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501.1 > Physiological Changes of Aging > Flashcards

Physiological Changes of Aging Flashcards

1
Q

Changes in cardiovascular circulation

A
  • Decrease contractibility, increase fat and collagen
  • myocardial hypertrophy (esp. left ventricle)
  • decrease cardiac reserve
  • thickening and fibrosis of heart valves
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2
Q

What happens in cardiovascular circulation?

A
  • decrease cardiac output
  • decrease blood flow to vital organs and periphery
    -Incomplete closure of valves, therefore heart murmurs
  • Baroreceptors in the aortic arch & carotid sinus become less sensitive
  • Arterial blood vessels thicken, becoming more rigid and loosing elasticity
    -Blood supply to various organs decreases & peripheral resistance increases. Rigid arteries contribute to CAD, HTN & PVD
  • Lower extremity edema develops, risk for DVTs
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3
Q

Changes in cardiovascular electricity

A
  • Cellular aging and fibrosis, changes the conduction system

- There is a ↓ number of pacemaker cells in SA node (by 75, only 10% of normal # of pacemaker cells)

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4
Q

What happens in cardiovascular electricity?

A

-There is a ↓ in amplitude of the QRS complex & lengthening of the PR, QRS & QT intervals
(these are defined as cardiac arrhythmias = atrial fibrillation, atrial flutter, etc.)
-Sinus bradycardia, premature beats

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5
Q

Sinus Bradycardia

A 
Rate			˂ 60
Regularity		regular rhythm
P wave			normal, upright, uniform
PR interval		0.12 – 0.20 seconds
QRS			0.06 – 0.10 seconds
T wave			normal
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6
Q

Atrial Fibrillation

A

Rate atrial rate 350–450, vent rate varies with AV conduction
Regularity irregularly irregular
P wave no P waves, replaced by fine fibrillatory waves
PR interval indiscernible
QRS 0.06 – 0.10 seconds
T wave indiscernible

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7
Q

Structural changes in respiratory system

A
  • ↑ anteroposterior diameter of the thoracic cage
  • ↓ elastic recoil of the lung and ↓ chest wall compliance
  • Alveolar ducts and bronchioles enlarge and the number of alveoli decreases
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8
Q

What happens in structural changes of respiratory system

A
  • Barrel chest appearance, displacement of apical pulse
  • ↓ vital capacity, ↑ residual volume; therefore diminished breath sounds particularly at lung bases
  • Reduced overall efficiency of ventilatory exchange, therefore a decrease in PaO2
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9
Q

Changes in respiratory defenses

A
  • A decline in cell-mediated immunity and formation n of antibodies (↓ in alveolar macrophages)
  • ↓ cough force and less functional cilia
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10
Q

What happens in changes in respiratory defenses

A
  • ↑ risk of respiratory infections

- ↓ cough effectiveness and ↓ secretion clearance

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11
Q

Changes in respiratory control

A
  • ↓PaO2

- ↑PaCO2

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12
Q

What happens in changes of respiratory control

A
  • ↓ response to hypoxemia
  • ↓ response to hypercapnia
  • Ability to maintain acid-base balance ↓
  • In addition, retained secretions, excessive sedation, or positioning that impairs chest expansion may substantially alter PaO2 or SpO2 values
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13
Q

Changes in muscle, ligaments, and tendons

A
  • Muscle fibers decrease and have atrophy of muscle cells
  • Loss of elasticity and ↓ flexibility in ligament/tendons
  • Gradual reduction in the speed and power of skeletal or -voluntary muscle contractions
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14
Q

What happens in changes in muscle, ligaments, and tendons

A
  • ↓ muscle mass, tone & strength
  • Movement is more rigid, changes in gait and ↓ in agility
  • Slowed reaction time and reflexes
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15
Q

Changes in joints

A
  • Deterioration of joint cartilage

- Loss of water from disk between vertebrae, therefore narrowing of intervertebral spaces

