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 Description and Patho Pneumococcal pneumonia is the most common type and is caused by Streptococcus pneumoniae Other pneumonias are caused by gram-negative bacilli The other types are Klebsiella pneumoniae, Legionella pneumophila, anaerobic bacteria, and influenze Symptoms Differences in body temperature may cause minimal or no fever Slight cough Fatigue Rapid perspiration Confusion Restlessness Behavioral changes Nursing Considerations Close observation for subtle changes Encourage mobility to prevent parylitic ileus Encourage pneumococcal vaccine over the age of 65

1.2.2. Emphysema Causes Chronic bronchitis Chronic irritation from dusts or air pollutants Distension of alveolar sacs Rupture of the alveolar walls Destruction of alveolar capillary beds Symptoms Increased dyspnea Chronic cough develops Fatigue Anorexia Weight loss Weakness Recurrent respiratory infection Malnutrition Treatment Postural drainage Bronchodilators Avoid stressful situations Breathing exercises Cessation of smoking Nursing Considerations Assess for lack of energy to consume food, and arrange for dietary interventions if needed Use oxygen with extreme caution and close supervision Prevent respiratory infections, and report it immediately to the physician if present Sedatives, hypnotics, and narcotics may be contraindicated 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 Description Leading cause of hospitilization in older adults Common in older adults because of common aging changes Causes and Risk Factors Coronary Artery Disease is responsible for most cases Diabetes mellitus Dyslipidemia Sleep-disordered breathing Albuminiura Anemia Chronic Kidney Disease Use of illicit drugs Sedentary lifestyle Psychological stress Symptoms Dyspnea on exertion Confusion Insomnia Wandering during the night Agitation Depression Anorexia Shortness of breath Orthopnea Wheezing Weight gain Crackles on asucultation Categories Class 1 Class 2 Class 3 Class 4 Treatment Bed rest ACE Inhibitors Beta-blockers Digitalis Diuretics Reduction in sodium intake

2.2.2. Arrhythmias Causes Digitalis toxicity Hypokalemia Acute infections Hemorrhage Anginal syndrome Coronary insufficiency Symptoms Weakness Fatigue Palpitations Confusion Dizziness Hypotension Bradycardia Syncope Treatment Tranquilizers Antiarrhythmic drugs Digitalis Potassium supplements Nursing Considerations Provide education to help the patient modify diet, smoking, and activity Assess and monitor to detect subtle changes and atypical symptoms 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 Description Affects about half of people in the U.S over 50 Low fiber diet may contribute to this There are 2 types of this condition Symptoms Heartburn Dysphagia Belching Vomiting Regurgitation Pain Bleeding Treatment If obese, patient may be recommended weight reduction Bland diet Milk and antacids for symptom relief Several small meals instead of 3 large ones H2 blockers: ranitidine, cimetidine, nizatidine Proton Pump Inhibitors: lansoprazole, and omeprazole

3.2.2. Diverticular disease Diverticulosis Description Symptoms Treatment Diverticulitis Description Symptoms 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 Description More than half of the institutionalized older population, 90% of nursing home residents, and 24% of community based older adults have this condition Transient Established Stress incontinence Caused by weak supporting pelvic muscles Intra-abdominal pressure is placed on the pelvic floor and urine is involuntarily lost Obesity can contribute to this Can be treated with kegel exercises, biofeedback, and medications Urgency incontinence Caused by UTI, enlargement of the prostate, diverticulitis, or pelvic bladder tumors Irritation or spasms of the bladder cause sudden elimination Can be treated by adherence to a toileting schedule and sometimes kegel exercises and medications Overflow incontinence Caused by bladder neck obstructions and medications such as anticholinergics, and calcium channel blockers Bladder muscles fail to contract or periurethral muscles do not relax which causes excessive urine in the bladder Could benefit from a toileting schedule, use of the Crede method, intermittent catheterization, and medicationss Neurogenic Incontinence Arises from cerebral cortex lesions, multiple sclerosis, and other disturbances in the neural pathway Unable to sense the urge to urinate Functional incontinence Caused by dementia, disabilities that prevent independent toileting, sedation, inaccessible bathrooms, and medications that affect cognition Can be treated with improvement of mobility or provision of a bedside commode Mixed incontinence Can be a combination of the above factors Nursing Considerations Inconsistency of nurses is detrimental to the progress of the patients, so it is important to be consistent in their care Positive reinforcement and encouragement are beneficial Use indwelling catheters only in special circumstances since they can lead to complications like UTIS

