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The Older Adult - Coggle Diagram

- - - - More time spent in stages I and II, and less time spent in stages III and IV
  - - - Neural plaques containing beta-amyloid protein, neurofibrillary tangles in the cortex, & loss/degeneration of neurons and synapses
        
        Most common form of dementia; irreversible
    - - Rapid, altered level of consciousness caused by hypoxia, dehydration, hypernatremia, hyponatremia, infection (respiratory, urinary tract, cellulitis), pain, cognitive impairment, and new medications
        
        Reversible with prompt action
    - - Irreversible, progressive memory loss due to damage or injury to the brain; high levels of aluminum and mercury
        
        Difficulty with reasoning, orientation, problem solving, attention, and language
    - - Reduction in cerebral perfusion
        
        Recovery usually occurs within 1 day
    - - Ischmeic Type
        
        Inadequate blood supply
      - Hemorrhagic Type
        
        Internal bleeding
      - Deficits in brain functioning depending on the area that is affected
        
        Drop attack
      - FAST acronym for what to do: Facial drooping, arm weakness, speech, and time
    - - Affects CNS; low amounts of dopamine; high mounts of acetylcholine; affects basal ganglia and substantia nigra
        
        Tremor AT REST, hypertonicity, postural instability, bradykinesia (slow movements), masklike facial expressions, constipation, drooling, shuffling gait, "pill-rolling" movement
    - - False memory created by the client that is accepted as truth to fill in gaps when real experience cannot be recalled
- - - - Caused by irritation to the esophagus and poor oral hygiene
        
        Weight loos, excessive salivation, thirst, hiccups, dysphagia, and anemia
    - - Caused by low antioxidant consumption and high amount of red meat consumption
        
        Indigestion, epigastric pain, anemia, weight loss, and anorexia
    - - Caused by large volumes of food and obesity
        
        Increased heartburn, abdominal discomfort, and belching
    - - Abdominal pain, nausea, vomiting, change in bowel habits, sense of incomplete evacuation, abdominal distention, weight loss, cachexia, family hx, hx of polyps
        
        About 10 years before death from the point polyps occur
    - - Caused by structural disorders, GERD, and stroke
        
        Increased risk for aspiration
    - - Caused by obesity, chronic constipation, and atrophy of the intestinal wall muscles
        
        Left Lower Quadrant pain, rectal bleeding, and increased flatus
    - - Inability to voluntarily control the passage of stool due to dementia or musculoskeletal conditions
        
        Often associated with fecal impaction (look for this first)
    - - Cholelithiasis (gallstones)
      - Gallbladder cancer
    - - Atypical presentation
    - - Due to tumor, intersession, and stool impaction
        
        Large intestine affected by cancer
        
        Small intestine affected by hernias and adhesions
- - - - Chronic Bronchitis: chronic sputum with cough production daily for a minimum of 3 months in each of 2 consecutive eyars
        
        Increase in mucus, cilia projection, bronchial wall thickness
        
        Chronic hypoxemia, fluid overload, excessive secretions with treatment, persistent and productive cough, wheezing, recurrent respiratory infections, SOB
      - Emphysema: reduced gas exchange surface area
        
        Increased work with increased 02 consumption and increased air trapping
        
        Barrel chest, distant quiet breath sounds, wheezes, pulmonary blebs on x ray
      - Asthma: intermittent disease with reversible airflow obstruction and wheezing due to a variety of stimulants
    - - Tachypnea, rapid bounding pulse, productive cough, bronchial breath sounds, crackles, tactile fremitus, elevated WBC, decreased O2 saturation
      - Abnormally presented in older adults: confusion, lethargy, anorexia, rapid respiratory rate, and tachycardia
    - - Caused by pneumonia, tuberculosis, malignancy, trauma, and aspiration
      - Anorexia, weight, loss, elevated temperature, and chronic cough
      - Diagnosis is same as other age groups
    - - Higher incidence in men than in women
      - Dyspnea, coughing, wheezing, respiratory infections, chest pain, fatigue, and anorexia
- - - - Often caused by long-term cigarette smoking or other irritants
        
        Blood in urine, urgency, frequency, and dysuria
    - - Involuntary loss of urine
      - Functional
        
        Caused by dementia, medications that impair cognition, or inaccessibility to the bathroom
        
        Interfering with ability to reach the bathroom
      - Overflow
        
        Bladder muscles lack flexibility; bladder muscles fair to contract; periurethral muscles do not relax
        
        Bladder neck obstructions, medications (calcium channel blockers, anticholinergics, and adrenergics)
      - Stress
        
        Weak supporting pelvic muscles giving way when intra-abdominal pressure is placed on the pelvic floor
      - Urgency
        
        Spasms of or irritation to the bladder wall causing sudden urine elimination
        
        Diverticulitis, enlarged prostate, pelvic tumor, bladder tumor, and UTI
      - Neurogenic (Reflex)
        
        Disturbances along the neural pathway, such as multiple sclerosis and cerebral cortex lesions
    - - Often caused by fecal incontinence
        
