Geria Prelims

CARE OF THE OLDER ADULT LECTURE
University of Santo Tomas - College of Nursing Batch 2024 PRELIMS | LEVEL III 1ST SEMESTER
NURSING CARE OF OLDER ADULTS WITH

OXYGENATION NEEDS & PROBLEMS
REFERENCE LINKS:
Aging Changes Aging Changes of the Cells,

of the Cells, Respiratory, and Cardiovascular
Respiratory, and System
Cardiovascular ● Calcium and fat deposits in the arterial walls (due to
System the individual’s diet and lifestyle)
○ Increased arterial resistance
RECALL ○ Increased workload
How does blood flow into the heart, lungs, and different
organs in the body? CARDIOVASCULAR SYSTEM CHANGES RELATED TO
AGING
Blood flows through the heart in the following order: 1) body EFFECTS OF CARDIOVASCULAR SYSTEM CHANGES
–> 2) inferior/superior vena cava –> 3) right atrium –> 4) ● Decreased cardiac output
tricuspid valve –> 5) right ventricle –> 6) pulmonic valve –> 7) ● Decreased ability to respond to stress
pulmonary arteries –> 8) lungs –> 9) pulmonary veins –> 10) ● Heart rate and stroke volume do not increase with
left atrium –> 11) mitral or bicuspid valve –> 12) left ventricle maximum demand
–> 13) aortic valve –> 14) aorta –> 15) body ● Slower heart rate recovery
● Increased blood pressure
● Deoxygenated blood from the body enters the vena
cava.
● Heart transports deoxygenated blood to the lungs to
be oxygenated
● Oxygenated blood will be transported to the different
parts of the body through the aorta.
OXYGENATION
● Cardiovascular
○ Heart
● Respiratory
○ Lungs
● These organs are main organs for blood circulation
and oxygenation
CARDIOVASCULAR SYSTEM CHANGES RELATED TO
AGING
CLINICAL MANIFESTATIONS
AGING
● Fatigue with increase in activity
● Myocardial hypertrophy
● Increased heart rate recovery time
○ Left ventricular changes and functions
● Pre HTN (>120/80 to 130/89)
○ Valve fibrosis and stenosis
● HTN (>140/90)
● Decreased pacemaker cells
SABATE, SABIO, SACDAL, SADURAL, SALAC, SALANAP, SALIDO, SAMSON | RLE # 3 | 3NUR-6 1
○ Gradual increase of activities should be done

● Pace activities
● Avoid smoking
● Low fat and low Na diet
● Stress reduction activities
○ Perform rest and relaxation methods such as
yoga and simple deep breathing exercises
● BP check regularly
○ If a client does not have a companion at
home to measure BP manually, automatic
blood pressure can be purchased and used.
○ Make sure that there should be new batteries
AGING
or outlet-rechargeable batteries for constant
COMMON CARDIOVASCULAR SYSTEM DISORDERS
readings.
ASSOCIATED WITH AGING
○ BP measurement can be done at 8 am, 12nn,
● Hypertension (HPN)
in the afternoon, and before sleeping to have
● Coronary Artery Disease (CAD)
a point of comparison and baseline
● Arrhythmia
measurement.
○ Atrial fibrillation
● Medication compliance
○ Ventricular Tachycardia (V-tach)
○ Geriatric clients tend to be hard-headed
○ Bundle branch block
when it comes to intake of medications
● Orthostatic Hypotension
○ Ex: A female patient questions the intake of
● Syncope with Cardiac Cause
various BP medications, takes each medicine,
● Valvular Disease
even if she already has low BP.
● Congestive Heart Failure (CHF)
○ Explain to the patient that the occurrence of
● Peripheral Artery Occlusive Disease (PAD)
low blood pressure is due to her compliance
● Venous Disorders
with the medication.
○ Varicose veins
○ If the medication is tapered by the patient on
● Anemia
her own, there could be a tendency of high
BP again.
● Weight control
○ Diet and exercise

AGING
RISK FACTORS FOR CARDIAC DISEASES
● High-cholesterol diet
● Hypertension
CARDIOVASCULAR SYSTEM CHANGES RELATED TO ● Diabetes
AGING ● Tobacco use
PROMOTING CARDIOVASCULAR HEALTH ● Physical activity: Obesity
● Regular Exercise ● Alcohol-use
○ Not only beneficial for geriatrics, but is better ● Advancing Age
to be started at a young age ● Hereditary
○ If a person becomes older and have found out ● Atherosclerosis
that he/she is hypertensive, there is a ○ Buildup of fat and cholesterol in the blood
tendency they immediately increase their vessels
activities ○ Usually present years before the client would
○ Instead of helping your heart adjust properly, have a heart attack or have symptoms of
these sudden change cause heart attack angina
● ACE inhibitors
● Beta blockers
● Anticoagulants
● anticholesterol/oral lipidomics
● Allay anxiety by explaining the use of the medications
○ Some patients would have denial or fear so
they would be resistant to treatment
○ Manage expectations
● Reduce sodium and fat intake, increase potassium
intake
● Teach stress reduction techniques
● Should gradually increase activity
○ From 10-15 mins a day to 1hr walking 3-4
Symptoms of angina: times a week
● Substernal chest pain radiating to the left side of the ● Avoid smoking
body or upper arm
● Heartburn DIAGNOSIS
● Management is through lifestyle modification and ● Take their blood pressure
diet ● Doctor may prescribe ECG to check if the patient had
a MI, so doctor may order troponin 1 or 2
COMMON CARDIOVASCULAR SYSTEM DISORDERS ● CBC because it may also be caused by anemia
ASSOCIATED WITH AGING ● Metabolic panel because there may be an
HYPERTENSION abnormality in sodium and potassium
Hypertension is a silent killer because most of the time, they ● Chest X-ray to check if there is already cardiomegaly,
do not know that they are hypertensive pulmonary edema, or heart failure
● Primary hypertension - cause is unknown; family ● 2D echo
history, age, diet, lifestyle ● Stress test
● Secondary hypertension - secondary to another ○ Through activities
disease such as renal diseases, metabolic disorders, ○ Younger: Treadmill connected to an ECG
problems in the aorta monitor
● Management: check OTC medications the patient is ○ Geriatrics: Dobutamine stress test
taking, such as amphetamines, decongestants (no to ■ Dobutamine increases HR
prolonged use because it may have rebound effect) ● Ask them
○ “Kapag umaakyat po ba kayo ng hagdan
Obesity - category that will say there is excess fat in the body hinihingal?”
● Females: any waist that is more than 35 inches ○ “Kamusta po yung pag akyat nyo ng hagdan?
● Males: 40 inches Mga hanggang ilang palapag?”
● Weight control: any 1kg that is reduced from the ○ How many floors can they go without feeling
patient’s weight, there is 1mmHg decrease in the the exhaustion or breathlessness
blood pressure ○ “Dumadaan po ba kayo sa overpass?
Kamusta po? Nakakaakyat at baba po ba
Sodium intake kayo ng may hingal o kayang-kaya po?”
● 1000mg/day decrease is equal to 2-6mmHg decrease
in blood pressure ORTHOSTATIC HYPOTENSION
● When we change position from a lying to an abrupt
MANAGEMENT FOR HYPERTENSION sitting or standing position, an estimated 500 mL of
● Diuretics blood would be redistributed by the heart
● Potassium sparing diuretics ● In geriatric patients, their heart is not that effective in
● Spironolactone pumping blood, hence they get dizzy
● Calcium channel blockers
● Any decrease of 20 mm of mercury or more in the ○ And when they elevate these extremities,
systolic BP and 10 mm of mercury in the diastolic BP they become pale or dusty red
● DANGER: Syncope episodes ● WORST CASE SCENARIO: If they develop ischemia
○ Hinihimatay ○ Bluish or darker complexion on their lower
legs
NURSING INTERVENTION ● They should be monitored so that they can be given
● Ask the patient to slowly and gradually move from medications
one position to another ○ Otherwise, since there is a decreased blood
○ For instance, when waking up, remain in a flow in their dependent or lower extremities,
side lying position for about 3 minutes, then it may lead to gangrene
sit while legs are down the bed, wait for a ○ The development of gangrene may lead to
minute or so, then stand up amputation if it can no longer be treated
● DIAGNOSTIC PROCEDURE: Doppler ultrasound (of the
VALVULAR DISEASES artery)
● Due to the generation or calcification of aortic
stenosis VENOUS DISORDERS
● They sometimes develop mitral regurgitation ● Varicosities
● Identified using ultrasound ● Problem in the heart valves
● The veins look tortuous
SIGNS AND SYMPTOMS ○ Looks like worms
● Difficulty breathing when they do activities
MANAGEMENT
MANAGEMENT ● Ask the patient to elevate their legs, wear
● Monitor BP, heart rate, and RR anti-embolic stockings, wash their feet daily, proper
● Instruct to increase the height of the head of their foot care, and wear cotton socks
bed ● In geriatric clients, their shoes should be well-fitted to
○ Semi-fowler’s position support their feet
● During the interview, patients are often asked how
many pillows they use when sleeping ANEMIA
● By laboratory
CONGESTIVE HEART FAILURE ○ Blood extraction
● For monitoring purposes, we should take the weight ● Iron-deficiency anemia
during the same time of the day ○ Chronic disease
○ Usually before breakfast or upon waking up ● Chronic Kidney Disease
before they do anything for the day ○ Patients with renal failure
● Due to fluid retention, they are also asked to elevate ● Low B12 and Folate
the head of the bed during sleep to help with their ○ Doctors would often prescribe medications
breathing with B complex and folic acid + vitamin C to
○ Same with patients with valvular disease prevent anemia
■ All in one capsule to decrease
MANAGEMENT polypharmacy and increase
● Use of prescribed diuretics compliance
● Diet (decrease sodium intake)
MANIFESTATIONS
PERIPHERAL ARTERY OCCLUSIVE DISEASE ● Fatigue
● Comes with arterio- and atherosclerosis (calcification) ● Weakness
● Patients usually complain of pain on their calves when ● Headache
they do activities, at the end of the day, or during ● Dyspnea upon exertion
exercises ● Palpitations
● They may have cold or numbness of extremities ● Poor concentration
● Dizziness
MANAGEMENT
● Diet (increase iron-rich foods)
○ Lean meat, liver, shellfish, green leafy
vegetables (spinach, kangkong, malunggay,
mustasa, pechay)
● Supplements
RESPIRATORY SYSTEM CHANGES RELATED TO AGING

