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Changes in Aging, Connection between UTI and alkaline vaginal ph,…

- - - - Patho: Death of dopaminergic neurons as a result of changes in biological activity in the brain
      - Symptoms: tremor at rest, increased muscle (rigidity). Slowness in the initiation and execution of movement, (bradykinesia), and postural instability (difficulty with gait and balance), pill rolling tremors, mask face, stooped posture, drooling, shuffling gait
      - Treatment: no cure. Anticholinergics may control symptoms.
      - Medication of choice: Sinemet
  - - - Patho: Accumulation of neurofibrillary tangles and plaques in brain
      - Symptoms: memory loss, forgetfulness, loss of activities of daily living, incontinence, confusion
      - Treatment: OT, PT, ST, preservation of independence, comfort.
    - - Supportive care: Structured environment, remove safety hazards, used items to trigger memory, CAM therapy, Qigong, Close observation of individual during eating, bathing, skin care, promoting activity
      - Delirium: Possible symptom of Dementia
        
        Causes: Dementia, infection, hypoxia, dehydration, medication changes, pain
        
        Symptoms: Rapid, altered level of consciousness and onset of confusion
        
        Is emergency! Can be life threatening
- - - - Decreased esophageal motility
    - - Patho: Irritation of stomach lining/esophagus due to reflux of stomach contents
      - Symptoms: Heart burn, epigastric pain, nausea, vomiting
    - - Difficulty swallowing which may cause aspiration of food/fluid into lungs
  - - - Patho: Inflammation/irritation of stomach lining that may lead to ulceration
      - Symptoms: Epigastric pain, nausea, vomiting, bleeding
    - - Calcium, iron, folic acid, B12, B, D
    - - Muscle atrophy
  - - - Treatment: Offer prune juice/warm cup of water. Promote safe use of laxatives and develop bowel regimen. Increase fiber and fluid intake.
      - Fecal Impaction
      - Intestinal obstruction
  - - - Risk factors: Smoking, aging, alcohol consumption, poor hygiene, GERD, indigestion
      - Symptoms: weight loss, dysphagia, excessive salivation, thirst, hiccups, anemia
    - - Risk factors: Diet high in red meat, alcoholism, smoking, aging, untreated H. pyloris
      - Symptoms: Anorexia, epigastric pain, weight loss,
        indigestion, anemia
    - - Risk factors: Diet high in red meat, diverticulitis, aging, smoking, alcoholism, polyps
      - Symptoms: Change in bowel habits, sense of incomplete evacuation, abdominal pain, nausea, vomiting, weight loss, cachexia, abdominal distention
- - - - Pressure injury
        
        Patho: Stage 1 (Intact nonbanchable erythema) Stage 2 (partial thickness wound with exposed epidermis) Stage 3 (Full thickness loss of skin into the dermis) Stage 4 (Full thickness loss of skin, epidermis, and dermis into muscle and bone).
        
        Symptoms: infection, bleeding, pain
        
        Treatment: Wound care, prevent friction and shearing, proper cleansing of perineum, Q2 turning
        
        Risk factors: Bed rest, paralysis, dementia, incontinence
- - - - Hypothyroidism
        
        Patho: Low T3 and T4 hormones, more common in older woman
        
        Symptoms: Fatigue, weight gain, puffy face, edema, dry skin, dry hair, slow speech, cold intolerance, constipation
        
        Bowel elimination plan: Consume at least 3L of fluid a day, high fiber diet, increase activity
        
        Treatment: Synthroid, thyroxine
      - Hyperthyroidism
        
        Patho: Enlargement of thyroid and overproduction of T3/T4
        
        Symptoms: Weight loss, hunger, goiter, exophthalmos, diarrhea, nervousness, insomnia, heat intolerance
        
        Diet: High calorie, high protein, low fiber, how caffeine
        
        Treatment: thyroid ablation/radioactive iodine treatment
        
        Complication: thyroid storm
  - - - ACTH secretion decreases
        
        Symptoms: weight loss, anorexia, muscle weakness, hypotension
  - - - Type 2 Diabetes
        
        Patho: Insufficient release of insulin due to decreased tissue sensitivity causing hyperglycemia
        
        Symptoms: Random blood glucose concentration above 200 mg/dL, Fasting glucose above 126 mg/dL, hunger, thirst, and frequent urination
        
        1st line treatment: Oral metformin
        
        Risk factors: Obesity, lack of exercise, improper diet/nutrition, genetics
        
        Complications: Retinopathy, CAD, PAD, UTI, neuropathy's, confusion
- - - - Aortic dilation
        
        Symptoms: arrhythmias, dyspnea, palpitations
  - - - Congestive Heart Failure
        
        Right Sided HF
        
        Patho: Inability of right ventricle to pump blood to lungs
        
        Symptoms: peripheral edema, weight gain, JVD, anorexia, weakness, hepatomegaly, ascites
        
        Left Sided HF
        
        Patho: Inability of left ventricle to pump blood to body
        
        Symptoms: dyspnea, crackles, pulmonary edema, tachycardia, restlessness, confusion
  - - - Peripheral artery disease
        
        Arteriosclerosis
        
        Patho: Thickening and hardening of vessel walls that occurs with aging, blocking blood flow to extremities and organs
        
        Symptoms: Numbness, hypertension, weakness, angina
        
        Varicose veins
        
        Patho: Enlargement and twisting of veins causing backflow of the valves, increasing incidence of blood pooling in lower extremities
        
        Symptoms: Swollen prominent veins, leg pain, burning, edema, aching
      - Coronary artery disease
        
