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