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Skin and feet
- these two are overlooked bc of focus on disease and illness
- integrity of skin and functional ability of feet are essential for well being
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age related changes
- dryness
- loss of dermis thickness
- decrease elasticity
- decreased collagen synthesis
- changes in melanocytes
- nails: thick hard brittle
- decrease blood supply to feet
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Physical assessment
- comprehensive and detailed
- review past lecture notes...lol
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skin of the older adult
- exposure to heat, cold, water, trauma, friction and pressure affects the integrity of the skin.
- skin problems of older adults include:
- xerosis
- pruritis
- seborrheic keratosis
- herpes zoster
- cancer
- those who are immobile or medically fragile are at risk for fungal infections or pressure ulcers
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xerosis
- extremely dry skin, cracked itchy skin
- is primarily seen on extremities but can affect the face and truck
- cause: age related changes
- - worsened by inadequate fluid intake, exposure to environmental elements, smoking and nutritional defciencies
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xerosis prevention
- natural oils, creams, lotions
- tepid bath water
- avoid alcohol base products
- fluid hydration
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pruritis
- itchy skin
- - syndrome not disease
- accompanies disorders such as chronic renal failure, bilary of hepatic disease and iron deficiency
- can damage the intergrity of the skin: scratching
- - inflammation and infection
- aggrevated by:
- - perfumed detergents, fabric softeners, heath and sudden temperature changes, pressure, sweating, restrictive clothing, fatigue, exercise, and anxiety
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Pruritis helpful measures
- rehydration
- cool compresses
- oatmeal or epsom salt
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Scabies
- skin condition that causes itching especially at night but the burrowing mite called sarcoptes scabiei
- contagious
- diagnosis is made by close observation or scraping
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Scabies treatment
- treatment is for entire family, care givers, close contact
- eliminate infestation with prescribed lotions and creams
- - elimite, lindane
- oral agents: stromectol
- wash: hot, soapy, and high heat
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Purpura
- extravasation of blood into the surrounding tissue caused by fragility of capillaries, thinning of dermis
- usually observed on the dorsal surface of the forearm and hands
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Purpura treatment prevention
- care givers need to be gentle with older adults
- wearing long sleeves shirts for protection reduces shear and friction
- to reduce the risk of skin tears, nonadherent dressings are secured with tubular retention bandages
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keratoses
- two types: seborrheic and actinic
- seborr
- - benign growth on truck, face, neck and scalp
- in single or multiple lesions
- usually appears in 65 over
- is more common in men
- tag like appearance in people with darker skin
- Actinic
- pre cancerous
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Keratosis
- stuck on appearacen waxy raised lesion
- treatment removed by dermalogist
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Actinic keratosis
- is precancerous lesion
- can become squamous cell carcinoma
- directly related to UV light exposure
- usually found- face, lips, hands and arms
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Keratosis prevention
- sun block and reduce sun exposure
- follow up by dermatologist
- early identification and treatment are essential
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Herpes Zoster
- Viral infection: shingles
- occurs mostly in adults who are fifty yrs and older with compromised immuned systems and/on immunosuppresive therapy
- cause: reactivation of varicella zoster virus (VZV) within sensory nerves of dorsal root ganglion, decades after initial VZV infection
- - occurs along nerve pathway, decades after initial VZV infection
- - occurs along nerve pathway (dermatone)
- - usually thoracic region
- - affects eye medical emergency**
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Herpes zoster how it starts and what it looks like
- onset begins with itching, tingling, or pain affected dematone (pathway), several days before rash appears
- rash: clusters of papulovesicles along dermatone
- can be painful and pruritic
- lesions rupture and crust and resolve
- scarring can occur
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Herpes zoster treatment
- early identification and treatment
- oral agents: antiviral agents
- pain and pruritic management
- vaccine all over age of 60 yrs
- complications: infection, postherpetic neuralgia (pain), eye involvement emergency can go blind
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Photo damage of the skin
- is damage of the skin, prolonged exposure to sun light
- - enviroment and tanning beds
- overexposure to the sun is themost common cause of skin damage and skin cancer
- - approx 90% age related cosmetic problems
- most incidents of sun damage is preventable
- - start early
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Skin Cancers
- skin cancers are the most common of all cancers
