NCM 114 LONG EXAM 1

○    
 
AGING BY SYSTEMS  
 
INTEGUMENTARY 

A. EFFECTS OF AGING ON THE INTEGUMENT 

■ Flattening of the dermal-epidermal junction 
■ Reduced thickness and vascularity of the dermis 
■ Decrease rate of epidermal turnover 
■ Degeneration of elastic fibers 
■ Increased coarseness of collagen  
■ Reduction in melanocytes (grey hair) 
■ Atrophy of hair bulbs 
■ Decline of rate in hair and nail growth 
 
 
 
➢ Heightened risk for:  
■ Nurse  should  emphasize  to  persons  young  and  old that no 
○ skin tears 
cream,  lotion,  or  miracle  drug  will  remove  wrinkles  and 
○ bruising 
lines or return youthful skin 
○ ulcer formation 
○ money  that  could  be  applied to more basic needs 
○ skin infection 
is sometimes invested in attempts to defy reality 
 
■ The  nurse  can  encourage  the  use  of  cosmetics  to  promote 
■ Effect:  
the skin and maintain an attractive appearance  
○ visible signs of aging 
■ Gerontological  nurses  to  be  informed  of  the  different 
○ body image 
surgical  interventions  (inc.  number of aging individuals who 
○ self-concept 
seek cosmetic surgery) 
○ reaction from others 
■ Nurses can also help in locating a competent cosmetologist/ 
○ socialization 
cosmetic  surgeon  (unfortunate complications have resulted 
○ other psychosocial factors 
from  from  unskilled  physicians  performing  cosmetic 
 
surgery; injecting collagen or silicone) 
B. INTEGUMENTARY HEALTH PROMOTION 
■ Explore  for  underlying  reason  behind  seeking  cosmetic 
■ Avoid  drying  agents,  rough  clothing,  highly  starched linens,  surgery  to  ensure  its  a  rational  decision  rather  than  a  sign 
and other irritating to the skin  of depression or neurotic disorder 
■ Good  skin  nutrition and hydration: activity, bath oils, lotions  ■ Counseling  and  therapy  may  be  more  pressing  than  a 
and massages  surgical intervention 
■ Skin  cleanliness  is  important  but  excessive  bathing  may  be  ■ As  society  achieves  a  greater  acceptance  and 
hazardous to skin  understanding  of  the  aging  process,  the  masking  of  the 
■ Daily  partial  sponge  baths  and  complete  baths  every  third  effects  of  aging  with  cosmetics and surgery will be replaced 
or fourth day are sufficient for the average older person  by an appreciation of natural beauty of age.  
■ Attention  and  treatment  of  pruritus  and  skin  lesions  to   
prevent irritation, infection and other problems  ➢ Nursing diagnosis r/t Dermatologic problems: 
■ UVR damages the skin causing solar elastosis or photoaging 
○ loss of elasticity and wrinkling of the skin  
○ high  risk:  fair-skinned  who  easily  burns  when 
Causes or Contributing
under the sun; sunbathing during youth  Nursing Diagnosis
○ sun screening lotions are beneficial (with SPF 
Factors
or sun protection factor) 
  Altered body appearance anxiety
■ Skin  cancer  in  late  life  is  prevalent  therefore  inspection  for 
abnormalities is a beneficial action  Pruritus, infection, ulcer acute pain
○ A- A ​ symmetry​: if a mole is not round or 
symmetrical  ,  or  half  of  the  mole  is  not  similar to 
the other half, it could be a sign of MELANOMA  Ulcer, fragile skin risk for infection
○ B-​ Border Irregularity​: Cancerous moles have 
irregular borders that may be uneven, ragged,  More fragile skin risk for injury
notched, or blurred. 
○ C- C​ olor​: The typical color of a mole is 
Age-related changes to skin, hair, disturbed body image
consistently brown throughout. A change in 
color overtime or is varied in a shade of brown, 
and nails; pain
tan, and black may be cancerous.  
altered self-concept due to sexual dysfunction
● Melanoma​-​ red, blue or white 
○ D- D ​ iameter​: Cancerous moles can be more 
age-related changes; more fragile
than 6 mm in diameter (about 1/4 inch or the  vaginal epithelium
size of a pencil eraser 
● Other  indication of melanoma: elevation 
Fragile skin, immobility impaired skin integrity
of  height  both  horizontally  and 
vertically;  a  change  in  feeling  (itchiness,  Altered self-concept due to impaired social interaction
tenderness  or pain; tendency to bleed  if  age-related changes in the
scratched) 
Long Exam 1 Study Guide - (aes)
NCM 114 LONG EXAM 1

integument

Pressure sites, ulcer risk for ineffective peripheral

tissue perfusion
 
➢ ASSESSMENT GUIDE: SKIN STATUS 
■ General observation 
○ skin color, moisture, and cleanliness 
○ presence of lesions 
○ hair condition and grooming 
○ condition of nails 
○ pallor or flushing 
■ Interview 
○ ask  about itching, burning sensations on 
skin 
○ ask  for  hair  loss,  increased  fragility  of 
skin 
○ ask  for  other  symptoms  associated with 
 
integumentary system problems 
■ Mongolian spots 
○ review  bathing  and  shampooing 
○ irregular,  dark  areas  (resembling 
practices 
bruises)  that  may  be  found  in  the 
■ Physical Examination 
buttocks,  lower  back,  and  to  a  lesser 
○ Skin  surface:  examin  head  to  toe  (ears, 
extent on the arms and thighs 
skin folds, breast, between toes) 
■ Skin turgor 
○ bathing  and  massages  are  good 
○ test skin turgor by pinching areas of skin 
opportunities  to  inspect  the  skin  in  the 
○ area  over  sternum  and  forehead  do 
course of patient care 
experience  less  of  an  age  related 
○ note  moles,  skin  tears,  bruises, 
reduction  in  turgor  (good  areas  for 
discoloration and other unusual finding 
assessment) 
■ Lesions 
■ Pressure tolerance 
○ Color (black, purple or hypopigmented) 
○   inspecting  a  pressure  point  after  the 
○ configuration  (linear,  separate, 
patient  has  been  in  the  same  position 
confluent, annular) 
for half an hour 
○ size (depth and diameter) 
○ if  redness  is  present,  the  patient  must 
○ drainage 
be  in  turning  schedule  every  half  an 
○ types 
hour 
■ Types 
○ if  not,  remain  in  same  position  for  1 
○ macule​:  small  nonpalpable  spot  or 
hour and inspect 
discoloration 
■ Temperature 
○ papule​:  discoloration  <1/2  cm  in 
○ Use  back  of  hands and touching various 
diameter with palpable elevation 
areas 
○ plaque​: group of papules 
○ note  coldness  or  temperature 
○ nodule​:  1/2  to  1  cm  in  diameter  with 
inequalities between extremities 
palpable  elevation;  skin  may  not  be 
 
discolored  
■ Pruritus 
○ tumor​:  >1  cm  with  palpable  elevation, 
○ most common 
skin may not be discolored 
○ precipitated  by  any  circumstances  that 
○ wheal​:  red  or  white  palpable  elevation 
dries  the skin (excessive bathing and dry 
with variable sizes 
heat) 
○ vesicle​:  <1/2  c in diameter that contains 
○ other  factors:  DM,  arteriosclerosis, 
fluid and has palpable elevation 
hyperthyroidism,  uremia,  liver  disease, 
○ bulla​:  a  >1/2  cm  in  diameter  that 
cancer,  pernicious  anemia,  and  certain 
contains  fluid  and  has  palpable 
psychiatric problems 
elevation 
○ if  not  controlled,  may  result  to 
○ pustule​:  containing  purulent  fluid  of 
traumatizing  scratching,  leading  to 
variable size and palpable elevation 
breakage and infection of skin 
○ Fissure​: a groove in the skin 
○ underlying  cause  should  be  corrected: 
○ Ulcer​:  open  depression  in  the  skin  that 
ex. scabies 
may occur in variable sizes 
○ ttt:  bath  oils,  moisturizing  lotions,  and 
 
massage 
○ diet:  vitamin  supplements  and 
vitamin-rich diet 
○ topical: zinc oxide  
○ antihistamines  and  topical  steroids  for 
relief 
■ Keratosis 
○ actinic or solar keratosis 

