Introduction

Older adults are known to be the most vulnerable among the age brackets in the society. They are
known to have saggy skin and sluggish movement but they are the most priority in the
community — they always have a special place in the hearts of every human being especially in
the hearts of the Filipino people who give importance to family and the elderly. Adults, known to
be immune-compromised and immunosuppressed is required of utmost care and 24/7 eye
observation just to make sure everything they need is served and everything they want is being
provided. Nonetheless, the older community has shaped the nation for the current generation;
they fought so many fights and undergone steam pressure and challenges to make this place a
livable one. We owe to them the present and the future for they made sure everything is fine and
well.

Aging causes physiological changes in all organ systems. Cardiac production declines, blood
pressure rises, and arteriosclerosis develop. The lungs show impaired gas exchange, a decrease in
vital capacity and slower expiratory flow rates. Owing to a proportionate age-related decline in
creatinine intake, the creatinine clearance decreases with age while the serum creatinine level
remains relatively constant. Senescence causes functional changes in the gastrointestinal system,
mostly due to altered motility patterns, and atrophic gastritis and altered hepatic drug metabolism
are normal in the elderly. A lean body mass also decline with age and this is primarily due to loss
and atrophy of muscle cells. Degenerative changes occur in many joints and this, combined with
the loss of muscle mass, inhibits elderly patients' locomotion. These age-related developments
have significant clinical consequences for the care of elderly patients.

Aging is a process of adapting to changes that occur on a regular basis. Many older adults'
perspectives on their lives may be influenced by the changes they go through. Many people
believe they have lost their autonomy. They can suffer from low self-esteem and lose sight of
who they are at this point in their lives. So many changes and adjustments can lead to a lack of
confidence in one’s ability to live a meaningful life and continue to make valuable contributions
to the community. Older adults may also experience a sense of loss of the respect of others. One
unchangeable fact of life is that people, no matter how old they are, they never stop evolving.
Aging brings a slew of physical and emotional changes, which can result in a wide range of
behavioral changes that can confuse or concern loved ones of the elderly. Dementia causes a lot
of behavioral changes. People with dementia often behave in ways that are very different from
their "old selves," and family and friends may find it difficult to cope with these changes. For a
variety of factors, people's behavior shifts. Dementia is caused by the loss of neurons in different
parts of the brain. Depending on which part of the brain is losing cells, you can see behavioral
changes. Dementia affects a person's ability to adapt to their surroundings. Alzheimer's disease
causes people to forget things and have trouble understanding conversations. They can become
enraged and irritated as a result of their inability to understand what is going on. Noise,
conversation, crowds, and movement can all be over stimulating and difficult to process.
In our case study, there are several problems that our patient encountered. First is hearing; noise,
aging, disability, and heredity all contribute to hearing loss. Conversations with friends and
family can be difficult for people with hearing loss. In older adults, they may have difficulty in
comprehending medical advice, reacting to warnings, and hearing doorbells and alarms. Dry
skin; this is a common dermatological feature in older people. In this case, the skin is more likely
to crack as a result of water loss from the stratum corneum, which can cause scratching,
bleeding, and asteatotic dermatitis. Interrupted sleep pattern; sleep disturbances can also be
caused by mental and physical health issues. Heart disease, diabetes, and conditions that cause
discomfort and pain, such as arthritis, are all common sleep disruptors in the elderly.
Osteoarthritis; this is the most common form of arthritis in older people, and it is also one of the
leading causes of physical disability and both men and women are affected by the disease.

There are diagnostic tools or procedure that health care professionals use to diagnose
osteoarthritis. 1. Imaging, while magnetic resonance imaging (MRI) is a more sensitive imaging
method, it is used less often than X-rays due to cost and availability. MRI scans show cartilage,
bone, and ligaments. 2. X-rays are typically used to confirm the diagnosis of osteoarthritis and it
can reveal assymetric joint space narrowing, osteophytes at the joint margins, joint space
narrowing, and subchondral bone sclerosis. 3. Physical examination; the physician will assess
each of the joints for pain, tenderness, and range of motion. The pattern of affected joints is
important since it can sometimes tell the difference between rheumatoid arthritis and
osteoarthritis.

