1. Reproductive System
1.1. Age Related Changes
1.1.1. Male
1.1.1.1. Fluid training capacity of seminal vesicles reduced
1.1.1.2. Possible reduction in sperm count
1.1.1.3. Venous arterial sclerosis of penis
1.1.1.4. Prostate enlarges in most men
1.1.2. Female
1.1.2.1. Fallopian tubes atrophy and shorten
1.1.2.2. Ovaries become smaller and thicker
1.1.2.3. Cervix becomes smaller
1.1.2.4. Drier, less elastic vaginal canal
1.1.2.5. Flattening of labia
1.1.2.6. Endocervical epithelium atrophied
1.1.2.7. Uterus becomes smaller
1.1.2.8. Endometrium atrophied
1.1.2.9. Alkaline vaginal environment
1.1.2.10. Loss of vulvar subcutaneous fat and hair
1.2. Male
1.2.1. Health promotion
1.2.1.1. Men with prostatic hypertrophy be examined every 6 months
1.2.1.2. Routine prostate specific antigen testing in men with no hx of prostate cancer is not recommended
1.2.1.3. Complete history and physical exam
1.2.2. Prostatitis
1.2.2.1. patho: swelling of the prostate caused by UTI
1.2.2.2. Signs and Symptoms: fever, chills, lower stomach tenderness, body aches, flushing of skin
1.2.2.3. Treatment
1.2.2.3.1. antibiotics
1.2.3. Erectile Dysfunction
1.2.3.1. cannot keep erection or firm during sex
1.2.3.2. may be from medications or illness
1.3. Female
1.3.1. Health promotion
1.3.1.1. Annual gynecological exam
1.3.1.1.1. Pap smear
1.3.1.1.2. Knowledgeable about self breast examination
1.3.1.2. Complete history and physical exam
1.3.2. Reproductive conditions
1.3.2.1. Vaginitis
1.3.2.1.1. Increased fragility of vagina in post menopausal women cause it to be more easily irritated
1.3.2.1.2. s/s: soreness, pruritus, burning, reddened vagina accompanied by foul smelling vaginal discharge
1.3.2.1.3. Tx: local estrogens in suppository or cream form
1.3.2.1.4. Advise to avoid douching and perfumed soaps and sprays on genitalia
1.3.2.2. Cancer of the cervix
1.3.2.2.1. Signs: cervical bleeding and luekorrhea
1.3.2.2.2. Can develop urinary retention, incontinence (urine and fecal), uremia
1.3.2.2.3. Tx: radium or surgery
1.3.2.2.4. 65 and older can stop cervical cancer screening as long as it was done regularly past 10 years and no serious precancers
1.3.2.3. Menopause
1.3.2.3.1. permanent cessation of menses
1.3.2.3.2. awakening of body, mind and spirit
2. Respiratory
2.1. Emphysema
2.1.1. Patho
2.1.1.1. Abnormal permanent enlargement of air spaces distal to the terminal bronchioles with destruction of alveolar walls.
2.1.2. Signs and symptoms: slow onset, increased dyspnea, chronic cough, hypoxia, fatigue, weight loss
2.1.3. Treatment
2.1.3.1. Postural drainage
2.1.3.2. Bronchodilators
2.1.3.3. Avoidance of stressful situations
2.1.3.4. Breathing exercises
2.1.3.5. Cessation of smoking cigarettes
2.2. Pneumonia
2.2.1. Leading cause of death
