Patients at Risk- HESI Case Study (Evolve)

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, 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? A soft sheet or towel, applied under Mr. Esserman, can be used to assist with turning (Use of a "turning sheet" can help with positioning Mr. Esserman. The sheet would allow a broad area of Mr. Esserman's body to be supported when moving him from side to side, and when shifting his position while he remains on a given side. This should reduce rubbing of the skin against the sheets, and thus the effects of friction. When two people are present to help, a "turning sheet" can also make moving Mr. Esserman up or down in the bed easier, and eliminate dragging. Mr. Esserman can also be taught to use his unaffected arm to assist with moving and turning. Holding onto a side rail and pulling up with the trapeze can facilitate moving and turning. Mr. Esserman can also be taught to use his unaffected leg and arm to lift his body when shifting his weight or changing positions.) When moving Mr. Esserman, the person doing the moving should bend his/her knees (Persons helping Mr. Esserman should be aware of proper body mechanics to use when assisting with moving and positioning. Important principles of body mechanics include working with the bed at a comfortable level, facing the direction of movement, and using flexed knees when lifting. With flexed knees, the legs and hips are used, instead of the back.) You teach the Essermans that when Mr. Esserman is in bed his position should be changed at least every: 2 hours (When in bed, Mr. Esserman should change position at least every two hours, although this schedule should be individualized based on his tolerance.) When assessing a reddened area, it is important that it be checked for: blanching (A reddened area should be checked for blanching, that is, whether or not finger pressure causes the skin to temporarily turn white. Blanching would indicate that skin damage has not occurred, and that reactive hyperemia is successful in restoring oxygen and nutrients to tissues that had been blood-deprived. When erythema is nonblanchable, it indicates that redness is a result of an inflammatory response to tissue damage that has occurred. Nonblanchable erythema characterizes a Stage I pressure ulcer.) sensation (A reddened area should be checked for sensation. Pain or numbness can characterize poor tissue perfusion.) When Mr. Esserman is in a chair, his weight should be shifted every: 15 minutes When in a chair, Mr. Esserman's weight should be shifted every 15 minutes. With regard to the reddened area, which of the following is indicated? Plans should be made to keep the area free of pressure (Redness indicates that the area has been oxygen-deprived. Blanching indicates that tissues are not damaged. A pressure ulcer is not present. However, because the area has been oxygen-deprived, it would be prudent to keep pressure off the area. Plans are made to temporarily avoid positions that place any pressure on this area.) Which of the following techniques can be used to determine if the air-filled static overlay on Mr. Esserman's bed is adequate in reducing pressure? With Mr. Esserman in bed, place a hand between the mattress and the overlay (When a support surface such as an air-filled static overlay is used, it is important to check for "bottoming out." This occurs when the patient's weight compresses the surface so much that the pressure reduction ability is insufficient. "Bottoming out" is checked by placing a palm-up hand with the fingers extended under the overlay. If the patient's body can be felt through the surface, more air is needed or a higher level of support surface device is required. You determine that the air-filled static overlay on Mr. Esserman's bed is adequate. The gel support surface used for his armchair and wheelchair, checked before he was put into bed, are also adequate. Turning and positioning schedules are reviewed and reinforced.)