recorded and it will be the recordings will be posted in the announcements for your classes along with these PowerPoints that we're looking at tonight so you all are the first group to see the review okay chapter one was Trends and issue so this was this was the chapter in the very beginning where we were learning about the Aging population you know who are they what are their demographics um what is their economic status like um and also we learned about Concepts like agism and age discrimination gerontophobia which is fear of Aging um so you want to know a little bit about that and also some of the myths and facts in our culture that we have about older people uh one the reference point for that would be box 1.1 in your book it says like myths and facts about aging or myths about aging the aging process so you want to remember some of those myths like the fact that there's this idea that all older people live in nursing homes we know that's not true all older people are very poor all older people are sick they're depressed they don't need connections with other people so a lot of that is stereotypes about aging um does anybody remember like what is the single biggest fear that most older people have about aging people and their caregivers what are they afraid of losing Independence yes right exactly exactly they're afraid of losing Independence a lot of those other fears that we have about aging kind of boil down to Independence like we were afraid of losing Mobility we're afraid of losing income we're afraid of losing important relationships and a lot of that boils down to Independence so that's really the greatest fear um the terms agism and AG age discrimination they're very similar in fact in your book that your book defines agism using the term age discrimination in the definition so that makes it a little harder even to tell the difference but there actually is a slight difference does anybody know how you differentiate agism versus age discrimination um I know age description is discriminating against a certain age group a group well a people in a certain age group agism I would think is like the study of Aging um that's close but it does have to do with aging it defin it's it's more like the the stereo the dislike of Aging so agism is kind of it's an emotional Prejudice or a feeling of dislike against people just because they're older so you might hear statements like you know I really don't like taking care of older patients they're so difficult they're always cranky they don't smell good you know and and those are agist that's those are all examples of agism because it's more like an attitude now when you get into age discrimination you're taking it one step further and actually denying the person something because of their age for example denying them the opportunity for a promotion at work because they're in their 60s rather than in their 40s or 30s denying them access to health care services because younger people have better outcomes so we don't really like to focus our attention on the Aging population um one example I can think of a really subtle age discrimination was a clinic in my community where they didn't have any access for handicap patients um so older patients we were try to send you know some of the residents from our nursing home there and they weren't able to go because they couldn't nobody in a wheelchair could get up the ramp so they were also probably in violation of the of um anti- discrimination for Disabilities but um basically that's the difference so agism is is like an emotional Prejudice age discrimination is actually taking action and denying them something so if if you are working as a nurse in a clinic there's another wor nurse working with you and she says gosh I just you know here comes another older patient I just don't like these older people I wish they would go somewhere else you know they're just too much trouble would that be agism or age discrimination agism agism right agism because even though you know they're talking about not liking older people they haven't actually done anything about it now if they were to actually confront that patient the old patient was 80 or whatever and say Hey you know we're really not taking new older patients here you know we're capped out on Medicare we prefer to focus on younger clients at this point that would be age discrimination okay so economics of Aging remember it's a myth that all older people are extremely poor and live below the poverty line we know that really it was only about 12.8% as of I think 2019 who were living below the poverty line um which group had the higher median income was it older men or older women older men old men right exactly now now why would older men have a higher median income than older women men get paid more in general than women do yeah and that's that's still the case but um you know because the women were stay home at stay at home wives and a men went out and got the money yes and and both of those are correct men have gotten greater pay for equal work and also Al had more um more employment outside of the home this was especially true with older Generations so what about lowincome people now what's their major source of income if they're elderly and and don't have a lot of money Social Security Social Security right Social Security is the major source of income for lowincome adults actually for a lot of adults but especially lowincome now you might have noticed in your blueprint we mentioned healthare Provisions for older adults and by that we're mostly talking about Medicare the federal program that helps cover expenses for aging Americans So based on what you remember from your reading or from class help me match these Medicare A which one which description does that match in column two can you see the slides the definitions Hospital right hospital care yeah exactly it's Medicare A is hospital care this is the type of Medicare that everybody qualifies for at 65 and it does cover Hospital services and also some skilled nursing after the hospital in some cases um what about uh Medicare B insurance plans out that's 80% of outpatient services so that includes providers fees Physical Therapy other services the way you might remember that if you want like a little memory device is I and O Medicare A is I for inpatient Medicare B is O for outpatient so I and O everybody gets a Medicare B the individual has to pay for and it usually comes out of their social security check so what about C insurance plans that allow Medicare reist to receive good it's those commercial insurance plans that will take over and manage Medicare for the patient and then of course d is just prescription drug benefits and that's very helpful for people who take a lot of medications and have pretty high copay okay so the different residential options we discussed a few different options in class uh we talked about the difference between assisted living and skilled nursing and then also some specialized acute care if somebody wants to go to an assisted living community what is their kind of functional status what would you expect them to be able to do why would they be going there right yeah what was that t independent like just a little assistance and helping them yeah good A little assistance yeah theoretically they're supposed to be able to do most of their ADLs themselves but they do need some assistance with activities of daily living uh things like meal preparation usually there's a meal service in the community there may be some housekeep keeping some uh for for people who need a little bit more help they may be even able able to have medication management um so assisted living is basically some light assistance with ADL skilled nursing is going to be more intensive it's around the clock there's going to be a nurse in the building with Assisted Living there's you know they can usually get away with only having a nurse um like during business hours on call except for the on call so on site it would only be business hours and then sub Ute that's more for people who've been discharged from the hospital but they are um they're basically too sick for a nursing home but not sick enough for the hospital they still need rehab and special services like ventilators or trakes or things like that okay still on chapter one Advanced directives now these what you see here is three different examples of advanced directives so what what would would you say as a general definition of advanced directives what are they designed foris wishes yeah right they're supposed to make your wishes known uh in in written form in a the documented documents that show what kind of care you desire if you know you become incapacitated or if you're no longer to make