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Older Adult, Sensory Changes, Cardiac Issues, Falls cont, Falls!!, Elder…

- - - - Chronic, progressive, debilitating neurologic disease of the basal ganglia and substantia nigra, affecting motor ability and characterized by tremor at rest, increased muscle (rigidity).
      - Slowness in the initiation and execution of movement (bradykinesia), and postural instability (difficulty with gait and balance).
    - - cognitive impairments characterized by gradual progressive onset. Irreversible & affects judgement, memory, abstract thinking, and social behavior.
    - - temporary or intermittent neurological events due to decreased circulation that lasts minutes to hours and recovers in one day
    - - Ischemic
        
        resulting from thrombus or embolus
      - Hemorrhagic
        
        occur from ruptured cerebral blood flow
    - - usually reversible
      - altered LOC
      - most common causes: UTI, respiratory infections, cellulitis
- - - - intermittent disease with reversible airflow obstruction and wheezing due to variety of stimulants
        
        reversible
    - - Chronic sputum production, chronic hypoxemia, cor pulmonale, increased bronchial wall thickness; BLUE BLOATER
        
        COPD
    - - reduced gas exchange surface area; increased air trapping; decreased capillary network; increased work; increased O2 consumption; PINK PUFFER
        
        COPD
    - - inflammation of lower respiratory tract caused by aspiration, inhalation, or hematogenous spread
        
        more at risk for developing if have COPD and Asthma
    - - Caused by pneumonia, TB, malignancy, trauma or aspiration that is manifested by anorexia, weight loss, elevated temperature and chronic cough
    - - caused by SARS- CoV-2 respiratory virus; seen through cold like symptoms, watery eyes, persistent cough, heart palpitations, extreme fatigue, loss of smell or taste
- - - - systolic > 140mmHg and diastolic <90 mmHg
    - - Heart cannot pump or fill blood to meet body's needs. It is due to atherosclerosis and CAD and hypertension
    - - angina and MI in people over 70. With angina: vague discomfort under sternum after meals. With MI: pain radiating up left arm, neck and back with confusion, cyanosis, decreased BP, increased temp, etc as a result
    - - breakage of plaque or blood clot in leg that travels up to lungs and gets stuck., causing chest pain
- - - - born with it; insulin dependent; autoimmune; familial tendencies
    - - seventh leading cause of death; less specific symptoms; due to lifestyle;
        
        older adults have insufficient insulin release and reduced tissue sensitivity to circulating insulin
        
        can cause orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, confusion, glaucoma, confusion, cognitive impairment
        
        no glucosuria
        
        no validity of urine test
    - - fatigue, weakness, weight gain, moon face, truncal obesity, dry hair, dry skin
        
        more common in older adults than hyperthyroidism
        
        Tx: bowel elimination plan, high fiber diet, increased activity, increased fluid intake
    - - weight loss, increased appetite, tachycardia, palpitations, diaphoresis, nervousness, insomnia
        
        caused by someone who as hypothyroidism and taking too much hormone replacement
        
        can also be caused by a tumor
- - - - most often develops on areas of skin exposed to the sun, such as the face
    - - Cancer caused by an uncontrolled growth of abnormal squamous cells.
    - - tend to metastasize or spread more easily than other forms of skin cancer making it deadly if not caught early
      - Types
        
        Lentigo Maligna
        
        Superficial Spreading
        
        Nodular
    - - irregular, dark areas like bruises that are found on bottom and lower back as well as arms, abdomen and thighs (but less prominent)
    - - Small, light-colored lesions, usually grey or brown on exposed area of skin. Due to keratin accumulation, a horn with reddened and swollen base is formed
      - Seborrheic Keratoses
        
        dark, wart-like lesions on skin that is common in older adults that increase in size and number; lesion appear dark and oily
    - - Stage I
        
        Persistent area of redness without break in skin; usually over bony prominence
      - Stage III
        
        Full thickness of skin is lost through epidermis, exposing subcutaneous tissue and can have tunneling
      - Stage II
        
        Partial thickness loss of akin layers involving the epidermis that presents as an intact or open ruptured blister
      - Stage IV
        
