CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND

IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC

BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

GROUP 1: Aging and Mucous Membrane ✓ Most nurses find that head-to-toe
progression is the most helpful, as is a body
Age-related Changes in Skin, Hair, and Nails
diagram on which observation are indicated.
✓ Changes in the skin, hair and nails may
indicate variety of problems related to poor
nutrition and circulation.
✓ Because these structures are the ones most
easily observed, they can provide a great
deal of information about the metabolic
health of the entire body.

Skin

✓ With aging, the skin undergoes changes that

make it more susceptible to damage.
Overtime, the epidermal layer becomes
thinner and the subcutaneous padding
diminishes, increasing the risk for traumatic
injuries. (E.g.: skin tears or pressure injuries) Skin Color
✓ Medications used to treat various health
issue can cause problems: ✓ Changes in skin color can indicate variety of
o Costicosteriods – makes the skin disorders.
more fragile ✓ Assessment:
o Anticoagulants – increases the risk o Be aware of the differences in skin
for bleeding with even minor trauma. pigments among ethnic groups.
✓ Although the skin problems are not usually o Examine the skin in good, preferably
life-threatening, they are significant because natural, light and compare one side of
they can distress the older person and lead the body with the other.
to a decreased quality of life. Skin problems o Use touch to determine skin
should be prevented whenever possible. temperature or the presence of
rashes or irritation.
o Stretching the skin slightly may help
in determining the underlying tones.

Assessment (Data Collection)

✓ What is the skin color? Are there any signs of

Assessment pallor, jaundice, cyanosis, or erythema? If so,
where?
✓ Can be performed during a bath, during daily ✓ Is there any sign of pallor or erythema over
personal hygiene, at bedtime, or at any other bony prominences?
convenient time for the older person.
✓ Privacy must be maintained and modesty
protected during the skin inspection. Dry Skin
✓ Assessment of the skin and related
structures is an important responsibility of
nurses.
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

✓ One of the most common problems of aging. ✓ Scabies is a superficial infection caused by a
Studies has shown that 75% of people older parasitic mite (sarcoptes scabiei var.
than 65 years old of age experience dry skin. hominis) that burrows under the skin.
✓ Physiological changes, excessive bathing, ✓ Older adults – especially individuals who
the use of harsh soaps, and a dry suffer from chronic illness, dementia, or a
environment all contribute to problem with depressed immune system – are particularly
dry skin. vulnerable to scabies infection.
✓ Dry skin can result in pruritus, burning, and ✓ Signs:
cracking of the skin. o Intense itching
o Fine dark wavy lines at the flexor
Assessment (Data Collection)
surface of the wrist or elbow, the
✓ Are there any areas of dry skin? If so, where? webbed are of the fingers, the axillae,
Does the person complain of itching? and the genitals.
✓ Scabies may be difficult in older adult
because it has an asymptomatic incubation
period of 4 to 6 weeks and atypical
presentations are common.
✓ Mode of Transmission:
o Scabies is spread from person to
person by direct contact.
o Because recognition is difficult,
treatment may be delayed, allowing
the parasite to infect other people.
✓ Infection Control:
Rashes and Irritation o All new residents in extended-care
✓ Rashes and skin irritation can be caused by settings should be assessed carefully
factors other than dryness: on admission. All cases must be
o Communicable disease identified and treated promptly to
o Contact with chemical substances prevent spread or reinfestation with
o Allergic response to medication the parasites.

Assessment (Data Collection)

✓ Is there any evidence of scratching?

✓ Are there any signs of scabies (fine wavy
dark lines, or spot at the webs of the fingers
or folds of the skin)?
✓ Are there any rashes? If so, where are they
located? What is their appearance (e.g.:
macular, popular, or vesicular)?

Scabies

✓ Scabies is one communicable source of skin

irritation and sever pruritus.
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Tissue Integrity

✓ Breaks in tissue integrity increase the

older person’s risk for infection and often
result in the need for costly, time-
consuming treatments.
✓ These breaks can cause disfigurement
and are frightening to older adults.
✓ Even simple incidents – such as bumping
a leg into an open dishwasher door,
sliding across bed linens, or the removal
of tape – can result in significant skin
trauma to the older person.
Pigmentation
Pressure Injuries
✓ Many such changes are cosmetics and do
not cause problems unless they are located ✓ These are skin damage caused by
on the face or arms, where they may be persistent contact with an external surface,
resulting in the breakdown of skin integrity.
distressing to the affected person.
✓ Common conditions such as acne rosacea ✓ Development depends on the amount of
can be treated with topical medications, pressure, the length of time the pressure
is exerted and underlying status of tissues
which help heal the skin and reduce redness,
whereas other can be concealed by involved.
appropriate use of cosmetics. ✓ Pressure injury risk assessment tool
✓ Changes in size or pigmentation of moles are o Braden Scale
of greater significance and must be reported o Norton Risk Assessment Scale
because these changes may indicate the Nursing Process/Clinical Judgement Model for
presence of a precancerous or cancerous Altered Skin Integrity
condition that needs immediate medical
attention. ✓ Assessment (Data Collection)
✓ Data Analysis/ Problem Identification
✓ Planning
✓ Implementation

Assessment (Data Collection)

✓ Are there any areas of dry skin? If so, where?

Does the person complain of itching?

Data Analysis/Problem Identification

✓ Analyze cues and prioritize hypotheses:

problem statements for older adults with skin
integrity issues include:
o Altered Skin Integrity
o Potential for Altered Skin
o Integrity Altered Tissue Integrity
o Potential for Altered Tissue Integrity
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Planning

✓ Generate Solutions: The patient goals for

older individuals with or at risk for altered skin
or tissue integrity are to:
o Remain free from excessive skin
dryness or skin breakdown;
o Display timely healing of wound,
lesions, and ulcerations; and
o Maintain optimal nutritional status to
promote tissue integrity and healing.

Implementation

✓ Take Action: The following nursing

interventions should take place in hospitals
✓ Home
or extended care facilities:
o Encourage adequate fluid intake and
o Assess the level of alteration and the
good nutrition
contributing factors.
o Maintain adequate humidity in the
o Institute measures to reduce the
environment
potential for skin and tissue
o Avoid excessive exposure to the sun
breakdown.
o Use any appropriate interventions
▪ Reduce the frequency of
that are used in the institutional
complete bathing
setting
▪ Keep the skin free from
wastes and exudate by using Hair
mild non-detergent soaps
✓ The amount, distribution, appearance, and
▪ Use emollients, lotions,
consistency of the hair change with aging.
creams, and oils to maintain
✓ Hair typically becomes thinner and has a
skin moisture
finer consistency with advanced age.
▪ Encourage older adults at
✓ Heredity and gender play a role in hair loss
high risk for skin tears to wear
patterns. Men tend to lose more hair than do
long sleeves, long trousers, or
women, although some men retain full head
knee-high socks
of hair throughout life. Male pattern baldness
▪ Encourage adequate rest
typically results in progressive loss of hair at
the temples and back of the head.
✓ Abnormal hair loss can be related to high
fevers, medications, nutrition problems,
fungal or bacterial infections, endocrine
disorders, or stress.
✓ The amount and distribution of body hair also
change with aging. Diminished or absent hair
on the lower legs or feet – particularly when
combined with excessively dry, scaly, or flaky
skin and weak or absent pedal pulses
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

indicates decreased blood supply to the Age-Related Changes in Oral Mucous

lower extremities. Membranes

✓ Older adults may struggle to chew certain

foods due to oral cavity problems.
✓ Poor oral hygiene is a major problem in older
population.
✓ Reasons are:
Assessment (Data Collection) o Dental care is not priority
o Cost of dental care
✓ Are any lesions evident on the scalp?
o Restricted access in rural areas
✓ Is there any change in the amount,
distribution, or appearance of the hair?

