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Significant Physiological Changes

Special Care Needs

Integumentary

Loss of pigment; Thinning of epidermis; Easy bruising; Decreased skin turgor, elasticity, SQ fat; Increased nail thickness/decreased nail growth; Decreased perspiration; Dry, itching, scaly skin; Seborrheic dermatitis/keratosis formation

Neurological

Slowed reflexes; Slight tremors/difficulty with fine motor movement; Loss of balance; Sleep pattern disturbances; Short term memory decline

Musculoskeletal

Decreased muscle mass/strength; Decreased mobility/ROM/flexibility/

coordination/stability; Change of gait; Increased brittleness of bones; Kyphosis

Cardiovascular

Diminished energy; Decreased cardiac output; Decreased resting heart rate; Diminished peripheral pulses; Increased blood pressure/susceptibility to postural hypotension; stiffening/thickening of valves and vessels

Respiratory

Decreased respiratory function secondary to anatomical changes in respiratory muscles/alveoli; Increased rate respirations; Decreased depth respirations/oxygen intake; Decreased ability cough/expectorate

Gastrointestinal

Decreased need for calories; Decreased appetite/thirst/oral intake; Decreased body weight; Digestive disturbances; Decreased absorption of CHO/proteins/fats/vitamins; Increased tendency constipation/dehydration; Dysphagia; teeth changes

Endocrine

Decreased secretion of hormones; Decreased metabolic rate; Decreased glucose tolerance/resistance to insulin

Renal

Decreased kidney size/function/ability to concentrate urine; Decreased GFR; Decreased capacity of bladder; Increased residual urine/incontinence; Increased incidence UTI; Impaired medication excretion

Reproductive

Decreased testosterone production/size of testes in males; Changes in prostate gland in males; Decreased secretion of female hormones/menopause; Vaginal changes in females; Sexual dysfunction both sexes (potential)

Special Senses

Decreased visual acuity/accommodation/peripheral vision; Cataract formation; Decreased hearing; Inability to discern food tastes; Decreased sense of smell; Changes in touch sensation; Decreased pain awareness

Guillain-Barre

ALS (Lou Gehrig’s)

Myasthenia Gravis

What is

This?

Auto-Immune or not?

A PNS disorder, acute inflammatory demyelinating polyneuropathy, rapidly progressing flaccid paralysis.

Auto-immune

Rapidly progressing fatal CNS disease that affects voluntary muscle control, leads to death of the cells resulting in the brain losing the ability to initiate and control muscle movement

Affects the diaphragm and chest wall resulting in respiratory failure and need for placement of an artificial airway and ventilator support, does not impair the senses or ability to think.

Neuromuscular junction disorder that results in the body’s immune system attacking healthy cells

Auto-immune

What are the risk factors/Causes it?

Cause: infection by virus or bacteria usually respiratory or GI

No known cause but environment and genetic plays a role

No known risk factor

How do you Diagnose?

Lumbar puncture to obtain CSF (findings include elevated protein)

Electro myography

reveals slowed nerve conduction velocity soon after the patient develop paralysis

Both upper and lower motor neuron damage that cannot be attributed to other causes

Serological test

Electro myography

Edrophonium (Tensilon)- Anticholinesterase

IVP, (Diarrhea, Bradycardia)

Antidote: Atropine

What are the signs and symptoms?

How do you treat?

Nursing Considerations

Cardiac

Rhythm

s

Rhythm

What is it?

What causes it?

S/S and Diagnose

Treatment

Normal Sinus Rhythm

Sinus Bradycardia

Rate less than 60 bpm

Normal P wave preceding each QRS complex

Regular atrial and ventricle rhythms

Normal in a well-conditioned heart, example, athletes

Increased intracranial pressure, increased vagal tone due to straining during defecation,

Administer atropine for symptoms of low cardiac output

Pacemaker

Sinus Tachycardia

Rate more than 100 bpm

Atrial and ventricular rhythms are regular

Normal P wave preceding each QRS complex

Beta-adrenergic blockers or calcium channel blockers for symptomatic patients

PVC

Atrial and ventricular rhythm is regular

QRS complex premature, usually followed by a complete compensatory pause

QRS complexes are wide and distorted, usually less than 0.14 second

Premature QRS complexes occurring singly, in pairs, or in threes, alternating with normal beats, focus from one or more sites.

