Older Adult Client

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Older Adult Client by Mind Map: Older Adult Client

1. Sleep

1.1. More time in stage I and II sleep

1.2. Sleep less soundly

1.3. Delay in onset of sleep

1.4. Impacted by noise and sound

1.5. Increased body temp, cortisol levels, and blood pressure during the day

1.6. Increased melatonin, growth hormone, and prolactin

1.7. Moss heart attacks happen in early morning

1.8. Temperature spikes in the evening

1.9. Insomnia

1.9.1. Difficulty falling or staying asleep or prematurely waking

1.9.2. Short term Change in environment Illness Stress

1.9.3. Chronic 3 weeks or more Physical or mental illness Substance abuse Medications

1.10. Nocturnal myoclonus

1.10.1. Jerking legs during sleep

1.10.2. 5 or more times in an hour

1.10.3. Causes Tricyclics antidepressants Renal failure

1.11. Restless leg syndromes

1.11.1. Neurological urge to move legs

1.11.2. Associated with Iron deficiency anemia Uremia Parkinson’s RA Diabetes Neurological lesions

1.12. Sleep apnea

1.12.1. 5 episodes of cessation of breathing lasting 10 seconds

1.12.2. Central sleep apnea Disorder in central nervous system affecting diaphragm

1.12.3. Obstructive sleep apnea Obstruction in airway

1.12.4. Evaluation at sleep clinic

1.12.5. Sleep in supine position should be avoided

1.13. Medical conditions affecting health

1.13.1. Chronic disease

1.13.2. Respiratory problems

1.13.3. CV problems

1.13.4. Diabetes

1.13.5. GERD

1.13.6. Dementiad

1.13.7. Depression

1.14. Drugs that affect sleep

1.14.1. Anticholinergics

1.14.2. Antidepressants

1.14.3. Antihypertensives

1.14.4. Benzodiazepines

1.14.5. Beta blockers

1.14.6. Diuretics

1.14.7. Levodopa

1.14.8. Steroids

1.14.9. Caffeinea

1.14.10. Alcohol

2. Nutrition

2.1. Reduced need for calories

2.2. Decreased lean body mass

2.3. Basal metabolic rate declines

2.4. Protein needs to be 10-20% of calories

2.5. Calcium absorption decreases

2.6. 5 servings of fruits and vegetables

2.7. Avoidance of trans fats

2.8. Supplements do not make up for intake of nutrients

2.9. Threats to good nutrition

2.9.1. Food intolerance

2.9.2. Anorexia

2.9.3. Dysphasia

2.9.4. Constipation

2.9.5. Malnutrition

2.10. Exercise

2.10.1. 150 activity per week

2.10.2. Strength exercises 2 or more daysbe

2.10.3. Benefit every area of your life

3. Integumentary System Health

3.1. Changes of Aging

3.1.1. Decreased skin elasticity

3.1.2. Dry skin

3.1.3. Decreased subcutaneous fat

3.1.4. Increased skin neoplasms

3.1.5. Gray hair

3.1.6. Reduced sweat glands

3.2. Education

3.3. Nursing diagnosis

3.4. Skin cancer

3.5. Keratosis

3.6. Pruritis

4. Hydration

4.1. Vital

4.2. Regulates body temperature

4.3. Protects internal organs

4.4. Intracellular fluid lost

4.5. 1500 ml minimal required fluid intake

4.6. Over hydration

5. Health education

5.1. 9/10 Americans have limited health literacy skills

5.1.1. Health information accessible to the public needs to be made easier to read and understand for the general population

5.2. More Americans use the internet for health information but the older population has issues related to vision and hearing that can affect this

5.2.1. Online sources need Clearly written content Accessible content Uncluttered websites Usability of the websitec Clean layouts

6. Pain

6.1. Greatest threat to comfort

6.2. Unpleasant sensory or emotional experience

6.3. Predominant in older population

6.3.1. Low back pain most commonthr

6.3.2. Thresholds are different

6.4. Types of pain

6.4.1. Nociceptive Mechanical thermal chemical Somatic Bone or soft tissuel calizedtho Throbbing aching Visceral Cause generalized or referred pain Deepa Aching

