The Older Adult

Older adult changes --> Gero

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The Older Adult by Mind Map: The Older Adult

1. Reproductive System

1.1. Female

1.1.1. Normal Age related changes

1.1.1.1. Hormonal Changes

1.1.1.1.1. Vulva atrophies

1.1.1.1.2. Flattening of the labia

1.1.1.1.3. Loss of subcutaneous fat and hair

1.1.1.2. Vaginal epithelium thins

1.1.1.2.1. Vaginal environment is drier and more alkaline

1.1.1.3. Cervix, uterus and fallopian tubes atrophy

1.1.1.3.1. May not be palpable during exam

1.1.1.4. Vaginal canal changes

1.1.1.4.1. reduction in collagen and adipose tissue

1.1.1.4.2. Shortening and narrowing of the canal

1.1.1.4.3. Less lubrication

1.1.1.5. Uterus and ovaries decrease in size

1.1.1.6. Endometrium continues to respond to hormonal stimulation

1.1.1.7. Fallopian tubes become shorter and straighter

1.1.1.8. Breast sag and are less firm

1.1.1.9. Nipple retraction R/T shrinkage and fibrotic changes

1.1.2. Senile Vulvitis

1.1.2.1. Patho

1.1.2.1.1. Vulvar inflammation or infection assoc. w/ hypertrophy or atrophy , could also be caused by incontinence and poor hygiene

1.1.2.2. S/S

1.1.2.2.1. Itching, restlessness, constant touching themselves at the genitals, redness, burning, swelling, vaginal discharge.

1.1.2.3. Nursing Interventions

1.1.2.3.1. Educate good hygiene practices, good nutrition practices, administer saline compresses or steroid creams as prescribed, urinate w/ urge, before and after intercourse, proper wiping after void

1.1.2.4. Treatment / Management

1.1.2.4.1. Good nutritional status

1.1.2.4.2. Sitz bath

1.1.2.4.3. Local applications of saline compresses or steroid creams

1.1.2.4.4. Keep the incontinent patient clean and dry as much as possible

1.1.3. Vaginitits

1.1.4. Vagina Cancer

1.1.5. Vulva tumors

1.1.6. Cervix Cancer

1.1.7. Endometrium Cancer

1.1.8. Ovary Cancer

1.1.9. Perineal Herination

1.1.10. Dyspareunia

1.1.10.1. S/S

1.1.10.1.1. Pain at sexual entry

1.1.10.1.2. Pain with penetration (even a tampon)

1.1.10.1.3. Deep pain during thrusting

1.1.10.1.4. Burning or aching pain

1.1.10.1.5. Throbbing pain lasting hours after intercourse

1.1.10.2. Patho

1.1.10.2.1. Painful intercourse that accompanies hormonal changes. The pain can primarily be on the external surface of the genitalia, or deeper in the pelvis upon deep pressure against the cervix.

1.1.10.3. Nursing Interventions

1.1.10.3.1. Evaluate the medications the patient is on

1.1.10.3.2. Help achieve satisfactory sexual life

1.1.10.3.3. Talk and assess your patient about what makes intercourse more enjoyable and what triggers the pain

1.1.10.3.4. Express that communication between partners is very important

1.1.10.4. Treatment / Management

1.1.10.4.1. If a infection is the cause --> treat the infection

1.1.10.4.2. Topical estrogen

1.1.10.4.3. Osphena

1.1.10.4.4. Desensitization therapy

1.1.10.4.5. Intrarosa

1.1.10.4.6. Sex therapy

1.1.11. Breast Cancer

1.1.11.1. Patho

1.1.11.1.1. Decreased fat tissue and atrophy in older women's breast can cause tumors.

1.1.11.1.2. Develop from the cells of the breast and most breast malignancies arise from epithelial elements and are categorized as carcinomas.

