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INTRODUCTION
Geriatrics, the care of aged people, differs
from gerontology, which is the study of the aging process
itself. The term geriatrics comes from
the Greek  geron meaning "old man" and iatros meaning
"healer".
Geriatrics is a sub-specialty of internal medicine that
focuses on health care of elderly people. It aims to
promote health by preventing and treating diseases and
disabilities in older adults.

DEFINITIONS OF GERIATRICS

The study of health and disease in later life; the

comprehensive health care of older persons; and the well-
being of their informal caregivers.

Butler, 2008

The branch of medicine concerned with the diagnosis,

treatment and prevention of disease in older people and the
problems specific to aging.

medicinenet.com
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PROBLEMS AND NEEDS

 Mental Changes
 Learning
 Memory
 Reaction time
 Intelligence
 Life skills
 Stresses

 Caregiving

 Loss and grief

 Changing roles as we age

 Social status

Mental changes

Losing mental function is perhaps the most feared aspect of

aging. In fact, the fear itself often begins to wear down our
quality of life. This can lead to loss of self-esteem and
withdrawal from others.
Learning: The ability to learn continues throughout life,
although we may learn in different ways as we age. Older
people often require more time and effort to absorb new
information.
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As we get older, we tend to avoid learning things that
are not meaningful or rewarding to us, or that cannot be
linked to one of our other senses, such as sight or hearing.
The reasons for these changes in learning are not known,
but they may be partly caused by changes in our sight,
hearing, and other senses that we use for memory.

Memory: Older people may have trouble remembering

some things, but not others. Short-term memory (ie, less
than 30 minutes) worsens as we age. Very long-term
memory (months to years) is basically permanent, collected
through a lifetime of day-to-day education and experience.
This type of memory increases from the age of 20 to about
the age of 50 and then remains essentially the same until
well after 70.

Reaction time: As age advances, they tend to process

information at a slower pace. This means it takes longer to
figure out what is going on and what to do about it (if
anything). Most of this "slow down" is caused by changes in
the nervous system over time.

Intelligence: Whether intelligence declines as we age is

hotly debated. Although overall intelligence stays about the
same throughout life, older people don’t do as well as
younger people on many standardized intelligence tests.
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Life skills: Most intelligence tests do not address things that
we deal with in our daily lives. For example, older people
tend to do better than younger people on tests that deal
with practical activities, such as using a telephone directory.
In fact, as we age, most of us get much better at being able to
manage our daily affairs. It is usually only in times of stress
or loss that we may be pushed beyond our limits, and having
a support network to help us cope is very important. Older
adults can continue to gain support, care, respect, status,
and a sense of purpose by interacting with younger people.

STRESSES

Older adults often must face a great number of stresses

that can be caused by a broad range of events and situations.
Stresses can be physical or social. They can be an ongoing
part of day-to-day life, or caused by sudden traumatic
events. Common stresses for older people include the
following:

 diseases or health conditions, possibly chronic (eg,

arthritis)
 perceived loss of social status after retirement

 death of a spouse

Caregiving: Chronic diseases and conditions affect most

older adults. Family members, especially spouses, are most
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often the caregivers. Many older adults are also caregivers
for another family member.

Loss and grief: As we get older, the death of friends and

family becomes more common. Losing and grieving for a
spouse is one of the most traumatic situations commonly
faced by older adults. Getting treatment for depression can
also help avoid the mental and physical health problems
associated with a grieving process that goes on far longer
than usual.

Changing roles as we age: People shift through many roles

throughout their lives. We are children, parents, friends,
workers, patients, students, sports enthusiasts, artists, etc.
One of the most dramatic changes involves retirement.
When older adults retire, they leave work and social roles
that likely provided economic rewards as well as social
status.

Social status: Many social factors affect how we think about

ourselves and how others think about us. Our sex, race, and
economic status all affect our real and perceived social
status. These factors also can affect the resources that are
available to us to help cope with aging and health.
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AGING PROCESS AND CHANGES

Changes that occur with aging fall into three categories:

physical, psychological, and social. As changes begin to
happen in one area of a person’s life, most likely the other
two will be affected as well. There is a wide variation among
individuals in the rate of aging and, within the same person,
different organ systems age at different rates.

