Geriatric Midterm PDF

sequence (can affect inflammatory age-related COMMON AGING CHANGES disorders) Common but not universal Physiological changes Psychosocial changes ○ Can be influenced by socioeconomic...

sequence (can affect inflammatory age-related COMMON AGING CHANGES disorders) Common but not universal Physiological changes Psychosocial changes ○ Can be influenced by socioeconomic status, cultural status, and available support systems Psychosocial concerns AGING Sum total of all the changes that normally occur in an organism with the passage of time Process of growing older that usually begins at birth (having different changes per age group - manifested by our body, mentally, and a. inflammaging - chronic low-grade emotionally) inflammation, a characteristic feature of aging (dysregulated immune response) b. Accumulation of metabolic waste FACTORS ASSOCIATED WITH AGING products INTERNAL FACTORS EXTERNAL FACTORS Biological and genetic mechanisms Lifestyle Can be Combined with external factors Environmental exposures Socioeconomic factors TELOMERE SHORTENING protective caps at the ends of chromosomes SUN EXPOSURE can cause skin aging (development of wrinkles, CELLULAR SENESCENCE (CELL AGING) age spots, and sagging of skin) state of irreversible cell cycle arrest in response to various stressors; having illness in DIET (POOR DIETARY CHOICES) accordance with age (arthritis) can accelerate aging, lacking in antioxidants can increase oxidative stress, cellular damage MITOCHONDRIAL DYSFUNCTION responsible for energy production SMOKING accelerated aging of the skin, increase wrinkles, ACCUMULATION OF OXIDATIVE DAMAGE higher risk of age related diseases oxidative stress occurs when there is a n (cardiovascular diseases and cancer) imbalance between the production of reactive oxygen species (ROS) and the body’s ability to ALCOHOL CONSUMPTION neutralize them (overtime, oxidative damage will can negatively affect various aging, can lead to accumulate and lead to cell aging, disrupt liver damage and cognitive decline protein synthesis, DNA, and RNA replication) ○ Build-up = oxidative stress CHRONIC STRESS accelerate, disrupt hormonal balance, decline Epigenetic changes - epigenetic modifications regulate immune response gene expression patterns without altering the DNA 12 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo ENVIRONMENTAL TOXINS Low socioeconomic status air pollution, pesticides (can damage cell and ○ Retirees tissues) Predominantly female ○ 54% 60 yrs old are female; 62% 80 yrs olds are female Possibly isolated living OCCIPITAL FACTORS conditions stress, posture, irregular working hours More and longer hospital stays, and More money spent on healthcare and drugs HEALTHCARE & MEDICAL INTERVENTIONS access to healthcare; regular medical checkup CARDIOVASCULAR SYSTEM (detect age related conditions); availability and affordability VASCULAR AGING ENVIRONMENTAL FACTORS retirement savings, resources for healthcare PARTS OF BLOOD VESSEL (access necessary support and services) 1. Tunica adventitia - contains collagen fibers, Aging is a multi-factorial dynamic process elastic tissue - maintains elasticity 2. Tunica media - middle layer, relatively thicker layer composed of connective tissue; smooth PHYSIOLOGIC CHANGES IN AGING muscle, and elastic tissue; the contractile properties of the arterial wall are determined primarily by the variations in the composition of PHYSIOLOGIC CHANGES IN AGING the media Aging process in one physiological system can Changes in middle layer: studies show directly or indirectly influence other physiological that the number of vascular muscle cells systems in the tunica media declines with age, It is an extremely individual process that is while the remaining cells increase in the greatly affected by a person’s genetic makeup, size health behaviors, and availability of resources. 3. Tunica intima - innermost layer; consists of These are changes can occur to everyone, but connective tissue layer and inner layer of does not occur in same rate endothelial cells; thickness in the intima We have to consider: increases due to increasing amount of collagen ○ Chronological age and the decreasing amount of elastin resulting to ○ Physiological age stiffness and thickness between the fold; by 90 ○ Functional age yrs, arteriosclerosis is a risk factor. ○ Biological age Atherosclerosis - hardening of arterial wall Old and aging may vary to an individual or person These changes may affect the REMODELING respiratory system Thickening, stiffening and dilatation of arteries. May affect the changes of other body system ○ Increase in systolic pressure, and no ○ Genetically program change to diastolic pressure (isolated ○ Environmental factors systolic hypertension - most common ○ Health Behaviors hypertension in older adults) ○ Different culture, different practices may Increases risk for development of affect health changes atherosclerosis FRAIL ELDERLY Poor mental and physical health ○ Develop physical and cognitive problems 13 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  Increased systolic pressure, decreased diastolic pressure and increased pulse pressure Pulse pressure is the difference (minus) between systolic and diastolic pressure Results to isolated systolic hypertension ○ Common form of hypertension in older adults AGING HEART AT REST Preserved systolic function and altered diastolic function Brought about by stiffness, it keeps on contracting ENDOTHELIAL AGING Reduced rate of ventricular filling during early VASCULAR ENDOTHELIUM diastole Metabolically active tissue involved in the ○ 50% reduction between 20-80 yo changes needed to maintain and regulate blood ○ Due to flow. Left ventricular stiffness - During younger age: synthesizes and releases a brought about by increase variety of regulatory substances in response to collagen and decrease elastin both chemical and mechanical stimuli Prolonged contraction - uptake During older age: decreased nitric oxide of intracellular calcium – CA production resulting to impaired blood vessel contribute to contraction of relaxation muscles Aorta stiffness - increases the NITRIC OXIDE workload of the heart or maintains vascular tone or arterial walls. decreases cardiac workload, which is taught to promote which is observed in aging heart AGING CARDIAC STRUCTURE Increased in thickening and stiffening of heart EXERCISE AND AGING walls (esp. Left Ventricle) Enlargement of heart chambers (esp. atria) Maximum Cardiac Output + Systemic oxygen SA node manifests fibrosis and loss of reserve: (VO2max) or maximum oxygen pacemaker cells - cannot generate electrical consumption during exercise impulses; cant contract normally ○ Declines 10% per decade beginning 2nd Decline in cardiac myocytes with subsequent decade of life hypertrophy of remaining cells ○ Reduces 50% by 80 Declines to approximately 35% VO2max - maximum rate of oxygen consumption Decrease is greater in males than females measured; during incremental exercise Larger number of fibroblasts Incremental means increase in intensity Cells that produce collagen and elastin provide ANA is able to publish that the Vo2 max should elasticity of arterial walls, with reduction of be regularly assessed like the vital signs; lower elastin then eventually it can produce elastic fitness levels are associated with high risk of recoil of the heart. cardiovascular diseases. Maximum heart rate attained during exercise decreases ARTERIAL STIFFNESS IN AGING ○ B-adrenergic stimulation declines with age - maximum heart rate is also decreased 14 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  ○ B-adrenergic receptors Increase the Alcohol and diet - Prolong alcohol intake can heart rate increase chances for those people to develop ○ Decreased population of SA node pulmonary artery disease which contributes to pacemaker cells - stiffness due to your hypertension. increased fibroblast, in response to the Exercise - referred to sedentary life/ lack of electrical conduction of the heart, exercise, required to 30 mins which contributes eventually it will have to fail in to hypotensive effect; would prevent contraction hypertension ASSESSMENT HYPERTENSION Asymptomatic – majority “Silent killer” - it has no symptom: not until it Early indicators already had destruction to the heart ○ Fatigue Systolic BP increases to a greater extent than ○ Headache – increase in the BP the diastolic BP ○ Epistaxis – increase in vasodilation ○ Isolated systolic hypertension (ISH) - ○ Dizziness most common form of hypertension in older people Severe HPN Throbbing occipital headache prevalent in the morning RISK FACTORS NURSING DIAGNOSIS LIPID ABNORMALITIES 1. Knowledge deficit: Hypertension and self-care total cholesterol and LDL (bad cholesterol) management related to new diagnosis and remains significant indicator in both sexes; interventions associated 30-35% increase higher in 2. Ineffective individual coping related to perceived developing CHD rate limitations to diagnosis 3. Ineffective management of therapeutic regimen DIABETES MELLITUS 4. Altered nutrition: more than body requirement doubles the risk of developing coronary heart related to high fat, caloric and sodium intake disease 65-94 NON PHARMACOLOGICAL MANAGEMENT BODY MASS INDEX referral to truncal obesity (trunk) - increase weight in hip ration; most commonly associated WEIGHT LOSS to hypertension since risk factor is obesity; 2kg over 6 month period will reduce bp by over 4⁄5 of mmHg; 10% SMOKING of ideal - improve mobility, respiratory and Relative risk of stroke is 5 times than does with circulatory function; improves glycemic control normotensive SALT RESTRICTION ATRIAL FIBRILLATION decrease 80mmol/day leads to BP reduction of 8 abnormal heart rhythm/electrical impulses that mmHg started in atria; contribute to hypertension and doubles the risk to CAD, CVA or stroke INCREASE POTASSIUM INTAKE Left ventricular hypertrophy - hypertrophy increase of 40 mmol/day contributed to (increase size of left ventricle); its presence hypotensive reaction reduction BP to 10/6 induce 65 to 94 y.o, risk in men and women for mmHg CAD 15 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo REDUCE ALCOHOL INTAKE slows the heart (Lanoxin) EXERCISE mild to moderate exercise; brisk walking for 30 Potassium Helps control K-Dur, K-Tab mins heart VITAMIN C encourage intake of vit c rich food provides mild rhythm reduction in hypotensive action and a positive effect on the lipid profile of older hypertensive Blood thinners Prevents clots Warfarin (Coumadin); Heparin PHARMACOLOGICAL MANAGEMENT HYPOTENSION (POSTURAL) MEDICATIONS USED FOR BOTH CHF AND HPN Experience this due to vasoactive medication; DRUG FUNCTION EXAMPLE esp in elderlies who have maintenance medications Diuretics Decrease water Furosemide Decline in systolic pressure of 20 mmHg or more and salt (Lasix) after rising and standing for 1 min retention Causes: ○ increase intake of vasoactive meds Beta-blockers Lower cardiac Atenolol ○ age-related changes such as blunting of output and heart (Tenormin) ○ baroreflex- mediated heart response to rate hypotensive and hypertensive Can be a serious consequences for older person ACE inhibitors Block hormone Captopril such as falls, stroke, syncope and coronary that (Capoten) complication causes artery constriction MANAGEMENT Central alpha Block Clonidine Get out of bed slowly and in stages agonists constriction of (Catapres) Sleep with head of