NR 601 Midterm Exam Study Guide on Age-Related Changes, Exams of Nursing

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NR 601 Midterm Exam Study Guide

Developmental Changes

• Replicative senescence: theory states that cells can

replicate or divide a specific number of times.

o This ability decreases with age

• Oxidative damage: Is the cumulative result of the

aerobic metabolism, which generates chemicals called

free radicals

o Free radicals may interact with other chemicals in the body

and cause damage to cells

• Telomere shortening theory that links aging to a reduction in cell

division

• Weakening of the immune response: Leaves older adults

more vulnerable to infection and debilitating diseases

Dunphy physiological p.

Age- Relate d Chang

e

Appearance or

Functional Change

Implic

ation

Integumentary System Loss of dermal and epidermal thickness

Loss of SQ tissue and thin epidermis

Prone to skin breakdown and injury

Decreased vascularity •^ Atrophy^ of^ sweat

glands resulting in

decreased sweat

production

• Decreased body odor
• Decreased heat loss
• Dryness
  • Alteration in thermoregulatory response
  • Fluid

requirements

may change

seasonally

• Loss of skin water
• Increased risk of heat stroke Respiratory System Decreased lung tissue elasticity

Decreased vital capacity Reduced overall efficiency of ventilatory exchange Cilia atrophy Change in mucociliary transport

Increased susceptibility to infection

Decreased

respiratory

muscle

strength

• Reduced ability to

handle secretions and

reduced effectiveness

against noxious

foreign particles

• Partial inflation of lungs at rest

Increased risk of atelectasis

Laxity of skin

Loss of dermal and epidermal thickness Paper-thin skin Prone to skin tears

Integumentary System

Age-Related Change Appearance or Functional Change Implication

Kennedy physiological

Flattening of papillae

Shearing and friction force more readily peels off the dermis

Diminished cell-

mediated immunity

in the skin

Prone to skin breakdown and injury

Atrophy of the sebaceous glands

Decreased production of oil and cerumen

Frequent pruritus and xerosis

Atrophy of the sebaceous glands

Decreased sweating ability

Impaired thermoregulation

Decreased vascularity

Slower recruitment of sweat glands by thermal stimulation

Alteration in thermoregularity response;

diminished ability to

adapt to

temperature

changes

Fluid

requirements

may change

seasonally

Decreased body odor

Decrease

d heat

loss

Dryness

Loss of skin water

Increased risk of

heat stroke

Collagen cross- linking

Increased wrinkling Potential effect

on one’s morale

and feeling of

self-worth

Elastic regression

Loss of SQ fat Intraosseous atrophy, especially on the back of hands and to the face

Loss of fat tissue on soles of feet – trauma of walking increases foot problems

Decreased elasticity Difficulty assessing skin

turgor

Loss of SQ tissue Purpuric patches after minor surgery

Reduced insulation against cold temperatures; prone to hypothermia

Check why injury is

occurring; be alert

for potential abuse

or falls

Decreased # of melanocytes

Loss of pigment Teach^ the importance of using sun block

creams; refer to

a dermatologist

as needed

Pigment plaque appears

Decreased turnover

rate of keratinocytes

Increased exposure of the epidermal cells

to the

environment to

include UV

radiation

Increased risk of nonmalignant skin cancers and malignant melanoma

Decline in fibroblast proliferation Decreased epidermal growth rate Decreased tissue repair response

