SAS 1: INTRODUCTION TO GERONTOLOGIC ROLES OF GERONTOLOGICAL NURSE

NURSING
PROVIDER OF CARE
GERIATRIC or GERONTOLOGICAL NURSING  Gives direct, hands-on care to older adults in a
 one of the fields of nursing that deals with variety of settings
proper care and hospitalization of aged or
geriatric patients. TEACHER
 it involves understanding the aging process and  An essential part of all nursing is teaching.
the tremendous changes that every individual Gerontological nurses focus their teaching
has to face. on modifiable risk factors. Many diseases
of aging can be prevented through lifestyle
FLORENCE NIGHTINGALE
modifications such as a healthy diet,
 Pioneered this specialized field.
 The first geriatric nurse because of her nurse smoking cessation, appropriate weight
superintendent position in an English institution, maintenance, increased physical activity,
where she cared for helpers and maids of and stress management.
wealthy women.
MANAGER
DEFINITION OF TERMS  Gerontological nurses act as managers
 Gerontology during everyday care as they balance the
 It is the study of aging and/or the aged. This concerns of the patient, family, nursing,
includes the biopsychosocial aspects of and the rest of the interdisciplinary team.
aging. Nurse managers need to develop skills in
 Geriatrics
staff coordination, time management,
 This term is often used as a generic term
relating to the aged, but specifically refers assertiveness, communication, and
to medical care of the aged. organization.
 Gerontological Nursing
 It is the aspect of gerontology that falls ADVOCATE
withing the discipline of nursing and the  on behalf of older adults to promote their
scope of nursing practice. best interests and strengthen their
 Old age autonomy and decision making. Advocacy
 often defined as over 65 years of age may take many forms, including active
 Gerontological rehabilitation nursing involvement at the political level or helping
 combines expertise in gerontological to explain medical or nursing procedures to
nursing with rehabilitation concepts and
family members on a unit level.
practice.
 Social Gerontology
 concerned mainly with the social aspects of
RESEARCH CONSUMER
aging  The appropriate level of involvement for
 Geropsychology nurses at the baccalaureate level is that of
 refers to specialists in psychiatry whose research consumer. This involves
knowledge, expertise, and practice are gerontological nurses being aware of
with the older population. current research literature, continuing to
 Financial Gerontology read and put into practice the results of
 another emerging subfield that combines reliable and valid studies. Using evidence-
knowledge of financial planning and based practice, gerontological nurses can
services with a special expertise in the
improve the quality of patient care in all
needs of older adults.
settings.

1
SAS 2: STANDARDS AND GERONTOLOGIC  STANDARD V.
NURSING PRACTICE / PERSPECTIVE OF AGING  Ethics: Decisions and actions on behalf of
older adults are determined in an ethical
STANDARDS OF PRACTICE manner.
 Standards of nursing practice developed by the  STANDARD VI.
AMERICAN NURSES ASSOCIATION (ANA)  Collaboration: Collaborates with older
provide guidelines for nursing performance adults, the older adults caregiver, and all
 they are the rules or definition of what it means member of interdisciplinary team to
to provide competent care provide comprehensive care.
 STANDARD VII.
ANA STANDARDS OF GERONTOLOGICAL  Research: Interprets applies and
NURSING PRACTICE evaluates research findings to improved
gerontological nursing practice.
NURSING CARE  STANDARD VII.
 STANDARD I.  Resource Utilization: Considers the
 Assessment: The gerontological nurse factors related to safety, effectiveness and
collects patient health data. cost in planning and delivering patient care.
 STANDARD II.
 Diagnosis: The gerontological nurse PERSPECTIVE OF AGING
analyzes the assessment data in A. Aging is a developmental process
determining diagnoses. a) Starts at birth
 STANDARD III. b) Gradual changes I body structures and
 Outcome Identification: The gerontological symptoms
nurse identifies expected outcomes c) Not all changes at the same rate and same
individualize to the older adult. impact
 STANDARD IV. d) Changes can impact function, participation
 Planning: Develops a plan of cares that and quality of life
prescribes interventions to attain outcomes. B. Demographic of Aging and Implications for
 STANDARD V. Health and Nursing Care
 Implementation: Implements the a) Global aging
interventions identified in the of core. b) Aging in the Philippines
 STANDARD VI.
 Evaluation: Evaluates the older adults
progress towards attainment of expected
outcomes.

QUALITY CARE
 STANDARD I.
 Quality of Care: The gerontological
systemically evaluates the quality of care
and effectiveness of nursing practice.
 STANDARD II.
 Performance Appraisal: The
gerontological nurse evaluates his/her own
nursing practice in relation to professional
practice standards and relevant statutes
and regulations.
 STANDARD III.
 Education. The gerontological nurse
acquires and maintains current knowledge
in nursing practice.
 STANDARD IV.
 Collegiality: Contributes to professional
development of peers, colleagues and
others.

2
SAS 3: BIOLOGICAL AND PSYCHOSOCIAL a) Activity Disengagement
THEORIES OF AGING / NURSING THEORIES OF i. Remaining occupied and involved is
AGING necessary to a satisfying late-life. Gradual
withdrawal from society and relationships
THEORIES OF AGING severes to maintain social equilibrium and
 Human aging in influenced by a composite of promote internal reflection
biologic, psychologic, social functional, and b) Subculture
spiritual factors. i. the elderly prefer to segregate from
society in an aging subculture sharing loss of
status and societal negativity regarding the
BIOLOGICAL THEORIES OF AGING aged. Health and mobility are key
A. STOCHASTIC THEORIES determinants of social status
- based on random events that cause cellular c) Continuity
damage that accumulates as the organisms i. Personality influences roles an dlife
ages. satisfaction and remains consistent
a) Free Radical Theory throughout life.
i. membranes, nucleic acids, and d) Age stratification
proteins are damaged by free radicals, i. Society is stratified by age groups
which cause cellular injury and aging that are the basis for acquiring resources,
b) Error Theory roles, status, and deference from others
i. Errors in DNA and RNA synthesis e) Person-Environment Fit
occur with aging i. Function is effected by ego strength,
c) Wear and Tear Theory mobility, health, cognition,m sensory,
i. Cells wear out and cannot function perception, and the environment.
with aging Competency changes one’s ability to adapt to
d) Connective tissue / cross-link Theory environmental demands
i. With aging, proteins impede metabolic f) Gerotranscendence
processes and cause trouble with i. The elderly transform from a
getting nutrients to cells and removing materialistic/rational perspective toward
cellular waste products. oneness with the universe
B. NONSTOCHASTIC THEORIES
- based on genetically programmed events B. PSYCHOLOGICAL THEORIES
that cause cellular damage that accelerated - explain aging in terms of mental processes,
aging of the organism. emotions, attitudes, motivation, and personality
a) Programmed Theory development that is characterized by life stage
i. Cells divide until they are no longer transitions.
able to, and this triggers apoptosis or a) Human Needs
cell death i. 5 basic needs motivate human
b) Gene/biological Clock Theory behavior in a lifelong process toward
i. Cells have genetically programmed need fulfillment
aging code b) Individualism
c) Neuroendocrine Theory i. Personality consists of an ego and
i. Problems with the hypothalamus- personal and collective
pituitary-endocrine gland feedback unconsciousness that views life from
system cause disease; increased a personal or external perspective
insulin growth factor accelerates aging c) Stages of Personality Development
d) Immunological Theory i. Personality develops in 8 sequential
i. Aging is due to faulty immunological stages with corresponding life tasks
function, which is linked to general ii. The 8th phase. INTEGRITY vs
well-being. DESPAIR, is characterized by
evaluating life accomplishments;
PSYCHOSOCIAL THEORIES OF AGING struggles
A. SOCIOLOGICAL THEORIES d) Life-course/Lifespan Development
- changing roles, relationships, status, and i. Life stages are predictable and
generational cohort impact the older adult’s structured by role, relationships,
ability to adapt.

