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Gerotonlogy > Skin Care, Nutrition, Hydration, Elimination, Sleep, & Exercise Exam 2 > Flashcards

Skin Care, Nutrition, Hydration, Elimination, Sleep, & Exercise Exam 2 Flashcards

1
Q

What are Common Skin Problems in GERO ? ( 7)

A
  1. Xerosis
  2. Pruritis
  3. Purpura
  4. Actinic keratosis
  5. Seborrheic keratosis
  6. Herpes zoster
  7. Candidiasis
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2
Q

What is Xerosis ?

A

Dry, cracked, itchy skin. Inadequate fluid intake worsens. Use super-fatted soaps or cleansers.

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3
Q

What is Pruritis ?

A

Itchy skin. A symptom not a diagnosis. May be r/t med side effects or secondary to disease. A threat to skin integrity

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4
Q

What is Purpura ?

A

Thin, fragile skin – extravasation of blood into the surrounding tissue. Wear long sleeves & protect from trauma.

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5
Q

What is actinic keratosis?

A

Precancerous skin lesion. From sun exposure. Dermatology visits every 6-12 months to monitor & treat

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6
Q

What is Seborrheic keratosis ?

A

Waxy, raised, “stuck-on” appearance, benign lesion. Almost ALL older adults over 65 yo.

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7
Q

What is Herpes Zoster ?

A

Painful, vesicular rash, over a dermatome. Get vaccine at age 60.

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8
Q

What is Candidiasis ?

A

Yeast infection, often in skin folds. Keep skin clean and dry.

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9
Q

What are the Risk Factors for Pressure Injuries ? ( 7 )

A

Skin changes

Comorbid disease

Nutrition

Frailty

Cognitive deficits

Incontinence

Reduced mobility

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10
Q

How can we as nurses prevent pressure injuries ? ( 5 )

A

Risk assessment

Skincare

Nutrition

Mechanical loading & support surfaces

Education

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11
Q

Adequate diet is an important factor in what ?

A

delaying onset and managing chronic illness associated with aging

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12
Q

What is the MNA ?

A

Mini Nutritional Assessment ( Identifies adults and older adults who have or are at risk for developing malnutrition)

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13
Q

Proper nutrition includes all the essential nutrients

A

50% fruits & veggies

25% grains (whole)

25% protein-rich

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14
Q

A score of 12-14 on the MNA means…

A

normal nutritional status

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15
Q

A score of 8-11 on the MNA means…

A

risk of malnutrition

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16
Q

A score of 0-7 on MNA means…

A

malnourished

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17
Q

Why are institutionalized older adults at high risk for malnutrition ?

A

due to chronic disease and functional impairments

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18
Q

Older Adults with malnutrition have an increased risk for ?

A

risk of infection, pressure ulcers, anemia, hip fractures, hypotension, impaired cognition and increased morbidity and mortality

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19
Q

What is linked as the contributing/underlying risk factor of malnutrition ?

A

INFLAMMATION

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20
Q

How to Diagnose Malnutrition ?

A

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
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21
Q

Malnutrition Development ( Insufficient consumption of nutrients)

A

Micro – vitamins, minerals, phytochemicals

Macro – protein, carbs, fat, water

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22
Q

Malnutrition Development ( Inflammation- related )

A
  • Trigger – injury, surgery, or disease state
  • Inflammatory mediators INCREASE metabolic rate & impair nutrient utilization
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23
Q

What are the Factors affecting fulfillment of nutritional needs

A

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

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24
Q

What are the interventions to improve nutritional status ?

A

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

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25
Q

What is Dyshagia?

