Chapter 9: Management of Common Illnesses, Diseases, and Health Conditions.

Chapter 9: Management of

Common Illnesses, Diseases, and Health

Conditions

Learning Objectives

Name the major risk factors associated with cardiovascular disease (CVD).Discuss the impact of the major CVDs seen in older adults on the health of the U.S. population.Recognize signs of myocardial infarction that may be unique to the older adult.Utilize resources and research to promote heart-healthy lifestyles in older adults.State the warning signs of stroke.Apply the Mauk model for poststroke recovery to the care of stroke survivors.Identify common treatments for pneumonia, tuberculosis (TB), and chronic obstructive pulmonary disease (COPD).

Discuss how to minimize risk factors for common gastrointestinal problems in the elderly.Describe nursing interventions for patients dealing with gastro- esophageal reflux disease (GERD).Discuss ways to prevent catheter- associated urinary tract infection (CAUTI).Identify signs, symptoms, and treatments for benign prostatic hyperplasia (BPH) and vaginitis.Recognize common treatments for several cancers in older adults: bladder, prostate, colorectal, cervical, and breast.List several medications that can contribute to male impotence.Recognize the clinical treatments for persons with Parkinson’s disease (PD).

Learning Objectives (cont’d)

Devise a nursing care plan for someone with Alzheimer’s disease (AD).Discuss possible causes and solutions for dizziness in the elderly.List the modifiable risk factors for osteoporosis.Distinguish between osteoarthritis and rheumatoid arthritis in relation to typical presentation, treatment, and long-term implications.Contrast rehabilitative care for older adults with hip and knee replacement surgery.Describe the most effective way to condition a stump to promote use of a prosthesis.

Distinguish the signs and symptoms of cataracts, glaucoma, macular degeneration, and diabetic retinopathy.Contrast management of the 4 most common eye disorders seen in the elderly.Distinguish among the 3 major types of skin cancer.Identify signs and symptoms of herpes zoster appearing in the elderly.Review prevention of the most common complications of diabetes in older adults.Devise a plan for good foot care for older adults with diabetes.Synthesize knowledge about hypo- thyroidism into general care of the older adult.

Aging Cardiovascular system

• Heart – enlargement heart chambers, thickening heart walls.

• Arterial circulation – extended, twisted, thicken, stiffen, increased blood velocity.

• Peripheral pulses- stiffen due to accumulating mineral, lipid, collagen residues.

• Murmurs – heard in ½ of the elderly, asymtomatic.

• Blood pressure – resistance increase in the artery and vascular periphery.

Cardiovascular Problems

• Hypertension• Coronary Heart Disease(CHD): MI, Angina Figure, P. 276-277

• Congestive Heart Failure (CHF)• Stroke

– TIA

• Peripheral Artery Disease

QuestionNurses can best help older clients

prevent hypertension by teaching:

1. Low-fat, low-cholesterol diets

2. The importance of exercise

3. How to handle stressful situation

4. How to maintain a normal blood

pressure

Question

Older clients experiencing anginal pain with complaints of fatigue or weakness usually are medicated with which of the following types of medication?

1. Sublingual nitroglycerin

2. Cardiac glycosides

3. Aspirin

4. Morphine Sulfate

QuestionAn elderly client is being monitored for evidence of congestive heart failure. To detect early signs of heart failure, the nurse would instruct the certified nursing attendant (CNA) to do which of the following during care of the patient?

1.Observe electrocardiogram readings and report deviations to the nurse.

2.Assist the client with ambulation three times during the shift.

3.Monitor vital signs every 15 minutes and report each reading to the nurse.

4.Accurately weigh the patient, and report and record the readings.

QuestionA common arrhythmia found in some older clients is chronic atrial fibrillation. Based on the nurse's knowledge of the disease pathology, which of the following prescriptions should the nurse expect to be ordered?

