Gerontological Concept Map

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Gerontological Concept Map by Mind Map: Gerontological Concept Map

1. Musculoskeletal

1.1. Normal Changes of Aging

1.1.1. DECREASED:

1.1.1.1. Size & # of muscle fibers

1.1.1.2. Muscle mass

1.1.1.3. Flexibility of joints d/t changes in connective tissue

1.1.2. Sarcopenia

1.2. Pathologies

1.2.1. Fractures

1.2.1.1. Brittle bones fracture more easily and heal at a slower rate

1.2.1.2. Common sites: radius, hip, compression fractures of vertebrae (falls)

1.2.2. Osteoarthritis: progressive deterioration of joint cartilage

1.2.2.1. S/S: grading crepitation, heavy aching pain in the joints

1.2.2.2. Common sites: hips, knees, vertebrae, fingers

1.2.2.3. Nursing interventions: apply ice, massage, use of splints/braces

1.2.2.4. Diet: cold water fish (high in fatty acids), Vitamins A, B, C, E; Zn, Se, Ca

1.2.3. Osteoporosis: porous bone

1.2.3.1. Risk factors: post-menopausal women, family history, Caucasian, Asian, long-term use of corticosteriods

1.2.3.2. Prevention: diet high in Ca and protein, adequate Vitamin D absorption, weight-bearing exercise, avoid smoking/drinking

1.2.4. Gout: metabolic disorder in which excess uric acid accumulates in blood

1.2.4.1. Hallmark sign = EXTREME pain

1.2.4.2. Low purine diet: no rich meats, alcohol, or seafood

1.2.4.3. Medications: allopurinol, indomethacin

2. Nervous

2.1. Normal Changes of Aging

2.1.1. DECREASED:

2.1.1.1. Nerve Cell Mass (atrophy of brain and spinal cord)

2.1.1.2. # of dendrites

2.1.1.3. Cerebral blood flow

2.1.1.4. Neurons/Neurotransmitters

2.1.1.5. Central processing (takes longer to perform tasks)

2.1.1.6. Function in cranial nerves affecting taste and smell

2.1.2. Comprised Thermoregulation

2.1.3. Demyelinization

2.1.3.1. Slower nerve conduction and raaction times

2.1.3.2. Weaker reflexes

2.1.4. Fatty deposits accumulate in blood vessels

2.2. Pathologies

2.2.1. Parkinson's Disease (PD)

2.2.1.1. 4 Cardinal Symptoms

2.2.1.1.1. Resting tremors

2.2.1.1.2. Muscle rigidity

2.2.1.1.3. Bradykinesia

2.2.1.1.4. Postural instability

2.2.1.2. 80% of dopamine neurons lost by diagnosis (responsible for emotions & smooth motor movement)

2.2.2. Transient Ischemic Attacks (TIA)

2.2.2.1. Temporary/intermittent reduction in cerebral perfusion

2.2.3. Cerebrovascular Accident (CVA)

2.2.3.1. Predisposing factors: HTN, gout, atherosclerosis, DM, anemia, hypothyroidism, hx of TIA/silent MI, smoker, dehydration

