Repuya, Jenea Mae

3E Geriatrics
Gerontological Nursing collaborated to develop the Hartford Geriatric Nursing
History of Gerontological Nursing Initiative (HGNI) in 2003.
• Rich in diversity and experiences • The Journal of Gerontological Nursing Research was
• Increasing life expectancy emerged in 2008.
• Larger numbers of older people over the next decades. • In 2011, Baby boomers enter the older age group.
• Health prevention and promotion What’s in name
• Nightingale and Norton provided an early insight into GERIATRICS Greek words “geras,” meaning old age,
the “care of the aged”. and “iatro,” meaning relating to
• Florence Nightingale was the first geriatric nurse. She medical treatment. Medical specialty
is the nurse superintendent in an English institution. that deals with the physiology of aging
• Doreen Norton provided a well-versed speech about and with the diagnosis and treatment
geriatric nursing at the annual conference of the of diseases affecting older adults.
Student Nurses Association in London. GERONTOLOGY Greek words “gero,” meaning related
• She identified the advantages of learning geriatric care to old age, and “ology,” meaning the
in basic nursing education as: study of. Study of all aspects of the
o Learning patience, tolerance, understanding aging process.
and basic nursing skills GERONTICS Nursing care and the service provided
o Witnessing the terminal stages of disease and to older adults.
the importance of skilled nursing care. Holistic view of aging with the goal of
o Preparing for the future, because no matter increasing health, providing comfort,
where one works in nursing the aged will be and caring for older adult need
a great part of the care. SOCIAL Aspect of gerontology which mainly
o Recognizing the importance of appropriate GERONTOLOGY concerns the social aspects of aging
rehabilitation, which calls upon all the skill that versus the biological or psychological.
nurses possess This also help to understand how the
o Being aware of the need to undertake biological processes of aging influence
research in geriatric nursing the social aspects of aging
• In 1960, ANA recommended a specialty group for GEROPSYCHOLOGY A branch of psychology concerned
geriatric nurses and the formation of geriatric nursing with helping older persons and their
division as well as convened the first national nursing family’s main well-being, overcome
meeting on geriatric nursing practice. problems and achieve maximum
• In 1970s, the ANA Standards for Geriatric Practice potential during later life.
and the Journal of Gerontological Nursing were GEROPHARMACOLOGY The study of pharmacology as it relates
published. to older adults
• Enactment of Medicare and Medicaid. FINANCIAL An emerging subfield that combines
• Veterans Administration funded a number of Geriatric GERONTOLOGY knowledge of financial planning and
Research Education and Clinical Centers (GRECCs) at services with a special expertise in the
VA medical centers across the US. needs of older adults.
• In 1976, the ANA Geriatric Nursing Division changed its GERONTOLOGICAL A combine expertise in gerontological
name to Gerontological Nursing Division and published REHABILITATION nursing with rehabilitation concepts
the Standards of Gerontological Nursing. NURSING and practice.
• National Gerontological Nursing Association was GERONTOLOGICAL A discipline of nursing and the scope
established in early 1980s. NURSING of nursing practice. It involves nurses
• Increased numbers of nurses began to obtain master’s advocating for the health of older
and doctoral preparation in gerontology. persons at all levels of
• Robert Wood Johnson (RWI) Foundation Teaching – prevention
Nursing Homes provided the opportunity for nursing
faculty and nursing homes to collaborate to enhance
care to institutionalized elders.
• In the 1990s, the John A. Hartford Foundation Institute
for Geriatric Nursing was established at the NYU
Division of Nursing.
• The Nurses Improving Care for Health system Elders
(NICHE) program gained a national reputation as the
model of acute care for older adults.
• John A. Hartford Institute for Geriatric Nursing, ANA
and the American Association of Colleges of Nursing
Repuya, Jenea Mae
3E Geriatrics
• Ethnicity
• Socioeconomic status
Older Persons in the Philippines
• 9.1 % of Filipinos aged 60 and over in 2018 lived below
the unbelievably low poverty threshold of Php71 a day
according to IBON foundation.
• More than half (57.3%) of Filipino elderly reported
experiencing some or considerable difficulty in
meeting expenses.
• Healthcare utilization among the elderly is low.
• Only 20% of the senior citizens population have
pension from SSS and GSIS
Attitudes toward Aging and Older Adults Phil health
• Perception towards older adults were influenced by • Government-owned and controlled corporation that
your observations of family members, friends, serves as the national health insurance of the
neighbor, social media and your own experience with Philippines aiding employees nationwide.
older adults. • Contributions are acquired monthly through automatic
• Gerontophobia is the fear of aging and the refusal to deductions that range from P1,400 to P6,600 yearly
accept older adults into the mainstream of society. Senior Citizen Members
• Ageism is an emotional prejudice or discrimination • Senior citizens can claim their PhilHealth benefits in
against aging population (Negative attitude). two ways:
• Age discrimination reaches beyond emotions and • They become lifetime members. These are employed
leads to actions; older adults are treated differently people aged 60 and above or retired individuals who
simply because of their age. paid no less than 120 months of contributions.
• Very few of the “best and brightest” nurses and • They become “automatic” members. Under the
physicians seek careers in geriatrics despite the Expanded Senior Citizen Act or RA 10645, all senior
increasing need for these services. citizens aged 60 and above automatically become
• This is the reason for studying the aging process – to PhilHealth members even if they didn’t pay for monthly
examine the myths and realities, to separate fact from contributions.
fiction, and to gain an appreciation for what older adults HMO
have to offer. • Health maintenance organizations, or HMOs, are
Aging and health provided to employees by companies upon
• The pace of aging population is much faster than in the regularization.
past. • It may come free or deducted monthly from their
• In 2020, the number of people aged 60 years and older salaries.
outnumbered children younger than 5 years. Health Insurance
• Between 2015 and 2050, the proportion of the world's • Agreement formalized through a contract between an
population over 60 years will nearly double from 12% insurer and a policyholder guaranteeing financial
to 22%. support from the former in the event of hospitalization,
Common Health Problems associated with Aging costly surgeries, life-threatening health concerns, and
• Hearing loss even death.
• Cataracts • Aside from healthcare benefits, health or life insurance
• Refractive errors policies come with investments that can be useful
• Back and Neck pain when you retire.
• Osteoarthritis Impact of Aging Members in the Family
• Chronic obstructive pulmonary disease • Emotional
• Diabetes • Financial
• Depression • Structural
• Dementia • Physical
• Older age is also characterized by the emergence of The Nurse and Family Interactions to Older Adults
several complex health states commonly Self - Neglect
called geriatric syndromes. • More likely to be seen when an older person has few
• They are often the consequence of multiple underlying or no close family or friends, but it can occur despite
factors and include frailty, urinary incontinence, falls, their presence.
delirium and pressure ulcers. • Failure to provide for the self because of a lack of ability
Factors Influencing Healthy Aging or lack of awareness.
• Genetic • Most likely to be recognized by neighbors and reported
• Physical and social environments to the police
• Gender
Repuya, Jenea Mae
3E Geriatrics
• Found injured on the street, after a fire, or in some Emotional Abuse
other state of distress. • Most subtle and difficult to recognize type of abuse.
• Connected with some form of mental illness or • Includes behaviors such as isolating, ignoring, or
dementia. depersonalizing older adults.
Indicators of Self – Neglect • Verbal or Non-verbal
• The inability to maintain ADL (personal care, shopping, • shouting or voicing threats of punishment or
meal preparation, household tasks) confinement. Emotional abusers often threaten older
• The inability to obtain adequate food and fluid as adults
indicated by malnutrition or dehydration • sighing, head shaking, door slamming, or other
• Poor hygiene negative body language.
• Changes in mental function, such as confusion, Financial Abuse
inappropriate responses, disorientation, incoherence • Resources of an older person are stolen or misused
• The inability to manage personal finances as indicated • Overly trusting of family members, refusing to believe
by the failure to pay bills or by hoarding, squandering, that their children would steal from them
or giving away money inappropriately Abandonment
• Failure to keep important business or medical • When dependent older persons are deserted by the
appointments person responsible for their custody
• Life-threatening or suicidal acts, such as wandering, • Abandonment usually leaves the older person
isolation, or substance abuse. physically, emotionally, and financially defenseless
Abuse or Neglect by the family • They become wards of the state.
• Intentional abuse occurs when any person deliberately Theories of Aging
plans to mistreat or harm another person. • There is no single universally accepted definition of
• History of family conflict, a history of violence or aging.
substance abuse, those with mental impairment, • Aging is best looked at as a series of changes that
severe financial problems or unemployment. occur over time, contribute to loss of function, and
• Unintentional abuse when the caregiver lacks the ultimately result in the death of a living organism.
necessary knowledge, stamina, or resources needed • The maximal life expectancy for humans today appears
to care for an older loved one. to be 120 years, but why is this so?
Physical Abuse • Theories of aging have been considered throughout
• Any action that causes physical pain or injury. history as mankind has sought to find ways to avoid
• Older people may be locked in bedrooms, or closets aging.
• Older women may be sexually abused or raped. • No one has identified a single unified rationale for why
• Older people are starved or given food that is we age and why different people live lives of different
unsuitable lengths.
