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Older Adult - Coggle Diagram

- - - - tongue atrophies
      - xerostomia
      - certain medications
      - diseases
      - smoking
    - - reduction in chewing efficiency
        
        thinning of the oral mucosa
        
        weakening of muscles involved in mastification
        
        dysphagia
        
        GERD, stroke, and structural disorders are common causes
        
        can be oropharyngeal (difficulty transferring food bolus from the mouth into the pharynx), esophageal (difficulty moving food down the esophagus)
        
        observing food intake can offer insight into the nature of the problem
        
        MAJOR GOALS: prevention of aspiration and promotion of adequate nutrition status
        
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        can also be due to decreased neuronal function and the destruction of cranial nerves
    - - Decreased intensity of propulsion waves and an increased frequent of non-propulsive waves in esophagus
    - - decreased elasticity of the stomach reduces amount of food the stomach can hold
      - stomach has a higher pH
        
        peptic ulcer
        
        CAUSES: stress, diet, genetic predisposition, COPD, drugs that increase gastric secretions and reduce the resistance of the mucosa
        
        S/S: pain, bleeding, obstruction, perforation
        
        OLDER ADULTS: more likely to have constipation and diarrhea caused by antacids and pyloric obstruction resulting in hemorrhage, peritonitis, dehydration, and shock
    - - reduced presence of pepsin interferes with the absorption of pepsin
      - decrease in HCl can interfere with the absorption of calcium, iron, folic acid, and vitamin B12
      - fewer absorbing cells in the intestines affecting the absorption of dextrose, xylose, calcium, iron, and vitamins B, B12, and D
  - - - reduced ability to concentrate urine which leads to a lower specific gravity
      - decreased resorption from filtrate leads to higher levels of protein in the urine
      - higher BUN levels can contribute to lethargy, confusion, headache, and drowsiness
        
        glomerulonephritis
        
        inflammation of the glomeruli within the Bowman’s capsule of the kidney triggered by an immunological mechanism
        
        S/S: fever, fatigue, nausea, vomiting, anorexia, abdominal pain, anemia, edema, arthralgias, elevated blood pressure, increased sedimentation rate, headache, oilguria, proteinuria, hematuria, altered mental status
        
        TREATMENT: antibiotics, restricted sodium and protein diet, monitor fluid intake and output
        
        OLDER ADULTS: watch for cumulative toxic effects resulting from compromised kidney function if receiving digitalis, diuretics, or antihypertensive drugs
        
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    - - Urinary frequency
        
        hypertrophy of the bladder muscle and thickening of the bladder
        
        decreased ability of the bladder to expand and reduced storage capacity
      - Urinary urgency
        
        bladder cancer
        
        RISK FACTORS: chronic irritation of the bladder, exposure to dyes, cigarette smoking
        
        S/S: frequency, urgency, dysuria, painless hematuria
        
        TREATMENT: surgery, radiation, immunotherapy, chemotherapy, monitor for signs of metastasis
      - Nocturia
        
        age-related changes in the cortical control of micturition
        
        nighttime urinary frequency
    - - reflects physical or mental disorder
    - - inefficient neurological control of bladder emptying and weaker bladder muscles
  - - - Loses efficiency and contractile strength (diastolic murmur)
      - Reduced CO
    - - Ateriosclerosis
        
        common problem especially among those with diabetes
        
        affects the smaller vessels further from the heart
        
        nurse should keep the patient in a warm, stable room temperature for at least 1 hour before testing
        
        TREATMENT: bed rest, warmth, vasodilators
    - - Myocardial infarction
        
        diagnosis can be delayed or missed in older adults because of atypical set of symptoms and the absence of pain
        
        S/S: pain radiating to the left arm, entire chest, the neck, jaw, and the abdomen; numbness is neck, arms, or back; confusion; moist, pale skin; decreased BP; syncope; SOB
        
        confusion is a common symptom in older adults and can be hard to extinguish for an MI
        
        output should be observed because anuria can occur
        
        anuria is not a common aging change for the renal system
        
        early ambulation is encouraged and can help prevent complications with mobility
  - - - Snoring
      - Obstructive apnea
    - - Decreased secretions from submucosal glands
        
        chronic bronchitis
        
        recurrent inflammation and mucus production in the bronchial tubes, which over time, produce blockage and scarring that restrict airflow
        
