NURSING SKILLS RELATED TO PHYSIOLOGICAL CHANGES IN THE ELDERLY

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NURSING SKILLS RELATED TO PHYSIOLOGICAL CHANGES
IN THE ELDERLY

• Susan Hench, RN, MSN
• Assistant Professor of Nursing
• N102

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(No Transcript)
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Pharmacokinetics

• Absorption
• Age-related changes
• Decreased intracellular fluid, increased gastric
  ph, decreased cardiac function and circulation,
  slower metabolism, slower drug absorption
• Route of administration
• Concentration and solubility of drug
• Diseases and symptoms
• Diabetes and hypokalemia cause faster absorption
  while edema and pain slow absorption

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Pharmacokinetics

• IM, SQ, PO and PR (less moisture in the rectum
  and the vagina prolong the melting time of
  suppositories) not absorbed as well as inhaled,
  topical or IV (monitor for fluid/ circulatory
  overload when giving IV meds and fluid)
• Drugs that are highly soluble are absorbed
  quickly

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Pharmacokinetics

• Distribution
• Changes in circulation, body temperature, tissue
  structure and cell membrane permeability affect
  distribution
• Adipose tissue increases as compared to lean body
  mass
• If several drugs are taken together that compete
  for binding sites, distribution will be slowed

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Pharmacokinetics

• Reduced serum albumin levels affect drug
  effectiveness
• Decreased cardiac output reduces circulation time
  of medications
• Be sure to monitor blood levels of medication
  frequently-toxicity happens quickly in
  dehydration and hypoalbuminemia

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Pharmacokinetics

• Metabolism, Detoxification, And Excretion
• Renal system primarily responsible
• Nephron units are decreased in number and may not
  function well
• Decrease in blood flow to the kidneys

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Pharmacokinetics

• Liver also has detoxification and excretion
  functions
• Liver decreases in size and function with age,
  hepatic blood flow decreases
• Liver removes less poisonous nitrogen
• Forms less bile, secretes less enzymes that are
  responsible for detoxification of meds

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• WHAT NURSES CAN DO
• Encourage exercise to stimulate circulation
• Prevent hypothermia and fluid volume deficit
• Monitor drug-drug (Rx, OTC and herbal) and
  drug-food interactions
• Consider the most effective route for the drug

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Pharmacodynamics In Older Persons

• Biologic and therapeutic effects of drugs at the
  site of action or on the target organ
• High risk of adverse reactions in the elderly
• Nurses should make sure that drug-induced
  cognitive and behavioral changes are not treated
  with additional drugs
• Any symptom in an older adult should be suspected
  as being related to a drug interaction or adverse
  reaction until proven otherwise

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• The elderly person sometimes forgets to tell the
  doctor about other medications he or she is
  taking
• Really need a good history-ask questions about
  medication they take for constipation, GI upset,
  coughing, if they get a cold, do they take any
  vitamins, etc.

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• Polypharmacy and drug misuse among the elderly
  can be a significant medical problem that can go
  unrecognized

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Measures To Improve Safety

• Pill boxes
• Pre-pour meds
• Charts
• Check off lists
• Maintain accurate drug history

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Measures To Improve Safety

• Teach in terms the older person can understand
• Have them write out questions for pharmacist or
  doctor
• Make list with all meds-Rx and OTC
• Include adverse reactions or allergies on list
• Emphasize no sharing of meds

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Measures To Improve Safety

• Make sure it is clear to you and to the patient
  why the drug was ordered or why they are taking
  it, is there any other nondrug therapy that would
  work?
• Are they taking the smallest possible dose?

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Measures To Improve Safety

• Are they following any special instructions that
  may come with the drug, eg-on an empty stomach,
  at a certain time of day, not with other meds,
  etc.
• Is the most effective route being used?
• Is the best form being used? Are pills being
  crushed that should not be?

