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Geriatric Nursing

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By: Kirk Odrey O. Jimenez, B.S.N., R.N.
Introduction
Of all the animals in this planet, we humans go furthest beyond the
stage of procreation. We continue to grow and develop into our
grey years.

Growing old is a natural part of life, our bodies changes with the
passing of time and like rocks upon a flowing stream, it withers.

This is the faith of all mortal men, the body moves from birth to
death in a straight one-way line and with that evidence of ware and
tare start to appear.
Introduction
This presentation aims to impart the common health conditions
that an older adult will experience as he journeys through life.
In this presentation are common diseases per system and its
corresponding interventions that they may be delayed of
prevented.
Sensory System Disorders of the Older Adult
Vataract
' Definition
èv cataract is a clouding of the eye's lens that leads to
decreased vision. The lens of the eye focuses an image
onto the retina at the back of the eye. This is where an
image is processed and then sent to the brain.
è vs the cataract matures, it often causes glare, as well
as decreased vision, contrast, and color sensitivity.
' Vauses
è The lens of the eye is made of mostly water and
protein. The protein is arranged in a way that keeps the
lens clear and lets light pass through it. v cataract
forms when some of the protein clumps together and
starts to cloud an area of the lens. v cataract won't
spread from one eye to the other, although most people
develop cataracts in both eyes at a similar times.
è There are several causes of cataracts, including:
 vging (the most common cause)
 Smoking
 Diabetes
 Infection
 Injury
 Exposure to radiation
 Taking adrenal cortical hormones for a long time
 Excessive exposure to sunlight
 Birth defect
' Risk Factors
' v risk factor is something that increases your chance of getting a disease or
condition.
' Risk factors for cataracts include:
' vge
' Exposure to UV-B radiation from sunlight
' Family members with cataracts
' Diabetes
' Trauma
' Smoking
' Symptoms
è When a cataract is in the early stages, you may not notice
any changes in your vision. Cataracts tend to mature slowly.
Vision gets worse gradually. Some people with a cataract
find that their close-up vision suddenly improves, but this is
temporary. Vision is likely to worsen as the cataract
becomes more cloudy. Because the decrease in vision is
gradual, many people do not realize that they have a
cataract until it is discovered during an otherwise routine
eye examination.
è Symptoms include:
 Cloudy or blurry vision
 Problems with light, including:
 Headlights that seem too bright at night
 Glare from lamps or very bright sunlight
 v halo around lights
 Colors seem faded
 Poor night vision
 Frequent changes in your eyeglass or contact lens prescription
' Diagnosis
' v comprehensive eye examination usually includes:
è Visual acuity test³an eye chart test that measures how well
you see at various distances
è Pupil dilation³the pupil is widened with eye drops to see
more of the lens and retina
è Tonometry³a standard test to measure the pressure inside
the eye. Increased pressure may be a sign of glaucoma .
' Äreatment
è For an early cataract, vision may be improved by using different
eyeglasses, magnifying lenses, or stronger lighting. If these
measures don't help or if vision loss interferes with your daily
activities, such as driving, reading, or watching TV, surgery is the
only effective treatment.
è Cataract surgery is almost never an emergency. Therefore, in most
cases, waiting until you are ready to have cataract surgery will not
harm your eye. However, your cataract will only get more cloudy
with time.
è Cataract surgery is almost always performed in one eye at a time. vfter
the cloudy lens is removed, the eye surgeon (ophthalmologist) places an
intraocular lens (IOL) in its place. vn IOL is a clear lens that requires no
care and becomes a permanent part of your eye.
è vfter cataract surgery, most people need reading glasses and many
people need glasses for distance. There is a relatively new option,
multifocal intraocular lenses, which focus for both near and far distance
in the same lens. Many patients who receive multifocal intraocular lenses
see well at both a distance and nearby without glasses.
è vlthough every surgery has risks, the majority of patients who have
cataract surgery have better vision afterward.
' ·revention
è vlthough there is no way to completely prevent cataracts, the
following precautions may help:
è Do not smoke.
è Consume antioxidants (such as antioxidant vitamin supplements).
è Wear a hat and UV-protected sunglasses when outdoors.
è It is also important to get a comprehensive eye examination
regularly. But since vision problems increase with age, if you are
aged 60 or older, you should have a comprehensive eye
examination once a year.
Hearing Loss
' Definition
è Hearing loss is a decreased ability to hear. There are two main
categories of hearing loss:
è Conductive hearing loss due to something interfering with the
sound passing to the inner ear
è Sensorineural hearing loss due to damage to:
è The major organ in the ear responsible for hearing (the cochlea)
è The major nerve pathway (8th cranial nerve) and/or area of the
brain responsible for hearing
' Vauses
' Causes of conductive hearing loss
include:
è Impacted ear wax è Missing bones from the middle ear due to
previous surgery
è Fluid in the middle ear
è Congenital anomaly causing complete
è Ear infections closure of the ear canal (vtresia)
è Perforation of ear drum è Tumors
è Stiff bones in the middle ear ( otosclerosis ) è Causes of sensorineural hearing loss include:
è Injury è Excess noise
è Loose or fractured bones in the middle ear è vging
è Family history
è Exposure to toxic substances, including è Cardiovascular disease
such drugs as: è Multiple sclerosis
 Streptomycin
è Viruses ( measles , mumps , adenovirus ,
 Gentamicin rubella )
 Chemotherapy drugs è History of meningitis or syphilis
 Diuretics è Neurologic diseases such as multiple
 Steroids sclerosis and stroke
 Heart medicines è Inner ear disorders such as Meniere·s
 vnesthetics disease
 Quinine è Otosclerosis affecting the inner ear
 vspirin-containing drugs è Previous brain or ear surgery causing
damage to the inner ear
è vcoustic neuroma
è Trauma
' Risk Factors
è Risk factors for hearing loss include:
 Family history
 vging
 Meniere's disease
 Not receiving all recommended immunizations
 Repeated or poorly treated ear infections
 Exposure to loud noise, music, or machinery
 Use of certain antibiotics and chemotherapy drugs
 Diseases that may result in blocked blood flow, including atherosclerosis ,
problems with blood clots, and collagen vascular diseases
' Symptoms
' Symptoms may include:
' Decreased ability to hear any of the following:
è Higher pitched sounds
è Lower pitched sounds
è vll sounds
è Speech when there is background noise
' Dizziness
' Ringing sounds in the ears
' Problems with balance
' In children, hearing loss may cause difficulty learning to speak.
' Diagnosis
è The doctor will ask about your symptoms and medical history, and
perform a physical exam. Tests may include:
è Weber test³a tuning fork sounded and placed on your forehead or
teeth. This can help distinguish conductive from sensorineural hearing
loss.
è Rinne test³a tuning fork sounded and placed in front and then
behind of the ear. This can help distinguish conductive from
sensorineural hearing loss.
è vudiometric tests ³These involve listening to tones in a soundproof
room and reporting whether or not you hear the tones.
' Diagnosis
è Tympanometry³This test measures the pressure in the middle ear and
examines the middle ear's response to pressure waves.
è CT or MRI scan of the head ³a type of imaging study that uses a
computer to make pictures of the inside of the head. This may be done
to check for a tumor or bone injury.
è Brain stem auditory evoked responses³electrodes attached to the scalp
and used to measure the electrical response of the brain to sound
è Electrocochleography³This tests the cochlea and the auditory nerve.
' Äreatment
' Treatment includes:
è [arwax Removal
è This is probably the simplest, easiest treatment for
hearing loss.
è Îearing Aids
 There are many types. Digital technology has created tiny
devices that cause little distortion.
è Devices
 One example of a device is the FM trainer. With this device, a
person speaks into a microphone. The sound is then transmitted
by radio waves directly to the earphone set worn on your ear.
This can be particularly helpful if you have trouble hearing
speech when there is background noise. FM trainers can also
help children with hearing loss to understand their teachers.
' Vochlear Implant
è The cochlear implant is surgically implanted. It directly
stimulates part of the brain and uses a tiny computer
microprocessor to sort out incoming sound.
' Äreat Other Medical Illnesses
è When hearing loss is caused by other medical conditions, it
may be possible to improve hearing by treating those
conditions.
' Discontinue or Vhange Medications
è If your hearing loss may be caused or worsened by a medication,
talk to your doctor about stopping that particular drug or
changing to a drug that doesn't affect hearing.
' Address Nutritional Deficiencies
è It may be possible to slow age-related hearing loss in elderly
persons through dietary modification. For example, if you are
deficient in folic acid , this supplement may be helpful for you.
Talk to your doctor.
' Surgery
è Surgery may be done in some cases of conductive
hearing loss to correct the middle ear problem, such as
in otosclerosis , ossicular damage or fixation, and ear
infections.
' ·revention
è To help prevent hearing loss:
è Stop smoking.
è vdequately treat ear infections.
è Get all appropriate immunizations.
è Treat all medical conditions.
è vvoid exposure to excess noise.
è Use adequate ear protection when using noisy equipment.
Respiratory System Disorders of the Older Adult
Chronic Obstructive Pulmonary
Disease
' Definition
' Chronic obstructive pulmonary disease (COPD) makes it
difficult to push air out of the lungs. The oxygen-poor air will
build up. If the lungs are filled with this air, there is no room
for fresh, oxygen-rich air. COPD includes:
' Emphysema ³air sacs of lungs are damaged
' Chronic bronchitis ³disorder of the large airways of lungs
' The changes to lung tissue differ with the two diseases.
However, the causes and treatment are similar.
Normal and [mphysemic Lung
' Vauses
è COPD develops due to:
è Cigarette smoking

