Gerontological Patient

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Gerontological Patient by Mind Map: Gerontological Patient

1. Intelligence

1.1. Age related changes

1.1.1. Crystallized intelligence maintained

1.1.2. Fluid intelligence decreases

1.1.3. Basic intelligence is maintained

2. Musculoskeletal system

2.1. Age related changes

2.1.1. Impaired flexion and extension movements

2.1.2. Slight wrist flexion

2.1.3. Slight kyphosis

2.1.4. Shortening of vertebrae

2.1.5. Between ages 20 and 70, height decreases approximately 2 inches

2.1.6. Bones more brittle

2.1.7. Slight knee flexion

2.1.8. Decrease in bone mass and bone mineral

2.2. Pathologies

2.2.1. Osteoarthritis Progressive degeneration and abrasion of joint cartilage, with 5e formation of new bone at the joint surface Effects most people over 55 to some extent Risk factor: disequilibrium between destructive and synthetic elements leads to a lack of homeostasis necessary to maintain cartilage, causing joint changes. Excessive use of joint, trauma, obesity, low vitamin d and c, genetic factors, acromegaly, S/S: crepitus of the joints, discomfort at the joint with extended use Nursing interventions: rest, heat/ice, t’ai chi, aqua therapy, gentle massage, splints, braces, canes, weight reduction, occupational and physical therapy, arthroplasty-joint replacement Medications: analgesics to control pain Diet: abundance of cold water fish and other foods high in essential fatty acids, vitamin a, b, b6, c, and e. Zinc, selenium, niacin-amide, calcium, magnesium

3. Urinary system

3.1. Age related changes

3.1.1. Decreased bladder capacity

3.1.2. Decreased size of renal mass

3.1.3. Decreased tubular function

3.1.4. Decrease in nephrons

3.1.5. Between ages 20 and 90 renal blood flow decreases 53%, and glomerular filtration rate decreases 50%

3.1.6. Weaker bladder muscles

3.2. Pathologies

3.2.1. Urinary tract infection Most common infection of older adults Risk factors: Poor hygiene, improper cleaning after bowel elimination, low fluid intake, excessive fluid loss, hormonal changes, catheter Escherichia coli (women), proteus (men) S/S: burning, urgency, fever, retention, incontinence, hematuria Diagnostic: Bacteriuria- >105 Nursing interventions: adequate urinary drainage, I&O’s, fluids, cranberry juice, avoid urinary catheter

3.2.2. Urinary incontinence Common and bothersome disorder of older adults, in more than half of institutionalized older population Risk factors: delirium, dementia, cerebrovascular accident, diabetes mellitus, congestive heart failure, UTI medications that can affect continence: diuretics, antianxiety agents, antipsychotics, antidepressants, sedatives, narcotics, antiparkinson agents, antispomodics, antihistamine, calcium channel blockers, alpha-blockers, alpha-stimulants Symptoms: urgency, burning, vaginal itching, pain, pressure in bladder area, fever Nursing interventions: refer patient for a comprehensive medical evaluation, assess activities of daily living, note degree of dependency

4. Gastrointestinal system

4.1. Age related changes

4.1.1. Slower peristalsis

4.1.2. Fewer cells on absorbing surface of intestines

4.1.3. Less production of HCL, pepsin, lipase, and pancreatic enzymes

4.1.4. Decreased stomach motility and hunger contractions, and emptying time

4.1.5. Atrophy of gastric mucosa

4.1.6. Decrease esophageal motility

4.1.7. Decreased taste sensation

4.1.8. Esophagus more dilated

4.1.9. Reduced saliva and salivary ptyalin

4.1.10. Liver smaller in size

4.1.11. Reduced intestinal blood flow

4.2. Pathologies

4.2.1. Hiatal hernia Affects about half of the people in the US over age of 50, more common in women Risk factors: low-fiber diet, GERD, obesity S/S: heartburn, dysphagia, belching, vomiting, regurgitation, pain, and bleeding Diagnostics: barium swallow and esophagoscopy Nursing interventions: weight reduction, bland diet, milk, several small meals, avoid eating before bedtime, sleep in slight recombinant position Medications: antacids, H2 blockers, proton pump inhibitor

