Geriatric Diseases - Block 4 Flashcards
What is a geriatric syndrome?
Multifactoral health conditions that leads to impairments rendering patient vulnerable
What are the series of I’s?
- Immobility
- Instability
- Incontinence
- Intellectual impairment
- Infection
- Impairment of vision and hearing
- Irritable colon
- Isolation
- Inanition
- Insomia
- Immune def
- Impotence
Outcomes of immobility?
Deconditioning -> regaining what was lost takes longer in older adults
Outcomes of immobilization?
Inability to obtain water -> decreased plasma volume -> syncope, falls and, fractures
Outcomes of sensory deprivation?
Delirium -> treated by restraints or antipsychotics
Outcomes of immobilization caused by tethers?
Neccessitate nursing assistance to bathorrm and delay -> incontinence, cathers, infections, pressure sores
Outcomes of prescribed diets or NPO?
Dehydration, malnutrition, insertion of feeding tubes, and aspiration pneumonia
What is a pressure ulcer?
Localized injury to the skin or tissue as a result of pressure
What are extrinsic RF for pressure ulcers?
- Lying on hard surfaces
- Nursing homes
- Poorly fitting prostheses
- Pooor skin hygiene
- Patient restraints
What are examples of intrinsic RF for pressure ulcers?
- Diabetes
- ANemia
- Smoking
- Malnutrition
- Immunosuppression
- Vascular dx
- Spinal cord injury/paralysis
- Contractures
- Prolonged immobility
- Advanced age
What is considered a high risk patient for pressure ulcers?
- Older
- Trauma
- SCI
- Fractured hip
- Long term care
- Acutely ill
- Diabetes
- Critical care
How can we prevent pressure ulcers?
- Repositioning and mobility (move 4H if sitting, 2H for lying down): support surfaces, medical devices
- Clean and dry skin
- Don’t massage skin
- Individualized continence management plan
- Barrier product
- SKin moisturize
- Adequate nutrition
Topical barriers for pressure ulcers?
- Occlusives
- Humectants
What is the difference between occlusive and humectant?
Occlusive: insoluable in water
Humectants: increase skin’s ability to hold water
What are the types of occlusives?
- Petroleum jelly
- Silicone/dimethicone
- Zinc oxide
What are types of humectants?
- Glycerin
- Sorbitol
- Urea
- Seaweed extract
- Hyaluronic acid
- Alpha-hydroxl acids
What are physical characteristics used to assess pressure ulcers?
- Location
- Stage
- Size
- Tissue type
- Color
- Periwound
- Wound edge
- Sinus tracts
- Undermining
- Tunneling
- Exudate
- Odor
Would cultures are only for infections
What are the classes of pressure ulcers?
Stage I: Nonblanchable Erythema
Stage II: Partial Thickness Skin Loss
Stage III: Full Thickness Skin Loss
Stage IV: Full Thickness Tissue Loss
Unstageable: Depth Unknown
Suspected Deep Tissue Injury: Depth Unknown
What is the tx for pressure ulcers?
- Pressure relief
- Infection control
- Debridement
- Dressing, topicals
- Patient optimization
- Control of contamination
- Surgery for reconstruction
What are the types of dressings?
- Alginate dressings
- Foam dressings
- Gauze dressings
- Honey dressings
- Hydrocolloid dressings
- Hydrogel dressings
- Silver dressings
- Transparent film dressing
Alginate dressing
Advantages, Disadvantages, Ideal wound
A: Absorbent, infrequnet changes
D: expensive
Ideal: Infected wounds
Foam dressings
Advantages, Disadvantages, Ideal wound
A: Absorbent, provides padding
D: expensive
Ideal wound: Infected, fragil surrounding skin, Stage 1, prevention
Gauze dressing
Advantages, Disadvantages, Ideal wound
A: Inexpensive, microdebridement
D: frequent changes
Ideal wound: Large complex wounds with exudate or biofilm
Honey dressing
Advantages, Disadvantages, Ideal wound
A: Mild antibiotic
D: poor efficacy
Ideal wound: Stage II with mild infection
Hydrocolloid dressings
Advantages, Disadvantages, Ideal wound
A: absorbent
D: expensive
Ideal wound: wounds with minimal discharge, Stage II and III
Hydrogel dressing
Advantages, Disadvantages, Ideal wound
A: hydrating
D: moves easily
Ideal wound: Dry or dehydrated, uninfected granulating wounds
Silve dressing
Advantages, Disadvantages, Ideal wound
A: Antibiotic
B: Prevents epitheliazation
Ideal wound: Infected wounds, remove once infection is cleared
Transparent film dressing
Advantages, Disadvantages, Ideal wound
A: Barrier from bodily fluids, infrequent changes
D: Not porous, can rip skip on removal
Ideal wound: Stage I, Stage II without exudate
*Must be dry, fentanyl patch
How do we decide on what dressing to use?
Describe the mechanism for swallowing?
How does the ability to swallow affected by aging?
ALteration in olfaction and gustatory sensation -> affecting appetite, diet, and amount of intake
Lower salivary flow rate
What is sarcopenia?
Decreased muscle mass and quality with advancing age
What are the types of dysphagia?
Oral, Pharyngeal, esophageal
What med can reduce attention and oral praxis?
Sedatives neuroleptics
What meds cause xerostoma?
Anticholinergics, TCA
What meds cause weakness in the tongue and mouth strength?
Steroids
What are med that impair pharyngeal phase?
Antipsychotics
What meds impair esophageal phase?
Bisphosphonates
Drugs that are common causes of pill esophagitis?
- Tetracycline
- KCl
- NSAIDs
- ALendronate
- Quinidine
- Metformin
What are drugs used for dysphagia?
- Botulinum toxin type A
- Diltiazem
- Nitrates
- Glucagon
Define Compression of morbidity?
Limiting morbidity to a shorterr period closer to the natural end of life
Define health span?
The period of life free of major chronic clinical dx and disability
What are the phases of a health span?
- Period of healthy aging
- Period of disease and disability
What are biological implications of longevity?
Increase health span by slowing the biological process of aging
What are the Psychological and social implications of aging?
- Ageism
- Negative attitudes aboout one’s own aging
What are the factors that affect preventative health?
Prevalence of problem and likelihoos of an effective intervention
* must focus on the QOL rather than mortality
What are type of preventative activities?
Primary: Makes the patient more resistant or the environment less harmfull
Secondary: to screen or not to scfree
Tertiary: delay dx progression
What are examples of primary activities?
- Immunizations
- Blood pressure
- Smoking
- Exercise
- Diet/sodium restriction
- Cholesterol
- Social support
- Home improvements
- Seat belts
- Medication review
- Oral Care
What are types of secondary activities?
Cancer screening
What are types of tertiary activites?
- Proactive primary care
- Comprehensive geriatric assessment
- Foot care
- Dental care
- Toileting efforts
- Rehabilitation/exercise
- Dietary protein
What are the preventative health guidelines?
- U.S. Preventative Services Task Force
- My health finder
- HealthyPeople.gov
What is Healthy People 2030?
Sets data-driven national objectives to improve health and well-being over the next decade