2.2.2. 2 types
2.2.2.1. Pneumococcal pneumonia
2.2.2.2. Gram-negative bacilli causing
2.2.3. Patho
2.2.3.1. Patient inhales or aspirates a pathogen, such as bacteria or a virus. Lungs' defense mechanisms are impaired
2.2.4. Signs and symptoms: pleuritic pain (amy not be as severe as youth), temperature (minimal or no fever), slight cough, fatigue, rapid respiration
2.3. Influenza
2.3.1. Patho
2.3.1.1. Destroys ciliated epithelial cells of respiratory tract and depresses mucociliary clearance. Acquired through inhalation of infected droplets
2.3.2. Signs and symptoms: fever, myalgia, sore throat, nonproductive cough
2.3.3. Prevention
2.3.3.1. Annual influenza vaccine
2.4. Age Related Changes
2.4.1. PO2 reduced as much as 15% between ages 20 and 80
2.4.2. Loss of elasticity and increased rigidity
2.4.3. Decreased ciliary action
2.4.3.1. Complicates ability to expel mucous and debris
2.4.4. Forced expirations volume reduce
2.4.5. Blunting of cough and laryngeal reflexes
2.4.6. By 90 years old, approximately 50% increase in residual capacity
2.4.7. Alveoli fewer in number and larger in size
2.4.8. Thoracic muscles more rigid
2.4.9. Reduced basilar inflation
2.4.10. Residual volume increases, vital capacity is reduced
2.4.11. Connective tissue changes
3. GI
3.1. Peptic ulcer
3.1.1. Patho: imbalance between factors that can damage the gastroduodenal mucosal lining and defense mechanisms that normally limit injury
3.1.2. Signs and symptoms: pain, bleeding, obstruction, perforation
3.1.3. Treatment
3.2. Dysphagia
3.2.1. Patho
3.2.1.1. Anything that impacts several cranial nerves or muscles of face, mouth, pharynx, esophagus causes dysphagia
3.2.2. Signs and symptoms: occasional difficulties swallowing certain types of food, complete inability to swallow
3.2.3. Treatment
3.2.3.1. Referral to speech language pathologist
3.2.3.2. Soft diet and thickening of liquids
3.2.3.3. eat in upright position
3.2.3.4. Ingest small bites in a non-hurried manner
3.3. Hiatal Hernia
3.3.1. Patho: displacement of the gastroesophageal junction above the diaphragm decreases the lower esophageal sphincter
3.3.2. signs and symptoms: heartburn, dysphagia, belching, vomiting, regurgitation
3.3.3. Treatment
3.3.3.1. Managed medically
3.3.3.2. If obese, lose weight
3.3.3.3. Bland diet
3.3.3.4. Milk and antacids for symptom relief
3.3.3.5. several small meals a day
3.3.3.6. H2 blockers
3.3.3.6.1. Ranitidine, cimetidine, nizatine
3.3.3.7. proton pump inhibitors
3.3.3.7.1. Lansoprazole, omeprazole
3.4. Colorectal Cancer
3.4.1. Cancer at any site along the large intestine
3.4.2. Signs and symptoms: rectal bleeding, bloody stools, change in bowel pattern, anorexia, nausea, anemia, abdominal discomfort, pain over affected region
