This document summarizes aging changes and common diseases affecting the cardiovascular, respiratory, endocrine, urinary, and nervous body systems and describes related nursing care. Key points include: the heart pumps less efficiently with age and arteries lose elasticity, increasing risk for hypertension, heart disease, and heart failure; lung capacity decreases and secretions increase risk for infections; diabetes and vitamin deficiencies impact fluid balance and nutrition; urinary changes cause incontinence and infections; and nervous system changes impact mobility, cognition, and sensitivity. The summary provides an overview of the main topics and systems covered in the document.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)silla elsa soji
SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH). Inappropriate, continued secretion or action of ADH despite normal or increased plasma volume. Results in impaired water excretion, and subsequently hyponatremia and hypo-osmolality.
Ischemic heart disease (IHD) caused by atherosclerosis of the epicardial vessels leading to coronary heart disease (CHD) is the main etiology of IHD.
Leading cause of death
Resulting from myocardial ischemia—an imbalance between the supply (perfusion) and demand of the heart for oxygenated blood.
90% of cases, the cause of myocardial ischemia is reduced blood flow due to obstructive atherosclerotic lesions in the coronary arteries.
IHD is often termed coronary artery disease (CAD) or coronary heart disease.
There is a long period (up to decades) of silent, slow progression of coronary lesions before symptoms appear.
IHD are only the late manifestations of coronary atherosclerosis that may have started during childhood or adolescence
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)silla elsa soji
SIADH is a disorder of impaired water excretion caused by the inability to suppress the secretion of antidiuretic hormone (ADH). Inappropriate, continued secretion or action of ADH despite normal or increased plasma volume. Results in impaired water excretion, and subsequently hyponatremia and hypo-osmolality.
Ischemic heart disease (IHD) caused by atherosclerosis of the epicardial vessels leading to coronary heart disease (CHD) is the main etiology of IHD.
Leading cause of death
Resulting from myocardial ischemia—an imbalance between the supply (perfusion) and demand of the heart for oxygenated blood.
90% of cases, the cause of myocardial ischemia is reduced blood flow due to obstructive atherosclerotic lesions in the coronary arteries.
IHD is often termed coronary artery disease (CAD) or coronary heart disease.
There is a long period (up to decades) of silent, slow progression of coronary lesions before symptoms appear.
IHD are only the late manifestations of coronary atherosclerosis that may have started during childhood or adolescence
Heart failure (HF) is a common cardiovascular condition with increasing incidence and prevalence. Unlike western countries where heart failure is predominantly a disease of elderly, in India it affects younger age group. Heart failure is a chronic condition in which the heart cannot pump enough blood and oxygen to support other organs in your body.
A brief presentation on anatomy of heart, different types of cardiovascular disease, their symptoms, causes, prevention methods and medical treatments available to cure heart disease.
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2. Objectives
• Describe the aging changes and their
consequences for the following body
systems:
–
–
–
–
–
Cardiovascular
Respiratory
Endocrine
Urinary
Nervous
• Describe the related nursing care for each
3. Changes of Aging:
Cardiovascular System
• Heart may pump blood less efficiently.
• Heart cannot accommodate to meet
increased need.
• Arteries loss elasticity.
• Blood pressure may increase.
• Blood flow to brain and vital organs may be
decreased.
