The Elderly Person

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The Elderly Person by Mind Map: The Elderly Person

1. Filtration efficiency of the kidneys decreases affecting the body’s ability to eliminate drugs

2. Cathedral associated UTIs are the single most common type of health care associated infection

3. Urinary Elimination

3.1. Age related changes

3.1.1. Increased urinary frequency

3.1.1.1. Caused by hypertrophy of the bladder muscle and thickening of the bladder

3.1.2. Nocturia

3.1.3. INCONTINENCE IS NOT A NORMAL CHANGE OF AGING

3.1.3.1. E

3.1.3.2. Inefficient bladder emptying can cause urine retention

3.2. Urinary Conditions

3.2.1. Urinary Tract Infection

3.2.1.1. Most common infection in older adults and increase in prevalence with age

3.2.1.1.1. More frequent in women than men

3.2.1.2. Inefficient bladder emptying can be a cause

3.2.1.3. Symptoms include: burning, urgency, fever

3.2.2. Urinary incontinenece

3.2.2.1. Present in more than half of the institutionalized older population and as many as 90%of nursing home residents with dementia

3.2.2.2. Transient Incontinence

3.2.2.2.1. Acute and reversible, caused by infections, delirium, medication reactions, excessive urine production, fecal impaction, mood disorders

3.2.2.3. Established incontinence

3.2.2.3.1. Chronic and persistent

3.2.3. Glomerulonephritis

3.2.3.1. Usually already exists in persons who develop acute condition

3.2.3.2. Symptoms include fever, fatigue, nausea, vomitting, anorexia, abdominal pain, anemia, edema, arthralgias, elevated BP, increased sedimentation rate

4. Respiratory

4.1. Age related changes

4.1.1. Increased nasal septal deviations

4.1.2. Reduced secretions from sub mucosal gland

4.1.2.1. Mucus in nasopharyngeal to be thicker and harder to expel

4.1.3. Nasal passages have thicker hair

4.1.3.1. Interferes with normal inspiration of air

4.1.4. Calcification of cartilage in trachea causes stiffening

4.1.4.1. Coughing reduced

4.1.4.2. Gag reflex weaker

4.1.5. Lungs become smaller in size and weight

4.1.6. connective tissues responsible for respiration weaker

4.1.7. Elastic recoil during expiration is decreased

4.1.8. Reduction in vital capacity

4.1.8.1. Alveoli are less elastic

4.1.8.2. Loss of skeletal muscle strength in thorax and diaphragm

4.1.9. External age related changes that affect respiratory system

4.1.9.1. Reduced body fluid, reduced fluid intake

4.1.9.1.1. Drier mucus membranes causing mucus plugs and infection

4.1.9.2. Altered pain sensation

4.1.9.3. Different norms for body temp can cause fever to go unnoticed

4.1.9.4. Relaxed sphincters and lower gastric motility can contribute to aspiration

4.1.9.5. Impaired mobility can reduce respiratory function

4.2. Common respiratory conditions

4.2.1. Chronic Obstructive Pulmonary Disease

4.2.1.1. Includes a group of diseases such as asthma, chronic bronchitis, emphysema

4.2.1.1.1. Asthma

4.2.1.1.2. Chronic Bronchitis

4.2.1.1.3. Emphysema

4.2.2. Pnneumonia

4.2.2.1. Leading cause of death in older adults due to

4.2.2.1.1. Poor chest expansion and shallow breathing due to age related changes

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

4.2.2.1.3. Lower resistance to infection

4.2.2.1.4. Reduced pharyngeal reflexes

4.2.2.1.5. Higher likelihood for older adults to be hospitalized and develop nosocomial pneumonia

4.2.2.1.6. Higher incidence of reduced mobility and debilitation

4.2.2.2. Signs and symptoms may be altered in older persons

4.2.3. Influenza

4.2.3.1. Influenza A most serious cause of illness and death in older adults

4.2.3.2. Age related change of impaired immune response means older person is highly susceptible

4.2.3.3. Secondarily bacterial infections and other complications

4.2.3.3.1. Patients with chronic respiratory, cardiac, or metabolic disease

4.2.3.4. Non pulmonary complications can include myositis, pericarditis, Giuliani Barre syndrome, encephalitis, loss of smell or taste

