NCM 114 - Geri (Modul 3) - People who have low incomes are more

likely to report poor health.

Lesson 5: Understanding Chronic
- Few people are prepared to live with
Illness chronic illness.
★ Chronic Illness - Chronic illness involves suffering.
- Group of health conditions that last a - Suffering involves crisis and threats
long time. that constitute a degradation or
- "chronos" = time alienation of our being.
- “The irreversible presence, ★ The Impact of Chronic Illness - The
accumulation, or latency of disease Individual
states or impairments that involve the - Initial Impact:
total human environment for 1. Shock
supportive-care and self-care, 2. Denial
maintenance of function, and prevention 3. Loss and grief
of further disability.” Curtin and Lubkin 4. Anxiety and depression (20-25%
(1995,) experience psychological symptoms)
- “Chronic conditions as conditions lasting - Must adjust to:
1 year or more and requiring ongoing 1. Symptoms of the disease
Medical attention and/or the limiting of 2. Stress of Treatment
activities of daily living (ADLs)” 3. Feelings of vulnerability
Anderson and Horvath (2004) 4. Loss of Control
- “Chronic disease or a chronic condition 5. Threat to self-esteem
is also defined as any condition that 6. Financial Concerns
requires ongoing adjustments by the 7. Changes in family structure
affected person and requires periodic ★ The Impact of Chronic Illness – The
interaction with the health-care Family
system”.(Improving Chronic Illness - Must adjust to:
Care, 2016). 1. Increased stress
★ Terminologies Related to Chronic Illness 2. Change in the nature of the relationship
1. Chronic conditions: a general term that 3. Change in family structure/roles
includes chronic illnesses and 4. Lost income all have impact
impairment. ★ Impact of chronic illness
2. Chronic Illness: the presence of a long - Chronic illness affects the person on
term( i.e. 3 or more months) disease or many levels and can bring suffering on
symptoms . all of these levels: Psychologically,
3. Secondary condition: conditions related Socially, Physically, Spiritually
to the main illness or impairment that ★ CHRONIC ILLNESS (3 reasons for the
further diminish the person’s quality of rapid increase)
life, threaten his health or increase 1. Aging of the population
vulnerability to further disability. 2. Success of medical science
★ Life with Chronic Illness 3. Worsening Obesity
- Has a significant impact on the patient
and their caregivers.
Lesson 6: Major chronic illness of
older adult understanding the
Pathophysiology and Nursing
Intervention
★ MAJOR CHRONIC ILLNESSES
1. Essential hypertension
2. Arthritis
3. Musculoskeletal impairments
4. Cancer ★ Chronic obstructive pulmonary disease
5. Heart disease - Refers to a group of diseases that
6. Diabetes cause airflow blockage and breathing-
7. Chronic airway obstruction related problems.
8. Peripheral vascular disease - CAUSES:
★ Heart Disease The primary cause of COPD is tobacco
- Heart failure (HF) is generally defined smoke Other risk factors include:
as the inability of the heart to supply 1. Indoor air pollution (such as
sufficient blood flow to meet the needs biomass fuel used for cooking
of the Body. and heating)
The Syndrome of Heart Failure 2. Outdoor air
pollution:(Occupational dusts and
chemicals (vapors, irritants, and
fumes)
3. Frequent lower respiratory
infections

- Left-sided Heart Failure

Backward failure of the left ventricle
causes congestion of the pulmonary
vasculature, and so the symptoms are
predominantly respiratory in nature. ★ DIABETES MELLITUS

- Right-sided Heart Failure - Disease in which the body doesn’t

Backward failure of the right ventricle produce or properly use insulin, leading

Leads to congestion of systemic to hyperglycemia.

