Geriatric Patient

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Geriatric Patient by Mind Map: Geriatric Patient

1. Respiratory

1.1. Normal Aging Changes

1.1.1. Po2 reduced as much as 15% between ages 20 and 80

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. By age 90 years, approximately 50% increase in residual capacity

1.1.7. Alveoli fewer in number and larger in size

1.1.8. Thoracic muscles more rigid

1.1.9. Reduced basilar inflation

1.2. Pathological Changes

1.2.1. Pneumonia

1.2.1.1. Description and Patho

1.2.1.1.1. Pneumococcal pneumonia is the most common type and is caused by Streptococcus pneumoniae

1.2.1.1.2. Other pneumonias are caused by gram-negative bacilli

1.2.1.1.3. The other types are Klebsiella pneumoniae, Legionella pneumophila, anaerobic bacteria, and influenze

1.2.1.2. Symptoms

1.2.1.2.1. Differences in body temperature may cause minimal or no fever

1.2.1.2.2. Slight cough

1.2.1.2.3. Fatigue

1.2.1.2.4. Rapid perspiration

1.2.1.2.5. Confusion

1.2.1.2.6. Restlessness

1.2.1.2.7. Behavioral changes

1.2.1.3. Nursing Considerations

1.2.1.3.1. Close observation for subtle changes

1.2.1.3.2. Encourage mobility to prevent parylitic ileus

1.2.1.3.3. Encourage pneumococcal vaccine over the age of 65

1.2.2. Emphysema

1.2.2.1. Causes

1.2.2.1.1. Chronic bronchitis

1.2.2.1.2. Chronic irritation from dusts or air pollutants

1.2.2.1.3. Distension of alveolar sacs

1.2.2.1.4. Rupture of the alveolar walls

1.2.2.1.5. Destruction of alveolar capillary beds

1.2.2.2. Symptoms

1.2.2.2.1. Increased dyspnea

1.2.2.2.2. Chronic cough develops

1.2.2.2.3. Fatigue

1.2.2.2.4. Anorexia

1.2.2.2.5. Weight loss

1.2.2.2.6. Weakness

1.2.2.2.7. Recurrent respiratory infection

1.2.2.2.8. Malnutrition

1.2.2.3. Treatment

1.2.2.3.1. Postural drainage

1.2.2.3.2. Bronchodilators

1.2.2.3.3. Avoid stressful situations

1.2.2.3.4. Breathing exercises

1.2.2.3.5. Cessation of smoking

1.2.2.4. Nursing Considerations

1.2.2.4.1. Assess for lack of energy to consume food, and arrange for dietary interventions if needed

1.2.2.4.2. Use oxygen with extreme caution and close supervision

1.2.2.4.3. Prevent respiratory infections, and report it immediately to the physician if present

1.2.2.4.4. Sedatives, hypnotics, and narcotics may be contraindicated

1.2.2.4.5. Provide education to the patient

2. Cardiovascular

2.1. Normal Aging Changes

2.1.1. More prominent arteries in head, neck, and extremities

2.1.2. Valves become thicker and more rigid

2.1.3. Stroke volume decreased by 1% each year

2.1.4. Heart pigmented with lipofuscin granules

2.1.5. Less efficient O2 utilization

2.1.6. Aorta becomes dilated and elongated

2.1.7. Cardiac output decreases

2.1.8. Resistance to peripheral blood flow increases by 1% per year

2.1.9. Blood pressure increases to compensate for increased peripheral resistance and decreased cardiac output

2.1.10. Less elasticity of vessels

2.2. Pathological Changes

2.2.1. Congestive Heart Failure

2.2.1.1. Description

2.2.1.1.1. Leading cause of hospitilization in older adults

2.2.1.1.2. Common in older adults because of common aging changes

2.2.1.2. Causes and Risk Factors

2.2.1.2.1. Coronary Artery Disease is responsible for most cases

