Physiologic Disorders and Nursing Care in

Older Adults
NCM 114 | CARE OF THE OLDER ADULTS | THEORY | 1F
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● Most common symptom of

INTEGUMENTARY SYSTEM
patients with dermatologic
disorders
● Manifested by
Common Disorders of the
Aging Integumentary System ○ Rash
○ Lesion
● Nursing Management
Prurities
○ Evaluate the
● Aka = generalized itching
effectiveness of
● Occur = with or without a
therapy
rash
○ Instruct px to avoid
● Caused
situations that cause
○ Internal
vasodilation
■ Renal
○ Advise wearing
■ Hematopoieti
cotton clothes next
c
to the skin rather
■ Endocrine
than synthetic
disorders
materials
○ Psychological factors
○ The room should be
factors
kept cool and
○ Oral medications
humidified
■ Opioids
○ Vigorous scratching
○ Radiation therapy
should be avoided
○ Woolen garments
and nails kept
○ Certain soaps and
trimmed
chemicals
○ Prickly heat
● Medical Management Rashes
○ Px history and ● Common manifestations
physical examination of skin conditions such as
○ Identification of ○ Infections
signs of infection ○ Allergic reactions
and environmental ○ Chemical irritations
clues ○ Psychological
○ A warm bath with stressors
mild soap followed ○ Poor hygiene =
by application of a commonly seen in
bland emollient to older adults who are
moist skin can not independent in
control xerosis bathing
○ Applying a cold ● Underlying factors that
compress, ice cube predispose to fungal
or cool agents that infection
contain menthol and ○ Immunosuppressant
camphor may also drug use
help relieve pruritus ○ Diabetes mellitus
● Pharmacological ○ Antibiotic therapy
Management ● Common site of rashes
○ Topical antipruritic ○ Women = breast
agents ○ Both = groin
■ Lidocaine ● Nursing Management
■ Prilocaine ○ State the
■ Capsaicin importance of
○ Cream proper hygiene
■ Capzasin ○ Educate the px on
○ Topical how the proper way
corticosteroids of managing rashes
○ Oral antihistamines
○ Selective serotonin
reuptake inhibitor
antidepressants
 ● Medical Management
○ Px history and
physical examination
○ Identification of
signs of infection
and environmental
clues
● Pharmacological
Management
○ Application of
moisturizers that are
fragrance free
○ OTC creams and
ointments
○ Prescription strength
cortisone creams
○ Cortisone pills and
shots
Inflammatory conditions
Dermatitis
● Aka = eczema
● Excessive scratching
associated with pruritus
can lead to acute r chronic
dermatitis
● Dry agents Seborrheic Dermatitis
● Acute dermatitis
○ 4 signs are
represent
■ Erythema
■ Edema
■ Heat
■ Pain
● Chronic dermatitis
○ Less obviously
inflammatory and
skin is scalier, darker,
thickened and
leathery with
exaggerated normal
skin markings
● Nursing Management
○ Application of
moisturizer and
topical
immunosuppressant
s
● Medical Management
○ Avoidance of the
drying agents
● Pharmacological
Management
○ Topical
corticosteroids
○ Tacrolimus ; prograf
ointment
○ Pimecrolimus ; elidel
cream
● Often bothersome to older
people ; appearance of
erythema and greasy
appearing scales affecting
the scalp, eyebrows, side of
the nose, hairline, sternum
and axilla
● Believed to be = Intertrigo
inflammatory response to ● Erythematous skin eruption
Malassezia yeasts with inflammation in the
● Present = Pitysporum ovale skinfolds under the breasts,
● Nursing Management groin, transverse abdominal
○ Educate the px folds, axilla
about measures for ● Main symptom = intense
treatment and pruritus
prevention of dry ● Intertrigo = more common
skin in obese elderly persons
■ Artificial who do not maintian an
humidification appropriate level of
■ Bathing cleanliness
■ Cleansing ● Nursing Management
cream/ soap ○ Keeping affected
■ Wearing of areas clean and dry
protective ○ Proper hygiene
clothing ● Pharmacological
■ Use of bath Management
oils for ○ Treatment of topical
bathing antifungal agents
● Pharmacological ○ OTC medications
Management ○ Oral therapy
○ Cream or shampoo
containing Lichen Simplex Chronicus
ketoconazole ● Characterized =
○ Topical erythematous papules that
glucocorticoids coalesce to form plaques
○ Application of ● Lichenification = a
steroid solution thickening of the skin
○ Lithium succinate ● A chronic dermatitis
ointment caused by repeated skin
○ Oral homeopathic scratching and or rubbing
medications
● Nursing Management Pruritus Ani
○ Encourage to keep
fingernails short
○ Application of a
dressing
○ Mittens for older
adults
○ Application of cold
pack
○ Recommend
oatmeal baths
○ Application of
moisturizers or
menthol
● Medical Management
○ Ultraviolet B light
● Pharmacological
Management
○ Treatment of steroid
creams and
antihistamines
○ Tape with topical Drug eruptions
steroid
○ Intralesional
injection of
botulinum toxin type
A persons
○ Topical aspirin
● Dermatitis that affects the
perineal area
● Caused = irritation from
heat, swelling, hemorrhoids
or fissures
● Nursing Management
○ Advise to avoid
irritating
medications
○ Application of warm
compress or baths
● Pharmacological
Management
○ Application of
steroid creams
○ Administration of
oral antipruritic
medications
○ Capsaicin
● An adverse cutaneous
reaction
● Drugs = common cause of
allergic reactions in older
● Types
○ Morbilliform
■ Antibiotics
○ Photosensitivity ■ Aminopenicili
■ Photosensitisi ns
ng ■ Sulfonamides
medications ■ Quinolones
■ Sunburn ○ Serum sickness
■ Dermatitis reaction
○ Lichenoid ■ Antivenom
■ Anticonvulsan ■ Antitoxin
ts ● Pharmacological
■ Antihypertens Management
ives ○ Withdrawal of the
■ ACE inhibitors drug therapy
■ Beta blockers treatment
■ Methyldopa ○ Topical
■ Nifedipine corticosteroids
○ Urticaria ○ Antipruritic lotions
■ Penicillins ○ Antihistamines
■ Sulfonamides
■ Nonsteroidal Infectious disorders
anti Herpes Zoster
inflammatory ● Aka = shingles
drugs ● Caused = Varicella Zoster
○ Fixed drug eruption Virus ; VZV
■ Antibiotics ● Classic symptoms
■ Antiepileptics ○ Burning pain
■ NSAIDS ○ Eruption of papular
■ Sildenafil rash distributed
■ Cashews along a single
■ Licorice dermatome
○ Vasculitis ● Pharmacological
■ Antibiotics ; Management
LCV ○ Antiviral medications
■ Penicillins ■ Famciclovir
■ Valacyclovir
 ○ OTC pain Dermal Ulcers
medications ● 3 major contributors to
■ Acetaminoph dental ulcers
en ○ Arterial insufficiency
■ Non steroidal ○ Venous insufficiency
anti ○ Chronic unrelieved
inflammatory pressure
drugs ● Nursing Management
■ Ibuprofen ○ Keep skin clean and
dry
Psoriasis ○ Investigate and
● Inflammatory disease manage
● Key role = T cells incontinence
● Cause = genetic immune ○ Do no vigorously rub
system or massage the px
● Nursing Management skin
○ Administer ○ Use a pH
prescribed appropriate skin
medications cleanser and dry
○ Enhance skin thoroughly to
integrity protect the skin from
○ Prevent infection excess moisture
○ Provide client and ○ Use water based
family health skin emollients to
teaching maintain skin
● Medical Management hydration where
○ Intralesional therapy possible
○ Systemic therapy ● Medical Management
○ Photochemotherapy ○ Compression
● Pharmacological bandaging for
Management venous leg ulcers
○ Topical therapy ○ Exercise
○ Cleansing of the
affected leg
 ● Pharmacological prompt treatment
Management for signs of infection
○ Apply skin barrier ○ Treatment of
cream underlying condition
○ Toe, foot or leg
Foot problems amputation
● Range of problem ● Pharmacological
includes Management
○ Dry skin ○ Mild soap
○ Onychogryphosis ○ Fragrance free
○ Diminished moisturizers
sensation ○ OTC creams and
○ Deformities of feet ointments
and nails ○ Prescription
○ Inadequate hygiene medications for
○ Improperly fitting infection, diabetes
footwear etc.
● Nursing Management
○ State the
importance of
proper hygiene
○ Educate the px on
how the proper way
of managing rashes
○ Emphasize the
importance of
wearing properly
fitting shoes
● Medical Management
○ Regular physical
examination
○ Monitoring
identification and
 ● Medical Management
MUSCULOSKELETAL
○ Fracture
SYSTEM
management
■ Percutaneous
Common Disorders of the vertebroplasty
Aging Musculoskeletal ■ Kyphoplasty
System ● Pharmacological
Management
Metabolic Bone Disease ○ Calcitonin
Osteoporosis ○ Calcium
● Characterized = decrease supplements
in bone mass per unit ○ Vitamin D
volume supplements
● Producing = porous looking
skeletal frame that Osteomalacia
fractures easily when ● Softening of the bones with
stressed an excessive accumulation
● Nursing Management of bone matrix
○ Encourage the px to ● Resulting = impaired
have a healthy diet mineralization with calcium
■ Rich in and phosphorus
calcium and ● Nursing Management
vitamin D ○ Assess the px
○ Encourage client to knowledge of
do exercise osteomalacia and
■ Regular weight provide education
bearing regarding dietary
exercise intake and exercise
■ 20-30 mins ● Medical Management
■ 3x a week ○ Corrective
osteotomy
 ● Pharmacological
Management
○ Vitamin D
supplements
○ Calcium
supplements
○ Phosphate
supplements
Paget’s Disease
● Associated = older age in
which there is excessive
reabsorption and
deposition of bone
● Characterized = periods of
increased bone resorption
which result in
replacement if original
bone with fibrous material,
altering with periods of
increased bone formation,
which result in the
appearance of slerotic ir
osteoblasitc lesions
● Nursing Management
○ Let the px take the
prescribed
medications as DO
○ Encourage the px to
exercise as much as
possible
● Medical Management
○ Treatment with
potent biphosphate
○ Corrective
osteotomy
● Pharmacological
Management
○ Calcitonin
○ Etidronate
○ Disodium
○ Plicamycin
Muscular Disorders
Polymyalgia Rheumatica
● Rheumatic disease
● Characterized = muscular
pain and stiffness that lasts
a month or more and
affects the shoulders, neck,
hips and pelvic girdle
● Nursing Management
○ Educate the px
about the disease
itself, medications
required and the
potential impact of
the condition on the
person as a whole
○ Reinforce and clarify
the information
given to them by the
doctor
● Medical Management
○ Px history and
physical examination
 ● Pharmacological ● Characterized = sustained,
Management involuntary, and painful
○ Low dose contractions of muscle
glucocorticoid groups of the calf, foot,
○ Prednisone thigh, hand or hip
● Primarily from
Giant Cell Arteritis ○ Peripheral vascular
● Involves = large and insufficiency
medium sized arteries, ○ Sodium deprivation
specially the extracranial ○ Low serum calcium
branches of the carotid ○ Toxins
arteries ○ Hypoglycemia
● Nursing Management ○ Peripheral nerve
○ Encourage the px to disease
do a healthy diet ● Nursing Management
○ Educate the px ○ Avoid dehydration
about exercising ○ Minimal stretching
regularly ● Medical Management
○ Stress management ○ Gentle massage
● Medical Management ○ Flexing of ankles
○ Color duplex ○ Stretching
ultrasound ○ Standing up and
○ Temporal artery walking around
biopsy ● Pharmacological
○ ESR Management
● Pharmacological ○ Potent diuretic
Management medications
○ High doses of ■ Furosemide ;
corticosteroids lasix
○ Less potent diuretics
Muscle Cramps
● Occur = at night after a
day’s activity
 ● Factors that might cause
Joint Disease RA
Osteoarthritis ○ Immunoregulatory
● Aka = degenerative joint abnormalities
disease ; DJD ○ Autoimmunity
● Noninflammatory disorder ○ Microbial infections
of movable joints ● Nursing Management
● Affects all joint structures ○ Px history and
not cartilage alone physical assessment
● Nursing Management ○ Extra-articular
○ Physical assessment changes
○ Px history ● Medical Management
● Medical Management ○ Blood test
○ X-ray ○ X- ray
○ MRI ○ Rest and exercise
○ Use of heat ○ Biologic response
○ Weight reduction modifiers
○ Joint rest ○ Nutrition
○ Orthotic devices ○ Therapy
● Pharmacological ● Pharmacological
Management Management
○ Analgesic ○ NSAIDS
○ Acetaminophen ○ COX-2
○ NSAIDS ○ Methotrexate
○ COX-2 enzyme ○ Analgesics
○ Opioids ○ Cyclosporine
○ Intra Articular ○ Neoral
Corticosteroids ○ Immunosuppressant
○ Antidepressants
Rheumatoid Arthritis ○ Corticosteroids
● A chronic, systemic,
progressivew disease of an
unknown origin
Gouty Arthritis Mobility and Mobility
● A syndrome or collection Disability in Older Adults
of metabolic disorders in
which uric acid crystallizes Factors that affect mobility
in body fluids and is ● Musculoskeletal conditions
deposited in tissues ● Depression and anxiety
● Nursing Management ● Medically prescribed
○ Hydration treatments
○ Dietary ● Environmental factors
modifications ○ Physical
■ Limit purine environment
intake ○ Policies
● Medical Management ○ Caregiver
○ Joint fluid test characteristics
○ Blood test
○ X- ray Effects of Immobility
○ Ultrasound ● Activity intolerance
○ Dual energy city ● Self care deficits
scan ● Incontinence
○ Nutrition ● Pressure ulcers
○ Limit alcohol intake ● Social isolation
● Pharmacological ● Psychological disturbances
Management ● Loss of muscle mass and
○ NSAIDS strength
○ Uric acid synthesis ● Bone demineralization
○ Synthesis inhibitors ● Increased risk for
○ Colchicine ; small thromboembolism
dose ● Respiratory infection
○ Uricosuric agents ● Poor balance
○ XOIs ; allopurinol and
febuxostat
Taxonomy of Disability
CARDIOVASCULAR SYSTEM
● Pain
● Balance
● Weakness Common Disorders of the
● Endurance Aging Cardiovascular System
● Other symptoms
Coronary Artery Disease
Mobility status of Older Adults ● Cause
● Data are often reported in ○ Plaque buildup in the
terms of diagnoses rather wall of the arteries
than function ● Nursing Management
● Self report surveys lack ○ Assist in angioplasty
validation ○ Assist in coronary
● An array of assessment bypass surgery
instruments are used ● Medical Management
● Prevalence of various ○ Cardiac
problems varies with the catheterization
setting ○ Angiogram
● Pharmacological
Falls Management
● Dreaded occurrence for ○ Cholesterol
older adults modifying
● Leading cause of death medication
related injury among older ○ Aspirin
adults ○ Beta blockers
○ Calcium channel
blockers
○ Ranolazine
○ Nitroglycerin
○ Ace INHIBITORS
○ ARBs
Dysrhythmias ● Pharmacological
● Cause Management
○ Problems with the ○ Amiodarone
heart valves ○ Flecainide
○ CAD ○ Propafenone
○ Heart failure ○ Sotalol
○ Drug use ○ Dofetilide
○ Some medications
● Nursing Management Hearts Failure
○ Assist in valve ● Cause
surgery ○ CAD
○ Assist in bypass ○ Heart attack
surgery ○ Cardiomyopathy
● Medical Management ○ Heart defects
○ Electrical present at birth
cardioversion ○ Diabetes
○ Catheter ablation ○ High BP
○ Pulmonary vein ○ Arrhythmias
isolation ○ Kidney disease
○ Electrical devices ○ Obesity
○ Permanent ○ Tobacco and illicit
pacemaker drug use
○ Implantable ○ Medications
cardioverter ● Nursing Management
defibrillator ○ Assist in coronary
○ ATP bypass surgery
○ Cardioversion ○ Assist in heart
○ Defibrillation transplant
● Medical Management
○ Implantable
cardioverter
defibrillators ; ICDs
 ○ Cardiac ● Medical Management
resynchronization ○ CTA scanning
therapy ; CRT ○ MRI
○ Ventricular assist ○ Arteriography
devices ; VADs ● Pharmacological
● Pharmacological Management
Management ○ Antiplatelet
○ Ace inhibitors medications
○ Angiotensin II ○ Anticoagulants
receptor blockers
○ Beta blockers Cerebrovascular Disease and
○ Diuretics Transient Ischemic Attack
○ Aldosterone ● Cause
antagonists ○ Buildup of plaques in
○ Inotropes an artery or one of
○ Digoxin ; lanoxin its branches
○ Hydralazine and ○ Blood clot moving to
isosorbide dinitrate ; an artery
BiDil ● Nursing Management
○ Vericiguat ; verquvo ○ Control BP
○ Reduce LDL
Valvular Disease cholesterol
● Cause ○ Maintain glycemic
○ Valvular stenosis control
○ Valvular insufficiency ○ Maintain a healthy
● Nursing Management diet
○ Educate the px with ○ Take up appropriate
valvular heart physical activity
disease ○ Restrict alcohol use
○ Instruct the px to of levels
report symptoms or ○ Maintain a healthy
changes weight
○ Vital signs
 ● Medical Management ○ Emphasize the
○ Cardiac importance of
catheterization keeping laboratory
○ Angiogram and physician’s
● Pharmacological appointment
Management ● Medical Management
○ Cholesterol ○ Electrical
modifying cardioversion
medications ○ Catheter ablation
○ Aspirin ○ Pulmonary vein
○ Beta blockers isolation
○ Calcium channel ○ Electrical devices
blockers ○ Permanent
○ Ranolazine pacemaker
○ Nitroglycerin ○ Implantable
○ ACE inhibitors cardioverter
○ ARBS defibrillator
○ ATP
Dysrhythmias ○ Cardioversion
● Cause ○ Defibrillation
○ Problems with the ● Pharmacological
heart valves Management
○ VAD ○ Amiodarone
○ Heart failure ○ Flecainide
○ Drug use ○ Propafenone
○ Some medications ○ Sotalol
● Nursing Management ○ Dofetilide
○ Initiate CPR
○ Provide oxygenation
○ Monitor
predisposing factors
○ Teach the px how to
take pulse
Heart Failure ● Pharmacological
● Cause Management
○ CAD ○ ACE inhibitors
○ Heart attack ○ Angiotensin II
○ Cardiomyopathy receptor blockers
○ Heart defects ○ Beta blockers
present at birth ○ Diuretics
○ Diabetes ○ Aldosterone
○ High BP antagonists
○ Arrhythmia ○ Inotropes
○ Kidney disease ○ Digoxin
○ Obesity ○ BilDil
○ Tobacco and illicit ○ Vericiguat
drug use
○ Medications Valvular Disease
● Nursing Management ● Cause
○ Promote activity ○ Congenital
tolerance ○ Acquired
○ Managing fluid ○ Valvular stenosis
volume ○ Valvular insufficiency
○ Controlling anxiety ● Nursing Management
○ Minimizing ○ Educate the px with
powerlessness the disease
● Medical Management ○ Instruct the px to
○ Implantable report any
cardioverter symptoms
defibrillators ○ Measures the vital
○ Cardiac signs
resynchronization ● Medical Management
therapy ○ Echocardiography
○ Ventricular assist ○ Chest x-ray
devices
 ● Pharmacological Peripheral Vascular Disease :
Management Claudication
○ Dihydropyridine ● Cause
calcium channel ○ Narrowing or
blockers ACE blocking of arteries
inhibitors in the legs
● Nursing Management
Stroke ○ Avoid smoking
● Cause ○ Plan diet in low
○ Ischemic stroke saturated fats
○ Hemorrhagic stroke ○ Allow client to rests
● Nursing Management ○ Assistr px to walk
○ Position the px to rest walk exercise
prevent 30-45 mins
contractures ○ Maintain the px a
○ Apply splint healthy weight
○ Teach the px to ● Medical Management
maintain balance in ○ Ankle-brachial index
position ○ Doppler ultrasound
● Medical Management ○ Angiogram
○ CT scan ● Pharmacological
○ Cerebral Management
angiography ○ Statins
● Pharmacological ○ Antiplatelet drugs
Management
○ Tissue plasminogen
activator ; tPA
○ Antiplatelet agents
Venous Disease ● Pharmacological
● Cause Management
○ Varicose veins = ○ Anticoagulation
twisted swollen veins therapy
○ DVT = blood clot in
lower legs
Risk Factor Modifications for
○ Venous ulceration = CAD in Older Adult
open skin sores
● Nursing Management
Hypertension
○ Assess skin integrity
● Lack of physical activity
○ Elevate affected leg
● Unhealthy diet
○ Encourage px to
● Obesity
wear elastic
● Alcohol
compression
● Sleep apnea
○ Allow besd rest
● High cholesterol
○ Clean and apply
● Diabetes
dressing in ulcer
● Smoking
wound
● Tobacco abuse
○ Avoid prolonged
standing of the px
Dyslipidemia
○ Encourage
● Diet high in saturated or
ambulation to
trans fat
enhance collateral
● Sedentary lifestyle
circulation
● Smoking
● Medical Management
● Obesity
○ Plethysmography
○ Venous duplex
Obesity
ultrasonography
● Lack of physical activity
○ Contrast venography
● Family inheritance and
○ Doppler
influence
ultrasonography
● Unhealthy diet
● Liquid diet
Diabetes mellitus ● Nursing Management
● Obesity ○ Auscultate the lungs
● Physical inactivity ○ Auscultate the S3
● Hypertension sounds
● Abnormal cholesterol ; lipid ○ Measure urinary
levels output
○ Weigh the px daily
Anemia ● Medical Management
● Diet ○ Cardiac
● Pregnancy rehabilitation
● Obesity ● Pharmacological
● Age Management
● Family history ○ Vasodilators
○ Aldosterone
Atherosclerosis inhibitors
● Unhealthy blood ○ ACE inhibitors
cholesterol levels ○ Digitalis glycosides
● Hypertension ○ Anticoagulants
● Smoking ○ Antiplatelets
● Diabetes ○ Beta blockers
● Obesity ○ Tranquilizers
● Lack of physical activity
Atherosclerosis: Atrial Disease
● Cause
Cardiovascular Disease in
Women Older Adult ○ Plaque build up
● Nursing Management
○ Assess the client
Congestive Heart Failure
vital signs
● Cause
○ Observe for signs of
○ High blood pressure
decreasing
○ Coronary artery
peripheral tissue
disease
perfusion
○ Valve conditions
○ Administer prescribe
medications
 ○ Educate the px ○ Inspect skin for
about stress pallor or cyanosis
management ○ Monitor urine output
● Medical Management ● Medical Management
○ Cholesterol ○ Cholesterol
reduction medication
○ Antiplatelet therapy ○ Blood pressure
○ Blood pressure medications
control ● Pharmacological
○ Smoking cessation Management
● Pharmacological ○ Aspirin
Management ○ Calcium channel
○ Antiplatelet blockers
medication ○ Statins
○ Beta blockers ○ Long acting nitrates
○ ACE inhibitors
○ Calcium channel
RESPIRATORY SYSTEM
blockers

Microvascular Coronary Disease Common Disorders of the

● Cause Aging Respiratory System
○ Narrowing
○ Further spasms Obstructive Pulmonary Disease:
○ Endothelial Asthma
dysfunction ● Cause
● Nursing Management ○ Airborne allergens
○ Auscultate apical ○ Respiratory
pulse infections
○ Assess HR ○ Physical activity
○ Note heart sounds ○ Cold air
○ Assess for ○ Air pollutants and
palpitations or irritants
irregular heart beat
○ Monitor BP
 ○ Strong emotions and ○ Immunomodulators
stress
○ Sulfites and Chronic Obstructive Pulmonary
preservatives Disease
○ GERD ● Cause
● Nursing Management ○ Airflow blockage
○ Assess the px ● Includes
respiratory status ○ Emphysema
○ Assess for breath ○ Chronic bronchitis
sounds ● Nursing Management
○ Assess px breath ○ Inhalers
sounds ○ Oxygen therapy
○ Assess the px peak ● Pharmacological
flow Management
○ Assess the level of ○ Bronchodilators
oxygen saturation ; ○ Corticosteroids
pulse oximeter ○ Alpha 1 antitrypsin
○ Monitor the px vital augmentation
signs therapy
● Medical Management ○ Antibiotic agents
○ Treatment of acute ○ Mucolytic agents
asthmatic episodes ○ Antitussive agents
○ Control of chronic ○ Vasodilators
symptoms ○ Narcotics
○ Nocturnal and
exercise induced Tuberculosis
asthmatic ● Cause
symptoms ○ Mycobacterium
● Pharmacological tuberculosis
Management ● Nursing Management
○ Anticholinergics ○ Educate the px n
○ Corticosteroids coughing exercise
○ Leukotriene ○ Deep breathing
modifiers exercise
 ○ Wearing of face ● Medical Management
mask ○ Radiation therapy
○ Room is well ○ Chemotherapy
ventilated ○ Stereotactic body
● Medical Management radiotherapy
○ Diagnostic test ○ Targeted drug
○ Skin test therapy
○ Blood test ○ Immunotherapy
○ Chest x-ray ○ Palliative care
○ CT scan ● Pharmacological
○ Sputum test Management
● Pharmacological ○ Cisplatin ; platinol
Management ○ Carboplatin ;
○ Isoniazid paraplatin
○ Rifampin ○ Docetaxel ; taxotere
○ Ethambutol ○ Gemcitabine ;
○ Pyrazinamide gemzar
○ Paclitaxel ; taxol
Cancer of the Lung ○ Vinorelbine ;
● Cause navelbine
○ Smoking tobacco
○ Secondhand smoke Obstructive Sleep Apnea
● Nursing Management ● Cause
○ Administer ○ Excess weight
medications as ○ Obesity
ordered ● Nursing Management
○ Provide ○ Awareness of the
psychological signs and symptoms
support as well as risk factors
○ Manage symptoms ○ Assess the quality of
○ Provide referrals sleep and symptoms
○ Provide home care of daytime fatigue
coordination
 ○ Px education ○ Impared cardiac or
■ Use of device respiratory function
■ Application of ○ Emotional stress
mask ○ Unfamiliar
● Medical Management surroundings
○ Positive airway ○ Malnutrition
pressure ; CAP or ○ Anemia
BIPAP ○ Dehydration
○ Mouthpiece ; oral ○ Alcoholism
device ○ Hypoxia
● Pharmacological ● Nursing Management
Management ○ Communication to
○ Tricyclic provide orientation
antidepressants and cognitive
○ Serotonin agents stimulation
○ Sleep
○ Facilitate mobility
NEUROLOGICAL SYSTEM
○ Prevent sensory
misperception
○ Provide adequate
Common Disorders of the
Aging Neurological System hydration
● Medical Management
○ Fluid and nutrition
Delirium
○ Reorientation
● Cause
techniques
○ Fluid and electrolyte
○ Supportive therapy
imbalances
● Pharmacological
○ Infection
Management
○ Congestive heart
○ Antipsychotic ;
failure ; CHF
haloperidol
○ Certain medications
○ Atypical
or polypharmacy
antipsychotic ;
○ Pain
risperidone,
 olanzapine, restrictive
quetiapine environment
○ Benzodiazepine ; ○ Let the px an
lorazepam identification tag
○ Anti depressant and ensure that the
px does not leave
Dementia the premises
● Cause ○ Assist the px in his
○ Irreversible ADLs ; provide
■ Head trauma independence
■ Infections ○ Reorient client
■ Brain tumors frequently to his
■ Genetic environment
diseases ○ Provide objects that
■ Progressive the px would recall
diseases ○ Avoid frequent
■ Vascular arrangements in
disease furniture
○ Reversible ○ Adequate sleep and
■ Depression rest
■ Hypothyroidis ○ Nutritional therapy
m ○ Speak in a slow
■ Drug toxicity paced manner
■ Hypocephalus ○ Encourage the px to
■ Vitamin B12 involve productive
deficiency non stimulating
■ Infection activities
● Nursing Management ● Medical Management
○ Ensure safe ○ Experimental
environment therapies
○ Provide necessary ○ Dietary measures
handrails/support ○ Physical activity
○ Provide a
comfortable, non
 ● Pharmacological ○ Mild cognitive
Management impairment
○ Cholinesterase ○ Head trauma
inhibitors ○ Air pollution
■ Acrine ; ○ Excessive alcohol
cognex consumption
■ Donepezil ; ○ Poor sleep patterns
aricept ○ Lifestyle and heart
■ Rivastigmine health
tartrate ; ● Nursing Management
exelon ○ Establish an
■ Galantamine ; effective
reminyl communication
○ N-methyl system
D-aspartate agonist ; ○ Provide emotional
NMDA support
■ Memantine ; ○ Administer ordered
namenda medications and not
their effects
Alzheimer’s Disease ○ Protect px from
● Cause injury
○ Abnormal buildup of ○ Provide rest periods
proteins in and between activities
around brain cells ○ Encourage the px to
■ Beta-amyloid exercise
plaques ○ Encourage sufficient
■ Tau- tangles fluid intake and
● Risk factors adequate nutrition
○ Age ○ Hygiene and
○ Family history and dressing
genetics ○ Vital signs
○ Down syndrome ○ Inspect the px skin
○ Sex for evidence of
trauma
 ○ Family orientation ○ Tremor
● Medical Management ○ Gait changes
○ Keep requests for ● Nursing Management
the px sample ○ Instruct in the areas
○ Avoid confrontation of medication
○ Remain calm and ○ Safety promotion
supportive and prevention of
○ Maintain a falls
consistent ○ Potential swallowing
environment problems
○ Provide frequent ○ Sleep promotion
cause and reminders ○ Communication
to reorient the px ○ Encourage the px to
○ Adjust expectations have regular exercise
for the px as he she ● Pharmacological
has different Management
capacity ○ Levodopa and
● Pharmacological carbidopa ; sinemet
Management ○ Dopamine receptor
○ Donepezil ; aricept agents
○ Galantamine ; ■ Pergolide
razadyne mesylate
○ Rivastigmine l exelon ● Permax
○ Namenda ■ Bromocriptine
● Periodel
Parkinson’s Disease ■ Selegiline
● Cause ■ Anticholinergi
○ Genes cs
○ External factors ■ Benztropine
○ Presence of lewy mesylate
bodies ● Cogenti
● Cardinal signs n
○ Bradykinesia
○ Rigidity
 ● Tablett importance of rest
en ; and avoid stress
artane ○ Maintain stable
blood levels of
Structural Abnormalities anticholinesterase
Myasthenia Gravis medications
● Cause ● Medical Management
○ Antibodies ○ Video assisted
○ Thymus gland thymectomy
● Symptoms ○ Robot assisted
○ Eye muscle = thymectomy
drooping of one or ● Pharmacological
both eyes ; double Management
vision ○ IV immune globulin
○ Face and throat ○ Azathioprine ; imuran
muscles = impair ○ Prednisone ; rayos
speaking ; cause ○ Pyridostigmine
difficulty swallowing ; bromide ; mestinon
change facial
expression Myasthenia Gravis
○ Neck and limb ● Cause
muscles impairment ○ Dehydrated disks
● Nursing Management ○ Herniated disks
○ Monitor respiratory ○ Bone spurs
status and px ability ○ Stiff ligaments
to breathe/ cough ● Nursing Management
adequately ○ Encourage the px to
○ Monitor speech and have regular exercise
swallowing ○ Intake of pain
○ Encourage the px to relievers
spit up while eating ○ Apply heat or ice on
○ Emphasize the px neck
and family about the ○ Wear soft neck
braces
 ● Medical Management ● Medical Management
○ Cervical soft collar ○ Cervical soft collar
○ Cervical traction ○ Cervical traction
○ Laminectomy ● Pharmacological
○ Dissection and Management
fusion ○ Acetaminophen
○ Laminoplasty ■ Tylenol
○ Foraminotomy ○ NSAID
● Pharmacological ■ Ibuprofen
Management ○ Muscle relaxant
○ Acetaminophen ■ Cyclobenzapri
■ Tylenol ne
○ NSAID ○ Anti epileptic drug
■ Ibuprofen ■ Gabapentin
○ Muscle relaxant
■ Cyclobenzapri
GASTROINTESTINAL
ne
SYSTEM
○ Anti epileptic drug
■ Gabapentin
Common Disorders of the
Cervical Spondylosis Aging Gastrointestinal System
● Cause
○ Dehydrated disks Disorders of the Oral Cavity
○ Herniated disks Xerostomia
○ Bone spurs ● Cause
○ Stiff ligaments ○ Insufficient
● Nursing Management production of saliva
○ Regular exercise from the salivary
○ Pain Relievers as glands
prescribed ● Nursing Management
○ Apply heat or ice ○ Dental hygiene
pack on neck habits
○ Wear soft neck ○ Regular dental visits
braces
 ○ Hydration
● Medical Management Oral Malodor
○ Protect teeth to ● Cause
prevent cavities ○ Accumulation of
○ Fluoride trays food debris
○ Weekly use of a ○ Dental bacterial
chlorhexidine rinse plaque on the teeth
● Pharmacological and tongue
Management ○ Poor oral hygiene
○ Biotene dry mouth ○ Gingival
oral rinse ○ Periodontal
○ Act dry mouthwash inflammation
○ Pilocarpine ; salagen ● Nursing Management
○ Cevimeline ; evaxoc ○ Oral hygiene
● Medical Management
Disorders of the Tongue ○ Regular clinical
Oral Lesions review ; effective
● Cause hygiene
○ Viruses ● Pharmacological
○ Fungi Management
○ Bacterial infections ○ Antimicrobial
○ Dentures toothpaste and
○ Sharp tooth edges mouthwash
○ Loose orthodontic ■ Chlorhexidine
wire gluconate
● Nursing Management ■ Cetylpyridiniu
○ Oral hygiene m
○ Diet changes ■ Oil water rinse
○ Saltwater rinses ■ Triclosan
● Pharmacological ■ Sodium
Management fluoride
○ NSAIDS toothpaste
■ Aspirin
■ Ibuprofen
Periodontal Disease Disorders of the Esophagus
● Cause Dysphagia
○ Bacteria ● Cause
● Nursing Management ○ Achalasia
○ Deep cleansing ○ GERD
○ Brushing and ○ Foreign bodies
flossing everyday ○ Neurological
○ Checkups disorders
● Medical Management ● Nursing Management
○ Scaling ○ Check for coughing
○ Root planing or choking during
● Pharmacological eating and drinking
Management ○ Maintain px in high
○ Antimicrobial fowler’s position ;
mouthwash head flexed
○ Antibiotic gel ○ Instruct px not to
Caries and Tooth Loss talk while eating
● Cause ○ Proper eating
○ Breakdown of the ● Medical Management
tooth enamel ○ Endoscope
● Nursing Management ● Pharmacological
○ Brush teeth ; 2x a Management
day ○ Corticosteroids
● Medical Management ○ Smooth muscle
○ Dental check ups relaxants
● Pharmacological
Management Gastroesophageal Reflux
○ Bacteriological Disease
etiology ● Cause
○ Incompetent lower
esophageal
sphincter
○ Pyloric stenosis
○ Hiatal hernia
 ○ Motility disorder Hiatal Hernia
● Nursing Management
○ Avoid eating or
drinking 2 hours
before bedtime
○ Maintain body
weight
○ Avoid tight fitting
clothes
○ Elevate the head of
the bed by at least
30 degrees
● Medical Management
○ Educate px to avoid
lower esophageal
pressure
○ Low fat diet
○ Avoid caffeine,
tobacco, milk, beer,
food with spearmint,
carbonated
beverages
● Pharmacological
Management
○ Antacids
○ Histamine-2
receptor antagonists
○ Prokinetic agents
○ Proton pump
inhibitor
○ Reflux inhibitor
○ Surface agents
● Cause
○ Arge related changes
in diaphragm
○ Trauma
○ Injury
○ Surgery
○ Being born with an
unusually large
hiatus
● Nursing Management
○ Px not to recline for 1
hour after eating
○ Elevate head of the
bed on 4-8 inch
○ Advance diet slowly
from liquids to solids
○ Monitor
postoperative
belching, vomiting,
gagging, abdominal
distention and
epigastric chest pain
● Medical Management
○ Frequent small
feedings
● Pharmacological
Management
○ Antacids
Barrett’s Esophagus
● Cause
○ GERD
● Nursing Management
○ Control reflux
symptoms
● Medical Management
○ Follow up biopsies
○ Endoscopic reaction Gastritis
○ Radio frequency
ablation
○ Consideration of
metal stents
Esophageal Carcinoma
● Cause
○ GERD
● Nursing Management
○ Improve nutritional
and physical status
○ Promote weight gain
○ Low fowler’s position
○ Vigorous pulmonary
plan of care
○ Monitor temperature
○ Small sips of water
○ Px remains upright
at least 2 hours after
each meal
● Medical Management
○ Preoperative
combination
chemotherapy
○ Radiation therapy
○ NPO
○ Palliative treatment
● Pharmacological
Management
○ Controlled analgesia
pump
Disorders of the Stomach
● Cause
○ Local irritants
■ Aspirin
■ NSAID
○ Infection with
helicobacter pylori
○ Ingestion of strong
acid or alkali
● Nursing Management
○ Reducing anxiety
○ Promoting optimal
nutrition
○ Promoting fluid
balance
○ Relieving pain
● Medical Management
○ Refrain px form
alcohol and food
○ Non irritating diet
○ Fiberoptic
endoscopy
● Pharmacological
Management
○ PPI
 ○ Antibiotics Atrophic Gastritis
○ Bismuth salts ● Cause
○ H.pylori
Peptic Ulcer Disease ○ Inherited
● Cause ○ Genetic condition
○ Infection with ● Nursing Management
H.pylori ○ Pain management
○ Long term use of ○ Address fluid loss
NSAIDs and or prevent
○ Acid hypersecretory dehydration
states ○ Provide client
○ Gastric cancer education
○ Lymphomas ● Medical Management
○ Lung cancers ○ Periodic endoscopy
○ Acute illness ○ Endoscopic
aftermath resection
● Nursing Management ● Pharmacological
○ Relieving pain Management
○ Reducing anxiety ○ Combination of
○ Maintaining optimal antimicrobial agents
nutritional status ○ Proton pump
● Medical Management inhibitors
○ Avoid NSAIDs ■ PPI
○ Endoscopy with ■ RBC
biopsy ■ BS
● Pharmacological ○ B-12 injections
Management
○ Triple therapy
○ Proton pump
inhibitor
Pernicious Anemia Gastric Adenocarcinoma
● Cause ● Cause
○ Loss of stomach ○ Stomach cancer
cells ○ Ongoing research
○ Autoimmune ● Nursing Management
condition ○ Nutritional
○ After gastric bypass management
surgery ○ Console and
● Nursing Management educate the client
○ Address fatigue and family
○ Educate on safety ○ Provide comfort
○ Maintain proper ○ Provide discharge
nutrition and home health
○ Educate on the care instructions
importance of ● Medical Management
continuous ○ Radiation therapy
treatment ○ Chemoradiation
● Medical Management ○ Targeted therapy
○ Advice px to avoid ○ Immunotherapy
strenuous activities ○ Endoluminal laser
○ Change diet therapy
● Pharmacological ○ Endoscopic mucosal
Management resection
○ Vitamin B12 ● Pharmacological
supplement Management
■ IM ○ Chemotherapy
■ Oral ; high ○ Antiemetics
dose ○ Sedatives
○ Tranquilizers
○ Narcotics
○ Antispasmodics
Disorders of the Small Intestine
Celiac Disease
● Cause
○ Autoimmune
disorder
○ Gluten
○ Genetic factor
○ Environmental factor
● Nursing Management
○ Provie px and family
education regarding
gluten free diet
● Medical Management
○ Refrain from gluten
food and other
products
Changes in Bowel Habits
Disorders of the Large Intestine
Diverticular Disease
● Cause
○ Degeneration and
structural changes in
the circular layers of
the colon
○ Cellular hypertrophy
● Nursing Management
○ Scheduled meals
○ Schedules
defecation
○ Increase fluid intakes
○ Soft foods, high fiber
○ Individualized
exercise
○ Intake of laxatives
● Medical Management
○ Clear liquid diet then
high fiber diet
○ NGT if vomiting or
distention occurs
○ Withholding oral
intake
○ Administering IV
fluids
● Pharmacological
Management
○ Broad spectrum
antibiotics
○ Opioid
○ Analgesic
● Cause
○ Temporary infection
○ Underlying medical
disorder
● Nursing Management
○ Increasing fluid
intake
○ Encourage the px to
follow a high fiber
diet
○ Encourage the px to
exercise regularly
● Medical Management
○ Colonoscopy
○ CT scan
○ X- ray
 ● Pharmacological Pancreatitis
Management ● Cause
○ Antibiotics ○ Alcoholism
○ Anti inflammatory ○ gallstones
drugs ● Nursing Management
○ Pain management
Disorders of the Pancreas ○ Oral hygiene
Pancreatic Cancer ○ Assess pulmonary
● Cause status
○ H.pylori infection ○ Deep breathing
○ Smoking ○ Coughing exercise
○ Liver cirrhosis ○ Nutritional status
● Nursing Management ○ Semi fowler’s
○ Pain management position
○ Nutritional ○ Carry out wound
requirements care as prescribed
○ Skin care ● Medical Management
○ Specialty mattress ○ Withhold oral intake
○ Hospice care ○ Enteral feeding
● Medical Management ○ NGT
○ MRI ● Pharmacological
○ Spiral CT scan Management
○ Angiography ○ Analgesia
○ Radiation ○ Histamine 2
○ Chemotherapy antagonist
● Pharmacological
Management Alcoholic Liver Disease
○ Opioids ● Cause
○ Patient controlled ○ Heavy use of alcohol
analgesia ● Nursing Management
○ Healthy diet
○ Vitamin
supplementation
■ B complex
 ■ Folic acid ● Medical Management
○ Alcohol recovery ○ Bilirubin test
program ○ Ultrasound scanning
● Medical Management ○ Adequate diet
○ Alcohol abstinence ○ Alcohol avoidance
○ Lifestyle changes ● Pharmacological
○ Weight loss Management
○ Smoking cessation ○ Antacid
● Pharmacological ○ H2 antagonist
Management ○ Potassium sarong
○ Corticosteroids diuretics
■ Pentoxifylline ○ Vitamins
○ Probiotics
○ Antibiotics Disorders of the Gallbladder
Cholecystitis
Cirrhosis ● Cause
● Cause ○ Bile gets trapped ;
○ Chronic alcohol gallstones are
abuse blocking the tube
● Nursing Management ● Nursing Management
○ Healthy diet ○ Monitor and
○ Vitamin maintain fluid
supplementation balance
■ B complex ○ Pain management
■ Folic acid ○ Improving nutritional
■ Vitamin A status
■ Vitamin C ● Medical Management
■ Vitamin K ○ Percutaneous
○ Alcohol recovery cholecystostomy
program ○ Endoscopic
○ Rest retrograde
○ Safety precautions cholangiopancreatog
○ Sodium restriction raphy ; ERCP
 ○ Percutaneous ○ Extracorporeal
drainage shock wave
● Pharmacological lithotripsy
Management ● Pharmacological
○ IV fluid Management
○ Pain medication ○ Oral dissolution
○ Broad spectrum ■ Ursodiol ;
antibiotics actigall
○ Oral dissolution ■ Chenodiol ;
therapy chenix
○ Pain management
Cholelithiasis ■ NSAIDs
● Cause ■ Narcotic pain
○ Too much relievers
cholesterol in the
bile
GENITOURINARY SYSTEM
○ Too much bilirubin in
the bile
○ Gallbladder does not
Common Disorders of the
empty all the way Aging Genitourinary System
● Nursing Management
○ Relieving pain
Acute Renal Failure
○ Improving
● Cause
respiratory status
○ Prerenal causes
○ Maintaining skin
■ Dehydration
integrity and
○ Intrarenal causes
promoting biliary
■ Nephrotoxic
drainage
agents
● Medical Management
○ Complications in
○ Endoscopic
surgery
retrograde
cholangiopancreatog
raphy ; ERCP
● Nursing Management Glomerular Disease
○ Nutritional therapy ● Cause
○ Monitor for ○ Infection
complication ○ Drug
■ Hyperkalemia ○ Diabetes
○ Assess progress and ○ Lupus
responses ● Nursing Management
○ Inform family ○ Nutritional therapy
members on px ○ Assess fluid status
condition and ○ Daily weight
progress ○ Vital signs
● Medical Management ● Medical Management
○ Elimination of ○ Maintain kidney
underlying cause function
○ Maintaining fluid ● Pharmacological
balance Management
○ Avoiding fluid ○ Corticosteroids
excesses
○ Providing renal Chronic Renal Failure and End
replacement therapy Stage Renal Disease
● Pharmacological ● Cause
Management ○ Impaired kidney
○ Cation-exchange function
resins ● Nursing Management
■ Sodium ○ Preserve renal
polystyrene function
■ Sulfonate ; ○ Delay need for
kayexalate dialysis or
○ Retention enema transplantation
● Medical Management
○ Hemodialysis
○ Kidney transplant
 ● Pharmacological ■ Tamsulosin
Management ■ Terazosin
○ Antihypertensive
Benign Prostatic Hyperplasia
Lower Urinary Tract Symptoms ● Cause
● Cause ○ Increasing in size
○ Medication ○ Male hormones ;
○ Neurological dihydrotestosterone
conditions ● Nursing Management
○ Bladder stones ○ Relieve acute urinary
○ Bladder cancer retention
○ Diabetes mellitus ○ Promote comfort
○ Stress incontinence ○ Prevent
○ Urge incontinence complications
○ Menopause ○ Provide information
○ Benign prostatic ● Medical Management
hyperplasia ○ Cystostomy
○ UTI ● Pharmacological
● Nursing Management Management
○ Px medical history ○ Alpha adrenergic
○ Urinalysis ■ Alfuzosin ;
● Medical Management uroxatral
○ Change of lifestyle ■ Terazosin ;
○ Avoid too much hytrin
caffeine ■ Doxazosin ;
○ Doing bladder cardura
exercise ■ Tamsulosin
○ Lose weight ○ 5-alpha reductase
● Pharmacological inhibitors
Management ■ Finasteride ;
○ Oral antibiotics proscar
○ Alpha blockers ■ Dutasteride ;
■ Alfuzosin avodart
■ Doxazosin
Prostate Cancer and Bladder ● Pharmacological
Cancer Management
● Cause ○ Antibiotics
○ Cells in the prostate
and bladder stops Pyelonephritis
developing ● Cause
● Nursing Management ○ Gram negative
○ Encourage annual bacteria
screening for ■ E. coli
prostate cancer ■ Proteus
● Pharmacological ■ Klebsiella
Management ■ Enterobacter
○ Degarelix ; firmagon ● Nursing Management
○ Combination ○ Relieve pain
■ Methotrexate ○ Provide comfort
■ Vinblastine ○ Encourage fluid
■ Doxorubicin intake
■ Cisplatin ○ Encourage frequent
voiding
Urinary Tract Infections ○ Educate px about
Asymptomatic Bacteriuria urinary irritants
● Cause ■ Coffee
○ Affects woman than ■ Tea
man ■ Colas
● Nursing Management ■ Alcohol
○ Avoid caffeine, ● Medical Management
alcohol, citric juices, ○ Urine culture
chocolate, spicy ○ STD test
food ○ CT scan
● Medical Management ○ Ultrasonography
○ Review all prescribed ○ Acute
medications pharmacologic
therapy
 ○ Long term Urinary Incontinence
pharmacologic
therapy
● Pharmacological
Management
○ Semisynthetic
penicillin
○ Cephalosporin
○ Fluoroquinolone
○ Vancomycin
Urinary Retentions
● Cause
○ Weakened bladder
muscles
○ Bladder sag and
move out of normal
position
● Nursing Management
○ Prevent
overdistention of the
bladder
○ Treat infection or
correct obstruction
○ Provide privacy
● Medical Management
○ Apply warmth to
relax the sphincter
○ Hot beverages
○ Minimize triggers
● Cause
○ Age related changes
in the urinary tract
● Nursing Management
○ Provide support
○ Encourage
○ Log and record
timing of pelvic floor
muscle exercise
○ Frequency of voiding
○ Any changes in
bladder function
○ Any episodes of
incontinence
● Medical Management
○ Behavioral therapy
○ Colored drinks
should be avoided
● Pharmacological
Management
○ Anticholinergic
agents
○ Tricyclic
antidepressant
medication
○ Pseudoephedrine
sulfate ; sudafed
Overactive Bladder Sexual Dysfunction
● Cause
○ Weak bladder
muscles
○ Nerve damage
○ Use of medications
○ Alcohol or caffeine
○ Infection
○ Overweight
● Nursing Management
○ Provide support
○ Encourage
○ Log and record
timing of pelvic floor
muscle exercise
○ Frequency of voiding
○ Any changes in
bladder function
○ Any episodes of
incontinence
● Medical Management
○ Lifestyle
interventions
○ Bladder training
○ Pelvic floor muscle
exercise
● Pharmacological
Management
○ Tolterodine ; detrol
○ Oxybutynin ; pill
○ Oxytrol ; patch
○ Gelnique ; gel
● Cause
○ Diabetes mellitus
○ High BP
○ High cholesterol
○ Alcoholism
○ BP pressure
○ Antidepressants
● Nursing Management
○ Provide a safe space
for the px to talk
about the disease
○ Educate the px
about the disease
● Medical Management
○ Target and treat the
underlying cause
○ Physical and
psychological
examination
○ Ultrasound tests
○ Urine tests
○ Blood tests
● Pharmacological
Management
○ Sildenafil ; viagra
○ Tadalif ; cialis
○ Vardenafil ; levitra
○ Avanafil ; stendra
Vaginitis Diabetic Cystopathy
● Cause ● Cause
○ Discharge ○ Lower urinary tract
○ Itching symptoms
○ Pain ○ Diabetic cystopathy
○ Infection ● Nursing Management
○ After menopause ○ Assess the px’s
○ Skin disorders adeptness in
● Nursing Management self-monitoring of
○ Provide a safe space blood glucose
for the px to talk ○ Assess the pattern
about the disease of physical activity
○ Educate the px ● Medical Management
about the disease ○ Scheduled voiding
○ Provide comfort ○ Cholinergic
○ Hot or cold baths treatment
○ Encourage fluid ○ Transurethral surgery
intake
○ Proper hygiene Nocturia
● Medical Management ● Cause
○ Provide ○ High fluid intake
prescriptions ○ Sleep disorders
● Pharmacological ○ Bladder obstruction
Management ● Nursing Management
○ Metronidazole ; flagyl ○ Restrict fluids in the
○ Metronidazole gel ; evening
metrogel vaginal ○ Avoiding caffeine
○ Clindamycin cream ; ○ Use of aspartame
cleocin ○ Recommend use of
cranberry juice or
vitamin C
● Medical Management
○ Time intake of
diuretics
 ● Pharmacological
Management
○ Anticholinergic
medications
○ Bumetanide ; bumex
○ Furosemide ; lasix
○ Desmopressin ;
DDAVP
ENDOCRINE SYSTEM
Common Disorders of the
Aging Endocrine System
○ Intensive therapy
with an insulin pump
○ Nutrition
○ Meal planning
○ Weight control
○ Increased activity
● Pharmacological
Management
○ Insulin therapy
○ Insulin regimens
■ 1-4 injections
per day
○ Oral antidiabetic
agents

Thyroid Disease
Diabetes Mellitus (Type II)
Hyperthyroidism
● Cause
● Cause
○ Destruction of
○ Grave’s disease
pancreatic cells
○ Toxic multinodular
○ Changes in
goiter
metabolism of
○ Iodine - induced
glucose, fat and
hyperthyroidism
protein
● Nursing Management
● Nursing Management
○ Directed toward
○ Provide px education
reducing thyroid
■ Self
hyperactivity to
monitoring
relieve symptoms
■ Administratio
and preventing
n of insulin
complications
● Medical Management
● Medical Management
○ Normalize insulin
○ Radioactive iodine
activity and blood
therapy
glucose level
 ○ Surgery to remove replacing the
the hyperfunctioning missing hormone
tissue and prevent
● Pharmacological progression and
Management complication of
○ Radioisotope disease
○ Antithyroid ● Pharmacological
medications Management
○ Synthetic
Hypothyroidism levothyroxine
● Cause ○ High dose
○ Thyroid autoimmune glucocorticoids
disease
○ Neck irradiation Subclinical Thyroid Disorders
○ Previous surgical or ● Cause
medical treatments ○ Graves disease
of hyperthyroidism ○ Autonomous
○ Administration of functioning
drugs such as ○ Thyroid adenoma
lithium or ○ Multinodular goiter
amiodarone ● Nursing Management
● Nursing Management ○ Monitor vital signs ;
○ Monitor vital signs HR and BP
and increasing ○ Ask the px for chest
severity of pain
symptoms ○ Listen to heart
○ Monitor px for murmurs
adverse effects ○ Obtain ECG
○ Assist px in ○ Teach px to relax
developing a ○ Check for intake and
treatment schedule output
● Medical Management ○ Aducte px about
○ To restore a normal thyroid surgery
metabolic state by
 ● Medical Management
○ Treatment of thyroid
function
○ Medical therapy
● Pharmacological
Management
○ Antithyroid drug
therapy
○ Beta- adrenergic
blockers
Thyroid Carcinoma
● Cause
○ Family history of
goiter
○ High levels of ● Nursing Management
radiation
○ Certain hereditary
syndromes
● Types
○ Papillary carcinoma
= most common and
more aggressive in
older patients
○ Follicular
carcinoma = greater
tendency to
metastasize,
invading neighboring
blood vessels and
more distant sites ● Medical Management
○ Medullary
carcinoma = less
common ;
commonly affects
women in their 50s
○ Anaplastic
carcinoma = most
serious and life
threatening for of
thyroid cancer ;
affects older
persons, women only
slightly than man,
90% deaths from
thyroid cancer
○ Relaxation
techniques
○ Analgesics
○ Assess for dyspnea,
stridor and cyanosis
○ Provide oxygen
therapy
○ Small meals and
snacks daily
○ Promote adequate
and timely fluid
intake to reduce
possibility of early
satiety
○ Radioactive iodine
○ Radiation therapy
○ Chemotherapy
 ○ Drug therapy ● Pharmacological
○ Palliative care Management
● Pharmacological ○ Chemotherapy
Management ○ Anti estrogens
○ Thyroid hormone ○ Hormonal agents
therapy
■ Levothyroxine Vulvar Cancer
● Cause
Cancer of the Female ○ Cigarette smoking
Reproductive System ○ HPV infection
Breast Cancer ○ Immunosuppression
● Cause ○ Chronic vulvar
○ DNA in breast cells conditions
mutate or change ○ Prior history of
○ Disabling specific cervical cancer
function ● Nursing Management
● Nursing Management ○ Emotional support
○ Monitor for adverse ○ Relieve pain and
effects of radiation discomfort
therapy ○ Sexual dysfunction
○ Monitor for adverse ○ Assess px of
effects of knowledge about the
chemotherapy disease
○ Involve the px in ● Medical Management
planning of care ○ Radiation therapy
○ Administer IV fluids ○ Chemotherapy
○ Teach all women the ● Pharmacological
recommended Management
cancer screening ○ Paclitaxel
procedure ■ Taxol
● Medical Management ■ Cisplatin
○ Depends on ○ Cisplatin ; 50mg
classification
Cervical Cancer
Cause
○ HPV
○ Multiple sexual
factors
○ Smoking
○ Weakened immune
system Uterine Cancer
○ Multiple pregnancies ● Cause
○ Giving birth at avery
young age
○ Long term use of
contraceptive pill
○ Family history
● Nursing Management
○ Encourage to take
folate
○ Educate women
regarding HPV
○ Safe sexual practice
and avoid multiple ● Nursing Management
sexual partners
○ Regular cervical
screening
○ Quit smoking
● Medical Management
○ Chemotherapy
○ Radiotherapy
○ Combined therapy
● Pharmacological
Management
○ 1st line therapy with
radiotherapy
■ Cisplatin ;
40mg/m2 IV
○ Early menarche
○ Late menopause
○ Nulliparity
○ PCOS syndrome
○ Obesity
○ Diabetic
○ Hypertensive
○ Family history of
endometrial cancer
○ Long term use of
oral contraceptives
○ Routine screening of
all asymptomatic
women on HRT and
tamoxifen therapy
○ Vaginal examination
○ Weight reduction
○ Restrict use of
estrogen after
menopause
 ● Medical Management ● Medical Management
○ Chemotherapy ○ Staging the tumor
○ Radiation therapy ○ Total abdominal
● Pharmacological hysterectomy
Management ○ Bilateral salpingo
○ Endometrial cancer oophorectomy
chemotherapy ○ Biopsy of the lymph
■ Cisplatin + ● Pharmacological
doxorubicin Management
○ Intraperitoneal
Ovarian Cancer chemotherapy
● Cause ○ IV chemotherapy of
○ Family history platinum and taxane
○ Older age agents
○ Early menarche ○ Liposomal therapy
○ Late menopause
○ Obesity Erectile Dysfunction
○ Late pregnancy ● Cause
○ Non full term ○ Psychogenic
pregnancy fertility ■ Anxiety
treatment ■ Faitue
○ Hormone therapy ■ Depression
● Nursing Management ■ Pressure to
○ Administer IV fluids perfomr
○ Parenteral nutrition seuxally
○ Providing ■ Negative body
postoperative care image
○ Controlling pain ■ Absence of
○ Managing drainage desire
tube ■ Privacy
■ Trust and
relationship
issues
 ○ Organic ● Pharmacological
■ Cardiovascula Management
r disease ○ Phosphodiesterase
■ Endocrine type 5 inhibitors
disease ■ Viagra
■ Cirrhosis ○ Penile injections
■ Chronic ■ Alprostadil
kidney failure
■ Genitourinary
IMMUNE SYSTEM
conditions
■ Hematologic
conditions
Common Disorders of the
■ Neurologic Aging Immune System
conditions
■ Trauma to
Infectious Disease
pelvic or
Pneumococcal Disease
genital area
● Cause
■ Smoking
○ Streptococcus
■ Medicine and
pneumoniae
drug abuse
● Nursing Management
● Nursing Management
○ Encourage px bed
○ Efer px to a sex
rest
therapist
○ Teach the px on the
○ Inform the px about
proper way to do
support groups
coughing exercises
● Medical Management
● Medical Management
○ Endocrine therapy
○ Oxygen
○ Referral
administration
○ Aggressive
respiratory
measures
 ● Pharmacological Viral Disease
Management ● Cause
○ Macrolides ○ Viruses
○ Antitussives ● Nursing Management
○ Place the px in
Varicella (Herpes Zoster) protective isolation
● Cause ○ Wear PPE
○ Varicella-zoster virus ○ Each the px of
; VZV proper hygiene
● Nursing Management ● Medical Management
○ Apply cool, moist ○ Identify microbial
dressings to pruritic causes of an
lesions infection
○ Avoid temperature ○ Initiate necessary
extremes, in both air antimicrobial
and bathwater therapy against
● Medical Management microbes
○ Use universal ○ Helps to control host
precautions in caring reactions to
for the px to prevent infection
transmission of ● Pharmacological
disease to self or Management
other px ○ Antibiotics
● Pharmacological
Management Autoimmune Disorders and
○ Acyclovir Immunosenescence
○ IV acyclovir Pernicious Anemia
● Cause
○ Deficiency in
intrinsic factor
○ Vitamin B12
deficiency
 ● Nursing Management ● Medical Management
○ Check vital signs ○ Antidepressant
○ Assess neuro vitals therapy
and cognition ○ Antidiarrheal therapy
○ Assess for lung ○ Nutritional therapy
sounds
○ Educate the px
SPECIAL SENSES SYSTEM
about the disorder
○ Encourage healthy
diet
Common Disorders of the
● Medical Management Aging Special Senses System
○ Absorption of oral
vitamin B12
Sense of Sight
● Pharmacological
Cataracts
Management
● Cause
○ Vitamin B12 1000 mg
○ Diabetes
1st week ; 4 doses
○ Steroids
○ Phenothiazine drugs
Acquired Immune Deficiency
○ Eye surgery
● Cause
○ Radiation treatment
○ Human
○ Smoking
immunodeficiency
○ UCV radiation
virus
○ Long term use of
● Nursing Management
steroids
○ Nutritional status
● Nursing Management
○ Inspect for skin and
○ Provide preoperative
mucous membranes
care
○ Assess px level of
○ Provide
knowledge of the
postoperative care
disease
● Pharmacological
Management
○ Dilating drops
○ Antibiotic drugs
 ○ IV sedation Age Related Macular
Degeneration
Glaucoma Diabetic Retinopathy
● Cause ● Cause
○ Optic nerve damage ○ Having diabetes for a
● Nursing Management long time
○ Provide information ○ Poor control of your
about the disease blood sugar level
○ Provide information ○ High BP
about the therapy ○ High cholesterol
done ○ Pregnancy
○ Teach the px about ○ Tobacco use
specific safety ○ Being black, hispanic
precautions or native american
● Medical Management ● Nursing Management
○ Prescription eye ○ Monitor blood
drops glucose levels
○ Lowering the ICP ○ Administer
● Pharmacological medications
Management ○ Health teaching of
○ Cholinergics diabetes
○ Adrenoceptor ○ Management of
agonists diabetic
○ Anhydrase inhibitors complications
○ Beta adrenoceptor ● Medical Management
antagonists ○ Optical coherence
○ Prostaglandin tomography
anticoagulants ○ Fluorescence
angiography
● Pharmacological
Management
○ Vascular endothelial
growth factor
inhibitors
 ○ Lucentis ● Pharmacological
Management
Senila Entropion and Ectropion ○ Eye lubricants
● Cause ○ Onabotulinumtoxina
○ Entropion
■ Muscle Sense of Hearing
weakness Conductive Hearing Loss
■ Scars or ● Cause
previous ○ Damage to the inner
surgeries ear
■ Eye infection ○ Gradual buildup of
■ Developmenta the earwax
l complication ○ Ear infection and
○ Ectropion abdominal growths
■ Facial or tumors
paralysis ○ Tympanic
■ Eyelid growths membrane
■ Genetic perforation
disorders ● Nursing Management
■ Muscle ○ Cerumen
weakness management
● Nursing Management ○ Use of hearing
○ Orient the px with devices
reduced vision ○ Communication
○ Use aseptic strategies
technique ● Medical Management
○ Health teachings ○ Physical exam
about the disease general screening
● Medical Management tests
○ Application of soft ○ App based hearing
contact lens test
○ Stitches that turn te ○ Tuning fork tests
eyelid outward ○ Audiometer tests
○ Skin tape

Sensorineural Hearing Loss
● Cause
○ Interrupted inner
part of the brain
○ Presbycusis
● Nursing Management
○ Speak clearly and
slowly
○ Gain attention when
trying to speak with
the px
○ Lessen frequent
movement during
the conversation Tinnitus
● Medical Management
○ Cochlear implants
○ Hearing aids
● Pharmacological
Management
○ Corticosteroids
Central Hearing Loss
● Cause
○ Problem in auditory
nerve or sound
centres
○ Inability of the nerve
pathway to send
electrochemical
impulses to the
brain
○ Head injury
● Nursing Management
○ Instruct in and care
of hearing air
○ When
communicating use
simple and
emphasize words
● Medical Management
○ Cochlear implants
○ Hearing aids
● Pharmacological
Management
○ Corticosteroids
● Cause
○ Long term exposure
to environmental
noise
○ Affects men than
women
● Nursing Management
○ Educate the impact
of tinnitus
○ Encourage to purse
parallel interventions
○ Reduce exposure to
extremely loud noise
avoid total silence
● Medical Management
○ Tinnitus retraining
therapy
○ Relaxing therapy
 ○ Cognitive behavioral Sense of Touch, Vibration and
therapy Pain Sensitivity
● Pharmacological ● Cause
Management ○ Skin becomes less
○ N methyl D sensitive with aging
aspartate receptor ● Nursing Management
antagonists ○ Lower water heater
○ Benzodiazepine temperature
○ Antidepressants ○ Monitor temperature
○ Inspect px skin
Sense of Tastes and Smell
● Cause
○ Taste
■ Disruption in
taste
receptors and
cell
membranes
○ Smell
■ Olfactory
neurons
decreases
● Nursing Management
○ Assess taste and
smell pleasure
○ Examine the px
medication
○ Encourage family
members for
support
 114 Module 2F: Psychosocial Changes
• People age in a number of ways and it can be viewed
in chronological, biological, psychological, and social
age. These ages may or may not be the same.
Chronological Age – measured by the number of years
lived
Biological Age – predicted by the person’s physical
condition and how well vital organ systems are
functioning.
Psychological Age – expressed through a person’s ability
and control of:
• Memory
• Learning capacity
• Skills
• Emotions
• Judgement
Maturity in capacity will direct the manner in which one
is able to adapt psychologically over time to the
requirements of the physical and social environment.
Models and Theories
Psychological Theories of Aging
• Carl Jung’s Theories of Personality
o Suggested that aging results in the movement
from extraversion to introversion, beginning
perhaps at midlife where individuals begin to
question their own dreams, values, and
priorities.
o Personality is the extrovert and oriented
toward the external world
o Introverted are oriented toward the subjective
inner world of the individual
Sociological Theories of Aging
• Measured by age graded behaviors that perform to
an unexpected status and role in the particular
culture or society. The psychological and social
theories are not always based on empirical
evidence because of the methodological and
measurement related problems
• The majority of these theories were developed
from a Eurocentric perspective and may be less
useful to describe aging with other cultures
especially those that are collective rather than
individualistic.
• The importance of opportunity, ethnicity, gender
and social status are largely ignored.
• In addition, the theories have little to do with
personal meaning and motivation. However, they
may be useful as guide in helping us understand the
world around us and move toward healthy aging.
As current generation of elders move to this period
of life development, many of the ideas we have of
this period of life are being and will continue to be
redefined.
Personality and Aging
Personality – refers to individual differences in
characteristic patterns of thinking, feeling, and behaving.
- What makes an individual unique from the other
Focused on 2 broad areas:
1. Understanding individual differences in
particular personality characteristics, such as
sociability or irritability.
2. Understanding how the various parts of a person
come together as a whole.
“Much of what we know about optimal aging has focused
on the lifelong importance of health-related behavior –
exercise, drinking, and eating in moderation… being
engaged in life and having a strong social network.” She
said. “But personality is arguably the driving force behind
all of these.” - Oregon State University Psychologist
Karen Hooker, PhD
• Late life is often when a person’s personality is most
evolved.
Healthy Personality
Jahoda (1958) observed Schultz (1977) assessed
that “positive mental components of healthy
health includes one or personality and stated
more of the following six the following
(6) aspects of individuals: characteristics to be
 • The degree of agreed upon by most Components of cognitive function
personal integration theorists:
achieved by the • Capability to • Language
individual. consciously and • Thought
• The degree of rationally direct • Memory
autonomy achieved one’s behavior. • Executive function
by the person. • Being in-charge of • Judgment
• The adequacy of the one’s own destiny • Attention
person’s perception • Knowing who and • Perception
of reality. what one is and
• The degree of being accepting of **The determination of intellectual capacity and
environmental strengths and performance has been the focus of the major portion of
mastery achieved weaknesses. gerontological research.
by the person. • Being firmly
• The attitudes anchored in the • Cognitive functions may remain stable or decline
shown by a person present. with increasing age.
toward his or her • Pursuit of challenge • The cognitive functions that remain stable include:
own self. through new goals attention span, language skills, communication
• The style and and new skills, comprehension and discourse, and visual
degree of a person’s experiences. perception.
self-actualization. • Recent neuroimaging research has suggested that
changes in the brain once seen only as a
• Self-actualization – the complete realization of compensation for declining skills are now thought
one’s potential and the full development of one’s to indicate the development of new capacities.
abilities and appreciation of life These changes include using both hemispheres
o Self-actualized people have an acceptance of more equally than younger adults. Greater density
who they are despite their faults and of synapses and more use of the frontal lobe which
limitations and experience the drive to be are thought to be important in abstract reasoning,
creative in all aspects of their lives. problem solving, and concept formation.
• Healthy personality is manifested by individuals • The renewed emphasis of the cognitive capabilities
who have been able to gratify their basic needs, provide a view of aging that reflects the history of
their acceptable behavior, such as their own many cultures and provides a much hopeful view of
personality, is no longer a problem to oneself. They aging and human development.
can take themselves more or less for granted and
devote energies and thoughts to socially
meaningful interests and problems beyond security
or lovability or status.
• Therefore, to have a good and positive mental
health, we are required to have a healthy
personality.

Cognition and Aging

Cognition – both a biological and psychological factor
that must be considered in caring for the older adult.
Cognition and Memory
- It is the process of acquiring, storing, and in
1. Fluid intelligence – “native intelligence”
sharing and using information.
- Skills that are biologically determined,
independent of experience or learning
- Associated with flexibility thinking, inductive
reasoning, abstract thinking and integration
 - Assists people to identify and draw conclusions o maintain social relations with people of same
about complex relationships age
o establishing good physical living
2. Crystallized intelligence arrangements
- Knowledge and abilities that the person acquires • Such tasks arise in response to the changes in the
through education and life. biological condition of the body related to age,
- Include verbal meaning, word association, social cultural traditions, and individual aspirations.
judgment, number skills

Classic Aging Pattern (Hooyman & Kiyak, 2011)
• Older people perform more poorly on performance
scales (fluid intelligence), but scores on verbal
scaled (crystallized intelligence) remain stable.
• May be due to age-related changes in sensory and
perceptual abilities, as well as psychomotor skills.
Age-associated Memory Impairment (AAMI)
• One of the first few human development as a
lifelong process composed of many aspects of
human activity manifested as development tasks.
• These developmental tasks may be regarded as the
challenges of people from a certain age.
2. Erik Erikson’s Theory
o Highlights Integrity vs Despair

• Has been used to describe memory loss that is

considered normal in light of a person’s age and
educational level.
• May include a general slowness in processing,
storing, and recalling new information, and
difficulty remembering names and words.
• Natural process associated directly with growing
age. Almost 40% of people aged 65 up experience
gradual memory loss which has no direct link to any
of the medical conditions
• First, is a desire to achieve a sense of integrity – that
Developmental Tasks
is to achieve a sense of meaning and a sense of a
2 Common theories associated: well-lived life
• The other is a tendency to fall into despair and
• Two classical general developmental theories
hopelessness. It is possible to overcome the fear
authored by Havighurst and Erikson examine the
associated with death by adopting a commitment
specific nature of each stage of human
to integrity accompanied by acceptance. This
development.
commitment fosters the feeling that one’s life
• They posit a trajectory of development spans
makes sense and is derived from a broader
infancy to old age and emphasizes the key
perspective of synthesis of lived experience that is
elements of functioning in each particular life
experiencing the balance of life
period. Experience in deteriorating health and
infirmity compared to others and their own past On the other hand, this theory of crisis and psychosocial
selves, the individual is preset to strong opposing development throughout the lifetime, Erikson highlights
forces. the need for a space for the continuum of integrity and
despair during the period of late adulthood.
1. Robert Havighurst’s Theory
• Faced by people 60 years and above
o Adapting to a decline in physical strength
o adapting to retirement and reduced income
o coming to terms with the death of a spouse
 Promoting Mental Health in the Older Adults
Mental Health – Global Incidence (WHO, Dec 2017)
• Over 20% of adults aged 60 and over suffer from a
mental or neurological disorder.
• 6.6% of all disability (disability adjusted life years –
DALYs) among people over 60 years is attributed
to mental and neurological disorders.
• Most common mental neurological disorders in
this age group are:
o Dementia and depression (approximately 5%
and 7% of the world’s older population)
o Anxiety disorders (affects 3.8%)
o Substance use problems (affect almost 1%)
• Substance abuse problems among older adults are
often overlooked or misdiagnosed.
• Psychological aging influences the way we view with
the biological changes in a capacity to adjust to
different life events
• It is affected by education, income, employment
history, and social and support networks.
• Social aging comprises the external changes
imposed in individuals based on their chronological
age (Ex. Being forced to retire at age 65)
• An important aspect of healthy aging is the
promotion of good mental health and well being in
later life.
• It is assumed that quality of life decreases with age,
but this is not necessarily true. Study shows that for
many people, particularly women, life satisfaction
increases as they grow older.
Mental health – the positive ability to enjoy life and cope
with its difficulties. It is a resource that enables us to
grow and learn and experience life as enjoyable and
fulfilling.
George Valliant describes 7 concepts of positive mental
health:
• Effective functioning
• Strengths of character
• Maturity
• Positive emotional balance
• Socio-emotional intelligence
• Life satisfaction (true happiness)
• Resilience
• It is widely acknowledged that the mental
health and well-being of older people has been
neglected in across the spectrum of promotion,
prevention, and treatment services.
• Within mental health policy, older people are
often neglected and mental health initiatives
have tended to target adults of working age,
many adults up to age 65, as well as children
and young people.
• This has resulted in an even progress in mental
health developments for people of different
ages.
• This inequality is starting to get recognized that
more work is needed to ensure that mental
health programs address older people’s needs
and interests.
With Good Mental Health, we can:
• Develop emotionally, creatively, intellectually, and
spiritually
• Initiate, develop and sustain mutually satisfying
personal relationships
• Face problems, resolve them and learn from them
• Be confident and assertive
• Be aware of others and empathize with them
• Use and enjoy solitude
• Enjoy life and have fun
• Laugh, both at ourselves and at the world
Why Pay Attention to Mental Health?
• Good mental health and well-being in layer life
benefit each of us personally
• Good mental health and well-being in later life
benefit society by maximizing the contributions
that older people can make.
• Good mental health and well-being in later life
benefit society by minimizing costs of care related
to poor mental health.
Mental Health Promotion
- Any activity or action that strengthens or
protects mental health and well-being
Works at 3 levels:
1. Strengthening individuals. By increasing
emotional resilience through interventions
designed to promote self-esteem, life and coping
 skills such as communicating, negotiating, and
relationship skills.
2. Strengthening communities. By increasing social
inclusion and participation, improving
neighborhood environments, developing a range
of interventions which supports mental health
for all people of all ages, including anti-bullying
strategies at school, programs to improve health
in the workplace or community safety measures,
or self-help networks
3. Reducing structural barriers to mental health.
By tackling societal structures through initiatives
to reduce discrimination and inequalities to
promote access to education, meaningful
employment, housing services, and support for
those who are vulnerable.
ENHANCEMENT LECTURE NOTES
• Mental health disorders occur in nearly 20% of the
older population, with the most frequent diagnoses
being anxiety and depression (Touhy & Jett, 2010).
• Symptoms are often underreported by and under-
diagnosed in older individuals.
• Only 3% of older persons report being actively
treated by a mental health professional, and it is
estimated that 63% of those individuals who are
diagnosed with a mental illness do not receive
appropriate care.
• As a maladaptive response to the challenges of
aging, older adults may present with symptoms of
anxiety and/or depression (Fiske, Loebach-
Weatherell & Gatz, 2009).
• Often older adults will minimize their concerns
about possible symptoms of anxiety and
depression because of learned sociocultural
patterns of beliefs about mental illness.
Risk Factors of Developing Anxiety
1. Family history of anxiety disorders
2. Female gender
3. Perimenopause (due to hormonal changes)
4. Increased frailty
5. Acute or chronic illness
6. Chronic pain
7. Loss of family members, friends, independence, or
home (including being moved to another residence
such as a nursing home)
8. Lack of social supports
9. Recent traumatic event
10. Poor self-rated health
11. Concurrent diagnosis of depression, dementia,
bipolar disorder, or schizoaffective disorder
12. Certain medications
Types of Anxiety
1. Generalized anxiety disorder (GAD)
- Constant worries and fears distract an individual
from day-to-day activities or the person is
troubled by a persistent feeling that something
bad is going to happen
- Chronic fear with anxious symptoms nearly all of
the time, through the individual may not even
know why
- Often presents with physical symptoms like
insomnia, stomach upset, restlessness, and
fatigue.
2. Agoraphobia
- Anxiety about being in places where escape
might be difficult or available should a panic
attack develop
- Can be with or without panic disorder
3. Panic Disorder
- Repeated, unexpected episodes of severe
anxiety, as well as fear of experiencing another
episode
- May be incapacitating, where the individual may
be frozen and unable to move, may have feelings
of shortness of breath or smothering as well as
feelings of choking
- Panic disorder may also be accompanied by
agoraphobia, which is a fear of being in places
where escape or help would be difficult in the
event of a panic episode
4. Obsessive-compulsive disorder
- Unwanted thoughts or behaviors that seem
impossible to stop or control
- Recurring worry or obsessed by a thought such
as forgetting to turn off the oven or that a fall
may occur
5. Phobia
- An unrealistic or exaggerated fear of a specific
object, activity, or situation that in reality
presents minimal to no danger.
- Common phobias include fear of animals, fear of
places such as hospitals, or fear of events such as
testing situations
- In the case of a severe phobia, an individual
might go to extreme lengths to avoid the thing
feared.
6. Posttraumatic stress disorder (PTSD)
- PTSD is a condition that can develop following a
medical event (such as a fall or cardiac arrest),
traumatic or terrifying event (such as a sexual or
physical assault), the unexpected death of a
loved one, or a natural disaster, as well as
present in individuals who have served in war
situations.
- Older individuals who exhibit symptoms of PTSD
often have lasting and frightening thoughts and
memories of the event and tend to be
emotionally numb.
7. Social phobia
- Persistent and irrational fear of situations that
may involve scrutiny or judgement by others,
especially in social settings such as parties and
other social events.
8. Substance-induced anxiety disorder
- Prominent anxious symptoms that are
determined to be the direct physiological
consequences of a drug of abuse, a medication,
or toxin exposure.
Nursing Care for the Patient Experiencing
Anxiety
1. Decrease environmental stimuli
2. Stay with the patient
3. Make no demands and do not ask the patient to
make major decisions
4. Support current coping mechanisms (crying,
talking, etc.)
5. Do not confront or argue with the patient
6. Speak slowly in a soft, calm voice.
7. Avoid reciprocal anxiety (emotions can be
contagious, and sensing anxiety in the nurse can
worsen the patient’s anxiety).
8. Reassure the patient you will help develop a
solution to managing the problem
9. Reorient the patient to reality (unless this causes
more anxiety).
10. Respect the patient’s personal space.
Depression
- A significant number of older individuals
experience depression, which can impact
individual health and overall quality of life as well
as decrease an individual’s lifespan.
Types of Depression
1. Major Depression
- A depressive episode where an individual
experiences pervasive feelings of anxiety and
sadness that coincide with anhedonia, or loss of
pleasure and interest in daily activities.
2. Minor Depression
- A subset of major depression and is defined as an
episode of depressive thoughts that is less
severe than major depression, but has a similar
2-week time frame for presentation.
3. Dysthymia
- Is a chronic form of depression that is often
diagnosed in older adults with prolonged illness
or those who experience long-term challenges in
their daily living.
- Older adults who present with dysthymia
experience mild to moderate depressive
symptoms that are present throughout most
days over a 2-year period.
Different Presentations of Depression
Symptoms of depression can also manifest in varying
patterns of thought and behavior.
• Catatonic depression – individual is very
withdrawn, thinking, speech, and general activity
may slow down, as well as the cessation of all
voluntary activities, may not take care of
him/herself, household, or pets; and may also
mimic others’ speech (echolalia) or movements
(echopraxia).
• Melancholic depression – individual does not
receive pleasure from usual activities; may appear
sluggish, sad, and withdrawn; may speak little, stop
eating, and lose weight; often shows no emotions,
or may feel excessively or inappropriately guilty.
• Psychotic depression – individual has false beliefs
(delusions) about having committed unpardonable
sins or crimes, having incurable or shameful
disorders, or being watched or persecuted, may
have hallucinations, usually of voices accusing
 them of various misdeeds or condemning them to
death; and some individuals may imagine that they
see cons or deceased relatives.

Schizophrenia
- Is a severe mental disorder characterized by two
or more of the following symptoms: delusions,
hallucinations, disorganized thinking,
disorganized or catatonic behavior (called
positive symptoms) and affective flattening,
poverty of speech, or apathy (called negative
symptoms) that cause significant social or
occupational dysfunction, and are not
accompanied by prominent mood symptoms or
substance abuse or can be attributed to medical
causes (American Psychiatric Association, 2000).
MODULE 2F: Psychosocial Changes in the Older
adult and their Implication to Nursing Care
Pre-Recorded Lecture:
Model and Theories:
Psychological Theories of Aging
- Psychological age is expressed through a
person’s ability and control of the following:
● Memory
● Learning Capacity
● Skills
● Emotions
● Judgements
Sociological Theories of Aging
Personality
Personality refers to individual differences in
characteristic patterns of thinking, feeling and behaving.
Focuses on 2 broad areas:
1. Understanding individual differences in particular
personality characteristics, such as sociability or
irritability.
2. Understanding how the various parts of a person
come together as a whole
Healthy Personality
Jahoda (1958) observed that “positive mental health”
includes one or more of the following six aspects of
individuals :
1. The degree of personal integration achieved
by the individuals
2. The degree of autonomy achieved by the
person.
3. The adequacy of the person’s perception of
reality
4. The degree of environmental mastery
achieved by the person.
5. The attitudes shown by a person toward his or
her own self
6. The style and degree of a pearson’s
self-actualization
Schultz (1977) assessed components of health
personality and stated the following characteristics to
be agreed upon by most theorists:
- Capability to consciously and rationally direct
one’s behavior
- Being in-charge of one’s own destiny
- Knowing who and what one is and being
accepting of strengths and weaknesses
- Being firmly anchored in the present
- Pursuit of challenge through new goals and
new experiences
Cognitions
- Cognition is both a biological and psychological
factor that must be considered in caring for the
older adult.
Cognition and Memory
1. Fluid Intelligence – “native intelligence”
- Skills that are biologically determined,
independent of experiences or learning.
- Associated with flexibility thinking, inductive
reasoning, abstract thinking and integration
2. Crystallized Intelligence
- Knowledge and abilities that the person acquires
through education and life.
- Include verbal meaning, word association, social
judgement, number skills
● Classic Aging Pattern (Hooyman & Kayak,
2011)
- Older people perform more poorly on
performance scales (fluid intelligence), but
scores on verbal scales (Crystallized
intelligence) remain stable.
● Age-associated Memory Impairment (AAMI)
- Has been used to describe memory loss that is
considered normal in light of a person’s age and
educational level.
- May include a general slowness in processing,
storing, and recalling new information, and
difficulty remembering names and words

Developmental Tasks
2 Theories Common:
R.Havighurst
- Faced by people 60 years and above
● Adapting to a decline in physical strength
● Adapting to a retirement and reduced income
● Coming to terms with the death of a spouse
● Maintaining social relations with people of same
age
● Establishing good physical living arrangements
E. Erikson
- Highlights Integrity vs Despair
Promoting Mental Health in Older Adults
Global Incidence:
● Over 20% of adults aged 60 and over suffer from
a mental or neurological disorder.
● 6.6% of all disability (disability adjusted life
years- DALYs) among people over 60 years is
attributed to mental and neurological disorders
Most Common mental neurological disorder in this
age group are:
● Dementia and Depression (approximately 5%
and 7% of the world’s older population)
● Anxiety disorders (affects 3.8%)
● Substance use problems (affect almost 1%)
Mental Health
- Is the positive ability to enjoy life and cope with
its difficulties. It is a resource that enables us to
grow and learn and experience life as enjoyable
and fulfilling
George Valliant describes 7 concepts of positive
mental health:
- Effective functioning
- Strengths of character
- Maturity
- Positive emotional balance
- Socio-emotional intelligence
- Life satisfaction (True happiness)
- Resilience
With Good Mental Health, We Can:
● Develop emotionally, creatively, intellectually and
spiritually
● Initiate, develop and sustain mutually satisfying
personal relationships
● Face problems, resolve them and learn from
them
● Be confident and assertive
● Be aware of others and empathize with them
● Use and enjoy solitude
● Laugh, both at ourselves and at the world
Why Pay Attention to Mental Health
● Good mental health and well-being in later life
benefit each of us personally
● Good mental health and well-being in later life
benefit society by maximizing the contributions
that older people can make
● Good Mental health and well-being in later life
benefit society by minimizing costs of care
related to poor mental health.
Mental Health Promotion
- Is any activity or action that strengthens or
protects mental health and well-being
Works at 3 Levels:
1. Strengthening Individuals
2. Strengthening Communities
3. Reducing structural barriers to mental health
Group Reporting Disorders :
Mood Disorders: Depression and Bipolar Disorder
Depression
Definition
- Depression is a mood disorder characterized by
a persistent feeling of sadness and loss of
interest. It affects how you feel, think and
behave and can lead to a variety of emotional
and physical problems
- A significant number of older individuals
experience depression which can impact
individual health and overall quality of life. As
well as, decrease an individual's lifespan
- Depression in late life is not normal part of aging
● So it is important to take note that it is a
misconception of depression is a normal
inevitable part of aging
Types of Depression
Major Depression
- A depressive episode where an individual
experiences pervasive feelings of anxiety and
sadness. At least five or more of the following
 symptoms must be present for a minimum of two
consecutive weeks
- 8 Cardinal Symptoms:
● Increased fatigue w/ loss of energy
● Irritability and/or restlessness
● Oversleeping or trouble sleeping
● Poor concentration or difficulty with
mental processing
● Inappropriate guilt or perception of
worthlessness
● Changes in appetite that lead to weight
gain or weight loss,
● And thoughts of suicide or death and/or
attempts at suicide.
Minor Depression
- A mood disorder that does not meet full criteria
for major depressive disorder but in which at
least two depressive symptoms are present for 2
weeks
- Individuals show evidence of only one to four of
the eight cardinal symptoms of major depressive
disorders
Dysrhythmia
- A chronic form of depression that is often
diagnosed in older adults with prolonged illness
or those who experience long term challenges in
their daily living.
- Older adults experiencing Dysrhythmia
experience mild to moderate depressive
symptoms that are present throughout most
days over a 2 year period
- A type of neurotic depression that is a mood
disorder consisting of chronic depression, with
less severe but longer lasting symptoms than
major depressive disorder
- Individuals must also report two of the following
symptoms: poor concentration or difficulty
making decisions, poor appetite or overreacting,
fatigue, low energy, excessive sleep, or
insomnia.
Causes of Depression
There are a lot of factors that can contribute in the
elderly to depression include:
● Isolation - Isolation and loneliness can lead to a
negative impact on the physical and mental
health of elderly. Especially those who have
cognitive impairment. Also due to the changes in
health and social relationships that occur in
aging such as hearing, vision, memory loss
disability, difficulty moving around the elderly is
in high risk of isolation and loneliness.
● Health Condition - Depression can occur as a
result of serious illness or be triggered by
another medical condition such as life
threatening diseases. Commonly older adults
have more serious medical conditions such as
heart disease, stroke, and cancer which may
cause depressive symptoms.
● Multiple Medication - Exposure to multiple
medications and their associated side effects as
well as drug interaction, can cause elderly to feel
physically and mentally down. While everyone
can be affected by the mood related diverse
effects of prescription medication.
● Living Alone - Older adult are in high risk or
more likely to experience depression
● Transitioning from a private house to an
assisted living facility - Having to move from
private homes to assisted living facility because
of decreasing ability to live independently can
influence or might cause depression.
Management / Treatment
(Non-pharmacological)
Psychotherapy
- Also known as “talk therapy”, is when a person
speaks to a trained therapist to identify and learn
to cope with the factors that contribute to their
mental health conditions
Electroconvulsive therapy
- Uses electrical currents to induce a seizure, and
has been shown to help people with clinical
depression. It’s used in people with severe
depression or depression that is resistant to
other treatments or antidepressant medications.
Cognitive behavioral therapy
- A therapist will work with you to uncover
unhealthy patterns of thought and identify how
they may be causing harmful behaviours,
reactions, and beliefs about yourself
(Pharmacological)
Serotonin-Norepinephrine Reuptake Inhibitor
therapy
 - SNRIs are the most commonly prescribed
antidepressant medications and tend to have
few side effects. They treat depression by
increasing the availability of the neurotransmitter
serotonin in your brain
Serotonin and Norepinephrine reuptake inhibitors
- SNRIs treat depression by increasing the
amount of the neurotransmitters serotonin and
norepinephrine in your brain.
Tricyclic and Tetracyclic antidepressants
- Tricyclic antidepressants (TCAs) and tetracyclic
antidepressants (TECAs) treat depression by
increasing the amount of the neurotransmitters
serotonin and norepinephrine in your brain
(Atypical Antidepressants)
Noradrenaline and dopamine reuptake inhibitors
(NDRIs)
- These drugs can treat depression by increasing
the levels of dopamine and noradrenaline in
your brain
Monoamine oxidase inhibitors
- MAOIs treat depression by increasing the levels
Trusted Source of norepinephrine, serotonin,
dopamine, and tyramine in your brain
N-methyl D-aspartate (NMDA) antagonists
- NMDA antagonists treat depression trusted
source by increasing levels of glutamate in the
brain
Bipolar Disorder
Definition
- Is a lifelong condition were the person has
serious shifts in mood, energy, thinking, and
behavior “mood episodes”; lifelong condition
- Mood episodes could be manic / neutral /
depressive
- In Manic phase a person could be:
● Restless
● Flight of Ideas
● Irritable and hyper
● Delusions
● Hallucination
● Impulsivity
● Manipulative behavior
- In depressive phase a person could be:
● Sad
● Low energy
● Sleep disturbance
Types
Bipolar I Disorder
- Manic episodes that last at least 7 days, or by
manic symptoms that are so severe that the
person needs immediate hospital care.
- Depressive episodes occur as well, typically
lasting at least 2 weeks
- Mixed features
Bipolar II Disorder
- Pattern of depressive episodes and hypomanic
episodes, but not the full-blown manic episodes
that are typical of Bipolar I disorder.
Cyclothymic Disorder
- Periods of hypomanic symptoms as well as
periods of depressive symptoms lasting for at
least 2 years (1 year in children and
adolescents). However, the symptoms do not
meet the diagnostic requirements for a
hypomanic episode and a depressive episode.
Cause
The exact cause of bipolar disorder is unknown, but
several factors may be involved, such as:
● Biological differences. People with bipolar
disorder appear to have physical/ chemical
changes in their brains. The significance of
these changes is still uncertain but may
eventually help pinpoint causes.
● Genetics. Bipolar disorder is more common in
people who have a first degree relative, such as
a sibling or parent, with the condition.
Researchers are trying to find genes that may
be involved in causing bipolar disorder
Diagnosis and treatment are difficult as older bipolar
patients the number of comorbidities include:
● Depression
● Mania
● Hyperthyroidism and hypothyroidism
● Cerebrovascular pathology
● Dementia
● Delirium
Management / Treatment
(Non-Pharmacological)
- Electroconvulsive therapy
● Useful in the treatment of the factory
disease
- Psychotherapy
 - Routine
(Pharmacological)
- Lithium Medical Management:
- Divalproex sodium - Cognitive Therapy
- Carbamazepine - Medications prescribed
- Lamotrigine - Diet
- Atypical Psychotics
- Antidepressants Pharmacological Management
- Anxiolytics
- Benzodiazepines
- Selective Serotonin reuptake inhibitors
Anxiety, Stress, Defense Mechanism, and
Coping strategies Surgical Management
- There is no surgical management for anxiety
Anxiety

- Is a common illness among older adults,

Stress
Affecting as many as 10-20% of the older
population, though it is often undiagnosed. Older
- Stress is a feeling of emotional or physical
adults often do not recognize or acknowledge
tension. For seniors, stress has the potential to
their symptoms. Some older adults may not
be especially overwhelming. This type of tension
seek treatment because they have suffered
in older adults has unique contributing factors
symptoms of anxiety for most of their lives and
such as the loss of an elderly spouse or friends
believe the feelings are normal.
living alone can increase the sense of isolation.
- Most common for Women. 2nd for men
- The effects of stress can sometime exhaust the
rate health condition from which some seniors
Signs and Symptoms
suffer causing additional worry
1. Shakiness and panicky feeling
- Stress is known to suppress the immune
2. Difficulty breathing, sweating, and nausea
system, making you more susceptible to illness.
3. Dizziness or feeling lightheaded
Furthermore, older adults are already more
4. Digestion problems and chest pain
susceptible to illness due to the age-related
5. Headaches and confusion
suppression of their immune system
6. Eye and vision
7. Muscle tension
Signs and Symptoms of Stress
8. Soreness and Fatigue
a. Physiological
9. Irrational thoughts
- Insomnia, Nightmare
10. Forgetfulness
- Muscle pain and tiredness
11. Irritability
- Frequent Urination
12. Avoidance of Activity
- Loss of Appetite
13. Changes in weigh, eating habits
- Palpitation
14. Obsessive thoughts
b. Emotional and Psychosocial
- Anxiety, Fear, Frustration, Depression
Causes
- Restlessness, Poor Concentration,
1. Stressful or Traumatic Events
Forgetfulness
2. Alcohol
3. Medications
Causes of Stress
4. Caffeine
- Changes of lifestyle and financial status after
5. Family history of anxiety disorders
retirement
- Caring for grandchildren
Management:
- Caring for a sick spouse
Nursing Management:
- Death of relatives, beloved or close friends
- Assess the client’s history and current state of
- Worries for not being able to live independently
mind
- Worries for institutionalization
- Behavioral counseling

Management:
Nursing Management
- Assess cause of stress
- Assist clients to identify feelings and begin to
deal with problems
- Promote wellness
- Stress reduction
Medical Management
- Cognitive Therapy
- Medications
Pharmacological Management
- Benzodiazepines
- Antidepressant
- Beta blockers
Surgical Management
- There is no surgical management for stress
Defense Mechanisms and Coping Strategies
- Are thought to safeguard the mind against
feelings and thoughts that are too difficult for the
conscious mind to cope with.
- Such as:
● Displacement: This involves taking out
frustrations , feelings, and impulses on
people or objects that are less
threatening
● Denial: It is an refusal or to recognize
that something has occurred or is
currently occurring this also functions to
protect the ego from things which the
individual cannot cope
● Repression and Suppression:
Repression acts to keep information out
of conscious awareness sometimes
older adults do this consciously by
forcing the unwanted information out of
our awareness which is also known as
suppression
● Projection: this involves taking one's
own acceptable qualities or feelings
and ascribing them to other people. It
works by allowing the expression of the
impulse but in a way that ego can't
recognize their for reducing anxiety
● Intellectualization: This avoids thinking
about the stressful emotional aspects of
a situation that has happen
● Rationalization: this involves explaining
unacceptable behavior or feeling in a
rational or logical manner avoiding the
true reason for the behavior
Coping Strategies
- Are psychological patterns that individuals use
to manage thoughts, feelings, and actions
encountered during various stages of ill health
and treatments.
Best Ways of Coping Strategies:
● Deep breathing exercises: Is one of the best
ways to lower stress in the body because when
you breathe deeply it sends a message to your
brain to calm down and relax.
● Relaxation techniques: Make an older person
to focus on sounds or that make them anxious.
These include distraction of music therapy,
visual imagery, aroma therapy, or imagination of
relaxation techniques thru guided instructions
● Cognitive Restructuring: Helps the person
identify their own triggers or stimuli that causes/
maintain anxiety to increase awareness of
trigger so they may slowly gain control over the
effect of the stimuli to the coping strategies
Personality Disorder
- A personality disorder is a type of mental
disorder in which an individual has a rigid and
unhealthy pattern of thinking, functioning and
behaving. A person with a personality disorder
has trouble perceiving and relating to situations
and people. This causes significant problems
and limitations in relationships, social activities,
work and school.
- An empirical study was made of the prevalence
of personality disorder in which there is a
specific effect for aging. Community dwelling
older persons demonstrated more schizoid and
obsessive-compulsive characteristics and in
comparison with younger groups, the older
 mental health patients had more schizoid
disorder and fewer high-energy disorder
characteristics.
Types:
Cluster A: Suspicious
● Paranoid personality disorder. People with
paranoid personality disorder may be distrustful
of others and suspicious of their motives.
● Schizoid personality disorder. People with
schizoid personality disorder can display little
interest in forming personal relationships or
partaking in social interactions. They can have
trouble interpreting social cues, causing them to
seem emotionally distant.
● Schizotypal personality disorder. People with
schizotypal personality disorder often believe
that they can influence other people or events
with their thoughts. They may misinterpret
behaviors, leading to inappropriate emotional
responses. They may also avoid having intimate
relationships.
Cluster B: Emotional and impulsive
● Antisocial personality disorder. People with
antisocial personality disorder tend to
manipulate or treat others without expressing
remorse for their actions. They may engage in
dishonest behavior like lying and stealing, and
they may be prone to heavy alcohol and drug
use.
● Borderline personality disorder. People with
borderline personality disorder often feel empty
and abandoned, regardless of family or
community support. They may have difficulty
dealing with stressful events and have episodes
of paranoia. They also tend to engage in risky
and impulsive behavior, such as binge drinking
and gambling.
● Histrionic personality disorder. People with
histrionic personality disorder frequently try to
gain more attention by being dramatic or
provocative. They may be easily influenced by
other people and are sensitive to criticism or
disapproval.
● Narcissistic personality disorder. People with
narcissistic personality disorder often believe
that they’re more important than others. They
tend to exaggerate their achievements and may
brag about their attractiveness or success. Other
symptoms include a deep need for admiration
but lack empathy for other people.
Cluster C: Anxious
● Avoidant personality disorder. People with
avoidant personality disorder often experience
feelings of inadequacy, inferiority, or
unattractiveness. They may dwell on criticism
from others and avoid participating in new
activities or making new friends.
● Dependent personality disorder. People with
dependent personality disorder depend on other
people to meet their emotional and physical
needs. They usually avoid being alone and
regularly need reassurance when making
decisions. They may also be more likely to
tolerate physical and verbal abuse.
● Obsessive-compulsive personality disorder.
People with obsessive-compulsive personality
disorder have an overwhelming need for order.
They strongly adhere to rules and regulations,
and they feel extremely uncomfortable when
perfection isn’t achieved. They may even
neglect personal relationships to focus on
making a project perfect.
Signs and Symptoms
Cluster A: Suspicious
Paranoid personality disorder
● Pervasive distrust and suspicion of others and
their motives
● Unjustified belief that others are trying to harm
or deceive you
● Unjustified suspicion of the loyalty or
trustworthiness of others
● Hesitancy to confide in others due to
unreasonable fear that others will use the
information against you
● Perception of innocent remarks or non
threatening situations as personal insults or
attacks
● Angry or hostile reaction to perceived slights or
insults
● Tendency to hold grudges
● Unjustified, recurrent suspicion that spouse or
sexual partner is unfaithful
Schizoid personality disorder
● Lack of interest in social or personal
relationships, preferring to be alone
● Limited range of emotional expression
● Inability to take pleasure in most activities
● Inability to pick up normal social cues
● Appearance of being cold or indifferent to others
● Little or no interest in having sex with another
person
Schizotypal personality disorder
 ● Peculiar dress, thinking, beliefs, speech or
behavior
● Odd perceptual experiences, such as hearing a
voice whisper your name
● Flat emotions or inappropriate emotional
responses
● Social anxiety and a lack of or discomfort with
close relationships
● Indifferent, inappropriate or suspicious response
to others
● "Magical thinking" — believing you can influence
people and events with your thoughts
● Belief that certain casual incidents or events
have hidden messages meant only for you
Cluster B: Emotional and Impulsive
Antisocial personality disorder
● Disregard for others' needs or feelings
● Persistent lying, stealing, using aliases, conning
others
● Recurring problems with the law
● Repeated violation of the rights of others
● Aggressive, often violent behavior
● Disregard for the safety of self or others
● Impulsive behavior
● Consistently irresponsible
● Lack of remorse for behavior
Borderline personality disorder
● Impulsive and risky behavior, such as having
unsafe sex, gambling or binge eating
● Unstable or fragile self-image
● Unstable and intense relationships
● Up and down moods, often as a reaction to
interpersonal stress
● Suicidal behavior or threats of self-injury
● Intense fear of being alone or abandoned
● Ongoing feelings of emptiness
● Frequent, intense displays of anger
● Stress-related paranoia that comes and goes
Histrionic personality disorder
● Constantly seeking attention
● Excessively emotional, dramatic or sexually
provocative to gain attention
● Speaks dramatically with strong opinions, but
few facts or details to back them up
● Easily influenced by others
● Shallow, rapidly changing emotions
● Excessive concern with physical appearance
● Thinks relationships with others are closer than
they really are
Narcissistic personality disorder
● Belief that you're special and more important
than others
● Fantasies about power, success and
attractiveness
● Failure to recognize others' needs and feelings
● Exaggeration of achievements or talents
● Expectation of constant praise and admiration
● Arrogance
● Unreasonable expectations of favors and
advantages, often taking advantage of others
● Envy of others or belief that others envy you
Cluster C: Anxious
Avoidant personality disorder
● Too sensitive to criticism or rejection
● Feeling inadequate, inferior or unattractive
● Avoidance of work activities that require
interpersonal contact
● Socially inhibited, timid and isolated, avoiding
new activities or meeting strangers
● Extreme shyness in social situations and
personal relationships
● Fear of disapproval, embarrassment or ridicule
Dependent personality disorder
● Excessive dependence on others and feeling the
need to be taken care of
● Submissive or clingy behavior toward others
● Fear of having to provide self-care or fend for
yourself if left alone
● Lack of self-confidence, requiring excessive
advice and reassurance from others to make
even small decisions
● Difficulty starting or doing projects on your own
due to lack of self-confidence
● Difficulty disagreeing with others, fearing
disapproval
● Tolerance of poor or abusive treatment, even
when other options are available
● Urgent need to start a new relationship when a
close one has ended
Obsessive-compulsive personality disorder
● Preoccupation with details, orderliness and rules
● Extreme perfectionism, resulting in dysfunction
and distress when perfection is not achieved,
such as feeling unable to finish a project
because you don't meet your own strict
standards
● Desire to be in control of people, tasks and
situations, and inability to delegate tasks
● Neglect of friends and enjoyable activities
because of excessive commitment to work or a
project
● Inability to discard broken or worthless objects
● Rigid and stubborn
● Inflexible about morality, ethics or values
 ● Tight, miserly control over budgeting and
spending money
Cause
Your genes - Certain personality traits may be passed
on to you by your parents through inherited genes.
These traits are sometimes called your temperament.
Your environment - This involves the surroundings you
grew up in, events that occurred, and relationships with
family members and others.
Management
Cognitive Therapy (Cognitive Behavioral and
Cognitive Remediation Therapy)
- In CBT, the patient would be encouraged to
actively participate by examining the evidence
for and against the distressing belief,
challenging the habitual patterns of thinking
about the belief, and using reasoning and
personal experiences to develop rational and
acceptable alternative explanations and
interpretations for coping, problem solving, and
self-management of the illness and its
symptoms.
- CBT is a highly structured and standardized
therapy to help patients with schizophrenia cope
with their psychotic symptoms by examining and
reevaluating their thoughts and perceptions of
experiences
Psychoeducation Programs
- With the strategies and skills taught in coping
with schizophrenia, psychoeducation programs
for both patients and their family members have
accumulated much evidence regarding their
efficacy in overall mental state, treatment
compliance, relapse prevention, and satisfaction
with mental health services
- Programs are designed and led by health
professionals, they are mainly medium term,
lasting between 9 months and 2 years, and they
may be delivered to single or multiple
participants at the patient’s home or in a clinical
setting; and mainly include both the patient and
his/her family members during the intervention
sessions.
Family Interventions
- Family dynamics and emotional climate affect
the recurrence of positive symptoms, and
therefore the course of the illness. This can be
helpful in treatment planning and
implementation. There would also be an
enhanced competence and ability of the families
to detect and notify mental health professionals
about any warning signs of relapse are crucial
for relapse prevention to avoid contributing to
long delays in treatment and to achieve early
recovery.
Social Skills Training
- A lack of social skills can provoke stressful
interactions with the social environment and lead
to social withdrawal and isolation.
- Social Skills Model by Robert Liberman:
- Three main components:
● Receiving skills (social perception)
● Processing skills (social cognition)
● Sending information skills (behavioral
responding or expression)
- Aims to enhance patients’ social competence in
terms of interpersonal and communication skills,
illness management, community reintegration,
workplace social skills, and instrumental
activities of daily life.
- Important for patients to be equipped with skills
to deal with stressful life events and daily
hassles, they are proficient in solving their life
problems and challenges, and consequently,
those life stressors are less likely to trigger
exacerbations or social decompositions.
- Social skills compliance can also expand
patients’ participation and partnership in
treatment decisions and partnership, as
evidenced by its effectiveness in teaching
medication self-management skills.
Schizophrenia
Is a chronic, severe mental disorder that affects the way
a person thinks, acts, expresses emotions, Perceives
reality, and relates to others
Cause:
- The exact causes of schizophrenia are unknown
- Research suggests a combination of physical,
genetic, psychological and environmental factors
can make a person more likely to develop the
condition.
- Some people may be prone to schizophrenia,
and a stressful or emotional life event might
trigger a psychotic episode.
Types of Schizophrenia

Paranoid
- Most common form and is usually characterized
by positive schizophrenia symptoms like
delusions and hallucinations
- Paranoia may be extreme and may act on it
Catatonic
- Rare type of schizophrenia
- Have negative symptoms and are not very
responsive
- May not react to stimuli, stay in strange body
positions, make odd movements, or have rigid
limbs that will stay in the position they are
moved to
- Person shuts down emotionally mentally and
physically
- People appear to be paralyzed
Hebephrenic
- “Disorganized schizophrenia”
- People usually have disorganized speech and
behavior
- May have inappropriate emotional responses or
lack of any emotional response
Residual
- Used when people have a past history of
positive schizophrenia but now has lingering
negative symptoms or none at all
- Lingering symptoms include poor attention,
some mental disorganization, and emotional
withdrawal
Undifferentiated
- Classification given to people who may not fit
into any of the other classifications
- Shows symptoms for more than one kind
- Vague Symptoms
- Exhibit both positive and negative symptoms
Management
Nursing Management:
● Assess positive symptoms
- Assess for command hallucinations
● Promote social skills
- Provide support in assisting him to learn
social skills
● Ensure safety
- Maintain a safe environment with
minimal stimulation
● Deal with Hallucinations by presenting reality
- Explore the content of hallucinations
● Encourage family involvement
- Involve family in patient treatment and
teach members to recognize impending
relapse
● Promote compliance and monitor drug
therapy
- Administer prescribed drugs and
encouraged the patient to comply
Medical Management:
● Individual Therapy
- Psychotherapy may help to normalize
thought patterns. Also, learning to cope
with stress and identify early warning
signs of relapse can help people with
schizophrenia manage their illness
● Social Skills training
- Focuses on improving cognitive
communication and social interactions
and improving the ability to participate in
the activities.
● Family Therapy
- This provides support and education to
families dealing with schizophrenia.
● Cognitive Behavioral Therapy
- is collaborative, time-limited in nature,
and provides clients with the rationale
and methods necessary to develop
self-management skills
● Lifestyle and Dietary Modifications
- All the patients are to be advised for a
change in lifestyle and diet to reduce the
risk of metabolic side effects and
cardiovascular morbidity and mortality.
These include physical exercises,
dietary modifications and abstinence
from smoking etc.
● Electroconvulsive therapy
- For adults with schizophrenia who do
not respond to drug therapy,
electroconvulsive therapy (ECT) may be
considered. ECT may be helpful for
someone who also has depression.
Pharmacological Management:
Antipsychotic Medications
- Are typically used to treat symptoms such as
delusions and hallucinations that people with the
condition may experience
- This type of medication can be taken orally as a
daily pill or liquid form or given at less frequent
intervals as a shot or injection.
 - Block the dopamine receptor D2, which reduces
dopamine levels in neurons. This suggests that
maybe schizophrenia has something to do with
increased levels of dopamine.
- These medications though are neither
universally nor completely effective and don't
work.for everyone with schizophrenia, which
adds to the confusion and means there’s
probably more to it than d2 receptors.
- One of the effective antipsychotic drugs,
clozapine, a second generation Atypical
Second-generation antipsychotics are, in
general, more efficacious than first-generation
antipsychotics. and a weak d2 antagonist
suggesting that other neurotransmitter systems
like norepinephrine, serotonin and GABA are
involved.
● Common side effects which no need to
report are:
Weight gain - teach clients about weight
management;
Hypersalivation or basically drooling and
sedation - inform clients to prevent
engaging activities that puts them at risk
for injury such as driving
● Adverse effects: leukopenia and low
wbc, granular cytosis or basically low
WBC's and low immunity AKA
leukopenia and decreased neutrophils
so put in mind that the elderly will
increase their risk for infection while
taking this medication- comply with
regular blood monitoring and teach
measures to prevent infection
Surgical Management:
Deep Brain Stimulation
● Deep Brain Stimulation (DBS) is a surgical
procedure involving the implantation of a thin
flexible wire called a lead.
● It's a new treatment that uses electric pulses to
help parts of your brain communicate better.
● When you get DBS, a surgeon places wires and
electrodes in your brain. They're connected to
another device that they put under the skin in
your chest to control the electric signals.
MODULE 3F: End of Life Care
Pre-Recorded Video
Models for End to Life Care
Curative or Acute Care
- Commonly seen when an older adult is rush in
the emergency department and transferred in
Intensive care unit (ICU)
- Hospital death
- When the patient, families and culture choose
life-prolonging focus of care
- ICU settings, with support devices
Hospice Care
- Non-life prolonging care
- Recognizes dying as part of the normal process
of living
- Focuses on maintaining the quality of remaining
life
Considerations:
- Based on life expectancy of 6 months of less
- Cater to clients even longer than 6 months as
long as terminally ill
- Utilizes team approach
Services:
- Nursing Services and Coordination of Care
- Physical, Occupational Therapy and Speech -
Language Pathology Services
- Medical Social Services
- Home Health Aides
- Counseling Services
- Short-term inpatient care
- Medical Appliances and Supplies
- Medications and Biologicals
Palliative Care
- More mainstream - whole person care for
persons with life-limiting illness
- Accommodates those who are not yet eligible for
hospice support
- Comprehensive management based on
existential needs of the patient
Ethical Principles and Considerations:
● Patient Self- Determination Act of 1990
● Autonomy
● Advance Directives and Living Wills
Advance Directives
- Legal Documentations that direct the health care
team or family members/ loved ones
- Medical Care preferences of the patient
- Applicable when the patient can not make
decision due to serious medical conditions or
emergencies
 3.0 – CARE OF THE OLDER ADULT
2F: PSYCHOSOCIAL CHANGES
I. DEPRESSION
Depression
• Persistent sadness and lack of interest or
pleasure in previously rewarding or
enjoyable activities, characterized by
anhedonia Not feeling pleasure?
• Assessed in older adults through the
Geriatric Depression Scale
o A score of 5 or more suggests
depression
Types
Major Pervasive feelings of anxiety
and sadness that coincide with
anhedonia
Minor Less severe than major
depressive episodes with a
similar 2-week timeframe
Dysthymia Associated with chronic illness
or loss
Presentations
a. Catatonic
o Individual is very withdrawn
o Thinking, speech, and general
activity may slow down or
cessation of all voluntary activities
o Echolalia (mimic of speech) or
echopraxia (mimic of movement)
b. Melancholic
o Does not receive pleasure from
usual activities
o Sluggish, sad, and withdrawn
c. Psychotic
o Individual has delusions or even
hallucinations
o Delusions = false beliefs
about things that exist
MS. PHOEBE KATES MANGARIN
| 11/21/2022
o Hallucinations = sensory
perception of things that Repression Unconscious mechanism
do not exist employed by the ego to keep
disturbing or threatening
II. BIPOLAR DISORDER thoughts from becoming
Bipolar Disorder conscious
• Formerly manic-depressive illness
• Involves extreme mood swings from Ex. Oedipus complex
episodes of mania to episodes of depression Denial Blocking external events from
• Watch out for suicidal symptoms in manic awareness. If some situation is
state just too much to handle, the
individual refuses to
Types experience it
Bipolar I Severe mood episodes from
mania to depression Ex. Smokers refuse to admit
Bipolar II Milder form of mood themselves that smoking is bad
elevation, involving milder for their health
episodes of hypomania (less- Projection Involves attributing their own
intense elevated moods in unacceptable thoughts,
bipolar II disorder feelings and motives to
another person
III. STRESS
Ex. Blaming your partner for
Stress
being angry when you’re the
• Threatens physical, emotional, and spiritual
one angry
being
Displacement Satisfying an impulse with a
• Caused from temperature changes, substitute object
pollutants, viruses, injury, interpersonal
conflicts, time pressures, fear, bad news,
Ex. Someone who is frustrated
and unpleasant or difficult tasks
by his boss at work may go
home and kick the dog
Defense Mechanism
Regression A movement back in
• Psychological strategies that are psychological time when one is
unconsciously used to protect a person
faced with stress in an age-
from anxiety arising from unacceptable
inappropriate way
feeling or thoughts
Sublimation Satisfying an impulse with a
• Involve a distortion of reality in some way substitute object in a socially
so that we are better able to cope with a
acceptable way
situation
Cairo, Jheneivy Faith 1
 3.0 – CARE OF THE OLDER ADULT MS. PHOEBE KATES MANGARIN
2F: PSYCHOSOCIAL CHANGES | 11/21/2022
available should a panic attack Dependent People depend too much on
develop others to meet their emotional
Coping Strategies Panic Disorder Repeated unexpected episodes and physical needs
• Response to stressful or unpleasant of severe anxiety, as well as Histrionic Excessive emotionality and
situations whether it be a single action, a fear of experiencing another attention-seeking behaviors
series of actions, or a thought process, or a episode wherein people have a larger-
way to change one’s response to it. Obsessive- Unwanted thoughts or than-life personality and are
Compulsive behaviors that seem frequently the life of the party
IV. ANXIETY Disorder impossible to stop or control Narcissistic People have an inflated sense
Risk Factors Phobia Unrealistic or exaggerated fear of their own importance, a
1. Family history of a specific object, activity, or deep need of excessive
2. Female gender situation that in reality attention and admiration,
3. Perimenopause presents minimal to no danger troubled relationships, and a
4. Increased frailty Posttraumatic A condition that can develop lack of empathy for others
5. Acute or chronic illness Stress Disorder after a traumatic event Obsessive- A person is preoccupied with
6. Chronic pain Social Phobia Persistent and irrational fear of Compulsive Rules, Orderliness, Control,
7. Loss of family members, friends, situations that may involve and Causes
independence, or home scrutiny or judgment by others Paranoid Intense anxious or fearful
8. Lack of social supports Substance- Prominent anxious symptoms feelings and thoughts often
9. Recent traumatic event Induced Anxiety that are determined to be the related to persecution, threat,
10. Poor self-related health Disorder direct physiological or conspiracy
11. Concurrent diagnosis of other mental consequence of a drug abuse
disorders or toxin exposure Most frequently seen in
12. Certain medications psychotic disorders
V. PERSONALITY DISORDERS Schizoid Overall disinterest in social
Types Personality Disorders relationships and a tendency
Generalized Constant worries and fear Antisocial Long-term pattern of towards a solitary lifestyle
Anxiety distract an individual from day- manipulating, exploiting, or Schizotypal Unusual or eccentric behavior
Disorder to-day activities violating the rights of others in its sufferers, who typically
without any remorse have few or no intimate
Chronic fear with anxious Avoidant Lifelong pattern of feeling very connections w/ depressive
symptoms nearly all of the shy, inadequate, and sensitive
episodes
time to rejection VI. SCHIZOPHRENIA
Agoraphobia Anxiety about being in places Borderline Difficulties regulating emotion Schizophrenia
where escape might be as they feel emotions intensely • A severe mental disorder characterized by
difficult or embarrassing or in and for long periods of time two symptoms:
which help may not be

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 3.0 – CARE OF THE OLDER ADULT MS. PHOEBE KATES MANGARIN
2F: PSYCHOSOCIAL CHANGES | 11/21/2022
o Positive = delusions, Increase activity sa brain
hallucinations, disorganized
thinking, or catatonic behavior
o Negative = affective flattening,
poverty of speech, or apathy
• Usually occurs between the late teens and
the mid 30s. However, in rare cases,
schizophrenia has an onset after age 45.
• Symptoms can cause significant social or
occupation dysfunction, and are not
accompanied by prominent mood
symptoms or substance abuse can be
attributed to medical causes

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 NCM 114: End of Life Care
Dr. Johanna Kristeen de la Torre, RN
End of Life Care
Bambam2017
✨Gayle: 00:00-02:57
Margaret Mead: “When a person is born, we
rejoice, and when they’re married, they jubilate, but
when they die, we try to pretend nothing
happened.”
Limitations:
• Have little clinical time;
• Lesser exposure to end-of-life experiences;
• A few partnering local hospices or palliative
care facilities
Models for End-of-Life Care
1. Curative or Acute Care
2. Hospice Care
3. Palliative Care
Curative or Acute Care
• Hospital death
• When the patient, families and culture
choose life-prolonging focus of care
• ICU settings, with support devices
Discussion: This option is commonly seen when
the older adults are rushed in the emergency
department and eventually transferred in the
intensive care unit prioritizing them because of
their age. With its cause the length of stay to fully
recover and the uncertain chances of survival,
some discussion on end-of-life care is brought up
by the family members. We allow this despite the
number of tubes and machines attached to them
because we want them to prolong their lives. It is
important that we don’t make judgements about
these choices rather take note that there are other
choices that exists.
Hospice Care
• Non-life prolonging care
• Recognizes dying as part of the normal
process of living
• Focuses on maintaining the quality of
remaining life
Discussion: this model provides care and support
to the older adults in the last phases of incurable
diseases so they may live fully and comfortably as
Cebu Doctors’ University Fated Nurses
Bambam2017
possible. Its philosophy affirms that life neither
hastens nor postpones death. This exists in the
hopes that through appropriate care the patients
including their family may be free to attain a degree
of mental and spiritual preparation for death that is
satisfactory to them.
✨Joy: 02:57- 04:51
Hospice Facilities
• Loving Home Nursing Care
• Daughters of St. Camillus
- Base on life expectancy of 6 months or
less
- Cater to clients even longer than 6 months
as long as terminally ill
- Utilizes Team Approach
Expected Services in Hospice Care
• Nursing Services and Coordination of
Care
• Physical, Occupational and Speech-
Language Pathology Services
• Medical Social Services
• Home Health Aides
• Counselling Services
• Short-term in-patient care
• Medial Appliances and Supplies
Palliative Care
1. More mainstream – whole person care for
persons with life- limiting illnesses
2. Accommodates those who are not yet
eligible for hospice care
3. Comprehensive management based on
existential needs of the patient
Ethical Principles and Considerations
• Patient Self-Determination Act of 1990
• Autonomy
- right to decide whether his life will be
shorten or prolonged
- provides our clients to express their
preferences regarding life sustaining or
lifesaving care that need proper
documentation.
• Advance Directives and Living Wills
- as part of a healthcare team acts as an
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 NCM 114: End of Life Care
Dr. Johanna Kristeen de la Torre, RN
advocate ensuring that an adequate
information may be supplied.
Bambam2017
✨Janica: 04:52-06:40
Advance Directives
Legal documents that directs the health
care team or family members/loved ones
Medical care preferences of the patient
Applicable when the patient cannot make
decision due to serious medical conditions
or emergencies
Discussion:
• When decision in life saving or life
sustaining care needed, it is best that these
are made by the client itself
o This will prevent crisis from the
significant others and the
healthcare team
o Prepared when the patient is still of
sound mind (?)
• Most common type of advanced directives
are the living will
Ethical Principles and Considerations
Durable Power of Attorney
A legal document that designates an
alternative decision maker in the event that
the person is incapacitated
Decreased conflicts among family
members
Discussion:
• This is one of the many important legal
documents that may be part of the living will
• Allows another person the authority to
make healthcare decisions even to
financial transactions or sign legal
documents at the principle or the patient
cannot do
• In some cases, the patient may choose a
friend who now supersedes immediate
family member
• Whoever is designated in the living will
allows the person to perform roles
negotiated in advance with the patient
Cebu Doctors’ University Fated Nurses
Bambam2017
Do Not Resuscitate (DNR) Order
Notice: “Do not resuscitate” does not mean “do
not treat”
• In the absence of a living will, the HCT
requires all possible efforts at resuscitation
should be initiated
• Paternalism
Discussion:
• When it is clearly stated that the person
gives up his chances of survival by not
performing CPR, but other treatment
continues
• When the decision of the patient or family
members arises, the disagreeing
approaches from the recommendations of
the professionals, concerns around
autonomy could occur.
• The paternalistic behavior of the physicians
including nurses may lead to ethical
conflicts
✨Gwyn: 06:48 (Allow Natural Death and Order)-
09:00
Allow Natural Death (AND) Order
• A more positive order than the DNR
• Focuses on allowing death to naturally take
place
• This is a more descriptive order that
focuses on allowing death to occur at its
course at the end of an illness.
• As DNR sounded like taking something or
not doing life-reviving interventions, the
AND order provides more comfort
measures.
• Although this is not commonly discussed
on our health care system, it is good to
know that such order exists as an option for
the older adults.
Assisted Suicide
• Another ethical issue of self-determination
and autonomy.
• This can be very difficult to decide as this
is influencing most often dictated by the
social values and beliefs which plays a big
part in continuing or ending life, especially
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 NCM 114: End of Life Care
Dr. Johanna Kristeen de la Torre, RN
when dealing with patients whose lives are
clearly not satisfactory, brought about
Bambam2017
chronic illnesses.
• Considerations: health status, age, etc.
• American Nurses Association (ANA)
considers this as a violation of the Code of
Ethics
• Death with Dignity Act (Oregon) allowing
the residents to use voluntary self-
administration of lethal medications.
Death with Dignity Act (1997)
• The law applies to those mentally
competent adults who must Provide written
documentation of their intentions.
• Be diagnosed as terminally ill
• Participate in the waiting period
• Take the prescribed medications
themselves
Discussion: Lethal injections, mercy killings, or
active euthanasia and other processes that can
cause liabilities and criminal prosecutions are not
supported by this act.
Ethical Dilemmas
• Arises when there is an ethical conflict.
Ethical conflict happens when one chooses
between two equal possibilities, moral, or
ethical conflict – can either be moral
distress, moral uncertainty, and moral
dilemma.
• Moral distress occurs when someone
wants to do the right thing but is limited by
the constraints of the organizations or
society.
• Moral uncertainty happens when the
person is uncertain what the moral problem
is, or what values are to be applied.
• Moral dilemma arises when two or more
moral principles applied support
inconsistent actions.
• True dilemma occurs when it appears that
there are no acceptable choices.
• To address these dilemmas, nurses
understand the moral principles based on
the professional code of ethics.
Cebu Doctors’ University Fated Nurses
Bambam2017
✨Cher: 09:04 (Moral Principles)-12:07
Moral Principles
• Advocacy
• Autonomy
• Beneficence/Nonmaleficence
• Confidentiality
• Fidelity
• Fiduciary Responsibility
• Justice
• Quality and Sanctity of Life
• Reciprocity
• Veracity
Communicating about Death
• Not a responsibility limited to the
physicians
• An essential skill for nurses, physicians
and other health disciplines
Discussion: Nurses, most of the time have longer
interactions with the patients may be caught off
guard when asked by the family members or the
clients themselves. So, our knowledge and
communication skills have to be good enough to
deal with this topic.
The Education in Palliative and End-of-Life
Care (EPEC) Project has identified 6-step
approach:
1. Get started
2. Find out what the patient knows
3. Find out how much the patient knows
4. Share information
5. Respond to feelings
6. Plan/follow up
Symptom Management:
Discussion: As older adults are admitted in the
facilities, family members and patients want to
know the transition they have in the end-of-life
care process. Nurses, as provider of care must
assist with symptom management.
Physical, Non-pain Symptoms
Dyspnea (Terminal dyspnea)
Goal: To relieve the perception of breathlessness
Opioid Therapy- Morphine 2.5-5mg every 4
hours PO
Cebu Doctors’ University 3
 NCM 114: End of Life Care
Dr. Johanna Kristeen de la Torre, RN
Anxiety Bambam2017
Aggravates dyspnea or
Dyspnea causes anxiety
Nonpharmacologic measures
• Elevation of bed
• Cool, humidified air
• Relaxation techniques
Discussion: As defined, this symptom is a
distressing difficulty in breathing that is usually
experienced by anyone who has associated
comorbidity. Among older adults, they experience
this when they perform vigorous activities or in this
concept, a manifestation of near death. When
experiencing Terminal dyspnea, our primary goal
is to relieve the perception of breathlessness. This
is often treated with opioid therapy such as low
dose of morphine. Although we were taught to
administer oxygen with respiratory-related
concerns, if this is not caused by hypoxemia or a
decrease of oxygen in the blood, oxygen therapy
may not be effective. Oxygen may be given as a
placebo effect and should be started at 2L/min via
nasal cannula.
Constipation
Causes
• Nonmedical
• Pharmacologic
Management: Stool softeners
Discussion: Another non-pain symptom is
constipation. This is caused by nonmedical factors
like inactivity or inadequate food and fluid intake.
Pain relievers can also cause constipation
because pain may be equally distressing to the
client. Analgesics can still be taken while
addressing constipation with stool softeners.
Increasing fluids, will not contraindicate it.
✨Rai: 12:07-14:11
Physical, Non pain Symptoms: Anxiety
• Loss of control
• Loss of self-esteem
• Loss of independence
Cebu Doctors’ University Fated Nurses
Bambam2017
Discussion: Anxiety is a physiological and
psychological state of distress which may alter
several components such physical and mental
aspects of a man. At the end of life anxiety
happens when there is a loss of control, loss of
self-esteem, loss of independence. For example;
an older adult is moved to an environment like to a
home or hospice facility this event can be very
distressing for them, adjusting to the professional
staff, the place of care, air bed, and their
medications.
Physical, Non pain Symptoms: Terminal
Restlessness or Delirium
Discussion: Delirium, more than anxiety. Delirium
causes fluctuating cognitive disturbances that
change the person’s mental status over a short
period of time. This symptom occurs approximately
25-85% of terminally ill patients at time of death.
This will help the nurse manage delirium:
A. Asses, prevent and manage pain
B. Both spontaneous awaken trial and
spontaneous breathing trial
C. Choice of analgesic and sedation
D. Asses, prevent and manage Delirium
E. Early mobility and exercise
F. Family engagement and empowerment
Discussion: Aside from environmental comfort
that is provided by reducing stimuli, having familiar
persons visiting, and staying at bedside helping in
reorientation, the social support. The management
mentioned above are proven to ease symptoms.
For spontaneous awaken and breathing trial fixes
applied with an older adult that is attached to a
mechanical ventilator leaning them to prevent
ventilator associated pneumonia. When
uncontrollable restlessness happens, the client
requires pharmacological treatment like terminal
sedation, this induces the client to
unconsciousness but not death.
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 NCM 114: End of Life Care
Dr. Johanna Kristeen de la Torre, RN
✨Nath: 14:12-17:06
Bambam2017
Physical, Pain Symptoms
Pain is indeed a terrible feeling that affects the
physical and psychosocial well-being of a person
Albert Schweitzer: “Pain is more terrible lord of
mankind than even death himself”
Older Adults: suffering, hastens death
Misconceptions about pain in older adults:
• Pain is a natural outcome of growing old
• Pain perception or sensitivity decreases
with age
• If they report pain, or appears to be asleep
or distracted, he does not have pain.
• Potential side effects of opioids make them
too dangerous to use.
• Alzheimer patients with cognitive
impairment who report pain are most likely
invalid
Assess and Manage Pain
Oral pain relievers at lower dosages are usually
given. If not possible, other routes may be
acceptable depending on the medication.
Pain relievers (acetaminophen, NSAIDS)
“start low and go slow” - to prevent possible drug
reactions, half dosages are administered.
However, this practice may create under
treatment.
Moderate to Severe: Opioids with special
considerations. Opioids such as morphine can
cause constipation
Loss and Grief
A variety of different losses of different aspects can
also be experienced by the elderly.
1. Support System
Cebu Doctors’ University Fated Nurses
Bambam2017
Most common are the death of spouse or
family members and close friends
2. Body functions
Loss of body functions are prevalent to a case with
illnesses and complications which lead to loss of
independence. Very specific is the altered or
impaired mobility.
3. Independence
Loss of independence also relates to the inability
of the older adult to make decisions.
Grief
• Normal response
• Individualized/personal process to loss
• Goal of grieving is not to get over the loss,
but to better cope with the changes without
the loved one.
Mourning
• Cultural manifestation of grief
• Shared social response
✨Nia: 17:08 (Spiritual care)- Till the end~✨
Spiritual Care:
• To prepare their departure spiritually they
must understand that some practices are
spiritual without religious types and
practices rather just finding comfort.
• Nurses becoming manager, collaborate
with priest requesting for confession. The
nurse should know how to facilitate of
these.
Objective: To find peace and comfort in religion,
its practices or rituals. Confession, communion
and anointing.
Cebu Doctors’ University 5
 NCM 114: End of Life Care
Dr. Johanna Kristeen de la Torre, RN
Bambam2017
Cebu Doctors’ University Fated Nurses
Bambam2017
Nurses should be aware this is happening,
proceed to self- care and practice healthy living

