The Older Adult Patient

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The Older Adult Patient by Mind Map: The Older Adult Patient

1. Cardiovascular

1.1. Normal aging changes

1.1.1. More prominent arteries

1.1.2. Valves more thicker and more rigid

1.1.3. SV decreases

1.1.4. Less efficient O2 utilization

1.1.5. Aorta becomes dilated and elongated

1.1.6. Resistance to peripheral blood flow increases

1.1.7. BP increases

1.1.8. Less elasticity in blood vessels

1.1.9. Decreased cardiac output

1.2. Pathological changes

1.2.1. Congestive Heart Failure Risk factors Diabetes Mellitus Dyslipidemia Albuminuria CDK Sedentary lifestyle MI Symptoms Dyspnea on exertion Confusion Insomnia and wandering during the night Orthopnia Anorexia Nausea and weakness Wheezing Weight gain Bilateral ankle edema Classes 1: cardiac disease without physical limitation 2: symptoms experienced with ordinary physical activity; slight limitations may be evident 3: symptoms experienced with less than ordinary activities; physical activity significantly limited 4: symptoms experienced with any activity and during rest; bed rest may be required Management Bed Rest Medications Reduction in sodium intake Regular skin care and frequent changes in positioning Nurses role Assist the patient into the chair Provide patient adequate support Observe signs of fatigue, dyspnea, changes in skin color and pulse when the patient is sitting

1.2.2. Arrhythmias Causative factores Digitalis toxicity Hypokalemia Acute infections Hemorrhage Anginal syndrome Coronary insufficiency Symptoms Weakness and fatigue Palpitations Confusion Dizziness Confusion Hypotension and bradycardia Syncope Treatment Tranquilizers antiarrhythmic drugs Digitalis Potassium supplements Cardioversion Education Help individual modify diet, smoking, drinking, and activity patterns Teach about digitalis toxicity Types Atrial fibrilation

2. Urinary

2.1. Normal aging changes

2.1.1. Decreased size of renal mass

2.1.2. Decreased tubular function

2.1.3. Decreased bladder capacity

2.1.4. Decrease in nephrons

2.1.5. Renal blood flow and GFR decreases

2.1.6. Weaker bladder muscles

2.2. Pathological changes

2.2.1. Urinary incontinence Types Mixed incintinence Neurogenic incontinence Urgency incontinence Stress incontinence Overflow incontinece Functional incontinence Assessment Medical history Medications Functional status and cognition Neuromuscular function in lower extremities Urinary control and retention Bladder fullness and pain Elimination pattern Fecal impaction DIet Symptoms Urgency, burning, vaginal itching, pain, pressure in bladder area, and fever Nursing Diagnosis Impaired urinary elimination Risk for impaired skin integrity related to incontinence Risk for injury related to incontinence Chronic low self-esteem related to incontinence

3. Reproductive

3.1. Normal aging changes

3.1.1. Male Possible reduction in sperm count Fluid retaining capacity of seminal vesicles reduces Venous and arterial sclerosis pf penis Prostate enlarges in most men

3.1.2. Female Fallopian tubes atrophy and shorten Ovaries become thicker and smaller Cervix becomes smaller Drier, less elastic vaginal canal Flattening of labia Endocervical epithelium atrophies Uterus becomes smaller in size Endometrium atrophies More alkaline vaginal environment Loss of vulvar subcutaneous fat and hair

3.2. Pathological changes

3.2.1. Male Benign Prostatic Hyperplasia Symptoms Patho Tretament

3.2.2. Female Vaginitis Symptoms Cause Treatment Teaching

4. Neurological

4.1. Normal aging changes

4.1.1. Decreases conduction velocity

4.1.2. Slower response and reaction time

4.1.3. Decreased brain weight

4.1.4. Reduced blood flow to the brain

4.1.5. Changes in sleep pattern

4.1.6. Hypothalamus regulates temperature less effectively

4.2. Pathological changes

4.2.1. Parkinson's Disease Patho Affects ability of the CNS to control body movements as a result of the basal ganglia on the midbrain Occurs when neurons that produce dopamine in the substantial nigra die or become impaired Damage to a significant number of dopamine-producing cells Thought to be associated with a hx of exposure to toxins, encephalitis, and cerebrovascular disease Symptoms Tremors Muscle rigidity and weakness Drooling Difficulty swallowing Slow speech Monotone voice Face assumes a mask like appearance Moist skin Bradykinesia Shuffling gait and leaning forward from the trunk Secondary symptoms Management Medications Diet Other treatments The nurses role

4.2.2. Alzheimer's Disease Patho Two changes in the brain Also changes in neurotransmitter systems like reductions in serotonin receptors, serotonin uptake into platelets, production acetylcholine in the areas of the brain in which plaque and tangles are found, acetylcholinesterase, and choline acetyltransferase Possible causes Environmental factors Genetic factors Free radicals leading to oxidative damage Symptoms Early on, patients may be aware of changes in intellectual ability and become depressed Brain scans that show changes in the brains structure Decreased cognitive functioning Memory loss that interrupts ADL's Confusion with time or place Difficulty swallowing Treatment No treatment to prevent or cure this disease Ways have been found to slow the progression of the disease There has been interest in estrogen role in enhancing cognitive function Medications that slow the enzyme acetylcholinesterase Antioxidants, anti-inflammatory agents, supplements and gene therapy

