Kristen Mauk

/Kristen Mauk

About Kristen Mauk

President/CEO - Senior Care Central, LLC

Shingles (Herpes Zoster)

Commonly known as shingles, herpes zoster is the reactivation of the varicella virus that causes chicken pox. Older persons may be infected with this latent virus after initial exposure to it in the form of chicken pox. The virus then lays dormant in the neurons until it is reactivated, often due to immunosuppression, when it appears in the form of painful vesicles or blisters along the sensory nerves. This reactivation tends to occur once in a lifetime, with repeat attacks occurring about 5% of the time (Flossos & Kostakou, 2006). Herpes zoster occurs in both men and women equally, with no specific ethnic variations, but is more common in the elderly.

Risk Factors

Risk factors for developing shingles are age over 55 years, stress, and a suppressed immune system. For many older women particularly, emotional or psychological stress can trigger recurrence.

Warning Signs

Signs and symptoms of herpes zoster include painful lesions that erupt on the sensory nerve path, usually beginning on the chest or face. They may appear as initially as a rash, looking much like chicken pox, often wrapping around the chest area in a band-like cluster. These weepy vesicles get pustular and crusty over several days, with healing occurring in 2-5 weeks (Kennedy-Malone et al., 2004; NINDS, 2013).

Diagnosis

Diagnosis is usually made by viewing the appearance of the lesions and a history of onset. A scraping will confirm some type of herpes virus. The most common complaint of those with herpes zoster is the painful blisters that usually subside in 3–5 weeks (NINDS, 2013). Postherpetic neuralgia, a complication of herpes zoster, may last 6–12 months after the lesions disappear and may involve the dermatome, thermal sensory deficits, allodynia (the perception of pain where pain should not be), and/or severe sensory loss, all of which can be very distressing for the patient (Flossos & Kostakou, 2006).

Prevention

Zostavax, a vaccine for shingles, has become available, and it is recommended for all persons age 60 or older who have already had the chicken pox. A person can still get shingles even after having the vaccine, but the symptoms and complications would be less severe. The vaccine has also been approved for persons age 50 – 59, and research has shown that receiving the vaccine significantly decreases the rate of shingles in the population (NINDS, 2013; PubMed Health 2012).

Treatment

Antiviral medications (such as Acyclovir) are used to treat shingles, but must be given within 48 hours of the eruption of the lesions. Topical ointments may help with pain and itching. Pain medications, particularly acetaminophen (Tylenol), are appropriate for pain management in older adults. If a fever is present, rest and drinking plenty of fluids is suggested. Persons with pain that lasts past 6 weeks after the skin lesions are gone and that is described as sharp, burning, or constant require re-evaluation by a physician. Postherpetic neuralgia may be a long-term complication lasting years (PubMed Health, 2012).

The person should be advised to seek medical attention as soon as he or she suspects shingles, in order to receive the best results from Acyclovir. The virus will run its course, but the person is contagious while vesicles are weepy. Persons should not have direct contact (even clothing) with pregnant women, people who have not had chicken pox, other elderly persons, or those with suppressed immune systems. The older person with shingles may experience concerns with pain management and feel a sense of isolation, particularly if they live alone. Arranging for a family member or friend who does not have a high risk of infection to check on the older person at home is advisable.

Visit the National Institute of Neurological Disorders and Strokes (NINDS) for an informational page on Shingles at: http://www.ninds.nih.gov/disorders/shingles/shingles.htm

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

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By |2019-10-27T23:01:56-05:00November 8th, 2019|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Shingles (Herpes Zoster)

Bladder Cancer Risk Factors and Treatment

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Background

This type of cancer occurs mainly in older adults, with an average age at diagnosis of 73 years, with 9 out of 10 cases of bladder cancer diagnosed in persons over age 55. The American Cancer Society (ACS)(2012) reported that over 73,000 cases were diagnosed in 2012 and that this diagnosis rate has been relatively stable over the last 20 years. Men are three times as likely to get cancer of the bladder as women (American Foundation for Urologic Disease, 2008) and the incidence increases with age.

Risk Factors

Risk factors include chronic bladder irritation and cigarette smoking, the latter contributing to over half of cases. Male gender and age are also risk factors.

