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Old Person - Coggle Diagram

- - - - Increase Antidiuretic Hormone
      - Increase Atrial Natriuretic Peptide
      - Decrease Aldosterone
  - - - Treatment
        
        Anticholinergic drugs
        
        Desmopressin
      - Complex and multifactorial
        
        Idiopathic nocturnal detrusor overactivity
        
        Bladder cancer
        
        Diabetes insipidus
        
        Sleep apnea
        
        Depression
    - - Symptoms
        
        Stress incontinence
        
        Urge incontinence
        
        Overflow incontinence
        
        Functional incontinence
        
        Mixed incontinence
      - Diagnosis
        
        Urinalysis
        
        Bladder diary
        
        Postvoid residual measurement
      - Treatment
        
        Bladder training
        
        Fluid and diet management
        
        Scheduled toilet trips
        
        Kegel exercises
        
        Medications
        
        Anticholinergics
        
        Mirabegron (Myrbetriq)
        
        Alpha blockers
        
        Topical estrogen
      - Multifactorial
        
        A failure of the storage function of the lower urinary tract
        
        Inappropriate activity of the bladder (detrusor) muscle
        
        Incompetence of the continence maintaining mechanisms
- - - - Nursing Plans and Interventions
        
        Teach to avoid temperature extremes
    - - Nursing assessment
        
        Skin dryness or tears
      - Nursing Plans and Interventions
        
        Encourage the use of oils at least twice a day
        
        Discourage the use of powders that may be drying
        
        Teach to avoid overexposure to sunlight
        
        Encourage balanced nutrition and increase in fluid intake
        
        Teach good foot care
    - - Elongated ears
      - Baggy eyelids
      - Double chin
    - - Pressure Injury is more likely
        
        Nursing Assessment
        
        Bony prominences for signs of pressure ulcers
        
        Nursing Plans and Interventions
        
        Observe the bony prominences for signs of pressure
    - - Hair loss occurs
      - Women have increased facial hair
    - - Nursing Assessment
        
        Lesions to differentiate normal from abnormal
    - - Nursing Assessment
        
        Nail changes in shape, color and brittleness
  - - - Diagnosis
        
        Hormone Blood tests
        
        Testosterone
      - Treatment
        
        Depends on the underlying cause
        
        Medications
        
        Oral contraceptives
        
        Anti-androgens
        
        Spironolactone (Aldactone, CaroSpir)
        
        Topical cream
        
        Eflornithine (Vaniqa)
      - Symptoms
        
        Deepening voice
        
        Balding
        
        Acne
        
        Decreased breast size
        
        Increased muscle mass
        
        Women specific
        
        Excessive growth of dark or coarse hair in a male-like pattern — face, chest and back.
      - Androgen-dependent disorder resulting from the interaction between circulating androgen levels and the sensitivity of the hair follicle to androgens
        
        Retains testosterone in a more active androgen, dihydrotestosterone (DHT)
        
        After exclusion of an exogenous intake of androgens, hirsutism results either from hypersecretion of androgens, from the ovary or the adrenal gland, or the increased cutaneous sensitivity of the skin to normal circulating levels of androgens
- - - - Hope
      - Dignity
      - Meaning and purpose
      - Forgiveness
      - Love
      - Transcendence
      - Gratitude
      - Expression faith
    - - Faith beliefs and practices
      - Spiritual assessment
      - Affiliation with faith community
      - Extent to which spiritual needs are satisfied
      - Initial and ongoing
      - Fosters holistic care
  - - - Nurses supervise unlicensed personnel and are accountable for their actions
      - Problems faced by older adults may have complex legal implications
        
        Advances in Medical Technology
        
        Fiscal Constraints
        
        Conflicts of Interest
        
        Greater Numbers of Older Adults
        
        Assisted Suicide
      - Gerontological nurses' function in autonomous roles
      - Nurses are in a unique position to advocate for older adults
        
        Conflicts can occur with the nurses’ value system
        
        External systems affect ethical decisions
        
        Conflicts occur with the rights of patients and the nurses’ responsibility
    - - Physical and emotional exhaustion
      - Taking shortcuts
      - Lack of adherence to agency policies and procedures
      - Insufficient resources
      - Consent
        
        Patients are entitled to know the full implications of procedures, ability to make independent choices and decisions
        
        Consent must be obtained prior to any medical/surgical procedure
        
        Consider mental status
        
        Consent must be informed
        
        Elements:
        
