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Promoting a self care environment, promoting psychosocial health and wellness, protecting the vulnerable older adult

Acute Care Environment

Primary objective is to get the medical condition resolved. The big picture is important to focus on to incorporate rehabilitative techniques.

Negs of acute care environment

lack of quality sleep, med or electrolyte imbalances can cause confusion, lack of time for staff to assist with ADL's, limited space and privacy, unusual noises and odors, sensory overload.

Long term care environment

required when the older adult needs help meeting everyday needs.

Two categories of residents are found in a long term care facility

Short term and long term

skilled nursing facility environment

offers subacute care that has a strong rehab focus and a shorter length of stay

Four most common client care needs (at skilled nursing facilities)

physical rehab, stroke rehab, wound care, and recovery from hip fracture

Home care environment

older adult receives care at home from family members or organized sources such as visiting nurses or home health aides.

The typical caregiver is

female and over 65

assisted living

separate living quarters, community activity area, and dining room. provides supervision to relatively independent older adults and some health services

adult day care

a setting that provides structured activities during the day much like a child day care.

medical model of adult day care

provides health care services along with structured activities during the day

social model of adult day care

stresses social activity during structured activities during the day

respite care

scheduled stays at a facility to give "time off" to a caregiver

6 services available for those caring for older adults at home

respite care, day care, home health, nutrition programs, senior center, transportation services

home health

assistance with ADL's via aide or nursing care via nurses at home

nutrition programs

congregate meals or home delivery for a nominal fee, senior centers, meals on wheels

senior center

Gov funded centers that provide recreational activities, lunch, health screening, and transportation to and from the site

transportation services

transportating services for grocery shopping or medical appts

Age related changes

absorption, distribution, metabolism, excretion, increased sensitivity, decreased sensitivity, adverse drug reaction

absorption

stomach contents become more alkaline, blood flow to intestines and motility is slowed leading to slower absorption

NI for absorption

always administer meds on time

distribution

slower d/t decreased circulation, decreased body water & increased body fat causing a sustained release and the drug to remain in the body longer. Can cause greater effects or toxicity

NI for distribution

Start low with dosage and go slow, checking for toxicity

metabolism

occurs in the liver. decrease in liver size and blood flow and functions in the kidney

NI for metabolism

A little goes a long way

excretion

occurs in the kidney and is slowed due to reduced blood flow and function in the kidneys

NI for excretion

lower doseages recommended

increased sensitivity

can be increased with CNS drugs

NI for increased sensitivity

monitor and assess

decreased sensitivity

can be decreased with cardiac drugs

NI for decreased sensitivity

monitor and assess

adverse drug reactions

not always typical and can arise after a drug is D/Cd

NI for adverse drug reactions

monitor, assess, report, document

Factors that can lead to medication misuse

loss of manual strength, decreased dexterity, visual changes, memory deficits, knowledge deficits, cultural values, financial concerns

loss of manual strength/decreased dexterity

older adult may not be able to open childproof containers

visual changes

small typeface on prescription label/ bottle may be misread

memory deficits

complex med regimens may be difficult to remember, polypharmacy can cause confusion

polypharmacy

The use of many different drugs concurrently in treating a patient, who often has several health problems.

knowledge deficits

older adult may be unaware of importance of taking medication according to exact schedule

cultural values

older adult may have cultural bias about medications not shared with caregivers

financial concerns

medications may be skipped or schedule altered owing to expense of the medications

Normal temperature for elderly

96.4 to 99.1

normal pulse for elderly

60 to 100

normal resp rate for elderly

10-20/min

normal systolic b/p for elderly

110-140

normal diastolic b/p for elderly

60-90

Examples of ADLs

grooming, bathing, dressing, eating, elimination, mobility

ADL

activities of daily living

IADL

shopping, managing finances, making it to appts on time, cooking, ect

IADL

instrumental activities of daily living

Fall risk factors in the older adult

Cognitive impairment, problems with mobility(decreased muscle strength, unsteady gait, loss of balance), acute or chronic illness, sensory impairment, environmental hazards: extension cords, loose rugs,ect), unfamiliar environments, medications, normal changes from aging, dehydration

