1. Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 35 Common Health Problems

2. Slide 2 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  CANCER  A new growth of abnormal cells is called a tumor.  Tumors are benign or malignant.  Metastasis is the spread of cancer to other body parts.

5. Slide 5 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  The National Cancer Institute describes these risk factors: Growing older Growing older Tobacco use Tobacco use Sunlight Sunlight Ionizing radiation, which can cause cell damage that leads to cancer Ionizing radiation, which can cause cell damage that leads to cancer Certain chemicals and other substances Certain chemicals and other substances Some viruses and bacteria Some viruses and bacteria Certain hormones Certain hormones Family history of cancer Family history of cancer Alcoholism Alcoholism Poor diet, lack of physical activity, and being overweight Poor diet, lack of physical activity, and being overweight

6. Slide 6 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Treatment depends on: The type of tumor The type of tumor Its site and size Its site and size If it has spread If it has spread  Common treatments include: Surgery Surgery Radiation therapy (radiotherapy) Radiation therapy (radiotherapy) Chemotherapy Chemotherapy Hormone therapy Hormone therapy Biological therapy (immunotherapy) Biological therapy (immunotherapy)

7. Slide 7 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  MUSCULOSKELETAL DISORDERS  Arthritis Arthritis means joint inflammation. Arthritis means joint inflammation. It is the most common joint disease. It is the most common joint disease. There are two basic types of arthritis. There are two basic types of arthritis.  Osteoarthritis (degenerative joint disease)  Rheumatoid arthritis (RA) Arthroplasty is the surgical replacement of a joint. Arthroplasty is the surgical replacement of a joint.

8. Slide 8 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  With osteoporosis, the bone becomes porous and brittle. Older men and women are at risk. Older men and women are at risk. All ethnic groups are at risk. All ethnic groups are at risk. Other risk factors include: Other risk factors include:  A family history of the disease  Being thin or having a small frame  Eating disorders  Tobacco use  Alcoholism  Lack of exercise  Bedrest and immobility

9. Slide 9 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  A fracture is a broken bone. Fractures are open or closed. Fractures are open or closed. Causes include falls and accidents, bone tumors, metastatic cancer, and osteoporosis. Causes include falls and accidents, bone tumors, metastatic cancer, and osteoporosis. For healing, bone ends are brought into and held in normal position. For healing, bone ends are brought into and held in normal position.  Closed reduction or external fixation  Open reduction or internal fixation Casts immobilize fractures. Casts immobilize fractures. Traction reduces and immobilizes fractures. Traction reduces and immobilizes fractures. Hip fractures are common in older persons. Hip fractures are common in older persons.  Older women are at risk.  Healing is slower in older people.  The fracture requires internal fixation.

12. Slide 12 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Loss of limb An amputation is the removal of all or part of an extremity. An amputation is the removal of all or part of an extremity. Much support is needed. Much support is needed. The person is fitted with a prosthesis. The person is fitted with a prosthesis. The person may feel that the limb is still there. The person may feel that the limb is still there.

13. Slide 13 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  NERVOUS SYSTEM DISORDERS  Stroke (brain attack or cerebrovascular accident [CVA]) Stroke is a disease that affects the arteries that supply blood to the brain. Stroke is a disease that affects the arteries that supply blood to the brain. Stroke is the third leading cause of death in the United States. Stroke is the third leading cause of death in the United States. It is a leading cause of disability in adults. It is a leading cause of disability in adults. The person needs emergency care. The person needs emergency care. Some risk factors can be controlled; others cannot. Some risk factors can be controlled; others cannot. Stroke can occur suddenly, or the person may have warning signs. Stroke can occur suddenly, or the person may have warning signs. If the person survives, some brain damage is likely. If the person survives, some brain damage is likely. Rehabilitation starts at once. Rehabilitation starts at once.

