Assigment #1: Concept Map for the Older Adult

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Assigment #1: Concept Map for the Older Adult by Mind Map: Assigment #1: Concept Map for the Older Adult

1. Respiratory System

1.1. Common Age Related Changes

1.1.1. Reduced cough & laryngeal reflexes

1.1.1.1. Assess need for suction

1.1.2. Calcification of the trachea & coastal cartilage

1.1.3. Increased risk of respiratory infection d/t....

1.1.3.1. Decreased respiratory muscle strength

1.1.3.1.1. Normal RR: 12-24 breathes/min

1.1.3.1.2. Provide oxygen as needed

1.1.3.1.3. Educate on smoking cessation

1.1.4. Stiffer chest wall with reduced compliance

1.1.5. Drier mucus membranes & decrease ciliary activity

1.1.5.1. Maintain hydration & mobility

1.1.6. Decreased response to hypoxia and hypercapnia

1.1.6.1. Assess blood gas levels & pulse oximetry

1.1.7. With exertion:

1.1.7.1. Dyspnea

1.1.7.2. Decreased exercise tolerance

1.2. Prevalent Diseases

1.2.1. Chronic Obstructive Pulmonary Disease

1.2.1.1. Made up of Chronic Bronchitis and Emphysema

1.2.1.1.1. Emphysema

1.2.1.1.2. Chronic Bronchitis

1.2.1.2. Greater incidence in women & smokers

1.2.1.3. Stimulus to breathe is low oxygen levels not high CO2 levels

1.2.1.3.1. Use caution when applying oxygen

1.2.2. Lung Cancer

1.2.2.1. #1 cause is smoking. Others include exposure to environmental factors such as air pollution, coal, gases, etc.

