NCMB 314 PRELIM REVIEWER PDF

Property of: Alfie Velasco BSN 3-Y1-11 INTRODUCTION TO GERONTOLOGIC NURSING: Geriatrics- branch of medicine that deals with the disease and problem of old age Gerontology- scientific study of process of aging Gerontology Nursing- focuses...

Property of: Alfie Velasco BSN 3-Y1-11 INTRODUCTION TO GERONTOLOGIC NURSING: Geriatrics- branch of medicine that deals with the disease and problem of old age Gerontology- scientific study of process of aging Gerontology Nursing- focuses on caring older adult, provide practical care, develop care plan and educate patient on well being and quality of life Age Discrimination – emotional prejudice among the older adults. Ageism – dislike of the aging and the older adult. Senescence- defined as a change in the behavior of an organism with age, leading to a decreased power of survival and adjustment, occur as well - Classification of Geriatric Patient 64-74 = young old 75-84 = middle old 85 above = very old frail elderly Factors increase life expectancy: Age dynamics Declining fertility rates Longevity increase Theories of Aging - Biological Theories- theories that address the physiological aspects of aging Programmed Theory- postulated that we are genetically programmed to age and die Programmed longevity- life is determined by a sequential turning on and off genes. Endocrine Theory- -hormones, which control the function of organs, could be behind the aging process. Immunologic theory- aging is largely controlled by the immune system - Error Theories- environmental assaults to living organisms that induce cumulative damage at various levels as the cause of aging Wear and Tear theory- proposed by Dr. August Weismann; that bodies wear out after time. Cross-Link Theory- AKA glycosylation theory; proposed by Johan Bjorksten; an accumulation of cross-linked proteins damages cells and tissues, slowing down bodily processes resulting in aging. the binding of glucose (simple sugars) to protein, (a process that occurs under the presence of oxygen) that causes various problems. protein becomes impaired and is unable to perform as efficiently. Free-radical theory- free radicals bond to other molecules in the body causing proteins and other essential molecules to have impaired function - Free radicals- by products of normal cell function. Can be processed naturally or can be processed through stress, alcohol intake, smoking and sun exposure ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 Somatic DNA Damage- accumulation of mutations in the genetic material of somatic cells as a function of time results in a decrease in cellular function. Implication in Nursing - Aging and disease do not necessarily go hand in hand. Have a clear understanding between age related changes and those that may be pathologic. - Among biological theories two concept have gained wide acceptance: Programmed Theory and Free-radical Theory - Gerontological nurse can promote health Lifestyle modification, avoiding excessive sun exposure and Vitamin Supplementation (C and E) - Prevention of atrophy of muscle Deep breathing exercise, daily walk, preventive approach, recognition of stressors Psychological Theory of Aging- various adaptive changes occurs, it include not only behavioral but also developmental aspects Maslow’s Hierarchy of Human Needs- -everyone has an innate internal hierarchy of needs that motivate all human behavior Jung’s Theory of Individualism- -individual personality is compose of ego (personal unconsciousness and collective consciousness) a person’s personalities is either toward external word (introversion) or toward subjective inner experience (extroversion) - Middle life crisis ( at middle age person questions values, beliefs, and possible dream and left unrealized) - Successful aging person looks inward & value him/herself accepts past accomplishment and limitations Erikson’s theory- a certain task should be accomplished in different stages of life - Generativity VS self absorption or stagnation When you feel a sense of care and responsibility, it’s called generativity. If you don’t act as a mentor in some capacity, you may feel bitter and unhappy leads to restlessness and isolation from your friends, family, and society - Ego VS Despair If you’re satisfied with your life, you age with grace. You often feel pride in what you’ve accomplished and want to demonstrate your wisdom to others. If you don’t feel a sense of accomplishment when you look back on your life, you may fall into despair. When that happens, you tend to focus more on regrets. Nursing Management: - Promote positive self esteem task keep in mind that intellectual functioning remains intact in most older adults Nurse recognize essential needs must be met before self actualization. ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 - Planning activities for older adults nurses need to remember that all individuals enjoy feeling needed and respected. Programs promoting interaction between older adult and young children As eyesight and manual dexterity diminish, many older adults enjoy the opportunity to cook or work in the garden. Sociological Age Theory- focus on changing roles and relationship. - Disengagement theory- Postulated by Elaine Cumming and William Earle Henry; outlines a process of disengagement from social life that people experience as they age and become elderly Complete disengagement happens when both the individual and society are ready for this to occur. People who have disengaged adopt new social roles so as not to suffer a crisis of identity or become demoralized Disengagement occurs across all cultures but is shaped by the culture in which it occurs - Activity Theory- Havighurst proposes that the idea that aging successfully is related to staying active. Even with illness or advancing stage the older person can remain active and achieve the sense of life satisfaction 3 Assumptions 1. It's better to be active than inactive 2. Better to be happy than unhappy 3. Older individuals is the best judge of his or her success in achieving the first two assumptions - Continuity Theory- individuals will respond to aging in the same way they have responded to previous life. -as people age they try to maintain or continue previous habits, values, preferences, commitments, values, beliefs, and factors that have contributed to their personalities. Nursing Management: - Withdrawal in older adults may be a manifestation of deeper problem such as depression. Older adults may refuse to engage in activity because of fear of failure. plan a realistic activity, successful completion of activity provide increase older person’s self confidence - Examine the past and being aware of significant event the health care provide deeper understanding on why older adults act the way Helping older adult to adjust to limitation while accentuating positive attributes may enable them to remain independent ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 PHYSIOLOGIC CHANGES IN AGING Integumentary - Decreased protection against trauma and sun exposure; protection against extreme temperature - Diminished secretion of natural oils and perspiration (impaired thermoregulation) - Loss of thickness, elasticity, vascularity and strength that may delay the healing process and increase the risk of skin tear and bruising - Loss of hair follicle along with thinning and graying - Increase hair density in the nose and ears particular in men w/c may clog external ear canal and impaired hearing - Higher incidence and malignant skin growths Subjective/Objective Data: - Skin is thin, wrinkled, saggy and dry - Graying of hair - Thick nails with longitudinal lines - Complaint of bruises and intolerance to heat - Bone structure is prominent Nursing Management - Avoid excessive sun exposure; use sunscreen - Dress in accordance with the weather - Take short bath (5-10 mins) - Use gentle cleansers - Maintain safe indoor temperature - Gently pat (rather than rub) the skin to dry - Apply skin moisturizer immediately after drying - Use ointment or cream rather than lotion - Skin care products should unscented and alcohol free - If needed, use humidifier to add moisture - Wear fabrics such as cotton - Keep client hydrated if not contraindicated Musculo-Skeletal - Loss of bone density; More prominent in menopausal women - Loss of muscle strength and size - Degenerative joint cartilage Subjective/Objective Data - Height loss - Prone to fracture - Joint pains - Kyphosis and other spine deformities (scoliosis, lordosis) - Loss of muscle strength, flexibility and endurance Health Promotion Strategies - Exercise regularly (Range-of-motion) ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 - Diet: High calcium diet, vitamin D - Limit phosphorus intake Respiratory System - Increase in lung rigidity and decrease in lung elasticity - Ribs become less mobile and chest wall compliance decrease - Diaphragm muscle strength decreases thus breathing requires effort - Increase lung residual volume; decrease lung vital capacity and cough efficiency Factors Affecting Lung Function - Lifestyle (smoking, sedentary, exposure to pollutants) - Obesity - Anesthesia and Surgery Subjective/Objective Data - Easily fatigued, breathlessness with sustained activity - Impaired healing tissue due to decreased oxygenation - Difficulty in coughing up secretion - Use of accessory muscle when breathing Health Promotion Strategies: - Lifestyle modification: smoking cessation, eating healthy foods, losing appropriate weight, exercise daily - Take adequate fluids to liquify thick secretions - Encourage patient to receive influenza vaccine annually - Avoid exposure to infection, pollutants and irritant by wearing protective equipments such as mask - Avoid known allergens - Ensure early diagnosis and treatment of resp. tract infection - Adhere to medical regimen for chronic respiratory illness Cardiovascular System - Heart valves becomes thicker; prone in valve stenosis - Heart muscle and