Review of System/Physical

Date: September 2, 2016

Time: 10:00 AM

System

A. General/Overall
Health Status

ROS

Mode of
Assessmen
t

No verbal
cues

Inspection and
palpation

Ideal

There should be no sign of pain. Appearance is clean, no body

odor, neatly dressed according to the environment. The patient
should exhibit body symmetry. No obvious deformity and a well
appearance.
Physiological changes in elderly patients:
The dermis decreases in thickness by about 20%. As it thins it
loses vascularity, cellularity and sensitivity. Its ability to exchange
or retain internal heat is diminished. The skin becomes thin, fragile
and slow to heal. Sweat and sebaceous glands are reduced both
in number and effectiveness. Sensory neurons are decreased by
30% from the age of 10 years to 90 years old.
Subcutaneous fat deposition is altered in the elderly. Muscle,
blood vessels and bone become more visible beneath the skin
due to thinning of subcutaneous fat on the extremities. Fat
deposition occurs mainly on the abdomen and thighs.

B. Integument (skin,
hair, nail)

No verbal
cues

Inspection and
palpation

The skin is uniform in color, unblemished and no presence of any

foul odor. Skin should be dry with a minimum of perspiration. No
breaks in the skin, scars, lesions, wounds, redness or irritation.
Skin turgor, color, temperature and moisture of the skin are within
the normal limit. Skin should be dry with minimum perspiration.
Moles may be presence, but no changes in shape, color or size.
Hair should be thick and silky; it should be evenly distributed and
has a fair amount of body hair. There are also no signs of infection
and infestation observed. The nails should be light brown and has
the shape of convex curve. The nail surface should be smooth and
is intact with the epidermis. When nail bed is pressed the nails
should return to usual color in less than 4 seconds.
Physiological changes in elderly patients:

Ecchymoses may occur readily when skin is traumatized,

often on the forearm, because the dermis thins with aging.

Uneven tanning may be normal because melanocytes are

progressively lost with aging.

Longitudinal ridges on the nails and absence of the

Observed

(+) Right sided weakness

(+)Altered Consciousness
(-) Verbal cues
(+) O2 Therapy 10.5 L/min via
T-Piece
(+) Left Heparin lock
(+) asymmetrical face
(+)Frail Looking
(+) Pale
(+) Tracheostomy tube

(+) Uneven Skin color

distribution
(+) brittle nails
(+) Toe nails (yellow)
(+) Long toe nails
(+) thin gray hair
(+) Foul Odor
(+) Dry skin
(+) Warm skin temperature
(+) Stage 2/3 bedsores on left
posterior foot , scattered
formation in 2-5 mm diameter
(+) Poor Skin Turgor
(+) Moles in about 2mm
- Neck
- Chest
- Shoulder

Significance

Due to Basal Ganglia

bleeding it affects the
patients control of motor,
sensory, sleep, conscious
level, regulation of
neurotransmitters and other
functions of CNS resulting to
Altered Consciousness, no
verbal cues and right sided
weakness significant to
patient.

Presence of Bedsores in the

Left posterior of foot is due to
inability to turn patient in
ordered time. Patient prefers
to bend her legs which led to
sores on her foot.
Other observed changes is
normal physiologic changes
of the elderly

Cardiovascular Changes
The changes in the cardiovascular system associated with aging are a decrease in elasticity and an increase in stiffness of the arterial system. This results in increased afterload on the left
ventricle, an increase in systolic blood pressure, and left ventricular hypertrophy, as well as other changes in the left ventricular wall that prolong relaxation of the left ventricle in diastole. There is a
dropout of atrial pacemaker cells resulting in a decrease in intrinsic heart rate. With fibrosis of the cardiac skeleton there is calcification at the base of the aortic valve and damage to the His bundle
as it perforates the right fibrous trigone. Finally there is decreased responsiveness to beta adrenergic receptor stimulation, a decreased reactivity to baroreceptors and chemoreceptors, and an
increase in circulating catecholamines. These changes set the stage for isolated systolic hypertension, diastolic dysfunction and heart failure, atrioventricular conduction defects, and aortic valve
calcification, all diseases seen in the elderly.