3
 values, and goals. Persons adapt to SAS 4: MEDICATIONS OF OLDER ADULTS
changing roles and relationships
e) Selective Optimization with A. The Effect of Aging on Drugs
Compensation Normal aging is associated with certain
i. Individuals cope with aging losses physiological changes that can significantly
through activity/role selection, influence drug response. Both pharmacokinetics and
optimization, and compensation. pharmacodynamics play a role in how a person will
ii. Selective optimization with respond to a drug.
compensation facilitates successful
aging 1. Pharmacokinetics
 Absorption
IMPLICATIONS FOR NURSING  the rate of drug movement through the
 Nursing has incorporated psychosocial theories body may decrease with age, the extent of
such as Erikson’s personality development drug absorption is least affected by age.
theory into its practice (Erikson, 1963)  Distribution
 Psychosocial theories enlighten us about the  As patients age, total body water declines
development tasks and challenges faced by and fat stores increase. This physiological
older adults and the importance of finding a change affects the distribution phase of
accepting meaning in one’s life highly water-soluble and fat-soluble drugs.
Therefore, the volume of distribution may
NURSING THEORIES OF AGING be decreased for drugs that are highly
A. Functional Consequences Theory water soluble and increased for drugs that
a) Environmental and biopsychosocial are highly lipid soluble.
consequences impact functioning
b) Nursing’s rile is risk to minimize age- 2. Pharmacodynamics
associated disability in order to enhance a) The effects of similar drug concentrations
safety and quality of living. at the site of action may be greater or less
B. Theory of Thriving than those in younger patients.
a) Failure to thrive results from a discord b) Therefore, the potential for increased
between the individual and his or her sensitivity to medications at the cellular
invronment or relationships level must be considered when
b) Nurses identify and modify factors that administering them to an elderly patient.
contribute to disharmony among theses
elements. 3. Adverse Drug Reactions
a) Older patients, with multiple disease states,
THEORY OF SUCCESSFUL AGING often consume many different medications
 According to this theory, aging successfully to treat both acute and chronic medical
means remaining physically, psychological, and conditions
socially engaged in meaningful ways that are b) Age-related alterations in drug distribution,
individually defined. hepatic metabolism, and renal clearance
 Aging is a progressive process adaptation all play a significant role in the chances of
 Aging may be successful or unsuccessful an elderly patient developing an ADR.
depending upon a person’s ability to cope c) Overall, ADRs represent a major problem
 Successful aging is influenced by a person’s for elderly patients. In addition to better
choices prescribing patterns from the physicians,
 Aging people experience changes, which there’s a need for nurses and pharmacists
uniqualy characterize their beliefs and to increase medication monitoring.
perspectives in ways that differ from those
of younger adults (Flood, 2006) B. Polypharmacy
 Many older patients are prescribed multiple
drugs, take over-the-counter medications, and
are often prescribed additional drugs to treat
the side effects of the medications that they are
already taking.
 The increase in the number of medications
often leads to polypharmacy, which is defined

4
 as the prescription, administration, or use of Pharmacotherapy in older Adult
more medications than are clinically indicated in
a given patient. Potential adverse outcomes of General Information
polypharmacy include adverse drug reactions,  Decreased body weight, dehydration, alteration
increased cost, and noncompliance. in fat to muscle ratio, slow organ functioning
may cause accumulation of the drugs in the
Reasons for polypharmacy: body due to higher concentration in the tissues
a. Lack of communication among multiple health- and slowed metabolism and excretion of the
care providers. drug
b. Lack of information about over-the-counter drug  Multiple chronic disease affecting older adults
use. may also causes changes in the metabolism
c. Lack of information about client noncompliance. and excretion of medications.
d. Use of complementary (alternative, folk medicine)  Medication errors among adult community-
therapies and fear of telling health-care provider. dwelling adults are estimated to be 25-50%.
e. Assumption that, once medication is started, it  Drug-drug interactions are increased secondary
should be continued indefinitely and not changed. to older adult often having more than one
f. Assumption that, if there are no early side effects, prescribing health care provider.
there will not be any later.
g. Changes in daily habits (smoking, activity, Nursing Care
diet/fluid intake).  Conduct a “brown bag” evaluation to assess all
h. Changes in mental-emotional status that may prescription , over-the-counter, herbal
affect consumption patterns. medications the client may be taking
i. Changes in health status.  Assess the clients understanding of the
j. Financial limitations (drug substitution). reasons for the drug therapy
 Assess the client’s vision, memory, and
Several interventions that may help the judgement. Reading level, level dexterity and
prescriber to prevent polypharmacy: motivation to determine ability to self-medicate
 Knowing all medications, by both brand and  Provide instructions in large print premeasured
generic name, being used by the patient; syringes, memory aid and daily drug does
containers to enhance self-medicating abilities
 Identifying indications for each medication;
 Check with the pharmacist for any drug-drug
 Knowing the side effect profiles of the medications;
interactions if unsure
 Eliminating drugs with no benefit or indication;  Before beginning a medication, obtain baseline
 Avoiding the urge to treat a drug reaction with vital signs, mental status , vision, and
another drug. bowe/bladder function
 Drug-induced side effects may present as
C. Inappropriate Prescribing confusion, incontinence , falls, or immobility
 Overall there is no generalized rule for  Assess the client’s ability to pay for the
prescribing drugs to the geriatric population. prescription;
 There are numerous studies that indicate that  If the client requires assistance in taking
some prescribing patterns in the elderly medications, teach family members. Proper
population are inappropriate, such as no techniques for administering oral medication
indications for use of a drug, inappropriate include: position head forward with neck slightly
frequency of medications, inadequate dosages, flexed to facilitate swallowing and avoid risk of
and the possibility of drug interactions or ADRs aspiration.
 If client has swallowing difficulties, obtain liquid
D. Compliance form of oral medications wherever possible.
 Although age alone does not affect compliance,  Assess client for effectiveness of medications
about 40% of elderly persons do not adhere to and any adverse reactions.
their medication regimen.
 The more complex the medication regimen, the
less likely the patient will comply.
 For elderly patients, nonadherence may result
from the patient trying to avoid side effects and
therefore reduce the amount of drug consumed,
lack of money, or forgetfulness (early dementia).