• Veins are less efficient in returning blood to
the heart
4. Common Diseases
Cardiovascular System
• Common Diseases:
– Hypertension (High Blood Pressure)
– Coronary Artery Disease
– Angina
– Myocardial Infarction (Heart Attack)
– Congestive Heart Failure
5. High Blood Pressure
• Blood pressure higher than 140 systolic (top); 90
diastolic (bottom)
• Caused by narrowed blood vessels
–
–
–
–
Kidney disorders
Head injuries
Pregnancy
Adrenal Tumors
• Signs and Symptoms
– “Silent Killer”
• Headache, blurred vision, dizziness, nose bleeds
• Treatment
– Life Style Changes
• Diet, no smoking, healthy weight, exercise
6. Coronary Artery Disease
• Coronary arteries become hardened and narrow
• Caused by build up of plaque on the arterial walls
• Major complications
–
–
–
–
Angina
Myocardial Infarction (MI)
Irregular Heart Beat
Sudden Death
• Treatment
– Life Style Changes
• Diet, Exercise, quit smoking, reduce stress
– Medications
• Decrease workload on heart and relieve symptoms
7. Angina
• Chest Pain
• Caused by reduced blood flow to the heart
• Signs and Symptoms
– Tightness, pressure or squeezing in the chest
– Pain in the shoulder, arm, neck, jaw or back
– Pale, nauseated or weak
• Treatment
– Rest – stop any activity
– Nitroglycerine Tabs
– Avoid triggers
• Over-exertion
• Heavy meals or overeating
• Stress
8. Myocardial Infarction (MI)
• Death of part of the heart muscle
• Caused by blocked blood flow to the heart
• Signs and Symptoms
– More severe and lasts longer than Angina
– Sudden tightness, pressure or squeezing in the chest, usually on the left
side “elephant sitting on my chest”
– Indigestion or “heartburn”
– Pain in the shoulder, arm, neck, jaw or back
– Pale, nauseated or weak
– Low blood pressure
– Not relieved by rest or nitroglycerin
• Treatment
–
–
–
–
EMERGENCY: Call 911
Stop any activity
Treat symptoms
May need surgery to open or bypass blockage
• Cardiac Catheterization
9. Congestive Heart Failure
• Heart is weak and cannot pump blood normally; blood backs up =
tissue congestion
• Caused by damaged or weakened heart
• Signs and Symptoms
– Left side of heart = lungs
• Respiratory congestion = short of breath; more sputum, cough, gurgling in lungs
= pulmonary edema
– Right side of heart = venous system
• Edema in extremities, neck veins bulge, liver congestion
• Treatment
–
–
–
–
–
–
–
–
Drugs = strengthen heart and/or reduce fluid
Low sodium diet
Oxygen and semi-fowlers position
Rest and activity as ordered
Intake and Output
Restrict fluids
Daily weights
Elastic (anti-embolic) stockings
10. Consequences
Cardiovascular Changes
• Adequate exercise is necessary - may not
be able to tolerate great amounts.
• Circulation changes affect blood pressure
& fluid balance.
• Dizziness may occur with sudden changes
in position.
• Decreased venous return many cause
discoloration, coldness & swelling of legs.
11. Nurse Aide Actions
• Pace activities and allow time for rest
periods.
• Be aware of dietary restrictions.
• Assist resident to change positions slowly and
be aware of episodes of dizziness and report
to nurse.
• Remove and reapply anti-embolic stockings
to lower extremities, as ordered.
• Report changes to the nurse!
12. Changes of Aging
Respiratory System
• Lung capacity decreases as a result of
muscular stiffness in the lungs.
• Ability to cough is less effective, causing
secretions and fluid in the lungs,
increasing the risk of infections and
choking.
• Shortness of breath on exertion as result
of aging changes in lungs
• Airway size decreases with age.
14. Chronic Obstructive Pulmonary
Disease (COPD)
• Two disorders grouped
– Bronchitis
– Emphysema
• Interfere with CO2 and O2 exchange in the lungs;
less air gets in, less CO2 gets out
– Airways & alveoli become less elastic
– Walls between many alveoli are destroyed
– Walls of airway becomes thick, inflammed and
swollen
– Airways secrete more mucus = clogs airways
• Cause: Cigarette Smoking or tobacco use
15. COPD
• Signs and Symptoms
– Bronchitis
• Smoker’s Cough in am
– First dry, cough up mucus over time
• Mucus may have pus
• Difficulty breathing; tires easily
– Emphysema
• Alveoli are enlarged – trap O2 and CO2 = barrel
chest
• Shortness of breath; tires easily
• Cough; mucus may have pus
20. Nurse Aide Actions
• Position comfortably.
• Keep needed items within reach.
• Be aware of dietary restrictions
– Sodium restrictions are common
• Pace activities and allow time for rest
periods.
• Follow facility policies regarding oxygen in
use.
• Be alert to changes and report to nurse!
21. Changes & Consequences
Endocrine System
• Water and fluid balance
– Imbalances occur with illness, hospitalizations, , use
of medications, and extremes in temperatures.
• Dehydration: altered mental status, lethargy,
lightheadedness or syncope.
– Signs of dehydration: reduced skin turgor, dry
mucous membranes, and hypotension (low blood
pressure).