4.2.2. Colorectal cancer Cancer along large intestine is common with advancing age Diagnostics: colonoscopy with biopsy and CT colonoscopy, fecal occult blood testing S/S: rectal bleeding, bloody stools, change in bowel pattern, feeling of incomplete emptying of bowel, anorexia, nausea, abdominal discomfort, pain over affected region, weakness, fatigue, unexplained weight loss, anemia Nursing interventions: preparation for surgery, have regular meals, restrict tea and coffee, reduce alcohol and carbonated drinks, eat something solid with each meal Radiotherapy: can downstage tumor to aid complete excision Surgical resection Chemotherapy: with high-risk Dukes B or Dukes C tumors with nodal disease to reduce recurrence

5. Cardiovascular system

5.1. Age related changes

5.1.1. Less elasticity of vessels

5.1.2. Blood pressure increases

5.1.3. Resistance to peripheral blood flow increases slightly each year

5.1.4. Cardiac output decreases

5.1.5. Aorta becomes dilated and elongated

5.1.6. More prominent arteries in head, neck, and extremities

5.1.7. Valves become thicker and more rigid

5.1.8. Stroke volume decreases

5.1.9. Heart pigmented with lipofuscin granules

5.1.10. Less efficient O2 utilization

5.2. Pathologies

5.2.1. Hypertension Most prevalent CV disease among older adults Causes: vasoconstriction, peripheral resistance, hyperthyroidism, Parkinson disease, Paget’s disease, anemia, thiamine deficiency S/S: high blood pressure, awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, and a slow tremor Diagnostics: systolic bp >140 and diastolic bp > 90 Nursing interventions: rest, reduce sodium intake, reduce weight, Nonpharmocologic measures advised: biofeedback, yoga, meditation, relaxation exercises, fish oil supplements, garlic, hawthorn berries, Rauwolfia, periwinkle, increase whole grain in diet DASH Diet: rich in fruits, veggies, whole grain, low-fat dairy foods Medications:

5.2.2. Congestive heart failure Leading cause of hospitalization of older adults Causes: arteriosclerotic heart disease, coronary artery disease, hypertension, diabetes mellitus, dyslipidemia, sleep-disordered breathing, albuminuria, Anemia, chronic kidney disease, illicit drug use, sedentary lifestyle, psychological stress S/S: dyspnea on exertion, confusion, insomnia, wandering during the night, agitation, depression, anorexia, nausea, weakness, shortness of breath, wheezing, weight gain, bilateral ankle edema, moist crackles on auscultation Nursing interventions: bedrest (not complete), reduce sodium intake, skin care, frequent repositioning, emotional support Medication: ACE inhibitor, beta blocker, digitalis, diuretics

6. Respiratory system

6.1. Age related changes

6.1.1. Thoracic muscles more rigid

6.1.2. Reduced basilar inflation

6.1.3. Alveoli fewer in number and larger in size

6.1.4. By age 90 years, approximately 50% increase in residual capacity

6.1.5. Blunting of cough and laryngeal reflexes

6.1.6. PO2 reduced as much as 15% between ages 20 and 80

6.1.7. Loss of elasticity and increased rigidity

6.1.8. Decreased ciliary action

6.1.9. Forced expiratory volume reduced

6.2. Pathologies

6.2.1. Pneumonia Common among older adults, one of the leading causes of death in age group Risk factors: shallow breathing, poor chest expansion, high prevalence of respiratory diseases, lowered resistance to infection, reduced sensitivity of pharyngeal reflexes Causes: Streptococcus pneumonia, gram negative bacilli, anaerobic bacteria, and influenza S/S: pleuritic pain, minimal fever, slight cough, fatigue, rapid respirations, confusion, restlessness Diagnostics: chest x-ray, chest auscultation, ABG levels Nursing interventions: pneumonococcal vaccine, hydration-IV fluids, higher calorie intake, monitor oxygen saturation, oxygen therapy if needed, rest to conserve energy

