1. cardiovascular system
1.1. valves become thicker and more rigid
1.2. stroke volume + cardiac output decreases
1.3. less efficient O2 utilization
1.4. resistance to peripheral flow increases
1.5. BP increases
1.6. less elasticity of vessels
1.7. health promotion
1.7.1. stop smoking
1.7.2. exercise
1.7.3. proper diet
1.7.4. manage stress
1.7.5. proactive interventions
1.8. cardiovascular conditions
1.8.1. hypertension
1.8.1.1. BP > 140/90
1.8.1.2. symptoms: dull headache, impaired memory, disorientation, confusion, epistaxis, tremors
1.8.2. postural hypotension
1.8.2.1. drop in BP upon standing or changing positions
1.8.2.2. due to increased intake of vasoactive meds and decreased baroreceptor activity
1.8.2.3. consequences: falls, stroke, syncope
1.8.3. CHF
1.8.3.1. complication of arteriosclerotic heart disease
1.8.3.2. leading cause of hospitalization
1.8.3.3. symptoms: SOB, dyspnea upon exertion, confusion, insomnia,wandering at night, agitation, depression, wheezing, weight gain, edema
1.8.4. pulmonary emboli
1.8.4.1. risk factors: fractures, CHF, SOB, arrhythmias, thrombosis, immobilization
1.8.4.2. S/S: confusion, apprehension, SOB, increased temp, pneumonitis, elevated ESR
1.8.5. coronary artery disease
1.8.5.1. ischemic heart disease
1.8.5.2. angina
1.8.5.3. myocardial infarction
1.8.6. hyperlipidemia
1.8.6.1. evaluate full lipid profile, triglycerides, HDL, LDLs
1.8.6.2. tx: dietary changes, medications, alternative therapies
1.8.7. arrhythmias
1.8.7.1. causes: digitalis toxicity, hypokalemia, acute infections, hemmorage, anginal syndrome, coronary insufficiency
1.8.7.2. symptoms: fatigue, weakness, palpitations, confusion, dizziness, hypotension, bradycardia, syncope
1.8.7.3. tx: antiarythmics, digitalis, potassium supplements and cardioversion
1.8.7.4. education: modify diet, stop smoking, decrease alcohol, exercise
1.8.8. peripheral vascular disease
1.8.8.1. arteriosclerosis: common especially w/ diabetes
1.8.8.2. tx: warmth, exercise, vasodilators
1.8.9. varicose veins
1.8.9.1. dull, cramping, can interfere with sleep, dizziness may occur
1.8.9.2. tx: compression boots, elevation, avoid crossing legs and restrictive clothing, avoid prolonged standing, reduce venous stasis
1.9. nursing implications:
1.9.1. keep pt informed, prevention, promote circulation, provide foot care
2. gastrointestinal system
2.1. esophagus more dilated
2.2. reduced saliva & salivary pytalin
2.2.1. interferes with absorption of protein
2.3. liver smaller in size
2.4. reduced intestinal blood flow
2.5. decreased esophageal motility
2.5.1. increased risk of indigestion and aspiration
2.6. atrophy of gastric mucosa
2.7. decreased stomach motility, hunger contractions, emptying time
2.7.1. less food accommodation at one time
2.8. less production of HCl
2.8.1. increased gastric irritation
2.8.2. interferes with absorption of calcium, vitamins
2.9. fewer absorbing cells on intestines
2.10. slower peristalsis
2.10.1. risk of constipation
2.11. conditions
2.11.1. xerostomia (dry mouth)
2.11.1.1. results from: some medications, decreased saliva, mouth breathing, and altered cognition
2.11.1.2. interventions: salt substitutes, sucking on hard candy, increase water intake
2.11.2. dysphagia
2.11.2.1. causes: GERD, structural disorders
2.11.2.2. interventions: prevent aspiration, promote adequate nutrition
2.11.3. hiatal hernia
2.11.4. esophageal cancer
2.11.5. peptic ulcer disease
3. reproductive system
3.1. male
3.1.1. fluid-retaining capacity of seminal vesicles reduces
3.1.2. reduction in sperm count
3.1.3. venous & arterial sclerosis of penis
3.1.4. prostate enlarges
3.1.4.1. erectile dysfunction: unable to maintain an erection