è Inhaling toxins or other irritants

è Genetic predisposition can make a person's lungs more


susceptible to damage from smoke or pollutants
(includes alpha-1-antitrypsin deficiency)
' Risk Factors
è Factors that increase your chance of developing COPD include:
è Smoking cigarettes
è Long-term exposure to second-hand or passive smoke
è Family members with COPD
è Exposure to pollutants
è History of frequent childhood lung infections
è vge: 50 or older
' Symptoms
è Early symptoms of COPD include:
 Coughing in the morning
 Coughing up clear sputum (mucus from deep in the lungs)
 Wheezing
 Shortness of breath with activity
è vs the disease progresses, symptoms may include:
 Increased shortness of breath
 Choking sensation when lying flat
 Fatigue
 Trouble concentrating
 Heart problems
 Weight loss
 Breathing through pursed lips
 Desire to lean forward to improve breathing
 More frequent flare-ups (periods of more severe symptoms)
' Diagnosis
' Tests may include:
è Chest x-ray ³x-rays of the chest that may detect signs of lung
infection
è CT scan ³a type of x-ray that uses a computer to make pictures
of structures inside the chest
è Blood tests³to assess the amount of oxygen and carbon dioxide
in the blood
è Lung function tests
' Äreatment
è Thereis no treatment to cure COPD. Treatment aims to
ease symptoms and improve quality of life.
' Smoking Vessation
è Quitting smoking slows the disease. Doctors consider it
the most important part of treatment. Smoking cessation
programs may include behavior modification and
medicines to help you quit.
' [nvironmental Management
è Limit
the number of irritants in the air you breathe. It
may help make breathing easier. vvoid smoke, dust,
smog, extreme heat or cold, and high altitudes.
' Medication
' Some may be taken by mouth. Nebulizers and inhalers deliver drugs
directly to the lungs. Drugs for COPD may work in the following ways:
è Opening the airways
è Relaxing the breathing passages
è Decreasing inflammation
è Helping thin secretions and bring up mucus from the lungs
è Treating lung infections (antibiotics): If you have chronic bronchitis and mild-to-
moderate COPD, you may not need antibiotics. If you do need them, a study
found that shorter antibiotic treatment (five days or less) is as effective as longer
treatment (more than five days).
'  accines
è Getvaccinated against pneumonia and the flu . The flu
vaccine may reduce COPD flare-ups.
' Oxygen
è Itis given to improve the air you breathe in. It increases
the amount of available oxygen. This can increase
energy levels and heart and brain function.
' [xercise
è Special exercises can strengthen chest muscles and make
breathing easier. Physical activity builds endurance and
improves quality of life. Yoga is an example of an exercise
routine that may offer benefits for people with COPD.
' Breathing and Voughing Äechniques
è Special methods of breathing can help bring more air into
and force trapped air out of the lungs. Coughing helps clear
the lungs of mucus.
' Nutrition
è Maintain a normal weight. Excess weight causes the lungs and
heart to work harder.
è Eat a healthy diet that is low in saturated fat and rich in fruits,
vegetables, and whole grain foods.
è Eat several small meals during the day. It makes breathing easier.
è vvoid gas-producing foods. Large meals and excess gas swell the
stomach, which pushes up on the diaphragm.
è Drink fluids to keep mucus thin.
' Lifestyle Vhanges
è Pace your activities.
è Learn relaxation techniques and other methods to manage stress.
è Seek emotional support from professionals, family, and friends.
vnxiety can increase the rate of respiration, making breathing
more strenuous.
' Surgery
è v small number of patients may benefit from surgery. (Lobectoy)
' ·revention
' Take these steps to reduce chance of developing
COPD:
è If you smoke, quit.
è vvoid exposure to second-hand smoke.
è vvoid exposure to air pollution or irritants.
è Wear protective gear if exposed to irritants or toxins at
work.
Common Cold
' Definition
è Thecommon cold is an infection that can irritate your
upper respiratory tract (nose and throat).
Sore Ähroat Due to Inflammation
' Vauses
è The common cold is caused by a virus. There are over 200
different viruses that can cause a cold, including:
 Rhinovirus
 Corona virus
 vdenovirus
 Coxsackie virus
 Paramyxovirus
 Parainfluenza virus
 Respiratory syncytial virus
' Risk Factors
' Risk factors for a cold are:
è Being near someone who has a cold
è Touching your nose, mouth, or eyes with contaminated fingers
è Having allergies (lengthens duration of cold)
è Smoking or being near cigarette smoke (due to decreased
resistance)
è Stress (due to decreased resistance)
' Symptoms
' Symptoms include:
è Sore or scratchy throat è Watery eyes
è Stuffy nose (hard to è Slight cough
breathe through your nose) è Headache
è Runny nose è vches and pains
è Sneezing è Low energy
è Itchy, stuffed sensation in è Low-grade fever
the ears
' Diagnosis
è Your doctor will ask about your symptoms and medical
history. v physical exam will be done.
' Äreatment
èv cold usually lasts more than 10 days. There are no
cures for a cold. But there are treatments that can
relieve your symptoms, including:
' ·ain Relievers
' You can take these for aches and pains, as well as
fever:
' vcetaminophen (Tylenol)
' Ibuprofen (Motrin)

' v  (Not recommended for viral Infections)


' Decongestants
' Pills or nasal sprays can shrink nasal passages and decrease mucus
production. Nasal sprays should only be used for 2-3 days. If used
longer, increased congestion may occur when treatment is stoped
è OTC cough and cold products include:
 Decongestants
 Expectorants
 vntihistamines
 vntitussives (cough suppressants)
' Fluids
è Drinks lots of fluids. Warm beverages, like tea, and chicken
soup are soothing and help reduce congestion.
' Îumidifier
è v cool-mist humidifier can keep your nasal passages moist
and reduce congestion. Be sure to clean the humidifier every
day.
' Saline Nasal Sprays
è Saline nasal sprays may provide relief from congestion.
' Alternative Äreatments
' Examples of alternative treatments include:
è Vitamin C ³Some people take vitamin C at the start of a cold, hoping that it will reduce symptoms and
shorten how long the cold lasts. But, there is not a lot of evidence to support this. Taking vitamin C every day,
though, may help to shorten a cold.
è Zinc lozenges³People who take zinc at the start of a cold may have reduced symptoms.
è Echinacea ³Echinacea may help people to recover faster from a cold.
è · 
  ³This herb may improve symptoms and speed recovery. It is the main ingredient in
products like Umcka ColdCare and Zucol.
è Honey ³Honey appears to improve nighttime cough and sleep disruption in children. Do not give honey to
infants younger than 12 months because of the risk of infant botulism .

' r

  
 





 

 

 
  



 

' Salt Water Gargle


è Gargling with warm salt water can help relieve a sore
throat.
' Over-the-Vounter Vough Drops
è Using throat lozenges as needed every couple of hours
can help relieve sore throat and cough.
' ·revention
è The most important way to keep from getting or spreading
a cold is by washing your hands. Wash your hands well and
often. Other ways to keep from getting a cold:
è Keep your hands away from your nose, mouth, and eyes.
è Stay away from people who have a cold.
è If you smoke, stop or cut down on smoking.
è Some people take vitamin C to keep from getting a cold.
But, doctors are not yet sure if vitamin C works.
Genetourinary System disorders of the Older Adults
·rostate Vancer
' Cancer occurs when cells in the body (in this case prostate cells)
divide without control or order. Normally, cells divide in a regulated
manner. If cells keep dividing uncontrollably when new cells are not
needed, a mass of tissue forms, called a growth or tumor. The term
cancer refers to malignant tumors, which can invade nearby tissue
and spread to other parts of the body. v benign tumor does not
invade or spread.

' The sooner prostate cancer is treated, the better the outcome. Call
your doctor right away if you think you have this condition.
·rostate Vancer
' Vauses
è Thecause of prostate cancer is unknown. However,
research shows that certain risk factors are linked to the
disease.
' Risk Factors
è vge: 55 or older
è Race: Black

è Family history of prostate cancer, especially father or


brother
è Family history of prostate cancer diagnosed at a young age

è v high-fat diet
' Symptoms
è v need to urinate frequently, especially at night
è Difficulty starting urination or holding back urine
è Not able to urinate
è Weak or interrupted urine flow
è Painful or burning urination
è Difficulty having an erection
è Painful ejaculation
è Blood in urine or semen
è Frequent pain or stiffness in the lower back, hips, or upper thighs
' Diagnosis
è Digital rectal exam³examination of the rectum with the doctor's gloved finger inserted
into your rectum
è Urine test³to check for blood or infection
è Blood test³to measure prostate specific antigen (PSv) and prostatic acid phosphatase
(PvP)
' Other tests to learn more about the cause of your symptoms are:
è Transrectal ultrasonography³a test that uses sound waves and a probe inserted into the
rectum to find tumors
è Intravenous pyelogram ³series of x-rays of the organs of the urinary tract
è Cystoscopy ³the doctor looks into the urethra and bladder through a thin, lighted tube
è Biopsy ³removal of a sample of prostate tissue to test for cancer cells
' Äreatment
è Once prostate cancer is found, tests are done to find
out if the cancer has spread and, if so, to what extent.
Treatment depends on how far the cancer has spread.
Talk to a radiation oncologist and urologist. They can
help you decide the best treatment plan. Discuss the
benefits and risks of each treatment option.
' Watchful Waiting
' There is no treatment with watchful waiting. Your doctor
will do tests to see if the cancer is growing. Watchful
waiting is for:
è Early stage prostate cancer that seems to be growing slowly
è Older prostate cancer patients or those with serious medical
problems that may make the treatment risks outweigh the
possible benefits
' Surgery
' Surgery involves removing the cancerous tumor
and nearby tissues, and possibly nearby lymph
nodes. Surgery is offered to patients who are
in good health and are younger than 70 years
old.
' Types of surgery:
è Pelvic lymphadenectomy³removal of lymph nodes in the pelvis to
determine if they contain cancer
 If they do, removal of the prostate and other treatment may be
recommended.
è Radical retropubic prostatectomy ³removal of the entire prostate and
nearby lymph nodes through an incision in the abdomen
è Radical perineal prostatectomy ³removal of the entire prostate through
an incision between the scrotum and the anus
 Nearby lymph nodes are sometimes removed through a separate incision
in the abdomen.
è Transurethral resection of the prostate (TURP) ³removal of part of the
prostate with an instrument inserted through the urethra
 TURP is not a cancer surgery, but can be used to relieve the symptoms if you
have either prostate cancer or an enlarged gland due to other reasons.

è · 
 
 


   


 

 





 




   
   
 


 

  




 


   
 
 


 

 


 


  

è Robotic surgery and laparoscopic surgery may be other options. These


minimally invasive techniques can reduce side effects, blood loss, and
recovery time.
' Radiation Äherapy
è Radiation therapy involves the use of radiation to kill cancer cells and shrink
tumors. Radiation may be:
 External radiation therapy³radiation is directed at the tumor from a source outside
the body
 Internal radiation therapy³radioactive materials placed into the body near the
cancer cells
 Internal radiation therapy is often used for treating earlier stage cancers. Radiation therapy
for prostate cancer may cause impotence, urinary problems, and bowel problems. Most
studies show that impotence rates are less for radiation therapy than for standard
prostatectomy and slightly less than that for nerve-sparing procedures. Rates of incontinence
following radiation therapy are also less than following prostatectomy. But, there is an
increased risk of cystitis due to radiation.
' Îormone Äherapy
è Hormone therapy is used for patients whose prostate
cancer has spread beyond the prostate or has recurred
after treatment. The goal of hormone therapy is to
lower levels of the male hormones, called androgens.
The main androgen is testosterone. Lowering androgen
levels can cause prostate cancers to shrink or grow
more slowly, but does not cure cancer.
' Methods of hormone therapy include:
' Orchiectomy³a surgical procedure to remove one or both
of the testicles, which are the main source of male hormones
è Orchiectomy decreases hormone production. This can shrink or
slow the growth of most prostate cancers.
' Luteinizing hormone-releasing hormone (LHRH) agonists³
injections that can decrease the amount of testosterone
made by the testicles
' vnti-androgens (eg, flutamide , bicalutamide )³medications that
can block the action of androgens
è These medications are used in combination with orchiectomy or LHRH
agonists, a combination called total androgen blockade.
' Drugs that prevent adrenal glands from making androgens (eg,
ketoconazole , aminoglutethimide )
' Estrogens³drugs that prevent the production of testosterone in the
testicles
è Estrogens are rarely used today because of the risk of serious side
effects.
' Hormone therapy for prostate cancer may cause:
è Hot flashes
è Impaired sexual function