Physical Changes
Decrease in Physical Strength, Endurance, and Flexibility
Muscle strength and flexibility decrease with age. A major
reason muscles tend to become weaker is that there is less
lean muscle mass and they shrink from lack of use. It
happens whether a person is young or old.

Decline in Efficiency of Body Organs

Functioning of all body organs is not as efficient as before.
Examples include: The heart becomes a less efficient pump.
It requires more oxygen to do the same work it used to do
with less oxygen.
 Lungs become less elastic, and do not expand as well;
thus, less oxygen gets into them. Smoking makes this
problem worse at a much earlier age in people that
smoke versus those who do not.
 As age increases, it takes longer for kidneys to get rid of
waste products. These substances tend to remain in the
body for a longer period of time.
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Urinary incontinence is not a normal change with aging.
Alterations in skin become very obvious early on if not
taken care off. Wrinkling is the most common and most
notable. Increased wrinkling is due to a normal loss of
elastic tissue, excessive sun exposure, smoking, and
heredity.

Loss of Bone Mass

Thinning and shrinkage occurs in the bone, most noticeably
in the vertebrae (the back) and the long bones of the arms
and legs. The compression of the spinal column is
responsible for many people getting shorter as they age. It
also may account for the stooping posture of many older
people.

Slower Reflexes
Joint movements slow with age because of changes within
the joints themselves. Reaction time also is slower because
of changes in the central nervous system. The time lapse
between the brain receiving the signal and the person
responding to the signal increases with age.

Taking Longer to Return to Equilibrium

It takes longer for the body to return to balance following a
stress. The older person’s body does not bounce back as
readily as a younger person’s body does from exercise,
illness, surgery, or situational stress.
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Decline in the Senses
All the senses are affected to some degree as people age. The
changes are particularly important because it is through
your senses that you keep in contact with the world. The
most impactful changes are those in hearing and vision.
When losses in these senses are significant, they can affect a
person in several ways.
 Communication and interaction with others
 Mobility and independence
 Perception of and response to the environment
 Ease in accomplishing tasks
 How a person feel about self

PSYCHOLOGICAL CHANGES IN ELDERLY

There are also psychological changes when people

are getting old. When caring for them, we need to take care
of their mind as well.

General psychological condition

Old people get tired easily. They may have lessened

ability to express. Be patient when communicating with
them. Let them finish what they want to say.

Self-protection: Elderly people tend to resist strangers and

do not trust people. Before starting a health care procedure
to them, or even before moving their furniture at home, tell
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them beforehand what you are going to do.

Dignity/discrimination

We often use Old Papa or Old Mama to address elderly

people. Before providing health care, we should show
respect to them by asking them how to address them such
as Mr…., Mrs…. or …..Madam. What is more, no matter how
old and what gender they are, their privacy should be
properly protected and respected.

Death

With the advent of death, old people may experience some

emotional changes. Some event like the death of spouse or
getting a terminal disease may bring them through a
grieving process including: Denial, Anger, Bargaining,
Depression, and Acceptance. When dealing with these
elderly people and their family members, never take death
for granted for old people and adopt an indifferent attitude.

SOCIAL CHANGES

Loss, Grief, and Bereavement: Grief is a normal response to

loss. We grieve over any perceived loss, not just the death of
a loved one. Mourning is the process we go through to try to
diminish the pain of loss and look to “let go.” Grieving is a
very personal, individualized process.
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Emotional Needs Later in Life
Emotional needs do not necessarily change as we age. In
fact, our needs become more apparent as we become less
able to be totally independent and must rely on others for
support.

Retirement
Retirement is a time often spoken about by those not
approaching “the” age or others fantasizing about a life of
leisure and irresponsibility. Much to your chagring, as
retirement quickly approaches, it becomes a time of hidden
feelings and secret thoughts.