        Written description of the procedure and the purpose
        
        Explanation by the person performing the procedure
        
        Alternatives to the procedure
        
        Expected consequences and risks
        
        Signature of the patient, witnessed, and dated
      - Competency
        
        Persons who are mentally incompetent are unable to give legal consent
        
        Next of kin may not be legal guardian and may not be able to give consent
        
        Guardianship differs from power of attorney for health care
        
        Various forms of legal guardianship
    - - Encourage patients’ expression of desires
      - Identify significant others who impact and are impacted
      - Know your own values
      - Consult experts
      - Share and evaluate decisions
      - Engage an Ethics Committee
- - - - Vaginal epithelium thins
      - Hormonal changes
        
        Cervix, uterus, and fallopian tubes atrophy
        
        Loss of subcutaneous fat and hair
        
        Vulva atrophies
        
        Flattening of the labia
      - Vaginal Canal
        
        Reduction in collagen and adipose tissue
        
        Shortening and narrowing of the canal
        
        Less lubrication
        
        More alkaline vaginal pH as a result of lower estrogen changes
      - Cervix, uterus, and fallopian tubes atrophy
      - Uterus and ovaries decrease in size
      - Endometrium continues to respond to hormonal stimulation
      - Fallopian tubes become shorter and straighter
      - Breasts sag and are less firm
      - Some retraction of nipples related to shrinkage and fibrotic changes
      - Pathology
        
        Cancer of the Endometrium
        
        Symptoms
        
        Hematuria
        
        Difficult or painful urination
        
        Pain during intercourse
        
        Pain and/or mass in the pelvic area
        
        Treatment
        
        Surgery
        
        hysterectomy
        
        salpingo-oophorectomy
        
        Radiation
        
        external beam radiation
        
        Internal radiation (brachytherapy)
        
        Chemotherapy
        
        Hormone Therapy
        
        Immunotherapy
        
        Palliative Care
        
        Diagnosis
        
        Pelvic Exam
        
        Sound waves to create a picture of uterus
        
        Transvaginal ultrasound
        
        Scope
        
        Hysteroscope
        
        Biopsy
      - Nursing Interventions
        
        Teach client signs of vaginitis & to report and treat if present
        
        Promote proper perineal care as needed
        
        Prescription creams can help with vaginal dryness
        
        Encourage client to obtain mammogram per guidelines
    - - Seminal vesicles develop thinner epithelium
      - Increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen
      - Seminiferous tubule changes
      - Atrophy of the testes and reduction in testicular mass
      - Decreased capacity to retain fluids
      - Ejaculation fluid contains less live sperm
      - Muscle tissue replaced with connective tissue
      - Testosterone stays the same or decreases slightly
      - More time required to achieve an erection
      - Enlargement of the prostate gland
      - Pathology
        
        Cancer of the prostate
        
        Treatment
        
        BPH should be followed closely
        
        PSA
        
        Realistic explanation of risk/benefit
        
        Symptoms
        
        Asymptomatic disease progression
        
        Frequent urination
        
        Weak or interrupted urine flow or the need to strain to empty the bladder.
        
        The urge to urinate frequently at night.
        
        Hematuria
        
        New onset of erectile dysfunction
        
        Pain or burning during urination
        
        Diagnosis
        
        Detected by digital rectal examination
      - Nursing Interventions
        
        Teach client about symptoms of prostatic enlargement
        
        Encourage annual digital examination for early identification of prostate cancers
    - - Annual gynecologic exam with Pap smear
      - Breast self-examination
      - Men with prostatic hypertrophy examined every 6 months
      - Testicular self-examination
      - Complete history and physical examination
      - Nursing diagnoses
- - - - Diastolic murmurs occur in 50% of older adults
    - - Slight ventricular hypertrophy
      - Thickening of left ventricular wall
    - - Decreased contractile strength & prolonged cardiac cycle
      - Unable to meet the demands of increased activity
    - - Dysrhythmias become more common in aging
      - Bradycardia, Tachycardia, Atrial Fibrillation, Heart Block
      - Syncope, Falls, and Transient Ischemic Attacks (TIA’s)
    - - Edema
      - Coronary artery disease: acute coronary insufficiency, myocardial infarction, dysrhythmias, heart failure
      - Peripheral Vascular Disease
    - - Arrhythmias
        
        Symptoms:
        
