Republic of the Philippines

CAVITE STATE UNIVERSITY

Don Severino de las Alas Campus
Indang, Cavite


College of Nursing

A Case Study on
DEMENTIA


Presented by:

Baro, Jenelyn L.
Bon, Kelieraine U.
Braga, Rhodeva Joy T.
Cedron, Ariane Rose S.
Cubillo, Irish Jane B.
Espineli, Leanna Mae S.
Lacson, Leonise Joie R.

IV BSN-1/ 3A



Presented to:
Mary Antoinette D. Viray, RN, MAN
Clinical Instructor, Level IV




August 1, 2014





In Partial Fulfillment of the Requirement in NURS 85B for the Degree Bachelor of Science in
Nursing

VISION
A premier university in historic
Cavite recognized for
excellence in the development
of morally upright and globally
competitive individuals.
MISSION
Cavite State University shall provide
excellent, equitable and relevant
educational opportunities in the arts,
science and technology through quality
instruction and relevant research and
development activities. It shall provide
professional, skilled and morally upright
individuals for global competitiveness.


Page 1

TABLE OF CONTENTS
I. Introduction...2
II. Demographic Data.2
III. Past Medical History..2
IV. History Of Present Condition.3
V. Heredo-Familial History4
VI. Physical Examination.4
VII. Gordons Functional Health Patterns...14
VIII. Developmental History20
IX. Anatomy And Physiology23
X. The Activities-Specific Balance Confidence (Abc) Scale...42
XI. Drug Study...44
XII. Nursing Care Plan45
XIII. Bibliography















Page 2

I. INTRODUCTION
Dementia is a loss of brain function that occurs with certain diseases. It affects
memory, thinking, language, judgment, and behavior (PubHealth). 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 total population in the Philippines.

II. DEMOGRAPHIC DATA

A. Clients Initials: J.S. Date of Interview: July 12, 2014
B. Address: Dasmarinas, Cavite Primary Informant: Patient JS
C. Age: 78 years old Secondary Informant: Daughter
D. Birth Date: June 29, 1936
E. Birth Place: Aklan
F. Gender: Female
G. Civil Status: Widowed
H. Religion: Roman Catholic
I. Highest Educational Attainment: College undergraduate

III. PAST MEDICAL HISTORY
She cannot remember if she had completed her immunization during childhood. Client JS
had chicken pox and measles. However, she cannot remember when it was. There were
times that she fell and her head bled.
The patient 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


Page 3

order. She prefers to go to professional doctors than quack doctors. She also takes herbal
medicine like lagundi.
According to client J.S., she has never been hospitalized. Client J.S. 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 patient J.S. 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 pwee sakin, kasi pag kumain ako sasakit
ang tuho ko. As verbalized by patient J.S.
IV. HISTORY OF PRESENT CONDITION
According to patients daughter, patient J.S. started to be forgetful a year ago. They did
not consult a doctor about it because they thought it was because patient J.S is already
old. There was once an incident that patient J.S. took a jeepney but passed by her
destination. She is not allowed to go out alone. During the interview, patient J.S. gave
relevant answers but there were information given by her that are not true as the
interviewer confirmed to her daughter.












Page 4

V. HEREDO-FAMILIAL HISTORY










Interpretation:
As illustrated in the heredo-familial, patients parents are both dead. They have history of
hypertension and diabetes mellitus. Her mother died but the patient 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.
VI. PHYSICAL EXAMINATION

A. 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.

B. General Appearance

Patient J.S. 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

Died during the World War
Kidney failure; DM
Heart Attack
Hypertension


Page 5

without the assistance. Patient J.S. looks clean and neat. She has no any foul odor. Patient
J.S. does not look pale and weak. She was cooperative in answering what was asking to
her thought. The patient was easily to have a conversation with the interviewer. The
patients quality of speech is comprehensible. The arrangements of conversation are that
precise.
Patient JSs vital signs were taken and recorded during the assessment. Her vital signs
were as follows. Blood pressure of 140/70mmHg, temperature was 36.5C, her
respiratory rate was 21 cycles/minute and pulse rate of 83 beats/ minute.


C. Focused Assessment

Body Part Examined Review of System Actual Finding Normal Finding Clinical Significance
INTEGUMENTARY
SYSTEM

Syempre hindi na
gaya ng dati, laylay na
ang balat ko lalo na
ditto sa may braso.
As stated by the client.