Warning signs

The classic symptom of bladder cancer is painless hematuria (blood in the urine). Older adults may attribute the bleeding to hemorrhoids or other causes and feel that because there is no pain, it must not be serious.

Diagnosis

Assessment begins with a thorough history and physical. Diagnosis may involve several tests including an intravenous pyelogram (IVP), urinalysis, and cystoscopy (in which the physician visualizes the bladder structures through a flexible fiber-optic scope). This is a highly treatable type of cancer when caught early. In fact, the ACS (2012a ) estimates that there were more than 500,000 survivors of this cancer in 2012.

Treatment

Once diagnosed, treatment depends on the invasiveness of the cancer. Treatments for bladder cancer include surgery, radiation therapy, immunotherapy, and chemotherapy (ACS, 2012). Specifically, a transurethral resection (TUR) may involve burning superficial lesions through a scope. Bladder cancer may be slow to spread, and less invasive treatments may continue for years before the cancer becomes invasive or metastatic, if ever. Certainly chemotherapy, radiation, and immune (biological) therapy are other treatment options, depending on the extent of the cancer.

Immune/biological therapy includes Bacillus Calmette-Guérin (BCG) wash, an immune stimulant that triggers the body to inhibit tumor growth. BCG treatment can also be done after TUR to inhibit cancer cells from re-growing. Treatments are administered by a physician directly into the bladder through a catheter for 2 hours once per week for 6 or more weeks (Mayo Clinic, 2012a). The patient may be asked to lay on his/her stomach, back, and or sides throughout the procedure. The patient should drink plenty of fluids after the procedure and be sure to empty the bladder frequently. In addition, because the BCG contains live bacteria, the patient should be taught that any urine passed in the first six 6 hours after treatment needs to be treated with bleach: One cup of undiluted bleach should be placed into the toilet with the urine and allowed to sit for 15 minutes before flushing (Mayo Clinic, 2012a).

If the cancer begins to invade the bladder muscle, then removal of the bladder (cystectomy) is indicated to prevent the cancer from spreading. Additional diagnostic tests will be performed if this is suspected, including CT scan or MRI. Chemotherapy and/or radiation may be used in combination with surgery. When the cancerous bladder is removed, the person will have a urostomy, a stoma from which urine drains into a collection bag on the outside of the body, much like a colostomy does. Bleeding and infection are two major complications after surgery, regardless of type, whether a TUR or cystectomy is performed. Significant education of the patient related to intake/output, ostomy care, appliances, and the like is also indicated.

For more information on Bladder Cancer, visit National Cancer Institute at:
http://www.cancer.gov/cancertopics/wyntk/bladder/

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

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By |2019-10-27T22:58:20-05:00November 1st, 2019|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Bladder Cancer Risk Factors and Treatment

Be informed about Stroke

May is National Stroke Awareness month, so this is a good time to reflect on stroke prevention and treatment. Consider these facts about stroke from the American Stroke Association (2013): Be informed about stroke.

• Nearly 800,000 Americans annually suffer a new or recurrent stroke.
• A stroke occurs about once every 40 seconds. About every 4 minutes, someone dies of a stroke.
• Stroke is the 4th leading cause of death in the United States, killing more than 137,000 people a year.
• Risk of stroke death is higher for African American males and females than for whites. Females have a higher rate of death from stroke than males.
• In 2010, Americans paid about $73.7 billion for stroke-related medical costs and disability.

Stroke is simply defined as an interruption of the blood supply to the brain. It is most often caused by a clot that either originated in the brain or traveled from another part of the body. Warning signs of stroke include (National Stroke Association, 2013):
• Sudden weakness or paralysis, usually on one side of the body
• Sudden confusion, speaking or understanding
• Sudden changes in vision
• Sudden dizziness, incoordination, or trouble walking
• Sudden severe headache with no known cause

If you or someone you love experiences any of these symptoms, call 911 immediately. Do not delay. New medical treatments may be able to reverse the effects of stroke, but time is critical. Note the time that the symptoms started so that you can inform the medical professionals who are providing treatment.
The effects of stroke depend on the area of the brain that is damaged. Some common results of stroke are weakness or paralysis on one side of the body, difficulty walking or dressing oneself, aphasia, trouble eating or swallowing, bowel and bladder changes, cognitive changes such as memory problems, and emotional issues such as depression and mood swings. Stroke affects the entire family, so be sure to seek out resources and support in your community if a stroke has touched your family.