Geriatric nurses are trained to recognize and manage the physical and mental health needs of the
elderly. They work to ensure that their patients' health is protected and that they can cope with
changes in their mental and physical capacities as they age, so that they can remain independent
and involved for as long as possible. Many older people have health problems that don't
necessitate hospitalization but need medication, dietary modifications, special equipment (such
as a blood sugar monitor or walker), regular workouts, or other adjustments. Patients and their
families benefit from the assistance of geriatric nurses in the design and explanation of these
healthcare regimens. They also serve as "case managers," connecting families with community
services to assist them in caring for elderly relatives.

Patient’s Profile
Client F.O. is a 78-year-old, woman. Her religious affiliation is Roman Catholic. She
was born on May 15, 1943. She is happily married to a loving and kind husband and blessed with
4 children. After marriage, they are living at Casicallan, Gattaran, Cagayan with their children
but they decided to transfer to Upper, lallo, Cagayan because of traumatic experience wherein
they are attacked by the terrorist which brought fear to them.
History of Present Illness

According to the client, she was diagnosed with osteoarthritis and upon physical assessment,
swelling on the right knee is evident but both knees are tender when palpated. She also have
problem in hearing and was not able to hear clearly the whisper of the examiner during
assessment.

Past Health History

Client F.O. completed her immunizations. She had childhood illnesses such as chicken pox and
measles as well.

Social History

Client F.O. has a good relationship with her husband, children, grandchildren and friends. She
doesn’t have enemies and could deal properly with other people around her. However, she
sometimes avoids social interaction because she misinterprets what is being told to her whenever
she engaged in a conversation.

Family History
According to the client, she is the youngest among her 5 siblings.. Her father was died
because of old age. She didn’t know if her mother already died because she was not able to see
her. Her eldest sister was died already by the unknown cause while the other siblings don’t have
disease. She is married to Mr. R.O. for almost 59 years.

Physical Assessment

Skin When skin is pinched it goes to previous state after 3 seconds.

With fair complexion.
With dry skin

Hair Evenly distributed hair.

With short, dry, black and some grey hair at the top of the head.
With no presence of pediculosis Capitis.
Nails Smooth and has intact epidermis
With short and clean fingernails and toenails.
Convex and with good capillary refill time of 2 seconds.
Skull Rounded, normocephalic and symmetrical, smooth and has
uniform consistency.Absence of nodules or masses.

Face Symmetrical facial movement, palpebral fissures equal in size,

symmetric nasolabial folds.
Eyes and Vision
Eyebrows Hair evenly distributed with skin intact.
Eyebrows are symmetrically aligned and have equal movement.
Eyelashes Equally distributed
Eyelids Skin intact with no discharges and no discoloration.
Lids close symmetrically and blinks involuntary.
Presence of eye bags
Bulbar conjunctiva Transparent with capillaries slightly visible
Palpebral Conjunctiva Shiny, smooth, pink
Sclera Appears white.
Lacrimal gland, No edema or tenderness over the lacrimal gland and no tearing.
Lacrimal sac,
Nasolacrimal duct
Cornea
Clarity and texture Transparent, smooth and shiny upon inspection by the use of a
penlight which is held in an oblique angle of the eye and
moving the light slowly across the eye.
Have [brown] eyes.
Corneal sensitivity Blinks when the cornea is touched through a cotton ball from
the back of the client.
Pupils Black, equal in size with consensual and direct reaction, pupils
equally rounded and reactive to light and accommodation.
Visual Fields When looking straight ahead, the client can see objects at the
periphery which is done by having the client sit directly facing
the nurse at a distance of 2-3 feet.
The right eye is covered with a card and asked to look directly
at the student nurse’s nose. Hold penlight in the periphery and
ask the client when the moving object is spotted.
Ear and Hearing
Auricles Color of the auricles is same as facial skin, symmetrical, auricle
is aligned with the outer canthus of the eye, mobile, firm, non-
tender, and pinna recoils after it is being folded.
External Ear Canal Without impacted cerumen.
Whisper Test Was not able to hear whispering on both ears at a distance of
one feet
Nose and sinuses
External Nose Symmetric and straight, no flaring, uniform in color, air moves
freely as the clients breathes through the nares.
Nasal Cavity Mucosa is pink, no lesions and nasal septum intact and in
middle with no tenderness. She can smell kind of scent
Mouth and Oropharynx Symmetrical, pink lips and gums
Teeth With decayed lower molars in the prosthethic gums. She is
using a prosthetic teeth.
Tongue and floor of the Central position, pink but with whitish coating which is normal,
mouth with veins prominent in the floor of the mouth.
Tongue movement Moves when asked to move without difficulty and without
tenderness upon palpation.
Uvula Positioned midline of soft palate.

