The Older Adult Patient

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The Older Adult Patient by Mind Map: The Older Adult Patient

1. Renal

1.1. Normal age related changes

1.1.1. Urinary frequency

1.1.2. Hypertrophy of bladder muscle & thickening of bladder

1.1.3. Reduced storage capacity of bladder

1.1.4. Nocturia

1.1.5. Urinary retention from weaker bladder muscles

1.1.6. Decreased efficiency of kidney filtration

1.1.7. Decreased kidney tubular function

1.1.8. Cortical changes of micturition

1.1.9. Inefficient neurological control of bladder

1.2. Pathological changes

1.2.1. Incontinence Patho Involuntary loss of urine control Signs and symptoms Many different types: slight loss of urine after sneezing, coughing, or laughing to complete inability to control urination Treatment behavioral therapy, medications, medical devices, and surgery

1.2.2. Bladder Cancer Patho Numerous environmental, molecular, or genetic factors are involved in the development of urothelial cell cancers Signs and symptoms Blood in the urine, pain during urination, increased frequency, dark urine Treatment Surgery, radiation, immunotherapy, chemotherapy, depends on the extent and location of lesions

1.2.3. Glomerulonephritis Patho renal injury in which large amounts of protein are lost in the urine Signs and symptoms Fever, fatigue, nausea, vomiting, anorexia, abdominal pain, anemia, edema, arthralgia, elevated BP, proteinuria, hematuria, headache, delirium Treatment Dietary changes, smoking cessation, immunosuppressants, blood pressure medications

2. Respiratory

2.1. Normal age related changes

2.1.1. Reduced support of connective tissue causing nasal septal deviation

2.1.2. Reduced secretions from submucosal glands - mucus is thicker and harder to expel

2.1.3. Thicker hair in nostril

2.1.4. Trachea stiffens from calcification

2.1.5. Reduced coughing reflex

2.1.6. Lungs smaller in size and weight

2.1.7. Expiration requires use of accessory muscles

2.1.8. Reduced vital capacity and increased residual volume

2.1.9. Slight barrel chest

2.2. Pathological changes

2.2.1. Lung Cancer Patho activation of oncogenes or the inactivation of tumor suppressor genes, which leads to uncontrolled replication and growth of the cells in the lungs Signs and symptoms cough (often with blood), chest pain, wheezing, weight loss, shortness of breath, frequent respiratory infections, pressure in chest Treatment Immunotherapy, chemotherapy, radiation, palliative care, healthy lifestyle habits, surgery

2.2.2. Emphysema Patho decline in the alveolar surface area available for gas exchange Signs and symptoms Increased dyspnea, chronic cough, hypoxia, fatigue, anorexia, weight loss, recurrent respiratory infections, malnutrition, CHF, arrhythmias Treatment Postural drainage, bronchodilators, avoidance of stressful situation, breathing exercises, pain management, low levels of oxygen

2.2.3. Asthma Patho airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness Signs and symptoms difficulty breathing, wheezing, breathing through the mouth, fast breathing, frequent respiratory infections, rapid breathing, or shortness of breath at night Treatment Medications, healthy lifestyle, patient education,

3. Cardiovascular

3.1. Normal age related changes

3.1.1. Heart valves increase in thickness and rigidity

3.1.2. Aorta becomes dilated

3.1.3. Slight ventricular hypertrophy

3.1.4. Myocardial muscle less efficient and loses some of its contractile strength

3.1.5. Reduced cardiac output

3.1.6. Calcification and reduced elasticity of vessels

3.1.7. Less sensitive to baroreceptor regulation of blood pressure i

3.1.8. Increased resistance of peripheral vessels

3.2. Pathological changes

3.2.1. Hypertension Patho body's smaller blood vessels narrow, causing the blood to exert excessive pressure against the vessel walls and forcing the heart to work harder to maintain the pressure Signs and symptoms Awakening with dull headache, Impaired memory, disorientation, confusion, epistaxis, slow tremor, high blood pressure readings consistently Treatment Eating a healthier diet with less salt, exercising regularly, and taking medications

3.2.2. Congestive Heart Failure Patho syndrome that can be caused by a variety of abnormalities, including pressure and volume overload, loss of muscle, primary muscle disease or excessive peripheral demands such as high output failure Signs and symptoms Dyspnea on exertion, confusion, insomnia, wandering during night, agitation, depression, anorexia, nausea, weakness, shortness of breath, orthopnea, wheezing, weight gain, bilateral ankle edema, crackles on auscultation Treatment Bed rest, ACE inhibitors, beta blockers, diuretics, reduction of sodium intake

3.2.3. Pulmonary Embolus Patho a clump of material, most often a blood clot, gets wedged into an artery in your lungs. Signs and symptoms shortness of breath, chest pain, cough, feeling of impending doom, heart palpitations, tachypnea, lightheadedness Treatment Blood thinners and thrombolytics; compression socks and physical activity to prevent clots

