Name: Pregnancy Study Guide
Brand: EduBirdie
Rating: 5.0 (34 reviews)

University:
East Coast Polytechnic Institute
Course:
NUR 205 | Medical Surgical Nursing I
Academic year:

2021
Views:

403

Pages:

10
Author:

Jameson Hunt

PREGNANCY PREGNANCY ➢ Zygote ² Blastocyte ² Embryo ² fetus ➢ Naegele’s rule: o Subtract 3 months from first day of LMP, add 7 days = 40 weeks (280 days) ➢ 1st trimester ultrasound – crown-rump measurement (with 7-day error) ➢ 2nd trimester ultrasound – using multiple fetal measurements (with 10-14-day error) ➢ Uterine size, etc.: o Nongravid – lemon o 8 weeks – orange o 10 weeks – baseball (? Doppler heart) o 12 weeks – above symphysis pubis ▪ grapefruit (FHT doppler) o 16 weeks – between symphysis pubis and umbilicus o 16-18 weeks – quickening (feeling baby move) o 20 weeks – at umbilicus (FHT stethoscope) o 20-36 weeks – about 1 cm about symphysis pubis +/- 1 cm o At term – fundus height dropped ➢ If uterus is smaller than expected (IUGR) SIGNS OF PREGNANCY Positive signs ➢ ➢ ➢ ➢ Additional 300 kcal/d Lactation 500 kcal/d Calcium 1000-1500 mg/d Folic acid 0.4-1 mg/d (green leafy veg, cereal) BMI <18.5 18.5 – 24.9 25.0 – 29.9 >30 Total Weight Gain 28 – 40 25 – 35 15 – 25 11 – 20 ➢ ➢ ➢ ➢ Twins: ± weight gain (37-54lbs) After delivery – loss of 20-30lbs in first few weeks Avoid soft cheese, uncooked meats, raw milk Do not eat raw shellfish or raw oysters (Vibrio vulnifucus infection) ➢ Be careful with cold cuts, uncooked hot dogs and deli meats (Liesteria monocytogenes) ➢ Regular coffee 8 oz. ➢ Most weight is gained in 3rd trimester (about 1-2 lbs. per week) RISK FOR ECTOPIC ➢ Hx of salpingitis ➢ Prior ectopic pregnancy ➢ Hx of tubal surgery ➢ Assisted reproduction ➢ Hx of infertility ➢ Cigarette smoking ➢ Progestin use ➢ Current IUD use ➢ Previous cervicitis or PID ➢ Tubal ligation failure Consider if hcg > 1500 and us fails to show pregnancy Methotrexate or surgical Palpation of fetus by health care provider Ultrasound and visualization of fetus Fetal Heart Tones auscultated ▪ 10-12 weeks doppler ▪ 20+ fetoscope/stethoscope Probable signs o o Weight Gain: Underweight Normal weight Overweight Obese o o o Goodell’s sign (4 weeks) – cervical softening Chadwick’s sign (6-8 weeks) – blue color o cervix and vagina o Hegar’s sign (6-8 weeks) softening uterine isthmus o Enlarged uterus o Ballottement – when fetus is pushed, it can be felt to bounce back by tapping the palpating fingers inside vagina o Urine HCG (because also can present in molar pregnancy and ovarian cancer) Presumptive signs o Amenorrhea o N/V o Breast changes o Fatigue o Urinary frequency o Slight increase in body temperature o 1000 daltons ➢ Pregnancy with asthma – bronchospasm in 36-40 wk. PREGNANCY LABS ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ ➢ UA every visit Alkaline phosphatase always ±due to bones Leukocytosis with neutrophilia is normal Alpha-Fetoprotein (AFP) – check 16 -20 weeks o Low – order triple screen to evaluate for Down syndrome o High – r/o neural tube defects or multiple gestation ± sono Triple Screen Test (AFP, beta HCG, estriol serum) Quad – triple + inhibin A (hormone by placenta) o Down syndrome Amniocentesis –gold standard for genetic disorder is fetal chromosomes/DNA (spontaneous fetal loss 1-400) Tay-Sachs disease (neurologic, common Jews) Cystic Fibrosis (white) Sickle cell trait (blacks) 1st prenatal – document HCG o Pap, GC/chlamydia o Rubella, varicella, rubeola o Syphilis, HIV, HBsAg, consider