14. Slide 14 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Parkinson’s disease is a slow, progressive disorder with no cure. The area of the brain that controls muscle movement is affected. The area of the brain that controls muscle movement is affected. Persons over the age of 50 are at risk. Persons over the age of 50 are at risk. Signs and symptoms become worse over time. Signs and symptoms become worse over time.  Tremors  Rigid, stiff muscles in the arms, legs, neck, and trunk  Slow movements  Stooped posture and impaired balance  Mask-like expression Treatment includes: Treatment includes:  Drugs to treat and control the disease  Exercise and physical therapy  Therapy for speech and swallowing problems  Help with eating and self-care as needed  Safety measures to prevent falls and injury

15. Slide 15 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Multiple sclerosis (MS) is a chronic disease. The myelin in the brain and spinal cord is destroyed. The myelin in the brain and spinal cord is destroyed. Nerve impulses are not sent to and from the brain in a normal manner. Nerve impulses are not sent to and from the brain in a normal manner. Functions are impaired or lost. Functions are impaired or lost. There is no cure. There is no cure. Symptoms usually start between the ages of 20 and 40. Symptoms usually start between the ages of 20 and 40. Risk factors Risk factors  More women are affected than men.  Whites are at greater risk than other groups.  A person’s risk increases if a family member has MS. Symptoms depend on the damaged area. Symptoms depend on the damaged area.

16. Slide 16 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Amyotrophic lateral sclerosis (ALS) (Lou Gehrig’s disease) attacks the nerve cells that control voluntary muscles. ALS affects more men than women. ALS affects more men than women. It usually strikes between 40 and 60 years of age. It usually strikes between 40 and 60 years of age. Motor nerve cells in the brain, brainstem, and spinal cord are affected. Motor nerve cells in the brain, brainstem, and spinal cord are affected. The disease usually does not affect: The disease usually does not affect:  The mind, intelligence, or memory  Sight, smell, taste, hearing, and touch  Bowel and bladder functions ALS has no cure. ALS has no cure. Persons with ALS are kept active as long as possible and as independent as possible. Persons with ALS are kept active as long as possible and as independent as possible.

17. Slide 17 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Head injuries result from trauma to the scalp, skull, or brain. Traumatic brain injury (TBI) occurs when a sudden trauma damages the brain. Traumatic brain injury (TBI) occurs when a sudden trauma damages the brain. Causes include motor vehicle crashes, falls, firearms, assaults, and sports and recreational injuries. Causes include motor vehicle crashes, falls, firearms, assaults, and sports and recreational injuries. Death can occur at the time of injury or afterward. Death can occur at the time of injury or afterward. If the person survives TBI, some permanent damage is likely. If the person survives TBI, some permanent damage is likely. Disabilities depend on the severity and location of the injury. Disabilities depend on the severity and location of the injury. Rehabilitation is required. Rehabilitation is required.

18. Slide 18 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Spinal cord injuries can permanently damage the nervous system. Young adult men have the highest risk. Young adult men have the highest risk. Common causes are stab or gunshot wounds, motor vehicle crashes, falls, and sports injuries. Common causes are stab or gunshot wounds, motor vehicle crashes, falls, and sports injuries. Problems depend on the amount of damage to the spinal cord and the level of injury. Problems depend on the amount of damage to the spinal cord and the level of injury. Damage to the spinal cord may be incomplete or complete. Damage to the spinal cord may be incomplete or complete. The higher the level of injury, the more functions are lost. The higher the level of injury, the more functions are lost. Emotional needs require attention. Emotional needs require attention.

20. Slide 20 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. If the person survives, rehabilitation is necessary. If the person survives, rehabilitation is necessary. Autonomic dysreflexia affects persons with spinal cord injuries above the mid-thoracic level. Autonomic dysreflexia affects persons with spinal cord injuries above the mid-thoracic level.  If untreated, stroke, heart attack, and death are risks.  Autonomic dysreflexia is treated by raising the head of the bed 45 degrees or having the person sit upright if allowed.  The most common causes of autonomic dysreflexia are a full bladder, constipation or fecal impaction, and skin disorders.

21. Slide 21 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  RESPIRATORY DISORDERS  Chronic obstructive pulmonary disease (COPD) Three disorders are grouped under COPD (chronic bronchitis, emphysema, and asthma). Three disorders are grouped under COPD (chronic bronchitis, emphysema, and asthma). COPD is a leading cause of death in the United States. COPD is a leading cause of death in the United States. Risk factors include: Risk factors include:  Cigarette smoking  Pipe, cigar, and other smoking tobaccos  Exposure to second-hand smoke Not smoking is the best way to prevent COPD. Not smoking is the best way to prevent COPD. COPD has no cure. COPD has no cure.

