Older Adult Client

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Older Adult Client by Mind Map: Older Adult Client

1. Normal Changes in Aging

1.1. Cells

1.1.1. Lean body mass is reduced, fat tissue increases (until 6th decade of life)

1.1.2. Total body fat as a proportion of body composition increases

1.2. Physical Appearance

1.2.1. Gray hair, wrinkles

1.2.2. Elongated ears, baggy eyelids, double chin

1.2.3. Loss of tissue elasticty

1.2.4. Decline in body’s natural insulation

1.2.4.1. More sensitive to temperature changes

1.2.5. Body shrinkage

1.2.5.1. Due to reduced hydration, loss of cartilage, thinning of the vertebrae

1.2.6. Loss of height (approximately 2 inches by 80 years of age)

1.3. Respiratory System

1.3.1. Decrease in blunting or cough and laryngeal reflexes

1.3.2. Loss of elasticity and increased rigidity

1.3.3. Mouth breathing becomes more common

1.3.4. Decreased ciliary action

1.3.5. Alveoli fewer in number and larger in size

1.3.6. Thicker secretions that are harder to excrete

1.3.7. Anterior-posterior chest diameter increases

1.3.7.1. Results in kyphosis

1.3.8. Less effective gas exchange

1.4. Cardiovascular System

1.4.1. Heart size does not commonly change

1.4.1.1. If size changes, usually due to cardiac disease

1.4.2. Marked inactivity can cause cardiac atrophy

1.4.3. Cardiac output decreases

1.4.4. Less elasticity of vessels

1.4.4.1. Leads to atherosclerosis

1.4.5. Pacemaker cells become increasingly irregular

1.4.6. Stroke volume decreases by 1% per year

1.5. Gastrointestinal System

1.5.1. Alterations/loss in taste

1.5.2. Dentition changes causes changes in eating patterns

1.5.3. Less saliva production

1.5.4. Swallowing takes approximately twice as long

1.5.4.1. Food remains in the esophagus twice as long

1.5.5. Higher pH in stomach

1.5.5.1. Increased incidence of gastric irritation

1.5.6. Decreased absorption in certain vitamins and nutrients

1.5.6.1. Vitamin B12

1.5.6.2. Vitamin D

1.5.6.3. Calcium

1.5.6.4. Iron

1.6. Urinary System

1.6.1. Renal mass becomes smaller

1.6.2. Atrophy of kidney

1.6.3. Decrease in nephrons

1.6.4. Decreased bladder capacity

1.6.4.1. Retention of large volumes of urine

1.6.5. Weaker bladder muscles

1.7. Reproductive System

1.7.1. Decrease in serum and bio available testosterone for men

1.7.2. Potential reduction in sperm count

1.7.3. Prostate enlarges in most men

1.7.4. Ovaries become thicker and smaller

1.7.5. Cervix becomes smaller

1.7.6. Drier, less elastic vaginal canal

1.7.7. Flattening of labia

1.7.8. More alkaline vaginal environment

1.7.9. No loss of ability to engage in/enjoy intercourse

1.8. Musculoskeletal System

1.8.1. Shortening of vertebrae

1.8.2. Slight kyphosis

1.8.3. Decrease in bone mass and bone mineral

1.8.3.1. More prevalent and common in older women

1.8.4. Bones more brittle

1.8.5. Impaired flexion and extension movement

1.9. Sensory Organs

1.9.1. Vision

1.9.1.1. Pupil is less responsive to light

1.9.1.2. Yellowing of the lense

1.9.1.3. Depth perception becomes distorted

1.9.1.4. Density and size of lens increases

1.9.1.4.1. Leads to development of cataracts

1.9.1.5. Reduced lacrimal secretions

1.9.2. Hearing

1.9.2.1. Progressive hearing loss: PRESBYCUSIS

1.9.2.2. Speech may sound distorted

1.9.2.3. Acoustic reflex is diminished due to weakening and stiffening of middle ear muscles and ligaments

1.9.3. Taste and Smell

1.9.3.1. Approximately half of older adults lose some of their ability to smell

1.9.3.1.1. Since taste acuity is most affected by smell, sense of taste also decreases

1.9.3.2. Ability to detect salt is more affected than other taste sensations

1.9.4. Touch

1.9.4.1. Changes in the structural integrity of touch receptors

1.9.4.1.1. Causes large safety risk since older adults have a harder time sensing pressure, pain and differentiating temperatures

