Transcript for:
Aging and Healthcare Lecture Summary

e e afternoon Miss Singleton if you're ready yes ma'am Miss W okay Miss seals yes ma'am yes ma'am okay you can just go ahead and do your room SC there's my paper and my calculator how you had C was good good I'm go get uh sheet of paper okay Miss whittle come back Miss Brown if you're ready go able to see the keyboard no quite it's right here it's my bookst that's good okay Miss Williams if you're ready we can do yours yes ma'am [Music] [Music] looks good hey Miss almond if you're ready we can do yours need a minute okay Miss Watts if you're ready we'll do yours you take the blur background off missb yes ma'am one second okay there we go Miss are you ready one second okay all right I'll come back Miss Clark okay I'm ready all right one second Miss wi about to get it Miss Clark I'm seeing your screen I'm not seeing your keyboard you can go ahead Miss whittle okay Miss Clark right and then miss wh if you'll push your either slide your phone forward to push your phone back I mean your computer screen back because I can see your screen one of them okay that's good like that that works hey Miss bowling you ready okay good Miss Buchanan okay M Martin yes ma'am you ready do your room drop it like your head that looks good okay Miss almond you ready right see right Miss Clark that looks good can you hear now your sound yes can you hear me yes ma'am okay all right Miss Pew are you ready and tilt it down just a little bit because I'm saying screen not keyboard than okay that's good that's good right what about Miss Ward Miss zakaya Ward no Miss Ward got Miss seals got Miss Singleton Miss wat Miss Whittle Miss W Miss Williams Miss Andrews Miss Alman bowling Brown Buchanon Clark Martin anybody heard anything from Miss Ward today see let check right quick check my email give me one second okay we SW whenever you you ready for your room scan e e do your room scan Miss Ward and then prop your phone to the side so I can see your hands and your keyboard all [Music] right he that looks it all right let me make this quiz accessible to you one second once your quiz is done I ask that you kind of sit tight and you can run to the restroom if you need to and we're going to go ahead and get started fairly quick after that quiz [Music] three all right hit refresh you should be able to see it once you can see it if you will give me a thumbs up okay you will have 15 minutes to complete your quiz e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e okay all right we will pick up where we left off last week right quick let me just double check Miss Williams Williams yep Miss Wy here miss Whittle here miss Watts here miss Ward this Mor this if you are here when I call your name say something and it makes the camera shift to your face because with so many faces I cannot see everybody all at once Miss Ward if you're here miss Singleton here okay Miss seals here miss Pew here right Miss Martin Miss Martin Miss Clark Miss Clark right Miss Buchanon here Miss Brown here um can I switch to my laptop yes okay Miss bowling here miss almond here miss Andrews here Clark not all right let's see CL Miss Martin hear if you say something it makes the camera I don't know why it's not I don't know she can hear you not but she on camera hello can you hear me okay now I can okay all right y okay right Miss Ward is having some technical difficulties she messaged so let's see if we can get her back going all right so before we begin there was a message sent out that I will have to read and you will see it in your announcements a little bit later this evening but I will go ahead and read it uh has to go out to all it's a little snippet from the catalog but the online classroom is this is just a friendly reminder that the online class classroom is to be treated the same as your ground onr classroom please do not attend the online class laying in bed changing clothes preparing dinner applying beauty treatments or any activity that you would not do in the onr class also streaming surfing the web or playing video games while in Zoom interferes with the zoom feed for all attendees we would like to thank you for your compliance with this so please again make sure that you're on camera visible and attentive at all times I do not want want any issues with your attendance or your financial aid due to you not being in front of your camera attentive during class also helps as well if they hear your voice when they're doing the um audits of the classes as well again not my rule bis by guidelines of the Department of Education so please please comply no issues um I don't want anything um to to come up with this when it's time to move on to your next FL no problem all right so we're gonna pick up where we left off last week go for I don't know about another 30 minutes or so then I'll give you guys a break then we'll keep it moving um going forward we of course do have another quiz next week then we'll have exam two in week seven um there will be live reviews starting next week for exam 2 um if you have received an email from me please respond um um I am asking if I emailed you to meet with me one onone um if you also if you didn't get an email and you would like to meet oneon-one to discuss any of the concepts that we've gone through um maybe you're having a struggle or you have some questions please um respond so that we can set up a mutually agreeable time to talk to make sure that you are understanding because every week there's some more piled on so if you're stuck in week three there's no way you're going to get any understanding of what's going on in week five so please make sure that you um reach out and follow up also miss Ward can you hear me now all right change your name to Zaki Ward instead of Zoom user and then we'll be good to go all right so last week I think we stopped right here so we're going back into chapter 3 and you'll notice that of course any textbook you don't read it Page by Page word for word um but we're bouncing back over into chapter three where we talk about the physiologic changes um as we um talk about our aging or our older adult and some of the learning objectives that we're going to talk about a little bit more today are being able to describe the structural and functional changes that are involved with aging also being able to identify some of the common disease common diseases that are related to the um aging process and what happens you know know in each of the body systems being able to differentiate between what is normal aging and those normal changes that happen and what are some normal you know expected diseases with the aging process then also discuss the impact of age related changes um on the care that we provide as nurses so again a lot of information every week there's a lot of reading there's a lot of assignments how do I take this information and compartmentalize it there's various ways or various you know methods to to study some people are visuals you know Learners where they have to see you know pictures or um some people you know can see somebody do something and then they can copy that others have to write things down various strategies are out there some people can learn things by the body system so you can look at those body systems you know maybe you list your body system on a piece of paper or you type it in on your computer and you just give yourself you know take a few minutes and write down an overview everything you can remember about that body system and then think about how does this body system change as one ages and then what are some common disorders that are related to the respiratory system for example um as related to the Aging population um or you may like Maps you might like pictures so then a concept map maybe you will put the heart in the center congestive heart failure and we've done a lot of talk on congestive heart failure and then make some um you know draw pictures you know how how does the heart change what happens with the heart as um you know our client age or maybe you are a writer I was a writer when I was in in nursing school so I made flashcards and I would write out the information and then either my husband or my sister or whoever I could find somebody at work when we had a downtime I would get somebody to flip flashcards to help me um there's various online resources I will tell you that everything out there you know is not correct but um you can be a good judge of that um anything that is peer-reviewed um and of course anything that is matching up with your text and your readings those are good things you can also make up little quizzes you have your um sers inlex um book you also have your Hy book that you can utilize for quizzes and then quiz LS out there that you can actually go in and make little quizzes for yourself um so there's various ways that you can try to get this information you know in and compartmental lives to make sure but just keep in mind that your textbook is very good about pulling information and and putting it in a a spot where you can find it like making charts and boxes and tables again many of those items that were on your exam many of the items that you're going to see on your hessie on the inlex are those things that are in those charts in tables and boxes never say that Dr Corker said don't read your textbook but those textbook writers know what is going to be on that inlex they know what's on the hessie so they take that information and they make it look different they either make it blue or red or they put it in a box and make it yellow but they do something to try to draw your attention to it or they make a picture out of it to help make make sure that you draw your attention and you spend some time you know learning that information so as we move a little bit further what is the function of the skin why do you have skin somebody talk to me about it why do you have skin why is skin important protection or protection that's one of those top things what else why what is another reason you might have some skin protect me from the elements that's right it covers our body it's our larg orans or protects what else for temperature regulation Thermo regulator yes if I get too hot I'm gonna do something if I get too cold I do something else so it helps to regulate my temperature anything else keeps all that gunk out keeps the for absorption of nutrients like vitamin okay all right it absorbs all right it makes a vitamin D okay helps absorb that vitamin D from where uh the Sun from the Sun absolutely we got to have that calcium with a nice dose of vitamin D that we can get from outside vitamin D is free all right so again our skin is to protect it helps to regulate heat or thermal regulation it secretes and excretes also I don't think anybody said anything about it but it's sensation let you know that the stove is too hot or you need a jacket before you go outside because it's too cold it also helps to absorb that vitamin D also helps to absorb moisture you know that's why we put moisturizers on so those are the overall functions of the skin but as we age again we list another table here what are some of the changes that are seen with the skin as our client's age what happens to the skin it gets dry okay dries out uh it loses that elasticity whatever that word is that's it that's it it loses elasticity all right gets dry it's not as elastic doesn't stretch as much so what is the result of dry skin and and skin that is lost its elasticity skin tears skin tears absolutely somebody else was talking who else said something say becom weaker like your skin it becomes weaker so that is why older adults have these Bodacious skin tears it look like all we did was touch them and the whole sheet of skin is just peeled right off all right so when we look at that because of a decrease in subcutaneous fat then they have those