Chapter 14 Renal and Urological Disorders

Chapter 14 Renal and Urological Disorders 1. Mrs. Borden is 67 years old and her primary care physician wants her to be seen by a nurse practitioner who specializes in geriatric issues. On completing the interview and examination, the nurse practitioner tells Mrs. Borden that she will order a blood laboratory specimen for thyroid function and pancreatic function. Mrs. Borden asks what the reason is. Which of the following is the nurse practitioner's best response? 1. Diabetes is more common in older patients. 2. Thyroid issues are less common in older patients. 3. These are common tests to be done on any new patient. 4. These tests are necessary to obtain baseline information. - 1. Answer: 1 Page: 361 Feedback 1. The nurse practitioner recognizes that normal aging changes of the endocrine system primarily are related to a decrease in pancreatic function (inability to sufficiently secrete insulin), resulting in diabetes mellitus. 2. The nurse practitioner needs to screen older adults periodically for diabetes mellitus and thyroid disease because the incidence of these conditions increases with age. 3. The nurse practitioner managing the care of older adults needs to differentiate among four clinical states. One of those is an endocrine function that is altered relative to that of younger patients, but is an expected consequence of normal aging. 4. Overall, the nurse practitioner managing the care of older adults needs to differentiate among four clinical states: 1. An endocrine function that is altered relative to that of younger patients, but is an expected consequence of normal aging. 2. Altered endocrine function secondary to coincident nonendocrine disease, but is not of known pathological significance. 3. Iatrogenic changes in endocrine function that largely reflect the polypharmacy seen in the older adult population. 4. Authentic endocrinopathy. 2. Mr. Jones is 70 years old and sees the nurse practitioner for a yearly checkup. He states that he needs to urinate a lot and seems to always be thirsty. He also finds himself gaining some weight. In the process of the examination, the nurse practitioner detects that he is vague in his answers. Which of the following may be the reason? 1. Mr. Jones is cold and bundled in a sweater. 2. There is no family history of diabetes. 3. The symptoms seem to have appeared slowly. 4. He does not want to admit to eating too much. - 2. Answer: 3 Page: 361 Feedback 1. Explore with the patient any difficulty with temperature regulation, changes in skin texture, or distribution of body hair. 2. Reevaluate the patient's family history for endocrine and metabolic disease. 3. Because changes in the endocrine system may appear subtle to the older person or atypical as compared to younger patients, it may be difficult to pinpoint the onset of the presentation. 4. Review with the patient any episodes of unexplained weight loss or gain, new or increased fatigue, weakness, malaise, and recent infections.