Published on March 7, 2014
Recognizing Changes in Body Function NATCEP Day Thirty-One &Thirty-Two
Objectives • Describe the aging changes and their consequences for the following body systems: – – – – – Cardiovascular Respiratory Endocrine Urinary Nervous • Describe the related nursing care for each
Changes of Aging: Cardiovascular System • Heart may pump blood less efficiently. • Heart cannot accommodate to meet increased need. • Arteries loss elasticity. • Blood pressure may increase. • Blood flow to brain and vital organs may be decreased. • Veins are less efficient in returning blood to the heart
Common Diseases Cardiovascular System • Common Diseases: – Hypertension (High Blood Pressure) – Coronary Artery Disease – Angina – Myocardial Infarction (Heart Attack) – Congestive Heart Failure
High Blood Pressure • Blood pressure higher than 140 systolic (top); 90 diastolic (bottom) • Caused by narrowed blood vessels – – – – Kidney disorders Head injuries Pregnancy Adrenal Tumors • Signs and Symptoms – “Silent Killer” • Headache, blurred vision, dizziness, nose bleeds • Treatment – Life Style Changes • Diet, no smoking, healthy weight, exercise
Coronary Artery Disease • Coronary arteries become hardened and narrow • Caused by build up of plaque on the arterial walls • Major complications – – – – Angina Myocardial Infarction (MI) Irregular Heart Beat Sudden Death • Treatment – Life Style Changes • Diet, Exercise, quit smoking, reduce stress – Medications • Decrease workload on heart and relieve symptoms
Angina • Chest Pain • Caused by reduced blood flow to the heart • Signs and Symptoms – Tightness, pressure or squeezing in the chest – Pain in the shoulder, arm, neck, jaw or back – Pale, nauseated or weak • Treatment – Rest – stop any activity – Nitroglycerine Tabs – Avoid triggers • Over-exertion • Heavy meals or overeating • Stress
Myocardial Infarction (MI) • Death of part of the heart muscle • Caused by blocked blood flow to the heart • Signs and Symptoms – More severe and lasts longer than Angina – Sudden tightness, pressure or squeezing in the chest, usually on the left side “elephant sitting on my chest” – Indigestion or “heartburn” – Pain in the shoulder, arm, neck, jaw or back – Pale, nauseated or weak – Low blood pressure – Not relieved by rest or nitroglycerin • Treatment – – – – EMERGENCY: Call 911 Stop any activity Treat symptoms May need surgery to open or bypass blockage • Cardiac Catheterization
Congestive Heart Failure • Heart is weak and cannot pump blood normally; blood backs up = tissue congestion • Caused by damaged or weakened heart • Signs and Symptoms – Left side of heart = lungs • Respiratory congestion = short of breath; more sputum, cough, gurgling in lungs = pulmonary edema – Right side of heart = venous system • Edema in extremities, neck veins bulge, liver congestion • Treatment – – – – – – – – Drugs = strengthen heart and/or reduce fluid Low sodium diet Oxygen and semi-fowlers position Rest and activity as ordered Intake and Output Restrict fluids Daily weights Elastic (anti-embolic) stockings
Consequences Cardiovascular Changes • Adequate exercise is necessary - may not be able to tolerate great amounts. • Circulation changes affect blood pressure & fluid balance. • Dizziness may occur with sudden changes in position. • Decreased venous return many cause discoloration, coldness & swelling of legs.
Nurse Aide Actions • Pace activities and allow time for rest periods. • Be aware of dietary restrictions. • Assist resident to change positions slowly and be aware of episodes of dizziness and report to nurse. • Remove and reapply anti-embolic stockings to lower extremities, as ordered. • Report changes to the nurse!
Changes of Aging Respiratory System • Lung capacity decreases as a result of muscular stiffness in the lungs. • Ability to cough is less effective, causing secretions and fluid in the lungs, increasing the risk of infections and choking. • Shortness of breath on exertion as result of aging changes in lungs • Airway size decreases with age.
