week 9 : tissue integrity

Question 1

what concepts connect to tissue integrity?

Answer 1

nutrition
perfusion
gas exchange
elimination
thermoregulation
fluids and electrolytes
infection
pain
sensory perception
mobility

Question 2

what is the major difference between young and old skin

Answer 2

subcut declines
fewer langerhans cells - related to immune response
thinner epidermis
flatter basement membrane
fewer melanocytes
diminished dermal blood supply

Question 3

age related changes to the epidermis

Answer 3

thins - bruising increases
T cell function declines - increase risk for herpes and herpes simplex
Increase in skin renewal time and decrease in turnover of epidermal replacement - inflammatory response takes longer
Decrease in melanocytes and concentrated areas of melanocytes (lentigines and seborrheic keratoses)

Question 4

age related changes to dermis

Answer 4

Dermis
◦ Thinner
◦ Provides a supportive layer of connective tissue made of collagen
◦ Collagen synthesis decreases
Decreased blood vessel
Skin temperature increases fragments
◦ Elastin thickens and
◦ Dermis supports hair follicles, sweat and sebaceous glands, nerve fibers, muscles and blood vessels

Question 5

what are the age related changes related to hypodermis?

Answer 5

Fat distribution changes- layer of fat atrophies in some areas (hands, face, feet)
◦ Nails- slower growth, nails become thinner, fragile, brittle and more prone to splitting, more opaque
◦ Changes in hair colour- quality and distribution
◦ Reduced efficiency of sweat (eccrine) glands
◦ Reduction in sebaceous glands

Question 6

what are some age related changes to hair and nails

Answer 6

determined by genetics
Most men lose hair (75% by age 70)
◦ Hair increases in men in the ears, nose and eybrows Women have decreased hair
◦ Women can lose hair in their lower legs that can be misinterpreted as peripheral vascular disease
Nails become more brittle, harder and thicker
Shape can change to become flat, or concave and vertical ridges can appear
Rate of nail growth decreased

Question 7

Risk factors related to the individual:
cardiovascular problems - arterial/venous

Answer 7

arterial insufficiency
PAD (peripheral arterial disease)
risk factors: obesity, CAD smoking, HTN diabetes
* Increase risk related to slight trauma can cause arterial ulcer - between toes or tips of toes

venous insufficiency
risk factor: diabetes
edema in lower legs
explains brown color of lower legs
Skin tissue becomes vulnerable to trauma from minor assaults

Question 8

what are some risk factors relate to ind: skin problems?

Answer 8

Xerosis
most common skin problem
more moisture escapes related to thinner epidermis
Causes: inadequate fluid intake, exposure to environment, nutritional deficiencies and smoking, drying soap, incontinence
Pruritus
Itchy skin can be a result of xerosis
Be alert for signs of infection
Causes: environmental, can be a sign of systemic disease
Herpes Zolster (shingles)
Rash occurs occurs along a nerve pathway (dermatone)
Clusters of papulovesclicles
Pain and tingling along nerve pathways
20% have Post herpatic neuralgia

Question 9

risk factors related to ind: foot problems

Answer 9

Corns and Calluses

Bunions

Hammer toe

Fungal infection

Question 10

what are corns and calluses?

Answer 10

◦ Growths of impacted skin that occur as a result of prolonged pressure
◦ People with diabetes, neurological impairment or poor circulation are at risk and need
considered treatment

Question 11

what are bunions?

Answer 11

◦ Bony prominence
◦ heredity
◦ Walking can be compromised Foot problems
Hammer toe

Question 12

what is a hammer toe?

Answer 12

◦ A toe that is permanently flexed
◦ Seen in conjunction with bunions

Question 13

what is a fungal infection?

Answer 13

◦ Skin and nail can be affected
◦ Associated with degeneration of the nail plate
◦ Sides of the nail can dig into the skin like an ingrown toenail

Question 14

what is the most common skin damage factor that can cause cancer?

Answer 14

THE SUN
risk of damage to the skin from the sun is higher with the older adult
* Preventable - sunscreen

Question 15

what are some health risks related changes - individual risk factors that impact and environment?

Answer 15

photo aging
skin cancer
basal cell cancer
shamus cell cancer
malignant melanoma

decreased ability to manage environmental temperature variation
Decreased ability to stabilize fluids and electrolytes
Foot problems can cause impaired mobility

Question 16

what are some interventions : education to reduce risk of impaired skin function

Answer 16

Maintaining Healthy Skin
* Thermoregulation/ electrolyte balance (keeping hydrated)
* Protection
* Inspection

Personal Care Practices
* Protection of epithelium of skin * Dryness, moisture
* Method of drying
* Protection of skin from injury * eg. falling
Preventing Sun Damage
* Protection – use at least SPF 15
Preventing injury from abrasive forces
* Protection of epithelium from shearing

Question 17

what are some ways to reduce the risk of damage to skin?

