NCM 114 Older Adult RLE

Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,

2023
BSN III Prof. Darwin Tan, MAN,
RN

Introduction of Geriatrics

Geriatrics is the medical discipline concerned with the health and well-being of the
elderly. It is a discipline of medicine concerned with the special health issues and requirements
of the elderly, generally people aged 65 and older. As the world's population ages, the area of
geriatrics has grown increasingly important in tackling the complex healthcare concerns that
come with ageing. Geriatric is a multidisciplinary field that includes features of internal medicine,
family medicine, psychiatry, and rehabilitation, among other things. Geriatricians are healthcare
professionals who specialize in the diagnosis, treatment, and prevention of illnesses and
impairments in the elderly. They encourage a holistic approach to old age, taking into account
not just physical diseases but also psychological, social, and functional elements of getting
older. Chronic illnesses, cognitive impairments, mobility limits, and medication-related disorders
are all common side effects of the aging process. Geriatric professionals such as nurses and
physicians are adept in managing these diseases, with the goal of improving the quality of life
and promoting independence in older people. They collaborate with other healthcare
practitioners, carers, and families to create complete care plans that are tailored to each
patient's individual requirements. Furthermore, geriatrics focuses preventative treatment, with
the goal of promoting good aging and preventing illness start or progression. This might include
methods for maintaining physical fitness, cognitive function, and mental well-being, as well as
interventions to avoid falls, manage chronic diseases, and guarantee proper drug
administration. In short, geriatrics is crucial in meeting the healthcare demands of the aged
population, creating a greater knowledge of the aging process, and providing a higher quality of
life for older persons. It is not just about extending years to life, but also about adding years to
life, guaranteeing that older people may live out their lives with dignity, independence, and
maximum health.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN
My Expectation for Geriatric RLE

I expect that as a nursing student I will learn on how to give the basic needs and care of
an older adult since it would be different to the past duties that I had and the patients that I’ve
handled. This can also test my skills and my emotions since caring an older adult is quite
difficult especially their emotions that’s why I anticipate that our clinical instructor teaches us
and how us nursing students should understand the feelings of an older adult. Other than that, I
look forward to that our clinical instructor will help us on how to enhance our holistic approach
and comprehensive patient care to the older adult patients not just the medical issues but also
the social, functional aspects of aging, and the psychological that an individual experiences.
Moreover, my expectations in the Geriatric RLE would revolve around on providing
compassionate, specialized, and comprehensive care in order to enhance the quality of life of
an older adult.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN

Missionaries of the Charity

On our first day, we had our orientation on the area’s rules and regulations, as well as
the activities we need to accomplish such as paper works, feeding the older patients, helping
the staffs clean the dishes and the area, etc. At first, I was overwhelmed on the said activities
since it is different from the past duties that we had. However, it also excites me since it is a
new experience and there are new learnings that I can gather from the staff as well as the older
patients who stays there. On our second day, the first thing that we did is to take the vital signs
of the older adults because some of them has high blood pressure. After taking the vital signs,
around 9am the staff is giving the medications of each patient and we asked her if it’s alright
that we are the one who will give the medications and since we don’t each of them, the staff
calls the name of the patient and the patient will raise their hand to let us know who we will give
the medication. After the medications, our clinical instructor called our names and asked us who
are the assigned people in laundry area that’s why I volunteer to do the laundry. To be honest I
was very tired after doing that but the fulfillment that I felt and knowing that we helped the staff
to alleviate their job. Other than that, we also washed the dishes after feeding the older patients.
For the paper works and presentation, we were divided into two groups in order to make a case
study. For my group, since we don’t have the access to check the records and chart of the
patient, our two members had an interview with her along with the assessment by inspecting
from head to toe. On our last day of duty, we had our mini program for the older patients where
we gave our gifts and performed a song to remind them, they’re all always loved and
remembered. Overall, I gained lots of knowledge especially to our clinical instructor who always
remind us to serve and be humble to the patient especially to the older adults.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN

PHYSICAL EXAMINATION

I. GENERAL APPEARANCE

 The patient is well groomed and shows no sign of neglect. She was laying on a

wheelchair. Aside from that, the patient looks well and has no signs of distress.

She also appears to be clean and dressed appropriately for the temperature of

the room.

II. SKIN, HAIR, & NAILS

 The patient has a uniform brown complexion, except in areas exposed to the

sun. Her skin is also warm to touch and has no signs of edema. The patient also

has thin hair and decreased skin elasticity caused by aging. Her nails appear to

be in convex curvature and smooth in texture. Normal capillary refill time is also

observed.

