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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
' r
' 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 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 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
' 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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' 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 Depressed breathing
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)
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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.