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Gero Concept Map - Coggle Diagram
Gero Concept Map
Cardiovascular System
Common Older Changes
Heart muscle loses efficiency
contractile strength + reduced cardiac output with physiologic stress
Valves become thick and rigid
Blood vessels reduce elasticity
Oxygen used less efficiently
Heart dimensions are unchanged
Affects on Older Health
Heart valves become thick and more rigid
Aorta becomes dilated
Myocardial muscle less efficient
prolonged cardiac cycle
Calcification & reduced elasticity of vessels
Less sensitive to baroreceptor regulation of blood pressure
Dysrthymias are more common
Arteriosclerosis can cause vascular problems
Preventable?
Lifestyle and DIET (DASH!)
Important practices: proper diet, exercise, no cigarette smoking, and manage stress.
Stress Management
Women
Increases with age, after menopause CAD is equal to men
Hypertension
Evaluation of blood pressure at least two occasions
Systolic blood pressure ≥ 140 mm Hg
Diastolic blood pressure ≥ 90 mm Hg
Symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremo
Wide range of treatment
Orthostatic Hypertensionn
Decline in systolic blood pressure of 20 mm Hg or more after
changing positions
Coronary Artery Disease / Atherosclerosis
Ischemic heart disease
Prevalence increases with age-some form is present
after 70 years of age
Angina
Atypical presentation: vague discomfort under the
sternum, indigestion, coughing, syncope, sweating, and
confusion
Nitroglycerin might be used
Myocardial infraction
Atypical presentation: confusion, decreased blood pressure, shortness of breath, elevated
temperature, and sedimentation rate
Heart Failure
Left Sided
causes pulmonary edema-results in pulmonary congestion
due to the inability of the left ventricle to pump blood to the periphery
Symptoms : dyspnea, crackles, cough, tachycardia, fatigue, anxiety, restlessness,
confusion
Right Sided
causes peripheral edema-results in peripheral congestion
due to the inability of the right ventricle to pump blood out to the lungs this may occur because of left sided failure or pulmonary disease
Hyperlipidedema
Risk of coronary artery disease with elevated total cholesterol
Diabetes
Providing education on how to draw up and administer insulin
Foot Care!
Common Age Related Changes
Physical Appearance
Hair loss, graying, wrinkles
Loss of tissue elasticity : elongated ears, baggy eyelids, double chin
Loss of subcut fat
Diminished stature related to reduce hydration , loss of cartilage , and thinning vertebrae
Cellular Level Changes
Function Cell number decreases, lean body mass decreases, total body fat increases, ECF = constant ICF = reduced
Intelligence
Basic intelligence is upheld
Fluid intelligence may decline
Crystallized intelligence is upheld
Chronic psychological stress associated with increased incidence of mild cognitive impairment
Sensory Changes
All senses are less proficient with advanced age: vision, hearing, taste, smell, and touch
Decreased efficiency of the senses can affect well-being, activities of daily living, safety and health
Vision
Presbyopia- inability to focus on close objects clearly
Narrowing of the visual field-decreased peripheral vision
Pupil size reduction & less reactive to light
Depth perception distortion
Decline in visual acuity
Hearing
Presbycusis: Progressive loss of hearing
Cerumen increases: Affecting hearing
Alteration in equilibrium
Distortion of high-pitched sounds
Taste and Smell
Sense of smell altered with age
Taste acuity is dependent on smell
Atrophy of the tongue
Decreased saliva, poor oral hygiene,
and medications
GI System Changes (Digestive)
Common Changes
Less acute taste sensations
•Decreased esophageal motility
•Atrophy of the small and large intestines
•Increased risk of aspiration, indigestion and constipation
GI Health Promotion
Good dental hygiene and regular dental visits can prevent disorders that threaten nutritional intake
Proper nutrition enhances general health and minimizes the risk of indigestion and constipation
Knowledge of the impact of medications on GI health is important
Utilization of natural means (fiber, fluids, and timing) to promote
bowel elimination
Dry Mouth (Xerostomia)
Results from
Decreased saliva, some medications, Sjögren’s syndrome, mouth breathing and altered cognition
Consequences of decreased saliva production in the older adult
population
Interventions
Saliva substitutes, sipping water, sugarless candy and gum
Dysphagia
incidence of swallowing difficulties increases with age
Causes
Gastroesophageal reflux disease (GERD), stroke, and structural disorders
Goals of care and interventions:
prevention of aspiration
promotion of adequate nutritional status
Hiatal Hernia
Herniation of the esophagogastric junction & a portion of the stomach is in the chest.
Causes
Obesty, large volumes of food
Types
Sliding (axial)
Rolling (paraesophageal)
S.S
heartburn, belching, abdominal discomfort
Treatment/management
small meals, avoid meals at bedtime, bland diet, sleeping in a partial recumbent position
Diverticular Disease
Incidence
Present in 50% of older adults
Causes
chronic constipation, obesity, atrophy of the intestinal wall muscles
Signs and Symptoms
Diverticulitis : left lower quadrant pain, increased flatus, rectal bleeding
Obstruction : fever, anorexia, abd distention, constipation alternating with diarrhea
Treatment/Management
Nutrition
acute phase-NPO, Recovery phase-no fiber or foods that irritate the bowel
Maintenance
high-fiber diet with bulk-forming laxatives to prevent pooling of foods. Avoid small poorly digested food such as popcorn, nuts, seeds.
