Gero HESI Random Stuff

Random things for the HESI:                Pt with diabetes: o Wound from cutÝng skin when doing toenail care – schedule routine visits for nail care w a podiatrist o A1C level – greater than 8% = uncontrolled diabetes Pt not sleeping during the night and napping during the day o Keep window blinds in the room open during the day for natural light  this helps reorient their sleep/wake cycle Skin/veins: o Skin is thinner + looser, muscle mass is decreased  This causes veins to roll instead of being anchored in their natural surroundings; veins lose elasticity, become hardened, can easily be injured, and are prone to collapse o Venipuncture:  Many risks d/t aging skin + veins  hematoma  Stimulate the chosen site with alcohol wipes to make veins more prominent; can then locate veins that are suitable for venipuncture  Select a smaller gauge needle – prevent vein collapse  Do not tap veins – increased risk of bruising  Avoid adhesive bandages – skin tearing; use folded gauze with paper tape Bilateral crackles = sign of poor oxygenation Progressive confusion with unchanged vital signs + intact neurologically  suspect that medications could be causing confusion, review their meds! Loss in height = diagnostic finding associated w osteoporosis o Priority for pt w osteoporosis = fall prevention!! BUN: 0-20 mg/dL Creatinine: 0.5-1.2mg/dL Vancomycin is excreted renally – those with impaired kidney function need trough levels drawn to make sure they aren’t experiencing toxic levels of Vanco Renally impaired: penicillin should be questioned bc it is excreted through the kidneys Hgb: 12-18 g/dL Platelet count: 150,000-450,000 Dementia pt doing something inappropriate (ie: touching penis) o Ask if he needs to urinate o Distract w TV/book o Assist back to his room/private area Usually “acute pain” = priority for client… other things can be addressed later once the pain is taken care of S/S depression: change in sleep patterns, loss of energy/fatigue, inability to concentrate, change in appetite leading to weight loss or gain, psychomotor retardation (slow body movements)                  o Depressed pt  chronic pain is a BIG factor that contributes to older adult depression 30 mL in 1 ounce Abdominal pain that wakes up pt in the middle of the night: peptic ulcer disease o Bleeding = sign of peptic ulcer disease (low Hbg = bleeding) Sudden changes in personality/onset of combativeness = sign of poor oxygenation; CHECK VITALS FIRST! Least invasive intervention FIRST Safety: o Provide live examples of safety hazards that occur in the home environment o Pt takes bath + slips, next day put pt in a shower chair for safety Apraxia: inability to carry out learned and purposeful movements such as washing the face or eating Agnosia: inability to recognize objects Anomia: inability to name objects Erikson’s integrity vs. despair: will probably discuss past accomplishments and experiences OR be sad that they are dying and think they lived a pointless life Provide toileting Q2H/promote independence as much as possible before briefing a pt that experiences incontinence Cane: o Use on UNAFFECTED SIDE o The affected leg + cane should move at the same time o Cane should go slightly to the side, about 2 inches to the front Opioid use: constipation risk… encourage fresh fruit + vegetables in the diet Alzheimer’s: o Trouble w short term memory o May be hard to get a past medical history Malnutrition: serum albumin level determines protein intake of a client w malnutrition o 3.4-5.4 o Respiratory diseases: encourage small frequent meals rather than large meals to prevent malnutrition Herpes zoster (shingles) vaccine = important for those 60 years old and up Dialysis – risk for dehydration! Assess blood pressure if pt feels confused/lightheaded Maintain integrity + independence: put all useful items within reach of pt with limited mobility Sometimes older pt doesn’t adhere to their medical treatment simply bc they don’t understand  always assess underlying causes + reasons that a pt may not being adhering