ADVENTIST MEDICAL CENTER COLLEGE

SAN MIGUEL, ILIGAN CITY

ACTIVITY 3
GROUP DYNAMIC
GROUP 2: ABDULLAH, ALYZAH M. DATE: 30TH OF AUGUST, 2020 SECTION: BSN3A
ABDULMALIK, HANIMAH
ANTICAMARA, DIMPLE A.
CARLOM, JERRAH G.
MEDINA, DONEVA LYN B.
MEJIA, AIRA SHANELLE C.
MONTERO, AMBER DAWN M.
OBINAY, PALOMA
SIAHAAN, ROLAND
VALENZUELA, REYNETTE N.
SARCENO, AUREA DOROTHY B.
TOMAMBILING, JALIDAH P.

PHYSIOLOGIC CHANGES IN AGING AFFECTING VARIOUS SYSTEMS.

1. CARDIOVASCULAR
The cardiovascular system consists of a network of vessels
that circulates blood throughout the body, motored by the
action of the heart.

Major Components of Cardiovascular System

Heart. Pumps blood through the body.
Four chambers:
 Left and right atria
 Left and right ventricle

Blood Vessels. A tubular structure carrying blood through the
tissues and organs.
 Pulmonary vessels
 Systemic vessels
Three main types of blood vessels:
 Arteries, Veins
 Capillaries
Blood Pressure
 Systolic Pressure. Maximum arterial blood pressure reached during ventricular systole.
 Diastolic Pressure. Maximum arterial blood pressure achieved during ventricular diastole.

Blood. Transports gases, nutrients, and waste products.
Aging Changes of Cardiovascular
Decreased cardiac output. By age 70, a person’s cardiac output has probably decreased by
approximately 1/3. Because of the decrease in the reserve strength of the heart, many people
have a limited ability to respond to emergencies, infections, blood loss, or stress.
Hypertrophy of the left ventricles. Result from a gradual increase in the pressure in the aorta
(afterload), against which left ventricle must pump. The increased aortic pressure results from a
gradual decrease in the aorta’s elasticity. Because the left ventricle is enlarged, its ability to
pump out blood is reduced, which can cause in an increased left atrial pressure and lead tp
increased pulmonary edema.
Maximum heart rate decreases. Aging cardiac muscle requires a greater amount of time to
contract and relax. Both the resting and maximum cardiac output slowly lower as people grow
older, and by age 85, the cardiac output has decreased 30-60%.
Stenosed aortic semilunar valve. Age related changes also affect the connective tissue of the
heart valves. The connective tissue becomes less flexible, and calcium deposits develop in the
valves resulting to a stenosed or incompetent aortic semilunar valve.
Increased in cardiac arrhythmias. Occurs as a consequence of a decreased number of cardiac
cells in the SA node and because of cell replacement in the AV bundle.
Coronary artery and heart failure. Approximately 10% of elderly people over age 80 have heart
failure, and a major contributing factor is coronary heart disease.

Changes in structural
 Increased left ventricle wall thickness.
 Increased heart weight.
 Decreased myocardial cells.
 Increased artery stiffness.
 Increased elastin and collagen levels.
 Increased left atrium size.
 Decreased aortic distensibility.
 Decreased vascular tone.

Changes in functional
 Increased left ventricular end-diastolic pressure.
 Elongation of muscle contraction and relaxation phase.
 Elongation of ventricle relaxation.
 Decreased diastolic pressure (during initial filling.
 Decreased reaction to beta-adrenergic stimulus.
 Increased systolic pressure.
 Increased arterial pressure.
 Increased wave velocity.

Nursing Intervention
The nurse’s role is to support, listen, encourage, advise and direct on modifiable risk factors –
but not to lecture.

Nurses should use national health service screening to assess patients’ risk of developing CVD –
it should be offered to individuals between 40 and 74 years of age. Take a family history of CVD,
blood pressure and assess cholesterol status. If a high level is identified, a statin should be
started as primary prevention to help reduce the low-density lipoprotein level and reduce the
risk of CVD. The current recommendation is usually atorvastatin 20mg.  

Also take a random blood glucose level, measure the weight and BMI, and ask about alcohol
intake. Discussing the results enables the patient to make informed choices about their health.
They are then more likely to adhere to a treatment plan.9 The nurse should also discuss with
patients their perceived risk and health-related behaviour, and be aware of influences such as
the blame culture, the environment and stress.
Risk levels are as follows:
If <10% – at low risk of developing CVD.
If 10-20% – moderate risk.
If >20% – high risk.

