part 2 FINAL Geriatrics chapters 17,5,6,

average duration of herpes zostener is _____

3 weeks

serum albumin level below ___g have a correlation with pressure injury development and poor wound healing

3.5

research has demonstrated that compression therapy of at least ___ to ____ mm Hg at the ankle and distal lower leg decreases edema by compressing fluid through the fibrin cuff *This therapy is only for pt that are able to walk

30 to 40

Age-Related Changes in Skin Structure and Function dermis

Number of sweat glands, blood vessels, and nerve endings decrease in number leading to diminished thermoregulatory function and inflammatory responses, decreased tactile sensation, reduced pain perception.

venous ulcers occur more in

WOMEN

known mediator of pruritus?

histamine

Herpes zoster is also known as

shingles

Acral-lentiginous melanoma:

usually occurs on palms, soles, fingers, and toes

acrochordons

"skin tags"; overgrowths of normal skin that form a stalk and are polyp-like

Age-Related Changes in Skin Structure and Function Epidermis

- Is thinner (reducing healing time, barrier protection, and delayed absorption of medications and chemicals placed on the skin) -skin tears -bruising -Age spots

Nursing Assessment Inflammatory Dermatoses

- Recognizing inflammatory dermatitis and noting location, degree of erythema, itching, and scaling - nurse should inquire about itching, usually hygienic habits and steps the pt has taken to control the scaly, erythematous dermatitis

How should emollients be applied?

- applied at least twice daily and immediately after bathing to trap moisture -pt should gently pat the skin dry and avoid brisk drying with towel

Age-Related Changes in Skin Structure and Function Appendages

- decreased body odor and reduced evaporative heat loss because of decrease sweating

Norton Risk Assessment Scale

-A tool for predicting pressure ulcer risk -Simple to use, with five assessment categories -Those with a score of 16 or lower considered to be at risk

ischemic ulcer results from

-Arterial Ulcer from arterial insufficiency

Lower Extremity Ulcers:

-Arterial Ulcers -Venous Ulcers -Diabetic Neuropathic Ulcers

Malignant Skin Growths:

-Basal Cell Carcinoma -Squamous Cell Carcinoma -Melanoma

Seborrheic keratoses

-Characterized by slow growth -Borders may be round and smooth or irregular and notched -Have greasy feeling and often occur in sun-exposed areas but can appear anywhere on body

benign skin growths

-Cherry angiomas -Seborrheic keratoses -Skin tags (acrochordons)

Nursing assessment Pruritus

-Full skin assessment warranted when patient complains of pruritus -Inquire about patterns of behavior that precipitate itching and obtain information about bathing practices and kinds of soaps, detergents, and skin products used

nursing intervention for pt with candidiasis?

-Keep skin dry -it is important to keep topical antifungal agents on the infected area until healing is complete, which may take 2 to 3 weeks

Inflammatory Dermatoses

-Seborrheic dermatitis -Intertrigo

older adults are at greater risk of heat stroke. Why?

-because of compromised cooling mechanism *older adults should avoid heat exposure over long periods and in humidity * they need to stay hydrated

Age-Related Changes in Skin Structure and Function subcutaneous fat

-because of loss of subcutaneous tissues the risk for hypothermia, skin shear and blunt trauma injury is greater. - increase vulnerability of pressure points

Nursing assessment Herpes Zoster

-identify prodromal symptoms -determine ADLs

nursing assessment for pt with candidiasis

-inspection of skin (particularly under any fat folds, where moisture will accumulate) -medication assessment

medical management intertrigo

-lose weight - apply topical hydrocortisone cream - keep skin clean and dry

Risk factors for developing diabetic foot ulcer are:

-peripheral neuropathy -foot deformity -peripheral arterial disease -previous foot lesions

how squamous cell carcinoma presents?

