MS Focus/Older Adults
This type of illness typically develops slowly over time, may not have a clear beginning or end, and requires long-term management or lifestyle changes.
Answer: What is a chronic illness?
Rationale: Chronic illnesses develop gradually and persist over time, often for months to years or even a lifetime. They include conditions such as diabetes, hypertension, and osteoarthritis. Chronic illnesses usually require ongoing management, lifestyle modifications, and sometimes medication to control symptoms and prevent complications. In contrast, acute illnesses have a rapid onset, short duration, and often resolve with treatment or self-care (e.g., flu, pneumonia, or a sprained ankle).
This type of IV fluid has the same osmolarity as blood plasma and does not cause a shift in fluid between compartments.
What is an isotonic solution?
Rationale: Isotonic solutions, such as 0.9% Normal Saline (NS) and Lactated Ringer’s (LR), have an osmolarity similar to plasma (~275-295 mOsm/L). They remain in the intravascular space, increasing blood volume without causing fluid shifts between cells and blood vessels.
This simple assessment technique is used to check for dehydration by pinching the skin and observing how quickly it returns to normal.
Answer: What is skin turgor assessment?
Rationale: Skin turgor is a quick way to assess dehydration (fluid volume deficit - FVD). When the skin (usually on the forearm or sternum) is pinched, it should return to normal quickly. In dehydration, skin turgor is decreased, meaning the skin remains "tented" for a longer time before returning to its normal position. However, this test may be less reliable in elderly patients due to natural skin elasticity changes.
This electrolyte is the primary cation in the extracellular fluid and is essential for nerve impulses and fluid balance.
Answer: What is sodium (Na⁺)?
Rationale: Sodium is the major extracellular electrolyte responsible for maintaining fluid balance, nerve function, and muscle contractions. Normal serum sodium levels range from 135-145 mEq/L. Imbalances can lead to hyponatremia (low sodium) or hypernatremia (high sodium), both of which can cause neurological symptoms.
This type of anemia is caused by a deficiency in iron, leading to small, pale red blood cells.
Answer: What is iron deficiency anemia?
Rationale: Iron deficiency anemia is the most common type of hypoproliferative anemia, characterized by microcytic (small) and hypochromic (pale) red blood cells. It is often caused by blood loss (e.g., heavy menstruation, GI bleeding), poor dietary intake, or malabsorption (e.g., celiac disease). Symptoms include fatigue, pallor, and brittle nails. Treatment includes iron supplementation and addressing the underlying cause.
This type of disability is typically the result of an injury, illness, or trauma that occurs after birth and can affect a person’s physical, cognitive, or emotional abilities.
Answer: What is an acquired disability?
Rationale: Acquired disabilities develop as a result of events such as trauma (e.g., spinal cord injury), illness (e.g., stroke, multiple sclerosis), or accidents after birth. These disabilities can affect mobility, cognition, sensory perception, and emotional functioning. Unlike congenital disabilities (which are present from birth), acquired disabilities require adaptations, rehabilitation, and support to help individuals manage their new condition. Identifying an acquired disability often involves understanding its cause and impact on daily functioning and quality of life.
This IV fluid is commonly used to treat cellular dehydration and diabetic ketoacidosis because it causes fluid to move into cells.
Answer: What is a hypotonic solution?
Rationale: Hypotonic solutions, such as 0.45% Normal Saline (1/2 NS) or Dextrose 5% in Water (D5W, once metabolized), have a lower osmolarity than plasma. They cause water to move into cells, helping to rehydrate them. This is useful in conditions like diabetic ketoacidosis (DKA), where cells are dehydrated due to osmotic diuresis.
This condition occurs when there is excessive fluid retention in the body, leading to weight gain, edema, and increased blood pressure.
Answer: What is fluid volume excess (FVE)?
Rationale: FVE occurs when fluid intake exceeds fluid output, often due to heart failure, kidney disease, excessive IV fluids, or liver cirrhosis. Symptoms include peripheral edema, hypertension, crackles in the lungs, and jugular vein distension (JVD).
A positive Trousseau’s sign or Chvostek’s sign may indicate a deficiency of this electrolyte.
Answer: What is calcium (Ca²⁺)?
Rationale: Trousseau’s sign (carpal spasm with a blood pressure cuff inflation) and Chvostek’s sign (facial twitching when tapping the facial nerve) are classic signs of hypocalcemia (low calcium levels, < 8.5 mg/dL). Hypocalcemia can result from vitamin D deficiency, hypoparathyroidism, or chronic kidney disease, leading to neuromuscular excitability, tetany, and seizures if severe.
A deficiency of this vitamin leads to megaloblastic anemia, characterized by large, immature red blood cells.
