Stephanie Engler, RN

1
Welcome to Geriatric Nursing

• Stephanie Engler, RN
• Wednesday
• 940-1035am

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Introductions

• About Me
• General Questions
• Student Motivators
• Syllabus Review
• Objectives of Course
• Expectations of Me
• Expectations of You...
• Questions???

3
For next week

• Unit 1- Chapters 1 2
• Complete Lecture Notes- will check before class
• Print PowerPoint Outline Notes for Ch. 1 2
• Read chapters 1 2 and Review Key Concepts,
  Tables, Figures, and Boxes for each chapter.
• Quiz in one week over Chapters 1, 2, 4, 6, 7
• Bring 7 scantrons to class next week

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Chapter 1The aging population

• Gerontology is the study of the aging processes
  and individuals as they grow from middle age
  through later life. It includes
• the study of physical, mental, and social changes
  in older people as they age
• the investigation of the changes in society
  resulting from our aging population
• the application of this knowledge to policies and
  programs. As a result of the multidisciplinary
  focus of gerontology, professionals from diverse
  fields call themselves "gerontologists
• Geriatrics is
• the specialty that concerns itself with the
  provision of nursing services to geriatric or
  aged individuals.
• the study of health and disease in later life
• the comprehensive health care of older persons
  and the well-being of their informal caregiver

5
Chapter 1

• Dr. I. L. Nasher- father of geriatrics wrote
  the first geriatric textbook in 1914.
• Federal Old Age Insurance Law under the Social
  Security Act in 1935- hope to ensure financial
  security of older Americans
• Characteristics of the Older Adult Population
• Age 65 and older
• Represent more than 12 of the population in the
  US
• 2020- 17 of the population
• The population gt85 approx. 40 of the older
  population
• More than half of women gt65 are widowed

6
Chapter 1

• Income and Employment- Social Security
• Most older people depend on Social Security for
  more than half of their income.
• Franklin D. Roosevelt- The New Deal in 1935
• Benefit check paid to retired workers of a
  specific minimum age
• Social Security is currently estimated to keep
  roughly 40 percent of all Americans age 65 or
  older out of poverty
• By dollars paid, the U.S. Social Security program
  is the largest government program in the world
  and the single greatest expenditure in the
  federal budget

7
Chapter 1

• In 2011, there will be 56 million beneficiaries
  and 158 million workers paying in. The trust fund
  would then be exhausted by 2036 without
  legislative action.
• The earliest age at which (reduced) benefits are
  payable is 62. Full retirement benefits depend on
  a retiree's year of birth.

8
Chapter 1

• Asset rich and cash poor. What does this mean?
• Baby Boomers (born between 1946 and 1964)are
  working past retirement.
• Baby Boomers control over 80 of personal
  financial assets and more than 50 of
  discretionary spending power.
• They are responsible for more than half of all
  consumer spending, buy 77 of all prescription
  drugs, 61 of OTC medication and 80 of all
  leisure travel.

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Chapter 1

• Health Status- http//www.youtube.com/watch?vMT8x
  hWD5BB0playnext1listPLA40BB183BB302BAAfeature
  results_video
• Chronic illness is a major problem for the older
  population.
• Most older adults have at least one chronic
  disease or more that need to be managed
  simultaneously.
• Chronic diseases are not only major sources of
  disability, but they are the leading cause of
  death.

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Chapter 1

• Leading Chronic Conditions
• Arthritis
• Hypertension
• Heart conditions
• Visual impairments
• Diabetes

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Chapter 1

• Leading Causes of Death
• Heart disease 33
• Cancer 21.8
• Stroke 8.2

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Chapter 1

• Baby Boomers and Care Facilities
• Entering their senior years between 2008 and 2030
• They will not be satisfied with the conditions of
  todays nursing homes and will demand that their
  long-term care facilities be equipped with
  computer stations, gymnasiums, juice bars, pools,
  and alternative therapies
• Gerontological nurses need to be advocates in
  ensuring that cost-containment efforts do not
  jeopardize the welfare of older adults.
• What are some examples of Care Facilities or
  Retirement Options?

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Chapter 1

• Point to Ponder page 7
• A higher proportion of older adults in our
  society means that younger age groups will be
  carrying a greater tax burden to support the
  older population. Should young families
  sacrifice to support services for older adults?
  Why or why not?