2.2.1.2.2. Diabetes mellitus

2.2.1.2.3. Dyslipidemia

2.2.1.2.4. Sleep-disordered breathing

2.2.1.2.5. Albuminiura

2.2.1.2.6. Anemia

2.2.1.2.7. Chronic Kidney Disease

2.2.1.2.8. Use of illicit drugs

2.2.1.2.9. Sedentary lifestyle

2.2.1.2.10. Psychological stress

2.2.1.3. Symptoms

2.2.1.3.1. Dyspnea on exertion

2.2.1.3.2. Confusion

2.2.1.3.3. Insomnia

2.2.1.3.4. Wandering during the night

2.2.1.3.5. Agitation

2.2.1.3.6. Depression

2.2.1.3.7. Anorexia

2.2.1.3.8. Shortness of breath

2.2.1.3.9. Orthopnea

2.2.1.3.10. Wheezing

2.2.1.3.11. Weight gain

2.2.1.3.12. Crackles on asucultation

2.2.1.4. Categories

2.2.1.4.1. Class 1

2.2.1.4.2. Class 2

2.2.1.4.3. Class 3

2.2.1.4.4. Class 4

2.2.1.5. Treatment

2.2.1.5.1. Bed rest

2.2.1.5.2. ACE Inhibitors

2.2.1.5.3. Beta-blockers

2.2.1.5.4. Digitalis

2.2.1.5.5. Diuretics

2.2.1.5.6. Reduction in sodium intake

2.2.2. Arrhythmias

2.2.2.1. Causes

2.2.2.1.1. Digitalis toxicity

2.2.2.1.2. Hypokalemia

2.2.2.1.3. Acute infections

2.2.2.1.4. Hemorrhage

2.2.2.1.5. Anginal syndrome

2.2.2.1.6. Coronary insufficiency

2.2.2.2. Symptoms

2.2.2.2.1. Weakness

2.2.2.2.2. Fatigue

2.2.2.2.3. Palpitations

2.2.2.2.4. Confusion

2.2.2.2.5. Dizziness

2.2.2.2.6. Hypotension

2.2.2.2.7. Bradycardia

2.2.2.2.8. Syncope

2.2.2.3. Treatment

2.2.2.3.1. Tranquilizers

2.2.2.3.2. Antiarrhythmic drugs

2.2.2.3.3. Digitalis

2.2.2.3.4. Potassium supplements

2.2.2.4. Nursing Considerations

2.2.2.4.1. Provide education to help the patient modify diet, smoking, and activity

2.2.2.4.2. Assess and monitor to detect subtle changes and atypical symptoms

2.2.2.4.3. Provide close observations and early problem detection to prevent MI

3. Gastrointestinal

3.1. Normal Aging Changes

3.1.1. Decreases taste sensation

3.1.2. Esophagus more dilated

3.1.3. Reduced saliva and salivary ptyalin

3.1.4. Liver smaller in size

3.1.5. Reduced intestinal blood flow

3.1.6. Decreased esophageal motility

3.1.7. Atrophy of gastric mucosa

3.1.8. Decreased stomach motility, hunger contractions, and emptying time

3.1.9. Less production of hydrochloric acid, pepsin, lipase, and pancreatic enzymes

3.2. Pathalogic Changes

3.2.1. Hiatal Hernia

3.2.1.1. Description

3.2.1.1.1. Affects about half of people in the U.S over 50

3.2.1.1.2. Low fiber diet may contribute to this

3.2.1.1.3. There are 2 types of this condition

3.2.1.2. Symptoms

3.2.1.2.1. Heartburn

3.2.1.2.2. Dysphagia

3.2.1.2.3. Belching

3.2.1.2.4. Vomiting

3.2.1.2.5. Regurgitation

3.2.1.2.6. Pain

3.2.1.2.7. Bleeding

3.2.1.3. Treatment

3.2.1.3.1. If obese, patient may be recommended weight reduction

3.2.1.3.2. Bland diet

3.2.1.3.3. Milk and antacids for symptom relief

3.2.1.3.4. Several small meals instead of 3 large ones

3.2.1.3.5. H2 blockers: ranitidine, cimetidine, nizatidine

3.2.1.3.6. Proton Pump Inhibitors: lansoprazole, and omeprazole

3.2.2. Diverticular disease

3.2.2.1. Diverticulosis

3.2.2.1.1. Description

3.2.2.1.2. Symptoms

3.2.2.1.3. Treatment

3.2.2.2. Diverticulitis

3.2.2.2.1. Description

3.2.2.2.2. Symptoms

3.2.2.2.3. Treatment

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. Between ages 20 and 90, renal blood flow decreases 53%, and glomerular filtration rate decreases 50%