1.1.11.2. S/S

1.1.11.2.1. Swelling of part or all of breast

1.1.11.2.2. Skin irritation or dimpling

1.1.11.2.3. Breast or nipple pain

1.1.11.2.4. Nipple retractions

1.1.11.2.5. Redness, scaliness, or thickening of the nipple or breast skin

1.1.11.2.6. Nipple discharge

1.1.11.3. Nursing interventions

1.1.11.3.1. Encourage women to have regular breast exams

1.1.11.3.2. Teach the proper way to perform a at home breast self exam

1.1.11.3.3. Explain the importance of mammograms and s/s of breast cancer

1.1.11.3.4. Teach the patient if a lump is felt to make a appointment ASAP

1.1.11.4. Educate about sexual positions and lubricants that make intercourse easier

1.1.11.5. Treatment / Management

1.1.11.5.1. Radiation

1.1.11.5.2. Chemo

1.1.11.5.3. Surgery

1.1.11.5.4. Hormone Therapy

1.1.11.5.5. Targeted therapy

1.1.11.6. Diagnosis

1.1.11.6.1. Breast exam

1.1.11.6.2. Mammogram

1.1.11.6.3. Breast ultrasound

1.1.11.6.4. Biopsy

1.1.11.6.5. Breast MRI

1.2. Male

1.2.1. Normal Age related changes

1.2.1.1. Seminal vesicles develop thinner epithelium

1.2.1.2. Muscle tissue replaced w/ connective tissue

1.2.1.3. Decreased capacity to retain fluids

1.2.1.4. Seminiferous tubule changes

1.2.1.4.1. Increased fibrosis

1.2.1.4.2. epithelium thinning

1.2.1.4.3. Thickening of the basement membrane

1.2.1.4.4. narrowing of the lumen

1.2.1.5. Atrophy of the testes and reduction in testicular mass

1.2.1.6. Ejaculation fluid contains less live sperm

1.2.1.7. Testosterone stays the same or decreases slightly

1.2.1.8. more time required to achieve an erection

1.2.1.9. enlargement of the prostate gland

1.2.2. Erectile Dysfunction

1.2.2.1. Patho

1.2.2.1.1. The inability to achieve and sustain an erection for intercourse

1.2.2.2. S/S

1.2.2.2.1. Trouble getting an erection

1.2.2.2.2. Trouble keeping an erection

1.2.2.2.3. Reduced sexual desire

1.2.2.3. Diagnosis

1.2.2.3.1. For underlying conditions:

1.2.2.4. Nursing interventions

1.2.2.4.1. Ask the male What they mean by erectile dysfunction

1.2.2.4.2. Keep noise and disruptions down when trying to arouse

1.2.2.4.3. Assess the meds the patient is on

1.2.2.4.4. Assess when ED occurs? Has the patient been drinking?

1.2.2.4.5. What conditions or diseases are they diagnosis with? (DM, Renal failure, etc.)

1.2.2.5. Treatment / Management

1.2.2.5.1. Oral erectile agents

1.2.2.5.2. Injectables

1.2.2.5.3. Penile implants

1.2.2.5.4. Vacuum pump devices

1.2.3. BPH

1.2.3.1. Patho

1.2.3.1.1. hyperproliferative process of epithelial and stromal cells in the transition zone of the prostate, enlargement of the prostate in general

1.2.3.2. S/S

1.2.3.2.1. Dysuria

1.2.3.2.2. Hesitancy

1.2.3.2.3. decreases force of urinary stream

1.2.3.2.4. frequency

1.2.3.2.5. nocturia

1.2.3.2.6. Dribbling

1.2.3.2.7. Poor bladder control

1.2.3.2.8. Overflow incontinence

1.2.3.2.9. Hematuria

1.2.3.3. Diagnosis

1.2.3.3.1. Urine flow study

1.2.3.3.2. Digital Rectal Exam

1.2.3.3.3. Prostate-specific antigen

1.2.3.3.4. Cystoscop

1.2.3.3.5. Transrectal ultrasound

1.2.3.3.6. Transabdominal ultrasound

1.2.3.3.7. Prostate MRI

1.2.3.4. Nursing interventions

1.2.3.4.1. Encourage patient to void with urge

1.2.3.4.2. Assess for stress incontinence

1.2.3.4.3. Percuss and palpate suprapubic area

1.2.3.4.4. Encourage oral fluids up to 3000 mL daily, within cardiac tolerance, if indicated.

1.2.3.4.5. Monitor vital signs closely. Observe for hypertension, peripheral and dependent edema, changes in mentation. Weigh daily. Maintain accurate I&O.

1.2.3.5. Treatment / Management

1.2.3.5.1. Prostatic massage

1.2.3.5.2. Urinary antiseptics

1.2.3.5.3. Diuretic, anticholinergics, anti arrhythmic avoidance if possible

1.2.3.5.4. Transurethral surgery

1.2.4. Prostate Cancer

1.2.4.1. Patho

1.2.4.1.1. cells may spread from the prostate to other areas of the body, particularly the bones and lymph nodes.

1.2.4.1.2. cancer cells begin to multiply and spread to the surrounding prostate tissue forming a tumor

1.2.4.2. S/S

1.2.4.2.1. The symptoms can be similar to BPH

1.2.4.2.2. Back pain

1.2.4.2.3. anemia

1.2.4.2.4. weakness

1.2.4.2.5. weight loss

1.2.4.3. Diagnosis

1.2.4.3.1. Digital rectal exam

1.2.4.3.2. PSA test

1.2.4.3.3. Biopsy

1.2.4.4. Nursing interventions

1.2.4.4.1. Get regular physical exams

1.2.4.4.2. BPH should be followed closely because it is thought to be associated with prostate cancer

1.2.4.5. Treatment / Management

1.2.4.5.1. If metastasis HAS NOT occurred

1.2.4.5.2. If metastasis has occurred

1.2.5. Penis Cancer

1.2.6. Testicular Cancer

1.2.7. Scrotum Cancer

2. Respiratory

2.1. Normal Age related changes

2.1.1. Respiratory problems develop easily; difficult to manage

2.1.2. Changes occur in upper airway paths, nose, and trachea

2.1.2.1. Nose experiences connective tissue changes that reduce support and can cause nasal septal

2.1.3. Reduced cough

2.1.4. lungs reduce in size and weight

2.1.5. hair in nostrils become thicker and may accumulate greater amount of dust and dirt

2.1.6. decreased elastic recoil

2.1.7. alveoli less elastic

2.1.8. reduction in vital capacity, increase residual volume

2.1.9. loose or brittle teeth can be aspired

2.1.10. trachea stiffens due to calcification of cartilage

2.1.11. loss of skeletal muscle strength in thorax and diaphragm --> kyphosis & barrel chest