• The inappropriate use of drugs, force-feeding, and the • Although there is no question that aging is a biologic
use of physical restraints or punishment of any kind process, sociologic and psychological components
Warning Signs of Physical Abuse play a significant role.
• Bruising Biologic Theories
• Lacerations • Explain the physical changes of aging, the gradual loss of
• Broken teeth function over time
• Broken glasses Programmed Theory
• Sprains and fractures • Everyone has a “biologic clock” that starts ticking at
• Burn marks conception.
• Wounds in various stages of healing • Each individual has a genetic “program” specifying an
• Unexplained injuries unknown but predetermined number of cell divisions.
• Torn or Bloody underwear • As the program plays out, the person experiences
• Signs of vaginal trauma predictable changes such as atrophy of the thymus,
• Delay in seeking medical treatment or history of menopause, skin changes, and graying of the hair.
“doctor shopping,”
• Refusal by the caregiver to let visitors see the older Run-Out-Of-Program Theory
adult. • Every person has a limited amount of genetic material
Neglect that will run out eventually.
• Physical abuse involves one or more actions that cause Rate of Living Theory
harm. • Which proposes that individuals have a finite number
• Neglect is a passive form of abuse in which caregivers of breaths or heartbeats that are used up over time.
fail to provide for the needs of the older person under Gene Theory
their care. • Aging is controlled by genetic materials that are
• Intentional or unintentional encoded to predetermine growth and decline.
Repuya, Jenea Mae
3E Geriatrics
Error Theory mass, increased body fat, and changes in
• Errors in ribonucleic acid protein synthesis cause reproductive function.
errors to occur in cells in the body, resulting in a Immunologic Theory
progressive decline in biologic function • The immune system—an important defense
Somatic Mutation Theory mechanism of the body—weakens over time, making
• Aging results from deoxyribonucleic acid (DNA) an aging person more susceptible to disease.
damage caused by exposure to chemicals or radiation Calorie Intake Theory
and that this damage causes chromosomal • Low calorie diet combined with high nutrient intake and
abnormalities that lead to disease or loss of function exercise leads to metabolic efficiency.
later in life. Psychosocial Theories
Free Radical Theory • Explain why older adults have different responses to
• Free radicals are unstable molecules produced by the the aging process
body during the normal processes of respiration and Disengagement Theory
metabolism or following exposure to radiation and • Most controversial
pollution. • Explain why aging persons separate from the
• These free radicals are suspected to cause damage mainstream of society
to the cells, DNA, and the immune system. • Older people are systematically separated, excluded, or
• Excessive free radical accumulation in the body is disengaged from society because they are not
purported to contribute to the physiologic changes of perceived to be of benefit to the society
aging and a variety of diseases, such as arthritis, • This theory further proposes that older adults desire to
circulatory diseases, diabetes, and atherosclerosis. withdraw from society as they age; the disengagement
• One free radical, named lipofuscin, has been identified is mutually beneficial.
to cause a buildup of fatty pigment granules that cause • Critics of this theory believe that it attempts to justify
age spots in older adults. ageism, oversimplifies the psychosocial adjustment
• The number of free radicals can be reduced by the use to aging, and fails to address the diversity and
of antioxidants, such as vitamins A, C, and E, complexity of older adults.
carotenoids, zinc, selenium, and phytochemicals. Activity Theory
Crosslink or Connective Tissue Theory • Proposes that activity is necessary for successful aging
• Cell molecules from DNA and connective tissue • Active participation in physical and mental activities
interact with free radicals to cause bonds that decrease helps maintain functioning well into old age
the ability of tissue to replace itself. • Purposeful activities and interactions that promote
• This results in the skin changes typically attributed to self-esteem improve overall satisfaction with life, even
aging such as dryness, wrinkles, and loss of at an older age
elasticity. • “Busy work” activities and casual interaction with
Clinker Theory others were not shown to improve the self-esteem of
• Combines the somatic mutation, free radical, and older adults.
crosslink theories Life-Course Theories
• Cause damage to body organs, such as the muscles, • Traces personality and personal adjustment
heart, nerves, and brain. throughout a person’s life.
Wear-and-Tear Theory Erikson’s Theory
• Presumes that the body is similar to a machine, which • Eight stages of psychosocial development
loses function when its parts wear out. • The last of these stages is the domain of late
• As people age, their cells, tissues, and organs are adulthood, but failure to achieve success in tasks
damaged by internal or external stressors. earlier in life can cause problems later in life.
• When enough damage occurs to the body’s parts, • Late adulthood is the time when people normally
overall functioning decreases. review their lives and determine whether they have
• This theory also proposes that good health been negative or positive overall.
maintenance practices will reduce the rate of wear • The most positive outcomes of this life review are
and tear, resulting in longer and better body function. wisdom, understanding, and acceptance; the most
Reliability Theory of Aging and Longevity negative outcomes are doubt, gloom, and despair.
• It is used as a model to describe degradation (disease) Havighurst’s Theory
and failure (death) of human body systems. • Delineates specific tasks for late life.
Neuroendocrine Theory • Specific tasks for late life:
• Focuses on the complicated chemical interactions set o ✔ Adjusting to decreased physical growth
off by the hypothalamus of the brain. and strength
• With age, the hypothalamus appears to be less o ✔ Adjusting to retirement and decrease
precise in regulating endocrine function, leading to income
age-related changes such as decreased muscle o ✔ Adjusting to the loss of spouse
Repuya, Jenea Mae
3E Geriatrics
o ✔ Establishing relationship with one’s age C, and E) and minerals (beta carotene; folic acid; and
group selenium)
o ✔ Adapting social rules in a flexible way • Generally safe when consumed as fruits and
o ✔ Establishing satisfactory living vegetables as part of the overall diet
arrangements • High doses of some antioxidants may cause more
Newman’s Theory harm than benefits
• The theory asserts that every person in every situation, • No proof that antioxidants are effective
no matter how disordered and hopeless it may seem, • Discuss with physician before starting use
is part of the universal process of expanding Hormone Therapy
consciousness—a process of becoming more of • Proposed to replace a reduction in hormones, which
oneself, of finding greater meaning in life, and of naturally decrease with aging
reaching new dimensions of connectedness with other • Includes hormones, such as dehydroepiandrosterone
people and the world. (DHEA), estrogen, testosterone, melatonin, and human
• Identifies the tasks of aging as growth hormone (HGH)
o ✔ Coping with the physical changes of aging • Little evidence to support claims made by advocates
o ✔ Redirecting energy to new activities and • May actually cause more harm than provide benefits
roles, including retirement, grandparenting, • Usually requires prescription or supervised medical
and widowhood; administration
Supplements
o ✔ Accepting one’s own life
• Proposed to replace or enhance nutritional status;
o ✔ Developing a point of view about death
often marketed as “natural” remedies
Jung’s Theory
• Include substances such as ginseng, coral calcium,
• Proposes that development continues throughout life
Echinacea, and other herbal preparations
by a process of searching, questioning, and setting
• No proof of effectiveness o Not regulated by the Food
goals that are consistent with the individual’s
and Drug Administration, so there is no control
personality.
regarding the amount of active ingredients, purity, and
• Life becomes an ongoing search for the “true self.”
quality
• As individuals age, they go through a reevaluation
• High risk for interaction with prescription medications;
stage at midlife, at which point they realize there are
physician must be notified if these products are used
many things they have not done.
Calorie – Restricted Diet
• At this stage, they begin to question whether the
• Proposes that significant calorie reduction can extend
decisions and choices they have made were the right
life; based on studies in rats, mice, fish, and worms;
choices for them – Midlife Crisis
not proven in humans
• Jung proposes that the individual is likely to shift from
• Severe calorie restriction can result in inadequate
an outward focus (with concerns about success and
consumption of necessary nutrients
social position) to a more inward focus
• Studies show that severely underweight persons have
• Successful aging, according to Jung, includes
a higher risk for some diseases and even death
acceptance and valuing of the self without regard to
• Dietary changes should be discussed with a physician
the view of others.
or nutritionist to ensure that adequate nutrition is
Implications for Nursing
maintained.
• Physical theories of aging indicate that, although
Physiologic Changes in Aging Affecting Various
biology places some limitations on life and life
• Changes in body function with age are part of a
expectancy, other factors are subject to behavior and
continuum that starts the moment life begins.
life choices.
• From the moment of conception, tissues and organs
• Nursing can help individuals achieve the longest,
develop in an orderly manner.
healthiest lives possible by promoting good health
• By approximately age 18, the human body reaches full
maintenance practices and a healthy environment.
anatomic and physiologic maturity
• Psychosocial theories help explain the variety of
• The peak years of physiologic function last from the
behaviors seen in the aging population.
late teens through the thirties—the so-called PRIME OF
• Understanding all of these theories can help nurses
LIFE.
recognize problems and provide nursing interventions
• In 50s to 60’s, these physiologic changes become
that will help aging individuals successfully meet the
more apparent.
developmental tasks of aging.
• Beyond 70’s, they are significant and no longer
Alternative and Complementary Therapies to Slow or Reverse
deniable.
