NR 601 Midterm Exam Study Guide

Developmental Changes

• Replicative senescence: theory states that cells can replicate or divide a specific number of

times.

o This ability decreases with age

• Oxidative damage: Is the cumulative result of the aerobic metabolism, which generates

chemicals called free radicals

o Free radicals may interact with other chemicals in the body and cause damage to cells

• Telomere shortening theory that links aging to a reduction in cell division

• Weakening of the immune response: Leaves older adults more vulnerable to infection and

debilitating diseases

Dunphy physiological p.1285

Age-Related

Change

Appearance or Functional Change Implication

Integumentary System

Loss of dermal and

epidermal thickness

Loss of SQ tissue and thin epidermis Prone to skin breakdown and injury

Decreased vascularity • Atrophy of sweat glands resulting in decreased

sweat production

• Decreased body odor

• Decreased heat loss

• Dryness

• Alteration in thermoregulatory response

• Fluid requirements may change

seasonally

• Loss of skin water

• Increased risk of heat stroke

Respiratory System

Decreased lung tissue

elasticity

Decreased vital capacity Reduced overall efficiency of ventilatory exchange

Cilia atrophy Change in mucociliary transport Increased susceptibility to infection

Decreased respiratory

muscle strength

• Reduced ability to handle secretions and

reduced effectiveness against noxious foreign

particles

• Partial inflation of lungs at rest

Increased risk of atelectasis

Cardiovascular System

Heart valves thicken and

become fibrotic

Reduced stroke volume, cardiac output; may be altered Decreased responsiveness to stress

Fibroelastic thickening of

the SA node; decreased

# of pacemaker cells

Slower heart rate Increased prevalence of arrhythmias

Decreased baroreceptor

sensitivity (stretch

receptors)

Decreased sensitivity to changes in blood pressure Prone to loss of balance, which increases the risk

for falls

Gastrointestinal System

Liver becomes smaller Decreased storage capacity

Decreased muscle tone Altered motility Increases risk of constipation, functional bowel

syndrome, esophageal spasm, diverticular

disease

Decreased basal

metabolic rate (rate at

which fuel is converted

into energy)

May need fewer calories

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Laxity of skin

Kennedy physiological

Age-Related Change Appearance or Functional Change Implication

Integumentary System

Loss of dermal and epidermal thickness Paper-thin skin Prone to skin tears

Decreased vascularity Slower recruitment of sweat glands by

thermal stimulation

Alteration in thermoregularity response;

diminished ability to adapt to temperature

changes

Fluid requirements may change

seasonally

Decreased body odor

Decreased heat loss

Dryness

Loss of skin water

Increased risk of heat stroke

Collagen cross-linking Increased wrinkling Potential effect on one’s morale and

feeling of self-worth

Elastic regression

Loss of SQ fat Intraosseous atrophy, especially on the

back of hands and to the face

Loss of fat tissue on soles of feet –

trauma of walking increases foot

problems

Decreased elasticity Difficulty assessing skin turgor

Loss of SQ tissue Purpuric patches after minor surgery Reduced insulation against cold

temperatures; prone to hypothermia

Check why injury is occurring; be alert for

potential abuse or falls

Decreased # of melanocytes Loss of pigment Teach the importance of using sun block

creams; refer to a dermatologist as

needed

Pigment plaque appears

Decreased turnover rate of keratinocytes

Increased exposure of the epidermal cells

to the environment to include UV

radiation

Increased risk of nonmalignant skin

cancers and malignant melanoma

Decline in fibroblast proliferation Decreased epidermal growth rate Decreased tissue repair response

Slower re-epithelialization

Decreased vitamin D production and

synthesis

Increased risk for developing

osteoporosis and other conditions

associated with vitamin D deficiency

Decreased hair follicle density Loss of body hair

Decreased growth phase of individual

fibers

Thin, short villus hairs predominate

Slower hair growth

Loss of melanocytes from the hair bulb Graying of the hair Potential effect on self-esteem

Flattening of papillae Shearing and friction force more readily

peels off the dermis

Diminished cell-mediated immunity in the

skin

Prone to skin breakdown and injury

Atrophy of the sebaceous glands Decreased production of oil and cerumen Frequent pruritus and xerosis

Atrophy of the sebaceous glands Decreased sweating ability Impaired thermoregulation

Alternating hyperplasia and hypoplasia of Longitudinal ridges Nails prone to splitting

nail matrix Thinner nails of the fingers Advise patient to wear gloves, keep nails

short, and avoid nail polish remover

(causes dryness); refer patient to

podiatrist

Thickened, curled toenails or claw-like

nails known as onychogryphosis

May cause discomfort

Respiratory System

Decreased lung tissue elasticity Decreased vital capacity Reduced overall efficiency of ventilatory

exchange

Increased residual volume

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Decreased maximum breath capacity