your own decisions um if you're unconscious and your heart stops beating so these three uh types of advanced directives that you see they all are pretty specialized for people who don't want um a higher level of care um the living will usually specifies the patient wants to die naturally uh the pulst or the most form that's gradually replacing the classic DNR so you may have seen those in your patients charts if you are in clinicals or at work they're usually brightly colored pink or green paper and they say you know what does the person want CPR do they want you know just Comfort Care do they or do they want full care if something happens and those are actually a medical order signed by the doctor and then the durable power of attorney what is the power of attorney for for someone else to make decisions for them good somebody else to make decisions for them like a spouse or an adult child or somebody like that so here's a little exercise to test your knowledge you're the nurse taking care of an 88-year-old patient who's admitted to the hospital as a full code but now she tells you that she's decided she does not want CPR if her heart stops beating so you're looking at her chart thinking oh my gosh she's a full code that means we would have to resuscitate her if anything happens if I walk in and she's not breathing we have to call a code and do CPR and get her resuscitated that's not what she wants so what does she need to do revive her uh her living will or her uh her her end of life plan just basically let the doctor know she wanted to change her code status from a full code to com for measures with no CPR right exactly she needs to sign an advanced directive if she doesn't have one that says what she wants she just wants comfort care she wants to die naturally if she goes into cardiac arrest she doesn't want to be at resuscitated so she needs Advanced Directive it looks like she doesn't have anything in her chart she's just got the default um can she change her mind if she wants to yes absolutely absolutely yes she can definitely change her mind can she does she have to tell her family no no no not in this you know not the way this is phrased now if this was an 88-year-old patient who whose husband was her POA or who was cognitively impaired or unresponsive um it could be different you know it maybe then they would need to get the family involved but she has the right to make her own choices she doesn't necessarily have to talk to the family first okay so elder abuse another important topic out of chapter one so there's a lot of different signs of abuse then some are very obvious some are really subtle um what's an example of emotional abuse speaking for the patient speaking for the patient on their behalf without letting them talk yeah that isn't uh an example just down just being negative towards them like oh you can't do this or you know stuff like that good yeah just being negative derog making derogatory comments like oh you know it takes you so long to get dressed why don't you just let me let get you dressed right now and I'll pick out your clothes you know even that could be considered a form of abuse and definitely a violation of their rights um isolating the person making them stay alone in their room all day instead of getting them out and socializing if they want to that's another uh form of abuse um what would be an example of financial abuse misusing mishandling their funds yep yeah that's it yeah maybe saying grandma I'll take over paying all your bills um all you have to do is write me a check every month and I'll make sure your electric and your water gets paid and then they don't pay it or they say you know let me use your credit card and I'll pay out pay off anything I buy but you really don't know um Can older people give gifts to PE to their caregivers no you're not supposed to accept monetary gifts from older people nothing right you're not yeah you're not supposed to accept gifts I know agencies always are teaching us no gifts no you know if they want to give you a box of candy it can't be worth more than $5 or something like that however that doesn't necessarily mean the person can't offer it it just means we're not supposed to accept it so signs of elder abuse remember that could include abusive behavior in the family or signs that they're you know financially they're not as well off as they used to be um what what would be like your priority intervention if your caregiver is telling you that they feel really stressed and they don't think they can handle the care at this point resfit yeah respit why is rfit a priority like why is that like a safety intervention because it can prevent abuse good it can prevent abuse nobody really you know we don't go into these caregiving situations wanting to abuse people however when somebody has is at the end of their rope and they're getting too many demands from too too many different people in their lives it can become a a potentially dangerous situation for both the caregiver and the patient so yeah respit care support groups are great um Assisted Living could be an option if the person can't live at home but the priority would be talk to them about rest foit care first because that will put distance between that caregiver and their patient um now institutional abuse in health care settings that's another common issue that we have to deal with and some of you may have dealt with that in your own lives you know where you work or where you've gone to clinicals but um one form of abuse that's kind of subtle is violating the patients rights um that could include their right to make decisions like uh to choose their own clothing or their own meals or activities if someone is making all the decisions for a patient then that could be a rights violation so we really want to make sure that people are as independent as possible even if they can't speak you know if they have a fasia or they're not able to talk or Express their needs for some reason they still have the right to choose you know we could give them a communication board a whiteboard have them point to what they want so here's some true false questions for you about mandated reporting all mandated reporters here because of our relationship with with vulnerable populations whether you're a student employee teacher whatever but is it true or false that a mandated reporter is a person who's required by law to report a suspicion of abuse true true yes that is true how about nurses do not need to report elder abuse if it is strictly emotional false right exactly that is definitely false how about concrete evidence of abuse is needed before a report can be filed false false false right that is false how about a nurse working in a hospital or clinic doesn't need to report abuse if it took place in the patient's home false false yeah that's correct if somebody tells you you know I'm not safe at home I my son is abusive to me or my daughter is always yelling at me they still need to report that good okay theories of Aging now we don't go into this a whole lot in this class they talk about a lot of different theories in your chapter but some of them are kind of I don't know if you've had a chance to read about them in depth some of them are a little more evidence-based than others some of them are kind of old school old-fashioned the ones that we focus on are the more contemporary theories like the gene Theory the immunologic or the wear and tear those are all the biologic theories so this is how aging affects our bodies our cells our tissues our organs and then we have our psychosocial theories which is how how do our attitudes and our lifestyle practices affect the quality of our aging so for example the activity Theory just states that the more active you are the more happy and successfully you'll age so uh somebody who's really involved will be probably have uh you know have a better experience of Aging than someone who's not involved in the community who doesn't get out doesn't make friends and then you have Ericson's theory of lifespan development um the two stages of that are uh that we deal with in this class are um generativity versus stagnation and integrity versus despair so both of those are at the older age of the spectrum and basically what they state is that as we get older we have more of a need to prove that we've contributed something to society otherwise we could end up you know feeling like our life didn't have any meaning um now the gene Theory does anyone remember what Gene theory was all about it's kind of self-explanatory basically it just states that um there are harmful genes that are in all of our DNA and they're activated at a certain point in our lives so that we um we that and that triggers the