capillaries. This generates excess fluid
- TYPES:
they have that accumulation in the body.
1. TYPE 1 DM - develops due to B-cell
.
destruction and results in a lack or
underproduction of insulin in the body.
2. TYPE 2 DM- the most prevalent form of
 diabetes in all age groups results from a
combination of insulin resistance and an
insulin secretory defect.
- What goes wrong in diabetes?
1. Multitude of mechanisms
● Insulin
1. Regulation
2. Secretion
3. Uptake or breakdown
● Beta cells
1. damage
★ CANCER
- Known as carcinoma or malignancy, is a
tumor that invades the surrounding
tissue with the capability of spreading
to other tissues at distant site.
- It is a leading cause of death in the
elderly; the most common malignancies
include neoplasm of the lung, breast,
and prostate, leukemia, lymphoma and
colorectal carcinoma.
- Progression from normal tissue to
invasive cancer is 5 – 20 years
- Driven by a series of accumulative
genetic changes
★ DEMENTIA
- is an acquired syndrome that causes
progressive loss of intellectual; abilities.
- Dementing disorders are characterized
by gradual onset plus continuing decline
that is not due to other brain disease.
- Short term memory impairment is
usually the first symptom of dementia.
Clinical diagnosis requires:
- Loss of an intellectual ability with
impairment severe enough to interfere
with social or occupational functioning
. breaks
CEREBROVASCULAR ACCIDENT
- The medical term for a stroke.
- A stroke is when blood flow to a part of
your brain is stopped either by a
blockage or the rupture of a blood
vessel.
- May result from tumor, large blood clot,
swollen brain tissue.
- There are two main types of
cerebrovascular accident, or stroke:
1. An ischemic stroke is caused by a
blockage.
2. A hemorrhagic stroke is caused by the
rupture of a blood vessel. Both types of
stroke deprive part of the brain of
blood and oxygen, causing brain cells to
die.
Lesson 7: Health Education in Chronic
Illness
Guidelines for Effectively Teaching Older
Adults
★ Vision
- large easy-to-read typeface;
- emphasize black & white;
- avoid blues & greens;
- use non-glare paper,
- write short simple paragraphs,
- make sure glasses are clean & in place.
★ Hearing
- speak slowly;
- enunciate clearly;
- lower pitch of your voice,
- eliminate background noise;
- face the learner;
- use nonverbal cues;
- have hearing aid in place & working
correctly
★ Energy level / attention
- use short teaching sessions
- offer liquid refreshments & bathroom
- promote comfort
★ Information processing/memory
present most important info first
clarify information w use of examples;
- motor skills
 - teach one step at a time {have written 2. Seeking information
easy to understand instructions}; 3. Learning to provide one’s own medical
- be concrete & specific, care
- eliminate distractions; 4. Setting concrete, limited goals
- correct wrong answers/ reinforce 5. Recruiting support
correct answers; 6. Considering possible future events
- offer praise & encouragement 7. Gaining a manageable perspective

Behavioral Management in Chronic Illness ★ Issues and Trends in Chronic Care

★ Behavioral and Personal Factors - Costly chronic care needs are growing
- Good “copers” have hardy or resilient and exerting considerable demand on
personalities – can remain positive health systems.
- Men have more difficulty adjusting to - Chronic diseases and conditions are on
chronic illness the rise worldwide.
- Timing during the lifespan affects - An ageing population and changes in
reactions societal behavior are contributing to a
- Personal health belief issues steady increase in these common and
costly long-term health problems.
★ Physical and Social Environmental - Chronic diseases are expected to
Factors increase by 57% by 2020
- Hospital environments can be - Economic burden
depressive
- Home/hospital environments may not Lesson 7: Basic Skills for
foster self-sufficiency Gerontologic Nursing
- Social support enhances coping
Health Promotion
- Network members may act as bad
examples
Health Maintenance
Home Health Considerations
★ The Tasks and Skills of Coping
- Cope with symptoms or disabilities ★ Health promotion for the elderly
- Adjust to hospital or procedures ● Health promotion - is the process of
- Develop and maintain good relationships enabling people to increase control over
with practitioners & improve their health by developing
their resources to maintain or enhance
★ Psychosocial Functioning Tasks well being.
- Control negative feelings and remain ● Health promoting is an action for health
positive using knowledge, communication &
- Maintain satisfactory self-image understanding.
- Preserve good relationships ● Health promotion involves making
- Prepare for uncertain future lifestyle and behavior changes in order
to move towards optima health. Health
★ Coping Skills promotion efforts include:
1. Denying or minimizing
 - Increasing awareness of health - Maintain mind’s function
issues. - Promote sense of normality
- Promoting healthier behaviors - Peristaltic movement
- Creating supportive environments ● Psychological benefits of exercise
- Developing preventive strategies - Improve mood state
- Encouraging early detection and - Improve self image
treatment - Reduces stress and anxiety
● Objectives of health promotion: - Enhance sleep
- Increase quality and years of - Improve depressive state of
healthy life elderly
- Maintain function - Improves cognitive function
- Eliminate health disparities and - Helps with memory and
promote independency concentration
- Improve (enhance) quality of life - Improves mood
- Extend life expectancy -> ↓ ● Social benefits of exercise
premature mortality caused by - Improve social interaction &
chronic & acute diseases. relation with other
★ Components of health promotion - Improves social function
- Exercise - Increase independence
Psychological —------ - Increase social networks and
Physical—------------ Benefits of exercise involvement
Social —------------ - Enables people to participate in
- Nutrition and enjoy social activities more.
- Rest and sleep ★ Types of exercise
- Periodic medical check up ● Isotonic
- High risk behavior ● Isometric
- Spiritual well-being
- Psychosocial well-being ★ Role of the nurse during exercise
- Safety measures 1. Assessment done at the beginning of
● Physical benefits of exercise exercise program include:
- Consumption of body fat - History & physical examination (
- Improve cardio-vascular capacity CVS, resp, musculoskeletal &
( by increase blood flow — keep Neurological system)
tissue healthy) - Renal & liver function test
- Control hypertension & blood - ECG & exercise stress test
sugar - Assess ROM & use of assistive
- Improve respiratory function devices.
- Improve joint flexibility - Assess environmental hazards.
- Improve pattern of sleep and 2. Set a regular time to exercise each day
rest 3. Before starting exercise the nurse
- Increase independency should advice the elderly about:
- Improve sense of well-being and
relaxation
 - Document baseline resting
Speak clearly and shout
function status (Ht & resp rate, slowly in a low tone of
bl.sugar) voice
- 10 minutes warms up stretching
Get to know the Make generalizations
exercise
person about older people
- Drink water before and after
exercise is important as water Listen empathetically Pay too much attention
will be lost during exercise. to tasks and forget the
- Clothes worn during exercise person

