER part of middle age |
| Perceptions of Aging -Ageism | -Prejudices & stereotypes applied to older people soley based on their age -Having this view separates elderly from others by: -Leads to lack of understanding of elderly/issues -Reduces opportunities for the young to gain realistic insight into aging |
| Psychosocial Tasks of the AGED | -Role changes (retired, grand-parent, widowhood-most difficult task of this generation, may be intolerable). Big adjustment. Identity may be threatened. Harder on current old men because wives were homemakers. This will change with future generations) |
| Psychosocial Tasks of the AGED (cont.) | -Awareness of mortality/shrking social world -Maintain standard of living ("fixed income") -Cope with physical changes (most have 1 or more chronic diseases) -Loss of independence (fear disease will lead to loss of independence) |
| Age ranges of the AGED | Total: 66 years-death -Young old: 66-74 -Middle old: 75-84 -Old old: 85-99 -Elite old: 100+ |
| AGED Erikson | Integrity vs. Despair -Integrity: individual derives satisfaction from an evaluation of his/her life -Despair: disappointment with life and the lack of opportunities to alter the past (miserable/negative people) |
| AGED Maslow | Self-Actualization: to become everything one is capable of being (very few people actually get here) |
| Community Resources for the AGED | -Adult day care -SNF's (skilling nursing facility/nursing home) -VNA (visiting nurse association) -Medicare/medicaid (government financial medical assistance) -MOW (meals on wheels) -Etc... |
| AGED-sexuality and aging | 0Sexuality and sexual interest in late life REFLECT LIFELONG PATTERNS -Common misconceptions -Factors threatening the elderly person's ability to remain sexually active -Factors can interfere with sexual process (ex-diabetes, less blood flow to genital |
| AGED-sexual dysfunction factors | -(Un)Availability of a partner -Psychological barriers (taking on attitudes of surrounding individuals) -Physical barriers (sometimes this can be helped) -Erectile Dysfunction -Drugs -Cognitive impairment |
| AGED-types of elder abuse | -Physical (bruises, timid, afraid, improper use of restraints) -Psychological -Sexual (rape, sexual, STD of unknown origin) -Financial (missing $) -Caregiver neglect -Self-neglect -Abandonment (dropping off @ emergency dept) |
| AGED-older adults AT RISK for abuse | -75+ -Female -Low socioeconomic status -Low educational level -Impaired functional and/or cognitive status -History of domestic violence, depression, stressful events/abuse |
| Cardiovascular System- Physiological Changes (these changes can lead to an increase risk of cardiovascular disease) | -Valves stiffen -SLIGHTLY less cardiac output -Arteries less elastic -Vein walls thicken -Myocardial hypertrophy (heart larger) -Less Renin-angio-aldoster production (changes in BP) -Less pacemaker cells -Lipid deposits & calcification of blood ves |
| Cardiovascular System Assessment: HISTORY | -Family history increases risk -Smoking -Occupation/lifestyle (ex-sedentary vs. active) -Diet (sodium, fat, cholesterol, sugars) -Medications -Secondary illness (diabetes-increases CV disease risk x3; atherosclerosis) |
| Cardiovascular System Assessment: HISTORY-Modifiable Risk Factors | Exercise, smoking, diet, control the secondary illness, obesity, alcohol intake, stress |
| Cardiovascular System Assessment: HISTORY-NON-MODIFIABLE Risk Factors | Family history, age, gender (men more at risk when younger, women more at risk when older), post-menopausal, history of diabetes, race (African Americans, Hispanics) |
| Cardiovascular System Assessment: PHYSICAL | -Ht, Wt, vitals (BMI; fluid gains) -Funduscopic eye exam (damaged veins) -Examine neck -Ascultate heart (sound/rate) -Examine abdomen (can auscultate vena cava, aorta-aneuryism) -Examine extremities (pulse, temp, pain...) -Labs Cholesterol, renal pr |
