NR 601 Midterm Study Guide/( Complete Solution Rated A+).

NR 601 Midterm Study Guide Developmental changes • Review Kennedy and Dunphy readings for age related changes: • Physiological: 1. Limited chest wall expansion 2. Cilia atrophy 3. Immune system alterations 4. Cardiac, respiratory and renal reduced physiological reserve 5. Reduced homeostatic mechanisms that fail to adjust regulatory systems such as temperature control and fluid and electrolyte balance. 6. Changes in the sympathetic response which contributes to orthostasis and falls, as well as lack of hypoglycemic response. 7. Impaired immunological function: infection risk is greater and auto-immune diseases are more prevalent. o Lab results- Dunphy Table 77.2- PAGE 1. Protein: rises slightly- kidney changes with age, UTI, renal pathology 2. Specific gravity: lower maximum in elderly- the decline in nephrons impairs the ability to concentrate urine. 3. ESR: significant increase- neither sensitive nor specific in aged. 4. Iron Binding: slight decrease 5. HGB: men slight decrease, women no change- anemia common in elderly. 6. HCT: slight decrease speculated: decline in hematopoiesis. 7. Leukocytes: slight decrease due to drugs or sepsis and should not be attributed immediately to age. 8. Lymphocytes: T-CELL AND B-CELL levels fall- therefore infection risk is higher and immunizations should be encouraged. 9. Platelets: no change 10. Albumin: decline- related to a decrease in liver size and enzymes: protein-energy malnutrition, infection, and liver disease. 11. BUN: increases significantly up to 69mg/100 ml.- decline in GFR; decreased cardiac output. 12. Creatinine: increases to 1.9 mg/100 ml- related to lean body mass decrease. 13. Creatinine clearance: decreases 10%/decade after 30 years of age- used for prescribing meds excreted by kidneys. 14. Glucose tolerance: slight increase of 10mg/DL per decade after 30 years of age- diabetes increasingly prevalent; drugs may cause glucose intolerance. o Atypical disease presentations- PG. 4 1. Acute abdomen: absence of symptoms or vague symptoms, acute confusion, mild discomfort and constipation, some tachypnea and possibly vague respiratory symptoms, appendicitis pain may begin in right lower quadrant and become diffuse. 2. Depression: anorexia, vague abdominal complaints, new onset of confusion, insomnia, hyperactivity, lack of sadness. 3. Hyperthyroidism: Hyperthyroidism presenting as “apathetic thyrotoxicosis,” i.e., fatigue and weakness; weight loss may result instead of weight gain; patients report palpitations, tachycardia, new onset of atrial fibrillation, and heart failure may occur with undiagnosed hyperthyroidism . 4. Hypothyroidism: confusion, agitation, new onset anorexia, weight loss, and arthralgias may occur. 5. Malignancy: new or worsening back pain secondary to metastasis from slow growing breast masses. Silent masses of the bowel. 6. Myocardial infarction: absence of chest pain. Vague symptoms of fatigue, nausea, and a decrease in functional and cognitive status. Classic presentations include dyspnea, epigastric discomfort, weakness, vomiting, history of previous cardiac failure. Higher prevalence in females versus males. Non-Q- WAVE MI. 7. Overall infectious disease processes: absence of fever or low-grade fever, malaise, sepsis without usual leukocytosis and fever. Falls, anorexia, new onset of confusion and/or alteration and change in mental status, decrease in usual functional status. 8. Peptic ulcer disease: absence of abdominal pain, dyspepsia, early satiety, painless, bloodless, new onset of confusion, unexplained tachycardia, and/or hypotension.