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The Older Adult - Coggle Diagram
The Older Adult
Integumentary System
Thin skin provides a less effective barrier
Pressure injury
Tissue anoxia and ischemia from pressure can cause necrosis, sloughing, and ulceration of the skin. Typically occurring on bony prominences like the sacrum and heels.
Also associated with poor nutritional status, decreased sensation of pressure and pain, and immobility
Decreased ability to detect and regulate temperature
Dry skin from decrease in endocrine secretion
Loss of elastin
Increase in vascular fragility
Respiratory System
Breathing mechanics
Lungs lose elastic recoil
Changes occur in upper airway paths, nose, trachea
Declining muscle strength, reduced cough reflex
Lung size and weight reduction
Oxygenation
Increased ventilation and perfusion are imbalanced
Chronic bronchitis
Chronic sputum and cough production resulting in chronic hypoxemia caused by smoking and other irritants
Cyanosis, right heart failure, jugular venous distention, persistent and productive cough, wheezing, recurrent respiratory infection, shortness of breath
Cardiac and peripheral effects seen with right sided heart failure. The heart is losing efficiency and has decreased oxygenation when trying to pump blood to the lungs.
Increased dead space in the lungs
Decreased alveolar surface area
Emphysema
Reduced gas exchange surface area on the alveoli caused by chronic irritation and morphologic changes in the lung (cigarette smoking)
Barrel chest, distant quiet breath sounds, wheezes
Ventilation control
Decreased reaction of peripheral and central chemoreceptors to hypoxia and hypercapnia
Cardiovascular System
Heart valves become more thick and rigid
Diastolic murmurs
Aorta becomes dilated
Slight ventricular hypertrophy
Thickening of left ventricular wall
Myocardial muscle is less efficient
Decreased contractile strength and 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
Increased peripheral resistance
Dysrhythmias more common
Brady cardia, tachycardia, atrial fibrillation, heart block
Syncope, falls, transient ischemic attacks
Syncope is also called orthostatic hypotension. It is a decline in systolic BP of 20 mmhg or more after changing positions
Causes are from vasoactive medications and decreased sensitivity to baroreceptor regulation of blood pressure
Complications can be serious: falls, stroke, other heart complications
Arteriosclerosis
Peripheral vascular disease
Edema
Edema can promote skin breakdown so it is important to reposition frequently and monitor the skin. Also fluid balance and vital signs should be monitored.
Coronary artery disease
Acute coronary insufficiency, myocardial infarction, dysrhythmias, heart failure
Arteriosclerosis/atherosclerosis causes coronary artery disease by reducing the blood flow which results in decreased oxygenation to the heart and its vessels. This causes angina and potentially myocardial infarction.
Angina presents atypically in the older adult. Vague discomfort, indigestion, coughing, syncope, sweating and confusion
MI also presents atypically with confusion, decreased blood pressure, shortness of breath, elevated temperature and ESR
Nervous System
Sensory Organs
Vision
Reduced elasticity and stiffening of the muscle fibers of the lens
Decreased ability to focus, presbyopia
Reduced pupil size
Opacification of the lens
Visual acuity declines
Cataracts
Clouding of the lens, leading cause of low vision in older adults
Seeing halos around lights, fading or yellowing of colors, frequent changes in prescriptions for glasses
Loss of photoreceptor cells in the retina
Light perception threshold decreases
Dark and light adaptation takes longer
Difficulty with vision at night
Importance of night lights for safety, reduce falls
Increased sensitivity to glare
Distortion of depth perception
Peripheral vision reduced
Tear production decreased
Hearing
Sensorineural hearing loss, presbycusis
High tones are diminished and the ability to discriminate tones is lost
Impacted cerumen
Taste
Number of functioning taste buds decreased
Tactile
Pressure and temperature not sensed as easily
Smell
Loss of cells in olfactory bulb of the brain causes decrease in smell
Thermoregulation
Normal body temperatures lowered
Older adults need to have an environmental temperature that is consistent and warm due to their decreased natural insulation
Ability to respond to cold temperatures is reduced
Response to heat is altered
Intelligence remains constant
Slowed central processing
Delayed time to perform tasks
Verbal skills maintained
Number and sensitivity receptors, dermatomes, and neurons decrease
Dulls tactile sensation
Decline in function of cranial nerves affects taste and smell
Loss of nerve cell mass
Atrophy of brain and spinal cord
Brain weight decreases
Neurocognitive Disorder (Dementia)
Cognitive impairments that are gradually progressive and irreversible. Affects judgement, memory, abstract thinking, social behavior. Symptoms include personality changes, confusion, disorientation, deterioration of intellectual function, decline of appropriate judgement and ADLs, difficulty performing tasks, changes in mood. Not to be confused with delirium.
