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. Thermoregulation

2.1. Age related changes

2.1.1. Impaired sweating mechanism

2.1.1.1. More susceptible to heat stress

2.1.2. Reduced ability to respond to cold temperatures

2.1.3. Lower temperature

3. Endocrine system

3.1. Age related changes

3.1.1. Pancreases

3.1.1.1. Delayed and insufficient release of insulin

3.1.1.2. Reduced ability to metabolize glucose

3.1.2. Pituitary gland

3.1.2.1. Decreases in volume by 20%

3.1.2.2. Gonadal secretions decrease

3.1.3. Adrenal cortex

3.1.3.1. ACTH secretion decreases

3.1.3.2. Secretion of glucocorticoids is reduced

3.1.4. Thyroid gland

3.1.4.1. Fibrosis

3.1.4.2. Cellular infiltration

3.1.4.3. Lower BMI

3.1.4.4. Reduced radioactive iodine uptake

3.2. Pathologies

3.2.1. Hypothyroidism

3.2.1.1. Condition increases in prevalence with age

3.2.1.2. 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

3.2.1.3. Diagnostics: blood test TSH, T4 levels

3.2.1.4. Nursing Interventions: synthetic T4 replacement, treat and prevent signs and symptoms ( constipation, wear extra clothes if cold intolerant)

4. Integumentary system

4.1. Age related changes

4.1.1. Reduced melanocytes

4.1.2. Lines, wrinkles, sagging

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

4.1.4. Increased quantity and degeneration of elastin fibers

4.1.5. Reduced thickness and vascularity of the dermis

4.1.6. Flattening of dermal-epidural junction

4.2. Pathologies

4.2.1. Pruritus

4.2.1.1. Most common skin disease among older adults

4.2.1.2. Risk factors: diabetes, arteriosclerosis, hyperthyroidism, uremia, liver disease, cancer, pernicious anemia

4.2.1.3. S/S: uncomfortable, irritating sensation that makes you want to scratch

4.2.1.4. Nursing interventions: bath oils, moisturizing lotions, massage, vitamin supplements and diet high in vitamins, zinc oxide

4.2.1.4.1. Medications: antihistamines and topical steroids

5. Immune system

5.1. Age related changes

5.1.1. Inflammatory response declines

5.1.2. IgM concentration lower, IgA and IgG are higher

5.1.3. Large decline in cell-mediated immunity

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

5.1.5. Immunosenescence- depressed immune response

5.1.5.1. Increases risk for infection

6. Sensory organs

6.1. Age related changes

6.1.1. Vision

6.1.1.1. Presbyopia

6.1.1.2. Stiffening of muscle fibers of lens

6.1.1.3. Visual field narrows

6.1.1.4. Pupillary sphincter hardens

6.1.1.5. Light perception threshold increases

6.1.2. Hearing

6.1.2.1. Atrophy of hair cells of organ of corti

6.1.2.2. Tympanic membrane sclerosis and atrophy

6.1.2.3. Increased cerumen and concentration of keratin

6.1.3. Taste and smell

6.1.3.1. High prevalence of taste impairment

6.1.3.2. Impaired ability to identify and discriminate among odors

6.1.4. Touch

6.1.4.1. Reduced tactile sensation

6.2. Pathologies

6.2.1. Cataracts

6.2.1.1. Clouding of the lens or its capsule causes the lens to lose its transparency

6.2.1.2. Common among older people

6.2.1.3. Risk factors: UV B rays exposure, diabetes, cigarette smoking, high alcohol consumption

6.2.1.4. 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

6.2.1.5. 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

7. Nervous system

7.1. Age related changes

7.1.1. Changes in sleep pattern

7.1.2. Reduced blood flow to the brain

7.1.3. Decreased brain weight

7.1.4. Decreased conduction velocity

7.1.5. Slower response and reaction time

7.2. Pathologies

7.2.1. Cerebrovascular accidents

7.2.1.1. Third leading cause of death and disability in older people

7.2.1.2. Risk factors: hypertension, obesity, diabetes, severe arteriosclerosis, gout, anemia, hypothyroidism, TIAs, dehydration

