Changes in Aging

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Changes in Aging by Mind Map: Changes in Aging

1. GI

1.1. Effects of Aging

1.1.1. Atrophy of the tongue and taste buds

1.1.1.1. Less acute taste sensation

1.1.2. decreased esophageal motility

1.1.3. atrophy of the small and large intestines

1.1.4. increased risk of aspiration, digestion and constipation

1.1.5. Decreased elasticity of the stomach

1.1.5.1. reduces the amount of food accommodation at one time

1.1.6. Stomach has a higher pH

1.1.6.1. decline in hydrochloric acid and pepsin

1.1.6.1.1. Interferes with absorption of calcium, iron, folic acid, vitamin b12 and protein

1.1.7. Slower peristalsis, inactivity, reduced food intake, drugs and low fiber diet

1.1.7.1. increase risk of constipation

1.2. Health Promotion

1.2.1. good dental hygiene and regular dental visits can prevent disorders that threaten nutritional intake

1.2.2. proper nutrition enhances general health and minimizes the risk of indigestion and constipation

1.2.3. utilization of natural means to promote bowel elimination

1.2.3.1. fiber, fluids, activity

1.3. Dysphagia

1.3.1. Difficulty swallowing

1.3.2. Causes related to aging

1.3.2.1. Atrophy of tongue

1.3.2.2. decreased esophageal motility

1.3.2.3. reduced stimulation of cranial nerves

1.3.3. Consequences

1.3.3.1. GERD

1.3.3.2. Aspiration

1.3.3.2.1. pneumonia

1.3.4. Treatment

1.3.4.1. Observe food intake

1.3.4.2. promotion of adequate nutrition

1.3.4.3. Speech therapy

1.3.4.4. Eat in an upright position

1.3.4.4.1. small bites

1.3.4.5. accessible suction

1.4. Chronic Constipation

1.4.1. Infrequent, hard and dry stools that are difficult to pass

1.4.2. Causes related to aging

1.4.2.1. atrophy of the small and large intestine

1.4.2.2. decrease in peristalsis

1.4.2.3. inactivity and immobility

1.4.2.4. reduced fiber intake

1.4.3. Treatment

1.4.3.1. increased dietary fiber

1.4.3.1.1. prunes, raisins, dates

1.4.3.2. increased fluids

1.4.3.3. increased physical activity

1.4.3.4. safe use of laxatives and enemas

1.4.3.5. review of medications

1.4.3.5.1. antibiotics, antacids, calcium and narcotics

1.4.3.6. monitor for fecal impaction

1.5. Xerostomia

1.5.1. "dry mouth"

1.5.2. results from decreased saliva production, medication, mouth breathing and altered cognition

1.5.3. treatment

1.5.3.1. saliva substitutes, increased fluid, sugarless candy and gum

2. Renal

2.1. Effects of Aging

2.1.1. Decline of renal blood flow and glomerular filtration by approximately 50% by age 90

2.1.1.1. high blood urea nitrogen level

2.1.1.2. affects the ability to eliminate drugs

2.1.1.2.1. potential for adverse drug reactions

2.1.1.3. concentration of urine changes in response to eater and/or sodium excess

2.1.2. Hypertrophy and thickening of the bladder muscle

2.1.2.1. reduced bladder capacity

2.1.2.1.1. daytime urinary frequency

2.1.2.1.2. nocturia

2.1.3. inefficient neurological control of bladder emptying and weaker bladder muscle

2.1.3.1. male

2.1.3.1.1. prostatic hypertrophy

2.1.3.2. female

2.1.3.2.1. fecal impaction

2.1.4. increase in renal threshold for glucose

2.1.4.1. false-negative results in glucose in the urine without symptoms

2.2. Incontinence is NOT a normal change in aging

2.2.1. Factors to assess for urinary incontinence

2.2.1.1. cognition

2.2.1.2. urinary control and retention

2.2.1.3. elimination pattern

2.2.1.4. fecal impaction

2.2.1.5. diet (amount)

2.2.2. Types

2.2.2.1. Stress

2.2.2.1.1. weak supporting pelvic muscles

2.2.2.2. Urgency

2.2.2.2.1. UTI, enlargement of prostate

2.2.2.2.2. irritation or spasms of bladder

2.2.2.3. overflow

2.2.2.3.1. bladder neck obstruction and medications

2.2.2.3.2. fail to contract and relax appropriately

2.2.2.4. Neurogenic

2.2.2.4.1. inability to sense the urge

2.2.2.5. Functional

2.2.2.5.1. dementia

2.2.2.6. Mixed

2.3. Health Promotion

2.3.1. adequate fluid intake

2.3.2. maintenance of acidic urine

2.3.3. avoidance of catheterization

2.3.4. appropriate level of activity

2.3.5. frequent toileting

2.3.6. interventions and education to enhance voiding and prevent retention

2.4. Renal Calculi

2.4.1. Painful formation of stones

2.4.2. Causes related to aging

2.4.2.1. immobility

2.4.2.2. misuse of calcium

2.4.2.3. changes of pH in urine

2.4.2.4. excessive elimination of uric acid

2.4.3. Symptoms

2.4.3.1. Pain

2.4.3.2. hematuria

2.4.3.3. UTI like symptoms

2.5. Nursing Consideration for Urinary Conditions

2.5.1. Consider fear and anxiety toward urinary incontinence

2.5.2. provide education and realistic expectations

2.5.3. maintain dignity

3. Sleep and Comfort

3.1. Pain

3.1.1. Predominat in older population

3.1.2. One in four suffer day-long bouts of pain

3.1.3. three of five patients aged 65+ experience pain lasting for 1 year or more