Inspection:
-dryness of the skin
-decreased elasticity of
the skin especially in
the face and arms
-presence of moles on
face
-with wrinkles
-no rashes

Palpation:
-Rough and dry skin
on both upper and
lower extremities
-temperature: 36.5 C

*Dry skin is common.
*Decreased elasticity of the
skin.
*Facial wrinkles are
prominent.
*Hyperpigmentation occurs
in skin exposed to sunlight,
manifests as brown
pigmented areas called
lentigenes (age spots)
*Dermatologic lesions are
common in the elderly but
many are benign.


*Decrease in eccrine,
sebaceous and apocrine
glands function causes the
common complaint of
dryness.
*Gradual replacement of
elastic collagen with more
fibrous tissue and loss of
subcutaneous tissue.
*Because of subcutaneous fat
decreases with age, wrinkles
are visible.
*Hypothermia is due to
decreased vascularity and loss
of subcutaneous tissue.
Hair Puro puti na nga ang
buhok ko eh. As
stated by the client.
Inspection:
-grayish to white in
color
-no signs of infestation
-short hair
-fine dry hair
-Dry scalp

*Loss of hair pigment is the
cause of graying.
* Scalp, axillary and pubic
hair gradually becomes
thinner and coarser.
*Somewhat transparent,
pale, skin with an overall
decrease in body hair on

*Hair color begins to gray
with age, initially appearing
during the third decade of life,
when the loss of melanin
begins to become apparent.




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lower extremities.
Nail Wala naman akong
problema sa mga kuko
ko.as stated by the
client.
Inspection:
-hard and fine in
texture
-nails are short and
clean
-Pale color of nail bed
*Toenails usually thicken,
but fingernails may become
thin and split. They may
also appear yellowish and
dull.

Paleness of the nail bed or
skin can also be caused by
environmental and dietary
factors, such as cold
temperatures and dehydration.
Eyes and Vision









Eyebrows







Eyelashes



Eyelids



Hindi pa malabo ang
mga mata ko. As
stated by the client.
Inspection:
-Pupil size: 3mm
-20/20 vision
-dry

Palpations:
- no nodules
- no masses


Inspection:
-few hair in the
eyebrows
-limited movements
-Symmetrical
-grayish to white in
color

-eyelashes are black in
color
-Turned outward.

-loss of skin elasticity
-decreased muscle
tone with wrinkles
-with eye bags
*Dryness of the eyes is
common among elderly
clients.

* Upper lid may limit
peripheral field of vision
and may produce a feeling
of heaviness and tired
appearance.






*Loss of hair pigment is the
cause of graying.





*Decreased elasticity and
tone of the eyelids tend to
drop the lids and cover the
*Decreased tear production
by the lacrimal gland often
results in dry eye

*Hair color begins to gray
with age, initially appearing
during the third decade of life,
when the loss of melanin
begins to become apparent.






The finding is normal.







*Eyelid skin is the thinnest
skin of the body; it tends to
stretch over time.


Page 8





Lacrimal gland sac,
nasolacrimal duct


Pupil




Inspection/Palpation
-pale
-no tearing

Inspection:
- 3mm in size
-minimal response in
light
-Pupil dilation
eyes.

*Lower eyelid forms
bags.

*Decreased tear production
by the lacrimal gland often
results in dry eyes.


*Decreased in size and its
ability to dilate in the dark.






*With age, the overall size
decrease in the size of the
pupil and its ability to dilate
in the dark
Ears and Hearing
External canal












Internal canal
Mahina na ang
pandinig ko. As
stated by the client.
Inspection:
-Earlobes are
elongated in shape
-presence of mole on
left earlobe
-no lesions, nodules,
discharges
-dry ears
-decreased ability to
hear sounds in both
ears

Palpation:
- no tenderness
-soft

Inspection:
-No found cerumen

*Elongated earlobes. Pinna
increases in length and
width.
*Common type of hearing
loss associated with aging is
called presbycusis.








*Decreased cerumen
production


*Cerumen production
decreases leading to dryness.
*Diminished ability to hear
high-frequency sounds due to
degeneration in the hair cells
of the inner ear.








The finding is normal.


Page 9

-no discharge or
lesions
Nose and Sinuses












Nasal Mucosa









Maxillary and frontal
sinuses
Wala naman akong
problema sa pang-
amoy. As stated by
the client.
Inspection:
-slightly moist
-no swollen sinuses
-no masses or
tenderness
-symmetric







Inspection:
-no redness in nasal
mucosa
-no discharge or
swelling

Palpation:
- no masses
- no tenderness

- no tenderness in
palpating
*Olfactory function
gradually decreases with
aging and may lead to a
decreased ability to detect
odors.

