ADAMSON UNIVERSITY

College of Nursing
900 San Marcelino Street, Ermita, 1000 Manila

In Partial Fulfillment of Requirements in NCM 325:

Hospice Palliative Care

A CASE STUDY ON DEMENTIA

Submitted By:
John Michael R. Opolinto
BSN 301

Submitted To:
Mrs. Teresita Flores Merin, MPH, RN
Professor

March 26, 2015

TABLE OF CONTENTS

I.

OBJECTIVES OF THE STUDY......................................................................................................2

II. INTRODUCTION.............................................................................................................................2
a.

Definition of Case...........................................................................................................................2

b.

Etiology...........................................................................................................................................2

c.

Incidence.........................................................................................................................................3

d.

Theoretical Framework.................................................................................................................3

III. CLIENTS PROFILE........................................................................................................................3

a.

Client Data.....................................................................................................................................3

b.

Nursing History..............................................................................................................................4
1.

Chief Complaint.........................................................................................................................4

2.

Present Medical History............................................................................................................4

3.

Past Medical History.................................................................................................................4

4.

Family History...........................................................................................................................5

5.

Developmental History..............................................................................................................5

6.

Physical Examination..............................................................................................................10

IV.

ANATOMY AND PHYSIOLOGY...............................................................................................30

V.

PATHOPHYSIOLOGY.................................................................................................................45

VI.

THE ACTIVITIES-SPECIFIC BALANCE CONFIDENCE (ABC) SCALE...........................46

VII.

DRUG STUDY..............................................................................................................................48

VIII. NURSING CARE PLAN..............................................................................................................49

IX.

IMPLICATIONS OF THE CASE STUDY..................................................................................50

X.

BIBLIOGRAPHY..........................................................................................................................51

I. OBJECTIVES OF THE STUDY

2

The student nurse will be able to:

Participate in the course of care of client.

Provide health teachings to the client about certain interventions in the maintenance
of healthcare.

Establish rapport and therapeutic interaction with the client and significant others to
obtain necessary information and positive compliance to care being provided.

Provide health teachings necessary for the palliative care of the client from the
condition.

Share the learning acquired to co-student nurses to increase awareness and help them
if ever they will encounter a client with the same condition.

II.

INTRODUCTION
a. Definition of Case
According to PubHealth, dementia is a loss of brain function that occurs with
certain diseases. It affects memory, thinking, language, judgment, and behavior. It is a
chronic or persistent disorder of the mental processes caused by brain disease or injury and
marked by memory disorders, personality changes, and impaired reasoning.
b. Etiology
Dementia is caused by damage to brain cells. This damage interferes with the
ability of brain cells to communicate with each other. When brain cells cannot
communicate normally, thinking, behavior and feelings can be affected.
The brain has many distinct regions, each of which is responsible for different
functions (for example, memory, judgment and movement). When cells in a particular
region are damaged, that region cannot carry out its functions normally.
c. Incidence
3

The numbers and statistics surrounding dementia are staggering. Worldwide, there
are now an estimated 24 million people living with some form of dementia. Without a
major medical breakthrough in the fight against dementia, this number could jump to as
many as 84 million who have age-related memory loss by the year 2040 (DisabledWorld).
Most people with dementia live in developing countries: 60% in 2001 rising to 71% by
2040 (Alzheimers Disease International). In a research done in 2004, there were an
estimated 116,781 cases of dementia over 86,241,697 of the total population in the
Philippines.
d. Theoretical Framework
Person-centered care focuses on the individual needs of a person rather than on
efficiencies of the care provider; builds upon the strengths of a person; and honors their
values, choices, and preferences (McCance, McCormack, and Dewing, 2011; Edvardsson,
Fetherstonhaugh, and Nay, 2010; Brooker, 2007; McCormack and McCance, 2006;
McCormack, 2003; Kitwood, 1992). A person-centered model of care reorients the medical
diseasedominated model of care that can be impersonal for those oriented to holistic wellbeing that encompasses all four human dimensions: bio-psycho-social-spiritual.
III.

CLIENTS PROFILE
a. Client Data
1. Clients Initials: I.T.

10. Date of Interview: March 20,2015

2. Address: Malate, Manila

11. Primary Informant: Client I.T.

3. Age: 78 years old

12. Secondary Informant: Daughter

4. Birth Date: June 29, 1936

5. Birth Place: Aklan
6. Gender: Female
7. Civil Status: Widowed
8. Religion: Roman Catholic
9. Highest Educational Attainment: College undergraduate
b. Nursing History
1. Chief Complaint
4

According to client I.T.s daughter, she has a chief complaint of being

forgetful and does not remember recent activities.
2. Present Medical History
According to clients daughter, client I.T. started to be forgetful a year ago.
They did not consult a doctor about it because they thought it was because client
I.T. is already old. There was once an incident that client I.T. took a jeepney but
passed by her destination. She is not allowed to go out alone. During the interview,
client I.T. gave relevant answers but there were information given by her that are
not true as the interviewer confirmed to her daughter.
3. Past Medical History
She cannot remember if she had completed her immunization during
childhood. Client I.T. had chicken pox and measles. However, she cannot
remember when it was. There were times that she fell and her head bled.
The client also verbalized that she takes over the counter drugs for fever,
cough and cold; she directly consults her doctor for serious illness and comply
with her doctors order. She prefers to go to professional doctors than quack
doctors. She also takes herbal medicine like lagundi.
According to client I.T., she has never been hospitalized. Client I.T. has no
vices. She is hypertensive. According to her, she takes Losartan daily. She takes it
in the morning after eating breakfast. She also has increased uric acid, so she does
not usually eat meat and legumes. According to client I.T., she has medicine
whenever she experiences pain on her joints especially on her knee though she
cannot remember the name of the medicine.
Halos isa at gulay gaya ng kangkong lang ang pwede sakin, kasi pag
kumain ako sasakit ang tuhod ko. as verbalized by client I.T.

4. Family History

Died during the World War

Hypertension

Heart Attack

Kidney failure; DM
Interpretation:
As illustrated in the diagram, clients parents are both dead. They have history of
hypertension and diabetes mellitus. Her mother died but the client cannot remember the reason
of her death. The client is the only child. She has eight children. Her first son died because of
diabetes mellitus and kidney failure as complication. Other children are well and alive.
5. Developmental History

Jean Piagets Cognitive Theory of Development

Jean Piaget is a Swiss psychologist who introduced concepts of cognitive

development that are similar to Freud and Erikson and yet separate from each.
Piaget defined four stages of cognitive development. Each period is an advance
over the previous one. To progress from one period to the next, the child
recognizes his or her thinking process to bring them closer to reality.
Life Stage

Characteristics/ Description

Analysis/Justification

1. Sensorimotor

Coordination of sensation and The client was not observed to have

6

Simple

Reflexes

Birth-6 weeks

action

through

behaviors.

reflexive difficulty in terms of hand and eyes

Three

primary coordination. She can easily grab the

reflexes are described by Piaget: objects that were asked her to get and also
sucking of objects in the mouth, was able to eat and shallow without
following moving or interesting difficulty. Due to her age, she seldom has
objects

with

the

eyes,

and hand tremors but it does not hinder her to

closing of the hand when an still perform house chores.

object makes contact with the
palm (palmar grasp). Over the
first six weeks of life, these
reflexes

begin

to

become

voluntary actions; for example,

the

palmar

reflex

becomes

intentional grasping.)
First

habits

primary
reactions

and

Coordination of sensation and The client was not observed having

circular

two types of schemes: habits habitual actions. During the interview, the

phase

(reflex) and primary circular client was simply sitting with her hands in

6 weeks-4 months

reactions (reproduction of an her knees.

event that initially occurred by
chance). Main focus is still on
the infant's body. As an example
of this type of reaction, an infant
might repeat the motion of
passing their hand before their
face.

