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GERIATRICS

Goal of Geriatric Nursing

“Promoting, and maintaining functional status and helping older adult to identify and use their strength to achieve optimal independent DEFINITION OF TERMS

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Geriatrics - the study of old age , include the physiology, pathology, diagnosis, and management of the diseases of older adults Gerontology - study of aging process, draws from psychological, biological, sociologic science Geriatric Nursing - is the field of nursing that specializes in the care of the elderly DEFINITION OF TERMS

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Ageism- bias against older people w/o considering their functional status Intrinsic aging- refers to those changes caused by normal aging process Extrinsic aging- refers to aging that results from influences outside the person

CAUSE OF DEATHS IN 65 YRS AND ABOVE Heart diseases Neoplasms Cerebrovascular diseases COPD Pneumonia and influeza DM Accidents Alzheimer’s diseases Renal problems

BIOLOGIC THEORIES OF AGING Immune system theory Cross-linking theory Free radical theory Stress theory (wear and tear) Genetics theory Neuroendocrine theories

IMMUNE SYSTEM THEORY

autoimmune disease. cause physical decline by damaging proteins. degradation of elastin and collagen causes connective tissue to become stiffer and less elastic Different Aspect of Aging : . causing controversy over the concept GENETICS THEORY • times Pre-programmed life expectancy. Cells can only divide a specific number of • • • Life expectancies among family members is similar. eg. body’s ability to maintain homeostasis become increasingly diminished with cellular aging and organ system 2. interfering with normal cell functioning and intracellular transport over a lifetime Eventually causes tissue and organ failure FREE RADICAL THEORY Molecules that are highly reactive as a result of oxygen metabolism in the body Over time. will eventually “wear out” secondary to repetitive usage. and cancer with aging CROSS-LINKING THEORY a chemical reaction that binds glucose to protein. enzymes and DNA Beta-carotene and Vitamins C and E are naturally occurring anti-oxidants that counteract the free radicals STRESS THEORY (wear and tear) • The body. which causes abnormal division of DNA. cells become less able to replace and accumulate as pigment called lipofuscin 3. like any machine.• • • • • • • The two primary immune organs. the children are more likely to live to that age NEUROENDOCRINE THEORIES Anterior pituitary hormones are thought to contribute to the aging process An imbalance of certain chemicals in the brain may contribute to altered cell division within the body NORMAL AGE –RELATED CHANGES Intrinsic aging – changes cause by normal aging process Extrinsic aging – influences outside the person) air pollution. If the parents died over the age of 80. illness and disease that may hasten the aging process 1. which contributes to a decline in T-cell production and stem cell efficiency Increase of infections. damage and stress • While this theory is seen as having some merit. the thymus and bone marrow. are affected by the aging process. individuals react differently to stress (positive and negative).

being in control of one’s life HAVIGHURST DEVELOPMENTAL THEORY OF AGING task of older people are the ff: • 1. adjusting to retirement after a lifetime of employment with possible reduction of income • 2. Developmental theory of aging .determined by past experiences 2. adapting to new social roles in a flexible way • 6.erickson – ego integrity vs despair . Stress and coping in the older adult .Havighurst 3. accepting one’s lifestyle 2. social environmental losses related to loss of income and decrease abilities to perform previous roles and activities 4.positive self-image . sociologic theories of aging COMMON STRESSORS 1. believing that one’s choice were the best at particular time 3. normal aging changes that impair physical function. death of significant others 5.• • • • • Physical aspect of aging Psychosocial aspect of aging Cognitive aspect of aging Environmental aspect Pharmacological aspect PHYSICAL CHANGES OF AGING PSYCHOLOGICAL ASPECT OF AGING • Ageism – prejudice or discrimination against older people • Comprises of the ff: 1. activities and appearance 2. death of spouse • 4. disabilities from chronic illness 3. decreases in physical strength and health • 3. establishing satisfactory physical living arrangement COMBINING THE CONCEPT: ERICKSON AND HAVIGHURST . lack of social engagement ERICKSON DEVELOPMENTAL THEORY OF AGING • • ego integrity vs despair Achieving ego integrity: 1. establishing affiliation with one’s age group • 5.

