Katheractrics T2: Feet, Skin, Constipation And Sex

Front 1

What should be involved in general foot care?

Back 1

daily inspection, thorough drying, nail trims, pumice stone, soft soled shoes w/ ample shoe box, natural fiber stockings.

Front 2

Elderly pt c/o heel medial heel pain when they first get up in the morning. PE showed point tenderness over calcaneal tuberousity and flat feet. a heel spur is present. Dx?

Back 2

Plantar fasciitis - tight achilles tendon &/or insufficiency of the posterior tibial tendon that produces stress on plantar fascia and inflammation. Heel spur is a result and NOT the cause of heel pain.

Tx?

Hint 2

Achilles stretching = MOST important. others: heel cups, NSAIDS (kathy doesn't really use), cortisone inj., surgery as last resort.

Front 3

where do corns (cavus) form?

Back 3

between toes on bony prominences.

Tx?

Hint 3

wide toe boxed shoes, corn trimming (WTF), durgical therapy.

Front 4

Define constipation

Back 4

< 3 BM/ week; straining during >25% stools; hard stools >25%; feeling of incomplete evacuation.

What should you be comparing in defining constipation for an idividual pt?

Hint 4

Compare what is normal for them to their new sxs.

Front 5

what are the RED FLAGS of constipation?

Back 5

ACUTE onset; heme positive; weight loss; anemia.

What could an increased RDW without anemia present indicate in a pt with constipation?

Hint 5

MALIGNANCY

Front 6

Prevalence of constipation

Back 6

45% in nursing homes

causes?

Hint 6

immobility, poor diet/dehydration, slower motility, and of course Kathy's favorite answer to everything, DRUGS!!!

Front 7

What labs might you order to look for "red flags" in a pt with constipation?

Back 7

CBC (anemic), SMA 8 (the old term for chem 8), Ca & Mg, TSH (hypothyroid), hemmocult).

imaging you should order?

Hint 7

abdominal XR

Front 8

Treatment of constipation?

Back 8

water + fiber, exercise, laxatives, and GET RID of DRUGS (anticholinergics).

What are the complications of untreated/prolonged constipation?

Hint 8

obstruction, Impaction, Delirium (from pain of impaction) stercoral ulcers (impaction causes ulcer in rectum), behavioral problems, DEATH

Front 9

Types of laxatives

Back 9

Softeners (AVOID); Osmotics (lactulose and sorbitol); stimulants (bisocodyl & Senna); newer agents (lubriprostone)

What is Kathy's FAVORITE??

Hint 9

SORBITOL - but can cause hyperglycemia : (

Front 10

What medication is known to cause intractable constipation?

Back 10

opiods

How should opiod induced constipation be treated?

Hint 10

MUST use stimulants: bisocodyl or senna**

Front 11

What are the characteristics of the skin that all decrease with age?

Back 11

proliferative potential of epidermis; melanocytes (less photoprotection); epidermal adhesion; fibroblasts of the dermis; blood vessels; immediate hypersensitivity to loss of mast cells; innervation; fat tissue; epocrine and apocrine glands (more prone to hypothermia); sebaceous glands and sebum (causing dryness); and hairs and hair growth.

How many times did kathy have to type the word "decrease" in those 3 slides?

Hint 11

11 times - so 11 characteristics of the skin decrease with age.

Front 12

Dry scaling & lineation of skin with crackled porcelain appearance?

Back 12

XEROSIS: if it becomes inflamed it is erythema craquele.

Tx for Xerosis?

Hint 12

less bathing, tepid water (hot water makes it worse), indoor humidity, emollients applied post bath.

Front 13

reddish brown discoloration that could result in ulceration if not addressed?

Back 13

Stasis dermatitis

initial treatment? management if healing doesn't occur w/in 3 months?

Hint 13

elevate legs, reduce edema, emollients. If ulcers don't heal in 3 months of max therapy: BIOPSY as they may contain squamous (or basal) cell in 10% of them.