Secondary

circular

Infants become more object- During the interview, the client stated that

reactions phase 4

oriented, moving beyond self- she usually sweep their street every

8 months

preoccupation;

repeat

that

interesting

bring

actions morning, she verbalized that it gives her

or pleasure when doing this. She does not
7

pleasurable results. This stage is miss a day without doing the chores.
associated primarily with the
development

of

coordination

between vision and pretensions.

Three new abilities occur at this
stage: intentional grasping for a
desired

object,

circular

secondary

reactions,

differentiations

and

between

ends

and means. At this stage, infants

will intentionally grasp the air in
the direction of a desired object,
often to the amusement of
friends and family. Secondary
circular

reactions

or

the

repetition of an action involving

an external object begin; for
example, moving a switch to turn
on

light

repeatedly.

The

differentiation between means

and ends also occurs. This is
perhaps

one

of

the

most

important stages of a child's

growth as it signifies the dawn of

Coordination
secondary

of
circular

logic.
Coordination

of

touch--hand-eye

vision

and

coordination; Despite of her age, the client was still

coordination of schemes and active as the head of BHW or Barangay

reactions stages 8

intentionality.

12 months

associated primarily with the According to client, she still attends to

This

stage

is Health Workers in their neighborhood.

development of logic and the meetings and was able to participate in the
8

coordination between means and activities

of

their

organization.

As

ends. This is an extremely observed during the interview, although

important stage of development, the she does not remember some of the
holding what Piaget calls the events that were asked to her and
"first proper intelligence." Also, disoriented in date, she was rational in
this stage marks the beginning of some of her answers.
goal orientation, the deliberate
planning of steps to meet an
objective.

Tertiary

circular

Infants become intrigued by the During the interview, the client was able

reactions,

novelty,

many properties of objects and to ask questions to the student and seems

and

curiosity

12

18 months

by the many things they can a little intrigued since it was the first time
make happen to objects; they she was able to meet the student.
experiment with new behavior.
This stage is associated primarily
with the discovery of new means
to meet goals. Piaget describes
the child at this juncture as the
"young

scientist,"

conducting

pseudo-experiments to discover
new

methods

of

meeting

challenges.
Internalization
Schemes
24 months

of
18

Infants develop the ability to use During interview, the student has not
primitive

symbols

and

form noticed

any

rituals

or

symbolic

enduring mental representations. presentation of her thoughts.

This stage is associated primarily
with the beginnings of insight, or
true creativity. This marks the
9

passage into the preoperational

stage.
2.

Preoperational

The

hallmark

the The client can identify the objects that are

of

Thought (2-7 years

preoperational stage is sparse presented to her. She also knows where

old)

and logically inadequate mental and how to use them. As part of the
interview, the client was able to describe

operations.

During this stage, the child learns certain objects that were asked her to
to use and to represent objects by visualize.
images, words, and drawings.

The child is able to form stable

concepts as well as mental
reasoning and magical beliefs.

The child however is still not

able to perform operations; tasks
that the child can do mentally
rather than physically.

Thinking is still egocentric: The

child has difficulty taking the
viewpoint of others.

3.Concrete
Operational
Thought (7-12 years
old)

Concrete

operations

include The client was able to determine the

colors and sizes from larger to smaller

systematic reasoning.

Classifications involve sorting during the interview. She was able to

objects according to attributes reason out her answers whenever her
such as color; seriation, in which children contradict her responses.
objects are ordered according to
increasing
measures

or
such

decreasing
as

weight;

multiplication, in which objects

are simultaneously

classified
10

and seriated using weight.

Child is aware of reversibility, an

opposite

operation

or

continuation of reasoning back to

a starting point.

4.Formal
Operational
Thought

Can solve hypothetical problems The client was a college undergraduate.

with

(12

yrs.

old)

scientific

reasoning; She was also the current president of the

understands causality and can BHW or Barangay Health Workers in

deal with the past, present, and their neighborhood. According to her, she
future.

still

participates

in

discussions

and

planning of activities in their organization.

6. Physical Examination
i.

Anthropometric Data
Height: 172.7 cm
Weight: 63 kg
Body Mass Index: 21.1 cm/kg *(normal weight)
*According to World Health Organization, Body Mass Index normal standard
is 18.5-24.9.

ii.

General Appearance
Client I.T. is a 78 year old female. She has a mesomorph type of the body
and has light body built. She has a good posture and can stand still unless she
feels dizzy. She can walk without the assistance. Client I.T. looks clean and
neat. She has no any foul odor. Client I.T. does not look pale and weak. She
was cooperative in answering what was asking to her thought. The client was
easily to have a conversation with the interviewer. The clients quality of
speech is comprehensible. The arrangements of conversation are that precise.
11

Client I.T.s vital signs were taken and recorded during the assessment.
Her vital signs were as follows. Blood pressure of 140/70 mmHg, temperature
was 36.5C, her respiratory rate was 21 cycles/minute and pulse rate of 83
beats/ minute.
iii.

Review of Systems

Body Part Examined

Review of System

Actual Finding

Normal Finding

INTEGUMENTARY

Syempre hindi na

Inspection:

SYSTEM

gaya ng dati, laylay

-dryness of the skin

na ang balat ko lalo

-decreased elasticity of *Decreased elasticity of the

seb

na ditto sa may

the skin especially in

skin.

gla

braso. As stated by

the face and arms

*Facial wrinkles are

com

the client.

-presence of moles on

prominent.

dry

face

*Hyperpigmentation occurs

*G

-with wrinkles

in skin exposed to sunlight,

ela

-no rashes

manifests as brown

fib

pigmented areas called

sub

Palpation:

lentigenes (age spots)

*B

-Rough and dry skin

*Dermatologic lesions are

dec

on both upper and

common in the elderly but

are

lower extremities

many are benign.

*H

*Dry skin is common.

-temperature: 36.5 C

*D

dec
of

Hair

Puro puti na nga ang

Inspection:

buhok ko eh. As

-grayish to white in

*Loss of hair pigment is the

*H

stated by the client.

color

cause of graying.

wit

-no signs of infestation * Scalp, axillary and pubic

dur

-short hair

hair gradually becomes

wh

-fine dry hair

thinner and coarser.

beg

-Dry scalp

*Somewhat transparent,
12

pale, skin with an overall

decrease in body hair on
lower extremities.
Nail

Eyes and Vision

Wala naman akong

Inspection:

problema sa mga kuko

-hard and fine in

*Toenails usually thicken,

Pal

ko. as stated by the

texture

but fingernails may become

ski

client.