wrinkles they have decreased cushion and so they're more susceptible to the development of pressure ulcers and they're often cold because we know that fat is a nice insulator um they have a decrease in peripheral circulation so if you look at your older adults feet and often times their fingernails those toenails are thick and yellow and crusty and that's CA they have decreased circulation the skin is the epidermis is a lot thinner decreased thickness so that's why they're more susceptible to trauma they're easily the skin is easily torn um also increased capillary fragility that's why they have those little purple bruises that cile per that we see all over the skin because the capillaries burst a lot easier and they're more fragile decreased in um sebaceous um glands and fat as well as sweat that is why that skin is so dry so our older adults are more susceptible to heat heat injury as well they're overheat a lot quicker than our um uh younger people as well so again on these hot days like it is in south Georgia and many of you are in Florida as well we have to be very careful with our older adults making sure that they're not out in the heat too long because they will overheat very quickly same way with our babies as well so again we've seen this cross-section of the skin um last week you we saw it at the end of last week as well and you've also seen it in anatomy and biology class but when we are assessing the skin and the skin changes of our old adult we have to think about you know what layers of the skin are involv and with staging those pressure osers and when what is involved when we talk about the epidermis and what is there in the dermis and then in the subq layers and then that soft tissue and Bone um and then if we got a stage one versus a two and a three or four how deep is that going and then really how much tissue is involved um if I'm looking at uh the layers of the skin on my arm my thigh my butto versus the back of my heel at the Achilles area a lot easier lot quicker to develop a pressure oer on my achilles than it is on you know maybe my bottom because there's a lot more depth you know you know there to the tissue but still it's the same layers of skin at my achilles as it is at my bottom it's just more thick it's thicker that skin has a little a lot more depth there so again we have to be reminded of you know the epidermal layer and what is there what is involved in that dermis subc then we get down to that soft tissue where the muscle is and then all the way down to the bone so when we assess um and intervene related to to those skin changes we want to make sure that we're looking for color changes you know over those areas of pressure is it non-blanchable redness you know you see a area of redness over an area of pressure light pressure remove your hand your finger did it blanch out if it didn't that may be a stage one of course you need to get the pressure off of that because it can quickly develop into a two or three is the temperature different you want to compare it right to left side what does an elevated temperature or increased warmth mean does that mean that it's in infected or inflamed what about skin trigger and why do I check skin trigger over the sternum versus the hand in the odor anyone why on a 90y old would I check their sternum versus their hand because as you get older the skin on your hand is looser it's looser why loss of Circ c y because of decreasing peripheral circulation so therefore you want to go someplace more Central because that circulation has shown it more Central to check their hydration status so you're going to want to check the collar bone the sternum area to check for their hydration also you want to make sure because of that loose skin there's going to be more creases and more skin folds so you want to make sure you're lifting and looking assessing between those skin foldes for breakdown also don't forget the fingernails make sure we're cleaning and looking on those fingernails because there can be um breakdown there as well so what are some nursing interventions what can you do as the nurse related to skin changes anyone what can you do uh you can rotate the client so they won't get like um uh what's them things called uh bed like if they're laying there to yeah b or pressure ERS okay we're going to turn and reposition you know the written rule is at least every two hours what I say is every two hours and as needed PRN okay we're gonna change their position what else can we do as nurses use some soft padding for um some so for the softer pressure okay you said use something to support you said softer pressure say that again yes ma'am so uh to support where the pressure is so it's softer all right so we can do positioning AIDS like are you saying like bolsters or pillows or something to help with repositioning okay Miss almond you were going to say keeping their skin moisturized yes Keep Their Skin moisturized anything else uh when you're giv you can give like bed bath you can make sure you like Pat instead of like going to rough yes Pat them dry instead of taking that towel and just rubbing them dry absolutely making sure we getting all the soap off of them as well cuz that will dry them out too making sure we're keeping them dry and clean if they're soiling their briefs or if they're not um wearing briefs but they're in continent making sure we're cleaning taking those pads out changing those pads Inc continent pads so again adjusting the room temperature making sure that although you know they look all nice and bundled and tucked with the the blankets and sheets all the way up to their neck it might be too warm so making sure that they're dressed according to the temperature in their room um removing the blankets uh again they look all nice and cuddly but it might be too warm make sure they're getting adequate hydration reducing pressure as Miss um Singleton said making sure that they have pads in the correct places maybe they're on the correct mattress also when we're taking care of their incant episodes use Barrier cream and then as was mentioned repositioning at least every two hours again every two hours and as needed also again if they develop the wound what are some of the you know things that they need of course we need um increased calories but they got to be the right calories we can't have you know just load them up with all fat and sugar we got to have lots of lots of lots of protein okay protein helps with collagen formation and wound healing also sufficient vitamin A and vitamin C as well as zinc and again here's that hydration two to three milliliters of fluid per day or two to three liters of fluid per day again calorie demands that include protein you see protein is highlighted it's all encaps not highlighted but it's all encaps vitamins A and C the mineral zinc and at least two to three liters or 2,000 to 3,000 milliliters per day of fluid again decreased water intake is going to lead to decreased skin elasticity which is going to interfere with absorption and also appetite so think for yourself when you get ready to eat a meal or eat anything if you hadn't drank anything anything for last hour you going to take a drink of soda or water whatever first before you put what food in your mouth because it's going to stick to your mouth so again you need adequate hydration also if you're really really thirsty you really don't have an appetite if you're thirsty but once you drink some water um and you you know quench that thirst then your appetite will come back again protein is needed to repair damaged tissue vitamin C helps to form collagen zinc the mineral zinc helps helps to make the skin more durable carbs help to provide energy and it also helps for collagen and fiber blast formation vitamin A helps with the inflammatory response keep in mind that in healing you have to go through that phase of inflammation it's when that phase of inflammation is prolonged when it's an issue so anytime you know even if you just barely cut your finger like a paper cut you know it's going to turn red around there you've got to go through that inflammatory phase in order to heal so you need Vitamin A for the inflammatory response to kick in however when the inflammatory response does not turn off that's when you have an issue also you need albumin which is linked to protein albumin levels really reflect healing not necessarily nutrition so we need to keep in mind that the majority of our older adults um are likely malale nourish so we need to make sure that we're increasing the calories with the right things make sure those foods have plenty of protein and what are some examples of foods that are high in protein peanut butter peanut butter eggs chicken chicken I'm glad first thing someone said was would was a steak because then I was going to say what happens if they have no teeth or very few teeth where else can we get it so we got some of those things that maybe some of our older adults are able to chew and swallow all right so we have a client who's recovering from a pressure uler on their right leg the nurse or a nurse encourages the client to eat foods high in vitamin C to promote wound healing which meal is going to be best to meet the client's needs so again need a a diet or meal that's high in vitamin C to promote wound healing of these choices which is going to meet the needs is it the glass of milk with baked chicken and apple pie is it the cheese and broccoli omelette with a side of fresh strawberries is it the milk and whole grained cereal with sliced bananas or is it a black bean burger with baked beans and potato salad which is going to be the best meal BSN boy B BSN boy absolutely of course you've got calcium vitamin B but it has too much sugar in that first one piece of apple pie C has calcium folic acid and some protein but you know doesn't have that vitamin C and then of course the black bean burger has some protein but a little bit too much salt and too much fat in that potato salad so B is your best choice got protein got that leafy green and you got those strawberries with the vitamin C all right just want to talk a little bit about interal feedings what does the word dysphasia or dysphasia mean anybody we break that word down what does dysphasia or dysphasia mean difficulty swallowing that's it if you take it and break it apart the IIA on the end means pertaining to dyss is dysfunctional or difficulty f is swallowing so pertaining to difficulty swallowing so um when we have a client who has problem swallowing from whatever the cause may be we got to feed them somehow so these um are these clients are usually fed interally usually by uh NG tube or a peg tube so often times um sometimes of course they're fed with uh tpn and all those things but we're going to talk a little bit about those interal feedings or the through the with the pump and this is what you see here um some of the risk factors or why this happens is the client has some type of neurologic damage it could be from a stroke could be Advanced Parkinson's or Alzheimer's disease where that brain body connection is not working anymore where they don't remember to swallow so what you see here of course is the NG or the nasogastric tube where the tube goes through the nose down into the stomach where they're getting the feedings through there then you have the peg um tube where it actually goes through the um uh abdominal wall down into the stomach percutaneous endoscopic Gastronomy tube um some of the precautions you need to be concerned about you always want to make sure that you check for residual before feeding your client what is residual this is where you pull back to check to see if the stomach is adequately emptying when you're feeding your client if you're pulling back and it's different Pro protocols but it's always within a few cc's of it is some places have a 200 some