Neck Positioned at the midline without tenderness and flexes easily.

No masses palpated.
Head movement Coordinated, smooth movement with no discomfort, head
laterally flexes, head laterally rotates and hyperextends.
Muscle strength With equal strength
Lymph Nodes Non-palpable, non tender
Thyroid Gland Not visible on inspection, glands ascend but not visible in
female during swallowing and visible in males.
Thorax and lungs
Posterior thorax Chest symmetrical
Spinal alignment Spine vertically aligned, spinal column is straight, left and right
shoulders and hips are at the same height.
Breath Sounds With normal breath sounds without dyspnea.
Anterior Thorax Quiet, rhythmic and effortless respiration
Abdomen Unblemished skin, uniform in color, symmetric contour, not
distended.
Abdominal movements Symmetrical movements cause by respirations.
Auscultation of bowel With audible sounds
sounds
Upper Extremities Without scars and lesions on both extremities.
Lower Extremities With minimal scars on lower extremities. With no presence of
edema in legs.
Muscles Equal in size both sides of the body, smooth coordinated
movements, 100% of normal full movement against gravity and
full resistance.
Bones and Joints Presence of deformities in hands and swelling in the knee joint
(right side)
Mental Status
Language Can express oneself by speech or sign.
Orientation Oriented to a person, place, date or time.
Attention span Able to concentrate as evidence by answering the questions
appropriately.
PERTINENT DATA DURING PHYSICAL ASSESSMENT ARE AS FOLLOWS:
GORDON’S 11 FUNCTIONAL HEALTH PATTERN

GORDON’S 11 PRESENT HEALTH PATTERN

FUNCTIONAL
HEALTH PATTERN
HEALTH The client believes that health is important to an
PERCEPTION- individual; she follows doctor’s order to improve her
HEALTH health condition and complies with her medication regimen
MANAGEMENT but there are times where she skips her naproxen and take
PATTERN it only whenever pain occurs in the joints of her knees. She
also manage the pain by massaging the body part involved.

NUTRITIONAL The client verbalized that she has no allergies to food and
AND METABOLIC drugs, she ate three times a day with snack in between. She
PATTERN typically consumes 7-8 glasses of water a day. She also
drinks black coffee in the morning and afternoon. “Kada
bigat ken malem akapkape nak”, as reported by the patient.
ELIMINATION The client usually urinates three times a day with light
PATTERN yellow color. She defecates once a day with golden brown
color, firm and soft consistency. She doesn’t express any
problem in voiding and defecating.
ACTIVITY- According to the client, she stretches her ankle every
EXERCISE morning when she wakes up. She can still tolerate doing
PATTERN household chores such as cleaning their backyard and
gardening which serves as her daily exercise. She even
reported “Haan nak sanay nu awan ti ububbraek, kasla
mandi ti rikriknaek nu awan ti ar aramidek.
SEXUALITY- The client claimed that she is sexually inactive due to her
REPRODUCTIVE age and aging process.
PATTERN
SLEEP-REST The client usually sleeps 5-6 hours; her earliest time in
PATTERN going to sleep was around 9-10 o’clock in the evening just
after she finished watching TV then wakes up at around 2-
3 am in the morning. She experience difficulty in going to
sleep . She also stated, “Hannak makaturturug nu
mapmapan kayo dita war ta adda ti napasamak idi kanyami
nga hanku malipatan”. Additionally, the patient doesn’t use
any medication to promote sleep.
COGNITIVE- The client is oriented to people, time and place. She
PERCEPTUAL responses to stimuli verbally and physically. The client
PATTERN able to respond to questions asked by the student nurse.
The client educational attainment is elementary
undergraduate but she is able to read and write.
ROLES- The client plays the role of a grandmother to her
RELATIONSHIP grandchildren and a wife to her husband. She is well
PATTERN supported by her family. Additionally, she maintains a
good relationship with her family. The client even stated,
“Mayat met ti komunikasyon mi a agkakabbalay pati
karrubak ngem mas pilyek lang umadayo nukwa ta adda
dagiti sao a sabali pagawawatak”. She also clarified that
there are no conflicts among them.
SELF- The client is experiencing negative behaviors toward
PERCEPTION-SELF herself primarily regarding her bone derformities. She
CONCEPT stated,””. Seeing her family's support, love and care makes
PATTERN her contented and also it serves as her distraction to
alleviate herself in her condition.
COPING-STRESS The client copes up with stress through watching
PATTERN television, cleaning their backyard and gardening. Every
time there's a problem in their family, they resolve it by
talking to each other with the people who are involve. The
client has a traumatic experience in the past wherein they
were almost attacked by terrorists which brought fear to
them and led them to transfer in another place.
VALUE BELIEF The client's religious affiliation is Roman Catholic. She
PATTERN seldom goes to church because of the pandemic and also
because of her condition but she never forgot to pray. The
client also believes in quack doctors and sometimes, she
consults to them.
 PATHOPHYSIOLOGY
Conductive Hearing Loss Sensorineural Hearing Loss