should allow for easy movement Pay attention to body Ignore non-verbal
and perspiration. language-yours and messages as
- Athletic shoes provide both theirs. insignificant
support and protection
Use touch Be afraid to use touch
- Outdoor exercise should be
appropriately and as a method of
avoided in extremely hot or cold frequently communication.
weather.
- Enclose shopping malls are
★ Information Sharing (Framing the
sheltered places for walking
Message)
during the extreme weather or
- Verbal Communication
when there are concerns about
▪ Send & receive messages using words
neighborhood safety.
▪ Some are formal, structured, & precise
- Exercising with a partner
▪ Some are informal, unstructured, &
provides both encouragement to
flexible
continue exercising and safety.
▪ Formal or therapeutic communications
- Nurse should advice the older
have a specific intent & purpose
adults to stop exercising and
▪ Informal or social conversations are
seek help if they experiences
less specific; used for socialization
chest pain or tightness, sob,
▪ Nurses must be effective in both
dizziness, or palpitation during
formal & informal communication
exercise.
▪ Must know how & when to use each
Lesson 8: Communicating with Older type.
Adults - Nonverbal Communication
Communication Dos and Don'ts When working ● Takes place without words
with older adults ● We communicate all the time, whether
we are aware of it or not.

DO DON’TS ● Importance of understanding nonverbal

communication can be summed up in the
Identify yourself Assume that the person statement, “What you are saying
knows who you are
(nonverbally) is so loud I can’t hear you.”
Address the person Use “ baby talk” or ● Approximately 38% of communication is
using the name he or patronizing names such transmitted by paralinguistic cues (i.e.,
she desires (e.g., Ms. as “sweetie” or honey. tone, pitch, volume of voice), & 55% is
Smith, Mr.Bill) transmitted by body cues.
 ★ Formal or Therapeutic Communication ✔ The study of the use of personal space
Effective verbal communication requires: in communication is referred to
-The ability to use a variety of techniques as proxemics.
when sending & receiving messages ✔ Personal space refers to how close we
● This type of communication looks easy & allow someone to get to us before we
natural when performed by an feel uncomfortable.
experienced health professional Gestures
● But it is a skill that requires time,
effort, & practice to develop. ✔ Gestures are a specific type of
★ Informal or Social Communication nonverbal communication intended to
Social Communication convey ideas
● Small talk, pleasantries, & ✔ Example: nodding the head up and down
conversations about the weather, a means yes in most cultures, but to some
favorite television show, or the latest Eskimo tribes it means no.
news can demonstrate that the nurse ✔ -helpful for people who cannot use
thinks of the patient as a real person, words.
not just as a patient Facial Expressions
● Remember that it’s okay to laugh at
yourself, but never at the other person ✔ another form of communication.
Non-verbal communication ✔ Smiles, frowns, and grimaces
● Symbols ✔ Fear, anger, joy, and a variety of other
● Uniform styles & colors emotions can be conveyed by a simple
✔ Help distinguish the various caregivers change in facial expression.
Nurses may not place much importance ✔ Eye contact is often interpreted to be a
on wearing a uniform, it does play a role sign of attentiveness and acceptance –
in communication Filipinos
✔ Nurses may not always wear a ✔ American nurses -maintain eye contact
distinguishing uniform or they may wear when speaking with their patients.
scrub suits; ✔ Arabic persons- direct eye contact
✔ This may be confusing to the older adult impolite and aggressive
but ✔ Native North Americans also regard
direct eye contact as improper
Body Language ✔ staring at the floor during
✔ communicate many things by how we conversations shows that they are
move, stand, sit, and position of our listening carefully to the speaker.
bodies Hispanics use eye contact only when
✔ Don’t create barriers between us and deemed appropriate by their cultural