2.2. COPD

2.2.1. Asthma

2.2.2. Chronic bronchitis

2.2.2.1. Patho

2.2.2.1.1. Recurrent inflammation and mucus production in the bronchial tubes, which over time produce blockage and scarring that restrict airflow

2.2.2.2. S/S

2.2.2.2.1. Persistent, productive cough

2.2.2.2.2. wheezing

2.2.2.2.3. recurrent respiratory infections

2.2.2.2.4. SOB

2.2.2.3. Diagnosis

2.2.2.3.1. Chest xray

2.2.2.3.2. Sputum culture

2.2.2.3.3. Spirometry

2.2.2.4. Nursing interventions

2.2.2.4.1. Special encouragement to maintain good fluid intake

2.2.2.4.2. encourage the patient to expectorate secretions

2.2.2.4.3. Encourage the patient to avoid smoking and educate patient on ways that help with cessation

2.2.2.5. Treatment / Management

2.2.2.5.1. Remove bronchial secretions

2.2.2.5.2. Prevent obstruction of airway

2.2.2.5.3. Maintain adequate fluid intake

2.2.3. Emphysema

2.2.3.1. Patho

2.2.3.1.1. Factors causing this destructive disease includes chronic bronchitis, chronic irritation for dusts or certain air pollutants, and morphologic changes in the lungs, cause distention of alveolar sacs, rupture of the alveolar walls, and destruction of the alveolar capillary bed.

2.2.3.2. S/S

2.2.3.2.1. Dyspnea

2.2.3.2.2. Chronic cough

2.2.3.2.3. SOB

2.2.3.2.4. Hypoxia

2.2.3.2.5. Fatigue

2.2.3.2.6. weight loss

2.2.3.2.7. anorexia

2.2.3.2.8. Recurrent respiratory infections

2.2.3.3. Diagnosis

2.2.3.4. Nursing interventions

2.2.3.4.1. Very similar to Chronic bronchitis

2.2.3.4.2. Use oxygen with extreme caution in any COPD patient

2.2.3.4.3. Pace daily activities, avoid extreme cold, administer meds correctly, and recognize s/s of respiratory infections

2.2.3.5. Treatment / Management

2.2.3.5.1. postural drainage bronchodilators

2.2.3.5.2. avoidance of stressful situations

2.2.3.5.3. breathing exercises

2.2.3.5.4. Cessation of smoking

2.2.4. Lung cancer

2.2.5. Lung abscess

2.3. Pneumonia

2.3.1. Patho

2.3.1.1. Pneumococcal pneumonia

2.3.1.1.1. Caused by Streptococcus pneumoniae

2.3.1.1.2. Most common type in older adults

2.3.1.2. Others are caused by g- bacilli

2.3.1.2.1. Klebsiella pneumoniae

2.3.1.2.2. Legionella pneumophila

2.3.1.2.3. anaerobic bacteria

2.3.1.2.4. Influenza

2.3.2. S/S

2.3.2.1. May be altered in older adults and may present w/ no S/S

2.3.2.2. slight cough

2.3.2.3. fatigue

2.3.2.4. Tachypnea

2.3.2.5. Confusion

2.3.2.6. Restlessness

2.3.2.7. behavioral changes

2.3.3. Diagnosis

2.3.3.1. Chest xray

2.3.3.2. Sputum culture

2.3.3.3. CBC

2.3.4. Nursing Interventions

2.3.4.1. Close observation for subtle changes

2.3.4.2. Increase fluids

2.3.4.3. Mobility to decrease risk for paralytic ileum

2.3.4.4. Encourage deep breathing

2.3.5. Treatment / Management

2.3.5.1. Pneumococcal vaccines recommended for pts. > 65

2.3.5.2. Antibiotics

2.3.5.3. Cough medicines

2.3.5.4. Fever reduces and pain relievers

3. Circulation

3.1. Normal Age related changes

3.1.1. Heart valves become thicker and rigid

3.1.2. Aorta becomes dilated

3.1.2.1. Slight ventricular hypertrophy

3.1.2.2. Thickening of left ventricular wall

3.1.3. Myocardial muscle less efficient

3.1.3.1. Decreased contractile strength

3.1.3.2. Decreased CO when demands increased

3.1.4. Calcification, reduced elasticity of vessels

3.1.5. Less sensitive to baroreceptor regulation of BP

3.1.6. decreased coronary blood flow

3.1.7. Vasoconstriction

3.2. Cardiovascular disease

3.3. HTN

3.3.1. Patho

3.3.1.1. occurs when the body's smaller blood vessels narrow, causing the blood to exert excessive pressure against the vessel walls and forcing the heart to work harder to maintain the pressure.

3.3.2. S/S

3.3.2.1. dull headache

3.3.2.2. Impaired memory

3.3.2.3. disorientation

3.3.2.4. confusion

3.3.2.5. epistaxis

3.3.2.6. slow tremor

3.3.3. Diagnosis

3.3.3.1. BP systolic pressure > 140 and diastolic pressure > 90

3.3.4. Nursing interventions

3.3.4.1. Encourage DASH diet and educate about nonpharm treatments

3.3.4.2. Educate about antihypertensives, the Side effects, and what to watch for --> SAFE DOSAGES

3.3.4.3. Teach how to properly take your own BP

3.3.5. Treatment / Management

3.3.5.1. Wide range of treatment

3.3.5.2. Antihypertensives are usually not prescribed alone

3.3.5.3. Thiazide diuretics with caution!!

3.3.5.4. Beta blockers

3.3.5.5. Calcium channel blockers

3.3.5.6. ACE inhibitors

3.3.5.7. Nonpharm measures to lower BP whenever possible

3.4. Hypotension

3.5. Congestive HF

3.6. Pulmonary Emboli

3.6.1. Patho

3.6.1.1. Usually arise from thrombi that originate in the deep venous system of the lower extremities, then travels to the lung, large thrombi can lodge at the bifurcation of the main pulmonary artery or the lobar branches and cause hemodynamic compromise.

