A nurse on an acute care unit is disturbed by the increasing ...

[evelyn o bentley]

A nurse on an acute care unit is disturbed by the increasing incidence of pressure ulcers among older adults. Which of the following measures should the nurses on the unit prioritize in order to prevent the formation of pressure ulcers?
 
  A) Apply emollient lotions with baths
  B) Frequent repositioning of immobilized clients
  C) High-protein, high-calorie diet
  D) Massage bony prominences each shift

Question 2

Which of the following functional consequences of skin changes will impact the nursing care of older adults?
 
  A) Older adults have an increased incidence of moles requiring intervention.
  B) There is a decreased incidence of skin cancer in older adults because of an increase in melanocytes.
  C) In older adults, tactile sensitivity increases and there is an intense response to cutaneous stimulation.
  D) Collagen changes interfere with tensile strength of older adults' skin, causing the skin to be less resilient.

[djofnc]

Answer to Question 1

Ans: B
Frequent repositioning is an important measure in prevention. Lotions should be applied; relief of pressure is the highest priority. Nurses should ensure that those at risk for pressure ulcers do receive enough calories, vitamins, and protein. Nurses do not massage bony prominences for concern of damage.

Answer to Question 2

Ans: D
There is less tensile strength of the skin because of collagen changes, which predisposes the older adult to abrasive and tearing skin damage. There is a decreased incidence of moles after 40 years of age. There is an increased incidence of skin cancer in older adults, and decreased melanocytes is one factor that impacts this. Tactile stimulation decreases, and there is a less intense response to cutaneous stimulation.