Geriatric Nursing 1.

67% live in family setting

2. 66%- child within 30 minutes
3. 62%- weekly visits
Terms 4. 76%- talk weekly
geriatrics- study of old age including physiology, pathology, dx., 3. sickness & aging synonymous
& treatment of diseases of old adults 1. almost 50% rate health as good or excellent
gerontology- broader, the study of the aging process including 2. 28% 65+ assessed poor health
biological, psychological, & sociological 4. incapable of learning- although slowed due to
gerontologic or gerontic nursing- specializes in care of the elderly reflexes, capable of learning new things
5. no longer interested in sexuality/ sexual act
Aging 1. sexuality (lifelong need)
normal process of time related change starting with birth & 2. can provide intimacy & love without sexual
continuing throughout life way person ages influenced by relations
1. genetics 6. constipation/ incontinence- expected
2. lifestyle 1. never normal
3. availability & quality of health care 2. constipation due to inactivity or diet
4. socioeconomics 3. incontinence- seek medical help
5. 7. senility- expected result of age
old age- final phase of life predict by 2030- 69.4 Million (8 Mil. 1. senility (dementia found in elderly)
over 85) 2. dementia- result of disease- not aging
23% over 65 while only 18% under 18 8. elderly financially impoverished
ageism- prejudice against distinct group define by age 1. median net worth- $86,300
boundariesstereotypes 2. poverty rate- 12.9%
1. 3. median income- $28,983
1. simplified and often untrue beliefs 9. spend last years in nursing home
2. reinforce society's negative image of the aged 1. about 5% in nursing home
3. about 5% live in nursing homes 2. % increases with age (+1%- 65-74, +4%- 75-
84, 20%- 85+)
Old Age
definition varies with frame of reference society indicates age 65 Income
as beginning of old age Social Security (Federal Old-Age, Survivors, & Disability
1. Insurance)
1. young-old- 65-74 1.
2. middle-old- 75-84 1. single largest source
3. old-old- 85 & up 2. funded by employee & employer payroll taxes
3. benefits determined by age, earnings, & credits
Terms worked
life span- maximum number of years person can live under the 4. reduced benefits can start at 62
best of conditions in absence of disease 2. SSI- Supplemental Security Income
life expectancy- average number of years a person can be 1. provides for disabled, blind, or aged with limited
expected to live incomes or resources
2007: 77.7 years 2. generally under age 62
over 80% have @ least 1 chronic illness, 50% have 2
34 Million older- 4.4 Million (14.5%) difficulty with @ least 1 Psychological Aspects
ADL (eating, bathing, dressing, transferring, toileting) developmental theories
about 1 of 8 1.
fastest growing age group- over 75 1. Freud, Sullivan
2. Maslow (hierarchy of needs)
Myths vs Reality 3. Erikson
1. 1. eighth stage- 65-100 years
1. families do not care for elder- 80% do take care 2. integrity vs despair
2. elderly- alone & deserted
 1. integrity- acceptance of self, in control, 5. skin drier & more susceptible to irritation
dignity 6. change in pigmentation (age or liver spots)
2. despair- disappointed, dissatisfied, out 7. nails- thick & brittle
of control 8. less efficient cooling system
4. Peck (expanded Erikson), Havighurst 9. less tolerance to temperatures
achievements & adaptations recommended for the aged 10. Recommend
1. 1. avoid sun
1. maintain feelings of worth 2. avoid heat
2. resolve old conflicts; 3. dress warmly in winter
3. adjust to loss of power roles 4. bathe 1-2 weekly
4. adjust to deaths of significant others 5. oil or lotion prn
5. adapt to environmental changes; 2. Nervous
6. maintain optimum level of wellness 1. slowed reactions
2. altered sleep cycle
Sociologic Theories 3. short term memory loss
1. disengagement 4. impaired senses
1. controversial 5. Recommend
2. mutual withdrawal from social interaction by aged 1. at risk for accidents
& society 2. assist ADL prn
3. leisure is form of activity 3. watch for possibility of burns prn
4. respects individual rights & values 3. Sensory
2. activity 1. vision
1. individual 1. presbyopia
2. remains active & interacts with society 2. reading glasses
3. pursues new friends & interests 3. problem with blue vs green
3. continuity or development 4. difficulty adjusting to dark-light changes
1. lifelong personality characteristics continue (night blindness)
2. supportive network of relationships established 5. Recommend
1. adequate lighting
Health Promotion & Maintenance 2. avoid glare
1. personal hygiene 3. vision aids
1. bath 2-3/ week 4. large print
2. lotion prn 5. contrasting colors
3. shampoo 1-2/ week 2. hearing
4. keep nails short 1. presbycusis
5. dental supervision 2. problem with some consonants
6. try to make dresssing easier (loose clothing, zippers, 3. cerumen accumulation
velcro) 4. Recommend
2. exercise 1. low tone speaking voice
1. individual planned 2. reduce background noise
2. consider- general health, ?chronic illness, personal 3. face person
preference, environment, finances 4. enunciate clearly
3. nutrition 5. moderate pace