Front 14

Violaceous to red-brown macules that are seen MC on sun exposed areas?

Back 14

SENILE PURPURA -
may also occur with relatively minor trauma (can be confused w/ abuse)

Treatment?

Hint 14

NONE: they heal spontaneously.

Front 15

brown/black sharply demarcated lesions w/ verrucous or "stuck on" appearance

Back 15

Seborrheic keratosis - a benign neoplasm. Can be difficult to differentiate from melanoma to biopsy.

Treatment?

Hint 15

liquid nitro; curettage

Front 16

benign, sharpy demarcated, hyper pigmented macules on sun exposed areas?

Back 16

Lentiges - AKA "age spots"

MC locations?

Hint 16

face, hands, arms

Front 17

Firm, round lesion with "rolled border", pearly papule with telangiectasia that is MC on sun exposed areas (especially the NOSE)?

Back 17

Basal cell carcinoma - MC malignancy in humans; slow growing & rare metastasis

treatment for BCC?

Hint 17

Rx MOHS microscopic surgery - 99% cure rate (if kathy did it it would be 101%) and 1/3 develop reoccurrence

Front 18

Indurated, red, scaly plaque on sun exposed areas that may ulcerate and crust and is the 2nd MC malignancy?

Back 18

Squamous cell carcinoma.

treament?

Hint 18

MOHS surgery and lymph node check

Front 19

predisposing factors for SCC?

Back 19

inorganic arsenic exposure, chronic radiation dermatitis, HPV, chronic burns/scars, & leg ulcers. ACTINIC KERATOSES are precursors for SCC.

What did Kathy call SCC and why?

Hint 19

SCC is THE bad actor. MC one to metastasize is on the lower lip***

Front 20

Rough or scaly patches or scaly papules on sun - exposed areas that are often erythematous?

Back 20

Actinic keratosis.

Treatment?

Hint 20

local fluorinated creams and liquid nitro. Each one has .24% to turn into cancer (SCC) - so they more you have = higher risk

Front 21

Most dentition loss correlates with _______________ and is MC secondary to ______________.

Back 21

# of teeth lossed correlates with increased mortality; MC secondary to Gingival disease.

Examples?

Hint 21

Leukoplakia (white patches) - less malignant potential and Erythroplakia - much more likely to become cancerous.

Front 22

What is the best predictor of amount of sexual activity in the elderly?

Back 22

Amount of activity in the past usually correlates. Most report they are satisfied. loss of partner may lead to masturbation.

List the social factors that contribute to sexual activity in elders?

Hint 22

1. belief systems 2. access to partner 3. peer/family attitudes 4. conducive environment/privacy (MC issue in the nursing homes) -

Front 23

4 phases of sexuality (desire, excitement, orgasm, resolution) and how they are affected in males? then females?

Back 23

Duration/intensity of errection decreases (duh). Excitement phase takes longer to achieve (can't get it up by just thinking - needs touch). Orgasms shorten and less intense. Rapid Detumescence (or the act of subsiding from a swollen state of errection)

Hint 23

ALL PHASES CONTINUE but are less intense. entrance of resolution phase is more rapid. orgasms may be painful when the atrophic uterus contracts*** tx: IBUprofen before sex. Lubrication is an issue in atrophic aginitis.

Front 24

What disease states affect sexuality?

Back 24

Disease burden is the MC factor. Poor health and surgery decrease libido. Incontinence is problematic as well.

What drugs can affect sexuality?

Hint 24

antihypertensives** (especially BB); SSRI's (decreases orgasm which could increase their depression); narcotics, barbituates, antihistamines.

Front 25

Thinning of the females vaginal epithelial tissue increases their risk of

Back 25

Sexually transmitted diseases. Females become MORE susceptible to STIs.

This is especially true for what STI?

Hint 25

HIV! 10% occur in pts > 55 yoa.