CHAPTER 10 – GERIATRIC CARE ON RESPIRATION

EFFECTS OF AGING ON RESPIRATORY HEALTH

Older adult is at risk for aspiration and infection , enlarged alveoli, lung surface area decrease
therefore reduce ventilation and respiratory gas exchange

• Nose experiences connective tissue changes (cause nasal deviation)

• Thicker hair in the nostril (accumulate great amount of dust and dirt particles during
inspirations) use cotton tip with warm water/ saline solution
• Trachea stiffens (due to calcification and hardening of tissue and cartilages)
• Lungs becomes smaller in size and weight (increase residual capacity; gag reflex is weaker due to
reduced number of nerve ending in larynx)
• Elastic recoil during expiration is decreased (due to less elastic collagen and elastin)
• Alveoli are less elastic, develop fibrous tissue, and contain fewer functional capillaries (less air
exchange and more air secretions in lungs)
• Loose /brittle tooth can dislodge (can lead to lung abscess or infection)
• Relaxed sphincters & slower gastric motility (cause risk for aspiration)
• Impaired mobility, inactivity, & s/e from medications used (cause decrease respiratory function;
promote infection)

RESPIRATORY HEALTH PROMOTION

1. Obtaining influenza and pneumonia vaccines.

2. Avoiding exposure to individuals who have respiratory infections (MOT: airborne or by droplets)

3. Nurses should teach all older adults to do deep breathing exercises several times daily (before meals).

4. Smoking cessation (factor for respi disease)

5. When immobility is unavoidable, hourly turning, coughing, and deep breathing will promote
respiratory activity. (cold for weeks can be an indicator for respi problems; refer to doctor)

6. Review all medications used by older persons. (decreased respi rate and shallow breathing may be
caused by drugs being taken).

7. Environmental factors (pollutants; spores, pollen, household dust, cigarette smoke)

8. Oral cavity infections (decrease appetite and facilitate poor health general status).

Quality of Indoor air can be improved by:

1. Installing and maintaining air filters in heating and air-conditioning systems

2. Vacuuming regularly
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3. Damp-dusting furnishings

4. Discouraging cigarette smoking

5. Opening windows to air out rooms

6. Maintaining green houseplants

SELECTED RESPIRATORY CONDITIONS

Asthma (can be developed in old age)

-Older adult asthmaticus ( high risk for Bronchiectasis and cardiac problems)

-Precautions to avoid adverse drug effect:

- Overuse of bronchodilator nebulizer (risk for cardiac arrhythmias that can lead to sudden death)
- New steroid inhalants (effective and carry lower risk of systemic absorption and adverse reaction)

Chronic Bronchitis

- Recurrent inflammation & mucus production in the bronchial tubes (overtime it produce blockage and
scarring of tissue overtime; restrict airflow).

-Sign & symptoms may include persistent, productive cough; wheezing; recurrent respiratory

infections; and shortness of breath (may develop gradually, it can take years)

-Episodes of hypoxia begin to occur (mucus obstruct bronchial tree and causes c02 retention)

Management: (Aim to remove bronchial secretions and prevent obstruction of airway; for all age group)

1. Maintain good fluid intake (to expectorate secretions)

2. Discouraging chronic respiratory irritation (smoking and prevent respi infections)

Empysema

Causative factors:

1. Chronic bronchitis

2. Chronic irritation (dust or air pollutants)

3. Cigarette smoking

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Sign & symptoms include dyspnea, chronic cough, fatigue, weight loss, anorexia and weakness. (slow
onset and initially may assemble age related changes in respi system that cause delayed identification
and treatment of disease)

Management:

1. Postural drainage, bronchodilators, avoidance of stressful situations, & breathing exercises.

2. Smoking should be stop

3. Low oxygen level rather than a high carbon dioxide level ( patient with emphysema has a higher risk for c02
narcosis) ; condition with excessive c02 in bloodstream

4. Sedatives, hypnotics, & narcotics may be contraindicated

5. Complications should be avoided.

Patient self care: avoid extreme cold weather , proper self administration of medication, and recognize
symptoms of infections. Complications: Malnutrition, Recurrent respiratory infection, Congestive heart
failure and cardiac arrhythmias.

