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Older Adult - Coggle Diagram
Older Adult
Cardiovascular
Hypertension
Hypotension
Congestive Heart Failure
Class 1:
Cardiac Disease without physical limitation
Class 2
: Symptoms experienced with ordinary physical activity; slight limitations may be evident
Class 3
: Symptoms experienced with less than ordinary activities; physical activity significantly limited
Class 4
: Symptoms experienced with any activity and during rest;bed rest may be required
One of the leading causes of hospitalization for older persons
Pulmonary Embolism
Risk Factors
: Fractured hip, CHF, arrhythmias, and a hx of thrombosis
Coronary Artery Disease
Angina
Pain may be diffuse and of a less severe nature than described by younger adults
Myocardial Infarction
Frequently seen in older adults, especially men with hx of htn and arteriosclerosis
Hyperlipidemia
Arrhythmias
Atrial Fibrillation, occurs over the age of 65
Risk Factors
Affected by age: digitalis toxicity, hypokalemia, acute infections, hemorrhage, anginal syndrome, and coronary insufficiency
Peripheral Vascular Disease
Arteriosclerosis
Specific Problems Associated with Diabetes
Aneurysms
Varicose Veins
Venous Thromboembolism
Changes of Aging:
More prominent arteries in head, neck, and extremities. Valves become thicker and more rigid. Stroke volume decreases by 1% per year. Heart pigmented with lipofuscin granules. Less efficient O2 utilization. Aorta becomes dilated and elongated. Cardiac output decreases. Resistance to peripheral blood flow increases by 1% per year. Blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output
Reproductive
Problems with the Female system
Vaginitis
Reduction on collagen and adipose tissue, shortening and narrowing of vaginal canal, decrease elasticity, fewer vaginal secretions, and a more alkaline vaginal pH
Symptoms: Soreness, pruritus, buring, a reddened vagina, foul smelling vaganal discarch which can be clear, brown, or white
Cancer of the Vagina
Rare and often comes from metastasis than the vaginanal area as the primary location
Risk Factors
: chronic irritation, chronic vaginitis, those who wear pessary
Problems with the cervix
Cervix becomes smaller with age and endocervical epithelial atrophies. This can cause the endocervical glands to seal over leading to the formation of nabothian cysts
Frequent gynecologic examinations are recommended as a result
Cancer of the cervix
Average age is 49, highest rate in Hispanic women, followed by Black, White, Native American/Alaskan Native, and Asian/Pacific Islander
Most endocervical polyps are benign in older women, but all should be reviewed just in case
Initial signs: Vaginal bleeding and leukorrhea
As disease progresses: Urinary retention or incontinence, fecal incontinence, and uremia
Cancer of the ovaries
Increases with incidence with age
Leading cause of death from gynecological malignancies
Early signs are nonspecific and can be confused with gastrointestinal discomfort
As the disease progresses manifestations include bleeding, ascites, and the presence of multiple masses
Perineal Herniation
Result of muscles stretching and tearing during childbirth and of muscle weakness associated with age
Common problem in older women
Three Types
Prolapse
Rectocele
Does not worsen with age
Cystocele
Worsens with age
Dyspareunia
Common problem in older women associated with hormonal changes
More common in women who did not have children than those who did
Contributing problems
: vulvitis, vaginitis, other gynecologic problems
Cancer of breast
Decrease fat tissues and atrophy in older women's breasts can lead to tumors
Second leading cause of death in women
Occurrences increase with age
Annual mammograms are recommended beginning at age 40. At age 75 it changes to 2 to 3 three years unless otherwise recommended
Problems with the Male system
Erectile Dysfunction
Affects nearly half of men over the age of 70
Incidences increase with age
Not normal rather a result of alcoholism, diabetes, dyslipidemia, htn, hypogonadism, MS, renal failure, spinal cord injury, thyroid conditions, and psychological factors
Benign prostatic Hyperplasia
Causes 1 in 4 men to have dysuria
Symptoms progress slowly, but continuously
Symptoms: decreased force of urinary stream, frequency and nocturia
As disease progresses bladder was becomes thinner and loses elasticity
Cancer of the prostate
Incidence increases with age
Over half men over the age of 70 have had histologic evidence of prostate cancer
Often asymptomatic, but can be detected by digital rectal exam
Eventual symptoms: back pain, anemia, weakness, and weight loss. these are present in occurrence with metastasis
Tumors of the penis, testes, and scrotum
Cancer of the penis is rare and appears as a painless lesion 0r wart-like growth on the prepuce glans
Testicular cancer in older males is uncommon but is usually malignant when it does occur
Scrotal masses are typically benign, these can result from conditions like hydrocele, spermatocele, varicocele, and hernia
Changes of aging
Male: Fluid-retaining capacity of seminal vesicles reduces. Possible reduction in sperm count. Venous and arterial sclerosis of penis. Prostate enlarges in most men
Female: Fallopian tubes atrophy and shorten. Ovaries become thicker and smaller. Cervix becomes smaller. Drier, less elastic vaginal canal. Flattening of labia. Endocervical epithelium atrophies. Uterus becomes smaller in size. Endometrium atropies. More alkaline vaginal environment. Loss of vulvar subcutaneous fat and hair.