6.4.2. Neuropathic Abnormal processing of sensory stimuli by CNS or PNS Sharp stabbing tingling o Onset is high intensity

6.5. Pain perception

6.5.1. Role in age is unclear

6.5.2. Research is limited

6.5.3. Complicated by chronic disease

6.5.4. Unique pain experience

6.6. Effects of pain

6.6.1. Limited mobility

6.6.2. Pressure ulcers

6.6.3. Pneumonia

6.6.4. Constipation

6.6.5. Poor appetite

6.6.6. Depression

6.6.7. Hopelessness

6.6.8. Spiritual distress

6.7. Pain assessment

6.7.1. Qualitative and quantitative assessment

6.7.2. Detailed pain history

6.7.3. Numeric rating scale

6.7.4. Visual scale

6.7.5. Questionnaire

6.8. Complementary therapies

6.8.1. Acupuncture

6.8.2. Aromatherapy

6.8.3. Biofeedback

6.8.4. Exercise

6.8.5. Herbals

6.8.6. Prayery

6.8.7. Yoga

6.9. Medications

6.9.1. Risk of adverse effects high

6.9.2. Analgesics monitored closely

6.9.3. Trial nonopiods first

6.9.4. Use narcotics cautiously

6.10. Foods to avoid

6.10.1. High fat dairy products

6.10.2. Egg yolks

6.10.3. Beef fat

6.10.4. Corn

6.10.5. Soybean

6.10.6. Sugars

7. Sexuality/Intimacy

7.1. Attitudes towards sex in older adult

7.1.1. Stereotypes

7.1.2. Violations of older adults sexual identity

7.2. Menopause

7.2.1. Permanent cessation of menses

7.2.2. Awakening of body mind and spirit

7.2.3. Hormone therapy Estrogen and progesterone increase heart risks Age at start alters risk Individual decision for treatment

7.2.4. Self acceptance Care for self Broaden perspectives

7.3. Andropause

7.3.1. Testosterone levels decline

7.3.2. Does not happen in all men

7.3.3. Reduced muscle mass

7.4. Intimacy

7.4.1. Love

7.4.2. Warmth

7.4.3. Carings

7.4.4. Sharing

7.4.5. Intimate exchange of words and touch

7.4.6. Feeling important and wanted

7.5. Barriers to sexual activity

7.5.1. Physical pathology

7.5.2. Lack of partner Particularly for older women Most older men are married and older women are widowed

7.5.3. Psychological barriers Negative attitudes from society Fear Body image Relationship issues

7.5.4. Cognitive impairment Dementia Touching may be misinterpreted Explain to family

7.6. Healthy sexual function

7.6.1. Basic education

7.6.2. Nurse openly discusses sex

7.6.3. Masturbation beneficial

7.6.4. Foster positive attitudes

8. Reproductive system health

8.1. Changes of Aging

8.1.1. Female Vulva atrophies Flattening of the labia Vaginal epithelium thins Cervix,uterus, Fallopian tubes atrophies Reduction in collagen Less lubrication More alkaline vaginal pH Uterus decrease in size

8.1.2. Male Decreased capacity to retain fluids Atrophy of testes Decreased testicular mass Less live sperm More time required to achieve an erection Enlargement of prostate