3.4.3. Treatment
3.4.3.1. surgery to remove the cancer
3.4.3.2. chemotherapy
3.4.3.3. radiation
3.5. Age Related Changes
3.5.1. Decreased taste sensation
3.5.2. Esophagus more dilated
3.5.3. Reduced saliva and salivary ptyalin
3.5.4. Liver smaller in size
3.5.5. Reduced intestinal blood flow
3.5.6. Decreased esophageal motility
3.5.7. Atrophy of gastric mucosa
3.5.8. Decreased stomach motility, hunger contraction, emptying time
3.5.9. Less production of hydrochloric acid, Pepsin, lipase, and pancreatic enzymes
3.5.10. Fewer cells on absorbing surface of intestine
3.5.11. Slower peristalsis
4. Mobility (Musculoskeletal)
4.1. Osteoarthritis
4.1.1. Patho: progressive deterioration of the joint cartilage with the formation of new bone at the joint surface.
4.1.2. Signs and symptoms: Crepitation on joint motion may be noted, Joints more uncomfortable during damp weather and extended use
4.1.2.1. Systemic symptoms not present
4.1.3. Treatment
4.1.3.1. Analgesics to control pain
4.1.3.2. Acetaminophen first drug of choice
4.1.3.3. Rest
4.1.3.3.1. Splints, braces, canes
4.1.3.4. Heat or Ice
4.1.3.5. T’ai chi
4.1.3.6. Aqua therapy
4.1.3.7. Gentle massage
4.1.3.8. Acupuncture
4.1.3.9. Diet high in cold water fish. Vitamins A,B,B6,C and E, zinc, selenium, niacinamide, calcium, magnesium help in controlling symptoms
4.1.3.10. Weight reduction
4.1.3.11. If treatments fail: arthoplasty
4.2. Rheumatoid Arthritis
4.2.1. Patho
4.2.1.1. Synovium becomes hypertrophied and edematous with projections of synovial tissue protruding into the joint cavity
4.2.2. Signs and symptoms: joint pain (during rest and activity, fatigue, malaise, weakness, weight loss, wasting, fever, anemia
4.2.3. Treatment
4.2.3.1. Rest and support to effected limbs
4.2.3.2. Range of motion exercises
4.2.3.3. Anti-inflammatory agents
4.2.3.4. Disease-modifying antirheumatic drugs (methotrexate)
4.2.3.5. Corticosteroids
4.2.3.6. Immunosuppressive
4.2.3.7. Surgery if significantly impaired, pain severe
4.2.3.7.1. Joint replacement surgery
4.3. Osteoporosis
4.3.1. Patho: asymptomatic decrease in bone density due to inactivity, diseases, reduction in sex hormones, diet and drugs
4.3.2. Signs and symptoms
4.3.2.1. Usually asymptomatic until detected by radiology
4.3.3. Treatment
4.3.3.1. Depends on cause of disease
4.3.3.2. Calcium, vitamin D supplements
4.3.3.3. Estrogen receptor modulators
4.3.3.4. Hormone therapy
4.3.3.5. Synthetic form of calcitonin
4.3.3.6. Bisphosphonates
4.3.3.7. Diet rich in protein and calcium
4.3.3.8. Regular exercise
4.4. Gout
4.4.1. Patho
4.4.1.1. Metabolic disorder in which excess Uris acid accumulates in the blood. Crystallization of Uris acid deposited around joints causing pain.
4.4.2. Signs and symptoms: severe pain, tenderness of joint, warmth of joint, redness, swelling of surrounding tissues
4.4.3. Treatment
4.4.3.1. Low-purine diet: Avoid bacon, turkey, veal, liver, kidney, anchovies, salmon, sardines, legumes, alcohol
4.4.3.2. Colchicine or phenylbutazone for acute attacks
4.4.3.3. Colchicine, allopurinol, probenecid, or indomethacin for long term
4.4.3.4. Avoid thiazide dietetics
4.4.3.5. Vitamin E, folic acid, eicosapentaenoic useful dietary supplements
4.5. Age Related Changes
4.5.1. Shortening of vertebrae
4.5.2. Height decreases 2in from age 20-70
4.5.3. Bones more brittle
4.5.4. Slight knee flexion
4.5.5. Decrease in bone mass and bone mineral
4.5.6. Slight kyphosis
4.5.7. Slight hip flexion
4.5.8. Slight wrist flexion
4.5.9. Impaired flexion and extension movements
5. Vision
5.1. Visual deficits
5.1.1. Cataracts
5.1.1.1. Patho
5.1.1.1.1. Clouding of Lens or its capsule that causes the lens to lose transparency
5.1.1.2. Signs and symptoms: vision is distorted, night vision decreased, objects appeared blurred, glare from sunlight and bright lights is bothersome, nuclear sclerosis develops
5.1.1.3. Treatment
5.1.1.3.1. Surgery
5.1.2. Glaucoma
5.1.2.1. Patho
5.1.2.1.1. Degenerative eye disease in which the optic nerve is damaged from an above normal intraoculat pressure
5.1.2.2. Signs and symptoms
5.1.2.2.1. Acute glaucoma: severe eye pain, headache, nausea, vomiting
5.1.2.2.2. Chronic: peripheral vision slowly becomes impaired, tired feeling in their eyes, headaches, misty vision, seeing halos around lights, symptoms more pronounced in mornings
5.1.2.3. Treatment
5.1.2.3.1. Acute glaucoma
5.1.2.3.2. Chronic
5.1.3. Detached retina
5.1.3.1. Patho
5.1.3.1.1. Forward displacement of the retina from its normal position against the choroid