Observation of the following to determine resp. status:

1. Color (face, neck, nail beds) body with pink complexions occurs with patient with emphysema; caused
by hypoxia, blue/grey can be an indication for chronic bronchitis caused for lack of 02.
2. Chest structure and pasture (Emphysema; Increase anteroposterior chest diameter)
3. Breathing pattern (decrease expansion of chest; caused by chest, fractured ribs, pulmonary emboli
and pleural effusions.
4. Cough (dry or productive)

Pneumonia (one of the leading cause of death ; broncho pneumonia)

-Factors:

Poor chest expansion and more shallow breathing (due to age related changes)

High prevalence of respiratory diseases (promote mucus formation and bronchial obstruction)

Lowered resistance to infection

Reduced sensitivity of pharyngeal reflexes (promote aspiration)

- Pneumococcal pneumonia is the most common type of pneumonia in older adults.

gram negative (haemophilus influenzae)

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Symptoms may include a slight cough, fatigue, rapid respiration, confusion, restlessness, and behavioral
changes (may deveop a paralytic ileus due to immobility)

Management:

1. Close observation

2. Pneumococcal vaccines (for oldies age 65; shouldn't be administered if febrile)

Influenza

Types of Influenza:

1. Influenza A ( most death for elderly)

2. Influenza B (less severe)

Symptoms include fever, myalgia, sore throat, and nonproductive cough.

Annual influenza vaccines (given at October before flu season; vaccine is contraindicated if febrile, egg
allergy and hx of Guillain-Barré syndrome).

Caregiver should be immunized too.

Lung Cancer (older than 65 yo.)

Factors:

1. Increase prevalence rate in black men

2. Cigarette smokers

3. Chronically exposed to chemical (asbestos & radioactive gas)

Symptoms: Dyspnea, coughing, fatigue, anorexia

Diagnostic test (sputum cytology, bronchoscopy and biopsy).

Treatment (surgery/chemotherapy and radio therapy)

Lung Abscess

Causes include pneumonia, tuberculosis, a malignancy, or trauma to the lung, aspiration of foreign
material.

Symptoms are anorexia, weight loss, fatigue, temperature elevation, and a chronic cough.

- Postural drainage

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- High protein, high caloric diet (protein loss, maintain nutritional status)

GENERAL NURSING CONSIDERATIONS

Recognizing symptoms

1. Seek medical attention promptly

2. Report changes in the character of sputum (thick/w blood)

Preventing complications

• Close monitoring

ENSURING SAFE OXYGEN ADMINISTRATION

• Monitor blood gas
• Watch out for signs of carbon dioxide narcosis (confusion, visual defect, hypotension,
profuse perspiration)
• Appropriate oxygen administration (check gauge frequently; at prescribed level)
• Nasal passages should be clean regularly (maintain patency)
• Home environment needs to be evaluated for safety.

POSTURAL DRAINAGE

• Prescribed for removing bronchial secretions

• Aerosol medication (done before postural
drainage).
• Position of postural drainage (depends on lung
involved; usually lying face down with head at floor
level but can be stressful and have adverse effect;
consult physician for appropriate position).
• Oral hygiene & period of rest
• Cupping and vibration (for drainage)
• Documentation (patient tolerance, amount and characteristics of mucus)

PROMOTING PRODUCTIVE COUGHING

• Hard candy and other sweets

• Breathing exercises
• Fluid intake
• Drugs (expectorant to loosen secretions)
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 • Hand washing & oral hygiene (tissue rather than handkerchief)

COMPLEMENTARY THERAPIES

*Herbs are believed to affect respiratory health

* Aromatherapy (eucalyptus, lavender and lemon)

Hot spicy foods

Acupuncture (asthma, emphysema, hay fever)

Yoga (promotes deep breathing)

Rolfing (use of fingers and knuckles to realign the body to balance)

* Nurse should keep an open mind

PROMOTING SELF-CARE

• Bronchodilator (inhaler)
• Home-ventilator used

Nurse Management

- Discuss instructions and precautions

- health education: cardiac effect of excessive use
- 1-2 inhalation of medication for 4 hours
- test fullness of inhaler (put in a bowl of water; if it sink it is full)

PROVIDING ENCOURAGEMENT

• Psychological support and reassurance

• Repeated encouragement

CHAPTER 11 – GERIATRIC CARE ON DIGESTIVE & BOWEL ELIMINATION

EFFECTS OF AGING ON GASTROINTESTINAL HEALTH

- Xerostamia (dry mouth)

- Decreased stomach elasticity and higher PH
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 - Constipation
- Bile salt synthesis decreases
- Intolerance for fatty foods
- Reduced hepatic blood flow

GASTROINTESTINAL HEALTH PROMOTION

1.Good dental hygiene & regular visits to the dentist
2. Natural means to promote bowel elimination
• Dietary fiber intake of 20 to 35 g/d is advisable
• Attempt a bowel movement following breakfast
• Ensure complete elimination

SELECTED GASTROINTESTINAL CONDITIONS

Xerostomia Management:
Causes:
1. Medication 1. Oral hygiene
2. Sjogren’s Syndrome 2. Saliva substitutes
3. Mouth breathing 3. Sipping of water
4. Sugarless candy
Dental Problems
Causes:
1. Poor condition of teeth
2. Altered taste sensation , poor diet, low-budget
carbohydrate diet with excessive intake of sweets
3. Deficiencies of vitamin B complex and calcium, Hormonal imbalances,
hyperparathyroidism, diabetes, osteomalacia, Cushing’s disease, syphilis
4. Drugs

Dental Problems
• Benign neoplastic lesions develop
• Periodontal disease
• Dental caries

Management:
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1. Good oral hygiene
2. Daily flossing
3. Regular dental examination
4. Instruct patients to inform their dentists about health problems & medication
they take.
5. Flouride treatment

Dysphagia
Causes:
1. GERD
2. Stroke
3. Structural disorder
Symptoms: occasional difficulties swallowing to a complete inability to swallow.

