Senses working overtime
This condition causes central vision loss and can be detected early using an Amsler grid, where patients may see wavy or distorted lines.
What is macular degeneration (wet or dry)?
This degenerative joint disease results from overuse and wear and tear on cartilage, making it the most common form of arthritis in older adults.
What is osteoarthritis?
THINK: Wear and tear, can be unilateral.
Who is at greatest risk?
What can reduce the wear and tear on joints?
When screening for skin cancer, nurses use this mnemonic to identify suspicious lesions that may have progressed from pre-cancerous actinic keratosis.
What is the ABCDE assessment (or ABCDE rule)?
Asymmetry, Border irregularity, Color variation, Diameter greater than 6mm, and Evolving.
THINK: What if some of the criteria are met, but others are not?
Bowel impaction due to constipation can cause spurious diarrhea or this type of urinary incontinence, particularly if the pelvic floor muscles are not as strong as they used to be.
What is stress incontinence?
THINK: What else causes stress incontinence?
-Sudden changes in abdominal pressure from activities like coughing, jumping, sneezing.
This demineralization condition makes people prone to big injuries related to a small event, such as a fractured femur following a ground level fall, and most people have no idea that they have it till they get a fracture, particularly in underweight Caucasian females.
What is osteoporosis?
THINK: Although this is a bone problem, treatment is with Vitamin D, Calcium, and weight bearing exercises to stimulate bone regeneration.
What are your nursing priorities for a person with osteoporosis?
This eye condition results in decreased color perception, loss of night vision, double vision due to clouding in the lens, and it requires surgical correction.
What are cataracts?
THINK: Who is at the biggest risk?
Cataracts: Risk factor: UV exposure, Diabetes
Unlike osteoarthritis which worsens with activity, this systemic autoimmune condition causes morning stiffness requiring rest and characteristically affects joints bilaterally and symmetrically.
What is rheumatoid arthritis (RA)?
THINK: How can you modify your plan of care to optimize this patient's ability to comply?
This full thickness injury cannot be properly classified if there is significant presence of eschar, slough, or necrotic tissue present.
What is an unstageable pressure ulcer?
But we know that it is at least a stage 3-why?
Stg 1: Non-blanchable and red, 30 mins after pressure relief
Stg 2: Partial thickness of the skin, dermis intact
Stg 3: Full thickness-subcutaneous tissue visible
Stg 4: Muscle, tendons, or bone are visible
I may require digital disimpaction if I have a severe case of this common condition that can be caused by immobility, is worsened by dehydration, and is very commonly caused by opioid analgesics.
What is constipation?
THINK: What promotes peristaltic motion?
Why is water intake important?
How can you prevent constipation, especially in post-op patients?
Unlike the other common peptic ulcer where pain occurs soon after eating and worsens with food, this type of ulcer causes pain 2-3 hours after meals or during the night and is relieved by eating or taking antacids.
What is a duodenal ulcer?
THINK: Why are gastric ulcers worsened with food, but duodenal ulcers are relieved by it?
Think about the triggers for gastric juice secretions, and the relationship between acid and ulcers.
Unlike other eye conditions which affect central vision, this is due to increased intraocular pressure that damages the optic nerve, often called the "silent thief of sight", and it requires lifelong compliance with medications to slow the progression of the disease and prevent blindness.
What is glaucoma?
THINK: Lifelong compliance - EDUCATION!
Glaucoma: Peripheral vision loss (tunnel vision), increased intraocular pressure (IOP), optic nerve damage, often asymptomatic until advanced, requires regular screening with tonometry
Patients with this incurable progressive disorder will be at high risk for falls, and aspiration due to dysphagia, due to poor muscle coordination.
What is Parkinson's disease?
THINK: Tremor at rest, bradykinesia, rigidity, postural instability
- FALL and ASPIRATION precautions
- Maintain activity to support core stability to reduce fall risk
I would pay extra attention in assessing for these if my patient had risk factors of being diabetic, underweight, dehydrated, with low pre-albumin levels or a low Braden score.
What are pressure ulcers?
THINK: Are overweight or underweight people at higher risk?
What is the relationship between protein and hydration for pressure ulcers?
I may see emesis of undigested food, without hematemesis, if a patient has this condition.
What is a gastrointestinal obstruction?
THINK: How does food progress through the GI tract?
Why might you vomit if there is an obstruction?
Hematemesis, coffee-ground emesis, melena, or tarry black stools can be found if I have this condition.
What is gastrointestinal bleeding?
THINK: Which section of the GI tract would likely cause which of the descriptors?
What is the difference between coffee-ground emesis and hematemesis?
A person with this hereditary condition should be given longer to respond to questions, and if possible, avoid ototoxic medications.
(We need the medical term!)
What is presbycusis?
This systemic autoimmune disease causes photosensitivity and is identified by its characteristic rash.
What is lupus (systemic lupus erythematosus/SLE)?
THINK: What group of people is at highest risk? Malar rash (butterfly rash) is characteristic and covers both cheeks and the bridge of the nose.
-Patient education includes sun protection because of extreme photosensitivity
This may be the plan for wound closure when there is concern for infection or there is missing tissue that would result in vascular compromise if the wound was closed immediately.
What is secondary wound closure?
Primary: Sew it up now
Secondary: Dressing changes and allow healing from the bottom up.
Tertiary, or delayed primary closure: Perform dressing changes and clean the wound, then days, weeks, or months later - sew it up.
This is how I would describe a large intestine bowel diversion that is beefy pink due to adequate vascularization.
What is a healthy colostomy stoma?
THINK: Why is it red?
What would cause you to be concerned and call the provider immediately?
A person is at higher risk of this condition if they are obese, in the late stages of pregnancy, or eat large meals, because these things put pressure on their incompetent lower esophageal sphincter.
What is GERD?
THINK: What nursing interventions would you recommend, and why?
Unlike cataracts which typically require a loose covering over the affected eye after surgery, this acute condition usually affects only one eye and requires immediate intervention to prevent permanent vision loss.
What is retinal detachment?
THINK: If your immediate nursing goal is to prevent further separation of the retinal layers, how would you achieve that goal?
Retinal Detachment: Sudden onset, flashing lights, floaters, vision loss, SURGICAL EMERGENCY!
This painful inflammatory condition is triggered by diet high in purines and occurs when needle-shaped synovial crystals deposit in joints, classically affecting the great toes first.
What is gout?
THINK: What foods are high in purines?
- How will you educate your patient to help them reduce the frequency of flare ups?
If I were concerned for an internal wound - particularly in an extremity, I would assess distal perfusion by assessing for these 6 P's.
(We need ALL of them)
What are: pain, pressure, paralysis, pallor, paresthesia, and pulselessness?
THINK: How do these symptoms relate to the injury, and what is the condition that causes them?
This autoimmune demyelinating disease can cause this type of incontinence, due to demyelination of the spinal cord.
(We need the condition AND the type of incontinence)
What is multiple sclerosis (MS)?
THINK: All nervous pathways can be affected, including vision, touch/temperature discernment, as well as bladder and bowel dysfunction
-How will you educate to promote patient safety?
This complication of an ulcer creates a hole completely through the stomach wall that allows gastric contents and digestive juices/enzymes to leak out into the abdominal cavity, often causing life threatening peritonitis.
What is gastric perforation?
THINK: How does this differ from gastric penetration?