• Vitamin deficiencies: cognitive impairments, poor
wound healing, anemia, and increase in infections.
22. Changes & Consequences
Endocrine System
• "Under" Nutrition: fatigue, pressure sores, decreased
muscle strength, infections, hypotension and lower
extremity edema.
• Type II diabetes is more common in elderly with
upper body obesity (non-insulin dependent).
– Increased risk of macrovascular disease = stroke, coronary
artery disease, skin breakdown and infection.
– Poorly controlled for several years can lead to retinopathy,
nephropathy, and peripheral neuropathy.
• Hypothermia: diabetes = 6x greater chance due to
vascular disease; medical emergency.
• Hyperthermia: heat cramps, heat exhaustion & heat
stroke.
24. Diabetic Coma
• Hyperglycemia: High Blood Glucose
• Symptoms
–
–
–
–
–
–
–
–
Coma
Face flushed
Breath fruity
Tongue dry
Labored respirations
Blood pressure low
Weak and rapid pulse
Skin dry
• Treatment
– Insulin
25. Insulin Shock
• Hypoglycemia: Low Blood Glucose
• Signs and Symptoms
– CHANGE IN Behavior
–
–
–
–
–
• Excited, nervous, dizzy, confused, irritable
Face pale
Shallow or rapid respirations
Full or pounding pulse
Skin moist – excessive sweating
Lack of coordination - trembling
• Treatment
– Glucose via an Intravenouse Infusion (I.V.)
– High sugar foods
26. Diabetic Treatment Plan
• Diet
• Medications
– Pills : pancreas to produce and secrete
insulin
– Insulin (injection)
• Diet
– Sugars
– Carbohydrates
– Proteins
27. Nurse Aide Actions
• Closely monitor fluid intake.
• Monitor food intake and diet.
– Know dietary restrictions
• Be alert to signs and symptoms of diabetes
–
–
–
–
–
–
Excessive thirst
Excessive hunger
Frequent urination
Pain in abdomen
Nausea & vomiting
Drowsiness
28. Nurse Aide Actions
• Assure activity/exercise
– Plan of care
• Foot Care
– Well fitting shoes
– Lotion on feet daily
– DO NOT CUT nails
• Skin care
– Be alert to breaks in skin & report
• Be aware of signs and symptoms
– Diabetic Coma
– Insulin Shock
29. Complications & Precautions
• Decreased circulation
– Poor Healing
– Nails: DO NOT CUT TOENAILS!
• Check plan of care for nail care
• Retinopathy
– Blindness
• Manage blood sugar level
• Diet
• Exercise
30. Changes of Aging
Urinary System
• Kidneys decrease in size
• Urine production less efficient
• Kidney function increases at rest
– Nocturia
• Bladder capacity decreases & muscles weaken
– Frequency
– Leaking
• Prostate Gland in men enlarges
31. Common Diseases
Urinary System
• Common Diseases:
– Urinary Tract Infections
– Prostrate Enlargement
– Kidney Stones (Renal Calculi)
– Renal Failure
• Acute
• Chronic
32. Urinary Tract Infection
• Infection of tract of the urinary system
• Signs & Symptoms
–
–
–
–
Painful urination
Frequency
Urgency
Fever
• Treatment
– Drugs for infection & pain
– Increased fluids
– Rest
33. Prostate Enlargement
• Surrounds urethra; enlargement can prevent
urine from passing
• Signs & Symptoms
–
–
–
–
Weak urine stream
Frequency with small amounts or urine
Urgency with leaking or dribbling of urine
Urinary retention
• Treatment
– Drugs
– Surgery may be necessary
34. Kidney Stones (Renal Calculi)
• Small as sand; can be as large as golf balls
• Signs & Symptoms
–
–
–
–
–
Severe, cramping pain in back and side (flank)
Nausea & vomiting
Fever & chills
Painful urination, urgency & frequency
Blood in the urine (hematuria)
• Treatment
–
–
–
–
Drugs
Increased fluids
Strain urine
Surgery may be required
35. Renal Failure
• Kidneys severely impaired or not working
• Signs & Symptoms
– Small amounts of urine (oliguria)
• Less than 400 cc in 24 hours
– Very ill – all body systems affected as waste backs up
• Treatment
– Drugs
– Retrict fluids
– Hemodialysis
• Waste removed from blood by machine
36. Consequences
Urinary System Changes
• Incontinence causes the person to feel
embarrassed, isolated and depressed
• UTIs are common
–
–
–
–
–
Low urine output
Frequency
Incontinence
Flank pain
Fever