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NCM 114 LONG EXAM 1

○ small,  light  colored  lesions,  usually  gray  ○ may  develop  in  scar  tissue  and  is 
or brown, on exposed areas of the skin  associated  with  suppression  of  the 
○ keratin  may  be  accumulated  in  these  immune system 
lesions,  causing  the  formation  of  ○ typically  appear  as  firm,  skin-colored  or 
cutaneous  horn  with a slightly reddened  red nodules 
and swollen base  ○ usually  stays  in  the  epidermis  but  may 
○ ttt:  freezing  agents  and  acids  can  be  metastasize (lower lip) 
used  ■ Melanoma 
○ electrodesiccation  or  surgical  excision  ○ tends  to  metastasize,  or  spread  more 
ensures a more thorough removal   easily 
○ close  monitoring  because  it  is  ○ deadly if not caught earlier 
precancerous   ○ due  to  sun  exposure,  fair  skinned, 
■ Seborrheic keratosis  increases with age 
○ dark, wart like projections of the skin   
○ can  be  small  as  a  pinhead or as large as  ■ Classifications​ of melanoma:  
a quarter  ○ Lentigo maligna melanoma​: 
○ increase in size and number as we age  ● black,  brown,  white  or  red 
○ areas:  trunk,  face,  neck,  and  in  persons  pigmented  flat  lesion  occurs 
with oily skin  predominantly  in  sun exposed 
○ oily skin: they appear dark and oily  areas of the body 
○ in  less  sebaceous  areas,  they  are  dry  in  ● With  time,  it  becomes  larger 
appearance and of a light color  and  becomes  progressively 
○ normally,  base  is  not  swelling  or  no  irregularly pigmented 
reddening  ● age of diagnosis: 67 years old 
○ abrasive  activity  with  a  gauze  pad   
containing  oil  will  remove  seborrheic  ○ Superficial spreading melanoma​: 
keratosis  ● most common melanoma; 
○ freezing  agents  or  by  curettage  and  ● variable  pigmented  plaque 
cauterization can remove it  with an irregular  border  and 
○ benign;  but  medical  evaluation  is  can  occur  at  any  parts  of  the 
important  to  differentiate  from  body 
precancerous lesions  ● incidence  peaks  at  middle  age 
  and continues to  be  high  in 
➢ Skin Cancer(3 major types)  the 8th decade (80 years old) 
 
○ Nodular melanoma:  
● can  be  found  in  any  parts  of 
the body 
● darkly  pigmented  papule  that 
increase in size  overtime 
 
■ Suspicious  lesions  should  be  evaluated  and 
biopsied 
■ Excision  of  melanomas  and  its  surrounding 
tissues and subcutaneous fat 
  ■ Physicians  recommend  removal  of  ALL  palpable 
  lymph nodes 
■ Basal Cell Carcinoma:   ■ Prognosis:  depends  on  the  depth  of  the 
○ most common form  melanoma rather than type 
○ grows slowly and rarely metastasizes  ■ Nurse  should  teach  older  adults  to  inspect 
○ risk  factors:  advancing  age,  exposure  to  themselves  for  melanomas,  identify  moles  that 
sun, UVR, and therapeutic radiation  demonstrate changes in pigmentation or size. 
○ most  common:  face;  but  can  erupt  ■ Early detection means better prognosis 
anywhere   
○ growth  tend  to  be  small,  dome-shaped  ➢ Vascular Lesions:  
elevations  covered  by  small  blood  ■ Age-related  changes  can  weaken  the  walls  of  the 
vessels   veins  and  reduces  the  ability  of  the  vein  to 
○ resemble  benign  ,  flesh  colored  moles  respond to increased venous pressure. 
with a pearly surface  ■ Factors: obesity and hereditary 
○ the  surface  sometimes  is  dark,  rather  ■ Can cause varicose veins to develop 
than shiny (contains melanin pigments)  ■ Poor  venous  return  and  congestion  leads  to 
■ Squamous Cell Carcinoma   edema of lower extremities 
○ arises  from  the  squamous  cells  (skin,  ■ Poorly  nourished  legs  accumulate  debris  and 
hollow  organs  of  the  body,  passages  of  gains  a  pigment,  cracked  and  exudative 
the respiratory and digestive tract  appearance 
○ sun exposure most prevalent factor  ■ Results  to  stasis  dermatitis  (inflammatory 
○ other  factors:  exposure  to  condition) 
hydrocarbons, arsenic and radiation  ■ Subsequent  scratching,  irritation  or  other  trauma 
(ex. elastic bond stockings) develops to leg ulcers 

Long Exam 1 Study Guide - (aes)