3.1.4.2. BPH: very common in older men, may be reluctant at or embarrassed to seek treatment which could result in kidney damage
3.2. female
3.2.1. fallopian tubes atrophy & shorten
3.2.2. ovaries become thicker & smaller
3.2.3. cervix becomes smaller
3.2.3.1. regular gynecological exam exams to check cervix latency are very important
3.2.4. drier, less elastic vaginal canal
3.2.4.1. painful intercourse
3.2.5. uterus becomes smaller
3.2.6. endometrium atrophies
3.2.7. loss of vulvar subcutaneous fat and hair
3.2.8. hormonal changes
3.2.8.1. vulva atrophies
3.2.8.1.1. vulva becomes more fragile and more susceptible to irritation and infection
3.2.8.2. flattening of the labia
3.2.8.3. loss of subcutaneous fat and hair
3.2.8.4. more alkaline vaginal pH as a result of lower estrogen changes
3.2.8.5. dyspareunia
4. sensory organs
4.1. vision
4.1.1. presbyopia
4.1.2. near vision decreased
4.1.3. visual field narrowsmaking peripheral vision more difficult
4.1.4. pupil less responsive to light
4.1.5. night vision difficult
4.1.6. loss in central vision
4.1.7. less able to differentiate low tone colors
4.1.8. depth perception distorted
4.1.9. visual acuity progressively declines
4.1.10. communication problematic
4.1.10.1. facial expressions and gestures may be missed or misinterpreted
4.1.10.2. limitation of lip reading and written communication
4.1.11. health promotion
4.1.11.1. routine exams by ophthalmologist
4.1.11.2. early detection and tx of problems
4.1.11.3. consideration of financial ability to receive tx
4.1.11.4. prompt eval of symptoms that may indicate a visual problem
4.1.12. vision conditions
4.1.12.1. glaucoma
4.1.12.2. macular degeneration
4.1.12.3. detached retina
4.1.12.4. corneal ulcer
4.2. hearing
4.2.1. loss of hair cells, decreased blood supply, reduced flexibility of basilar membrane, degeneration of spiral ganglion cells, reduced production of endolymph
4.2.2. high frequency sounds lost
4.2.3. equilibrium altered
4.2.4. accumulation of cerulean increased
4.2.5. health promotion
4.2.5.1. good care of ears throughout lifetime
4.2.5.2. prompt/complete tx of infection
4.2.5.3. assessment for impacted cerumen
4.3. taste
4.3.1. atrophy of the tongue
4.3.2. ability to detect salt is decreased
4.4. smell
4.4.1. decrease in number of sensory cells in the nasal lining & fewer cells in the olfactory bulb of the brain
4.5. touch
4.5.1. reduction in # of & changes in the structural integrity of tough receptors
4.5.2. reduced ability to sense pressure & pain & differentiate temperatures
5. integumentary system
5.1. reduced thickness & vascularity of the dermis, slowing of epidermal proliferation, increased quantity & degeneration of elastin occurs
5.2. skin becomes irritated & breaks down more easily
5.3. skin immune response declines
5.4. scalp, pubic, & axillary hair thins & grays & rate declines
5.5. perspiration slightly reduced
5.6. health promotion
5.6.1. avoid agents irritanting to the skin
5.6.2. good skin nutrition
5.6.3. promote activity
5.6.4. hydration, using bath oils, lotion, massage
5.6.5. avoid excessive bathing
5.6.6. early tx of pruritus and skin lesions
5.6.7. avoid exposure to UV rays
5.6.8. encourage self-inspection of entire body on a regular basis
5.6.9. accurate info about type of cosmetic surgery available
5.7. pressure ulcers
5.7.1. stage 1
5.7.1.1. a persistent area of redness (w/o a break in the skin) that does not disappear when pressure is relieved
5.7.2. stage 2
5.7.2.1. a partial thickness loss of skin layers involving the epidermis that presents clinically as an abrasion, blister, or shallow cater
5.7.3. stage 3
5.7.3.1. full thickness of skin is lost extending through the epidermis & exposing the subQ; presents as a deep crater with or without undermining adjacent tissue