è Loss of sexual desire

è Weakened bones
' Other Äreatment Options
' Other treatments are being tested. Patients may want to consider taking part in a
clinical trial when weighing treatment options. The treatments that are currently
being tested include:
' Vryosurgery
è Cryosurgery uses an instrument to freeze and destroy prostate cancer cells.
' Vhemotherapy
è Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms,
including: pill, injection, and via a catheter. The drugs enter the bloodstream and travel
through the body, killing mostly cancer cells, but also some healthy cells.
è One type of chemotherapy is docetaxel (Taxotere). This drug was found to prolong life in
men with hormone refractory prostate (HRPC) cancer. (In HRPC, PSv levels continue to rise
or the tumor continues to grow despite hormone therapy.)
' Biological Äherapy
è Biological therapy is the use of medications or substances made by the body to increase or restore the
body·s natural defenses against cancer. It is also called biological response modifier (BRM) therapy.
' Îigh-intensity Focused Ultrasound
è This treatment uses an endorectal probe that makes ultrasound (high-energy sound waves). This can
destroy cancer cells.
' Vonformal Radiation Äherapy
è Conformal radiation therapy uses three-dimensional radiation beams that are conformed into the shape
of the diseased prostate. This treatment spares nearby tissue the damaging effects of radiation.
' Intensity-Modulated Radiation Äherapy (IMRÄ
è IMRT uses radiation beams of different intensities to deliver higher doses of radiation therapy to the
tumor and lower doses to nearby tissues at the same time.
' ·revention
è Talk to doctors about screening. Starting at age 50,
è Eat a healthy diet. Diet should be high in fruits, vegetables
and fish, and low in red meat.
è vsk the doctor about taking certain medicines. Daily aspirin
therapy and 5-alpha reductase inhibitors (eg, finasteride
[Proscar, Propecia], dutasteride [vvodart]) may reduce your
risk of prostate cancer.
Impotence
' Definition
è Impotence is the inability to attain or maintain an
erection of the penis that is firm enough for sexual
intercourse.
' Vauses
è Toinitiate and maintain an erection, the penis must fill
with blood. Nerve signals cause the blood to flow there.
The blood vessels expand so blood can fill it.
Meanwhile, other blood vessels constrict, trapping
blood inside.
' The following factors can cause erectile dysfunction:
è  enous Leak
 v leak in the blood vessels in the penis can allow blood to escape. This means that
an erection cannot be made or may not last long. Injury or disease can cause a
venous leak.
è Neurovascular Function
 Problems with nerve signals and blood flow
 Nerve dysfunction³can reduce feeling in the penis, resulting in impotence
 Diabetes ³interferes with nerve signals
 Complete loss of nighttime erections
 Hardening of the arteries ³can cause reduced blood flow
 Peripheral neuropathy , spinal cord injury, and surgery³can damage nerves
 Side-effects from medications
Blood  essels and Nerves of Male ·elvis
' ·sychological Factors
è The brain causes many of the nerve signals needed for
an erection. Emotional problems may play a role in men
who suddenly develop impotence.
' Risk Factors
è These factors increase your chance  Chronic kidney disease
of developing impotence. Tell your  Liver failure
doctor if you have any of these risk  Peyronie's disease (bending of the
factors: penis caused by scar tissue)
è vge: 65 and older  Endocrine disorders
è Race: Hispanic  Neurological disorders (eg, multiple
sclerosis , peripheral
è Obesity neuropathy , stroke )
è Medical conditions:  Hypertension
 Diabetes  Psychiatric disorders
(eg, anxiety , depression )
 Hardening of arteries
è Traumatic conditions:  Interpersonal conflicts with a
 Vascular surgery sexual partner
 Pelvic surgeries (particularly è Medications:
for prostate cancer )  vntihypertensives
 Spinal cord injury  vntihistamines
è Behaviors:  vntidepressants
 vlcohol use  Tranquilizers
 Illegal drug use  vntipsychotics
 vnabolic steroid use
 Heavy smoking
' Symptoms
è Symptoms include:
è v less firm penis

è Fewer erections
' Diagnosis
è The doctor will ask about your symptoms and medical history, and
perform a physical exam. Expect questions about the frequency,
quality, and duration of your erections. Your answers may help
the diagnosis.
è The doctor will examine your penis, testes, and rectum. If a
physical cause is suspected, you will need lab tests, including:
è Hormone levels such as thyroid function tests
è Prolactin levels
è Testosterone levels
' Nocturnal ·enile Äumescence Äesting
è Thistest can help your doctor determine if the cause is
due to emotional problems or physical problems.
' Imaging
è Sometimes Doppler imaging may be done to look at
the blood flow. The test is also done to check for
blockage in the arteries or veins that supply the penis.
' Äreatment
è Treatment options include:
 Medications
 Your doctor may prescribe:
 Phosphodiesterase inhibitors, such as:
 Sildenafil (Viagra)
 Tadalafil (Cialis)
 Vardenafil (Levitra)
 Do not take these medications if you are also taking nitrates.
 Oral testosterone , if you have low testosterone levels
 vlprostadil , either injected into the penis or inserted into the urethra as a suppository
 Use caution and talk to your doctor before taking any over-the-counter medicines for
impotence. Some of them may be unsafe.
'  acuum Devices
è Plastic cylinder for the penis
è Hand pump for pumping air out of the cylinder
è Elastic band for holding the erection after removal of the cylinder
'  ascular Surgery
è Vascular surgery repairs venous leaks. This has been shown to be
effective in some cases.
' ·enile Implants
è There are semi-rigid, malleable, and inflatable implants. They are
surgically inserted into the penis.
·enile Implant
' Sex Äherapy
è Sex therapy may help impotence resulting from:
è Ineffective sexual techniques

è Relationship problems

è vnxiety

è Depression
' ·revention
è To reduce your chance of becoming impotent:
è Take medications to manage blood pressure , diabetes, or depression.
è vsk your doctor about changing medications.
è Maintain a healthy weight .
è Eat a healthful diet .
è If you smoke, quit . Smoking is significantly associated with impotence in
middle-aged and older men.
è Talk to a therapist or counselor.
Menopause
' Definition
è Menopause is the time when the menstrual period
ceases and the ovaries permanently stop releasing
eggs. Menopause is considered complete when a
woman has been without her period for a full year.
vlthough menopause can occur anytime between ages
40 to 58, the average age is 51 years old.
' Vauses
è Natural menopause is a gradual process. The ovaries begin producing lower amounts of
estrogen and other steroid hormones prior to menopause during a phase called
perimenopause.
è When menopause occurs before the age of 40 it is called premature menopause.
Premature menopause can occur naturally but may also be the result of several conditions,
including:
è Family history of premature menopause
è vutoimmune diseases
è X-chromosome abnormalities
è Medical treatments (pelvic surgery, surgical removal of ovaries, chemotherapy , or pelvic
radiation therapy)
è Medications that lower estrogen levels
è Smoking
' Symptoms
è vs menopause approaches, women often è Vaginal dryness and pain with sexual
experience a number of physical and intercourse
emotional symptoms including: è Difficulty concentrating
è Irregular menstrual periods è Trouble remembering things
è Hot flashes and night sweats è Diminished interest in sex
è Disturbed sleep patterns, insomnia è Frequent urination or leaking of urine
è vnxiety è Headaches
è Significant mood changes è vchy joints
è Depression è Fatigue
è Dry skin è Early morning awakening
è Irritability
' Diagnosis
è Natural menopause is usually diagnosed when a woman has
not had a menstrual period for 12 consecutive months.
è Some women have had a hysterectomy before menopause,
and they no longer have periods. For these women, if
menopause is suspected but needs confirmation, the test
considered most accurate for the diagnosis of menopause is
the measurement of follicle stimulating hormone (FSH) . High
levels of FSH (greater than 40) may indicate menopause.
' Äreatment
è Menopause is a natural part of life and does not
necessarily require treatment. Symptoms and health
risks associated with low estrogen can be treated.
These include hot flashes, vaginal dryness,
and osteoporosis (loss of bone mass).
Osteoporosis in Îip
' Îormone Replacement Äherapy (ÎRÄ
è v number of different types of hormones are available. They include:
è Natural, synthetic, and plant-derived estrogens
è Progesterone
è Combinations of estrogen and progesterone
è vddition of small amounts of male hormones
è HRT is available as tablets, gels, skin patches, vaginal rings, vaginal tablets,
injections, and pellets inserted into the skin.
è There are a number of possible risks associated with HRT . Some of these include
cancer (endometrial , breast , ovarian ), heart disease, gallstones ,
and gastroesophageal reflux disease(GERD).
' ·hytoestrogens
èv high intake of phytoestrogens (or plant estrogens)
may help menopausal women. They may reduce the risk
for diseases associated with estrogen. Phytoestrogens
are found in soybeans, black cohosh , rhubarb
extract (a supplement), whole grains, legumes, tempeh,
and flax seed. They are also found in concentration in
capsule form.
' Îealthful Diet
è v healthful diet during menopause can improve a woman's sense of
well-being. It may also reduce the risk of heart disease, osteoporosis,
and certain cancers. The diet should be low in fat and high in fruits,
vegetables, whole grains, calcium , and vitamin D .
' Limit Vaffeine and Alcohol
è Cutting back on caffeine and alcohol may reduce symptoms of anxiety,
insomnia, and loss of calcium.
' uit Smoking
è Giving up smoking can reduce the risk of early menopause, heart
disease, and osteoporosis.
' Regular [xercise
è Regular exercise may reduce hot flashes. Weight-bearing exercises such
as walking, climbing stairs, and resistance exercises such as lifting
weights help strengthen bones and decrease the risk of osteoporosis.
' Stress Management
è Stress management may help ease tension, anxiety, and possibly other
menopausal symptoms. Deep breathing, massage , warm baths, and
quiet music are examples of relaxation techniques.
' Over-the-Vounter ·roducts
è Moisturizers and lubricants are used to help vaginal dryness.
' Nonhormonal Medications for Îot Flashes
è Certain blood pressure medicines (taken in lower doses)
 Examples include: clonidine (Catapres), methyldopa (vldomet)
è Selective serotonin reuptake inhibitors (SSRIs) and serotonin and
norepinephrine reuptake inhibitors (SNRIs)
 Examples
include: fluoxetine (Prozac), paroxetine (Paxil), venlafaxine (Effexor),d
esvenlafaxine (Pristiq)
 Note: SSRIs and SNRIs should not be used if you are
taking tamoxifen (Nolvadex), a medication to reduce the risk
of breast cancer recurrence.
' ·revention
è Menopause is a natural biologic event that does not
need to be prevented. Quitting smoking could slightly
delay the onset of menopause.
Urinary Incontinence³Female
' Definition
è Urinary incontinence is the loss of voluntary bladder
control leading to urine leakage. It can be temporary
or chronic (lasting for a long time). Incontinence is a
symptom, not a condition in and of itself.
' Vauses
' Temporary incontinence can be caused by:
è Medicines
è Constipation
è Infection
è Muscle weakness
è Restricted mobility
è Obesity
è Endocrinological disorders (for example, diabetes )
' Stress Incontinence
è This results when certain activities lead to increased pressure
on the bladder. Triggers may be laughing, sneezing, lifting
heavy objects , or exercise. This is the most common type of
incontinence. It may be caused by:
è Weakening of the muscles that suspend the bladder
è Weakening of muscles that control urine flow
è Obesity
Muscles Involved in Incontinence in
Women
' Urge Incontinence
è Urge incontinence is a loss of bladder control following
a strong urge to urinate. The person is not able to hold
urine long enough to make it to a restroom. This is also
known as overactive bladder.
è It may be caused or
worsened by:
 Urinary tract infection  vlcohol
 Diabetes type 1 and 2  Nerve damage due to:
 Bladder irritation (stone,  Spinal cord injury
tumor)  Stroke
 Drugs (eg, hypnotics,  Multiple sclerosis
diuretics)  Parkinson's disease
 Caffeine  Constipation
' Overflow Incontinence
è This occurs when the bladder will not empty. Urine
builds up, and this causes an overflow and leaking of
urine
' It may be caused by:
è v bladder that is blocked, such as by a scar in the urethra (stricture)
è Fecal impaction
è Drugs (eg, antidepressants, hypnotics, antipsychotics, antihistamines, calcium channel
blockers)
è Vitamin B12 deficiency
è Weak bladder muscles
è Nerve damage due to:
 Surgery
 Diabetes
 Spinal cord injuries
 Other factors
' Functional Incontinence
è Thisoccurs when there is normal bladder control, but an
inability to reach the toilet in time. vn example would
be severe arthritis . Drugs that cause confusion or
sedation can also cause functional incontinence.
' Risk Factors
è vge: older than 65 è Menopause
è Having been pregnant multiple times or having a è Diabetes
comlicated delivery è Stroke
è Urinary tract infection è Multiple sclerosis
è Obesity è Spinal cord injury or disease
è Chronic lung disease è Use of certain substances/medicines:
è Urethritis  Caffeine

