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

1.2.1.1. Patho

1.2.1.1.1. Involuntary loss of urine control

1.2.1.2. Signs and symptoms

1.2.1.2.1. Many different types: slight loss of urine after sneezing, coughing, or laughing to complete inability to control urination

1.2.1.3. Treatment

1.2.1.3.1. behavioral therapy, medications, medical devices, and surgery

1.2.2. Bladder Cancer

1.2.2.1. Patho

1.2.2.1.1. Numerous environmental, molecular, or genetic factors are involved in the development of urothelial cell cancers

1.2.2.2. Signs and symptoms

1.2.2.2.1. Blood in the urine, pain during urination, increased frequency, dark urine

1.2.2.3. Treatment

1.2.2.3.1. Surgery, radiation, immunotherapy, chemotherapy, depends on the extent and location of lesions

1.2.3. Glomerulonephritis

1.2.3.1. Patho

1.2.3.1.1. renal injury in which large amounts of protein are lost in the urine

1.2.3.2. Signs and symptoms

1.2.3.2.1. Fever, fatigue, nausea, vomiting, anorexia, abdominal pain, anemia, edema, arthralgia, elevated BP, proteinuria, hematuria, headache, delirium

1.2.3.3. Treatment

1.2.3.3.1. 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

2.2.1.1. Patho

2.2.1.1.1. activation of oncogenes or the inactivation of tumor suppressor genes, which leads to uncontrolled replication and growth of the cells in the lungs

2.2.1.2. Signs and symptoms

2.2.1.2.1. cough (often with blood), chest pain, wheezing, weight loss, shortness of breath, frequent respiratory infections, pressure in chest

2.2.1.3. Treatment

2.2.1.3.1. Immunotherapy, chemotherapy, radiation, palliative care, healthy lifestyle habits, surgery

2.2.2. Emphysema

2.2.2.1. Patho

2.2.2.1.1. decline in the alveolar surface area available for gas exchange

2.2.2.2. Signs and symptoms

2.2.2.2.1. Increased dyspnea, chronic cough, hypoxia, fatigue, anorexia, weight loss, recurrent respiratory infections, malnutrition, CHF, arrhythmias

2.2.2.3. Treatment

2.2.2.3.1. Postural drainage, bronchodilators, avoidance of stressful situation, breathing exercises, pain management, low levels of oxygen

2.2.3. Asthma

2.2.3.1. Patho

2.2.3.1.1. airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness

2.2.3.2. Signs and symptoms

2.2.3.2.1. difficulty breathing, wheezing, breathing through the mouth, fast breathing, frequent respiratory infections, rapid breathing, or shortness of breath at night

2.2.3.3. Treatment

2.2.3.3.1. 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

3.2.1.1. Patho

3.2.1.1.1. 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

3.2.1.2. Signs and symptoms

3.2.1.2.1. Awakening with dull headache, Impaired memory, disorientation, confusion, epistaxis, slow tremor, high blood pressure readings consistently

3.2.1.3. Treatment

3.2.1.3.1. Eating a healthier diet with less salt, exercising regularly, and taking medications

3.2.2. Congestive Heart Failure

3.2.2.1. Patho

3.2.2.1.1. 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

3.2.2.2. Signs and symptoms

3.2.2.2.1. 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

3.2.2.3. Treatment

3.2.2.3.1. Bed rest, ACE inhibitors, beta blockers, diuretics, reduction of sodium intake

3.2.3. Pulmonary Embolus

3.2.3.1. Patho

3.2.3.1.1. a clump of material, most often a blood clot, gets wedged into an artery in your lungs.

3.2.3.2. Signs and symptoms

3.2.3.2.1. shortness of breath, chest pain, cough, feeling of impending doom, heart palpitations, tachypnea, lightheadedness

