Fatigue
Subjective Measurement
If someone is having trouble sleeping, what intervention could we use?
Encourage pt to go outside, because sunlight helps with melatonin levels
What is a intervention for a older adult who is having trouble sleeping because of a constant need to go to the bathroom
Wear depends (adult diapers)
A newley admitted patient is having multiple problems. What symptom do you report first?
Breathing
What is a primary sexual right?
2 consenting adults
To be effective communicators, nurses must…
Develop awareness of their own values and beliefs and the way they influence their perception of patients’ experiences
Cultural Competence
A set of behaviors that includes understanding the impact of cultural values and beliefs on human experiences, while maintaining awareness of own cultural values and their effect on the perception of self and others.
Circadian
From Latin word “about a day”
What is the average amount of sleep needed for people ages 20 to 60 years?
7.5 hours
What body system controls sleep?
Central Nervous System
What causes older adults to feel sleepy earlier in the evening and to wake earlier in the morning? Know as “phase advance”
Decreases in melatonin (which regulates the sleep-wake cycle) and growth hormone (which promotes sleep) lead to a shift in circadian rhythm
Does sleep efficiency increase with age?
No, sleep efficiency decreases, older adults may complain that they do not feel refreshed after sleep.
Does the risk for sleep disorders increase with age?
Yes
Nocturnal Movement Disorders
Restless leg syndrome, which is an irresistible urge to move the lower extremities, or nocturnal myoclonus, which causes sudden repetitive jerking or kicking movements of the lower extremities.
What is the most effective nonpharmacological therepy for insomnia?
Cognitive Behavioral Therapy
What do you teach a UAP who is feeding a patient with trouble swalowing?
Feed them slow, with frequent rest breaks.
Lak of tendon reflexes/ deep muscle reflexes is a sign of what? (flaccid)
Hypercalcemia
What are the normal calcium levels?
8.5 to 10
Water Soluble Vitamins
Vitamins B & C (Birth Control)
Fat Soluble Vitamins
All- A
Dogs-D
Eat-E
Kibble- K
If you overdose on Vitamins A,D,E & K what will happen?
Liver Damage
What is the primary prevention for the flu?
Flu Shot
If someone is complaining of fatigue, what are some interventions we can tell our patient?
To rest and exercise.
What is the Valsalva Maneuever?
Breathing through the mouth during exercise.
What is the main cause of stress?
Change
What are external physical threats?
Extreme heat or cold, noise, physical trauma
What are internal or psychological threats?
Thoughts and feelings
What are external social threats?
Job pressure or changeable social relationships
Can stress be benificual?
Yes, some stress is normal and necessary. Individual are able to pay attention to detail, to learn and to solve problems
Signs someone is experiencing high stress.
Individuals are more likely to complain of fatigue, tension and anxiety. They may appear distracted, irritable, short-tempered, even angry.
People living with high stress may have feelings of…..
Poor self-worth or low self-esteem
Why are signs of alcohol and drug abuse sometimes missed in the elderly?
They mimic age-related changes such as bone density changes, urinary incontinence, altered sleep patterns, unsteadiness, hypertension, stomach complaints and falls
What can prevent illness or improve a person’s ability to cope with existing illness.
Decreasing the number of stressors or the level of stress.
Problem-focused coping
Attempt to change or eliminate the stressful event or threat.
If someone is overcoming any kind of surgery, what is important?
A diet high in protein
Is strenuous exercise good for the elderly?
No
What does a physical therapist assess for?
Gait, pain and ROM
If you have a patient who is bed bound what should you do?
ROM, isometric exercises
What is a good exercise for a patient who have osteoporosis?
Wight bearing exercise
If someone is in pain and you are trying to do something to improve the pain, what can you do?
Find something that improves the pain by ASKING them
Orthostatic Hypotension
When a person stands up, blood pressure drops, person could faint
What are interventions for orthostatic hypotension?
Have patient stand up slowly, let patient sit on the side of the bed and dangle feet.