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16
Q

What happens in changes in joints

A
  • Osteoarthritis; pain & joint stiffness, ↓ ROM, and crepitation on movement
  • Loss of height from disk compression
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17
Q

Changes in bones

A
  • ↓ in bone density
  • Decalcification of bones
  • Osteoporosis
  • Posture and structural changes (deformities such as dowager’s hump)
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18
Q

Changes in mouth

A
  • Loss of teeth
  • ↓ taste buds, ↓ sense of smell
  • ↓ salivary production
  • Atrophy of gingival tissue
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19
Q

What happens in changes of mouth

A
  • Difficulty chewing may lead to decrease in appetite
  • Diminished sense of taste (esp. with salty & sweet) may leads to excessive use
  • Diminished sense of taste & smell may result in ↓ appetite and weight loss
  • Dry oral mucosa
  • Poor-fitting dentures
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20
Q

Changes in esophagus or stomach

A
  • ↓ tone & motility of the esophagus
  • Lower esophageal sphincter pressure is decrease (or becomes incompetent)
  • ↓ gastric acid secretion, atrophy of gastric mucosa and less resistant to damage
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21
Q

What happens in changes in esophagus or stomach

A
  • ↓ esophageal peristalsis, therefore propulsion of food is less effective, complaints of dysphagia & heartburn (GERD)
  • Entry of food is delayed into the stomach, causing a premature feeling of fullness
  • Food intolerance
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22
Q

Changes in small intestine

A
  • ↓ motility and ↓ secretions of digestive enzymes in the small intestines
  • Liver - ↓ hepatic blood flow, ↓ in actual size, and ↓ in production of enzymes
  • Pancreas - ↑ fibrosis, decreased secretion of enzymes and hormones
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23
Q

What happens in changes in small intestines

A
  • Slowed intestinal transit, delayed absorption
  • Impaired drug metabolism
  • Impaired fat absorption and decreased glucose intolerance
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24
Q

Changes of the bottom of the barrel or your ass

A
  • ↓ anal sphincter tone and nerve supply to rectal area
  • ↓ muscle tone, ↓ motility in large intestines
  • ↑ transit time
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25
Q

What happens in changes of your ass

A
  • Fecal incontinence
  • Flatulence, abdominal distension
  • Constipation, fecal impaction
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26
Q

Changes in kidneys

A
  • ↓ number of nephrons, ↓ function of loop of Henle and tubules
  • ↓ renal blood flow, ↓ glomerular filtration rate
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27
Q

What happens in changes of the kidneys

A
  • A reduced ability to concentrate urine and conserve water (potential for hydration is increased)
  • ↓ creatinine clearance – excretion of toxins/drugs is decreased, ↑ BUN level
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28
Q

Changes in urinary bladder

A
  • ↓ elasticity and muscle tone of bladder, weakening of urinary sphincter
  • ↓ ability of bladder to completely empty
  • ↑ residual urine
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29
Q

What happens in changes of the urinary bladder

A
  • Stress incontinence, frequency, urgency
  • Nocturia
  • Retention
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30
Q

Changes in male reproductive system

A
  • ↓ testosterone levels
  • Prostate enlarges
  • Testes atrophy
  • ↓ sperm count
  • ↓ rate & force of ejaculation
  • ↑ refractory period after orgasm
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31
Q

Changes in female reproductive system

A
  • ↓ estrogen levels
  • Ovaries, uterus, cervix slowly atrophy
  • ↓ in vaginal secretions
  • Vaginal pH becomes alkaline
  • Cessation of menses
  • ↑ refractory period after orgasm
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32
Q

Changes in skin

A
  • ↓ subcutaneous fat, ↓ elasticity, collagen stiffens and ↓ thickness of epidermis
  • ↓ sebaceous and sweat gland activity
  • Skin tissue fluid ↓
33
Q

