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NR601,midterm.sg
pdf ,compatibility mode
Week 1 Developmental changes o Review Kennedy readings for age related changes Physiological Age related Change Functional Change Implications Integumentary System Loss of dermal and epidermal thickness Loss of subcutaneous tissue and thin epidermis. Prone to skin breakdown and injury Decreased vascularity see
- Atrophy of sweat glands resulting in decreased sweat production
- Decreased body odor
- Alteration in thermoregulatory response
- Fluid requirements may change seasonally
- Decreased heat loss • Loss of skin water
- Dryness • Increased risk of heat stroke Respiratory System Decreased lung tissue elasticity Decreased vital capacity Reduced overall efficiency of ventilatory exchange Cilia atrophy Change in mucociliary Increased susceptibility to
transport infection
diverticular disease
Decreased basal metabolic rate (rate at which fuel is converted into energy) May need fewer calories o Lab results (JACKELINE CONDE) Lab results Lab Test Normal Changes with age Comments UA Protein 0-5mg/100ml Rises slightly May be due to kidney changes with age, urinary tract infection, renal pathology Specific Gravity 1.005-1.020 Lower max in elderly 1.016-
Decline in nephrons impairs ability to concentrate urine Hematology ESR Men: 0- Women: 0- Significant increase Neither sensitive nor specific in aged Iron Binding 50- 160mcg/dl 230- 410mcg/dl Slight decrease Decrease
Hematocrit Men: 45-52% Women 37-48% Slight decreased speculated Decline in hematopoiesis Leu Leukocytes 4,300–10,800/ mm Drop to 3,100– 9,000/mm Decrease may be due to drugs or sepsis and should not be attributed immediately to age Lymphocytes 00–2,400 T cells/mm3 50– 200 B cells/mm T-cell and B- cell levels fall Infection risk higher; immunization encouraged Platelet 150,000– 350,000/ No change in number Blood Chemistry Albumin 3.5–5.0 Decline Related to decrease in liver size and enzymes; protein-energy malnutrition common Globulin 2.3–3.5 Slight increase Total serum protein 6.0–8.4 g No change Decreases may indicate malnutrition, infection, liver disease
Blood urea nitrogen Men: 10– Women: 8– mg Increases significantly up to 69 mg Increases significantly up to 69 mg
appendicitis pain may begin in right lower quadrant and become diffuse
- Depression Anorexia, vague abdominal complaints, new onset of constipation, insomnia hyperactivity, lack of sadness
- Hyperthyroidism Hyperthyroidism presenting as “apathetic thyrotoxicosis,” i.e., fatigue and weakness; weight loss may result instead of weight gain; patients report palpitations, tachycardia, new onset of atrial fibrillation, and heart failure may occur with undiagnosed hyperthyroidism
- Hypothyroidism Hypothyroidism often presents with confusion and agitation; new onset of anorexia, weight loss, and arthralgias may occur
- Malignancy New or worsening back pain secondary to metastases from slow growing breast masses Silent masses of the bowel
- Myocardial Absence of chest pain infarction (MI), vague symptoms of fatigue, nausea, and a decrease in functional and cognitive status; classic presentations: dyspnea, epigastric discomfort, weakness, vomiting; history of previous cardiac failure, higher prevalence in females versus males Non-Q-wave MI
- Overall infectious diseases process Absence of fever or low-grade fever, malaise
- Sepsis Without usual leukocytosis and fever, falls, anorexia, new onset of confusion and/or alteration in change in mental status, decrease in usual functional status
- Peptic ulcer disease Absence of abdominal pain, dyspepsia, early satiety, painless, bloodless, new onset of confusion, unexplained, tachycardia, and/or hypotension
- Pneumonia
- Pulmonary edema Lack of paroxysmal nocturnal dyspnea or coughing; insidious onset with changes in function, food or fluid intake, or confusion
- Tuberculosis (TB) Atypical signs of TB in older adults include hepatosplenomegaly, abnormalities in liver function tests, and anemia
- Urinary tract infection Absence of fever, worsening mental or functional status, dizziness, anorexia, fatigue, weakness o Geriatric syndromes refers to conditions that involve multiple organ systems. Most common are delirium, falls, dizziness and incontinence. risk factors include: older age, cognitive impairment, functional impairment,and impaired mobility. Bowel incontinence- involuntary passage of stool or the inability to control stool from expulsion. More prevalent in women than men. 3 types: urge incontinence, passive incontinence, and fecal seepage. urge- has desire to go but cannot make it to the toilet despite attempts to avoid defecating. Passive-involuntary loss of gas and stool without awareness. fecal seepage- leakage of stool after a normal bowel movement. etiology : a number of reasons including GI issues, cognitive or neurological diseases. Treatment: treat related etiology such as impaction of increasing fiber. Habit training is also recommended. Once clear evidence of no impaction, infection, or cause is determined. antidiarrheal medication like Imodium can be tried.
