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The Older Adult - Coggle Diagram
The Older Adult
Cardiovascular System
Normal changes in aging
Heart valves become more thick
Heart valves become more rigid
Aorta become dilated
Aorta becomes slightly dilated
slight ventricular hypertrophy
sickening of the ventricular wall
myocardial muscle less efficient
decreased contractile strength
prolonged cardiac cycle
unable to meet the demands of increased activity
calcification and reduced elasticity of vessels
less sensitive to baroreceptor regulation of blood pressure
Pathologies
Heart failure
Inability of the heart to pump enough blood to meet the tissue's O2 demands.
Left sides heart failure: causes pulmonary edema - results in pulmonary congestion due to the inability of the left ventricle to pump blood into the peripheral system
Right Sided Heart failure: causes peripheral edema due to the the inability of the right ventricle to pump blood out of the lungs which may occur because of left sided heart failure or pulmonary disease
Symptoms of this include dyspnea, crackles, cough, tachycardia, fatigue, anxiety, restlessness, confusion, peripheral edema, weight gain, distended neck veins, anorexia, weakness, hepatomegaly, ascites
This can be prevented through proper exercise, proper diet, quit smoking, etc
Typical treatment includes diuretics
Hypertension
Elevation of blood pressure at least at two occassions
Systolic is greater than 140
Diastolic is greater than 90
Symptoms: can be asymptomatic or have a dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremor
Blood pressure can increase with anxiety, stress, or activity before treatment, caffeine, etc. Make sure to ask about these factors in order to obtain an accurate blood pressure
There is a wide range of treatment: thiazide medications, diuretics, ACE inhibitors, ARBs, etc
Cross Link: Your cardiovascular system has a big impact on your respiratory system. For example, in heart failure you can not be having enough oxygen get to your lungs
Gastrointestinal System
Normal Changes in Aging
atrophy of the tongue affects taste buds and decreased taste senations
saliva production decreases
swallowing may be difficult
Weaker esophageal contractions and weakness in the sphincter
esophageal and stomach motility decreases leading to risk for aspiration and indigestion
decreased elasticity of the stomach which reduces the amount of food accommodation at one time
Decline in hydrochloric acid
increased incidence of gastric irritation
interferes with absorption of calcium, iron, folic acid, and vitamin B12
stomach has a higher pH and as a result of decline in hydrochloric acid and pepsin
Decline of pepsin which interferes with absorption of protein
fewer cells on absorbing surface of intestinal wall impact the absoprtion of dextrose, xylose, and vitamins B and D
Decrease enzyme production in the liver which affects drug metabolism and liver detoxification processes
Decline in peristalsis, inactivity, reduced food/fluid intake, drugs, and low fiber diet which increases the risk for constipation
sensory perception decreases which. may lead to constipation or imcomplete emptying of the bowel
Bile salt Synthesis
Increase risk of gallstone development
Affects digestion of fats
Pathologies
Hiatal Hernia
herniation of the esophogastric function and portion of the stomach is in the chest
causes: obesity, large volumes of food
Signs and symptoms include heart burn, belching, abdominal discomfort
Treament/ management includes small meals, avoid meals at bed time, bland diet, sleeping in partial recumbent position
Esophageal Cancer
cancer of the esophagus
incidence is greater with increased age and alcohol and smoking
There are two types of esophageal cancer: squamous cell or adenocarcinoma
causes can include poor oral hygiene or irritation
Signs and symptoms include dysphasia, weight loss, excessive salivation, thirst, hiccups, anemia
Cross link: Problems in your GI system can cause problems in your urinary system such as urinary and bowel incontinece and fecal impactions
Nervous System
Normal Changes in Aging
Intelligence remains constant in an older adult
slow in central processing which causes a delay in time required to perform tasks
verbal skills remain until age 70
number and sensitivity of sensory receptors, dermatomes, and neurons decrease
decline in the function of the cranial nerves affecting taste and smell
loss of nerve cell mass
atrophy of the brain and spinal cord
brain weight decreases
number of dendrites declines
demyelinations: slower nerve conduction, response and reaction times are slower, and reflexes become weaker
Plaques, tangles, atrophy in brain
free radicals accumulate
