Senile lentigo

Seborrheic Keratosis

Cutaneous papilloma/skin tags

Crow's feet/wrinkles

Faded hair color/grey & hair distribution patterns change

fingernails grow more slowly & become thick, yellow, brittle

xerosis

senile purpura

Upper 1/2 of body, start appearing at age 50

Raised, can potentially be ripped off if not careful

Can be excised, but will most likely grow back

Usually harmless

expected age related change

liver spots/age spots

From the sun

common on hands/face/head

expected age related changes

generally happens on heavier set people

can be hereditary

prediabetic people/diabetic

if removed can grow back

dry skin can turn into an ulceration

expected age related change

sometimes raised.

very common

d/t leaking blood b/c capillaries can't hold the blood b/c of less fat and muscle.

expected age related change

ptINR may be off if taking aspirin or a blood thinner. Get CBC b/c they may be bleeding internally.

cause of sun exposure, genetic link

highly cancerous! metastasizes inside organs

raised, irregular border

wide excision then send to pathology

common on face, nose

shave off parts of skin and then burn it

skin is dry

yellow crusty wax like material

sebaceous glands are blocked

common areas are eyebrows, sides of face, axillary & groin

Vaccine

Unilateral

Pain on nerve line can last for months up to years after

rash and blister that seeps and then crusts

Can be viral or from stress, autoimmune

Need to avoid stress, sunlight, alcohol & spicy foods

Topical and oral meds taken to tx

blister like.

Do not pop!

Body will reabsorb fluid.

If the blisters open they're susceptible to infection.

for them to remain strong they need adequate dietary intake of calcium, phosphorus, vitamins A, C, and D.

Also necessary to apply stress to long bones to keep the minerals in the bones.

Hormones also play an important role : calcitonin, parathyroid hormone, insulin, thyroxine, estrogen, and testosterone.

Decreased bone calcium

Decreased fluid in intravertebral discs

Decreased blood supply to muscles

Decreased tissue elasticity

Decreased muscle mass

Brittle bone disease, more porous

Happens more often in post menapausal women, alcoholics, smokers, small framed people, caucasions/asians, people who take immunosuppresant drugs

Leading cause of functional impairment in older adults.

Rare to find an elderly person that has not experienced some degree of discomfort, disability, or deformity from a musculoskeletal disorder.

Not a normal part of aging

Cause is unknown

Also known as degenerative joint disease (DJD)

*Leading cause of physical disability in older adults*

Joints may become inflammed causing edema and pain

This increases risk for falls (b/c of pain & kyphosis), immobility, depression, and loss of indepedence.

caused by increased levels of uric acid

Uric acid crystals deposit into the synovial joints and other tissue.

Need to evaluate to rule out FX.

Happens more frequently in adult males.

Reduce consumptions of foods containing high purine!

If untreated can lead to tophii crystals that ooze out of the skin.

Need to avoid when you have gouty arthritis

ETOH

Liver

Sardines

Beans

Mushrooms

Spinach

Asparagus

Cauliflower

Shellfish

Redmeats

If untreated can lead to tophii crystals that oooze out.

Rule out FX.

Can use allupurinol/cholchizine.

NSAIDs, but not long term b/c can lead to GI bleeding

Decreased body fluids

Decreased number of fluids (Increased risk for resp inf)

Decreased number of macrophages

Decarsed tissue elasticity in the avleoli in lower lung (secretions build up)

Decreased muscle strength and endurance

Decreased number of capillaries

Increased calcification of cartilage within ribcage so it makes it hard to expand and cough up any secretions.

Decreased cardiac muscle tone

Increased heart size, left ventricle (thickening)

Decreased cardiac output

Decreased elasticity of heart muscle and blood vessels

Decreased pacemaker cells

Decreased baroreceptor sensitivity (regulates BP)

Increased incidence of valvular sclerosis (thickening of valves-aortic & mitral)

Increased atherosclerosis (thickening of vessels d/t plaque)

Aka Ischemic Heart Disease

Most people over 70 will develop this.

S/SX: angina

-pain may be vague unlike younger adults

-frequent after exertion/large meal

-over time leads to myocardial weakness and potentially CHF

Some anginal attacks can be prevented by avoiding such factors as:

COLD wind

Emotional stress 

Strenuous activity (this is why I don't work out)

Tachycardia

Frequently seen in older persons especially in men with a history of HTN and arteriosclerosis.

S/SX in older adults may differ from younger people:

SUDDEN onset of dyspnea or SOB.

Anxiety/confusion.

Atrial fibrillation

Back pain (common in women)

Chest pain may/may not be present.

May present with just vommitting.

Symptoms might be vague**

Damage from MI is irreverisble. It's DEATH of tissue!

Medications: anticoagulants, beta blockers, ace inhibitors, 81mg of aspirin, Nitroglycerin

Early ambulation to prevent complications of immobilization

Fitness program, proper nutrition.

Important to increase perfusion!