bed elevated several inches vessels Have a daily fluid intake 2 to 3 liters Avoid hot showers or baths Calcium Relax blood Amlodipine Avoid straining at stool channel vessels (Norvasc) Exercise regime must be recommended by the blockers to the heart physician Avoid prolonged standing Angiotensin II Relax blood Irbesartan pharmacotherapy : Fludrocortisone, as receptor vessels (Avapro) prescribed blockers by blocking angiotensin II CORONARY ARTERY DISEASE Vasodilators Relax the walls Hydralazine Coronary heart disease (CHD), or ischemic heart of (Apresoline) disease the arteries Refer to a broad group of condition that partially or completely obstruct blood flow to the heart MEDICATIONS USED FOR CHF muscle Atherosclerosis is the usual cause Digitalis Strengthens and Digoxin Complications include angina, myocardial infarction, sudden death 16 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  Older adult may not exhibit similar manner as ANGIOPLASTY young adult balloon angioplasty, a minimally invasive Do not manifest typical chest pain - neuropathies procedure where it will insert a balloon using a ○ Neuropathies- decrease in pain catheter, recognition. May not seek medical attention right away, need to instruct the CORONARY ARTERY BYPASS GRAFT (CABG) patient especially if elderly and taking a blood vessel from another part of the verbalizing chest pain body (usually the chest, leg or arm) and Involves reduction of the blood flow to the heart attaching it to the coronary artery above and due to buildup of atherosclerosis as the most below the narrowed area or blockage. common cause of CAD while CAD is the most common CHD; can lead to Angina Pectoris OXYGEN THERAPY (chest pain) - most common symptoms of CAD, increases the amount of oxygen in the blood pain may radiate to shoulders, arms, back, neck or the jaw or abdomen due to vasospasm of CARDIAC REHABILITATION PROGRAM arterial walls; occasionally patient may physical activity, education about healthy living, experience heartburn, lasts for few minutes diet, medications, smoking cessation program, improve with rest, if not resolve then it is counseling to relieve emotional stress and considered Myocardial Infarction (Heart Attack) promote mental health INSIGHT (LUECKENOTTE, 2000) PHARMACOLOGIC CAD is the leading cause of death and disability Beta-blocker- decreases cardiac output in women over 40 years old. ACE inhibitors - lowers blood pressure Approximately 1 of every 2 women will die of Antihypertensives – nitroglycerine CAD Chest pain - nitroglycerine or nitrates Women experience more epigastric pain and shortness of breath than chest pain Anatomically speaking women have smaller ANGINA coronary arteries, which allow the arteries to occlude so it is more prone to occlusion, which Spasm of arteries; imbalance of oxygen demand increases the risk for CAD and oxygen supply Women experience more epigastric pain and First symptom of CAD in the older adult shortness of breath than chest pain Often occurs related to exercise or stress and is relieved by rest and/or nitroglycerin ATYPICAL PRESENTATION OF CAD/CORONARY ○ Nitroglycerin - dilation of arteries; HEART DISEASE (CHD) IN OLDER PERSON increase blood flow preventing vasospasm and increase circulation Shortness of breath through myocardial perfusion Fatigue Chest pain is generally shorter (less than 5 Syncope - fainting spells; loss of consciousness minutes) than MI Confusion ○ Classic presentation - squeezing pain or Abdominal or back pain pressure in the sternal area (Levine’s Older client may not recognize seriousness and sign) may cause delay in seeking medical attention ASAP ASSESSMENT MANAGEMENT Dyspnea Dizziness Confusion Most times older adult does not have typical chest pain 17 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  Indigestion or epigastric discomfort, especially TYPES OF ANGINA when not relieved with antacids 1. Unstable angina - pain occurs even when the Of particular significance in the elderly person is resting or at rest. May require hospitalization since it may lead to heart attack. STEPS TO FOLLOW WHILE AWAITING EMERGENCY Pain is long lasting and worsen through time TREATMENT: 2. Stable angina: medication and lifestyle; pain 1. Have the patient rest. (if at home, take occurs when the person has performed and nitroglycerine, after 5 mins then take again, after activity; usually relieved by rest and medication; 5 mins take again but it not relieved after the 4-5 minutes third take then go to the hospital) 1. Provide supplemental oxygen. 2. Give nitroglycerin sublingually every 5 minutes ASSESSMENT three times and monitor vital signs. Unstable angina - may require hospitalization 3. Give aspirin if not contraindicated Stable angina - medication and lifestyle modifications MANAGEMENT ○ Weight management ○ Stress management STRATEGIES FOR OLDER ADULTS TO REDUCE ○ Limiting caffeine RISK OF HEART ATTACK ○ Smoking cessation Exercise regularly. ○ Exercise regimen based on myocardial Do not smoke. capacity Eat a balanced diet with plenty of fruits and ○ Control of hypertension vegetables; avoid foods high in saturated fats. Maintain a healthy weight. MYOCARDIAL INFARCTION Manage stress appropriately. Control existing diabetes by maintaining healthy Risk increases with age blood sugars and take medications as Infarction – death of tissue prescribed. MI – death of heart muscle Limit alcohol intake to 1 drink per day for women Layman’s term – Heart Attack and 2 drinks per day (or less) for men. Portion of heart does not receive adequate Visit the doctor regularly. oxygenated blood leading to myocardial After a heart attack, participate fully in a cardiac necrosis; signs - CAD due to fatty deposits rehabilitation