Slower re-epithelialization

Decreased vitamin D production and synthesis

Increased risk for developing

osteoporosis and

other conditions

associated with

vitamin D

deficiency

Decreased hair follicle density Loss of body hair

Decreased growth phase of individual fibers

Thin, short villus hairs predominate

Slower hair growth

Loss of melanocytes from the hair bulb Graying of the hair

Potential effect on self-esteem

Alternating hyperplasia and hypoplasia of

Longitudinal ridges Nails prone to splitting

nail matrix (^) Thinner nails of the fingers

Advise patient to wear gloves, keep nails

short, and avoid

nail polish

remover (causes

dryness); refer

patient to

podiatrist

Thickened, curled

toenails or claw-

like nails known as

onychogryphosis

May cause discomfort

Respiratory System

Decreased maximum breath capacity

Dental enamel thins

Gums recede

Staining of tooth surface occurs

Teeth deprived of nutrients

Tooth and gum decay; tooth loss

Thoracic wall calcification

Increased

anteroposterior

diameter of chest

Obscuration of heart and lung sounds

Displacement of apical impulse

Cilia atrophy Change in

mucociliary

transport; mucus-

producing cells

increase

Increased susceptibility to infection

Decreased respiratory muscle strength

Reduced ability to handle secretions and

reduced

effectiveness

against noxious

foreign particles

Partial inflation of

lungs at rest

Prone to atelectasis

Less sensitivity to

hypoxia; impaired

ability to recognize

bronchoconstriction

Increased respiratory distress Increased risk of

mortality from

acute respiratory

conditions

Cardiovascular System Heart valves fibrose and thicken Reduced^ stroke

volume; cardiac

output may be

altered

Decreased responsiveness to stress; heart rate and BP take longer to return to normal resting rate following exertion

Slight left ventricular hypertrophy

Increased incidence of murmurs, particularly aortic stenosis and mitral regurgitation

Mucoid degeneration of mitral valve

S4 sound commonly heard

Valve less dense;

mitral leaflet

stretches with

intrathoracic

pressure

Fibroelastic thickening of the SA node; decreased # of pacemaker cells

Slower HR Increased prevalence of arrhythmias and extra heart beats become more common Irregular HR Increased sub pericardial fat

Collagen

accumulation

around heart

muscle

Elongation of

tortuosity and

calcification of

arteries

Increased rigidity of arterial wall

Aneurysms may form

Elastin and collagen

cause progressive

thickening and loss

of arterial wall

resiliency

Increased peripheral vascular resistance

Decreased blood flow to body organs

Altered distribution

of blood flow

Loss of elasticity of

the aorta dilation

Increased systolic

BP, contributing

to CAD

Increased lipid

content in artery

wall

Lipid deposits form (^) Increased incidence of atherosclerotic events such as angina pectoris, stroke, gangrene

Increased

baroreceptor

sensitivity (stretch

receptors)

Decreased sensitivity to change in BP

Prone to loss of

balance—

potential for falls

Decreased baroreceptor mediation to straining

Valsalva maneuver may cause sudden

drop in BP,

orthostatic

hypotension, and

dizziness when the

patient changes

from a lying or

sitting position to

standing

Gastrointestinal System

Liver becomes

smaller

Decreased storage capacity; decreased efficiency in metabolizing drugs that pass through the liver

Less efficient

cholesterol

stabilization

absorption

Increased evidence of gallstones

Atrophy of muscles

and bones of the jaw

Difficulty with mastication

Ability to thoroughly chew food is impaired and can contribute to dysphagia with solid foods

Fibrosis and atrophy Prone to dry mucous Shift^ to^ mouth

Histological changes in small vessel wallsDecreased renal blood flow Sclerosis of supportive circulatory system

Decreased muscle mass Decreased muscle strength Increased muscle cramping

May interfere with

breakdown of

starches

Atrophy and decrease in # of taste buds

Decreased taste sensation

Altered ability to taste sweet, sour, and bitter

Change in

nutritional

intake

Excessive

seasoning of

foods

Delay in esophageal emptying

Decline in esophageal peristalsis Occasional discomfort as food stays in esophagus longer Stiffening of the esophageal wall Decreased hydrochloric acid secretion Reduced in amount of iron and vitamin Possible delay in vitamin and drug B12 that can be absorbedabsorption, especially calcium and iron

Decrease in gastric acid secretion Altered drug effect

fewer cases of

gastric ulcers

Decreased muscle tone

Altered motility Prone^ to constipation, functional bowel syndrome, esophageal spasm, diverticular disease

Decreased colonic peristalsis

Atrophy of mucosal lining

Decreased

hunger

sensations and

emptying time

Decreased

proportion of dietary

calcium absorbed

Altered bone

formation, muscle

contractility,

hormone activity,

enzyme activation, clotting time, immune response

Symptoms more

marked in women

then in men

Decreased basal metabolic rate (rate at which fuel is converted into

May need fewer calories

Possible effect on

energy) life span

Genitourinary and Reproductive Systems Reduced renal mass Decreased sodium-conserving ability Administration and dosage of drugs may need to be modified

