Older Adult Patient

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Older Adult Patient by Mind Map: Older Adult Patient

1. Environmental Safety

1.1. Lighting

1.1.1. Fluorescent lights bothersome Causing eye strain and glare

1.1.2. Soft red light in the bedroom at night can improve night vision

1.1.3. Exposure to natural light during normal 24 hour dark-light cycle to maintain body rhythms Influences body temperature, sleep cycles, hormone production

1.2. Temperature

1.2.1. Recommended room temperature should not be lower than 75 degrees If less than 70 degrees, can lead to hypothermia

1.2.2. Temperature greater than 106 degrees can lead to brain damage

1.3. Color

1.3.1. Wall colors like red, yellow, white are stimulating Increases blood pressure, pulse and appetite

1.3.2. Wall colors like blue, brown, earth tones are relaxing

1.3.3. Orange stimulates appetite

1.3.4. Violet decreases appetite

1.3.5. Green is a healing color and allows for a sense of well being

1.3.6. Black and grey are depressing

1.4. Floor coverings

1.4.1. Carpeting can reduce fractures associated with falls

1.4.2. Plush carpeting difficult for wheelchair mobility

1.4.3. Carpeting can be applied to wall surfaces for a noise buffer

1.4.4. Cockroaches, moths, fleas can reside underneath carpet

2. Cardiovascular

2.1. Age Related Changes

2.1.1. Valves are thicker and more rigid

2.1.2. Decreased stroke volume

2.1.3. Less efficient use of O2

2.1.4. Decreased cardiac output

2.1.5. More prominent arteries in head, neck, extremities

2.1.6. Less elasticity of vessels

2.1.7. Aorta becomes dilated and elongated

2.1.8. Increase of blood pressure

2.2. Pathological Changes

2.2.1. Hyperlipidemia Pathophysiology In older adults, most likely caused from conditions the adult has Elevated total levels of cholesterol Diagnosis Obtain full lipid profile If secondary causes are ruled out, autosomal dominant trait Treatment Dietary changes and exercise First drug of choice for elevated LDL is 3-hydroxy-3-methylglutaryl-coenzyme (HMG CoA) reductase inhibitor Complementary therapies

2.2.2. Atrial Fibrillation Pathophysiology Common in older adults with structural defects and comorbidities Degeneration of electrical impulses in the atria Signs and Symptoms Palpitations Irregular pulse SOB Chest pain Fatigue Dizziness Delirium Diagnosis Physical examination, pt history, ECG, electrophysiology studies, stress tests, echocardiograms Treatment Antiarrhythmics, electrical cardioversion are the first things done If no response to previous treatments, catheter ablation and maze procedure is done Nurses role Educate pt of disease, treatment regimen, activity modifications Have pt report symptoms

3. Urinary

3.1. Age Related Changes

3.1.1. Decreased size of renal mass

3.1.2. Decreased tubular function

3.1.3. Decreased bladder capacity

3.1.4. Decrease in amt of nephrons

3.1.5. Weaker bladder muscles

3.1.6. Renal blood flow decreases by 53%

3.1.7. Glomerular filtration rate decreases by 50%

3.2. Pathological Changes

3.2.1. Urinary Incontinence Pathophysiology Failure of storage function of the lower urinary tract Types Stress Incontinence Urgency Incontinence Overflow Incontinence Neurogenic (reflex) Incontinence Functional Incontinence Mixed Incontinence Treatment Kegel exercises Catheterization

3.2.2. Urinary tract infection Pathophysiology Inflammation of renal tract due to bacteria Symptoms Early indicators Older adults can develop delirium and incontinence Retention and hematuria can occur Treatment Antibiotics to control infection

4. Neurological

4.1. Age Related Changes

4.1.1. Decreased conduction velocity

4.1.2. Slower response and reaction time

4.1.3. Decreased brain weight

4.1.4. Reduced blood flow to brain

4.1.5. Changes in sleep pattern

4.2. Pathological Changes

4.2.1. Dementia Pathophysiology Damage to brain tissue due to degenerative tissue, circulatory problems, lack of oxygen, infection, trauma, hydrocephalus, tumor, alcoholism Onset Slow takes months to years before symptoms are evident Behavior Inappropriate May be unsteady on feet Have difficulty with coordinated movements Recovery Progression can be slowed but cannot be reversed Continues to worsen

