1. Muskuloskelotal
1.1. Shortening vertebrae
1.2. Reduced strength and muscle mass
1.3. Decreased bone calcification
1.3.1. Related to decreased calcium absorption of bones
1.4. Risk of fractures
1.5. Osteoarthritis
1.5.1. s/s: pain, tenderness, stiffness, loss of flexibility
1.5.2. Treatment: acetaminophen for pain, physical therapy, cortisone injections, or joint replacement
1.6. Rheumatoid Arthritis
1.6.1. Autoimmune
1.6.2. s/s: tender and warm swollen joints, fatigue, fever, weight loss
1.6.3. No cure; treatment includes surgery, medication for pain, and therapy
1.7. Osteoporosis
1.7.1. Demineralization of bone
1.7.2. Caused by: inadequate amounts of calcium
1.7.3. s/s: reduction in height, spinal pain, and easily fractured bones
1.7.4. Treatment: calcium supplements, vitamin D supplements, high-protein diet, and possible bracing
1.8. Fractures
1.8.1. Causes: trauma, cancer, and osteoporosis
1.8.2. s/s: pain, change in shape/length of limb, restricted motion, edema, and tissue discoloration
1.8.3. Treatment: Increased fluids, good nutrition, early mobilization
2. Nervous
2.1. Decreased blood flow to brain
2.2. Reduced number of neurons
2.3. Change in ability to balance
2.4. Hypothalamus not as effective in temp. regulation
2.4.1. Lower body temp.
2.5. Sleep pattern changes- more disturbed
2.6. Decreased conduction velocity
2.6.1. Leads to slower reaction time
2.7. Parkinson's Disease
2.7.1. s/s: tremors, shuffling gate, stiffness, slow movement
2.7.2. Cause: decreased dopamine level in brain (from genetics or environment) inhibiting communication between neurons
2.7.3. No specific treatment
2.7.3.1. Management: levodopa to increase dopamine, along with speech and physical therapy to manage tremors
2.8. Transient Ischemic Attack
2.8.1. Cause: brief blockage of blood supply to brain
2.8.2. s/s: one sided weakness/droopiness of face, slurred speech, loss of coordination
2.9. Cerebrovascular Accident
2.9.1. Ischemic
2.9.1.1. most common
2.9.1.1.1. blood clot blocks blood flow to brain
2.9.1.2. s/s: prolonged symptoms of TIA
2.9.1.3. Prevent blood clot formation and atherosclerosis of vessels
2.9.2. Hemorrhagic
2.9.2.1. less common- hemorrhage of brain
3. Immune
3.1. Depressed immune response
3.1.1. T-cell activity declines
3.1.2. Risk for infection increases
3.1.3. Inflammatory defenses decline
3.2. Increase in pro inflammatory cytokines
3.3. Infection
3.3.1. Urinary Tract Infection
3.3.1.1. s/s: urethral burning upon urination, frequency, fever, foul-smelling urine
3.3.1.1.1. can spread to kidneys
3.3.1.2. Causes: diseases causing urinary retention (Parkinson's, Alzheimers); poor hygiene
3.3.1.3. Treatment: antibiotics, increased fluids
3.3.2. Pneumonia
3.3.2.1. Usually in form of community-aquired
3.3.2.2. s/s: cough with sputum, sharp pain in chest, shortness of breath, fatigue
3.3.2.3. Treatment: vaccine for prevention, antibiotics, breathing treatments,
3.3.3. Herpes Zoster
3.3.3.1. Cause: reactivation of chickenpox in body
3.3.3.1.1. for many older adults, chickenpox was vaccine not available in childhood