arteries lose their elasticity; prone in unstable blood pressure - Accumulation of calcium and fat deposits; atherosclerosis - Veins becomes tortuous - Decrease cardiac output and cardiac reserve = less reserve and less response to stress - Left ventricular wall thickens = increase oxygen demand - A and AV node become fibrotic with age - Common aging changes reflected by ECG (arrhythmias) - During stress stimulation heart rate increase move slowly, once elevated it take longer to return Risk for Cardiovascular Diseases - Non-modifiable: Gender (prone to males), Genetics, Age - Modifiable: Lifestyle, Diet, Tobacco use Subjective/Objective Data - Complaint of fatigue with increase activity ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 - Increase heart rate recovery time - Normal BP < or equals to 140/90 mmHg Health Promotion Strategies: - Lifestyle modification: Exercise daily, medication compliance, smoking cessation, limit alcohol intake - Diet Modification: DASH Diet; Low salt and low fat diet - Stress management: Relaxation technique, meditation - BP Control and weight control Reproductive System Female- vaginal narrowing and decrease elasticity, decrease vaginal secretions (prone in vaginitis), slower sexual response and arousal Male- decrease size of penis and testes; slower sexual response and arousal; erectile dysfunction. Delayed achievement of orgasm Subjective/Objective Data Female: Dysparenuia, vaginal bleeding following intercourse, delayed orgasm, vaginal itchiness and irritation Male: delayed erection and achievement of orgasm, benign prostatic hyperplasia Health Promotion Strategy - May require vaginal estrogen replacement - Gynecology and Urology follow up - Use of lubricant during sexual intercourse - Pelvic floor exercise (kegel exercise) Genito-Urinary System Male- Benign prostatic hyperplasia; enlargement of the prostate often non-malignant Female- relaxed perineal muscles, urethral dysfunction Subjective/Objective Data - Urinary retention, incontinence, irritative voiding symptoms - Frequency, feeling of incomplete voiding - Bladder emptying urgency/ frequency syndrome drop of urine mostly when coughing Health Promotion Strategies - Seek referral to urology - Make an easy access to the toilet - Wear easily manipulated clothing - Drink adequate amount of fluids Gastrointestinal System - Decrease salivation, acuity of taste, motility of the GI tract - Delayed esophageal and gastric emptying; prone for acid reflux - Atrophy of gingival tissue = gingival retraction → loss of teeth - Lower esophageal sphincter pressure decreased = Potential for hiatal hernia and aspiration ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 - Abdominal wall is thinner and less taut, decrease in number and sensitivity of sensory receptors - Atrophy of gastric mucosa, decrease in blood flow - Small intestine decreases in secretion of most digestive enzyme and motility - Liver decreased size and lower in position, decrease in protein synthesis, ability to regenerate decreased = Decrease drug metabolism - Large intestine to rectum has decreased anal sphincter tone and nerve supply to rectal area, decreased muscular tone, decreased motility = Increase in transit time, sensation to defecation decrease - Pancreatic duct distended, lipase production decreased, pancreatic reserve impaired = Impaired fat absorption, decreased glucose tolerance Subjective/Objective Data - Loss of teeth, use of dentures - Weight loss - Complaint of dry mouth, fullness, constipation, flatulence - Heartburn and indigestion - Abdominal discomfort - Diminished sense of taste; Food intolerance - Signs of anemia as result of cobalamin malabsorption decrease gastric emptying - More visible peristalsis, easier palpation of organs, less sensitivity to surface pain - Dysphagia - Fecal incontinence and impaction Health Promotion Strategies - Use of ice chips and adequate fluid intake - Oral care; Mouthwash - Well balanced diet; Eat high fiber and low fat diet - Limit laxatives and defecate on a regular basis - Correct administration of medication: 10 rights in medication Nervous System - Reduced speed of nerve conduction - Increase confusion with physical illness and loss of environment cues - Reduced cerebral circulation Subjective/Objective Data - Learning takes longer to process - Slower to react and respond to a stimuli - Altered level of consciousness (syncope) and frequent falls Health Promotion Strategies - Pace teaching - Enhance sensory stimulation - Encourage slow rising from resting position to prevent orthostatic hypotension ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 Special Senses Vision: diminished ability to focus on close objects, inability to tolerate glare; difficulty adjusting to change of light intensity; decrease ability to distinguish colors. Eyelid lose tone and internal eye Pupil decrease in size and loses to constrict Hearing and Balance: decreased hearing acuity (sensorineural hearing) Auditory canal narrows Decrease