Exam 4 Gerontological Nursing

Question 1

Type I

IgE Mediated Disorders

Answer 1

• Most common
• Results from the production of an antigen-specific IgE after exposure to an environmental allergen
• Common allergens: seasonal (grass, pollen, ragweed), mold, mildew, dust, animals, food, drugs, chemicals in products, insect venom

Question 2

Type II

Antibody Mediated Disorders

Answer 2

• Direct interaction of IgG and IgM with cell surface antigens causing the release of complement
• Increased release of CD8 (cytotoxic killer cells)
• Examples include mismatched blood reaction, hemolytic anemias, some severe drug reactions (Stevens-Johnson Syndrome), autoimmune thyroiditis

Question 3

Type III

Immune Complex Mediated Disorders

Answer 3

• Insoluble antigen-antibody complexes activate complement
• Complement activates chemotactic and vasoactive responses that cause tissue damage and vascular damage
• Vascular responses: ↓ blood flow, ↑ capillary permeability, pathologic inflammatory response
• Examples: vascular damage in the autoimmune diseases SLE and acute

Question 4

Type IV

Cell-Mediated Disorders

Answer 4

• Hypersensitivity is mediated by cells, not antibodies
• Response is usually delayed for 24-72 hours after exposure to antigen
• Cells involved in response are T8 lymphocytes (cytotoxic killer cells) and lymphokines producing cells
• Other inflammatory cells are involved: monocytes, neutrophils, eosinophils, basophils
• Examples: reaction to TB skin test, latex

Question 5

SUSCEPTIBILITY OF INFECTIONS IN EDLERLY

Answer 5

• Febrile response blunted
• Lower body temperature
• Absence of tachycardia
• Medications may affect fever response
• Class signs of infection absent
• No elevated or mildly elevate WBC’s
• Atypical presentation

Question 6

SUSCEPTIBILITY OF INFECTIONS IN EDLERLY

Non-specific signs & symptoms: CLEAR

Answer 6

C: cognitive changes/agitation

L: loss of bladder control

E: eating and nutritional changes

A: activity/functional changes

R: recurrent falls/postural instability

Question 7

Common infections in elderly

Answer 7

• Pneumonia
  
  • Leading cause of death in persons >65
• UTI
  
  • Females: decreased estrogen
  • Males: BPH: urinary retention
  • Decreased total body water (chronic hypovolemia)
  • Decreased # nephrons, renal blood flow, creatinine clearance, GFR
• Skin infections
  
  • Susceptible to injury/tissue breakdown due to aging changes of skin
  • Cellulitis common
  • Erysipelas: superficial cellulitis group A strep usually affects lower extremities/face
  • Staph aureus common
  • Skin infections can lead to bacteremia/septic shock
  • Herpes zoster (Shingles): reactivation of varicella virus latent in nerve tissues

Dermatomal distribution common along spinal nerves T3 to L2 and CN V

* Prevention: One-time Zoster vaccine recommended for persons 60 years of age or older. Persons who have had shingles can receive vaccine to help prevent further occurrences.

• Bacteremia (the presence of bacteria in the blood.)
  
  • Early recognition of symptoms of infection
  • Complication of pneumonia, UTI, skin/soft tissue infections, dental procedures
  • Blood cultures to identify organism
  • Septic shock serious complication

Question 8

Tuberculosis

Answer 8

• Highest in people over 65 years of age
• Majority due to reactivation of dormant infection not effectively treated in past
• Older adults are at risk for initial infection of TB due to compromised immune system especially those who are chronically ill/debilitated and live in nursing homes or have HIV
• Due to compromised immune system, elderly often have false negative TB tests
• Because of this anergy testing is often done along with TB test (candida, mumps, tetanus toxoid)
• Most adults should have developed antibodies to these antigens through vaccination or disease

Question 9

Treatment for Osteoarthritis

Answer 9

• Tylenol
• NSAIDS/COX-2
• Topical analgesics (e.g.,Capsaicin, Voltaren gel, Aspercreme)
• Heat/cold application
• Glucosamine Chondroitin (?)
• Hyaluronic acid injections (e.g.,Orthovisc, Synvisc)
• Weight reduction
• Exercise/PT,OT
• Short rest periods
• Use of assistive devices such as canes, quad-cane, walkers
• Hip repair/joint-replacement surgery

Question 10

Paget’s Disease

Answer 10

• A disease that disrupts the replacement of old bone tissue with new bone tissue.

Treatment:

• Bisphosphonates and Calcitonin (Alendronate (Fosamax) 40mg. po daily for 6 months; Calcitonin (Miacalcin) 50 to 100 units SQ/IM daily to 3x/week for 6 months)

Exercise/PT/OT

Question 11

OSTEOMALACIA

Answer 11

• softening of the bones caused by impaired bone metabolism primarily due to inadequate levels of available phosphate, calcium, and vitamin D, or because of resorption of calcium.
• The impairment of bone metabolism causes inadequate bone mineralization

SS:

• diffuse joint and bone pain
• muscle weakness
• difficulty walking
• Postive Chvostke Sign (hypocalcemia)
• compressed vertebrae and diminished stature
• easy fracturing
• bending of bones

Treatment:

• Vitamin D in doses of 50,000 to 100,000 units/day for 1-2 weeks followed by a daily dose of 400 to 800 units/day
• Calcium 1,000 to 1500mg. per day
• Spacing activities
• PT/OT home evaluation

Question 12

Pseudogout

Answer 12

• Form of arthritis caused by formation of calcium pyrophosphate-dihydrate crystals in large joints
• Occurs in people 60 years of age or older
• Women affected more than men
• Knee most common joint affected
• May affect several joints at same time

Treatmen:

• NSAIDS
• Treatment is the same as treatment for gout except for Allopurinol which controls uric acid levels

Question 13

TREATMENT FOR

GOUT AND PSEUDOGOUT

Answer 13

• Rest the joint
• Increase fluid intake to 3L/day to promotoe renal function and prevent stones
• Avoid head - apply cold to relieve pain
• Avoid foods high in purine (shellfish and organ meats)
• Avoid alcoholic beverages