The end~✨
“We all must die. But if I can save him from days
of torture, that is what I feel is my great and ever
new privilege”.-Albert Schweitzer

Family Caregiving, Issues and Compassion

Fatigue

• Providing care to older adults both in the

hospice palliative care expect to extent
over a period of time.
• Goals beyond 4 months. We recognized
the issue that affect the person ability to
provide quality care
• Nurses are at moderate to high risk for
developing compassion fatigue
Compassion fatigue is present when they
continue to provide compassionate care to others
in very stressful situation.
Determinants:

• Stress
• Trauma
• Anxiety
• Life Demands
• Excessive empathy

Cebu Doctors’ University 6

NCM 114 3F: End of Life Nursing Care of the Older Adult
Models for End-of-Life Care
▪ Curative or Acute Care
• Hospital death
• When the patient, families, and culture
CHOOSE LIFE – prolonging the focus of care
• ICU settings, with support devices
− commonly seen in older adults rushed in
the emergency department and are
eventually transferred in the Intensive
Care Unit, prioritizing them because of
their age
− With its cost, the length of stay to fully
recover and uncertain chances of
survival
− Some end-of-life discussion care are
brought up by the family members. We
allow this despite the number of tubes
and machines attached to them because
we want them to prolong their life
− It is important not to make judgments
about these choices. Rather, take note
that there are other choices that exists
▪ Hospice Care
• Non-life prolonging care
• Recognized dying as part of the normal
process of living
• Focuses on maintaining the quality of
remaining life
− Provides care and support to the older
adults in the last phases of incurable
diseases so they may live fully and
comfortably as possible
• Hospice Care Considerations
o Based on life expectancy of 6
months or less
o Cater to clients even longer than 6
months as long as terminally ill
o Utilizes team approach
• Hospice Services
o Nursing services and Coordination of
Care
o Physical, Occupational Therapy and
Speech – Language Pathology
Services
o Medical Social Services
o Home Health Aides
o Counseling Services
o Short-term inpatient care
▪ Palliative Care
o More mainstream-whole person
care for persons with life-limiting
illnesses
o Accommodates those who are not
yet eligible for hospice support
o Comprehensive management based
on existential needs of the patient
− Achieve the best possible palliative life
by controlling pain and other symptoms
felt by the older adults
Ethical Principles and Considerations
− One of the most fundamental phase of the
patient’s rights is the right to decide whether
his life will be shortened or prolonged. These
are few of the concerns that the nurse will
encounter in end-of-life care.
− With Patient Self-Determination Act, the
principle of autonomy provided our clients
to express their preferences regarding life-
sustaining or lifesaving care that need
proper documentation which are tackled in
Advance Directives and Living Wills
− As part of the healthcare team, be the client
advocate ensuring that adequate
information may be supplied.
Advance Directives
• Legal documents that direct the health care
team or family members or loved ones
• Medical care preferences of the patient
• Applicable when the patient cannot make
decision due to serious medical
• conditions or emergencies
− When decisions of lifesaving or life
sustaining care are needed, it is best that
these are made by the client itself. This is to
prevent crisis to the significant others of the
healthcare team
− Ideally, these are prepared when the patient
is still of sound mind
The most common type of Advance Directives
are the Living Will.
▪ Durable Power of Attorney
• A legal document that designates an
alternative decision maker in the event
that the person is incapacitated
• Decreases conflict among family
members
− This allows the person the authority to
make healthcare decisions, even do
financial transactions, or sign legal
documents that the principle or the
patient cannot do
− In some cases, the patient may choose a
friend who precedes an immediate
family member.
− Whoever is designated in the living
willing allows the person to perform
roles negotiated in advance with the
patient.
▪ Do Not Resuscitate (DNR) Order
• In the absence of a living will, the HCT
requires all possible efforts at resuscitation
should be initiated
− Clearly states that a patient clearly gives
up his chances of survival by not
performing CPR but other treatment
plan continues
• Paternalism behavior of both doctors
and nurses may lead to ethical conflicts.
This happens when the decision of the
patient or family members arises, and
this agreement approaches from the
recommendations from the
professionals. Concerns around
autonomy can occur.
▪ Allow Natural Death (AND) Order
• A more positive order than the DNR
• Focuses on allowing death to naturally take place
− Provides more comfort measures
▪ Assisted Suicide
• Considerations: health status, age, etc.
• American Nurses Association (ANA) considers
this as a violation of the Code of Ethics
• Death with Dignity Act (Oregon) allowing the
residents to use voluntary self-administration of
lethal medications
− Another ethical issue in health
determination and autonomy. This can be
very difficult to decide as system is often
dedicated by the social values and beliefs
− Plays a big part in continuing or ending life
especially when dealing with patient whose
lives are clearly not satisfactory brought
about by chronic illness
• Law applies to those mentally capable adults
who must:
Death with Dignity Act (1997)
1. Provide written documentation of their
intentions
2. Be diagnosed as terminally ill
3. Participate in the waiting period
4. Take prescribed medications themselves
− Lethal injections, mercy killings or active
euthanasia that can cause liabilities and criminal
persecutions are not supported in this act
Ethical Dilemmas
• Arises when there is an ethical conflict
− Ethical conflict happens when one chooses
two equal possibilities. It can either be moral
distress, moral uncertainty and moral
dilemma
− Moral distress occurs when someone wants
to the right thing but is limited with the
constraints of the organizations or society
 − Moral uncertainty literally happens when
the person is uncertain what the moral
problem is or what values are to be applied
− Moral dilemma arises when two or more
principles support inconsistent actions
• True dilemma occurs when it appears that there
are no acceptable choices
• To address these dilemmas, nurses understand
the moral principles based on the professional
code of ethics
In Gerontological nursing, know these added
principles and Read articles that support these principles
that relate to End of Life Care.
Communicating about Death
• An essential skill for nurses, physicians and other
health disciplines
− Not a responsibility limited to physicians.
− Nurses most of the time have longer
interactions with the patient may be caught
off guard
− Knowledge and communication skills have to
be good enough to be good with this topic.
• The Education in Palliative and End of Life Care
EPEC Project has identified 6-step approach:
Symptom Management
− As older adults are admitted in the facilities,
family members and patients want to know the
transition they have in the end of life care
process
− Nurses, as provider of care, must assist with
symptoms management:
1. Physical, Nonpain Symptoms
a. Dyspnea: distressing difficulty in breathing that is
usually by anyone who is associated with
comorbidities. Among older adults, they
experience this, when they perform vigorous
activities or a manifestation of near death.
Terminal Dyspnea
− Goal: to relieve the perception of
breathlessness
Often Treated with Opioid Therapy:
− Morphine 2.5 - 5 mg every 4 hours PO
Anxiety
− Aggravates dyspnea or
− Dyspnea causes anxiety
− Often aggravated by anxiety and often treated
with anti-anxiety agents
Non-pharmacologic measures (not caused by
hypoxemia):
− Note: oxygen therapy may not be
effective. Oxygen can be given as a
placebo effect and should be started at
2L/min via nasal cannula.
− Elevation of bed 30–45 degrees
− Cool, humidified air
− Relaxation techniques
b. Constipation: caused by non-medical factors like
inactivity or inadequate food and fluid intake. Pain
relievers can also cause constipation because pain
may be equally distressing to the client. Analgesics
can still be taken while addressing constipation
with stool softeners. Increasing fluids are not
contraindicated.
Causes: Nonmedical, Pharmacologic
Management: Stool softeners
c. Anxiety: a physiological and psychological state
of distress which may alter several components
such as physical and mental aspects of man. At
the end of life, anxiety happens when there is
loss of control, loss of self-esteem and loss of
independence.
− For example, when a client is moved to a
hospice facility, this event can be very
distressing for them: adjusting to the
professional staff, the places of care,
their bed and also their medications.
d. Terminal Restlessness: commonly known as
Delirium
 − More than anxiety, delirium can cause
fluctuating cognitive disturbances that
change the person’s mental status over
a short period of time.
− Occurs approximately 25-85% of
terminally ill patients at time of death
− Common physical causes of Delirium:
include dyspnea, pain, constipation or
urinary retention
Help manage nurses manage symptoms of delirium that
have proven to ease symptoms.
Aside from environmental comfort that is
provided by reducing stimuli, having familiar
persons visiting and staying at bedside helping in
reorientation, and social support
when older adults are attached to a mechanical
ventilator, WEANING them will prevent
ventilator-associated pneumonia
When uncontrollable restlessness happens, the
client requires pharmacological treatment like
terminal sedation. This induces the clients to
unconsciousness but not death.
2. Physical, Pain Symptoms
− Pain is a terrible feeling that affects the physical
and psychosocial well-being of a person. To older
adults, pain is perceived as suffering, and they
accept this symptom as part of growing old. They
may not report this as often, Instead use other
words to describe it such as discomfort,
soreness or aching. This report will lead us to
neglect their complaints, underestimate or
undertreat this because of fear of addiction
towards pain medications.
− Oral pain relievers at lower dosages are usually
given.
− Other routes may be acceptable depending on
the route of medication
− Half-dosages are given to prevent possible drug
reactions. However, this practice may create
undertreatment of pain.
− Opioids such as Morphine can cause
constipation, that is why it is essential to
include bowel programs in the plan of care.
Death and Dying
− is a part of natural life
− vary perspectives across culture
− prepare for one’s death:
• to prevent ethical dilemmas
• to support family members’ decision
making
• to respect patient’s last wishes
Loss and Grief
▪ Support system – death of spouse, family, or
close friends
▪ Body Functions – loss of body functions which
are prevalent to a number of case and body
functions which leads to loss of independence =
ALTERED or IMPAIRED MOBILITY
▪ Independence – inability to make decisions than
what is usually did before his illness
GRIEF
− Normal response
− Individualized / personal process to loss
MOURNING
− Cultural manifestation of grief
− Shared social response

Whatever the older adult is experiencing, Nurses should

assist both psychologically and emotionally by letting
them go on with their life.

Goal of grieving: Not to get over the loss, but to

better cope with the changes without a loved
one. It is yet the right of the person to embrace
Family Caregiving, Issues, and Compassion Fatigue
the pain of the loss. Eventually it will develop
− Nurses are at moderate to high risk for
into a new identity.
developing compassion fatigue
− Compassion fatigue – person ability to provide
Spiritual Care
quality care. Commonly present when nurse
Objective: To find greater peace and comfort in
continues to provide compassionate care to
a religion, its practices or rituals
others in various stressful situation
Confession, communion, and anointing

− Nurses become managers and collaborate with

priests requesting for confession or depending
on the client and family’s requests.
− Nurse must know to facilitate all of these

Associated terms:
• grief
• suffering
• hospice care
• pain
• depression
• retirement
• ethical and moral principles
• DNR

Roles of the Nurse in the End-of-Life Care

1. Provider of Care
a. Providing medications
2. Advocate
a. Help client make the best decisions
3. Communicator
a. Educator
b. Initiating conversations, giving the best
options possible
 4. Manager and collaborator
a. Hospice nurse, assist direct provider care
and assist in the grieving process
b. Spiritual guidance and counseling (working
with priests)

Thanatology
− The scientific study of death and other aspects
associated to it
− Dame Cicely Saunders: hospice
− Hospice: centered on the holistic,
interdisciplinary care that helps the dying
person, “live until they die.”

End-of-Life Care
1. Ethical and Moral Principles
2. Advance Directives
3. Symptom Management
− Interventions for pain, dyspnea,
constipation, depression, and diarrhea
4. Loss, Grieving, and Mourning