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37 Cards in this Set
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The Aging Process - begins after birth but more evident about 30 years. - process is irreversible but rate and effects of aging vary greatly and do not necessarily match chronological age. - typical changes in various organs do not occur at same time or in any particular order - extent of changes also depends on individual's genetic makeup, lifestyle, and health status |
Senescence - Biological processes that lead to aging - Begins prior to birth - Several theories as to cause - Also refers to period from onset of old age to death - overall women live longer than men - physical exercise occurs on a routine basis and increases cardiac output and ventilation may slow tissue changes associated with senescence by providing improved nutrition and oxygenation to tissues - cognitive activities requiring problem solving such as card games, puzzles, and reading seem to reduce senescence in CNS - social interactions during exercise or games also maintaining function |
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With aging, general reduction in function occur at cellular and organ level and body is decreased capacity to adapt to change - degenerative changes associated with aging may predispose an individual to certain pathologies and pathologic changes can hasten aging. - brain and myocardium cannot regenerate - General reduction in function occurs throughout body - Most vulnerable tissues are those that cannot regenerate effectively: = CNS, Skeletal muscle, Cardiac muscle and Kidney |
Theories of Aging Genetically programmed - Apoptosis—programmed cell death — = this control directly limits the cells' reproductive capacity “Wear-and-tear” - cell damage - Accumulated wastes - Altered proteins (amyloid) - Lipofuscin (lipid) components - increased Degenerative changes in collagen and elastin fibers Random errors during cell mitosis some theory: aging is related to resident latent viruses or increased autoimmune reactions in which body rejects its own tissues or to environmental agents that affect cells - free radicals (peroxides - reactive chemical) produced during cell metabolism; known to cause damage to nucleic acids and cells = lead to cancer and other diseases. |
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Aging Process Continues Changes in tissue obvious, cells assume less regular arrangements in tissues later in life - elastic fibers lost and number of collagen cross-linkages or other abnormal structures in tissues and organs increases - mitosis/cellular reproduction gradually slows down, partly in response to slower metabolic rate = decreased tissue repair - some cells (neurons and muscle cells) cannot replicate, result in decreased tissue repair - certain cells have limits on # of replications, cannot be replaced in older individuals - other cells accumulate wastes or altered by environmental factors become less function or die, lead to organ failure. - prolonged exposure to numerous environmental factors: radiation, viral infections, and chemicals over years lead to increased risk of cancer and other diseases in older people. *may occur in younger individuals - not unique to aging process |
TA 24-1 a) Age-related changes include loss of elastic fibers and cross-linkage of collagen fibers. There is less mitosis, more irregular arrangement, accumulation of lipids or other waste, and decreased fluid content in the cells. b) signs of aging at 30, 50, and 80 years old = After age 30 years, changes include increasing wrinkles or lines in the skin, a slight change in skin pigmentation (e.g., dark patches), and slight hair loss. After 50, there is some loss of height, slower reflexes, decreased skeletal muscle strength, decreased skeletal flexibility and range of movement in joints, and visual or auditory loss. After 80, there is some loss of coordination, slower movements, more flexion of the head, shoulders, and hips, slower reflex responses, and more difficulty in chewing food and discomfort resulting from some foods. (Note that there is much individual variation.) |
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Physiological Changes with Aging: Hormonal Changes - With the exception of estrogen and testosterone, the level of hormone secretion remains relatively constant (with advancing age) - Number of tissue receptors decreases - Speed of hormonal response may diminish = effect is apparent in type 2 diabetes mellitus (sufficient insulin produced but # of receptors reduced, glucose does not enter the cells) - major natural hormonal change occurs in women about age 50 (ovaries cease to reproduce estrogen and progesterone) = serum levels of FSH and LH rise in response to natural feedback mechanisms - gradual decrease in testosterone levels in males, testes do not totally cease function - testosterone levels in males peak during teen and early adulthood. After age 30 testosterone levels about 1& a year. (decline is usually not obvious until later in life) |
Reproductive System Changes Menopause (average age, 51 years) women around 50 years old - Ovaries do not respond to FSH and LH - Result in Lack of ovulation - Declining estrogen and progesterone levels - Cessation of menstrual cycle - Hot flashes - Decreased levels of sex hormones lead to changes (thinning of mucosa, loss of elasticity, and decreased glandular secretions in vagina and cervix) = may cause inflammation and dyspareunia (painful sexual intercourse) - effects can be minimized by topical (local) administration of estrogen creams - risks associated with oral hormone replacement therapy; therefore individual case assessment is necessary. = pH of vaginal secretions becomes more alkaline, predisposing older women to recurrent vaginal infections - breast tissue decreases in volume = these early stages of menopause frequently lead to systemic signs such as "hot flashes" involve periodic sweating of vascular disturbances, headaches, irritability and insomnia (common) - effects of menopause may be felt short or long periods of time (several years) and marked more in some women than others. = approx 25% of women experience significant effects, surgical removal of ovaries is necessary before menopause occurs naturally (similar effects will be evident) |