23. Slide 23 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Influenza (flu) is a respiratory infection caused by viruses. Most deaths from flu occur in older persons. Most deaths from flu occur in older persons. Treatment involves: Treatment involves:  Fluids, rest, and relief of symptoms  Drugs for symptom relief and to shorten the flu episode Flu viruses are spread through coughing and sneezing. Flu viruses are spread through coughing and sneezing.  Standard Precautions must be followed. The flu vaccine is the best way to prevent the disease. The flu vaccine is the best way to prevent the disease.

24. Slide 24 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Pneumonia is an inflammation and infection of lung tissue. Affected tissues fill with fluid. Affected tissues fill with fluid. Bacteria, viruses, and other microbes are causes. Bacteria, viruses, and other microbes are causes. Children under 2 years of age and adults over 65 years of age are at risk. Children under 2 years of age and adults over 65 years of age are at risk. Older adults are at great risk of dying from the disease. Older adults are at great risk of dying from the disease. Risk factors include smoking, aging, stroke, bedrest, immobility, chronic disease, and tube feedings. Risk factors include smoking, aging, stroke, bedrest, immobility, chronic disease, and tube feedings. Pneumonia from aspiration is common in older persons. Pneumonia from aspiration is common in older persons.

25. Slide 25 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Tuberculosis (TB) is a bacterial infection in the lungs. TB is spread by airborne droplets with coughing, sneezing, speaking, singing, or laughing. TB is spread by airborne droplets with coughing, sneezing, speaking, singing, or laughing. Risk factors include living in close, crowded areas; age; poor nutrition; and HIV infection. Risk factors include living in close, crowded areas; age; poor nutrition; and HIV infection. Chest x-ray and TB testing can detect the disease. Chest x-ray and TB testing can detect the disease. Drugs for TB are given. Drugs for TB are given. The mouth and nose are covered with tissues when the person sneezes, coughs, or produces sputum. The mouth and nose are covered with tissues when the person sneezes, coughs, or produces sputum. Hand washing after contact with sputum is needed. Hand washing after contact with sputum is needed. Standard Precautions and Isolation Precautions are followed. Standard Precautions and Isolation Precautions are followed.

26. Slide 26 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  CARDIOVASCULAR DISORDERS  With hypertension (high blood pressure), the resting blood pressure is too high. Narrowed blood vessels are a common cause. Narrowed blood vessels are a common cause. Signs and symptoms develop over time. Signs and symptoms develop over time. Hypertension can lead to: Hypertension can lead to:  Stroke  Hardening of the arteries  Heart attack  Heart failure  Kidney failure  Blindness

27. Slide 27 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. These measures can lower blood pressure: These measures can lower blood pressure:  A diet low in fat and salt  A healthy weight  Regular exercise  No smoking  Limiting alcohol and caffeine  Managing stress and sleeping well  Certain drugs

28. Slide 28 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Coronary artery disease (CAD) In CAD, the coronary arteries become hardened and narrow. In CAD, the coronary arteries become hardened and narrow. The most common cause is atherosclerosis. The most common cause is atherosclerosis. The major complications of CAD are: The major complications of CAD are:  Angina  Myocardial infarction (heart attack)  Irregular heartbeats  Sudden death These risk factors cannot be controlled: These risk factors cannot be controlled:  Gender (Men are at greater risk than women.)  Age  Family history  Race (African-Americans are at greater risk than other groups.)

31. Slide 31 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. These factors can be controlled: These factors can be controlled:  Being overweight  Lack of exercise  High blood cholesterol  Hypertension  Smoking  Diabetes  Stress (anger, worry, arguing) Angina is chest pain. Angina is chest pain.  It is from reduced blood flow to part of the heart muscle.  Symptoms are relieved by rest and a nitroglycerin tablet.  Chest pain lasting longer than a few minutes and that is not relieved by rest and nitroglycerin may signal heart attack.

32. Slide 32 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Myocardial infarction (MI) Myocardial infarction (MI)  In MI, blood flow to the heart muscle is suddenly blocked.  CAD, angina, and previous MI are risk factors.  The person may need medical or surgical procedures to open or bypass the diseased artery.  The person needs cardiac rehabilitation.