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Chapter 2Theories of aging

• The biological, psychological, and social
  processes of aging are interrelated and
  interdependent.
• Read and Review Box 2-1 and 2-2 from Chapter 2
• Read and Review Key Concepts from Chapter 2

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Chapter 4Life transitions and Story

• Ageism- the prejudices and stereotypes that are
  applied to older people sheerly on the basis of
  their age
• Changes in Family Roles and Relationships-
  Parenting and grandparenting
• Loss of a Spouse- affects more women than men
  because women tend to have a longer life
  expectance than men many are widowed by their
  eighth decade of life.
• Retirement- Loss of the Work Role and Reduced
  Income

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Chapter 4

• Changes in Health and Functioning- changes in
  appearance and bodily function occur
• Cumulative Effects of Life Transitions- Shrinking
  Social World and Awareness of Mortality
• Responding to Life Transitions- Life Review, Life
  Story and Self Reflection, and Strengthening
  Inner Resources
• Review Key Concepts and Box 4-1, 4-2

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Chapter 6The Specialty of Gerontological nursing

• Frustration over lack of value placed on
  geriatric nursing led to the American Nurses
  Association (ANA) establishing the Conference
  Group on Geriatric Nursing Practice 1962
• Older people exhibit great diversity in terms of
  health status, cultural background, lifestyle,
  living arrangement, socioeconomic status, and
  other variables.
• Factors such as limited finances and social
  isolation, affect the state of health and
  well-being.

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Chapter 6

• Core Elements of Gerontological Nursing Practice
• Evidence-Based Practice practice has moved from
  trial and error to following a systemic approach
  that uses existing research for clinical
  decision-making a process known as
  evidence-based practice
• Standards Professional nursing practice is
  guided by standards. Standards serve to both
  guide and evaluate nursing practice. See Box 6-2
  ANA Standards of Gerontological Nursing Practice.
• Principles Nursing principles are those proven
  facts or widely accepted theories that guide
  nursing actions. See Box 6-3.

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Chapter 6

• Factors Influencing the Aging Process
• Heredity
• Nutrition
• Health Status
• Life Experience
• Environment
• Activity
• Stress
• Nurses must understand the multitude of factors
  that influence the aging process and recognize
  the unique outcomes for each individual.

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Chapter 6

• Gerontological Nursing Roles
• Healer- Nightingale wrote nursing put the
  patient in the best condition for nature to act
  upon him. As medical knowledge and technology
  grew more sophisticated and the nursing
  profession became grounded more in science than
  in healing arts, the early emphasis on
  nurturance, comfort, empathy, and intuition was
  replaced by detachment, objectivity, and
  scientific approaches.
• Caregiver- active participation of older adults
  and their significant others and promotion of the
  highest degree of self-care.

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Chapter 6

• Educator- Nurses must take advantage of formal
  and informal opportunities to share knowledge and
  skills related to the care of older adults
• Advocate- For individual older adults, and to
  facilitate a communitys efforts to affect change
• Innovator- Nurses need to think out of the box
  and take risks associated with traveling down new
  roads, and transform visions into reality.

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Chapter 6

• Point to Ponder
• Based on changes in the health care system and
  society at large, what unique services could
  gerontological nurses offer in the future within
  your community?

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NCLEX Questions

• A new patient is not satisfied with the
  conditions of the nursing home, takes a highly
  active role in her healthcare, and because of her
  ability to access information is as knowledgeable
  as her care providers on some issues. This
  patient is most likely
• A young female baby boomer that just turned 65.
• An older woman between 75-85 years old.
• A woman over the age of 85 years old.
• A woman over the age of 95 years old.

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NCLEX Questions

• Nurses need to understand the aging process in
  order to help their patients
• a. Live longer with their long term
  disabilities.
• Maintain youth and delay the onset of old age.
• Accept the limitations imposed by genetic
  tendencies toward cellular degeneration.
• Postpone the negative consequences of the aging
  process.

