Exam #1: Altered Homeostasis Flashcards
What is altered homeostasis in geriatrics?
Process of change that happens with age
*****Our reserve generally goes down with age
What are the implications of altered homeostasis as related to the cardiac system?
- Decreased CO
- Decreased maximal HR w/ stress & exercise*****
- Greater difficulty maintaining cardiac output in a. fib.
What are the changes occur in the cardiac system w/ age?
1) Decreased diastolic function i.e. slower/less filling of the left ventricle
2) Decreased response to SNS
3) More reliance on atrial kick
What are the changes occur in the pulmonary system w/ age?
1) Decreased collagen & elastin
2) Collapse of small airways with no change in total lung capacity
3) Ventilation/perfusion imbalance
What are the implications of altered homeostasis as related to the pulmonary system?
Decreased lung elasticity, arterial saturation, & maximal oxygen uptake
*E.g. hip fracture–>hypoxia following the stress
What are the changes occur in the GI system w/ age?
1) Slowed colonic transit time
2) Slower metabolism of alcohol
What are the implications of altered homeostasis as related to the GI system?
- Constipation
- Decreased tolerance
*****Note that diarrhea in the elderly can be the result of seepage around a fecal impaction
What are the changes occur in the CNS w/ age?
1) Cerebral atrophy i.e. loss of volume that is “normal & universal”
2) Decreased blood flow to the brain
What are the implications of altered homeostasis as related to the CNS system?
- Cognitive decline
- Limited/ loss of reserve
**Note that neuroimaging when there is cognitive decline is really only done to R/O a more organic pathology i.e. tumor, bleed…etc.
Where are new neurons produced on a daily basis? What causes these neurons to survive?
1) Memory center (hippocampus)
2) Olfactory
*****Only survive with exercise & learning new things
What are the changes occur in the ocular system w/ age?
1) Increased rigidity of iris
2) Accumulation of yellow substance in the lens
3) Decreased size of the anterior chamber
4) Decreased elasticity of the lens
What are the implications of altered homeostasis as related to the ocular system?
- Decreased size of the pupil
- Alteration of perception
- Impaired vision in darkness
- Challenges going from near to far vision
**Challenges for the elderly with driving
What are the implications of altered homeostasis as related to the auditory system?
- Hearing loss for pure tones
- Higher frequencies are effected more than lower frequencies
What are the changes occur in the auditory system w/ age?
1) Loss of cochlear neurons
2) Tinnitus (ringing or constant noise in the ears)
- Brain compensation for loss of neurons
What are the changes occur in the skin w/ age?
1) Decreased vascularity of the dermis
2) Altered epidermal turnover time
3) Decreased melanocytes
4) Low dermis density and eccrine function
What are the implications of altered homeostasis as related to the skin?
- Dry skin
- Decreased sweating response
- Prolonged wound healing b/c of altered epidermal turnover time
- Poor insulation (need to monitor temperature changes)
- Uneven tanning
How do you care for dry skin?
- Wet
- Lock in w/ lotion
*****Note that in the elderly, you need to keep wounds moist & covered for best healing
What are the changes occur in the MSK system w/ age?
1) Decreased bone mass, muscle mass, lead body mass, & repair of microfracture
2) Flattening of the arch of the feet
What are the implications of altered homeostasis as related to the MSK system?
- Osteoporosis
- Decreased muscle strength
- Loss of height
- Increased curvature of the spine
- Decrease muscle strength for breathing
- Gait impairment
What are the changes occur in the renal system w/ age?
1) Decreased renal mass
2) Decreased GFR
3) Decreased renal tubular secretion & concentrating ability
4) Decreased bladder capacity
What are the implications of altered homeostasis as related to the renal system?
- Decreased drug clearance
- Facilitation of incontinence
- Decreased creatinine clearance
- Higher risk of dehydration due to decreased concentrating ability
*****Note that liver & renal clearance need to be taken into account when prescribing medications
What are the changes occur in the endocrine system w/ age?
1) increased NE, vasopressin, insulin, ANP, parathyroid hormone
What are the implications of altered homeostasis as related to the endocrine system?
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What are the changes occur in the immune system w/ age?
Globally, there is a decrease in function of the immune system
What are the consequences of the altered changes in the immune system?
Increased risk of infection
What are they keys to healthy aging?
1) Socialization
2) Exercise
3) Stress reduction
4) Use of talents for self & others
5) Avoidance of accidents on the road & in the home
6) Nothing in excess
7) Rest one day per week
8) Healthcare
9) maximize spiritual life
