Exam 2 Flashcards
Prevention and treatment of Xerosis
- Maintain environment of 60% humidity
- Promote adequate fluid intake
- Creams should be applied to towel-patted damp skin immediately after bath
- Mineral oil/Vaseline effective and more economical
- Tepid water for bathing, avoid long baths, may not need daily baths, sponge bathing is better
- Use super-fatted soaps, avoid deodorant soap except for groin and axillae
- Petroleum jelly in extremely dry areas before bed
Which category of skin tears is the worst?
Category 3 = complete tissue loss
Prevention and treatment of candidiasis
- Adequate and immediate drying of target areas (after bath or incontinence)
- Dry washcloth or cotton bad under breasts and between skin folds
- Loose fitting clothing, change when damp
- Do not use cornstarch
- Optimize nutrition and glycemic control
- Antifungal meds
Age related changes in taste
Number of taste cells decrease and atrophy
Mouth produces less saliva
Salty and sweet taste loss first
Dentures, smoking, and meds affect taste
Age related changes in smell
Decline in number of sensor cells
Less mucous production
Increase in odor threshold and decline in odor identification
Age related changes in digestive system
- Decreased gastric motility and reductions in bicarbonate and gastric mucous results in hypochlorhydria (insufficient hydrochloric acid)
- Decreased production of intrinsic factor can lead to pernicious anemia
- More susceptible to H. Pylori
- More prone to GERD and hiatal hernia
- Loss in smooth muscle of stomach delays emptying time
Age related changes in body composition
- Increase in body fat, including visceral fat stores
- Decrease in muscle mass
- Body weight usually peaks around 50 or 60, remains stable until around 65 or 70 and then starts to decline for remainder of life
How much fiber is recommended for OA?
25 grams daily
How many servings of fruits/veggies daily?
5
Most common type of dysphagia
Oropharyngeal dysphagia (OD)
Risk factors for dysphagia
CVA
Parkinson’s
Neuromuscular disorders (ALS, MS, myasthenia gravis)
Dementia
Head/neck cancer
Traumatic brain injury
Aspiration pneumonia
Inadequate feeding technique
Poor dentition
S/S of dysphagia and possible aspiration
Pocketing of food in mouth
Difficulty chewing
Prolonged eating time
Difficult/labored swallowing
Coughing/choking at meals
Discomfort during swallowing
Sensation of something stuck in throat during swallowing
Drooling/copious oral secretions
Food or liquid leaking from nose
Nasal voice or hoarseness
Wet or gurgling voice
Excessive throat clearing
Interventions for dysphagia to prevent aspiration
SLP consult
Postural changes (chin tuck/head turns while swallowing)
Modification of food volume/consistency/temp/rate
Neuromuscular electrical stimulation (go on swallowing muscles in throat, used in combo with other therapies)
Hand feeding recommendations to prevent aspiration
30 mins of rest before meals
Pt should sit at 90 degrees and maintain for 1 hr after meal
Alternate between solids and liquids
Swallow twice before next bite
Stroke under chin to initiate swallowing
Avoid sedatives that may impair cough/swallow reflexes
Keep suction equipment ready at all times
Monitor temperature
Observe color of phlegm
Check for pocketing
Check for food under dentures
Provide mouth care every 4 hours and before and after meals, including cleaning dentures
Age related changes affecting hydration
Thirst sensation diminishes
Creatinine clearance declines
Total body water decreases
Loss of muscle mass and increase in fat cells (fat cells have less water)
Meds, functional impairment, comorbid conditions
Main reason older adults die from dehydration
Reduce fluid intake
Rule of thumb for rehydration through IV
Replace 50% of loss within first 12 hours (or sufficient quantity to relieve tachycardia and hypotension)
*Watch out for pts with heart failure
What is hypodermoclysis?
Infusion of isotonic fluids into subcutaneous space
Most common oral cancer
Squamous cell
Risk factors for oral cancers
Tobacco use
Alcohol use
HPV
Genetic susceptibility
Which poor outcomes does keeping teeth clean help prevent?
Aspiration pneumonia
Ventilator-associated pneumonia
Oral hygiene for pts with gastrostomy tubes
Provide oral care every 4 hours and brush teeth after each feeding
S/S of dehydration
Dry mucous membranes in mouth and nose
Furrows on tongue
Orthostasis
Speech incoherence
Rapid pulse
Decreased urine output
Extremity weakness
Dry axilla
Sunken eyes
(*Skin turgor is not a reliable indicator)
Types of established UI
Stress - pressure causes small amt of urine
Urge - loss of mod to large amt of urine before getting to toilet
Functional - unable to reach toilet due to environmental barriers
Mixed - combo of problems (usually stress and urge)
When is bacteria in the urinary tract considered benign?
Asymptomatic bacteriuria in older women is transient and fairly common
What is considered a CAUTI?
UTI developed with indwelling catheter in place or within 48 hours of removal
ABCDE for prevention of CAUTI
Adherence to infection control principles
Bladder u/s may aid in indwelling catheterization
Condom catheters or alternatives to indwelling catheters
Do not use catheter unless you must, do not use antimicrobial catheters, do not irrigate catheters unless obstruction anticipated. Do no clean periturethral area with antiseptics
Early removal of catheter
What does the Rome criteria help determine?
Level of constipation
What type of pharmacological intervention should not be used in OA and why?
Sodium phosphate fleets
Can cause metabolic disorders
4 types of exercise for OA
Aerobic
Muscle strength in
Flexibility
Balance
If an OA on anticoagulants has a fall with head injury, what should be done?
CT scan. If negative, should be observed for 24 hrs then another CT
What is prostprandial hypotension
Occurs after ingestion of carbohydrate meal
May be related to release of vasodilators peptide
How to prevent postprandial hypotension
Encourage smaller more frequent meals and increase water intake
Target populations for fall risk assessment
- Low risk community-dwelling: asked once per year
- Individuals who report single fall: observed for mobility and unsteadiness. Those with unsteadiness should be referred for further assessment
- High-risk: more comprehensive and detailed assessment
Two types of fall risk assessments
Morse fall scale (hospital)
Hendricks II fall risk model (includes get up and go test, for long term care and outpatient care)
