NR 601 Midterm Study Notes

NR 601 Midterm Exam Study Guide Weeks 1-4 content Week Topics 1  Developmental changes Review Kennedy and Dunphy readings for age related changes Replicative senescence is theory states that cells can replicate or divide a specific number of times. This ability tends to decrease with age. Oxidative damage is the cumulative result of the aerobic metabolism, which generates chemicals called free radicals. Free radicals may interact with other chemicals in the body and cause damage to cells. Telomere shortening is a theory that links aging to a reduction in cell division. Weakening of the immune response leaves older adults more vulnerable to infection and debilitating diseases. Travel Increased risk for thromboembolic events, altitude sickness with effect on cardiac and cerebral functioning, effect on pulmonary function from air pollution, dehydration and inability to tolerate temperature changes, anxiety r/t change of place (central nervous changes), decreased hearing (sensory changes), increased risk for accidents due to decreased vision, longer reaction times, some vaccines are less effective for older adults. Routine immunizations for older adult’s r/t travel, Influenza, pneumococcal, Td/Tdap, zoster, Hep B for some, and certain vaccines based on destination Yellow fever not effective until 10 days post administration and if a herpes zoster vaccine has been given, they must wait 30 days to receive the yellow fever vaccine. If the patient has received a yellow fever vaccine, they must wait 28 days for a herpes zoster vaccine. Beer’s Criteria The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults. They emphasize deprescribing medications that are unnecessary, which helps to reduce the problems of polypharmacy, drug interactions, and adverse drug reactions, thereby improving the risk–benefit ratio of medication regimens in at-risk people. Exercise in Older Adults - OA: walking, aquatic, tai chi, resistance exercises, cycling - Anxiety: walking, biking, weightlifting, - Fibromyalgia: Aerobic, aquatic, strengthening, tai chi, Pilates - Sleep: Tai chi, walking, aqua therapy, biking -Preferred amount of exercise: 30 minutes per day for 5 days a week of moderate exercise; if weight management is part of this, 60 minutes per day is advised (Can be completed in 10 min. intervals) 2 Laboratory Changes in Older Adults • Protein rises slightly renal pathology, UTI, aging kidney changes  Specific gravity: lower maximum in elderly: 1.016-1.022-decline in nephrons ability to concentrate urine • ESR: increases-not sensitive/nor specific in the aging adult • Iron binding-decreases • Hgb: decreases-anemia is common in the elderly • HCT: slight decrease-decline in hematopoiesis • Leukocytes: drop-drugs/sepsis • Lymphocytes-T and B cell fall-risk for infection is higher-immunization encouraged • Platelets: no change in number • Albumin-decline-smaller liver-and enzymes-protein energy malnutrition • Globulin: slight increase • Total serum protein: decreases indicate malnutrition, infection and liver disease • BUN: increases and decline in GFR-decreased cardiac output • CR: increases-r/t lean body mass decrease • CR clearance: decreases-10% per 10 years after 40-careful prescribing drugs that are excreted by kidneys • Glucose tolerance: increase of 10 mg/dL/decade after 30-diabetes more prevalent-drugs can cause glucose intolerance • Alk phosp: increase-elevations 2 Geriatric Syndromes • Sleep Disturbances • Problems with eating or feeding • Incontinence • Confusion • Evidence of falls • Skin breakdown Categories for Aging • Young – old = 65–74 years • Old = 75–84 • Oldest-old = 85 and older