Kristen Mauk

About Kristen Mauk

President/CEO – Senior Care Central, LLC

Hypothyroidism Warning Signs and Treatment

bigstock-Thyroid-gland-19336097

Background

Hypothyroidism results from lack of sufficient thyroid hormone being produced by the thyroid gland. Older adults may have subclinical hypothyroidism, in which the TSH (thyroid-stimulating hormone) is elevated and the T4 (thyroxine or thyroid hormone) is normal; 4.3–9.5% of the general population has this problem (Woolever & Beutler, 2007). In this condition, the body is trying to stimulate production of more thyroid hormone. Some older adults with this condition will progress to have primary or overt hypothyroidism. This is when the TSH is elevated and T4 is decreased. Hashimoto’s disease is the most common cause and represents 90% of all patients with hypothyroidism (American Association of Clinical Endocrinologists [AACE], 2005; Woolever & Beutler, 2007), though certain pituitary disorders, medications, and other hormonal imbalances may be causal factors.

Warning Signs

Older adults may present an atypical picture, but the most common presenting complaints are fatigue and weakness.

Diagnosis

Diagnosis should include a thorough history and physical. Bradycardia and heart failure are often associated factors. Lab tests should include thyroid and thyroid antibody levels (common to Hashimoto’s), and lipids, because hyperlipidemia is also associated with this disorder.

Treatment

Treatment centers on returning the thyroid ¬hormone level to normal. This is done through oral thyroid replacement medication, usually L-thyroxine. In older adults with coexisting cardiovascular disease, starting with the usual doses may exacerbate angina and worsen the underlying heart disease, so it is important to start low and go slow. Titration should be done cautiously, with close monitoring of the older adult’s response to the medication. The does should be adjusted on 6- week intervals until normal levels of thyroid hormone are achieved. Once the TSH is within normal limits, then checking the TSH should be done every 6 to 12 months to monitor effectiveness and blood levels, because hyperthyroidism is a side effect of this therapy and can have serious implications on the older person’s health.

Patients need to learn the importance of taking thyroid medication at the same time each day without missing doses. Sometimes older adults have other problems associated with hypothyroidism, such as bowel dysfunction and depression. Any signs of complicating factors should be reported to the physician, and doctors’ appointments for monitoring should be religiously kept. Strategies for managing fatigue and weakness should also be addressed, because some lifestyle modifications may need to be made as treatment is initiated.

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 Hypothyroidism, visit the NIH:
http://www.nlm.nih.gov/medlineplus/ency/article/000353.htm

 

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By | 2017-09-21T10:33:23+00:00 September 21st, 2017|News Posts|Comments Off on Hypothyroidism Warning Signs and Treatment

Chronic Sinusitis

Sinus pain

Background

One of the common health complaints of the elderly is chronic sinusitis. About 14.1% of Americans 65 and older report suffering from chronic sinusitis; for those 75 years and older, the rate is slightly lower at 13.5% (American Academy of Otolaryngology, 2012). Age-related physiological and functional changes that occur can cause restrictions to the airflow. This results from irritants blocking drainage of the sinus cavities, leading to infection.

Warning Signs

Symptoms include a severe cold, sneezing, cough (that is often worse at night), hoarseness, diminished sense of smell, discolored nasal discharge, postnasal drip, headache, facial pain, fatigue, malaise, and fever (Kelley, 2002). The person may complain of pain around the sinus areas, and swelling and redness of the nasal mucosa may be evident.

Diagnosis

Allergies, common cold, and dental problems should be ruled out for differential diagnosis. When symptoms continue over a period of weeks and up to 3 months and are often recurring, chronic sinusitis should be suspected. A CT scan of the sinuses will likely show areas of inflammation.

Treatment

Treatment for chronic sinusitis is with antibiotics, decongestants, and analgesics for pain. Inhaled corticosteroids may be needed to reduce swelling and ease breathing. Irrigation with over-the-counter normal saline nose spray is often helpful and may be done two to three times per day. The person with chronic sinusitis should drink plenty of fluids to maintain adequate hydration and avoid any environmental pollutants such as cigarette smoke or other toxins. Chronic sinusitis is a condition that many older adults wrestle with their entire life. Avoidance of precipitating factors for each individual should be encouraged.

For more information on Sinus Sinusitis, visit The Mayo Clinic at:
http://www.mayoclinic.com/health/chronic-sinusitis/DS00232/DSECTION=risk-factors/

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 | 2017-09-11T12:15:57+00:00 September 11th, 2017|News Posts|Comments Off on Chronic Sinusitis

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
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