3.6.2. S/S

3.6.2.1. confusion

3.6.2.2. apprehension

3.6.2.3. SOB

3.6.2.4. high temperature

3.6.2.5. pneumonitis

3.6.2.6. elevated sedimentation rate

3.6.3. Diagnosis

3.6.3.1. lung scan

3.6.3.2. angiography

3.6.4. Nursing interventions

3.6.4.1. Preventions

3.6.4.1.1. Ambulate early

3.6.4.1.2. Anticoagulants

3.6.4.1.3. Cough and deep breathing

3.6.4.1.4. Incentive spirometry

3.6.4.2. Watch for S/S of DVT and PE

3.6.5. Treatment / Management

3.6.5.1. The goal of treatment is to stop the PE by reducing the breaking off of an existing clot or preventing a new clot from forming and embolizing.

3.6.5.2. Thrombolytics

3.6.5.3. Anticoagulants

3.6.5.4. IVC filter

3.6.5.5. Embolectomy

3.6.5.6. DVT prophylaxis

3.7. CAD

3.7.1. Angina

3.7.2. MI

3.8. Hyperlipidemia

3.8.1. Patho

3.8.1.1. Elevated total cholesterol found in the blood, one type of fat or lipid

3.8.2. S/S

3.8.2.1. Usually have no seen symptoms and you will only see symptoms in the other conditions it can cause

3.8.2.2. yellowish fatty growths around the eyes or the joints

3.8.3. Diagnosis

3.8.3.1. Full lipid profile

3.8.4. Nursing interventions

3.8.4.1. Educate about the diet prescribed to the patient

3.8.4.2. Encourage the patient to engage in daily exercise

3.8.4.3. Encourage the patient to limit alcohol intake

3.8.5. Treatment / Management

3.8.5.1. Exercise

3.8.5.2. Self management to reduce lipid proteins

3.8.5.3. Dietary changes

3.8.5.4. Limit alcohol

3.8.5.5. HMG CoA-reductase inhibitors

3.8.5.6. Reduce weight

3.9. Arrhythmias

3.9.1. Atrial Fibrillation

3.10. Peripheral Vascular Disease

3.10.1. Special problems assoc. w/ DM

3.10.2. Arteriosclerosis

3.10.3. Aneurysms

3.10.4. Varicose Veins

3.10.5. Venous thromboembolism

4. Elimination

4.1. Dry mouth can have significant consequences. Saliva is important in many functions, such as lubricating, soft tissues, assisting in remineralizing teeth, promoting taste sensations, and helping to control bacteria and fungus in the oral cavity.

4.2. Bowel and Digestion

4.2.1. Normal Effects of aging

4.2.1.1. Atrophy of the tongue affects taste buds and decreases taste sensation

4.2.1.2. Saliva production decreases

4.2.1.2.1. swallowing may be difficult

4.2.1.3. Presbyesophagus

4.2.1.3.1. results in weaker esophageal contractions and weakness sphincter

4.2.1.4. Esophageal and stomach motility decreases

4.2.1.4.1. Risk for aspiration and indigestion

4.2.1.5. Decreases elasticity of the stomach

4.2.1.5.1. reduces the amount of food accommodation at one time

4.2.1.6. stomach has higher pH as a result of decline in hydrochloric acid and pepsin

4.2.1.7. Decline in hydrochloric acid

4.2.1.7.1. increase in incidence of gastric irritation

4.2.1.7.2. interferes w/ absorption of calcium, iron, folic acid, and vitamin B12

4.2.1.8. Decline in pepsin

4.2.1.8.1. Interferes w/ absorption of protein

4.2.1.9. Fewer cells on absorbing surface of intestinal wall impact the absorption of dextrose, xylose, and vitamins B and D

4.2.1.10. Slower peristalsis, inactivity, reduced food/fluid intake, drugs and low fiber diet

4.2.1.10.1. increase in the risk of constipation

4.2.1.11. sensory perception decreases

4.2.1.11.1. may lead to constipation or incomplete emptying of the bowel

4.2.1.12. Bile salt synthesis decreases

4.2.1.12.1. increase in the risk of gallstone development

4.2.1.13. pancreas changes

4.2.1.13.1. affects digestion of fats

4.2.2. Xerostomia

4.2.2.1. Patho

4.2.2.2. S/S

4.2.2.2.1. sticky, dry feeling in mouth

4.2.2.2.2. frequent thirst

4.2.2.2.3. sores in the mouth

4.2.2.2.4. burning or tingling sensation in the mouth

4.2.2.2.5. dry, raw tongue

4.2.2.2.6. difficulty chewing/swallowing

4.2.2.2.7. bad mouth

4.2.2.3. Diagnosis

4.2.2.3.1. dependent upon a careful and detailed history and thorough oral examination.