        Urinary frequency, urgency, or dysuria; infection signs such as fever, chills, and elevated serum WBCs (>10,000)
    - - Damage to the glomeruli of the kidneys, causing impairment to the filtering abilities of the kidneys
        
        Blood or protein in the urine, high blood pressure, and edema of the face or ankles
    - - Substances high in calcium, oxalate, and uric acid
- - - - Deterioration and abrasion of joint cartilage, leading to remodeling of the joint
    - - Autoimmune activation of T-cells due to antigens mistaking antibodies as foreign substances
        
        Inflammation around synovial joints
    - - Osteoclastic bone resorption without compensation from osteoblastic activity
        
        Weak and fragile bones
        
        Risk Factors
        
        Northwestern European or British Isle descent
        
        Cigarette smoking
        
        Men >80 y.o.
        
        High alcohol consumption
        
        Women >65 y.o.
        
        Excessive use of corticosteroids, thyroid hormone, and/or anticonvulsants
        
        Multiple pregnancies
        
        Family history of osteoporosis
        
        Early menopause
    - - Uric acid accumulation in the blood, leading to crystal deposition in and around the joints
        
        Warmth, redness, and swelling
    - - Compression of the vertebrae increases pressure on the bones, causing fractures; cancer metastasis travels to the bone
        
        A break in the bone
        
        Impacted
        
        Greenstick
        
        Fissure
        
        Avulsion
        
        Comminuated
        
        Spiral
        
        Oblique
        
        Transverse
- - - - Superficial, pigmented epithelial lesions
        
        Head, neck chest, or back
    - - Due to prolonged exposure of skin to same surface without repositioning; common over bony prominences
        
        Stage 3: full thickness
        
        Stage 1: non-blanchable redness, warmth
        
        Stage 4: full thickness; bone exposed
        
        Stage 2: partial thickness
    - - Squamous Cell Carcinoma
        
        UV rays from sunlight exposure damaging DNA of skin cells
        
        Rough, thick, and scaly patches or light red or skin-colored nodule with a rough surface
      - Melanoma
        
        Melanocytes grow continuously due to sun exposure
        
        C: color variation
        
        D: diameter >6 mm
        
        B: border irregularity
        
        A: asymmetry
        
        E: evolution
      - Basal Cell Carcinoma
        
        UV rays from sunlight exposure damaging DNA of skin cells, impairing the ability to divide and grow normally
        
        Red patches, pink growths, shiny bumps, open sores, and scars or growths with elevated and rolled edges
    - - Loss of skeletal muscle mass and strength
- - - - High TSH, low T4
        
        Cold intolerance, weight gain, muscle weakness & cramps, constipation, tiredness, depression, and constipation
    - - Low TSH, high T4
        
        Heat intolerance, exophthalmos, hyperactivity, nervousness, anxiety
    - - Insulin dependence (DM1) or insulin resistance (DM2)
        
        Diagnostic: Random blood glucose >200 mg/dL, Fasting blood glucose >126 mg/dL, & Blood glucose 2 hr after oral glucose intake >200 mg/dL
        
        Classic nonspecific symptoms may be absent
        
        Coronary artery disease (CAD)
        
        Urinary tract infections
        
        Retinopathy leading to blindness
        
        Cerebral arteriosclerosis
        
        Neuropathies
        
        Cognitive impairment
        
        Monitor: Hemoglobin (Hgb or Hb) A1c test, Triglyceride (ideal is below 150 mg/dL)
- - - - Mutation of B lymphocytes, allowing proliferation of Reed-Sternberg cells
        
        Swollen lymph nodes, fever, persistent fatigue, unexplained weight loss, night sweats, and pruritis
    - - Mutation of B lymphocytes, T cells, and/or NK cells
        
        Swollen lymph nodes, fatigue, unexplained weight loss, chills, chest pain, shortness of breath, and swollen abdomen
- - - - Sealing over of endocervical glands
        
        Evident when secretions accumulate and a palpable, tender mass is formed
    - - Displayed by postmenopausal bleeding
    - - Increased vaginal fragility increases risk of irritation, leading to vaginitis
        
        Occurs postmenopause
    - - Increased incidence with aging; BRCA 1 and BRCA 2 genes
        
        Frequent urination
        
        Constipation
    - - Painful intercourse
    - - Rectocele
      - Prolapsed uterus
      - Cystocele
    - - BRCA 1 and BRCA 2 genes
        
        Presented through painless irregularly shaped and hard masses in the breast tissue and armpit area
    - - Unable to attain or maintain erection of penis for sexual intercourse
        
        Caused by hypertension, diabetes, alcoholism, renal failure, atherosclerosis, structure abnormalities, psychological factors, and medications
    - - Annual digital examinations done for early identification
    - - Inguinal hernia
        
        Intestines or fat from abdomen making an opening into the inguinal/groin region
      - Hydrocele
        
        Accumulation of serous fluid around the testicle
      - Varicocele
        
        Enlargement of veins within the scrotum