Health Assessment - Lecture 6

Front 1

For aging adults, what changes occur for the following systems: Integumentary (6) Eyes?(7)

Back 1

-skin loses elasticity, folds, sags, epidermis & dermis thin & flatten>>wrinkles, sebacious/eccrine glands decrease>>dry skin -lacrimil gland decrease, pupil decreaes, lens hardens(glasslike), cataracts, glaucoma, macular degeneration, decreased acuity & peripheral (after 70)

Front 2

For aging adults, what changes occur for the following systems: Ears(2) Nose/Mouth (4) Respiratory(4)

Back 2

-cilia stiffen>>reduce hearing, presbycusis(nerve degen) -diminished olfactory, reduction in taste, teeth loss, malnutrition -decreased resp strength, Decreased elasticity in lungs, Increased small airway closure = decreased vital capacity = increased residual volume, decreased alveoli = less surface area for gas exchange

Front 3

For aging adults, what changes occur for the following systems: Cardiovascular (3) Breasts(2) Immune system? Peripheral Vascular?

Back 3

-stiffening of large arteries(>>higher bp(20mm 20-60, another 20mm 60-80)), arrythmias more common, ECG (Longer P-R, and Q-T intervals) -breasts atrophy(menopause - lack of E&P), palpable lumps -loss of lymph tissue/nodes -arteriosclerosis(blood vessels more rigid with age)

Front 4

For aging adults, what changes occur for the following systems: Neurological (3) Males(4) Musculoskeletal

Back 4

-loss of neurons in brain & spine, slower reaction time, decrease in cerebral blood flow>>dizziness -smaller penis, sagging scrotum, shrinking testes, slower/less intense sex -loss of bone density/matrix>>osteoporosis, decreased height

Front 5

Explain integrity vs despair for elders? Life Review? Self actualization?

Back 5

Integ-feeling of content life, good life, good experiences Despair-failure to resolve conflicts>>hopeless, fear of death -finished all or most of their life's work - the motive to realize one's full potential

Front 6

How is health history important for older adults? (5) Which documentation is especially important for assessment?

Back 6

-determines: risk of falls, visual changes, major illness, muscle weakness, dizziness/vertigo/LOC -advance directives

Front 7

Describe: a health pessimist, Health optimist, multiple pathologies, disease presentation, polypharmacy

Back 7

-exagerate symptoms, opposite more often true -downplay symptoms, positive eval of health in spite of disease -many conditions concurrent -presents differently than younger adults(i.e-uti in young =specific symptom, uti in old-delerious) - so many drugs at once, may forget, mismatch, reach toxic levels of meds

Front 8

Explain the following causes of incontinence: Stress, Urge, Overflow, Functional, Good treatment for these?

Back 8

-loss of control during cough, sneeze, or laugh(from pelvic floor laxity) -inability to delay voiding after sensation of bladder fullness(detrusor hyperactive, cns disorder, GU condition) -leakage resulting from overdistended bladder(mechanical obstruction or acontractile bladder) -inability to get to toilet as result of cognitive/physical impairment -KEGELS!

Front 9

Explain the following skin lesions for older adults: Lentigines, Ichthyosis, Acrochordons -Actinic keratosis

Back 9

-(liver spots) hyperpigmented macular lesions - dry, scaly, fishlike skin - skin tag w/benign growth of hanging skin -skin dmg due to sun exposure/precancerous macule/papule

Front 10

Explain the following skin lesions for older adults: Seborrheic keratosis, Senile Purpura(caused by)

Back 10

-benign proliferation of keratinocytes in epidermis associated w/aging and sun exposure - vascular lesions of echymoses and petechaie on arms & legs (frail capillaries, decreased collagen support)

Front 11

Explain the following skin lesions for older adults: Venous lakes, Senile ectasias, Basal cell carcinoma, squamous cell carcinoma

Back 11

-bluish-black papular vascular lesions -red-purple macule/papule lesions -pearly, papular lesion ulcerated in center from sun exposure -erythematous scaly area assoc w/ sun exposure (grows more rapid than basal)

Front 12

Is the liver usually papable?

Back 12

-no, but can be if moves below the ribcage

Front 13

What is the overall assessment tool used for older adults?

Back 13

SPICES -sleep disorders, problems eating/feeding, incontinence, confusion, evidence of falls, skin breakdown

Front 14

Purpose of the Up and Go test? How are ADL index scores useful for a nurse?

Back 14

-fall risk (have them rise from chair and walk 10 ft and back to sit) -for discharge planning in acute care

Front 15

Explain the following conditions for cognitive alteration (onset, reversible, attention, definition, causes): Dementia, Delirium, Depression

Back 15

-gradual, irreversible, normal, recent & remote memory impaired w/normal perception, ETOH/brain infarcts/cerebral anoxia/AIDS -abrupt, reversible, impaired, memory impaired recent & immediate w/impaired perception, acute illness/fever/infection/rx/etoh/ electrolyte imbal -either, variable, variable, memory impairment w/normal perception, life event/ death family/lost friend or pet

Front 16

What is the gold standard for cognition assessment? What are two other tests commonly used? Test used for mild cognitive dysfunction?

Back 16

Mini Mental State Exam (cognitive impairment screening) -Clock drawing test and Mini Cog (MMSE + clock + 3 item recall) -Montreal cognitive assessment(MOCA)

Front 17

What does the assessment of old adults include? What might be some signs of burnout? (6)

Back 17

-assessment of caregivers -stress, anxiety, depression, weight loss, social isolation, somatic complaints

Front 18

What are the two forms of elder mistreatment? Explain each of the following types of mistreatment: Physical, sexual, emotional, financial, abandonment, neglect, self neglect

Back 18

-omission (neglecting) or commission (committing a crime) -harm or injure willfully -inflicting nonconsensual sex -inflict mental anguish through verbal/nonverbal -illegal use of their money, property, assets -desertion from person assuming care -failure to take care of elder -behaviors threaten elders health or safety

Front 19

What are some signs of possible elder abuse?(5)

Back 19

-reluctant to leave elder alone, pt looks at caregiver to answer questions, delay in seeking treatment, inconsistencies in report of injury, lack of hygeine

Front 20

Mnemonic used to help identify high risk situations? Mnemonic used to help detect, diagnose, and manage elder mistreatment?

Back 20

SAVED - Social isolation/stressed caregiver, alcohol/sub abuse, violence, emotions, dependency b/w caregiver & client STOP HARM -Screen all elder abuse, think about risk factor, ominous danger present?, physical findings, hisotry, address elder mistreatment, report to APS, manage w/prevention

Front 21

Another mnemonic for spirtual assessment?

Back 21

FICA-faith(are u religious), influence(are these beliefs important in your life?) community(how does religious community support you), address(how do u want me to address health issues?)