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Older Adult - Coggle Diagram

- - - - CONNECTION TO MUSCULOSKELETAL: If a patient has decreased bone density and osteoporosis, it is possible for a patient to suffer a pathological fracture. This is why it is important for older adults to practice weight-bearing exercises and to take biphosphonates for osteoporosis to decrease risk for pathological fractures.
- - - - CONNECTION TO SAFETY : Distorted depth perception increases the risk for falls and the need to maintain safe environmental surroundings by providing adequate lighting, reducing the number of rugs that are tripping hazards, and utilizing handles and grab bars for stability when they cannot see where they are going due to eyesight
  - - - CONNECTION TO CARDIAC: The decreased ability to taste salt due to decreased taste buds and atrophy of the tongue can cause an older adult patient to put more salt on their food in order to taste it, and the salt can draw more fluid into the vasculature and increase their blood pressure. Older adults might already have an increased systolic BP due to arteriosclerosis, and this can precipitate heart failure since the heart cannot withstand high BP over prolonged periods of time.
  - - - Narrow-Angle: sudden increase in IOP, surgical emergency
      - Open-Angle: chronic increased IOP
- - - - Will usually not have symptoms but can display dull headaches, impaired memory, disorientation, confusion, epistaxis (nosebleeds), slow tremors
  - - - Will have pulmonary edema, pulmonary congestion, crackles in lungs, cough, tachycardia, fatigue, restlessness, confusion
  - - - Will have peripheral edema, weight gain, distended neck veins (JVD), anorexia, weakness, hepatomegaly, ascites; Can be caused by left heart failure
- - - - Attributed to atherosclerosis, diabetes, HTN, MS, thyroid problems, renal failure, ETOH, psychological factors, and medications
    - - S/S: urinary hesitancy, decreased force of urine stream, nocturia
        
        Treat with tamsulosin or possible transurethral resection
    - - Hormonal changes can often contribute to this issue (less vaginal lubrication)
- - - - Slight cyanosis
      - Hypercapnia
      - RHF/JVD
      - Mucous plug formation/bronchial wall thickening
      - Persistent cough, SOB, persistent respiratory infection
      - Wheezing
    - - Barrel chest
      - Thin
      - Pursed-lip breathing
      - Tripod posture
      - pulmonary blebs in CXR
      - Increased air trapping d/t decreased gas exchange surface area
      - Diminished breath sounds
      - Prolonged expiration
- - - - CONNECTION TO MEDICATION SAFETY: If a patient has issues with swallowing due to dysphagia, it might be harder for patients to practice safe medication use due to absorption being impaired, since it is hard for the PO medication to get into the body in the first place. This can result in noncompliance for medication when patients are unable to swallow pills. Situations in which patients cannot swallow pills require discussion of crushing up pills in applesauce, or even the need for medications via enteral feeding tubes.
    - - Sliding (axial): when the stomach slides up above the level of the diaphragm and causes reflux of stomach content
      - Rolling (paraesophageal): when the stomach slides up through the diaphragm next to the esophagus and causes indigestion d/t reflux of stomach contents
    - - Diverticulitis: when the out-pouching of the intestine becomes inflamed
    - - Liquid stool will ooze around impaction and there will be abdominal bloating and cramping, will feel palpable mass in rectum
  - - - Decreased absorption of folate, calcium, iron, vitamin B12
    - - Decreased absorption of dextrose, xylose, vitamins B and D
    - - Altered digestion of fats, increased gallstone development
- - - - Looks like a papule and has a pearl-like appearance
- - - - Decrease in bone mass with age
        
        Occurs more commonly in women due to decrease in protective effects of estrogen
        
        Results in pathological fractures
        
        Should do weight bearing and balancing exercises and exercise at least 150 minutes/week combined with strength training
    - - Joint (cartilage) deterioration and pain; will have Heberden nodes
        
        Osteoarthritis affects ability to do ADLs, draw up insulins, compress inhalers, crush up medications
- - - - Supine sleeping position should be avoided and CPAP should be used
    - - Attributed to iron deficiency anemia, uremia, Parkinson's, RA, diabetes, neurological lesions
    - - Tricyclic antidepressants and renal failure contribute to this
- - - - CONNECTION TO FRAILTY: A decreased protein intake can precipitate the condition of frailty, as a decrease in protein in the diet can cause excessive sarcopenia and cachexia seen in frailty, as the body needs protein that is not found in the diet, and it will degrade the protein out of the muscle fibers to provide those nutrients for the body; thus, precipitating frailty
  - - - Can cause aspiration and aspiration pneumonia
      - Need to thicken liquids if possible and allow ample time for chewing and swallowing
      - Sit patient up in high-fowler's during feeding to prevent aspiration
- - - - People over 45 should get their blood glucose levels screened every 3 years
        
        Hyperglycemia over long periods of time can result in microvascular and macro-vascular diseases, as well as peripheral neuropathies and eventual death
        
        CONNECTION TO RENAL: Prolonged levels of high blood glucose can cause damage to the glomeruli of the kidneys, damaging them and decreasing the GFR to the point where the kidneys can no longer filter the blood adequately, and the patient may need dialysis.
      - If random blood glucose or postprandial blood glucose is over 200 and fasting blood glucose is over 126 then it is a diabetes diagnosis
      - Metformin is the first line of treatment
      - Sulfonylureas and Thiazolidinedions are also oral hypoglycemic agents used
      - Insulin can be used if production decreases (should be giving basal dose of long-acting insulin and bolus doses of short acting insulin at meals to mimic pancreas)
- - - - Slower reflexes
      - Slower nerve conduction
      - Reaction time decreases
  - - - Usually caused by a blood clot that dislodges in the artery in minutes to hours, recovery usually in one day
        
        Results in increased risk for stroke in the future
    - - Causes: Electrolyte imbalance, med side effects, dehydration, stress, surgery, insomnia, disturbances in blood flow, ETOH withdraw
        
        S/S: short term memory impaired, hallucination, incoherent speech, suspicious of others, confused, may be agitated or dull, hyper or hypoactive
    - - Causes: decreased oxygen to the brain, damage to brain from degenerative diseases, infection, trauma
- - - - Nocturia
        
        CONNECTION TO SLEEP: Since there is a decreased carrying capacity in the bladder for urine and nocturia occurs as a result, there is an interruption of sleep since the patient needs to keep getting up in the middle of the night to go to the bathroom
      - Daytime frequency and urgency
    - - Causes nocturia
    - - Causes urine to stay in bladder and reflux up to kidneys to cause pyelonephritis
    - - Reduced ability to excrete drugs, causes toxicity
      - Causes slight, normal proteinuria after age 80 and higher BUN
    - - Causes urine to be more dilute and less concentrated
    - - Might have a false negative result for glucosuria
  - - - Cognitive impairments or paralysis/weakness
    - - Laughing, sneezing, running
    - - Can happen in different brain and spinal cord injuries
    - - Can be caused by BPH in men and fecal impaction in women
    - - Early S/S: Proteinuria, hematuria, edema in ankles and in face
        
        S/S as it progresses to kidney failure: n/v, trouble sleeping, anorexia, fatigue, dry and itchy skin, nighttime muscle cramps
        
        Late stage: cerebral edema, confusion, convulsions, headache