HCV o CBC, blood type, antibody screen o TSH if being treated 16-20 weeks o Quad marker/screen 24-28 weeks o Screen for gestational DM 28-32 weeks o STI o RhoGAM if indicated (Rh -) 32-36 weeks o Fetal presentation o Kick counts 35-37 weeks o Group B strep culture o Positive – pen G 5 million IV followed by 2.5-3 million Q4 until delivery 40-42 week o Vaginal exam to assess cervical ripeness PHYSIOLOGICAL CHANGES ➢ Heart is shifted anteriorly and towards left ➢ Heartrate ± 15-20 BPM ➢ Heart sounds are louder, S3 is common, splitting of S2 may be heard ➢ Systolic ejection murmur (II/IV) heard over pulmonary and tricuspid area ➢ CO ± 30-50% (± preload), ³ SVR and BP (³ afterload) ➢ Plasma volume ±50% ➢ Physiological anemia ➢ Uterus compresses vena cava (orthostatic HTN) ➢ Hypercoagulable state ➢ Basal rales that disappear with coughing ➢ No change in FEV1 but ³ total lung capacity ➢ Constipation, heartburn ➢ ± melanocyte-stimulating hormone causing linea nigra (dark line from down abdomen) and nipples and areola darken ➢ Chloasma (melasma) – blotchy hyperpigmentation on forehead, cheeks, nose and upper lip – more common in dark skin, due to ± estrogen level ➢ Striae gravidarum ➢ Telogen effluvium (hair loss) – during postpartum ➢ Kidney size ± - GFR ± due to ±CO and renal blood flow ➢ Nasal congestion, epistasis due to ± blood flow ➢ Varicose veins ➢ Peripheral edema OBSTETRIC HISTORY ➢ ➢ ➢ ➢ ➢ Gravida Term Preterm Abortion Living ➢ Category A – o Vitamin A, Levothyroxine ➢ Category B – SAFE o PCN, Cephalosporin, macrolides, acetaminophen, Pulmicort, Maalox, Colace, methyldopa (check LFT – discontinue with jaundice, abnormal LFT or unexplained fever), CCB (Procardia), BB (labetalol), insulin ➢ Category C – Probably SAFE o Sulfa in 3rd trimester, Clarithromycin, NSAIDs (premature closure of ductus) ➢ Category D – May NOT be safe o ACE/ARB, quinolone, tetracycline, Tegretol, Depakote, fluoxetine, paroxetine ➢ Category X – NOT Safe o Accutane, Thalidomide, statins, Proscar, misoprostol, Evista ➢ Teratogens – alcohol (FAS), aminoglycosides (deaf), cigarettes (IUGR), cocaine (CVA), isotretinoin, lithium (cardiac defects), gestational diabetes (LGA, neural tube defects) ➢ Cat litter or raw/undercooked meat can cause toxoplasmosis ➢ Smoking (IUGR) and alcohol are contraindicated ➢ Do not use hot tubs, saunas or expose oneself to excessive heat ➢ Progesterone, CCBs relaxes esophageal sphincter and contributes to heartburn ➢ Uterine involution – uterine contractions for 2-3 days after birth. Soft boggy uterus with heavy vaginal bleeding is atony (inadequate contraction). Involution takes about 6 weeks. Breastfeeding speeds this up. ➢ Edwards trisomy 18 PREGNANCY Name Cause Signs/Symptoms Placental Abruption (Abruptio Placentae) Late third trimester pregnancy with sudden onset vaginal bleedin g accompanied by contracted uterus, painful. Hard abdomen, rigid uterus. Up to 20% do not have vaginal bleeding Placenta Previa Multipara late 2 nd to 3 rd trimester with new onset painless bleeding worsened by intercourse. Soft, nontender uterus. Primigravida in late 3 rd trimester (>34 weeks); sudden onset recurrent headaches, visual abnormalities (blurred vision, scotomas) and pitting edema. Edema easity seen on face/eyes and fingers. Sudden rapid weight gain in 1-2 days. New onset RUQ pain, BP > 140/90 with urine protein 1+, oliguria. N/V are worrisome for encephalopathy. Can start at 20 weeks. If seizures, Eclampsia. Diagnostics