NR I601 IMidterm IStudy IGuide
Developmental Ichanges
o Review IKennedy Iand IDunphy Ireadings Ifor Iage Irelated Ichanges:
o Physiological:
1. Limited Ichest Iwall Iexpansion
2. Cilia Iatrophy
3. Immune Isystem Ialterations
4. Cardiac, Irespiratory Iand Irenal Ireduced Iphysiological Ireserve
5. Reduced Ihomeostatic Imechanisms Ithat Ifail Ito Iadjust Iregulatory Isystems Isuch Ias Itemperature Icontrol
Iand Ifluid Iand Ielectrolyte Ibalance.
6. Changes Iin Ithe Isympathetic Iresponse Iwhich Icontributes Ito Iorthostasis Iand Ifalls, Ias Iwell Ias Ilack Iof
Ihypoglycemic Iresponse.
7. Impaired Iimmunological Ifunction: Iinfection Irisk Iis Igreater Iand Iauto-immune Idiseases Iare Imore
Iprevalent.
o ILab Iresults- IDunphy ITable I77.2- IPAGE
1. Protein: Irises Islightly- Ikidney Ichanges Iwith Iage, IUTI, Irenal Ipathology
2. Specific Igravity: Ilower Imaximum Iin Ielderly- Ithe Idecline Iin Inephrons Iimpairs Ithe Iability Ito
Iconcentrate Iurine.
3. ESR: Isignificant Iincrease- Ineither Isensitive Inor Ispecific Iin Iaged.
4. Iron IBinding: Islight Idecrease
5. HGB: Imen Islight Idecrease, Iwomen Ino Ichange- Ianemia Icommon Iin Ielderly.
6. HCT: Islight Idecrease Ispeculated: Idecline Iin Ihematopoiesis.
7. Leukocytes: Islight Idecrease Idue Ito Idrugs Ior Isepsis Iand Ishould Inot Ibe Iattributed Iimmediately Ito Iage.
8. Lymphocytes: IT-CELL IAND IB-CELL Ilevels Ifall- Itherefore Iinfection Irisk Iis Ihigher Iand Iimmunizations
Ishould Ibe Iencouraged.
9. Platelets: Ino Ichange
,10. Albumin: Idecline- Irelated Ito Ia Idecrease Iin Iliver Isize Iand Ienzymes: Iprotein-energy Imalnutrition,
Iinfection, Iand Iliver Idisease.
11. BUN: Iincreases Isignificantly Iup Ito I69mg/100 Iml.- Idecline Iin IGFR; Idecreased Icardiac Ioutput.
12. Creatinine: Iincreases Ito I1.9 Img/100 Iml- Irelated Ito Ilean Ibody Imass Idecrease.
13. Creatinine Iclearance: Idecreases I10%/decade Iafter I30 Iyears Iof Iage- Iused Ifor Iprescribing Imeds
Iexcreted Iby Ikidneys.
14. Glucose Itolerance: Islight Iincrease Iof I10mg/DL Iper Idecade Iafter I30 Iyears Iof Iage- Idiabetes
Iincreasingly Iprevalent; Idrugs Imay Icause Iglucose Iintolerance.
o I Atypical Idisease Ipresentations- IPG. I4
1. Acute Iabdomen: Iabsence Iof Isymptoms Ior Ivague Isymptoms, Iacute Iconfusion, Imild Idiscomfort
Iand Iconstipation, Isome Itachypnea Iand Ipossibly Ivague Irespiratory Isymptoms, Iappendicitis Ipain
Imay Ibegin Iin Iright Ilower Iquadrant Iand Ibecome Idiffuse.
2. Depression: Ianorexia, Ivague Iabdominal Icomplaints, Inew Ionset Iof Iconfusion, Iinsomnia,
Ihyperactivity, Ilack Iof Isadness.
3. Hyperthyroidism: IHyperthyroidism Ipresenting Ias I“apathetic Ithyrotoxicosis,” Ii.e., Ifatigue Iand
Iweakness; Iweight Iloss Imay Iresult Iinstead Iof Iweight Igain; Ipatients Ireport Ipalpitations,
Itachycardia, Inew Ionset Iof Iatrial Ifibrillation, Iand Iheart Ifailure Imay Ioccur Iwith Iundiagnosed
Ihyperthyroidism I .
4. Hypothyroidism: Iconfusion, Iagitation, Inew Ionset Ianorexia, Iweight Iloss, Iand Iarthralgias Imay
Ioccur.
5. Malignancy: Inew Ior Iworsening Iback Ipain Isecondary Ito Imetastasis Ifrom Islow Igrowing Ibreast
Imasses. ISilent Imasses Iof Ithe Ibowel.