Respiratory System
Affects of Aging
Calcification of costal cartilage, trachea
rib cage more rigid
Reduction of cough and laryngeal reflexes
Increased residual capacity and reduced vital capacity
High risk for respiratory infection
Lifetime of insults to respiratory system takes its toll during older age
COPD is the leading to cause of respiratory disability
Breathing Mechanisms
declined muscle strength
lungs lose elastic recoils
Changes occur in upper airway systems
Terms to know
Chronic obstructive pulmonary disease (COPD): group of diseases including asthma, chronic bronchitis, and emphysema
Kyphosis: curvature of the spine
Elastic recoil: lungs’ ability to expand and contract
Total lung capacity: maximum volume that lungs can expand during fullest inspiration
Vital capacity: maximum amount of air that can be expelled following
maximum inspiration
Asthma
is an intermittent disease with reversible airflow obstruction and wheezing due to a
variety of stimulants
Evaluate aerosol nebulizer use
Precaution: avoid adverse drug interactions
Nursing Interventions
Administer bronchodilators
Chronic Bronchitis
Chronic sputum with cough production daily for a minimum of 3 months in each of 2 consecutive years
Chronic hypoxemia, cor pulmonale
Increase in mucus, cilia projection
Increase in bronchial wall thickness
Assessment
General cyanosis, “Blue Bloater”, R heart failure, distended jugular veins.bCauses persistent, productive cough; wheezing; recurrent respiratory infections; shortness of breath
Interventions
Lowest FiO2 possible to prevent CO2 retention
Watch for fluid overload
management of chronic bronchitis
remove secretions
Emphysema
Causes: chronic bronchitis, chronic irritation,
and morphologic changes in the lung
Cigarette smoking major role in development
Symptoms develop slowly; can delay diagnosis,
treatment
"Blue Bloater" - cough, DOE, hypercapnia, hypoxemia, mild cyanosis
Treatment
Postural drainage, bronchodilators, avoid stress,
and breathing exercises
Nervous System
Common Changes
Decline in weight and blood flow to the brain
Reduction in neurons, nerve fibers and cerebral blood flow
Slower response to change in balance
Hypothalamus less effective in temperature regulation
Changes in sleep patterns with frequent awakening
Affects of aging on Neuro Health
Intelligence remains constant in the healthy older adult
Slowing in central processing
Verbal skills maintained until age 70
Number and sensitivity of sensory receptors, dermatomes, and
neurons decrease
Decline in the function of cranial nerves affecting taste and smell
Loss of nerve cell mass
Atrophy of the brain and spinal cord, Brain weight decreases
Demyelination, # of dendrites declines
Neurologic Health Promotion
Many neurologic disorders occur for reasons beyond a person’s control
Preventive measures for neurologic health
Nurses can detect new or subtle symptoms of neurologic disorders
Nursing Interventions
Perform mental status exam
screen for depression
screen for cognitive impairment
Provide assistive devices as needed for ambulation
Encourage walking, ROM, and balance exercises
Minimize potential sources of injury in the environment
Teach stress management and adaptive self-care management
Monitor for conditions caused by lack of sleep (fatigue, confusion, disorientation
Parkinson's Disease
Affects ability of the central nervous system (CNS) to control body movements
Degeneration of basal ganglia and substantia nigra, affecting motor ability and characterized by tremor at rest, bradykinesia, muscle rigidity and postural instability (gait and balance)
Treatment/Management
Anticholinergic Medications and Technologies to control symptoms
Goal : maximum independence achieved
Nursing Assessment
Rigidity of extremities, "mask like" facial expressions
Drooling
Stooped Posture
Slow shuffling gait
Tremors, "pill rolling"
incrased tremors with anxiety/stressors
Dementia
cognitive impairments characterized by progressive onset. Irreversible and affects judgement, memory, abstract thinking, and social behavior
Characteristics
Personality changes, confusion, disorientation, decline of judgement and ADLs, difficult preforming familiar tasks, changes in mood or behavior
Confabulation
false memory created by the client that is accepted as truth to fill in gaps when real experience cannot be recalled. it is a plausible but imagined theory
Theories of Aging
Aging is viewed as a process in which society and the individual
gradually withdraw, or disengage, from each other to the mutual satisfaction and benefit of both.