For stroke survivors, treatment in an acute rehabilitation facility with an interdisciplinary team approach is highly recommended and results in more positive outcomes. The rehabilitation team works together with the survivor and family to accomplish personal goals and achieve the highest level of function possible. Although some of the effects of stroke may be long-lasting or permanent, there is hope of continued progress and good quality of life after stroke.

By |2019-10-27T22:57:38-05:00October 31st, 2019|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Be informed about Stroke

The 6-Step Process of Stroke Recovery

Caring For Husband

 

According to the CDC, nearly 800,000 persons in the United States have a stroke each year. This is about one every 4 minutes, resulting in over 130,000 deaths annually. Stroke is simply defined as an interruption to the blood supply to the brain and is caused by a clot or hemorrhage. It can be a devastating problem for survivors, resulting in changes in mobility, cognition, speech, swallowing, bowel and bladder, self-care, and general functioning to varying degrees.  Some people recover completely after a stroke, but others experience lifelong challenges.

The good news is that there is hope and quality of life after stroke. In my research with stroke survivors, I discovered 6 phases that survivors reported as they made the journey through rehabilitation towards recovery. These steps can be used to see where a person is in the recovery process, help us understand how they may be feeling, and help guide the way we interact with them.

Agonizing:  In this first phase of the process, stroke survivors are in shock over what has happened to them. They can’t believe it, and may even deny the warning signs of stroke. The important task during this time is survival from the stroke itself.  Call 911 if you see the warning signs of facial droop, arm weakness, or speech difficulties.

Fantasizing:  In the second phase of the stroke process, the survivor may believe that the symptoms will all go away. Life will return to normal, and there is a sense of the problem being unreal. Time takes on a different meaning. The way to help is to gently help them recognize reality, and without taking away hope for recovery.

Realizing: This is the most important phase that signals a turn in the recovery process. This is when the survivor realizes that he/she may not fully recover from the effects of the stroke and that there is work to be done to rehabilitate and reclaim life. Common feelings during this phase of realizing are anger and depression. The way to help is to encourage the person to actively engage in rehabilitation. The real work of recovery is just beginning.

Blending: These last 3 phases in the process of stroke recovery may be occurring at much the same time. This is where the real work of adaptation to life after stroke begins. The survivor begins to blend his “old life” before stroke with his new life as a stroke survivor. He/she may start to engage in former activities even if it requires adaptations to be made. He/she will be actively engaged in therapy and finding new ways to do things. The way to help is to promote education. This is a time when survivors are most ready to learn how to adjust to life after stroke. Listen to your rehab nurses, therapists, and physician. Be active in the recovery process.

Framing: During this phase, the individual wants to know what caused the stroke. Whereas in the Agonizing phase they were asking “why me?”, now they need to the answer to “what was the cause?”  Stroke can be a recurring disorder, so to stop a subsequent stroke, it is important to know the cause. Interestingly, if the physician has not given the survivor a cause for the first stroke, patients often make up a cause that may not be accurate. Help the survivor to learn from the health care provider what the cause of his/her own stroke was. Then steps can be taken to control those risk factors.

Owning:  In this final phase of stroke recovery, the survivor has achieved positive adaptation to the stroke event and aftermath. The survivor has accomplished the needed grief work over the losses resulting from the stroke. He/she has realized that the effects may not go away and has made positive adjustments to his/her life in order to go on. Survivors in this phase have blended their old life with the new life after stroke and feel better about their quality of life. While they still may revisit the emotions of the prior phases at times, they have accepted life as a survivor of stroke and made good adjustments to any changes that resulted. They feel that they have a more positive outlook on life. At this point, survivors can use their experience to help others cope with life after stroke.

For more information about stroke recovery, visit www.seniorcarecentral.net and view Dr. Mauk’s model for stroke recovery.

