Kristen Mauk

About Kristen Mauk

President/CEO - Senior Care Central, LLC

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 |2018-08-19T17:39:36+00:00August 23rd, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Pneumonia Information

Kidney Stone versus Labor – And the Winner is?

I had always heard that kidney stones were the closest thing to labor pain and childbirth that a man could experience, but being a woman who had been through labor four times, I didn’t quite believe it or understand the comparison. That is, until the other day…

I was sitting at the computer writing and felt a pain like a muscle cramp in my right side. But, since I couldn’t recall having done anything strenuous the day before, I just figured I had been sitting too long in one spot. Moving around helped for a brief time until the pain returned, more intense and radiating from the right flank around my side and down to my groin. Hmmm….being a nurse I wondered what this could be so I tried the usual techniques as the pain intensified: Tylenol, the massage chair, walking, lying down, sitting up, and having the kids rub my back. Yikes, the pain that can only be described as an unrelenting, constant hurt of the greatest magnitude, a 12 on the pain scale of 1 – 10, which no positioning or over the counter pain medication can touch had me rolling on the floor and telling the kids to call Dad to come home from work now.

Yes, that was just the beginning of my kidney stone experience. In trying to explain the pain to my husband on the phone, he said I sounded so short of breath that he thought I was having a heart attack and called EMS. When they arrived, the pain had subsided and I was left to diagnose myself with a kidney stone, with which the paramedics agreed. But since the pain was completely gone, did I really need to go to the hospital and in an ambulance no less? On their recommendation, the answer was yes.

In the ER, the IV was started and a CAT scan done to confirm our suspicions. Having no history of kidney stones, I was surprised at this painful attack that came on with no warning at all.

The ER doctor came in to see us and said in a thick accent, “Well, you were right. In 5 – 7 days you will have a special delivery!” he laughed.

I glanced at my husband who had turned white and later told me he thought for a second, “you mean she’s having a baby?!” (which at 53 surely would have been some sort of miracle). My first thought was “5 – 7 days of this pain? Are you kidding me?” How will I survive?

Another painful bout came as I lay on the gurney, and four strong IV medications didn’t completely take away the pain. We were told the pain comes from the spasms of the ureter as the stone blocks the flow of urine and irritates the inflamed tissues. Who could imagine that a 2 mm stone the size of a grain of sand could cause so much discomfort? The word intractable pain had new meaning for me now and I wished I had been more sympathetic to people and patients with kidney stones.

They sent us home with a urine strainer and prescriptions for Flomax and a combination of anti-inflammatories and pain medications. Another attack in the car and all I could do was writhe in pain and pray for relief. My husband kept repeating, “I hope I never get one of those”. It is the type of pain that one would do almost anything to stop but that nothing relieves short of passing the stone.

As I took my pain pills, strained my urine, and drank copious amounts of water to help the delivery along, I had time to reflect on the age old debate of kidney stone pain being akin to labor and childbirth. Having some experience in the childbirth area, I still found no way to compare the two in terms of what hurts more, but here were my reflections:

Labor pains were more predictable and increased with intensity as you moved towards the goal of delivery. Kidney stone pain, on the other hand, was unpredictable and had the most intense pain with every bout.

Doctors can predict when the baby will be delivered by closeness of contractions, and examining cervical dilation and effacement. Kidney stone delivery is much less predictable.
If your baby is too big to be delivered vaginally or there are complications, a C-section can be performed. And if your kidney stone is too big to pass, you may have laser treatment to break up the stones or major surgery to retrieve them. Both can mean painful recoveries.

There are medications they can give you for labor and delivery. You can even get an epidural, which I never had, but am told they can make the experience much less painful. But the kidney stone pain didn’t seem to be completely obliterated by anything short of passing it.

In comparing types of pain, I guess I can see where men would say they come close to labor pain with a kidney stone, but 10 hours of back labor was equally as bad, and having your OB doctor turn your baby internally prior to a natural birth still rates as the #1 pain I have ever had (but at least it was over quickly).