2.2.3.2. Common sequelae

2.2.3.2.1. Hemiparesis: weakness to one side of body

2.2.3.2.2. Homonymous hemianopia: condition where a person sees only one side of the visual field of each eye

2.2.3.2.3. Expressive aphasia (Broca's): partial loss of ability to produce language (comprehension remains intact)

3. Gastrointestinal

3.1. Normal Changes of Aging

3.1.1. DECREASED:

3.1.1.1. Saliva production

3.1.1.2. Esophageal/Stomach motility (risk for aspiration and indigestion)

3.1.1.3. Elasticity of stomach (reduces amount of food accomodation/storage)

3.1.1.4. Production of hydrochloric acid (HCl) and pepsin

3.1.1.4.1. Increased gastric irritation

3.1.1.4.2. HCl: interferes w/ absorption of Ca, Fe, folic acid, Vit B12

3.1.1.4.3. Pepsin: interferes w/ absorption of protein

3.1.1.5. Cells on absorbing surface (ileum)

3.1.1.5.1. Interferes w/ absorption of sugars and Vit B & D

3.1.1.6. Peristalsis (lead to constipation)

3.1.1.7. Sensory perception (incomplete emptying of bowel)

3.1.1.8. Bile salt synthesis (gallstone development)

3.1.2. Atrophy of tongue: affects taste buds/decreases taste senstation

3.1.3. Presbyesophagus: weaker esophageal contractions/weakness of sphincter

3.1.4. Pancreas changes: impacts digestion of fats

3.2. Pathologies

3.2.1. Xerostomia (Dry Mouth)

3.2.1.1. Interventions: saliva substitutes, sipping water, sugarless candy/gum

3.2.2. Dysphagia (Swallowing Difficulties)

3.2.2.1. Cause: GERD, CVA, structural abnormalities

3.2.2.2. Interventions: thicken feeds, eat upright, tip chin down while swallowing

3.2.3. Hiatal Hernia (Sliding & Rolling)

3.2.3.1. Interventions: lose weight, small/frequent meals, sleep upright; PPIs (decrease Vit B12)

3.2.4. Cancer

3.2.4.1. Esophageal: men (smoking, ETOH, poor oral hygiene)

3.2.4.2. Stomach: not as common (smoking)

3.2.4.3. Colorectal

3.2.4.3.1. S/S: Ascending (R side) = anemia, SOB, abnormal CBC; Transverse/Sigmoid (L side) = changes in bowel patterns

3.2.4.3.2. 2nd most common malignancy in US but VERY preventable - takes 5 years for CA to develop after first polyp appears