NCM 114 LONG EXAM 1

■ Leg  ulcers  or  stasis  ulcers  appears  on  the  medial  ■ Heel protectors are useful 
aspect  of  the  tibia  above  the  malleolus  and  ■ Sheets are wrinkle free 
appears as dark discoloration before breakdown  ■ Check  bed  for  foreign  objects  (syringes  and 
■ stasis ulcers need special attention  utensils) 
■ infection  must  be  controlled  and  necrotic  tissue  ■ Diet:  high  protein,  vitamin-rich  diet  to  maintain 
must be removed to promote healing   and improve tissue health  
■ good nutrition is an important component  ■ Good skin care is essential 
■ diet high in protein and vitamins is recommended  ■ Skin should be kept dry and clean 
■ once  healed,  avoiding  situations  that  promote  ■ Do not rub when wiping patient; blot instead 
stasis dermatitis is of concern  ■ Bath oils and lotions 
■ weight reduction  ■ massage of bony prominences 
■ elevate legs several times a day  ■ ROM exercises to promote circulation 
■ avoid  standing  for  long  periods,  sitting  with  legs  ■ Incontinent  patients-  thoroughly  cleansed  with 
crossed,  and  wearing  garters  (interferes  with  soap  and  water  and  dried  after  each  episode  to 
circulation)  prevent skin irritation from excreta 
■ Elastic  support  stockings  may  be  prescribed  but   
challenging for older adults to wear  ➢ Treatment  measures  depend  on  the  state  of  the 
■ Assess for ability to wear elastic support stockings  pressure ulcer as identified: 
■ Some  may  need  ligation  and  stripping  of  veins to  ■ Hyperemia 
prevent further episodes of stasis dermatitis  ○ redness  of  the  skin  appears  quickly and 
  can disappear if pressure is removed 
➢ Pressure Ulcers:   ○ remove  pressure  by  the  use of a square 
■ Tissue  anoxia  and  ischemia  resulting  from  of adhesive foam 
pressure  can  cause  the  necrosis,  sloughing  and  ○ products:  DuoDerm  (Squibb)  or 
ulceration of tissue  Tegasorb  (3M)  before  applying  the 
■ Also known as decubitus ulcer  adhesive 
■ Any  part  can  develop  a  pressure  ulcer  but  the  ■ Ischemia 
most  common  parts  are  the  sacrum,  greater  ○ redness  of  the  skin  develops from up to 
trochanter, and ischial tuberosities  6  hours  of  unrelieved  pressure  and  is 
■ Elderly at high risk:  often  accompanied  by  edema  and 
○ have fragile skin  induration 
○ poor nutritional state  ○ takes  days  before  the  area  return  to  its 
○ reduced sensation to pain and pressure  normal  color,  during  which  the 
○ frequently affected by immobile and  epidermis may blister 
edematous conditions  ○ Protect  skin  with  Vigilon,  which contains 
○ pressure  ulcers  requires  a  longer  time  water and is soothing to the area 
to heal in older adults  ○ if  skin  is  broken,  cleanse  daily  with 
■ Stages​:   normal saline solution 
○ I-  a  persistent  area  of  skin  redness;  no  ■ Necrosis 
skin breakdown  ○ Unremitting  pressure  extending  over  6 
○ II-  a  partial  thickness  loss  of  skin  layers  hours  can  cause  ulceration  with  a 
involving  the  epidermis  that presents as  necrotic base 
abrasion, blister or shallow crater  ○ this  requires a transparent dressing that 
○ III-  full  thickness  of  skin  lost  extending  protects  it  from  bacteria  but  is 
through  the  epidermis and exposing the  permeable to oxygen and water vapor 
subcutaneous  tissues;  presents  as  deep  ○ thorough  irrigation  during  dressing 
crater  with  or  without  undermining  changes 
adjacent tissues  ○ topical antibiotics  
○ IV-  full  thickness  of  skin  and  ○ may  take  weeks  to  months  before  full 
subcutaneous  tissue  is  lost,  exposing  healing to occur 
muscles,  bones,  or  both;  presents  as  ■ Ulceration 
crater  that  may  include  necrotic  tissue,  ○ if  pressure  is  not  relieved,  necrosis  will 
exudate,  sinus  tract  formation  and  extend  to  through  the  fascia  and 
infection  potentially to the bone 
■ The  most  important  measure  is  to  prevent  the  ○ eschar: thick, coagulated crust 
formation  ○ debridement  is  essential  to  promote 
■ Avoid unrelieved pressure  healing underlying tissues 
■ Turning schedule (varies)  ■ Assessment tool:  
■ Shearing  forces  that causes two layers of tissue to  ○ Braden  Scale  and  Norton  Scale​-  to 
move across each other should be prevented  assess  risk  of  having  pressure  ulcers 
■ Do not elevate head of bed more than 30 degrees,  upon admission 
not  allowing  patient  to  slide  in  bed,  and  lifting  ○ Pressure Sore Status Tool (PSST) offers 
instead of pulling patients wh moving them  a  means  of  assessing  and  monitoring 
■ Use  pillows,  flotation  pads,  alternating  pressure  existing  pressure  ulcers  using  13 
mattresses  and  water  beds can disperse pressure  indexes  (ex.  size,  exudate,  necrotic 
from bony prominences  tissue, edema and granulation 
■ Devices  do  not  eliminate  the  need  for  frequent   
position changes 
■ When sitting, urge to move around  

Long Exam 1 Study Guide - (aes)

 NCM 114 LONG EXAM 1

C. GENERAL NURSING CONSIDERATIONS 

Wrinkling of skin; thinning, loss Disturbed body image r/t age related
■ Psychological  support:  skin  problems are visibly unpleasant 
to patient and to others 
and change in hair color changes to appearance
■ Visitors  and  staff  may  unnecessarily  avoid  touching  and 
being with the patient   Decreased cardiac output Activity intolerance r/t less efficient
■ Reassure  visitors  regarding  safety  of  contact  with  the  management of stress
patient  and  instruct  for  any  special  precautions  that  must 
be followed  Reduced breathing capacity Activity intolerance r/t shortness of breath
■ Emphasize  that  the  patient  is  still  normal,  with  normal  and efficiency
needs  and  feelings,  and  will  appreciate  normal  interaction 
and contact  Delayed oxygen diffusion ineffective peripheral tissue perfusion r/t
■ Wrinkles can not be avoided  delayed oxygen diffusion
■ advise  persons  of  all  ages  to  avoid  excessive  sun exposure 
and use sunscreen  Decrease in muscle mass, Activity intolerance r/t muscle weakness
■ Topical products (b-hydroxy acids) that can reduce wrinkling 
strength and movements and fatigue
■ advise  individuals  to  only  seek reputable providers who are 
experienced in cosmetic procedures 
■ Alternative Therapies  Lower basal metabolic rate Impaired physical mobility r/t slower
○ External  application  of  chamomile  extract  is  used  functions
for skin inflammation 
○ Witch  hazel  is  used  for  its  astringent  effect  and  Risk for injury and infection r/t decreased
applied on bruise and swelling  bodily functions during resting/sleeping
○ Essential  oils  like  thyme  oil  (antiseptic),  thyme  states
linalol and rosewood oil for topical acne 
○ Rosemary oil for cell regeneration 
○ Oils  of  basil,  cinnamon,  garlic,  lavender,  sage,  Higher prevalence of chronic, Risk for ineffective activity planning r/t
savory, and thyme for insect bites or stings  disabling disease chronic disease
○ peppermint  oil  (anti-inflammatory)  speed  the 
healing of wounds and mild burns  Chronic Pain r/t chronic disease
○ homeopathic and naturopathic remedies 
○ acupuncture 
○ biofeedback, guided imagery, relaxation exercise  Reduced income Deficient diversional activity r/t fewer funds
○ supplements:  zinc,  magnesium,  essential  fatty  available for leisure pursuits
acids, vitamin A, B complex, B6, and E 
 
 
Chronic low self-esteem r/t decrease
MUSCULOSKELETAL  
income
● Introduction 
○ Physical activity aids respiratory, circulatory, 
Social isolation r/t fewer funds available for
digestive, excretory and musculoskeletal functions 
○ Mental acuity and mood are enhanced by exercise 
transportation , entertainment and leisure
○ Physical activity can be a means to engage in  pursuits
social activity 
○ A physically fit state support older adults in 
participating in social events 
○ Multiple health problems such as atherosclerosis, A. EFFECTS OF AGING ON MUSCULOSKELETAL FUNCTION 
obesity, joint immobility, pneumonia, constipation, ■ Decline in number and size of muscle fibers and 
pressure ulcers, depression and insomnia can be subsequent reduction in muscle mass decrease muscle 
avoided when an active state is maintained strength ; grip strength endurance declines 
○ Maintaining a physically active state is more ■ Connective tissue changes reduce the flexibility of joints 
challenging in late life due to the effects of aging and and muscles 
the symptoms and restrictions imposed by chronic ■ Atrophy of muscles 
health conditions that are highly prevalent among ■ Tendons shrink and harden 
older adults ■ Reduction in bone mineral and mass 
■ Loss of height 
CAUSES AND CONTRIBUTING ■ Joint activity and motion 
NURSING DIAGNOSIS ■ Increased risk for fractures 
FACTORS

Demineralization of bone; Impaired physical mobility r/t decreased

deterioration of cartilage, range of motion
surface of joints

Brittleness of bones Risk for injury

Poorer vision and hearing
B. SARCOPENIA 
Social isolation r/t sensory deficit
■ Age related reduction of muscle mass and/or function, 
resulting from a reduction of protein synthesis and an 
increase in muscle protein degeneration 

Long Exam 1 Study Guide - (aes)

