Gerontological Concept Map

Get Started. It's Free
or sign up with your email address
Gerontological Concept Map by Mind Map: Gerontological Concept Map

1. Musculoskeletal

1.1. Normal Changes of Aging

1.1.1. DECREASED: Size & # of muscle fibers Muscle mass Flexibility of joints d/t changes in connective tissue

1.1.2. Sarcopenia

1.2. Pathologies

1.2.1. Fractures Brittle bones fracture more easily and heal at a slower rate Common sites: radius, hip, compression fractures of vertebrae (falls)

1.2.2. Osteoarthritis: progressive deterioration of joint cartilage S/S: grading crepitation, heavy aching pain in the joints Common sites: hips, knees, vertebrae, fingers Nursing interventions: apply ice, massage, use of splints/braces Diet: cold water fish (high in fatty acids), Vitamins A, B, C, E; Zn, Se, Ca

1.2.3. Osteoporosis: porous bone Risk factors: post-menopausal women, family history, Caucasian, Asian, long-term use of corticosteriods 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 Hallmark sign = EXTREME pain Low purine diet: no rich meats, alcohol, or seafood Medications: allopurinol, indomethacin

2. Nervous

2.1. Normal Changes of Aging

2.1.1. DECREASED: Nerve Cell Mass (atrophy of brain and spinal cord) # of dendrites Cerebral blood flow Neurons/Neurotransmitters Central processing (takes longer to perform tasks) Function in cranial nerves affecting taste and smell

2.1.2. Comprised Thermoregulation

2.1.3. Demyelinization Slower nerve conduction and raaction times Weaker reflexes

2.1.4. Fatty deposits accumulate in blood vessels

2.2. Pathologies

2.2.1. Parkinson's Disease (PD) 4 Cardinal Symptoms Resting tremors Muscle rigidity Bradykinesia Postural instability 80% of dopamine neurons lost by diagnosis (responsible for emotions & smooth motor movement)

2.2.2. Transient Ischemic Attacks (TIA) Temporary/intermittent reduction in cerebral perfusion

2.2.3. Cerebrovascular Accident (CVA) Predisposing factors: HTN, gout, atherosclerosis, DM, anemia, hypothyroidism, hx of TIA/silent MI, smoker, dehydration Common sequelae Hemiparesis: weakness to one side of body Homonymous hemianopia: condition where a person sees only one side of the visual field of each eye 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: Saliva production Esophageal/Stomach motility (risk for aspiration and indigestion) Elasticity of stomach (reduces amount of food accomodation/storage) Production of hydrochloric acid (HCl) and pepsin Increased gastric irritation HCl: interferes w/ absorption of Ca, Fe, folic acid, Vit B12 Pepsin: interferes w/ absorption of protein Cells on absorbing surface (ileum) Interferes w/ absorption of sugars and Vit B & D Peristalsis (lead to constipation) Sensory perception (incomplete emptying of bowel) 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) Interventions: saliva substitutes, sipping water, sugarless candy/gum

3.2.2. Dysphagia (Swallowing Difficulties) Cause: GERD, CVA, structural abnormalities Interventions: thicken feeds, eat upright, tip chin down while swallowing

3.2.3. Hiatal Hernia (Sliding & Rolling) Interventions: lose weight, small/frequent meals, sleep upright; PPIs (decrease Vit B12)

3.2.4. Cancer Esophageal: men (smoking, ETOH, poor oral hygiene) Stomach: not as common (smoking) Colorectal S/S: Ascending (R side) = anemia, SOB, abnormal CBC; Transverse/Sigmoid (L side) = changes in bowel patterns 2nd most common malignancy in US but VERY preventable - takes 5 years for CA to develop after first polyp appears Colonoscopy at age 50+ Pancreas Very poor prognosis Gallbladder Poor prognosis

3.2.5. Diverticulitis (infection in diverticula)

3.2.6. Intestinal Obstruction Large: cancer; feel heavy dullness Small: adhesions, hernias, NE tumor; high acute pain HIGH PITCHED, TYMPANIC BOWEL SOUNDS (severe = absent)

