Geriatric Nursing 2023 with complete solution

Older adults - Aging population - Surviving acute illness - Living with chronic illness - Becoming more educated and resourceful - More ethnically diverse Demographics of aging - Increasing life expectancy anticipated to continue - 77.8 for men - 80.8 for women - Young old are 65-74. - Old old are 85 and older. - Frail old have some dysfunction. Attitudes toward aging Aging is normal. Older adults have diverse characteristics. Care should not be based on age alone. Myths and stereotypes can lead to poor care. Ageism leads to discrimination and disparate care Theories of aging Genetic—genes control "genetic clocks" Immunity—focuses on the functions of the immune system Cross-linkage—chemical reaction produces damage to the DNA and cell death Free radical—molecules with separated high-energy electrons have adverse effects on adjacent molecules Common myths of the older adults - Old age begins at 65 years. - Most older adults are in nursing homes. - Older adults are sick, and mental deterioration occurs. - Older adults are not interested in sex. - Older adults do not care how they look and are lonely. - Bladder problems are a problem of aging. - Older adults do not deserve aggressive treatment for illnesses. Changes of older adulthood - Physical strength and health - Retirement and reduced income - Health of spouse - Relating to one's age group - Social roles - Living arrangements - Family and role reversal Physiologic development all organ systems undergo some degree of decline, body less efficient Cognitive development does not change appreciably, may take longer to respond and react Psychosocial self-concept is relatively stable throughout adult life Disengagement theory Aging is an inevitable, mutual withdrawal or disengagement, resulting in decreased interaction between the aging person and others in the social system he belongs to Erikson Ego integrity versus despair and disgust; life review Havighurst Major tasks; maintenance of social contacts and relationships, adjusting to health Moral and spiritual development- Kohlberg - Older adults have completed their moral development and most are at a conventional level - Many adults demonstrate conjunctive faith and trust in a greater power - Self-transcendence is characteristic of later life Housing options Home modifications Home sharing Accessory apartments Elderly cottage housing opportunities Senior retirement communities Continuing care retirement communities Assisted living Board and care homes Nursing homes Special older adult populations Homeless Older Adults Numbers are increasing. Mortality rates are 3 times higher than for those with housing. Have more health problems and appear older Require an interdisciplinary services approach Social support Elder Mistreatment/Abuse From 2-10% of community-dwelling older adults in the United States are abused, neglected, or exploited by trusted others. Mortality risk is 3 times higher. Self-Neglect Medicare - Is federally funded insurance for people 65. - Also covers those 65 with disabilities or end-stage kidney disease Medicaid - Medicaid is a state-administered, needs-based program to assist eligible low-income people with medical expenses. Care alternatives Special care needs Need assistance with ADLs Cognitively impaired Homebound No longer able to live at home Homeless Home health care Homebound Intermittent or acute health needs Supportive caregiver involvement Long- term care Transition may be difficult for patients and families Relocation stress syndrome Legal and Ethical issues Many complex and emotional situations may arise for older adults. Decisions may be difficult. You can help. Stay informed about concerns. Be knowledgeable about resources. Advocate for patients and resolution. Gerontology nursing Specialty of Gerontology Nursing Complex, skilled, creative care Older adult disease symptoms are often atypical and underreported. Patients may be fearful and anxious about both health problems and institutions of care. Aspects of geriatric nursing Physical Psychosocial & Cognitive Pharmacological Safety Goal of nursing care Promote independent function. Support individual strengths. Prevent complications of illness. Secure a safe and comfortable environment. Promote return to health. Collecting data Adapting interview techniques Determining functional status Family and caregiver assessment Recognizing geriatric syndromes Fluid intelligence The capacity to think logically Declines during middle age Crystallized intelligence and vocab and verbal reasoning Ability to use skills, knowledge and experience Improves Spatial perception - Ability to evaluate how things are arranged in space, and investigate their relations in the environment. - Constant visuospatial perception - Declines in spatial navigation tasks Synthesis of new information Declines during middle age Mental performance speed Declines during middle age Short- term recall memory Declines during old age Long- term recall memory Constant SPICES Sleep disorders Problems with eating or feeding Incontinence Confusion Evidence of falls Skin breakdown Special considerations Skin & Sensory Organs Dysphagia and Nutrition Elimination Functional Status What else with nutrition? Fluid Status Elimination Vitamin intake Protein intake Specialty diets Cardiac (low fat, low sodium, fluid restrictions*) Pureed Soft Nectar thick SCALES Sadness or mood change Cholesterol, high Albumin, low Loss or gain of weight Eating problems Shopping and food preparation problems Ethnogeriatric The specialty of providing culturally competent care to older adults Primary and preferred social support Family caregivers Semiformal levels of support Clubs, faith-based organizations, neighborhoods, senior centers Formal systems of support Social welfare agencies, health facilities, government agencies Nursing implementation Acute Care — Depression Not a normal part of aging 20% of suicides Co-occurs with medical conditions Geriatric Depression Scale Depression Range: 16-30% of nursing home residents. Events, loss, chronic illness, pain Signs and symptoms? What