Exam 2: Gero Lecture 6 Flashcards
Describe acute illness.
Occurs suddenly and often without warning
Stroke, myocardial infarction, hip fracture, infection
Describe chronic illness.
Managed rather than cured
Always present but not always visible
Most common chronic condition in persons over 65 is arthritis, followed by hypertension
What is the preventive phase, definitive phase, crisis phase, and acute phase of chronic illness trajectory?
Preventive phase (pre-trajectory)
No S/Sx
Definitive phase (trajectory onset)
S/Sx & diagnosis PRESENT
Crisis phase
Life-threatening situation
Acute phase
Active illness requiring hospitalization
what is the stable, unstable, downward, and dying phase of chronic illness trajectory?
Stable phase
Controlled illness course/symptoms
Unstable phase
Not controlled but not requiring/desiring hospitalization
Downward phase
Progressive decline
Dying phase
Immediate weeks/days/hours before death
what are the key points of chronic illness trajectory framework?
Majority of health problems in late life are chronic
Chronic illnesses
Acute phase of illness management
Other phases of management
Maintaining stable phases is central in managing chronic illness
Primary care nurse is the coordinator of multiple resources needed to promote quality of life along the trajector
What is frailty?
Incidence increases with age
Normal age-related decreases in reserve capacity are depleted and not able to compensate
Combination of geriatric syndromes
regarding frailty: The formal diagnosis is made in the presence of at least three of the following:
Unintentional weight loss
Self-reported exhaustion
Weak grip strength
Slow walking speed
Low activity
What are CV diseases?
HTN
HF
what is HTN?
HTN is a complex disease with a core defect of vascular dysfunction that leads to target organ damage.
HTN is the MOST COMMON chronic condition in people > 65 yo.
In short: 60 yrs or older
BP is OK if LESS THAN 150 SBP OR 90 DBP
what are the HTN interventions?
Weight reduction (5-20 mmHg reduction)
DASH diet (8-14 mmHg reduction)
Lower sodium intake (2-8 mmHg reduction)
Increase physical activity (4-9 mmHg reduction)
EtOH in moderation (2-4 mmHg reduction)
LOSE WEIGHT!
what is HF?
Most common cause for hospitalization, re-hospitalization, and disability for those over 65 yo
Heart cannot keep up with workload of the heart
Results in insufficient oxygen delivery to body
what is the HF etiology?
Results from damage from hypertension and CHD
Ventricles ENLARGE and DILATE Results in weaker muscle
what is HF also related to?
(weakens the heart muscles)
EtOH abuse
Drug abuse
Chronic hyperthyroidism
Valvular disease
Some chemotherapy medications
Radiation therapy near heart (breast cancer, for example)
What happens with LHF?
pump failure to body
SBP –> decreased contractility can’t squeeze
DBP –> decreased filling can’t relax
think DYSPNEA
What happens with RHF?
pump failure to lungs
results from left side failure
think EDEMA – but also ascites
what happens with congestive HF? (acute decompensated)
swelling, edema, fluid in lungs (pulmonary edema)
must remove fluid
what are the CV interventions?
Complete assessment of all risk factors and existing disease
lifestyle changes
Medication regimen tailored to specific disease process and patient needs
Focus on symptom management and prevention of exacerbations of disease
What are the CV drugs?
ACE (captopril, etc.)
ARB (losartan, etc.)
Diuretics (loop and K+ diuretics, thiazide)
B-Blocker (-lol, etc.)
What is the action for ACE’s and ARB’s?
vasodilation –> reduces the cardiac preload and post load improving
What is the action of diuretics?
reduce fluid retention
what is the action of B-Blockers?
improve contractility of heart muscles
What is neuro-Parkinson’s disease?
Progressive disease – over 10-20 yrs
Think DOPAMINE – Dopamine is lost or inhibited
Dopamine regulates nerve impulses for MOTOR function
More common (slightly) in men than women
Onset approximately 60 years
Considered a terminal diagnosis
What is the classic TRIAD for PD? (motor dysfunction)
- cogwheel rigidity
- bradykinesia/dyskinesia –> ALL skeletal muscles are affected
- resting/non-intention tremors
what is associated with cogwheel rigidity?
Cogwheel Rigidity
Small jerking movements when affected muscles stretched
Muscle rigidity