Thank you. Okay, good afternoon everyone. It's 2 p.m. Let us begin with our review. I hope you can hear me well. We will start by the Gerontology final exam review. This is already for the finals. Remember that. We have 49 items equivalent to 51 points. I will give you the first 19 items and then every week thereafter, I will give you 15 items. So we will have all total 49 items. Okay, so get your pens and papers ready as well as your other sources. If you want to check the information from the gerontology book. Number one is study post-mortem nursing care. This will be pages 929 to 930. Okay, so we have some information in the book regarding post-mortem nursing care, but I am afraid it is not enough. It is not enough. So what I did was I had to search the web and look for some appropriate post-mortem nursing care. And if you will kindly go to chat. you will see there a hyperlink. I have shared a hyperlink in chat. It is from Elsevier. publication, elsevier.health, and it is all about post-mortem care. Okay, so please copy that hyperlink and review the information or study the information when you have the time. Okay, so there will be additional valuable information with regards to how nurses should take care of what we call the cadavers. When the patient has died, we nurses are responsible for the initial care of these individuals for their remains. So please go ahead, read up those. Number two. a client sorry for interrupting professor did you send the link already i don't see it in the group chat uh it's there in under my meeting under my meeting yeah we have chat you go to uh if you go below this uh screen you you click on more i see it now thank you hijin yeah thank you Hygiene was able to copy it. So that means she saw it. Yeah, I don't know why I didn't. Sorry about that. Thank you. All right. At least you got it. Okay. That's important for me. You got it. Okay. Thank you again, Ms. Lee. All right. So we go to number two. A client who has a new diagnosis of COPD requires supplemental oxygen. and might require palliative care to improve their quality of life. A client who has stage 4 breast cancer may be expected to leave within 3 months. This client is terminal and is eligible for hospice care to provide comfort and support to the client and their family. A client who has terminal lung cancer may have discontinued or may have stopped all treatment already. This client is terminal and is eligible for hospice care to provide comfort and support to the client and their family. A client who has end-stage kidney disease may have the dialysis stopped. This client is terminal and is eligible for hospice care to provide comfort and support to the client and their family. A client who has type 1 diabetes mellitus and is on an insulin pump. This client is receiving treatment but is not terminal. Number three, factors that influence a client's perception of death include age and stage of development. Personal relationships. Cultural practices, financial concerns, socioeconomic status, religious beliefs, and coping strategies. Number four, performing nasopharyngeal suctioning for a client who is at the end of life causes distress. and is ineffective in clearing secretions for clients who are near end-of-life. Give the client privacy when providing care for a client with an end-of-life condition. Giving the client privacy demonstrates respect and provides dignity. Demonstrate empathy when caring for the client with an end-of-life condition. Demonstrating empathy shows caring by the nurse and promotes the client's dignity. Provide care with an optimistic attitude for a client with an end-of-life condition. Providing care with an optimistic attitude demonstrates caring by the nurse and promotes the client's dignity. Telling the client that their condition will improve is not telling the client the truth and demonstrates disrespect to the client. So you have to be honest to the client. Number five. Study the information included in post-mortem care documentation. Document the description and location of the client's belongings. The nurse should document who the nurse has notified about the client's death, such as family members or the funeral home. The name of the client's mortician. does not need to be included in the client's post-mortem care documentation. The length of time the family stayed with the client's body is not documented. The nurse is not responsible for documenting whether an autopsy will be performed on the client. Number six, in the end of life, using opioid narcotics will not limit options available for future management of the client's pain. The dosage of the opioid narcotic can be increased as needed. Opioid narcotics are not restricted. For clients who are at the end of life because of the risk for addiction, the dosage of the opioid narcotic can be increased as needed. The use of opioid narcotics is not restricted to when death is imminent. They should be used throughout the dying process to relieve pain. and decrease anxiety. Number seven, heart palpitations are a manifestation, or rather is, I repeat, heart palpitations is a manifestation of grief. Agitation, anger, and headaches are manifestations of grief. Sleep disturbances such as insomnia are a manifestation of grief. The inability to focus is a manifestation of grief. 