• In addition to odors, skin becomes irritated
resulting in infection and pressure ulcers
37. Nurse Aide Actions
•
•
•
•
Encourage fluids unless directed otherwise
Record output according to care plan & policy
Assist to bathroom as needed and per care plan
Observations about urine:
–
–
–
–
–
–
Color
Odor
Frequency with small amounts of urine
Pain/burning with urination
Difficulty urinating
Incontinence
38. Changes of Aging:
Nervous System
• Slowed transmission of nerve impulses:
slowed reaction time
– Speed
– Fine Motor Skills
• Balance and coordination problems
• Deep sleep is shortened; awakening more at
night
• Decreased sensitivity of nerve receptors in
skin: heat, cold, pain & pressure
39. Common Diseases
Nervous System
• Common Diseases:
– Stroke
– Dementia
– Alzheimers’ Disease
– Parkinson’s Disease
– Multiple Sclerosis
– Huntington’s Disease
40. Stroke
• Blood flow interrupted to the brain by a clot or
aneurysm
• Signs & Symptoms
–
–
–
–
F:
A:
S:
T:
face uneven?
Arm held out to side without drifting down?
Speech strange or unclear?
Tongue straight or off to one side?
• Treatment
– Drugs immediately
– Based on functions impacted or lost
41. Dementia
• Loss of cognitive function that interferes with
routine, personal, social, and occupational
activities – not a normal part of aging
• Signs & Symptoms
–
–
–
–
–
Memory loss that affects job skills
Problems with ADLs
Problems with common language
Getting lost in familiar places
Misplacing things
• Treatment
– Comfort & safety
– Keep involved as much as possible
42. Alzheimers’ Disease
• A disease of the brain as a result of nerve
damage in the brain. There is a steady decline;
can only be diagnosed by autopsy
• Signs & Symptoms (gradual)
–
–
–
–
Problems with work & everyday functions
Problems with family & relationships
Steady decline in memory & mental function
Live 8 to 10 years after diagnosis
• Treatment
– Comfort & safety
– Keep involved as much as possible
43. Parkinson’s Disease
• Slow, progressive disease that effects the area of the brain that
controls muscle movement
• Signs & Symptoms
– All worsen over time
•
•
•
•
•
Tremors
Rigid, stiff muscles
Slow movements
Stooped posture
Mask-like expression
• Treatment
–
–
–
–
Drugs
Exercise & Physical Therapy
Based on symptoms
Hemodialysis
• Waste removed from blood by machine
44. Multiple Sclerosis
• A slow, progressive, disease in which the myelin
in the brain & spinal cord is destroyed
• Signs & Symptoms
– Begin between 20 – 40 years of age
– Depend on damaged area
•
•
•
•
•
Vision blurred, double vision or blindness
Muscle weakness
Balance problems – coordination & cluminess
Tingling, prickling, numbness
Problems with concentration, attention, memory & judgment
• Treatment
– Focus on keeping active and independent
45. Huntington’s Disease
• Inherited; causes progressive breakdown of brain nerve cells
• Signs & Symptoms
– Movement
•
•
•
•
Involuntary jerking or contractures of muscles
Problems with gait, posture & balance
Slow, uncoordinated fine movements
Slow or abnormal eye movement
– Cognitive
• Difficulty planning, organizing and prioritizing tasks
• Inability to start a task or conversation/slow thought processes
• Lack of impulse control that can result in outbursts, acting without thinking
and sexual promiscuity
– Psychiatric
• Depression based on neurological changes
• Treatment
– Focus on keeping active and independent
46. Consequences
Nervous System Changes
• Slowed responses
– Increased risk for falls
• Sleep patterns changes
– Harder time falling asleep = fatigue & more
rest/napping during the day
• Lost brain cells
– Changes in mental function and personality
• Decrease sensitivity
– Increased risk of injury
• Stroke
– Dependent on affected areas
47. Nurse Aide Actions
•
•
•
•
Provide for safety
Encourage activity
Prevent injuries to paralyzed parts.
Consider the resident first; the disease
and condition second
• Provide support in ADLs (activities of daily
living