-nails are short and

thin and split. They may

env

clean

also appear yellowish and

fac

-Pale color of nail bed

dull.

tem

Hindi pa malabo ang

Inspection:

mga mata ko. As

-Pupil size: 3mm

*Dryness of the eyes is

*D

stated by the client.

-20/20 vision

common among elderly

by

-dry

clients.

res

- no nodules

* Upper lid may limit

*H

- no masses

peripheral field of vision

wit

and may produce a feeling

dur

of heaviness and tired

wh

appearance.

beg

-few hair in the

*Loss of hair pigment is the

Th

eyebrows

cause of graying.

Palpations:

Eyebrows

Inspection:

-limited movements
-Symmetrical
-grayish to white in
color
Eyelashes

-eyelashes are black in

color
-Turned outward.
13

Eyelids

-loss of skin elasticity

*Decreased elasticity and

*E

-decreased muscle

tone of the eyelids tend to

ski

tone with wrinkles

drop the lids and cover the

stre

-with eye bags

eyes.
*Lower eyelid forms
bags.

Lacrimal

gland

sac,

Inspection/Palpation

nasolacrimal duct

Pupil

-pale

*Decreased tear production

*W

-no tearing

by the lacrimal gland often

dec

results in dry eyes.

pup

Inspection:

in t

- 3mm in size

*Decreased in size and its

-minimal response in

ability to dilate in the dark.

light
Ears and Hearing

Mahina na ang

-Pupil dilation
Inspection:

External canal

pandinig ko. As

-Earlobes are

*Elongated earlobes. Pinna

*C

stated by the client.

elongated in shape

increases in length and

dec

-presence of mole on

width.

*D

left earlobe

*Common type of hearing

hig

-no lesions, nodules,

loss associated with aging is

deg

discharges

called presbycusis.

of

-dry ears
-decreased ability to
hear sounds in both
ears
Palpation:
14

- no tenderness
Internal canal

-soft
Inspection:

Nose and Sinuses

-No found cerumen

*Decreased cerumen

-no discharge or

production

Wala naman akong

lesions
Inspection:

problema sa pang-

-slightly moist

*Olfactory function

amoy. As stated by

-no swollen sinuses

gradually decreases with

the client.

-no masses or

aging and may lead to a

tenderness

decreased ability to detect

-symmetric

odors.

Th

Th

*Diminished smell,
however may lead to a
decline appetite.
*Nasal hairs are coarser and
may not filter air well.
Nasal Mucosa

Inspection:

Th

-no redness in nasal

mucosa
-no discharge or
swelling
Palpation:
- no masses
- no tenderness

15

Maxillary and frontal

- no tenderness in

sinuses
Mouth/

Okay naman ang

palpating
Inspection

Oropharynx /Lips

paglunok ko. as

-symmetric

*Decrease in saliva

*U

stated by the client.

-lips are pale in color

production with aging.

cau

-Dry mouth and lips

*Tooth loss may be

-with dentures

observed

*T

-no nodules or masses

*Dry mouth (xerostomia)

fro

-no mouth sore

*Esophageal motility is

cha

-with positive gag

slower and more

mo

reflex

disorganized.

per

los
-pale brown in color

Gums

(gums)

*The gums recede; become

-no bleeding

ischemic

*T

- no retraction

isc

- no swelling

cha

-no lesions
-no mass
Tongue

*T

-no presence of bony

prominence

*hard palate is concave

-no lesion
Palate
-in the midline

Uvula
Neck

Inspection:
-symmetrical

*Cervical curvature may

-no mass

increase because of
16

*T

-no nodules

kyphosis of the spine.

Thyroid
RESPIRATORY

Hindi naman ako

-symmetrical

SYSTEM

nahihirapan

Inspection:

Thorax and Lungs

huminga. As stated

-effortless in

*Use of accessory muscle

by the client.

respiration

when breathing.

-3 dark spots on

*Barrel chest

*T

cervical area approx.

0.5cm
-RR 21cpm
-Diaphragmatic
excursion: 3cm
Palpation:
Anterior Thorax

-Symmetric excursion
-equal expand
-no tenderness
-no masses
-no pulsation
Auscultations:
-no abnormal breath
sound
-no auscultated
crackles

CARDIOVASCULAR

Basta ang sakit ko

SYSTEM

lang, hilo. Umiinom

Inspection

*Pulse rate: 80bpm

*T

Heart

ako ng losartan

-Pulse rate 83 bpm:

(60~100bpm)

inc

tuwing umaga.As

-BP 140/70 mmHg

*Blood pressure in elderly

dec

stated by the client.

-regular rhythm

may have possible higher

diastolic.

*B
17

pre

a lo

and

gen

sys
Auscultation:

aw

pre

GASTROINTESTINAL Wala naman akong

-no murmur
Inspection:

SYSTEM

problema sa tiyan

-natural brown color

*The occurrence of lactose

*R

Abdomen

ko. as stated by the

of skin

intolerance increases with

deh

client.

-no lesions

age and may result bloating,

-no rashes

abdominal discomfort and

-rough skin

increased flatus.

Palpation:
-no mass
Musculoskeletal System

Kayang kaya ko pa.

Inspection:

Upper Extremities

Nakakapagwalis pa

-symmetric structure

*Decreased muscle tone

*D

Features

nga ako ng buong

and development of

*Decreased muscle strength

fib

paligid namin. as

muscles

*Tendons shrink and

inc

stated by the client.

-no masses

sclerose that causes muscle

als

-decreased muscle

cramping

atro

tone

*L

-decreased muscle

attr

strength on both arms

the

sid
Range of Motion

-hyperextension, 30;

*Poor range of motion may

*M

adduction 20; flexion

be related to muscle atrophy

we

160; extension 180

and weakness

lim

Palpation:

*H
18

-arm has a cold

dec

temperature

of

Lower Extremities

Inspection:

Features

-no lesions

Range of Motion

-no ulcer

*M

-decreased muscle

we

tone and strength

lim

-hip flexion with knee

*Poor range of motion may

*H

flexed 80; hip flexion

be related to muscle atrophy

dec

with knee straight 75;

and weakness

of

hyperextension 5

*Sw

arth

the
iv.

