gero Chap 10

• Maslow's Hierarchy of Needs
• Chronic Illness Trajectory

• Self actualization
• Self esteem
• Belonging
• safety and Security
• Biological needs

• pre-trajectory- no signs or symptoms
• present
• trajectory on­set- symptoms are present, includes diagnostic period
• crisis phase- Life-threatening
• situation
• acute phase- Active illness or complications that require hospital­ization for management
• stable phase - Illness
• course/symptoms controlled by regimen
• un­stable phase - not controlled by regimen but not requiring hospitalization
• downward - Progressive deterioration in status / increasing disability/symptoms
• dying phase - immediate weeks. days, hours preceding death

Maintaining stable phases is central in the work of man­aging chronic illness

• leading cause of death
• second most common cause of disability

• hypertension;
• coronary heart disease (CHD), including myocardial infarc­tion and angina; and
• heart failure (HF)

• most common
• HTN is diagnosed any time the dia­stolic blood pressure reading is 90 or higher or the systolic reading is 140 or higher on two separate occasions

Older adults most often have either isolated systolic hypertension or diastolic-systolic hypertension; they rarely have isolated diastolic hypertension

• Normal <120
• systolic and <80 diastolic

• Prehypertension 120-139
• systolic or 80-89 diastolic

• Stage 1 HIN 140-159
• systolic or 90-99 diastolic

• Stage 2 HTN >160
• systolic or >100 diastolic

• for all persons > 140/90
• diabetic = > 130/80

primarily unknown: therefore it is called essential hypertension

Secondary cause are relatively rare in older adults but include pheochromocytoma

• Blood pressure : 130/80 Total
• cholesterol <200
• LDL <100
• HDL >40
• Triglycerides<150

• heart depends on the circulation delivered by the coronary arteries
• conditions that either completely or partially obstruct the blood flow to the heart muscle
• com­plete occlusion from ischemia is an AMI, or acute myocardial infarction

• genetic and envi­ronmental factors
• arteriosclerosis or atherosclerosis (accumulation of lipid-laden macrophages formation of lesions called plaques)
• Arteriosclerosis is considered an inflammatory condition

• Chest pain is the most common symptom of CHD
• due to ischemia described as a pressing or squeezing under breast bone
• In elder mild, localized to the back, abdomen, shoulders, or either or both arms.
• Nausea and vomiting or heartburn only

requires documentation of changes in biochemical markers within 24 to 72 hours of the event

• known as angina, may be intermittent and relieved by nitroglycerine and/or nitrates
• unstable angina ischemic increase in frequency, intensity,
• or duration with less and less provocation (associated with arrhythmias, tachycardia, and
• ventricular fibrillation)

Chronic CHD, the body attempts to compensate for damage of MI heart enlarges, changes shape leads to a decrease in cardiac pumping, gradual onset of heart failure months or years after the AMI

• Left-sided (diastolic) failure pulmonary symptoms, eventually cause right-sided failure
• right-sided (systolic) failure cardiac output that is inadequate to perfuse the vital tissues.
• definitive diagnosis heart chambers en­largement especially the ventricles.

• damage from hypertension and coronary heart disease
• compensate for the damage, ventricles, enlarges and dilates
• remodeling decreases heart function

• inflammation of the heart muscle, a condition termed .
• causes:
• viral infections
• bacterial infections
• lupus and other inflammatory diseases.
• Valvular heart dis­ease, regurgitation, increasingly cause of heart failure,

• present with exertion, eventually at rest
• periods of "baseline" symp­tomatology, then periods of exacerbation lead to hospitalization for stabilization with a return to baseline.

• fatigue or sob, orthopnea,
• paroxysmal nocturnal dyspnea, weight gain, and lower extremity edema.
• older adult, symptoms of exacerbations may
• general malaise. Common symptom clusters
• are present for right- and left-sided failure; however, many older adults have both-sided failure, the distinction is not very helpful.

• cluster of disorders vascular insufficiency affects primarily the lower extremities
• peripheral artery disease (PAD) (also called lower extremity arterial disease (LEAD]
• Chronic venous insufficiency (CVI) damaged or incompetent venous walls and valves, vericose viens , deep vein, thrombosis (DVT)

Pain from intermittent blockage of circulation

• 4 causes are arterial disease, cardioembo­lism,
• hematological disorders, and systemic hypoperfusion.

• occlusion of the vessel lumen from
• thrombus or embolus
• rupture of the vessel
• alteration in vessel permeability, such as changes in bloodviscosity

• uncontrolled hypertension malformations
• of the blood vessels (e.g., aneu­rysms)

• chronic hypertension causes thickening of the vessel wall,
• microaneurysms, and necro­sis.

• Resolution resorption of excess blood
• and damaged tissue.

Hemorrhagic strokes more life threatening but much less frequent than thrombotic strokes.

acute neurological deficits

heralded by a severe headache.

• clinical signs and symptoms suggest either
• ischemia or hemorrhage

• hemorrhage
• more focal neurological changes more depressed level of
• consciousness than ischemic stroke.

