Case Analysis On Geriatrics Final

MARIANO MARCOS STATE UNIVERSITY
College of Health Sciences
GERIATRIC ASSESSMENT TOOL
(Client with Chronic Illness)
A. PERSONAL DATA:
Name: Incarnasion G. Medrano
Age: 83 years old
Sex: Female
Address: Barangay Binacag, Banna, Ilocos Norte
Place of Birth: Banna, Ilocos Norte
Civil Status: Married
Highest Educational Attainment: High School Undergraduate
Client’s Chronic Illness: Hypertension and Cataract
✓ Diagnosed
Undiagnosed
Chief Complaint: Pain at the midsternal chest with a pain scale of 4/10
B. . SOCIO-ECONOMIC BACKGROUND
Occupational History:
Retired? ✓ Yes ______ No
If yes, what was the previous occupation?
If No, is client currently working? ________ Yes ________ No
If Yes, what is the occupation? Retired Barangay Official (6 years in service)
#16S Quiling Sur, City of Batac, Ilocos Norte

 [email protected]  077 600 20-56 www.mmsu.edu.ph
List of Financial Resources:
Where does client get finances to support his/her daily expenses?
______ salary
_______ Pension
o SSS
o GSIS
o Foreign
o Others: Pls specify___________
_______ Consultancy
_______ Own business (Pls specify) ________________
✓ Financial support
o ✓ Spouse
o ✓ Children
o Grandchildren
o Other Relatives (Please Specify)
_____________
o Others (Please specify
Adequacy of Financial Resources:
Are finances enough to support client’s daily expenses?
✓ Yes _______ No
Is client worried about his/her ability to support his/her own health care needs?
________ Yes ✓ No
With health Insurance? ✓ Yes

o✓ PhilHealth
o Other HMOs Please specify
_________ No
Living Arrangements:
____ Living alone
✓ Living with others
o ✓ Spouse
o ✓ Son/daughter
o ✓ Grandchild/children
o Other Relatives (Please specify)
_________
o Others (Please specify) _________________
With Primary Caregiver? ✓ Yes ______ No
Who is the Primary Caregiver? Evelyn and Edilyn G. Medrano
Relationship to the primary caregiver: Daughter
State of Client’s Housing:
✓ Owned _____ Shared renting
____ Rented ______ “Nakikitira”
_____ Mortgage ______ Others: ______________________

C. HEALTHHISTORY
A. FAMILY HEALTH HISTORY
The hereditary diseases that are present in the patient’s family are asthma, colon
cancer, cataract and hypertension. According to the patient the causes of mortality are
hypertension, asthma and colon cancer. Both of her parents are already deceased. Her father
died due to old age while her mother died due to asthma. The most prevalent disease is asthma
which was present on the brother of her father and the brother and sister of her mother. As
reported by the patient, manifestations of asthma that were present to them were shortness of
breath, dyspnea or chest tightness and wheezing while exhaling. Colon cancer was the cause of
mortality on the sister of the father of the patient. Unfortunately, the patient couldn’t recall the
physician who diagnosed her and the age when her aunt died. It was manifested by diarrhea,

blood in the stool, rectal bleeding and weakness. Hypertension was manifested by dizziness,
fatigue, irregular heartbeat, vision problem and chest pain. And cataract is manifested by
blurring of vision and increased difficulty with vision at night. The patient reported that the
managements for each disease were not available that time so they usually neglect the
manifestations of the diseases. However, they ensure that eating healthy foods and adequate
fluid intake were practiced to maintain their body healthy.
The patient was not able to remember if the family experienced childhood illnesses.The
common illnesses experienced by their family are fever, coughs and colds. For the fever, cough
and colds, they only managed it bed rest, taking warm water, and increased fluid intake until
these illnesses are gone. According to the patient, the managements were effective.
Unfortunately, the patient’s family immunizations were not reported because she
cannot recall the vaccines that were administered to them.
The only smoker in the family was the patient’s husband but he already stopped at the
age of 58 and the family were not fond of drinking alcohol-containing beverages. There were no
accidents nor injuries reported by the patient.
B. PAST HEALTH HISTORY
As claimed by the patient, she experienced various childhood illnesses such as chicken
pox, and measles. While the common illnesses experienced by the patient were cough, colds
and fever. The patient did also mention that she had undergone laser cataract surgery.
The patient was 6 years old when she experienced chicken pox. She reported that she
experienced it with fluid-filled itchy rashes that started from her upper extremities and radiated
to her chest and she remembered that it was also accompanied by fever for 2 days. Her fever
was managed by taking adequate fluids and enough rest. For her chicken pox, she reported that