-presents as a firm, elevated LUMP; it may have a thick, adherent scale with a center that is often ulcerated or crusted

prevention and treatment of dry xerosis in older adults

-short showers (5-10 min) with warm water -fragrance-free products -gently pat skin -apply skin moisturizer immediately after drying (use ointment or cream rather than lotion) - no alcohol products -drink at least 8 glasses of water

chronic leg ulcers are a common problem in older adults, occurring primarily from 3 causes:

1. arterial insufficiency 2. venous hypertension 3. diabetic neuropathy

Braden scale categories

1. sensory perception 2. moisture 3. activity 4. mobility 5. nutrition 6. friction/shear

pt with a score of __ or lower on the Norton scale are at risk for pressure injury development

16

_________ is another term for itching so intense it causes the patient to scratch the offending area

Pruritus

arterial insufficiency pulses

Pulses distal to restriction may be present as a result of collateral circulation

Braden Scale

A tool for predicting pressure ulcer risk

most common melanoma found in blacks and Asians

Acral-lentiginous melanoma

Patient complains of cramping, burning, or aching while he is at rest

Arterial Ulcer

___________________ is the most common skin cancer. It is more prevalent in fair-skinned, blond, or red-headed individuals with extensive previous sun exposure

Basal Cell Carcinoma

how does begins?

Begins as reddish macule or papule that has rough, yellowish brown scale that may itch or cause discomfort

Inflammatory process of epidermis caused by yeast-like fungus Candida albicans

Candidiasis

Common, bright red, 1- to 5-mm SUPERFICIAL vascular lesions that begin around age 30 and increase in number with age

Cherry angiomas

How is shingles transmitted?

Direct contact with fluid from shingles blisters *is not necessary to isolate pt

pt with xerosis should take baths or showers every day to clean skin

FALSE pt should decrease the frequency of baths or showers to a maximum of every other day

Results from friction of opposing skin surfaces and the irritation this causes

Intertrigo

Malignant neoplasm of pigment-forming cells capable of metastasizing to any organ of body, even before lesion is noted

Melanoma

The most serious form of skin cancer

Melanoma

_________ melanoma is hard, usually dark nodule arising from a preexisting mole

Nodular melanoma

How does basal cell carcinoma present?

Pearly papule with depression in center, giving lesion a doughnut-shaped appearance with telangiectasia on or around lesion

primary causative factor of pressure ulcer

Pressure on soft tissue over bony prominences or other hard surfaces is primary causative factor

malignant tumor of the squamous epithelial cells in the epidermis

Squamous cell carcinoma

_________________ is a common Chronic inflammation of skin

Seborrheic dermatitis

Benign lesions more commonly seen in older adults. These are scaly growths with "stuck-on," crumbly appearance; varies in color from tan to brown to black; elevated and range in diameter from 2 to 3 mm

Seborrheic keratoses

-Common stalklike, benign tumors often found on neck, axilla, eyelids, and groin, although can be located anywhere on body. -Tiny, flesh-colored or brown excrescences that develop into a long, narrow stalk (up to 1 cm) -As they mature, can be easily removed with scissors, electrocautery, or liquid nitrogen

Skin tags (acrochordons)

_________ is a skin cancer arising from epidermis and found most often on scalp, outer ears, lower lip, and dorsum of hands

Squamous cell carcinoma

most common type of melanoma?

Superficial spreading melanoma: -slower growing - FLAT -irregular colors

eccrine glands

These glands produce sweat.

melanoma can be attributed to

UV light

___________, also known as stasis ulcers, are thought to arise secondary to chronic venous insufficiency

Venous Ulcers

Shingles caused by

by the reactivation of latent varicella zoster virus * virus remains in the dorsal nerve endings after an episode of chickenpox

actinic keratosis

a precancerous skin growth that occurs on sun-damaged skin

premalignant lesion of epidermis caused by long-term exposure to UV rays. Most common in individuals with light complexion

actinic keratosis

primary cause for decreased BP flow that results in ischemia and eventually tissue death

arteriosclerosis

ABCDEs of melanoma

asymmetry, border, color, diameter, EVOLUTION

the Braden scale assesses sensory perception rather than mental status. Assessing sensory perception is a more precise risk indicator. Why?

