Select Geriatric Syndromes/ Pressure Ulcers Flashcards
- _____ ____r: Any lesion caused by unrelieved extemal pressure resulting in the occlusion of blood flow, tissue ischemia, and cell death
Pressure ulce
a. Impaired or restricted ______ is an important agent in the developmem of the pressure ulcers.
mobility
- Aging Skin
a. Skin loses _________ and immune response
sensation
- Aging Skin
b. Skin is ____ as resistant to the development of pressure ulcers
not
- Aging Skin
c. ___ warning signs may precede pressure ulcer formation
No
- Pressure ulcers may signal ____________, impaired dermatological functioning, and comorbidities.
malnutrition
- Mortality increases __-___ for people with pressure ulcers and six-fold for people with non-healing ulcers.
four-fold
- In dark-skinned people, Ulcers may be difficult to see; look for:
i) Discoloration
ii) Warmth
iii) ______
iv) Induration
v) Hardness
Edema
Staging Pressure Ulcers
3. Stage ___: Full-thickness skin loss involving the subcutaneous tissue
3
Staging Pressure Ulcers
4. Stage ___: Extensive tissue damage which extends to muscle, bone, or underlying structures
4
Staging Pressure Ulcers
1. Stage __: Intact skin with erythema that does not blanch
1
Staging Pressure Ulcers
2. Stage ___: Partial-thickness lesions extending into the epidermis and dermis
2
Staging Pressure Ulcers
- Stage 4:
a. Staging is not possible when _____ is present
until the devitalized tissue is removed and the
base of the wound can be seen
eschar
Staging Pressure Ulcers
- Stage 4:
b. Once a pressure ulcer is staged the healing
wound is not _________.
restaged
- Describe the wound’s location, shape, ______, size, type, and color
distribution
- _____________- is a reliable risk factor for pressure ulcer development, along with increased morbidity and mortality.
Hypoalbuminemia
Treatment Pressure ulcer:
1. Remove source of ischemic injury: Relieve ______
pressure
Treatment Pressure ulcer:
2. Wound care _____ consult
specialist
Non-operative for stage ____ and ___ pressure
ulcers
I and II
Stage III and IV ulcers may require ______
interventions
surgical
c. Approximately ___ to ____% of pressure ulcers are superficial and heal by secondary intention. As soon as pressure is relieved on otherwise healthy, vascularized skin, clinical improvement can be evident within 48 hours.
70% to 90%
Treatment Pressure ulcer:
6. ___ management, as needed
Pain
Treatment Pressure ulcer:
7. ______ consult and assessment
Nutritional
- Rehabilitation and ____ therapy
physical
- The literature suggest that approximately 6% of elderly report being abused, and it is estimated that ___ times as many are unreported
five
Elder Abuse
2. Women are more at risk than ____.
men
Elder Abuse
3. Most of the time (__%) the victim knows the abuser.
90%
Elder Abuse
4. Embarrassment, feeling overwhelmed, intimidation, and ____ contribute to reporting and addressing abuse.
isolation
Elder Abuse
5. Early intervention by addressing caregiver _____ through education, counseling, and referral to community agencies is prudent.
stress
Types of Elder Abuse:
1. Physical abuse
a. \_\_\_\_\_\_ that results in physical pain or injury
i) Pushing
ii) Slapping
iii) Hitting
iv) Improper physical restraintsViolence
Elder Abuse:
2. \_\_\_\_\_\_ or psychological abuse
a. Bestowing mental anguish
i) Intimidation
ii) Threatening
iii) Shunning
iv) Isolation
v) Insulting
vi) YellingEmotional
- ___ ____
a. Forced or non-consensual sexual activity
i) Rape
ii) Sexual harassment
iii) Forced viewing of pornography
iv) Molestation
v) Demented, delusional, sedated, and mentally
retarded individuals cannot give consent
Sexual abuse
- _____ ______
a. Misappropriate funds
i) Withdrawing money from accounts
ii) Removing valuable possessions
iii) Signing over of assets
Financial exploitation
- ______ neglect
a. Disregarding or ignoring needs of elders
i) Isolating the elder
ii) Unhealthy diet, oversedation
iii) Non-hygienicliving conditions
iv) Non-attention to one’s physical state
Cargiver
- ___-neglect
a. Non-attention to one’s own physical being: possible
mental health problems
i) Poor hygiene
ii) Untreated medical conditions
iii) Poorly kept home environment
Self
Elder Abuse Risk Factors
1. Lack of close _____ ties
family
Elder Abuse Risk Factors
2. Increasing ____
age
Elder Abuse Risk Factors
- Physical or ____ impairment
a. Caregiver stress
b. Unsafe housing
c. Poverty or financial distress
mental
Elder Abuse Risk Factors
4. Identifying and reporting elder abuse
a. The ____ _____mandates that hospitals
have procedures and training for reporting elder
abuse:
Joint Commission
Elder Abuse Risk Factors
4. Identifying and reporting elder abuse
a. The Joint Commission:
i) Collection, retention, and ______ of
evidence pertaining to elder abuse and
notification of proper authorities
safeguard
Elder Abuse Risk Factors
a. The Joint Commission mandates:
ii) Medical record includes:
a) Documentation of ______
b) Treatment given
c) Any referrals made to medical professionals
or community agencies
d) List of private and public community
agencies for evaluation and elder abuse
care
exam
Elderly Abuse Risk Factors:
5. Questioning a potential victim
a. Frame questions in a _______, non-judgmental
manner.