And last, but most significantly, with labor and childbirth you expect and usually earn a wonderful, lasting, happy surprise at the end of the process, where you hold your newborn in your arms and experience the glory of motherhood, quickly forgetting the pain that was endured to have your bundle of joy. Whereas, at the end of your kidney stone passing, you collect a little grain of something that goes into a plastic container for the urologist to later analyze and you can’t believe how much that little devil hurt to get out. You may experience relief and joy at the passing, but there are lifestyle modifications to make to try to avoid it ever happening again, and still without the assurance that it can be prevented, so unlike the conception process. Who, having had one kidney stone, would ever make plans to have another?

Fortunately, my stone did not take 7 days to pass and was gleefully collected in a matter of hours.

So, my answer to the question of which is more painful, a kidney stone or labor and delivery, is a simple one: they cannot be compared. It’s like apples and oranges. Different types of pain, but both extremely intense, though the kidney stone is much more unpleasant because the outcome is not a lasting joy for the rest of your life. Since every person experiences pain differently, no one could really answer this question anyway because pain is a subjective experience.

For me, given the choice between labor and a kidney stone, I pick labor. Childbirth is definitely more fun and with rewards that last a lifetime.

By |2018-08-19T17:39:01+00:00August 21st, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Kidney Stone versus Labor – And the Winner is?

Five tips for Grandparents to stay connected with family

bigstock-grandma-with-your-grandson-12149147

With the birth of my daughter’s second child, I began to reflect on the important role that grandparents can play in the lives of their grandchildren. Here are five essential tips for older adults who want to have a lasting influence in the lives of their children and grandchildren.

Visit often. For those of us fortunate enough to live near our children and grandchildren, it is easy to see them often. Grandparents may even be the caregivers while parents are working. Visits don’t always have to be planned. Sometimes the best family time is a spontaneous invitation to dinner and a movie. However, sometimes distance can prevent regular visits. Some grandparents make it a goal to see their distant grandchildren once every 6 weeks or every few months. Be sure to take advantage of technology for your time together. Set a regular time to Skype or do Face-time. Don’t miss out on the subtle changes in those early years while babies are growing. Exchanging pictures may help, but they don’t replace the in-person experience. You may even think of relocating to be closer to family. For older grandchildren, be sure to have their cellphone number. Text them often and exchange pictures to stay involved in their lives and let them know you are available to them. Even small connections throughout the week (but without being annoying to teenagers of course) can make a difference in your relationship with your grandchildren.

Offer to help in practical ways. Working parents with young children will need a break at times. Ask how you can best help. Offer to keep the children for an overnight while mom and dad have a special dinner or weekend getaway. Many grandparents like to take their grandchildren on trips without the parents. Places like amusement parks, the zoo, or day trips to the water park or national forest all provide good diversion and quality time with Grandma and Grandpa while giving parents a rest. For even more quality time, take the older grandchildren on a cruise, camping in the mountains, or to a resort without their parents. For the mom with a newborn, take meals to the house (if you live close), do her grocery shopping or laundry, or send her a new bathrobe to show you are thinking of her. A favorite role model of mine sends the grandchildren a “baby shower in a box” with all sorts of goodies when she can’t be present due to distance or health concerns.

Plan special activities. Special activities need not be expensive. This could mean a trip to the park with Grandma or a special morning walk each week with Grandpa. My father used to take every grandson on a bow-hunting trip when they turned 12 years old. This was a rite of passage for every boy in the family. Grandpa would mount their first deer head for them and buy them a special hunting knife to commemorate the occasion. The girls in the family would take a trip to a Disney resort while the men were hunting. Grandchildren remember these events forever.

Attend special events. How fortunate are the kids whose grandparents are able to attend basketball and volleyball games, swimming tournaments, and Grandparent’s Day at school! Take advantage of being able to attend those dance recitals and school plays. If you live far, plan your visits to be able to attend some significant events like graduations, wedding showers, or school performances. This makes lasting memories with your family.

Be a constant in their lives. My parents divorced when I was 9 years old, and my paternal grandparents were the one constant in my life at that time. When a child’s world is jolted by change, grandparents can be that steadying influence that doesn’t change. They provide stability and security in an unsteady world for a child. The most important thing to remember is to be there. You don’t have to be the all-star parent or grandparent, but your children will remember that you were there for them when it counted the most.

