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


Title: Chapter 20: Teaching Old Adults Author: jimmauk Last modified by: Dr. Molly Hahm Created Date: 7/7/2005 12:51:56 PM Document presentation format – PowerPoint PPT presentation

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

Chapter 9 Management of Common Illnesses,
Diseases, and Health Conditions
Learning Objectives
Name the major risk factors associated with cardiovascular disease (CVD). Discuss the impact of the major CVDs seen in older adults on the health of the U.S. population. Recognize signs of myocardial infarction that may be unique to the older adult. Utilize resources and research to promote heart-healthy lifestyles in older adults. State the warning signs of stroke. Apply the Mauk model for poststroke recovery to the care of stroke survivors. Identify common treatments for pneumonia, tuberculosis (TB), and chronic obstructive pulmonary disease (COPD). Discuss how to minimize risk factors for common gastrointestinal problems in the elderly. Describe nursing interventions for patients dealing with gastro- esophageal reflux disease (GERD). Discuss ways to prevent catheter- associated urinary tract infection (CAUTI). Identify signs, symptoms, and treatments for benign prostatic hyperplasia (BPH) and vaginitis. Recognize common treatments for several cancers in older adults bladder, prostate, colorectal, cervical, and breast. List several medications that can contribute to male impotence. Recognize the clinical treatments for persons with Parkinsons disease (PD).

Learning Objectives (contd)
Devise a nursing care plan for someone with Alzheimers disease (AD). Discuss possible causes and solutions for dizziness in the elderly. List the modifiable risk factors for osteoporosis. Distinguish between osteoarthritis and rheumatoid arthritis in relation to typical presentation, treatment, and long-term implications. Contrast rehabilitative care for older adults with hip and knee replacement surgery. Describe the most effective way to condition a stump to promote use of a prosthesis. Distinguish the signs and symptoms of cataracts, glaucoma, macular degeneration, and diabetic retinopathy. Contrast management of the 4 most common eye disorders seen in the elderly. Distinguish among the 3 major types of skin cancer. Identify signs and symptoms of herpes zoster appearing in the elderly. Review prevention of the most common complications of diabetes in older adults. Devise a plan for good foot care for older adults with diabetes. Synthesize knowledge about hypo- thyroidism into general care of the older adult.

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Aging Cardiovascular system
  • Heart enlargement heart chambers, thickening
    heart walls.
  • Arterial circulation extended, twisted,
    thicken, stiffen, increased blood velocity.
  • Peripheral pulses- stiffen due to accumulating
    mineral, lipid, collagen residues.
  • Murmurs heard in ½ of the elderly, asymtomatic.
  • Blood pressure resistance increase in the
    artery and vascular periphery.

Cardiovascular Problems
  • Hypertension
  • Coronary Heart Disease(CHD) MI, Angina
  • Figure, P. 276-277
  • Congestive Heart Failure (CHF)
  • Stroke
  • TIA
  • Peripheral Artery Disease

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  • Nurses can best help older clients
  • prevent hypertension by teaching
  • Low-fat, low-cholesterol diets
  • The importance of exercise
  • How to handle stressful situation
  • How to maintain a normal blood
  • pressure

  • Older clients experiencing anginal pain with
    complaints of fatigue or weakness usually are
    medicated with which of the following types of
  • Sublingual nitroglycerin
  • Cardiac glycosides
  • Aspirin
  • Morphine Sulfate

  • An elderly client is being monitored for evidence
    of congestive heart failure. To detect early
    signs of heart failure, the nurse would instruct
    the certified nursing attendant (CNA) to do which
    of the following during care of the patient?
  • Observe electrocardiogram readings and report
    deviations to the nurse.
  • Assist the client with ambulation three times
    during the shift.
  • Monitor vital signs every 15 minutes and report
    each reading to the nurse.
  • Accurately weigh the patient, and report and
    record the readings.

