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The Older Adult - Coggle Diagram
The Older Adult
Nervous
Intelligence remains constant in the healthy older adult
Slowing in central processing
Delay in time required to perform tasks
Verbal skills maintained until age 70
Number and sensitivity of sensory receptors, dermatomes, and neurons decrease
Dulling of tactile sensation
Decline in function of cranial nerves affecting taste and smell
Loss of nerve cell mass
Atrophy of the brain and spinal cord
Brain weight decreases
Number of dendrites decline
Demyelination which results in slower nerve conduction, slower reaction and response times, and weaker reflexes
Plaques, tangles, atrophy of the brain
Decrease in cerebral blood flow
Free radicals accumulate
Intellectual performance maintained until at least 80 years of age
PATHOLOGIES
Cerebrovascular Accident (Stroke)
Risk factors: HTN, arteriosclerosis, diabetes, gout, anemia, hypothyroidism, Mi, dehydration, smoking, PE, DVT
S/S are variable and depend on the area of the brain affected: slurred speech, facial drooping on one side, weakness on one side, difficulty seeing, confusion, severe headache
Ischemic stroke is when there is a lack of blood supply to the brain most likely due to a clot. Hemorrhagic stroke is from bleeding in the brain which causes a loss of blood volume and O2.
Tx: Rehabilitation and reducing risk of recurring strokes. Anticoagulants and tpa.
Parkinson Disease
Affects the ability of the CNS to control body movements as a result of impaired function of basal ganglia in the midbrain
Neurons that produce dopamine in the substantia nigra die or become impaired
Dopamine is necessary for smooth motor movement and has a role in emotions
S/S: tremors at rest, shuffling gait, bradykinesia, stooped posture, mask-like facial expression, difficulty chewing, swallowing, speaking, "pill-rolling" movement
Tx: Schedule activities later in the day, encourage activity/exercise, soft diet easy to swallow, medications such as carbidopa/levodopa (sinemet)
Gastrointestinal
Atrophy of the tongue affects taste buds and decreases taste sensation
Decreased saliva and dry mouth (xerostomia)
Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter
Esophageal and stomach motility decreases
Risk for aspiration and indigestion
Decreased elasticity of the stomach
Reduces the amount of food accommodation at one time
Stomach has a higher pH as a result of decline in hydrochloric acid and pepsin
Decline in hydrochloric acid
Increase in incidence of gastric irritation
Interferes with absorption of calcium, iron, folic acid, and vitamin B12
Decline in pepsin
Interferes with absorption of protein
Decreased enzyme production in the liver which affects drug metabolism and detoxification processes
Slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet
Increase risk of constipation
Bile salt synthesis decreases
Increase in the risk of gallstone development
Affects digestion of fats
PATHOLOGIES
Colorectal Cancer
Cancer at any site along the large intestine is common with advancing age
Sigmoid colon and rectum tend to be frequent sites for carcinoma
S/S: rectal bleeding, bloody stools, change in bowel pattern, feeling of incomplete emptying of bowel, anorexia, nausea, abdominal discomfort, weakness, unexplained weight loss
Dx: fecal occult blood test, Cologuard, CBC, colonoscopy
Tx: Colon resection
Chronic Constipation
Common concern for older adults
Factors: inactive lifestyle, low fiber and low fluid intake, depression, laxative abuse, medications like opioids, dulled sensations that cause the signal for bowel elimination to be missed
Promote bowel elimination
scheduling a regular time, incorporating high-fiber foods, rocking the trunk side to side and back and forth while sitting on toilet
Safe use of laxatives, but need to monitor for diarrhea and dehyrdation
Integumentary
Thin skin provides a less effective barrier
Decreased ability to detect and regulate temperature
Dry skin
Decreased endocrine secretions
Loss of elastin
Increase in vascular fragility
Keratinocytes become smaller and regeneration slows
Hair loss occurs; gray hair; women have increased facial hair
Nails become brittle and thick
PATHOLOGIES
Seborrheic Keratosis
Increased appearance of "age spots" and raised lesions
Dark, wart-like projections that can be as small as a pinhead or as large as a quarter
Commonly on various parts of the body. Swelling or redness will not be present around the base.