        Symptoms: Angina (chest pain), shortness of breath, heart attack
        
        Patho: Vessels that supply blood to heart become narrowed
      - Hypertension
        
        Criteria: Systolic > 140, diastolic > 90
        
        Patho: Change in aging causing calfication and increased peripheral resistance in vessels
        
        Symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor
- - - - Decreased immune function causes frequently reoccurring infections, and increased death associated with sickness
        
        Reactivation of Mycobacterium tuberculosis
        
        Symptoms: cough, bloody sputum, fever, chills, night sweats, hypoxia, weight loss, fatigue
        
        Patho: Bacterial infection of upper lobes of lungs
        
        Treatment: Antibiotics, respiratory therapy, fluids
        
        Pneumonia
        
        Urinary tract infections
        
        Patho: Bacteria (E.Coli) of urinary tract caused by increase susceptibility to infection, poor hygiene
        
        Symptoms: confusion in the older adult, dehydration, delirium, pain, fever
        
        Treatment: Full course of antibiotics, fluids
        
        Influenza
  - - - Pneumococcal vaccine recommended for adults aged 65 and up
      - Receive flu shot annually
      - Tdap every 10 years
      - 2 doses of varicella
      - 2 doses of zoster recombinant
- - - - Symptoms: Breast enlargement, erectile dysfunction, fatigue, osteoporosis
  - - - Symptoms: Loss of menses, osteoporosis, night sweats, hot flashes, vaginal dryness
    - - Dyspareunia: Pain with sexual intercourse due to decrease vaginal lubrication and shrinkage
- - - - Ineffective medication clearance and increase risk for toxicity
      - Proteinuria
        
        Protein in urine
      - High BUN
        
        Infective kidney clearance
      - Renal Calculi
        
        Patho: Build up of crystal forming substances in urine causing kidney stone formation
        
        Symptoms: Severe sharp pain, hematuria, fever, difficulty voiding
        
        Treatments: Encourage 3 L fluid intake a day, analgesics, laser therapy, surgical removal, supportive treatment while patient voids stone naturally
    - - Glycosuria
  - - - Difficulty emptying bladder completely
    - - Urinary frequency
      - Nocturia
        
        Symptoms: Increase urinary frequency during night time
        
        Treatment: Avoid liquids close to bedtime, voiding schedule
    - - Glomerunephritis
        
        Patho: Inflammation of glomeruli in kidneys
        
        Symptoms: hematuria, proteinuria, high blood pressure, ankle swelling, nighttime muscle cramping, confusion
        
        Treatment: Diuretics, ACE inhibitors, low sodium low protein diet
    - - Urinary retention in men
        
        Patho: Hypertrophy of prostate due to aging
        
        Symptoms: Difficulty starting stream of urine, straining, weak stream, urinary retention
        
        Treatment: Alpha blockers, surgical resection or removal of prostate, laser therapy, embolization of vein supply blood to prostate
- - - - Muscle cramping
    - - Patho: degeneration of extrapyramidal system
    - - Symptoms: Decrease in tendon jerks and reflexes
  - - - Brittle bones
        
        Osteoporosis
        
        Patho: Continual resorption and re-deposition of bone mineral causing bone to become more porous and brittle
        
        Symptoms: Fractures, bone pain, stooped posture, slow healing fractures
        
        Treatment: Estrogen replacement if menopause, calcium and vitamin D supplements, weight bearing exercises, dietary changes
        
        Greater risk for bone fractures
    - - Kyphosis
        
        Patho: Outward rounding or curvature of the spine measuring 50 degrees or more via x ray
        
        Treatment: Spinal brace, bisphosphates, supplements, analgesics, spinal fusion, PT, change in diet and proper nutrition
        
        Symptoms: Pain, rounded spinal appearance, decrease in height, difficulty breathing
      - Decrease in height
    - - Arthritis
        
        Patho: Cartilage degeneration and erosion causing progressive joint pain and stiffness
        
        Symptoms: Joint pain, swelling, stiffness, redness, decreased range of motion
        
        Treatment: Analgesics, corticosteroids, supplements, preservation of range of motion and activities of daily living
    - - Symptoms: pain, stiffness, difficulty completing range of motion exercises
      - Treatment: Surgical removal, analgesics
- - - - Emphysema
        
        Patho: Reduced gas exchange, increased air trapping, decreased capillary network
        
        Symptoms: barrel chest, wheezing, quiet breath sounds, weight loss
        
        Treatment: Polarize drainage, bronchodilator, avoid stress, pursed lip breathing
      - Chronic bronchitis
        
        Patho: Chronic productive cough due to increase in bronchial wall thickness causing hypoxia
        
        Symptoms: Chronic productive cough, edema, clubbing
        
        Treatment: fluids, cessation of smoking, bronchodilator
    - - Treatment: antibiotics, fluids
      - Patho: Inflammation of lower respiratory tract by bacteria
      - Symptoms: Tachypnea, rabid bounding pulse, fever, productive cough, confusion, anorexia, lethargy, elevated WBCs
      - Diagnostic: Infiltrates with consolidation on X ray, elevated WBC, decreases O2 sat
      - Prevention: flu vaccine, pneumococcal vaccine, avoid infection
    - - Patho: Tumors arising in the lungs may be caused by smoking
      - Symptoms: dyspnea, coughing, chest pain, fatigue, anorexia,
        wheezing, and respiratory infections
      - Treatment: surgery, chemotherapy, and radiotherapy
      - Risk: Smoking, 65+