Nails

✓ Aging results in hyperkeratosis of the nails,

particularly the toenails.
✓ Thick, hard nails are difficult to cut using
normal foot care equipment.
✓ Soaking the feet in warm water before
attempting to cut the nails may soften them
and make them easier to cut.
✓ Assistance from a family member or health
care provider is appropriate when there is no Dental Caries
history of circulatory problems or diabetes. ✓ Decay, or caries, is a condition where
✓ When diabetes or circulatory problems are bacteria penetrate the tooth enamel shield,
present, care should be provided by a foot leading to the destruction of the tooth.
care specialist, because nails can be thick ✓ The tooth can be rebuilt with fillings, but this
and the underlying tissue is easily injured, results in a weakened structure that is
which can lead to infection. susceptible to issues.
✓ Special heavy-duty equipment may be
needed to accomplish proper nail care.
✓ If proper nail care is neglected, uncut nails
confined in shoes often begin to curl under
the toes, resulting in a condition called ram’s
horn nails.

Assessment (Data Collection)

✓ What is the appearance of the toenails?

✓ Are they thickened?
✓ Difficult to cut?
✓ Discolored?
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Periodontal Disease ✓ Partial plates tend to catch particles of food

and may weaken the healthy teeth which
✓ Food debris and plaque accumulate in
they are attached.
the mouth and on the teeth when oral
✓ Complete dentures are expensive and
hygiene is inadequate.
difficult to fit.
✓ Periodontal disease is a less obvious but
✓ Challenges: Food particle trapping,
potentially more serious complication of
discomfort due to improper fit.
poor oral care.
✓ Consequences:
o Difficulty in chewing, shifting
teeth, and potential systemic
effects.
✓ Can cause:
o Halitosis
o Gingivitis

Dry Mouth

✓ Xerostomia, or dry mouth, is common with

aging.
✓ Dryness may result from the normal age-
related reduction in saliva reaction,
inadequate hydration, or disorders such as
diabetes.
✓ Causes: Aging, reduced saliva secretion,
and disorders like diabetes
Pain ✓ Consequences: Difficulty in chewing,
swallowing, tooth decay, and altered taste.
✓ Dental caries and periodontal disease are
the most common reasons for oral pain, but Leukoplakia
oral lesions, such as stomatitis or altered ✓ White patches in the mouth, called
sensations in the mouth, are frequently leukoplakia, are often precancerous and
reported. require prompt medical attention.
✓ Can cause: ✓ Lesions on the posterior third or the sides of
o Loss of appetite the tongue are often abnormal and should be
o Decreased food intake brought to the attention of the primary care
o Can have negative effect on the provider.
overall quality of an older person’s
life. Cancer

Dentures ✓ According to the Oral Cancer Foundation,

as many as 45,750 people are diagnosed
✓ Both partial plates and dentures can cause with oral or pharyngeal cancer each year.
problems for the wearer. ✓ The incidence of this cancer increases with
✓ Types: Partial Plates and Complete age.
Dentures.
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

✓ These forms of cancer have poor prognosis,

primarily because they are often discovered
Nursing Process/Clinical Judgement Model
late.
for Altered Oral Mucous Membrane
✓ Early recognition and treatment before the
cancer has metastasized to other tissues Assessment
offer the best hope.
✓ Recognize cues:
o Does the person have their own
teeth? If so, how many?
o What is the condition of the teeth?
Are any teeth loose or decayed?
o Does the person have halitosis?
o Do they wear dentures? If so, are
they uppers, lowers, or both
Partial plates or bridges?
o Are the dentures worn during
meals or removed? How do they
Alcohol and Tobacco-related Problems fit?!
o Are there any signs of irritation in
✓ Alcohol and tobacco, even in small amounts, the mouth? Any bleeding?
can harm mucous membranes. o Are food particles trapped under
✓ Alcohol is chemically irritating and drying to the dentures at meals?
the mucous membrane. o Is any residual food or debris
✓ Tobacco, whether smoked, chewed, or taken evident in the mouth?
as snuff, increases risk for oral cancer. o How good is the person's
✓ Tobacco use can cause black or brown appetite? What types
discoloration on the tongue. o and consistencies of food do they
Problems caused by Neurologic Conditions prefer to eat?
o What is the condition of the oral
✓ Good oral hygiene practices are part of mucous membranes? Are they
routine health maintenance. moist or dry?
✓ Neurologic conditions such as stroke, o What is the condition of the
multiple sclerosis, or Parkinson’s Disease tongue? Is it coated, pale, red, or
can decrease coordination and strength, irritated?
making it difficult for the person to manipulate o Does the person use tobacco or
the equipment for oral hygiene. have a history of tobacco use?
✓ Challenges: o What medications are they
o Reduced coordination and strength receiving?
o Limited mouth opening due to severe o Does the person have any
arthritis physical conditions that would
o Medication-related gingival interfere with performing oral
hyperplasia hygiene?
o Resistance to care in Alzheimer’s
Diseases
Data Analysis/Problem Identification
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

✓ Analyze Cues and Prioritize to the primary care provider and

Hypotheses: Problem statement for dentist.
older adults with oral mucous membrane ✓ The following interventions should take
issues includes: place in the home:
o Altered Oral Mucous Membranes o Complete a thorough assessment
of the oral mucous membranes.
Planning
o Stress the importance of regular
✓ Generate Solutions: The patient goals dental visits.
for older individuals diagnosed with o Review the person’s oral hygiene
altered oral mucous membranes are to: practices.
o Obtain regular professional o Provide assistive devices as
dental care; needed.
o Demonstrate techniques for o Obtain the assistance of family
maintaining or restoring the members, friends, or community
o Integrity of the mucous agencies.
membranes; o Explain the need to avoid alcohol
o Inspect the oral cavity regularly and tobacco.
and seek care promptly if any o Promote adequate intake of
symptoms arise; nutrients and fluids.
o Experience no unusual signs or o Discuss the benefits of adequate
symptoms, such as irritation, moisture in the environment.
inflammation, or ulceration; o Suggest use of hard candy,
o Ingest foods and fluids without chewing gum, or artificial saliva to
discomfort; and increase moisture in the mouth.
o Verbalize specific actions to o Discuss the relationship between
promote healthy oral mucous medications and oral hygiene.
membranes. o Use any appropriate interventions
that are used in the institutional
Implementation setting.
✓ The following nursing interventions Nutrition and Hydration
should take place in hospitals or
extended-care facilities. Nutritional Health
o Complete a thorough assessment
✓ Adequate and affordable food supplies and
of the oral mucous membranes.
improved nutrition are concerns worldwide,
o Initiate referral to a dentist or
with some differences between developed
dental hygienist.
and developing countries. Although issues
o Provide oral hygiene.
vary among different areas of the globe,
o Promote adequate intake of
nutrition as a major contributor to health is a
nutrients and fluids.
significant concern for all nations.
o Provide lozenges or topical
✓ Need to focus more on eating a healthy diet.
analgesics as prescribed.
Older adults may be less physically active.
o Communicate suspected oral
The quality and quantity of diet are important
side effects of medication therapy
factors in preventing, delaying the onset of,
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