Management:

1. Careful assessment & observation

2. Speech-language therapist
3. Prevention of aspiration
4. Promotion of adequate nutritional status
5. Suctioning

Hiatal Hernia
2 types: Management:
1. Sliding 1. Diet
2. Rolling 2. Position
Symptoms: Heartburn, dysphagia, belching, 3. Drugs
vomiting, regurgitation, pain & bleeding
Diagnostic: Barium swallow and Esophagoscopy.

Esophageal Cancer
Causes: Poor oral hygiene and chronic irritation from tobacco, alcohol, Barrett’s
Esophagus
Symptoms: Dysphagia, weight loss, excessive salivation, thirst, hiccups, anemia,
and chronic bleeding

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Diagnostic: Barium swallow, esophagoscopy, & biopsy
Management: surgical resection, radiation, chemotherapy, laser therapy, and
photodynamic therapy.

Peptic Ulcer
Causes: Stress, diet, genetic predisposition, drugs
Risk Factors: smoking, heavy alcoholic beverage
consumption, caffeine & Helicobacter pylori infection
Symptoms: pain, bleeding, obstruction, & perforation
Treatments: Addressing risk factors, prevent complications

CA of Stomach
-Prevalent among men, cigarette smokers, poor socioeconomic groups, African
American, Hispanic
Symptoms: Anorexia, epigastric pain, weight loss, anemia, bleeding and
enlargement of the liver
Diagnostics: Barium swallow & Gastroscopy with biopsy
Treatments: Diet, surgery
Prognosis: Good/bad

Diverticular Disease Diverticulosis

Causes: Chronic constipation, obesity, hiatal hernia, and
atrophy of the intestinal wall muscles
Symptoms: Slight bleeding, change in bowel habits , tenderness
Diagnostic: Barium enema
Treatments: Diet, avoidance of constipation, surgery

Diverticular Disease Diverticulitis

Causes: Overeating, straining during a bowel movement,
alcohol, and irritating foods
Symptoms: Nausea, vomiting, constipation, diarrhea,
low-grade fever, and blood or mucus in the stool, pain
Treatments: Reducing infection, providing nutrition,
relieving discomfort, and promoting rest

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Colorectal CA
Symptoms: fatigue, bloody stools, change in bowel pattern, abdominal
discomfort, rectal bleeding, unexplained weight loss, anemia
Diagnostics: Digital rectal exam, Fecal Occult test, Colonoscopy
Treatment: Surgery

Chronic constipation
Factors: Inactive lifestyle, Low fiber and low fluid intake, depression, laxative
abuse, medications, dulled sensations, failure to complete emptying of the bowel
Management: Diet, Drugs, Records

Flatulence
Causes: Constipation, irregular bowel movements, certain foods, poor
neuromuscular control of the anal sphincter.
Management: Avoiding flatus-producing foods, sitting upright after meals,
increased activity, knee–chest position

Intestinal Obstruction
Causes: cancer of the colon, adhesions & hernias;
Diverticulitis, ulcerative colitis, hypokalemia, vascular
problems, and paralytic ileus
Symptoms: pain, abdominal distention, bowel sound
Diagnostic: X-ray, blood test
Management: Intestinal intubation, surgery

Fecal Impaction
Indications: Distended rectum, Abdominal and rectal discomfort, Oozing of fecal
material, often mistaken as diarrhea, Palpable, hard fecal mass, Fever
Management: Enema, manual breaking & removal of feces, injecting 50 mL
hydrogen peroxide through a rectal tube, prevention of constipation

Fecal Incontinence
Causes: decreased contractile strength, impaired automaticity of the puborectal
and external anal sphincter , loss of cortical control, and reduced reservoir
capacity

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Diagnostic: Proctosigmoidoscopy, proctography, and anorectal manometry
Management: bowel retraining drugs, surgery, biofeedback.