8. Hospice care can be provided in a client's home or in a health care facility. The goal of hospice care is to provide comfort and dignity to clients who are at the end of life, not to cure an illness or prolong life. Hospice care can be discontinued at any time. Hospice care is restricted to clients who are terminally ill. such as those who have a life expectancy of less than six months. Number nine, palliative care can be provided in a client's home or in a health care facility. The goal of palliative care is to provide the quality of life for clients who have a chronic or life-threatening condition, not to cure an illness or prolong life. Palliative care can be provided to a client who is receiving curative treatment. Palliative care can be provided for clients who have a life-limiting condition regardless of their life expectancy. Hospice care is restricted to clients who are terminally ill with a life expectancy of less than six months. Number 10 Number 10 In end-of-life care, respite care provides short-term support for caregivers. This can include running errands, child care, transportation, and visitation. Restorative care is available to clients who are recovering from a chronic or acute condition. It is intended to assist the client with regaining maximum function in independence and self-care. Home care is available to clients who require assistance achieving independence in their home. Post-mortem care is physical care performed for a client after they have died. Number 11. In end-of-life care, the nurse should administer an opioid narcotic as prescribed to promote vasodilation, relieve anxiety, and improve breathing. The nurse should not perform nasotracheal suctioning because it will cause distress and it is ineffective in clearing secretions for a client who is near the end of life. The nurse should elevate the head of the client's bed to promote comfort. and increased ventilation. The nurse should place a fan in the client's room to move and cool the air. This action might provide comfort for the client who is near the end of life and has dyspnea. Number 12 In end-of-life care, a client who is at the end of life experiences decreased gastrointestinal activity. A client who is at the end of life experiences mottled skin and cyanosis due to decreased circulation. A client who is at the end of life experiences hypotension due to decreased circulation. A client who is at the end of life experiences dry mucous membranes due to mouth breathing. Number 13 In end-of-life care, it has been found that spirituality or spiritual health allows a more positive view of life and less physical discomfort observed in depressive conditions. Spiritual well-being is protective against depression. hopelessness, and desire for death in terminal illness. Studies point to the impact of patients'spirituality on end-of-life decision-making and show that high levels of spiritual well-being associate with improved quality of life, disease coping, adjustment to diagnosis, the ability to cope with symptoms and protect against depression, hopelessness, and the desire for a hastened death. Okay, and once again, I will copy a hyperlink. and share this with you in the chat portion. So you can read more regarding end-of-life care and spirituality or spiritual health. So I just posted it now there. So for the latecomer, I have already posted a hyperlink regarding post-mortem nursing care. Now I am following up with another hyperlink, this time regarding end-of-life care and spirituality or spiritual health. So read up these two sources of information so you can have more information regarding these two topics. We don't have too much of these topics in the gerontology book. That's why I had to look for more information from the World Wide Web. Okay, we go to number 14. In the care of a grieving client, the nurse should implement an individualized treatment plan for the client. The nurse should evaluate whether the plan was successful and suggest revisions as needed in the plan of care. When using the nursing process, the first action the nurse should take is to establish whether the client's grieving is healthy or complicated. The nurse should check the client for manifestations of grieving, determine what phase of grieving the client is experiencing, and establish whether the client's grieving is healthy or complicated. is healthy or complicated, the nurse should create a treatment plan that includes client-specific goals and outcomes. Number 15. Compassion fatigue is cumulative stress from repeatedly caring for clients who are suffering. and can result in difficulty feeling sympathy and connecting to clients. Prolonged grief disorder is grief that lasts longer than six months in which the client is unable to accept the loss of a loved one. Adventitious stress is caused by an unexpected natural event such as a flood. PTSD is a stress disorder that occurs following a traumatic event. PTSD can result in sleep disturbances and depression. So you have four terms being compared here. Compassion fatigue, prolonged grief disorder, adventitious stress, and PTSD. Number 16, normal or uncomplicated grief lasts several months to a year and diminishes over time. Time. Anticipatory grief is grief that is experienced before. the loss occurs. Disenfranchised grief is grief that is not considered accepted by society, such as the death of a pet. Prolonged grief disorder is grief that lasts longer than six months. The client who is experiencing prolonged grief disorder is unable to accept the death of a loved one. Number 17. A client is at risk for a pressure injury because they have decreased nutritional intake. A client is at greatest risk for a pressure injury