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Stephanie Engler, RN


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Title: Stephanie Engler, RN

Welcome to Geriatric Nursing
  • Stephanie Engler, RN
  • Wednesday
  • 940-1035am

  • About Me
  • General Questions
  • Student Motivators
  • Syllabus Review
  • Objectives of Course
  • Expectations of Me
  • Expectations of You...
  • Questions???

For next week
  • Unit 1- Chapters 1 2
  • Complete Lecture Notes- will check before class
  • Print PowerPoint Outline Notes for Ch. 1 2
  • Read chapters 1 2 and Review Key Concepts,
    Tables, Figures, and Boxes for each chapter.
  • Quiz in one week over Chapters 1, 2, 4, 6, 7
  • Bring 7 scantrons to class next week

Chapter 1The aging population
  • Gerontology is the study of the aging processes
    and individuals as they grow from middle age
    through later life. It includes
  • the study of physical, mental, and social changes
    in older people as they age
  • the investigation of the changes in society
    resulting from our aging population
  • the application of this knowledge to policies and
    programs. As a result of the multidisciplinary
    focus of gerontology, professionals from diverse
    fields call themselves "gerontologists
  • Geriatrics is
  • the specialty that concerns itself with the
    provision of nursing services to geriatric or
    aged individuals.
  • the study of health and disease in later life
  • the comprehensive health care of older persons
    and the well-being of their informal caregiver

Chapter 1
  • Dr. I. L. Nasher- father of geriatrics wrote
    the first geriatric textbook in 1914.
  • Federal Old Age Insurance Law under the Social
    Security Act in 1935- hope to ensure financial
    security of older Americans
  • Characteristics of the Older Adult Population
  • Age 65 and older
  • Represent more than 12 of the population in the
  • 2020- 17 of the population
  • The population gt85 approx. 40 of the older
  • More than half of women gt65 are widowed

Chapter 1
  • Income and Employment- Social Security
  • Most older people depend on Social Security for
    more than half of their income.
  • Franklin D. Roosevelt- The New Deal in 1935
  • Benefit check paid to retired workers of a
    specific minimum age
  • Social Security is currently estimated to keep
    roughly 40 percent of all Americans age 65 or
    older out of poverty
  • By dollars paid, the U.S. Social Security program
    is the largest government program in the world
    and the single greatest expenditure in the
    federal budget

Chapter 1
  • In 2011, there will be 56 million beneficiaries
    and 158 million workers paying in. The trust fund
    would then be exhausted by 2036 without
    legislative action.
  • The earliest age at which (reduced) benefits are
    payable is 62. Full retirement benefits depend on
    a retiree's year of birth.

Chapter 1
  • Asset rich and cash poor. What does this mean?
  • Baby Boomers (born between 1946 and 1964)are
    working past retirement.
  • Baby Boomers control over 80 of personal
    financial assets and more than 50 of
    discretionary spending power.
  • They are responsible for more than half of all
    consumer spending, buy 77 of all prescription
    drugs, 61 of OTC medication and 80 of all
    leisure travel.

Chapter 1
  • Health Status- http//
  • Chronic illness is a major problem for the older
  • Most older adults have at least one chronic
    disease or more that need to be managed
  • Chronic diseases are not only major sources of
    disability, but they are the leading cause of

Chapter 1
  • Leading Chronic Conditions
  • Arthritis
  • Hypertension
  • Heart conditions
  • Visual impairments
  • Diabetes

Chapter 1
  • Leading Causes of Death
  • Heart disease 33
  • Cancer 21.8
  • Stroke 8.2

Chapter 1
  • Baby Boomers and Care Facilities
  • Entering their senior years between 2008 and 2030
  • They will not be satisfied with the conditions of
    todays nursing homes and will demand that their
    long-term care facilities be equipped with
    computer stations, gymnasiums, juice bars, pools,
    and alternative therapies
  • Gerontological nurses need to be advocates in
    ensuring that cost-containment efforts do not
    jeopardize the welfare of older adults.
  • What are some examples of Care Facilities or
    Retirement Options?

Chapter 1
  • Point to Ponder page 7
  • A higher proportion of older adults in our
    society means that younger age groups will be
    carrying a greater tax burden to support the
    older population. Should young families
    sacrifice to support services for older adults?
    Why or why not?