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NCLEX Questions

• Mr. B, age 73, has a terminal illness. He has
  entered into a nursing home, where he will reside
  until his death. Until age 70, he worked as a
  successful bank president and was an active
  community leader. The nurse should be alert for
  signs that he most resents his
• Mortality
• Unemployment
• Family
• Dependency

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NCLEX Questions

• Gerontological nursing is a complex specialty.
  Which of the following most contributes to this
  fact
• Elderly are generally compromised in their health
  status.
• Cost for the elderly costs more than care for
  younger patients.
• Numerous health conditions can overlap in the
  elderly.
• Complications after surgery or illness result in
  death in most cases.

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Update!!!!

• Quiz 2 on Sept. 26th will cover Chapters 8,9,13
• Chapter 16 will not be covered- please cross it
  off of your schedule

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Chapter 8Legal aspects of gerontological nursing

• Laws Governing Gerontological Nursing Practice-
  Box 8-1
• Because laws are developed at the state and local
  levels, variation exists among the states.
• Constitutions- basic rights, grant powers, and
  place limits on government agencies
• Court decisions- establish precedents from cases
  heard in state or federal courts
• Statutes- established by local, state and federal
  legislation (nurse practice acts)
• Regulations- laws enacted by state and federal
  agencies that define the methods to achieve goals
  (conditions for agencies to receive reimbursement
  from Medicare or Medicaid)
• Attorney General Opinions- laws derived from the
  opinions of the chief attorney for the state or
  federal government

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Chapter 8

• Acts that could result in legal liability for
  nurses- Box 8-2
• Negligence- omission or commission of an act that
  departs from acceptable and reasonable standards,
  which can take several forms
• Malfeasance- unlawful or improper act (surgical
  procedure)
• Misfeasance performing an act improperly (no
  signed consent)
• Nonfeasance failure to take proper action (not
  notifying the MD with changes)
• Malpractice failure to abide by the standards of
  ones profession (not checking that a NG tube is
  in the stomach before administering a tube
  feeding)
• Criminal negligence disregard to protecting the
  safety of another person (allowing a confused
  patient to have matches)

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Chapter 8

• Reducing the Risk of Malpractice Box 8-3
• Guardianship- court appointment of an individual
  to have the authority to make decisions for an
  incompetent person
• Power of Attorney- Competent individuals appoint
  parties to make decisions for them (Box 8-4)

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Chapter 8

• Restraints- chemical and physical
• Anything that restricts a patients movement can
  be considered a restraint
• Alternatives should be used whenever possible-
  alarmed doors, wristband alarms, bed alarm pads,
  beds and chairs close to the floor, increased
  staff and supervision
• When restraints are necessary, a physicians
  order must be obtained- must include the type of
  restraint, condition of patient, and duration of
  use

32
Chapter 8

• No-code orders
• Terminally ill patients that are going to die and
  resuscitation attempts would not be therapeutic
• A physician order must be obtained to clearly
  state the wishes for no resuscitation- it is
  negligence to withhold CPR without an order
• DNR at bedside is not valid without an official
  order

33
Chapter 8

• Advance Directives or a Living Will
• Protects the patients right to make decisions
  about terminal care
• Express the desires of competent adults regarding
  terminal care, life-sustaining measures, and
  other issues pertaining to their death and dying
• 1990- Patient Self-Determination Act- requires
  all health care institutions receiving Medicare
  or Medicaid funds to ask patients on admission if
  they possess a living will for health care

34
Chapter 8

• Elder abuse
• Many forms- inflicting pain or injury stealing,
  mismanaging funds, misusing medications, causing
  psychological distress, withholding food or care,
  sexual abuse, confinement
• Threatening to commit these acts is a crime
• Nurses have a legal responsibility to report
  cases of known or suspected abuse
• Signs of abuse- see page 104

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Chapter 9

• Chapter 9 Unit 2Ethical Aspects of
  Gerontological Nursing
• Ethics- ancient Greece- ethos means those beliefs
  that guide life
• The concept of accepted standards of conduct and
  moral judgment
• Ethics help determine right and wrong courses of
  action
• The American Nursing Association (ANA) Code of
  Ethics for Holistic Nursing and various standards
  of practice supplement the nurses personal value
  system to influence ethical decision making

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Chapter 9

• Ethical Principles-
• Beneficence- to do good for patients- nurses are
  challenged to take actions that are good for
  patients desires
• Nonmaleficence- to prevent harm to patients
• Justice- to be fair, treat people equally, and
  give patients the service they need
• Fidelity and veracity- fidelity means to respect
  our words and duty to patients veracity is
  truthfulness
• Autonomy- to respect patients freedoms,
  preferences, and rights
• See Box 9-1

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Chapter 13

• Chapter 13 Unit 3
• Spirituality
• A positive, harmonious relationship with God or
  other higher power (the Divine) helps individuals
  to feel unified with other people, nature, and
  the environment
• Spirituality differs from religion, which
  consists of human-created structures, rituals,
  symbolism, and rules for relating to the Devine-
  highly spiritual individuals may not identify
  with a specific religion.