program. leading to decrease in blood supply, particularly Involve the entire family in heart-healthy lifestyle the oxygenated blood modifications. Report any signs of chest pain immediately. WARNING SIGNS OF HEART ATTACK Chest pain appearing as tightness, fullness, or NURSING DIAGNOSIS pressure 1. Pain related to imbalance between oxygen need Levine’s sign and supply Pain radiating to arms 2. Risk for decreased cardiac output related to Unexplained numbness in arms, neck, or back decreased pumping ability of the heart Shortness of breath with or without activity 3. Knowledge deficit: CAD related to new diagnosis Diaphoresis and treatment plan Sweating 4. Anxiety: Death Nausea Pallor Dizziness CONGESTIVE HEART FAILURE Unexplained jaw pain 10 per 1,000 people over the age of 65 Risks: 18 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  ○ Hypertension - doubles for blood "stroke" pressures >160/90 Transient ischemic attacks ○ Diabetes Mellitus ○ Goes away within 24 hours; leaving no ○ CAD residual effects ○ Renal Disease ○ Usually last for a few minutes. Happens ○ Myocardial infarction when blood supply in the part of the ○ CHF- often occurs within 6 years after a brain is blocked. heart attack ○ They don't last long. They happen 2 types: left and right suddenly. ○ left - inability of the left side of heart to ○ Numbness or weakness one side of the pump blood effectively body SYMPTOMS: RISK FACTORS: Shortness of breath Edema CONTROLLABLE UNCONTROLLABLE Coughing or wheezing Fatigue Modifiable through Lack of appetite or nausea lifestyle Confusion changes Increased heart rate Prevent heart disease - Atypical signs exercise regularly ○ Decreased appetite ○ Weight gain of a few pounds Hypertension Advanced age ○ Insomnia High cholesterol Gender (male Shortness of breath, persistent coughing, Heart disease more than female wheezing, dyspnea when lying down (elevate to Smoking until menopause) breathe properly and promote lung expansion), Obesity Race (African edema in legs and ankles, trouble with memory Stress Americans more and concentration d/t back up of blood Diabetes than whites) Progress then lead to the right Heredity ○ left sided is common cause for right Hormonal sided (congestive hepatopathy replacemenT -accumulation of fluid in the liver); Therapy ascites Oral estrogen replacement - increases the blood clotting factors SYMPTOMS 3 QUICK ASSESSMENTS 1. Facial droop - one side of the face is numb 2. Motor weakness - hemiparesis; hemiplegia 3. Language difficulties - aphasia; tend to stutter CEREBROVASCULAR ACCIDENT Other warning signs 19 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  ○ Vision problems homonymous Aphasia ○ Uncoordinated gait hemianopsia (especially ○ Temporary loss of consciousness (loss of half expressive ○ Appearance of classic warning signs of visual field) type) that disappears quickly Difficulty with (language cognitive disorder; ACUTE MANAGEMENT tasks such as expressive; Seek immediate treatment CT scan or MRI spatial- difficulty in ○ Determine type and location of stroke perceptual expressing) tasks, Reading/writi SURGERY sequencing, ng problems ○ Evacuate blood and stop bleeding for following, Dysarthria hemorrhagic stroke multi- step Dysphagia instructions, Anxiety when Tissue plasminogen activator (t-PA) and writing trying new ○ Gold standard treatment for ischemic Memory tasks stroke deficits Tendency to ○ 3-hr window after onset of symptoms related to worry and be Administered intravenously performance easily Can cause bleeding inside the May not frustrated brain; the longer the treatment; recognize or Slow, outweigh the benefits accept cautious Even if mag lagpas sa 3 hr limitations or Memory period, the doctor can still deficits deficits administer antiplatelet and Overestimati related to anticoagulant ng abilities language Impulsive COMMON CHARACTERISTICS ASSOCIATED WITH Quick STROKE OF EITHER SIDE movements Anosognosia Weakness/paralysis or other Fatigue forms of Depression left-sided Emotional lability neglect Some memory impairment (neurological Sensory changes condition; Social isolation unaware of; Altered sleep patterns unable use the impaired RIGHT LEFT HEMISPHERE part) HEMISPHERE STROKE Impaired STROKE judgment Inappropriatel Left Right y low anxiety hemiparesis hemiparesis Higher risk or or hemiplegia for falls due hemiplegia(p Right to lack of aralysis) homonymous safety Left hemianopsia awareness Deficits less 20 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  easily (related recognized to toileting, by others dressing, eating, bathing) Impaired PHARMACOLOGIC MANAGEMENT communication Prevent clot formation and recurrence of stroke Activity ○ Aspirin intolerance ○ Ticlopidine (Ticlid) ○ Plavix ○ Dipyridamole (Persantine) POST-STROKE REHABILITATION Anticoagulants ○ Heparin KEY PRINCIPLES ○ Coumadin _____________________________________________ ○ Lovenox Maximize functional ability Prevent complications NURSING DIAGNOSIS: Promote quality of life Encourage adaptation - we provide ways in Alteration in Decreased which they can still perform their functional ability tissue perfusion: endurance Enhancing independence – long term goals; cerebral High risk for achieve maximum functionality Alteration in impaired tissue perfusion: skin integrity peripheral High risk for NURSING MANAGEMENT Impaired injury Encourage use of the affected side – reduce swallowing Altered role neglect Ineffective airway performance Place items on the unaffected side - promote clearance Spiritual distress self-care and provide safety Impaired gas Hopelessness Use a variety of teaching modalities during exchange Powerlessness educational sessions – health teachings should Alteration in Pain be short and relevant; they