4.2.3.5. Vaccine recommended

4.2.4. Lung Cancer

4.2.4.1. Mostly in patients older than 65

4.2.4.1.1. Smokers

4.2.4.2. More frequent in men

4.2.4.3. Environmental exposures in crease risk

4.2.4.4. Higher incidence based on ethnicity

4.2.4.4.1. In order from highest to lowest: Black, American Indian/ Alaskan NAtive, Asian Pacific Islander, Hispanic Women

5. Cardiovascular

5.1. Age related changes

5.1.1. Heart Valves increase in thickness and rigidity

5.1.2. Aorta becomes dialated

5.1.2.1. Ventricular hypertrophy develops

5.1.2.2. Thickening of left ventricular wall

5.1.3. Myocardial muscle is less efficient, losses contractility

5.1.3.1. Reduction in cardiac output when demands on heart are increased

5.1.4. More time required for diastolic filling and systolic emptying

5.1.5. Blood Pressure becomes harder to regulate

5.1.5.1. Calcification and reduced elasticity of the vessels

5.1.6. Conditions that alter tissue perfusion in older adults

5.1.6.1. Cardiovascular disease

5.1.6.2. Diabetes, cancer, renal failure

5.1.6.3. Anemia, thrombus, and transfusion reactions

5.1.6.4. Hypotension, hypovolemia, hypoglycemia, hyperglycemia, orthostatic hypotension

5.1.6.5. Medications

5.1.6.5.1. Antihypertensives

5.1.6.5.2. Vasodialators

5.1.6.5.3. Diuretics

5.1.6.5.4. Antipsychotics

5.1.6.6. Edema, inflammation, prolonged immobility, hypothermia and malnutrition

5.2. Cardiovascular conditions

5.2.1. Hypertension

5.2.1.1. Most prevalent cardiovascular disease of older adults

5.2.1.1.1. Vasoconstriction associated with aging

5.2.1.2. Symptoms can include

5.2.1.2.1. Awakening with a dull headache

5.2.1.2.2. Impaired memory

5.2.1.2.3. Disorientation

5.2.1.2.4. Confusion

5.2.1.2.5. Epitaxis

5.2.1.2.6. Slow tremor

5.2.1.3. Encourage older adults to try non medicated methods to control BP as some antihypertensives have a higher incidence of adverse reactions in older adults

5.2.2. Hypotension

5.2.2.1. Older adults experience postural and post prandial hypotension

5.2.2.1.1. Due to increased intake of vasoactive medications decrease in physiologic function such as baroreceptor sensitivity

5.2.3. Congestive Heart Failure

5.2.3.1. Leading cause of hospitalization in older adults

5.2.3.2. CAD responsible for most cases of CHF

5.2.3.2.1. Other risk factors include DM, dyslipidemia, sleep disordered breathing, albuminuria, anemia, chronic kidney disease, illicit drugs, sedentary lifestyle, stress

5.2.3.3. Symptoms include dyspnea on exertion, confusion, insomnia, depression, anorexia, nauseas, weakness, SOB, ankle edema, wheezing, weight gain

5.2.3.4. Managed with ACE inhibitors, beta-blockers, digitalis, a reduction in sodium intake

5.2.3.5. Skin breakdown is a risk of this disease

5.2.3.5.1. Edema

5.2.3.5.2. Poor nutrition of the tissue

5.2.4. Pulmonary Emboli

5.2.4.1. Patients at high risk for developing this are those with a fractured hip, CHF, arrhythmia, a history of thombosis