        Weakness
        
        Fatigue
        
        Palpitations
        
        Confusion
        
        Dizziness
        
        Hypotension
        
        Bradycardia
        
        Syncope
        
        Causes:
        
        Digitalis toxicity
        
        Hypokalemia
        
        Acute infections
        
        Hemorrhage
        
        Anginal syndrome
        
        Coronary insufficiency
        
        Treatment
        
        Antiarrhythmic drugs
        
        Digitalis
        
        Potassium supplements
        
        Cardioversion
        
        Education
        
        Modify diet
        
        Smoking cessation
        
        Decrease alcohol
        
        Activity
        
        Rhythm disturbances result from abnormalities of impulse formation, impulse conduction, or both
      - Pulmonary Emboli
        
        Risk Factors
        
        Fractures
        
        Congestive heart failure
        
        Arrhythmias
        
        History of thrombosis
        
        Immobilization
        
        Symptoms
        
        Confusion
        
        Apprehension, shortness of breath
        
        Temperature elevation
        
        Pneumonitis
        
        Elevated sedimentation rate
        
        A blood clot (thrombus) becomes lodged in an artery in the lung and blocks blood flow to the lung
        
        Usually from DVT
    - - Encourage regular low impact exercise
      - Teach to change positions slowly to avoid falls and injuries
      - Encourage frequent rest periods to avoid fatigue
      - Take apical and radial pulse; note deficits or rhythm abnormalities
      - Monitor B/P in lying, sitting, and standing position
      - Teach to avoid sitting with feet in a dependent position
      - Teach to avoid extreme hot and cold because of decrease in peripheral sensation
      - Assess edema: Weigh daily if indicated
      - Determine support system for follow up
      - Encourage medication adherence
    - - BP & VS
      - Hx of dizziness or blackouts with sudden position change
      - Diuresis after lying down
      - Feeling of heart palpitations
      - Angina
      - Swelling of hands and feet
      - Weight gain without change in eating pattern
      - Difficulty breathing at night. Confusion & personality change can result from oxygen deficit.
- - - - Diabetes Insipidus
        
        Dysfunctions
        
        Decreased renal tubular response to ADH, leading to increase in urinary output, dehydration, increased thirst
        
        Vasopressin
        
        Altered production of synthesis of ADH, leading to increase in urinary output, dehydration, increased thirst
        
        Treatment
        
        Central
        
        Hormone replacement therapy with DDAVP [Desmopressin]
        
        Usually caused by abnormality in the pituitary gland or hypothalamus
        
        Nephrogenic
        
        Low-salt diet
        
        Hydrochlorothiazide (Microzide)
        
        Gestational
        
        Synthetic hormone desmopressin
        
        Primary polydipsia
        
        Decreasing fluid intake
        
        Diagnosis
        
        Water deprivation test
        
        MRI
      - Hypothyroidism
        
        Primary disease: Hashimoto's
        
        Secondary disease: insufficient thyroid stimulating hormone
        
        Risk Factors:
        
        Insufficient iodine intake
        
        Exposure to high doses of radiation
        
        Certain medications can increase risk of hypothyroidism—Amiodarone, Lithium
        
        Symptoms
        
        Fatigue
        
        Weight gain
        
        Constipation
        
        Fertility issues [inability to conceive, decreased libido in men]
        
        Coarse, dry hair
        
        Edema [around eyes]
        
        Goiter
        
        Hypothermia
        
        Enlarged tongue
        
        Laboratory Assessment
        
        Elevated TSH [in primary disease]
        
        Decreased free T4
        
        Management
        
        Replacement of thyroid hormone
        
        Levothyroxine is the most common agent used
        
        Dosage is individualized—to keep the free T4 and TSH within the normal range
        
        Take on an empty stomach, 1 hour before or 2 hours after meals
        
        Permanent loss or atrophy of functional thyroid tissue (primary hypothyroidism)
        
        Insufficient stimulation of a normal thyroid gland as a result of hypothalamic or pituitary disease (secondary hypothyroidism, often accompanied by compensatory thyroid gland enlargement)
- - - - Lungs lose elastic recoil
      - Changes occur in upper airway paths, nose, and trachea
      - Declining muscle strength-Reduced cough reflex
      - Lung size and weight reduction
    - - Increased ventilation and perfusion are imbalanced
      - Increased dead space in the lungs
      - Decrease in alveolar surface area
    - - Decreased reaction of peripheral & central chemoreceptors to hypoxia and hypercapnia
    - - Decrease in cilia
      - Decreased ability to clear mucus secretions
      - Decreased ability to cough and deep breathe
      - Decreased immune response
    - - Chronic Bronchitis
        
