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HSM 330 (12)
Chapter 6

HSM330 Chapter 6 notes

10 Pages

Health Services Management
Course Code
HSM 330
Daolun Chen

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Chapter 6- Aging of the Internal Organs Cardiovascular System - body’s main transporter system - Sends supplies such as fluids, nutrients, hormones, oxygen and antibodies - Removes waste products such as carbon dioxide and hydrogen ions - Composed of heart, blood vessels (arteries, arterioles, capillaries, veins and venules) and blood - Arteries carry blood away from heart and veins carry blood to the heart Blood o Composed of water, red and white blood cells and platelets, as well as nutrients such as fat globules, carbs and proteins o Carries electrolytes, to help maintain acid/base balance and chemicals (hormones, NT, peptide) necessary to regulate homeostasis, cognition, movement and function Heart o Located behind chest wall in slanted position o Enclosed in fibrous sac called pericardium o Two upper chambers –atria (collect blood) and two lower chambers- ventricles (pump blood to lungs and body) o Atria – thin walled; Ventricles- thicker more muscular (long distance pumping ) o Oxygen poor blood is collected in right atrium from large veins, superior and inferior vena cava o Than flows to right ventricle and pumped via pulmonary arteries in capillary system of the lungs for carbon dioxide and oxygen exchange o Oxygen rich blood is sent via pulmonary veins to the left atrium, where flows to left ventricle and is pumped out through the aorta o Blood from aorta flows into large arteries and than to the smaller arteries, arterioles and capillaries o Venules collect blood from capillaries and move it into larger veins until it reached superior and inferior vena cava o Veins serve as a huge reservoir for the body’s blood supply as 64% of its volume found in veins o Arteries- composed of smooth muscle, elastic fibres, and collagen o in healthy heart oxygen poor blood is never mixed with oxygen rich blood o beat is started in sinoatrial node or pacemaker and in upper part of right atrium o signal spreads down the heart through the atrial myocardium to reach atrioventrical node o them impulse is conducted to atrioventricular bundle and to the parkinje fibres where it is sent to both ventricles o as signal moves down contraction of cardiac or heart muscle occurs, contraction= systolic; relaxation= diastole; asystole=no heart beat o “lub” when valves between atria and ventricles close, and ventricles contract o “dub” when closure of valves between the ventricles and the large arteries (pulmonary and aorta) o Carotid artery on neck and radial pulse on outer edge of wrist is familiar spot o Top of Foot (pedal pulse) and back of knee (popliteal pulse) o Veins have valves eg. Great saphenous found in the back of legs o Flapper valve forcing blood flow in one direction toward heart o Skeletal muscle movement puts pressure on vein to keep the blood moving o Whole system is referred to as venous pump o After exercise, person stands for 15 min. + venous pumps are less able to work causes fainting o Blood flows increased to deliver ore oxygen and other nutrients but also remove waste, such as lactic acid o Stimulation to decrease and increase heart rate is under the direction of the ANS, with SNS increasing rate and strength of heart beat, and PSNS decreasing its rate and strength Age Related Changes o Enlargement of heart mass, duce to increase in size of muscle cells and myocytes o Slowing of electrical activity of heart o 10% of pacemaker cells that are found in younger people remain o Increase in amount of fat tissue around the sinoatrial node, interferes with conduction system, leads to an abnormally slow pulse=bradycardia o Collagen thicken and becomes stiff in middle layer of large arteries o Larger size and rigidity of large arteries require the heart to work harder, eventually increasing BP o Decreased ability of smaller arteries to dilate or constrict when necessary, affecting the exercise tolerance of older person as well as body’s ability to heat and cool off o Capillaries narrow with age, minimal changes in veins o Heart function less efficient with age, decrease in CV responsiveness to exercise and reduction in max. Heart rate that can be reached Hypertension  Optimal blood pressure for adults over 18 = 120/80 or lower  Systolic hypertension: high reading in systolic pressure, increases in life, whereas elevation in diastolic pressure tends to level off in later life  Both conditions damage collagen in arterial walls, making them stifger, also damages lignin of arteries contributing to atherosclerosis which increases the risk of heart and kidney disease, peripheral vascular disease, and cerebral vascular accidents (strokes) which eventually lead to dementia  Caused by : changed in kidney function, obesity, hormonal changes, increased sensitivity to Na, genetic propensities, arterioscelrosis and atherosclerosis  Managing = weight control, decrease in Na intake, diuretics (side effects: low BP, confusion, impotence and depression)  Medications used for older person initial daily dose should be half for middle aged Arteriosclerosis and Atherosclerosis  Arteriosclerosis refers to the thickening and loss of elasticity of arterial walls  Stiffened arteries tend to be slightly contracted, rasing BP and leading to hypertension which can create further damage to walls  High BP both results from and is a cause of arteriosclerosis  Common form = Atherosclorsis: deposition of plagues inside the arterial walls  Atleast half of the mortality in Europe and north America  Disease started with injury in inner lining of artery caused by trauma, toxins or viruses  Cholesterol especially in the form of oxidized low density lipoproteins (LDL) and triglycerides cause plaque to form  Plaques are sticky, eventually attracting more dead cells, blood clots, bacteria further narrowing the artery and creating an inflammatory process  HDL is “good” form of cholesterol because not sticky and less likely to adhere to arterial walls  First visible sign of atherosclerosis is fatty streak on the inner lining of artery  Risk factors: being male, family history, diet high in fat, diabetes, hypertension, obesity, high levels of homocystine  Primary treatment decrease in dietary cholesterol and lipid lowering medications such as statins  Statins are possible protective against Alzheimers disease Peripheral Vascular Disease  Atherosclerosis can damage peripheral blood vessels  Peripheral arterial occlusive disease (PAOD) arteries that carry blood to the legs and feet are partially or completely blocked due to atherosclerosis  Symptoms: pain, pale or bluish color of skin of feet and legs, lack of hair growth in these areas  Weak or nonexistent arterial pulse in lower extremities  Lack of blood flow causes pain when walking  Ulcerations and gangrene of the lower extremeties  Smoking = constriction of blood vessels, diabetes= impaired circulation Coronary Heath Disease  Results from atherosclerosis of the coronary arteries of the heart  85% of deaths from HD due to CHD  After menopause, rapid progression of disease in women, due to estrogen levels  Arteries of women smaller, more vulnerable to minor problems  Risk factors: smoking, high BP, high cholesterol, overweight, abdominal and chest fat  Angina pectoris is common for CHD, develops with demand for blood to the heart muscle is greater than what can be supplied  Angina felt as pain that radiates to the left shoulder and down the left arm or the jaw or back  Older people have dyspnea(difficulty breathing) , coughing or confusion  CHD lead to myocardial infarction (MI) or heart attack , occurs when artery in heart is blocked because of blood clot  Symptoms : obscure, confusion, abdominal pain, severe head ache  An MI be silent or occur while sleeping or at rest  Initial goal of caring for someone with MI reduce further heart damage or risk  Angiograms and catherization are used to determine how occluded arteries are, and treatment includes administratin of medication to think the blood and control the rhythm of HB  Coronary bypass surgery and angioplasty have been successful  Reduce reoccurances is taking a daily aspirin to reduce blood clotting Heart Failure  Heart that is no longer able to pump blood to meet metabolic needs for the body’s tissues  Exclusively disease of older people  Left ventricle is less able to pump blood out through the aorta and into the arteries of the body, so the supply of oxygen and nutrition to the body’s tissues are reduced  Overt symptoms: shortness of breathe, fatigue, confusion and lethargy  Causes: fluid retention (diet high in Na and use of estrogens), nonsteroidal anti- inflammatory medications (NSAIDs) – conserve water in body that create abnormal fluid levels Promoting Optimal Aging o Folic acid important in preventing cardiovascular disease o CVD inflammatory process, antioxidants such at Vit. E helpful o Light to moderate alcohol use may help to prevent HD, high levels can promote it o Smoking = damaging arterial lining, constricting blood vessels, increasing BP, and promoting atheroscelorsis o Antidepressents helpful to quitting smoking o Physically fit older adults can increase their cardiac output by 50% Respiratory System - Transfer oxygen from the air into the bloodstream and remove carbon dioxide - Involves respiratory tract, and muscles of abdomen, chest and diaphragm - To breathe the diaphragm and intercostals (rib cage) muscles of the chest contact causing the diaphragm to lower and the thoracic cavity to expand - With expiration (breathing out) the relaxing diaphragm bows upward and intercostals muscles relax, allowing the air to leave the lungs - A pleural lining surrounds the outside of the lung tissue and another one lines the chest wall - Two linings do not touch each other, instead a fluid flows between them, lubricating the movement of the lungs - Albeolie are perfused by capillaries, and it is in the alveoli that blood gases are exchanges, replenishing the supply of oxygen and extracting carbon dioxide from the blood - Lungs have the most extensive capillary network surface for any organ in the body - Mast cells linging the respiratory tract are the immune system’s first line of dense, against airborne germs and viruses - Control center in brain, which governs the rate and depth of breathing is located in medulla oblongata and pons - Person is resting quietly , amount of air is tidal volume - Vital capacity of lungs is a combination of tidal volume and extra amounts a person can inspire (inspiratory reserve volume) and expire (expiratory reserve capacity) - Vital capacity is measured by the total amount a person can expire after taking a deep breath - Forced vital capacity (FVC) which is determined by blowing as hard as possible into a spirometer, an instrument that measures the volume of air inhaled and exhaled Age-related Changes o Decrease lung’s ability to exchange oxygen and carbon dioxide o Intercostals and diaphragm muscles become weaker and atrophy with age and chest wall becomes stiffer, reducing the ability of the lungs to expand and contract o Less elastic airways to be open for a shorter period of time o Alveoli become enlarged and flatten with age o Decrease in vital capacity and increase in air left in the lungs after maximal expiration o Normal decrease in cough reflex which reduces the ability of airways to clean themselves and fight infection o Ciliary function decreases with age, as does T-cell immunity o Result in decrease capacity for exercise and maximal exertion Lung Cancer  leading cause of cancer death  smoking accounts for 90% of all lung cancers  secondary lung cancers can occur as metastasis from other sites such as brease or bone  small-cell: generally grow rapidly and have a high rate of metastasis (spread quickly) and non-small cell: slower growing less likely to metastasize common among adults, main types  underdiagnosed among older people because common symptoms with other diseases  chemotherapy Pneumonia  serious illness for fail older adults  spread rather rapidly among nursing home patients  frail adults more vulnerable  normal aging changes in lungs including decreased lung capacity, inadequate cough reflex, decline in immune function  comorbid conditions such as diabetes or heart failure, further limit the ability off the body to heal itself  aspiration pneumonia: common for those who have difficulty drinking, eating, or taking medications; caused by aspiration (inhalation) of substances such as food, fluids or medications into the respiratory tract as right bronchi is shorter and has become less acute angle than the left bronchi (as it leaves the trachea) aspiration of a foreign body is more likely to occur at that side  symptoms may include confusion, poor appetite, weakness , falls  success
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