NURSING fer ellness in Older AdultsContents pant/ Older Adults and Wellness 1 CHAPTER 1 Seeing Older Adults Theough the Eyes of Wellness 1 Images of Aging 1 ‘The Relationship Between Wellness and Aging 2 Descriptions of Wellness 2 Definitions of Aging 3 Descriptions of Successful Aging 4 Altitudes Toward Aging 4 Historical Auitudes 4 Ageism 5 Aging Anxiety and Anti-Aging 7 Addressing Autitudes of Nurses 7 Debunking Myths: Understanding Realities About Older Adults in the United Staves 8 (Characteristics of the Older Adult Population 8 Family Relationships of Older Adults. 12 Living Arrangements of Older Adults. 14 CHAPTER 2 Applying a Mutsing Model for Promoting Wellness in Older Adulis 1 A Nursing Theory for Wellness-Focused Care of Older Adults 20 Concepts Underlying the Functional Consequences Theory 20 Functional Consequences 21 Age-Related Changes and Risk Factors 23 Person 24 Nursing 24 Health: 25 Environment 25 Applying the Theory to Promote Wellness in Older Adults 26 CHAPTER 3 Theoretical Perspectives an Aging Well 29 How Can We Live Long and Well? 29 Life Span and Life Expectancy 30 Mortality Rates and the Rectangularization of the Curve 30 Active Life Expectancy 31 Relationships Among Aging, Disease, and Disability 33, How Do We Explain Biologic Aging? 34 Genetic Theories 34 Wear-and-Tear Theories 35 Immunity Theories 35 Cross-Linkage Theory 35 Free Radicals Theory 35 Neuroendocrine Theories 36 Apoptosis Theory 36 Conclusions About Biologic Theories 36 Relevance of Biologic Perspectives on Aging to Nurses 37 Sociologic Perspectives on Axing. 38 Disengagement Theory 38 Activity Theary 39 Subculture Theory 39 ‘Age Stratification and Age Integration Theories 39 Person-fnvironment Fit Theory 40 Relevance of Sociologic Theories of Aging Nurses 40 Psychological Perspectives on Aging 41 Human Needs Theory 41 Life-Course and Personality Development Theories 41 Theory of Gerotranscendence 42 Theories About Gender and Aging 43 Relevance of Psychological Theories of Aging to Nurses 43 A Holistic Perspective on Aging and Wellness 44 CHAPTER 4 Perspectives on Culture and Diyeisity of Clder Adults 48 Cultural Diversity of Older Adults inthe United States 48 Cultural Competence and Transcultural Nursing for Older ‘Adults 49 ‘A Nursing Model for Providing Culturally Sensitive Care 50 Sources af Information for Developing Cultural Competence 51 Linguistic Competence in Care of Older Adults 52 Overview of Cultural Groups of Older Adu inthe United States 52 African Americans 53 Hispanics or Latinos 54 Asians and Pacific landers 55 ‘American Indians and Alaska Natives 57 Older Adults in Other Diverse Communities $8 Older Adults in Rural Areas 58 Homeless Older Adults 58 PART Nursing Considerations for Older Adults 61 CHAPTER & Gerontological Mursing and Health Promotion BI Gerontology and Geriatries 61xx Contents Gerontological Nursing 62 History of Gerontological Nursing 62 Education of Gerontological Nurses 63 Gerontological Nursing Resources 64 Research Imperatives for Gerontological Nurses 64 Health, Wellness, and Health Promotion 65 Heaith Promotion Initiatives for Older Adults 65 Focus of Health Promotien Programs 67 Types of Healt Promotion Interventions for Older Adults 67 ‘The Transtheoretical Model of Health Promotion 70 CHAPTER 6 Diverse Health Care Settings for Older Adults 77 Development of s Continuum of Care for Older Adults. 