and managing chronic illnesses associated ✓ Reduce the proportion of adults with obesity
with aging. ✓ Increase the proportion of adults who are at
✓ Adoption of healthful eating patterns and a healthy weight
exercise has been shown to improve ✓ Increase the proportion of physician office
markers of age-associated diseases and visits made by adult patients who are obese
reduce biological aging. that include counseling or education related
✓ Some age-related changes in the to weight reduction, nutrition, or physical
gastrointestinal (GI) system do occur, these activity.
changes are rarely the primary factors in ✓ Increase the proportion of primary care
inadequate nutrition. physicians who regularly measure the body
✓ Fulfillment of nutritional needs in older adults mass index of their patients
is more often affected by numerous other. ✓ Reduce cholesterol in adults
✓ Increase the proportion of eligible people
Age-related Changes Affecting Nutrition
completing Centers for Disease Control and
✓ Taste Prevention (CDC)–recognized type 2
✓ Smell diabetes prevention programs.
✓ Digestive System
✓ Buccal Cavity
✓ Regulation of Appetite
✓ Body Composition

Age-related Nutritional Requirements

(Dietary Guidelines for Americans, 2020-2025)

United States Dietary Guidelines

✓ Follow a healthy eating pattern across the

lifespan to meet nutrient needs, help achieve
a healthy body weight, and reduce the risk of
chronic disease.
✓ Customize and enjoy nutrient-dense food
and beverage choices to reflect personal
preferences, cultural traditions, and
budgetary considerations. ✓ Many experts regard the Mediterranean and
✓ Focus on meeting food group needs with DASH diets as two of the healthiest diets.
nutrient-dense foods and beverages and ✓ Research has shown that they can lower
stay within calorie limits. blood pressure and reduce the risk of heart
✓ Limit foods and beverages higher in added disease, diabetes, and several other
sugars, saturated fat, and sodium and limit diseases.
alcoholic beverages. ✓ Fruit intake has been linked with improved
✓ Support healthy eating patterns for all. brain function, but berries in particular are
supported by the strongest evidence.
Nutrition and Weight Status (Healthy People in
✓ These foods contain many nutrients that
2023)
promote good brain health, possibly by
✓ Reduce household food insecurity and reducing oxidative stress, inflammation, and
hunger the formation of beta-amyloid plaques.
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

o Green, leafy vegetable 3. Fiber

o Beans ✓ It is abundant in raw fruits and vegetables
o Berries and in unrefined grains and cereals.
o Poultry & Fish ✓ A daily intake of 25 g of fiber is
o Nuts recommended and must be combined
o Wine with adequate amounts of fluid.
o Olive oil Insufficient amounts of fiber in the diet,
o Whole grains and insufficient fluids, contribute to
constipation.
4. Vitamins and Minerals
✓ Vitamin B12 plays a key role in antiaging,
but 50% of adults over the age of 50
years are deficient. Vitamin B12
deficiency is a common and
underrecognized condition.
✓ After age 50, the stomach produces less
gastric acid, which makes vitamin B12
absorption less efficient.
✓ Individuals consuming a vegetarian diet
Other Dietary Recommendations: and those with some form of weight loss
surgery are also more likely to be low in
1. Fats
the vitamin.
✓ older adults should limit intake of
saturated fat and trans fatty acids. Malnutrition (Undernutrition)
✓ Less than 10% of calories per day should
✓ A recognized geriatric syndrome.
come from saturated fats.
✓ Too little or too much energy, protein, and
2. Protein
nutrients, which can cause adverse effects
✓ The current protein reference nutrient
on a person’s body and its function and
intake (RNI) is 0.8 g protein/kg body
clinical outcomes.
weight in healthy adults of all ages.
✓ Malnutrition happens when a person has an
✓ Inadequate protein intake along with
imbalance between the nutrients needed and
skewed protein distribution among meals
those received, and can result from both
has been associated with reduced
overnutrition and undernutrition.
muscle protein synthesis, muscle
✓ Up to 50% of older adult patients are
mass, strength, and physical or
malnourished when discharged from the
functional performance.
hospital. Malnutrition is estimated to occur in
✓ Energy-protein deficiencies can cause a
up to 15% of community-dwelling older
reduction in production of T cells and
adults, 20% to 60% of hospitalized older
reduced innate and adaptive immunity,
adults, and 30% to 85% of those living in
increasing the risk for infection.
nursing homes. These figures are expected
✓ In a study conducted by Gropper et al.
to rise dramatically in the next 30 years with
(2020), protein intake differed among
the aging of the population.
ethnic or racial groups, but all groups
studied were below recommendations for
protein intake
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

✓ Those at greatest risk are older women, Factors Affecting Fulfillment of Nutritional
minorities, and people who are poor or live in Needs
rural areas.
✓ Lifelong habits. This includes unique eating
patterns of various cultural and religious
groups. Foodways influence food
preferences, meal expectation, and
nutritional intake.
✓ Socialization. The fundamentally social
aspect of eating has to do with sharing and
the feeling of belonging that it provides. All of
us use food as a means of giving and
receiving love, friendship, or belonging.
✓ Socioeconomic Deprivation. There is a
strong relationship between poor nutrition
and socioeconomic deprivation. Older adults
are the fastest-growing food-insecure
population in the United States, which means
they are not sure where or how they will get
their next meal.
✓ Transportation. Available and easily
Obesity (Overnutrition) accessible transportation may be limited for
older adults. Many small, long-standing
✓ Overweight and obesity kills more people neighborhood food stores have been closed
than underweight. in the wake of the expansion of larger
✓ Every country, except for those in sub- supermarkets, which are located in areas
Saharan Africa, faces alarming obesity rates that serve a greater segment of the
that have risen 82% since 2000. More than population.
two thirds of individuals ages 65 and older ✓ Chronic Diseases and Conditions. Heart
are obese or overweight in the United States, failure and chronic obstructive pulmonary
with a higher prevalence in women than men. disease (COPD) are associated with fatigue,
✓ Since the 1990s, the prevalence of older increased energy expenditure, and
adults who are obese has doubled. decreased appetite. Dietary interventions for
✓ The World Health Organization (WHO, 2020) diabetes are essential but also may affect
defines overweight and obesity as follows: customary eating patterns and require
overweight is a body mass index (BMI) lifestyle changes. Conditions of the teeth and
greater than or equal to 25; obesity is a BMI dental problems also affect nutrition.
greater than or equal to 30. However, there
is no consensus about the best way to Using Clinical Judgement to Promote Healthy
measure obesity in the older population. Aging: Nutritional Health
✓ According to some research, the obesity ✓ The role of nursing in evaluation of nutrition
paradox has discovered that among and development of solutions and nursing
individuals who have lived to the age of 70.
actions should be comprehensive and
✓ Age-related mortality risk is lowest in people
include attention to the process of eating, the
with a BMI of overweight. entire ritual of meals, and the assessment of
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

nutritional status within the interprofessional intentional or unintentional, and

team. during what period it occurred.
✓ Comprehensive nutritional screening and o A history of anorexia is also
assessment are essential in identifying older important, and many older adults,
adults at risk for nutrition problems or who especially women, have limited their
are malnourished. weight throughout life.
✓ Nutrition risk screening using a validated tool
such as the Mini-Nutritional Assessment
Short-Form (MNA-SF) should be performed
routinely and can be incorporated into annual
health checks for those ages 75 years and
older.