Neurological
Changes of aging
: Decreased conduction velocity. Slower response and reaction time. Decreased brain weight. Reduced blood flow to brain. Changes in sleep pattern.
Common Problems
Parkinson's Disease
Affects the ability of the central nervous system to control body movements. Dopamine levels are low
S/S; Tremor, shuffling gait, muscle rigidity, weakness, difficult swallowing, and poor balance.
Tx: management of symptoms. Medicine, carbidopa/levodopa
Transient Ischemic Attacks
Temporary or intermittent neurological events that can result from any situation reducing cerebral circulation.
S/S: Hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, nausea, vomiting, and dysphagia.
Tx: Correction of underlying disease process or problem,anticoagulant therapy, or vascular reconstruction
Cerebrovascular Accidents
Risk Factors: Hypertension, severe arteriosclerosis, diabetes, gout, anemia, hypothyroidism, silent myocardial infarction, TIAs, dehydration, and smoking
Major signs: hemiplegia, aphasia, and hemianopsia. Warning signs: lightheadedness, dizziness, headache, drop attack, and memory and behavioral changes
Endocrine
Changes of aging
: Decrease thyroid gland activity. Adrenal gland activity decreases. Pituitary gland activity decreases. Delayed and insufficient release of insulin.
Common problems
Type 2 Diabetes Mellitus
Glucose intolerance in older adults who are obese and inactive
Signs and symptoms: orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, neuropathy, confusion, glaucoma, Dupuytren's contracture, and infection
Recommended to keep fasting glucose between 70 to 130 mg/dL
Tx: Metformin, sulfonylurea drugs, acarbose, thiazolidinediones, insulin
Hypothyroidism
A subnormal concentration of thyroid hormone in the tissues
Prevalence increases with age
S/S: fatigue, weakness, and lethargy. Depression and disinterest in activities. Anorexia. Weight gain and a puffy face. Impaired hearing. Periorbital or peripheral edema. Constipation. Cold intolerance. Myalgia, paresthesia, and ataxia. Dry skin and coarse hair
Tx: replacement of thyroid hormones
Hyperthyroidism
Thyroid gland secretes an excess amount of thyroid hormones.
S/S: diaphoresis, tachycardia, palpitation, hypertension, tremor, diarrhea, stare, lip lag, insomnia, nervousness, confusion, heat intolerance, increased hunger, proximal muscle weakness, and hyperreflexia
Tx: depends on the cause
Urinary
Changes of aging
: Decreased size of renal mass. Decreased tubular function, decreased bladder capacity. Decrease in nephrons. Between ages 20 and 90 renal blood flow decreases 53%, and glomerular filtration rate decreases 50%. Weaker bladder muscles.
Common Problems
UTI
Most common infection in older adults and prevalence increases with age
Presence of a foreign antibody in the urinary tract which slows or obstructs urinary flow
S/S: Burning, urgency, and fever. Incontinence and delirium
Urinary incontinence
Involuntary loss of urine
Types: Stress incontinence, urgency incontinence, overflow incontinence, neurogenic (reflex) incontinence, functional incontinence, and mixed incontinence
Respiratory
:
PO2 reduced as much as 15% between ages 20 and 80. Loss of elasticity and increased rigidity. Decreased ciliary action. Forced expiratory volume reduced. Blunting of cough and laryngeal reflexes. By age 90, approximately 50% increase in residual capacity.
