Study guide
Pressure Injury Prevention/Staging, Urinary/Fecal Incontinence & Frailty Assessment
AANPCB Adult-Gerontology Primary Care Nurse Practitioner A-GNP
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1 Exam Structure, APRN Foundations & Geriatric Assessment
A-GNP Exam Logistics, Blueprint & Scoring Structure APRN Scope of Practice, Consensus Model & Interprofessional Collaboration Comprehensive Health History & Subjective Assessment Across Adult Lifespan Comprehensive Physical Examination & Clinical Assessment Skills
2 Health Assessment, Diagnostic Reasoning & Clinical Procedures
Diagnostic Reasoning, Test Interpretation & Clinical Decision-Making Screening Guidelines & Evidence-Based Health Promotion (USPSTF) Comprehensive Geriatric Assessment (CGA), Frailty & Function In-Office Clinical Procedures, ECG Interpretation & Minor Surgical Skills
3 Cardiovascular & Peripheral Vascular Disorders
Essential Hypertension & Hypertensive Urgency/Emergency Management Coronary Artery Disease, Acute Coronary Syndromes & Post-MI Care Heart Failure (HFrEF & HFpEF) Diagnosis, Staging & 4-Pillar GDMT Arrhythmias (Atrial Fibrillation), Valvular Heart Disease & PAD
4 Respiratory, HEENT & Dermatological Disorders
Asthma Management across the Adult Lifespan (GINA Guidelines) Chronic Obstructive Pulmonary Disease (COPD) Staging & Management (GOLD Guidelines) Community-Acquired Pneumonia & Lower Respiratory Tract Infections Common HEENT Disorders: Otitis, Sinusitis, Pharyngitis, Glaucoma & Macular Degeneration
5 Endocrine, Metabolic & Renal/Genitourinary Disorders
Type 2 Diabetes Mellitus Management Thyroid Disorders: Hypothyroidism, Hyperthyroidism & Subclinical Disease Chronic Kidney Disease (CKD) Staging & Diabetic/Hypertensive Nephropathy Genitourinary Disorders: BPH, Urinary Incontinence, UTIs & Prostatitis
6 Gastrointestinal, Hematologic & Immunologic Disorders
Upper Gastrointestinal Disorders: Dyspepsia, GERD, PUD & H. pylori Lower Gastrointestinal Disorders: IBS, IBD, Diverticulitis & Colorectal Screening Liver, Biliary & Pancreatic Disorders: NAFLD/MASLD, Cirrhosis & Cholecystitis Hematologic & Immunologic Disorders: Anemias, Anticoagulation & Immunizations
7 Neurological, Cognitive & Psychiatric Disorders
Cognitive Assessment: Delirium, Dementia & Mild Cognitive Impairment Neurological Disorders: Stroke, TIA, Parkinson's Disease & Headache Syndromes Major Depressive Disorder & Anxiety Disorders in Adults & Older Adults Sleep Disorders, Insomnia & Restless Legs Syndrome
8 Geriatric Syndromes, Polypharmacy & Deprescribing
The Beers Criteria & STOPP/START Criteria for Potentially Inappropriate Medication Use Polypharmacy Management, Pharmacokinetics/Pharmacodynamics in Aging & Deprescribing Protocols Fall Risk Assessment (CDC STEADI), Gait/Balance & Mobility Impairments Pressure Injury Prevention/Staging, Urinary/Fecal Incontinence & Frailty Assessment
9 APRN Professional Practice, Ethics, Quality & Healthcare Policy
Musculoskeletal Disorders: Osteoarthritis, Osteoporosis, Gout & Back Pain Dermatological Disorders: Lesions, Skin Cancers, Infections & Rash Evaluation Palliative Care, Advance Care Planning, Pain Management & End-of-Life APRN Professional Practice, Quality Improvement, Ethics & Healthcare Policy
Pressure Injury Prevention/Staging, Urinary/Fecal Incontinence & Frailty Assessment
Key Takeaways Explain This Topic AI
National Pressure Injury Advisory Panel (NPIAP) staging classifies pressure injuries based on tissue depth: Stage 1 (non-blanchable erythema), Stage 2 (partial-thickness loss with exposed dermis), Stage 3 (full-thickness loss with visible adipose tissue), and Stage 4 (exposed muscle, tendon, ligament, or bone).