she was prohibited to go out, was advised not to scratch the rashes and she wore black clothes
for they believed that rashes will come out. She did not take any medications instead she did
“suob” which they believed it is effective for healing the chicken pox because of its heat that
dries the rashes. When she was 8 years old, she experienced measles. She experienced it with
small bumps over the flat red spots that appeared on her stomach and spread to her arms and
legs. It was also accompanied with fever on which they managed it with increased fluid intake
and adequate rest. Her measles was managed by doing the “suob” again since they believed
that it has soothing effect that may decrease the itchiness of the rashes. In 2008, the patient
had undergone laser cataract surgery due to frequently seeing halo. After, the surgery, she
was recommended to wear eyeglasses. Unfortunately, she can’t recall the physician/surgeon
who diagnosed and did the surgery and the medications prescribed after the surgery. In 2017,
the patient suffered from pneumonia. She was admitted in Marcos District Hospital and stayed
for five (5) days. She cannot recall the names of the prescribed medications as well as the
physician who diagnosed her. However, she reported that the treatment that was rendered to
her was effective and had fully recovered, gained its strength and able to do things on her own
without any difficulty of breathing.
Common illnesses such as cough, colds, and fever were also experienced by the patient.
She only managed them with increased fluid intake and having an adequate rest and sleep.
However, if these illnesses persist for 1 week, she consults to a physician in their Rural Health
Unit wherein she was usually prescribed with Paracetamol (500mg), oxymetazoline (Afrin) 2-3
sprays in each nostril 10-12 hours and Guaifenesin (400mg) TID. She reported that both the
cough and colds will last for less than a week and for the fever, it usually subsides to normal
after one day. Thus, her managements are effective.

The patient is fond of eating vegetables and fruits. She ensures that she takes adequate
fluid everyday and she usually walks for 20 minutes around their neighborhood. She sleeps at
8:00 PM and wakes up around 5:30 AM. She also reported that she usually take herbal
medicines such as calamansi and ginger for her cough and colds. As for her immunization, she
reported that she does not remember taking any vaccination when she was younger.
C. PRESENT HEALTH HISTORY
The patient is 83 year-old retired Kagawad with a long history of hypertension that was
previously well controlled with her medication, Losartan (150mg). She was first admitted to
Mariano Marcos Memorial Hospital and Medical Center in 2002 when she presented with a
complaint of intermittent pain at the lower part of the breast bone and frequent headaches
and dizziness. She was advised to have a monthly check-up to monitor her blood pressure
and she had this for 1 year. While in 2003, she was advised to have check-up for every 6
months since her blood pressure is within the normal range.
Aside from hypertension and postmenopausal state, other risk factors for coronary
artery disease, such as diabetes, or cigarette smoking are denied. However, the patient
admitted that she loves to fatty and oily foods. She can finish a whole course meal consisting
of one cup of rice, 3 cuts of meat and a dessert.
She was well until 3 pm on the afternoon prior to consultation when she noted the
onset of “aching pain with a pain scale of 5/10 on her midsternal chest”, pain at the back of
her neck and experienced dizziness. The pain was described as “kasla adda tumudtudok
barukong ko”. These were experienced after she ate “tinuno nga karnet baboy” during her
lunch. Her blood pressure was 140/90 mmHg and a pulse rate of 123 beats per minute. She
was immediately given with Losartan (100mg) per orem and advised to take a rest. After 3
hours, the blood pressure decreased to 120/80 and pulse rate of 88 and with a reduction of

pain scale to 1/10 as verbalized by the patient. She was sent home after she was relieved
from signs and symptoms. However, 45 minutes after she went home, she experience again a
mild pain at her midsternal chest with a pain scale of 4/10.
D. Erick Erikson Developmental Task
The Erik Erikson’s psychosocial theory of development consists of eight stages. It
emphasizes that ego makes positive contributions to development by mastering attitudes, ideas
and skills at each stage of development but there is a psychological conflict that must be
overcome to move on to the next stage or considered successful. The patient is 83 years old.
She is in the maturity stage which is between 65 years up to until death. The area of resolution
or conflict of this stage is the ego integrity vs despair. Positive resolution is the ego integrity and
the developmental hazard is despair. The developmental tasks needed to be achieved by the
patient are to reflect on their lives to derive a sense of integrity and satisfaction with one’s past
achievements. One needs to accept death as acceptable. The outcome will be wisdom. The
developmental hazard in this stage is despair. They believe that they made poor choices during
life and wished they lived life over. Regrets and what-ifs are evident in this area. One felt that
they did not accomplish their life goals. They face the end of life with feelings of bitterness,
depression and despair.
Developmental Supporting Cues Not achieved Partially Fully achieved

Task achieved
Feel sense of ✓
satisfaction
when reflecting
life
Feels good about ✓
life choices
Willingness to ✓
face death
Analysis:

The patient currently is in the ego integrity. According to McLeod, the outcome is
the virtue of wisdom if it is considered a success. Wisdom enables a person to look back on
their life with a sense of closure and completeness, and also accept death without fear
(McLeod, 2018). Past experiences and achievements were mentioned by the patient and
she uses this knowledge in assisting and educating others especially in her family’s younger
generation. Regrets from the past are none as mentioned. The death of oneself was
accepted as stated by the patient. The patient can continue to flourish in this stage if the
patient continues to maintain her current perspectives in life and was able to complete the
developmental tasks mentioned hence it is considered successful.
Reference: McLeod. (2018). Erik Erikson’s Stages of Psychosocial Development. Retrieved from:
Simplypsychology.Org. https://www.simplypsychology.org/Erik-Erikson.html

