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The Older Adult - Coggle Diagram
The Older Adult
Neurologic system
Sensory
Decrease visual acuity
Decrease taste buds
presbycusis
Slowing in central processing = delay in time required to perform tasks
Disease Confabulation
Pathophysiology: false memory created to fill in gaps when real experience cannot be recalled
Nursing Intervention: safe/controlled environment, maintain health, set routine, simple/direct statements
Symptoms: false memories that did not occur
Verbal skills maintained until age 70 = crystallized intelligence remains
Decrease number & sensitivity of sensory neurons, dermatomes, and neurons decrease = dulling tactile sensation
Decline in the function of cranial nerves affecting taste & smell
loss of nerve cell mass = atrophy of brain and spinal cord + brain weight decreases
Decrease number of dendrites
Demyelination = slower nerve conduction, response/reaction times slower, weaker reflexes
Disease Parkinson
Pathophysiology: debilitating basal ganglia and substantia nigra, low dopamine Tx w/ anticholinergic meds
Nursing Intervention: schedule activities later in the day, encourage activity, soft mechanical diet, Tx with Levodopa
Symptoms: tremors at rest, shuffling gait, pill rolling hand,
Cardiac system
Heart valves become thick and more rigid
diastolic murmurs occur in 50% of older adults
TIAs, syncope, Afib, Tachycardia
Aorta becomes dilated = ventricular hypertrophy + wall thickening
Myocardial muscle less efficient = sarcopenia
Calcification and reduced elasticity of vessels
Disease Atherosclerosis
Pathophysiology: buildup of plaque inside arteries
altered tissue perfusion - ischemic heart disease
Nursing Interventions: healthy lifestyle changes - diet and activity, low sodium and cholesterol, aspirin, supplemental oxygen
Signs/Symptoms: high cholesterol, angina - discomfort under sternum, other complications that are a sign - stroke, MI
Disease Coronary artery disease
Pathophysiology: affected circulation of blood flow in the heart due to plaque buildup
Nursing Interventions: maintain blood pressure, continuous ECG,
Symptoms: signs differ in women - fatigue and jaw pain
Less sensitive to baroreceptor regulation of blood pressure and increase peripheral resistance
Disease: Hypertension
Pathophysiology: increased vascular resistance and/or cardiac output that increases BP over 140/90
unmanaged HTN causes vascular complications
Nursing Interventions: Lifestyle choices - more activity, low sodium diet, maintain healthy weight, reduce stress, medication therapy
Symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor - also asymptomatic
Cardiac health promotion - Cardiac Diet: cholesterol control, DASH diet, exercise, stress management
Respiratory System
Normal Change:
Decrease ability to clear secretions
Disease: Emphysema
Pathophysiology: reduced gas exchange surface area, decrease capillary network
Nursing Implications: reduce stress, quit smoking, bronchodilators, pursed lip breathing
Symptoms: productive cough, wheezing, SOB, chest tightness
Disease: Asthma
Pathophysiology: inflammatory reaction with reversible airflow obstruction and wheezing
Nursing Interventions: Administer bronchodilators, fluids and humidification, ABGs, C-pap
Symptoms: wheezing, SOB, chest tightness, dyspnea
Disease: Chronic Bronchitis
Pathophysiology: increase in mucus, cilia projection, bronchial wall thickness, chronic hypoxemia
Nursing Interventions: Lowest FiO2 possible = prevent CO2 retention, s/s fluid overload, remove secretions
Symptoms: cyanosis, "blue bloater," RHF, DJV, persistent/productive cough, wheezing, SOB
Decrease reaction of peripheral & central chemoreceptors to hypoxia/hypercapnia
Increase imbalance of ventilation and perfusion
Decrease lung elastic coil
Decreased cough reflex
Disease: Lung Abscess
Pathophysiology: causes by aspiration or infection, an abscess accumulates in lung
Nursing Interventions: postural drainage, high-protein, high cal diet
Symptoms: anorexia, weight loss, fever, chronic cough
Decreased immune response
Disease: Lung Cancer
Pathophysiology: uncontrolled cell replication in lung tissue
Nursing Interventions: reduce stress, palliative care, management, education
Symptoms: dyspnea, cough, chest pain fatigue, anorexia, wheezing, respiratory infections
Integumentary system
Normal change
Thin skin = less effective barrier
Pressure Injury
Patho: bodyweight creates sustained downward force on tissue - decreasing circulation and causing skin breakdown
Intervention: maintain dry/clean skin, hygiene, rotate every 2 hours, nutritious diet - high protein
Symptom: painful injury site, discolored skin, itchiness, warm and red skin
Decreased ability to detect and regulate temp
Dry skin from decrease in endocrine secretion
Loss of elastin
seborrheic keratosis
Patho: multifactorial noncancerous skin condition
Symptoms: brown waxy pigmented skin spots
Interventions: see dermatologist - possible removal, sunscreen use, laser therapy, freeze therapy
Increase vascular fragility
Female reproductive system
Normal changes
Menopause = declined estrogen
Hormonal changes- vulva atrophies, flattening of labia, loss of subcut fat and hair
Disease Atrophic vaginitis
Patho: thinning, drying, inflammation of the vaginal walls due to low hormones
