1. Renal and GU
1.1. decrease in drug clearing
1.1.1. decrease in ability of kidney filtration
1.2. decrease in kidney size
1.3. decrease in GFR rate
1.4. decrease in bladder capacity
1.5. prostate enlargement in men
1.5.1. increase risk for BPH
1.6. hypertrophy and thickening of bladder muscle
1.7. changes in cortical control of micturition
1.7.1. nocturia
1.8. decreased tubular function
1.9. increase in renal threshold for glucose
1.10. Common disease processes
1.10.1. Urinary incontience
1.10.1.1. stress, urgency, overflow, neurogenic, functional, mixed
1.10.2. Renal calculi
1.10.2.1. small, hard stone in kidney
1.10.2.2. painful when passing
1.10.3. Glomerulonephritis
1.10.3.1. acute inflammation of kidneys
1.10.3.2. chronic and acute
1.10.3.3. s/s: hematuria, proteinuria, hypertension, edema
2. Gastrointestinal
2.1. atrophy of the tongue
2.1.1. decreased taste sensation
2.2. decrease in saliva production
2.2.1. swallowing can be difficult
2.3. prebyesophagus
2.3.1. weaker esophageal contractions
2.3.2. weakens sphincter
2.4. esophageal and stomach motility decreases
2.4.1. risk for aspiration and indigestion
2.5. decreased elasticity of the stomach
2.5.1. reduction in amount of food accommodation at one time
2.6. decline in hydrochloric acid and pepsin
2.6.1. stomach has higher pH
2.6.2. gastric irritation
2.6.3. interferes with absorption of calcium, iron, folic acid, and vitamin b12
2.6.4. interferes with absorption of protein
2.7. fewer cells on absorbing surface of intestinal wall
2.7.1. impact absorption of dextrose, xylose, and vitamin B and D
2.8. slower peristalsis, inactivity, reduced food/fluid intake, drugs, and low-fiber diet
2.8.1. risk of constipation
2.9. sensory perception decreases
2.9.1. constipation or incomplete emptying of bowel
2.10. decrease synthesis of bile salt
2.10.1. risk of gallstones
2.11. digestion of fats affected by pancreas changes
2.12. Common disease processes
2.12.1. Dysphagia
2.12.1.1. difficult in swallowing
2.12.2. Chronic constipation
2.12.3. Colorectal cancer
2.12.3.1. changes in bowel consistency
2.12.3.2. s/s: bloody stool and abdominal pain
2.12.4. GERD
2.12.4.1. acid reflex causing heartburn
2.12.5. Hiatal hernia
2.12.5.1. part of stomach protrudes into diaphragm
2.12.6. Peptic ulcer disease
2.12.6.1. sore in the lining of stomach, small intestine or esophagus
2.12.6.2. upper abdominal pain is main symtpom
3. Musculoskeletal
3.1. decline in size and number of muscle fibers
3.1.1. decreased body strength
3.1.2. decline in endurance
3.2. reduction in muscle mass
3.3. connective tissue changes
3.3.1. reduced flexibility
3.4. decrease bone strength
3.5. common musculoskeletal conditions
3.5.1. fractures
3.5.1.1. s/s: swelling, brusing, deformity
3.5.2. osteoarthritis
3.5.2.1. s/s: joint pain, stiffness, swelling
3.5.3. rheumatoid arthritis
3.5.3.1. s/s: painful swelling, stiffness, weakness
3.5.4. osteoporosis
3.5.4.1. s/s: bone fractures, loss of height
3.5.5. Gout
3.5.5.1. uric acid build up--kidney stones
3.5.5.2. painful passage
4. Immune system
4.1. decline in size of thymus
4.2. increased number of immature T cells
4.3. T cell function decreaes
4.3.1. reduced response to foreign antigens
4.3.2. decrease in cell-mediated and humoral immunity
4.4. reduced antibody response
4.5. decreaed number of langerhans cells
4.6. reduced thickness and decreased circulation of the skin
4.7. immunologic heal promotion
4.7.1. diet
4.7.2. exercise
4.7.3. immunizations
4.7.4. stress managment
4.7.4.1. could have stress-related diseases
4.7.4.1.1. ex. hypertension can be a result of stress