8.2. Education

8.2.1. Annual gynological exam

8.2.2. Breast self exam

8.2.3. Monitor PSA

8.2.4. Testicular self exam

8.2.5. Complete history and physical exam

8.3. Nursing diagnoses

8.3.1. Anxiety

8.3.2. Acute pain

8.3.3. Risk for infection

8.3.4. Disturbed body image

8.3.5. Impaired skin integrity

8.4. Senile vulvitis

8.4.1. Thinning drying and agitation of the vaginal walls

8.4.2. Causes Postmenopausal Decrease in estrogen

8.4.3. Symptoms Soreness pruritis Burning Foul smelling discharge Bleeding

8.4.4. Treatment Good hygeine Suppository cream Wear cotton underwear Avoid perfumed soap Use lube for sex

8.5. Tumors of the vulva

8.5.1. Occurs on the outer surface of the female genitals

8.5.2. Symptoms Lump or sore Itching

8.5.3. Diagnosis Biopsy

8.5.4. Treatment Skin grafting Lymph node dissection Radiation Supportive

8.6. Perineal herniation

8.6.1. Stretching and tearing of muscle and muscle weakness

8.6.2. Types Cystocele Rectocele Prolapsed uterus

8.6.3. Symptoms Lower back pain Pelvic heaviness Pulling sensation

8.6.4. Diagnosis Palpate mass in vagina

8.6.5. Treatment Surgical repair

8.7. Erectile dysfunction

8.7.1. Problem affecting most men over 70

8.7.2. Causes Alcoholism Diabetes MS Renal failure Antidepressants Digoxins Sedatives

8.7.3. Symptoms Inability to achieve erection

8.7.4. Treatment Viagra Levitra Cialis

8.8. Benign prostatic hyperplasiac

8.8.1. Most older men have some degree

8.8.2. Symptoms Hesitancy Decreased flow of stream Nocturia

8.8.3. Treatment Realistic explanation of risk benefit TURP Prostatic massage

8.9. Cancer of prostate

8.9.1. Asymptomatic disease progression

8.9.2. Symptoms Back pain Anemia Weakness Weight loss

8.9.3. Treatment Chemo Radiation

8.9.4. Diagnosis Digital rectal exam PSA test

9. Frailty

9.1. Increased vulnerability, impaired capability to withstand stressors, and limited capacity to maintain physiological and psychological homeostasis

