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Care of the Older Adult - Coggle Diagram
Care of the Older Adult
Respiratory System
ventilation control: decreased reaction fo peripheral and central chemoreceptors to hypoxia and hypercapnia
breathing mechanics: lungs lose elastic recoil
lung size and weigh reduction
decline muscle strength
reduced cough reflex
increased residual capacity and reduced vital capacity
oxygenation: increased ventilation and perfusion are imbalanced and there is increased dead space in the lungs
decreased alveolar surface area
immune response issues: decrease in cilia, decreased ability to clear mucus secretions, decreased ability to cough and deep breathe, and decreased immune response
Pathologies
Chronic Bronchitis
chronic sputum w/ cough production daily for minimum of 3months in each of 2 consecutive years
chronic hypoxemia, cor pulmonale
increase in mucus, cilia projection and bronchial wall thickness
Assessment: general cynosis, "blue bloater", R heart failure, distended jugular veins, persistent and productive cough, wheezing, recurrent respiratory infection, and SOB
Interventions: lowest FiO2 possible to prevent CO2 retention, watch for s/s of fluid overload, management of chronic bronchitis, remove bronchial secretions, prevent obstruction of airway, and maintain adequate fluid intake
Emphysema
reduced gas exchange surface area, increased air trapping, decreased capillary network, increased work (increased O2 consumption)
Assessment: barrel chest, "pink puffer", distant quiet breath sounds, wheezes, pulmonary blebs on x ray
Causes: chronic bronchitis, chronic irritation, and morphologic changes in the lung and cigarette smoking
Symptoms develop slowly which delays diagnose and treatment
treatment involves postural drainage, bronchodilators, avoiding stress, and breathing exercises
Cardiovascular System
valves thicken and become rigid: thickening of left ventricular wall and slight ventricular hypertrophy
diastolic murmors can occur in 50% of older adults
inability of heart to pump enough blood to meet the tissue's O2 demands
reduced elasticity in blood vessels
efficiency and contractile loss in heart muscle
reduced cardiac output due to physiologic stress
increased peripheral resistance
Pathologies
Hypertension
systolic bp: ≥ 140 mm Hg / diastolic bp: ≥ 90 mm Hg
factors influencing bp: anxiety, stress, and activity before assessment
symptoms: impaired memory, disorientation, dull headache, epistaxis, slow tremor
treatment:
moderate alcohol intake: ≤2 drinks per day for men and ≤1 drink per day for women
physical activity: ≤30 minutes aerobic activity per day
ACE inhibitors, ARBS, direct renin inhibitors, calcium channel blockers, thiazide diuretics (first-line treatment)
beta-blockers: not preferred for older adult due to being associated with more adverse effects
DASH diet
diet rich in fruits/vegetables and low-fat dairy products with reduced content of saturated and total fat
Heart Failure
Right sided HF
peripheral edema
symptoms: weight gain, distended neck veins, anorexia, weakness, hepatomegaly, ascites
peripheral congestion d/t inability of right ventricle to pump blood out to the lungs which can cause left sided HF
Left sided HF
pulmonary edema
symptoms: dyspnea, cough, crackles, tachycardia, fatigue, anxiety, confusion, restlessness
pulmonary congestion d/t inability of left ventricle to pump blood to periphery
Gastrointestinal System
atrophy of small and large intestines
less acute taste sensations d/t atrophy of the tongue
presybyesophagus resulting in weaker esophageal contractions and weakness of the sphincter
decreased esophageal and stomach motility
risk for aspiration and indigestion
decreased elasticity of the stomach
reduced amount of food accommodation
decline in hydrochloric acid and pepsin
higher pH in stomach
increase in incidence of gastric irritation
interferes with absorption of calcium, iron, folic acid, and vitamin B12
intergeres with absorption of protein
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
affects drug metabolism and detoxification processes
slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet
increase in risk for constipation
bile salt synthesis decreases
increase in risk of gallstone development and affects digestion of fats
Urinary System
reduced bladder capacity
urinary frequency, nocturne, and urgency
renal blood flow decline and glomerular filtration
Musculoskeletal System
increased risk of fractures
diminished calcium absorption
reduced muscle mass, movement, and strength
decreased bone mineral and mass
thinned disks and shortened vertebrae
Nervous System
hypothalamus less effective in temperature regulation
ruction in neurons, cerebral blood flow, and nerve fibers
decline in weight and blood flow to the brain
slower response to change in balance
Intelligence/Memory
increased incidence of mild cognitive impairment due to chronic psychological stress
fluid intelligence may decrease
short-term memory may decline
age related forgetfulness