4.1.6. Weaker bladder muscles

4.2. Pathalogic Changes

4.2.1. Urinary Incontinence

4.2.1.1. Description

4.2.1.1.1. More than half of the institutionalized older population, 90% of nursing home residents, and 24% of community based older adults have this condition

4.2.1.1.2. Transient

4.2.1.1.3. Established

4.2.1.2. Stress incontinence

4.2.1.2.1. Caused by weak supporting pelvic muscles

4.2.1.2.2. Intra-abdominal pressure is placed on the pelvic floor and urine is involuntarily lost

4.2.1.2.3. Obesity can contribute to this

4.2.1.2.4. Can be treated with kegel exercises, biofeedback, and medications

4.2.1.3. Urgency incontinence

4.2.1.3.1. Caused by UTI, enlargement of the prostate, diverticulitis, or pelvic bladder tumors

4.2.1.3.2. Irritation or spasms of the bladder cause sudden elimination

4.2.1.3.3. Can be treated by adherence to a toileting schedule and sometimes kegel exercises and medications

4.2.1.4. Overflow incontinence

4.2.1.4.1. Caused by bladder neck obstructions and medications such as anticholinergics, and calcium channel blockers

4.2.1.4.2. Bladder muscles fail to contract or periurethral muscles do not relax which causes excessive urine in the bladder

4.2.1.4.3. Could benefit from a toileting schedule, use of the Crede method, intermittent catheterization, and medicationss

4.2.1.5. Neurogenic Incontinence

4.2.1.5.1. Arises from cerebral cortex lesions, multiple sclerosis, and other disturbances in the neural pathway

4.2.1.5.2. Unable to sense the urge to urinate

4.2.1.6. Functional incontinence

4.2.1.6.1. Caused by dementia, disabilities that prevent independent toileting, sedation, inaccessible bathrooms, and medications that affect cognition

4.2.1.6.2. Can be treated with improvement of mobility or provision of a bedside commode

4.2.1.7. Mixed incontinence

4.2.1.7.1. Can be a combination of the above factors

4.2.1.8. Nursing Considerations

4.2.1.8.1. Inconsistency of nurses is detrimental to the progress of the patients, so it is important to be consistent in their care

4.2.1.8.2. Positive reinforcement and encouragement are beneficial

4.2.1.8.3. Use indwelling catheters only in special circumstances since they can lead to complications like UTIS

4.2.2. Glomerulonephritis

4.2.2.1. Description

4.2.2.1.1. Inflammation of the tiny filters in your kidneys

4.2.2.1.2. Can be acute or chronic, may older persons who have acute glomerulonphritis already have the chronic version

4.2.2.1.3. Can occur on its own or part of its disease

4.2.2.1.4. If severe, can lead to kidney damage

4.2.2.2. Symptoms

4.2.2.2.1. Can be subtle and nonspecific and often go unnoticed

4.2.2.2.2. Fever

4.2.2.2.3. Fatigue

4.2.2.2.4. Nausea

4.2.2.2.5. Vomiting

4.2.2.2.6. Anorexia

4.2.2.2.7. Abdominal pain

4.2.2.2.8. Anemia

4.2.2.2.9. Edema

4.2.2.2.10. Elevated blood pressure

4.2.2.2.11. Increased sedimentation rate

4.2.2.2.12. Oliguria, moderate proteinuria and hematuria can also occur

4.2.2.3. Treatment

4.2.2.3.1. Antibiotics

4.2.2.3.2. Restricted sodium and protein diet

4.2.2.3.3. Close attention to fluid intake and output

5. Male Reproductive

5.1. Normal Aging Changes

5.1.1. Fluid-retaining capacity of seminal vesicles reduces

5.1.2. Possible reduction in sperm count

5.1.3. Venous and arterial sclerosis of penis

5.1.4. Prostate enlarges in most men

5.2. Pathalogical Changes

5.2.1. Benign Prostatic Hyperplasia

5.2.1.1. Description

5.2.1.1.1. Most older men have some degree of BPH

5.2.1.1.2. Causes 1 in 4 men to have dysuria

5.2.1.1.3. Characterized by proliferation of the cellular elements of the prostate

5.2.1.1.4. Prostate becomes enlarged and can cause urine to be blocked from flowing out

5.2.1.1.5. Obstruction of the vesical neck and compression of the urethra that causes a compensatory hypertrophy of the detrusor muscle and subsequent outlet obstruction