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Chapter 13

• Spiritual Needs-
• Love- people need to feel love regardless of
  physical or mental condition, social position,
  material possessions
• Meaning and Purpose- achieving a sense of
  integrity- wholeness- is supported by the belief
  that life experiences- both good and bad- make
  sense and have served a purpose
• Hope- something in the future- belief relief and
  eternal reward are possible 
• Dignity- make a sense of value and worth through
  their connection with God or other higher power 

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Chapter 13

• Forgiveness- achieving closure to unfinished
  business 
• Gratitude- at a time of many losses, they may be
  guided by a review of the positive aspects in
  their life- an attitude of thankfulness nourishes
  the spirit 
• Transcendence- connected to a greater power, life
  beyond material existence and face difficult
  circumstances
• Expression of Faith- practices include prayer,
  worship, scripture reading, rituals, and
  celebration on specific holy days

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Unit 4 Ch. 17safety

• Older persons face the same environmental hazards
  as any adults, but their risks are compounded by
  age related factors that reduce their capacity to
  protect themselves from and increase their
  vulnerability to safety hazards.
• Age related changes can reduce the capacity of
  older adults to protect themselves from injury
  and increase their vulnerability (Key Concept)
• Accidents rank as the sixth leading cause of
  death for older adults- falls is the leading
  cause

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Chapter 17

• Importance of the Environment to Health and
  Wellness
• Environment can be considered in two parts-
• Microenvironment- our immediate surroundings with
  which we closely interact
• Macroenvironment- elements in the larger world
  that affect groups of people or entire
  populations
• Nursing Diagnosis- table 17-3

42
Chapter 17

• Impact of Aging on Environmental Safety and
  Function
• Potential Environmental Impact of Various
  Physical Limitations (Table 17-5)
• Assessing basic standards for older adults
  environment (Box 17-1)
• Lighting function, orientation, mood and
  behavior
• Temperature because older adults have lower
  normal body temperatures and decreased amounts of
  natural insulation, they are especially sensitive
  to lower temperatures.
• Colors red, yellow, and white can be
  stimulating/blue, brown, and earth tones can be
  relaxing
• Orange?
• Green?
• Black? Grey?

43
Chapter 17

• Scents- used for aesthetic and medicinal
  purposes- aromatherapy
• Floor Coverings- pros and cons- rugs?
• Furniture- functional, comfortable, easy to clean
• Sensory Stimulation- soft blankets, pictures,
  sculptures, plants, flowers, coffee, food
  cooking, soft music, textured walls
• Noise control- many sounds create difficulties
  for older adults

44
Chapter 17

• Bathroom Hazards- cause of many accidental
  injuries
• Lighting- urinary frequency
• Floor surface- de cluttered and no throw rugs
• Faucets- lever-shaped vs. round
• Tubs and shower stalls- nonslip surfaces, grab
  bars
• Toilets- grab bars, raised seat
• Electrical appliances- accidental fall into water
• Psychosocial Considerations-
• Feelings and behavior influence and are
  influenced by the individuals surroundings-
  depression, regression, humiliation, anger
• Important to recognize the need for personal space

45
Chapter 17

• Falls- Risk and Prevention (Box 17-2)
• Age-related changes-
• Improper use of mobility aids-
• Medications-
• Unsafe clothing-
• Disease-related symptoms-
• Environmental hazards-
• Caregiver-related factors-

46
Chapter 18Safe medication use

• Effects of Aging on Medication Use
• Polypharmacy- The high prevalence of drugs
  consumed by older people and the complexity of
  drug dynamics in old age require geri nurses to
  evaluate the effects of drugs given (figure
  18-1).
• Altered Pharmacokinetics- absorption,
  distribution, metabolism, and excretion of drugs.
  
