Tabloski ch19 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

The Endocrine System

19

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Describe age-related changes that affect endocrine function.

2. Recognize the impact of age-related changes on endocrine function.


Learning Objectives

3. Identify risk factors to health for the older person with an endocrine problem.

4. Understand unique presentations of diabetes and thyroid problems in the older person.


Learning Objectives

5. Apply appropriate nursing interventions directed toward helping older adults with endocrine problems develop self-care abilities.

6. Identify and implement appropriate nursing interventions to care for the older person with endocrine problems.


Introduction

• The endocrine glands control the body’s metabolic processes. The endocrine and metabolic control systems offer many of the greatest opportunities for preventing the disabilities associated with aging.

• Two major endocrine problems of importance to gerontological nursing are diabetes mellitus and thyroid disease.


Introduction

• Knowledge of endocrine function and metabolism and an understanding of normal changes associated with aging are crucial for gerontological nurses in order to interpret signs and symptoms of illness and advise older persons on health promotion activities.


Diabetes Mellitus

• Diabetes mellitus (DM) is highly prevalent and its incidence is increasing in persons over 65, particularly in racial and ethnic minorities.


Figure 19-3 U.S. diabetes prevalence in people age 20 years or older, 2010.Source: Centers for Disease Control and Prevention. National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States 2011, Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.


Risk Factors for Development of Diabetes Mellitus

• Patients with type 2 DM are often overweight and have higher percentages of body fat.

• Blood glucose levels decrease and may return to normal when the patient loses weight.

• Lifestyle modification may delay or prevent the development of type 2 DM in high-risk individuals.


Diagnostic Criteria

• When an older person is identified as high risk for diabetes and presents with the symptoms of DM such as polyuria, polydipsia, unexplained weight loss, plus a random plasma glucose concentration of >200 mg/dL, appropriate testing includes a fasting plasma glucose (FPG) level (preferred), a 2-hour oral glucose tolerance test (OGTT), and a HbA1c greater than 6.5.


Diagnostic Criteria

• The nurse should inform older persons and their families regarding the need to prepare carefully for the FPG and the 2-hr OGTT and explain how the ingestion of food can raise the blood glucose levels and result in a false positive diagnosis of DM.


Diagnostic Criteria

• The principal goals of therapy are to enhance quality of life, decrease chance of complications, improve self-care through education, and maintain or improve general health status.


Therapeutic Management

• The goals of management of DM in the older person include achieving normal or near-normal blood glucose levels through self-management techniques, including self-monitoring of blood glucose levels; recognition, treatment, and prevention of hypoglycemia; prevention, early detection, and treatment of chronic complications; nutrition therapy; regular physical activity; and provision of continuing education.


Therapeutic Management

• Controlling DM in the older person requires intervention in several areas:–Weight management–Appropriate use of medications–Aggressive management of comorbid

conditions–Prevention of complications


Weight Management

• Nutritional guidelines for older persons with DM include:–Eat less fat.–Eat less sugar.–Eat less salt.–Eat foods with higher fiber.–Avoid or reduce alcohol.– Limit protein intake to about 20% of

daily energy intake.


Weight Management

• Regular exercise can reduce cardiovascular risk factors, decrease risk of falls, improve functional capacity, and improve blood glucose control.

• Walking is one of the easiest ways to be active. It can be done almost anywhere and anytime.


Medications Used to Control DM

• Pharmacologic therapy is recommended for older adults who have been unable to achieve optimal blood glucose control after 6 months of intensive lifestyle modification (exercise and improved diet); have symptomatic hyperglycemia; are ketotic; and/or have concurrent illness, medications, or surgery that worsen glycemic control.


Effect of Acute Illness

• The nurse and other members of the healthcare team will attempt to regulate medications and oral intake to prevent dangerous variations in blood glucose levels.


Nonketonic Hyperglycemic-hyperosmolar Coma

• Nonketotic hyperglycemic-hyperosmolar coma (NKHHC) is a complication of type 2 DM that has a high mortality rate.


General Health Promotion

• The nurse should teach older persons with DM and their families self-management skills including self-monitoring for signs of hypoglycemia, blood glucose monitoring skills and medication adjustment, nutrition management, and development and maintenance of a physical activity plan.


Difficulties in Caring for Older Adults with DM

• Six geriatric syndromes represent areas where gerontological nurses can intervene and collaborate with other healthcare professionals to improve the quality of care provided to older persons with DM. They include:–Polypharmacy–Depression–Cognitive impairment


Difficulties in Caring for Older Adults with DM

• Six geriatric syndromes represent areas where gerontological nurses can intervene and collaborate with other healthcare professionals to improve the quality of care provided to older persons with DM. They include:–Urinary incontinence– Injurious falls–Pain


Thyroid Disorders

• When thyroid dysfunction is present, and insufficient or excessive amounts of thyroid hormone are produced, the nurse may see dramatic effects in the cardiovascular system, hematologic system, and central nervous system.

• Hypothyroidism is characterized by a generalized reduction in metabolic function that most often manifests as a slowing of physical and mental activity.


Thyroid Disorders

• Hyperthyroidism, or thyrotoxicosis, is the result of excess thyroid hormone with metabolic overstimulation of body function.


Hyperthyroidism

• The nurse should obtain a comprehensive health history and physical assessment with emphasis on weight and blood pressure, pulse rate and rhythm, thyroid palpation, neuromuscular examination, eye examination, vision assessment, and cardiovascular assessment.


Nursing Diagnoses Associated with Endocrine Problems

• Nursing diagnoses associated with older persons with endocrine problems are diverse and depend upon the older person’s severity of illness and success of treatment:– Imbalanced Nutrition

More Than Body Requirements

–Risk for Infection and Risk for Sensory/Perceptual Alterations Tactile


Nursing Diagnoses Associated with Endocrine Problems

• Nursing diagnoses associated with older persons with endocrine problems are diverse and depend upon the older person’s severity of illness and success of treatment:–Sleep Deprivation, Fatigue–Risk for Activity Intolerance– Ineffective Thermoregulation–Risk for Imbalanced Body Temperature

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Tabloski ch19 lecture