6. Myocardial Iinfarction: Iabsence Iof Ichest Ipain. IVague Isymptoms Iof Ifatigue, Inausea, Iand Ia
Idecrease Iin Ifunctional Iand Icognitive Istatus. IClassic Ipresentations Iinclude Idyspnea, Iepigastric
Idiscomfort, Iweakness, Ivomiting, Ihistory Iof Iprevious Icardiac Ifailure. IHigher Iprevalence Iin
Ifemales Iversus Imales. INon-Q- IWAVE IMI.
7. Overall Iinfectious Idisease Iprocesses: Iabsence Iof Ifever Ior Ilow-grade Ifever, Imalaise, Isepsis
Iwithout Iusual Ileukocytosis Iand Ifever. IFalls, Ianorexia, Inew Ionset Iof Iconfusion Iand/or Ialteration
Iand Ichange Iin Imental Istatus, Idecrease Iin Iusual Ifunctional Istatus.
8. Peptic Iulcer Idisease: Iabsence Iof Iabdominal Ipain, Idyspepsia, Iearly Isatiety, Ipainless, Ibloodless,
Inew Ionset Iof Iconfusion, Iunexplained Itachycardia, Iand/or Ihypotension.
, 9. Pneumonia: Iabsence Iof Ifever, Imild Icoughing Iwithout Icopious Isputum, Iespecially Iin Idehydrated
Ipatients, Itachycardia Iand Itachypnea, Ianorexia Iand Imalaise Iare Icommon, Ialteration Iin Icognition.
10. Pulmonary Iedema: Ilack Iof Iproximal Inocturnal Idyspnea Ior Icoughing, Iinsidious Ionset Iwith
Ichanges Iin Ifunction, Ifood Ior Ifluid Iintake, Ior Iconfusion.
11. Tuberculosis: Ihepatosplenomegaly, Iabnormalities Iin Iliver Ifunction Itest, Iand Ianemia.
12. UTI: Iabsence Iof Ifever, Iworsening Imental Ior Ifunctional Istatus, Idizziness, Ianorexia, Ifatigue, Iand
Iweakness.
o IGeriatric Isyndromes: Ifocus Ishould Ibe Ion Imaintaining Ifunction, Idignity, Iand Iindividual IcontrolIto
Ipromote Ihealth Iand Iquality Iof Ilife. IEarly Idetection Iand Icorrection Iof Iproblems Isuch Ias Isensory
Ideficits, Iconfusion, Iand Igait Iand Ibalance Iissues Ican Iincrease Iindependence Iand Ilongevity Iamong
Ithis Igroup.
1. SPICES Igeriatric Isyndrome Imarkers:
S: Isleep Idisturbances
P: Iproblems Iwith Ieating Ior Ifeeding.
I: Iincontinence
I
C: Iconfusion- Ioften Icaused Iby Idelirium Iand Idementia. I(PAGE I1291-
• Delirium Iis Ia Istate Iof Imental Iconfusion Ithat Idevelops Isuddenly Iand Ican Ifluctuate
Iover Itime. ISymptoms Iinclude Ihallucinations, Idelusions, Iand Ia Idream Ilike Istate Iof
Iincoherent Iand Imental Iconfusion. ICommon Icauses Iof Idelirium Iinclude Iinfection
Ioften Iurinary Itract Iinfection, Ianticholinergic Imedications, Isedatives, Iantidepressant
Idrugs, Isteroids, Idehydration Iand Ielectrolyte Iin Ibalance, Imetabolic Iand
Iencephalopathy, Ivitamin Ideficiencies, Ior Idiabetes Iand Ithyroid Idisease.
• Dementia Ihas Ia Igradual Ionset Iover Imonths Ior Ieven Iyears. IEvidence Ithat Iregular
Iphysical Iexercise Ireduces Ithe Irisk Iof Idementia. IThis Ioccurs Iwhen Ithere Iis Itoo Imuch IofIa
Ibreakdown Iof Iacetylcholine. IDefined Ias Ia Ichronic Iorganic Idisorder Iof Imental
Iprocesses Iwith Isymptoms Iof Imemory Iloss, Ipersonality Ichanges, Iand Iimpaired
Ireasoning. IThe Imost Icommon Itype Iof Idementia Iis IAlzheimer’s Idisease. IA Istandard
diagnosis Irequires Itwo Iof Ithe Ifollowing Iimpairments Ito Ibe Ipresent;
• A. Imemory Iimpairment
• B. Icommunication Iand Ilanguage Iimpairment
• C. Iinability Ito Ifocus Ior Ipay Iattention
• D. Ireasoning Iand Ijudgment Iimpairment
Developmental Ichanges
o Review IKennedy Iand IDunphy Ireadings Ifor Iage Irelated Ichanges:
o Physiological:
1. Limited Ichest Iwall Iexpansion
2. Cilia Iatrophy
3. Immune Isystem Ialterations
4. Cardiac, Irespiratory Iand Irenal Ireduced Iphysiological Ireserve
5. Reduced Ihomeostatic Imechanisms Ithat Ifail Ito Iadjust Iregulatory Isystems Isuch Ias Itemperature Icontrol
Iand Ifluid Iand Ielectrolyte Ibalance.
