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NR 601 FINAL EXAM latest – Chamberlain college of nursing | NR601 FINAL EXAM latest A grade.

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NR 601 FINAL EXAM latest – Chamberlain college of nursing How to conduct Mini-Cog- • The Mini-Cog has been demonstrated to have comparable psychometric properties to the MMSE • The primar... y advantage of the Mini-Cog is that it is shorter than the MMSE and measures executive function. • It is composed of a three-item recall and the Clock Drawing Test (CDT) and takes about 3 minutes to administer • The Mini-Cog is a short dementia assessment that combines three-word recall with clock-drawing capability. • Patients are given a total score reflecting accuracy in clock drawing and recollection of the given three words. • A score of 0 to 2 is a positive screen for dementia Causes of delirium in elderly- • Causes of delirium are numerous and in elderly hospitalized patients there are often multiple etiologies, including metabolic, infection, cardiac, neurological, pulmonary, sensory impairments, medications, and toxins. • Regardless of cause, a consistent finding is significant reduction in regional cerebral perfusion during periods of delirium in comparison with blood flow patterns after recovery. • A possible neurological common pathway may involve acetylcholine and dopamine, and the disruption in the sleep-wake cycle in delirium indicates melatonin as a possible factor. (Kennedy-Malone 59) Agnosia • Loss of ability to identify objects ADA criteria for diagnosing DM- • FPG ≥126 mg/dL (7.0 mmol/L). Fasting is defined as no caloric intake for at least 8 h.* • 2-h PG ≥200 mg/dL (11.1 mmol/L) during OGTT. The test should be performed as described by the WHO, using a glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water.* • A1C ≥6.5% (48 mmol/mol). The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay.* • In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L). •   Urinary incontinence- • Involuntary loss of urine from the bladder ▪ So common in women many consider it normal ▪ Common in older men w/ enlarged prostate o Can affect quality of life o Significance-One of the most common complains w/ older adults, Distress & embarrassment, Cost burden to pt & society as a whole, Not life-threatening, may effect QOL, PCP essential to educating individuals o Epidemiology- Increased prevalence w/ age in men & women, Nursing home population – 40-70%, Often a factor in placement ▪ URGENCY UI is greater in men ▪ STRESS UI is greater in women o Terminology ▪ UI- Unintentional voiding, loss or leakage of urine ▪ Continuous incontinence-Continuous loss or leak of urine ▪ Increased daytime frequency-More frequent during day than considered normal ▪ Nocturia-Interruption of sleep one or more times due to the need to urinate – increases in frequency after age 50 ▪ Urgency-Sudden, compelling desire to pass urine that’s difficult to prevent ▪ Overactive bladder syndrome- Urgency, frequency, nocturia w/ or w/o incontinence o Risk Factors-Aging,Obesity,Smoking, Caffeine,Uncontrolled DM, Constipation,Use of diuretics o Risk Factors by gender-Women:Aging, obesity, smoking, caffeine intake, DM, pregnancy, multiparity, estrogen deficiency, hx of pelvic surgery, diuretics Men:Aging, obesity, smoking, caffeine, DM, prostate dx, hx of prostate surgery, hx of UTIs, diuretics o Physical changes w/ aging that contribute to UI ▪ Lower urinary tract-Detrusor muscle over activity,Decrease in detrusor contractility, Increase in post void residual,Decrease in urethral blood flow ▪ Women – decrease in urethral closure pressure,Low estrogen following menopause - leads to atrophy of ureteral mucosal epithelium & increase in urethral sensation ▪ Men can experience constriction of urethra due to BPH which may result in bladder outlet obstructing symptoms - Initial clinical workup for UI in Men o PMH, PE, UA, DRE: Eval of prostate,PSA w/ new onset in men - UI workup in women:Exclude underlying causes,PMH, PE, UA, Pelvic exam, vaginal exam, perineal, Identify estrogen status of pt, Pelvic prolapse, fistula, -Cough test, Integrity of pelvic musculature, leaking of urine ▪ Full bladder ▪ Standing position ▪ Asked to cough ▪ If urine leak