Common Diseases Respiratory System • Common Diseases: – Chronic Obstructive Pulmonary Disease (COPD) – Pneumonia – Tuberculosis – Asthma
Chronic Obstructive Pulmonary Disease (COPD) • Two disorders grouped – Bronchitis – Emphysema • Interfere with CO2 and O2 exchange in the lungs; less air gets in, less CO2 gets out – Airways & alveoli become less elastic – Walls between many alveoli are destroyed – Walls of airway becomes thick, inflammed and swollen – Airways secrete more mucus = clogs airways • Cause: Cigarette Smoking or tobacco use
COPD • Signs and Symptoms – Bronchitis • Smoker’s Cough in am – First dry, cough up mucus over time • Mucus may have pus • Difficulty breathing; tires easily – Emphysema • Alveoli are enlarged – trap O2 and CO2 = barrel chest • Shortness of breath; tires easily • Cough; mucus may have pus
COPD • Treatment – Stop Smoking – Oxygen Therapy – Breathing Exercises – Respiratory Therapy – Medications
Pneumonia • Inflammation and infection of lungs • Signs & Symptoms – Sudden onset – Very ill • • • • Fever (chills) Painful cough Chest pain when breathing Rapid pulse • Treatment – – – – Drugs for infection & pain Increased fluids Rest Semi-Fowlers
Tuberculosis • Bacterial infection of lungs • Signs & Symptoms – – – – – Tiredness Loss of appetite Weight loss Fever & Night sweats Cough with sputum (may contain blood) • Treatment – Drugs – Comfort measures – Respiratory Isolation
Consequences Respiratory System Changes • • • • Shortness of breath Infections Choking Fatigue
Nurse Aide Actions • Position comfortably. • Keep needed items within reach. • Be aware of dietary restrictions – Sodium restrictions are common • Pace activities and allow time for rest periods. • Follow facility policies regarding oxygen in use. • Be alert to changes and report to nurse!
Changes & Consequences Endocrine System • Water and fluid balance – Imbalances occur with illness, hospitalizations, , use of medications, and extremes in temperatures. • Dehydration: altered mental status, lethargy, lightheadedness or syncope. – Signs of dehydration: reduced skin turgor, dry mucous membranes, and hypotension (low blood pressure). • Vitamin deficiencies: cognitive impairments, poor wound healing, anemia, and increase in infections.
Changes & Consequences Endocrine System • "Under" Nutrition: fatigue, pressure sores, decreased muscle strength, infections, hypotension and lower extremity edema. • Type II diabetes is more common in elderly with upper body obesity (non-insulin dependent). – Increased risk of macrovascular disease = stroke, coronary artery disease, skin breakdown and infection. – Poorly controlled for several years can lead to retinopathy, nephropathy, and peripheral neuropathy. • Hypothermia: diabetes = 6x greater chance due to vascular disease; medical emergency. • Hyperthermia: heat cramps, heat exhaustion & heat stroke.
Common Diseases Endocrine System • Common Diseases: – Diabetes
Diabetic Coma • Hyperglycemia: High Blood Glucose • Symptoms – – – – – – – – Coma Face flushed Breath fruity Tongue dry Labored respirations Blood pressure low Weak and rapid pulse Skin dry • Treatment – Insulin
Insulin Shock • Hypoglycemia: Low Blood Glucose • Signs and Symptoms – CHANGE IN Behavior – – – – – • Excited, nervous, dizzy, confused, irritable Face pale Shallow or rapid respirations Full or pounding pulse Skin moist – excessive sweating Lack of coordination - trembling • Treatment – Glucose via an Intravenouse Infusion (I.V.) – High sugar foods
Diabetic Treatment Plan • Diet • Medications – Pills : pancreas to produce and secrete insulin – Insulin (injection) • Diet – Sugars – Carbohydrates – Proteins
Nurse Aide Actions • Closely monitor fluid intake. • Monitor food intake and diet. – Know dietary restrictions • Be alert to signs and symptoms of diabetes – – – – – – Excessive thirst Excessive hunger Frequent urination Pain in abdomen Nausea & vomiting Drowsiness
Nurse Aide Actions • Assure activity/exercise – Plan of care • Foot Care – Well fitting shoes – Lotion on feet daily – DO NOT CUT nails • Skin care – Be alert to breaks in skin & report • Be aware of signs and symptoms – Diabetic Coma – Insulin Shock
Complications & Precautions • Decreased circulation – Poor Healing – Nails: DO NOT CUT TOENAILS! • Check plan of care for nail care • Retinopathy – Blindness • Manage blood sugar level • Diet • Exercise
Changes of Aging Urinary System • Kidneys decrease in size • Urine production less efficient • Kidney function increases at rest – Nocturia • Bladder capacity decreases & muscles weaken – Frequency – Leaking • Prostate Gland in men enlarges
Common Diseases Urinary System • Common Diseases: – Urinary Tract Infections – Prostrate Enlargement – Kidney Stones (Renal Calculi) – Renal Failure • Acute • Chronic
Urinary Tract Infection • Infection of tract of the urinary system • Signs & Symptoms – – – – Painful urination Frequency Urgency Fever • Treatment – Drugs for infection & pain – Increased fluids – Rest