3.3.3.2. Painful rash, blisters, scabs, pain like pins and needles
3.3.3.3. Treatments: pain relief measures, and antiviral medications.
3.3.3.3.1. Can be prevented in older adults with shingles vaccine
3.3.4. Tuberculosis
3.3.4.1. Bacterial disease affecting lungs
3.3.4.1.1. spread through coughing/sneezing
3.3.4.2. s/s: cough (sometimes blood-tinged,) fever/night sweats, and weight loss
3.3.4.3. Treatment: long term antibiotics for those with symptoms
3.3.4.4. Diagnosed with Quantiferon GOLD blood test or skin test
4. GI
4.1. Less acute taste sensations
4.2. Decreased motility of esophagus
4.2.1. Presbyesophagues
4.3. Wasting away of gastric mucosa
4.4. Losing of teeth
4.4.1. Increased risk for constipation
4.4.2. Alters nutritional intake
4.5. Reduced saliva
4.5.1. Affects breakdown of starches
4.5.2. Can cause swallowing to take twice as long
4.6. Decreased absorption of vitamin B, vitamin D, calcium, and iron
4.7. Hiatal hernia
4.7.1. s/s: heartburn, dysphasia, belching, vomiting, and regurgitation
4.7.1.1. bleeding may also occur
4.7.2. Diagnosis:
4.7.2.1. barium swallow and esophagoscope
4.7.3. Management:
4.7.3.1. weight loss if applicable
4.7.3.2. bland diet
4.7.3.3. small frequent meals
4.7.3.4. H2 blockers and proton pump inhibitors prescibed
4.8. Dysphagia
4.8.1. Difficulty swallowing
4.8.2. Causes:GERD, stroke, and structural disorders of mouth and esophagus
4.8.3. s/s: range from difficulty swallowing some foods, to not being able to swallow any food at all
4.8.4. Management:
4.8.4.1. prevention of aspiration
4.8.4.2. adequate nutritional status
4.8.4.3. soft diet and thickening of liquids
4.8.4.4. eat in upright position
4.8.4.5. suctioning if needed
4.9. GERD
4.9.1. Causes: food choices, smoking, obesity
4.9.2. s/s: heartburn, reflux, and chest pain after eating
4.9.3. Patho: relaxed lower esophageal sphincter causing reflux of gastric content
4.9.4. Treatment: lifestyle modifications, elevation of bed, cigarette smoking cessation, antacids
5. Renal
5.1. Glomerular filtration declines by 50% by 90 y.o
5.2. Decreased bladder capacity
5.3. Atrophy of kidneys r/t atherosclerosis
5.4. Decrease in tubular function
5.4.1. Can lead to hyponatremia and nocturne
5.5. Decrease in tubular function
5.5.1. Decreased absorption of glucose
5.5.1.1. Can cause protein/glucose in urine
5.6. Increased frequency, urgency, and nocturne
5.7. Urinary Incontinence
5.7.1. Transient
5.7.1.1. Acute and reversible
5.7.1.1.1. Caused by: infection, delirium, fecal impaction, etc.
5.7.2. Established
5.7.2.1. Chronic and persistant
5.7.2.1.1. Stress incontinence
5.7.2.1.2. Urgency incontinence
5.7.2.1.3. Overflow incontinence
5.7.2.1.4. Functional incontinence
5.7.3. Treatment: Kegel exercises, biofeedback, and medications
5.7.3.1. Toileting schedule
5.8. Glomeruloronephritis
5.8.1. s/s: fever, nausea/vomiting, anorexia, anemia, edema, elevated BP, and abdominal pain
5.8.2. Treatment:
5.8.2.1. Antibiotics
5.8.2.2. Restricted sodium and protein
5.8.2.3. Close attention to fluid intake
5.9. Renal Calculi
5.9.1. "Kidney stones"
5.9.2. Causes:
5.9.2.1. Immobilization
5.9.2.2. Infection
5.9.2.3. Chronic dehydration
5.9.2.4. Hypercalcemia
5.9.3. s/s: pain, hematuria, and common UTI symptoms
5.9.4. Treatment: increased fluids, and sometimes surgery if needed
6. Respiratory
6.1. Stiffened chest wall
6.1.1. Increased respiratory rate- 14-24 breaths per minute
6.2. Decreased cough reflex
6.3. Drier mucous membranes
6.4. Decreased response to hypoxia/hypercapnea
6.4.1. Less effective gas exchange
6.5. Risk for respiratory infections
6.6. Mouth breathing during sleep
6.7. Decreased cilia number
6.7.1. affects ability to expel mucous
6.8. Decreased ability to exhale
6.8.1. increased residual volume (by as much as 50%)
6.9. COPD
6.9.1. Asthma
6.9.1.1. Nursing responsibility: overuse of bronchodilators in treatment can cause cardiac arrhythmias- monitor for adverse effects with treatment
6.9.2. Chronic bronchitis
6.9.2.1. s/s: productive cough; wheezing; respiratory infections; shortness of breath