5.1.3.2. Signs and symptoms: reception of spots moving across the eye, blurred vision, flashed of light, feeling that a coating is developing over the eye
5.1.3.3. Treatment
5.1.3.3.1. Prompt treatment
5.1.3.3.2. Bed red
5.1.3.3.3. Use of bilateral patches
5.1.3.3.4. Surgery
5.2. Age Related Changes: Sensory organs
5.2.1. Vision
5.2.1.1. More opaque lens
5.2.1.2. Decreased pupil size
5.2.1.3. More spherical cornea
5.2.2. Smell
5.2.2.1. Impaired ability to identify and discriminate among odors
5.2.3. Taste
5.2.3.1. High prevalence of taste impairment
5.2.4. Hearing
5.2.4.1. Atrophy of hair cells of organ of corti
5.2.4.2. Tympanic membrane sclerosis and atrophy
5.2.4.3. Increased crewmen and concentration of keratin
6. Integumentary
6.1. Pruritus
6.1.1. Patho: itchy skin due to drones
6.1.2. Excessive itching can cause infection and skin breakdown
6.1.3. Treatment
6.1.3.1. Bath oils
6.1.3.2. Moisturizing lotions
6.1.3.3. Massage
6.1.3.4. Zinc oxide
6.1.3.5. Antihistamines and topical steroids
6.1.3.6. Vitamin supplements and high quality, rich vitamin diet
6.2. Pressure injury
6.2.1. Patho: injuries to the skin resulting from prolonged pressure on the skin
6.2.2. Signs and symptoms: swelling, unusual skin color or texture, redness, heat, pus drainage
6.2.3. Treatment
6.2.3.1. High protein, vitamin rich diet
6.2.3.2. Good skin care
6.2.3.3. Depends on state of injury
6.2.3.3.1. Hyperemia
6.2.3.3.2. Ischemia
6.2.3.3.3. Necrosis
6.2.3.3.4. Deep tissue damage
6.3. Age Related Changes
6.3.1. Flattening of the dermal-epidermal junction
6.3.2. Reduced thickness and vascularity of dermis
6.3.3. Slowing of epidermal proliferation
6.3.4. Increased quantity and degeneration of elastin fibers occur
6.3.5. Collagen fibers become more coarser and random
6.3.5.1. Reduce skin elasticity
6.3.6. Irritated and breaks down more easily
6.3.7. Dermis more avascular and thinner
6.3.8. Reduction in number of melanocytes by 10-20% each decade of life stating with third decade
6.3.8.1. Tan more slowly and less deeply
6.3.9. Skin immune response declines
6.3.9.1. More prone to skin inflections
6.3.10. Benign and malignant skin neoplasms
6.3.11. Growth rate of scalp, pubic, and axillary hair declines
6.3.12. Fingernails grow more slowly, brittle, develop longitudinal striations, decrease in lungless size
7. Safety
7.1. Pharmacology
7.1.1. Most commonly used drugs
7.1.1.1. Cardiovascular agents, antihypertensive, analgesics, antiarthritic agents, sedatives, tranquilizers, laxatives, antacids
7.1.1.1.1. Can cause confusion, dizziness, falls, and fluid and electrolyte imbalance which effects quality of life.
7.1.2. Taking more then one drug can cause risk of drug- food interactions
7.1.3. Altered pharmacokinetics
7.1.3.1. Absorption
7.1.3.1.1. IM, subcutaneous, oral and rectal are not absorbed as efficiently as inhaled, applied topically, or instilled IV
7.1.3.1.2. Highly soluble and high concentrations are absorbed at greater speed
7.1.3.1.3. Decreased intracellular fluid, increased gastric PH, decreased gastric blood flow and motility, reduced CO and circulation, and slower metabolism can slow absorption
7.1.3.1.4. Exercise stimulates circulation and aids in absorption
7.1.3.2. Distribution
7.1.3.2.1. Hard to predict
7.1.3.2.2. Dehydration and hypoalbuminemia decrease distribution
7.1.3.3. Metabolism, detoxification, and excretion
7.1.3.3.1. Dehydration, hyperthermia, immobility and liver disease decrease metabolism of drug
7.1.3.3.2. Extended biological half life
7.1.3.3.3. Detoxification and conjugation of drugs reduced
7.1.3.3.4. Renal system excretes drugs; implications of reduced kidney efficiency important
7.1.3.3.5. Liver influences drug detoxification and excretion
7.1.4. Increased risk of adverse reactions
7.1.4.1. S/s of an adverse reaction in an older person can differ from given drug
7.1.4.2. Adverse reaction may take longer to become apparent
7.1.4.3. Adverse effect may occur after drug is discontinued
7.1.4.4. Can develop suddenly
7.1.4.5. Mental dysfunction one of the early symptoms of adverse reaction
7.1.5. Promoting safe use
7.1.5.1. Beers Criteria
7.1.5.1.1. Include drugs that are inappropriate to use in presence of specific conditions and in general. (Anticholinergics, tricyclics antidepressants, antipsychotics, barbiturates, and benzodiazepines)
7.1.5.2. Ensure drugs are used selectively and cautiously
7.1.5.2.1. Why is the drug ordered?
7.1.5.2.2. Is the smallest possible disaster ordered?
7.1.5.2.3. Is the patient allergic to the drug?
7.1.5.2.4. Can this drug interact with others being used?
7.1.5.2.5. are there special instructions for administration?
