The Older Adult Patient

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

1. Respiratory

1.1. Normal aging changes

1.1.1. PO2 reduced

1.1.2. Loss of elasticity and increased rigidity

1.1.3. Decreased ciliary action

1.1.4. Forced expiratory volume reduced

1.1.5. Blunting of cough and laryngeal reflexes

1.1.6. Increase in residual capacity

1.1.7. Fewer alveoli and larger in size

1.1.8. Thoracic muscle more rigid

1.1.9. Reduced basilar inflation

1.2. Pathological changes

1.2.1. Pnuemonia

1.2.1.1. Contributing factos

1.2.1.1.1. Poor chest expansion and more shallow breathing due to age related changes in respiratory system

1.2.1.1.2. Lowered resistance to infection

1.2.1.1.3. Reduced sensitivity to pharyngeal reflexes which promotes aspiration of foreign materials

1.2.1.1.4. High prevalence of respiratory diseases that promote mucus formation and bronchial obstruction

1.2.1.2. Bacterial causes

1.2.1.2.1. Pnuemococcal pnueminia

1.2.1.2.2. Gram negative bacteria

1.2.1.2.3. Anaerobic bacteria

1.2.1.2.4. Influenza

1.2.1.3. Symptoms

1.2.1.3.1. Pleuritic pain

1.2.1.3.2. Fever

1.2.1.3.3. Slight cough

1.2.1.3.4. Fatigue

1.2.1.3.5. Rapid respiration

1.2.1.4. Nursing care

1.2.1.4.1. Close observation of subtle changes

1.2.1.4.2. Look for complication of paralytic

1.2.1.4.3. Encourage patient to get the vaccine to help prevent pneumonia

1.2.2. Emphysema

1.2.2.1. Causes

1.2.2.1.1. Chronic bronchitis

1.2.2.1.2. Chronic irritation from dust or certain air pollutants

1.2.2.1.3. Smoking

1.2.2.2. Patho

1.2.2.2.1. Dissension of alveolar sacs

1.2.2.2.2. Rupture of alveolar walls

1.2.2.2.3. Destruction of alveolar capillary beds

1.2.2.3. Symptoms

1.2.2.3.1. Dyspnea

1.2.2.3.2. Chronic cough

1.2.2.3.3. Hypoxia

1.2.2.3.4. Fatigue and weakness

1.2.2.3.5. Anorexia and weight loss

1.2.2.4. Complications

1.2.2.4.1. Recurrent respiratory infections

1.2.2.4.2. Congestive heart failure

1.2.2.4.3. Cardiac arrhythmia's

1.2.2.4.4. Malnutrition

1.2.2.4.5. Carbon dioxide narcosis

1.2.2.5. Treatment

1.2.2.5.1. Postural drainage

1.2.2.5.2. Bronchodilaters

1.2.2.5.3. Breathing exercises

1.2.2.5.4. Dietary restrictions

1.2.2.6. Education

1.2.2.6.1. Educate on lifestyle change

1.2.2.6.2. Help patient learn how to pace activities

1.2.2.6.3. Patient should avoid extremely cold weather

1.2.2.6.4. Teach patient the signs of infection

2. GI

2.1. Normal aging changes

2.1.1. Esophagus more dilated

2.1.2. Atrophy of gastric mucosa

2.1.3. Decreased esophageal motility

2.1.4. Reduced intestinal blood flow

2.1.5. Liver smaller in size

2.1.6. Reduced saliva and salivary ptyalin

