Care for older adults with illness Flashcards
Cancer
Two types of tumors
Benign and malignant
Benign
Do NOT turn into malignant
Malignant
Cells grow into nearby tissues
and spread to other parts of
the body via blood or lymph.
* Can still come back after
removal.
How cancers are named
After the body part in which it started
New tumors that spread from tumor of origin are called
Called metastases
Bladder cancer in the lungs
Causes lung metastases
Cancer that is spread to another part of the body i.e. the lungs
Secondary lung cancer
Primary cancer
Located where the cancer started
Precancerous conditions
Incldes
Atypiua
Metaplasia
Dysplasia
Carcinoma in situ
Atypia
Cells that are slightly abnormal
Metaplasia
means that there has been
a change to the types of cells that are
normally found in this area of the body.
The cells look normal but they aren’t
the type of cells that are normally
found in that tissue or area.
Dysplasia
means that cells are
abnormal, there are more cells than
normal, the cells are growing faster
than normal, and they aren’t arranged
like normal cells.
Carcinoma in situ
is the most severe
type of precancerous change. The cells
are abnormal but have not grown into
nearby tissue. Carcinoma in situ is
usually treated because it has a high
risk of developing into cancer.
People with precancerous conditions
Usually checked regularly so they can bebe treated quickly if changes begin more severe
Cancers stages often include
Size of tumor
Which part of organ has cancer
Whether cancer has spread 9metastasized)
Where it has spread
Staging cancer describes
cancer based on how
much cancer is in the body and where it is
when first diagnosed. This is often called the
extent of cancer.
Cancer stages
stage 0 – indicates that the cancer is where
it started (in situ) and hasn’t spread
* stage I – the cancer has formed small tumor and hasn’t spread anywhere else
* stage II – the cancer has grown, but hasn’t
spread
* stage III – the cancer is larger and
may have spread to the surrounding
tissues and/or the lymph nodes (part of
the lymphatic system)
* stage IV – the cancer has spread from
where it started to at least one other body
organ; also known as “secondary” or
“metastatic” cancer
Purpose of staging cancers
Treatment planning
Prognosis including chance of recovery
Predict treatment success
Cnacers in the same part of the body with the same stage tend to have
Similar prognosis
Cnacer grading is done by
Observeing cancer cells under microscope
Grading depends on
How different cancerlcells look from normal cells (differentiation)
Features of tumor like size and shape of cells and arrangement
Speed of cell proliferation
Whether there are areas of cell death
Low grade tumor
tend to grow slowly and are less
likely to spread.
Grade 3 cancer cells
High-grade cancers tend to grow more quickly and
are more likely to spread.
Don’t look normal
Prognostic factors for the cancer
Type of cancer
Subtype of cancer-based on the type ofc. ells or. tissue
Size of the tumour
Stage
Grade
Prognostic factors based on person
Age and gender
Presence of other health problems
Ability for ADLs
Weight loss and how much weight has been lost
Response to treatment
Ability to cope with treatment side effects
Significant weight loss in a short time with cancer
SIgnificant nutrition distress
Two forms of treatment
Curative treatment or elongation of time treatment
Older adult treatment of cancer
Complex
Older adults are underrepresented in clinical trials so there are fewer evidence-based guidelines
Co-existing conditions increase an older adult’s susceptibility to adverse effects of treatment
Decisions abt screening and treatment may be influenced by ageism
Treatment decisions in older adults
Chronological age
Effects of normal age-related changes
Life-expectancy
Potential harms v benefits
Prognosis
Expected outcome
Cancer diagnosis
Diagnosed by expert (pathologist) through tissue sample under microscope with a biopsy
Primary prevention of cancer
Smoking cessation
* Avoiding secondhand smoke
* Maintaining an ideal body weight
* Diet and intake
* Limiting intake of fats and both red and processed
meats
* Avoiding excessive exposure to sunlight
* Avoiding excessive alcohol consumption
Cancer screening recommendations
FIT test
Sigmoidoscopy/colonscopy
DRE
Pap smear
Mammogram
Genetic cancer
A gene has been determined. to influence the development of cancer
Heriditary/familial cancer
Not proven as genetic, but family history allows qualification for screening
FOBT
Fecal occult blood test
FIT
fecal immunochemical test
Cancer Treatment
Surgery
* Chemotherapy
* Radiation Therapy
* Immunotherapy
* Targeted Drug Therapy
Could be all none, or some
Chemotherapy
Use of drugs to destry cancer cells
Also attack rapidly growing cancer cells, but they can also affect healthy cells that grow rapidly
Chemotherapy as a drug
Mostly systemic
Deliver IV or PO
Delivered on cycles
Side effects of chemotherapy
Easy bruising and bleeding
* Infection
* Anemia (low red blood cell counts)
* Appetite changes
* Constipation
* Nausea/ vomiting
* Hair loss (alopecia)
* Fatigue
XRT
Radiation Therapy
Works by making small breaks in the DNA inside cells. Nearby normal cells can also be affected by radiation. But most should recover and go back to working the way they should
Diabetes Mellitis pathology
Discrepancy bw the amount of insulin required by body and the amount available
In normal digestion food is broken down to the basic
component, glucose.