4. Reproductive

4.1. Normal age related changes

4.1.1. Males Reduction of sperm count Seminal vessels have thinner epithelium and less capacity to retain fluid Increased fibrosis of seminiferous tubules Atrophy of testes Reduction of testicular mass Enlargement of prostate gland Testosterone stays the same or decreases slightly

4.1.2. Females Vulva atrophy Flattening of labia Loss of subcutaneous fat and hair Vaginal environment is dry and alkaline Cervix, uterus, Fallopian tubes, and ovaries atrophy Retraction of nipple Breasts sag due to increased fat tissue after menopause

4.2. Pathological changes

4.2.1. Females Ovarian Cancer Patho Signs and symptoms Treatment Perineal Herniation Patho Signs and symptoms Treatment Breast Cancer Patho Signs and symptoms Treatment

4.2.2. Males Erectile Dysfunction Signs and symptoms Treatment Prostate Cancer Patho Signs and symptoms Treatment BPH Patho Signs and symptoms Treatment

5. Integumentary

5.1. Normal age related changes

5.1.1. Reduced thickness and vascularity of the dermis

5.1.2. Slowing of epidermal proliferation

5.1.3. Increased quantity and degeneration of elastin fiber

5.1.4. Collagen fibers become coarse

5.1.5. Subcutaneous fat decreases

5.1.6. Skin breakdown occurs more easily

5.1.7. Reduction in melanocytes

5.2. Pathological changes

5.2.1. Pruritus Patho Caused by atrophic changes or any circumstance that dries a persons skin. Signs and symptoms uncomfortable, irritating sensation that creates an urge to scratch Treatment Vitamin supplements, high quality vitamin rich diet, topical application of zinc oxide, antihistamines, topical steroids, bath oils, moisturizing lotion

5.2.2. Basal Cell Carcinoma Patho most common skin cancer in humans, which typically appears over the sun-exposed skin as a slow-growing, locally invasive lesion that rarely metastasizes Signs and symptoms lesion, redness, loss of color, small bump, swollen blood vessels in the skin, or ulcers Treatment Topical anti tumor medication, chemotherapy, tissue scraping, Mohs surgery

5.2.3. Pressure Ulcers Patho Pressure against the skin that leads to lack of blood flow and development of sore Signs and symptoms redness, dark scab, chronic wound, ulcer of ankle, ulcer of heel and midfoot, ulcer of hip, ulcer of tailbone (most common sites) Treatment Dietary supplements, antibiotics, debridement, relieving pressure off skin, barrier cream, high protein diet

6. GI

6.1. Normal age related changes

6.1.1. Tongue atrophies - decreasing taste sensation

6.1.2. Decreased saliva production

6.1.3. Swallowing may be more difficult

6.1.4. Reduced chewing efficiency

6.1.5. Presbyesophagus

6.1.6. Decreased elasticity of stomach

6.1.7. Declines in hydrochloric acid and pepsin which increases stomach pH

6.1.8. Decreased absorption of vitamins and protein

6.1.9. Slower peristalsis

6.1.10. Decreased sensory perception of bowel movement

6.2. Pathological changes

6.2.1. Dysphagia Patho difficulty or pain in swallowing, caused by lesions or stricture of the upper digestive tract, obstruction of the upper digestive tract by tumours or foreign bodies, or disturbances in the nervous or muscular control of swallowing Signs and symptoms Painful swallowing, difficulty swallowing, food gets stuck in throat, drooling, hoarse, frequent heartburn, food regurgitation Treatment Speech-language therapist, modified diet, eat small frequent meals, eat in upright position

6.2.2. Esophageal Cancer Patho inflammation of the squamous epithelium that leads to dysplasia Signs and symptoms Dysphagia, weight loss, excessive salivation, thirst, hiccups, anemia, chronic bleeding Treatment Surgical resection, radiation, chemotherapy, laser therapy, photodynamic therapy

6.2.3. Peptic Ulcer Disease Patho imbalance between factors that can damage the gastroduodenal mucosal lining and defense mechanisms that normally limit the injury Signs and symptoms Constipation, diarrhea, pain in chest of upper abdomen, heartburn, nausea, vomiting, fatigue, Treatment Medications that decrease stomach acid production, antibiotics, antidiarrheals, endoscopy

7. Neuro

7.1. Normal age related changes

7.1.1. Decreased conduction velocity

7.1.2. Slower response and reaction time

7.1.3. Decreased brain weight

7.1.4. Reduced blood flow to the brain

7.1.5. Changes in sleep pattern

7.1.6. Loss of nerve cell mass

7.1.7. Demyelination

7.1.8. Decreased number of dendrites

7.1.9. Decreased cerebral blood flow

7.1.10. Fatty plaque build up

7.2. Pathological changes

7.2.1. Parkinson’s Disease Patho Impaired function of the basal ganglia in the midbrain Signs and symptoms Tremor, stiff muscles, difficulty standing, difficulty walking, difficulty with bodily movements, involuntary movements, muscle rigidity, problems with coordination, rhythmic muscle contractions, slow bodily movement, or slow shuffling gait, fatigue, apathy Treatment Medications: Dopamine promoter, Anti-Tremor, Cognition-enhancing medication, and Antidepressant; physical exercises