5.2.1.1.6. Risk factors include a family history, obesity, type 2 diabetes, not enough exercise, and erectile dysfunction

5.2.1.2. Symptoms

5.2.1.2.1. Progress slowly but continuously

5.2.1.2.2. Begins with hesitancy,decreased force of urinary stream, frequency, and nocturia

5.2.1.2.3. Dribbling

5.2.1.2.4. Poor control

5.2.1.2.5. Overflow incontinence

5.2.1.2.6. Bleeding

5.2.1.2.7. Once the hyperplasia progresses, bladder loses its elasticity and becomes thinner, leading to urinary retention and an increased risk of urinary infection

5.2.1.2.8. Can leave to kidney damage if symptoms are not treated

5.2.1.3. Treatment

5.2.1.3.1. Prostatic massage

5.2.1.3.2. Urinary antiseptics

5.2.1.3.3. Avoidance of diuretics, anticholonergics, and anti arryhtmic agents if possible

5.2.1.3.4. Transurethral surgery-most common

6. Female Reproductive

6.1. Normal Aging Changes

6.1.1. Fallopian tubes atrophy and shorten

6.1.2. Ovaries become smaller and thicker

6.1.3. Cervix becomes smaller

6.1.4. Drier, less elastic vaginal canal

6.1.5. Flattening of labia

6.1.6. Endovervical epithelium atrophies

6.1.7. Uterus becomes smaller in size

6.1.8. Endometrium atrophies

6.1.9. More alkaline vaginal environment

6.1.10. Loss of vulvar subcutaenous fat and hair

6.2. Pathalogical Changes

6.2.1. Vaginitis

6.2.1.1. Causes

6.2.1.1.1. Fragility of vagina caused by normal aging changes:

6.2.1.1.2. Reduction in collagen and adipose tissue

6.2.1.1.3. Shortening and narrowing of vaginal canal

6.2.1.1.4. Decreased elasticity

6.2.1.1.5. Fewer vaginal secretions

6.2.1.1.6. More alkaline pH

6.2.1.2. Symptoms

6.2.1.2.1. Soreness

6.2.1.2.2. Pruritis

6.2.1.2.3. Burning

6.2.1.2.4. Reddened vagina

6.2.1.2.5. Foul smelling vaginal discharge that is clear, brown, or white

6.2.1.3. Treatment

6.2.1.3.1. Local estrogens in suppository or cream form

6.2.1.3.2. Boric acid

6.2.1.3.3. Zinc

6.2.1.3.4. Lysine

6.2.1.3.5. Gentian violet douches

6.2.1.4. Nursing Considerations

6.2.1.4.1. Ensure patients understand the proper use of medications

6.2.1.4.2. If patient is administering a douche at home, emphasize the need to measure the solutions temperature

6.2.1.4.3. Advise patient to avoid douches, use of scented soaps and perfumes to genitalia area, wear cotton underwear, and use lubricants during intercourse

7. Musculoskeletal

7.1. Normal Aging Changes

7.1.1. Shortening of vertebrae

7.1.2. Between ages 20 and 70, height decreases approximately 2 inches

7.1.3. Bones more brittle

7.1.4. Slight knee flexion

7.1.5. Decrease in bone mass and bone mineral

7.1.6. Slight kyphosis

7.1.7. Slight hip flexion

7.1.8. Slight wrist flexion

7.1.9. Impaired flexion and extension movements

7.2. Pathological Changes

7.2.1. Osteoperosis

7.2.1.1. Description

7.2.1.1.1. Most prevalent metabolic disease of the bone

7.2.1.1.2. Demineralization of the bone occurs, which is shown by a decrease in the mass and density of the skeleton

7.2.1.1.3. Can be caused by health problems associated with inadequate calcium intake, excessive calcium loss, or poor calcium absorption