NCM 114 LONG EXAM 1

■ This can lead to disability, particularly in patients with  ○ Regular exercise can delay or prevent some age 
disease or organ impairment   related losses in cardiovascular function and 
■ Cause​: immobility, lack of exercise, increased levels of  improve maximal oxygen uptake 
proinflammatory cytokines, increased production of oxygen  ○ It can lower resting systolic and diastolic blood 
free radicals and impaired detoxification, low anabolic  pressure 
hormone output, malnutrition and reduced neurologic  ○ Physical activity can increase muscle strength and 
drive   flexibility and slow the rate of bone loss 
■ Activity can be imparied by:   ○ Exercise can improve body tone, circulation, 
○ Loss of spouse  appetite, digestion, elimination, respiration, 
○ Retirement  immunity, sleep and self concept 
○ Relocation   ○ Exercise is beneficial but may create problems if 
  adjustments are not made for their age 
C. MUSCULOSKELETAL HEALTH PROMOTION  ○ Higher systolic and diastolic pressure during rest 
■ CARDIOVASCULAR ENDURANCE​:   and exercise (may rise to 200 mmHg) 
○ Aerobic Training- enhances the ability of the  ○ Reduced vital capacity and increased residual 
heart, blood vessels, and lungs to deliver oxygen  capacity limit the air movement, causing the 
to all body cells  respiratory muscles to work harder and 
○ Aerobic exercise: walking, swimming, jogging,  respiratory rate to increase 
cycling, rowing, tennis, and aerobic dancing  ○ Susceptible to heat stroke 
○ should be done at least 20 minutes , at least 3x a  ○ Dehydration  
week  ○ Assess older adults before they start an exercise 
○ heart rate should fall within the target heart range  program and monitoring their status during 
during exercise  physical activity 
  ○ Exercise programs are best followed if they match 
■ CALCULATING MAXIMUM AND TARGET HEART RATES  the individual’s needs and interest (Zumba) 
○ Maximum heart rate: 220- age  ○ Daily routines: climbing the stairs, parking car 
○ Target heart rate= maximum heart rate x 75%  farther away from the destination to increase 
○ Target heart rate range= 65% to 80% of maximum  walking, walking the dog outside, house cleaning 
heart rate  ○ Pacing the exercise throughout the day to avoid 
○ Example: 70 year old 
■ Maximum heart rate: 220 – age 
■ 220 – 70 = 150 bpm 
■ Target heart rate: maximum heart rate x 
75 % 
■ 150 x 75%= 112.5 or 113 bpm 
■ Target heart rate range: 65%-80% of 
maximum heart rate 
■ minimum= 150 x 65% = 97.5 or 98 bpm 
■ maximum= 150 x 80% = 120 bpm 
■ Range: 98 bpm to 120 bpm 
■ Commercial heart rate monitors, available 
at sports supplies stores, can provide 
feedback on heart rate during exercise 
without having the inconvenience of 
having to stop to palpate the pulse  fatigue and muscle pain and cramping 
  ○ Stretching exercise in the morning to loosen stiff 
■ FLEXIBILITY: T
​ he ability to freely move muscles and joints  joints and muscles 
through their range of motion   ○ If not accustomed to great deal of physical 
○ Gentle stretching help maintain flexibility of joints  activity, begin gradually and increase them 
and muscles  according to progress 
○ Stretching exercise for about 5-10 minutes before  ○ Longer periods must be allowed for the older 
and after exercise can reduce muscle soreness  adult to perform exercise, with rest periods in 
○ Major muscle groups should be stretched twice a  between 
week  ○ Warm water and warm washcloths or towels 
■ STRENGTH TRAINING: e ​ xercise that challenges the muscles  wrapped around the joints to ease joint motion 
○ Key elements: resistance and progression  and facilitate exercise 
○ Resistance​: Achieved by lifting weights and the  ○ Exercise that stress an immobile joint, strenuous 
use of weight machines  sports and running and jumping exercise should 
● Isometric Exercise (use of own weight)  be avoided to prevent trauma 
through calisthenics, such as push-ups  ○ Seek advice from a physician to identify best 
and pull-ups  exercise that suits the capacity and limitation 
○ Progression​: Increasing the workload on the  ○ Tai chi and yoga (complementary and alternative 
muscles  treatment/ modality) 
● lifting heavier weights (older adult: 8-12  ○ Less aggressive exercise into their daily routine: 
reps at least 2x a week)  ● Foot, leg, shoulder and arm circling 
  while watching television 
■ Exercise programs tailored for older adults  ● Deep breathing and limb exercises 
between awakening and rising from bed 

Long Exam 1 Study Guide - (aes)

NCM 114 LONG EXAM 1

● Wash dishes and do laundry (warm  ■ Nutrition 

water)  ○ Well  balanced  diet  rich  in  protein  and  minerals 
● When greeting a patient in the hall, ask  will  help  maintain  the  structure  of  bones  and 
the patient to raise both arms as high as  muscles 
possible and wave  ○ 1500  mg  calcium  for  both  men  and  women 
● When giving a medication, ask the  (supplements):  1000  mg  from  diet  and  500  mg 
patient to bend each extremity several  from supplement 
times  ○ Weight  reduction  to  each  musculoskeletal 
● During bathing exercise, ask the patient  discomfort for obese older adults 
to flex and extend all body parts   
 
■ The Mind Body Connection:  
○ Cognitive and emotional states can influence the 
physical activity 
○ Depressed individuals may be poorly motivated to 
engage in exercise 
○ Persons with Alzheimer’s may lack memory, 
judgment and coordination to safely exercise 
○ Inactive states may lead to the ill effects of 
immobility that can affect the mind 
○ Promotion of physical activity can have positive  
effect on mood and cognition  
○ Activities must be planned according to patient’s 
interest: art, crafts, culinary, travel, classes, 
 
gardening, auto repair, dancing, listening to 
 
music, people watching, and collecting 
 
○ Pets (companionship for older adults) 
 
○ Therapeutic recreation: clay (exercise fingers), 
 
painting (express feelings), cooking (restore or 
 
maintain roles) 
 
 
 
■ Prevention of inactivity:  
 
 
E. SELECTED MUSCULOSKELETAL DISORDERS 
○ Educate the public, especially caregivers, about 
the importance of physical activity for older adults  ➢ Fractures 
○ Families believe they are assisting their older  ○ NECK  OF  THE  FEMUR:  most  common  site, 
relatives by “doing for” and allowing them to be  especially in older women 
sedentary  ○ Colles’  fracture​:  break  of  the  distal  radius 
○ Promotes a sense of worth by providing an  (attempt to stop a fall) 
opportunity for them to be productive  ○ COMPRESSION  FRACTURE  OF  THE  VERTEBRAE: 
○   carrying heavy objects 
  ○ Older  adults  heal  at  a  slower  rate  compared  to 
D. NURSING DIAGNOSIS HIGHLIGHT  younger adults 
● Predisposing  them  to  many 
■ Interventions 
complications related to immobility 
○ Assess  muscle  strength  and  tone,  active  and 
○ Aim of the gerontology nurse is PREVENTION 
passive range of motion, and mental status. 
○ Poor coordination and equilibrium: 
○ Review  history  for  conditions  that  can  limit 
● Avoid  risky  activities  (climbing  the 
mobility  or  require  alteration  in  level  of  mobility. 
ladders or chairs to reach high places) 
Consult  with  the  physician  as  to  restrictions  on 
● Rise  from  a  sitting  or  kneeling  position 
mobility  and  any  necessary  modifications  for 
slowly (postural hypotension) 
exercises 
● Properly  fitting  shoes  with  a  low,  broad 
○ Develop  an  individualized  exercise  program, 
heel  can  prevent  stumbling  and  loss  of 
which  could  include  passive  or  active  ROM 
balance 
exercises 
● Handrails  for  stairs  or  rising  from  the 
○ Assist  the  patient  in  maintaining  good  body 
bath tub for support and balance 
alignment and hourly position changes 
● Place  both  feet  at  the  edge  of  the  curb 
○ Promote a good nutritional status 
before  going  up  and  down  on  and from 
○ Refer  for  canes,  walkers,  wheelchairs,  braces, 
a bus 
traction  devices,  and  other  aids  to  increase 
● Avoid damaged sidewalks 
mobility, if necessary 
● Wear sunglasses to avoid glare 
○ Collaborate  with  other  members  of  the 
● Nightlight  during  night  visits  to 
interdisciplinary team 
bathroom 
○ Encourage  family  and  SO  to  assist  in  efforts  to 
○ Symptoms of fracture: 
increase patient’s mobility 
● Pain 
○ Provide  diversional  activities  based  on  patient’s 
● Change in shape or length of limb 
interest and level of function 
● Abnormal or restricted motion of limb 
○ Observe  for complications of immobility  and seek 
● Edema 
prompt correction 
● Spasm 
 