78 Acute Care Settings 78 Models for Acute Care of Older Adults 78 Roles for Gerontological Nurses in Acute Care Settings 79 Long-Term Care Setting: $0 Mursing Home Models for Long-Term Care 80 Newer Models for Long-Term Care 80 Roles for Gerontological Nurses in Long-Term Care Settings 82 Home Care Services 82 Skilled Home Care 82 Long-Term Home Care &3 Payment for Home Care Services 83 Roles jor Gerontological Nurses in Home Cave Sertings 84 ‘Community-Based Services 84 ‘Adult Day Centers 85 Respite Services 85 Parish Mursing Programs 86 Health Promotion Programs 86 Geriatric Care Management Services 86 Roles for Gerontological Nurses in the Community 86 Paying for Health Care Services for Older Adults 87 Medicare 87 Medicaid 89 Private Insurance 89 Out-of-Pocket Spending 90 Comprehensive Models 90 CHAPTER 7 Assessment af Health and Functioning $4 General Approach to Assessing the Older Adult's Health and Functioning 94 Functional Assessment 95 Development of the Funciional Assessment Approach 95 Application of Functional Assessment in Practice Settings 96 Tools for Functional Assessment 96 Assessment of Activities of Daily Living (ADLs) 97 Assessment of Instrumental Activities of Daily Living (ADLs) 97 Assessing the Effect ofthe Older Adult's Environment on Functioning 97 Assessing the Use or Potential Use of Adaptive and Assistive Devices 103 Assessing the Effect of the Older Adult's Cognitive Abilities on Function 103 Assessing and Addressing Driving Safety 103, Idenuifying Risks 108 Addressing Risk Factors 108 CHAPTER 8 Medications and Other Bioactive Substances. 117 Introduction o Bioactive Substances 112 Considerations Regarding Medications 113 Considerations Regarding Herbs and Homeopathy 114 ‘Age-Related Changes That Affect Bioactive Substances in Older Adults 119 Changes That Affect the Acton of Bioactive Substances in the Body 119 Changes That Affect Behaviors Related to Taking Bioactive Substances 121 Risk Factors That Aifect Bioactive Substances 121 Pathologic Processes and Functional Inpairments 121 Behaviors Based on Myths and Misunderstandings 122 Communication Barriers 122 Lack of Information 123 Inappropriate Presribing Practices 123 Polypharmaey and Inadequate Monitoring of Medications 124 Medication Nonadherence: Financial Concerns and Other Contributing Factors. 125 Insufciens Recognition of Adverse Medication Biecis 126 Medication Interactions 127 Medication-Medicaion interacions 127 Medications and Herbs 127 Medications and Nutrients 127, Medications and Alcohol 128 Medications and Caffeine 129 Medications and Nicotine 129 Functional Consequences Associated With Bioactive Substances in Older Adulws 129 Altered Therapewic Effects 129 Increased Potential for Adverse Effects 129 Nursing Assessment of Medication Use and Effects 132 Communicatian Techniques for Obtaining Accurate Information 132 Scope of a Medication Assessment 133 Observing Patterns of Medication Use 134 Linking the Medication Assessment to the Overall Assessment 135 Haentfsing Adverse Medication Effects 136 Norsing Diagnosis 136 Planning for Wellness Outcomes 136 Nursing Interventions to Promote Healthy Mediation-Taking Patterns 137 Teaching About Medications 137 Teaching About Herbs and Other Bioactive Substances 138 Adressing Factors That fect Adherence 138 Decreasing the Number af Medications 140 Evaluating Effectiveness of Nursing Interventions: 144CHAPTER § Legal and Ethical Concerns 147 Autonomy and Rights 147 Competency 148 Decision-Making Capacity 148 Advance Directives 149. Living Wills and Do Not Resuscitate (DNR) Orders 150 Durable Power of Attorney for Health Care 150 Legal Issues Spevifie 10 Long-Te 3 151 Ethical Issues Commonly Addressed in Gerontological ‘Nursing 151 Ethical Issues in Everyday Care of Older Adults 151 Bihical Issues Specific to LongeTerm Care Setings 152 Ethical Issues in Chronic and Terminal Illness 153 Cultural Aspects of Legal and Ethical Issues. 