7.2.1.3. S/S: light-headedness, dizziness, headache, drop attack, memory and behavioral changes, hemiplegia, aphasia, hemianopsia

7.2.1.4. 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

8. Musculoskeletal system

8.1. Age related changes

8.1.1. Impaired flexion and extension movements

8.1.2. Slight wrist flexion

8.1.3. Slight kyphosis

8.1.4. Shortening of vertebrae

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

8.1.6. Bones more brittle

8.1.7. Slight knee flexion

8.1.8. Decrease in bone mass and bone mineral

8.2. Pathologies

8.2.1. Osteoarthritis

8.2.1.1. Progressive degeneration and abrasion of joint cartilage, with 5e formation of new bone at the joint surface

8.2.1.2. Effects most people over 55 to some extent

8.2.1.3. 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,

8.2.1.4. S/S: crepitus of the joints, discomfort at the joint with extended use

8.2.1.5. Nursing interventions: rest, heat/ice, t’ai chi, aqua therapy, gentle massage, splints, braces, canes, weight reduction, occupational and physical therapy, arthroplasty-joint replacement

8.2.1.5.1. Medications: analgesics to control pain

8.2.1.5.2. 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

9. Reproductive system

9.1. Age related changes

9.1.1. Male

9.1.1.1. Possible reduction in sperm count

9.1.1.2. Fluid-retaining capacity of seminal vesicles reduces

9.1.1.3. Venous and arterial sclerosis of the penis

9.1.1.4. Prostate enlarges in most men

9.1.2. Female

9.1.2.1. Flattening of labia

9.1.2.2. Drier, less elastic vaginal canal

9.1.2.3. Cervix becomes smaller

9.1.2.4. Ovaries become thicker and smaller

9.1.2.5. Fallopian tube atrophy and shortens

9.1.2.6. Endocervical epithelium atrophies

9.1.2.7. Uterus becomes smaller in size

9.1.2.8. Endometrium atrophies

9.1.2.9. More alkaline vaginal environment

9.1.2.10. Loss of vulvar subcutaneous fat and hair

9.1.2.11. Diseases related to body system

9.2. Pathologies

9.2.1. Female

9.2.1.1. Perineal herniation

9.2.1.1.1. Result of stretching and tearing of muscles during childbirth, common among older women

9.2.1.1.2. S/S: lower back pain, pelvic heaviness, pulling sensation, urinary and fecal incontinence, retention, constipation

9.2.1.1.3. Nursing interventions: educate on how intercourse can be painful, preparing and informing about surgical repair treatment

9.2.2. Male

9.2.2.1. Benign prostatic hyperplasia

9.2.2.1.1. Most older men have to some degree

9.2.2.1.2. S/S: hesitancy, frequency, nocturia, dribbling, bleeding

9.2.2.1.3. Nursing intervention: prostatic massage, urinary antiseptics, prostatectomy-educate on surgery

10. Urinary system

10.1. Age related changes

10.1.1. Decreased bladder capacity

10.1.2. Decreased size of renal mass

10.1.3. Decreased tubular function

10.1.4. Decrease in nephrons

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

10.1.6. Weaker bladder muscles

10.2. Pathologies

10.2.1. Urinary tract infection

10.2.1.1. Most common infection of older adults

10.2.1.2. Risk factors:

10.2.1.2.1. Poor hygiene, improper cleaning after bowel elimination, low fluid intake, excessive fluid loss, hormonal changes, catheter

