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Author Question: An older adult patient complains of thirst, headache, and weight loss. The patient appears ... (Read 117 times)

soccerdreamer_17

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An older adult patient complains of thirst, headache, and weight loss. The patient appears emaciated. On physical assessment the nurse finds that the patient's skin does not return to nor-mal shape after being assessed.
 
  This finding is consistent with which of the following? a. Pallor
  b. Cyanosis
  c. Erythema
  d. Poor skin turgor

Question 2

An older adult African-American woman has gone to the clinic where a RN volunteers twice a week. She is a diabetic and has some skin breakdown on the calf of her right leg. Her skin is very darkly pigmented.
 
  To best examine the patient's skin, the nurse should use which of the follow-ing? a. Halogen lighting
  b. Artificial warming to increase room tem-perature
  c. Natural sunlight
  d. Air conditioning to lower room tempera-ture



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sarah_brady415

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Answer to Question 1

D
Turgor is the skin's elasticity. To assess skin turgor, grasp a fold of skin on the back of the fo-rearm or sternal area with the fingertips and release. Normally the skin lifts easily and snaps back immediately to its resting position. The skin stays pinched or tented when turgor is poor. You can see pallor (unusual paleness) more easily in the face, buccal mucosa (mouth), conjunctivae, and nail beds. Localized skin changes, such as pallor or erythema (red discoloration), often indicate circulatory changes or are caused by localized vasodilation resulting from sunburn or fever. Observe for cyanosis (bluish discoloration) in the lips, nail beds, palpebral conjunctivae, and palms.

Answer to Question 2

C
The recommended light is natural sunlight, with halogen lighting being another option. Sunlight is the best choice for detecting skin changes in patients with darker skin. A room that is too warm causes superficial vasodilation, resulting in an increased redness of the skin. Patients who become too cold by air conditioning can develop cyanosis (bluish color) around the lips and nail beds.





 

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