3.1.4. lower back pain is most common

3.1.5. severe joint pain increased with age

3.1.6. Experience of pain is complicated by chronic disease in many older adults

3.1.7. Management

3.1.7.1. Medication

3.1.7.1.1. trial non-opioids prior to opioids

3.1.7.1.2. acetaminophen is most commonly used

3.1.7.1.3. NSAIDS

3.1.7.1.4. Propoxyphene and pentazocine contraindicated with older adults

3.1.7.2. Complementary Therapy

3.1.7.2.1. exercise, acupuncture, yoga, herbal, heat and cold

3.1.7.3. Dietary changes

3.1.7.3.1. avoid: high fat foods, high sugar foods and animal products

3.1.8. Complications of unresolved pain

3.1.8.1. Limited mobility

3.1.8.2. develop pressure ulcers

3.1.8.3. pneumonia

3.1.8.4. constipation

3.1.8.5. poor appetite

3.1.8.6. depression, hopelessness

3.1.8.7. spiritual distress

3.1.9. Types

3.1.9.1. Nociceptive

3.1.9.2. Neuropathic

3.1.9.3. changes in neurotransmitter systems

4. Dementia and Delirium

4.1. Fear of loss of normal cognition

4.2. losses that result from impaired cognition

4.3. With aging there is an increased risk

4.4. Dementia

4.4.1. Irreversible

4.4.2. Progressive

4.4.3. Impairment in cognitive function affects

4.4.3.1. memory, orientation, reasoning, attention, language, and problem solving

4.4.4. Caused by damage or injury to the brain

4.4.5. 4.5 million adults are affected

4.4.6. Alzheimer's Disease

4.4.6.1. Most common form of dementia

4.4.6.2. Changes in the brain

4.4.6.2.1. neuritic plaques containing beta-amyloid protein

4.4.6.2.2. neurofibrillary tangles in the cortex

4.4.6.2.3. loss or degeneration of neuron and synapses

4.4.6.2.4. Symptoms develop gradually and progress at different rates among individuals

4.4.6.2.5. Staging

4.4.6.2.6. Treatment

4.4.7. Caring for Persons with Dementia

4.4.7.1. Ensure safety

4.4.7.2. Providing Physical Care

4.4.7.2.1. Close observation and attention to physical needs

4.4.7.2.2. eating and drinking, bathing and skin care, consider inability to communicate needs and discomforts