Nurses should reinforce the importance of adopting a healthy lifestyle, even if all screening
results are negative and low risk.
No one is exempt and we do not want to cause a false sense of security. The nurse should also
explain that once CVD is diagnosed, it never goes away and more risk factors are likely to
develop.
 If a patient has been prescribed medication for any of the following – hypertension,
hyperlipidaemia, angina, atrial fibrillation (AF) and diabetes – discuss the importance of
compliance because it reduces the risk of having an MI myocardial infarction or a stroke.
Discuss complications associated with type 2 diabetes.
 If appropriate, refer the patient to a smoking cessation clinic, local support networks or to
the GP for nicotine replacement therapy.
 Encourage physical activity and exercise as appropriate. Refer to local exercise
programmes, safety permitting.
 Provide dietary advice literature on reducing intake of salt and saturated fat, or refer to a
dietitian.
 Be alert for the early stages of diabetes so that diagnoses can be made and management
started.
 Provide links to alcohol support networks. 
 Encourage realistic and achievable goal setting for patients and their families.

Nurses should also keep their own professional development up to standard. Guidance can be
obtained from the British Heart Foundation Alliance and advice from the National Institute for
Health and Clinical Excellence (NICE) – see resources.

Most activity intolerance is related to generalized weakness and debilitation secondary to acute
or chronic illness and disease. This is especially apparent in older patients with a history of
orthopedic, cardiopulmonary, diabetic, or pulmonary-related problems. The aging process itself
causes a reduction in muscle strength and function, which can impair the ability to maintain
activity.

Activity intolerance may also be related to factors such as obesity, malnourishment, anemia,
side effects of medications (e.g., beta-blockers), or emotional states (e.g., depression or lack of
confidence to exert oneself). Nursing goals are to reduce the effects of inactivity, promote
optimal physical activity, and assist the patient with maintaining a satisfactory quality of life.
2. HEMATOPOIETIC & LYMPHATIC
I. LYMPHATIC
The lymphatic system is related to, yet separate from, the hematologic system. Body cells
normally are bathed in tissue fluid. Some of this fluid drains into blood capillaries and flows
directly to the veins. Another group of vessels, called lymphatic vessels, also drains this fluid.
The lymphatic vessels begin as a network of tiny closed-ended lymphatic capillaries in spaces
between cells. These capillaries are slightly larger than blood capillaries and have a unique
structure that allows interstitial fluid to flow into them but not out. The excess fluid and certain
other waste products that collect there form the thin, watery, colorless liquid known as lymph.
Because lymph originally derives from plasma, its composition is much the same, except that
lymph is lower in protein content. Specialized lymphatic capillaries called lacteals absorb
digested fats and fat-soluble vitamins in the small intestine.

Lymphatic vessels are thin-walled vessels with one-way valves that prevent backflow of
lymphatic fluid. These vessels are located both superficially (near the skin surface) and deeper in
the body. Most lymphatic vessels are located near the venous system and are named according
to their body location.

Lymph Nodes and Nodules

Small bundles of special lymphoid tissue termed lymph nodes are situated in clusters along the
lymphatic vessels. Many of these nodes appear in the neck (cervical), groin (inguinal), and
armpits (axillary)(see Fig. 23-4). Before lymph reaches the veins, it passes through these nodes.
A capsule of connective tissue covers each node. Each node is densely packed with lymphocytes.

Lymph Nodes and Cancer

Cancer cells can travel from their primary site of invasion to distant sites by way of the lymph
nodes. Lymph nodes may either function to filter out cancer cells or may inadvertently spread
cancer to other body sites.

Lymphatic Organs
The lymphatic organs are the tonsils, spleen, and thymus. They are masses of lymphatic tissue
with somewhat different functions than those of the lymph vessels or nodes.

SYSTEM PHYSIOLOGY
Blood Circulation
Blood flows in a circuitous route throughout the entire body. The blood vessels, subdivided into
two circuits (pulmonary and systemic), together with the four chambers of the heart, form the
closed system for the flow of blood.

Lymphatic Circulation
Lymph only carries fluid away from tissues. It does not have a pumping system of its own. Its
circulation depends on the movement of skeletal muscles. As stated previously, muscular
contractions and pressure changes that the thoracic cavity produces during respiration also
assist with lymph circulation.