For retrosphincter dysfunction biofeedback with strengthening exercises for the sphincter can be done.
diet ○ Fatigue in older adults may be an early indicator of the aging process, as well as debility or another disorder ● Occurrence ○ 25% of the US population ● Age ○ Common among the elderly ● Gender ○ More common in women ● Ethnicity ○ Not significant ● Contributing Factors
○ Poor dietary habits, overexertion, alcohol abuse, smoking, stress, chronic illness, drug interactions, misuse of drugs, and sleep apnea ○ In the older adult individual, it is compounded by a decrease in muscle strength, loss of muscle neurons, muscle atrophy, a decrease in hormone levels, and lack of exercise. ● Signs and symptoms ○ Conduct a complete symptom assessment, including the onset; duration; severity; and precipitating, aggravating, and relieving factors. ○ Identify other indicators or associated symptoms of fatigue, which may include decreased energy expenditure, decreased endurance, sleep disturbance, attention deficits, somatic complaints (aching body, tired eyes), dyspnea, and weakness ○ Carefully review the adequacy of the diet, all medications (evaluating for potential medication side effects), activity level (including degree of independence of ADLs), and potential causes or contributing factors. Identify the impact fatigue is having on the person’s ADLs and quality of life and current stressors. ○ Distinguish between generalized fatigue and actual weakness by testing for muscle strength and presence of localized tenderness ○ A thorough physical examination will include a mental status examination to screen for dementia and rule out depression. ● Diagnostic tests ○ Diagnostic tests on all patients with persistent unresolved fatigue should include CMP, CBC with differential, erythrocyte sedimentation rate (ESR), and/or C-reactive protein, because these are low cost and offer significant screening capacity. ○ Thyroid function, urinalysis, and pulmonary function tests. ○ If symptoms and signs indicate cardiac decompensation, a B-type natriuretic peptide (BNP) may indicate degree of heart failure and an EKG may reveal cardiac arrhythmias, enlargement of the heart, myocardial infarction, or abnormalities in the conduction system ● Differential diagnosis ○ Psychiatric disorders, including depression and generalized anxiety disorder, account for 70% of cases of fatigue ○ Fatigue that cannot be relieved by rest or sleep is often a sign of disease. ● Treatment ○ Symptom management includes regular exercise, attention-restoring activities, psychosocial techniques, energy conservation measures, good sleep hygiene, improving diet, and possibly adding nutritional supplements
○ May be indicated based on the results of the work-up ● Education ○ If the fatigue has a physiological cause, teaching should be related to the findings; psychological counseling, changes in the environment, behavior modification, and stress reduction may be needed Goal of fatigue management - provide the patient with self-help tools to eliminate or alleviate fatigue Headache: Hematuria: Description: Presence of RBCs in the urine, classified either gross or microscopic Gross hematuria: urine appears either red or brown in color to the naked eye Microscopic hematuria: identified by lab analysis. Significant if 3 or more RBCs per high-power field on accurately collected urine specimen. *requires evaluation, 5% with microscopic hematuria are found to have malignancy, & 30-40% with gross hematuria are have to have malignancy Etiology: renal or contamination from outside the urinary tract. Renal hematuria may result from glomerular or nonglomerular causes.Source of hematuria may be the upper collection system (renal, ureter) and/or lower collection system (bladder, prostate, urethra). Common finding on routine UA and etiologies range from life- threatening to benign incidentals. Patho depends on the anatomica site from which blood loss occurred, older adults, most common causes are malignancy or BPH Occurrence: prevalence of asymptomatic microscopic hematuria ranges form 2% to 31% in the adult population, older than 50 yrs., prevalence 13% Age: increases with age, younger pts are less likely to have an etiology identified Ethnicity: not significant Contributing factors: infection, anticoagulation, renal calculi, trauma, anatomical defects such as rectocele, menstruation, atrophic vaginitis, renal disease, or recent urological procedure, malignancy include age more than 35 yrs. male sex, current
or past history of smoking, occupational exposures to chemicals or dyes, hx of gross hematuria, chronic cystitis,pelvic irradiation, exposures to cytotoxic agents S/Sxs: thorough HX, presence of visible blood in the urine, Hx of vigorous exercise, recent prostate examination or procedure, recent trauma to the abdomen, recent catherterization, menstruation, renal disease, viral illness, medications (analgesics, antibiotocs, anticoagulants,