4.4.7.3. Promoting therapy and activity

4.4.7.4. Support the patient and the patient's family

4.4.8. Assessment

4.4.8.1. Mini-Cog

4.5. Delirium

4.5.1. Rapid onset; altered level of consciouness

4.5.2. prompt treatment may reverse condition and prevent permanent damage

4.5.3. Causes

4.5.3.1. Hypoxia

4.5.3.2. Infections

4.5.3.2.1. urinary tract

4.5.3.2.2. respiratory

4.5.3.2.3. cellulitis

4.5.3.2.4. mouth

4.5.3.2.5. feet

4.5.3.3. Dehydration

4.5.3.4. Hypernatremia

4.5.3.5. Hyponatremia

4.5.3.6. Pain

4.5.3.7. Medications

4.5.4. Interventions

4.5.4.1. Establish medical stability

4.5.4.2. minimizing stimulation

4.5.4.3. consistency in care

4.5.4.4. prevention of harm to self and others

4.5.4.5. support and realistic expectations

5. Endocrine

5.1. Effects of Aging

5.1.1. ability to metabolize glucose is reduced

5.1.2. higher blood glucose in nondiabetic patients

5.1.3. Thyroid gland activity decreases

5.1.4. pituitary gland decreases

5.1.5. ACTH secretion decreases

5.1.6. insulin released by beta cells is delayed and insufficient

5.2. Diabetes Mellitus

5.2.1. Type 2

5.2.1.1. seventh leading cause of death in older adults

5.2.1.2. Glucose intolerance due to the insulin being released by beta cells is delayed and insufficient

5.2.1.3. classic nonspecific symptoms may be absent

5.2.1.4. Screening

5.2.1.4.1. Fasting blood glucose recommended every 3 years for persons over the age of 45

5.2.1.4.2. glucose tolerance test is the most effective test

5.2.1.5. Causes related to aging

5.2.1.5.1. reduced ability to metabolize glucose

5.2.1.5.2. insulin released by beta cells of pancreas is delayed and insufficent

5.2.1.6. Diagnosis

5.2.1.6.1. symptoms and a random blood glucose concentration of >200

5.2.1.6.2. Fasting blood glucose concentration >126

5.2.1.6.3. blood glucose concentrations 2 hours after oral glucose intake >200

5.2.1.7. Management

5.2.1.7.1. Education

5.2.1.7.2. Drug Therapy

5.2.1.7.3. Hygiene

5.2.1.7.4. Exercise

5.2.1.8. Complications

5.2.1.8.1. Hypoglycemia

5.2.1.8.2. Peripheral Vascular Disease

5.2.1.8.3. Diabetic retinopathy

5.2.1.8.4. drug interaction

5.2.1.8.5. Urinary tract infections

5.2.1.8.6. cognitive impairment

5.2.1.8.7. Metabolic syndrome

5.3. Hypothyroidism

5.3.1. Primary

5.3.1.1. results from a disease process that destroys part of the thyroid gland

5.3.2. Secondary

5.3.2.1. insufficient pituitary secretion of TSH

5.3.3. Symptoms

5.3.3.1. fatigue, weakness, depression, disinterest in activities, anorexia, weight gain, puffy eyes, impaired hearing, constipation, cold intolerance, dry skin

5.3.4. Treatment

5.3.4.1. replacement of hormone

5.3.4.2. Management of symptoms

5.4. Hyperthyroidism

5.4.1. less prevalent than hypo

5.4.2. more common in women

5.4.3. a frequent cause is the use of aminodarone

5.4.4. Diagnosis

5.4.4.1. T3 not always telling

5.4.4.2. Must look at T4, free T4 and TSH

5.4.5. Symptoms

5.4.5.1. diaphoresis, tachycardia, palpitations, hypertension, tremor, diarrhea, stare, lid lag, insomnia, confusion, nervousness, muscle weakness

5.4.6. Treatment

5.4.6.1. Depends on cause, treat underlying disease

5.4.6.2. surgery

5.4.6.3. Radioactive iodine therapy

6. Sensory

6.1. all senses are less proficient with advanced age: vision, hearing, taste, smell and touch

6.2. decreased efficiency of the senses can affect well-being, activities of daily living, safety and health

6.3. Changes in Aging

6.3.1. presbyopia

6.3.1.1. inability to focus on close objects clearly

6.3.2. narrowing of the visual field-decreased peripheral vision

6.3.3. pupil size reduction and less reactive to light

6.3.4. depth perception distortion

6.3.5. decline in visual activity

6.3.6. Loss of photoreceptor cells in the retina

6.3.6.1. light perception threshold decreases

6.3.6.2. dark and light adaption takes longer

6.3.6.3. difficulty with vision at night

6.4. Vision

6.4.1. Glaucoma

6.4.1.1. damage to the optic nerve from an above normal intra-ocular pressure

6.4.1.2. second leading cause of blindness in older adults

6.4.1.3. Causes related to aging

6.4.1.3.1. changes in lens

6.4.1.3.2. decline in visual activity

6.4.1.4. Causes

6.4.1.4.1. iritis

6.4.1.4.2. allergies

6.4.1.4.3. endocrine imbalances

6.4.1.4.4. family history

6.4.1.4.5. drugs with anticholinergic properties may exacerbate

6.4.1.5. Acute (closed or narrow angle)

6.4.1.5.1. severe eye pain, headache, nausea and vomiting

6.4.1.5.2. rapid increase in tension and edema

6.4.1.5.3. need for early treatment to prevent blindness

6.4.1.5.4. diagnosis with tonometry to measure IOP

6.4.1.5.5. If pressure doesn't decrease in 24 hours surgery is necessary

6.4.1.6. Chronic (open angle)

6.4.1.6.1. most common form

6.4.1.6.2. need for early treatment to prevent blindness

6.4.1.6.3. blindness from glaucoma cannot be restored

6.4.1.6.4. peripheral vision becomes slowly impaired but may not realize what is happening