154 Role of Nurses Regarding Legal and Bthical Issues 155 Implementing Advance Directives 155 Facilitating Decisions About Care 156 CHAPTER 10 Elder Abuse and llegleet 188 Overview of Elder Abuse and Neglect 159 Definitions 159 Historical Recognition af a Social Problem 160 Incidence and Causes 161 Cultural Considerations: 162 Risk Factors for Elder Abuse and Neglect 162 Invisibility 162 Vulnerability 163 Psychosocial Factors 163 Caregiver Factors 163 Functional Consequences Associated With Elder Abuse and Neglect 164 Nursing Assessment of Abused or Neglected Older ‘Adults 165 Unique Aspects of Elder Abuse Assessment 165 Physical Health 166 Activites of Daily Living 168 Paychosocial Function 169 Support Resources 169 Environmental Influences 169 Threats to Life 170 Cultural Aspects 170 Nursing Diagnosis. 171 Planning for Wellness Outcomes 172 Nursing Interventions to Address Elder Abuse and ‘Neglect 172 Interventions in Institutional Sestings: 172 Inserventions in Commity Setings 173 Interventions in Multdisciplinary Teams. 173 Referrals 174 Prevention and Treatment Interventions. 174 Legal Interventions 176 Adult Protective Services 176 Ethical Issues 178 Evaluating Effectiveness of Nursing Interventions 180 Contents xxi pantcd Promoting Wellness in Psychosocial Function 185 CHAPTER 11 Cognitive Function 185 Age-Related Changes That Affect Cognition 186 Central Nervous System 187 Fluid and Crystallized Intelligence 187 Memory 188 Adult Psychological Development 189 Risk Factors That Affect Cognitive Wellness. 190 Personal and Social Influences 190 Sensory Function and Health Factors 190 Nutritional and Chemical Factors 191 Medication Esfeets 191 Functional Consequences Affecting Cognitive Function 191 ‘Nursing Assessment of Cognitive Function 191 Nursing Diagnosis 192 Planning for Wellness Outcomes 192 [Nursing Interventioas to Promote Cognitive Wellness 192 Encouraging Educational Opportunities 193 Teaching About Memory and Cognition 193 Improving Concentration and Attention 195 Adapring Health Education Materials 195 Evaluating Effectiveness of Nussing CHAPTER 12 Psychososial Function 200 Life Events: Age-Related Changes Affecting Psychosocial Function 200 Retirement 202 Relocation 202 Chronic Miness and Functional Impairments 202 Decisions About Driving a Car 208 Widowhood 203 Death of Feiends and Family 203 Ageist Atitudes 204 “Theories About Psychosocial Function in Older Adults 204 Theories About Emotional Development During Later Adulthood 204 Theories About Stress 204 Theories About Coping 205 Factors That Influence Psychosocial Function in Older ‘Adults 206 Religion and Spirituality 206 Culture 207 Risk Factors That Influence Psychosocial Function 210, Functional Consequences Associated With Psychosocial Function in Older Adults. 211 Nursing Assessment of Psychosocial Function 211 Nursing Diagnosis 211 Planning for Wellness Outcomes 212xxii Contents Nursing Interventions to Promote Healthy Psychosocial Function 212 Enhancing Self-Esteem 213 Promoting a Sense of Control 214 Involving Older Adults in Decision Making 215 Addressing Role Loss 215 Encouraging Life Review and Reminiscence 215 Fostering Social Supports 216 Addressing Spiritual Needs 216 Promoting Wellness Through Healthy Aging Classes 218 Evaluating Effectiveness of Nursing Interventions 221 CHAPTER 13 Psychosocial Assessment 226 Overview of Psychosocial Assessment of Older Adults 227) Purposes of the Psychosoclal Assessment Process 227 Procedure for the Psychosocial Assessment 227 Scope of the Psychosocial Assessment 228 Communication Skills for Psychosocial Assessment 229 Identifying Communication Barriers 229 Enhancing Communication With Older Adults 230 Creating an Evironment That Supports Good ‘Comraunication 232 Mental Status Assessment 233, Physical Appearance 233, Motor Function