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Patients at Risk- HESI Case Study (Evolve)

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Which of the following modifications are recommended when teaching older persons? Use of large print in printed materials (The lens becomes less elastic, larger, and thicker as a person gets older. Visual acuity, the ability to see at distance of 20 feet what a normal eye sees at 20 feet, decre...

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  • January 10, 2023
  • 9
  • 2022/2023
  • Exam (elaborations)
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Patients at Risk- HESI Case Study
(Evolve) correctly 2023
Sally makes ongoing rounds, recommending prevention strategies and treatments for a
wide variety of wounds, including pressure ulcers. A pressure ulcer is a/an: - answer
Localized area of tissue necrosis

A pressure ulcer is a localized area of tissue necrosis (death), caused by ischemia
associated with prolonged, unrelieved pressure. Unrelieved pressure causes ischemia
(poor circulation) which deprives the affected area of oxygen and nutrients, potentially
leading to necrosis. Pressure ulcers usually develop in areas where soft tissue
capillaries are compressed between a bony area and an external surface. Both the
intensity and duration of pressure are important contributors to pressure ulcer risk.

Which of the following contribute to Mr. Esserman's risk for development of pressure
ulcers? - answer Paralysis of arm and leg

(Mr. Esserman's paralysis increases his risk for pressure ulcers. Any person who has
limited ability to move himself and change position is at risk for developing a pressure
ulcer. The person must rely on others to help move and change position to prevent
pressure ulcer development. Also, Mr. Esserman sits in his favorite chair for most of the
day. Being confined to a chair for a prolonged period of time can cause continuous
unrelieved pressure on the same areas. This can lead to pressure ulcer development.)

Loss of sensation

(With loss of sensation, the normal ability of the nervous system to alert a person to
"numbness" that happens after being in one position for too long is no longer present.
Sensations of discomfort or pain may also be absent. Thus, skin damage can occur
without being noticed. Mr. Esserman has some sensation, but feeling is limited on his
affected side.)

Difficulty swallowing

(The inability to swallow properly can interfere with adequate food and fluid intake, and
lead to malnutrition. Malnutrition can starve the skin of adequate nutrients and decrease
tissue tolerance to pressure. Persons who are malnourished are at increased risk for
developing pressure ulcers.)

Slurred speech

(With slurred speech, Mr. Esserman may not be able to effectively communicate any
discomfort he might feel. This increases his risk for pressure ulcers.)

, Urinary incontinence

(Incontinence increases the likelihood of moisture contact with skin and therefore the
risk for pressure ulcers. Moisture is a skin irritant, which makes the skin more vulnerable
to breakdown from pressure, friction, and shearing forces.)

With Sally, you prepare to teach the Essermans about pressure ulcer prevention. Which
of the following approaches is best? - answer A combination of both of the above

(Optimally, teaching is accomplished with verbal instruction and discussion,
supplemented by written materials.)

Which of the following modifications are recommended when teaching older persons? -
answer Use of large print in printed materials

(The lens becomes less elastic, larger, and thicker as a person gets older. Visual acuity,
the ability to see at distance of 20 feet what a normal eye sees at 20 feet, decreases.
The larger the size of print, the easier it is for many older persons to read it. 12-point
print is recommended. Also, as the lens of the eye ages, it becomes more opaque and
yellowed, and the ability to distinguish between colors diminishes. For many older
persons, reading is easier when there is a sharp contrast in the colors of print and the
paper it is printed on. Solid, standard print types are easier to read than fancy prints like
script or italics.)

Presentation and discussion should be slow and unrushed

(A slow and unrushed presentation is important when working with older persons. The
recommended rate of speech is 125 words per minute or less. In many older persons,
stimulus persistence is present. Sensory stimuli take longer to arrive and longer to
leave. An older person may still be processing one thought while another topic is being
presented by a fast speaker. An older person may need more time to focus and process
information than a younger person.)

A slightly louder, low-pitched speaking voice may be needed

(Hearing loss is a common problem in older persons, and high-pitched voices and
certain sounds are harder to hear. Because of this difficulty with discriminating sounds,
especially consonants, older persons can misunderstand what word is being said. A
slightly louder low-pitched speaking voice may be better heard. Shouting is not
necessary and should be avoided. Words should be clearly pronounced and the person
should be faced directly when content is presented and discussed. Background noises
such as televisions and radios should be eliminated as much as possible.)

What should the Essermans be taught about moving and positioning? - answer A soft
sheet or towel, applied under Mr. Esserman, can be used to assist with turning

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