è Previous hysterectomy or urethral surgery  vlcohol

è Pelvic organ prolapse  vlpha-agonists

è Depression  Cholinergic agents


 Cyclophosphamide
è Dementia including vlzheimer·s disease
' Symptoms
è Urinary incontinence is a symptom of other conditions.
vny loss of bladder control can be considered
incontinence.
' Diagnosis
' Tests may include:
è Stress test³You relax then cough as your doctor watches for loss of urine. This will confirm
if you have stress incontinence.
è Urine tests
è Blood tests to detect diabetes
è Ultrasound ³a test that uses sound waves to examine structures inside the body to
determine the residual urine volume after voiding
è Cystoscopy³a thin tube with a tiny camera is inserted in the urethra to view the urethra
and bladder
è Urodynamic tests³tests used to measure the flow of urine and pressure in the bladder
' Äreatment
' Treatments may include:
è Behavioral Äherapy
è Behavioral therapy includes:
è Making muscles stronger by doing Kegel exercises
 This strengthens the muscles that hold the bladder in place and those that control urine flow.
 Painless electrical stimulation is sometimes used to strengthen the muscles more quickly and is helpful
for stress incontinence.
è Bladder training
 This can be done by setting a regular, timed schedule for emptying your bladder and by drinking
fewer liquids.
è Weight Loss
è If you are a woman who is overweight or obese, losing weight may help to reduce the number of
episodes due to stress or urge incontinence. Talk to your doctor about a weight loss program that is
right for you.
' Medication
è Medicines may be prescribed to relax the bladder muscles.
These types of medicines, called anticholinergics, are often
used in treating urge incontinence. Examples include:
 Oxybutynin (Ditropan)
 Tolterodine (Detrol)
 Darifenacin (Enablex)
 Solifenacin (Vesicare)
' Nerve Stimulation
è Nerve stimulation is effective for urge urinary incontinence. It can be done by stimulating a
nerve in your ankle. Or, it can be done by implanting a device that stimulates the bladder
nerves.
' Surgery
è In women, surgery can support weakened muscles related to bladder function. Other
procedures involve collagen injections into the urethra.
' Devices
è vbsorbent diapers are often used with incontinence.
è Plugs and patches that hold urine in place are available for women. Catheters are
sometimes used to treat more severe cases. vlternatively, pessaries may be used in
women. Pessaries are devices that raise the uterus or the prolapsed bladder. This
decreases pressure on the bladder.
' ·revention
è Incontinence is really a symptom of another condition. There
are several ways to prevent incontinence:
è do Kegel exercises.
è Reduce intake of substances that lead to incontinence (eg,
caffeine, alcohol, and certain drugs).
è Lose weight.
è Eat a healthy diet to avoid constipation.
Vardiovascular System Disorders of the Older Adults
Voronary Artery Disease
' Definition
è Coronary arteries bring oxygen rich blood to the heart
muscle. Coronary artery disease (CvD) is blockage of these
arteries. If the blockage is complete, areas of the heart
muscle may be damaged. In severe case the heart muscle
dies. This can lead to a heart attack, also known as a
myocardial infarction (MI).
è Coronary artery disease is the most common form of heart
disease. It is the leading cause of death worldwide.
Voronary Artery Disease
' Vauses
è Causes include:
 Thickening of the walls of the arteries feeding the heart muscle
 vccumulation of fatty plaques within the coronary arteries
 Sudden spasm of a coronary artery
 Narrowing of the coronary arteries
 Inflammation within the coronary arteries
 Development of a blood clot within the coronary arteries that
blocks blood flow
' Risk Factors
è Major risk factors include:
 Sex: male (men have a greater risk of heart attack than women)
 vge: 45 and older for men, 55 and older for women
 Heredity: strong family history of heart disease
 Obesity and being overweight
 Smoking
 High blood pressure
 Sedentary lifestyle³Poor fitness can also increase your risk of CvD and premature death.
 High cholesterol (specifically, high LDL cholesterol, and low HDL cholesterol)
 Diabetes
 Metabolic syndrome (combination of high blood pressure, abdominal obesity, and insulin
resistance)
è Other risk factors may include:
 Stress
 Excessive alcohol use
 Depression
 v diet that is high in saturated fat,  fat, cholesterol,
and/or calories³ 

  


 

 

 

 



' Symptoms
è CvD may progress without any symptoms.
 vngina is chest pain that comes and goes. It often has a squeezing or
pressure-like quality. It may radiate into the shoulder(s), arm(s), or
jaw. vngina usually lasts for about 2-10 minutes. It is often relieved
with rest. vngina can be triggered by:
 Exercise or exertion
 Emotional stress
 Cold weather
 v large meal
 Chest pain may indicate more serious unstable angina or a heart attack if:
 It is unrelieved by rest or nitroglycerin
 Severe angina
 vngina that begins at rest (with no activity)
 vngina that lasts more than 15 minutes
 vccompanying symptoms may include:
è Shortness of breath
è Sweating
è Nausea
è Weakness

è  

  



 



 




 




 


 
 

  

  
' Diagnosis
è Tests may include:
 Blood tests³to look for certain substances in the blood
called troponins which help the doctor determine if you are
having a heart attack
 Electrocardiogram (ECG, EKG)³ records the heart's activity by
measuring electrical currents through the heart muscle, and can
reveal evidence of past heart attacks, acute heart attacks, and
heart rhythm problems
 Echocardiogram ³uses high-frequency sound waves (ultrasound)
to examine the size, shape, and motion of the heart, giving
information about the structure and function of the heart
 Exercise stress test ³records the heart's electrical activity during
increased physical activity
 Nuclear stress test³the heart is observed while exercising
and radioactive material highlights impaired blood flow to
help locate problem areas
 Coronary calcium scoring³a type of x-ray called a CvT
scan that uses a computer to look for the presence of
calcium in the heart arteries
 Coronary angiography ³x-rays taken after a dye is
injected into the arteries to allows the doctor to look for
abnormalities in the arteries
' Äreatment
è Treatment may include:
 Nitroglycerin
 This medicine is usually given during an attack of angina. It can be given as a
tablet that dissolves under the tongue or as a spray. Longer-lasting types can be
used to prevent angina before an activity known to cause it. These may be given
as pills or applied as patches or ointments.
 Blood-Ähinning Medications
 v small, daily dose of aspirin has been shown to decrease the risk of heart
attack. vsk your doctor before taking aspirin daily.
 Warfarin (Coumadin)
 Ticlopidine (Ticlid)
 Clopidogrel (Plavix)
 Beta-Blockers, Valcium-Vhannel Blockers, and AV[-
Inhibitors
 These may help prevent angina. In some cases, they may lower
the risk of heart attack.
 Medications to Lower Vholesterol
 Medicines, like statins, are often prescribed to people who have
CvD. Statins (eg, atorvastatin [Lipitor]) lower cholesterol levels,
which can help to prevent CvD events.
' Revascularization
è Patients with severe blockages in their coronary arteries may benefit
from procedures to immediately improve blood flow to the heart muscle:
è Percutaneous coronary interventions (PCI)³such as balloon angioplasty ,
in some cases, a wire mesh stent is placed to hold the artery open
è Coronary artery bypass grafting (CvBG) ³segments of vessels are
taken from other areas of the body and are sewn into the heart arteries
to reroute blood flow around blockages
è Some studies have shown that CvBG may be more effective than PCI.
Lifestyle changes and intensive medicine may also be just as effective as
PCI.
' Options for Refractory Angina
è For patients who are not candidates for revascularization procedures
but have continued angina despite medicine, options include:
è Enhanced external counterpulsation (EECP)³large air bags are inflated
around the legs in tune with the heart beat. The patient receives 5 one-
hour treatments per week for seven weeks. This has been shown to
reduce angina and may improve symptom-free exercise duration.
è Transmyocardial revascularization (TMR)³surgical procedure done with
laser to reduce chest pain.
è Researchers are also studying gene therapy as a possible treatment.
' ·revention
è To reduce your risk of getting coronary artery disease:
è Maintain a healthy weight.
è Eat a heart healthy diet that is low in saturated fat , red meat and processed meats,
and rich in whole grains , fruits, and vegetables .
è Begin a safe exercise program with the advice of your doctor.
è If you smoke, quit .
è Treat your high blood pressure and/or diabetes.
è Treat high cholesterol or triglycerides.
è vsk your doctor about taking a low-dose aspirin every day.
è In certain patients, taking rosuvastatin (Crestor) may be another option. Talk to your
doctor.
Îeart Attack
' Definition
èv heart attack occurs when blood flow to the heart
muscle is interrupted. Oxygen can't get to the heart
muscle, causing tissue damage or tissue death.
Îeart Attack (Myocaedial Infarction
' Vauses
è v heart attack may be caused by:
è Thickening of the walls of the arteries feeding the heart muscle
(coronary arteries)
è vccumulation of fatty plaques in the coronary arteries
è Narrowing of the coronary arteries
è Spasm of the coronary arteries
è Development of a blood clot in the coronary arteries
è Embolism that affects the coronary arteries
' Risk Factors
è Sex: male (specifically, high LDL
è Increased age
cholesterol, and low HDL
cholesterol)
è Obesity
è High blood triglycerides
è Smoking
è Diabetes
è High blood pressure
è Stress
è Sedentary lifestyle
è Family members with heart
è High blood cholesterol disease
' Symptoms
è Symptoms include:
 Shortness of breath
 Squeezing, heavy chest pain,
especially with:  Sweating, clammy skin
 Exercise or exertion  Nausea
 Emotional stress  Weakness
 Cold weather  Loss of consciousness
 v large meal  vnxiety , especially feeling a
 Pain in the left shoulder, left arm, sense of doom or panic without
or jaw apparent reason
è Unusualsymptoms of heart attack (may occur more
frequently in women):
 Stomach pain
 Back and shoulder pain
 Confusion
 Fainting
' Diagnosis
è Tests may include:
 Blood tests³to look for certain enzymes found in the blood within
hours or days after a heart attack
 Urine tests³to look for certain substances found in the urine within
hours or days after a heart attack
 Electrocardiogram (EKG) ³records the heart's activity by measuring
electrical currents through the heart muscle, changes can show if there
is blockage or damage
 Echocardiogram ³uses high-frequency sound waves (ultrasound) to
examine the size, shape, function, and motion of the heart
 Stress test ³records the heart's electrical activity under increased
physical stress, usually done days or weeks after the heart attack
 Nuclear scanning³uses radioactive material to show areas of the
heart muscle where there is diminished blood flow
 Electron-beam computed tomography (EBCT) ³a type of x-ray
that uses a computer to make detailed pictures of the heart,
coronary arteries, and surrounding structures; may be helpful if
you are at immediate risk of coronary artery disease
 Coronary angiography ³uses dye and x-rays to look for
narrowing or blockage in the coronary arteries
' Äreatment
è Treatment includes:
 Oxygen
 Pain-relief medications (such as morphine)
 Nitrate medications
 vspirin and other antiplatelet agents
 Beta-blocking and/or vCE inhibitor medications (frequently given)
 vnti-anxiety medications
 Clot-dissolving agents (thrombolytics)³Within the first six hours
after a heart attack, you may be given medications to break up
blood clots in the coronary arteries.
 Other medicines that may be given include those that block the
function of platelets (called platelet IIb/IIIa receptor blockers).
 Cholesterol-lowering medications (eg, statin drugs)
' Surgery
è Surgery includes:
 Coronary artery bypass grafting (CvBG)
 vtherectomy
 Balloon angioplasty with or without stenting

