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140 terms

Gerontology

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