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Changes in Older Adults - Coggle Diagram

- - - - Necrosis, sloughing and/or ulceration may be present
      - Many different stages
        
        Stage 1: Redness of skin but no breakage of skin
        
        Stage 2: Partial thickness loss of skin, typically involves blisters
        
        Stage 3: Full thickness loss of skin, exposing the subcutaneous tissue, may include tunneling
        
        Stage 4: Full thickness of skin and subcutaneous tissue, exposing bone, muscle or both, tunneling and undermining often present
        
        Unstageable: If covered with slough and/or eschar it cannot be staged until this is removed
- - - - Leads to the reactivation of varicella zoster and mycobacterium tuberculosis
- - - - The change in pH make older adult women more prone to vaginitis
        
        S/S: soreness, pruritus, burning, reddened vagina, and foul smelling vaginal odor that is clear, brown, or white
        
        Treatment: local estrogens in suppository or cream form
  - - - Erectile Dysfunction
        
        NOT A NORMAL CHANGE OF AGING!! However, caused by chronic conditions that many older adults may have: diabetes, thyroid conditions, hypertension, renal failure, alcoholism, drug abuse, multiple sclerosis, and spinal cord injuries
        Also can be caused by several medications that many older adults may be on: anticholinergics, antidepressants, antihypertensives, digoxin, sedatives, and tranquilizers
        
        Treatment: oral erectile agents, drugs injected into the penis, penile implants, vacuum pump devices, surgical implantation of devices, and penile artery reconstruction
    - - Benign prostatic hyperplasia
        
        S/S: dysuria, hesitancy, decreased force of urinary stream, frequency, nocturia, dribbling, poor urinary control and incontinence
        
        Treatment: prostatic massage, urinary antiseptics, and prostatectomy
- - - - Dysrhythmias are more common with age
    - - Left sided: pulmonary edema, pulmonary congestion, dyspnea, crackles, cough, tachycardia, fatigue, anxiety, restlessness, confusion
      - Right sided: peripheral edema, weight gain, distended neck veins, anorexia, weakness, hepatomegaly, ascites (related to respiratory system: with right sided heart failure all the blood and fluid backs up into the lungs and causes respiratory complications)
  - - - Hypertension
        
        Elevated systolic BP 120-129
        Stage I HTN: Systolic BP 130-139 or diastolic BP 80-89
        Stage II HTN: Systolic BP 140+ or diastolic BP 90+
        Hypertensive crisis: Systolic BP > 180 or diastoli. BP > 120
        
        S/S: usually non but if there are any they would include awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor
        
        S/S indicating hypotension if on antihypertensive meds: dizziness, confusion, syncope, restlessness, and drowsiness
        
        Treatment should be focused on lifestyle modification because older adults are more prone to adverse effects from anti-hypertensive meds;
        
        Rest, biofeedback, yoga, meditation, reduce weight
        
        Reduce sodium intake and increase consumption of garlic, probiotics, fish oil, and whole grains
        
        DASH diet; rich in fruits, vegetables, whole grains and low-fat dairy foods
    - - Arteriosclerosis
        
        Usually affects smaller vessels farthest away from the heart
        
        Diagnosed with arteriography and radiography
        
        Treatment: bed rest, warmth, Buerger-Allan exercises and vasodilators
        
        Buerger-Allan exercise consists of lying flat with legs elevated, then sitting on edge of bed, then lying back down completely flat
  - - - Decline in systolic blood pressure of 20 mmHg or more after changing positions
      - Can cause falls, strokes, syncope, or other coronary complications
- - - - S/S: burning while urinating, urgency, and fever are the first indications
      - Can cause delirium if left untreated (related to neurological system)
      - Nursing interventions and pt education: carefully monitor the pt's I&O, encourage fluid intake, observe for new S/S (bladder distention, skin irritation, any other unusual signs), encourage intake of cranberry juice, avoid catheters if possible
  - - - S/S: pain, hematuria, and symptoms similar to urinary tract infection, GI upset may occur
      - Management: prevent urinary stasis, provide adequate fluid intake, if calcium stone...decrease calcium intake
- - - - Mouth breathing at night
        
        Obstructive Sleep Apnea
        
        Signs and Symptoms: excessive daytime sleepiness, loud snoring, morning headache, observed episodes of stopped breathing in the night
        
        Treatment: weight loss, sleep on your side, CPAP, avoid alcohol, surgery to remove tonsils if necessary
        