'  




  
  

  




  




  
 
  
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' ·hysical or Rehabilitative Äherapy


è During recovery , the client may need physical or
rehabilitative therapy to help him or her to regain
his/her strength.
' Äreatment for Depression
è Clients
may feel depressed after having a heart attack.
Therapy and medication can help relieve depression .
' ·revention
è Preventing or treating coronary artery disease may help prevent a heart attack.
è Maintain a healthy weight .
è Begin a safe exercise program . Follow your doctor's advice.
è If you smoke, quit .
è Eat a healthful diet . Your diet should be low in saturated fat and rich in whole grains, fruits, and
vegetables.
è Treat high blood pressure , diabetes and high cholestrol .
è Manage stress .

 vsk your doctor about taking a small, daily dose of aspirin.


 vlthough most people are able to tolerate such a low dose of aspirin, even this small amount can
rarely lead to serious bleeding, particularly from the gastrointestinal (GI) tract .
 vspirin may not work as well when combined with other pain medications.
Musculoskeletal System Problems of the Older vdult
Îip Fracture
' Definition
èv hip fracture is a break in the thigh bone just below
the hip joint. The hip joint consists of a ball at the top of
the thigh bone (femur) and a rounded socket
(acetabulum) in the pelvis. Most hip fractures occur in
the neck of the femur 1-2 inches below the ball portion
of the hip.
Îip Fracture
' Vauses
è Factors that may contribute to a hip fracture include:
 Falls (the most frequent cause of hip fractures)
 Osteoporosis ³a bone-thinning condition that weakens all bones
including the hip
 Motor vehicle accidents and other types of major trauma
 Stress fractures in athletes (rare)
 Bone conditions such as osteomalacia (rare)
 Bone tumors (rare)
' Risk Factors
è Previous hip fracture or history of falling
è vge: 65 years or older
è Sex: female (especially after menopause)
è Heredity
 Family history of fractures later in life
 Small-boned, slender body (low body weight)
 Caucasian or vsian race
è Others:
 Poor nutrition  vrthritis
 Deficient intake or absorption of  Parkinson's disease
calcium and vitamin D  History of stroke
 Low body weight  Mental impairments including
 Physical inactivity vlzheimer·s disease
 Weakness  Problems with vision
 Poor balance and coordination  Certain medications which cause
 Smoking dizziness, drowsiness, or weakness
 Excessive alcohol use  Systemic cortisone or other steroids
 Chronic disease or fragile health  Excess thyroid hormone
 Irregular heart beat or low blood
pressure
' Symptoms
è Symptoms may include:
 Pain in the hip
 Difficulty or inability to stand, walk, or move the hip
 vbnormal appearance of the broken leg:
 Looks shorter
 Turns outward
' Diagnosis
è Tests may include:
 X-ray ³to determine exactly where the bone is broken and
how far out of place the pieces have moved
 Bone scan or MRI scan³used if the fracture doesn't show up
on x-rays but symptoms indicate a fracture has occurred
' Äreatment
è The goal is to get the client back on his feet again as quickly as
possible while his broken bone heals. For older patients, staying in
bed for even several days may lead to serious complications.
' Treatment includes:
è ·rompt [mergency Äreatment
 Taking all weight off the injured leg and immobilizing the fracture
 Checking vital signs such as blood pressure
 Treating problems such as internal blood loss
 Pain control with pain killers and other drugs
' Surgery
è Surgery is performed to set the broken bone and hold it in the correct position.
This may involve:
è Inserting a surgical plate and screws at the fracture site
è Replacing the hip with a metal implant (prosthesis), which has a ball that fits into
the hip socket and an attached stem which goes into the thigh bone to hold the
implant in place
' ·hysical Assistance
è Exercises or therapy to help you return to your normal level of activity
è v cane or walker as advised by your doctor
è vid with activities of daily living until you can return to normal activity
' ·revention
è Early corrective action may help alleviate many of the factors that can lead to a hip fracture. Here's what you
can do:
è Eat a diet with nutrients for strong bones:
 Calcium ³about 1000 milligrams daily but check with your doctor
 Vitamin D ³400-800 units a day
 vdequate protein intake
è Exercise:
 Weight-bearing activities such as walking
 Strengthening exercises for both upper and lower extremities
è Preventive medication may include:
 Hormone replacement therapy for women after menopause
 Biphosphonates
 Calcitonin
è vsk doctor if any of the client·s medications may contribute to:
 Bone loss
 Dizziness, drowsiness, or confusion
è Reduce falling hazards at work and home:
 Clean spills and slippery areas immediately.
 Remove tripping hazards such as loose cords, rugs, and clutter.
 Use non-slip mats in the bathtub and shower.
 Install grab bars next to the toilet and in the shower or tub.
 Put in handrails on both sides of stairways.
 Walk only in well-lit rooms, stairs, and halls.
 Keep flashlights on hand in case of a power outage.
è Get eyes checked regularly.
Osteoarthritis
' Definition
è Osteoarthritis is the breakdown of cartilage in the
joints. This is followed by chronic inflammation of the
joint lining. Healthy cartilage is a cushion between the
bones in a joint. Osteoarthritis usually affects the hands,
feet, spine, hips, and knees. People with osteoarthritis
usually have joint pain and limited movement of the
affected joint.
Joints Affected by Osteoarthritis
' Vauses
è Osteoarthritis is associated with aging. The exact cause
is unclear. vs osteoarthritis develops, you experience
loss of cartilage, bone spurs around the joint, and
muscle weakness of the extremity. It is related to
constant ware and tare of joints that comes with aging.
' Risk Factors
è Obesity
è Genetic factors
è Injury to the joint surface
è Occupations and physical activities that put stress on
joints
è Neuromuscular disorders, like diabetes
' Symptoms
è Symptoms include:
 Mild to severe pain in a joint, especially after overuse or long
periods of inactivity, such as sitting for a long time
 Creaking or grating sound in the joint
 Swelling, stiffness, limited movement of the joint, especially in the
morning
 Weakness in muscles around the sore joint
 Deformity of the joint
' Diagnosis
è Tests may include:
 X-ray ³a test that uses radiation to take a picture of
structures inside the body, especially bones
 Blood tests
 vrthrocentesis ³a procedure that involves withdrawing fluid
from a joint
' Äreatment
è There is no treatment that stops cartilage loss or repairs
cartilage that is damaged. The goal of treatment is to
reduce joint pain and inflammation and to improve joint
function.
' Medications
è Over-the-counter pain medicine
 vcetaminophen (eg, Tylenol) and nonsteroidal anti-inflammatory drugs
(NSvIDs), such as ibuprofen (eg, vdvil) and naproxen (eg, vleve)
è Prescription pain medicine
 vrthrotec ³nonsteroidal anti-inflammatory drug; may reduce the risk for
gastrointestinal bleeding
 Opiates and opiate-like medications
è Viscosupplementation³injection of a substance called hyaluronan into
the joint, which helps lubricate the joint
è Pain relief creams³ capsaicin , methyl salicylate, and menthol
' Dietary Supplements
è There is some evidence that glucosamine and chondroitin may relieve
pain and/or decrease osteoarthritis progression. Talk with your
doctor before taking any herbs and supplements.
' Alternative Äreatments
è Some doctors report that acupuncture has been successful in reducing
the pain of osteoarthritis, although the evidence is not consistent.
è While more studies are needed, balneotherapy (hot water therapy),
relaxation therapy , exercise , yoga , and tai chi may be helpful.
' Mechanical Aids
è Shoes with shock-absorbing soles may provide some relief
while you are doing daily activities or exercising. Splints or
braces help to properly align joints and distribute weight.
Knee and wrist joints may benefit from elastic supports. v
neck brace or corset may relieve back pain . vlso, a firm
mattress may help chronic back pain. Canes , crutches ,
walkers , and orthopedic shoes also can help those with
advanced osteoarthritis in the lower body.
' Weight Reduction
è Losing weight can lessen the stress on joints affected by osteoarthritis. Losing five pounds can
eliminate at least 15 pounds of stressful impact for each step taken. The more weight lost, the
greater the benefit.
' [xercise and ·hysical Äherapy
è Strengthening the muscles supporting an arthritic joint (particularly the knee, lower back, and
neck) may decrease pain and absorb energy around the joint. For example, if you have arthritis
in the knee, exercise, including strength training , can also help improve knee function.
è Swimming and water aerobics are good options because they do not put stress on the joint.
è vnother option is transcutaneous electrical nerve stimulation (TENS). With TENS, you are connected
to a machine that sends electrical signals through the skin to nerves. This type of therapy may
decrease pain in some people.
' Assist Devices
è If you are having difficulty getting around due to arthritis pain, your doctor might
recommend that you install handrails and grips throughout your home. These are useful in
the bathroom and shower. You may need elevated seats (including toilet seats) if you're
having difficulty rising after sitting.
' Îeat and Ice
è vpplying heat (with hot water bottles or heating pads) helps joints and muscles move more
easily. It can also lessen pain. Using ice packs after activity can also help.
' Steroids
è Corticosteroid injections to the inflamed joint may be given if other pain medicines do not
work. Because repeated cortisone injections can be harmful to the cartilage, they are
reserved for those with severe symptoms.
' Surgery
è Surgery can:
 Reposition bones to redistribute stress on the joint
 Replace joints
 Remove loose pieces of bone or cartilage from joints
' ·revention
è To reduce chance of getting osteoarthritis:
 Maintain a healthy weight.
 Do regular, gentle exercise (eg, walking, stretching, swimming,
yoga).
 vvoid repetitive motions and risky activities that may contribute to
joint injury, especially after age 40.
 With advancing age, certain activities may have to be dropped
or modified. But, continue to be active.
Neurologic System Disorder s of the Older vdults
Alzheimer's Disease
' Definition
è vlzheimer's disease is a progressive condition that
destroys brain cells. It is the most common cause of
dementia . People with this disease slowly lose the
ability to learn, function, and remember.
Areas of the Brain Affected by
Alzheimer's Disease
' Vauses
è The cause is not yet known. Studies suggest that two main
mechanisms are involved with the development of
vlzheimer's disease:
è Plaques³abnormal deposits of a substance called beta
amyloid in different areas of the brain
è Neurofibrillary tangles³twisted fibers (called tau fibers)
within nerve cells
' Risk Factors
è Factors that may increase your è Women under 35 who give birth to
chance of vlzheimer's disease a child with Down's syndrome
include: è Smoking
è vge: 65 and older è Family history of vlzheimer's
è Previous serious, traumatic brain disease
injury è Presence of a certain variety type
è Lower educational achievement of protein (vPOE-e4)
è Down's syndrome è Depression
è Down's syndrome in a first-degree è Elevated levels of homocysteine
relative è Heart disease
' Researchers are studying the following to see if they
are related to vlzheimer's disease:
è Poor nutrition and vitamin deficiency in childhood
è Excess metal in the blood, especially zinc, copper, aluminum,
and iron
è Certain viral infections
è Diabetes
è High Cholesterol
' Symptoms
' The disease begins as mild memory lapses. It moves to
profound loss of memory and function. vlzheimer's disease is
divided into three stages:
è Early³memory and cognition loss are noticeable but still able to
function independently
è Intermediate³mental loss, personality changes more dependent
on others for basic needs
è Severe³loss of personality and bodily functions; total
dependence for care
' Symptoms include:
è Increasing trouble remembering things, such as:
 How to get to familiar locations
 What the names of family and friends are
 Where common objects are usually kept
 How to do simple math
 How to do usual tasks, such as cooking, dressing, bathing,
etc.
è Having difficulty concentrating on tasks
è Having difficulty completing sentences due to
lost/forgotten words (may progress to complete
inability to speak)
è Forgetting the date, time of day, season