Gordons Functional Health Patterns

a) Health Perception- Health Management Pattern

Client I.T. has a great view in life. She considers herself as healthy individual
in terms of physical condition. She added that she can do anything such as household
chores. She also admitted that she is experiencing some cognitive impairment and
hypertension. She tends to forget things as she verbalized nakakalimutan ko na ang
ibang bagay lalo na kung saan ko naiilagay.
She uses any herbal medications such as lagundi for cough and currently
taking her maintenance, Losartan once a day after breakfast for her Hypertension.
According to her second informant, her daughter R.E., client I.T. has monthly check
up with the Barangay Health Center and sometimes in the hospital. She prefers to go
to professional doctors than quack doctors because she is a volunteer in the Barangay
Health Center and current president of the organization.
19

b) Nutritional-Metabolic Pattern
MEALS

Breakfast
(6am)

Snacks

Lunch
(12 nn)

Dinner (5
pm)

Total :

Kilocalorie
March 18,
2015
(Wednesday)
1 serving of rice 100 kcal
2 ham
172 kcal
1 glass of milk
110 kcal
2 glasses of
water
1 biscuit
140 kcal
1 glass of juice
30 kcal

3-Day Diet Recall

Kilocalorie
March 19,
2015
(Thursday)
1 serving of rice 100 kcal
1 hardboiled
86 kcal
egg
122 kcal
1 hotdog
3 glass of water
1 pc of puto
180 kcal
1 glass of juice
30 kcal

1 serving of rice
1cup gulay
(leafy)
3 glass of water

1 serving of rice
Sinagang na
Isda
2 glass of water

100 kcal

1 serving of rice
1 cup gulay
1 glass of water

100 kcal

1760 ml

Kilocalorie
965

100 kcal
60kcal

1 serving of rice 100 kcal

fish (paksiw)
140 kcal
1 glass of water
Fluid Intake
1760 ml

Kilocalorie
952

247 kcal

March 20, 2015

(Friday)

Kilocalorie

1 serving of rice
100 kcal
1 longganisa 3
glass of water
100 kcal
1 pc banana and 4
45kcal
slices pakwan
1 serving of
386 kcal
Arroz caldo with
200kcal
chicken and 1
hardboiled egg
1 glass of soft
drinks
1 serving of rice,
100 kcal
Ginisang mais and 35kcal
1 Fried chicken leg 185 kcal
with 2 glass of
water
1 serving of rice
100 kcal
Tuyo
45kcal
Toge
80 kcal
1 glass of water
1760 ml

Kilocalorie
1381

According to her, clients appetite was good. She likes vegetables and fruits.
She prefers to eat fish than meat. She also mentioned that she eats biscuits for snack.
She drinks eight glasses of water a day and 1 glass of milk every morning. Client I.T.s fluid

intake in her 3-day diet recall is 1760 ml of water daily. Client I.T.s fluid intake is
normal. Her caloric intake ranges from 952 to 1381, is balanced to her daily needs.
Upon taking client I.T.s BMI, it was found out that she is in normal weight.
c) Elimination Pattern

20

She eliminates depending on the food she eats. Usually, if it is vegetables and
fruits, its twice but if she eats meaty foods, she defecates only once a day. In terms of
voiding, she approximately urinates 800 to 1000 mL of urine in a day. She also
mentioned that she can urinate three times a day. She has a soft, formed brown to dark
stool. She defecates approximately 1-2 times/day and does not feel any discomfort in
defecating.
According to Weber and Kelly, the normal defecation pattern of an adult is (3)
or lessen times/day and a urine amount of 30 cc per hour.
d) Activity- Exercise Pattern
Client I.T. is currently a barangay health worker for almost thirty years and
president of the organization for almost thirty two years. She assists in taking blood
pressure and calling for the clients. She also helps in general barangay survey about
maternal and child health conditions.

7-Day Activity Table

Time
Mar 13

Mar 14

Days of the week & date

Mar 15
Mar 16
Mar 17

Mar 18

Mar 19

1am
2 am
3 am
4 am
5 am
6 am
7am
8 am
9 am
10 am
11 am
12 nn

21

1 pm
4 pm
5 pm
6 pm
7 pm
8 pm
12 mn
Waking up

Eating

Bathing

Boiling
water
helping

Transporting

Watching

to mall
movie
Legend:

Sleeping

Resting

and
in

cooking
Assisting in Chatting
health center

Relaxing

friends

with Cleaning

Going

to Watching TV

the street church

She wakes up at 5am to eat breakfast and drinks coffee and does some morning
rituals like walking in their backyard and cleaning their street and takes a rest and
sleeps at about 8 in the evening. She still has active way of living.
KATZ index
Activities
Bathing
Dressing
Toileting
Transferring
Continence
Feeding
Total Points:

Independence = 1 pt.
1
1
1
1
1
1
6

Dependence = 0 pt.

Client I.T. was able to do her activities of daily living such as bathing, dressing,
toileting, transferring, continence and feeding without the assistance of any health
care provider. Using the Katz Index of Independence in activities of daily living, it
shows that client I.T. is basically independent.
e) Sleep-Rest Pattern
22

Client I.T. used to have 6 to 8 hours of sleep. She does not have difficulty in
falling asleep. She does not use any medication to fall asleep and she does not even
have any bed time rituals. According to her she feels rested upon waking up and she
has enough rest periods during the day.
According to Weber and Kelley, the optimal sleep duration for adults is
approximately 6-8 hours.
f) Cognitive-Perceptual Pattern
According to client I.T., she has no problems in his vision with grade of 20/20
and her daughter also added that kaya pa ni nanay magpasok ng sinulid sa karayom
at malinaw pa ang mata ni nanay. Her hearing ability is not in good condition
because her both ears have a negative result in whisper test (1-2 feet distance). During
the conversation, the student should speak louder for her to respond. However, her
smell and taste preferences have not been changed.
She was able to express her feelings and thoughts verbally and through body
language but there are times that she forgets some words and cannot complete the
sentence. She also forgets some of her short and long term memory. When she asked
about her children, she was not able to answer the names in chronological order. She
also forgets some special occasions in their family like wedding anniversary, exact
date of death of her husband, etc.
In assessing her short term memory, she got five errors in Short Portable
Mental Status Questionnaire by Pfeiffer which means she has moderate intellectual
impairment. Her family is not permitting her to go far places alone because there are
circumstances that she was not able to reach her destination properly. And they are
not giving her money because the client was not able to recall where she placed it.

23

Client reported headaches occuring every morning. Using a Verbal Descriptor

Scale (VDS) to gauge it as Severe Pain. May panahon na sobrang sakit ng ulo
ko as stated by the client.
g) Self-Perception- Self- Concept Pattern
Malakas naman ako, makakalimutin lang at sakit ng ulo. Kaya ko pa, kaya
ko pa! as stated by the client. She was aware of her condition but shes trying to
be physically powerful than she is. The client was self-conscious especially when the
student has performed the physical assessment. She depicts simplicity on her looks
and actions.