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• Discontinuing Medications
• The older adult is extremely sensitive to drugs
• Drugs should always be withdrawn slowly or weaned
• Stopping or decreasing a medication suddenly may
  cause rebound symptoms

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• Factors That Affect The Discontinuation Of Drugs
• Type of drug
• Reason given
• Dosage
• Length of time person has been taking the drug

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Nursing Implications

• Certain drugs can cause serious rebound symptoms
  when withdrawn or stopped abruptly
• All patients and caregivers should understand
  their medication regimen
• Stress to never increase or decrease a medication
  dose or stop taking a medication without
  consulting their physician

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Integumentary System

• The external and visible sign of aging lines,
  wrinkles, gray hair
• The system most of us use to guess someones
  age
• Heredity and genetics play a role in skin aging
• Exposure to sunlight is the single most important
  factor in age-related skin changes

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Integumentary System

• Lines, wrinkles
• Thicker nails
• Graying hair
• Solar elastosis or photoaging-loss of elasticity
  and wrinkling of the skin from sun exposure-fair
  skinned persons more prone

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Integumentary System

• Nurses need to regularly assess patients skin
  status
• Astute attention to skin status is critical to
  prevent serious problems
• Skin is the first line of defense against
  infection

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Integumentary System

• SKIN CHANGES
• Wrinkles
• A result of the redistribution of subcutaneous
  fat and collagen changes
• Collagen is responsible for giving strength and
  elasticity to the skin
• Cartilage keeps growing in the nose and ears
  causing lengthening and broadening

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Integumentary System

• SKIN CHANGES
• Dryness
• Sebaceous glands decrease in their secretion of
  sebum
• Dryness leads to pruritis, open areas
• Leads to increased risk of breakdown, slower
  healing, and infection

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Integumentary System

• SKIN CHANGES
• Pigmentation
• Melanocytes cluster causing age spots
• Less melanocytes (or melanin) which leads to a
  pale skin appearance
• Skin appears thin and translucent

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Integumentary System

• Subcutaneous fat is lost
• Cold intolerance increases
• Skin sags
• Benign growths such as skin tags or nevi
• Heat intolerance due to fewer sweat glands and
  decreased perspiration
• Increased heat stroke susceptibility

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Integumentary System

• SKIN CHANGES
• Pruritis - itching
• Keratosis rough, raised, yellowish patches
• Seborrheic Keratosis
• Actinic Keratosis
• Malignant Melanoma - cancer
• A,B,C,Ds - asymmetry, border, color, diameter

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SCABS FROM PRURITIS Severe itching
Ear w/ ACTINIC KERATOSIS
SEBORRHEIC KERATOSIS-SINGLE AND MULTIPLE
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AGE SPOT ON CHEEK
MALIGNANT MELANOMA
SEBORRHEIC KERATOSIS VS SQUAMOUS CELL CARCINOMA
LENTIGOMELANOMA ON HEAD
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Integumentary System

• NAIL CHANGES
• Related to decreased vascular supply and
  nutritional changes
• Grow more slowly
• Thick, hard and brittle
• Become yellow and have ridges

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Integumentary System

• HAIR CHANGES
• Graying from loss of melanin in the hair
• Thins on scalp, legs, axilla, and pubic region
• Nose and ear hair gets thicker
• Women may get facial hair

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Integumentary System

• NURSING IMPLICATIONS IN SKIN CARE
• Promote activity to increase circulation
• May need humidified air along with adequate
  hydration
• Maintain good nutrition
• Avoid over use of soap
• Add emollients to bath water
• Avoid skin irritants and rough clothing
• Use lotions, creams, and oils

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Integumentary System

• NURSING IMPLICATIONS IN SKIN CARE
• Daily baths are not always necessary
• Every 3 to 4 days for average older person
• Excessive bathing may be hazardous to the skin
• Pay early attention to skin irritations and
  abnormalities
• Employ good nursing techniques to prevent
  pressure ulcers

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Integumentary System

• NURSING IMPLICATIONS FOR HAIR CARE
• Shampoo hair less frequently
• Combing the hair distributes the oils and
  stimulates the scalp
• NURSING IMPLICATIONS FOR NAIL CARE
• Soak feet and hands
• Cut nail straight across
• Filing nails is best

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NOTE!!!!