● Discoloration of tissue 
Long Exam 1 Study Guide - (aes)
NCM 114 LONG EXAM 1

● Bone protruding through the tissue  ●Joint  more  uncomfortable  during  damp 
● The  absence  of  this  symptoms does not  weather and periods of extended use 
rule out fracture  ● Excessive  exercise  will  cause  more  pain 
○ Complications:  and  degeneration  (advice  isometric  and 
● Pneumonia  mild exercise) 
● Thrombus formation  ○ Management: 
● Pressure ulcers  ● Analgesics (DOC: Acetaminophen) 
● Renal calculi  ● Rest 
● Fecal impaction  ● Heat 
● contractures  ● Tai chi 
○ Nursing Intervention:  ● Aquatherapy 
● Activity  within  limits  determined  by  the  ● Gentle massage 
physician  ● Splints,  braces  and  canes  provide 
● Deep breathing and coughing exercises  support 
● Isometric exercise and ROM  ● Acupuncture for short-term relief 
● Fluids  should be encouraged; note urine  ● Oral  calcitonin  for  post  menopausal 
output  women  effectively  protects  them  from 
● Frequent turning positions (TTS)  pain and disability of joint  
● Good  nutrition  (facilitate  healing,  ● Proper  body  alignment  and  body 
increase  resistance  against  infection,  mechanics 
decrease  likelihood  of  other  ● Foods  high  in  essentially  fatty  acid  have 
complications)  anti-inflammatory effects 
● Joint exercise to prevent contractures  ● Vitamin  A,  B,  B6,  C  and  E  and  zinc, 
● Use  of  foot  boards,  trochanter  roll,  and  selenium,  niacinamide,  calcium  and 
sandbags to maintain body alignment  magnesium supplements 
● Keep  skin  dry,  prevent  pressure,  ● Glucosamine  and  chondroitin 
massage (stimulate circulation)  supplements 
● Patient  should  be  mobilized  as  early  as  ● Weight reduction 
possible  (explanation  and  reassurance  ● Occupational  and  physical  therapy  can 
needed)  be  done  (seek  consult  for  assistive 
● Progress  in  small  steps  for  tolerance  devices  and  promote  independence  in 
(bedside,  nearby  chair,  bathroom);  self-care activities) 
assisted  by  two  persons  at first because  ● Arthroplasty,  or  joint  replacement,  to 
weakness and dizziness is common  restore  joint  motion,  improve  function 
  and reduce pain 
➢ Osteoarthritis  ● Contraindications:  obese,  joint  sepsis, 
○ Progressive  deterioration  and  abrasion  of  joint  dementia,  neurotrophic  joints,  diabetes 
cartilage  (poor wound healing), PVD 
○ It occurs more in women more than in men  ○ Complications of arthroplasty: 
○ 55 years old and above  ● DVT 
○ Leading cause of physical disability in older adults  ● Pulmonary  embolism  (warfarin  is  used 
○ Myth:   as prophylaxis) 
● Unlike  rheumatoid  arthritis,  ○ Post-operative care: 
osteoarthritis does not cause:  ● Analgesics  round  the  clock  for 
● Inflammation,  deformity,  and  post-operative  pain  (monitor  closely  for 
crippling   effects) 
● Reassure  older  adults  who  fears  the  ● Patient  informed  of  precautions needed 
effect  of  rheumatoid  arthritis  (severe  when taking anticoagulants 
disability)  ● Specific  instruction  pertaining  toe 
● Wear  and  tear  of  the  joints  was  exercise,  weight-bearing,  and  activity 
responsible;  however,  recent  studies  restrictions 
show  that  disequilibrium  between   
destructive  (matrix  metalloproteinase  ➢ Rheumatoid Arthritis 
enzymes)  and  synthetic  (tissue  inhibitor  ○ 20-40 years old 
of  metalloproteinase)  elements  leads  to  ○ Major cause of arthritic disability in later life 
a  lack  of  homeostasis  necessary  to  ○ The  synovium  becomes  hypertrophied  and 
maintain  cartilage,  causing  the  joint  edematous  with  projections  of  synovial  tissue 
changes.  protruding into the joint cavity 
○ Excessive use of the joint  ○ Signs and symptoms: 
○ Trauma  ● Affected  joints  is  painful,  stiff,  swollen, 
○ Obesity  red and warm to touch 
○ Low vitamin D and C levels  ● Pain is present during REST and activity 
○ Patients with acromegaly  ● Subcutaneous  nodules  over  bony 
○ Weight  bearing  joints  are  most  affected  (knee,  prominences  and  bursae  may  be 
hips, vertebrae and fingers)  present 
○ Symptoms:  ● Systemic:  fatigue,  malaise,  weakness, 
● Crepitation on joint motion   weight loss, wasting, fever and anemia 
● Bony  nodules  at  the  distal  joints  ○ MANAGEMENT: 
(Heberden nodes)  ● Rest 

Long Exam 1 Study Guide - (aes)