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

2.1.8. Fewer cells on absorbing surface of intestine

2.1.9. Slower peristalsis

2.2. Pathological changes

2.2.1. Dysphagia

2.2.1.1. Difficulty swallowing

2.2.1.1.1. Oropharyngeal

2.2.1.1.2. Esophageal

2.2.1.2. Symptoms

2.2.1.2.1. Can be difficult to swallow certain foods

2.2.1.2.2. Can be as sever as the complete inability to swallow

2.2.1.3. Assessment

2.2.1.3.1. When the problem began

2.2.1.3.2. What other symptoms accompany dysphagia

2.2.1.3.3. What types of food trigger symptoms

2.2.1.3.4. Observe food intake

2.2.1.4. Interventions

2.2.1.4.1. Refer to a speech pathologist

2.2.1.4.2. Offer a soft diet or thickened liquids

2.2.1.4.3. Patient should eat in an upright position and eat small bites

2.2.1.4.4. Monitor food intake and weight

2.2.1.4.5. Accessible suctioning should be near by in case of aspiration

2.2.2. Hiatal Hernia

2.2.2.1. Types

2.2.2.1.1. Sliding (axial

2.2.2.1.2. Rolling (paraesophageal

2.2.2.2. Symptoms

2.2.2.2.1. Heartburn

2.2.2.2.2. Belching

2.2.2.2.3. Dysphagia

2.2.2.2.4. Vommitting

2.2.2.2.5. Regurgitation

2.2.2.2.6. Pain

2.2.2.2.7. Bleeding

2.2.2.3. Diagnosis

2.2.2.3.1. Confirmed with a barium swallow test

2.2.2.3.2. Perform an endoscopy

2.2.2.4. Management

2.2.2.4.1. Diet

2.2.2.4.2. Obese patients

2.2.2.4.3. Medications

3. Cardiovascular

3.1. Normal aging changes

3.1.1. More prominent arteries

3.1.2. Valves more thicker and more rigid

3.1.3. SV decreases

3.1.4. Less efficient O2 utilization

3.1.5. Aorta becomes dilated and elongated

3.1.6. Resistance to peripheral blood flow increases

3.1.7. BP increases

3.1.8. Less elasticity in blood vessels

3.1.9. Decreased cardiac output

3.2. Pathological changes

3.2.1. Congestive Heart Failure

3.2.1.1. Risk factors

3.2.1.1.1. Diabetes Mellitus

3.2.1.1.2. Dyslipidemia

3.2.1.1.3. Albuminuria

3.2.1.1.4. CDK

3.2.1.1.5. Sedentary lifestyle

3.2.1.1.6. MI

3.2.1.2. Symptoms

3.2.1.2.1. Dyspnea on exertion

3.2.1.2.2. Confusion

3.2.1.2.3. Insomnia and wandering during the night

3.2.1.2.4. Orthopnia

3.2.1.2.5. Anorexia

3.2.1.2.6. Nausea and weakness

3.2.1.2.7. Wheezing

3.2.1.2.8. Weight gain

3.2.1.2.9. Bilateral ankle edema

3.2.1.3. Classes

3.2.1.3.1. 1: cardiac disease without physical limitation

3.2.1.3.2. 2: symptoms experienced with ordinary physical activity; slight limitations may be evident

3.2.1.3.3. 3: symptoms experienced with less than ordinary activities; physical activity significantly limited

3.2.1.3.4. 4: symptoms experienced with any activity and during rest; bed rest may be required