1.10. Endocrine System

1.10.1. Decreased thyroid gland activity

1.10.1.1. Lower basal metabolic rate

1.10.1.2. Reduced radioactive iodine uptake

1.10.1.3. Less thyrotropin secretion and release

1.10.2. Decrease in ACTH secretion

1.10.2.1. Addition decrease in secretion of:

1.10.2.1.1. Estrogen

1.10.2.1.2. Glucocorticoids

1.10.2.1.3. Progesterone

1.10.2.1.4. Androgen

1.10.3. Delayed and insufficient release of insulin by beta cells in pancreas

1.11. Immune System

1.11.1. Depressed immune response

1.11.2. T-cell activity declines

1.11.3. Increase in pro-inflammatory cytokines

1.11.3.1. Believed to be linked to atherosclerosis,diabetes, and osteoporosis

1.12. Integumentary System

1.12.1. Scalp, pubic and axillary hairy thins and grays

1.12.1.1. Due to loss of pigment cells and atrophy/fibrosis of hair bulbs

1.12.2. Reduced thickness

1.13. Thermoregulatiom

1.13.1. Lower than in younger years of life

1.13.2. Reduced ability to respond to cold temperatures due to inefficient vasoconstriction

1.14. Personality

1.14.1. Drastic personality changes usually do not occur with age

1.15. Memory

1.15.1. Retrieval from long term memory is slowed

1.15.2. Memory deficits can result from a number of factors outside of normal aging

1.16. Nervous system

1.16.1. Decreased brain weight

1.16.2. Reduced blood flow to brain

1.16.3. Changes in sleep pattern

1.16.4. Slower response and reaction times

2. Safe Medication Use

2.1. Most commonly used drugs by the elderly

2.1.1. Cardiovascular agents

2.1.2. Antihypertensives

2.1.3. Analgesics

2.1.4. Anti-arthritic agents

2.1.5. Sedatives

2.1.6. Tranquilizers

2.1.7. Laxatives

2.1.8. Antacids

2.1.8.1. Aluminum antacids can cause a depletion in phosphate and calcium

2.2. Slowing of drug absorption can be affected by:

2.2.1. Decreased of intracellular fluid

2.2.2. Increased gastric pH

2.2.3. Decreased gastric blood flow

2.2.4. Reduced cardiac output

2.2.5. Slower metabolism

2.3. Metabolism:

2.3.1. Metabolism of drugs can be slowed by a variety of factors including:

2.3.1.1. Dehydration

2.3.1.2. Hyperthermia

2.3.1.3. Immobility

2.3.1.4. Liver disease

2.4. Excretion:

2.4.1. Drug excretion can be complicated by:

2.4.1.1. Reduced efficiency of body organs

2.4.1.2. Advanced age in general

2.4.1.3. Decrease in number of nephrons

3. Endocrine

3.1. Diabetes Mellitus

3.1.1. 7th leading cause of death among older adults

3.1.2. Glucose intolerance is a common occurrence in older adults

3.1.3. Diagnosis:

3.1.3.1. 1. Random blood glucose greater than or equal to 200 mg/dL

3.1.3.2. 2. Fasting blood glucose greater than 126 mg/dL

3.1.3.3. 3. Blood glucose concentration 2 hours after oral glucose intake of greater than or equal to 200 mg/dL