1. External ear conditions 1. Trauma

• Impacted earwax or foreign body • Head injury
• Otitis externa • Noise
2. Middle ear conditions 2. Central nervous system infections (e.g., meningitis)
• Otosclerosis 3. Vascular
• Atherosclerosis
4. Medication
5. Tumors
• Vestibular schwannoma (acoustic neuroma)
Blockage • Meningioma
• Metastatic tumors

Sound does not enter into the

inner ear
6. Degenerative
conditions
Hearing Loss • Presbycusis
 Sensory Neural Metabolic Mechanical
Presbycusis Presbycusis Presbycusis Presbycusis

Loss of sensory Degeneration of Atrophy of stria Thickening and

hair cells nerve cells in cochlea vascularis stiffening of basilar
membrane of
cochlea

Drop in high Damage in

frequency No drop of Speech
frequency discrimination cochlea Gradual sloping of
threshold sensorineural
threshold
Low frequency frequency
Decrease threshold
healing ability

Hearing loss

OSTEOARTHRITIS
Predisposing Factors
Precipitating Factors
 Age
 Repetitive use
 Trauma/previous joint damage
(occupational/recreational)
 Female gender
 Anatomic deformity
 Genetic susceptibility
 Chondrocyte Response

Release of Cytokines

Stimulation, Production, and Release of Proteolytic

Enzymes, Metalloproteases, Collagenase

Degradation of Cartilage

Irritate Synovial Lining Osteocytes are stimulated to Remodeling of bone

activate Osteoblasts
(Repair Mechanism)
Limit Joint Movements Formation of
Osteophyte
Exposure of underlying
Subchondral Bone
Alteration of
Bony Contour
Sclerosis

Pain/Stiffness
Thickening and hardening
of cartilage

Joint space is progressively

lost over time.
NCP

ASSESS DIAGN PLANN INTERVEN RATION EVALUA

MENT OSIS ING TION ALE TION
Objective Acute At the Independendent Nursing GOAL
Data pain r/t end of Interventions MET:
(+)Swellin joint 1hr of Assessed To After 1hr.
g knees degenera nursing the client’s identify of nursing
Pain scale: tion intervent description the interventio
4/10 ions, the of pain. appropria ns, the
Subjectiv patient te nursing patient
e Data will interventi reported
“Nasakit report on for the pain is
nu pain is patient. relieved
ingatum relieved Assessed the To from 4/10
ti takyag from client’s determine to 0/10
ku”, as 4/10 to previous if there
verbalized 0/10 experiences are
by the with pain practices
patient and pain being
relief. done that
could
exacerbat
e the
problem.
Emphasized To raise
to the patient awarenes
the s
importance regarding
of taking the
medication prescribe
accordingly. d
medicatio
n that
alleviates
pain
occurrenc
e.
Applied cold Cold
pack in the reduces
knee of the pain,
patient and inflamma
instructed to tion, and
do it muscle
whenever spasticity
pain occurs. by
decreasin
g the
release of
pain-
inducing
chemicals
and
slowing
the
conductio
n of pain
impulses.
Supported Flexion
Joints in a of the
slightly joints
 flexed may
position reduce
through the muscle
use of spasms
pillows. and other
discomfo
rts.
Instructed Limiting
the patient to the
rest in factors
between that could
activities. cause
stress of
the joints
may
reduce
pain
occurrenc
e.
Dependent Nursing
Intervention
Instructed This
the patient to NSAID
take drugs
naproxen as acts by
prescribed reducing
prostagla
ndin
synthesis
vie the
inhibition
of
cyclooxy
gens e-2
(COX-2)