Patient Name: Incarnasion S. Medrano Patient ID # 001 Date: 10/12/2020
Katz Index of Independence in Activities of Daily Living
Activities Independence Dependence

Points (1 or 0) (1 Point) (0 Points)
NO supervision, direction or personal WITH supervision, direction,

assistance. personal assistance or total
care.
BATHING (1 POINT) Bathes self completely or (0 POINTS) Need help with bathing
needs help in bathing only a single more than one part of the body,
Points: 1 part of the body such as the back, getting in or out of the tub or
genital area or disabled extremity. shower. Requires total bathing
DRESSING (1 POINT) Get clothes from closets and (0 POINTS) Needs help with
drawers and puts on clothes and outer dressing self or needs to be
Points: 1 garments complete with fasteners. completely dressed.
May have help tying shoes.
TOILETING (1 POINT) Goes to toilet, gets on and (0 POINTS) Needs help
off, arranges clothes, cleans genital transferring to the toilet,
Points: 1 area without help. cleaning self or uses bedpan or
commode.
TRANSFERRING (1 POINT) Moves in and out of bed or (0 POINTS) Needs help in moving
chair unassisted. Mechanical transfer from bed to chair or requires a
Points: 1 aids are acceptable complete transfer.
CONTINENCE (1 POINT) Exercises complete self- (0 POINTS) Is partially or totally
control over urination and incontinent of bowel or bladder
Points:1 defecation.
FEEDING (1 POINT) Gets food from plate into (0 POINTS) Needs partial or total
mouth without help. Preparation of help with feeding or requires
Points: 1 food may be done by another person. parenteral feeding.
TOTAL POINTS: 6 SCORING: 6 = High (patient independent) 0 = Low (patient very dependent

Katz Index of Independence in Activities of Daily Living
• Bathing- I asked the patient if she bath herself completely or need help, and if only need
help with bathing only a single part of her body such as back. The patient verbalized,
“kayak paylang agdigus na sisiak ma’am”, this implies she does not need supervision,
direction or personal assistance in bathing so the score is 1.
• Dressing- I asked the patient if she puts on clothes and outer garments completely
without assistance, may need help in tying shoes, or need assistance in dressing self
completely. The patient verbalized, “diak kasapulan tulong nuh agbado nak ma’am
mabadwak paylang bagbagik”, this implies that she does not need supervision, direction
or personal assistance in dressing so that score is 1.
• Toileting- I asked the patient if she goes to the toilet without supervision, arranges
clothes by herself, need assistance to clean after toileting, need help in transferring to
the toilet or use a bedpan or commode. The patient verbalized, “kayak mapan cr na
siasiak ma’am”, this implies that she does not need supervision, direction or personal
assistance in toileting so the score is 1.
• Transferring- I asked the patient if she can move in and out freely from bed and chair, or
use mechanical assistance like gait belt, or need help in moving from bed to chair and
requires complete assistance. The patient verbalized, “maakabangon kada makapagna
nak paylang ma’am”, this implies that she does not need supervision, direction or
personal assistance in transferring so the score is 1.
• Continence- I asked the patient if she has a complete self-control in urination and
defecation, is she has partially or totally incontinent bowel or bladder. The patient
verbalized, “awan met paylang madi pinagisbok and pinak takkik ma’am kayak na pigilan
paylang nukwa”, this implies that she does not have bowel or bladder incontinence so

the score is 1.
• Feeding- I asked the patient if she does not need help in getting food and plating food
for herself, or may be partially done by another person and needs partial or total help in
feeding. The patient verbalized, “kayak paylang aglabay bagbagik ken mangan ma’am”,
this implies that she does not need supervision, direction or personal assistance in
feeding so the score is 1.
Analysis:
Based on the assessment tool, the patient has total points of 6 which mean that
she is highly independent and does not need assistance in every activities of daily living.
The patient’s ability to do all the tasks by herself clearly means that she is strong enough
and does not have any trouble in accomplishing all the activities.
Coping with change is challenging, especially when in periods of aging. The
particular challenge for elderlies is the numerous changes and transitions that are
starting to develop such as their children moving away, the death of parents, friends,
and other loved ones, end their career, declining health, and even loss of independence.
It’s natural to feel those losses. But if that sense of loss is balanced with positive coping
mechanisms, you have a formula for staying healthy and independent as you age.
Healthy aging means continually reinventing yourself as you pass through landmark ages
such as 60 and beyond. It means finding new things you love, learning to adapt to
changes, staying physically and socially active, and feeling the enjoyment and
connection to your community and loved ones (White et al., 2019).
And according to the website Comfort keepers, maintaining independence
promotes a sense of achievement that for many seniors generates a great sense of self-

worth and well-being. So being independent during elderly years is an accomplishment
because it shows how well and strong you are despite aging.
Reference: Smith, M.A., Segal, Ph.D., and White, Ph.D., M. S. J. S. . a. n. d. . M. W. (2019,
November). Aging Well. HelpGuide.Org. https://www.helpguide.org/articles/alzheimers-
dementia-aging/staying-healthy-as- you-age.html