7.1.6. Promoting safe and effective administration
7.1.6.1. Most common route to administer drugs is orally
7.1.6.1.1. This can interfere with process (EX: dry mucous membranes and not being able to swallow)
7.1.6.2. Suppository: may take longe to melt due to lower body temperature
7.1.6.3. IM and subcutaneous administration: immobile limb will reduce rate of absorption
7.1.6.4. monitor for complications when giving IV
7.1.7. Patient education
7.1.7.1. Functional limitations
7.1.7.1.1. Impaired ADLs can decrease ability to administer meds
7.1.7.2. Cognitive limitations
7.1.7.2.1. Impairments that prevent them from remembering to take medications, may retake meds because forgot they already took, confuse medication schedule and dosage.
7.1.7.3. Educational limitations
7.1.7.3.1. Difficult reading labels, and instructions from being adequately seen
7.1.7.4. Sensory limitations
7.1.7.4.1. Hearing deficits can cause instructions to be missed or misunderstood. Poor vision can effect reading labels and instructions
7.1.7.5. Financial limitations
7.1.7.5.1. Limited funds could cause the older person to not fill prescription, skip dosage or use an old prescription
7.1.7.6. Choice
7.1.7.6.1. Some may choose not to take medications due to effect, lack of motivation, denial of condition or prefer to use funds elsewhere
7.2. Environmental
7.2.1. Lighting
7.2.1.1. Function: more mobile and participate in more activities in bright lit area
7.2.1.2. Orientation: lose perception of tine in a room that is constantly lit or darkened
7.2.1.3. Mood and behavior: blinking psychedelic lights cause a different reaction from candlelight.
7.2.1.4. Several diffuse lighting sources are best
7.2.1.5. Nightlights help facilitate orientation during the night and visibility to locate light switches
7.2.1.6. exposure to natural light during normal 24 hour dark-light cycle helps maintain body rhythms
7.2.2. Temperature
7.2.2.1. Maintain adequate environmental temperature is significant
7.2.2.2. Room temperature should no be lower than 75 degree Fahrenheit
7.2.2.3. brain damage can occur if the temperature is over 106 degrees Fahrenheit
7.2.3. Colors
7.2.3.1. red, yellow, white
7.2.3.1.1. stimulatng, increase pulse and BP
7.2.3.2. blue, brown, earth tones
7.2.3.2.1. relaxing
7.2.3.3. orange
7.2.3.3.1. stimulating
7.2.3.4. Violet
7.2.3.4.1. decreases appetite
7.2.3.5. green
7.2.3.5.1. sense of well being
8. Thermoregulation
8.1. Body temperature lower in later life than younger years
8.2. Reduced ability to respond to colder temperatures
8.2.1. Due to: inefficient vasoconstriction, reduced peripheral circulation, decreased cardiac output, diminished shivering, reduce muscle mass and subcutaneous tissue
8.3. Impaired responses to heat
8.3.1. Due to : impaired sweating mechanisms and decreases cardiac output
8.4. More susceptible to heat stress
9. Cell
9.1. Number of cells reduced
9.2. Lean body mass decreased
9.3. Fat tissue increases until 6th decade of life
9.4. Total body fat increases
9.5. Bone mass decreases
9.6. Extracellular fluid remains constant
9.7. Intracellular fluid decreased
9.7.1. Prone to dehydration
9.7.2. Fluid electrolyte imbalance
10. Immune system
10.1. Depressed immune response
10.2. Thymus mass decreases steadily
10.3. T cell activity declines and more immature T cells present in thymus
10.4. Inflammatory defense declines
10.5. Increase in proinflammatory cytokines
11. Physical
11.1. Graying and thinning of hair
11.2. Ectropion of eyelids