✓ Recognizing and Analyzing Cues

o Nutritional screening is the first step
in identifying individuals who are at
risk for malnutrition or have
undetected malnutrition
o Interprofessional approaches are key
to appropriate assessment and
intervention and should involve
medicine; nursing; dietary; physical,
occupational, and speech therapy;
and social work.
✓ Food and Nutrient Intake
o Frequently, a 24-hour diet recall
compared with the MyPlate for Older
Adults
o Keeping a dietary record for 3 days is
another tool. This can be completed
by the individual, family, or
caregivers. The diet recall includes
what foods were eaten, when food
was eaten, and the amounts eaten.

✓ Weight and Height Considerations

o considerations weight change (from
usual) offers the most useful
information on nutritional status, and
a detailed weight history should be
obtained along with current weight.
o History should include a history of
weight loss, if the weight loss was
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Hydration

✓ Hydration Management is the promotion of

an adequate fluid balance, which prevents
complications resulting from abnormal or
undesirable fluid levels.
✓ Essential part of nutritional requirements:
WATER
✓ Function of Water: thermoregulation,
dilution of water-soluble medications,
facilitation of renal and bowel function, and
creation of requisite conditions for and
maintenance of metabolic processes.
✓ Older adults (up to 85% of those 85 years of
age and older) drink less than 1 liter of fluid
(850 cc) per day.
✓ Older adults, except for those with fluid
restrictions, should consume at least 1500
mL of fluid per day.
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Oral Health
Dehydration
✓ Oral or dental health is a basic need that is
✓ Considered a geriatric syndrome
increasingly neglected with advanced age,
✓ Adults older than 65 years of age have the
debilitation, and limited mobility.
highest rates of acute care admissions for
✓ Older adults who are dependent on
dehydration as a primary diagnosis.
caregivers for bodily care assistance exhibit
✓ Older adults are particularly at risk for
worse oral hygiene than those who are self-
dehydration: kidneys are less able to
sufficient.
concentrate urine and some medications
✓ Poor oral health is recognized as a risk factor
(diuretics) increase fluid excretion.
for dehydration, malnutrition, and a number
✓ Main reason for dehydration is reduced fluid
of systemic diseases.
intake.
✓ A connection between poor oral health and
mortality has been identified in a cohort of
older adults (Gerontological Society of America,
Types of Dehydration
2021; Kohli et al., 2017).
✓ Water-loss dehydration (hypertonic, ✓ Poor oral health is an important public health
hyperosmotic, intracellular): Results from issue and a growing burden to countries
insufficient fluid intake. worldwide. Health disparities are evident
✓ Volume depletion (hypovolemia) (salt across and within regions and result from
loss, extracellular dehydration): Results living conditions and availability of oral health
from excess fluid loss as occurs in services.
vomiting/diarrhea, excessive bleeding, loss
of plasma.

Risks of Dehydration

✓ Age-related changes, Medications, Use of

four or more medications, Functional deficits,
Communication and comprehension
problems, Oral problems, Dysphagia,
Delirium, Dementia, Hospitalization.
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

retract the lips and cheek with a tongue

blade or fingers to see the area that is
being cleaned. Use a mouth prop as
needed if the individual cannot hold the
mouth open. If manual flossing is too
difficult, use a floss holder or
interproximal brush to clean the proximal
surfaces between the teeth. Use a
dentifrice containing fluoride. Brush the
tongue.
✓ Provide the conscious individual with
fluoride rinses or other rinses as
indicated by the dentist or hygienist.
Providing Oral Care
Providing Denture Care
✓ Explain all actions to the individual; use
✓ Remove dentures or ask individual to remove
gestures and demonstration as needed;
dentures. Observe ability to remove
cue and prompt to encourage as much
dentures.
self-care performance as possible.
✓ Inspect oral cavity.
✓ If the individual is in bed, elevate the
✓ Rinse denture or dentures after each meal to
head by raising the bed or propping it with
remove soft debris. Do not use toothpaste on
pillows and have the individual turn the
dentures because it abrades denture
head to face you. Place a clean towel
surfaces.
across the chest and under the chin and
✓ Once each day, preferably before retiring,
place a basin under the chin.
remove denture and brush thoroughly.
✓ If the individual is sitting in a stationary
o Although an ordinary soft toothbrush
chair or wheelchair, stand behind the
is adequate, a specially designed
individual and stabilize the head by
denture brush may clean more
placing one hand under the chin and
effectively.
resting the head against your body. Place
o Brush denture over a sink lined with a
a towel across the chest and over the
facecloth and half-filled with water.
shoulders.
This will prevent breakage if the
✓ The basin can be kept handy in the
denture is dropped.
individual’s lap or on a table placed in
o Hold the denture securely in one
front of or at the side of the patient. A
hand, but do not squeeze. Hold the
wheelchair may be positioned in front of
brush in the other hand. It is not
the sink.
essential to use a denture paste,
✓ If the individual’s lips are dry or cracked,
particularly if dentures are soaked
apply a light coating of petroleum jelly or
before being brushed to soften
use lip balm.
debris. Never use a commercial tooth
✓ Inspect the oral cavity to identify teeth in
powder because it is abrasive and
ill repair, pain, lesions, or inflammation.
may damage the denture materials.
✓ Brush and floss the individual’s teeth (use
Plain water, mild soap, or sodium
an electric toothbrush, if possible, with
bicarbonate may be used.
sulcular brushing). It may be helpful to
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