5
SAS 5: ETHICAL / LEGAL PRINCIPLES AND REPUBLIC ACT NO. 9994
ISSUES An Act Granting Additional Benefits and
Privileges to Senior Citizens, Further Amending
Nursing: Scope and Standards of Practices Republic Act No. 7432
 Standards are authoritative statement by which
the nursing profession describes the Section 5. Government Assistance
responsibility for which its practitioners are A. Employment
accountable a) “senior citizens who have the capacity and
 It reflects the values and priorities of the desire to work, or re-employed, shall be
profession. provided information and matching
services to enable them to be productive
SEC. 28 SCOPE OF NURSING members of society
 A person shall be deemed to be practicing
nursing within the meaning of this Act when ETHICAL PRINCIPLES
he/she singly or in collaboration with another,  the gerontological nurse follow all ethical
initiates and performs nursing services to principles in the roles of clinician, advocate,
individuals, families and communities in any case manage, researcher, and administrator
health care setting  Basic ethical principles include:
 It shall be the duty to the nurse to: A. Autonomy
a) Provide nursing care through the utilization a) Concept that each person has a right to
of the nursing process. make independence choice and decision
b) Establish linkages with the community B. Beneficence
resources and coordination with the health a) Doing acts of mercy and kindness that
team directly benefit the patient; these act
c) Provide health education to individuals, promote the health of the patient
families, and communities C. Non-maleficence
d) Teach, guide and supervise students in a) Requiring to act in such manner as to avoid
nursing education programs causing harm to patients
e) Undertake nursing and health human D. Fidelity
resource development training and a) Concepts of faithfulness and the practice of
research keeping promise
E. Justice
REPUBLIC ACT 7432 a) “fairness”; the right to demand to be treated
An Act to Maximize the Contribution of Senior justly, fairly and equally
Citizens to Nation Building, Grant Benefits and F. Veracity
Special Privileges and for other Purposes. a) Relates to the practice of telling the truth
G. Confidentiality
Section 4: privileges for the Senior Citizens a) Require not disclosure of private or secret
1. The grant of 20% discount from all establishments information in which one is entrusted
relative to utilization
2. Minimum of 20% discount on admission fees PATIENT’S RIGHTS
charged  Patient’s rights direct action on ethical issues in
3. Exemption from the payment of individual income the care of geriatric populations
taxes  Advance Directives and Living Wills
4. Exemption from training fees for socioeconomic  Describes actions to be taken in a
programs undertaken by the OSCA (Office of the situation where the patient is no
Senior Citizen Agency) as part of its work longer able to provide informed
5. To extent practicable and feasible, the consent
continuance of the same benefits and privileges  Durable Power of Attorney
given by the Government Service Insurance  A legal document designating an
System (GSIS), Social Security System (SSS), alternative decision maker in the
and Pag-Ibig event that the person in incapacitated

6
PATIENT’S BILL OF RIGHTS SAS 6: LEVELS OF CARE AMONG OLDER
1. Right to appropriate medical care and humane ADULTS
treatment
2. Right to informed consent LONG-TERM CARE
3. Right to privacy and confidentiality  Refers to health, mental health, social, and
4. Right to information residential services provided to a temporarily or
5. The right to choose health care provider and chronically disabled person over an extended
facility period of time with a goal of enabling the
6. Right to self-determination person to function as independently as possible
7. Right to religious belief
8. Right to medical records  Assisted living
9. Right to leave  Assisted living provides an alternative for
10. Right to refuse participation in medical research those older adults who do not feel safe
11. Right ti correspondence and to receive visitors living alone, who wish to live in a
12. Right to express grievances community setting, or who need additional
13. Right to be informed of his rights and obligations help with activities of daily living (ADLs)
as a patient  the most common type of long-term care is
PERSONAL CARE
ETHICS IN PRACTICE  It is difficult to predict how much or what
 Ethical dilemmas and conflicts surround us in type of long-term care of a person might
real life, and ethical principles alone are not need
likely to address many of the quandaries and  Several things increase the risk of
dilemmas occurring in the care of geriatric needing long-term care:
patients:  Age
 Mistakes  Gender
 Considerable effort has been put into  Marital status
reducing mistakes and improving  Lifestyle
patient safety  Health and Family History
1.Honestly admitting the error  Intermediate Care
occurred in a neutral and  This level of care provides 24-hour per day
objective manner direct nursing contact and may be
2.Taking proper steps to correct the considered to be the entry level into
situation nursing home care
3.Apologizing for the mistake  Skilled Care
4.Making amends as possible  Skilled care units or skilled nursing
5.Evaluating how to prevent such facilities (SNFs) are for those older adults
mistakes in the future requiring more intensive nursing care
 Conflict of Interest  Alzheimer’s Care
 Conflict of interest situations arise  Because of the higher incidence of AD with
from completing loyalties and advanced age, there is a growing need for
opportunities units that provide nursing care for elders in
1. Conflict of values between the the various stages of dementia that occur
nurse’s value system and choices with Alzheimers
made by the patients PALLIATIVE CARE
2. Discussions related to resource  Refers to the comprehensive management of
allocation and end-of-life care the physical, psychological, social, spiritual, and
3. Occur when incentive systems or existential needs of the patients
other financial gains create conflict  It is an approach that improves the quality of life
between professional integrity and of patients and their families facing problems
self-interest. associated with life-threatening illness.
END-OF-LIFE CARE
 Refers to the services provided to terminally ill
patients whose incurable disease has
advanced to a stage near death.
 End-of-life treatments are subject to
considerations of patient’s autonomy