7.2.1.1.4. Potential causes commonly found in older adults

7.2.1.2. Symptoms

7.2.1.2.1. May cause kyphosis and a reduction in height

7.2.1.2.2. Spinal pain

7.2.1.2.3. Bones may fracture more easily

7.2.1.2.4. Can by asymptomatic

7.2.1.3. Treatment

7.2.1.3.1. Depends on underlying cause of the disease

7.2.1.3.2. Calcium supplements

7.2.1.3.3. Vitamin D supplements

7.2.1.3.4. SERMS

7.2.1.3.5. Hormone therapy

7.2.1.3.6. Synthetic form of calcitonin

7.2.1.3.7. Biphosphonates

7.2.1.3.8. Diet rich in protein and calcium

7.2.1.3.9. Braces for the limbs

7.2.1.3.10. Bed board

7.2.1.3.11. Regular exercise

7.2.2. Gout

7.2.2.1. Symptoms

7.2.2.1.1. Severe pain and tenderness of the joint

7.2.2.1.2. Warmth, redness and swelling of the surrounding joint

7.2.2.1.3. Acute attack can cause the person to not be able to bear weight or have a blanket or clothing rest on the joint

7.2.2.1.4. Swelling

7.2.2.2. Treatment

7.2.2.2.1. Aims to reduce sodium urate

7.2.2.2.2. Low-purine diet

7.2.2.2.3. Alcohol should be avoided

7.2.2.2.4. Colchicine or phenylbutazone for acute attacks

7.2.2.2.5. Colchicine, allopurinol, probenecid, or indomethacin for long-term management

7.2.3. Description

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

7.2.3.2. Uric acid crystals are deposited in and around the joints

7.2.3.3. Attacks can be precipitated by thiazide diuretics

8. Neurologic

8.1. Normal Aging Changes

8.1.1. Decreased conduction velocity

8.1.2. Slower response and reaction time

8.1.3. Decreased brain weight

8.1.4. Reduced blood flow to the brain

8.1.5. Changes in sleep pattern

8.2. Pathological Changes

8.2.1. Parkinson's Disease

8.2.1.1. Description

8.2.1.1.1. Affects the ability of the CNS to control body movements which is a result of impaired function of basal ganglia in the midbrain

8.2.1.1.2. Occurs when nuerons that produce dopamine in the substantia nigra die or are impaired

8.2.1.1.3. The loss of dopamine causes symptoms of Parkinson's, and once the symptoms appear 80% of dopamine neurons have been lost

8.2.1.1.4. More common in men

8.2.1.1.5. Most often occurs in the 7th decade of life

8.2.1.1.6. Cause is unknown, but is thought that exposure to toxins, encephalitis, and cerebrovascular disease can lead to it

