Confusion is a common problem in persons over 65 years of age.

The decline in normal

cognitive ability may be acute, or it may be chronic and progressive. In older persons, confusion
is most likely to be a symptom of delirium or dementia, although it can also be associated with
psychoses and affective disorders, specifically major depression

Kebingungan adalah masalah umum pada orang di atas 65 tahun. Penurunan kemampuan
kognitif normal mungkin akut, atau mungkin kronis dan progresif. Pada orang yang lebih tua,
kebingungan kemungkinan besar merupakan gejala delirium atau demensia, meskipun juga
dapat dikaitkan dengan psikosis dan gangguan afektif, khususnya depresi berat.

Delirium is a transient global disorder of cognition and consciousness. The delirious

patient may also have psychomotor and emotional disturbances. In most patients,
delirium due to a medical disease is reversible with treatment of the underlying
condition.

Delirium adalah gangguan kognisi dan kesadaran global sementara. Pasien mungkin
juga memiliki gangguan psikomotor dan emosional. Pada kebanyakan pasien, delirium
karena penyakit medis dapat dibalik dengan pengobatan kondisi yang mendasarinya.

Decubitus ulcers, also termed bedsores or pressure ulcers, are skin and soft tissue injuries that form as a
result of constant or prolonged pressure exerted on the skin. These ulcers occur at bony areas of the
body such as the ischium, greater trochanter, sacrum, heel, malleolus (lateral than medial), and occiput.
These lesions mostly occur in people with conditions that decrease their mobility making postural
change difficult.

Ulkus dekubitus, juga disebut luka baring atau luka tekan, adalah cedera kulit dan jaringan lunak yang
terbentuk sebagai akibat dari tekanan yang konstan atau berkepanjangan yang diberikan pada kulit.
Ulkus ini terjadi di daerah tulang tubuh seperti iskium, trokanter mayor, sakrum, tumit, malleolus
(lateral dari medial), dan oksiput. Lesi ini sebagian besar terjadi pada orang dengan kondisi yang
menurunkan mobilitas mereka membuat perubahan postural menjadi sulit.

COPD comprises a diverse group of clinical syndromes that share the

common feature of limitation of expiratory airflow.12 The American
Thoracic Society defines COPD in terms of chronic bronchitis and
emphysema.13 Chronic bronchitis is characterized by the clinical
symptoms of excessive cough and sputum production; emphysema
refers to chronic dyspnea, resulting from enlarged air spaces and
destruction of lung tissue. The GOLD initiative defines COPD as “a disease
state characterized by airflow limitation that is not fully reversible. The
airflow limitation is usually both progressive and associated with an
abnormal inflammatory response of the lungs to noxious particles or
gases.”14 Asthma is also characterized by airflow obstruction and
inflammation, but in addition it involves hyperresponsiveness of the
airways to stimulus; therefore, the reversibility of functional deficits in
asthma differentiates it from COPD

PPOK terdiri dari kelompok beragam sindrom klinis yang berbagi fitur
umum keterbatasan aliran udara ekspirasi. Masyarakat mendefinisikan
PPOK dalam istilah bronkitis kronis dan emfisema.13 Bronkitis kronis
ditandai dengan gejala klinis batuk yang berlebihan dan produksi
sputum; emfisema mengacu pada dispnea kronis, akibat dari ruang
udara yang membesar dan kerusakan jaringan paru-paru

Common Causes of Delirium

Metabolic disorders

Electrolyte abnormalities

Acid-base disturbances

Hypoxia

Hypercarbia

Hypoglycemia or hyperglycemia

Azotemia

Infections

Decreased cardiac output

Dehydration
 Acute blood loss

Acute myocardial infarction

Congestive heart failure

Stroke (small cortical)

Medications

Intoxication (alcohol and/or other substances)

Hypothermia or hyperthermia

Acute psychoses

Transfer to unfamiliar surroundings

Miscellaneous

Fecal impaction
Common

 Hypoglycaemia
 Urinary tract infection (lower) in adults

Infrequent

 Wernicke's encephalopathy
 Sepsis
 Acute exacerbation of COPD
 Alcohol withdrawal
 Pneumonia
 Alcohol excess
 Diabetic ketoacidosis
 Ascending cholangitis
  Herpes simplex encephalitis
 Hyperosmolar hyperglycaemic state
 Subdural haemorrhage

Rare

 Viral meningitis
 Carbon monoxide poisoning
 Acute liver failure
 Neuroleptic malignant syndrome
 Malaria (Falciparum)
 Central venous thrombosis
 Subarachnoid haemorrhage
 Extradural haematoma
 Acute fatty liver of pregnancy
 Legionella pneumonia
 Anti-NMDA receptor encephalitis