5.7.4. stage 4
5.7.4.1. 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
6. mind
6.1. personality
6.2. memory
6.3. intelligence
6.4. learning
7. cells
7.1. lean body mass reduced
7.2. number of cells reduced = fewer functional cells in the body
7.3. total body fat increases
7.4. intracellular fluid decreased = total body fluid decreased
8. physical appearance
8.1. graying and thinning of hair
8.2. ectropion of eyelids
8.3. elongated ears
8.4. diminished muscle mass and skin fold thickness
8.5. decreased height
8.6. darkening & wrinkling of skin
9. respiratory system
9.1. PO2 reduced
9.2. loss of elasticity & increased rigidity
9.3. decreased ciliary action
9.4. forced expiratory volume reduced
9.5. blunting of cough and laryngeal reflexes
9.6. increase in residual capacity
9.7. alveoli fewer in #; larger in size
9.8. thoracic muscles more rigid
9.9. reduced basilar inflation
9.10. respiratory conditions:
9.10.1. asthma
9.10.1.1. high risk of complications of bronchiectasis, cardiac problems, high rates of mortality, evaluate nebulizer use
9.10.2. COPD
9.10.2.1. causes persistent, productive cough, wheezing, recurrent respiratory infections, SOB
9.10.3. emphysema
9.10.3.1. causes: chronic bronchitis, chronic irritation, morphological changes in the lung
9.10.3.2. tx: postural drainage, bronchodilators, breathing exercises
9.10.4. chronic bronchitis
9.10.5. lung cancer
9.10.5.1. symtoms: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, respiratory infections
9.10.5.2. tx: surgery, chemo, radiation
9.10.6. lung abscess
9.10.6.1. causes: pneumonia, tuberculosis, malignancy, trauma, aspiration
9.10.6.2. tx: postural drainage, high protein high calorie diet
9.11. nursing implications
9.11.1. assess to detect respiratory problems
9.11.2. assess oxygen use
9.11.3. promote productive coughing
9.11.4. promote self care
10. urinary system
10.1. decreased size of renal mass
10.2. decreased tubular function
10.2.1. concentration of urine changes in response to water and/ poor sodium excess or depletion
10.3. decreased bladder capacity
10.4. decrease in nephrons
10.5. renal blood flow & GFR decreases
10.6. weaker bladder muscles
10.6.1. decreases ability to expand,
10.6.2. reduced storage capacity
10.6.2.1. daytime urinary frequency
10.6.2.2. nocturia
10.7. health promotion: adequate fluid intake, maintenance of acidic urine, avoid catheterization, appropriate level of activity, frequent urination,
11. musculoskeletal system
11.1. shortening of vertebrae
11.2. decreases in bone mineral & mass
11.3. muscle mass, strength & movement decrease
11.4. reflexes are lessened
11.5. diminished calcium absorption
11.6. cartilage deteriorates
11.7. frailty: increased vulnerability, impaired capability to withstand intrinsic and environmental stressors, and limited capacity to maintain physiological homeostasis
11.7.1. symptoms: weakness, weight loss, muscle wasting, frequent falls, immobility
11.7.2. causes: hormonal dysregulation, immuno-aging, pre-coagulation, pro-inflammatory status
11.8. musculoskeletal conditions
11.8.1. fractures
11.8.1.1. extremely common in the hips, forearms
11.8.1.2. brittle bones fracture more easily which place pt at risk for complications w immobility
11.8.1.2.1. importance of calcium and vitamin B intake at young age throughout life
11.8.1.3. s/s: pain, change in shape or length of limb, limited movement of limb, muscle spasms
11.8.2. osteoarthritis
11.8.2.1. progressive deterioration of joint cartilage with the formation of new bone at the joints
11.8.3. rheumatoid arthritis
11.8.3.1. affected joints are red, stiff, swollen,painful, warm to touch.