Aging
• Heredity, environment, and health maintenance
Antioxidant Therapy
significantly affect the timing of age-related changes.
• Proposed as a method of neutralizing free radicals,
• Some are quite young but appear old. The most
which may contribute to aging and disease processes
severe cases is called progeria.
o Includes a number of vitamins (vitamins A, B6, B12,
Repuya, Jenea Mae
3E Geriatrics
o – 8 or 9 years of age children with progeria • Uneven pigmentation
have the physiology and appearance of 70- • Wrinkling, skin folds, and decreased elasticity
year-old • Dry skin
Leading Causes of Disability Among Older Adults • Hair color tends to fade (gray) and hair distribution
• Arthritis patterns change.
• Heart Disease • Fingernails grow more slowly and become thick and
• Stroke brittle
• Hypertension • Sweat gland function decreases
• Diabetes • Capillary walls become increasingly fragile with age
• Cancer and may hemorrhage, leading to senile purpura - red,
• Heart disease purple, or brown areas commonly seen on the legs and
• Cancer arms.
• Chronic lower respiratory disease • By 70 years of age, the body has approximately 30%
• Cerebrovascular disease fewer cells than at age 40
• Alzheimer disease • Total body fluid decreases with age
Skin • Plasma and extracellular volume remain somewhat
• Largest organ of the body constant, but intracellular fluid decreases
• Functions • Decrease in subcutaneous tissue
o Protection • Increased fragility and increased potential for injury
o Sensation • Reduced healing ability
o Fluid balance • Melanocyte’s activity declines with age
o Temperature regulation o Senile Lentigo
Hair and nails o Seborrheic keratosis
• Are composed of dead keratinized cells. o Cutaneous papilloma
• Hair pigment, or color, is related to the amount of Common Disorders
melanin produced by the follicle and, like skin • Basal Cell Carcinoma and Melanoma
pigmentation, is hereditary. o Commonly observed to older adults who
• Nails are rigid structures that protect the sensitive, spent significant amount of time in the sun.
nerve-rich tissue at the tips of the fingers and toes. o Older men are more at risk for melanoma
• Nails also aid dexterity in fine finger manipulation. o Older men, in particular, should be taught to
Epidermis screen themselves for changes in the skin
• Outermost layer o Suspicious changes should be documented
• Provides protection, keeps out chemicals and and reported so that they can be examined
microorganisms promptly by a physician
• Body’s fluid regulation system
• Regulate body temperature and eliminate waste Pressure Ulcer
products. • Breakdown of the skin and tissues located over bony
• It has melanocytes that produce MELANIN, which prominences
provides protection from ultraviolet radiation. • This is a significant problem for immobilized people
Dermis such as those who are bedridden or confined to
• contains collagen and elastin fibers, which give wheelchairs
strength and elasticity to the tissues. • Changing position every 2 hours helps keep blood
• The sebaceous (oil-producing) and eccrine (sweat flowing and prevent further skin damage.
producing) glands are located in the subcutaneous Inflammation and Infection
tissue, as are the hair and nail follicles and the sensory • Skin inflammation and infection often occur on visible
nerve receptors. body surfaces, such as the face, scalp, and arms,
Subcutaneous tissue making the conditions distressing to older adults
• consists of areolar connective tissue, which connects • Common types of inflammation include rosacea and
the skin to the muscles, and adipose tissue, which various forms of dermatitis
provides a cushion over tissue and bone. • Rosacea appears as redness, dilated superficial blood
• Insulation to regulate body temperature vessels, and small “pimples” on the nose and center of
• WBCs are available to protect from microbial invasion the face
through the skin. • Treatment of vasodilation includes lifestyle
• Blood vessels in the SQ supply the tissue with modification, for example avoidance of triggers such
nourishment and assist in the process of heat as stressful situations, extreme heat, sun exposure,
exchange. spicy foods, and alcoholic beverages.
Normal Aging Changes • Oral and topical medications or light and laser
• Thinning of skin treatments may provide some benefits.
Repuya, Jenea Mae
3E Geriatrics
• Common dermatitis in older adults is contact, allergic • The spinal cord, the nerve tissue that extends
and seborrheic downward from the brain, passes through the vertebral
• Contact and allergic dermatitis appear as rashes or canal
inflammation that is either localized to certain areas of • The bones of the spinal column protect this nerve
the body or generalized tissue from injury.
• Seborrheic dermatitis is an unsightly skin condition Joints, Tendons and Ligaments
characterized by yellow, waxy crusts that can be either • Joints are the places where bones meet.
dry or moist • Cartilage, allows free movement of the joint surfaces.
• Infectious diseases of the skin and nails commonly • Many of these joints contain a bursa, which is a fluid
seen in older adults include herpes zoster (shingles); sac that provides lubrication to enhance joint mobility.
fungal, yeast, and bacterial infections; and infestation • Tendons are structures that connect the muscles to
with scabies (mites). the bone.
Hypothermia • Ligaments are structures that connect bones to other
• The decrease in subcutaneous tissue reduces the older bones.
adult’s ability to regulate body temperature. Muscles
Musculoskeletal System • Types of muscles: Cardiac, Smooth and Skeletal.
• The skeletal bones provide a rigid structure that gives • Cardiac muscle, located only in the heart, is
the body its shape. responsible for the pumping action of the heart that
• Red bone marrow in the cavities of spongy bones maintains the blood circulation.
produces red blood cells (RBCs), platelets, and WBCs. • Smooth muscle is found in the walls of hollow organs
• Ribs and pelvis protect easily damaged internal organs. such as the blood vessels, stomach, intestines, and
• Muscles provide a power source to move the bones. urinary bladder.
• Combined functions of bones and muscles allow free • Skeletal muscle accounts for the largest amount of
movement and participation in the activities necessary muscle tissue in the body. The major function of
to maintain an active life skeletal muscle is to move the bones of the skeleton.
Bone • Controlled and coordinated movement of bones and
• consists of protein and the mineral (calcium and muscles allows us to perform the variety of
phosphorus). movements required for activities of daily living.
• Calcium is necessary for bone strength, muscle • Special effort and practice allow us to perform special
contraction, myocardial contraction, blood clotting, and activities such as dancing, playing sports, and playing
neuronal activity. the piano.
• Vitamin D is needed for the absorption of calcium and Expected Age-Related Changes
phosphate through the small intestine. • Loss of calcium.
• Vitamins A and C are needed for ossification, or bone • This change begins between age 30 and 40. • Skeletal
matrix formation. bones become thinner and relatively weaker.
• Hormones also play an important role in bone • Women lose approximately 8% of skeletal mass each
maintenance. decade, whereas men lose approximately 3%.
o Hormones also play an important role in bone • Decalcification of various parts of the skeleton, such as
maintenance. the epiphyses, vertebrae, and jaw bones, can result in
o Calcitonin, produced by the thyroid gland, increased risk for fracture, loss of height, and loss of
slows the movement of calcium from the teeth.
bones to the blood, lowering the blood • The intervertebral disks shrink as the thoracic
calcium level. vertebrae slowly change with aging – Kyphosis.
o Parathyroid hormone (PTH) increases the • Connective tissues tend to lose elasticity, leading to
movement of calcium from the bones to the restriction of joint mobility.
blood, increasing the blood calcium level. • Muscle tone and mass typically decrease with aging,
o Insulin and thyroxine aid in the protein and these decreases are directly related to reductions
synthesis and energy production needed for in physical activity and exercise.
bone maintenance. • Decreased in endurance and agility.
o Estrogen and testosterone, produced by the • Absorption and metabolism of drugs can be
ovaries and testes, respectively, help retain significantly different from those in younger persons.
calcium in the bone matrix. Common Disorders seen with Aging
Vertebrae Osteoporosis
• The spinal column supports the head and allows for • Excessive loss of calcium from bone combined with
flexible movement of the back. insufficient replacement.
• Spinal column consists of cervical, thoracic, lumbar, • It is characterized by porous, brittle, fragile bones that
and sacral vertebrae. are susceptible to breakage.
Repuya, Jenea Mae
3E Geriatrics
• Factors that increase the risk for osteoporosis include o Dietary supplements, such as glucosamine
the following: and chondroitin sulfate.
o Female gender • Medication precautions:
o Caucasian or Asian race o Chondroitin can potentiate blood thinners
o Small body frame o Patients allergic to seafood should avoid
o Family history of osteoporosis glucosamine, because it is made from
o Poor nutrition (diet low in calcium and vitamin shellfish shells
D) o Intraarticular injection of hyaluronic acid, it
o Malabsorption disorders, such as celiac does provide pain relief to some people, but
disease often only temporarily.
o Menopause (low estrogen levels) • In severe cases, arthroscopic removal of bone
o Chemotherapy fragments or surgical joint replacements may be
o Lack of exercise/immobility necessary.
o Excessive alcohol consumption Rheumatoid Arthritis
o Cigarette smoking • is a collagen disease that results from an autoimmune
o Hormonal imbalances (hyperthyroidism and process, affecting more women than men.
hyperparathyroidism) • This disease causes inflammation of the synovium,
o Long-term use of medications, including damage to the cartilage and bone of joints, and
phenytoin (Dilantin), heparin, and oral instability of ligaments and tendons that support the
corticosteroids joints.