1hour to several days 3.influences by the ff: 1.lifetime ESSENTIAL COMPONENTS OF MEMORY PROCESS • • 1. conflict resolution 3.life satisfaction in normal aging requires maintaining the active lifestyle of a middle age Continuity theory . memory COGNITIVE ASPECT OF AGING 1.5 to 30 secs. recent memory . short-term memory. intelligence – decline beginning in midlife (spatial perception and non intellectual information) 2. learning 3. maintenance of optimal level of wellness SOCIOLOGIC THEORIES OF AGING • • • Sociologic theories . acquisition of information 2. physical status 3. maintenance of self-worth 2. memory-integral part of learning 1. intelligence 2. sensory impairment 2. adjustment to the death of significant others 5. 2. adjustment to the loss of dominant roles 4. environment and psychosocial influences Comprises by the ff: 1.successful adjustments to old age requires continuing life patterns across a lifetime COGNITIVE ASPECT OF AGING Affected by the ff: • • • • • • 1. learning – decline especially after 7th decade of life . long term memory. motivation 2.attempt and predict social interaction and roles that contribute to the older adult successful adjustment to old age Activity theory. physiologic health 3. environmental adaptation 6. speed of performance 3.• • • • • • 1. registration .

a document that assess and evaluates a client’s present. keep teaching periods short 10. living arrangement option 2. anti-slip mat. health care and living needs Role of family. links new information with familiar information 4. sharply contrasting colors. auditory and other sensory cues 5. encourage verbal participation of learners 11. supplies mnemonics to enhance recall of related data 2. community support services 5. recall benign senescent forgetfulness – age-related loss that affect the short term and recent memory ROLE OF A NURSE 1.planning for care and understanding psychosocial issues in adults must be accomplished w/in the context of the family ENVIRONMENTAL ASPECTS OF AGING Community support services – helps the older person to maintain independence Home health care – means to prevent hospitalization Safety and comfort in the home – adequate lighting. future. grab bars. life care plans 3. loose clothing and ill-fitted shoes should be avoided. sets short term goals with input from the learners 9. provides glare – free lighting 7. familiar settings . safety comfort in the home environment 7. uses visual. hospice services LIVING ARRANGEMENT OPTIONS    • • • • • Continuing Care Retirement Communities (CCRCs) Assisted living facilities Skilled nursing facility ENVIRONMENTAL ASPECTS OF AGING Life care plans .• • 3. reinforce successful learning in a positive manner ENVIRONMENTAL ASPECT OF AGING 1. home health care 6. provide quiet non distracting environment 8. encourage ongoing learning 3. encourage learners to wear prescribed glasses and hearing aids 6. role of the family 4. retention 4.

impaired mobility 2. Prolonged medication actions due to slowing metabolism causing increase tissue and plasma levels 7. Meds w/ a narrow safety margin (digitalis) must be administered cautiously 3. urinary incontinence 5. explain the reaction.reduce capacity of the liver and kidney to metabolize and excrete the medications. High fiber diet and use of psyllium (metamucil) or other laxatives may accelerate GIT transport and reduce absorption of meds 9. AIDS COMMON MENTAL PROBLEMS • • • • • Depression Delirium Dementia GERIATRIC SYNDROME “ frail syndrome” frail person are those who are more vulnerable to significant problem and meeting 1 or more of the ff: condition : . write out the medication schedule 3.dosages should be reduced and overdosage and toxicity monitored 2. falls and falling 4. Check that patient’s are dependable and religiously taking medications 10. side effects and dosage of each medication 2. Teach self-administration of medications and request return demo NURSES ROLE TO IMPROVE COMPLIANCE 1. review the medication scheduled periodically 6. including OTC medication with him or her regularly when visiting the primary health care provider PHYSICAL HEALTH PROBLEM Geriatrics syndrome : 1. Meds removed by renal excretion remain in the body longer. encourage the use of standards containers without safety lids 4. Watch out for idiosyncratic or unusual responses to meds 6. A decline in CO may decrease the delivery rate to the target organ or storage tissue 4. lowered efficiency of the circulatory and nervous system in coping w/ effects of medications NURSING INTERVENTION 1. encourage the patient to take all the medication. destroy all unused medication 5. The circulatory and CNS are less able to cope w/ effects of certain medications 5. Check for drug-drug interactions 8. dizziness 3. discourage the use of the OTC medication and herbal medicine without consulting health professionals 7.PHARMACOLOGIC ASPECT OF AGING • Altered pharmacokinetics .