ASSESSM DIAGN PLANN INTERVEN RATION EVALUA

ENT OSIS ING TION ALE TION
Objective Interrupt At the Independent Nursing After 30
Data ed sleep end of Interventions minutes. Of
(+) pattern 30 Instructed the Caffeine nursing
Eyebags r/t minutes. patient to intake interventio
Subjective caffeine Of limit/avoid specially n, the
Data intake nursing drinking in the patient
“Kada bigat and intervent coffee. afternoon demonstrat
ken malem ineffectiv ion, the could ed
akapkape e coping patient interfere techniques
nak”, as will the to improve
verbalized Traumati demonst patient’s sleep
by the c rate ability to pattern
patient experien techniqu relax and
ce es to sleep.
“Hannak improve Encouraged L-
makaturturu sleep patient to tryptopha
g nu pattern take milk n is a
mapmapan instead. componen
kayo dita t of milk
war ta adda which
ti promotes
napasamak sleep.
idi kanyami Instruct the Consisten
nga hanku patient to t
malipatan”, follow a schedules
as consistent facilitate
verbalized daily regulation
by the schedule for of the
patient rest and circadian
sleep. rhythm
and
decrease
the energy
needed
for
adaptation
to
changes.
Introduced These
reading a activities
book or provide
listening to relaxation
calm music and
before distractio
bedtime. n to
prepare
mind and
body for
sleep.
Suggest To
patient to get prevent
out of bed distractin
temporarily g thoughts
 and perform
DBE for 30-
45 minutes

ASSESS DIAGN PLAN INTERVE RATION EVALUA

MENT OSIS NING NTION ALE TION
Objective Impaired At the Independendent Nursing
Data verbal end of Interventions
Whisper communi 1hr of Instructed To
test result cation r/t nursing the patient protect
as follows: hearing interven to stay away hearing
Slight disability tion, the from noise
auditory patient
hearing will
impairmen interact
t without
hesitati
Subjective on and
Data preserv
“Mayat e
met ti hearing.
komunikas
yon mi a
agkakabba
lay pati
karrubak
ngem mas
pilyek lang
umadayo
nukwa ta
adda dagiti
sao a
sabali
pagawawat
ak”,as
verbalized
by the
patient
Reinforced Too
to the much
patient that build up
earwax can
removal reduce
 should be hearing
done every while
two weeks performin
interval g it
frequentl
y impairs
hearing
as well.
Involved the Enhances
S/Os in plan participat
of care as ion and
much as commitm
possible ent of the
client
Used and Promotin
encouraged g the
S/Os to quality of
speak to the transmitti
client slowly ng
and with informati
appropriate on also
volume. promotes
communi
cation
Dependent Nursing
Interventions
Referred to To
an ENT determine
doctor for the extent
further of
assessment hearing
impairme
nt and
obtain
prescribe
d hearing
aid, as
appropria
te

ASSESS DIAGN PLANN INTERVEN RATION EVALU

MENT OSIS ING TION ALE ATION
Objective Disturbe At the Independent Nursing After 1hr
Data d body end of Interventions of
(+) Bone image r/t 1hr of Encouraged Sharing nursing
deformitie bone nursing the patient to their interventi
s on both features interven express feelings on, the
arms tion, the feelings provides patient
Subjectiv patient about body excellent demonstr
e Data will changes.  insight into ated
“Kitam ne demonst the strategies
nakkung, rate patient’s to adjust
nagmandi strategie insecurities to new
nga s to and helps reality.
kitkitan adjust to the nurse
tuy imak”, new in
as reality. individuali
verbalized zing care.
by the Supported Expression
patient verbalization of different
of positive kinds of
and negative feelings
feelings can
towards her. enhance
the
patient’s
coping
strategies.
Assured the Reassuranc
patient about e of that
the normalcy bone
of deformity
undergoing is part of
to this age- aging
related process
process may be
comforting
for the
patient and
promotes a
normal
healing
process. 
Advised the Strengthen
patient to ing skills
focus on can boost
remaining the
abilities. patient’s
confidence
and
distract
 from
feelings of
loss. 