1.2.2.2. Increased incidence in those 65 or older

1.2.2.2.1. Men > women

1.2.2.3. High risk groups should be screened because symptoms can show up late

1.2.2.3.1. Dyspnea, coughing, chest pain, fatigue, anorexia, respiratory infections

1.2.3. Pneumonia

1.2.3.1. Pneumococcal & influenza vaccinations are important

1.2.3.2. Avoid exposure to people with known respiratory infections

1.2.3.2.1. A cold lasting longer than a week should get checked out

2. Urinary System

2.1. Common Age Related Changes

2.1.1. Decline in renal mass, blood flow & GFR = reduced renal function

2.1.1.1. 50% reduction by age 90

2.1.1.2. Decreased DRUG CLEARANCE

2.1.1.2.1. Risk of adverse drug reactions

2.1.1.3. Risk for:

2.1.1.3.1. Dehydration

2.1.1.3.2. Volume overload with heart failure

2.1.1.3.3. Hyponatremia if taking thiazide diuretics

2.1.1.3.4. Hypernatremia with fever

2.1.1.3.5. Hyperkalemia with potassium-sparing diuretics

2.1.1.4. High blood urea nitrogen levels

2.1.1.5. Increased renal threshold for glucose

2.1.1.5.1. false-negative results for glucose in the urine

2.1.1.5.2. Can be hyperglycemic w/o symptoms

2.1.2. Decreased bladder capacity

2.1.2.1. Frequency

2.1.2.2. Urgency

2.1.2.3. Nocturnal polyuria

2.1.2.3.1. Increases fall risk

2.1.2.3.2. Limit fluids & caffeine in evening

2.1.2.3.3. Can decrease quality of sleep

2.1.3. Incontinence is NOT normal

2.1.3.1. Occurs in women > men

2.1.4. Increased risk of urinary tract infections

2.2. Prevalent Diseases

2.2.1. Urinary problems are not easily discussed by/with older adults

2.2.1.1. Results in delayed diagnosis & treatment

2.2.2. Males

2.2.2.1. Benign Prostatic Hypertrophy (In reproductive)

2.2.2.1.1. causes urinary retention & issues

2.2.3. Bladder Cancer

2.2.3.1. Risk increases with age; 90% of bladder CA occurs in people > 55 years old

2.2.3.2. Riks Factors: age, men, Caucasian, smoking

2.2.3.3. Sign/symptoms: frequency, urgency, dysuria, PAINLESS HEMATURIA

2.2.3.4. Observe for signs of metastasis that include pelvic or back pain

2.2.4. Urinary Tract Infections

2.2.4.1. Avoid catheterization unless absolute needed

2.2.4.2. Educate on proper hygiene

2.2.4.3. Increased fluid intake

2.2.4.3.1. Cranberry juice can help

2.2.4.4. Antibiotic used for treatment

3. Integumentary System

3.1. Common Age Related Changes

3.1.1. Skin is more fragile, dry, and less elastic

3.1.1.1. d/t connective tissue changes

3.1.2. Decreased subcutaneous fat

3.1.3. Increased benign & malignant skin neoplasms

3.1.4. Reduced sweat gland activity

3.1.4.1. Decreased ability to regulate temperature

3.1.4.2. Increased risk of overheating

3.1.5. Decreased melanocytes

3.1.5.1. Remaining ones increase in size causing age spots in sun-exposed areas

3.1.6. Blood vessels in dermis become more fragile

3.1.6.1. Increased bruising under skin

3.1.7. Sebaceous glands produce less oil

3.1.7.1. Women > men

3.1.7.1.1. Women typically after menopause

3.1.7.2. Harder to keep skin moist

3.1.7.2.1. Dryness & itching

3.1.7.2.2. Avoid excessive bathing

3.1.8. Growths such as skin tags, warts, and rough patches more common

3.1.9. Aging skin takes longer to repair itself

3.1.9.1. Up to 4x slower

3.1.9.2. Increases risk for pressure ulcers and infections

3.1.10. Atrophy of hair bulbs plus decline in hair & nail growth

3.1.11. Most skin changes are related to sun exposure

3.1.11.1. Prevent sunburn throughout life

3.1.11.2. Wear-sunglasses & sunscreen

3.1.11.3. Teach ABCDE skin inspection

3.2. Prevalent Diseases

3.2.1. Pressure Ulcers & Skin Tears

3.2.1.1. promote good nutrition and activity

3.2.1.1.1. High protein, vitamin-rich diet

3.2.1.2. D/t tissue anorexia and ischemia

3.2.1.2.1. take longer to heal in older adults

3.2.1.3. Nursing interventions:

3.2.1.3.1. frequent assessments

3.2.1.3.2. Turn & reposition q 2 hours or less

3.2.1.3.3. DO NOT elevate HOB > 30 degrees

3.2.1.3.4. Lift do not pull

3.2.2. Skin cancer

3.2.2.1. Basal cell carcinoma

3.2.2.1.1. Most common & rarely metastasizes

3.2.2.2. Squamous cell carcinoma

3.2.2.2.1. on skin, linings of hollow organs, respiratory and GI tract