should be able to nutrition: less Self-esteem grasp the idea and understand them easily than body disturbance Minimize distractions during educational requirements Social isolation sessions. Keep these teaching items short and Alteration in Sleep pattern relevant. bowel elimination disturbance Use terms such as "affected/unaffected" side or (constipation, Impaired home "weak/strong" side instead of "good/bad." - can diarrhea) maintenance motivate the client in performing the activities Alteration in management Alternate rest and activity urinary Discharge Build endurance slowly elimination planning Include the person and family in the plan of care (incontinence, needs Assist the patient and family in setting retention) Knowledge deficit reasonable goals Impaired physical Fear/ Connect the family with a stroke support group mobility or club Unilateral neglect Altered sensory RIGHT HEMISPHERE STROKE: perception Foster a calm and unhurried care environment. Self-care deficits Break tasks into simple steps. 21 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  Be especially attentive to safety issues that may RESPIRATORY DISORDERS arise from poor judgment and lack of safety awareness. Protect the patient from injury. Avoid overstimulation OUTLINE I. Assessment II. Respiratory Efficiency Declines with Age LEFT HEMISPHERE STROKE: III. Changes that Occur in Aging Speak slowly and distinctly. IV. Respiratory Volumes and Capacities Use simple sentences for those with aphasia. V. Common Respiratory Problems Among the Use a variety of communication techniques: Elderly gesturing, cues, pointing, writing, communication boards, yes/no questions Allow time for the person to respond to ASSESSMENT questions. Provide teaching in a quiet, structured Decreased vital capacity environment. Dyspnea Monitor the patient for swallowing difficulties. Cough capacity decrease Promote a positive self-image by attention to Mucus secretion collection increase good grooming, personal hygiene, and positive reinforcement RESPIRATORY EFFICIENCY DECLINES WITH AGE Vital Capacity – the amount of air that the lungs can expel after having been filled completely/after a maximum inhalation. Older adult has decreased vital capacity. To compensate for increased oxygen need they increase the amount of air inspired. Capacity to cough efficiently decreases because of weaker expiratory muscles. Mucus secretions tend to collect more readily in the respiratory tree, thus, susceptibility to respiratory infections increases. HEALTH PROMOTION TEACHING 1. Cessation of smoking, if appropriate 2. Preventing respiratory infections by washing hands 3. Ensuring that influenza and pneumonia vaccinations are up to date CHANGES THAT OCCUR IN AGING ALVEOLI Flatter and shallower alveoli Decrease in the amount of tissue dividinG individual alveoli Alveolar surface area drops to as much as 20% 22 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  ○ Resulting to higher tendency for alveoli RESPIRATORY VOLUMES AND CAPACITIES to collapse Senile emphysema may occur ○ Due to changes of elastin and collagen resulting to loss of elasticity and VOLUMES DEFINITION AGE-RELATED subsequent dilatation of alveolar ducts CHANGES and air spaces Tidal Volume Amount of air DECREASE Decrease glandular epithelial cells (TV) inspired and ○ Leads to reduced production of mucus, expired during impairing the respiratory defense against normal breath infection Inspiratory Amount of air DECREASE LUNG ELASTICITY Reserve Volume that can be (IRV) inspired after maximum Decreased lung elasticity which results to inspiration decrease recoil properties Decreased efficiency of oxygen delivery Expiratory Amount of air DECREASE - Blood flows at lowers portion of the Reserve Volume that can be lungs while air flows at the upper portion (ERV) expired after of the lungs. Yet, it is the lower lung that maximum has a greater capillary network and expiration blood supply for oxygen delivery. Thus, the decreased airflow through the lower Residual Amount of air INCREASE lung results in efficient delivery of Volume (RV) remaining in the oxygen to the body. lungs following maximum CHEST WALL expiration Stiffer Chest Wall Forced Amount of air DECREASE Due to loss of rib elasticity and Expiratory that can be calcification of the cartilage that attaches Volume (FEV) forcefully ribs to the breastbone. expelled in one The stiffness of the chest reduces its second ability to expand during inhalation and contract during exhalation. As a result, CAPACITY DEFINITION AGE-RELATED older persons often rely heavily on the CHANGES diaphragm for expansion and contraction of the chest cavity when they Total Lung Maximum NO CHANGE breathe Capacity (TLC) capactiy to Diaphragm weakens by 25% which the lungs ○ Reduces the contractual abilities of the can expand diaphragm, limiting respiration during maximum inspiratory effort Vital Capacity Amount of air DECREASE (VC) that can be expelled following 23 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  maximum COMMON RESPIRATORY PROBLEMS AMONG inspiration THE ELDERLY Inspiratory Maximum DECREASE Capacity (IC) capacity of air PNEUMONIA (IC= TV + IRV) that can be inspired after An infection in the lungs that can be caused by reaching the factors including bacteria, viruses, and aspiration end of a normal A leading cause of death among the elderly expiration Incidence of CAP among age 71-85 is 50/1000 per year Functional Amount of air INCREASE Residual remaining in the FACTORS THAT CONTRIBUTE TO HIGHER Capactiy (FRC) lungs following INCIDENCE a normal expiration Poor chest expansion and shallow breathing Lowered resistance to infections Reduced mobility and debilitation Reduced sensitivity of pharyngeal