6.4.2. Cataracts

6.4.2.1. clouding of the lens and loss of transparency

6.4.2.2. leading cause of low vision in older adults

6.4.2.3. older women with blue eyes at most risk

6.4.2.4. treatment

6.4.2.4.1. surgery is only treatment

6.4.2.4.2. not preformed until vision is completely lost

6.5. Hearing

6.5.1. Care of the Person with a hearing deficit

6.5.1.1. encourage testing

6.5.1.2. patience

6.5.1.3. safety considerations

6.5.1.4. Hearing aids should only be bought with correct prescription

6.5.2. Changes in Aging

6.5.2.1. Presbycusis

6.5.2.1.1. progressive loss of hearing

6.5.2.2. distortion of high-pitched sounds

6.5.2.3. alteration in equilibrium

6.5.2.4. cerumen increases

6.5.3. Causes of hearing loss

6.5.3.1. exposure to loud machinery

6.5.3.2. loud music

6.5.3.3. certain drugs are ototoixc

6.5.3.3.1. aspirin, -mycins,

6.6. Taste and Smell

6.6.1. Changes of Aging

6.6.1.1. taste acuity dependent on smell

6.6.1.2. sense of smell altered with age

6.6.1.3. decreased saliva and poor oral hygiene

6.6.1.4. atrophy of tongue

6.7. Touch

6.7.1. reduction of tactile sensation

6.7.2. reduced ability to sense pressure, discomfort, change in temperautre

6.7.2.1. Normal body temperature are lowered in older adults (96.9-98.3)

6.8. Health Promotion

6.8.1. Vision

6.8.1.1. Routine eye exams

6.8.1.2. Incorporate Zinc, Selenium, Vitamin A and C into diet

6.8.2. Hearing

6.8.2.1. Take good care of ears throughout years

6.8.2.2. prompt treatment of infections

6.8.2.3. Education

6.8.2.3.1. reduce environmental noise, trauma and regular examinations

7. Musculoskeletal

7.1. Effects of Aging

7.1.1. Thinning disks and shortened vertebra

7.1.2. reduced muscle mass, strength and movement

7.1.3. decreased bone mineral and mass

7.1.4. diminished calcium absorption

7.1.5. increased risk of fractures

7.2. Osteoporosis

7.2.1. Most prevalent metabolic disease of the bone

7.2.2. Risk Factors

7.2.2.1. advanced age

7.2.2.2. sex (female)

7.2.2.3. small-frame

7.2.2.4. history of early menopause

7.2.2.5. cigarette smoking and alcohol consumption

7.2.2.6. family history

7.2.3. Causes Related to aging

7.2.3.1. Immobility and Inactivity

7.2.3.2. Diminished Calcium absorption

7.2.3.3. reduced muscle mass, strength and movement

7.2.3.4. Poor Nutrition

7.2.3.4.1. related to decreased access, loss of teeth, difficulty swallowing

7.2.3.5. Reduction in sex hormones

7.2.3.5.1. Estrogen has protective effect

7.2.4. Diagnosis

7.2.4.1. Bone mass Density tests

7.2.4.1.1. DEXA scan

7.2.4.1.2. DPA

7.2.5. Treatment

7.2.5.1. treat underlying cause

7.2.5.1.1. disease

7.2.5.2. calcium supplements

7.2.5.3. a diet rich in protein

7.2.5.4. regular exercise

7.3. Health Promotion

7.3.1. Management of Pain

7.3.2. Preventing Injury

7.3.3. Promoting Independence

8. Cancer

8.1. Second leading cause of death in person over the age of 65

8.2. Probability of cancer increases with age

8.3. Aging and Cancer

8.3.1. Advanced stage when initially diagnosed

8.3.2. increased risk of complications, disability and death

8.3.3. biological age-related changes that impair the ability to resist disease

8.3.4. prolonged exposure to carcinogens

8.4. Prevention

8.4.1. healthy lifestyle

8.4.1.1. avoid use of tobacco and alcohol

8.4.1.2. limit exposure to sun

8.4.1.3. eat a diet rich in fiber, fruits and vegetables

8.4.1.4. maintain weight in an ideal weight range

8.4.1.5. protect against known carcinogens

8.4.2. Screening

8.4.2.1. Women

8.4.2.1.1. mammograms

8.4.2.1.2. papsmears

8.4.2.2. Men

8.4.2.2.1. colonoscopy

8.4.3. Education

8.4.3.1. CAUTION

8.4.3.1.1. change in bowel habits

8.4.3.1.2. a sore that does not heal

8.4.3.1.3. unusual bleeding or drainage

8.4.3.1.4. thickening or lump in the breast

8.4.3.1.5. Indigestion or swallowing difficulties

8.4.3.1.6. Obvious change in a wart or mole

8.4.3.1.7. nagging persistent cough

8.5. Treatment

8.5.1. Conventional

8.5.1.1. Depends on type of cancer

8.5.1.2. surgery, radiation, chemotherapy, and biologic therpapy

8.5.1.3. with age comes advanced risks for complications

8.5.2. Complementary and Alternative medicine

8.5.2.1. special diets, psychotherapy, spiritual practices, vitamin regimes, herbal remedies

8.5.2.2. Relationship-centered care

8.5.2.3. Support

8.5.2.4. Healing Partnerships

8.5.2.5. Comfort

8.5.2.6. Hope

9. Cardiovascular

9.1. Effects of Aging

9.1.1. Heart dimensions are unchanged

9.1.2. heart muscles loses efficiency and contractile strength and reduced cardiac output with physiologic stress

9.1.3. Valves become thick and rigid

9.1.4. blood vessels reduce elasticity

9.1.5. oxygen use less efficiently

9.1.6. Aorta becomes dilated

9.1.6.1. slight ventricular hypertrophy

9.1.6.2. thickening on ventricular wall

9.1.7. less sensitive to baroreceptor regulation of blood pressure

9.2. Health Promotion

9.2.1. alterations modified by lifestyle and diet

9.2.2. Identify and lower risks through education

9.2.3. proper nutrition

9.2.3.1. control of cholesterol

9.2.4. adequate exercise

9.2.4.1. enhance circulation with aerobic exercise, yoga, strengthening exercises, balance exercises

