Exam 3 and final

Question 1

Coronary Artery Disease vs. Chronic Heart Disease

Answer 1

Coronary Artery Diseaase:

• Can begin early in young adulthood
• Obstructions that limit blood flow In coronary arteries
• Not enough obstruction to significantly impair the function of cardiac muscle

Chronic Heart Disease:

• Obstruction to coronary arteries
• Permanent damage to cardiac muscle
• Limited cardiac function

Question 2

True/False:

Advanced age, by itself, is a risk factor for impaired integumentary integrity.

Answer 2

• False
  
  • Advanced age, by itself, is not a risk factor for impaired integumentary integrity.
    *

Question 3

The most significant extrinsic cause of skin degeneration is:

Answer 3

• Photoaging
  
  • the effect of exposure of the skin to ultraviolet irradiation
  • primarily the face, neck, and hands
    • primary areas exposed to the sun

Question 4

Cellulitis is most commonly seen in the:

Answer 4

• face and extremities where the skin is broken
  
  • higher risk of cellulitis where edema is present
  • in obese people, highest risk in folds and rolls of skin

Question 5

MRSA infections largely originate in:

Answer 5

• MRSA infection largely originate in hospitals and LTC settings
  
  • hospitalizations = systemic MRSA
  • community acquired MRSA = infections of skin and soft tissue

Question 6

Candida most commonly presents in [areas of body]:

Answer 6

• groin, axilla, or breast folds
• Affected skin may appear macerated and erythematous with papules and pustules.

Question 7

[5] Risk factors for skin cancer include:

Answer 7

• men and women older than age 65 years
• patients with atypical moles
• patients with more than 50 moles
• family history of skin cancer
• a history of severe sunburns.

Question 8

Signs of a lesion suspicious for skin cancer:

Answer 8

• asymmetry
• border irregularity
• diameter greater than 6 mm
• a rapidly changing lesion

Question 9

The most common infections among older adults:

Answer 9

• Urinary Tract Infections

Question 10

Reasons patients have risk of UTI:

Answer 10

• Female Sex
• Prolonged catheterization
• Errors in catheter care
• Weakened pelvic floor musculature
• Diabetes
• Multiple sclerosis
• Spinal cord injuries
• Urinary obstruction
• Kidney stones
• Enlarged prostate
• Alzheimer’s disease
• Parkinson’s disease
• History of neurogenic bladder
• History of stroke

Question 11

Sepsis:

Answer 11

• Describes systemic bacteremia with or without organ dysfunction.
  
  • sepsis is an immunologic response to bacteria and can easily attack any organ system.
• Pulmonary and Renal systems most affected.

Question 12

Sepsis signs and symptoms:

Answer 12

Sepsis:

• Fever above 101.3°F
• Heart rate greater than 90 beats per minute
• Respiratory rate greater than 20 breaths per minute
• Probable or confirmed infection

Severe Sepsis:

• Mottled skin
• Decreased Urine output
• Mental status change
• Decreased platelet count
• respiratory difficulties
• Changes in cardiac function

Septic shock:

• All signs of severe sepsis
• Extremely low blood pressure

Question 13

Three primary reasons the older adult is susceptible to dehydration:

Answer 13

• blunted thirst mechanism.
• reduction in total body fluid with the reduction in muscle mass and an increase in body fat.
• decrease in renal function that concentrates the urine prevents the body from retaining enough fluid to avert dehydration.

Question 14

Three types of dehydration:

Answer 14

1. Hypertonic
   
   • occurs when there is a greater loss of water when compared to sodium loss.
   • more common in the presence of infection or exposure to hot environmental temperatures.
2. Isotonic
   
   • equal loss of water and sodium
   • vomiting and diarrhea are the two most common causes
3. Hypotonic
   
   • caused by a greater loss of sodium than water
   • The use of diuretics is the most common cause of hypotonic dehydration.

Question 15

Most common type of dehydration in the older adult:

Answer 15

• Hypotonic

Question 16

Metabolic syndrom is characterized by:

Answer 16

A cluster of no fewer than three cardiovascular risk factors that are strongly associated with myocardial infarction.

• increased abdominal fat
  
  • greater than 102 cm in men
  • greater than 88 cm in women
• high levels of triglycerides
  
  • greater than or equal to 150 mg/dL
• low levels of high-density lipopro- teins (HDLs)
  
  • less than 40 mg/dL in men
  • less than 50 mg/dL in women
• HTN
  
  • greater than 130 mmHg systolic
  • greater than 85 mmHg diastolic
• elevated level of fasting plasma glucose
  
  • greater than 110 mg/dL (fasting)

Question 17

Three types of prevention:

Answer 17

1. Primary
   
   • instilling healthy behaviors and reducing risk factors by intervening prior to the biological signs of a disease.
2. Secondary
   
   • the pathology or disease is present, but intervention is focused on behavior modification to manage the disease
3. Tertiary
   
   • The focus of tertiary prevention is on functional mobility and education of signs of symptoms of the disease and the prevention of further deterioration.

Question 18

Antidepressants, antianxiety drugs, sedatives, tranquilizers, diuretics, and sleep medications:

Answer 18

• all related to increasing the risk of falling in older adults

Question 19

Ankle Strategy

Answer 19

• activation of the muscles around the ankle joint after a small disturbance of BOS when standing on a “normal” support surface.
• The latency is approximately 73 to 110 ms with a distal-to- proximal muscle sequence.
• may be able to “train” people to execute an ankle or hip strategy based on training paradigms

Question 20

Hip Strategy:

Answer 20

• Activation of the muscles around the hip joint as a result of a sudden and forceful disturbance of BOS while standing in a narrow support surface.
• The latency is the same as in the ankle strategy; however, the muscle sequence follows a proximal-to-distal pattern.
• It has been suggested that older adults often utilize the hip strategy rather than an ankle strategy.

Question 21

Stepping strategy:

Answer 21

• Defined as taking a forward or backward step rapidly to regain equilibrium when the COG is displaced beyond the limits of the BOS.
• This can be observed clinically by resisting the patient enough at the hips to cause a significant loss of balance requiring one or more steps to maintain postural control.

Question 22

Reaching strategy:

Answer 22

• Includes moving the arm to grasp or touch an object for support.
• Arm movements play a significant role in maintaining stability by altering the COG or protecting against injury.

Question 23

Suspensory strategy:

Answer 23

• Includes bending knees standing or ambulation for the purpose of maintaining a stable position during a perturbation.
• Bending of the knees usually lowers the COG to be closer to the BOS, thereby enhancing postural stability