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Older adult, RISK OF INFECTION: Decrease lung ability to fight infection…
Older adult
Urinary
Normal Changes
Size & wt of kidneys decrease
Hypertrophy & thickening of bladder mm.
decreases bladders ability to expand
Reduced storage of urine
Emptying bladder may become more difficult
Daytime reduced frequency & nocturia
Changes in cortical control also causes nocturia
Increased frequency & dribbling
Decrease sense of urge
Inefficient neuro control of bladder emptying & weaker bladder mm.
Increased risk of urine reflux into the ureters
Retention of large volumes of urine
Female: constipation
Male: prostatic hypertrophy
Glomerular filtration decreases from decreased blood flow & decrease # of function glomeruli
Affects ability to eliminate drugs (penicillin, tetracycline, dig)
Slowed organ function
increases risk for drug reaction
Reduced tubular function
Higher blood urea nitrogen levels
Proteinuria is common over 80 y/o
Concentration of urine changes in response to H2O/Na+ excess/ depletion
Increase renal threshold of glucose
False negative results
Decline in renal blood flow
Incontinence
not normal change in aging
Types of incontience
stress: : d/t weakened perineal floor typically occurs during laughing, coughing, running
Urgency: have to go can’t wait
Overflow: r/t obstruction (prostate
Neurogenic (reflex): neural not communicating
Functional: cognitive issues, dementia, paraplegia
UTI
Inflammation/infection at any part of the urinary tract usually E.coli from fecal material
older adults usually S/S
Sudden incontinence that’s unexplained
Disorientation & confusion
Interventions
specific antibiotics r/t bacteria
Encourage 3000 mL fluid/day
void eery 2/3 hrs
GI
Normal Changes
Esophagus & stomach motility decreases
Risk for aspiration & indigestion
Decreased elasticity of the stomach
reduces amt of food accommodation at 1 time
Higher pH of stomach
decline of HCl
increase gastric irritation
interferes with absorption of Ca++, iron, folic acid, Vitamin B12
decline pepsin
interferes with protein absorption
essential for healing
Fewer cells on absorbing surface on intestinal wall
decrease absorption of dextrose, xylose, vitamins B & D
Vitamin B affects mental
Vitamin D affects immune system & decreases Ca++
Decrease enzyme production of liver
decreases drug metabolism
decrease in detoxification process
Increase risk of constipation
low fiber
promotes bowel elimination
slow peristalsis
inactivity
reduced fluid/food intake
proper nutrition minimizes
decrease sensory perception
Bile salt synthesis decreases
increase risk of gallstone development
affects fat digestion
Common Diseases
Dry mouth
sip water, use candies
Dental issues
Dental hygiene is important
increase risk of other infections
restricts food intake
Dysphagia
from GERD, stroke, structure
Prevent with thickened liquids, slow eating
Esophageal cancer
alcohol & smoking contribute, increases with age
Respiratory
Normal Changes
Imbalance of ventilation & perfusion
Increased dead space in lungs; all the air inhaled isn't involved in gas exchange
Decrease in alveolar surface area; decrease area of gas exchange
Breathing mechanisms decrease
Lungs lose elastic recoil = decreases pressure & ability to rebound
Decline in mm. strength = decrease cough reflex
Promote coughing to remove secretions
Hard candy & increase fluid intake
Breathing exercises
Humidifier, expectorants
Lung size & wt reduction
Decreased sensitivity of hypoxia & hypercapnia
Lacks control
Immune response decreases in lungs
Decrease in cilia (decreases amt of sweeping/dirt out of lungs
Decrease ability to clear secretions (decrease mm.)
Decreased ability to cough & deep breathe (mm. & reflex decreased)
Older adults overall have a decreased immune system that can effect lungs
Common Disease Process
COPD
Chronic Bronchitis
Increase mucus, increase brochial wall thickness, chronic hypoxemia
"Blue Bloater
General cynasosis
R heart failure (JVD)
Persistenet cough
Reoccurent resp. infections
SOB
Hypercapnia, Hypoxemia
Emphysema
Tenacious/sticky sputum
Reduced gas exchange, increased air trapping, decrease cap netowek
"Pink Puffer"
Barrel chest
Dyspenic
Prolonged expiration
Hunched over (tripod)
Pursed lip breathing
Increase incidence in older adults, smoking plays major role
Commonly associated with smoking, even second hand
Asthma
Can develop in later years
Intermittent disease with reversible airflow obstruction
Evaluate use of inhaler
Watch for drug interactions (raises HR & BP)
To prevent pneumnia & flu = get vaccines!!!