3.2.2.3. Melanoma

3.2.2.3.1. Early detection improves prognosis

3.2.2.3.2. Very deadly

3.2.3. Pruritus

3.2.3.1. Most common dermatologic problem among older adults

4. Musculoskeletal System

4.1. Common Age Related Changes

4.1.1. Sarcopenia: Decreased muscle mass & strength

4.1.1.1. Increase weakness & poor exercise tolerance

4.1.1.2. Decreased mobility & movement

4.1.1.2.1. Disability

4.1.1.2.2. Increased fall risk

4.1.1.2.3. Unstable gait

4.1.2. Decreased ligament and tendon strength

4.1.3. Decreased bone mass

4.1.3.1. Increased risk for osteoporosis & osteopenia

4.1.3.1.1. Increased risk of factures

4.1.4. Lean body mass replaced by fat

4.1.5. Kyphosis: reduced height

4.1.5.1. D/t intervertebral disc degeneration

4.1.6. Articular cartilage erosion

4.1.6.1. Risk for osteoarthritis

4.1.7. Administer pain medications as needed to enhance functionality

4.2. Prevalent Diseases

4.2.1. Osteoporosis

4.2.1.1. Decreased bone mass

4.2.1.1.1. Bones loss begins around age 35

4.2.1.2. Occurs in women more than men

4.2.1.3. Diagnosed with a DEXA scan

4.2.1.4. Prevention strategies:

4.2.1.4.1. Weight-bearing physical exercise

4.2.1.4.2. Smoking cessation

4.2.1.4.3. Routine bone-mineral density screening

4.2.1.4.4. Adequate daily intake of calcium & vitamin D

5. Cardiovascular System

5.1. Common Age Related Changes

5.1.1. Valves turn thick and rigid

5.1.1.1. Sclerosis of arterial & mitral valves

5.1.2. Reduced elasticity of blood vessels

5.1.2.1. Arterial wall thickening and stiffening

5.1.3. Decreased contractile strength

5.1.3.1. Reduced cardiac output

5.1.4. Diminished peripheral pulses

5.1.5. Left ventricular & atrial hypertrophy

5.1.6. NO change in heart rate at rest

5.1.7. Physiological stress & exercise lead to....

5.1.7.1. Decreased maximal HR

5.1.7.2. Decreased cardiac output

5.1.7.2.1. Fatigue

5.1.7.2.2. SOB

5.1.7.2.3. Slower recovery from tachycardia

5.1.8. Increased risk for postural & diuretic induced hypotension

5.1.8.1. Assess BP lying, sitting, and standing

5.2. Prevalent Diseases

5.2.1. Hyptertension

5.2.1.1. Systolic BP > 140 mmHg, Diastolic > 90 mmHg

5.2.1.2. Increased incidence with age

5.2.1.3. Can be asymptotic or slight HA, impaired memory, disorientation, confusion, epistaxis, slow tremor

5.2.1.4. Treatment

5.2.1.4.1. Decrease sodium intake

5.2.1.4.2. diuretics, beta-blockers, ACE inhibitors, CCB

5.2.2. Orthostatic Hypotension

5.2.2.1. Drop in BP by 20 mmHg or more upon standing

5.2.2.2. Fall Risk

5.2.2.3. Less sensitive to baroreceptor regulation of BP

5.2.3. Congestive Heart Failure

5.2.3.1. Leading cause of hospitalization

5.2.3.1.1. heart is unable to pump blood to meet body requirements

5.2.3.1.2. Right sided

5.2.3.1.3. Left sided

5.2.3.2. D/t coronary artery disease & atherosclerosis

5.2.3.3. SOB, dyspnea on exertion, insomnia, depression, orthopnea, wheezing, edema, weight gain, etc.

5.2.4. Coronary Artery Disease & Peripheral Vascular Disease

5.2.4.1. Evident in most people after age 70.

5.2.4.2. Risk increased with hyperlipidemia

5.2.4.3. CAD affects vessels of heart while PVD affects smaller vessels furthest from heart

5.2.4.3.1. PVD can cause arterial insufficiency

5.2.4.4. Angina

5.2.4.4.1. Chest pain d/t myocardial ischemia

5.2.4.4.2. Atypical presentation

5.2.4.4.3. Treated with Nitroglycerin

6. Nervous System

6.1. Common Age Related Changes

6.1.1. Decreased blood flow to the brain

6.1.1.1. Plaques, tangles, atrophy of the brain

6.1.1.1.1. increased free radicals

6.1.2. Reduced neurons & nerve fibers & neurotransmitters

6.1.2.1. Slower cognitive processing

6.1.2.1.1. To maintain cognitive function:

6.1.3. Decreased response to changes in balance

6.1.3.1. Increased fall risk

6.1.4. Change in sleep patterns

6.1.4.1. Increased risk for sleep disorders, delirium, and neurodegenerative diseases

6.1.4.2. Common Conditions:

6.1.4.2.1. Insomnia

6.1.4.2.2. Sleep Apnea

6.1.4.2.3. Excessive Daytime Sleepiness

6.1.4.3. Poor sleep can lead to many comorbid conditions

