Q & A With the Expert on: Coronary Artery Disease Management of an Older Person With Unrecognized Q-Wave Myocardial Infarctio
- Fri, 9/5/08 - 4:54pm
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- 5069 reads
Q: A 73-year-old asymptomatic woman with no history of myocardial infarction (MI) is seen by her physician. She is a nonsmoker. Her blood pressure is 150/80 mm Hg. Her heart rhythm is regular with a ventricular rate of 82 beats per minute. Her body mass index is 25 kg/m2. Her physical examination is normal except for her blood pressure.
A routine electrocardiogram shows evidence of an old anterior wall MI not present on a routine electrocardiogram obtained 1 year previously. A 2-dimensional echocardiogram shows a left ventricular ejection fraction (LVEF) of 39%. Her comple
Q & A With the Expert on: Pressure Ulcers and Undernutrition
- Fri, 9/5/08 - 4:54pm
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Undernutrition in an Elderly Woman with a Pressure Ulcer
Q: An 85-year-old woman was admitted to my nursing home after a hip fracture. She developed a Stage 4 sacral pressure ulcer in the hospital. She lost a lot of weight since her fall, and the nurses report that she is eating about 75% of her diet. Is there any specific vitamin or nutritional supplement that I should be using to help heal her pressure ulcer?
A: Despite having reasonably good nutrition status prior to hospitalization, weight loss and a deterioration of nutritional status often occurs in the hospital.1 Almost 90% of
Q & A With the Expert on: Osteoporosis
- Fri, 9/5/08 - 4:54pm
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Minimizing the Risk of Another Hip Fracture in a Patient with Osteoporosis
Q: A 90-year-old female sustained a hip fracture as a result of a fall. She is now admitted to the nursing home after undergoing hip fracture surgery. What does a nursing home practitioner need to do to minimize her risk of suffering another hip fracture?
A: This is a frequently encountered situation in skilled nursing facilities. This 90-year-old patient is at increased risk of suffering another hip fracture, and efforts should be taken to minimize this risk.1 These efforts should not only focus on increasing he
Q& A With the Expert on: Coronary Artery Disease
- Fri, 9/5/08 - 4:54pm
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Q: A 72-year-old asymptomatic woman taking no medications had a routine 12-lead electrocardiogram obtained in her physician’s office, which showed an old anterior Q-wave myocardial infarction. She was an ex-smoker. Her body mass index was 24 kg/m2. Her blood pressure was 126/80 mm Hg. Her cardiovascular examination showed no abnormalities except for a fourth heart sound heard at the apex. Her fasting blood sugar was 95 mg/dL. Her fasting serum lipids showed a serum total cholesterol of 195 mg/dL, a serum low-density lipoprotein (LDL) cholesterol of 130 mg/dL, a serum high-density lipoprote
Q& A With the Expert on: Coronary Artery Disease
- Fri, 9/5/08 - 4:54pm
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- 991 reads
Management of the Older Person with a Clinically Unrecognized Myocardial Infarction
Q: A 72-year-old asymptomatic woman taking no medications had a routine 12-lead electrocardiogram obtained in her physician’s office, which showed an old anterior Q-wave myocardial infarction. She was an ex-smoker. Her body mass index was 24 kg/m2. Her blood pressure was 126/80 mm Hg. Her cardiovascular examination showed no abnormalities except for a fourth heart sound heard at the apex. Her fasting blood sugar was 95 mg/dL. Her fasting serum lipids showed a serum total cholesterol of 195 mg/dL, a serum
With the Expert on: Communicating with Families
- Fri, 9/5/08 - 4:54pm
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- 1860 reads
Discontinuing Medications for a Resident with Advanced Alzheimer's Disease.
Q: How does one approach the family of a resident with advanced Alzheimer’s disease residing in a long-term care (LTC) facility regarding discontinuing medications that may no longer be clinically indicated, even though the family insists that “everything be done” to treat the resident?
A: There are no “typical” families of residents with advanced Alzheimer’s disease or dementia. Many family members will tell you that “Mom isn’t like other people with Alzheimer’s disease.” Concerned families
Presentation and Diagnosis of Rapidly Progressing Encephalopathy
- Fri, 9/5/08 - 4:54pm
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- 1566 reads
Q: A 71-year-old woman is brought to your office by her daughter, who relays her concern that over the past three months, her mother has developed worsening anxiety, periods of confusion, and a change in her usual pleasant personality. In addition, her mother has undergone a 10-pound weight loss. Her daughter also describes several episodes where her mother sits and stares, picks at things with her hands, and occasionally smacks her lips.
The patient has been on paroxetine 20 mg daily for a depressive episode that started two years ago, following the death of her husband of 51 years. Her p
Vitamin D Deficiency in Long-Term Care Residents
- Fri, 9/5/08 - 4:54pm
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Q: Should I give all of my nursing home residents a vitamin D supplement?
A: Vitamin D deficiency is common in residents of long-term care facilities. Sixty percent of female residents of a nursing home in Wisconsin were found to have levels of vitamin D low enough to cause secondary hyperparathyroidism, and only 4% of the 49 women studied had vitamin D levels above 30 ng/mL, a level considered optimal.1 Many of these female residents were taking a daily multivitamin. Skin exposure to the sun—something in short supply for most residents of long-term care facilities—is necessary for the
With the Expert on: Fecal Incontinence
- Fri, 9/5/08 - 4:54pm
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Managing an Elderly Resident with Fecal Incontinence
Q: A 75-year-old female is admitted to a nursing home, and the staff has noted that she has fecal incontinence. What does a nursing home practitioner need to do to treat her fecal incontinence?
A: Prevalence of fecal incontinence in the nursing home exceeds 50%.1,2 Double incontinence (ie, fecal incontinence and urinary incontinence) is 12 times more common than fecal incontinence alone, with 50-70% of persons with urinary incontinence also suffering from fecal incontinence.3-5 Both urinary and fecal incontinence are the second most
Identifying Elder Abuse in the Home Care Setting
- Fri, 9/5/08 - 4:54pm
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- 2762 reads
Q: A 78-year-old woman is brought to your office by her son. She has moderate Alzheimer’s disease and has had a previous stroke, which impairs her ability to communicate. She has episodes of agitation several times weekly, which eventually respond to behavioral modification. She lives in her own home, but requires care by home health aides 18 hours daily. Thus far, she has been able to stay alone at night. She seems depressed and fearful, and does not attempt to answer your questions. She has lost 15 pounds since her last visit 3 months ago. Several skin tears are noted, along with bruises o