• Focal changes alternations in motor,
• sensory, and visual
• function; coordination; cogni­tion; and language

• • Sudden weakness or numbness on one side of the body (face, arm, or leg)
  • Dimness or loss of vision in one eye
  • Slurred speech, loss of speech, difficulty comprehending speech
  • Dizziness, difficulty walking, loss ofcoordination, loss of balance, a fall
  • Sudden severe headache
  • Difficulty swallowing
  • Sudden confusion
  • Nausea and vomiting

• presentation in elders one of dehydration, confusion, delirium,
• decreased visual acuity. In severe cases, the person may be found obtunded in a nonketotic hyperglycemic-hyperosmolar coma
• plasma glucose 200 mg/dL with symptoms OR TWO of any combination of positive tests on different days: Fasting plasma glucose (FPG) >/=126 mg/dL on sepa­rate occasions (NOTE: This is not blood glucose levels that are obtained with a fingerstick.) Oral glucose tolerance test (OGTT) >/=200 mg/dL 2 hours after glucose Random plasma glucose >/=200 mg/dL without symptoms Diagnosis of impaired glucose tolerance requires: Glucose between 141 and 199 mg/dL 2 hours after a glucose challenge impaired fasting glucose (IFG) requires: Fasting blood glucose between 110 and 125 mg/d1

• develops in early life
• autoimmune destruction of the insulin-producing
• cells of the pancreas.

• non insulin­dependent diabetes mellitus
• a relative insulinopenia.
• insulin resistance in peripheral tis­sues

• TSH is elevated in hypothyroidism as the pituitary tries to stimulate theunderfunctioning thy­roid;
• TSH decreased in hyperthyroidism as the pituitary responds to the elevated blood levels of the thyroid hormone thyroxine (T4)

• multinodular toxic goiter.
• ingestion of iodine or iodine-containing substance seafood, radio-contrast agents
• medication

s/s palpitations excessive perspiration

• more common
• autoimmune thyroiditis, radioiodine treatment, subtotal thyroiddectomy, or a number of medications, pituitary or
• hypothalamic abnormality

• s/s
• the elder - fatigue, weakness, depression, confusion. The

aging, polypharmacy,co-morbid conditions, inactivity,

• disorders of thegastrointestinal
• most common are constipation
• diverticular disease,
• gastroesophageal reflux disease (GERD).

• Diverticula are small herniations through the muscle
• layers of the sigmoid colon

• Diverticulitis is an acute inflamma­tory complication of
• diverticulosis, bleeding, possible fever and ele­vated white blood cell count

LLG PAIN AND possible palpable mass

• gastric contents, especially gas­tric acid into the
• esophagus
• abnormality of the lower esophageal sphincter (LES)

• s/s - this is usually diagnosed as dyspepsia. When com­bined with sensations of heartburn and especially regurgita­tion or a sour or burning taste in the mouth, it is
• more likely to be GERD

• adults more commonly have more atypi­cal
• symptoms of persistent cough, exacerbations of asthma, laryngitis, and
• intermittent chest pain. Abdominal pain may occur within 1 hour of eating, and symptoms are
• worse when lying down with the added pressure of gravity on
• the LES

• acute or chronic
• upper or lower respiratory tract
• obstructive—preventing airflow out as a result
• of obstruction or narrowing
• restrictive— causing a decrease
• in total lung capacity as a result of limited expansion

• catch-all term used to encompass those conditions that
• obstruct airflow and include emphysema and chronic bronchitis
• Chronic bron­chitis - 3 months in 2 consecutive years or 6 months in 1 year
• Emphysema - dilated air spaces distal to the terminal bronchiole associated with destruction of the alveolar wall

• inhalation of toxins and pollutants, especially tobacco
• smoke—either directly or indirectly
• from secondhand smoke

s/s cough, dyspnea on exertion, and increased phlegm production

• later signs wheezin, prolonged expiration, pursed-lip breathing, barrel chest. air trapping, hyperresonance, pale lips or nail beds,
• fingernail clubbing, and use of accessory
• breathing muscles

• inflammatory airway disease
• linked to allergic mechanisms
• brochio constriction
• Spirometry before and after the administration
• of broncho­dilators is used in
• diagnosis

s:s - recurrent episodes of wheezing, shortness of breath, non­productive cough, worse at night or in the early morning

• communicable and infectious disease
• Mycobacterium tuberculosis, Mycobacterium bovis, and Myco­bacterium africanum

• Etiology: transmitted from person to person by airborne droplets,
• HIV factor into reactivation of the bacilli

SS - Weight loss, cough, night sweats, fever,

• osteoarthritis, rheumatoid arthritis, and gout also
• giant cell (temporal) arteritis (GCA)
• granulomatous inflammation of the aorta and its
• branches and the cranial arteries
• antigen-driven disease

ss - HA Sclap tendrness/ with visual medical emergency because of the blindness.