Chapter 2Theories of aging
  • The biological, psychological, and social
    processes of aging are interrelated and
  • Read and Review Box 2-1 and 2-2 from Chapter 2
  • Read and Review Key Concepts from Chapter 2

Chapter 4Life transitions and Story
  • Ageism- the prejudices and stereotypes that are
    applied to older people sheerly on the basis of
    their age
  • Changes in Family Roles and Relationships-
    Parenting and grandparenting
  • Loss of a Spouse- affects more women than men
    because women tend to have a longer life
    expectance than men many are widowed by their
    eighth decade of life.
  • Retirement- Loss of the Work Role and Reduced

Chapter 4
  • Changes in Health and Functioning- changes in
    appearance and bodily function occur
  • Cumulative Effects of Life Transitions- Shrinking
    Social World and Awareness of Mortality
  • Responding to Life Transitions- Life Review, Life
    Story and Self Reflection, and Strengthening
    Inner Resources
  • Review Key Concepts and Box 4-1, 4-2

Chapter 6The Specialty of Gerontological nursing
  • Frustration over lack of value placed on
    geriatric nursing led to the American Nurses
    Association (ANA) establishing the Conference
    Group on Geriatric Nursing Practice 1962
  • Older people exhibit great diversity in terms of
    health status, cultural background, lifestyle,
    living arrangement, socioeconomic status, and
    other variables.
  • Factors such as limited finances and social
    isolation, affect the state of health and

Chapter 6
  • Core Elements of Gerontological Nursing Practice
  • Evidence-Based Practice practice has moved from
    trial and error to following a systemic approach
    that uses existing research for clinical
    decision-making a process known as
    evidence-based practice
  • Standards Professional nursing practice is
    guided by standards. Standards serve to both
    guide and evaluate nursing practice. See Box 6-2
    ANA Standards of Gerontological Nursing Practice.
  • Principles Nursing principles are those proven
    facts or widely accepted theories that guide
    nursing actions. See Box 6-3.

Chapter 6
  • Factors Influencing the Aging Process
  • Heredity
  • Nutrition
  • Health Status
  • Life Experience
  • Environment
  • Activity
  • Stress
  • Nurses must understand the multitude of factors
    that influence the aging process and recognize
    the unique outcomes for each individual.

Chapter 6
  • Gerontological Nursing Roles
  • Healer- Nightingale wrote nursing put the
    patient in the best condition for nature to act
    upon him. As medical knowledge and technology
    grew more sophisticated and the nursing
    profession became grounded more in science than
    in healing arts, the early emphasis on
    nurturance, comfort, empathy, and intuition was
    replaced by detachment, objectivity, and
    scientific approaches.
  • Caregiver- active participation of older adults
    and their significant others and promotion of the
    highest degree of self-care.

Chapter 6
  • Educator- Nurses must take advantage of formal
    and informal opportunities to share knowledge and
    skills related to the care of older adults
  • Advocate- For individual older adults, and to
    facilitate a communitys efforts to affect change
  • Innovator- Nurses need to think out of the box
    and take risks associated with traveling down new
    roads, and transform visions into reality.

Chapter 6
  • Point to Ponder
  • Based on changes in the health care system and
    society at large, what unique services could
    gerontological nurses offer in the future within
    your community?

NCLEX Questions
  • A new patient is not satisfied with the
    conditions of the nursing home, takes a highly
    active role in her healthcare, and because of her
    ability to access information is as knowledgeable
    as her care providers on some issues. This
    patient is most likely
  • A young female baby boomer that just turned 65.
  • An older woman between 75-85 years old.
  • A woman over the age of 85 years old.
  • A woman over the age of 95 years old.

NCLEX Questions
  • Nurses need to understand the aging process in
    order to help their patients
  • a. Live longer with their long term
  • Maintain youth and delay the onset of old age.
  • Accept the limitations imposed by genetic
    tendencies toward cellular degeneration.
  • Postpone the negative consequences of the aging

NCLEX Questions
  • Mr. B, age 73, has a terminal illness. He has
    entered into a nursing home, where he will reside
    until his death. Until age 70, he worked as a
    successful bank president and was an active
    community leader. The nurse should be alert for
    signs that he most resents his
  • Mortality
  • Unemployment
  • Family
  • Dependency

NCLEX Questions
  • Gerontological nursing is a complex specialty.
    Which of the following most contributes to this
  • Elderly are generally compromised in their health
  • Cost for the elderly costs more than care for
    younger patients.
  • Numerous health conditions can overlap in the
  • Complications after surgery or illness result in
    death in most cases.