T&G infeksi

Demam
Seringkali tidak mencolok.  banyak penderita lansia yang jelas menderita infeksi
tidak menunjukkan gejala demam. Walaupun demikian untuk diagnosis infeksi tanda
adanya demam masih penting, sehingga Yoshikawa tetap menganjurkan batasan
sebagai berikut :

  Terdapat peningkatan suhu menetap > 2°F

  Terdapat peningkatan suhu oral > 37,2°C atau rektal > 37,5°C

 Gejala tidak khas

Gejala nyeri yang khas pada apendisitis akut, kolesistitis akut, meningitis, dll sering
tidak dijumpai. Batuk pada pneumonia sering tidak dikeluhkan, mungkin oleh
penderita dianggap batuk “biasa” (

   Gejala akibat penyakit penyerta (ko-morbid)

Sering menutupi, mengacaukan bahkan menghilangkan gejala khas akibat penyakit
utamanya
Risk Factors

Cigarette smoking is the principal risk factor for COPD. However,

approximately 1 of 6 Americans with COPD has never
smoked.15 Occupational and environmental exposures to chemical
fumes, dusts, and other lung irritants account for 10% to 20% of
cases.15 Individuals with a history of severe lung infections in childhood
are more likely to develop COPD.15 Alpha-1 antitrypsin deficiency is a
rare cause of COPD but should be suspected in persons in whom
emphysema develops before the age of 40 or those who lack the common
risk factors.16

Diagnosis

The diagnosis is primarily clinical,25 and most patients are diagnosed by

primary care physicians. Suggestive symptoms include chronic cough,
excessive sputum production, and dyspnea, especially when any of these
symptoms are accompanied by a history of cigarette smoking or regular
exposure to occupational or environmental pollutants or toxins. 

spirometry 
Stage Description Findings (postbronchodilator FEV1)
0 At risk Risk factors, chronic symptoms, but normal spirometry
1 Mild FEV1/FVC ratio <70%
FEV1 at least 80% of predicted value
May have symptoms
2 Moderate FEV1/FVC ratio <70%
FEV1 50% to <80% of predicted value
May have chronic symptoms
3 Severe FEV1/FVC ratio <70%
Stage Description Findings (postbronchodilator FEV1)
FEV1 30% to <50% of predicted value
May have chronic symptoms
4 Very severe FEV1/FVC ratio <70%
FEV1 <30% of predicted value
OR
FEV1 <50% of predicted value plus severe chronic symptoms

The Norton score for pressure ulcer risk calculator comprises of 5 parameters,
relevant to skin condition, which are applied, each with different answer choices
which weigh a different number of points:
■ Physical condition;
■ Mental condition;
■ Activity;
■ Mobility;
■ Incontinence.
The answer choices are rated on a domain specific ordinal scale from 4 to 1, with
choices awarded 4 points being suggestive of a normal state while choices given 1
point, indicating a severe condition.

Norton score Pressure ulcer risk

<10 Very high risk
10 – 14 High risk
14 – 18 Medium risk
>18 Low risk

TTLKSN

Regular use of inhaled bronchodilators, either alone or in combination,

to prevent and relieve symptoms is the mainstay of COPD management.
Although short-acting inhaled agents are often used when needed to
provide immediate symptom relief, especially in mild COPD, long-acting
inhaled bronchodilators are more effective and offer greater
convenience

On the basis of clinical evidence, the American College of Physicians

recommends that physicians prescribe oxygen therapy for patients with
COPD and resting hypoxemia, which is defined as a PaO2 ≤55 mm Hg.
Supplemental oxygen for at least 15 hours daily has been shown to help
increase survival in patients with severe airway obstruction (FEV1 <30%
of predicted value) and resting hypoxemia.
Prevention is clearly the best treatment with excellent skincare, pressure dispersion cushions, and
support surfaces. Support surfaces decrease the amount of pressure on the wound. Support surfaces
can be either static (e.g., air, foam, and water mattress overlays) or dynamic (e.g., alternating air
overlay). Repositioning and turning the patient every two hours can also lessen pressure on the area,
but some patients may require more frequent repositioning, while others may require less frequent
repositioning.

Hydrocolloid dressings should be used. Good antibiotic cover decreases septicemia.

The depth and severity of the ulcer determine whether surgical management may be required.
The ulcer must be thoroughly cleaned and drained to remove any dead tissue and debris.
Vacuum-assisted closure (VAC) may be a preoperative option to provide a favorable wound for
the surgical closer.[11] Surgical management aims to fill the dead space and provide durable skin
through flap reconstruction.
There is also some evidence to suggest that hyperbaric oxygen therapy can help with wound
healing, as it improves oxygenation in and around the area of the wound
Thus, the treatment of decubitus ulcers has its basis on the following:
 Prevention of additional ulcers
 Decreasing pressure on the wound
 Wound management
 Surgical intervention
 Nutrition