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Female Reproductive System Changes Mood swings - Hormonal changes - Social expectations - Fatigue Dyspareunia—painful sexual intercourse - Thinning of vaginal mucosa, loss of elasticity - Decreased glandular secretions |
Male Reproductive System Changes - testosterone levels decline gradually, the testes decrease in size, sperm production is somewhat reduced and glandular secretions of prostate are decreased but older male is capable of fathering a child - common problem in older males: benign prostatic hypertrophy (BPH) central part of gland around the urethra hypertrophies, result in degree of obstruction of urethra, if urinary flow is significantly impaired, surgery may be necessary. - Cancer if the reproductive organs more common in males (prostatic cancer) and females (uterine and breast cancer) (in later years and may be related to altered hormonal levels) |
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Male Reproductive System Changes - Testosterone levels decline gradually. - Muscle mass decreases. - Testes decrease in size. - Sperm production somewhat reduced - Glandular secretions of prostate decrease - Benign prostatic hypertrophy (BPH) common |
TA 24-2 a) Compare changes in reproductive hormones and structures that occur in older males and females = Females have marked changes at menopause (e.g., a great decrease in estrogen and progesterone levels from the ovaries, no ovulation, degenerative changes in the vagina and cervix, including thinning and decreased elasticity of the mucous membranes, decreased secretions, decreased breast tissue).Males show a gradual decline in testosterone secretion with aging (some decrease in testicular size, sperm production, and prostatic secretion); a common change is benign prostatic hypertrophy. |
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TA 24-2 b) suggest some effects of decreased secretion of sex hormones on various body tissues and structures = Decreased secretion of sex hormones results in decreased anabolism or protein synthesis for tissue regeneration and repair, particularly in the reproductive system (e.g., estrogen promoted breast development). Also, bone and skeletal muscle development is promoted by the sex hormones; therefore, with aging, these tissues will decline (e.g., osteoporosis). |
Changes in Skin and Mucosa - Some related to genetic factors - Many based on exposure to sun and weather - Skin and mucous membranes become thin and more easily damaged. - Dermis thinner—subcutaneous tissue diminished - fewer capillaries are present and cell proliferation is decreased = slower wound healing and atrophy of the glands - the numbers of sensory receptors in skin and mucosa decline = these factors increase susceptibility to injury, bruising occurs frequently and mucosal membranes become inflamed or ulcerated |
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Changes in Skin and Mucosa - skin is often dry and appears wrinkled as elastic fibers reduced and collagen fibers become less flexible - obvious lesions include skin tags (small projections of skin) on neck and axillary areas, keratoses (rough raised masses, often dark in color) - hair becomes gray as melanocytes are reduced in number and thinning occurs as number of hair follicles decreases - Number of specialized structures declines: = Sweat glands and Receptors |
Cardiovascular System Changes - age-related changes occur in cardiac muscle fibers and connective tissues of heart - fatty tissue and collagen fibers accumulate in heart muscle with aging and may interfere with impulse conduction and cardiac muscle contraction - the size and number of cardiac muscle cells declines, reducing strength of cardiac contractions - in the absence of any pathologic changes, left ventricle appears smaller, because demand is also reduced. - cardiac muscle fibers do not undergo mitosis and cannot be replaced = heart valves often thicken and become less flexible and efficient - some vascular degeneration causes decrease in oxygen supply to heart muscle and decrease oxygen supply to heart muscle and reduces ability of heart muscle to use oxygen = cardiac output and cardiac reserve are diminished, decreasing the maximum cardiac output possible with stress - adequate fluid intake important to maintain cardiovascular function, as % of fluid in body declines in older individuals - regular fitness program help maintain cardiac function |
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Common pathologies of cardiovascular system - degenerative changes in arteries (both in heart and throughout body) - loss of elasticity and accumulation of collagen in arterial walls result in thickening of the arterial wall (limiting expansion of large arteries and obstructing lumina of smaller arteries) = Arteriosclerosis and elevated blood pressure - degenerative changes promote accumulation of cholesterol and lipid walls of large arteries (Atherosclerosis) when individual has elevated blood lipid levels (lipid plaques obstruct blood flow and predispose to thrombus formation) - atherosclerosis is a common cause of angina, myocardial infarction (heart attacks), peripheral vascular disease in the legs and strokes = dietary changes including reduced cholesterol intake and regular exercise programs assist in lowering blood lipid and cholesterol levels and lessen risk of vascular degeneration and high blood pressure - |
