Elderly Patient

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Elderly Patient by Mind Map: Elderly Patient

1. Hormonal Changes

1.1. Vulva atrophies

1.2. Flattening of the labia

1.3. Loss of subcutaneous fat and hair

2. Neuro

2.1. Normal Age Related Changes

2.1.1. Loss of nerve cell mass Atrophy of the brain and spinal cord Brain weight decreases

2.1.2. Number of dendrites declines

2.1.3. Demyelinization Slower nerve conduction Response and reaction times are slower Reflexes become weaker

2.1.4. Plaques, tangles, atrophy of the brain

2.1.5. Free radicals accumulate

2.1.6. Decrease in cerebral blood flow

2.1.7. Fatty deposits accumulate in blood vessels

2.1.8. Ability to compensate declines with age

2.1.9. Intellectual performance maintained until at least 80 years of age

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

2.1.11. Verbal skills maintained until age 70

2.1.12. Number and sensitivity of sensory receptors, dermatomes, and neurons decrease Dulling of tactile sensation

2.1.13. Decline in the function of cranial nerves affecting taste and smell

2.2. Parkinson's Disease

2.2.1. Affects ability of the CNS to control body movements

2.2.2. Role of dopamine

2.2.3. Exact cause unknown

2.2.4. Tremors and shuffling gait are characteristic

2.2.5. Treatment/management Anticholinergic medications Technologies to control symptoms

2.2.6. Nursing Interventions Education Psychosocial Physical Goal: maximum level of independence preserved

2.3. Cerebrovascular Accident

2.3.1. Third leading cause of death in older adults

2.3.2. Types Ischemic Hemorrhagic

2.3.3. Risk factors Obesity Hyperlipidemia

2.3.4. Warning signs Face Arms Slurred speech Time

2.3.5. Drop attack

2.3.6. Signs and symptoms Variable Depend on the area of brain affected

2.3.7. Nursing care during the acute phase; after patient stabilization, focus is on rehabilitation

3. Cardiacvascular

3.1. Normal Age Related Changes

3.1.1. Heart valves become thicker and rigid

3.1.2. Aorta becomes dilated Slight ventricular hypertrophy Thickening of left ventricular wall

3.1.3. Myocardial muscle less efficient Decreased contractile strength Decreased cardiac output when demands increased

3.1.4. Calcification, reduced elasticity of vessels

3.1.5. Less sensitive to baroreceptor regulation of blood pressure

3.1.6. Conditions altering tissue perfusion Cardiovascular diseses Diabetes, cancer, renal failure Blood dycrasias Hypotension Medication side effects

3.2. Hypertension

3.2.1. Incidence and prevalence increases with age

3.2.2. Evaluation of blood pressure Systolic BP > 140 mm Hg Diastolic BP > 90 mm Hg Factors to consider when monitoring BP Anxiety Stress Activity before assessment

3.2.3. Symptoms Dull headache Impaired memory Disorientation Confusion Epistaxis Slow tremor Treatment Exercise Antihypertensive medication Low sodium diet Quit smoking

3.3. Congestive Heart Failure

3.3.1. Incidence increases with age

3.3.2. Leading cause of hospitalization

3.3.3. Chronic condition where the heart doesn't pump as much blood as it should

3.3.4. Complication of arteriosclerotic heart disease

3.3.5. Coronary artery disease responsible for most cases

3.3.6. Symptoms Shortness of breath Dyspnea on exertion Confusion Agitation Depression Insomnia Weight gain

3.4. Coronary Artery Disease

3.4.1. ischemic heart disease

3.4.2. Prevalence increase with age

3.4.3. Angina Atypical presentation Coughing Syncope Sweating Confusion Nitroglycerin effective

3.4.4. Myocardial infaction Atypical presentation: confusion, decreased BP, SOB, elevated temperature, and sedimentation rate

