Fluid and Electrolytes & Infusion Therapy
Ears, Hearing, Eyes and Vision
Health Issues of Older Adults & Intro
Pain
Acid/Base Imbalance
100
-_____L of water weighs 2.2lbs (or 1kg)
-weight change of 1lb is a fluid change of _____mL
what is 1,500?
100
What are the eye functions?
1. refraction: happens when light rays are bent from the outside through curved surfaces
2. pupillary constriction: how the pupils react to light
3. accommodation
4. convergence
100
What drugs are used to treat alzheimer's?
Donepezil
Memantine
100
what are the pain categories
localized -localized to one area
-ex. migraine is localized to head
projected-not well localized, can't be specified
-ex. general pain all over
radiating-starts one place and travels
-ex. sciatica: sciatic pain starts at back then can shoot down leg
referred-not in the area of the cause
-ex. shoulder pain from gallbladder issue
100
acidosis vs alkalosis
normal blood ph is 7.35-7.45:
-acidosis: ph < 7.35
-alkalosis: ph > 7.45
200
dehydration labs
-elevated hemoglobin
-elevated hematocrit
-elevated serum osmolarity
-elevated glucose
-elevated protein
-elevated bun/creatinine
-elevated electrolytes
-hemoconcentration
200
rinne test
-tap tuning fork, put it behind ear on mastoid bone
-when pt can no longer hear it, move tuning fork to front of ear (sound conducts longer through air than bone)
-normal: pt should hear it when it returns to ear
200
polymedicine vs polypharmacy
-polymedicine: the use of many medications to treat multiple health problems for older adults (okay and expected)
-polypharmacy: the use of multiple drugs and a lot of times there is a duplicate drug therapy, high dose medication, multiple otc meds (this is bad, drug interaction risks)
200
acute vs chronic pain
-acute: short-lived, results from sudden, accidental trauma; surgery; ischemia; acute inflammation
-chronic: can last a person's lifetime, either cancer or noncancer
200
metabolic acidosis
low hco3, low ph:
-overproduction/under-elimination of h+
-underproduction/over-elimination of hco3
300
What is hyponatremia
sodium level below 136 mEq/L
300
arcus senilis
-opaque bluish/white ring within the edge of the cornea
-caused by buildup of fatty deposits
-does not effect vision at all
300
What is the older adult assessment
-understanding of geriatric subgroup
-functional assessment (what is their ability to perform adl's independently?)
-assessment of health protecting behaviors
-assessment of common health issues
300
nociceptive pain
normal pain transmission:
-somatic: pain arises from skin and superficial surfaces (ex. cutting your finger)
-visceral: pain arises from a deeper organ (ex. gallbladder attack)
300
acidosis indicates _____, while alkalosis indicates _____
What is hyperkalemia, hypokalemia?
400
patients with abnormal _____ and/or _____ levels must be on continuous hr monitoring; _____ also causes cardiac issues
what is potassium, calcium, magnesium
400
menieres disease pharm treatment
-diuretics: furosemide (correct fluid loss)
-antiemetics: meclizine, promethazine
-intratympanic therapy with gentamycin: injecting gentamycin into the ear (try diuretics and antiemetics before this option)
400
Explain Medication Reconciliation
-formal evaluative process
-reconciles pt's current meds: drug name, dose, frequency, route, and purpose should be done on all admissions, transfers, discharges
-addresses duplications, omissions, and any possible interactions
400
opioid administration
-appropriate opioid analgesic: consider age, type of pain
-titration: start low and go slow
-dose range: start on lower end of range, then give higher end of range if ineffective
-carefully assess older adults to avoid untreating pain (be their advocate!)
400
combined metabolic and respiratory acidosis
-uncorrected respiratory acidosis always leads to poor oxygenation and lactic acidosis
-combined acidosis is more severe than metabolic or respiratory acidosis alone.
-cardiac arrest is an example of a problem leading to combined metabolic and respiratory acidosis (another example is a pt with dka and copd that doesn't adhere to meds)
500
hyponatremia interventions
-treat underlying cause: ex. lower dose of diuretics
-sodium replacement: hypertonic iv (avoid rapid correction, can use isotonic solution if not too severe), diet (HIGH in sodium), medications (manitol if dilutional)
-monitor: i&o's, urine sg, bp, cv, respiratory status, neuro status, daily weights, edema
500
glaucoma
-increased iop, cupping and atrophy of optic disk
-cause: disrupted balance between production and absorption of aqueous humor (either overproduction or under absorption)
-types: open-angle (most common), angle-closure, secondary
-s/s: headache, brow pain, n/v, colored halos around lights, sudden blurred vision with decreased light perception
500
state the medication considerations
-bp meds: pt shouldn't have alcohol, grapefruit juice
-antacids
-anticoagulants (warfarin): no foods high in vitamin k (ex. green leafy vegetables like spinach/kale)
-laxatives
-diuretics: can cause dehydration, lose electrolytes through excess urination (eat high potassium foods like bananas, oranges)
-decongestants: pt shouldn't have alcohol, grapefruit
500
nonpharm interventions
-used alone or in combo with drug therapy
-physical measures: application of heat, cold, or pressure, therapeutic massage, vibration, transcutaneous electrical nerve stimulation (tens)
-pt and ot
-cognitive/behavioral measures: body-based and mind-body therapies
500
abg analysis
-look at ph draw arrow if it is high or low
-low=acidosis, high=alkalosis
-look at co2 (respiratory) draw arrow low or high
-if arrows in opposite direction=respiratory acidosis or alkalosis
-look at hco3 (metabolic) draw arrow low or high
-if ph arrow and hco3 arrow in same direction=metabolic acidosis or alkalosis
-compensation is present if the arrows of co2 and hco3 are opposite
-partial compensation is present if the arrows of o2 and hco3 are in same direction