NEEDS OF THE ELDERLY

 Elderly people do tend to require a certain amount of
assistance with age. In this article, we will have a look
at the different possible needs of the elderly, and how
to fulfill them.
 Having a good amount of awareness about the
various possible needs and requirements of the
elders, is extremely important for those people who
have the responsibility of taking care of their aged
family members, parents or relatives. In this article,
we will have a generic look at the type of assistance
and help that elderly people commonly require, in
addition to a few elderly special needs.
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FinancialNeeds
If elderly individuals happen to be living on their own, i.e.
without anyone else's support, it is but natural that they will
have a certain amount of financial needs. They will need to
fend for themselves for everything such as food, groceries,
medicines, etc. Pensioners would have the benefit of a
steady source of monthly income (whatever be the amount
trickling in). However, those senior citizens who do not have
any pension facilities or any other sources of income, would
have to live entirely on the basis of their savings or through
special senior citizen government finance schemes.

Health Care Requirements

Senior health is the most important requirement when it
comes to elderly needs. With advancing age, the body tends
to slow down and becomes less efficient. Elderly people are
prone to a few age-related health issues. This is a normal
aspect of life and one cannot help it. However, through
proper care and nursing facilities, one can definitely help in
keeping most of these health issues in check and preventing
them from causing any serious harm. Regular medical
checkups is necessary. They can help in anticipating
potential future health-related issues. At the same time, they
may help in identifying serious health problems at an early
enough stage during which treatment is possible.
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DietaryRequirements
As people age, their digestive system gradually starts
weakening. Aged and elderly people especially, face this
problem wherein they start finding certain foods
indigestible or difficult to digest. What one must realize is
that their diet can no longer be the same as it was say,
twenty years ago. Their diet should now be modified
accordingly such that it remains a nutritious, balanced diet
and yet, contains foodstuffs that their system is able to
accept, without causing them any discomfort or problems.
Often, the diets of elderly people need to be altered
depending on their medicinal prescriptions.

NursingRequirements
If you have an elderly family member whose mobility has
become limited due to aging, he or she would require a
certain amount of assistance in his or her daily routine. If it
is not possible for someone in the family to be around the
aged person the whole day long, you could consider having a
full-time nurse to assist the elderly person.

SocialandOtherNeeds
One thing that you should keep in mind is, to shower all
your love and care on your elderly relative or family
member. Spend time with them, chat with them and make
them feel wanted, cared for and loved. Pay special attention
to their room. You could consider installing a few senior
citizen friendly appliances which they would be comfortable
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MYTHS AND FACTS OF AGING

1) Senility is a Normal Part of Aging

Getting a little forgetful is a normal part of aging. It is
normal to forget to stop for milk at the store, or to forget
someone’s name. It is not normal to become so forgetful
that it is impossible to manage the tasks of everyday life.

2) Most old people are alone and lonely.

Friends and family are very important in the lives of older
adults. In fact, the number of close friends remains relatively
stable throughout life. It’s true, the number of casual friends
may decrease, but the number of close friends stays the
same. People who have many close friends throughout life
continue to have many close friends as they age.

3) Most old people are in poor health.

