Precribing in older people and pressure ulcers

Question 1

What are the main physiological changes that occur in the body as we age?

Answer 1

Reduced renal clearance
Reduced lean body mass
Increased body fat

Question 2

How can prescribing in the elderly be improved?

Answer 2

Should only prescribe things that are clearly indicated
Should have regular medication reviews and stop any medication that is not needed.
In review can add drugs that may be beneficial e.g. vitamin D and calcium
Drug regimes should have as few doses per day as possible to avoid confusion

Question 3

What screening tools can be used to look at polypharmacy?

Answer 3

STOPP-START criteria

Question 4

What is the waterlow assessment tool used for?

Answer 4

Used to risk assess for pressure sores

Question 5

What is included in the waterlow tool?

Answer 5

Malnutrition
Neurological deficit
Continence
Skin appearance
Smoking, vascular disease
Medication
Weight
Mobility

Question 6

What prevention can be used for pressure ulcers?

Answer 6

Regular turning
control of incontinence
Improved nutrition
Pressure relieving aids

Question 7

How are pressure sores graded?

Answer 7

Grade 1 - discolouration with non blanching erythema
Grade 2 partial thickness skin loss with ulceration that does not involve subcut tissue
Grade 3 - full thickness loss with necrosis of subcut tissue
Grade 4 - full thickness loss with necrosis extending down to bone, tendon and muscle

Question 8

How should pressure ulcers be treated?

Answer 8

Should inform the tissue viability nurse
Use wet evironments such as a vac dressing to encourage healing
Consider swabbing regularly as they are likely to be colonised by bacteria
Consider for sugical debridement and grafting