In the sebaceous areas of the trunk, face, and neck and appear dark and oiliy
Skin Cancer
Basal cell carcinoma
Most common form of skin cancer. Grows slowly and rarely metastasizes
Risk factors: Advanced age, sun exposure, UV radiation, and therapeutic radiation
Commonly occurs on the face and tends to be small, dome-shaped elevations covered by small blood vessels that resemble a flesh-colored mole with a "pearly" surface
Squamous cell carcinoma
Arises in squamous cells on the surface of the skin, the lining of hollow organs, and passages of the respiratory and digestive tract
Sun exposure most common cause
Appear as firm, skin-colored or red nodules
Melanoma
Metastasizes and spreads more easily than the others. Deadly if not caught early
Risk factor is sun exposure
Black, brown, white or red pigmented flat lesions with irregular borders
Lines and wrinkles increase
Respiratory
With aging, O2 demand increases, and multiple exposures to toxins or infectious agents damages the lungs and can become life threatening
Lungs lose elastic recoil
Muscles become rigid and lose muscle mass and strength
Declining muscle strength--Reduced cough reflex
Lung size and weight reduction
Increased dead space in the lungs
Decrease in alveolar surface area
Decreased reaction of peripheral and central chemoreceptors to hypoxia and hypercapnia
Decreased cilia, immune response, and ability to clear mucus secretions
PATHOLOGIES
COPD
A group of diseases including a form of asthma, chronic bronchitis, and emphysema
S/S: cough, dyspnea, wheezing, SOB, and increased sputum production
Chronic bronchitis consists of inflammation and mucus production in the bronchial tubes which blocks and restricts airflow. Blue bloater: cough, hypercapnic, hyoxemic, mild cyanosis
Emphysema consists of destruction and damage to the alveoli and restricts recoil and elasticity which increases air trapping in the lungs. Pink puffer: barrel-chest, dyspneic, prolonged expiration, hunched-over, pursed lip breathing
Risk factors: smoking, occupational exposure to pollutants, genetics
Tx: Long acting and short acting bronchodilators, O2, breathing exercises, spirometry
Lung Cancer
Leading cause of cancer-related death
S/S: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, and respiratory infections
Tx: surgery, chemotherapy, and radiotherapy
Risk factors: chronic exposure to cigarette smoke, asbestos, coal gas, radon gas, and air pollutants
Musculoskeletal
Shortening of the trunk due to thinning of vertebral disks and
Reduced muscle mass, strength and movement
Loss of bone calcium, atrophic cartilage, and muscle occurs
Bone mineral density decreases, resulting in osteopenia and osteoporosis
Rand of motion of joints decreases
Progressive loss of cartilage occurs, resulting in osteoarthritis
Muscle cells are lost and not replaced
Lean body mass decreases with increased body fat
PATHOLOGIES
Gout
Metabolic disorder in where excess uric acid accumulates in the blood
Uric acid crystals are deposited in and around the joints
S/S: severe pain and tenderness of the joint, warmth, redness, and swelling of the surrounding tissue
Attacks can last from weeks to months, with long remissions between attacks possible
Tx: Reduce sodium urate through a low-purine diet (no bacon, turkey, liver, sardines, salmon, and legumes), drugs (colchicine or phenylbutazone, allopurinol), avoidance of alcohol
Osteoarthritis
Progressive deterioration and abrasion of joint cartilage, with formation of new bone at the joint surfaces
Affects several joints rather than a single one. Weight-bearing joints are most affected, the common sites being the knees, hips, vertebrae, and fingers
Leading cause of physical disability in older people
S/S: Pain with activity, limited range of motion, joint stiffness, joint swelling, knee tenderness, grating sensation
Tx: Analgesics, Tylenol, rest, heat or ice, acupuncture, splints, braces, canes, vitamins zinc, calcium supplements. Pt and Ot referrals
Endocrine
Thyroid atrophies and activity decreases
Metabolic rate slows
Estrogen production ceases with menopause; ovaries, uterus, and vaginal tissue atrophy
Gonadal secretion of progesterone and testosterone decreases
Insulin production decreases or insulin resistance increases
Decrease in adrenocorticotropic hormone secretion
Production of parathyroid hormone decreases
Volume of pituitary gland decreases
PATHOLOGIES
Hypothyroidism
Insufficiency of thyroid gland to secrete thyroid hormone
Low T3 (<70) & low T4 (<5), presence of T4 antibody
S/S: fatigue, weakness, lethargy, depression, weight gain, puffy face, peripheral edema, constipation, cold intolerance, dry skin and coarse hair
Tx: Thyroid replacement medications (synthroid and thyroxine). Prescribed at a low dose at first to monitor for cardiac complications
Hyperthyroidism
Thyroid secretion of excess amounts of thyroid hormone
High T3 (>220) & high T4 (>12)
S/S: Enlarged thyroid, exophthalmos, increased appetite, diarrhea, tachycardia, diaphoresis, heat intolerance, nervousness
Tx: Thyroid ablation, radioactive iodine therapy, thyroidectomy
Cardiovascular
Heart valves become thick and more rigid
Diastolic murmurs occur in 50% of older adults
Aorta becomes dilated
Slight ventricular hypertrophy
Thickening of left ventricular wall
Cardiac output decreases as a result of a decrease in heart rate and stroke volume
Dysrhythmias become more common due to higher systolic BP and increased size of the atria
Increase in systolic BP as a result of altered distribution of blood flow and increased peripheral resistance
Calcification and reduced elasticity of vessels