  • Quiz 2 on Sept. 26th will cover Chapters 8,9,13
  • Chapter 16 will not be covered- please cross it
    off of your schedule

Chapter 8Legal aspects of gerontological nursing
  • Laws Governing Gerontological Nursing Practice-
    Box 8-1
  • Because laws are developed at the state and local
    levels, variation exists among the states.
  • Constitutions- basic rights, grant powers, and
    place limits on government agencies
  • Court decisions- establish precedents from cases
    heard in state or federal courts
  • Statutes- established by local, state and federal
    legislation (nurse practice acts)
  • Regulations- laws enacted by state and federal
    agencies that define the methods to achieve goals
    (conditions for agencies to receive reimbursement
    from Medicare or Medicaid)
  • Attorney General Opinions- laws derived from the
    opinions of the chief attorney for the state or
    federal government

Chapter 8
  • Acts that could result in legal liability for
    nurses- Box 8-2
  • Negligence- omission or commission of an act that
    departs from acceptable and reasonable standards,
    which can take several forms
  • Malfeasance- unlawful or improper act (surgical
  • Misfeasance performing an act improperly (no
    signed consent)
  • Nonfeasance failure to take proper action (not
    notifying the MD with changes)
  • Malpractice failure to abide by the standards of
    ones profession (not checking that a NG tube is
    in the stomach before administering a tube
  • Criminal negligence disregard to protecting the
    safety of another person (allowing a confused
    patient to have matches)

Chapter 8
  • Reducing the Risk of Malpractice Box 8-3
  • Guardianship- court appointment of an individual
    to have the authority to make decisions for an
    incompetent person
  • Power of Attorney- Competent individuals appoint
    parties to make decisions for them (Box 8-4)

Chapter 8
  • Restraints- chemical and physical
  • Anything that restricts a patients movement can
    be considered a restraint
  • Alternatives should be used whenever possible-
    alarmed doors, wristband alarms, bed alarm pads,
    beds and chairs close to the floor, increased
    staff and supervision
  • When restraints are necessary, a physicians
    order must be obtained- must include the type of
    restraint, condition of patient, and duration of

Chapter 8
  • No-code orders
  • Terminally ill patients that are going to die and
    resuscitation attempts would not be therapeutic
  • A physician order must be obtained to clearly
    state the wishes for no resuscitation- it is
    negligence to withhold CPR without an order
  • DNR at bedside is not valid without an official

Chapter 8
  • Advance Directives or a Living Will
  • Protects the patients right to make decisions
    about terminal care
  • Express the desires of competent adults regarding
    terminal care, life-sustaining measures, and
    other issues pertaining to their death and dying
  • 1990- Patient Self-Determination Act- requires
    all health care institutions receiving Medicare
    or Medicaid funds to ask patients on admission if
    they possess a living will for health care

Chapter 8
  • Elder abuse
  • Many forms- inflicting pain or injury stealing,
    mismanaging funds, misusing medications, causing
    psychological distress, withholding food or care,
    sexual abuse, confinement
  • Threatening to commit these acts is a crime
  • Nurses have a legal responsibility to report
    cases of known or suspected abuse
  • Signs of abuse- see page 104

Chapter 9
  • Chapter 9 Unit 2Ethical Aspects of
    Gerontological Nursing
  • Ethics- ancient Greece- ethos means those beliefs
    that guide life
  • The concept of accepted standards of conduct and
    moral judgment
  • Ethics help determine right and wrong courses of
  • The American Nursing Association (ANA) Code of
    Ethics for Holistic Nursing and various standards
    of practice supplement the nurses personal value
    system to influence ethical decision making

Chapter 9
  • Ethical Principles-
  • Beneficence- to do good for patients- nurses are
    challenged to take actions that are good for
    patients desires
  • Nonmaleficence- to prevent harm to patients
  • Justice- to be fair, treat people equally, and
    give patients the service they need
  • Fidelity and veracity- fidelity means to respect
    our words and duty to patients veracity is
  • Autonomy- to respect patients freedoms,
    preferences, and rights
  • See Box 9-1

Chapter 13
  • Chapter 13 Unit 3
  • Spirituality
  • A positive, harmonious relationship with God or
    other higher power (the Divine) helps individuals
    to feel unified with other people, nature, and
    the environment
  • Spirituality differs from religion, which
    consists of human-created structures, rituals,
    symbolism, and rules for relating to the Devine-
    highly spiritual individuals may not identify
    with a specific religion.