The Braden Scale assesses pressure injury risk across six subscales (Sensory Perception, Moisture, Activity, Mobility, Nutrition, Friction/Shear), with a total score <=12 indicating high risk and triggering intensive preventative measures.
Urinary incontinence is categorized into stress, urge, mixed, overflow, and functional types, requiring tailored behavioral, physical, and pharmacological interventions while avoiding anticholinergic toxicity.
The Fried Frailty Phenotype identifies physical frailty based on five operational criteria (unintentional weight loss >=10 lbs, exhaustion, low physical activity, slow gait speed, weak grip strength), defining frailty as a score of >=3.
Last updated: July 2026
- Pressure Injury Prevention/Staging, Urinary/Fecal Incontinence & Frailty Assessment
- Pressure Injury Prevention and NPIAP Staging
A pressure injury is defined by the National Pressure Injury Advisory Panel (NPIAP) as localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical device. Pressure injuries result from intense, prolonged pressure or pressure combined with shear. In older adults, age-related skin changes—including dermal thinning, flattened dermo-epidermal junction, decreased subcutaneous fat, and reduced vascularity—greatly increase tissue vulnerability.
- NPIAP Pressure Injury Staging System
- 1. Stage 1 Pressure Injury: Non-Blanchable Erythema
Clinical Presentation: Intact skin with a localized area of non-blanchable erythema (redness that does not turn white when pressed). In darkly pigmented skin, erythema may not be obvious; look for changes in skin temperature, tissue firmness (induration), or localized pain.
2. Stage 2 Pressure Injury: Partial-Thickness Skin Loss
Clinical Presentation: Partial-thickness skin loss with exposed dermis. The wound bed is viable, pink or red, moist, and may present as an intact or ruptured serum-filled blister . Adipose (fat) tissue and deeper anatomical structures are not visible . Granulation tissue, slough, and eschar are absent.
3. Stage 3 Pressure Injury: Full-Thickness Skin Loss
Clinical Presentation: Full-thickness loss of skin in which subcutaneous adipose (fat) tissue is visible within the ulcer. Granulation tissue and epibole (rolled wound edges) are frequently present. Slough or eschar may be visible. Deep tissue structures—such as fascia, muscle, tendon, ligament, cartilage, and bone—are NOT exposed . Undermining and tunneling may occur.
4. Stage 4 Pressure Injury: Full-Thickness Skin and Tissue Loss
Clinical Presentation: Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone . Slough and eschar may be present. Epibole, undermining, and tunneling are common. There is a high clinical risk of osteomyelitis and systemic sepsis.
5. Unstageable Pressure Injury: Obscured Full-Thickness Tissue Loss
Clinical Presentation: Full-thickness skin and tissue loss in which the extent of tissue damage cannot be confirmed because it is obscured by slough or eschar . If slough or eschar is removed, a Stage 3 or Stage 4 injury will be revealed. Stable, dry, adherent, intact eschar on the heels should not be softened or debrided.
6. Deep Tissue Pressure Injury (DTPI)
Clinical Presentation: Intact or non-intact skin with localized, persistent non-blanchable deep red, maroon, or purple discoloration , or epidermal separation revealing a dark wound bed or blood-filled blister.
The Braden Scale for Predicting Pressure Injury Risk
The Braden Scale is a validated clinical risk assessment tool evaluated upon admission and periodically thereafter. It assesses six subscales: Sensory Perception (1-4), Moisture (1-4), Activity (1-4), Mobility (1-4), Nutrition (1-4), and Friction and Shear (1-3).
Total score range: 6 to 23. Lower scores indicate higher risk.
