NSG 6420 FINAL EXAM STUDY GUIDE
1. General Concepts in Geriatrics
Impact of physiological changes with aging: Kennedy Chapter 1.
The major impact of all of these physiological changes can be highlighted with
three primary points. First, there is a reduced physiological reserve of most body
systems, particularly cardiac, respiratory, and renal. Second, there are reduced
homeostatic mechanisms that fail to adjust regulatory systems such as temperature
control and fluid and electrolyte balance. Third, there is impaired immunological
function: infection risk is greater, and autoimmune diseases are more prevalent.
Reduced renal function, particularly the glomerular filtration rate (GFR), affects
the clearance of many drugs, and creatinine clearance provides an index of renal
function for use in choosing doses of renally eliminated or nephrotoxic drugs (such
as digoxin, H2 blockers, lithium, and water-soluble antibiotics).
Normal age related changes:
Changes in kidney function begin in the fourth decade of life and continue to
decline with each subsequent decade. by age 70, an individual might reasonably
have a 40% to 50% decrease in renal function, even in the absence of disease.
With advancing age, the ability of the liver to metabolize drugs does not decline.
Although liver size and blood flow do decline with age, routine liver function test
results are typically normal when no disease exists. Decreased liver size and blood
flow can result in decreased first-pass metabolism.
Older adults often experience more sedation from central nervous system drugs
than younger persons at the same concentration.
Signs and symptoms of depression:
Altered presentation is another common feature in older adults. The patient with
depression may not present with a dysphoric mood but rather agitation and
psychotic features.
Questions
The major impact of the physiological changes that occur with aging is:
All of the following statements are true about laboratory values in older adults
except
Reference ranges are preferable
Abnormal findings are often due to physiological aging
Normal ranges may not be applicable for older adults
Reference values are not necessarily acceptable values
Mini Mental Status: Buttaro Chapter 13
Geriatric specialists have multiple assessment tools, such as the Folstein Mini-
Mental State Examination, the Mini-Cog screen for dementia, the Short Portable
Mental Status Questionnaire, the AD8 Dementia Screening Interview, and the
Montreal Cognitive Assessment (MoCa), to differentiate short-term memory loss
from dementia and to observe the progression of cognitive impairment.
Questions
When prescribing medications to an 80-year-old patient, the provider will
a. begin with higher doses and decrease according to the patient’s response.
b. consult the Beers list to help identify potentially problematic drugs.
c. ensure that the patient does not take more than five concurrent medications.
d. review all patient medications at the annual health maintenance visit.
The Beers list provides a list of potentially inappropriate medications in all patients
age 65 and older and helps minimize drug-related problems in this age group. Older
patients should be started on lower doses with gradual increase of doses depending
on response and side effects. Patients who take five or more drugs are at increased
risk for problems of polypharmacy, but many will need to take more than five drugs;
providers must monitor their response more closely. Medications should be
reviewed at all visits, not just annually. REF: Polypharmacy/Consequences of
Polypharmacy/Management
,An 80-year-old woman who lives alone is noted to have a recent weight loss of 5
pounds. She appears somewhat confused, according to her daughter, who is
concerned that she is developing dementia. The provider learns that the woman still
drives, volunteers at the local hospital, and attends a book club with several friends
once a month. What is the initial step in evaluating this patient?
a. Obtain a CBC, serum electrolytes, BUN, and glucose
b. Ordering a CBC, serum ferritin, and TIBC
c. Referring the patient to a dietician for nutritional evaluation
d. Referring the patient to a neurologist for evaluation for AD
Patients with weight loss, confusion, and lethargy are often dehydrated and this
should be evaluated by looking at Hgb and Hct, electrolytes, and BUN. This patient
is currently leading an active life, so the likelihood that recent symptoms are related
to AD, although this may be evaluated if dehydration is ruled out. Anemia would be
a consideration when dehydration is ruled out. Referrals are not necessary unless
initial evaluations suggest that malnutrition or AD is present. REF:
Dehydration/Pathophysiology/Clinical Presentation/Physical Examination
The practitioner is establishing a plan for routine health maintenance for a new
female client who is 80 years old. The client has never smoked and has been in good
health. What will the practitioner include in routine care for this patient?
Select all that apply.
a. Annual hypertension screening
b. Baseline abdominal aorta ultrasound
c. Colonoscopy every 10 years
d. One-time hepatitis B vaccine
e. Pneumovax vaccine if not previously given
f. Yearly influenza vaccine
For older clients a one-time pneumovax is given after age 65. Influenza vaccine
should be given every year. Hypertension screening should be performed at each
office visit, not just annually. An abdominal aorta US is performed once for every
smoking male. Colonoscopy is performed every 10 years after age 50, but not after
age 74. REF: Table 13-1: Recommended Screening and Immunizations
, 2. HEENT
Pharyngitis Buttaro Chapter 101
In noninfectious pharyngitis the patient reports a sore throat and dryness; if
environmental allergens are the cause, symptoms often include rhinorrhea, watery
eyes, and postnasal drip.
Viral causes are more common (rhinorivus) In viral pharyngitis, findings include
fever, cough, nasal symptoms, and mild erythema with little or no pharyngeal
exudate. Treatment of viral pharyngitis includes rest, fluids, humidification, voice
rest, and warm saline gargles to ease discomfort. 7 Acetaminophen or ibuprofen
should be used for fever and general discomfort.
Bacterial pharyngitis is more common in children younger than 15. Streptococcus
pyogenes is the etiologic agent for acute pharyngitis. Group A β-hemolytic
Streptococcus (GAS) is the most important to identify because it is responsible for
acute rheumatic fever (ARF) and poststreptococcal glomerulonephritis. Patients
may report a sudden onset of sore throat, painful swallowing, fever (temperature
higher than 38.5° C [101.3° F]), chills, headache, nausea, vomiting, and abdominal
pain. With bacterial pharyngitis, rhinitis, cough, conjunctivitis, and myalgias are
not typically present. Diagnostic studies used to detect GAS infection include a
throat culture, a rapid antigen detection test (RADT).
Penicillin V, 500 mg 2-3 times daily for 10 days) is indicated in GAS pharyngitis
primarily to prevent complications, such as suppurative tonsillitis,
glomerulonephritis, and rheumatic fever. Clarithromycin, 250 mg twice daily for
10 days, is indicated for patients with penicillin allergy.
questions
A patient has sore throat, a temperature of 38.5° C, tonsillar exudates, and cervical
lymphadenopathy. What will the provider do next to manage this patient’s
symptoms?
a. Order an antistreptolysin O titer
b. Perform a rapid antigen detection test
c. Prescribe empiric penicillin
d. Refer to an otolaryngologist
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