NCM 114 LONG EXAM 1

● Limb  support  to  avoid  pressure  ulcers  ● Synthetic  form  of  calcitonin  (reabsorb 
and contractures  calcium) 
● Splints to avoid deformities  ● Bisphosphonates​ (antiresorptive) 
● ROM exercise  ● Diet rich in protein and calcium 
● Physical and occupational therapy  ● Avoid  heavy  lifting,  jumping  and  other 
● Heat and gentle massage  activities that results to fracture 
● Analgesics and anti-inflammatory agents  ● Potential  complication:  compression 
(prostaglandins)  fracture 
● Corticosteroids  ● ROM  exercise  and  ambulation  to 
● Rheumatic  heart  disease  (RHD)  patients  maintain  function  and  prevent  greater 
are  sensitive  to  “nightshade”  foods”  damage 
(they prefer to grow in shady areas)   
● Potatoes  ➢ Gout​:  
● Peppers  ○ Excess uric acid accumulates in the blood 
● Eggplant  ○ Uric acid crystals around the joints 
● Tomatoes  ○ Severe pain and tenderness in the joints 
● Herbs  that  may  help:  turmeric,  ginger,  ○ Warm, swelling, redness of the surrounding tissue 
skullcap and ginseng   ○ Acute  attack:  pain  is  severe,  may  not  be  able  to 
● Patient education/ Home visit  bear weight and have a blanket or clothing rest on 
● Consult  a  physician  before  using  any  the affected joint 
dietary  supplement  sold  by  salespeople  ○ TREATMENT​: 
(elderly are easy target)  ● Low  purine  diet:  avoid  bacon,  turkey, 
  liver,  kidney,  brain,  anchovy,  sardines, 
➢ Osteoporosis  mackerel,  salmon,  legumes,  all  alcoholic 
○ INACTIVITY OR IMMOBILITY  beverages, shellfish, scallops) 
○ DISEASES:   ● Colchicine  can  be  used  to  manage 
● Cushing  syndrome  (excessive  acute attacks 
production  of  glucocorticosteroids  by  ● Long  term  management:  colchicine, 
the  adrenal  gland  inhibits the formation  allopurinol, probenecid, indomethacin 
of bone matrix)  ● Precipitated  by  the  use  of  thiazide 
● Increased  metabolic  activity  of  diuretics (increases uric acid in blood) 
hyperthyroidism  causes  more  rapid  ● Dietary  supplements:  vitamin  E,  folic 
bone  turnover  and  the  faster  rate  of  acid and eicosapentaenoic acid 
bone  resorption  to  bone  formation  ○ Herbs: yucca and ​devil’s claw 
causes osteoporosis  ○ EOF 
● Excessive  diverticulitis  causes   
malabsorption of calcium  ➢ Podiatric Conditions 
○ REDUCTION OF ANABOLIC SEX HORMONES  ○ Foot problems 
● Loss  of  estrogens  and  androgens  ○ 90%  of  65  years  old  and  above  have  foot 
(postmenopausal)  problems 
○ DIET  ○ Podogeriatrics  ​(specializing  in  foot  problems  in 
● Insufficient  amount  of  calcium,  vitamin  old age) 
D,  vitamin  C,  protein,  and  other  ○ Conditions:  lifelong  foot  problem,  changes in gait, 
nutrients  gout,  diabetes,  PVD  and  age  related  loss  of  fat 
● Excessive  consumption  of  caffeine  or  padding of the foot contribute to foot problems 
alcohol decreases calcium absorption  ○ Shaving,  cutting  and  chemical  treatment  of 
○ DRUGS THAT CAN CAUSE OSTEOPOROSIS  podiatric conditions can cause serious problems 
● Heparin  ○ Refer to a podiatrist 
● Furosemide  ○ PROPER  FOOT  CARE  (keep  feet  clean,  wear  safe 
● Thyroid supplements  and  properly  fitting  shoes,  exercising  feet, cutting 
● Corticosteroids  nails straight) 
● Tetracycline  ○ Foot  massage  to  aid  in  circulation,  reduce edema 
● Magnesium  and  aluminum  based  and  promote  comfort  (​contraindicated  if  with 
antacids  PVD or lesions) 
○ Osteoporosis  may  cause  kyphosis  and  reduction   
of height  ■ Calluses​:  
○ Spinal pain, especially in the lumbar region  Plantar keratosis 
○ Bones fracture easily  ● Friction creating layers of thickened skin 
○ Bone mass density can be measured by:  ● Reduced  fat  padding,  dryness, 
● CT  scan,  Dual  Energy  X-ray  decreased  toe  function  and  poor  fitting 
Absorptiometry  (most  widely  used),  shoes can cause callus formation 
single or dual photon absorptiometry  ● Usually appears in the heels and soles 
○ TREATMENT:  ● People  attempt  to  shave  or  cut  off 
● Calcium supplements  calluses 
● Vitamin D supplements  ● Massage  and  apply  lotions  and  oils  to 
● Progesterone  prevent callus  
● Estrogen   
● Anabolic agents  ■ Corns: 

Long Exam 1 Study Guide - (aes)

NCM 114 LONG EXAM 1

● Cone  shaped layers of thick dry skin that  ■ Muscle stiffness may last for an hour 

forms over a bony prominence  ■ Muscle  atrophy,  joint  deformity  and  low  grade 
● Pressure  on the area causes discomfort/  fever 
pain  ■ Cause: unknown, genetics 
● Do not attempt to remove corns on their  ■ Diagnosis: ESR and CRP 
own  ■ Management: Corticosteroids and NSAIDs 
   
■ Bunions:    
● Hallux Valgus  ➢ Giant Cell Arthritis 
● Bursa,  bony  prominence  over  the  first  ■ An  immune-mediated  condition  that  involves 
metatarsal head  large and medium sized arteries 
● Medial  deviation  of  the  first  metatarsal  ■ Manifestation:  throbbing  unilateral  temporal 
with abduction of the great toe  headache,  fever,  visual  disturbance,  jaw 
● Occur more in women (shoes)  claudication 
● Causes  difficulty  in  finding  shoes  ■ Others:  weight  loss,  anorexia,  night  sweats, 
(widen)- custom made shoes  malaise, depression 
● Surgery can be indicated  ■ Diagnosis: ESR and CRP 
  ■ Management: Corticosteroids and NSAIDs 
■ Hammer Toes:   
● Digiti Flexus  ➢ Osteomalacia 
● Hyperextension  of  the  ■ Softening  of  the  bone  with  an  excessive 
metatarsophalangeal  joint  with  flexion  accumulation  of  bone  matrix  resulting  from 
and  often  corn  formation  at  the  impaired  mineralization  with  calcium  and 
proximal interphalangeal joint  phosphorus 
● Toe  resembles  the  shape  of  the  ■ Causes:  vitamin  D  deficiency,  renal  failure, 
hammers inside a piano  hypophosphatemia, less exposed to sunlight 
● Orthotics can provide relief  ■ Manifestation:  pain,  tenderness,  proximal  muscle 
● Surgery is necessary for correction  weakness, waddling gait, hypotonia 
  ■ TTT: calcium and vitamin D supplements 
■ Plantar Fasciitis:   
● Common cause of heel pain   
● Plantar  fascia  is  a  ligament  that  runs   
from the ball of the foot to the heel   
● Inflammation  of the plantar fascia/ band  ➢ Paget’s Disease 
at its heel attachment  ■ Characterized by excessive resorption   
● Prolonged walking and standing  ■ and deposition of bone 
● Ttt:  stretch  exercise (pull up ball of foot),  ■ Cause: genetics 
apply  ice  for  30  mins.,  wear  cushion  in  ■ Manifestations:  bone  pain  frequently  occurs  at 
the heel, custom made orthotics  rest, under pressure and during the night 
  ■ Dx: imaging studies 
■ Infections​:   ■ Management:  bisphosphonates  (Risedronate, 
Onychomycosis  Clodronate) 
● Fungal infection of the nail or nail bed   
● Toenails  become  enlarged,  thick,  brittle,   
and  flaky  (fungus displaces the nails up);  RESPIRATORY 
the  side  of  the  nails are pushed into the 
skin and causes pain  A. EFFECTS OF AGING ON RESPIRATORY HEALTH 
● Antifungal preparation 
■ Nasal septum deviation due to connective tissue changes 
 
■ Reduced secretions from the submucosal gland 
Tinea pedis or athlete’s foot 
■ Mucus in the nasopharynx becomes thicker and harder to 
● Burning and itching 
expel 
● Skin  surface  peel,  crack  and  be  often 
■ Hair in the nostrils becomes thicker- accumulates greater 
red, often with vesicular eruptions 
amount of dust and dirt particles during inspiration 
 
■ Trachea stiffens due to calcification of cartilage 
■ Ingrown Nails 
■ Coughing is reduced due to blunting of the laryngeal and 
● Tight fitting shoes 
coughing reflex 
● Cutting of nails excessively short 
■ Lungs becomes smaller in size and weight 
● Nails  cut deep into the tissues leading to 
■ Elastic recoil of the lungs during expiration is decreased 
inflammation 
therefore the use of accessory muscles is required 
● Soaks  and  topical  antibiotics  can  be 
■ Alveoli less elastic, develop fibrous tissue and contain fewer 
prescribed 
functional capillaries 
● Podiatrist to remove ingrown nails 
○ affects gas exchange 
 