What happens in changes of skin

A
  • Appearance of wrinkles
  • Tendon, veins & knuckles are more prominent
  • Skin has transparent, tissue-like appearance and is fragile (prone to breakdown)
  • Day flaking skin with minimal to no perspiration
  • ↓ skin turgor (dehydration)
  • ↑ melanocytes
  • ↓ blood supply & sensory receptors in skin
  • ↑ capillary fragility
  • ↓ proliferative capacity
  • Lentigines on face & back of hands
  • Skin is cool to touch, ↓ awareness of pain, touch, temperature & vibration
  • Evidence of bruising
  • ↓ rate of wound healing
34
Q

Changes in hair

A

-Melanin in hair is decreased
-↓ oil
-↓ density of hair follicles
Cumulative androgen effect, ↓ estrogen levels

35
Q

What happens in changes of hair

A
  • Hair colour becomes gray or white
  • Dry, coarse hair with scaly scalp
  • Thinning/loss of hair
  • Older men have more nasal hair and hair in ears
  • Older women have increase facial hair
36
Q

Changes in nails

A
  • ↓ blood supply to nail beds

- Longitudinal ridges/striations increased

37
Q

What happens in changes of nails

A
  • Thick, brittle nails with diminished nail growth

- Nails prone to splitting – potential for fungal infection

38
Q

Changes in central nervous system

A
  • Reduction in cerebral blood flow
  • Brain weight decreases from loss of neurons
  • The number of synapses, axons and dendrites also decreases
39
Q

What happens in changes of central nervous system

A
  • Alterations in selected mental functions
  • Mild memory impairment
  • Intellectual performance without brain dysfunction remains constant, however the performance of tasks may take longer (fluid intelligence)
40
Q

Changes in the nervous system

A
  • ↓ neurotransmitters and ↓ in rate of nerve cell conduction impulses
  • ↓ motor response and ↓ reflexes
  • Decrease in efficiency of temperature regulating mechanism
41
Q

What happens in changes of the nervous system

A
  • Monoamine oxidase and norepinephrine production often increase with age while serotonin production may go up or down (depression may be the result)
  • Sluggish reflexes and ↓ reaction time (impaired response to imbalance = falls)
  • Less able to adapt to extremes in environmental temperatures
42
Q

Changes in peripheral nervous system

A
  • Diminished sense of touch and vibration

- Kinesthetic sense or proprioception (one’s position in space) is altered

43
Q

What happens in changes of peripheral nervous system

A
  • Decreased sensitivity is translated into delayed reactions to things such as hot surfaces, significant increasing the risk for burns
  • If one is less aware of body position and has less tactile awareness, the risk for falling is dramatically increased
44
Q

Changes in sleep

A
  • Modification of hypothalamic function, loss of deep sleep

- REM sleep is decreased in the elderly over 85

45
Q

What happens in changes of sleep

A
  • Increased frequency of spontaneous awaking (sleep is lighter)
  • Interrupted sleep, insomnia, tiredness
46
Q

Changes in visual system

A

-Elasticity and tone of eyelid muscles is decrease and have loss of orbital fat (shrunken appearance of eyes)
-Presbyopia – gradual decline in the ability to focus on close objects
-Lens becomes less elastic, thickened, more dense and visual acuity decreases as the lens becomes more opaque (↑ sensitivity to glare)
-Pupils become smaller and slower to react to changing levels of illumination
-↓ colour perception especially to blue, green and violet
-Tear production is decrease (dry eyes)
-↓ peripheral vision & distorted depth perception
↑ risk for glaucoma

47
Q

Changes in auditory system

A
  • Presbycusis – hearing loss, ↓ ability to hear high-pitched sounds
  • ↑ production of and drier cerumen (ear wax) results in impacted wax
  • Atrophic changes of tympanic membrane
  • Hair cells degeneration, neuron degeneration in the auditory nerve and central pathway, reduced blood supply to cochlea - ↓ sensitivity to high-pitched sounds
  • Alterations in balance and body orientation due to less effective vestibular apparatus in semicircular canals
48
Q