Any group of conditions in which there is abnormal electrical activity in the heart.

The heartbeat may be too fast or too slow and may be regular or irregular.

Causes: Hypokalemia (low potassium 3.5-5 norm)

Acute infections, Anginal syndromes

Coronary Insufficiency (insufficient bloodflow/O2)

Same as in a younger adult:

Potassium replacement (HUGE pill)

Patient education

Antibiotics (if infection)

Pacemaker

Cardiac ablation (go into femoral artery/arm and is an electrode that shocks heart into normal rhythm)

Mainage S/SX of disease!

Audible rattling, feels like they're drowning in secretions

Dyspnea, Orthopnea

Cough/wheezing

Peripheral Edema, wt gain, fatigue

Paroxysmal noctural dyspnea (intermittant attacks at night)

Incidence of increased BP increased with advancing age.

Is the most prevalent cardiovascular disease of the elderly.

Many older people have increased BP due to peripheral resistance from vasoconstriction associated with aging

S/SX: MAY BE NONE (known as the silent killer)

Headache (dull) & Disorientation/confusion

Epistaxis (nosebleeds)

TX: *Decrease sodium intake*

decrease body wt (even if only by 10%),  meds

yoga/meditation/relaxation exercises

Vessels change with age and can lead to mild/severe problems.

They may narrow & interfere with blood flow especially in the lower extremities.

Tissue deprived of oxygen & nutrients can cause severe pain and is called ischemia.

Tissue death results if there is complete blockage.

Severe obstruction increases risk for amputation.

Nurses caring for pt with circulation problems should report any complaints of :

sudden pain

pallor, pulselessness

loss of sensation or change in body temp

Teach pt to:

Avoid crossing legs & tight fitting shoes

Avoid stockings, other than prescribed by Dr.

Control wt to increase possibility for venous return.

Avoid tobacco, which causes vasoconstriction.

Avoid immobility. Need to be walking throughout the day.

Transportation of nutrients, waste products, blood gases, and hormones.

Regulation of fluid electrolyte balance, acid base blanace, and body temp.

Protection against pathogenic attack by WBCs and against excessive blood loss through clotting mechanisms.

Lymph System

Lymph vessels, fluid, and nodes

These permeable vessels absorb fluid and proteins from the tissues.

Fluid moves through a series of lymph nodes and nodules that trap and phagocytize foreign materials before the fluid enters the circulatory system at the subclavian veins.

Lymph System

Spleen & thymus

The spleen is responsible for producing lymphocytes and monocytes, which enter the bloodstream.

It also contains fixed plasma cells, which produce antibodies to foreign antigens, and fixed macrophages.

The embryonic bone marrow and the spleen produce the initial T lymphocytes.

Increased plasma viscosity

Decreased RBC production (can make them anemic)

Decreased mobilization of neutrophils

Increased immature T-cell response (increases their chance of infection)

May not display a fever

Urinary tract infections (may not have pain/dysuria)

Absense of pain with any infection at all

Confusion & agitation

Falls

Changes in blood sugar (even without diabetes dx)

Quiet/more reserved

Change in urine color/odor (strong smell of ammonia)

Increased dental caries and tooth loss (d/t gingivitis)

Decreased thirst perception

Decreased gag reflex (can choke & aspirate)

Decreased muscle tone at sphincters

Decreased saliva & gastric secretions (makes it hard to swallow, risk for aspirating)

Decreased liver size & enzyme production

They usually complain of acid reflex. Do scope to diagnose.

Buldges through diaphragm. Causes major pain and distress.

S/SX: indigestion, heartburn, sore stomach, epigastric distress, distention feeling, pain after meals (high fat), pain upon waking (empty stomach), can resemble heart attack.

TX: proton pump inhibitor (prilosec), H2 receptor antagonist (zantac, tagamet)

NI: sit up 1/2 after meals.

Avoid spicy and high fat meals.

Elevate head of bed. Smaller portion and meals.

Lose weight if morbidly ovese.

Need replacement of B12 because of intrinsic factor because of the amount of medication they're taking causing pernicious anemia.

Given SL/SQ NOT orally!

Diverticulosis - the outpouching

Diverticulitis - inflammation.

Avoid certain foods that upset the diverticulum.

Sometimes doctors recommened avoiding seeds and nuts.

Flares and exacerbations can occur.

Oral steroids prescribed to decrease inflammation.

Happens more in women because of childbearing. It puts pressure on rectal area.

External - visible distened veins

Internal - in the rectum, can irritate the lining.

There's surgeries avaliable. Need to stop constipation. Keep hydrated. Use stool softeners (colace, miralax)

If this occurs the rectum is not sterile so you can push it back in.

If it's painful or bleeding or no there's no history then you can notify the physician or send them out.

If extreme enough they can surgically repair it.