è Getting lost in familiar surroundings


è Having mood swings
è Being withdrawn, losing interest in usual activities

è Having personality changes

è Walking in a slow, shuffling way

è Having poor coordination

è Losing purposeful movement


' Diagnosis
è There are no tests to definitively diagnose this disease. The doctor will ask
about your symptoms and medical history. v physical exam will be done. The
doctor will ask many questions. This will help to rule out other causes.
 Tests to rule out other medical conditions may include:
 Neurological exam
 Psychological and mental status testing
 CT scan ³a type of x-ray that uses a computer to make pictures of the brain
 MRI scan ³a test that uses magnetic waves to make pictures of the brain
 Electroencephalogram (EEG) ³a test that measures electrical currents in the brain
 Blood tests and urine tests
 Lumbar puncture ³to test for levels of certain brain proteins that increase with
vlzheimer·s disease and to rule out other disorders
 PET scan of the brain³a test that makes images showing activity in the brain
' Äreatment
è There is no cure for vlzheimer's disease. There are also no certain ways to
slow its progression. Four medicines have received approval for the treatment
of some symptoms. Various drugs are being studied to see if they can
manage the symptoms or slow the condition's course.
' Medications for Symptoms and Disease ·rogression
è Only two types of medicines have been approved to reduce the symptoms of
vlzheimer's disease:
è Cholinesterase inhibitors³approved and recommended for mild to moderate
vlzheimer's disease (eg, donepezil [vricept], rivastigmine [Exelon],
galantamine [Reminyl])
è N-methyl-D-aspartate (NMDv) receptor antagonist³approved for moderate
to severe vlzheimer's disease (eg, memantine )
' Äreatments that are being studied include:
è Gamma-secretase inhibitors
è Tau fiber aggregation inhibitors

è Herbs and supplements (eg, vitamin E , ginkgo biloba


)³The evidence is mixed as to the effectiveness of
these natural remedies.
' Lifestyle Management
è Managing the disease includes:
 Creating an environment in which you can receive the care you need
 Optimizing your quality of life
 Keeping yourself safe
 Helping yourself learn to deal with the frustration of your uncontrollable behavior
 Providing a calm, quiet, predictable environment
 Providing appropriate eyewear and hearing aids, easy-to-read clocks and calendars
 Playing quiet music
 Light, appropriate exercise to reduce agitation and relieve depression
 Encouraging family and close friends to visit frequently
' ·sychiatric Medication
è Psychiatricsymptoms may occur with vlzheimer·s
disease. Doctors may prescribe medicine to treat:
 Depression
 vnxiety
 Confusion, paranoia, and hallucinations
' Varegiver Support
è Caring for a person with vlzheimer's disease is
extremely difficult and exhausting. The primary
caregiver needs emotional support, as well as regular
respite.
' ·revention
è Thereare no guidelines for preventing vlzheimer's
disease because the cause is unknown.
Depression
' Definition
è Depression is a mental illness marked by feelings of
profound sadness and lack of interest in activities.
Depression is not the same as a blue mood. It is a persistent
low mood that interferes with the ability to function and
appreciate things in life. It may cause a wide range of
symptoms, both physical and emotional. It can last for
weeks, months, or years. People with depression rarely
recover without treatment.
' Vauses
è The precise cause is not known. It can be difficult to determine if an illness causes
depression or depression caused the illness. Possible causes may be mental, physical, or
environmental and include:
è Stressful life events (usually in combination with one or more of the following causes)
è Chronic stress
è Low self-esteem
è Imbalances in brain chemicals and hormones
è Lack of control over circumstances (helplessness and hopelessness)
è Negative thought patterns and beliefs
è Chronic pain
è Heart disease and heart surgery
è Genetic predisposition
è vltered brain structure and function, including after a stroke
è Parkinson·s disease
è Postpartum depression occurs after childbirth
è Seasonal affective disorder (SvD) is a type of depression or a worsening of symptoms
thought to be due to the decreased exposure to sunlight that occurs during winter months
è Hypothyroidism
è vnemia
è Cancer
è Substance abuse
Brain

' Researchers are


studying how problems
with synapses in the
brain may be linked to
depression.
' Risk Factors
' Risk factors include:
è Sex: female
è vge: elderly
è Chronic physical or mental illness, including thyroid disease, headaches,
chronic pain, and stroke
è Previous episode of depression
è Major life changes or stressful life events (eg, bereavement, trauma )
è Postpartum depression
è Winter season for SvD
è Little or no social support
è Low self-esteem
è Lack of personal control over circumstances
è Family history of depression (parent or sibling)
è Feelings of helplessness
è Certain medicines, including medicines used to treat asthma , high blood pressure , arthritis, high
cholesterol , and heart problems
è Smoking
è vnxiety
è Insomnia
è Personality disorders
è Hypothyroidism
è Type 2 diabetes
' Symptoms
è Depression can differ from person to person. è Trouble concentrating, remembering, or making
Some people have only a few symptoms, while decisions
others have many. è Trouble sleeping, waking up too early, or
è Symptoms can change over time and may oversleeping
include: è Eating more or less than usual
è Persistent feelings of sadness, anxiety, or è Weight gain or weight loss
emptiness
è Thoughts of death or suicide with or without
è Hopelessness suicide attempts
è Feeling guilty, worthless, or helpless è Restlessness or irritability
è Loss of interest in hobbies and activities è Physical symptoms that defy standard
è Loss of interest in sex diagnosis and do not respond well to medical
treatments
è Feeling tired
' Diagnosis
è There is no blood test or diagnostic test for depression. The doctor will ask about your
symptoms and medical history, giving special attention to:
è vlcohol and drug use
è Thoughts of death or suicide
è Family members who have or have had depression
è Sleep patterns
è Previous episodes of depression

è !
 

 
 
 
 
  
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' Äreatment
è Treatment may involve the use of medicine, psychotherapy,
or the use of both.
è Severe depression usually requires hospital care and the use
of drugs.
' Antidepressant Medications
è Up to 70% of depressed patients find relief from their
symptoms with medicine. They can take 2-6 weeks to reach
their maximum effectiveness. The medicines include:
Selective Serotonin Reuptake
Inhibitors (SSRIs Äricyclic Antidepressants
è Fluoxetine (eg, Prozac) è Imipramine (eg, Tofranil)
è Sertraline (eg, Zoloft) è Doxepin (eg, vdapin,
è Paroxetine (eg, Paxil) Sinequan)
è Citalopram (eg, Celexa) è Clomipramine (eg,
è Fluvoxamine (eg, Luvox) vnafranil)
è Escitalopram (eg, è Nortriptyline (eg, Pamelor)
Lexapro) è vmitriptyline (eg, Elavil)
Monoamine Oxidase Inhibitors (MAOIs Other Antidepressants

è Phenelzine (eg, Nardil) è Venlafaxine (eg, Effexor)


è Nefazodone (eg, Serzone)
è Tranylcypromine (eg,
è Mirtazapine (eg, Remeron)
Parnate)
è Bupropion (eg, Wellbutrin)
è Duloxetine (eg, Cymbalta)
' ·sychotherapy
è Short-term (10-20 weeks) cognitive-behavior therapy
(CBT) can help some people. Psychotherapy is designed
to help you:
è Cope with difficulties in relationships

è Change negative thinking and behavior patterns

è Resolve difficult feelings


' [lectroconvulsive Äherapy ([VÄ
è ECT is the use of an electric stimulus to produce a
generalized seizure. It may be used in people with
severe or life-threatening depression. ECT is also used
for people who cannot take or do not respond to
medicine. It is considered a safe and effective
procedure.
' [xercise
è v regular exercise program has been shown to relieve some of
the symptoms. It should play a large role in the overall
management of depression.
' Bright Light Äherapy
è If you have SvD, your doctor may recommend bright light
therapy. This involves being exposed to high levels of light from a
special "light box" that has a screen on it. Light therapy may
decrease melatonin , a hormone that affects sleep cycles, and
reduce symptoms of depression.
' Dietary Supplements and Îerbal Äherapy
è The herb St. John's wort may be an effective alternative to
standard medicines with fewer side effects. St. John's wort,
though, may reduce the effectiveness of many drugs, such as
antidepressants, birth control pills, blood thinners, and other
medicines.
è There is also some evidence that dehydroepiandrosterone
(DHEv), a hormone that is available as a dietary
supplement, may help some people.
' Dietary Vhanges
è Research suggests that diets high in tryptophan and certain B
vitamins may be helpful. There is also mixed evidence that fish oil
may reduce symptoms.
è If you want to take supplements or change your diet, talk to your
doctor first.
'  agal Nerve Stimulation ( NS
è VNS is used as therapy for depression when multiple trials of
medicine do not work. v pacemaker-like device stimulates the
vagus nerve in the neck.
 agus Nerve