Delirium and dehydration 2. Restricted mobility and restraint 3. being unable to perform ADL 3. 5. suffering from multiple chronic dse IMPAIRED MOBILITY • • • • • • • • • FALL Common cause 1. DM neuropathy Management: encourage them to stay active as possible DIZZINESS true dizziness – sensation of disorientation in relation to position Vertigo – spinning sensation • • • common and most preventable source of mortality major cause of trauma in elderly URINARY INCONTINENCE common causes: 1. Inflammation and infection 4. CVS 4. Parkinson dses. being 85 years of age older 2. osteoarthritis 3. Pharmaceutical and polyuria DEPRESSION • • • • • • • • • • most common affective or mood d/o of old age feeling of sadness fatigue diminished memory and concentration feeling of guilt and worthlessness sleep disturbance suicidal ideation MANAGEMENT Antidepressant TCA SSRI . osteoporosis 2.1.

affect. downward decline in mental function . Alzheimer's disease ASSESSMENT I. and decision-making capabilities 2. HEALTH HISTORY AND GERENTOLOGIC FOCUS A . memory. level of alertness. Depending on the client’s stability. is characterized by an uneven. calculation 5. the interview may take more than one session B. Allow sufficient time to conduct a thorough healthy history interview 2. has 2 types: 1. delusion. multi-infarct dementia 2. visuospatial function 4.• psychosocial approach DELIRIUM • • • • • • • • • • • • “ acute confusion state “ medical emergency common S/Sx -hallucination. encourage family and friend to touch and talk to patient DEMENTIA to diagnose at least 2 domain of altered function must exist: memory and at least 1 of the ff: 1. Assessment of the older adult client is complex 1. environment should be calm and quiet. problem solving. anxiety and paranoia Management: nutritional and fluid intake should be supervised. fear. It is important t maintain a baseline for orientation. Client may not exhibit chest pain with a myocardial infarction) The problem is likely to have multiple contributing factors and affect the client’s functional abilities C. Assess the client for quality of life issues. judgement 6. abstraction 7. mood. perception 3. LIFESTYLE AND FUNCTION . language 2. PRESENTING PROBLEM • • • • • Assess client systematically depending upon the presenting problem Typical presentations of disease may change with age (eg. and anxiety D. MENTAL STATUS AND MENTAL HEALTH 1.

PAST MEDICAL HISTORY 1. and herbal medications • 2. Urinary incontinence or pain from arthritis 2. hospitalizations. and any special considerations or interactions for all medications • 3. Determine any difficulties ingesting food/ fluids (chewing. Be sure the client understands the purpose. and social health • 3. Ask for information about all types of medications that the client is taking. Renewing prescriptions. NUTRITION AND HYDRATION • 1. Inquire about all chronic diseases and conditions. eg. Use the client’s own baseline from previous assessments to determine any changes in function • 4. dressing self) E. swallowing. including prescription medications. tremors) • 3. sodium. side effects. psychology.• • 1. Taking in adequate amounts of water daily to stay hydrated? • 5. Average older adult takes 11 prescription medications per day F. Any foods the client is unable to eat (dairy products. Be aware that the client may not even consider certain conditions treatable and therefore does not mention them. Discuss the client’s abilities to obtain medications (eg. salivation. Obtain food/ fluid intake profile (either 24 hours or 3 days) • 2. Polypharmacy is often present. paying for medications) • 4. The functional assessment provides a clearer picture of physical. Have the client demonstrate function wherever possible (eg. Often. Activity intolerance . Ability to afford/purchase/prepare food? G. sugar) or foods the client should eat (potassium. vitamin supplements. and surgeries DIAGNOSIS  • • Physical Examination Assess body systems as indicated Note physical changes in the older adult III. non-prescription medications (especially analgesics and laxatives). manual dexterity. drinking glass of water. there is little correlation between diseases and functional abilities 2. Laboratory/Diagnostic Tests • Laboratory tests as indicated according to symptoms of individual client • Interpret lab test results with aging changes in mind ANALYSIS/ NURSING DIAGNOSES FOR OLDER ADULT CLIENTS A. Observe gait and balance.or calcium-rich foods/fluids) • 4. MEDICATION USAGE • 1. Obtain information about previous illnesses. dosage.