• Do not cut diabetics nails-should be seen by a
  podiatrist
• Persons on Coumadin and other blood thinners
  should file nails

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Integumentary System

• NURSING DIAGNOSES
• Impaired skin integrity or risk for impaired skin
  integrity
• Deficient knowledge
• Bathing/hygiene self-care deficit
• Others related to incontinence, mobility,
  nutrition

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Respiratory System
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Respiratory System

• Respiratory health is vital to the elderly
  persons ability to maintain a physically,
  mentally, and socially active lifestyle

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Respiratory System

• MAIN PROBLEM IS DIMINISHED OXYGENATION
• Lifetime of insult
• Insult from smoking, pollution, and infection
  takes its toll in old age
• Respiratory disease is leading cause of
  disability

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Respiratory System

• AGING FACTORS
• Rib cage becomes more rigid, costal cartilage
  calcifies and is not as flexible so breaths are
  more shallow
• More use of the diaphragm and abdominal breathing
• Osteoporosis and kyphosis create a stooped
  posture which leads to a decreased ability to
  expand chest

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Respiratory System

• Abdominal muscles lose tone and weaken
• Reduction in body fluid and reduced fluid intake
  can cause drier mucus membranes making the
  removal of mucus more difficult and may lead to
  the development of mucus plugs and infection

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Respiratory System

• AGING CHANGES
• Lung tissue loses elasticity
• Decrease in the total number of aveoli decrease
  in lung capacity
• Development of a barrel chest

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Respiratory System

• Decreases in residual volume, vital capacity and
  total lung capacity
• Leads to faster SOA with increasing activity
• The alveoli also enlarge (more so with COPD) thus
  creating less alveolar surface for gas exchange
• Arteriosclerotic changes lead to decreases in
  circulation through the lungs as well

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Respiratory System

• AGING CHANGES
• Diminished cough R/T rigidity of thoracic wall
  and decreased strength of the expiratory muscles
• Decreased ciliary action of the bronchial lining
• Clearing of the bronchi decreases (happens in
  younger persons during sleep)
• Secretions are retained

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Respiratory System

• Elderly more predisposed to pneumonia and
  emphysema
• The most important risk factor for pneumonia is
  aspiration
• Pneumonia also can be due to retained secretions
• Emphysema due to the lung and alveoli changes
  characterized by over distended alveolar sacs

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Respiratory System
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Respiratory System

• NURSING IMPLICATIONS
• Encourage coughing and deep breathing
• Encourage and promote exercise to increase lung
  expansion
• Encourage adequate hydration

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Respiratory System

• Remember respiration will normally increase with
  activity but an increase in respirations not
  related to activity or too large for the amount
  of exercise may indicate an infection
• Exercise can be ambulation, getting in and out of
  bed, sitting up, dangling, changing position in
  bed
• Hydration will help thin secretions and will make
  them easier to cough up

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Respiratory System

• NURSING IMPLICATIONS
• May need to administer oxygen
• Be diligent after surgery because the elderly can
  develop atelectasis and pneumonia rapidly

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Respiratory System

• NURSING DIAGNOSES
• Ineffective airway clearance
• Risk for aspiration
• Ineffective breathing pattern
• Impaired gas exchange
• Activity intolerance

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Digestive System
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Digestive System

• GI tract includes mouth, pharynx, esophagus,
  stomach, and small and large intestine
• Continuous tube of mucosa about 4.5 m or 15 feet
  in length from mouth to anus
• Nonsterile, external area

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Digestive System

• AGING CHANGES-ORAL
• Decreased Chewing Abilities
• By age 65 2/3 of all people in the us have lost
  most of their teeth
• Elderly need regular dental care
• Often neglected due to lack of money or insurance

