Geri week 5

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Geri week 5
2010-03-16 03:16:56
geri week 5

Geri week 5
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  1. Hydration Management (3)
    • Promotion of adequate fluid balance
    • Prevents complications resulting from abnormal or undesirable fluid levels
    • Water: an essential part of nutritional requirements, functions in the body include:
    • thermoregulation
    • Dilution of water-soluble medications
    • facilitation of renal and bowel function
    • creating and maintaining metabolic processes.
  2. Risks factors for dehydration (7)
    • Physical or emotional illness
    • surgery
    • trauma
    • conditions of higher physiologic demands
    • diminished thirst sensation
    • medications
    • environmental constraints
  3. Assessment (6)
    • Prevention is essential
    • Clinical signs may not appear until dehydration is advanced
    • attention to risk factors
    • skin turgor should be assessed at the forehead
    • elevated sodium, elevated serum osmolarity, and BUN/creatinine ratio
    • Urine color
  4. Interventions (2)
    • Oral hydration
    • Rehydration methods: intravenous, hypodermoclysis (inj of fluid into subq tissue to supply the body with liquids quickly.
  5. Bladder function: Normal bladder function requires..
    • An intact brain and spinal cord
    • competent lower UT function
    • motivation to maintain continence
    • functional ability to recognize voiding signals and use a toilet
    • environment that facilitates the process
  6. Age-related changes in bladder function
    • Decreased capacity
    • increased irritability
    • altered cueing (cued when bladder already 80% filled)
    • Contractions during filling
    • incomplete emptying
  7. Urinary incontinence
    • The involuntary loss of urine sufficient to be a problem
    • A stigmatized, underreported, under diagnosed, under treated condition that is erroneously through to be part of normal aging.
  8. Urinary incontinence: prevalence, consequences
    • Prevalence:
    • Affects an estimated 200 million adults worldwide
    • 75%-80% are female
    • Prevalence increased with age and functional dependency
    • Consequences:
    • Affects quality of life and has physical, psychosocial, and economic consequences
    • Loss of dignity, independence, and self-confidence, as well as feelings of shame and embarrassment
  9. Urinary Incontinence risk factors (8)
    • Cognitive impairment
    • limitations in daily activities
    • institutionalization
    • stroke
    • diabetes
    • obesity
    • poor general health
    • comorbidities
  10. Urinary incontinence types (2)
    • Transient: sudden onset, present for 6 months or less, usually caused by treatable factors
    • Established: either a sudden or gradual onset, categorized into the following types (urge, stress overflow, functional, mixed, and reflex and total incontinence)
  11. Implications (interventions 2)
    • Behavioral -
    • scheduled voiding
    • promted voiding
    • bladder training
    • biofeedback
    • pelvic floor muscle exercises

    • Lifestyle modifications:
    • dietary factors (increased fluid, avoidance of caffeine)
    • weight reduction
    • smoking cessation
    • bowel management
    • physical activity
  12. Interventions (4)
    • Urinary catheters: intermittent catheterization, continuous indwelling catheter, external catheters (condom catheters)
    • Absorbent products
    • Pharmacological
    • Surgical
  13. Fecal or Bowel Incontinence (3)
    • Continuous or recurrent uncontrolled passage of fecal material for at least one month
    • Transient or persistent
    • Devastating social ramifications for the individuals and families.
  14. Assessment: complete client history
    • Stool consistency and frequency
    • use of laxatives or enemas
    • surgical and obstetrical history
    • medication
    • effect on quality of life
    • focused physical exam with attention to the gastrointestinal system
    • bowel record
  15. Interventions (7)
    • Environment manipulation (access to toilet)
    • Diet alterations
    • habit-training schedules
    • improving transfer and ambulation ability
    • sphincter training exercises
    • biofeedback
    • medication and or surgery to correct underlying defects.
  16. Application of maslow's heierarchy
    Meeting elimination needs is basic to the maintenance of biological and physiological integrity.

    • May cause:
    • Excess disability
    • insecurity
    • social isolation
    • curtailment of meaningful activities and relationships
    • inability to achieve a meaningful and fulfilling life
  17. Age related sleep changes (9)
    • More time spent in bed awake before walling asleep
    • Total sleep time and sleep efficiency are reduced
    • awakenings are frequent, increasing after age 50 (>30 minutes of wakefulness after sleep onset in >50% of older subjects)
    • Daytime napping
    • Changes in circadian rhythm *early to bed, early to rise)
    • Sleep is subjectively and objectively lighter
    • Rapid eye movement (REM) sleep is short, less intense, and more evenly distributed.
    • Freq. of abnormal breathing events is increased
    • Freq. of leg movement during sleep is increased
  18. Sleep disorders (2)
    • Insomnia:
    • Sleep-onset insomnia
    • Sleep-maintenance insomnia
    • Nonrestorative sleep