Less sensitive to baroreceptor regulation of blood pressure
PATHOLOGIES
Congestive Heart Failure
Risk factors include: CAD, hypertension, diabetes, CKD
Common problem in older adults due to reduced elasticity and lumen size of vessels
S/S: dyspnea on exertion (COMMON), confusion, insomnia, agitation, wheezing, weight gain, bilateral ankle edema. Moist lung crackles heard
Inability of heart to pump enough blood to meet the tissue's O2 demands
Tx: Monitor weight, avoid salt, space activities apart, light activity, use of diuretics
Coronary Artery Disease (Ischemic heart disease)
Angina
Atypical presentation: vague discomfort under the sternum
S/S: Indigestion, coughing, syncope, sweating, and confusion
Cause: Atherosclerosis, HTN, physical exertion
Chest discomfort or pain that occurs when myocardial O2 demands exceed supply
Tx: Administer no more than 3 nitroglycerin tablets 5 minutes apart, teach avoidance of isometric activity, implement an exercise program, modify diet to cut back on saturated fats and sodium
Myocardial Infarction
Causes: thrombus/clotting, or shock/hemorrhage
Atypical presentation: confusion, decreased BP, SOB, elevated temperature, and sedimentation rate
Disruption/deficiency in coronary artery blood supply, resulting in necrosis of myocardial tissue
Tx: O2, Morphine, Nitrates, ACE inhibitors, Beta blockers. MONA: Morphine, Oxygen, Nitroglycerin, Aspirin
Urinary
Changes in cortical control of micturition
nocturia
Inefficient neurological control of bladder emptying and weaker bladder muscle
Increased risk for reflux of urine into the ureters
Retention of large volumes of urine: Females caused by fecal impaction, and Males caused by prostatic hypertrophy
Glomerular filtration rate decreases due to decreased renal blood flow and decreased numbers of functioning glomeruli
Affects the ability to eliminate drugs especially penicillin, tetracycline, and digoxin
Slowed organ function which is a potential for adverse drug reactions
Reduced tubular function
Higher blood urea nitrogen levels
Proteinuria is common in adults over 80
Decreased tubular function
Concentration of urine changes in response to water and/or sodium excess/depletion
Increase in renal threshold for glucose
False-negative results for glucose in the urine without symptoms
PATHOLOGIES
Glomerulonephritis
Inflammation of the glomeruli, which filter blood as it passes through the kidneys
S/S may be so subtle and non specific that they are initially unnoticed. Fever, fatigue, nausea, vomiting, anorexia, abdominal pain, anemia, edema, hematuria, oliguria, proteinuria
Tx: Antibiotics, restricted sodium and protein diet, and attention to I&Os
Chronic glomerulonephritis already exists in older persons who develop an acute condition
Urinary Tract Infections
Infection or inflammation at any site in the urinary tract
Most common infectious agent is
Escherichia coli
High risk: Diabetes, pregnancy, prostatic hypertrophy, immunosuppressed persons, catheterizations, urinary retention
S/S: Fever, chills, urinary frequency, urgency, dysuria, hematuria, elevated WBC
Tx: Antibiotics, encourage fluids of 3000mL/day, encourage voiding every 2-3 hours, routine perineal hygiene, remove catheter within 24-48 hours
Immune
Depressed immune response
T-Cell activity declines
Cell-mediated immunity declines
Risk for infection becomes significant
Inflammatory defencses decline
Inflammation presents atypically
Reproductive
Women
Hormonal changes
Vulva atrophies
Flattening of the labia
Loss of subcutaneous fat and hair
Vaginal epithelium thins
Cervix, uterus, and fallopian tubes atrophy
Vaginal Canal changes
Reduction in collagen and adipose tissue
Shortening and narrowing of the canal
Less lubrication
More alkaline vaginal pH as a result of lower estrogen levels
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
PATHOLOGIES
Vaginitis
S/S: Soreness, pruritus, burning, and a reddened vagina. Vaginal discharge is clear, brown or white
Increased fragility of vagina in postmenopausal women causes the vagina to become easily irritated
Tx: Local estrogens in suppository or cream form, boric acid, zinc, lysine
Ovarian Cancer
Leading cause of death from gynecologic malignancies
S/S: bleeding, ascites, and multiple masses
Tx: surgery or irradiation
Ovarian cancer is less common than endometrial or cervical cancer, but is more deadly when it occurs
Men
Seminal vesicles develop thinner epithelium
Muscle tissue replaced with connective tissue
Decreased capacity to retain fluids
Seminiferous tubule changes
Increased fibrosis, epithelium, thickening of the basement membrane, and narrowing of the lumen
Atrophy of the testes and reduction in testicular mass
Ejaculation fluid contains less live sperm
Testosterone stays the same or decreases slightly
More time required to achieve an erection
Enlargement of the prostate gland
PATHOLOGIES
Benign Prostatic Hyperplasia (BPH
All men will have some degree
S/S: Hesitancy, decreased force of urinary stream, nocturia
Most common cause of urinary retention
Tx: Surgery-transurethral resection, prostatic massage, use of urinary antiseptics, and avoidance of diuretics, anticholinergics, and antiarrhythmic agents
Enlargement on prostate gland putting more pressure on the urethra
Erectile Dysfunction
Inability of male to attain and maintain an erection sufficient to allow him to engage in sexual activity
Causes: Atherosclerosis, diabetes, HTN, Multiple sclerosis, thyroid disfunction, alcoholism, renal failure, medications
Tx: Sildenafil citrate (viagra), injections such as alprostadil to increase blood flow, vacuum pumps and penis implants