process of Aging then you have the immunologic theory that's another real self-explanatory one it just states that as the immune system wears down with age because you know we do become more vulnerable to illness and infection when we get older for various reasons as the immune system breaks down the um aging occurs and then the wear and tear Theory does anyone remember what that is that's one of my favorites it's like how you treat your body like the wear and tear on your own physical body good it's the wear and tear on your physical body how the way you treat your body or the way you know or the life experiences you have I mean we don't all deliberately harm our bodies you know if you work as a nurse or a CNA or a you know doctor for 30 years walking back and forth on the concrete Hospital floor you're probably going to get some wear and tear on your knees so it it but could also apply to things like smoking or sedentary lifestyle so yeah it's the the Aging occurs because the body breaks down so match these theories with the description in the examples so which one of these patients 1 two 3 or four is an example of the immunologic theory who right is it four yeah it's actually two okay yeah because it's the 88-year-old man who gets a lot of respiratory infections so because of his weakened immune system he gets a lot of infections gets pneumonia and he declines quickly and then Erikson's theory of lifespan development which one would that be one one good 77y old trying to decide if he made a contribution in life what about free radical theory that was an interesting one four yeah four that was was this is the theory that our body produces unstable molecules that harm us and cause aging and if we take a lot of vitamins and a lot of you know these antioxidant supplements we can fight that process um the only problem with that theory is that it's really not backed up by research so if your patient is telling you gosh if I take all these hundreds of dollars worth of vitamins can I avoid cancer probably ought to have a talk with them about the research and the fact that it's not necessarily um backed up by research and then of course wear and tear That's the older lady who needs a knee replacement due to severe osteoarthritis osteoarthritis is the classic example of wear and tear because um joints and the cart the cartilage in our joint starts to break down or wear down over time and um that causes nodules to form on the bones so there's your aging theories so you basically just want to know some of those definitions okay and stop me if you have questions at any point or comments um health promotion and health maintenance this is this is what I call the primary care or the preventive care chapter because it's all about the practices that we can teach our older patients or remind them of or encourage them to do they probably don't need to be taught these practices but they may need to be encouraged to do them so um our health behaviors are learned early in life it's going to be really hard to change someone's dietary practices if they've had you know maybe a meat-based diet their whole life getting them to be vegan at age 78 may not may or may not be effective um change can be challenging older adults usually adapt pretty well to aging but they do have some problems sometimes adjusting to new living situations that's where that adherence and non-adherence comes in sometimes people are non-adherent or non-compliant because they just don't want to change their practices that they've had for a lifetime you can't really blame them in some cases so remember with your daily practices uh for diet maintaining the healthy weight older people tend to have need fewer calories but more nutritional content so a bigger bang for their Buck um one priority when you are evaluating or assessing your older patients is looking at their body weight so any kind of sudden unintentional change in body weight like a sudden weight gain or a sudden weight loss would be a priority when you're doing your assessments for example if you had a patient who came into your clinic and said you know i' I've gained four pounds this week uh it's getting kind of hard for me to do my usual activities that would be a priority what would your concern be for a patient like that like they intake and stuff like their nutritional needs uh yeah you would be concerned about their nutritional needs and what they're eating or drinking um if their if their diet is normal and they're just taking on a lot of fluid that could be a sign possibly that they they're having some heart problems so you'd ask them about like as you said their nutritional practices are they the same as anything changed you eating more eating more salt now if they are if nothing is changed and they're still gaining weight quickly that could be a sign same with weight loss um we want them to try to reduce levels of sodium sugar and fat and then that will help with managing their blood sugar and their blood and their sodium levels now what's the best way to manage sodium levels reading food labels yeah being aware of what the nutritional content is looking at those nutrition facts labels that will tell you how much sodium is in your food a lot of sodium is hidden so for people who have hypertension high blood pressure or other conditions that are affected by sodium or sugar like diabetes it's especially important that they be aware of how much sodium and sugar is in their food um now exercise recommendations for your older people what was the standard recommendation in terms of the amount of exercise they should get 30 minutes 30 minutes for 30 minutes a day for a week yeah 30 minutes three to five times a week so like Monday Wednesday Friday they would get out for a walk for 30 minutes and that would be a great way to exercise that's the most effective way to maintain cardiovascular health and health in general now doing like a one once a week stretching class or exercising for 10 minutes a day that's helpful but not as helpful as consistently exercising for 30 minutes 3 to 5 days a week so exercises like walking are really great for the elderly because for one thing it's inexpensive it's easy most people are able to walk it helps promote Mobility so just think of all those benefits of exercise then you have dental health I think dental care and dental health were discussed on page 82 in your book um when somebody gets new Dentures do they do they know do they still need to worry about choking yes yeah absolutely probably even more so because when you have Dentures you have to get used to all these textures that are going to feel differently with dentures in so they may need to adjust they still need to worry about choking they also have to think about oral health considerations like dry mouth which is zeria x e r o St o m i a that's a word you'll probably see at other times during this class uh gum disease and oral cancer those are just three different things to be worried about when it comes to denture care they can brush their Dentures or soak them overnight either one um and do they still need Dental exams yes yes absolutely yeah absolutely for all of those reasons um zero stomia gum disease or oral cancer could all you know be something that we could deal with also checking to make sure Dentures fit so table 4.1 this is page 81 in your book if you're using the eth Edition in the newest edition um you definitely want to remember some of the time frames of these exams and also whether it's male or female is it are they recommended for men or women another thing to remember with these exams is these guidelines apply to people with average risk they wouldn't necessarily apply to somebody who had breast cancer or someone who had coloral cancer or has a first-degree relative with those diseases so when you're looking at these guidelines and you think wait a second you know I know that my mother has to have a mammogram every year so I'm going to say I'm going to pick that you're then you have to think you know she may need a mamogram every year because there's some specific reason they're following up with her yearly um for the average patient mammograms is that men or women women women women definitely um and every other year when they're um uh when they get older clinical breast exams though they still need those every year bone density exam is that typically recommended at 65 for men or women women yeah it's for women at 65 for men it's a little bit older usually 70 if men don't have a sign of osteoporosis like a decrease in height or fractures they may not it may not be recommended for them but bone density screening for women definitely is because the risk of osteoporosis is so high in females so age 65 Pap test for