3.2.7. Bowel Incontinence Usually d/t fecal impaction Late stage dementia, paralysis

3.2.8. Cholelithiasis (gallstones)

4. Respiratory

4.1. Normal Changes of Aging

4.1.1. DECREASED: Cough Size/weight of lungs Elastic recoil & elastcity of alveoli Vital Capacity

4.1.2. INCREASED: Residual volume Risk for aspiration

4.2. Pathologies

4.2.1. Emphysema Causes: chronic bronchitis, cigarette smoking Treatment: postural drainage, bronchodilators, avoid stress, breathing exercises

4.2.2. Chronic bronchitis Persistent, PRODUCTIVE cough; wheezing, recurrent respiratory infections

4.2.3. Lung cancer More common in men 65+ and twice as common in smokers vs non-smokers S/S: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, respiratory infections

4.2.4. Lung abscess Cause: pneumonia, TB, malignancy, trauma, aspiration 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 Slight ventricular hypertrophy Thickening of L ventricular wall

5.1.3. Myocardial muscle less efficient Decreased contractile strength 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 S/S: dull headache, impaired memory, disorientation, confusion, epistaxis, slow tremor 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) Leading cause of hospitalization Most common cause: CAD S/S: SOB, dyspnea on exertion, confusion, insomnia, wandering at night, agitation, depression, orthopnea, wheezing, weight gain, edema

5.2.4. Pulmonary Emboli (PE) Risk factors: Afib, fractures, immobilization, CHF S/S: confusion, apprehension, SOB, temperature elevation, pneumonitis, elevated sedimentation rate

5.2.5. Coronary Artery Disease (CAD) Angina Atypical presentation: coughing, syncope, sweating, confusion Nitroglycerine (don't take if on ED meds!) Myocardial Infarction Atypical presentation: confusion, decreased BP, SOB, elevated temperature

5.2.6. Varicose Veins Dilated, tortuous nature of vein Dull pain, cramping, can interfere with sleep Susceptible to trauma & infection

6. Renal/Genitourinary

6.1. Normal Changes of Aging

6.1.1. DECREASED: Kidney Filtration Impacts ability to eliminate drugs Renal function (High BUN) Tubular function (concentration of urine changes in reponse to water and/or sodium excess/depletion)

6.1.2. Hypertrophy/thickening of bladder muscle Decreases bladder ability to expand Reduces storage capacity

6.1.3. Changes in cortical control of micturition

6.1.4. Inefficient neurological control Unable to fully empty bladder Retention of large volumes of urine

6.2. Pathologies

6.2.1. Urinary Incontinence Stress: ability of pelvic floor muscles to hold urine Urgency: bladder tumors, prostate enlargement Overflow: drugs, bladder outlet issues Neurogenic (reflex) Functional: dementia, inability to get to toilet (ambulation)

6.2.2. Renal Calculi Flank, severe pain Stain stones to save for diagnosis; if stone is too large - lithotripsy

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

7. Immune

7.1. Normal Changes of Aging

7.1.1. DECREASED: Strength of immune/antibody response Size of thymus gland T-cell function Thickness of skin

7.1.2. INCREASED: Risk of infection d/t chronic conditions Risk of exposure d/t hospitalizations and institutionalization # of immature T-cells

8. Reproductive/Sexuality

8.1. Normal Changes of Aging

8.1.1. Sexuality Menopause: permanent cessation of menses Risks of hormone therapy: increased risk of cardiac problems and breast cancer Manage symptoms: change in emotions, hot flashes Older adults are able to be sexually active, although some age-related changes have impact on sexual function Andropause: testosterone levels decline in men Results in reduced muscle mass, energy, strength and stamina Does not occur in all men

8.1.2. Women Vaginal canal changes Reduction in collagen and adipose tissue Shortening/narrowing of canal Less lubrication More alkaline vaginal pH Fallopian tubes become shorter and straighter

8.1.3. Male Seminal vesicles develop thinner epithelium Muscle tissue replaced with connective tissue Ejaculation fluid contains less live sperm

8.2. Pathologies

8.2.1. Yeast Infection (vulva) Vulva is more fragile and susceptible to irritation/infection

8.2.2. Erectile Dysfunction Cause: diabetes (#1 cause), HTN, atherosclerosis, MS, thyroid dysfunction, alcoholism, renal failure, structure abnormalities Medical treatments available: do NOT take nitroglycerine if on ED meds bc it will bottom out BP!

