Skin Care, Nutrition, Hydration, Elimination, Sleep, & Exercise Exam 2 Flashcards
What are Common Skin Problems in GERO ? ( 7)
- Xerosis
- Pruritis
- Purpura
- Actinic keratosis
- Seborrheic keratosis
- Herpes zoster
- Candidiasis
What is Xerosis ?
Dry, cracked, itchy skin. Inadequate fluid intake worsens. Use super-fatted soaps or cleansers.
What is Pruritis ?
Itchy skin. A symptom not a diagnosis. May be r/t med side effects or secondary to disease. A threat to skin integrity
What is Purpura ?
Thin, fragile skin – extravasation of blood into the surrounding tissue. Wear long sleeves & protect from trauma.
What is actinic keratosis?
Precancerous skin lesion. From sun exposure. Dermatology visits every 6-12 months to monitor & treat
What is Seborrheic keratosis ?
Waxy, raised, “stuck-on” appearance, benign lesion. Almost ALL older adults over 65 yo.
What is Herpes Zoster ?
Painful, vesicular rash, over a dermatome. Get vaccine at age 60.
What is Candidiasis ?
Yeast infection, often in skin folds. Keep skin clean and dry.
What are the Risk Factors for Pressure Injuries ? ( 7 )
Skin changes
Comorbid disease
Nutrition
Frailty
Cognitive deficits
Incontinence
Reduced mobility
How can we as nurses prevent pressure injuries ? ( 5 )
Risk assessment
Skincare
Nutrition
Mechanical loading & support surfaces
Education
Adequate diet is an important factor in what ?
delaying onset and managing chronic illness associated with aging
What is the MNA ?
Mini Nutritional Assessment ( Identifies adults and older adults who have or are at risk for developing malnutrition)
Proper nutrition includes all the essential nutrients
50% fruits & veggies
25% grains (whole)
25% protein-rich
A score of 12-14 on the MNA means…
normal nutritional status
A score of 8-11 on the MNA means…
risk of malnutrition
A score of 0-7 on MNA means…
malnourished
Why are institutionalized older adults at high risk for malnutrition ?
due to chronic disease and functional impairments
Older Adults with malnutrition have an increased risk for ?
risk of infection, pressure ulcers, anemia, hip fractures, hypotension, impaired cognition and increased morbidity and mortality
What is linked as the contributing/underlying risk factor of malnutrition ?
INFLAMMATION
How to Diagnose Malnutrition ?
2 or more must be present
- Insufficient energy intake
- Weight loss
- Loss of muscle mass
- Loss of subcutaneous fat
- Localized or generalized fluid accumulation that may mask weight loss
- Diminished functional status as measured by handgrip strength
Malnutrition Development ( Insufficient consumption of nutrients)
Micro – vitamins, minerals, phytochemicals
Macro – protein, carbs, fat, water
Malnutrition Development ( Inflammation- related )
- Trigger – injury, surgery, or disease state
- Inflammatory mediators INCREASE metabolic rate & impair nutrient utilization
What are the Factors affecting fulfillment of nutritional needs
Prolonged NPO status
Age associate changes in taste and smell
Oral health status
Chronic diseases and conditions
Side effects of medications
Lifelong eating habits
Socialization
Anorexia of aging
Income
Transportation
Housing
40% - 60% of hospitalized older adults are malnourished or at risk for malnutrition in the United States
Severely restricted diets
Insufficient time for feeding assistance
What are the interventions to improve nutritional status ?
Visually appealing pureed foods
Family involvement when possible
Use of nutritionally dense supplements with medication pass
Restorative dining rooms
Consideration of ethnic food choices
Easy access to refreshment stations with juices, water, and healthy snacks
Liberal diets
Finger foods
Establish routine for meals and snacks consistent with accustomed eating schedule
Incorporate favorite foods, especially nutritionally dense foods and finger foods
Visual cueing and hand-over-hand assistance as needed
Appropriate utensils and dinnerware
Offer fluids in between bites of food
Eliminate distractions
Allow time for older person to enjoy and complete meal
What is Dyshagia?
difficulty swallowing
What are Complications with Dysphagia ? (4)
Weight loss
Malnutrition and dehydration
Aspiration pneumonia
Death
What are the Risk Factors with Dysphagia ? (6)
CVA
Parkinson’s, Dementia
Traumatic Brain Injury
Aspiration Pneumonia
Improper Feeding Technique
Poor dentition
What are the S/S of Dysphagia ? (9)
- Hiccups
- Voice rattle
- Gurgling in throat
- Throat clearing
- Pain
- Hiccups
- Chest pain
- Wet or gurgling voice
- Frequent respiratory infections
How to Prevent Dysphagia ? ( 10 )
- Supervise all meals
- Seated and rested before eating
- Sitting up at 90 degrees
- Don’t rush meals
- Alternate solids and liquids
- Chin-tuck swallow
- Thickened liquids and pureed foods
- Avoid sedatives – may impair cough reflex
- Keep suction readily available
- Oral care
PEG Tubes in Advanced Dementia ( MYTH ) ( 4)
- Prevent death from inadequate intake
- Reduce aspiration pneumonia
- Improve nutritional status
- Provide comfort at end-of-life
PEG Tubes in Advanced Dementia ( FACT )
- Do not improve QOL
- Do not prolong survival in dementia
- Associated with increased agitation, use of restraints, and worsening pressure injuries
- 50% of patients die within 6 mo of insertion
- Are associated with infection, GI symptoms and abcesses
- Are popular r/t convenience and labor costs
What is Hydration ?
