NUR 170 Chronic Illness Exam 4
Skin:
• Scabies: o Scabies is a skin condition that causes intense itching, particularly at night. o
Scabies is caused by a tiny burrowing mite called sarcoptes scabiei. Scabies is contagious
and can be passed easily by an infested person to his or her household members,
caregivers, or sexual partners. Scabies can spread easily through close physical contact.
o In addition, individuals with crusted scabies have thick crusts of skin or linear
ridges that contain large numbers of scabies mites and eggs.
Around the hands
• Herpes Zoster o Always occurs along a nerve pathway or dermatome.
o The more dermatomes involved the more serious the infection, especially if it
involves the head.
o When the eye is affected, it is always a medical emergency.
o Most occur in the thoracic region but can also occur anywhere on the body. The
vesicles never cross the midline.
o Severity of the infection increases with age.
o Onset may be proceeded by itching, tingling, or pain in the affected dermatome
several days before the outbreak of the rash.
o Important to differentiate herpes zoster from herpes simplex- Herpes simplex
does not occur in a dermatome pattern and is recurrent.
o Healing process of zoster-clusters of papulovesicular develop along a nerve
pathway. The lesions themselves eventually rupture, crust over, and resolve.
Scarring may result especially if scratching or poor hygiene leads to a secondary
bacterial infection. Zoster is infectious until it becomes crusty.
o May be very painful or pruritic.
Skin cancer:
• Basal cell carcinoma:
o Very common, slow growing, and a pearly papule Squamous cell carcinoma:
o Lesions begin as a firm, irregular, fleshy, pink colored nodule that becomes
reddened and scaly, may increase rapidly in size.
o They get really red and then scaly.
• Melanoma
o Most progressive, but less common
• LEARN HOW TO EDUCATE TO PREVENT-WEAR PROTECTIVE CLOTHING AND SUNSCREEN
Pressure injuries:
• Don’t raise the head of bed for too long because it puts a lot of pressure on the bottom.
• Turn or reposition every 2 hours.
• Make sure to examine skin thoroughly to be sure they aren’t having any breakdown.
Falls
, • Elderly have multiple chronic illnesses which put them at a higher risk for falls.
• Consequences of falls:
o Hip Fracture: Recovery from hip fracture is complicated by the presence of
multiple comorbid conditions and potentially avoidable problems such as weight
loss, delirium, pain, falls, and incontinence.
Priority nursing diagnosis post-surgery would be decreased mobility (high
risk for DVT) Intrinsic and extrinsic risk factors:
• Intrinsic risk factors are unique to each individual and are associated with factors such as
reduced vision and hearing, unsteady gait/shuffles their feet, cognitive impairment,
acute and chronic illnesses, and effects of medications.
Gait disturbances:
• Parkinson’s diseases due to the shuffling of feet makes them higher risk for falls.
Interventions:
• Fall risk reduction programs:
o Interventions should include risk assessment, patient and staff education,
bedside signs, and wristband alerts, footwear assessment, scheduled and
supervised toileting programs and medication reviews.
o Giving older adult males urinals to reduce falls when getting up to go to the
bathroom.
Environmental Modifications:
• Patient activities that contribute to falls include walking, transferring and urinary and
bowel elimination needs.
• They will only HELP not get rid of
• No throw rugs, move things out of the way, don’t change things too much.
Assistive devices:
• Interventions including the use of assistive devices has demonstrated benefits in fall risk
reduction.
• Many devices are available that are designed for specific conditions and limitations.
• New technologies such as canes that “talk” and provide feedback to the user, sensors
that detect when falls have occurred or when risk of falling is increasing, and other
developing assistive technologies hold the potential to significantly improve functional
ability, safety, and independence for older people.
Restraints:
• Side rail use: restrictive side rail use is defined as two full length, or four half-length
raised side rails.
