Marie Messier, BSN, MSN, MEd Associate Professor of Nursing Germanna Community College Locust Grove, Virginia. Loretta Wack, RN, MSN Associate Professor of Nursing Blue Ridge Community College Weyers Cave, Virginia.
Coping with Chronic Disorders in Late Life 14 Living with Chronic Illness 223
Caring for Elders and Their Caregivers 23 Economic and Legal Issues 361
1 evolve.elsevier.com/Ebersole/gerontological
CHAPTER Introduction to Healthy Aging
These changes present major challenges in meeting the needs of the aging global community as the number of young adults providing care and financial support diminishes. Although the number of very old people remains small, the relative number of centenarians in the world's population is increasing dramatically only in the United States (Figures 1-3).
HEALTHY PEOPLE 2020 OverarchingGoals
As people's basic needs are met, they will feel safe and secure (Maslow's second level). While interacting with others, people often begin to satisfy their affiliation needs (Maslow's third level).
KEY CONCEPTS
It is the nurse's responsibility to help the elderly achieve the highest level of well-being given the situation that exists. Through knowledge and affirmation, the nurse can empower, strengthen and support the person's movement towards the highest possible level of well-being and quality of life.
ACTIVITIES AND DISCUSSION QUESTIONS
The nurse and the elder jointly implement interventions to achieve individual goals and evaluate their effectiveness. Compare your drawing with others who have done the same and discuss the implications of the picture.
Consider Maslow's hierarchy of needs and discuss which level you think is most important. Research the American Nurses Association's scope and standards for gerontological nursing practice and the recommended competencies for gerontological nursing practice.
CHAPTER Gerontological Nursing History,
Knowledge of aging and gerontological nursing is foundational knowledge for the nursing profession (Young, 2003). BOX 2-1 Reflections on gerontological nursing by gerontological nursing pioneers and current leaders in the field.
HEALTHY PEOPLE 2020 Older Adults
I think we do a pretty good job here because a lot of patients say when they leave and come back, 'Oh, I'm so glad to be home.' Our philosophy here is that we don't work in this institution, we are guests in these people's homes."
CHAPTER
Note: This list of rights is a sample of federal and some state lists of rights of long-term care residents or participants. Nurses should check.
SAFETY ALERT
Past, current and recent losses Losses involved in the decision to move Feelings of powerlessness. Interpreter A person who transfers the meaning of what is spoken, in one language, into another.
CHAPTER Culture and Aging
HEALTHY PEOPLE 2020 Goals to Reduce Potentially Preventable
Department of Health and Human Services, Office of Disease Prevention and Health Promotion: Healthy people 2020.
HEALTHY PEOPLE 2020 Goals for Immunizations
Although there are many ways that nurses can promote healthy aging in the presence of these changes, when nurses can begin to differentiate these normal changes from the signs and symptoms of potential health problems, the positive impact of nursing interventions is multiplied. Many normal aging changes can be misinterpreted as pathological, and some pathological conditions can be mistaken for normal aging changes. In McCance KL, Huether SE, Brashers VL, et al, editors: Pathophysiology: the biological basis of disease in adults and children, St.
In McCance KL, Huether SE, Brashers VL, et al, editors: Pathophysiology: the biological basis for disease in adults and children, ed 6, St. In Halter B, Ouslander J, Tinetti M, et al, editors: Hazzard's principles of geriatric medicine and gerontology, New York, 2009, McGraw-Hill, pp.
CHAPTER Social, Psychological, Spiritual,
CHAPTER Assessment and Documentation
The assumption of confidentiality in the use of the first name when addressing an elderly person can easily be perceived as condescending, especially when the nurse is younger than the patient or of a different ethnic background. For example, if the patient says "I have a runny nose", this is not recorded as "The patient has a cold" until analysis of the data. This naturally implies that data collection is followed by analysis and determination of the person's needs followed by development of nursing interventions.
The beginning of the health history marks the beginning of the nurse-client relationship and the assessment process. In older adults, family history itself becomes less important as the person ages and is replaced by the increasing importance of
EVIDENCE-BASED PRACTICE
Because of the complexity of life and health in later life, this raises the responsibility of the nurse. Both arms should be checked (at heart level) and the highest used recorded. Support one arm of the person while he or she positions the legs as demonstrated above.
The FIM provides much more detail and therefore a better picture; however, in the detail is the problem of the time. At the end of the assessment, a cumulative impairment score (CIS) is established, which can range from the most able (6) to total disability (30).
APPENDIX Chapters in Which Assessment
CHAPTER 8
The older the person gets, the more likely the body will have an altered or unreliable response to the drug. Drug metabolism is also biorhythmic due to changes in the liver during the day. It has been estimated that 27% of ADRs in the community and 42% of those in the nursing home are preventable (AGS, 2012).
Another common side effect seen in older adults is lethargy, especially with the use of some cardiovascular and antidepressant drugs. Because of the complex needs of the elderly patient, education can be particularly challenging.