Heart failure; old or acute myocardial ischemia, infraction or contusion

Caffeine, tobacco, or alcohol use.

Psychological stress, anxiety, pain

Potassium chloride IV if PVS induced by hypokalemia.

Magnesium sulfate IV if PVC induced by hypomagnesemia.

PAC

Premature, abnormal-looking P waves that differ in configuration from normal P waves

QRS complexes after P waves except in very early or blocked PACs

May prelude supraventricular tachycardia.

Stimulates, hyperthyroidism, COPD, infection and other heart diseases.

Usually no treatment is needed.

Carotid sinus massage.

SVT

A-Fib

Atrial rhythm grossly irregular rate less than 300 to 600 bpm.

Ventricular rhythm grossly irregular, rate 160 to 180 bpm.

PR interval indiscernible.

No P waves, or P waves that appear as erratic, irregular baseline fibrillatory waves.

Heart failure, COPD, ischemic heart disease, sepsis, pulmonary embolus, hypertension, atrial irritation.

If a patient is unstable with ventricular rate less than 150bpm, prepare for immediate cardioversion.

If stable, drug therapy may include calcium channel blockers, beta-adrenergic blockers, digoxin, amiodarone, quinidine

A-Flutter

V-Tac

V-Fib

Asystole

No atrial or ventricular rate or rhythm

No discernible P waves, QRS complexes, or T waves

Cocaine overdose

Chronic Stable Angina

Unstable Angina

Variant Angina

EKG Interpretation

“P” Wave

“R-R” Interval

“P-R” Interval

“QRS”

“T” Wave

“ST Segment”

Older Adult

Cancer

Cardiovascular changes

Cardiac conduction is affected by the decrease in the number of pacemaker cells in the SA node with age. By age 60, the number in the pacemaker is decreased SA node. In advancing age, there is an increase in elastic and collagenous tissue in all parts of the conduction system. Fat accumulates around the SA node, sometimes it produces a partial or complete separation of the node from the atrial musculature. Cardiac output is unaffected by age.

What is This?

Cancer is a disease in which some of the body’s cells grow uncontrollably and spread to other parts of the body. Cancerous tumors spread into, or invade, nearby tissues and can travel to distant places in the body to form new tumors (a process called metastasis). Cancerous tumors may also be called malignant tumors. Benign tumors do not spread into, or invade, nearby tissues. When removed, benign tumors usually do not grow back, whereas cancerous tumors sometimes do.

Respiratory changes

Alveoli lose their shape and become baggy. The diaphragm over time become weaker, decreasing the ability to inhale and exhale, this happens when exercising. Ribcage bones become thinner and the shape changes, which makes it less able to expand and contract with breathing.

What are the risk factors/Causes it?

The most common risk factors for cancer include aging, tobacco, sun exposure, radiation exposure, chemicals and other substances, some viruses and bacteria, certain hormones, family history of cancer, alcohol, poor diet, lack of physical activity or being overweight.

Gastro changes

Alterations in taste and smell, gastric motility, intestinal overgrowth and changes in gastro hormone release are the basis of the physiological anorexia of aging. Alterations in swallowing lead to silent aspiration. Changes in gastro function can lead to constipation and fecal incontinence. Changes in probiotics can lead to diarrhea and altered immune system. In the liver, aging is associated with delayed drug metabolism.

How do you Diagnose?

The doctor does a biopsy to diagnose cancer. A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist looks at the tissue under a microscope and runs other test to determine if the tissue is cancer.

