ACTIVITY 2

Mr. de la torre, 86 years old, is admitted to your unit and requires assistance with dressing each day. He has a history of T2DM, heart failure, hypertension and
mild cognitive impairment. His medications included glipizide 10 mg. BID, metformin 850 mg. BID, lisinopril 40 mg OD, metolazone 20 mg. OD and donepezil 10
mg. HS.

Mr. de la Torre eats alone as he has no significant others with him. He states he likes to have a companion. He is 6’ tall and last week his weight was 135 pounds
and enjoys spending a time in his garden, tending to his vegetable plants; according to him, when he is in his garden, he wears a straw hat and always has his
water bottle at his side. Mr. de la Torre saw his health care provider last week and a urinalysis was obtained. The results:

● Urine is straw color and clear, pH 4.5, urine specific gravity 1.003, nitrite negative and leukocyte esterase trace, blood negative, WBC 2/hpf and bacteria
occasional.

1. USE AN X TO INDICATE WHICH CLIENT FACTORS LISTED IN THE LEFT COLUMN MAY PLACE TIS CLIENT AT RISK FOR DEHYDRATION.

CLIENT FACTORS RISK FOR DEHYDRATION

86 yrs. Old x
Metolazone 20 mg. daily x
Results of urinalysis
Lisinopril 40 mg. OD x
Eats alone
BMI 18.31 kg/m2

2. Demonstrate/ illustrate on how to dress/undress an elderly client.

DRESSING AN ELDERLY CLIENT:

Getting Ready
Collect bath sheet and necessary clothing and follow getting ready instructions for undressing.
Procedure
Assist the individual by putting on his or her undergarments
Underpants
● Facing the foot of the bed, gather the underpants together at the leg opening and at the waistband
● Working with one foot at a time, slip first one foot and then the other through the waistband and through the leg opening.
● Slide the underpants up the individual’s legs as far as they will go, then ask the individual to lift his or her buttocks off the bed.
● Gently slide the underpants over the buttocks. If the individual cannot raise his/her buttocks off the bed, help the individual to roll first to his or
her strong side, allowing you to pull the underpants up on the weak side. Then roll the individual on to his/her weak side and finish pulling the
underpants up. Adjust the underpants so that they fit comfortably.
 Undershirt
● Facing the head of the bed, gather the top and bottom of the undershirt together at the neck opening.
● Place the undershirt over the individual's head.
● Working with the individual’s weak side first, slip the arms through the arm openings
● Raise the individual's head and shoulders and help the individual to lean forward so that you can pull the undershirt down, smooth out
any wrinkles.

Pants/slacks/trousers
● Assist the individual with putting on his or her outerwear.
● By following the same procedure for putting on underpants.
● Fasten any buttons or zippers, snaps or ties.

Bra
● Working with an individual's weak side first, slip the arms through the straps and position the straps on the shoulders so that the front of
the bra is covering the individual's chest.
● Ensure the straps are not twisted Adjust the cups of the bra over the individual’s breasts.
● Raise the individual's head and shoulders and help the individual to lean forward so that you can fasten the bra at the back. If back
fastening.

Finish Up
● Finish up as for dressing the individual i.e.
1. Provide for comfort
2. Complete a safety check
3. Clean and replace equipment

UNDRESSING AN ELDERLY CLIENT

Getting Ready
● Wash your hands and observe standard precautions as necessary.
● Gather needed supplies.
● Knock and introduce yourself, if the individual is in bed.
● Identify the individual and greet him or her by name.
● Explain the procedure
● Provide for privacy
● Attend to safety
● Establish an individual's willingness to participate.
Pre Procedure
● Get a bath sheet and clothing chosen by the individual
● Provide for privacy, dignity and comfort.
● Follow the individual’s care plan If the individual is in bed and needs assistance, raise the bed to the best level for good body mechanics (this may not be
possible in the home situation).
● Ensure the wheels are locked. Make sure bed rails are up if used.
● Lower the bed rail at the individual’s weak side (if applicable)
● Assist the individual into the supine position (lying on back, face upwards)
● Cover the individual with the bath sheet.
● Fold bed linen down to the foot of the bed.
● Do not expose the individual during the activity