• Absorption- decreased gastric blood flow and
  motility, slower metabolism
• Distribution- dehydration will decrease drug
  distribution, and lower dosage levels may be
  necessary
• Metabolism, detoxification, and excretion- the
  renal system is primarily responsible for the
  bodys excretory functions. Drugs are not as
  quickly filtered from the blood stream and are
  present in the body longer.

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Chapter 18

• Promoting the Safe Use of Drugs
• Avoiding Inappropriate Drugs (Box 18-1)
• Reviewing Necessity and Effectiveness of
  Prescribed Drugs
• Why is drug ordered?
• Is the smallest possible dosage ordered?
• Is the pt. allergic?
• Can this drug interact with other drugs?
• Special instructions?
• Most effective route?

48
Chapter 18

• Safe Use Cont
• Promoting Safe and Effective Administration
• Encourage good oral hygiene, fluids, proper
  positioning to facilitate swallowing
• Frequently an older person will bleed or ooze
  after an injection because of decreased tissue
  elasticity.
• Provide Patient Teaching
• Assess a patients risk for medication errors
  (Box 18-2)

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Unit 5 chapter 19respiration

• Read beginning of chapter
• A lifetime of insults to the respiratory system
  from smoking, pollution, and infection takes its
  toll in old age.
• Respiratory disease a leading cause of disability
  and 4th leading cause of death in persons over 70
  years of age.

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Chapter 19respiration

• Age related changes
• Respiratory problems can develop more easily and
  be more difficult to manage
• Connective tissues for respiration and
  ventilation are weaker
• Elastic recoil of the lungs during expiration is
  decreased
• Alveoli are less elastic, develop fibrous tissue,
  and contain fewer functional capillaries
• Loss of skeletal muscle strength in the thorax
  and diaphragm barrel chest
• The net effect of these changes is a reduction in
  vital capacity
• (The greatest volume of air that can be expelled
  from the lungs after taking the deepest possible
  breath) and increase in residual volume (The
  volume of air remaining in the lungs at the end
  of a maximal expiration)

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Chapter 19respiration

• Health Promotion for the Elderly Person
• Risks, symptoms, and care associated with
• Asthma
• Chronic Bronchitis
• Emphysema
• Lung Cancer
• Lung Abscess

52
Chronic obstructive pullmonary disorder (copd)

• http//www.youtube.com/watch?vaktIMBQSXMo
• http//www.youtube.com/watch?vttdma8PnFJINR1
• http//www.youtube.com/watch?vk77vqaUnd1Yfeature
  relmfu

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Unit 5 Chapter 20Circulation

• Objectives
• Identify age related physiological changes of the
  cardiovascular system.
• Describe common cardiovascular diseases and
  nursing interventions that assist clients with
  cardiovascular conditions.

54
Circulation

• Heart
• The heart is a myogenic muscular organ found in
  all animals with a circulatory system (including
  all vertebrates), that is responsible for pumping
  blood throughout the blood vessels by repeated,
  rhythmic contractions. The term cardiac (as in
  cardiology) means "related to the heart" and
  comes from the Greek ?a?d??, kardia, for "heart
  (themedicaldictonary.com).

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Anatomy of theheart

• http//www.youtube.com/watch?vH04d3rJCLCE

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Aging Circulation
Heart Blood Vessels Blood
Aorta dilates and valves thicken Baroreceptors (monitor the pressure of the blood being delivered to the brain) become less sensitive orthostatic hypotension Reduction in total body water blood volume decreases
Pathways develop fibrous tissue and fat deposits Capillary walls thicken of RBCs are reduced fatigue
Heart wall thickens may have slower fill time Aorta becomes thick, stiff, less flexible HTN of lymphocytes decreases decreased ability to fight infection
Abnormal ECG (afib)
Heart muscle cells degenerate slightly
57
Common heart conditions

• Coronary artery disease (CAD)-
• a narrowing of the small blood vessels that
  supply blood and oxygen to the heart

58
Common heart conditions

• Congestive heart failure (CHF)-
• condition in which the heart
• can no longer pump enough
• blood to the rest of the body

59
Common heart conditions

• Myocardial infarction-
• heart attack-
• interruption of blood supply to a part of the
  heart, causing heart cells to die.

