Week 6: Endocrine And Immune Disorders Flashcards
What are normal age-related changes to the immune system?
- Total number of T cells don’t change with aging.
- B cell function decreases with aging
- Increase in number of immunoglobulins -> decrease in innate immunity
T cells
Scan the body for invading substances such as infections and contributes to the body’s immunity.
B cells
Secrete antibodies in response to the presence of antigens such as infectious agents and foreign substances.
Decrease in function of B cells results in
Reduced ability to produce antibodies leading to a decreased ability to develop adequate immunity after an infection or after an immunization (i.e influenza)
Immunosenescence
Gradual deterioration of the immune system brought on by natural aging advancement
Diabetes Mellitus
A chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both.
Criteria for diagnosis of DM
- One fasting hemoglobin A1C value >/= 6.5% (or)
- One random plasma glucose >/= 200 mg/dL (or)
- Fasting plasma glucose >/= 126 mg/dL (or)
- Oral glucose tolerance test (OGTT) >/= 200 mg/dL 2 hours after glucose administration (or)
- When classic symptoms of hyperglycemic or hypoglycemic crisis are present.
The U.S Preventative Services Task Force recommends screening for DM always be done for those whose:
- BP consistently > 135/80 mmHg
- Any risk factors for CV disease
DM is the leading cause of
- Adult blindness
- End-stage renal disease
- Non-traumatic lower limb amputations
DM is a major contributing factor for
Heart Disease
Stroke
DM Pathophysiology/Etiology
-Absent/insufficient insulin and/or poor utilization of insulin.
Insulin
- Produced by -cells in islets of Langerhans (Pancreas).
- Released continuously into bloodstream in small increments with larger amounts released after food.
- Stabilizes glucose level in range of 70 to 110 mg/dL.
Type II Diabetes Mellitus
Formerly known as adult-onset diabetes (AODM) or non–insulin-dependent diabetes (NIDDM).
Risk factors for type II DM
- Overweight
- Obesity
- Advanced age
- Family history
Type 2 DM Pathophysiology/Etiology
-Pancreas continues to produce some endogenous insulin but
1. Not enough insulin is produced
(OR)
2. Body does not use insulin effectively
Signs and symptoms of diabetes mellitus
- Polyuria, polyphagia, polydipsia
- May have fatigue, weight loss and visual changes.
- Prolonged wound healing.
- Woman may present with candidiasis, as first sign.
Complications of Type II DM more common in older adults
- Compounded by the presence of multiple morbid diseases and disorders.
- Dry mouth, dry eyes, dehydration
- Incontinence
- Weight loss, anorexia and nausea
- Confusion, delirium
- Delayed wound healing
Complications of DM
Mobility impairment, muscle weakness, falls Cognitive impairments Fatigue Weight loss Incontinence
Type II DM is often a diagnosis not made until evidence of end organ damage becomes visible such as
- Decreased visual acuity
- Neuropathy
- Heart disease
- Stroke
- Periodontal disease
Hypoglycemia Levels in older adults
<60
Signs of hypoglycemia in older adults
- Tachycardia
- Palpitations
- Diaphoresis
- Tremors
- Pallor
- Anxiety
Later symptoms of hypoglycemia in older adults include
- Headache
- Dizziness
- Fatigue
- Irritability
- Confusion
- Hunger
- Visual changes
- Seizures
- Coma
Immediate care for hypoglycemia
-Give glucose orally or IV
Hyperglycemia levels in older adults
200-600 or higher
Hyperglycemia
-Harder to detect and with aging there is higher tolerance.
Hyperglycemia increases the risk for
hyperosmolar hyperglycemic nonketotic coma → important in persons who are frail and should be considered in any older adult with diabetes who is difficult to arouse.
What is the best measurement for ongoing glycemic control?
Hgb A1C
Medications for DM
- Anti-glycemics and preventative adjuvant therapy such as ACE inhibitors and aspirin.
- Metformin is commonly prescribed as first-line therapy.
- Sulfonylureas may cause hypoglycemia and can only be used in persons who can monitor signs. (Chlorpropamide and glyburide are contraindicated)
- Insulin is used when all other strategies have failed.
Nonpharmacological Management of DM
- Nutrition
- Weight management
- Exercise
- Self-care
Self-care for DM
- Glucose self monitoring
- Medication self-administration
- Foot care and examination
- Recognize s/s hyperglycemia and hypoglycemia
Cause of hypothyroidism
- Insidious in onset, thought to be most commonly caused by chronic autoimmune thyroiditis (previously called Hashimotos disease)
- May be iatrogenic (induced inadvertently by provider, surgeon, or treatment) resulting from radioiodine treatment, subtotal thyroidectomy, or a number of medications, especially amiodarone (antiarrhythmic).
Subclinical Hypothyroidism
Normal serum T4 and somewhat elevated TSH (5-10 IU/mL)
Signs and symptoms of hypothyroidism that are probably less common in older adults
-Fatigue
-Weakness
-Depression
-Dry skin
Significantly less common include:
-Weight gain
-Cold intolerance
-Muscle cramps
Hyperthyroidism is caused by
It is most often caused by the autoimmune disorder Grave’s disease with multinodular or uninodular goiter
Hyperthyroidism can also result in
Ingestion of iodine or iodine-containing substances
Clinical manifestations of hyperthyroidism
- Often atypical and may not be diagnosed until the person has unexplained fibrillation, HF or even dementia.
- Likely to have tachycardia, tremors and weight loss.
Complications of Thyroid Disease
-Myxedema coma is a serious complication of untreated hypothyroidism in the older adult.
Myxedema coma
Severe hypothyroidism leading to decreased mental status, hypothermia and other symptoms related to slowing of function in multiple organs.
Myxedema coma symptoms
- Delayed DTRss
- Puffy Skin
- Bradycardia
- Hypotension
- Hypoventilation
- Stupor
- Coma
Why is rapid replacement of thyroxine in myxedema coma not possible?
Due to risk for drug toxicity
Death may occur
Over Replacement with thyroxine increases
Myocardial oxygen consumption.
May result in exacerbation of angina in those with pre-existing CAD or precipitate CHF.
Thyroid Disorders: Promoting Healthy Aging
The nurse caring for frail elders can be attentive to the possibility that the person who is diagnosed with anxiety, dementia, or depression may have a thyroid disturbance.
All persons having a depressive disorder must be checked for hypothyroidism.
The nurse works with the person and significant others in the correct self-administration of medications and appropriate timing of monitoring blood levels and signs and symptoms indicating exacerbation (Box 24-15, pg. 316 Touhy & Jett).
