1. Muskuloskelotal
1.1. Shortening vertebrae
1.2. Reduced strength and muscle mass
1.3. Decreased bone calcification
1.3.1. Related to decreased calcium absorption of bones
1.4. Risk of fractures
1.5. Osteoarthritis
1.5.1. s/s: pain, tenderness, stiffness, loss of flexibility
1.5.2. Treatment: acetaminophen for pain, physical therapy, cortisone injections, or joint replacement
1.6. Rheumatoid Arthritis
1.6.1. Autoimmune
1.6.2. s/s: tender and warm swollen joints, fatigue, fever, weight loss
1.6.3. No cure; treatment includes surgery, medication for pain, and therapy
1.7. Osteoporosis
1.7.1. Demineralization of bone
1.7.2. Caused by: inadequate amounts of calcium
1.7.3. s/s: reduction in height, spinal pain, and easily fractured bones
1.7.4. Treatment: calcium supplements, vitamin D supplements, high-protein diet, and possible bracing
1.8. Fractures
1.8.1. Causes: trauma, cancer, and osteoporosis
1.8.2. s/s: pain, change in shape/length of limb, restricted motion, edema, and tissue discoloration
1.8.3. Treatment: Increased fluids, good nutrition, early mobilization
2. Nervous
2.1. Decreased blood flow to brain
2.2. Reduced number of neurons
2.3. Change in ability to balance
2.4. Hypothalamus not as effective in temp. regulation
2.4.1. Lower body temp.
2.5. Sleep pattern changes- more disturbed
2.6. Decreased conduction velocity
2.6.1. Leads to slower reaction time
2.7. Parkinson's Disease
2.7.1. s/s: tremors, shuffling gate, stiffness, slow movement
2.7.2. Cause: decreased dopamine level in brain (from genetics or environment) inhibiting communication between neurons
2.7.3. No specific treatment
2.7.3.1. Management: levodopa to increase dopamine, along with speech and physical therapy to manage tremors
2.8. Transient Ischemic Attack
2.8.1. Cause: brief blockage of blood supply to brain
2.8.2. s/s: one sided weakness/droopiness of face, slurred speech, loss of coordination
2.9. Cerebrovascular Accident
2.9.1. Ischemic
2.9.1.1. most common
2.9.1.1.1. blood clot blocks blood flow to brain
2.9.1.2. s/s: prolonged symptoms of TIA
2.9.1.3. Prevent blood clot formation and atherosclerosis of vessels
2.9.2. Hemorrhagic
2.9.2.1. less common- hemorrhage of brain
3. Immune
3.1. Depressed immune response
3.1.1. T-cell activity declines
3.1.2. Risk for infection increases
3.1.3. Inflammatory defenses decline
3.2. Increase in pro inflammatory cytokines
3.3. Infection
3.3.1. Urinary Tract Infection
3.3.1.1. s/s: urethral burning upon urination, frequency, fever, foul-smelling urine
3.3.1.1.1. can spread to kidneys
3.3.1.2. Causes: diseases causing urinary retention (Parkinson's, Alzheimers); poor hygiene
3.3.1.3. Treatment: antibiotics, increased fluids
3.3.2. Pneumonia
3.3.2.1. Usually in form of community-aquired
3.3.2.2. s/s: cough with sputum, sharp pain in chest, shortness of breath, fatigue
3.3.2.3. Treatment: vaccine for prevention, antibiotics, breathing treatments,
3.3.3. Herpes Zoster
3.3.3.1. Cause: reactivation of chickenpox in body
3.3.3.1.1. for many older adults, chickenpox was vaccine not available in childhood