vestibular sensitivity Taste and Smell: decrease acuity to taste and smell Alteration of smell and taste result from alterations in the oral mucosa and tongue Decrease reduction in cell number, damage to cell and diminished level of neurotransmitter Xerostomia (dry mouth) is the most common change in the sense Touch: Sensitivity to light touch diminished in older adult Subjective/Objective Data - Complaint glare, poor night vision, blurred vision - Use excessive seasoning - May give inappropriate response when asking question - Prone to falls Health Promoting Strategies - Use of eyeglasses to aid for vision, Hearing aid if necessary - Enunciate words clearly; speak with low pitch voice; use nonverbal cues - Encourage use of lemon, spices and Herbs - Encourage patient to rise slowly before standing up - Notify physician of any pain, discharge redness, swelling, dizziness, ringing in ears or loss of hearing - See physician for early detection and appropriate treatment of hearing difficulties and ear disease Pressure Ulcers/Injury - Scale that Assess Pressure Injuries Braden Scale: ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 Norton Scale Basic Principle of Preventing Pressure Ulcer - Eliminate or minimize precipitating factors such as pressure, friction shearing and poor nutrition - Provide nutritional support and monitor a clear moist wound environment with adequate circulation and oxygenation - Always turn patient at least every 2 hours CHANGES TO THE MIND Psychological changes can be influenced by: - General health status - Genetic factors - Educational achievement - Activity - Physical and Social changes Sensory organ impairment can impede interaction with the environment and other people. Feeling depressed and socially isolated may obstruct psychological function Personality - Drastic changes in basic personality normally do not occur at one age. Excluding pathologic processes - The alleged rigidity of older persons is more a result of physical and mental limitations than a personality change - Changes in personality traits May occur in response to events that alter self -attitude, such as retirement, death of spouse. ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 Memory - 3 Type of Memory Short Term- lasting from 30 seconds to 30 minutes Long Term- memories learned long ago Sensory- obtained through the sensory organs and lasts only a few seconds - Retrieval of information from long -term memory can be slowed - Working memory function is reduced. - Older adults can improve some age -related forgetfulness by using memory aids (mnemonic devices) such as associating a name with an image, making notes or lists, and placing objects in consistent locations Intelligence - Basic intelligence is maintained; one does not become more or less intelligent with age - High levels of chronic psychological stress have been found to be associated with an increased incidence of mild cognitive impairment Learning - Learning ability is not seriously altered with age, other factors can interfere with the older person’s ability to learn, including motivation, attention span, delayed transmission of Information to the brain, perceptual deficits, and illness. - Generally a greater problem to learn new habits when old habits exist and must be unlearned, relearned, or modified Attention Span - Older adults demonstrate a decrease in vigilance performance (i.e. the ability to retain attention longer than 45 minutes). They are more easily distracted by irrelevant information and stimuli and are less able to perform tasks that are complicated or require simultaneous performance. ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 NURSING CARE OF THE OLDER ADULT IN WELLNESS Comprehensive geriatric assessment- multidimensional process designed to assess the functional ability, health (physical, cognitive, and mental), and socio environmental situation of older people - Benefits: Improved care and clinical outcomes Greater diagnostic accuracy Improved functional and mental status Reduced mortality Decreased use of nursing homes and acute care hospitals Greater satisfaction with care Principal Domains to be Assessed: 1. Functional ability- Ability to do activities of daily living (ADLs) and instrumental ADLs (IADLs) - ADLs include eating, dressing, bathing, transferring between the bed and a chair, using the toilet, and controlling bladder and bowel - IADLs enable people to live independently and include preparing meals, doing housework, taking drugs, going on errands, managing finances, and using a telephone 2. Physical health- History and physical examination should include problems common among older people problems with vision, hearing, continence, gait, and balance 3. Cognition and mental health- validated screening tests for cognitive dysfunction (eg, mental status examination) and for depression (eg, Geriatric Depression Scale, Hamilton Depression Scale) can be used 4. Socio Environmental situation- patient’s social interaction network, available social support resources, special needs, and the safety and convenience of the patient’s environment are determined KATZ INDEX ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 Clients are scored yes/no for independence in each of the six functions. A score of 6 indicates full function, 4 indicates moderate impairment, and 2 or less indicates severe functional impairment MINI-MENTAL STATE EXAMINATION (MMSE) Any score of 24 or more (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10–18 points) or mild (19–23 points) cognitive impairment. ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 Geriatric Depression Scale (GDS) Scoring Instructions: Score 1 point for each bolded answer. A score of 5 or more suggests depression. 1. Are you basically satisfied with your life? Yes / No 2. Have you dropped many of your activities and interests? yes/no 3. Do you feel that your life is empty? yes/no 4. Do you often get bored? yes/no 5. Are you in good spirits most of the time? yes/no 6. Are you afraid that something bad is going to happen to you? yes/no 7. Do you feel happy most of the time? yes/no 8. Do you often feel helpless? yes/no 9. Do you prefer to stay at home, rather than going out and doing things? yes/no 10. Do you feel that you have more problems with memory than most? yes/no 11. Do you think it is wonderful to be alive now? yes/no 12. Do you feel worthless the way you are now? yes/no 13. Do you feel full of energy? yes/no 14. Do you feel that your situation is hopeless? yes/no 15. Do you think that most people are better off than you are? yes/no Score of > 5 suggests depression Gordon’s 11 Basic functional Health Patterns of Older Adult 1. Self-Perception/ Self-Concept Pattern- a sense of personal identity; body language, attitudes, and view of self in cognitive, physical, and affective realms; and expressions of sense of worth and emotional state 2. Roles/ Relationship Pattern- his pattern encompasses the achievement of expected developmental tasks. 3. Health Perception/ Health Management Pattern- perceived level of health and current management of any health problems 4. Nutritional / Metabolic Pattern- his pattern encompasses evaluation of dietary and other nutrition-related indicators 5. Coping/ Stress-Tolerance Pattern- This pattern encompasses the client’s reserve and capacity to resist challenges to self-integrity, and his or her ability to manage difficult situations 6. Cognitive/ Perceptual Pattern- This pattern encompasses self-management of pain, presence of communication difficulties, and deficits in sensory function. 7. Value/ Belief Pattern- This pattern encompasses elements of spiritual well-being that the older adult perceives as important for a satisfactory daily living experience and the philosophic system that helps him or her function within society. 8. Activity/ Exercise Pattern- This pattern encompasses information related to health promotion that encourages the older adult to achieve the recommended 30 minutes daily of physical activity on most days of the week. 9. Rest and Sleep Pattern- This pattern encompasses the sleep and rest patterns over a 24-hour period and their effect on function. ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 10. Sexuality/ Reproductive Pattern- This pattern encompasses the older adult’s behavioral expressions of sexuality. 11. Elimination Pattern- This pattern encompasses bowel and bladder excretory functions. Home Care - Consist of multiple health and social services delivered to recovering, chronically ill, or disabled individuals in their place of residence - 3 Main Category of Home Care Home care organization Medicare-certified agencies include hospice and free standing Facility based home health agencies - Indication for Home Care Have a skilled care need Be homebound Be unable to perform the skilled care alone and have no one in home to provide care Require only intermittent care High Risk Indicators for Home Care - Unexpected readmission to hospital within 15-30 days - Frequent readmissions - Alteration of health care problems or management - Changes in mental status - Nonadherent behavior before or during hospitalization - Terminal or pre terminal condition - Seen in the hospital by physical, occupational or speech therapist. - After amputation - After hip or knee replacement - New assistive device - Foley catheter etc. - Enteral or parenteral feeding - Ostomies or tubes of any kind - Draining wounds - After wound debridement or irrigation and debridement of pressure injury - Pain management - Intravenous antibiotics - PIC line - IV chemo - Multiple medication or a major medication change - Ventilator dependence - Low air loss bed or other complex medical equipment Palliative Care- therapy aimed at relieving or reducing the intensity of uncomfortable symptoms ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 Hospice Care- Medical care for people with an anticipated life expectancy of 6 months or less, when cure