7.2.2. TIA Patho Temporary or intermittent neurological events that can result from any situation that reduces cerebral circulation Signs and symptoms Hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, nausea, vomiting, dysphagia Treatment Correct underlying cause, anticoagulant therapy, vascular reconstruction

7.2.3. CVA Patho Ischemic: from thrombus or embolus Hemorrhagic: from ruptured vessel Signs and symptoms Hemiplegia, aphasia, hemianopsia; symptoms vary depending on area of brain effected Treatment Speech therapy, PT, OT, stroke rehabilitation, supportive care, continuous monitoring, medications, surgery

8. Safety Considerations

8.1. Sensory

8.1.1. Sight More opaque lens Decreased pupil size More spherical cornea

8.1.2. Smell Impaired ability to identify and discriminate among odors

8.1.3. Taste High prevalence of taste impairment especially for salt

8.1.4. Touch Reduction in tactile sensation

8.1.5. Hearing Atrophy of hair cells of organ of Corti Tympanic membrane sclerosis and atrophy Increased cerumen and concentration of keratin

8.2. Polypharmacy

8.2.1. high prevalence of health conditions, large use of medications

8.2.2. taking more than one drug increases risk of drug-food interactions

8.2.3. risk of adverse drug reactions higher in older adults r/t altered pharmacokinetics and pharmacodynamics

8.2.4. Beer' criteria = identification of drugs that carry high risk for older adults

8.2.5. assess for risk of medication errors and plan interventions

8.2.6. benefits vs risks

9. Musculoskeletal

9.1. Normal age related changes

9.1.1. Shortening of vertebrae

9.1.2. Height decreases about 2 inches by age 70

9.1.3. Bones more brittle

9.1.4. Slight knee flexion

9.1.5. Decrease in bone mass and bone mineral

9.1.6. Slight kyphosis

9.1.7. Slight hip flexion

9.1.8. Slight wrist flexion

9.1.9. Impaired flexion and extension movements

9.2. Pathological changes

9.2.1. Rheumatoid arthritis Patho A chronic inflammatory disorder affecting many joints, including those in the hands and feet Signs and symptoms Pain in the in the joints, back, or muscles, stiffness, swelling, tenderness, weakness, fatigue, anemia, malaise, lumps or redness Treatment Heating pads, surgery, medications, stretching, physical therapy

9.2.2. Osteoporosis Patho bone disease that occurs when the body loses too much bone, makes too little bone Signs and symptoms Back pain, loss of height, stooped posture, fractures Treatment medications, healthy diet, and weight-bearing exercise to help prevent bone loss or strengthen already weak bones

10. Psychosocial

10.1. Depression

10.1.1. Patho Most frequent problem psychiatrists treat in older adults

10.1.2. Signs and symptoms Insomnia, fatigue, anorexia, weight loss, constipation, decreased interest in sex, guilt, apathy, helplessness, changes in sleep pattern

10.1.3. Treatment Therapy, antidepressants, SSRIs, antipsychotics, electroconvulsive therapy

10.2. Demetria

10.2.1. Patho Irreversible, progressive impairment in cognitive function caused by damage or injury to brain

10.2.2. Signs and symptoms disoriented, confused, changes in personality, impaired judgement, inappropriate behavior, may have uncoordinated balance

10.2.3. Treatment no cure but progression can be slowed

10.3. Delirium

10.3.1. Patho acute, rapid disruption in brain function

10.3.2. Signs and symptoms Rapid, altered level of consciousness, disoriented, incoherent speech, short term memory impairment, fluctuation in behavior. highly agitated, change in LOC

10.3.3. Treatment can be reversed and normal mental status regained

11. Endocrine

11.1. Normal age related changes

11.1.1. Thyroid gland atrophies and activity decreases

11.1.2. Diminished adrenal function

11.1.3. ACTH secretion decreases

11.1.4. Volume of pituitary gland decreases

11.1.5. Insufficient release of insulin

11.2. Pathologic

11.2.1. Hyperthyroidism Patho Thyroid gland secretes excess amount of thyroid hormones Signs and symptoms Diaphoresis, tachycardia, palpitations, tremor, diarrhea, stare, lid lag, insomnia, nervousness, confusion, heat intolerance, hyperreflexia Treatment Anti thyroid medications, radioactive iodine

11.2.2. Hypothyroidism Patho Subnormal concentration of thyroid hormone in the tissues Primary: disease process destroys thymus gland Secondary: caused by insufficient pituitary secretion of TSH Signs and symptoms Fatigue, weakness, depression, anorexia, weight gain, impaired hearing, peripheral edema, constipation, cold intolerance, dry skin, coarse hair Treatment Thyroid replacement hormones

11.2.3. Diabetes Patho Type 2 diabetes: peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells Type 1 diabetes: beta cells produce little or no insulin Signs and symptoms Increased thirst, frequent urination, extreme hunger, unexplained weight loss, presence of ketones in the urine, fatigue, irritability Treatment monitoring blood glucose levels, dietary management, maintaining physical activity, keeping weight and stress under control, monitoring oral medications, insulin use