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Age Related Changes and Common Disorders The Story of Mr. Taylor

Mr. Taylor is a 78 year old man, who lives on his own in his 3 bedroom bungalow. His wife passed away 8 months ago, and he is struggling to maintain his home. He has 3 children, two of which live in the same city.
by

Jocelyn Rempel

on 3 September 2011

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Transcript of Age Related Changes and Common Disorders The Story of Mr. Taylor

Mr. Taylor is a 78 year old man, who lives on his own in his 3 bedroom bungalow. His wife passed away 1.5 years ago, and he is struggling to maintain his home. He has 3 children, two of which live in the same city.
Mr. Taylor's daughter went to visit her father, and something just didn't seem right so she took him to his family physician. She told the doctor she wasn't exactly sure what was wrong but he just seemed more lethargic than usual. The daughter noticed that he was short of breath when he climbed the stairs in his home and reported this to the doctor as well.
Mr. Taylor stated he "was tired but that was just part of growing old". The Story of MR. TAYLOR The nurse questions Mr. Taylor about his medical history. He reports the following:
He has had ongoing hypertenstion since the age of 50. His family physician has had a difficult time controlling his blood pressure, and has tried a number of different medications. He reported that has tried exercising on a regular basis, but admitted he has been quite inconsistent with his exercise patterns. He has also tried to eat more healthy but this has been extremely difficult since his wife passed away. Mr. Taylor was diagnosed with left-sided Congestive Heart Failure six months ago, and has begun to notice that he becomes tired very easily when he tries to complete any task.

His current cardiovascular medications are:
Carvedilol 50mg PO BID
Ramipril 5mg BID
Irbesartan 300mg OD THE NURSING PROCESS

Assessment
Diagnosis
Plan
Implementation
Evaluation His physical examination reveals the following:
Temperature: 37.6
HR: 88
BP: 104/58
Resp: 20
O2: 90%
S1 and S2 heart sounds, no S3 or S4 sounds heard, slight pedal edema, capillary refil 5 seconds, fine crackles to lower lobes R>L, no cough, dry mucous membranes. The nurse inquires about Mr. Taylor's ability to take care of his home and himself.
He reports that he has difficulty now that his wife is gone.
"I just get so tired sometimes, and just don't have the strength I used to, and my knees and hands, well they hurt real bad from the arthritis and I don't like to take those Tylenol 3 pills too often. It makes it difficult for me to do my gardening and clean, and I only shower about once a week because I get too tired to shower any more than that." RESPIRATORY SYSTEM
Common Respiratory Conditions:
Respiratory Infections
COPD --> Chronic Bronchitis and Emphysema
Asthma
Lung Cancer QUESTION 2:
Older adults who have asthma should be aware of which potential side effect of sympatho-mimetic bronchodilating nebulized drugs?

a. Respiratory infection
b. Cardiac arrhythmias
c. Elevated serum potassium
d. Peptic ulcer QUESTION 1:
Which of the normal age-related changes in the respiratory system can increase the risk of infection in the older adult population?

a. Decrease in the anterior-posterior diameter of the chest
b. Increased strength of the thoracic musculature
c. Increase in residual volume and reduction in vital capacity
d. Decreased calcification of costal cartilage CARDIOVASCULAR SYSTEM
Common Cardiovascular Disorders
Hypertension
Hypotension
Congestive Heart Failure
Arrhythmias
Peripheral Vascular Disease QUESTION 3
Is the following statement true or false?

Symptoms of age-related changes in the cardiovascular system become most apparent when the older adult is faced with unusual physiologic stress. QUESTION 4
Postural and postprandial hypotension is most often related to:

a. Vasoactive medications and decreased baroreceptor activity
b. Antibiotics and increased cardiac output
c. Antispasmodic drugs and increased levels of potassium
d. Antibiotics and decreased renal function QUESTION 5
Which of the following breath sounds heard on auscultation would indicate an exacerbation of congestive heart failure?

a. Crackles
b. Vesicular
c. Bronchovesicular
d. Rhonchi QUESTION 6
Is the following statement true or false?

