Lecture 5: altered homeostasis

Question 1

Define altered homeostasis

Answer 1

• refers to the process of change brought on by the normal aging process and the impact of illness and injury

Question 2

describe the cardiac system changes

Answer 2

• decreased diastolic function –> decreased cardiac output
• Decreased response to sympathetic NS stimulation –> decrease in max HR with exercise and stress
• more reliance on atrial kick –> greater difficulty maintaining cardiac output in A.FIB

Question 3

describe the lung changes

Answer 3

• alteration of collagen and elastin –> decreased lung elasticity, arterial saturation, and maximal oxygen uptake
• AT RISK FOR POOR OXYGENATION

Question 4

GI changes

Answer 4

• slowed colonic transit time –> CONSTIPATION (not normal, but common)
• Slower metabolism of alcohol –> decreased tolerance

Question 5

CNS system changes

Answer 5

• cerebral atrophy –> cognitive decline (loss in volume of neurons)
• blood flow to the brain –> age associated atrophy of the brain
• *BRAIN CELLS Can only be made/maintained if we are exercising and learning new things**

Question 6

define delirium

Answer 6

• occurs with age since the BRAIN LOSES RESERVES

Question 7

Ocular changes

Answer 7

• increased rigidity of iris –> reduced accommodation (decreased size of pupils)
• accumulation of yellow substances in lens (alterations of color perception)
• decreased size of Anterior chamber –> impaired adaption to darkness
• decreased elasticity of lens

Question 8

auditory changes

Answer 8

• Loss of choclear neurons (remaining become MORE stimulated, almost self-stimulating causing TINNITUS (ringing in ears))
• hearing loss for pure tones (higher frequencies more difficult to hear)
• socialization can be difficult without this sense
• hearing aids can HELP

Question 9

Skin and CT

Answer 9

• decreased vascularity of dermis –> dry skin (treated: WET IT (apply water then lock the water in w/lotion or VASOLINE)
• altered epidermal turnover time –> slowing healing time
• decreased melanocytes –> poor insulation
• low dermis density and eccrine function

Question 10

musculoskeletal changes

Answer 10

• decreased bone mass, muscle mass, lean body mass, repair of microfractures
• flattening of arch of feet

Question 11

describe osteoporosis

Answer 11

• decreased muscle strength, loss of height, increased curvature of spine, decreased muscle strength for breathing and gait impairment
• fractures are SILENT KILLERS
• Important to treat osteoporosis before fractures occur

Question 12

Renal and Urologic

Answer 12

• decreased renal mass, GFR, renal tubular secretion and CONCENTRATING ABILITY –> high risk for dehydration causing decreased drug clearance
• decreased bladder capacity
• facilitation of incontinence

Question 13

Endocrine

Answer 13

Increased NE, vasopressin, insulin, ANP and parathormone –> impaired extracellular volume regulation, NA homeostasis (impaired)

• decreased plasma renin and aldosterone
• resistance to insulin stimulated glucose uptake –> glucose INTOLERANCE (deconditioning, poor diet and lack of exercise)
• predisposition to hyperkalemia

Question 14

Immune system

Answer 14

• Less vigorus immune system –> anergy to various skin tests
• -> inadequate response to extrinsic antigens
• ELDERLY has an issue, differential should be some sort of infection

Question 15

Keys to healthy aging

Answer 15

• SOCIALIZATION
• Exercise
• stress reduction
• use of talents for self and others
• avoidance of accidents on the road and in the home
• nothing in excess
• rest one day per week
• have a good health care team
• maximize one’s spiritual life