The Older Adult

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The Older Adult by Mind Map: The Older Adult

1. Integumentary

1.1. Thinning of skin

1.2. Loss of subcutaneous tissue

1.3. Drying of skin

1.4. Loss of elastin

1.5. Decrease in ability to regulate temperature

1.5.1. Decreased overall body temperature

1.6. Decrease in lean body mass and water

1.6.1. Increased risk for dehydration

1.7. Delayed wound healing d/t increased vascular fragility

1.8. Hair loss

1.9. Nails become brittle and thick

1.10. Regeneration slows

1.11. Keratinocytes become smaller

1.12. Women have increased facial hair

1.13. Increased age spots

1.14. Pathophysiology

1.14.1. Pressure ulcers No blood supply Increased pressure over bony prominences 4 stages

1.14.2. Keratosis Can be precancerous Treated with freezing agents and acids Small gray or brown lesions on area of exposure

1.14.3. Seborrheic keratosis Dark, wart like Increase in size and number w/ age Benign

1.14.4. Pruritus Caused by excessive bathing/ dry heat Possible cause: atrophy Most common dermatological problem

2. Musculoskeletal

2.1. Loss of bone mass

2.2. Thinking of vertebral disks

2.2.1. Shortening of trunk

2.3. Decreased bone calcium

2.4. Loss of cartilage

2.5. Decreased muscle mass

2.6. Bone mineral density decreases

2.7. Decreased ROM

2.8. Increased body fat

2.9. Pathophysiology

2.9.1. Fractures Trauma Bone cancer Often due to falls PREVENTION

2.9.2. Osteoarthritis Progression of deterioration of joint cartilage Affects most persons over 55 Women are affected more after menopause Joint injury, genetics, obesity

2.9.3. Rheumatoid arthritis Projection of synovial tissue Painful, stiff, red, swollen, warm to touch

2.9.4. Osteoporosis Most prevalent metabolic disease of the bone Demineralization of the bone D/t: inactivity, other diseases, decreased hormone production, diet, medication

3. Cardiovascular

3.1. Dysrhythmias

3.1.1. Increased systolic BP

3.1.2. Increased size of atria

3.2. Cardiac output decreases

3.3. Increased peripheral resistance

3.4. Decreased heart rate

3.5. Decreased stroke volume

3.6. Loss of elasticity of vessels

3.7. Mitral and aortic valves become thick and rigid

3.8. Contractility decreases in response to increase demand

3.9. Pathophysiology

3.9.1. Hypertension Most prevalent cardiovascular disease Vasoconstriction with age Peripheral resistance

3.9.2. Congestive heart failure Edema and poor nutrition of tissues

3.9.3. Pulmonary embolism Increased incidence with fractured hip Often challenging to diagnosis with increased age Shortness of breath, chest pain, cough

3.9.4. Myocardial infarction Increased risk in men with hypertension Tightness or pain in chest, abnormal heart beat, anxiety