Mini Nutritional Assessment:
Screening:
A. I asked the patient if she had eaten less than normal over the past 3 months, or if so, is
it because of lack of appetite, chewing, or swallowing difficulties and if it is much less
than before or only a little less. The patient verbalized, “awan nagbaliwan na ma’am”,
this implies that the patient has no decrease in food intake in the past 3 months so the
score is 2.
B. I asked the patient if she lost any weights without trying over the past 3 months, if her
waistband short gotten loosen. The patient verbalized, “diak ammo ma’am kase diak
met agkilkilo nukwa”, this implies that the patients do not know if she has any weight
loss as she does not monitor her weight in the past 3 months so the score is 1.
C. I asked the patient if she is able to get out on a bed and chair same with the KATZ
“transferring” but with the addition of, if she is able to get out on a bed and chair but
unable to go out of her home or able to leave home. The patient verbalized,”
makawawar nak nukwa paylang balay ma’am”, this implies that the patient was
physically normal in mobility as she goes out home without any assistance so the score
is 2.
D. I asked the patient if she suffered any stress recently or have been severely ill recently in
the past 3 months. The patient verbalized, “wen ma’am detoy high blood ko pasaray
ngumato ket isupay nukwa kabutbuteng ko”, this implies that the patient suffered
psychological stress or acute disease in the past 3 months so the score is 0.
E. I asked the patient if she has dementia or had prolonged severe sadness. The patient
verbalized, “haan met ma’am”, this implies that the patients have no psychological
problems so the score is 2.

F. The patient weight 50 kg with a height of 147 cm and her total BMI is 23 so the patient
has a score of 3.
• The total score in screening is 10 which implies that the patient is at risk of malnutrition.
Assessment:
G. The patient lives independently in her own home not in a nursing home so the score is
1.
H. I asked the patient what is her drug regimen and she stated that she is taking “losartan”
for her hypertension, but she does not take 3 or more prescription drugs so the score is
1.
I. I asked the patient if she has pressure ulcer and she stated that she does not have any
pressure ulcer so the score is 1.
J. I asked the patient how many meals a day does she eat and if she normally eats
breakfast, lunch, and dinner. The patient verbalized, “wen ma’am, ken agmermeryenda
nak pay nukwa ti bigat na ma’am”, this implies that the patient eats a 3-4 full meals a
day so the score is 2.
K. I asked the patient is if she consume any dairy products a day like milk, cheese, and if
she eats eggs, vegetable and meat. She stated that she does not eat dairy products a
day, but eat vegetable and meat every day. This implies that the patient has a score of
0.5 because she answered two yes and one no.
L. I asked the patient if she also eats fruits and also how many portions of vegetable and
fruits she eats per day. And the patient stated that she eats about one cup cooked
vegetables so the score is 1.

M. I asked the patient if how many cups of fluid she drinks every day. She stated that she
drinks about 7-8 cups of water every day so the score is 1.
N. I already asked this question in KATZ “feeding” so the score of the patient is 2 as she is
able to feed self without any problems.
O. I asked the patient if how she describe her nutritional state if it is poorly malnourished,
uncertain or no problems at all. She stated that she is uncertain of her nutritional status
as she does not know if her BMI is normal or not and because she has hypertension and
like to eat fatty and oily food, so the score is 1.
P. I asked the patient how would she describe her state of health compared to others in
her age if it is not as good as others, not sure, or as good as others or way better. The
patient stated that she views herself not as good as others because she has
hypertension so the score is 0.
Q. I measured the mid arm circumferences of the patient from the edge of her right collar
bone to the tip of the middle finger and got 21 cm so the score is 0.5.
R. I measured the calf circumference of the patient in her widest part of the calf and got 29
cm so the score is 0.
• Th patient has a total score of 10 in screening and 11 in assessment, so the patient has a
total score of 21 points which indicated she is at risk of malnutrition.
In order to assess malnutrition in elderly patients a multidimensional approach is
needed. The Mini Nutritional Assessment (MNA) is a validated instrument initially developed
to assess nutritional status in elderly patients. The tool contains 18 items and evaluates 4
different aspects: anthropometric assessment (body mass index (BMI), weight loss, and arm
and calf circumferences); general assessment (lifestyle, medication, mobility and presence of
signs of depression or dementia); short dietary assessment (number of meals, food and fluid

