gero lec 2 Flashcards
Cardiovascular age-related changes seen in older adults
Increased heart weight; left ventricle hypertrophy
Decreased baroreceptor sensitivity
Decreased force of contraction, contractile efficiency, stroke volume
Valvular sclerosis
Decrease in pacemaker cells
Decreased beta adrenergic response
Arterial stiffening & wall thickening with decreased compliance
Dilated aorta, tortuous veins
Decreased O2 uptake by tissues
Cardiac symptoms seen in cardiovascular age-related changes
fatigue
SOB
Increased systolic blood pressure, pulse pressure, peripheral resistance
Risk of postural & diuretic-induced hypotension
Cardiovascular: what to assess in patients
BP (lying, sitting, standing), pulse pressures
Assess carotid arteries, right internal jugular vein, varicosities. Monitor ECG. Assess exercise tolerance.
Cardiovascular interventions
Safety precautions! for orthostatic hypotension
Health promotion/Disease prevention
Medication Regimens
Weigh Daily
Independence maintenance
Avoid fatigue
Respiratory symptoms seen in respiratory age-related changes
Kyphosis; Barrel-shaped Why?
Respiratory rate 12-24
Decreased respiratory excursion & 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 & 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
Respiratory changes seen in older adults
Thorax & vertebrae rigid
Decreased muscle strength & endurance
Diminished ciliary & macrophage activity
Increased airway reactivity
Drier mucus membranes
Decreased alveolar function, vascularization, elastic recoil
Decreased response to hypoxia & hypercapnia
Respiratory assessment/what to assess in patients?
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 oximetry
Monitor secretions, sedation, positioning which can reduce ventilation/oxygenation
Presbyphonia (article)
Larynx stiffening, larynx muscle atrophy, decrease FEV
Respiratory interventions
Maintain patent airway through repositioning, suctioning
Prevention of respiratory infections
Incentive spirometry/Pursed-lip breathing
Health promotion/Disease prevention
Vaccines: Flu & Pneumonia
Education on cough enhancement, avoidance of environmental contaminants, smoking cessation
GI age-related symptoms
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) & smell
Risk of dysphagia, hiatal hernia, aspiration
Delayed emptying of stomach with risk of maldigestion
Gastroesophageal reflux Disease (GERD)
Decreased absorption of fat, carbohydrate, protein, vitamin B12, iron, folate, calcium, and vitamin D
Constipation, flatulence
Risk of fecal impaction
Risk of adverse drug reactions
Cholecystolithiasis
GI age-related changes
Decreased thirst perception
Decreased saliva with dry mucosa, bone loss
Atrophy of taste & olfactory receptors
Decreased esophageal motility & 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 & hormonal secretory cells
GI assessment
Assess abdomen (note smaller liver), bowel sounds
Monitor weight, dietary intake, elimination patterns
Assess dentition, chewing & swallowing abilities, eating habits/nutrition
Assess pulmonary infection from aspiration/dysphagia
Presence of NVD
Evaluate chemosensory complaints of poor food taste
GI interventions
Health promotion/Disease prevention
Educate on nutrition/diet, approaches to flavor enhancement, fluid intake, toileting habits/bowel training
Watch hidden Na+ in foods
Genitourinary age-related changes
Decreased functional reserve when water/salt overload/deficit
Decreased kidney weight, blood flow, oxygenation, glomerular filtration rate (often < 50%, measured by creatinine clearance)
Tubule degeneration
Reduced response to ADH
Impaired capacity to dilute, concentrate, acidify urine; impaired sodium regulation
Genitourinary age-related symptoms/signs
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; decreased pelvic area elasticity; gland & epithelial atrophy; alkaline vaginal pH
GU risks with older adults
Risk of renal complications in illness; susceptibility to acute ischemic renal failure & 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
More GU risks in older adults
Risk of urinary tract infection (UTI) Why? Increased post-void residual urine
Nocturnal polyuria- risk for falls
In males, risk of urinary hesitancy dribbling, frequency, incontinence Why? (BPH)
In females, risk of atrophic vaginitis, urethritis, vaginal stenosis, vaginal/uterine prolapse
GU assessment
Assess renal function, particularly in acute/chronic illness
Monitor blood pressure (orthostatic) Why?
Assess for dehydration, volume overload, electrolyte imbalances, proteinuria
Determine source of fluid/electrolyte imbalance. Monitor laboratory data e.g.,creatinine clearance What else?
Assess choice/dose/need for nephrotoxic agents (incl. aminoglycoside antibiotics, radiocontrast dyes) and renally excreted medications
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
GU interventions
Safety precautions in nocturnal or urgent voiding & 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
Fluid intake 2-3L/day unless contraindicated
Skin age-related changes
Decreased subcutaneous fat, interstitial fluid, muscle tone, glandular activity, sensory receptors
Collagen stiffening
Reduced blood supply & capacity for repair
Capillary fragility
Cumulative androgen effect
For hair - decreased melanin & follicles
Reduced blood supply to fingernails
Skin age-related signs
Thick, brittle, easily split nails with slow growth & risk of fungal infections
Decreased fat, muscle tone of feet affecting ambulation
Risk of dehydration and pressure ulcers
Decreased elasticity, turgor, wound healing, and perspiration with reduced ability to maintain temperature
Skin assessment
Monitor skin temperature, turgor (anterior chest wall, not forearm), hydration status (How?)