Impaired physical mobility I. Impaired urinary elimination U. diarrhea C. Optimal cognitive functioning G. alterations in fat to muscle ratio. Maximum functional independence B. grooming. bathing/hygiene. Sexual dysfunction P. Positive self-concept E. Acute or chronic pain D.B. Bowel incontinence. and slowed organ functioning may cause accumulation of a drug in the body due to higher concentrations in the tissues and slowed metabolism and excretion of the drug • Multiple chronic diseases affecting older adults may also cause changes in the metabolism and excretion of medications • Medication errors among older community-dwelling adults are estimated to be 20-50% . or impaired gas exchange L. Sufficient communication skills D. Disturbed thought process S. General Information • Decreased body weight. Anxiety or death anxiety E. Risk for other-directed violence Y. Relocation stress syndrome AA. Disturbed body image or ineffective role performance N. Disturbed sensory perception O. Imbalanced nutrition: less or more than body requirements K. dehydration. Impaired home maintenance PLANNING AND IMPLEMENTATION Goals : Client will maintain A. Impaired skin integrity Q. toileting M. Ineffective airway clearance or breathing pattern. Normal bowel and bladder elimination patterns C. constipation. dressing. Wandering W. Adequate nutritional status and fluid balance H. A restful sleep pattern I. Disturbed sleep pattern R. Impaired oral mucous membrane J. Risk for falls or injury Z. Deficient fluid volume F. Ineffective tissue perfusion T. Social contacts and interpersonal needs J. Self-care deficits: feeding. Treatment regimens are prescribed INTERVENTIONS PHARMACOTHERAPY IN THE OLDER ADULT 1. Risk for infection G. Freedom from injury and infection F. Deficient diversional activity V. Impaired memory H. Impaired social interaction X.

mental status. NURSING CARE • • • • • • • • • Conduct a “brown bag” evaluation to assess all prescription. teach family members. Client performs self-care activities or caregiver provides assistance as needed B. incontinence. reading level. Skin is intact without pressure ulcers H. Proper techniques for administering oral medications include: position head forward with neck slightly flexed to facilitate swallowing and avoid risk of aspiration • • If client has swallowing difficulties. Client eats a nutritionally balanced diet and maintains a stable weight I. Client maintains friends. Client describes and adheres to treatment plan DEATH AND DYING OVERVIEW OF DEATH AND DYING • • One of the most difficult issues in nursing practice Often difficult for nurses to maintain objectivity because of identification and response to death based on own value system and personal experiences . voids in adequate amounts and has regular bowel movements C. and oriented if possible G. Client is able to successfully communicate needs and concerns D. and herbal medications the client may be taking Assess the client’s understanding of the reasons for the drug’s therapy Assess the client’s vision. calm. obtain liquid forms of oral medications wherever possible Assess client for effectiveness of medications and any adverse reactions EVALUATION A. judgement. Client is alert. social interactions. premeasured syringes. Client makes positive statements about self E.• Drug-drug interactions are increased secondary to older adults often having more than one prescribing health care provider 2. and sexual function J. over-the-counter. obtain baseline vital signs. and bowel/ bladder function Drug-induced side effects may present as confusion. and daily drug dose containers to enhance self-medicating abilities Check with the pharmacist for any drug-drug interactions if unsure Before beginning a medication. Client/ caregiver modifies environment to support safety F. falls or immobility Assess the client’s ability to pay for the prescriptions If the client requires assistance in taking medications. vision. memory. memory aids. and motivation to determine ability to self-medicate Provide instructions in large-print. Client is continent of bowel and bladder.

or impending loss. Emotional reaction (withdrawal. Depression – feeling of loneliness and withdrawal from others 5. Denial – refuses to believe that the loss has occurred 2. 4. Anger – the individual resists the loss and may “act out” feelings. Bargaining – the individual attempts to make a deal in an attempt to postpone the reality of loss. and the interaction to other people resumed PNEUMONIC: (DABDA) Stages of beliefs in death End of life care Assessment of end of life care beliefs.• • • • • • • Nurses need to take time to analyze their own feelings about death before they can effectively help others with terminal illness ASSESSMENT A. Acceptance – the individual comes to terms with loss. psychological reactions to loss to the loss cease. Stages of dying (Kuber-Ross) STAGES OF GRIEVING (Kubbler-Ross) 1. value of own life D. Level of consciousness E. preferences & practices          Disclosure or truth telling Decision making style Symptom management Life sustaining treatment expectations Desired location of dying Spiritual or religious practices Care of the body after death Expression of grief Funeral & burial practices Mourning practices End of life care • •   Goal setting in palliative care Discussing end of life care Initiate discussion Clarify understanding of medical treatment plan & prognosis . anger. Family needs F. acceptance) and stage of dying C. 3. Physical discomfort B. Desire to discuss impending death.