11.3. Elongated ears
11.4. Acrus senilis
11.5. Growth of facial hair in women
11.6. Diminished muscle mass and skin fold thickness
11.7. Thicker hair in ears and nose
11.8. Darkening and wrinkling of skin around orbits
11.9. Narrower gait in women, wider gait in men
11.10. Stature decreases
11.10.1. 2 in lost by age 80
11.10.2. Loss of cartilage and thinning of vertebrae
11.11. Changes are Gradual and subtle
12. Cardiac
12.1. Age Related Changes
12.1.1. More prominent arteries in head, neck, extremities
12.1.2. Valves become thicker and more rigid
12.1.2.1. Result of sclerosis and fibrosis
12.1.3. Stroke volume decreases by 1% per year
12.1.4. Heart pigmented with lip furs in granules
12.1.5. Less efficient O2 utilization
12.1.6. Aorta becomes dilated and elongated
12.1.7. Cardiac output decreases
12.1.8. Resistance to peripheral blood flow increases by 1% per year
12.1.9. Blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output
12.1.10. Less elasticity of vessels
12.1.11. Diastolic filling and systolic emptying requires more time to be completed
12.1.12. Blood vessels
12.1.12.1. Tunica intima
12.1.12.1.1. Most direct changes
12.1.12.2. Tunica media
12.1.12.2.1. Thinning and calcification of elastin fibers
12.1.12.2.2. Increase in collagen
12.1.12.2.3. Impaired baroreceptor function
12.1.12.2.4. Peripheral resistance
12.1.12.3. Tunica adventitia
12.1.12.3.1. Not affected by aging process
12.2. Hypertension
12.2.1. Most prevalent cardiac disease in older adults
12.2.2. Patho: high blood pressure due to the amount of resistance to flow in your arteries
12.2.3. Signs and symptoms: awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor
12.2.4. Treatment
12.2.4.1. Reduce sodium intake
12.2.4.2. Reduce weight if necessary
12.2.4.3. Antihypertensive drugs
12.2.4.3.1. Thiazide diuretics
12.2.4.4. Non-pharmacological methods
12.2.4.4.1. Biofeedback
12.2.4.4.2. yoga
12.2.4.4.3. Meditation
12.2.4.4.4. Relaxation exercises
12.2.4.5. Diet rich in fruits, vegetables, whole grain, and low-fat in dairy foods
12.3. Congestive Heart Failure
12.3.1. Leading cause of hospitalization in older adults
12.3.2. Patho: heart muscle does not pump blood as well as it should
12.3.3. signs and symptoms: dyspnea on exertion, confusion, insomnia, wandering during the night, agitation, depression, weakness, SOB, bilateral ankle edema
12.3.4. Treatment
12.3.4.1. Bed rest
12.3.4.2. ACE inhibitors
12.3.4.3. Beta-blockers
12.3.4.4. Digitalis
12.3.4.5. Diuretics
12.3.4.6. Reduction in sodium intake
12.4. Coronary Heart Disease
12.4.1. Myocardial infarction
12.4.1.1. Patho: caused by blockage or clot forming in the coronary arteries that occludes the blood flow causing lack of oxygen
12.4.1.2. signs and symptoms: pain radiating to left arm, entire chest neck, jaw, abdomen; numbness in arms, neck or back; confusion; moist, pale skin; decreased BP; syncope; decreased BP
12.4.1.3. Treatment
12.4.1.4. Treatment
12.4.1.4.1. Reduce amount of time in which patient is limited to bed rest to allowing to sit up in chair next to bed.
12.4.1.4.2. Early ambulation following MI
12.4.1.4.3. Thrombolytic therapy
12.4.1.4.4. Fitness programs
12.5. Peripheral Vascular Disease
12.5.1. Arteriosclerosis
12.5.1.1. Patho: hardening of the arteries
12.5.1.2. Signs and symptoms: chest pain or angina, pain in leg, SOB, fatigue
12.5.1.3. Treatment
12.5.1.3.1. Bed rest
12.5.1.3.2. Warmth
12.5.1.3.3. Buerger-Allen exercises
12.5.1.3.4. Vasodilator
12.5.2. Venous thromboembolism