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Digestive System

• AGING CHANGES-ORAL
• Enamel thins with age
• Teeth may darken
• Dentures may be needed
• Watch the fit poor fit causes difficulty eating
  and possible weight loss

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Digestive System

• AGING CHANGES-ORAL
• Decreased saliva production
• May be complicated by medications
• Decreased muscular strength for chewing
• Decrease in number of taste buds
• Decrease in appetite
• Leading to poorer nutrition seen as a decreased
  serum albumin

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Digestive System

• NURSING IMPLICATIONS-ORAL
• Promote good oral hygiene
• Assist with referral to dentists for care and
  dentures
• Assess denture fit
• Educate patients about care for dry mouth
• Encourage use of spices
• Creative meal planning

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Digestive System

• Offer am, after meals, and hs
• Clean dentures at least one time per day
• Use soft tooth brush
• May need special adaptive tooth brushes for
  arthritic hands,
• Social service, different agencies that can help
  pay

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Digestive System

• Sugarless gum, sugarless hard candy, artificial
  saliva
• Smaller portions, more frequent feedings,
  attractive presentation
• Consider the environment-eating alone, cooking
  for one
• Nurses must be inventive to assist the elderly in
  good nutrition

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Digestive System

• AGING CHANGES-DIGESTION
• HYPOCHLORHYDIA
• Decrease in HCl secretion in the stomach slower
  digestive process
• Less ability to break down protein and absorb it
• Less ability to stop bacterial growth
• Less support for other digestive enzymes
• Causes increased flatus and episodes of diarrhea

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Digestive System

• AGING CHANGES-DIGESTION
• Stomach atrophy shrinks in size and feels full
  more quickly
• Decrease in bile production and gallbladder
  function
• Predisposed to gall stones and fatty intolerance
• Decreased peristalsis
• Leads to constipation and hemorrhoids
• Decrease in villi in small intestine
• Leads to decreased absorption of nutrients,
  vitamins and minerals

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Digestive System

• NURSING IMPLICATIONS-DIGESTION
• Encourage small, frequent meals
• Encourage adequate fluid intake
• Increase fiber and roughage
• Use meal supplements
• Make meals appealing and fun make it a social
  time, it is more enjoyable to eat meals with
  others

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Digestive System

• AGING CHANGES-OTHER
• Decreased brain response for thirst sensation
  elderly do not feel thirsty, leads to dehydration
• Dysphagia difficulty swallowing
• Elimination
• Constipation, diarrhea
• Fecal incontinence less sphincter control

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Digestive System

• NURSING IMPLICATIONS
• Activity as tolerated
• Adequate hydration
• Fiber in diet
• Assess medications
• Use laxatives with caution
• Provide privacy
• Toileting schedule
• Assess normal bowel pattern

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Digestive System

• Nursing Interventions
• Monitor bowel sounds
• Increased bowel sounds may indicate diarrhea or
  early intestinal obstruction, decreased bs may
  indicate bowel obstruction, peritonitis
• Ask about bowel movements
• If the patient says that he is constipated or has
  diarrhea ask him what that means to him. If hes
  constipated, assess the meds he is taking to see
  if one of them might be the culprit

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Digestive System

• Nursing Interventions
• Encourage proper diet
• High-fiber and plenty of noncaffeinated,
  nonalcoholic fluids, unless contraindicated
• Encourage activity
• Especially ambulation, may need physical therapy
  consult

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Digestive System

• Nursing Interventions
• Monitor fluids, electrolytes, and liver function
  closely
• Watch for s/s of ventral hernia
• Ventral hernia localized bulge in the abdominal
  wall. Notify MD.
• Monitor serum albumin
• Decreasing levels indicate declining nutrition

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Digestive System

• NURSING DIAGNOSES
• Risk for aspiration
• Bowel incontinence
• Constipation
• Impaired dentition
• Diarrhea
• Failure to thrive
• Fluid volume
• Nutrition