ASSESS DIAGN PLANN INTERVEN RATION EVALUA

MENT OSIS ING TION ALE TION
Objective Risk for At the Independendent Nursing After 30
Data impaired end of Interventions minutes of
(+)Minima skin 3o Assessed Healthy nursing
l scars integrity minutes general skin interventio
(+) Dry related of condition of varies n, the
Skin to aging nursing skin. from patient
Capillary process interven individua described
refill Time tion, the l to measures
: 3 sec. Patient individua to protect
describe l, but skin
s should integrity
measure have
s to good
protect turgor (an
skin indication
integrity of
moisture)
, feel
warm and
dry to the
touch, be
free of
impairme
nt, and
have
quick
capillary
refill
(less than
4
seconds).
Encouraged Position
the patient to changes
change the relieve
pt's position pressure,
frequently restore
during blood
bedtime. flow, and
promote
skin
integrity .
Suggested These
using bed equipmen
cushion t
redistribu
te
pressure
when
frequent
position
changes
are not
possible.
Instructed to These
apply lotion prevent
if not friction
contraindicat and
ed. shear.
Encouraged Skin
to wear friction
fabric caused by
clothes stiff or
rough
clothes
leads to
irritation
Emphasized Improve
the nutrition
importance and
of adequate hydration
nutrition and will
oral fluid improve
intake. skin
condition
.
DRUG STUDY

GENERIC NAME: NAPROXEN

BRAND NAME:

DOSE: 500 mg PO BID

THERAPEUTIC ACTION:

Naproxen has anti-inflammatory, analgesic, antipyretic actions. It reduces prostaglandin

synthesis by inhibiting the enzyme cyclooxygenase. It also inhibits platelet aggregation.

CONTRAINDICATION:

 Hypersensitivity.

 Aspirin or NSAID allergy.

 Perioperative pain in the setting of CABG surgery.

 Pregnancy (3rd trimester).

NURSING CONSIDERATIONS:

Assessment

 History: Allergy to naproxen, salicylates, other NSAIDs; asthma, chronic urticaria, CV

dysfunction; hypertension; GI bleeding; peptic ulcer; impaired hepatic or renal function;
pregnancy; lactation

 Physical: Skin color and lesions; orientation, reflexes, ophthalmologic and audiometric
evaluation, peripheral sensation; P, BP, edema; R, adventitious sounds; liver evaluation;
CBC, clotting times, LFTs, renal function tests; serum electrolytes; stool guaiac

Interventions

 BLACK BOX WARNING: Be aware that patient may be at increased risk for CV event,
GI bleeding; monitor accordingly.

 Give with food or after meals if GI upset occurs.

 Arrange for periodic ophthalmologic examination during long-term therapy.

 WARNING: If overdose occurs, institute emergency procedures—gastric lavage,

induction of emesis, supportive therapy.

Teaching points
 Take drug with food or meals if GI upset occurs; take only the prescribed dosage.

 Dizziness, drowsiness can occur (avoid driving or the use of dangerous machinery).

 Report sore throat; fever; rash; itching; weight gain; swelling in ankles or fingers;
changes in vision; black, tarry stools.
WORKING CARE PLAN

Medication

Advice client to take her maintenance medication (naproxen) with exact dosage, frequency and
time as prescribed by her physician

Exercise

Instruct the client for:

 Aerobic exercise such as walking to reduce pain and improve health.

 Avoiding vigorous activities such as carrying heavy loads due to risk for injury and falls.

 Rest between activities to limit exhaustion and fatigue.

Treatment

Emphasize to the client the importance of taking her maintenance medicine regularly
with exact dosage, frequency and time as prescribed by her physician.

Hygiene

Instruct client to practice and maintain good personal hygiene.

Out/In Patient Referral

Instruct patient for follow-up checkup and advice to seek medical care if any severe symptoms
occur to provide proper health care and refer if there’s any abnormalities upon evaluating and
assessing her condition.

Diet

Advice client the importance of eating nutritious food such as green leafy vegetables and
instruct about importance of good hydration such as drinking 7 to 8 glasses of water a day.

Spiritual

Advice client to keep her faith in God, and advice to keep praying.