intake and autonomy of feeding); and subjective assessment (self- perception of health and
nutrition).The results of the assessment categorized individuals as “at normal nutritional
status,” “at risk of malnutrition,” or “malnourished.”
Analysis:
Basing from the results from the MNA, it shows that the patient has a total score of
21 points, which indicates that the patient is at risk for malnutrition. Malnutrition is often
caused by a combination of physical, social and psychological issues. She is at risk for
malnutrition as she is fond of eating fatty and oily foods which is contraindicated for the
patient because she has hypertension. As cited by R. Sesso et al. in 2004, hypertension is
associated with malnutrition. The said illness can also contribute to decrease in appetite and
changes in how the body processes nutrients. Which is now evident as the patient
manifested having only a mid-arm and calf circumferences of 21cm and 29cm, respectively.
Also, normal age-related changes like changes in taste, smell and appetite, making it more
difficult to enjoy eating and keep regular eating habits. And some medications can affect
appetite or the ability to absorb nutrients.
It was also stated in the MNA assessment tool of the patient that she is uncertain of
her nutritional status and viewed herself not as good as the others. As cited by Malek et al.
in 2012, due to the age-related physiological changes in the elderly, disabilities are induced,
which in turn may increase mental problems and low self- esteem in them. Hence, low levels
of self-esteem and cognitive ability in the elderly may probably be associated with her
uncertainty of her nutritional status and her belief that she is not good as the others with
same age. Which may also predispose her at risk for malnutrition.

Reference:
• An overview of appetite decline in older people. (2015, June). Nursing Older People.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589891/#:~:text=The%20physiologica
l %20changes%20that%20occur,can%20contribute%20to%20declining%20appetite.
• Franak, Alireza, and Malek, J. F. K. A. . a. n. d. . M. M. (2015, April 5). Self-Esteem Among
the Elderly Visiting the Healthcare Centers in Kermanshah-Iran (2012). Global Journal of
Health Science.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803852/#:~:text=Due%20to%20the%
2 0age%2Drelated,be%20associated%20with%20physical%20problems.
PSYCHOLOGICAL ASSESSMENT OF THE ELDERLY:
The patient served as a Barangay Kagawad for six (6) straight years. According to her,
she had so many experiences as an official that teaches her many things in life such as
being a role model to everyone. As reported by the patient, she missed serving for
people, however she claimed that she already accepted that it is now time for her to
relax and enjoy remaining years of her life and just teach the younger generations on
how to become a great model and politician to people. She admitted that she is what
she is now because of her previous experiences as a politician and after retiring, she had
this positive mindset that she will have more chance of relaxing her body, mind and soul
and even lend more time for her family especially her grandchildren. She had nothing to
worry about not working anymore, since her children already have their own jobs which
is already sufficient enough to meet their daily needs. She was able to teach and take
good care of her grandchildren. She was able to share her knowledge and stories with
the younger generations of her family. And according to her, these makes her really

happy because she feels like she already has done her obligation. According to the
patient, during her retirement years, she now has more time on her hobbies such as
watching her favorite tv shows or dramas and gardening. It is her way of killing
boredom. Her garden is for aesthetic purpose wherein she collects different kinds of
plants from their neighbors and some part of her garden was planted with vegetables.
With her garden, she was able to communicate with their neighbors, they share plants
with each other and was able to make new friends. The patient is always attending each
Barangay assemblies, because she believes that it is still her obligation even if she is
already retired. In Barangay Fiestas, she attends yearly and even facilitates the program.
Together with her family, they always attend mass. She reported that every Sunday,
worshiping God is their priority. It is a day for them to relax and worship God so every
other works should be set aside and will be done after the mass.
Having a strong bond with the family and friends as her source of strength and
support made her value the worth of life. She reported that she is already satisfied with
what life brings on her, knowing that she has someone to lean on when in times of crisis
or when she has any problem she can’t handle alone. And most especially, when she
witnessed how her children was raised as a good man and being able to stand up in life
on their own. Having her feel how her family supports and takes good care of her makes
her so happy, contented and view life as worthwhile.
Our life will soon change as time passes by and will lose things that recently
involved our time and life reason. In aging, functions of some body parts are gradually
decreasing or weakens a portion of the capacity of the body parts but that doesn’t
affect the patient. She was able to adapt with the changes and maintain her high self-
esteem. She sees herself worthy as she feels the love and support from her family and
other networks of support system despite the changes she is experiencing. She was able

to feel contented as she made all her children become successful and knowledgeable
enough to stand with their own feet. She was able to gain support from value system
and spiritual philosophy. She abides the words of the Lord in the bible and worships him
every day. She reported that they have a schedule twice a week for their family to pray
together and read the bible.
The patient already accepted the death of her parents and siblings with a
verbalization of “Haan tayu pulos malik likan iti papatay iti mesa a tao. Mesa lang ti
biyag nga inpaay ni Apo kadatayu isu nga habang sibibyag tayu ubraen tayu amin a
kabaelan tayu ken ditayu lip lipatan nga ipakita ti pamilya ti ayat tayu kanyada. Idi un
una narigat nga akseptaren, ngem idi bumay bayag, napan panunutko nga parte lang ti
biyag talaga deta. Addan to met latta aldaw ko ngem sisasaganaak ta makitak met
nagbanagan annak kon.”
ANALYSIS:
In some articles, it stated that having a network of family and friends as a
support system will make an elderly value life more and will be satisfied. On the other
hand, more established elderlies who are happy with their life are more likely to create
and maintain a wider social network and are found to show less loneliness and anxiety.
Participation in social and recreation activities decreases the probability of suffering
from stress, depression and anxiety and provides a sense of attachment, belongingness
and positive values. Being active all through most of one's lifetime has a significant
effect on generally wellbeing and prosperity. Confidence is connected to the nature of
adaptation, life fulfillment and wellbeing. In this way, she is psychologically competent
and is adapting in spite of the alterations during the last aspect of her life.
In elderlies, stressful situations will become an everyday challenge for them. But
these can be balanced when an elderly possesses a coping mechanism. Coping consists