9.2. Common signs and symptoms

9.2.1. Weakness

9.2.2. Weight loss

9.2.3. Muscle wasting

9.2.4. Exercise intolerance

9.2.5. Decrease in grip strength

9.2.6. Frequent falls

9.2.7. Immobility

9.2.8. Sarcopenia

9.2.9. Osteopenia

9.3. Causes

9.3.1. Hormonal dysregulation

9.3.2. Immune-aging

9.4. Adult Failure to Thrive

9.4.1. Seen in those who have more than one chronic illness

9.4.2. Mean age 79

9.4.3. Average of 6 diagnoses

9.4.4. Malnourishedd

9.4.5. Dehydration

9.4.6. Skin ulcers

9.4.7. Falls

10. Safety

10.1. Restraints

10.1.1. Anything that restricts movementp

10.1.2. Physical

10.1.3. Chemical

10.1.4. New Topic

10.2. Lighting

10.2.1. Low lighting and natural light better than bright lights

10.2.2. Soft red light in bedroom

10.3. Temperature

10.3.1. Lower than normal in older adults

10.3.2. Decreased natural insulation

10.3.3. Recommended room temperature is 75

10.4. Colors

10.4.1. Red yellow white Stimulating Increase blood pressure

10.4.2. Blue brown Relaxing

10.4.3. Orange Stimulate appetite

10.4.4. Violet Decrease appetite

10.4.5. Greenb Sense of well being

10.4.6. Black Depressing

10.5. Scents

10.5.1. Aromatherapy

10.5.2. Essential oils

10.6. Floor coverings

10.6.1. Carpeting full floor

10.6.2. Difficult wheel chair mobility

10.6.3. Scattered rugs lead to falls

10.7. Furniture

10.7.1. Appealing

10.7.2. Comfortable

10.7.3. Functional

10.7.4. Arm rests on chairs

10.7.5. Sturdy tables

10.8. Sensory stimulationn

10.8.1. Textured walls

10.8.2. Soft blankets

10.8.3. Wall hangings

10.8.4. Coffee brewings

10.8.5. Pot of flowers

10.8.6. Soft music

10.9. Noise control

10.9.1. Noise control begins with the design of the building

10.9.2. Intercoms disruptive

10.10. Bathroom hazards

10.10.1. Adequate lighting

10.10.2. Shower chair

10.10.3. Handrail in showers

10.10.4. Electrical appliances away from water

10.11. Fire hazards

10.11.1. Risk for burn injury

10.11.2. Unattended pots on stove

10.11.3. Careless disposal of cigarettes

10.11.4. Space heaters

10.12. Falls

10.12.1. 1/3 of adults 75 and up fall every year

10.12.2. Risk for falls Improper use of mobility equipment Medications

10.12.3. Prevention Eyeglasses Slowly change position Use of assistive devices Handrails Regular med review

10.12.4. Nursing assessment Regular home inspection Medication review

10.13. Interventions to reduce safety risks

10.13.1. Monitor temp

10.13.2. Prevent infection

10.13.3. Avoid crime

10.13.4. Safe drivin

10.13.5. Early detection of safety concerns

10.14. Risks associated with mobility limitations

10.14.1. Slower reaction times

10.14.2. Poor coordination

10.14.3. Poor judgement

10.14.4. Denial

11. Respiratory System Health

11.1. Changes of Aging

11.1.1. Calcification of costal cartilage

11.1.2. Reduction of cough reflex

11.1.3. Increased residual capacity

11.1.4. High risk for respiratory infection

11.1.5. Septal deviation

11.2. Education

11.2.1. Flu and pneumonia vaccines

11.2.2. Avoid contact with people who have infections

11.2.3. Deep breathing exercises

11.2.4. Smoking cessation

11.3. Nursing diagnosis

11.3.1. Impaired gas exchange

11.3.2. Ineffective airway clearance

11.3.3. Risk for infection

11.3.4. Alterations in hydration

11.3.5. Activity intolerance

11.4. Asthma

11.4.1. Causes Obesity Smoking Exposure to fumes

11.4.2. Symptoms Shortness of breath Chest tightness Trouble sleeping Wheezing Coughing

11.4.3. Treatment Bronchodilator Stop smoking Oxygen Steroids

11.5. Emphysema

11.5.1. Increase incidence in older age

11.5.2. Causes Chronic bronchitis Chronic irritation Smoking

11.5.3. Symptoms Lung infections Mucus Wheezing Fatigue Blue tinged lips

11.5.4. Treatment Postural drainage Bronchodilators Avoid stress Breathing exercises

11.6. Lung cancer

11.6.1. Increased incidence in 65 and older

11.6.2. Higher in men

11.6.3. Causes Smoking

11.6.4. Symptoms Dyspnea Coughc chest pain Fatigue Anorexia Wheezing

11.6.5. Treatment Surgery Chemo Radiation

11.7. Nursing interventions

11.7.1. Preform postural drainage Used to remove secretions D/c if palpitations, dyspnea, Chet’s pain, apprehension

11.7.2. Promote productive coughing Removes secretions Hard candy Breathing exercises Humidifier

11.7.3. Complementary therapies Aromatherapy Acupuncture Massage