Fear F. Hopelessness PLANNING GOALS: 1. Self-care I. Pain C. Powerlessness H. Help client accept losses 5. Social isolation E. Have opportunity to discuss what death means and to progress through stages of dying 4. Provide relief from loneliness. Maintain sense of security 3. Anxiety B.  Identify end of life priorities Contribute for the interdisciplinary care plan SIGNS OF APPROACHING DEATH • • • • • • • • • • • • • • • Anorexia Decrease urine output Patient sleeps more & begins to detach from environment Mental confusion Audio-visual impairment & incomprehensible speech Secretions may accumulate at the back of throat Irregular breathing with apnea Restlessness Initially px feels hot then cold after Loss of bladder control NURSING DIAGNOSES FOR THE DYING CLIENT MAY INCLUDE: A. fear and depression MAJOR GOALS FOR THE DYING CLIENTS ARE • •  To maintain PHYSIOLOGIC and PSYCHOLOGIC support To achieve a dignified and peaceful death To maintain personal control INTERVENTION • Recognize clients/families have own way of dealing with death and dying • Support clients/families as they work through dying process • Accept negative responses from clients/ families • Encourage clients/families to discuss feelings related to death and dying . Maintain optimum physical comfort 2. Impaired mobility G. Anticipatory grieving J. Ineffective coping D.

ENCOURAGE PARTICIPATION NURSING INTERVENTIONS FOR GRIEF AND MOURNING Support expression of feelings Encourage telling of stories in open ended statements Assist mourner to find an outlet Assess emotional affect Assess for guilt and regrets Assess for presence of social support Assess for coping skills Assess for signs of complicated grief & offer referral EVALUATION A.ALLOW EXPRESSION AND PROVIDE FOR SAFETY A .• Support staff and seek support for self when dealing with dying client and grieving family INTERVENTION • • • • •         D – SUPPORTIVE A . thoughts.PROVIDE STRUCTURE AND CONTINUITY B – LISTEN AND ENCOURAGE D . • • • • LOSS= something valuable is gone GRIEF= total response to emotional experience related to loss BEREAVEMENT= Subjective response by loved-ones MOURNING= behavioral response OVERVIEW OF GRIEF AND LOSS . Family discussed feelings about loss of loved one GRIEF AND LOSS • • • • Grief is a form of sorrow involving feelings. Been comfortable and participated in self-care for as long as possible B. Taken opportunity to discuss feelings about impending death and eventually acknowledges inevitable outcome 2. Client has 1. and finally accepts a loss. and behaviors caused by bereavement Loss is a universal experience that occurs throughout life span Responses to loss are strongly influenced by one’s cultural background The grief process involves a sequence of affective. cognitive and psychological states as a person responds to.

investment in others / interests H. Hopelessness C. Sleep disturbances C. Despair. Accept negative feelings/ defenses C. Shock. anger 3. body part. Refer client/ family to support groups EVALUATION Client/ Family has: 1. social implications C. Possible fear of becoming mentally ill ASSESSMENT A. withdrawal. visual hallucinations 4. Family system effects D Mourning is process to resolve grief E. Resume normal sleeping/eating patterns 3. Possible auditory. Resentment. Detachment from loss G. Renewed interest. Disturbed thought process E. Risk for violence. psychologic. Possible guilt 5. Biologic. Weight loss B. self-directed PLANNING Goals: Client/Family will • • • • • • • • 1. Thoughts centered on loss D. Expressed feelings .A . Dependency. Mourning is process to resolve grief 1. Sleep pattern disturbances D. Employ emphatic listening D. Ineffective coping B. Resume ADL as they accept loss IMPLEMENTATION A. Response to loss (person. guilt E. role) B. disbelief are short term 2. Encourage client/family to express feelings B. Suicide potential NURSING DIAGNOSIS • • • • • A. Discuss responses to loss 2. Explain mourning process and relate to client/ family responses E. anger. depression F.

2. Seeked necessary support groups . Progressed through mourning process 3.