4. Respiratory

4.1. Decreased immune response

4.2. Imbalanced perfusion

4.3. Lungs loose elasticity

4.4. Increased demands for oxygen

4.5. Increased breaths

4.6. Decreased alveolar surface area

4.7. Decreased ability to clear mucus secretion

4.8. Decreased cilia

4.9. Decreased ability to cough and deep breathe

4.10. Pathophysiology

4.10.1. Asthma Wheezing, chest pain,shortness of breath

4.10.2. Chronic bronchitis Persistent productive cough, shortness of breath, often takes years to be diagnosed

4.10.3. Emphysema Cigarette smoking Air sacs are damaged / enlarged Air is abnormally present in body tissues

5. Gastrointestinal

5.1. Decreased saliva and dry mouth

5.2. Dental caries, loss of teeth

5.3. Decreased ability to chew food

5.4. Decreased hunger sensations

5.5. Loss of taste buds

5.6. Increased risk of GERD and aspiration

5.6.1. Relaxation of lower esophageal sphincter

5.6.2. Sliding hiatal hernia

5.7. Delayed gastric emptying

5.8. Weigh loss

5.9. Decreased peristalsis

5.10. Decreased absorption in small intestine

5.11. Production of Pepsin and hydrochloride acid decreases

5.12. Decreased enzyme production in liver

5.12.1. Affects drug metabolism

5.12.2. Affects detoxification process

5.13. Pathophysiology

5.13.1. Dysphagia Difficulty swallowing Changes in diet

5.13.2. Hiatal hernia May be caused by high fiber diet Surgically fixed

5.13.3. Peptic ulcer D/t stress and diet Complication of chronic diseases

5.13.4. Diverticular disease Multiple pouches of mucosa Avoid seeds and acidity in diet

6. Genitourinary

6.1. Size and weight of kidney decrease

6.2. GFR decreases d/t decrease in renal blood flow

6.3. Drug metabolism decreased

6.4. Tubular function diminishes

6.5. Risk for reflux of urine into the ureters

6.6. Bladder capacity decreases

6.6.1. Increased urinary frequency

6.6.2. Nocturia

6.7. Increase frequency and dribbling

6.7.1. Weakened bladder

6.7.2. Enlarged prostate in men

6.8. Prostatic enlargement

6.8.1. Urinary retention

6.8.2. Bladder infection

6.9. Women experience stress incontinence

6.10. Pathophysiology

6.10.1. Urinary Incontinence Stress, urgency, overflow, neurological, functional, mixed

6.10.2. Renal calculi Stones resulting from immobilization, infection, changes in pH of urine

6.10.3. Glomerulonephritis Older adult w/ acute condition Inflammation of kidney due to immune response

7. Reproductive

7.1. Ovarian function decreases

7.2. Breast tissue decreases

7.3. Ovaries and uterus atrophy

7.4. Perineal muscle weakness

7.5. Atrophy of vulvla

7.6. Vaginal mucus membrane: becomes dry, decreases in elasticity, reduced secretions which may lead to painful intercourse

7.7. Testes atrophy and soften

7.8. Prostate enlargement due to changes in testosterone

7.9. Erection can be less firm and shorter

7.10. Decreased force with ejaculation

7.11. Pathophysiology

7.11.1. Benign prostatic hyperplasia In men, often have dysuria and dribbling

7.11.2. Atrophic vaginitis Reduction in collagen and adipose tissue Shortening and narrowing of vaginal canal Easily irritated

7.11.3. New Topic

7.12. Women experience menopause

8. Neurologic

8.1. Decrease in neurons and neurotransmitters — do not regenerate

8.2. Decrease in CNS and PNS function

8.3. Intelligence remains consistent

8.4. Performance of tasks is slower

8.5. Decrease in tactile sensitivity

8.6. Loss of connection in nerve ending in the skin

8.7. Loss of proprioception— affects balance

8.8. Pathophysiology

8.8.1. Parkinson’s disease Central nervous system can no longer control body movements Decreased dopamine production More common in men

8.8.2. TIA reduction in cerebral blood flow Increased risk for CVA

8.8.3. CVA Risk factors: hypertension, arteriosclerosis, diabetes, gout, anemia, hypothyroidism, silent MI, TIA, dehydration, smoking

9. Endocrine

9.1. Glands atrophy

9.2. Decreased rate of secretion of hormones

9.3. Thyroid activity decreases

9.4. Metabolic rate slows

9.5. Cessation of estrogen with menopause

9.6. Reproductive organs atrophy in women

9.7. Gonadal secretion of progesterone and testosterone decrease

9.8. T4 and T3 metabolic clearance rates decreases

9.9. Pathophysiology

9.9.1. Diabetes Insulin production decreases or insulin resistance increases

9.9.2. Hypothyroidism Decrease tissue use of hormones More common in women

9.9.3. Hyperthyroidism Thyroid excretes excess amount Weight loss, irregular heart beat

10. Sensory

10.1. Loss off cells in olfactory bulb

10.2. Decrease in sensory cells

10.3. Sensitivity to smell declines

10.4. Taste perception decreases

10.5. Tear production decreases

10.6. Cataracts can form

10.6.1. Abnormal progressive clouding or opacity of the lens in the eye

10.7. Marcus senilis

10.7.1. Partial or co,Pete white ring encircles the periphery of the cornea

10.8. Hearing of high pitch sounds decrease

10.9. Discrimination of times diminishes

10.10. Pathophysiology

10.10.1. Detached retina Forward displacement of retina Causes spots or floaters

10.10.2. Hearing deficits Hearing aids

10.10.3. Glaucoma Optic nerve damage

10.10.4. Macular degeneration

10.10.5. Corneal ulcer Inflammation of cornea

11. Needs

11.1. Nutrition

11.1.1. Less lean body mass

11.1.2. Do not burn calories as quickly

11.1.3. Activity level usually slower

11.1.4. Calories needs decrease

11.1.5. Fiber is important for bowel function

11.1.6. Nutritional supplements may be needed

11.1.7. Pathophysiology Anoxeria Familial losses, stress Dysphagia Constipation Slowed peristalsis, inactivity, drug metabolism , less fiber and fluid in diet

11.2. Sleep

11.2.1. Stages 3 and 4 less prominent

11.2.2. Nocturia

11.2.3. Insomnia

11.2.4. Napping

11.2.5. Sleep apnea

11.2.6. Restless leg syndrome

11.2.7. Nocturnal myoclonus

11.3. Sexuality

11.3.1. More interest in religion

11.3.2. Older women experience painful intercourses

11.3.3. Age spots

11.3.4. Arthritic joints

11.3.5. Loss of muscle tone

11.3.6. Graying and loss of hair

11.3.7. More women than men with increased age

11.4. Spirituality

11.4.1. Need to feel they are cared for

11.4.2. Hope, forgiveness of past relationships, expression of faith

11.4.3. New involvement in community or group home