*Diminished smell,
however may lead to a
decline appetite.

*Nasal hairs are coarser and
may not filter air well.





The finding is normal.












The finding is normal.
Mouth/
Oropharynx /Lips




Okay naman ang
paglunok ko. as
stated by the client.
Inspection
-symmetric
-lips are pale in color
-Dry mouth and lips
-with dentures

*Decrease in saliva
production with aging.
*Tooth loss may be
observed

*Use of Anticholinergic can
cause dry mouth

*Tooth surfaces may be worn
from prolonged use. These


Page 10








Gums





Tongue


Palate



Uvula
-no nodules or masses
-no mouth sore
-with positive gag
reflex

-pale brown in color
(gums)
-no bleeding
- no retraction
- no swelling

-no lesions
-no mass

-no presence of bony
prominence
-no lesion

-in the midline
*Dry mouth (xerostomia)
*Esophageal motility is
slower and more
disorganized.


*The gums recede; become
ischemic







*hard palate-is concave



changes make the older client
more susceptible to
periodontal disease and tooth
loss.


*The gums recede, become
ischemic and undergo fibrotic
changes as a person ages.




*The finding is normal.
Neck




Thyroid
Inspection:
-symmetrical
-no mass
-no nodules

-symmetrical
*Cervical curvature may
increase because of
kyphosis of the spine.

*The finding is normal.
RESPIRATORY
SYSTEM
Thorax and Lungs



Hindi naman ako
nahihirapan
huminga. As stated
by the client.

Inspection:
-effortless in
respiration
-3 dark spots on
cervical area approx.

*Use of accessory muscle
when breathing.
*Barrel chest



*The finding is normal.


Page 11







Anterior Thorax









0.5cm
-RR 21cpm
-Diaphragmatic
excursion: 3cm

Palpation:
-Symmetric excursion
-equal expand
-no tenderness
-no masses
-no pulsation

Auscultations:
-no abnormal breath
sound
-no auscultated
crackles
CARDIOVASCULAR
SYSTEM
Heart
Basta ang sakit ko
lang, hilo. Umiinom
ako ng losartan
tuwing umaga.As
stated by the client.

Inspection
-Pulse rate 83 bpm:
-BP 140/70 mmHg
-regular rhythm






Auscultation:
-no murmur

*Pulse rate: 80bpm
(60~100bpm)
*Blood pressure in elderly
may have possible higher
diastolic.








*The heart undergoes an
increase fibrotic tissue and a
decrease in elastic tissue.

*Both systolic and diastolic
pressures rise with age due to
a loss of elasticity of the aorta
and arteries. There are
generally increase in the
systolic pressure, resulting in
a widening of the pulse
pressure.
GASTROINTESTINAL
SYSTEM
Wala naman akong
problema sa tiyan ko.
Inspection:
-natural brown color
*The occurrence of lactose
intolerance increases with
*Rough skin might due to
dehydration


Page 12

Abdomen






As stated by the client of skin
-no lesions
-no rashes
-rough skin

Palpation:
-no mass
age and may result bloating,
abdominal discomfort and
increased flatus.




Musculoskeletal System
Upper Extremities
Features







Range of Motion








Lower Extremities
Features



Range of Motion

Kayang kaya ko pa.
Nakakapagwalis pa
nga ako ng buong
paligid naming. As
stated by the client.
Inspection:
-symmetric structure
and development of
muscles
-no masses
-decreased muscle
tone
-decreased muscle
strength on both arms

-hyperextension, 30;
adduction 20; flexion
160; extension 180

Palpation:
-arm has a cold
temperature


Inspection:
-no lesions
-no ulcer
-decreased muscle
tone and strength
-hip flexion with knee
flexed 80; hip flexion
*Decreased muscle tone
*Decreased muscle strength
*Tendons shrink and
sclerose that causes muscle
cramping




*Poor range of motion may
be related to muscle atrophy
and weakness











*Poor range of motion may
be related to muscle atrophy
*Decrease in type II muscle
fibers accompanied by an
increase in small type I fibers
also contributes to muscle
atrophy with aging.
*Loss of muscle strength
attributable to aging should be
the same on both left and right
sides.
*Muscle atrophy and
weakness are accompanied by
limited range of motion.

*Hypothermia is due to
decreased vascularity and loss
of subcutaneous tissue.




*Muscle atrophy and
weakness are accompanied by
limited range of motion.

