Kristen Mauk

About Kristen Mauk

President/CEO - Senior Care Central, LLC

Diverticulosis and Diverticulitis Treatment

Colorful fresh group of vegetables and fruits

Background

Diverticulosis results from pouches that form in the wall of the colon (or large intestine). Diverticulitis is an inflammation or infection of these pouches. Diverticular disease is more common among older adults than younger people (Tursi, 2007). Sixty-five percent of older adults will develop diverticulosis by age 85 (Kennedy-Malone et al. 2004). The exact cause of diverticulosis is not known, but it is speculated that a diet low in fiber and high in refined foods causes the stool bulk to decrease, leading to increased colon transit time. Retention of undigested foods and bacteria results in a hard mass that can disrupt blood flow and lead to infection. The earlier the diagnosis and treatment, the better the outcomes will be; however, if complications such as bleeding increases the risk of less- than- optimal outcomes.

Warning Signs

Risk factors for diverticulosis include obesity, chronic constipation, and straining, irregular and uncoordinated bowel contractions, and weakness of bowel muscle due to aging. Other risk factors are directly related to the suspected cause of the condition. These include older than 40 years old of age, low-fiber diet, and the number of diverticula in the colon (Thomas, 2011). Diverticulosis may result in pain in the left lower quadrant (LLQ), can get worse after eating, and may improve after a bowel movement. Warning signs of diverticulitis include fever, increased white blood cell count, bleeding that is not associated with pain, increased heart rate, nausea, and vomiting.

Diagnosis

Evaluation of the abdomen may reveal tenderness in the LLQ and there may be rebound tenderness with involuntary guarding and rigidity. Bowel sounds may be initially hypoactive and can be hyperactive if the obstruction has passed. Stool may be positive for blood. The initial evaluation is abdominal Xx-ray films, followed by a barium enema, though a CT scan with oral contrast is more accurate in diagnosing this condition (Thomas, 2011). A complete blood count may be done to assess for infection.

Treatments

Diverticulosis is managed with a high-fiber diet or daily fiber supplementation with psyllium. Diverticulitis is treated with antibiotics, but in acute illness the person may require hospitalization for IV hydration, analgesics, bowel rest, and possible NG tube placement. Morphine sulfate should be avoided because it increases the intraluminal pressures within the colon, causing the symptoms to get worse (Thomas, 2011). Patients should learn about a proper diet, avoidance of constipation and straining during bowel movements, and when to seek medical care. The diet should include fresh fruits, vegetables, whole grains, and increased fluid intake, unless contraindicated. In extreme cases, either where the person has complications that do not resolve with medical management or has many repeated episodes, a colon resection may be needed. Patients will need to work closely with their primary care provider to manage any ongoing problems.

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. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

For more information on Diverticulosis, visit NDDIC at:
digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/

 

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By | 2017-08-30T09:14:08+00:00 August 30th, 2017|News Posts|Comments Off on Diverticulosis and Diverticulitis Treatment

Shingles (Herpes Zoster)

Background

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 | 2017-08-16T09:40:18+00:00 August 16th, 2017|News Posts|Comments Off on Shingles (Herpes Zoster)

Peripheral Artery Disease

Background

Peripheral artery disease (PAD), the most common type of peripheral vascular disease (PVD), affects 8–12 million Americans, 12–20% of those over the age of 65, and could reach as many as 9.6 million Americans by the year 2050 (Cleveland Clinic, 2012).

Risk Factors/Warning Signs

The risk factors for PAD are the same as those for coronary heart disease (CHD), with diabetes and smoking being the greatest risk factors (AHA, 2005). Ac¬cord¬ing to the American Heart Association, only 25% of those older adults with PAD get treatment. PAD increases the risk of CHD, heart attack, and stroke.

Diagnosis

The most common symptoms of PAD are leg cramps that worsen when climbing stairs or walking, but dissipate with rest, commonly called intermittent claudication (IC). The majority of persons with PAD have no symptoms (AHA, 2005). PAD is a predictor of CHD and makes a person more at risk for heart attack and stroke. Left untreated, PAD may eventually lead to impaired function and decreased quality of life, even when no leg symptoms are present. In the most serious cases, PAD can lead to gangrene and amputation of a lower extremity.

Treatments

Most cases of PAD can be managed with lifestyle modifications such as those for heart-healthy living. This includes maintaining an appropriate weight, limiting salt intake, managing stress, engaging in physical activity as prescribed, quitting smoking, and eating a heart-healthy diet.
Patients with PAD should discuss their symptoms with both their healthcare provider and a physical therapist, because some patients find symptom relief through a combination of medical and therapy treatments (Aronow, 2007; Cleveland Clinic, 2012).

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.

For more information on PAD, visit NIH at:
www.nhlbi.nih.gov/health/health-topics/topics/pad/

 

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By | 2017-08-11T09:19:41+00:00 August 11th, 2017|News Posts|Comments Off on Peripheral Artery Disease
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