Adequate fluid consumption and maintenance of fluid balance essential to health
What are the Risk factors for changes in fluid balance ? (7)
- Physiological changes in body water content
- Impaired thirst sensation
- Medications
- Functional impairments
- Chronic illness
- Emotional illness
- High environmental temperatures
What is Dehydration ?
Reduction in total body water
A geriatric syndrome
What Diseases are Dehydration Associated with ?
DM, HF, respiratory disease, frailty
What are the Complications for Dehydration ?(6)
- Delirium
- Thromboembolism
- Infection
- Renal failure
- Kidney stones
- Constipation
What to look for when assessing for Dehydration ?(10)
- Skin turgor (unreliable r/t skin changes)
- Weight
- Mucous membranes
- Speech changes
- Tachycardia
- Decreased UOP
- Dark urine
- Weakness
- Dry axilla
- Sunken eyes
Dehydration generally confirmed with lab testing.
What are interventions for dehydration ?(12)
- At least 1500 mL/day
- Fluid quality - Water is BEST
- Bulk of fluid intake should be H20
- Milk, fruit juice, and non-salty soups are ok
- Coffee and tea
*Diuretic effects
- Reasonable amounts
- Offer fluids often
- Make fluids readily available
- Encourage fluids with meds
- Provide preferred fluids
- Verbal reminders
Oral Care ( If the Client has teeth ) (5)
- Need teeth brushing and flossing daily
- Ultrasonic toothbrush best
- Foam swabs help to moisturize but don’t replace brushing
- Never use lemon glycerin swabs for older
- Rinses and mouthwashes ok
Oral Care ( If the Client has no teeth )- Dentures (11)
- Same care! Just don’t need flossing
- Need to be brushed just like natural teeth daily
- Rinse after meals
- Wear constantly during the day
- Remove while sleeping
- Must be kept in water to prevent warping
- Dentures are personal and expensive
- Often lost, broken, or mixed up in healthcare settings
- Ill-fitting dentures may lead to malnutrition
- Encourage to eat fruits and veggies
- Denture wearers often consume more soft foods
Urinary incontinence - Urge
- Overactive bladder
- > 8/day, nocturia, urgency
Urinary incontinence - Stress
Increased intra-abdominal pressure > leakage of 50mL or more
Urinary incontinence - Functional
- Nothing wrong with tract
- Just can’t get to the restroom for some reason
Urinary Incontinence - Interventions(8)
- A thorough assessment of continence
- Scheduled & Prompted voiding
- Pelvic floor muscle exercises (Kegels)
- Lifestyle Modifications
- Avoid caffeine (not much evidence), smoking cessation, bowel mgmt, healthy weight, exercise
- Medications
- Most have anticholinergic effects. Think about side effects
- Urinary catheters – last resort
What is the most common cause of Sepsis in Older Adults ?
UTI
UTI in older adults
- Cognitively impaired may not report symptoms
- Atypical Symptoms
- Mental status change
- Decreased appetite
- Incontinence
- Normal for older adults to have asymptomatic, uncomplicated bacteria in urine.
What does Constipation look like in Older Adults ?
- Reduction in bowel movement frequency or difficulty in forming or passing of stool
- 40% of older experience constipation
- More common in women
What are the Complications of Constipation ?
- Impaction, obstruction, cognitive dysfunction, delirium, falls, increased morbidity & mortality
- Increased risk for bowel cancer
What are the Interventions for Constipation ?
Increase physical activity
- Increases motility
Proper positioning
- Squatting, leaning forward (physiology)
- Squatty Potty
Toileting regimen
- Normalizes bowel function
- Attempt BM after breakfast or dinner (gastrocolic reflex)
- Allow at least 10 minutes for BM
Increase fluid intake – at least 1.5L per day
Increase dietary fiber
- Know foods high in fiber (p 176)
Bulk-forming (fiber)- psyllium (Metamucil) ( Constipation )
- Usually First line and contraindicated in very frail or with dysphagia
- MUST – adequate fluid
Osmotic- polyethylene glycol (PEG), milk of magnesia, lactulose ( Constipation )
Increases shift of water into stool
Often causes diarrhea – Less with PEG
Assess electrolyte levels
Stimulant – bisacodyl, senna ( Constipation)
Stimulates peristalsis – good for opioid-induced constipation
Often causes cramping
May cause dehydration and electrolyte disturbances
What are the Nursing Considerations about Enemas ?
- Last resort
- Don’t use on regular basis
- May alter fluid and electrolyte status
- Sodium phosphate enemas contraindicated in older
What is A Fecal Impaction ?