4.2.2. Glomerulonephritis Description Inflammation of the tiny filters in your kidneys Can be acute or chronic, may older persons who have acute glomerulonphritis already have the chronic version Can occur on its own or part of its disease If severe, can lead to kidney damage Symptoms Can be subtle and nonspecific and often go unnoticed Fever Fatigue Nausea Vomiting Anorexia Abdominal pain Anemia Edema Elevated blood pressure Increased sedimentation rate Oliguria, moderate proteinuria and hematuria can also occur Treatment Antibiotics Restricted sodium and protein diet 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 Description Most older men have some degree of BPH Causes 1 in 4 men to have dysuria Characterized by proliferation of the cellular elements of the prostate Prostate becomes enlarged and can cause urine to be blocked from flowing out Obstruction of the vesical neck and compression of the urethra that causes a compensatory hypertrophy of the detrusor muscle and subsequent outlet obstruction Risk factors include a family history, obesity, type 2 diabetes, not enough exercise, and erectile dysfunction Symptoms Progress slowly but continuously Begins with hesitancy,decreased force of urinary stream, frequency, and nocturia Dribbling Poor control Overflow incontinence Bleeding Once the hyperplasia progresses, bladder loses its elasticity and becomes thinner, leading to urinary retention and an increased risk of urinary infection Can leave to kidney damage if symptoms are not treated Treatment Prostatic massage Urinary antiseptics Avoidance of diuretics, anticholonergics, and anti arryhtmic agents if possible 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 Causes Fragility of vagina caused by normal aging changes: Reduction in collagen and adipose tissue Shortening and narrowing of vaginal canal Decreased elasticity Fewer vaginal secretions More alkaline pH Symptoms Soreness Pruritis Burning Reddened vagina Foul smelling vaginal discharge that is clear, brown, or white Treatment Local estrogens in suppository or cream form Boric acid Zinc Lysine Gentian violet douches Nursing Considerations Ensure patients understand the proper use of medications If patient is administering a douche at home, emphasize the need to measure the solutions temperature 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 Description Most prevalent metabolic disease of the bone Demineralization of the bone occurs, which is shown by a decrease in the mass and density of the skeleton Can be caused by health problems associated with inadequate calcium intake, excessive calcium loss, or poor calcium absorption Potential causes commonly found in older adults Symptoms May cause kyphosis and a reduction in height Spinal pain Bones may fracture more easily Can by asymptomatic Treatment Depends on underlying cause of the disease Calcium supplements Vitamin D supplements SERMS Hormone therapy Synthetic form of calcitonin Biphosphonates Diet rich in protein and calcium Braces for the limbs Bed board Regular exercise

7.2.2. Gout Symptoms Severe pain and tenderness of the joint Warmth, redness and swelling of the surrounding joint Acute attack can cause the person to not be able to bear weight or have a blanket or clothing rest on the joint Swelling Treatment Aims to reduce sodium urate Low-purine diet Alcohol should be avoided Colchicine or phenylbutazone for acute attacks Colchicine, allopurinol, probenecid, or indomethacin for long-term management

7.2.3. Description Metabolic disorder in which excess uric acid accumulates in the blood Uric acid crystals are deposited in and around the joints 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 Description Affects the ability of the CNS to control body movements which is a result of impaired function of basal ganglia in the midbrain Occurs when nuerons that produce dopamine in the substantia nigra die or are impaired The loss of dopamine causes symptoms of Parkinson's, and once the symptoms appear 80% of dopamine neurons have been lost More common in men Most often occurs in the 7th decade of life Cause is unknown, but is thought that exposure to toxins, encephalitis, and cerebrovascular disease can lead to it Symptoms Faint tremor in hands or feet that progresses over a long time Muscle rigidity and weakness Mask like appearance Moist skin Bradykinesia Poor balance Shuffling gait May become unable to ambulate Secondary Symptoms Treatment Carbidopa/Levidopa Anticholinergic Amantadine Mono oxidase inhibitors Catechol-O-methyltransferase inhibitors Deep brain stimulation Active and passive range of motion exercises Nursing Considerations Close monitoring of drug therapy If taking carbidopa/levidopa, patients should avoid foods high in Vitamin B Offer psychological support and minimize emotional upsets Educate about the disease and its management Do not underestimate the mental abilities of the patients Encourage communication and mental stimulation Skillful assessment of deteriorating conditions Assess caregivers for stress and fatigue