Administration of Medications Through Enteral Feeding Tubes: The Three Most
Since the development of newer drugs such as selective serotonin reuptake inhibitors (SSRIs) and SNRIs (serotonin-norepinephrine reuptake inhibitors), MAOIs and TCAs are rarely used to treat depression in older adults. However, due to the aforementioned problems, they should be avoided except in extreme cases. Although it most often occurs in the first 2 weeks after starting treatment, each dose increase should also be considered.
What are the age-related changes that occur in the pharmacokinetics of older adults. Explain the role of the elder, caregiver, and social network in reducing drug abuse.
CHAPTER Nutrition and Hydration
Develop a care plan to help an older person develop and maintain adequate nutrition and hydration. Dysphagia and oral care are included as additional concerns related to adequate nutrition in older adults. Readers are referred to a nutrition text for more comprehensive information on nutrition and aging and disease.
The 2010 Dietary Guidelines for Americans, an evidence-based nutritional guideline published by the federal government, is designed to promote health, reduce the risk of chronic diseases, and reduce the prevalence of overweight and obesity through improved nutrition and physical activity. (www.dietaryguidelines.gov). In addition to the main recommendations, there are recommendations for specific population groups, including older adults (U.S. Department of Agriculture [USDA], 2012).
HEALTHY PEOPLE 2020 Nutrition and Weight Status
For older adults who are not getting enough dietary calcium, supplemental calcium may be used. The increasing incidence of malnutrition in older adults has been documented in acute care, long-term care and the community. Protein-energy malnutrition (PEM) is the most common form of malnutrition in older adults.
For elderly people with a computer, shopping via the internet and having groceries delivered offers advantages, although the prices can be higher than in the store. Older adults in hospitals and long-term care facilities are more likely to have a number of problems that contribute to inadequate nutrition.
Evidence-Based Practice Nutrition, Oral Care, Hydration
Printouts can provide the elder and caregiver with a visual chart of intake. Muscle mass measurements are obtained by measuring the arm circumference of the non-dominant upper arm. Skin turgor, assessed at the sternum and often included in the assessment of dehydration, is an unreliable marker in older adults due to the loss of subcutaneous tissue with aging.
It is important to obtain a careful history of the older adult's response to dysphagia and to observe the person at meal times. PEG tube feeding deprives people of the taste of food and contact with caregivers during feeding.
HEALTHY PEOPLE 2020 Dental Health Goals for Older Adults
Patients and families also need education about the importance of good oral health in older adults and techniques for providing adequate oral care. Protein-calorie malnutrition (PCM) is the most common form of malnutrition in older adults. Age-related changes in the thirst mechanism, reduction in TBW, and decreased kidney function increase the risk of dehydration in older adults.
Available at http://nurse-practitioners-and-physian-assistants.advanceweb.com/article/malnutrition-in-older-adults. Mentes JC: Oral hydration in older adults: greater awareness is needed in the prevention, recognition, and treatment of dehydration, Am J Nurs.
151Elimination
CHAPTER 10
Urinary incontinence (UI) is the involuntary loss of urine sufficient to be a problem (Dowling-Castronovo, 2008; . Dowling-Castronovo & Bradway, 2012). Dementia does not cause urinary incontinence, but affects the person's ability to find a bathroom and recognize the urge to void. Older adults with UI experience loss of dignity, independence, and self-confidence, as well as feelings of shame and embarrassment (MacDonald & Butler, 2007; Dowling-Castronovo & . Spiro, 2008).
Nursing Practice Standard Protocol: Urinary Incontinence (UI) in Older Adults Admitted to Acute Care (Dowling-Castronovo &. Assessment of Urinary Incontinence in Older Adults: Part I: Transient Urinary Incontinence (Dowling-Castronovo & Spiro, 2013) http:// consultgerirn.org/uploads/File/trythis/try_this_11_1.pdf.
Continence Care
Reason for
Liquid
- Beverley-Travis Natural Laxative Mixture Ingredients
Subjective and objective measures included in sleep assessment available to nurses include visual analog.
EVIDENCE-BASED PRACTICE Sleep
How many times there is a call for help to the toilet or for pain medication or subjective symptoms of inability to sleep (e.g. anxiety). Regular physical activity throughout life is likely to improve health and functional status as people age.
HEALTHY PEOPLE 2020 Physical Activity
Frail adults will need more comprehensive assessment and close monitoring to ensure benefits without compromising safety. they are adults. Motivational interventions are important when encouraging older adults to initiate and maintain physical activity. How would you rate an older person for the adequacy or inadequacy of rest, sleep, and activity?
Bloom H, Ahmed I, Alessi C, et al: Evidence-based recommendations for the assessment and management of sleep disorders in. Centers for Disease Control and Prevention: How Much Physical Activity Do Older Adults Need? (2011).Available athttp://www.cdc.
CHAPTER Promoting Healthy Skin and Feet
Nutritional deficiencies and smoking lead to dehydration of the outer layer of the epidermis. It is a symptom, not a diagnosis or disease, and is a threat to skin integrity because of the attempts to relieve it by scratching. If rehydration of the stratum corneum is not sufficient to control itching, cool compresses, or oatmeal or Epsom salt baths may be helpful.
The onset may be preceded by itching, tingling or pain in the affected dermatome several days before the onset of the rash. Skin cancer (including melanoma and non-melanoma skin cancer) is the most common of all cancers.