3.2.4.3.3. Colonoscopy at age 50+

3.2.4.4. Pancreas

3.2.4.4.1. Very poor prognosis

3.2.4.5. Gallbladder

3.2.4.5.1. Poor prognosis

3.2.5. Diverticulitis (infection in diverticula)

3.2.6. Intestinal Obstruction

3.2.6.1. Large: cancer; feel heavy dullness

3.2.6.2. Small: adhesions, hernias, NE tumor; high acute pain

3.2.6.3. HIGH PITCHED, TYMPANIC BOWEL SOUNDS (severe = absent)

3.2.7. Bowel Incontinence

3.2.7.1. Usually d/t fecal impaction

3.2.7.2. Late stage dementia, paralysis

3.2.8. Cholelithiasis (gallstones)

4. Respiratory

4.1. Normal Changes of Aging

4.1.1. DECREASED:

4.1.1.1. Cough

4.1.1.2. Size/weight of lungs

4.1.1.3. Elastic recoil & elastcity of alveoli

4.1.1.4. Vital Capacity

4.1.2. INCREASED:

4.1.2.1. Residual volume

4.1.2.2. Risk for aspiration

4.2. Pathologies

4.2.1. Emphysema

4.2.1.1. Causes: chronic bronchitis, cigarette smoking

4.2.1.2. Treatment: postural drainage, bronchodilators, avoid stress, breathing exercises

4.2.2. Chronic bronchitis

4.2.2.1. Persistent, PRODUCTIVE cough; wheezing, recurrent respiratory infections

4.2.3. Lung cancer

4.2.3.1. More common in men 65+ and twice as common in smokers vs non-smokers

4.2.3.2. S/S: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, respiratory infections

4.2.4. Lung abscess

4.2.4.1. Cause: pneumonia, TB, malignancy, trauma, aspiration

4.2.4.2. Treatment: postural drainage, high-protein, high-calorie diet

5. Cardiovascular

5.1. Normal Changes of Aging

5.1.1. Heart valves: thicker/rigid

5.1.2. Aorta dilated

5.1.2.1. Slight ventricular hypertrophy

5.1.2.2. Thickening of L ventricular wall

5.1.3. Myocardial muscle less efficient

5.1.3.1. Decreased contractile strength

5.1.3.2. Decreased CO

5.1.4. Calcification & reduced elasticity of vessels

5.1.5. Less sensitive to baroreceptor regulation of BP (causes orthostatic hypotension)

5.2. Pathologies

5.2.1. Hypertension: BP > 140/90 on two occasions

5.2.1.1. S/S: dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor

5.2.1.2. Factors to consider while measuring: anxiety, stress, activity before assessment

5.2.2. Hypotension: decrease of systolic BP more than 20 mmHg after changing positions

5.2.3. Congestive Heart Failure (CHF)

5.2.3.1. Leading cause of hospitalization

5.2.3.2. Most common cause: CAD

5.2.3.3. S/S: SOB, dyspnea on exertion, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, edema

5.2.4. Pulmonary Emboli (PE)

5.2.4.1. Risk factors: Afib, fractures, immobilization, CHF

5.2.4.2. S/S: confusion, apprehension, SOB, temperature elevation, pneumonitis, elevated sedimentation rate

5.2.5. Coronary Artery Disease (CAD)

5.2.5.1. Angina

5.2.5.1.1. Atypical presentation: coughing, syncope, sweating, confusion

5.2.5.1.2. Nitroglycerine (don't take if on ED meds!)

5.2.5.2. Myocardial Infarction

5.2.5.2.1. Atypical presentation: confusion, decreased BP, SOB, elevated temperature

5.2.6. Varicose Veins

5.2.6.1. Dilated, tortuous nature of vein

5.2.6.2. Dull pain, cramping, can interfere with sleep

5.2.6.3. Susceptible to trauma & infection

6. Renal/Genitourinary

6.1. Normal Changes of Aging

6.1.1. DECREASED:

6.1.1.1. Kidney Filtration

6.1.1.1.1. Impacts ability to eliminate drugs

6.1.1.2. Renal function (High BUN)

6.1.1.3. Tubular function (concentration of urine changes in reponse to water and/or sodium excess/depletion)

6.1.2. Hypertrophy/thickening of bladder muscle

6.1.2.1. Decreases bladder ability to expand

6.1.2.2. Reduces storage capacity

6.1.3. Changes in cortical control of micturition

6.1.4. Inefficient neurological control

6.1.4.1. Unable to fully empty bladder

6.1.4.2. Retention of large volumes of urine

6.2. Pathologies

6.2.1. Urinary Incontinence

6.2.1.1. Stress: ability of pelvic floor muscles to hold urine

6.2.1.2. Urgency: bladder tumors, prostate enlargement

6.2.1.3. Overflow: drugs, bladder outlet issues

