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Older Adult, Arianna Dziadkowiec - Coggle Diagram
Older Adult
Gastrointestinal
Irritable bowel syndrome
Indigestion and constipation
Less production of hydrochloric acid, pepsin, lipase, and pancreatic enzymes
Dyspepsia
stomach has a higher pH due to decline of hydrochloric acid and pepsin
gastric irritation
Interferes with absorption of calcium, iron, folic acid, and vitamin B12
Interferes with absorption of protein
GERD
Increased risk of aspiration
Celiac Disease
Less acute taste sensations
Decreased esophageal and stomach motility
Atrophy of the small and large intestines
Reduced intestinal blood flow
Atrophy of gastric mucosa
Slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet
Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter
Saliva production decreases (difficult swallowing)
Fewer cells on absorbing surface of intestinal wall impact the absorption of dextrose, xylose, and vitamins B and D
Decreased enzyme production in the liver which affects drug metabolism and detoxification processes
Bile salt synthesis decreases
increase in the risk of gallstone development
affects digestion of fats
Dysphagia
Causes: Gastroesophageal reflux disease (GERD), stroke, and structural disorders
Hiatal Hernia
Signs and symptoms: heartburn, belching, abdominal discomfort
Herniation of the esophagogastric junction & a portion of the stomach is in the chest
Causes: Obesity, large volumes of food
Esophageal Cancer
Causes: poor oral hygiene, irritation
Signs and symptoms: dysphagia, weight loss, excessive salivation, thirst, hiccups, anemia
Colorectal Cancer
Signs and symptoms: Change in bowel habits, sense of incomplete evacuation, abdominal pain, nausea, vomiting, weight loss, cachexia, abdominal distention, family hx, hx of polyps
Integumentary
Loss of subcutaneous fat
Thin skin provides less effective barrier
Loss of tissue elasticity: elongated ears, baggy eyelids, double chin
Hair loss, graying and wrinkles
Decreased ability to detect and regulate temperature
Dry skin from decrease in endocrine secretion
Loss of elastin
Increase in vascular fragility
Increased appearance of age spots and raised lesions (seborrheic keratosis)
Hair loss occurs; women have increased facial hair
Keratinocytes become smaller and regeneration slows
Nails become brittle and thick
Seborrheic Keratosis
Skin Cancers
Squamous Cell Carcinoma
Melanoma
Basal Cell Carcinome
Pruritus
Pressure injury
Nervous System
Hypothalamus less effective in temperature regulation
Insomnia
Difficulty falling or staying asleep or prematurely waking
Guillain-Barre Syndrome, Carpal Tunnel Syndrome
Neuropathy
Changes in sleep pattern and frequent awakening
Reduction in neurons, nerve fibers, cerebral blood flow, and dendrites
Dementia
cognitive impairments characterized by gradual progressive onset. Irreversible & affects judgement, memory, abstract thinking, and social behavior
Decline in the function of cranial nerves affecting taste and smell
Loss of nerve cell mass
Brain weight decreases
Plaques, tangles, atrophy of brain and spinal cord
Demyelination
Slow response to change in balance and reaction time
Reflexes become weaker
Slower nerve conduction
Free radicals accumulate
Fatty deposits accumulate in blood vessels
Parkinson Disease
Affects ability of the central nervous system (CNS) to control body movements
Chronic, progressive, debilitating neurologic disease of the basal ganglia and substantia niagra, 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)
Respiratory
Pneumonia
Occurs when there is consolidation in particular area of lung (cause= staph infection)
Asthma
Can develop in later years
Is an intermittent disease with reversible airflow obstruction and wheezing due to a variety of stimulants
Chronic Obstructive Pulmonary Disorder
Chronic Bronchitis
Chronic sputum with cough production daily for a minimum of 3 months in each of 2 consecutive years
S/S: "Blue Bloater"
cough, dyspnea on exertion, hypercapnia, hypoxemia, mild cyanosis
Emphysema
Reduced gas exchange surface area
S/S: "Pink Puffer"
Barrel-chested, dyspneic prolonged expiration, hunched-over position, breathes through pursed lips
increased air trapping and decreased capillary network
Reduction of cough and laryngeal reflexes
Increased residual capacity and reduced vital capacity
Calcification of costal cartilage, trachea, and rib cage more rigid
High risk for respiratory infection
Forced expiratory volume reduced
Alveoli fewer in number and larger in size
Reduced basilar inflation
Thoracic muscles more rigid
Decreased reaction of peripheral and central chemoreceptors to hypoxia and hypercapnia (high CO2 levels)
Cardiovascular
Hypertension
Blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output
Symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremor
Treatment
DASH diet, regular exercise, medications, control cholesterol
Usually no symptoms
Coronary Artery Disease/ Atherosclerosis
Edema
Myocardial infarction
Atypical presentation: confusion, decreased BP, SOB, elevated temperature, and sedimentation rate
Peripheral Vascular Disease
Affects smallest vessels furthest from heart
Angina
Vague discomfort under sternum, indigestion, syncope, sweating, confusion
Prevalence increases with age- some form is present after 70 years of age
Congestive Heart Failure
Symptoms: crackles on auscultation, shortness of breath, dyspnea on exertion, cough, fatigue, restlessness, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, and bilateral ankle edema
Heart muscle loses efficiency and contractile strength + reduced cardiac output with physiologic stress
Oxygen used less efficiently
Heart pigmented with lipofuscin granules
