Normal Changes of Aging

1. cells

1.1. lean body mass reduced

1.2. number of cells reduced = fewer functional cells in the body

1.3. total body fat increases

1.4. intracellular fluid decreased = total body fluid decreased

2. physical appearance

2.1. graying and thinning of hair

2.2. ectropion of eyelids

2.3. elongated ears

2.4. diminished muscle mass and skin fold thickness

2.5. decreased height

2.6. darkening & wrinkling of skin

3. respiratory system

3.1. PO2 reduced

3.2. loss of elasticity & increased rigidity

3.3. decreased ciliary action

3.4. forced expiratory volume reduced

3.5. blunting of cough and laryngeal reflexes

3.6. increase in residual capacity

3.7. alveoli fewer in #; larger in size

3.8. thoracic muscles more rigid

3.9. reduced basilar inflation

3.10. respiratory conditions:

3.10.1. asthma

3.10.1.1. high risk of complications of bronchiectasis, cardiac problems, high rates of mortality, evaluate nebulizer use

3.10.2. COPD

3.10.2.1. causes persistent, productive cough, wheezing, recurrent respiratory infections, SOB

3.10.3. emphysema

3.10.3.1. causes: chronic bronchitis, chronic irritation, morphological changes in the lung

3.10.3.2. tx: postural drainage, bronchodilators, breathing exercises

3.10.4. chronic bronchitis

3.10.5. lung cancer

3.10.5.1. symtoms: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, respiratory infections

3.10.5.2. tx: surgery, chemo, radiation

3.10.6. lung abscess

3.10.6.1. causes: pneumonia, tuberculosis, malignancy, trauma, aspiration

3.10.6.2. tx: postural drainage, high protein high calorie diet

3.11. nursing implications

3.11.1. assess to detect respiratory problems

3.11.2. assess oxygen use

3.11.3. promote productive coughing

3.11.4. promote self care

4. cardiovascular system

4.1. valves become thicker and more rigid

4.2. stroke volume + cardiac output decreases

4.3. less efficient O2 utilization

4.4. resistance to peripheral flow increases

4.5. BP increases

4.6. less elasticity of vessels

4.7. health promotion

4.7.1. stop smoking

4.7.2. exercise

4.7.3. proper diet

4.7.4. manage stress

4.7.5. proactive interventions

4.8. cardiovascular conditions

4.8.1. hypertension

4.8.1.1. BP > 140/90

4.8.1.2. symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, tremors

4.8.2. postural hypotension

4.8.2.1. drop in BP upon standing or changing positions

4.8.2.2. due to increased intake of vasoactive meds and decreased baroreceptor activity

4.8.2.3. consequences: falls, stroke, syncope

4.8.3. CHF

4.8.3.1. complication of arteriosclerotic heart disease

4.8.3.2. leading cause of hospitalization

4.8.3.3. symptoms: SOB, dyspnea upon exertion, confusion, insomnia,wandering at night, agitation, depression, wheezing, weight gain, edema

4.8.4. pulmonary emboli

4.8.4.1. risk factors: fractures, CHF, SOB, arrhythmias, thrombosis, immobilization

4.8.4.2. S/S: confusion, apprehension, SOB, increased temp, pneumonitis, elevated ESR

4.8.5. coronary artery disease

4.8.5.1. ischemic heart disease

4.8.5.2. angina

4.8.5.3. myocardial infarction

4.8.6. hyperlipidemia

4.8.6.1. evaluate full lipid profile, triglycerides, HDL, LDLs

4.8.6.2. tx: dietary changes, medications, alternative therapies

4.8.7. arrhythmias

4.8.7.1. causes: digitalis toxicity, hypokalemia, acute infections, hemmorage, anginal syndrome, coronary insufficiency

4.8.7.2. symptoms: fatigue, weakness, palpitations, confusion, dizziness, hypotension, bradycardia, syncope

4.8.7.3. tx: antiarythmics, digitalis, potassium supplements and cardioversion

4.8.7.4. education: modify diet, stop smoking, decrease alcohol, exercise

4.8.8. peripheral vascular disease

4.8.8.1. arteriosclerosis: common especially w/ diabetes

4.8.8.2. tx: warmth, exercise, vasodilators

4.8.9. varicose veins

4.8.9.1. dull, cramping, can interfere with sleep, dizziness may occur

4.8.9.2. tx: compression boots, elevation, avoid crossing legs and restrictive clothing, avoid prolonged standing, reduce venous stasis

4.9. nursing implications:

4.9.1. keep pt informed, prevention, promote circulation, provide foot care

5. gastrointestinal system

5.1. esophagus more dilated

5.2. reduced saliva & salivary pytalin

5.2.1. interferes with absorption of protein

5.3. liver smaller in size

5.4. reduced intestinal blood flow

5.5. decreased esophageal motility

5.5.1. increased risk of indigestion and aspiration

5.6. atrophy of gastric mucosa

5.7. decreased stomach motility, hunger contractions, emptying time

5.7.1. less food accommodation at one time

5.8. less production of HCl

5.8.1. increased gastric irritation

5.8.2. interferes with absorption of calcium, vitamins

5.9. fewer absorbing cells on intestines

5.10. slower peristalsis

5.10.1. risk of constipation

5.11. conditions

5.11.1. xerostomia (dry mouth)

5.11.1.1. results from: some medications, decreased saliva, mouth breathing, and altered cognition

5.11.1.2. interventions: salt substitutes, sucking on hard candy, increase water intake

5.11.2. dysphagia

5.11.2.1. causes: GERD, structural disorders

5.11.2.2. interventions: prevent aspiration, promote adequate nutrition

5.11.3. hiatal hernia

5.11.4. esophageal cancer

5.11.5. peptic ulcer disease

6. urinary system

6.1. decreased size of renal mass

6.2. decreased tubular function

6.2.1. concentration of urine changes in response to water and/ poor sodium excess or depletion

6.3. decreased bladder capacity

6.4. decrease in nephrons

6.5. renal blood flow & GFR decreases

6.6. weaker bladder muscles

6.6.1. decreases ability to expand,

6.6.2. reduced storage capacity

6.6.2.1. daytime urinary frequency

6.6.2.2. nocturia

6.7. health promotion: adequate fluid intake, maintenance of acidic urine, avoid catheterization, appropriate level of activity, frequent urination,

7. reproductive system

7.1. male

7.1.1. fluid-retaining capacity of seminal vesicles reduces

7.1.2. reduction in sperm count

7.1.3. venous & arterial sclerosis of penis

7.1.4. prostate enlarges

7.1.4.1. erectile dysfunction: unable to maintain an erection

7.1.4.2. BPH: very common in older men, may be reluctant at or embarrassed to seek treatment which could result in kidney damage

7.2. female

7.2.1. fallopian tubes atrophy & shorten

7.2.2. ovaries become thicker & smaller

7.2.3. cervix becomes smaller

7.2.3.1. regular gynecological exam exams to check cervix latency are very important

7.2.4. drier, less elastic vaginal canal

7.2.4.1. painful intercourse

7.2.5. uterus becomes smaller

7.2.6. endometrium atrophies

7.2.7. loss of vulvar subcutaneous fat and hair

7.2.8. hormonal changes

7.2.8.1. vulva atrophies

7.2.8.1.1. vulva becomes more fragile and more susceptible to irritation and infection

7.2.8.2. flattening of the labia

7.2.8.3. loss of subcutaneous fat and hair

7.2.8.4. more alkaline vaginal pH as a result of lower estrogen changes

7.2.8.5. dyspareunia

8. musculoskeletal system

8.1. shortening of vertebrae

8.2. decreases in bone mineral & mass

8.3. muscle mass, strength & movement decrease

8.4. reflexes are lessened

8.5. diminished calcium absorption

8.6. cartilage deteriorates

8.7. frailty: increased vulnerability, impaired capability to withstand intrinsic and environmental stressors, and limited capacity to maintain physiological homeostasis

8.7.1. symptoms: weakness, weight loss, muscle wasting, frequent falls, immobility

8.7.2. causes: hormonal dysregulation, immuno-aging, pre-coagulation, pro-inflammatory status

8.8. musculoskeletal conditions

8.8.1. fractures

8.8.1.1. extremely common in the hips, forearms

8.8.1.2. brittle bones fracture more easily which place pt at risk for complications w immobility

8.8.1.2.1. importance of calcium and vitamin B intake at young age throughout life

8.8.1.3. s/s: pain, change in shape or length of limb, limited movement of limb, muscle spasms

8.8.2. osteoarthritis

8.8.2.1. progressive deterioration of joint cartilage with the formation of new bone at the joints

8.8.3. rheumatoid arthritis

8.8.3.1. affected joints are red, stiff, swollen,painful, warm to touch.

