Kristen Mauk

About Kristen Mauk

President/CEO - Senior Care Central, LLC

Heart Failure Warning Signs and Treatment

Background

Heart failure (HF) happens when the heart is not strong enough to pump the needed blood with oxygen to the rest of the body. The CDC estimated that 5.7 million people in the U.S. have heart failure. The incidence of congestive heart failure (CHF) varies among races and across age groups. It is the cause of 55,000 deaths each year (CDC, 2012). The lifetime risk for someone to have CHF is 1 in 5.

Risk Factors

The major risk factors for HF are diabetes and MI. African American males are at higher risk than Caucasians. The risk of CHF in older adults doubles for those with blood pressures over 160/90. Seventy-five percent of those with CHF also have hypertension (AHA, 2012). Congestive heart failure often occurs within 6 years after a heart attack.

Warning Signs

Signs and symptoms of heart failure include shortness of breath (that also worsens when lying down), weight gain with swelling in the legs/ankles, and general tiredness. It is essential that older adults diagnosed with HF recognize signs of a worsening condition and report them promptly to their healthcare provider. Older adults may not have the typical symptoms but complain of other things like decreased appetite, weight gain of a few pounds, or insomnia (Amella, 2004).

Diagnosis

For in-home monitoring, daily weights at the same time of day with the same clothes on the same scale are essential. The physician or primary care provider will give guidelines for the person to call if the weight exceeds his or her threshold for weight gain. This is usually between 1 and 3 pounds. The decision regarding when to call the primary care provider is made based upon the severity of the HF and the relative stability/frailty of the person.

Treatment

Treatment for HF involves the usual lifestyle modifications discussed for promoting a healthy heart, as well as several possible types of medications. These include ACE inhibitors, diuretics, vasodilators, beta-blockers, blood thinners, angiotensin II blockers, calcium channel blockers, and potassium. Lifestyle changes, per recommendation of the primary care provider, may include (AHA, 2009):
Maintaining an appropriate weight
Limiting salt intake
Limiting caffeine and alcohol intake
Managing stress
Getting adequate rest
Engaging in physical activity as prescribed
Quitting smoking
Eating a heart-healthy diet
To minimize exacerbations, patient and family counseling should include teaching about the use of medications to control symptoms and the importance of regular monitoring with a health care provider (Agency for Healthcare Research and Quality [AHRQ], 2012; Hunt et al., 2009). With the proper combination of treatments such as lifestyle changes and medications, many older persons can still live happy and productive lives with a diagnosis of heart failure and minimize their risk of complications related to this disease.

For additional information on heart failure visit the American Heart Association website at:
target=”_blank”>http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp”

 

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.

By | 2018-06-12T10:33:43+00:00 June 17th, 2018|News Posts|Comments Off on Heart Failure Warning Signs and Treatment

Stroke Warning Signs and Risk Factors

Portrait of Worried Senior Couple

Background

Stroke, also known as cerebrovascular accident (CVA) or brain attack, is an interruption of the blood supply to the brain that may result in devastating neurological damage, disability, or death. Approximately 795,000 people in the United States have a new or recurrent stroke each year (American Stroke Association [ASA], 2012a). Stroke accounts for 1 in 18 deaths, making it the fourth leading cause of death in the United States. A death from stroke occurs every 4 minutes and the cost of stroke treatment and disability was over $73 billion dollars in 2010. Death from stroke is generally higher among females, with higher rates in Black males (67.7/100,000) and females (57.0/100,000) than in Caucasians (ASA, 2012a). In Canada, stroke is the fourth leading cause of death, affecting 50,000 people each year (Heart and Stroke Foundation of Canada, 20059).
There are two major types of stroke: ischemic and hemorrhagic. The vast majority of strokes are caused by ischemia (87%), usually from a thrombus or embolus (ASA, 2012a). The symptoms and damage seen depend on which vessels in the brain are blocked. Carotid artery occlusion is also a common cause of stroke related to stenosis

Risk Factors

Some risk factors for stroke are controllable and others are not. The most significant risk factor for stroke is hypertension. Controlling high blood pressure is an important way to reduce stroke risk. Those with a blood pressure of less than 120/80 have half the lifetime risk of stroke as those with hypertension (ASA, 2012a). Smoking 40 or more cigarettes per day (heavy smoking) increases the stroke risk to twice that of light smokers. If a person quits smoking, their risk after 5 years mirrors that of a nonsmoker, so older adults should be particularly encouraged to stop smoking.