* Glucose is stored in cells for energy and in the muscle
cells and liver as glycogen for energy back-up.
* Insulin (from beta cells of pancreas) is required to guide
glucose into cells for energy and storage, to increase
glycogen storage in the liver, and aid in the metabolism
of triglycerides, nucleic acids and proteins.
Type 1 DM
No insulin
Beta cells aof pancreas are deestryoed by an autoimmune process
Typically diagnosed before 30
abt 5-10% of diabetic patients
Type 2 DM
A decreased sensitivty to insulin or decreased amount of insulin
DM risk factors
Ethnicity
Increased age
High Blood pressure
First-Degree relative with DM
Obesity
Low birthweight
High cholesterol
Acute complication of DM
Hypoglycemia
Diabetic Ketoacidosis
Hyperglycemic Hyperosmolar Nonketoic Syndrome
Athrosclerosis
Stiffing of ateries and veins throughout the body
Chronic complications of DM
Cardivascular disease: Arthersclerosis
Cardiovascular disease: Atherosclerosis
*Macrovascular (large vessel) disease: Affects coronary, peripheral vascular, and cerebral vascular function (increased risk for
stroke).
*Microvascular (small vessel) disease: Affects eyes (retinopathy) or kidneys (nephropathy).
*Neuropathic disease: Affect sensory motor and autonomic nerves (ex. foot ulcer).
*Peripheral neuropathy and neuropathic pain.
*Increased risk for amputation
*Higher risk for infection (elevated glucose encourages bacterial growth)
*GI paresis (decreased peristalsis)
*Nausea, vomiting, constipation, ‘bloating,’ heartburn
Clinical Manifestations of Hyperglycemia
- Thirst
- Frequent urination
- Abdominal cramping
- Lethargy
- Anorexia, N/V
- Signs of dehydration
- Fruity breath (if ketotic)
- Kussmaul breathing
Pharmacological Intervention to DM
Insulin
Types of Insulin
Rapid-Acting
Short- Acting
Intermediate Acting
Long Acting
Non Pharm interventions for DM
Teach about diet, blood glucose monitoring,
nutrition, exercise, foot or skin care.
- Monitor blood sugar and managing potential
complications. - Hypoglycemia: treat with juice or glucose table;
encourage patient to eat full meals or snacks. - Monitor risk for infection and reduced healing.
- Maintain fluid and electrolyte balance.
- Interprofessional team approach (wound care nurse,
dietitian, pharmacist, podiatrist, ophthalmologist,
endocrinologist, physician, nurse practitioner,
certified diabetic educator, and counsellor)
Heart Failure
Often Follows CAD, especially after a myocardial infarction
Clinical manifestation of heart failure
Diminshed cardiac output with accompanying dizziness, congfusion, gatiuge, cool extermities
Stages of heart failure (NOT ON EXAM)
Class I: Asymptomatic
* Cardiac disease, but no limitations noted.
*
Class II: Mild Heart Failure
* Some limitation of physical activity, comfortable at rest.
* An increase in activity may cause fatigue, palpitations, dyspnea, or angina pain.
*
Class III: Moderate Heart Failure
* Marked limitation in physical activity, but comfortable at rest.
* Ordinary walking or climbing of stairs brings on fatigue, palpitations, dyspnea, angina pain.
* Substantial periods of bed rest required.
Class IV: Severe Heart Failure
* Almost permanently confined to bed rest.
* Inability to carry out any physical activity without discomfort or severe symptoms.
* Some symptoms at rest; chronic shortness of breath common.
Assessment and Diagnostic Methods for heart falure
Echocardiam
Diagnostic stress test
Pharm interventions
Medication titrated throughout the stages
- Diuretics
Non Pharm interventions
Symptom management