and Psychomotor Behaviors 234 Social Skills 235 Response to the Interview 235 Orientation 235 Aleriness and Attention 236 Memory 237 Speech and Language Characteristics 237 Higher Language Skills 238 Decision Making and Executive Function 239 ‘Affective Function 241 Guidelines for Assessing Affective Function Mood 241 Aniety 242 Self-Esteem 243 Depression 243 Happiness and Well-Being 244 Contact With Reality 244 Delusions 245 Hallucinations and Hlusions 248 Special Considerations for Assessing Contact With Reality in Older Adults 250 Social Supports 251 Social Network 251 Barriers to Obsaining Social Supports 252 Economic Resources 253 Religion and Spisituatity 253 CHAPTER 14 Ingaived Cogaitive Function: Delirium and Dementia 250 Detirium 260 Overview and Types 260 Prevalence and Risk Factors 260 Functional Consequences of Delirium 260 Nursing Assessment of Delirium 261 Nursing Diagnosis andl Outcomes 261 ‘Nursing Interventions for Delirium 261 Overview of Dementia 261 Terminology to Describe Dementia 261 Theories to Explain Dementia 263 ‘Types of Dementia 264 Alzheimer’s Disease 264 Vascular Dementia 267 Dementia With Lewy Bodies 268 Frontotemporal Dementia 269 Factors Associated With Dementia 269 Factors That Increase the Risk for Development of Dementia. 269 Factors That Protect Against Dementia 269 Factors That Interfere With Assessment of and Interventions for Dementia 270 Functional Consequences Associated With Dementia in Older ‘Adults 270 ‘Nursing Assessment of Dementia in Older Adults 273, Initial Assessment 273 Ongoing Assessment of Consequences 273 ‘Nursing Diagnosis 274 Planning for Wellness Outcomes! 274 ‘Nursing Taterventions to Address Dementia 275 Theoretical Frameworks for Nursing Interventions 276 General Principles of Nursing Interventions in Different Settings 277 Improving Safety and Function Through Environmental Modifications 278 Communicating With Older Adults With Dementia 279 Teaching About Medications 279 Teaching About Complementary and Alternative Care Practices 281 Facilitating Decisions About Care for People With Dementia 282 Evaluating the Effectiveness of Nursing Interventions 285 CHAPTER 15 Inpaired Afective Function: Depression 292 ‘Theories About Late-Life Depression 292 Payehosocial Theories 293 Cognitive Triad Theory 294 Biologic Theories 294 Theories About Depression and Dementia 204 ‘Types of Depression 295 Risk Factors for Depression in Older Adults 295 Demographic Factors and Psychosocial Influences 295 ‘Medica! Conditions and Functional Impairments 296 Effecs of Medications and Alcohol 297 Functional Consequences Associated With Depression in ‘Older Adults 297 Physical Health and Functioning 297 Psychosocial Function and Quality of Life 298 Suicide 299 Nursing Assessment of Depression in Older Adults 299 Identifying the Unique Manifestations of Depression 299 Using Screening Tools 300 Assessing the Risks for Suicide 30Nursing Diagnosis 303 Planning for Wellness Outcomes 303 Nursing Interventions to Address Depression 303 Alleviating Risk Factors 304 Improving Psychosocial Function 304 Promoting Health Through Exercise and Nutrition 304 Providing Education and Counseling 30S Facilitating Referrals for Psychosocial Therapies 306 Teaching About and Managing Antidepressant Medications 306 Teaching About Blectroconvulsive Therapy 308 Teaching About Altemative Health Care Practices 309 Preventing Sulcide 309 Evaluating the Effectiveness of Nursing Interventions 309 pant Promoting Wellness in Physical Function 315 CHAPTER 16 Hearing 316 Age-Related Changes That Affect Hearing 315 External Ear 316 Middle Ear 317 Inner Ear 317 Auditory Nervous System 318 Risk Factors That Affect Hearing Wellness 318 Lifestyle and