Cardiovascular changes - Size and number of cardiac muscle fibers decrease - Fatty tissue and collagen fibers accumulate. - Reduced strength of contraction - Heart valves thicken, become less flexible - Vascular changes may cause a decrease in oxygen supply to heart - Cardiac reserve diminished |
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Arteriosclerosis - Loss of elasticity, accumulation of collagen - Thickening of arteriolar walls - Increased peripheral resistance - Tissue ischemia - Cause of nonspecific brain changes |
Atherosclerosis - Hyperlipidemia - Promotes accumulation of cholesterol in walls of large arteries - Increased peripheral resistance - Tissue ischemia - Common cause of angina, myocardial infarction, peripheral vascular disease, strokes |
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Musculoskeletal System Changes - Loss of calcium and bone mass - Higher incidence in postmenopausal women - Fractures of spine, pelvis, and limbs common - Risk factors: = Asian or northern European ancestry = Low body mass index = Decreased estrogen levels = Sedentary or inactive lifestyle = Decreased intake of calcium, vitamins C and D = Decreased intestinal calcium absorption = decreased osteoblastic activity (increased risk with glucocorticoid/cortisol use) |
Osteoporosis - recommended that older women have a routine bone density test to check for silent development of osteoporosis - deposition of new bone is reduced, leading to decreased bone mass and density. - bones often porous and brittle thus precipitating frequent fractures (vertebrae and pelvis) - spontaneous vertebral fractures result in decreased height and kyphosis with increased age = as thoracic curvature increases, individual compensates by increasing the cervical curvature and tilting the head, leading to typical hunchback posture (dowager's hump) and shuffling gait (impairs ventilation and mobility) |
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Recommendations to reduce risk and progression of osteoporosis with aging - Adequate calcium and vitamin D intake (current recommendation for daily calcium intake for greater than 50 is 1500 mg plus 800 IU vitamin D) - walking, Weight-bearing exercises, physiotherapy, or rehabilitation program - Bone density testing for women at age 50 years or earlier - drugs: bisphosphonates (e.g. alendronate sodium [Fosamax] an inhibitor of bone resorption - individualized hormone therapy (selective estrogen receptor modulations (e.g. raloxifene/[Evista], estrogen/progestin replacement therapy or synthetic calcitonin (Miacalcin) or parathyroid hormone |
Risk Reduction for Osteoporosis - Note that loss can be 1-3% per year post menopause and fractures occur at about 25% loss. Most important risk reduction factor is a healthy skeleton in teen and young adult years as osteoblastic activity drops off dramatically after age 40. |
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Osteoarthritis - degeneration of cartilage in joints is a common problem - articular cartilage becomes thin and erosions occur, impairing joint movement and causing pain, particularly in large weight-bearing joints (knees and hips) - in some cases: bone spurs or overgrowths develop at points of stress, further restricting movement - pain increases with walking and other movements - joint replacement may be necessary |
Herniated Intervertebral Disc - fibrocartilage in intervertebral discs in spine degenerates with age and sudden stress on back may result in herniated disc - cause pressure on spinal nerves and results in severe back pan - if pressure is not relieved, permanent damage to nerves can result - as intervertebral discs become thinner, loss of height becomes apparent |
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Other Musculoskeletal System Changes - Skeletal muscle mass declines with aging (atrophy and decreased number of fibers) Skeletal muscle fibers cannot be replaced - loss of muscle and subcutaneous tissue leads to increased susceptibility to skin breakdown and pressure-related ulcers (reduced cushion between skin and bone) = less "insulation" to retain heat in body and less "cushioning" against falls or pressures - Dependent on level of fitness - Strength of muscle contractions may decrease. (but also depends on activity level) - Flexibility is reduced (elastic fibers degenerate) - Stiffness becomes evident (often movements become slower, and coordination and balance reduced) - Coordination and balance reduced |
Other Changes in Musculoskeletal System - regular moderate low-impact exercise (swimming or Tai Chi) helps maintain mobility and flexibility (increasing efficiency and activity of muscle and bone by improving circulation of blood to tissues) - good nutrition (protein, minerals, and vitamins) important in maintaining integrity of basic structures. |
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TA 24-4 a) Increased blood flow provides more nutrients for bone production. The increased stress on bone during exercise promotes osteoblastic activity to increase bone mass and density. Exercise also prevents muscle atrophy and prevents tendons and ligaments from shortening or tightening. b) how pain from osteoarthritis affect ability to exercise and maintain appropriate body mass - Pain can dissuade a patient from exercising, which can lead to inactivity and have an effect on body mass, including decreased bone density, skeletal muscle atrophy, and increased fat deposits. c) Why would severe trauma to skeletal muscle (crush injury) have permanent disabling effects? = Skeletal muscle fibers do not regenerate, and blood flow to the damaged area is impaired. |