Number of dendrites declines
Demyelination
Slower nerve conduction
Response and reaction times are slower
Reflexes become weaker
Plaques, tangles, atrophy of the brain
Free radicals accumulate
Decrease in cerebral blood flow
Cerebrovascular Accident (Stroke)
Can be ischemic or hemorrhagic. Signs depend on the area of the brain affected. Warning signs of stroke are facial drooping, imbalance in arm strength, and slurred speech.
Fatty deposits accumulate in blood vessels
Ability to compensate declines with age
Endocrine System
Thyroid gland atrophies
Diminished adrenal function
Adrenocorticotropic hormone secretion decreases
Volume of pituitary gland decreases
Insufficient release of insulin and reduced tissue sensitivity to circulating insulin
Type 2 Diabetes Mellitus
Less insulin or decreased sensitivity leads to higher blood glucose concentrations. DM is diagnosed with high out of range blood glucose tests
Managed through patient education, drug therapy, and lifestyle changes
Proper foot care, regular exercise, consistent daily intake of food, and recognition of complications are important
Older adult symptoms may include fatigue, increased hunger or thirst, weight loss, polyuria, blurred vision, infections
Other
Physical Appearance
Hair loss, graying, wrinkles
Loss of tissue elasticity
Elongated ears, baggy eyelids, double chin
Loss of subcutaneous fat
Diminished stature related to reduced hydration, loss of cartilage, and thinning vertebrae
Cells
Functional cell number decreases
Lean body mass decreases
Total body fat increases
Extracellular fluid remains constant, intracellular fluid reduced
Less total body fluid
Dehydration more common in older adult. Decreased thirst perception. Changes in water and sodium balance
Dry skin, decreased elasticity, sunken cheeks, concentrated urine, elevated BUN, confusion
Also decreases drug distribution, metabolism, and excretion. Reduced kidney efficiency and dehydration indicate the need for careful drug monitoring in the older adult.
Urinary System
Size and weight of the kidney decreases
Hypertrophy and thickening of bladder muscle
Decrease in bladder ability to expand which decreased capacity
Reduced storage capacity
Changes in cortical control of micturition, nocturia
Inefficient neurological control of bladder emptying and weaker bladder muscle
Risk for reflux of urine into ureters
Retention of urine
Can lead to urinary tract infections. Infection or inflammation at any site in the urinary tract
S/S: signs of infection (fever, chills), urinary frequency, urgency, dysuria, hematuria, pain at costovertebral angle, elevated WBC
A symptom of the older adult may be disorientation or confusion
Glomerular filtration rate decreases due to decreased renal blood flow and decreased numbers of functioning glomeruli
Affects ability to eliminate drugs
Slowed organ function, potential adverse drug reactions
Reduced tubular function
Higher BUN levels
Proteinuria is common
Concentration changes of urine
Renal calculi
Most commonly caused by dehydration in the older adult
Signs include sharp flank pain, hematuria, urgency, frequency, dysuria, urinary retention, and cloudy or foul smelling urine
Increase in renal threshold for glucose
Decrease in filtration efficiency affects medication effects greatly
Gastrointestinal System
Atrophy of the tongue affects taste buds and decreases taste sensation
Saliva production decreases
Difficulty swallowing
Dysphagia is difficulty swallowing
Can be caused by GERD (caused by increase in stomach pH), stroke, structural disorders
Nurses need to be aware to prevent aspiration and promote nutrition
Presbyesophagus results in weaker esophageal contractions and weakness of the sphincter
Esophageal and stomach motility decreases
Risk for aspiration and indigestion
Decreased elasticity of the stomach
Reduces the amount of food accommodation at one time
Stomach has higher pH as a result of decline in hydrochloric acid and pepsin
Increase in incidence of gastric irritation
Interferes with absorption of calcium, iron, folic acid, vitamin B12
Interferes with absorption of protein
Fewer cells on absorbing surface of intestinal wall impact he absorption of dextrose, xylose, vitamin B and D
Decreased enzyme production in the liver affects drug metabolism and detoxification processes
Slower peristalsis, inactivity, reduced food/fluid intake, drugs, low fiber diet
Constipation
Chronic constipation can lead to fecal impaction
Signs include liquid stool leaking from rectum, abdominal pain, bloating, nausea/vomiting, headache, weight loss, dehydration
This is a big cause in females for urinary retention
Can also cause bowel incontinence (involuntary defecation) and intestinal obstruction
Sensory perception decreases
Constipation or incomplete emptying of the bowel
Bile salt synthesis decreases
Affects digestion of fats
Musculoskeletal System
Thinning disks and shortened vertebrae
Reduced muscle mass, strength and movement
Decreased bone mineral and mass
Diminished calcium absorption
Osteoporosis
Any health problem that causes decreased levels of calcium can cause osteoporosis
Kyphosis and reduction in height, decreased bone density, spinal fractures, pathologic fractures
Increased risk of fractures
Immune Response
Decrease in cilia
Decreased ability to clear mucus secretions
Decreased ability to cough and deep breath
Caused by declining muscle strength in respiratory system. Greater change for infection.