NI to decrease the fall risk in the older adult

Strengthing exercises, physical activity to improve strength mobility & flexibility, environmental modifications(grab bars & railings), clothing modifications:nonskid footwear, adequate staffing/supervision, judicious use of medications that have sedative effects, education regarding proper use of mobility aids

How to assess the elderly

Use head to toe assessment, know normal changes of aging, realize there may be typical/atypical presentation

Typical/atypical presentation may be related to

age, interactions of chronic conditions with acute illness, under reporting of symptoms

6th leading cause of accidental death among older adults over age 65

falls

most preventable and prevalent accident among elderly

falls

The greater the number of risk factors the greater the risk of

falls

Mortality rate of an older adult after a broken hip increases to ___-____% within 6 months of the accident

60-65%

lead to injuries, fractures, and hospitalizations as well as loss of independence

falls

socially accepted behavior pattern

role

a connection formed by the dynamic interaction of individuals who play interrelated roles

relationship

sets standards for designated roles and relationships

each culture and subculture

major problem among the elderly but is not a normal part of aging

depression

whole-body syndrome that causes numerous, physical, emotional, and cognitive changes in the elderly

depression

depression most often occurs when elderly face

physiologic stress, loss of control over a situation, lack of support of significant others, normal coping mechanisms overwhelmed by stressors

risk factors for depression include

bereavement, illness, isolation, alcoholism

symptoms of depression as listed in DSM IV

Changes in appetite and weight, disturbed sleep, motor agitation or retardation, fatigue and loss of energy, depressed or irritable mood, loss of interest or pleasure in usual activities, feelings of worthlessness, self-reproach or excessive guilt, suicidal thinking or attempts, difficulty with thinking or concentration

signs of symptoms of depression in older adults

pseudodementia, chronic pain, anxiety disorder, alcohol and/or other substance abuse, somatization

goals of treatment of depression in old folks

decrease symptoms of depression, reduce risk of relapse and recurrence, improve quality of life, improve medical health status

common treatment for depression in elderly

counseling, antidepressants

at least ___ people 65 years and older commit suicide each year

6000

Who is the most likely to commit suicide

White men, especially over the age of 85

increase risk of suicide

social isolation, serious depression, Hx of self destructive behaviors, life events such as loss of loved one, uncontrollable pain, and major life changes such as retirement

What is included in the basic criteria for psychological health?

In touch with reality, able to cope with ADL's, functions within the rules of society

become more ingrained resulting in less flexibility in problem solving and behavior

personality traits

therapies/interventions and the benefits are often helpful in promoting psychosocial wellness

pet therapy, music therapy, volunteer activities, senior centers, humor, spirtuality

pet therapy

widely used because of healing effect both physically and mentally

benefit of pet therapy

emotional support, decreases bp and heart rate, decreases tension, induces relaxtion, recover quickly

music therapy

based on need and individual task, a way of touching the very core of the older adult

benefit of music therapy

acts as a catalyst for activity, socialization, increased cognition, and sing-alongs. a motivator for exercise and strength exercises

volunteer activities

a way to stay engaged in life and maintain higher cognitive and physical functioning

benefit of volunteer activities

enhanced sense of purpose, giving back to society

senior services

focus on senior services, best serves those who are able to come to the centers

humor

powerful communication tool, timing, appropriateness and the person involved are all important aspects

benefit of humor

relieves stress, releases endorphins, enhances memory and learning

spirtituality

unique to each older adult. assessment of this is part of the nursing process but is often neglected by nurses

benefit of spirituality

there is a connection between spiritual well-being and a sense of purpose in life

depression is often misdiagnosed as

alzheimer's, dementia

role change

changes in family dynamics

examples of role changes

grandmothers caring for grandkids

Two parts of erik eriksons theory

integrity and despair

integrity

acceptance of the life they have lived and feeling at peace with life

despair

not able to accept their lives, not at peace

threats to psychological wellness

powerlessness, alcohollism, depression, suicide

powerlessness

no independency, don't allow to do what they can for themselves

alcoholism

missed often when people live at home, don't have visitors, get depressed and just get deeper into it

