The Older Adult

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The Older Adult by Mind Map: The Older Adult

1. Cardiovascular System

1.1. Age-Related Changes

1.1.1. Heart dimensions unchanged

1.1.2. Lost efficiency and contractile strength

1.1.3. Reduced cardiac output with physiologic stress

1.1.4. Valves become thick and rigid

1.1.5. Reduced elasticity in blood vessels

1.1.6. Oxygen used less efficiently

1.1.7. Increased blood pressure

1.2. Abnormal Processes

1.2.1. Congestive Heart Failure Description Due to a number of combined factors, the heart muscle begins to fail/cannot keep up with the workload demanded by the body Leading cause of hospitalization in older adults Pathophysiology Commonly a complication of arteriosclerotic heart disease Coronary artery disease is responsible for most cases Reduced elasticity and lumen size of vessels + rises in blood pressure interfere with blood supply to heart muscle Signs/Symptoms Shortness of breath Dyspnea on exertion Confusion Insomnia Agitation Orthopnea Wheezing Weight gain Edema Nursing Interventions Assess ability to perform ADLs Administer oxygen as prescribed Educate importance of exercise as tolerated Smoking Review symptoms which must be reported

2. Gastrointestinal System

2.1. Age-Related Changes

2.1.1. Taste sensations are less acute

2.1.2. Decreased esophageal motility

2.1.3. Atrophy of the small and large intestines

2.1.4. Increased risk of aspiration, indigestion, and constipation

2.1.5. Impaired absorption of certain vitamins and nutrients

2.2. Abnormal Processes

2.2.1. Hiatal Hernia Description Sliding (Axial) Rolling (Paraesophageal) Pathophysiology Weakness in the diaphragm allows for the opening to stretch, allowing parts of the stomach/esophagus to advance upwards Often leads to a reflux of stomach acid into the esophagus, and trapping since it cannot move back down into the stomach Signs/Symptoms Heartburn Dysphagia Belching Vomiting/regurgitation Pain Bleeding Treatment/Management Barium swallow and esophagoscopy confirm diagnoses Weight reduction can minimize problem in overweight patients Bland diet recommended Antacids and H2 blockers can be helpful for symptom relief Nursing Interventions Educate regarding diet Instruct pt to eat slowly and sit upright during/1 hr post-meal Avoid heavy lifting, bending, wearing girdles or tight pants, coughing/sneezing strenuously

3. Urinary System

3.1. Age-Related Changes

3.1.1. Decline of renal blood flow Glomerular filtration by approximately 50% by age 90 Affects ability to eliminate drugs High BUN levels

3.1.2. Reduced bladder capacity Urinary frequency Urinary urgency Nocturia

3.1.3. Inefficient neurological control of bladder emptying and weaker bladder muscle Retention of large volumes of urine could be caused by: Female: fecal impaction Male: prostatic hypertrophy

3.2. Abnormal Processes

3.2.1. Incontinence - not a normal part of aging Stress Caused by weak supporting pelvic muscles Laughing, sneezing, coughing, etc. can cause involuntary loss of urine Obesity contributes to this problem Treatment/Interventions Urgency Caused by UTI, enlarged prostate, diverticulitis, pelvic/bladder tumors Irritation or spasms of the bladder wall cause sudden loss of urine Treatment/Interventions Overflow Caused by bladder neck obstructions, certain medications Treatment/Interventions Neurogenic/Reflex Caused by cerebral cortex lesions, MS, or other neural pathway disturbances Treatment/Interventions Functional Caused by a functional inability to reach the bathroom Treatment/Interventions General Incontinence Important Factors to Assess Positive reinforcement and encouragement are extremely beneficial

4. Nervous System

4.1. Age-Related Changes

4.1.1. Decline in weight and blood flow to the brain This does not affect thinking/behavior

4.1.2. Reduction in neurons, nerve fibers, and cerebral blood flow

4.1.3. Hypothalamus less effective in temperature regulation Lower body temperature is the norm

4.1.4. Changes in sleep patterns More time spent in stages I and II of sleep, less time in stages III and IV

4.1.5. Slowing in central processing Delay in time required to perform tasks

4.1.6. Number/sensitivity of sensory receptors, dermatomes, and neurons decrease This dulls tactile sensation

4.1.7. Decline in function of cranial nerves affecting taste and smell

4.2. Abnormal Processes

4.2.1. Parkinson's Disease Description Affects the ability of the central nervous system to control body movements Pathophysiology Exact cause is not understood Dopamine receptors in the brain are no longer properly stimulated; dopamine is not conserved properly Signs/Symptoms Bradykinesia: slowing of movements Tremors at rest Rigidity due to an involuntary increase in muscle tone Loss of balance Shuffling gait Hallucinations Treatment/Management Anticholinergic medications Dopamine simulators Technology to control symptoms Nursing Interventions Goal: preserve patient's independence as much as possible Education Allow for extra time to complete tasks or answer questions

5. Endocrine System

5.1. Age-Related Changes

5.1.1. Thyroid gland atrophies, leading to decrease of activity

5.1.2. ACTH secretion decreases This leads to an increase in blood pressure

5.1.3. Pituitary gland activity decreases

5.1.4. Insulin release by beta cells is delayed and can be insufficient Reduced tissue sensitivity to circulating insulin Higher blood glucose in non diabetic patients