3.2.1.4. Management

3.2.1.4.1. Bed Rest

3.2.1.4.2. Medications

3.2.1.4.3. Reduction in sodium intake

3.2.1.4.4. Regular skin care and frequent changes in positioning

3.2.1.5. Nurses role

3.2.1.5.1. Assist the patient into the chair

3.2.1.5.2. Provide patient adequate support

3.2.1.5.3. Observe signs of fatigue, dyspnea, changes in skin color and pulse when the patient is sitting

3.2.2. Arrhythmias

3.2.2.1. Causative factores

3.2.2.1.1. Digitalis toxicity

3.2.2.1.2. Hypokalemia

3.2.2.1.3. Acute infections

3.2.2.1.4. Hemorrhage

3.2.2.1.5. Anginal syndrome

3.2.2.1.6. Coronary insufficiency

3.2.2.2. Symptoms

3.2.2.2.1. Weakness and fatigue

3.2.2.2.2. Palpitations

3.2.2.2.3. Confusion

3.2.2.2.4. Dizziness

3.2.2.2.5. Confusion

3.2.2.2.6. Hypotension and bradycardia

3.2.2.2.7. Syncope

3.2.2.3. Treatment

3.2.2.3.1. Tranquilizers

3.2.2.3.2. antiarrhythmic drugs

3.2.2.3.3. Digitalis

3.2.2.3.4. Potassium supplements

3.2.2.3.5. Cardioversion

3.2.2.4. Education

3.2.2.4.1. Help individual modify diet, smoking, drinking, and activity patterns

3.2.2.4.2. Teach about digitalis toxicity

3.2.2.5. Types

3.2.2.5.1. Atrial fibrilation

4. Urinary

4.1. Normal aging changes

4.1.1. Decreased size of renal mass

4.1.2. Decreased tubular function

4.1.3. Decreased bladder capacity

4.1.4. Decrease in nephrons

4.1.5. Renal blood flow and GFR decreases

4.1.6. Weaker bladder muscles

4.2. Pathological changes

4.2.1. Urinary incontinence

4.2.1.1. Types

4.2.1.1.1. Mixed incintinence

4.2.1.1.2. Neurogenic incontinence

4.2.1.1.3. Urgency incontinence

4.2.1.1.4. Stress incontinence

4.2.1.1.5. Overflow incontinece

4.2.1.1.6. Functional incontinence

4.2.1.2. Assessment

4.2.1.2.1. Medical history

4.2.1.2.2. Medications

4.2.1.2.3. Functional status and cognition

4.2.1.2.4. Neuromuscular function in lower extremities

4.2.1.2.5. Urinary control and retention

4.2.1.2.6. Bladder fullness and pain

4.2.1.2.7. Elimination pattern

4.2.1.2.8. Fecal impaction

4.2.1.2.9. DIet

4.2.1.3. Symptoms

4.2.1.3.1. Urgency, burning, vaginal itching, pain, pressure in bladder area, and fever

4.2.1.4. Nursing Diagnosis

4.2.1.4.1. Impaired urinary elimination

4.2.1.4.2. Risk for impaired skin integrity related to incontinence

4.2.1.4.3. Risk for injury related to incontinence

4.2.1.4.4. Chronic low self-esteem related to incontinence

5. Reproductive

5.1. Normal aging changes

5.1.1. Male

5.1.1.1. Possible reduction in sperm count

5.1.1.2. Fluid retaining capacity of seminal vesicles reduces

5.1.1.3. Venous and arterial sclerosis pf penis

5.1.1.4. Prostate enlarges in most men

5.1.2. Female

5.1.2.1. Fallopian tubes atrophy and shorten

5.1.2.2. Ovaries become thicker and smaller

5.1.2.3. Cervix becomes smaller

5.1.2.4. Drier, less elastic vaginal canal

5.1.2.5. Flattening of labia

5.1.2.6. Endocervical epithelium atrophies

5.1.2.7. Uterus becomes smaller in size

5.1.2.8. Endometrium atrophies

5.1.2.9. More alkaline vaginal environment

5.1.2.10. Loss of vulvar subcutaneous fat and hair

5.2. Pathological changes

5.2.1. Male

5.2.1.1. Benign Prostatic Hyperplasia

5.2.1.1.1. Symptoms

5.2.1.1.2. Patho

5.2.1.1.3. Tretament

5.2.2. Female

5.2.2.1. Vaginitis

5.2.2.1.1. Symptoms

5.2.2.1.2. Cause

5.2.2.1.3. Treatment

5.2.2.1.4. Teaching

6. Musculoskeletal

6.1. Normal aging changes

6.1.1. Decreased bone mass and bone mineral

6.1.2. Slight knee flexion

6.1.3. Bone more brittle

6.1.4. Hight decreases by approximately 2 inches

6.1.5. Shortening of vertebrae

6.1.6. Slight kyphosis

6.1.7. Slight hip and wrist flexion

6.1.8. Impaired flexion and extension of movements

6.2. Pathological changes

6.2.1. Osteoarthritis

6.2.1.1. Predisposing factors

6.2.1.1.1. Excessive use of joints, trauma, obesity, low vitamin C, and genetic factors

6.2.1.1.2. Acromegaly

6.2.1.2. Patho

6.2.1.2.1. Progressive deterioration and abrasions joint cartilage, with the new formation of new bone at the joint surfaces