CBC, PT/PTT, Type and Cross, Rh, sono Triad: HTN, proteinuria and edema > 20 weeks BP > 140/90 Proteinuria 0.3 gram in 24 hours Edema face, eyes, hands Preeclampsia Unknown – risk factors: primigravida, multipara, > 35, obesity, prior hx., HTN or kidney disease HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Serious but rare complication of preeclampsia/eclampsia Signs and symptoms of preeclampsia that present suddenly ±AST, ALT, lactate dehyrogenase Total Bili > 1.2 Platelets <100,000 ³ H/H Rh-negative mother with Rh-positive fetus Maternal immune system produces antibodies against Rh-positive blood if not given RhoGAM. Give for all pregnancies of Rh-negative mothers – even if they terminate in miscarriage, abortion, ectopic etc. Coombs: detects Rh antibodies (indirect) and infant (direct) Rh-incompatibility Gestational Diabetes Associated with higher rates of neural tube defects, congenital heart disease, birth trauma (shoulder dystocia), preeclampsia, hydramnios, macrosomia, fetal organomegaly and neonatal hypoglycemia. Risk factors – hx, obesity, Asian, Native American, Pacific islander, black, Hispanic, infant > 9lbs, older than 35 Screen at first visit if high risk otherwise screen at 24-28 weeks Diabetes in 1st trimester = Type 2 diabetes Test 6-12 Weeks postpartu m and every 3 years afterwards Treatments Concerns Deliver fetus; severe case can cause hemorrhage ± Risk with HTN, preeclampsia/eclampsia, cocaine use or hx of abruptio placentae Bedrest. Mag sulfate for cramping. If mild, uterus will reimplant. No vaginal or rectal stimulation. If cervical dilation or hemorrhaging, fetus is delivered via Csection ± risk hx., C-section, multipara, older age, smoking, fibroids, cocaine Delivery – can occur up to 4 weeks after delivery HT N before 20 weeks is HTN – may be able to get off meds during 1st and 2 nd tri mester Multipara > 25 RhoGAM (anti-D immune globulin) made from pooled IgG antibodies. If not given, this will result in fetal hemolysis in future pregnancies. ³ risk by destroying fetal Rh+ RBC that have crossed placenta RhoGAM 300mcg IM – first dose 28 weeks 2 nd dose within 72 hours of delivery One-Step Method – 75 g OGTT – fasting (8 hrs.) >92 1 hour >180 2 hours >153 Two Step Method – 50 g OGTT (not fast) Check plasma glucose at 1 hour (if > 140 – order 100 g OGTT – Fasting (8 hrs.) > 95 1 hour > 180 2 hours > 155 3 hours > 140 Glycemic targets – Preprandial 95 or less 1 hour < 140 2 hours < 120 A1C goal: 6-6.5% Lifestyle measures ² insulin, glyburide, metformin Higher risk for Type 2 diabetes SEXUALLY TRANSMITTED DISE Name HIV Cause HIV-1 most common strain in US Attacks CD4 Tlymphocytes Signs/Symptoms Hairy leukoplakia of ton gue (caused by EpsteinBarr virus of tongue), recurrent candidiasis, thrush, fever, weight loss, diarrhea, cough, shortness of breath, Kaposi’ s sarcoma; symptoms develop within 2-4 weeks Petechial or pustular skin lesions of hands/soles; swollen, red, tender joints in one large joint (knee). May have s/s STD, pharyngitis w/ green purulent throat exudates not responding to antibiotics Chlamydia trachomatis Atypical bacteria Incubation 7-14 days Asymptomatic. Most common STD in US; Samples from urine, cervix, urethra, fallopian tubes, oral and rectal sites. Can occur in endometrium Neisseria gonorrhoeae Gm- diplococci bacteria Incubation 1-5 days Purulent green-colored vaginal/penile discharge; exam shows discharge on cervix which may bleed. May be