Please enable JavaScript.
Coggle requires JavaScript to display documents.
Gerontology - Coggle Diagram
Gerontology
Digestive system
Saliva
Swallowing may be diffcult
Production decreases
Esophagus
Presbyesophagus
Motility decreases
Tongue
Decreased taste sensation
Atrophies
Stomach
pH increases
Motility decreases
Decreased elasticity
Decline in pepsin and hydrochloric acid
Fecal impaction
Distended rectum, abdominal and rectal discomfort, oozing of fecal material around the impaction, palpable, hard fecal mass and fever
Detection through observing frequency and character of bowel movements
Bowel elimination record
Treatments
Manual breaking and removal of feces with lubricated gloves
oil retaining enema
Injection of 50 mL f hydrogen peroxide through rectal tube
Liver
Bile salt synthesis decreases
Deceased enzyme production
#
Cardiovascular system
Vessels
Reduced elasticity
#
#
Increased peripheral resistance
#
Less sensitive to baroreceptor regulation of blood pressure
Calcification
Arteriosclerosis
Hardening and narrowing of arteries due to plaque buildup in vessel walls
Most often affects smaller vessels farthest from the heart
Interventions
Buerger-Allen exercises
Warmth
Bed rest
Vasodialators
Varicose Veins
May be due to lack of exercise, job entailing a great deal of standing or loss of vessel elasticity and strength
Dilated, tortuous nature of veins, especially in the lower extremities
Dull pain and cramping in the legs, dizziness, and reduced cerebral circulation
Interventions
Proper use of elastic stockings and bandages (not to constricting)
Reduce venous stasis
Elevate and rest affected limb
Exercise
Skin is more susceptible to trauma and infection
Myocardial muscle
Less efficient
#
#
Prolonged cardiac cycle
Decreased contractile strength
Heart failure
Inability of the heart to pump enough blood to meet the tissues oxygen demands
Right sided failure
Causes peripheral edema resulting in peripheral congestion
Due to the inability of the right ventricle to pump blood out to the lungs
weight gain, distended neck veins, anorexia, weakness, hepatomegaly, ascites
Left sided failure
Causes a pulmonary edema resulting in pulmonary congestion
dyspnea, crackles, cough, tachycardia, fatigue, anxiety, restless, confusion
Due to the inability of the left ventricle to pump blood to the periphery
Interventions
Monitor B/P in lying, sitting, and standing position
Encourage frequent rest periods to avoid fatigue regular low impact exercise
Teach to change positions slowly to avoid falls and injuries and avoid sitting with feet in a dependent position
Assess edema: Weigh daily if indicated
Take apical and radial pulse; note deficits or rhythm abnormalities
Teach to avoid extreme hot and cold because of decrease in peripheral sensation
Aorta
Thickening of left ventricular wall
Ventricular hypertrophy
#
#
Dilated
Heart valves
Rigid
Thicken
Respiratory system
Oxygenation
Increase in number of dead spaces in the lungs
Imbalance between ventilation and perfusion
Decrease in alveolar surface area
Emphysema
Reduced gas exchange surface area and capillary network, increased air trapping, work and O2 consumption
#
#
Assess barrel chest, distant quiet breath sounds, wheezes and pulmonary blebs on x ray
Increase incidence in older adults, cigarette smoking plays a major role in development
Interventions
Postural drainage
bronchodialators
avoid stress
Breathing exercises
Pink puffer: Barrel chest, dyspneic, prolonged expiration, hunched-over position, breathes through pursed lips
Ventilation control
Decreased reaction of chemoreceptors
#
Breathing mechanics
Reduced cough reflex
Reduction in lung size and weight
Lungs lose elastic recoil
Immune response
decreased ability to clear mucous secretions and deep breath
Chronic bronchitis
Chronic sputum with cough production daily for a minimum of 3 months in each of 2 consecutive years
#
Assess for general cyanosis, right sided heart failure and distended jugular veins