• Bone mineral density (BMD) may be assessed in • This can be resulted to muscle atrophy, soft tissue
someone at risk for osteoporosis changes, and bone and cartilage changes.
• Measurement of bone density generally reflects its • Symptoms include:
strength and ability to bear weight. o Pain and stiffness, particularly after rest
• This can be best prevented and treated by lifestyle o Warm, tender, painful joints
modifications and medications o Fatigue
• Lifestyle modifications such as: o Sense of feeling unwell
o well-balanced diet with adequate amounts of o Occasional fevers
calcium and vitamin D, • Treatments include lifestyle changes such as stress
o regular weight-bearing exercise, reduction, balanced rest and exercise, and joint care
o smoking cessation using splints to support joints.
o restriction of alcohol intake. • Early (within 2 years of onset) and aggressive
• Medications needed are: treatment is being advised for some patients to try to
o Anabolic drugs - increase bone strength and encourage remission and avoid joint damage.
density • Medications include:
▪ Testosterone o NSAIDs, such as aspirin, acetaminophen,
▪ Oxymetholone ibuprofen, and naproxen
o Antiresorptive medications -inhibit bone loss. o Corticosteroids, such as methyl prednisone
▪ Alendronate (Fosamax) o Disease-modifying antirheumatic drugs
▪ Calcitonin (Calcimar) (DMARDs), such as cyclosporine,
• Most common form for arthritis azathioprine, sulfasalazine, and methotrexate
• Not a normal part of aging. o Tumor necrosis factor inhibitors, such as
• The cartilage within a joint begins to break down and etanercept and infliximab
the underlying bone begins to change. o Interleukin-1 inhibitor, such as anakinra
• Abnormal cartilage or bony enlargement may be seen • Surgical interventions, including synovectomy, tendon
in the distal finger joints – Heberden nodes. reconstruction, and joint replacement, may be
• Risk factors are: performed.
o Obesity Bursitis
o Age • inflammation of the bursa and the surrounding fibrous
o Joint injury or overuse tissue.
o Genetic • can result from excessive stress on a joint or from a
o Muscle weakness localized infection.
• Can be treated with the combination of exercise, weight • commonly results in joint stiffness and pain in the
control, physical or occupational therapy, and shoulder, knee, elbow, and hip, ultimately leading to
medications. restricted or reduced mobility
• Medication Therapy • Treatment includes resting the joint and administering
o NSAIDs NSAIDs.
o Corticosteroids • Corticosteroid preparations are occasionally injected
into the painful areas to reduce inflammation.
Repuya, Jenea Mae
3E Geriatrics
• Mild range-of-motion exercise is encouraged to • Decrease tissue elasticity in the alveoli and lower
prevent permanent reduction or the loss of joint lung lobes
function. o Decrease gas exchange, increase pooling
Gouty Arthritis secretion
• is caused by an inborn error of metabolism that results • Decrease muscle strength and endurance
in elevated levels of uric acid in the body. o Decrease ability to breathe deeply; diminished
• Crystals of these acids deposit within the joints and strength of cough.
other tissues, causing episodes of severe, painful joint • Decrease number of capillaries
swelling. o Decrease gas exchange
• Chills and fever may accompany a severe attack. • Increase calcification of cartilage
• Untreated cases can be resulted to joint destruction. o Increase rigidity of rib cage; decrease lung
• More often to men and postmenopausal women. capacity
• Recommendations may include reduction of body
weight and decreased intake of alcohol and foods rich Assessment
in purines, such as liver or dried beans or peas. • Assess breathing depth and effort
• Medications are NSAIDs, steroids and anti-gout drugs • Assess cough and sputum production
(Colchicine) • Assess for s/sx of respi infection
• Common first aids include: Nursing care strategies
o Ice therapy • Drink plenty of water • Position to facilitate ease of respiration.
o Elevate and rest affected joints • Encourage incentive spirometer or nebulizer
o Take anti-inflammatory drug such as • Encourage adequate fluid intake
Ibuprofen • Encourage smoking cessation and avoid of
Physiologic Changes in Aging Affecting Various Systems environmental pollutants
(Respiratory System) • Teach avoid individual with active infection.
Respiratory • Hand washing and disposal contaminated secretion.
• Respiratory system provides the body with the oxygen • Encourage annual influenza vaccination
needed for life. Common disorder seen aging
• is typically into two parts and lined with mucous COPD
membrane • Refers to a group of disease that cause airflow
• breathing is the process of inhaling and exhaling, blockage
occurs 12 to 20 times/min • emphysema and chronic bronchitis
• URT: nose, nasal cavity, pharynx, larynx (accessory: • may co-exist with asthma
mouth) • history of smoking or high lvl of exposure
• LRT: trachea, bronchi, bronchiole, alveoli, L and R environmental pollutants.
lungs. • Emphysema: characterized by changes in alveolar
• Inhalation: The diaphragm moves downward, structure. Alveoli loss elasticity become overflowed.
intercostal muscles ribs upward and outward • Chronic bronchitis: inflammation of the trachea and
• Diaphragm and intercostal muscle relax: the bronchioles. Chronic irritation leads to excessive
diaphragm moves upward and the ribs move inward, mucus secretion and a productive cough.
making the chest smaller Video:
• Ventilation: movement of air into and out of the alveoli • Chronic bronchitis: cause of inflamed airways, excess
Video: mucus and coughing.
• Alveoli: covered with larger blood vessels • Emphysema: occurs when tiny air sacs are destroyed
• o2 combine with hemoglobin and leading to repairable holes and make u SOB
• Exhalation: sternum move inward and diaphragm • common cause of CB
moves upward 1. Smoking
• movement of diaphragm and sternum is controlled by 2. 2nd hand smoking
brain 3. Air pollution
Expected Age- Related Changes 4. Exposure to chemical
• Decrease body fluid • Mild COPD: maybe you don't have s/sx
o Decrease ability to humidify air, resulting in • Worse: coughing, wheezing, plem, and SOB
drier mucous membranes s/sx
• Decrease number of cilia • Sob
o Decrease ability to trap debris • Wheezing
o Risk infection • Chest tightness
• Decrease number of macrophages • Chronic cough that may produce mucus (clear, white,
o Increase risk of respiration infection yellow, or greenish)
• Frequent respiratory infection
Repuya, Jenea Mae
3E Geriatrics
• Lack of energy • Coughing exercises
• Weight loss • Chest physiotherapy
• Swelling in ankles, feet’s or legs • Semi - fowler's position
COPD: NURSING INTERVENTION • Increase and electrolytes intake
• Stop smoking • Antibiotics, antiviral and antifungal as ordered
• Medication • Antitussive for cough
o Bronchodilators, mucolytics • Antipyretic
• Lifestyle TB
• O2 therapy • Caused by mycobacterium tuberculosis
• Pulmonary rehabilitation • Every year 10 m ppl fall i'll with tb, 1.5 m ppl die in tb
COPD: Healthy teaching s/sx
• Healthy weight and well balance diet • Exposure
• Drink 6-8 glass/ day o Low grade fever
• Eat 4-6 small meals/day o Fatigue
• Eat complex carbs, good sources, of protein, and o Cough
mono- and poly- unsaturated fats • Latent infection
Influenza o No symptoms during latent tb infection
• Ruffed as flu highly contagious • Active infection
• The virus usually spread through airborne droplets o Cough
• Incubation period: 1-3 days from time on exposure. o Coughing blood or mucus
s/sx o Chest pain
• Fever o Pain with breathing and coughing
• Headache o Fever
• Fatigue o Chills
• Aches o Night sweats
• Cough o Weight loss
• Sore throat o Not wanting to eat or loss of appetite
• Runny or stuffy nose o Loss of appetite
Nursing interventions o Tiredness
• Annual flu vaccine o Not feeling well in general
• Bed rest Nursing interventions
• Administer o2 as ordered • Airborne precautions
• Monitor sao2 • Increase fluid intake
• Monitor vs • Small frequent feeding
• Breathing exercises • Mouth care
• Administer antipyretics • Immune therapy
• Increase fluid intake • Nutrition intake
Pneumonia • Anti tb medication
• Acute inflammation of lungs caused by bacterial, o Isoniazid
viral, fungal, chemical, or mechanical agents o Rifampin
• Happens when air sacs in the lungs fill up with bacteria o Pyrazinamide
or pus o Ethambutol
• Mostly community and hospital acquired Lung cancer
S/sx • Most deadly form cancer in US
• Chest pain • Age range: 55 to 65 years old
• Chills • Carcinogenic
• Chough w/ or without mucus • Small cell lung cancer
• Fever o Occurs almost exclusively in heavy smokers
• Low o2 level in blood • Non-small cell lung cancer
• SOB • Include squamous cell
• Headache Risk factors
• Muscle pain • Smoking
• Fatigue • Exposure to asbestos
• Nausea • History of lc
• Vomiting • Smoking
• Diarrhea • 2nd smoke
Pneumonia: nursing interventions • Previous radiation therapy
• Removal secretions • Exposure to radon gas
Repuya, Jenea Mae
3E Geriatrics
• Family hx • Decrease cardiac muscle tone.
s/sx o Decrease tissue oxygenation related to
• A new cough doesn't go away decreased cardiac output and reserve.