say 250 um CC's pull back then you want to hold that feeding until that food digests um or until it goes on down if there's no residual then you of course you can continue your feeding you also want to make sure that head of the bed is at least 30 degrees you don't want to have somebody on an interal feeding and they're laying flat on their back again that increases their risk for aspiration by the way what is aspiration anybody know what aspiration is BAS you're like choking on your throw up or whatever okay choking and where does the food go then in your lung yeah so again you that where whether it's food or this is again the feeding is getting into the lungs it could be food or water whatever but aspiration is again what's supposed to be going down your throat and into your stomach is actually going into your lungs also you want to make sure you're following protocol and checking the order to for the rate um of the infusion making sure it's going at the order rate for your client or patient and also the temperature for most facilities again you have to follow what their protocol is the tubing and feeding setup is usually changed at um every 24 hours some places it's every 12 hours so it just depends on what your um facility or organization policy is but it does not go over 24 hours where all the tubing is changed from the machine to the client now of course the um tubing that is inside the patient it stays you know usually if they're permanent tube feeders it gets changed every 28 to 30 days all right so here's another table listed again age related cardiovascular changes we a few more minutes and we'll take a break guys so what changes are related to the heart so here we are again maybe a table method and we look at the heart and we know that as one ages your heart muscle tone is going to decrease so this is going to result in increased risk for heart failure we've been talking about this since the very beginning where you've seen that picture of CHF and the um signs and symptoms of the complications that clients or patients have with CHF also if my heart muscle tone decreases then my cardiac output or their cardiac output because I'm 12 so I'm not going to age so um decreasing cardiac output this is going to increase blood flow to my extremities so peripheral circulation or profusion is going to decrease hence those thick yellow toenails that you see and fingernails that you see on your older adult also you will note decreased elasticity of the heart muscle and the blood vessels as well as increased hardening of the arteries or AOS sclerosis what this is going to lead to is increased risk of heart disease hypertension and also heart attacks also you will knowe increased risk of peripheral vascular disease these are all age related cardiovascular changes now of course this does that mean that everybody that's 65 and older has um cardiovascular um age related ches that equal this again because we talked about the difference between physiologic and chronologic age and not everybody ages um physiologically the same but these are some of these age related cardiovascular changes that we may um you know stumble upon and if you see this then these are the results that you will see so if you see someone who's having issues with peripheral vascular disease this is related to paring of the arteries you I mean you already know that that's what you're going to expect also with our heart failure another view you've seen the man or you know pictoral view of the man now we can see it you know in another light what does cardiac um or congestive heart failure do it decreases ventilation that's that shortness of breath that you've seen on the other picture if I'm not ventilating or having shortness of breath then I'm not going to be able to pump those um oxygenated blood cells around I'm not going to be able to fuse which is going to cause C circulation backup or swollen feet and ankles or kangles hence um if my heart pump power is not as um strong then it's going to change my heart rate causing me to be short of breath or be breathless ultimately having a circulation back up causing that edema all right moving on talk a little bit more about those fluids and electrolytes with heart failure okay so when we look at our profusion when we have conest congestive heart failure and we talked about decreasing cardiac output and profusion if they are having heart failure issues they're going to have also decreased profusion to those renal arteries so if there's decreased profusion to the arteries to the kidneys then that's going to decrease the output from my kidneys decrease urine output so what happens when you don't have enough urine output then the doctor ultimately is going to likely put you on diuretics so what happens when you take a diuretic like fosi what happens what does that medicine do a lot make sure urinate a lot and when you're urinating a lot what are you urinating out say pottassium and sodium yep your sodium and potassium is going with that that fluid that water out so if my sodium and potassium is going out what organ what system is probably going to be having some problems too if I'm excreting too much potassium heart heart absolutely so again this is how we begin to make these connections if you're reading your h&p or your client is um presenting with um shortness of breath you're reading the h&p they have a a history of congestive heart failure they're taking diuretics you know they're you know taking all and they're you're getting a diet history and they're telling you oh I ate potato chips and a sandwich for lunch and going through all the go wait wait wait wait wait wait wait wait and they're taking these diuretics but they don't have a potassium supplement so again you're again being able to develop a care plan based on what you know okay yes I have decreased pump power so therefore there was a decrease in profusion to those renal arteries so I was retaining my urine retaining fluid so the doctor resultantly put them on those diuretics diuretics made to ur made them urinate more which was making them spill their uh electrolyte pottassium now their heart rate is um they're having arrhythmias so again how do we develop a care plan specific to this client and what is going on with them and how do we help them educate them on how they you know what they need to eat and the diet that they need to follow so again for those of us who like pictures here we go so we know that with the CHF you know our centralized disease process right in the center for the lung system what is it going to cause difficulty breathing so we can educate them on being able to alternate periods of activity with rest um also being reinforcing the importance of having small frequent meals because you know for yourself it's difficult for you to breathe if you overeat even if you don't have CHF you're just stuffed and you have a hard time breathing so think of someone who already has congestive heart failure so the importance of teaching them small frequent meals that are high in calorie but making sure that it's low salt but high in potassium because again they're like on a diuretic that's spilling that potassium out um also again to help them breathe easier make sure that they're positioning themselves upright um for sleep not all the way bolt upright but maybe slightly elevated um they may have to use some supplemental oxygen at times they also need to monitor their blood pressure and pulse also monitor themselves for dehydration okay as well as what is poly Pharmacy y'all remember what that word means from a few weeks ago um many medicines yeah yeah taking multiple medicines so we need to reinforce proper education and proper teaching also an importance of taking daily weights if they have that diagnosis of um congestive heart failure um that those daily weights need to be done at the same time you know each morning approximately the same time with about the same amount of clothes on you know before they get dressed after their first void also to help with that um circulation Elevate those lower extremities and that true elevation is above the heart so when they're sitting and resting not just propping them on a stool but maybe they need to get in the recliner and Elevate the legs all the way up or prop up on the couch and put the legs on the legs of the couch what labs you know need to be drawn and what are some of the signs of an elevated or or an elevated or a low potassium hypo versus Hyper calmia again we need to make sure that you know you educate the family watch for confusion many times before that potassium gets way out of line the patient themselves you know wait a minute I'm just not thinking quite clearly I I might need to you know get in my doctor to have some Lo Labs drawn all right so it is right at the top of the hour so we're going to take about a 15 minute break and we're going to come back at 4:15 so you guys can take a break and we'll pick up here in 15 minutes e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e [Music] okay I'm back Miss Williams Miss W here miss Whittle Miss Watts here right Miss Ward Singleton yeah M seals here miss Pew here miss Martin Miss Clark Miss buin here Miss Brown here miss Bing here miss almond here miss Andrews here miss Ward Miss Whittle here Miss W are you able to hear for Miss wart can you hear me going to go ahead and begin res sharing screen little pick up keep it moving hear me now miss Ward okay all right just change your name we go there finish these up then move on all right so when we talk about our older adults and how they present with various illnesses we do know that many times their presentation of um illnesses such as like heart attack um it's not going to be that crushing chest pain but they may just have a general feeling of maybe um chest heaviness or fatigue or nausea just I don't feel good the you know several days in a role of just um being fatigued and they may just you know you may notice some confusion so just keep in mind that the older adult may not have that crushing chest pain to signify that they are having a cardiac injury or heart attack so you may want to assess especially if they say I just feel heavy or you know my chest just doesn't feel right you want to assess a little bit further so here's a Do's calculation that we want to just throw in here right quick you have a client with heart failure who has an order for 40 milligram of feride IV times one now the medication on hand is feros 10 milligrams per 2 milliliters how many meals will you administer once you have it figured out raise your hand okay Miss Whittle what you got you ask me right say Miss wh is it eight okay how'd you come up with that tell us how you did it um I divided the 40 um the 40 and the 10 because that's what the D over orders and what you got on hand times about of two MLS okay all right so you got um what you got on hand or uh well you got your dosage over on hand times your vehicle so your desired amount is what you need is the 40 milligrams what you have on hand is 10 milligrams in the vehicle and it's 10 milligrams in 2 milliliters so 40 over 10 you'll cancel out those milligrams it gives you four times the 2mil bottle so you're going to have to give eight meals again if anybody is having any difficulty figuring out how she got that or how we're getting that please make a um send a message to me so that we can get together and figure these out before our next Quiz and or exam so 2 milliliters times over 10 * 40 is 8 Ms all right what about these respiratory changes as our clients age what happens you know in our lungs and with our respiratory system there's a decreased number of cyia what are cyia who remembers what silia are from class isn't it like the small hairs that filter yes those little hairlike projections in our lungs it helps to flush makes you cough it helps to move that