6.2.1.2.2. Disequilibrium between destructive and synthetic elements leads to a lack of homeostasis necessary to maintain cartilage causing joint changes

6.2.1.3. Symptoms

6.2.1.3.1. Crepitation on joint movement

6.2.1.3.2. Bony nodules on distant joints

6.2.1.3.3. Joints more uncomfortable in damp weather

6.2.1.3.4. Pain during excessive exercise

6.2.1.4. Treatment

6.2.1.4.1. Medications

6.2.1.4.2. Rest, heat, ice, tai chi, aqua therapy, ultrasound and gentle massage to help relieve joints

6.2.1.4.3. Splints, braces, and canes can provide support and rest to joints

6.2.1.4.4. Diet

6.2.1.4.5. Arthroplasty or joint replacement

6.2.1.5. Nursing diagnosis

6.2.1.5.1. Chronic pain related to joint inflammation, stiffness, and fluid inflammation

6.2.1.5.2. Impaired physical mobility related to pain and limited joint movement

6.2.2. Gout

6.2.2.1. Patho

6.2.2.1.1. Metabolic disorder in which excess uric acid accumulates in the blood

6.2.2.2. Acute attack

6.2.2.2.1. 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

6.2.2.2.2. Can last from weeks to months

6.2.2.3. Treatment

6.2.2.3.1. Aims to reduce sodium urate through a low purine diet

6.2.2.3.2. Medications

6.2.2.3.3. Dietary supplements

7. Neurological

7.1. Normal aging changes

7.1.1. Decreases conduction velocity

7.1.2. Slower response and reaction time

7.1.3. Decreased brain weight

7.1.4. Reduced blood flow to the brain

7.1.5. Changes in sleep pattern

7.1.6. Hypothalamus regulates temperature less effectively

7.2. Pathological changes

7.2.1. Parkinson's Disease

7.2.1.1. Patho

7.2.1.1.1. Affects ability of the CNS to control body movements as a result of the basal ganglia on the midbrain

7.2.1.1.2. Occurs when neurons that produce dopamine in the substantial nigra die or become impaired

7.2.1.1.3. Damage to a significant number of dopamine-producing cells

7.2.1.1.4. Thought to be associated with a hx of exposure to toxins, encephalitis, and cerebrovascular disease

7.2.1.2. Symptoms

7.2.1.2.1. Tremors

7.2.1.2.2. Muscle rigidity and weakness

7.2.1.2.3. Drooling

7.2.1.2.4. Difficulty swallowing

7.2.1.2.5. Slow speech

7.2.1.2.6. Monotone voice

7.2.1.2.7. Face assumes a mask like appearance

7.2.1.2.8. Moist skin

7.2.1.2.9. Bradykinesia

7.2.1.2.10. Shuffling gait and leaning forward from the trunk

7.2.1.2.11. Secondary symptoms

7.2.1.3. Management

7.2.1.3.1. Medications

7.2.1.3.2. Diet

7.2.1.3.3. Other treatments

7.2.1.3.4. The nurses role

7.2.2. Alzheimer's Disease

7.2.2.1. Patho

7.2.2.1.1. Two changes in the brain

7.2.2.1.2. 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

7.2.2.2. Possible causes

7.2.2.2.1. Environmental factors

7.2.2.2.2. Genetic factors

7.2.2.2.3. Free radicals leading to oxidative damage

7.2.2.3. Symptoms

7.2.2.3.1. Early on, patients may be aware of changes in intellectual ability and become depressed

7.2.2.3.2. Brain scans that show changes in the brains structure

7.2.2.3.3. Decreased cognitive functioning

7.2.2.3.4. Memory loss that interrupts ADL's

7.2.2.3.5. Confusion with time or place

7.2.2.3.6. Difficulty swallowing

7.2.2.4. Treatment

7.2.2.4.1. No treatment to prevent or cure this disease

7.2.2.4.2. Ways have been found to slow the progression of the disease

