Direction: Read the case carefully. Identify and list at lea

Direction: Read the case carefully. Identify and list at least 15…  Direction: Read the case carefully. Identify and list at least 15 physiologic and/or psychosocial changes in this elderly client and write the scientific rationale or theories to explain those changes. Please follow the format below: PHYSIOLOGIC/PSYCHOSOCIAL CHANGESSCIENTIFIC RATIONALE / THEORIES        Personal Data: Ms. Rizal is a 70-year-old female, residing at Sta. Cruz, Manila. She is single,  Filipino citizen and a Roman Catholic. Her usual source of health care is at the Barangay Health Center.   REVIEW OF SYSTEMS    Psychological The client views herself as a simple person, gifted with a peaceful life. Even though she lives all alone byherself, family members would visit her occasionally. She is alone most of the time and have less chance now to socialize with her family members and neighbors.  She is one of the consultants of the Senior Citizen Club in the community and helps in planning of older clients’ care.  Elimination The client urinates 5-6 times a day scanty in amount, yellowish color with no accompanying discomfort.She defecates once a week, brown in color, scanty in amount and is hard. According to her, this is the usual characteristic of her bowel. She perspires a lot.   Rest and Activity She used to watch television and listens to the radio whenever she gets tired. Her usual activities of dailyliving Include cleaning her house, doing the chores and gardening. She expresses concern like learning simple exercises, but she gets tired easily with exercise  Safe Environment Ms. Sy feels secure in her place since the Barangay Hall is just adjacent to her house. According to her,she seldom hears troubles in their place since the Baranggay Tanods are very active. She lives in a house made of concrete material. There are no allergies to food, drugs and to the environment.   Oxygenation             She does not have any signs of respiratory distress and never had symptoms of difficulty in breathing.  Nutrition             The client used to eat root crops  and tomatoes from her garden since these are her favorite foods.  24-Hour Diet Recall: Breakfast: 1 pandesal, steamed mixed vegetables, 1 cup of coffee Lunch: 1 cup of rice, 1 tilapia, 1 cup pinakbet, 1 glass of water Supper: 1 cup of rice, 1 pc chicken adobo,  5 pcs steamed okra, 1 glass of water  B. PHYSICAL EXAMINATION   General Appearance The client has small body built, thin, with stooped posture and coordinated movement. She isappropriately dressed, neat, without body odor. No obvious signs of physical deformity or illness noticed.   Her vital signs: Temperature= 36.’`C PR= 65 beats per minute RR= 17 cycles  per  minute BP= 110/180 mmHg   Mental Status She is conscious, coherent, and cooperative with good affect oriented to time, place, date, and person.She responded appropriately and slowly in an understandable manner. She used simple words incommunicating.   Skin Client’s skin color  is  light  to  deep  brown,  uniform  in  color  with  prominent  veins  on  the  arms  and  toes. Sagging and wrinkling were noted. Brownish, circular “age spots” (lentigo senilus) was noted on the area of both arms ranging from 1-2cm width. Skin temperature is warm within normal range. Decreased skin turgor is noted. There are no lesions and fine white hairs are evenly distributed all over the body.   Hair With white, straight hair at shoulder level, evenly distributed, thin, silky, and resilient. No infection/infestation and dandruff seen. Absence of nasal, ear, eyebrow, and axillary hair coarse is noted.   Nails The nail plate has 160 angle smooth texture, and pinkish w/ longitudinal ridges. Epidermis is intact, capillary refills within 3 seconds.   Head and Face She has round normocephalic  and  symmetrical  w/  frontal,  parietal  and  occipital  prominence.Hair is evenly distributed;  Head  contour  is  smooth  w/  uniform  constituency;  without  nodules  or  masses  and  withsymmetrical facial movements and features.   