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semi final clinfo " Geriatric Notes "

semi final clinfo " Geriatric Notes "

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Published by: xeniabelle on Aug 27, 2010
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01/14/2013

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GERIATRICS
“Grow old with me/ the best is yet to be. /The last of life, for which the first was made.”By: Robert BrowningLate Adulthood can be divided into 4 subgroups:
65 to 74 yrs. Of age – Young old
75 to 84 yrs. Of age – Middle age
85 to 99 yrs. Of age – Old old
100 yrs. Or more – Elite oldDEFINITION OF TERMS:
GERONTOLOGY – the science & study of aging process
GERONTOLOGIC NURSING the care & attention to individuals undergoing the agingprocess with the emphasis on the developmental stages of aging
GERIATRICS – the science & study of the physiologic & pathologic problems of individualsin their later maturity; a medical specialty that addresses the diagnosis and treatment of physical problems of the elderly
GERIATRIC NURSING care of the elderly individual regardless of whether they arediseased or not
SENESCENCE – the normal aging process
SENILITY – aging process characterized by severe mental deterioration
AGING – physiologic, behavioral & social changes that occur with increasing chronologicalageI.
A.COMMON BIOLOGIC THEORIES OF AGINGTHEORY TYPEHYPOTHESIS1.WEAR & TEARTHEORY 
-Proposes that humans like automobiles have different parts thatrun down with time, leading to aging & death-proposes that the faster an organism lives, the quicker it dies-proposes that cell wear out through exposure to internal &external stressors (trauma, chemicals, build up of natural wastes)
2.ENDOCRINETHEORY 
-proposes that events that occurring in the hypothalamus &pituitary are responsible for changes in hormone production &response that result in the organism’s decline
3.FREE RADICALTHEORY -
proposes that unstable free-radicals (groups of atoms) resultfrom the oxidation of organic materials such carbohydrates, &proteins. These radicals cause biochemical changes in the cells &the cells cannot regenerate themselves.
4.GENETIC THEORY /MUTATION THEORY -
proposes that organism is genetically programmed for apredetermined number of cell divisions, after which thecells/organism dies-proposes that when damage to the protein synthesis occurs,faulty proteins will be synthesized & will gradually accumulates,causing a progressive decline in the organism
5. CROSS LINKINGTHEORY / COLLAGENTHEORY -
proposes that the irreversible aging of proteins such as collagenis responsible for the ultimate failures of tissues & organs-proposes that cells age, chemical reactions create strong bonds,or cross- linkages between proteins. These bonds cause loss of elasticity, stiffness, & eventual loss of function
6. AUTOIMMUNETHEORY /IMMUNOLOGICTHEORY -
proposes that the immune system becomes less effective withage, & viruses that have incubated in the body become able todamage body organs-proposes that a decrease in immune function may result in anincrease in an autoimmune responses causing the body toproduce antibodies that itself 
I.B. PSYCHOSOCIAL THEORIES
Described the aging individual in terms of his / her social group / culture.
1.DISENGAGEMENTTHEORY -
the basis of this theory arises from the fact that human beingsare mortal & must eventually leave their place & role in society. Therefore, it is their responsibility to look for suitable replacement
2.ACTIVITY THEORY-
assumes that the same norms exists for all mature individuals. The degree to which the individual “acts like” or “looks like” amiddle – aged is the determinant of the aging process1
 