7.2.2.4.3. There has been interest in estrogen role in enhancing cognitive function

7.2.2.4.4. Medications that slow the enzyme acetylcholinesterase

7.2.2.4.5. Antioxidants, anti-inflammatory agents, supplements and gene therapy

8. Sensory

8.1. Normal aging changes

8.1.1. Sight

8.1.1.1. More opaque lens and reduced elasticity

8.1.1.1.1. Causes presbyopia

8.1.1.1.2. Opacification

8.1.1.2. Decreases pupil size

8.1.1.3. More spherical cornea

8.1.1.4. Alteration of blood supply to the retina

8.1.1.4.1. Macular degeneration

8.1.1.5. Less efficient reabsorption of intraocular fluid

8.1.1.5.1. Increases risk of older person developing glaucoma

8.1.2. Smell

8.1.2.1. Impaired ability to identify and discriminate among odors

8.1.2.2. Decrease in the number of sensory cells in nasal lining

8.1.2.3. Fewer cells in olfactory bulb of the brain

8.1.2.4. Men tend to have greater loss than women

8.1.3. Taste

8.1.3.1. Decreases taste sensation

8.1.3.2. Atrophy of the tongue

8.1.3.3. Loss of taste due to decreased salivary production

8.1.4. Touch

8.1.4.1. Reduction in tactile sensation

8.1.4.1.1. Causes reduced ability to sense pressure and pain and differentiate temperatures

8.1.4.1.2. Leads to profound safety risks

8.1.5. Hearing

8.1.5.1. Atrophy of hair cells of organ of Corti

8.1.5.1.1. Leads to presbycusis

8.1.5.1.2. Alterations in eqilibrium

8.1.5.2. Tympanic membrane sclerosis and atrophy

8.1.5.3. Increased cerumen and concentration of keratin

8.1.5.4. Weakening and stiffening of inner ear muscles

8.1.5.4.1. Contributes to loss of the acoustic reflex

9. Endocrine

9.1. Normal aging changes

9.1.1. Thyroid gland

9.1.1.1. Thyroid gland undergoes fibrosis, cellular infiltration and increased nodularity

9.1.1.1.1. Reduction of thyroid gland activity

9.1.1.1.2. Can be caused by loss of adrenal function

9.1.2. Adrenal gland

9.1.2.1. ACTH secretion decreases with age

9.1.2.1.1. Causes secretory decrease of the adrenal gland

9.1.2.2. Less aldosterone is produced and excreted in the urine

9.1.2.3. Reduction in secretion of glucocorticoids, progesterone, androgen and estrogen

9.1.3. Pituitary gland

9.1.3.1. Decreases its volume by 20%

9.1.3.2. Decreased blood level of growth hormone

9.1.3.3. Decrease in ACTH, TSH, FSH, LH, and luteotropic hormone

9.1.3.4. Gonadal secretion declines

9.1.3.4.1. Decrease in estrogen, testosterone, and progesterone

9.1.4. Pancreas

9.1.4.1. Delayed and insufficient release of insulin by the beta cells

9.1.4.1.1. Decreased tissue sensitivity to circulating insulin

9.1.4.2. Older persons ability to metabolize glucose is reduced

9.1.4.2.1. Can cause prolonged hyperglycemic episodes

9.1.4.2.2. Not uncommon to see higher blood glucose levels in an older, non-diabetic patient

9.2. Pathological Changes

9.2.1. Hypothyroidism

9.2.1.1. Patho

9.2.1.1.1. Subnormal concentration of thyroid hormone in the tissues

9.2.1.1.2. Primary

9.2.1.1.3. Secondary

9.2.1.2. Symptoms

9.2.1.2.1. Weight gain and puffy face

9.2.1.2.2. Peripheral edema

9.2.1.2.3. Cold intolerance

9.2.1.2.4. Dry skin and course hair

9.2.1.2.5. Fatigue, weakness, and lethargy

9.2.1.2.6. Myalgia, paresthesia, and ataxia

9.2.1.2.7. Constipation