6. Changes Iin Ithe Isympathetic Iresponse Iwhich Icontributes Ito Iorthostasis Iand Ifalls, Ias Iwell Ias Ilack Iof
Ihypoglycemic Iresponse.
7. Impaired Iimmunological Ifunction: Iinfection Irisk Iis Igreater Iand Iauto-immune Idiseases Iare Imore
Iprevalent.
o ILab Iresults- IDunphy ITable I77.2- IPAGE
1. Protein: Irises Islightly- Ikidney Ichanges Iwith Iage, IUTI, Irenal Ipathology
2. Specific Igravity: Ilower Imaximum Iin Ielderly- Ithe Idecline Iin Inephrons Iimpairs Ithe Iability Ito
Iconcentrate Iurine.
3. ESR: Isignificant Iincrease- Ineither Isensitive Inor Ispecific Iin Iaged.
4. Iron IBinding: Islight Idecrease
5. HGB: Imen Islight Idecrease, Iwomen Ino Ichange- Ianemia Icommon Iin Ielderly.
6. HCT: Islight Idecrease Ispeculated: Idecline Iin Ihematopoiesis.
7. Leukocytes: Islight Idecrease Idue Ito Idrugs Ior Isepsis Iand Ishould Inot Ibe Iattributed Iimmediately Ito Iage.
8. Lymphocytes: IT-CELL IAND IB-CELL Ilevels Ifall- Itherefore Iinfection Irisk Iis Ihigher Iand Iimmunizations
Ishould Ibe Iencouraged.
9. Platelets: Ino Ichange
,10. Albumin: Idecline- Irelated Ito Ia Idecrease Iin Iliver Isize Iand Ienzymes: Iprotein-energy Imalnutrition,
Iinfection, Iand Iliver Idisease.
11. BUN: Iincreases Isignificantly Iup Ito I69mg/100 Iml.- Idecline Iin IGFR; Idecreased Icardiac Ioutput.
12. Creatinine: Iincreases Ito I1.9 Img/100 Iml- Irelated Ito Ilean Ibody Imass Idecrease.
13. Creatinine Iclearance: Idecreases I10%/decade Iafter I30 Iyears Iof Iage- Iused Ifor Iprescribing Imeds
Iexcreted Iby Ikidneys.
14. Glucose Itolerance: Islight Iincrease Iof I10mg/DL Iper Idecade Iafter I30 Iyears Iof Iage- Idiabetes
Iincreasingly Iprevalent; Idrugs Imay Icause Iglucose Iintolerance.
o I Atypical Idisease Ipresentations- IPG. I4
1. Acute Iabdomen: Iabsence Iof Isymptoms Ior Ivague Isymptoms, Iacute Iconfusion, Imild Idiscomfort
Iand Iconstipation, Isome Itachypnea Iand Ipossibly Ivague Irespiratory Isymptoms, Iappendicitis Ipain
Imay Ibegin Iin Iright Ilower Iquadrant Iand Ibecome Idiffuse.
2. Depression: Ianorexia, Ivague Iabdominal Icomplaints, Inew Ionset Iof Iconfusion, Iinsomnia,
Ihyperactivity, Ilack Iof Isadness.
3. Hyperthyroidism: IHyperthyroidism Ipresenting Ias I“apathetic Ithyrotoxicosis,” Ii.e., Ifatigue Iand
Iweakness; Iweight Iloss Imay Iresult Iinstead Iof Iweight Igain; Ipatients Ireport Ipalpitations,
Itachycardia, Inew Ionset Iof Iatrial Ifibrillation, Iand Iheart Ifailure Imay Ioccur Iwith Iundiagnosed
Ihyperthyroidism I .
4. Hypothyroidism: Iconfusion, Iagitation, Inew Ionset Ianorexia, Iweight Iloss, Iand Iarthralgias Imay
Ioccur.
5. Malignancy: Inew Ior Iworsening Iback Ipain Isecondary Ito Imetastasis Ifrom Islow Igrowing Ibreast
Imasses. ISilent Imasses Iof Ithe Ibowel.
