If mobility is limited. How does this affect continence in the elderly?

Case Study:

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Case Study 1

Concepts of Altered Health in Older Adults

Joseph P. is an 82-year-old male living at home. He is in overall good health and enjoys taking long walks as often as possible. During his walks, he likes to stop for a cold glass of fruit juice at the local cafeteria. On cold or rainy days, he rides a stationary bicycle at home for 30 minutes to “stay in good shape.”

  1. What physiological factors would typically increase Joseph’s risk of falling while walking outdoors?
  2. What are the common changes in blood pressure regulation that occurs with aging?
  3. Joseph enjoys fruit juice when he walks. Considering the renal system in the older adult, why would dehydration be a particular concern?

Case Study 2

Structure and Function of the Kidney

Rivka is an active 21-year-old who decided to take a day off from her university classes. The weather was hot and the sun bright, so she decided to go down to the beach. When she arrived, she found a few people playing beach volleyball, and they asked if she wanted to join in. She put down her school bag and began to play. The others were well prepared for their day out and stopped throughout the game to have their power drinks and soda pop. Several hours after they began to play, however, Rivka was not feeling so good. She stopped sweating and was feeling dizzy. One player noted she had not taken a washroom break at all during the day. They found a shaded area for her, and one of the players shared his power drink with her. Rivka was thirstier than she realized and quickly finished the drink.

  1. In pronounced dehydration, hypotension can occur. How would this affect the glomerular filtration rate of the kidney? What actions by the juxtaglomerular apparatus would occur to restore GFR?
  2. What is the effect aldosterone has on the distal convoluted tubule? Why would the actions of aldosterone be useful to Rivka in her situation?
  3. What does a specific gravity test measure? If someone tested the specific gravity of Rivka’s urine, what might it indicate?

Case Study 3

Disorders of Fluid and Electrolyte Balance

Amanda is an 18-year-old with anorexia nervosa. She was recently admitted to an eating disorders clinic with a BMI of 13.9, and although she was a voluntary patient, she was reluctant about the treatment. She was convinced she was overweight because her clothes felt tight on her. She complained that even her hands and feet “were fat.” One of her nurses explained that a protein in her blood was low. The nurse further explained that, as difficult as it may be to believe, eating a normal healthy diet would make the “fat hands and feet” go away.

  1. What protein do you suspect the nurse was referring to? How would a deficiency in this protein contribute to edema?
  2. What is the difference between the physiology of pitting and nonpitting edema?
  3. Because of her weakened condition, Amanda was moved around the ward in a wheelchair when she was not on bed rest. How does this affect her edematous tissues?

Case Study 4

Disorders of Acid–Base Balance

Shauna is a healthy, fit 28-year-old who decided to go on a 2-week tour of Mexico for young singles. One hot afternoon in a small market community, she grabbed some fruit juice from a street vendor. Several hours later, she developed abdominal cramping and diarrhea. The diarrhea became so severe that she missed 3 days of the tour and stayed in her hotel room. By the end of her illness, she felt weak and tired. Her head ached, but the mild fever had disappeared, and she was able to join her new friends for the rest of the tour.

  1. What is the acid–base imbalance Shauna might have experienced and its etiology?
  2. What are the functions and importance of the bicarbonate buffer system in the body?

Case Study 5

Disorders of Renal Function

Fred, a fit and healthy 44-year-old, was working outside one warm summer afternoon. When he returned home by the end of the day, his lower back felt sore and he felt nauseated. His wife made him dinner, but he was not hungry and chose to go to bed instead. Fred’s symptoms progressed, and soon he was rolling on the bed with excruciating pain. He said his back hurt as well as his stomach and groin area. The pain would ease off only to return a short while later, and when it did, Fred would begin to sweat and run to the bathroom to vomit. His wife became concerned and started the car. When his symptoms abated, she helped him into the car and rushed him to the hospital.

  1. At the hospital, an abdominal radiograph showed the presence of renal calculi in Fred’s right ureter (urolithiasis). What is the mechanism of stone formation in the kidney? What is the role of citrate in the kidneys?
  2. Why would the administration of calcium supplements be useful for a patient with calcium oxalate stones?
  3. Hydronephrosis can be a complication of renal calculi. What is hydronephrosis? How does back pressure occur in a kidney, and what physiological mechanism is responsible for nephron damage when back pressure is present?

Case Study 6

Acute Renal Injury and Chronic Kidney Disease

Will is a 68-year-old male with a history of hypertension. Eight months ago, he started regular dialysis therapy for ESRD. Before that, his physician was closely monitoring his condition because he had polyuria and nocturia. Soon it became difficult to manage his hypertension. He also lost his appetite, became weak, easily fatigued, and had edema around his ankles. Will debated with his physician about starting dialysis, but she insisted, before the signs and symptoms of uremia increased, the treatment was absolutely necessary.

  1. What is the difference between azotemia and uremia?
  2. Two years ago, Will’s physician told him to decrease his protein intake. In spite of what the physician ordered, Will could not stop having chicken, beef, pork, or eggs at least once a day. Why did his physician warn him about his diet?
  3. Will’s feelings of weakness and fatigue are symptoms of anemia. Why is he anemic?
  4. Knowing what you do about Will’s history, why is left ventricular dysfunction a concern for his physician?

Case Study 7

Disorders of the Bladder and Lower Urinary Tract

Alvita is a frail 89-year-old woman residing in a nursing home. She is able to move slowly around the residence with the use of a walker, but appreciates when her daughter is there to hold her arm and walk alongside her. When one of the health care staff changes Alvita, her daughter helps. Alvita’s incontinence has progressed, particularly over the last six years since she has resided in the nursing home. Alvita can smile at her lack of bladder control, however, and says that her incontinence really began when she was a young woman, just after the birth of her second daughter.

  1. Alvita’s mobility is limited. How does this affect continence in the elderly?
  2. Shortly after the birth of her second daughter, Alvita experienced mild incontinence, particularly after laughing or coughing. What was she experiencing? What is the pathophysiology behind this type of incontinence?
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