Advanced Practice Nursing in the Care of Older Adults
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SECOND EDITION
About this book
With the continued rapid growth of the older adult popu- lation, there remains an increased demand for health-care providers to deliver age-specifi c care and direct disease man- agement.
Advanced Practice Nursing in the Care of Older Adults will serve as a guide for advanced practice nurses who are privileged to provide care to older adults. Designed as a text for students, as well as a reliable source of evidence-based prac- tice for advanced practice nurses, this book contains informa- tion on healthy aging, comprehensive geriatric assessment, and common symptoms and illnesses that present in older adults. Given the complexity of prescribing for older adults taking multiple medications, a new chapter on polyphar- macy is included. The book concludes with a chapter on care delivery for patients with chronic illnesses who face end-of- life care. Throughout the book, case studies are included to provide further practice and review. An important feature of this book is the use of the Strength of Recommendation Taxon- omy (SORT) [Ebell, M. H., Siwek, J., Weiss, B. D., Woolf, S. H., Susman, J., Ewigman, B., & Bowman, M. (2004). Strength of recommendation taxonomy (SORT): A patient-centered approach to grading evidence in medical literature American Family Physician, 69 (3), 548–556], which provides a direct reference to evidence-based practice recommendations for clinicians to consider in the care of older adults.
Questions & Answers from this book
Questions and answers are connected to the referenced book and its available source material.
Chapter 3: Exercise in Older Adults
Chapter 5: Symptoms and Syndromes
How does fecal incontinence prevalence differ between community-dwelling elders and nursing home residents according to the chapter?
Fecal incontinence is more prevalent among nursing home residents, with a prevalence of up to 65%, compared to 36% in community-dwelling elders.
What are some common causes of fecal incontinence related to medications as discussed in the chapter?
Common medication-related causes of fecal incontinence include the use of laxatives, fiber products, magnesium-containing antacids, antibiotics, proton pump inhibitors, SSRIs, and NSAIDs. These medications can increase gastric motility or water in stools, disrupt the colon's natural flora, and lead to diarrhea.
What are the recommended initial treatments for constipation in older adults?
The recommended initial treatments for constipation in older adults include dietary modifications such as increasing fiber intake, ensuring adequate fluid intake, and engaging in regular exercise. If these measures are insufficient, bulk-forming laxatives like psyllium or polycarbophil may be used. In some cases, osmotic laxatives such as polyethylene glycol or lactulose are recommended.
Chapter 6: Skin and Lymphatic Disorders
How should blisters be managed in burn wound care as discussed in the chapter?
Blisters in burn wound care can be managed by allowing intact blisters to remain while removing loose tissue during cleansing. This approach considers the protective nature of blisters but also the potential for infection if the blister fluid is retained.
What are the six stages of pressure injuries as described in the chapter on Skin and Lymphatic Disorders?
The six stages of pressure injuries are Stage 1, Stage 2, Stage 3, Stage 4, Unstageable, and Deep Tissue Pressure Injury (DTPI).
Chapter 7: Head, Neck, and Face Disorders
What are the key signs to assess for during an oral cavity examination in older adults?
During an oral cavity examination in older adults, key signs to assess for include color, moisture, and any abnormal lesions on the lips, oral mucosa, and pharynx. Look for herpes simplex I, chancres, angular stomatitis, mucous retention cysts, angioedema, and fissures. Check for nodules, ulcers, white patches, loose or broken teeth, caries, gum bleeding, discoloration, swelling, retractions, and enamel loss.
What factors contribute to the increased risk of fungal infections in older adults according to the chapter?
The increased risk of fungal infections in older adults is due to a decline in the immune system with aging, increased comorbidities, use of multiple medications, and potential decline in personal hygiene.
How should the condition of the eyes be assessed during a head and neck examination according to the chapter?
During a head and neck examination, the eyes should be assessed by inspecting the position and symmetry of the surrounding skin and tissues, and the position of the eyebrows and eyelashes. Visual acuity should be screened using a Snellen chart or a handheld chart. The condition of the skin around the eyes, the sclera, and the color of the conjunctiva should be noted. The lids should be examined for any abnormalities, and the cornea should be checked for scarring or opacities. Extraocular motions, visual fields, corneal reflexes, and pupillary reactions should also be assessed.
Chapter 8: Chest Disorders
How does isolated systolic hypertension (ISH) differ from normal blood pressure readings in older adults?
Isolated systolic hypertension (ISH) in older adults is characterized by a systolic blood pressure (SBP) greater than 160 mm Hg and a diastolic blood pressure (DBP) of less than 90 mm Hg. In contrast, normal blood pressure readings do not exceed these values and typically have a lower SBP and a DBP that is not below 90 mm Hg.
What are the two most important non-remediable risk factors for atherosclerosis in older adults?
The two most important non-remediable risk factors for atherosclerosis in older adults are advanced age and male gender.