mucus out of your lungs anything that gets trapped in your lungs that shouldn't be there it helps to sweep it out it's like your little sweepers so you have also decre decreased strength in endurance which also makes you have a decreased or them have a decreased lung capacity this is also linked to an increase in calcification of those cartilage the cartilage that is in your um rib cage so that cartilage gets hard or it calcifies and so therefore your lungs can't expand because your um ribs won't move you they're kind of like stuck they're calcified you also have a decreased number of macro phases or macro what is a maccrage what are those what are those part of what what cells who remembers macras what kind of cells are those what kind of blood cells are those it say white blood cells white blood cells so if I have a decreased number of white blood cells floating around I have a ined capacity to fight off infection I don't have enough white blood cells right so that's going to mean I'm might have a diminished immune response all right also have a decreased number of capillaries all right um also tissue elasticity is going to decrease which means I have a decreased ability to exchange gases this is going to be linked to increasing the pooling of secretion so those secretions are going to want to stay hanging around in my lungs making me more susceptible to that ponia or pneumonia right so again these are all of those kind of expected changes as our clients age so when we talk about pneumonia again pneumonia is basically pertaining to you know inflammation in the lungs and pneumonia can be caused by bacteria it can be caused by vir a virus fungi various chemicals can cause it or mechanical agents like we talked about a few slides ago with that um feeding where you that client can aspirate or they can aspirate on some food but regardless of the cause of the pneumonia it's inflammation in the lungs um in the and usually those lower loes where that fluid is pooling hanging out so when we look at that what are some of the symptoms if your client has fluid in the lungs what do you think you might assess what what how might they present to you you think if they've got fluid in their lungs they got pneumonia crackling yep you'll hear some crackles likely and coughing yep don't cough shortness of breath yes gonna have difficulty breathing breathing's gonna be hard for um gasping uh dis dis whatever dis that's it that's that word and again all of these words learn how to spell them and you'll be fine yes but yes this meal so these are a lot of those um and many times depending upon the type if it's a bacterial pneumonia um they may also exhibit a fever because they'll have increased white blood cell count but keep in mind that our older adults that immune resp response is going to be slowed because they have a decreased number of macras so by the time they develop a fever they really sick all right um also usually with this um pneumonia they're going to have an increas in heart rate so that's Tac cardia increas in respiratory rate again they're going to have difficulty breathing but they're going to be breathing faster and trying to breathe a little bit harder trying to exchange those gases called Topia and of course that increased work of the heart increased work of breathing is going to make them fatigued and you already mentioned that cough because that that IR ation of that mu mucus that's pooling that fluid that's pooling in those lungs again just like I said the elderly may not have a fever um and by the time they develop the fever it's Advanced that pneumonia is has been there for a while another one of those lung issues or respiratory problems with the older that can be seen in the older adult is TB or tuberculosis this is caused by the bacillus microbacterium tuberculosis some of the symptoms include same similar to pneumonia cough but a Telltale sign is hopsis what does hopsis mean what does hemo mean heo means blood blood so that's going to be that kind of old rusty that rust colored um spew so that's going to tell you the difference between is this possibly pneumonia versus TB hottois it's going to be that blood tinged or rust colored sput in addition to possibly night sweats um again they may have a little fever but the tail toil is going to be that hopis that rust color sputum they'll also have difficulty breathing and weight loss if they have TB you're going to have to put them on airborne droplet precautions and this is um high risk for our nursing home clients um again because they have that weakened immune system so our frailed older adults are very susceptible to um getting TB so again when you're assessing those older adults like with this 92 year old and they're being evaluated for an infectious respiratory disease what is going to be a Telltale sign that they have TB the sputum that rust colored sputum is going that hottois and again there's going to be a difference in uh usually if it's something uh bacterial or you know B relet is going to be yellow to Green if it's TB is going to be rust and then if it's cancer it's going to be more really active bleeding because if anybody's ever seen even a cancer wound is usually Frank blood it's like red blood so again that'll help you again when you're making your columns to study um these respiratory um illnesses make your columns and how do I separate now if I'm thinking these disease processes TB TB versus you know lung cancer versus uh t uh pneumonia how can I tell them a part they all cough they all have you know spew them how do I tell the difference they all short of breath how do I tell the difference so this is kind of how you could put them in columns and figure it out um if it's you know if they're having night sweats with rust colored sputum chest pain and it's been going on for a long time that rust colored sputum is really GNA tell you that's likely to be you look over here to the other side they're going to have coughing and disia they'll even have chest pain it's going to be chronic but the sputum is going to be frank blood it's going to be bloody it's going to be more red than Rusty like old blood then of course you've got your pneumonia in the center that's more acute that's something that's you know just happened more recently you know in the last three to five days you know 10 days um they'll have yellow to Green sputum you do a white blood count it'll be elevated along with increased heart rate and respiratory rate and then usually with that pneumonia they'll be achy you know and just generalize just feeling bad but again doing those compare and contrast columns kind of helps you um separate it in your brain what about you know COPD that osma asthma you know what are those signs and symptoms and what are some of the risk factors for development of COPD how would you you know is this you know a pneumonia or how would I know this is you know maybe empyema a COPD client what would they look like how would they present what are some of the Telltale signs that says up Yep this is COPD this is something chronic here what do the O2 saturations look like over time low O2 stats yeah O2 saturations are low cons consistently low now again of course anything less than you 95 we're g I need to do something about it but our cop deer they're normal is like 88 85 you if you can get them up to 90 that's good 85 87 is usually about where they stay that's your C COPD what does their chest look like what does their upper body look like is it broader it's kind of like a barrel it's like a rounded chest and that's again because they're retaining that CO2 their lungs are always overinflated so it deforms their chest so you usually see that COPD client that has that barrel chest that rounded chest because they're retaining air they don't ever expel ex you know exhale all of that air because they're not able to so some of the risk factors with that of course you see that cigarette there they can even um be someone who may be worked in asbest you know or worked in a chemical plant where there was a lot of or live somewhere where there's a lot of pollution it's not always smoking but COPD empy is usually linked to you know someone who has smoked or been around smoke what are some of the interventions for COPD how do we treat that how is it treat oxygen okay we can do oxygen but do we just blast them with oxygen no you can do um Bronco dilators steroids um stop smoking yes we always want to see if we can teach some smoking sensation someone said we don't just blast them with oxygen who said no we don't do that about how much oxygen is safe isn't there a formula how you would tell which what level they would need on oxygen for our COPD client I mean it's usually safe to give them about two liters no more than three because if we blast them with that oxygen it kills their act their hypoxic drive it kills their drive to breathe so we can actually kill them so we actually give them you know one to two liters and again that just kind of supplements it gives them a little bit of help but if we give them too much it kills that because what makes us breathe is that we have too little oxygen so that's what automatically makes us breathe but if we force it on them their body can accommodate for that so it kills their hypoxic Drive kills their drive to breathe all right also when we think about our clients who have COPD we also have to make sure that we get them adequate nutrition and adequate hydration we need to make sure that we're make that they're getting their fluid so that we can keep those um kidneys working so that we can filter those medications out so that they don't become toxic also we need to think think about um if they're on supplemental oxygen keeping it moist um if you've seen in the hospital often times with our clients who have a nasal can and you'll see the little bubbling water that is attached to it that helps to keep the mucosa moist as well as offering them water between meals um again that helps to keep everything moist and also keeps uh the the kidneys filtering out those toxins so again another study tip again memorization doesn't work of course rope memor ization you just got to know those conversions you just have to know you know the the pounds to kilograms the milligrams to the grams you just have to know that but for like these disease processes and Concepts you can't really memorize it and really if a client or patient can't breathe it don't really matter if they have you know COPD or if they just ran a mile running from a dog they're having shortness of breath right now so give me some oxygen so that I can I can breathe so we have to look at the concept and what's really going on with someone who's having difficulty breathing of course their heart rate and respiratory rate is going to be up regardless of what cost it so initially you know before I ever get a physician's order I can you can Elevate the head of the bed and give them that two liters of oxygen you can go ahead and do that then we have to figure out you know what is causing this you know if it's um an acute asthma attack then do I need to do some Bronco dilators and a breathing treatment or is this related to to them having a a PE they're throwing a blood clot in it you know in their lung you know what is causing this and what are the other accompanying symptoms so that we can adjust the interventions but initially if someone is having you know shortness of breath just raise the head of the bed give them some oxygen and then we go further into the assessment but again you can't just memorize you know what everybody who's having a heart attack this is how we treat them everybody who's had a stroke this is how we treat it because that won't work you have to um do your assessments and then of course you develop your care plan based on how that client or patient is presenting to you so