Changes in immune system

A
  • Antibody function is impaired
  • Response to foreign antigens decrease
  • Thymus decreases in size and activity
  • Both T and B cells show deficiencies in activation
  • Increased prevalence of autoimmune disorders
  • Therefore: susceptibility to infections increases
49
Q

Changes in endocrine system

A
  • ↓ production of TSH - ↑ incidence of hypothyroidism
  • ↑ levels of PTH - ↑ calcium resorption (loss) from bone
  • ↑ glucose intolerance and ↓ sensitivity to insulin (contributes to increase incidence of DM)
  • Adrenal glands’ secretion of glucocorticoids decrease by -25% by age 70 (involved in reactions to stress)
  • Plasma renin levels and aldosterone concentrations decline (may have fluid and electrolytes abnormalities)
  • ↓ sensitivity of renal tubules to ADH (fluid deficits)
  • Defects in thermoregulation – poor perception of changes in temperature
  • Reduction of febrile response (fever not always present with infectious process)
50
Q

Nursing interventions to promote drug therapies

A
  • Monitor clinical responses and plasma drug levels to provide a rational basis for dosage adjustment
  • Employ the simplest regimen possible
  • Monitor for drug-drug interactions
  • Periodically review the need for continued drug therapy
  • Encourage the patient to dispose of expired medications
51
Q

How to promote compliance

A
  • Clear & concise verbal & written instructions
  • Suggest a dosette box
  • Evaluated if patient able to self-administer or not
52
Q

Cardiovascular implications

A
  • Irregular cardiac rhythms
  • Decrease capacity for physical work
  • Risk of orthostatic hypotension
  • Circulatory changes in periphery (PVD)
  • Possible anemia, dehydration
53
Q

Cardiovascular interventions

A
  • Monitor pulses (ECG)
  • Monitor for weakness, SOB, dizziness, chest pain
  • Assess BP supine vs. standing
  • Encourage rising slowly when getting up
  • Neurovascular assessment
  • Monitor labs –hemoglobin, hematocrit
54
Q

Respiratory implications

A
  • Exercise tolerance diminished
  • Cough and deep breathing diminished, dyspnea
  • Mucus thickens
  • Decreased ability to bring up secretions
  • Increase risk for infections
55
Q

Respiratory interventions

A
  • Monitor exercise, tailor to patient
  • Monitor RR, lung sounds, O2 saturation, encourage inspirometer, DB&C
  • Promote adequate fluid intake to keep secretions liquefied
  • Encourage influenza and pneumonia immunization
56
Q

Musculoskeletal implications

A
  • Muscle atrophy, ↓ strength
  • ↓ ROM and flexibility
  • ↓ ability to perform ADLs
  • Pain and joint stiffness
  • Changes in gait
  • Increase risk of falls
57
Q

Muscoloskeletal interventions

A
  • Exercise as per patient’s tolerance
  • Passive ROM, consult with PT
  • ADL assessment scales
  • Pain scale, pharm/non-pharm strategies
  • Encourage use of walking aids
  • Protect patient from injury (safe environment assistive device)
  • Morse fall scale, Timed up-and-go test
58
Q

Consequences of immobility

A
  • Muscle atrophy
  • Orthostatic hypotension
  • Recurrent sepsis
  • Pressure sores
  • Contractures
  • Risk for falls
59
Q

Changes in sleep interventions

A
  • Establish a bedtime ritual & wake-up time
  • Avoid long naps during the day
  • Avoid caffeine products after 16:00
  • Relaxation methods
60
Q

Nutrition implications

A
  • ↓ taste can make eating less enjoyable
  • Difficulty chewing or swallowing
  • Possible malnutrition
  • Diabetes increasingly prevalent
  • Heartburn, indigestion & food intolerance
61
Q

Nutrition interventions

A
  • Promote herb seasoning & salt replacement
  • Cut food into small bites
  • Food diary, monitor albumin, BMI (weight)
  • Encourage smaller meals
  • Reduce acidic/spicy foods
  • The Nestle Mini Nutritional Assessment tool
62
Q