#
Persistent productive cough, wheezing, recurrent respiratory infections, hypoxemia and shortness of breath; symptoms may develop gradually, even over years
Interventions
Lowest FiO2 possible to prevent CO2 retention
Watch for signs of fluid overload
Management of chronic bronchitis
Remove bronchial secretions
Prevent obstruction of airway
Maintain adequate fluid intake
Blue bloater: cough, dyspnea on exertion, hypercapnia, hypoxemia, mild cyanosis
Decrease in cilia
Integumentary system
Skin
Decreased ability to detect and regulate temperature
#
loss of elastin
Less effective barrier
increase in vascular fragility
Thin and dry
Decreased rate of epidermal turnover
Increased appearance of age spots and raise lesions
Skin cancer
Squamous cell carcinoma
arises from squamous cells on the skin, lining of the hallow organs and the passage of the respiratory and digestive tract
Sun exposure is the most prevalent risk factor
Appear as firm, skin colored or red nodules
Typically stays in the epidermis, but may metastasize
Melanoma
Fair-skinned individuals are at higher risk
Metastasize more easily than other forms of skin cancer
nodular melanoma
Any area on body
Darkly pigmented papule that increases over time
Superficial spreading melanoma
Variable pigmented plaque with irregular border
Most common form of melanoma, occurs on any area of the body
Lentigo maligna melanoma
black, brown, white or red flat lesion
sun exposed areas of the body
enlarges over time and becomes progressively irregularly pigmented
Basal cell carcinoma
Grows slowly and rarely metastasizes
Most common form of skin cancer, frequently occurs on the face but can be anywhere
Risk factors include advanced age, exposure to the sun, ultraviolet radiation and therapeutic radiation
Growth is small, dome-shaped elevations covered by small blood vessels or flesh colored moles with a pearly surface
Interventions
educate older adults to frequently inspect the skin and identify moles that demonstrate changes in pigmentation or size
Nails
Brittle
Thick
Hair
Increased facial hair in women
Graying
overall loss
Cells
Reduction in melanocytes
#
keratinocytes become smaller and regeneration slows
#
Endocrine system
Thyroid gland
Activity decreases
#
atrophies
Hypothyroidism
prevalence increases with age, more common in women
#
Subnormal concentration of thyroid hormone in the tissues
Fatigue, weakness, lethargy, anorexia, weight gain, puffy face, impaired hearing, periorbital or peripheral edema, myalgia, paresthesia, ataxia, dry skin and hair, husky voice tone and slowed speech
Primary: Disease process that destroys thyroid gland
Diagnostics: Low free T4, elevated TSH
Secondary: Insufficient pituitary secretion of TSH
Diagnostics: Low free T4, low TSH
Nursing interventions
Develop a bowel elimination plan
Increase activity
high fiber diet
3L of fluid a day
Avoid use of laxatives
Ongoing follow-up for serum hormone levels
Medication regimen
Myxedema coma hypoventilation: hypotension, hypoglycemia, hyponatremia, hypothermia, lactic acidosis and respiratory failure
Hyperthyroidism
Amiodarone-induced thyroid dysfunction
Diagnostics: T3 > 220 ng/dL , T4 > 12 mcg/dL
Evaluation may strictly depend on T4 due to malnourishment in the elderly causing a decrease in T3, making the serum levels fall within normal range
Less prevalent than hypothyroidism, affects woman more than men
Enlarged thyroid, exophthalmos, increased appetite, diarrhea, tachycardia, palpations, increased systolic BP, diaphoresis, nervousness, insomnia, heat intolerance
Excess amount of thyroid hormone
Nursing interventions
teach daily hormone replacement
Observe for thyroid storm
Diet: high calorie and protein, low fiber and caffeine
Wear Med alert
Adrenal gland
Function diminished
adrenocorticotropic hormone secretion decreases
Pituitary gland
Somatotropin growth hormone levels decrease
Atrophies
Insulin
Reduced tissue sensitivity
Insufficient release by pancreas
Nervous system