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Musculoskeletal System

• AGING CHANGES
• Loss of bone minerals and mass skeletal
  structure becomes brittle and weak
• Vertebrae less firm
• Vertebral column compresses and there is a loss
  of height

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Musculoskeletal System

• AGING CHANGES
• Muscle atrophy
• Decrease in isometric strength
• Muscles do not regenerate- replaced with fibrous
  tissue
• Decline in muscle mass decline in strength

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Musculoskeletal System

• Muscle wasting occurs secondary to actual
  decrease in the number of muscle fibers, the
  diameter of the muscle fiber also decreases
• More noticeable in the arms and legs
• Back and hand grip muscles retain much of their
  strength
• Fibrous tissue causes muscles to feel stiff

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Musculoskeletal System

• AGING CHANGES
• Body fat is redistributed
• Women into the chest, waist, hips and thighs
• Men into the chest and lower abdomen
• Lean body mass decreases

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Musculoskeletal System

• Movement is more sluggish
• Prolonged contraction
• Prolonged recovery time
• Prolonged muscle action results in decreased
  spontaneous movement, decreased facial
  expressions, infrequent blinking, loss of balance
  and shuffling gait

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Musculoskeletal System

• Osteoporosis
• Demineralization of bone mass r/t Ca loss
• Especially affects trabecular bone in the spine
  (compression fx) and cortical bone in the long
  bones (hip and femur fx)

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Musculoskeletal System

• AGING CHANGES
• Osteoporosis
• Postural changes
• Loss of height 2 or more
• Also from narrowing of intervertebral discs
• Increased risk of fractures
• White females with small frames are more prone to
  osteoporosis

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Musculoskeletal System

• AGING CHANGES
• Feet change flatten and may get smaller
• Changes in nose and ears get larger
• Shoulders narrow and pelvis widens causing a more
  pear-like shape
• Stooped posture thoracic kyphosis
• Extremities appear longer

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Musculoskeletal System

• Osteoarthritis
• Most common form of arthritis in the elderly
• Cartilage thins and the weight bearing joints are
  most affected

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Musculoskeletal System

• AGING CHANGES
• Joint degeneration
• Pain and stiffness

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Musculoskeletal System

• NURSING IMPLICATIONS
• Mobility assessment gait, posture, strength,
  ROM, condition of joints, balance, coordination,
  cognitive ability
• Encourage activity as tolerated
• Encourage position changes
• ROM exercises
• Safety fall prevention

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Musculoskeletal System

• NURSING DIAGNOSES
• Impaired comfort
• Risk for falls
• Fatigue
• Risk for injury
• Impaired physical mobility
• Chronic pain
• Impaired walking

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Circulatory System
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Circulatory System

• AGING CHANGES-HEART
• Significant changes to heart do not normally
  occur with age
• Heart disease is what causes changes
• Heart size normally remains unchanged
• Cardiac output does decrease normally pumping
  becomes less effective

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Circulatory System

• AGING CHANGES-HEART
• Diseases
• CHF
• Weigh daily
• Cardiomyopathy
• Dysrhythmias
• Conduction issues
• Cardiac Meds
• S/E of bradycardia and orthostatic hypotension
  more often in the elderly

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Circulatory System

• AGING CHANGES-BLOOD VESSELS
• Loss of elasticity
• Thickening of walls
• Plaque build up - atherosclerosis
• Prevalence of hypertension
• Orthostatic hypotension
• Valves in veins do not work well and blood pools
  in lower extremities causing edema

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Circulatory System

• Hypertension is most common disease in elderly
• Orthostatic hypotension is also common in the
  elderly as blood pressure does not adjust as
  quickly with position changes
• Slightly lower H H is normal in the elderly

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Circulatory System

• AGING CHANGES
• Fatigue
• Feeling cold due to decreased circulation
• Decrease in bone marrow leading to a decrease in
  red blood cell production low HH anemia

