Older Adult
Circulatory system
Respiratory system
Digestive System
Sensory system
Changes of aging
Heart valves become thick and more rigid
Aorta becomes dilated
Myocardial muscle is less efficient
Calcification & reduced elasticity of vessels
Less sensitive to baroreceptor regulation of blood pressure
Changes of Aging
Atrophy of the tongue affecting taste buds and causing taste sensations
Saliva production decreases causing swallowing to be more difficult
Esophageal and stomach motility decreases
Decreased elasticity of the stomach
Changes of aging
Breathing mechanics
Changes occur in upper airway paths, nose and trachea
Declining muscle strength causing decreased cough reflex
Lung size and weight reduction
Oxygenation
increased ventilation and perfusion are imbalanced
decreased alveolar surface area
Ventilation Control
decreased reaction of peripheral and central chemoreceptors to hypoxia and hypercapnia
increased need for an older adult to eat smaller meals
Higher risk for aspiration and indigestion
Decline in hydrochloric acid
increase in incidence of gastric irritation
Interferes with absorption of calcium, iron, folic acid and B12
Decline in pepsin
Interferes with absorption of protein
changes of aging
Hearing changes
Impacted cerumen
High pitches are diminished and the ability to discriminate tones is lost
Vision changes
Loss of photoreceptor cells in the retina
difficulty with vision at night
dark and light adaption takes longer
Light perception threshold decreases
opacification of the lens and viterous
Visual acuity declines
reduced pupil size
Decreased ability to focus
reduced elasticity and stiffening of the muscle fibers of the lens
Abnormal changes
Glaucoma
Damage to the optic nerve from an above normal intraocular pressure
Second leading cause of blindness in older adults
Lungs lose elastic recoil
Diastolic murmurs occur in 50% of older adults
Slight ventricular hypertrophy
Thickening of left ventricular wall
Decreased contractile strength and prolonged cardiac cycle
unable to meet the demands of increased activity
Endocrine System
Neurological System
Thyroid gland atrophies and acitivty decreases
decreased production fo thyroid hormone, which drives metabolism leading to weight gain
Diminished adrenal function
Stabilization of mineral within body compensation is more fragile
Adrenocorticotropic hormone (ACTH) secretion decreases
Affects BP regulation
Volume of pituitary gland decreases
TSH, growth hormone, oxytocin, prolactin, luteinizing hormones, FSH hormones affected
Insufficient release of insulin and reduced tissue sensitivity to circulating insulin
Leads to diabetes mellitus
Urinary/Renal System
Changes of aging- urinary elimination
Size and weight of the kidney decreases
Hypertrophy and thickening of the bladder muscle
Decreases bladder ability to expand
reduces stroage capacity
daytime urinary frequency
Nocturia
Changes in cortical control of micturition
nocturia
Ineffecient neurological control of bladder emptying and weakened bladder muscles
Retention of large volumes
GFR decreases due to decreased renal blood flow and decreased numbers of functioning glomeruli
Affects the abilty to eliminate drugs
Slowed organ function
Reduced tubular function
Bladder capacity decreases by one-half
Weakening of the bladder and perineal muscles and decrease in sensation of urge to void
Integumentary System
Changes of Aging
Slowing in central processing
Delay in time required to perform tasks
Number and sensitivity of sensory receptors, dermatomes and neurons decrease
Dull in tactile sensation
Decline in the function of cranial nerves affecting taste and smell
Loss of nerve cell mass
atrophy of the brain and spinal cord
brain weight decreases
Demyelination
slower nerve conduction
response and reaction times are slower
reflexes become weaker
decrease in cerebral blood flow
Fatty deposits accumulate in blood vessels
Parkinson disease
Affects ability of the CNS to control body movements
Chronic, progressive, debilitating neurologic disease of the basal ganglia and substantia nigra, affecting motor ability and characterized by tremor at rest, increases muscle rigidity. Slowness in the initiation and execution of movement and postural instability