Less elasticity of vessels
Aorta becomes dilated and elongated
Ventricular hypertrophy and thickening of left ventricular wall
Calcification and reduced elasticity of vessels
Valves become thick and rigid
diastolic murmurs occur in 50% older adults
Less sensitive to baroreceptor regulation of blood pressure
Hyperlipidemia
Risk CAD with elevated total cholesterol
Evaluate full lipid profile, triglycerides, high-density lipoprotein, low-density lipoprotein
Musculoskeletal
Reduced muscle mass, strength, and movement
Bones more brittle
Thinning disks and shortened vertebrae
Decreased bone mineral and mass
Increased risk of fractures
Osteomalacia
Osteoporosis
Kyphosis
Sarcopenia
Impaired flexion and extension movements
Renal and Urinary Elimination
Hypertrophy and thickening of the bladder muscle
Reduced storage capacity
Daytime urinary frequency
Emptying bladder may become more difficult
Size and weight of kidney decreases
Changes in cortical control of micturition
Nocturia
Inefficient neurological control of bladder emptying and weaker bladder muscle
vesicoureteral reflux
increased risk for reflux into the ureters
distended bladder
bladder hypertrophy
retention of large volumes of urine
males: prostatic hypertrophy
BPH
females: fecal impaction (constipation)
Reduced tubular function
proteinuria
nephrolith
renal calculi
indication of chronic kidney disease
high blood pressure
diabetes mellitus
glomerulonephritis (inflammation of kidney)
intravascular hemolysis
destruction of red blood cells and release of hemoglobin into the blood stream
high blood urea nitrogen levels
diabetes directly affects kidneys
high blood pressure directly affects kidneys
dehydration (low blood flow to kidneys)
heart failure
concentration of urine changes in response to water and/or sodium excess/depletion
glomerular filtration rate decreases d/t decreased renal blood flow and decreased numbers of functioning glomeruli
slowed organ function
decreased drug elimination
Bladder Cancer
Urinary tract infection
Endocrine
Diminished adrenal function
Adrenocorticotropic hormone (ACTH) secretion decreases
Thyroid gland atrophies and activity decreases
Insufficient release of insulin and reduced tissue sensitivity to circulating insulin
Volume of pituitary gland decreases
Diabetes Mellitus
Type 2 DM
Classic specific symptoms may be absent; only nonspecific s/s are clues
Glucose intolerance
7th leading cause of death in older adults
Hypothyroidism
Hypofunction of the thyroid gland with resulting insufficiency of thyroid hormone
Low T3, Low T4
S/S: fatigue, weakness, lethargy, anorexia, weight gain, impaired hearing, periorbital or peripheral edema, myalgia, paresthesia, ataxia, dry skin and dry hair, husky voice, slow speech
Hyperthyroidism
High T3, High T4
Secretion of excess amounts of thyroid hormone
S/S: enlarged thyroid, exophthalmos, increased appetite, diarrhea, tachycardia, palpitations, diaphoresis, nervousness, insomnia, heat intolerance
Reproductive System
Males
Muscle tissue replaced with connective tissue
Decreased capacity to retain fluids
Seminal vesicles develop thinner epithelium
Atrophy of testes and reduction in testicular mass
Enlargement of prostate gland
More time required to achieve erection
Ejaculation fluid contains less live sperm
Increased fibrosis, epithelium thinning, thickening of basement membrane, and narrowing of lumen
Females
Cervix, uterus, and fallopian tubes atrophy
Vaginal canal changes
Shortening and narrowing of canal
Less lubrication
Reduction in collagen and adipose tissue
More alkaline vaginal pH d/t lower estrogen
Vaginal epithelium thins
Hormonal changes
Flattening of labia
Loss of subcutaneous fat and hair
Vulva atrophies
Fallopian tubes become shorter and straighter
Atrophic vaginitis
Soreness, pruritus, burning, and a reddened vagina are symptoms, and the accompanying foulsmelling vaginal discharge is clear, brown, or white
Occurs in postmenopausal women
Cancer of Endometrium
higher incidence in women who have had a late onset of menstrual periods, been infertile, have a personal or family history of hereditary nonpolyposis colon cancer (HNPCC) or polycystic ovary disease, used estrogen without progesterone, or who are obese.
S/S: Postmenopausal bleeding
Benign prostatic hyperplasia
Sensory
Touch
Reduction in tactile sensation
Reduced ability to sense pressure
Difficulty with discrimination of temperatures
Vision
Opacification of lens and virteous
Presbyopia
inability to focus on close objects early
Decreased pupil size and less reactive to light
More spherical cornea
Narrowing of visual field (decreased peripheral vision)
Depth perception distortion
Decline in visual acuity
Lose photoreceptor cells in retina
Light perception threshold decreases
Dark and light adaptation takes longer
Difficulty with vision at night
Increased sensitivity to glare
Partial or complete white ring encircles periphery of the cornea (arcus senilis)
Tear production decreases
Cataracts
Clouding of the lens and loss of transparency
Leading cause of low vision in older adults
Hearing
Presbycusis
progressive loss of hearing
Cerumen increases
Tympanic membrane sclerosis and atrophy
Distortion of high-pitched sounds
Alteration in equillibrium
Otosclerosis
Smell
Impaired ability to identify and discriminate odors
Loss of cells in olfactory bulb of brain
Taste
Decreased saliva
Atrophy of tongue
Poor oral hygiene
Medications
Number of functioning taste buds decreased
sweet and salty flavors
Xerostomia
dry mouth
Immune System
T-Cell Activity declines
Risk for infection
Cell-mediate immunity declines
Inflammatory defenses decline
inflammation presents atypically
Progressive loss in efficiency of the body to repair damaged tissue
Arianna Dziadkowiec