Prostate Enlargement • Surrounds urethra; enlargement can prevent urine from passing • Signs & Symptoms – – – – Weak urine stream Frequency with small amounts or urine Urgency with leaking or dribbling of urine Urinary retention • Treatment – Drugs – Surgery may be necessary
Kidney Stones (Renal Calculi) • Small as sand; can be as large as golf balls • Signs & Symptoms – – – – – Severe, cramping pain in back and side (flank) Nausea & vomiting Fever & chills Painful urination, urgency & frequency Blood in the urine (hematuria) • Treatment – – – – Drugs Increased fluids Strain urine Surgery may be required
Renal Failure • Kidneys severely impaired or not working • Signs & Symptoms – Small amounts of urine (oliguria) • Less than 400 cc in 24 hours – Very ill – all body systems affected as waste backs up • Treatment – Drugs – Retrict fluids – Hemodialysis • Waste removed from blood by machine
Consequences Urinary System Changes • Incontinence causes the person to feel embarrassed, isolated and depressed • UTIs are common – – – – – Low urine output Frequency Incontinence Flank pain Fever • In addition to odors, skin becomes irritated resulting in infection and pressure ulcers
Nurse Aide Actions • • • • Encourage fluids unless directed otherwise Record output according to care plan & policy Assist to bathroom as needed and per care plan Observations about urine: – – – – – – Color Odor Frequency with small amounts of urine Pain/burning with urination Difficulty urinating Incontinence
Changes of Aging: Nervous System • Slowed transmission of nerve impulses: slowed reaction time – Speed – Fine Motor Skills • Balance and coordination problems • Deep sleep is shortened; awakening more at night • Decreased sensitivity of nerve receptors in skin: heat, cold, pain & pressure
Common Diseases Nervous System • Common Diseases: – Stroke – Dementia – Alzheimers’ Disease – Parkinson’s Disease – Multiple Sclerosis – Huntington’s Disease
Stroke • Blood flow interrupted to the brain by a clot or aneurysm • Signs & Symptoms – – – – F: A: S: T: face uneven? Arm held out to side without drifting down? Speech strange or unclear? Tongue straight or off to one side? • Treatment – Drugs immediately – Based on functions impacted or lost
Dementia • Loss of cognitive function that interferes with routine, personal, social, and occupational activities – not a normal part of aging • Signs & Symptoms – – – – – Memory loss that affects job skills Problems with ADLs Problems with common language Getting lost in familiar places Misplacing things • Treatment – Comfort & safety – Keep involved as much as possible
Alzheimers’ Disease • A disease of the brain as a result of nerve damage in the brain. There is a steady decline; can only be diagnosed by autopsy • Signs & Symptoms (gradual) – – – – Problems with work & everyday functions Problems with family & relationships Steady decline in memory & mental function Live 8 to 10 years after diagnosis • Treatment – Comfort & safety – Keep involved as much as possible
Parkinson’s Disease • Slow, progressive disease that effects the area of the brain that controls muscle movement • Signs & Symptoms – All worsen over time • • • • • Tremors Rigid, stiff muscles Slow movements Stooped posture Mask-like expression • Treatment – – – – Drugs Exercise & Physical Therapy Based on symptoms Hemodialysis • Waste removed from blood by machine
Multiple Sclerosis • A slow, progressive, disease in which the myelin in the brain & spinal cord is destroyed • Signs & Symptoms – Begin between 20 – 40 years of age – Depend on damaged area • • • • • Vision blurred, double vision or blindness Muscle weakness Balance problems – coordination & cluminess Tingling, prickling, numbness Problems with concentration, attention, memory & judgment • Treatment – Focus on keeping active and independent
Huntington’s Disease • Inherited; causes progressive breakdown of brain nerve cells • Signs & Symptoms – Movement • • • • Involuntary jerking or contractures of muscles Problems with gait, posture & balance Slow, uncoordinated fine movements Slow or abnormal eye movement – Cognitive • Difficulty planning, organizing and prioritizing tasks • Inability to start a task or conversation/slow thought processes • Lack of impulse control that can result in outbursts, acting without thinking and sexual promiscuity – Psychiatric • Depression based on neurological changes • Treatment – Focus on keeping active and independent
Consequences Nervous System Changes • Slowed responses – Increased risk for falls • Sleep patterns changes – Harder time falling asleep = fatigue & more rest/napping during the day • Lost brain cells – Changes in mental function and personality • Decrease sensitivity – Increased risk of injury • Stroke – Dependent on affected areas
Nurse Aide Actions • • • • Provide for safety Encourage activity Prevent injuries to paralyzed parts. Consider the resident first; the disease and condition second • Provide support in ADLs (activities of daily living
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