        Symptoms
        
        General cynosis
        
        Right heart failure
        
        Distended jugular veins
        
        Wheezing
        
        Persistent, productive cough
        
        Recurrent respiratory infections
        
        Shortness of breath
        
        Nursing interventions
        
        Lowest FiO2 possible to prevent CO2 retention
        
        Watch for signs of fluid overload
        
        Management of chronic bronchitis
        
        Remove bronchial secretions
        
        Prevent obstruction of airway
        
        Maintain adequate fluid intake
        
        Chronic sputum with cough production daily for a minimum of 3 months in each of 2 consecutive years
      - Emphysema
        
        Symptoms
        
        Develop slowly
        
        Barrel chest
        
        Distant quiet breath sounds
        
        Wheezes
        
        Pulmonary blebs on x ray
        
        Treatment
        
        Postural drainage
        
        Bronchodilators
        
        Avoid stress
        
        Breathing exercises
        
        Reduced gas exchange surface area
        
        Increased air trapping
        
        Decreased capillary network
        
        Increased work, increased O2 consumption
    - - Barrel chest
      - Lungs for decreased breath sounds, congestion, crackles or atelectasis
      - Changes in breathing pattern
      - Dyspnea, orthopnea and fatigue
      - Vital Signs
      - Cough
      - Confusion (Recognize that hypoxia can manifest as confusion)
      - Poor Nutrition, weight loss
      - Sputum production
      - Anxiety
- - - - Risk for aspiration and indigestion
    - - Reduced need for calories
        
        Less lean Body Mass
        
        Basal metabolic rate declines
        
        Activity level lowered
      - Needs for Food
        
        Carbohydrates
        
        Reduction of intake
        
        Soluble Fiber
        
        Improves glucose tolerance
        
        Lowers serum cholesterol
        
        Dietary Fats
        
        < 30% of calories
        
        Protein
        
        10% to 20% of calories
        
        Calcium
        
        Absorption ability decreases with age
        
        Fruits and vegetables
        
        At least five servings daily
      - Nursing Assessment
        
        Type and amount of nutritional supplement
        
        Monitor the supplements and dosages for toxicity
      - Pathology
        
        Heart disease
        
        Cancer
        
        Osteoporosis
        
        Diabetes
        
        Hiatal Hernia
        
        Symptoms
        
        heartburn
        
        Belching
        
        Abdominal discomfort
        
        Treatment
        
        Small meals
        
        Avoid meals at bedtime
        
        Bland diet
        
        Sleeping in a partial recumbent position
        
        Types
        
        Sliding (axial)
        
        Rolling (paraesophageal)
        
        Herniation of the esophagogastric junction & a portion of the stomach is in the chest
        
        Esophageal Cancer
        
        Types
        
        Squamous cell
        
        Adenocarcinoma
        
        Symptoms
        
        Dysphagia
        
        Weight loss
        
        Excessive salivation
        
        Thirst
        
        Hiccups
        
        Anemia
        
        Diagnosis
        
        Barium swallow
        
        Esophagoscopy
        
        Biopsy
        
        Treatment
        
        Surgical resection
        
        Radiation
        
        Chemotherapy
        
        Laser therapy
        
        Photodynamic therapy
        
        The chronic reflux of gastric acid and bile at the gastroesophageal junction and the subsequent damage to the esophagus has been implicated in the pathogenesis of Barrett metaplasia.
      - Needs for Water
        
        Intracellular fluid lost results in decreased total body fluid
        
        1,500 mL minimal required fluid intake
        
        Nursing Assessment
        
        Evaluate factors that may cause older adults to consume less fluid
        
        Risks of fluid restrictions
        
        Effects of overhydration
    - - Increase in incidence of gastric irritation
      - Interferes with absorption of calcium, iron, folic acid, and vitamin B12
    - - Interferes with absorption of protein
    - - Reduces the amount of food accommodation at one time
    - - 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
- - - - Ability to respond to cold temperatures is reduced
      - Response to heat is altered
      - Normal body temperatures are lowered in older age; Mean body temperature can range from 96.9 F. to 98.3 F
    - - Hearing
        