4.2.2. Delirium Pathophysiology Disruption in brain function d/t medication side effect, circulatory disturbance, dehydration, low of high BP, low or high thyroid activity, low or high blood glucose, surgery, stress Symptoms Altered attention span Worsened memory Poor judgement Altered LOC Hyper vigilance Mild drowsiness Semicomatose status Onset Rapid Change is noted within days Mental status Short term memory impaired Disoriented and confused Incoherent speech Hallucinations Exaggeration of personality features Behavior Hyperactive Less active than normal Recovery Can be reversed and normal mental status can return if cause is treated promptly

5. Integumentary

5.1. Age Related Changes

5.1.1. Thicker hair in ears and nose

5.1.2. Darkening and wrinkling of skin around orbits

5.1.3. Growth of facial hair in women

5.1.4. Ectropion of eyelids

5.2. Pathological Changes

5.2.1. Skin cancer Pathophysiology Types Basal cell carcinoma Squamous cell carcinoma Melanoma

5.2.2. Pressure Injury Pathophysiology Tissue anoxia and ischemia from pressure can result in necrosis, sloughing, and ulceration of the tissue Stages Stage 1 Stage 2 Stage 3 Stage 4 Unstageable Nursing interventions Encourage activity Turn pt Avoid shearing forces by not elevating the HOB greater than 30 degrees Use pillows, flotation devices, alternating pressure mattresses, or water beds Keep sheets wrinkle free High protein, vitamin rich diet Good skin care

6. Musculoskeletal

6.1. Age Related Changes

6.1.1. Shortening vertebrae

6.1.2. High decreases by approx 2 inches

6.1.3. Bones are more brittle

6.1.4. Slight knee flexion

6.1.5. Decrease in bone mass and bone material

6.1.6. Slight kyphosis

6.1.7. Slight hip flexion

6.1.8. Slight wrist flexion

6.1.9. Impaired flexion and extension movements

6.2. Pathological Changes

6.2.1. Osteoporosis Pathophysiology Metabolic disease of the bone Demineralization of the bone Decrease in mass and density of the bones Symptoms Inactivity or immobility Diseases Reduction in anabolic sex hormones Diet Drugs Treatment Calcium or vitamin D supplements Selective estrogen receptor modulators (SERMs) Hormone therapy Biphosphonates Diet rich in protein and calcium Braces can be used to prevent spasms Avoid heavy lifting, jumping, or other activities that can result in fracture

6.2.2. Gout Pathophysiology Metabolic disorder excess uric acid accumulates in blood Symptoms Severe pain Tenderness of joint Warmth, redness, swelling of tissue surrounding joint Treatment Aimed to reduce sodium urate through a low-purine diet Alcohol and drugs should be avoided Colchicine or phenylbutazone manage acute attacks Long term management Nurses role Monitor pain Encourage good fluid intake to prevent formation of renal stones

7. Sensory

7.1. Safety

7.1.1. Reduced peripheral vision Approach individuals from the back or side

7.1.2. Altered depth perception Reduce the ability to detect changes in levels Alleviated by good lighting, no clutter on staircase, use contrasting colors on stairs

7.1.3. Hearing deficits Hearing impaired individuals should live near people with adequate hearing Can be alerted about fire alarms or other warnings Trained dogs for people with hearing deficits

7.2. Age Related Changes

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

7.2.2. Smell Impaired ability to identify and discriminate among odors

7.2.3. Taste High prevalence of taste impairment

7.2.4. Touch Reduction in tactile sensation

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

7.3. Pathological Changes

7.3.1. Cataracts Pathophysiology Clouding of the lens or its capsule that causes the lens to lose its transparency Symptoms No discomfort or pain Vision distorted Night vision decreased Nuclear sclerosis develops Treatment Only cure - surgical removal of lens Only affects one eye

8. Endocrine

8.1. Age Related Changes

8.1.1. Decrease thyroid gland activity Lower basal metabolic rate Reduced radioactive iodine uptake Less thyrotropin secretion and release

8.1.2. ACTH secretion decreases Secretory activity of adrenal gland also decreases

8.1.3. Pituitary gland decreases in volume by 20%

8.1.4. Decrease TSH, follicle-stimulating hormone, LH, luteotropic hormone

8.1.5. Delay and insufficient release of beta cells by pancreas

8.1.6. Ability to metabolize glucose reduced Higher concentrations of glucose and more prolonged hyperglycemia levels

8.2. Pathological Changes

8.2.1. Hypothyroidism Pathophysiology Decreased levels of thyroxine (T4) and triiodothyronine (T3) that are produced by the thyroid gland Symptoms Fatigue, weakness, lethargy Depression Anorexia Weight gain and puffy face Impaired hearing Periorbital or peripheral edema Constipation Cold intolerance Myalgia, parenthesia, ataxia Dry skin, coarse harir Treatment Replacement of thyroid hormone using synthetic T4 Nursing interventions Help pt with management of other symptoms Help pt understand that they will need thyroid replacement therapy for the rest of their life

8.2.2. Hyperthyroidism Pathophysiology Thyroid gland excretes excess amounts of thyroid hormones Symptoms Diaphoresis Tachycardia Palpitations HTN Tremor Diarrhea Stare Lid lag Insomnia Nervousness Confusion Heat intolerance Increased hunger Proximal muscle weakness Hyperreflexia Treatment Graves’ disease Goiter

8.2.3. Diabetes Mellitus Pathophysiology Glucose intolerance Increased amount of fat tissue in older adults who are obese and inactive Diagnosis Fasting blood sugar every 3 years if over 45 years of age Glucose tolerance test Diagnosis is established if one of these exist Results are confirmed by repeat testing on another day Patient education Barriers Provide reassurance, support, and information to reduce barriers Drug Therapy Metformin Sulfonylurea Acarbose Patient self care and monitoring Observe patients ability to handle a syringe and a vial of insulin Observe the patient performing the finger-prick technique Monitor triglycerides due to the development of metabolic syndrome Exercise and nutrition Regular exercise is very important! Maintain consistent daily food intake Nutritional supplements can reduce the complications Symptoms of hypoglycemia in the older adult Confusion Abnormal behavior Altered sleep patterns Nocturnal headache Slurred speech

9. Respiratory

9.1. Age Related Changes

9.1.1. Decreased ciliary action

9.1.2. Forced expiratory volume reduced

9.1.3. Loss of elasticity

9.1.4. increased rigidity

9.1.5. PO2 reduced by 15%

9.1.6. Blunting of cough and laryngeal reflexes

9.1.7. Alveoli fewer in number and larger in size

9.1.8. Thoracic muscles more rigid

9.1.9. Reduced basilar inflation

9.1.10. Increase in residual capacity by about 50% by age 90

9.2. Pathological Changes

9.2.1. Pneumonia Pathophysiology Infection of the lungs caused by bacteria, virus, or fungi Alveoli become inflammed and fill with pus and/or fluid Signs & Symptoms Pleuratic pain Minimal or no fever Cough, fatigue, rapid respirations Confusion, restlessness, behavioral changes Treatment Mobility Pneumococcal vaccine

9.2.2. Lung cancer Pathophysiology Genetic factors Exposure to environmental pollutants and carcinogens At Risk Cigarette smoker or exposure to cigarettes Abestos Coal and radon gas Air pollutants Highest African American males, white American Indian/Alaska native, Asian/Pacific Islander, Hispanic Men Signs & Symptoms Dyspneac Cough Chest pain Fatigue Anorexia Wheezing Recurrent upper respiratory tract infections Treatment Diagnosis Surgery Chemotherapy Radiotherapy