Acute Appendicitis

Symptoms: severe pain , Fever , and leukocytosis

Management: Surgery
Cancer of the Pancreas
Symptoms: Anorexia, weakness, weight loss, fever, Dyspepsia, belching, nausea,
diarrhea, constipation, and obstructive jaundice, pain
Management: surgery

Biliary Tract Disease

Cholelithiasis
Symptoms: pain
Treatment: Rotary lithotrite treatment and Extracorporeal shock wave lithotripsy
CA of Gallbladder
Symptoms: Pain in the right upper quadrant,
anorexia, nausea, vomiting, weight loss, jaundice,
weakness, and constipation
Prognosis : poor

CHAPTER 12 – GERIATRIC CARE ON REPRODUCTIVE SYSTEM HEALTH

EFFECTS OF AGING ON REPRODUCTIVE SYSTEM

• Female reproductive
-Flattening of the labia and loss of subcutaneous fat and hair
-Vaginal epithelium becomes thin, & the vaginal environment is drier and
more alkaline
-Uterus and ovaries also decrease in size
-Breasts sag, less firm; firm linear strands may develop
• Male reproductive
-Structural changes in the seminiferous tubules
-Enlargement of the prostate gland

REPRODUCTIVE SYSTEM HEALTH PROMOTION

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 • Female:
* Annual gynecologic examination
• Male
Prostate-specific antigen (PSA)
Testicular self-examination
Complete history and physical examination

SELECTED REPRODUCTIVE SYSTEM CONDITIONS

Infections and Tumors of the Vulva

• Vulvitis
- Incontinence and poor hygienic practices
- Pruritus
- Treatment aims to find and manage any underlying cause.

Infections and Tumors of the Vulva

• Vulvar Tumor
Symptoms: Pruritus, mass at clitoris

CA of Vulva
Symptoms: large, painful, foul-smelling fungating/ulcerating tumors
Treatment: Radical vulvectomy, Radiation therapy, Counseling

Vaginitis
Symptoms: Soreness, pruritus, burning, and a reddened vagina, foulsmelling
vaginal discharge is clear, brown, or white, bleeding
Treatments: Local estrogens, topical medication, douches, good hygiene

CA of Vagina
Diagnostic: Biopsy, Paps smear
Treatment: Irradiation, topical chemotherapeutic agents, or surgery

Cancer of the Cervix

Symptom: Vaginal bleeding & Leukorrhea; urinary retention or incontinence, fecal
incontinence, and uremia
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Treatment: Radiation, surgery, regular screening

Problems of the Cervix

Nabothian cysts
Regular gynecologic examinations

Endometrium CA
Causes: late onset of menstrual periods, been infertile, HNPCC , obese.
Diagnostic: D & C
Treatment: Surgery, irradiation, or a combination of both

CA of Ovaries
Symptom: bleeding, ascites, and the presence of multiple masses.
Treatment: Surgery or irradiation

Perineal Herniation
Types: Cystocele, rectocele, and prolapse of the uterus
Symptom: lower back pain, pelvic heaviness, and a pulling sensation. Urinary and
fecal incontinence, retention, and constipation, pressure or palpate a mass in her
vagina
Treatment: Surgical repair

Dyspareunia
Cause: Vulvitis, vaginitis, and other gynecologic problems
Treatment: Gynecological examination
Breast CA
Regular breast examination
Annual mammograms

Problems of the Male Reproductive System

Erectile Dysfunction
Causes: alcoholism, diabetes, dyslipidemia, HTN hypogonadism, multiple
sclerosis, renal failure, spinal cord injury, thyroid conditions, drugs
Treatment: oral erectile agents, drugs injected into the penis, penile implants,
and vacuum pump devices.
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Benign Prostatic Hyperplasia
Symptoms: dysuria, dribbling, poor control, overflow urine incontinence, bleeding
Treatment: prostatic massage,use of urinary antiseptics, diuretics,
anticholinergics, and antiarrhythmic agents, Transurethral surgery

CA of the Prostrate
Diagnostic: Digital rectal examination
Symptoms: Back pain, anemia, weakness, and weight loss can develop as a result
of metastasis.
Treatment: Monitoring, irradiation, or a radical prostatectomy; palliative
treatment

Tumors of the Penis

Diagnostic: Biopsy
Treatment: Irradiation and local excision

Testicular Tumor
Symptoms: testicular enlargement and pain and enlargement of the breasts
Treatment: Chemotherapy, irradiation, orchiectomy

Scrotal masses, usually benign, can result from

Causes: Hydrocele, spermatocele, varicocele, hernia
Treatment: Counselling

CHAPTER 13 – GERIATRIC CARE ON URINARY ELIMINATION

EFFECTS OF AGING ON URINARY ELIMINATION
• Decreases the ability of the bladder to expand and reduces storage capacity
• Nocturia
• Retention of large volume of urine
• Higher blood urea nitrogen levels
• Increase in the renal threshold for glucose