1. balanced 6. gestures prn
2. decrease CHO, caffeine, fat, & Na 3. touch
1. sense of touch dulled
Normal Aging Changes 2. pain threshold higher
4. taste
1. Integumentary
1. dull salt & sweet (want more sweets)
1. skin thinner
2. prefer salty & highly seasoned foods
2. less subcutaneous tissue
5. smell- diminishes
3. wrinkles
4. gray hair 4. Respiratory
 1. decreased gas exchange & cough efficiency 4. decreased saliva
2. decreased activity tolerance 5. constipation
3. more vulnerable to infection 1. lack of bulk
4. Recommend 2. prolonged use of laxatives
1. exercise 3. ignore urge to defecate
2. no smoking 4. drug side effects
3. not in smoking areas 5. emotional problems
4. force fluids 6. inactivity
5. flu vaccine 7. insufficient fluid
6. avoid exposure to infection 8. excess dietary fat
5. Reproductive 9. Recommend
1. decreased hormone production 1. regular dental & oral care
2. menopause in female 2. small frequent meals
3. decreased vaginal secretions 3. sit up after meals
4. penis & testes decrease in size 4. no heavy activity after meals
5. sperm production slowed 5. antacids with supervision
6. Recommend 6. limit laxatives
1. sexual desires & activity decline but not 9. Urinary
disappear 1. decreased nephron activity
2. water-soluble lubricant 2. lose of muscle tone results in more frequent voiding
3. sexual counselor prn 3. retention, frequency, urgency, & incontinence
6. Musculoskeletal common
1. osteoporosis 4. Recommend
2. pathologic fractures 1. ready access to toilet,
3. muscles lose strength, flexibility, & endurance 2. void regularly
4. height loss 3. pelvic floor exercises
5. changes in posture 4. avoid bladder irritants (caffeine, ETOH,
6. Recommend sweetners)
1. high Ca, low Ph 10. Endocrine
2. exercise o change in hormones
3. handle gently o decreased basal metabolic rate (BMR)
4. reduce environmental hazards 11. Immune
5. extra time to perform activities 0. decreased function
6. prevent deformities 1. more susceptible to infection & disease
7. Cardiovascular 2. atypical S&S of infection
1. heart disease leading cause of death
2. heart valves-thicker & stiffer Mental Health Disorders
3. arteries lose elasticity & accumulate deposits 1. depression
4. decreased response to stress 1. most common affective, mood, or functional disorder
5. B/P increases 2. can be reaction to loss of independence, status or
6. cardiac output decreases spouse
7. Recommend 3. some medications
1. exercise 4. physical illness & changes
2. no smoking 5. nursing
3. weight control 1. encourage self expression & esteem
4. low fat diet 2. improve appearance
5. relieve stress 3. provide structure & routine
6. check B/P 4. assist to maintain or regain control
8. GI 5. kind & understanding attitude
1. decreased motility 6. safety, security
2. decreased teeth 7. realize potential for suicide
3. ill fitting dentures 1. about 25% occur in over 65
 2. white males over 75 highest rate 4. many not receiving full benefits due to lack of
2. aggressive behavior knowledge or inability to find out resources
1. abnormal anger, rage, or hostility 1. lack of mobility
2. result of anxiety, stress, guilt, insecurity, forced 2. health problems
dependence 5. penalties of losing social security benefits if
3. nursing employed
1. express feelings 4. health
2. set limits 1. 40% more than one chronic disease
3. other- regression, paranoid behavior 2. increase in health care needs & costs
4. rehabilitation for mental problems 5. housing
1. reality orientation 1. prefer to remain independent
2. remotivation 2. live with spouse, alone, or with family
3. reminiscence 3. own own home
4. cognitive training 4. alternatives (mobile homes, retirement communities,
5. relaxation therapy foster homes, life care facilities, nursing homes,
homes for the aged, convalescent homes, rest homes,
Role Changes house sharing, public housing, rooming houses,
1. crisis- sudden, not able to plan for appropriate hotels for single room occupancy)
replacement, substitute not readily available, stress 5. require special assistance (transportation, meals,
producing health hotlines, house cleaners, homemaker services,
2. gradual- develop slowly & allow time for preparation social services, home care services)
3. changes generally crisis-forced retirement, loss of spouse, 6. recreation
illness, friends move away or die, family relocate or assume 1. more time available
new roles decreasing time for relationship 2. problems (cost, health, decreased energy, lack of
4. role losses- work (no longer bread winner), family (no incentive, sensory losses, lack of environmental aids,
longer decision maker, loss of esteem or independence) lack of conveniently located facilities)
5. role gains- new friends, activities, or interests, purpose & 3. most depend on family
opportunity, rest & relaxation 4. alternatives (religious, community activities, day
care, senior citizen centers, adult education, cultural
events)
Alterations in Life-style
1. employment
1. increase in number of older females working
Intelligence
2. decrease in number older males working test scores decline but due to slowed responses not actual ability