o When cleaning a removable partial ✓ Long-term care residents with dementia who
denture, great care must be taken to exhibit CRBs are three times more likely to
remove plaque from the curved metal have more tooth decay than those who allow
clasps that hook around the teeth. mouth care.
This can be done with a regular
Elimination
toothbrush or with a specially
designed clasp brush. Normal Elimination Patterns
✓ After brushing, rinse denture thoroughly;
then place it in a denture-cleaning solution ✓ Typical adult bowel movement consists of a
and allow it to soak overnight or for at least a moderate amount of formed brown stool that
few hours. In the morning, remove denture is passed without difficulty.
from the cleaning solution and rinse it ✓ The urge to defecate most commonly occurs
thoroughly before inserting it into the mouth. 30 to 45 minutes after meal.
Use denture paste if necessary to secure ✓ Another common time for defecation is first
dentures. thing in the morning after consumption of a
✓ Dentures should be worn constantly except warm beverage.
at night (to allow relief of compression on the Elimination and Aging
gums) and replaced in the mouth in the
morning. ✓ Most common elimination problems
experienced by older adults are
Oral Hygiene in Hospitals and Long-Term Care constipation, diarrhea and incontinence
✓ Factors contributing to less than adequate of bladder and/or bowel.
oral care include inadequate knowledge of ✓ Incontinence of bladder and/or bowel is one
how to provide care, lack of appropriate of the most common reasons that older
supplies, inadequate training and staffing, adults are institutionalized.
and lack of oral care protocols. Constipation
✓ Most nursing curricula offer limited training
and education in oral care practices, and ✓ Defined as hard stools that are difficult to
graduates therefore may be unprepared to pass.
implement nursing actions to promote oral ✓ It is common complaint of older adults.
health (Red & O’Neal, 2020). ✓ Rome Criteria have been developed as an
✓ In the acute care setting, good oral care is objective way to classify functional GI
crucial to the prevention of ventilator- disorder.
associated pneumonia (VAP). ✓ Peristalsis normally slows with aging.
✓ Individuals residing in long-term care Fecal Impaction
facilities are particularly vulnerable to
problems with oral care because of functional ✓ Presence of mass of hardened feces that is
and cognitive impairments. trapped in the rectum and cannot be
✓ A large number are dependent on staff for the expelled.
provision of oral hygiene. ✓ Symptoms of impaction include delay in
✓ Care-resistant behavior (CRB) is one of the defecation that is longer than usual.
primary reasons for the omission of mouth ✓ Older adults suffering from fecal impaction
care (Hoben et al., 2017; Jablonski-Jaudon are likely to complain of cramping or rectal
et al., 2016). pain, abdominal distention, and loss of
appetite.
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Nursing Actions for Fecal Impaction and ✓ Use any appropriate interventions that are
Constipation used in the institutional setting.

✓ Assess bowel elimination pattern and Fecal Incontinence

contributing factors.
✓ A common problem among older adults due
✓ Increase physical activity.
to a variety of factors such as physical and
✓ Increase intake of dietary fiber and fluids.
cognitive impairments, chronic diseases that
✓ Schedule or encourage toileting at times
affect the gastrointestinal system, and the
when the person’s defecation urge is
side effects of medications.
strongest.
✓ Fecal Incontinence is defined as the
✓ Position the person to facilitate ease of
involuntary loss of solid or liquid stool.
elimination.
✓ Provide privacy for elimination. Nursing Actions for Fecal Incontinence
✓ Administer stool softeners or bulk-forming
laxative as prescribed. ✓ Assess patterns of elimination and causative
factors.
Diarrhea ✓ Establish a toileting schedule.
✓ Take measures to prevent or reduce
✓ Diarrhea is defined as having three or more
episodes of constipation.
loose or watery stools in a day.
✓ Use appropriate aids or garments.
✓ Older adults are more susceptible to
✓ Clean the person promptly after each
infections that can cause diarrhea, such as
episode of incontinence.
norovirus, Clostridium difficile (C. diff)
✓ Use any appropriate interventions that are
infections, and other bacterial, viral or
used in the institutional setting.
parasitic infections.
✓ Diarrhea can be a serious problem for older Normal Urine Elimination Patterns
adults because it can lead to dehydration,
electrolyte imbalances, and malnutrition. ✓ Urine elimination in adults also follows
patterns.
Nursing Action for Diarrhea ✓ Typical adult experiences the urge to urinate
when the bladder contains approximately
✓ Assess the elimination pattern and
300 mL of urine.
suspected causative factors.
✓ Voluntary control of the external sphincter
✓ Maintain adequate fluid intake.
muscles enables healthy adults to hold larger
✓ Institute measures to maintain skin integrity.
amounts within the bladder until urination is
✓ Promptly report observations to the primary
convenient.
care.
✓ Most adults void between 6 to 10 times per
✓ Provider, and follow up on care provider’s
day.
orders regarding medications that decrease
intestinal motility. Urinary Retention
✓ Explain the importance of seeking medical
attention if the person is experiencing ✓ Is an abnormal accumulation of urine in the
diarrhea. bladder
✓ Explain the importance of proper food ✓ No more than 50 mL of urine remains in the
preparation and storage in preventing bladder after voiding (normal)
bacterial diarrhea. ✓ Urinary retention in older adults can result in
different aspects.
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

✓ Symptoms: o Assess changes in urinary patterns

o Feeling of fullness such as frequency, urgency, or
o Discomfort or tenderness in bladder hesitancy.
o Restlessness o Assess the patient’s knowledge
o Diaphoresis about antimicrobials and preventive
✓ Assessment: health care measures.
o Inspecting or palpating the area over o Assess the characteristics of the
the symphysis pubis. patient’s urine such as the color,
✓ Nursing Management: concentration, odor, volume, and
o Medication / sitz bath cloudiness.
▪ If retention is caused by
Urinary Incontinence
perineal trauma or anxiety,
noninvasive measures. This ✓ Involuntary loss of urine in sufficient amount
treatment may be enough to or frequency to be a social or hygiene
stimulate effective voiding. problem.
o Catheterization / surgery ✓ Not a normal part of aging.
✓ Major problem in the aging population.
Urinary Tract Infection (UTI)
✓ Symptoms:
✓ Urinary tract infections are a common o Feeling sudden, uncontrollable urges
problem, particularly for older women. to urinate.
✓ Common infections that happen when o Frequent urination.
bacteria, often from the skin or rectum, enter o Waking up many times at night to
the urethra, and infect the urinary tract. urinate.
✓ The infections can affect several parts of the o Urinating during sleep
urinary tract, but the most common type is a o Leaking urine when:
bladder infection (cystitis). ▪ Coughing
✓ Symptoms: ▪ Sneezing
o A need to pee more often than usual. ▪ Laughing
o Pain or discomfort when peeing. ▪ Exercising
o Sudden urges to pee. ✓ Assessment:
o Feeling as though you're unable to o Involuntary loss of urine
empty your bladder fully. ✓ Nursing Management:
o Pain low down in your tummy. o Assess patterns of elimination and
o Urine that's cloudy, foul-smelling causative factors
o Feeling generally unwell, achy and o Establish a toileting schedule.
tired. o Use appropriate aids or garments.
✓ Assessment: o Clean the person promptly after each
o Medical History (Hx) including the episode of incontinence
details about onset, frequency, and
Stressing Urinary Continence
volume of urine loss.
o Urine analysis ✓ Leakage of urine during conditions that
o Check for dark colored urine increase intraabdominal pressure.
✓ Symptoms:
✓ Nursing Management
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