Warning Signs

Several warning signs are common. These include:
SUDDEN numbness or weakness of face, arm or leg – especially on one side of the body.
SUDDEN confusion, trouble speaking or understanding.
SUDDEN trouble seeing in one or both eyes.
SUDDEN trouble walking, dizziness, loss of balance or coordination.
SUDDEN severe headache with no known cause (National Stroke Association, 2013)

Diagnosis

There are several tools for assessing for signs and symptoms of stroke. One easy acronym is FAST:
F stands for facial droop. Ask the person to smile and see if drooping is present.
A stands for arm. Have the person lift both arms straight out in front of him. If one is arm is drifting lower than the other, it is a sign that weakness is present.
S stands for speech. Ask the person to say a short phrase such as “light, tight, dynamite” and check for slurring or other abnormal speech.
T stands for time. If the first F-A-S checks are not normal, then one is to remember F-A-S-T that Time is important and the emergency medical system should be activated (National Stroke Association, 2012).
Older adults experiencing the warning signs of stroke should note the time on the clock and seek immediate treatment by activating the emergency response system in their area calling 911 (American Stroke Association, 2012). Transport to an emergency medical facility for evaluation is essential for the best array of treatment options. A history and neurological exam, vital signs, as well as diagnostic tests including electrocardiogram (ECG), chest Xx-ray, platelets, prothrombin time (PT), partial thromboplastin time (PTT), electrolytes, and glucose are routinely ordered. Diagnostic testing imaging may include computed tomography (CT) without contrast, magnetic resonance imaging (MRI), arteriography, or ultrasonography to determine the type and location of the stroke. The CT or MRI should ideally be done within 90 minutes so that appropriate emergency measures may be initiated to prevent further brain damage.

Treatment

The first step in treatment is to determine the cause or type of stroke. A CT scan or MRI must first be done to rule out hemorrhagic stroke. Hemorrhagic stroke treatment often requires surgery to evacuate blood and stop the bleeding.
The gold standard at present for treatment of ischemic stroke is t-PA (tissue plasminogen activator). At this time, t-PA must be given within 3 hours after the onset of stroke symptoms. This is why it is essential that older adults seek treatment immediately when symptoms begin. Only about 3 – 5% of people reach the hospital in time to be considered for this treatment (ASA, 2012d). t-PA may be effective for a select group of patients after the 3-hour window (up to 4.5 ½ hours), and this treatment window has been approved in Canada (Heart and Stroke Foundation of Canada, 2009). The major side effect of t-PA is bleeding. t-PA is not effective for all patients, but may reduce or eliminate symptoms in over 40% of those who receive it at the appropriate time (Higashida, 2005). Other, much less common procedures such as angioplasty, laser emulsification, and mechanical clot retrieval may be options for treatment of acute ischemic stroke.
To prevent recurrence of thromboembolic stroke, medications such as aspirin, ticlopidine (Ticlid), clopidogrel (Plavix), dipyridamole (Persantine), heparin, warfarin (Coumadin), and enoxaparin (Lovenox) may be used to prevent clot formation. Once the stroke survivor has stabilized, the long process of rehabilitation begins. Each stroke is different depending on location and severity, so persons may recover with little or no residual deficits or an entire array of devastating consequences.
The effects of stroke vary, and some persons may recover with no residual effects. But more often, stroke survivors may have problems that include hemiplegia or hemiparesis (paralysis or weakness on one side of the body), visual and perceptual deficits, language deficits, emotional changes, swallowing dysfunction, and bowel and bladder problems. Ninety percent of all dysphagia (swallowing problems) results from stroke (White, O’Rourke, Ong, Cordato, & Chan, 2008).

Poststroke Rehabilitation

Rehabilitation after a stroke focuses on several key principles. These include maximizing functional ability, preventing complications, promoting quality of life, encouraging adaptation, and enhancing independence. Rehabilitation emphasizes the survivor’s abilities, not disabilities, and helps him or her to work with what he or she has while acknowledging what was lost.
Stroke survivors go through a unique recovery process. This model shows the process of stroke recovery where forward progress after stroke lead to acceptance and adaptation:

If significant functional impairments are present, evaluation for transfer to an intensive acute inpatient rehabilitation program is recommended. Inpatient rehabilitation units offer the survivor the best opportunity to maximize recovery, including functional return. An interdisciplinary team of experienced experts, including nurses, therapists, physicians, social workers, and psychologists, will help the survivor and the family to adapt to the changes resulting from the stroke. Outcomes for geriatric stroke survivors are enhanced by intensive rehabilitation programs, whether offered in rehabilitation units or in skilled nursing facilities (Duraski, Denby, Danzy & Sullivan, 2012; Jett, Warren, & Wirtalla, 2005).
A large amount of teaching is often done by stroke rehabilitation nurses who work with older survivors and their families. These include knowing the warning signs of stroke and how to activate the emergency response system in their neighborhood, managing high blood pressure, understanding what medications are ordered as well as how often to take them and why, the importance of regular doctor visits, preventing falls and making the home environment safe, available community education and support groups, and the necessity of maintaining a therapeutic regimen and lifestyle to decrease the risk of complications and recurrent stroke. All survivors will need assistance in re-integrating into the community. This is generally begun in the rehabilitation setting.

For more information on Stroke, visit American Stroke Association at:
http://www.strokeassociation.org/

 

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By | 2018-06-12T10:32:40+00:00 June 13th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Stroke Warning Signs and Risk Factors

Guest Blog: Inexpensive, Fun Activities For Seniors

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Whether you’ve recently retired, are planning to retire soon or are facing an unknown future where retirement seems virtually impossible, when you’re living on a fixed or tight income, you’re always looking for ways to save money. Plus, since one of the first areas to get cut when the budget is tight is entertainment, you may wonder how can you still have fun, without spending a fortune. To answer that question, here’s a list of inexpensive activities that could be perfect for you!

Attend Free Events. From free nights at the museum to local art gallery showings in town, keep your radar on for free activities in the area that you might enjoy. Most cities will host free lectures, concerts, movie nights and other activities from time to time.

Start a Club or Discussion Group.

    1. Start a book club, movie group or discussion group with a handful of friends, hosted either at your home or rotating homes month to month. Getting together will cost little more than making some snacks — and it will still be a fun night for everyone.

Take Advantage of Community Centers and Libraries. Rent movies or check out books at the library, and go for walks at the local community center track. Within your specific city or town, find what other amenities are available to you and decide to make the most of them, either on your own or with a friend.

Volunteer in the Community. Volunteering not only makes you feel good about helping others, but it also connects you with people in the community and often qualifies you for some cool, cash-saving perks. Whether it’s free food when you’re volunteering at the local school district or a place to socialize when you’re serving as a greeter at the hospital, volunteering helps you reach outside yourself and have fun in the process.

Host Potlucks. Rather than always going out to eat with friends, try hosting potlucks where everyone brings a dish to pass. You’ll only need to make one dish, still have the fun of socializing with friends or loved ones, and save a bundle in the process.

Enjoy the Outdoors. Go to the park, take walks on trails at the forest preserve, plan a picnic or watch a local Little League game. Getting outside is not only good for your spirits, it’s usually inexpensive too!

Mark Westerman is the Chief Marketing Officer for CareOne, Inc., a provider of debt relief services nationwide.

By | 2018-05-22T08:31:54+00:00 May 22nd, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: Inexpensive, Fun Activities For Seniors

A Mom for all Seasons

I have been fortunate to have a number of mothers in my life – by birth, marriage, or adoption. Each of these women has helped to shape my perspectives and  values in various ways during different seasons of life.  As Mother’s Day approaches, reflecting on the role that mothers play in our lives is a worthy exercise. So, here is my tribute to my mothers.

My first mother is the one who gave me life. I like to think of this as the Spring of my life. Mom Phyllis raised me until the age of 9 years. She tended to the scrapes and cuts, helped to mold my personality, hand-made my clothes, and made life an adventure, all whilst being the wife of a busy doctor who was studying to be a pediatric surgeon. Thank you, Mom, for treasuring my childhood.

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When my parents got divorced, a second mother entered the Summer of my life. Mom Kay took three confused and fragile children under her wings as a young step-mother in her early 20’s. She nurtured us as if we were her own. She helped me navigate the difficult teenage years and transition into young adulthood, listening to countless stories of puppy love, crushed hearts, and future dreams. Mom brought faith and light into a home that had been shattered by divorce. She has given me an example of a loving and faithful wife to my father for 45 years. Thank you, Mom, for preserving my spirit and encouraging my faith in God.