Sensory issues-vision and hearing
• Cataracts: lens of the eye is turning yellow or opaque white color o Nursing
interventions pre- and post-surgical
Post-surgery: CANNOT BEND OVER, AVOID HEAVY LIFTING, STRAINING,
AND BENDING AT THE WAIST-no show tying Glaucoma: damage of the optic nerve
Skin:
• Scabies: o Scabies is a skin condition that causes intense itching, particularly at night. o
Scabies is caused by a tiny burrowing mite called sarcoptes scabiei. Scabies is contagious
and can be passed easily by an infested person to his or her household members,
caregivers, or sexual partners. Scabies can spread easily through close physical contact.
o In addition, individuals with crusted scabies have thick crusts of skin or linear
ridges that contain large numbers of scabies mites and eggs.
Around the hands
• Herpes Zoster o Always occurs along a nerve pathway or dermatome.
o The more dermatomes involved the more serious the infection, especially if it
involves the head.
o When the eye is affected, it is always a medical emergency.
o Most occur in the thoracic region but can also occur anywhere on the body. The
vesicles never cross the midline.
o Severity of the infection increases with age.
o Onset may be proceeded by itching, tingling, or pain in the affected dermatome
several days before the outbreak of the rash.
o Important to differentiate herpes zoster from herpes simplex- Herpes simplex
does not occur in a dermatome pattern and is recurrent.
o Healing process of zoster-clusters of papulovesicular develop along a nerve
pathway. The lesions themselves eventually rupture, crust over, and resolve.
Scarring may result especially if scratching or poor hygiene leads to a secondary
bacterial infection. Zoster is infectious until it becomes crusty.
o May be very painful or pruritic.
Skin cancer:
• Basal cell carcinoma:
o Very common, slow growing, and a pearly papule Squamous cell carcinoma:
o Lesions begin as a firm, irregular, fleshy, pink colored nodule that becomes
reddened and scaly, may increase rapidly in size.
o They get really red and then scaly.
• Melanoma
o Most progressive, but less common
• LEARN HOW TO EDUCATE TO PREVENT-WEAR PROTECTIVE CLOTHING AND SUNSCREEN
Pressure injuries:
• Don’t raise the head of bed for too long because it puts a lot of pressure on the bottom.
• Turn or reposition every 2 hours.
• Make sure to examine skin thoroughly to be sure they aren’t having any breakdown.
Falls
, • Elderly have multiple chronic illnesses which put them at a higher risk for falls.
• Consequences of falls:
o Hip Fracture: Recovery from hip fracture is complicated by the presence of
multiple comorbid conditions and potentially avoidable problems such as weight
loss, delirium, pain, falls, and incontinence.
Priority nursing diagnosis post-surgery would be decreased mobility (high
risk for DVT) Intrinsic and extrinsic risk factors:
• Intrinsic risk factors are unique to each individual and are associated with factors such as
reduced vision and hearing, unsteady gait/shuffles their feet, cognitive impairment,
acute and chronic illnesses, and effects of medications.
Gait disturbances:
• Parkinson’s diseases due to the shuffling of feet makes them higher risk for falls.
Interventions:
• Fall risk reduction programs:
o Interventions should include risk assessment, patient and staff education,
bedside signs, and wristband alerts, footwear assessment, scheduled and
supervised toileting programs and medication reviews.
o Giving older adult males urinals to reduce falls when getting up to go to the
bathroom.
Environmental Modifications:
• Patient activities that contribute to falls include walking, transferring and urinary and
bowel elimination needs.
• They will only HELP not get rid of
• No throw rugs, move things out of the way, don’t change things too much.
Assistive devices:
• Interventions including the use of assistive devices has demonstrated benefits in fall risk
reduction.
• Many devices are available that are designed for specific conditions and limitations.
• New technologies such as canes that “talk” and provide feedback to the user, sensors
that detect when falls have occurred or when risk of falling is increasing, and other
developing assistive technologies hold the potential to significantly improve functional
ability, safety, and independence for older people.
Restraints:
• Side rail use: restrictive side rail use is defined as two full length, or four half-length
raised side rails.
Sensory issues-vision and hearing
• Cataracts: lens of the eye is turning yellow or opaque white color o Nursing
interventions pre- and post-surgical
Post-surgery: CANNOT BEND OVER, AVOID HEAVY LIFTING, STRAINING,
AND BENDING AT THE WAIST-no show tying Glaucoma: damage of the optic nerve