1.Aspirin

2.Warfarin sodium (Coumadin)

3.Simvastatin (Zocor)

4.Vinorelbine tartrate (Navelbine)

Respiratory Problems

• Pneumonia– Bacterial– Viral

• Chronic Obstructive Pulmonary Disease – Chronic bronchitis– Emphysema

• Tuberculosis (Table 9-17)

Aging of the Respiratory System

• Chest wall – stiffer• Alveoli – flatter, shallower• Diaghragm – weaken by up to 25% with age.• Pulmonary circulation – reduced • Respiratory accessory muscles – loss• Anatomic structure – less able to provide

sufficient gas exchange due to loss of lung tissue and the chest wall, reduced contractual abilities of the diaphragm.

QuestionWhich of the following medications should the nurse anticipate the physician would prescribe for "rescue" from sudden-onset wheezing, tightness in the chest, or shortness of breath due to an asthma (or COPD) diagnosis?

1. Albuterol inhaler (Proventil, Ventolin)

2. Warfarin (Coumadin)

3. Alendronic acid (Fosamax)

4. Cromolyn Sodium inhalation (Intal)

Gastrointestinal Problems

• Gastroesophageal Reflux Disease (GERD)• Peptic Ulcer Disease (PUD)• Diverticulitis• Constipation• Cancers

– Colorectal– Gastric (stomach)– Esophagus– Pancreas

Age-related changes in the GI system

• Mastication – difficulty d/t , lose teeth; atrophy of muscles, bones of the jaw and mouth.

• Swallowing – decreased saliva may result in feelings of food being stuck.

• Peristalsis – mildly reduced• Nutrients absorption – no change with age• Enzymes – pancreas decreases in wt. with

age. No changes with gallbladder.

Gastrointestinal Problems- GERD

• Teach: Lifestyle modificationsAvoid large meals

Lose weight

Avoid food and drink within 3 – 4 hours of lying down

Avoid tight clothing

Elevate HOB (on blocks, not just head of bed)

• Avoid certain foods: limit spicy and tomato-based foods, acidic, nicotine, caffeine, chocolate, alcohol, mints, high fat

QuestionIn managing the symptoms associated with GERD, the nurse should assign the highest priority to which of the following interventions?1.Decrease daily intake of vegetables and water, and ambulate frequently.

2.Drink coffee diluted with milk at each meal, and remain in an upright position for 30 minutes.

3.Eat small, frequent meals, and remain in an upright position for at least 30 minutes after eating.

4.Avoid over-the-counter drugs that have antacids in them.

Genitourinary Problems

• Urinary Tract Infection• Bladder Cancer• Female Reproductive System

– Atrophic Vaginitis– Breast Cancer

• Male Reproductive System– Benign Prostatic Hyperplasia– Prostate Cancer

Aging of the Genitourinary System• Renal blood flow: declines with age due to

changes in the arteries and capillaries in the kidneys.

• Glomerular filtration rate (GFR): a decline in GFR, usually measured by creatinine clearance, becomes significant because elimination of waste and toxins declines, causing an accumulation of harmful substances such as uric acid and medications in the body.

Aging of the Genitourinary System• Bladder: decreases in size and develops

fibrous matter in the bladder wall, changing its overall stretching capacity and contractibility.

• Incontinence is not a normal part of aging and is highly treatable.

Older individuals experience nocturia which can disturb sleep patterns.

QuestionWhich of the following are significant renal changes at the ninth decade of life? (Select all that apply.)

1.Increased glomerular filtration rate

2.Decreased glomerular filtration rate

3.Lower creatinine clearance rate

4.Less concentrated urine-specific gravity

QuestionWhich of the following muscle exercises is frequently taught by nurses when caring for clients with urge or stress urinary incontinence?1.Abdominal exercises

2.Kegel exercises

3.Buerger Allen’s exercises

4.Aerobic exercises

QuestionWhich of the following complementary, non-prescribed products have been shown to relieve hot flashes in post-menopausal women? (Select all that apply.)