4.2.2.4. Nursing interventions

4.2.2.4.1. Frequent oral hygiene

4.2.2.4.2. increase fluids

4.2.2.5. Treatment / Management

4.2.2.5.1. Saliva substitutes

4.2.2.5.2. hard sugarless candy

4.2.2.5.3. increase fluids

4.2.2.5.4. limit caffeine

4.2.2.5.5. stop tobacco

4.2.2.5.6. no mouth washing

4.2.3. Dental problems

4.2.4. GERD

4.2.5. Dysphagia

4.2.6. Hiatal Hernia

4.2.6.1. Patho

4.2.6.1.1. Sliding (axial)

4.2.6.1.2. Rolling (paraesophageal)

4.2.6.2. S/S

4.2.6.2.1. heartburn

4.2.6.2.2. dysphagia

4.2.6.2.3. belching

4.2.6.2.4. vomiting

4.2.6.2.5. regurgitation

4.2.6.3. Diagnosis

4.2.6.3.1. barium swallow

4.2.6.3.2. esophagoscopy

4.2.6.4. Nursing interventions

4.2.6.4.1. Assist in identifying things that make the problem better or worse

4.2.6.4.2. encourage the patient to have smaller frequent meals

4.2.6.4.3. discourage of spicy foods

4.2.6.4.4. administer meds as prescribed

4.2.6.5. Treatment/ Management

4.2.6.5.1. if obese --> weight management

4.2.6.5.2. bland diet

4.2.6.5.3. Milk and antacids for symptom relief

4.2.6.5.4. several small meals

4.2.6.5.5. eating before bedtime is not encouraged

4.2.6.5.6. H2 blockers

4.2.6.5.7. Proton pump inhibitors

4.2.7. Esophageal Cancer

4.2.8. PUD

4.2.9. Stomach cancer

4.2.10. Diverticular disease

4.2.11. Colorectal Cancer

4.2.11.1. Patho

4.2.11.1.1. common with advancing age, the sigmoid colon and rectum tend to be frequent sites for carcinoma

4.2.11.1.2. 2nd most common malignancy in America

4.2.11.2. S/S

4.2.11.2.1. Rectal bleeding, bloody stools

4.2.11.2.2. Change in bowel pattern

4.2.11.2.3. Feeling of incomplete emptying of bowel

4.2.11.2.4. anorexia

4.2.11.2.5. Nausea

4.2.11.2.6. Abdominal discomfort, pain over affected region

4.2.11.2.7. weakness, fatigue

4.2.11.2.8. unexplained weight loss

4.2.11.2.9. anemia

4.2.11.3. Diagnosis

4.2.11.3.1. Digital rectal examination

4.2.11.3.2. Fecal occult blood testing

4.2.11.3.3. Colonoscopy w/ biopsy

4.2.11.3.4. CT colonography

4.2.11.4. Nursing interventions

4.2.11.4.1. Educate about early S/S for the patient to report

4.2.11.4.2. Teach about the physical exams that will be performed

4.2.11.4.3. Ask trigger questions

4.2.11.4.4. Educate the patient about the risk factors and family history

4.2.11.5. Treatment / Management

4.2.11.5.1. Surgical resection w/ anastomosis

4.2.11.5.2. formation of a colostomy

4.2.11.5.3. Chemo, radiation, surgery

4.2.12. Chronic Constipation

4.2.13. Flatulence

4.2.14. Intestinal obstruction

4.2.15. Fecal impaction

4.2.16. Bowel incontinence

4.2.17. Acute Appendicitis

4.2.18. Pancreas cancer

4.2.19. Biliary tract disease

4.3. Urinary Elimination

4.3.1. Age related changes

4.3.1.1. Hypertrophy and thickening of the bladder muscle

4.3.1.1.1. Decreases bladder ability to expand

4.3.1.1.2. reduces storage capacity

4.3.1.2. Changes in cortical control of micturition

4.3.1.2.1. nocturia

4.3.1.3. Inefficient neurological control of bladder emptying and weaker bladder muscle

4.3.1.3.1. retention of large volumes of urine

4.3.1.4. Retention of urine

4.3.1.5. Kidney filtration ability decreases

4.3.1.5.1. affects the ability to eliminate drugs

4.3.1.6. reduced renal function

4.3.1.6.1. high BUN levels

4.3.1.7. Decreased tubular function

4.3.1.7.1. concentration of urine changes in response to water and/or sodium excess/depletion

4.3.1.8. Increase in renal threshold for glucose

4.3.1.8.1. false-negative results for glucose in the urine w/o symptoms

4.3.2. Urinary incontinence

4.3.3. Bladder cancer

4.3.4. Renal calculi

4.3.4.1. Patho

4.3.4.1.1. Stone growth starts with the formation of crystals in supersaturated urine which then adhere to the urothelium, thus creating the nidus for subsequent stone growth.

4.3.4.2. S/S

4.3.4.2.1. Pain

4.3.4.2.2. Hematuria

4.3.4.2.3. Symptoms of UTI

4.3.4.2.4. Fever

4.3.4.2.5. chills

4.3.4.2.6. N/V

4.3.4.3. Diagnosis

4.3.4.3.1. Blood tests

4.3.4.3.2. CBC

4.3.4.3.3. Urinalysis

4.3.4.3.4. Xray

4.3.4.3.5. Kidney function

4.3.4.3.6. Kidney ultrasound

4.3.4.4. Nursing interventions

4.3.4.4.1. Prevent urinary stasis

4.3.4.4.2. provide ample fluids

4.3.4.4.3. facilitate prompt UTI treatment t

4.3.4.5. Treatments / Management

4.3.4.5.1. Pain relief may require narcotic medications

4.3.4.5.2. lithotripsy

4.3.4.5.3. Tunnel surgery

4.3.4.5.4. Ureteroscopy

4.3.4.6. Causes

4.3.4.6.1. immobilization, infection, changes in pH, concentration of urine.