*Hypothermia is due to


Page 13



with knee straight 75;
hyperextension 5
and weakness

decreased vascularity and loss
of subcutaneous tissue.

*Swollen joints may indicate
arthritis or inflammation of
the joints.


VII. GORDONS FUNCTIONAL HEALTH PATTERNS

A. Health Perception- Health Management Pattern
Patient JS 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., patient JS 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 as a volunteer in the Barangay
Health Center and current president of the organization.

B. Nutritional-Metabolic Pattern
3 day Diet Recall
MEALS July 10, 2014
(Monday)
Kilocalorie
July 11, 2014
(Tuesday )
Kilocalorie
July 12, 2014
(Wednesday)
Kilocalorie
Breakfast
(6am)
1 serving of rice
2 ham
1 glass of milk
2 glasses of
water
100 kcal
172 kcal
110 kcal
1 serving of rice
1 hardboiled
egg
1 hotdog
3 glass of water
100 kcal
86 kcal
122 kcal
1 serving of rice
1 longganisa 3
glass of water
1 pc banana and 4
slices pakwan
100 kcal

100 kcal
45kcal
Snacks 1 biscuit
1 glass of juice
140 kcal
30 kcal

1 pc of puto
1 glass of juice
180 kcal
30 kcal
1 serving of
aros kaldo with
chicken and 1
hardboiled egg
1 glass of soft
drinks
386 kcal
200kcal






Page 15

Lunch
(12 nn)
1 serving of rice
1cup gulay
(leafy)
3 glass of water
100 kcal
60kcal
1 serving of rice
Sinagang na
Isda
2 glass of water
100 kcal

247 kcal

1 serving of rice,
Ginisang mais and
1 Fried chicken leg
with 2 glass of
water
100 kcal
35kcal
185 kcal
Dinner (5
pm)
1 serving of rice
fish (paksiw)
1 glass of water
100 kcal
140 kcal
1 serving of rice
1 cup gulay
1 glass of water
100 kcal 1 serving of rice
Tuyo
Toge
1 glass of water
100 kcal
45kcal
80 kcal
Total : Fluid Intake
1760 ml
Kilocalorie
952
1760 ml Kilocalorie
965
1760 ml Kilocalorie
1381

According to her, patients 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. Patient SJ fluid intake in her 3-day
diet recall is 1760 ml of water daily. Patient J.S.s fluid intake is normal. Her caloric
intake ranges from 952 to 1381, is balance to her daily needs.
Upon taking patient J.S.s BMI, we found out that she is in normal weight.
C. Elimination Pattern
She eliminates depending on the food she eats. Usually, if it is vegetables and fruits, its
twice but if he 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 SJ 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 patients. She also helps in general barangay survey about maternal and
child health conditions.


Page 16

7 day Activity Table
Time Days of the week & date
July 06 July 07 July 08 July 09 July 10 July 11 July 12
1am
2 am

3 am

4 am
5 am
6 am
7am
8 am
9 am

10 am
11 am

12 nn

1 pm
4 pm

5 pm

6 pm
7 pm

8 pm
12 mn

Legend:
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 sleep at about
8in the evening. She has still active way of living.




Waking up Eating Bathing Boiling water
and helping in
cooking
Sleeping Relaxing Resting
Transporting
to mall
Watching
movie
Assisting in
health center
Chatting with
friends
Cleaning
the street
Going to
church
Watching
TV


Page 17

KATZ index
Activities Independence = 1 pt. Dependence = 0 pt.
Bathing 1
Dressing 1
Toileting 1
Transferring 1
Continence 1
Feeding 1
Total Points: 6

Patient J.S. was able to do her activity 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 P.A is basically independent.
E. Sleep-Rest Pattern
Client SJ 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 J.S. 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 ear
has a negative in whisper test (1-2feet distance). During the conversation, speaker should
speak louder for her to respond. However, her smell and taste preferences have not been
changed.


Page 18

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. And she 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 patient was not able to recall where she placed it.
Patient 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 patient.
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 patient. She was aware of her condition but shes trying to be
physically powerful than she is. Client was self-conscious especially when we have
performed the physical assessment. She depicts simplicity on her looks and actions.

H. Role Relationship Pattern
Patient lives with her family in their house. Client J.S. 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 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 and they were in a good condition. She also has
six grandchildren whose always visiting her every day. May apo narin ako sa tuhod. as


Page 19

stated by the patient and she seems contented. But because of her age and her health
condition she tends to forget some of her family members name which lead to
misunderstanding.

The patient J.S. 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 advices 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.