10.2.1.2.2. Escherichia coli (women), proteus (men)

10.2.1.3. S/S: burning, urgency, fever, retention, incontinence, hematuria

10.2.1.4. Diagnostic: Bacteriuria- >105

10.2.1.5. Nursing interventions: adequate urinary drainage, I&O’s, fluids, cranberry juice, avoid urinary catheter

10.2.2. Urinary incontinence

10.2.2.1. Common and bothersome disorder of older adults, in more than half of institutionalized older population

10.2.2.2. Risk factors: delirium, dementia, cerebrovascular accident, diabetes mellitus, congestive heart failure, UTI

10.2.2.2.1. medications that can affect continence: diuretics, antianxiety agents, antipsychotics, antidepressants, sedatives, narcotics, antiparkinson agents, antispomodics, antihistamine, calcium channel blockers, alpha-blockers, alpha-stimulants

10.2.2.3. Symptoms: urgency, burning, vaginal itching, pain, pressure in bladder area, fever

10.2.2.4. Nursing interventions: refer patient for a comprehensive medical evaluation, assess activities of daily living, note degree of dependency

11. Gastrointestinal system

11.1. Age related changes

11.1.1. Slower peristalsis

11.1.2. Fewer cells on absorbing surface of intestines

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

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

11.1.5. Atrophy of gastric mucosa

11.1.6. Decrease esophageal motility

11.1.7. Decreased taste sensation

11.1.8. Esophagus more dilated

11.1.9. Reduced saliva and salivary ptyalin

11.1.10. Liver smaller in size

11.1.11. Reduced intestinal blood flow

11.2. Pathologies

11.2.1. Hiatal hernia

11.2.1.1. Affects about half of the people in the US over age of 50, more common in women

11.2.1.2. Risk factors: low-fiber diet, GERD, obesity

11.2.1.3. S/S: heartburn, dysphagia, belching, vomiting, regurgitation, pain, and bleeding

11.2.1.4. Diagnostics: barium swallow and esophagoscopy

11.2.1.5. Nursing interventions: weight reduction, bland diet, milk, several small meals, avoid eating before bedtime, sleep in slight recombinant position

11.2.1.5.1. Medications: antacids, H2 blockers, proton pump inhibitor

11.2.2. Colorectal cancer

11.2.2.1. Cancer along large intestine is common with advancing age

11.2.2.2. Diagnostics: colonoscopy with biopsy and CT colonoscopy, fecal occult blood testing

11.2.2.3. 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

11.2.2.4. Nursing interventions: preparation for surgery, have regular meals, restrict tea and coffee, reduce alcohol and carbonated drinks, eat something solid with each meal

11.2.2.4.1. Radiotherapy: can downstage tumor to aid complete excision

11.2.2.4.2. Surgical resection

11.2.2.4.3. Chemotherapy: with high-risk Dukes B or Dukes C tumors with nodal disease to reduce recurrence

12. Cardiovascular system

12.1. Age related changes

12.1.1. Less elasticity of vessels

12.1.2. Blood pressure increases

12.1.3. Resistance to peripheral blood flow increases slightly each year

12.1.4. Cardiac output decreases

12.1.5. Aorta becomes dilated and elongated

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

12.1.7. Valves become thicker and more rigid

12.1.8. Stroke volume decreases

12.1.9. Heart pigmented with lipofuscin granules

12.1.10. Less efficient O2 utilization

12.2. Pathologies

12.2.1. Hypertension

12.2.1.1. Most prevalent CV disease among older adults

12.2.1.2. Causes: vasoconstriction, peripheral resistance, hyperthyroidism, Parkinson disease, Paget’s disease, anemia, thiamine deficiency

12.2.1.3. S/S: high blood pressure, awakening with a dull headache, impaired memory, disorientation, confusion, epistaxis, and a slow tremor

12.2.1.4. Diagnostics: systolic bp >140 and diastolic bp > 90

12.2.1.5. Nursing interventions: rest, reduce sodium intake, reduce weight,

12.2.1.5.1. Nonpharmocologic measures advised: biofeedback, yoga, meditation, relaxation exercises, fish oil supplements, garlic, hawthorn berries, Rauwolfia, periwinkle, increase whole grain in diet