  • A common arrhythmia found in some older clients
    is chronic atrial fibrillation. Based on the
    nurse's knowledge of the disease pathology, which
    of the following prescriptions should the nurse
    expect to be ordered?
  • Aspirin
  • Warfarin sodium (Coumadin)
  • Simvastatin (Zocor)
  • Vinorelbine tartrate (Navelbine)

Respiratory Problems
  • Pneumonia
  • Bacterial
  • Viral
  • Chronic Obstructive Pulmonary Disease
  • Chronic bronchitis
  • Emphysema
  • Tuberculosis (Table 9-17)

Aging of the Respiratory System
  • Chest wall stiffer
  • Alveoli flatter, shallower
  • Diaghragm weaken by up to 25 with age.
  • Pulmonary circulation reduced
  • Respiratory accessory muscles loss
  • Anatomic structure less able to provide
    sufficient gas exchange due to loss of lung
    tissue and the chest wall, reduced contractual
    abilities of the diaphragm.

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  • Which of the following medications should the
    nurse anticipate the physician would prescribe
    for "rescue" from sudden-onset wheezing,
    tightness in the chest, or shortness of breath
    due to an asthma (or COPD) diagnosis?
  • Albuterol inhaler (Proventil, Ventolin)
  • Warfarin (Coumadin)
  • Alendronic acid (Fosamax)
  • Cromolyn Sodium inhalation (Intal)

Gastrointestinal Problems
  • Gastroesophageal Reflux Disease (GERD)
  • Peptic Ulcer Disease (PUD)
  • Diverticulitis
  • Constipation
  • Cancers
  • Colorectal
  • Gastric (stomach)
  • Esophagus
  • Pancreas

Age-related changes in the GI system
  • Mastication difficulty d/t , lose teeth
    atrophy of muscles, bones of the jaw and mouth.
  • Swallowing decreased saliva may result in
    feelings of food being stuck.
  • Peristalsis mildly reduced
  • Nutrients absorption no change with age
  • Enzymes pancreas decreases in wt. with age. No
    changes with gallbladder.

Gastrointestinal Problems- GERD
  • Teach Lifestyle modifications
  • Avoid large meals
  • Lose weight
  • Avoid food and drink within 3 4 hours of lying
  • Avoid tight clothing
  • Elevate HOB (on blocks, not just head of bed)
  • Avoid certain foods limit spicy and tomato-based
    foods, acidic, nicotine, caffeine, chocolate,
    alcohol, mints, high fat

  • In managing the symptoms associated with GERD,
    the nurse should assign the highest priority to
    which of the following interventions?
  • Decrease daily intake of vegetables and water,
    and ambulate frequently.
  • Drink coffee diluted with milk at each meal, and
    remain in an upright position for 30 minutes.
  • Eat small, frequent meals, and remain in an
    upright position for at least 30 minutes after
  • Avoid over-the-counter drugs that have antacids
    in them.

Genitourinary Problems
  • Urinary Tract Infection
  • Bladder Cancer
  • Female Reproductive System
  • Atrophic Vaginitis
  • Breast Cancer
  • Male Reproductive System
  • Benign Prostatic Hyperplasia
  • Prostate Cancer

Aging of the Genitourinary System
  • Renal blood flow declines with age due to
    changes in the arteries and capillaries in the
  • Glomerular filtration rate (GFR) a decline in
    GFR, usually measured by creatinine clearance,
    becomes significant because elimination of waste
    and toxins declines, causing an accumulation of
    harmful substances such as uric acid and
    medications in the body.

Aging of the Genitourinary System
  • Bladder decreases in size and develops fibrous
    matter in the bladder wall, changing its overall
    stretching capacity and contractibility.
  • Incontinence is not a normal part of aging and is
    highly treatable.
  • Older individuals experience nocturia which can
    disturb sleep patterns.