a little question here when you're reviewing the discharge plan for a patient or client with COPD the nurse should anticipate that the client will do which of the following this is for a patient or client with COPD will they develop infections easily will they more likely maintain their C current weight as this disease um progresses will they require less supplemental oxygen or will they show permanent Improvement what do you expect to happen with a client who has chronic obstructive pulmonary disease develop infections easily absolutely because they have that again as we age those clients have decreased number of macres okay all right again and we look at this um they're going to Inc develop those infections again it's slowly Progressive therefore maintaining their current status is not going to be a goal of requiring less supplemental oxygen because of the slow impr um progression of the disease permanent Improvement is highly unlikely another one you have an elderly client who has been ill with the flu they have um experiencing headache fever and chills after three days she develops a cough productive of yellow sputum the nurse osculates her lungs and she hears duse crackles how would the nurse best interpret these findings so first she has the flu now she has headache fever and chills after 3 days there's yellow sputum now listening to the lungs you hear crackles what is this is it likely that they developed a secondary pneumonia these are consistent with the flu and to be expected the client is getting dehydrated and needs to increase the fluid intake the client has not been taking her decongestants and Bronco dilators as um prescribed what's likely going on here number one yeah number one say number two all right so let's walk it out we go back to our columns that we talked about with a client having flu and they're experiencing headache fever and chills and in three days they have a cough productive of yellow sputum and the lungs have crackles in them what is likely happening or what are these findings suggestive of number four no number one I still St number one is what is suggestive of because if it's just viral flu in three days we likely are getting better in three days if it's flu and we're doing what it is we need to do but if we're getting worse we're getting yellow sputum remember that is Con uh in the lines of pneumonia also fluid in the lungs if you listen to the lungs you will hear crackles back from that slide that is suggestive of them developing a secondary bacterial pneumonia and decongestants and Bronco dilators are not typically prescribed for a flu all right so muscular skeletal changes again still hanging around in chapter three a little bit longer um talks about a table in chapter three as well again please pay attention to those tables and those things that are in bold and on charts when we talk about those muscular skeletal conditions um that are clients may or may not have again please make sure that we are sitting up and engaged um we're talking about o osto arthritis versus rheumatoid arthritis and we have two different pictures here who can tell me a little bit about this picture here on the left side where we have the the fingers the hand who can tell me a little bit about though that picture there the finger and the Hand who knows what that may be suggestive of versus the one on the right with the knee joint showing I'm so sorry can you repeat the question I'm so sorry okay what these two pictures you see here on the screen on the left side you see a picture of some hands with an arthritic condition and then you see one on the right with uh looks like a knee joint with an arthritic condition what are the differences between these two types of arthritis anybody have any idea one's inflamed okay and which one is inflamed and do you know that type of arthritis versus the other uh left side would be the rheumatoid arthritis and the right's The Joint arthritis okay all right so we've got rheumatoid on the left which sorry real quick are we doing from the picture left to right or from the swelling left to right from the hands are on your left when you're looking at it no no no no I get that but I'm saying like in my computer left to right or to like flip my whole body and actually be left to right hands to on on my screen hands are to the left yeah I get that I'm saying like if I was to look at it like the swelling is for me is on my left so but if I turn my body like my actual body to match up their hands it the swelling is on the right hand so that's why no I'm just talking about the whole picture on the left side of the screen and then the whole picture on the right side of the screen because it's showing you a normal hand and then a normal knee you see what I'm saying a normal hand a arthritic hand normal knee arthritic knee okay thank you all right so yeah the hands are showing you rheumatoid arthritis with which is an autoimmune arthritis versus the right picture with the knee is an Osteo or wear and tear you go back several weeks where we talked about the various theories the wear and tear or the overuse um injury um with the um osteoarthritis on the right so how would I keep this separate in my brain you know and also um we talk about other um muscular skeletal conditions like osteoporosis um with our aging adult what are some of those risk factors for developing osteoporosis who remembers some of those from your readings and from the weeks prior um you said risk smoking yes smoking for osteoporosis what else menopause menopause yes Co female yes Caucasian or Asian female of small body frame all right anything else anti acids yes use of an acids like Tums and also anti-seizure medications anything else not getting enough what calcium calcium in your diet and also exercise low impact exercise how much is the recommended amount of exercise what type and how many days per week how long 30 minutes three to five times a week and low impact like swimming or walking yes absolutely 30 minutes three to five times a week low impact exercise this helps again to keep those bones healthy and strong we need a diet that's rich in calcium and vitamin D of course where do we get vitamin D and where do we get calcium vitamin D with the sun calcium uh milk y any of those dairy products also you can get a little bit from some fish again that's uh fish like salmon um and then also if you're not getting enough C you can do calcium supplements with vitamin D you can also do supplements but it's best to to try to ingest as much and of course that vitamin D You Can Get It Free from outside when you're taking that 30 minute walk three to five times a week all right so let's do a little bit of matching all right so on our left side of your screen here you have decreased calcium decreased in um fluid in the intervertebral disc decrease elasticity decrease muscle mass and decrease muscle I mean blood supply matched to the other side we have decreased height decreased mobility and flexibility decreased strength leading to Falls decrease muscle strength and then decrease um bone density leading to osteoporosis so which one matches with decreas in bone calcium which one on the right matches with a decrease in bone calcium of those choices um is it the last one last one on the right that says decrease bone density that's the one you're talking about the bottom one um yeah okay all right what about decreased intervertebral disc someone else what do you think which one on the right side matches with a decrease in the inter decrease of fluid in the intervertebral disc is it the second one second one in the you're saying mobility and flexibility yes okay all right somebody agree or disagree with her on that one what do our dis do in our back intervertebral dis is it decre height decreas height yeah decreased height that's the one absolutely all right what about decrease in tissue elasticity what does that do the mobility and the flexibility right right right all right what about muscle mass and then decrease in muscle mass and decrease in blood supply how do we fix those what you think the muscle mass would be muscle stress all right and then but blood supply then um the one with the Falls okay all right let's see so actually muscle mass is decreased strength leading to Falls and blood supply is decreased muscle strength again those two can actually be interchangeable but calcium decreased bone density those again those dis uh spaces have the fluid in them to help maintain height and if you have a decrease in elasticity and flexibility that is going to to um decrease your mobility and decrease your ability to you know be flexible when you look at muscle mass you decrease the muscle mass that a client or patient has their strength is going to be decreased and again muscle strength strength um decreased strength is going to um also lead to Falls if you have decreased strength that's decreased strength in your muscles going to lead to um Falls here's another comparison and contrast what we talked about just a few minutes ago a arthritis osteoporosis rheumatory arthritis so how can we keep them straight again we know that um those risk factors for osteoporosis so what is osteoporosis we know that it's fragile bones that break more susceptible in females who are Caucasian and Asian can be related to long-term use of various medicines that include cortical steroids um uh anti-seizure medications like photoin um aluminum and acids like Tums or proton pump inhibitors also can be linked to those clients who have endocrine issues it can be treated with calcitonin which is a calcium um supplement many times it is a nasal spray um that you that the clients get with the osteoarthritis women again poor women with this these Osteo problems are more affected than men this is that overuse injury that wear and tear and it's actually worse with activity and it's usually more one-sided often times if you're right-handed you're actually more right sided where you overuse that right side you even bear more weight on your right side than you do on your left this can be treated with controlling the weight and doing um strengthening exercises also with non-steroidal anti-inflammatories and steroids um with the rheumatoid arthritis again women are more affected than men this is an autoimm autoimmune inflammation um disorder where it has flares where it waxes and wains generally if you have rheumatoid arthritis going to affect both sides of the body um it's usually worse if you don't move around so you need to balance stress in the joint with rest and exercise it is also treated with inets and cortical steroids as well as Demars and biologics but again just go into your text and read about these um three different ones and make a little chart to get them kind of separated in your brain all right let's see all right we're good keep it moving older adults in the GI tra we do know that our stomach is lying with the mucus membrane and this helps protect it but as one ages those digestive um those that you know mucus membrane Thins and it goes away so we have to be mindful of those Hydrochloric acids in those digestive juices and also those medications that can injure the lining of the stomach causing ulcerations so many times um as our adults age there's going to be a change um in their gastric sec they're going to decrease so we have to be careful um um and be mindful of those medications that can damage that lining of the stomach so many of the medications that our older adults take um have the inter coating I know you've heard you know over time your aspirin a day keeps the doctor day away so you will see that the um candy coated or the Interac coated aspirin are better than just a plain Aspirin because the aspirin you know irritate the stomach many of our inets like AR proen the proxin they'll have the coating on it again same way with the iron