• Coughing blood • Increase heart size, left ventricular enlargement
• Sob o Compensation for decrease muscle tone
• Chest pain • Decrease cardiac output
• Hoarseness of voice o Increase chance of heart failure
• Weight loss • Decrease elasticity of heart muscle and blood vessel
• Bone pain o Decrease venous return, increase dependent
• Headache edema (feet, arms and legs)
Medical intervention o Increase incidence of orthostatic
• Surgery hypotension
• Radiation therapy o increase varicosities (varicose veins) and
• Chemotherapy hemorrhoids
Nursing interventions • Decrease pacemaker cells
• Improve gas exchange o HR rate 40 to 100 beats/min
o Monitor respiration o increase incidence of ectopic
o Provide adequate rest o Decrease pacemaker cells
o Smoking cessation • Decrease baroreceptors sensitivity
o Positioning (sitting - supine - side lying o Decrease adaptation to change in blood
position) pressure
o Deep and lip course • Increase incidence of valvular sclerosis
• Maintain pt airway clearance o increase risk for heart murmur
o Auscultate the characteristics of breath and • Increased atherosclerosis
presence of secretion o increase BP, weak peripheral pulse
o ABG and X-ray Nursing assessment
o Elevate head • Assess apical and peripheral pulses
o Position frequently o Observe closely for abnormal sounds and
o Deep breathing exercises irregular of rhythm
o Determine presence and strength of
Physiologic Changes in Aging (cardiovascular system) peripheral
• The cardiovascular system moves blood through the • Assess blood pressure lying, sitting and standing
body. o Hypotension
• Responsible for transport of blood and O2 and o Encourage patient to change positions slowly
nutrients to all body tissues. and to seek assistance if dizzy
• Transport waste products to the organ that removes • Assess ability to tolerate activity
them from the body. o Instruct patient to rest
Heart Coronary artery disease
• Muscular organ located centrally in the thoracic cavity • Some degree of CAD is present in most person over
between the lungs age 70
• The sternum, or breastbone, protects anterior surface • Caused by plaque buildup the wall of the arteries that
• The tip or apex supply blood to the heart
Blood vessels • Plaque: made up cholesterol deposits.
• Carry blood away from heart Risk factors
• Except pulmonary artery, carries O2 blood. • Smoking
• Aorta, largest artery in the body, leaves the heart and • Hb pressure
branches • High cholesterol
• Vessels run through the entire body to reach all organs • Diabetes
and tissues • Obesity
• Arteries design for high pressure and high • Strong family hx of heart disease
Conduction system s/sx
• Cardiovascular system must work in controlled, • Chest pain (angina)
organize, and rhythmic manner • SOB
• This process empties and fills the chambers, which • fatigue
pump blood through the System • heart attack (MI)
• Pacemaker: electrical conduction of the heart Medical intervention
• SA NODES: natural pacemaker • Cholesterol drugs
Expected age related Changes • Aspirin
Repuya, Jenea Mae
3E Geriatrics
• Beta blockers o Fatigue
• Calcium channel blockers o Dizziness
• Ace inhibitors and arbs o low or high blood pressure, depending on
• Nitroglycerin SOB
• Ranolazine o Abdominal pain due to an enlarged
o Leg swelling
Surgeries Diagnostic test
• Coronary Artery stent • ECG
• Coronary Artery Bypass surgery • Exercise stress tests
• Coronary Artery angiogram • Chest X-ray
Nursing Interventions • CT scan
• Treat angina Medical intervention
o Assess pt angina • Surgery in severe case
o Complete bed rest (semi fowler) o Surgical aortic valve replacement (SAVR)
o Administer 02 as ordered • Medication
o Nitroglycerin o Antibiotic
• Reducing anxiety o Diuretics – Furosemide
o Therapeutic communication o Antiarrhythmic - Lidocaine, Amiodarone
o Stress reduction method o ACE Inhibitors - Captopril, Enalapril
o Addressing spiritual need of the pt o Beta-Blockers – Metoprolol, Bisoprolol
• Reduce Pain o Anticoagulants – Heparin
o Assess level of pain Nursing Interventions
o Identify triggering Factors can cause pain • Assess mental status, Vs, I and O
o Plan pt activity accordingly • Eat healthy balanced diet (low salt and fat)
o Balance activity and rest appropriately • Maintain intake output daily check weight
Health teaching Maintain careful control of blood sugar
• Don't smoke • Adequate ventilation and perfusion
• Control bp • Avoid constipation
• Manage cholesterol • Smoking cessation
• Check blood sugar regularly Cardiac arrhythmias
• Eat heart healthy foods • Including ventricular arrhythmias, atrial fibrillation, and
• Limit alcohol conduction disturbances, common in elderly
• Manage stress • Heart block is a common conduction disturbance
Heart valve disease • Sinus nodes dysfunction called sick sinus syndrome
• Common in elderly Risk factors
• Sometimes can get damage and either become too • Tobacco products
narrow to close • Drinking alcohol
• Heart is unable to pump the blood out and when they • Caffeine
become too loose, the blood keeps on flowing back • Cold medicine and herbal supplements
into the heart. • Hbp
Causes • Bmi higher that 30
• Wear and tear due advancing age • High blood sugar
• Infection • sleep apnea
• Trauma s/sx
• Congenital (born with a detective valve) • In general
• Linked to other disease, like cad • Fluttering in the chest
Common valve disorder • Racing heart beat (tachycardia)
• Aortic stenosis • Slow heartbeat
• Aortic regurgitation • Chest pain
• Mitral stenosis • Sob
• Mitral regurgitation • Other:
s/sx • Anxiety
• mild to moderate may not cause any symptoms • Fatigue
• in severe, most common symptoms of heart valve • Lightheadness
disease: • Fainting
o Chest pain Diagnostic test
o Palpitations caused by irregular • ECG
o Heartbeats • Blood tests
Repuya, Jenea Mae
3E Geriatrics
• Ambulatory monitors • History of taking drugs that can damage
• Stress test your heart muscle, such as some cancer
• Echocardiogram drugs.
• Cardiac catheterization Treatments
• Tilt table test • Regular exercise, such as walking every
• Computed tomography (CT) day.
• Heart MRI (magnetic resonance imaging) • No tobacco products.
Medical intervention • Treatment for high blood pressure
• cardioversion and defibrillation • Medication
• pacemaker therapy • Low-sodium diet
• surgeries • Active lifestyle
o valve surgery • Treatment for high cholesterol
o maze procedure • No alcohol or recreational drugs
Nursing interventions • (ACE-I) or (ARB) if you have coronary
• monitor side effects of arrhythmias medication artery disease, diabetes, high blood
• limit stress pressure or other vascular or cardiac
• well-balanced diet conditions.
• vagal maneuvers Stage B • Stage B (pre-heart failure) means your left
• lifestyle changes ventricle isn’t working well and/or is
o manage bp structurally abnormal but you’ve never
o avoid tobacco had symptoms of heart failure
Health Failure Treatment:
• Primarily a problem of the aging population. • Treatments for Stage A.
• The patient’s lungs are often congested, and edema • (ACE-I) or (ARB) if your EF is 40% or
appears because the heart’s pumping action is lower.
ineffective. • Beta-blocker if you’ve had a heart attack
• Not a single disease but rather a syndrome that and your EF is 40% or lower (if you aren’t
accompanies and results from many other disorders. already taking one).
• Coronary artery disease, MI, hypertension, valve • Aldosterone antagonist if you’ve had a
disease, and cardiac infection or inflammation may heart attack or if you have an EF of 35%
increase the risk for HF. or less.
• Diseases of other body systems, including bronchitis, • Possible surgery or intervention as a
emphysema, asthma, hyperthyroidism, liver disease, treatment for coronary artery blockage,
kidney disease, and anemia, can also lead to HF. heart attack, valve disease (valve repair or
• Metabolic changes and fluid and electrolyte replacement) or congenital heart disease.
imbalances seen with malnutrition can lead to HF. Stage C • People with Stage C heart failure have a
• Excessive sodium intake with fluid retention congestive heart failure diagnosis and
increases the risk for HF. currently have or previously had signs and
• The effects of alcohol, digoxin, hormones, some symptoms of the condition.
antineoplastics, corticosteroids, and NSAIDs can Treatment
directly or indirectly lead to HF. • Treatments from Stages A and B
• Beta-blocker
• Aldosterone antagonist
• Sodium-glucose transport 2 inhibitors
(SGLT2i)
• Medications that slow your heart rate if
your heart rate is faster than 70 beats per
minute and you still have symptoms
• A diuretic (“water pill”) if symptoms
Stage and Treatments continue
Stage A Signs and Symptoms • Restriction of sodium (salt) in your die
• Hypertension • Weight tracking every day. Tell your
• Diabetes healthcare provider if you gain or lose
more than 4 pounds.
• Coronary artery disease
• Possible fluid restriction
• Metabolic syndrome
Possible cardiac resynchronization
• History of alcohol use disorder
therapy (biventricular pacemaker)
• History of rheumatic fever
• Family history of cardiomyopathy
Repuya, Jenea Mae
3E Geriatrics
• Possible implantable cardiac lumen is completely obstructed, tissue death may
defibrillator (ICD) therapy result.
