Question

Case Study #8

P.J. is an 82-year-old man who presents to the outpatient office for an annual check-up.

Subjective Data

Lives in assisted living facility

Widower

One meal a day in dining room, has light meals for breakfast and lunch

Nonsmoker, never smoked

Retired police officer

Has three grown children who live nearby

Walks with cane

Complains of urinary incontinence

Objective Data

Vital signs: T= 97.7 BP= 108/62 HR= 62 Resp= 14

Height and weight = 5 ft 9 in, 230 lbs

Immunizations = Up-to-date

Medications: Digoxin (Lanoxin) 0.5 mcg daily, hydrochlorothiazide 5 mg daily, aspirin 81 mg daily

Allergy to sulfa medications (reaction= hives)

Questions (10 points total)

1. What special considerations should the nurse keep in mind regarding the physical exam for individuals in this patient’s age group? (2 points)

2. What are the expected findings in the older adult for the following systems: skin, hair and nails, eyes and vision, ears and hearing, mouth, and musculoskeletal system? (2 points)

3. What are some abnormal findings in the older adult for the following systems: skin, eyes and vision, ears and hearing, mouth, and musculoskeletal system? (2 points)

4. Based on the readings and the objective and subjective findings, what is the most likely cause of this patient’s urinary incontinence? (2 points)

5. What interventions should be implemented for this patient’s urinary incontinence? (2 points)

Answer 1

Findings andspecial considerations
@EXPECTED FINDINGS W OLDER ADULT O ECCHYMOSES - ageing leads to thinning of dermis layer. © LONGITUDINAL RIDGES 10 NAILS - age related © FRACTURE OF NAIL PLATE. ☺ FONGAL INFECTIONS CRARE) © COLOR pallos icterus cyanosis odentified © WRINKLES & DRY SKIN & THICK HAIR IN EARS NOSE @ CHIN DESCENT EVES O REFRACTWE ERRORS ORBIT FAT LOSS Ⓡ W VERSION OF LOW EYELD and Of LOW EYELIDS. EVERSION © PRESENCE OF WHITE RING AT LIMBOS CATARACT.

EARS - o was presence in external auditory canal ② Hearing loss Presbycusis MOUTH 8- 0 Teeth ② Fassues of tongue, mouth ③ Halitosis Gums edema MuscuLOSKELETAL SYSTEM 0 JOINT - tenderness swelling ③ DEFORMITIES * SUBLUXATION © Special considerations o ☺ Physical examination done partly at differe antervals due to old age @ Movements should be obsewed ③ Time should be taken for the patients to cooperate for the examination Potective measures such as mattress padding should be used
cause and intervention
Usage of hydrochloro thiazide is related to winary incontinance. They are alpha- adreno gic antagonists which delute blood vessels which may also relax the bladder neck and cause continence Digoxin can also lead to usinary incontinance. INTERVENTIONS : The underlying cause is consected ② Bladdes training to control the enconlinance & done. ② Learn to completely void. © Exercises to pelvic floos is done ② Maintain soutine boilet usage © Medications %s given ③ Devises such as pessar y kept. ® Surgery such as sling procedure; bladdos neck suspension done