| Cardiovascular System Assessment: PHYSICAL (Neck examination) | -JVD: jugular venous distention NOT NORMAL(although it can be normal if lying) Sign of excess fluid -Equal carotid arteries -Clogged arteries/atherosclerosis: Thrill (feel vibration under skin w/ pulse) & Bruit (auscultate w/ stethoscope) -Enlarge thy |
| Cardiovascular Health Problems -HYPERTENSION JNC7 Guidelines | How to treat/diagnose HTN -Optimal <120/<80 -Prehypertension 120-139/80-89 -Hypertension Stage 1 140-159/90-99 -Hypertension Stage 2 160+/100+ |
| JNC7 Goal | Avoid TARGET ORGAN damage -Heart -Kidneys -Brain -Blood Vessels -Eyes |
| JNC7 Treatments | Prehypertension: Lifestyle changes (exercise & diet-individualized. NOT MEDS) Hypertension Stage 1: Lifestyle changes + 1 drug at diagnosis Hypertension Stage 2: Lifestyle changes + 2 or more drugs at diagnosis |
| JNC7 Lifestyle Changes for any HTN situation | -DASH diet (dietary approaches to stop HTN)-increase fruits/vegies; decrease fat, sodium, cholestrol -Decrease weight (MOST EFFECTIVE) -Decrease sodium intake -Exercise -Decrease alcohol intake |
| First Line/Choice HTN Drug | Thiazide Diuretics (ex. HCTZ)-most patients are on HCTZ |
| Hypertension: Pathophysiology (An increase in any of the pathophysiological factors will increase BP; decrease in factor will decrease BP) | -Sympathetic Nervous System & Renin-Angiotensin System provide overall control -Cardiac Output and Peripheral Vascular Resistance are primary regulating factors |
| Hypertension: Pathophysiology (An increase in any of the pathophysiological factors will increase BP; decrease in factor will decrease BP) (CONTINUED) | -Baroreceptors (Carotid sinus & aortic arch)/Chemoreceptors (brain) sense changes in BP and cause response through sympathetic and parasympathetic nervous system |
| Hypertension: Pathophysiology (An increase in any of the pathophysiological factors will increase BP; decrease in factor will decrease BP) (CONTINUED 2) | -Renin-Angiotensis system controls BP by releasing Angiotensin II (potent vasoconstrict, increases BP) and the production of aldosterone (water and sodium rention, also increases BP because more blood volume) |
| Hypertension-Nursing Implications | -Accurate BP assessment (2 step if needed; proper cuff-small=high, large=low; position; release of pressure; arm @ heart; don't smoke within 30 min; no exercise within 5 min) -Physical assessment -Patient teaching (meds, s/e, diet, exercise) -Med admin |
| Diuretics (3 types) | -Thiazides -Loop Diuretics -Potassium Sparing Diuretics |
| Diuretics-THIAZIDES | HCTZ (hydrochlorothiazide) -Most common -Cheap -First line therapy -Not good choice for diabetes because it ups BS, not good w/ gout (hyperurecemia)but still may see pt's on it -Not alot of diuresis loss compared to loop diuretics (only 5%) |
| Diuretics-THIAZIDES side effects | -Increase urination -Electrolyte imbalance (hypokalemia) -Hyperurecemia (uric acid), hyperglycemia |
| Diuretics-LOOP DIURETICS | -furosemide (Lasix) -bumetanide (Bumex) -torsemide (Demadex) -Affects: Loop of Henle -Potassium DEPLETING diuretics S/E: Increase urination, electrolyte imbalance (hypokalemia), often used in heart failure patients |
| Diuretics-POTASSIUM SPARING DIURETICS | -triamterene (Dyrenium) -spironolactone (Aldactone) -Can cause HYPERkalemia. Inhances affect of Loop Diuretic if given 30 minutes apart |
| Diuretics: Hyperkalemia & Hypokalemia | Can cause life threatening cardiac arrhythmia (S/E of all diuretics) |
| Beta-Adrenergic Blockers (-lol) -Action | -Generic all end in "LOL" -Action: Decrease myocardial stimulation, act-directly on cardiac cells decreasing stimulation, contractility and thus BP |
