Getting old is not for sissies. No matter who we are, man, woman, rich or poor, we all grow old.
But the pace and precise way it happens varies from person to person, depending on genetic, lifestyle and
environmental factors. However, as we grow old the deterioration rally starts to kick in, hence ailments
in later life may seem unavoidable. Last Febuary 23, 2018, we, the Adventist Medical Center College
(AMCC) nursing students had an exposure in Iligan City Elderly Clinic and probed for an elderly individual
to be interviewed and assessed. As we accommodate the clients, we came across an individual whom we
called as Nanay Belle. She was suffering from hypertension and gouty arthritis with complaints of hearing
impairments.
Brunnner & Suddarth’s (2014) defines hypertension as a systolic blood pressure greater than 140
mmHg and a diastolic pressure greater than 90 mmHg based on two or more accurate blood pressure
measurements taken during two or more contacts with a health care provider. The prevalence of
hypertension increases significantly as people get older or have other cardiovascular risk factors.
Structural and functional changes in the heart, blood vessels and kidneys contribute to increases in blood
pressure that occur with aging. These changes include accumulation of atherosclerotic plaque,
fragmentation of arterial elastins, increased collagen deposits, impaired vasodilation and renal
dysfunction.
The result of these changes is decreased elasticity of the major blood vessel and volume
expansion. Consequently, the aorta and large arteries are less able to accommodate the volume of blood
pumped out by the heart, and the energy that would have stretched the vessels instead elevates the
systolic blood pressure. Hypertension accompanies risk factors such as advancing age, race,
atherosclerotic heart disease, obesity, diabetes, metabolic syndrome, sedentary lifestyle, heart failure,
Hypertension can either be viewed as a sign, a risk factor or as a disease. Physical examination
may reveal no abnormalities other than elevated blood pressure. It is often called as silent killer because
individuals with hypertension may be asymptomatic and remain for so many years. However, when
specific signs and symptoms appear, they usually indicate vascular damage with specific manifestations
Prolonged blood pressure elevation gradually damages blood vessels throughout the body,
particularly in target organs such as the heart, kidneys, brain and eyes. Left ventricular hypertrophy occurs
in response to the increased workload placed on the ventricles as it contracts against higher systemic
pressure. When heart damage is extensive, heart failure follows. Pathologic changes in the kidneys may
manifest as nocturia. Cerebrovascular involvement may led to transient ischemic attack (TIA), manifested
Nanay Belle reported that she had suffered from mild stroke in her early 50’s due to inability to
control anger upon arguing with her son. She was hospitalized for a night and was prescribed with some
medications. She was unable to recall the prescribed drugs she has taken. She was then given a
When hypertension is detected, nursing assessment involves carefully monitoring the blood
pressure at frequent intervals and then at routinely scheduled intervals. When the patient begins an
antihypertensive treatment regimen, blood pressure assessments are needed to determine the
effectiveness of the medication and to detect changes in blood pressure that indicate the need for lifestyle
modification in the treatment plan. Older patients should begin treatment with lifestyle modifications.
Medication starting dose should be the lowest available and then gradually increased with the second
medication from a different class added if control is difficult to achieve. As older adults often have other
comorbid conditions, awareness of possible drug interactions is critical. In addition, older adults are at
increased risk for the side effects of hyperkalemia and orthostatic hypertension, putting them at increased
Another diagnosis of our chosen client is gouty arthritis (GA). Musculoskeletal problems are the
most frequently reported conditions in older adults. According to Brunner & Suddarth’s (2014), GA is the
most common form of inflammatory arthritis. Gout is a disease characterized by an abnormal metabolism
of uric acid, resulting in an excess of uric acid in the tissues and blood. People with gout either produce
too much uric acid, or more commonly, their kidneys are inadequate in removing it. Men are three to four
times more likely to be diagnosed with gout than women. The incidence of gout increases with age, BMI,
alcohol consumption, hypertension and diuretic use. Evidence links the consumption of fructose-rich
beverages with the risk of GA for both men and women (Choi, Willett & Curhan, 2010; Greener, 2011).
Comorbid conditions such as hypertension, dyslipidemia, diabetes, OA and kidney disease may be present
The first symptom of gouty arthritis is typically the sudden onset of a hot, red, swollen, stiff,
painful joint. Almost any joint can be involved (e.g. big toe, knee, ankle, and small joints of the hands). In
some people, the acute pain is so intense that even a bed sheet on the toe causes severe pain. Even
without treatment, the first attacks stop spontaneously, typically within one to two weeks. While the pain
and swelling completely go away, gouty arthritis commonly returns in the same joint or in another joint.
With time, attacks of gouty arthritis can occur more frequently and may last longer.
In gout uric acid crystals can form outside joints, it is a by-product of purine metabolism; purines
are basic chemical compounds found in high concentrations in meat products. Collections of these
crystals, complications known as tophi, can occur in the earlobe, elbow, and Achilles tendon (back of the
ankle), or in other tissues. The initial cause for the gout attack occurs when the macrophages in the joint
space phagocytize urate crystals. Through a series of immunologic steps, IL-1 beta is secreted, increasing
the inflammation. This process is exacerbated by the presence of free fatty acids. Both alcohol and large
meal consumption especially red meat can lead to increases in free fatty acid concentrations. Altered
renal tubular function, either as a major action or as unintended side effect of pharmacologic agents (e.g.
diuretics, low-dose salicylates or ethanol) can also contribute to uric acid overexcretion.
Hence, management between gout attacks needs to include lifestyle modification such as
avoiding purine-rich foods, weight loss, decreasing alcohol consumptions and avoiding certain
medications. Acute attacks are managed with colchiline, NSAID such as indomethacin or corticosteroid.
Uricosuric agents such as probenecid or sulfinpyrazone may be indicated in patients with frequent acute
attacks. In an acute episode of gouty arthritis, pain management with prescribed medication is essential,
along with avoidance of factors that increases pain and inflammation such as trauma, stress and alcohol.
Once the acute attacks have subsided, uric acid lowering therapy should be considered. Xanthine oxidase
Your ears are also not immune to aging, age-related hearing loss is one of the most common
health conditions that affect older individuals. Factors include auditory nerve degeneration leading to
hearing loss or few changes occuring in the ear. Cerumen tends to become harder and drier posing a
greater chance of impaction in the external ear. In the middle ear, the tympanic membrane may atrophy
or become sclerotic. In the inner ear, cells at the base of the cochlea degenerate. A familial predisposition
is also seen, manifested by inability to hear high frequency sounds, followed in time by the loss of middle
and lower frequencies. The term presbycusis is used to describe this progressive hearing loss (Eliopoulos,
2010). Exposure to loud-noises, certain medications (e.g. aminoglycosides, aspirin, loop-diuretics, quinine
and platinum-based antineoplastic medications) imposes ototoxicity effects hence can affect hearing in
older people. Loss of hearing can contribute to confusion, anxiety, disorientation, misinterpretation of the
environment, feelings of inadequacy and social isolation, which puts a negative impact on quality of life
Aging imposes various anatomical and physiological problems, hence, it is a great challenge for
health care providers to deal with older individuals. They serve as a catalysts throughout the health care
system to ensure that accommodation are made to meet the communication needs of these clients.
This exposure did not only provide an avenue to apply what we have acquired in the classroom
but also provides an opportunity to serve our fellowmen. Because being in the community is more than
meeting the requirements in the related learning experience, it is the experience in the real world, making