Cardiovascular System

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Cardiovascular System

• General changes
• Changes in O2 consumption
• Decreased HR
• Vessel changes
• Decreased cardiac output

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Congestive Heart Failure

• Leading cause of hospitalization in the elderly
• CAD and HTN are leading causes of the disease

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Symptoms

• Confusion
• SOB
• Orthopnea
• Weight gain
• Edema
• Moist crackles

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• Increased risk for skin breakdown
• Why??

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Treatment

• Raise HOB
• Bed-rest
• Diuretics
• Low sodium diet
• Digitalis
• Psych support

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Coronary Artery Disease

• Broad category
• Ischemic heart disease
• Leading cause of death in the U.S.
• Angina and MI are clinical manifestations of the
  disease

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Angina

• AnginaChest pain
• What are some symptoms of chest pain?
• Treatments
• Meds
• Nitroglycerin
• Decrease stress
• Decrease activity

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Myocardial Infarction (MI)

• AKA heart attack
• Symptoms
• Chest pain
• Radiates down left arm, neck, jaw
• Decrease BP
• Cool clammy skin
• Confusion

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Treatment

• Anticoagulants
• Watch for signs of bleeding
• Watch for signs of CHF
• Common complication in the elderly client

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PVD

• Arteriosclerosis of small tissues furthest from
  the heart
• Symptoms
• Poor to absent peripheral pulses
• Cool skin
• DM patients
• Resting pain
• No pulses
• Skin discoloration
• Ulceration

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• Treatment
• Vasodilators
• Bed-rest
• Warmth

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Venous Thromboembolism

• Who is at risk??
• Symptoms
• Edema
• Warmth
• Pain
• What assessment technique are you learning to
  assess for this??
• Pain and warmth may be missing in the elderly

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• Treatment
• Anticoagulants
• Elastic stockings
• Elevation
• Rest
• Analgesics if having pain

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• Prevention
• What can we do to help prevent this??

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Nursing Care

• Exercise
• No smoking
• Considerations
• Skin breakdown
• IO
• O2
• Anorexia
• Foot care
• Non-traditional therapies
• Herbs
• Relaxation
• Acupuncture

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Immune system

• Major changes
• T-cell function declines
• More immature T-cells in circulation
• Thymus gland declines in size
• Deficiency of cell-mediated immunity
• Antibody response to vaccines is reduced
• Skin loses macrophages

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Pneumonia

• Common in elderly
• One of the leading causes of death in this age
  group
• Death rate goes up as age goes up

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• Contributing factors
• Age related changes in respiratory system
• High incidence in debilitating conditions
• Hospitalization
• Reduced sensitivity to pharyngeal reflexes

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• Symptoms
• May be altered in elderly person
• Pleuritic pain may not be as severe
• Minimal or no fever
• Cough
• Fatigue
• Rapid respiration
• Confusion
• Restlessness
• Behavioral changes

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• Pneumococcal vaccines are recommended for persons
  over 65

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Care Plan

• Assessment
• Assessment alert
• Nursing Diagnosis

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• Plan/intervention
• Evaluation Criteria

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Influenza

• Most deaths from influenza occur in the elderly
  population
• Influenza A is the most frequent cause
• Age related changes cause elderly to be more
  susceptible

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• Symptoms
• Fever
• Myalgia
• Sore throat
• Nonproductive cough

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• Destroys ciliated epithelial cells of the
  respiratory tract
• Secondary bacterial infections and complications
  increase risk of death
• What could be some complications?