| Beta-Adrenergic Blockers (-lol) S/E and Parameters | -Most common s/e: BRADYCARDIA (also hypotension, dizzy, weak) -Hold if HR <50; SBP <100 or per Dr parameters -Common male s/e: Erectile dysfunction |
| Angiotensin Converting Enzyme: ACE Inhibitors (-pril) -Action | -Generic all end in "PRIL" Block angiotensin I from converting to angiotensin II (works in kidneys and a little in lungs) -Usually used in conjunction with other drugs (not usually used by itself) |
| ACE Inhibitors (-pril) S/E | -Most common s/e: Dry Cough -Other s/e: angioedema (head, throat, face-allergic reaction, cannot use ARB's either!), HYPERkalemia, hypotension, renal dysfunction |
| ACE Inhibitors (-pril) Renal Dysfunction | Complication: Renal insufficiency If BUN & Creatinine are both high=renal failure If BUN is high and creatinine is normal/low=dehydration |
| Angiotensin II Receptor Blockers ARB's(-tan) -Action | -Generic name ends in -TAN -Angiotensin II already formed but the medicine blocks their receptors -Works in kidneys (NOT LUNGS) -Good alternative for ACE inhibitor if patient experiencing dry cough -Work just as good as ACE's but not as studied |
| ARB's (-tan) S/E | -Angioedema, renal dysfunction, hypotension |
| Calcium Channel Blockers (-pine) 2 Types/Action | -Generic DIHYDROPYRIDINES end in -PINE Action: Prevents calcium from entering channels in myocardial cells and blood vessels-smoothing and relaxing allowing for better blood flow 1-Non-dihydropyridine 2-Dihydropyridine |
| Calcium Channel Blockers -Non-dihydropyridines | -diltiazem (Cardizem) -verapamil (Calan, Isoptin) -Preferred in African Americans (works better than Beta's for this population) -S/E: bradycardia, constipation Parameters: Hold for apical <50 or Dr parameter |
| Calcium Channel Blockers -Dihydropyridines (-pine) | -Preferred in African-Americans and Elderly -S/E: Peripheral edema -Parameters: Hold if apical <50 or dr parameters |
| Vasodilators Old school, but very effective | -hydralazine (Apresoline)-common PRN med -minoxidil (Loniten) (also need to be on a diuretic-fluid retention & beta block-tachycardia) -S/E (lots): tachycardia, hirsutism, fluid retention (minoxidil), SLE/lupus (hydralazine) -LAST LINE AGENT |
| Alpha I Blockers -azosin | -Generic all end in -AZOSIN -Action: relax smooth muscle around BV-better blood flow -Not preferred due to increased mortality -Preferred if co-treatment for BPH -S/E: postural/orthostatic hypotension (common) |
| Alpha 2 Agonists and Adrenergic Antagonists | -clonidine (Catapres) -methyldopa (Aldomet) -reserpine -guanfacine (Tenes) -LAST LINE -Need tapered if stopped-significant withdrawl if stopped abruptly! *Rebound tachycardia & HTN |
| Special Situations (HTN) Renal | Chronic Renal Failure -BP goal: <130/80 |
| Special Situations (HTN) Women Non-Pregnant | -Incidence and SBP lower than men in first 5 decades -Quickly rises after 5th decade to that of men or higher (menopause-due to drop in estrogen) -Oral contraceptives induced HTN |
| Special Situations (HTN) Woman Pregnant | -1st Line: labetalol (Normodyne) -2nd Line: methyldopa (Aldomet) |
| Special Situations (HTN) Erectile Dysfunction | -Common in men >50 with HTN, diabetic, obese, smokers or taking antidepressants/Beta Blockers (if Beta Block is the issue can usually switch to different antiHTN agent) -Reduced perfusion to genitals -Treatment: lifestyle changes, switch antiHTN agents |
| Arteriosclerosis | -BROAD term -Describes hardening and thickening of arteries from a variety of causes (smoking, diet, heredity...) |
| Atherosclerosis | -Specific -Hardening/thickening arteries from PLAQUE development -Begins w/ cholesterol deposits in arteries -If you lower cholesterol level, you lower lesion formation or stabilize lesion by replacing w/ connective tissue (decrease risk of erosion) |