8.8.3.2. systemic symptoms manifest (fever, anemia, muscle weakness, malaise, nausea

8.8.4. osteoporosis

8.8.4.1. occurs due to excessive calcium loss, insuffienct calcium intake, or excess excretion of calcium

8.8.4.2. increased risk of fracture - ROM exercise is VITAL and intake of calcium

8.8.5. gout

8.8.5.1. metabolic disorder caused by excess uris acid secretions which crystallize in the blood and place pt at risk for renal stones

8.8.5.2. avoid high protein, red meat and alcohol.... want diet low in purine

9. sensory organs

9.1. vision

9.1.1. presbyopia

9.1.2. near vision decreased

9.1.3. visual field narrowsmaking peripheral vision more difficult

9.1.4. pupil less responsive to light

9.1.5. night vision difficult

9.1.6. loss in central vision

9.1.7. less able to differentiate low tone colors

9.1.8. depth perception distorted

9.1.9. visual acuity progressively declines

9.1.10. communication problematic

9.1.10.1. facial expressions and gestures may be missed or misinterpreted

9.1.10.2. limitation of lip reading and written communication

9.1.11. health promotion

9.1.11.1. routine exams by ophthalmologist

9.1.11.2. early detection and tx of problems

9.1.11.3. consideration of financial ability to receive tx

9.1.11.4. prompt eval of symptoms that may indicate a visual problem

9.1.12. vision conditions

9.1.12.1. glaucoma

9.1.12.2. macular degeneration

9.1.12.3. detached retina

9.1.12.4. corneal ulcer

9.2. hearing

9.2.1. loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, reduced production of endolymph

9.2.2. high frequency sounds lost

9.2.3. equilibrium altered

9.2.4. accumulation of cerulean increased

9.2.5. health promotion

9.2.5.1. good care of ears throughout lifetime

9.2.5.2. prompt/complete tx of infection

9.2.5.3. assessment for impacted cerumen

9.3. taste

9.3.1. atrophy of the tongue

9.3.2. ability to detect salt is decreased

9.4. smell

9.4.1. decrease in number of sensory cells in the nasal lining & fewer cells in the olfactory bulb of the brain

9.5. touch

9.5.1. reduction in # of & changes in the structural integrity of tough receptors

9.5.2. reduced ability to sense pressure & pain & differentiate temperatures

10. endocrine system

10.1. lower basil metabolic rate, reduced radioactive iodine uptake, less thyrotropin secretion & release

10.2. thyroid gland atrophies

10.3. reduction in T3

10.4. secretion of glucocorticoids, 17 keto-steroids, progesterone, androgen, estrogen reduced

10.5. decrease in pituitary hormones

10.6. delayed and insufficient release of insulin

10.7. ability to metabolize glucose reduced

10.8. endocrine system conditions

10.8.1. diabetes mellitus

10.8.1.1. criteria for diagnosis

10.8.1.1.1. symptoms and a random blood glucose concentration > 200 mg/dl

10.8.1.1.2. fasting blood glucose concentration > 126 mg/dL

10.8.1.1.3. blood glucose concentration 2 hrs after glucose intake > 200 mg/dL

10.8.1.2. management

10.8.1.2.1. education through overview of disease process, nutrition, education

10.8.1.3. monitor pt self care

10.8.1.3.1. ability to handle a syringe and vial of insulin

10.8.1.3.2. ability to read calibrations in insulin syringe

10.8.1.3.3. hyperglycemic without being glycosuric

10.8.1.3.4. instructed in finger-prick technique and demonstrate competency

10.8.1.4. complications

10.8.1.4.1. hypoglycemia

10.8.1.4.2. PVD

10.8.1.4.3. diabetic retinopathy

10.8.1.4.4. neuropathies

10.8.1.4.5. cognitive impairment

10.8.1.4.6. CAD

10.8.1.4.7. UTIs

10.8.2. hypothyroidism

10.8.2.1. primary

10.8.2.1.1. results from a disease that destroys the thyroid gland

10.8.2.2. secondary

10.8.2.2.1. due to insufficient thyroid stimulating hormone - the problem is in the pituitary gland

10.8.2.3. risk factors

10.8.2.3.1. insufficient iodine intake of exposure to high amounts of radiation

10.8.2.4. symptoms

10.8.2.4.1. coarse, dry hair, edema, goiter, hypothermia, enlarged tongue

10.8.2.5. mgmt

10.8.2.5.1. thyroid replacement drugs for life (levothyroxine)

10.8.3. hyperthyroidism

10.8.3.1. over production of thryroid hormones cause by graves’ disease or toxic nodule