8.2.1.2. Symptoms

8.2.1.2.1. Faint tremor in hands or feet that progresses over a long time

8.2.1.2.2. Muscle rigidity and weakness

8.2.1.2.3. Mask like appearance

8.2.1.2.4. Moist skin

8.2.1.2.5. Bradykinesia

8.2.1.2.6. Poor balance

8.2.1.2.7. Shuffling gait

8.2.1.2.8. May become unable to ambulate

8.2.1.2.9. Secondary Symptoms

8.2.1.3. Treatment

8.2.1.3.1. Carbidopa/Levidopa

8.2.1.3.2. Anticholinergic

8.2.1.3.3. Amantadine

8.2.1.3.4. Mono oxidase inhibitors

8.2.1.3.5. Catechol-O-methyltransferase inhibitors

8.2.1.3.6. Deep brain stimulation

8.2.1.3.7. Active and passive range of motion exercises

8.2.1.4. Nursing Considerations

8.2.1.4.1. Close monitoring of drug therapy

8.2.1.4.2. If taking carbidopa/levidopa, patients should avoid foods high in Vitamin B

8.2.1.4.3. Offer psychological support and minimize emotional upsets

8.2.1.4.4. Educate about the disease and its management

8.2.1.4.5. Do not underestimate the mental abilities of the patients

8.2.1.4.6. Encourage communication and mental stimulation

8.2.1.4.7. Skillful assessment of deteriorating conditions

8.2.1.4.8. Assess caregivers for stress and fatigue

8.3. Transient Ischemic Attacks

8.3.1. Description

8.3.1.1. Temporary or intermittent neurologic events that result from reduced cerebral circulation

8.3.1.2. Hyperextension and flexion of the head can impair cerebral blood flow

8.3.1.3. Anemia, certain drugs, cigarette smoking, can decrease cerebral circulation

8.3.1.4. Increase risk of a CVA

8.3.2. Symptoms

8.3.2.1. Hemiparesis

8.3.2.2. Hemianesthesia

8.3.2.3. Aphasia

8.3.2.4. Unilateral loss of vision

8.3.2.5. Diplopia

8.3.2.6. Vertigo

8.3.2.7. Nausea

8.3.2.8. Vomiting

8.3.2.9. Dysphagia

8.3.3. Treatment

8.3.3.1. Correction of the underlying cause

8.3.3.2. Anticoagulation therapy

8.3.3.3. Vascular reconstruction

9. Sensory

9.1. Normal Aging Changes

9.1.1. Sight

9.1.1.1. More opaque lens

9.1.1.2. Decreased pupil size

9.1.1.3. More spherical cornea

9.1.1.4. Presbyopia

9.1.2. Smell

9.1.2.1. Impaired ability to indentify and discriminate among odors

9.1.2.2. Decrease in number of sensory cells in nasal lining

9.1.2.3. Fewer cells in the olfactory bulb of the brain

9.1.2.4. By age 80, the detection of scent is almost 50% as it was at it speak

9.1.3. Taste

9.1.3.1. High prevalance of taste impairment, although most likely due to factors other than normal aging changes

9.1.3.2. Atrophy of tongue

9.1.4. Touch

9.1.4.1. Reduction in tactile sensation

9.1.4.2. Can cause safety risks

9.1.5. Hearing

9.1.5.1. Presbycusis is a result of age related changes

9.1.5.2. Loss of hair cells

9.1.5.3. Decreased blood supply

9.1.5.4. Reduced flexibility of basilar membrane

9.1.5.5. Degeneration of spiral ganglion cells

9.1.5.6. Reduced production of endolymph

9.2. Pathalogical Changes

9.2.1. Cataracts

9.2.1.1. Descripton

9.2.1.1.1. Clouding of the lens or its capsule that causes the lens to lose its transparency

9.2.1.1.2. Common in older adults because everyone develops a degree of lens opacity with age

9.2.1.1.3. Leading cause of low vision in older adults

9.2.1.1.4. Can be caused by exposure to ultraviolet B, cigarettes, diabetes, high alcohol consumption, and eye injury

9.2.1.2. Symptoms

9.2.1.2.1. There is no discomfort or pain

9.2.1.2.2. Vision in distorted, night vision is decreased, and objects appeared blurred as the condition progresses

9.2.1.2.3. Trouble seeing street signs

9.2.1.2.4. Feeling of film over the eye

9.2.1.2.5. Lens opacity and vision loss will eventually happen

9.2.1.2.6. Lens becomes yellow or yellow brown due to nuclear sclerosis

9.2.1.2.7. Pupil turns cloudy white

9.2.2. Treatment

9.2.2.1. Surgery is the only cure, but every person has a unique condition and may not always need surgery

9.2.2.2. If surgery is not needed it would be because there is only a cataract in one eye and the other eye's vision is good

9.2.2.2.1. Patient would need to strengthen their visual capacity, reducing limitations, and perform safety measures

9.2.2.3. Sunglasses

9.2.2.4. Curtains over windows

9.2.2.5. Furniture placed away from bright lights

9.2.2.6. Several soft lights instead of fewer bright lights

9.2.2.7. Intracapsular extraction

9.2.2.8. Extracapsular extraction

10. Integumentary

10.1. Normal Aging Changes

10.1.1. Flattening of the dermal-epidermal junction

10.1.2. Reduced thickness and vascularity of the dermis

10.1.3. Slowing of epidermal proliferation

10.1.4. Collagen fibers become coarser and more random, reducing skin elasticity

10.1.5. Lines, wrinkles, and sagging

10.1.6. Skin becomes irritated and breaks down more easily

10.1.7. Reduction in the number of melanocytes by 10% to 20% each decade

10.1.7.1. Causes skin to tan more slowly and less deeply

10.1.8. Melanocytes cluster causing age spots

10.1.9. Skin immune response declines, causing older adults to be more prone to skin infections

10.1.10. Scalp, pubic, and axillary hair thins and grays due to progressive loss of pigment cells

10.1.11. Growth rate of scalp, pubic, and axillary hair declines

10.1.12. Fingernails grow more slowly, are fragile and brittle, longitudinal striations develop, and have a decrease in lunula size