of the individual effort required to handle stressful problems and emotions that affect
the psychological and physical results of a destabilizing situation. It is a
multidimensional, dynamic process that raises a number of responses and encompasses
the individual's interaction with their environment, using mechanisms to manage an
impending threat and difficult life situations (Souza et al., 2017).
Reference: Ribeiro, Borges, Araújo and Souza, M. S. R. M. S. B. T. A. . a. n. d. . M. S. (2017).
Coping strategies used by the elderly regarding aging and death: an integrative review.
SciELO. https://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-
98232017000600869#aff1
PHYSICAL ASSESSMENT
General Health Condition
The patient was seen in a sitting or fowler’s position with her back resting on the
chair with her one leg over the other leg and arms relaxed over her lap and wearing a
violet “terno” clothes. The patient is in smiley face as she was approached and her lips
appeared to be pinkish. The skin appeared to be brown in color without any prominent
lesions and the patient’s body built appeared to be mesomorph. She sits comfortable
with body relaxed and head turns normally. Hair is in curly medium cut (shoulder level)
and gray hair was more prominent than the black hair and appeared to be well-
groomed. The stated age is congruent to the apparent age. There are no obvious
deformities. There are no bad signs of body and breath odor. The patient maintains eye
contact and expressions are appropriate to the situation. The patient appears to be
strong and interacts actively and pleasantly, comfortable, and cooperative. She speaks
clearly and with proper answers to the questions. She conveys ideas clearly and

communicates easily. There are no signs of distress rather she is normally active during
the interview. She is alert and oriented.
ANTHROPOMETRIC MEASUREMENTS
Height: 1.4732 m
Weight: 50 kg
BMI: 23. 13 (Normal weight)
VITAL SIGNS
Respiratory Rate: 16 bpm Blood Pressure: 120/80 mmHg
Pulse Rate: 88 bpm Body Temperature: 36.7
Head to toe assessment
HEAD
• Normocephalic
• Hard and smooth
• No lesions or masses when palpated
• Face is symmetric with round appearance
• Atrophy of face and neck muscles
• Reduced range of motion (ROM) of head and neck
EYES
• Eyeballs are symmetrically aligned in sockets without protruding or sinking
• No presence of discharges, no discoloration and lids close symmetrically
• Bulbar conjunctiva is clear, moist and smooth
• Sclera appeared white

• Skin around the eyes is thin and wrinkles appeared
• A “bags” form in the lower eyelid
• A cloudy ring around the iris and decreased pigment in iris
• Overall decrease in size of pupil and ability to dilate in dark and constrict in light
• Impaired near vision
• Slight decreases in peripheral vision
EARS
• Equal in size bilaterally
• Skin is smooth, with no lesions, lumps or nodules
• Color is consistent with the facial color
• Earlobes become elongate and pinna increases in length and width
• Decrease cerumen production
• Inability to hear high- frequency sounds
• No tenderness noted upon palpation
NOSE
• Color is consistent with the facial color
• Nose and nasal passages are not inflamed
• Skin and mucous membranes are intact
• Nose seem more prominent on face because of loss of subcutaneous fat
• Nasal hair is coarser
• Slightly diminished sense of smell and ability to detect odors
• Free of lesions
• No tenderness noted upon palpation

MOUTH
• Lips are smooth and moist without lesions or swelling
• Slight decrease in saliva production
• Tongue is pink and moist
• Buccal mucosa is pink, tissue is smooth and moist without lesions
• Presence of complete dentures in the upper gums
• Mild decrease in swallowing ability
• Gag reflex IS slightly sluggish
NECK
• Neck is symmetric with head centered and without bulging masses
• No tenderness and enlargement of lymph nodules
• Reduced range of motion (ROM) of head and neck
• Shortening of neck due to vertebral degeneration
• Neck movement is smooth and controlled
ABDOMEN
• Abdominal skin is paler than the general skin tone
• Free of lesions or rashes
• Umbilical skin tone is similar to surrounding abdominal skin tones
• Umbilicus is midline at lateral line
• Umbilicus and surrounding area are free of swelling, bulges or masses
• Abdomen is flat
• Non tender and soft and there is no guarding
• 5- 30 bowel sounds/min are heard