Another myth of aging is that being old means being sick.
Yes, physical changes occur with age. Thinning hair and
sagging skin are normal physical changes that happen with
age. Older adults have a higher risk of developing certain
diseases. Arthritis, heart disease, osteoporosis, diabetes, and
cancer are more common among older adults than younger
people. But even when they have one of those diseases,
older adults make changes in their lives so they can remain
independent.
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4) Old people are more likely to be victims of crime
The notion that older people are “prisoners in their own
homes” because they are afraid of crime is a great
exaggeration.
In fact, older adults are less likely than younger people to be
robbed, assaulted, or raped. In spite of this reality, older
adults are more fearful of crime. There are good reasons to
be afraid. Crime is a serious problem in many
neighborhoods. In those neighborhoods, everyone is at risk,
not just older people.
5) Most older people live in poverty.
6) Elders become more religious with age.
People who are not committed to religious practices
throughout their lives are not likely to become involved in
religious activities simply because they are older
Research has found a slight decrease in organized religious
activities among older adults who were actively involved in
their religion in their younger years. Older adults may be
less involved in religious activities because of transportation
problems such as difficulty driving at night. They may also
have problems getting into places of worship because of
stairs. When they are not able to attend and participate in
religious activities, older adults find other ways to worship.
They spend more time reading, watching religious programs
on television or listening to religious programs on the radio.
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7) Older workers are less productive than younger
workers.
Older employees produce high quality work. They draw on
years of experience to solve problems. Older workers are
known to be highly motivated, are flexible about work
schedules, and have low rates of absenteeism. Given the
opportunity, older workers are excellent mentors for
younger workers.

8) Retirees suffer decline in health and early death.

9) Most old people have no interest in or capacity for

sexual relations.
Just like many other aspects of life, sexual behavior in later
life mirrors sexual behaviors in young and middle
adulthood. Researchers have found that good health, not
age, is the key to sexual relationships throughout life. The
way older adults express sexuality may change over the
years. In later years, older adults may prefer touching and
cuddling to maintain sexual intimacy.

10) Most old people end up in nursing homes.

This is perhaps one of the greatest untruths about aging.
Fears of aging and the media continue to feed this untruth.
The reality is that on any given day, only about 5% of older
adults are living in a nursing home, or long-term care
facility.
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HEALTH ASSESSMENT

The geriatric assessment is a multidimensional,

multidisciplinary diagnostic instrument designed to collect
data on the medical, psychosocial and functional capabilities
and limitations of elderly patients.
The geriatric assessment differs from a standard medical
evaluation in three general ways: (1) it focuses on elderly
individuals with complex problems, (2) it emphasizes
functional status and quality of life, and (3) it frequently
takes advantage of an interdisciplinary team of providers.

The History
Demographic Data
 Full name
 Age, sex and birth date
 Marital status
 Source of history and reliability of historian
Chief Complaint
 Primary reason for visit, ideally in patient's own
words
 Duration of presenting symptoms
Present Illness
 Chronological narrative of reasons for patient visit.
 Persistence, change, severity, character, resolution
and disabling effects of initial
symptoms.
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 Presence of new symptoms and/or associated
symptoms
 History of similar symptoms in the past
 Aggravating and mitigating factors
Past History
 Previous medical history.
 General state of health
 Childhood diseases
 Immunizations (Tetanus-diphtheria, pertussis,
measles, mumps, rubella, hepatitis
 A&B, influenza, varicella, h. flu., polio)
 Chronological list of adult medical diseases, injuries
and operations (not already
mentioned in "Present Illness"
 Hospitalizations (not already mentioned)
 Allergies, including clinical description of exposure
 Medications, including dosage, duration and
indication
 Diet
Social History
 Birthplace and residences (if not native born, year of
entry into United States)
 Level of education
 Ethnicity and race
 Marital status
 Quality of significant relationships and health of
partner
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 Vocation, including type of industry, past and present
industrial exposures, duration of employment and
retirement
 Avocations, including hobbies and other interests
 Habits, including quality of sleep, exercise,
recreation, consumption of alcohol and other drugs
(including route of administration, if applicable),
tobacco use (in packyears), alcohol use, and travel
abroad
Family History
Presence of disease with recognized familial importance in
first degree relatives -
type II diabetes, tuberculosis, cancer, hypertension, allergy,
heart disease, neurological or psychiatric disease, arthritis,
osteoporosis, bleeding tendency.