4.3.5. Glomerulonephritis

4.3.5.1. Patho

4.3.5.1.1. Most frequently, chronic glomerulonephritis is already in older adults

4.3.5.1.2. inflammation of the tiny filters in your kidneys.

4.3.5.2. S/S

4.3.5.2.1. subtle and nonspecific

4.3.5.2.2. fever

4.3.5.2.3. fatigue

4.3.5.2.4. N/V

4.3.5.2.5. anorexia

4.3.5.2.6. abdominal pain

4.3.5.2.7. anemia

4.3.5.2.8. edema

4.3.5.2.9. arthralgia

4.3.5.2.10. elevated BP

4.3.5.2.11. increased sedimentation rate

4.3.5.2.12. oliguria

4.3.5.2.13. proteinuria

4.3.5.2.14. hematuria

4.3.5.3. Diagnosis

4.3.5.3.1. Urine test

4.3.5.3.2. Blood test

4.3.5.3.3. Imaging test

4.3.5.3.4. Kidney biopsy

4.3.5.4. Nursing interventions

4.3.5.4.1. close attention to fluid intake and output

4.3.5.4.2. if older adults are taking digitalis, diuretics, or antihypertensives, close observation for cumulative toxic effects resulting from compromised kidney function

4.3.5.4.3. control high BP

4.3.5.4.4. Seek prompt treatment of a strep infection with a sore throat or impetigo.

4.3.5.5. Treatment / Management

4.3.5.5.1. antibiotics

4.3.5.5.2. restricted sodium and protein diet

4.3.5.5.3. Specific to underlying causes

4.3.6. UTI

4.3.6.1. Patho

4.3.6.1.1. Infection caused by organisms mostly E. Coli in women and Proteus species in men. The present of any foreign body in the urinary tract or anything that obstructs urine flow

4.3.6.2. S/S

4.3.6.2.1. burning

4.3.6.2.2. urgency

4.3.6.2.3. fever

4.3.6.2.4. incontinence

4.3.6.2.5. delirium

4.3.6.2.6. retention

4.3.6.2.7. hematuria

4.3.6.3. Diagnosis

4.3.6.3.1. CBC

4.3.6.3.2. Urinalysis

4.3.6.3.3. Elevated temp

4.3.6.4. Nursing interventions

4.3.6.4.1. Asses I & O closely and increase fluids

4.3.6.4.2. Educate patient ways to prevent UTIs

4.3.6.4.3. assess elimination patterns

4.3.6.4.4. Palpate the bladder often for distention

4.3.6.4.5. Encouraging voiding with urge

4.3.6.5. Treatment/management

4.3.6.5.1. establish adequate urinary drainage

4.3.6.5.2. Antibiotics

4.3.6.5.3. Cranberry juice

4.3.6.5.4. Increase fluids

4.3.6.5.5. Vaginal estrogen therapy if you're postmenopausal

5. Neuro

5.1. Age related changes

5.1.1. Loss of nerve cell mass

5.1.1.1. Atrophy of the brain and spinal cord

5.1.1.2. Brain weight decreases

5.1.2. Number of dendrites declines

5.1.3. Demyelinization

5.1.3.1. slower nerve conduction

5.1.3.2. response and reaction times are slower

5.1.3.3. Reflexes become weaker

5.1.4. Plaques, tangles, atrophy of the brain

5.1.5. Reduced sensation of pressure and pain

5.1.6. Free radicals accumulate

5.1.7. Decrease in cerebral blood flow

5.1.8. Fatty deposits accumulate in blood vessels

5.1.9. ability to compensate declines w/ age

5.1.10. Intellectual performance maintained until at lease 80 years of age

5.1.11. Slowing in central processing

5.1.11.1. delay in time required to perform tasks

5.1.12. Verbal skills maintained until age 70

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

5.1.13.1. dulling of tactile sensation

5.1.14. Decline in the function of cranial nerves affecting taste and smell

5.2. Parkinson's Disease

5.3. Transient Ischemic Attacks

5.3.1. Patho

5.3.1.1. temporary or intermittent neurological events that can result from any situation that reduces cerebral circulation