Hypokalemia, acute infections, hemorrhage, and coronary insufficiency are potential causes of arrhythmias in the older adult population. QUESTION 7
Which of the following foot care interventions is essential to older adults who have peripheral vascular disease?

a. Daily inspection of the feet
b. Wearing tight-fitting shoes for comfort
c. Application of heat to areas of infection
d. Vaccination to prevent varicella zoster Nurse: Do you get out of your house much?
Mr. Taylor: No, not really anymore. Ever since the cataracts started acting up again, I can't see well enough to drive. I used to be part of a bridge club just down the street at the community centre, but they always play music in the background, and my hearing aid just picks up that noise, so I never can hear anyone. And I'm just tired of always asking people to repeat themselves. I think people were getting annoyed at me, so I stopped going. Nurse: What about your eating patterns?
Mr. Taylor: I just don't have the appetite I used to. I mean I used to be able to eat at least two helpings of my wifes cooking, but ever since she passed away, I just don't feel like eating. And everything just doesn't taste as good as her cooking. I usually make myself a piece of toast in the morning and of course my coffee. My daughter brings me dinner about three times a week, but she never puts enough salt in there.
Nurse: Do you have lunch or snack throughout the day?
Mr. Taylor: I don't wake-up until 10, so I find I just need two meals a day. If I do get hungry, I always have a bag of cheezies or coffee crisp chocolate bar, but don't tell my daughter that because she will get mad and tell me how I shouldn't be eating that food because of my diabetes. GASTROINTESTINAL SYSTEM
Common GI Disorders:
Dental Problems
Dysphagia
Constipation SENSATION
Changes occur in all 5 senses
Hearing - Presbycusis
Sight - Presbyopia
Taste - decreased
Smell - decreased
Sensation -decreased QUESTION 13
Is the following statement true or false?

Atrophy of the small and large intestine, with fewer cells present on the absorbing surface of the intestinal wall, causes certain vitamins and minerals to have a decreased rate of absorption. QUESTION 14
Which of the following medical problems may result in dysphagia?

a. Hypertension
b. Gastroesophageal reflux disease
c. Osteoporosis
d. Diverticulosis GENITOURINARY SYSTEM
Common GI Disorders
Urinary Incontinence QUESTION 15
Is the following statement true or false?

Urinary frequency is caused by the normal age-related changes of hypertrophy of the bladder muscle and thickening of the bladder. QUESTION 16
Which of the following types of incontinence is caused by bladder neck obstructions and medications?
a. Stress incontinence
b. Urgency incontinence
c. Overflow incontinence
d. Neurogenic (reflex) incontinence QUESTION 17
Is the following statement true or false?

Half of all patients who have received an indwelling Foley catheter will develop bacteriuria within the first 24 hours of being catheterized. REPRODUCTIVE SYSTEM
Common Reproductive Disorders
Benign Prostatic Hyperplasia (BPH)
Erectile Dysfunction
Breast Cancer ENDOCRINE SYSTEM
Common Endocrine Disorders
Type II Diabetes Mellitus QUESTION 18
Is the following statement true or false?

Benign prostatic hyperplasia is a rare occurrence in otherwise healthy older men. QUESTION 22
Which of the following statements best describes the effects of aging changes on thyroid gland activity?
a. Lower basal metabolic rate
b. Inability of the thyroid to meet daily needs
c. Improved secretion of thyrotropin
d. Increased radioactive iodine uptake QUESTION 23
The effects of aging on the action of insulin include which of the following?
Insufficient release of insulin by the beta cells
Increased tissue sensitivity to circulating insulin
Improved ability to metabolize glucose
Decreased glucagon production QUESTION 24
Glycosylated hemoglobin levels monitor average blood glucose levels over what period of time?
a. 1-2 weeks
b. 3-4 weeks
c. 6-12 weeks
d. 12-20 weeks QUESTION 25
Is the following statement true or false?

Confusion and abnormal behavior are symptoms that may demonstrate hypoglycemia episodes in an older adult. MUSCULOSKELETAL SYSTEM
Common MSK Disorders
Osteoporosis
Fractures
Osteoarthritis
Rheumatoid Arthritis
Kyphosis QUESTION 8
Which of the following fractures is common in older adults as a result of a fall?
a. Neck of the femur
b. Colles’ fracture
c. Vertebral fracture
d. All of the above QUESTION 9
Is the following statement true or false?