Environmental Factors 318 Impacted Cerumen 319 Medication Effects 319 Disease Processes 320 Combinations of Risk Factors 320 Pathologic Conditions Affecting Hearing: Tinnitus 320 Functional Consequences Affecting Hearing Wellness 320 Effects on Communication 321 Effects on Quality of Life, Safety. and Functioning 322 Nutsing Assessment of Hearing 322 Interviewing About Hearing Changes 323 Observing Behavioral Cues 324 Using an Oroscope and Tuning Fork 325 Nursing Diagnosis 326 Planning for Wellness Outcomes 326 Nursing Interventions for Hearing Wellness 326 Promoting Health for Hearing Wellness 326 Compensating for Hearing Deficits 328 Communicating With Hearing-Inpaired Older Adults 331 Evaluating Effectiveness of Nursing Interventions 332 CHAPTER 17 Vision 337 Age-Related Changes That Affect Vision 337 Eye Appearance and Tear Ducts 338 The Eye 339 The Retinal-Newral Pathway 340 Contents xxiii Eifects of Age-Relsted Changes on Vision 340 Loss of Accommodation 340 Diminished Acuity 340 Delayed Dark and Light Adaptation 341 Increased Glare Sensitivity 341 Reduced Visual Field 341 Diminished Depth Perception 341 Altered Color Vision 341 Diminished Critical Flicker Fusion 342 Slower Visual Information Processing 342 Risk Factors That Aflect Vision Wellness 342 Pathologie Conditions Affecting Vision 343, Cataracts 343, Age-Related Macular Degeneration 345 Glaucoma 345 Functional Consequences Affecting Vision Wellness 347 Effects on Safety and Function 347 Effects on Quality of Life 348 Effects on Driving 348 [Nursing Assessment of Vision 349 Inierviewing About Vision Changes 349 Identifying Opportunities for Health Promotion 350 Observing Cues to Visual Function 350 Using Standard Vision Tests 350 Nursing Diagnosis 352 Planning for Wellness Outcomes 352 ‘Nursing Interventions for Visual Wellness 352 Health Promotion for Visual Wellness 353, Comfort Measures for Dry Eyes. 354 Environmental Modifications. 354 Low- Vision Aids 356 Maintaining and Improving Quality of Life 356 Evaluating Effectiveness of Nursing Interventions 357 CHAPTER 18 Digestion and Nutrition 362 ‘Age-Related Changes That A\fect Digestion and Eating Patterns 362 Smell and Taste 362 Oral Cavity 364 Esophagus and Stomach 364 Intestinal Tract 364 Lier, Pancreas, and Gallbladder 365 ‘Age-Related Changes in Nutritional Requirements 365, Calories 365 Protein 366 Carbohydrates and Fiber 366 Fats 367 Water 367 Risk Factors That Affect Digestion and Nutrition 367, Inadequate Oral Care 367 Functional Impairments and Disease Processes 369 Medication Effects 369 Lifestyle Factors 369 Psychosocial Factors 370 Cultural and Socioeconomic Factors 370 Environmental Factors 372 Behaviors Based on Myths and Misunderstandings 372 Pathologic Condition Affecting Digestive Wellness: Constipation 372xxiv Contents Functional Consequences Affecting Digestion and Nutrition 373 Ability to Procure, Prepare, and Enjoy Food 373 Oral Function and Digestion of Food 373 [Nusritional Status and Weight Changes 374 Quality of Life 374 Nursing Assessment of Digestion and Nutrition 375 Interviewing About Digestion and Nutrition 375 Observing Cues to Digestion and Nutrition 375 Using Physical Assessment and Laboratory Information 376 Using Assessment Tools 377 Nursing Diagnosis. 378 Planning for Wellness Outcomes 380 Nursing Interventions to Promote Healthy Digestion and ‘Nutrition 380 . Addressing Risk Factors That Interfere With Digestion and Nucrition 380 Promoting Oral and Dental Health 381 Promoting Optimal Nutrition and Preventing Disease 383 Evaluating Eifeciveness of Nursing Interventions. 