1. Recognizing Changes in Body
Function
NATCEP Day Thirty-One &Thirty-Two

2. Objectives
• Describe the aging changes and their
consequences for the following body
systems:
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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
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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
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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
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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
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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.

13. Common Diseases
Respiratory System
• Common Diseases:
– Chronic Obstructive Pulmonary Disease
(COPD)
– Pneumonia
– Tuberculosis
– Asthma

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

16. COPD
• Treatment
– Stop Smoking
– Oxygen Therapy
– Breathing Exercises
– Respiratory Therapy
– Medications

17. Pneumonia
• Inflammation and infection of lungs
• Signs & Symptoms
– Sudden onset
– Very ill
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Fever (chills)
Painful cough
Chest pain when breathing
Rapid pulse
• Treatment
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Drugs for infection & pain
Increased fluids
Rest
Semi-Fowlers

18. Tuberculosis
• Bacterial infection of lungs
• Signs & Symptoms
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Tiredness
Loss of appetite
Weight loss
Fever & Night sweats
Cough with sputum (may contain blood)
• Treatment
– Drugs
– Comfort measures
– Respiratory Isolation

19. Consequences
Respiratory System Changes
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Shortness of breath
Infections
Choking
Fatigue

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.

23. Common Diseases
Endocrine System
• Common Diseases:
– Diabetes

24. Diabetic Coma
• Hyperglycemia: High Blood Glucose
• Symptoms
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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
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• 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
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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
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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
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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
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Severe, cramping pain in back and side (flank)
Nausea & vomiting
Fever & chills
Painful urination, urgency & frequency
Blood in the urine (hematuria)
• Treatment
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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
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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
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Encourage fluids unless directed otherwise
Record output according to care plan & policy
Assist to bathroom as needed and per care plan
Observations about urine:
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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
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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
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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)
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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
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Tremors
Rigid, stiff muscles
Slow movements
Stooped posture
Mask-like expression
• Treatment
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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
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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
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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
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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