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Older Adult By: Olivia Ferris - Coggle Diagram
Older Adult By: Olivia Ferris
Cardiovascular System
Common changes of aging:
Heart dimensions are unchanged
Heart muscle loses efficiency and contractile strength + reduced cardiac output with physiologic stress
Valves become thick and rigid
Blood vessels reduce elasticity
Oxygen used less efficiently
Congestive Heart Failure
Coronary artery disease responsible for most cases in the older adult, followed by HTN.
Living with CHF-
Monitor Weight
Avoid salt
Light activity
Plan activities to be spaced apart
Monitor pulse for tachycardia (fast heart rate) & dysrhythmia (irregular)
Assess for mental status changes
Frequent repositioning
Check for skin breakdown
Heart muscle has reduced contractility, which reduces cardiac output.
Muscle contractility decreases, preload increases, afterload increases, heart rate increases.
Left-sided HF- Fluid backs up in the lungs and causes SOB.
Right-sided HF- Fluid backs up in the legs/feet and abdomen causing edema.
Incidence increases with age. Leading cause of hospitalization.
CHF is a complication of arteriosclerotic heart disease, followed by hypertension, diabetes, dyslipidemia, cardiomyopathy, sleep apnea, chronic kidney disease, illicit drugs, sedentary lifestyle, and psychological stress.
Symptoms: crackles on auscultation, shortness of breath, dyspnea on exertion, cough, fatigue, restlessness, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, and bilateral ankle edema.
Gastrointestinal System
Common changes of aging:
Less acute taste sensations
Decreased esophageal motility
Atrophy of the small and large intestines
Increased risk of aspiration, indigestion and constipation
Dysphagia
Goals of care and interventions:
Offer soft diet
Thicken liquids
Take small bites
Monitor intake and output
Prevention of aspiration
Promotion of adequate nutritional status
Cranial nerves and muscles in the mouth, face, pharynx, and esophagus aid in swallowing so anything that affects those things can cause dysphagia.
Causes
Gastroesophageal reflux disease (GERD)
stroke
structural disorders
Musculoskeletal System
Common changes of aging
Thinning disks and shortened vertebrae
Reduced muscle mass, strength and movement
Decreased bone mineral and mass
Diminished calcium absorption
Increased risk of fractures
Osteoarthritis
Progressive deterioration and abrasion on joint cartilages, with the formation of new bone at the joint surfaces
Affects most people over 55
More common in women
Leading cause of physical disability in older adults
Does not cause inflammation, deformity and crippling
Causes- excessive use of joint, trauma, obesity, low vitamin D and C levels, and genetic factors
Having Acromegaly increases your risk of developing Osteoarthritis
Affects several joints especially weight bearing joints such as kness, hips, vertebrae and fingers
Treatment- analgesics, rest, heat, ice, t’ai chi, aquatherapy, ultrasound and gentle massage, weight reduction
Acupuncture helps with short-term relief
Nursing interventions- help patient maintain proper body alignment, educate patient on increased need for fatty fish
Respiratory System
Common changes of aging:
Calcification of costal cartilage, trachea, and rib cage more rigid
Reduction of cough and laryngeal reflexes
Increased residual capacity and reduced vital capacity
High risk for respiratory infection
Asthma
Is an intermittent disease with reversible airflow obstruction and wheezing due to a variety of stimulants
Can develop in later years
Assess for causative factors and educate patient
Evaluate aerosol nebulizer use
Precaution: avoid adverse drug interactions
Nursing Interventions
Administer bronchodilators
Administer fluids and humidification
ABG’s
C-Pap or Bi-Pap
Signs and symptoms
SOB
Wheezing
Coughing
Chest tightness
Nursing intervention- encourage use of incentive spirometer
Higher risk for developing cardiac problems due to stress asthma puts on heart
Higher rates of mortality from this condition in older adults
Endocrine System
Common changes of aging:
Thyroid gland atrophies and activity decreases
Diminished adrenal function
Adrenocorticotropic hormone (ACTH) secretion decreases
Volume of pituitary gland decreases
Insufficient release of insulin and reduced tissue sensitivity to circulating insulin
Hyperthyroidism
Secretion of excess amounts of thyroid hormone in the thyroid gland follicles
Signs and symptoms
Weight loss
Rapid HR
Irritability
Sweating
Heat intolerance
Diagnosis
T3 level > 220ng/dL
T4 level >12 mcg/dL
Treatment/management
Thyroidectomy
Thyroid ablation
Radioactive iodine therapy
Propylthiouracil
Beta blockers
Assessment
Enlarged thyroid
Exophthalmos
Radioactive iodine uptake
Acceleration of body process
Thyroid scan
Increased appetite
Diarrhea
Tachycardia, palpitations, increased systolic B/P
Heat intolerance
Diaphoresis
Nervousness, insomnia
Nursing Interventions
Observe for thyroid storm
Teach daily hormone replacement
Wear Med Alert
High calorie High protein Low caffeine Low fiber
Immune System
Common changes of aging:
Depressed immune response
T-Cell activity declines
Cell-mediated immunity declines
Risk for infection becomes significant
Inflammatory defenses decline
Inflammation presents atypically
COVID
Older adults more susceptible due to a weakened immune system
Causes by an virus called SARS-CoV-2
Takes people longer to show symptoms and is contagious for longer than the flu
Signs and symptoms:
cold symptoms
fever
cough
SOB
fatigue
muscle aches
sore throat
diarrhea
congestion or runny nose
loss of taste or smell
headache
Treatments:
Rest
Corticosteroids
Anticoagulants
Respiratory virus
Spread through respiratory droplets
Nervous System
Common changes of aging:
Decline in weight and blood flow to the brain
Does not affect thinking and behavior
Reduction in neurons, nerve fibers and cerebral blood flow
Slower response to change in balance
Hypothalamus less effective in temperature regulation
Changes in sleep patterns with frequent awakening
Parkinson’s
Disease
Affects ability of the central nervous system (CNS) to control body movements
Chronic, progressive, debilitating neurologic disease of the basal ganglia and substantia nigra, affecting motor ability and characterized by tremor at rest, increased muscle (rigidity). Slowness in the initiation and execution of movement (bradykinesia), and postural instability (difficulty with gait and balance).