oLeaking urine when coughing, oMedical Hx including the details

sneezing, laughing, or exercising. about onset, frequency, and volume
o Feeling sudden, uncontrollable urges of urine loss.
to urinate. o Assessing the abdomen for
o Frequent urination. distention or tenderness
o Waking up many times at night to o Palpating the bladder for fullness
urinate. o Diagnostic tests; urine analysis and
o Urinating during sleep urodynamic studies
✓ Assessment: ✓ Nursing Management:
o Immobility/functional limitations o Implementing bladder training
o Enlarged prostate and treatment for techniques
prostate cancer o Pelvic floor muscle exercise
o Disorders: Diabetes, Parkinson o Lifestyle modification
disease, stroke, chronic o Educating patients about their
o Obstructive pulmonary disease, condition
arthritis/back problems o Use of incontinence Product
o Pelvic organ Prolapse. o Regular follow up
✓ Nursing Management:
Reflex Urinary Incontinence
o Assess elimination patterns.
o Assess fluid intake patterns. ✓ Define as the involuntary loss of urine at a
o Explain measures that help improve fairly predictable interval after a certain
tone of the sphincter muscles. bladder volume has been reached.
o Modify clothing to make toileting ✓ Occurs when there is an exaggerated reflex
easier. of a bladder muscle in patients with
o Reduce environmental barriers by neurologic disorders (spinal cord injury).
providing grab bars in the bathroom, ✓ Patient may not feel the urge to void or have
installing toilet risers, keeping the any sensation of bladder fullness.
urinal or bedpan readily available. ✓ Symptoms:
o Involuntary loss of urine
Urge Urinary Incontinence
o Lack of sensation or awareness of
✓ Caused by involuntary contraction of the bladder fullness
detrusor muscle of the bladder. o Frequent episodes of urine leakage
✓ Sudden strong urge to void o Nocturia
✓ Often seen in older adults who suffer from ✓ Assessment:
diseases o Medical history (neurologic disorder
✓ Symptoms: or spinal injuries)
o Sudden urge to urinate that is difficult o Assess bladder function
to control o Palpating the bladder for fullness
o Frequent urination during the night o Diagnostic test
(nocturia) ✓ Nursing Management:
o Bedwetting o Bladder Training
✓ Assessment: o Prompted Voiding
o Pelvic Floor Muscle Exercises
o Medications
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

o Environmental Modifications
o Education and Support
Nursing Process for Altered Urinary Tract
o Regular Follow-up
Infection
Overflow Urinary Incontinence
✓ Assess elimination patterns.
✓ Defined as leakage of a small amount of ✓ Assess fluid intake patterns.
urine from an overly full bladder. ✓ Explain Measures that help improve tone of
✓ Common problem for people with diabetes. the sphincter muscles.
✓ Also common in older men with benign ✓ Modify clothing to make toileting easier.
prostatic hyperplasia. ✓ Reduce environmental barriers by providing
grab bars in the bathroom, installing toilet
Nursing Actions of Overflow Urinary
risers, keeping urinals or bedpan readily
Incontinence
available, and providing a call light for
✓ Develop a toileting schedule assistance.
✓ Encourage individuals to establish a pattern ✓ Answer call lights promptly.
of urine elimination. ✓ Develop a toileting schedule.
✓ Discuss methods for coping with ✓ Familiarize older adults with the locations of
incontinence. bathrooms throughout the facility.
✓ Provide support and encouragement.
Functional Urinary Incontinence ✓ Initiate actions to maintain skin integrity.
✓ Caused by poor relationship between the ✓ Provide incontinence pads or garments
aging person’s abilities and their when appropriate.
environment. ✓ Administer medications as prescribed by the
✓ Environmental factors contribute to the primary care provider.
problem of functional urinary incontinence ✓ Insert a straight catheter as prescribed by the
and increase its likelihood. primary care provider.

Nursing Action of Functional Urinary GROUP 2

Incontinence PHYSICAL CARE OF THE OLDER ADULTS
✓ Modify clothing to make toileting easier. Activity and Exercise
✓ Keep urinals or bedpan readily available and
provide a call light for assistance. Definition
✓ Provide incontinence pads or garments
Physical activity is defined as any bodily movement
when appropriate.
produced by skeletal muscle that requires energy
Mixed Urinary Incontinence expenditure.

✓ Mixed urinary incontinence is a common type Regular physical activity throughout life is essential for
of incontinence, and the causes can vary. healthy aging. Physical activity enhances health and
✓ UI can be a continuous and ongoing problem functional status.
or may occur only occasionally.
The frail health and loss of function we often associate
✓ Combination of two or more types of
with aging are in large part due to physical inactivity.
incontinence, such as stress incontinence,
urge incontinence, and/or overflow Importance
incontinence.
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Physical activity is important for all older adults. • ENDURANCE

Reducing sedentary time, independent of physical - Walking, Jogging, and Yard Work
activity, has cardiovascular, metabolic, and functional • BALANCE
benefits. - Tai Chi
• STRENGTH
It also improves brain health, lower the risk of
- Use of Resistance Bands or Weightlifting
dementia, and improve performance of activities of
• FLEXIBILITY
daily living (ADLs) in individuals with dementia, thus
- Stretching
reducing caregiver burden.
Special Considerations
Nursing Actions
EXERCISE SAFETY
Nurses should be knowledgeable about recommended
physical activity guidelines, educate individuals about • Wear comfortable clothes.
the importance of exercise and physical activity, and • Warm up
provide exercise counseling on ways to incorporate • Drink water
exercise into daily routines. Giving an exercise • Safety
prescription with specific advice about the type and • Wear sunscreen
frequency of exercise is important.
STOP EXERCISE
Older adults need at least:
• PAIN (chest, neck,shoulder or arm)
2 hours and 30 minutes (150 minutes) of moderate-
• PAIN (joints, feet, ankles or legs)
intensity aerobic activity every week (anything that gets
• Feel dizzy
your breathing harder and your heart beating faster)
• Muscle cramps
(e.g., brisk walking, swimming, bicycling, water aerobics,
• Trouble in breathing
raking leaves or pushing a lawn mower)
REST AND SLEEP
Muscle-strengthening activities that work all major
muscle groups (hips, abdomen, chest, shoulders, and Definition of Sleep
arms) at least 2 days a week.
A basic need.
Activities to improve balance (e.g., standing on one foot,
yoga, tai chi) 2 to 3 times a week or incorporated in A barometer of health and can be considered one of the
other exercises. vital signs.

Benefits Short sleep duration (6 hours or less per 24-hour period)

• To Prevent Weight Gain Long sleep duration (≥9 to 10 hours per 24-hour period)
• To Reduced Risk of Hypertension, CAD, Heart The optimal sleep duration in adults for good health is 7
Attack, Stroke, Diabetes, and Depressions to 9 hours,
• To Improve Quality of Sleep
Sleep disturbance and deficiency have been linked with
• To Improve Bone and Functional Health
dementia and all-cause mortality.
• To Decrease Risk of Early Death
• To Improve Cardiorespiratory and Muscular Fitness Sleep problems constitute a global epidemic affecting up
• To reduce Risks of Fall and Hip Fracture to 50% of the world’s population.
• To Improve Functional Independence
Importance of Sleep
Examples
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

It occupies one-third of our lives and is a vital function • Body temperature drops
that affects cognition and performance.
N3
Restorative function of sleep may enhance removal of
potentially neurotoxic waste products. • Deepest and most restorative sleep
• Blood pressure drops.
May prevent the protein from building up in the brain. • Breathing becomes slower.
Taking care of sleep by practicing good sleep hygiene • Muscles are relaxed
may contribute to reducing the amyloid buildup over • Blood supply to muscles increases
the lifespan, reducing the symptoms of Alzheimer’s, or • Tissue growth and repair occurs
delaying onset or progression of the disease (Clark et al., • Energy is restored
2022). • Hormones are released, such as growth hormone