11.7.4. Promote self care

12. Circulatory System Health

12.1. Changes of Aging

12.1.1. Heart loses efficiency

12.1.2. Reduced cardiac output

12.1.3. Increased stroke volume

12.1.4. Valves become thick and rigid

12.1.5. Decreased elasticity in blood vessels

12.1.6. Left ventricular atrophy

12.1.7. AV valve thickens leads to murmurs

12.1.8. Thinning of tunica media

12.1.9. Fibrosis of tunica intima

12.2. Education

12.2.1. Healthy diete

12.2.2. Exercise

12.2.3. No smoking

12.2.4. Manage stress

12.3. Nursing diagnosis

12.3.1. Risk for decreased cardiac output

12.3.2. Activity intolerance

12.3.3. Risk for impaired gas exchange

12.3.4. Acute pain

12.3.5. Anxiety

12.3.6. Ineffective tissue perfusion

12.4. Hypertension

12.4.1. Elevation of Bp greater than 140/90

12.4.2. Causes Poor diet Sedentary lifestyle Medications Stress

12.4.3. Symptoms Dull headache Impaired memory epistaxis Slow tremor

12.4.4. Treatment Medications Proper nutrition Exercise

12.5. Congestive heart failure

12.5.1. Leading cause of hospitalization

12.5.2. Causes Coronary artery disease a Arteriosclerotic heart disease

12.5.3. Symptoms SOB Dyspnea Confusion Insomnia Agitation Weight gain Edema

12.5.4. Treatment Physical exercise Low sodium diet Diuretics ACE inhibitors Surgery Implantable defibrillator

12.6. Hyperlipidemia

12.6.1. Causes Alcohol consumption Obesity Steroid use Kidney disease

12.6.2. Symptoms Typically has no symptoms

12.6.3. Treatment Dietary changes Medications Alternative therapies

12.7. Coronary artery disease

12.7.1. Ischemic heart disease

12.7.2. Angina

12.7.3. Causes Plaque buildup due to obesity or poor nutrition

12.7.4. Symptoms Coughing Syncope Sweating Confusion SOBele Elevated temp

12.7.5. Treatment Exercise Statins Beta blockers Calcium channel blocker Coronary stent

12.8. Nursing interventions

12.8.1. C reactive protein screening

12.8.2. Comprehensive assessment

12.8.3. Teach about supplements

12.8.4. Administer aspirin daily

13. Digestive System Health

13.1. Changes of Ages

13.1.1. Decreased esophageal motility

13.1.2. Decreased intestinal blood flow

13.1.3. Atrophy of intestines

13.1.4. Increased risk of aspiration

13.1.5. Indigestion

13.1.6. Constipation

13.1.7. Decreased HCL production

13.1.8. Lower fat absorption

13.2. Dysphagia

13.2.1. Causes GERD Stroke Structural disorders

13.2.2. Interventions Observe food intake Refer to speech pathology Soft diett thicker liquids Eat sitting upright

13.2.3. Goal Prevent aspiration Adequate nutrition

13.3. Hiatal hernia

13.3.1. Causes Older females Low fiber diet Obese

13.3.2. Type Sliding Rolling

13.3.3. Symptoms Heartburn Dysphagia Belching Vomiting Pain Bleeding

13.3.4. Treatment Weight loss Surgery Proton pump inhibitor

13.4. Esophageal cancer

13.4.1. Types Squamous cell Adenocarcinomas

13.4.2. Causes Alcoholism Older men Heavy smoking Poor oral hygiene

13.4.3. Symptoms Dysphagia Weight loss Excessive salivation Thirst Hiccups

13.4.4. Diagnosis Barium swallow Esophagoscopy Biopsy

13.4.5. Treatment Surgical resection Radiation Chemo Laser therapy Photodynamic

13.5. Education

13.5.1. Good dental hygiene

13.5.2. Proper nutrition

13.5.3. Knowledge of medications

13.5.4. Natural remedies

13.6. Nursing diagnosis

13.6.1. Deficient fluid volume

13.6.2. Risk for imbalanced nutrition

13.6.3. Acute pain

13.6.4. Knowledge deficit

13.6.5. Constipation

13.6.6. Risk for impaired skin integrity

14. Urinary System Health

14.1. Changes of Aging

14.1.1. Decreased renal blood flow

14.1.2. Glomerular filtration decreases by 50%

14.1.3. Urinary frequency and urgency

14.1.4. Nocturia common

14.1.5. Weaker bladder muscles

14.1.6. Decreased production of RBCs

15. Endocrine System Health

15.1. Changes of Aging

15.1.1. Thyroid gland activity decreased

15.1.2. T3 changes

15.1.3. Secretion of ACTH decreases

15.1.4. Insulin release is delayed

15.1.5. Ability to metabolize glucose decreased

16. Sensory System Health

16.1. Changes of Aging

16.1.1. Eyes Presbyopia Inability to focus on close objects clearly Narrowing of visual field Decreased peripheral vision Reduction in pupil size Decline in visual acuity Decreased elasticity of lens Macular degeneration Loss of central vision Lens become more opaque

