What are the physiological changes of aging
- Reduced physiological reserve of most body systems
2.Reduced homeostatic mechanisms that fail to adjust - Changes in the sympathetic response
- Impaired immunological function- infection risk is greater and autoimmune diseases are more prevalent.
What factors influence lab value interpretation in the older adult
- physiological changes with aging
- the prevalence of chronic disease
- changes in nutritional and fluid intake
- Lifestyle
What lab values is important
Creatinine clearance, GFR and renal function
What are examples of drugs are eliminated renally
Digoxin, H2 blockers, lithium and water-soluable antibiotics
What are the two formulas to evaluate the kidney function
The Cockcroft-Gault formula and the Modification of Diet in Renal Disease (MDRD)
What neurological conditions commonly have an initial onset in older age?
Parkinson’s, dementia, stroke, and complex partial seizures
What are geriatric syndromes
Diseases that involve multiple systems and have more than one underlying cause
What are the geriatric syndrome giants currently
Frailty, anorexia of aging, sarcopenia and cognitive impariment
What are bimodal presentations of disease
Diseases that can present in a younger age and an older age.
What are examples of bimodal diseases?
Psoriasis, Inflammatory bowel disease, Ulcerative Colitis, Crohn’s disease, Hodgkin’s lymphoma, and myasthenia gravis
What is primary prevention?
Activities to prevent the occurrence of a disease or adverse, including mental health
What is secondary prevention
Tasks directed towards detection of a disease or adverse health condition in an asymptomatic individual who has risk factors
What is tertiary prevention
The management of existing conditions to prevent disability and minimize complications to prevent disability for optimal function
What is the key to increasing geriatric physical activity
motivation
What is the nutrition screening tool for community dwelling older adults
Mini-Nutritional Assessment (MNA)
What factors affect maintaining a healthy balanced diet in geriatrics?
- Chronic illness and disability-related to ADLs like shopping and meal preparation,
- Financial hardships-limit food choices
- Prescribed medications-affects absorption of nutrients, sense of taste or appetite
- Depression or social isolation
- Obesity
What is a big influence of geriatric functionality and quality of life?
Injury prevention
What are important 6 areas of geriatric safety prevention
- Safe storage and removal of firearms
- Fall prevention
- Wearing seatbelts
- no drinking and driving
- Having a working smoke detector
- Keeping hot water set below 120 degrees
Periodic screening of gums and mouth can screen for what?
- Oral cancer
- ill-fitting or poorly functioning dentures
- Periodontal disease
- Erosion of dentin
- dependence on others for dental resources
What screening tools are covered by Medicare?
1.HIV
- Alcohol misuse
- Smoking cessation
- Depression
- High blood pressure
- Blood glucose r/t cardiovascular risk assessment
- Lipids screening
- Mammography until aged 75
- Osteoporosis
- Colorectal cancer
What are the immunizations recommended for geriatrics?
- influenza- annually for all over 50
- Tetanus-diphtheria (Tdap)-once in a lifetime booster, then every 10 years
- Pneumococcal -1 time dose of PCV13 at 65 years old then PPSV23 1 year (12 months) later
- Hep B for high risk persons 1st dose then 6 months later 2nd dose, the 4-6 mos later the 3rd dose
- Shingrix for zoster
What are contraindications for exercise therapy
- unstable angina
- uncompensated heart failure
- Severe anemia
- Uncontrolled blood glucose
- Unstable aortic aneurysm
- Uncontrolled hypertension or tachycardia
- Severe dehydration or heat stroke
- Low oxygen saturation
What are the benefits of exercise?
Strengthen muscles
Maintain flexibility
Promote balance
Build and maintain bone mass
Prevent injury
Improve daily functioning, especially in elderly
Prevent chronic disease
What assessment screening tool evaluates functional decline?
How long is the time frame?
The Timed Get up and go Test
16 seconds.
What screening tool is used for domestic violence?
HITS
What screening tool is used for cognitive and affective disorders like dementia, delirium,depression and spiritual health
- Mini-Mental SE,
- The mini-Cog and
- the Montreal Cognitive (MoCA),
- Geriatric Depression scale
- HOPE, and SPIRIT
agitation
Change in behavior,-repeating questions, arguing,
Labs- CBC, CMP, B12, TSH
Tx-Psychotropic meds ( Abilify, Risperdal)
- antiseizure meds (Tegretol, Lamictal)
anxiolytics- alprazolam, diazepam
Alcoholism
alcohol misuse-tachycardia, peripheral neuropathy, tremors
Labs- SBIRT
Tx- sobriety or total abstinence
what is anxiety? what labs? what meds?
excessive worry difficult to control-poor health, financial insecurity, etc.
Labs- CBC, CMP, TSH Geriatric Anxiety Inventory screening
TX- start low and go slow-SSRIs-Escitalopram, sertraline, citalopram
What are the 5 domains of a comprehensive geriatric assessment
- Physical health,
- functional health
- psychological health
- socioenvironmental supports
- quality of life
What 3 things do a comprehensive geriatric assessment do?