non-threatening
Elderly Abuse Risk Factors:
- Questioning a potential victim
b. Note any signs of ________
defensiveness.
Elderly Abuse Risk Factors:
- Questioning a potential victim
c. Has anyone tried to ___ you?
hurt
Elderly Abuse Risk Factors:
- Questioning a potential victim
d. Have you any recent ______?
injuries
Elderly Abuse Risk Factors:
- Questioning a potential victim
e. How did that injury (mark, ______ eye, burn, etc.) get there?
black
Elderly Abuse Risk Factors:
- Questioning a potential victim
f. Is there ____ where you live?
stress
Elderly Abuse Risk Factors:
- Questioning a potential victim
g. ____ me about your caregiver.
Tell
Elderly Abuse Risk Factors:
- Questioning a potential victim
h. How is your _____ being handled?
money
Elderly Abuse Risk Factors:
- Questioning a potential victim
i. Is anyone making you do anything you do not ____ to
do?
want
Elderly Abuse Risk Factors:
6. Physical examination
a. Injuries
i) Burns
ii) Bite marks
iii) Lesions from improper restraint use
iv) \_\_\_\_\_\_\_\_\_
v) Lacerations
b. Malnutrition
c. Personal hygiene
d. Appropriate dress
e. Dehydration
f. Pressure ulcers
g. Pain
h. Mobility and range of movement problems
i. Genital/rectal
i) Bleeding
ii) Discharge
iii) Infections
iv) Irritation
v) Injury
vi) Scarring
vii) Sexaully transmitted disease
j. Serum levels of medicationsHematomas
Elderly Abuse Risk Factors:
- Psychological assessment
a. Screen for depression
b. ______
c. Mental disorders
d. Dementia
e. Delirium
f. Evaluate for behavior
g. Mood
h. Affect
Anxiety
Elderly Abuse Risk Factors:
8.Evaluate, refer, and report
a. Most states have mandatory statutes for reporting.
b. All states have protection for those who report from
civil and criminal liability.
c. Penalties for not reporting include
i) Fines
ii) Damages
iii) \_\_\_\_\_ terms
iv) Loss of professional licenses Prison
Elderly Abuse Risk Factors:
8.Evaluate, refer, and report
a. Most states have mandatory statutes for reporting.
b. All states have protection for those who report from
civil and criminal liability.
c. Penalties for not reporting include
i) Fines
ii) Damages
iii) \_\_\_\_\_ terms
iv) Loss of professional licenses Prison
Sleep Disorders
General Comments:
1. More than ___-____ of all older adults report at least one recurring sleep complaint.
one-half
a. ________: Difficulties going to sleep, maintain sleep, or
early awakening
Insomnia
b. _______: Excessive sleepiness
Hypersomnia
c. ________: Strange behaviors during sleep
Parasomnias
d. ___ ____ ____: Restless leg syndrome
Nocturnal movement disorders
- Difficulty falling asleep or remaining asleep or the feeling that one is not getting a sufficient amount of sleep
Insomnia
- Typical complaints of insomnia include:
a. Inability to ____ asleep
fall
- Typical complaints of insomnia include:
b. Recurrent __________
awakenings
- Typical complaints of insomnia include:
c. Inability to _____ to sleep
return
- Typical complaints of insomnia include:
d. Difficulty ______ asleep
staying
- Insomnia may also be of three types:
a. ____ ____: Occurs over a few weeks, usually due to a temporary stressful event (e.g., stress at work, loss of a relative, or fear of losing job)
Short term
- Insomnia may also be of three types:
b. ______: Restless nights that happen occasionally and caused by environmental changes (e.g., jet lag, noisy construction near home, sleeping in new place)
Transient
- Insomnia may also be of three types:
c. ____ _____: Lasts at least weeks or throughout the rest of one’s life (e.g., poor sleeping habits, psychological problems, alcohol abuse)
Chronic insomnia
- Excessive sleepiness at a time when the individual should be awake
- Results in poor sleep at night, though they may feel that their sleeping habits are fine
- Sleep apnea is a common cause of ___________
a. Snoring, interrupted breathing of at least 10 seconds
b. Unusual daytime sleepiness - Chronic use of hypnotic medications (e.g., cough suppressants, over-the-counter preparations, etc.) often results in daytime sleepiness.
- Fatigue, weakness, memory and learning difficulties are common associated complaints.
Hypersomnia
____________
- Strange or unusual behaviors during sleep
a. Nightmares
b. Talking walking in one’s sleep - Nocturnal confusion
- May be exacerbated by drugs or medications such as caffeine, alcohol, beta blockers, etc.
Parasomnia
Management of Sleep Disorders:
_____ Prevention
a. How well does the older person sleep at home?
b. How many times each night does the patient awaken?
c. What rituals occur at bedtime?
Interventions
d. What amount and type of exercise does the patient
get?
e. How much room ventilation is desired?
f. What sleep medications are used?
Secondary
Managment of Sleep Disorders:
________
a. Maintain conditions conducive to sleep
b. Help the patient relax (e.g., bedtime snack, massage)
c. Ensure proper positioning, as well as provision of warmth with blankets or coolness with a fan.
d. Do not permit caffeine in the afternoon or evening.
e. Encourage daily exercise.
Interventions
Management of Sleep Disorders
____ Prevention
a. Sleep only as much as needed b. Daily exercise c. Discourage reading or watching TV in bed
Primary
Pain
General Comments
1. Pain is not a _______ part of aging.
normal
Pain
General Comments
2. ______ pain is a symptom of a pathological process.
Chronic
Pain
General Comments
3. Patient Barriers
a. Lack of knowledge about the \_\_\_\_ of uncontrolled
paineffects
Pain
General Comments
3. Patient Barriers
b. Inability to express pain: Poor \_\_\_\_- or mental
functioningcognitive
Pain
General Comments
3. Patient Barriers
c. Decreased perception, concerns about \_\_\_\_\_\_\_,
fear of side effectsaddiction
Pain
General Comments
3. Patient Barriers
d. Belief that reporting pain will not be taken _____
seriously
Pain
General Comments
3. Patient Barriers
e. Wanting to be a good, ____-_____ patient
non-complaining
Pain
General Comments
3. Patient Barriers
f. Fear that ______ pain means worsening disease
worsening
Pain
General Comments
3. Patient Barriers
g. \_\_\_\_\_\_ members suggesting not to take pain
medicationFamily
Pain
General Comments
3. Patient Barriers
h. ______ that pain is part of aging
Misbelief
Healthcare Professional Barriers
1. Underestimation of the ____ of pain
extent
Healthcare Professional Barriers
2. Unfounded concerns over _____
tolerance
Healthcare Professional Barriers
3. Fear of physical dependence or _______
a. May wean apatient off of a medication that might
cause physical dependence
addiction
Healthcare Professional Barriers
4. Fear of being _______ for prescribing opioids to an
elder person
investigated
Long-term Care Facility Barriers
1. _______ education
Limited
Long-term Care Facility Barriers
2. Not wanting to consult/refer to ____ pain
management services
outside
Long-term Care Facility Barriers
3. ______ drug formularies
Limited
Long-term Care Facility Barriers
4. Standardized and not ________ dosing regimens
individualized
Long-term Care Facility Barriers
5. Limited _______ to assess and treat pain
staffing
Management: Pharmacological
1. _____ to Pharmacology Considerations in the Elderly
Refer
Falls
General Comments
1. Contribute up to around ___% of nursing home
admissions
2. Leading cause of injury-related deaths
40%
Falls
Causes: ________ Factors
1. Medical and neuropsychiatric conditions
2. Impaired vision and hearing
3. Age-related changes in neuromuscular function, gait, posture, and reflexes
Intrinsic
Falls Causes: \_\_\_\_\_\_\_ Factors 1. Medications 2. Improper use of assistive devices for ambulation 3. Environmental hazards
Extrinsic
Assessment
- Questions to ask when a fall occurs:
a. What was the patient _____ at the time of the fall?