TA 24-3 a) several ways restricting diet to reduce the risk of cardiovascular problems? = Decreasing lipid and cholesterol intake by reducing animal fat in the diet and decreasing sodium (salt) intake can reduce the risk of cardiovascular disease. b) Suggest different types of exercise appropriate for older individuals and explain how regular exercise can delay onset of degenerative changes = Walking, cycling, or swimming promotes cardiovascular activity and protects the joints. Regular exercise promotes peripheral circulation, improves cardiac and respiratory activity, extends endurance, and maintains muscle tone and strength. Blood clots and atherosclerotic plaques have less opportunity to build up when blood flow is well maintained. Tissues are less likely to degenerate when adequate nutrition and removal of wastes are ensured by maintaining good circulation. |
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24-3 c) explain how reduced blood supply may affect the skin and mucosa? = Decreased mitosis and regeneration lead to tissue breakdown and ulceration as well as reduced secretions. d) describe outcome of a blocked artery = Blockage of an artery reduces blood flow to the point that cell necrosis occurs in the area supplied by that artery. |
Respiratory System Changes - ventilation (inspiration and expiration) is limited for several reasons = Elasticity in lung tissue is reduced. = Costal cartilage (between rib and sternum) calcifies, reducing rib movement = Skeletal (intercostal) muscles atrophies and weaken. = any skeletal change (rib shape) may reduce thoracic movement - Expiration is reduced. = Residual volume increased = Decreased expansion for deep breathing and coughing (more restricted lung movements) - weaker skeletal muscles also reduce cough effectiveness. - when capability for initiating an effective cough is impaired, secretions tend to accumulate and risk for pneumonia increases - Vascular changes = Decreased perfusion = Reduced gas exchange in alveoli = tend to be reduced oxygen level rather than increased carbon dioxide level Treatment: regular physical exercise is effective in maximizing ventilation and circulation. - breathing exercises and oxygen therapy may be helpful in assisting respiratory function in those respiratory pathologies and supporting physical activity |
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Nervous System Changes - neurons are not replaced after birth = = Natural reduction in neurons with aging (does not affect cognitive function in many individuals because considerable reserve of neurons) - loss may occur in different areas of brain at different times - maintenance of high activity levels and stimulation of nervous system appear to assist in maintaining brain function - exposure to toxic materials (lead) tends to hasten the degeneration - Lipid accumulations in neurons (loss of myelin sheath, develop abnormal neurofibrils (masses of tiny, tangled fibrils) and plaques on cells. = neurofibrils and plaques are present in much higher numbers (in those mentally in competent) through organic brain syndrome (includes senile dementia and Alzheimer's disease) - decreased cellular response in brain to NT chemicals (norepinephrine - delays in synaptic transmission) - Loss of myelin - Decreased response to neurotransmitters - Slower response time, decreased reflexes, and short-term memory lapses. |
The ANS does not always provide adequate adaptation = decreased tolerance to extreme hot or cold temps - poor circulation, decreased metabolism, decreased activity levels - reduced temp sensitivity in skin when touching hot or cold surfaces |
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Changes in Special Senses Eye: iris and associated muscle degenerate = decreased adaptation by pupil to light possible obstruction of aqueous humor flow = lead to increased intraocular pressure and glaucoma - tend to become yellow and less transparent, interfere with color perception (esp blue hues) - night vision is impaired and many elderly are unable to drive safely in dark - lens eventually may become opaque (cataracts) develop) - if vision lost, surgery may be required to remove cataract - lens become larger and less elastic, causing presbyopia (farsightedness) and possibly cataracts. - vascular degeneration may affect retina of eye (contains nerve cells for receiving images and condition cause permanent visual loss. |
Hearing loss - caused by degenerative changes in inner ear (either nerve receptor cells of cochlea or nerve fibers supply ear) - in noisy surroundings, may become difficult to discriminate among sounds, impair communication and deterring socialization |
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Taste and Smell - often diminish with aging - taste may be altered by reduced salivary secretions or decreased perception within the CNS - ability to discriminate among odors is reduced - diminished powers of taste and smell may impair appetite and nutrition |
TA 24-5 a) describe 4 neurologic changes that can be expected to occur - Expected neurological changes include loss of some neurons in the brain, which might affect function. Reflexes are slower. Night vision is decreased and farsightedness is common. Some hearing loss is experienced. The stress response is less effective. - Vascular degeneration may affect retina (contain nerve cells for receiving images - cause permanent visual loss |