UPPER EXTREMITIES
• Arms are bilaterally symmetric.
• Skin tone is the same bilaterally
• Skin is warm to touch bilaterally
LOWE EXTREMITIES
• Skin tone is the same bilaterally
• Identical size and shape bilaterally
• Toes, feet, and legs are equally warm bilaterally
• No edema on both feet

NURSING CARE PLAN
NURSING DIAGNOSIS
Acute pain related to increased cardiovascular pressure as manifested by presence of mid-
sternal pain and a pain scale of 3/10 with a verbalization of “medyo nasakit manen tuy barukong kon
ma’am”
NURSING INFERENCE
High blood pressure causes the blood vessels to become narrow, blood flow to the heart can slow. There
is increased cardiovascular pressure, it leads to decreased transport of oxygen into the heart muscles,
hence acute pain.
NURSING GOAL
After 1-2 hours of rendering nursing interventions, the patient will report relief of pain/discomfort as
will be manifested by absence of mid sternal pain and a pain scale of 0/10-1/10 with a verbalization of “
haan nga nasakit tuy barukong konma’am”.
NURSING INTERVENTION
INTERVENTION RATIONALE
1. Have the patient to assume a position of Helps reduce tension and promotes sense of
comfort. control, aiding reduce pain.
2. Provide diversional activities such as Distracts the patient’s attention from pain and
listening to music or watching television. refocuses his/her attention, promoting relaxation
which may improve coping abilities.
3. Encourage use of stress management skills Enables patient to participate actively in nondrug
or complementary therapies such as treatment of pain and enhances sense of control.
relaxation techniques including deep
breathing exercises.
4. Encourage adequate rest periods To prevent fatigue that can impair ability to
manage or cope with pain.
5. Instruct the patient to adhere to the This will ensure the achievement of the optimal
therapeutic regimen. effect of the medications.
NURSING EVALUATION
After 1 hour of rendering nursing interventions, the patient was able to report relief of pain/discomfort
as will be manifested by absence of mid sternal pain and a verbalization of “ haan unay nga nasakit tuy
barukong kon ma’am.”

NURSING CARE PLAN

NURSING DIAGNOSIS
Risk for decreased cardiac output related to increased systemic vascular resistance
(vasoconstriction).
NURSING INFERENCE
Old age causes reduction in elastic tissues in the arteries leading them to become stiffer and less
compliant. At the same time, the patient also was diagnosed with hypertension. An elevation of blood
pressure come about as a result of an increase in total systemic vascular resistance (SVR) or
vasoconstriction. Vasoconstriction reduces the volume or space inside affected blood vessels.
When blood vessel volume is lowered, blood flow is also reduced, hence, risk for decreased cardiac
output.
NURSING GOAL
After 1-2 hours of rendering nursing interventions, the patient will be able to display hemodynamic
stability as will be manifested by blood pressure of 120/80mmHg-120/90mmHg and a pulse rate of 60-
100 bpm.
NURSING INTERVENTIONS AND RATIONALE

INTERVENTIONS RATIONALE
1. Monitor and record BP. • Comparison of pressures provides a more
complete picture of vascular involvement
or scope of problem.
2. Evaluate client reports or evidence of • To assess for signs of poor ventricular
extreme fatigue, intolerance for activity function or impending cardiac failure. And
and progressive shortness of breath. early detection of these changes promotes
timely intervention to limit the degree of
cardiac dysfuntion.
3. Provide calm, restful surroundings, • Helps lessen sympathetic stimulation;
minimize environmental activity and noise. promotes relaxation.
4. Maintain activity restrictions (bedrest or • Lessens physical stress and tension that
chair rest); schedule periods of affect blood pressure and the course of
uninterrupted rest; assist patient with self- hypertension.
care activities as needed.
5. Provide comfort measures (back and neck • Decreases discomfort and may reduce
massage, elevation of head). sympathetic stimulation.
6. Instruct in relaxation techniques, guided • To reduce stressful stimuli, produce
imagery and distractions. calming effect, thereby reducing BP.
7. Monitor response to medications to • Response to drug therapy is dependent on
control blood pressure. both the individual as well as the
synergistic effects of the drugs. Because of
• Losartan (150mg). side effects, drug interactions, and
patient’s motivation for taking
antihypertensive medication.
8. Implement dietary sodium, fat, and • To help manage fluid retention and, with
cholesterol restrictions as indicated. associated hypertensive response,
decrease myocardial workload
9. Discuss the individual’s particular risk • To avoid the occurrence of elevated blood
factors such as diet, stress and etc. pressure and prevent complications.
10. Educate the client and caregiver about the • To potentiate the drug effect and prevent

drug regimen, including indications, dose complications.

and dosing schedules, potential adverse
side effects and drug-to-drug interactions.
11. Emphasize the importance of regular • To monitor the client’s condition and
medical follow- up care. provide early intervention when indicated
to prevent complications
NURSING EVALUATION
After 1 hour of rendering nursing interventions, the patient will be able to maintain hemodynamic
stability as manifested by blood pressure of 120/80mmHg and a pulse rate of 88 bpm.