8.2.3. Benign Prostatic Hyperplasia (BPH) Men are reluctant/embarrassed to seek treatment May result in kidney damage

8.2.4. Prostate Cancer Asymptomatic disease progression Diagnosis: digital rectal examination and elevated PSA levels BPH does NOT cause prostate cancer, but can hide cancerous nodules

9. Cellular

9.1. Normal Changes of Aging

9.1.1. DECREASED: Functional cell number Lean body mass Intracellular fluid

9.1.2. INCREASED: Total body fat

10. Physical Appearance

10.1. Normal Changes of Aging

10.1.1. DECREASED: Tissue elasticity Elongated ears Baggy eyelids Double chin Subcutaneous fat Stature d/t loss of cartilage and thinning vertebrae

10.1.2. INCREASED: Facial hair in women Graying/thinning of hair on scalp

11. Endocrine

11.1. Normal Changes of Aging

11.1.1. DECREASED: Thyroid gland activity Adrenal function Volume of pituitary gland Release of insulin

11.2. Pathologies

11.2.1. Diabetes Mellitus Glucose intolerance Screening recommended every 3 years for people 45+ (glucose tolerance test - GTT) Treatment goal varies for pt. but usually A1C < 6% Interventions: exercise and nutrition, insulin education if needed Complications (at higher risk than younger adult) Hypoglycemia Peripheral Vascular Disease, Atherosclerosis Diabetic retinopathy, Neuropathies Drug interactions UTI

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

11.2.3. Hyperthyroidism S/S: nodule goiters, anxious, weight loss, difficulties sleeping Treatment: radioactive iodine, surgical removal

12. Changes to the Mind

12.1. Normal Changes of Aging

12.1.1. Learning Motivation changes Delayed transmission of information to brain

12.1.2. Memory Retrieval of information from long-term memory can be slowed Working memory function reduced Short-term memory only lasts for a few seconds

12.1.3. Personality Consistent with younger age

12.2. Pathologies

12.2.1. Dementia Irreversible, progressive impairment in cognitive function Caused by damage or injury to the brain Alzheimer's Disease Most common form of Dementia Neurofibrillary tangles in cortex, neurtitic plaques containing beta-amyloid in the brain Causes: genetics, environmental factors, free radicals, levels of aluminum and mercury in brain Treatment: no current cure; clinical trials in place to improve function and slow disease progression Other Types Vascular (TIAs) - mood swings/memory loss not as profound Frontotemporal: severe/radical personality changes Lewy body: common in PD Care: ensure patient safety and support family/caregiver

12.2.2. Delirium Rapid, altered level of consciousness Abrupt change in the brain that causes mental confusion Cause: infection, brain tumor, medications, kidney/liver failure, alcohol withdrawal

13. Integumentary

13.1. Normal Changes of Aging

13.1.1. DECREASED: Thickness/vascularity of dermis Melanocytes Rate of hair/nail growth

13.1.2. Flattening of dermal-epidermal junction

13.1.3. INCREASED: Coarseness of collagen Fragility of skin

13.1.4. Atrophy of hair bulbs

13.2. Pathologies

13.2.1. Pruritus: itchiness Most common dermatologic problem among older adults Potential for skin breakdown/infection

13.2.2. Cancer Basal Cell Carcinoma Most common form Grows slowly Rarely metastasizes Melanoma Rising incidence in the US Tends to more easily metastasize

13.2.3. Pressure Ulcers Tissue anoxia/ischemia that results in necrosis, sloughing and tissue ulceration Braden Scale used to grade: 1-4 Prevention: avoid unrelieved pressure

14. Sensory

14.1. Normal Changes of Aging

14.1.1. Vision Presbyopia: decreased ability to focus d/t reduced elasticity of lens Visual acuity declines: opacification of lens Loss of photoreceptor cells in retina Light perception threshold decreases Dark/light adaptation takes longer Difficulty with night vision Increased sensitivity to glare Distortion in depth perception Peripheral vision reduced

14.1.2. Hearing Presbycusis: sensorineural hearing loss Impacted cerumen

14.1.3. Taste Sweet/salty flavors impacted

14.1.4. Touch Decreased tactile sensation Difficulty discriminating between temperatures

14.2. Pathologies

14.2.1. Glaucoma Damage to optic nerve from increased intraocular pressure (IOP) Second leading cause of blindness in older adults Acute (closed-angle) and Chronic (open angle)

14.2.2. Macular Degeneration Most common cause of blindness in adults 65+ Damage/breakdown of macula leading to loss of central vision

15. Madison Balsinger (001)