3.3.3.2. Painful rash, blisters, scabs, pain like pins and needles
3.3.3.3. Treatments: pain relief measures, and antiviral medications.
3.3.3.3.1. Can be prevented in older adults with shingles vaccine
3.3.4. Tuberculosis
3.3.4.1. Bacterial disease affecting lungs
3.3.4.1.1. spread through coughing/sneezing
3.3.4.2. s/s: cough (sometimes blood-tinged,) fever/night sweats, and weight loss
3.3.4.3. Treatment: long term antibiotics for those with symptoms
3.3.4.4. Diagnosed with Quantiferon GOLD blood test or skin test
4. Encodcrine
4.1. Thyroid gland activity decreases
4.1.1. Lower basal metabolic rate
4.2. ACTH secretion decreases
4.3. Pituitary gland decreases
4.4. Insulin release delayed and insufficient
4.5. Ability to metabolize glucose decreased
4.5.1. Increased blood glucose in even non diabetic patients
4.6. Gonadal secretion declines
4.7. Diabetes Mellitus
4.7.1. Mostly Type 2 in older adults
4.7.1.1. Causes: increased obesity, age-related insufficiency of insulin,
4.7.2. Complications: visual changes, ulcers on feet, cardiovascular disease,
4.7.3. Management: glycemic level control, weight loss/proper diet
4.8. Hypothyroidism
4.8.1. s/s: weight gain, fatigue, dry skin, constipation
4.8.1.1. Often overlooked r/t common age-related changes
4.8.2. Treatment: thyroid replacement
5. Integumentary
5.1. Skin less elastic, dry
5.1.1. Nursing diagnosis: Risk for skin breakdown r/t decreased elasticity of skin
5.2. decreased subcutaneous fat
5.3. Reduced sweat gland activity
5.4. Fragile and brittle fingernails
5.5. Skin Cancer
5.5.1. Causes: increased exposure to sun
5.5.2. Melanoma
5.5.3. Basal Cell
5.5.4. Carcinoma
5.5.5. s/s: dark pigmentation, change in mole size, color, texture, size, etc.
5.5.6. Treatment: may have part of skin removed, laser surgery, and sometimes radiation
5.6. Pressure Ulcers
5.6.1. Causes: immobilization, poor nutrition, dry/fragile skin
5.6.2. s/s: reddened area usually appearing over bony prominences, edema around affected area, pain
5.6.3. Treatment: frequent turning and dressing changes
5.7. Pruritis
5.7.1. Simple terms: itching
5.7.2. Treatment: keep skin moisturized, use warm not hot water, use of humidifier, and refrain from urge to scratch by using ice packs
6. Psychological
6.1. Activities
6.2. Social changes
6.2.1. shrinking social world
6.2.2. loss of spouse
6.2.3. retirement
6.3. Psychical Changes
6.3.1. graying of hair
6.3.2. elongated ears
6.3.3. diminished stature
6.4. Memory
6.5. Intelligence
6.5.1. Crystallized intelligence (skills, knowledge, and experience) is maintained
6.5.2. Fluid intelligence (new situations) can decline
6.6. Depression/Anxiety
6.6.1. Management: may need medications or therapy, social support, and family involvement
6.7. Dementia
6.7.1. Permanent cognitive impairment
6.7.1.1. Alzheimer's Disease one of most common
6.7.1.1.1. s/s: memory loss, difficulty speaking, disorientation, personality change, paranoia, and hallucinations
6.7.1.1.2. Cause: damage to nerve cells within brain
6.7.1.1.3. Diagnosis: brain scans to evaluate function
6.7.1.1.4. Treatment: medications and therapy, encourage exercise, foster communication, and keep calendar
6.8. Delirium
6.8.1. Temporary cognitive impairment
6.8.2. Causes: infection, intoxications, dehydration, sleep deprivation
6.8.3. s/s: memory change, irrability or anger, restlessness, hallucinations, being quiet and withdrawn
6.8.4. Treatment: treat underlying issue, rehydrate, and implement safety precautions
7. Reproductive
7.1. Men
7.1.1. Reduction in sperm count
7.1.2. Venous and arterial sclerosis of penis
7.1.2.1. Can affect ability to have erection
7.1.3. Enlargement of prostate
7.1.4. Erectile dysfunction
7.1.4.1. Causes: alcoholism, diabetes, hypertension, multiple sclerosis, thyroid conditions, and psychological
7.1.4.2. Treatment: oral erectile agents, drugs injected into penis, penile implants, and vacuum pump devices
7.1.5. Benign Prostatic Hyperplasia
7.1.5.1. s/s: hesitancy, decreased force, frequency, and nocturia
7.1.5.2. Treatment: prostatic massage and use of urinary antiseptics