cervical cancer screening every 3 to five years and as that men or women women women women yeah I know it seems obvious but sometimes when you take these tests and you get nervous read the questions carefully does it apply to men or women um I know for me sometimes I go back and think oh my gosh I was so nervous I I said men need a PO test every three years let's see colar rectal cancer screening um how often do people need a colonoscopy yearly no not yearly um let me go back to my notes every like five years every 10 years yeah it's every 10 years right now five years could be for somebody who had a history uh you know a a higher risk so coloral cancer screening can be very individualized some people need one a screening every year if they have like an inflammatory bowel condition or if they are you know if they have a history of coloral cancer um and there's a whole process for determining but remember the standard is 10 years at starting at age 45 now used to be age 50 now it's age 45 so what is the preferred type uh form of screening for colar rectal cancer colonoscopy colonoscopy colonoscopy absolutely why is that more reliable than like a fecal Ault blood test or a flexible sigmoidoscopy well because they able to go in with the scope and actually see absolutely yes exactly they can um they can actually visualize the interior of the lower GI tract with a colonoscopy they can see polyps they can see inflamed areas they can remove pops um and do biopsies so there's a lot of different things they can see with these now the flexible sigmoidoscopy is similar to a colonoscopy you don't need to know a whole lot about it but um it's it's like a colonoscopy in some ways but it doesn't go as far into the GI tract as the colonoscopy does and if people have a flex Sig or a flexible sigmoidoscopy it's usually every five years um but I would focus mostly on the colonoscopy that this is the preferred method and it's every 10 years for men or women and then prostate cancer screening that's pretty individual um it depends on the on the male patient and his history and risk factors um and then vision and dental these are your two annual screenings Dental every year because of the risk of possibly uh tooth decay gum disease and then Vision um of course because of all those different visual disorders that can affect older adults like cataract um glaucoma macular degeneration hearing is typically like every 3 to 5 years or as needed okay immunizations what we really want you to be able to do is to read an immunization a vaccination table and answer questions based on it as if you were going to be giving injections do any of you use these at work like medical assistant maybe to give vaccines or maybe for your kids you take them to get immunized yes yeah so they're pretty self-explanatory um the vaccine is listed in this particular form uh the vaccine is listed there on the left in the vertical column so we've got influenza tetanus diptheria pacle pcv1 and then pacle ppsv23 and then shingles the reason it's these five vaccines or four vaccines really is that these are the major immunizations recommended for the elderly they're not this is not all inclusive of what they could have but it it's the major ones um then in this horizontal bar you see the age groups and you can see how you know you've got your 27 to 49 which is like your young to middleaged adults then you've got your 50 to 64 which is older middleaged younger old age and then 65 and older which is more like geriatric so influenza all of those groups are getting it the bar goes straight across with no breaks tetanus dip theia pertusus or teap booster every 10 years applies to all age groups but when we get to pneumonia these two new mocal injections it's uh the first one one dose for adults age 65 and older and the second one ppsv23 is is a year later now there is another form of the num Mao vaccine now that can be given as a single injection but I want you to remember the the protocol for the two injections as well and then shingles starting at age 50 recommended once per lifetime for adults age 50 and older either one or two injections depending on which vaccine they're using um now shingles vaccine is recommended for adults age 50 and older partly because of the changes in our immune system system as we get older that um virus the vericella virus can mutate into the um herpes zoster virus which is shingles what is the veracel virus what childhood disease is that chickenpox right chickenpox so that can that can remain in the nerve tracts and reactivate over time um causing shingles which is very painful so even people with normal immune system should have shingles the the vaccine doesn't guarantee that you won't that that you will not get it but it's still very helpful to prevent it so if I went into your clinic today and you're the nurse and I just turned 65 and I'm here to get my yearly injections would I would you be giving me two Pneumonia shots or one one one right just the first one I would get the second one a year later so remember if you have a question that's related to what shots are you giving your patient remember it's just what you're giving at this visit not for like the next year here's another example this is Mrs Jones who is 66 you're the LPN reviewing her immunization record so what vaccinations will you give her to bring her up to date so let's say we're in October 2024 so we're jumping ahead uh which one of those are you going to give her today influenza T and the PC ppsb good good right she had that PCB 13 probably last year so now okay I see it yeah yeah so she had this in 2022 so we'll give her the ppsv23 in now that it's it's been actually over a year but we can still give it to her okay safety risks so what do you think is the biggest change age related change that contributes to an increased risk of injuries like Falls sensory maybe Rog sensory right good yeah sensory changes loss of vision loss of hearing if you are losing the ability to see your surroundings it's going to become a much higher risk of falling or tripping or um not being able to read your medications correctly or read warning signs loss of hearing we might not hear uh sounds in traffic or alarms even changes in taste or smell what kind of health risks could be caused by a loss of the sense of taste or smell they won't want to eat yeah they may lose the their appetite like who wants to eat when you can't taste anything I mean we've all lost our taste and smell like if you get sick or something like that and then it's like who wants to eat so they may not want to eat they may eat something that is spoiled or toxic or non non-edible um and they may also not be able to smell odors like uh you know maybe natural gas or something like that so we also see a decrease in Mobility with the elderly that can affect ambulation and also range of motion here's another term to remember we referred to this briefly just a little while ago an adherence following the plan adherence just means that your patient is following your treatment plan non-adherence they're not following so the word adherent the way you might think of it is it means sticky it means something that sticks to something like an adherent dressing if you've ever done helped with wound care or done your wound care um and adherent dressing is a dressing that sticks to the patient's skin and adherent patient patient sticks to the nurse's treatment plan so a non-adherent patient does not follow the plan um let's see medication safety now this is Page 82 in your book there is a little green box on the bottom right page a right corner of page 82 and it's called um health promotion medication safety tips or something like that so you want to know what some of these precautions are for keeping your patient safe uh like wearing that medical alert bracelet like the one in the picture uh patient has an amoxicillin injury um reviewing over the- counter and herbal meds with the provider nurse or pharmacist um keeping that med list up to date discarding out of date or unused meds and contacting the doctor with any questions which one of those has the biggest effect the most uh impact on preventing poly Pharmacy or adverse drug reactions the medication list good keeping that med list up to date is going to be the most important why is that so influential on um preventing adverse drug reactions because they could have had so many other medications that they were taken before that can react with new medications that they are probably prescribed now exactly so that reconciliation keeping the medist up to date which nurses are doing hopefully at every stage of the patient's care will help to prevent what clarencia just talked about like getting duplicate medications