' Stimulation of the


vagus nerve (yellow)
at the neck is a
depression therapy
option.
' Äranscranial Magnetic Stimulation (ÄMS
è TMS is still under investigation, but seems to have some
issues in treatment-resistant depression. vn
electromagnetic coil is held against your forehead. The
change in electrical field stimulates nerves, improving
symptoms of depression.
' ·revention
è Being aware of your personal risk
è Having a psychiatric evaluation and psychotherapy if needed
è Developing social supports
è Learning stress management techniques
è Exercising regularly
è Not abusing alcohol or drugs
è Getting adequate sleep, rest, and recreation
è Eating a Mediterranean diet . This includes plant foods, olive oil, and fish
and chicken.
Gastrointestinal Disorders of the Older Adults
Constipation
' Definition
è Constipationis infrequent and/or uncomfortable bowel
movements. Stool is often hard and dry. It is the most
common gastrointestinal complaint in the United States
and accounts for 2 million annual visits to the doctor.
' Vauses
è Constipation has many causes, including:
 Not enough fluid intake
 Overuse of laxative medicines
 Too little exercise
 Bed rest
 Certain medications, including:
 Pain relievers
 Narcotics
 vluminum-containing antacids
 vntidepressant and antipsychotic medications
 Medications for epilepsy and Parkinson's disease
 vntispasmodic medications
 Tranquilizers
 Iron supplements
 Calcium channel blockers
 Frequently delaying the need to have a bowel movement
 Pregnancy
 Diabetes
 Spasm of the anal sphincter, due to painful anal fissures
or hemorrhoids
 Underactive thyroid
 Irritable bowel syndrome (periods of constipation may
alternate with episodes of diarrhea)
 Neurological diseases such as:
 Parkinson's disease
 Multiple sclerosis
 Stroke
 Spinal cord injuries
 Spinal cord tumors
 Scleroderma
 Systemic lupus erythematosus
 Intestinal disorders, including:
 Scarring
 Tumors
 Cancer
 Inflammation
 Travel (due to schedule changes, stress, and poor diet)
' Risk Factors
è v risk factor is something that increases your chance of
getting a disease or condition.
è Risk factors for constipation include:
è vdvancing age
è Sedentary lifestyle
è Prolonged bed rest due to surgery or an accident
è Diet that is high in fat and sugar but low in fiber
' Symptoms
è Symptoms include:
 vbdominal pain
 Sensation of abdominal fullness
 Rectal pain and pressure
 Difficulty passing stool, despite straining
 Hard, dry, small stool
 Black stool
 "Rabbit pellet" appearance to stool
 Sensation of retained stool after defecating
' Diagnosis
è There are over-the-counter medications to treat constipation called laxatives.
However, changes in bowel habits, such as constipation, may indicate a more
serious medical condition.
è Consult a healthcare provider if client has:
 Constipation plus:
 vbdominal pain
 Bleeding
 Black stool
 Distended abdomen
 Fever
 Consistent and significant change in your bowel habits
 Constipation that lasts longer than three weeks
' Tests to rule out other medical conditions include:
è Physical exam or blood tests may be performed.
è Digital rectal exam³examination of the rectum with the doctor's gloved,
lubricated finger inserted into your rectum
è vbdominal x-ray ³a test that uses radiation to take a picture of
structures inside the abdomin
è Barium enema ³injection of fluid into the rectum that makes your colon
light up on an x-ray
è Flexible sigmoidoscopy ³a thin, lighted tube with a camera inserted
into the rectum to examine the rectum and the lower colon
Barium [nema
' Äreatment
è Treatment may include:
 Understanding Normal Bowel Movements
 Talk to your doctor about what is a normal frequency of bowel
movements for you. The range of normal is quite broad. Some
people have several stools a day. Others have one stool every
several days.
 Making Lifestyle Vhanges
 Eat a healthful, balanced diet that is high in fiber (unprocessed
bran, whole-wheat grains, fresh fruit, and cereals). Limit your
intake of processed and fatty foods.
 Exercise regularly.
 Drink at least eight, 8 oz glasses of water each day.
 Äaking Laxatives, Stool Softeners, or Glycerin
Suppositories
 Regularly using laxatives or enemas can be habit forming. Your
bowels can become accustomed to these products and require
them in order to produce a stool. Stool softeners, though, are not
habit-forming. vsk your doctor about how often and for how long
to use these products.
 Examples of medications include:
 Polyethylene glycol 3350 (GlycoLax, MiraLax)³a type of laxative
 Psyllium ³a bulk laxative
 Docusate ³a stool softener
 Lactulose ³a type of laxative
 Lubiprostone (vmitiza)³a medication that increases fluid in stool
 Tegaserod ³a medication that brings fluids to the colon
 Colchicine ³medication used to treat gout; sometimes used for
constipation
 Botulism injections³may be used to treat certain types of
constipation
' Future Äreatments
è Prucalopride³not currently approved but showing
promise in clinical trials
è Cisapride ³only available as an investigational drug;
removed from the market
' Bowel Retraining
è Set aside the same time each day to move your bowels. Typically this works
best after breakfast and coffee. Sit on the toilet for 15-20 minutes. Over
time your body will learn to have regular bowel movements at the same
time each day.
' Biofeedback
è Biofeedback works by attaching sensors to the body. v therapist helps you
understand your body·s signals and then you use them to help you move
your bowels.
' Äreating Underlying Medical Vonditions
è Work with your doctor to treat other conditions that may be causing your
constipation.
' Vhanging Medications
è Ifthe client·s mediation causes constipation, there might
be a need to change the medication or simply increase
the fluid intake
' ·revention
è To reduce your chance of getting constipation:
è Eat a healthy, balanced diet that is high in fiber.
è Exercise regularly.
è Drink at least eight, 8 oz glasses of water a day.
è In an effort to train your bowels, schedule a time daily to sit on
the toilet just after a meal.
è Don't rush yourself when using the bathroom.
è If you feel the urge to defecate, listen to your body.
Vitamin B12 Deficiency
' Definition
è Vitamin B12 deficiency can occur when the body needs
more vitamin B12 than it receives from the diet.
vlternatively, the condition may occur when the body is
unable to use the vitamin B12 from the diet. v shortage of
vitamin B12 can lead to anemia . vnemia is the insufficient
delivery of oxygen by red blood cells from the lungs to the
cells of the body. The sooner this anemia is treated, the
more favorable the outcome.
Red Blood Vells
' Vauses
è There are many causes of vitamin B12 deficiency. Some are listed
below.
 Removal of part of the small intestine or stomach
 vdvancing age
 Long-term use of certain acid-reducing stomach medications:
 H2 blockers
 Proton pump inhibitors
 vtrophic gastritis (inflammation of the stomach) due to:
 Iron deficiency anemia
 Bacterial infection with Î  

 Chronic alcohol abuse
 vutoimmunity
 Disorders affecting vitamin absorption:
 Crohn·s disease
 Cystic fibrosis
 Celiac disease
 Tropical sprue
 Whipple·s disease
 Tuberculosis
 Long-term pancreatitis
 Pernicious anemia (lack of intrinsic factor)
 vIDS
 Inadequate intake of vitamin B12
 Long-term veganism (nonconsumption of animal products) or vegetarianism
 Breastfed infants of vegan or vegetarian mothers
 Poor infant nutrition
 Inadequate nutrition for a pregnant woman
 Chronic alcohol abuse
 Stillness of the intestinal contents which can be caused by:
 vbnormal narrowness of intestines
 Pockets in intestines
 Connections between loops of the intestine
 Blind intestinal loops
 Intestinal blockage which can be caused by:
 Diabetes mellitus
 Scleroderma
 vmyloidosis
 Inflammation of the intestine due to radiation treatment
 Inability to use vitamin B12:
 Lack of a needed enzyme
 Cancer
 Malnutrition
 Nonfunctioning transport protein
 Increased need of vitamin B12:
 Hyperthyroidism
 Tapeworm affliction
 Other types of anemia
 Over-use of nitrous oxide:
 Frequent use
 Extended single use of nitrous oxide (more than six hours)
 Metabolic disorders:
 Methylmalonic aciduria
 Homocystinuria
' Risk Factors
è vlcoholism
 Colchicine
 Neomycin
è Use of certain drugs:
 Cimetidine
 Biguanides for diabetes
 Cholestyramine
 Para-aminosalicylic acid for
tuberculosis è vge: over 50 years old
 Calcium-chelating drugs è Strict vegan or vegetarian
taken by mouth diet
' Symptoms
è Thesymptoms of pernicious anemia can vary from
person-to-person. Symptoms may change or worsen
over time. If you experience any of these symptoms, do
not assume it is due to this anemia. These symptoms
may be caused by other health conditions.
' Symptoms can include:
è Sensation of pins and needles in feet or è Depression
hands è Impaired sense of balance, especially in
è vlternating constipation and diarrhea the dark
è Stinging sensation on the tongue or smooth è Ringing in the ears
red tongue è Cracked lips
è Substantial weight loss è Yellow skin
è Inability to distinguish the colors yellow è Fever
and blue
è Inability to sense vibrations in feet or legs
è Tiredness
è Dizziness when changing to standing
è Paleness position
è Loss of hunger è Rapid heart rate
è vltered sense of taste
è Confusion
' Diagnosis
è Tests may include the following:
 Complete blood count (CBC)³a count of the number of red and
white blood cells in a blood sample
 Vitamin B12 level³a test that measures the amount of vitamin B12 in
the blood
 Methylmalonic acid (MMv) level³a measurement of the amount of
methylmalonic acid in the blood; this test determines whether a
vitamin B12 deficiency exists.
 Homocysteine level³a test that measures the amount of homocysteine
in the blood (homocysteine is a building block of protein). The
homocysteine level will be elevated if there is a shortage of vitamin
B12, folate, or vitamin B-6.
 Schilling test³a test in which a harmless amount of radiation is used
to assess whether a vitamin B12 deficiency exists (rarely used)
 Red blood cell folate level³a measurement of the amount of a B
vitamin called folate
 Gastrin level³a test that may help determine the cause of a vitamin
B12 deficiency
 Intrinsic factor assay³a measurement of the amount of a protein
called intrinsic factor normally produced in the stomach; this test helps
to rule out pernicious anemia as the cause of symptoms.
 Bone marrow staining³a test that shows whether an iron deficiency
exists
' Äreatment
è Oral  itamin B12 Supplement
 This treatment consists of high doses of an oral vitamin B12
supplement.
è  itamin B12 Injections
 The doctor may advise the patient to receive injections of vitamin
B12 into a muscle. Injections of vitamin B12 may be given 2-4
days per week. When blood tests show improvement, the doctor
may give injections on a monthly basis.
è Äreatment With Antibiotics
 This type of medication may be needed in cases where bacterial
overgrowth in the intestines exists. The bacteria compete with the
body to absorb the vitamin B12 in the intestines.
è Intranasal  itamin B12
 The doctor gives the patient a supplement of vitamin B12 that is
placed in the nose.
è Oral Iron Äherapy
 The physician will recommend this treatment when an iron
deficiency exists. In this case, the doctor will tell the patient to take
iron supplements before treating with vitamin B12.
' ·revention
è To help reduce your chances of developing a deficiency
of vitamin B12, take the following steps:
è vvoid long-term over-consumption of alcohol.
è vs directed by your doctor, take a daily supplement
containing vitamin B12.
 vs directed by your doctor, give vitamin B12 to your
breastfed baby if you are a vegan or vegetarian.
è vvoid overuse of nitrous oxide.
è Seek diagnosis and treatment of any suspected
tapeworm infestation.
è Have your doctor check you for iron deficiency.

