COLEGIO SAN AGUSTIN-BACOLOD

COLLEGE OF NURSING

GERIATRIC CASE STUDY

OBJECTIVES
Within 24 hours of proving care to the client at Saint Vincent Home for the Aged, I
will be able to:

Knowledge

1. Determine the client’s past and present illnesses correctly.

2. Comprehend different physiological and psychological changes in aging
accurately.
3. Relate the changes in the physical and cognitive ability of an elderly
appropriately.
4. Identify actual and potential problems of the client correctly.
5. Evaluate the knowledge learned during the exposure effectively.

Skills

1. Gather pertinent data accurately.

2. Document pertinent information efficiently.
3. Conduct physical assessment using cephalocaudal approach thoroughly.
4. Apply Principles of Gerontology effectively.
5. Create a comprehensive Geriatric Case Study.

Attitude

1. Manifest Augustinian core values at all times.

2. Establish rapport with geriatric clients and health team members.
3. Accept constructive criticism and suggestions positively.
4. Respect the client’s norms and practices.
5. Show courtesy at all times.
I. CLIENT’S PROFILE

Name: P. G.
Gender: Female
Nickname: Perl
Religion: Catholic
Birthdate: August 6, 1927
Educational Attainment: BSE-ED
Place of Birth: Hinigaran
Date of Admission: February 28,
Age: 89 2011

II. INTRODUCTION

Lola P was born on August 6, 1927 in Hinigaran, Negros Occidental. She has 5

siblings including her. According to Lola P, all of her siblings are now dead and she is

the only one left. She graduated as BS-Ed and got married at the age of 26 years old. She

has two sons who live in Mindanao and the other one, Lola P doesn’t know his son’s

whereabouts. In the year 1995, her husband died due to heart failure. She was left alone

in their apartment for some time. She was depressed and due to not being able to cope up

with loneliness and stress, she complained to her friends that she is not feeling well. She

had a BP of 180/100 mmHg. The land lady accompanied her to Riverside and Doctors’s

Hospital to get herself checked. Since she is living alone, she was visited by the social

worker and nuns one day. She was advised to go to Saint Vincent Home for the Aged so

she could be more taken care of since it is not good for her to stay at home alone without

anyone to call in case of emergencies.

III. HEALTH ASSESSMENT

A. Cephalocaudal Assessment

PARAMETERS BOOK VIEW OBSERVATION/ASSESSMENT

a. Temperature The normal temperature is July 25, 2016 - 36 0C

36.5- 37.5 C July 26, 2016 - 36.2 0C
July 27, 2016 - 36.7 0C

b. Pulse The normal pulse is 60- June 8, 2015: 68 bpm

100 bpm. June 9, 2015: 69 bpm
June 10, 2015: 72 bpm

c. Respiration The normal respiration is June 8, 2015: 21 cpm

12-20 cpm. June 9, 2015: 20 cpm
June 10, 2015: 22 cpm

d. Blood Pressure Normal blood pressure is June 8, 2015: 120/70 mmHg

120/80 mmHg. June 9, 2015: 110/80 mmHg
June 10, 2015: 120/80 mmHg

e. Height Height is an important Lola P’s height is 144.78 cm

indicator of Body Mass
Index (BMI) to assess
nutritional status in
elderly. BMI can be used
to assess risk of Chronic
Energy Deficiency (CED)
and obesity. However,
measurement of stature in
elderly cannot be
conducted perfectly due to
kyphosis and scoliosis. It
may be more appropriate
to estimate stature from
measurement of other
skeletal segments such as
knee height, arm span and
sitting height. Aging
process does not influence
 length of arm, leg (knee)
and vertebral bone. Arm
span is less influenced by
aging.

f. Weight Weight should be recorded The weight of Lola P is 36 kg.

at each visit due to
decrease metabolic weight.

g. Skin The skin loses its elasticity Lola P’s skin is fair in complexion
resulting to sagging and and has no lesions. Wrinkling and
wrinkling of the skin. varicosities in the skin is noted
especially on the upper and lower
Presence of freckles or extremities.
brown-colored macules are
normally apparent in some
areas of the skin which
are frequently exposed to
sun.

h. Hair Scalp hair often starts The color of Lola P’s hair is black
graying usually at the with streaks of white. Her hair is
temples and extends to the short and well-groomed.
top of the scalp.
Hair color becomes
lighter, eventually turning
white.

i. Nails Nails grow more slowly Lola P’s nails are long and thick.
and thicken. According to her, she has a
Local discolorations of the manicurist who goes to SVHA to
nail may indicate possible clean and polish her nails. No
associated illness. cracks and discoloration noted on
the nails.