is observed, stress incontinence is confirmed - Red flags in males o Higher level of suspicion for serious diseases, Refer to urology if Previous pelvic surgery, Pelvic radiation, Pelvic pain, Severe incontinence, Severe UTI symptoms, Recurrent urologic infection,Abnl Prostate exam,Elevated PSA o Be alert to these with NEW ONSET UI- Hematuria,Pelvic pain,Abdominal mass, Dysuria, Proteinuria, Glucosuria, CVA tenderness,Nodular prostate,Any new neuro symptoms - Goals of treatment: Reduce symptoms, Improve QOL, Increase social activity, Reduce leakage volumes, increase dryness, use less protection; Increase independence in incontinence management; Decrease caregiver burden - 1st line management guidelines o AHRQ guidelines for management of UI in women ▪ Behavioral therapy ▪ Lifestyle modification ▪ Try for 3 months before pharm management o Weight loss, Smoking cessation(Tobacco is a bladder irritant),Less coughing o Dietary changes-Alcohol, soda, coffee with or without caffeine, acidic foods and spicy foods o Maintain adequate fluid balance to reduce constipation, provide adequate flow to kidneys - Behavioral strategies:Bladder training, Bladder control strategies,Timed voiding,Kegels, Pelvic floor training - 2nd line management - Medication o Antimuscarinic medication: 1st line for women ▪ Block the parasympathetic muscarinic receptors - - - - - - - - - - - - - - - - - - - - - - - - -Arrhythmia evaluation SIG-E-CAPS- • S: sleep (insomnia or hypersomnia) • I: interests (diminished interest or pleasure); • G: guilt: (excessive or inappropriate guilt; feeling worthless); • E: energy (loss of or fatigue); • C: concentration (diminished concentration or indecisiveness); • A: appetite (decrease or increase; weight gain or weight loss); • P: psychomotor retardation/agitation (move slow, agitated, restless); • S: suicide (recurrent thoughts of death, ideation, or attempt) DEXA scan results findings- (Pg 499) • BMD measurement is expressed as the number of standard deviations from the mean for normal young adults of the same sex (T-score) and as the number of standard deviations from the mean for persons of the same sex and age (Z score). • The World Health Organization diagnostic criterion for osteoporosis is a T-score of less than -2.5. Osteopenia is defined as a T-score between -1.0 and -2.5. A Z score of less than -1.5 suggests a secondary cause of osteoporosis • Osteoporosis: -2.5 or lower • Osteopenia: -1 to -2.5 (lower than normal bone density w/o full osteoporosis) Anxiety treatment- • Treatment for anxiety should reduce symptoms and improve functioning. • Simply listening, being compassionate, and showing respect are important to improving outcomes. Treat comorbid depression and medical conditions that cause anxiety. • There are no large-scale studies of pharmacotherapy for late-life anxiety disorders to guide treatment decisions. • Start low and go slow with medication dosing to avoid risks from drug interactions, because older adults are more likely to take many medications and may have side effects from aging changes in absorption, metabolism, distribution, and excretion of medication. • Evaluate and manage side effects, because as many as 25% of patients stop taking medication in the first 6 months due to side effects. • First-line treatment is the selective serotonin reuptake inhibitors (SSRIs) o citalopram (Celexa), escitalopram (Lexapro), and sertraline (Zoloft). In older adults, they have the least risk of drug interactions, side effects, or worsening existing medical conditions. o Benzodiazepines, including lorazepam (Ativan), alprazolam (Xanax), and clonazepam (Klonopin), are effective according to research but are not the first choice due to the risk of falls and confusion. Research supports referral to psychotherapy for older adults, but this recommendation is limited to GAD and no other anxiety disorders (American Psychiatric Association, n.d.; Cassidy & Rector, 2008; Hollander & Simeon, 2008; Lenze et al., 2005; Lenze & Wetherell, 2009; Mohlman, 2005; National Institute of Mental Health, n.d.; Stanley et al., 2003; Wetherell, Lenze, & Stanley, 2005; Wetherell, Sorrell, Thorp, & Patterson, 2005). (Kennedy-Malone 553-554) [Show More]

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