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Final 314 Frail Elde
Final 314 Frail Elderly Weber chap 26
| Question | Answer |
|---|---|
| Major concerns acronym | SPICES |
| S | Skin impairment |
| P | poor nutrition |
| I | incontiwnce |
| C | Cognative impairment |
| E | evidence of falls |
| S | sleeping distrubances |
| dysphagia | Difficulty in swallowing. |
| dyspnea | ficulty in breathing, often associated with lung or heart disease and resulting in shortness of breath. Also called air hunger. |
| intermittant claudication | An aching, crampy, tired, and sometimes burning pain in the legs that comes and goes -- it typically occurs with walking and goes away with rest -- due to poor circulation of blood in the arteries of the legs. |
| abdoman parkinsons dM diabetes mellitus decimorgan | ?? dont understand notes |
| Name the 4 types of urinary incontinence | urge, stress, overflow, functional |
| urge, | This occurs when the need to urinate comes on too fast -- before you can get to a toilet. Your body may only give you a warning of a few seconds to minutes before you urinate. Urge incontinence is most common in the elderly and may be a sign of an infecti |
| stress, | Stress incontinence is when urine leaks because of sudden pressure on your lower stomach muscles, such as when you cough, laugh, lift something or exercise. Stress incontinence usually occurs when the pelvic muscles are weakened, for example by childbirth |
| overflow, | This type of incontinence is a constant dripping of urine. It's caused by an overfilled bladder. You may feel like you can't empty your bladder all the way and you may strain when urinating. This often occurs in men and can be caused by something blocking |
| functional | This type occurs when you have normal urine control but have trouble getting to the bathroom in time. You may not be able to get to the bathroom because of arthritis or other diseases that make it hard to move around. |
| fall assessment age highest % of falls occur? | 80/89 1 IN 5 = DEATH |
| fall assessment SELF IMPOSED ACTIVITY RESTRICTION due 2? | fear of falling |
| fall assessment time of day = falls? why? | early morning orthostatic hypertention |
| orthostatic hypertension | Relating to or caused by standing upright, as hypertension.Abnormally elevated blood pressure. |
| nursing assessment normal age related changes in skin hair nails | Lentigines,venous lakes, skintags, cherry angiomas,senile,purpura |
| nursing assessment normal age related changes in skin hair nails Lentigines | liver spots,Lentigines are small (usually <3 cm) circumscribed, dark brown macules that can appear anywhere on the body. They are not related to sun exposure and do not fade(1). Multiple or generalized lentigines occur without associated abnormalities |
| nursing assessment normal age related changes venous lakes | reddish dilated blood vessels usually on the face venous = Of, relating to, or contained in the veins. |
| nursing assessment normal age related changes in skin hair nails skin tags | Abnormal outward pouching of skin, with a varying size. |
| nursing assessment normal age related changes in skin hair nails cherry angiomas | cherry angiomas start @ age 30 |
| nursing assessment normal age related changes in skin hair nails senile purpura | senile purpura vivid purple patches The skin of an aged person is thinner and easily disrupted. Blood vessels, too, are easily disrupted, resulting in bruises called senile purpura. Senile purpura is commonly seen on the forearms. Its presence does not in |
| nursing assessment normal age related changes head & neck = | atrophy, ROM, "Buffalo Hump" |
| atrophy, | Pathology. A wasting or decrease in size of a body organ, tissue, or part owing to disease, injury, or lack of use: muscular atrophy of a person affected with paralysis. |
| ROM, | some loss |
| "Buffalo Hump" | shortening of neck |
| nursing assessment normal age related changes mouth & throat | salivary glands, low production, gum ridges, recedes (dentures may not fit as well), swalling, gag reflex |
| nursing assessment normal age related changes Nose & sinuses | smell decreases, breathing, sinuses free lesion, NG tubes high risk for infection |
| nursing assessment normal age related changes eyes and hearing | hair in ears men, cerumen,dryer and more production,sounds, high pitch harder to hear |
| cerumen | earwax |
| nursing assessment normal age related changes thorax & lungs | respiratory rate increases 16-24, diaphragm use more i breaths,lung bases diminshed d/t lach of use i more shallow breaths |
| nursing assessment normal age related changes heart and blood vessels orthosatic BP why? | barrell receptors not as receptive |
| heart and blood vessels exercise tolerence | not as tolerent raises pulse 10-20 bpm |
| heart and blood vessels pulses | easier doppler pedal |
| heart and blood vessels veins | more prominent return to normal i in 2 min |
| heart and blood vessels extra heart sounds | some are normal |
| nursing assessment normal age related changes breasts | pendulous, fat compasation,high fibriotic tissues, nipples retract loss musculaturs, make sure skin is intact |
| nursing assessment normal age related changes abdomen | gastoric production declines, malnuitriation wt < 80% IBW |
| nursing assessment normal age related changes musculoskeletal standing | widen base of support |
| nursing assessment normal age related changes musculoskeletal get up & go test | clients wo gait or complete thr test appx 10 min. |
| nursing assessment normal age related changes musculoskeletal | full ROM feet problems |
| physical declines in aging are often noticed | acute or chronic illness places excessive demands on the body |
| lentigo | A small, flat, pigmented spot on the skin. a small brownish spot (of the pigment melanin) on the skin |
| postural instabality iin advanced age caused by? | diminished vibitory sensations and slowed motor responses |
| sign of infection in ederly more common than fever | confusion |
| age 90 renal blood flow decreased by | 50% |
| neurologic change associated w/ normal aging = | -reacation time |
| calcification stiffening and dilation of the aortic valve | soft systolic murmur @ base of heart |
| -ventricule compliance | s4 |
| - of elasticity in aorta & arteries | rise in systolic blood preassure |
| decreased baroreceptor sensivity | orthostatic hypertension |
| meds with anticholinergic side effects assessment paramaters indicated = | delieriam, nausia, stop breathing |
| anticholinergic | Inhibiting or blocking the physiological action of acetylcholine at a receptor site: anticholinergic drugs. |
| acetylcholine | A white crystalline derivative of choline, C7H17NO3, that is released at the ends of nerve fibers in the somatic and parasympathetic nervous systems and is involved in the transmission of nerve impulses in the body. |