12.5.2.1. signs and symptoms: edema, warmth over affected area, pain in sole of foot
12.5.2.2. Treatment
12.5.2.2.1. Location determines the treatment
12.5.2.2.2. Elastic stockings, or bandages
12.5.2.2.3. Rest
12.5.2.2.4. elevation of affect limb may promote venous return
12.5.2.2.5. analgesics to relieve pain
12.5.2.2.6. Anticoagulants
12.5.2.2.7. Surgery
13. Urinary elimination
13.1. Urinary tract infection
13.1.1. Patho
13.1.1.1. Caused by organism Escherichia coli in women and Proteus species in men
13.1.2. Signs and symptoms: burning, urgency, fever
13.1.3. Treatment
13.1.3.1. Aims to establish adequate urinary draining and control of infection through antibiotic therapy
13.1.3.2. Forcing fluids is advisable
13.1.3.3. cranberry juice promotes reduction of UTIs
13.2. Bladder cancer
13.2.1. Patho: malignancy of the urothiel cells
13.2.2. Signs and symptoms: frequency, urgency, dysuria, painless hematuria
13.2.3. treatment
13.2.3.1. Surgery
13.2.3.2. radiation
13.2.3.3. Immunotherapy
13.2.3.4. Chemotherapy
13.3. Renal calculi
13.3.1. patho: small hard deposit that forms in the kidney due to excessive calcium or uric acid
13.3.2. Signs and symptoms: pain, hematuria, symptoms of UTI, GI upset
13.3.3. treatment
13.4. Glomerulonephritis
13.4.1. Patho: inflammation of the glomerulus
13.4.2. Signs and symptoms
13.4.2.1. Subtle and nonspecific, initially go unnoticed
13.4.2.2. Clinical manifestations: fever, fatigue, nausea, vomiting, abdominal pain, increased sedimentation rate
13.4.3. Treatment
13.4.3.1. Antibiotics
13.4.3.2. Restriction in sodium and protein diet
13.4.3.3. Close attention to fluid intake and output
13.4.3.4. If older adults are receiving digitalis, diuretics, antihypertensives then close observation for cumulative toxic effects from compromised kidney function must be maintained
13.5. Urinary system: Age Related Changes
13.5.1. Decreased size of renal mass
13.5.2. Decreased tubular function
13.5.3. Decreased bladder capacity
13.5.4. Decreased nephrons
13.5.5. Renal blood flow decreases
13.5.6. Globular filtration rate decreases
13.5.7. Weaker bladder muscles
14. Neurology
14.1. Parkinson’s Disease
14.1.1. Patho
14.1.1.1. Affects ability of CNS to control body movements as a result of Impaired function of basal ganglia in the midbrain. Neurons that produce dopamine in substantial nigra die or become impaired
14.1.2. Signs and Symptoms: fair tremor in hands or feet that progresses over time, muscle rigidity and weakness, drooling, difficulty swallowing, slow speech, monotone voice, face is a mask like appearance, bradykinesia and poor balance, appetite increases, shuffling gait
14.1.3. Treatment
14.1.3.1. Carbidopa/levodopa in forms of sinemet
14.1.3.2. Dopamine agonists
14.1.3.3. Anricholinergics
14.1.3.4. Amantadine, mono oxidase inhibitors, catechol-O-methyltransferase
14.1.3.5. Active and passive ROM exercises
14.1.3.6. Psychological support
14.2. Transient Ischemic Attacks
14.2.1. Patho
14.2.1.1. Temporary or intermittent neurological events that can result from any situation that reduces cerebral circulation
14.2.2. Signs and symptoms: hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, N/V, dysphagia
14.2.3. Treatment
14.2.3.1. Correction of underlying cause
14.2.3.2. Anticoagulant therapy
14.2.3.3. Vascular reconstruction
14.3. Cerebrovascular Accidents
14.3.1. Patho: Can be ischemic or hemmorhagic causing compromise and damage to the brain. Need to stabilize patient and focus on rehabilitation