5. Endocrine

5.1. Normal aging changes

5.1.1. Thyroid gland Thyroid gland undergoes fibrosis, cellular infiltration and increased nodularity Reduction of thyroid gland activity Can be caused by loss of adrenal function

5.1.2. Adrenal gland ACTH secretion decreases with age Causes secretory decrease of the adrenal gland Less aldosterone is produced and excreted in the urine Reduction in secretion of glucocorticoids, progesterone, androgen and estrogen

5.1.3. Pituitary gland Decreases its volume by 20% Decreased blood level of growth hormone Decrease in ACTH, TSH, FSH, LH, and luteotropic hormone Gonadal secretion declines Decrease in estrogen, testosterone, and progesterone

5.1.4. Pancreas Delayed and insufficient release of insulin by the beta cells Decreased tissue sensitivity to circulating insulin Older persons ability to metabolize glucose is reduced Can cause prolonged hyperglycemic episodes Not uncommon to see higher blood glucose levels in an older, non-diabetic patient

5.2. Pathological Changes

5.2.1. Hypothyroidism Patho Subnormal concentration of thyroid hormone in the tissues Primary Secondary Symptoms Weight gain and puffy face Peripheral edema Cold intolerance Dry skin and course hair Fatigue, weakness, and lethargy Myalgia, paresthesia, and ataxia Constipation Treatment Replacement of thyroid hormone using synthetic T4 Nurses should support the treatment plan and assist patients with management of symptoms

5.2.2. Hyperthyroidism Patho Disorder in which the thyroid gland secretes excess amounts of thyroid hormone Can be caused by the use of amioderone Diagnostics Blood tests Evaluation of T4 and free T4 and TSH Increased uptake of radionuclide thyroid scans Symptoms Diaphoresis Tachycardia Palpitations Hypertension Tremor Diarrhea Nervousness and confusion Hyperreflexia Treatment Depends on the cause of the disease People with a history of thyroid disease need monitoring when experiencing an acute illness, surgery, or trauma because this can participate a thyroid storm

6. Immune

6.1. Normal aging changes

6.1.1. Decreased immune response Immunosenescence Increases risk of infection

6.1.2. Thymic mass decreases

6.1.3. T-cell activity declines

6.1.4. More immature T cells present in the thymus

7. Respiratory

7.1. Normal aging changes

7.1.1. PO2 reduced

7.1.2. Loss of elasticity and increased rigidity

7.1.3. Decreased ciliary action

7.1.4. Forced expiratory volume reduced

7.1.5. Blunting of cough and laryngeal reflexes

7.1.6. Increase in residual capacity

7.1.7. Fewer alveoli and larger in size

7.1.8. Thoracic muscle more rigid

7.1.9. Reduced basilar inflation

7.2. Pathological changes

7.2.1. Pnuemonia Contributing factos Poor chest expansion and more shallow breathing due to age related changes in respiratory system Lowered resistance to infection Reduced sensitivity to pharyngeal reflexes which promotes aspiration of foreign materials High prevalence of respiratory diseases that promote mucus formation and bronchial obstruction Bacterial causes Pnuemococcal pnueminia Gram negative bacteria Anaerobic bacteria Influenza Symptoms Pleuritic pain Fever Slight cough Fatigue Rapid respiration Nursing care Close observation of subtle changes Look for complication of paralytic Encourage patient to get the vaccine to help prevent pneumonia

7.2.2. Emphysema Causes Chronic bronchitis Chronic irritation from dust or certain air pollutants Smoking Patho Dissension of alveolar sacs Rupture of alveolar walls Destruction of alveolar capillary beds Symptoms Dyspnea Chronic cough Hypoxia Fatigue and weakness Anorexia and weight loss Complications Recurrent respiratory infections Congestive heart failure Cardiac arrhythmia's Malnutrition Carbon dioxide narcosis Treatment Postural drainage Bronchodilaters Breathing exercises Dietary restrictions Education Educate on lifestyle change Help patient learn how to pace activities Patient should avoid extremely cold weather Teach patient the signs of infection

8. GI

8.1. Normal aging changes

8.1.1. Esophagus more dilated

8.1.2. Atrophy of gastric mucosa

8.1.3. Decreased esophageal motility

8.1.4. Reduced intestinal blood flow

8.1.5. Liver smaller in size

8.1.6. Reduced saliva and salivary ptyalin

8.1.7. Decreased stomach motility, hunger contractors, and emptying time

8.1.8. Fewer cells on absorbing surface of intestine

8.1.9. Slower peristalsis

8.2. Pathological changes

8.2.1. Dysphagia Difficulty swallowing Oropharyngeal Esophageal Symptoms Can be difficult to swallow certain foods Can be as sever as the complete inability to swallow Assessment When the problem began What other symptoms accompany dysphagia What types of food trigger symptoms Observe food intake Interventions Refer to a speech pathologist Offer a soft diet or thickened liquids Patient should eat in an upright position and eat small bites Monitor food intake and weight Accessible suctioning should be near by in case of aspiration

8.2.2. Hiatal Hernia Types Sliding (axial Rolling (paraesophageal Symptoms Heartburn Belching Dysphagia Vommitting Regurgitation Pain Bleeding Diagnosis Confirmed with a barium swallow test Perform an endoscopy Management Diet Obese patients Medications

9. Musculoskeletal

9.1. Normal aging changes

9.1.1. Decreased bone mass and bone mineral

9.1.2. Slight knee flexion

9.1.3. Bone more brittle

9.1.4. Hight decreases by approximately 2 inches

9.1.5. Shortening of vertebrae

9.1.6. Slight kyphosis

9.1.7. Slight hip and wrist flexion

9.1.8. Impaired flexion and extension of movements

9.2. Pathological changes

9.2.1. Osteoarthritis Predisposing factors Excessive use of joints, trauma, obesity, low vitamin C, and genetic factors Acromegaly Patho Progressive deterioration and abrasions joint cartilage, with the new formation of new bone at the joint surfaces Disequilibrium between destructive and synthetic elements leads to a lack of homeostasis necessary to maintain cartilage causing joint changes Symptoms Crepitation on joint movement Bony nodules on distant joints Joints more uncomfortable in damp weather Pain during excessive exercise Treatment Medications Rest, heat, ice, tai chi, aqua therapy, ultrasound and gentle massage to help relieve joints Splints, braces, and canes can provide support and rest to joints Diet Arthroplasty or joint replacement Nursing diagnosis Chronic pain related to joint inflammation, stiffness, and fluid inflammation Impaired physical mobility related to pain and limited joint movement

9.2.2. Gout Patho Metabolic disorder in which excess uric acid accumulates in the blood Acute attack The pain can get quite severe and the person may not be able to bear weight or have a blanket or clothing on their affected joint Can last from weeks to months Treatment Aims to reduce sodium urate through a low purine diet Medications Dietary supplements

10. Sensory

10.1. Normal aging changes

10.1.1. Sight More opaque lens and reduced elasticity Causes presbyopia Opacification Decreases pupil size More spherical cornea Alteration of blood supply to the retina Macular degeneration Less efficient reabsorption of intraocular fluid Increases risk of older person developing glaucoma

10.1.2. Smell Impaired ability to identify and discriminate among odors Decrease in the number of sensory cells in nasal lining Fewer cells in olfactory bulb of the brain Men tend to have greater loss than women

10.1.3. Taste Decreases taste sensation Atrophy of the tongue Loss of taste due to decreased salivary production

10.1.4. Touch Reduction in tactile sensation Causes reduced ability to sense pressure and pain and differentiate temperatures Leads to profound safety risks

10.1.5. Hearing Atrophy of hair cells of organ of Corti Leads to presbycusis Alterations in eqilibrium Tympanic membrane sclerosis and atrophy Increased cerumen and concentration of keratin Weakening and stiffening of inner ear muscles Contributes to loss of the acoustic reflex

11. Integumentary

11.1. Normal aging changes

11.1.1. Reduced thickness and vascularity of the dermis

11.1.2. Slowing of epidermal proliferation

11.1.3. Increased in quantity and degeneration of elliptic fibers occur

11.1.4. Benign and malignant skin neoplasms occur with age

11.1.5. Skin immune response declines

11.1.6. Reduction in the number of melanocytes Causes tanning to occur more slowly

11.1.7. Skin becomes less elastic and more fragile with wrinkles

11.1.8. Subcutaneous fat is lost

11.1.9. Scalp, pubic, and axillary hair becomes thin and gray due to fibrosis of hair bulbs

11.1.10. Hair in the nose and ears become thicker and increased growth of eyebrow, ear and nostril hair in men

11.1.11. Lessening of the number and function of sweat glands

11.1.12. Fingernails grow more slowly and decrease in lanula size

11.2. Pathological Changes

11.2.1. Skin cancer Basal cell carcinoma Most common form of skin cancer, grows slowly and rarely metastasizes Growths tend to be small, dome-shaped elevations covered by blood vessels Risk factors include exposure to the sun, UV radiation, and therapeutic radiation Squamous cell carcinoma On the surface of the skin, lining of the hollow organs of the body, and passages of the respiratory and digestive tracts Sun exposure is the most prevalent contributing factor Can develop in scar tissue and is associated with suppression of the immune system Usually stays in the epidermis and the lower lip is a common site Melanoma Lentigo maligna melanoma Superficial spreading melanoma Nodular melanoma Nurses roll Nurses should encourage patient to inspect themselves for melanomas, identify moles that demonstrate changes in pigmentation or size, and seek evaluation of suspicious lesions Lesions may need to be removed and possible removal of the surrounding subcutaneous fat

12. Site

12.1. Eliopoulos, C. (2018). Gerontological nursing. Philadelphia: Wolters Kluwer.