        Presbycusis: Progressive loss of hearing
        
        Distortion of high-pitched sounds
        
        Cerumen increases: Affecting hearing
        
        Alteration in equilibrium
      - 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
      - Touch
        
        Reduction of tactile sensation
        
        Reduced ability to sense pressure, discomfort, change in temperature
      - Smell
        
        Sense of smell altered with age
      - Taste
        
        Taste acuity is dependent on smell
        
        Atrophy of the tongue
        
        Decreased saliva, poor oral hygiene, and medications
    - - Basic intelligence is upheld
      - Crystallized intelligence is maintained
      - Fluid intelligence may decline
      - Chronic psychological stress associated with increased incidence of mild cognitive impairment
      - Memory
        
        Long-term stays the same
        
        Short-term memory decline
        
        Age related forgetfulness
        
        The hippocampus deteriorates with age
        
        Hormones and proteins that protect and repair brain cells and stimulate neural growth decline with age
        
        Older individuals may experience decreased blood flow to the brain
      - Learning
        
        Learning ability is usually not changed
        
        Learning is best when new information relates to previous learned Information.
    - - Temperatures are lowered in older age
        
        Mean body temperature can range from 96.9 F. to 98.3 F
      - Ability to respond to cold temperatures is reduced
      - Response to heat is altered
    - - Parkinson Disease
        
        Treatment
        
        Anticholinergic medications
        
        Technologies to control symptoms
        
        Goal: maximum level of independence preserved
        
        Nursing Interventions
        
        Encourage activities and exercise. A cane or walker may be needed
        
        Eliminate environmental noise
        
        Soft diet, which is easy to swallow
        
        Schedule activities later in the day to all sufficient time for client to perform self-care activities without rushing
        
        Antiparkinsonian drugs as prescribed
        
        Parkinson disease involves and imbalance between acetylcholine and dopamine. Symptoms can be controlled by a dopamine precursor (levodopa).
        
        Nursing Assessment
        
        Rigidity of extremities
        
        Masklike facial expression
        
        Difficulty in chewing, swallowing, and speaking
        
        Drooling
        
        Stooped posture and slow, shuffling gait
        
        Tremors at rest, “pill-rolling” movement
        
        Emotional Liability
        
        Increased tremors with stress or anxiety
        
        Symptoms
        
        Tremors and shuffling gait
        
        Nursing Diagnosis
        
        Impaired physical mobility
        
        Disturbed body image
        
        Self-care deficit
        
        Impaired verbal communication
        
        Imbalanced nutrition; less than body requirements related to
      - Neurocognitive Disorder
        
        Symptoms
        
        Personality changes
        
        Confusion
        
        Disorientation
        
        Deterioration of intellectual functioning, loss of memory
        
        Decline of appropriate judgement and ADL’s
        
        Difficult performing familiar tasks
        
        Changes in mood or behavior
        
        Nursing Assessment
        
        Limited attention span, easily distracted
        
        Confusion & disorientation
        
        Delusions, visual hallucinations, or sensory illusions
        
        Labile affect; sudden anger
        
        Anxiety & depression
        
        Loss of recent memory
        
        Increased psychomotor activity
        
        Decreased personal hygiene
        
        Sleep deprivation, day-night reversal
        
        Incontinence and constipation
        
        Nursing Interventions
        
        Safe consistent environment
        
        Maintain health, nutrition, hygiene, and rest
        
        Set a routine in daily activities
        
        Use simple, direct statements
        
        Reinforce reality: Reorient the client as needed
        
        Redirect the client who exhibits combative behavior
        
        Engage the client in simple tasks and activities
        
        Consistent caregivers. Change increases anxiety & confusion
        
        Support family and caregivers
        
        Encourage end-of-life planning, a will, do not resuscitate status, power of attorney, and funeral arrangements
    - - Many neurologic disorders occur for reasons beyond a person’s control
      - Nurses can detect new or subtle symptoms of neurologic disorders
      - Nursing assessment of neurologic function
    - - Functional assessment
      - Weakness
      - Tremors
      - Gait
      - History of falls
      - Pain
      - H/A
      - ROM
      - Neuropathies
      - Changes in vision
      - Cognition
      - Muscle weakness
      - Depression
      - Sleep patterns
    - - 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
- - - - T-Cell activity declines
      - Cell-mediated immunity declines
      - Risk for infection becomes significant
      - Inflammatory defenses decline
        
        Inflammation presents atypically