7.1.5.2.1. Surgery: Transurethral
7.2. Women
7.2.1. Drier/less elastic vagina
7.2.2. Uterus decreases in size
7.2.3. More alkaline vaginal environment
7.2.3.1. Nursing diagnosis: Increased risk for UTI r/t alkaline environment
7.2.4. Atrophic Vaginitis
7.2.4.1. s/s: itching, foul-smelling discharge, postcoital bleeding
7.2.4.2. Treatment: topical estrogen creams and estrogen replacement
7.2.4.2.1. Avoid couches, wear cotton underwear, and keep vagina dry
7.2.5. Cancers of reproductive system (cervix, vagina, endometrium, breasts, ovaries)
8. GI
8.1. Less acute taste sensations
8.2. Decreased motility of esophagus
8.2.1. Presbyesophagues
8.3. Wasting away of gastric mucosa
8.4. Losing of teeth
8.4.1. Increased risk for constipation
8.4.2. Alters nutritional intake
8.5. Reduced saliva
8.5.1. Affects breakdown of starches
8.5.2. Can cause swallowing to take twice as long
8.6. Decreased absorption of vitamin B, vitamin D, calcium, and iron
8.7. Hiatal hernia
8.7.1. s/s: heartburn, dysphasia, belching, vomiting, and regurgitation
8.7.1.1. bleeding may also occur
8.7.2. Diagnosis:
8.7.2.1. barium swallow and esophagoscope
8.7.3. Management:
8.7.3.1. weight loss if applicable
8.7.3.2. bland diet
8.7.3.3. small frequent meals
8.7.3.4. H2 blockers and proton pump inhibitors prescibed
8.8. Dysphagia
8.8.1. Difficulty swallowing
8.8.2. Causes:GERD, stroke, and structural disorders of mouth and esophagus
8.8.3. s/s: range from difficulty swallowing some foods, to not being able to swallow any food at all
8.8.4. Management:
8.8.4.1. prevention of aspiration
8.8.4.2. adequate nutritional status
8.8.4.3. soft diet and thickening of liquids
8.8.4.4. eat in upright position
8.8.4.5. suctioning if needed
8.9. GERD
8.9.1. Causes: food choices, smoking, obesity
8.9.2. s/s: heartburn, reflux, and chest pain after eating
8.9.3. Patho: relaxed lower esophageal sphincter causing reflux of gastric content
8.9.4. Treatment: lifestyle modifications, elevation of bed, cigarette smoking cessation, antacids
9. Renal
9.1. Glomerular filtration declines by 50% by 90 y.o
9.2. Decreased bladder capacity
9.3. Atrophy of kidneys r/t atherosclerosis
9.4. Decrease in tubular function
9.4.1. Can lead to hyponatremia and nocturne
9.5. Decrease in tubular function
9.5.1. Decreased absorption of glucose
9.5.1.1. Can cause protein/glucose in urine
9.6. Increased frequency, urgency, and nocturne
9.7. Urinary Incontinence
9.7.1. Transient
9.7.1.1. Acute and reversible
9.7.1.1.1. Caused by: infection, delirium, fecal impaction, etc.
9.7.2. Established
9.7.2.1. Chronic and persistant
9.7.2.1.1. Stress incontinence
9.7.2.1.2. Urgency incontinence
9.7.2.1.3. Overflow incontinence
9.7.2.1.4. Functional incontinence
9.7.3. Treatment: Kegel exercises, biofeedback, and medications
9.7.3.1. Toileting schedule
9.8. Glomeruloronephritis
9.8.1. s/s: fever, nausea/vomiting, anorexia, anemia, edema, elevated BP, and abdominal pain
9.8.2. Treatment:
9.8.2.1. Antibiotics
9.8.2.2. Restricted sodium and protein
9.8.2.3. Close attention to fluid intake
9.9. Renal Calculi
9.9.1. "Kidney stones"
9.9.2. Causes:
9.9.2.1. Immobilization
9.9.2.2. Infection
9.9.2.3. Chronic dehydration
9.9.2.4. Hypercalcemia
9.9.3. s/s: pain, hematuria, and common UTI symptoms
9.9.4. Treatment: increased fluids, and sometimes surgery if needed
10. Respiratory
10.1. Stiffened chest wall
10.1.1. Increased respiratory rate- 14-24 breaths per minute
10.2. Decreased cough reflex
10.3. Drier mucous membranes
10.4. Decreased response to hypoxia/hypercapnea
10.4.1. Less effective gas exchange
10.5. Risk for respiratory infections
10.6. Mouth breathing during sleep
10.7. Decreased cilia number
10.7.1. affects ability to expel mucous
10.8. Decreased ability to exhale
10.8.1. increased residual volume (by as much as 50%)
10.9. COPD
10.9.1. Asthma
10.9.1.1. Nursing responsibility: overuse of bronchodilators in treatment can cause cardiac arrhythmias- monitor for adverse effects with treatment
10.9.2. Chronic bronchitis
10.9.2.1. s/s: productive cough; wheezing; respiratory infections; shortness of breath