Chapter 13
  • Spiritual Needs-
  • Love- people need to feel love regardless of
    physical or mental condition, social position,
    material possessions
  • Meaning and Purpose- achieving a sense of
    integrity- wholeness- is supported by the belief
    that life experiences- both good and bad- make
    sense and have served a purpose
  • Hope- something in the future- belief relief and
    eternal reward are possible 
  • Dignity- make a sense of value and worth through
    their connection with God or other higher power 

Chapter 13
  • Forgiveness- achieving closure to unfinished
  • Gratitude- at a time of many losses, they may be
    guided by a review of the positive aspects in
    their life- an attitude of thankfulness nourishes
    the spirit 
  • Transcendence- connected to a greater power, life
    beyond material existence and face difficult
  • Expression of Faith- practices include prayer,
    worship, scripture reading, rituals, and
    celebration on specific holy days

Unit 4 Ch. 17safety
  • Older persons face the same environmental hazards
    as any adults, but their risks are compounded by
    age related factors that reduce their capacity to
    protect themselves from and increase their
    vulnerability to safety hazards.
  • Age related changes can reduce the capacity of
    older adults to protect themselves from injury
    and increase their vulnerability (Key Concept)
  • Accidents rank as the sixth leading cause of
    death for older adults- falls is the leading

Chapter 17
  • Importance of the Environment to Health and
  • Environment can be considered in two parts-
  • Microenvironment- our immediate surroundings with
    which we closely interact
  • Macroenvironment- elements in the larger world
    that affect groups of people or entire
  • Nursing Diagnosis- table 17-3

Chapter 17
  • Impact of Aging on Environmental Safety and
  • Potential Environmental Impact of Various
    Physical Limitations (Table 17-5)
  • Assessing basic standards for older adults
    environment (Box 17-1)
  • Lighting function, orientation, mood and
  • Temperature because older adults have lower
    normal body temperatures and decreased amounts of
    natural insulation, they are especially sensitive
    to lower temperatures.
  • Colors red, yellow, and white can be
    stimulating/blue, brown, and earth tones can be
  • Orange?
  • Green?
  • Black? Grey?

Chapter 17
  • Scents- used for aesthetic and medicinal
    purposes- aromatherapy
  • Floor Coverings- pros and cons- rugs?
  • Furniture- functional, comfortable, easy to clean
  • Sensory Stimulation- soft blankets, pictures,
    sculptures, plants, flowers, coffee, food
    cooking, soft music, textured walls
  • Noise control- many sounds create difficulties
    for older adults

Chapter 17
  • Bathroom Hazards- cause of many accidental
  • Lighting- urinary frequency
  • Floor surface- de cluttered and no throw rugs
  • Faucets- lever-shaped vs. round
  • Tubs and shower stalls- nonslip surfaces, grab
  • Toilets- grab bars, raised seat
  • Electrical appliances- accidental fall into water
  • Psychosocial Considerations-
  • Feelings and behavior influence and are
    influenced by the individuals surroundings-
    depression, regression, humiliation, anger
  • Important to recognize the need for personal space

Chapter 17
  • Falls- Risk and Prevention (Box 17-2)
  • Age-related changes-
  • Improper use of mobility aids-
  • Medications-
  • Unsafe clothing-
  • Disease-related symptoms-
  • Environmental hazards-
  • Caregiver-related factors-

Chapter 18Safe medication use
  • Effects of Aging on Medication Use
  • Polypharmacy- The high prevalence of drugs
    consumed by older people and the complexity of
    drug dynamics in old age require geri nurses to
    evaluate the effects of drugs given (figure
  • Altered Pharmacokinetics- absorption,
    distribution, metabolism, and excretion of drugs.
  • Absorption- decreased gastric blood flow and
    motility, slower metabolism
  • Distribution- dehydration will decrease drug
    distribution, and lower dosage levels may be
  • Metabolism, detoxification, and excretion- the
    renal system is primarily responsible for the
    bodys excretory functions. Drugs are not as
    quickly filtered from the blood stream and are
    present in the body longer.