Stage D • People who have Stage D HFrEF have • An early symptom of arterial occlusive disease is pain.
&reduced advanced symptoms that don’t get better • Intermittent claudication, which manifests as a
EF with treatment. This is the final stage of cramping pain in the legs during or after walking, is
(Ejection heart failure. common with diminished peripheral circulation.
Fraction) Treatment • Severe circulatory impairment can result in tissue
• Treatments for Stages A, B and C. In necrosis and may require amputation.
addition, it includes evaluation for more • Acute occlusion may occur if a thrombus or embolus
advanced treatment options, including: obstructs the blood vessel. Sudden pain, pallor,
o Heart transplant pulselessness (the “3 Ps”), loss of sensation, or a
o Ventricular assist devices change in body temperature should be assessed and
o Heart surgery reported promptly
o Continuous infusion of inotropic Nursing Intervention
drugs • Manage Acute Pain
o Palliative or hospice care o Assess the pain characteristics
Cardiomegaly o Assess patient’s prior pain relief efforts
• It is enlargement of the heart, which is often related to o Administer pain relief medication as ordered
chronic HF. o Instruct the patient to avoid massaging
• The muscles of the left ventricle hypertrophy in an affected extremities.
attempt to improve the output of blood from the heart o Encourage exercise
to meet the body’s tissue demands for oxygenated • Assess the environment and self-care abilities
blood. • Assess for mobility issues
• Right-sided enlargement is a result of increased • Prevent fall when walking
resistance in the pulmonary circulation. When one • Manage underlying cause of PVD
side of the heart is weakened, the other side is soon • Educate on lifestyle modifications
affected. • Instruct patients on foot care
• Stop smoking
Varicose Veins
• Varicose veins are seen when blood pools in the veins
and dilates or stretches them.
• The decrease in vascular muscle tone that occurs
with aging increases the risk for this.
• Varicosities are most often seen as a twisting
discoloration in the superficial veins of the lower
• In some people, an enlarged heart (cardiomegaly) extremities.
causes no signs or symptoms. Others may have these Signs and Symptoms
signs and symptoms of cardiomegaly: • Pain, heaviness or discomfort
o Shortness of breath, especially while lying flat • Leg cramps
o Waking up short of breath • Swelling of the legs
o Irregular heart rhythm (arrhythmia) • Itching around the ankles or legs
o Swelling (edema) in the belly or in the legs • Burning sensation
Nursing Interventions • Changes in the skin, like change in skin color or
• Address the underlying problem thickening of the skin.
• Monitor blood pressure and I/O • Chronic sore or leg ulcer
• Control hypertension • Clotting of the blood, be it deep vein thrombosis or
• Assist patient to do pursed-lip breathing thrombophlebitis
• Encourage the patient to rest • Excessive bleeding from the varicose vein
• Administer oxygen supplement as ordered Varicose Veins
Peripheral Vascular Disease • Older adults who are obese, are inactive, or spend a
• Vessel changes with aging can lead to mild or severe great deal of time standing are more likely to have
problems. varicosities.
• If the lumen becomes too narrow, blood flow to • The risk for inflamed varicosities increases with age
peripheral sites, particularly the lower extremities, may • Varicosities can result in leg cramps or a dull, aching
be restricted. pain in the legs.
• This decreased blood flow deprives the tissue of • Patients can reduce or prevent related problems by:
oxygen and nutrients and causes ischemia. If the o Avoid constricting garments, such as garters
or rolled stockings.
Repuya, Jenea Mae
3E Geriatrics
o Refrain from sitting with crossed legs. o Renal, vascular, and endocrine pathologic
o Increasing activity conditions are among the most common
o Rest with the legs elevated causes of secondary hypertension.
o Wear elastic stockings that promote venous • Essential hypertension tends to have a gradual onset
return and is often asymptomatic until complications arise.
Aneurysm • Most often, hypertension is discovered during a
• Aneurysm, the pouching or ballooning of arteries, is routine physical examination.
common in older adults who suffer from • It is diagnosed based on two elevated blood pressure
arteriosclerotic blood vessel changes. determinations on three separate days.
• Older adults with a history of angina, MI, or HF are at • A reading of 140/90 mm Hg is considered the upper
increased risk for developing aneurysms. limit of normal in adults.
• As parts of the muscular walls of the arteries develop Common signs and symptoms
plaque and become rigid, other areas of the vessels • Headache
stretch, dilate, and weaken. • Chest pain
• The walls of the dilated areas become thin and prone • Blurring of vision
to rupture. Hypertensive Disease
• Aneurysms of the abdominal aorta are most common • Essential hypertension cannot be cured, but it can be
in older adults. treated.
• These are sometimes observed as a pulsating mass Treatment includes
near the umbilicus, or navel. • nonpharmacologic approaches,
• Patients may have abdominal pain and GI complaints. o Such as rest
• Aneurysms in the thoracic aorta are higher up the o Smoking cessation,
aorta and can present as back pain, cough, or o Use of stress-reduction techniques
hoarseness. o Weight loss, and
Abdominal Aortic Aneurysm o Dietary sodium restriction.
• Signs and Symptoms • Pharmacologic approaches
o Pain in the abdomen or back. The pain may o administration of a thiazide diuretic
be severe, sudden, persistent, or constant. o calcium channel blocker
o Passing out o and either an angiotensin converting enzyme
o Clammy skin inhibitor, or angiotensin receptor blocker (but
o Dizziness not both).
o Nausea and vomiting • The person experiencing hypertension must be
o Rapid heart rate monitored continuously to determine the
o Shock effectiveness of therapy.
• Medical Interventions • Treatment of secondary hypertension is directed at
o Surgery the underlying pathologic condition.
▪ Open abdominal repair Nursing Interventions
▪ Endovascular repair • Weight reduction
o Medications • Adopt DASH
▪ Beta blockers and Calcium channel • Dietary sodium retention
blockers • Physical activity: aerobic physical activities
▪ Phenytoin and Valproic acid Moderation of alcohol consumption
▪ Aspirin, Ibuprofen and Ketorolac
• Nursing Interventions Hematopoietic and lymphatic
o Quit smoking ● Body fluid distribute essential protective factors,
o Keep blood pressure under control
nutrients, oxygen, and electrolytes
o Monitor cholesterol
o Eat healthy and well-balance diet ● The two major fluid of the body are blood and lymph
o Monitor weight ○ Majority of the body is composed of fluid
o Adequate rest approx 91-92% (plasma) 9-8% are wbc rbc
o Encourage patient to be physically active platelets
Hypertensive Disease ● These fluids flow through the body within two parallel
• Essential and Secondary circulatory system
• Essential – no known cause
Blood
o Many factors, including heredity, diet,
● Flows within the heart and vessel
obesity, stress, smoking, increased serum
cholesterol levels, and abnormal sodium ● Gen function
transport ○ Transport
• Secondary – result of an existing disease ○ Regulation
Repuya, Jenea Mae
3E Geriatrics
○ Protection ● Lightheadedness
● RBC ● Chest pain
● WBC ● Tachycardia
○ NEUTROPHILS: bacterial infection ● SOB
● Platelets: clotting agent ● Intervention
Lymphatic system ■ Supplement
● Group of organs, vessels, tissues that protect you ■ Treat underlying cause
from infection and keep a healthy balance of fluid ● Health teaching
● Parallel independent to circulatory ○ Iron rich tablet
● Bone marrow, thymus, lymph ○ Take iron in an empty stomach (pH
Expected physiologic change dependent:2-3)
● Increased plasma viscosity ○ Don't take with antacid
○ Prolonged exposure to chemicals (nicotine) ○ Take with vit C
● Increased vascular occlusion ● Pernicious B12 anemia
○ Processed food ■ Associated with decreased intake or
● Decreased RBC production absorption of vit b12
○ Stimulate mitosis (vit B12 and folic acid) ■ Autoimmune disorder that hurts the
○ Increased incidence anemia parietal cells in the stomach and
● Decreased mobilization of neutrophils inhibits the proper functioning of
○ Less effective phagocytosis intrinsic factor (production of
● Increased immature t cells response enzyme)
○ Decreased immune system ■ Sx:
● Lower serum albumin level ● Fatigue
○ Edema: increased levels of meds that are ● Weakness
highly protein bound ● Headaches
● Chest pain
Nursing assessment and care strategies. ● Weight loss
● Monitor lab tests: Hgb, Hct, WBC, and differentials ● Pale skin
○ Report abnormal finding promptly to primary ● Intervention
care provider ○ Vit B12 with limited physical act (to absorb
● Assess nutri intake of adequate properly)
○ Administer nutritional supplements as ○ Eat food high in b12 and folate
ordered ○ Do not drink alcohol (alcohol causes