Score ≤ 12 \le 12 ≤ 12 indicates HIGH RISK (Score 15-18 = mild risk; 13-14 = moderate risk; 10-12 = high risk; ≤ 9 \le 9 ≤ 9 = severe/very high risk).
Preventative Protocols for High Risk ( ≤ 12 \le 12 ≤ 12 ): Scheduled Q2H repositioning, pressure-redistribution mattress overlays, heel offloading boots, barrier creams for moisture management, and protein-enriched nutritional supplementation (1.2 to 1.5 g protein/kg/day).
Urinary Incontinence (UI) Staging and Clinical Management
Urinary incontinence is not a normal consequence of aging. It affects up to 50% of community-dwelling older adults and carries severe psychosocial and physical consequences.
Reversible Causes (The DIAPPERS Mnemonic):
Before diagnosing chronic UI, rule out reversible causes: D elirium, I nfection (UTI), A trophic vaginitis, P harmaceuticals, P sychological, E xcessive urine output, R estricted mobility, and S tool impaction.
Chronic Urinary Incontinence Types:
Incontinence Type Pathophysiology Clinical Symptoms First-Line Management
Stress UI Urethral hypermobility or sphincter deficiency Involuntary leakage with coughing, sneezing, laughing Pelvic floor muscle training (Kegels), topical vaginal estrogen, pessaries
Urge UI (OAB) Detrusor muscle overactivity Urgency, frequency, nocturia, leakage preceded by urge Bladder training, timed voiding, Mirabegron ; avoid antimuscarinics
Overflow UI Bladder distension due to obstruction/atony Continuous dribbling, weak stream, high PVR (>200 mL) Alpha-1 blockers, 5-ARIs for BPH, double voiding, intermittent cath
Functional UI Intact urinary tract; physical/cognitive barrier Inability to reach toilet in time due to severe impairment Scheduled/prompted voiding, environmental modifications, bedside commode
Mixed UI Combined stress and urge incontinence Leakage with exertion accompanied by urge symptoms Combined pelvic floor training and behavioral bladder re-training
Fecal Incontinence Assessment
Fecal incontinence is the involuntary passage of stool. The most common cause in older adults is fecal impaction with overflow diarrhea , where liquid stool leaks around a firm, impacted fecal mass in the rectum. Clinical management requires digital rectal examination (DRE), manual disimpaction if present, followed by a regular bowel regimen (osmotic laxatives like polyethylene glycol, fiber supplementation, and scheduled toileting after meals).
Frailty Assessment: The Fried Frailty Phenotype
Frailty is a vulnerable biological state resulting from age-related decline in physiological reserve across multiple organ systems, compromising the body's ability to withstand acute stressors.
The 5 Operational Criteria of the Fried Phenotype:
Unintentional Weight Loss: Loss of ≥ 10 \ge 10 ≥ 10 pounds (or ≥ 5 \ge 5 ≥ 5 % of body weight) in the preceding 12 months.
Self-Reported Exhaustion: Self-reported exhaustion on the CES-D depression scale ("I felt that everything I did was an effort").
Low Physical Activity Level: Low weekly energy expenditure (<383 kcal/week for men; <270 kcal/week for women).
Slowness (Slow Gait Speed): Standardized walking time over a 15-foot distance exceeding sex- and height-adjusted thresholds.
Weakness (Reduced Grip Strength): Dominant hand grip strength measured by dynamometer in the lowest 20th percentile.
Clinical Scoring & Categorization:
- 0 Criteria: Robust (Non-frail)
- 1 or 2 Criteria: Pre-Frail (High risk of progressing to frailty)
≥ 3 \ge 3 ≥ 3 Criteria: Frail (High risk of falls, hospitalization, disability, surgical complications, and mortality)
Clinical Interventions for Frailty:
Frailty management requires a multidisciplinary approach: prescribing resistance exercise and physical therapy, providing high-protein nutritional supplementation (1.2 to 1.5 g/kg/day), correcting Vitamin D deficiency, aggressively deprescribing PIMs, and conducting advance care planning.