3.2.3.3. Treatment

3.2.3.3.1. Blood thinners and thrombolytics; compression socks and physical activity to prevent clots

4. Reproductive

4.1. Normal age related changes

4.1.1. Males

4.1.1.1. Reduction of sperm count

4.1.1.2. Seminal vessels have thinner epithelium and less capacity to retain fluid

4.1.1.3. Increased fibrosis of seminiferous tubules

4.1.1.4. Atrophy of testes

4.1.1.5. Reduction of testicular mass

4.1.1.6. Enlargement of prostate gland

4.1.1.7. Testosterone stays the same or decreases slightly

4.1.2. Females

4.1.2.1. Vulva atrophy

4.1.2.2. Flattening of labia

4.1.2.3. Loss of subcutaneous fat and hair

4.1.2.4. Vaginal environment is dry and alkaline

4.1.2.5. Cervix, uterus, Fallopian tubes, and ovaries atrophy

4.1.2.6. Retraction of nipple

4.1.2.7. Breasts sag due to increased fat tissue after menopause

4.2. Pathological changes

4.2.1. Females

4.2.1.1. Ovarian Cancer

4.2.1.1.1. Patho

4.2.1.1.2. Signs and symptoms

4.2.1.1.3. Treatment

4.2.1.2. Perineal Herniation

4.2.1.2.1. Patho

4.2.1.2.2. Signs and symptoms

4.2.1.2.3. Treatment

4.2.1.3. Breast Cancer

4.2.1.3.1. Patho

4.2.1.3.2. Signs and symptoms

4.2.1.3.3. Treatment

4.2.2. Males

4.2.2.1. Erectile Dysfunction

4.2.2.1.1. Signs and symptoms

4.2.2.1.2. Treatment

4.2.2.2. Prostate Cancer

4.2.2.2.1. Patho

4.2.2.2.2. Signs and symptoms

4.2.2.2.3. Treatment

4.2.2.3. BPH

4.2.2.3.1. Patho

4.2.2.3.2. Signs and symptoms

4.2.2.3.3. 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

5.2.1.1. Patho

5.2.1.1.1. Caused by atrophic changes or any circumstance that dries a persons skin.

5.2.1.2. Signs and symptoms

5.2.1.2.1. uncomfortable, irritating sensation that creates an urge to scratch

5.2.1.3. Treatment

5.2.1.3.1. 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

5.2.2.1. Patho

5.2.2.1.1. most common skin cancer in humans, which typically appears over the sun-exposed skin as a slow-growing, locally invasive lesion that rarely metastasizes

5.2.2.2. Signs and symptoms

5.2.2.2.1. lesion, redness, loss of color, small bump, swollen blood vessels in the skin, or ulcers

5.2.2.3. Treatment

5.2.2.3.1. Topical anti tumor medication, chemotherapy, tissue scraping, Mohs surgery

5.2.3. Pressure Ulcers

5.2.3.1. Patho

5.2.3.1.1. Pressure against the skin that leads to lack of blood flow and development of sore

5.2.3.2. Signs and symptoms

5.2.3.2.1. redness, dark scab, chronic wound, ulcer of ankle, ulcer of heel and midfoot, ulcer of hip, ulcer of tailbone (most common sites)

5.2.3.3. Treatment

5.2.3.3.1. 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

6.2.1.1. Patho

6.2.1.1.1. 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

6.2.1.2. Signs and symptoms

6.2.1.2.1. Painful swallowing, difficulty swallowing, food gets stuck in throat, drooling, hoarse, frequent heartburn, food regurgitation

6.2.1.3. Treatment

6.2.1.3.1. Speech-language therapist, modified diet, eat small frequent meals, eat in upright position

6.2.2. Esophageal Cancer

6.2.2.1. Patho

6.2.2.1.1. inflammation of the squamous epithelium that leads to dysplasia

6.2.2.2. Signs and symptoms

6.2.2.2.1. Dysphagia, weight loss, excessive salivation, thirst, hiccups, anemia, chronic bleeding

6.2.2.3. Treatment

6.2.2.3.1. Surgical resection, radiation, chemotherapy, laser therapy, photodynamic therapy

6.2.3. Peptic Ulcer Disease

6.2.3.1. Patho

6.2.3.1.1. imbalance between factors that can damage the gastroduodenal mucosal lining and defense mechanisms that normally limit the injury

6.2.3.2. Signs and symptoms

6.2.3.2.1. Constipation, diarrhea, pain in chest of upper abdomen, heartburn, nausea, vomiting, fatigue,

6.2.3.3. Treatment

6.2.3.3.1. 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

7.2.1.1. Patho

7.2.1.1.1. Impaired function of the basal ganglia in the midbrain

7.2.1.2. Signs and symptoms

7.2.1.2.1. 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

7.2.1.3. Treatment

7.2.1.3.1. Medications: Dopamine promoter, Anti-Tremor, Cognition-enhancing medication, and Antidepressant; physical exercises

7.2.2. TIA

7.2.2.1. Patho

7.2.2.1.1. Temporary or intermittent neurological events that can result from any situation that reduces cerebral circulation