7
SAS 7: SPIRITUALLY AMONG OLDER ADULTS, TAKING SPIRITUAL HISTORY AND
ETHICAL DILEMMA ASSESSMENT
 The models guide the nurse in domains of
 A spiritual connection can boost seniors questions that to be addressed
wellness, especially when their senior living  Available tools:
community supports faith practices. 1. FICA
 Best practice increasingly identifies spiritual
care as a component of care in general

SPIRITUALITY
 Root words: (Hebrew, Latin< & Greek): wind,
breath or air which gives life
 Allows a person to experience transcendent
meaning in life….. whatever beliefs and values
give a person a sense of meaning and
purposes in life. 2. HOPE Model Developed by Anadarajah &
 Test have personal meaning Hight
 Where do I find meaning?

RELIGION
 Root word: Latin, to tie / secure / bind / fasten
together to create system of attitudes and
beliefs
 Participation in a “organized” religion may 3. 3 questions Model Developed by C. Kinney.
involve: PhD, RN
 Practices
 Adherence to certain beliefs
 Participation in a religious community
 Religious text of tradition
 What is true and right

SPIRITUALITY, RELIGION, AND CULTURE

SETTING OF CARE: Spiritual Advisors

 know who is available for spiritual support in all
care settings - from the home to the nursing
home
 Chaplains, clergy, pastoral care, or other
spiritual leaders
HEALTHCARE CHAPLAINS
 CHAPLAINS: generic term refers to any clergy
GEROTRANSCENDENCE or qualified layperson who assists patients,
 Considered the 9th stage of lifecycle families and staff in addressing spiritual /
development (Erik Erikson developed 8 stages religious needs
of lifecycle)  May come from any religious tradition, they
 3 dimension: may be certified
 Cosmic (life, death)
 Self-transcendent (personal self no INTERVENTIONS OF SPIRITUAL CARE: Overlap
longer center of attention) with Cultural / Psychosocial Care
 Social selectivity (focus on dose friends A. Creative / expressive arts
and family) elements B. Music
SPIRITUALITY & SUFFERING C. Story
 “state of severe distress associated with events D. Spiritual reminiscence
that threaten the intactness of person E. Compassionate presence
F. humor

8
SAS 8: SETTINGS OF CARE FOR OLDER  They may refer to end-of -life care as comfort
ADULTS / ADVOCACY PROGRAMS RELEVANT care
TO THE CARE OF OLDER ADULT When Should HOSPICE Care be CONSIDERED?
 Since the purpose of hospice care is to provide
SETTING OF CARE comfort at the end of life during a terminal
A. Home Care illness, the decision to receive hospice services
a) Home health care older adults requiring a is major.
longer period of observation or care from Admission Criteria for Hospice
nurses may be candidates for home health  In other to receive hospice care, the patient
care services. must be diagnosed as terminally ill by their
b) Home health care services must be flexible medical provider.
and designed to fulfill individual health care  Depending on the health insurance provider,
needs. such as Medicare or private health insurance
Health Education companies, there may be additional
 For elderly and family members, including on requirements for getting placed in hospice care.
nutrition, prevention of falls healthy lifestyle and Hospice Services and Benefits
so on  Hospice care providers offer an array of
 Personal Care services to patients.
 Exercising, checking VS  This can include caring for the senior in their
 Preventive Services and Early Detection own home, as well as providing them with
 Prevention of bed ulcers, dressing of medical appliances and supplies in their home,
wounds if needed such as hospital beds and wheelchairs.
 Psychosocial Support and Social Services  Hospice services may also include social
 Counselling for the elderly and family services and counseling, in addition to a
members homemaker and home health aide to provide
 Building the Capacity of Family Members to daily care needs.
Provide day-to-day Care
 Management of Simple Diseases and C. Drop In/ Day Care Centers
Follow-up  Adult day care or day services provide yet
 Transitional Home Health Care another avenue for older adults who are unable
 To empower the elderly to become more to remain at home during the day without
involved in managing their chronic supervision.
illnesses and more confident in  Usually these services are used by family
communicating with health care members who are caring for older parents or
professionals loved ones in their own home, but who may
work during the day and wish to have their
B. Hospice Facilities relative safely cared for in their absence.
a) Hospice Gerontological nurses may also
choose to work in hospice, caring for dying The intent is primarily two-fold:
persons and their families  To provide older adults an opportunity to get
b) Although many patients in hospice are not out of the house and receive both mental and
elderly, the majority of the dying are older social stimulation, as well as the continuing
care they need.
Hospice Care VS. Comfort Care  To give caregivers a much-needed break in
 Hospice care is often confused with palliative which to work, attend to personal needs, or
care, but these are not the same types of senior simply to rest and relax.
care
 Palliative care begins when a patient starts Services provided by adult day care centers
receiving treatment for a condition.  A well-run adult day care center’s goals will
 With palliative care, the goal is to provide focus on enriching participants’ lives, building
comfort with a holistic approach while the upon their skills and strengths, and providing
patient continues with treatment lots of social interaction. Each facility differs in
Hospice Care VS Comfort Care terms of features, but services may include:
 Comfort care is just another term for hospice Social activities.
care that may be used by a medical doctor or  Planned activities tend to be tailored to the
nurse participants’ abilities and health conditions, but