Systemic symptoms often accompany osteoarthritis. QUESTION 10
Is the following statement true or false?

Key elements of strength training are resistance and progression. QUESTION 11
Which of the following age-related changes warrants adjustments in exercise programs for the older adult?

a. Increased stroke volume
b. Increased resistance to blood flow
c. Decreased residual capacity of the lungs
d. Proportionate decrease in body fat QUESTION 12
Is the following statement true or false?

Choosing an exercise program for an older adult can be achieved by identifying common activities that older adults enjoy and implementing a program based on your findings from the literature. NEUROLOGICAL SYSTEM
Common Neurological Disorders
Dementia
Delirium
Depression
Parkinson's Disease
TIA and Cerebrovascular Accident QUESTION 26
Which of the following is a normal age-related change of the nervous system?

a. Decline in the weight of the brain
b. Increase in cerebral blood flow
c. Stage I and II sleep are interrupted
d. Higher nerve conduction velocity QUESTION 27
Is the following statement true or false?

Cerebral blood flow decreases by 50% in older adults. QUESTION 28
Is the following statement true or false?

Secondary symptoms of Parkinson’s disease include depression, sleep disturbances, and dementia. QUESTION 29
Is the following statement true or false?

Signs and symptoms of a transient ischemic attack can last for several days, and complete recovery usually occurs within a week. QUESTION 30
Is the following statement true or false?

Persons who have experienced a cerebrovascular accident may experience depression and irritability toward others. QUESTION 19
Is the following statement true or false?

Arteriosclerosis, hypertension, diabetes, and nutritional deficiencies can threaten an older adult’s vision. QUESTION 20
Is the following statement true or false?

Patient compliance with treatment for glaucoma can be a problem in the older adult population. QUESTION 21
Which type of visual problem is associated with macular degeneration?

a. Loss of peripheral vision
b. Loss of central vision
c. Perception of spots moving across the eye
d. Pain with movement of the eye INTEGUMENTARY SYSTEM
Common Disorders
Pressure ulcers
Senile purpura
Abnormal healing
Telangiectasia
Cherry Angiomas
Venous Lake
Onychogryphosis
Onychomycosis
Herpes Zoster
Candidiasis IMMUNE SYSTEM CHANGES

Overall ability to provide protection … thus elders

are immuno-compromised
(this is a guiding clinical principle)

infections: ________? _______? ________?
cancers: ________? _______? ________?
autoimmune process ________? ________? SENSATION
Common Disorders to the Senses
Entropion
Ectropion
Cataracts
Glaucoma
Macular Degeneration The doctor diagnoses Mr. Taylor with pneumonia and sends him home on an oral antibiotic that he is to take for 7 days.
The daughter is concerned about her father's ability to take care of himself and his home and asks if there is anyway for him to get some assistance.
A homecare referral is completed. A homecare nurse comes to Mr. Taylor's home to complete an initial assessment. She knocks on the door and it takes several minutes before the door opens. Mr. Taylor apologizes for taking so long to get the door and informs the nurse that he sometimes feels dizzy when he stands up too quickly and needs to take his time .
The homecare nurse sits down with Mr. Taylor to complete the assessment. Symptoms:
Breathlessness, dyspnea, orthopnea (unable to breath when lying down), paroxysmal nocturnal dyspnea (fluid from extremities moves into circulation when lying down and produced pulmonary edema). Left-sided – crackles in lungs. Right-sided – edema, dilated neck vessels and congested liver The nurse inquires about his bowel routine.
Mr. Taylor described that he has been trying to increase his fibre intake lately because he has been feeling constipated lately. He is taking metamucil every morning, but it hasn't been too effective. He doesn't want to take anymore medications because he has a hard enough time swallowing all the pills he has to take now. He's not sure what else to try. Nurse: Mr. Taylor, do you have any trouble voiding?

Mr. Taylor: No, not really, but sometimes I feel like I can't get the urine to come out, and it takes a lot of force. And then when it does come out, it a very weak stream. Why do you think that is?
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