1. Welcome to Geriatric Nursing
Stephanie Engler, RN
Wednesday
9:40-10:35am

2. Introductions About Me… General Questions… Student Motivators…
Syllabus Review
Objectives of Course…
Expectations of Me…
Expectations of You...
Questions???

3. 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

4. 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

5. 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 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
% of the population
The population >85 = approx. 40% of the older population
More than half of women >65 are widowed

6. 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

7. 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.

8. 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.

9. Chapter 1
Health Status-
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.

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

11. Chapter 1
Leading Causes of Death
Heart disease 33%
Cancer %
Stroke 8.2%

12. 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?

13. 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?

14. 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

15. 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

16. 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

17. Chapter 6 The 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 well-being.

18. 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.

19. 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.

20. 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.

21. 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.

22. 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?

23. 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 years old.
A woman over the age of 85 years old.
A woman over the age of 95 years old.

24. NCLEX Questions
Nurses need to understand the aging process in order to help their patients:
a. Live longer with their long term disabilities.
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 process.

25. 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

26. NCLEX Questions
Gerontological nursing is a complex specialty. Which of the following most contributes to this fact:
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.

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

28. 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.
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

29. 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)

30. 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)

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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.

38. 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 

39. 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

40. 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

41. Chapter 17 Importance of the Environment to Health and Wellness:
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 populations
Nursing Diagnosis- table 17-3

42. 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?

43. 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

44. Chapter 17 Bathroom Hazards- cause of many accidental injuries
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

45. 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-

46. 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.

47. 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?

48. 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)

49. 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 4th leading cause of death in persons over 70 years of age.

50. 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)

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

52. Chronic obstructive pullmonary disorder (copd)

53. 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.

54. 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).

55. Anatomy of the heart

56. 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 RBC’s 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

57. Common “heart” conditions
Coronary artery disease (CAD)-
a narrowing of the small blood vessels that supply blood and oxygen to the heart

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

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

60. 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.

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

62. Common “vessel” conditions
Stroke-
Occurs when a blood vessel in the brain bursts or, more commonly, when a blockage develops

63. 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.

64. 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.

65. Normal Age Related Changes-
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

66. 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!!!!!

67. Managing Musculoskeletal Pain
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.

68. 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!!!

69. 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.

70. 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.

71. 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.

72. 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.

73. Cognition/Mental Health
Unit 6: Chapter 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”

74. Cognition/Mental Health
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 (Eliopoulos, 2010).
Advantages of being older...
Great depression…
Good mental health practices throughout the life span promote good mental health in old age.

75. 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

76. 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.

77. Unit 6 chapter 32 & 33 Depression Con’t.- 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-

78. 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.

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

81. 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.

82. Unit 7: Chapter 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.

83. 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”.

84. 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”.

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

86. 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.

87. 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.

88. 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.

89. 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.

90. Unit 7: chapter 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