From the book: 10 years of abstinence from smoking would RESPIRATORY SYSTEM CHANGES RELATED TO AGING
have the same risk as someone who is a non-smoker (resets). PROMOTING RESPIRATORY HEALTH
Then again, we need to take into consideration factors such as ● Regular Exercise
secondhand and thirdhand smoke. ● Avoid smoking
● Adequate hydration
Which is better: Cigarettes or Vape? ● Yearly influenza shot
● None because both are harmful. ● Pneumonia Vaccine (>65y/o, q5 years)
● Vaping was found to cause popcorn lungs since aside ● Avoid exposure to URTI
from inhaling smoke, it is quite moist, so the effects
are worse compared to a normal cigarette COMMON RESPIRATORY SYSTEM DISORDERS ASSOCIATED
WITH AGING
● Calcification and weakening of chest wall muscle OBSTRUCTIVE PULMONARY DISEASE
○ Diminished respiratory efficiency Obstructive Pulmonary Disease (Asthma, Chronic Obstructive
○ Increased residual lung volume Pulmonary Disease)
○ Decreased muscle strength, endurance, vital
capacity ASTHMA
● Decreased cough efficiency ● Allergens cause hypersensitivities and inflammation,
● Decreased gas exchange that’s why we give them bronchodilators, steroids,
○ Practice deep breathing exercises with pursed mucolytics, antibiotics if with bacterial infection
lip breathing
EMPHYSEMA
● Usually 60-70 yrs old; progressive destruction of the
alveoli and decrease in supporting structure of the
lungs; smokers and those exposed to secondhand
smoke
BRONCHIECTASIS
● Ineffective coughing, excessive production of
secretions
○ Teach the patient to do proper deep
breathing and coughing exercises, give
mucolytics and antihistamines as needed (if
RESPIRATORY SYSTEM CHANGES RELATED TO AGING there is flaring)
CLINICAL MANIFESTATIONS ● Nursing Management = quit smoking, weight
● Fatigue and breathlessness with sustained activity management, exercise, breathing retraining, incentive
● Decreased respiratory excursion spirometer, hydration, coughing techniques
● Difficulty coughing up secretions ○ Incentive spirometer
■ Volume oriented
●1 cylinder, slowly deep ● Management: O2 administration, diuretics,

breathing while using morphine, allay their anxiety
mouthpiece
■ Flow oriented PULMONARY EDEMA
● Patient should be able to ● Occlusion of pulmonary arteries by a thrombus, fat,
make the 3 colored balls float or air
○ Hydration - to help the body cough out the ● At risk: Elderly patients with DVT
phlegm ● Management: Heparin therapy and oxygen;
sometimes would be sedated and IV therapy as
RESTRICTIVE PULMONARY DISEASE needed
Restrictive Pulmonary Disease (Lung Carcinoma,
Tuberculosis) OBSTRUCTIVE SLEEP APNEA
● At risk: Obese and increasing age
BRONCHOPULMONARY INFECTION ● During the day, they would have excessive daytime
Bronchopulmonary Infection (Influenza, Pneumonia) sleepiness or frequent naps. When they sleep during
the night, it's ineffective or not well rested. That's
COMMUNITY-ACQUIRED PNEUMONIA why they are still sleepy during the daytime. They
● Patient who was admitted in the hospital developed it snore loudly, sometimes coughing. When they wake
in the 1st 2 days (48 hours) of the hospitalization up, they have a headache, dry mouth.
● Management: Ordered sleep study in a laboratory in
HOSPITAL-ACQUIRED PNEUMONIA a hospital to be observed for sleeping. Lifestyle
● Manifestation after 2 days modification if obese
● As diagnosed, they will be asked to use a CPAP
ASPIRATION PNEUMONIA machine which helps deliver air to the patient.
● Improper feeding position in the patient
CARE OF THE OLDER ADULT WITH
MANAGEMENT FOR PNEUMONIA
● Proper hydration
PERCEPTION, COORDINATION AND
● Effective airway clearance BALANCE NEEDS & PROBLEMS
● Proper positioning during feeding
● Vaccination for pneumonia for elderly and PERCEPTION AND COORDINATION
immunocompromised ● Nervous System
● Sensory Perceptual Functions
OTHER RESPIRATORY ALTERATIONS ● Musculo-Skeletal System
Other Respiratory Alterations (Severe Acute Respiratory ● Changes experienced similarly by the older adults due
Syndrome, Cardiogenic/Non-Cardiogenic Pulmonary Edema, to the normal aging process
Pulmonary Emboli, Obstructive Sleep Apnea
SARS
● Patient will present with fever, cough, shortness of
breath, headache, body malaise, myalgia, lower
respiratory tract infections, pneumonia
● With mask and observance of universal precautions
● Physical Exam: Abnormal increased amount of fluid in
the alveoli and interstitial spaces of the lungs,
complications in the heart and lung diseases
● Older adults aged 85 and above may have left
ventricular failure
● Ex: When the

elderly will heat
the water to be
used for drinking
or shower; at first
they will feel as if
it has a tolerable
temperature.
Afterwards, they
will only feel the
water when it is
already too hot
and will only
notice it when
there is already
AGE-RELATED CHANGES IN THE STRUCTURE AND the presence of a
FUNCTION OF THE CENTRAL NERVOUS SYSTEM skin burn.
● Sometimes, the
PHYSIOLOGIC CHANGES EFFECTS elderly
unnoticeably
Loss of brain cells Supposedly able to placed their
maintain function with extremities on
remaining cells hot
objects/surfaces.
Decreased brain blood flow Short-term memory loss
Increased reaction times Slow response, injury risk
Decreased regulation of body Hypothermia,
● Ex: When an
temperature hyperthermia risk
older adult
● Gerontologic
experiences
consideration:
dizziness, they
Impaired
will have a slow
thermoregulation
reaction time to
Decreased endorphins Increased depression step back or to
● “Happy hormones” ● Varies among the grasp/hold onto
elderly something to
● Not all older prevent falling
adults experience down.
depression as
Decreased motor coordination Unsteady, fall risk
they age.
● In the Philippine
Orthopedic
Center, around
AGE-RELATED CHANGES IN THE STRUCTURE AND
70-80% of
FUNCTION OF THE PERIPHERAL NERVOUS SYSTEM
patients in the
PHYSIOLOGIC CHANGES EFFECTS female traction
ward are geriatric
Decreased sensation Risk for injury, burns clients.
● Impaired ● Increased
thermoregulation occurrence in
● Lewy Body Dementia

females due to
● Frontotemporal Dementia
various
● Other Dementia-related Diseases
considerations:
○ Multiparit
y, w/o
intake of
calcium
suppleme
nts
ASSESSMENT OF COGNITIVE FUNCTION

● Cognitive Function: how the information an
individual receives and understands enables him/her
to interact with the environment.
● Cognitive Functions play a role in:
○ Attention
○ Memory
○ Executive functions DEPRESSION
○ Concentration ● According to studies, there are more older adults who
○ Mood commit suicide compared to younger adults,
○ Mental Performances especially adults ages 85 years and above (CDC,
○ Cognitive functions 2012).
○ Oxidative Stress ● Elderly need professional help
● Functional Assessment ● As nurses, we utilize assessment tools such as the
● Mental Status Examination Geriatric Depression Scale.
● Depression Assessment ● Not all available tools are applicable to the general
population of geriatric clients.
● Consider the patient’s illness state (critically ill), and
cognitive function impairment in selecting the
appropriate tool to be used.
Depressive Signs and Symptoms:

● Fatigue
● Psychomotor retardation
● Mood swings
● Loss of interest in previously liked activities (Ex.
gardening, walking, conversing will fellow elders)
● Loss of energy
● Loss of sexual function/ libido
COMMON NEUROLOGICAL PROBLEMS ASSOCIATED
● Reduced pleasure in day-to-day activities
WITH AGING ● Presence of eyebags (Disturbed Sleep Pattern)
ALTERED THOUGHT PROCESSES ● Weight loss/thinning (Loss of Appetite)
Altered Thought Processes: (Neurofunction, genetics, ● Anxious/agitated
lifestyle, nutrition, tissue perfusion, environment)
● Depression DELIRIUM
● Delirium ● Change or disturbance in the attention of clients.
● Dementia ● Decreased ability to focus; cannot sustain attention
● Alzheimer’s Disease ● Usually has a rapid onset
● Vascular Dementia ● Fluctuates during the day
● Significant decline in the client’s cognition ○ CT scan

● Confusion Assessment Method ○ MRI
○ PET scan (more specific)
DEMENTIA
● According to WHO, dementia is termed as VASCULAR DEMENTIA
“forgetfulness” or “pagiging makakalimutin”. ● Due to ischemia, hemorrhage, or hypoperfusion in
● Syndrome of gradual and progressive cognitive the brain
decline
● Alteration in memory function, and language deficit. LEWY BODY DEMENTIA
● Apraxia (difficulty manipulating objects) ● Small deposits in the brain
● Agnosia (inability to identify and recognize objects or
persons) FRONTOTEMPORAL DEMENTIA
● Agraphia (inability to draw objects) ● Focal atrophy on the front or anterior-temporal
● When clients are referred to a Neuropsychiatrist for region
assessment, the doctor will instruct them to draw, ● Other causes of dementia:
repeat simple instructions/words that must be ○ Hydrocephalus
remembered within a minute or two (Mini-Cog Tool). ○ Subdural hematoma
● Mini-Cog Assessment Tool is widely used for ○ Brain tumors
dementia clients.
● 3Ds: Depression, Delirium, and Dementia (refer to the MANAGEMENT FOR PATIENTS WITH DEMENTIA
picture below). ● A very careful assessment should be done (usually
○ Problem with cognition non invasive)
○ Better if caught early in order to preserve
cognitive function
● Surgery can be done if recommended
● As nurses, we should support the existing sensory
perceptions of the client
○ Extend support for whatever gross or fine
motor is left
● Promote nutrition
● Promote or maximize self care
● Before, nurses were confined in the hospital, but now,
● Note: Some tools are readily available online, while we are coordinators of care. We assist families in
some need to be bought taking care of the elderly since facilities are expensive
● Degrees: ○ More familiar surroundings, they know the
○ Mild geriatric’s preferences
○ Moderate ○ Some hire a caregiver or let the geriatric
○ Severe client join group activities (especially in the
community, to allow interaction)
ALZHEIMER’S DISEASE ● We give health teachings to the family on how to care
● Type of dementia commonly found in older adults for the elderly
● At risk: genetics, nutrition, viral infection, ● Examples of Brain Exercises:
environment, age (usual onset: 60 years old) ○ Word hunt
● Forgetfulness and cannot do IADLs anymore ○ Crossword puzzles
● Geographic problems - cannot go home on their own ○ Encouraged to go out and see the sun
● Disorientation and sometimes memory loss ○ Gardening
● Confusion, restlessness, and mood swings ○ Zumba exercises on YouTube
● Change in cognition, personality, and ability to
function
● Diagnostic procedures:
WANDERING, PARANOIA OR SUSPICIOUSNESS, ● Same with hallucinations

HALLUCINATIONS AND DELUSIONS, AND CATASTROPHIC ● If mild, reorient to reality
REACTIONS ● If progressive or severe, play along with their
WANDERING delusions. But, modify if they have destructive or bad
● Older adults who were active when they were behavior
younger often have excess energy, that’s why they
wander around CATASTROPHIC REACTIONS
● Older adults who use psychotropic drugs ● Overreacts too much on stressful events (nagwawala,
umiiyak)
Sundowning syndrome
● Patient is happy during the day, then confusion and
ADDITIONAL:
anger starts during late afternoon up until the night
Caregiver’s Strain assessment tool
time, then happy again in the morning
● Focus on relatives as well.
● May lead to wandering
● As needed, they may need time off
○ Since it's tiring to take care of these
Management:
patients
● Always have a medic alert bracelet for the patient
● Proper referral must be done
● Provide a space for the patient to be safe (Either with
someone or a place where they could not easily go
Respite Care
out)
● If caregiver is so close to experiencing burnout
● Reorient
● May be for hours, days, weeks of break in taking
care of a patient
PARANOIA OR SUSPICIOUSNESS
● Community will take turns in taking care of them
● Geriatric patients that have insecurities about their
declining cognition or sensory loss
PARKINSON’S DISEASE
Management: ● Slowing in the initiation and execution of movement,
● Avoid actions that make them feel they are being increased muscle tone, tremor at rest, and impaired
talked about postural reflexes caused by progressive degenerative
disorder of the basal ganglia involving the
HALLUCINATIONS dopaminergic nigrostriatal pathway
● False perceptions on hearing, smelling, touch or taste ● Decreased dopaminergic
(sensory) ● Very challenging to care for these patients
● Most common type of progressive degenerative
Management: disease in older patients
● Orient to reality ● Dopamine - neurotransmitter needed for normal
● Importance of pharmacotherapy (since it may motor functions
sometimes be caused by medications)
● Behavioral management SIGNS AND SYMPTOMS
○ Sense of uniformity in activities ● Fatigue
○ Decreased stimuli ● Slight resting tremor
○ Reassurance and reorientation ● Muscle Rigidity
○ Medic Alert Bracelet ● Bradykinesia
● Caregivers must have a calm and collected behavior ● Posture abnormalities
● Pain
DELUSIONS ● GI issues
● Visual or auditory which could be caused by ● Sweating
medications ● Melanoma
● Vocal symptoms
Management: ● Problem getting in and out of chairs - risk for injury
● Gait changes - no more regular walking / shuffling gait

● Posture - forward bend
● Other symptoms
○ Seborrhea, excess perspiration, and heat
intolerance
○ Urinary issues
○ Weight loss
○ Sexual concerns
○ Constipation
○ Anxiety
○ Depression
○ Sleep disturbance
○ Dysphagia
DIAGNOSIS AND MANAGEMENT

● Diagnosis
○ No specific but depends on clinical
manifestations of the adult
● Are usually given Monoamine oxidase inhibitors or
MAOIs
○ As nurses, our role is to prevent contractures CEREBROVASCULAR ACCIDENT OR BRAIN ATTACK
and muscle rigidity through active and ● Disruption in the normal blood supply to the brain
passive range of motion exercises, tissue that produces focal neurologic deficits
encouraging to walk at least 3-4 times per day ● Difference between stroke and heart attack
● If problem is with balance, make use of assistive ○ Stroke/CVA - Affects the brain. Due to
devices such as walkers or cane ischemia, hemorrhage, or decreased blood
● Assess for communication skills, speech, writing flow.
● Because of the rigidity, refer to Speech pathologist ○ Heart attack - Affects the heart. Complaints
○ Speech pathologist - checks the capacity for of crushing chest pain (like an elephant is
swallowing to prevent aspiration weighing down on your chest), numbness on
● Prevent malnutrition and falls left upper extremity
● Assist in coping with their conditions ● CVA is a medical emergency and must be addressed.
If a person has a stroke, there will be eye drooping
which may last for more than 24 hours.
○ Transient Ischemic Attack: A category of CVA.
Symptoms resolve within 24 hours.
MANIFESTATIONS
● Numbness of face, legs, arm on one side
● Confusion
● Trouble speaking
● Eye disturbance
● Dizziness
RISK FACTORS
● Genetics
● Lifestyle
○ Ischemic CVA: Atherosclerosis (plaque ● If with sudden confusion, find out the cause
deposit in arteries), Inflammatory disease, ● Reality reorientation PRN
Thromboembolism
○ Hemorrhagic CVA: Affects the Subarachnoid
or Intracerebral; Hypertensive, ruptured
aneurysm, vascular malformations FUNCTION OF THE EYES
(congenital), bleeding into a tumor or
PHYSIOLOGIC CHANGES EFFECTS
prolonged use of anticoagulants; brain
trauma. Lens less elastic Decreased near and
peripheral vision
NURSING MANAGEMENT
● Prevent malnutrition and falls. Assist them in coping Lens opaque, yellows Cataracts
with their condition ● The protein that
● Post-operative: enables the eyes to
○ Place the client's HOB into 30-45 degrees to allow light to enter
decrease intracranial pressure. clumps together,
○ Decrease stimuli in the room thereby causing
○ Passive range of motion exercises on affected cataracts
extremities and active range of motion
exercises on unaffected extremities Cornea more translucent Blurry vision
○ Turn the patient every 2 hours (depends on
the doctor) Smaller pupil Decreased dark adaptation
● Upon discharge:
○ Provide teachings on dressing, hygiene; refer Decreased violet, blue, See red, orange, yellow
client to OT and Physical Therapist green color vision color better
○ Homonymous hemianopia (no vision on one
Arcus senilis - milky lipid ring No effect on vision
eye): Instruct patient to scan their visual field
on iris edge that does not
using their working eye
cover pupil
HYPOTHERMIA / HYPERTHERMIA
● Inability to manage extreme temperatures COMMON VISUAL PROBLEMS ASSOCIATED WITH AGING
● Consider safety of patients PRESBYOPIA
● The lens loses its ability to focus on close objects
PROMOTING NEUROLOGIC HEALTH ● Usually starts by age 40
● Pace teaching ● Lens thicken so it loses elasticity, so it is difficult to
○ Allow adequate time for geriatric clients to accommodate
grasp health teachings. ● Reading glasses are necessary (bifocal lenses)
○ As needed, ask if we may do demonstrations ● Check up with ophthalmologist should be done at
and ask them to re-demonstrate least twice a year
○ Simplify content when talking to a layperson
● Encourage visitors during hospitalization
○ To prevent/decrease feelings of sadness on
the client
○ Familiarization
● Enhance sensory stimulation
○ Activity groups, Light & soothing music,
○ Avoid action or gory movies. Ideal would be
nostalgic movies/movies during their time.
● Slow rising from resting position
○ Done for safety
● May be chronic open angled or acute close angled

ECTROPION AND ENTROPION ○ Chronic is usually more from the degenerative
● External eye conditions specifically malpositions of ○ Acute is sudden
the lower lid, which irritate the eye ● If left unchecked and the intraocular pressure
● Ectropion - outwards continues to rise, it may lead to blindness
● Entropion - inwards ● Sometimes only eye drops are needed
● The lashes rubs on the cornea ● Surgery is called trabeculoplasty
○ May cause pain and watering of the eye ● Usual complaint is tunnel vision; they do not see
● The cornea is overexposed so there is dryness, which peripherals
may cause irritation and redness ● Perimetry test is usually done
○ Machine checks peripheral vision
BLEPHARITIS
● Chronic inflammation of the eyelid margins
● Usually in patients with seborrheic dermatitis or
infection; in some when they use antihistamines,
anticholinergics, diuretics, or antidepressants CATARACTS
● We must always check the medications of our ● Clouding of the normally clear and transparent lens of
patients the eye
● There is redness and swelling of the eyelids, matting, ● Opacity of the lenses
and crusts ● Blurred vision
● Initial management is proper hygiene ● Lenses can be seen
● Use mild soap ● Surgery is called phacoemulsification
● Proper storage of contact lenses ○ Removes and replaces the lens
● Eye makeup is only good for 3-6 months ○ Reading glasses would no longer be necessary
● Eye lubricants may be used after
● Steroid eye drops may be recommended by the ● Focus on patient safety:
ophthalmologist ○ Do not bend down
● Hairspray may also be a cause ○ Wear goggles to avoid touching the eyes
○ Eye drops
GLAUCOMA
● Blockage in the drainage of the aqueous humor in the
anterior chamber
RETINAL DISORDERS
AGE-RELATED MACULAR DEGENERATION

● Cells within the macula diminish in functional ability
and replacement of the damaged cells is decreased,
causing irreversible damage to the macula
● #1 leading cause of blindness in older adults 50 and
older
● Complaint is loss of central vision (but periphery is
normal)
● Risks: smokers and lifestyle
● Management
○ Quit smoking
○ Exercise RETINAL DETACHMENT
○ Healthy diet ● Sensory layer of the retina separates from the
○ Adequate consumption of green leafy pigmented layer
vegetables ● May be due to trauma or aging
○ Fish (good in omega-3) ● Fluid seeps inside, leading to retinal detachment
○ BP and Cholesterol kept at a normal range ● Complaints of flashes of light, shower, or floaters
○ Like seeing spiders or bugs moving in their
vision
● Complete retinal detachment - complete loss of
vision or loss of half of your vision (parang may
kurtina)
● If there is a change in the field of vision, the patient
will have anxiety. So, we need to give reassurance and
refer them to a specialist.
DIABETIC RETINOPATHY
● Altered circulation to the eye that result to retinal
edema, degeneration, or detachment
● Complication from diabetes because blood usually
becomes viscous and blood vessels in the eyes are
small
● Hemorrhage and scarring may happen and can lead Management
to blindness ● Ophthalmologist may do laser surgery (depending on
● Diagnosis through an Ophthalmoscope examination the type of retinal detachment) as to where the
○ Dye is injected for visualization location is so that they can inject air, gas, or oil
○ Uses a very bright light; uncomfortable ● Vitrectomy - to remove excess fluid in the eyes
● Scleral Buckling
PROMOTING VISUAL HEALTH

● Wear eyeglasses
○ Some prefer using a magnifying glass instead
of eyeglasses
● Use sunglasses outdoors
○ UVA and UVB
● Avoid abrupt changes from dark to light
● Adequate indoor lighting

● Large print books
● Use magnifier for reading as needed
● No driving during the night and during bad weather
conditions
● Avoid glare and direct sunlight
● Use contrasting colors for color coding
● Avoid/stop smoking
● Regular eye check-up
● Optimal nutrition (lutein supplements)

FUNCTION OF THE EARS
PHYSIOLOGIC CHANGES EFFECTS TINNITUS

● Subjective sensation of noise in the ear
Degeneration of auditory Lose high-frequency tones, ● Can be combination of conducive and sensorineural
nerve deafness (hissing, buzzing, and ringing sound)
● Higher risk at people who are exposed to noises that
Excess bone impairs sound Deafness cause damage to the hair receptors
conduction ○ This is why ENT does not recommend using
cotton applicators everyday because the
COMMON AUDITORY PROBLEMS ASSOCIATED WITH AGING natural hair is being removed from the ear
PRURITUS ● Cleaning everyday causes dryness, which may lead to
● Itching within the external auditory canal pruritus
● Due to atrophy of the epithelial and epidermal ○ If it cracks, it may cause ear infection
sebaceous glands ● Unilateral - more serious because it has relation to
● Doctor may prescribe mineral oil, glycerin drops, and Meniere’s disease, or if they have a tumor or vascular
steroids (as needed and if still not addressed) problem
HEARING LOSS
● Conducive, sensorineural or mixed hearing
impairment
CERUMEN IMPACTION
CONDUCIVE HEARING LOSS
● Caused by dry cerumen, narrowed auditory canal, and
● Interruption of transmission of sound through the
stiffer, courser hairs lining the canal
external auditory canal and middle ear
● Ear candling is not advisable
SENSORINEURAL HEARING LOSS
● When the inner ear, auditory nerve, brainstem, or ● Reduce background noise
cortical auditory pathways do not function properly ● Speak with low pitch voice or normal tone
so that sound waves are not interpreted correctly ● No shouting
● Use non-verbal cues
PRESBYCUSIS ● Enunciate clearly
● Bilateral difficulty hearing high pitched tones and
conversational speech Spoken words should be enunciated clearly and should be
● Sensorineural said slowly. It is better to get them a hearing aid.
MANAGEMENT FOR DECLINE IN HEARING

● Talk in a low tone of voice
● Use non verbal communication FUNCTION OF THE NOSE
● Write in bigger letters
● Use of hearing aid
● Referred to oral rehabilitation (auditory, speaking, Decreased smell Decreased ability to smell
and reading) substances such as smoke or
gas, causing safety risk; loss
DIZZINESS AND DISEQUILIBRIUM of appetite
● Decrease in vestibular sensitivity coupled with
inability to maintain balance
COMMON OLFACTORY AND GUSTATORY PROBLEMS
BENIGN PAROXYSMAL POSITIONAL VERTIGO ASSOCIATED WITH AGING
● Having vertigo while changing the position of head ● Normal for aging to have a decreased sense of smell
due to medications, long term exposure to toxic
AMPULLARY DISEQUILIBRIUM fumes, or head trauma
● Rotational head movements
XEROSTOMIA
MACULAR DISEQUILIBRIUM ● Subjective sensation of abnormal oral dryness
● Change of head position in relation to gravitational ● Decreased salivary flow
pull ● At risk for respiratory infections
● Kunwari nakahiga ka tas babangon ka bigla can cause ● Low appetite and decreased ability to communicate
vertigo ● May also complain of abnormal taste, burning of oral
mucosa and tongue, and dentures falling out
VESTIBULAR ATAXIA OF AGING
MENIERE’S DISEASE
● Usually occurs in older women
○ They can also have tinnitus, vertigo,
progressive low frequency hearing loss
MANAGEMENT FOR VERTIGO

● Meclizine
● Physical Therapy
○ In physical therapy, the use of other senses is
taught in order to substitute the vestibular
disturbances
● Safety issues
PROMOTING AUDITORY HEALTH MANAGEMENT

● Hearing examination PRN
● Maintain oral hygiene (encourage brushing with a soft

bristle brush, floss regularly during the night and use
non-abrasive toothpaste)
● Encourage the older adult to drink 2L-3L of water if
not contraindicated
● Use sugar free candy or gums to stimulate saliva
production
PROMOTING OLFACTORY AND GUSTATORY HEALTH

● Encourage use of lemon, spice, herbs, and garlic
● Salt substitute (K iodide)
○ Kakadagdag ng salt baka magdevelop ng high
blood pressure
● Stop smoking

FUNCTION OF THE MUSCULO-SKELETAL SYSTEM
Decreased muscle mass Reduced strength
Decreased muscle tone Muscles look flabbier
Deceased elasticity of Movements are restricted

tendons and ligaments
Slowed muscle responses Response time increased
Bone thinning, softening Decreasing bone density
Joint stiffening Decreased flexibility
Vertebral disk water loss Decreased height
OSTEOARTHRITIS
COMMON MUSCULO-SKELETAL PROBLEMS ASSOCIATED
● Progressive articular cartilage deterioration with the
WITH AGING
formation of new bone in the joint space
FRACTURE (HIP, COLLES, CLAVICLE)
● Degenerative joint disease
● Break or disruption in the continuity of the bone
● As we grow old, there is wear and tear
● Usually hip fractures are femoral or intertrochanteric
● Pain is usually encountered at the end of the day
because these are weight bearing
● Colles fracture - distal part of the radius because
MANAGEMENT
when an elderly falls, their free hand catches the fall
● NSAIDs
● Exercise and mobilization (ex. 30 minutes of walking
per day) for their condition to not worsen
OSTEOPOROSIS
● Porous bone or brittle bone disease characterized by
reduction in the bone mass and loss of bone strength
● Also called “silent bone disease” because
manifestations only show when you get fractured
● Diagnosed through a bone densitometry
● Can be checked even when you’re as young as 30
years old, especially when you do not exercise, lack
calcium intake and vitamin D, aren’t exposed to the
sun, and love drinking coffee
RHEUMATOID ARTHRITIS
● Chronic, systemic inflammatory disease that causes
joint destruction and deformity that results in
disability
● Autoimmune (it means that even if you are young,
you can get the disease)
● Pain manifests upon rising (because it is inflamed)
MANAGEMENT
● Some prefer to take warm baths in the morning to
reduce swelling
● Steroids and NSAIDs MANAGEMENT
● Exercise and mobilization (ex. 30 minutes of walking ● Vitamin D and Calcium supplements
per day) for their condition to not worsen ● Weight bearing exercises
GOUTY ARTHRITIS OSTEOMYELITIS

● Acute attacks of arthritis pain due to elevated levels ● Infection of the bone that can be either acute or
of serum uric acid chronic
● The body cannot digest uric acid properly ● May be due to trauma, nutritional status, fracture
● At risk: those who like to drink and eat “laman loob” (especially if open fracture), URTIs and UTI (organism
● Formation of tophi is usually seen on the big toe or went into the blood and into the bone then
the knees proliferated)
○ Extreme pain because of crystallization ● May lead to amputation if not caught and treated
early
MANAGEMENT
● Anti-gout medications
● Lifestyle modification
MANAGEMENT
● Specific antibiotics (for the microorganism that
caused the infection)
● Nutritional support
● Surgery, if needed
FOOT PROBLEMS
CORNS
● Thickened and hardened dead tissue that develops
over bony protuberances
● Should not be manipulated since skin of geratric
clients are thinner
● Properly moisturize and use cotton socks
HAMMERTOE
● A deformity of the second toe
● Metatarsal phalangeal is dorsiflexed
● Caused by ill-fitting shoes, leading to muscle
weakness
CALLUSES
● Are dead tissue found on the plantar surfaces of the
feet
NAIL DISORDERS
● Should not be manipulated since skin of geratric
● Toe nail problems (onychauxis, onychomycosis)
clients are thinner
● Onychauxis - nail curves on the soft tissue on the nail
bed, causing irritation, infection, and pain
● Onychomycosis - due to fungal infections; nails look

brittle and may be hypertrophic; may have yellowish
or brownish discoloration
BUNIONS
● Are bony protuberances on the side of the great toe
NUTRITIONAL, METABOLIC, AND

ELIMINATION FUNCTIONS
REFERENCE LINKS:
Age-Related Aging Changes of the GI, GU, and

Changes in the Reproductive Systems
GI, GU, and
● Due to moisture, ill-fitting shoes, or recurrent trauma Reproductive
● At risk: Diabetic Systems
● Takes months before it resolves
Gastrointestinal Gastrointestinal Symptoms
Management Symptoms
● Topical antifungal medications
● Oral antifungal medications as needed, depending on Improving Digestion for elderly
the severity of the infection Digestion for the
Elderly
MUSCLE CRAMPS
● Idiopathic muscle cramps without muscle weakness Geriatric Geriatric Pharmacology
● Usually happens during rest, especially at night when Pharmacology
they are already sleeping
● Very painful
● Muscles suddenly shorten to the point that toes and AGE RELATED CHANGES IN THE STRUCTURE AND
foot plantarflexes FUNCTION OF THE GASTROINTESTINAL SYSTEM
PHYSICAL CHANGES EFFECTS

MANAGEMENT
● Light stretching activities before they sleep (for at
Reduced taste and smell Appetite can be reduced
least 1 minute interval)
○ Especially in the calf Decreased saliva Dry mouth, altered taste
PROMOTING MUSCULO-SKELETAL HEALTH Decreased gag reflex, Increased aspiration risk

● Regular exercise relaxation of lower
● High calcium diet esophageal sphincter
○ Always check blood work because excess may
lead to the development of calcium stones Delayed gastric emptying Reduced appetite
● Limit phosphorus
● Calcium and Vitamin D supplement as ordered Reduced liver enzymes Reduced drug metabolism
● Fall and safety precautions and detoxification
○ Non skid shoes
○ Carpets should be nakadikit; loose carpets Decreased peristalsis Reduced appetite,
should be removed constipation
○ Cotton socks
○ Leather shoes (should be breathable) GASTROINTESTINAL SYSTEM
○ Avoid wearing pointed shoes AGE-RELATED CHANGES AFFECTING THE GASTROINTESTINAL
SYSTEM
CARE OF THE OLDER ADULTS WITH ● Environmental factors (meds, smoking, Vit B
NEEDS AND PROBLEMS IN deficiencies) + neurological changes
● Diminished taste
● Dysphagia ○ Low Na: confusion

● Slowed gastric motility ○ Low K: arrhythmia
● Delayed esophageal + gastric emptying
● Early satiety (fullness) NURSING INTERVENTIONS
● Decreased salivation
● Food, medications, activities, constipation, and
● Decreased sense of thirst, smell
diarrhea should be checked
● If the patient vomits: check the amount,
characteristics (if recently ingested food), presence of
● Risk of dehydration, electrolyte imbalance
food particles, color (greenish: the presence of bile),
● Poor nutritional intake
presence of blood (bright or dark red)
● Dry mouth
● Assess: if feverish, sweating, pallor, dizziness, pain,
● Complaints of fullness, heartburn, indigestion
dehydration, electrolyte imbalance
● Constipation
● Assess VS, including pain score and location
● Flatulence
● Advise small frequent feeding, and frequent sips of
● Abdominal discomfort
water
● Clear liquid, bland, and soft diet
● Risk for aspiration: Advice client to assume Semi to
High-Fowlers position when eating
● Sleep on sides
● Be careful on giving medications since it can cause
sedation, confusion, and delirium for the elderly.
ANOREXIA
● Lack of appetite
● Monitor if with abdominal pain, N/V, weight loss,
NUTRITIONAL HEALTH diarrhea, constipation, stress, or in the grieving
● Decreased Physical Activity + Slower Basal Metabolic process.
Rate (BMR) = Weight Gain ● May also be caused by lack of finances
○ Require fewer calories
● Decreased Pleasure in Eating (taste, smell) = NURSING INTERVENTIONS
Malnourished ● Monitor weight, input & output
○ Require more nutrient rich, healthy diet ● Encourage to eat nutritional food
● Give alternative food choices or preferences
COMMON GASTROINTESTINAL SYMPTOMS ● Check abdominal wall for stretching
● Because of the systemic changes in digestion, there’s
also reduction of absorption in nutrition. ABDOMINAL PAIN
● It is also attributed to cardio and neurological ● Use OLD CART or PQRST in assessing pain
changes. ● Some questions that can be asked:
● Ex: Patients with cardiac conditions such as ○ Was it related to the food intake that they
atherosclerosis, there is a decrease in blood flow in had?
the overall system. The mesentery is also affected, as ○ What are the factors that make it worse?
well as the absorption in the small intestine ○ Does it radiate to the back, groin, neck area?
● Ex: When it comes to the central and peripheral ○ Was the patient able to pass out stools or
nervous system, there's an alteration in peristalsis so gas?
there is decreased motility and GI function. ● Assessment of Pain (PQRST):
○ P-recipitating/Provoking Factors
NAUSEA AND VOMITING ○ Q-uality
● Common complaint is that they feel sick or dizzy ○ R-egion/Radiation
● Geriatrics are at risk for dehydration and electrolyte ○ S-everity
imbalances ○ Time - Onset of pain (When is this felt?)
● Somatic Parietal Pathway - sharp, constant, more ○ Type of stool (semi-formed, watery)
intense type of pain; better localized pain than ○ Steatorrhea
visceral; pain starts in the parietal or peritoneum ○ Previous travel
● Visceral Pathway - gnawing, burning and cramping ○ Weight loss
type of pain; diffused and poorly localized; due to ○ Abdominal pain
stretching and distended abdominal wall ○ Vomiting
● Referral Pathway - sharp and well localized ○ Change of diet/medication
○ Irritable Bowel Syndrome (presence of mucus
NURSING INTERVENTIONS in stool, sudden urge to defecate)
● Relieve discomfort ● Ask for amount, smell, and presence of blood
● Hospital admission and IV therapy, as needed, ● Dehydration is a problem - release of electrolytes may
depending on the assessment lead to complications (Potassium - controls cardiac
● Doctor may order NG tube for decompression function). This is considered life threatening for
● Monitor and record VS and I&O; assess pain from geriatric clients.
time to time ○ Ask if the client feels thirsty, dizzy
● Medications ordered depending on the type of pain ○ Check for palpitations and fatigue
experienced
NURSING INTERVENTIONS
GAS ● Know the main cause
● Feeling of belching, fullness, and passing of flatus ○ Usually asked for a stool sample
● Apply PQRST ● Antibiotics and antispasmodics (to lessen cramping)
● Ask if the patient is able to pass out stool or gas as needed
● Talking too much and fast, and chewing gum may lead ● Antidiarrheals as needed
to build up of gas ○ Not everyone should be given antidiarrheals
● Older adults may frequently pass gas: 7 to 20 passage because it’s better to let it out of your system
of gas is normal ● NPO, clear liquid diet, or BRAT Diet (Banana, Rice,
● Gas can be odorless or with smell (usually recently Apple Sauce, Toast) as tolerated
intaken food)
● Foul smell can be observed in patients with PUD and CONSTIPATION
gastritis ● Inability to pass stool
● Usually dry, hard, and clamped feces
NURSING INTERVENTIONS ● Ask first about the usual bowel movement and
● Positions and home remedy to promote peristalsis: patterns prior to onset
Knee to chest or Side-lying position, Drinking warm ● Bristol stool chart - 7 classifications of stool (Hard
water or tea to promote peristalsis lumps, soft and semi formed, hard to pass, watery, or
● Encourage the patient to talk slowly to enable the no passage of stool)
mouth to close, preventing gas build-up.
● Encourage less intake of gas-forming foods such as
cabbage, legumes, and raisins.
● NGT may be used to release gas for decompression
● Monitor vital signs and record input and output
DIARRHEA
● Increase in the defecation or change in consistency of
feces
● Assessment
○ Onset
○ Intake (Food Recall)
○ Precipitating factors
○ Frequency of defecation
○ Listerine and betadine is too alcoholic and

hurts the tongue
● Brush, floss, massage gums daily
● Regular dental care
○ Usually twice a year
○ More regular if with oral/teeth conditions
● Small, frequent meals
● Sit up and avoid heavy activities post eating
● High fiber, low fat diet
● Hydration
○ 2-3L per day if not contraindicated
○ Water (as much as possible)
● Toilet regularly and do not abuse laxatives
COMMON GASTROINTESTINAL SYSTEM PROBLEMS

GINGIVITIS
● May also be due to overuse or improper use of ● Inflammation of the gums surrounding the teeth
laxatives, immobility because of sensory, neuro and ● If brushing and flossing are not done correctly
muscular problems, ignorance of urge to defecate,
low roughage in diet, inadequate fluid intake
NURSING INTERVENTIONS
● If not contraindicated (CHF or kidney diseases),
instruct pt to increase water fluid intake (At least 2
liters per day; distributed throughout the day)
● Increase fiber intake
● Ambulate as tolerated to promote peristalsis
● Prescribed laxatives (bulk-forming, stool, surfactants,
emollients, contact stimulators like castor oil)
○ Common laxatives in hospitals: lactulose,
docusate (colace), senna/senokot
PERIODONTITIS
● Enemas (soap sud enema, fleet, suppositories)
● Spread of the inflammation to the underlying tissues,
bones, or roots of the teeth
FECAL INCONTINENCE
● Very difficult to manage
● Involuntary passage of stool (acute or chronic);
● Promote preventive instead of curative
● May be due to: a colorectal lesion, perianal disease,
● If aggravated, can lead to tooth extraction
“propitis(?)”, presence of tumors, dementia, stroke,
spinal cord lesion
● Laxatives should be prescribed as chronic use will lead
to fecal incontinence
● May also be caused by poor diet and immobility
PROMOTING GASTROINTESTINAL HEALTH AMONG THE

OLDER ADULTS
● Ice chips, mouthwash
○ Promote salivation
○ If mouthwash is not tolerated, saline mix is
okay to be used
MANAGEMENT
● Saline wash if unable to tolerate mouthwash ● Heartburn

● Properly-fitted dentures
● Remember to brush the dentures (pustiso) RISK FACTORS
● Pain relievers (except narcotics) as needed ● Medications: Aspirin, NSAIDS, Vitamin C/Ascorbic
● Soft diet Acid, Potassium Chloride
● Fatty diet
DYSPHAGIA ● Caffeine
● Difficulty swallowing
● Weakened smooth muscle or incompetent sphincter ESOPHAGITIS
● May be due to stroke, neurologic problems, local ● Inflammation of the esophagus
trauma, or brain tumor ● Prolonged vomiting
● Problem in the esophageal sphincter
● Same management with GERD
MANAGEMENT
● Modify to soft mechanical diet
● Prevent aspiration through upright position while
eating
SIGNS AND SYMPTOMS
● Emotional support: Encourage and motivate to take
● Heartburn
time while eating.
● Acid sensation in the throat and stomach
● Retrosternal discomfort
GASTROESOPHAGEAL REFLUX
● Regurgitation of a bitter or sour taste
● Movement of gastric contents back up into the
○ The usual cause is caused by a person who
esophagus
likes fatty, spicy and alcoholic drinks.
● Impaired lower esophageal sphincter
MANAGEMENT
● Avoid or lessen fatty, oily, and spicy foods
● If caused by medications, it will be discontinued or
switched to another medicine.
HIATAL HERNIA
● Major cause of reflux and esophagitis which occurs
when part of the stomach protrudes through an
opening of the diaphragm
SIGNS AND SYMPTOMS

● Increased intraabdominal pressure
● Bitter taste
● Decreased/delayed gastric emptying time
SIGNS AND SYMPTOMS MANAGEMENT

● Feeling of heartburn ● Orally given Cyanocobalamin 1000 mg, as ordered
● Gastric regurgitation ● Intramuscular injections, if severe
● Dysphagia
● Indigestion PEPTIC ULCER DISEASE
● Results from an imbalance between the aggressive
Geriatric Symptoms forces of gastric acid and pepsin and the defensive
● Hoarseness in voice forces in the gastric and the duodenal mucosa
● Chest pain ● Causative agent is H. pylori
● Feeling of fullness after eating ● Because of stress and anxiety, an imbalance of H.
● Respiratory symptoms pylori occurs in which antibiotic therapy is needed to
● Belching treat it
● Aspirins, NSAIDs increase the risk for ulcer
MANAGEMENT
● Proper nutrition
● Prevent aspiration
● Avoid smoking
● Avoid food that causes these symptoms
● Ask to record and recall a certain food that triggers
the feeling of burning sensation to avoid aggravation.
PERNICIOUS ANEMIA
● Degeneration of the parietal cells in the gastric
mucosa that causes a decrease in the production of
intrinsic factor
● Deficient Vit. B12
● RBCs become oval-shaped, fragile, and die easily SIGNS AND SYMPTOMS
(<120 days) ● Gnawing, burning and aching pain
● Malabsorption due to gastritis, alcoholic lifestyle, ● After eating, if sumakit agad ang tiyan ng patient it is
gastric surgery, irritable bowel disease, autoimmune, gastric pain.
excessive use of H2 receptor antagonists and proton ● If the pain is felt 2 hours after eating, it is duodenal.
pump inhibitors.
MANAGEMENT
● Lifestyle modification
● Diet
● Quit smoking
● Lessen alcohol or caffeine intake
● Physician may also order for a proton pump inhibitor
● Avoid NSAIDs and Aspirin
● Proper relaxation techniques ● If lumiit, may stricture

● Exercise ● May lead to peritonitis, for some patients
● Resection of stomach, if severe
○ May lead to Dumping Syndrome (fast
digestion)
■ Experiences dizziness and sweating
○ If with Dumping Syndrome, should lie down
on right side after eating
ENTERITIS
MANAGEMENT
● Inflammatory process of the stomach or small
● Note the type of vomit, diarrhea, pain, check for
intestine
bowel sounds, abdominal distention, I&O, vital signs
● Inspect, Auscultate, Percuss, Palpate (last because it is
CAUSES
more invasive)
● Bacteria or virus
● Hydrate patient and insert NGT tube for
● Food irritant
decompression and pain relief
● Food poisoning
○ S. aureus, Salmonella, C. Botulinum
DIVERTICULA / DIVERTICULITIS
○ Amoebiasis - poor sanitation; usually seen in
● Saclike protrusions of the mucosa along the GI tract
tropical countries
● Diverticulitis - there is an infection and inflammation
○ Protozoal or Trichinosis
● Diverticulosis - outpouching occurs; may have
○ Improperly cooked food
presence of infection
● Allergic reaction
● Medications
● Radiation therapy
MANAGEMENT
● Assess recent travel, recent food ingestion, presence PREVENTION
of N/V, diarrhea ● Increase fiber in diet and water intake, as much as
● Assess amount, frequency, and characteristics of stool possible, avoid constipation
passed ○ Normal bowel movement is dependent on
● Assess medications that they took the patient
● Since there is N/V, replace fluid loss with ORS
MANAGEMENT
INTESTINAL OBSTRUCTION ● If with infection and inflammation, address the pain
● Partial or complete blockage of GI contents in either and promote bowel rest (NPO, low fiber diet)
small or large intestines ● Since they are Geriatrics, they may be hospitalized, as
● If there is a blockage, may bukol needed, for fluid maintenance
POLYPS CHOLELITHIASIS
● Any growth that protrudes from a mucous membrane ● Presence or formation of gallstones in the gallbladder
in the GI tract ● Patient complains RUQ pain (very painful)
● Seen through colonoscopy ● For some, there is jaundice due to blockage
● This will cause bleeding ● Fat, Female, 40 (prone to developing cholelithiasis)
HEMORRHOIDS
● Hemorrhoids - dilatations of the veins in the mucous
membrane inside or outside the rectum
● Can be external or internal but both polyps and
hemorrhoids will still cause bleeding MANAGEMENT
○ External hemorrhoids may cause anemia ● Pain relief and surgery as needed
● “Cauliflower / chicharon bulaklak sa pwet” ● Ask patient if he/she like fatty foods
● This has different grades/stages ○ Ask to avoid fatty foods
● Medications
● Can sometimes still be removed through lithotripsy
(ultrasound; uses shock waves to durog the gallstones
and be passed out by the patient)
● Antibiotic as needed
● Clear, liquid diet
● Usually, open surgery is done
CHOLECYSTITIS
● Inflammation of the gallbladder
● Antibiotic therapy as needed
MANAGEMENT FOR POLYPS AND HEMORRHOIDS

● Prevent constipation
○ Increasing fiber and oral fluid intake
● Light exercises
● Do not carry heavy objects since carrying heavy
objects will make them exert pressure on their
bottom
● Hot sitz bath
● Regular toilet routine should be encouraged
● Comfortable clothing
● Hepatitis D - blood to body exposure; more severe

and life threatening
● Hepatitis E - common in Asia; through contaminated
water
Note: Both cholelithiasis and cholecystitis are found through

abdominal ultrasound SIGNS AND SYMPTOMS
● During the prodromal stage, complains of body
PANCREATITIS malaise, fever, discoloration or jaundice, nausea and
● Inflammation of the pancreas vomiting, anorexia, possible RUQ pain, low grade
● Those who are most likely to get this are alcoholics fever
● Can be acute or chronic ● During the icteric stage, they turn yellow (not all
○ Chronic is usually alcohol induced; experience jaundice), urine may be dark yellow or
permanent, progressive, forms fibrous tissue normal
● Convalescence stage - jaundice and other symptoms
disappear
● It takes 3-6 months for the liver to fully recover
MANAGEMENT
● Vaccinations
● Proper barriers during intercourse
● Increase carbohydrate intake
● Decrease fat
● Hydrate patient (2-3L per day)
● Manage pruritus
○ Ask to take a bath
MANAGEMENT ○ Use mild soap
● Check for alcohol abuse, presence of gallstones ● Take antihistamines as needed
● Pain medications ● Moisturize the skin
● Watch out for F&E imbalance
ALCOHOLIC CIRRHOSIS
HEPATITIS ● A permanent and irreversible destruction of the
● Inflammation of the liver hepatocytes and the normal architecture of the organ
● Hepatitis A - fecal-oral route; commonly seen ● Chronic
● Hepatitis B - exposure to blood and body fluids; ● Normal appearance of liver:
commonly seen reddish/purplish/brownish, smooth, glistening, shiny
● Hepatitis C - related to blood transfusion, those who ● With Alcoholic Cirrhosis, there is nodular feeling,
undergo hemodialysis; patient may be asymptomatic painful during palpation
● Skin is red and irritated
● Early stages: hepatitis mechanisms responding to the presence of a foreign

● Serious complication since our liver is also responsible invader
for clotting and coagulation ● With infection
○ Can have bleeding and esophageal varices ● Possible cause is Polypharmacy
● Albumin is monitored and assessment for ascites is ● Usually because of prolonged use of Acetaminophens
done
○ Recall: ascites = big, hard abdomen
○ Decreased albumin = fluid shift
○ Ascites may compromise respiratory
functions
● Usually would have Portal Hypertension
● May have Encephalopathy because liver cannot
properly metabolize body toxins, resulting in an
increase in ammonia
○ Patients would undergo behavioral changes,
are irrational, combative
● May also have Asterixis (muscle tremors)
○ If unresolved, will lead to hepatic coma
MANAGEMENT
● Insertion of NG tube as needed (connected to a
suction machine)
● Monitor for signs of liver failure
● Percuss liver size
● Check sclera of eyes, LOC
GASTROINTESTINAL CANCERS
For cancers, there usually is an abnormal lesion where it
would grow. The usual cancers are Gastric cancer and
Colorectal carcinoma, unless there is family history of other
cancers such as pancreatic cancer.
MANAGEMENT
● Prevent complications
● Encourage to take a bath
● Use mild soap, lotion, or moisturizers as needed to
decrease irritation
● Change positions every 2 hours
● Place in Semi-Fowler’s to promote maximum lung
expansion
● Use of soft bristle brush
● Use mouthwash as needed
● Orient patients if with behavioral changes
● Small frequent feeding or bland diet
○ Should have high carbohydrates, low protein,
and low fat ● Oral Cancer
● Natural fruit juice to give them energy ● Esophageal Cancer
● Gastric Cancer
DRUG-INDUCED LIVER DISEASE ● Colorectal Carcinoma
● Hepatic injury that results from direct toxicity, ● Pancreatic Cancer
conversion of a drug to an active toxin, or immune ○ Diagnosed at a late stage
○ Patient is usually seen to be yellow in color
○ For most of the patients diagnosed, their ● Up in pH (less acid)

doctors would opt for palliative care because ● Reduced GI motility
in less than a year, they would already die ● Prolonged gastric emptying
○ Management is usually encouraging to spend
time with family, alleviating pain, nutritional ABSORPTION
support ABSORPTION EFFECT
● Metastatic Liver Disease ● Delayed RATE of absorption
○ Ex. Complaints about constipation; upon ● Extent of absorption NOT affected
colonoscopy, tumor was seen in lower
sigmoid; MRI revealed Stage 4 colorectal, DISTRIBUTION
lung, and liver cancer CHANGES AND EFFECTS
● Liver cancer ● Decreased albumin sites - increased effects of drugs
○ Usual cause of death: Pneumonia, embolism, ● Reduced CO and peripheral blood flow
hepatic failure, malnutrition, or hemorrhage ○ Increased % of body fat
○ Increased storage of fat-soluble medications
NURSING ASSESSMENT (Barbiturates, Morphine, Lidocaine,
● We have to monitor the regular bowel movement Diazepam, Vitamin A, D, E, K)
because diarrhea or constipation may be the ● Reduced lean body mass
manifestation. ○ Decreased body volume
● Differential diagnosis - colonoscopy or endoscopy ○ Increased peak levels of medications
● Abdominal Pain METABOLISM
● Melena (depending on the location of the bleeding) CHANGES AND EFFECTS
○ Upper GI: black tarry ● Decreased Cardiac Output
○ Lower GI: bright red ○ Decreased liver perfusion
● Family history of cancer ○ Decreased drug metabolism
● Bowel sounds ○ Increased duration of medication
● History of bowel surgeries ○ Toxicity
● Nausea and vomiting
● Weight loss EXCRETION
○ Since there is pain when eating and they CHANGES AND EFFECTS
cannot regularly pass out stool, they would ● Decreased renal blood flow
limit their food intake ● Loss of functional nephrons
● Weakness ○ Decreased renal efficiency
○ Decreased excretion rate of medications
MANAGEMENT ○ Increased duration effect
● Proper nutritional support ○ Drug toxicity
● Pain management ○ Aminoglycosides, Cimetidine, Digoxin, Lithium
● Surgery, Chemotherapy, Radiation therapy, if needed
● Geriatric considerations: NURSING CONSIDERATIONS
○ Do they still want to undergo surgery? ● Explain drug analysis
○ How aggressive should the management be? ● Provide medication schedule in WRITING
○ What kind of chemotherapy are they willing ● Standard containers without safety lid
to undergo (IV or oral) ● Use of multiple day, multiple dose medication
GERIATRIC PHARMACOLOGY dispenser
● Adhere to medication schedule
(LIVER CHANGES) ● Destroy or remove old unused meds
● Keep list of meds plus OTC and herbal in purse/wallet
ABSORPTION ● MD visit and emergencies
ABSORPTION CHANGES
● Reduced gastric acid
● Review medication schedule periodically and update ● Obtain an accurate medication and medical history
PRN ● Link each prescribed medication to a disease state
● Recommend using one supplier for RX - same pharma ● Identify medications that are treating side effects
store can track and notice RX problems (duplication, ● Initiate interventions to ensure adherence
contraindication) ● Reconcile medications upon any discharge from
● If patient’s competence doubtful, identify reliable hospital or skilled nursing facility
caregiver/relative to monitor patient medication ● Prevention
compliance
● DO NOT remove meds from original packaging or NURSING CARE OF THE OLDER ADULTS
container
WITH NEEDS & PROBLEMS IN ENDOCRINE
POLYPHARMACY SYSTEM
● Concurrent use of multiple medications by a patient -
five or more medications daily
● Most common in the elderly affecting about 40% of AGE-RELATED CHANGES IN THE STRUCTURE AND
older adults living in their own homes FUNCTION OF THE ENDOCRINE SYSTEM
POLYPHARMACY PHYSICAL CHANGES EFFECTS

CONSEQUENCES OF POLYPHARMACY
Slowed basal metabolic Possible weight gain
● Increased Healthcare Costs
rate
● Adverse Drug Events
● Drug-Interactions Altered adrenal hormone Decreased ability to respond
● Medication Non-Adherence production to stress
● Decline Functional Status
● Geriatric Syndromes Decreased insulin release Hyperglycemia
● Cognitive Impairment
● Falls - use of 4 or more medications was associated
with increased risk of falling and the risk of falling and COMMON ENDOCRINE SYSTEM PROBLEMS
the risk of recurrent fall ASSOCIATED WITH AGING
● Urinary Incontinence METABOLIC SYNDROME
● Nutrition - 50% of those taking 10 or more ● Caused by improper nutrition, inadequate physical
medications were found to be malnourished or at risk activity, and obesity, which increase the risk of type 2
of malnourishment diabetes and atherosclerotic cardiovascular disease
● Patients with metabolic syndrome are observed to
POLYPHARMACY have central obesity, increased triglycerides, low HDL,
WAYS TO IMPROVE MEDICATION QUALITY IN OLDER ADULTS hypertension, and hyperglycemia
USING MULTIPLE MEDICATIONS
● Pharmacist
○ Review, written drug recommendations to
PCP and patient counseling at each clinic visit
○ Review of medication related issues;
pharmacist implemented recommendations
agreed to by patient’s GP
● Multidisciplinary, protocol-driven Geriatric Evaluation
Management (GEM) clinic
● Case conference with MDs, pharmacist, care worker,
dementia expert
POLYPHARMACY
TREATMENT OF POLYPHARMACY NURSING RESPONSIBILITY
● Focus on the root cause (improper diet and exercise)
● Encourage patients to follow a green leafy & high ● Antidepressants PRN (Some patients with chronic
fiber diet diseases may develop depression)
● Avoid or decrease the use of artificial sweeteners ● Adopt a patient attitude in discussing diet
● Limit consumption of fruits modifications and medications they have to take as
● Decrease intake of fatty and salt food they may have problems with memory
● Encourage an active lifestyle ● In creating a meal plan, make sure the letters are
○ If lifestyle is modified, maintenance large enough to read.
medication for DM and HTN are decreased to ● Arrange their medications
just one or two medications per day
HYPERTHYROIDISM
TYPE 2 DIABETES MELLITUS ● Hyperfunctioning endocrine state that results from
● Hyperglycemic state that results from defects in excessive secretion of thyroid hormones
insulin secretion, insulin action, or both ● Patients with hyperthyroidism may look thin,
○ Review: Insulin acts as the key to metabolize manifests palpitation/tachycardia, fatigue, tremors,
sugar or glucose we take in nervousness
● Life threatening in older adults as they may manifest
SIGNS AND SYMPTOMS arrhythmia
● Polyphagia, Polydipsia, Polyuria
MANAGEMENT
COMPLICATIONS ● Antithyroid Medication
● Hyperglycemia ● Radiotherapy (Radioactive Iodine), as needed
● Hypoglycemia ● Given beta blockers - decreases heart rate
○ At risk for injuries, especially falls or fractures
○ Cardiovascular accidents or Dysrhythmia HYPOTHYROIDISM
● Increased chance of having Dementia ● Hypo functioning endocrine state that results from
inadequate thyroid hormone
DIAGNOSIS ● Opposite of hyperthyroidism
● Sometimes, in older clients, DM is usually diagnosed
due to the presence of infection (UTI, leg ulcers, MANIFESTATIONS
vaginitis); which is confirmed upon blood work and ● Bigger in stature
doctor’s consultation. ● Cold intolerance
● It is difficult to diagnose DM in older clients due to ● Weight gain
changes related to their age (decreased appetite, ● Easily fatigued
fatigue, and blurring of vision, and weight changes). ● Muscle cramps
● Geriatric patients have different HbA1C ranges from ● Paresthesia
normal adults ● Confusion
○ 150 mg/dl is acceptable (normal ranges:
80-120) TREATMENT
○ If geriatric patient has coexisting chronic ● Synthetic thyroxine medications
condition/ life-expectancy is more than 10
years = Greater than 7.5% is acceptable LABORATORY TESTS
○ If geriatric patient’s life-expectancy is less ● T3
than 5 years = 8% is normal ● T4
■ They want to avoid hypoglycemia ● TSH
which is difficult to treat in older ● Symptoms
clients ● Ultrasound of thyroid
MANAGEMENT
● Diet, Moderate Exercise, Routine check-up
NURSING CARE OF THE OLDER ADULTS

GENITOURINARY SYSTEM
WITH NEEDS & PROBLEMS IN AGE-RELATED CHANGES AFFECTING THE MALE
GENITOURINARY SYSTEM GENITOURINARY SYSTEM
● Benign Prostatic Hypertrophy
○ Urine retention
AGE-RELATED CHANGES IN THE STRUCTURE AND ○ Overflow incontinence
FUNCTION OF THE GENITOURINARY SYSTEM ○ Incomplete voiding
● Incomplete stream
PHYSICAL CHANGES EFFECTS ● Multiple night time voiding
● Stress and urge incontinence
Kidney size decreases Able to live with 10% renal
function
Decreased bladder size, Frequency of urination

tone, changes from pear increases
to funnel shaped
Weakened muscles Incontinence
Decreased ability to Nocturia

concentrate
Less sodium saved Risk for dehydration GENITOURINARY SYSTEM

AGE-RELATED CHANGES AFFECTING THE FEMALE
Reduced renal blood flow Decreased renal clearance of GENITOURINARY SYSTEM
medications ● Relaxed perineal muscles
● Be careful in ○ detrusor instability
prescribing ○ urge incontinence
medications for ○ frequency syndrome
geriatric patients ○ decreased “warning time”
● Multiple night time voiding
● Urethral dysfunction
GENITOURINARY SYSTEM ○ stress incontinence
AGE-RELATED CHANGES AFFECTING THE GENITOURINARY ○ urine leakage with cough, laugh, position
SYSTEM changes
● Loss of nephrons (significant loss at the age of 90)
○ decreased kidney mass
○ decreased filtration rate
○ diminished tubular function
○ decreased ability to concentrate urine and
maintain fluid and electrolyte balance
PROMOTING GENITOURINARY HEALTH AMONG THE

OLDER ADULTS
● Hydration
○ 2-3 liters, if not contraindicated
● Acidify urine - avoid citrus fruits
● Hygiene
those
○ Front to back
experiencing
● Blood pressure monitoring
incontinence
○ RAAS System
● Note for signs and symptoms of urinary tract infection Urologic work-up as
needed
PROMOTING GENITOURINARY HEALTH AMONG THE
OLDER ADULTS COMMON GENITOURINARY SYSTEM PROBLEMS
FEMALE MALE
ACUTE INCONTINENCE
Easily manipulated Limit drinking in evening ● Sudden onset, usually associated with medical or
clothing (especially caffeinated, surgical condition
● Applicable for alcohol)
both female and ● For both male and
male female
● Reason they don’t
want to go to the
CR (too many
buttons, too hard
to bring clothes
down)
Use pads PRN No long periods between

● Some may think voiding
they are ● Schedule routine for
menopause but voiding CHRONIC INCONTINENCE
still have to use ● Continuous overtime and gets worse
pads because
there may be STRESS INCONTINENCE
times wherein a ● Second most common in the female population
little urine goes ● Increased pressure in the bladder
out ● May have bladder issues, dementia, stroke,
● Used if they do Parkinson's, or uterine cancer
not want to use ● More common in females because there is a lack of
diaper estrogen, obesity, or increased vaginal deliveries
Adequate hydration Full empty bladder when URGE INCONTINENCE

● To prevent UTI voiding ● Most common for geriatric population
● If cut short, you have ● Usually due to overactive bladder, UTI, medications,
to urinate again or bladder irritants (caffeine-containing drinks or
alcohol)
Avoid bladder irritants Urologic Follow Up
(artificial sweeteners, tea, OVERFLOW INCONTINENCE
caffeine containing ● Second most common for the male population
drinks) ● Constant dribbling
● Weakened bladder
Kegel (pelvic floor) ● Parkinson’s Disease or Multiple Sclerosis
exercises ● May have daytime or nighttime accidents
● Especially for
● Could be due to urethral blockage such as BPH or

stones
● Ask your male patient: Kamusta po ang pag-ihi niyo?
Normal? Pag ba umihi kayo, nailalabas niyo lahat? (if
yes), kapag umiihi ba kayo may force pa rin or yung
parang tumutulo?
FUNCTIONAL INCONTINENCE
● Due to physical, mental, and psychological
environments
● Patient may be depressed, prefers to lie down or sit
all day
● Refuse caregiver’s help when going to the distant CHRONIC RENAL FAILURE
restroom ● Progressive, irreversible loss of renal function that
● Does not prefer ambulatory aids: walker, cane develops over time
● Need to transfer from chair to wheelchair ● Increased Creatinine, BUN levels
● Prefer not to urinate if their clothes are hard to ● Creatinine Clearance is computed based on the age,
manipulate weight, and creatinine result of the client
● Clients hold but eventually urinates due to ● Check for the presence of protein or albumin in the
incontinence urine
● If kidney problem is suspected, Micral Urine Analysis
MIXED INCONTINENCE is ordered, which can show much smaller urine
● Combination of two or more types of incontinence. particles and (+) protein excreted by the patient.
MANAGEMENT
● Proper history-taking
● Teach clients to do Kegel’s exercises
● Advise to sit on the toilet bowl longer to ensure
emptying of bladder
● Lifestyle Modification and Nutrition: Avoid bladder
irritants
● If clients are in extended care facilities, caregivers
may schedule the time where the geriatric clients may
use the bathroom to encourage urination.
ACUTE RENAL FAILURE MANAGEMENT

● Sudden loss of renal function characterized by ● Maintain proper fluid and electrolyte levels
retention of metabolic waste products, fluid and ● Prevent Nephrotic Syndrome (inflammation of the
electrolyte alterations and acid-base disturbance kidney due to too much protein waste)
● Once the main cause is resolved, the patient’s kidney ● Diet Management
may recover and return to normal condition. ○ Low-protein diet to decrease kidney workload
● How to know if there is a problem in the kidney? ○ Low sodium, potassium, and phosphorus
○ Blood Workup (BUN, Creatinine) ● Medication Compliance
■ BUN shows how the liver and kidneys ● Address patient’s fatigue and low energy through
detoxify waste products in the body scheduling of activities
■ Creatinine shows how well the
kidneys are functioning. Who is susceptible to Chronic Renal Failure?
○ Urine Output ● History of Diabetes and/or Hypertension
■ Includes patient’s fluid intake
○ If these conditions are resolved, the life of the NURSING INTERVENTIONS

patient’s kidney is usually extended ● Educate the patient
○ Provided compliance in medication regimen, ● Give psychosocial support as needed
lifestyle, and diet modifications ○ Depression due to body changes
● If caught early, they may do surgery and it will depend
URINARY TRACT INFECTION on the type of surgery
● Characterized by dysuria, urgency, frequency and ● For some patients, the bladder is completely removed
hematuria secondary to damaged superficial blood and they have an ostomy. They may get some part of
vessels in the mucosa of the bladder the intestine that will serve as the reservoir or the
● Confusion and alteration of mental status among patient has to be inserted with a catheter to drain the
geriatrics can be an indicator of UTI upon thorough urine
physical assessment. ● Pain management as needed
● Fluids and electrolytes, and proper nutrition to help
cope with the cancer
● May undergo Chemotherapy or Radiotherapy
BENIGN PROSTATIC HYPERTROPHY

● Age related enlargement of the prostate gland that
constricts the urethra and obstructs the outflow of
urine
● Usually seen in patients 80 years old and above
MANAGEMENT
● Increase oral fluid intake
● Compliance in prescribed antibiotics
● Diuretics for Urinary Retention
BLADDER CANCER
● Characterized by painless hematuria, dysuria,
urgency, burning with urination, frequency and
nocturia
● Always check family history of the patient
● If the patient mentioned that they have history of SIGNS AND SYMPTOMS
bladder cancer, they are only able to pass urine in ● There is hesitancy prior to voiding
small volumes ● Decreased force when urinating
● Dribbling
● Sensation of full bladder even after they try to urinate
● Urinary retention after voiding
DIAGNOSTIC TESTS
● PSA (prostate specific antigen)
● Doctor may order an ultrasound of the kidney, ureter,
and bladder to see if there is presence of hypertrophy
○ if caught early, they can do surgery
● History and physical exam
● Urologist – digital rectal exam
● Urinalysis
● Order for function of the kidneys
● Blood workup
Decreased subcutaneous Less insulation and protective
● Ultrasound and Cystoscopy as needed
fat cushioning
NURSING INTERVENTIONS Decreased sebaceous and Dryness and decreased
● Inform patients, especially geriatrics, that whenever sweat glands temperature regulation
they are taking any decongestants or diet pills, it may
cause acute urinary retention Hard, dry nails Brittle nails
● Surgery; no incision (sa urethra na idadaan)
Baldness Thinning scalp hair
PROSTATE CANCER
● Typically asymptomatic but if it spreads to the Decreased melanin Gray hair
urethra, may cause symptoms of urinary obstruction
that leads to perineal and rectal discomfort, Decreased skin elasticity Wrinkle development
weakness, nausea, hematuria and lower extremity
edema INTEGUMENTARY SYSTEM
● Usually seen in patients 90 years old and above AGE-RELATED CHANGES AFFECTING THE INTEGUMENTARY
SYSTEM
● Decreased number of capillaries - decreased blood
supply
● Decreased sensory receptors
● Diminished secretion of natural oils and perspiration
MANAGEMENT
● Surgery
● Pain management
● If sexually active, sexual counselling
● Routine check ups
INTEGUMENTARY SYSTEM
NURSING CARE OF THE OLDER ADULTS CLINICAL MANIFESTATIONS
WITH NEEDS & PROBLEMS IN ● Thin, wrinkled, dried skin
● Injuries, bruises, sunburns
INTEGUMENTARY SYSTEM ● Cold / heat intolerance
● Prominent bony structure
AGE-RELATED CHANGES IN THE STRUCTURE AND ● White hair
FUNCTION OF THE INTEGUMENTARY SYSTEM
PROMOTING INTEGUMENTARY HEALTH AMONG THE
PHYSICAL CHANGES EFFECTS
OLDER ADULTS
Reduced cell replacement Healing slower ● Limit sun exposure (10-15 minutes daily) for Vitamin
D
Water loss Dryness of the skin ○ Preferably in the morning before 10 am or in
the afternoon at 4pm
Increasing pigmentation Aging spots ○ Patients with cancer usually have low Vitamin
D levels
Thinning of skin layers Skin more fragile ● Use sunscreen SPF>50
○ May reapply every 4 hours

● Dress appropriately for the temperature
○ If they are going somewhere cold, we ask
them to bring extra layers of clothing like
cardigan
○ If it is hot, we ask them to wear cotton
● Shower rather than hot tub bath
○ Soaking in water dries up skin
● Skin moisturizers
○ After bathing while the skin is moist to trap
SEBORRHEIC DERMATITIS
the moisture
● Chronic inflammations seen in the scalp ear canal,
● Hydration
eyebrow, eyelash, mucolabial fold, axilla, breast,
○ 2-3L in a day unless contraindicated
chest, or groin
● Optimal nutrition
● Dry skin
● Early cancer screening avoid smoking
● Itchy, similar to dandruff
○ Abnormal marks on the skin should be
checked with a pathologic dermatologist
MANAGEMENT
● Avoid smoking
● May use special shampoos like those with pyrithione
zinc, selenium sulfide, or ketoconazole
COMMON INTEGUMENTARY SYSTEM PROBLEMS
ASSOCIATED WITH AGING INTERTRIGO
BENIGN SKIN GROWTHS
PSORIASIS
● Well-circumscribed pink plaques covered with
silver-white loosely adherent scales
● Auto-immune
● A reactive disorder due to the presence of infections,
smoke, extreme temperatures or climate, or
hormonal factors that triggers this
● Sun exposure decreases attacks
CHERRY ANGIOMAS
● Red or deep purple colored (dog?) shaped papule
● Usually seen on the trunks
SEBORRHEIC KERATOSES
● Stick-on, crumbly appearance, greasy feeling
● Appears in sun-exposed areas like the face, neck, and
trunk
SKIN TAGS
● Usually in the neck or axilla, and the eyelid or groin MANAGEMENT
● If extremely itchy, antihistamines may be prescribed
INFLAMMATORY DERMATOSES ● Encourage proper hygiene
● Use mild soap
● Use moisturizers as needed
● Steroids as needed
● May be prescribed phototherapy
PRURITUS
● Intense itching to the point that it causes wounds
● Assess for inflammation, location, degree of
erythema, itching, presence of scaling
● Can be due to dry skin, hot showers, temperature
changes, wet clothing, cleansing products, fatigue,
emotional stress, and severe climates
MANAGEMENT
● If extremely itchy, antihistamines may be prescribed
● Encourage proper hygiene MANAGEMENT
● Use mild soap ● Promote nutrition
● Use moisturizers as needed ● Take vitamins as needed
● Steroids as needed ● Observe for secondary infections since there are open
● May be prescribed phototherapy wounds
● Check for headaches, neck rigidity, or pulmonary
CANDIDIASIS congestion because this means they have
● Inflammatory process of the epidermis caused by the disseminated herpes zoster
yeastlike fungus candida albicans ● Even after infection, patients may still complain of
● Sa mga “singit” nerve pain where the nerve endings are. The pain is
called post herpetic neuralgia. Doctors can prescribe
antidepressants.
ACTINIC KERATOSIS
● Pre-malignant lesion of the epidermis that is caused
by long-term exposure to UV rays
MANAGEMENT
● Maintain dry skin
● Change the sheets and diapers as needed (especially
if with incontinence)
● Use of calmoseptine (barrier) and antifungal creams
(takes 2-3 weeks before results can be seen)
MANAGEMENT
● Avoid too much sun exposure
HERPES ZOSTER (SHINGLES)
● Apply topical antibiotics
● Reactivation of latent varicella zoster (chickenpox)
virus
BASAL CELL CARCINOMA
● Usually triggered by advanced age, stress, emotional
● Pearly papule with a depression in the center, giving
upset, fatigue, radiotherapy, HIV, patients with
the lesion a doughnut-like appearance with
leukemia
telangiectasia on or around the lesion
● Contact with the wound/ blister must happen for a
● Risk Factors: Monitor when it first appeared and how
person to become infected. It is not airborne.
long has it been since Doctors might need to remove
Therefore, a patient with shingles must be isolated.
it
● Viral = self limiting
● Main Cause: Prolonged sun exposure
ARTERIAL ULCERS
SQUAMOUS CELL CARCINOMA
● Result from arterial insufficiency
● Thick, adherent scale with a soft, movable tumor that
● When Diabetic and Hypertensive Patients complain of
has well-defined borders
leg pain, a doppler ultrasound is requested to
diagnose.
DIABETIC NEUROPATHIC ULCERS

● Diabetic foot ulcer
● At risk: Those who have peripheral neuropathy, foot
deformity or those who have peripheral artery
disease
● Patients don’t usually find out about this since there
is loss of sensation on the foot. They only notice it
when the ulcer starts to smell.
MELANOMA ● Diabetic patients are taught to check their feet
● Malignant neoplasm of pigment-forming cells that is everyday. If they cannot lift it up, a mirror can be
capable of metastasizing to any organ of the body used.
even before the lesion is noted ● If it is not caught early, amputation might be needed.
Take note of the skin assessment if there is any new growth

that seems to grow in size and have irregular borders.
Consultation with a pathologic dermatologist is suggested.
VENOUS ULCERS
● Results from chronic venous insufficiency
PRESSURE ULCERS
● Bedsores or decubitus ulcers ● Male Reproductive System

● Usually in immobile patients ● Female Reproductive System
MANAGEMENT AGE RELATED CHANGES IN THE MALE

● Pressure areas must be avoided for bedridden REPRODUCTIVE SYSTEM
patients ● Less firm testes
● Areas such as the sacral or heel area/ bony ● Decreased sperm production
prominences ● Decreased testosterone
● Change position every two-three hours as ordered ● Slower sexual response
● If not caught early, it can progress in stages.
AGE-RELATED CHANGES IN THE FEMALE

REPRODUCTIVE SYSTEM
● Menopause (cessation of estrogen and progesterone
production)
CARE OF THE OLDER ADULTS WITH NEEDS ● Thin vaginal wall, shorter vagina, loss of elasticity
● Decreased vaginal secretions
& PROBLEMS IN SEXUALITY AND ● Slower sexual response
REPRODUCTIVE FUNCTIONS
REFERENCE LINKS:
Age-Related Aging Changes of the GI, GU, and

Changes in the Reproductive Systems
Reproductive
Functions of the
Older Adults
(7:56 - 10:51)
Sexuality and From our collaborators at Johns

the Older Adult Hopkins Medicine | Sexuality and
the older adult
REPRODUCTION
FEMALE MALE
● Vaginal dryness ● Delayed erection

○ Painful
intercourse
○ Vaginal
bleeding
post
intercourse
COMMON REPRODUCTIVE SYSTEM DISORDERS
● Vaginal itching and ● Delayed orgasm ● Prostate Cancer
irritation ● Testicular Cancer
● Uterine Cancer
● Delayed orgasm ● Cervical Cancer
OTHER FACTORS CONTRIBUTING TO ERECTILE DYSFUNCTION

AND DECREASED LIBIDO
● Cardiovascular Diseases
● Diabetes Mellitus
● Neurologic Diseases
● Medications
○ Antihypertensive Medications
○ Tricyclic Antidepressants
PRINCIPLES ABOUT SEXUALITY IN MID AND LATER LIFE

● Sexuality is a positive, life-affirming force
○ A positive approach to sexuality means
acknowledging the pleasures, not just the
dangers of sex
● Older adults deserve respect
○ This respect includes an appreciation for
individual’s sexual histories and the current
stage of a person’s sexual journey.
● Older adults are not alike
○ Older adults vary in their comfort with sexual
language, in the discussion of sexual topics,
and in participating in learning activities
related to sexuality.
● Forget the cliche about “old dogs” and “new tricks”
PROMOTING REPRODUCTIVE HEALTH ○ Older adults can write new sexual scripts that
● Vaginal estrogen replacement can invigorate their sexual journeys
● Gynecologic and urologic follow up ○ Sex is more than intercourse, and there are
● Sex therapist consultation PRN many ways to be sexual without penetrative
● Use of lubricant with sexual intercourse sex.
○ Avoid the word “sex” whenever possible
because of its vague meaning - when talking
about intercourse, use the word, ○ Thinning of epithelium, thickening of

“intercourse.” basement membrane, and decreased size of
● Older adults learn from each other. lumen
○ Older adults have many “lessons” to learn ● Increased LH and FSH
from each other. ● Decreased testosterone production
○ Discussing ideas with peers helps people take ● All of these changes lead to decreased sperm
responsibility for their own learning. production
● Older adults deserve accurate and explicit ○ Even with less sperm production, older
information, as well as resources for discovery. healthy men do not lose their ability to
○ Most people in this culture have lived with ejaculate and experience orgasm. However,
the message that sexuality is mysterious, these are less intense
secret, and shameful. Having access to the ○ Many chronic diseases, such as cardiovascular
facts and a chance to talk openly helps people disease, lead to inability to form an erection
overcome those negative messages. and ejaculate
● Gay, lesbian, bisexual, and transgender individuals
must be acknowledged respected and included in ENLARGED PROSTATE GLAND
discussions.
○ Participants in your groups will likely mirror
society, and, therefore, have a variety of
sexual orientations and gender identities.
Acknowledging all sexual orientations and
identities can help all participants feel
included.
● Flexible gender roles behavior is fundamental to
personal and sexual health.
○ Strict adherence to traditional gender roles
and stereotypes limits individuals’ potential
as human beings.
● Make no assumptions! Avoid making assumptions
about the sexual behaviors or orientations of
participants.
○ Some may be currently involved in sexual
relationships, others may not. ● It’s not uncommon for men to have enlarged prostate
● The prostate gland sits just below the opening of the
bladder. If enlarged, it makes it difficult to initiate
YOUTUBE VIDEO 1: urination and completely empty the bladder
AGE-RELATED CHANGES IN THE ● Most men over the age of 65 have an enlarged
prostate gland
REPRODUCTIVE FUNCTIONS OF THE ● An enlarged prostate does not mean that it is
cancerous. It is crucial, however, to monitor closely
OLDER ADULTS for the development of cancer.
● Prostate cancer is usually very slow growing. Because
MEN’S REPRODUCTIVE SYSTEM of this, it may not be treated in older men as they
● Decreased fluid retaining capacity of seminal vesicles may likely die of something else; prior to the cancer
○ Seminal vesicles - store and secrete many of taking their lives.
the components of semen ○ However, This is treated aggressively in young
● Narrowed lumen of seminiferous tubules men.
○ Seminiferous tubules - located within the
testicles under the place where sperm is FEMALE REPRODUCTIVE SYSTEM
produced
● Untreated Conditions like depression can impact

libido
● Changes related to aging can contribute to challenges
in sexual activity.
○ Geriatric Patients with heart disease may
have normal sex drive but feel anxious with
sexual drive due to fear of damaging the
heart
○ Geriatric Patients with arthritis may find it
challenging to have sex in certain positions.
Working it through with their partner or
● The reproductive organs tend to atrophy or gets guidance of healthcare provider may help in
smaller developing other approaches
○ Vagina tends to become thinner and drier
which can lead to dyspareunia or painful
WHAT ARE IMPORTANT SYMPTOMS OF DECLINING
intercourse for older women
SEXUAL ACTIVITY?
○ Most older women do not lose the ability to
● Symptoms are the same with younger adults
engage in and enjoy intercourse.
○ Difficulty with performing, arousal, or interest
○ In some cases, older women actually develop
in sex
an increased sex drive due to not having to
● Conditions that may cause these symptoms are
worry about becoming pregnant
important to address with the HCP (chest pain,
● There is also a decrease in estrogen production
stomach pain, depression)
○ Can lead to decreased strength of the pelvic
○ Those who stay sexually active up until their
floor muscles and in turn, stress incontinence
advanced age tend to live longer.
YOUTUBE VIDEO 2:
SEXUALITY AND THE OLDER ADULT
WHAT ARE WAYS TO STAY SEXUALLY ACTIVE?

● Most people are quite interested in sex as they get
older.
● Most older adults stay sexually active right until very
advanced ages.
● Sexual activity is normal and healthy even though it
may be portrayed differently by the media and
culture.
HOW CAN AN OLDER ADULT INCREASE LIBIDO?

● Most older adults have normal sexual drives right up
until age 75 where testosterone decreases for both
men and women. This can contribute to declining
libido
In order adults experiencing declining libido, it is crucial to

evaluate for treatable causes:
● Medications (blood pressure, antidepressants) are
common causes of declining libido which facilitates
change in dosage. Switches to other agents may also
be done

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CARE OF THE OLDER ADULT LECTURE

NURSING CARE OF OLDER ADULTS WITH

Aging Changes Aging Changes of the Cells,

○ Gradual increase of activities should be done

CARDIOVASCULAR SYSTEM CHANGES RELATED TO

RESPIRATORY SYSTEM CHANGES RELATED TO AGING

●1 cylinder, slowly deep ● Management: O2 administration, diuretics,

● Ex: When the

● Lewy Body Dementia

ASSESSMENT OF COGNITIVE FUNCTION

Depressive Signs and Symptoms:

● Significant decline in the client’s cognition ○ CT scan

WANDERING, PARANOIA OR SUSPICIOUSNESS, ● Same with hallucinations

● Gait changes - no more regular walking / shuffling gait

DIAGNOSIS AND MANAGEMENT

● May be chronic open angled or acute close angled

AGE-RELATED MACULAR DEGENERATION

PROMOTING VISUAL HEALTH

● Adequate indoor lighting

AGE-RELATED CHANGES IN THE STRUCTURE AND

PHYSIOLOGIC CHANGES EFFECTS TINNITUS

MANAGEMENT FOR DECLINE IN HEARING

MANAGEMENT FOR VERTIGO

PROMOTING AUDITORY HEALTH MANAGEMENT

● Maintain oral hygiene (encourage brushing with a soft

PROMOTING OLFACTORY AND GUSTATORY HEALTH

AGE-RELATED CHANGES IN THE STRUCTURE AND

PHYSIOLOGIC CHANGES EFFECTS

Decreased muscle mass Reduced strength

Decreased muscle tone Muscles look flabbier

Deceased elasticity of Movements are restricted

Slowed muscle responses Response time increased

Bone thinning, softening Decreasing bone density

Joint stiffening Decreased flexibility

Vertebral disk water loss Decreased height

GOUTY ARTHRITIS OSTEOMYELITIS

● Onychomycosis - due to fungal infections; nails look

NUTRITIONAL, METABOLIC, AND

Age-Related Aging Changes of the GI, GU, and

PHYSICAL CHANGES EFFECTS

PROMOTING MUSCULO-SKELETAL HEALTH Decreased gag reflex, Increased aspiration risk

● Dysphagia ○ Low Na: confusion

○ Listerine and betadine is too alcoholic and

COMMON GASTROINTESTINAL SYSTEM PROBLEMS

PROMOTING GASTROINTESTINAL HEALTH AMONG THE

● Saline wash if unable to tolerate mouthwash ● Heartburn

SIGNS AND SYMPTOMS

SIGNS AND SYMPTOMS MANAGEMENT

● Proper relaxation techniques ● If lumiit, may stricture

MANAGEMENT FOR POLYPS AND HEMORRHOIDS

● Hepatitis D - blood to body exposure; more severe

Note: Both cholelithiasis and cholecystitis are found through

● Early stages: hepatitis mechanisms responding to the presence of a foreign

○ For most of the patients diagnosed, their ● Up in pH (less acid)

POLYPHARMACY PHYSICAL CHANGES EFFECTS

NURSING CARE OF THE OLDER ADULTS

Decreased bladder size, Frequency of urination