Answer: What is vitamin B12 (cobalamin) deficiency anemia?
Rationale: Vitamin B12 deficiency leads to megaloblastic anemia, in which red blood cells are macrocytic (large) and immature due to impaired DNA synthesis. It can be caused by pernicious anemia (lack of intrinsic factor), malabsorption disorders, or strict vegan diets. Symptoms include fatigue, glossitis (inflamed tongue), and neurological symptoms (paresthesias, balance issues). Treatment includes B12 injections or high-dose oral supplementation.
This phase of the Trajectory Model of Chronic Illness is characterized by a progressive decline in health, increased complications, and a need for more intensive management and care.
Answer: What is the "Downward Phase"?
Rationale: The Downward Phase in the Trajectory Model of Chronic Illness is marked by progressive worsening of the chronic illness, often accompanied by increased symptoms, complications, and functional decline. This phase may require more intensive treatment, interventions, or hospitalization, and patients may experience exacerbations or a decline in their ability to perform daily activities. For both patients and healthcare providers, this phase emphasizes the need for supportive care, palliative measures, and advanced care planning to manage the illness and address the patient's emotional, physical, and spiritual needs.
This IV fluid contains electrolytes like sodium, potassium, and calcium and is often used for fluid resuscitation in burn patients and those undergoing surgery.
Answer: What is Lactated Ringer’s (LR) solution?
Rationale: LR is an isotonic solution that contains sodium (Na⁺), potassium (K⁺), calcium (Ca²⁺), chloride (Cl⁻), and lactate, which acts as a buffer to prevent metabolic acidosis. It is preferred for burn patients, trauma victims, and surgical patients because it helps maintain electrolyte balance and blood volume.
This vital sign change is commonly seen in a patient with fluid volume deficit (FVD).
Answer: What is tachycardia (increased heart rate)?
Rationale: In dehydration (FVD), the body tries to compensate for low blood volume (hypovolemia) by increasing the heart rate (tachycardia) to maintain adequate circulation. Additionally, patients may experience hypotension and orthostatic hypotension, especially when standing.
This electrolyte imbalance is the most life-threatening due to its effect on the heart and can cause arrhythmias or cardiac arrest.
Answer: What is hyperkalemia (high potassium levels, > 5.0 mEq/L)?
Rationale: Potassium (K⁺) is vital for cardiac and muscle function. Hyperkalemia can cause dangerous cardiac arrhythmias, including peaked T waves, widened QRS complexes, and even asystole (cardiac arrest). It is commonly seen in renal failure, acidosis, and potassium-sparing diuretics (e.g., spironolactone). Treatment includes calcium gluconate, insulin with glucose, and dialysis in severe cases.
This type of anemia results from the bone marrow failing to produce enough red blood cells, white blood cells, and platelets.
Answer: What is aplastic anemia?
Rationale: Aplastic anemia is a rare but serious condition where the bone marrow fails to produce enough blood cells (pancytopenia). It can be idiopathic or caused by autoimmune diseases, infections, radiation, chemotherapy, or exposure to toxins (e.g., benzene). Symptoms include fatigue, recurrent infections (due to low WBCs), and bleeding tendencies (due to low platelets). Treatment may involve bone marrow transplants, immunosuppressive therapy, or blood transfusions.
The personal confidence to perform well at a particular task, having emotional stability and problem-solving skills.
Answer: What is self-efficacy?
Rationale: Self-efficacy is the belief in one’s own ability to succeed in specific situations or accomplish a task. It influences motivation, goal-setting, and perseverance when facing challenges. In healthcare, a high sense of self-efficacy can encourage patients to engage in self-care, manage chronic conditions, and adhere to treatment plans. Nurses can help enhance patients' self-efficacy by providing support, education, and positive reinforcement, helping them feel more confident in their ability to manage their health.
Self-efficacy is the confidence to perform well at a particular task or life domain and high levels of self-efficacy are associated with healthy aging. Characteristics of an older adult with high self-efficacy include emotional stability, problem-solving skills, confidence in abilities, and knowing when to ask for support when needed. Financial resources are not used as a measure of self-efficacy
This type of IV solution is used to treat patients with severe hyponatremia and should be administered cautiously due to the risk of cerebral edema.
Answer: What is a hypertonic saline solution (e.g., 3% NaCl or 5% NaCl)?
Rationale: Hypertonic saline solutions have a higher osmolarity than plasma and pull water from cells into the bloodstream, helping to raise sodium levels in hyponatremic patients. However, they must be administered slowly and with close monitoring because rapid sodium correction can cause osmotic demyelination syndrome (ODS), leading to severe neurological damage.