or medications that interact with each other or excess medications that they really don't need so that's the most important way to prevent some of these adverse drug reactions that we see in older adults here's an example this is Mr Jones he has hypertension and Osteo arthritis he's taking beta blocker and a diuretic every day he also takes over-the-counter ibuprofen and recently he started taking glucosamine for joint health so one of his friends at church has arthritis and sometimes he lets Mr Jones take his pain pills so what safety measures would you recommend to him not to do that not to do that yeah church is not to get pain medicine from your friends maybe have them speak to their provider about their pain and what he's on and if they can try it right yeah have him talk to talk to the doctor um or you know nurse practitioner you know uh to recommend or to see if it's the right choice for him because you know using other people's medication is not a good idea another thing you sometimes see is stockpiling meds or saving them for later uh like you know someone has a prescription for an antibiotic and they say well you know I felt so much better after a few doses I just thought I'd save the rest and I wouldn't take it right now so you might see that too um anything else that you see that he's doing that he the doctor really needs to know about how about his over the counter products he's taking ibuprofen and now he also started taking glucosamine so we don't know how much ibuprofen he's taking for his his arthritis but ibuprofen could put him at risk of uh a peptic ulcer stomach ulcer um if he has heart problems it's probably not a great decision for him to take a lot of ibuprofen because it can increase heart failure so he really we really need to keep an eye on how much of that he's taking why he's taking it and probably recommend Tylenol instead um but you know all these meds and supplements they're right there at the grocery store all you have to do is go buy them you can buy a giant bottle of ibuprofen it's kind of scary um box 4.2 this is uh signs and symptoms that require prompt medical attention and this is also on page 82 that's why I always tell students you know look at Pages 81 882 because there's all kinds of in information on those two pages especially but um so basically what this what this box is telling you about is which types of conditions need to be followed up on immediately versus which ones could maybe could the nurse handle or maybe the doctor could handle them in a week or so how about a severe headache that won't go away is that immediate attention yes yes absolutely could be sign of a stroke could be a brain aneurysm it definitely needs help if it's a severe headache that won't go away how about chest pain that radiates or feels crushing yes yes yes yes absolutely how about loss of consciousness or fainting yes yeah definitely that one even if they fainted earlier I would still have them follow up on it how about dry flaky skin for the past six months no no no I mean that's something you know nurse could Rec some lotion or other products it it can be extremely irritating but it's probably not life-threatening how about nausea and vomiting for 24 hours or more yes yes absolutely dehydration is a big risk there or electrolyte imbalance how about no bowel movement for 48 hours yes no and no because medications can uh make them constipated then they will need like a laxative or modium to help them go yeah typically with with with constipation 72 hours is when we you know if if you have tracked um eyes and o or bowel movements on patients you probably noticed that 72 hours was the cut off when you're letting the nurse know and things like that that's usually when those laxatives are are prescribed after 72 hours if it's a PRN not something they're taking all the time now I would the exception to that would be if the patient also has abdominal pain nausea and vomiting um blood in their stool dizziness you know or um signs of abdominal distension severe discomfort um not passing any gas um I would definitely do an abdominal assessment and get attention in that case but if it's just no bowel movement for 48 hours and that's the only information you're given I would say no because that's something we could give them you know talk about laxatives good so communication remember your therapeutic communication techniques like open-ended questions letting patients verbalize active listening validating their feelings using silence so therapeutic communication the whole purpose is establishing that Rapport what was the definition of rapport having like Mutual trust and understanding good atmosphere of mutual trust and understanding so it's when you have a good relationship with your doctor or your nurse you feel like you can tell them things like they care you know some some providers it's just you would never want to tell them anything because they just don't listen and they don't care so um but with a good rapport then you have that relationship open-ended questions allow people to verbalize feelings and then validating feelings one example of validation could be if you have an angry patient who's upset because you know maybe they've been on their call light a long time or they didn't get the meal that they wanted or their meds are late you know and they're and they're attacking you verbally which happens sometimes um one way to approach it would be to validate what they're experiencing I understand it seems like it's been a long time or I see you're upset because your meal was incorrect how can I help you with this you know let me change the meal for you what can you what can we do now um always focus on the patient and what their needs are rather than comparing it to what else you may have been doing earlier like saying there's another patient down the down the hall who was really sick and we were having a code and I'm sorry I couldn't be here because they probably won't that won't matter to them now the communication barriers this was another important part of chapter 5 was things like hearing loss vision loss with older adults because of sensory neural hearing loss which is um Presby presbycusis p r SB c s i s I don't know if you'll see this word at this point in the class but remember that age related hearing loss um the person can hear low tones better than high pitched voices so it's easier to hear for example an adult nurse than their little 2-year-old granddaughter because those little high pitch sounds are harder to hear so using low tones you don't have to shout to get somebody's attention um make eye contact we can use light touch and visual aids with vision loss um it's important to introduce yourself to the client so they know you're in the room and who you are um obviously they can't really see who it is and then pay attention to that non-verbal communication and also use Touch appropriately like touching somebody on the hand or the shoulder just to let them know where you are now this term is something you definitely want to know in this class it's pretty important um what what is the definition of AP fasia is it do they have trouble um understanding words or like saying words right exactly either understanding language or speaking language is difficult for them so with Aphasia um a lot of patients who have Aphasia have a specific type of aphasia where they can understand language but they can't pronounce it correctly or it takes them a very long time to form words so a stroke can affect someone's ability to produce speech without affecting their ability to understand other people's speech it just depends on what brain Center is affected so AP fasia results in a lot of frustration if any of you ever had a patient who had a stroke and they were just kind of upset because nobody understands what they're trying to say it can be really frustrating so we want to make sure that the messages to them are simple but mature and the priority intervention would be offering them a way to communicate if somebody's already frustrated because they can't communicate can't tell the nurse they're in pain or you know they're hungry or need the bathroom give them a communication board or a whiteboard or something that they can communicate with uh with confused adults of course you probably remember this um from earlier in the week we want to speak slowly maintain eye contact and always ask one question at a time shouldn't be too many questions one after the other um non-verbal communication there's just a few points to remember about that um gestures can be misinterpreted pretty easily so some gestures just don't cross cultural barriers very well so be careful about using gestures or slang terms especially with people