33. Slide 33 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Heart failure or congestive heart failure (CHF) occurs when the heart is weakened and cannot pump normally. Left-sided failure (Blood backs up into the lungs.) Left-sided failure (Blood backs up into the lungs.) Right-sided failure (Blood backs up into the venous system.) Right-sided failure (Blood backs up into the venous system.) Common causes include: Common causes include:  CAD  MI  Hypertension  Age  Diabetes  Irregular heart rhythms  Damaged heart valves  Kidney disease

34. Slide 34 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  URINARY SYSTEM DISORDERS  Urinary tract infections (UTIs) Infection in one area can involve the entire system. Infection in one area can involve the entire system. Common causes include: Common causes include:  Catheterization  Urological exams  Intercourse  Poor perineal hygiene  Immobility  Poor fluid intake

35. Slide 35 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Risk factors Risk factors  Women are at high risk.  An enlarged prostate increases the risk of UTI in older men.  Older persons are at high risk. Cystitis is a bladder infection caused by bacteria. Cystitis is a bladder infection caused by bacteria.  Treatment involves antibiotics and encouraging fluids.  If untreated, cystitis can lead to pyelonephritis. Pyelonephritis is inflammation of the kidney pelvis. Pyelonephritis is inflammation of the kidney pelvis.  Infection is the most common cause.  Treatment involves antibiotics and fluids.

36. Slide 36 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Prostate enlargement The prostate grows larger as the man grows older (benign prostatic hyperplasia [BPH]). The prostate grows larger as the man grows older (benign prostatic hyperplasia [BPH]). BPH causes urinary problems. BPH causes urinary problems. Treatment depends on the extent of the problem. Treatment depends on the extent of the problem. Transurethral resection of the prostate (TURP) is a common surgical procedure. Transurethral resection of the prostate (TURP) is a common surgical procedure.  Urinary diversions Sometimes the urinary bladder is surgically removed. Sometimes the urinary bladder is surgically removed. A new pathway (urinary diversion) is needed for urine to exit the body. A new pathway (urinary diversion) is needed for urine to exit the body.

37. Slide 37 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Renal calculi are kidney stones. Risk factors Risk factors  White men between the ages of 20 and 40 years are at risk.  Bedrest  Immobility  Poor fluid intake Treatment involves: Treatment involves:  Drugs for pain relief  Drinking 2000 to 3000 ml of fluid a day  Straining all urine  Surgical removal of the stone if necessary Some dietary changes can prevent stones. Some dietary changes can prevent stones.

40. Slide 40 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  In renal failure, the kidneys do not function or are severely impaired. Waste products are not removed from the blood. Waste products are not removed from the blood. The body retains fluid. The body retains fluid.  Heart failure and hypertension easily result. Acute renal failure is sudden. Acute renal failure is sudden. With chronic renal failure, the kidneys cannot meet the body’s needs. With chronic renal failure, the kidneys cannot meet the body’s needs. Treatment for chronic renal failure includes: Treatment for chronic renal failure includes:  Fluid restriction  Diet therapy  Drugs  Dialysis  Some persons have kidney transplants.

41. Slide 41 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  THE ENDOCRINE SYSTEM  Diabetes is the most common endocrine disorder. With this disorder, the body cannot produce or use insulin properly. With this disorder, the body cannot produce or use insulin properly.  Without enough insulin, sugar builds up in the blood. Risk factors include: Risk factors include:  A family history of the disease  For type 1, whites are at greater risk than non-whites.  Type 2 is more common in older and overweight persons.  African-Americans, Native Americans, and Hispanics are at risk for type 2.

42. Slide 42 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc. Types of diabetes Types of diabetes  Type 1 occurs most often in children, teenagers, and young adults.  Type 2 can occur at any age.  Gestational diabetes develops during pregnancy. Complications occur if diabetes is not controlled. Complications occur if diabetes is not controlled. Treatment Treatment  Type 1 is treated with daily insulin therapy, healthy eating, and exercise.  Type 2 is treated with healthy eating, exercise, and sometimes drugs. Blood glucose is monitored daily or 3 or 4 times a day for hypoglycemia and hyperglycemia. Blood glucose is monitored daily or 3 or 4 times a day for hypoglycemia and hyperglycemia.