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• Annual influenza vaccine is recommended
• Can help prevent complications if not the disease
  itself

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Care Plan

• Assessment
• Assessment Alert
• Nursing Diagnosis

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• Plan/intervention
• Evaluation Criteria

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Respiratory System

• General changes
• Increased anterior/posterior diameter
• Weaker respiratory muscles
• Decreased lung expansion
• Less air exchange, more staying in the lungs
• Decreased cilia
• Dryer mucosa

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Respiratory Disorders

• Obstructive Disorders (COPD)
• Chronic Bronchitis
• Emphysema
• Asthma

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Chronic Bronchitis

• Signs and symptoms include
• Persistent productive cough
• Wheezing
• Recurrent resp. infections
• SOB
• Difficulty breathing in cold, damp air
• As disease progresses, it may turn to emphysema

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Management

• Elderly clients may need encouragement to
  maintain good fluid intake
• Remove secretions and prevent blockage of airway
• Prevent it before it happens
• No smoking
• Help prevent resp. infections

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Emphysema

• Contributing factors
• Chronic bronchitis
• Chronic irritation from dust pollutants
• Morphologic changes in the lungs
• Distention of alveolar sacs
• Rupture of the walls
• Destruction of capillary beds
• Smoking

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• Signs and symptoms
• May be slow onset and may cause a delay in
  treatment
• Increased dyspnea, not relieved by sitting
  upright
• Chronic cough
• Hypoxia
• Fatigue
• Anorexia
• Weight loss
• Weakness
• Recurrent resp. infections
• Cardiac arrhythmias

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Treatment

• Postural drainage
• Bronchodilators
• Avoidance of stressful situations
• Breathing exercises
• Prevent infections
• STOP cigarette smoking
• Oxygen therapy??

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Integumentary

• General changes
• Moisture
• Texture
• Nails

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Keratosis

• Light gray or brown lesions
• On exposed area of skin
• Freezing agents, acids, surgical excursion can
  remove them
• Precancerous

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Pruritis

• Most common dermatologic problem among elders
• Excessive drying and itching
• Early identification and treatment is key!
• Bath oils, lotions
• Try to avoid triggers that aggravate it
• Dry heat
• Excessive bathing

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Nursing

• What risks are increased with pruritis?

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Scabies

• Highly contagious, pruitic skin eruption
• Caused by a mite
• Intense pruritis is caused by an allergic
  reaction to mite and the waste products
• Rash typically on
• Interdigital webs
• Hands, wrists
• Elbows
• Abdominal folds
• Nipples
• Genitalia

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• Elders can have rash on
• Face
• Scalp
• Back
• Buttocks
• Knees
• Inspection can reveal a linear ridge where the
  mite has burrowed

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Warning signs of cancer

• Any spots on the skin that are changing
• Size
• Color
• Shape
• Any unusual
• Sore
• Lump
• Blemish
• Marking
• Any change in the way an area of skin looks or
  feels
• Skin may become oozy, crusty or bleeding
• May feel itchy, tender, painful. Redness or
  swelling may develop

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Endocrine/metabolic System

• General changes
• Thermoregulation
• Decreased sensitivity
• Sedentary lifestyle

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Diabetes Mellitus

• Patho
• Decreased sensitivity to circulating insulin
• Decreased release of insulin
• Decreased ability to metabolize glucose
• Symptoms
• Classic symptoms are absent in elderly!
• What are the classic symptoms?

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What we do see!

• Decrease in B/P
• Stroke
• Neuropathy
• Confusion
• Infection
• Labs can be misleading

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Treatment

• Education
• Diet
• Exercise
• Meds
• Illness management
• Vision screenings

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Hypothyroidism

• Thyroid activity decreases with age
• Hypthyroidism increases with age
• More prevalent in women
• Symptoms
• Fatigue
• Weakness
• Depression
• Anorexia
• Weight gain
• Impaired hearing
• Edema
• Constipation
• Cold intolerance
• Dry skin

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Treatment

• Replacement of the thyroid hormone
• Nursing should include assisting patients manage
  the symptoms

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Hyperlipidemia

• Increase in cholesterol
• Increase in LDL
• DM causes lipoprotein disorders
• Treatment
• Exercise
• Diet
• What is on a low cholesterol diet?
• Meds

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Gastrointestinal System

• General changes
• Esophagus
• Decreased motility
• Delayed esophagus emptying
• Stomach
• Decreased motility
• Decreased hunger
• Decreased secreting of enzymes
• Increased indigestion

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• Intestines
• Decreased peristalsis
• Increased risk for constipation
• Gall bladder
• Increased development of stones
• Decreased emptying, thicker bile
• Liver
• Enzymes changes affect ability to metabolize
  drugs and detoxify
• Pancreas
• Decrease enzymes lead to poor tolerance for fatty
  meals

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Disorders

• Dental problems
• Leads to poor eating
• Malnutrition
• Constipation
• Prevention is key!!