I . Sexuality- Reproductive Pattern
Patient J.S. is a78 years old and her husband died since 1987, she said that she is
satisfied with her sexual relationship with her loving husband, back then. The client had
her post menopausal period when forty five years old. The client had her first
menstruation at the age of twelve 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
P
8
- T
8
P
0
A
0
L
8.
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 for every problem in her life and feels relieved.
Nanonood din ako ng telebisyon para mawili, as stated by the patient. Aside from
watching TV, the patient 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. Patient always attends the
mass every Sunday and seeks for guidance as she verbalized lagi ako nagsisimba


Page 20

tuwing Linggo ng umaga. For her, God and her family are the most important things or
person in her life that she wont trade for anything in this world.
She does not believe in any superstitions. And as a health care provider in their barangay
she practice proper caring for ill family member. 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.
Patient J.S. 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 visitors.

VIII. 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


Simple Reflexes
Birth-6 weeks
Coordination of sensation
and action through reflexive
behaviors. Three primary
reflexes are described by
Piaget: sucking of objects
inthe mouth, following
moving or interesting
objects with the eyes, and
closing of the hand when an
object makes contact with
the palm (palmar grasp).
The patient was not observed to have
difficulty in terms of hand and eyes
coordination. She can easily grab the
objects that were asked her to get and.
Also was able to eat and shallow without
difficulty. Due to her age, she seldom has
hand tremors but it does not hinder her to
still perform house chores.


Page 21

Over the first six weeks of
life, these reflexes begin to
become voluntary actions;
for example, the palmar
reflex becomes intentional
grasping.)

First habits and
primary circular
reactions phase
6 weeks-4 months


Coordination of sensation
and two types of schemes:
habits (reflex) and primary
circular reactions
(reproduction of an 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.

The patient was not observed having
habitual actions. During the interview, the
patient was simply sitting with her hands
in her knees.

Secondary circular
reactions phase 4
8 months

Infants become more object-
oriented, moving beyond
self-preoccupation; repeat
actions that bring interesting
or pleasurable results. This
stage is associated primarily
with the development of
coordination between vision
and pretensions. Three new
abilities occur at this stage:
intentional grasping for a
desired object, secondary
circular reactions, and
differentiations between
ends and means. At this
stage, infants will
intentionally grasp the air in
the direction of a desired
object, often to the

During the interview, the patient stated
that she usually sweep their street every
morning, she verbalized that it gives her
pleasure when doing this. She does not
miss a day without doing the chores.


Page 22

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 a 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 logic.

Coordination of
secondary circular
reactions stages 8
12 months

Coordination of vision and
touch--hand-eye
coordination; coordination
of schemes and
intentionality. This stage is
associated primarily with
the development of logic
and the coordination
between means and ends.
This is an extremely
important stage of
development, holding what
Piaget calls the "first proper
intelligence." Also, this
stage marks the beginning
of goal orientation, the
deliberate planning of steps
to meet an objective.



Despite of her age, the client was still
active as the head of BHW or Baranggay
Health Workers in their neighborhood.
According to client, she still attends to
meetings and was able to participate in the
activities of their organization. As
observed during the interview, although
the she does not remember some of the
events that were asked to her and
disoriented in date, she was rational in
some of her answer.

Tertiary circular
reactions, novelty,
and curiosity 12

Infants become intrigued by
the many properties of
objects and by the many
things they can make

During the interview, the client was able
to asked questions to the students and
seems little intrigue to them since it was


Page 23

18 months happen to objects; they
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.
the first time she was able to meet them.

Internalization of
Schemes 18
24 months

Infants develop the ability
to use primitive symbols
and form enduring mental
representations. This stage
is associated primarily with
the beginnings of insight, or
true creativity. This marks
the passage into the
preoperational stage.

During the interview we have not notice
any rituals or symbolic presentation of her
thoughts.

2. Preoperational
Thought (2-7 years
old)

The hallmark of the
preoperational stage is
sparse and logically
inadequate mental
operations.

During this stage, the child

learns to use and to
represent objects by 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

The client can identify the objects that are
presented to her. She also knows where
and how to use them. As part of the
interview, the patient was able to describe
certain object that was asked her to
visualize.


Page 24

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
systematic reasoning.
Classifications involve
sorting objects according to
attributes such as color;
seriation, in which objects
are ordered according to
increasing or decreasing
measures such as weight;
multiplication, in which
objects are simultaneously
classified and seriated using
weight.
Child is aware of
reversibility, an opposite
operation or continuation of
reasoning back to a starting
point.

