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Older Adult, These 4 changes in the vaginal canal leading to dryness, and…

- - - - enlarged thyroid
      - exophthalmos
      - increase appetite
      - tachycardia, palpitations, increased systolic BP
      - Heat intolerance
    - - thyroid ablation
      - radioactive iodine therapy
      - thyroidectomy
- - - - Decreases bladder ability to expand
      - reduces stroage capacity
        
        daytime urinary frequency
        
        Nocturia
    - - nocturia
    - - Retention of large volumes
    - - Affects the abilty to eliminate drugs
      - Slowed organ function
        
        Potential for adverse drug reactions
    - - Higher blood urea nitrogen levels
      - Proteinuria is common in adults over 80
    - - Weakening of the bladder and perineal muscles and decrease in sensation of urge to void
    - - 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
  - - - fever and chills
      - urinary frequency, urgency and dysuria
      - Hematuria
      - Evaluated WBC
      - Disorientation and confusion
        
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    - - Administer antibiotics specific to infectious agent
      - encourage fluids of 3000 mL per day
      - Encourage frequent voiding and proper perineal care
  - - - unbearable pain
      - blood in the urine
    - - ultrasound
    - - lithotripsy or bursting the stones
      - internal procedure to remove the stones
    - - push fluids
      - no caffeine
      - avoid urinary irritants
- - - - Vulva atrophies
      - Flattening of the labia
      - Loss of subcutaneous fat and hair
    - - Reduction in collagen and adipose tissue
      - Shortening and narrowing of the canal
      - Less lubrication
      - More alkaline vaginal pH as a result of lower estrogen
  - - - Increased vaginal fragility increases the risk of irritation leading to vaginitis
        
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    - - Vaginal dryness
      - Vaginal burning
      - Vaginal discharge
      - Burning with urination
    - - Topical vaginal estrogen
      - Oral estrogen
- - - - 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
  - - - crackles on auscultation
      - SOB, dyspnea on exertion
      - cough
      - confusion, wandering at night
      - weight gain, ankle edema
    - - 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
    - - monitor weight
      - avoid salt
      - plan activities spaced apart and include lots of rest
      - monitor pulse for tachycardia and dysrhythmias
- - - - Changes occur in upper airway paths, nose and trachea
      - Declining muscle strength causing decreased cough reflex
      - Lung size and weight reduction
      - Lungs lose elastic recoil
    - - increased ventilation and perfusion are imbalanced
      - decreased alveolar surface area
      - Increased dead space in the lungs
    - - decreased reaction of peripheral and central chemoreceptors to hypoxia and hypercapnia
    - - decrease in cilia
      - Decrease ability to clear mucus secretions
      - Decreased ability to cough and deep breathe
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        Decreased immune response due to respiratory issues/changes can lead to more immune system attacks
  - - - cyanosis, "blue bloater"
      - R heart failure
      - Distended JV
      - chronic, productive cough
      - wheezing, SOB
    - - maintain lowest FiO2 possible to prevent CO2 retention and decreased drive to breathe
      - watch for s/s of fluid overload
- - - - Higher risk for aspiration and indigestion
    - - increased need for an older adult to eat smaller meals
    - - increase in incidence of gastric irritation
      - Interferes with absorption of calcium, iron, folic acid and B12
    - - Interferes with absorption of protein
      - Leads to stomach having a higher pH
        
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    - - Increase in the risk of constipation
  - - - squamous cell
      - adenocarcinoma
    - - dysphagia
      - weight loss
      - excessive salivation
      - thirst
      - hiccups
    - - poor oral hygiene
      - irritation
    - - surgical resection
      - radiation
      - chemotherapy
      - laser therapy
      - photodynamic therapy
- - - - Impacted cerumen
      - High pitches are diminished and the ability to discriminate tones is lost
      - Sensorineural hearing loss (presbycusis)
    - - 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
      - 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
  - - - Damage to the optic nerve from an above normal intraocular pressure
      - Second leading cause of blindness in older adults
      - 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
- - - - Delay in time required to perform tasks
    - - Dull in tactile sensation
    - - atrophy of the brain and spinal cord
      - brain weight decreases
    - - slower nerve conduction
      - response and reaction times are slower
      - reflexes become weaker
  - - - Anticholinergic medications
      - Technologies to control symptoms
    - - Rigid extremities
      - Masklike facial expressions
      - Drooling
      - Stooped posture and slow, shuffling gait
      - Tremors at rest, pill-rolling movement
- - - - less aggressive
      - appears like a papule and has a pearlescent look to it
    - - more aggressive than basal cell but less then melanoma
    - - most aggressive
      - black to brown irregular surface
- - - - 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
  - - - Auto attacking of the bodies immune system
    - - Pain in the muscles and joints
      - Anemia
      - Fatigue
      - Hair loss
      - Rash
    - - Immunosuppressive drugs
      - Steriods
- - - - Critical for bone health
      - Associated with Vit. D levels
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  - - - Breakdown of cartilage
    - - Pain in the joints, hands, hips, knees, lower back and/or neck
      - pain during colder months
      - Joint stiffness, crackling, swelling and/or tenderness
    - - NSAIDs
      - Analgesics
      - Dietary calcium and vit. d
      - Exercise
      - Physical therapy