6. Myocardial Iinfarction: Iabsence Iof Ichest Ipain. IVague Isymptoms Iof Ifatigue, Inausea, Iand Ia
Idecrease Iin Ifunctional Iand Icognitive Istatus. IClassic Ipresentations Iinclude Idyspnea, Iepigastric
Idiscomfort, Iweakness, Ivomiting, Ihistory Iof Iprevious Icardiac Ifailure. IHigher Iprevalence Iin
Ifemales Iversus Imales. INon-Q- IWAVE IMI.
7. Overall Iinfectious Idisease Iprocesses: Iabsence Iof Ifever Ior Ilow-grade Ifever, Imalaise, Isepsis
Iwithout Iusual Ileukocytosis Iand Ifever. IFalls, Ianorexia, Inew Ionset Iof Iconfusion Iand/or Ialteration
Iand Ichange Iin Imental Istatus, Idecrease Iin Iusual Ifunctional Istatus.
8. Peptic Iulcer Idisease: Iabsence Iof Iabdominal Ipain, Idyspepsia, Iearly Isatiety, Ipainless, Ibloodless,
Inew Ionset Iof Iconfusion, Iunexplained Itachycardia, Iand/or Ihypotension.
, 9. Pneumonia: Iabsence Iof Ifever, Imild Icoughing Iwithout Icopious Isputum, Iespecially Iin Idehydrated
Ipatients, Itachycardia Iand Itachypnea, Ianorexia Iand Imalaise Iare Icommon, Ialteration Iin Icognition.
10. Pulmonary Iedema: Ilack Iof Iproximal Inocturnal Idyspnea Ior Icoughing, Iinsidious Ionset Iwith
Ichanges Iin Ifunction, Ifood Ior Ifluid Iintake, Ior Iconfusion.
11. Tuberculosis: Ihepatosplenomegaly, Iabnormalities Iin Iliver Ifunction Itest, Iand Ianemia.
12. UTI: Iabsence Iof Ifever, Iworsening Imental Ior Ifunctional Istatus, Idizziness, Ianorexia, Ifatigue, Iand
Iweakness.
o IGeriatric Isyndromes: Ifocus Ishould Ibe Ion Imaintaining Ifunction, Idignity, Iand Iindividual IcontrolIto
Ipromote Ihealth Iand Iquality Iof Ilife. IEarly Idetection Iand Icorrection Iof Iproblems Isuch Ias Isensory
Ideficits, Iconfusion, Iand Igait Iand Ibalance Iissues Ican Iincrease Iindependence Iand Ilongevity Iamong
Ithis Igroup.
1. SPICES Igeriatric Isyndrome Imarkers:
S: Isleep Idisturbances
P: Iproblems Iwith Ieating Ior Ifeeding.
I: Iincontinence
I
C: Iconfusion- Ioften Icaused Iby Idelirium Iand Idementia. I(PAGE I1291-
• Delirium Iis Ia Istate Iof Imental Iconfusion Ithat Idevelops Isuddenly Iand Ican Ifluctuate
Iover Itime. ISymptoms Iinclude Ihallucinations, Idelusions, Iand Ia Idream Ilike Istate Iof
Iincoherent Iand Imental Iconfusion. ICommon Icauses Iof Idelirium Iinclude Iinfection
Ioften Iurinary Itract Iinfection, Ianticholinergic Imedications, Isedatives, Iantidepressant
Idrugs, Isteroids, Idehydration Iand Ielectrolyte Iin Ibalance, Imetabolic Iand
Iencephalopathy, Ivitamin Ideficiencies, Ior Idiabetes Iand Ithyroid Idisease.
• Dementia Ihas Ia Igradual Ionset Iover Imonths Ior Ieven Iyears. IEvidence Ithat Iregular
Iphysical Iexercise Ireduces Ithe Irisk Iof Idementia. IThis Ioccurs Iwhen Ithere Iis Itoo Imuch IofIa
Ibreakdown Iof Iacetylcholine. IDefined Ias Ia Ichronic Iorganic Idisorder Iof Imental
Iprocesses Iwith Isymptoms Iof Imemory Iloss, Ipersonality Ichanges, Iand Iimpaired
Ireasoning. IThe Imost Icommon Itype Iof Idementia Iis IAlzheimer’s Idisease. IA Istandard
diagnosis Irequires Itwo Iof Ithe Ifollowing Iimpairments Ito Ibe Ipresent;
• A. Imemory Iimpairment
• B. Icommunication Iand Ilanguage Iimpairment
• C. Iinability Ito Ifocus Ior Ipay Iattention
• D. Ireasoning Iand Ijudgment Iimpairment