-one must constantly struggle to remain functional & take on newactivities to replace lost one
3.CONTINUITY THEORY 
-accounts for the continuous flow of phases in the life cycle &does not limit itself to change-it assumes that persons will remain the same unless there arefactors that stimulate change or necessitate adaptation
II.NORMAL PHYSICAL CHANGES ASSOCIATED WITH AGINGPHYSICAL CHANGESRATIONALEINTEGUMENTARY 
Increased skin dryness
Increased skin pallor
Increased skin fragility
Progressive wrinkling & sagging of theskin
Brown “age spots” (lentigo senilus) onexposed body parts (face, arms, hands)
Decreased perspiration
 Thinning & graying of scalp, pubic &axillary hair
Slower nail growth & increased thickeningwith ridges-↓in sebaceous glands activity & tissue fluid-↓vascularity of the dermis-reduced thickness & vascularity of thedermis; loss of subcutaneous fats-loss of skin elasticity, increased dryness, & subcutaneous fat-clustering of melanocytes-reduced number of sweat glands-progressive loss of pigment cells from hairbulbs; decrease melanin production-↑ calcium deposits
NEUROMUSCULAR
Decreased speed & power of skeletalmuscle contractions
Slower reaction time
Loss of height (stature)
Osteoporosis
 Joint stiffness
Impaired balance-↓ in muscle fiber-diminished conduction speed of nerve fibers& ↓ muscle tone-atrophy of intervertebral disk-bone demineralization, loss of calcium fromthe bones= increase propensity to Fracture-deterioration of joint cartridge-↓muscle reaction time & coordination
SENSORY / PERCEPTION
VISION
loss of visual acuity
increased sensitivity to glare & decreasedability to adjust to darkness
partial or complete glossy white circlearound the periphery of the cornea (arcussenilis)
loss of color sensitivity (esp. color
PURPLE
)--------------------------------------------------------------------------
progressive loss of hearing
decreased sense of taste, especially sweetsensations @ the tip of the tongue(prefersSALTY DIET)
decreased sense of smell
increase threshold for sensations of pain,touch, & temperature-Degeneration leading to lens opacity(cataract), thickening & inelasticity(presbyopia)-changes in the ciliary muscle; rigid pupilsphincter; decrease in pupil size-fatty deposits---------------------------------------------------------------------------changes in the structures & nerve tissues inthe inner ear (presbycusis); thickening of theear drum-↓ in number of taste buds in the tonguebecause of tongue atrophy-atrophy of the olfactory bulb at the base of the brain (responsible to smell perception)-possible nerve conduction & neuron changes
PULMONARY 
decreased ability to expel foreign objector accumulated matter
decreased lung expansion, less effectiveexhalation, reduced vital capacity &increased residual volume-↓ elasticity & ciliary activity-weakened thoracic muscles; calcification of costal cartilage- making the rib more rigid;dilatation from inelasticity of alveoli2
 
difficult, short, heavy, rapid breathing(dyspnea) following intense exercise-diminished delivery & diffusion of oxygen tothe tissues to repay the normal oxygen debtbecause of exertion or changes in bothrespiratory & vascular tissues
CARDIOVASCULAR
reduced cardiac output & stroke volume,particularly during increased activity orunusual demands; may result in shortnessof breath in exertion & pooling of blood inthe extremities
reduced elasticity & increased rigidity of the arteries
increased in diastolic & systolic pressure
orthostatic hypertension-↑ rigidity & thickness of the heart valves(hence ↓filling/emptying abilities); contractile strength-↑ calcium deposits in the muscular layer-inelasticity of systemic arteries & peripheral resistance-Reduce sensitivity of the blood pressure regulating baroreceptors
GASTROINTESTINAL
delayed swallowing time
increased tendency for ingestion
increased tendency for constipation-alteration in swallowing mechanism-gradual decrease in digestive enzyme,reduction in gastric pH & slower absorptionrate-↓ muscle tone of the intestines; ↓ peristalsis
URINARY 
reduced filtering ability of the kidney &impaired renal function
less effective concentration of urine
urinary urgency & urinary frequency
tendency for a nocturnal frequency &retention of residual urine-number of functioning nephrons &arteriosclerotic changes in blood flow-↓ tubular function-enlarged prostate gland in men; weakenedmuscle supporting the bladder or weakness of the urinary sphincter in women-↓ bladder capacity & tone
GENITALS
prostate enlargement (benign) in men
multiple changes in women (shrinkage &atrophy of the vulva, cervix, uterus,fallopian tubes & ovaries; reduction insecretions; & changes in vagina flora)
reduced vaginal lubrication
increase in time for full sexual response-exact mechanism is unclear; possibleendocrine changes-diminished secretion of female hormones &more alkaline vaginal pH
Erikson (1963) -
developmental task = “ego integrity vs. despair”EGO INTEGRITYDESPAIR
views life with a sense of wholeness &derives satisfaction from pastaccomplishments
views death as an acceptablecompletion of life
accepts one’s one and only life cycle
bringing serenity & wisdom
believes they have made poor choicesduring life & wish they live life longer
inability to accept one’s fate
gives rise to feeling with frustration,discouragement, & a sense that one’s lifehas been worthless
Peck (1968):
proposed the 3 developmental task for older adults (contrast-Erikson’s)Ego Differentiation vs. work – role preoccupationBody transcendence vs. body preoccupation3

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