NURSING CARE PLAN
NURSING DIAGNOSIS
Risk for malnutrition related to poor diet and non- compliance to food regimen.
NURSING INFERENCE
Adequate nutrition is very essential to the human body because it supplies the daily metabolic
requirements in order to functions normally and effectively. The adequacy in the nutritional
requirements of a person is not met such as taking an unbalanced diet in which certain nutrients are
lacking, in excess or in wrong proportions does not provide adequate calories and protein for
maintenance and growth, or cannot fully utilize the food to eat due to illness, hence, risk for
malnutrition.
NURSING GOAL
After 20- 30 minutes of rendering nursing interventions, the patient will be able to verbalize
understanding on the health teachings imparted with a verbalization of “Tungpalek amin dagita bilin ken
pammagbagam kanyak ma’am”
NURSING INTERVENTIONS AND RATIONALE

INTERVENTIONS RATIONALE
1. Check actual weight of the patient • Serve as baseline parameter which will
help determine the presence of
malnutrition
2. Encourage patient participation in • Determination of type, amount, and
recording food intake using a daily log pattern of food or fluid intake as facilitated
by accurate documentation by patient or
caregiver as the intake occurs.
3. Link usual food intake to USDA Food • The Food Guide Pyramid emphasizes the
Pyramid, noting slighted or omitted food importance of balanced eating. Omission
groups. of entire food groups increases risk of
deficiencies.
4. Encourage patient to have small, frequent • To enhance the appetite and will have
feedings better digestion of food intake, hence
good bowel elimination.
5. Maintain good oral hygiene • To enhance good appetite and better taste
of the food
6. Discourage patient to eat fatty and oily • It may contraindicate and worsen her
foods. illness.
7. Encourage the patient to comply with her • To decrease the risk of malnutrition.
diet and food regimen.
NURSING EVALUATION
After 30 minutes of rendering nursing interventions, the patient was able to verbalize understanding on
the health teachings imparted with a verbalization of “Tungpalek amin dagita bilin ken pammagbagam
kanyak ma’am”

Case Analysis On Geriatrics Final

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MARIANO MARCOS STATE UNIVERSITY

College of Health Sciences

GERIATRIC ASSESSMENT TOOL

(Client with Chronic Illness)

Name: Incarnasion G. Medrano

Age: 83 years old

Address: Barangay Binacag, Banna, Ilocos Norte

Place of Birth: Banna, Ilocos Norte

Civil Status: Married

Highest Educational Attainment: High School Undergraduate

Client’s Chronic Illness: Hypertension and Cataract

Retired? ✓ Yes ______ No

If yes, what was the previous occupation?

If No, is client currently working? ________ Yes ________ No

If Yes, what is the occupation? Retired Barangay Official (6 years in service)

#16S Quiling Sur, City of Batac, Ilocos Norte

List of Financial Resources:

Where does client get finances to support his/her daily expenses?

o Others: Pls specify___________

_______ Own business (Pls specify) ________________

o Other Relatives (Please Specify)

o Others (Please specify

Adequacy of Financial Resources:

Are finances enough to support client’s daily expenses?

With health Insurance? ✓ Yes

#16S Quiling Sur, City of Batac, Ilocos Norte

o Other HMOs Please specify

____ Living alone

✓ Living with others

o Other Relatives (Please specify)

o Others (Please specify) _________________

With Primary Caregiver? ✓ Yes ______ No

Who is the Primary Caregiver? Evelyn and Edilyn G. Medrano

Relationship to the primary caregiver: Daughter

State of Client’s Housing:

✓ Owned _____ Shared renting

____ Rented ______ “Nakikitira”

_____ Mortgage ______ Others: ______________________

#16S Quiling Sur, City of Batac, Ilocos Norte

A. FAMILY HEALTH HISTORY

#16S Quiling Sur, City of Batac, Ilocos Norte

fluid intake were practiced to maintain their body healthy.

cannot recall the vaccines that were administered to them.

accidents nor injuries reported by the patient.

B. PAST HEALTH HISTORY

#16S Quiling Sur, City of Batac, Ilocos Norte

without any difficulty of breathing.

after one day. Thus, her managements are effective.

#16S Quiling Sur, City of Batac, Ilocos Norte

C. PRESENT HEALTH HISTORY

months since her blood pressure is within the normal range.

of one cup of rice, 3 cuts of meat and a dessert.

#16S Quiling Sur, City of Batac, Ilocos Norte

mild pain at her midsternal chest with a pain scale of 4/10.

D. Erick Erikson Developmental Task

The Erik Erikson’s psychosocial theory of development consists of eight stages. It

depression and despair.

Developmental Supporting Cues Not achieved Partially Fully achieved

#16S Quiling Sur, City of Batac, Ilocos Norte

If No, is client currently working? Yes No

_ Own business (Pls specify) __________

Rented __ “Nakikitira”

_ Mortgage Others: ____________________