about suicide? Treatment for depression? Delirium - Acute, confused state that begins with disorientation. - If not immediately evaluated and treated, can progress to changes in level of consciousness, irreversible brain damage, sometimes death. Dementia - Broad term for syndrome characterized by general decline in higher brain functioning (reasoning) with pattern of eventual decline in ability to perform even basic activities of daily living (toileting, eating). - Vascular Dementia - Alzheimer's disease Sundowning - Common observed tendency for people with dementia to become more confused and agitated around late afternoon to nightfall. - May resemble delirium. - Decreased attention, altered sleeping/waking pattern, and disturbed psychomotor behavior. - No specific cause. - Modified and/or managed with behavioral interventions. Alzheimer's disease Chronic, progressive, degenerative Disease of the brain Most common form of dementia ~5.2 million Americans suffer from AD. 11% people over age 65 have AD. ~ 33% of those over age 85 have AD. 6th leading cause of death in the United States Alzheimer's - Only cause of death among the top 10 that cannot be prevented, cured, or even slowed - Burden of care is staggering. - Known as the "long good-bye" or "death in slow motion" Cause of Alzheimer's - Exact cause is unknown -Likely a combination of genetic and environmental factors Early onset 60 years old Late onset 60 years old Familial Alzheimer's disease (FAD) - Clear pattern of inheritance - Onset before age 60 - Rapid disease course Sporadic Alzheimer's disease - No familial connection Affects of the brain from Alzheimer's - Gradual loss of connections between neurons and neuron death - Results in structural damage - Affected parts of brain shrink - Brain atrophy - Significant in final state of AD Retrogenesis - Process where degenerative changes occur in the reverse order in which they were acquired - Developmental stages in children compared with deterioration in AD patients Early signs of Alzheimer's disease 1. Memory loss that affects job skills 2. Difficulty performing familiar tasks 3. Problems with language 4. Disorientation to time and place 5. Poor or ↓ judgment 6. Problems with abstract thinking 7. Misplacing things 8. Changes in mood or behavior 9. Changes in personality 10. Loss of initiative As the disease progresses.... ↓ Personal hygiene ↓Concentration and attention Unpredictable behavior Delusions and hallucinations Changes are not under the control of the patient Additional cognitive impairments Dysphasia Apraxia Visual agnosia Dysgraphia Some long-term memory loss Wandering Severe late stage Alzheimer's - Unable to communicate - Cannot perform activities of daily living (ADLs) - Patient becomes unresponsive and incontinent. - Total care is required. Cure? - There is no cure - No treatment exists to stop the deterioration of brain cells in AD. Collaborative management aimed at - Controlling undesirable behavioral manifestations - Providing support for the family caregiver Actual diagnosis What is actually going on with the person Wellness diagnosis Person's well being Potential diagnosis What are they at risk for? Nursing management - Supporting cognitive function - Promoting physical safety - Promoting independence in self-care activities - Reducing anxiety, agitation - Improving communication - Providing for socialization, intimacy needs - Promoting adequate nutrition - Promoting balanced activity, rest - Supporting home and community-based care Use of restraints Acute Care — Physical restraints Chemical restraints Used to ensure safety ONLY Least restrictive approach Highly regulated Geriatric syndromes - 65 & older - Cognitive impairment, falls, low BMI, dizziness, hearing/ seeing impairment Pharmacology - Pharmacokinetics - Interactions - Polypharmacy - Quality of life - Financing - Adherence - Risk - Safety Safety Medications, Falls, Environment, Toileting, Turning, etc. How do we assess risk? PREVENTION IS KEY !!!! Causes of accidental injuries - Changes in vision and hearing - Loss of mass and strength of muscles - Slower reflexes and reaction time - Decreased sensory ability - Combined effects of chronic illness and medications - Economic factors Patient education - Chronic illness limits activities in almost half of older adults. - Meeting expenses of healthcare is often difficult. - Medication costs, hospitalization costs, and costs of special equipment and supplies - Family members must learn to cope with needs of the ill person. - Family members must adapt to psychological stressors. On which two principles should gerontologic nursing care be based? - Most older adults are not impaired but are functional members of the community who benefit from health-oriented interventions. - Older adults are more vulnerable to physical, emotional, and socioeconomic problems than people in other age groups. - May require special attention to health promotion/maintenance How can the acronym SPICES assist you, specifically, in your gerontologic nursing practice? SPICES is an acronym for an effective assessment tool in identifying common problems older adults may experience, which can lead to negative outcomes—in any setting. The letters and their corresponding assessment area include: SPICES S: Sleep disorders P: Problems with eating or feeding I: Incontinence C: Confusion E: Evidence of falls S: Skin breakdown Social gatherings, travel, attending sporting events, and so on are part of the residents' daily lives. What are some of the purposes of these activities? - Assists in adapting to life role changes - Need for one's socialization doesn't change with aging - Prevents loneliness and isolation - Results in increased life satisfaction - Increases the ability to maintain high levels of activity and function - Allows one to share common interests and concerns - Enables one to find status among peers What are some of the changes that can occur as a result of increasing age in an older adult? Physical strength and health Retirement, reduced income Spouse's health Relating to one's age group Social roles Living arrangements