Ageism
Prejudices and stereotypes applied to older adults based on age
• Bias against older adults
• Stereotypes and misconceptions
• Consequences of ageism: eroding dignity
Reduction in Income, Retirement, Loss of Spouse, Grandparenting, Parenting,
Nursing Interventions to Transitions
Life review-intentionally reflecting on past
experience
Eliciting a life story-benefits the younger
generation
Promoting self-reflection- Knowledge- Body
Spirit Mind
Art, Journals, Writing, E mail
Endocrine System Changes
Affects of aging
Thyroid gland atrophies and activity decreases
Diminished adrenal function
Adrenocorticotropic hormone (ACTH) secretion decreases
Volume of pituitary gland decreases
Insufficient release of insulin and reduced tissue sensitivity to
circulating insulin
Type 2 Diabetes
Seventh leading cause of death in older adults
Diagnosis of diabetes in the older adult
Classic nonspecific symptoms may be absent
Screening
Fasting blood sugar recommended
every 3 years for persons over 45
years of age
Metformin : 1st line of defense
Should not be used if the patient has: hepatic disease, alcoholism, severe
congestive heart failure, severe peripheral vascular disease.
Hypothyroidism
everything SLOWS down
Hypofunction of the thyroid gland with resulting insufficiency of
thyroid hormone
Low T3 <70 T4 <5
S/S
fatigue, weakness, lethargy, anorexia, weight gain or a puffy face, impaired hearing, edema, dry skin and hair, constipation
Teaching
3L fluid a day, higher fiber diet, increase activity and avoid laxatives
Treatment : Synthroid : replacement of thyroid therapy
Start with low dose to avoid problems for asymptomatic CAD
Hyperthyroidism
S/S
T3 > 220 and T4 > 12
everything speeds up, insomnia, weight loss, activity increase, wet skin and hair
Treatment : Thyroid ablation, radioactive iodine therapy, Thyroidectomy. Avoid and watch for thyroid storm, wear med alert, High calorie and high protein diet!
Secretion of excess amounts of thyroid hormone
Reproductive/Sleep
Sexuality/Reproductive
Terms to Know
Andropause: a decline in testosterone levels with aging
Dyspareunia: painful intercourse
Erectile dysfunction: the inability to attain and maintain an
erection of the penis sufficient to engage in sexual intercourse
Hormone replacement therapy (HRT): replacement of estrogen and/or progestin hormone that is no longer being made by the body
Menopause: the permanent cessation of menses for at least 1
year
Perimenopause: the several years prior to the onset of
menopause
Postmenopause: time beginning 12 months after the last
menstrual cycle
Andropause
Testosterone levels decline in men
Low testosterone levels result in reduced muscle mass, energy, strength, and stamina
Other changes. Erectile dysfunction, breast enlargement, osteopenia, osteoporosis, and smaller tests
Misconceptions
Misconception by health professionals: older adults not interested in nor capable of sex
Health professionals lack experience in discussing sex with any age group
Medical and nursing assessments lack inquiry of sexual history and activity
Need to promote understanding of older adults’ sexuality
Negative attitudes from other adults
Intimacy
Sexuality encompasses more than
just physical acts
Love, warmth, caring, and sharing
Intimate exchange of words and
touch
Feeling important and wanted by
another person
Multiple losses have significant effect
on intimacy
Age-related changes have impact
on sexual function
Older adults are physically able to
remain sexually active
Erectile Dysfunction
unable to attain or maintain erection of
penis for sexual intercourse
Multiple causes: atherosclerosis,
diabetes, hypertension, multiple
sclerosis, thyroid dysfunction,
alcoholism, renal failure, structure
abnormalities, medications, and
psychological factors
Physical exam essential
Medical treatments and other options
available
Medications can also effect
Aging and female Reproductive System
Hormonal changes
Vaginal epithelium thins
Cervix, uterus, and fallopian tubes atrophy
Shortening and narrowing of vaginal canal
Uterus and ovaries decrease in size
Endometrium continues to respond
to hormonal stimulation
Fallopian tubes become shorter and
straighter
Terms to Know (Sleep)
Insomnia: inability to fall sleep, difficulty staying asleep,
or premature waking
Nocturnal myoclonus: condition characterized by at
least five leg jerks or movements per hour during sleep
Phase advance: falling asleep earlier in the evening and
awakening earlier in the morning
Restless leg syndrome: neurological disorder characterized by an uncontrollable urge to move the legs when one lies down
Sleep apnea: disorder in which at least five episodes of cessation of breathing, lasting at least 10 seconds, occur per hour of sleep, accompanied by daytime sleepiness
Sleep latency: delay in the onset of sleep
Urinary System Changes
Common Changes
Decline of renal blood flow and
glomerular filtration by approximately 50% by age 90.
Reduced bladder capacity
Urinary frequency, urgency, and nocturia are common in older adults
Incontinence is NOT a normal part of aging
Circulation
Terms
Arrhythmia: abnormal heart rate or rhythm
Atherosclerosis: hardening and narrowing of arteries due to plaque buildup in vessel walls
Physical deconditioning: decline in cardiovascular function due to physical inactivity
Hypertension: consistent blood pressure reading >140 mm Hg systolic and >90 mm Hg diastolic
Postural hypotension (AKA Orthostatic Hypotension): decline in systolic blood pressure of 20 mm Hg or more after rising and standing for 1 minute