Question

Case Study

A.D. is an 82-year-old man who presents to the outpatient office for a 6-month check-up.

Subjective Data

• Lives in assisted living apartments
• 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 37.7 BP 108/62 HR 62 Resp 14
• Height and weight = Within normal limits
• Immunizations = Up-to-date
• Medications: Digoxin (Lanoxin) 0.5 mcg per day, hydrochlorothiazide (HCTZ) 5 mg per day, aspirin 81 mg per day
• Allergy to sulfa medications = Hives

Questions to answer:

Important points to address:

• What special considerations should the nurse keep in mind regarding the physical exam for individuals in this patient’s age group?
• 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?
• What are some abnormal findings in the older adult for the following systems: skin, eyes and vision, ears and hearing, mouth, and musculoskeletal system?
• Based on the readings and the objective and subjective findings, what is the most likely cause of this patient’s urinary incontinence? What interventions should be implemented for this patient’s urinary incontinence?

Answer 1

Ans: special considerations should the nurse keep in mind regarding the physical exam for individuals in this patient’s age group

In the case of the older adult patient, consider collecting health history information from the patient instead of accompanying relatives.

During a conversation with patient maintain eye contact to observe patient hearing abilities and allow patients to observe our lip movement for effective communication.

Observe for the patients hearing problems of eye disorders in case of an older patients

Ans: Expected findings in the older adult for the following systems:

Skin: The skin over bony prominences becomes thin, hangs loosely to the internal structures, losses adipose tissue and elasticity, Skin becomes cool due to reduced blood supply.

The following disorders may be observed

Solar lentigo, Skin tag, and seborrheic keratoses

Hair and nails: The hair becomes coarse and thin, both men and women get a decrease in the amount of hair such as body, pubic, and axillary hair occurs

Eyes and vision: Upper eyelid becomes relaxed, decrease in orbital fat, loss in lacrimal apparatus function, the conjunctiva may appear dry, clear, and light pink, The cornea is transparent and clear

Mouth: Deep wrinkling of lips, The gum may move backward that's why teeth may be seen longer.

Musculoskeletal system: muscle mass is decreased, osteoarthritis. decreased range of motion of joints.

Ears and hearing: wiry hair in the opening of the auditory canal. If patient use hearing aid, there is a chance of cerumen impaction

Ans: Abnormal findings in the older adult for the following systems:

skin: Dry skin, dehydration, and malnutrition. edema may occur due to heart or renal diseases.

eyes and vision: ectropion or entropion may be observed

ears and hearing: Presbycusis and slurred speech

mouth: fissures at the corners of the mouth, perleche, anemia, squamous cell carcinoma of the lip may occur in the pipe smokers

musculoskeletal system: cervical arthritis, pain, crepitus, dizziness, and limited movement.

Ans: The patient may have a urinary tract infection,

Interventions include an  

A antibiotic for the urinary tract infection

Avoid sulfa drugs because a patient is allergic to it.

To enhance healing and to prevent UTI, increase fluid intake.