385 CHAPTER 18 Urinary Function 396 Age-Related Changes That Affect Urinary Wellness 390 ‘Changes in the Kidneys 391 Changes in the Bladder and Urinary Tract 392 Changes in Control Mechanisms 393 Changes Affecting Control Over Socially Appropriate Urinary Elimination 393 Risk Factors That Affect Utinary Wellness 393 Behaviors Based on Myths and Misunderstandings 394 Functional Impairments 394 Disease Processes 395 Medication Effects 396 Dietary and Lifestyle Factors 396 Environmental Factors 397 Pathologic Condition Affecting Urinary Function: Urinary Incontinence 397 Functional Consequences Affecting Urinary Wellness 397 Effects on Homeostasis: 398 Effects on Voiding Patterns 399 Consequences of Urinary Incontinence 399 Nursing Assessment of Urinary Function 400 Talking With Older Adults About Urinary Function 400 Identifving Opportunities for Health Promotion 401 Using Laboratory Information 401 Nursing Diagnosis 403 Planning for Wellness Outcomes 403 Nursing Interventions to Promote Healthy Urinary Function 404 Teaching About Urinary Wellness 404 Promoting Continence and Alleviating Incontinence 405 ‘Managing Incontinence 410 Evaluating Bifectiveness of Nursing Interventions 412, CHAPTER 20 Cardiovascular Function 417 Age-Related Changes That Affect Cantiovascular Function 417 ‘Myocardium and Neuroconduction Mechanisms 419 Vasculonure 419 Baroreflex Mechanisms 419 Risk Factors That Affect Cardiovascular Function 420 Physical Deconditioning 420 Risks for Cardiovascular Disease 420 Gender-Speeific Risks 422 Risks for Orthostatic and Postprandial Hypotension 422 Pathologic Condition Affecting Cardiovascular Wellness Atherosclerosis 422 Functional Consequences Affecting Cardiovascular Wellness 423 Effects on Cardiae Funetion 423 Effects on the Response to Fxewise 423 Effects on Blood Pressure 424 Effects on Circulation 424 ‘Nursing Assessment of Cardiovascular Function 425 Assessing Baseline Cardiovascular Function 425 Assessing Blood Pressure 425 Hdentifying Risks for Cardiovascular Disease 427 Assessing Signs and Symptoms of Heart Disease 427 Assessing Knowledge About Heart Disease 427 Nursing Diagnosis 430 Planning for Wellness Outcomes 430 [Nursing Interventions to Promote Healthy Cardiovascular Function 431 Addressing Risks Through Nutrition and Lifessyle Interventions 431 Addressing Risks Through Pharmacologic Interventions 432 Preventing and Managing Hypertension 432 Preventing and Managing Dyslipidemia 434 Preventing and Managing Orthostatic or Posiprandial Hypotension 435 Evaluating Effectiveness of Nursing Interventions 436 CHAPTER 21 Aespiratory Funstion 442 ‘Age-Related Changes That fect Respiratory Function 442 Upper Respiratory Structures 442 ‘Chest Wall and Musculoskeletal Sructures 444 Lung Structure and Function 444 Risk Factors That Affect Respiratory Wellness 445, Tobacco Smoking #45 Exvtronmental Factors #46 ‘Additional Risk Factors 446 Pathologic Condition Affecting Respiratory Funetion COPD 447 Functional Consoquences Affecting Respiratory Wellness 447 [Narsing Assessment of Respiratory Fanction 448 “ensifing Opportunities for Health Promotion 448 Detecting Lower Respiratory Infections 449 ‘Assessing Smoking Behaviors 450 Identifying Other Risk Factors 450 Physical Assessment Findings 451 Nursing Diagnosis 451 Planning for Wellness Outcomes 452 Nursing Intentions for Respiratory Wellness. 