9
 may encompass such things as arts and crafts,
musical entertainment and sing-a-longs, mental E. Foster Care / Group Homes
stimulation  Foster care and/or group homes are for those
Nutrition. older adults who can do most of their ADLs, but
 Day care centers provide seniors with nutritious may have safety issues and require supervision
meals, including those that accommodate with some activities such as dressing or taking
special diets, along with snacks. medications.
Personal care.
 Center staff can help with the activities of daily 10 Facts on Aging and the Life Course (and Dr.
living such as grooming, toilet hygiene, walking, Hofmeyer's final pitch for older adult practice
and feeding. and advocacy)
Health services. 1. The world's population is rapidly ageing (we need
 These may vary from medication dispensing, to prepare ourselves to work with this population)
blood pressure monitoring, hearing checks, and 2. There is little evidence that older people today are
vision screening, for example, to symptom in better health than their parents
management and more intensive medical or 3. The most common health conditions in older age
therapeutic services. are non-communicable diseases
Transportation. 4. When it comes to health, there is no 'typical' older
 Some adult day care centers provide person (we need to practice consumer centricity)
transportation to and from the center and for 5. Health in older age is not random
any local outings. 6. Ageism may now be more pervasive than sexism
or racism* (need to advocate against ageism //
Benefits for the older adult everyone should be treated with respect)
 For the participant, an adult day care 7. Comprehensive public health action will require
center’s benefits can be extensive. fundamental shifts in how we think about ageing and
 Adult day care provides a safe, secure health
environment in which to spend the day or 8. Health systems need to be realigned to the needs
part of the day. of older populations
 Offers enjoyable and educational activities. 9. In the 21st century, all countries need an
 Appropriate physical exercise can help to integrated system of long-term care
reduce falls.
10. Healthy Ageing involves all levels and sectors of
 Meaningful social interaction can improve
government
both mental and physical health and help
to prevent or delay cognitive decline.
Need for Health Advocates for Older Adults:
 Mental and social stimulation during the
 Some seniors may benefit from having a
day can improve the quality of your sleep
'Senior Advocate' who assists the older adult
at night.
navigate health concerns:
 Participation in adult day care activities
 Oftentimes the advocate is a family member or
may even enhance or maintain your level
close family friend.
of independence, keeping you living at
 In cases of suspected abuse or neglect,
home longer by relieving caregiver fatigue
organizations can appoint an Advocate to the
and delaying your escalation of
older adult.
dependence.
 Having control over activities you partake
Senior Advocates help enhance health by:
in can bolster your self-esteem.
 Adult day care offers the chance to build 1. Tracking old and new symptoms, problems with
new friendships and enjoy peer support. current treatments, or significant changes to discuss
with the health provider.
D. Independent living 2. Helping medical professionals understand the
 In the community setting, independent living complete health situation, coordinating treatments to
arrangements often take the form of senior improve health problems without causing problems
housing, such as with apartment complexes or side effects, and working with health
that are exclusively devoted to the elderly. The professionals if side effects do become an issue.
accommodations will be as homelike as 3. Managing current medications and making sure
possible with kitchens, bathrooms, living areas, all medications and supplements are reviewed on a
and the like, similar to assisted living. regular basis.

10
4. Going together to appointments, taking notes, Program Accomplishments/ Status
bringing up important questions for the health 1. Provision of influenza and pneumococcal vaccine
providers, and making sure critical details aren't 2. Wellness camp for senior citizens
overlooked. 3. Elderly Filipino week (Walk for Life) Celebration
5. Taking plenty of time to explain their health
conditions, treatments, and why it's important to Under the Expanded Senior Citizens Act of 2010,
follow the health provider's instructions.  older persons can lodge complaints against
6. Finding the doctors, specialists, and hospitals that individuals and institutions through the OSCA.
meet your older adult's treatment needs and are The OSCA is mandated by law “to assist the
covered by their insurance plan. senior citizens in filing complaints or charges
7. Dealing with health insurance - coverage against any individual, establishments,
questions, claims, billing errors, payments, business entity, institution, or agency refusing
to comply with the privileges before the
RA 9257 (The Expanded Senior Citizens Act of Department of Justice (DOJ), the Provincial
2003) and the RA 9994 (Expanded Senior Citizen Prosecutor’s Office, the regional or the
Act of 2010), municipal trial court, or the municipal trial court.”
 the Department of Health issued Administrative
Orders for health implementers to undertake Advocacy Consortium for the Elderly (ACE)
and promote the health and wellness of  Pasali is founding member of the Advocacy
senior citizens as well as to alleviate the Consortium for the Elderly (ACE), along with
conditions of older persons who are Family Planning Organization of the Philippines
encountering degenerative diseases With the (FPOP) and Mindanawan Community
goal of Health and Wellness Program for Senior Development Organization, Inc. (MCDOI).
Citizen of promoting quality of life among  ACE is a community-based program working
older persons and contribute to the nation for the elderly rights and development with
building, special attention to Moro and Indigenous
 the HWPSC intends to provide the following: People’s.
1. focused service delivery packages and  Objectives
integrated continuum of quality care,  The proposed project generally aims at
a) Essential Health Care Package for improving the welfare of the older people/
Older Persons senior citizens through advocacy for the
1) Management of Illness following mechanisms:
2) Counseling on substance abuse 1) Existing laws and policies favorable to the
3) Nutrition and diet counseling older people/ senior citizens shall be
4) Mental health implemented fully;
5) Oral care 2) The older people/ senior citizens’ sector shall
6) Healthy lifestyle advocacy be represented in the local special bodies/ or
7) Screening and management of committees;
chronic debilitating and infectious 3) Budget to support programs for the older
diseases people/ senior citizens shall be included in the
8) Post-reproductive health care annual budget/ Annual Investment Plan (AIP) of
2. patient-centered and environment standard the LGU.
to ensure safety and accessibility for Sustainable Urban Gardening (SUGa)
senior citizens,  As co-actor of a project for Older Persons, with
3. equitable health financing, partners Family Planning Organization of the
Philippines (FPOP) and Mindanawan
4. capacitated health providers in the
Community Development Organization, Inc.
implementation of health programs for
(MCDOI), Pasali designed for the Older
senior citizens,
Persons in the community a form of livelihood
5. data base management, and that is accessible and sustainable.
6. Strengthened coordination and collaboration
with other stakeholders involved in the The Commission on Human Rights of the
implementation of programs for senior Philippines (CHRP),
citizens.  as the country’s national human rights
institution, submits this written inputs to the