EFFECTS OF AGING ON THE SYSTEM

In the older adult, hematopoiesis may decline due to a loss of active bone marrow. Alterations in
tissue oxygenation may therefore occur, especially during periods of stress, due to ineffective
RBC production. The number of platelets in older adults may also slightly decrease, although
fibrinogen levels and coagulation factors may increase. WBC production itself typically shows no
real change. However, age related changes in organs of the immune system can result in altered
antigen-antibody responses and increased incidence of infection. Blood volume is reduced in
older adults, due to decreased muscle mass and metabolic rate. The range for albumin also
drops.

II. HEMATOPOIETIC SYSTEM (BLOOD)

The hematopoietic system is dependent on a small pool of Hematopoietic Stem Cells (HSCs),
their surrounding microenvironment, and regulatory molecules (hematopoietic growth factors)
that dictate cell turnover and maturation.

As with nearly all tissues, the hematopoietic system suffers the consequences of aging. Although
hematopoietic stem cells (HSCs) can sustain blood production throughout life, with aging they
undergo dramatic phenotypic and functional changes.

Stem cells are usually characterized by their self-renewal and multi-lineage differentiation
capacity. However, even within the hematopoietic developmental hierarchy, cellular quality and
proliferative potential decrease to a certain degree with age; thus, in HSCs, as in somatic cells.
The hematopoietic system utilizes a variety of homeostatic mechanisms to regulate cell
production and cell death, and thus maintains a normal level of blood cells throughout life. HSCs
sustain blood homeostasis through extensive proliferation and differentiation.

While the balance between stem cell self-renewal and differentiation is tightly regulated to
maintain blood production and sustain the HSC pool, stem cells are subject to exhaustion, both
quantitatively and qualitatively, during the aging process.

HSCs age with repeated proliferation. In Extensive proliferation of HSCs eventually exhausts the
stem cell pool and reduces the quality of HSCs, limiting their self-renewal capacity, regenerative
potential, multi-lineage potential and homing and engraftment potentials

This increases the development of chronic anaemia, immune dysfunction, increased incidence of
myeloproliferative syndromes, and overt chronic and acute myeloid malignancies among the
elderly.

NURSING INTERVENTION
The hematologic and immune systems are affected by aging in multiple ways, which can
increase risk of infection and delay recovery from illness. Total body water decreases with age,
thus reducing blood volume. Bone marrow mass decreases and fat in bone marrow increases, so
functional reserves of bone marrow are reduced with age. Blood disorders such as anemia,
clotting, and bleeding in older adults may also occur at higher rates.

Manage Fatigue. Assisting the patient to prioritize activities and to establish a balance between
activities and rest that is realistic and feasible from the patient's perspective.
Maintaining adequate nutrition. Provide a healthy diet rich in iron, vitamin B12, folic acid, and
protein should be encouraged. Advise the patient to avoid alcoholic beverages.
Maintain adequate perfusion. Lost volume is replaced with transfusions or intravenous (IV)
fluids. Supplemental oxygen may be necessary, but it is rarely needed on a long-term basis
unless there is underlying severe cardiac or pulmonary disease. Monitor the patient's vital signs
and pulse oximeter readings closely
Monitor and Manage Potential complications. Patient with anemia should be assessed for
signs and symptoms of heart failure. A daily record of body weight can be more useful and
accurate than a record of intake and output.

NURSING RESPONSIBILITIES
Supportive nursing actions provide comfort, treatment, and restoration. Help patient cope
more effectively with stress and prevent further health problems. In addition, provide guidance,
encouragement support and relief to enable the person to regain health.
Generative nursing actions innovative and rehabilitative actions. Help the person or family
develop different approaches to coping with stress or crisis and are especially used when
assisting another with struggles involved in roll changes or identity crisis.

Protective nursing actions create measures to promote health and prevent disease. such as
immunizations, health teaching and preventing complications and disease sequelae.

3. GASTROINTESTINAL
The main role of the digestive system is to mechanically and chemically break down food into
simple components that can be absorbed and assimilated by the body. The gut and accessory
organs also play an important role in the elimination of indigestible food components, bile
pigments, toxins and excess salts. The system performs a range of anatomically and
physiologically distinct functions, each of which is affected differently by ageing.