supplements you'll see the the Slow Fe but it'll have that candy coating on it to help um coat the stomach to keep from eating away at the stomach causing an ulcer another table is listed here when our older adults are complaining um of stomach discomfort many times it's not the crushing stomach pain that you or I may have it may generalize I just don't feel good or you'll notice a little different in their demeanor they may not be eating or eating as much you'll notice like you know over time you know over a few days or week they may lose a pound or two um they also May complain of nausea or they may vomit one or two times again vomiting is never normal may want to look a little bit further into that for our older adults who are you know Continental bowel and bladder you may want to ask them you know what if your stools look like um if they say oh they were really dark what is a tar stool or dark stool indicative of anybody know what does that mean if they have a black stool iron supplement sometimes it is an iron supplement but if they're not on iron supplements what might that tar stool be blood blood so that could be um indicative of a GI ble so again as you're assessing these older adult clients and they're just kind of just moping around maybe not eating saying that they're not hungry the stomach just doesn't feel good and again any time that they're vomiting not anybody can have a one off and and throw up but if they're complaining of nausea and vomiting you want to assess a little further and if you're seeing that tar sto it just might be a g okay moving on to endocrine disorders and diabetes can talk to us a little bit about some complications of diabetes and some risk factors what you know about diabetes anyway what are some comp applications of our clients who have diabetes what have you noticed s somebody said losing sight okay losing limbs limbs right neuropathy neuropathy I was about say all linked to neuropathy whether it's diabetic retinopathy that causes the eyesight or neuropathy that causes decreased feeling in the lower extremity so they have open wounds on their feet that they don't know or see um because they can't you know see um they don't feel because of the neuropathy and then they develop an infection ultimately the the limbs have to be amputated because of you know the deep bone infection all right any other things diabetic keto acidosis yes okay yes having those extremely high blood sugars related to again their diet many times related to their um diet if you take a look at these feet and we talked about as our clients age the changes in peripheral circul this is due to decreased circulation in the feet and Toes not getting proped so those feet become deformed so we have these feet that are shaped for lack of different terminology like a football and then you stuff them into a regular shoe and you've got these bunions you know hanging off to the side and then you rub wounds onto these bones that are sticking out to the side you've got calluses everywhere and then of course this develops into a wound so again teaching our older adult clients the importance of again if they can't see their feet having their feet assessed every morning and every night making sure that they are seeing the podiatrist and having those toenails trim um as they should um what are some risk factors for developing diabetes anyone weight yes weight yes diet yes weight diet your race your family history yes nothing we can do about who we're related to it's the unfortunate thing can't do anything about who we're related to but we can change you know and educate our patients and clients on you know diet and exercise um and you know making healthy choices again we have to keep in mind too those physiological barriers that we talked about in those psychosocial when it you know finances so again if they're not able to afford you know always fresh fruits fresh um fresh like fresh vegetables fresh meats um the next best thing is frozen also be um cognizant of the resources in your your area you know when when is the Mana drop you know what types of you know resources do they have for the elderly is there a Food Bank where they can actually get some of these items to help them to stay um compliant with their diet or adhere to their diet and medication reg regime because we don't want them to choose do I buy my medicine or do I pay my electric bill you know what are some of the resources that are available for our clients so that they can be adherent to the the um plan all right then we have hypo versus hyperthyroid roidism and um go back and review you know from A and B Class you know why do we have a thyroid and what is it for what is that thyroid gland for and then our clients um how will they present to us if they have hypothyroidism versus hyperthyroidism so we have a visual here our client who has a low or um decreased functioning of their thyroid gland they're usually um more of a puffy face both will exhibit hair loss but they'll have a puffy um face and they're more on the overweight or weight gaining side versus the one who has that overactive thyroid um they both will oftentimes have the goer but they will have the hypothyroid um client will be more intolerant to Cold versus the client with the overactive thyroid they're always hot they're not in um they're not tolerant to to heat at all very well um they will have a slower heart rate if they are hypothyroid versus the hyper who has a rapid heart rate um constipation and our slower or lower AC thyroid versus the opposite with diarrhea with the hyperthyroidism again both will have issues with fertility the eyes with our hyperthyroid client the one with the overactive thyroid they will have the bulging or the you know the the um bulging eye so again compare and contrast these endocrine disorders all right also some more you know study methods compare and contrast the neurological um disorders we've talked about of course we will not leave Alzheimer's and Parkinson's we're going to talk about that some more in the coming weeks but you know make a column Parkinson's Alzheimer's and CVA or stroke and do some comparison and contrast what is a like about them what is different how do your clients present um based on you know the diagnosis what is similar what is different to help you um be able to you know separate those Concepts stop this one y'all need a breather or we can go a little longer Miss Brown her eyes told it all yes she needed breather she said she ain't gonna say nothing but she answered for y'all her eyes are like mine that they spoke for so y'all get a breather see you at 5:15 and then we'll take it all home he e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e e okay come back and finish up the day come back on camera start on our next session and section and then just before we're done I'll give you some Concepts to review for our next Quiz there'll be a quiz at the beginning of class class next week and then week seven will be exam to again starting next week there will be some live exam reviews want to say right now we have two scheduled Wednesday one on Thursday and one on Sunday there may be another on Thursday we don't have a whole lot of uh attendance on Friday so we may not be continuing to have one on Friday so maybe another one on on Thursday and then also one on Sunday so actually last semester and then started out this semester nobody comes on Friday so I don't know if it's a clinical day or you all have just had all you can take by Friday but usually no no attendance on Friday review day so um we'll just have to readjust that but I know there's two Friday one Friday evening not Friday I'm Excuse Wednesday evening then Wednesday night then Wednesday at lunch Thursday at lunchtime and then I know Sunday evening but um we'll see where that goes so again see all faces here let me go ahead and share this all [Music] right right moving over to chapter 17 talk a little bit about care of the aging skin a little bit more all right so some learning objectives for chapter 17 what are some of the age related changes that affect the skin and the mucous membranes and as nurses you know what do we do how do we handle that also identifying older um older adults and um their risk for skin related problems and then also being able to describe interventions that help older adults maintain their integrity um that Integrity of again that skin and the mucous membranes so again here's another cross-section of the skin so again I guess we need to make sure we go back and review that know what that cross-section of the skin looks like and what is what um remember what is involved what is in the epidermis you know those melanocytes and um we do know as our um adults age they get older there's a decreased number of me melanocytes in the epidermal layer then what's in the dermal layer that's where you have you know your hair follicles and blood vessels and those sweats or and oil glands sebaceous glands are located there um also then as we get a little bit deeper in that subq tissue we have that fatty tissue and then below that that soft tissue the muscle is and then below that the bone so don't forget what that cross-section again we just talked about this a few slides ago you know when you're doing your assessment on your older adult where you're comparing the skin compare size of the body we already talked about why why won't you check um skin trigger on the hand on the back of the hand and on the forearm for the older ad do who remembers that what changes elasticity elasticity changes so again on your older adult they're gonna tint anyway so again I'm 12 see I don't tint so uh you always want to check at the coll bone or the sternal and if you're checking the C bone check the right and the left make sure it's equal checking that hydration status you also want to check temperature right versus left is it equal um look at the color have you know are the color changes symmetrical um what about dryness you know again we also know that when our clients are dry that can lead to them being more susceptible to injury because again dry skin is itchy skin so if they're scratching the skin has less elasticity less moisture it's going to be more susceptible to injury scratching can lead to skin tears or little tiny openings another word for dry skin is xerosis so again you may see xerosis on a quiz or an exam or you may see dry skin know that those mean the same thing um we know that about you know 75% of our older adults older than 65 have dry skin and why and that's because they have a decrease in sebum or oril production from those sebaceous glands we also know that it is linked to dehydration and having those nutritional deficiencies as they age also those chronic disease processes that are linked to um uh aging like uh kidney disease and diabetes as well as those other endocrine disorders that deal with thyroid also we mentioned earlier this afternoon about those harsh soaps making sure that we rinse those cleansers off our patients when we're bathing them um if not again results in itching so if they're scratching that thin dry skin they can tear it again we got a break in the skin our largest organ that is there to protect us that's a portal for infection a portal of entry for infection also be mindful of rashes and various irritations rashes can be caused by medications um various communicable diseases um and also chemical coming in contact with um chemical substances also scabies what are scab anybody know about scab bees or had any look at Miss bu's face she must have worked in long-term care what you know about scab no my um my ex-husband one time when we was like up in middle school he had a dog and they had watched he cleaned the dog in the tub and he end up uh taking a b and got okay all right that's all right so what what anybody had any contact with skabes