our patients standards.
✔ We must watch messages that patients ✔ based on age, sex, social position,
are communicating through body economic status, and position of
movements authority.
✔ For instance, Hispanic elders speaking
Space, Distance and Position with children use eye contact, but it is
 considered inappropriate for Hispanic increase. Making older adults wait
children to look directly at their elders unnecessarily constitutes a subtle form
when speaking to them. of abuse.
✔ In a healthcare environment, Hispanic
patients expect nurses and other Touch
healthcare providers to give direct eye ✔ form of communication.
contact when interacting with them, but ✔ No words are required, and there is no
it is not expected that Hispanic need for high-level sensory or cognitive
patients reciprocate with direct eye functioning.
contact when receiving medical and ✔ When all else fails, touch is left.
nursing care. ✔ Caring touch is a basic need of all
humans, and many older adults suffer
Pace or Speed of Communication from touch deprivation.
✔ Patience and active listening are greatly
needed skills when working with older Silence
adults. “Slower is better” should be the ✔ it is seen as an absence of speech
motto impressed in the mind of anyone Advantages:
who chooses to work with older adults. ✔ Promotes healthy communication in
relationships
Time and Timing ✔ Fosters active listening
✔ Timing is related to the pace of ✔ Supports effective negotiations
communication
✔ The amount of time a person must wait Disadvantages:
after seeking attention is important. ✔ Silence can cause miscommunication
Delays in response to a call light or ✔ Negative silent communication can be
direct request from a person may be toxic
interpreted as a lack of concern, even if ✔ Empathy involves attempting to
this is not intended. The response to understand the other person's
this perception may manifest in anger, perspective and feelings and
displeasure, anxiety, fear, and many communicate that understanding back
other feelings. Studies have shown that to them.
nurses take longer to respond to
terminally ill patients. Nurses also tend ★ Barriers to Communication
to give delayed responses to demanding
individuals. This can set up a vicious ✔ Hearing impairment
cycle, because the longer a person waits ✔ Aphasia- comprehension and
for a response, the greater his or her communication (reading, speaking, or
anger, fear, and anxiety becomes. This writing) disorder resulting from damage
only increases the demanding behaviors, or injury to the specific area in the
which often occur in an attempt to brain.
reduce fear. If the older adult’s needs ✔ Dementia- a term used to describe a
are dealt with promptly, the number of group of symptoms affecting memory,
demands tends to decrease not thinking and social abilities.
 ✔ Cultural Differences
✔ Skills and techniques
✔ Informing
✔ Direct questioning
✔ Using open-ended techniques
✔ Confrontation
✔ Communicating with visitors and families
✔ Delivering bad news
✔ Effective communication
✔ Older adult/ health care team

Lesson 9: Maintaining Fluid Balance

and Meeting Nutritional Needs
★ Role of Nutrition
✔ The basic components of a well
balanced diet for older adults.
✔ How the normal physiologic changes of
aging change nutritional needs.
✔ How the normal physiologic changes of
aging may interfere with purchasing,
preparation, and consumption of
nutrients.
How cognitive, psychosocial & pathological
changes impact the aging individual’s nutritional
status.
★ Water
✔ Essential for human life.
✔ Humans can survive without food but
MUST have water.
✔ Plays a huge role in body function.
✔ 60%
✔ Dehydration

★ Malnutrition
✔ Elderly are at risk
✔ Definition
✔ Symptoms
✔ Failure to thrive.

★ Factors that affect nutritional status

✔ Physiological economic
✔ Social factors:
○ Chronic health factors
 ○ Alcoholism
○ Sensory changes
○ Pain
○ Medication
○ Problem chewing, swallowing or
digesting food.
○ Malabsorption syndrome
○ Cost of food
○ Transportation
○ Obtaining an appropriate variety
and sufficient amount of food.
✔ Other factors:
○ Depression
○ Loneliness
○ Lack of motivation
○