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Hiatal hernia

• More common in women
• Affects about half of people over the age of 50
• Weight contributes
• Symptoms
• Regurgitation
• Heart burn

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• Treatment
• Diet changes
• Bland foods
• Antacids
• Meds
• Surgery

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Peptic Ulcer

• On the rise in the elderly
• Can be a complication of COPD!
• Stress diet contribute
• Medications may contribute to the causes
• Aspirin, corticosteroids
• May see pain, bleeding and obstruction
• Nursing
• Education

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Constipation

• Causes
• Inactive lifestyle
• Low fiber
• Low fluid
• Depression
• Meds
• Failure to allow adequate time to finish

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• Nursing
• Education
• Increase fiber and liquids
• Medications
• ROM exercises

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Genitourinary system

• General changes
• Increase BUN
• Decreased glomular filtration rate
• Decreased ability to concentrate urine

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Incontinence

• Twice as prevalent in women than in men
• Different types (pg. 358-360)
• Stress
• Caused by weak supporting muscles. When pressure
  is put on muscles by laughing, sneezing,
  coughing, urine is lost
• Urgency
• Caused by UTI, enlargement of prostate, tumors

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• Overflow
• Associated with bladder neck obstruction and meds
• Neurogenic
• Cerebral cortex lesion, MS
• Functional
• Dementia, disabilities that prevent independent
  toileting
• Mixed
• Combination of these

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• Treatment
• Depends on type of incontinence
• Stress
• Kegels
• Urgency
• Planning
• Total incontinence
• Prevent complications

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UTI

• Most common infection
• Why?
• Poor cleaning
• Decreased fluid intake
• DM
• Catheters
• Early symptoms
• Fever
• Burning
• Urgency
• Change in color and odor

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• Treatment
• Increase fluids
• Cranberry juice
• Medications
• Recognize symptoms and identify problem

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Musculoskeletal

• General changes
• Pelvis widens
• Knees and hips flex
• Decreased muscle strength and mass

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• Leading cause of functional impairment in older
  adults
• Wide range of manifestations
• Can have devastating effects

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Fractures

• Symptoms
• Pain
• Change in shape of bone
• Change in the length of limb
• What do you think are the most common broken
  bones in the elderly?

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• Treatment
• Varies depending on type of break, location and
  severity

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• Nursing
• Healing takes longer
• Focus on skin integrity
• Body alignment
• Mobilize ASAP
• Complications
• Prevention

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Osteoarthritis

• Leading cause of physical disability
• Affects more women than men
• Affects several joints
• Weight bearing joints are most affected
• Most common joints
• Knees, vertebrae, hips and fingers

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• Symptoms
• Pain after activity
• Pain can increase in damp weather
• May have bony nodules in joint
• Treatment
• Tylenol over NSAIDS
• Rest
• Heat
• Weight loss
• Joint replacement

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Rheumatiod Arthritis

• Chronic systemic inflammation of joints
• Symptoms
• Painful, swollen, red to touch, warm joints
• Systemic
• Fatigue
• Weakness
• Wt. Loss
• Pain with rest and activity

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• Treatment
• Anti-inflammatory agents
• Steriods
• Immunosuppresive drugs
• Heat
• Gentle massage

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Osteoporosis

• Demineralization of the bone occurs
• Causes
• Inactivity or immobility
• Diseases
• Reduction in sex hormones
• Diet
• Drugs

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• Treatment
• Calcium supplements
• Exercise
• Diet

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Pain management

• Goal is to improve quality of life
• Other options vs. meds

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