Chapter 9: Peripheral Vascular Disorders
What are the recommended dietary sodium restrictions for patients with heart failure according to the chapter?
The recommended dietary sodium restriction for patients with heart failure is 2 to 3 grams per day.
What lifestyle modifications are recommended for cholesterol management according to the chapter?
Lifestyle modifications for cholesterol management include increasing physical activity, managing weight, reducing saturated fats to less than 7% of total calories, limiting trans fats to less than 1% of total calories, and keeping cholesterol intake under 200 mg per day.
How does ethnicity modify the association between risk factors and atherosclerotic disease as discussed in the chapter?
Ethnicity significantly modifies the association between risk factors and atherosclerotic disease. The association between age and atherosclerotic disease is weaker in African American and Hispanic populations. In Asians, systolic blood pressure elevations are strongly related to disease onset, whereas HDL cholesterol and smoking have a lesser association with disease onset in African Americans.
Chapter 10: Abdominal Disorders
What are the common complications associated with colorectal cancer as mentioned in the chapter?
Common complications associated with colorectal cancer include bowel obstruction, perforation, colostomy, post-resection recurrence, radiation proctitis, bowel adhesions, chronic pain, and metastasis to the liver and bone.
What are the symptoms associated with bowel obstruction as described in the chapter?
The symptoms associated with bowel obstruction include cramping abdominal pain, nausea, vomiting, and obstipation.
Chapter 11: Urological and Gynecological Disorders
What are the normal aging changes observed in the female genitoreproductive system as described in the chapter?
Normal aging changes in the female genitoreproductive system include atrophic changes such as thinning and drying of the vaginal epithelium, decreased secretions, and a more alkaline environment. The vagina becomes shorter, narrower, and less elastic. The uterus shrinks, and the ovaries atrophy and are not palpable. Pelvic floor muscles and supporting structures relax, often leading to organ prolapse.
What are the common symptoms associated with atrophic vaginitis as described in the chapter?
Common symptoms of atrophic vaginitis include vaginal dryness, dysuria, vulvar and vaginal itching, urinary frequency, blood-tinged vaginal discharge, and dyspareunia.
How should the examination of the urogenital system in older male patients be conducted according to the chapter?
The examination of the urogenital system in older male patients is similar to that of younger males. It includes a rectal examination to assess the prostate, inspection and palpation of the genitalia for lesions, and palpation of the scrotum and inguinal areas for masses or lymphadenopathy.
Chapter 12: Musculoskeletal Disorders
What are the recommended diagnostic tests for a femoral neck fracture according to the chapter on musculoskeletal disorders?
The recommended diagnostic tests for a femoral neck fracture include ordering radiographs of the affected area in two and three views and a complete blood count (CBC) to check for internal blood loss. Additionally, a Westergren ESR may be conducted to assess if an infectious process contributed to the fracture.
What are the most common types of fractures related to osteoporosis as mentioned in the chapter?
The most common types of fractures related to osteoporosis are femoral neck fractures, pathological fractures of the vertebrae, and thoracic and lumbar spine vertebral fractures.
Chapter 17: Polypharmacy
What are the key factors to consider before prescribing medication to older adults according to the AGS Stepwise Approach?
Before prescribing medication to older adults, the AGS Stepwise Approach suggests considering patient goals and preferences, the risk-benefit ratio of the drug, quality of life, cost-benefit ratio, the narrow therapeutic index of the drug, and pill burden. Consulting with a pharmacist, especially a geriatric consulting pharmacist, can also be beneficial.
How does aging affect drug distribution and what implications does this have for medication management in older adults?
Aging affects drug distribution by altering body composition, such as decreased body water and increased body fat, leading to changes in drug concentration and action. This impacts medication management by necessitating careful monitoring and dosage adjustments to avoid adverse drug reactions.
Chapter 18: Chronic Illness and the APRN
Chapter 19: Palliative Care and End-of-Life Care
What are the five criteria used to define frailty according to the clinical syndrome described in the chapter?
The five criteria used to define frailty as a clinical syndrome are: unintentional weight loss of 10 pounds in the past year, self-reported exhaustion, weakness based on grip strength, slow walking speed, and low physical activity.
What is the primary goal of palliative care as described in the chapter?
The primary goal of palliative care is to improve the quality of life for patients and their families facing life-threatening illnesses by preventing and relieving suffering through early identification and treatment of pain and other physical, psychosocial, and spiritual problems.
What are the key components of palliative care as outlined in the chapter on Palliative Care and End-of-Life Care?
The key components of palliative care include providing relief from pain and distressing symptoms, affirming life while regarding dying as a normal process, integrating psychological and spiritual care, supporting patients and families, using a team approach, and enhancing quality of life. Palliative care is applicable early in the disease process and can be combined with life-prolonging therapies.
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