Nursing Intervention: vaginal estrogen, pelvic floor physiotherapy
Vaginal epithelium thins
cervix, uterus, fallopian tubes atrophy
Disease Perineal herniation
Patho: damage to muscle causing tissue to stretch/ weaken and prolapse
Interventions: surgical intervention repair, pain management, promote rest
vaginal canal changes: reduction in collagen, shortening canal, less lubrication, more alkaline pH
Musculoskeletal system
Normal change
Thinning disks and shortened vertebrae
Reduced muscle mass, strength, movement
Fragility
Patho: multifactorial affected by aging
Symptoms: weakness, Hx of falls, exercise intolerance, immobility, weight loss
Intervention: fall prevention, control environment, nutrition, activity
Decreased bone mineral and mass
Diminished calcium absorption
Male reproductive system
Normal changes
testosterone levels decline
Reduced muscle mass, energym, strength, and stamina
Atrophy of testes and reduction in testicular mass
Ejaculation fluid less live sperm
Erectile Dysfunction
Patho: cannot maintain erection
Intervention: drug therapy, hormone therapy. lifestyle modification, chronic condition management
Symptoms: soft erections, low sex drive
Enlargement of prostate gland
Disease Benign Prostate Hyperplasia
Patho: Enlarged prostate
Symptoms: decreased force of urinary system, nocturia, hesitancy
Intervention: drug therapy, transurethral resection, bedside urinal, toilet every 2 hr
Renal system
Normal Changes
size/weight of kidney decreases
Hypertrophy and thickening of bladder muscle
decrease bladder ability to expand
reduced storage capacity (Nocturia)
Decreased tubular function
Disease UTI
Pathophysiology: Infection or inflammation at any site in the urinary tract - E.coli, catheterized pt high risk
Nursing Interventions: antibiotics, 300mL fluid daily, void every 2 hr, perineal hygiene
Symptoms: Fever, chills, urinary frequency, urgency, dysuria, hematuria, pain, elevated WBC, confusion
Higher blood urea nitrogen levels
Proteinuria is common over 80
Disease Glomerulonephritis
Pathophysiology: glomerular injury and inflammation progressing to kidney failure, toxins and waste not filtered properly and build up
Nursing Interventions: restricting salt, fluid, protein, promoting rest
Symptoms: hematuria, proteinuria, HTN, edema, fatigue
Disease Renal Calculi
Pathophysiology: stone formation - minerals like calcium build up and form kidney stones - obstructing kidney function
Nursing Interventions: restrict stone causing substance in diet, restrict legumes, TX with Flomax, diagnosis with ct scan, restrict fluids
Symptoms: flank pain, ureter spasm, abdominal pain
Increase in renal threshold for glucose
Digestive system
Normal Changes
Atrophy of tongue affects taste buds and decreases taste sensation
Bile salt decreases
Disease: Biliary Tract
Pathophysiology: Cholelithiasis/gallstones - mineral deposits and gallbladder cancer with uncontrolled cell growth, affects fat digestion
Nursing Interventions: maintaining fluid and electrolyte balance, surgery to remove stone, limited diet
Symptoms: thickening and fibrosis of gallbladder, referred pain on shoulder, acute abdominal pain, nausea
Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter and saliva production decreases
Slower peristalsis
Disease Intestinal Obstruction
Pathophysiology: slower GI motility, inactivity, decreased food/fluid intake causes constipation and stool impaction, also caused by tumor and intersession - intestines are blocked (partial/complete) also due to cancer, adhesions, hernias
Nursing Interventions: Assess bowel sounds, medical/surgical management needed, hydration
Symptoms: Abdominal cramps, anorexia, distended abd, constipation, inability to pass gas
Endocrine
Thyroid gland atrophies and activity decrease
Disease: Hyperthyroidism
Pathophysiology: Excess amount of thyroid hormones
Nursing Interventions: observe for thyroid storm, wear med alert, high calorie/protein, low caffeine/fiber diet
Symptoms: enlarged thyroid, increased appetite, diarrhea, tachycardia, palpitations, sweating, insomnia, heat intolerance
Disease: Hypothyroidism
Pathophysiology: hypofunction of thyroid gland = insufficient T3 and T4 hormones
Nursing Interventions: medication (synthroid), high fiber diet, avoid laxative, increase activity, 3L fluid daily
Symptoms: fatigue, weakness, lethargy, anorexia, weight gain, periorbital edema, dry skin, myalgia, slow speech
Diminished adrenal function - ACTH secretion decreases
Normal Changes
Volume of pituitary gland decreases
insufficient release of insulin and reduced tissue sensitivity to circulating insulin
Disease: Diabetes
Pathophysiology: glucose intolerance, defect in pancreatic beta islet cells or insulin receptor cells
Nursing Interventions: fasting blood sugar, Pt education and management, high protein diet, healthy lifestyle changes, monitor for complications such a vascular diseases and infection
Symptoms: classic nonspecific symptoms may be absent, s/s of hypoglycemia and hyperglycemia - shaky, clammy, anxious
Immune system
Normal Change
reduced production of B and T cells in bone marrow
Cancer mutations metastasis - body immune response is weaker
Failure to thrive: malnutrition, weakness, anorexia
Inflammatory response decreases
