Final Lecture #5 Flashcards
dry cracked, itchy skin, inadequate fluid intake worsens, use super fatted soaps and cleansers
xerosis
itchy skin, a symptom not a diagnosis, may be r/t med SE or secondary to disease, a threat to skin integrity
pruritis
thin fragile skin extravasation of blood into surrounding tissue, wear long sleeves to protect from trauma
purpura
precancerous skin lesions, from sun exposure, dermatology visits every 6-12 months to monitor and treat
Actinic keratosis
waxy, raised, “stuck on” appearance, benign lesion, almost all older adults over 65 y/o
seborrheic keratosis
painful vesicular rash over a dermatome, get vaccine at age 60
herpes zoster
yeast infection, often in skin folds, keep skin clean and dry.
candidiasis
can significantly impair recovery/rehab and impact QOL, increased risk for mortality, high prevalence of HC litigation, a PREVENTABLE AE.
pressure injuries
proper nutrition?
carbohydrates 45-65%, fat 20-35%, vit and minerals – 5 servings of fruit and veggies.
- Overweight BMI = 25-29.9
- Obese BMI = 30-39.9 (majority women)
- Morbid Obese BMI = 40+
a geriatric syndrome, high risk: acute care, LTCF, community, and institutionalized older adults. Cause increased risk in: infections, pressure ulcers, anemia, hip FX, hypotension, impaired cog, increased morbidity and mortality.
malnutrition
difficulty swallowing, about 20% of those 50+ and up to 60% of LTC pts.
SE: difficult labored swallow, drooling, copious choking at meals, holding or pocket food or liquid, nasal voice or hoarseness, wet gurgling voice, excessive throat clearing, food and liquid leaking from nose, prolonged eating time, pain with swallow, unusual head or neck posturing, sensation of something in throat, heartburn, chest pain, hiccups, weight loss, and frequent resp. tract infections (pneumonia).
dysphagia
Prevention: supervise all meals, seated and rested b4 eating, sitting up 90 degrees, don’t rush, alternate solids and liquids, chin-tuck, avoid sedatives, keep suction available, and oral care.
= able to drink, may not know what adequate intake is, possible cog impairs, encourage and make fluids accessible
can drink
= physical incapable to ingest or access fluids, dysphagia prevention, swallow evaluation, safe drinking techniques
can’t drink
= highest risk for dehydration, able to drink but won’t, offer frequently, and prevent incontinence
won’t drink
= terminally ill, could be any of the previous 3, refer to advance directives regarding hydration wishes
end of life
Signs of dehydration?
Skin turgor, weight, mucous membranes, speech changes, tachycardia, decreased UOP, dark urine, weakness, dry axilla, and sunken eyes. GENERALLY, CONFRIMED BY LAB TESTING!
at least 1500 mL/day (2-3 L), H2O is best, offer often, make available, encourage with meds, provide preferred fluids, and verbal reminders.
hydration interventions
UTIs
most common cause of sepsis, anticholinergic properties and diuretics can worsen UTIs. Often asymptomatic, cog impaired may not report symptoms, and normal for older adults to be asymptomatic, uncomplicated bacteria in urine.
o SE: mental status changes, decreased appetite, incontinence
reduction in BM frequency or difficulty in forming or passing stool, common in women. Complications: impaction, obstruction, cog dysfunction, delirium, falls, increased morbidity and mortality, and increased risk for bowel cancer. Interventions: activity, motility, proper position, toileting regimen, fluid intake, and dietary fiber.
constipation
= psyllium (Metamucil); use with caution in frail elders, bed bound, those with swallow probs. Usually 1st line agent due to low cost and few AE.
bulk forming
= docusate Na+ and mineral oil; increases moisture content of stool
emollients
= polyethylene glycol (PED), milk of mag, lactulose; causes H2O retention in colon
osmotic
= bisacodyl, senna; stimulates colorectal motor activity
stimulant
fecal impaction?
complication of constipation, common in incapacitated and those in institutions (increased with narcotics)
SE: malaise, urinary retention, increased temp, incontinence, cog decline, hemorrhoids, and intestinal obstruction.
age related changes in the body perception of light-dark cycles and circadian sleep wake rhythm
biorhythm and sleep
disrupted sleep in the presence of adequate opportunities and circumstances, DIAGNOSIS, difficulty falling asleep >1 month and impaired in daytime function.
insomnia
sleep apnea?
periods of no breathing when sleeping
SE: excessive daytime sleepy, snorting, gasping, choking, HA, irritability
Obstructive sleep apnea risk factors: increased age, neck circumference, males, anatomical abnormal of the upper airway, fam HX, excess weight, use of ETOH, sedatives, or tranquilizers, smoking, and HTN.
don’t exercise when?
SBP >200 mmHg, DBP > 100 mmHg, resting HR > 120 BPM, for 2 H after a big meal.
thick, compacted skin often from prolonged pressure, pad and protect area is BEST, proper fitting shoes.
corns/calluses
bony deformities, great toe or fifth toe from chronic squeezing or hereditary, custom shoes, surgery, or steroid injection.
bunions
permanently flexed toe (claw like), custom shoes or surgery
hammer toe
yellow, brown, opaque, brittle, and thick nails, difficult to treat costly and limited effectiveness
onchomycosis
Falls?
Hip FX, traumatic brain injury, fallophobia (fear of fallowing causing limits in function) Fall tools: Hendrich II fall risk model, morse fall scale