III. HEAD & NECK

 Upon assessment, the head is round, erect and in midline. The skull appears to

be normocephalic and has smooth skull contour. Facial features are also

symmetric with no signs of abnormalities. As for the patient's neck, the muscles

are equal in size and the head is centered. The patient was also able to move

and extend her head in certain angles accordingly. There is also no deviation of

trachea, no signs of bulging lumps, masses, nodules, and swelling.

IV. EYES

 Upon inspection, the patient has symmetrical and equal movement of external

eye structures. Her eyebrows are intact and hair is evenly distributed. Her
 eyelashes are also equally distributed and curled slightly outward. Her eyelids

appear symmetrical and meet completely when eyes are closed. No signs of

ptosis or exophthalmos observed. Pupils are also equal, round and reactive to

light. She was able to see objects in the periphery of visual fields and can move

her eyes in unison.

V. EARS

 When assessed, the ears appear to be symmetrical with no signs of

abnormalities and lesions. The patient can also hear commands clearly and

identify which side the sound is coming from.

VI. MOUTH, THROAT, NOSE, & SINUSES

 The patient shows equal color of the lips, white/slightly yellowish teeth with loose,

missing, chipped, and broken teeth. Gums are pink in color with no swelling,

bleeding, or pain. The tongue is central in position with no presence of nodes,

ulcerations, discoloration and areas of tenderness. The patient’s throat also

appears to be normal. She does not have any complaints regarding pain and

discomfort concerning her throat. The tonsils appear to be pink and smooth with

no signs of discharge. The patient’s external nasal structure appears to be

symmetric. She was able to identify smells presented and breathe to each nostril

when occluded.

VII. THORAX & LUNGS

 Upon inspection, the thorax is symmetric in structure. The patient is able to

breathe normally and confirms having no difficulty in inspiration and expiration

except when talking for so long. There was also full symmetric excursion

observed. Upon auscultation, no abnormal lung sounds were heard (such as

wheezes and crackles).

VIII. ABDOMEN

 Upon auscultation, normal bowel sounds were heard. There were also no signs

of tenderness and enlargement of spleen or liver.

IX. CARDIOVASCULAR
  Upon assessment of vital signs, the patient shows an alteration of blood

pressure. Symmetric pulse volumes were felt and heard upon palpation of carotid

arteries and radial arteries. Regular speed and heart rhythm were also observed.

Peripheral pulses of the patient appear to be symmetric and in full pulsations.

X. MUSCULOSKELETAL or NEUROLOGIC

The patient is unable to stand and walk due to her condition and she’s a

bedridden patient. That’s why she can’t participate on the daily exercises and

stretching.

XI. GENITOURINARY

 Due to immobility, the patient mainly relies on the assistance when voiding. Her

urine appears to be yellow in color and she does not have any complaints or

discomfort felt during voiding.

XII. GENITAL

 Patient confirms that she does not experience any problems related to her

genitals.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN

Learning Feedback

My overall feedback on the Geriatric rotation is that I gained lots of knowledge and
experiences during the 6 days of duty. Since I have a grandmother who is already 85 years old,
it made me realize that I should not make her feel neglected, instead I should help her live the
life the fullest and help her to do her desires in life. Not only that, the rotation helps me
enhanced my understanding to older patients especially their emotions because I was having a
hard time to understand my own grandmother whenever her mood changes. Other than that,
with the help of our clinical instructor by giving us insights on how the older patient live their life
inside the charity and give us wisdom where us future nurses will serve the older adults with
compassion and has a holistic approach.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN

Day 1

In our first day, it was our first time to meet Mr. Darwin Tan for our Geriatrics Duty. The
first thing that he did is orient us regarding on the two weeks orientation in the Missionaries of
the Charity: Home for the Aged in which they take care of the poor older patients who has
illnesses. This project is made by St. Theresa of Calcutta who cares for the poor. During the
orientation, our clinical instructor discussed what are the things that we need to do inside the
charity as well as the rules and regulations that we need follow. After the orientation, he also
discussed the paper works such as NCP, Drug Study, Case Presentation, etc. In addition to
that, he also said that we need to formulate a plan for the program for our last day of duty. The
initial plan is Kumustahan and performing by singing in front of them. Other than that, we also
decided that we will give something that they will definitely use in their everyday lives. I was
excited about it since our patient is older adults. Not only that, I was also excited about the new
experiences and knowledge that I will learn from our clinical instructor and inside the Home for
the Aged.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN

Day 2

It was morning, I woke up early because the excitement that I felt for the first day of our
duty. However, it was announced that the classes are suspended as well the internship. All I did
in the whole day is to take a rest and took the opportunity to read the topics on a major subject.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN

Day 3

It is finally the day where we had the opportunity to go in the Missionaries of the Charity
for our duty. Upon entering the home for the aged, we proceed to the mini chapel in order to
pray with the sisters. After the praying session in the chapel, we entered in area where in the
male and the female are separated. As for girls including Mr. Gerong, we were assigned to the
female side. The first thing that we did is to take the vital signs of each patient. After taking the
vital signs, we saw one of the staffs giving the medications, we decided to take over and asked
her the where we should give the medicines. After the medications, we encourage and help the
older patients to participate in the exercise in order for them to stretch to stretch their limbs and
arms. Other than that, our clinical instructor called our names and asked us to participate in the
laundry. However, the staffs are already doing the laundry and assigned us to hang all of the
clothes and the linens. After that, we help the staffs to feed the older patient who cannot feed
themselves. It was tiring but I felt the fulfillment of being a student-nurse and we learned on how
we should be humble and how to serve the older patients.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN

Day 4

For our 4th day, we were supposedly in the school, but the head of the missionaries of
the charity let us continue our geriatric duty. Our daily routine is to get the vital signs of each
older patients, give the medications, participate on the morning exercise, and do the chores. I
experience feeding on a NGT and it was a fun and I learned on how to feed the right way via
NGT. One of the older patients is kind of grumpy and she doesn’t want any people on her sight.
That’s why we respect her decision and let the staff knows. Another older patient reminds me of
my grandmother who always telling her stories, experiences in her life, and sometimes she
writes her thoughts on a paper. After that, we feed the patient, help the staff to move the
patients inside the ward, and clean the dishes. Although it’s the same routine, but I still learned
from the experiences of the older patient’s life.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN

Day 5

I was a bit late because I woke up around 6:45am because I didn’t hear my alarm ring.
We did the usual routine by getting the vital signs, feeding the patients, giving the medications,
and cleaning their area. One of the sisters is having her daily exercise, the staffs let us help the
older sister and she asked our names. She always acknowledges our kindness and humbleness
by serving the older patients, including her. After that, we still did our daily routine and we
proceed to the room where we will discuss the program for tomorrow. We change the initial plan
instead of kumustahan, we ended up on the bingo since the staffs and the older patients
request for it. We also give our contributions for the gift that they will use for their daily lives.
After the duty, we go to the divisoria and grocery stores to buy the things that we need and the
prices that we will give after the bingo.
 NCM 114 Older Adult RLE
Dela Cruz, Althea Marie M. October 5 – 7 and 12 – 14,
2023
BSN III Prof. Darwin Tan, MAN,
RN

Day 6

It was our last day of rotation and I was a bit sad because that will be the last time, we
will serve the older patients. We once again do the daily routine and help the staffs to alleviate
their job. We were a bit early because we need to prepare the things that we will use for the
program. The good thing is that the staff has the speaker and two mics for us emcees for the
program. Although our patients are older adults, but the nervousness is still there. However, my
partner and the other members of the group for the program assured me that the program we
prepared for the older patients will definitely enjoy and remember in their hearts. The program
started with a prayer, next is opening remarks, and introduction of the emcees which is I and Mr.
Kyle. The first activity that we did is to exercise, the older patients really enjoyed the exercise
and they also enjoyed because of the background music during the exercises. After that, we
proceed to the exciting game which is the bingo. Although the one that I help for the bingo didn’t
win but he still enjoyed it. The last part of the program is we sang “Kahit Maputi na ang Buhok
ko”, “Handog”, and “Wonderful Tonight”. Those songs literally touched the hearts of our
patients. Also, us got teary eyed and our clinical instructor. To end our program, Mr. Gerong
was the closing remarks and for the closing remarks was Mr. Herrera. After the program, we
presented our case studies and remind some few things especially the paper works. The last
duty has a place in my heart. It was memorable and we were able to provide the care that they
need.
PERPETUAL HELP COLLEGE OF MANILA
College of Nursing

Geriatrics Rotation
Missionaries of Charity:
Home for the Aged

NCM 114 Care of Older Adult RLE

Submitted by:
Dela Cruz, Althea Marie M.
 BSN 3

Submitted to:
Mr. Darwin Tan, RN
Clinical Instructor