Chapter 18
  • Promoting the Safe Use of Drugs
  • Avoiding Inappropriate Drugs (Box 18-1)
  • Reviewing Necessity and Effectiveness of
    Prescribed Drugs
  • Why is drug ordered?
  • Is the smallest possible dosage ordered?
  • Is the pt. allergic?
  • Can this drug interact with other drugs?
  • Special instructions?
  • Most effective route?

Chapter 18
  • Safe Use Cont
  • Promoting Safe and Effective Administration
  • Encourage good oral hygiene, fluids, proper
    positioning to facilitate swallowing
  • Frequently an older person will bleed or ooze
    after an injection because of decreased tissue
  • Provide Patient Teaching
  • Assess a patients risk for medication errors
    (Box 18-2)

Unit 5 chapter 19respiration
  • Read beginning of chapter
  • A lifetime of insults to the respiratory system
    from smoking, pollution, and infection takes its
    toll in old age.
  • Respiratory disease a leading cause of disability
    and 4th leading cause of death in persons over 70
    years of age.

Chapter 19respiration
  • Age related changes
  • Respiratory problems can develop more easily and
    be more difficult to manage
  • Connective tissues for respiration and
    ventilation are weaker
  • Elastic recoil of the lungs during expiration is
  • Alveoli are less elastic, develop fibrous tissue,
    and contain fewer functional capillaries
  • Loss of skeletal muscle strength in the thorax
    and diaphragm barrel chest
  • The net effect of these changes is a reduction in
    vital capacity
  • (The greatest volume of air that can be expelled
    from the lungs after taking the deepest possible
    breath) and increase in residual volume (The
    volume of air remaining in the lungs at the end
    of a maximal expiration)

Chapter 19respiration
  • Health Promotion for the Elderly Person
  • Risks, symptoms, and care associated with
  • Asthma
  • Chronic Bronchitis
  • Emphysema
  • Lung Cancer
  • Lung Abscess

Chronic obstructive pullmonary disorder (copd)
  • http//
  • http//
  • http//

Unit 5 Chapter 20Circulation
  • Objectives
  • Identify age related physiological changes of the
    cardiovascular system.
  • Describe common cardiovascular diseases and
    nursing interventions that assist clients with
    cardiovascular conditions.

  • Heart
  • The heart is a myogenic muscular organ found in
    all animals with a circulatory system (including
    all vertebrates), that is responsible for pumping
    blood throughout the blood vessels by repeated,
    rhythmic contractions. The term cardiac (as in
    cardiology) means "related to the heart" and
    comes from the Greek ?a?d??, kardia, for "heart

Anatomy of theheart
  • http//

Aging Circulation
Heart Blood Vessels Blood
Aorta dilates and valves thicken Baroreceptors (monitor the pressure of the blood being delivered to the brain) become less sensitive orthostatic hypotension Reduction in total body water blood volume decreases
Pathways develop fibrous tissue and fat deposits Capillary walls thicken of RBCs are reduced fatigue
Heart wall thickens may have slower fill time Aorta becomes thick, stiff, less flexible HTN of lymphocytes decreases decreased ability to fight infection
Abnormal ECG (afib)
Heart muscle cells degenerate slightly
Common heart conditions
  • Coronary artery disease (CAD)-
  • a narrowing of the small blood vessels that
    supply blood and oxygen to the heart

Common heart conditions
  • Congestive heart failure (CHF)-
  • condition in which the heart
  • can no longer pump enough
  • blood to the rest of the body

Common heart conditions
  • Myocardial infarction-
  • heart attack-
  • interruption of blood supply to a part of the
    heart, causing heart cells to die.

Common vessel conditions
  • Aneurysm-
  • an abnormal widening
  • or ballooning of a
  • portion of an artery
  • due to weakness in
  • the wall of the blood
  • vessel.