4.7.5. mind-body connection
4.7.6. careful use of antibiotics
5. Integumentary
5.1. flattening of the dermal-epidermal junction
5.2. reduced thickness and vascularity of the dermis
5.3. reduction of epidermal turnover
5.4. degeneration of elastic fibers
5.5. increased coarseness of collage
5.6. reduction in melanocytes
5.7. atrophy of hair bulbs and decline in the rate of hair and nail growth
5.8. increased fragility of the skin
5.9. common problems
5.9.1. puritis
5.9.1.1. itching which increases potential for skin breakdown and infection
5.9.2. keratosis
5.9.2.1. acne like bumps on skin
5.9.3. skin cancer
5.9.3.1. basal cell carcinoma
5.9.3.2. squamous cell carcinoma
5.9.3.3. melanoma
5.9.3.4. monitor for changes in moles, moles with irregular borders, "growing" moles
5.9.4. stasis dermatitis
5.9.4.1. s/s: itching, thickened skin, broken skin
5.9.5. pressure ulcers
5.9.5.1. nercosis, sloughing, and tissue ulcerations
5.9.5.2. prevention is the priority intervention
6. Endocrine
6.1. thyroid gland atrophies and activity decreases
6.2. adrenal function decreases
6.3. secretion of ACTH decreases
6.4. decrease volume of pituitary gland
6.5. insufficient release of insulin
6.6. reduced tissue sensitivity to circulating insulin
6.7. common disease processes
6.7.1. Diabetes Mellitus
6.7.1.1. screening, monitoring, and good control of disease is very crucial
6.7.1.2. s/s: polyuria, polydipsia, polyphagia
6.7.2. hypothydroidism
6.7.2.1. s/s: everything slows down
6.7.3. hyperthyrodism
6.7.3.1. s/s: everything speeds up
7. Cardiovascular
7.1. thicker and rigid heart valves
7.2. dilated aorta
7.2.1. slight ventricular hypertrophy
7.2.2. thickening of left ventricular wall
7.3. less efficient myocardial muscle
7.3.1. decreased contractile strength
7.3.2. when demands are increased, CO decreased
7.4. reduced elasticity and calcification of vessels
7.4.1. decreased compliance
7.5. less sensitive to baroreceptor regulation of Blood pressure
7.6. strong arterial pulses, diminished peripheral pulses
7.6.1. cool extremities
7.7. Common disease processes
7.7.1. Hypertension
7.7.1.1. BP of 140/90 on 3 separate occasions
7.7.1.2. s/s: headache, impaired memory, disorientation, confusion, tremors
7.7.2. Congestive Heart failure
7.7.2.1. complication of arteriosclerosis
7.7.2.2. s/s: SOB, dyspnea on exertion, confusion, insomnia, orthopnea, wheezing, edema, weight gain
7.7.3. Coronary artery disease
7.7.3.1. ischemic heart disease
7.7.4. Hyperlipidemia
7.7.4.1. elevated total cholesterol
7.7.5. Arrythmias
7.7.5.1. irregular heart beat
7.7.5.2. s/s: weakness, fatigue, palpitations, confusion, dizziness, hypotension, bradycardia
8. Respiratory
8.1. Decreased respiratory muscle strength
8.2. stiffer chest wall
8.2.1. reduced compliance
8.3. reduced cough reflex
8.4. reduction in lung size and weight
8.5. decreased elastic recoil
8.6. less elastic alveoli
8.7. reduction in vital capacity
8.8. increased residual volume
8.9. drier mucous membranes
8.10. decreased response to hypercapnia and hypoxia
8.11. Common disease processes
8.11.1. COPD
8.11.1.1. group of diseases
8.11.1.1.1. Asthma
8.11.1.1.2. Chronic bronchitis
8.11.1.1.3. Emphysema
8.11.2. Lung cancer
8.11.2.1. s/s: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, resp. infections
8.11.3. Lung abcess
8.11.3.1. s/s: anorexia, weight loss, elevated temp, chronic cough
8.11.4. smoking common risk
8.11.5. Pulmonary Emboli
8.11.5.1. blood clot in pulmonary system
8.11.5.2. s/s: confusion, SOB, elevated temp
9. Nervous system and Cognition
9.1. loss of nerve cell mass