4. Integumentary

4.1. Normal Age Related Changes

4.1.1. Flattening of the dermal-epidermal junction

4.1.2. Reduced thickness and vascularity of the dermis

4.1.3. Reduction of epidermal turnover

4.1.4. Degeneration of elastic fibers

4.1.5. Increased coarseness of collagen

4.1.6. Reduced in melanocytes

4.1.7. Atrophy of hair bulbs and decline in the rate of hair and nail growth

4.1.8. Increased fragility of the skin

4.2. Pruritus

4.2.1. Most common dermatologic problem among older adults

4.2.2. Causes Hair regrowth Insect bites Sunburn Dry skin

4.2.3. Potential for skin breakdown and infection

4.2.4. Prompt recognition

4.2.5. Treatment Topical cannabinoid cream

4.3. Skin cancer

4.3.1. Basal cell carcinoma Most common form Grows slowly Rarely metastasized Slightly transparent bump on skin Usually develops on the sun-exposed parts of the body Electrodesiccation and curettage

4.3.2. Squamous cell carcinoma Contributing factors Sun exposure Other factors that facilitate growth Uncontrolled growth of abnormal squamous cells Second most common form Firm red nodule Electrodesiccation and curettage

4.3.3. Melanoma Tends to more easily metastasize Rising incidence in the United States Pigment-producing cells that give color to the skin become cancerous. A new unusual growth or mole or a change in an existing mole Surgery, radiation, medications

5. Reproductive

5.1. Normal Age Related Changes-Female

5.1.1. Vaginal epithelium thins

5.1.2. Cervix, uterus, and fallopian tubes atrophy

5.1.3. Vaginal canal changes Reduction in collagen and adipose tissue Shortening and narrowing of the canal Less lubrication May lead to discomfort with intercourse More alkaline vaginal pH as a result of lower estrogen changes

5.1.4. Uterus and ovaries decrease in size

5.1.5. Fallopian tubes become shorter and straighter

5.1.6. Breasts sag and are less firm

5.2. Vaginitis

5.2.1. The increased fragility of the fragile vagina in postmenopausal women causes it to be more easily irritated, which heightens the risk of vaginitis

5.2.2. Symptoms Soreness Pruritus Burning Reddened vagina Foul-smelling vaginal discharge is clear, brown, or white; could progress and cause bleeding and adhesions

5.2.3. Treatment Local estrogens in suppository or cream form Boric acid, zinc, lysine, or gentian violet douches may also be prescribed Good hygienic practices help treat and prevent

5.3. Cervical Cancer

5.3.1. Median age when diagnosed is 49 years old

5.3.2. Although less than 20% of all diagnosed cases are in older women, about 1/3 of cervical cancer deaths occur among this group

5.3.3. Signs Vaginal bleeding Leukorrhea Urinary retention Fecal incocontinence Uremia

5.3.4. Treatment Radium Surgery

5.4. Normal Age Related Changes-Male

5.4.1. Seminal vesicles develop thinner epithelium

5.4.2. Muscle tissue replaced with connective tissue

5.4.3. Decreased capacity to retain fluids

5.4.4. Seminiferous tubule changes Increase fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen

5.4.5. Atrophy of the testes and reduction in testicular mass

5.4.6. Ejaculation fluid contains less live sperm

5.4.7. More time required to achieve an erection

5.4.8. Enlargement of the prostate gland

5.5. Erectile Dysfunction

5.5.1. Inability to achieve and sustain an erection for intercouse

5.5.2. Nearly half of the men over 70 years of age are affected

5.5.3. Caused by alcoholism, diabetes, dyslipidemia, HTN, hypogonadism, multiple sclerosis, renal failure, spinal cord injury, thyroid conditions, psychological factors, and certain medications.

5.5.4. Treatments Oral erectile agents Viagra Levitra Cialis Drugs injected into the penis Penis implants Vacuum pump devices

5.6. Benign Prostatic Hyperplasia

5.6.1. Symptoms Hesitancy Decreased force of urinary stream Frequency Nocturia

5.6.2. Prostate enlarges putting pressure on the urethra

5.6.3. As the hyperplasia progresses, the bladder wall loses its elasticity and becomes thinner, leading to urinary retention and an increased risk of urinary infection

5.6.4. May develop kidney damage if left untreated

5.6.5. Treatment Prostatic massage Urinary antiseptics The avoidance of diuretics, anticholinergics, and antiarrhythmics Transurethral surgery