■ kyphosis and barrel chest seen- effect: reduction of vital 
➢ Polymyalgia Rheumatica  
capacity and an increase in residual volume 
■ A  rheumatic  disease  characterized  by  muscular 
■ reduced body fluid and reduced fluid intake CAN MAKE 
pain and stiffness that lasts a month or more 
DRIER MUCUS MEMBRANE, the development of mucus 
■ Muscle  pain  that  begins  in  the  posterior  neck 
plugs and infection 
muscles  and  spreads  to  the  shoulders  and  pelvic 
■ loose or brittle teeth can dislodge or break and can be 
girdle 
aspirated 
Long Exam 1 Study Guide - (aes)
NCM 114 LONG EXAM 1

  ■ Smoking cessation (smoking can cause bronchoconstriction, 
early  airway  closure,  reduced ciliary action, inflammation of 
the mucosa, and increased mucus secretion and coughing) 
■ Prevent  fractures,  pain,  weakness,  depression  and  other 
problems that can cause immobility 
■ Hourly turning, coughing, and DBE when immobile 
■ Avoid OTC drugs 
■ Analgesics,  antidepressants,  antihistamines, anti-parkinson, 
antispasmodics,  sedatives  and  tranquilizers  decreased 
respirations or causes rapid, shallow breathing 
■ Indirect room ventilation is best 
■ Remove pollutants  
■ Remove danders, pollens, mites 
■ To improve quality of indoor air:  
○ installing and maintaining air filters 
  ○ vacuum regularly 
  ○ damp dusting 
B. ASSESSMENT GUIDE  ○ discourage smoking 
○ open windows 
GENERAL OBSERVATION 
○ maintaining green house plants to detoxify air 
■ Color: color of the face, neck, limbs, and nail beds;  
■ 7 Indoor plants that can purify indoor air 
○ ruddy,  pink  complexion  (emphysema  assoc.  with 
○ ALOE VERA 
hypoxia) 
○ SNAKE PLANT 
○ blue  or  gray  complexion  (chronic  bronchitis  due 
○ SANSEVIERIA MIKADO 
to dec. Hgb) 
○ POTHOS 
■ Chest  structure  and  posture:  Anteroposterior  chest 
○ BOSTON PLANT 
diameter increases with age; note for kyphosis, lordosis and 
○ ENGLISH IVY 
scoliosis 
○ SPIDER PLANT 
■ Breathing  pattern:  symmetrical  expansion  during 
■ Healthy  oral  cavity  (infection  of  the  oral  cavity  may  lead  to 
respiration,  as  well  as  depth,  rhythm  and  length  of 
respiratory infections) 
respiration;  
■ Check for loose tooth; remove asap 
■ Decreased  expansion  may  indicate  pain,  fractured  ribs, 
 
pulmonary emboli, pleural effusion or pleurisy 
INTERVIEW 
■ Do you ever have wheezing, chest pain, or a heavy feeling in 
the chest? 
■ How  often  do  you  get  colds?  Does  it  recur?  How  do  you 
treat it? 
■ How  far  can  you  walk?  How  many  steps  can  you  climb 
before SOB? 
■ Do  you  have  any  breathing  problems  when  the  weather 
gets cold or hot? 
■ How  many  pillows  do  you  sleep  on?  Do  breathing patterns 
awaken you from sleep? 
■ How  much  do  you  cough  during  the  day?  each  hour?  Can 
you control it? 
■ Do  you  bring  up  sputum,  phlegm,  or  mucus  when  you 
cough? How much? Color? Consistency? 
■ How do you manage respiratory problems? medications? 
■ Did you ever smoke?  
 
■ What kind of jobs have you had over a lifetime? 
C. SELECTED RESPIRATORY PROBLEMS 
■ Do you live near factories? high traffic areas? 
  ➢ Asthma 
PHYSICAL EXAMINATION  ■ older  asthmatics  have  a  high  risk  of  developing 
■ Palpate  the  posterior  chest  to  evaluate  the  depth  of  complications  like  bronchiectasis  and  cardiac 
respiration,  degree  of  chest  movements  and  presence  of  problems 
masses or pain.  ■ assess  for  emotions,  mouth  breathing,  and 
■ Tactile  fremitus  best  felt  in  the  upper  lobes;  increased  chronic respiratory infections 
fremitus  in  lower  lobes  may  indicate  pneumonia  and  ■ educate  patient  on  early  recognition  of  asthma 
masses.   attack and prompt attention towards it 
■ Lack of fremitus may indicate COPD or pneumothorax  ■ use of aerosol nebulizers 
■ Percussion- production of a resonant sound (hollow)  ■ use  spacers  when  using  inhalers  (difficulty  in 
■ Auscultation- breath sounds (rhonchi, crackles, wheezes)  using it) 
  ■ overuse  of  sympathomimetic  bronchodilator 
HEALTH PROMOTION  nebulizers  creates  a  high  risk  of  cardiac 
■ Obtain pneumonia and influenza vaccine  arrhythmias  leading  to  sudden  death  (smooth 
■ Avoid individuals with respiratory infection  muscle relaxation) 
■ Deep  breathing  exercise  several  times  daily;  1  sec   
inspiration and 3 sec expiration; (1:3) ratio  ➢ Chronic Bronchitis 
■ Yoga 
Long Exam 1 Study Guide - (aes)
NCM 114 LONG EXAM 1