5.1.5. Ability to metabolize glucose is reduced

5.2. Abnormal Processes

5.2.1. Hypothyroidism Description A pathologic reduction in serum levels of hormones T3 and T4 Pathophysiology Primary Secondary Signs/Symptoms Fatigue, weakness, lethargy Depression and disinterest in activities Anorexia Weight gain and puffy face Impaired hearing Periorbital or peripheral edema Constipation Cold intolerance Myalgia, paresthesia, and ataxia Dry skin and coarse hair Treatment/Management Replacement of thyroid hormone using synthetic T4 Nursing Interventions Regular monitoring of symptoms Education Assist with symptom management

6. Integumentary System

6.1. Age-Related Changes

6.1.1. Hair loss/graying

6.1.2. Loss of tissue elasticity Elongated ears Baggy eyelids Double chin

6.1.3. Wrinkles

6.1.4. Loss of subcutaneous fat

6.2. Abnormal Processes

6.2.1. Pressure (Decubitus) Ulcers Description Stage I: persistent area of unblancheable red skin; no break in skin Stage II: Partial thickness loss of skin layers; involves the epidermis Stage III: Full thickness of skin is lost; extends through the epidermis, exposing subcutaneous tissues Stage IV: Full thickness of skin and subcutaneous tissue lost; exposed muscle, bone, or both presenting as a deep crater than may include necrotic tissue or educate Pathophysiology When the skin/flesh over a bony prominence undergoes continuous pressure or shearing, this can result in tissue anoxia/ischemia Common at sacrum, coccyx, ischium, knees, elbows, heels, occiput Nursing Interventions PRIORITY: prevention Avoid unrelieved pressure

7. Respiratory System

7.1. Age-Related Changes

7.1.1. Calcification of costal cartilage and trachea Rib cage becomes more rigid Increased residual capacity Reduced vital capacity

7.1.2. Reduction of cough and laryngeal reflexes

7.1.3. High risk for respiratory infections

7.2. Abnormal Processes

7.2.1. Pneumonia Higher risk due to age-related changes; not a normal process Pathophysiology Signs/Symptoms Treatment/Management Nursing Interventions

8. Musculoskeletal System

8.1. Age-Related Changes

8.1.1. Thinning disks and shortened vertebrae Loss of height

8.1.2. Reduced muscle mass, strength, and movement

8.1.3. Decreased bone mineral and mass

8.1.4. Diminished calcium absorption

8.1.5. Increased risk of fractures

8.2. Abnormal Processes

8.2.1. Osteoporosis Risk Factors Advanced age Ethnicity - white women with a northwestern European or British Isles background, Asian women Calcium deficiency Vitamin D deficiency Small-framed, thin women Hx of early menopause Estrogen deficiency Cigarette smoking High alcohol consumption Prolonged immobility Family hx of osteoporosis Pathophysiology Any health problem associated with inadequate calcium intake, excessive calcium loss, or poor calcium absorption can cause osteoporosis Signs/Symptoms May cause kyphosis May cause a reduction in height Spinal pain, especially in lumbar region Bones tend to fracture more easily Often asymptomatic, pts can be unaware of the problem until detected by radiography Treatment/Management Depends on underlying cause of disease Calcium supplements Vitamin D supplements Selective estrogen receptor modulators Hormone therapy Diet rich in calcium and protein Nursing Interventions Advise the patient to avoid heavy lifting, jumping, and other activities with risk for fracture Be gentle when providing care for these patients; moving, exercising, or lifting them can cause fractures Range-of-motion exercises and ambulation are important to maintain function and prevent greater damage

9. Sensory Changes

9.1. Vision

9.1.1. Age-Related Changes Presbyopia (far-sightedness) Narrowing of the visual field leads to decreased peripheral vision Pupil size reduction and less reaction to light Depth perception distortion Decline in visual acuity

9.1.2. Abnormal Processes Chronic Glaucoma Description Pathophysiology Signs/Symptoms Treatment/Management Nursing Interventions

9.2. Hearing

9.2.1. Age-Related Changes Presbycusis = progressive loss of hearing Distortion of high-pitched sounds Cerumen increases: affecting hearing Alteration in equilibrium

9.2.2. Abnormal Processes Impaired hearing should not be assumed a normal process of aging; requires attention and audiometric examination Pathophysiology Impacted cerumen Cysts Vascular problems inside of the ear Viral infections Otitis media Tinnitus: ringing in the ears Signs/Symptoms Pt reports difficulty in understanding Volume on devices is consistently turned up higher than necessary for those with appropriate hearing These may vary based on the cause of hearing loss Treatment/Management Depending on the cause, treatments can vary Hearing Aids Nursing Interventions Provide education through visual and tactile aids as well Speak more slowly and clearly, ensure lips are visible for those who lip-read Practice patience while teaching

9.3. Taste and Smell

9.3.1. Age-Related Changes Taste acuity is dependent on smell Atrophy of the tongue Decreased saliva Poor oral hygiene Certain medications Sense of smell altered with age

9.4. Touch

9.4.1. Age-Related Changes Reduction of tactile sensation Reduced ability to sense pressure, discomfort, change in temperature

10. Immune System

10.1. Age-Related Changes

10.1.1. Depressed immune response T-cell activity declines Reduced response to foreign antigens Thymus gland decreases in size Increased number of immature T-cells Cell-mediated immunity declines Inflammatory defenses decline; inflammation presents atypically Reduced antibody response Decreased number of Langerhans cells in the skin Reduced thickness of skin Decreased circulation in skin

10.1.2. Risk for infection becomes significant