In college, I attended a little Baptist church where they had a program in which families could “adopt” a college student. Through a round-about way, I was adopted by Marvin and Patsy Bell. Grandma Bell, as my children later called her, saw me through my first 17-year  marriage, a painful divorce, and was a second mother to many other young women like me. She has been a faithful friend and mentor for more than 38 years. Ma Bell stood in the place of the mothers who couldn’t be with me during some of the coldest and darkest Winters of life. She attended countless school programs for my kids and never forgets a birthday to this day. Thank you, Ma, for giving me the example of the kind of Grandmother I want to be.

Lastly, when I remarried to my current husband, Jim, I gained a wonderful mother-in-law. Gracie is true to her name. She has a loving and nonjudgmental spirit. She always thinks the best of people and is kind and gentle.  In the Fall of my life, she embraced me as a daughter and is always ready to help in times of need.  Thank you, Mom Mauk, for showing me what unconditional love looks like.

All of us have mothers in our lives that we need to thank. So, this Mother’s Day, purpose to give a special blessing to those women who have so influenced your life. Without them, our days would be less rich and the journey much lonelier. Celebrate those who have traversed the seasons of life with you!

By | 2018-05-16T08:19:46+00:00 May 14th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on A Mom for all Seasons

Nurses Are….

This week we celebrate National Nurse’s Week beginning on May 6th and ending on May 12th (Florence Nightingale’s birthday). The profession of nursing has come far since its inception. When I went to nursing school in the late 1970’s, we were still wearing blue pin-striped uniforms and caps. There were striping and pinning ceremonies to mark milestones in the 4 year journey to the Bachelor of Science in Nursing degree, and it wasn’t until the early 1980’s when my nursing school started to eliminate those bulky caps that were so difficult to keep on our head. When the mandatory uniforms and nursing caps were no longer the symbol of the nurse, we had to develop other ways for patients and families to recognize us. I hope that we are now recognized for the knowledgeable care and comfort that we provide to others. It has been said that nurses are the backbone of the healthcare system.  I would suggest that we are that and much more:

Nurses are timeless. Florence Nightingale left the comforts of home care for the sick. Nurses are there for the beginnings and ends of countless lives. We hold the hands of the young, the old, and everyone in between. The shifts are long and if a patient needs us, we work overtime to finish the job. We might wear a uniform, scrubs, a lab coat, or a suit, but we transcend fashion to don whatever our patients need for safe, quality care.

Nurses are trusted. Gallup polls consistently show that the public trusts the ethics and honesty of nurses above even that of physicians, making us one of the most trustworthy professions in the eyes of the people.  Nurses adhere to the ANA Code of Ethics that emphasizes supporting patients’ autonomy and the concepts of beneficence, justice, fidelity, and veracity. All nurses receive education in ethics, with patient care at the center.

Nurses are inspiring.  How many people can say that their jobs changed a life? As a rehabilitation nurse, one woman who had experienced a stroke told me, “I had stroke and died three times. I was in ICU for weeks, but I didn’t feel alive until I came to rehab. Rehabilitation nurses helped me live again!” Yes, transforming lives is what nurses engage in daily. In fact, many of us can name that one nurse that we remember and would choose to have with us if we were sick or dying – that nurse who knows how to inspire and care.

Nurses are experts.  Nurses are expert caregivers, patient advocates, teachers, and researchers. We know the realm of health care better than anyone because we are the licensed professionals who are there 24/7. There are more nurses with advanced practice degrees and certifications than ever before. Nursing has evolved into a discipline with multiple specialties that support best practice in numerous areas that affect health and wellness. Nurses hold positions of leadership in government, the military, organizational systems, health care corporations, and major companies, all attesting to the value of our knowledge and education.

Nurses are still carriers of light. Florence Nightingale was known as “the lady with the lamp”. I always found that image inspiring. One of my favorite memories from my early career occurred while I was working the night shift on a geriatric unit. An elderly man couldn’t get the music he liked to play on the radio, so he asked for someone to sing some old hymns to him. I did so reluctantly at first, holding his hand and singing all the old songs of the faith that I could remember. The next day, I heard him excitedly telling his family members, “An angel came to my room and held my hand and sang to me last night!”  I was puzzled when later he didn’t seem to recognize me as the singing “angel”.  The following night, he died unexpectedly. Reflecting on that experience, I believe that higher powers were at work there. Maybe I was just the vessel through which a bit of healing flowed. Since then, I have seen countless similar examples of extraordinary happenings when caring nurses are involved.

Nurses do more than just enact art and science. Sometimes…our work is like a little piece of heaven.

 

By | 2018-05-10T08:07:37+00:00 May 10th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Nurses Are….