asymptomatic, Cervicitis, urethritis, pharyngitis, Bartholin gland abscess, salpingitis, epididymitis/prostatitis Fitz-Hughes-Curtis Syndrome (Perihepatitis) ELISA – screening Western blot – Confirmatory for HIV antibodies HIV PCR if both + Normal CD4 count 500-1500 It can take 3-12 W eeks for HIV antibody test to detect HIV Disseminated Gonococcal disease Syphilis Diagnostics Treponema pallidum (spirochete) 2-4-week incubation Primary – painless chancre with lymphadenopathy that last 3 weeks. Heals spontaneously (Chancre should start healing 3-7 days after injection if treated) Secondary – ***most contagious nonpruritic skin rash, involving palms and soles, mucous membranes. Fever, lymphadenopathy, sore throat, patchy hair loss, headaches, weight loss, condyloma lata Latent – variable Tertiary – neurosyphilis, gumma, aneurysms, valve damage Chlamydial and/or gonococcal infection of liver capsule causing scarring Symptoms of PID complaining of RUQ abdominal pain and tenderness on palpation Treatments Prophylaxis if CD4 <200: Bactrim daily; If allergic: Dapsone, atovaq uone, aerosolized pentamidine Pregnancy – start Zidovudine (AZT) ASAP; Newborn s start within 6-12 hours of delivery Best sign of treatment is ³ viral load Pneumocystis jirovecii causes most deaths in people with HIV Tenofovir disoproxil fumarate – UA every 6 months - nephrotoxic; Zidovudine – CBC (bone marrow suppression) If exposed PEP – start ASAP PrEP reduces HIV transmission 90% Concerns AIDS = CD4 < 200 Toxoplasma gon dii (protozoa) CD4<100 Bactrim daily; headaches, blurred vision, confusion Avoid: cat litter, uncooked pork/beef, bird stool, turtles/amphibians, gardening Refer – Ceftriaxone 1-gram IM or IV every 24 hours NAAT test for pharynx/rectal samples; GenProbe for cervix/urethra Friable cervix with yellow discharge NAAT test for pharynx/rectal samples; GenProbe for cervix/urethra RPR or VDRL for screening (nontreponemal test) confirm w/ FTA-ABS (treponemal test) Liver function normal Azithro mycin 1G, Doxycycline 100mg x7d Treat sexual partners – Azithromycin 1G Test of cu re only for pregnant women 3w after comple tion with Azith or Amox. Comp licated: Rocephin 250mg IM + doxycycline PO BID x 14 days with or without Flagyl PO BID x 14 days Leads to PID (PID has + chandelier’s test) Most common < 25 Ceftriaxone 250 mg IM (Rocephin) + Azithro mycin 1-gram PO (if allergic Ge mifloxacin 320 mg PO + azithromycin 1gram PO) IF GC + always co-treat for chlamydia even if test negative Incubation 1-5d Primary: Ben zathine PC N G 2.4mil x 1D ose or doxycycline for allergy. If latent syphilis administer weekly x 3 weeks (Genital ) Recheck RP R 6-12 months Treat partners and test for HIV/STDs Refer to infectious disease if latent or tertiary Treat as co mplicated gon orrheal/chlamydial infection Rocephin 250mg IM + doxycycline PO BID x 14 days with or without Flagyl PO BID x 14 days Risk: men with men, HIV infection. most contagious during secondary stage False positive RPR: pregnancy, Lyme disease, autoimmune disease, chronic or acute disease Jarisch-Herxheimer Reaction – acute febrile reaction during first 24 hours of treatment. Acute onset fever, chills, HA, myalgias. Supportive treatment. SEXUALLY TRANSMITTED DISE Name Reiter’s syndrome Condyloma Acuminata; Verruca Vulgaris (genital warts) Cause Immune mediated reaction secondary to infection with bacteria (chlamydia) that resolves Signs/Symptoms Diagnostics Mostly in males. Presents w/ history of chlamydia c/o