Pneumonia, inflammation of lower resp tract
Multiple causative agents
Aspirations
Common with older adults
Bacteria, viral, fungal, chemical
Community vs medical associated
More susceptible as older adult
Assess sputum, find cause
Loosen secretions
Increase fluids, humidity, deep breathing
Hard candies can help
Important to have a productive cough
Breathing exercises, expectorants,
Considerations: atyplical symptoms
Confusion r/t hpoxia
No chest pain
Lower body temp
Different types of sputum
Respiratory issues promotes anxiety
Needs support through chronic & acute respiratory disease
Musculoskeletal
Muscle
Normal Changes
reduced muscle mass, strength & movement
strength training is important to decrease sarcopenia
Bones
Normal Changes
thinning discs & shortened vertebra
decreased bone mineral & mass
Diminished calcium absorption
decrease acidity in GI
Supplemental Ca++ needs Vitamin D to absorb
Increased risk of fractures
esp females when lose the protective effects of estrogen
Osteoporosis
most prevalent metabolic disease of the bone
Risks
Advanced age women over 75 y/o
Men over 80 y/o
Early menopause
Cigarette smoking
Multiple pregnancies
High alcohol consumption
Chronic use of corticosteroids, thyroid hormones, and anticonvulsants
Nervous System
Neuro
Normal Changes
Central processing slows; delay in time required for tasks
Give adults more time to respond
Decrease of # and sensitivity of neurons and dermatomes
Dulling tactile discrimination
Decline in function of cranial nn.
affects taste & smell
Loss of nerve cells mass: atrophy of brain & spinal cord
Demyelination: slower nerve conduction
Response & reaction times slow
Reflexes become weaker
Free radicals accumulate
Decrease in cerebral blood flow
fatty deposits accumulate in blood vessels
ability to compensate for lack of blood flow declines with age
Intelligence
Short term memory declines & long term stays the same
Intelligence remains constant in healthy normal adult till age 80
crystallized intelligene is maintained, fluid intelligence may decline
Personality
personailty remains constant
unless cognitive disease develops
Common diseases
Stroke
Lack of blood flow to brain
TIA: temporary reduction of cerebral perfusion
CVA warning sign
Most older adults strokes are ischemic
blockage from thrombus
Warning signs: light headed, dizzy, headache, drop attack
higher mortality rates in older adults
RISKS: HTN, arteriosclerosis, diabetes, gout, anemia, hypothyroidism, MI, dehydration, smoking
Parkinsons
affects CNS ability to control body movements, specifically basal ganglia & substantia nigra
Chronic & progressive
S/S: tremor at rest (pill rolling), increased muscle rigidity, bradykinesia (slowness of initiation & execution of movement), instability (shuffled gait, lack balance), masked facial expressions, difficulty chewing, swallowing, & speaking (needs soft diet)
needs more time to perform ADLS
Possibly need soft diet
Saftey: may need help ambulating
Treatment: dopamine replacement with levodopa
precursor (able to cross BBB, then becoming active dopamine
Dementia
Delirium
Sensory
Vision
Normal Changes
presbyopia: inability to focus on close objects clearly
Narrowing of visual fields, decreased peripheral vision
Pupil size reduces & less reactive to light
cant see in the dark
depth perception distortion
Decline in visual acuity
Touch
Normal Changes
reduced tactile senses
Reduces ability to sense pressure, discomfort, change in pressure
Safety risk
Hearing
Normal Changes
presbycusis -- progressive loss of hearing
distortion of high pitched sounds
harder to hear female voices
Cerumen increases which if impacted can decrease hearing
Alteration in equilibrium
increase risk of falls
Taste/Smell
Normal Changes
atrophy of the tongue
decreased saliva
Taste is dependent on smell
smell is altered with age
Decreased taste/smell -- at risk for nutritional deficiencies
Thermoregulation
Normal Changes
normal body temps are lower
mean is 96.9 to 98.3
ability to respond to cold temps is reduced (d/t loss of subq fat)
Response to heat is altered -- safety risks