possibly from you know your work relationship with your older adult work work Miss Martin says she has a little insight from work I know he something about it like it Scapes over and then it's um I'm so sorry I'm so sorry um something about escapes over and then it's not as contagious but see I still like take precautions um if I'm saying it right something something happens like it's another layer over the scab Beast that doesn't make it yeah it's like a little itch mite and they Burl underneath the skin they're little insects and they burrow underneath the skin our older adults and it usually and they I mean they spread like wildfire if they get into your facility um and they're usually asymptomatic and they're so tiny that you don't see them until you itching like crazy well you don't know have it and they like to get in um it's usually around where like um the the waist because that's where the pants there's rubber around the waist but there you'll see like these little tracks um that are buring around around the waist sometimes it's around the wrist especially if they have like on a bracelet or they have on a long sleeve shirt that has a a sleeve that closes around there but it usually takes about four to six weeks for them to show up so many my experience with them you know we have client who was admitted to our long-term care facility and they come in with them you don't really know them CU you can't see them and then they're there for two or three weeks and all of a sudden you know that whole end of the hall is itching and scratching um but they they are very hard to eradicate you actually H you have to actually burn them pretty much you have to like clean all the Linens off the bed all their clothes and and wash them in scalding hot water um and you have to pretty much quarantine that whole area of the facility and that includes the the same employees have to work on that area as well because I mean you can really we had a a huge problem at one of our facilities um here in the town where I worked some years ago with um scab but again it's like little itch mites and they burrow little tracks up under the skin melanoma so when we look at melanoma as our clients age they're going to have fewer melanocytes and those are those uh cells that cause the pigment but with um when you're looking at your client and you're assessing their skin and you begin to see what you're thinking maybe an age spot so you need to evaluate that age spot is it symmetrical or is it asymmetrical and you can use the ABCD method you know are the the borders of it are they you know are the borders of it uneven are the edges you know as opposed to smooth has the color changed um is it dark or does it have multiple colors um is the diameter is it getting larger is it larger than six millimeters or is it changing shape did you assess their skin you know 10 days ago 14 days ago and you're looking at it again wait a minute now this spot was a little bit different last time so again if you see these large irregular shaped dark spots you might want to you know advocate for them to be assessed further because they could be the developing a melanoma again you take it through that AB B CDE e you know is it asymmetric what do the borders look like what is the color what is the diameter and is it evolving or changing in size color or shape then what about acne rosace again this is that Rosy cheek is triggered usually by the sun heat drinking hot drinks or eating spicy foods um that is the and it's usually you can see it more on your fair skin clients but it's like the the rosy cheeks um so when we look at this um what is the difference those AG spots are going to be um irregular shaped lesions that are varying in color and size rosacea is usually the rosy cheeks and around the nose again changes in the size or pigmentation of moles um also need to be assessed further 70% of Americans age 70 or older will develop some type of skin cancer so irregular lesions that are darker than normal or change color or shape need further evaluation so let's do some matching which one of these is cile per which one what you think of these pictures I'm g go with the T because that's probably like one now Perle what you say is it the one with the tee the mouth with the the purple skin okay the purple skin skin that's right and that kind of a tail to tail tail the way it's um um purple that's the capillary fragility is um causing an issue so the capillaries are popping open or bursting open so it's causing those purple spots what about luopa the teeth the stuff in your mouth yeah that's the white plaqu underneath the tongue okay which one is scab the one with the pattern dot skin okay there yeah those are those little burrow it mes and then rosacea The Rosy Cheeks all right rosy cheeks on the lady all right all right the nurse is collecting data from an older adult client which change is most likely to indicate a potential complication associated with the skin of this client a complication associated with the skin is r a complication thinning and loss of elasticity in the skin a dark irregular lesion on the shoulders or dry skin that requires moisturizing which is a complication associated with the skin c c c c a dark irregular lesion on the shoulders all right risk factors all right so pressure ulcers when we look at the risk factors for pressure ulcers again compromise circulation is a risk factor that again pressure being on an area cutting off circulation over time also just compromise circulation whether it be from you know Advanced age where peripheral circulation has you know decreased a client who has restricted Mobil Mobility also altered level of Consciousness they don't know that they are feeling uncomfortable you know so that they change their position for you or I we moved a 100 times over the last you know hour where we just you know change just because we don't feel as comfortable if they're having problems with incontinence of feces or urine you know decreasing uh nutrition whether not getting enough protein or vitamin A or C sheer INF friction where we're you know transferring our clients you know from bed to chair or they're sitting or we have them you know bolt upright 90 degree angle where those friction and sheer forces are on their body this can cause increased incidents for pressure injuries also the negative effects on overall health can also make them more susceptible for pressure injuries keeping in mind that these pressure ERS pressure injuries can lead to infection pain loss of function and ultimately can lead to death so when we look at these pressure injuries we look at the various um pressure points that can be uh on our clients but again bony prominences number you know are at the top of the line here and you'll see the three pictures here with the various bony prominences the back of the head are the oxop put shoulders elbow and buttocks as well as the heel and then depends on the the uh position whether they're supine s side Ling or prone what bone imp prominences may be um in contact with the surface so we need to be mindful of that as well so we need to make sure that you're doing a formal risk assessment at the time of admission upon discharge and when there's any change in their condition all also at regular intervals again I know that you do a shift assessment you know at the beginning and at the end of every shift again but it depends on your client condition your clients in ICU sometimes those assessments are done you know every two hours every hour again one of those assessments that is you know well known is the braiding scale again depends on your organization which one they utilize but the braiding scale is a a pressure Ula risk um scale that you can follow and it helps you to um de iate what risk level is this client for developing a pressure uler all right so what are some of the nursing interventions that can help prevent pressure ulcers Q2 turn okay all right making sure we're turning them and it's an Unwritten rule that we need to turn and reposition at least every two hours uh making sure the skin is dry and moist like not moist as far far as but like um just make sure ain't Dy as moisturized make sure we're keeping the moisturized but if our clients are in content making sure that we're keeping them clean and dry so whether they're in briefs or we have incontinence pads under them if they get wet or soil that we're changing them all right like Barrier cream yes barrier creams right making sure that if there's wrinkles underneath them in the covers in the sheets we smooth that out if they're sweating we're changing out those Linens making sure that we're getting dry Linens also when we're bathing them that we are um you know patting them dry and not rubbing them dry with the towel so all of these things can help prevent pressure ulcers also making sure that they're Ade adequately nourished as well as hydrated all right so here's some other interventions utilizing a turn sheet we already mentioned uh repositioning peric care after incontinent episodes head of the bed again at less than 30 degrees we don't want them sitting you know at 90 degrees um less than 30 want to encourage activity even if they're bed bound we need to get them up get them out of the bed you know put them in you know a Jerry chair or some of the other chairs making sure that again dietary console adequate nutrition adequate hydration okay alopecia hair loss um that is related to some type of systemic problem or systemic condition this can be seen on the scalp or it can be in the extremities but usually when you see it in the lower extremities or in the arms it is related to a reduction in circulation so you will see this often times with our older adult that is linked to a decrease in circulation or reduction in circulation let's look at this time there go a couple more so when we look at the tissue of the feet many of our older adults they neglect or they don't look at their feet or they don't take care of their feet for a number of reasons often times it's because they can't see them remember they have a loss of sensory function they're not able to see them or they have decreased Mobility they have you know a physiological reason that they don't care for their feet they can't reach them so we want to make sure that we advocate for them to see a podiatrist often at you know regular intervals so that they can get the toenails clipped and have their feet inspected remember we talked about because of the decrease in peripheral circulation those toenails will be very thick and hard so they will have hyptosis which is those thick hard nails so they're not going to be um able to cut them usually at home can't cut them so they need to go to a podiatrist who has that specialized equipment to cut them also there's going to be decreased sensation um related to possible maybe diabetes or peripheral vascular disease and it also um if they have decreased circulation or decreased sensation they're more going to be more susceptible to injury and if they don't have enough sensation they won't feel the injury so they'll have an open wound or an open area a portal of infection so that's going to be an issue so if we look at the picture over on the right you see the normal artery that has you know can have proper blood flow versus that artery that is filled with plaque or aor sclerosis what do you think might happen you know with the blood flow versus you know with the artery up top versus the one on the bottom someone talk to me about that what might be the difference it just less blood flow through the artery right so you're not going to have enough blood flow so if you have an open wound or you get an infection and you're taking the antibiotics and you don't have good profusion to your feet the antibiotics are not going to even get down to that open wound or that