6.2.1.4. Neurogenic (reflex)

6.2.1.5. Functional: dementia, inability to get to toilet (ambulation)

6.2.2. Renal Calculi

6.2.2.1. Flank, severe pain

6.2.2.2. Stain stones to save for diagnosis; if stone is too large - lithotripsy

6.2.3. Glomerulonephritis

6.2.3.1. Kidney infection that can lead to kidney failure (ESRD)

7. Immune

7.1. Normal Changes of Aging

7.1.1. DECREASED:

7.1.1.1. Strength of immune/antibody response

7.1.1.2. Size of thymus gland

7.1.1.3. T-cell function

7.1.1.4. Thickness of skin

7.1.2. INCREASED:

7.1.2.1. Risk of infection d/t chronic conditions

7.1.2.2. Risk of exposure d/t hospitalizations and institutionalization

7.1.2.3. # of immature T-cells

8. Reproductive/Sexuality

8.1. Normal Changes of Aging

8.1.1. Sexuality

8.1.1.1. Menopause: permanent cessation of menses

8.1.1.1.1. Risks of hormone therapy: increased risk of cardiac problems and breast cancer

8.1.1.1.2. Manage symptoms: change in emotions, hot flashes

8.1.1.2. Older adults are able to be sexually active, although some age-related changes have impact on sexual function

8.1.1.3. Andropause: testosterone levels decline in men

8.1.1.3.1. Results in reduced muscle mass, energy, strength and stamina

8.1.1.3.2. Does not occur in all men

8.1.2. Women

8.1.2.1. Vaginal canal changes

8.1.2.1.1. Reduction in collagen and adipose tissue

8.1.2.1.2. Shortening/narrowing of canal

8.1.2.1.3. Less lubrication

8.1.2.1.4. More alkaline vaginal pH

8.1.2.2. Fallopian tubes become shorter and straighter

8.1.3. Male

8.1.3.1. Seminal vesicles develop thinner epithelium

8.1.3.2. Muscle tissue replaced with connective tissue

8.1.3.3. Ejaculation fluid contains less live sperm

8.2. Pathologies

8.2.1. Yeast Infection (vulva)

8.2.1.1. Vulva is more fragile and susceptible to irritation/infection

8.2.2. Erectile Dysfunction

8.2.2.1. Cause: diabetes (#1 cause), HTN, atherosclerosis, MS, thyroid dysfunction, alcoholism, renal failure, structure abnormalities

8.2.2.2. Medical treatments available: do NOT take nitroglycerine if on ED meds bc it will bottom out BP!

8.2.3. Benign Prostatic Hyperplasia (BPH)

8.2.3.1. Men are reluctant/embarrassed to seek treatment

8.2.3.2. May result in kidney damage

8.2.4. Prostate Cancer

8.2.4.1. Asymptomatic disease progression

8.2.4.2. Diagnosis: digital rectal examination and elevated PSA levels

8.2.4.3. BPH does NOT cause prostate cancer, but can hide cancerous nodules

9. Cellular

9.1. Normal Changes of Aging

9.1.1. DECREASED:

9.1.1.1. Functional cell number

9.1.1.2. Lean body mass

9.1.1.3. Intracellular fluid

9.1.2. INCREASED:

9.1.2.1. Total body fat

10. Physical Appearance

10.1. Normal Changes of Aging

10.1.1. DECREASED:

10.1.1.1. Tissue elasticity

10.1.1.1.1. Elongated ears

10.1.1.1.2. Baggy eyelids

10.1.1.1.3. Double chin

10.1.1.2. Subcutaneous fat

10.1.1.3. Stature d/t loss of cartilage and thinning vertebrae

10.1.2. INCREASED:

10.1.2.1. Facial hair in women

10.1.2.2. Graying/thinning of hair on scalp

11. Endocrine

11.1. Normal Changes of Aging

11.1.1. DECREASED:

11.1.1.1. Thyroid gland activity

11.1.1.2. Adrenal function

11.1.1.3. Volume of pituitary gland

11.1.1.4. Release of insulin

11.2. Pathologies

11.2.1. Diabetes Mellitus

11.2.1.1. Glucose intolerance

11.2.1.2. Screening recommended every 3 years for people 45+ (glucose tolerance test - GTT)

11.2.1.3. Treatment goal varies for pt. but usually A1C < 6%

11.2.1.4. Interventions: exercise and nutrition, insulin education if needed

11.2.1.5. Complications (at higher risk than younger adult)

11.2.1.5.1. Hypoglycemia

11.2.1.5.2. Peripheral Vascular Disease, Atherosclerosis

11.2.1.5.3. Diabetic retinopathy, Neuropathies

11.2.1.5.4. Drug interactions

11.2.1.5.5. UTI

11.2.2. Hypothyroidism

11.2.2.1. S/S: dry skin, coarse hair, constipation, cold, periorbital edema, weight gain, impaired hearing, anorexia, depression