9.2.5. Cigarette smoking cessation

9.2.6. Stress management

9.2.7. proactive interventions

9.2.7.1. low-dose aspirin daily; preventive measure

9.2.7.2. nutritional supplements

9.3. Hypertension

9.3.1. incidence and prevalence increases with age

9.3.2. evaluation of blood pressure

9.3.2.1. systolic >140

9.3.2.2. diastolic >90

9.3.3. symptoms

9.3.3.1. dull headache, impaired memory, disorientation, confusion, epistaxis, and slow tremor

9.3.4. Treatment

9.3.4.1. thiazide diuretics

9.3.4.1.1. watch for electrolyte imbalances

9.3.4.2. beta blockers

9.3.4.3. calcium channel blockers

9.3.4.4. ACE

9.3.4.5. nonpharmacologic measures taken first due to increased risk of adverse effects of medications in older adults

9.3.4.5.1. diet, exercise, stress management

9.3.5. Causes Related to Aging

9.3.5.1. oxygen use less efficiently

9.3.5.2. heart muscles loses efficiency and contractile strength and reduced cardiac output with physiologic stress

9.3.5.3. Blood vessels lose elasticity

9.3.5.4. Less sensitive to baroreceptor regulation

9.4. Hypotension

9.4.1. Decline in systolic blood pressure of 20 mmHg or more after changing positions

9.4.2. postural and postprandial hypotension due to increased intake of vasoactive medications and baroreceptor sensitivity

9.4.3. Consequences

9.4.3.1. falls, stroke, syncope, other coronary complications

9.5. Congestive Heart Failure

9.5.1. Incidence increases with age

9.5.2. Leading cause of hospitalization

9.5.3. complication of arteriosclerotic heart disease

9.5.4. symptoms

9.5.4.1. shortness of breath, dyspnea on exertion, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight, gain

9.5.5. treatment

9.5.5.1. ACE inhibitors

9.5.5.2. beta-blockers

9.5.5.3. digitalis

9.5.5.4. diuretics

9.5.5.5. reduction in sodium intake

9.6. Coronary Artery Disease

9.6.1. Ischemic heart disease

9.6.2. prevalence increases with age

9.6.3. angina

9.6.3.1. atypical presentation

9.6.3.1.1. coughing, syncope, sweating and confusion

9.6.3.2. Nitroglycerin is effective

9.6.3.2.1. more likely to experience orthostatic hypotension

9.6.3.3. Education

9.6.3.3.1. avoid aggravating factors

9.6.3.3.2. Nitroglycerin administration education

9.6.3.4. Causes related to Aging

9.6.3.4.1. oxygen use less efficiently

9.6.3.4.2. Valves more rigid

9.6.3.4.3. blood vessels lose elasticity

9.6.4. Myocardial Infarction

9.6.4.1. atypical presentation

9.6.4.1.1. confusion, decreased blood pressure, shortness of breath, elevated temperature, and sedimentation rate

9.6.4.2. Treatment

9.6.4.2.1. bed rest with minimal exertion

9.6.4.2.2. early ambulation

9.6.4.2.3. Thrombolytic therapy

9.6.4.2.4. Fitness programs

9.7. Arrhythmias

9.7.1. Causes

9.7.1.1. digitalis toxicity, hypokalemia, acute infections, hemorrhage, anginal syndrome and coronary insufficiency

9.7.2. Symptoms

9.7.2.1. weakness, fatigue, palpitations, confusion, dizziness, hypotension, bradycardia, syncope

9.7.3. Treatment

9.7.3.1. anti-arrhythmic drugs, digitalis, potassium supplements, cardioversion

9.8. Venous Thromboembolism

9.8.1. High Risk persons

9.8.1.1. restricted to bed rest

9.8.1.2. recent surgery

9.8.1.3. fractures

9.8.2. Signs and symptoms

9.8.2.1. edema, warmth over affected area, pain in foot, cyanosis, aching, and engorgement of superficial veins

9.8.3. Treatment

9.8.3.1. Anticoagulants, surgery, elastic stockings, bandages, and elevation of extremities

10. Respiratory

10.1. Effects of Aging

10.1.1. Calcification of costal cartilage, trachea and rib cage more rigid

10.1.2. Decreased elastic recoil

10.1.3. increased residual capacity and reduced vital capacity

10.1.4. high risk for respiratory infection and more difficult to manage

10.1.5. reduction of cough and laryngeal reflexes

10.1.6. alveoli less elastic

10.2. Health Promotion

10.2.1. Prevention of Infection

10.2.2. Smoking cessation

10.2.3. influenza and pneumonia vaccines important

10.2.4. avoiding exposure to people with respiratory infections

10.2.5. deep-breathing exercises

10.2.6. immobility is a major threat

10.2.7. caution with self-treatment of respiratory issues

10.3. Pneumonia

10.3.1. One of the leading causes of death in the elderly population

10.3.2. Causes related to aging

10.3.2.1. Poor chest expansion

10.3.2.2. Lowered resitance to infection

10.3.2.3. reduced pharyngeal reflexes

10.3.2.3.1. promotes aspiration of foreign material

10.3.2.4. immobility and inactivity

10.3.3. Signs and symptoms

10.3.3.1. cough, fatigue, confusion, restlessness, usually no change in temperature