9.2.3. Influenza Pathophysiology Virus enters the respiratory tract Signs & Symptoms Fever (not as high compared to young adults) Myalgia Sore throat Nonproductive cough Treatment Influenza vaccine annually

10. GI

10.1. Age Related Changes

10.1.1. Decreased taste sensation

10.1.2. Esophagus more dilated

10.1.3. Reduced saliva

10.1.4. Smaller liver

10.1.5. Reduced intestinal blood flow

10.1.6. Slower peristalsis

10.1.7. Fewer cells on absorbing surface of intestines

10.1.8. Atrophy of gastric mucosa

10.1.9. Decreased esophageal motility

10.1.10. Decreased stomach motility

10.1.11. Decreased hunger contractions

10.1.12. Decreased emptying time

10.1.13. Less production of HCl acid, pepsin, lipase, pancreatic enzymes

10.2. Pathological Changes

10.2.1. Dysphagia Pathophysiology Lesions on upper digestive tract Obstruction of upper digestive tract Alterations in the nervous or muscular control of swallowing Assessment When did the problem begin? Any other symptoms? Do certain foods trigger the symptoms? Solids or liquids? Does it occur with every meal? Observe intake of food Refer to speech language pathologist Monitor I&O’s and weight Treatment Goal: adequate nutritional status and prevent aspiration Soft diet Thickening of liquids Eat sitting in an upright position

10.2.2. Hiatal Hernia Pathophysiology Displacement of the gastroesophageal junction More common in older women Low fiber diet can contribute to this condition Types Sliding (axial) Rolling (paraesophageal) Symptoms Heartburn Dysphagia Belching Vomiting Regurgitation Diagnosis Barium swallow Esophagoscopy Treatment Weight loss if pt is obese Bland diet Milk and antacids for symptomatic relief Multiple small meals a dayd Do not eat before bed H2 blockers (ranitidine, cimetidine, or nizatidine) proton pump inhibitors (lansoprazole or omeprazole)

10.2.3. Diverticulitis Pathophysiology Multiple pouches of intestinal mucosa in the weakened muscular wall of the large bowel Symptoms Slight bleeding Changes in bowel habits Overeating, straining during a bowel movement, alcohol, irritating foods may contribute Abrupt onset of pain in LLQ n/v Blood or mucus in stool Low grade fever Treatment Reducing infection, provide nutrition, relieve discomfort, promote rest IV therapy Acute attack; consume low residue diet Surgery may be performed

11. Reproductive

11.1. Male

11.1.1. Pathological Changes Erectile Dysfunction Pathophysiology Causes Treatment BPH Pathophysiology Symptoms Treatment

11.1.2. Age Related Changes Prostate enlarges Venous and arterial sclerosis of penis Reduction in sperm count Fluid-retaining capacity of seminal vesicles reduces

11.2. Female

11.2.1. Age Related Changes Fallopian tubes atrophy and shorten Ovaries become thicker and smaller Cervix becomes smaller Drier, less elastic vaginal canal Flattening of the labia Endocervical epithelium atrophies Uterus becomes smaller in size Endometrium atrophies More alkaline vaginal environment Loss of vulvar subcutaneous fat and hair

11.2.2. Pathological Changes Perineal Herniation Pathophysiology Types Symptoms Treatment Cervical Cancer Pathophysiology Symptoms Treatment Most prevalent among Hispanic women, then black women, white Native American/Alaskan Native, Asian Pacific women

12. Immune System

12.1. Age Related Changes

12.1.1. Immunosenescence Increase in the amount of infections Decline in T cell activity More immature T cells Decline in cell mediated immunity T lymphocytes are not able to proliferate as well in response to mitogens IgM lower IgA and IgG higher Responses to certain vaccines are less effective Influenza Parainfluenza Pneumococcal Tetanus Decline in inflammatory responses Inflammation presents atypically in older adults Low grade fever Minimal pain Increase in proinflammatory cytokines Associated with atherosclerosis, diabetes, osteoporosis

13. Eliopoulos, C. (2018). Gerontological nursing. Philadelphia: Wolters Kluwer.