Download Welcome to Geriatric Nursing

WELCOME TO
GERIATRIC
NURSING
Stephanie
Engler, RN
Wednesday
9:4010:35am
INTRODUCTIONS
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 1:
THE 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 US
2020- 17% of the population
The population >85 = approx. 40% of the older population
More than half of women >65 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 Statushttp://www.youtube.com/watch?v=MT8xhWD5BB0&playnext
=1&list=PLA40BB183BB302BAA&feature=results_video
 Chronic illness is a major problem for the older population.
 Most older adults have at least one chronic disease or more
that need to be managed simultaneously.
 Chronic diseases are not only major sources of disability, but
they are the leading cause of death.
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 today’s
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 2:
THEORIES OF AGING
The biological, psychological, and social
processes of aging are interrelated and
interdependent.
Read and Review Box 2-1 and 2-2 from
Chapter 2
Read and Review Key Concepts from
Chapter 2
CHAPTER 4:
LIFE 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
Income
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 6
T H E SP E C IA L T Y OF GE R ON T OL OGI C AL N U R SI N G
 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 well -being.
CHAPTER 6
 Core Elements of Gerontological Nursing Practice:
1. 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
2. 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.
3. 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
community’s 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.
b.
c.
d.
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 disabilities.
b. Maintain youth and delay the onset of old age.
c. Accept the limitations imposed by genetic tendencies toward
cellular degeneration.
d. Postpone the negative consequences of the aging process.
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:
a.
b.
c.
d.
Mortality
Unemployment
Family
Dependency
NCLEX QUESTIONS
 Gerontological nursing is a complex specialty. Which of the
following most contributes to this fact:
a.
b.
c.
d.
Elderly are generally compromised in their health status.
Cost for the elderly costs more than care for younger patients.
Numerous health conditions can overlap in the elderly.
Complications after surgery or illness result in death in most
cases.
UPDATE!!!!
Quiz #2 on Sept. 26 th will cover Chapters 8,9,13
Chapter 16 will not be covered- please cross it off
of your schedul e
CHAPTER 8:
LEGAL 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.
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
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 procedure)
 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 one’s profession (not
checking that a NG tube is in the stomach before administering a tube
feeding)
 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 patient’s 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 physician’s order must be obtained - must
include the type of restraint, condition of patient, and duration of use
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 order
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 2
Ethical 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 action
 The American Nursing Association (ANA) Code of Ethics for
Holistic Nursing and various standards of practice supplement the
nurse’s 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 truthfulness
 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 badmake 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 business
 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 circumstances
 Expression of Faith- practices include prayer, worship, scripture
reading, rituals, and celebration on specific holy days
UNIT 4: CH. 17
SAFETY
 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 cause
CHAPTER 17
Importance of the Environment to Health and Wellness:
 Environment can be considered in two parts 1. Microenvironment- our immediate surroundings with which we
closely interact
2. Macroenvironment- elements in the larger world that affect
groups of people or entire populations
 Nursing Diagnosis- table 17-3
CHAPTER 17
Impact of Aging on Environmental Safety and Function:
 Potential Environmental Impact of Various Physical Limitations
(Table 17-5)
 Assessing basic standards for older adult’s environment (Box 17 -1)
 Lighting= function, orientation, mood and behavior
 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 relaxing
 Orange?
 Green?
 Black? Grey?
CHAPTER 17

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

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 injuries

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Lighting- urinary frequency
Floor surface- de cluttered and no throw rugs
Faucets- lever-shaped vs. round
Tubs and shower stalls- nonslip surfaces, grab bars
Toilets- grab bars, raised seat
Electrical appliances- accidental fall into water
 Psychosocial Considerations  Feelings and behavior influence and are influenced by the individual’s
surroundings- depression, regression, humiliation, anger
 Important to recognize the need for personal space
CHAPTER 17
 Falls- Risk and Prevention (Box 17 -2)
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Age-related changesImproper use of mobility aidsMedicationsUnsafe clothingDisease-related symptomsEnvironmental hazardsCaregiver-related factors-
CHAPTER 18:
SAFE 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 18 -1).
 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 necessary
 Metabolism, detoxification, and excretion - the renal system is primarily
responsible for the body’s 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 Con’t:
 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 elasticity.
Provide Patient Teaching
 Assess a patient’s risk for medication errors (Box 18 -2)
UNIT 5: CHAPTER 19
RESPIRATION
 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 4 th leading
cause of death in persons over 70 years of age.
CHAPTER 19:
RESPIRATION
 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 decreased
 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 19:
RESPIRATION
 Health Promotion for the Elderly Person
 Risks, symptoms, and care associated with:

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


Asthma
Chronic Bronchitis
Emphysema
Lung Cancer
Lung Abscess
CHRONIC OBSTRUCTIVE PULLMONARY
DISORDER (COPD)
 http://www.youtube.com/watch?v=aktIMBQSXMo
 http://www.youtube.com/watch?v=ttdma8PnFJI&NR=1
 http://www.youtube.com/watch?v=k77vqaUnd1Y&feature=rel
mfu
UNIT 5: CHAPTER 20
CIRCULATION
Objectives:
 Identify age related physiological changes of the cardiovascular
system.
 Describe common cardiovascular diseases and nursing
interventions that assist clients with cardiovascular conditions.
CIRCULATION
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 καρδιά, kardia , for "heart“
(themedicaldictonary.com).
ANATOMY
OF THE
HEART
http://www.youtu
be.com/watch?v=
H04d3rJCLCE
AGING & CIRCULATION
Heart
Blood Vessels
Blood
Aorta dilates and valves
thicken
Baroreceptors (monitor the
Reduction in total body
water= blood volume
decreases
Pathways develop fibrous
tissue and fat deposits
Capillary walls thicken
Heart wall thickens= may
have slower fill time
Aorta becomes thick, stiff, # of lymphocytes
less flexible= HTN
decreases= decreased
ability to fight infection
Abnormal ECG (afib)
Heart muscle cells
degenerate slightly
pressure of the blood being delivered to
the brain)
become less
sensitive= orthostatic
hypotension
# of RBC’s are reduced=
fatigue
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
Aneurysman 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
StrokeOccurs when a blood vessel in the
brain bursts or, more commonly,
when a blockage develops
UNIT 5:
CHAPTER 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 5:
CHAPTER 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 person’s
independence and quality of life!!!
UNIT 5:
CHAPTER 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 5:
CHAPTER 27
Endocrine Function
Objectives:
 List the symptoms of hypothyroidism and
hyperlipidemia.
 Describe the age related differences in the diagnosis,
presentation, and management of diabetes.
UNIT 5:
CHAPTER 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 6:
CHAPTER 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 6:
CHAPTER 32 & 33
Cognition/Mental Health
What does mental health mean to you?

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
Dementia
Confused
Memory loss
Disoriented
Decreased level of functioning
Coping effectively
Wellbeing
“Happy place”
UNIT 6
CHAPTER 32 & 33
Cognition/Mental Health
 Mental health indicates a capacity to cope effectively with and
manage life’s stress in an effort to achieve a state of emotional
homeostasis ( E l i o p o u lo s , 2 0 1 0 ).
 Advantages of being older...
 Great depression…
 Good mental health practices throughout the life span promote
good mental health in old age.
UNIT 6
CHAPTER 32 & 33
Challenging Emotional Homeostasis -








Illness
Death
Retirement
Increased vulnerability
Social isolation
Sensory deficits
Greater awareness of own mortality
Increased risk of institutionalization
UNIT 6
CHAPTER 32 & 33
Depression The most frequent problem that psychiatrists treat in older adults.
 As many as 25% of elderly in long -term care facilities.
 Signs and Symptoms:
Some older adults who are depressed demonstrate cognitive
deficits secondary to the effects of depression.
UNIT 6
CHAPTER 32 & 33
Depression Con’t. TreatmentAnxiety 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 6
CHAPTER 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 delirium.
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 6
CHAPTER 32 & 33
Table 33-1 Delirium vs. Dementia
State:
 cause
 onset
 mental status
 level of consciousness
 behavior
 recovery
 http://www.youtube.com/watch?v=tzFNTtHyTzo&feature=relat
ed
UNIT 7:
CHAPTERS 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 today.
UNIT 7:
CHAPTER 39
 End of Life Care
1. Review the stages of dying.
2. List the physical care needs of dying individuals and the
related nursing interventions.
3. Identify factors that have increased ethical dilemmas for
nurses.
4. Describe the ethical principles that guide nursing practice.
5. Discuss euthanasia and the associated legal and professional
responsibilities.
UNIT 7:
CHAPTER 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 7:
CHAPTER 39
 “An examination of one’s 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 7:
CHAPTER 39
The five stages of the dying process include:
 Denial
 Anger
 Bargaining
 Depression
 Acceptance
UNIT 7:
CHAPTER 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 7:
CHAPTER 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 7:
CHAPTER 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 schedule.
UNIT 7:
CHAPTER 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 7:
CHAPTER 39
 Signs of imminent death 
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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