1. Soy products2. Fish3. Milk4. Ginkgo buloba (GBE)

Neurological Disorders

• Alzheimer’s Disease– Most common type of dementia

• Parkinson’s Disease• Four major types of dizziness:

– Vertigo– Presyncope (light-headedness)– Disequilibrium (related to balance)– Ill-defined

• Seizures

Aging of the Nervous System• The aging brain: decreases in size and wt.

Neurotransmitter, chemical messenger, changes and influence memory and cognition as well as behavior and motor function.

• The aging spinal cord: aging spine may narrow due to pressure.

• The aging peripheral nervous system: sensory and motor neuron function decline.

QuestionWhich of the following statements accurately describes Alzheimer's disease (AD)?1.Alzheimer's disease is a form of dementia, with reversible manifestations of memory loss and altered cognition.

2.Alzheimer's disease is a form of dementia that begins with memory loss, which is immediately noticeable.

3.Alzheimer's disease results from complex interactions between genetic and environmental factors.

4.Alzheimer's disease is a rapid, progressive, degenerative neurologic disease, which causes brain degeneration without inflammation.

Musculoskeletal Disorders

• Osteoporosis• Arthritis

– Osteoarthritis: characterized by deterioration of the cartilage at the end of the bones.

– Rheumatoid arthritis: characterized by remissions and exacerbations of inflammation within the joint.

• Joint Replacement• Amputation

Aging of the Skeletal Muscle• With age, there is not only a loss of muscle

mass, but also a loss of bone strength.--> osteoporosis

• Decreased ROM in joints. Joints are more fixed and stiff.

• Height – may lose 2-10 cm of height d/t intervertebral space compression

Sensory Impairments

• Vision– Cataracts– Glaucoma– Macular Degeneration– Diabetic Retinopathy– Retinal Detachment– Corneal Ulcer

• Chronic Sinusitis

QuestionWhile assessing the ears of the patient, you observed dry, hard cerumen developing in the ear canal. Which of the following actions should you take?

1. Do nothing, since this a normal finding in the older adult.

2. Document finding and report your concern to the physician.3. Irrigate the ear canal with a mixture of hydrogen peroxide and normal saline.4. Ask the patient if he is experiencing any discomfort.

The Aging Integumentary system

• Skin texture: thinner, dry, and less elastic• Color: age spots and wrinkles are common• Temperature: cooler• Fat distribution: increased fatty

distribution on trunk vs. arms/legs• Hair and nails: become more brittle,

thinner hair and male baldness patterns.

Integumentary Problems

• Skin Cancers– Basal cell carcinoma– Squamous cell carcinoma– Malignant melanoma

• Herpes Zoster (Shingles)

Herpes Zoster

• Senile Purpura: discolored areas of aging skin due to damage to capillaries.

QuestionAn 84-year-old patient's skin is assessed to be wrinkled, thin, and dry. These findings should be interpreted as related to:1. An increase in elastin and decrease in subcutaneous fat.2. Loss of elastin and a decrease in subcutaneous fat.3. Increased numbers of sweat and sebaceous glands.4. Increased vascularity of the skin.

Aging of the Endocrine System• Immune response: weaken• Changes in hormones levels: Most hormones,

except sex hormones, do not significantly change with age.– thyroid gland – ACTH (pituitary hormone) secretion– Sex hormones

• Adrenal function: decrease with age• Insufficient insulin secretion, insulin resistance• Glucose metabolism: impaired glucose

tolerance with age due to defect in insulin action.

Endocrine/Metabolic Disorders

• Diabetes Mellitus– Type 2– Characterized by hyperglycemia and insulin

resistance– Impaired insulin secretion may also be present

• Hypothyroidism– Elevated TSH and normal T4 (progressing to

decreased T4)

Summary

• Several notable conditions commonly seen in older adults may be the result of a variety of factors, not just one physical problem or disease.– Depression– Anxiety– Delirium– Dementia– Insomnia