reflexes, which promotes aspiration of foreign body DIAGNOSTICS Chest x-ray Complete blood count Sputum culture History taking ASSESSMENT Crackles may be heard in the lungs through auscultation Chest pain with shortness of breath VIRAL Symptoms - Fever - Nonproductive hacking cough - Muscle pain - Weakness - Shortness of breath BACTERIAL - Sudden or gradual onset - SYMPTOMS: Chills, chest pain, sweating, productive cough, or dyspnea and confusion - May not be present with typical symptoms - CAnith the typical symptoms - Can be often be treated successfully when detected early 24 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo NURSING DIAGNOSIS INFLUENZA Ineffective airway clearance related to decreased energy and trachea bronchial inflammation/obstruction/secretion Older patients accounts for 90% of all Impaired gas exchange related to altered oxygen influenza-related deaths supply and alveolar-capillary membrane Prone to complication from influenza especially changes is they have comorbidities such as metabolic, Ineffective breathing pattern related to cardiac, and chronic respiratory disease respiratory muscle fatigue Older adult has decrease ability to clear secretions and to protect airway; as well as MANAGEMENT impaired immune response (highly susceptible to Rest influenza) Increased oral fluid intake Antipyretics ASSESSMENT Report signs of respiratory complications (leading cause of death) Fever, chills, anorexia, and body malaise - Shortness of breath, high fever or Which may be blunted or atypical in older adults symptoms that do not improve General fatigue , malaise and decreased Pneumonia and Flu vaccine for >65 appetite and decrease fluid intake may indicate influenza in older patients MANAGEMENT Annual influenza vaccine - best way to prevent infection Rest and Hydration Antibiotic if with secondary bacterial infection CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Characterized by progressive airflow limitation that is not fully reversible Represents a group of disease most common are chronic bronchitis and emphysema CHRONIC BRONCHITIS a clinical syndrome characterized by excessive mucus production with cough on most days for a minimum of 3 months of a year for at least 2 consecutive years EMPHYSEMA characterized by progressive destruction of the alveoli and their supporting structures 25 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  GASTROINTESTINAL MOUTH Difficulty chewing and swallowing ○ Edentulous with decayed or diseases teeth ○ Age-related changes in teeth (less an tomia sensitive and more brittle) ○ Atrophy of muscles 40% of older adults complain of dry mouth RISK FACTOR (XEROSTOMIA) Smoker/passive smoker, air pollution, poor ○ Reduced production of saliva nutrition, familiar allergies, alcohol intake ○ Lead to changes in taste senstation - ○ - Oral mucosa susceptible to infection SIGNS & SYMPTOMS ○ May be due to medications, nutritional Progressive dyspnea, cough, increased sputum deficiencies, disease and treatment production therapies MANAGEMENT Smoking Cessation – single most important PERIODONTAL DISEASE and cost-effective intervention A stepwise approach to pharmacology -C Inflammation of gums extending to the underlying tissue, roots of tooth shrinks and the Healthy lifestyle – regular exercise and weight - - gingiva retracts control - Causes tooth loss in elderly e - Proper nutrition Predispose older adult to systemic infection Pneumococcal and annual influenza vaccine - COR PULMONALE DECREASE GUSTATORY Enlargement of the right ventricle (right side heart failure) secondary to diseases of the lungs, - O Taste buds atrophy with age Decreased ability to discriminate sweet, sour, thorax, or pulmonary circulation; the most - salty, and bitter tastes - common cause is COPD Elevated thresholds for salt and bitter taste In COPD, low levels of O2 can raise blood Sweet taste appears stable - pressure in the arteries of the lungs (pulmonary hypertension) DECREASE OLFACTORY NURSING MANAGEMENT: Teach breathing exercise and coughing by 9th decade - - 90 year O The olfactory threshold increases by about 50% techniques Poor smell recognition - Instruct to turn, cough, and deep breath at least every 2 hours Postural drainage Monitor rate, depth, and rhythm of respiration, f G ESOPHAGUS Preserved esophageal functioning until around blood gas, and mental status 80 lossotabilitate Stiffening of the esophageal wall potentially - caused loss of muscle abilities and nerve nerve innervations innervations Common complaints 26 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  - thinning external anal sphincterthick ○ Dysphasia, heartburn, and chest pain Thinning external anal sphincter with thickening internal sphincter (the more kipot, the more power) STOMACH Declines in peristaltic contractions & stomach - LIVER emptying do not appear to be significantly significant (no changes) Decrease size and perfusion by 30-40% Secretions Hepatocytes (cells in the liver) undergo structural ○ No change in gastric acid secretions alterations ○ Decline in pepsin, bicarbonate, & Compensated due to liver’s large reserve sodium ion secretions & prostaglandin capacity and the hepatocytes ability to content regenerate after damage 2) - - Pepsin is activated once there is low pH (1.5 to GALLBLADDER Decrease in hydrochloric acid leads to decreased absorption of calcium No structural changes except bile ducts Elasticity of stomach lessens The longer it stays, the more it reabsorbs the bile Small frequent feeding, not advisable to eat Choledocolelithiasis - stone in the common bile many duct Choledogle Lithiasis O Diet: balanced Less bile during digestion Increasing bile volume Increasing risk for gallbladder stones SMALL BOWEL (SMALL INTESTINE) (Cholelithiasis) No change/ minor changes in contraction no change in transit time (movement of the food PANCREAS 6-8 Stomach a s to the intestine); N: 6-8 hrs from the stomach to 36 hr the small intestine; 36 hrs from stomach to the Decreases in weight with age death large intestine Histological changes: fibrosis & cell atrophy reporte Bacterial overgrowth is a common clinical results Insulin (vehicle para madala sa cell) Bacterial - of malabsorption & malnutrition (not due Compensated by large reserve capacity of the to...) pancreas No changes in nutrient absorption Vitamin absorption incachine a ○ INCREASE: Vitamin A (fat soluble) Vit , D RENAL SYSTEM ○ DECREASE: Vitamin D, Zinc, and Calcium KIDNEY LARGE BOWEL Shrink in length and weight Secretes enzymes such as renin () and Loss of intestinal neurons and inhibitory nerve - erythropoietin (stimulates red blood production) connection to the smooth muscle - Decrease in size and number of nephrons decreased ability to inhibit colonic contractions - # of glomeruli decreases to 30-40% by 90 and/or by decreased colonic relaxation (jejunum - Glomerular filtration rate of 300ml/min to ileum - waste food) ○ Decreases 10% per decade beginning Increased transit time 20 Increased - colonic pressure - due to slow ○ No elevation of serum creatinine due to movement, many content, diverticulosis - decline in muscle mass problem, no evacuation. Decreased number and length of renal tubules - Increased fibrous tissue in the rectum - not that Decrease in reabsorption and excretion elastic to stretch the size of the stool functions 27 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  Glomerulosclerosis = Scarring of glomerulus ○ No remaining viable follicle at 50-65 Renal blood flow: years of age Young adults average = 600ml/min Uterus decreases to 50% and impalpable by age Older adults (80 yrs old) = 300ml/min 75 Vagina shortens and narrows Vaginal walls become thinner and weaker HORMONES Loss of mucosal layer in the vagina (dryness) Decrease level of plasma renin and aldosterone beginning 40 yrs of age MALE REPRODUCTIVE ○ Impaired ability to conserve salt Increased release of antidiuretic hormone The testes decrease in both size and weight Decreased serum calcium muscles Leydig cells decrease in number ○ Increased parathyroid hormone ○ Decline in testosterone level with stable Decreased vitamin D Supplementation estrogen level ○ Increase need for Vitamin D Benign Prostatic Hyperplasia (BPH) is common. supplementation Increases fibrosis in erectile tissues of penis ○ Increases amount of time to achieve an erection BLADDER ○ More stimulation is required to maintain Decrease level of plasma renin and aldosterone erection Decreases in size and develops fibrous matter in ○ Less intense orgasm and ejaculation the bladder wall ○ Decrease in filling capacity and ability to MUSCULOSKELETAL SYSTEM withhold voiding Detrusor muscle dysfunction (detrusor muscle is Shortening of the vertebra to contract during urination to push the urine out ○ KYPHOSIS of the bladder and into the urethra) Contract and ○ Height decreases approximately 2 detrusor, relax ang sphincter if urinating inches detrusor-contract sphincter relax Atrophy and decrease number of muscle fibers ○ Decrease muscular strength & function Grief all muscle mass, muscle strength, and URETERS AND URETHRA muscle movements are decreased NO age related changes in the ureters ○ SARCOPENIA ○ Arm & leg muscles flabby and weak URETHRA Bone mineral and bone mass reduced WOMEN: decreased length and thinning of the ○ OSTEOPOROSIS (common in women); urethra; weakening of sphincters at risk for fracture MEN: prostate enlargement around the bladder Diminish calcium absorption and urethra (BPH- constricted, di kaihi) ○ Risk for fracture Benign Prostatic Hyperplasis REPRODUCTIVE SYSTEM NERVOUS SYSTEM Decline in brain weight Reduction of blood flow to the brain FEMALE REPRODUCTIVE Degeneration and atrophy of neurons Decreases number of ovarian follicles ○ Loss of memory (recent memory) ○ Begins at the age of 30-40; more rapid Decreased muscle coordination after 35 ○ Decreased ability to perform fine motor ○ Decrease amount of estrogen and activities progesterone Slower nerve conduction velocity 28 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  ○ Slower reflexes & delayed response to VISION multiple stimuli Kinesthetic sense lessens Decrease In amount of tears produced (dry eye ○ Risk for fall syndrome) ○ Feeling of irritation (as if something is stuck in eyes) SENSORY SYSTEM Reduced transparency of cornea “glare” Nerve conduction velocity: Decreased ability of iris and pupil to work Speed to response to stimuli together to constrict and dilate ○ Thickening collagen fibers ○ Unable to appropriately adapt to TOUCH changing light intensities Decrease in number & changes of the Loss of elasticity of the lens meissner’s corpuscles and pacinian corpuscles ○ Less curved and more flat ○ Decrease ability to touch & distinguish ○ Decreased transparency to colors of texture and sensation in hands and feet light (blue) ○ Formation of opaque spots Decreased transparency of vitreous humor SMELL ○ Increased scattering of light resulting to Reduced with age “hyposmia” floaters Sense of smell and taste peaks in the 20s and Decreased amount aqueous humor 40s, but decline in smell by the 60s and 70s ○ Flattening Presbyopia “farsightedness” EFFECTS Decline in visual acuity Inability to smell harmful odors such as gas or ○ Decrease of neurons along the visual smoke pathway Inability to smell pleasurable memory-invoking Decline in sensitivity to contrast aromas such as flowers ○ Problems seeing road signs at night Influence the sense of taste; change in eating