doing
Assessment
- Questions to ask when a fall occurs:
b. Loss of _________?
consciousness
Assessment
- Questions to ask when a fall occurs:
c. In what ______ did the patient fall (forward or
backward) ?
direction
Assessment
- Questions to ask when a fall occurs:
d. Did the patient _____ the fall (awareness vs.
syncope) ?
break
Assessment
1. Questions to ask when a fall occurs:
e. Were any _______ devices being used
appropriately (or not)?
assistive
- Further Assessment
a. Determine whether the fall was a first occurrence or
whether falls have _______ in number.
increased
- Further Assessment
b. A thorough history of the patient’s medical problems
and all medications, including _____, pain
medications, and over-the-counter medications/herbs
alcohol
- Further Assessment
c. Environment assessment:
i) Home or health facility?
ii) ____ ____: Clutter, poor lighting, and throw rugs
can prove critical in preventing falls
Risk factors
- Further Assessment
d. Home Safety _____ may be used by the patient to
examine their surroundings, if provider or nurse is not
able to visit the home of patient.
Checklist
Physical Examination Falls:
- Comprehensive exam with a special focus on:
a. ________: Blood pressure and pulse checks
Orthostasis
Physical Examination Falls:
- Comprehensive exam with a special focus on:
b. _________: Dysrhytlnrtias, murmurs
Cardiovascular
Physical Examination Falls:
- Comprehensive exam with a special focus on:
c. ______: Visual or hearing impairments
Sensory
Physical Examination Falls:
- Comprehensive exam with a special focus on:
d. ______: Fractures, joint movement limitations, foot problems
Musculoskeletal
Physical Examination Falls:
- Comprehensive exam with a special focus on:
e. _____: Tremors, weakness, rigidity
Neurologic
Physical Examination Falls:
- Comprehensive exam with a special focus on:
f. _____ _____ Mini-Mental State Examination
Cognitive status:
Physical Examination Falls:
- Comprehensive exam with a special focus on:
g. ______: Geriatric Depression Scale
Mood
Physical Examination Falls:
2.Special attention should be given to:
a. Observation of the patient's gait and \_\_\_\_\_ with and without assistive devices
i) Functional reach
ii) Berg balance test
iii) Timed up and go test (TUG)
b. Footwear (stability and fit)
c. Assistive devices for size, fit, and the patient's knowledge of usebalance
Fall Interventions
1. Patients’ risk of falling should be assessed _______
annually.
Fall Interventions
2. ________ members must be included in education and intervention planning.
Family
Fall Interventions
3. Targeted interventions for risk factors
a. ____ _____ for balance and gait training, and
strengthening
b. Weight training and an exercise program
c. Assistive devices such as a cane or walker for additional stability
Physical therapy
Fall Interventions
4. Other general interventions
a. Minimize medications and dosages.
b. Prevent and treat \_\_\_\_\_\_\_\_\_.
c. Recommend proper footwear.
d. Recommend a well-lit environment.
e. Raise toilet seat and chair heights.
f. Remove home hazards.
g. Install grab bars in places such as the bathroom and
shower.
h. Install hand rails at entrances to the home.osteoporosis
Palliative Care
General Comments
1. Common signs/symptoms in the year leading to death for elderly patients
a. Pain: __%
72
Palliative Care
General Comments
1. Common signs/symptoms in the year leading to death for elderly patients
b. Dyspnea: ___%
49
Palliative Care
General Comments
1. Common signs/symptoms in the year leading to death for elderly patients
c. Loss of appetite: ___%
47
Palliative Care
General Comments
1. Common signs/symptoms in the year leading to death for elderly patients
d. Sleeplessness: ____%
44
Palliative Care
General Comments
1. Common signs/symptoms in the year leading to death for elderly patients
e. Drowsiness: ___%
44
Palliative Care
General Comments
1. Common signs/symptoms in the year leading to death for elderly patients
f. Constipation: ____%
36
Palliative Care
General Comments
1. Common signs/symptoms in the year leading to death for elderly patients
g. Depression: ____%
36
Palliative Care
General Comments
1. Common signs/symptoms in the year leading to death for elderly patients
h. Vomiting and feeling sick: ___%
36
Palliative Care
General Comments
2. Review living will, advance health care directive, or durable power of _____
attorney
General Definition of ____ ____
1. The study and management of patients with active, progressive, far-advanced disease for which the prognosis is limited and the focus of care is on the quality of life; includes active, total care of patients whose disease is no longer responsive to curative treatment
Palliative Care
- Widely adopted Core Principles for ___-___-___ _____:
a. Respect the dignity of both patient and caregivers.