who are older because they may not understand the slang of younger Generations also use natural facial expressions avoid exaggerated mouth movement ments and make eye contact if appropriate let's see and then Therapeutic Touch I think we talked about this it's not Therapeutic Touch is a little bit different from the kind of touch we do with um when you're giving a uh like for example doing an assessment or doing a procedure like a catheter or something like that or wound care in those cases we usually let the patient know we'll be touching them if you're just ing someone's hand though we don't need to ask permission but be careful um and communicating through interpreters um in this case you probably have had experiences with people from different countries or people who speak different languages um a lot of our patients speak multiple languages so it may not just be two languages or one language but three or four so the first step is always figuring out ask them which language they prefer preer to speak or find out what they prefer to speak give them a little more time to respond and notice their emotional responses um use official interpreters or translators not family avoid asking family to translate so why would why would you not want family to interpret medical information because you don't know if they're interpreting it completely or the way they should right we don't know for example what their agenda is or um whether they understand so um clarencia I'm sorry I put you on mute just because you're um talking in the background but if you want to answer a question please come back um so yeah so some of you may have had experiences where you're working in a situation where you had somebody with um you know who spoke a different language and you brought in another staff member or somebody who wasn't really you know certified to be a translator to translate for them I know I have um but remember when you're when you're taking a test the test world is different from the real world where we do you know shortcuts and have to sometimes make do with what we have um in the test World you've always got what you need so if you need a certified interpreter then there will be one in the test um then avoiding medical jargon what is jargon how would you define find that terms like medical terms medical terms yeah it's medical terms or medical slang that the general public may not understand now if you have a patient who does have a medical background or maybe they watch a lot of you know medical TV shows or you do a lot of research on the internet they may know some terms but if you don't know for sure it's always best to use the most General terminology just to make sure that they understand you like for example would you say gallbladder removal or cystectomy to your patient gallbladder removal REM um what if your patient was you have an antibiotic you want to give them would you say amoxicillin for your infection or antibiotic antibiotic antibiotic because it's more General most people know what that is uh Mi or heart attack ATT right how about URI or upper respiratory infection infection right or just respiratory infection they would probably understand that better um esbar communication now I know have you uh talked about esbar in some of your other classes like fundamentals and basic skills okay as far it's basically just a format that kind of standardizes how we communicate to other medical professionals about our patients so that no matter who you're talking to whether it's a doctor or a nurse on another unit or some other Specialist or provider you know exactly what information to present to them and how to present it it lets you get all your ducks in a row so it's the situation background assessment and recommendation situation is just who is your patient what's their name their age where are they and a quick little description of what's happening to them um background is a little bit more about their diagnosis their Vital Signs and other factors that could contribute to the situation why it's happening and then assessment this isn't this is slightly different from the way we understand assessment in nursing what it means is more like this is my evaluation or this is my conclusion based on the data I collected about what this patient is going through like I believe that this patient has pneumonia based on my data collection or I believe this patient has um I believe this patient has appendicitis based on the data I've collected and then recommendation is what would you like your provider to do what do you want to order do you want your your patient to go to the emergency department do you want Labs ordered do you want medications ordered what do you want and then your provider will determine you know which orders to give so that's the different steps so here's an example where your SAR are scrambled all the different components are kind of scrambled so let's try to put them in order which one of those do you think is the S the situation where you're just telling them who it is and what's happening is it Miss the third one the situation yes because it's it says who she is where she is and what's going on what's her situation she has burning urine flank pain for two days and then you include her temperature because the fever is part of you know one of the most important factors of identifying what's going on so which one is B the frequent urinary tract infections good yeah she has a history of frequent UTI and these are her current Vital Signs so background is more like her diagnostic history any other relevant information and typically that's where the vitals most of the vitals go and then what about a the would be the first one the first one right according to my assessment she has signs and symptoms of a UTI and then of course R is I would like to have an order for a year analysis with culture and sensitivity of indicated so that's how to put them in order so you might have something like that so this is what they look like when they're all together okay let's see chapter 7 I know we've been talking for an hour um there's not a whole lot left to review on medications and assessment so um don't fear that it will last um probably about another 15 minutes and then 15 minutes on your math if you want to stay and review math with me so poly Pharmacy you want to know the definition not just the fact that it's multiple medications or many medications s but some are not clinically necessary that means that some of them may be duplicates two prescriptions of the same pill or some of them may not be needed anymore or some of them may be over the counter that the patient is taking that they haven't told anybody about so poly Pharmacy usually refers to five or more medications some of which are not clinically necessary um you may have some patients who have a lot of medications and they're all clinically necessary that wouldn't necessarily be poly Pharmacy if they need them all then that's just their medical reality um poly Pharmacy does increase the risk of drug toxicity what are some causes of poly Pharmacy oh not a medication Rec facility good lack of medication reconciliation the that step is being omitted about looking at the patients medications and every time they go to a new doctor or go from the ER to the hospital or from the hospital to home there should be a nurse or and or doctor looking at every stage anything else that's a reason for poly Pharmacy I think sometimes they can have like too many vitamins and stuff and it's not organized like over the counter medications that interfere with it yeah absolutely that's that's a big problem having too many vitamin supplements you know every time the latest herbal supplement comes out on late night TV they're buying it for their memory or you know for their Fitness or stamina or whatever and they end up with a ton of different supplements some of which might may interact with medications that's a good one remember a lot of your older patients are also just seeing a lot of doctors they have a lot of chronic conditions that they need medications for um so there's a lot of different reasons uh how about patient identification which of these following forms of identification is the most accurate name and data name and data [Laughter] birth name and date of birth is pretty accurate that that's very accurate but what if they can't tell you what their name is or they're unresponsive or confused identification bracelet yeah the ID bracelet is actually going to be the most accurate if you just have to choose one now you're doing you know I know what we teach you is two identifiers so in the ideal situation you would have their ID bracelet and you look at it and say oh antney um I'm going to ask