452 Promoting Heath for Respiratory Wellness 452 Preventing Lower Respiratory Injections 453 Eliminating the Risk From Smoking 454 Evaluating Effectiveness of Nursing Interventions 455CHAPTER 22 Mobility and Safety 460 ‘Age-Related Changes That Affect Mobility and Safety 460 Bones 460 Muscles 462 Joints and Connective Tissue 462 Nervous System 462 Osteoporosis as an Age-Related Change 462 Risk Factors That Affect Mobility and Safety 463, Risk Factors for Impaired Musculasketetal Function 463 Risk Factors for Osteoporosis and Fractures 463 Risk Factors for Falls 465 Pathologic Condition Affecting Musculoskeletal Funetion: ‘Osteoarthritis 468 Functional Consequences Affecting Musculoskeletal Wellness 468) Effects on Musculoskeletal Function 468 Susceptibility fo Falls and Fractures 469 Psychosocial Consequences 470 Nursing Assessment of Musculoskeletal Function 470 Assessing Musculoskeletal Performance 471 Identifying Risks for Osteoporosis 471 Kdentfying Risks for Falls and Injury 472 Nursing Diagnosis 475 Planning for Wellness Outcomes 475 ‘Nursing interventions for Musculoskeletal Wellness 475 Promoting Healthy Musculoskeletal Function 475 Preventing and Treating Osteoporosis 476 Preventing Falls and Fall-Related Injuries 480 Evaluating Effectiveness of Nursing Interventions 484 CHAPTER 23 Tntegument 490 ‘Age-Related Changes That Affect the Skin 491 Epidermis 491 Dermis 492 Subcutaneous Tissue and Cutaneous Nerves 492 ‘Sweat and Sebaceous Glands 492 Nails 493 Hair 493 Risk Factors That Affect Skin Wellness, 493 Genetic Influences 493 Lifestyle and Environmental Influences 493 Medication Egfects 494 Risk for Skin Breakdown 494 Pathologic Conditions Affecting Skin and Nails 494 ‘Skin Cancer 494 Pressure Ulcers 495 Functional Consequences Affecting Skin Wellness 496 Susceptibility to Injury 495 Response to Ultraviolet Radiation 496 Comfort and Sensation 496 Quality of Life 497 Nursing Assessment of Skin 497 dentifing Opportunites for Health Promotion 498. Observing Skin, Hair and Nails 498 Assessing Pressure Ulcers 509 Nursing Diagnosis 502 Planning for Wellness Outcomes 504 Contents xxv Nursing Interventions for Skin Wellness. $04 Promoting Healthy Skin S04 Proventing Skin Wrinkles 504 Preventing Dry Skin 505 Detecting and Treating Harmful Skin Lesions 506 Preventing and Managing Pressure Ulcers 506 Evaluating Bifectiveness of Nursing Interventions $06 CHAPTER 24 Sleep and Rest 511 ‘Age-Related Changes That Affect Sleep and Rest Programs $12 ‘Tome in Bed and Tota! Sleep Time 512 Sleep Efficiency and Number of Arousals 512 Sleep Cycles and Stages 512 Circadian Rhythm 513 Gender Related Differences in Sleep Patterns 513 Risk Factors That Can Affect Sleep 513 Psychosocial Factors S14 Environmental Factors 514 Physiologie Factors S14 Pathologie Condition Affecting Sleep: Obstructive Sleep Aptea 516 Functional Consequences Affecting Sleep Wellness 516 Nursing Assessment of Sleep Patterns 517 Kaentifving Opportunities for Health Promotion $17 Using Sleep Assessment Tools $17 Nursing Diagnosis 518 Planning for Wellness Outcomes 520 ‘Nursing Interventions for Sleep Wellness 520 Promoting Healthy Sleep Patterns 520 Modifying the Environment 10 Promote Sleep 520 Individualizing Cave in Institutional Settings 521 Educating Older Adults About Medications and Sleep 522 Addressing Obstructive Sleep Apnea 523 Evaluating Effectiveness of Nursing Interventions 524 CHAPTER 25 Thermoregulation 828 Age-Related Changes That Affect Thermoregulation 528 ‘Response to Cold Temperatures: 529 Response to Hot Temperatures. 530 Normal Body Temperature and Febrile Response to Hiness $30 Risk Factors That Affect Thermoregulation $30 Brvironmental and Socioeconomic Influences 530 Behaviors Based on Lack of Knowledge 531 Conditions That Predispose to Hypothermia or Hyperthermia 531 Functional Consequences Associated With Thetmoregulation in, Older Adults S31 Altered Response to Cold Environments 532 Altered Response to Hot Environments 532 Altered Thermoregulatory Response to liness 533 ‘Altered Perception of Environmental Temperatures $33 Peychosocial Consequences of Altered Thermoregulation 533, Nussing Assessment of Thermoregulation 533, Assessing Baseline