The client was able to determine the
colors and sizes from larger to smaller
during the interview. She was able to
reason out her answers whenever her
children contradict her responds.

4.Formal
Operational
Thought (12 yrs.
old)

Can solve hypothetical
problems with scientific
reasoning; understands
causality and can deal with
the past, present, and future.

The client was a college under graduate,
she was also the current president of the
BHW or Barangay Health Workers in
their neighborhood. According to her, she
still participates in discussions and
planning of activities in their organization.






Page 25

IX. 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.
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


Page 26

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



Page 27

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.



Page 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.


Page 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.


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."


Page 30



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


Page 31

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.


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,


Page 32

substantia nigra, and subthalamic nucleus. Diseases affecting these parts can cause a
number of neurological conditions, including Parkinson's disease and Huntington's
disease.


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


Page 33

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

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.


Page 34



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


Page 35

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 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


Page 36

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)
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.


Page 37


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
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


Page 38

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
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


Page 39

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 patient 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.
A recent report announced the discovery of a vaccine that may hold promise for
preventing or treating AD. The study considered mice who 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. When older mice, who 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.



Page 40

Possible Causes of Alzheimer's disease
Several possible causes have been implicated in the development of AD. About 10%
of patients 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.
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 patient 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,


Page 41

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.
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 high-electricity
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.







Page 42

X. THE ACTIVITIES-SPECIFIC BALANCE CONFIDENCE (ABC) SCALE
Instructions for Scoring
The ABC is an 11point scale and ratings should consist of whole numbers (0-100) 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. )






Level of Confidence Rating Scale
0% 10 20 30 40 50 60 70 80 90 100%
No confidence 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%
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? 9%
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)


Page 43

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 patient J.S
ability to perform activities of daily living. Based on this scale, patient J.S. 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 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 patients being forgetful does not affect
the physical ability of the patient.



















Page 44

X I. DRUG STUDY
DRUG MECHANISM OF
ACTION
INDICATION CONTRAINDICATIONS ADVERSE
EFFECTS AND
SIDE EFFECTS
NURSING
RESPONSIBILITIES
Generic Name:
Losartan
Potassium

Brand Name:
Cozaar

Classification:
Antihypertensive

Dosage:
50mg

Route:
Oral

Frequency:
OD

Form:
Tablet

Color:
White

Inhibits
vasoconstrictive and
aldosterone-
secreting action of
angiotensin II by
blocking angiotensin
II receptor on the
surface of vascular
smooth muscle and
other tissue cells.

To reduce the
risk of stroke in
patients with
hypertension and
left ventricular h
ypertrophy
Treatment
of diabetic
nephropathy wit
h an elevated
serum creatinine
and proteinuria (
urinary albumin t
o creatinine ratio
300 mg/g) in
patients
with type 2
diabetes and a
history of
hypertension.
Contraindicated in:
Hypersensitivity

Cross-sensitivity may occur
with other s, including
aspirin

Active GI bleeding

Ulcer disease

Adverse Effects:

CNS:
Headache,
dizziness,
somnolence

GI:
Nausea, dyspepsia,
GI pain,
constipation

Hemat: blood
dyscrasias,
prolonged bleeding
time.

CV:
hypotension

Side Effects:

EENT: tinnitus,
visual disturbances.

Resp: dyspnea.

Pre-administration:
Verify doctors
written prescription
Observe 10 Rs
Provide health
teaching about drug
prescription
Check vital signs
before administration
Intra-administration:
Give with food.
Post-administration:
Check vital signs after
administration
Monitor urine output if
taking diuretics
Document that drug
was given



Page 45

X II. NURSING CARE PLAN


Page 46

X III. BIBLIOGRAPHY

Nursing Department, Khwopa Poly-Technic Institute Japan International Cooperation
Agency (JICA). Fundamentals of Nursing Procedure Manual for PCL course (pg. 53~77 )
Bare, B.G., Cheever,, K.H., Hinkle, J.L., & Smeltzer, S.C. (2010). Brunner and
Suddarth's textbook for MS. Lippincott Williams & Wilkins.
Maurice A Cerulli, MD, FACP, FACG, FASGE, AGAF (Oct 7, 2013). Upper
Gastrointestinal Bleeding. Retrieved March 14, 2014 from
http://emedicine.medscape.com/article/187857-overview.
Mims Philippines (2014). Mucosta. Retrieved March 14, 2014 from
http://www.mims.com/Philippines/drug/info/Mucosta/?q=mucosta&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