Dental enamel thins

Gums recede

Staining of tooth surface occurs

Teeth deprived of nutrients

Tooth and gum decay; tooth loss

Thoracic wall calcification Increased anteroposterior diameter of

chest

Obscuration of heart and lung sounds

Displacement of apical impulse

Cilia atrophy Change in mucociliary transport; mucusproducing cells increase

Increased susceptibility to infection

Decreased respiratory muscle strength Reduced ability to handle secretions and

reduced effectiveness against noxious

foreign particles

Partial inflation of lungs at rest

Prone to atelectasis

Less sensitivity to hypoxia; impaired

ability to recognize bronchoconstriction

Increased respiratory distress Increased risk of mortality from acute

respiratory conditions

Cardiovascular System

Heart valves fibrose and thicken Reduced stroke volume; cardiac output

may be altered

Decreased responsiveness to stress;

heart rate and BP take longer to return to

normal resting rate following exertion

Slight left ventricular hypertrophy Increased incidence of murmurs,

particularly aortic stenosis and mitral

regurgitation

Mucoid degeneration of mitral valve S4 sound commonly heard

Valve less dense; mitral leaflet stretches

with intrathoracic pressure

Fibroelastic thickening of the SA node;

decreased # of pacemaker cells

Slower HR Increased prevalence of arrhythmias and

extra heart beats become more common

Irregular HR

Increased sub pericardial fat

Collagen accumulation around heart

muscle

Elongation of tortuosity and calcification

of arteries

Increased rigidity of arterial wall Aneurysms may form

Elastin and collagen cause progressive

thickening and loss of arterial wall

resiliency

Increased peripheral vascular resistance Decreased blood flow to body organs

Altered distribution of blood flow

Loss of elasticity of the aorta dilation Increased systolic BP, contributing to

CAD

Increased lipid content in artery wall Lipid deposits form Increased incidence of atherosclerotic

events such as angina pectoris, stroke,

gangrene

Increased baroreceptor sensitivity (stretch

receptors)

Decreased sensitivity to change in BP Prone to loss of balance—potential for

falls

Decreased baroreceptor mediation to

straining

Valsalva maneuver may cause sudden

drop in BP, orthostatic hypotension, and

dizziness when the patient changes from

a lying or sitting position to standing

Gastrointestinal System

Liver becomes smaller Decreased storage capacity; decreased

efficiency in metabolizing drugs that pass

through the liver

Less efficient cholesterol stabilization

absorption

Increased evidence of gallstones

Atrophy of muscles and bones of the jaw Difficulty with mastication Ability to thoroughly chew food is

impaired and can contribute to dysphagia

with solid foods

Fibrosis and atrophy of salivary glands Prone to dry mucous membranes Shift to mouth breathing is common;

frequent complaints of dry mouth are

expressed

Decreased salivary ptyalin Membrane more susceptible to injury and

infection

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Histological changes in small vessel walls Decreased renal blood flow

Sclerosis of supportive circulatory system

Decreased muscle mass Decreased muscle strength Increased muscle cramping

May interfere with breakdown of starches

Atrophy and decrease in # of taste buds Decreased taste sensation Altered ability to taste sweet, sour, and

bitter

Change in nutritional intake

Excessive seasoning of foods

Delay in esophageal emptying Decline in esophageal peristalsis Occasional discomfort as food stays in

esophagus longer

Stiffening of the esophageal wall

Decreased hydrochloric acid secretion Reduced in amount of iron and vitamin Possible delay in vitamin and drug

B12 that can be absorbed absorption, especially calcium and iron

Decrease in gastric acid secretion Altered drug effect fewer cases of gastric

ulcers

Decreased muscle tone Altered motility Prone to constipation, functional bowel

syndrome, esophageal spasm,

diverticular disease

Decreased colonic peristalsis

Atrophy of mucosal lining Decreased hunger sensations and

emptying time

Decreased proportion of dietary calcium

absorbed

Altered bone formation, muscle

contractility, hormone activity, enzyme

activation, clotting time, immune

response

Symptoms more marked in women then

in men

Decreased basal metabolic rate (rate at

which fuel is converted into energy)

May need fewer calories

Possible effect on life span

Genitourinary and Reproductive Systems

Reduced renal mass Decreased sodium-conserving ability Administration and dosage of drugs may

need to be modified

Loss of glomeruli Decreased GFR

Decreased creatinine clearance

Increased BUN concentration

Decline in # of functioning nephrons Decreased ability to dilute urine Altered response to reduced fluid load or

concentrate increased fluid volume

Reduced bladder muscular tone Decreased bladder capacity or increased Sensation of urge to urinate may not

residual urine occur until bladder is full

Atrophy of fibrosis of cervical and uterine Menopause; decline in fertility Urination at night may increase

walls

Reduced # and viability of oocytes in the Narrowing of cervical canal

aging ovary

Decreased vaginal wall elasticity Vaginal lining thin, pale, friable

Narrowing of vaginal canal

Potential for discomfort in sexual

intercourse

Decreased level of circulating hormones Reduced lubrication during arousal state Increased frequency of sexual

dysfunction

Degeneration of seminiferous tubules Decreased seminal fluid volume

Decreased force of ejaculation

Reduced elevation of testes

Proliferation of stromal and glandular

tissue

Prostatic hypertrophy Potentially compromised genitourinary

function; urinary frequency and increased

risk of malignancy

Involution of mammary gland tissue Connective tissue replaced by adipose Easier to assess breast lesions

tissue

Neuromuscular System

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