11
 Special Rapporteur on the Rights of Persons management of various clinical programs within
With Disabilities for the Report to the 74th the UP-PGH system, including:
Session of the General Assembly which aims to 1. Outpatient geriatric evaluation and
identify and address specific human rights wellness clinic Inpatient geriatric medical
concerns faced by both persons with disabilities consultation
who are ageing and older persons who acquire 2. Memory clinic, Department of
a disability. Neurosciences
 The CHRP is also conducting a pilot study 3. Stroke unit, Department of
on the rights of older Filipinos with focus on Neurosciences Rehabilitation unit
four (4) thematic areas: (physical, occupational and speech
 (1) longterm care and palliative care; therapy)
 (2) autonomy and independence; 4. Menopause clinic Specialized services
 (3) education, training, lifelong learning, such as Spine/Osteoporosis care.
and capacitybuilding; and 5. Rheumatology clinic
 (4) autonomy and independence.
Republic Act No. 9336, known as The General
The Committee on Aging and Degenerative Appropriations Act of 2006, under Section 32
Diseases National Institutes of Health University  mandates that all government agencies and
of the Philippines Manila. instrumentalities should allocate 1 percent of
 The COMADD is currently comprised of their total agency budget to programs and
volunteer consultants from various Clinical and projects for older persons and persons with
Basic Sciences Departments of the UPPGH disabilities.
system: Presidential Proclamations and Executive
1. Philippine General Hospital - Clinical Orders Presidential Proclamation No. 470, Series
Departments are involved through their of 1994,
representatives, including: Internal Medicine,  declaring the first week of October of every
Family Medicine, Surgery, Orthopedics, year as “Elderly Filipino Week.” Presidential
Rehabilitation, Neurology, Psychiatry and Proclamation No. 1048, Series of 1999,
Nutrition. declaring a Nationwide Observance in the
2. UP College of Nursing - membership Philippines of the International Year of Older
representation Persons. 9 Executive Order No. 266, Series
3. UP Manila College of Arts and Sciences - of 2000, approved and adopted the Philippine
membership representation thru the Plan of Action for Older Persons (PPAOP)
Department of Behavioral Sciences 1999-2004, a strategy to ensure that the
(Anthropology) present and future needs of the growing
4. College of Allied Medical Professionals number of older persons in society, both in
terms of human development and service
5. College of Pharmacy delivery would be met.
6. College of Dentistry
Vision:
 The Filipino elderly enjoying a healthy body,
mind and spirit, being treated with dignity, and
valued as a productive member of society, in a
dynamic process unique to himself, and
beginning a life of unlimited possibilities.
Mission
 The institute shall create with the aging Filipino,
unlimited possibilities for their value added life
through scientific research, training and
education, and specialized services.
Clinical Programs
 The Committee on Aging and Degenerative
Diseases through its multidisciplinary
membership is involved in the development and

12
SAS 9: COMMUNICATING WITH OLDER D. Patient who are Visually impaired
PERSONS a) Check for use of glasses or contact lenses
b) Identify yourself when you enter room and
 Good communication is an important part of the notify patient when you leave room
healing process c) Speak in a normal tone of voice
 Ppor communication with this vulnerable and
growing population can undermine your efforts  Communication
to provide good patient care.  is most effective when the receiver and
sender accurately perceive the meaning of
EFFECTIVE COMMUNICATION HAS PRACTICAL one’s messages via feedback loops and
BENEFITS, IT CAN: validation.
 Help prevent medical errors  The sender and receiver’s physical and
 Lead to improved health outcomes developmental status, perception, values,
 Strengthen the patient-provider relationship emotions, knowledge , sociocultural
 Make the most of limited interaction time background, roles and environment all
influence message transmission.
 A nurse caring for a patient with Impaired  Effective verbal communication
Verbal Communication related to cognitive  requires appropriate intonation, clear, and
impairment can use several techniques to concise, phrasing, proper pacing of
enable the patient to understand the caregiver. statement , proper timing and relevance of
The nurse use picture, drawing or a message
demonstration such as eating behavior to help  Effective nonverbal communication
the patient understand the verbal direction.  complements and strengthens the
message conveyed by verbal
Communicating with patients who have special communication.
needs
A. Patient who cannot Speak Clearly (aphasia,  Verbal communication
dysarthria, muteness)  This involves sending and receiving
a) Listen attentively, be patient and do not messages by means of words. Some
interrupt verbal communication is formal, structured,
b) Ask simple questions that require “yes” or and precise; some is informal,
“no” unstructured, and flexible. Formal or
c) Allow time for understanding and response therapeutic communications have a
d) Use visual cues(words, pictures and specific intent and purpose.
objects)when possible  Nonverbal communication
e) Allow only one person to speak at a time  This takes place without words. We are
communicating all the time, whether we
B. Patient who are cognitively Impaired are aware of it or not.
a) Use simple sentences and avoid long
explanation Formal or therapeutic communication
b) Ask one questions at a time  Therapeutic communication is a conscious and
c) Allow time for patient to respond deliberate process used to gather information
d) Be an attentive listener related to a patient’s overall health status
(physical, psychosocial, spiritual, etc.) and to
C. Patients who are hearing impaired respond with verbal and nonverbal approaches
a) Check for hearing aids and glasses that promote the patient’s well-being or improve
b) Reduce environment noise the patient’s understanding of ongoing care.
c) Get patient’s attention before speaking
d) Face patient with mouth visible Informal or social communication
e) Rephrase rather than repeat if  Simple chitchat has a place in nurse-patient
misunderstood communications. If nurses talked only about
f) Provide a sign –language interpreter if things related to health treatment, they would
indicated know little about their patients. Small talk;
pleasantries; and conversations about the
weather, a favorite television show, or the latest

13
 news can demonstrate that the nurse thinks of one culture may be considered offensive in
the patient as a real person, not just a patient. another.
 Some gestures that are accepted today as
Nonverbal communication commonplace were once considered crude
 Symbols or insulting.
 In the health care setting, uniform styles  Facial Expressions
and colors help patients distinguish the  Facial expressions are yet another form of
various caregivers. communication. The human face is most
 Many patients, particularly older adults, expressive, and facial expressions have
were unhappy when nurses stopped been shown to communicate across
wearing caps. The white uniform and cap cultural and age barriers.
were symbols that helped older adults  Humans respond to facial expressions
distinguish nurses from other caregivers. from the time they are born. We tend to
 Tone of Voice mirror the expressions of the person with
 Think of the sound of a whisper, shout, or whom we are communicating:
whine. Try saying, “I don’t want to do that,”  Smiles tend to elicit smiles, and frowns
first in a whisper, shout, and whine, and elicit frowns. Fear, anger, joy, and a
then in a normal speaking voice. Was your variety of other emotions can be
understanding of the message the same in conveyed by a simple change in facial
each situation? Probably not. expression.
 To survive we learn early in life to  Eye Contact
understand that tone of voice is a fairly  “Look me in the eye” is a phrase many
reliable way of judging a person’s white Americans have heard.
emotions.  Looking someone in the eye is perceived
 Because the nonverbal message is so in our culture and other cultures as a
strong, we typically respond to the emotion measure of honesty. Yet in some cultures
we perceive from the tone of voice and (e.g., African Americans and some groups
may not even hear the words. from Southeast Asia), averting the eyes
 Body Language communicates respect
 You walk past a room and observe a nurse  Pace or Speed of Communication
standing in the doorway, with his or her  Nurses tend to be substantially younger
head sticking into the room and body still than the aging people they serve. The
in the hallway. resulting difference in rate of speech and
 We communicate many things by how we movement can be overwhelming and
move, stand, sit, and position our bodies. frustrating to older adults.
In dealing with all patients, but particularly  Many choose not to respond or interact
older adults, it is important that we be with younger nurses because they feel
aware of what we are communicating they are being hurried.
through our body language.  Do not become impatient or uneasy with
 Space, Distance, and Position silence; give the older person enough time
 Physical space, distance, and position are to think and organize a response.
other ways we communicate. The study of  Time and Timing
the use of personal space in  Timing is related to the pace of
communication is referred to as proxemics. communication, but it has other distinct
 Personal space implications as well.
 refers to how close we allow someone  The amount of time a person must wait
to get to us before we feel after seeking attention is important.
uncomfortable. The amount of space  Touch
that separates two individuals when  Touch is a form of communication. No
they communicate is significant. words are required, and there is no need
 Gestures for high-level sensory or cognitive
 Gestures are a specific type of nonverbal functioning.
communication intended to convey ideas.  When all else fails, touch is left. Caring
Gestures are highly cultural and touch is a basic need of all humans, and
generational; those that are acceptable in many older adults suffer from touch
deprivation.

