Week 2 Outline Flashcards
Aging changes?
Anatomical and physiological changes are attributed to aging
All cells are affected by aging.
Respiratory:
Define bronchiectasis?
There is permanent abnormal widening of the airways due to inflammation.
Respiratory:
Define elastic recoil
The lungs ability to expand and contract
Respiratory;
Define kyphosis
Curvature of the spine causing bowing of upper spine
Respiratory:
Define vital capacity
Maximum amount of air that can be expelled following maximum inspiration.
What are the risks due to adequate respiration of the aging adult?
o The trachea stiffens due to calcification of its cartilage. This reduces the ability to cough because it blunts the laryngeal and coughing reflexes.
o Reduced number of nerve endings may lead to a weaker gag reflex.
o The lungs become smaller in size and weight. Connective tissues needed for effective respiration and ventilation in the lungs weaken. This leads to decreased elastic recoil. Respiration then requires the use of accessory muscles. This leads to lungs being stiffed.
o Alveoli are less elastic, develop fibrous tissue, contain fewer functional capillaries and have less surface area. This reduces gas exchange.
o Loss of skeletal muscle strength in the thorax and diaphragm. This combined with the loss resilient force (tissues) that holds the thorax in slightly contracted leads to Kyphosis or a look of having a “barrel chest”.
o These changes add up to a reduction in vital capacity. = Less air exchange and more secretions remaining in the lungs.
*respirations are easier to count for the older adult
What are other age related changes in respiratory:
o Decreased response to hypoxia and hypercapnia.
o Different normal baseline temperature
o Baseline is lower, a fever may be lower for them.
Nursing considerations for repsiratory:
o Less effective gas exchange (hypoxia, )
o Easily fatigued r/t decreased respiratory efficiency
o Reduced airway clearance risk for asthma
o Increased potential for infection
Assessment for respiratory system:
o Breathing patterns
o Breath sounds
o Palpate the chest for fremitus
o Chest expansion
o Cough
o Deep breathing
o Respiratory rate
o O2 saturation
o Secretions can lead to an infection, if not able to swallow can aspirate and lead to aspiration pneumonia
o Mental status / behavioral changes will see when they get an infection, sometimes it is key.
o Pneumonia and UTI are leading causes of death in elderly they become septic
Symptoms of pneumonia in older adults:
o Slight cough o Fatigue o Rapid respiration o Confusion * alerted LOC o Restlessness o Behavioral changes *
Pneumonia IS A LEADING CAUSE OF DEATH IN OLDER ADULTS what are the contributing factors:
o Poor chest expansion and more shallow breathing
o Lowered resistance to infection
o Reduced Mobility (laying down)
o Increased mucus formation and bronchial obstruction (secretions)
o Increased incidents of hospitalization and institutionalization (long-term care) leads to increased nosocomial pneumonia.
o Changes due to aging may mask signs and symptoms:
o Pleuritic pain -less severe in older adults
o Lower Temperature -may not show fever because they tend to have lower temperature
Interventions for pneumonia:
PREVENTION IS KEY
o Encourage good fluid intake importance is to keep hydrated
o Manage bronchial secretions
o Prevent obstructions
o Preventative measures for infections if needed ask for a swallow test
o Instruction in breathing exercises
o Raise HOB at least 30 degrees (unless it is contraindicated)to help prevent pneumonia
o Educate and instruct patient to turn, cough and deep breath every two hours
o Health Promotion: Vaccines: Pneumonia and Influenza
Cardiovascular
Define physical deconditioning
Decline in cardiovascular function due to physical inactivity
Cardiovascular
Define Postural (orthostatic) Hypotension
decline in systolic blood pressure of 20mm Hg or more after rising and standing for 1 minute
they stand up they hit the floor, big problem for older population
Nursing considerations for cardiovascular:
o Poor peripheral circulation
o Capillary refill
o Easily fatigued
o Inadequate circulation to heart tissue
o Will damage the muscles
o Shortness of Breath
o Reduced cardiopulmonary tissue perfusion
o Hypotension
o Tachycardia
o Edema
o Dyspnea
o Delirium lack of oxygen will cause a mental status change
o Restlessness
o Pallor a little blueish due to lack of oxygen
o Memory disturbance a change, an addition to.