5.2.4.2. Immobilization and poor nutrition can contribute to development of this disease

5.2.4.3. Symptoms include confusion, apprehension, increasing dyspnea, slight temperature, pneumonia is

5.2.4.4. Older people may not experience chest pain due to decreased pain sensation

5.2.5. Coronary Artery Disease

5.2.5.1. Angina

5.2.5.1.1. Pain can be vague and less intense in older adults

5.2.5.1.2. Nitrates can be helpful in treating

5.2.5.1.3. Factors that may aggravate this problem are cold wind, emotional stress, anemia, tachycardia, arrhythmia, hyperthyroidism, and strenuous activity

5.2.5.2. Myocardial infarction

5.2.5.2.1. More common in men with hypertension and arteriosclerosis

5.2.5.2.2. Symptoms include pain radiating to the left arm, the entire chest, the neck, the jaw, the abdomen, numbness in arms, neck, or back,decreased bp, Moist pale skin, syncope, SOB, cough, low grade fever

5.2.5.2.3. Early ambulatory is encouraged after an MI

5.2.5.2.4. Thrombolytic therapy used

5.2.6. Peripheral Vascular Disease

6. Gastrointestinal

6.1. Interfere with absorption or PROTEIN

6.2. Age related changes

6.2.1. Tongue atrophy

6.2.1.1. Affects taste buds and decreases taste sensation

6.2.2. Decreased saliva production

6.2.2.1. Swallowing may be more difficult

6.2.3. Decreased oral mucosa, weakening of muscles involves in mastication

6.2.3.1. Reduction in chewing

6.2.4. Loose teeth

6.2.5. Weaker esophageal contractions and weakness of the sphinter

6.2.6. Decreased elasticity of the stomach reduces amount of food one can eat

6.2.7. Reduce presence on PEPSIN

6.2.8. Slower Peristalsis

6.2.8.1. Increased constipation

6.2.9. Gall bladder function, bile ducts and liver remain UNCHANGED

6.3. GI conditions

6.3.1. Dysphagia

6.3.1.1. Common causes are GERD, stroke, structural disorders

6.3.1.2. Oropharyngeal

6.3.1.2.1. Difficulty transferring food bonus or liquid from mouth into the pharynx and esophagus

6.3.1.3. Esophageal

6.3.1.3.1. Difficulty with the transfer of food down the esophagus

6.3.2. Diverticula disease

6.3.2.1. Multiple pouches of intestinal mucosa in the weakened muscular wall of the large bowel.. common in older persons.

6.3.2.1.1. Chronic constipation, obesity, hiatal hernia, and atrophy of the intestinal walls contribute to this

6.3.2.2. Symptoms include, slight bleeding, change in bowel habits, tenderness on palpating of the lower left quadrant

6.3.2.3. Over eating, straining during a bowel movement, alcohol, and irritating foods contribute

6.3.3. Intestinal obstruction

6.3.3.1. Most often occurs due to cancer of the colon

6.3.3.1.1. Other causes include diverticulitis, ulcerative colitis, hypokalemia, vascular problems, paralytic ileum, a mechanical obstruction

6.3.3.2. Note bowel sounds

7. Endocrine

7.1. Age related changes

7.1.1. Thyroid gland atrophied and activity decreases

7.1.1.1. Lower basal metabolic rate

7.1.1.2. Reduced radioactive iodine uptake

7.1.1.3. Less secretion and release of thyrotropin

7.1.2. Adrenocorticotropic hormone secretion decreases

7.1.2.1. Reduces secretionactivity of the adrenal gland which reduces the secretion of estrogen, progesterone, androgen, 17-ketosteroids, and glucocorticoids

7.1.3. Insufficient release of insulin.. reduced ability to metabolize glucose

7.2. Common Endocrine conditions

7.2.1. Diabetes Mellitus

7.2.1.1. 7th leading cause of death amount older adults

7.2.1.1.1. Highest in African Americans 65-74 years old

7.2.1.2. Some indications of DM in older adults include : orthostatic hypotension, periodontal disease, stroke, gastric hypotonic, impotence, neuropathy, confusion, glaucoma, infection

7.2.1.3. Diabetes can be managed well with medication but older adults may not realize the improvements in medicine had made so much progress

7.2.2. Hyoerthyroidism

7.2.2.1. Thyroid glad secretes excess amounts of thyroid hormone

7.2.2.2. Less prevalent in older adults that hypothyroidism and more prevalent in women

7.2.2.3. Amiodarone, a. Cardiac drug used for older adults, can be a cause due to iodine delivered by the drug into the tissues

7.2.2.4. Symptoms include: diaphoresis, tachycardia, palpitations,hypertension’s, tremor, diarrhea, insomnia, increased hunger, nervousness, muscle weakness

7.2.3. HYpothyroidism

7.2.3.1. A subnormal concentration of thyroid hormone

7.2.3.1.1. Increases in prevalence with age. More common in women

7.2.3.2. Symptoms include: fatigue, weakness, lethargy, depression, anorexia, weight gain, periorbital or peripheral edema, cold intolerance, dry skin, coarse hair

8. Integumentary

8.1. Age related changes

8.1.1. Increased fragility of skin

8.1.1.1. Pressure ulcers, bruises

8.1.2. Lines, wrinkles, thicker nails, graying hair

8.1.3. Psychosocial factors

8.1.3.1. Body image, socialization, self image

8.2. Integumentary conditions

8.2.1. Pruitis

8.2.1.1. Most common dermatological problem in older adults

8.2.1.2. Can be caused by problems that dry peoples skin

8.2.1.3. Untreated itching may cause traumatizing scratching that leads to breakage and infection

8.2.2. Skin Cancer

8.2.2.1. Three major skin cancers common in older age

8.2.2.1.1. Basal cell carcinoma

8.2.2.1.2. Squamous cell carcinoma

8.2.2.1.3. Melanoma

8.2.3. Vascular legions

8.2.3.1. Age related changes weaken the walls of the veins and reduce the ability to respond to increased venous pressure

8.2.3.2. Poor Venus return and congestion lead to edema of the lower extremeties

8.2.3.3. Infection must be controlled and monitored. Older adults must educated on how to care for ulcers

8.2.4. Pressure Injury

8.2.4.1. Most common sites of pressure ulcers are sacrum, greater trochanter, and ischial tuberosities... although they can happen anywhere

8.2.4.2. Older adults at higher risk

8.2.4.2.1. They have skin that is fragile and damages easily

8.2.4.2.2. Are often in a poor nutritional state

8.2.4.2.3. Have reduced sensation of pressure and pain

8.2.4.2.4. Are more frequently affected by immobile and edematous conditions, which contribute to skin breakdown

8.2.4.3. Require a longer time to heal in older adults

8.2.4.4. 5 stages of pressure ulcers

8.2.4.4.1. Stage 1 - No break in skin, redness that does. Not disappear when blanched

8.2.4.4.2. Stage 2 - partial thickness loss of skin layers involving the epidermis

8.2.4.4.3. Stage 3 - Full thickness of skin is lost extending through the epidermis and exposing sub q tissue

8.2.4.4.4. Stage 4 - Full thickness of skin and sun q tissue is lost, exposing muscle, bone, or both

8.2.4.4.5. UNSTAGEABLE - Full thickness loss of tissue with base covered by slough and/or eschar

9. Neorological

9.1. Age related changes

9.1.1. Loss of nerve cell mass causes atrophy of the brain and spinal cord

9.1.2. Demyelination of cells occurs

9.1.2.1. Slow nerve conduction. Response and reaction times are slower

9.1.3. Cerebral blood flow decreases

9.1.3.1. Increased risk of strokes

9.2. Common Neurological conditions

9.2.1. Pakinsons

9.2.1.1. Affects the ability of the central nervous system to control body movements as a result of the impaired function of the basal ganglia in the midbrain