Fluid and electrolytes implications

A
  • Fluid imbalances
  • Risk of hypernatremia
  • Risk of hypokalemia
63
Q

Fluid and electrolytes interventions

A
  • Promote adequate fluids
  • Monitor I/Os, monitor for signs of fluid overload or dehydration
  • Monitor electrolytes
64
Q

Urinary implications

A
  • Decrease in GFR affects excretion of drugs
  • Nocturia
  • Urinary retention, risk of UTI
  • Urgency and frequency is common
  • Prone to fluid and electrolyte imbalances
65
Q

Urinary interventions

A
  • Monitor for toxicity – Cr clearance
  • Limit fluids prior to bed
  • Urinary analysis, promote cranberry juice
  • Encourage kegel exercises, absorbent products, assistive toileting equipment
  • Monitor I/Os, weight, electrolytes
66
Q

Bowel implications

A
  • Decrease motility in large intestines

- Risk for constipation, fecal impaction

67
Q

Bowel interventions

A
  • Explore bowel pattern
  • Explore diet
  • Encourage fluids & fiber intake with mobilizing
  • Assess need for stool softener
68
Q

Protection implications

A
  • Dry, fragile skin, prone to abrasions and skin lacerations
  • Decrease rate of wound healing
  • Less ability to control temperature
  • Risk for infections
69
Q

Protection interventions

A
  • Prevent skin breakdown
  • Positioning, lotions, bed sheet to be taut, Braden Scale
  • Keep extremities warm & room at moderate temperature
  • Monitor WBC, obtain baseline temp., encourage immunization
70
Q

Neurological implications

A
  • Slowed reaction time & reflexes (falls)
  • Kinesthetic sense is altered (falls)
  • Memory impairment
  • Fluid intelligence changes (takes longer to perform task)
71
Q

Neurological interventions

A
  • Schedule task so as to give patient enough time
  • Ensure safety (environment)
  • Offer orienting, leave notes
  • Allow time for the patient to process questions
72
Q

Visual implications

A
  • Presbyopia
  • Decreased capacity to adjust to changing levels of illumination
  • Diminished night vision
  • Increased sensitivity to glare
  • Decreased depth perception
73
Q

Visual interventions

A
  • Encourage eye exams and use of eye glasses
  • Write clearly and largely
  • Ensure appropriate lighting
  • Nightlights
  • Encourage non-glare lighting
  • First and last step of stairs can be marked
74
Q

Auditory implications

A
  • Generalised hearing loss
  • Risk of social isolation
  • Decrease in sebaceous gland causing cerumen to become dry
  • Alteration in balance & body orientation
75
Q

Auditory interventions

A
  • Reduce background noise, speak closely and clearly
  • Check ears for impacted wax and infection
  • Walking aids – walkers, canes
76
Q

Taste, smell and sensations implications

A
  • ↓ taste buds
  • ↓ sense of smell
  • Reduced tactile sensation, therefore ↓ ability to sense pressure, pain & temperature
77
Q

Taste, smell, and sensation interventions

A
  • Promote herb seasoning & salt replacement to enhance flavour
  • Promote safe environments, smoke detectors
  • Reduce environmental risks i.e. risk of burns
78
Q

Teaching strategies

A
  • Make sure patient is ready to learn
  • Sit facing the patient so that lips and facial expressions are readily seen by patient
  • Speak slowly
  • Keep your tone of voice low
  • Give the patient enough time to response
  • For concentration, focus on a single topic at a time
  • Keep environmental distractions to a minimum
  • With patient permission, invite another member of household to participate
  • Use auditory, visual, and tactile cues to enhance learning
  • Ask for feedback to ensure information has been understood
  • Refer to patient’s past experienced (connect new with old)
  • Compensate for physical discomfort and sensory alterations if needed

501.1 (15 decks)

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