6.1.4.3.1. Treatment begins with addressing sleeping habits and environmental factors

6.1.5. Decreased temperature regulation in the hypothalamus

6.1.5.1. Normal body temperature decreased: 96.9 F -98.3 F

6.1.5.2. Decreased ability to sense hot & cold

6.1.5.2.1. Safety issue

6.1.5.3. Assess temperature during illness and surgical procedures

6.1.6. Impaired general muscle strength, deep-tendon reflexes, and nerve conduction velocity

6.1.6.1. slowed motor skills

6.1.7. Most memory functions are adequate for normal life

6.2. Prevalent Diseases

6.2.1. Dementia & Alzheimer's Disease

6.2.1.1. Irreversible with a slow onset

6.2.1.1.1. Alzheimer's is the most common form of dementia

6.2.1.2. Inappropriate behavior with difficulty with coordinated movements

6.2.1.2.1. Help patient with physical needs such as eating, drinking, bathing

6.2.1.3. 4.5 million older adults are affected

6.2.1.4. Causes by damage or injury to the brain

6.2.1.5. Impairment in cognition, memory, orientation, reasoning, attention, language, and problem solving

6.2.1.5.1. SAFETY RISK

6.2.2. Parkinson's Disease

6.2.2.1. CNS unable to control body movements

6.2.2.1.1. Results in hand tremors & shuffling gait

6.2.2.2. D/t decreased dopamine reaching the brain

6.2.2.2.1. Treat with anticholinergic medications

6.2.2.3. Goal is to maintain maximum level of independence

6.2.2.3.1. SAFETY

6.2.2.4. Affects males > females

6.2.3. Transient Ischemic Attacks (TIA) & Cerebrovascular Accidents (CVA)

6.2.3.1. Recovery from a TIA is usually within a day to one week

6.2.3.1.1. Increases risk of future CVA

6.2.3.2. TIA signs/symptoms

6.2.3.2.1. Hemiparesis, aphasia, unilateral loss of vision, diplopia, vertigo, N/V, dysphagia

6.2.3.3. CVA is the 3rd leading cause of death in older adults

6.2.3.3.1. Can be ischemia (blockage of blood flow) or hemorrhagic (busted artery)

6.2.3.3.2. Need medical attention ASAP

6.2.3.3.3. Assessment for stroke: FAST

6.2.3.3.4. Following a CVA patients may be depressed & irritable d/t loss of independence they had before

6.2.3.4. Safety & preventing injury is a huge priority

7. Reproductive System

7.1. Common Age Related Changes

7.1.1. Loss of subcutaneous fat & hair

7.1.2. Flattening of the labia

7.1.3. Vaginal Canal

7.1.3.1. Shortens & narrows

7.1.3.2. Decreased lubrication

7.1.3.2.1. Painful intercourse

7.1.3.3. Decreased estrogen caused more alkaline pH

7.1.3.4. Epithelium thins

7.1.4. Fallopian tubes are shorter & straighter

7.1.5. Vulva, Cervix, uterus, ovaries, and fallopian tubes atrophy

7.1.6. Mammary glands replaced with fat

7.1.6.1. Breast sag

7.1.7. Retraction of nipples

7.1.8. Males

7.1.8.1. Seminal vesicles with thinner epithelium

7.1.8.2. Muscle tissue replaced with connective tissue

7.1.8.3. Seminiferous tubules

7.1.8.3.1. Fibrosis, thicker basement membrane, narrowed lumen

7.1.8.4. Testicular atrophy

7.1.8.4.1. Testosterone stays same or andropause

7.1.8.5. Less live sperm in ejaculation fluid

7.1.8.6. Increased time to achieve erection

7.1.8.7. Prostate enlargement

7.2. Prevalent Diseases

7.2.1. Male

7.2.1.1. Erectile Dysfunction

7.2.1.1.1. Increased time to achieve & maintain an erection

7.2.1.1.2. Treatment

7.2.1.2. Bengin Prostatic Hyperplasia

7.2.1.2.1. Most older men have some degree of BPH

7.2.1.2.2. Symptoms

7.2.1.2.3. Treatment

7.2.1.3. Prostate Cancer

7.2.1.3.1. Increased risk with age

7.2.1.3.2. Diagnosis

7.2.1.3.3. Asymptomatic

7.2.1.3.4. Treatment

7.2.2. Female

7.2.2.1. Ovarian Cancer

7.2.2.1.1. Leading cause of death d/t gynecologic malignancies

7.2.2.1.2. Signs/Symptoms

7.2.2.1.3. Treatment

7.2.2.2. Breast Cancer

7.2.2.2.1. Second leading cause of cancer deaths

7.2.2.2.2. Risk increased with age

7.2.2.2.3. Nursing Interventions

7.2.2.2.4. Diagnosis

7.2.2.2.5. Signs/Symptoms

7.2.2.2.6. Treatment

8. Gastrointestinal System

8.1. Common Age Related Changes

8.1.1. Decreased esophageal motility

8.1.2. Atrophy of small & large intestines

8.1.3. Increased risk for dysphagia & aspiration

8.1.3.1. watch for coughing or choking with food/fluid intake

8.1.3.2. Assess lungs if aspiration present