Unknown cause
Dopamine uptake plays a major role
Treatment
Anticholinergic medications
Technologies to control symptoms
Signs and Symptoms
Rigid extremities
Masklike facial expressions
Drooling
Stooped posture and slow, shuffling gait
Tremors at rest, pill-rolling movement
Bronchitis
Chronic sputum with cough production daily for a minimum of 3 months in each of 2 consecutive years
chronic hypoxemia
Increase in mucus, cilia projection
Increase in bronchial wall thickness
Signs and symptoms
cyanosis, "blue bloater"
R heart failure
Distended JV
chronic, productive cough
wheezing, SOB
Interventions
maintain lowest FiO2 possible to prevent CO2 retention and decreased drive to breathe
watch for s/s of fluid overload
Urinary tract infection
Infection or inflammation at any site in the urinary tract
Most common infectious agent is E.coli
Signs and symptoms
fever and chills
urinary frequency, urgency and dysuria
Hematuria
Evaluated WBC
Disorientation and confusion
Treatment
Administer antibiotics specific to infectious agent
encourage fluids of 3000 mL per day
Encourage frequent voiding and proper perineal care
Hyperthyroidism
An excess secretion of thyroid hormone
signs and symptoms
enlarged thyroid
exophthalmos
increase appetite
tachycardia, palpitations, increased systolic BP
Heat intolerance
Treatment
thyroid ablation
radioactive iodine therapy
thyroidectomy
Observe for thyroid storm
Signs and symptoms
severe eye pain
headache
nausea/vomiting
rapid increase in tension and edema
need for early treatment to prevent blindness
beta blockers
laser eye surgery
Interventions
avoid situations or activities that increase IOP
avoid emotional stress
avoid abuse or overuse of eyes
Esophageal cancer
Types
signs and symptoms
causes
poor oral hygiene
irritation
squamous cell
adenocarcinoma
dysphagia
weight loss
excessive salivation
thirst
hiccups
treatment
surgical resection
radiation
chemotherapy
laser therapy
photodynamic therapy
changes of aging
thin skin that provides a less effective barrier
decreased ability to detect and regulate temperature
dry skin from decrease in endocrine secretions
loss of elastin
increase in vascular fragility
decrease in size of keratinocytes
hair loss, women increase facial hair
increased appearance of age spots and raised lesions such as seborrheic keratosis
nails become thick and brittle
skin cancer
basal cell carcinoma
squamous cell carcinoma
melanoma
most aggressive
black to brown irregular surface
less aggressive
appears like a papule and has a pearlescent look to it
more aggressive than basal cell but less then melanoma
Congestive heart failure
complication of arteriosclerotic heart disease
leading cause of hospitalization in older adults
Coronary artery disease responsible for most cases in the older adult
signs and symptoms
crackles on auscultation
SOB, dyspnea on exertion
cough
confusion, wandering at night
weight gain, ankle edema
classes of CHF
class 1: cardiac disease without physical limitation
Class 2: symptoms experienced with ordinary physical activity, slight limitations
Class 3: symptoms experienced with less than ordinary activities, physical activity significantly limited
Class 4: symptoms experienced with any activity and during rest
Interventions
monitor weight
avoid salt
plan activities spaced apart and include lots of rest
monitor pulse for tachycardia and dysrhythmias
Renal Calculi
Formed by a buildup of calcium and oxalate in the kidneys
Signs and symptoms
unbearable pain
blood in the urine
Diagnosis
ultrasound
treatment
lithotripsy or bursting the stones
internal procedure to remove the stones
Nursing interventions
push fluids
no caffeine
avoid urinary irritants
Immune system
Changes of aging
Depressed immune response
T-cell activity declines
Cell-mediated immunity declines
Risk for infection increases significantly
Inflammatory defense declines
Inflammation presents atypically
Fever not as prevent of a sign of infection
Musculoskeletal system
Changes of aging
thinning disks and shortened vertebrae
reduced muscle mass, strength and movement- physical exercise can help to gain or maintain
Decreased bone mineral and mass
Diminished calcium absorption