The Physical Examination

General Appearance
Apparent age, state of health, nutritional status, alertness,
and evidence of discomfort.
Vital Signs
Temperature, blood pressure, pulse rate and rhythm
(regular or irregular), and respiratory rate and pattern.
Skin
Texture, moisture and temperature; eruptions, scars,
masses, nevi, telangiectasia; abnormalities of hair and nails.
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Lymph nodes
Size, consistency, mobility and tenderness in occipital,
cervical, post-auricular, submandibular, supra-clavicular,
epitrochlear, axillary and inguinal regions.
Head
Size, symmetry, evidence of trauma, tenderness (including
sinuses), masses, and condition of scalp.
Eyes
Eyebrows, lids, conjunctival inflammation and scleral
icterus; corneal opacities and abrasions; pupillary size,
equality and reaction to light and accommodation;
extraocular movements and exophthalmos; fundi for discs,
vessels, macula, exudates and morrhages; gross visual acuity
and fields.
Ears
Auricles, auditory canals, tympanic membranes and gross
hearing.
Nose
Deformities and septal deviation; obstruction, mucous
membrane inflammation, polyps, bleeding and discharge.
Mouth
Lip color, lesions and pigmentations; condition of teeth;
gingival color, inflammation, and bleeding; tongue color,
moisture, tremor and coating; buccal mucosa inflammation
and eruptions; soft palate; odor of breath. If patient wears
dentures, remove them.
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Throat
Mucosal color, exudates and lesions; tonsil size, symmetry
and exudates; post-nasal
discharge.
Neck
Range of motion; pain and tenderness; tracheal position,
thyroid size, symmetry and
consistency; carotid impulse strength and bruits.
Back
Range of motion; pain and tenderness over spine, muscles
and costovertebral angle;
symmetry.
Thorax
Shape and symmetry in excursion; intercostal retractions;
rib tenderness and chest
wall masses.
Lungs
Percussion, auscultation, bronchophony, egophony,
pectoriloquy and fremitus.
Breasts
Size, shape, symmetry, tenderness and masses.
Heart
Precordial movement, apical impulse, rate and rhythm;
heart sounds, murmurs, rubs
and gallops.
Abdomen
Shape, tenderness, bowel sounds and bruits; size of liver,
spleen, and kidneys; masses.
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Extremities
Deformities, tenderness, localized swelling, peripheral
pulses and edema, cyanosis, clubbing, temperature, varicose
veins, and hair loss.
Musculoskeletal
Joint mobility, tenderness, effusion, erythema and
deformity.
Neurologic
Screening exam in non-neurologic cases, otherwise full
exam. Mental status; cranial nerves; peripheral strength,
tone and sensation; deep tendon reflexes; Rhomberg and
gait.
Female Pelvic and Rectal
External genitalia; speculum exam for vaginal mucosa and
cervix, bimanual exam for uterus, adnexa, masses and
tenderness; digital rectal.
Male Pelvic and Rectal
Inguinal hernias; scrotal and testicular masses and
tenderness; digital rectal, with prostate exam.

COMPONENTS OF THE GERIATRIC ASSESSMENT

Demographic Data
Clinical medicine, largely a scientific endeavor, relies heavily
on the acquisition of objective information. Although
virtually all historical data is subjective to one degree or
another, clinicians must ultimately base their medical
decision on accurate information.
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Nurse educators also help students and practicing nurses

identify their learning needs, strengths and limitations, and they
select learning opportunities that will build on strengths and
overcome limitations.

state any three

In addition to teaching, nurse educators who work in academic
21. state the teacher’s hand out responsibilities of
responsibilities of settings have responsibilities consistent with faculty in other activity: discuss nurse educators
nurse educators learner’s
disciplines, including:
activity:
participate in
 Advising students discussion
 Engaging in scholarly work (e.g., research)

 Participating in professional associations

 Speaking/presenting at nursing conferences

 Contributing to the academic community through

leadership roles

 Engaging in peer review

 Maintaining clinical competence

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teacher’s chart
NURSE ENTERPRENEUR:
22. define the term 1min activity: explain
“nurse learner;s who is a nurse
entrepreneur” A nurse who usually has advanced degree and manages activity: listen entreprenure?
attentively
the health- related business. The nurse may be involved in
education, consultation, or research. They apply their skills and
training toward establishing, promoting, or consulting in
business ventures in the health care industry. They can build on
their nursing knowledge to develop medical devices or
computerized systems for delivering healthcare, freeing staff
nurses to spend more time caring for patients.