8.1.4. Malabsorption of carbohydrates, vitamins B12 & D, folic acid, and calcium

8.1.4.1. d/t higher pH d/t decrease in hydrochloric acid

8.1.5. Increased risk of indigestion

8.1.6. Decreased gastric motility & delayed emptying

8.1.6.1. Increased risk for constipation

8.1.6.1.1. Constipation is not a normal finding

8.1.6.1.2. Encourage mobility

8.1.6.1.3. Provide laxatives if on medications that cause constipation

8.1.7. Impaired sensation to defecate

8.1.7.1. Incontinence

8.1.8. Reduced hepatic function

8.1.8.1. slower metabolism of drugs

8.1.8.2. Check hepatic enzyme levels

8.1.9. Decreased strength in muscles of mastication & decrease taste & thirst sensation

8.1.9.1. Risk for malnutrition

8.1.9.2. Monitor weight & nutritional status

8.1.9.3. Risk for dehydration

8.1.10. Atrophy of protective mucosa

8.1.10.1. Increased risk for NSAID-induced ulcers

8.1.11. Decreased elasticity of the stomach

8.1.11.1. Reduced amount of food that can be consumed at one time

8.2. Prevalent Diseases

8.2.1. GERD

8.2.1.1. Education pt. on lifestyle changes:

8.2.1.1.1. Sit straight up after eating

8.2.1.1.2. Don't wear tight fitting clothing

8.2.2. Dysphagia

8.2.2.1. difficulty swallowing

8.2.2.1.1. malnutrition risk

8.2.2.2. Causes include GERD, stroke, and structural disorders

8.2.2.3. Aspiration risk

8.2.2.4. Interventions

8.2.2.4.1. Thicken foods

8.2.2.4.2. Sit upright while eating

8.2.2.4.3. No talking while eating

8.2.2.4.4. Have suction machine close by in case of choking

8.2.3. Hiatal Hernia

8.2.3.1. Occurs in half of people older than 50

8.2.3.2. Risk factors

8.2.3.2.1. Women

8.2.3.2.2. Low fiber diet

8.2.3.3. Signs & symptoms

8.2.3.3.1. heartburn, dysphagia, vomiting, belching, regurgitation, pain

8.2.3.4. Treatment

8.2.3.4.1. Weight reduction, not eating before bed, bland diet, H2 blockers, proton pump inhibitors

8.2.3.4.2. Several small meals throughout day

8.2.3.5. Two types: Sliding (axial) & Rolling (paraesophageal)

8.2.4. Colorectal Cancer

8.2.4.1. 2nd most common malignancy in the United States

8.2.4.2. Signs and Symptoms

8.2.4.2.1. Bloody stools, change in bowel habits, anorexia, naseau, epigastric pain, jaundice

8.2.4.3. Treatment: Colostomy

8.2.4.4. Colonoscopy every ten years is recommended to detect colon cancer; more often in high risk people

9. Endocrine System

9.1. Common age Related Changes

9.1.1. ACTH secretion decreases

9.1.2. Increased blood sugars in non-diabetics

9.1.2.1. Decreased insulin secretion

9.1.2.1.1. Reduced tissue sensitivity to insulin

9.1.2.2. Decreased ability to metabolize glucose

9.1.3. Thyroid gland atrophy

9.1.3.1. Decreased function

9.1.3.1.1. Uncontrolled weight gain

9.1.3.1.2. Hypothyroidism

9.1.4. Diminished adrenal function

9.1.5. Volume of pituitary gland decreases

9.2. Prevalent Diseases

9.2.1. Type II Diabetes Mellitus

9.2.1.1. Seventh leading cause of death in older adults

9.2.1.2. Recommends fasting blood sugar screening recommended every 3 years after 45 y/o

9.2.1.2.1. Test more than once to avoid false positives

9.2.1.3. Hgb A1C to measure effectiveness of disease control

9.2.1.4. Want triglycerides below 150 mg/dL

9.2.1.5. Criteria for diagnosis:

9.2.1.5.1. Symptoms plus random blood glucose > 200 mg/dL

9.2.1.5.2. Fasting blood glucose >126 mg/dL

9.2.1.5.3. Blood glucose concentration > 200 mg/dL after 2 hours of oral glucose intake

9.2.1.6. Treatment: insulin, oral anti-diabetics, lifestyle modifications such as diet and exercise

9.2.1.7. Hypoglycemic episodes worse than hyperglycemic

9.2.1.8. Safety

9.2.1.8.1. Proper foot care

9.2.1.8.2. Retinopathy

9.2.2. Hypothyroidism & Hyperthyroidism

10. Immune System

10.1. Common Age Related Changes

10.1.1. Reduced immune system function

10.1.1.1. T-cell activity declines

10.1.1.2. Increased susceptibility to infection

10.1.1.3. Reduced efficacy of vaccinations

10.1.2. Decreased inflammatory response

10.1.3. Nursing Interventions:

10.1.3.1. Follow immunization recommendations for pneumococcal, influenza, zoster, tetanus, and hepatitis for older patients