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Digestive System Changes and Nutrition - Maintenance of good nutrition may be a problem. - loss of teeth (periodontal disease- inflammation and infection in tissue surrounding teeth), decreased salivary secretions frequently restrict dietary choices as older person experiences difficulty in chewing many foods) - often dentures not good for chewing as gums and bone recede. - decreased saliva result from use of certain drugs or from mouth-breathing associated with many respiratory problems - difficulty swallowing (neurologic causes or mechanical obstructions (scar tissue or hiatal hernia may develop) - mucosa thin - decreased salivary secretions (frequently restrict dietary choices) - Decreased sense of smell and taste may lead to anorexia - Older individual may lack money for adequate nutrition - Muscle weakness and fatigue - Obesity in older individuals = Increases cardiac workload = Atherosclerosis and hypertension = Type 2 diabetes |
Obesity common in some older adults (those who had sedentary lives) - BMR decreases significantly as one ages - reduction must be accompanied by a decrease in intake of fats and carbs to maintain an appropriate weight. (sometimes excessive intake of fats and carbs may mask signs of protein, fiber, or vitamin deficits) - obesity increases cardiac workload (likelihood of atherosclerosis and hypertension) - gallstones also a complication of obesity as osteoarthritis affecting weight-bearing joints - insulin resistance caused by obesity is important factor in metabolic syndrome leading to altered glucose and lipid metabolism (and Type 2 diabetes) |
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Atrophy of mucosa and glands of digestive tract frequently reduces digestive secretions and absorption of essential nutrients - absorption of vitamin B12, calcium and iron may be impaired but can be replaced by vitamin B12 injections plus more easily absorbed forms of calcium and iron. - decreased mucus secretion and thinning of mucosa predisposes the older person to peptic ulcer development (signs of ulcers are vague or may be masked by self-medication in early stages) - older adults predisposed to malignancies in digestive tract (in stomach and colon) which my be related to hereditary factors and dietary intake. - carcinogenic substances in diet more hazardous when associated with constipation because prolonged exposure of tissues to these substances during transit thru the gut - constipation common in elderly - many factors contribute to it including decreased activity, low fiber and fluid intake, and excessive use of laxatives - chronic constipation frequently leads to hemorrhoids. |
TA 24-6 a) list factors that lead to constipation = Constipations results from low fiber content or bulk in the diet, decreased fluid intake, weak muscles because of inactivity, and excessive use of laxatives, which impair the defecation reflex. b) Describe several possible pathologic conditions involving the digestive tract in older people = Older adults may have problems with swallowing, such as obstructions, ulcerations with pain and inflammation, malabsorption problems because of impaired glandular function, mucosal atrophy or damage to the mucous membranes, and cancer at any point in the digestive tract. c) explain why obesity is undesirable in the elderly = Obesity increases the demands on the heart for greater circulation and predisposes to less activity and less blood supply through the tissues. Obesity aggravates joint and back problems. Increased fat intake increases the risk of gallstones and atherosclerosis. |
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Urinary System Changes Kidney function reduced - Loss of nephrons, glomeruli and degeneration of tubules and blood vessels - Diminished ability to adapt to changes in electrolyte and acid levels - Reduced capacity to excrete drugs into urine (result in excessively high levels of drugs in blood) Weakened urinary sphincter and bladder (reduced control of bladder function as urethra and bladder become weaker) - reduced bladder capacity and incomplete bladder emptying results in frequency, nocturia and infections. - Nocturia (frequent urination at night) - Incontinence (involuntary voiding of urine) In women: pelvic floor muscles often stretched and weakened by childbirth, reducing ability of external sphincter to restrict urinary outflow - deceased estrogen levels may decrease smooth muscle tone - sensory perception of a full bladder is reduced, combined with weakened urethral sphincter = incontinence. (usually leads to residual urine and frequent Urinary Tract and Bladder Infections (cystitis) |
Other Factors Infections - poor circulation impairs normal defense mechanisms - Delayed healing (Reduced rate of mitosis) - Less rapid immune responses - although antibody pool is large, immune response to new microbes is less effective because lymphocytes are slower to respond to antigens (less active in later years), Skin breakdown and ulcers may predispose those with immune-deficient states to infection high incidence of UTI, - men at risk because of prostatic obstruction - women: bladder prolapse, incontinence, and thinner mucosa in bladder. Cancer - Higher cumulative exposure to carcinogens - immune system less effective surveillance unit = incidence of breast cancer and prostate cancer increases dramatically with increasing age Autoimmune disorders and more degenerative pathologies related to wear and tear - many are chronic progressive disorders - adaptation to stressors is lower in elderly and more difficult because systems may be unable to respond to increased demands |