A

difficulty swallowing

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26
Q

What are Complications with Dysphagia ? (4)

A

Weight loss

Malnutrition and dehydration

Aspiration pneumonia

Death

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27
Q

What are the Risk Factors with Dysphagia ? (6)

A

CVA
Parkinson’s, Dementia
Traumatic Brain Injury
Aspiration Pneumonia
Improper Feeding Technique
Poor dentition

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28
Q

What are the S/S of Dysphagia ? (9)

A
  • Hiccups
  • Voice rattle
  • Gurgling in throat
  • Throat clearing
  • Pain
  • Hiccups
  • Chest pain
  • Wet or gurgling voice
  • Frequent respiratory infections
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29
Q

How to Prevent Dysphagia ? ( 10 )

A
  • 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
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30
Q

PEG Tubes in Advanced Dementia ( MYTH ) ( 4)

A
  • Prevent death from inadequate intake
  • Reduce aspiration pneumonia
  • Improve nutritional status
  • Provide comfort at end-of-life
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31
Q

PEG Tubes in Advanced Dementia ( FACT )

A
  • 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
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32
Q

What is Hydration ?

A

Adequate fluid consumption and maintenance of fluid balance essential to health

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33
Q

What are the Risk factors for changes in fluid balance ? (7)

A
  • Physiological changes in body water content
  • Impaired thirst sensation
  • Medications
  • Functional impairments
  • Chronic illness
  • Emotional illness
  • High environmental temperatures
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34
Q

What is Dehydration ?

A

Reduction in total body water

A geriatric syndrome

35
Q

What Diseases are Dehydration Associated with ?

A

DM, HF, respiratory disease, frailty

36
Q

What are the Complications for Dehydration ?(6)

A
  • Delirium
  • Thromboembolism
  • Infection
  • Renal failure
  • Kidney stones
  • Constipation
37
Q

What to look for when assessing for Dehydration ?(10)

A
  • 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.

38
Q

What are interventions for dehydration ?(12)

A
  • 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
39
Q

Oral Care ( If the Client has teeth ) (5)

A
  • 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
40
Q

Oral Care ( If the Client has no teeth )- Dentures (11)

A
  • 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
41
Q

Urinary incontinence - Urge

A
  • Overactive bladder
  • > 8/day, nocturia, urgency
42
Q

Urinary incontinence - Stress

A

Increased intra-abdominal pressure > leakage of 50mL or more

43
Q

Urinary incontinence - Functional

A
  • Nothing wrong with tract
  • Just can’t get to the restroom for some reason
44
Q

Urinary Incontinence - Interventions(8)

A
  • 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
45
Q

What is the most common cause of Sepsis in Older Adults ?

A

UTI

46
Q

UTI in older adults

A
  • 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.
47
Q

What does Constipation look like in Older Adults ?

A
  • Reduction in bowel movement frequency or difficulty in forming or passing of stool
  • 40% of older experience constipation
  • More common in women
48
Q

What are the Complications of Constipation ?

A
  • Impaction, obstruction, cognitive dysfunction, delirium, falls, increased morbidity & mortality
  • Increased risk for bowel cancer
49
Q

What are the Interventions for Constipation ?

A

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)
50
Q

Bulk-forming (fiber)- psyllium (Metamucil) ( Constipation )

A
  • Usually First line and contraindicated in very frail or with dysphagia
  • MUST – adequate fluid
51
Q

Osmotic- polyethylene glycol (PEG), milk of magnesia, lactulose ( Constipation )

A

Increases shift of water into stool

Often causes diarrhea – Less with PEG

Assess electrolyte levels

52
Q

Stimulant – bisacodyl, senna ( Constipation)

A

Stimulates peristalsis – good for opioid-induced constipation

Often causes cramping

May cause dehydration and electrolyte disturbances

53
Q

What are the Nursing Considerations about Enemas ?

A
  • Last resort
  • Don’t use on regular basis
  • May alter fluid and electrolyte status
  • Sodium phosphate enemas contraindicated in older
54
Q

What is A Fecal Impaction ?

A
  • Complication of constipation
  • Common in incapacitated and those in institutions
  • Increased incidence with narcotics
55
Q

What are the manifestations & complications of a fecal impaction ?(7)

A

Malaise, urinary retention, increased temp, incontinence, cognitive decline, hemorrhoids, intestinal obstruction.