10.3.4. Treatment

10.3.4.1. Antibiotics

10.3.4.2. Vaccine and booster after 5 years

10.3.4.3. watch for adverse effects

10.3.4.3.1. increased risk in elderly population

10.3.4.4. pain management

10.3.4.5. consult dietician for nutrition assessment

10.4. Asthma

10.4.1. Can develop in later years

10.4.2. Causes related to aging

10.4.2.1. alveoli less elastic

10.4.2.2. more exposure to irritants as we age

10.4.3. high risk of complication of bronchiectasis and cardiac problems

10.4.4. high rates of mortality

10.4.5. Assess for the use of aerosol nebulizers'

10.4.6. education

10.4.6.1. avoid environmental irritants

10.4.6.2. safe medication use

10.5. Chronic Bronchitis

10.5.1. causes persistent, productive cough, wheezing, recurrent respiratory infections, shortness of breath

10.5.2. Causes related to aging

10.5.2.1. reduction in vital capacity

10.5.2.1.1. less air leaving and more fluids remain

10.5.2.2. Reduced cough reflex

10.5.2.3. Loss of muscle strength in diaphragm

10.5.2.4. alveloi less elastic

10.5.3. Management

10.5.3.1. remove bronchial secretions

10.5.3.2. prevent obstruction of airway

10.5.3.3. maintain adequate fluid intake

10.6. Emphysema

10.6.1. Increasing incidence in older adults

10.6.2. Causes

10.6.2.1. Chronic bronchitis, chronic irritation, and morphologic changes in the lung

10.6.2.2. Cigarette smoking is major role in development

10.6.3. Symptoms develop slowly; can delay diagnosis and treatment

10.6.4. Treatment

10.6.4.1. postural drainage

10.6.4.2. bronchodilators

10.6.4.3. avoid stress

10.6.4.4. breathing exercises

11. Sexuality/Reproductive

11.1. Women

11.1.1. Menopause: permanent cessation of menses

11.1.1.1. Important transition in a woman's life

11.1.1.2. More than a physiological experience

11.1.1.3. awakening of body, mind and spirit

11.1.1.4. physical beauty of youth versus inner beauty of age

11.1.1.5. Hormone Therapy

11.1.1.5.1. age at the start of hormone replacement therapy alters risk (young the better)

11.1.1.5.2. Estrogen and progestin increased heart risks

11.1.1.5.3. Estrogen alone less risky

11.1.2. Effects of Aging:

11.1.2.1. Hormonal Changes

11.1.2.1.1. vulva atrophies

11.1.2.1.2. flattening of the labia

11.1.2.1.3. loss of subcutaneous fat

11.1.2.2. vaginal epithelium thins

11.1.2.3. cervix, uterus and fallopian tubes atrophy

11.1.2.4. vaginal canal changes

11.1.2.4.1. reduction in collagen and adipose tissue

11.1.2.4.2. shortening and narrowing of the canal

11.1.2.4.3. less lubrication

11.1.2.4.4. more alkaline vaginal pH as a result of lower estrogen changes

11.1.2.5. Uterus and ovaries decrease in size

11.1.2.6. endometrium continues to respond to hormnal stimulation

11.1.2.7. fallopian tubes become shorter and straighter

11.1.2.8. breast sag and are less firm

11.1.2.9. some retraction of nipples related to shrinkage and fibrotic changes

11.1.3. Health Promotion

11.1.3.1. Annual gynecologic exam with pap smear

11.1.3.2. breast self examination

11.1.4. Infections of the Vulva

11.1.4.1. Age related changes cause the vulva to be more fragile and more susceptible to irritation and infection

11.1.5. Problems of the Cervix

11.1.5.1. Age changes:

11.1.5.1.1. cervix becomes smaller

11.1.5.1.2. endo-cervical epithelium atrophies

11.1.5.2. Endo-cervical glands can seal over leading to formation of nabothian cysts

11.1.5.2.1. Secretions can accumulate and a palpable tender mass may be evident

11.1.5.3. regular gynecologic examinations to check cervix patency are very important

11.1.6. Dyspareunia (painful intercourse)

11.1.6.1. Not a normal consequence of aging

11.1.6.2. more frequent in nulliparous women

11.1.6.3. thorough gynecologic exam and sexual history

11.1.6.4. goal: achieve a satisfactory sexual life

11.2. Men

11.2.1. Andropause: testosterone levels decline in men (does not occur in all men)

11.2.1.1. can result in reduced muscle mass, energy, strength and stamina

11.2.1.2. other changes: erectile dysfunction, breast enlargement, osteopenia, osteoporosis and shrinkage of testes

