Final Lecture #5

Question 1

dry cracked, itchy skin, inadequate fluid intake worsens, use super fatted soaps and cleansers

Answer 1

xerosis

Question 2

itchy skin, a symptom not a diagnosis, may be r/t med SE or secondary to disease, a threat to skin integrity

Answer 2

pruritis

Question 3

thin fragile skin extravasation of blood into surrounding tissue, wear long sleeves to protect from trauma

Answer 3

purpura

Question 4

precancerous skin lesions, from sun exposure, dermatology visits every 6-12 months to monitor and treat

Answer 4

Actinic keratosis

Question 5

waxy, raised, “stuck on” appearance, benign lesion, almost all older adults over 65 y/o

Answer 5

seborrheic keratosis

Question 6

painful vesicular rash over a dermatome, get vaccine at age 60

Answer 6

herpes zoster

Question 7

yeast infection, often in skin folds, keep skin clean and dry.

Answer 7

candidiasis

Question 8

can significantly impair recovery/rehab and impact QOL, increased risk for mortality, high prevalence of HC litigation, a PREVENTABLE AE.

Answer 8

pressure injuries

Question 9

proper nutrition?

Answer 9

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+

Question 10

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.

Answer 10

malnutrition

Question 11

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).

Answer 11

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.

Question 12

= able to drink, may not know what adequate intake is, possible cog impairs, encourage and make fluids accessible

Answer 12

can drink

Question 13

= physical incapable to ingest or access fluids, dysphagia prevention, swallow evaluation, safe drinking techniques

Answer 13

can’t drink

Question 14

= highest risk for dehydration, able to drink but won’t, offer frequently, and prevent incontinence

Answer 14

won’t drink

Question 15

= terminally ill, could be any of the previous 3, refer to advance directives regarding hydration wishes

Answer 15

end of life

Question 16

Signs of dehydration?

Answer 16

Skin turgor, weight, mucous membranes, speech changes, tachycardia, decreased UOP, dark urine, weakness, dry axilla, and sunken eyes. GENERALLY, CONFRIMED BY LAB TESTING!

Question 17

at least 1500 mL/day (2-3 L), H2O is best, offer often, make available, encourage with meds, provide preferred fluids, and verbal reminders.

Answer 17

hydration interventions

Question 18

UTIs

Answer 18

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

Question 19

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.

Answer 19

constipation

Question 20

= 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.

Answer 20

bulk forming

Question 21

= docusate Na+ and mineral oil; increases moisture content of stool

Answer 21

emollients

Question 22

= polyethylene glycol (PED), milk of mag, lactulose; causes H2O retention in colon

Answer 22

osmotic

Question 23

= bisacodyl, senna; stimulates colorectal motor activity

Answer 23

stimulant

Question 24

fecal impaction?

Answer 24

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.

Question 25

age related changes in the body perception of light-dark cycles and circadian sleep wake rhythm

Answer 25

biorhythm and sleep

Question 26

disrupted sleep in the presence of adequate opportunities and circumstances, DIAGNOSIS, difficulty falling asleep >1 month and impaired in daytime function.

Answer 26

insomnia

Question 27

sleep apnea?

Answer 27

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.

Question 28

don’t exercise when?

Answer 28

SBP >200 mmHg, DBP > 100 mmHg, resting HR > 120 BPM, for 2 H after a big meal.

Question 29

thick, compacted skin often from prolonged pressure, pad and protect area is BEST, proper fitting shoes.

Answer 29

corns/calluses

Question 30

bony deformities, great toe or fifth toe from chronic squeezing or hereditary, custom shoes, surgery, or steroid injection.

Answer 30

bunions

Question 31

permanently flexed toe (claw like), custom shoes or surgery

Answer 31

hammer toe

Question 32

yellow, brown, opaque, brittle, and thick nails, difficult to treat costly and limited effectiveness

Answer 32

onchomycosis

Question 33

Falls?

Answer 33

Hip FX, traumatic brain injury, fallophobia (fear of fallowing causing limits in function) Fall tools: Hendrich II fall risk model, morse fall scale