10.1.13. Perspiration is slightly reduced due to decreased function of sweat glands

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

10.2.1.1.2. Grows slowly

10.2.1.1.3. Rarely metastasizes

10.2.1.1.4. Risk Factors

10.2.1.1.5. Commonly occurs on the face

10.2.1.1.6. Growth tends to be small, domed shape elevations covered by small blood vessels

10.2.1.2. Squamos Cell Carcinoma

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

10.2.1.2.2. Contributing Factors

10.2.1.2.3. Appear as firm, skin or red colored nodules

10.2.1.2.4. Usually stays in the epidermis but can metastasize

10.2.1.3. Melanoma

10.2.1.3.1. Tends to metastasize more easily

10.2.1.3.2. Classifications

10.2.1.3.3. Nursing Considerations

11. Immune

11.1. Normal Aging Changes

11.1.1. Thymic mass decreases decreases steadily after midlife

11.1.2. T-cell activity declines and more immature T cells are present in the thymus

11.1.3. T lymphocytes are less able to proliferate in response to mitogens

11.1.4. Inflammatory defenses decline, and imflammation presents atypically

12. Endocrine

12.1. Normal Aging Changes

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

12.1.2. Lower metabolic rate , reduced radioactive iodine uptake, and less thyrotropin due to decreased thyroid gland activity

12.1.3. Total serum iodine is reduced

12.1.4. The release of thyroidal iodine decreases, and excretion of the 17-ketosteroids declines

12.1.5. ACTH secretion decreases

12.1.6. Secretory activity of the adrenal gland decreases

12.1.7. Secretion of gluccocorticoids, progesterone, androgen, and estrogen are reduced

12.1.8. Pituitary gland decreases in volume by about 20%

12.1.9. Decrease in ACTH, TSH, follicle-stimulating hormone, luteinizing hormone, and luteotropic hormone

12.1.10. Delayed and insufficient release of insulin

12.1.11. Reduced ability to metabolize glucose, causing a higher blood sugar

12.2. Pathalogical Changes

12.2.1. Hypothyroidism

12.2.1.1. Description

12.2.1.1.1. Subnormal concentration of thyroid hormone

12.2.1.1.2. Increases in prevalence with age and is more common in women

12.2.1.1.3. Primary-resulting from a disease process that destroys the thyroid gland

12.2.1.1.4. Secondary- insufficient pituitary secretion of thyroid-stimulating hormone

12.2.1.2. Symptoms

12.2.1.2.1. Fatigue

12.2.1.2.2. Weakness

12.2.1.2.3. Lethargy

12.2.1.2.4. Depression

12.2.1.2.5. Anorexia

12.2.1.2.6. Weight gain and puffy face

12.2.1.2.7. Impaired hearing

12.2.1.2.8. Periorbital or peripheral edema

12.2.1.2.9. Constipation

12.2.1.2.10. Cold intolerance

12.2.1.2.11. Myalgia

12.2.1.2.12. Parasthesia

12.2.1.2.13. Ataxia

12.2.1.2.14. Dry skin

12.2.1.2.15. Coarse hair

12.2.1.3. Treatment

12.2.1.3.1. Replacement of thyroid hormone using a synthetic T4

12.2.2. Diabetes Mellitus

12.2.2.1. Description

12.2.2.1.1. Glucose intolerance is a common occurrence among older adults

12.2.2.1.2. Type 2 diabetes affects 20% of the older population

12.2.2.1.3. A physiologic deterioration of glucose tolerance may be a cause

12.2.2.1.4. More likely, increased amounts of fat tissue present in older adults and who are obese and inactive can cause Type 2

12.2.2.2. Indications and Diagnosis

12.2.2.2.1. Orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, neuropathym confusion, glaucoma, and infection are indicators

12.2.2.2.2. Fasting blood sugar is recommended every 3 years over the age of 45

12.2.2.2.3. Glucose tolerance test is the most effective diagnostic tool

12.2.2.2.4. Usually diagnosed from one of these criteria

12.2.2.2.5. Management of the Disease

13. Reference

13.1. Eliopoulos, C. (2018). Gerentological nursing. Philadelphia: Wolters Kluwer.