5.3.2. S/S

5.3.2.1. Hemiparesis

5.3.2.2. Hemianesthesia

5.3.2.3. Aphasia

5.3.2.4. Unilateral loss of vision

5.3.2.5. diplopia

5.3.2.6. vertigo

5.3.2.7. N/V

5.3.2.8. dysphagia

5.3.3. Diagnosis

5.3.3.1. physical exam and test

5.3.3.2. Carotid ultrasonography

5.3.3.3. CT scan

5.3.3.4. CTA scanning

5.3.3.5. MRI

5.3.3.6. MRA

5.3.3.7. Echo

5.3.4. Nursing interventions

5.3.4.1. NPO until order changes

5.3.4.2. Know what S/S to look for

5.3.4.3. Support airway, breathing and circulation

5.3.4.4. Monitor VS q 15 mins

5.3.4.5. Administer meds as prescribed

5.3.5. Treatment / Management

5.3.5.1. Correction of the underlying cause

5.3.5.2. anticoagulant therapy

5.3.5.3. vascular reconstruction

5.4. Cerebrovascular accidents

6. Integumentary

6.1. Age related changes

6.1.1. Flattening of the dermal-epidermal junction

6.1.2. Reduced thickness and vascularity of the dermis

6.1.3. reduction of the epidermal turnover

6.1.4. degeneration of elastic fibers

6.1.5. increased coarseness of collagen

6.1.6. reduction in melanocytes

6.1.7. Atrophy of hair bulbs and decline in rate of hair and nail growth

6.1.8. Increased fragility of skin

6.2. Pruritus

6.3. Keratosis

6.4. Seborrheic Keratosis

6.4.1. Patho

6.4.1.1. dark, wart-like projections on the skin

6.4.1.2. Lesions on various parts of the body

6.4.1.3. Small and pinhead or as large as a quarter

6.4.2. S/S

6.4.2.1. Varies in color, usually from light tan to brown or black

6.4.2.2. round or oval shaped

6.4.2.3. "pasted on" look

6.4.2.4. flat or slightly elevated with a scaly surface

6.4.2.5. itchy

6.4.3. Diagnosis

6.4.3.1. inspection of growth

6.4.3.2. May remove the tissue so it can be examined under a microscope.

6.4.4. Treatment / Interventions

6.4.4.1. Sometimes abrasive activity w/ gauze pad containing oil will remove small seborrheic keratoses

6.4.4.2. Larger lesions may be removed by freezing agents or by curettage and cauterization procedure

6.5. Skin Cancer

6.5.1. Basal cell carcinoma

6.5.2. Squamous cell

6.5.3. Melanoma

6.6. Vascular Lesions

6.7. Stasis dermatitis

6.8. Pressure ulcers

6.8.1. Patho

6.8.1.1. Tissue anoxia and ischemia resulting from pressure can cause necrosis

6.8.2. S/S

6.8.2.1. warm and red to touch

6.8.2.2. painful ulcer or open blister

6.8.2.3. painful itchy skin

6.8.3. Diagnosis

6.8.3.1. based on clinical grounds and there are no specific tests to confirm the diagnosis

6.8.4. Nursing interventions

6.8.4.1. Encourage activity

6.8.4.2. Frequent turnings

6.8.4.3. increase fluids

6.8.4.4. Proper diet

6.8.4.5. Use of pillows, floatation pads, alternating pressure mattresses, and water beds

6.8.5. Treatment / Management

6.8.5.1. High protein, vitamin-rich diet

6.8.5.1.1. avoidance of pressure ulcers

6.8.5.2. stage I sore, you can wash the area gently with mild soap and water.

6.8.5.3. NO use of hydrogen peroxide or iodine cleansers

6.8.5.4. Stage II pressure sores should be cleaned with a salt water (saline)

6.8.5.5. Apply the appropriate bandage as prescribed for the patient

7. Endocrine

7.1. Age related changes

7.1.1. Thyroid gland progressively atrophies

7.1.2. Thyroid gland activity decreases

7.1.2.1. lower BMR

7.1.2.2. reduced radioactive iodine uptake

7.1.2.3. less secretion and release of thyrotropin

7.1.3. Diminished adrenal function

7.1.4. Adrenocorticotropic hormone secretion decreases

7.1.4.1. reduces the secretory activity of the adrenal gland

7.1.4.1.1. reduces the secretion of estrogen, progesterone, androgen, 17-ketosteroids, glucocorticoids

7.1.5. Volume of pituitary gland decreases

7.1.6. somatotrophic GH blood levels reduce

7.1.7. insufficient release of insulin

7.1.8. reduced tissue sensitivity to the circulating insulin

7.1.8.1. reduced ability to metabolize glucose, particularly when a sudden high concentration of glucose is consumed

7.2. Diabetes Mellitus

7.2.1. Glucose intolerance

7.2.2. has several causes: genetics and lifestyle are the most important ones. A combination of these factors can cause insulin resistance, when your body doesn't use insulin as well as it should.