6.9.2.2. Patho: results from recurrent inflammation with mucus in bronchial, blocking airflow.
6.9.2.3. Management:
6.9.2.3.1. Remove bronchial secretions
6.9.2.3.2. Preventing obstruction of airway
6.9.2.3.3. Adequate fluid intake
6.9.2.3.4. Discourage smoking
6.9.3. Emphysema
6.9.3.1. Causes:
6.9.3.1.1. Chronic bronchitis
6.9.3.1.2. Irritation from pollutants
6.9.3.1.3. Distention of alveolar sac
6.9.3.1.4. Cigarette smoking
6.9.3.2. s/s: Increased dyspnea, chronic cough, fatigue, weight loss, anorexia
6.9.3.3. Treatment:
6.9.3.3.1. Bronchodilatorss
6.9.3.3.2. Postural drainage
6.9.3.3.3. Cessation of smoking
6.9.3.3.4. Oxygen therapy as needed
6.10. Lung Cancer
6.10.1. Demographics: more common in men; over 65 years old; higher in African Americans
6.10.2. Cigarette smoking high risk factor
6.10.3. s/s: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, frequent respiratory infections
6.10.4. Diagnosis:
6.10.4.1. chest roengenogram
6.10.4.2. sputum cytology
6.10.4.3. bronchoscopy
6.10.4.4. biopsy
6.10.5. Treatment:
6.10.5.1. Surgery
6.10.5.2. Chemotherapy
6.10.5.3. Radiotherapy
6.11. Lung Abscess
6.11.1. Causes: pneumonia, tuberculosis, cancer, or trauma to lung(s)
6.11.1.1. Also caused by aspiration of foreign material
6.11.2. s/s: anorexia, fatigue, temp. elevation, and chronic cough
6.11.3. Treatment:
6.11.3.1. Postural drainage
6.11.3.2. high-protein/high-calorie diet
7. Cardiovascular
7.1. Arterial wall thickening
7.2. Slight left ventricular hypertrophy
7.2.1. Decreased cardiac reserve
7.2.1.1. Decreased cardiac output
7.3. Diminished peripheral pulses
7.3.1. R/t resistance to peripheral blood flow
7.4. Sclerosis of valves
7.4.1. Can lead to diastolic/systolic murmurs
7.5. Oxygen not as well used
7.6. Increase in blood pressure
7.7. Vasoconstriction
7.8. Hyptertension
7.8.1. Most prevalent CV disease
7.8.2. Patho: Vasoconstriction from aging produces peripheral resistance, causing blood pressure to increase in effort to perfuse effectively
7.8.2.1. Other causes: hyperthyroidism, anemia, and Parkinsonism
7.8.3. Diagnosed if systolic >140 and diastolic >90
7.8.4. s/s: dull headache, impaired memory, disorientation, epistaxis, and slow tremor
7.8.5. Nonpharmacological treatment: rest, reduce sodium, and reduce weight
7.8.6. Pharmacological treatment: antihypertensives, diuretics, beta-blockers, calcium channel blockers, or ACE inhibitors
7.8.6.1. Nursing responsibility: monitor closely for adverse reactions
7.9. Congestive Heart Failure
7.9.1. Causes: coronary artery disease, hypertension, diabetes, anemia, CKD, and psychological stress
7.9.2. s/s: dyspnea on exertion**, insomnia, anorexia, nausea, shortness of breath, weight gain, bilateral ankle edema, crackles in lung fields
7.9.3. Management: bed rest, ACE inhibitors, diuretics, beta-blockers, and digitalis
7.9.3.1. Should provide frequent skin care and changing of position to prevent skin breakdown
8. Cellular
8.1. Functional cell numbers decrease
8.2. Lean body mass decreases
8.3. Total body fat increase until the sixth decade
8.4. Less total body fluid
8.4.1. Nursing diagnosis: Risk for dehydration
9. Sensory
9.1. Vision decreases
9.1.1. Nursing Diagnosis: Increased risk for falls r/t sensory impairment
9.2. Hearing decreases
9.2.1. Presbycusis
9.2.1.1. Progressive hearing loss
9.2.1.2. distortion of high-pitched sounds
9.2.2. Cerumen increases
9.3. Smell decreases
9.4. Taste decreases
9.5. Presbyopia
9.5.1. inability to focus on close objects
9.5.1.1. decreased peripheral vision
9.5.1.2. depth perception distortion
9.5.1.3. decline in visual acuity
10. Encodcrine
10.1. Thyroid gland activity decreases
10.1.1. Lower basal metabolic rate
10.2. ACTH secretion decreases
10.3. Pituitary gland decreases
10.4. Insulin release delayed and insufficient
10.5. Ability to metabolize glucose decreased
10.5.1. Increased blood glucose in even non diabetic patients
10.6. Gonadal secretion declines
10.7. Diabetes Mellitus
10.7.1. Mostly Type 2 in older adults
10.7.1.1. Causes: increased obesity, age-related insufficiency of insulin,
10.7.2. Complications: visual changes, ulcers on feet, cardiovascular disease,
10.7.3. Management: glycemic level control, weight loss/proper diet
10.8. Hypothyroidism
10.8.1. s/s: weight gain, fatigue, dry skin, constipation
10.8.1.1. Often overlooked r/t common age-related changes
10.8.2. Treatment: thyroid replacement
11. Integumentary
11.1. Skin less elastic, dry
11.1.1. Nursing diagnosis: Risk for skin breakdown r/t decreased elasticity of skin
11.2. decreased subcutaneous fat
11.3. Reduced sweat gland activity
11.4. Fragile and brittle fingernails
11.5. Skin Cancer
11.5.1. Causes: increased exposure to sun
11.5.2. Melanoma
11.5.3. Basal Cell
11.5.4. Carcinoma
11.5.5. s/s: dark pigmentation, change in mole size, color, texture, size, etc.