5.7. Prostate Cancer

5.7.1. More than half of men over 70 have evidence of prostate cancer; only a small percentage will die from it

5.7.2. Often asymptomatic Symptoms such as back pain, anemia, weakness, and weight loss can develop as a result of metastasis

5.7.3. Detected by digital rectal examination PSA test assists with diagnosis, confirmed through biopsy

5.7.4. Treatment Monitoring, irradiation, or a radical prostatectomy if metastasis has not occurred Hormones may be used to prevent tumor dissemination Palliative treatment is used if metastasis has occurred; includes irradiation, transurethral surgery, chemotherapy, orchiectomy, and hormone therapy

6. Musculoskeletal

6.1. Normal Age Related Changes

6.1.1. Shortening of vertebrae Height decreases approximately 2 inches

6.1.2. Slight knee, hip, and wrist flexion

6.1.3. Decrease in bone mass and bone mineral Bones more brittle

6.1.4. Slight kyphosis

6.1.5. Decline in size and number of muscle fibers, and reduction in muscle mass Decreased body strength Endurance declines

6.1.6. Connective tissue changes Reduced flexibility of joints and muscles

6.1.7. Sarcopenia Age-related reduction of muscle mass or function resulting from a reduction in protein synthesis and an increase in muscle protein degeneration Can lead to disability

6.2. Fractures

6.2.1. Risk Factors Posture Decreased calcium intake while 20-30 years old Slow reaction time Brittle bone Malnutrition

6.2.2. Common sites Hips Wrist

6.2.3. Brittle bones fracture more easily and heal at a slower rate Potential for complications associated with immobility

6.2.4. Interventions aimed at prevention

6.2.5. Immobility of the injured site

6.3. Osteoporosis

6.3.1. Most prevalent metabolic disease of the bone

6.3.2. Risk factors Inactivity or immobility Diseases Reduction in anabolic sex hormones Diet Drugs

6.3.3. May cause kyphosis, spinal pain, and fractures

6.3.4. Often asymptomatic

6.3.5. Diagnosis Bone density

6.4. Gout

6.4.1. Metabolic disorder in which excess uric acid accumulates in the blood

6.4.2. Excruciating pain

6.4.3. Exacerbations and remissions

6.4.4. Managing diet- decrease red meats and beer

7. Respiratory

7.1. Normal Age Related Changes

7.1.1. Changes occur in upper paths, nose, and trachea

7.1.2. Reduce cough

7.1.3. Lungs reduce in size and weight

7.1.4. Decreased elastic recoil

7.1.5. Alveoli less elastic

7.1.6. Reduction in vital capacity; increase residual volume

7.1.7. Loose or brittle teeth can be aspired

7.2. Asthma

7.2.1. Can develop in older years

7.2.2. High risk of complications of bronchiectasis, cardiac problems

7.2.3. High rates of mortality

7.2.4. Assess for causative factors and educate patient

7.2.5. Evaluate aerosol nebulizers' use

7.2.6. Precaution: avoid adverse drug effects

7.3. Chronic bronchitis

7.3.1. Causes persistent, productive cough; wheezing; recurrent respiratory infections; shortness of breath

7.3.2. Management of chronic bronchitis Remove bronchial secretions Prevent obstruction of airway Maintain adequate fluid intake

7.4. Emphysema

7.4.1. Increasing incidence in older adults

7.4.2. Causes Chronic bronchitis Chronic irritation Morphologic changes in the lung

7.4.3. Cigarette smoking major role in development

7.4.4. Symptoms develop slowly; can delay diagnosis, treatment

7.4.5. Treatment Postural drainage Bronchodilators Avoid stress Breathing exercises

8. Gastrointestinal

8.1. Normal Age Related Changes

8.1.1. Atrophy of the tongue affects taste buds and decrease taste sensation

8.1.2. Saliva production decreases Swallowing may be difficult

8.1.3. Presbyesophagus results in weaker esophageal contractions and weakness sphincter

8.1.4. Esophageal and stomach motility decreases Risk for aspiration and indigestion

8.1.5. Decreased elasticity of the stomach Reduces the amount of food accommodation at one time

8.1.6. Stomach has higher pH as a result of decline in HCL Interferes in incidence of gastric irritation Interferes with absorption of calcium, iron, folic acid, and vitamin B12

