Tiêu đề NCM 114 MIDTERMS RLE ✅

NCM 114 MIDTERMS BY TONS and MADS 3. Chronic oral use of mineral oil as lubricating laxative → lipid pneumonia due to aspiration of small residual oil droplets in the patient’s mouth. I. Patient noncompliance 1. 1/3 third of elderly fail to comply with prescribed doses or to follow the correct schedule. 2. Medication regimen should be reviewed with him/her. The patient must clearly understand the dose and the time and frequency of doses. Ch 8 Pg 260 in Gerontology Book if You Want to Read TERMS ● Drug-drug Interactions – alteration of pharmacokinetics and pharmacodynamics of drug A when taken at the same time as drug B ● Drug-disease Interactions – the worsening of a disease by a medication ● Polypharmacy – prescription, administration, or use of more medications than are clinically indicated in a given patient Questions to Ask to Avoid Inappropriate Prescribing for Elderly Patients: 1. Is the treatment necessary? 2. Is this the safest drug possible? 3. Is this the most appropriate dose, route, and dosage form? 4. Is the frequency appropriate? 5. Does the benefits outweigh the risks? Medication Blood Levels ● Random levels – not dependent upon the administration time of the medication; drawn when the order is received ● Trough levels – dependent upon administration times; drawn at the time that the blood level is expected to be at its lowest (right before a dose is due) ● Abnormally high trough levels → time between doses should be lengthened ● Abnormally low trough levels → time between doses should be shortened ● Peak levels – dependent upon time of administration; drawn within a set time after a dose is given ● Abnormally high peak level → dosage needs to be reduced ● Abnormally low peak level → dosage should be increased Pre-op and post-op considerations in gerontology nursing Perioperative Management of Geriatric Patient: https://emedicine.medscape.com/article/285433-overview Gerontologic Considerations PREOP ● The hazards of surgery for elderly are proportional to the number and severity of coexisting health problems and the nature and duration of the operative procedure. ● Less physiologic reserve (ability of an organ to return to normal after disturbance in its equilibrium) than younger patients. ● Respiratory and cardiac complications - leading causes of postop morbidity and mortality in older adults ● Cardiac reserves are lower, renal and hepatic functions are depressed, and GI activity reduced. ● Sensory limitations - reasons for falls ● Arthritis - common in older people; affect mobility, difficult for to turn1 or ambulate ● Ability to perspire decreases → dry, itchy skin that becomes fragile and is easily abraded ● Dehydration, constipation, and malnutrition may occur ● Decrease in subcutaneous fat → more susceptible to temperature changes ● Critical Factors: ○ Skillful preop assessment and treatment ○ Skillful anesthesia and surgery ○ Meticulous and competent post op and post anesthesia management Gerontologic Considerations INTRAOP (OA=older adult)- from 112 book ➢ 1⁄3 of surgical pt are 65 yrs of age or older. ➢ Higher risk for complications from anesthesia and surgery compared w/ younger adult pt due to several factors. ➢ Progressive loss of skeletal muscle mass in conjunction w/ ↑adipose tissue. ➢ Comorbidities, advanced systemic disease, and increased susceptibility to illness, even in the healthiest OA, can complicate perioperative management. ➢ Biologic variations of particular importance: age-related cardiovascular and pulmonary changes. ○ aging heart and blood vessels = ↓ ability to respond to stress. ○ ↓ cardiac output and limited cardiac reserve = vulnerable to changes in circulating volume and blood O2 levels. ➢ Excessive or rapid administration of IV solutions = pulmonary edema. ➢ Sudden or prolonged decline in BP = cerebral ischemia, thrombosis, embolism, infarction, and anoxia. ➢ ↓ gas exchange = cerebral hypoxia ➢ Lower doses of anesthetic agents due to ↓tissue elasticity (lung and cardiovascular systems) and ↓lean tissue mass. ○ ↓plasma proteins → more anesthetic agent remains free or unbound →more potent action ➢ ↑ duration of clinical effects of medications. ➢ Body tissues of OA - made up predominantly of water, and those tissues with a rich blood supply: skeletal muscle, liver, and kidneys, shrink as the body ages. ➢ Reduced liver size →↓rate the liver can inactivate many anesthetic agents ➢ ↓kidney function slows elimination of waste products and anesthetic agents. ➢ Other factors that affect elderly in intraop period: ○ Impaired ability to ↑metabolic rate and impaired thermoregulatory mechanisms → ↑susceptibility to hypothermia. ○ Bone loss (25% W, 12% M): careful manipulation and positioning during surgery. ○ ↓ability to adjust rapidly to emotional and physical stress influences surgical outcomes and requires meticulous observation of vital functions. ➢ Perioperative mortality and morbidity in OA pt ➢ Nursing management for elderly intraop: ○ Application of intraop warming techniques to reduce unintentional hypothermia. ○ Careful transfer and positioning on the OR bed. ○ Protect pressure points and bony prominences with extra padding. ○ Support back and neck to prevent stiffness while maintaining respiratory and circulatory support. ○ Use of antiembolic stockings or sequential compression device to prevent VTE formation. 2