h) Role Relationship Pattern

Client lives with her family in their house. Client I.T. is a mother of 5 men and
3 women; 4 have their own family, 1 is working abroad, 1 died and 2 is living with
her. According to her daughter her mother is a responsible and caring person because
she does everything for the sake of her family.
Currently, her daughter is the one who is taking care of to her. According to
her, she is happy because she had raised her family well and they were in a good
condition. She also has six grandchildren who are always visiting her every day.
May apo narin ako sa tuhod. as stated by the client and she seems contented. But
because of her age and her health condition she tends to forget some of her family
members names which lead to misunderstanding.
The client I.T. is a barangay health worker and current president of the
organization. She was called nanay by her co-workers and treats them as a family.
She gives pieces of advice to them and corrects their wrong doing. She was very
supportive and helpful to them. She also attends to church every weekend and she has
a good relationship with the community.
24

i) Sexuality- Reproductive Pattern

Client I.T. is 78 years old and her husband died last 1987. She said that she is
satisfied with her sexual relationship with her loving husband back then. The client
had her postmenopausal period when she was 45 years old. The client had her first
menstruation at the age of 12 when she was at her first year high school level. She
stated that she was able to use at least 2 napkins per day and it is always on a regular
blood flow. Moreover, she has a twenty eight (28) up to thirty (30) day cycle.
She has an OB score of G 8 P8- T8 P0 A0 L8. She had her delivery on her eight
kids on Normal Spontaneous Delivery (NSD) in term and had no abortion.

j) Coping Stress Pattern

She seeks help from greatest Almighty Father for every problem in her life
and feels relieved. Nanonood din ako ng telebisyon para mawili, as stated by the
client. Aside from watching TV, the client has other way of relieving her stress by
sharing it to her daughter. She does not take medications to relieve her stress.
k) Value-Belief Pattern
The client believes first and foremost to God which He exists, He guides us
and for every struggle in life that came, He is just testing our faith. Client always
attends the mass every Sunday and seeks for guidance as she verbalized lagi ako
nagsisimba tuwing Linggo ng umaga. For her, God and her family are the most
important persons in her life that she wont trade for anything in this world.
She does not believe in any superstitions. As a health care provider in their
barangay, she practices proper caring for ill family members. She also follows the
doctors advice and properly drinks her medication. She also believes in hilot and
herbal medicine as one of their primary health care access.

25

Client I.T. also practices the values such as respect for the people around her
most especially in elderly age and she teaches the young generation to behave
properly. She also practices hospitality and gratitude. During the interaction with the
client, she offers anything to the visitor.

IV.

ANATOMY AND PHYSIOLOGY

The human brain serves many important functions ranging from imagination,
memory, speech, and limb movements to secretion hormones and control of various
organs within the body. These functions are controlled by many distinct parts that
serve specific and important tasks. These components and their functions are listed
below.

26

Brain Cells: The brain is made up of two types of cells: neurons (yellow cells in the
image below) and glial cells (pink and purple cells in the image below). Neurons are
responsible for all of the functions that are attributed to the brain while the glial cells
are non-neuronal cells that provide support for neurons. In an adult brain, the
predominant cell type is glial cells, which outnumber neurons by about 50 to 1.
Neurons communicate with one another through connections called synapses.

Meninges: The bony covering around the brain is called the cranium, which combines
with the facial bones to create the skull. The brain and spinal cord are covered by a
tissue known as the meninges, which are made up of three layers: dura mater,
arachnoid layer, and pia mater. The dura mater is a whitish and nonelastic membrane
which, on its outer surface, is attached to the inside of the cranium. This layer
completely covers the brain and the spinal cord and has two major folds in the brain
that are called the falx and the tentorium. The falx separates the right and left halves
of the brain while the tentorium separates the upper and lower parts of the brain. The
arachnoid layer is a thin membrane that covers the entire brain and is positioned
between the dura mater and the pia mater, and for the most part does not follow the
folds of the brain. The pia mater, which is attached to the surface of the entire brain,
follows the folds of the brain and has many blood vessels that reach deep into the

27

brain. The space between the arachnoid layer and the pia mater is called the
subarachnoid space and it contains the cerebrospinal fluid.

Cerebrospinal Fluid (CSF): CSF is a clear fluid that surrounds the brain and spinal
cord, and helps to cushion these structures from injury. This fluid is constantly made
by structures deep within the brain called the choroid plexus which is housed inside
spaces within the brain called ventricles, after which it circulates through channels
around the spinal cord and brain where is it finally reabsorbed. If the delicate balance
between production and absorption of CSF is disrupted, then backup of this fluid
within the system of ventricles can cause hydrocephalus.

Ventricles: Brain ventricles are a system of four cavities, which are connected by a
series of tubes and holes and direct the flow of CSF within the brain. These cavities
are the lateral ventricles (right and left), which communicate with the third ventricle
in the center of the brain through an opening called the interventricular foramen. This
ventricle is connected to the fourth ventricle through a long tube called the Cerebral
Aqueduct. CSF then exits the ventricular system through several holes in the wall of
the fourth ventricle (median and lateral apertures) after which it flow around the brain
and spinal cord.
28

Brainstem: The brainstem is the lower extension of the brain which connects the
brain to the spinal cord, and acts mainly as a relay station between the body and the
brain. It also controls various other functions, such as wakefulness, sleep patterns, and
attention; and is the source for ten of the twelve cranial nerves. It is made up of three
structures: the midbrain, pons and medulla oblongata. The midbrain is inovolved in
eye motion while the pons coordinates eye and facial movements, facial sensation,
hearing, and balance. The medulla oblongata controls vegetative functions such as
breathing, blood pressure, and heart rate as well as swallowing.

Thalamus: The thalamus is a structure that is located above the brainstem and it
serves as a relay station for nearly all messages that travel from the cerebral cortex to
the rest of the body/brain and vice versa. As such, problems within the thalamus can
cause significant symptoms with regard to a variety of functions, including
movement, sensation, and coordination. The thalamus also functions as an important
component of the pathways within the brain that control pain sensation, attention, and
wakefulness.

29

Cerebellum: The cerebellum is located at the lower back of the brain beneath
the occipital lobesand is separated from them by the tentorium. This part of the brain
is responsible for maintaining balance and coordinating movements. Abnormalities in
either side of the cerebellum produce symptoms on the same side of the body.

30

Cerebrum: The cerebrum forms the major portion of the brain, and is divided into the
right and left cerebral hemispheres. These hemispheres are separated by a groove
called the great longitudinal fissure and are joined at the bottom of this fissure by a
struture called the corpus callosum which allows communication between the two
sides

of

the

brain.

The

surface

of

the

cerebrum

contains

billions

of neurons and glia that together form the cerebral cortex (brain surface), also known
as "gray matter." The surface of the cerebral cortex appears wrinkled with small
grooves that are called sulci and bulges between the grooves that are called gyri.
Beneath the cerebral cortex are connecting fibers that interconnect the neurons and
form a white-colored area called the "white matter."

31

Lobes: Several large grooves (fissures) separate each side of the brain into four
distinct regions called lobes: frontal, temporal, parietal, and occipital. Each
hemisphere has one of each of these lobes, which generally control function on the
opposite side of the body. The different portions of each lobe and the four different
lobes communicate and function together through very complex relationships, but
each one also has its own unique characteristics. The frontal lobes are responsible for
voluntary movement, speech, intellectual and behavioral functions, memory,
intelligence, concentration, temper and personality. The parietal lobe processes
signals received from other areas of the brain (such as vision, hearing, motor, sensory
and memory) and uses it to give meaning to objects. The occipital lobe is responsible
for processing visual information. The temporal lobe is involved in visual memory
and allows for recognition of objects and peoples' faces, as well as verbal memory
which allows for remembering and understanding language.