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Circulatory System

• NURSING IMPLICATIONS
• Patient education meds
• When to call health care provider
• Use of hot and cold
• Activity
• Special diets, fiber, and hydration
• Monitor vital signs
• Compression stockings
• Quit smoking

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Circulatory System

• NURSING DIAGNOSES
• Activity intolerance
• Decreased cardiac output
• Fatigue
• Excess fluid volume
• Deficient knowledge
• Risk for peripheral neurovascular dysfunction

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Genitourinary System
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Genitourinary System

• Involves urinary system and reproductive system
• Aging changes are seen as problems
• Bothersome
• Frequent to occur
• Hard for the elderly to talk about
• Can be life threatening

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Genitourinary System

• AGING CHANGES-URINARY TRACT
• Supportive muscles lose tone and bladder muscles
  change
• Leads to incontinence or urinary retention
• Do Kegel exercises to strengthen

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Genitourinary System

• AGING CHANGES-KIDNEYS
• Kidneys decrease in size as nephrons are lost
• Renal blood flow decreases and BUN increases
• Normal in elderly is nearly double (10 to 40
  mg/dl) the normal in younger adults (10 to 20
  mg/dl)
• Kidneys ability to concentrate urine and maintain
  electrolyte levels is decreased

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Genitourinary System

• AGING CHANGES-BLADDER
• Bladder capacity decreases
• Prostate enlargement in men can lead to
  difficulty urinating and nocturia
• Drugs are eliminated more slowly because of
  decreased kidney function drugs build up in
  body

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Genitourinary System

• Incontinence
• From decreased bladder capacity and muscle tone
• Stress - Loss of less than 50 ml with increased
  intra-abdominal pressure
• Urge - Gotta go now or else
• Overflow - Too much urine too fast
• Functional - Inability to get to the toilet

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Genitourinary System

• Urinary retention
• Related to hesitancy and incomplete bladder
  emptying
• Post void residual (PVR) more than 100 ml left
  in bladder after voiding
• May test for this with a bladder scan or straight
  catheterization

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Genitourinary System

• AGING CHANGES-REPRODUCTIVE SYSTEM
• Menopause
• Atrophy of organs, vaginal dryness
• Decreased hormones
• Prostate issues for men
• Loss of reproductive capacity
• Sexuality concerns hard for the elderly to talk
  about
• Attaining and maintaining erection
• Less interest or sexual drive

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Genitourinary System

• NURSING IMPLICATIONS
• Encourage adequate fluid intake
• 1600 2000 ml per day
• Talk about incontinence
• Toilet or offer bedpan frequently
• Toileting schedule, bladder retraining
• Prevent infections proper pericare
• Do not be embarrassed to discuss sexual problems

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Nervous System

• This System Has A Profound Effect On Our
  Interaction With The World

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Nervous System

• A healthy system allows us to
• Sense the pleasures around us
• Derive intellectual stimulation
• Protect ourselves
• Communicate our needs
• Dysfunction of this system has a ripple effect on
  other systems and can profoundly affect them

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Nervous System

• AGING CHANGES
• Loss of neurons does not mean a decrease in
  ones ability to learn but may produce memory
  changes
• Reduction in brain weight
• Decreased blood flow to brain due to
  atherosclerosis
• May cause dizziness
• May cause memory changes
• Risk for clot formation and CVA

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Nervous System

• AGING CHANGES
• Behavioral changes slower reaction time
• Memory changes more difficulty remembering
  recent events
• May have more trouble mastering motor skills

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Nervous System

• Important
• Pain does NOT decrease with aging, although the
  perception and description of pain may be altered
  in the elderly
• AND
• Always remember to promote safety
• Nervous system changes make the elderly more
  accident prone

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Nervous System

• NURSING IMPLICATIONS To help reduce memory
  changes
• Meds
• Patient and family education and support
• Safe environment
• Mental stimulation
• Reality orientation
• Be patient

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Nervous System

• NURSING DIAGNOSES
• Impaired adjustment
• Anxiety
• Caregiver role strain
• Ineffective coping
• Deficient diversional activity
• Risk for falls
• Deficient knowledge