9.2.1.2. Dopamine is needed to control. Movements. Treatments involve dopamine

9.2.1.3. More common in men

9.2.1.4. Symptoms include: Shuffling gait, dysphagia, decreased blinking, drooling

9.2.2. Transient Ischemic attacks

9.2.2.1. Results from reduced cerebral circulation

9.2.2.2. Symptoms include : hemiparesis, hemianesthesia, aphasia, unilateral loss of vision, diplopia, vertigo, nausea, vomiting, and dysphagia

9.2.2.3. Recovery is usual within a day

9.2.3. Cerebrovascular Incidents

9.2.3.1. Third leading cause of death and a major cause of disability in the older adult.

9.2.3.2. Older people at high risk include: hypertension, hypothyroidism, sever arteriosclerosis, diabetes, gout, anemia, silent MI, TIAS, dehydration, and smokers

9.2.3.3. Two types of CVA

9.2.3.3.1. Ischemic

9.2.3.3.2. Hemorragic

10. Musculoskeletal

10.1. Age related changes

10.1.1. Reduction in muscle mass decrease body strength

10.1.2. Reduced flexibility of joints and muscles

10.1.3. Sarcopenia - a decline in walking speed or grip strength

10.1.3.1. Caused by disease, immobility, decreased caloric intake, poor blood flow to muscles, mitochondrial dysfunction, a decline in anabolic hormones

10.1.4. Activity can also be affected by psychological factors

10.1.4.1. Loss of a spouse and friends

10.1.4.2. retirement

10.2. Common Musculoskeletal conditions

10.2.1. Rheumatoid Arthritis

10.2.1.1. Unusually develops earlier in life and becomes more debilitating with age

10.2.1.2. The synovium becomes hypertrophied and edematous with projections of synovial tissue protruding into the joint cavity

10.2.1.2.1. Joints are painful, stiff, swollen, red, and warm to the touch

10.2.2. Gout

10.2.2.1. Metabolic disorder in which excess Uris acid accumulates isn’t he blood

10.2.2.1.1. Uris acid crystals are deposited in and around the joints causing sever pain and tenderness of the joint and warmth, redness, and swelling of the surrounding tissue

10.2.2.2. Attacks can last from weeks to months

10.2.2.3. Avoid alcohol and red meat

10.2.2.4. Nurses should encourage fluid to reduce crystal formation

10.2.3. Fractures

10.2.3.1. The neck of the femur is a common site for fractures in older people

10.2.3.2. Most fractures result from falls

10.2.3.3. Older people also at risk for compression fractures of the vertebrae from falls or lifting heavy objects

10.2.3.4. Bones of older people heal slower and are more brittle

11. Vision

11.1. Age relates changes

11.1.1. Presbyopia -inability to focus on close objects clearly

11.1.2. Decreased peripheral vision

11.1.3. Pupil size reduction, less reactive to light

11.1.4. Depth perception distortion

11.1.5. Decline in visual acuity, reduction of elasticity of lenses, macular degeneration

12. Reproductive

12.1. Age related changes for women

12.1.1. Hormonal changes cause the vulva to atrophy

12.1.2. Flattening f the labia

12.1.3. Vaginal environment drier and more alkaline

12.1.3.1. Intercourse uncomfortable

12.1.4. Cervix, uterus, Fallopian tubes, and ovaries atrophy

12.2. Reproductive system condition

12.2.1. Vaginitis

12.2.1.1. Potmenapausal

12.2.1.2. Symptoms: soreness, pruitis, burning, reddened vagina, foul smelling vaginal discharge that is clear, brown, or white

12.2.2. Erectile Dysfunction

12.2.2.1. Inability to achieve or sustain an erection for intercourse

12.2.2.2. NOT A NORMAL OUTCOME OF AGING

12.3. Age related changes for men

12.3.1. Reduction in sperm count related to seminal vessels having a thinne repithelium

12.3.2. Structural changes in the seminiferous tubules

12.3.3. Atrophy of the testes

12.3.4. More time for erection, more easily lost

12.3.5. Enlargement of the prostate