Common disorders malabsorption)
Anemia ● Folic acid anemia
● Defined as inadequate levels of rbc or insufficient ○ Caused by poor nutrition, chronic alcohol
anemia abuse, malabsorption such as Crohns's
● Types: disease
● Iron deficiency ○ Sx:
○ Results from inadequate nutritional intake, ■ Reduced sense of taste (red
blood loss, malabsorption (gi problem) , or tongue: numb)
increased physiologic demand ■ Diarrhea
(compensatory mechanism) ■ Pins or needles feeling or
■ Most common is gastrointestinal numbness in your hands and feet
diseases ■ Muscle weakness
■ Green leafy, liver, red meat ● Depression
■ Initially asymptomatic ● interventions
■ Sx: ■ Supplementation (oral, IV,
● Fatigue (lack of O2) subcutaneous)
● Body weakness ■ Eat rich food
● Pale skin, cold hand and ■ Avoid alcohol
feet
Repuya, Jenea Mae
3E Geriatrics
leukemia ● Decreased liver size (expose chemicals), and
● Broad term of cancer in the blood enzyme production
● Types: ○ Decreased ability to metabolize drugs,
● Chronic lymphocytic leukemia leading to increased risk for toxicity
○ Most common Nursing assessment and care
○ Slow progression ● Assess oral cavity for dentition, condition of mucous
○ Asymptomatic initially membrane and hygiene
○ Sx: ○ Educate regarding importance of good oral
■ Enlarged but painless lymph nodes hygiene, stress needs for adequate fluid
■ Fatigue intake. Dental referral as necessary
■ Fever ● Assess swallowing and gag reflex
■ Pain in upper left portion of ○ Encourage posture that facilitates
abdomen (spleen) swallowing. Consult with speech therapy for
■ Night sweats swallow studies and safe dietary regimen
■ Weight loss ● Monitor weight changes
■ Frequent infection ○ Measure record weight at least once a
● Intervention month more often if fluid balance issue is
■ Chemotherapy present
■ Immunotherapy ● Assess intake of nutrient and fluid
■ Radiation ○ Educate regarding recommended diet
■ Bone marrow and stem cell ○ Establish calorie count and i&O if problems
transplant are suspected
Gastrointestinal tract ● Assess bowel sounds and elimination pattern
● Food and fluid containing the nutrients needed for ○ Establish bowel routine, teach importance of
survival normally enter the body through the GI tract adequate fluid fiber and act
● Cells require a regular supply of nutrients to support ○ Administer laxatives, stool softeners,
their normal physiologic activities suppositories, or enemas as needed to
● GI tracts digests, processes and absorbs the prevent constipation and impaction
nutrients, which are used by the cells of the body ● Assess effectiveness of medication
● It stores and discards wastes and plays major role in ○ Observe for therapeutic effect, signs of
maintaining fluid balance by absorbing water toxicity
● The gi tract begins at the mouth Common disorder
Expected age related changes Hiatal hernia
● Increased dental caries or tooth loss ● Protrusion of stomach into the thoracic cavity through
○ Decreased ability to chew normally; the esophageal opening in the diaphragm
decreased nutritional status ● Primary risk factor for hiatal are obesity and ages 50
● Decreased thirst perception and above
○ Increased risk for dehydration and ● Types
constipation ○ Sliding
● Decreased gag reflex ○ Paraesophageal
○ Choking and aspiration ● Reflux episodes occur after meal especially when the
● Decreased muscle tone at pyloric sphincter person lies down immediately after eating
○ Increased incidence of heart hurd (GERD) ● Complaints may includ3 heartburn, acid reflux
● decreased saliva and gastric secretion ; increased difficulty swallowing and sore throat
gastric pH ● Sometimes the symptoms can resemble an angina
○ Decreased digestion and absorption of attack
nutrients, altered absorption of some meds ● GERD is a major problem that can occur with all types
that are pH dependent of hiatal hernia
● Decreased gastric motility (peristaltic movement) ○ Gastric contents move back into the
○ Increased flatulence, constipation, and bowel esophagus
impaction
Repuya, Jenea Mae
3E Geriatrics
○ Present serious concerns in older adults ● Drug induced ulcer related to the use of iron
who have diminished gag or cough reflex supplements, aspirin, and nsaids can also occur in
● Intervention older adults
○ Antacid, histamine antagonist and proton ● Smoking and alcohol is contributory factor
pump inhibitor ● Sx
○ Avoid fatty food, alcohol, carbonated drinks, ○ Generalized pain
and caffeine (stimulates decreased pH lvl) ○ Decreased act level
○ Small but frequent feeding ○ Decreased appetite
○ No midnight snacks after evening meal ○ Weight loss
○ Avoid lying down after eating ○ Vomiting
○ In severe cases, HOB need to be elevated ○ Melena
during sleep ● intervention
Gastritis ○ Antibiotic
● Gasgas lang (ulcer: hukay) ■ Clarithromycin amoxicillin
● Inflammation of stomach lining metronidazole
● Chronic atrophic gastritis: common in older adult ○ Ppi (omeprazole)
○ It is an inflammatory change in the mucous ○ Bismuth salt
membranes of the stomach in which the ○ Stress reduction and rest
mucosa becomes thin and abnormally ○ Smoking cessation
smooth and may develop hemorrhagic Diverticulosis
patches ● Occurs when small bulging pouches (diverticula)
● sx develop in your digestive tract
○ Pain ● Between 30 to 40 people older than age 50 have
○ Burning sensation in the stomach some diverticula, and the incidence of diverticulosis
○ Fatigue (malabsorption) increase with each decade of life
○ Pernicious anemia ● Possible due to low fiber diet
● Interventions ● Sx
○ Antibiotic ○ Abdominal pain and feeling bloated diarrhea
■ Clarithromycin with metronidazole l, ○ Flatulence
amox) ○ Blood in feces
■ PPI (omeprazolel ○ Anemia
■ Antacid ● Intervention
○ Good hygiene ○ Acetaminophen
○ Small and frequent feeding ○ Fiber diet
○ Monitor i and o ○ Exercise
○ Nutrient supplementation ○ Plenty of water
○ Avoid food that may cause gastric irritation ○ Avoid alcohol
(dairy, spicy) Diverticulitis
○ Tobacco and tobacco avoidance ● When one or more pouches become inflamed or
○ Surgery if necessary infected
Ulcers ● Sx
● Peptic ulcer is the most common ○ Severe pain
○ Combination of gastric and buodenal ulcer ○ Fever
(also esophagus) ○ Nausea
● Excavation in the wall of stomach, particularly in the ○ Change in bowel habit
pylorus, duodenum or esophagus ● Intervention (uncomplicated)
● Either occur in aging but gastric ulcer are more ○ Liquid diet
common ○ Oral antibiotic (amoxicillin, cephalosporin,
● Helicobacter pylori has been implicated as major metronidazole)
cause of gastric ulcer ● Intervention (complicated)
Repuya, Jenea Mae
3E Geriatrics
○ Percutaneous drainage (drain excess ○ Warm water bath/ sizt bath
abscess) ○ Stool softener (laxative)
○ iv antibiotic (cefazolin, cefuroxime, PHYSIOLOGIC CHANGE LD RELATED WITH AGING: URINARY
amoxicillin, metronidazole SYSTEM
Cancer • Main: kidney
○ Incidence of cancer rises dramatically at the • Ureters - empty bladder
• Bladder - helps to store urine
layer stage in life
o Ma complete muna
○ Rectal cancer is the most common in older o Normal condition: 30-40mLl/hr
male while colon is common in women o Store: 1-12 1+1x30 13 up 1+2x 30
○ Due to diet and lifestyle • Filtrate blood, eliminate waste
● Sx: • Urethra
● Rectal cancer Urinary system
○ Change in bowel habits • Support hemostasis by eliminating waste and
excessive fluid from the body.
○ Blood in the stool
• Kidney continually filter blood and selectively save or
○ Narrow stool eliminate water, electrolytes and waste products
○ Abd pain • Those substances not reabsorbed on by the kidneys
○ Unexplained weight loss are eliminated
● Colon Urinary production: Filtration, Reabsorption, Secretion,
○ Blood in stool excretion
○ Change in bowel Expected Age- Related Changes
• Decrease number of functional nephrons
● Intervention
o Adult has physical activity (sedentary lifestyle,
● surgery unhealthy eating habits,)
● Chemo o Decrease filtration rate with decrease drug
○ observe for any sign of infection, bleeding, clearance
bruising, and anemia ▪ It will result toxicity
○ Monitor for possible hearing loss and • Decrease blood supply
balance problem o Blood vessels in order adult: constrict due to
alcohol beverage, smoking, high saturated
○ Monitor for any sign of cognitive problems
fats, unhealthy eating
○ Report asap wen the pt develop cough, pain o Removal of body wastes; increased
burning sensation when urinating concentration of urine
○ Monitor temp (38.3 and above) • Decrease muscle tone
○ Wash hands o Decrease stimulation of bladder results
○ Avoid rectal intercourse, tampon, douches, urinary incontinence
enema o Sarcopenia - decrease in muscle strength in
body
○ Avoid raw food
o Increase volume of residual urine
● Health teaching: radiation ▪ Normal: 50-100mL residual urine
○ Eat slowly (fatigue) • Decrease tissue elasticity
○ Small but frequent feeding o Collagen and elastin
○ Be active and plan ADL o Decrease bladder capacity (1000mL/day)
○ Use sunscreen • Delayed or decrease perception of need to void
○ Sleep 8 hrs every night o Di nila napapansin na lalaman na naiihi na pala
sila.