red, swollen joints that come and go (migratory arthritis) 4.0 Biopsy of prostatic tissue PSA looks good when taking Flomax; Prostate shrinks (temporarily) while on Proscar so PSA must be doubled BPH Non-cancerous enlargement of prostate gland Chronic Bacterial Prostatitis Chronic > 6 weeks of infection of prostate caused most commonly by E. coli and Proteus Hx of acute UTI or may be asymptomatic. Several weeks suprapubic or perineal discomfort w/ irritative voiding symptoms, dysuria, nocturia, frequency Acute Prostatitis Bacterial infection E. coli and Proteus or STD Sudden onset high fever, chills w/ suprapubic and/or perineal pain; pain radiating to back or rectum w/ dysuria, frequency, nocturia and cloudy urine. 4.0 for all or PSA > 2.5 if high risk Antiandrogens: Finasteride (Proscar) Hormone blockers (Lupron) USPSTF does not recommend screening asymptomatic DRE/PSA Refer to ED Inguinal – on exam LUTS – lower urinary tract symptoms. Nocturia, difficulty starting stream, weakened stream, dribbling, feelings of incomplete emptying, urinary retention Prostate size does not correlate well with severity of symptoms Concerns Surgical emergency School age; complains abrupt onset blue-colored mass on testicular surface resembling 71 Risk factors: African American, Jamaican s, obesity. Proscar teratogenic (don’t touch w/ bare hands – affects male fetus) Appendix teste is round, small pedunculated polyp-like structure attached to testicular surface Surgical repair Lifestyle changes: ³ caffeine, alcohol, fluids before bed, avoid diuretics Alpha-adrenergic antagonist - Terazosin (Hytrin), Tamsulosin (Flomax) – monitor for orthostatic hypotension (take at bedtime)- Finasteride; Refer to urology; Avoid: antihistamines, decongestants, caffeine; amitriptyline. Herb: saw palmetto may improve symptoms Seen in 50% of men > 50 80% men > 70 Trimethoprim-sulfamethoxazole (Bactrim), if sensitive, give ofloxacin or levofloxacin Treat 4-6 weeks <35: ceftriaxone and doxycycline >35: ciprofloxacin or Levaquin for 6 weeks antipyretics, NSAI Ds, stool soften ers w/o laxative, sitz bath, hydration. Should see improvement within 2-6 days Vigorous palpation of infected prostate can cause septicemia and pain MEN’S HEALTH Name Cause Testicular Torsion Spermatic cord becomes twisted Epididymitis Inflammation (can be infectious) Signs/Symptoms Diagnostics Abrupt onset extremely painful and swollen red scrotum. Frequent has N/V, affected testicle located higher and closer to body than unaffected testicle. Left side more often affected Loss of cremasteric reflex (testicle elevated toward body with stroking inner thigh) UA Ultrasound (done in ED) Acute or chronic swollen red scrotum that’s painful w/ unilateral testicular tenderness and discharge. Scrotum is swollen and erythematous w/ induration of the posterior epididymis, s/s UTI; most common when people sit too long CBC, UA, C&S, + Prehn’s sign (relief of pain with scrotal elevation) + Cremasteric reflex Check for STI Erectile dysfunction Vascular insufficiency (diabetes, HTN), neuropathy, medications (SSRI, BB), smoking, alcohol, hypogonadism Peyronie’s disease Inflammation Penile pain primarily occurring during erection. palpable nodules (fibrotic plaques) and crooked penile erection May resolve spontaneously or worsen over time Balanitis Candida infection Inflammation of glans penis, more common in uncircumcised men, DM, or immunocompromised males OTC azole creams Treat partner Phimosis Edema