decrease in cerebral blood flow
fatty deposits accumulate in the blood vessels
ability to compensate declines with age
intellectual performance maintained until at least 80 years of age
Pathologies
Parkinson's Disease
chronic, progressive, debilitating neurological disease of the basal ganglia and substantial nirga affecting motor ability and characterized by tremors at rest and increased muscle regidity
Patients have problems with slowness of initiation and execution of movement and postural instabulity
It is influenced by the role of dopamine
typically treated through anticholinergic medications along with technologies to control symptoms
the goal is the maintain maximum levels of independence
Some symptoms include difficulty chewing, swallowing, and speaking, drooling, mask like face, stooped posture, slow, shuffling gait, tremors at rest, pill-rolling movement
Dementia
cognitive impairment characterized by gradual progressive onset
irreversible and affects judgement, memory, abstract thinking, and social behavior
Characterized by personality changes, confusion, disorientation, loss of memory, deterioration to intellectual functioning, decline of judgement and ADLs, difficulty performing familiar tasks, changes in mood or behavior
Patients can have a limited attention span and be distracted easily, confusion and disorientation, anxiety and depression, incontinence and constipation as well
Treatments include maintaining health, nutrition, hygiene, and rest, set routine in daily activities, use simple direct statements, reinforce reality, safe consistent environment, etc
cross link: changes in your neurological system can cause changes to your musculoskeletal system. Example, Parkinson's disease has changes to neuro system which causes changes to musculoskeletal system
Immune System
Normal Changes in Aging
Decline in immune system increases the bodies sensitivity to infection
decreased strength of the immune response
increased risk of exposure to pathogens with hospitalization and institutionalization
thymus gland declines in size
increased number of immature T cells
T cell function declines causing reduced response to foreign antigens and decrease in cell mediated and humoral immunity
decreased antibody response
reduced number of langerhan cells in the skin
reduced thickness of the skin
reduced circulation of the skin
Pathologies
Influenza
serious infection in older adults
Type subtypes: A and B
age related factors leading to high sensitivity
Signs and symptoms include headache, fever (usually high), nausea, vomiting, muscle aches, extreme fatigue, sore throat, running nose, cough
prevent with the yearly flu vaccine
Herpes Zoster (Shingles)
acute viral infection caused by reactivation of the latent varicella virus
Most common symptom is a rash on the skin
Prevention is to be vaccinated against shingles as an older adult
potential for posttherpetic neuralgia
Cross link: a suppressed immune system is more likely to cause infections such as urinary tract infections in the urinary system
Reproductive System
Normal Changes in Aging Women
Hormonal changes
vulve atrophies
flattening of the labia
loss of subcutaneous fat and hair
vaginal epithlium thins
cervix, uterus, and Fallopian tubes atrophy
vaginal canal changes
reduction in collagen and elastic tissue
shortening and narrowing of the canal
more alkaline vaginal pH as a result of lower estrogen changes
Uterus and ovaries decrease in size
endometrium continues to respond to hormonal stimulation
breasts sag and are less firm
some retraction of nipples related to shrinkage and fibrotic changes
Pathologies
Benign Prostatic Hyperplasia (BPH)
Basically just an enlarged prstate
Alll men will have this to some degree
symptoms progress slowly but continuously
decreased force of urinary stream
Nocturia is a major symptom of this disease process
Dyspareunia
genital pain with sexual intercourse
not a normal consequence of aging
more frequent in nulliparous women
many gynecological exams contribute to this
the goal of treatment for this disease process is to achieve satisfaction in their sexual lives
Normal Changes in Aging Men
seminal vesicles develop thinner epithlium
muscle tissue is replaced with connective tissue
decreased capacity to retain fluids
increased fibrosis
epithelium thinning
thickening of the basement membrane
narrowing of the lumen
atrophy of the testes and reduction in testicular mass
testosterone stays the same or decreases slightly
more time required to achieve an erection
enlargement of prostate gland
Endocrine System
Normal Changes in Aging
thyroid gland atrophies and activity decreases
diminished adrenal function
ACTH hormone secretion decreases.