Intervention for someone experiancing shortness of breath?
Encourage patient to take frequent breaks
What is polypharmacy?
Multiple medications, multiple providers
What does polypharmacy increase the risk of?
Falls
What is hypothermia?
A core body temperature of 95 or lower
Why is the older adult at a increased risk for developing hypothermia?
Normal changes in aging affect the body’s ability to regulate temperature. Changes in the skin reduce the older person’s ability to perceive dangerously hot or cold environments. Decreased muscle tissue, decreased fat and decreased metabolic rate affect the amount of heat produced and retained in the body
What disease processes decrease heat production?
Hypothyroidism, hypoglycemia, and malnutrition
What medications that decrease enviromental awareness to extreme temperatures….
Barbiturates, tranquilizers, and antidepressants can increase risk of hypothermia.
Can alchohol increase the risk of hypothermia? If so, how?
It decreases environmental awareness and, at the same time, increases vasodilation with resulting in heat loss.
What is one of the first signs of hypothermia?
Mental confusion
Does pulse and respiratory rate increase or decrease with hypothermia?
Decrease, slow down
How may the face appear in hypothermia?
Swollen
Are heating pads, blankets a good intervention for a patent who has hypothermia?
No, because they can cause cardiovascular problems
What are early indicators of hyperthermia?
Cramps in the legs, arms and abdomen.
What is one the first signs of a UTI in the elderly?
Confusion
What 2 regions of the brain play key roles in language and speech?
Broca’s area, which is located in the posterior frontal lobe and Wernicke’s area, which is located in the posterior temporal lobe.
What is the most common language problem seen in adults?
Aphasia (or dysphasia)
What is a excellent resource for information about speech and swallowing disorders?
Speech pathologists
Dysphagia
Difficulty swallowing
Receptive Aphasia
A person has difficulty understanding language
Exspressive Aphasia
A person is unable to express himself or herself using language
Global Aphasia
A person loses the ability both to understand language and to express himself or herself.
Broca Aphasia
A person is able to understand verbal and written language but is unable to speak words fluently. The area of the brain that coordinates muscles of speech is damaged.
Wernicke Aphasia
the person is able to speak, but the words produced may be nonsensical or have little connection to reality.
Foods hgh in potassium OTHER than bananas?
Spinach and Apple Juice
Canned foods are high in which electrolyte?
Sodium
What is a sign that a person is having trouble coping?
They are not grooming themselves
What are some interventiosn for relocation syndrome?
Continuity of care, reduce the amount of change as possible
How can you help someone who is trying to overcome stress?
IDENTIFY problem and take steps to improve that problem
Arthritis
Inflammation of the joints
Rheumatoid Arthritis
Chronic inflammation of the synovial membrane of the diarthrodial joints (also called the synovial joints: the freely moveable joints in which continuous bony surfaces are covered by cartilage and connected by ligaments lined with synovial membrane.
Osteoarthritis
A nonsystemic, noninflammatory disorder that progressively causes bones and joints to degenerate.
Osteoporosis
Disorder that results in a loss of bone density
What disorder can cause a person to “shrink” or lose height?
Osteoporosis
What do we always monitor for in a patient who has been on anesthesia?
Pneumonia
What organization establishes safety goals?
The Joint Commission
What are signs that a person is getting good sleep?
Mental clarity
A person who has good self-esttem is….
They have strong personal values and believe they have the ability to control their lives
Our sense of self-control starts wtih.
Our bodies
When fatigue is persistant and impairs normal life functioning it is considered…
A health problem. Some fatigue is normal
Chrronic Fatigue
Persisting greater than 6 months
What is secondary fatigue caused by?
Underlying medical condition or treatment and will eventually be resolved or decreased when the underlying problem is addressed
What is the etiology of chronic fatigue?
Unknown
What are some causes of fatigue?
Waste product accumulation, insufficient supply of substances and inflammatory processes.
What can fatigue cause?