Decreased immune reponse
T cell activity declines
Cell-mediated immunity declines
Significant risk for infection
Inflammatory defenses decline
Inflammation presents atypically
Health Promotion
Cardiovascular
Aim at prevention of disease and prevention of complications
Promote circulation
Stress management and adequate exercise is important for optimal health
Proper nutrition includes control of cholesterol to reduce atherosclerosis and other heart problems, taking supplements, low sodium diet, and lifestyle modifications
No cigarette smoking
Safety
Due to decreases in sensory perceptions, safety precautions are necessary for the older adult
Falls are a dangerous consequence
Older adults need a safe environment with proper lighting, temperature, floor coverings, furniture, noise control, and psychological factors
Sensory
Vision
Routine exams
Early detection and treatment
Many nutrients beneficial to vision: Zinc, Vitamins C, A, E
Hearing
Good ear care, irrigation of impacted cerumen
Prompt treatment of infections
Educate on the impact of environmental noise
Hearing aid care
Respiratory
Prevent infection
Influenza and pneumonia vaccines are important
Avoid exposure to irritants
Deep breathing exercises
Smoking cessation
Review medications, risk factors, and complications
Gastrointestinal
Good dental hygiene and regular visits
Proper nutrition
Knowledge about medication impact on GI health
Natural means of fiber, fluids, and timing to promote bowel elimination
Neurological
Know the risk factors and preventative measures
Nurses can detect changes in neurologic function
Functional assessment may show weakness, tremors, gait, history of falls, pain, range of motion, neuropathies, changes in vision, cognition, muscle weakness, depression, sleep patterns
Urinary
Adequate fluid intake
Maintenance of acidic urine
Avoid catheterization
Adequate activity levels
Frequent toileting
Interventions and education to enhance voiding and prevent retention. Proper nursing assessment
Reproductive
Annual gynecologic exam with pap smear
Breast self examination
Men with prostatic hypertrophy examined every 6 months
Testicular self examination
Reproductive System
Female
Retraction of nipples related to shrinkage and fibrotic changes
Fallopian tubes become shorter and straighter
Uterus and ovaries decrease in size
More alkaline vaginal pH as a result of lower estrogen changes
Shortening and narrowing of the canal
Cervix, uterus, fallopian tubes atrophy
Nabothian cysts from the sealing over of the endocervical glands
Secretions accumulate and a palpable tender mass may be evident.
Regular gynecologic exams are needed to check cervix patency
Loss of subcutaneous fat and hair
Vulva atrophies
Flattening of the labia
Vaginal epithelium thins
Reduction in collagen and adipose tissue
Less lubrication
Discomfort with intercourse
Endometrium continues to respond to hormonal stimulation
Breasts sag and are less firm
Muscle weakness associated with childbirth and advanced age
Perineal herniation
Cystocele, rectocele, prolapse of the uterus
Lower back pain, pelvic heaviness, pulling sensation as well as possible urinary and fecal incontinence, retention, constipation
Male
Enlargement of the prostate gland
Benign prostatic hyperplasia
Can cause urinary hesitancy, decreased force of urinary stream, nocturia
BPH is top cause in men for urinary retention
Testosterone stays the same or decreases slightly
Atrophy of the testes and reduction in testicular mass
Decreased capacity to retain fluids
Seminal vesicles develop thinner epithelium
Muscle tissue replaced with connective tissue
Seminiferous tubule changes
Ejaculation fluid contains less live sperm
More time required to achieve an erection
Erectile dysfunction
Inability to attain or maintain erection of penis for sexual intercourse. Can be caused by atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structural abnormalities, medications, and psychological factors.