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The three types of pressure ulcers are:

 A necrosis of the epidermis or dermis, which may or may not progress to a
deep lesion.
 A deep or malignant pressure ulcer where necrosis is observed initially in the
subcutaneous tissue and tracks outward.
 Full-thickness wounds of dry black eschar.

 Prevention: Avoid sitting unless for meals, use pillows, reposition q2hrs,
encourage independent position changes

cellulitis. or breaking out in a cold sweat.Symptoms include: sleep disturbance. delayed skin healing. Cardiovascular -5 Changes- -Increased stiffness of the heart and blood vessels -Diastolic dysfunction due to impaired diastolic filling -Systolic dysfunction due to increased left ventricular afterload -Decreased cardiac output with rest and with exercise -A decrease in cardiovascular reserve or a decrease in cardiac output may be the result of deconditioning and/or disease or the result of natural aging processes CAD management- Women.  Stage 1. shortness of breath. Risk Factors . squeezing. fullness. They heal faster if reinjured.clean with tepid water without soap. Assessment- -Skin changes leave the older person increasingly susceptible to skin injuries such as pressure ulcers and skin tears with a steadily decreasing ability to effect skin repair -Common skin conditions of the older adult include skin cancer. pressure ulcers. or stomach. skin tears. jaw. and fingernail and toenail problems. chest discomfort. neck. or pressure that can come and go. and feelings of nausea and light-headedness. discomfort in the back.

Check for postural HTN! (orthostatic) Immune system-2 Responses . HTN.

especially infections. -Decrease in effectiveness of the cilia of the respiratory tract -Decreased production of antibodies after immunization -Suppressed immune system from the use of medications -Decrease in lymphocyte production -A decreased ability to respond to antigenic stimulation by B lymphocytes is a common characteristic of the aging humerol immune system. tissues are slower to repair and are more vulnerable to disease.Nosocomial infection Reduce risk= Begin aspiration precautions for dysphagia. • Remind pt to get pneumonia vaccine at age 65 because there is a decrease in antibody response in the body . As a result. -The number of B cells in the circulation decreases in some individuals. or immunosenescence. Changes- -Decrease in the nature and quantity of antibodies produced -progressive decrease in immune functioning.

Monitor during meals for a change in respirations. Raise the head of the bed to a 90 degree angle during meals.Biological changes in GI function include: Changes in the mouth Decreased esophageal motility Diminished gastric motility with increased stomach-emptying time Diminished capacity of the gastric mucosa to resist damage . • RA= antibodies form against pt’s own IgG and the inflammatory process is stimulated by T cells and they destroy articular cartilidge • Shrimp and asthma = Type 1 hypersensitivity • A decline in responsiveness of immune system-pt with pneumonia and temp of 99. 2.5F (baseline body temp in old people is lower) • Memory is a reason for the immune system to develop long lasting protection against specific antigens GI -6 Swallowing. 3. Slurred speech 2. 1. 5. Ensure that one bite has been swallowed before providing another.Dysphagia – is defined as difficulty in any part of the process involved with swallowing solid foods or liquids. 1. Weak voice and cough 4. Maintain an upright position for 1 hour after eating. Extreme lethargy 3. Drooling Changes.

gastric motility and stomach emptying elevates the risk for GERD (Hall. decreased peristaltic. Decrease in  esophageal sphincter pressures.pylori incidence increases with age and is implicated in 90% of duodenal and gastric ulcers not associated with NSAIDS. Damage to the stomach lining is more likely the result of decreased prostaglandin production. H. Taking an NSAID with food only slightly protects the stomach from local irritation. NSAIDS can also activate IBD. when combined with disease or med SE can lead to development of dysphagia or aspiration.11  CRF/ARF . 2009) this also contributes to decreased hunger can contribute to diminished food intake and malnutrition (Visvanathan & Chapman) How does damage to the gastric mucosa occur? Mucin Diminished capacity of the gastric mucosa to resist damage can be secondary to NSAID’s use and helicobacter pylori. Fluid and Electrolytes GU/sexuality. sphincter relaxation. While a normal change.

yellow or clear o Number and size of clots o Aseptic technique with catheter care and CBI . brick red. tea colored. amber. o Chronic renal failure is caused by irreversible damage to the kidneys. Risk factors Lab values Changes  CBI o Irrigation solution continuously infused and drained from bladder o Discontinue when bleeding stops o Urine should be light pink without clots o Inflow and outflow of irrigant must be monitored and documented o Document drainage o Terms: bright red.