3.1.4. Nursing Interventions:

3.1.4.1. Education:

3.1.4.1.1. Proper glucose administration

3.1.4.1.2. Acceptable food groups and diet

3.1.4.1.3. Recognition of symptoms and actions for each

3.1.4.1.4. Consistent pattern of food intake

3.1.4.2. Emphasis on the importance of daily foot exams and frequent eye exams for the onset of glaucoma

3.1.4.3. Monitor the progress of patient's disease and make appropriate adjustments to plan of care

3.1.4.4. Stress important of regular exercise and movement

3.1.5. Complications related to hypoglycemia:

3.1.5.1. Convulsions

3.1.5.2. Somnolence

3.1.5.3. Confusion

3.1.5.4. Disorientation

3.1.5.5. Poor sleep patterns

3.1.5.6. Nocturnal headache

3.1.5.7. Slurred speech

3.2. Hypothyroidism

3.2.1. Primary hypothyroidism is characterized by low free T4 with elevated TSH

3.2.2. Secondary hypothyroidism is low free T4 and low TSH

3.2.3. Signs and symptoms:

3.2.3.1. Fatigue, weakness and lethargy

3.2.3.2. Depression/uninterested in normal activities

3.2.3.3. Anorexia

3.2.3.4. Weight gain and puffy face

3.2.3.5. Impaired hearing

3.2.3.6. Periorbital edema

3.2.3.7. Constipation

3.2.3.8. Cold intolerance

3.2.3.9. Myalgia, paresthesia

3.2.3.10. Dry skin, coarse hair

3.2.4. Nursing Interventions:

3.2.4.1. Assist patient with a management of symptoms

3.2.4.2. Educate patients that thyroid replacement will be a life-long requirement

4. Respiratory

4.1. Chronic Obstructive Pulmonary Disease (COPD)

4.1.1. COPD represents a group of diseases including asthma, chronic bronchitis, and emphysema

4.1.1.1. Asthma

4.1.1.1.1. Can be affected throughout their lifetime or develop in old age

4.1.1.1.2. Nursing Interventions:

4.1.1.2. Chronic Bronchitis

4.1.1.2.1. Signs and symptoms:

4.1.1.2.2. Nursing Interventions:

4.1.1.3. Emphysema

4.1.1.3.1. Occurs with increasing incidence in older population

4.1.1.3.2. Causative factors:

4.1.1.3.3. Signs and symptoms:

4.1.1.3.4. Nursing Interventions:

5. Circulation

5.1. Hypertension

5.1.1. Common gerontological issue

5.1.2. Have high blood pressure due to vasoconstriction associated with aging; further produces peripheral resistance

5.1.2.1. Systolic is greater than 140 and diastolic is greater than 90

5.1.3. Diseases associated with hypertension:

5.1.3.1. Hyperthyroidism

5.1.3.2. Parkinsonism

5.1.3.3. Paget's disease

5.1.3.4. Anemia

5.1.3.5. Thiamine deficiency

5.1.4. Signs and symptoms:

5.1.4.1. Awakening with dull headache

5.1.4.2. Impaired memory

5.1.4.3. Disorientation

5.1.4.4. Confusion

5.1.4.5. Epistaxis

5.1.4.6. Slow tremor

5.1.5. Nursing Interventions:

5.1.5.1. Educate on weight loss and dietary restrictions if necessary

5.1.5.2. Observe lab values and monitor blood pressure closely

5.1.5.3. Monitor for side effects of antihypertensives

5.2. Coronary Artery Disease (CAD)

5.2.1. Damage or disease of the heart's major blood vessels

5.2.2. Coronary artery disease can lead to:

5.2.2.1. Myocardial infarction

5.2.2.1.1. Commonly seen in men with a history of hypertension and atherosclerosis

5.2.2.1.2. Signs and Symptoms:

5.2.2.1.3. Nursing Interventions:

6. Integumentary

6.1. Pruritus

6.1.1. Most common dermatological problem with older adults

6.1.2. Precipitated by any factor that causes drying of the skin

6.1.3. Conditions that can contribute to pruritus:

6.1.3.1. Diabetes

6.1.3.2. Arteriosclerosis

6.1.3.3. Hyperthyroidism

6.1.3.4. Uremia

6.1.3.5. Liver disease

6.1.3.6. Cancer

6.1.4. Nursing Interventions:

6.1.4.1. Determine underlying condition causing pruritus

6.1.4.2. Avoid factors that contribute to excess drying of skin

6.1.4.3. Educate patient on use of emollients

6.1.4.4. Advise patient to pat skin instead of vigorously itching area

6.1.4.5. Educate patient on antihistamine use and that it could be used to reduce certain cases of pruritus

6.2. Pressure Ulcers

6.2.1. Necrosis, sloughing, and ulceration of the skin resulting from excessive and prolonged pressure on one part of the body

6.2.2. Older adults are at high risk for pressure ulcers due to:

6.2.2.1. Fragile skin that easily damages

6.2.2.2. Older adults are often in poor nutritional state states

6.2.2.3. Reduced sensation of pressure and pain

6.2.2.4. Frequently affected by immobility

6.2.3. Pressure ulcer prevention:

6.2.3.1. Turn patient every 2 hours

6.2.3.2. Elevate/cushion bony prominences

6.2.3.3. Do not elevate head of bed greater than 30 degrees

6.2.3.4. Provide high-protein, vitamin rich diet

6.2.3.5. Provide good skin care; keep skin dry and clean

6.2.4. Early detection, prevention, and prophylaxis are KEY for pressure ulcer treatment

7. Neurological

7.1. Cerebrovascular Accident (CVA)

7.1.1. Third leading cause of death and major cause of disability in older adults

7.1.2. Diseases that increases risk for CVA:

7.1.2.1. Hypertensions

7.1.2.2. Atherosclerosis

7.1.2.3. Diabetes

7.1.2.4. Gout

7.1.2.5. Anemia

7.1.2.6. Hypothyroidism

7.1.2.7. Silent myocardial infarction

7.1.2.8. Dehydration

7.1.2.9. Smoking

7.1.3. Signs and symptoms (including warning signs):

7.1.3.1. Dizziness

7.1.3.2. Headache

7.1.3.3. Memory or behavior changes

7.1.3.4. Hemiplegia

7.1.3.5. Aphasia

7.1.4. Nursing Interventions

7.1.4.1. Aim for consistency in providing care

7.1.4.2. Monitor for neurological and vital sign changes

7.1.4.3. Prevent complications associated with immobility

7.1.4.4. Educate on smoking cessation

7.2. Parkinson's Disease

7.2.1. Affects ability of central nervous system to control body movements

7.2.2. More commonly seen in men and during the 5th decade of life

7.2.3. Signs and symptoms:

7.2.3.1. Faint tremor in hands or feet is often the first sign

7.2.3.2. Muscle rigidity and weakness

7.2.3.3. Drooling

7.2.3.4. Difficulty swallowing

7.2.3.5. Slow speech

7.2.3.6. Monotone voice/"mask-like" face

7.2.3.7. Shuffling gait

7.2.4. Nursing Interventions:

7.2.4.1. Promote highest level of functioning for patient

7.2.4.2. Educate patient that some anticholinergics can exacerbate glaucoma if present

7.2.4.2.1. Anticholinergics can cause anuria for brief periods of time

7.2.4.3. Educate patient if taking levodopa, avoid foods high in B6 because they will counteract the drug

7.2.4.4. Perform active and passive range of motion exercises with patient

7.2.4.5. Warm baths and massages to decrease muscle spasms caused by rigidity and promote comfort