Cardiovascular
Heart
Normal Changes
Heart valve thick & rigid
Causes diastolic murmurs
Aorta becomes dilated
Ventricular hypertrophy, causing larger heart margins
Thickenings of left ventricular wall
Myocardial muscle less efficient
Decreases in contractile strength
Unable to meet the demands of increased activity
Lack of physical activity promotes this
Physical deconditioning: decline in CV function d/t lack of physical activity
Prolonged cardiac cycle
Widened PQRST complex
Calcification & reduced elasticity of vessels
promotes common disease such as HTN, CAD (more at risk)
Less sensitive to baroreceptor regulation of blood pressure
Amount of pressure the receptor feels in the aortic arch determines feedback loop for blood pressure
Lack of feedback promotes orthostatic hypotension
Increased peripheral resistant
Blood pressure increases with age
Common Disease Processes
Arrhythmia: abnormal HR or rhythm
Dysrhythmias become more common in aging
Bradycardia
Low heart rare
Can be associated with anti HTN meds
Tachycardia
Fast heart rate
lacks time to fill up coronary sinus
O2 needs does not get met
Afib
Synchronization is lost in electrical conduction
Causes blood to pool in heart
increase risks for clots
Heart block
Spurts of asystole
Results in syncope, falls, TIA's
Hypertension: consistent BP of over 140 systolic & over 90 diastolic
Postural/orthostatic hypotension
Decline of 20 mmhg or more in systolic BP after rising/standing for 1 min
Heart Failure
Most heart disease is preventable
Needs EDUCATION
Life Style
Adequate Exercise
Regular excerisie is better than spurts of activity
Yoga, strengthening, walking, balance
Lack of exercise = physical deconditioning
Diet
Control Cholesterol
avoid fatty meat, processed foods
Cholesterol Lab values
HDL > 60 mg/dl
1 more item...
LDL <130 mg/dl
Total <300 mg/dl
DASH
whole foods, decrease salt, decrease processed foods
Proper wt management
Stress
Identify stressors
Evaluate reaction & management of stress
Healthy stress reducing activities - yoga, meditation
Vascular
Normal Changes
Arteriosclerosis: hardening of vessel walls
Can result in vascular issues = PVD, Edema, CAD
Abnormal/ Common Diseases
Atherosclerosis
Blood Dyscrasia's
Diabetes (microvascular)
Integumentary
Normal Changes
Graying of hair, wrinkles
Loss of tissue elasticity
elongated ears, baggy eyelids, double chin
Loss of elastin
Loss of sub q fat
linked to cold intolerance
Thin skin that is a less effective barrier (increase for microbes)
Decreased ability to detect & regulate temp
Dry skin from decreased in endocrine secretion
Increase vascular fragility -- bruising
Increased appearance of age spots & raised lesions
Keratinocytes become smaller & regeneration slows
wounds not able to heal as well
Pathology
Skin cancers
Basal cell carcinoma
Least aggressive; papules that can be metastatic but not likely
Squamous Cell Carcinoma
Melanoma
deadly; black/brown irregular shape
Immune System
Vulnerability
risk for infection becomes significant -- the older individual the more at risk
Compromised immune defenses means at risk for more complications
Normal Changes
decreased immune response
T cell activity declines; have them just not activated
Cell mediated immunity declines
Inflammatory defenses decline
inflammation presents atypically
risk for under-diagnosed
Low temps & delirium with infection
Reproductive Organs
Male
Normal Changes
small vesicles develop thinner epithelium
Muscle tissue replaced with connective tissue
Decreased capacity to retain fluids
Seminiferous tubule changes
Increase fibrosis, epithelium thinning, thickening of 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 prostate gland; BPH
All men will have some degree of BPH
Hesitancy
Decreased force of urinary stream
Nocturia
Erectile dysfunction: not normal part of aging
Impotence or 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
Female
Normal changes
Hormonal Changes
Vulva atrophies
Flattening of the labia
Loss of subcutaneous fat and hair
Vaginal epithelium things
Cervix, uterus and fallopian tubes atrophy