Loss of glomeruli Decreased GFR

Decreased

creatinine

clearance

Increased BUN

concentration

Decline in # of functioning nephrons Decreased ability to dilute urine Altered response to reduced fluid load or concentrate increased fluid volume Reduced bladder muscular tone Decreased bladder capacity or increased Sensation of urge to urinate may not residual urine occur until bladder is full

Atrophy of fibrosis of cervical and uterine Menopause;

decline in fertility Urination at night may increase walls

Reduced # and viability of oocytes

in the Narrowing of

cervical canal aging ovary

Decreased vaginal wall elasticity

Vaginal lining thin, pale, friable

Narrowing of vaginal

canal

Potential for discomfort in sexual intercourse

Decreased level of circulating hormones Reduced lubrication during arousal state Increased frequency of sexual dysfunction

Degeneration of seminiferous tubules

Decreased seminal fluid volume

Decreased

force of

ejaculation

Reduced

elevation of

testes

Proliferation of

stromal and

glandular tissue

Prostatic hypertrophy

Potentially compromised genitourinary function; urinary frequency and increased risk of malignancy Involution of mammary gland tissue Connective tissue replaced by adipose Easier to assess breast lesions tissue Neuromuscular System

Ciliary muscle atrophy Altered refractive

powers Corrective lens often required

Nuclear sclerosis (lens) Presbyopia Near

work and reading

may become

difficult

Reduced accommodation Hyperopia Increased lens size Myopia Accumulation of lens fibers

Lens yellows Color vision may be impaired Less able

to differentiate low

color tones: blue,

greens, violets

Diminished tear secretion

Dullness and dryness of the eyes

Irritation and discomfort may result

Intactness of corneal surface jeopardized

Neurofibrillary tangles in hippocampal neurons

Heavy tangle formation and neuritic plaques in cortex of patients with Alzheimer’s disease

Changes in sleep-wake cycle Decreased stage 4, stage 3, and rapid Increased or decreased time spent eye movement phases sleeping

Deterioration of circadian organization

Increased nighttime awakenings

Changed hormonal activity Slower stimulus identification and Delayed reaction time Prone to falls registration Decreased brain weight and volume May be present in absence of mental impairments

Sensory System

Morphological changes in choroid, Decreased visual acuity Corrective lenses required epithelium, retina (^) Visual field narrows Increased possibility of disorientation and social isolation Decreased rod and cone function Slower light and dark adaption Pigment accumulation Decreased speed of eye movements Difficulty in gazing upward and maintaining convergence Sclerosis of pupil sphincter Difficulty^ in^ adapting^ to^ lighting^ changes^ Glare^ may^ pose^ an environmental hazard Increased threshold for light perception Dark rooms may be hazardous Increased intraocular pressure Increased incidence of glaucoma Distorted depth perception Incorrect assessment of height of curbs and steps; potential for falls

Loss of auditory

neurons

Decreased tone

discrimination and

voice localization

Suspiciousness may

be increased

because of

paranoid

dimensions secondary to hearing loss High frequency sounds lost first

Social isolation

Angiosclerosis

calcification of

inner ear

membrane

Progressive

hearing loss,

especially at high

frequency

Presbycusis

Difficulty hearing, particularly under

certain conditions

such as

background nose,

rapid speech, poor

acoustics

Decreased # of

olfactory nerve

fibers

Decreased

sensitivity to odors

May not detect

harmful odors

Potential safety hazard

Alteration in taste

sensation

Possible changes in food preferences and eating patterns

Reduced tactile

sensation

Decreased ability to sense pressure, pain, temperature

Misperceptions of environment and safety risk

Endocrine system

Decline in secretion

of testosterone,

growth hormone,

insulin, adrenal

androgens,

aldosterone, thyroid

hormone

Decreased hormone

clearance rates

Increased mortality

associated with

certain stresses

(burns, surgery); increased prevalence of hormonal disease

Defects in

thermoregulation

Shivering less

intense

Susceptibility to temperature extremes (hypothermia/hypert hermia)

Reduction of febrile

responses

Poor perceptions of

changes in ambient

temperature

Reduced sweating;

increased

threshold for the

onset of sweating

Unrecognized

infectious

process

operative

Increased prevalence of

autoimmune disorders

Changes in serum immunoglobulin

Increased immunoglobulin A levels

Decreased

immunoglobulin G

levels

Increased prevalence of infection

Lab results- Dunphy Table 77.