Narrowing of peripheral and central visual fields habits and pleasure with food Impaired color discrimination Changes in rods photoreceptors TASTE Decreased elasticity Decrease in taste “hypogeusia” With age (lens become less curved and more ○ Usually more noticeable around the age flat) of 60 with more severe declines Opaque spots = formation of senile cataract occurring over the age of 70 (brought about by aging) ○ Other causes: chemotherapy and zinc deficiency HEARING ○ hypogeusia Can’t taste salty Outer ear losses elasticity Can’t detect salt changes External ear canals narrow Sweetness doesn’t change Shrinkage of cerumen glands Decrease in the number of taste buds and ○ Dyer cerumen change in taste receptors ○ Blockage of external canal and decreased hearing EFFECTS Tympanic membrane stiffens With poor smell - risk for food poisoning and Shrinkage of ossicles (particularly at the age of malnutrition 70) Hearing loss “presbycusis” Degeneration of the organ of Corti 29 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  ○ Increased shrinkage and loss of hair ○ Decrease in skin temperature cells ○ Dampened ability to adapt to Decreased endolymph production and vibration temperature change travel ○ Reduction in sweat and oil production ○ Due to degeneration of small blood Decline in number of Pacini’s and Meissner’s vessels in the cochlea corpuscles Decline in the hair, ganglion cells and sensory ○ Increased risk of injury nerve fibers of the vestibular system ○ Impaired ability to perform fine ○ Vertigo and balance problems maneuvers with hands. Conductive hearing loss Cermen is dryer SKIN ○ Decrease activity of apocrine sweat glands Auricles cannot properly vibrate ECCRINE INTEGUMENTARY SYSTEM Decreased number of glands Reduced efficiency of sweat production Impaired thermoregulation; increased risk of heat exhaustion and heat stroke EPIDERMIS Decreased number of active melanocytes SEBACEOUS ○ Increased risk of tumor formation and skin cancer Reduction of oil and wax production Reduction in pigment granules in melanocytes Increased roughness, dryness and itchiness of ○ Reduced ability to tan skin Grouping and increased size of melanocytes Age spots SUBCUTANEOUS Decreased turnover rate of keratinocyte Loss of thickness ○ Increased risk of skin cancer ○ General redistribution of body fat to the ○ Slower wound repair intra-abdominal region with age Reduction in number of Langerhans cells ○ Increased risk of heat loss and ○ Increased susceptibility to infection, hypothermia allergic reaction and tumor development ○ Increased risk of injury and bruising Decline in vitamin D3 production ○ Increased risk of osteoporosis, osteomalacia, and other diseases NAIL Decline in linear growth rate DERMIS Change in color, texture, and shape ○ Thinner, drier, and more brittle Loss of thickness ○ Become flat or concave instead of ○ Averaging to 20% generally due to loss convex of collagen ○ Longitudinal grooves or ridges may form Loss of collagen elasticity and overall loss of collagen ○ Increased likelihood of sagging and wrinkling Elastin loses resiliency and becomes more brittle ○ Sagging Loss of vascularity ○ Blood flow is reduced by approximately 60% 30 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  May experience changes in their social networks HAIR due to factors such as retirement, relocation, or Thinning and loss the passing of friends and family members Changes in length, appearance, and site of growth SENSE OF PURPOSE AND MEANING ○ Older men’s eyebrows and inside their ears become longer and coarser; by age May seek a renewed sense of purpose and 50, most men have some degree of meaning in life, often through engaging in baldness activities that give them a sense of fulfillment ○ Women may develop unwanted facial and contribute to their communities hair (hormonal changes associated with menopause) LIFE TRANSITIONS Graying ○ Gradual loss of functional melanocytes Downsizing or relocating to a different living ○ 50 years of age 50% of people have arrangement coping with the loss of 50% gray hair independence, or dealing with health-related challenges PSYCHOSOCIAL CHANGES RESILIENCE AND WISDOM Often have a broader perspective and a greater ability to cope with challenges in life RETIREMENT Lead to changes in one’s sense of identity and PSYCHOSOCIAL CONCERNS purpose, as well as adjustment to a new daily routine ISOLATION AND LONELINESS LOSS AND GRIEF May experience social isolation due to the loss May experience multiple losses, such as death of loved ones, retirement, reduced mobility, or of loved ones, declining health, or reduced limited social interactions independence DEPRESSION AND ANXIETY PHYSICAL CHANGES Conditions can be triggered by life changes, Decreased mobility, sensory decline, and chronic health problems, loss of independence, and health conditions social factors COGNITIVE CHANGES COGNITIVE DECLINE AND DEMENTIA Cognitive decline, inducing difficulties with Age-related cognitive decline (memory loss, memory, processing speed, and multitasking confusion, and changes in behavior) EMOTIONAL WELL-BEING FINANCIAL INSECURITY May experience a sense of emotional stability, May limit access to healthcare, social activities, contentment, may also be more susceptible to and adequate living conditions mood disorders, such as depression and anxiety AGEISM AND STIGMA SOCIAL NETWORKS 31 Lopez, Tuyogon, Hisolana, Javines, Camarote, Tamayo  May face societal biases, reduced opportunities, FOOD PYRAMID and a sense of marginalization WATER LIQUIDS LACK OF ACCESS TO HEALTHCARE Choose water, fruit or vegetable juice, low-or NUTRITIONAL CONSIDERATIONS nonfat milk, or soup 8 or more servings 8 oz = 3 ml OUTLINE Example of Serving SIzes: 8 oz. wate