■ signs:  persistent,  productive  cough,  wheezing,  ■ ttt:  postural  drainage,  high  protein  -  high  calorie 
recurrent respiratory infection, SOB  diet 
■ starts  when  patient  realizes  increased  dyspnea in   
cold  and  damp  weather  -  recurrent  inflammation  D. NCP (OLDER ADULTS WITH COPD) 
and  mucus  production  in  the  bronchial  tubes  ➢ Nursing Dx​: Impaired Gas Exchange r/t chronic tissue 
(causes  blockage  and  scarring)  -  hypoxia  -  hypoxia, Risk of Infection r/t pooling of secretions in the 
emphysema  lungs 
■ remove bronchial secretions  ■ Goal​: The patient maintains patent airway; the patient 
■ prevent obstruction of airway  expectorates secretions from lungs 
■ maintain good fluid intake  ■ INTERVENTIONS 
■ expectorate secretions  ○ DBE​: slowly inhale to the count of 5; lean forward 
■ avoid smoking  (30 to 40 degrees) and slowly exhale to the count 
  of 10; used pursed lip breathing for expiration 
➢ Emphysema  ○ Abdominal breathing (lying position) 
■ Cause​:  ● place a book or small pillow on the 
● chronic bronchitis  abdomen 
● chronic irritation (dust and pollutants)  ● push out the abdomen during 
● changes in the lung's morphology  inspiration and observe the book to rise 
● cigarette smoking  ● exhale slowly through pursed lip 
■ slow  onset  and  may  resemble  age  related  ○ Abdominal breathing (sitting position) 
changes  in  the  respiratory  system  -  delayed  ● hold a book or small pillow against 
identification and treatment  abdomen 
■ not relieved by sitting upright   ● push out the abdomen against the book 
■ chronic cough develops  or pillow 
■ develop  fatigue,  anorexia,  weight  loss,  and  ● during inspiration 
weakness  ● lean forward, exhale slowly through 
■ life  threatening:  malnutrition,  CHF,  cardiac  pursed lips and pull in the abdomen 
arrhythmias  (press the book against the abdomen) 
■ TREATMENT​:  ○ instruct patient to cough and breathe deeply at 
● Postural drainage  least once every 8 hours 
● bronchodilators  ○ perform postural drainage (avoid forceful 
● DBE  pounding) 
● avoid stressful situations  ○ proper antibiotic administration 
● avoid smoking  ○ avoid people with respiratory infection 
● frequent  small  feeding  and  high protein  ○ maintain 75F room temperature 
supplements  ○ close observation if in oxygen therapy 
● supervise oxygen therapy  ○ vaccines for influenza and pneumonia  
● sedatives,  hypnotics,  and  narcotics  are  ○  
avoided  due  to  increased  sensitivity  to   
these drugs  ➢ Nursing Dx:​ Activity Intolerance r/t chronic hypoxia 
● consult  physician  regarding  LUNG  ■ Goal​:  The  patient  performs  ADLs  without  becoming 
VOLUME  REDUCTION  SURGERY  -  fatigued or experience respiratory symptoms 
severely  diseased  portions  of  the  lungs  ■ INTERVENTIONS 
are  removed  allowing  remaining  tissues  ○ identify  actual  or  potential  deficits  in  ADLs  from 
and respiratory muscles to work better  impact  of  respiratory  symptoms;  provide 
● patient must learn to pace activities  assistance to compensate for deficits 
● avoid extremely cold weather  ○ schedule rest periods between activities 
● administer drugs correctly  ○ identify  factors:  interruptions  to  sleep  due  to 
● recognize symptoms of infection  cough,  lack  of  knowledge  of  ways  to  schedule 
  activities to preserve energy 
➢ Lung Cancer:   ○ Gradually  increase  activity  level,  monitor  vital 
■ Occurs  in  patients  older  than  65;  men;  cigarette  signs and discourage activity if: 
smokers have twice the incidence as non-smokers  ● dec. RR and PR 
■ exposed  to  asbestos  (scars  the  lung  tissue),  coal  ● lack of inc. in systolic pressure 
gas, radioactive dusts and chromates  ● 15 mmHg inc. in diastolic pressure 
■ s/sx​:  dyspnea,  cough,  chest  pain,  fatigue,  ● confusion and vertigo 
anorexia,  wheezing,  and  recurrent  respiratory  ● pain and respiratory distress  
infection  ○ consult with dietician 
■ dx​: X-ray, sputum test, bronchoscopy and biopsy   
■ ttt​: surgery, chemotherapy, and radiotherapy  E. GENERAL NURSING CONSIDERATIONS  
  ■ seek medical attention promptly if signs of respiratory 
➢ Lung Abscess  infection occurs 
■ results  from  pneumonia,  PTB,  malignancy,  or  ■ atypical​: older people do not experience chest pain 
trauma  of  the  lungs;  aspiration  of  foreign  associated with pneumonia to same degree as younger 
materials (dec. pharyngeal reflex)  adults; normally they have lower body temperature- 
■ s/sx:  anorexia,  wt.  loss,  fatigue,  hyperthermia,  therefore, pneumonia when detected is already in 
and  chronic  cough; sputum production may occur  advanced stage 
BUT  NOT  ALWAYS  DEMONSTRATED  in  older  ■ observe for changes in sputum 
adults  ○ COPD- tenacious, translucent grayish 

Long Exam 1 Study Guide - (aes)

NCM 114 LONG EXAM 1

○ lung abscess or bronchiectasis- purulent and foul  ○ good fluid intake 

○ pulmonary edema and left sided heart failure- red  ○ use paper tissues, not handkerchief when 
and frothy  expectorating 
■ Preventing Complications  ○ frequent handwashing 
○ Minimize disability and prevent mortality  ○ oral hygiene 
○ Check for:  ■ Complementary Therapies 
● RR and volume  ○ mullein, marshmallow and slippery elm have 
● PR (sudden increase can indicate  mucus secreting effects and can soothe irritated 
hypoxia)  respiratory linings 
● temp (infection, prevent stress on CV  ○ Lobelia, coltsfoot and sanguinaria as expectorants 
and respiratory systems as they attempt  ○ eucalyptus, pine, lavender and lemon for 
to meet the demand for increased  aromatherapy 
oxygenation   ○ spicy food are recommended to open air 
● neck veins (distended)  passages 
● patency of airway  ○ dairy products and processed foods are ill-advised 
● coughing (productive)  (mucus forming food) 
● quality of secretions  ○ Vitamins A, C, E and B6 
● mental status  ○ Zinc 
■ Ensuring Safe Oxygen Administration  ○ Acupuncture for asthma, emphysema, and allergic 
○ high levels of O2 can cause higher amount of CO2  rhinitis 
retention  ○ Acupressure for bronchitis, asthma, and 
○ carbon dioxide narcosis  emphysema 
○ monitor blood gases and observe for CO2  ○ Yoga to promote DBE 
narcosis (confusion, muscle twitching, visual  ○ Rolfing- pressure applied with the fingers, 
defects, profuse perspiration, hypotension,  knuckles and elbows to release fascial adhesion 
progressive degrees of circulatory failure and  and realign the body into balance 
cerebral depression- inc. sleeping and comatose  ○ massage to free ribcage and improve breathing 
state)   
○ check the gauge frequently   
○ check for any interruption (kinked tube)   
○ mouth breathers (nasal cannula not useful)   
○ emaciated persons whose facial structure does  ■ Promoting self care 
not allow for a tight seal of a face mask may lose a  ○ the ability of the patient to use inhalers correctly 
significant portion of oxygen through leakage  should be evaluated (problems like slower 
○ anxious/ emotional stress may not fully gain the  responses, poorer coordination, arthritic joints or 
therapeutic benefit  general weakness) 
○ regularly clean the nasal passages to maintain  ○ respiratory therapist to assist in recommending 
patency  devices that can assist patients in overcoming this 
○ home environment evaluated for safety  problems 
○ discharged: education and family/ caregiver  ○ education of overuse of inhalers (cardiac effects); 
support   1-2 inhalations is good for 4 hours 
■ Performing postural drainage:   ○ to ensure if inhaler does not become empty 
○ remove bronchial secretions  unexpectedly, evaluate periodically 
○ aerosol medications are administered before the  ● full inhaler, it will sink in a bowl of water 
procedure  ● empty inhaler, it will float  
○ position depends on the portion of the lung/s  ○ ventilator-dependent persons at home are 
involved  growing in numbers 
○ change positions slowly and allow rest in between  ○ respiratory care specialist to ensure proper 
○ trendelenburg (lying face down with head at floor  functioning, understanding and correct use of this 
level may be stressful to older adults- consult  ventilators 
physician  ○ strong multidisciplinary support to assist with the 
○ cupping and vibration facilitate drainage  complex web of physical, emotional, and social 
● if dyspnea, palpitation, chest pain,  care needs of those in ventilators 
diaphoresis, apprehension or any other  ○ sensory stimulation, expressive therapies, 
signs of distress occur, DISCONTINUE  counselling when in ventilator to improve quality 
● old tissues and bones are more fragile  of life 
and may injure easily  ■ Providing Encouragement 
○ oral hygiene at periods of rest  ○ respiratory problems can be frightening and 
○ documentation on tolerance towards procedure  produce anxiety 
and the amount and characteristic of mucus  ○ psychological support and reassurance especially 
drained  in periods of dyspnea 
■ Promoting Productive Cough  ○ complete understanding of the disease and its 
○ Coughing is important in the mgmt. of respiratory  mgmt to reduce anxiety 
problems  ○ repeated encouragement to assist patient in 
○ non-productive cough could be stressful to older  meeting demands of the disease 
adults- energy expenditure  ○ spend most of their times indoors to avoid 
○ hard candy and other sweets increase secretions  extremes of hot and cold weather 
and makes cough productive  ○ learn how to transport oxygen with them when 
○ humidifiers can be obtained   outside their homes 

Long Exam 1 Study Guide - (aes)

NCM 114 LONG EXAM 1

○ assist them to live the fullest of their lives rather 

than becoming prisoners of their disease 
 

Long Exam 1 Study Guide - (aes)