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Stephanie Engler, RN Wednesday 9:40- 10:35am WELCOME TO GERIATRIC NURSING.

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Presentation on theme: "Stephanie Engler, RN Wednesday 9:40- 10:35am WELCOME TO GERIATRIC NURSING."— Presentation transcript:

1 Stephanie Engler, RN Wednesday 9:40- 10:35am WELCOME TO GERIATRIC NURSING

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

3  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 FOR NEXT WEEK……

4 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: THE AGING POPULATION

5  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

6  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

7  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

8  “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

9  Health Status- http://www.youtube.com/watch?v=MT8xhWD5BB0&playnext =1&list=PLA40BB183BB302BAA&feature=results_video http://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

10  Leading Chronic Conditions  Arthritis  Hypertension  Heart conditions  Visual impairments  Diabetes CHAPTER 1

11  Leading Causes of Death  Heart disease 33%  Cancer 21.8%  Stroke 8.2% CHAPTER 1

12  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

13  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 1

14  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 2: THEORIES OF AGING

15  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: LIFE TRANSITIONS AND STORY

16  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 4

17  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 THE SPECIALTY OF GERONTOLOGICAL NURSING

18  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

19 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

20 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

21  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

22 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? CHAPTER 6

23  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.A young female baby boomer that just turned 65. b.An older woman between 75-85 years old. c.A woman over the age of 85 years old. d.A woman over the age of 95 years old. NCLEX QUESTIONS

24  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

25  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.Mortality b.Unemployment c.Family d.Dependency NCLEX QUESTIONS

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

27  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 UPDATE!!!!

28  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: LEGAL ASPECTS OF GERONTOLOGICAL NURSING

29  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

30  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

31  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

32  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

33  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

34  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 8

35 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

36 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 9

37 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

38 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

39  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 CHAPTER 13

40  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 UNIT 4: CH. 17 SAFETY

41 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

42 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

43  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

44  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 CHAPTER 17

45  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 17

46  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: SAFE MEDICATION USE

47  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

48  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) CHAPTER 18

49  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. UNIT 5: CHAPTER 19 RESPIRATION

50  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

51  Health Promotion for the Elderly Person  Risks, symptoms, and care associated with:  Asthma  Chronic Bronchitis  Emphysema  Lung Cancer  Lung Abscess CHAPTER 19: RESPIRATION

52  http://www.youtube.com/watch?v=aktIMBQSXMo http://www.youtube.com/watch?v=aktIMBQSXMo  http://www.youtube.com/watch?v=ttdma8PnFJI&NR=1 http://www.youtube.com/watch?v=ttdma8PnFJI&NR=1  http://www.youtube.com/watch?v=k77vqaUnd1Y&feature=rel mfu http://www.youtube.com/watch?v=k77vqaUnd1Y&feature=rel mfu CHRONIC OBSTRUCTIVE PULLMONARY DISORDER (COPD)

53 Objectives:  Identify age related physiological changes of the cardiovascular system.  Describe common cardiovascular diseases and nursing interventions that assist clients with cardiovascular conditions. UNIT 5: CHAPTER 20 CIRCULATION

54 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). CIRCULATION

55 http://www.youtu be.com/watch?v= H04d3rJCLCE ANATOMY OF THE HEART

56 HeartBlood VesselsBlood 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 AGING & CIRCULATION

57  Coronary artery disease (CAD)- a narrowing of the small blood vessels that supply blood and oxygen to the heart COMMON “HEART” CONDITIONS

58  Congestive heart failure (CHF)- condition in which the heart can no longer pump enough blood to the rest of the body COMMON “HEART” CONDITIONS

59  Myocardial infarction- “heart attack”- interruption of blood supply to a part of the heart, causing heart cells to die. COMMON “HEART” CONDITIONS

60  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

61  Pulmonary embolism- “blockage” caused by blood clots that travel to your lungs from another part of your body COMMON “VESSEL” CONDITIONS

62  Stroke- Occurs when a blood vessel in the brain bursts or, more commonly, when a blockage develops COMMON “VESSEL” CONDITIONS

63 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 21 & 22

64 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. UNIT 5: CHAPTER 24

65 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

66  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

67 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

68  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!!! CHAPTER 24

69 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 26

70 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 27

71 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 5: CHAPTER 28

72 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

73 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 6: CHAPTER 32 & 33

74 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. UNIT 6 CHAPTER 32 & 33

75 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

76 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

77 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-  Treatment- UNIT 6 CHAPTER 32 & 33

78 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

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

80  http://www.youtube.com/watch?v=tzFNTtHyTzo&feature=relat ed http://www.youtube.com/watch?v=tzFNTtHyTzo&feature=relat ed

81  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: CHAPTERS 37 & 39

82  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

83  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

84  “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

85 The five stages of the dying process include:  Denial  Anger  Bargaining  Depression  Acceptance UNIT 7: CHAPTER 39

86 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

87  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

88  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

89  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

90  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 UNIT 7: CHAPTER 39

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