Professional Documents
Culture Documents
Prevention
There is no known way to prevent presbyopia.
Mary Bekker
Resources
BOOKS
Glazier, Alan, O.D., F.A.A.O. Presbyopia Update: Helping Emerging Presbyopes. Optometric Management
Online. http://www.optometric.com/archive_results.
asp?loc=articles/03062000115646am. html/.
Kattouf, Richard S., O.D. Achieving Maximum Efficiency
(Without Sacrificing Quality of Care). Optometric
GALE ENCYCLOPEDIA OF SENIOR HEALTH
Pressure sores
Definition
Pressure sores are also known as Bed sores, and
by the medical term (Latin) as decubitus. They are
ulcers, or sores, that develop on areas of the body that
have endured sustained stress or pressure for long
periods of time, such as suffered by people in wheelchairs or confined to bed rest. Such sores indicate
what is known as deep tissue, injury and can be a sign
of more serious underlying complications.
Description
Pressure sores can range in stages from moderate
to severe. In appearance they can look as harmless as
any blister or discoloration on the skin, as in mild
bruises or scrapes. The National Pressure Ulcer Advisory Panel (NPUAP), with a concern for preventing
and treating pressure sores, has designated four categories, or stages in determining their severity.
According to the NPUAP, deep tissue injury can become first known by discolored skin that has a maroon or purplish tone, or the appearance of a bloodfilled blister. Sometimes skin spots will simply feel
painful to the touch, firmer or a different temperature
from the surrounding areas. In people with darker
skin tones, detecting deep tissue injury if often more
difficult than in lighter-skinned people. Due to evolution, a thin blister might actually develop over a
dark wound bed, according to the NPUAP. Further,
also due to what has developed through evolution, a
thin scab might cover the wound underneathwhile
that wound is growing deeper and more problematic.
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Pressure sores
Pressure sores
Demographics
Anyone subject to long periods of inactivity, and
confined to a bed or a wheelchair is especially vulnerable to pressure sores. The highest incidence is
likely to occur in those individuals suffering from
spinal cord injuries, Due to the permanent nerve
damage often suffered due to the injuries, skin and
other tissues experience ongoing compression. Thinning or atrophied skin, decreased circulation
movement enables the flow of oxygen that helps to
keep skin from developing sores and other infectionsand no nerve signal to indicate discomfort due
to a prolonged position, all combine to make the
person with spinal cord injuries at the greatest risk for
pressure sores. Others at risk for this condition are
those over 70. With thinning skin, nutrition deficiencies, underweight, lower activity rates, the possibility
of developing pressure sores, and the problem of
healing them causes the increased risk to the older
adult. People with diabetes, and vascular diseases are
also at a greater risk than the general population
should the conditions comprising the dangers of
pressure sores arise. As with the other risk factors, the
lack of circulation and oxygen flow necessary to heal
wounds is compromised.
Other external factors that can cause an increased
risk of pressure sores include nursing home residence
due to the fact that people who have been hospitalized
or are in a nursing home are probably frail, and where
the volume of patients might create negligence in care;
a lack of pain perception; natural thinnes or weight
loss from illness or prolonged healing of such conditions as hip surgery; malnutrition; urinary or fecal
incontinence, with skin staying moist and thus more
vulnerable to breakdown; muscle spasms or
GALE ENCYCLOPEDIA OF SENIOR HEALTH
contracted joints that can make a person more vulnerable to repeated trauma from friction or shear
forces.
Diagnosis
Physicians, physician assistants, nurses, or other
medical professionals will diagnose pressure sores
even in their initial stages by simple visibility. Experienced professionals will be able to see immediately
that something is wrong. Diagnosis will extend to
various blood tests, urine analysis and culture, stool
culture, and in severe cases that are not healing despite aggressive treatment, a biopsy of the tissue will
be taken to determine a complete bacterial analysis.
In this case, a cancer biopsy might also be taken
because of the increased risk people have with wounds
that do not heal after a long period of time.
Treatment
Because open wounds can take a long time to
close, treatment can be a slow and arduous process.
Due to damaged skin and tissues, even when wounds
are healed, evidence remains in scarring or fragile
skin. Because the problem of healing is complicated,
and often the individual is in fragile health already,
care is necessary for medical, emotional, and even
social aspects that arise with the condition. Primary
care physicians and nurses are the important first step
in diagnosis, and will assist in the process that might
involve social workers, physical therapists, urologists,
gastroenterologists, and for diabetics, endocrinologists if other than the primary physicians. When a
wound requires surgery for repair, a neurosurgeon,
orthopedic surgeon, and plastic surgeon might also be
involved. In a study reported by the Journal of the
American Geriatrics Society in August 2007, 52
nursing homes around the United States participated
in determining how best to treat pressure sores in
clients. Due to collaborative efforts by every department from the laundry to the hair salon, from the
kitchen staff to the health care professionals, severe
pressure sores that had been acquired within the
institutions themselves were reduced by 69 percent.