11.2.2. Effects of Aging:

11.2.2.1. Seminal vesicles develop thinner epithelium

11.2.2.2. muslce tissue replaced with connective tissue

11.2.2.3. decreased capacity to retain fluids

11.2.2.4. seminiferous tubule changes

11.2.2.4.1. increased fibrosis, epithelium thinning, thickening of the basement membrane, and narrowing of the lumen

11.2.2.5. Atrophy of the testes and reduction in testicular mass

11.2.2.6. ejaculation fluid contains less sperm

11.2.2.7. testosterone stays the same or decreases slightly

11.2.2.8. more time required to achieve an erection

11.2.2.9. enlargement of the prostate gland

11.2.3. Erectile Dysfunction

11.2.3.1. Unable to attain or maintain erection of penis for sexual intercourse

11.2.3.2. Multiple Causes:

11.2.3.2.1. Atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medication

11.2.3.2.2. antihypertensives, anticholinergics, digoxin and antidepressants

11.2.3.3. Age Changes

11.2.3.3.1. testosterone decreases

11.2.3.3.2. more time required to achieve erection

11.2.3.3.3. enlargement of prostate

11.2.3.4. Treatments

11.2.3.4.1. oral erectile agents

11.2.3.4.2. vacuum pump machines

11.2.4. Benign Prostatic Hyperplasia

11.2.4.1. most older men have some degree of benign prostatic hyperplasia

11.2.4.2. men reluctant to receive treatment

11.2.4.2.1. delay of treatment can cause kidney damage

11.3. Barriers to sexual activity

11.3.1. physical

11.3.1.1. unavailability of partner

11.3.1.1.1. particularly for older women

11.3.2. Emotional

11.3.2.1. negative attitudes from society

11.3.2.2. fear of losing sexual abilities

11.3.2.3. concerns about body image

11.3.2.4. relationship issues

11.3.3. Social

11.4. Promoting Healthy Sexual Function

11.4.1. Basic education

11.4.2. openly discuss sex and desires

11.4.3. masturbation beneficial

11.4.4. holding, caressing and exchanging loving words as means for sexual satisfaction

11.5. Health Promotion

11.5.1. testicular self-examination

11.5.2. men with prostatic hypertrophy examined every 6 months

12. Neuro

12.1. Effects of Aging

12.1.1. Decline in weight and blood flow to the brain

12.1.1.1. Loss of nerve cell mass

12.1.1.1.1. atrophy of the brain and spinal cord

12.1.2. reduction in neurons, nerve fibers and cerebral blood flow

12.1.3. slower response to change in balance

12.1.3.1. demyelinization

12.1.4. hypothalamus less effective in temperature regulation

12.1.5. changes in sleep patterns with frequent awakeneing

12.1.6. Number and sensitivity of sensory receptors, dermatomes and neurons decrease

12.1.6.1. affecting taste, smell and tactile sensation

12.2. Subtle Indications of Neurologic Problems

12.2.1. New headaches that occur in the early morning and/or interrupt sleep

12.2.2. changes in vision

12.2.3. sudden deafness, ringing in ears

12.2.4. mood, personality changes

12.2.5. clumsiness, unsteady gait

12.2.6. numbness, tingling of extremity

12.2.7. unusual sensation or pain over nerve

12.3. Cerebrovascular Accidents

12.3.1. third leading cause of death in elderly patients

12.3.2. Symptoms

12.3.2.1. light headedness, dizzy, aphasia, drop attack, headache

12.3.3. High Risk patients

12.3.3.1. hypertension, gout, diabetes, MI, dehydration and those who smoke

12.3.4. Causes related to Aging

12.3.4.1. decline in weight and blood flow to the brain

12.3.4.2. blood vessels less elastic

12.3.4.3. heart muscles loses efficiency and contractile strength and reduced cardiac output with physiologic stress

