Recognizing Changes in Body Function

NATCEP Day Thirty-One &Thirty-Two

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

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

Common DiseasesCardiovascular System• Common Diseases:

– Hypertension (High Blood Pressure)– Coronary Artery Disease– Angina– Myocardial Infarction (Heart Attack)– Congestive Heart Failure

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

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

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

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

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

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.

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!

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.

Common DiseasesRespiratory System• Common Diseases:

– Chronic Obstructive Pulmonary Disease (COPD)

– Pneumonia– Tuberculosis– Asthma

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

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

COPD• Treatment

– Stop Smoking– Oxygen Therapy– Breathing Exercises– Respiratory Therapy– Medications

Pneumonia• Inflammation and infection of lungs• Signs & Symptoms

– Sudden onset– Very ill

• Fever (chills)• Painful cough• Chest pain when breathing• Rapid pulse

• Treatment– Drugs for infection & pain– Increased fluids– Rest – Semi-Fowlers

Tuberculosis• Bacterial infection of lungs• Signs & Symptoms

– Tiredness– Loss of appetite– Weight loss– Fever & Night sweats– Cough with sputum (may contain blood)

• Treatment– Drugs– Comfort measures– Respiratory Isolation

Consequences Respiratory System Changes• Shortness of breath• Infections• Choking• Fatigue

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!

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.

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.

Common DiseasesEndocrine System• Common Diseases:

– Diabetes

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

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

Diabetic Treatment Plan• Diet• Medications

– Pills : pancreas to produce and secrete insulin

– Insulin (injection)• Diet

– Sugars– Carbohydrates– Proteins

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

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

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

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

Common DiseasesUrinary System• Common Diseases:

– Urinary Tract Infections– Prostrate Enlargement– Kidney Stones (Renal Calculi)– Renal Failure

• Acute• Chronic

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

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

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

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

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

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

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

Common DiseasesNervous System• Common Diseases:

– Stroke– Dementia– Alzheimers’ Disease– Parkinson’s Disease– Multiple Sclerosis– Huntington’s Disease

Stroke• Blood flow interrupted to the brain by a

clot or aneurysm• Signs & Symptoms

– F: face uneven?– A: Arm held out to side without drifting down?– S: Speech strange or unclear?– T: Tongue straight or off to one side?

• Treatment– Drugs immediately– Based on functions impacted or lost

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

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

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

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

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

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

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