because impaired sensation prevents an individual from sensing the need to change positions, which in turn would decrease pressure intensity

after changing lines, the nurse should cleanse and dry the skin well and apply a zinc-based cream to the buttocks and perineal area. cornstarch or powder is NOT recommended. Why?

because of clumping *use creams

systolic BP below 90 mm Hg has been found to be a risk factor for pressure injury formation. Why?

because of decrease peripheral circulation and subsequent ischemia

Why may pt may be concern with apperance of Cherry angiomas?

because these are a new growth, but nurse needs to reassured then that cherry angiomas are benign growth

Seborrheic dermatitis Usual pattern of distribution

begins with the scalp and moves down toward the eyebrows, progressing to the chest with a bilateral, symmetric presentation

Psoriasis

chronic skin condition producing red lesions covered with silvery scales

Lentigo maligna melanoma

common in elderly and occurs on parts of the face exposed to the sun; least likely to have vertical growth and thus, best prognosis

____________ are located on plantar surface of foot; circular,often deep wound

diabetic neuropathy

age spots

discolorations caused by sun exposure

xerosis

dry skin

most common cause of pruritus?

dry skin (xerosis)

Semmes-Weinstein Monofilaments

effective and inexpensive device for identifying diabetic patients at risk of foot ulceration.

Nursing interventions for someone that is suffering of pruritus. If dry, scaly skin (xerosis) is present with no lesions or erythema, the nurse should suggest that the pt apply ________, which have more lanolin or oily substances than many commercial lotions

emollients *Emollients are cosmetic preparations used for protecting, moisturizing, and lubricating the skin

Basal Cell Carcinoma is most commonly found on _______ and ________.

face and scalp

Where candidiasis normally occur?

flora in mouth, vagina, and gut

Lentigines

freckles age related change

shearing force

pressure exerted on the skin when it adheres to the bed and the skin layers slide in the direction of body movement

Dermatoporosis

in older adults, chronic skin fragility

arterial ulcer characteristics

irregular shaped wound; thin shiny, cool skin, LOSS HAIR, pain with activity, rest or at night

signs of melanoma

irregularly shaped nevus, papule, or plaque that has undergone a change, particularly in color

Seborrheic dermatitis is more common in pt who have

parkinson's disease or who have suffered a stroke

Basal Cell Carcinoma occurs more often in _______

men

arterial insufficiency is also referred as:

peripheral vascular disease

dermal appendages

nails, hair, sebaceous glands, eccrine and apocrine sweat glands

chickenpox is an airborne virus is herpes zoster as infectious?

no shingles is not as infectious as chickenpox

Intertrigo occurs in what type of pt

older pt who are obese or have diabetes

Where are arterial ulcers usually located?

outer ankle, feet and toes

venous ulcers

pain relieved with activity

most common sign of arterial insufficiency

pain with exercise, at night, or while resting

which older pt are prone to develop candidiasis?

pt with incontinence, bed-bound and in moisture-prone areas of the body

main reason for shingles

recurrence occurs because of low immune system (advance age)

Common bony prominences susceptible for pressure ulcers

sacrum, ischial tuberosity, lateral malleolus, trochanter, and heels

Characteristic signs of majority of malignant melanomas referred to as:

the ABCDEs -Asymmetry -border irregularity -color variation (red, white, blue) - diameter greater than 6 mm -evolution

valvular incompetence of the deep or perforating veins of the lower leg is present in most _________ ulcer cases

venous

PRIMARY CAUSE OF VENOUS ULCER

venous hypertension

Nodular melanoma:

worst prognosis because it usually invasive by the time it is diagnosed