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Multiple Disorders - common in older population - Osteoarthritis may lead to obesity and diabetes; cardiovascular disease may lead to changes in sexual function, cognitive deficits, or respiratory problems - many elderly take large number of medications (prescribed drugs and OTC) medications and herbal remedies. = these combinations increase possibility of undesirable drug interactions (if individual is consulting several doctors) - higher risk of idiosyncratic or unexpected reactions, toxic effects caused by unpredictable absorption, distribution, elimination of drugs and impaired function (lethargy or lack of coordination) - noncompliance may be an issue - tissue receptors and body mass change in elderly often necessary to adjust dosage and combos of meds. - Integrated treatment for all interacting problems is necessary (Unpredictable absorption, distribution, and elimination of drugs) - Changes in one system often cause cascade of other problems. - Synergistic effects |
TA 24-7 Suggest 3 ways which changes common to aging may be delayed to some extent = Changes may be delayed through an improved diet to prevent atherosclerosis, decrease blood pressure, and maintain bone and muscle and increased activity to maintain musculoskeletal, respiratory, and cardiovascular systems. Have timely health checkups. Do not assume that being old is to be sick or disabled. |
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Chapter 25 Immobility and Associated Problems |
Hemiplegia - Paralysis on one side of the body Paraplegia - Paralysis of the lower body half Quadriplegia - Paralysis of trunk and all four limbs Diplegia - Symmetrical paralysis in any area of the body |
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The effects of inactivity depend on extent of immobilization and its duration - physiotherapy or passive exercise imposed on the involved area of body can minimize the effects of lack of voluntary movement - respiratory therapy is significant in preventing infections (pneumonia) - when body is supine: (lying on back) loss of force of gravity affects many of its natural functions (intestines and urinary tract), - other noticeable effects results from lack of stress normally exerted on bone by skeletal muscle and decreased circulation of blood - bed rest also alters respiratory function, metabolism and renal function |
Musculoskeletal System Effects Inactive muscle - Loss of strength, endurance, and mass - Muscle atrophy (disuse atrophy - after confined in cast for several weeks) - Prolonged bed rest may lead to loss of half of the muscle strength (due to immobility) - Correct positioning and reduction of abnormal stress on immobilized muscles and joints important because these structures may stretch or shorten result in abnormal fixation of a joint, altering biomechanics) - Essential for inactive muscles and joints - generally flexor muscles are stronger than opposing extensor muscles (which atrophy more than flexor) = this imbalance may allow inactive joint to take abnormal position if flexibility is not maintained by range-of-motion exercises - with inactivity: tendons and ligaments shorten and lose elasticity - prolonged immobility causes fibrous tissue to replace muscle cells = muscle wasting and weakening, decreased flexibility, further possibly irreversible deformity (contracture) and loss of function - lack of muscle activity impairs venous return cause pooling of blood in dependent areas of body, development of dependent edema, and decrease in cardiac output, which may cause dizziness or fainting when changing position) |
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Loss of bone mass (bone deteriorates with inactivity) - bone is a "living" tissue, new bone is consistantly forming (osteoblastic activity) and other bone is being resorbed (osteoclastic activity) Bone demineralization occurs - Lack of weight-bearing activity and muscle action = Reduces osteoblastic activity (bone formation) = Osteoclastic activity continues - loss of bone mass and osteoporosis with potential for spontaneous fractures if undue stress is placed on bones |
Breakdown of muscle and bone tissue initially results in elevated serum levels of nitrogen wastes (creatinine) and in elevated serum calcium. - hypercalcemia may cause renal calculi or kidney stones if fluid intake is inadequate and urine becomes too concentrated. = high serum calcium level can further impede muscle tone and leads to flaccidity or loss of muscle tone = passive range of motion exercises and weight bearing if tolerated on regular bases helpful in preventing complications |
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Tendon and ligaments (connects muscles to bone) - Require movement to maintain structure and function - after 4-6 Days of immobility will shorten these connective tissue structures, and density increases. = Results in limited flexibility and range of motion |
TA 25-1 a) effects of immobility on posture and joints = Immobility can lead to muscle atrophy and/or decreased muscle size, muscle weakness, loss of elasticity, shortening or stretching of ligaments and tendons, and decreased bone mass and density. b) how immobility can lead to osteoporosis = The lack of weight bearing and muscle activity reduces bone formation while the bone breakdown activity continues, leading to loss of bone mass and osteoporosis. |
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Cutaneous Effects - skin breaks down easily when circulation is impaired and cell regeneration is reduced - blood supply often reduced where skin is stretched over bony projections and little fatty or muscular tissue to cushion weight of body - areas that are particularly vulnerable to poor blood perfusion (ischial tuberosities, sacrum, the greater trochanter of hip, the heels and the elbows) = pressure at these points cause ischemia and necrosis of tissue - lead to decubitus ulcers (pressure sores or bedsores) |