- Complication of constipation
- Common in incapacitated and those in institutions
- Increased incidence with narcotics
What are the manifestations & complications of a fecal impaction ?(7)
Malaise, urinary retention, increased temp, incontinence, cognitive decline, hemorrhoids, intestinal obstruction.
What are the Age related sleep changes ?(8)
- Decreased sleep efficiency & total time
- Sleep disorders
- Apnea, insomnia, etc
- Circadian rhythm responses diminished
- Increase in stage one of sleepless REM
- Longer to fall asleep
- Frequent awakenings
- Increased napping during the day
- The frequency of leg movement increased
What are the Nursing considerations in Sleep ?(5)
- Most changes in sleep begin 40-60 yo
- Less time in Stage 3-4 (begins 20-30 yo – continue until 50-60 yo)
- Stage 3-4 = Feeling rested and refreshed
- More time awake or Stage 1
- REM critical for elders – brain replenishment
Sleep deprivation and fragmented sleep can adversely affect what ?
cognitive, emotional, and physical functioning as well as quality of life
What is Biorhythm in Relation to sleep ?
Age related changes in the body’s perception of light-dark cycle and circadian sleep-wake rhythm
What is a Sleep Cycle ?
Changes in sleep cycle that reduce amount of deep sleep and time spent in REM sleep
What is Insomnia ?
Disturbed sleep in the presence of adequate opportunities and circumstances
What Factors Diagnose Insomnia ?
Difficulty falling asleep >1 month
AND impairment in daytime functioning r/t poor sleep
What Meds treat Insomnia ?
SSRIs, antihypertensives, anticholinergics, diuretics, stimulants, etc.
What are some Sleep teachings ?
Maximize comfort
Bedroom is for two things – both start with S
Avoid or limit naps
- Less than 2 hours
Exercise (not before bedtime) and outdoor time
Bedtime routine
Limit tobacco, caffeine and ETOH – in evening
Manage GERD
Avoid screen time just before bed
If can’t fall asleep
- Get up and go to another room until feeling sleepy
What are the S/S of Sleep Apnea ?
- Excessive daytime sleepiness
- Snoring, gasping, choking
- Headache, irritability
- Symptoms often blamed on age!
How do you Assess for Sleep Apnea ?
Epworth Sleepiness Scale
What is obstructive sleep apnea ?
A disorder in which a person, while asleep, stops breathing because his or her throat closes; the condition results in frequent awakenings during the night
What are consequences of Falls ?
Hip fractures
Traumatic brain injury
Fallophobia
- Fear of falling causing limitations in function
What are the Assessment tools for Falls ?
Hendrich II Fall Risk Model
Morse Fall Scale
Minimum Data Set (MDS 3.0)
What are the Major Risk Factors for Falls ?
- Orthostatic hypotension
- Cognitive impairment
- Impaired vision and hearing
- Medications
- Environmental factors
- Weakness and frailty
National Council on Aging: Fall Prevention - 1:39
6 Steps
Balance or exercise program
Talk to your Primary Care Provider
Review medications
Vision & hearing checks
Home safety
Talk with family
What are chemical restraints ?
any drug that is used for discipline or convenience and not required to treat medical symptoms
What are the Consequences of restraints in older adults ?
Do not effectively prevent falls, wandering, or removing medical equipment
Probably exacerbate the problem
Restrain-related death
- Asphyxiation
Pressure ulcers, agitation, cognitive decline, depression
EBP care = restraint-free care
- The goal for care in the older especially
- Should not be used to manage behavior symptoms
- Treat underlying problem
How much Physical Activity could be done in an Older Pt ?
- 2.5 hours weekly of moderate aerobic
AND Muscle strengthening activities at least 2 days per week
- All major muscle groups
What types of Physical Activity should a older client pt be taught to do ?
Mod intensity aerobic
Muscle-strengthening
Stretching
Balance
When should an Older pt NOT Exercise ? (4)
- SBP > 200 mm Hg
- DBP > 100 mm Hg
- HR > 120 bpm
- For 2 hrs after a big meal
Feet – Age-related changes(5)
- Skin becomes drier, less elastic, cooler
- Subcutaneous tissue on dorsum and sides of foot thins
- Plantar fat pad shrinks and degenerates
- Toenails become brittle, thicken, less resistant to fungal infections
- Degenerative joint disease decreases range of motion
What are some Common Foot Problems ?
- Corns/calluses
- Bunions
- Hammer toe
- Onchomycosis
What is Onychomycosis ?
Yellow, brown, opaque, brittle, and thick nails. Difficult to treat – costly & limited effectiveness.
What are Bunions ?
Bony deformities – great toe or fifth toe from chronic squeezing or hereditary. Custom shoes, surgery, or steroid injection.
What is a Hammertoe ?
Permanently flexed toe (clawlike). Custom shoes or surgery.
What are Corns/calluses ?
Thick, compacted skin often from prolonged pressure. Pad and protect area is BEST. Proper fitting shoes.
What is Proper foot care in the older population ?
- If DM - Must have annual foot exam by healthcare provider
- Care of toenails
- Best cut after bath or soaking 20-30 min – softens nails
- Clip straight across
- Proper fitting footwear
- Orthotic shoes as needed