Procedure
● Removing garments that fasten to the back
● Gently lift the individuals head and shoulders and gather the top and bottom of the garment together at the individual’s neck.
● Undo buttons, zippers, ties or snaps
● Working with the individual’s strongest side first, gently remove the arm from the garment by sliding the garment down the arm.
● Repeat with the other arm.
● If it is not possible to lift the individual’s head and shoulders, roll the individual on to his/her side facing away from you.
● Working with the individual’s strongest side first, gently remove the arm from the garment.
● Roll the individual on to his or her other side facing you and remove the other arm from the garment.
● Remove garment completely by lifting it over the individuals head

Remove pants/underpants or slacks / trousers

● Remove the individuals footwear and socks
● Assist the individual into the supine position
● Undo buttons, zippers etc. Remove a belt if worn
● Ask the individual to lift their buttocks off the bed if possible.
● Slide the garment down over the hips and buttocks. Have the individual lower the buttocks.
● If the individual cannot raise their hips off the bed
● Turn the individual towards you
● Slide the garment off the hips and buttocks on the strong side (if applicable)
● Turn the individual away from you
● Slide the garment off the buttocks on the weak side.
● Slide the garment down over the feet.
Assist the individual to dress as per dressing procedure
● Assist the individual out of bed if he/she is to be up. Cover the individual and remove the bath sheet if the individual is to remain in bed.

Finishing up
● Provide for comfort
● Ask the individual if he/she is comfortable
● Ask the individual if there is anything else you can do for him/her

Complete a safety check

● Lower the bed to its lowest position
● Raise or lower bed rails.
● Follow the individual’s care plan
● Ensure assistive devices are within reach, walker, walking stick, wheelchair etc.
● Floors are free of spills and clutter
● Wash your hands as per local Hand Hygiene Policy

3. Demonstrate on how to feed and elderly patient.

Tray set-up techniques:

● Wash hands
● Make sure silverware is accessible
● Open milk cartons, salt packets, etc
● Butter bread and season food as needed
● Cut meats or breads if needed
● Cue patient to eat if necessary
● Ask resident if there is anything else they need before moving on

Feeding techniques:

● Treat patient with dignity and respect

● Wash hands
● Assure proper positioning of patient
● Feed the patient small bites at a time
● Alternate liquids with solids
● Do not mix foods together
● Cue patient to open mouth if necessary
● Record intake as soon as possible after feeding patient
4. Make a medication study of Mr. de la Torre’s current medication emphasizing on how it affects his condition.

Name of Drug Classification Mechanism of Action Indications and Side Effects Nursing Responsibilities
Contraindications (Before, During, After)

Generic Name: A10BB07 - glipizide Glipizide appears to lower INDICATIONS: ● nausea BEFORE:
; Belongs to the blood sugar quickly by ● vomiting Assessment of:
Glipizide class of inducing the pancreas to Supplementing diet ● loss of appetite
sulfonylureas. Used produce more insulin; and exercise to reduce ● diarrhea History: type 1 diabetes,
Brand Name: however, this effect is blood sugar in people ● constipation significant hepatic or renal
in the treatment of
reliant on the pancreatic with type 2 diabetes. ● upset stomach impairment, uremia,
diabetes.
Glipdin islets' beta cells being ● headache thyroid or endocrine
functional. Oral As an adjunct to insulin ● weight gain dysfunction, glycosuria,
Antidiabetic sulfonylurea therapy, it can help hyperglycemia linked to
hypoglycemic stabilize some primary renal illness, allergy
Sulfonylurea medications' mechanisms instances of type 1 to sulfonylureas, pregnancy.
of action may also include diabetes by lowering
extrapancreatic effects. the need for insulin and Physical: Skin tone, lesions,
lowering the risk of orientation, reflexes,
hypoglycemia episodes. peripheral feeling, R,
adventitious noises, liver
CONTRAINDICATIONS: assessment, bowel sounds,
urinalysis, BUN, serum
Patients with creatinine, LFTs, blood
ketoacidosis, severe sugar, CBC, and a physical
infections, injuries, or examination
other serious
conditions where Check expiration date of
sulfonylurea is unlikely the medication.
to control the
hyperglycemia DURING:
shouldn't take glipizide;
instead, they should Ensure that the appropriate
use insulin. medication is prepared
appropriately, given in the
appropriate dosage, and
given to the appropriate
patient at the appropriate
time and via the
appropriate route. Many
hospitals use a single-dose
approach in order to
restrict or lower the
possibility of administration
errors.