    • Sleep Apena:
    • Obstructive Sleep Apnea (OSA)
    • -- A disorder characterized by repetitive cessation (>10 seconds) of respiration during sleep
  19. Restless Leg Syndrome (4)
    • A sensorimotor neurologic disorder
    • Characterized by the uncontrollable need to move the legs
    • Often accompanied by discomfort in the legs
    • Other symptoms: Paresthesias, creeping sensations, crawling sensations, tingling, cramping, burning sensations, pain
  20. Assessment (3)
    • Sleep habits should be reviewed with older adults in all settings
    • Evaluate: how well the person sleeps at home, how many times the person is awakened at night, what time the person retires, what rituals occur at bedtimes
    • Sleep diary or log
  21. Interventions (3)
    • Pharmacological treatment
    • nonpharmacological interventions
    • promote good sleep habit
  22. Activity (3)
    • Activity is a direct use of energy in voluntary and involuntary physical and mental ways
    • Alter the microenvironment and macroenvironment of the individual
    • Even a small amount of time can improve health.
  23. Application of maslow's heirarchy of activity
    • Sleep and activity needs must be met:
    • 1. maintain biological integrity
    • 2. meet higher-level needs as safety and security, belonging and attachment, self-esteem and self-efficacy, and self-actualization and transcendence
  24. Xerosis (4)
    • Extremely dry, cracked, and itchy skin
    • Occurs primarily in the extremities
    • Exposure to environmental elements contributes to skin dryness and dehydration
    • Dry skin may be just dry skin, but it may also be a symptom of more serious systemic disease.
  25. Pruritus (3)
    • A symptom, not a diagnosis or disease
    • A threat to skin integrity because of the attempts to relieve it by scratching
    • Aggravated by perfumed detergents, fabric softeners, heat, sudden temp changes, gentle touch, pressure, vibration, electrical stimuli, sweating, restrictive clothing, fatigue, exercise, and anxiety.
  26. Seborrheic Keratosis
    • A benign growth that appears mainly on the trunk, face, neck, and scalp as single or multiple lesions found especially in men
    • AA waxy, raised, verrucous lesion, flesh-colored or pigmented in varying sizes
  27. Herpes Zoster (Shingles)
    • A viral infection frequently seen in older adults
    • Peak incidence occurs between ages 50 to 70
    • Immunosupprressed elders and those with histories of chicken pox are at greatest risk
    • Always occurs along a nerve pathway or dermatome
  28. Photo Damage of the Skin
    • Most common causes of skin damage and skin cancer
    • Damage comes from prlonged exposure to environmental ultraviolet light or that received in tanning booths
    • Much of the associated damage is preventable
    • Preventive measures should begin in childhood.
  29. Actinic Keratosis (3)
    • A precancerous lesion which may become a squamous cell carcinoma
    • Directly related to years of overexposure to UV light
    • characterized by rough, scaly, sandpaper-like patches, pink to reddish-brown on an erythematous base
  30. Basal Cell Cacinoma
    • Most common malignant skin cancer
    • Slow-growing and metastasis is rare
    • precipitated by extensive sun exposure, especially burns, chronic irritation, and chronic ulceration of the skin
    • Usually begins as a pearly papule with prominent telangiectasis (blood vessels) or as a scare-like area where no history of trauma has occurred
  31. Squamous Cell Carinoma
    • The second most common skin cancer
    • Aggressive and has a high incidence of metastasis if not identified and treated promptly
    • More prevalent in fair-skinned, elderly men who live in sunny climates
    • Usually found on the head, neck, hands
    • Lesion begins as a firm, irregular, fleshy, pink-colored nodule that becomes reddened and scaly, much like actinic keratosis
  32. Melanoma (5)
    • A neoplasm of melanocytes
    • the least common skin cancer
    • high mortaliy rate because of its ability to metastasize quickly
    • classical, multicolor, raised appearance with an asymmetrical, irregular border
    • Treatable if caught very early before it has a chance to invade surrounding tissue.
  33. ABCD Rules of Melanoma
    • Asymmetry: One half does not match the other half
    • Border irregularity: The edges are ragged, notched, or blurred
    • Color: The pigment is not uniform in color, having shades of tan, brown, or black, or a mottled appearance with red, white, or blue areas
    • Diameter: The diameter is greater than the size of a pencil eraser or increasing in size
  34. Implications for xerosis and pruritus
    • The nurse attends to environmental prevention and treatment and provides expert care of the skin
    • cream to all skin after bathing -- always

    Pruritus: goal is to reduce and hopefully alleviate the itching
  35. Implications for Cancer and Herpes Zoster
    • Cancer: prevention and early recognition and treatment of skin cancers
    • Herpes Zoster:
    • Provide emotional support during the outbreak and education regarding reducing secondary infections and cross-contamination
    • Pain control
  36. Pressure ulcers (4)
    • Localized injury to the skin and/or underlying tissue
    • Usually over a bony prominence
    • Result of pressure, or pressure in combination with shear and or friction
    • Can develop anywhere on the body
  37. Key aspects of assessment of a pressure ulcer
    • Location and exact size
    • condition of the surrounding tissue
    • condition of the wound edges: for example, smooth and white or irregular and pink
    • wound bed: warmth, moisture, color, odor, amount, and color exudate
  38. Assessment (3)
    • Detailed head to toe skin examination - braden scale-assessment of risk of development
    • Analysis of laboratory findings
    • ulcers are assessed during each dressing change for worsening: PUSH tool
  39. Interventions (2)
    • Goal of nurses is to help maintain skin integrity against the various environmental, mechanical, and chemical assaults that are potential causes of skin breakdown
    • Nurses focus on prevention through any measure that relieves pressure to the vulnerable joints and bony prominences.
  40. Common Foot Problems (2)
    • Many foot problems occur because of the shoes we wear to protect them, wear and tear, and misuse of feet
    • Foot health and function may reflect systemic disease or give early clues to physical illness.
  41. Fungal Infections
    • May affect the skin of the foot as well as the nails
    • Nail fungus, onychomycosis
    • Characterized by degeneration of the nail plate with color changes to yellow or brown, and opacity, brittleness, and thickening of the nail
    • Fungal infection of the foot
    • - Tinea pedis (athlete's foot)
  42. Onychomycosis
    yellowing, crumbling, and thickening of the toenails
  43. Feet implications (4)
    • advocate for promoting the best foot health possible
    • care should be directed toward optimal comfort and function, removing possible mechanical irritants and decreasing the likelihood of infection.
    • assess the feet for clues to well-being and functional ability
    • referral to the podiatrist if foot assessment warrents