10.1.4. Infections presented atypically

10.1.4.1. Decline in functional or mental status

10.1.4.2. Decreased appetite

10.1.4.3. Incontinence

10.1.4.4. Falls

10.1.4.5. Fatigue

10.1.4.6. Exacerbation of chronic illness

10.1.4.7. Fever typically absent in very old, frail or malnourished adults

10.1.4.7.1. Baseline oral temperature is 97.4 degrees F

10.2. Prevalent Diseases

10.2.1. Type I Diabetes

10.2.1.1. D/t non-functioning beta cells in the pancreas

10.2.1.1.1. Results in insulin dependent individuals

10.2.1.2. More information under DM II in Endocrine Section

10.2.2. Antibiotic resistance

11. Physical Appearance & Personality

11.1. Hair loss & graying

11.2. Wrinkles

11.3. Loss of subcutaneous fat

11.4. Decreased height

11.4.1. Decreased hydration

11.4.2. Intervertebral cartilage loss

11.4.2.1. Kyphosis

11.4.3. Thinning vertebrae

11.5. Personality typically stays the same

11.5.1. Changes d/t disease, retirement, death of significant other, loss of independence, reduced income, disability

12. Sensory Changes

12.1. Vision

12.1.1. Presbyopia: age related farsightedness

12.1.1.1. Decreased ability to focus on close up objects

12.1.2. Pupils less reactive to light

12.1.2.1. Need more light in the dark

12.1.2.1.1. Fall risk

12.1.3. Decreased depth perception

12.1.4. Decreased visual acuity

12.1.4.1. Safety Risk

12.1.4.1.1. Inability to read medication labels, drive cross streets, etc.

12.1.4.2. Inhibits ability to remain independent

12.1.5. Myopia: nearsightedness

12.1.6. 30% of people over 65 years old have some level of visual impairment

12.1.6.1. Common Conditions:

12.1.6.1.1. Cataracts (clouding of the lens) are the 5th most common condition in those > 75 years old

12.1.6.1.2. Macular Degeneration

12.1.6.1.3. Glaucoma

12.2. Hearing

12.2.1. Impact quality of life & Safety

12.2.1.1. Impaired ability to communicate

12.2.1.1.1. Social isolation

12.2.1.2. Can not hear medication instructions

12.2.1.3. Can not hear phone, oncoming traffic, etc.

12.2.2. Hearing loss if the 3rd leading chronic condition affecting people over 75 years of age

12.2.2.1. Presbycusis: progressive loss of high frequency bilaterally

12.2.2.2. Conductive hearing loss

12.2.2.2.1. Involves outer and middle ear

12.2.2.2.2. D/t cerumen, foreign bodies, ruptured eardrum, otitis media

12.2.2.3. Sensorineural hearing loss

12.2.2.3.1. Damage to inner ear, cochlea, VIII cranial nerve

12.2.2.4. Tinnitus

12.2.2.4.1. ringing in the ears

12.3. Taste & Smell

12.3.1. Decreased ability to smell

12.3.2. Decreased ability to taste sweet foods

12.3.2.1. d/t decreased sense of smell, medications, disease, and tobacoo use

12.3.3. Risk for decreased nutritional status

12.3.4. Safety Risk

12.3.4.1. Inability to smell smoke or a gas leak

12.3.4.2. Can't smell rotten foods

12.3.4.2.1. Naseau, vomiting, diarrhea

12.4. Touch/Peripheral Sensation

12.4.1. Decreased ability to sense discomfort & pain & heat/cold

12.4.2. Reduced tactile sensation

12.4.3. Common Issues:

12.4.3.1. Peripheral & diabetic neuropathy

12.4.3.1.1. Safety Risk