Week 6: Endocrine And Immune Disorders

Question 1

What are normal age-related changes to the immune system?

Answer 1

• Total number of T cells don’t change with aging.
• B cell function decreases with aging
• Increase in number of immunoglobulins -> decrease in innate immunity

Question 2

T cells

Answer 2

Scan the body for invading substances such as infections and contributes to the body’s immunity.

Question 3

B cells

Answer 3

Secrete antibodies in response to the presence of antigens such as infectious agents and foreign substances.

Question 4

Decrease in function of B cells results in

Answer 4

Reduced ability to produce antibodies leading to a decreased ability to develop adequate immunity after an infection or after an immunization (i.e influenza)

Question 5

Immunosenescence

Answer 5

Gradual deterioration of the immune system brought on by natural aging advancement

Question 6

Diabetes Mellitus

Answer 6

A chronic multisystem disease characterized by hyperglycemia related to abnormal insulin production, impaired insulin utilization, or both.

Question 7

Criteria for diagnosis of DM

Answer 7

• One fasting hemoglobin A1C value >/= 6.5% (or)
• One random plasma glucose >/= 200 mg/dL (or)
• Fasting plasma glucose >/= 126 mg/dL (or)
• Oral glucose tolerance test (OGTT) >/= 200 mg/dL 2 hours after glucose administration (or)
• When classic symptoms of hyperglycemic or hypoglycemic crisis are present.

Question 8

The U.S Preventative Services Task Force recommends screening for DM always be done for those whose:

Answer 8

• BP consistently > 135/80 mmHg

- Any risk factors for CV disease

Question 9

DM is the leading cause of

Answer 9

• Adult blindness
• End-stage renal disease
• Non-traumatic lower limb amputations

Question 10

DM is a major contributing factor for

Answer 10

Heart Disease

Stroke

Question 11

DM Pathophysiology/Etiology

Answer 11

-Absent/insufficient insulin and/or poor utilization of insulin.

Question 12

Insulin

Answer 12

• Produced by -cells in islets of Langerhans (Pancreas).
• Released continuously into bloodstream in small increments with larger amounts released after food.
• Stabilizes glucose level in range of 70 to 110 mg/dL.

Question 13

Type II Diabetes Mellitus

Answer 13

Formerly known as adult-onset diabetes (AODM) or non–insulin-dependent diabetes (NIDDM).

Question 14

Risk factors for type II DM

Answer 14

• Overweight
• Obesity
• Advanced age
• Family history

Question 15

Type 2 DM Pathophysiology/Etiology

Answer 15

-Pancreas continues to produce some endogenous insulin but
1. Not enough insulin is produced
(OR)
2. Body does not use insulin effectively

Question 16

Signs and symptoms of diabetes mellitus

Answer 16

• Polyuria, polyphagia, polydipsia
• May have fatigue, weight loss and visual changes.
• Prolonged wound healing.
• Woman may present with candidiasis, as first sign.

Question 17

Complications of Type II DM more common in older adults

Answer 17

• Compounded by the presence of multiple morbid diseases and disorders.
• Dry mouth, dry eyes, dehydration
• Incontinence
• Weight loss, anorexia and nausea
• Confusion, delirium
• Delayed wound healing

Question 18

Complications of DM

Answer 18

Mobility impairment, muscle weakness, falls 
Cognitive impairments
Fatigue
Weight loss
Incontinence

Question 19

Type II DM is often a diagnosis not made until evidence of end organ damage becomes visible such as

Answer 19

• Decreased visual acuity
• Neuropathy
• Heart disease
• Stroke
• Periodontal disease

Question 20

Hypoglycemia Levels in older adults

Answer 20

<60

Question 21

Signs of hypoglycemia in older adults

Answer 21

• Tachycardia
• Palpitations
• Diaphoresis
• Tremors
• Pallor
• Anxiety

Question 22

Later symptoms of hypoglycemia in older adults include

Answer 22

• Headache
• Dizziness
• Fatigue
• Irritability
• Confusion
• Hunger
• Visual changes
• Seizures
• Coma

Question 23

Immediate care for hypoglycemia

Answer 23

-Give glucose orally or IV

Question 24

Hyperglycemia levels in older adults

Answer 24

200-600 or higher

Question 25

Hyperglycemia

Answer 25

-Harder to detect and with aging there is higher tolerance.

