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