Common vessel conditions
  • Pulmonary embolism-
  • blockage
  • caused by blood clots that travel to your lungs
    from another part of your body

Common vessel conditions
  • Stroke-
  • Occurs when a blood vessel in the brain bursts
    or, more commonly, when a blockage develops

Unit 5chapter 21 22
  • Effects of Aging on GI Health
  • Objectives
  • Identify aging changes in the GI system that
    affects nutritional status.
  • List symptoms and management of dental problems
    and chronic constipation.
  • Recall the types of urinary incontinence
    experienced by older adults.
  • Identify and describe behavioral therapies used
    with incontinence.

Unit 5Chapter 24
  • Movement and Physical Changes of Aging
  • Objectives
  • Recognize normal age-related changes and common
    health deviations in the musculoskeletal system
    that affects mobility of the frail elderly.
  • Use the nursing process in determining the care
    of persons with fractures, osteoarthritis,
    rheumatoid arthritis, and osteoporosis.
  • List measures that can be used for managing
    musculoskeletal pain.

Chapter 24
  • Normal Age Related Changes-
  • Decline in number and size of muscle fibers and
    muscle mass (sarcopenia)
  • Loss of Strength
  • Impairment in activities of daily living
  • Increased incidence of falls
  • Increased incidence in hip fractures

Chapter 24
  • Decrease body strength and the flexibility of
    joints and muscles
  • Impaired capacity for muscle regeneration
  • Exercise has been considered of great interest in
    treatment of sarcopenia!!!!!

Chapter 24
  • Managing Musculoskeletal Pain
  • Degenerative changes in the tendons and arthritis
    are responsible for painful shoulders, elbows,
    hands, hips, knees, and spines.
  • Cramps at night and joint strain cause pain in
    the elderly.
  • Pain relief is essential in promoting optimal
    physical, mental, and social function.

Chapter 24
  • Heat a warm bath at bedtime and warm blankets
    can reduce spasms and cramps
  • Passive stretching help to control muscle cramps
  • Excessive exercise and stress should be avoided
  • Rest and correct positioning weight-bearing
    joints and proper body alignment
  • Alternative therapies therapeutic touch,
    chiropractic therapy
  • Unrelieved pain can significantly affect an older
    persons independence and quality of life!!!

Unit 5chapter 26
  • Sensation
  • Objectives
  • Identify age related changes in vision, hearing,
    smell and taste.
  • State the major pathological causes of visual
    impairment in the frail elderly.
  • Assess the senses of sight, hearing, smell,
    taste, and touch of the frail elderly.
  • Recognize the psychological and sociocultural
    factors that interact with sensory functioning.
  • Identify the causes of sensory impairment.
  • Develop a nursing diagnosis and plan of care for
    a person with sensory impairment.

Unit 5chapter 27
  • Endocrine Function
  • Objectives
  • List the symptoms of hypothyroidism and
  • Describe the age related differences in the
    diagnosis, presentation, and management of

Unit 5chapter 28
  • Integumentary Function
  • Objectives
  • Identify age-related changes and the common
    health deviations in the integumentary system
  • State the warning signs of cancer.
  • State the general nursing considerations for
    Integumentary conditions.

Unit 6chapter 32 33
  • Objectives Cognition/ Mental Health
  • Describe the characteristics and care of
    delirium, dementia, depression, and anxiety.
  • Describe the common psychological changes of
    aging for the characteristics of stress reaction
    time, intelligence, learning, problem-solving,
    personality, and memory.

Unit 6Chapter 32 33
  • Cognition/Mental Health
  • What does mental health mean to you?
  • Dementia
  • Confused
  • Memory loss
  • Disoriented
  • Decreased level of functioning
  • Coping effectively
  • Wellbeing
  • Happy place

Unit 6Chapter 32 33
  • Cognition/Mental Health
  • Mental health indicates a capacity to cope
    effectively with and manage lifes stress in an
    effort to achieve a state of emotional
    homeostasis (Eliopoulos, 2010).
  • Advantages of being older...
  • Great depression
  • Good mental health practices throughout the life
    span promote good mental health in old age.