8.3. Transient Ischemic Attacks

8.3.1. Description Temporary or intermittent neurologic events that result from reduced cerebral circulation Hyperextension and flexion of the head can impair cerebral blood flow Anemia, certain drugs, cigarette smoking, can decrease cerebral circulation Increase risk of a CVA

8.3.2. Symptoms Hemiparesis Hemianesthesia Aphasia Unilateral loss of vision Diplopia Vertigo Nausea Vomiting Dysphagia

8.3.3. Treatment Correction of the underlying cause Anticoagulation therapy Vascular reconstruction

9. Sensory

9.1. Normal Aging Changes

9.1.1. Sight More opaque lens Decreased pupil size More spherical cornea Presbyopia

9.1.2. Smell Impaired ability to indentify and discriminate among odors Decrease in number of sensory cells in nasal lining Fewer cells in the olfactory bulb of the brain By age 80, the detection of scent is almost 50% as it was at it speak

9.1.3. Taste High prevalance of taste impairment, although most likely due to factors other than normal aging changes Atrophy of tongue

9.1.4. Touch Reduction in tactile sensation Can cause safety risks

9.1.5. Hearing Presbycusis is a result of age related changes Loss of hair cells Decreased blood supply Reduced flexibility of basilar membrane Degeneration of spiral ganglion cells Reduced production of endolymph

9.2. Pathalogical Changes

9.2.1. Cataracts Descripton Clouding of the lens or its capsule that causes the lens to lose its transparency Common in older adults because everyone develops a degree of lens opacity with age Leading cause of low vision in older adults Can be caused by exposure to ultraviolet B, cigarettes, diabetes, high alcohol consumption, and eye injury Symptoms There is no discomfort or pain Vision in distorted, night vision is decreased, and objects appeared blurred as the condition progresses Trouble seeing street signs Feeling of film over the eye Lens opacity and vision loss will eventually happen Lens becomes yellow or yellow brown due to nuclear sclerosis Pupil turns cloudy white

9.2.2. Treatment Surgery is the only cure, but every person has a unique condition and may not always need surgery 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 Patient would need to strengthen their visual capacity, reducing limitations, and perform safety measures Sunglasses Curtains over windows Furniture placed away from bright lights Several soft lights instead of fewer bright lights Intracapsular extraction 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 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 Basal Cell Carcinoma Most common form of skin cancer Grows slowly Rarely metastasizes Risk Factors Commonly occurs on the face Growth tends to be small, domed shape elevations covered by small blood vessels Squamos Cell Carcinoma Are on the surface of the skin, the lining of the hollow organs of the body, and the passages of respiratory and digestive tracts Contributing Factors Appear as firm, skin or red colored nodules Usually stays in the epidermis but can metastasize Melanoma Tends to metastasize more easily Classifications 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 Description Subnormal concentration of thyroid hormone Increases in prevalence with age and is more common in women Primary-resulting from a disease process that destroys the thyroid gland Secondary- insufficient pituitary secretion of thyroid-stimulating hormone Symptoms Fatigue Weakness Lethargy Depression Anorexia Weight gain and puffy face Impaired hearing Periorbital or peripheral edema Constipation Cold intolerance Myalgia Parasthesia Ataxia Dry skin Coarse hair Treatment Replacement of thyroid hormone using a synthetic T4

12.2.2. Diabetes Mellitus Description Glucose intolerance is a common occurrence among older adults Type 2 diabetes affects 20% of the older population A physiologic deterioration of glucose tolerance may be a cause More likely, increased amounts of fat tissue present in older adults and who are obese and inactive can cause Type 2 Indications and Diagnosis Orthostatic hypotension, periodontal disease, stroke, gastric hypotony, impotence, neuropathym confusion, glaucoma, and infection are indicators Fasting blood sugar is recommended every 3 years over the age of 45 Glucose tolerance test is the most effective diagnostic tool Usually diagnosed from one of these criteria Management of the Disease

13. Reference

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