Nurse Entrepreneurs combine their nursing background with

business and utilize their individual creativity and
resourcefulness to start their own companies. The Nurse
Entrepreneur may provide patient care, equipment, consulting
services, and education as it relates to nursing while assuming
inherent risks of business accountability
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“An advanced practice nurse entrepreneur is an individual who
can identify a patient's need and find a way for nursing to
respond to that need in an effective way, formulate and execute
a plan to meet that need”

 Excellent interpersonal skills, critical thinking skills,

collaboration skills, and credibility are essential for a successful
nurse entrepreneur. Nurse entrepreneurship is very rewarding
with financial stability, freedom, flexibility, status, enhanced
patient and professional satisfaction.

23. enumerate Personal characteristics of nurse entrepreneurs include: teacher’s hand out list two
personal activity: lecture characteristics of
characteristics of  independence learner’s nurse
nurse activity: entrepreneurs?
entreprenuer  flexibility listening

 assertiveness

 accountability

 creativity

 vision
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 a drive to achieve

 ability to accept and thrive on change

 ability to handle stress

 an appetite for hard work

 discipline

 good judgment

 independence

 self confidence

 ability to be alone, work alone

 make decisions alone

 and manage their time alone with a high level of energy

 enthusiasm, and commitment to their work

 OBJECTIVES

GENERAL OBJECTIVES:
By the end of the class, the group will be able to gain indepth knowledge regarding expanded role of nurse.

SPECIFIC OBJECTIVES:
By the end of the class the group will be able to:
 introduce the topic
 define nursing
 list out the qualities of a nurse
 describe the extended roles of the nurse
 explain the expanded roles of the nurse
 list out the services provided by the nurse practitioner
 explain the role of clinical nurse specialist in patient care
 explain the responsibiliities of nurse administrator
 describe the role of nurse as educator
 enumerate personal characteristics of nurse entreprenuer
NAME OF THE STUDENT TEACHER :

NAME OF THE SUBJECT :

NAME OF THE TOPIC :

CLASS/GROUP : post basic Bsc ( N ) I year

DATE OF PRESENTATION : 07-05-2011

METHODS OS TEACHING : Lecture, Disscussion

A.V. AIDS : Black board

Transparancies

Flip charts

Hand out

Chart

Power point slides

SIGNATURE OF THE EXAMINER :

 BIBLIOGRAPHY

 Barbara Kozier, Gleonora erb, Audrey Berman, Shirlee Snyder, Fundamentals of nursing concepts, process and practice. 7th edition.
Pearson education

 Sr. Nancy, principles and practice of nursing arts & procedures – I. 6th ed.N.R publishers

  Patricia A. Potter, Anne Griffin Perry, Patricia Stockert, & Amy Hall – 8 ed . elsevier

 Carol R Taylor, Carol Taylor, Carol Lillis, Priscilla LeMone, Pamela Lynn – 6th ed. Lippincott Williams & Wilkins

 www.nursingcenter.com

 www.nursing crib.com

 www.ncbi.nlm.nih.gov

 www.scribd.com
SUMMARY:

A nurse is a health care professional who is engaged in the practice of nursing. Nurses are responsible (along with other health care professionals)
for the treatment, safety and recovery of acutely or chronically ill or injured people, health maintenance of the healthy, and treatment of life-threatening
emergencies in a wide range of health care settings. Nurses may also be involved in medical and nursing research and perform a wide range of non-
clinical functions necessary to the delivery of health care to the clients by various expanded roles

CONCLUSION:
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover
optimal health and quality of life. Nurses work in a wide variety of specialties where they may work independently or as part of a team to assess, plan,
implement, and evaluate care. The roles required at a specific time depend on the needs of the client and aspects of the particular environment. So, we
should identify the needs of the patient and act in that particular role to help out the clients to recover from their illness and promote the well being of the
client.