        S/S: persistent, productive cough, wheezing, recurrent respiratory infections, SOB, episodes of hypoxia
        
        management is aimed at removing bronchial secretions and preventing obstruction of the airways
        
        OLDER ADULTS: may need special encouragement to maintain good fluid intake and to expectorate secretions
        
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    - - interfere with passage of air
    - - Progressive loss of elasticity
        
        emphysema
        
        CAUSES: chronic bronchitis, chronic irritation, distention of the alveolar sacs, rupture of the alveolar walls, and destruction of the alveolar capillary bed
        
        chronic bronchitis can lead to the irritation and the mucus can cause carbon dioxide retention which can lead to emphysema
        
        S/S: slow in onset (delayed identification), increased dyspnea, chronic cough, fatigue, anorexia, weight loss, weakness, recurrent respiratory infections, malnutrition, congestive heart failure, cardiac arrythmias
        
        TREATMENT: postural drainage, bronchodilators, avoidance of stressful situations, breathing exercises
        
        Oxygen should be used very cautiously - drive to breath is driven by low oxygen level rather than a high carbon dioxide level
        
        hypoxia from emphysema can lead to ischemia in the heart and can have negative effects on the heart
    - - elastic recoil is lost because of less collagen and elastin
    - - loss of skeletal muscle strength in the thorax and diaphragm
      - loss of resilient force that holds the thorax in a slightly contracted position --> slight kyphosis and barrel chest
  - - - More risk of compression fractures
    - - Reduced muscle strength, muscle mass, and movement
    - - osteoporosis
        
        most prevalent metabolic disease
        
        demineralization of the bone occurs, evidenced by a decrease in the mass and density of the skeleton
        
        CAUSES: inadequate calcium intake, excessive calcium loss, poor calcium absorption, inactivity, increased adrenal hormone secretion, reduction in anabolic sex hormones, diet, drugs
        
        S/S: kyphosis, reduction in height, spinal pain, bones may tend to fracture more easily, often asymptomatic
        
        nurse should advise the patient to avoid heavy lifting, jumping, and other activities that could result in a fracture
        
        age related changes in the endocrine system (adrenal hormones) and the reproductive system (sex hormones) can contribute to the development of this
    - - Increased risk of fractures
    - - metabolic disorder in which excess uric acid accumulates in the blood
        
        uric acid crystals are deposited in and around the joints, causing severe pain and tenderness of the joint (along with warmth, redness, and swelling of surrounding tissue)
        
        attacks can last from weeks to months, with long remissions between attacks
        
        TREATMENT: aims to reduce sodium urate through a low-purine diet, avoid alcohol
        
        nurses should encourage fluid intake to precent the formation of RENAL STONES
  - - - cerebrovascular accidents
        
        RISK FACTORS: hypertension, arteriosclerosis, diabetes, gout, anemia, hypothyroidism, slient MI, TIAs, dehydration, smokers
        
        usually result from a thrombus or embolus (ischemic) or from a ruptured cerebral blood vessel (hemorrhagic)
        
        WARNING SIGNS: light-headedness, dizziness, headache, drop attack, memory/behavioral changes
        
        OLDER ADULTS: have a higher mortality rate, but those who survive have a good chance at recovery
        
        connects to the cardiovascular, endocrine, and musculoskeletal systems. patients with those pre-existing diseases have a higher risk of experiencing a cerebrovascular accident
    - - Parkinson's disease
        
        affects the ability of the nervous system to control body movements as a result of impaired function of the basal ganglia in the midbrain
        
        neurons that produce dopamine in the substantia nigra die or become impaired
        
        presence of Lewy bodies
        
        S/S: tremors, muscle rigidity, weakness, drooling, dysphagia, slow speech, monotone voice, mask like expression, postural instability, shuffling gait, urinary hesitancy, urgency, dementia, hallucinations
        
        dysphagia can lead to malnutrition and puts the patient at risk for aspiration
  - - - T cell activity delines
      - Cell-mediated immunity declines
      - Risk for infection becomes significant
      - Inflammatory defenses decline
    - - Aging of the immune system
  - - - skin cancer
        