43. Slide 43 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  DIGESTIVE DISORDERS  Gastroesophageal reflux disease (GERD) is a disease in which stomach contents flow back from the stomach into the esophagus. Heartburn is the most common symptom of GERD. Heartburn is the most common symptom of GERD. Risk factors for GERD include being overweight, alcohol use, pregnancy, smoking, and hiatal hernia. Risk factors for GERD include being overweight, alcohol use, pregnancy, smoking, and hiatal hernia. Treatment includes: Treatment includes:  Drugs to prevent stomach acid production  Drugs to promote emptying of the stomach  Surgery if drugs and lifestyle changes do not work

44. Slide 44 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Diverticular disease Many people have small pouches in their colons. Many people have small pouches in their colons. Each pouch is a called a diverticulum. Each pouch is a called a diverticulum. The condition of having these pouches is called diverticulosis. The condition of having these pouches is called diverticulosis. The pouches can become infected or inflamed (diverticulitis). The pouches can become infected or inflamed (diverticulitis). Risk factors are age, a low-fiber diet, and constipation. Risk factors are age, a low-fiber diet, and constipation. The doctor orders needed dietary changes. The doctor orders needed dietary changes. Sometimes antibiotics are ordered. Sometimes antibiotics are ordered. Surgery is needed for severe disease, obstruction, and ruptured pouches. Surgery is needed for severe disease, obstruction, and ruptured pouches.

45. Slide 45 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Vomiting means expelling stomach contents through the mouth. It signals illness or injury. It signals illness or injury. Aspirated vomitus can obstruct the airway. Aspirated vomitus can obstruct the airway. Vomiting large amounts of blood can lead to shock. Vomiting large amounts of blood can lead to shock.

46. Slide 46 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  COMMUNICABLE DISEASES  Communicable diseases can be transmitted from one person to another in these ways: Direct—from the infected person Direct—from the infected person Indirect—from dressings, linens, or surfaces Indirect—from dressings, linens, or surfaces Airborne—through sneezing or coughing Airborne—through sneezing or coughing Vehicle—through ingesting contaminated food, water, drugs, blood, or fluids Vehicle—through ingesting contaminated food, water, drugs, blood, or fluids Vector—from animals, fleas, and ticks Vector—from animals, fleas, and ticks

47. Slide 47 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Hepatitis Hepatitis is an inflammation of the liver. Hepatitis is an inflammation of the liver. Protect yourself and others. Protect yourself and others.  Follow Standard Precautions  Follow the Bloodborne Pathogen Standard.  Follow Isolation Precautions as ordered.  Assist the person with hygiene and hand washing as needed. Hepatitis A is spread by the fecal-oral route. Hepatitis A is spread by the fecal-oral route. Hepatitis B is caused by the hepatitis B virus (HBV). Hepatitis B is caused by the hepatitis B virus (HBV). Hepatitis C is spread by blood contaminated with the virus. Hepatitis C is spread by blood contaminated with the virus. Hepatitis D is spread the same way as HBV. Hepatitis D is spread the same way as HBV. Hepatitis E is spread by food or water contaminated by feces from an infected person. Hepatitis E is spread by food or water contaminated by feces from an infected person.

48. Slide 48 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Acquired immunodeficiency syndrome (AIDS) AIDS is caused by the human immunodeficiency virus (HIV). AIDS is caused by the human immunodeficiency virus (HIV). The virus is spread through body fluids. The virus is spread through body fluids. The virus is transmitted mainly by: The virus is transmitted mainly by:  Unprotected anal, vaginal, or oral sex with an infected person  Needle and syringe sharing among IV drug users  HIV-infected mothers before or during childbirth  HIV-infected mothers through breast-feeding

49. Slide 49 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  Sexually transmitted diseases (STDs) are spread by oral, vaginal, or anal sex. Using condoms helps prevent the spread of STDs, especially HIV and AIDS. Using condoms helps prevent the spread of STDs, especially HIV and AIDS. Standard Precautions and the Bloodborne Pathogen Standard are followed. Standard Precautions and the Bloodborne Pathogen Standard are followed.

50. Slide 50 Copyright © 2007, 2003 by Mosby, Inc., an affiliate of Elsevier Inc.  QUALITY OF LIFE  A person may have one or many health problems.  The care you give affects the person’s quality of life.  Protect the right to privacy and confidentiality.  Protect the right to personal choice.  Protect the right to be free from abuse, mistreatment, and neglect.  Follow Standard Precautions and the Bloodborne Pathogen Standard.