Unit 6chapter 32 33
  • Challenging Emotional Homeostasis-
  • Illness
  • Death
  • Retirement
  • Increased vulnerability
  • Social isolation
  • Sensory deficits
  • Greater awareness of own mortality
  • Increased risk of institutionalization

Unit 6chapter 32 33
  • Depression-
  • The most frequent problem that psychiatrists
    treat in older adults.
  • As many as 25 of elderly in long-term care
  • Signs and Symptoms
  • Some older adults who are depressed demonstrate
    cognitive deficits secondary to the effects of

Unit 6chapter 32 33
  • Depression Cont.-
  • Treatment-
  • Anxiety-
  • Anxiety reactions can be manifested in various
    ways, including somatic complaints, rigidity in
    thinking and behavior, insomnia, fatigue,
    hostility, restlessness, chain smoking, pacing,
    confusion, and increased dependency.
  • Other symptoms-
  • Treatment-

Unit 6chapter 32 33
  • Delirium-
  • Impaired cerebral circulation and cause
    disturbances in cognitive function.
  • As older adults often have multiple health
    conditions, it is important to remember that
    several coexisting factors can be responsible for
  • Dementia-
  • An irreversible, progressive impairment in
    cognitive function affecting memory, orientation,
    judgment, reasoning, attention, language, and
    problem solving.
  • Caused by damage or injury to the brain.

Unit 6chapter 32 33
  • Table 33-1 Delirium vs. Dementia
  • State
  • cause
  • onset
  • mental status
  • level of consciousness
  • behavior
  • recovery

  • http//

Unit 7Chapters 37 39
  • Only Chapters 37 39 will be required for Unit 7
  • You will read and study the Economics/Healthcare-
    Resources for Support objectives independently
    (chapter 37 in book).
  • End of Life Care objectives will be covered

Unit 7Chapter 39
  • End of Life Care
  • Review the stages of dying.
  • List the physical care needs of dying individuals
    and the related nursing interventions.
  • Identify factors that have increased ethical
    dilemmas for nurses.
  • Describe the ethical principles that guide
    nursing practice.
  • Discuss euthanasia and the associated legal and
    professional responsibilities.

Unit 7chapter 39
  • More than 80 of deaths occur in old age
  • All nurses must learn to deal with the entire
    process- using a blend of sensitivity, insight,
    and knowledge about the complex topic of death in
    order to diagnose nursing problems and
    effectively intervene.
  • With fewer people dying at earlier ages than in
    the past and most deaths occurring in hospitals
    or nursing homes, most people have minimal direct
    involvement with dying individuals.

Unit 7chapter 39
  • An examination of ones own feelings and
    attitudes about death can be therapeutic to a
    nurse personally, as well as helpful in the care
    of dying patients.
  • Patients reactions to dying are influenced by
    previous experiences with death, age, health
    status, philosophy of life, and religious,
    spiritual, and cultural beliefs.

Unit 7Chapter 39
  • The five stages of the dying process include
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

Unit 7chapter 39
  • Physical Care Needs-
  • Pain
  • For the dying patient, the goal of pain
    management is to prevent pain from developing
    rather than treat it once it occurs.
  • Complaints of pain or discomfort, nausea,
    irritability, restlessness, and anxiety are
    common indicators of pain.
  • Alternatives to medications should be included in
    the pain-control program of dying patients.

Unit 7chapter 39
  • Respiratory Distress
  • A common problem in dying patients.
  • Discomfort resulting from dyspnea, and
    psychological distress associated with the fear,
    anxiety, and helplessness that results from the
    thought of suffocating.
  • Causes- pleural effusion and deteriorating blood
    gas levels.

Unit 7chapter 39
  • Constipation-
  • Reduced food and fluid intake, inactivity, and
    the effects of medications cause constipation.
  • Nursing staff should take measures to promote
    regular bowel elimination
  • Laxatives usually are administered on a regular

Unit 7chapter 39
  • Poor Nutritional Intake
  • Anorexia, nausea, and vomiting can prevent the
    ingestion of nutrients
  • Serve small-portioned meals that have appealing
    appearances and aromas that can boost appetite.
  • Control nausea and vomiting.

Unit 7chapter 39
  • Signs of imminent death-
  • Decline in blood pressure
  • Rapid, weak pulse
  • Dyspnea and periods of apnea
  • Slower or no pupil response to light
  • Profuse perspiration
  • Cold extremities
  • Bladder and bowel incontinence
  • Pallor and mottling of skin
  • Loss of hearing and vision

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