AFTER:
Do health teachings.
Teaching points should be:

● Take this drug 30

minutes before
breakfast for best
results.
● Do not discontinue
this drug without
consulting your
healthcare provider.
● If taking ER tablets,
swallow them whole;
do not crush, chew,
or divide tablets. The
empty tablet may
appear in your stool.
● Avoid alcohol while
using this drug.
● Report fever, sore
throat, unusual
bleeding or bruising,
rash, dark urine,
light-colored stools,
hypoglycemic or
hyperglycemic
 reactions.

Document.

How it affects the condition of the patient:

Glipizide is sometimes combined with other drugs to treat type 2 diabetes, in addition to diet and exercise (condition in which the body does not use
insulin normally and, therefore, cannot control the amount of sugar in the blood). Sulfonylureas are a class of drugs that includes glipizide. Glipizide
lowers blood sugar by encouraging the pancreas to create insulin, a hormone that the body naturally needs to break down sugar. It also facilitates the
body's effective utilization of insulin. This drug only lowers blood sugar in those whose bodies naturally manufacture insulin. Glipizide is not used to treat
diabetic ketoacidosis or type 1 diabetes, a condition in which the body does not create insulin and cannot regulate the quantity of sugar in the blood (a
serious condition that may occur if high blood sugar is not treated). People with diabetes and high blood sugar over time may experience serious or fatal
complications, such as heart disease, stroke, kidney issues, nerve damage, and vision issues. It may be possible to control your diabetes and enhance
your health by taking medication(s), making lifestyle changes (such as diet, exercise, and quitting smoking), and monitoring your blood sugar frequently.
This treatment may also lower your risk of heart attack, stroke, kidney failure, nerve damage (resulting in numb, cold legs or feet and diminished sex
capacity in both men and women), eye issues, such as changes in eyesight or blindness, or gum disease, which are all symptoms of diabetes. The optimal
strategy to manage your diabetes will be discussed with you by your doctor and other healthcare professionals.
Name of Drug Classification Mechanism of Action Indication and Side Effects
Contraindications
Generic Name: A10BD05 - metformin The exact mechanism of INDICATIONS:
and pioglitazone ; action of metformin is
Metformin Belongs to the class of unclear but it appears to When a sulfonylurea or
combinations of oral reduce glucose insulin is used in
Brand Name: blood glucose lowering absorption from the GI combination therapy
drugs. Used in the tract, reduce since neither medication
Actosmet treatment of diabetes. gluconeogenesis and by itself can manage
enhance insulin blood sugar levels in
sensitivity by increasing people with type 2
peripheral glucose uptake diabetes mellitus.
and utilisation.
CONTRAINDICATIONS:
metabolic acidosis,
either acute or chronic,
with or without coma
(including diabetic
ketoacidosis). Renal
failure, severe renal or
hepatic impairment, and
acute circumstances like
dehydration, severe
infection, or shock that
may influence renal
function. severe thyroid
dysfunction, cardiac
failure, CHF, IDDM, and
acute or chronic
drinking. illnesses,
whether acute or
chronic, such as cardiac
or respiratory failure, a
recent MI, or shock, that
may result in tissue
hypoxia pregnancy and
nursing
Nursing Responsibilities
● nausea BEFORE:
● vomiting
● decreased Assessment of History
appetite and Present condition.
● abdominal
discomfort Take a special
● consideration on geria
patients 80 years old and
above with renal
impairment because of
declining kidney function.
Check the expiration date
of the medication.
DURING:
Ensure that the
appropriate medication is
prepared appropriately,
given in the appropriate
dosage, and given to the
appropriate patient at the
appropriate time and via
the appropriate route.
Many hospitals use a
single-dose approach in
order to restrict or lower
the possibility of
administration errors.
AFTER:
Do health teachings to
the patient. Teaching
 points should be:

● Swallow
extended-release
tablets whole; do
not cut, crush, or
chew.
● Do not use this
drug during
pregnancy; if you
become pregnant,
consult with your
health care
provider for
appropriate
therapy.
● Avoid using
alcohol while
taking this drug.

Documentation.

How it affects the condition of the patient:

Metformin is used to treat type 2 diabetes, a form of diabetes mellitus or sugar diabetes that results in high blood sugar levels. In people with this type of
diabetes, the pancreas's insulin is unable to adequately transport sugar into the body's cells. When blood sugar levels are excessively high, metformin
alone, together with an oral diabetes medication known as a sulfonylurea, or insulin, can help lower them and improve how you use food for energy.
Name of Drugs Classification Mechanism of Action
Generic Name: C09AA03 - lisinopril ; Lisinopril competitively
Belongs to the class inhibits
Lisinopril of ACE inhibitors. angiotensin-converting
Used in the enzyme (ACE) from
Brand Name: treatment of converting angiotensin I to
cardiovascular angiotensin II resulting in
Zestril disease. decreased levels of
angiotensin II (a potent
Antihypertensive vasoconstrictor). This
increases plasma renin
activity and reduces
aldosterone secretion. It
also increases bradykinin
levels.
Indications and Side Effects
Contraindications
INDICATIONS:
Treatment of
hypertension alone or in
combination with
thiazide-type diuretics
Treatment of stable
patients within 24 hr of
acute MI to improve
survival with beta
blocker, aspirin, or
thrombolytics
CONTRAINDICATIONS:
History of angioedema
related to previous
treatment with ACE
inhibitors, hereditary or
idiopathic angioedema.
Bilateral renal artery
stenosis. Pregnancy
(2nd or 3rd trimester),
lactation.
Nursing Responsibilities
(Before, During, After)
● dry cough BEFORE:
● dizziness
● headache Assessment of History and
● tiredness Present condition.
Keep epinephrine readily
available in case of
angioedema of the face or neck
region; if breathing difficulty
occurs, consult physician, and
administer epinephrine.
Store between 20-25°C. Protect
from freezing and excessive
heat.
Check the expiration date.
DURING:
Ensure that the appropriate
medication is prepared
appropriately, given in the
appropriate dosage, and given
to the appropriate patient at
the appropriate time and via
the appropriate route. Many
hospitals use a single-dose
approach in order to restrict or
lower the possibility of
administration errors.
AFTER:
Notify the surgeon, and mark the
patient's chart with notice that
lisinopril is being taken. The
angiotensin II formation
subsequent to compensatory
renin release during surgery will
be blocked. Hypotension may be
reversed with volume expansion.

Monitor patients on diuretic

therapy for excessive hypotension
following the first few doses of
lisinopril.

Do health teachings to the

patient. Teaching points should
be:

Take this drug once a day. It

may be taken with meals. Do
not stop taking without
consulting your health care
provider.

Be careful with any conditions that

may lead to a drop in blood
pressure (such as diarrhea,
sweating, vomiting, dehydration).
If light-headedness or dizziness
occurs, consult your health care
provider.

