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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: How Do Seniors With Alzheimer’s Handle Change?

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When seniors develop diseases affecting cognition, like the various kinds of dementia, caregivers typically make an effort to make their living environment as safe and comfortable as possible.  Sometimes caregivers make lots of changes to a senior’s living space, with the best intentions of helping them.  However, this can have a two-sided effect, because seniors with mentally deteriorating illnesses can find change to be a confusing or frightening thing.  Caregivers might change the entire layout of a house, remove everything that could be a hazard, or add numerous locks to provide security.  Changes like these can actually prove to be disorienting for a senior, in addition to being helpful.  So the question becomes, how much change can seniors with Alzheimer’s handle?

 

It’s typical to find instances where seniors have lived in the same home for decades, and have a curious ability to navigate the living space with a sort of muscle memory after memory-harming diseases like Alzheimer’s set in.  Routine is very important to the delicate psyche of an elder with dementia, so finding the perfect balance of what to change for their own good can be tricky.  Making abrupt overwhelming makeovers to their home’s layout can make them flustered and end up actually making  it more difficult for them to get around, adding to their impaired cognition. So it is best to maintain an environment that is familiar as much as possible.  And make any alterations subtly and slowly over time.

 

The necessity to make changes will depend of the severity of a senior’s individual case.  If the Alzheimer’s is in the mid to late stages and a senior is wandering out of the home constantly, then immediate action to prevent hazard is surely appropriate.  Installing door alarms or adding locks can be great helps. If a senior with dementia typically kept a messy household, then the mess may add to their unease or make it easier to trip and fall.  De-cluttering their living space can be advantageous in these cases.

 

Thus, change will surely be necessary at times.  Though it is advisable to make changes as gradually and calmly as possible, to avoid overwhelming or distressing what was comfortable, normal, and assuring to the mind of a loved one with dementia.  Routine is key for security in these instances.  It may also be helpful to make sure you let them see when you move something, or set their things some place, to help then more easily adapt to the change.

 

By | 2017-07-31T13:10:24+00:00 August 9th, 2017|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: How Do Seniors With Alzheimer’s Handle Change?

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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