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the older adult - Coggle Diagram
the older adult
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respiratory
age related changes:
- breathing mechanisms: lungs loose elastic recoil, decline in muscle strength --- reduce cough
- oxygenation: increase ventilation and perfusion are imbalanced, increased dead space in the lungs, decreased alveolar surface area
- ventilation control: decreased reaction of peripheral & central chemoreceptors to hypoxia and hypercapnia
pathologies:
- asthma: intermittent disease with reversible airflow obstruction and wheezing
= can develop when older, evaluate aerosol nebulizer use
= interventions: admin bronchodilators, admin fluids, abgs, bi-pap
- chronic bronchitis: chronic sputum with cough production daily for 3 month min in 2 consecutive years, chronic hypoxemia, increase mucus, increase wall thinkness
= cyanosis "blue bloater" right heart fail, distended jugualr vein
= interventions: lower Fio2 to prevent Co2 retention, watch for fluid overload, manage chronic bronchitis, remove bronchial secretions
neuro
age related changes:
- slowing central processing (delay in time required to preform a task)
- intelligence remains constant
- number and sensitivity of sensory receptors, dermatomes and neurons decreases (dull tactile)
- decline in function of cranial nerves affecting taste and smell
- loss of nerve cell mass (atrophy brain and spinal cord)
- decline in dendrites and demylination (slower nerve conduction, response and reaction times slower, reflexes weaker)
- plaques, fatty deposits in blood vessels, ability to compensate declines
pathologies:
- parkinsons disease: affects cns ability to control movement s/s = tremors at rest, mask like face treatment: anticholinergic meds
- Dementia: cognitive impairments characterized by gradual progressive onset, irriversible, affects judgement, memory, abstract thinking and social behavior
urinary
age related changes:
- increased risk of kidney and bladder problems like leakage or urinary incontinence (NOT normal change in aging)
- urinary retention (unable to completely empty bladder)
- urinary tract infections and chronic kidney dieases
- number of nephrons (filtering units) decreases and blood vessels supplying kidney harden, decreasing function
- bladder muscles weaken and prolapse may occur
pathologies:
- urinary tract infection: infection of kidney, bladder, urethra. common in women, often involves the kidney
=s/s: pelvic pain, increased urge to urinate, pain with urination, blood in urine
= treatment: antibiotics and penicillin
- enlarged prostate: urinary system weak or stop and start. Can lead to infections, bladder stones and decreased kidney function
= s/s: urinary dribbling after urination, nocturia, urgency, incontinence, sexual dysfunction
= treatment: meds that relax bladder and shrink prostate (alpha blockers like rapaflo) as well as surgery
reproductive
age related changes:
- misconceptions in attitude that older adults dont also have active healthy sex lives
- menopause: natrual decline in reproductive hormones between 40-55 yrs old, point at which a woman hasn't had a period within the last 12 months
- andropause: testosterone levels decrease in men, reduced muscle mass, energy, stamina, erectile dysfucnt, osteopenia
- erectilce dysfunction: unable to attain erection for sexual intercourse
= causes: atherosclerosis, diabetes, hypertenstion, etc
pathologies:
- nabothian cysts: endocervical glands seal over, secretions can accumulate and palpable tender masses may be evident
= regular gynochologic exams to check cervix patency
= cervix becomes smaller, endocervical eoithelium atrophies
- breast cancer: second leading cancer death, risk increases with age, can be present in male patients as well
= encourage regular breast examinations, older women less liekley to recieve yearly mamograms and breast examinations by health professionals
= treat with chemo, mastectomy, radiation
integumentary
age related changes:
- skin thinner, more fragile, lose protective fat layer
- less able to sense touch, pressure, vibration, heat, cold
- frequent, easier skin tears, fragile blood vessels break easily
- wrinkles, moles, age spots, dryness, thinning, pigment changes
pathologies:
- Psoriasis: patches of thick red skin and silvery scales seen often on elbow, knee, scalp, face, palms. commonly caused plaque psoriasis. thought to be an immune problem
= s/s: pain in joints, rashes, dryness, flaking, small bumps, peeling
= treatment: steroids, vitamin A, photodynamic therapy, petroleum jelly
- skin cancer: abnormal growth of skin cells (basal and squamous cell carcinoma, melanoma)
= s/s: ABCDE's, moles changing in color, size, feel or bleeding, small lesions with irregular borders, painful itching lesions
= treatment: surgery, chemotherapy, radiation, creams and lotions
endocrine
age related changes:
- thyroid gland atrophies and activity decreases
- diminished adrenal function
- ACTH secretions decrease and vol of pituitary gland decreases
- insuffifient release of insulin and reduced tissue sensitivty to circulating insulin
pathologies:
- diabetes mellitus: glucose intolerance, normal a1c 5.7% , classic nonspecific symptoms, sceen fasted blood sugar evert 3 yrs, manage with insulin and life style changes
- hypothyroidism: hypofunction of thyroid gland resulting insufficency of thyroid hormone
= s/s: fatigue, weakness, lethargy, anorexia, weight gain
= interventions: water, fiber, synthroid and thyroxine
digestive
age related changes:
- strength of esophageal contractions and tension in upper esophageal sphincter decreases
- stomach lining's capacity to resist damage decreases resulting in peptic ulcer disease
- decreased stomach and intestional elasticity
- slower movement of contents through large intestine
- weakend pelvic floor in older women can lead to fecal incontinence
pathologies:
- bowel obstruction: blockage that keeps food or liquid from passing through small intestine, large intestine. caused by fibrous tissue that compresses the gut
=s/s: severe abdominal pain, nausea, vomiting, inability to pass gas or stool
= treatment: avoid solid foods, nausea meds, bowel resection surgery
- GERD: (gastroesophageal reflux disease) stomach acid repeatedly flows back into esophagus creating acid reflux which irritates the esophagus
= s/s: burning pain in chest that occurs after eating or worse after lying down, belching, heartburn, regugitation, bitter taste
= treatment: lifestyle changes and over the counter medications like antacids and proton-pump inhibitors. elevate HOB, dietary modifications, weight loss
muscular
age related changes:
- muscles rigid and lose tone even with regular exercise
- joints are affected with changes in cartilage and in connective tissue
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- lose muscle tissue as the number and size of muscle fibers decrease
- muscle fibers contract slower. reaction time slower
pathologies:
- fibromyalgia: pain throughout body, sleep problems, fatigue. = s/s: widespread muscle pain and tenderness in muscles, abdomen, back neck. Often occurs at night
= treatment: medications like SSRIs, analgesics,NSAIDs, muscle relaxants, exercise, stress managment techniques
- myostitis: inflammation of muscles used to move body. an injury, infection or autoimmune diseases causes it. (polymyositis and dermatomyositis
= s/s: muscle weakness in muscles close to trunk, pain, aching muscles. progressive, tripping and falling from being tired walking
= treatment: steriods, immunosuppressive therapy, controlled exercise
skeletal
age related changes:
- bones become more brittle (lose mass and density, especially in post menopausal women
- height decreases (trunk and spine shorten)
- breakdown of joints leads to inflammation, pain, stiffness, deformity
- fluid in joints decrease and cartilage rubs and wears away. calcification from mineral deposits occurs
- lean body mass decreases due to mucle atrophy
- stooped posture and decreased endurance
pathologies:
- osteoporosis: bones break easily especially in women due to low calcium intake/ absorbtion, undereating and lack of exercise
= s/s: fragility related stress fractures, height loss, curved spine, lower back pain, decreased mobility
= treat with calcium supplements, diet and lifestyle changes
- fasciculations: muscle twitches that have a cause not due to any other underlying diseases. Reasons include low magnesium, muscle fatigue, medication side effects
= treatment: adequate rest, well balanced diet, avoid caffeine and smoking
lymphatic
age related changes:
- decreased contractile pressure and pumping frequency
- increased permiability and delayed immune response
- reduced production of B and T cells in bone marrow and thymus
- diminished function of mature lymphocytes in secondary lymph nodes
pathologies:
- lymphedema: tissue swelling due to accumulation of protein rich fluid drained through body's lymphatic system. caused by blockage in lymphatic system
= s/s: swelling in arm or leg accompanied by pain/ discomfort, dimpled skin, swollen lymph nodes
= treatment: exercise, wrapping, compression device
- Gorham's Disease: bone disorder causing bone loss due to abnormal blood vessel growth that has potential to spread to soft tissue
= s/s: pain, swelling, increased fracture risk, difficulty breathing, weight loss, chest pain
= treatment: radiation therapy, anti-osteoclastic meds, alpha-2b interferon, surgery such as resection of lesion
circulatory
age related changes:
- heart valves become thick and more rigid (diastolic murmor in 50% adults
- aorta becomes dilated (slight ventricular hypertrophy, thickening left ventricular wall)
- myocardial muscle less efficient (decreased contractile strength, can't meet demands of left ventricular wall)
- dysrhythmias, bradycardia, tachycardia, TIA's
- increased peripheral resistance
- arteriosclerosis (edema, pvd, coronary artery disease)
pathologies:
- coronary artery disease/ atherosclerosis: ischemic heart disease
= prevalence increases with age-some form is present after 70yrs
= angina: vauge discomfort under sternum, indigestion, coughing
= myocardial infarctions
- pulmonary emboli: high incidence, diagnosis challenging = risk factors: fractures, congestive HF, arrhythmias
= s/s: confusion, apprehension, SOB, temperature
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