Page 92 nursing.elitecme.com Complete Your CE Test Online - Click Here Nursing consideration: LPR is sometimes misdiagnosed as a sinus infection because of complaints of post-nasal drip. This sensation is not due to an infection but to mucous “sticking” in the irritated throat. Remember that the body normally produces sinus and nasal mucous daily. The excess acid in the throat causes the “sticking” feeling and the assumption that the sinuses are draining abnormally high amounts of mucous [55,56]. LPR can affect anyone, but is more frequent as people age. People who have certain dietary habits, and consistently wear tight or binding clothing, and those who are overweight and are over-stressed are more susceptible to LPR [55,56]. Most people respond well to a combination of lifestyle changes and medication. It usually takes a longer course of medication (compared to gastroesophageal reflux (GERD)) with protein pump inhibitors that must often be taken for several months. Other medications administered for LPR treatment include antacids and stomach acid reducers [55,56]. Other treatment initiatives include [55,56]: ● ● Losing weight, if needed. ● ● Smoking cessation. ● ● Avoiding alcohol. ● ● Restrict chocolate, mints, fats, citrus fruits, carbonated beverages, spicy or tomato-based products, alcohol, and caffeine. ● ● Do not wear tight or binding clothing. ● ● Take steps to reduce stress. ● ● Elevate the head of the bed four to six inches. ● ● Chew gum to increase saliva and neutralize acid. ● ● Avoid eating less than two hours before bedtime. The prognosis for LPR is very good because following a healthy lifestyle can control the disease. If untreated or undiagnosed, however, LPR can lead to a number of complications including [55,56]: ● ● Chronic cough. ● ● Chronic sore throat. ● ● Swelling of the vocal cords. ● ● Ulcers on the vocal cords. ● ● Worsening asthma. ● ● Masses in the throat. In rare instances, untreated LPR may also contribute to the development of cancer of the voice box [55,56]. Nursing consideration: Nurses need to be alert to the signs and symptoms of LPR. These signs and symptoms are often ignored or even misdiagnosed as a throat or sinus infection. It is imperative that LPR be diagnosed and treated promptly. Gastric/peptic ulcers It is estimated that about 4.5 million people in the U.S. have peptic ulcer disease. Hospitalization, morbidity, and mortality rates for peptic ulcer disease are higher in older adults compared to other adult age groups [9]. Peptic ulcers are defined as circumscribed lesions in the mucus membranes, and can be located in the lower esophagus, stomach, pylorus, duodenum, or jejunum. Most peptic ulcers (about 80%) are located in the duodenum. Gastric ulcers are most common in middle-aged and older men. Risk factors for peptic ulcer development include chronic use of nonsteroidal anti-inflammatory drugs, alcohol, and tobacco products [13]. Ulcer development is caused by infection with the bacteria Helicobacter pylori and subsequent pathologic hyper secretory disorders. Gastric acid is believed to contribute to the development of infection [13]. Nursing consideration: Blood type seems to influence peptic ulcer development. Gastric ulcers are more common in people with Type-A blood, and duodenal ulcers are more common in people with Type-O blood [24]. Signs and symptoms include heartburn and indigestion, bloating, abdominal distention, and nausea. Specific symptoms are as follows: ● ● Duodenal ulcers cause heartburn, and localized mid-epigastric pain that is relieved with eating. Weight gain often occurs because patients eat to relieve pain. There is often an unusual sensation of hot water bubbling at the back of the throat. ● ● Gastric ulcers cause heartburn and indigestion, pain with eating since food causes the gastric wall to stretch, thus causing pain, and feelings of fullness and bloating [13]. Treatment includes antibiotic therapy, analgesics, and drugs to reduce gastric acid production [13]. Colorectal cancer Benign colorectal tumors and polyps are found in 30% of people over the age of 50. Malignant tumors (colorectal cancer) are responsible for nine percent of all cancer deaths in the U.S. The disease becomes more common after the age of 65 [9]. Early diagnosis and treatment is associated with improvement in survival. Routine colonoscopies are the best diagnostic tool for early diagnosis. Signs and symptoms may not appear until the disease is advanced. They include: overt or covert bleeding; changes in the quality and/or quantity of bowel movements; black, tarry stools; cramps; urgent need to defecate when first getting up in the morning; feelings of fullness or incomplete evacuation of stool; and blood or mucus in the stool [9,13]. Treatment depends on the extent of the tumor and the stage of the disease. It can include simple removal of the tumor, removal of part of the intestine, radiation, and/or chemotherapy. A colostomy may be needed. This could be temporary or permanent [13]. Nursing consideration: Older adults may assume that symptoms of colorectal cancer are due to aging changes or hemorrhoids and not report them. Educate patients, families, and caregivers about the signs and symptoms of this type of cancer and the importance of appropriate preventive screening. The genitourinary system The genitourinary system is composed of the kidneys, ureters, bladder, and urethra, and reproductive organs. Since this system is so broad in scope, this section concentrates on those issues most closely associated with the aging process. Age-related changes associated with the genitourinary system include the following [9,17]: ● ● Nighttime production of urine increases, and the ability to concentrate urine decreases. ● ● Blood flow to the kidneys decreases. ● ● Glomerular filtration rate decreases. ● ● Bladder capacity is decreased. ● ● Bladder contractility increases. ● ● Risk of overflow incontinence, and urinary retention increases in men. ● ● Detrusor becomes unstable in women, causing an increased potential for incontinence. ● ● Prostate increases in size in men. ● ● Half-life of drugs is prolonged due to a reduction in renal function. Nursing consideration: Assess for signs of drug toxicity due to changes in excretion ability of the kidneys [9]. Older adults are more prone to drug toxicity because of changes in the efficiency of kidney and liver function [17]. Common age-related problems of the kidneys and related structures include the following conditions [9,13]. Urinary incontinence Urinary incontinence affects over 13 million adults [9]. It is of considerable concern to older adults who are often ashamed and embarrassed by the problem. They may not seek help for this problem because they assume it is a normal part of the aging process. Be sure to