Answer 17

Education on risk of photodamage and smoke damage
- sun protection

Education on observation of skin Recognize skin problems related to
change in moles
when in doubt, check it out

Cardiovascular disease (Peripheral artery disease and Venous insufficieny
Can lead to serious skin infections
* Mild dermatitis (inflammation of the skin), to ulceration and gangrene
* Prevent trauma to skin

Question 18

what are some interventions to reduce risk in sin problems?

Answer 18

Xerosis
Keep skin hydrated
Treatment: treat dehydration and reduce environmental stressors (tepid bath rather than hot bath)
Environmental humidity at 60%
Use skin products that help retain moisture of the skin
Lubricants and oils, petroleum jells, zinc oxide (protects skin)
Pruritus
Reduce itching
Treat: rehydration of skin, cool compresses or baths with oatmeal, Epsom salts
Herpes Zolster
Prevention re: vaccines can prevent !Medical and Pain management
Antiviral medication and pain management Emotional support

Question 19

Interventions to reduce risk for skin
integrity related to foot problems - assessment and care of toenails

Answer 19

assessment:
◦ Observation of gait
◦ Past medical history
◦ Assess feet

care of toenail:
Trim after bath
Nails trimmed straight across
Footcare of person with diabetes is done by a trained nurse or podiatrist
Diabetics should never have nails done at a commercial establishment
Ingrown toe nails require attention by a specialist
Footwear can improve symptoms of arthritis (firm soles may decrease pain associated with walking)

Question 20

what are some intervention to reduce the risk related to foot problems?

Answer 20

Corns and Calluses
◦Oval corn pads, moleskins or lambswool, gelpads
◦Daily lubrication

Bunions
◦Medical management
◦Shoes that do not add pressure to the area

Hammer toe
◦ Non constricting footwear

Fungal infection
◦ Difficult to treat medically
◦ Keep feet try and hygiene

Question 21

what is the definition of pressure injury?

Answer 21

“any lesion caused by unrelieved pressure that results in damage to underlying tissues. Pressure ulcers usually occur over a bony prominence and are staged to classify the degree of tissue damage observed”

Question 22

how would you reduce the risk for pressure injury?

Answer 22

Identify risk
Monitor older adults who are at risk Prevention/Assessment – Nursing Interventions

Question 23

select all that is true regarding the risk fo having pressure injury?
One of the top three safety concerns for the institutionalized patients
Preventable but remain prevalent in LTC settings
Associated with increased length of stay in hospitals
decreased mortality
Increased rate of bacteremia and multi- drug resistant organisms
Decreases social well being and quality of life
High treatment costs

Answer 23

everything true except increased mortality

Question 24

select all that it true: Risk factors for pressure injury

Frailty
Immobility and or neurologically impaired Acute illness
Weight loss
Poor nutrition (dehydration) Hypoproteinemia
Impaired sensory feedback system- Diabetes Moist skin
Sedated or unconscious
Ventilation requiring head of the bed elevation

Answer 24

true

Question 25

what are some of the bony prominences associated with the highest risk fo pressure injury

Answer 25

sacrum coccyx, knees heels and toes

Question 26

true or false: how to identify risk: Assess for risk factors ple: Braden Scale Close monitoring of skin Initiate appropriate interventions (interprofessional collaboration) to prevent further skin breakdown and promote healing

Answer 26

true

Question 27

what do you recognize when monitoring skin conditions?

Answer 27

Observe and Assess- Skin condition ◦ Daily head to toe assessments of persons at risk focusing on bony prominences ◦ Hyperemia – redness (consider that this is more difficult to assess in darkly skinned people) ◦ Changes in temperature ◦ Assess existing pressure injuries with every dressing change ◦ Assess pain and discomfort

Question 28

what are the different stages of dermal pressure ulcers?

Answer 28

stage I, Stage II, stage III stage IV and unstageable

Question 29

is this true regarding unstageable pressure ulcer? Wound bed covered by necrotic tissue/ slough/eschar Unable to accurately stage injury Depth unknown

Answer 29

yes

Question 30

what is a deep tissue pressure injury

Answer 30

A localized area of purple or maroon discoloured intact skin A blood filled blister due to damage of underlying soft tissue from pressure &/or shear An area which is painful, firm, mushy, boggy, warmer or cooler than adjacent tissue

Question 31

what are some Interventions to reduce risk for pressure injuries?

Answer 31

Occupational Therapist Physiotherapist Dietician Clinical Nurse Specialist

Question 32

true or false: effective interventions lead to: Maintenance of intact and health skin Absence of pressure injuries. Reduce risk for skin cancer Positive self esteem

Answer 32

true

Question 33

what is tissue intolerance?

Answer 33

Factors that impact the degree to which tissue is able to tolerate persistent pressure

Question 34

select all that is true regarding tissue intolerance: Blood vessels are constricted by persistent pressure on the skin and underlying structures Cellular respiration is impaired Cells die from ischemia and anoxia Variable between people and bodies Inversely affected by moisture, friction, shearing, amount of pressure, age, nutritional status, anemia, and low arterial pressure

Answer 34

all true

Question 35

what are some clinical judgement steps that can be used to treat pressure injuries?

Answer 35

Recognize changes in the skin Recognize risks for reduced skin integrity Intervention to treat pressure injury Interventions to decrease risk How do we know if what has been done is effective?