Mrs turny what's your name and your date of birth and then I would tell you if I can but if I can't tell you um you want to rely on the ID bracelet so uh remember the identification bracelet will be more accurate the most accurate if you had to choose one photo of the patient oh I don't know that can vary and then room number is a terrible idea never know who's going to be in somebody else's room in a long-term care facility for example um okay so box 7.3 in your textbook is a list of meds that could not be crushed or chewed which what are some examples of ones you cannot crush or chew what was that to is centerco oh right inter coated exactly yeah like aspirin that's a good example of an intera coated is you know it's coated to protect the stomach so uh what else sublingual sublingual you don't want to crush any sublingual man it's supposed to be absorbed through the oral membranes under the tongue not the not the GI tract how about capsules can you crush capsules no no but some capsules you can open and like put an apple sauce but you can't crush them but you can open it and take the contents out of it exactly yeah there are some that are meant meant for that reason that you can open them up and and and resolve the contents and something you'd want to look at the at what medication it is but um there are some examples of that but in general you don't want to crush capsules unless you absolutely know you you can dissolve what's in it um and then what can you crush pills you yeah you can Crush certain types of scored tablets um you don't want to ever Crush an extended release tablet either because extended release or controlled release they're supposed to last for 12 hours or however long and you don't want to give that whole dose in one little cup up but if it's like a Lasix tablet with a score a line down the middle you can crush it now reading prescription labels we have to go through some of these tips with our patients just to make sure that they see what's important in reading a label what would you this is this is a a vicadin so it is a narcotic what do you see on the label that you would want to warn your patient about um May yes it can cause some drowsiness not drink with alcoholic beverages if there's any food warnings you want to make sure they know what food or beverage they're not supposed to take with it or that they need to take with it um in order for it to be effective so you always want to point out any food or uh warnings or any other precautions okay chapter8 is about health assessment so you want to know the difference between objective and he and subjective data when you're assessing your patients so tell me which type each one of these is how about this is Mrs Lee she has abdominal pain her abdomen looks distended would that be objective or subjective objective object yeah because her abdomen looks distended so you're looking at it you're visually getting data about it how about she describes the pain as dull and continuous Sub sub yeah that is subjective because that's what she says so s think s for what she says how about she has hypoactive vowel sounds OBC objective right that's because you're you're osculating how about her abdomen feels firm objective objective objective yeah you're doing your palpation good um now when you're interpreting vital signs you want to be aware of safety factors that could contribute to changes in vitals like for example um you want to be aware of acute changes versus expected age related changes like uh with acute changes it could be um one example of an acute change might be a sudden drop in blood pressure um s and you want to think about what are the safety considerations of a sudden drop in blood pressure which of the following patients would you consider a safety risk take a look at those AB C and D the first one b no a 92 year old with the no respirations are 16 to 20 so that's the blood pressure C it's actually C because the systolic is below it's a 78y old systolic is below 100 so for an older person you know that's not necessarily a potential safety risk maybe that's their Baseline to have a systolic in the 90s but it's um that would be the one I'd consider a safety risk because all of the others are within normal limits so think about the possibility of falling you know if somebody had a blood pressure of 80 over 50 or something like that they definitely would have a fall risk speaking of blood pressure just to review a couple points about uh blood pressure what are some other ways to Lifestyle Changes you would encourage for your patients to avoid hypertension high blood pressure what sodium intake and stuff yeah reduce sodium intake anything else daily exercise or good daily exercise drinking fluids yeah drinking fluids um that aren't alcohol drink and uh yeah alcohol and smoking are not good for blood pressure so if they're smoking or drinking heavily we definitely want to get them to quit smoking and they should also lose weight if they do need to lose weight you know if that's something they're willing to do managing their weight can help too so just be aware of some of those positive things they can do what about if you have a patient you're trying to teach them how to check their own pulse where's the best place to do that uh is it radio your wrist yeah radial is probably the easiest it's probably the easiest for them to reach and they're easiest for them to feel um the sometimes you may check the kateed the ne but that's not always easy to find it depends on how active they are or um you know with activity it's sometimes a little bit easier to feel the kateed but if you're just checking it just you know before you take a medication and that they're taking it home of course as the nurse if we're checking their pulse before we give a medication we're going to check the apical pulse with a stethoscope but for somebody just checking at home the rist should be okay okay are there any questions no anything you wanted clarification on from the blueprint or anything like that no okay well um I'm going to go over a few math questions and a few tips on math so if you want to stay and do a little bit of math with me that's that's great if you would rather um sign off for the night that's fine too and um we'll just go ahead so if you do want to um uh do math I'm going to do some dosage calculations and also just a few tips um math rights for exams these are this just something I made up as reminders for students on math make sure it's the right conversion so double check your conversion factors and by that I mean like understanding that a teaspoon is 5 milliliters a tablespoon is 15 an is 30 milliliters so double check those those factors like when you're doing your fluid um calculations then the right unit double check the final unit of measurement make sure you're answering the question giving the unit that the question is asking for so if your question gives you a medication dose in milligrams but then it asks you for the final dose in grams just be aware of reading that correctly and then write round in double check your rounding instructions if it says round to the nearest 10th um then you're going to end up with one number after the decimal point if it's round to the nearest whole number you don't have numbers after the decimal point it's just a single number and if it's anything five or greater we're rounding up by one if it's anything below five um we're keeping it at the same level the same number I'll show you some examples so here's conversion factors if you want to use this just as a reference um a teaspoon is 5 MLS a tablespoon 15 an ounce 30 a cup is 8 ounces so it's always going to be 240 a kilogram is 2.2 lound a liter is 1,000 milliliters a gram is 1,000 milligrams and a milligram is 1,000 micrograms so these are just some of the basic conversion factors that you might see um you don't have the option to have a conversion card with you during the exam so you do want to know some of these by heart um especially anything that that would be involved in a fluid calculation like a cup a tablespoon um a liter for example so this comes from your calculate with confidence and it's just a review on rounding and I apologize I know this is probably pretty basic and a lot of you are aware of it but remember your decimal point um to the left of your decimal point are your whole numbers and to the right are your decimal numbers which are which represent fractions basically so if I wanted to round 120 if I if I said in the question round 125.75 to the nearest whole number what would your answer be 126 126 excellent so how did you get 126 seven is higher than five good 7even is higher than five so you just bumped up that 125 to 126 good um so at the 10th place is the seven