        MOST COMMON: basal cell carcinoma, squamous cell carcinoma, melanoma
        
        RISK FACTORS: increased age, exposure to UV radiation, therapeutic radiation, extreme sun exposure
        
        S/S:
        
        basal cell: pearly, translucent, flesh-colored papules, superficial telangiectasias are usually visible, rolled edges or ulcerations
        
        squamous cell: crusted papules and plaques that can become indurated and ulcerated, large lesions can become painful and bleed, can arise from chronically open wounds, burn scars, or leg ulcers
        
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    - - pruritis
        
        can be precipitated by any activity that dries out the skin
        
        DISEASES R/T: diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia
        
        Itching can cause scratching, leading to breakage and infection of the skin
        
        PREVENTION: bath oils, moisturizing lotions, massage, topical zinc oxide, antihistamines, topical steroids
  - - - reduction in sperm count related to the seminal vesicles having a thinner epithelium
      - fibrosis of seminiferous tubules
      - atrophy of testes and reduction in the testicular mass
      - testosterone stays the same or only decreases slightly
      - more time is required for an erection
      - enlargement of the prostate gland
        
        benign prostatic hyperplasia
        
        change in the balance between estrogen and testosterone
        
        prostate gland begins to enlarge at the age of 25
        
        accumulation of dihydrotestosterone and a high intake of calories, protein, calcium, and polyunsaturated fats
        
        pinches the urethra and can interfere with the flow of urine from the bladder
        
        S/S: difficulty starting the flow of urine even with straining, a weak stream of urine, multiple interruptions during urination, dribbling once urination is complete, urgency, frequency, the feeling that the bladder has not completely emptied after urination, and nocturia
        
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    - - flattening of the labia and loss of subcutaneous fat and hair
      - vulva atrophies
      - vaginal epithelium becomes thin
      - vaginal environment is drier and more alkaline
        
        vaginitis
        
        increased fragility of the vagina causes it to be more easily irritated --> increases risk of vaginitis
        
        S/S: soreness, pruritis, burning, reddened vagina, foul-smelling vaginal discharge (clear, brown, or white), bleeding, adhesions
        
        OLDER WOMEN: should avoid douches and the use of perfumed soaps and sprays to the genitalia, wear cotton underwear, use lubricants for intercourse
      - cervix, uterus, fallopian tubes, and ovaries atrophy
      - replacement of mammary glands by fat tissue
      - uterus and ovaries decrease in size and may not be palpable
  - - - lower BMR
      - reduced radioactive iodine uptake
      - less secretion and release of thyrotropin
      - Hypothyroidism
        
        decreased metabolism and decreased secretion of T3 and T4, with increased secretion of TSH due to the feedback system
        
        primary: due to destruction of thyroid gland itself
        
        secondary: due to a disorder of the anterior pituitary gland
        
        tertiary: due to lack of TRH from the hypothalamus
        
        S/S: decreased energy, increased sleep, fatigue, weight gain, decreased appetite, and susceptibility to cold temperatures
        
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    - - reduces secretion of estrogen, progesterone, androgen, and glucocorticoids
    - - type 2 DM
        
        increased amounts of fat tissue and inactive lifestyle are significant in the development of this disease
        
        pancreas cannot keep up with the increased demand for insulin due to beta cell failure
        
        patients eventually require insulin therapy to maintain normal blood glucose levels
        
        OLDER ADULTS: can be hyperglycemic without being glycosuric
        
        S/S: poor wound healing, fatigue, cardiovascular disease, visual disturbances, renal insufficiency, recurring infection
        
        can also lead to arteriosclerosis and other heart diseases