j. Head Smooth, uniform The head of Lola P is round in

consistency and absence of shape and symmetrical. Her head is
nodules and masses. in proportion with the body. No
 nodules and masses noted upon
palpations.

k. Face The skin of the face is Lola P’s face is symmetrical.

wrinkled due to loss of its Presence of wrinkles is noted wit
elasticity. Well distributed skin color.

l. Nose Sense of smell markedly Lola P’s still has good sense of
diminishes because of a smell. According to her, she can
decrease in the number of easily distinguish and identify
olfactory nerve fibers and pleasant or unpleasant odors.
atrophy of the remaining
fibers. Elders are less able
to identify and
discriminate odors.

m. Mouth Oral mucosa may be drier No dryness and cracking of the lips
because there is a decrease noted. Taste sensation is not
in salivation. diminished. She is a picky eater
Taste sensation may be and has own preference on what to
diminished. eat that is suitable to her taste.

n. Eyes The lens becomes less Lola P had undergone 2 operations

elastic and less able to in both eyes because of cataract
change shape when last 3 years ago. She still wears
focusing on close objects. glasses and was advised to have
Ability of the iris to her check-up if she felt severe
compensate for darkness headache and blurriness of vision.
diminishes. According to Lola P, her left eye is
Color vision may also be more affected than her right eye.
affected.

o. Ears Tophi, a normal age- Lola P has difficulty in hearing at

related finding, may be her left ear. She has a hearing aid
noted during inspection of which she thinks is bothersome to
the pinna. The external use.
auditory canal is examined
for cerumen, especially if
a hearing problem is noted
during the interview.
 p. Neck Lymph nodes are not No lymph nodes palpated. The skin
palpable. Neck muscles in the neck area is wrinkled.
are equal in size.

B. Systemic Assessment

a. Integumentary It consists of the skin, hair, The skin of Lola P has

nails, glands. wrinkles and varicosities
Increased skin dryness noted. Her hair is black with
Increased skin pallor streaks of white in color. Lola
Increased skin fragility P’s fingernails and toenails
Progressive wrinkles and are long and thick but was
sagging asked to trimmed and polish
Decreased perspiration it.
Thinning and graying of the
scalp, pubic and axillary hair
Slower nail growth and
increased thickening with
ridges.

b. Neurologic It deals with the nervous Lola P still has a good

system and disorders affecting memory. She has an impaired
it. balance due to fall injury in
Slower reaction time her left hip and uses her
Impaired balance “baston” as an aid.
Greater difficulty in complex
learning and abstraction.

c. Muscular It is consist of skeletal, Lola P loves to exercise every

smooth and cardiac muscles. morning and before going to
Loss of height sleep. She believes that it will
Loss of bone mass make your muscles strong and
Joint stiffness will give you good blood
circulation. She has no
problem in ambulation
however her movements are
slow. Loss of muscle mass
reduces strength noted.
d. Respiratory It consists of specific organs Lola P has no difficulty in
and structures used for the breathing and her breathing
process of respiration in an rhythm is normal.
organism.
Decreased lung expansion,
less effective exhalation,
reduced vital capacity, and
increased residual volume
Difficult, short, heavy rapid
breathing (dyspnea) following
intense exercise.

e. Gastrointestinal It is an organ system Lola P is a picky eater who

responsible for consuming has food preferences. She has
and digesting food, absorbing no difficulty in swallowing
nutrients, and expelling waste. noted. According to Lola P,
Delayed swallowing time she defecates mostly 1-2x a
Increased tendency for day and sometimes 3x a day
indigestion depending on the amount and
Increased tendency for what food she ate. She also
constipation mentioned having peptic ulcer
due to her love for soft drinks
up until now.

f. Cardiovascular Reduced cardiac output and Lola N’s blood pressure and
stroke volume, particularly heart rate is within the normal
during increased activity or range yet she has maintenance
unusual demands. for hypertension.
Reduced elasticity and
increased rigidity of arteries
Increased in diastolic and
systolic blood pressure.

g. Urinary Reduced filtering ability of Lola P usually urinates 3-4

the kidney and impaired renal times a day. She has no
function problem in her kidney. She
Less effective concentration verbalizes that she loves to
of urine drink water.
Urinary urgency and
frequency

h. Reproductive Decreased vaginal secretions Not assessed.

 Cervical and uterine lining
becomes thin
Pubic hairs become gray or
white in color
Pubic hairs become thin.