Demyelination
reflexes become weaker
response and reaction times are slower
slower nerve conduction
Central processing
delay in time required to perform tasks
#
Ability to compensate declines
Nerve cells
atrophy of brain and spinal cord
dulling of tactile sensation
Plaques, tangles, fatty deposits and free radicals increase
sensory receptors, dermatomes, dendrites and neurons decrease
Transient ischemic attacks
Caused by hyperextension and flexion of the head, reduced blood pressure, cigarette smoking
Hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, nausea, vomiting, and dysphagia
symptoms may last from minutes to hours
complete recovery within a few days
Temporary or intermittent neurological events that can result from any situation that reduces cerebral circulation
Increase risk of CVA
treatment includes correction of underlying cause, anticoagulant therapy, or vascular reconstruction
Cranial nerves
reduced taste and smell
#
decline
Musculoskeletal system
Mobility
Sarcopenia
#
Bone
Demineralization
brittleness
deterioration of cartilage
Thinning disks
Shortened vertebrae
Gout
Metabolic disorder in which excess uric acid accumulates in the blood
#
Uric acid crystals are deposited in and around the joints
Severe pain and tenderness around joint and warmth, redness and swelling of the surrounding tissue
Attacks can last from weeks to months
Remissions between attacks
Treatment aims to reduce sodium urate
Low-purine diet
Avoidance of bacon, turkey, veal, liver, salmon, legumes and alcohol
Interventions
Encourage good fluid intake
Monitor pain
Muscle
muscle fibers decrease in number and size
Decreased flexibility of joints and muscles
reduced muscle mass, strength and movement
impaired capacity for regeneration
lymphatic system
Depressed immune response
Risk for infection becomes significant
Cell-mediated immunity declines
#
#
Inflammatory defense declines
Thymus
T-cell activity declines
thymus mass steadily decreases
More immature T cells present
T lymphocytes are less able to proliferate
Inflammation
Increase in pro inflammatory cytokines
Presents atypically
Urinary system
Kidney
decrease in glomerular filtration
#
Decrease in renal blood flow
Increase in threshold for glucose
Reduced ability to dilute and concentrate urine
#
Renal Calculi
Results from immobilization, infection, changes in the pH or concentration of urine, chronic diarrhea, dehydration, excessive elimination of uric acid, and hypercalcemia
Pain, hematuria, GI upset and symptoms of UTI are associated manifestations
Interventions
prevent urinary stasis
Providing ample fluids
Facilitating prompt treatment of UTIs
Formation of stones
Bladder
Thickening of bladder, reduces ability to expand and decreases storage
Urinary frequency, urgency and nocturia are common
#
Hypertrophy of bladder muscles
Reproductive system
Female
Breasts
Retraction of nipples
Sag
Less firm
Breast cancer
Decreased fat tissue and atrophy can cause tumors
Annual mammograms are recommended for women starting at age 40
Incidence increases with age
Uterus, ovaries, fallopian tubes and cervix
Atrophy
Vaginal canal changes
shortening and narrowing
Reduction in collagen and adipose tissue
Less lubrication
Alkaline vaginal pH
Hormonal changes
Flattening of the labia
Loss of subcutaneous fat and hair
#
Vulva atrophies
Male
Seminal vesicle
Thinner epithelium
ejaculation fluid contains less live sperm
Prostate gland
Enlargement
Testes
Atrophy
Testosterone decreases slightly
#
More time required to achieve an erection
Erectile Dysfunction
Inability to achieve and sustain an erection for intercourse
Incidence increases with age
#
Can occur due to medications and/or condtions
Conditions: Diabetes, hypertension, alcoholism, dyslipidemia, hypogonadism, multiple sclerosis, renal failure, spinal cord injury, thyroid conditions, and psychological factors
#
Medications: Anticholinergics, antidepressants, antihypertensives, digoxin, sedatives, tranquilizers