Hemorrhoids
o Increase incidence of incontinence
● Sedentary lifestyle
• Increase nocturnal urine production
● Frequent episode of constipation o Due to disturbed circadian pattern
● WOF: o Alter: history of hospitalizations, work during
○ Rectal bleeding night, grow old
○ Anal itching o Increase need awaken to void or episode of
○ Anal lump nocturnal incontinence
• Increase size of prostate (Male)
○ Painful bowel movement
o Help nourish sperm
● Intervention o Hindi na nagagamit
○ High fiber diet
Repuya, Jenea Mae
3E Geriatrics
o Increase risk infection; decrease stream of o Initiate action to maintain skin integrity
urine; increase hesitancy and frequency of o Insert catheter as order
urination. Urinary Tract Infection
o Located at below the bladder • The incidence of UTIs Increase significantly with age
▪ There's pain during urination • Most common in women than man
Nursing assessment and Care strategies • Both normal changes of aging and the increased
• Monitor of sign of drug toxicity incidence of health problems contribute
o Promptly notify primary care provider of • Risk factors
relevant observation. o Malnutrition
• Assess for urinary frequency o Diabetes mellitus
o Create schedule o Poor bladder control
o Palpate bladder after voiding or use Doppler o Constipated
to determine whether bladder is emptying o Long term hospitalizations
completely o Vaginal atrophy
• Assess for sign and symptoms of urinary tract o Prostate hyperplasia
infection o Unhygienic living conditions
o Obtain a urine specimen for analysis o Altered mental state
• Assess frequently and timing of episode of • Sign and symptoms
incontinence o Hypotension
o Establish a toileting schedule based on o Tachycardia
assessment data. o Urinary incontinence
Common disorder seen with Aging o Poor appetite
Urinary incontinence o Drowsiness
• Involuntary loss of urine or overactive bladder o Frequent falls
• Not a normal part of aging o Delirium
o It happens cause of disorder: DM, • Intervention
Neurological disorder o Antibiotics (Amox and nitrofurantoin)
• Most common in older adult women ▪ Ciprofloxacin and Levofloxacin
• Weak bladder and pelvic floor muscles o Adequate water fluid
• It has medical, emotional, social and economic o Keep genital areas clean
consequences for older adult o Offer toileting as soon possible
o Cause ulceration (peptic ulcers) o Estrogen hormone therapy
• Incontinence may occur due to Chronic renal failure
o Physiologic Changes • Gradual of kidney function
o Medical problems • May result other health condition
o Neurological problem o HPN
Most common
o Changes in ability to function o DM
• Types of incontinence o Chronic
o Stress incontinence UTI
▪ Due to increase abdominal pressure o Urinary tract obstruction
under stress (weak pelvic floor • It may also result from acute renal failure caused by
muscle) o Hypovolemia
o Urge incontinence o HPN
▪ Due to involuntary contraction of the o Antibiotic toxicity
bladder muscles • Medical intervention
o Overflow incontinence o Calcium and phosphorus binders
▪ Due to blockage of the urethra o Antihypertensive and cardiovascular agents
o Neurogenic incontinence o Anti-seizure agents
▪ Due to disturbed function of nervous o Erythropoietin
system o Dialysis
• Intervention • Nursing Interventions
o Assess elimination patterns and fluid intake o Monitor weight I/O, Vs and skin turgor
o Kegel exercise and biofeedback o Promote intake high biological value protein
o Modified clothing to make to toileting easier foods
than o Encourage alternating activity with rest
o Reduce environmental barriers o Encourage increase self-care and greater
o Develop toilet schedule independence
o Provide emotional support and
encouragement Nervous System
Repuya, Jenea Mae
3E Geriatrics
• Thought process, memory, cognition, sensory and o Many have trouble either starting to walk or
motor function stopping once have begun
• Perception, movement and coordination of different o Loss of smell
function of the body (hormones) ▪ (no motor: late sign)
• It processes with and controls body functions and links o Sleep problems
us with the outside world o Constipation
• We perceive sensation and detect changes in our ▪ Bladder and bowel movement affect
environment of dopamine
• We store information about the world o Depression
• Many of the function of the NS occur at an unconscious o Frigidity (gait and balance)
level • Predisposing factor
o Breathing, heart pump, reflexes o Genetic
o Voluntary and o Environment (farmer; prolong exposure to
• Other activities can be done with conscious thought pesticides)
and effort only. • Intervention
• Some activities, such as breathing, occur o Levodopa; minimize the s/sx of Parkinson
unconsciously but can also be controlled consciously. disease (hallucination effect)
Neuro transmitter ▪ Partner with carbidopa
• Epi and nor epi o Amantadine;
• Dopamine and serotonin ▪ anti-dyskinetic drug (robotic
Expected Age changes related movement), controls involuntary
• Decrease number of brain cell and uncontrolled movement
o Di na regenerate yung brain cell o Bromocriptine
o Effect: lifestyle, ▪ dopamine drug, stimulates
o Slowed though process, decrease ability to production of dopamine
respond to multiple stimulus and task o Anticholinergic drugs
• Decrease number of nerve fiber ▪ Orpinodrine drugs
o Slowed fibers are the passageway of the o Provide stress free environment
stimuli to the brain ▪ Lessen depression
o Slow o Deep brain stimulation or DBS
o Decrease reflexes. Decrease coordination ▪ Surgery to produce dopamine,
decreased proprioception implanted
• Decrease amount of neuroreceptors o Watch out medication side effect
o Decrease neurotransmitter ▪ Daytime sleepiness
o Decrease perception of stimuli ▪ Hallucination
• Decrease peripheral nerve function ▪ Decrease BP
o Decrease motor responses, increased risk • (Increase dopamine level;
for ischemic paresthesia in extremities rest and digest
Common disorder seen in Aging ▪ Psychosis
Parkinson’s disease • Schizophrenia
• Paralysis agitans o Assist pt with ambulation
o Increase dopamine ▪ Provide assistive device
• Unknown cause ▪ Independent assistance
• Produce the neurotransmitter dopamine are lost o Encourage Tai Chi exercise
• Symptom usually begin age 40 to 50 years and appear ▪ Stimulate the movement
gradually o Monitor pt weight
Sign and symptoms ▪ Avoid weight gain to avoid disruption
• Onset in ambulation
o Slight tremors on one side o Assess for sign of aspiration pneumonia
▪ Usually, right side ▪ Due to inability swallowing
o General weakness o Assess upright position during feeding
• Progressed Dementia
o Tremors become typical and obvious at rest • Term for a permanent or progressive organic mental
o Both died of the body become affected disorder
o Flat, open- mouthed expression • Common type: Alzheimer disease
o Speech slow and may be unclear • Can be result of
o Swallowing may be affected o Drug intoxication
o Trauma
o CVA
Repuya, Jenea Mae
3E Geriatrics
o Diabetes milieus atrophy, beta-amyloid plaques,
o Disease process neurofibrillary tangles.
o Hormonal imbalance o S/sx
o Vitamin deficiencies ▪ Memory loss
▪ Vitamin D can cause dementia, ▪ Poor judgement
responsible for growth bone also ▪ Difficulty completing task
WARNING SIGN
responsible cognition of our brain ▪ Changes in mood and behavior
• S/sx o Intervention
o Personally Changes ▪ Cholinesterase inhibitors
o Confusion • Limit the break down of
o Disorientation ▪ Memantine (Namenda)
o Deterioration of intellectual functioning • Poor judgment
o Impaired control of memory, judgment and ▪ Vitamin C and E, coenzyme Q10,
impulses selenium, gingko biloba
• Types of dementia ▪ Provide games and activities to their
o Vascular Dementia cognitive level
▪ Result from hemorrhage or ischemic ▪ Help them remember who they are
brain lesions and the exact ▪ Provide stress free and safe
symptoms depends on the are of the environment
brain affected ▪ Put name tag with complete details
▪ Onset is usually sudden ▪ Use signage around the house
▪ HPN or other types of
cerebrovascular disease are most
likely to develop this form of
dementia
▪ Identify and treat the factor that
contribute to the development
o Dementia with Lewy bodies (DLB)
▪ Protein found
▪ Caused microscopic protein clumps
in the brain (lewy bodies) that cause
damage to nerve cells
▪ Visual hallucination
▪ Experience Parkinson’s-like-
symptoms, including slowness,
limb and facial stiffness and
tremors
o Parkinson’s Disease Dementia (PDD)
▪ Usually occurs with progression of
Parkinson disease caused by protein
clumps in the substantia nigra of the
brain.
o Mixed Dementia
▪ Occur more that from of dementia is
present. This will present as
primarily one type of dementia with
features of other dementias.
o Alzheimer disease
▪ Senile dementia
▪ Usually seen in individuals older 65
years age
▪ Hereditary
▪ Common in women than man
▪ The brain lvl of the neurotransmitter
acetylcholine decrease
▪ Cause is unknown
▪ Chronic, progressive, degenerative
disease in which large number of
brain cells and tissue are affected by