Lab Test

Normal Values

Changes with Age

Comments

Urinalysis

Protein 0-5mg/100 mL Rises slightly

May be due to kidney changes with age, UTI, renal pathology

Specific

gravity

Lower maximum in elderly 1.016-1.

Decline in nephrons impairs ability to concentrate urine

Hematology

Erythroc yte sedim entatio n rate

Men: 0- Women: 0-

Significant increase

Neither sensitive nor specific in aged

Iron binding

50-60 mcg/dL 230-410 mcg/dL Slight

decrea

se

Decrea

se

Hemogl obin

Men: 13-18 g/ mL

Women: 12-

g/100 mL

Men: 10- g/mL

Women:

none noted

Anemia common in the elderly

Hemato crit

Men: 45-52% Women: 37-48% Slight

decrea

se

specul

ated

Decline in hematopoiesis

Leukocy tes

mm^

Drop to 3,100-9, mm^

Decrease may be due to drugs or sepsis and should not be attributed immediately to age

Lympho cytes

500-2,400 T

cells/mm^ 50-200 B cells/mm^

T-cell and B- cell levels fall

Infection risk

higher;

immunization

encouraged

Platelets 150,000-350,00 mm^3 No change in #

Blood Chemistry

Albumin 3.5-5.0/100 mL Decline R/T decrease in liver size and enzymes; protein-energy malnutrition common

Globulin 2.3-3.5 g/100 mL Slight increase

Total serum protein

6.0-8.4 g/100 mL No change Decreases may indicate malnutrition, infection, liver disease Blood urea

Men: 10- mg/100 mL

Increases significantly

Decline in glomerular filtration

Atypical Disease Presentations

• Erroneously associated aging with disease, disuse,

and disability, older adults perceive this change as

inevitable and either fail to present to their provider or,

if they do, fail to challenge the assumption that this

represents normal aging. At times an acute symptom

such as pain or dyspnea is superimposed on a chronic

symptom, and the older adult may not recognize that

it represents a new or exacerbated pathology.

Illness Atypical Presentations

Acute abdomen

• Absence of symptoms or vague symptoms
• Acute confusion
• Mild discomfort and constipation
• Some tachypnea and possibly vague respiratory

symptoms

• Appendicitis pain may begin in RLQ and become

diffuse

Depressio n

• Anorexia, vague abdominal complaints, new

onset of constipation, insomnia,

hyperactivity, lack of sadness

Hyperthyr oidism

• Presenting as ―apathetic thyrotoxicosis‖ i.e.,

fatigue and weakness; weight loss may result

instead of weight gain; patients report

palpitations, tachycardia, new

onset of a-fib, and HF may occur with

undiagnosed hyperthyroidism

Hypothyro idism

• Confusion and agitation
• New onset of anorexia, weight loss, and

arthralgias may occur

Malignanc y

• New or worsening back pain secondary to

metastases from slow growing breast masses

• Silent masses of the bowel

Myocardial

Infarction

(MI)

• Absence of chest pain
• Vague symptoms

o Fatigue, nausea, and a decrease in function

and cognitive status

o Classic presentations: dyspnea,

epigastric discomfort, weakness,

vomiting, history of previous cardiac

failure

• Higher prevalence in females vs males: Non-Q-

wave MI

Over

all

infect

ious

disea

ses

proc

ess

• Sepsis w/o usual leukocytosis and fever
• Falls
• Anorexia
• New onset of confusion and/or alteration in change in mental status
• Decrease in usual functional status

Peptic

ulcer

diseas

e

• Absence of abdominal pain, dyspepsia, early satiety
• Painless, bloodless
• New onset of confusion, unexplained
• Tachycardia, and/or hypotension

Pneumoni

a

• Absence of fever
• Mild coughing w/o copious sputum, especially in

dehydrated patients

• Tachycardia and tachypnea
• Anorexia and malaise common
• Alteration in cognition

Pulmo

nary

edem

a

• Lack of paroxysmal nocturnal dyspnea or coughing
• Insidious onset with changes in function, food or fluid intake
• Confusion

Tuberculo

sis

• Hepatosplenomegaly, abnormalities in liver function tests, and anemia

Urinary

Tract

• Absence of fever