NR 601 MIDTERM EXAM STUDY GUIDE 2023|GRADED A+ 100% Complete Verified answers Graded A+NR 601 Chapter 1: Changes with Aging - Notes Fundamental Considerations - Recognize that presenting features of disease/illness may be different and having a greater aw

NR 601 MIDTERM EXAM STUDY GUIDE 2023|GRADED A+ 100% Complete Verified answers Graded A+NR 601 Chapter 1: Changes with Aging - Notes Fundamental Considerations - Recognize that presenting features of disease/illness may be different and having a greater awareness ofthe impact of chronic illness on the patient. - Perspective is different than with younger adults. Physiological Changes with Aging - The clinician must be aware that all the systemsinteract an, in doing so, can increase the older person’s vulnerability to illness/disease. - During the clinical decision-making process, the clinician knowledgeable about physiological changes with aging will be less likely to undertreat a treatable condition. -Example- Use the diagnostic process to differentiate the more benign seborrheic keratosis from actinic keratosis. - Be informed; do not attribute a finding to the aging process alone. The elder may conclude there is no point in changing behavior, because the process is inevitable. - Three primary points: 1) There is a reduced physiological reserve of most body systems, particularly cardiac, respiratory, and renal. 2) There are reduced homeostaticmechanismsthatfail to adjust regulatory systemssuch astemperature control and fluid and electrolyte balance. 3) There isimpaired immunological function: infection risk is greater, and autoimmune diseases are more prevalent. Laboratory Values in Older Adults - Many factors can influence lab value interpretation in the elderly, including the physiological changes with aging, the prevalence of chronic disease, changes in nutritional and fluid intake, lifestyle (including activity), and the medications taken. - Reference ranges therefore may be preferable. Reference ranges or intervals, such as age, sex, or race can be defined demographically. For example,the reference range for older adultsmight be the intervals within which 95% of persons over age 70 fall. - Further defined physiologically (fasting or activity status) or pharmacologically (medication,tobacco or ETOH use). - Biochemical individuality is of particular importance in detecting asymptomatic abnormalities in older adults. Significant homeostatic disturbancesin the same individualmay be detected through serial laboratory tests, even though all individual test results may lie within normal limits of the reference interval for the entire group. - The clinician must determine whether a value obtained reflects a normal aging change, a disease, or the potential for disease. - Misinterpretation of an abnormal lab value as an aging change can lead to underdiagnosis and undertreatment in other (anemia orUTI) and overdiagnosis and overtreatmentin others(hyperglycemia or asymptomatic bacteriuria). - Attimes,the result of a lab value may be within the appropriate reference range yetindicate pathology for the older adult. - Calculation of creatinine clearance isimportant in the estimation ofrenal function. - Reduced renal function, particularlyGFR, affects clearance ofmany drugs, and creat clearance provides an index of renal function for use in choosing doses of renally eliminated or nephrotoxic drugs (such as dig, H2 blocker, lithium, and water soluble antibiotics) - The Modiciation ofDiet in RenalDisease (MDRD) and Cockcroft-Gault equations both provide useful estimates of the GFR. - Any risksinvolved in lab testing must be considered with respect to the patient’s clinical condition and weighed NR 601 MIDTERM EXAM STUDY GUIDE 2023|GRADED A+ against the test’s expected benefits. Pharmacokinetic & Pharmacodynamic Changes - Polypharmacy and the potential for an adverse drug reaction (ADR) are major concernsin elders. - Polypharmacy primary predictor for an ADR (any unwanted response). - The therapeutic window narrows with age. The potential for benefiting the patient measured againstrisk of doing harm important. - Pharmacokinetics(what the body doesto the drug) and pharmacodynamics(what the drug doesto the body) alter the dynamic processes that drugs undergo to produce therapeutic effect due to the effects of the aging process. Absorption - Lessimpact than distribution, metabolism, elimination. - Gastric acidity declines with age; offset by the longer contacttime that occurs astransit time slows – which is more functional than physiological. - Presence offood and other drugsin the stomach atthe same time affect drug absorption. - Antacids and Fe can inhibit absorption. - Anticholinergic meds cause a slowing of colonic motility and can result in greater absorption rates. - Metabolic diseases,such asthyroid disease/DM can increase or decrease transit time, can cause either increased/decreased drug absorption. - When the med passesthrough the esophagus