onions. fever  Hematuria o Managing UI o Retrograde ejaculation o Anxiety o Sexual counseling o ED o 2 months for bladder capacity return to normal o Urinate q 2-3 hr o Avoid bladder irritants (aged cheeses. sour cream. o Tape catheter to leg o Maintain closed drainage system o Don’t allow irrigant to go dry (Can cause bleeding) o Refrain driving or intercourse until see MD o Catheter care (if discharged with catheter) o Maintain oral fluids 2-3 L per day o Observe S/S UTI and wound infection o Signs of bladder infection  Bladder spasm  Change in mental status (confusion) vs. citrus juices…. chocolate.) o Hospice care if late stage o Pain control o • BPH Irritative • Urinary frequency • Urgency • Dysuria • Bladder pain • Nocturia • Incontinence • Complications • Acute urinary retention • UTI • Obstructive • Decrease in caliber and force of urinary stream • Difficulty initiating voiding . rye and sourdough breads.

dizziness. • Intermittency • Dribbling • Early signs of urinary retention • Treatment • Avoid decongestants and anticholinergics • 5-alpha-reductase inhibitors • Finasteride (Proscar) & Dutasteride (Avodart) • SE: decreased libido. discontinue prior to surgery. INCREASE risk of bleeding: contraindicated if concurrent GI disorders. GI side effects. decreased volume of ejaculate and ED • Alpha-Adrenergic receptor blockers • Tamsulosin (Flomax) • SE: orthostatic hypotension. may increase BP Incontinence • Treatments for UI fall into five categories: • Lifestyle modification • Scheduled voiding regimens • Pelvic floor muscle strengthening • Anti-incontinence devices • Supportive interventions Sexuality-9 . nasal congestion • Herbals: Saw palmetto -Can improve urinary symptoms and urinary flow measures. retrograde ejaculation.

safe sex Respiratory-6 • Changes- -Stiffening of elastin and the collagen connective tissue supporting the lungs. vasomotor instability. approximately 9 billion people. Womens changes. more frequent UTIs.Impotence. • The highest burden of TB continues to be among older adults. • Tuberculosis (TB) infects one third of the world’s population. UI. -Altered alveolar shape resulting in increased alveolar diameter -Decreased alveolar surface area available for gas exchange -Increased chest wall stiffness -Stiffening of the diaphragm Pneumonia- TB- • Mycobacterium tuberculosis – is spread through the air and usually infects the lungs and sometimes other organs are involved.the cessation of menses. and sleep Men’s changes. cognitive changes. atrophic vaginitis. or erectile dysfunction (ED). o Transmission: Airborne o Diagnosis: skin test and chest x-ray o Treatment: Antibiotics Endocrine-9 • Changes Decreased secretion of insulin • Potential for thyroid function problems with systemic symptoms that may be attributed to aging. adults ages 65 years and older had a case rate of 5.5 cases per 100. Intimacy. These include decreased vaginal lubrication. affects nearly 70% of men over the age of 70. • In 2010. . • Decreased sensitivity to insulin resulting in variation blood glucose levels. It is defined as the inability to achieve or maintain an erection sufficient for sexual satisfaction.

family history. • Peripheral tissues may become insulin resistant. but the average age is 51 in the United States. low HDL. Diabetes Risk factors Increased waist circumference BP > 129/84 or on antihypertensive meds Plasma triglycerides > 149 or on meds HDL< 40 for men or 50 for women or on meds FBS > 99 Race. • Menopause is the time that marks the end of menstrual cycles. screen q3 yrs  Treatment-  Foot Care  Insulin  Complications  Heart disease  Stroke  Kidney failure  Nerve damage  Vision problems  Diet  Exercise  Emergency medications  Monitoring  Life style Changes  Sick day management  Skin alterations  Wound infections . gestational diabetes. • Adrenopause a gradual and progressive decrease in the secretion of hormones by the adrenal glands that occurs normally with increasing age during adult life • Somatopause a gradual and progressive decrease in growth hormone secretion that occurs normally with increasing age during adult life and is associated with an increase in adipose tissue and LDL levels and a decrease in lean body mass. 40s or 50s. • Andropause is a condition that is associated with the decrease in the male hormone testosterone. especially with obesity. glucose intolerance. It's diagnosed after 12 months without a menstrual period. HTN. obesity.

Thyroid • Hasimoto’s Tyroiditis • Prevalence age>74 • 21% women • 16% men • Causes • Hashimoto’s disease or autoimmune thyroiditis most common cause • Drug induced: lithium carbonate. weight gain. o . Hyperthyroidism – radioactive sodium iodide (131I). subclinical presentation with atypical symptoms • Most common complaint in older adult • Fatigue. and 12 months • Graves disease • Autoimmune disorder associated with sustained thyroid over activity • Treatment- Hypothyroidism – Levothyroxine sodium • The average dose for persons over 65 years of age is 25 to 30 mcg/day by mouth. cold intolerance. iodine • Diagnosis • History and Physical exam • TSH. amiodarone.6. serum free T4 • Subclinical hypothyroidism in the older adult • TSH elevated • T4 levels normal • May progress to overt hypothyroidism • Older adults • Insidious onset. muscle cramps. paresthesias and confusion • Treatment • Thyroid hormone replacement L-thyroxine • Follow up 3.