Cutaneous Effects Factors that promote skin breakdown - Poor general circulation or anemia - Edema - Inadequate subcutaneous tissue in older adults or disabled persons - Loss of sensation - Mechanical irritation or friction - Excessive moisture from perspiration or urine - Inadequate personal hygiene - Inadequate nutrition or hydration - Trauma to the skin: due to friction against clothing or sheets if patient is moved without due care or slides down in bed or if skeletal muscle spasms occur; adhesive tape may irritate the skin directly or indirectly when removed. |
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The affected area first appears red, then superficial skin breakdown is apparent - ulceration follows and area become purplish-red (if damage is deep) - eventually necrosis destroys deeper tissue and large open area develops with full-thickness damage - local infection is common - risk of skin breakdown can be reduced if sensitive areas are protected by sheepskin pads or flotation devices and patient's position is changed frequently to avoid prolonged pressure, maintaining adequate circulation |
TA 25-2 a) why elderly person confined to wheelchair might develop decubitus ulcers? = Sitting in one position in a wheelchair causes pressure on the skin, compression of blood supply, ischemia, and breakdown of skin. In older adults, loss of subcutaneous and fatty tissue and muscle leads to less padding over pressure points. b) suggest several ways of reducing risk of skin breakdown and ulceration = The risk of skin breakdown can be decreased by frequent changes in position or movement and miniexercises of limbs, padding pressure points over bony projections, particularly if there is little fatty tissue present, avoiding rough materials against the skin, keeping the skin dry, and maintaining nutrition and hydration |
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Cardiovascular System Effects Full immobilization—initially - horizontal body position leads to more blood returning to heart from legs - Blood pools in trunk (esp in lungs) - Venous return may increase = leads to increased intracardial pressure, increasing heart rate and stroke volume Prolonged immobility and bedrest - Venous return and cardiac output reduced - Orthostatic hypotension—at change of position = Short periods of dizziness = Fainting = Pallor and sweating = Rapid pulse (whenever body position is quickly changed) - normally: skeletal muscle contraction assist in returning venous blood to heart - body position supine to upright: reflex vasoconstriction occurs in skin and viscera to promote venous return = adequate venous return ensures sufficient cardiac output to supply brain and prevent a drop in blood pressure and fainting = after patient becomes mobile again, may take several weeks for reflex controls to return to normal (ensuring adequate circulation) |
Other problems Blood pooling—stasis associated with immobility - Increased capillary pressure and edema - Promotes thrombus formation in veins = Particularly in deep leg veins - Blood clotting in patients with dehydration or cancer (by increased coagulability of blood) - sluggish blood flow and decreased venous return, blood clots may be encouraged by compression or damage of blood vessels (pressure from body position in bed or wheelchair) = May be encouraged by increased venous pressure or damage to blood vessels - action of skeletal muscles (contraction of calf muscles, compresses major veins in legs aiding in venous flow back to heart) |
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Combo of 3 factors - venous stasis - hypercoagulability - blood vessel damage = Virchow's triad - dramatically increases chances of a deep vein thrombosis - Thrombi threat because may break away movement or massage resulting in pulmonary embolus, (serious consequences for respiratory and cardiovascular function) = depending on primary problem: antiembolic stockings, exercises or anticoagulant therapy may be helpful prophylactic measures |
Respiratory System Effects - Decreased metabolism - Respiration slow and shallow - Deep breathing and coughing more difficult - Drugs = Sedatives and analgesics = Depress neuromuscular activity and respiratory control center - Increased secretions in the lungs = Pneumonia = Atelectasis |
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Respiratory Effects - when immobilized, less demand for oxygen because metabolism is decreased, unless some factors such as infection is increasing, the resting rate or metabolism or basal metabolic rate (BMR), = respiratory system can easily meet body's requirements - usually respirations become slow and shallow - when person is supine in bed, deep breathing and coughing become difficult because chest expansion is restricted by body weight and upward pressure of abdominal contents against diaphragm = gas exchange decreased as thoracic capacity is reduced and ventilation is diminished = any muscle weakness will impair effectiveness of respiratory efforts - Drugs: sedatives (promote sleep and reduce anxiety) and analgesics (control pain) depress neuromuscular activity and respiratory control center = lead to slowed, shallow respiration. |
When person immobilized - secretions build up in airways, difficult to remove (cough mechanism is less effective) - ciliary action may be reduced if nutrition is impaired or the patient is a smoker - other factors: lead to increased secretions in lungs: more viscous mucus due to dehydration and inflammation (due to instrumentation- surgery or testing procedures) = increased fluid in lungs impair lung expansion = stasis of secretion predisposes patient to serious respiratory complications = lead to infection (hypostatic pneumonia) or obstruction of airway and collapse of lung (atelectasis) - Pneumonia and Atelectasis may result from aspiration of food or water intake, occurs more easily when patient is immobilized or in a supine position = normally in upright position: gravity assists rapid movement of food down esophagus |
