Normal Age Related Changes

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Normal Age Related Changes by Mind Map: Normal Age Related Changes

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 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 most common blood clot blocks blood flow to brain s/s: prolonged symptoms of TIA Prevent blood clot formation and atherosclerosis of vessels

2.9.2. Hemorrhagic 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 s/s: urethral burning upon urination, frequency, fever, foul-smelling urine can spread to kidneys Causes: diseases causing urinary retention (Parkinson's, Alzheimers); poor hygiene Treatment: antibiotics, increased fluids

3.3.2. Pneumonia Usually in form of community-aquired s/s: cough with sputum, sharp pain in chest, shortness of breath, fatigue Treatment: vaccine for prevention, antibiotics, breathing treatments,

3.3.3. Herpes Zoster Cause: reactivation of chickenpox in body for many older adults, chickenpox was vaccine not available in childhood Painful rash, blisters, scabs, pain like pins and needles Treatments: pain relief measures, and antiviral medications. Can be prevented in older adults with shingles vaccine

3.3.4. Tuberculosis Bacterial disease affecting lungs spread through coughing/sneezing s/s: cough (sometimes blood-tinged,) fever/night sweats, and weight loss Treatment: long term antibiotics for those with symptoms 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 bleeding may also occur

4.7.2. Diagnosis: barium swallow and esophagoscope

4.7.3. Management: weight loss if applicable bland diet small frequent meals 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: prevention of aspiration adequate nutritional status soft diet and thickening of liquids eat in upright position 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 Can cause protein/glucose in urine

5.6. Increased frequency, urgency, and nocturne

5.7. Urinary Incontinence

5.7.1. Transient Acute and reversible Caused by: infection, delirium, fecal impaction, etc.

5.7.2. Established Chronic and persistant Stress incontinence Urgency incontinence Overflow incontinence Functional incontinence

5.7.3. Treatment: Kegel exercises, biofeedback, and medications 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: Antibiotics Restricted sodium and protein Close attention to fluid intake

5.9. Renal Calculi

5.9.1. "Kidney stones"

5.9.2. Causes: Immobilization Infection Chronic dehydration 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 Nursing responsibility: overuse of bronchodilators in treatment can cause cardiac arrhythmias- monitor for adverse effects with treatment

6.9.2. Chronic bronchitis s/s: productive cough; wheezing; respiratory infections; shortness of breath Patho: results from recurrent inflammation with mucus in bronchial, blocking airflow. Management: Remove bronchial secretions Preventing obstruction of airway Adequate fluid intake Discourage smoking

6.9.3. Emphysema Causes: Chronic bronchitis Irritation from pollutants Distention of alveolar sac Cigarette smoking s/s: Increased dyspnea, chronic cough, fatigue, weight loss, anorexia Treatment: Bronchodilatorss Postural drainage Cessation of smoking 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: chest roengenogram sputum cytology bronchoscopy biopsy

6.10.5. Treatment: Surgery Chemotherapy Radiotherapy

6.11. Lung Abscess

6.11.1. Causes: pneumonia, tuberculosis, cancer, or trauma to lung(s) Also caused by aspiration of foreign material

6.11.2. s/s: anorexia, fatigue, temp. elevation, and chronic cough

6.11.3. Treatment: Postural drainage high-protein/high-calorie diet

7. Cardiovascular

7.1. Arterial wall thickening

7.2. Slight left ventricular hypertrophy

7.2.1. Decreased cardiac reserve 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 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 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 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 Progressive hearing loss 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 decreased peripheral vision depth perception distortion 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 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 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 Alzheimer's Disease one of most common s/s: memory loss, difficulty speaking, disorientation, personality change, paranoia, and hallucinations Cause: damage to nerve cells within brain Diagnosis: brain scans to evaluate function 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 Can affect ability to have erection

13.1.3. Enlargement of prostate

13.1.4. Erectile dysfunction Causes: alcoholism, diabetes, hypertension, multiple sclerosis, thyroid conditions, and psychological Treatment: oral erectile agents, drugs injected into penis, penile implants, and vacuum pump devices

13.1.5. Benign Prostatic Hyperplasia s/s: hesitancy, decreased force, frequency, and nocturia Treatment: prostatic massage and use of urinary antiseptics 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 Nursing diagnosis: Increased risk for UTI r/t alkaline environment

13.2.4. Atrophic Vaginitis s/s: itching, foul-smelling discharge, postcoital bleeding Treatment: topical estrogen creams and estrogen replacement Avoid couches, wear cotton underwear, and keep vagina dry

13.2.5. Cancers of reproductive system (cervix, vagina, endometrium, breasts, ovaries)

14. Bolded and filled in bubbles= Disease processes

15. Reference: Gerontological Nursing, by Charlotte Eliopoulos (2014)