Structure
The GI tract is a hollow muscular tube surrounded by four tissue layers. The lumen, or inner
wall, of the GI tract consists of four layers: mucosa, submucosa, muscularis, and serosa.
 The mucosa, the innermost layer, includes a thin layer of smooth muscle and
specialized exocrine gland cells. It is surrounded by the submucosa, which is made up
of connective tissue.
 The submucosa layer is surrounded by the muscularis.
 The muscularis is composed of both circular and longitudinal smooth muscles, which
work to keep contents moving through the tract.
 The outermost layer, the serosa, is composed of connective tissue.
Although the GI tract is continuous from the mouth to the anus, it is divided into specialized
regions. The mouth, pharynx, esophagus, stomach, and small and large intestines each perform
a specific function. In addition, the secretions of the salivary, gastric, and intestinal glands; liver;
and pancreas empty into the GI tract to aid digestion.

Function
The functions of the GI tract include secretion, digestion, absorption, motility, and elimination.
Food and fluids are ingested, swallowed, and propelled along the lumen of the GI tract to the
anus for elimination. The smooth muscles contract to move food from the mouth to the anus.
Before food can be absorbed, it must be broken down to a liquid, called chyme. Digestion is the
mechanical and chemical process in which complex foodstuffs are broken down into simpler
forms that can be used by the body. During digestion, the stomach secretes hydrochloric acid,
the liver secretes bile, and digestive enzymes are released from accessory organs, aiding in food
breakdown. After the digestive process is complete, absorption takes place. Absorption is
carried out as the nutrients produced by digestion move from the lumen of the GI tract into the
body’s circulatory system for uptake by individual cells.

GASTROINTESTINAL CHANGES ASSOCIATED WITH AGING

Physiologic changes occur as people age, especially ages 65 years and older. Changes in
digestion and elimination that can affect nutrition are common. As individuals age, the smooth
muscle activity and absorption may change in the gastrointestinal system. This may result in
more issues with constipation, appetite, and nutritional imbalances. Other changes with aging
include:
 Decreased saliva production
 Desynchronization of contraction and relaxation of smooth muscle and sphincter
control, making deglutition less effective
 Altered protein metabolism and nutrient absorption
 Prolonged transit time
 Atrophy of gastrointestinal mucosa
 Decreased strength of colonic muscle
 Decrease in liver and pancreas size

Ageing can have drastic effects on the functions of the digestive system. One of these is reduced
appetite due to changes in hormone production and an alteration in smell and taste.
Physiological changes in pharyngeal skills and oesophageal motility may lead to dysphagia and
reflux. In the intestines, several factors contribute to changes in the regular gut microbial fauna,
making older people more prone to bloating, pain and bacterial infection.

THE ‘ANOREXIA OF AGEING’

Food intake diminishes with age due to a range of complex reasons that lead to reduced
appetite. These include physiological changes and changes in psychosocial and pharmacological
circumstances.

Appetite is controlled mainly by sensors in the gastrointestinal tract, which detect the physical
presence of food and prompt the GI tract to produce a range of hormones. These are released
before, during and after eating, and control eating behaviours, including the amount consumed.
They include: 
 Ghrelin;
 Peptide tyrosine tyrosine (PYY); 
 Cholecystokinin (CCK);
 Insulin;
 Leptin (Pilgrim et al, 2015). 

NURSING RESPONSIBILITIES
Prevent malnutrition although aging is not inevitably accompanied by malnutrition, many
changes due to aging can promote this serious condition.
Proper nutrition
Maintenance of regular bowel
Encourage the patient to avoid smoking and drinking alcohol
Oral Hygiene (fitting dentures and professional dental care)
REFERENCES
VanPutte, C., et. al. (2019). Essentials of Anatomy & Physiology, 10e.
New York: McGraw-Hill Education.

Mauk, Kirsten. (2014). Advantage Access for Gerontological Nursing.

United States of America: Jones & Bartlett Learning.

Halter, B., et. al. (2017). Hazzard's Geriatric Medicine and Gerontology, 7e.
United States of America: Jones & Bartlett Learning.

Khudhair, A. (2020). Nursing Management for Patients with Blood Disorders.

https://www.researchgate.net/publication/339031608_Nursing_Management_for_Patients_wit
h_Blood_Disorders

Ignatavicius, D. Assessment of the Gastrointestinal System.

https://nursekey.com/assessment-of-the-gastrointestinal-system/