An older woman asks a nurse in the cardiology practice, What is ...

[Alygatorr01285]

An older woman asks a nurse in the cardiology practice, What is the ideal number that my cho-lesterol levels should be? I am confused by all of the different numbers. The nurse formulates her response on the knowledge that:
 
  a. recent guidelines from the American Heart Association state that there is no one size fits all recommendation and that recom-mendations must be individualized to each patient.
  b. recent guidelines from the American Heart Association provide different recommen-dations for individuals age 65-74, 75-84, and over age 85.
  c. recent guidelines from the American Heart Association recommend a total serum cholesterol level below 100.
  d. recent guidelines from the American Heart Association recommend a total serum cholesterol level over 200.

Question 2

An older resident of a long-term care facility diagnosed with dementia has in the last 48 hours become more confused than usual and while usually requiring help with toileting has been incon-tinent of urine.
 
  The client's health care provider orders a complete blood count and serum electrolytes. When the laboratory tests are all within normal limits, the nurse initially:
  a. attributes the changes in the resident's functioning to advancing dementia.
  b. suggests that the resident be placed on broad-spectrum antibiotics to prevent in-fections.
  c. speaks with the health care provider re-garding the changes in the client's func-tion and the possibility of obtaining a urine culture.
  d. changes the plan of care to include blad-der training and implement a 24-hour cal-orie count.

[joanwhite]

Answer to Question 1

ANS: A
Recent guidelines from the American Heart Association state that there is no one size fits all recommendation and that recommendations must be individualized to each patient. Multiple factors that must be considered include family history, other risk factors for heart disease, and long-term risk-benefit ratios.

Answer to Question 2

ANS: C
Waiting for usual signs of infection or illness in older adults can be fatal. In older adults, signs of infection may be absent or not seen until the patient is septic or very ill. The nurse needs to be alert to the subtle changes in the patient. A change in mental status may be indicative of an infec-tion. Laboratory values do not always change in older adults, often not until the patient is very ill. Placing a patient on broad-spectrum antibiotics does not prevent infections. This action may in fact cause bacteria to become drug resistant. All evidence points to the changes in functioning being attributable to acute illness. The nurse needs to respond to the acute illness first.