- basal cell, squamous cell and melanoma
- prevention, early identification and treatment are essential
- - primary
- secondary
- - tertiary
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Basal cell carcinoma
- most common MAGLINANT skin cancer
- occurs in older adult but becoming more frequent in younger adults
- triggered by extensive sun exposure, chronic irritation or ulceration
- begins as pearly like papule with blood vessels or scar like tissue in an area with no previous trauma, can ulcerate
- diagnosed by biopsy
- early detection and treatment are necessary
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Squamous cell carcinoma
- second most common skin cancer
- aggressive and high incidence of metastasis
- incidence: fair complexion, older men, chronic exposure to the sun
- is found on the head, neck and hands
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Squamous cell carcinoma description
- lesions are firm, irregular, fleshy, pink colored nodules that become reddened and scaly
- maybe wart like with gray top and horny texture and/or ulcerated with raised defined borders
- because of a different appearance they tend to be overlooked
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melanoma
- less than 5% of skin cancers are this type- incre in the last 30 yrs
- currently it occurs more often in young fair skinned women and older men
- occurs in those with a history of blistering sunburns, who are faired skin with freckles and have red or blond hair
- appears on the legs and backs of women and on the back of men
- metastasizes quickly, high mortality rate
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melanoma ABCD
- ABCD rules for melanoma
- early identification and treatment are essential
- asymmtry, border, color, diameter (no bigger than an eraser)
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Candidiasis
- fungal infection
- risk: obesity, malnutrition, antibiotics or steriouds therapy hx of dm
- grows in warm, moist, dark areas- skin folds, axillae, groin, under breast folds, and corner of mouth and vagina (yeast infection)
- tx prevention
- - dry areas, incontinence care
- topical anitfungal agents- nystatin
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Candida infection
- thrush
- risk: compromise immune system, long term steriod use,
- irregular white flat raised patches on a reddened base
- painful
- tx nystatin swish
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Pressure ulcers
- injury to the skin usually as a result of pressure over boney prominence
- older adults account for more than 70% of presssure ulcers
- risk factors for elders are co morbid illness, nutritional status, cognitive decifits and reduce mobility
- prevention is consider the key to care- frequent position change to minimize pressure
- medicare and medicaid reimbursement is not given if pressure ulcers are acquired during hospital care
- is costly to treat and requires extensive rehabiltation at times
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braden scale
- assesses the risk in a numerical scoring system based on sensory perception, moisuture, activity, mobility, nutrition, and friction or shearing
- thorough hx of risk factors, age, medication, and co morbids is taken
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Implication to geron nurising and healthy aging skin
- treatment and prevention of pressure uclers is complex
- assessment should be performed upon admission with a risk for development and healing assessed
- nutritional health should be maintained
- education should be provided to clients and families
- review notes from fundies
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Feet
- influence physical, psychological, and social well being
- feet support weight, hold the body erect and coordinates and maintains balance in walking and are adaptable to conform to different walking surfaces
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assessment of feet
- observation of mobility
- - gait, use of assistive devices, foot wear
- past medical hx
- - musculoskeletal, neuro, vascular, sensory hc of falls
- bilateral assessment
- -color, CSM, edema, rash structural or functional deformities and conditions of toenails
- - assess irritation, abrasions and lesions
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Common foot problems
- older feet have trouble adapting bc of inflammatory changes in bone and soft tissue
- common foot problems
- - bunions
- - hammer toes
- - fungal infection
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Fungal infections
- incidence increase with age
- affect skin of foot and or nails
- fungal (skin)
- - tinea pedis
- - risk: warm, moist area,
- - prevention:dry completely, assess risk
- - treatment: antifungal topical agent
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Fungal infections nails
- Nails (onychomycosis)
- fungus forms under the center of the nail, seperate layers
- degeneration of nail plate with color changes
- opague thicken and brittle of nails
- dx- culture
- tx- oral therapy, long term management up to a yr, hepatic and heart side effects. also photodynamic therapy
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care of toenails
- poor close vision, difficulty bending, obesity and incre thickness of the nails makes self care difficult to the older adult
- slip on shoes are helpful for those unable to bend
- low heeled shoes and rubber soles are recommended to avoid injuries
- prevention- nail care, foot wear- not too tight
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