Common problems
COPD
Represents a group of other diseases. Asthma, chronic bronchitis, and emphysema
Asthma
Some adults deal with it throughout life, others develop it at a late age. :
Chronic Bronchitis
Many adults present with persisten, productive cough , wheezing, SOB, and recurrent respiratory infections
Emphysema
Factors causing the disease are chronic bronchitis, chronic irritation from dusts or certain air pollutants, and morphological changed in the lungs
Pneumonia
Gastrointestinal
Changes of aging
Tongue atrophies, this affects taste buds and decreased taste sensation. Saliva production decreases. Swallowing may be more difficult. Thinning of oral mucosa and weakening of mastication muscles. Gingival recession of buccal surfaces. Esophageal and stomach motility decrease. Decrease stomach elasticity. Stomach has higher pH. Slower peristalsis, inactivity, reduced food and fluid intake. Decreased sensory perception r/t bowel elimination
Common Problems
Dysphagia
Swallowing difficulties increases with age. Difficulty transferring food bolus or liquid from the mouth to the pharynx and esophagus
Common causes
: GERD, strokes, and structural disorders
Hiatal Hernia
Incidence increases with age. Affects over half people older than 50, especially women
Symptoms
: Heartburn, dysphagia, belching, vomiting, regurgitation, pain, and bleeding
Diverticular Disease
Multiple outpouches of the intestinal mucosa in the weakened muscular wall of the large bowel.
Risk factors
: Chronic constipation, obesity, hiatal hernia, and atrophy of the intestinal wall muscles with aging
Symptoms
: slight bleeding, changes in bowel habits (constipation, diarrhea, or both), and tenderness on palpation of the left lower quadrant
Chronic Constipation
Contributing factors
: Inactive lifestyle, low fiber and low fluid intake, depression, laxative abuse, certain medications, dulled sensations, failure to allow sufficient time for complete emptying of the bowel
Treat with increased fiber intake and regular activity. Provide a regular time for bowel elimination
Musculoskeletal
Changes of aging: Shortening of vertebrae, between ages 20 and 70 height decreases approximately 2 inches. Bones more brittle. Slight knee flexion. Decrease in bone mass and bone mineral. Slight kyphosis. Slight hip flexion. Slight wrist flexion. Impaired flexion and extension movements.
Common Problems
Fractures
Causes: Trauma, cancer metastasis to the bone, osteoporosis, and other skeletal diseases
Most common in the neck of the femur, especially in females. In the upper extremity the most common is a Colles' fracture (break at the distal radius)
Heal more slowly in older adults. Progress in small steps will be beneficial for healing and to promote psychological healing as well
Osteoarthritis
Progressive deterioration and abrasion of joint cartilage
Occurs increasingly with advanced age to people over the age of 55
Risk Factors: Excessive use of a joint, trauma, obesity, low vitamin D and C levels, and genetic factors.
Tx: Analgesics for pain control. Acupuncture has been used to bring short-term relief. Splints, braces, and canes provide support and rest to the joints
Integumentary
Changes of aging: Flattening of dermal-epidermal junction. Reduced thickness and vascularity of the dermis. Slowing of epidermal proliferation. Increased quantity and degeneration of elastin fibers occur.
Common Problems
Skin Cancer
Three types
Squamous cell carcinoma
Appear on the surface of the skin, the lining of hollow organs, and the passages of the respiratory and digestive tracts
Risk Factors: Sun exposure and exposure to hydrocarbons, arsenic, and radiation.
Melanoma
Tends to metastasize or spread more easily than the other forms of skin cancer causing it to be more deadly.
Risk Factors: Sun exposure (especially for fair skinned people) and the incidence increases with age
Basal cell carcinoma
Grows slowly and rarely metastasizes
Risk Factors: advanced age and exposure to ultraviolet radiation, sun, and therapeutic radiation
Vascular Lesions
Age-related issues weaken the walls of veins and reduce their ability to respond to increase venous pressure
Common causes: Obesity and heredity. Weakened vessel walls. Poor venous return and congestion resulting in edema.
Treatment depends on which kind of ulcer is identified. Hyperemia, Ischemia, Necrosis, and Deep tissue damage