        Full thickness of skin and subcutaneous tissue is lost, exposing muscle or bone or both, presents as deep crater with necrotic tissue, slough, or eschar. Tunneling is often present.
      - Unstageable
        
        Full thickness of tissue with the base is covered by slough and eschar. Stage cannot be determined until slough or eschar is removed to expose base and depth of wound
  - - - decrease in collagen in skin
    - - decrease in sweat glands can cause drier skin
    - - poor thermoregulation
- - - - chronic irritation of bladder, exposure to dyes, and cigarette smoking are avoidable factors; symptoms are urine frequency, urgency and dysuria; a painless hematuria is the first sign of bladder cancer
    - - formation of stones resulting from immobilization, infection, changes in pH, chronic diarrhea, dehydration, excess elimination of uric acid and hypercalcemia; presents as UTI symptoms like pain and hematuria
    - - Symptoms are subtle and nonspecific at first so may not be noticed. Clinical manifestations include fever, fatigue, nausea, vomiting, anorexia, abdominal pain, anemia, edema, elevated BP, and increased sedimentation rate. Oliguria may also occur and can have protein and blood in urine. Cerebral edema can also be associated which manifests as paralysis, aphasia, coma, headache, convulsions, etc
- - - - Decreased saliva, some medications, Sjögren’s syndrome, mouth breathing, and altered cognition
    - - swallowing difficulties increases with age
    - - Herniation of the esophagogastric junction & a portion of the stomach is in the chest.
        Opening to diaphragm is expanded and stomach pulls up into chest cavity
    - - squamous cell carcinoma or adenocarcinoma caused by poor oral hygiene, irritation, GERD
    - - Diverticulosis (asymptomatic: outpouching of colon) and diverticulitis (inflammation: outpouching of colon)
    - - cholelitiasis (gallstones): acute, harsh right sided pain under rib cage that radiates up right shoulder
  - - - absorption
        
        route can be messed up due to difficulty swallowing
      - excretion
        
        can build up in body so give lowest dose
      - distribution
        
        altered due to hyperalbuminemia, changes in permeability, body temp and tissue structure
      - metabolism
        
        liver issues alter this and can increase half life of drug in body which means you need to use smallest dose of drug possible because it stays in body longer
- - - - metabolic disorder with excess uric acid accumulates in the blood
        
        severe pain and tenderness around the joint as well as swelling, redness, and warmth
    - - synovium becomes hypertrophied and edematous with projections of synovial tissue protruding out of joint cavity
    - - Demineralization of bones as evidence by decreased mass and density of skeleton
  - - - Decrease in muscle mass
- - - - the inability to attain and maintain an erection of the penis sufficient to engage in sexual intercourse
    - - painful intercourse
    - - permanent cessation of menses for at least one year
    - - increased vaginal fragility increases risk of irritation leading to vaginitis and it occurs in postmenopausal women
    - - leading cause of death of gynecologic malignancies
      - clinical manifestations include bleeding, ascites, and presence of multiple masses
    - - decreased fat tissue and atrophy in older women's breasts can cause tumors
      - encourage regular breast examinations
    - - progresses slowly but continuously and the enlarged prostate puts pressure of urethra
    - - often disease is asymptomatic; however, most prostatic cancers can be detected by digital rectal examination
  - - - Fluid retaining capacity decreases, prostate enlarges, increase in FSH and L, can still get erect and ejaculate but it is less intense, venous and arterial sclerosis of penis
    - - atrophy of vulva, decrease in subcutaneous fat, drier and less elastic vagina, alkaline pH, endometrium atrophies, smaller uterus, ovaries are thicker and smaller, and fallopian tubes become shorter and atrophy
- - - - no random rugs everywhere
      - no glares
      - diffuse lighting
      - carpet needs to be smooth so no tripping
      - implement hand rails
- - - - use assistive devices if needed to move and do ADLs
- - - - This increases falls due to improper lighting in room too
        
        Patients also lose vision as they age
        
        This increases risk of falls
- - - - Q2 turns
      - prevent immobilization
      - implement OT/PT to get patient up and moving
        
        to chair and to bed throughout day