Foreskin cannot be pushed back from glans penis. Usually seen in neonates Varicocele Abnormally dilated spermatic vein Varicose veins in scrotal sac (85% Orchiopexy to prevent recurrence <35 -Doxycycline x 10d >35 – Ofloxacin or levofloxacin x 10d NSAI Ds, scrotal support/elevation Phosphodiesterase 5 inhibitor – take Viagra on empty stomach Viagra or Levitra – take prior to sex Cialis – take within 36 hours of sex May cause headache, flushing, dizziness, hypotension, nasal congestion, priapism Inability to have an erection firm enough to perform sexual intercourse Concerns Most common between 10-20; more common with bell clapper deformity Infertility is possible post infection due to scarring of vas deferens Concomitant nitrates, caution alpha-blockers, recent MI, post CVA Refer to urology Scrotal ultrasound Treatment if causing pain, atrophy or infertility includes -surgery or percutaneous embolization Scrotal support can help Scrotal ultrasound Refer to urologist May have decreased sperm count Non-co mmunicating disappears within 1st year of life – scrotu m will look like deflated balloon. ELDERL DELIRIUM VS DEMENTIA DELIRIUM Sudden state of rapid changes in brain function reflected in confusion, change in cognition, activity and LOC Etiology Onset Memory Duration Reversible Sleep disturbance Psychomotor Perceptual Disturbances Speech Acute underlying cause such as acute illness Abrupt, over hours to days. Impaired but variable recall Hours to days Usually reversible Disturbed sleep-wake cycle with hour-to-hour variability often worse as day progresses Usually a change, hyperkinetic, hypoactive or mixed. None in almost 15% Yes, including hallucinations Incoherent, confused with inappropriate words DELIRIUM ETIOLOGY DEMENTIA Slowly developing impairment of intellectual or cognitive function that is progressive and interferes with normal functioning Variety of causes ➢ antihistamines, antipsychotics, opioids, opiates, benzodiazepines, alcohol, etc.) ➢ Emotional – mood disturbances, loss Electrolyte disorder (hyponatremia) ➢ Low PO2 – CAP, COPD, MI, Pulmonary edema Lack of drugs ➢ Infection – UTI, CAP Retention of urine or feces ➢ Insidious that cannot be related to a precise date, gradual change in mental status. Memory loss, especially for recent events Months to years Chronically progressive and irreversible Disturbed sleep-wake cycle but lacks hour-tohour variability, often day-night reversal None until late in disease None until later in the disease In early stages Drugs – when any medication is added, or dose adjusted. (Anticholinergics, TCA, Reduced sensory input (blindness, deafness, darkness, change in surroundings) ➢ ➢ Ictal or post ictal state Undernutrition – protein/calorie malnutrition, vitamin B12 or folate deficiency, dehydration ➢ Metabolic – diabetes, thyroid, MI ➢ Subdural hematoma INTERVENTION ➢ Assess those at greatest risk ➢ Treat underlying condition ➢ ➢ ➢ ➢ DEMENTIA ETIOLOGY Alzheimer-type 50-80% (loss of executive functioning) Vascular dementia - 20% (memory loss after stroke) Parkinson disease – 5% Misc. – HIV, dialysis encephalopathy, neurosyphilis, normal pressure hydrocephalus, Pick’s disease, Lewy body disease, frontotemporal dementia CANCER IN OLDER ADULTS ➢ Cancer with highest mortality: lung and bronchial cancer (both genders) – most common risk factor – smoking; non-small cell lung carcinoma (90%) – if presents in clinic with cough etc. CXR, then CT scan, gold standard is positive