14
SAS 10: BARIERS AND TECHNIQUES FOR  When the nurse and the patient do not
EFFECTIVE COMMUNICATION share a common language, interaction
between them is strained and very limited.
EFFECTIVE COMMUNICATION  Cultural differences
 Effective communication is not easy, even  Culture is another hindrance. The patient’s
among people of the same age group and culture may block effective nurse–patient
background. interactions because perceptions on health
 Communication among people from different and death are different between patients.
age groups and backgrounds is even more  The nurse needs to be sensitive when
challenging. dealing with a patient from a different
 This is particularly true when one of the culture. What is acceptable for one patient
parties is elderly; however, effective may not be acceptable for another.
communication can occur even when  Conflict
people hold significantly different values,  Conflict is a common effect of two or more
beliefs, and perspectives. parties not sharing common ground.
 Effective communication does not mean that Conflict can be healthy in that it offers
we will like or agree with everything that alternative views and values.
another person says, but rather that we respect  However, it becomes a barrier to
the person’s right to think and say it. communication when the emotional ‘noise’
detracts from the task or purpose. Nurses
Effective communication requires the following: aim for collaborative relationships with
1. The need or desire to share information patients, families and colleagues.
2. Acceptance that there is value and merit in what  Setting in which care is provided
the other person has to say, demonstrated by a  The factors in care setting may lead to
willingness to treat the other person with genuine reduction in quality of nurse–patient
dignity and respect communication.
 Increased workload and time constraints
3. Understanding of factors that may interfere with restrict nurses from discussing their
or become barriers to communication
patients concerns effectively.
4. Development of the skills and techniques that  Nurses work in busy environments where
facilitate effective interchange of information they are expected to complete a specific
amount of work in a day and work with a
Barriers to effective communication variety of other professionals, patients and
 Effective communication skills and strategies their families.
are important for nurses. Clear communication  Lack of collaboration between the nurses
means that information is conveyed effectively and the doctors in information sharing also
between the nurse, patients, family members hinder effective communication. This leads
and colleagues. to inconsistencies in the information given
 The meaning of a message depends on its to patients making comprehension difficult
literal meaning, the non-verbal indicators for the patient and their families
accompanying it and the context in which it is  Internal noise, mental/emotional distress
delivered. It is therefore, easy to misinterpret  Internal noise has an impact on the
the message, or to interpret it correctly, but to
communication process. Fear and anxiety
decide not to pursue its hidden meaning this
can affect the person’s ability to listen to
leads to obstruction to communication. what the nurse is saying.
 Continuous barriers to effective  People with feelings of fear and anger can
communication brings about a gradual
find it difficult to hear. Illness and distress
breakdown in relationships. The barriers to
can alter a person’s thought processes.
effective communication outlined below will
 Perception
help nurses to understand the challenges.
 If a healthcare professional feels that the
person is talking too fast, not fluently, or
 Language barrier does not articulate clearly etc., he/she may
 Language differences between the patient dismiss the person. Our preconceived
and the nurse are another preventive attitudes affect our ability to listen. P
factor in effective communication.

15
 Difficulty with speech and hearing SAS 11:
 People can experience difficulty in speech  RESEARCH AGENDA ON AGING /
and hearing following conditions like stroke  PHYSIOLOGICAL CHANGES IN AGING
or brain injury. AFFECTING INTEGUMENTARY SYSTEM
 Stroke or trauma may affect brain areas
that normally enable the individual to Summary: The 2030 Problem - Caring for Aging
comprehend and produce speech, or the Baby Boomers
physiology that produces sound. Key Issues:
 Medication 1. **Increasing Elderly Population**:
 Medication can have a significant effect on - By 2030, Baby Boomers (66-84) will reach 61
communication for example it may cause million; "oldest old" (born before 1946) will number 9
dry mouth or excess salivation, nausea million.
and indigestion, all of which influence the 2. **Rising Demand for Long-Term Care**:
person’s ability and motivation to engage - Surge expected as Baby Boomers age past 85.
in conversation. - Long-term care costs are high, often leading to
 Noise significant out-of-pocket expenses and heavy
 Equipment or environmental noise reliance on Medicaid and Medicare.
impedes clear communication. 3. **Insurance and Financial Strain**:
 The sender and the receiver must both be - Few have insurance for long-term care, leading
able to concentrate on the messages they to reliance on Medicaid after depleting personal
send to each other without any distraction. funds.
- Quality of care and worker shortages are major
 There are several points to be kept in mind concerns.
when communicating with patients. The first 4. **Family Caregiving Challenges**:
point is that you are there to provide care - Adult daughters primarily provide informal care,
and support to the patient. but availability may decline due to higher divorce
 Be open, respectful and gracious in all rates, fewer children, smaller family sizes, and
your interactions with the patient and keep increased women's workforce participation.
his/her cultural preferences in mind.  5. **Disability Rates and Care Needs**:
 Answer nurses’ bells promptly. - Future care demand hinges on old-age disability
 Make sure you have the patients’ attention rates.
when communicating. - Health improvements are uncertain, with rising
 Use words that are non-threatening – diabetes and obesity potentially increasing future
explain what you would like to do and do disability.
not give orders to the patient. 6. **Projections to 2040**:
 Use simple, understandable phrases, - Based on models and simulations using
not medical terms as most patients do DYNASIM3 and data from the 2002 Health and
not understand these terms. Retirement Study.
 Speak clearly and courteously. - Scenarios include:
 Use a pleasant and normal tone of - **Intermediate**: No specific trend in disability
voice to the hard of hearing. rates, influenced by mortality, education, income,
 Always stand so that the patient can and demographics.
see the nurse’s face when - **High Disability**: 0.6% annual increase in
communicating, as lip reading is part of disability rates (2000-2014), then constant.
all normal hearing. - **Low Disability**: 1% annual decline in
 Use body language that is appropriate. disability rates indefinitely.
 Explain facts and procedures before Conclusion
donning a mask that covers the wearer’s Addressing the "2030 problem" requires preparing
mouth and lower face. for increased long-term care demand, ensuring
 Be alert to the patient’s needs. Allow resources, and adapting to demographic shifts that
time for answers to your requests and to affect caregiving. Projections underscore the need
answer patient’s questions. for robust planning and policy to handle future
challenges.