infected area or not enough of it will get there to help you know heal that wound or decrease the infection so we need to also you know stay mindful of that with these um circulatory changes as our clients age all right so again there's that picture of luopa again we're going to stop there and I'm going to pull in some information for some concepts for you to make sure that you review um prior to next week so again with this is a sign of oral cancer those those white plaques underneath the tongue this is usually a poor prognosis those the white plaques those precancerous white patches on the side of the tongue early recognition and treatment is going to lead to the best outcomes but is this is usually related to our clients who are tobacco and alcohol users all right so we'll stop that one right there let me stop this share and I will pull in right just some reminders we'll call it an afternoon we made it all right so just a concept review we've talked about a lot today since 3 o' so just go back and review and be and be reminded of what is friction and Shear what are Shear forces and how can these be caused for our client you know uh what position is going to increase Shar INF friction what positions decrease shearing friction um with our clients you know how can we as nurses what interventions how can we um move and transfer our clients to reduce friction and Shear we just talked about this few seconds ago what are some interventions to help prevent pressure ulcers pressure injuries making sure the Skin's dry making sure your Skin's dry clean and dry repositioning the patient okay yes changing that position again Unwritten rule of Q2 hours but I say every two hours and as needed as often as needed anything else if they're laying in the bed wouldn't you um put like those wedges underneath them so the creases of their skin won't be bunched up together yes you can utilize wedges pillows you know sometimes we have to utilize pillows um you know blankets anything you know to prop them absolutely you know making sure you know if they're sweating or the take if they like um they in the bed they take them out the bed and put like in the chair and I keep changing position like yes yes activity get them up set them up for a while you know lay down prop them up just changing that position again how do we prevent shearing injuries with our bad bound patients not sliding them on the bed that's right let's not drag them across the bed and from the stretcher to the to the bed use a lift te so that we can actually completely lift them up or use the lift lift equipment also you can use your bed to help you position you know if you need to put that patient up to the top of the bed put that bed in that reverse Trendelenburg and it will help you to um off weight the patient and that way you can actually use the bed to help you reposition that patient so again the lift sheet too yes use your lift sheet and then what is that new uh I can't think of the the device now but you um put it under the client and you blow it up it's got air in it the is it the bear what is it called a lot of the hospital beds now have the automatic um pressure thing where every 15 minutes it inflates a part of their body and then deflates it to help with pressure absolutely and then there's one of these things now that we use and I can't think of the name of right now it may come to me that you can actually put under the patient and then you put air in it it helps you with the transfer it helps you transfer them from surface to surface but I can't think of the name of it now but yes use your lift and transfer equipment also how can you protect aging skin from skin tears and bruising being careful how you handle them yes careful how you handle them make sure that skin is moisturized and make sure they're adequately hydrated and nourished this will also help from um you know decrease incidents of skin tears and bruising also when we're bathing make sure we're getting rid of all of that soap um changing those damp um damp linin and providing that per care using those creams make making sure we're removing those um incontinence pads and also if they're wearing briefs make sure we're changing the briefs um adequately and there here is this xerostomia what does that word mean what does zeria mean the dry no yeah dry something mucus membrane zomia same thing as dry dry mucous membranes or dry mouth so same thing as dry mouth so what is your client at risk for if they have dry mouth thrush maybe no yeah they can develop thrush but what would they be more susceptible to if they have chronic dry MTH what might that do to their infection yes infection increase risk for infection also it would increase their susceptibility to gum disease and tooth decay because again we use that saliva it helps to kind of wash all of those you know wash impurities from our mouth all right so again go back and review that area though that information in the text on dry mouth and zer zeria what foods are natural atives prunes okay got prunes and raisins what else stuff with fiber in it stuff with fiber in it right so somebody said something else what was the next thing like apples or apples okay so we got high fiber foods foods that have um fiber supplements what do we have to have along with these high-fiber foods can't just fill them up with fiber supplements and high fiber foods what else do we have to add with that water water got to have that hydration what is the amount of fluid per day 1500 L it's two to three 12 oh I'm sorry two to three liters so that's 2,000 to 3,000 milliliters got to have enough fluid because if we pack in all of this fiber then they can actually it can lead to constipation if they're not getting enough hydration to help with that gastric motility to move it out so again if we don't remove the constipation keep every keep parastasis going it can also lead to impaction so again with these natural ative these foods like uh these prunes apples that you mentioned we've got some nuts here that will work dates any of the dried fruits really can help with um increasing fiber bulking things up but we got to have have some water with it to help it to to move all right so here we go we have our 70 year old client patient William who has an episode of vowel incontinence what is the first step you would take as his nurse to help him avoid these episodes what is your first step to help him to avoid being incontinent what might you do um no not monitor his output intake is just about take him to the bathroom to the so we would develop a schedule so we do know that um Mass colonic um contractions happen about 30 to 45 minutes after a meal so if you work in long-term care that's the reasoning that's the science behind the evidencebased practice behind after eat going to the bathroom it's not just to give us more work to do as nurses but we know that there Mass colonic contraction after they eat so that 30 to 45 minutes we do that bathroom rotation if he goes and you know trains his bowel to go then then he will have less incidents of incontinent bowel episodes us you know and once you become you know potty train like with your infant your toddler again after you feed them next you you know 30 15 to 30 minutes you take them and put them on the potty you will usually you know not have those incontinent bowel episodes but as you become you know small child adult you can train your bow to kind of work how you want it to work but again if you start have those incon episodes with the older adult put them on a bio program and then that will help to decrease incontinent um B episodes all right what causes stress urinari and conss stress say stress what kind of stress uh holding the PE holding your PE can that cause that not holding it per se but anything that increases that intraabdominal pressure like coughing sneezing laughing lifting a heavy load um anything that is going to abruptly increase that abdominal pressure is going to cause some stress on that bladder which may cause an incontinent episode when people be pregnant they go to sneeze St they go to like peeing a little bit that's it peeing a little bit or peeing a lot and as that fetus gets larger it's pressing it's stressing on that bladder so that's why um in those L that third trimester you can't hold it all right so that's it that stress urinary incontinence there's also other forms of incontinence um urgency um so when we look at that the factors that um play into being having urgent continence we know that the normal bladder it stays relaxed and the urethra will stay contracted and closed until the patient is ready that's for those of us who have who are continent of their bladder um but when you have urgent continents this one the bladder muscle contracts before the client is ready this can be caused by a bladder spasm or those who are taking diuretics the muscle can't hold it the bladder can't hold it um it can also be linked to neurological disorders like Parkinson's um Dementia or Ms it can also be caused by caffeine and alcohol that's why with your small children again I've said more than once once a man twice a child um you don't give them a whole lot of sodas when you're trying to potty train them because they will have that issue with urge and continence you don't give them sodas of course we never give kids of course alcohol that's why many times when people are drunk or inebriated they wet themselves because they cannot control that bladder muscle um with the urge um incontinence again because caffeine has a stimulant in it so it stimulates that bladder to work then we also have the stress that we just talked about where the urethra is too weak to stay closed when there's an increase in abdominal pressure whether it be from again a cough a sneeze or laugh or lifting a heavy load so some matching here on the left side of your screen you see the physiologic changes um listed arterior arteries grow grow stiffer and more narrow linked to a sclerosis cardiac function decline blood supply to muscle decreases and then strength of respiratory muscles decreases linked to the expected results on the right side so which one of these physiologic changes leads to the expected result on the right so if your arteries are growing stiffer and more narrow in other words AOS sclerosis what is the expected result of that on the right is it heart rate decreases muscle lose strength respirations are not as deep or blood pressure increases what happens when your arteries are stiff and narrow blood pressure increases okay absolutely what happens when your cardiac function declines heart rate decreases peripheral circulation decreases absolutely so what happens when your M blood supply to your muscles decreases muscles lose strength muscles aren't it strong then strength of respiratory muscles decrease um blood pressure increase respiratory what do your respiratory muscles do respiration respirations are not as deep right respirations are not as deep so again look at the physiologic change of our aging adult and what is the expected results so if you have a client who comes in and they're 80 years old and they are chronologically and physiologically 80 these are some of the things you might expect to find again not every 80 year old client has problems with their heart not every 80 year old client has problems with their respiratory system but if they are these are some of the expected changes that you might um find with them so we got those all right so as soon as the video converts then I will have these uploaded again if I have sent you an email please respond Al also if you have um if you want a one to one to discuss any of the concepts that you may be struggling with please reach out to me via email and we will find a mutual time to talk otherwise you have a wonderful rest of your day and a great weekend and I will see you next week