isn't an option, and the focus shifts to symptom management and quality of life.hospice provides comprehensive comfort care as well as support for the family, but, in hospice, attempts to cure the person's illness are stopped. Community Based Services- A score on a functional status test that indicates impairment does not necessarily indicate the need of for institutionalization, but it means older adult needs assistance Area agencies on aging - Older American act (OAA) of 1965 to remove barriers to independent living for older individuals and to ensure the availability of appropriate services for those in need Multipurpose senior centers- Services includes, health screening, health promotion and wellness programs, social, educational, and recreational activities, congregate meals, information and referral services - Based on Section 4 of RA 7876, all cities and municipalities in the country are required to establish a senior citizens center with an area of 500 square meters. Adult day care services- institutionalization for older adults who require some supervisions but who do not need continuous care Respite Care- Respite care is often provided at home or institutional settings, Provides short term relief or time off for persons providing home care to ill, disabled or frail older adults; care may be provided on a regular schedule (4 hours a week) or for longer time intervals Life Care Residences Philippines Homemaker services- include such things as housecleaning, laundry, food shopping, meal preparation, and running errands Nutrition services- provide older adults with inexpensive, nutritious meals at home or in group settings Telephone monitoring and friendly visitors- allows communication line and visitation hours to senior residents Personal emergency response system- home monitoring system that allow older person to obtain immediate assistance a small device worn on the body Assisted Living- rental housing arrangement that provides room, meal, utilities, and laundry and housekeeping services for a group of residents. ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 Characteristics of Adult Acute Care - Polypharmacy- inappropriate number of medication - Falls 79 % of all adverse inpatient incidents are related to fall 65 or older experience most fall 10 % fall more than once during hospital stay - Infection UTI are second most frequent GI tract infection (risk for colonization and infection w/ antibiotic-resistant strains) - Hazards of immobility Prone to rapid loss of muscle 5 Nursing Homes in the Philippines for Different Elderly Needs - RainTree Care- Known as a “premiere senior residence in the country”, RainTree Care specializes in caring for the elderly with dementia and Alzheimer’s disease, a progressive condition that affects a person’s memory and thinking. - Life Care- the first and only assisted living facility in the Philippines, incorporates IT in delivering assisted living lifestyles to the elderly. Its team assists seniors in Activities of Daily Living (ADLs), including meal preparations, bathing and grooming, dressing, toileting, and memory care through various programs and activities. - Mabuhaii Nursing Home- welcomes the elderly and their family to experience belongingness within the community. This senior care facility embodies the nurturing character of Filipinos with its variety of services ranging from short-term to long-term care - Golden Groves- Assisted Living provides 24/7 care for the elderlies, especially those who need supervision and rehabilitation. - Home Health Care- provides house calls with the help of its private duty caregivers (service starts at Php 1,000 for a 7:00 a.m. to 7:00 p.m. duty), nurses (Php 1,500), physical therapists (Php 1,100/one-hour session), and doctors (Php 5,500). ‘Cause even in the dark I feel your resistance, you can see my heart burning in the distance ~St. Lana Del Rey Property of: Alfie Velasco BSN 3-Y1-11 PHYSICAL CARE OF THE OLDER ADULT Skin and Mucous Membrane - Over time, the epidermal layer becomes thinner and subcutaneous padding diminishes, increasing the risk for traumatic injuries such as skin tears or pressure ulcers - Dry skin can result in itching (pruritus), burning, and cracking of the skin - Rashes and skin irritation can be caused by factors other than dryness. Medications, communicable diseases, and contact with chemical substances are common causes of skin rashes and pruritus - Breaks in tissue integrity increase the older person’s risk for infection and often result in the need for costly, time-consuming treatments. - Pressure ulcers are a particular risk to older adults who suffer from compromised circulation, restricted mobility, altered level of consciousness, fecal or urinary incontinence, or nutritional problems Risk of Pressure Ulcers and Nursing Intervention: Risk Factor Nursing Intervention Immobility Establish individualized turning schedule; reduce shear and friction by using trapeze and/or turning sheet; elevate HOB