14.3.2. Signs and symptoms: light-headedness, dizziness, headache, drop attack, memory and behavioral changes.
14.4. Age Related Changes
14.4.1. Decreased conduction velocity
14.4.2. Slower response and reaction time
14.4.3. Decreased brain weight
14.4.4. Reduced blood flow to brain
14.4.5. Changes in sleep pattern
14.5. Changes to the mind: Age Related
14.5.1. Personality
14.5.1.1. Drastic changes don’t occur with age. Consistent with earlier years
14.5.2. Memory
14.5.2.1. Retrieval from long term memory slowed
14.5.2.2. Working memory function reduced
14.5.3. Intelligence
14.5.3.1. Basic intelligence maintained
14.5.3.2. Crystallized intelligence maintained
14.5.3.3. Fluid intelligence declines
14.5.4. Learning
14.5.4.1. Not seriously altered. Other factors interfere with ability to learn: motivation, attention span, delayed transmission of information to the brain, perceptual deficits, illness
15. Endocrine
15.1. Diabetes mellitus
15.1.1. Patho: group of diseases that affect how your body uses glucose
15.1.2. Signs and symptoms: may be absent, orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, confusion, dupuytren's contracture
15.1.3. Treatment
15.1.3.1. Drug therapy
15.1.3.1.1. Metformin: Oral, first line treatment
15.1.3.1.2. Sulfonylurea drugs (glibenclamide)
15.1.3.1.3. Acarbose
15.1.3.1.4. Rosiglitazone and pioglitazone
15.2. Hypothyroidism
15.2.1. Patho: thyroid does not produce enough of the thyroid gland
15.2.2. Signs and symptoms: fatigue, weakness, lethargy, depression, anorexia, weight gain and puffy face, impaired hearing, periorbital or peripheral edema, dry skin, coarse hair
15.2.3. Treatment
15.2.3.1. Replacement of thyroid hormones using a synthetic T4 (synthroid and thyroxine)
15.3. Hyperthyroidism
15.3.1. Patho: loss of normal regulatory control of thyroid hormone secretion
15.3.2. Symptoms: diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, lid lag, increased hunger
15.3.3. Treatment
15.3.3.1. Depends on cause
15.3.3.2. Anti thyroid medications or radioactive iodine
15.3.3.3. Surgery
15.4. Endocrine System
15.4.1. Thyroid gland under goes fibrosis, cellular infiltration, and increased nodularity
15.4.1.1. Decreased metabolic rate
15.4.1.2. Reduce radioactive iodine uptake
15.4.1.3. Less thyrotropin secretion and release
15.4.2. Release for thyroid iodine decreases
15.4.3. Excretion of 17-ketosteriods declines
15.4.4. Reduction in triiodothyronine (T3)
15.4.5. TSH and T4 stay the same
15.4.6. ACTH secretion decrease
15.4.7. Secretory activity of adrenal gland decreases
15.4.7.1. Decrease of glucocorticoids, 17-ketosteroids, progesterone, androgen, estrogen
15.4.8. Pituitary gland decreases in volume
15.4.9. Gonadal secretion declines
15.4.10. delayed and insufficient resales of insulin by the beta cells of the pancreas
15.4.10.1. Reduce ability to metabolize glucose
16. Psychosocial
16.1. Depression
16.1.1. Signs and symptoms: Vegetative symptoms: insomnia, fatigue, anorexia, weight loss, constipation, decreased interest in sex; Express self-depreciation, guilt, apathy, remorse, hopelessness, and helplessness; Changes in sleep and psychomotor activity pattern
16.1.2. Treatment
16.1.2.1. Psychotherapy
16.1.2.2. Antidepressants
16.1.2.3. Electroconvulsive therapy
16.1.2.4. Acupressure, acupuncture, guided imagery and light therapy
16.1.2.5. Good health practices: proper nutrition, regular exercise
16.2. Anxiety
16.2.1. Signs and symptoms: somatic complaints, rigidity in thinking and behavior, insomnia, fantasizing, hostility, restlessness, increase in pulse, BP, respirations, psychomotor activity and frequency
16.2.2. Treatment
16.2.2.1. Depends on cause
16.2.2.2. Medications
16.2.2.3. Biofeedback, guided imagery, relaxation therapy
16.2.2.4. Control environmental stimuli
16.3. social changes
16.3.1. shrinking social world
16.3.2. loss of spouse
16.3.3. retirement
16.4. Dementia
16.4.1. Irreversible, progressive impairment in cognitive functions affecting memory, orientation, judgement, reasoning, attention, language, and problem solving.
16.4.1.1. Alzheimer’s disease
16.4.1.1.1. Patho: intracellular neurofibrillary tangles and extracellular amyloidal protein deposits contributing to senile plaques
16.4.1.1.2. Signs and symptoms
16.4.1.1.3. Treatment
16.5. Delirium
16.5.1. Signs and symptoms
16.5.1.1. Disorientation to place and time but usually not identity
16.5.1.2. Altered attention span
16.5.1.3. Meaningless chatter
16.5.1.4. Poor judgement
16.5.1.5. Altered level of. Consciousness; hypervigilance, mild drowsiness, semicomatose state
16.5.1.6. Hallucinations
16.5.1.7. Disturbances in sleep wake cycle
16.5.1.8. May be suspicious, personality changes, experience delusions
16.5.1.9. Physical signs; SOB, fatigue, slower psychomotor activities
16.5.2. Treatment
16.5.2.1. Depends on cause
16.5.2.1.1. Stabilize glucose, correcting dehydration, discontinuing a medication
16.5.2.2. Reversible in most circumstances, prompt care and treat as medical emergency