By |2018-08-15T10:18:34+00:00August 15th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Five tips for Grandparents to stay connected with family

Tips for Nursing Students: The Successful Interview

 

 

Job Interview Word Cloud Concept

The National League for Nursing and the National Students Nurses’ Association (NSNA)(2012) stated that “although there is a shortage of registered nurses, the economic recession has flooded the RN market with experienced nurses who were retired, planning to retire, or went from part-time to full-time employment. The need for RNs has declined due to low hospital census”. Nursing students graduating today face a competitive employment market. Much of your success at getting the position you want will depend on how well you interview for the job. Follow these steps to be better prepared and increase your chances for a successful interview.

Be prepared

Submit your resume and application in advance, but do not assume that the person interviewing you has read them carefully. Before the interview, think about how you can highlight important aspects of your experience or education.  Do some background research on the organization or place to which you are applying.

Familiarize yourself with the key people in authority, especially focusing on the person who will interview you. During the interview you can use this information to establish some common ground. Consider some key areas such as: How large is the organization and/or the unit where you are applying? What population and geographic area do they serve? What expertise do you have to offer that might be valuable to them? For example, if you are applying for a job on an inpatient rehabilitation unit, did you have a course in rehabilitation or do clinical rotations in rehab? If so, be sure to mention this during the interview.

Look professional

Paul Walden, writing on the NSNA website, stated, “appearance and attitude are everything. Dress in professional attire and smile. Make sure you arrive promptly”. Although professional attire may be more casual than it has been in years past, employers still expect an interviewee to look his/her best.  This means no blue jeans, shorts, cut-offs, flip-flops, low-cut blouses, miniskirts, overbearing jewelry, or other extremes in attire.  Business casual is usually acceptable, but when in doubt, err on the side of dressing more formally in business attire than casual.

Start with a good beginning

Introduce yourself and offer to shake hands with the interviewer while making direct eye contact. Do not sit down until directed to do so. The interviewer controls the interview. Express enthusiasm for the interviewer taking time to speak with you and make a positive comment about the surroundings or reputation of the facility. Smile and convey friendliness, approachability, and confidence. Most nurse managers are looking for a “good fit” in a new employee with their existing staff and unit milieu. Your personality may be as important to the manager as your skill set. Listen for comments made by the interviewer that suggest he/she is seeking someone who will be a team player and then be sure to share ways in which you have successfully blended with similar groups in the past.

Ask thoughtful questions

Have a few thoughtful questions ready to ask. For example: How does the open position fit within the organizational chart? Is there opportunity for gaining additional education? What type of orientation or mentoring do they provide for new nurses? Are there opportunities for advancement? These types of questions show that you are interested in a long-term relationship with the organization and are willing to learn and increase your professional skills. Asking deliberate questions can also help you assess whether or not this job is the right one for you.

Be memorable

You want the person conducting the interview to remember you in a positive light. What sets you apart from others who might be applying for this job? Answering that question in advance will point you in the direction where you need to shine. This might be your engaging personality, strong evaluations from clinical professors, your flexibility or willingness to learn, your experience in another country with service-learning projects, or your good academic performance.

End the interview well

If you were fortunate enough to be given a tour of the unit or facility, be sure to take advantage of any opportunities to greet or interact with staff or patients. The interviewer may be watching to see if you display positive interpersonal skills. Before you leave the interview, be sure that you know how you will be notified if they wish to hire you. Thank the interviewer and shake hands again (if appropriate), expressing your enthusiasm for this wonderful opportunity. If possible, send a follow-up email or thank you note to the interviewer for his/her time and attention. Be sure to continue to display warmth and cordiality as you leave the facility. You never know who may be watching.

See this article at StuNurse.com. Click on the link below:

http://www.digitaleditionsonline.com/publication/?i=157690&p=15

Save

Save

By |2018-08-04T10:15:40+00:00August 7th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Tips for Nursing Students: The Successful Interview

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/

 

Save

By |2018-07-21T11:04:28+00:00July 21st, 2018|News Posts|Comments Off on Peripheral Artery Disease