7.2.3. S/S

7.2.3.1. Polydipsia

7.2.3.2. Polyuria

7.2.3.3. Polyphagia

7.2.3.4. Blurry vision

7.2.3.5. Fatigue

7.2.3.6. weight loss

7.2.4. Diagnosis

7.2.4.1. Random Fasting blood sugar

7.2.4.2. Glycated hemoglobin (A1C) test.

7.2.4.3. Oral glucose test

7.2.5. Nursing interventions

7.2.5.1. Patient education

7.2.5.2. How to manage blood glucose w/ insulin

7.2.5.3. How to safely and correctly administer insulin

7.2.5.4. S/S of hypoglycemia and treatment

7.2.6. Treatment

7.2.6.1. Drug therapy

7.2.6.1.1. Oral anti diabetics

7.2.6.1.2. Insulins

7.2.6.1.3. metformin

7.2.6.1.4. Meglitinides

7.2.6.1.5. DPP-4 inhibitors

7.2.6.1.6. MANY MORE

7.3. Hypothyrodisim

7.3.1. Patho

7.3.1.1. Primary

7.3.1.1.1. Resulting from a disease process that destroys the thyroid gland

7.3.1.1.2. Secondary

7.3.2. Sulfonylureas

7.3.3. S/S

7.3.3.1. fatigue

7.3.3.2. weakeness

7.3.3.3. lethargy

7.3.3.4. anorexia

7.3.3.5. weight gain and puffy face

7.3.3.6. impaired hearing

7.3.3.7. constipation

7.3.3.8. cold intolerance

7.3.3.9. myalgia, paresthesia, and ataxia

7.3.3.10. dry skin and coarse hair

7.3.4. Diagnosis

7.3.4.1. Blood test

7.3.5. Treatment / Management

7.3.5.1. replacement of thyroid hormone using a synthetic T4

7.3.5.2. Initially a low dose is recommended

7.3.5.3. Desiccated thyroid preparations are avoided

7.3.5.4. Regular monitoring provides feedback for the need for dosage adjustments

7.3.6. Nursing interventions

7.3.6.1. support the treatment plan

7.3.6.2. assist patients with management of symptoms

7.3.6.3. Teach patients thyroid replacement needs to be taking AS PRESCRIBED and lifelong

7.4. Hyperthyroidism

7.4.1. Patho

7.4.1.1. The thyroid gland secretes excess amounts of thyroid hormones (LOOK FOR Amiodarone use --> frequent thyroid function screening)

7.4.2. S/S

7.4.2.1. Diaphoresis

7.4.2.2. Diarrhea

7.4.2.3. Stare

7.4.2.4. Palpitations

7.4.2.5. HTN

7.4.2.6. tremor

7.4.2.7. tachycardia

7.4.2.8. confusion

7.4.2.9. heat intolerance

7.4.2.10. increased hunger

7.4.2.11. proximal muscle weakness

7.4.2.12. hyperreflexia

7.4.3. Diagnosis

7.4.3.1. Can be challenging because blood tests do not always reflect hyperthyroidism

7.4.3.2. Evaluation of T4 and free T4, TSH, and increased uptake of radionuclide thyroid scans

7.4.4. Treatment / Management

7.4.4.1. Depends on cause

7.4.4.2. Antithyroid meds

7.4.4.3. Radioactive iodine

7.4.4.4. Goiter = surgery

8. Musculoskeletal

8.1. Age related changes

8.1.1. Decline in size and number of muscle fibers & reduction in muscle mass

8.1.1.1. decreased body strength

8.1.1.2. endurance declines

8.1.2. Connective tissue changes

8.1.2.1. Reduced flexibility of joints and muscles

8.1.3. Sarcopenia

8.1.3.1. Can lead to disability

8.1.4. reduction in muscle masss

8.1.5. decrease in body strength, grip, and endurance

8.1.6. reduced flexibility of joints and muscles

8.1.7. decrease in walking speed

8.1.8. impaired capacity for muscle regeneration

8.1.9. reduction of cartilage

8.1.10. loss of bone density

8.1.11. reduced opportunity for physical activity

8.2. Fractures

8.3. Osteoarthritis

8.4. Rheumatoid Arthritis

8.5. Osteoporosis

8.5.1. Patho

8.5.1.1. Demineralization of the bone occurs, evidenced by a decrease in mass and density of the skeleton

8.5.2. S/S

8.5.2.1. back pain

8.5.2.2. loss of height

8.5.2.3. stooped posture

8.5.2.4. increased fractures

8.5.3. Diagnosis

8.5.3.1. DEXA

8.5.4. Nursing Interventions

8.5.4.1. Promote mobilization

8.5.4.2. avoid head lifting

8.5.4.3. increased risk of fracture so avoid certain activities like jumping, running, etc.

8.5.5. Treatment / Management

8.5.5.1. Depends on underlying cause

8.5.5.2. Calcium supplements

8.5.5.3. Vitamin D supplements

8.5.5.4. selective estrogen receptor modulators

8.5.5.5. hormone therapy

8.5.5.6. Biphosphonates

8.5.5.7. Diet rich in protein and calcium is encouraged

8.5.6. Causes

8.5.6.1. inactivity or immobility

8.5.6.2. Diseases

8.5.6.3. Reduction in anabolic sex hormones

8.5.6.4. Poor diet

8.5.6.5. Drugs

8.6. Gout

8.6.1. Patho

8.6.1.1. Metabolic disorder in which excess uric acid accumulates in the blood, uric acid crystals than form and are deposited in and around the joints

8.6.2. S/S

8.6.2.1. severe pain

8.6.2.2. tenderness of joints

8.6.2.3. warmth, redness and swelling of surrounding tissue

8.6.2.4. Unable to bare weight

8.6.3. Diagnosis

8.6.3.1. joint fluid test

8.6.3.2. blood test

8.6.3.3. xray

8.6.3.4. Dual energy CT scan.

8.6.3.5. Ultrasound

8.6.4. Treatment

8.6.4.1. Reduce sodium rate through low purine diet

8.6.4.2. Alcohol avoidance

8.6.4.3. Colchicine or phenylbutazone

8.6.4.4. Allopurinol

8.6.4.5. Probenecid

8.6.4.6. Indomethacin

8.6.5. Nursing interventions

8.6.5.1. Monitor pain

8.6.5.2. Encourage fluids

8.6.5.3. Avoid know foods that cause gout

8.7. Podiatric conditions