Lecture #2 Flashcards
anatomical and physiological changes that are attributed to aging… ALL cells are affected by AGING
aging changes
what are the consequences of inappropriate assessment?
increased morbidity and mortality
missed diagnosis
unnecessary use of emergency rooms
What are the cardiovascular CHANGES?
increased heart weight; left ventricle hypertrophy
decreased baroreceptor sensitivity
decreased force of contraction, contractile efficiency, stroke volume
valvular sclerosis
decrease in pacemaker cells
decrease beta adrenergic response
arterial stiffening and wall thickening with decreased compliance
dilated aorta, tortuous veins
decreased o2 uptake by tissues
What are the cardiovascular implications/manifestations?
decrease cardiac reserve and output
decrease in maximum (peak exercise) HR
HR 40-100 bpm
slow recovery from tachycardia
fatigue, SOB increased premature or ectopic beats
risk of valvular dysfunction and systolic murmurs
extra heart sound common: S4 (not S3 which is always abnormal)
risk of conduction abnormalities
risk of postural and diuretic-induced hypotension
increased systolic BP, pulse pressure, peripheral resistance
risk of carotid artery buckling, JVD
strong arterial pulses; diminished peripheral pulses; cool extremities
risk of inflamed varicosities
What are the cardiovascular assessments?
assess BP (lying, sitting, standing) and pulse pressures
-note altered landmarks, distant heart sounds, difficulty in isolating point maximum intensity
assess carotid arteries, right internal JV, varicosities
monitor ECG. assess exercise tolerance
What are the cardiovascular intervention strategies?
SAFETY: institute fall precautions for orthostatic hypotension (rise slowly from lying or sitting position, monitor for overt signs of hypotension; change in sensorium/mental status, dizziness)
HEALTH PROMOTION/DISEASE PREVENTION:
medication regimens
weigh daily
independence maintenance
avoid fatigue
What are the respiratory CHANGES?
thorax and vertebrae rigid
decrease muscle strength and endurance
diminished ciliary and macrophage activity
increased airway reactivity
drier mucus membranes
decreased alveolar function, vascularization, elastic recoil
decreased response to hypoxia and hypercapnia
what are the respiratory implications?
kyphosis: barrel-shaped
RR: 12-24
decreased respiratory excursion and chest/lung expansion with less effective exhalation and increased residual volume
diminished breath sounds particularly at lung bases
decreased cough, deep-breathing, mucus/foreign matter clearance. RISK OF INFECTION AND ASTHMA
altered pulmonary function
lower maximal expiratory flow (FEV, FEV1/FVC1)
reduced vital capacity
unchanged total lung capacity
dyspnea on exertion, decreased exercise tolerance
PO2,SpO2 decreased.
decreased capacity to maintain acid-base balance
what are the respiratory assessments?
respirations: patterns, breath sounds throughout lung fields
note thorax appearance, chest expansion
assess cough, deep breathing, exercise capacity
assess for infections, asthma
monitor arterial blood gases, pulse ox
monitor secretions, sedation, positioning which can reduce ventilation/oxygenation
presbyphonia (article)
-larynx stiffening, larynx muscle atrophy, decrease FEV
What are the respiratory intervention strategies?
maintain patient airway through repositioning, suctioning
prevention of respiratory infections
incentive spirometry/pursed-lip breathing
HEALTH PROMOTION/DISEASE PREVENTION
-vaccines: flu and pneumonia
-education on cough enhancement, avoidance of environmental contaminants, smoking cessation
What are the GI CHANGES?
decreased thirst perception
decreased saliva with dry mucosa, bone loss
atrophy of taste and olfactory receptors
decreased esophageal motility and lower esophageal sphincter pressure
decreased stomach motility; mucosal atrophy
decreased small intestine motility, villi, digestive enzyme secretion
decreased large intestine blood flow, motility, defecation sensation
decreased liver size blood flow, enzymatic metabolism of drugs; increased biliary lipids
decreased pancreatic reserve, enzymatic and hormonal secretory cells
what are the GI implications?
impaired digestive ability with possible food intolerances
risk of dehydration, electrolyte imbalances, poor nutritional intake
in mouth, risk of gingivitis, tooth loss with chewing impairment
impaired perception of taste (also with many drugs) and smell
risk of dysphagia, hiatal hernia, aspiration
delayed emptying of stomach with risk of maldigestion
GERD
decreased absorption of fat, carbs, protein, vitamin B12, iron, folate, Ca+, and vitamin D
constipation, flatulence
risk of fecal impaction
risk of adverse drug reactions
cholecystolithiasis
What are the GI assessment?
assess abdomen (note smaller liver), bowel sounds
monitor weight, dietary intake, elimination patterns
assess dentition, chewing and swallowing abilities, eating habits/nutrition
assess pulmonary infection from aspiration/dysphagia
presence of NVD
evaluate chemosensory complaints of poor food taste
What are the GU CHANGES?