Hypothalamus: The hypothalamus is a structure that communicates with the pituitary

gland in order to manage hormone secretions as well as controlling functions such as
eating, drinking, sexual behavior, sleep, body temperature, and emotions.

32

Pituitary Gland: The pituitary gland is a small structure that is attached to the base of
the brain in an area called the sella turcica. This gland controls the secretion of
several hormones which regulate growth and development, function of various organs
(kidneys, breasts, and uterus), and the function of other glands (thyroid gland, gonads,
and the adrenal glands).

Basal Ganglia: The basal ganglia are clusters of nerve cells around the thalamus
which are heavily connected to the cells of the cerebral cortex. The basal ganglia are
associated with a variety of functions, including voluntary movement, procedural
learning, eye movements, and cognitive/emotional functions. The various components
of the basal ganglia include caudate nucleus, putamen, globus pallidus, substantia
nigra, and subthalamic nucleus. Diseases affecting these parts can cause a number of
neurological conditions, including Parkinson's disease and Huntington's disease.

33

Cranial Nerves: There are 12 pairs of nerves that originate from the brain itself, as
compared to spinal nerves that initiate in the spinal cord. These nerves are responsible
for specific activities and are named and numbered as follows:
Cranial nerve I (Olfactory nerve): Smell
Cranial nerve II (Optic nerve): Vision
Cranial nerve III (Oculomotor nerve): Eye movements and opening of the eyelid
Cranial nerve IV (Trochlear nerve): Eye movements
Cranial nerve V (Trigeminal nerve): Facial sensation and jaw movement
Cranial nerve VI (Abducens nerve): Eye movements
Cranial nerve VII (Facial nerve): Eyelid closing, facial expression and taste sensation
Cranial nerve VIII (Vestibulocochlear nerve): Hearing and sense of balance
Cranial nerve IX (Glossopharyngeal nerve): Taste sensation and swallowing
Cranial nerve X (Vagus nerve): Heart rate, swallowing, and taste sensation
Cranial nerve XI (Spinal accessory nerve): Control of neck and shoulder muscles
Cranial nerve XII (Hypoglossal nerve): Tongue movement

34

Pineal Gland: The pineal gland is an outgrowth from the back portion of the third ventricle,
and has some role in sexual maturation, although the exact function of the pineal gland in
humans is unclear.

35

Spinal Cord
The spinal cord is a long, thin, tubular bundle of neurons and support cells that
extends from the bottom of the brain down to the space between the first and second
lumbar vertebrae, and is housed and protected by the bony vertebral column. The
spinal cord functions primarily in the transmission of signals between the brain and
the rest of the body, allowing movement and sensation, but it also contains neural
circuits that can control numerous reflexes independent of the brain.

General Structure: The length of the spinal cord is much shorter than the length of
the bony spinal column, extending about 45 cm (18 inches). It is ovoid in shape and is
enlarged in the cervical (neck) and lumbar (lower back) regions. Similar to the brain,
the spinal cord is protected by three layers of tissue, called spinal meninges. The dura
mater is the outermost layer, and it forms a tough protective coating. Between the
dura mater and the surrounding bone of the vertebrae is a space called the epidural
space, which is filled with fatty tissue and a network of blood vessels. The arachnoid
mater is the middle protective layer. The space between the arachnoid and the
underlyng pia mater is called the subarachnoid space which contains cerebrospinal
fluid (CSF). The medical procedure known as a lumbar puncture (or spinal tap)
involves use of a needle to withdraw cerebrospinal fluid from the subarachnoid space,
usually from the lumbar (lower back) region of the spine. The pia mater is the
innermost protective layer. It is very delicate and it is tightly associated with the
surface of the spinal cord.

In the upper part of the vertebral column, spinal nerves exit directly from the
spinal cord, whereas in the lower part of the vertebral column nerves pass further
down the column before exiting. The terminal portion of the spinal cord is called the
36

conus medullaris. A collection of nerves, called the cauda equina, continues to travel
in the spinal column below the level of the conus medullaris. The cauda equina forms
as a result of the fact that the spinal cord stops growing in length at about age four,
even though the vertebral column continues to lengthen until adulthood.
Three arteries provide blood supply to the spinal cord by running along its
length. These are the two Posterior Spinal Arteries and the one Anterior Spinal Artery.
These travel in the subarachnoid space and send branches into the spinal cord that
communicate with branches from arteries on the other side.

Function: The spinal cord is divided into 33 different segments. At every segment, a
pair of spinal nerves (right and left) exit the spinal cord and carry motor (movement)
and sensory information. There are 8 pairs of cervical (neck) nerves named C1
through C8, 12 pairs of thoracic (upper back) nerves termed T1 through T12, 5 pairs
of lumbar (lower back) nerves named L1 through L5, 5 pairs of sacral (pelvis) nerves
numbered S1 through S5, and 3-4 pairs of coccygeal (tailbone) nerves. These nerves
combine to supply strength to various muscles throughout the body as follows:
C1-C6: Neck flexion
C1-T1: Neck extension
C3-C5: Diaphragm
C5-C6: Shoulder movement and elbow flexion
C6-C8: Elbow and wrist extension
C7-T1: Wrist flexion
C8-T1: Hand movement
T1-T6: Trunk muscles above the waist
T7-L1: Abdominal muscles
L1-L4: Thigh flexion
L2-L4: Thigh adduction (movement toward the body)
L4-S1: Thigh abduction (movement away from the body)
37

L2-L4: Leg extension at the knee

L5-S2: Leg extension at the hip
L4-S2: Leg flexion at the knee
L4-S1: Foot dorsiflexion (move upward) and toe extension
L5-S2: Foot plantarflexion (move downward) and toe flexion
The spinal nerves also provide sensation to the skin in an organized manner as
depicted below.

Vertebral Column
General Structure: The vertebral column is made up of 33 vertebrae that fit together
to form a flexible, yet extraordinarily tough, column that serves to support the back
through a full range of motion. There are seven cervical vertebrae (C1-C7), 12
38

thoracic vertebrae (T1-T12), five lumbar vertebrae (L1-L5), five fused sacral
vertebrae (S1- S5), and four coccygeal vertebrae in this column, each separated by
intervertebral disks.

The first two cervical vertebrae have very distinct anatomy as compared to the
ramaining vertebrae. The first cervical vertebra, known as the atlas, supports the head;
and pivots on the second cervical vertebra, the axis. The seventh cervical vertebra
joins the first thoracic vertebra. The thoracic vertebrae provide an attachment site for
the ribs, and make up part of the back of the chest (thorax). The thoracic vertebrae
join the lumbar vertebrae, which are particularly study and large, as they support the
entire upper body weight. At the top of the pelvis, the lumbar vertebrae join the sacral
vertebrae. By adulthood these five bones have usually fused to form a triangular bone
called the sacrum. At the tip of the sacrum, the final part of the vertebral column
projects slightly outward. This is the coccyx, better known as the tailbone. It is made
up of three to five coccygeal vertebrae.