è Undergo testing if your doctor suspects you are


infected with the bacterium Î  
 .
è Have you·re a health care provider monitor your health closely
if you are taking the following drugs:
 Biguanides
 vminosalicylic acid
 Calcium-chelating drugs taken by mouth
 Colchicine
 Neomycin
 Cimetidine
 Cholestyramine
[ndocrine System Disorders of the Older Adults
Hypothyroidism
' Definition
è Hypothyroidism happens when the thyroid gland does
not produce enough thyroid hormone. The thyroid gland
is a butterfly-shaped gland in the front of the neck. It
produces hormones that control metabolism. The most
common form is Hashimoto's thyroiditis.
Ähyroid Gland
' Vauses
è Hashimoto's thyroiditis occurs when the immune system produces antibodies that attack
cells of the thyroid gland. This causes chronic thyroid swelling and loss of function. Other
causes include:
è Idiopathic thyroid atrophy³destruction of thyroid tissue for unknown reasons
è Iodine deficiency³when a thyroid gland needs iodine to produce thyroid hormone (rare
in the US)
è Subacute thyroiditis³following a viral upper respiratory tract infection
è Medical treatments³ radiation to the head and neck or surgical removal of the thyroid
gland (called subtotal thyroidectomy )
è Medicines (eg, lithium , iodine, alpha-interferons, thiourea, amiodarone , interleukins)
è Certain diseases (eg, cancer or infection)
è Pituitary adenoma ³benign tumor of the pituitary gland
' Risk Factors
è Risk factors include:
 vge: risk increases with age, especially over 65 years old
 Sex: more common in females
 Genetics: multiglandular autoimmune syndrome
 Ethnicity: Caucasian, Hispanic
 History of family members with hypothyroidism
 History of other autoimmune diseases:
 Pernicious anemia
 Type 1 diabetes
 Underactive adrenal or parathyroid glands
 Rheumatoid arthritis
 Lupus
' Symptoms
è Symptoms include:
 Fatigue  Constipation
 Weakness  vchy feeling all over
 Coarse, brittle hair; hair loss  Depression and irritability
 Facial puffiness  Memory loss
 Dry skin  Difficulty with concentration
 Swollen hands or feet  Blurred vision
 Cold intolerance  Menstrual
abnormalities or infertility
 Weight gain
' Symptoms of severe or prolonged cases include:
è Stupor or coma
è Slow heart rate

è Depressed breathing

è Hypothermia (low body temperature)

è Hoarseness
' Diagnosis
è The doctor will ask about your symptoms and medical and
family history, and perform a physical exam. To confirm the
diagnosis, blood tests will be done, which include:
è Thyroid stimulating hormone (TSH)

è Free T4 and total T3

è vntibodies that attack the thyroid gland


' Äreatment
è Inthe early stages of Hashimoto's thyroiditis, there is no
specific treatment.
 Treatment includes:
 Medicine to replace the thyroid hormones (eg, levothyroxine ,
triiodothyronine)
 High-fiber diet to reduce constipation
 Low-fat , low-calorie diet if you are overweight or obese
' ·revention
è To help reduce your chance of getting hypothyroidism, take
the following steps:
è Get a screening test every five years if you are 50 years
old or older.
è Get regular screenings if you:
 Have Type 1 diabetes
 Have infertility (females)
 Take certain medicines
Type 2 Diabetes
' Definition
è Glucose comes from the breakdown of food. It is the body's energy
source. It can be absorbed from the blood into the cells with the help of
a hormone called insulin . Without insulin, glucose will build up in the
blood and cause hyperglycemia. vt the same time, your body's cells are
starved for glucose (energy).
è v lack of insulin or resistance to insulin causes diabetes. In type 2
diabetes, the body is resistant to high levels of insulin. There is plenty of
insulin in the body, but the cells are unable to use it.
è High blood sugar levels over a long period of time can damage vital
organs. This can include the kidneys, eyes, and nerves.
Ähe ·ancreas
' Vauses
è Twoconditions contribute to hyperglycemia in type 2
diabetes:
 Insulin resistance related to excess body fat
 Body's failure to make an adequate amount of insulin
Risk Factors
è Factors that increase your chance for
type 2 diabetes include:
 Having a family history of type 2  Having cholesterol problems (low HDL
diabetes "good" cholesterol and high triglycerides )
 Being obese or overweight (especially  Having high blood pressure
excess weight in the upper body and  Having a history of cardiovascular
abdomen) disease
 Eating a lot of meat, especially processed  Having a history of gestational
meat (eg, processed luncheon meats, hot diabetes or having a baby that weighs
dogs, sausages) over nine pounds
 Having an endocrine disorder ( Cushing·s
syndrome , hyperthyroidism , acromegaly
,polycystic ovary syndrome ,
pheochromocytoma, glucagonoma)
Risk Factors
 Having a condition associated with  Having a low birth weight
insulin resistance (eg, acanthosis  Gender: more common in older
nigricans ) women than men
 Having previous blood test results  Race: vfrican vmerican, Hispanic,
that show impaired glucose Native vmerican, Hispanic
tolerance and impaired fasting vmerican, vsian vmerican, or
glucose Pacific Islander
 Taking certain medicines  vge: 45 years or older and
(eg, pentamidine , nicotinic acid, younger people who are obese
glucocorticoids, thiazide) and belong to at risk ethnic
 Having a sedentary lifestyle groups
 Having sleep difficulties
' Symptoms
è Symptoms due to high blood sugar or
diabetic complications may include:
 Increased urination  Poor wound healing
 Extreme thirst  vngina
 Hunger  Painful leg cramps when walking
 Fatigue  Numbness or tingling in the hands or feet
 Blurry vision  In women: frequent vaginal yeast
infections and urinary tract infections
 Irritability
 Problems with gums
 Frequent or recurring infections
 Itching
 Impotence
' Diagnosis
è Diagnosis is based on the results of blood testing. These guidelines are from the
vmerican Diabetes vssociation (vDv):
è Symptoms of diabetes and a random blood test revealing a blood sugar level
greater than or equal to 200 mg/dL [11.1 mmol/L]
è Blood sugar tests after you have not eaten for eight or more hours (called fasting
blood sugar ) revealing blood sugar levels greater than or equal to 126 mg/dL (7.0
mmol/L) on two different days
è Glucose tolerance test measuring blood sugar two hours after you consume glucose
with a measurement greater than or equal to 200 mg/dL (11.1 mmol/L)
è Hbv1c level of 6.5% or higher, indicating poor blood sugar control over the past 2-4
months
è mg/dL=milligrams per deciliter of blood; mmol/L=millimole per liter of blood
' Äreatment
è Treatment aims to:
 Maintain blood sugar at levels as close to normal as
possible
 Preventing or delaying complications (regular medical care
is important for this)
 Control other conditions that you may have, like high blood
pressure and high cholesterol
' Diet
è Follow a balanced meal plan. Eat consistent and moderate amounts of food at
regular times.
 Nuts and peanut butter are a good choice for a snack. In women with diabetes, these snacks
may help reduce the risk of cardiovascular disease.
è Do not skip meals.
è Eat plenty of vegetables and fiber .
è Eat limited amounts of fat .
è Eat moderate amounts of protein and low-fat dairy products .
è Carefully limit foods containing high concentrated sugar .
è Keep a record of your food intake. This will help a dietitian or doctor advise you.
' Weight Loss
è Ifyou are overweight, talk to your doctor about a
reasonable weight goal. You and your doctor can
develop a safe diet program for you. Weight loss will
help your body respond better to insulin.
è Group education may help people recently diagnosed
with their goals in weight loss.
' [xercise
è Physical activity:
 Can make the body become more sensitive to insulin
 Will help you reach and maintain a healthy weight
 Can lower the levels of fat in your blood
 Has been found to improve blood sugar control³ verobic fitness, and resistance training can
help to improve Hbv1c levels. Researchers have also found that long-term strength and
endurance training may improve HbvIc, even in the absence of weight loss.
 Talk to your doctor about any restrictions. Work with your doctor to make an activity plan.
Even a brief counseling session may help to increase your activity levels.

 


 
 

 
  
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' Oral Medication
è Medicines taken by mouth may be used to lower blood sugar:
 Metformin : a class of drug that reduces the body's production of glucose. It also
makes the body more sensitive to insulin. This combination will help keep blood
sugar levels within the normal limits.
 Drugs that prompt the cells in the pancreas to make more insulin (eg, sulfonylureas
[glyburide , tolazamide ], dipeptidyl peptidase-4 inhibitors
[ saxagliptin , sitagliptin ], repaglinide[Prandin])
 The FDv has warned that sitagliptin may increase the risk of acute pancreatitis.
 Insulin sensitizers³a class of drugs that help the body better use insulin
(eg, pioglitazone )
 Starch blockers³a class of drugs (eg, acarbose , miglitol ) that lessen glucose
absorption into the bloodstream
' Injectable medicine, such as:
è Incretin-mimetics (eg, exenatide ) stimulate the pancreas to
produce insulin and suppress appetite often leading to
weight loss (twice daily injections).
è vmylin analogues (eg, pramlintide ) replace a protein that is
normally produced by the pancreas and is low in people
with type 2 diabetes (injection before each meal).
è Talk to your doctor about your drug program.
' Insulin
è In some cases the body does not make enough
insulin. Insulin injections may be needed.
è This is needed when blood sugar levels are not kept
low enough with lifestyle change and medicine.
' Blood Sugar Äesting
è Checking blood sugar levels during the day can help
you stay on track. It will also helps your doctor
determine if your treatment is working. Testing is easy
with a monitor. Keeping track of blood sugar levels is
especially important if you take insulin. Frequency of
testing is determined by how well your blood sugar
control is doing.
è The Hbv1c may also be done at your doctor's office.
Doctors advise that most keep their Hbv1c levels below 7%
(vDv recommendation). This level has been shown to lead to
fewer diabetic complications.
è Regular blood sugar testing may not be needed in patients
with type 2 diabetes. It may not be needed for those whose
condition is under reasonably good control without insulin.
Talk with your doctor before stopping blood sugar
monitoring.
' Alternative Äherapies
è One study focused on people with a specific type 2
diabetes. When given vitamin E, they showed a
decrease in the rates of heart problems.
' ·revention
è Lifestyle changes seem to be most effective. To reduce your chances of
developing type 2 diabetes:
 Participate in regular physical activity.
 Maintain a healthy weight.
 Drink alcohol in moderation (two drinks per day for a man, and one drink per
day for a woman)
 Eat a well-balanced diet:
 Get enough fiber
 vvoid fatty foods
 Limit sugar intake
 Eat more green, leafy vegetables
Bibliography:
' Isaacs v. (2001). Mental Health and Psychiatric Nursing (3rd e.d.). Nanticoke,
Pennsylvania, USv.: Lippincott Williams and Wilkins.
' Kozier, B. et. vl. (2004). Fundamentals of Nursing : Concepts, Process, and Practice.
(7th ed.), Singapore: Pearson Education.
' Potter, P. and Perry, v. (2001). Fundamentals of Nursing (5th ed.). USv.: Mosby Inc.
' Stuart, G.W. & Laraia, (2004) Principles & Practice of Psychiatric Nursing. (7th ed.)
USv.: Mosby.
' Meiner, S.E. and v.G. Lueckenotte, (2007). Gerontologic Nursing. (3rd
ed.).Singapore.: Elsevier.
' Sublett, C. and M. Blair (2008). Medical-Surgical Nursing (8th e.d.). Singapore.:
Elsevier.