maintenance of baseline homeostasis of fluid/electrolyte balances
decrease functional reserve when water/salt overload/deficit
decreased kidney wight, blood flow, oxygenation, GFR (often <50%, measured by creatinine clearance)
tubule degeneration: reduced response to ADH and impaired capacity to dilute, concentrate, acidify urine; impaired sodium regulation
reduced bladder elasticity, muscle tone, capacity
detrusor instability with involuntary bladder contractions
weakened urinary sphincter
decreased or delayed perception of voiding signal
increased nocturnal urine production
in males: decreased prostatic antibacterial factor; risk of benign prostatic hyperplasia (BPH)
in post-menopausal females: estrogen loss; decrease pelvic area elasticity; gland and epithelial atrophy; alkaline vaginal pH
what are the GU implications?
risk of renal complications in illness; susceptibility to acute ischemic renal failure and embolism
risk of dehydration, volume overload, hyperkalemia with potassium-sparing diuretics), hyponatremia (with thiazide diuretics), hypernatremia (with NSAIDs)
reduced excretion of acid load
risk of postural hypotension
decreased drug clearance
risk of nephrotoxic injury by drugs
normal renal function; constant serum creatinine level; absent proteinuria
risk of UTI: increased post-void residual urine. why? = changes in the immune system causing different bacteria to become present and more threatening
Nocturnal polyuria-risk for falls
in males: risk for urinary hesitancy dribbling, frequency, incontinence (BPH) why? = enlargement of the prostate gland
in females: risk of atrophic vaginitis, urethritis, vaginal stenosis, vaginal/uterine prolapse
What are the GU assessments?
assess renal function, particularly in acute/chronic ill
monitor BP (orthostatic) (why? = bc with a decreased bladder function, it will cause elders to have more nocturia, if they have orthostatic hypotension and they get up too quick to use the restroom, it can cause them to faint due to the decreased BP)
assess for dehydration, volume overload, electrolyte imbalances, proteinuria
determine source of fluid/electrolyte imbalance. Monitor lab data (creatinine clearance)
assess choice/dose/need for nephrotoxic agents (including amino-glycoside antibiotics, radio-contrast dyes) and renally excreted meds
palpable bladder after voiding due to retention
assess for urinary incontinence, UTI
assess for abnormal urine stream with BPH
assess fall risk in nocturnal or urgent voiding
What are the GU intervention strategies?
preparation for fluid/electrolyte correction as indicated
calculation of creatinine clearance/Cockroft-Gault equation
SAFETY: in nocturnal or urgent voiding and postural hypotension
monitor for nephrotoxic drugs, suggest change or alteration in dose (P&T)
HEALTH PROMOTION/DISEASE PREVENTION: bladder training (void Q2-3H), Kegel exercises, and fluid intake 2-3 L/day unless contraindicated
what are the skin CHANGES?
decreased SUBQ fat, interstitial fluid, muscle tone, glandular activity, sensory receptors
collagen stiffening
reduced blood supply and capacity for repair
capillary fragility
cumulative androgen effect
for hair: decreased melanin and follicles
reduced blood supply to fingernails
what are the skin implications?
cool, pale, dry skin
increased fragility, wrinkling, tenting, sagging (breasts and abdomen with risk of yeast infection)
decreased elasticity, turgor, wound healing, and perspiration with reduced ability to maintain temp
risk of skin tears, ecchymosis, dermatitis, pressure ulcers, dehydration
increased senile lentigines, neoplasms
decreased sensation with risk of injury
decreased fat, muscle tone of feet affected ambulation
graying, dry, thinner hair with facial hair alterations in men and women
thick, brittle, easily split nails with slow growth and risk of fungal infections
what are the skin assessments?
monitor skin temp, turgor (anterior chest wall, not forearm), hydration stats
inspect for changes in skin color, pigmentation, lesions, bruising
assess intertriginous areas (skin-folds; areas skin touches skin, groin, under breast)
assess hygiene; need for podiatry services
what are the skin intervention stategies?
prevent pressure ulcers
educate on care of dry, fragile skin
maintain environmental temp control to prevent hypo/hyperthermia
provide adequate fluid intake to prevent dehydration
What are the eye CHANGES?
decreased orbital fat, muscle elasticity, tear production
decreased corneal sensitivity, reflex; increased translucency, flattening
loss of pigment in iris, smaller pupil
increased vitreous gel debris
decreased aqueous humor secretion with reduced cleansing of lens and cornea
ciliary muscle atrophy
lens less elastic, denser, yellow with decreased light passage
what are the eye implications?
eyes dry and receded with limited upward gaze
risk of ectropion, entropion, conjunctivitis, infection, senile ptosis, artifactual visual fields deficit, arcus senilis; risk of corneal abrasion
blurred vision from scattered light rays
decreased visual
vitrious floaters –> webs in vision field
decreased accommodation and near vision (presbyopia)
decreased peripheral vision
impaired light/dark adaption, color discrimination
decreased night vision, altered depth perception
need for more light to see
difficulty in fundoscopic exam due to small pupil
cataracts, narrow-angle glaucoma