Question 36

what is the anatomy of the oral cavity?

Answer 36

oral cavity proper oropharynx nasal cavity soft palate hard palate oral vestibule lips teeth tongue uvula

Question 37

true or false: oral health is more than good teeth

Answer 37

true

Question 38

select all that is true about the benefits of oral health Oral health is associated with good quality of life for the older adult Oral care reduces the risks of pneumonia, viral respiratory infections, acute respiratory distress syndrome, and sepsis Good oral health contributes to bad nutritional status May reduce the risk of post viral complications from COVID in older populations Implementing oral care can reduce care worker’s burden Missed oral care in the hospitalized older adult is associated with deconditioning: aspiration pneumonia, dysphagia, and sarcopenia

Answer 38

false; contributes to good nutritional status

Question 39

does good oral health lead to the ability to taste and enjoy food - ability to chew - ability to swallow - body image

Answer 39

true

Question 40

what is the scope of oral health?

Answer 40

oral health - mucous membranes, teeth, chewing to oral health - periodontitis

Question 41

select all that is true about the age related changes to the oral cavity: Changes to the oral mucosa like other epithelial tissue but not exposed to radiation Subject to trauma from mastication Has a greater infectious burden Loss of elastic fibers and thickening and disorganization of collagen in the connective tissue

Answer 41

all true

Question 42

select all that is true about the age related changes to the oral cavity: Increase in function salivary glands primarily related to other pathological conditions and medications (anticholinergic meds) Decrease in blood vessels and nerves Teeth have a decrease in enamel Darker color of teeth Healthy oral aging is associated with normal function and comfort Good oral health associated with healthy aging

Answer 42

first one is false your sucked

Question 43

what is gingivitis, periodontal disease and what are these examples of?

Answer 43

gingivitis - gums are swollen and red and may bleed periodontal disease- increased severity of gum disease, infection and inflammation of the gum and bone that surround and support the teeth examples of altered oral health

Question 44

what are some cues for altered oral health?

Answer 44

Tooth loss – edentulous Bad breath Painful chewing Loss of teeth Decreased enjoyment of food

Question 45

what are some individual risk factors to a decline in oral health?

Answer 45

health conditions: diabetes functional decline: Older adult with moderate to severe impairment are at risk for reduced oral health medications: over 500 meds cause dry mouth mechanical ventilation and Oxygen therapy

Question 46

select all that is true regarding xerostomia: dry mouth Increases the risk of oral plaque build up and is a problem common to older adults Caused by decreased salivary flow Presents as dry, red mucosa, fissured tongue, dry, cracked lips Can result in build up of debris in mouth Over 500 medications have this as an adverse medication affect

Answer 46

all true

Question 47

select all that is true regarding periodontitis: severe gum infection Caused by bacterial dental plaque Hardens into tartar the promotes bacterial infection Build up results when there is poor oral hygiene

Answer 47

true

Question 48

what are some warning signs of bad oral health?

Answer 48

red swollen gums, loose teeth, sensitive teeth, teeth pulled away from gums

Question 49

what are some individual risk factors for poor oral health?

Answer 49

Smoking, Poor oral hygiene Stress Malnutrition Diabetes

Question 50

interventions to reduce risk fo oral health problems?

Answer 50

Regular oral exams Teeth cleaning Treatment of dental carries Education on dental hygiene Fluoride in water No smoking programs Access to good nutrition Fluoride treatments

Question 51

what do you use to monitor in terms of oral health?

Answer 51

oral health assessment too (OHAT) Lips ◦ Tongue ◦ Gums and Tissue ◦ Saliva ◦ Natural teeth ◦ Dentures ◦ Oral cleanliness ◦ Dental pain ◦ Dental examinations ◦ Family or guardian responses ◦ Oral health plan

Question 52

what can you use to assess oral cavity?

Answer 52

assess every 2 weeks use flashlight tongue depressor Document, describe, report and report – lumps, red or white patches, red swollen gums, broken teeth, debris or food Ability to perform oral hygiene Impaired manual dexterity (OT may be helpful)

Question 53

what is the genera; care for gums and teeth?

Answer 53

Twice daily brushing – 2 minutes each time * Twice a day flossing * Electric better than regular * Soft bristles to prevent oral mucousal injury * Flouride should be a part of toothpaste * Clean between teeth * Use nonalchohol based mouthwash once a day (Listerine)

Question 54

what is denture care?

Answer 54

Inflammation can result if dentures are not cared for Take out dentures over night Use Denture toothpaste Use soft toothbrush or denture brush Rinsed after every meal Cleaned once a day Cleansing of gums Tongue scraping

Question 55

what are some interdisciplinary support for oral hygiene?

Answer 55

Dieticians ◦ Optimizing diet Speech Language Therapy ◦ exercising perioral swallowing and speech muscles ◦ food/fluid staging and denture care Occupational Therapist ◦ optimal position on bed or chair, ◦ use of feeding tools, Dentists and dental hygienists ◦ Teeth cleaning and oral assessments