Geri Ch. 23 Endocrine

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- It Is a, multifactorial syndrome of aging, which varies among racial and ethnic groups and it is a strongly associated with abdominal obesity in America.
- Risks - abdominal obesity, insulin resistance, physical inactivity, and hormonal imbalance
- S/S: increased waist circumference Plus any two of the following:
1) blood pressure greater than 129/84
2) plasma triglyceride levels over 149 mg or taking triglyceride medication
3) high density lipid levels less than 40 mg in men or less than 50 mg in women like taking cholesterol medication
4) fasting glucose greater than 99 mg/dL (including patients with diabetes)
Diabetes type II cause- Caused by impaired carbohydrate metabolism, changes in pulsatile insulin release, And resistance to insulin- Mediated glucose disposalDiabetes type II S/S* excessive thirst (polydipsia) * excessive hunger (polyphagia) * excessive urination (polyuria) - Older individuals Will describe symptoms of fatigue, blurred vision, Weight change, and infectionsDiabetes type II what should the assessment include-History of urinary incontinence -Urinary frequency -Nocturia -Polyuria -Sexual dysfunction -Pain during urination -Presence of fecal incontinence, Constipation, and diarrhea -Stress incontinence, which is more common in older adults maybe intensified by hyperglycemiaWhat is the cornerstone therapy for diabetics?Diet modificationWhat are the barriers to diet therapy and insulin management in the older adult?Cognitive function Vision Motivation Ability to accurately draw up and self administer insulin Access sites Family supportWhy is exercise important?To decrease insulin resistance and hyperglycemia. Morning exercise has the greatest benefits because it is a time of greatest insulin resistanceSick day managementPatient must continue taking prescribed medications such as insulin and oral hypoglycemic agents, ensure adequate hydration, and test blood more often. Urine should be tested for ketones whenever the blood glucose level is greater than 240 mg/dLDiabetic foot syndrome cause:Vascular and neurologic pathology associated with diabetes. Inadequate blood flow to the feet and nerve damage contribute to the development of ulcers and infections Hyperglycemia plays a role because blood glucose levels of 200 mg or greater are associated with an altered immune system leukocytic responseDiabetic foot syndrome sign and symptomsThey vary from no symptoms to fever, erythema, warmth, this charge with alteration, and leukocytosisDiabetic foot syndrome preventionPerform daily foot inspection Do not apply skin cream between toes Keep toenails trimmed straight across Wear proper fitting shoes, and do not go barefootHyperthyroidism pathophysiologyHyper secretion (hyper functioning) of thyroid hormones, which is usually associated with an enlarged thyroid gland. In seniors is often caused by multinodular or unonodular TOXIC GOITER rather than Graves disease.Hyperthyroidism signs and symptoms- IN ELDERLY Tachycardia Fatigue Tremors And nervousness - IN YOUNG Tachycardia Heat intolerance FatigueHyperthyroidism medical management* The treatment of choice in older adult is generally radioactive sodium iodine * Patients must be rechecked every six months for the rest of their lives * Propranolol or other beta blocker are frequently used to manage hyperthyroidism induced tachycardiaHypothyroidism pathophysiology- A common hypofunctioning endocrine state that results from inadequate thyroid hormone function - Elevation of the serum TSH level - as a thyroid ages , It develops moderate atrophy, fibrosis, colloid nodules, and lymphocyte infiltration - T4 decreases by 30% between young adulthood and advanced age - Hypofunctioning thyroid states may result from defects in hormone production, Target tissues, or receptorsPrimary hypothyroidismIt involves a hypofunctioning peripheral gland like the thyroidSecondary hypothyroidismIf the hypothyroid state is a result of a nonfunctioning anterior pituitary glandHypothyroidism signs and symptomsThe clinical symptoms in older people are atypical compared with those of younger adults Fatigue Cold intolerance Weight gain Muscle cramps Paresthesia Confusion Symptoms are often attributed to old-age because of the lack of themHypothyroidism medical managementSerum TSH screening every five years it Is recommended for all men older than 65 years and for all women older than 35 years The treatment of choice is T4 replacement with levothyroxine sodium increased graduallyPrimary osteoporosis pathology- It is a disease characterized by low bone mass leading to fragile bones that break easily - Low vitamin D status in older persons contribute to bone loss mediated by the aging parathyroid gland - Diagnosed by dual x-ray of the proximal femur and lumbar spinePrimary osteoporosis signs and symptomsSpontaneous fractures or those calls by minimum trauma in addition to loss of height Dorsal kyphosis Chronic back pain Loss of heightPrimary osteoporosis medical management- Calcium supplementation (at least 1200 mg per day) - Vitamin D supplementation (at least 400 international units per day) in two divided doses to maximize gastrointestinal absorption - Exercise (Weight bearing and muscle strengthening) - Antiresorptive therapy (estrogens, biphosphonates, selective estrogen receptor modulators, and calcitonin) - Thiazide diuretic: for those with hypertension because it decreases urinary calcium excretion, which slows bone loss