Final Review Lecture Notes

Gerontology Review (Part 35-49)

• Medications and Interactions

  • Carbonated beverages: Recommendations vary; specific instructions per medication.
  • Milk: Recommendations vary; specific instructions per medication.
  • Orange juice: Recommendations vary; specific instructions per medication.
  • Grapefruit juice: High rate of food-to-drug interactions, especially with lipid-lowering agents (flavonoids affect liver enzymes).

• Ethical Principles in Nursing

  • Veracity: Truth-telling, no deception.
  • Autonomy: Recognizing and respecting client's choices based on personal values.
  • Fidelity: Keeping promises and commitments.
  • Justice: Fair treatment for all.

• Documenting and Reporting Abuse

  • Document bruises in client's chart after providing care.
  • Report findings to supervisor.
  • Provide crisis hotline number.
  • Discuss respite care to prevent caregiver role strain.

• Assessment of Client Abilities

  • Confusion: Assess if the client cannot understand or respond.
  • Healthcare proxy: Can be changed anytime; takes over when patient is incapacitated.
  • Competence: Legal decisions must be made by a competent person or one with durable power of attorney.

• Pain Management in Older Adults

  • Under-reporting pain: Due to not wanting to bother staff, fear of complaints, or belief pain is a natural part of aging.
  • Opioid use: Safe in small doses; monitor for nonverbal signs of pain.
  • Fear of addiction: Barrier to effective pain management, pain not expected with aging/dying.
  • Oral hygiene: Prevents aspiration pneumonia, elevate head of bed, chin-down swallowing technique.

• Alzheimer's and Communication

  • Validation therapy: Encouraging discussion about past to help cognitive disorders.
  • Avoid statements that could cause combative behavior or block communication.

• Safety and Restraints

  • Use least restrictive interventions (e.g., SIT alarms).
  • Sedatives (e.g., lorazepam) if necessary.

• Urinary Incontinence Management

  • Regular toileting schedule for clients with dementia.
  • Avoid invasive procedures like indwelling urinary catheters unless necessary.

• Caregiver Fatigue

  • Assess caregiver's difficulties first.
  • Encourage counseling and family meetings for additional support.

• Differences Between Delirium and Dementia

  • Delirium: Sudden onset, temporary, often due to medical conditions.
  • Dementia: Gradual onset, progressive, irreversible (e.g., Alzheimer's, Parkinson's).

• Injury Risk in Older Adults

  • Medical reasons: Impairment in sight, hearing, sensation, balance, etc.
  • Environmental factors: Rugs, slippery floors, cords, etc.

Pharmacology Review (Part 46-60)

• Fluoxetine (Prozac)

  • Therapeutic effects: 1-4 weeks, morning intake preferred to avoid insomnia.
  • Interaction: Grapefruit juice.

• Methylphenidate (Ritalin)

  • Key points: Avoid driving, reduce caffeine, take 6 hours before sleep, can cause weight loss.
  • ADHD medication, recommend extra reading.

• Impact on Blood Glucose

  • Cimetidine, Dextromethorphan: No impact.
  • Corticosteroids (e.g., prednisone): Hyperglycemia.
  • Atorvastatin: No impact on glucose.

• Xanax (Alprazolam)

  • Intermittent use to avoid dependence.
  • Avoid fatty foods, activities requiring alertness.
  • Comparison: Diazepam (sedation, dizziness), Morphine (urinary retention, constipation).

• Nalbufine

  • Side effects: Visual disturbances, headache, abdominal pain, urinary urgency.

• Post-TURP Medications

  • Use: Oxybutynine, Hyoscyamine to control bladder spasms.
  • Analgesics for pain, Bethanicol for bladder control.

• Baclofen

  • Avoid antihistamines, withdrawal risks (seizures, fever).
  • GI distress: Take with milk or food.

• Agranulocytosis

  • Not associated with excessive bleeding or hyperglycemia.
  • Disrupts white blood cell production, increases infection risk.

• Herbal Interactions

  • Ginger root, Ginkgo biloba, St. John’s Wort, Saw palmetto: Interactions with various drugs and conditions.

• MAO Inhibitors

  • Avoid high tyramine foods: Aged cheese, cured meats, fermented foods, etc.
  • Risk of severe hypertension with improper diet.

• Chlorpromazine (Thorazine)

  • Tardive dyskinesia: Involuntary movements due to long-term use.
  • Parkinsonism, dystonia, acathisia: Different side effects of medication.

• Olanzapine

  • Treats schizophrenia: Hypotension, seizures, fatigue as side effects.

• Alendronate

  • Side effects: Osteonecrosis, ocular inflammation, esophagitis.
  • Prevents osteoporosis.

• Food and Drug Interactions

  • Grapefruit juice: Atorvastatin toxicity.
  • Alcohol: Avoid with hypoglycemic drugs like glimepiride.

• Insulin Types

  • Insulin Glargine: Long-acting, duration 18-24 hours, once-a-day dose.
  • Short duration insulins: 3-6 hours.

Additional Study Tips

• Review medications not covered in-depth: Methylphenidate, Nalbufine, Baclofen, Chlorpromazine.
• Pay special attention to interactions, side effects, and proper administration times.

Final Exam Reminder: Be prepared, study well!