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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.
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.
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
6 services available for those caring for older adults at home
respite care, day care, home health, nutrition programs, senior center, transportation services
congregate meals or home delivery for a nominal fee, senior centers, meals on wheels
Gov funded centers that provide recreational activities, lunch, health screening, and transportation to and from the site
Age related changes
absorption, distribution, metabolism, excretion, increased sensitivity, decreased sensitivity, adverse drug reaction
stomach contents become more alkaline, blood flow to intestines and motility is slowed leading to slower absorption
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
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
The use of many different drugs concurrently in treating a patient, who often has several health problems.
older adult may be unaware of importance of taking medication according to exact schedule
medications may be skipped or schedule altered owing to expense of the medications
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
Mortality rate of an older adult after a broken hip increases to ___-____% within 6 months of the accident
a connection formed by the dynamic interaction of individuals who play interrelated roles
whole-body syndrome that causes numerous, physical, emotional, and cognitive changes in the elderly
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
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
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
therapies/interventions and the benefits are often helpful in promoting psychosocial wellness
pet therapy, music therapy, volunteer activities, senior centers, humor, spirtuality
benefit of pet therapy
emotional support, decreases bp and heart rate, decreases tension, induces relaxtion, recover quickly
benefit of music therapy
acts as a catalyst for activity, socialization, increased cognition, and sing-alongs. a motivator for exercise and strength exercises
a way to stay engaged in life and maintain higher cognitive and physical functioning
powerful communication tool, timing, appropriateness and the person involved are all important aspects
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
missed often when people live at home, don't have visitors, get depressed and just get deeper into it
nursing skills to assess/recognize psychosocial health, age related changes, use nursing process
Why are the elderly at increased risk for HIV
pregnancy is not possible so less concerned for safe sex
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
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
includes beatings, withholding of personal or medical care, or failure to supervise an impaired person adequately to prevent injury
insilling fear through verbal assaults or demands to perform demeaning tasks, making threats, or isolating an older adult
social abuse/ violation of rights
involves being forced out of one's home, or being denied the opportunity to exercise rights as an adult
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
be aware of potential abuse and always observe for it in the older adult who cannot care for himself or herself.
the major goals of intervention
protection of the older adult and prevention of further episodes of abuse or neglect
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.
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
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
the first action that should be taken when a vulnerable adult is at risk for abuse and neglect is
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
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
setting that has recently expanded the role of the licensed practical/vocational nurse owing to enactment of the OBRA law
one example of an "atypical presentation" of illness would be
confusion as the only sign of pneumonia
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