11.8.3.2. systemic symptoms manifest (fever, anemia, muscle weakness, malaise, nausea
11.8.4. osteoporosis
11.8.4.1. occurs due to excessive calcium loss, insuffienct calcium intake, or excess excretion of calcium
11.8.4.2. increased risk of fracture - ROM exercise is VITAL and intake of calcium
11.8.5. gout
11.8.5.1. metabolic disorder caused by excess uris acid secretions which crystallize in the blood and place pt at risk for renal stones
11.8.5.2. avoid high protein, red meat and alcohol.... want diet low in purine
12. endocrine system
12.1. lower basil metabolic rate, reduced radioactive iodine uptake, less thyrotropin secretion & release
12.2. thyroid gland atrophies
12.3. reduction in T3
12.4. secretion of glucocorticoids, 17 keto-steroids, progesterone, androgen, estrogen reduced
12.5. decrease in pituitary hormones
12.6. delayed and insufficient release of insulin
12.7. ability to metabolize glucose reduced
12.8. endocrine system conditions
12.8.1. diabetes mellitus
12.8.1.1. criteria for diagnosis
12.8.1.1.1. symptoms and a random blood glucose concentration > 200 mg/dl
12.8.1.1.2. fasting blood glucose concentration > 126 mg/dL
12.8.1.1.3. blood glucose concentration 2 hrs after glucose intake > 200 mg/dL
12.8.1.2. management
12.8.1.2.1. education through overview of disease process, nutrition, education
12.8.1.3. monitor pt self care
12.8.1.3.1. ability to handle a syringe and vial of insulin
12.8.1.3.2. ability to read calibrations in insulin syringe
12.8.1.3.3. hyperglycemic without being glycosuric
12.8.1.3.4. instructed in finger-prick technique and demonstrate competency
12.8.1.4. complications
12.8.1.4.1. hypoglycemia
12.8.1.4.2. PVD
12.8.1.4.3. diabetic retinopathy
12.8.1.4.4. neuropathies
12.8.1.4.5. cognitive impairment
12.8.1.4.6. CAD
12.8.1.4.7. UTIs
12.8.2. hypothyroidism
12.8.2.1. primary
12.8.2.1.1. results from a disease that destroys the thyroid gland
12.8.2.2. secondary
12.8.2.2.1. due to insufficient thyroid stimulating hormone - the problem is in the pituitary gland
12.8.2.3. risk factors
12.8.2.3.1. insufficient iodine intake of exposure to high amounts of radiation
12.8.2.4. symptoms
12.8.2.4.1. coarse, dry hair, edema, goiter, hypothermia, enlarged tongue
12.8.2.5. mgmt
12.8.2.5.1. thyroid replacement drugs for life (levothyroxine)
12.8.3. hyperthyroidism
12.8.3.1. over production of thryroid hormones cause by graves’ disease or toxic nodule
12.8.3.2. s/s: tremors, palpitations, weight loss, fatigue, weakness, exopthalamus
12.8.3.3. physical exam
12.8.3.3.1. warm, silky hair, moist skin, peripheral edema, nervous demeanor
12.8.3.4. mgmt
12.8.3.4.1. oral anti thyroid drugs
12.8.3.4.2. avoid amiodarone - can cause cardiac problems
13. immune system
13.1. decreased strength of immune response
13.2. high prevalence of chronic conditions increases the risk of infection
13.3. increased risk of exposure to pathogens with hospitalization and institutionalization
13.4. thymus gland declines in size
13.5. T cell function declines
13.6. reduced antibody response
13.7. decreased number of Langerhan’s cells
13.8. reduced thickness in the skin
13.9. health promotion
13.9.1. improve diet
13.9.2. nutrients with immune boosting effects
13.9.2.1. protein, magnesium, vitamins, manganese, folic acid, zinc, iron
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