- Identifies care needs
- Plans care
- Improves outcomes
What is the most frequently used criteria for evaluating drug use?
The BEERS criteria, the STOPP criteria and the START criteria
What are 9 biomarkers of nutritional deficiency?
- Prealbumin,
- transferrin,
- albumin,
- chemistries,
- cbc,
- vitamin B12,
- folate,
- vitamin D and
- thyroid panel
What bipolar disorder? What labs? What meds?
S and Sx: Euphoria or irritability, depression, hypomania, rapid speech and irritability, can begin after 50, assess with DIGFAST or SIGECAPS
Labs- cbc, cmp, tox screen, u/a, thyroid function, rpr
Meds: Mood stabilizers-lithium valproic acid, and the antipsychotics- quetiapine and olanzapine
Depression symptoms? Labs? Tx?
SIGECAPS measures the disturbance in:
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor slowing
Suicidal Ideation
Labs assist in causative factors
Tx-Beahvior stabilizer-Haldol, mood stabilizer- olanzapine, risperidone, quetiapine
Dementia, Iabs and, Tx
A slowly progressive global cognitive decline- confusion, disorientation
Labs: cbc, electrolytes, glucose, BUN, Cr. LFTs, TSH, folate, syphilis serology and UA, Mini mental or MoCA
Tx- Cholinesterase inhibitors – donepezil, rivastigmine, galantamine or
Namenda
Depression, labs, tx?
A pervasive feeling of sadness, discouragement, can start at age 60.
Labs- electrolytes, hormone levels, nutritional deficiency, B13 and vitamin D deficiency
Tx- SNRI’s- duloxetine, Effexor, SNRIs-citalopram, escitalipram, sertraline
elder abuse
Any knowing, intentional, or negligent act by a caregiver or any other person to an older adult; the act causes harm or serious risk of harm
Labs-?
Tx-call the elder abuse hot line
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED NURS 6540 Final Exam Question 12 out of 2 pointsHow does women’s anatomy make them more susceptible to UTIs? Selected Answer:d. Their urethras are shorter. Question 22 out of 2 pointsThe primary endocrine disorders affecting women are diabetes mellitus and: Selected Answer:b.Thyroid conditions Question 32 out of 2 pointsA common prenatal care model in which women have their first visit with one provider and then subsequent visits in a group setting is called:Selected Answer:NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED c. CenteringPregnancy d.Question 42 out of 2 pointsWithout treatment shortly after birth, as many as 90 percent of infants born to hepatitis B– infected mothers will:Selected Answer:Become infectedQuestion 50 out of 2 pointsOptimal weight gain during pregnancy is based on the woman’s prepregnant BMI and: Selected Answer:c. Nutritional assessment Question 62 out of 2 pointsIn the formula to estimate gestational age, woman are considered pregnant from:NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED Selected Answer:a. The first day of the last menstrual period Question 72 out of 2 pointsNURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED Gender differences in heart disease can be found in:Selected Answer:e. All of the above Question 82 out of 2 pointsWhat distinguishes pyelonephritis from cystitis? Selected Answer:b. The infection has ascended to thekidneys. Question 90 out of 2 pointsWhat has changed in terms of recommended antibiotic treatment for uncomplicated lower UTIs? Selected Answer:b. Three times a day of oral antibiotics are now recommended. Question 102 out of 2 pointsCarbohydrate intolerance and increased insulin resistance first recognized in pregnancy is known as:Selected Answer:NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED b. Gestational diabetes Question 112 out of 2 pointsAll except which of the following are important historical questions for a 29-year-old woman in clinic for right-sided weakness?Selected Answer:d. History of pelvic inflammatory disease Question 122 out of 2 pointsWhen can relief from pregnancy induces nausea and vomiting be expected? Selected Answer:b.12–14 weeks’ gestationQuestion 13NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED 2 out of 2 pointsWhat is a common cause of leg cramps during pregnancy? Selected Answer:a. An imbalance of calcium and magnesium b. Question 142 out of 2 pointsWhat is the leading cause of first-trimester maternal death? Selected Answer:a.Ectopic pregnancy Question 152 out of 2 pointsWhat do current theories suggest as to how cranberry products can reduce UTIs? Selected Answer:b.The fructose keeps E. coli bacteria from adhering to bladder cell walls. c. Question 162 out of 2 pointsScreening for hyperlipidemia is recommended to begin at what age for women with no risk factors?NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