12.2.1.5.2. DASH Diet: rich in fruits, veggies, whole grain, low-fat dairy foods

12.2.1.5.3. Medications:

12.2.2. Congestive heart failure

12.2.2.1. Leading cause of hospitalization of older adults

12.2.2.2. 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

12.2.2.3. 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

12.2.2.4. Nursing interventions: bedrest (not complete), reduce sodium intake, skin care, frequent repositioning, emotional support

12.2.2.4.1. Medication: ACE inhibitor, beta blocker, digitalis, diuretics

13. Respiratory system

13.1. Age related changes

13.1.1. Thoracic muscles more rigid

13.1.2. Reduced basilar inflation

13.1.3. Alveoli fewer in number and larger in size

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

13.1.5. Blunting of cough and laryngeal reflexes

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

13.1.7. Loss of elasticity and increased rigidity

13.1.8. Decreased ciliary action

13.1.9. Forced expiratory volume reduced

13.2. Pathologies

13.2.1. Pneumonia

13.2.1.1. Common among older adults, one of the leading causes of death in age group

13.2.1.2. Risk factors: shallow breathing, poor chest expansion, high prevalence of respiratory diseases, lowered resistance to infection, reduced sensitivity of pharyngeal reflexes

13.2.1.3. Causes: Streptococcus pneumonia, gram negative bacilli, anaerobic bacteria, and influenza

13.2.1.4. S/S: pleuritic pain, minimal fever, slight cough, fatigue, rapid respirations, confusion, restlessness

13.2.1.5. Diagnostics: chest x-ray, chest auscultation, ABG levels

13.2.1.6. Nursing interventions: pneumonococcal vaccine, hydration-IV fluids, higher calorie intake, monitor oxygen saturation, oxygen therapy if needed, rest to conserve energy

14. Cells

14.1. Age related changes

14.1.1. Intracellular fluid is decreased

14.1.1.1. Leads to less total body fluid

14.1.1.1.1. Risk for dehydration

14.1.2. Bone mass decreases

14.1.3. Fat tissue increases until sixth decade of life

14.1.4. Lean body mass reduced

14.1.5. Fewer functional cells in the body

14.1.6. Number of cells gradually reduced

15. Changes to the mind

15.1. Age related changes

15.1.1. Learning

15.1.1.1. Motivation changes

15.1.1.2. Delayed transmitting of information to the brain

15.1.2. Memory

15.1.2.1. Retrieval of information from long-term memory can be slowed

15.1.2.2. Sensory only lasts a few seconds

15.1.2.3. Working memory function is reduced

15.1.3. Personality

15.1.3.1. Consistent with how it was in earlier years

15.2. Pathologies

15.2.1. Dementia

15.2.1.1. Irreversible, progressive impairment of cognitive function affecting memory, orientation, judgment, reasoning, attention, language and problem solving

15.2.1.2. Alzheimer’s Disease

15.2.1.2.1. Most common form of dementia

15.2.1.2.2. Neurotic plaque with deposits of beta-amyloid protein, when clumping it impairs the function of nerve cells in the brain

15.2.1.2.3. Neurofibrillary tangles in the cortex, microtubules disintegrate and collapse the neuron transport system

15.2.1.2.4. Risk factors: Down syndrome, environmental and genetic factors, lipidemia, hypertension, smoking, head injury, mental and physical inactivity

15.2.1.2.5. S/S: changes in intellectual ability, anxious or depressed, language disturbances, visual disturbances, feeling of not being able to control limbs

15.2.1.2.6. Diagnostics: brain scan that reveals changes in brain structure, neurophysiology testing to evaluate cognition

15.2.1.2.7. 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)

16. Physical Appearance

16.1. Age related changes

16.1.1. Narrowing gait in women and wider gait in men

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

16.1.3. Darkening and wrinkling of skin around orbits

16.1.4. Thicker hair in ears and nose

16.1.5. Graying and thinning of hair

16.1.6. Ectropion of eyelids

16.1.7. Elongated ears

16.1.8. Arcus senilis

16.1.9. Growth of facial hair in women

16.1.10. Diminished muscle mass and skinfold thickness

16.1.11. Decreased height