Documentation.
Name of Drug Classification Mechanism of Action
Generic Name: C03BA08 - Absorption: Variable
metolazone ; absorption depending on
Metolazone Belongs to the class the formulation. Slowly
of low-ceiling and incompletely absorbed
Brand Name: sulfonamide from the gastrointestinal
diuretics. tract. Bioavailability:
Zaroxolyn Approx 65%. In some
counties, rapidly absorbed
and enhanced
bioavailability formulation
may be available.
Distribution: Crosses the
placenta and enters breast
milk. Volume of
distribution: 113 L. Plasma
protein binding: 95%
(approx 50-70% to RBCs;
15-33% to plasma
proteins).
Metabolism: Not
metabolised to a
substantial extent.
Excretion: Mainly via urine
(80-95% as unchanged
drug). Elimination half-life:
8-14 hours.
Indication and
Contraindication
INDICATIONS:
Treatment of hypertension
alone or in combination
with thiazide-type diuretics.
Adjunctive therapy in CHF
for patients unresponsive to
diuretics and digitalis alone
CONTRAINDICATIONS:
History of angioedema
related to previous
treatment with ACE
inhibitors, hereditary or
idiopathic angioedema.
Bilateral renal artery
stenosis. Pregnancy (2nd or
3rd trimester), lactation.
Side Effects Nursing Responsibilities
(Before, During, After)
● GI upset BEFORE:
● decreased
appetite Assessment of History and
● change in Present condition.
taste
perception Assess blood pressure
● dizziness periodically and compare to
● lightheadedn normal values to help document
ess antihypertensive effects. Report
low blood pressure (hypotension)
or other cardiac symptoms such
as chest pain or palpitations.
Check medication’s expiration
date.
DURING:
Ensure that the appropriate
medication is prepared
appropriately, given in the
appropriate dosage, and given to
the appropriate patient at the
appropriate time and via the
appropriate route. Many
hospitals use a single-dose
approach in order to restrict or
lower the possibility of
administration errors.
AFTER:
Do health teachings to the
patient. Teaching points should
be:
 Remind patients to take
medication as directed to control
hypertension and other cardiac
conditions even if they are
asymptomatic.

Counsel patients about additional

interventions to help control
blood pressure and cardiac
dysfunction, including regular
exercise, weight loss, sodium
restriction, stress reduction,
moderation of alcohol
consumption, and smoking
cessation.

Documentation.

How it affect the patient’s condition:

● Metolazone is a diuretic, or "water pill," that raises the amount of urine you produce, causing your body to flush out extra water.
High blood pressure is treated with this medication. This drug also lessens swelling/fluid retention (edema), which can be caused
by illnesses including congestive heart failure or kidney disease. Lowering high blood pressure helps avoid strokes, heart attacks,
and kidney issues. This may assist with symptoms including breathing difficulties.

Name of Drug Classification Mechanism of Action Indications and Side Effects Nursing Responsibilities
Contraindications (Before, During, After)

Generic Name: N06DA02 - Donepezil selectively INDICATIONS: ● nausea BEFORE:

donepezil ; Belongs and reversibly inhibits ● vomiting
 Donepezil to the class of the Symptomatic treatment ● headache Assessment of History and Present
anticholinesterases. acetylcholinesterase of mild to moderate ● diarrhea condition.
Used in the enzyme, which Alzheimer's dementia.
Brand Name: management of normally breaks down CONTRAINDICATIONS: Donepezil treatment should only be
dementia. acetylcholine. The started when there is a responsible person
Alzancer main pharmacological Hypersensitivity to (a relative of the patients, caregiver etc.)
actions of this drug donepezil HCl or who can regularly monitor the medicine
are believed to occur piperidine derivatives. intake of the patient.
as the result of this
enzyme inhibition, Check the expiration date of the
enhancing cholinergic medication.
transmission, which
relieves the symptoms DURING:
of Alzheimer's
dementia. Ensure that the appropriate medication is
prepared appropriately, given in the
appropriate dosage, and given to the
appropriate patient at the appropriate
time and via the appropriate route. Many
hospitals use a single-dose approach in
order to restrict or lower the possibility of
administration errors.

AFTER:

Check for vagotonic effects (like

bradycardia) may occur on the heartbeat
due to the pharmacological effects of the
cholinesterase inhibitors.