8.1.7. Decline in pepsin Interferes with absorption of protein

8.1.8. Fewer cells on absorbing surface of intestinal wall impact the absorption of dextrose, xylose, and vitamins B and D

8.2. Xerostomia

8.2.1. Caused by decreased saliva, some medications, Sjogren's syndrome, mouth breathing, and altered congnition

8.2.2. Consequences of decreased saliva production in the older adult population

8.2.3. Interventions Saliva substitutes Sipping water Sugarless candy and gum

8.3. Dysphagia

8.3.1. Incidence of swallowing difficulties increases with age

8.3.2. Causes GERD Stroke Structural disorders

8.3.3. Goals of care and interventions Prevention of aspiration Promotion of adequate nutritional status

9. Endocrine

9.1. Normal Age Related Changes

9.1.1. Thyroid gland atrophies and activity decreases

9.1.2. Diminished adrenal function

9.1.3. Adrenocorticotropic hormone secretion decreases Causes BP to increase

9.1.4. Volume of pituitary gland decreases

9.1.5. Insufficient release of insulin and reduced tissue insensitivity to circulating insulin

9.2. Type 2 Diabetes

9.2.1. Glucose intolerance

9.2.2. Incidence 25-33% of older adults have diabetes

9.2.3. Classic nonspecific symptoms may be absent

9.2.4. Screening Glucose tolerance test is the most effective test Fasting blood sugar recommended every 3 years for persons over 45 years of age Multiple tests should be performed to avoid false-positive results

9.2.5. Diagnosis Symptoms and a random blood glucose concentration >200 mg/dl Fasting blood glucose concentration >126 mg/dl Blood glucose concentrations 2 hours after oral glucose intake >200 mg/dl

9.2.6. Medication Metformin Increase insulin sensitivity Decrease glucose Glyburide

9.3. Hypothyroidism

9.3.1. Subnormal concentration of thyroid hormone

9.3.2. Primary hypothyroidism Low T4 and high TSH

9.3.3. Secondary hypothyroidism Low T4 and low TSH

9.3.4. Signs/Symptoms Fatigue Depression Disinterest in life Anorexia Constipation Weight gain Myalgia or parathesia

9.3.5. Treatment Requires medication replacement

9.4. Hyperthyroidism

9.4.1. Secretion of excess amounts of thyroid hormone

9.4.2. Signs/Symptoms Diaphoresis Tachycardia HTN Tremor Palpitations Diarrhea Lid Lag

9.4.3. Diagnosis Graves' Disease Autoimmune antibody to TSH Antithyroid medication or radioactive iodine Goiter Toxic multi nodular condition Surgically remove

10. Sensation

10.1. Vision

10.1.1. Normal Age Related Changes Reduced elasticity and stiffening of the muscle fibers of the lens Decreased ability to focus (presbyopia) Reduced pupil size Opacification of the lens and vitreous Visual acuity declines Loss of photoreceptor cells in the retina Light perception threshold decreases Dark and light adaptation takes longer Difficult with vision at night Increased sensitivity to glare Distortion in depth perception Peripheral vision reduced

10.1.2. Cataracts Clouding of the lens and loss of transparency Leading cause of low vision in older adults Risk Factors Increasing age; smoking; diabetes; high blood pressure Blurred vision Treatment/management Need for surgery must be evaluated on an individual basis

10.1.3. Glaucoma Damage to the optic nerve from an above normal intraocular pressure 2nd leading cause of blindness in older adults Acute Closed or narrow angle Severe eye pain, headache, N/V Rapid increase in tension and edema Need for early treatment to prevent blindness Diagnosis with tonometry to measure IOP Chronic Open angle Most common form Need for early prevention to prevent blindness Vision loss due to glaucoma cannot be restored Avoid situations that increase IOP Avoid abuse and overuse of the eyes