nurses role

nursing skills to assess/recognize psychosocial health, age related changes, use nursing process

is an important part of psychosocial health

sexuality

__% of HIV cases are in the older adult population

15

Why are the elderly at increased risk for HIV

pregnancy is not possible so less concerned for safe sex

promotes psychosocial well-being, can be expressed in many different ways

sexuality

Nursing role in sexuality

respectful of age appropriate behavior, set limits on inappropriate or harmful behavior, provide privacy

personal belief of how a person came to being, the meaning of life and the meaning of death

spirituality

nursing role of spirituality

knowledge of practices and religions

abuse

the willfull infliction of physical pain, injury, or debilitating mental anguish, unreasonable confinement, or the willfull deprivation of services necessary for the mainenance of physical or mental health

physical abuse

includes beatings, withholding of personal or medical care, or failure to supervise an impaired person adequately to prevent injury

psychological/emotional abuse

insilling fear through verbal assaults or demands to perform demeaning tasks, making threats, or isolating an older adult

financial abuse

theft or mismanagement of money or personal belongings

social abuse/ violation of rights

involves being forced out of one's home, or being denied the opportunity to exercise rights as an adult

5 types of abuse

physical, psychological/emotional, financial, social, violation of rights

four common indicators of abuse

unexplained bruises, repeated falls, lab values inconsistent with history, fractures or bruises in various stages of healing

common indicators of neglect

listlessness, poor hygiene, evidence of malnutrition, inappropriate dress, pressure ulcers or urine burns

five components of assessment and treatment of abuse and neglect

identification, access and assessment, intervention, follow-up, prevention

identification

be aware of potential abuse and always observe for it in the older adult who cannot care for himself or herself.

access

must be obtained before assessment can take place

assessment

focused questions

intervention

based on the findings of the assessment

the major goals of intervention

protection of the older adult and prevention of further episodes of abuse or neglect

follow-up

checking in on them to make sure the intervention is working

primary prevention

early efforts, designed to foster well-being, include interrupting the cycle of family violence, promoting effective family communication, increasing family understanding of the aging process, and maximizing nonfamily natural helping networks for dependent older adults.

secondary prevention

later efforts directed toward early detection and treatment, include identifying older adults at risk for self-neglect or abuse, identifying families at risk for abuse and neglect, monitoring high-risk situations, counseling, and recommending substance abuse programs.

designed to protect the moral and legal rights, deminish the uncertainty of what should be done, reduce conflict among decision makers

advance directives

two most common types of advance directives

living wills, durable power of attorney (DPOA)

living wills

documents in which clients express their health care wishes should they become terminally ill and lose the ability to make decisions

durable power of attorney

allows an individual to designate a person to make decisions under specific circumstances such as incompetence, incapacity, or terminal illness. person is called a proxy

beneficence is an ethical principle that means

doing good

older people are frequently restrained because they

are likely to be confused

one alternative for restraint use is

providing companionship

an indication that an older person is at risk for abuse is

alcohol abuse

the first action that should be taken when a vulnerable adult is at risk for abuse and neglect is

identification

which of the following defines emotional well-being as it applies to the older adult

able to adapt to age-related changes

according to the Georgia Centenarian study, which characteristics accurately reflect centenarians

optimistic, hopeful, engaged

what is the role of families in the continuing care of older adults

more involved then ever

how does depression become a threat to psychosocial wellness for the older adult

underlying cause of illness and suicide

why is the nursing role significant in promoting psychosocial wellness in the older adult

nursing process can uncover many problems that the nurse can respond to

serves as a bridge between acute care and long-term care

subacute care setting

setting that has recently expanded the role of the licensed practical/vocational nurse owing to enactment of the OBRA law

long-term care

a correctly stated normal change of aging that affects pharmacokinetics

Gastrointestinal motility

one example of an "atypical presentation" of illness would be

confusion as the only sign of pneumonia

most appropriate time to discuss potential postoperative complications

preoperatively

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