More common in males
Exact cause unknown; some theories
Signs and symptoms
Tremors
Shuffling gait
Bradykinesia
Increased appetite
-Leaning forward at trunk
Treatment/management
Carbidopa/Levodopa
Dopamine Agonists
Anticholinergics
Mao-B inhibitors
COMT inhibitors
Goal: maximum level of independence preserved
Integumentary System
Common changes of aging:
Changes of aging
Thin skin that provides a less effective barrier
Decreased ability to detect and regulate temp
Dry skin from decrease in endocrine secretion
Loss of elastin
Increase in vascular fragility
Pruritus
Most common dermatologic problem amount older adults
Precipitated by anything that drys the skin such as excessive bathing
Causes
Diabetes
Arteriosclerosis
Hyperthyroidism
Uremia
Liver disease
Cancer
Pernicous anemia
Scratching can cause a break in the skin which invites infection in
Treatment:
Bathing oils
Lotions
Massage
Vitamin supplements
Topical zinc oxide
Antihistamines
Steroids
Irritating sensation that causes the urge to itch
Urinary System
Common changes of aging:
Decline of renal blood flow and glomerular filtration by approximately 50% by age 90.
Reduced bladder capacity
Urinary frequency, urgency, and nocturia are common in older adults
Incontinence is NOT a normal part of aging
Decreased tubular function
Concentration of urine changes in response to water and/or sodium excess/depletion
Increase in renal threshold for glucose
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
Urinary Tract Infection
Infection or inflammation at any site in the urinary tract
Most common infectious agent is Escherichia coli
Bacteria enters the urinary tract through the urethral opening, invades the epithelial cells
High risk individuals
Diabetes
Pregnancy
Prostatic hypertrophy
Immunosuppressed persons
Catheterized clients
Urinary retention
Older women with bladder prolapse
Signs and Symptoms
Burning sensation while urinating
Small amounts of urine
Frequent urination
Cloudy urine
Treatment
Antibiotics to kill the bacteria
Nursing interventions
Teach female patients to wipe front to back
Drink water
Reproductive System
Common changes of aging:
Female
Ovarian Cancer
Cancer of the ovaries
Increased incidence with age
Leading cause of death from gynecologic malignancies
Early symptoms are nonspecific and can be confused with gastrointestinal discomfort
Clinical manifestations- bleeding, ascites, multiple masses present
Treatment/management- surgery or irradiation
Less common than endometrial cancer but more deadly
Hormonal changes
Vulve atropies
Flattening of labia
Loss of subcutaneous fat and hair
Vaginal epithelium thins
Cervix, uterus, and fallopian tubes atrophy
Vaginal canal changes
Reduction in collagen and adipose tissue
Shortening and narrowing of the canal
Less lubrication-May lead to discomfort with intercourse
More alkaline vaginal pH as a result of lower estrogen changes
Uterus and ovaries decrease in size
Endometrium continues to respond to hormonal stimulation
Fallopian tubes become shorter and straighter
Breasts sag and are less firm
Some retraction of nipples related to shrinkage and fibrotic changes
Seminal vesicles develop thinner epithelium
Muscle tissue replaced with connective tissue
Decreased capacity to retain fluids
Seminiferous tubule changes
Increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen
Atrophy of the testes and reduction in testicular mass
Ejaculation fluid contains less live sperm
Testosterone stays the same or decreases slightly
More time required to achieve an erection
Enlargement of the prostate gland
Male
Erectile Dysfunction
Inability to achieve and sustain an erection for intercourse
Effects half of men over 70y/o
Not a normal cause of aging
Causes- alcoholism, diabetes, dyslipidemia, hypertension, hypogonadism, MS, renal failure, spinal cord injury, thyroid conditions, psychological factors
Medications that causes erectile dysfunction- Anticholinergics, antidepressants, antihypertensives, digoxin, sedatives, tranquilizers
Treatments- Sildenafil, Vardenafil HCI , Tadalafil, penile implants, vacuum pump devices
SOURCES
Gerontological textbook
Medical Surgical textbook
Gerontological slides
COA slides
CDC