NS 272 Final Exam Questions and Complete Solutions

NS 272 Final Exam Questions a nd Complete Solutions How can you tell how well an older adult is functioning? ✅ADLs and IADLs What is homeostenosis? ✅-Homeostasis + stenosis -The physiologic limit (the limit beyond which homeostaisis cannot be restored aka physiologic reserves) decreases with age. - As we get holder, you go into homeostenosis where you don't have the compensatory reserve you onced did. For example, cardiac output reduces as we age. If you're exercising, you might not be able to supply the reserve as we once could. What are the two things is an older adult is having an issue? ✅change in cognition + change in function What does atypical presentation of illness include and who is it most often seen in? ✅The old -old (85+) Includes: vague, altered, or non -presentation What is geriatric syndromes? ✅Not diseases, they're conditions! You can have a bunch of diseases that maybe present with one symptom; they MULTIFACTORIAL When is delirium commonly seen? ✅After surgery What are the factors affecting geriatric syndromes? ✅Predisposing factors Precipitating factors Perpetuating factors What are predisposing factors for geriatric syndromes? ✅Normal aging changes Homeostenosis What are precipitating factors affecting geriatric symptoms? ✅Usual aging chronic conditions (most have 3+) Report health status as fair or poor Persistent pain What perpetuating factors affect geriatric syndromes? ✅Social isolation - loneliness inactivity - immobility (sedentary is the new smoking!) caregiving bereavement Acute vs. Chronic disease ✅Acute: without warning, sudden death, new chronic condition Chronic: managed not cured, coping can be influenced by perceived uncertainty, older adults have at least 3 chronic diseases How many times per day does the heart beat a day? ✅100,000x/day Pumps 2000 gallons of blood Through 60,000 miles of blood vessels every 24 hours What is the strongest muscle in the body? ✅The heart, particularly the left ventricle Types of cardiovascular disease ✅hypertension hypotension coronary heart disease heart failure heart valve disorder: aortic stenosis Rhythm disorder: atrial fibrillation Stroke Are men or women affected more by heart diseases? ✅Men! ...until women go through menopause. After they go through menopause, their risk is equal if not greater than men. What are associated complications of hypertension? ✅Stroke Kidney disease MI Heart failure What is known as the silent killer? ✅Hypertension Why do people stop taking hypertension meds? ✅It's the silent killer, people don't feel hypertension but they feel the side effects of the drugs What is considered normal BP? ✅Less than 120/80 If BP is high in a nursing home, what might be the reason? ✅Keeping it high to prevent falls What is systolic hypertension (HTN)? ✅Arterial system stiffens with age Known risk factors for cardiovascular disease due to left ventricular hypertrophy (starlings law - you can only stretch a muscle for so long until it's useless) When arteries are constricted, blood is backed up and the left ventricle gets bigger and then you go into CHF What is hypotension? ✅Postural/Orthostatic hypotension: BP supine and standing (within 3 minutes) < 20 mmHg systolic < 10 mmHg diastolic Examples: Baroreceptor impairment noted by HR < 15 bpm Volume depletion noted by HR > 15 bpm What is postprandial hypotension? ✅After eating and get up to go somewhere, BP drops Can be seen in restaurants What's the measurement for low blood pressure? ✅It's different for everyone What is Coronary Artery Disease (CAD)? ✅The leading cause of death in the US* Decreased blood low to heart muscle (ischemia) Atherosclerosis (plaques) CAD - pertains to arteries around heart Problem is that there might be blockages going to the heart. If you demand a supply to your heart, CAD prevents meeting this demand due to blockages. These blockages contribute to the disease atherosclerosis. When you have CAD and blood flow can't get to the heart, you start to develop... ✅collaterals The older you are, probably the more collateral you will develops and that's why you can survive a heart attack What is angina? ✅Chest pain With CAD, What is stable angina? ✅On exertion, you get chest pain What is unstable angina? ✅More dangerous Getting chest pain at rest Shows that CAD is getting worse Might lead to MI Also known as acute coronary syndrome What is an MI r/t CAD? ✅Total disruption of blood flow Classic presentation: severe chest pain which lasts much longer than normal angina, nausea, diaphoresis (sweating), SOB, dizziness, weakness Go to the ER with chest pain (they will be sent to cath lab within one hour because they may need to stent) What is atypical presentation of a myocardial infarction? ✅Chest pain may be absent SOB Fatigue Syncope (temporary loss of consciousness caused by a fall in blood pressure) Confusion Change in baseline function!!! Abdominal or back pain In females: epigastric pain and SOB Only half of people 65+ have chest pain What percentage of people 65+ have chest pain during an MI? ✅Only half! What is heart failure? ✅cardiac output is diminished, not pumping out enough blood results in edema + SOB (because blood is backing up) What is heart failure due to/what are some risk factors for heart failure? ✅The heart is not pumping efficiently CAD - pump Uncontrolled HTN - pump ETOH abuse Heart valves disorders Diabetes Angina? Is ETOH toxic to the heart? ✅Yes, alcohol abuse is toxic What are classic signs and symptoms of heart failure? ✅Fatigue/weakness Persistent cough or wheezing SOB on exertion Orthopnea (can't lie flat) Paroxysmal nocturnal dyspnea (PND) Weight Gain (indicator that they're retaining fluid) Lower extremities edema - feet, ankles, legs, or abdomen What is atypical presentation of heart failure? ✅Memory loss/confusion Diaphoresis Tachycardia Anorexia Insomnia How can you detect heart failure on assessment? ✅Listen to the lungs and you'll hear something in the bronchi