  • Which of the following are significant renal
    changes at the ninth decade of life? (Select all
    that apply.)
  • Increased glomerular filtration rate
  • Decreased glomerular filtration rate
  • Lower creatinine clearance rate
  • Less concentrated urine-specific gravity

  • Which of the following muscle exercises is
    frequently taught by nurses when caring for
    clients with urge or stress urinary incontinence?
  • Abdominal exercises
  • Kegel exercises
  • Buerger Allens exercises
  • Aerobic exercises

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

1. Soy products
2. Fish
3. Milk
4. Ginkgo buloba (GBE)
Neurological Disorders
  • Alzheimers Disease
  • Most common type of dementia
  • Parkinsons Disease
  • Four major types of dizziness
  • Vertigo
  • Presyncope (light-headedness)
  • Disequilibrium (related to balance)
  • Ill-defined
  • Seizures

Aging of the Nervous System
  • The aging brain decreases in size and wt.
  • Neurotransmitter, chemical messenger, changes
    and influence memory and cognition as well as
    behavior and motor function.
  • The aging spinal cord aging spine may narrow due
    to pressure.
  • The aging peripheral nervous system sensory and
    motor neuron function decline.

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  • Which of the following statements accurately
    describes Alzheimer's disease (AD)?
  • Alzheimer's disease is a form of dementia, with
    reversible manifestations of memory loss and
    altered cognition.
  • Alzheimer's disease is a form of dementia that
    begins with memory loss, which is immediately
  • Alzheimer's disease results from complex
    interactions between genetic and environmental
  • Alzheimer's disease is a rapid, progressive,
    degenerative neurologic disease, which causes
    brain degeneration without inflammation.

Musculoskeletal Disorders
  • Osteoporosis
  • Arthritis
  • Osteoarthritis characterized by deterioration of
    the cartilage at the end of the bones.
  • Rheumatoid arthritis characterized by remissions
    and exacerbations of inflammation within the
  • Joint Replacement
  • Amputation

Aging of the Skeletal Muscle
  • With age, there is not only a loss of muscle
    mass, but also a loss of bone strength.--gt
  • Decreased ROM in joints. Joints are more fixed
    and stiff.
  • Height may lose 2-10 cm of height d/t
    intervertebral space compression

Sensory Impairments
  • Vision
  • Cataracts
  • Glaucoma
  • Macular Degeneration
  • Diabetic Retinopathy
  • Retinal Detachment
  • Corneal Ulcer
  • Chronic Sinusitis

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

Do nothing, since this a normal finding in the older adult.
2. Document finding and report your concern to the physician.
3. Irrigate the ear canal with a mixture of hydrogen peroxide and normal saline.
4. Ask the patient if he is experiencing any discomfort.
The Aging Integumentary system
  • Skin texture thinner, dry, and less elastic
  • Color age spots and wrinkles are common
  • Temperature cooler
  • Fat distribution increased fatty distribution on
    trunk vs. arms/legs
  • Hair and nails become more brittle, thinner hair
    and male baldness patterns.

Integumentary Problems
  • Skin Cancers
  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Malignant melanoma
  • Herpes Zoster (Shingles)

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

  • An 84-year-old patient's skin is assessed to be
    wrinkled, thin, and dry. These findings should be
    interpreted as related to

An increase in elastin and decrease in subcutaneous fat.
2. Loss of elastin and a decrease in subcutaneous fat.
3. Increased numbers of sweat and sebaceous glands.
4. Increased vascularity of the skin.
Aging of the Endocrine System
  • Immune response weaken
  • Changes in hormones levels Most hormones,
    except sex hormones, do not significantly change
    with age.
  • thyroid gland
  • ACTH (pituitary hormone) secretion
  • Sex hormones
  • Adrenal function decrease with age
  • Insufficient insulin secretion, insulin
  • Glucose metabolism impaired glucose tolerance
    with age due to defect in insulin action.

Endocrine/Metabolic Disorders
  • Diabetes Mellitus
  • Type 2
  • Characterized by hyperglycemia and insulin
  • Impaired insulin secretion may also be present
  • Hypothyroidism
  • Elevated TSH and normal T4 (progressing to
    decreased T4)

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