b. Encompass alleviation of pain and other physical symptoms.
c. Offer continuity (the patient should be able to continue to be cared for, if desired, by his/her primary-care and specialist providers).
d. Provide access to palliative care and hospice care.
e. Respect the right to refuse treatment.
f. Promote clinical, evidence-based research on providing care at the end-of-life.
End-of-Life Care
- Perform a spiritual assessment Palliative Care:
a. Religion/religious/spiritual beliefs
b. Views on death and dying
c. Any rituals that the patient desires to be performed before death
d. Psychosocial and Spiritual Assessment Tool (____)
i) Faith or spiritual practice
ii) Importance of the spiritual practice
iii) Community: Patient’s participation in a spiritual or religious community and the benefits the patient receives from the community
iv) Assist: Discuss and evaluate how healthcare and other professionals can assist the patient with spiritual needs
FICA
- Perform a spiritual assessment Palliative Care:
d. Psychosocial and Spiritual Assessment Tool (FICA)
i) Faith or _____ practice
spiritual
- Perform a spiritual assessment Palliative Care:
d. Psychosocial and Spiritual Assessment Tool (FICA)
ii) Importance of the ____ practice
spiritual
- Perform a spiritual assessment Palliative Care:
d. Psychosocial and Spiritual Assessment Tool (FICA)
iii) _______: Patient’s participation in a spiritual or
religious community and the benefits the patient
receives from the community
Community
- Perform a spiritual assessment Palliative Care:
d. Psychosocial and Spiritual Assessment Tool (FICA)
iv) ____: Discuss and evaluate how healthcare and other professionals can ____ the patient with spiritual
needs
Assist
Management of Common Clinical Symptoms in Palliative Care
1. ________
a. Pay attention not only to clinical symptoms and diagnostics, but the patient’s subjective opinions as well.
b. Management may encompass
i) Anxiolytics
ii) Oxygen
iii) Opioids
iv) Bronchodilators
c. Oxygen may be an important placebo with no measurable improvement in 02 saturation.
d. Treat any anxiety associated with breathlessness.
e. Consider appropriate non-phamaacologic approaches.
f. Question the patient about the comfort of the environment and address any potential issues (e.g., fans, temperature, positioning, humidity, etc.)
Dyspnea
Management of Common Clinical Symptoms in Palliative Care
- ________
a. Bowel movements may be as infrequent as every three days.
b. Review medication and diet.
Constipation
Management of Common Clinical Symptoms in Palliative Care
- _____/______
a. Be aware of patient, primary caregivers’, and family/friends’ distress.
b. Some cultures may interpret not being able to eat as “‘giving up” and a rejection of medical intervention -resulting in distress of the family.
c. May be a signal of inadequate care or abuse
d. Review and modify or remove dietary restrictions.
Anorexia/Cachexia
Management of Common Clinical Symptoms in Palliative Care
______ and _______
a. Again, some cultures may interpret this as a sign
of”giving up.”
b. Physical therapy to maintain mobility if possible
Fatigue and Weakness
Management of Common Clinical Symptoms in Palliative Care
______ and _____
a. As with treating any mental illness, the most effective treatment includes pharmacological therapy and psychotherapy, as tolerated.
Depression and Anxiety
Management of Common Clinical Symptoms in Palliative Care
Be aware of treatment options presented by ____ ____:
a. Prayer or spiritual/religious
b. Animal/ pet therapy
c. Biofeedback
d. Herbal remedies, such as St. Johns Wort
e. Aromatherapy
alternative therapies
Management of Common Clinical Symptoms in Palliative Care
- ____ ____ ___ ___: Terminal phase or active dying
a. An extremely stressful time for the patient and family
b. Attend to the patient’s personal hygiene.
c. Assess and treat pain.
d. Be mindful not to force fluids, which may worsen symptoms.
e. Provide lubricating gels for the lips, eyes, and nares as needed.
f. Remind caregivers/family that the semi-comatose patient may hear and understand what is being said.
g. Educate caregivers/family that loss of the ability to swallow and changes in breathing patterns are normal and do not indicate discomfort or pain.
Final hours of life