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Senses

• AGING CHANGES IN THE EYE
• Becomes drier
• Slower and less blinking
• Lacrimal duct secretion decreases
• Smaller pupils that admit less light
• Yellowing of the lens alters color perception esp
  blues and greens
• Decreased night vision
• Presbyopia cannot accommodate, must wear
  reading glasses

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• CATARACTS
• No pain
• Lens becomes clouded
• Yellowish haze over vision
• Loss of sight
• Only cure is surgery

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• GLAUCOMA
• Cause unknown
• No pain
• Destroys optic nerves and vision
• Can be acute

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• MACULAR DEGENERATION
• Wet or dry
• Loss of central vision
• DIABETIC RETINOPATHY

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Senses

• NURSING IMPLICATIONS FOR VISION-ENCOURAGE THE
  ELDERLY
• Wear eyeglasses
• Increase light
• Allow extra time
• Avoid night driving
• Wear sunglasses
• See ophthalmologist regularly

109
Senses

• AGING CHANGES IN THE EAR
• Thickening of the tympanic membrane
• Less ability to hear high frequencies
• Remember, shouting is a high pitched sound
• Hearing loss - presbycusis

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Senses

• NURSING IMPLICATIONS FOR HEARING LOSS
• Hearing aids-batteries
• Get their attention
• Foster an environment that will enhance
  communication
• Use alternative forms of communication

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Senses

• AGING CHANGES IN SMELL AND TASTE
• Degeneration of the olfactory bulb
• Decrease in taste buds
• Can lead to anorexia

112
Senses

• NURSING IMPLICATIONS IN TASTE AND SMELL
• Nutrition concerns
• For example anorexia, loss of appetite, only
  eating one type of food
• Use creativity to increase food appeal
• Safety
• For example, cannot smell smoke or hot things as
  soon

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Senses

• AGING CHANGES IN TOUCH
• Decreased tactile sensation caused by
• Peripheral neuropathy
• Decreased circulation
• Decreased discrimination
• Reduced ability to feel subtle differences in
  objects, temperatures, textures, etc.

114
Senses

• NURSING IMPLICATIONS FOR TOUCH
• Safety
• Hot and cold
• Sharp objects/irritating objects
• Foot care
• Pressure points

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Senses

• NURSING DIAGNOSES
• Anxiety
• Ineffective coping
• Risk for falls
• Social isolation
• Self care deficit
• Ineffective protection

116
Endocrine System
117
Endocrine System

• AGING CHANGES IN THE ADRENAL GLANDS
• Decrease in activity related to
• Increase in connective tissue and loss of adrenal
  tissue
• Decrease in lipid metabolism by liver, adrenal
  glands, or endocrine glands

118
Endocrine System

• AGING CHANGES IN THE PANCREAS
• Decreased insulin production
• Leads to Type 2 DM
• Decreased glucose tolerance
• Prone to obstructions

119
Endocrine System

• NURSING IMPLICATIONS
• Encourage good nutrition
• Encourage hydration
• Monitor output
• Monitor blood sugar
• Elderly at risk for diabetes mellitus onset

120
Endocrine System

• NURSING DIAGNOSES
• Fatigue
• Risk for imbalanced fluid volume
• Deficient knowledge
• Diarrhea
• Acute pain

121
A Few More Related Items

• Parkinsons Disease
• Decreased spontaneous movement, decreased facial
  expressions, infrequent blinking, and shuffling
  gait is due to decreased muscle contraction time
  and increased muscle recovery time.

122

• The biggest concern in nursing care of the
  elderly is safety

123
More GU Information R/T Labs

• Decreased glomerular filtration rate (GFR)
  affects blood pressure by keeping fluid volume in
  the body increased/out of balance
• Decreased GFR has s/s of anorexia, edema, and
  fatigue.
• Lower electrolyte values in the BMP related to
  decreased function of the urinary system.