| Lipid Panel Blood Test | -Cholesterol -Triglycerides -HDL (healthy-want higher) -LDL (bad-want low) -VLDL (very bad-want lowest) -Ratio's of levels HDL+VLDL+LDL=total cholesterol |
| Atherosclerosis Treatment | -Dietary Changes (less fat/cholesterol, more fiber, fruits, vegies, lean meats) -Lifestyle changes (exercise, less weight, no smoking)-will drop cholesterol 20-30 max...if need more must go on meds -Medications (Lipid-lowering agents) |
| Lipid-Lowering Agents | -atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor) -cholestyramine (Questran): works in bowel to block reabsorption of cholesterol in GI tract. S/E: loose, fatty stools -fenofibrate (Tricor), niacin (Niaspan), gemfibrozil (Lopid) |
| Lipid-Lowering Agents -Required labs | Need to monitor Lipid & Liver Profiles! Very hard on liver. Need to get a baseline then check @ 3, 6, 12 months and then every 6-12 months |
| Formation of atherosclerosis | Starts w/ lipid core, the platelets & clotting factors stick to rough core causing collection/blockage Pieces can break off & go to other places starting new build-ups/stroke |
| Antiplatelet Agents (5) | -clopidogrel (Plavix) -ASA (aspirin) -ticlopidine (Ticlid) -cilostazol (Pletal) -pentoxifylline (Trental) NOT BLOOD THINNERS OR ANTI-COAGULATION MEDS! Take off before surgeries! NOT FOR HISTORY OF GI ULCERS! |
| Anti-platelet Agents -ASA | Aspirin -Can only crush chewable form -1 daily for MI & stroke prevention, usually 81 mg/day (may be higher w/ heavier history) -Make platelets less sticky, thus less likely to clump together (less clotting) -S/E: Bleeding, GI upset (take w/ food) |
| Anti-platelet Agents -ticlopidine (Ticlid) -cilostazol (Pletal) | -Affect bleeding times -S/E: Bloody gums, blood in urine, blood in stool, bruises |
| Anti-platelet Agents -pentoxifylline (Trental) | Action: Increase flexibility of RBCs, gets through narrow areas easier allowing more oxygen to cells -Decreases blood viscosity -Use: intermittent claudication-pain w/ walking in legs due to peripheral vascular disease |
| Anti-arrhythmic Medications -Action -Most common -Parameters | -Increase force of myocardial contraction -Decreases conduction through SA and AV nodes, which decrease heart rate -Increase cardiac output Example: digoxin (Lanoxin) MOST COMMON Parameters: Hold if HR<60!!! |
| Anti-arrhythmic Medications -S/E | -Arrythmias -Bradycardia (toxicity, need to check blood digoxin levels, should be in therapeutic range 0.5-2.0) *hyperkalemia=more susceptible to digoxin toxicity -Toxicity indicated by bradycardia, yellow-green halo, abdominal pain, nausea, arrhythmias |
| Common cardiovascular Tests | -EKG -Stress Test -Echocardiogram -Transesophogeal Echocardiogram (TEE) -Cardiac Catheterization -Cardiac Enzymes -Lipid Panel -CBC -Metabolic Profile -Brain Natriuretic Peptide (BNP) -C-Reactive Protein (CRP) |
| EKG | Electrical tracing of heart-shows rate, arrhythmias, A Fib, blocks |
| Echocardiogram | Structural components of heart (ultrasound) |
| Transesophogeal Echocardiogram | Invasive-go into esophagus, can see through esophageal wall to heart. Pt needs sedated |
| Cardiac Catheterization | Invasive-direct view of coronary arteries w/ use of dyes. Can put in stents. |
| Cardiac Enzymes | Blood tests (serial enzymes) baseline, 8 hr later, 8 hr later again |
| CBC | Platelets, WBC |
| Metabolic Profile | Na, Cl, K, electrolytes |
| Brain Natriuretic Peptide (BNP) | Specific to heart failure (degree of heart failure) |
| C-Reactive Protein (CRP) | Inflammation (ex-endocarditis). Sensitive test but NOT specific! Detects inflammation anywhere. |
Created by:
aprildaisley
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