because they have a very limited sensory perception. The nurse should monitor the client for a pressure injury. A client is at risk for a pressure injury because they have slightly limited mobility. A client is at risk for a pressure injury because they have a slightly limited activity level. Number 18. Expected changes to the skin that occur with aging can include thinning of the skin. Therefore, older adults are at an increased risk of injury to the skin. Expected changes to the skin that occur with aging can include a decrease in elasticity. Therefore, older adults are at an increased risk of injury to the skin. Expected changes to the skin that occur with aging can include a decrease in subcutaneous tissue. Therefore, older adults are at an increased risk of injury to the skin. Expected changes to the skin that occur with aging can include a decrease in blood supply to the skin. Therefore, older adults are at an increased risk of injury to the skin. Expected changes to the skin that occur with aging can include a decrease in skin hydration. Therefore, older adults are at an increased risk for injury to the skin. So there are many changes in the skin when the person is aging. So I gave it to you, those different conditions. Finally, number 19. BMI or body mass index has a normal range of 18.5 to 24.9. Obesity can increase the risk of pressure injury due to decreased blood and lymphatic flow. Peripheral neuropathy increases the client's risk for pressure injury due to a decrease in pain related to pressure sensation. Immobility increases the client's risk. for a pressure injury due to a decreased ability to reposition of bony prominences, meaning away, repositioning the body away from the bony prominences. So what are examples of the bony prominences? The back of the skull here, the occipital bone. the scapula on both sides, scapulae, the sacrum and the coccyx, and then finally the calcanei in the feet. Okay, those are examples of bony prominences. When you turn the patient in the prone position, a bony prominence would be the forehead here. Okay, and then the chest area. Okay, you have the rib cage here. When you put the patient in the prone position, the ribs overlying the internal organs will be pressed on the surface. And then the knees, and then finally the toes once again. And then you put the patient in the prone position. Let me continue. Let me restate. Peripheral neuropathy increases the client's risk for pressure injury due to decrease in pain related to pressure sensation. Immobility increases the client's risk for a pressure injury due to a decreased ability to reposition off or away from the bony prominences. Hypoperfusion increases the client's risk for a pressure injury due to decreased circulation in the tissues. The normal range of prealbumin is between 16 to 30 milligrams per deciliter. A prealbumin level that is lower than the expected reference range means malnutrition, which places the client at risk for a pressure injury. So if you want to know if there is evidence of malnutrition, you ask for the prealbumin serum level of the patient. It is not so much of the albumin serum level. It is the prealbumin, which is the determinant of malnutrition in a person. All right. So these are the first 19 items. OK. And I will share with you next week, next weekend, 15. And the last weekend, another 15. To make up for a total of 49 items, that's good for 51 points. All right? Okay. So if you have any questions, go ahead, ask your questions, please. Otherwise, if you have no questions, we will proceed to... review of pharmacology. Okay. Right. So give me a second. I'm putting up the pharmacology review. Okay. So for the pharmacology review, this is also for the final examination. We have 60 items, good for 60 points. and correct me, but as far as I remember, I have not given you any pharmacology review final exam yet. Okay, so I would start. From number one, we have three weekends. This weekend, next weekend, and then the final weekend. So we have three opportunities to review. And so if we have 60 items, I will give you 20 items per review. Okay, so I will give you the first 20 right now. Number one. In transdermal analgesic cream, spread the cream over the lateral surface of both forearms is not the right way. The nurse should apply the smallest amount of cream to the smallest area required to reduce the risk for systemic toxicity. Systemic effects of the anesthetic include bradycardia, heart block, and seizures. So what we just mentioned a moment ago is about the application of transdermal analgesic cream. If you apply a... transdermal analgesic cream applying applying it to intact skin is a good practice you're raising your hand yes um professor you gave us um the first review last week i did give you yeah up to 15 questions all right how many 15 yes you did okay so i gave you the first 15 so uh thank you for uh correcting me in that case i will give you the next uh 15 okay so let me just um uh correct correct this so we will get rid of this you and we will go now to number 16 okay number 16 all right there you go hold on please okay okay So let us go to number 16 now. Hyperglycemia means excess carbohydrates in the body systems. Glyphosate is an oral anti-diabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin and stimulating the release of insulin from the functioning beta cells of the pancreas. Insulin is produced by the pancreas or can be artificially replaced with parenteral insulin administration. Glyphosate