16.1.2. Taste Atrophy on tongue Decreased saliva Poor oral hygiene

16.1.3. Smell Taste acuity dependent on smell Impaired ability to identify odors

16.2. Education

16.3. Nursing diagnosis

16.4. Cataracts

16.5. Presbycusis

16.6. Macular degeneration

17. Musculoskeletal System Health

17.1. Changes of Aging

17.1.1. Slight kyphosis

17.1.2. Reduced muscle mass

17.1.3. Decreased bone mass

17.1.4. Decreased calcium absorption

17.1.5. Increased risk of fractures

17.2. Education

17.2.1. Promote physical activity

17.2.2. Exercise programs

17.2.3. Begin exercise gradually

17.2.4. Promote good nutrition

17.3. Nursing diagnosis

17.3.1. Activity intolerance

17.3.2. Impaired physical mobility

17.3.3. Activity intolerance

17.3.4. Impaired physical mobility

17.4. Osteoarthritis

17.4.1. Progressive deterioration of joint cartilage c

17.4.2. Causes Genetics Obesity Injury Overuse Genetics Obesity Injury Overuse

17.4.3. Symptoms Pain in joints Stiffnesss Swelling Limping Pain in joints Stiffnesss Swelling Limping

17.4.4. Treatment Exercise Weight loss Analgesics Hydrotherapy Joint replacement Exercise Weight loss Analgesics Hydrotherapy Joint replacement

17.5. Fractures

17.5.1. Causes

17.5.2. Interventions

17.5.3. Types

17.6. Gout

17.6.1. Excess Utica acid accumulation

17.6.2. Causes

17.6.3. Symptoms

17.6.4. Treatment

18. Neurological System Health

18.1. Delirium vs Dementia

18.1.1. Dementia Irreversible Impairment to in cognitive functiona Affects Memory Orientation Reasoning Attention Language Problem solving Caused by brain damage or injury Alzheimer’s Disease Most common form of dementia Symptoms gradually develop Global deterioration scale Changes in the brain Causes Treatment/Management Other dementias Vascular Frontotemporal Lewy Body Wernicke encephalopathyp Parkinson’s AIDS Care of patients with dementia CAM therapy Support family Therapeutic exercise

18.1.2. Delirium Causes Hypoxia Infection Dehydration Hypernatremia Cognitive impairment Medications Symptoms Altered level of conciousness Tachypnea Cyanosis Agitation Infection Treatment Based upon the cause Minimize stimulation Prevention of self harm

18.2. Changes of Aging

18.2.1. Loss of nerve cell mass

18.2.2. Decreased dendrites

18.2.3. Demyelinizations

18.2.4. owing in central processingl

18.2.5. Decline in taste and smell cranial nerves

18.3. Education

18.3.1. Neurological assessments at every doctors visit

18.3.2. Monitor and look for risk factors

18.4. Nursing diagnosis

18.4.1. Impaired physical mobility

18.4.2. Self care deficits

18.4.3. Disturbed sensory perceptions

18.4.4. Impaired verbal communication

18.5. Parkinson’s disease

18.5.1. Affects CNS ability to control movements

18.5.2. Dopamine Decreased due to nerve cell damage

18.5.3. Cause Unknown

18.5.4. Symptoms Tremors Shuffling gait

18.5.5. Treatment Anticholinergics Technology

18.5.6. Interventions Education Physical exercise help Psychosocial coping

18.6. Transient ischemic attack

18.6.1. Temporary or intermittent reduction in cerebral perfusionc

18.6.2. Causes Stress Peripheral artery disease High blood pressure Diabetes

18.6.3. Symptoms Muscle weakness Vertigo Blurred vision Numbness Mental confusion

18.6.4. Treatment Blood thinners Cardiac monitoring Surgery

18.6.5. Interventions Support airway Monitor vital signs Monitor neurological status

18.7. Cerebrovascular accident

18.7.1. Causes Ischemic Blockage in Brain Hemorrhagic Rupture of a blood vessel

18.7.2. Symptoms Difficulty walking Blurred vision Fatigue Difficulty speaking

18.7.3. Treatments ACE inhibitor Surgery Physical exercise