56
Q

What are the Age related sleep changes ?(8)

A
  • 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
57
Q

What are the Nursing considerations in Sleep ?(5)

A
  • 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
58
Q

Sleep deprivation and fragmented sleep can adversely affect what ?

A

cognitive, emotional, and physical functioning as well as quality of life

59
Q

What is Biorhythm in Relation to sleep ?

A

Age related changes in the body’s perception of light-dark cycle and circadian sleep-wake rhythm

60
Q

What is a Sleep Cycle ?

A

Changes in sleep cycle that reduce amount of deep sleep and time spent in REM sleep

61
Q

What is Insomnia ?

A

Disturbed sleep in the presence of adequate opportunities and circumstances

62
Q

What Factors Diagnose Insomnia ?

A

Difficulty falling asleep >1 month

AND impairment in daytime functioning r/t poor sleep

63
Q

What Meds treat Insomnia ?

A

SSRIs, antihypertensives, anticholinergics, diuretics, stimulants, etc.

64
Q

What are some Sleep teachings ?

A

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
65
Q

What are the S/S of Sleep Apnea ?

A
  • Excessive daytime sleepiness
  • Snoring, gasping, choking
  • Headache, irritability
  • Symptoms often blamed on age!
66
Q

How do you Assess for Sleep Apnea ?

A

Epworth Sleepiness Scale

67
Q

What is obstructive sleep apnea ?

A

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

68
Q

What are consequences of Falls ?

A

Hip fractures

Traumatic brain injury

Fallophobia

  • Fear of falling causing limitations in function
69
Q

What are the Assessment tools for Falls ?

A

Hendrich II Fall Risk Model

Morse Fall Scale

Minimum Data Set (MDS 3.0)

70
Q

What are the Major Risk Factors for Falls ?

A
  • Orthostatic hypotension
  • Cognitive impairment
  • Impaired vision and hearing
  • Medications
  • Environmental factors
  • Weakness and frailty
71
Q

National Council on Aging: Fall Prevention - 1:39

6 Steps

A

Balance or exercise program

Talk to your Primary Care Provider

Review medications

Vision & hearing checks

Home safety

Talk with family

72
Q

What are chemical restraints ?

A

any drug that is used for discipline or convenience and not required to treat medical symptoms

73
Q

What are the Consequences of restraints in older adults ?

A

Do not effectively prevent falls, wandering, or removing medical equipment

Probably exacerbate the problem

Restrain-related death

  • Asphyxiation

Pressure ulcers, agitation, cognitive decline, depression

74
Q

EBP care = restraint-free care

A
  • The goal for care in the older especially
  • Should not be used to manage behavior symptoms
  • Treat underlying problem
75
Q

How much Physical Activity could be done in an Older Pt ?

A
  • 2.5 hours weekly of moderate aerobic

AND Muscle strengthening activities at least 2 days per week

  • All major muscle groups
76
Q

What types of Physical Activity should a older client pt be taught to do ?

A

Mod intensity aerobic

Muscle-strengthening

Stretching

Balance

77
Q

When should an Older pt NOT Exercise ? (4)

A
  • SBP > 200 mm Hg
  • DBP > 100 mm Hg
  • HR > 120 bpm
  • For 2 hrs after a big meal
78
Q

Feet – Age-related changes(5)

A
  • 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
79
Q

What are some Common Foot Problems ?

A
  1. Corns/calluses
  2. Bunions
  3. Hammer toe
  4. Onchomycosis
80
Q

What is Onychomycosis ?

A

Yellow, brown, opaque, brittle, and thick nails. Difficult to treat – costly & limited effectiveness.

81
Q

What are Bunions ?

A

Bony deformities – great toe or fifth toe from chronic squeezing or hereditary. Custom shoes, surgery, or steroid injection.

82
Q

What is a Hammertoe ?

A

Permanently flexed toe (clawlike). Custom shoes or surgery.

83
Q

What are Corns/calluses ?

A

Thick, compacted skin often from prolonged pressure. Pad and protect area is BEST. Proper fitting shoes.

84
Q

What is Proper foot care in the older population ?

A
  • 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

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