Geri week 5

• 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.

• Physical or emotional illness
• surgery
• trauma
• conditions of higher physiologic demands
• diminished thirst sensation
• medications
• environmental constraints

• 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

• Oral hydration
• Rehydration methods: intravenous, hypodermoclysis (inj of fluid into subq tissue to supply the body with liquids quickly.

• 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

• Decreased capacity
• increased irritability
• altered cueing (cued when bladder already 80% filled)
• Contractions during filling
• incomplete emptying

• 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.

• 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

• Cognitive impairment
• limitations in daily activities
• institutionalization
• stroke
• diabetes
• obesity
• poor general health
• comorbidities

• 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)

• 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

• Urinary catheters: intermittent catheterization, continuous indwelling catheter, external catheters (condom catheters)
• Absorbent products
• Pharmacological
• Surgical

• Continuous or recurrent uncontrolled passage of fecal material for at least one month
• Transient or persistent
• Devastating social ramifications for the individuals and families.

• 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

• 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.

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

• 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

• 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

• 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

• 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

• Pharmacological treatment
• nonpharmacological interventions
• promote good sleep habit

• 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.

• 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

• 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.

• 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.

• 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

• 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

• 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.

• 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

• 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

• 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

• 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.

• 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

• 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

• 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

• 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

• 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

• 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

• 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.

• 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.

• 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)

yellowing, crumbling, and thickening of the toenails

• 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