A typical vertebra consists of two essential parts: the vertebral body in front
and the vertebral arch in the back. The vertebral arch consists of a pair of pedicles, a
pair of lamina, a spinous process, and four articular processes (joints) that connect the
vertebra to one another, as depicted below.
The vertebral bodies, stacked on top of each other, form a strong pillar for the support
of the head and trunk. Between each two vertebral bodies exists a hole, called the
intervertebral foramina, which allows for the transmission of the spinal nerves on
either side.

Anatomical Changes in the Brain with Alzheimers Disease

39

Alzheimer's disease is characterized by anatomical changes, including the

development of amyloid plaques and neurofibrillary tangles.

Amyloid plaques are sticky buildup which accumulates outside the nerve cells in the
brain. Amyloid is a protein which is normally found throughout the body. In AD this
protein begins to divide improperly, creating a substance called beta amyloid which is
toxic to brain cells. As the beta amyloid builds up, the brain cells begin to die.

Neurofibrillary tangles are the second anatomical hallmark of AD. Normally, every
brain cell contains long fibers made of protein which act as scaffolds, holding the
brain cell in its proper shape and also helping transport of nutrients within the cell. In
AD, these fibers begin to twist and tangle. The brain cell loses its shape and also
becomes unable to transport nutrients properly; it eventually dies.

As enough plaques and tangles accumulate in the brain, widespread cell death
occurs throughout the brain. At this point, it is unclear exactly why plaques and
tangles begin to form in the brain of a person with AD. Many researchers are studying
this question and trying to develop ways to halt or reverse the degeneration.

The plaques and tangles characteristic of Alzheimer's can be observed only

through biopsy, which is usually done during an autopsy. This means that a doctor can
only diagnose "probable" Alzheimer's in a living client based on the pattern of
behavioral symptoms, and by ruling out other possible causes. The firm diagnosis of
Alzheimer's is made or ruled out after death.

40

A recent report announced the discovery of a vaccine that may hold promise
for preventing or treating AD. The study considered mice which had been specifically
bred to develop AD-like plaques in their brains. Young mice given the vaccine
showed little or no development of plaques as they aged. The older mice, which had
already developed plaques, were given the vaccine. The plaques appeared to dissolve.
This vaccine is causing tremendous excitement among those who study AD, since it
suggests it might be possible to develop a way to immunize people against AD or
reduce AD in those who already suffer the disease. However, it is important to
remember that the rats in this study did not have AD: they were bred to develop
plaques, but they did not develop neurofibrillary tangles. Some researchers suspect
that the tangles, rather than the plaques, are the culprits that cause most of the damage
in AD. Worse, not every person who dies of AD has plaques in his brain. Thus, a
vaccine that fights plaques may not be enough to prevent or cure AD. It will take
years of further study in animals to answer some of these questions, and years more
before a human treatment becomes available. Nonetheless, this study is an example of
the progress that is being made in understanding the various components of AD.

Possible Causes of Alzheimer's disease

Several possible causes have been implicated in the development of AD.
About 10% of clients with AD have the early-onset form of the disease, in which
symptoms can appear as early as the 30s and 40s. Scientists have discovered that
many people with this form of the disease have a specific genetic abnormality:
mutation in genes located on chromosomes 1, 14, and 21. However, the correlation
isn't perfect; people with these genetic abnormalities account for only 50% of all
known cases of early-onset AD.

41

The more common form of AD is late-onset AD, in which symptoms begin to

appear only late in life. This form of AD is also linked to a genetic abnormality.
Chromosome 19 contains a gene called apoE which helps carry cholesterol in the
blood and also helps nerves to recover after injury. Each of us has two copies of apoE
- one inherited from each parent - and each copy can come in one of several forms:
apoE2, apoE3, and apoE4. ApoE3 is the most common in the general population. But
people who inherit one apoE4 gene have an increased risk of developing AD, and
people who inherit two copies of apoE4 are about eight times as likely to develop AD
as people with two copies of the "normal" apoE3 variant. Interestingly, the rarest
apoE2 form of the gene may lower an individual's risk of AD.

A simple blood test is available to determine which forms of apoE a person

has. However, this test cannot tell you whether or not you will develop AD, or when.
Over half of the people who develop late-onset AD do not have the apoE4 gene, and
not everyone with apoE4 does develop the disease. Right now, the blood test is most
useful as a research tool, helping scientists study AD risk factors in large groups of
people. Most scientists and health professionals do not recommend routine apoE4
tests for predicting AD risk in individuals, although it may be useful as part of a
medical evaluation of a client who already shows AD symptoms.

In addition to genetic factors, many biological factors have been implicated in

AD. One of the best-studied is overproduction of free radicals, substances formed
when the body metabolizes oxygen. Normally, free radicals serve important
functions, such as helping the immune system fight off disease. However, too many
free radicals can start to cause problems. Brain cells producing the mutated form of
amyloid protein - the beta amyloid that forms the plaques in AD - seem to produce
more free radicals. At this point, it's unclear whether free radicals boost beta amyloid
production or vice versa.
42

There are also several environmental factors which have been suspected of
contributing to AD risk. One of the earliest suspects was aluminum, which is a
common contaminant in drinking water. Both the plaques and tangles in AD contain
illuminum, and early studies linked AD with aluminum ingested through drinking
water or even by using aluminum cooking utensils. However, most researchers are
currently not convinced that there is a strong link between aluminum and AD.

Other environmental suspects which have been suggested to promote AD

include zinc (normally found in shellfish, beans and dark turkey meat), smoking, high
exposure to paint solvents, and exposure to electromagnetic fields (EMFs), the highelectricity areas around power lines and electrical machinery. People who have
experienced head injuries or strokes may also be more prone to develop AD. Viral
infections, such as HIV (the virus that causes AIDS), may also leave the brain
vulnerable to AD.

Neither toxin ingestion, nor brain injury, nor viral infection alone is enough to
cause AD. However, in people genetically predisposed to AD, these environmental
factors may help trigger the disease or cause symptoms to appear earlier. Currently,
much more research is needed to identify other triggering factors, to determine just
how much they increase risk, and to learn what can be done to offset this risk.

43

V.

PATHOPHYSIOLOGY

Advanced age (early onset 30-65 y/o)

Late onset (65 y/o and above)
Genetics

Neurodegeneration

Neural damage
Primarily in cerebral cortex

Formation of neuritic plaques

(deposits of amyloid protein,
which is found in brain)

Tangled masses of nonfunctioning neurons

(neurofibrillary tangles)

Decrease in brain size

Alteration of normal activity of

neurotransmitter

Decrease production of
acetylcholine

Cognitive deterioration
Signs and symptoms:
Forgetfulness, disorientation to
person, places, things, and
environment

Decrease production of
dopamine

Emotional and attention

deficit
Signs and symptoms:
-anxiety and agitation
-decrease attention span

Signs and
symptoms:
Decrease
functional
ability
44
-unable
perform ADLs
(finetomovements)
without assistance
-immobility (terminal
stage)

VI.