10.8.3.2. s/s: tremors, palpitations, weight loss, fatigue, weakness, exopthalamus

10.8.3.3. physical exam

10.8.3.3.1. warm, silky hair, moist skin, peripheral edema, nervous demeanor

10.8.3.4. mgmt

10.8.3.4.1. oral anti thyroid drugs

10.8.3.4.2. avoid amiodarone - can cause cardiac problems

11. integumentary system

11.1. reduced thickness & vascularity of the dermis, slowing of epidermal proliferation, increased quantity & degeneration of elastin occurs

11.2. skin becomes irritated & breaks down more easily

11.3. skin immune response declines

11.4. scalp, pubic, & axillary hair thins & grays & rate declines

11.5. perspiration slightly reduced

11.6. health promotion

11.6.1. avoid agents irritanting to the skin

11.6.2. good skin nutrition

11.6.3. promote activity

11.6.4. hydration, using bath oils, lotion, massage

11.6.5. avoid excessive bathing

11.6.6. early tx of pruritus and skin lesions

11.6.7. avoid exposure to UV rays

11.6.8. encourage self-inspection of entire body on a regular basis

11.6.9. accurate info about type of cosmetic surgery available

11.7. pressure ulcers

11.7.1. stage 1

11.7.1.1. a persistent area of redness (w/o a break in the skin) that does not disappear when pressure is relieved

11.7.2. stage 2

11.7.2.1. a partial thickness loss of skin layers involving the epidermis that presents clinically as an abrasion, blister, or shallow cater

11.7.3. stage 3

11.7.3.1. full thickness of skin is lost extending through the epidermis & exposing the subQ; presents as a deep crater with or without undermining adjacent tissue

11.7.4. stage 4

11.7.4.1. full thickness of skin and subcutaneous tissue is lost, exposing muscle, bone, or both; presents as a deep crater that may include necrotic tissue, exudate, sinus tract formation, and inspection

12. immune system

12.1. decreased strength of immune response

12.2. high prevalence of chronic conditions increases the risk of infection

12.3. increased risk of exposure to pathogens with hospitalization and institutionalization

12.4. thymus gland declines in size

12.5. T cell function declines

12.6. reduced antibody response

12.7. decreased number of Langerhan’s cells

12.8. reduced thickness in the skin

12.9. health promotion

12.9.1. improve diet

12.9.2. nutrients with immune boosting effects

12.9.2.1. protein, magnesium, vitamins, manganese, folic acid, zinc, iron

13. mind

13.1. personality

13.2. memory

13.3. intelligence

13.4. learning

14. nervous system

14.1. decreased conduction velocity

14.2. slower response & reaction time

14.3. changes in sleep patterns

14.4. reduced blood flow to the brain

14.5. decreased brain weight

14.6. loss of nerve cell mass

14.6.1. atrophy of the brain & spinal cord

14.7. demyelination

14.8. plaques, tangles, atrophy of the brain

14.9. free radicals accumulate

14.10. fat deposits accumulate in blood vessels

14.11. decline in the function of cranial nerves affecting taste and smell

14.12. indications of neurological problems

14.12.1. sudden headaches in the morning or that interrupt sleep

14.12.2. change in vision

14.12.3. sudden deafness, ringing in ears

14.12.4. mood, personality changes

14.12.5. altered cognition or LOC

14.12.6. clumsiness, unsteady gait

14.12.7. numbness, tingling of extremity

14.13. nervous system diseases

14.13.1. parkinson’s disease

14.13.1.1. affects ability of the CNS to control body movements

14.13.1.2. S/S: tremors, unsteady gait, drooling, dysphagia, masklike face, shuffling gate, trunk leans forward

14.13.1.3. treatment/mgmt: anticholinergic medications, carvidopa-levodopa, technologies to control symptoms

14.13.1.4. goal: max level of independence preserved

14.13.2. transient ischemic attacks

14.13.2.1. temporary or intermittent reduction in cerebral blood flow to the brain

14.13.2.2. S/S:hemiparesis, aphasia, diplopia, unilateral vision loss, vertigo, N/V, dysphagia

14.13.2.3. treat the underlying cause

14.13.2.4. increased risk of CVA

14.13.3. cerebrovascular attack

14.13.3.1. types

14.13.3.1.1. ischemic

14.13.3.1.2. hemorrhagic

14.13.3.2. S/S: cary, depend on area of brain affected

14.14. nursing considerations

14.14.1. promote independence

14.14.2. prevent injury