        Risk Factors; excess weight, smoking, diabetes, hypertension, narrowed airway
  - - - Secretions are thicker and more difficult to remove
  - - - Trachea and rib cage become more rigid
    - - Lungs become smaller, less firm and have less recoil (they are more stiff)
  - - - Pleuritic pain may not be present
      - Minimal or no fever
      - S/S; slight cough, fatigue, rapid respirations
      - Confusion, restlessness and changes indicate cerebral hypoxia
      - Could cause paralytic ileus if it further progresses
      - Reduced sensitivity of pharyngeal reflexes can lead to a higher risk of aspiration pneumonia
  - - - S/S: dyspnea that is not relieved with rest, chronic cough, fatigue, anorexia, weight loss, and weakness
      - Can lead to life threatening complications: recurrent respiratory infections, malnutrition, congestive heart failure, and cardiac arrythmias (related to cardiovascular system because this causes circulation and cardiac dysfunction)
      - Treatment: postural drainage, bronchodilators, avoidance of stressful situations, and breathing exercises
      - Be careful with supplemental oxygen because LOW O2 STIMULATES RESPIRATORY DRIVE!!! Increasing oxygen may then cause respiratory depression
      - Pt education: pace activities, avoid extremely cold weather, recognize symptoms of infection
      - Assessment: barrel chest, pink puffer, distant and quiet breath sounds, wheezes, pulmonary blebs on an X-ray
- - - - Causes; age related decline in saliva production, medications, mouth breathing
      - Management: frequent oral hygiene, saliva substances , adequate fluid intake, hard sugarless candy and gum
  - - - Increased risk for aspiration and indigestion
  - - - Keeping an elimination record will allow identification of changes in bowel habbits
      - Prevention of constipation is the #1 focus to prevent this
      - S/S: distended rectum, abdominal and rectum discomfort, oozing of fecal material around the impaction, palpable and hard fecal mass, fever
    - - Pt Education: Encourage a diet high in fiber and fluid and regular physical activity. Rock trunk side to side and back and forth while sitting on the toilet. Ensure they know how to safely use laxatives because laxative abuse could cause this.
      - Foods to aid in defecation: Raisins, prunes, dates, and currants
      - Nursing Interventions: Provide a regular time for bowel elimination (mornings are often best time). Keep an elimination chart.
- - - - Increased intolerance/sensitivity to cold temperatures
  - - - Abrasion of joint cartilage with formation of new bone at the joint surfaces
      - Leading cause of physical disability
      - Does not cause deformity and crippling
      - Treatment/Management: analgesics (preferably acetaminophen), rest, heat or ice, aqua-therapy, gentle massage, and acupuncture
  - - - Fractures should be suspected anytime an older adult falls or experiences trauma to the bones
      - S/S: pain, change in shape or length of limb, abnormal or restricted motion, edema, spasms of surrounding tissue, or bone protruding through tissue
      - Heal slower and higher risk for complications with older adults; pneumonia, thrombus formation, pressure injuries, and contractions
    - - Treatment/Management: calcium or vitamin D supplements, selective estrogen receptor modulators, and hormone therapy
      - Pt education: avoid heavy lifting, jumping, and other activities that could result in a fracture, encourage range of motion activities and ambulation
- - - - S/S: fatigue, weakness, lethargy, depression, anorexia, weight gain, puffy face, impaired hearing, periorbital edema, constipation, cold intolerance, dry skin, and coarse hair
      - Treatment: levothyroxine (give on empty stomach in the morning 1 hour before other medications and meal)
      - Pt education: medication is lifelong, always wear a Med Alert band, eat a diet that is high calorie and protein and low caffeine and fiber
  - - - S/S: orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, neuropathy, confusion, glaucoma, Dupuytren's contracture (fixed flexion of the hands), and infection
      - Nursing considerations: older adults have have a higher renal threshold for glucose so pt may be hyperglycemic without glycursuria (the higher renal threshold is a normal urinary system change in the older adult)
      - Diagnostics: glucose tolerance test is the most effective (minimum of 150 g of carbs must be ingested for several days before the test)
      - Diagnosis is established on one of the following: symptoms of diabetes and a random blood glucose of 200 or higher, HbA1C 6.5% or higher, fasting blood glucose of 126 or higher, or blood glucose 200 or higher after 2 hours of glucose intake for glucose tolerance test
- - - - Ischemic from a thrombus or embolis
      - Hemorrhagic from a ruptured cerebral blood vessel
      - Warning S/S: light headedness, dizziness, headache, drop attack and memory or behavioral changes
      - Nursing interventions during acute phase: maintain patent airway, provide adequate nutrition and hydration, monitor neurologic status and vital signs, and prevent complications with immobility
  - - - Cataracts
        
        Risk factors: exposure to UV light, diabetes, cigarette smoking, high alcohol consumption, and eye injury
        
        S/S: vision becomes distorted, night vision decreases, objects appear blurred, glares are more bothersome eventually complete lens opacity and vision loss
        
        Treatment: Surgery to remove the lens