9.2.1.3. Treatment

9.2.1.3.1. Replacement of thyroid hormone using synthetic T4

9.2.1.3.2. Nurses should support the treatment plan and assist patients with management of symptoms

9.2.2. Hyperthyroidism

9.2.2.1. Patho

9.2.2.1.1. Disorder in which the thyroid gland secretes excess amounts of thyroid hormone

9.2.2.1.2. Can be caused by the use of amioderone

9.2.2.2. Diagnostics

9.2.2.2.1. Blood tests

9.2.2.2.2. Evaluation of T4 and free T4 and TSH

9.2.2.2.3. Increased uptake of radionuclide thyroid scans

9.2.2.3. Symptoms

9.2.2.3.1. Diaphoresis

9.2.2.3.2. Tachycardia

9.2.2.3.3. Palpitations

9.2.2.3.4. Hypertension

9.2.2.3.5. Tremor

9.2.2.3.6. Diarrhea

9.2.2.3.7. Nervousness and confusion

9.2.2.3.8. Hyperreflexia

9.2.2.4. Treatment

9.2.2.4.1. Depends on the cause of the disease

9.2.2.4.2. People with a history of thyroid disease need monitoring when experiencing an acute illness, surgery, or trauma because this can participate a thyroid storm

10. Integumentary

10.1. Normal aging changes

10.1.1. Reduced thickness and vascularity of the dermis

10.1.2. Slowing of epidermal proliferation

10.1.3. Increased in quantity and degeneration of elliptic fibers occur

10.1.4. Benign and malignant skin neoplasms occur with age

10.1.5. Skin immune response declines

10.1.6. Reduction in the number of melanocytes

10.1.6.1. Causes tanning to occur more slowly

10.1.7. Skin becomes less elastic and more fragile with wrinkles

10.1.8. Subcutaneous fat is lost

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

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

10.1.11. Lessening of the number and function of sweat glands

10.1.12. Fingernails grow more slowly and decrease in lanula size

10.2. Pathological Changes

10.2.1. Skin cancer

10.2.1.1. Basal cell carcinoma

10.2.1.1.1. Most common form of skin cancer, grows slowly and rarely metastasizes

10.2.1.1.2. Growths tend to be small, dome-shaped elevations covered by blood vessels

10.2.1.1.3. Risk factors include exposure to the sun, UV radiation, and therapeutic radiation

10.2.1.2. Squamous cell carcinoma

10.2.1.2.1. On the surface of the skin, lining of the hollow organs of the body, and passages of the respiratory and digestive tracts

10.2.1.2.2. Sun exposure is the most prevalent contributing factor

10.2.1.2.3. Can develop in scar tissue and is associated with suppression of the immune system

10.2.1.2.4. Usually stays in the epidermis and the lower lip is a common site

10.2.1.3. Melanoma

10.2.1.3.1. Lentigo maligna melanoma

10.2.1.3.2. Superficial spreading melanoma

10.2.1.3.3. Nodular melanoma

10.2.1.4. Nurses roll

10.2.1.4.1. Nurses should encourage patient to inspect themselves for melanomas, identify moles that demonstrate changes in pigmentation or size, and seek evaluation of suspicious lesions

10.2.1.4.2. Lesions may need to be removed and possible removal of the surrounding subcutaneous fat

11. Immune

11.1. Normal aging changes

11.1.1. Decreased immune response

11.1.1.1. Immunosenescence

11.1.1.2. Increases risk of infection

11.1.2. Thymic mass decreases

11.1.3. T-cell activity declines

11.1.4. More immature T cells present in the thymus

12. Site

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