16
Future Size and Care of the Frail Older Conclusion
Population  The growing frail older population will
Key Projections: significantly increase the demand for long-term
1. **Growth in Disability Among Older Adults**: care services. Policy decisions will be pivotal in
a) **Intermediate Scenario**: managing this demand and ensuring that
i. Disability rates for those 65+ will fall quality, affordable care is available.
slightly (30% to 28%) between 2000
and 2040. United Nations Program for Aging
ii. The number of disabled older adults Key Initiatives and Instruments:
will more than double from 10 million 1. **Principles for Older Persons (1991)**:
to 21 million. a) UN General Assembly adoption.
iii. Support ratio: By 2040, only 9 adults 2. **Madrid International Plan of Action on
(25-64) per disabled older adult, down Ageing (MIPAA, 2002)**:
from 15 in 2000. a) Comprehensive action plan for building a
b) Optimistic Scenario**: society for all ages.
i. Even with a 1% annual decline in b) A focal point was later created to facilitate
disability rates, the disabled older MIPAA’s implementation.
population will grow by over 50%. 3. **Working Group on Human Rights of Older
2. **Use of Paid Long-Term Care Services**: Persons (2010)**:
a) Share of disabled older adults receiving a) Established to consider the human rights
paid help will increase from 22% to 26%. of older persons and identify gaps in their
b) Share receiving unpaid help from children protection.
will decrease from 28% to 24%. b) References include the UN Convention on
c) Number receiving paid home care will rise the Rights of Persons with Disabilities
from 2.2 million to 5.3 million. (UNCRPD).
d) Number of nursing home residents will
increase from 1.2 million to 2.7 million. 4. **Open Ended Working Group on Ageing
e) Even under the optimistic scenario, the (OEWG)**:
use of paid home care will increase by a) Mandated to consider the international
three-fourths, and nursing home residents framework of human rights for older
will increase by two-thirds. persons.
3. **Increase in Help Hours**: b) Tasks include identifying gaps and
a) Average paid help hours per frail elder will addressing these, considering options like:
rise by 36%, from 163 to 221 hours per c) New binding instruments.
month. d) Appointing a Special Rapporteur.
b) Total paid home care hours will more than e) Reviewing and appraising the Madrid
triple under the intermediate scenario and Action Plan on Ageing.
almost quadruple under the high disability f) Enhancing implementation of existing UN
scenario. mechanisms.
c) AGE Platform Europe’s Role:
 Policy Considerations:  Participating in OEWG sessions since 2012
 Future long-term care arrangements will and UN expert group meetings.
depend on policy choices.  Representing European senior citizens and
 Promoting private long-term care providing their perspectives
insurance could increase funding and use  Ensuring challenges faced by older Europeans
of paid care are considered in UN deliberations.
 Medicaid and Medicare expansions could Conclusion
make paid services more affordable.  The UN's ongoing efforts aim to strengthen the
 Recruiting and retaining long-term care protection and rights of older persons globally
workers is crucial to avoid service through various initiatives, action plans, and
limitations and cost increases working groups. The involvement of
 The organization and financing of long- organizations like AGE ensures that the voices
term care require more policy attention to and concerns of older individuals are included
ensure affordable, high-quality care for frail in international discussions and policymaking.
elders.

17
Review the Anatomy and Physiology of F. Family History:
Integumentary System a) diabetes mellitus, allergic disorder, blood
The Integumentary System dyscrasias, specific dermatologic problems,
 The integument, or the skin, is the body’s cancer
largest organ and consists of three layers: the Physiologic Changes of integumentary System
epidermis, the dermis and subcutaneous
layers.
 The epidermis
 is the outermost layer of the skin and
has up to five layers (depending on the
specific part of the body).
 The dermis
 is the second layer of the skin, is made
up of connective tissue, has an abundant
blood supply, and lymph and neurosensory
receptors. It supports and nourishes the
dermis.
 The subcutaneous layer
 lies below the dermis, attaches to
muscles and gives shape to the body and
provides a protective cushion for bones
and internal organs.
 There are also a number of accessory
structures that are part of the integumentary
system. These are the:
 hair, nails,
 sebaceous glands (which produce sebum
for skin lubrication) and produce sweat.
The skin is very important to health and
wellness. It is responsible for:
 Regulation of body temperature.
 Regulation of body fluids.
 Provision of a barrier to infection and promotion
of the immune system.
Assessment
Health History and Gerontology focus
A. Presenting problem:
a) symptoms may include changes in color or
texture of skin, nails, pruritus, infections,
tumors, lesions, dermatitis, ecchymoses,
rashes, dryness
B. Lifestyle:
a) hygienic practices (skin cleansing
measures, use of cosmetics, skin
exposure)
C. Nutrition/Diet:
a) intake of vitamins, essential nutrient, water,
food allergies
D. Use of medication:
a) steroids, vitamin use, hormones,
antibiotics, chemotherapeutic agents
E. Past medical history:
a) renal, hepatic, or collagen diseases,
trauma or surgery, food, drugs, or contact
allergies

18
Nursing Diagnosis:
1. Risk for Impaired Skin Integrity
2. Self-care deficit: Bathing/Hygiene
3. Risk for Infection
4. Pain
Goals:
1. Freedom from injury and infection
2. Adequate nutritional status and fluid balance
Evaluation
1. Skin is intact without pressure ulcers
2. Client performs self-care activities or caregiver
provides assistance as needed

19