12.3.5. Nursing Interventions

12.3.5.1. Maintain patient airway

12.3.5.2. provide adequate nutrition and hydration

12.3.5.3. monitor vital signs and neurologic symptoms

12.3.5.4. prevent complications associated with immobility

12.3.5.4.1. infections

12.3.5.4.2. atrophy of muscles

12.3.5.4.3. loss of independence

12.3.5.5. Assist with ADLs

12.3.5.6. Reorient patient

12.4. Parkinson's Disease

12.4.1. Affects ability of the central nervous system to control body movements

12.4.2. Lack of dopamine

12.4.3. Exact cause is unknown

12.4.4. Signs and Symptoms

12.4.4.1. Tremor

12.4.4.2. slow movement

12.4.4.2.1. shuffling unsteady gait

12.4.4.3. rigid movements

12.4.4.4. loss of muscle tone

12.4.4.5. impaired balance and posture

12.4.5. Treatments

12.4.5.1. Anticholinergic medications

12.4.5.2. Physical therapy

12.4.6. Goal

12.4.6.1. Maximum level of independence is preserved

12.5. Nursing Considerations for Neurologic Conditions

12.5.1. Promoting Independence

12.5.1.1. Assistive devices

12.5.1.2. Periodic home visits

12.5.1.3. Regular contact with family and friends

12.5.1.4. promoting self care

12.5.1.5. patience, reassurance and encouragement

12.5.1.6. Need to educate family members and friends

12.5.2. Prevent Injury

12.5.2.1. high risk of accidents

12.5.2.2. avoid hazards

13. Immune

13.1. Effects of Aging

13.1.1. Decreased immune response

13.1.2. inflammatory defenses decline; inflammation present atypically

13.1.3. risk for infection becomes significant

13.1.4. T-cell activity declines

13.1.5. cell-mediated immunity declines

13.1.6. Thymus gland declines in size

13.1.7. reduced number of langerhans cells in the skin

13.1.8. reduced thickness of skin

13.1.9. decreased circulation of the skin

13.2. Health Promotion

13.2.1. Diet

13.2.1.1. foods affect immunity both positively and negatively

13.2.1.2. protein, magnesium, vitamins A E B C, manganese, folic acid, selenium, pantothenic acid, zinc, iron

13.2.2. Exercise

13.2.2.1. regular physical activity enhances immune function

13.2.2.2. low impact

13.2.2.2.1. yoga, t'ai chi

13.2.3. immunizations

13.2.3.1. pneumococcal polysaccharide

13.2.3.1.1. booster every 5 years

13.2.3.2. influenza

13.2.3.2.1. every year before flu season

13.2.3.3. zoster

13.2.3.4. hepatitis A and B

13.2.4. Stress Management

13.2.5. Careful use of antibiotics

13.2.5.1. can develop resistance

13.2.5.2. side effects and adverse reactions increased in older adults

14. Integumentary

14.1. Effects of aging

14.1.1. Skin is less elastic, dry and fragile

14.1.2. thinning, graying of hair

14.1.3. increased benign and malignant skin neoplasms

14.1.4. reduced sweat gland activity

14.1.5. decreased subcutaneous fat

14.2. Health Promotion

14.2.1. Avoid agents irritating to the skin

14.2.2. good skin nutrition

14.2.3. promote activity

14.2.4. hydration using bath oils, lotions

14.2.5. avoid excessive bathing

14.2.6. skin inspection

14.2.6.1. A: asymmetry

14.2.6.2. B: border irregularity

14.2.6.3. C: color

14.2.6.4. D: diameter

14.3. Pressure Ulcers

14.3.1. Tissue anoxia and ischemia result in necrosis, sloughing and tissue ulceration

14.3.2. Common sites

14.3.2.1. Sacrum, head of femur, ankles, elbows

14.3.3. Predisposing factors

14.3.4. Longer healing periods needed for older adults

14.3.5. Causes related to aging

14.3.5.1. skin is less elastic, dry and fragile

14.3.5.2. decreased subcutaneous fat

14.3.5.3. Decreased nutrition

14.3.5.4. immobility and inactivity

14.3.6. Stages

14.3.6.1. 1

14.3.6.1.1. Persistent area of skin redness (without a break in the skin) that does not disappear when pressure is relieved

14.3.6.2. 2

14.3.6.2.1. a partial thickness loss of skin layers involving the epidermis that presents clinically as an abrasion, blister or shallow crater

14.3.6.3. 3

14.3.6.3.1. a full thickness of skin is lost extending through the epidermis and exposing the subcutaneous tissues; presents as a deep crater with or without undermining adjacent tissue

14.3.6.4. 4

14.3.6.4.1. a full thickness of skin and subcutaneous tissue is lost, exposing muscle, bone or both; presents as a deep crater that may include necrotic tissue, exudate, sinus tract formation and infection

14.3.6.5. unstagable

14.3.7. Treatment

14.3.7.1. encourage activity and turning

14.3.7.2. use of pillows, alternating pressure mattresses

14.3.7.3. high protein, vitamin rich diet

14.3.7.4. skin should be kept dry and clean

14.3.7.4.1. incontinent patients should be checked frequently

14.4. Pruritus

14.4.1. An uncomfortable itching sensation

14.4.2. most common dermatologic problem among older adults

14.4.3. Potential for skin breakdown and infection

14.4.4. Need for prompt recognition and correct the underlying cause

14.4.5. Treatment

14.4.5.1. topical application of zinc ointment

14.4.5.2. vitamin rich diet

14.4.5.3. antihistamines and topical steroids

14.5. Skin Cancer

14.5.1. Basal Cell Carcinoma

14.5.1.1. most common form

14.5.1.2. grows slowly

14.5.1.3. rarely metastasized

14.5.1.4. Causes

14.5.1.5. Risk factors

14.5.1.5.1. advanced age

14.5.1.5.2. ultraviolet radiation

14.5.1.5.3. exposure to sun

14.5.1.5.4. therapeutic radiation

14.5.1.6. Appearance

14.5.1.6.1. small, dome shaped elevations

14.5.1.6.2. flesh colored with pearly appearnace