is an oral anti-diabetic medication in the pharmacological classification of sulfonylurea agents. Sulfonylurea agents reduce the glucose output of the liver. Number 17. Haloperidol can cause anticholinergic effects such as dry mucous membranes, urinary retention, and constipation. The side effects of haloperidol can include extrapyramidal or parkinsonian symptoms such as fine hand tremors and pill rolling. The manifestations of tardive dyskinesia are tongue thrusting and lip smacking. Individuals who have tardive dyskinesia make repetitive and uncontrollable movements such as tongue thrusting and lip smacking, spine hand tremors, and pill rolling. are also present. Facial grimacing and eye blinking are also present. Individuals who have tardive dyskinesia make repetitive and uncontrollable movements such as facial grimacing and eye blinking. Involuntary pelvic rocking and hip trusting movements are also present. Repetitive, irregular, and involuntary movements of the head, neck, trunk, and extremities can occur in tardive dyskinesia. Number 18. Lithium is used to treat the manic stage of bipolar disorder. Toxicity occurs when the level of lithium in the blood becomes too high. 19. A low sodium level or factors which result in a low sodium level such as dehydration. diarrhea, sweating, excess exercise in hot weather, diuretic use, a low sodium diet, increases in lithium level because the kidney processes sodium and lithium in the same way. If sodium levels fall, the body conserves lithium, causing lithium levels to rise and causing lithium toxicity. Moderate exercise should not lead to lithium toxicity. Increasing sodium intake will lead to excretion of lithium and a drop in the lithium level. Both green and black tea can lower lithium levels, making it less effective. All right. Number 19. In a client with neuroleptic malignant syndrome, the nurse should suspect agranulocytosis. If a client reports flu-like manifestations and has a decreased white blood cell count, neuroleptic malignant syndrome is a rare and potentially fatal adverse effect of antipsychotic medications. that requires emergency medical intervention. Manifestations of neuroleptic malignant syndrome are sudden and include changes in the level of consciousness, seizures, and stupor. The nurse should suspect akathisia if the client exhibits motor restlessness such as foot tapping or constantly shifting weight back and forth. The nurse should suspect tardive dyskinesia if the client exhibits involuntary muscular movements. So as you can see, this item is all about differentiating between neuroleptic malignant syndrome, between akathisia, and between tardive dyskinesia. Okay. Number 20. If a nurse is suspected. of illegal conduct in the floor, the nurse manager should assess first regarding the nurse's job evaluation and the nurse's past job attendance. The nurse manager may see the nurse in question later or involve the risk manager later. or may refer the matter to the Board of Nursing diversion program later. Number 21, hypothyroidism is a long-term risk for clients who take lithium, not valproate. Spelling of valproate, V-A-L-P-R-O-A-T-E, valproate. An EEG is a test that examines brain waves and is used for clients who have a seizure disorder. Although valproate is used as an anticonvulsant in most or in some patients, An EEG is not necessary because this client is using valproate as a mood stabilizer for bipolar disease and not as an anticonvulsant. If we are going to use valproate as an anticonvulsant, then we have to have an EEG. But if you are using valproate as a mood stabilizer for bipolar disorder, then you do not have to perform an EEG, an electroencephalogram. Pancreatitis, hepatic dysfunction, and thrombocytopenia are serious adverse effects occasionally associated with valproate. Liver function tests should be monitored periodically to check for hepatic failure. Low serum sodium levels affect lithium levels. But serum sodium does not affect the blood levels of valproate. Okay. So again, this question is trying to differentiate between lithium and valproate. Okay. All right. Number 22. Study manic disorders and lithium therapy. including normal and abnormal serum lithium levels. If we monitor the patient's serum lithium level, we must know the normal range of lithium levels in the body. The nurse should continue to administer the lithium dose If the serum lithium level is within the expected initial therapeutic range of 0.8 to 1.3 mEq per liter. Note, however, that at a therapeutic level, the client might already demonstrate. adverse effects of lithium, such as a fine hand tremor, thirst, and mild nausea. The nurse should note if any of these manifestations are present. The nurse should continue to monitor for adverse effects and signs of toxicity. which usually occur at levels of 1.5 milliequivalents per liter or higher. Check if the client is regularly taking the lithium medication and study the different levels of lithium toxicity, its manifestations, and how to manage each level. Okay? 23. Anorexia is a common side effect, especially in the period after lithium has first been prescribed and the body is still adjusting to the medication. Flatulence is a common adverse effect, especially in the period after lithium is first prescribed and the body is adjusting to the medication. Since vomiting and diarrhea are early signs of lithium toxicity, The client should omit the next dose of lithium and call the provider. Headaches are a common adverse effect, especially