11.5.6. Treatment: may have part of skin removed, laser surgery, and sometimes radiation
11.6. Pressure Ulcers
11.6.1. Causes: immobilization, poor nutrition, dry/fragile skin
11.6.2. s/s: reddened area usually appearing over bony prominences, edema around affected area, pain
11.6.3. Treatment: frequent turning and dressing changes
11.7. Pruritis
11.7.1. Simple terms: itching
11.7.2. Treatment: keep skin moisturized, use warm not hot water, use of humidifier, and refrain from urge to scratch by using ice packs
12. Psychological
12.1. Activities
12.2. Social changes
12.2.1. shrinking social world
12.2.2. loss of spouse
12.2.3. retirement
12.3. Psychical Changes
12.3.1. graying of hair
12.3.2. elongated ears
12.3.3. diminished stature
12.4. Memory
12.5. Intelligence
12.5.1. Crystallized intelligence (skills, knowledge, and experience) is maintained
12.5.2. Fluid intelligence (new situations) can decline
12.6. Depression/Anxiety
12.6.1. Management: may need medications or therapy, social support, and family involvement
12.7. Dementia
12.7.1. Permanent cognitive impairment
12.7.1.1. Alzheimer's Disease one of most common
12.7.1.1.1. s/s: memory loss, difficulty speaking, disorientation, personality change, paranoia, and hallucinations
12.7.1.1.2. Cause: damage to nerve cells within brain
12.7.1.1.3. Diagnosis: brain scans to evaluate function
12.7.1.1.4. Treatment: medications and therapy, encourage exercise, foster communication, and keep calendar
12.8. Delirium
12.8.1. Temporary cognitive impairment
12.8.2. Causes: infection, intoxications, dehydration, sleep deprivation
12.8.3. s/s: memory change, irrability or anger, restlessness, hallucinations, being quiet and withdrawn
12.8.4. Treatment: treat underlying issue, rehydrate, and implement safety precautions
13. Reproductive
13.1. Men
13.1.1. Reduction in sperm count
13.1.2. Venous and arterial sclerosis of penis
13.1.2.1. Can affect ability to have erection
13.1.3. Enlargement of prostate
13.1.4. Erectile dysfunction
13.1.4.1. Causes: alcoholism, diabetes, hypertension, multiple sclerosis, thyroid conditions, and psychological
13.1.4.2. Treatment: oral erectile agents, drugs injected into penis, penile implants, and vacuum pump devices
13.1.5. Benign Prostatic Hyperplasia
13.1.5.1. s/s: hesitancy, decreased force, frequency, and nocturia
13.1.5.2. Treatment: prostatic massage and use of urinary antiseptics
13.1.5.2.1. Surgery: Transurethral
13.2. Women
13.2.1. Drier/less elastic vagina
13.2.2. Uterus decreases in size
13.2.3. More alkaline vaginal environment
13.2.3.1. Nursing diagnosis: Increased risk for UTI r/t alkaline environment
13.2.4. Atrophic Vaginitis
13.2.4.1. s/s: itching, foul-smelling discharge, postcoital bleeding
13.2.4.2. Treatment: topical estrogen creams and estrogen replacement
13.2.4.2.1. Avoid couches, wear cotton underwear, and keep vagina dry
13.2.5. Cancers of reproductive system (cervix, vagina, endometrium, breasts, ovaries)