THE ACTIVITIES-SPECIFIC BALANCE CONFIDENCE (ABC) SCALE

Instructions for Scoring
The ABC is an 11point scale and ratings should consist of whole numbers (0100) for each item. Total the ratings (possible range = 0-1600) and divide by 16 to get
each subjects ABC score. If a subject qualifies his/her response to items #2, #9, #11,
#14 or #15 (different ratings for up vs. down or onto vs. off), solicit separate
ratings and use the lowest confidence of the two (as this will limit the entire activity,
for instance the likelihood of using the stairs. )

80% = high level of physical functioning

50-80% moderate level of functioning
<50% = low level of physical functioning
Myers AM (1998)
<67% = older adults at risk for falling; predictive
of future fall
LaJoie Y (2004)

Level of Confidence Rating Scale

0%

10

20

30

40

50

60

70

No confidence

80

90

100%

Completely confident

How confident are you that you will not lose your balance or become unsteady
when you...
1. ... walk around the house? 100%
2. ... walk up or down stairs? YES
3. ... bend over and pick up a slipper from the front of a closet floor? 100%
4. ... reach for a small can off a shelf of eye level? 100%
45

5. ... stand on your tiptoes and reach for something above your head? 100%
6. ... stand on a chair and reach for something? 100%
7. ... sweep the floor? 100 %
8. ... walk outside the house to a car parked in the driveway? 100 %
9. ... get into or out of a car? YES
10. ... walk across a parking lot to the mall? 100%
11. ... walk up or down a ramp? YES
12. ... walk in a crowded mall where people rapidly walk past you? 100%
13. ... are bumped into by people as you walk through the mall? 90%
14. ... step onto or off an escalator while you are holding onto a railing? YES
15. ... step onto or off an escalator while you are holding onto parcels such that you
cannot hold onto the railing? YES
16. ... walk outside on icy sidewalks? -Interpretation
This Activities- Specific Balance Confidence Scale is useful to determine
client I.T.s ability to perform activities of daily living. Based on this scale, client I.T.
is very confident whenever she is doing things. Though she is already 78 years old,
she can still do things such as walking around the house, walking up or down the
stairs, bending over and picking up a slipper from the front of a closet floor, reaching
for a small can off a shelf of eye level, sweeping the floor and others with complete
confidence. This also shows that clients being forgetful does not affect the physical
ability of the client.

46

VII.

DRUG STUDY

DRUG
Generic Name:
Losartan
Potassium
Brand Name:
Cozaar
Classification:
Antihypertensive
Dosage:
50mg
Route:
Oral
Frequency:
OD
Form:
Tablet
Color:
White

MECHANISM
OF ACTION
Inhibits
vasoconstrictive
and aldosteronesecreting action
of angiotensin II
by blocking
angiotensin II
receptor on the
surface of
vascular smooth
muscle and other
tissue cells.

INDICATION

To reduce the
risk of stroke in
clients with
hypertension and
left ventricular
hypertrophy
Treatment
of diabetic
nephropathy
with an elevated
serum creatinine
and proteinuria
(urinary albumin
to creatinine
ratio 300
mg/g) in clients
with type 2
diabetes and a
history of
hypertension.

CONTRAINDICATIONS
Contraindicated in:
Hypersensitivity
Cross-sensitivity may occur
with other s, including
aspirin
Active GI bleeding
Ulcer disease

ADVERSE EFFECTS
NURSING
AND SIDE EFFECTS RESPONSIBILITIES
Adverse Effects:
Pre-administration:
Verify doctors
CNS:
written
Headache, dizziness,
prescription
somnolence
Observe 10 Rs
Provide health
GI:
teaching about
Nausea, dyspepsia, GI
drug prescription
pain, constipation
Check vital signs
before
Hemat: blood
administration
dyscrasias, prolonged
Intra-administration:
bleeding time.
Give with food.
Post-administration:
CV:
Check vital signs
hypotension
after administration
Monitor urine
Side Effects:
output if taking
diuretics
EENT: tinnitus, visual
Document that drug
disturbances.
was given
Resp: dyspnea.

VIII.

NURSING CARE PLAN

ASSESSMENT
Subjective:
- Nakakalimutan
ko na ang ibang
bagay lalo na kung
saan ko
naiilagayas
verbalized by client
-Nakakalimutan
niya ang
destinasyon niya
kapag nagjejeep
as verbalized by
daughter
(secondary
informant)

NURSING
DIAGNOSIS
Impaired memory
related to
neurological
disease secondary
to dementia
(Alzheimers
disease)

PLANNING
After 8 hours of
nursing
interventions, the
client will be able
to establish
methods to help in
remembering
essential things
when possible.

Objective:
-inability to
remember and say
past important life
events such as
anniversaries and
birthdays

IX.

INTERVENTION

RATIONALE

1. Assist client and 1. This is to

significant others
improve the
to establish
clients
compensation
functional
strategies such
lifestyle and
as checklist of
safety.
personal
materials and
reminding the
location of
things around
the house.
2. Assist client to
2. This is to help
deal with
maximize
functional
independence
limitations such
and establish
as not allowing
safety and
her to travel
security of
alone.
client.
3. Coordinate with 3. This is to help
significant others
client remember
in implementing
past significant
memoryevents and aid in
retaining
retaining these
techniques such
memories.
as writing on
calendars, lists

EVALUATIO

After 8 hours o
nursing
interventions, th
client was able
establish metho
in helping
remembering
essential things
through checkli
and memoryretaining
techniques.

IMPLICATIONS OF THE CASE STUDY

a. Nursing Research
This case study can become a tool for undergraduate researchers and
medical professionals in improving the gathering of data and quality of
research in the neurologic field, most especially about dementia in our
country.
b. Nursing Education

The data gathered in this case study can help nursing and medical students
in understanding the pathology of dementia to widen their knowledge.
c. Nursing Practice
This case study can help improve the provision of care of nurses for
clients with dementia, most especially in the palliative point-of-view.

X.

BIBLIOGRAPHY
Nursing Department, Khwopa Poly-Technic Institute Japan International Cooperation
Agency (JICA). Fundamentals of Nursing Procedure Manual (pg. 53~77 )

Bare, B.G., Cheever,, K.H., Hinkle, J.L., & Smeltzer, S.C. (2010). Brunner and
Suddarth's Textbook for Medical and Surgical Nursing. Lippincott Williams & Wilkins.

Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF (Oct 7, 2013). Dementia Alzheimers Disease. Retrieved March 24, 2015 from
http://emedicine.medscape.com/article/187857-overview.

Mims Philippines (2014). Losartan. Retrieved March 24, 2015 from

http://www.mims.com/Philippines/drug/info/Losartan/?q=losartan&type=brief .

Amy M. Karch (2010). Lippincott's Nursing Drug Guide. Lippincott Williams & Wilkins.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001748/

http://www.disabled-world.com/health/aging/dementia/statistics.php

http://www.alz.co.uk/adi/pdf/prevalence.pdf

http://www.cureresearch.com/d/dementia/stats-country_printer.htm

https://www.alz.org/downloads/Facts_Figures_2014.pdf