60
Common vessel conditions

• Aneurysm-
• an abnormal widening
• or ballooning of a
• portion of an artery
• due to weakness in
• the wall of the blood
• vessel.

61
Common vessel conditions

• Pulmonary embolism-
• blockage
• caused by blood clots that travel to your lungs
  from another part of your body

62
Common vessel conditions

• Stroke-
• Occurs when a blood vessel in the brain bursts
  or, more commonly, when a blockage develops

63
Unit 5chapter 21 22

• Effects of Aging on GI Health
• Objectives
• Identify aging changes in the GI system that
  affects nutritional status.
• List symptoms and management of dental problems
  and chronic constipation.
• Recall the types of urinary incontinence
  experienced by older adults.
• Identify and describe behavioral therapies used
  with incontinence.

64
Unit 5Chapter 24

• Movement and Physical Changes of Aging
• Objectives
• Recognize normal age-related changes and common
  health deviations in the musculoskeletal system
  that affects mobility of the frail elderly.
• Use the nursing process in determining the care
  of persons with fractures, osteoarthritis,
  rheumatoid arthritis, and osteoporosis.
• List measures that can be used for managing
  musculoskeletal pain.

65
Chapter 24

• Normal Age Related Changes-
• Decline in number and size of muscle fibers and
  muscle mass (sarcopenia)
• Loss of Strength
• Impairment in activities of daily living
• Increased incidence of falls
• Increased incidence in hip fractures

66
Chapter 24

• Decrease body strength and the flexibility of
  joints and muscles
• Impaired capacity for muscle regeneration
• Exercise has been considered of great interest in
  treatment of sarcopenia!!!!!

67
Chapter 24

• Managing Musculoskeletal Pain
• Degenerative changes in the tendons and arthritis
  are responsible for painful shoulders, elbows,
  hands, hips, knees, and spines.
• Cramps at night and joint strain cause pain in
  the elderly.
• Pain relief is essential in promoting optimal
  physical, mental, and social function.

68
Chapter 24

• Heat a warm bath at bedtime and warm blankets
  can reduce spasms and cramps
• Passive stretching help to control muscle cramps
• Excessive exercise and stress should be avoided
• Rest and correct positioning weight-bearing
  joints and proper body alignment
• Alternative therapies therapeutic touch,
  chiropractic therapy
• Unrelieved pain can significantly affect an older
  persons independence and quality of life!!!

69
Unit 5chapter 26

• Sensation
• Objectives
• Identify age related changes in vision, hearing,
  smell and taste.
• State the major pathological causes of visual
  impairment in the frail elderly.
• Assess the senses of sight, hearing, smell,
  taste, and touch of the frail elderly.
• Recognize the psychological and sociocultural
  factors that interact with sensory functioning.
• Identify the causes of sensory impairment.
• Develop a nursing diagnosis and plan of care for
  a person with sensory impairment.

70
Unit 5chapter 27

• Endocrine Function
• Objectives
• List the symptoms of hypothyroidism and
  hyperlipidemia.
• Describe the age related differences in the
  diagnosis, presentation, and management of
  diabetes.

71
Unit 5chapter 28

• Integumentary Function
• Objectives
• Identify age-related changes and the common
  health deviations in the integumentary system
• State the warning signs of cancer.
• State the general nursing considerations for
  Integumentary conditions.

72
Unit 6chapter 32 33

• Objectives Cognition/ Mental Health
• Describe the characteristics and care of
  delirium, dementia, depression, and anxiety.
• Describe the common psychological changes of
  aging for the characteristics of stress reaction
  time, intelligence, learning, problem-solving,
  personality, and memory.

73
Unit 6Chapter 32 33

• Cognition/Mental Health
• What does mental health mean to you?
• Dementia
• Confused
• Memory loss
• Disoriented
• Decreased level of functioning
• Coping effectively
• Wellbeing
• Happy place

74
Unit 6Chapter 32 33

• Cognition/Mental Health
• Mental health indicates a capacity to cope
  effectively with and manage lifes stress in an
  effort to achieve a state of emotional
  homeostasis (Eliopoulos, 2010).
• Advantages of being older...
• Great depression
• Good mental health practices throughout the life
  span promote good mental health in old age.