When the sores are classified as stage I or II sores,
treatment will involve nonsurgical measuresthe first
and most important being to remove the person from
the situation that can aggravate the sores or cause new
ones. These can include various options. One of them is
changing positions oftenevery 15 minutes for those
in wheelchairs, and every two hours for those who are
confined to bed, and using sheepskin or other padding
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Pressure sores
KEY TERMS
Pressure sores
to protect the wound from friction caused by movement. Another would be using other pads and measures of support such as foam, air, or water-filled
mattresses or cushions to use while sitting or lying,
using care to avoid using pillows and rubber rings that
can cause compression. Physicians and health-care
professionals recommend low-air-loss beds or airfluidized beds. Inflatable pillows are used with low-airloss beds to provide support. Air-fluidized beds work
by suspending an individual on an air-permeable
mattress filled with millions of silicon-coated beads.
Whether a pressure sore involves an open wound,
or is only in stage I, regular cleaning is critical in order
to prevent infection. Stage I sores can be cleansed with
a mild soap and warm water. Open sores must be
cleaned with a saline (salt water) solution every time
the dressing is changed. A simple saline solution can be
prepared at home by boiling one teaspoon of salt in one
quart of water for five minutes, or can be purchased at
a drug store. The container in which it is stored must be
sterile if it is made at home, and should not be used
until it is cooled. Topical antiseptics such as hydrogen
peroxide and iodine should be avoided. These can
cause irritation and damage to the sensitive tissue and
in fact will likely delay healing. Because moisture on
the skin surrounding a wound will continue to aggravate the condition, incontinence is also a crucial issue
to address. If bladder or bowel problems exist, people
should consult a physician to help them address it
whether it involves a lifestyle change, behavioral programs, bed pads or adult care products, or medications.
Any dressings used to treat pressure sores must
provide protection of the wound in order to speed the
healing process. Usually stage I wounds will not require a dressing or bandage. Stage II sores are often
approached by using hydrocolloids which are transparent semipermeable dressings designed to hold in
the moisture and encourage skin cell growth.
Removal of damaged tissue, also known as debridement, can be accomplished through surgery.
More commonly it is done by using a nonsurgical
high-pressure device that causes the bodys enzymes to
break down dead tissue. Another form of debridement
is the application of topical debriding enzymes.
Hydrotherapy (using whirlpool baths) are helpful
with those who can tolerate them, as they clean the
wounds and assist in removing contaminated or dead
tissue. Relief from muscle spasms also helps to prevent and to treat pressure sores. In those instances, a
physician will prescribe skeletal muscle relaxants that
will serve as nerve blocking agents in the spine or in
the muscle cells.
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Nutrition/Dietetic concerns
A healthy diet that promotes healing would include Vitamin C and zinc, proven to promote the
healing of wounds. Physicians will often prescribe
Vitamin C and zinc supplements. These, in addition
to a nutrition plan that includes sufficient calories,
adequate protein, and a full range of fruits and
vegetables will provide crucial assistance in the process as well.
Therapy
Physical therapy, including hydrotherapy, might
be necessary to assist in body movement either for
those with spinal cord injuries or paralysis, or after
someone has been immobile for a long period of time.
This might also assist in healing open wounds by
maximizing the amount of oxygen circulating
throughout a person's system.
Prognosis
The most difficult pressure sores to treat are those
in spinal cord patients, and thus the prognosis in such
cases is difficult at best but not impossible. Studies are
being conducted continually to find ways in which to
provide for optimal skin care that can heal and prevent
pressure sores. For anyone who is confined to bed or
wheelchair, is diabetic, or suffers chronic health care
GALE ENCYCLOPEDIA OF SENIOR HEALTH
Prevention
In order to prevent pressure sores in highindividuals a number o measures help. Those include the
following: frequent position changestaking care to
move otherwise immobile patients at least every two
hours, or moving every 15 to 20 minutes if confined to
a chair or wheelchair; when lying on the hipbone on
one side, the angle should be 30 degrees, not flat;
providing proper leg support by placing a pillow or
foam pad under the legs from the middle of the calf to
the ankle, avoiding support pads directly behind the
kneea practice that can cause the flow of blood to
be restricted; not placing the head at an angle more
than 30 degrees; and using a pressurereducing mattress or bed. In addition to these, daily skin inspection
is essential in order to notice the first sign of a problematic skin issue that can lead to a pressure sore, or
one that has already developed. Once any sign of a
sore appears, seeking medical advice can be crucial.
Maintaining a good weight through proper nutrition
and adequate calorie intake is also essential in maintaining optimum skin health that will not provide an
environment for its breakdown that can result in
pressure sores.
Resources
PERIODICALS
Caregiver concerns
When caring for someone who is at a high risk for
pressure sores, or might already have developed them,
a multidimensional approach is essential. Whether
or not the person is permanently immobile due to
paralysis, or recovering from or suffering a longterm
illness, the caregiver must serve as skin inspector,
body positioning aide, and nutritional guide even if
the person is participating in self-care. Infections can
be life-threatening and must be avoided, or treated for
optimal health.
Eat to heal
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Priapism
Definition
Priapism is a prolonged, sustained erection of the
penis that occurs in the absence of sexual excitation and
which may last hours to days, with or without pain.
Description
The penis has two cavities, called the corpora
cavernosa, which run the length of the organ and are
filled with spongy tissue. Blood flows in and fills the
open spaces in the spongy tissue to create an erection.
Sexual desire commonly triggers erections. After an
erection, the penis returns to its original flaccid state
(detumescence). Priapism is the condition in which
erections persist for a long time without sexual excitement.
There are three types of priapism:
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Priapism
issues, success in treatment is possible even if challengingespecially if caught in the earlier stages.