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NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED Selected Answer:d.45 Question172 out of 2 pointsWhen is round ligament pain most likely to occur in pregnant women? Selected Answer:f. Between 16–20 weeks’ gestationQuestion 182 out of 2 pointsAfter how many weeks’ gestation is a pregnancy loss considered a fetal death or stillbirth? Selected Answer:c. 20 weeks Question 192 out of 2 pointsNURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED What is the general goal of surgical treatment for stress UI? Selected Answer:c. To support and stabilize the urethrad. Question 202 out of 2 pointsWhat is more likely to occur in women with female genital cutting? Selected Answer:b. Birth-related complications Question 212 out of 2 pointsWhat is an indication of the second stage of labor? Selected Answer:a. Complete dilation of the cervix b. Question 220 out of 2 pointsHow are pregnancy-related DHA (docosahexaenoic acid) needs best met? Selected Answer:c. By taking a prenatal vitamin supplementNURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED d. Question 230 out of 2 pointsQualitative urine testing for hCG (human chorionic gonadotropin) can be done reliably days after implantation of the blastocyst (fertilized egg).Selected Answer:e. 9–14days Question 242 out of 2 pointsWhat is the most common cause of death in women in the United States? Selected Answer:b. Cardiovascular disease Question 252 out of 2 pointsWhat is the most common cause of medical complications in pregnancy? Selected Answer:NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED a.HypertensionQuestion 262 out of 2 pointsWhat is the term for a postpartum disorder in which bacteria ascend from the lower genital tract and infect the uterus?Selected Answer:b. Postpartum endometritis Question 272 out of 2 pointsAt what time during pregnancy does nausea typically occur? Selected Answer:b. At 6–8 weeks’ gestation Question 282 out of 2 pointsWhat is considered to be a common trigger of psoriasis? Selected Answer:NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED a. Stress Question 292 out of 2 pointsAny woman with a complicated cystitis or symptoms of upper tract disease needs a urine culture and:Selected Answer:a.Sensitivity test Question 300 out of 2 pointsWhat is a potential benefit of circumcision? Selected Answer:a.Decreased incidence of urinary tract infectionsQuestion 312 out of 2 pointsNURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED How does the third stage of labor end? Selected Answer:b.With the delivery of the placenta Question 322 out of 2 pointsWhat is the most common disorder leading to hyperthyroidism? Selected Answer:b. Graves’ disease Question 330 out of 2 pointsWhich of the following is a predictor of impending preterm birth? Selected Answer:c. Cervical length less than 15mm Question 342 out of 2 pointsWhat is important to consider when vaginal bleeding occurs during the first trimester? Selected Answer:NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED b. Ectopic pregnancy Question 352 out of 2 pointsWhat is significant about cytomegalovirus (CMV)? Selected Answer:b.It can remain dormant within the body for life. Question 362 out of 2 pointsWhat step can a clinician take to learn more about any chemicals used in a woman’s workplace? Selected Answer:c. Ask the woman to obtain her workplace MSDs (material safety data sheets). Question 372 out of 2 pointsWhat is the most typical schedule of prenatal care in the first 28 weeks of pregnancy? Selected Answer:d.Visits scheduled every 4 weeksNURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED Question 382 out of 2 pointsWhat significantly increases the risk of hypertension in women? Selected Answer:a.The onset of menopause Question 392 out of 2 pointsWhat is the potential danger of a fetus born through meconium-stained amniotic fluid? Selected Answer:b.The infant can breathe meconium intothe lungs. Question 400 out of 2 pointsWhat was the reason that prenatal care began in the early 1900s? Selected Answer:c. To predict preterm births Question 412 out of 2 pointsNURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED What is the most common type of UTI that affects women? Selected Answer:a. Acute bacterial cystitis Question 420 out of 2 pointsFever associated with pyelonephritis will usually resolve within how many hours of treatment with antibiotics?Selected Answer:a.24 hoursQuestion 432 out of 2 pointsHow can hormonal influences during pregnancy cause backache? Selected Answer:a. They loosen ligaments and joints.NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED Question 442 out of 2 pointsWhat tends to cause acne in adolescence? Selected Answer:d. An increase in testosterone Question 450 out of 2 pointsThe majority of early pregnancy losses are due to:Selected Answer:d.Chromosomal abnormalitiesQuestion 462 out of 2 pointsWhat can be used as a space-filling device, replacing normal pressure on the vaginal walls when levator ani support is unreliable?Selected Answer:b. Tampons NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED Question 470 out of 2 pointsWhat is the term for stimulation of the uterus by an external agent to enhanceuterine contractions after labor has started?Selected Answer:b. InductionQuestion 482 out of 2 pointsWhat should be addressed during late postpartum maternal evaluation (weeks 2–6)? Selected Answer:c. The need for birth control informationor supplies Question 490 out of 2 pointsIn order to maintain continence bladder pressure must be Selected Answer:NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED
NURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED b. equal to the pressure of the urethralsphincter. Question 502 out of 2 pointsWhat is a contributor to the increased incidence of heartburn during pregnancy? Selected Answer:d. The pregnancy hormone relaxin, which softens the lower esophageal sphincterQuestion 510 out of 0 pointsWhen completing this quiz, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity?Selected Answer:YesNURS 6540 Final Exam Q & AS LATEST DOWNLOAD A+ RATED