URINARY SYSTEM HEALTH PROMOTION

• Good fluid intake
• Taking Vitamin C and foods
STREAM LOCO/STAN ITZY-MHE
 • Catheterization should be avoided
• Nightlights should be used to improve visibility
• Reducing fluids immediately before bedtime
• Set a comfortable tone & display sensitivity during the assessment

Prevent urine retention by:

1. Voiding in upright position
2. Massaging bladder area
3. Rocking back and forth
4. Running water
5. Soaking hands in warm water

Urinary Tract Infection (UTI)

Cause: poor hygienic practices, improper cleansing after bowel elimination, low
fluid intake and excessive fluid loss, and hormonal changes
Causative agent: Escherichia coli, Proteus species
Symptoms: burning, urgency, and fever; incontinence, delirium
Management: Antibiotic therapy, note the patient’s fluid intake and output,
forcing fluids is advisable, observation for new symptoms, cranberry juice
Complication: Septicemia, Urosepsis

Prostatitis
Cause: bacterial in origin
Symptoms: fever, chills, and malaise
Diagnostic: Clean-catched urine sample
Treatment: antibiotic

Urinary Incontinence
Types: Transient/Established
Types of Established Incontinence:
1. Stress Incontinence
2. Urgency Incontinence
3. Overflow Incontinence
4. Neurogenic Incontinence
5. Functional Incontinence
STREAM LOCO/STAN ITZY-MHE
6. Mixed Incontinence

Bladder CA
Risk factors: Chronic irritation of the bladder, exposure to dyes, and cigarette
smoking
Symptoms: bladder infection, urgency, dysuria.
Diagnostic: Cytoscopic Exam.
Treatment: surgery, radiation, immunotherapy, or chemotherapy, observation of
symptoms of metastasis

Renal Calculi
Causes: infection, changes in the pH, chronic diarrhea, dehydration, excessive
elimination of uric acid, and hypercalcemia
Symptoms: Pain, hematuria
Management: Preventing urinary stasis, providing ample fluids, and facilitating prompt
treatment of UTIs.

Glomerulonephritis
Symptoms: fever, fatigue, nausea, anorexia, abdominal pain, anemia, edema,
arthralgias, hypertension, increased sedimentation rate, Oliguria
Management: Antibiotic, restricted sodium, protein diet, monitor intake & output

GENERAL NURSING CONSIDERATIONS FOR URINARY CONDITIONS

-Nurses need sensitivity in dealing with patients’ urinary problems.

-Realistic explanation
-Minimize embarrassment and promote a positive self-concept

CHAPTER 14 – GERIATRIC CARE ON MOBILITY

EFFECTS OF AGING ON MUSCULOSKELETAL FUNCTION
-Decline in the number and size of muscle fibers and subsequent
reduction in muscle mass
-Sarcopenia develops
-Activity can be impacted by psychosocial factors.
• Loss of spouse
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 • Retirement
• Relocation

MUSCULOSKELETAL HEALTH PROMOTION

Promotion of Physical Exercise in All Age Groups
Activities that hinders the elderly in physical activities
All exercise program should address:
• Cardivascular endurance
• Flexibility
• Strength training

Exercise Programs Tailored for Older Adults Advantages:

1. Improve body tone, circulation, appetite, digestion, elimination, respiration,
immunity, sleep, and self-concept.
2. Provide opportunities for socialization and recreation

Guidelines for Exercise Programs for Older Adults:

• Ensure that a recent physical examination hasbeen done
• Determine the training heart rate and evaluate heart rate during exercise
• Encourage warm-up exercises

Alternative exercises:

1. Suggest to do foot, leg, shoulder, and arm circling

2. Instruct to do deep-breathing and limb exercises
3. Encourage to wash dishes / light laundry by hand
4. During bathing activities, to flex and extend all
body parts.

The Mind–Body Connection

• Cognitive and emotional states can influence the physical activity.
• Promotion of physical activity
• Therapeutic recreation is structured leisure with a specific goal in mind

Prevention of Inactivity

STREAM LOCO/STAN ITZY-MHE

 • Inactivity can result in deconditioning
• Educate the caregivers
• Suggesting pastimes
• Enhance motivation
• Local resources
• Unique capacities, limitation & interest

Nutrition
• Good nutrition is an important factor
• 1,500 mg calcium should be included in the diet daily
• Obesity places strain on the joints

Fractures
Prevention of fall:
- Nightlight
- Avoid risky activities
- Rise from a kneeling or sitting position slowly
- Fitting shoes with a low, broad heel
- Careful where they are walking