      Decreased number of functional nephrons (lose up to 70% function)

Decreased blood supply to kidneys and periphery

Decreased muscle tone with bladder (leads to incontinence)

Decreased tissue elasticity with bladder, ureters, urethera

Delayed/decreased perception of need to void

Increased nocturnal urine production

Increased size of prostate (male)

Leakage of urine during conditions that increase intra-abdominal pressure, such as exercise, lifting heavy objects, laughing, coughing, or sneezing.

Happens more often in women from having children. 

There's drugs to help, but they have anticholinergic side effects.

Leakage of small amounts of urine from an overly full bladder.

Most common in men with benign prostatic hypertrophy (BPH) who are over 50.

They can have a prostate resection to allow urine to flow.

Seen in older adults whom have normal uretheral and bladder function.

Changes in functional ability may be cognitive or physical in nature.

They have previous control over bladder, but lose it due to someone else not helping them to the bathroom for example.

A condition in which older adults experience continuous and unpredictable loss of urine.

Absolute no control of bladder.

Decreased number of brain cells

Decreased number of nerve fibers

Decreased amounts of neuroreceptors (send messages)

Decreased peripheral nerve function

A progressive, degenerative disorder of the CNS.

The cause is unknown, but is believed to be a decrease in the neurons that produce dopamine, leading to a deficiency

And neurotransmitters are lost

Tend to be unilateral

General weakness

Rigidity & tremors

Falls & slow speech

Later stages may cause dementia

Masklike expression

Medications (levadopa)

New implanted devices

DBS (deep brain stimulation) "brain pacemaker"

Safety concerns d/t shuffling gait and quick steps (high risk for falls)

Changes in mental status occurs in the late stages of 50% of the PTs diagnosed

Decreased number of eyelashes

Decreased number of tear production

Increased discoloration of lens

Decreased tissue elasticity

Decreased muscle tone

Composed of three lays (sclera, choroid, retina)

The greatest part of the eye mass is made up of two fluid-filled cavities, anterior chamber and posterior chamber.

Composed of three portions (outer, middle, inner)

Two main functions are detection of sound and maintenance of balance.

Decreased joint mobility

Decreased tissue elasticity

Decreased ceruminous cells in the external ear canal

Atrophy of vestibular structures and structures in the inner ear.

The receptors for our sense of taste are located in the papillae or taste buds, on teh superior surface of the tongue.

In these papillae are chemical receptor cells sensitive to salty, sweet, sour, or bitter chemicals.

When we age our taste buds atrophy!

The detection of odors occurs when the olfactory receptors in the upper nasal cavities respond to airborne chemicals.

When vapors escape from food or other volatile substances they enter the nose and stimulate the receptors.

Decreased number of papillae on tongue

Decreased number of nasal sensory receptors

Often referred to as the "master gland" of the body because of the many functions it regulates.

There are two major segments of the pituitary gland, the anterior pituiatary and the posterior.

Surrounds the trachea and is located just below the larynx (voice box)

The major hormones produced by the thryoid gland are thyroxin, trilodothronine, and calcitonin

Located on the posterior surface of the lobes of the thyroid gland

Parathryoid hormone, an antagonist of calcitonin, stimulates the movement of calcium and phosphorus from the bones into the blood.

Functions as an exocrine gland in digestion

Endocrine secretions produce glucagon and insulin.

Located on the top of each kidney

Adrenal medulla secretes epinephrine and norepinephrine

Adrenal cortex releases mineralcorticoids, glucocorticoids, and small amounts of sex hormones.

Secrete the hormones involved in sexual maturation and function

Primary hormones secreted by the ovaries are estrogen and progesterone

The testes secrete testosterone, which are responsible for maturation of sperm and for development of the secondary sex characteristics

Decreated pituitary secretions (growth hormone)

Decreased production of thyroid stimulation hormone (TSH)

Decreased insuin production or inscreased insulin resistance (even if not diabetic)

Decreased production of parathyroid hormone (look at bone loss)

50% of elderly people have problem with glucose tolerance

Older adults don't have usual symptoms.

S/SX: stroke, slowed gastric empting (gastroparesis), confusion, neuropathy (numbness/tingling)

INCREASES with age.

the less sugar they filter out they spill sugar into their urine. It makes their blood stick to vessels and makes it thick.

Test HgA1C over 3-4 month period. That's how long RBC live. Blood sugar below 6.

shaking

h/a

irritability

falls

confusion

n/a

Tx: glucagon if passed out

 Changes in women

Decreased in estrogen levels

Decreased in tissue elasticity

Changes in men

Decreased testosterone levels

Decreased circulation

DO NOT increase physical activity

PROMOTE rest

Use elastic stockings

Elevate legs

2 different types (wet & dry)

wet: causes blood vessels to leak and damages the macula.

It's an emergency. Can go blind.

1st step in providing care

MAINTAIN AIRWAY!!!!

Stroke prevention education: Monitor BP/HTN!!!

SOB

Shortness of breath!

The higher the number the lower the risk

0-22

0-HIGH RISK

22-LOW RISK