lung biopsy. Baseline labs include CBC, FOBT, chemistry panel, UA. Refer to pulmonary for bronchoscopy and tumor biopsy. USPSTF recommends annual screening with CT (age 55-80) with 30 pack yr. smoking hx and currently smoke or quit within past 15 yrs. ➢ Cancer with 2nd highest mortality: colorectal cancer – about 20% have distant metastases at time of presentation – risk factors – advancing age, inflammatory bowel disease, or family hx of colorectal cancer, colonic polyps, lack of regular physical exercise, high-fat diet, low fiber diet, obesity. If presents with change in bowel habits, CBC, FOBT, chemistry panel, UA and refer to GI. At age 50 start with baseline colonoscopy (repeat every 10 yrs.); sigmoidoscopy every 5 yrs., Cologuard every 3 yrs. for low risk, or FOBT annually. ELDERL STANDARDS FOR ALZHEIMER CARE ➢ To slow the decline in dementia o Vitamin E 1000U BID or o Selegiline 5mg BID ➢ Mild to moderate stage disease o Cholinesterase inhibitors ▪ Donepezil (Aricept) ▪ Rivastigmine (Exelon) ▪ Galantamine (Razadyne) o Clear minor benefits ➢ More advanced dementia o N-methyl-D-aspartate receptor antagonist memantine (Namenda) ➢ Treat agitation and depression ➢ Consider non-AD related reasons for behavioral issues o Pain, infection ➢ If environmental manipulation fails o Psychotropic (risperidone) ELDERLY PEARLS ➢ Top 3 leading cause of death > 65 o Heart disease (MI, heart failure, arrhythmia) o Cancer (lung and colorectal) o Chronic lower respiratory disease (COPD) ➢ Fasting growing age is 85+ ➢ Young old is considered 65 to 74 ➢ Any unexplained iron-deficiency anemia who is older, male or postmenopausal should be referred for colonoscopy ➢ If chemistry shows ± calcium or alkaline phosphatase, indicative of cancerous metastasis of bone ➢ Depression is very common in dementia ➢ Cholinesterase inhibitor side effects include nausea and diarrhea ➢ Syncope ➢ Dizziness ➢ Vertigo ELDER ABUSE ➢ ➢ ➢ ➢ ➢ Presence of bruising, skin tears, lacerations and fractures that are poorly explained Presence of sexually transmitted disease, vaginal and/or rectal bleeding, bruises on breast are indicators of possible sexual abuse Malnutrition, poor hygiene, and pressure injuries Screen for abuse and financial exploitation Interview alone: o Do you feel safe where you live? o Who handles your checkbook and finances? o Who prepares your meals? ACTIVITIES OF DAILY LIVING ➢ ➢ ➢ ➢ MEDS TO AVOID IN ELDERLY ➢ Anticholinergic Effects o Tricyclic antidepressants o Overactive bladder medications o First generation antihistamines o Dry as a bone (dry mouth/eyes) o Red as a beet (flushing) o Mad as a hatter (confusion) o Hot as a hare (hyperthermia) o Can’t see (vision changes) o Can’t pee (urinary retention) o Can’t spit (dry mouth) o Can’t shit (constipation) ➢ Significant risk of orthostatic hypotension o Tricyclic antidepressants ➢ Increase in fall and fracture o Sleep medications ➢ Potential to promote fluid retention o NSAIDs ➢ Increased risk for hyponatremia o SSRI o Start elderly on SSRI and recheck in one month (esp. those taking thiazides) ➢ Use in caution with BPH, narrow-angle glaucoma and preexisting heart disease. Ability to feed self Ability to manage bowel and bladder elimination Personal hygiene and grooming ASSESS FOR FALL RISK INSTRUMENTAL ACTIVITES OF DAILY LIVING ➢ Timed Get up and Go o Grocery shopping o Housework o Managing finances o Using telephone o Driving a car

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