Causes: Trauma, cancer metastasis to the bone,

osteoporosis, and other skeletal diseases
Symptoms: Pain, change in the shape or length of a limb, edema, discoloration of tissue,
and bone protruding through the tissue.
Management: Limit activity within the limit, fluids should be encouraged, good
nutrition, correct body alignment, keep skin dry & clean
Complications: Pneumonia, thrombus formation, pressure ulcers, renal calculi, fecal
impaction, and contractures

Osteoarthritis
Causes: Trauma, obesity, low vitamin D and C levels, and genetic factors
Symptoms: Crepitation, bony nodules
Management: Rest, massage; Splints, braces, and canes; proper nutrition; weight
reduction; nutritionalsupplements, Arthroplasty / joint replacement

Rheumatoid Arthritis
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Symptoms: Joints are painful, stiff, swollen, red, and warm to the touch; fatigue,
malaise, weakness, weight loss, wasting, fever, and anemia
Management: rest, splints, range of motion exercise, heat & gentle massage, drugs,
surgery, Health education

Osteoporosis
Risk factors: Calcium and Vit. D deficiency, smoking, prolonged immobility, increase
alcoholic intake, family history
Symptoms: Kyphosis, pain
Management: Diet, brace, bed board, regular exercise, avoid heavy lifting, ROM, handle
with gentleness

Gout
Symptoms: Pain, tenderness of the joint, warmth,
redness, and swelling of the surrounding tissue.
Management: Diet, avoid alcohol intake, herbs, good fluid intake, drugs

Podiatric Conditions
* Callusses
Causes: Reduced fat padding of the foot, dryness of the skin, decreased toe function,
and poor fitting shoes
Symptoms: not painful, seen in heels and soles
Management: massage with oils/lotion; avoid to shave or cut off calluse

*Corns
Symptoms: discomfort, pain
Management: avoid to remove corns

*Bunions (Hallux Valgus)

Causes: heriditary, shoe’sstyle
Management: Shoe repairshops can; custom-made shoes , surgery

*Hammer Toe (Digiti Flexus)

Symptom: discomfort
Mangement: Orthotics , surgery
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*Plantar Fasciitis
Symptom: Pain
Management: Orthotics, symptomatic treatment

* Infections
1.Onychomycosis - pain, antifungal treatment
2. Tinea pedis - burning, itching, crack, peeling of skin

*Ingrown Nails (Onychocryptosis)

Cause: Tight-fitting shoes/ cutting the nail excessively short.
Management: Soaks and topical antibiotics

GENERAL NURSING CONSIDERATIONS FOR MUSCULOSKELETAL CONDITIONS

- Managing Pain
- Warm bath at bedtime
- Passive stretching of the extremity

- Correct positioning
- Back rubs
- Gentleness in turning and lifting older patients
- Divertional activities
- Complementary therapy

Preventing injury
• Using both feet for support
• Using railings and canes for added balance
• Wearing properly fitting, safe shoes
• Avoiding long trousers, nightgowns, or robes
• Gentle handling

Promoting Independence
- Canes, walkers, and other assistive devices
- Physical and occupational therapists

CHAPTER 15 – GERIATRIC CARE ON ENDOCRINE FUNCTION

STREAM LOCO/STAN ITZY-MHE

EFFECTS OF AGING ON ENDOCRINE FUNCTION
- Thyroid gland progressively atrophies and thyroid gland activity decreases
- Adrenocorticotropic hormone secretion decreases with age
- Insulin secretion is also affected by age
- Endocrine health promotion

Diabetes Mellitus
Risk factors: Obesity, inactivity, an increased amount of fat tissue, and genetic factor
Diagnostic: Fasting Blood Sugar, Urine test for glucose, Glucose tolerance test

Criteria in diagnosing DM:

1. Symptoms of diabetes & a random
blood glucose concentration ≥200 mg/dL.
2. Glycosylated hemoglobin (HbA1c)
≥6.5%.
3. Fasting blood glucose concentration
≥126 mg/dL
4. Blood glucose concentrations 2 hours
after an oral glucose intake ≥200 mg/dL

Diabetes Mellitus
Management:
Patient education
1. Teaching plan
2. Fear & Anxiety

Guidelines for Patient Education:

- Assess readiness to learn
- Assess learning capacities and
limitations
- Outline content of presentation
- Prepare the patient for the teaching-
learning session
- Provide environment conducive to
learning
- Most effective individualized
educational materials
- Leave material with patient
- Obtain feedback
- Re-evaluate periodically
- Documentation

Drug therapy 3. Acarbose

1. Metformin 4. Rosiglitazone and pioglitazone
2. Sulfonylurea drugs 5. Oral hypoglycemic agents
STREAM LOCO/STAN ITZY-MHE
 2. Retinopathy
Patient Self-care and Monitoring 3. Hypoglycemia
- Insulin injection 4. Drug interactions
- Blood glucose level testing using a finger- 5. Neuropathies
prick method
- Tryglyceride monitoring
- Hemoglobin A1c Test

Exercise & Nutrition

- Benefits of regular exercise
- Nutritional supplements
- Financial, energy, or social limitations.