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Respiratory Therapy - breathing exercises may be helpful and are frequently part of preoperative preparation - personal respirometers provide an incentive for patients to improve their ventilation capacity before and after surgery |
TA 25-3 explain why pneumonia is a common occurrence in immobilized persons = Secretions pool in the lungs because there are few position changes, and it is more difficult to have effective deep coughing to remove secretions. Bacteria drain down into the lungs, a good environment for microbial growth. |
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Digestive System Effects Decreased dietary intake - Appetite reduced - Negative nitrogen imbalance = Protein deficit Constipation (major problem with immobility) - Caused by muscle inactivity and body position - Reduced food, fiber, fluid intake - elimination affected by slower passage of feces thru intestine due to muscle inactivity and body position = results in harder stool - people who are ill: reduced intake of food, fiber, and fluid, = lead to reduced peristalsis in intestine and more water absorption from fecal mass - weakened muscles make defecation more difficult (and awkwardness of using bedpan in a supine position) = use laxatives, and increase fiber and fluid intake will reduce constipation (in patient with decreased activity) - appetite is often reduced, lead to decreased dietary intake - result in negative nitrogen balance (protein deficit), esp when muscle tissue is breaking down. - protein imbalance - low hemoglobin level and delays in healing - decrease food intake = fatigue and depression (further decrease appetite and may cause malnutrition and further delay healing and recovery) = if norma nutrition cannot be maintained orally: use t1otal parenteral nutrition (TPN) administered via vein or via nasogastric tube Obesity - When prolonged immobility occurs and caloric intake exceeds energy need - increase snacking due to stress/discomfort |
Urinary System Effects Stasis of urine - In kidneys or bladder = Normal drainage by gravity impeded (supine position leads to residual urine in calyces of kidney in dependent area) - Infection = Stasis of urine and calculi are predisposing factors. - Renal calculi (stones) = More likely in people with hypercalcemia (caused by prolonged immobility or with reduced fluid intake) - Bladder infection (cystitis) = Common if catheters are used - Increase in diuresis, resulting in dehydration = Variety of causes: blood shift into thorax can potentially stimulate release of atrial natriuretic peptide (ANP) from heart - which acts as a powerful diuretic (blood shift can stretch aortic arch and receptors in carotid sinus, reduces antidiuretic hormone (ADH) release) - reduction of ADH will reduce reabsorption of water by kidneys - further increases diuretic effect of ANP and increasing overall urine output (can lead to dehydration) |
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Neurological and Psychological Effects Neural effects - Continuous pressure on skin and underlying tissue will stimulate mechanoreceptors (nociceptors), pain receptors (exteroceptors) and others. - overtime, continued pressure can cause serious local tissue damage that can destroy the nerves = result in new sensation of tingling in affected area and eventually a total loss of feeling in area - Spasms may occur because of nerve damage, and therefore muscle innervation may ensue. Psychological effects - Effects of pain and lack of control over the environment - May cause depression and health-related problems (anxiety, confusion and forgetfulness) - overall increased levels of stress involved in immobility has been linked to release of stress hormones such as corticosteroids - can result in widespread physiologic changes affecting individual's overall health |
TA 25-4 Explain how immobility may affect urinary system to produce a systemic as well as local effect - Local urinary problems associated with immobility include infections and formation of renal calculi. Systemic effects can include a widespread systemic infection and an increase of diuresis, leading to dehydration. |
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Effects of Immobility on Children Immobilized for extended period of time - Normal growth and development often delayed because physical movement to stimulate bone and muscle development is lost Contractures and loss of muscle tone may affect: = Hips, Spine, Hands and feet Mobility returns. - Catch-up growth possible |
a) Circulation is more sluggish, and blood tends to pool in dependent areas, causing edema. Blood clots may form with stasis of blood or pressure on blood vessels. Orthostatic hypotension occurs after prolonged immobility because reflexes are slow. |
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Decreased circulating blood and any respiratory impairment limit the supply of nutrients available for healing. Edema in the area interferes with healing. Appetite may be reduced, or immobility may restrict the availability of food and water. Any infection or stress such as pain is an additional drain on resources. |
Explain how frequent changes of position would affect a.(amount of interstitial fluid) Interstitial fluid that has accumulated in a dependent area would probably be decreased when the body position changes, affecting blood flow and pressures at the capillaries. b. (respiratory function) Frequent changes in position promote movement of respiratory secretions, facilitating their removal; a different position may permit better expansion of the lungs, allowing deep breathing and coughing. c. (the Skin) Changes in position improve circulation by relieving pressure and edema and allowing exposure to air for drying. |