7.2.2.2. Signs and symptoms

7.2.2.2.1. Hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, nausea, vomiting, dysphagia

7.2.2.3. Treatment

7.2.2.3.1. Correct underlying cause, anticoagulant therapy, vascular reconstruction

7.2.3. CVA

7.2.3.1. Patho

7.2.3.1.1. Ischemic: from thrombus or embolus

7.2.3.1.2. Hemorrhagic: from ruptured vessel

7.2.3.2. Signs and symptoms

7.2.3.2.1. Hemiplegia, aphasia, hemianopsia; symptoms vary depending on area of brain effected

7.2.3.3. Treatment

7.2.3.3.1. Speech therapy, PT, OT, stroke rehabilitation, supportive care, continuous monitoring, medications, surgery

8. Safety Considerations

8.1. Sensory

8.1.1. Sight

8.1.1.1. More opaque lens

8.1.1.2. Decreased pupil size

8.1.1.3. More spherical cornea

8.1.2. Smell

8.1.2.1. Impaired ability to identify and discriminate among odors

8.1.3. Taste

8.1.3.1. High prevalence of taste impairment especially for salt

8.1.4. Touch

8.1.4.1. Reduction in tactile sensation

8.1.5. Hearing

8.1.5.1. Atrophy of hair cells of organ of Corti

8.1.5.2. Tympanic membrane sclerosis and atrophy

8.1.5.3. 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

9.2.1.1. Patho

9.2.1.1.1. A chronic inflammatory disorder affecting many joints, including those in the hands and feet

9.2.1.2. Signs and symptoms

9.2.1.2.1. Pain in the in the joints, back, or muscles, stiffness, swelling, tenderness, weakness, fatigue, anemia, malaise, lumps or redness

9.2.1.3. Treatment

9.2.1.3.1. Heating pads, surgery, medications, stretching, physical therapy

9.2.2. Osteoporosis

9.2.2.1. Patho

9.2.2.1.1. bone disease that occurs when the body loses too much bone, makes too little bone

9.2.2.2. Signs and symptoms

9.2.2.2.1. Back pain, loss of height, stooped posture, fractures

9.2.2.3. Treatment

9.2.2.3.1. 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

10.1.1.1. Most frequent problem psychiatrists treat in older adults

10.1.2. Signs and symptoms

10.1.2.1. Insomnia, fatigue, anorexia, weight loss, constipation, decreased interest in sex, guilt, apathy, helplessness, changes in sleep pattern

10.1.3. Treatment

10.1.3.1. Therapy, antidepressants, SSRIs, antipsychotics, electroconvulsive therapy

10.2. Demetria

10.2.1. Patho

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

10.2.2. Signs and symptoms

10.2.2.1. disoriented, confused, changes in personality, impaired judgement, inappropriate behavior, may have uncoordinated balance

10.2.3. Treatment

10.2.3.1. no cure but progression can be slowed

10.3. Delirium

10.3.1. Patho

10.3.1.1. acute, rapid disruption in brain function

10.3.2. Signs and symptoms

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

10.3.3. Treatment

10.3.3.1. 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

11.2.1.1. Patho

11.2.1.1.1. Thyroid gland secretes excess amount of thyroid hormones

11.2.1.2. Signs and symptoms

11.2.1.2.1. Diaphoresis, tachycardia, palpitations, tremor, diarrhea, stare, lid lag, insomnia, nervousness, confusion, heat intolerance, hyperreflexia

11.2.1.3. Treatment

11.2.1.3.1. Anti thyroid medications, radioactive iodine

11.2.2. Hypothyroidism

11.2.2.1. Patho

11.2.2.1.1. Subnormal concentration of thyroid hormone in the tissues

11.2.2.1.2. Primary: disease process destroys thymus gland

11.2.2.1.3. Secondary: caused by insufficient pituitary secretion of TSH

11.2.2.2. Signs and symptoms

11.2.2.2.1. Fatigue, weakness, depression, anorexia, weight gain, impaired hearing, peripheral edema, constipation, cold intolerance, dry skin, coarse hair

11.2.2.3. Treatment

11.2.2.3.1. Thyroid replacement hormones

11.2.3. Diabetes

11.2.3.1. Patho

11.2.3.1.1. Type 2 diabetes: peripheral insulin resistance and inadequate insulin secretion by pancreatic beta cells

11.2.3.1.2. Type 1 diabetes: beta cells produce little or no insulin

11.2.3.2. Signs and symptoms

11.2.3.2.1. Increased thirst, frequent urination, extreme hunger, unexplained weight loss, presence of ketones in the urine, fatigue, irritability

11.2.3.3. Treatment

11.2.3.3.1. monitoring blood glucose levels, dietary management, maintaining physical activity, keeping weight and stress under control, monitoring oral medications, insulin use