Relaxation Techniques Rapid Eye Movement (REM

Diaphragmatic Breathing - Diaphragmatic breathing is • Supports daytime performance.

an exercising technique to help strengthen your • Brain is active and dreams occur.
diaphragm and fill your lungs with air more efficiently. • Eyes dart back and forth.
• Body becomes immobile and relaxed, as muscles
White noise or music- Many use it for relaxation and
are turned off
sleep. White noise can also help the brain to relax by
giving it a sound to focus on instead of the cacophony of AGE RELATED SLEEP CHANGES
stressful thoughts inside our heads
• More time spent in bed awake before falling
Stretching- It can improve blood flow and relieve muscle asleep.
tension — both of which aid in muscle recovery and • Total sleep time and sleep efficiency are reduced.
sleep quality. • Awakenings are frequent, increasing after age 50
years.
Yoga or tai chi- are great for reducing stress and anxiety.
• Daytime napping
They help calm the mind and help you relax, which can
help you fall asleep faster and sleep more soundly. • Changes in circadian rhythm (early to bed, early to
rise)
The Stages of Sleep • Sleep is subjectively and objectively lighter (more
N1, little N3, more disruptions)
Non-Rapid Eye Movement (NREM)
• Rapid eye movement (REM) sleep is short, less
• 75% of night intense, and more evenly distributed.
• As we begin to fall asleep, we enter NREM sleep • Frequency of abnormal breathing events is
which is composed of N1-N3 (formerly Stages 1-4 increased.
• Frequency of leg movements during sleep is
N1
increased.
• Between being awake and falling asleep
Insomnia
• Light sleep
Insomnia is the most common sleep disorder
N2
worldwide. The American Academy of Sleep Medicine
• Onset of sleep defines insomnia as the subjective perception of
• Becoming disengaged from surroundings difficulty with sleep initiation, duration, consolidation,
• Breathing and heart rate are regular.
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

or quality that results in some form of daytime enough deep REM (rapid eye movement) sleep and
impairment (Dopheide, 2020). make you feel sleepy during the day.

Short-term- less than 3 months Diuretics- It increases urine production. Diuretics can
cause sleep problems due to their tendency to cause
Chronic - occurs three or more times a week for 3
more frequent nighttime urination.
months or longer
Cough and Cold medication- ingredients found in
Many influencing factors for insomnia including
asthma inhaler medications or common cold and cough
physiological, psychological and environmental
medications can cause anxiety, jitteriness, or
Can be primary sleeping disorder or symptoms of other relentlessness that can interfere with sleep.
sleep disorder like sleep apnea or restless leg syndrome
Cortisone- corticosteroid such as prednisone decreases
Risk Factors for Sleep Disturbances in Older Adults serum melatonin levels.

Physical Health Solutions and Actions to Enhance Sleep

• Age-related changes in sleep architecture • Keep a consistent sleep schedule. Get up at the
• Pain same time every day, even on weekends or during
• Polypharmacy vacations.
• Lack of exercise • Establish a relaxing bedtime routine.
• Excessive napping; spending too much time in bed • Keep the room at a comfortable, cool temperature.
• Sleep disorders (apnea, restless legs syndrome, • Turn off electronic devices at least 30 minutes
periodic leg movement, rapid eye movement before bedtime.
behavior disorder) • Don’t eat a large meal before bedtime.
• Smoking/Alcohol- Substance abuse • Avoid caffeine, alcohol, and tobacco in the late
afternoon or evening.
Psychological Health • Reduce fluid intake before bedtime.
• Depression, anxiety, delirium, psychosis • Limit or avoid daytime napping
• Life stressors or response to stress Benefits of sleeping
• Sleep habits (daily sleep-activity cycle, napping)
• Being a worrier Getting enough sleep has many benefits. It can help
• Family history of poor sleep you:
• Poor sleep hygiene • Get sick less often.
Physical Environment • Stay at a healthy weight.
• Lower your risk for serious health problems, like
• Environmental noises, institutional routines diabetes and heart disease.
• Caregiving for a dependent older adult • Reduce stress and improve your mood.
• Limited exposure to sunlight • Think more clearly and do better in school and at
• New environment work.
Medications Affecting Sleep • Get along better with people.
• Make good decisions and avoid injuries.
Antihypertensives (clonidine, beta blockers, resepine,
methyldopa)- Alpha blockers treat high blood pressure SAFETY AND SECURITY
and prostate problems. they can keep you from getting Definition
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

ENVIRONMENTAL SAFETY 1. Plan your route and stay alert to your

surroundings. Walk confidently.
SAFE ENVIRONMENT means one is capable of carrying
2. Have a companion accompany you
out activities of daily living (ADLs), instrumental
3. Stay in well- lighted areas
activities of daily living (IADLs), and the activities that
4. Have your key ready when approaching your front
enrich one’s life without fear of attack, accident, or
door
imposed interference.
5. Don’t dangle your purse away from your body,
HOME SAFETY carry only what you need

Recognizing safety concerns or home safety assessment In the Car

can play a CRUCIAL ROLE in devising strategies to
1. Always keep door locked when you are in or out of
support individuals staying at home for an extended
the car
period while they are aging (AGING IN PLACE)
2. Keep the car in gear at stop signs and traffic lights
Crimes Against Older Adults 3. Plan your route and travel well-lit and busy streets
4. Don’t leave your purse on the seat beside you; put
Risks and Vulnerability it on the floor
Most common crime against individuals ages 65 years 5. Lock bundles or bags in the trunk
and older is PROPERTY CRIME. 6. When returning to your car, check the front and
back seat and floor before entering
In 2020, reports about CYBERCRIME surged to an all- 7. If your car should break down, get far enough off
time high, resulting in total losses exceeding $4.2 the road, turn on emergency flashers, raise the
billion. hood, get back in the car, lock the door, and wait
Common Fraudulent Schemes: for help

• Investment fraud At Home

• Tech support scams 1. Never open your door automatically; use an
• Romance scams optical viewer or ring camera; consider a home
• Grandparent scams security system
• Government impersonation scams 2. At night, draw blinds or drapes
• Sweepstakes or lottery scams 3. Lock doors, windows, and garage door
• Home repair scams 4. Don’t leave notes on the door when going out;
• Family caregiver scams don’t place keys under mats, in mailbox, or in
• TV or radio scams other receptables outside your door
5. Leave lights on when going out at nihgt; use a
WHY ARE THEY BEING TARGETED? time to turn lights on and off when you are away
• They tend to be trusting and polite. for an extended period
• They have financial savings, owns a home, and 6. Notify neighbors and the police when going away
• have a good credit. on a trip; cancel deliveries and mail
7. Be wary of unsolicited offers to make repairs to
• They are also less likely to report fraud.
your home; deal only with reputable businesses
Crime Reduction 8. Don’t hesitate to report crimes or suspicious
activities
Walking
9. Organize a busy system or neighborhood watch