9.1.1. atrophy of brain and spinal carod
9.1.2. decrease in weight of brain
9.2. decreased number of dendrites
9.3. demyelinization
9.3.1. slower nerve conduction
9.3.2. slower reaction times
9.3.3. weaker reflexes
9.4. plaques, tangles, atrophy of brain
9.5. accumulation of free radicals
9.6. decrease in cerebral blood flow
9.7. fatty deposits accumulate in blood vessels
9.8. decline in ability to compensate
9.9. slowing in central processing
9.10. decrease in number and sensitivity of sensory receptors, dermatomes, and neurons
9.10.1. tactile sensation dulls
9.11. decline in function of cranial nerves
9.11.1. affects taste and smell
9.12. common disease processes
9.12.1. parkinsons disease
9.12.1.1. s/s: rigidity, bradykinesia, tremors, shuffling gait
9.12.2. TIAs
9.12.2.1. mini-strokes that last minute to hours
9.12.3. CVAs
9.12.3.1. paralysis, trouble waling, trouble talking
10. Sensory
10.1. Vision
10.1.1. reduced elasticity and stiffening of the muscle fibers of the lens
10.1.1.1. presbyopia
10.1.1.1.1. decreased ability to focus
10.1.2. reduction in pupil size
10.1.3. opacification of the lens and vitreous
10.1.3.1. decline in visual acuity
10.1.4. loss of photoreceptor cells in the retina
10.1.4.1. decrease in light perception threshold
10.1.4.2. longer time to adapt to dark and light
10.1.4.3. difficult with vision at night
10.1.5. increased sensitivity to glare
10.1.6. distortion in depth perception
10.1.7. reduced peripheral vision
10.2. hearing
10.2.1. sensorineural hearing loss
10.2.2. impacted cerumen
10.3. common disease processes
10.3.1. cataracts
10.3.1.1. blurry vision
10.3.2. glaucoma
10.3.2.1. slow vision loss
10.3.3. presbycusis
10.3.3.1. decrease ability to hear high pitched sounds
11. Reproductive
11.1. Male
11.1.1. thinner epthlium of seminal vesicles
11.1.2. decreased ability to retain fluids
11.1.3. increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of lumen of seminiferous tubules
11.1.4. atrophy of testes
11.1.5. less live sperm
11.1.6. harder time to achieve an erection
11.1.7. enlargement of prostate
11.1.8. common disease processes
11.1.8.1. erectile dysfunction
11.1.8.1.1. impotenence
11.1.8.2. Benign prostatic hyperplasia
11.1.8.2.1. s/s: dribbling, increased frequency, increased urge, reduced kidney function, nocturia
11.1.8.3. prostate cancer
11.1.8.3.1. usually asympotomatic
11.2. Female
11.2.1. hormonal changes
11.2.1.1. vulva atrophies
11.2.1.2. flattening of labia
11.2.1.3. loss of subcutaneous fat and hair
11.2.2. vaginal epithelium thins
11.2.3. cervix, uterus, and fallopian tubes atrophy
11.2.4. shortening and narrowing of vaginal canal
11.2.5. less lubrication of vagina
11.2.6. more alkaline vaginal pH
11.2.7. decrease in size of uterus and ovaries
11.2.8. breasts sag and less firm
11.2.9. cervix becomes smaller
11.2.10. common disease processes
11.2.10.1. infections of the vulva
11.2.10.1.1. senile vulvitis
11.2.10.1.2. more fragile and more susceptible
11.2.10.1.3. s/s of infections: smelly odor, fever, discharge
11.2.10.2. atrophic vaginitis
11.2.10.2.1. occurs in postmenupasual
11.2.10.2.2. can lead to discomfort in sexual activity
11.2.10.3. cancer of cervix and endometrium
11.2.10.3.1. postmenopasual bleeding
11.2.10.4. cancer of ovaries
11.2.10.4.1. leading cause of death from gynecologic maligancies
11.2.10.4.2. s/s: pain in abdomen, changes in bowel habits, weight loss
11.2.10.5. dyspareunia
11.2.10.5.1. painful intercourse
11.2.10.6. breast cancer
11.2.10.6.1. encourage regular breast exams
11.2.10.6.2. s/s: discomfort, lump in breast, discharge from nipple