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. Thermoregulation

2.1. Age related changes

2.1.1. Impaired sweating mechanism 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 Delayed and insufficient release of insulin Reduced ability to metabolize glucose

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

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

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

3.2. Pathologies

3.2.1. 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)

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 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

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 Increases risk for infection

6. Sensory organs

6.1. Age related changes

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

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

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

6.1.4. Touch Reduced tactile sensation

6.2. Pathologies

6.2.1. 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

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 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

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 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

9. Reproductive system

9.1. Age related changes

9.1.1. 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

9.1.2. 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

9.2. Pathologies

9.2.1. 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

9.2.2. 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

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 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

10.2.2. 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

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 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

11.2.2. 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

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 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:

12.2.2. 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

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 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

14. Cells

14.1. Age related changes

14.1.1. Intracellular fluid is decreased Leads to less total body fluid 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 Motivation changes Delayed transmitting of information to the brain

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

15.1.3. Personality Consistent with how it was in earlier years

15.2. Pathologies

15.2.1. 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)

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