Protection Against Fraud and Cybercrime

CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

1. Recognize scam attempts and end all Older adults in apartment. They deal with insufficient
communication with perpetrator maintenance and safety measures, as well as the
2. Search online for the contact information negligent actions of fellow residents.
and the proposed offer. Other people likely
Older adults in their own homes. They cannot afford
have posted information online about
home repairs, placing them at risk for fire.
individuals and businesses trying to run
scams Vulnerability to Environmental Temperature
3. Resist the pressure to act quickly. Call the
police if you feel there is danger to yourself
or a loved one
4. Be cautious of unsolicited phone calls,
mailings, and door to door service offers
5. Never give or send any personally
identifiable information, money, jewelry, gift Heat-related and cold-related deaths increase with age,
cards, checks, or wire information to especially for those over 75. Older adults, low-income
unverified people or businesses people, chronically ill individuals, and those without
6. Make sure all computer antivirus and electricity access are particularly vulnerable. Preventive
security software and malware protections measures and early intervention are crucial.
are up to date Preventing Cold Discomfort in Older Adults
7. Disconnect from the internet and shut down
your device if you see a pop- up message or • Maintain a comfortably warm ambient temperature
locked screen no lower than 20 celsius.
8. Be careful what you download, never open • Provide generous quantities of clothing and
an email attachment from someone you bedcovers.
don’t know, and be wary of email • Provide a head covering whenever possible. Cover
attachments forwarded to you patients well when in bed or bathing
9. Take precautions to protect your identity if a • Provide as much exercise as possible to generate
criminal gains access to your device or heat from muscle activity.
account. Immediately contact your financial • Provide hot, high-protein meals and bedtime
institutions to place protections on your snacks
accounts and monitor your accounts and
personal information for suspicious activity Vulnerability to Natural and Man-made Disasters

Fire Safety for Older Adults

Majority of home fires tend to happen at night.

Deaths are attributed to smoke injury more

often than burns.
Older adults face increased vulnerability during
According to the National Hispanic Council on
disasters due to lack of access to communication
Aging in 2017, individuals over 80 years old
technology, physical inability to evacuate, and
experience fire-related death rates that are 3 dependence on others. They’re at risk for those with
times higher than the rest of the population limited mobility, social isolation, cognitive impairment,
and institutionalization, with older and poorer
individuals being more vulnerable.
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Gun Safety Performance may precede cognitive issues in

Firearm safety for elderly individuals is a concern for

healthcare and public health professionals.

In the United States, older adults have the highest rate

of gun ownership:

- 27% of individuals aged 65 years and older owns one

or more firearms.

- 37% residing in households where firearms are

present.

Older adults, particularly White males, also have high

rates of suicide, and 71% of the time they use guns

Alzheimer’s stages

• Nurses can teach about health promoting

Transportation Safety behaviors and safety tips.
• Older adults have more accidents. • Voluntarily giving up a driver’s license can lead
• Possibility of social isolation, inadequate to more positive outcomes.
nutrition, depression, and declining health. The nurse can share key phrases:
• For many older adults, giving up driving is a
major loss, and the emotional and physical • “Driving on the roads today is so much more
consequences can be significant difficult than it used to be,”
• Older men value driving more, causing added • “That was a close call today while driving to the
stress in giving up ____; I worry about your safety.”
• “Did you speak with your doctor about the
Driving and Dementia effects of your recent medications on driving?”
• Dementia suggests cognitive and functional
impairments.
• Drivers with dementia face a twofold greater
risk of crashes
• Approximately 33% of older adults with
dementia are active drivers
• Half or 50% continuing to drive for up to 3 years
post-diagnosis.
• A diagnosis alone should not justify license
revocation.
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Assistive Technology

any device that allows a person to perform a task

independently

decreases dependency on others for personal care in

ADLs and presents cost-effective alternatives to human
services.

a. Telehealth

Telehealth is the use of technology to enable healthcare

providers to remotely diagnose, monitor, and treat
patients with the comfort at their home.

Factors Affecting Technology Access:

1. Cognitive and Sensory Impairments 2.

2. Disparities in access to broadband services
(Kalicki et al., 2021)
3. Specific Demographic Groups
b. Smart Homes

Enables older adults to control lighting, heating, cooling,

and security systems through voice commands or
mobile apps

enhances comfort & safety while reducing the physical

effort required for daily tasks

examples: Smart pill dispensers, smart stove, smart

mattress, virtual reality

c. Robots

Robots can assist with tasks such as lifting, cleaning, and

even providing companionship.
Emerging Technologies to Enhance Safety of Older This kind of technology reduces physical strain on
Adults caregivers and improve quality of life to older adults.
Technology advancements improves quality of life d. Robopets and Therapeutic Interactive Pets
and decreases the need for personal care. It
enhances independence and ability to live safely at Paro, a medical therapeutic pet developed in Japan
home and age in place. (Pepito & Locsin, 2019) By interaction with people, PARO responds as if it is
“Gerontechnology”, term used to describe assistive alive, moving its head and legs, making sounds, and
technologies for older adults. showing your preferred behavior

It increases interactions and engagement, reduces

agitation, decreases loneliness, pleasure and comfort.
 CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite

Others: Alternative living arrangements and approaches that

allow older adults to age with independence and dignity
• Self Care Assistive Technologies
while remaining connected to their communities.
• Mobility Assistive Technologies
• Safety Assistive Technologies Naturally Occurring Retirement Communities (NORCs)
• Communication Assistive Technologies
• A neighborhood or buildings which has a large
Benefits of Assistive Technology to Older Adults segment residents of older adults;
• a community where resident has aged and intends
1. Enhanced Independence to spend the rest of their lives.
2. Improved Safety
• provides a range of health and social services for
3. Increased Social Engagement
the residents as well as individual assessments of
4. Cognitive Support
risk, coordination of nonprofessional services, and
5. Enhanced Communication
referrals and follow-up.
6. Improved Mobility
7. Support for Caregiver The Village Model

Special Considerations • a specific neighborhood or community form a

"village" or network.
a. Assessment and Evaluation
• Villages typically offer services such as
b. Comprehensive education and training to older
transportation, home repairs, social activities, and
adults and caregivers on using different assistive
access to trusted service providers.
technologies.
c. Ensure that assistive technology is safe and well- Beacon HIll- a prototype village in Boston, an
maintained. independent self-governing, not-for-profit
d. Privacy and data security organization run by volunteers and paid staff who
e. Cultural Preferences coordinate access to affordable services for older
adults in their communities
Aging in Place
Cohousing Communities
Aging in place is the ability to live in one’s own home
and community safely, independently, and comfortably, • a concept originated in Denmark.
regardless of age, income, or ability level. • designed specifically for individuals 50 years of
age and older
• there’s no hierarchy; decisions are made by
Components of an Elder-friendly Community consensus
• It promotes social interaction and shared
resources while maintaining individual living
spaces

Shared Housing

• Shared housing among adult children and their

older relatives has become a choice for many
because of cultural preferences or need.
• The sharing may relieve the economic burdens
of maintaining a home after widowhood or
retirement on a fixed income.
Aging in Community Models
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTES, INFECTIOUS, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE, CELLULAR ABERRATIONS (ACUTE AND CHRONIC) LEC
BSN 3-1|FIRST SEM|BATCH 2025|
Bachelor of Science in Nursing – Emilio Aguinaldo College – Cavite