7. Cells

7.1. Age related changes

7.1.1. Intracellular fluid is decreased Leads to less total body fluid Risk for dehydration

7.1.2. Bone mass decreases

7.1.3. Fat tissue increases until sixth decade of life

7.1.4. Lean body mass reduced

7.1.5. Fewer functional cells in the body

7.1.6. Number of cells gradually reduced

8. Changes to the mind

8.1. Age related changes

8.1.1. Learning Motivation changes Delayed transmitting of information to the brain

8.1.2. Memory Retrieval of information from long-term memory can be slowed Sensory only lasts a few seconds Working memory function is reduced

8.1.3. Personality Consistent with how it was in earlier years

8.2. Pathologies

8.2.1. Dementia Irreversible, progressive impairment of cognitive function affecting memory, orientation, judgment, reasoning, attention, language and problem solving Alzheimer’s Disease Most common form of dementia Neurotic plaque with deposits of beta-amyloid protein, when clumping it impairs the function of nerve cells in the brain Neurofibrillary tangles in the cortex, microtubules disintegrate and collapse the neuron transport system Risk factors: Down syndrome, environmental and genetic factors, lipidemia, hypertension, smoking, head injury, mental and physical inactivity S/S: changes in intellectual ability, anxious or depressed, language disturbances, visual disturbances, feeling of not being able to control limbs Diagnostics: brain scan that reveals changes in brain structure, neurophysiology testing to evaluate cognition Nursing interventions: estrogens role in prevention is being researched more, antioxidants, anti-inflammatory agents, folic acid/b12/b6 supplements, gene therapy to add nerve growth factor, medication to break down acetylcholine (donepezil, rivastigmine, galantamine)

9. Physical Appearance

9.1. Age related changes

9.1.1. Narrowing gait in women and wider gait in men

9.1.2. Deepening of hollows of axillae and intercostal and supraclavicular spaces

9.1.3. Darkening and wrinkling of skin around orbits

9.1.4. Thicker hair in ears and nose

9.1.5. Graying and thinning of hair

9.1.6. Ectropion of eyelids

9.1.7. Elongated ears

9.1.8. Arcus senilis

9.1.9. Growth of facial hair in women

9.1.10. Diminished muscle mass and skinfold thickness

9.1.11. Decreased height

10. Thermoregulation

10.1. Age related changes

10.1.1. Impaired sweating mechanism More susceptible to heat stress

10.1.2. Reduced ability to respond to cold temperatures

10.1.3. Lower temperature

11. Endocrine system

11.1. Age related changes

11.1.1. Pancreases Delayed and insufficient release of insulin Reduced ability to metabolize glucose

11.1.2. Pituitary gland Decreases in volume by 20% Gonadal secretions decrease

11.1.3. Adrenal cortex ACTH secretion decreases Secretion of glucocorticoids is reduced

11.1.4. Thyroid gland Fibrosis Cellular infiltration Lower BMI Reduced radioactive iodine uptake

11.2. Pathologies

11.2.1. Hypothyroidism Condition increases in prevalence with age S/S: fatigue, weakness, disinterest in activities, anorexia, weight gain and puffy face, impaired hearing, peri orbital edema, constipation, cold intolerance, ataxia, paresthesia, dry skin, and coarse hair Diagnostics: blood test TSH, T4 levels Nursing Interventions: synthetic T4 replacement, treat and prevent signs and symptoms ( constipation, wear extra clothes if cold intolerant)

