Kristen Mauk

About Kristen Mauk

President/CEO - Senior Care Central, LLC

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

Guest Blog: What is Psoriasis?

Guest Blog: Lindsay Munden, DNP, RN, FNP-BC

Psoriasis

Psoriasis is a lifelong disease that causes scaling and inflammation of the skin. The condition starts beneath the skin’s surface and is triggered by an overactive immune system, which causes skin cells to be over-produced and accumulate on the skin’s surface faster than normal. This process is called cell turnover, and in psoriasis may take a few days instead of weeks. This causes the formation of thick, red, itchy, flaky patches with silvery scales known as plaques. While any part of your body can be affected, psoriasis most often occurs on the elbows, knees, scalp, back, face, palms, and feet.

Risks

According to the American Academy of Dermatology (2015) about 7.5 million people in the United States have psoriasis. Anyone can get the disease, but it occurs more often in adults.

  • Age: Adult men and women are affected equally. The two peak ages at onset are during the late teens to early 20s and in the late 50s to early 60s.
  • Genetics: Psoriasis has a strong genetic influence, with one-third of patients with psoriasis reporting having a family member with the disease.
  • Environmental Factors: Trauma to normal skin, repeated friction, infections, stress, fatigue, warm humid climates, changes in weather that dry the skin, and certain medications may trigger psoriasis flare-ups.

Causes

The primary cause of psoriasis remains unknown. Research has indicated that psoriasis is caused by genetic influences and a dysfunction of the immune system. Although, psoriasis plaques may look contagious, you cannot get the condition from someone that has the disease.

Symptoms

Symptoms can range from mild to severe and are often recurring. Itchy, red, inflamed and dry scaly plaques distributed symmetrically over areas of bony prominences such as the elbows and knees are characteristic of the disease. The joints, nails and scalp may also be affected. As with other chronic conditions, symptoms may flare or worsen for a few months and then subside for a period of time.

Diagnosis

Psoriasis may be hard to diagnose because it can be confused with other skin diseases. Usually your healthcare provider will make a diagnosis based on a thorough skin examination. Biopsy is seldom necessary because the clinical features of psoriasis are so distinctive. Plaque psoriasis is the most common form, but patients typically have one or more types.

Treatment

The goal of therapy is to control the symptoms and clear the plaque lesions.

For mild to moderate psoriasis, topical medications (those applied directly to the skin) and phototherapy (light therapy) are the mainstays of treatment.  For severe psoriasis, systemic treatments are recommended. Sometimes, combining topical, light and systemic treatments leads to the best results.

Topical Medication Options:

  • Topical steroids are widely used because they help reduce inflammation. Generally, a very potent topical corticosteroid preparation is applied two to three times daily for 2 weeks and then decreased to a lesser potency for maintenance therapy long term.
  • Coal tar works by causing the skin to shed dead cells from its top layer and slow down the growth of new skin cells. This effect decreases scaling and dryness. Coal tar is applied once or twice daily and is not well favored due to the potential for staining of the clothes and skin.
  • Anthralin works by slowing down the production of skin cells. This type of medication is applied to the skin for a prescribed period of time and then rinsed away, with increased increments until the skin is healed which may take a couple of weeks.
  • Topical immunomodulators are medications which work by decreasing the body’s immune system to help slow down the growth of the psoriasis plaques.
  • Vitamin D3 derivatives regulate cell growth and decrease lymphocyte (cells which play a role in the regulation of the immune system) activity. The medicine comes in a form of an ointment which is typically applied twice daily.

Phototherapy:

Phototherapy with ultraviolet-B (UVB) light is effective in the treatment of psoriasis lesions. This type of treatment reduces DNA synthesis of skin cells. Phototherapy can produce symptom-free periods of up to 2-4 months. UVB therapy units are often available at dermatologist offices and the use of commercial tanning beds (with both UVA and UVB lights) is not recommended. Dermatologists may recommend consistent light therapy 3-5 days a week for 2 to 3 months.

Systemic Medications:

Systemic therapy is reserved for patients that have severe or incapacitating disease. These medications are prescribed by expert specialists such as dermatologists or rheumatologists because they have a risk for serious side effects.

More Information:

National Psoriasis Foundation   www.psoriasis.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases www.niams.nih.gov

American Academy of Dermatology https://www.aad.org/

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By | 2017-08-07T15:32:07+00:00 August 7th, 2017|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: What is Psoriasis?
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