Documentation

How does this medication affect the patient’s condition:

● In the brain of a person with Alzheimer’s disease, there are lower levels of a chemical called acetylcholine. Acetylcholine helps to send messages
between certain nerve cells. In Alzheimer’s disease some of the nerve cells that use acetylcholine are also lost. Because of these changes in the brain,
symptoms of Alzheimer’s disease get worse over time. Donepezil, rivastigmine and galantamine all prevent an enzyme called acetylcholinesterase from
breaking down acetylcholine. This means there is a higher concentration of acetylcholine in the brain, which leads to better communication between
nerve cells. This may ease some symptoms of Alzheimer’s disease for a while.
 5. Solve for his BMI
BMI= weight in kilograms (kg) divided by height in meters squared (m²)
BMI= 61.2kg/1.82m²
BMI=18.3

6. Calculate for his BMR with the given formula.

BMR= 88.362+ (13.397x weight in kg) + (4.799 x height in cm) - (5.677 x age in years)
BMR= 88.362+ (13.397x 61.2kg) + (4.799 x 182cm) - (5.677 x 86)
BMR= 1,293 calories per day

7. Calculate for his caloric need for a day.

Multiply BMR by activity level using the Harris Benedict Equation.

sedentary: multiply BMR by 1.2

lightly active: multiply BMR by 1.375
moderately active: multiply BMR by 1.55
very active: multiply BMR by 1.725
extra active: 1.9

BMR= 1,293 x 1.375

= 1,778 calories per day

8. Try to make a diet plan for Mr. de la Torre basing on the My Plate or the Food Pyramid

MON TUE WED THUR FRI SAT SUN

B-FAST 4pcs. small pan de sal, 1 medium piece 1 cup of rice, 1 1 pc avocado 1 cup of rice, 1pc 1 medium sized 1 cup of rice, 2
3 glasses of water of camote, 3 fried bangus, 1 toast, 3 glasses of fried bangus, 2 cassava, 3 glasses servings of
glasses of water serving water servings of of water chopsuey, 1
ampalaya, 3 papaya green servings of lean
glasses of water, with malunggay, meat, 3 glasses
1 slice of mango 3 glasses of water water

SNACK 1 slice of papaya, 2 2 small slice of 2 pcs pinaypay, 2 1 pc banana que, 2 medium piece 1 medium piece 1 pc suman, 2
 glasses of water pineapple, 2 glasses of water 2 glasses of water loaf with peanut boiled camote glasses of water
glasses of water butter, 2 glasses
of water

LUNCH 1 cup of rice, 2 servings 1 cup of rice, 1 1 cup of rice, 2 1 cup of rice, 2 1 cup of rice, 1 pc 1 cup of rice, 1pc 1 cup of rice, 2
(30g) of pork adobo, 2 servings of beef servings of beef servings of fried, 2 servings fried bangus, 2 servings of pork
glasses of water, 1pc steak, 2 servings stew, 1 ½ serving chopsuey, 1 of ampalaya, 2 servings of sinigang, 1
medium sized banana of ginisang of carrots and servings of lean glasses of water papaya green servings of
talong, 2 glasses potatoes, 2 glass meat, 2 glasses with malunggay, kangkong, 2
of water, 1pc of water, 1 slice water 2 glasses of water glasses of water,
mango of watermelon 1 pc banana

DINNER 1 cup of rice, 2 servings 1 cup of rice, 1 1 cup of rice, 2 1 cup of rice, 1 1 cup of rice, 1 1 cup of rice, 1 1 cup of rice, 1
utan bisaya, 1 slice of serving of servings of fried galunggong, fried bangus, 1 servings of beef fried bangus, 1
big papaya, 2 glasses of ginisang talong, kalabasa, 2 1 serving of serving steak, 2 servings serving
water 1pc pritong isda, glasses of water chopsuey, 2 ampalaya, 2 of ginisang ampalaya, 2
2 glasses of water glasses of water glasses of water, talong, 2 glasses glasses of water,
1 slice of mango of water, 1pc 1 slice of mango
mango

GONZALES, KATRINA A. BSN2 N3

NUTRITION AND DIET THERAPY