Microsoft word - n150 geri outline ia.rtf

Gerontological Nursing Kim Baily RN PhD
o Aged: old, old person o Aging: continuous process of maturation o Ageism o Geriatrics o Gerontology o Life Span o Life expectancy o Senility • 35 million people over the age of 65 in 2000 • Among the 35 million older adults o 18 million Æ 65-74 o 12 million Æ 75-85 o 4.2 million Æ >85 (8.9 million by 2030) o By 2030, 75 million Æ 20% population o 85+ fasted growing segment o 1 ½ times more women than men o Ethnicity = 85% white o 2030 25% minorities • >95% live outside nursing homes
o 86% have chronic illness o Most common chronic illnesses include ƒ Visual impairment ƒ Diabetes ƒ Heart disease ƒ Hearing loss ƒ Arthritis ƒ Alzheimer’s Disease ƒ Osteoporosis ƒ Psychological Crisis o Heart disease o Cancer o Stroke o COPD • Principles of Gerontological Nursing • Minimize self-care limitations • Direct care as needed • Give older person time • Encourage to have and use personal possessions • Stimulate mental activity • Maintain challenges • Encourage socialization • Allow expression of sexual needs o Decreased health and strength o Retirement o Financial changes o Death of spouse o Accepting self as aging person o Change in living arrangements • Erikson’s Integrity versus despair • Physiological Assessment • Thorax and lungs • Heart and Vascular system • Perceptions, reasoning, judgment, intuition, and memory which allows a person to be aware of their • Memory
• NOTE: Cognitive impairment is NOT wide spread among the older adult
o This is a common misconception (ageism)
• Mini Mental State exam for cognitive function • Cognitions : Interrelated abilities, perceptions, reasoning, judgment, intuition, and memory which allows a person to be aware of their surroundings • Memory is a facet of cognition. Concerned with retaining and recalling past experiences from the • Absorption, Changes in GI motility/absorption • Plasma proteins reduced Î ^ risk of toxicity • Metabolism, Decreased liver enzymes • Medications to tx one illness cause other health problems • A disturbance of consciousness and a change in cognition that develop rapidly over a short period • (APA, 1994) • Disturbance of consciousness • Status tends to fluctuating o Changes in cognition o Develops over a short time period o Caused by direct physiological consequences of general medical condition, substance intoxication or withdrawal or other multiple etiologies ƒ Hypo/ hyperglycemia ƒ Hypoxia ƒ Hypo/ hyperthermia ƒ Electrolyte imbalances ƒ Surgery ƒ Cerebral vascular disease ƒ Congestive Heart Failure ƒ Head trauma & Seizures ƒ UTI ƒ Alcohol ƒ Anticholinergic agents & levodopa ƒ CNS Depressants ƒ Opioids ƒ Benzodiazepines ƒ Cocaine ƒ Lithium & TCA ƒ Steroids o Elderly o Terminally ill o Fever o Surgery o Night time o Lack of sleep o New or change in environment o New medication o Correct underlying cause o F/E, hypoxia, anorexia, DM etc o Low level of stimulation o Low dose neuroleptics o Low dose haldol o Depression (one of most common emotional problems - 15-30% of elderly experience) o Depression: rapid onset assoc. with some event, medication, etc. o Characterized by at least 4 of following S/S being present for a period of 2 weeks: (Clinical ƒ altered appetite or weight gain/loss ƒ altered sleep pattern ƒ expressions of self-reproach, guilt, hopelessness ƒ persistent sad, anxious or “empty” mood ƒ difficulty concentrating, remembering, or making decisions ƒ lack of energy, fatigue ƒ recurrent aches & pains that don’t respond to treatment ƒ excessive crying ƒ psychomotor retardation or agitation (irritability) ƒ loss of interest or pleasure in usual activities including sex ƒ recurrent thoughts of suicide ƒ Establish a therapeutic relationship ƒ If not responding to verbal communication, check for hearing loss before continuing ƒ Express concern for home life or institutional life as appropriate ƒ Keep promises ƒ Assist through grieving process (more with D & D) ƒ Maintain grooming, nutrition, safety, stable environment ƒ Identify & treat illness or any health problem o Acquired persistent intellectual impairment with compromised function in multiple cognitive o Primary o DAT o Multi-Infarct Dementia o Picks Disease o Lewy Body Dementia o Creutzfeldt-Jakob’s Disease o Over 65 o Genetics – 4 genes o Herpes simplex type I o Downs syndrome o Head injury- may have happened years before ƒ Loses ability to retain recent memories ƒ Forgets known address/ phone numbers o Aphasia - progressive loss of language ƒ Loses words and may replace with inappropriate ones ƒ Word searches o Apraxia - loss of purposeful movement in the absence of motor/sensory impairment o Loses more technical abilities first o No change in LOC o Thoughts - hallucinations, delusions, confabulates to maintain self ego o Emotions – rapid swings, withdrawn, confused, fearful, frightened, paranoia, dependent ƒ Profound forgetfulness ƒ Mild impairment ƒ Language ƒ Abstract thinking ƒ Attention ƒ Orientation ƒ Judgment ƒ Increased deterioration of cognitive function ƒ Changes in mood and verbal fluency ƒ Reminders for ADLs ƒ Anxious, depressed, agitated ƒ Safety ƒ Move to institution ƒ Stages of DATcont. ƒ Profound memory loss ƒ Confused over past and present ƒ Confusion r/t to being in childlike setting ƒ Incontinence ƒ Assist with all ADLs o Retirement o Possible social isolation o Sexuality o Housing and environment o Loneliness: a fear of emotional isolation • Classic signs and symptoms of disease may be absent, blunted or atypical in older adults. o For example: Geron with UTI may present with confusion, loss of appetite, weakness, • Functional Assessment of the older adult o Activities of Daily Living (ADL’s) o Bathing o Eating o Toileting o Instrumental Activities of Daily Living (IADL’s) o Shopping o Managing finances o Cooking and Housekeeping o Transportation o Managing Medications o The concurrent use of many medications, increases the risk of adverse reactions. o Refer to table 13-3 on pg 253 (Potter) o Patient Self Determination Act (1991) mandates that the rights of persons dying be upheld. o On admission patients are advised of their rights o To accept or refuse medical care. o Living Will o Durable power of Attorney for Healthcare. ƒ Nurses and students must know advance directives of pt
o Grief refers to the subjective state of anticipating or suffering the loss of a person with whom a ƒ Shock and denial ƒ Anger ƒ Bargaining ƒ Depression ƒ Acceptance • Refer to Common manifestations of Grief on pg 94 (Phipps) • Adaptation to the loss experience (pg 93 Phipps) o Adult children cause 35% abuse o Detected rather than assessed o Clinical Manifestations o Legal reporting obligations – that means YOU! o Resident Rights Under Federal Law o Care for client’s body with o Dignity o Religious/Culturally sensitive o Policies o Autopsy – death within 24 hours admit to hospital o Documentation o Identification of possible organ donors. (cultural impact) • Nurse is responsible for coordination of all aspects of care surrounding a client’s death. • Care of nurse – own concepts of death and spirituality • In the midst of winter, I finally learned that there was in me an invincible summer

Source: http://www.elcamino.edu/faculty/kbaily/Documents/N150%20Outlines/N150%20Geri%20Outline%20IA.pdf