Temperature 533 denifving Risk Factors for Altered Thermoregulation 534 Assessing for Hypothermia 535xxvi Contents: Assessing for Hyperthermia 535 “Assessing the Older Adult's Febrile Response to Hlness 535 [Nursing Diagnosis 535 Planning for Wellness Outcomes 536 Nursing Interventions to Promote Fiealthy Thermoregulation 536 Addressing Risk Factors 536 Promoting Healthy Thermoregulation 536 Promoting Comfort 537 Evaluating Effectiveness of Nursing Interventions $38 CHAPTER 26 Sexual Function 541 ‘Age-Related Changes That Alfect Sexual Function 541 Changes Affecting Older Women 542 Changes Affecting Older Men 543 Risk Factors That Affect Sexusl Function 543, Societal Influences 543 Auttudes and Behaviors of Families and Caregivers S44 Limited Opportunities for Sexual Activity 545 Adverse Effects of Medication, Alcohol, and Nicotine 545 Chronic Conditions and Functional Impairments 546 Pathologic Conditions Asfecting Sexual Wellness 547 Gender Specific Conditions $47 Sewual Dysfuction $47 Functional Consequences Affecting Sexual Wellness 548 Reproductive Ability S48 Response to Sexual Stimulation 548 Sexual Interest and Activity 549 Menopause and Andropause $50 Nursing Assessment of Sexual Function $51 Self Assessment of Attitudes About Sexual Function and Aging SSI Assessing Sexual Function in Older Adults 532 ‘Nursing Diagnosis 552 Planning for Wellness Outcomes $52 Nursing Interventions to Promote Healthy Sexual Function 554 Teaching Older Adults About Sexual Wellness 554 Addressing Risk Factors 554 Prometing Sexual Wellness in Long-Term Care Settings 535 Teaching About Hormonal Therapy for Women 556 Teaching About Interventions for Men 559 Evaluating Effectiveness of Nutsing Interventions $60 PAR 1 Promoting Wellness in All Stages of Health and illness 565 CHAPTER 27 Caving for Older Adults using Wlness. $66 (Characteristics of ness in Older Adults 565 ‘Connecting the Concepts of Wellness, Aging, and Hlness 567, Holistically Caring for Older Adults Who Are Il: Focusing on Caring and Comforting 567 Applying Wellness Concepis in Specific Pathologic or Chronic Conditions 569 Promoting Wellness for Older Adults With Cancer 569 Promoting Wellness for Older Adults With Diabetes Mellitus 570 Promoting Wellness for Older Adults With Heart Failure S72 Addressing Needs of Families and Caregivers $73 CHAPTER 28 Caving for Older Adults Experiencing Pain $17 Definitions: Acute Versus Persistent Pain 577 Anatomy and Physiology of Pain 578 ‘Types of Pain 579 Causes of Pain in Older Adults $80 ‘Age-Related Changes That Affect Pain. $80 Barsiers to Pain Management 580 Functional Consequences of Pain in Older Adults 580 [Nursing Assessment of Pain in Older Adults 582 Collecting Pertinent Information 382 Assessment of Pain Components 583 Assessment in Cognitively Impaired Older Adults 585 Principles of Analgesic Medication $86 Classifications of Analgesics 586 The World Health Organization's Three-Step Pain Relief Ladder for Pain Management 587 Management of Side Effects and Risks of Tolerance, Dependence, and Addiction 585 Development of a Pain Management Regimen $89 CHAPTER 29 Caring for Older Adults at the End of Life $92 End-of-Life Transitions. 592 ‘The Dying Process and Death 592 ‘Nursing Skill in Caring for the Dying 593 ‘Cultural and Historical Perspectives on Death and Dying $93, Demographics of Death and Dying 593 Sites of Death and Dying 594 Views af Death and Dying in Western Culture 594 Quality of Care atthe End of Life 59S ‘The Role of Nursing 396 Hospice Care $97 ‘Nursing Interventions in End-of-Life Care 598 Promoting Communication 598 Offering Spiritual Support 599 Managing Sympioms 599 Apgenix: Age-Related Variations in Laboratory Yalues 606 Index 607