Complications:
1. Peripheral vascular disease

Hypothyroidism
A subnormal concentration of thyroid hormone in the tissues.
*Types: Primary and Secondary
Symptoms: Fatigue, weakness, and lethargy, Depression and disinterest in activities,
Anorexia, Weight gain and puffy face, impaired hearing, Periorbital or peripheral edema,
Constipation, Cold intolerance, Myalgia, paresthesia, and ataxia, Dry skin
Treatment: Replacement of thyroid hormone

Hyperthyroidism
The thyroid gland secretes excess
amounts of thyroid hormones.
*Causes: Amiodarone
*Diagnostic: Thyroid function test, Radionuclide thyroid scans
Symptoms: Increased perspiration may not occur, and for the person with a history
of chronic constipation, diarrhea
Treatment: Antithyroid medications or radioactive iodine, surgery

CHAPTER 16 – GERIATRIC CARE ON VISION & HEARING

Cataract: clouding of crystalline lens of eye

Glaucoma: eye disease involving increased intraocular pressure
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Macular degeneration: loss of central vision
Presbycusis: age-related high-frequency sensorineural hearing loss
Presbyopia: age-related decrease in eye’s ability to focus on near objects

EFFECTS OF AGING ON VISION AND HEARING

Presbyopia
- Inability to focus.
-Visual acuity declines -Legally blind
-Light perception threshold decreases -Lip reading is difficult
-Visual fields becomes smaller -Visual limitations can make communication
-Eyes produce fewer tears and drier problematic

Presbycusis
- age related sensorineural hearing loss
-Limiting social contact
-Difficulty hearing telephone conversation
-Management: Professional evaluation

SENSORY HEALTH PROMOTION

- Promoting Vision
- Tonometry
- Annual eye examination
- Prompt evaluation
- Review diet (Vit. C, E, Selenium, Zinc)

Promoting Hearing
- Complete treatment of ear infections
- Prevention of trauma to the ear
- Regular audiometric examinations
- Education
- Assess for cerumen accumulation

SELECTED VISION CONDITIONSRELATED NURSING INTERVENTIONS

I. Visual Deficits

Cataracts
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Factors: Ultraviolet B, DM, smoking, alcohol, eye injury
Symptoms: Vision is distorted, night vision is decreased,
objects appear blurred, nuclear sclerosis
Treatment: Surgery, Ophthalmologists visit

Glaucoma
Factors: Increased size of the lens, iritis, allergy,
endocrine imbalance, emotional instability, family
history. Anticholinergic drugs

Acute Glaucoma
Symptoms: severe eye pain, headache, nausea & vomiting, blurred vision
Diagnostic test: Tonometer, Gonioscopy
Management: Surgery, Iricdectomy

Chronic Glaucoma
Symptoms: peripheral vision becomes slowly,central
vision is affected, tired feeling in their eyes, headaches,
misty vision, seeing halos around lights

Chronic Glaucoma
Management: Drugs , surgery
Preventions:
- Avoiding to increase IOP
- Carrying a card
- Abuse and overuse of the eyes
- Periodic evaluation

Macular Degeneration
Diagnostic: Ophthalmic exam.
Treatment: Laser therapy

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Detached Retina

Symptoms: Perception of spots

moving across the eye,
blurred vision, flashes of light,
feeling that a coating is
developing over the eye
Management: Bed rest, use of
bilateral eye patches,
surgery

Corneal Ulcer
Symptoms: Irritation, dietary deficiencies, lowered resistance, pain,
photophobia

Management: prompt assistance, early care, drugs, sunglass, surgery

II. Hearing Deficits

Factors: exposure to noise, drugs, illness

Otosclerosis

Tinnutus

Patient Care: encourage audiometric examination; explanation and instruction in writing,

neighbour should be alerted.

Hearing Aids
- Not all problems are solve
- It should be prescribed
- Variety of style is available
- Speech may sound distorted

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 - Aid must be checked regularly

Hearing Aid Care:

1. Turn the aid off or remove the battery when the aid is not being worn.

2. Clean the aid at least weekly.

3. Protect the aid from exposure to extreme heat

4. When changing the battery, turn off the aid first

5. Keep several new batteries available.

GENERAL NURSING CONSIDERATIONS FOR VISUAL AND HEARING DEFICITS

Hearing

Diet Vision
Different textures Ample lighting
Clocks that chime Large prints materials

CHAPTER 17 – GERIATRIC CARE ON SKIN HEALTH

EFFECTS OF AGING ON THE SKIN

- Common aging changes
- Increased fragility of the skin
- Effects on appearance
PROMOTION OF SKIN HEALTH