in the period after lithium has first been prescribed and the body once again is still adjusting to the medication. Okay? All right. Number 24. Study depression and suicide, the manifestations of suicide, and the therapeutic communication between the suicide patient and the nurse. Study the antidepressant medications. Amitriptyline, a tricyclic antidepressant, is used to treat depression. Over dosage of amitriptyline is dangerous. It needs emergency treatment. By expressing support to the patient calling for help, the nurse's therapeutic statement shows the nurse's concern for the client's safety and responds to the client's priority need. Maslow's hierarchy of needs states that the client's physical and safety needs come first. Therefore, the client needs to be evaluated immediately. Number 25, Dinoprostone. spelling D-I-N-O-P-R-O-S-T-O-N-E, dinoprostone is used to prepare or ripen the cervix for the induction of labor in clients who are a term. Dinoprostone stimulates uterine contractions. Number 26. Euphoria is an adverse effect of opioid analgesics and is due to activation of MU receptors. Observe the behavior of a person who is suspected of consuming opioid analgesics. Rhinorrhea can occur with opioid withdrawal, but it is not an effect from the medication. Hallucinations are an adverse effect of cannabis. Constricted pupils are an adverse effect of opioid analgesics. Number 27, to encourage the patient's adherence to taking the antipsychotic medication, the following could be done. Perform oral checks following the administration of the medication may not be effective because in mouth checks or checking the mouth, For pills, the client may have the ability to hide the pills in his or her mouth. Providing for one's daily dosing is effective. One's daily dosing of medications simplifies the therapy, making it easier for the client to comply. Use or using sustained release medications would be effective. Sustained release medications remain in the client's system longer, requiring less frequent dosing. Engaging the client in conversation following medication administration is effective. if the client is speaking, he will be less likely to be able to hide the medication in his mouth. And then rotating the staff, the nursing staff who will administer the medication may not be effective because rotating the staff who will provide the medications may be an obstacle that increases the risk of a client's non-adherence to treatment. Number 28. Clients who are on nitrates including isosorbide and nitroglycerin preparations cannot take sildenafil because of the serious medication interaction. There is the possibility of sudden death due to hypotension. phenytoin or commercially dilantin is an anti-convulsant metronidazole or commercially flagell is an anti-fungal medication and prednisone is a corticosteroid okay it is not a nitroglycerin based medication number 29 Study the medications for bipolar disorder. Paroxetine or commercially Paxil is an antidepressant in a class of medications called selective serotonin reuptake inhibitors or SSRIs. SSRIs are used to treat depressive episodes associated with bipolar disorder. Lithium is a salt that acts on the central nervous system and is used to treat the manic stage of bipolar disorder. It may also reduce the frequency and severity of depression in bipolar disorder. Donepezil, spelling D-O-N-E-P-E-Z-I-L. Donepezil is a cholinesterase inhibitor used to improve cognition in clients who have Alzheimer's disease. This is valproate. is an anticonvulsant medication which is also effective as a mood stabilizer for clients who have bipolar disorder. And then finally, carbamazepine. Carbamazepine is an anticonvulsant medication which is also effective as a mood stabilizer for clients who have bipolar disorder. So study the medications for bipolar disorder. And then we go to finally number 30. If the client is unable to sign the surgical consent form because he is sedated from an opiate, the neurosurgeon has the legal right to invoke implied consent and proceed with the surgery if it is determined an emergency surgery is in the client's best interest. The neurosurgeon should document the specifics of the situation in the client's medical record. Delaying the surgery until a relative is contacted places the client at risk for a poor outcome. The neurosurgeon should not ask the client to sign the consent form because he is sedated from the opiate. A client who is disoriented or unable to function because of the administration of a medication such as morphine is not competent to sign the surgical consent form. The purpose of naloxone is to reverse the effects of opioid toxicity. The neurosurgeon should not prescribe naloxone for the client. Because it can reverse the analgesic effects of morphine. Okay. All right. So this will be our second set of 15 numbers since I already had given you the first. 15 last week. Thank you for the correction. And so we have two more weeks. Okay. And every time I will see you, then I will give you 15 numbers. Okay. I'll give you 15 numbers until we've completely finished everything. All right. Okay. So does anybody have any question at this point? Do you have any questions? I'd be happy to answer your questions as much as I can. Any questions? Anyone? All right. No questions. All right. In that case, I wish you a pleasant weekend and I will see you this coming Tuesday. OK, I will see you this Tuesday. Right. Thank you, everyone. Have a good weekend. Bye. Thank you.