By |2019-10-27T21:17:30-05:00October 29th, 2019|Dr. Mauk's Boomer Blog, News Posts|Comments Off on The 6-Step Process of Stroke Recovery

Pneumonia Information


According to the CDC (2010), chronic lower respiratory disease and pneumonia with influenza are the third and ninth leading causes of death, respectively, among older adults. Older adults 65 and older are more often affected by these disorders than younger adults, and the risk of death from pneumonia increases with age. In 2005, there were 651,000 hospital discharges of males diagnosed with pneumonia and 717,000 discharges of females, with greater than 62,000 deaths attributed to pneumonia (American Lung Association [ALA], 2008). The majority of these cases occurred in those age 65 and older, with the elderly having 5–10 times the risk of death from pneumonia as younger adults (Kennedy-Malone, Fletcher, & Plank, 2004).

Pneumonia is an infection of the lung that can be caused by bacteria, viruses, or mycoplasmas. The two most common ways to get pneumonia are through inhalation of droplet particles carrying infectious germs and aspiration of secretions of the nose or mouth areas. Older adults are at higher risk for pneumonia and can get a more serious infection if they also have other chronic diseases such as COPD, heart failure, a suppressed immune system, cerebrovascular disease, and poor mobility (ALA, 2012). The incidence of community-acquired pneumonia (CAP) among people age 65 and older is about 221.3 per 10,000 (ALA, 2008). Streptococcus is the most common bacterial cause, with about 50% of people with CAP requiring hospitalization (Weinberger, 2004). When hospitalized, older people are at risk for poor health outcomes, including respiratory failure requiring ventilator support, sepsis, and longer length of hospitalization, duration of antibiotic therapy and other supportive treatment (ALA, 2012).

Warning signs

The onset of bacterial pneumonia can be sudden or gradual; however, older adults may not present with the typical symptoms of chills, fever, chest pain, sweating, productive cough, or shortness of breath. Instead, they may have a sudden change in mental status (confusion/delirium). Cases of viral pneumonia account for about half of all types of pneumonia and tend to be less severe than bacterial pneumonia. Symptoms of viral pneumonia include fever, nonproductive hacking cough, muscle pain, weakness, and shortness of breath.

Diagnosis

Diagnosis is made through chest x-ray, complete blood count, and/or sputum culture to determine the type and causal agents (if bacterial). A thorough history and physical that includes assessment of swallowing ability and eating (watch for coughing while eating) to evaluate for aspiration risk should be done. Crackles may be heard in the lungs through a stethoscope, and chest pain with shortness of breath may be present.

Treatment

Bacterial pneumonia can often be treated successfully when detected early, and viral pneumonia generally heals on its own (antibiotics are not effective if pneumonia is caused by a virus), though older adults may experience a greater risk of complications than younger adults. Oral antibiotics will significantly help most patients with bacterial pneumonia.

Aspiration pneumonia is caused by inhalation of a foreign material, such as fluids or food, into the lungs. This occurs more often in persons with impaired swallowing. For older adults receiving tube feedings, care must be taken to avoid having the person in a laying position during and immediately after tube feeding because aspiration can occur; it is important to note that tube feedings do not reduce the risk of aspiration. Having the head of the bed elevated or, even better, the person in a sitting position when eating or receiving nutrition through a feeding tube, helps to avoid the potential complication of pneumonia related to aspiration.

When recovering from pneumonia, one should get plenty of rest and take adequate fluids to help loosen secretions (with accommodations made to support the added need to urinate due to the increased fluid intake, a common reason why older adults may not drink adequate fluids). Tylenol or aspirin (if not contraindicated by other conditions) can be taken to manage fever as well as aches and pains. Exposure to others with contagious respiratory conditions should be avoided. Respiratory complications are often what lead to death in the older adults, so they should be cautioned to report any changes in respiratory status such as increased shortness of breath, high fever, or any other symptoms that do not improve. It is important to follow up with the physician or nurse practitioner and get a chest x-ray if ordered, since symptoms may improve with treatment before the pneumonia is actually completely gone.

Prevention of pneumonia is always best. Adults over the age of 65 are advised to get a pneumonia vaccine. Persons younger than age 65 who have higher risk (those with respiratory problems or persons in nursing homes) should get the vaccination. A yearly flu vaccine is also recommended for older adults, because pneumonia is a common complication of influenza in this age group. Medicare will cover these vaccines for older persons.

By |2019-10-11T12:14:46-05:00October 16th, 2019|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Pneumonia Information