3. parttime employment more common learning capacity continues memory
4. early retirement 1.
5. involuntary limitations (health, sensory or 1. short term concentration & retention decline
perceptual alterations, decline in strength, 2. remote generally better personality basically
endurance, & speed) unchanged
6. strengths (reliability, dependability, knowledge,
expertise, experience) Drugs & Elderly
2. retirement account for 34% of Rx. & 40% of OTC
1. mandatory age raised to 70 average more than 11 per year
2. health problems major cause of voluntary retirement decreased dosage due to decreased absorption, distribution,
3. increased leisure time metabolism, & excretion
4. stressful when decreased ability to handle stress Recommend
5. tremendous anxiety 1.
6. loss of daily routine & income 1. education
3. economic 2. administration times compatible with lifestyle
1. fixed incomes frequently below nation's poverty 3. color coding
levels (1 of 10) 4. larger print
2. costs increase 5. easily removable caps
3. buying power decrease ETOH abuse- tolerance decreases with age, men more
 4. no slip wax on floors, no scatter rugs or deep pile
Community 5. avoid clutter
95% live in community 6. rubber tips on canes
31% live alone 7. tong reachers rather than stools or ladders
married (40% female, 74% male) 8. temperature controlled faucets
48% females widowed but only 15% males (more remarry) 9. electric rather than gas, front controls
81% have living children 10. avoid trash accumulation
11. nonskid strips in tub or shower
12. handrails, high toilet seats, shower chairs
Elder Abuse
13. night light
active or passive act or behavior that is harmful to the elderly
14. siderails on bed prn
physical violence (battering, sexual)
15. telephone by bed
personal neglect
16. proper lighting
mental anguish (threat of institutionalization, social isolation,
17. stair rails, colored strips on step edges
sensory deprivation)
18. no frayed wires
financial exploitation
19. readily available emergency numbers
violation of rights (confinement or restraint)
20. smoke detectors
denial of health care
21. crime prevention assessment
self-inflicted abuse
22. drug precautions
profile of abuser
1.
1. 40-60
Personal Space
2. female many are set in ways
3. son/ daughter, relative, caretaker prefer to be in familiar place with memories
4. married should allow as long as possible
5. semi-skilled to professional
6. whites 88% Medicare
7. protestant federal social insurance program designed to provide health care
8. high school to college to elderly entitled to social security benefits
Prevention part A- hospital
1. part B- medical
1. identify predisposing factors 1.
2. increase public awareness & education 1. (voluntary
3. knowledge of community resources 2. must pay additional fee
elder must agree to be investigated 3. out-patient
4. office visits
not covered-nonskilled home nursing care, ongoing nursing home
Safety
care, prescriptions, glasses, dental care
1. accidents
deductible
o leading cause of death
only pays 45% of health care costs
o falls most
o also fires & MVA
o more likely
Medicaid
health assistance from state & federal funds for the poor
o decreased sense
cover expenses not covered by medicare
o increased reflex time
reduce expenses after medicare exhausted
o muscle weakness
defray expenses for those unable to afford medicare fees
o confusion, forgetful
o improper footwear
o environmental hazards Agency on Aging
o drugs created through Older Americans Act of 1965
2. prevention state, regional, area, or local units
1. short or 3/4 sleeve services- nutrition (on site meals, home delivered meals), senior
2. no long garments centers, home care (homemaker, home health aide, home visits,
3. chairs with arms telephone calls, chore maintenance, repairs)
information & referral allow family time with deceased
transportation

Legalities
now must have information on advanced directives concerning
durable power of attorney & living will
durable power/ healthcare proxy-individual has power even if
elder becomes disabled or incapacitated
living will
1.
1. document to prevent "heroic measures" to extend
life
2. written earlier
3. most states accept
4. copies should be available for all concerned
individuals
5. should talk with family
6. do not put in safety deposit box

Dying
Grief
natural & normal process experienced with loss
Kubler-Ross- 5 stages (denial, anger, bargaining, depression,
acceptance)

Nursing
1. pain mgt.- routine meds with prn for breakthrough pain
2. physical- mouth care, eye drops, turn at least q2h, skin
care, bowel & bladder care, grooming
3. be aware of cultural aspects

Death
Impending Signs
Cheyne-Stokes (apnea alternating with dyspnea)
extremities- cold, pale, & mottled
skin moist & cool
B/P & temp decrease, pulse increases
pupils nonreactive
verbal- weak or absent

hearing- last sense to go

rigor mortis- temporary stiffening for 24 hours

Post- mortem Care

Rx. with respect & dignity
bathe
remove dressing & tubes if no autopsy
body alignment
dentures replaced
comb hair