Eyes Thin eyebrows and eyelashes are evenly distributed and symmetrical. Skin is intact w/o any discoloration;lids close symmetrically w/ 15-20 blinks/min. The sclera is white, palpebral conjunctiva is shiny smooth and pinkish, while bulbar conjunctiva is clear. No edema or tenderness on lacrimal glands. Opaque white rings around the iris (arcus senilis) is  noted.  There are  some  opacities  present  in  the  lens.  The  pupils  are  equally  round  (5mm)  and reactive to light and accommodation. When looking straight ahead, client has difficulty in recognizing objects in the periphery. Both eyes are coordinated; moves in unison w/ parallel alignment (8 ocular movements). The client is unable to read font 12 of printout and have a vision of 20/100. Glaring into lights is one of her concern.   Ears The auricles are brown in color, symmetrical and aligned w/ outer canthus of eye, about 10′ from verticalview. Upon palpation, auricles are mobile, firm and not tender; pinna recoils after it is folded. Using an otoscope, distal 3rd contains thin hair follicles and glands; semi-transparent and pearly gray tympanic membrane. The client has difficulty in responding to normal voice and negative for watch tick test. Normal for Rinne’s and Weber’s test  Nose She has symmetrical and straight nares, without discharge, flaring and uniform in color. Air moves freelythrough the nares as the client breathe. Nasal mucosa is pink and clear without any lesions. Nasal septum is intact and in midline. Nasal sinuses are non-tender. The client had difficulty in recognizing the smell of coffee.   Mouth and Oropharynx Outer lips have uniform pink color, soft, dry, smooth in texture and able to purse lips. Inner lips and buccalmucosa is pink, moist, smooth, soft, glistening and elastic. She had 32 smooth and intact dentures, moist and firm.Absence of papillae is noted. Salivary glands are intact, pinkish in color w/o any lesions. Light pink hard and soft palate and are positioned in the midline w/o smooth posterior wall. Tonsils and uvula is not inflame0. Gag reflex is present.   Neck Neck  muscles  are  equal  in  size;  head  is  at  the  center.  Head  movement  is  coordinated,  smooth  w/o discomfort. There is equal muscle strength and non-palpable lymph nodes. The trachea is in the midline. Thyroid gland is not palpable but ascends during swallowing.   Breast and Axilla With brown, flat, symmetrical w/ fine glandular texture. There are no masses palpated. Nipples are pinkish color, dry and symmetrical. The axilla is brown in color, dry, w/o hair.   Chest and Lungs The  anteroposterior  to  transverse  diameter  is  2:1  ratio.  She  has  a  symmetrical  chest  expansion  and  a kyphotic spine. Skin is intact, with uniform color and temperature. No tenderness and masses upon palpation. She has bilateral symmetry of vocal and tactile fremitus. Resonance is heard over the thorax. Diapragmatic excursion is  3cm.  Costal angle is  80,  and  the ribs is  45.  Upon  auscultation,  bronchial  (trachea)  sounds,  bronchovesicular(main bronchi) sound and vesicular sounds (terminal bronchi) were heard.   Heart There are no masses and lesions in the skin. There is palpable pulsation at the left ICS (5th) MCL; in an area of 1-2 cm in diameter. The carotid pulse is bounding regularly synchronous with S1. The apical and radial pulse has equal rate and rhythm. Systolic murmur was heard during auscultation.   Abdomen The color is uniform and the skin is unblemished. There are symmetric movements caused by respiration.Aortic pulsations were also noted at the epigastric’ area. Bowel sounds is 3/min without arterial bruits and friction rub. Tympanic sounds were heard during auscultation. No tenderness, relaxed abdomen with smooth, consistent tension. The liver, bladder and spleen are not palpable.   Upper and Lower Extremities  Muscles are firm, smooth with coordinated movements and equal strength on both sides of the body. Theclient’s fingers have swollen joints. Stiffness on the joints on the client’s hands were noted. Patient claimed that the bones and joints on her hands, legs and feet are painful. Crepitations on the joints were also present.   Health Science Science Nursing

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