75
Unit 6chapter 32 33

• Challenging Emotional Homeostasis-
• Illness
• Death
• Retirement
• Increased vulnerability
• Social isolation
• Sensory deficits
• Greater awareness of own mortality
• Increased risk of institutionalization

76
Unit 6chapter 32 33

• Depression-
• The most frequent problem that psychiatrists
  treat in older adults.
• As many as 25 of elderly in long-term care
  facilities.
• Signs and Symptoms
• Some older adults who are depressed demonstrate
  cognitive deficits secondary to the effects of
  depression.

77
Unit 6chapter 32 33

• Depression Cont.-
• Treatment-
• Anxiety-
• Anxiety reactions can be manifested in various
  ways, including somatic complaints, rigidity in
  thinking and behavior, insomnia, fatigue,
  hostility, restlessness, chain smoking, pacing,
  confusion, and increased dependency.
• Other symptoms-
• Treatment-

78
Unit 6chapter 32 33

• Delirium-
• Impaired cerebral circulation and cause
  disturbances in cognitive function.
• As older adults often have multiple health
  conditions, it is important to remember that
  several coexisting factors can be responsible for
  delirium.
• Dementia-
• An irreversible, progressive impairment in
  cognitive function affecting memory, orientation,
  judgment, reasoning, attention, language, and
  problem solving.
• Caused by damage or injury to the brain.

79
Unit 6chapter 32 33

• Table 33-1 Delirium vs. Dementia
• State
• cause
• onset
• mental status
• level of consciousness
• behavior
• recovery

80

• http//www.youtube.com/watch?vtzFNTtHyTzofeature
  related

81
Unit 7Chapters 37 39

• Only Chapters 37 39 will be required for Unit 7
• You will read and study the Economics/Healthcare-
  Resources for Support objectives independently
  (chapter 37 in book).
• End of Life Care objectives will be covered
  today.

82
Unit 7Chapter 39

• End of Life Care
• Review the stages of dying.
• List the physical care needs of dying individuals
  and the related nursing interventions.
• Identify factors that have increased ethical
  dilemmas for nurses.
• Describe the ethical principles that guide
  nursing practice.
• Discuss euthanasia and the associated legal and
  professional responsibilities.

83
Unit 7chapter 39

• More than 80 of deaths occur in old age
• All nurses must learn to deal with the entire
  process- using a blend of sensitivity, insight,
  and knowledge about the complex topic of death in
  order to diagnose nursing problems and
  effectively intervene.
• With fewer people dying at earlier ages than in
  the past and most deaths occurring in hospitals
  or nursing homes, most people have minimal direct
  involvement with dying individuals.

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• An examination of ones own feelings and
  attitudes about death can be therapeutic to a
  nurse personally, as well as helpful in the care
  of dying patients.
• Patients reactions to dying are influenced by
  previous experiences with death, age, health
  status, philosophy of life, and religious,
  spiritual, and cultural beliefs.

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• The five stages of the dying process include
• Denial
• Anger
• Bargaining
• Depression
• Acceptance

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• Physical Care Needs-
• Pain
• For the dying patient, the goal of pain
  management is to prevent pain from developing
  rather than treat it once it occurs.
• Complaints of pain or discomfort, nausea,
  irritability, restlessness, and anxiety are
  common indicators of pain.
• Alternatives to medications should be included in
  the pain-control program of dying patients.

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• Respiratory Distress
• A common problem in dying patients.
• Discomfort resulting from dyspnea, and
  psychological distress associated with the fear,
  anxiety, and helplessness that results from the
  thought of suffocating.
• Causes- pleural effusion and deteriorating blood
  gas levels.

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• Constipation-
• Reduced food and fluid intake, inactivity, and
  the effects of medications cause constipation.
• Nursing staff should take measures to promote
  regular bowel elimination
• Laxatives usually are administered on a regular
  schedule.

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• Poor Nutritional Intake
• Anorexia, nausea, and vomiting can prevent the
  ingestion of nutrients
• Serve small-portioned meals that have appealing
  appearances and aromas that can boost appetite.
• Control nausea and vomiting.

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• Signs of imminent death-
• Decline in blood pressure
• Rapid, weak pulse
• Dyspnea and periods of apnea
• Slower or no pupil response to light
• Profuse perspiration
• Cold extremities
• Bladder and bowel incontinence
• Pallor and mottling of skin
• Loss of hearing and vision

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