What are the risks of adequate circulation related to aging adults:
o Heart valves increase in thickness and rigidity R/T sclerosis and fibrosis
o Aorta becomes dilated
o Slight ventricular hypertrophy
o Myocardial muscle loses some of its contractile strength causes a reduction in cardiac output, meaning it is less efficient with increased activity or demands on the heart. Because it is stiffening and losing its strength. Not allowing chambers to empty as they should.
o Example: more people tend to die at night or early morning. They got up and went to the bathroom = heart attack because of increased activity in the heart
o Diastolic filling and systolic emptying require more time to complete the cycle.
o Calcification and reduced elasticity of vessels. Becomes less sensitive to baroreceptors Reduces regulation of blood pressure. Reduced arterial BP leads to decreased tissue profession.
o Changes are usually gradual and become more apparent when the older adult is placed under increased activity. Consider early morning walks to restroom – increased death
Nursing assessment for cardiovascular:
o Blood Pressure (orthostatic) Lying, Sitting, Standing
o For orthostatic BP you always need a second person. As patient can fall and break hip= death
o Palpate carotid arteries
o ECG
o Exercise tolerance
Nursing interventions for cardiovascular:
o Monitor for S/S of hypotension o Encourage fluids o Hypotension, fluid drops = BP drops o Fall Precautions o Health Promotion: Medication, Diet, Exercise (as appropriate)
Gastrointestinal
Define presbyesophagus
Age-related chnages to the esophagus causing reduced strength of esophageal contractions and slower transport of food down the esophagus.
What are gastrointestinal issues related to aging?
o Tongue atrophies decreases taste sensation
o Difficulty swallow can choke more easily, and can’t swallow their meds that easily. Now issue is can they take their pills now?? Taste can result in eating more or less or more salt since they can’t taste anymore which can lead to GI issues (malnutrition, obesity, high levels of salt)
o Saliva production decreases may cause swallowing to be more difficult
o Degenerative changes in the smooth muscle lining of the lower esophagus (presbyesophagus).
o Can lead to GERD, sit patient up to eat and after eating don’t let them lay down right away. They need to eat small and more frequent meals during the day and snacks.. overeating = aspiration=pneumonia.
o Weaker esophageal contractions
o Weakness of sphincter
o Decreased esophageal motility
o Decreased stomach motility
o Decreased elasticity of the stomach reduces the amount of food the stomach can accommodate.
o The stomach has a higher pH r/t a decline in hydrochloric acid and pepsin causing increased incidence of gastric irritation in older adults.
o Reduced pepsin interferes with absorption of protein.
o Reduced hydrochloric acid interferes with absorption of calcium, iron, folic acid, and vitamin B12.
o Decreased sensory perception may lead to i ncreased incidence of constipation, as can inactivity, reduced food and fluid intake, and low fiver diet. o Pancreas fibrosis, atrophy, and reduced pancreatic secretions may affect the digestion of fats.
Nursing considerations in Gastrointestinal:
o Constipation o Big cause of UTI in females o Diarrhea o Vomiting o Acute pain (gurgling, constipated) o Dehydration o Inactivity o Insufficient nutritional intake
- ask when was your last movement?
- always watch for any changes, many times older patients won’t tell you what is wrong…
Assessment of GI:
Inspect, listen (auscultate), palpate, percussion o Abdomen o Bowel sounds o Tenderness o Distension o Dietary intake, food and fluids o Elimination patterns o Swallowing ability can’t chew well more likely to. choke o Chewing ability o Weight
Interventions for GI:
o Provide food the patient likes and can tolerate
o Keep patient sitting up after meals
o Health Promotion: Diet
Genitourinary:
Define nocturia
Voiding at least once during the night
What are urinary elimination changes related to aging:
o Hypertrophy of the bladder muscle and thickening decreases the ability of the bladder to expand and reduces capacity, leading to urinary frequency and nocturia. Kidney circulation improves when a person is in a recumbent position and increase the need to void. This is not a normal part of aging and is related to other aging issues.
o Retention of urine due to neurological inefficiencies and a weaker bladder that does not empty properly.
o Woman: fecal impaction like constipation
o Men: prostatic hypertrophy
o Reduced filtration efficiency of the kidneys affects the body’s ability to eliminate drugs and causing higher blood urea nitrogen levels.
o Incontinence Also not a normal part of aging, but usually caused by age-related physical or mental disorders. It is common but not normal
o If a man is having a UTI is is a very serious issue, try to find underlying problem.
Nursing considerations for GU:
o Potential for adverse drug reactions or toxicity because they are not clearing their systems o Pain o Risk for Infection - UTI o Risk for Falls they are up in middle of night, fall and trip its dark o Need for toileting assistance o Potential for skin breakdown o Sleep disruption o Potential for social isolation
Nursing assessment for GU
o Renal Function o Ability to void o BP for Hypotension o Fall Risk o Pain o Frequency mainly means UTI for female (urgency too) o Urgency o Constipation o Inactivity o Dehydration big cause of UTI for elderly o Indications of drug toxicity o Mental status change
- *Person in wheelchair and with cognitive issues is at higher risk for dehydration they are not likely to go and think of getting fluids on their own
Reduced immune response BOX 24-1
Labs to know
Other assessments to know chart:
