Republic of the Philippines
BICOL UNIVERSITY POLANGUI CAMPUS
Roselada, Jasmine Rose A.
BSN – III
PROBLEM
1.Common Obstructive
Pulmonary Disease
(Respiratory System)
- is a slowly progressive chronic
obstruction of airflow into or out
of lungs.
S/Sx: cough in the morning with
colorless sputum or mucus, short of
breath, wheezing
GERIATRIC PROBLEMS PER SYSTEM
Pathophysiology
Air travels down your windpipe
(trachea) and into your lungs through
two large tubes (bronchi). Inside your
lungs, these tubes divide many times —
like the branches of a tree — into many
smaller tubes (bronchioles) that end in
clusters of tiny air sacs (alveoli).
The air sacs have very thin walls full of
tiny blood vessels (capillaries). The
oxygen in the air you inhale passes into
these blood vessels and enters your
bloodstream. At the same time, carbon
dioxide — a gas that is a waste product
of metabolism — is exhaled.
Your lungs rely on the natural elasticity
of the bronchial tubes and air sacs to
force air out of your
body. COPD causes them to lose their
elasticity and over expand, which leaves
some air trapped in your lungs when
you exhale.
Polangui, Albay
S.Y 2017-2018
Nursing Intervention Drug Intervention Surgical Intervention
(if needed)
o Avoid irritants: Quit smoking or  Beta-Agonists: Such as Despite numerous
being around smoke Be mindful of albuterol work as medical treatments, surgery may be
the weather (very cold can bronchodilators considered for the symptomatic patient
aggravate the bronchi) Allergens  Anticholinergics: Such as with medically-optimized, end-
like dust or pollen Ipratropium work to relax stage COPD. Bullectomy, lung volume
bronchospasms reduction surgery (LVRS), and lung
o If the patient has been working very  Corticosteroids: Such as transplantation have all proven to be
hard to breath for a long period of Fluticasone work as an anti- important surgical therapies.
time and is getting worse, be inflammatory
prepared with an airway cart. And
for the love of the airway, have
your respiratory therapist aware of
the patient!
o Breathing Treatments and
medications
o Monitor Oxygen saturation
o Encourage a healthy weight Can be
either overweight or underweight
o Encourage movement/activity
o Assess for/Administer influenza

2.Constipation (Digestive
System)
- distressing disorder that is
common among older patients in
hospital. It is often
underdiagnosed and
undertreated, and can lead to
increased morbidity and
prolonged hospital stays.
S/Sx: Confusion, overflow
diarrhoea, nausea and loss of
appetite, urinary retention &
abdominal pain
3. Cerebrovascular
Accident/Stroke
(Cardiovascular System)
- The sudden death of some brain
cells due to lack of oxygen when
the blood flow to the brain is
impaired by blockage or rupture
of an artery to the brain.
A CVA is also referred to as a
stroke. Symptoms of a stroke
depend on the area of the brain
affected.
 S/Sx: Sudden numbness or
weakness in the face, arm, or
leg, especially on one side of
the body, Sudden confusion,
trouble speaking, or difficulty
understanding speech,
The digestive system moves food
through our bodies through a series of
muscle contractions. As we age, this
process can slow down.
When that happens, more water from
the food is absorbed into the body,
which can lead to constipation. Staying
hydrated is very important to help
prevent constipation. Inactivity can also
contribute to constipation, so remember
to get at least 30 minutes of moderate
physical activity four days a week.
A stroke occurs when the blood supply
to your brain is interrupted or reduced.
This deprives your brain of oxygen and
nutrients, which can cause your brain
cells to die. A stroke may be caused by
a blocked artery (ischemic stroke) or the
leaking or bursting of a blood vessel
(hemorrhagic stroke).
vaccine and pneumococcal vaccine
o Provide privacy
o Wheeling older immobile patients
to the toilet if possible;Ensuring
they sit correctly on the toilet to
raise their intra-abdominal
pressure during defecation
o ↑OFI
o Encourage mobility
o High fibre diet
During Acute Phase (1 to 3 days)
Weigh patient (used to determine
medication dosages), and maintain a
neurologic flow sheet to reflect the
following nursing assessment
parameters:
o Change in level of consciousness
or responsiveness, ability to
speak, and orientation
o Presence or absence of voluntary
or involuntary movements of the
extremities: muscle tone, body
posture, and head position
o Stiffness or flaccidity of the neck
o Eye opening, comparative size
of pupils and pupillary reactions
to light, and ocular position
 Medications taken for high N/A
blood pressure or muscle
and joint pain can lead to
constipation,— so
remember your water and
activity levels.
 Nonsteroidal anti-
inflammatories (NSAIDs),
such as ibuprofen and COX-
2 inhibitors, can increase
your risk of stomach
bleeding and ulcers. If you
take these medications, take
note of the color of your
stool, and tell your doctor if
it’s dark or shows sign of
blood.
 Recombinant tissue  Angioplasty - a tiny balloon at the
plasminogen activator (tPA), end of a long, thin tube is pushed
unless contraindicated; through the artery to the blockage.
monitor for bleeding When the balloon is inflated, it
 Anticoagulation therapy opens the artery. In addition, a mesh
 Management of increased tube may be placed inside the artery
intracranial pressure to help hold it open. The tube is
(ICP): osmotic diuretics, called a stent.
maintain PaCO2 at 30 to 35  Carotid endarterectomy -
mm Hg, position to avoid procedure cleans out and opens up
hypoxia (elevate the head of the narrowed artery. the surgeon
bed to promote venous scrapes away plaque from the wall
drainage and to lower of the artery. Blood can then flow
increased ICP) freely through the artery to the
 Possible hemicraniectomy for brain.
increased ICP from  Bypass surgery -  an artery on the
brain edema in a very large outside of the scalp is re-routed to
stroke the part of the brain that is not
 Sudden trouble seeing in one
or both eyes, Sudden trouble
walking, dizziness, loss of
balance, or lack of coordination
 Sudden severe headache with
no known cause
4. Chronic Kidney Disease
(Renal System)
- refers to kidney damage that
lasts for more than three
months. It is classified into
five stages based on how
Postacute Phase
Assess the following functions:
The gradual loss of kidney function.
Your kidneys filter wastes and excess
fluids from your blood, which are then
excreted in your urine. When chronic
kidney disease reaches an advanced
stage, dangerous levels of fluid,
o Color of face and extremities;
temperature and moisture of skin
o Quality and rates of pulse and
respiration; ABGs,
body temperature, and arterial
pressure
o Volume of fluids ingested or
administered and volume
of urine excreted per 24 hours
o Signs of bleeding
o Blood pressure maintained
within normal limits
o Mental status (memory, attention
span, perception, orientation,
affect, speech/language).
o Sensation and perception
(usually the patient
has decreased awareness of pain
and temperature).
o Motor control (upper and lower
extremity
movement); swallowing ability,
nutritional and hydration status,
skin integrity, activity tolerance,
and bowel and bladder function.
o Continue focusing nursing
assessment on impairment
of function in patient’s daily
activities.
o Educating patients on the
importance of blood pressure
control ensuring they are aware
that reducing raised blood
pressure is a key factor in
preventing progression of CKD.
 Intubation with an getting enough blood flow. When
endotracheal tube to establish blood flow is restored, the brain
a patent airway, if necessary works normally, and the symptoms
 Continuous hemodynamic disappear.
monitoring (the goals for
blood pressure remain
controversial for a patient
who has not received
thrombolytic therapy;
antihypertensive
treatment may be withheld
unless the systolic blood
pressure exceeds mm Hg or
the diastolic blood pressure
exceeds 120 mm Hg)
 Neurologic assessment to
determine if the stroke is
evolving and if other acute
complications are developing
 (ACE) inhibitors or  Dialysis. Dialysis artificially
angiotensin II receptor removes waste products and extra
blockers fluid from your blood when your
 statins - lower your kidneys can no longer do this. In
cholesterol hemodialysis, a machine filters
 supplements of the hormone waste and excess fluids from your
 well your kidneys are able to
filter your blood. In stage
one, your kidneys retain
much of their ability to filter
out wastes.
S/Sx: Nausea, Vomiting, Loss of
appetite, Fatigue and weakness,
Sleep problems, Changes in how
much you urinate, Decreased
mental sharpness, Muscle
twitches and cramps, Swelling of
feet and ankles, Persistent
itching, Chest pain, if fluid builds
up around the lining of the heart,
Shortness of breath, if fluid
builds up in the lungs, High
blood pressure (hypertension)
that's difficult to control
5. Diabetes (Endocrine System)
-  is a disease in which your blood
glucose, or blood sugar, levels
are too high. Glucose comes
from the foods you eat. Insulin
is a hormone that helps the
glucose get into your cells to
give them energy.
S/Sx: Increased thirst, Increased
hunger (especially after eating),
Dry mouth, Frequent urination or
urine infections., Unexplained
Electrolytes and wastes can build up in
your body.
Diseases and conditions that cause
chronic kidney disease include:
 Type 1 or type 2 diabetes
 High blood pressure
 Glomerulonephritis (gloe-mer-u-
low-nuh-FRY-tis), an
inflammation of the kidney's
filtering units (glomeruli)
 Interstitial nephritis (in-tur-
STISH-ul nuh-FRY-tis), an
inflammation of the kidney's
tubules and surrounding structures
 Polycystic kidney disease
 Prolonged obstruction of the
urinary tract, from conditions
such as enlarged prostate, kidney
stones and some cancers
 Vesicoureteral (ves-ih-koe-yoo-
REE-tur-ul) reflux, a condition
that causes urine to back up into
your kidneys
 Recurrent kidney infection, also
called pyelonephritis (pie-uh-low-
nuh-FRY-tis)
Diabetes occurs when there is a dis-
balance between the demand and
production of the hormone insulin.
Type 1 diabetes is caused by the
immune system destroying the cells in
the pancreas that make insulin. This
causes diabetes by leaving the body
without enough insulin to function
normally. This is called an autoimmune
reaction, or autoimmune cause, because
the body is attacking itself.
Type 2 diabetes causes are usually
o Encourage home blood pressure
monitoring where appropriate.
o Education on maintaining a good
glycaemic control to slow
progression of CKD.
o Advice on healthy eating and
exercise.
o Blood sugar monitoring: Normal
range 70-180 mg/dL *patient
may have a different target blood
sugar level
o Insulin administration -Rapid
Acting: Humalog Novolog -
Fast/short Acting: Regular -
Intermediate Action: NPH -Long
Acting:’ Lantus Levemir
o Educate about nutritional
changes and monitoring
o Monitor feet and educate about
erythropoietin
 diuretics
 calcium and vitamin D
supplements
 Meglitinides (Prandin and
Starlix)
 Nateglinide (Starlix)
 Sulfonylureas
 Metformin (Glucophage)
 Canagliflozin (Invokana) and
dapagliflozin (Farxiga)
 Thiazolidinediones:
pioglitazone (Actos) and
rosiglitazone (Avandia)
 Acarbose (Precose)
blood. In peritoneal dialysis, a thin
tube (catheter) inserted into your
abdomen fills your abdominal
cavity with a dialysis solution that
absorbs waste and excess fluids.
After a period of time, the dialysis
solution drains from your body,
carrying the waste with it.
 Kidney transplant. A kidney
transplant involves surgically
placing a healthy kidney from a
donor into your body. Transplanted
kidneys can come from deceased
or living donors. You'll need to
take medications for the rest of
your life to keep your body from
rejecting the new organ. You don't
need to be on dialysis to have a
kidney transplant.
Bariatric surgery is an
appropriate treatment for people with
T2DM and obesity not achieving
recommended treatment targets with
medical therapies.
weight loss (even though you are
eating and feel hungry), Fatigue
(weak, tired feeling), Blurred
vision., Headaches.
multifactorial - more than one diabetes
cause is involved. Often, the most
overwhelming factor is a family history
of type 2 diabetes.
This is the most likely type 2
diabetes cause.
There are a variety of risk factors for
type 2 diabetes, any or all of which
increase the chances of developing the
condition.
monitoring feet
o Monitor Blood Pressure (BP)
Normal Blood Pressure: 120/80
mmHg
o Educate about maintaining a
healthy weight and keeping
active

6. Alzheimer’s Disease (Nervous
System)
-also referred to simply as
Alzheimer's, is a chronic
neurodegenerative disease that
usually starts slowly and worsens
over time. It is the cause of 60%
to 70% of cases of dementia.
S/Sx: Memory Loss, Difficulty
Planning and Solving Problems,
Difficulty Completing Familiar
Tasks, Difficulty Determining
Time or Place, Vision Loss,
Difficulty Finding the Right Words,
Misplacing Items Often, Difficulty
Making Decisions
Like all types of
dementia, Alzheimer's is caused by
brain cell death. It is a
neurodegenerative disease, which means
there is progressive brain cell death that
happens over a course of time. The total
brain size shrinks with Alzheimer's -
the tissue has progressively fewer nerve
cells and connections.
o Establish an effective
communication system with the
patient and his family to help
them adjust to the patient’s
altered cognitive abilities.
o Provide emotional support to the
patient and his family.
o Administer ordered medications
and note their effects. If the
patient has trouble swallowing,
crush tablets and open capsules
and mix them with a semi soft
food.
o Protect the patient from injury by
providing a safe, structured
environment.
o Provide rest periods between
activities because the patient
tires easily.
o Encourage the patient to exercise
as ordered to help maintain
mobility.
o Encourage patient independence
and allow ample time for him to
perform tasks.
o Encourage sufficient fluid intake
and adequate nutrition.
 Donepezil (cholinesterase N/A
inhibitor; elevates
acetylcholine
concentration in cerebral
cortex by slowing
degradation of acetylcholine
released by intact
neurons)which improves
cognitive
symptoms; improves
cognitive function in the early
stages of the disease
only; drug effects diminish as
the disease progresses
 Antidepressants (selective
serotonin reuptake inhibitors;
increases activity of serotonin
in the brain) which treats
depression, anxiety,
and irritability
 o Take the patient to the bathroom
at least every 2 hours and make
sure he knows the location of the
bathroom.
o Assist the patient with hygiene
and dressing as necessary.
o Frequently check the the
patient’s vital signs.
o Monitor the patient’s fluid and
food intake to detect imbalances.
o Inspect the patient’s skin for
evidence of trauma, such as
bruises or skin breakdown.
o Encourage the family to allow
the patient as much
independence as possible while
ensuring safety to the patient and
others.

7. Shingles (Integumentary
System)
- a painful rash caused by the
varicella-zoster virus (VZV). The
varicella-zoster virus also causes
chickenpox.
S/Sx: Neurologic pain described as
painful, tingling or burning
sensation, Body weakness
Burning sensation of the blister
sites, Febrile episodes, Skin
vesicles along the peripheral
sensory nerves, the blisters actually
outline the nerves, Classic location:
along the trunk, thorax or face,
Lack of appetite,
Lymphadenopathy, Joint pains,
Chills
Shingles, also called herpes zoster, is
a painful skin rash. Shingles is caused
by reactivation of the varicella zoster
virus, the same virus that causes
chickenpox. Older adults and
individuals with a weakened immune
system are at greatest risk for
developing shingles.
o Monitor the vital signs.
o Observe proper measures in
containing the infectious agent.
o Observe proper personal
protective gear as well as
routine hand washing before
and after the procedures.
o Encourage complete
compliance with the
medications being ordered.
o Teach the patient as well as the
folks about proper disposal of
materials which are in contact
with the patient.
o Listen to the ideas and
perception of the patient about
being isolated, the prognosis as
well as recovery from the
present status.
 Corticosteroids Surgical care is not generally indicated
 Narcotic and nonnarcotic for the treatment of herpes zoster, though
analgesics (both systemic and it may be required to treat certain
topical) complications (eg, necrotizing fasciitis).
 Neuroactive agents (eg, Rhizotomy (surgical separation of pain
tricyclic antidepressants fibers) may be considered in cases of
[TCAs]) extreme, intractable pain.
 Anticonvulsant agents
 arcotic oxycodone
 oral anticonvulsant gabapentin
 valacyclovir,
 famciclovir,
 penciclovir
 desciclovir

8. Osteoporosis
(Musculoskeletal System)
- which literally means porous
bone, is a disease in which
the density and quality of
bone are reduced. As bones
become more porous and
fragile, the risk of fracture is
greatly increased. The loss of
bone occurs silently and
progressively. Often there are
no symptoms until the first
fracture occurs.
9. Pneumonia (Immune
System)
- is an infection in one or both
lungs. It can be caused by
bacteria, viruses, or fungi.
Bacterial pneumonia is the
Reduced total bone mass normal
homeostatic bone turnover is altered;
the rate of bone resorption that is
maintained by osteoclasts is greater than
the rate of bone formation that is
maintained by osteoblasts.
Progression, bones become porous,
brittle, fragile; they fracture easily under
stresses that would not break normal
bone. Postural changes result in
relaxation of the abdominal muscles and
a protruding abdomen. Age-related
losses calcitoin
and estrogen  with aging,
while parathyroid hormone ↑, increasing
bone turnover and resorption.
of bone mass over time. Consequence
of these changes is net loss of bone
mass over time.
Pneumonia is due to impairment of
normal defense mechanisms or lowered
host resistance
Normal defense mechanisms are nasal
clearance (sneezing, blowing,
swallowing), tracheobronchial clearance
o Teach the patient about the
possibility of having post
herpetic neuralgia or pain on the
sites of shingles which may be
present for months or even
years. Proper medications can
be given in order to lessen the
pain.
o Ensure a nutritious diet with
o  adequate calcium intake.
o Avoid protein malnutrition and
under-nutrition
o Maintain an adequate supply of
vitamin D.
o Avoid the effects of second-
hand smoking.
o Participation in regular weight-
bearing exercises results in
excellent bone maintenance.
o Modifications in lifestyle such
as reduced use of caffeine,
cigarettes, carbonated
softdrinks, and alcohol could
improve osteogenesis for bone
remodeling.
o Administer oxygen as
prescribed.
o Monitor respiratory status.
o Monitor for labored
respirations, cyanosis, and cold
and clammy skin.
 Calcitonin (Calcimar  Metal screws - Also called internal
or Miacalcin). This is a fixation, your surgeon may implant
naturally occurring hormone metal screws to stabilize the bone
that helps while the fracture heals.
regulate calcium levels in your  Hemiarthroplasty - Your surgeon
body and is part of the bone- may opt to remove the femoral head
building process. Calcitonin and neck and replace them with
also relieves pain caused by metal instrumentation.
spinal compression fractures.  Hip replacement - Your surgeon
 Denosumab (Prolia). It's used may implant a prosthesis after
to treat people who are at high removing the upper part of your
risk for bone fracturesrelated femur and pelvic bone socket.
to decreased bone density.
 Teriparatide (Forteo). It's used
for the treatment of men and
postmenopausal women who
have severe osteoporosis and
who are at high risk for bone
fracture.
 Raloxifene (Evista). This
medicine is a
selective estrogen receptor
modulator (SERM).
Antibiotics N/A
 Initial antibiotic: macrolides
including erythromycin,
azithromycin, roxithromycin
and clarithyromycin.
Macrolides provide coverage
most common type in adults. (mucociliary action) and alveolar
clearance (alveolar macrophages)
Impairment is due to primary or
acquired immunosuppression,
suppression of cough reflex (drugs,
virus, coma, anesthesia), injury to
mucociliary apparatus (smoking, virus,
Kartegeners syndrome), injury to
macrophages (tobacco, alcohol, anoxia),
pulmonary congestion / edema or
accumulation of secretions (cystic
fibrosis)
Note: viral pneumonia predisposes to
bacterial pneumonia
o Encourage coughing and deep for likely organisms in
breathing and use of incentive community-acquired bacterial
spirometer. pneumonia.
o Position client in semi-Fowler  Other antibiotics: Penicillin G
position to facilitate breathing for streptococcal pneumonia;
and lung expansion. nafcillin or oxacillin for
o Change client’s position staphylococcal pneumonia;
frequently and ambulate as aminoglycoside or a
tolerated to mobilize secretions cephalosporin for klebsiella
o Provide CPT pneumonia; penicillin G or
o Perform nasotracheal suctioning clindamycin for aspiration
if the client is unable to clear pneumonia .Alternatives:
secreations. amoxicillin and clavulanate
o Monitor pulse oximetry. (Augmentin); doxycycline;
o Monitor and record color, trimethoprim and
consistency, and amount of sulfamethoxazole (Bactrim
sputum. DS, Septra); levofloxacin
o Provide a high-calorie, high (Levaquin)
protein diet with small frequent
meals.
o Encourage fluids up to 3 L a
day to thin secretions unless
contraindicated.
o Provide a balance of rest and
activity, increasing activity
gradually.
o Administer antibiotics as
prescribed.
o Administer antipyretics,
bronchodilators, cough
suppressants, mucolytic agents,
and expectorants as prescribed.
o Prevent the spread of infection
by hand washing and the proper
disposal of secretions.
o consistency and characteristics
od sputum - removal of
secretions prevents obstruction
 of airways and stasis leading to
further infection and
consolidation of lungs; clearing
airways facilitates breathing.

10. Impotence/Erectile o For nurses who run chronic  Apomorphine SL is a

dysfunction (Reproductive
System) -  inability of a man to
achieve or maintain
penile erection and hence the
inability to participate fully
in sexual intercourse. In its
broadest sense the term impotence
refers to the inability to become
sexually aroused; in this sense it
can apply to women as well as to
men. In common practice, however,
the term has traditionally been used
to describe only male sexual
dysfunctions.
 The penile erectile tissue, specifically
the cavernous smooth musculature and
the smooth muscles of the arteriolar and
arterial walls, plays a key role in the
erectile process. In the flaccid state,
these smooth muscles are tonically
contracted, allowing only a small
amount of arterial flow for nutritional
purposes. The blood partial pressure of
oxygen (PO2) is about 35mmHg
range. 1 The flaccid penis is in a
moderate state of contraction, as
evidenced by further shrinkage in cold
weather and after phenylephrine
injection. The angle of the erect penis is
determined by its size and its attachment
to the puboischial rami (the crura) and
the anterior surface of the pubic bone
(the suspensory and funiform
ligaments). In men with a long heavy
penis or a loose suspensory ligament,
the angle usually will not be greater
than 90 degrees, even with full rigidity.
disease clinics, it is worth
being proactive and bringing
up the subject during routine
appointments. Nurses can
simply ask the man if he has
any problems in his
relationship. For patients
with chronic disease, a more
direct approach might be to
mention that erectile
problems are associated with
the condition but that
treatments are available.
o The final choice of treatment
lies with the patient, and the
nurse’s role is to give
unbiased advice and help
him make a choice that is
best for him and, where
applicable, his partner.
However, it is important to
make sure the patient has
reasonable expectations
since no treatment will solve
all his relationship problems.
For this reason, treatment
goals should be agreed at the
outset and psychosexual
therapy or relationship
counselling arranged as
appropriate.
o Penis pumps, which use a
vacuum tube to give you an
dopamine receptor agonist that
acts on the central nervous
system to enhance the erectile
process. In most patients who
respond, erection is facilitated
within 20 minutes of taking it,
which can help restore the
spontaneity for a more natural
sex life.
 Alprostadil, in intracavernosal
(Caverject, Viridal Duo) or
transurethral (MUSE)
formulations - first-line
treatment through patient
choice. Usually mild penile
pain on injection and fibrosis
are associated with
intracavernosal alprostadil
while penile and urethral pain
are reported with transurethral
pellets.
 Artery Repair Surgery for Erectile
Dysfunction - Young, otherwise healthy
men who are struggling with erectile
dysfunction after a pelvic injury could
benefit from artery repair. In this
procedure, another blood vessel is used
to bypass the damaged blood vessel
causing the erectile dysfunction.
Semi-rigid or inflatable penile implants -
are the alternative for men who are
unsuitable or do not respond to other
treatments. Implants can succeed in
selected patients, but the devices can
break down and become infected,
necessitating removal
 erection
o Penis implants - which use
inflatable or partially rigid
rods to allow you to control
the time and duration of your
erection.