afflict – v. 使痛苦，折磨
distinct – a. 不同的，特殊的
premature death – 英年早逝
coexisting – a. 同时存在的，共存的
geriatric – a. 老年病学的，老人的
polypharmacy – n. 多种药物疗法
incontinence – n. 失禁
injurious – a. 有害的，损伤的
complicate – v. 使错综复杂
fluctuation – n. 波动，起伏
Meals on Wheels – 送餐上门服务
“RN-ISPN考试复习要点提示”
帮助您尽快理清复习思路，准确抓住复习重点，是ISPN/RN考试复习的一大利器！
★RN-ISPN Review ★
Diabetes in the Elderly Population
老年人群的糖尿病
Diabetes is common in the elderly population. By the age of 75, approximately 20% of the population are afflicted with this illness. Diabetes in elderly adults is metabolically distinct from diabetes in younger patient populations, and the approach to therapy needs to be different in this age group.
Older individuals with diabetes have higher rates of premature death, functional disability, and coexisting illnesses, such as hypertension, coronary heart disease, and stroke, than those without diabetes. Older adults with diabetes also are at greater risk than other older adults for several common geriatric syndromes, such as polypharmacy, cognitive impairment, urinary incontinence, injurious falls, and persistent pain. Screening for diabetes complications in older adults should be individualized and periodically revisited, as the results of screening tests may impact therapeutic approaches and targets.
Older adults are at increased risk for depression and should therefore be screened and treated accordingly. Diabetes management may require assessment of medical, mental, functional, and social domains. This may provide a framework to determine targets and therapeutic approaches. Particular attention should be paid to complications that can develop over short periods of time and/or that would significantly impair functional status, such as visual and lower-extremity complications.
Older adults can have many underlying problems that complicate diabetic therapy. Poor vision and/or coordination may make it difficult to prepare a syringe. A week’s supply of syringes can be prepared and refrigerated for the usual dose of insulin.
Dietary deficiencies related to changes in taste, absorption, or attitude may lead to wide fluctuations in blood sugar levels, making it difficult to control diabetes. Many areas have nutritional assistance programs for older adults (e.g., Meals on Wheels) or have places that can refer patients to appropriate agencies that might be able to offer assistance.
Older adults have a greater incidence of renal or hepatic impairment, and kidney and liver function should be evaluated before starting any of these drugs. Combinations of oral agents may not be feasible with severe dysfunction, and the patient may need to use insulin to control blood glucose levels.
Older adults should receive periodic educational reminders about diet, the need for exercise, skin and foot care, and warning signs to report to the health care provider.
The older patient is also more likely to experience end organ damage related to the diabetes—loss of vision, kidney problems, coronary artery disease, and infections —and the drug regimen of these patients can become quite complex. Careful screening for drug interactions is an important aspect of the assessment of these patients.
1. Risk factors for type 2 diabetes include all of the following except:
A. Advanced age
B. Obesity
C. Smoking
D. Physical inactivity 2. Untreated hyperglycemia may lead to all of the following complications except:
A. Hyperosmolar syndrome
B. Vitiligo
C. Diabetic ketoacidosis
D. Coma
奥医教育“在线自测”题库
ISPN/RN复习练习、效果检验一站完成。
Answers 答案 1. C. Smoking Rationale: Additional risk factors for type 2 diabetes are a family history of diabetes, impaired glucose metabolism, history of gestational diabetes, and race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native Hawaiians, Pacific Islanders, and Native Americans are at greater risk of developing diabetes than whites. 2. B. Vitiligo Rationale: Excessively high blood sugar or prolonged hyperglycemia can cause diabetic ketoacidosis, the condition in which the body breaks down fat for energy and ketones spill into the urine. Diabetic hyperosmolar syndrome occurs when blood sugar is excessively high and available insulin is ineffective. In this case, the body cannot use glucose or fat for energy and glucose is excreted in the urine. Without immediate medical attention, both conditions may result in coma or death.
当前位置：