C. Gordon’s Functional Pattern

a. Health Perception The study examines in what According to Lola P, before

and Health way objective health-related she starts her day she usually
Management variables interfere with does exercise inside her room.
psychic health and personality She believes exercise helps
factors in explaining self- you have a good blood
perception of health in the circulation. If she’s not
elderly. feeling well, she would take a
few minutes to rest and sleep
This is a belief of what health or ask medication from the
and well-being is knowledge sisters. Lola P has
of benefits of good health. maintenance for her
hypertension. She also
verbalized that she has peptic
ulcer but still drinks soft drink
especially “coke”. She
verbalized that coke helps
with her digestion. She knows
not to drink soft drink with an
empty stomach to prevent
hyperacidity.

b. Nutritional and Pattern of food and fluid Lola P has a regular intake of
Metabolic Pattern consumption relative to fruits and vegetables every
metabolic needs and pattern day. Most especially banana.
indicators of local nutrient Lola P has food preferences.
supply. She always verbalize that she
does not like the taste of the
food. She usually has her
“Knorr liquid seasoning” to
put in her soup, rice or fish.
She verbalized that she has a
stock of canned food ready in
case she doesn’t like the food
 served for them.

c. Elimination Functional bowel disorders, According to Lola P, she

including constipation, fecal defecate mostly 1-2x a day
impaction, and fecal and sometimes 3x a day
incontinence, are common depending on the amount and
gastrointestinal diseases in the what food she ate. She usually
elderly and a major source of urinates 3-4 times a day. She
morbidity. has no problem in her kidney.
She verbalizes that she loves
Usual bowel and bladder to drink water. No signs of
habits or pattern. bowel or urinary incontinence
noted.

d. Activities and Adults aged 65 and over She usually does exercise
Exercise spend on average 10 hours or inside her room before she
more each day sitting or lying goes out to Marian Hall and
down. before she sleeps. Lola P also
prays every day before she
This makes them the most starts her day or goes to sleep.
sedentary age group. She has no problem in doing
her activity of daily living.
Pattern of exercise, activity,
leisure and recreation.

e. Sleep and Rest Sleep is required to provide Lola P sleeps early at night
Pattern energy for physical and around 8-9PM and wake up
mental activities. early in the morning around 4-
5AM. She wakes up early to
Pattern of rest, sleep and attend the mass. Lola N
relaxation. verbalized that she takes a nap
after lunch.

f. Cognitive and The ability to comprehend and Lola P can't see far objects, so
Perceptual Pattern use information an on the she is using eye glasses. She
sensory functions. Data has a difficulty of hearing in
pertaining to neurologic her left ear. She has a good
functions are collected to aid sense. Lola P can feel and
this process. identify hot and cold objects.
She has a good sense of taste.
Lola P can still recall all her
past experiences and she
knows what is happening in
 her surroundings.

g. Self-Perception and The person's attitudes toward Lola P said that she's happy
Self-Concept self, including identity, body and contented right now yet
image, and sense of self- sometimes all of them felt
worth. The person's level of loneliness and wishes they
self-esteem and response to were visited more often. Even
threats to his or her self- though her skin is full of
concept. wrinkles, she's not bothered
about it. Lola P has a good
self-esteem.

h. Role Relationship The person's roles in the Lola P has her own group of
world and relationships with friends but she is more close
others. Satisfaction with roles, with Lola R because
role strain, or dysfunctional according to her, Lola R is
relationships. kind and very quiet “wala
gamo”. Lola P communicates
well and gives accurate data.
She loves telling you her story
and also loves to ask
questions. She always
interacts with people around
her.

i. Sexuality and Satisfaction or dissatisfaction According to Lola P, she is

Reproductive with sexuality pattern and not interested in engaging in
relationships. such things because she is
already old. She does not have
plans to look for a partner in
life.

j. Coping and Stress Aging is related to a number Whenever Lola P is sad or

of factors that have a have problems, she just closes
detrimental effect on the her eyes for a few minutes to
quality of life. Recreational rest then pray the rosary. she
activities serve as both spends most of the time
common stress buffers and reading educational book and
stress coping responses. magazines, listening to radio.
Recreational behavior plays a

role in an individual's stress-

 related symptoms.

Usual ability to handle stress,

support system available.

k. Values and Belief Religion, spirituality, and Lola P is a devoted Roman

Pattern kinship ties may have an Catholic. She always attend
important role in elderly the mass that is being held at
understanding and treatment St. Vincent every day. She
of illness. Some elderly may loves to pray and even asked
view illness and death as a my name so she can include
natural part of life, or believe me and my family in her
illness is a result of natural prayers.
causes, improper diet or
eating habits, exposure to cold
air or wind, the will of God
for improper behaviour, or a
lack of spiritual balance.
Some older adults may delay
seeking medical care,
preferring self-treatment and
giving God a chance to heal,
or may seek care from folk
healers, lay advice, home
remedies, and prayer to treat
illness.