10.9.2.2. Patho: results from recurrent inflammation with mucus in bronchial, blocking airflow.
10.9.2.3. Management:
10.9.2.3.1. Remove bronchial secretions
10.9.2.3.2. Preventing obstruction of airway
10.9.2.3.3. Adequate fluid intake
10.9.2.3.4. Discourage smoking
10.9.3. Emphysema
10.9.3.1. Causes:
10.9.3.1.1. Chronic bronchitis
10.9.3.1.2. Irritation from pollutants
10.9.3.1.3. Distention of alveolar sac
10.9.3.1.4. Cigarette smoking
10.9.3.2. s/s: Increased dyspnea, chronic cough, fatigue, weight loss, anorexia
10.9.3.3. Treatment:
10.9.3.3.1. Bronchodilatorss
10.9.3.3.2. Postural drainage
10.9.3.3.3. Cessation of smoking
10.9.3.3.4. Oxygen therapy as needed
10.10. Lung Cancer
10.10.1. Demographics: more common in men; over 65 years old; higher in African Americans
10.10.2. Cigarette smoking high risk factor
10.10.3. s/s: dyspnea, coughing, chest pain, fatigue, anorexia, wheezing, frequent respiratory infections
10.10.4. Diagnosis:
10.10.4.1. chest roengenogram
10.10.4.2. sputum cytology
10.10.4.3. bronchoscopy
10.10.4.4. biopsy
10.10.5. Treatment:
10.10.5.1. Surgery
10.10.5.2. Chemotherapy
10.10.5.3. Radiotherapy
10.11. Lung Abscess
10.11.1. Causes: pneumonia, tuberculosis, cancer, or trauma to lung(s)
10.11.1.1. Also caused by aspiration of foreign material
10.11.2. s/s: anorexia, fatigue, temp. elevation, and chronic cough
10.11.3. Treatment:
10.11.3.1. Postural drainage
10.11.3.2. high-protein/high-calorie diet
11. Cardiovascular
11.1. Arterial wall thickening
11.2. Slight left ventricular hypertrophy
11.2.1. Decreased cardiac reserve
11.2.1.1. Decreased cardiac output
11.3. Diminished peripheral pulses
11.3.1. R/t resistance to peripheral blood flow
11.4. Sclerosis of valves
11.4.1. Can lead to diastolic/systolic murmurs
11.5. Oxygen not as well used
11.6. Increase in blood pressure
11.7. Vasoconstriction
11.8. Hyptertension
11.8.1. Most prevalent CV disease
11.8.2. Patho: Vasoconstriction from aging produces peripheral resistance, causing blood pressure to increase in effort to perfuse effectively
11.8.2.1. Other causes: hyperthyroidism, anemia, and Parkinsonism
11.8.3. Diagnosed if systolic >140 and diastolic >90
11.8.4. s/s: dull headache, impaired memory, disorientation, epistaxis, and slow tremor
11.8.5. Nonpharmacological treatment: rest, reduce sodium, and reduce weight
11.8.6. Pharmacological treatment: antihypertensives, diuretics, beta-blockers, calcium channel blockers, or ACE inhibitors
11.8.6.1. Nursing responsibility: monitor closely for adverse reactions
11.9. Congestive Heart Failure
11.9.1. Causes: coronary artery disease, hypertension, diabetes, anemia, CKD, and psychological stress
11.9.2. s/s: dyspnea on exertion**, insomnia, anorexia, nausea, shortness of breath, weight gain, bilateral ankle edema, crackles in lung fields
11.9.3. Management: bed rest, ACE inhibitors, diuretics, beta-blockers, and digitalis
11.9.3.1. Should provide frequent skin care and changing of position to prevent skin breakdown
12. Cellular
12.1. Functional cell numbers decrease
12.2. Lean body mass decreases
12.3. Total body fat increase until the sixth decade
12.4. Less total body fluid
12.4.1. Nursing diagnosis: Risk for dehydration
13. Sensory
13.1. Vision decreases
13.1.1. Nursing Diagnosis: Increased risk for falls r/t sensory impairment
13.2. Hearing decreases
13.2.1. Presbycusis
13.2.1.1. Progressive hearing loss
13.2.1.2. distortion of high-pitched sounds
13.2.2. Cerumen increases
13.3. Smell decreases
13.4. Taste decreases
13.5. Presbyopia
13.5.1. inability to focus on close objects
13.5.1.1. decreased peripheral vision
13.5.1.2. depth perception distortion
13.5.1.3. decline in visual acuity