GU changes

Kidney tissue decreases and kidney function diminishes. Number of filtering units decreases. Nephrons filters waste material from the blood. Blood vessels supplying the kidneys can become hardened, which causes the kidneys to filter blood more slowly. Bladder control issues, such as leakage or urinary incontinence or urinary retention. Bladder muscles weaken, the urethra can become partially or totally blocked, in women, this can be due to weakened muscles that causes that cause the bladder or vagina to prolapse. In men, the urethra can become blocked by an enlarged prostate gland.

What are the signs and symptoms?

Change in bowel or bladder habits, a sore throat that does not heal, unusual bleeding or discharge, thickening or lump in the breast or elsewhere, indigestion or difficulty in swallowing, obvious changes in a wart or mole, nagging cough or hoarseness.

Nervous System and Senses

The brain and spinal cord lose nerve cells and weight. Nerve cells may begin to pass messages more slowly than in the past. Waste products or other chemicals such as beta amyloid can collect in the brain tissue as nerve cells break down. This can cause abnormal changes in the brain called plaques and tangles to form. Breakdown of nerves can affect your senses. You might have reduced or lost reflexes or sensation, which leads to problems with movement and safety.

How do you treat?

Cancer can be treated with surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy, hormone therapy or stem cell transplants

Dementia

Is a group of symptoms affecting memory, thinking and social abilities severely enough to interfere with daily life. Memory loss, which is usually noticed by someone else. Difficulty communicating or finding words. Difficulty with visual and spatial abilities, such as getting lost while driving. Difficulty reasoning or problem-solving, difficulty handling complex tasks, difficulty with planning and organizing,

Coordination and motor functions, confusion and disorientation.

Chemotherapy Side effects

Chemo works by killing fast-growing cancer cells. Chemo decreases the number of white blood cells in your body, which weakens the body and increases you risk of infection. Hair loss, nausea and vomiting, rash, constipation and diarrhea, mouth, bruising and bleeding more easily.

Safety Considerations

Remove fall hazards, like throw rugs, clean up piled clutter, discard old furniture, wear non-slip footwear when inside. Keep emergency numbers handy, ensure a safe bathroom, by installing grab bars in the shower and beside the toilet, set water heater no more than 120 degrees Fahrenheit to prevent accidental burns, put rubber mats in the bathtub to prevent slipping and install a nightlight in the bathroom.

Nursing Considerations

Educate the patient on pain, nausea, vomiting, nutrition, skin changes, fatigue, anorexia, alopecia

Histologic Classification of Tumors

TNM, the T labels the size of the tumor

Multiple Sclerosis

Parkinson’s Disease

Bell’s Palsy

What is

This?

Auto-Immune

or not?

A neurologic disease resulting in impaired and worsening function of voluntary muscles. Affecting nerve cells in the brain and spinal cord.

Auto-Immune

Progressively debilitating disease affecting motor function. Overstimulation of the basal ganglia by acetylcholine, dopamine is decreased

Not Auto Immune

Muscle weakness on one side of the face.

Inflammation of the cranial nerve # 7

Recovery 3 weeks- 9 months (some patient may have residual affects)

What are the risk factors/Causes it?

Caused by a genetic, immune mediated attack or infection that destroys myelin.

Risks: Age between 20-40, females, family history, association with interleukin 7 and interleukin 2 receptor genes, viruses and infectious agents, living in a cold climate, physical injury, emotional stress, pregnancy, fatigue, overexertion

Risks: Onset findings age 40-70, males, genetic predisposition, environmental toxins, chemical solvents, chronic use of antipsychotic medications.

Complications: pneumonia, aspiration, dementia

Causes: reactivation of herpes, acute demyelination like Guillain Barre, viruses

Risks: Age, pregnancy, patients with diabetes or hypothyroidism

How do you Diagnose?

There is no single test to diagnose MS. A thorough physical and neurologic examination that includes MRI imaging and blood test, combined with a careful study of an individual’s medical history.

What are the signs and symptoms?

Decrease in cognitive function

Blurred vision

Incontinence and urinary urgency

Muscle spasms

Dizziness

Depression

How do you treat?

Corticosteroids

Plasma exchange

Interferon beta medications

Fingolimod (Gilenya)

Nursing Considerations

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