Exam 2 - Chapter 19 Flashcards
what happens to the plantar fat pad in old age?
shrinks and degenerates
what happens to the skin on the feet of older adults?
- drier
- less elastic
- cooler
- thinner
what are the are-related changes expected in toenails of older adults?
- more brittle
- less resistant to fungal infection
- thicker
subcutaneous tissue on dorsum and sides of foot becomes thinner in old age
true
what is a possible reason for an older adult to have decreased ROM?
degenerative joint disease
what are common foot problems among older adults?
- calluses
- bunions
- hammer toe
- onchomycosis
what are calluses?
thick compacted skin formed from prolonged pressure
what are bunions?
bony deformities that form on the great toe from chronic squeezing
define hammer toe
permanently flexed toe
what is onchomycosis?
a condition of the nails that makes it thick, yellow, brown, brittle, and opaque
fungal infection
how are calluses treated?
- padding in footwear
- OTC callus remover (avoid sharp tools)
- daily lubrication of feet
- use well-fitted shoes
how are bunions treated?
- surgery
- steroid injections
- anti-inflammatory pain medications
- custom-made shoes that provide forefront space
how are hammer toes treated?
- surgery
- well-fitted shoes
- professional orthotics
how is onchymycosis treated?
- oral medications
- photodynamic therapy
- keep toes clean, dry, and regularly exposed to sun and air
why is onchymycosis hard to treat?
- limited circulation to toenails
- oral medications have limited effectiveness & may be highly toxic to heart and liver
what are the factors that increase fall risk?
- unsteady gait
- cognitive impairment
- reduced vision and hearing
- medications
- chronic illness
- orthostatic hypotension
what are things to include in educating about proper foot care?
- annual foot examination
- care of toenails
- diabetic foot care
- proper footwear
- orthotic shoes
what is indicated in an annual foot examination?
- identify risk factors for ulcers and amputations
- assess for loss of protective sensation and pedal pulses
what is best practice for cutting nails?
- best time to cut after bath
- soak for 20-30 minutes
- clip straight across
- filing to make straight edge
which group people should not have pedicures in commercial establishments?
- diabetics
- those with PVD
what is a leading consequence of falls?
hip fractures
what is a consequence of having fallophobia?
restricts an individual’s perception of their own function
which leads to increased fall risk
how does fallophobia affect an older patient’s life?
- decreases mobility, safety and function
- increases fall risk
how do nurses contribute to enabling fallophobia?
- telling patients not to get up by themselves
- using restrictive devices (promotes dependence)
what are the major assessment tools for falls?
- Hendrich II
- Morse
what test does the Hendrich II include?
Get Up and Go
what are the components of the Hendrich II model?
- male gender
- vertigo
- depression
- confusion
- altered elimination
- antiepileptics
- bezodiazepines
- “get up and go”
what makes Morse Fall Scale different from Hendrich II?
more appropriate for use in acute care settings rather than LTC
what are the components of the Morse Fall Scale?
- fall history
- secondary diagnosis
- ambulatory aid
- IV access
- gait
- mental status
major risk factors of falls
- orthostatic hypotension
- cognitive impairment
- medications
- weakness and fraility
- environmental factors
- impaired vision and hearing
what is included in the “fall bundle”?
- arm bands
- signs
- education
- risk assessment
- footwear
- assisted toileting
interventions for falls
- environmental modifications
- assistive devices
- wheelchairs
- alarms
- motion sensors
- safe client handling
what are the measures for fall prevention?
- vision screening
- medication reduction
- assess for syncope and postural hypotension
- provide hip protectors
- fall prevention education
types of restraints
- vest
- belt
- mitten
- bedrails
- geriatric chairs
- medication
when are restraints typically used in the hospital setting?
- ICU
- on patients with dementia & medical devices
why do nurses use restraints in ICU?
prevent tube dislodgment related to greater frequency of invasive lines & mechanical ventilation
physical restraints should NOT be used to manage behavioral symptoms
true
daily evaluation of the necessity of medical devices (catheter, IV, tubes) is a nursing responsibility
true
best practice for restraints
- remove when deemed unnecessary
- preoperative teaching regarding devices
- use mitts instead of wrist restraints
- roll belts rather than vests
- remove restraints while working with the patient
- have IV lines out of sight
cons for restraints
- do not prevent falls
- might exacerbate problems
- asphyxiation
- pressure ulcer
- agitation
- cognitive decline
- depression
how can the nurse prevent falls related to restraint-free care?
- anticipate patient’s needs
- assess for incontinence/ nocturia
- reduce injury potential
- provide visual/ physical cues
- reduce sleep disturbances