Depression
What population is at the greatest risk of fatigue? Excluding college students
Middle aged adults between 40 and 50 years.
Individuals wth nutritional deficiencies, particulary protien-calorie malnutrition are at increased risk for….
Fatigue
What should the assessment for fatigue focus on?
The patient’s report about his or her fatigue experience, use OPEN-ENDED questions
Brief Fatifue Inventory (BFI)
Measures amount, activities affected by fatigue. Target population- Cancer patients
Multidimensional Fatigue Inventory (MFI)
Measures general, physical, mental, reduced motivation, and reduced activity. Target population- various patient population, including those with cancer, CFS, and COPD
Multidimensional Assessmet of Fatigue
Measures severity, distress, degree of interference in ADLs, timing (frequency of occurrence and changeability)
Fatigue Severity Scale (FSS)
Measures severity, how fatigue interferes with certain activities. Developed for patients with MS an lupus
NI for increasing skin integrity
- Turn Q 2 HR
- Use draw sheet
- Heels on pillows
- Bladder training
discharge instructions for cardiac patients
pace yourself
rest periods
conserve energy
unlicensed personal and fall prevention
toilet Q 2 hours
no loose socks
physiological changes in older adults
decreased peristalsis
decreased cardiac output
relocation stress syndrome
pt frequently irritable
pt stays in room
S/SX of stress
muscle tension
hyperventilation
decreased hr
dizziness
PTS @ greatest risk of stress related problems
also have chronic illness
loss of spouse
relocated
decreased income
screenings for older adults to assess stress
BMI
BP
cognitive
functional
Potential nutritional complications for older adults
limited income
limited transportation
neighborhood only has convenience stores
external stressors
hot and cold
noises
physical trauma
Intrinsic motivation
internal motivators
what do older adults fear the least
death
ostomies
change when 1/3 full
chronic fatigue syndrome
lasts longer than 6 months
priority to report to MD
obstructive sleep apnea
diet for sacral ulcer
high protein
if patient has stress
focus on emotion focus coping
vitamin D toxicity
liver is affected
flu vacine
primary prevention
hearing aides
can’t get wet
valsava maneuver
open mouth breathing
decreased appetite
caused by decreased peristalsis
of pt has low bone density
need to do weight bearing exercises
fall risk
use morse fall scale
fluid volume deficit
hypernatremia
fluid volume excess
hyponatremia
greatest risk for poly pharmacy
if pt has many doctors
expressive aphasia
cannot express what they want to say
best way to help relocation syndrome
same caregivers everyday
patients with hip fractures are at greatest risk to
develop pneumonia
ABC
airway
breathing
circulation
when teaching oral hygiene
mention fluoride toothpaste
when to get visual screenings
every 12 months
DVT
has swelling in legs or feet
older adults at risk for hypothermia
dementia patients
highest risk for suicide
patients who abuse alcohol
low self esteem behaviors
infrequent eye contact
sadness
anger
not motivatied
says “don’t waste your time on me”
contributing factors chronic fatigue
decreased sleep
pain
poor diet
lack of exercise
depression
labs to confirm chronic fatigue
kidney function test
electrolytes
liver function
hemoglobin
NI for chronic fatigue
validate with pt that fatigue is real
establish a therapeutic relationship
encourage pt to avoid over exertion
delegate to nursing assistance
snacks to pts
empty colostomy
lubricate lips
older adults value and beliefs
their beliefs impact their perception of the world
think their beliefs are normal
nurse must be tolerant of all pt values
different beliefs lead to miscommunication
ineffective coping leads to
anxiety
sleep disturbance
altered bowel/bladder
anger
depression
benefits of exercise
control
decreased bone loss
increased well being
increased balance
problem focused coping
the goal is to eliminate or reduce underlying cause
emotion focused coping
addresses the stressor but instead to control the emotional response
meaning focused coping
individual draws on values, beliefs, and goals to modify the personal interpretation and response to a problem
reframing
a positive coping strategy characterized by purposeful cognitive thoughts whereby the individual identifies positvie aspect of the situation
confrontational problem solving method
continuing to face the stressor and live with the consequences
escape problem solving method
completely leaving the situation
avoidance problem solving method
decrease contact with the stressor
emotional distancing problem solving method
consciously working to change your attitude toward the stressor
cardiovascular consequences of immobility
orthostatic hypotension
respiratory consequences of immobility
atelectasis
possible pneumoia
osteoarthritis
caused by gradual degenerative changes of the joint. Causing pain, swelling and reduced mobility of the joint.