12. Integumentary system

12.1. Age related changes

12.1.1. Reduced melanocytes

12.1.2. Lines, wrinkles, sagging

12.1.3. Collagen fibers coarse and more random, reducing elasticity of the skin

12.1.4. Increased quantity and degeneration of elastin fibers

12.1.5. Reduced thickness and vascularity of the dermis

12.1.6. Flattening of dermal-epidural junction

12.2. Pathologies

12.2.1. Pruritus Most common skin disease among older adults Risk factors: diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia S/S: uncomfortable, irritating sensation that makes you want to scratch Nursing interventions: bath oils, moisturizing lotions, massage, vitamin supplements and diet high in vitamins, zinc oxide Medications: antihistamines and topical steroids

13. Immune system

13.1. Age related changes

13.1.1. Inflammatory response declines

13.1.2. IgM concentration lower, IgA and IgG are higher

13.1.3. Large decline in cell-mediated immunity

13.1.4. T-cell activity declines and more immature T cells are present in the thymus

13.1.5. Immunosenescence- depressed immune response Increases risk for infection

14. Sensory organs

14.1. Age related changes

14.1.1. Vision Presbyopia Stiffening of muscle fibers of lens Visual field narrows Pupillary sphincter hardens Light perception threshold increases

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

14.1.3. Taste and smell High prevalence of taste impairment Impaired ability to identify and discriminate among odors

14.1.4. Touch Reduced tactile sensation

14.2. Pathologies

14.2.1. Cataracts Clouding of the lens or its capsule causes the lens to lose its transparency Common among older people Risk factors: UV B rays exposure, diabetes, cigarette smoking, high alcohol consumption S/S: no discomfort or pain, vision distorted, decreased night vision, blurred objects, feel like there is a film over eye, lens is yellow or yellow-brown, improvement in ability to see small print and objects Treatment: surgery to remove lens, if only one eye effected then focus on strengthening vision that exists, sunglasses, shear curtains over windows, multiple soft lights instead of one bright one

15. Nervous system

15.1. Age related changes

15.1.1. Changes in sleep pattern

15.1.2. Reduced blood flow to the brain

15.1.3. Decreased brain weight

15.1.4. Decreased conduction velocity

15.1.5. Slower response and reaction time

15.2. Pathologies

15.2.1. Cerebrovascular accidents Third leading cause of death and disability in older people Risk factors: hypertension, obesity, diabetes, severe arteriosclerosis, gout, anemia, hypothyroidism, TIAs, dehydration S/S: light-headedness, dizziness, headache, drop attack, memory and behavioral changes, hemiplegia, aphasia, hemianopsia Nursing interventions: maintain a patent airway, provide adequate nutrition and hydration, monitor neurologic and vital signs, prevent complications associated with immobility, frequent skin care, frequent turns

16. Reproductive system

16.1. Age related changes

16.1.1. Male Possible reduction in sperm count Fluid-retaining capacity of seminal vesicles reduces Venous and arterial sclerosis of the penis Prostate enlarges in most men

16.1.2. Female Flattening of labia Drier, less elastic vaginal canal Cervix becomes smaller Ovaries become thicker and smaller Fallopian tube atrophy and shortens Endocervical epithelium atrophies Uterus becomes smaller in size Endometrium atrophies More alkaline vaginal environment Loss of vulvar subcutaneous fat and hair Diseases related to body system

16.2. Pathologies

16.2.1. Female Perineal herniation Result of stretching and tearing of muscles during childbirth, common among older women S/S: lower back pain, pelvic heaviness, pulling sensation, urinary and fecal incontinence, retention, constipation Nursing interventions: educate on how intercourse can be painful, preparing and informing about surgical repair treatment

16.2.2. Male Benign prostatic hyperplasia Most older men have to some degree S/S: hesitancy, frequency, nocturia, dribbling, bleeding Nursing intervention: prostatic massage, urinary antiseptics, prostatectomy-educate on surgery