10.2. Hearing

10.2.1. Normal Age Related Changes Changes may negatively impact communication Sensorineural hearing loss (presbycusis) Impacted cerumen Self-conscious of limitation and avoid interactions Underlying cause determined by professional

10.3. Others

10.3.1. Number of functioning taste buds decrease Sweet and salty flavors

10.3.2. Pressure not sensed as easily in later life Decreased tactile sensation Difficulty discriminating b/t temperatures

10.3.3. Some olfactory function loss

11. Genitourinary

11.1. Normal Age Related Changes

11.1.1. Hypertrophy and thickening of the bladder muscle Decreases bladder ability to expand Reduces storage capacity Daytime urinary frequency Nocturia

11.1.2. Changes in cortical control of micturition Nocturia

11.1.3. Inefficient neurological control of bladder emptying and weaker bladder muscle Retention of large volumes of urine Female: fecal impaction Male: prostatic hypertrophy

11.1.4. Kidney filtration ability decreases Affects the ability to eliminate drugs Potential for adverse drug reactions

11.1.5. Reduced renal function High blood urea nitrogen levels

11.1.6. Decreased tubular function Concentration of urine changes in response to water and/or sodium excess/depletion

11.2. Bladder cancer

11.2.1. Incidence increases with age

11.2.2. Risk factors Chronic irritation of the bladder Exposure to dyes Cigarette smoking

11.2.3. Symptoms Frequency Urgency Dysuria

11.2.4. Treatment Sugery Radiation Immunotherapy Chemotherapy

11.3. Glomerulonephritis

11.3.1. Symptoms Usually subtle and nonspecific

11.3.2. Clinical manifestations Fever Fatigue N/V Anorexia Abdominal pain

11.3.3. Diagnosis/Treatemtn Differ significantly from those used for the young Antibiotics, a restricted sodium and protein diet, and pay attention to I & O's.

12. Safety

12.1. Risks are compounded by:

12.1.1. Age-related factors reducing their capacity to protect themselves

12.1.2. Increased vulnerability to safety hazards

12.2. Nursing assessment includes a review of risks to safety

12.3. Interventions necessary to address threats to safety, life, well-being

12.3.1. Lighting Light profound effect on visibility Function Orientation Mood and behavior Diffuse lighting better than bright light Nightlights: soft red light in bedroom

12.3.2. Temperature Older adults have lower than normal body temperatures Decreased natural insulation Maintaining adequate environmental temperature is significnat Recommended room temperature is 75 degree F: lower temperature leads to hypothermia

12.3.3. Floor coverings Carpeting: sound absorber but can cause problems Static electricity and cling Difficult wheelchair mobility Cleaning Odors Pests Scattered rugs or area rugs can cause falls

12.3.4. Furniture Appealing Functional Comfortable Tables and bookcases should be sturdy

12.4. Accidents rank sixth leading cause o fdeath

12.5. Falls leading cause of injury-related death

12.6. Environment

12.6.1. Microenvironment: immediate surrounding

12.6.2. Macroenvironment: elements in larger world

13. Safe Medication Use

13.1. Increased Risk of Adverse Reactions

13.1.1. Related to altered pharmacokinetics and pharmacodynamics

13.1.2. Mental dysfunction is often an early sign of adverse reaction to many medications

13.2. Age-related changes affect

13.2.1. Pharmacokinetics Absorption Factors altering absorption Distribution Difficult to predict drug distribution Considerations with the older adult Dehyrdration and hypoalbuminemia decrease drug distribution Metabolism Conditions decreasing metabolism of drugs Excretion Extended biological half-life: close evaluation of drug clearance Renal system excretes drugs; implications of reduced kidney efficiency important Liver influences drug excretion

13.2.2. Pharmacodynamics Increased myocardial sensitivity to anesthesia

13.3. Polypharmacy

13.3.1. High prevalence of health conditions, large use of medications

13.3.2. Taking more than one drug increases the risk of drug-food interactions

13.3.3. Most older adults use at least one medication regularly; many use several medications daily

13.4. Factors interference with safe administration

13.4.1. Functional limitations

13.4.2. Cognitive limitations