rheumatoid arthritis
systemic autoimmune condition with genetic predisposition that creates an inflammatory process in the synovial membranes on the joints and other body tissues
dexterity
the ability to perform fine manipulative skills that were perfected when younger such as playing an instrument or sewing
recommended weekly exercise for older adults
150 min of aerobic physical activity a week
muscle strengthening activities twice a week
preventing hypertension during exercise
breathe through mouth (valsalva maneuver)
home care education for fluid excess
educate pt to weigh in similar clothing or naked
impaired swallowing medical history
ask if history of stroke or neurological problem
FAST
face, arms, speech, timing
Assessment for stroke
alert?
following directions?
onset? (need to know within 4 hours)
poor swallowing signs and symptoms
choking
drooling
coughing
intervention for poor swallowing
consult speech for swallow eval
calcium in excess
causes weakness
deficit break down bones
when is stress worse
when it is accumulative
alternative methods
massage
if you think caregiver strain is suspected
gather info from caregiver
coping skills
learned early in life, but are modifiable. we teach to reuse positive mechanisms that have worked in the past
if potassium is high
report it to RN
what do you notice in the eyes if a person were stressed
pupil dilation
which enzymes decrease with stress
digestive enzymes
what kind of diets do cancer patients need
high calorie because it helps with healing
how do we teach patients to use a cane
cane on strong side
4-6 inches from foot
elbow flexed 15-30 degrees
where does the biggest loss of insensible fluid occur
though the skin
how does physical illness increase stress
takes away energy needed for coping
what will mild stress cause
mental alertness
what can hypercalcemia cause
muscle weakness
ROME
RESPIRATORY
OPPOSITE
METABOLIC
EQUAL
what is a goal for patients with impaired mobility
to remain free of contractures
what is important for prevention of osteoporosis
vitamin D
what is a primary prevention for mobility
balanced nutrition
what does alcohol interfere with
the absorption of nutrients
what can cause seizures
hyponatremia
to help heal wounds, what should a patient increase in their diets
protein
what should we watch for in patients with colitis
vitamin A loss
autonomy
freedom from external control or influence; independence
nonmaleficence
non harming or inflicting the least harm possible to reach a beneficial outcome
beneficence
action that is done for the benefit of others
justice
just behavior or treatment; fairness or equality
veracity
be truthful, encourage truthfulness
fidelity
adherence to your word
confidentiality
protecting privacy
clinical dehydration
extracellular volume deficit and hypernatremia
cellular dehydrating
when body cells are chronically dehydrated
antidiuretic hormone
regulates water not sodium
crucial stroke treatment time
4-5 hours
fluid excess initial signs
cerebral edema, hyponatremia
fluid excess late signs
drowsiness, confusion
data to collect for impaired swallowing
gag reflux
facial drooping
NAPNES – ethical
consider as a basic obligation the conversation of life and the prevention of diease
fulfill all duties faithfully and efficiently
function within established legal guidelines
ONPA – legal
observation and patient teaching and care in a diversity of healthcare settings
administration of medications and treatments, adult intravenous therapy
signs of major depression
symptoms must occur most of the day and nearly everyday for weeks
tasks that can’t be delegated
meds, labs, education, counseling, reporting to a physician, referrals
who can administer water through a G tube
only a licensed nurse or doctor
incentive spirometer
use 10 times every hour while awake
what does the pineal gland release relating to sleep
melatonin
what is the number 1 reason people can’t sleep
pain