11.2.3. Hyperthyroidism

11.2.3.1. S/S: nodule goiters, anxious, weight loss, difficulties sleeping

11.2.3.2. Treatment: radioactive iodine, surgical removal

12. Changes to the Mind

12.1. Normal Changes of Aging

12.1.1. Learning

12.1.1.1. Motivation changes

12.1.1.2. Delayed transmission of information to brain

12.1.2. Memory

12.1.2.1. Retrieval of information from long-term memory can be slowed

12.1.2.2. Working memory function reduced

12.1.2.3. Short-term memory only lasts for a few seconds

12.1.3. Personality

12.1.3.1. Consistent with younger age

12.2. Pathologies

12.2.1. Dementia

12.2.1.1. Irreversible, progressive impairment in cognitive function

12.2.1.2. Caused by damage or injury to the brain

12.2.1.3. Alzheimer's Disease

12.2.1.3.1. Most common form of Dementia

12.2.1.3.2. Neurofibrillary tangles in cortex, neurtitic plaques containing beta-amyloid in the brain

12.2.1.3.3. Causes: genetics, environmental factors, free radicals, levels of aluminum and mercury in brain

12.2.1.3.4. Treatment: no current cure; clinical trials in place to improve function and slow disease progression

12.2.1.4. Other Types

12.2.1.4.1. Vascular (TIAs) - mood swings/memory loss not as profound

12.2.1.4.2. Frontotemporal: severe/radical personality changes

12.2.1.4.3. Lewy body: common in PD

12.2.1.5. Care: ensure patient safety and support family/caregiver

12.2.2. Delirium

12.2.2.1. Rapid, altered level of consciousness

12.2.2.2. Abrupt change in the brain that causes mental confusion

12.2.2.3. Cause: infection, brain tumor, medications, kidney/liver failure, alcohol withdrawal

13. Integumentary

13.1. Normal Changes of Aging

13.1.1. DECREASED:

13.1.1.1. Thickness/vascularity of dermis

13.1.1.2. Melanocytes

13.1.1.3. Rate of hair/nail growth

13.1.2. Flattening of dermal-epidermal junction

13.1.3. INCREASED:

13.1.3.1. Coarseness of collagen

13.1.3.2. Fragility of skin

13.1.4. Atrophy of hair bulbs

13.2. Pathologies

13.2.1. Pruritus: itchiness

13.2.1.1. Most common dermatologic problem among older adults

13.2.1.2. Potential for skin breakdown/infection

13.2.2. Cancer

13.2.2.1. Basal Cell Carcinoma

13.2.2.1.1. Most common form

13.2.2.1.2. Grows slowly

13.2.2.1.3. Rarely metastasizes

13.2.2.2. Melanoma

13.2.2.2.1. Rising incidence in the US

13.2.2.2.2. Tends to more easily metastasize

13.2.3. Pressure Ulcers

13.2.3.1. Tissue anoxia/ischemia that results in necrosis, sloughing and tissue ulceration

13.2.3.2. Braden Scale used to grade: 1-4

13.2.3.3. Prevention: avoid unrelieved pressure

14. Sensory

14.1. Normal Changes of Aging

14.1.1. Vision

14.1.1.1. Presbyopia: decreased ability to focus d/t reduced elasticity of lens

14.1.1.2. Visual acuity declines: opacification of lens

14.1.1.3. Loss of photoreceptor cells in retina

14.1.1.3.1. Light perception threshold decreases

14.1.1.3.2. Dark/light adaptation takes longer

14.1.1.3.3. Difficulty with night vision

14.1.1.4. Increased sensitivity to glare

14.1.1.5. Distortion in depth perception

14.1.1.6. Peripheral vision reduced

14.1.2. Hearing

14.1.2.1. Presbycusis: sensorineural hearing loss

14.1.2.2. Impacted cerumen

14.1.3. Taste

14.1.3.1. Sweet/salty flavors impacted

14.1.4. Touch

14.1.4.1. Decreased tactile sensation

14.1.4.2. Difficulty discriminating between temperatures

14.2. Pathologies

14.2.1. Glaucoma

14.2.1.1. Damage to optic nerve from increased intraocular pressure (IOP)

14.2.1.2. Second leading cause of blindness in older adults

14.2.1.3. Acute (closed-angle) and Chronic (open angle)

14.2.2. Macular Degeneration

14.2.2.1. Most common cause of blindness in adults 65+

14.2.2.2. Damage/breakdown of macula leading to loss of central vision

15. Madison Balsinger (001)