Critical for bone health
Associated with Vit. D levels
Increased risk for fractures
Osteoarthritis
Causes
Signs and symptoms
Treatment
Breakdown of cartilage
NSAIDs
Analgesics
Dietary calcium and vit. d
Exercise
Physical therapy
Pain in the joints, hands, hips, knees, lower back and/or neck
pain during colder months
Joint stiffness, crackling, swelling and/or tenderness
Systemic lupus erythematosus
Causes
Signs and symptoms
Treatment
Auto attacking of the bodies immune system
Pain in the muscles and joints
Anemia
Fatigue
Hair loss
Rash
Immunosuppressive drugs
Steriods
Keratinocytes become smaller and regeneration slows
Increased peripheral resistance
Dysrhythmias become more common
Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter
Stomach has higher pH as a result of decline in hydrochloric acid and pepsin
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
Slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet
Increase in the risk of constipation
Increased sensitivity to glare
A partial or complete white ring encircles the periphery of the cornea (arcus senilis)
Distortion in depth perception
Peripheral vision reduced
Tear production decreased
Sensorineural hearing loss (presbycusis)
Potential for adverse drug reactions
Higher blood urea nitrogen levels
Proteinuria is common in adults over 80
Increase in renal threshold for glucose
False-negative results for glucose in the urine without symptoms
Decrease in the filtration efficiency has grave implications for clients on medications, esp. penicillin, tetracycline, and digoxin
Changes of aging- bladder
Emptying the bladder may become difficult because of a weakening of the bladder and perineal muscles and decrease in sensation of urge to void
Increased frequency and dribbling may occur because of a weakened bladder and enlarged prostate
Increased dead space in the lungs
Decreased immune response
decrease in cilia
Decrease ability to clear mucus secretions
Decreased ability to cough and deep breathe
Intelligence remains constant in the healthy older adult
Number of dendrites declines
Plaques, tangles, atrophy of the brain
Free radicals accumulate
Reproductive system
Changes of aging on the female reproductive system
Hormonal changes
Vulva atrophies
Flattening of the labia
Loss of subcutaneous fat and hair
Vaginal epithelium thins
Cervix, uterus, and fallopian tubes atrophy
Vaginal canal chnages
Reduction in collagen and adipose tissue
Shortening and narrowing of the canal
Less lubrication
More alkaline vaginal pH as a result of lower estrogen
Uterus and ovaries decrease in size
Endometrium continues to respond to hormonal stimulation
Fallopian tubes become shorter and straighter
Breasts sag and become less firm
Some retraction of nipples related to shrinkage and fibrotic chnages
Changes of aging on the male reproductive system
Seminal vesicles develop thinner epithelium
Muscle tissue replaced with CT
Decreased capacity to retain fluids
Seminiferous tubule changes
Increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen
Atrophy of the testes and reduction in testicular mass
Ejaculation fluid contains less live sperm
Testosterone stays the same or decreases slightly
More time required to achieve an erection
Enlargement of the prostate gland
Atrophic Vaginitis
Caused by...
Increased vaginal fragility increases the risk of irritation leading to vaginitis
Occurs in postmenopausal women
Signs and symptoms
Treatment
These 4 changes in the vaginal canal leading to dryness, and wall layers/wall thickness lead to atrophic vaginitis
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Vaginal dryness
Vaginal burning
Vaginal discharge
Burning with urination
Topical vaginal estrogen
Oral estrogen
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Leads to stomach having a higher pH
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Diminished calcium leads to bone fractures and bone pain
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Decreased immune response due to respiratory issues/changes can lead to more immune system attacks
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Severe infections can lead to alterations in mental status and orientation