nursing aging week 10

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Chapter 20

Metabolic Disorders

Up to 20% older than 65 years of age have hypothyroidism
Thyroid disorders are difficult to diagnose in older adults
Signs and symptoms may be nonspecific, atypical, or absent
Changes may be incorrectly attributed to normal aging, another disorder, or side effects of medications

Thyroid Disorders

The most common thyroid problem in older adults
Onset is slow
Thought to be caused by chronic autoimmune thyroiditis or inflamed thyroid; may be iatrogenic, resulting from radioiodine treatment, subtotal thyroidectomy, or medications
Symptoms include heart palpitations, slowed thinking, gait disturbances, fatigue, weakness, or heat intolerance
Treatment is to slowly replace the thyroxine

Hypothyroidism

Graves disease is the most common cause
Can also result from
Ingestion of iodine or iodine-containing substances
The medication amiodarone
The wrong dose of levothyroxine
May have sudden onset
Symptoms include unexplained atrial fibrillation, heart failure, constipation, anorexia, and muscle weakness
In older adults, apathetic thyrotoxicosis may occur

Hyperthyroidism

Complications occur
As a result of treatment
Because of failure to diagnose and treat in a timely manner
Myxedema coma occurs with untreated hypothyroidism, can result in death
Thyroxin increases myocardial oxygen consumption and increases risk of
Atrial fibrillation
Exacerbation of angina in persons with preexisting congestive heart disease
Congestive heart failure

Complications of Thyroid Disease

Pharmacologic intervention
Surgical or chemical ablation
Nursing role
Work with the patient and family to understand the seriousness of the condition
Provide teaching on the medication regimen

Implications for Gerontological Nursing and Healthy Aging

A nurse assessing an older adult would suspect hypothyroidism if which of the following complaints were present? (Select all that apply.)

Fatigue

Weakness

Slowed thinking

Heat intolerance

Heart palpitations

Question

A, B, C, E—All are symptoms of hypothyroidism except heat intolerance. The patient would experience cold intolerance with hypothyroidism.

Answer

Syndrome of disorders of glucose metabolism resulting in hyperglycemia
Two types
Type I: The body is unable to produce insulin needed to move glucose into the cells
Type II: The body does not make enough insulin to keep up with the needs of the body; insulin is available, but the cells are not able to use it
Wide variation of the prevalence of diabetes exists among ethnic and racial groups

Diabetes

Diagnosis requires the results of two of three possible tests on 2 different days
Prediabetes
Fasting plasma glucose (FPG) is 100 to 125 mg/dL
Hemoglobin A1c of 5.7% to 6.4%
Diabetes
FPG of ≥126 mg/dL
HgbA1c ≥6.5%
Random blood glucose of ≥200 mg/dL

Diagnosing Diabetes

Classic symptoms include thirst and polyuria
Hyperglycemia is well tolerated in older adults
Early warning signs include dehydration, confusion, delirium, and some incontinence
Vague symptoms include fatigue, nausea, delayed wound healing, and paresthesias

Signs and Symptoms of Diabetes

Can affect a person’s morbidity and mortality
Complications include heart disease, stroke, neuropathy, and periodontal disease
Is the leading cause of end-stage renal disease and blindness in those older than 65 years of age
Wound hearing is delayed
Relates to a high rate of depression
Sexual dysfunction can occur
Person often dies from heart disease

Complications of Diabetes

Nursing goals
Control the blood glucose level
Reduce the risk of complications
Have the patient maintain the best health that is realistically possible
Ensure that evidence-based care is received
Participate in early detection through screening
Assess for risk factors and signs and symptoms of complications

Implications for Gerontological Nursing and Healthy Aging

Promoting healthy aging in older adults with diabetes requires an array of interventions and an effective interdisciplinary team working together with the patient and significant others
Requires expertise in medication use, diet, exercise, counseling, and finding ways to support while empowering the person

Management

Blood glucose monitoring
Medication self-administration
Insulin use
Oral medication use
Foot care and examination
Handling sick days

Needed Self-Care Skills

Knowledge about the disease and its effects
Warning signs for high and low glucose levels
Managing hypoglycemia
Wearing an identification bracelet
Adequate and appropriate nutrition
Daily exercise

Patient Education

Nurses may be responsible for activities that would normally fall to the patient or caregiver to carry out
Nutritional status
Intake and output
Exercise and activity
Signs of hypo/hyperglycemia
Evidence of complications
Encourages self-care when possible

Long-Term Care and Older Adults With Diabetes

A major difference between type 1 and type 2 diabetes is

most older adults with diabetes have type 2 diabetes.

older adults with type 2 usually do not require insulin therapy.

an older adult with type 1 can maintain glycemia with diet and exercise.

the pancreas of an older adult with type 2 does not secret any insulin.

Question

A—Most older adults with diabetes have type 2 diabetes.

Answer