IV. DEVELOPMENTAL STAGE (ERICK ERIKSON)

BOOK VIEW OBSERVATION

Ego Integrity vs. Despair (Late adulthood,
65-death)

Psychosocial Task:
As people grow older and become senior Lola P is satisfied for what she had
citizens, they tend to slow down their accomplished in her life. She often tells me her
productivity and explore life as a retired life’s story about her success during her
person. It is during this time that they college years. She loves to learn. She believes
contemplate their accomplishments and are that education is “never ending”. She is happy
able to develop integrity if they see themselves with her accomplishments in life. She will
as leading a successful life. If they see their life always bring the heart of a teacher wherever
as unproductive, or feel that they did not she goes.
accomplish their life goals, they become
dissatisfied with life and develop despair, often
leading to depression and hopelessness.

Developmental Task:
The final developmental task is retrospection: Lola P has easily adapted to the way of living
people look back on their lives and in the area. She is contended and just wishes
accomplishments. her loved ones would visit often. Lola P has
her own group of friends that she socializes
with. At the same time, Lola P is an
They develop feelings of contentment and independent person. She prefers to do things
integrity if they believe that they have led a on her own so as not to burden other people.
happy, productive life. They may instead
develop a sense of despair if they look back on
a life of disappointments and unachieved goals.

Establishment of an exclusive relationship with

the same age group.

V. COMMON AILMENTS OF THE ELDERLY:

Hypertension: is the term used to describe high blood pressure. The excessive pressure
on your artery walls caused by high blood pressure can damage your blood vessels, as well as
 organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the
greater the damage. Excessive dietary sodium intake contributes to the development of resistant
hypertension both through directly increasing blood pressure and by blunting the blood pressure–
lowering effect of most classes of antihypertensive agents.

Risk Factors:
> Age. The risk of high blood pressure increases as you age. Through early
middle age, or about age 45, high blood pressure is more common in men. Women are more
likely to develop high blood pressure after age 65.

Nursing Interventions:

> Salt intake should be limited to approximately 5 to 6 g per day.

> Advised client to select low-fat foods - avoid foods containing a lot of fat and
sugar.
> Ensure client to eat breakfast.
> Client should be advised to not add salt to food and to avoid processed foods.
> Monitor and measure blood pressure in both hands, using a cuff and proper
techniques in terms of measuring blood pressure.
> Assist in performing self-care activities as needed.
> Discuss the importance of maintaining a stable weight.
> Auscultate heart tones and breath sounds.
> Provide calm, restful surroundings, minimize environmental activity/ noise.
Limit the number of visitors and length of stay.
> Maintain activity restrictions, e.g., bedrest/ chair rest; schedule periods of
uninterrupted rest; assist patient with self-care activities as needed.
> Provide comfort measures, e.g., back and neck massage, elevation of head.
> Monitor response to medications to control blood pressure.

Frequent falls, which can lead to fractures (Forearm APL LEFT): Because of the strong force
required to break the radius or ulna in the middle of the bone, it is more common for adults to
break both bones during a forearm injury. When only one bone in the forearm is broken, it is
typically the ulna — usually as a result of a direct blow to the outside of your arm when you
have it raised in self defense.

Peptic Ulcer refers to painful sores or ulcers in the lining of the stomach or first part of
the small intestine, called the duodenum.

An ulcer may or may not have symptoms. When symptoms occur, they may include:

 A gnawing or burning pain in the middle or upper stomach between meals or at night
 Bloating
 Heartburn
 Nausea or vomiting

e) Present evaluation
Lola P has primary hypertension. 140/90. She is aware of her condition. She always
wanted to check her BP. Blood pressure remains uncontrolled most often because of
persistent elevations in systolic blood pressure. She can’t hear clearly in her left ear.
She sometimes complain pain at the epigastric region when consuming soft drinks.

VI. EVALUATION OF FORMULATED OBJECTIVES

Based on the information that has been given in this case study, I can say that I was able to meet

my objectives. I was able to gather the pertinent data from my client and I was able to build good

relationship with Lola P. I also conducted physical examination to my client utilizing

cephalocaudal approach on which the observations that I was able to gather were reflected on

this case study. I was able to establish rapport with other geriatric clients. The Principles of

Gerontology like proper communication with the elderly were applied while gathering

information from my client and also this Geriatric Case Study will serve as an evaluation on

what we have learned throughout our 3 days of exposure in St. Vincent as we provide a well-

rounded and holistic care to our geriatric clients.

VII. REFERENCE

Black, Joyce & Hawks, Jane (2008). Medical-Surgical Nursing 8th edition. Saunders.
Berman, Audrey (2007). Fundamentals of Nursing 8th edition. Prentice Hall.

Medical Surgical Nursing: eleventh edition by smeltzer, bare, hinkle, cheever.

Med Surg Nursing- Demystified A Self- Teaching Guide

Textbook of Medical- Surgical Nursing by Brunner and Suddarth's