Vaginal canal changes
Reduction in collagen and adipose tissue
Shortening and narrowing of the canal
Less lubrication
can lead to discomfort in intercourse
More alkaline vagina pH as result of lower estrogen changes
Uterus & 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
Breast cancer
Encourage regular breast examinations
Older women less likely to receive yearly mammograms and breast examinations by a health care professional
Can be present in male patients, more commonly seen in women
Can be treated with mastectomy or chemo/radiation
Endocrine
Normal Changes
Thyroid gland atrophies
Decreases metabolism
This in combination of decrease activity = wt gain
Diminished adrenal function
Prone to electrolyte dysfunction
ACTH secretion decreases
Effects BP & cortisol regulation
Postural hypotension
Volume of pituitary gland decreases
decrease in TSH, GH, LSH, Oxytocin, & Prolactin
Decreased release of insulin & reduce tissue sensitivity to insulin
increases risk for type II diabetes
Common diseases
Diabetes
Type I
Autoimmune, insulin dependent
Type II
Glucose intolerance, some need insulin, others on oral
Metformin
Good for adults since low risk of hypoglycemia
1st line
Sulfonylureas
severe risk of hypoglycemia
Can remain in system longer
half hour before meals
Thiazolidines
increase insulin sensitivity
watch cardiac function
Insulin: has to be used for type I, might be used for type II
Basal Bolus resembles body, allows flexibility, reduces hypoglycemia
Basla: glargine
Bolus: Humalog
Sliding scale not beneficial out of hospital
Education
Read & handle syringe
Fingerstick technique
Hypoglycemia
Glycosuria, polyuria, hunger
older adults don't express specific symptoms
Screenings important
under 200 nonfasting
Fasting above 126
Hgb A1C >6.5%
Complications
PVD
Diabetic Retinopathy
leads to blindness
Drug interaction; lack absorption, hypoglycemia
Neuropathies
Increase risk of dementia
Cerebral arteriosclerosis
Increase risk of infection
UTI
Manage thru pt education
Balanced diet, allowed sugar but in moderation
Need a consistent daily intake of food
Activity, exercise, wt loss
Adhere to meds
Self monitor
know signs of hypoglycemia
Older adults at higher risk
Teach administration
Hypothyriodism
Insufficient thyroid hormone lack of T3 & T4
life long replacement of thyroid hormone
Metabolism slows = everything slows
Fatigue, weakness, lethargy, wt gain, edema, dry skin, low voice
Constipation
decrease motility of bowel
Bowel regimen
Increase fluids
High fiber
Increase activity
Avoid laxative use
RISK OF INFECTION:
Decrease lung ability to fight infection r/t decrease ability to cough up secretions
Skin is more fragile, decreased barrier to pathogens
Esophagus is not as strong increasing risk of aspiration which can lead to infection
Overall immunity is decreased from either decrease in number of immune cells or decrease in their function
Not only do they have increase risk of infection but it is also harder for older adults to fight infection
healing is impaired d/t not able to absorb protein
lack of immunity promotes infection
infection can promote delirium in older adults resulting in more issues (not able to care for self when confused, increase risk of fall)
RISK OF FALLS
ACTH secretion decreases resulting in less control of BP, causing postural hypotension which can cause falls
Reduced storage of urine can cause nocturia, older adults have hard time adjusting to darkness so getting up in the night can promote falls
Baroreceptors cannot respond to BP adjustments as well resulting in postural hypotension
The heart may not be able to respond as well to increased activity d/t less efficient myocardial muscle, if the heart can compensate it will lead to less physical activity & physical deconditioning
Decrease muscle mass and bone mass, body is not as strong to compensate, falls happen more often and even "minor" falls can cause detrimental effects
Demylenation causes decrease in reaction times
ALL SENSORY is decreased which leads to falls, especially decline in vision