- Avoid using drying agents, rough - Skin care

clothing, highly starched linens, and - Avoid exposure to ultraviolet rays
other items irritating to the skin. - Use of sun-screening lotions
- Good skin nutrition and hydration - Health teaching

In detecting unhealthy moles:

A—Asymmetry
B—Border Irregularity
C—Color
D—Diameter

Pruritus
Causes: Excessive bathing and dry heat, Illness
Management: Bath oils, moisturizing lotions, and massage ; vitamin supplements; drugs
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Keratosis
Symptoms: Slightly reddened and swollen lesion
Management: Freezing agents and acids; surgery, close observation

Seborrheic Keratosis
Symptoms: Lesions appear dark and oily; dry in appearance and of a light color.
Management: Gauze pad containing oil, freezing agents or
by a curettage and cauterization procedure.

Skin CA
1. Basal cell CA
Risk factors: Advanced age and exposure to the sun, ultraviolet radiation, therapeutic radiation.
Symptoms: Small, dome-shaped elevations , dark, rather than shiny

2. Squamous cell CA
- Firm, skin-colored or red nodules.
- Stays in the epidermis but can metastasize

3. Melanoma
Melanomas can be classified as follows:
- Lentigo maligna melanoma
- Superficial spreading melanoma
Nodular melanoma
Management: Biopsy, excision

Vascular Lesions
Causes: Obesity and hereditary factors
Symptoms: Stasis ulcer
Management: Good nutrition, elastic support stockings, Ligation & stripping

Pressure Injury
Causes: Tissue anoxia and ischemia
Management: Encouraging activity , urged to move, kept wrinkle free, check the bed
frequently, diet, skin care, Bath oils, ROM

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Pressure Injury

Stages:
Stage 1: Stage 2:
Sore are not open wound. The skin usually breaks open/form ulcers.

STAGE 4
Pressure Injury is very deep
STAGE 3
The sore gets worse

Treatment measures defends on • Psychological support

symptoms: • Treat elderly as normal persons
• Hyperemia • Avoiding excess sun exposure
• Ischemia and
• Necrosis using a sunscreen
• Deep tissue damage • Cosmetic surgery

Tool for assessing pressure injury: Using Alternatives Therapies

• Braden Scale • Use of herbs
• Norton Scale • Use of essentials oils
• Pressure Score Status Tool • Homeopathic and naturopathic
(PSST) remedies
• Nutritional supplements
Promoting Normalcy

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CHAPTER 18 – GERIATRIC CARE ON CANCER

BRCA - blood tests can be done to identify mutations in either one or two breast
cancer susceptible genes

CAM - those therapies that fall outside of mainstream Western medical practices

SPF - rating used for sunscreens to indicate the protection they offer from sun

AGING AND CANCER

Unique Challenges for Older Persons With Cancer
• Highest rate of most cancers
• Have another health condition
• Toleration of treatment
• Survival rates for older adults are lower

Explanations for Increased Incidence in Old Age

2 Major theories:
1. Biological, age-related changes
2. Prolonged exposure to carcinogens

RISK FACTORS, PREVENTION, AND SCREENING

Risk factors for cancers offer insights into some of the preventive measures that could prove
useful in avoiding these diseases.

CANCER RISK FACTORS AND ACTIONS TO REDUCE RISK

• Avoid the use of and exposure to tobacco products.
• Limit exposure to the sun.
• Maintain weight within an ideal range; exercise
and be physically active.
• Protect against exposure to known carcinogens.
• Limit alcohol consumption.
• Discuss chemoprevention
• Diet

RECOMMENDED CANCER SCREENING FOR OLDER ADULTS

• Annual checkup
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 • Annual mammogram
• Annual fecal occult blood test
• Colonoscopy
• Annual PSA tests
• Pap test

TREATMENT
Conventional Treatment
1. Surgery 3. Chemotherapy
2. Radiation 4. Biologic Therapy

Complementary and Alternative Medicine

• Relationship-centered care
• Support
• Healing partnership
• Comfort
• Hope

NURSING CONSIDERATIONS FOR OLDER ADULTS WITH CANCER

Providing Patient Education
C - hange in bowel or bladder habits
A - sore that does not heal
U - nusual bleeding or drainage
T - hickening or lump in the breast or elsewhere
I - ndigestion or swallowing difficulty
O - bvious change in a wart or mole
N - agging persistent cough or hoarseness

Promoting Optimum Care

- Close monitoring and taking actions
- The nurse should regularly assess for pain

Providing Support to Patients and Families

- Patients will need strong support
- The nurse assesses the patient’s understanding, clarifies
misconceptions and offers explanations where needed.
- Providing ample opportunity
- Physical, emotional, and spiritual support

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