Question 26

Hyperglycemia increases the risk for

Answer 26

hyperosmolar hyperglycemic nonketotic coma → important in persons who are frail and should be considered in any older adult with diabetes who is difficult to arouse.

Question 27

What is the best measurement for ongoing glycemic control?

Answer 27

Hgb A1C

Question 28

Medications for DM

Answer 28

- Anti-glycemics and preventative adjuvant therapy such as ACE inhibitors and aspirin. - Metformin is commonly prescribed as first-line therapy. - Sulfonylureas may cause hypoglycemia and can only be used in persons who can monitor signs. (Chlorpropamide and glyburide are contraindicated) - Insulin is used when all other strategies have failed.

Question 29

Nonpharmacological Management of DM

Answer 29

- Nutrition - Weight management - Exercise - Self-care

Question 30

Self-care for DM

Answer 30

- Glucose self monitoring - Medication self-administration - Foot care and examination - Recognize s/s hyperglycemia and hypoglycemia

Question 31

Cause of hypothyroidism

Answer 31

- Insidious in onset, thought to be most commonly caused by chronic autoimmune thyroiditis (previously called Hashimotos disease) - May be iatrogenic (induced inadvertently by provider, surgeon, or treatment) resulting from radioiodine treatment, subtotal thyroidectomy, or a number of medications, especially amiodarone (antiarrhythmic).

Question 32

Subclinical Hypothyroidism

Answer 32

Normal serum T4 and somewhat elevated TSH (5-10 IU/mL)

Question 33

Signs and symptoms of hypothyroidism that are probably less common in older adults

Answer 33

-Fatigue -Weakness -Depression -Dry skin Significantly less common include: -Weight gain -Cold intolerance -Muscle cramps

Question 34

Hyperthyroidism is caused by

Answer 34

It is most often caused by the autoimmune disorder Grave’s disease with multinodular or uninodular goiter

Question 35

Hyperthyroidism can also result in

Answer 35

Ingestion of iodine or iodine-containing substances

Question 36

Clinical manifestations of hyperthyroidism

Answer 36

- Often atypical and may not be diagnosed until the person has unexplained fibrillation, HF or even dementia. - Likely to have tachycardia, tremors and weight loss.

Question 37

Complications of Thyroid Disease

Answer 37

-Myxedema coma is a serious complication of untreated hypothyroidism in the older adult.

Question 38

Myxedema coma

Answer 38

Severe hypothyroidism leading to decreased mental status, hypothermia and other symptoms related to slowing of function in multiple organs.

Question 39

Myxedema coma symptoms

Answer 39

- Delayed DTRss - Puffy Skin - Bradycardia - Hypotension - Hypoventilation - Stupor - Coma

Question 40

Why is rapid replacement of thyroxine in myxedema coma not possible?

Answer 40

Due to risk for drug toxicity | Death may occur

Question 41

Over Replacement with thyroxine increases

Answer 41

Myocardial oxygen consumption. | May result in exacerbation of angina in those with pre-existing CAD or precipitate CHF.

Question 42

Thyroid Disorders: Promoting Healthy Aging

Answer 42

The nurse caring for frail elders can be attentive to the possibility that the person who is diagnosed with anxiety, dementia, or depression may have a thyroid disturbance. All persons having a depressive disorder must be checked for hypothyroidism. The nurse works with the person and significant others in the correct self-administration of medications and appropriate timing of monitoring blood levels and signs and symptoms indicating exacerbation (Box 24-15, pg. 316 Touhy & Jett).