Volume of pituitary gland decreases
insufficient release of insulin and reduced tissue sensitivity to circulating insulin
Pathologies
Diabetes Mellitus type 2
Seventh leading cause of death in older adults
glucose intolerance even with the presence of insulin
Management is through patient education: diet, exercise, overview of the disease process, medications
Treatment: first line is typically metformin
random blood glucose is >200 and a fasting blood glucose of 126
classic non specific sympotoms may be absent
Hypothyroidism
hypo functioning of the thyroid gland
subnormal concentration of the thyroid hormone
low T3 and T4 and presence of T4 antibody
Symptoms include fatigue, weakness, lethargy, anorexia, weight gain or puffy face, impaired hearing, periorbital or peripheral edema, myalgia, ataxia, dry skin, dry hair, husky voice, slow speech
Treatment is typically to replace thyroid hormone with a medication, typically thyroxine
cross link - endocrine dysfunctions can impair integumentary system thermoregulation
References
PowerPoints from in class
The textbook from class
my own learning material such as class work and notes
Respiratory System
Normal Changes in Aging
Lungs lose elasticity to recoil
declining muscle strength and reduced cough reflex
lung size and weight reduction
changes occur in upper airway pathos, nose, and trachea
decreased alveolar surface area
increased dead space in the lungs
decreased reaction to peripheral and central chemoreceptors to hypoxia and hypercapnia
decrease in cilia
decreased ability to clear mucous secretions
decreased ability to cough and deep breathe
decreased immune response
Pathologies
Pneumonia
Inflammation of the lower respiratory tract
caused by aspiration, inhalation, or hematogenous spread
can be bacteria, viral, fungal or chemical
can be community acquired or medical care associated
High risk people include smokers, immobility, hospitalized client, NG tube, experiencing a neuromuscular disorder, immunosuppressed, etc
Symptoms include tachypnea, rapid bounding pulse, abrupt fever with shaking or chills, elevated WBC, decreased O2 saturation, crackles, tactile fremitus, productive cough
assess sputum, deep breath every 2 hours, incentive spirometry, use humidity to loosen secretion, anti infective agents as prescribed
Emphysema
increasing incidence in older adults
causes can include chronic bronchitis and chronic irriation
smoking plays a major role in development
symptoms can develop slowly and delay treatment
treatment includes bronchodilatiors, breathing exercises, and avoiding stress
Reduced gas exchange surface air
increased air trapping
increased work and increased O2 consumption
symptoms include barrel chest, dyspneic, prolonged expriration, hunched-over position, breathes through pursed lips
Urinary System
Normal Changes in Aging
size and weight of the kidney decreases
hypertrophy and thickening of the bladder muscle
decrease in the bladder's ability to expand
reduced storage capacity
emptying of the bladder may become more difficult
increased urinary frequency
nocturia
changes in cortical control of mictrition
inefficient neurological control of bladder emptying and weaker bladder muscle
increased reflux of urine to the ureters
glomerular filtration rate decreases due to decreased renal blood flow and decreased numbers of functioning glomeruli
reduced tubular functions resulting in higher BUN levels and proteinuria is common in adults over 80
increased renal threshold for glucose
Pathologies
Urinary Tract Infections
infection or inflammation at any site of the urinary tract
most commonly E coli
high risk individuals include those with diabetes, pregnancy, prostatic hypertrophy, immunosuppressed persons, catheterized clients, urinary rentention etc.
Signs and symptoms include fever, chills, urinary frequency, urgency, or dysuria, hematuria, pain at costovertebral angle, disorientation or confusion in older adults may be a sign of a UTI
increase fluid intake, I/Os, administer antibiotics as prescribed, good perineal hygiene, encourage voiding every two hours
Glomerulonephritis
Early signs and symptoms include blood or protein in the urine, high blood pressure, swelling in the ankles or feet
diagnosis is had by labs and biopsy
You want the patient to be on a low sodium and low protein diet
late stage signs and symptoms would be kidney failure include lack of appetite, nausea, vomiting, tiredness, difficulty sleeping, dry and itching skin, night time muscle cramps
Musculoskeletal System
Normal Changes in Aging
Thinning of disks and shortened vertebrae
Reduced muscle mass strength and movement
Decreased bone mineral and mass
Diminished calcium absorption
Increased risk of fractures
Ability to respond to thermoregulation is reduced
reduced flexibility of joints and muscles
reduced body strength
decline in the number and size of muscle fibers
Pathologies
osteoporosis
disease that causes brittle bones
prevention is in diet and exercise
more common in women
calcium supplements
increased risk for trauma and other fractures
fall prevention is a massive priority
mobility is also a big priority
Gout
Excess uric acid in the blood
uric acid crystals deposit around joints
dietary supplements and pain management play a vital role
Treatment is in a specific diet
Signs and symptoms can include warmth, redness, swelling, and severe pain
acute attacks with remission is common
Integumentary System
Normal Changes in aging
The barrier that the skin provides is less effective
decrease in thermoregulation
decreased endocrine secretions leading to dry skin
loss of elastin and elasticity
Facial hair can occur more and less especially in women
heightened risk for pressure ulcers, tears, bruises, skin infections, and other types of trauma
Reduction of mellanocytes
Wrinkles are common
increase in coarseness of collagen
increase in vascular fragility
graying hair
increased appearance of aging spots and other types of lesions
nail beds can become brittle and thick
elongated ears
baggy eye lids
double chin
Pathologies
Pruritis
itching of the skin
one of the most common problems, especially among older adults
can be a symptom of a problem (such as a skin infection) or can be the problem in and of itself
Causes can include diabetes, bathing, cancer etc
can lead to scars due to breakage of the skin from scratching
Treatment for this is to correct the underlying issue
medications could include antihistamines and topical applications as well as again treating the underlying problem
Seborrheic Keratosis
dark, wart like projections on top of the skin
can be large or small but typically no larger than quarter size
increases in number with age
if there are abnormal edges or growth make sure to go get a clinical evaluation