so if I asked you to round to the nearest 10th what would it be 25.8 good excellent be 125.81614610 so you took that five and used it to bump up the seven to an eight so if it asks you to round to the nearest 10th you're going to have one number after that decimal point if it's round to the nearest whole number there won't be numbers after the decimal okay so let's quickly round these numbers to the nearest 10th how about 10.54 10.5 good how about 161.405 good how about 22.75 2276 oh sorry yeah 22.8 right 22.8 how about round the following numbers to the nearest whole number eight eight uhhuh 11 and 65 and 165 good now I know it seems like you know why is she emphasizing this we understand it believe it or not I see students get this wrong on tests all the time I think what happens is you know maybe being nervous or hurrying or you know not reading the instructions because you're just kind of having anxiety or something like that so just double check that you have the rounding correct okay how about this one this is uh this is one type of question you might provider orders glucophage 1 G uh po bid for a patient with type 2 diabetes and the pharmacy is giving you 500 milligram tablets how many milligrams will they get per dose if it's one gram how many milligrams are they getting would it be a thousand because one gram is a th000 milligram okay yes exactly yeah some of these are pretty simple um how many tablets will they get per dose five uh let's see glucophage one gram would it be two yeah two two two right because it's going to be a th over 500 so remember you're desired over available or or ordered over have so you just put a, over 500 it'll be two tablets um what about this one the order was for levadopa 1.6 gram po per day for someone with Parkinson's and your available is 250 how many milligrams are you giving per dose six now it's wait you said okay okay 500 yeah 1,500 milligrams yeah and then the tablets tablets is six so I think you just jumped ahead to the second question it's six tablets and you get that by dividing 1500 by yeah so so no you're correct it is six tablets so just remember you're ordered over have or desired over available um how about the provider orders to jock 0.25 MGR per day nurse has on hand dejin 125 micrograms two tablet be how many micrograms 250 right 250 how did you get two convert 2 20 0.2 to 250 0.25 time 1,00 good yeah 0.25 time 1,000 or if you prefer the method of you know the bouncing ball you could take it over uh three places to the right I personally don't like that because I get it confuses me so I multiply by a thousand or divide by a thousand but whatever works for you is the is the best way to do it um and remember when you're going from a larger number a larger unit like milligrams to a smaller unit like micrograms you are going to multiply by a th if it's the metric system so how many tablets are you giving if we're giving 250 micrograms how many tablets are we giving two two exactly yes so it's two tablets this is how we figured that out 250 over 125 remember whenever you're using this formula desired over available or ordered over have you have they both have to be the same unit so you have to convert one or the other to the other unit okay now here's another type you might see is these weight conversions patient a wears weighs two 42 LB what's his weight in kilog 110 would it be 13.6 so let's see yeah what it's 110 so remember it's two it's 2.2 pounds per kilogram so you're just dividing 242 by 2.2 if we were going the other way like if we knew he weighed 110 10 kilog and we wanted to find out how many pounds you would multiply 110 by 2.2 the way I always remember that is I I take my own weight and I just convert it back and forth and then I always remember that I weigh about half as much with kilograms or you can weigh your kids or you know patient or somebody and convert their weight back and forth and think oh yeah there's 2.2 pounds in every kilogram um so this patient be weighs 42 kilograms her weight in pounds would be 42 by 2.2 so it's 92.4 what if the question says round to the nearest whole number 92 92 right exactly okay now I won't make you go through all these conversions because I know that's a lot and you've been here for a while you're probably thinking no but they are available on the slides if you want to use these for practice you know if you just like to practice repetitively um which I think some is sometimes can be a really good idea but um I would recommend doing those conversions there's also practice conversions in the uh on the blueprint there's some practice conversions for you as well but just to get comfortable with them this slide is is available in the slide packet if you want to practice um so let's do a fluid in calculation so if you're calculating fluid intake for this shift this is the different fluids um what is the total going to be in milliliters I'm going to have to do this because I don't remember it I got 2235 anybody get a different answer 2235 right exactly 2235 so I think the most important conversion factors to know of those household numbers like cups and is probably cups and tablespoons if you can remember that a cup is 240 milliliters and a tablespoon is 15 you'll be good and for most of these a teaspoon is five how about this one um with this one you have an IV calculation but you have to have to multiply [Music] 38 80 y it was 3080 exactly so yeah with that IV you had to multiply 100 by eight because they're getting 100 Ms an hour for eight hours and then 1620 180 and 480 did anybody get anything different or have questions about that one okay one more type of question um this is the liquid do calculation you may have something like this um provider orders 150 milligrams of an antibiotic for a patient every 12 hours it's available in liquid suspension of 25 milligrams per 5 Ms how many milliliters will the patient receive for dose 30 yep 30 MS per dose so did you do the 150 over 25 and then multiply by five yeah yes if if anybody if you ever get confused about this kind of question I know in the past I I would find these confusing when I was in school because I would just think during the test like I can't remember what to do um start with your order 150 milligrams and remember you're looking for the other part of the order that is the same unit so it's going to be 150 over 25 it has to be that same unit because these two are milligrams which is a solid unit and the milliliters is liquid so what you want to do is just divide 150 over 25 milligrams by five which is the liquid and that'll give you 30 um how about this one order is for 1,000 units of medication for a patient IV per hour pharmacy provides 10,000 units in 250 Ms of solution how many milliliters per hour will the patient receive 25 right 25 Ms per hour so this is like a drip how how we do that can you explain me again please yes it's the same format it's just looks more complicated because we're talking about units and it's bigger numbers and it's IV don't let all that confuse you so it's a th is the order th000 units of medication per hour available is 10,000 units of the medication in 250 Ms so you want to divide a th000 by 10,000 and then multiply or by 250 so you got 25 Ms per hour yeah because I have to divide the order by the avable and then exct by the volume out exactly yeah and even though it looks more complicated because talking about an IV solution and all these units it it looks a little scary when you first look it up it's just the same type of question okay my last few slides if you want if you're still with me and you want to look at a couple more is Find the Errors these are correct answers but there's an error in the way that the student answered it so they got the basic right answer but they did one thing wrong that made them get the question wrong actually and these are not real students or real problems but um so order was for Tylenol 650 milligrams every 8 hours per pain how many grams will the patient receive in 20 24 hours um so 1.95 was the correct answer where was my error oh I didn't have it I think what I had in the original was something like 1950 or something because they hadn't converted to grams how about this one patient weighs 158 pounds what's their weight in kilograms round to the nearest whole number and they put 71.8 which is correct 72 right it should have been 72 and I 72 right so that should have been the correct answer and the last one 9,860 micrograms can be converted to how many milligrams round to the nearest 10 and they said 10 milligrams is that correct No it should have been 99 9.9 right exactly 9. night was correct so that's it thank you for your patience did anybody have any questions or want me to go over any other uh