Assess intertriginous areas Why? (skinfolds: areas skin touches skin, e.g. groin, under breasts)
Skin interventions
Prevent pressure ulcers
Educate on care of dry, fragile skin
Maintain environmental temperature control to prevent hypo/hyperthermia
Provide adequate fluid intake to prevent dehydration
Eye age-related 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 & cornea
Ciliary muscle atrophy
Lens less elastic, denser, yellow with decreased light passage
Eye age-related symptoms
Blurred vision from scattered light rays
Decreased visual
Vitrious floaters webs in vision field
Decreased accommodation & near vision (presbyopia)
Decreased peripheral vision
Cataracts, Narrow-angle glaucoma
Eye assessment
Assess visual acuity (under various light conditions), color vision
Evaluate impact of vision limitations on driving (day & night), ambulation, safety, social interactions
Appraise home environment for hazards, lighting
Eye interventions
Health promotion/Disease prevention
Educate on regular eye exams
Driving hazards due to visual impairments
Organize house…fall prevention, safety, adequate lighting
Appropriate use of colors—What colors are best? (light colors such as red)
Hearing age-related changes
Decreased ceruminal glands in external ear
In middle ear, ossicle joint degeneration; tympanic membrane thinning & loss of resiliency
In inner ear, atrophy of vestibular structures, cochlea, organ of Corti plus loss of hair cells
Hearing age-related signs/symptoms
Changes in external ear appearance (larger, longer)
Drier cerumen with risk of impaction & hearing loss
Decreased sound conduction
Risk of hearing loss (initially of high pitches, presbycusis), tinnitus, equilibrium-balance deficits
Hearing assessment
Assess hearing, balance & equilibrium,
Inspect ear for cerumen build-up; remove if impacted
Monitor psychosocial dysfunction if hearing loss
Evaluate safety of home environment, driving
Hearing interventions
Educate on regular auditory evaluation, safety if hearing loss
Encourage social interaction if isolated from hearing loss
Speak in low toned voice
Smell and taste changes in older people
Hyposmia: Decrease in smell acuity
Decrease neurons that send signal to the brain
Difficulty distinguishing smells
Decrease in taste secondary to change in smell acuity
What is hyposomia?
Decrease smell acuity
Musculoskeletal age-related changes
Lean body mass replaced by fat with redistribution of fat
Decrease in mass + decreased regeneration of muscle fibers = Sarcopenia = weakness
In joints, What type of changes occur? Articular cartilage erosion; increased bone overgrowths & calcium deposits –What problems result?
Musculoskeletal age-related signs
Joint stiffness with decreased mobility
Kyphosis, Height loss (1-4”)
Gait & balance instability common
Risk of osteoporosis & fractures, osteoarthritis
MS assessment
Assess functionality, mobility, fine & gross motor skills, ADLs
Ensure joint stabilization and slow movements in ROM exam to prevent injury
MS interventions
Health promotion/Disease prevention
Education on nutrition (e.g., calcium), regular exercise, muscle strengthening
Information on strategies to maximize function
Fall Prevention
Endocrine changes in older patient
Decreased adrenal functional reserve & hormonal response
Fluid/electrolyte balance affected by decreased renin-angiotensin-aldosterone activity, increased atrial natriuretic hormone
Reduced insulin secretion & increased insulin resistance
Endocrine age-related signs
Change in body composition with increased fat, decreased muscle & bone mass; decreased strength & functionality with risk of falls
Decreased glucose tolerance, risk of Diabetes Mellitus type 2
Bone mineral density loss with risk of osteoporosis, fractures. Risk of fluid/electrolyte imbalances & postural hypotension
Endocrine interventions
Health promotion/Disease prevention
Education on nutrition (especially calcium & carbohydrates), hydration, safety
Onset of Diabetes & Thyroid alterations
Nervous system age-related signs
Decreased ability to respond to multiple stimuli & manage multiple tasks concurrently
Risk of mild cognitive impairment, dementia
Risk of poor balance, postural hypotension, falls, injury
Nervous system intervention strategies
Health promotion/Disease prevention
Educate on safety, avoidance of falls
Therapeutic Communication
Reproductive intervention strategies
Health promotion/Disease prevention
Educate on STD prevention
Lubricants for vaginal dryness
Lab changes seen in older adults
decreased rbc
decreased sodium
increased ESR
decreased vit d
decreased calcium
decreased albumin
Is creatinine an accurate measure of renal function? what is it used to monitor?
yes, an accurate measure of renal function
Used to diagnose and monitor renal insufficiency