This electrolyte imbalance is most commonly associated with fluid volume excess (FVE).
Answer: What is hyponatremia (low sodium levels)?
Rationale: In FVE, excessive fluid dilutes sodium levels in the blood, leading to hyponatremia (serum Na⁺ < 135 mEq/L). Symptoms include confusion, muscle weakness, nausea, and seizures. This is common in SIADH (Syndrome of Inappropriate Antidiuretic Hormone) and excessive hypotonic IV fluids.
This electrolyte imbalance is commonly seen in chronic alcoholics and can cause muscle weakness, confusion, and torsades de pointes.
Answer: What is hypomagnesemia (low magnesium levels, < 1.5 mEq/L)?
Rationale: Magnesium (Mg²⁺) plays a key role in neuromuscular function, cardiac rhythm, and enzyme activity. Hypomagnesemia is common in chronic alcoholism, malnutrition, and prolonged diuretic use. It can cause neuromuscular excitability, seizures, and life-threatening arrhythmias like torsades de pointes, a form of polymorphic ventricular tachycardia. Treatment includes IV magnesium sulfate.
Side effects that can occur in clients who take with ferrous sulfate to treat iron deficiency anemia.
Answer: What is Gastrointestinal side effects, such as constipation, nausea, abdominal discomfort, and dark stools, are common?
Rationale: Ferrous sulfate is a common oral iron supplement used to treat iron deficiency anemia. It is absorbed in the small intestine and provides a source of iron to replenish depleted stores. Gastrointestinal side effects, such as constipation, nausea, abdominal discomfort, and dark stools, are common. To reduce these effects, patients may be advised to take ferrous sulfate with food (though absorption may be less effective) or switch to slow-release formulations. Increasing fiber and fluid intake can help alleviate constipation.
This age-related change often affects medication absorption and can lead to a slower onset of action in older adults, making them more sensitive to medication effects.
Answer: What is slower gastric emptying and reduced gastric acidity?
Rationale: As people age, gastric emptying slows down, and there is a reduction in gastric acidity, both of which can impact how medications are absorbed in the digestive system. Slower absorption can lead to a delayed onset of action, and decreased acidity may affect the dissolution of certain medications, particularly those requiring acidic environments. This can make older adults more sensitive to medication effects and may require dose adjustments or monitoring to avoid adverse reactions. Additionally, age-related changes in liver and kidney function can impact drug metabolism and excretion, further influencing medication effects.
This IV fluid should NOT be given to patients with increased intracranial pressure (ICP) because it can worsen cerebral edema.
Answer: What is a hypotonic solution (e.g., 0.45% NS or D5W once dextrose is metabolized)?
Rationale: Hypotonic solutions cause water to shift from the bloodstream into cells. In patients with increased ICP, this can lead to brain swelling, exacerbating neurological damage. Instead, isotonic (NS, LR) or hypertonic (3% NaCl) solutions are preferred to manage fluid balance in these patients.
This lung sound may be heard in a patient with fluid volume excess (FVE) and indicates fluid accumulation in the alveoli.
Answer: What are crackles (rales)?
Rationale: Crackles (also called rales) are abnormal lung sounds heard on auscultation, typically at the lung bases, in patients with fluid volume excess (FVE). They occur when fluid accumulates in the alveoli, which can happen in conditions like heart failure, pulmonary edema, and kidney failure. Severe FVE can lead to respiratory distress, requiring immediate intervention such as diuretics or oxygen therapy.
A patient with severe diarrhea is at risk for developing this electrolyte imbalance, which can lead to muscle weakness and decreased deep tendon reflexes.
Answer: What is hypokalemia (low potassium levels, < 3.5 mEq/L)?
Rationale: Hypokalemia occurs when the body loses excessive potassium, often due to severe diarrhea, vomiting, diuretics (e.g., furosemide), or metabolic alkalosis. Symptoms include muscle weakness, decreased reflexes, arrhythmias (flattened T waves, U waves on ECG), and ileus (paralytic gut). Severe cases require IV potassium replacement, but never given as an IV push due to the risk of cardiac arrest.
This type of food enhances non-heme iron absorption and should be included in the diet of a patient with iron deficiency anemia.
Answer: What is vitamin C-rich food?
Rationale: Vitamin C (ascorbic acid) enhances the absorption of non-heme iron, which is found in plant-based foods such as beans, lentils, and spinach. Patients with iron deficiency anemia should be encouraged to consume citrus fruits (oranges, strawberries), bell peppers, tomatoes, and leafy greens alongside iron-rich foods to improve absorption. They should also be advised to avoid calcium-rich foods and tea/coffee during iron-rich meals, as these can inhibit absorption.