Presentation on theme: "Welcome to Geriatric Nursing"— Presentation transcript:
1Welcome to Geriatric Nursing Stephanie Engler, RNWednesday9:40-10:35am
2Introductions About Me… General Questions… Student Motivators… Syllabus ReviewObjectives of Course…Expectations of Me…Expectations of You...Questions???
3For next week…… Unit 1- Chapters 1 & 2 Complete Lecture Notes- will check before classPrint PowerPoint Outline Notes for Ch. 1 & 2Read chapters 1 & 2 and Review “Key Concepts”, Tables, Figures, and Boxes for each chapter.Quiz in one week over Chapters 1, 2, 4, 6, 7Bring 7 scantrons to class next week
4Chapter 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 agethe investigation of the changes in society resulting from our aging populationthe 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 lifethe comprehensive health care of older persons and the well-being of their informal caregiver
5Chapter 1Dr. 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 AmericansCharacteristics of the Older Adult PopulationAge 65 and olderRepresent more than 12% of the population in the US% of the populationThe population >85 = approx. 40% of the older populationMore than half of women >65 are widowed
6Chapter 1Income and Employment- Social SecurityMost older people depend on Social Security for more than half of their income.Franklin D. Roosevelt- “The New Deal” in 1935Benefit check paid to retired workers of a specific minimum ageSocial Security is currently estimated to keep roughly 40 percent of all Americans age 65 or older out of povertyBy 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
7Chapter 1In 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.
8Chapter 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.
9Chapter 1Health 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.
10Chapter 1 Leading Chronic Conditions Arthritis Hypertension Heart conditionsVisual impairmentsDiabetes
11Chapter 1Leading Causes of DeathHeart disease 33%Cancer %Stroke 8.2%
12Chapter 1 Baby Boomers and Care Facilities Entering their senior years between 2008 and 2030They 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 therapiesGerontological 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?
13Chapter 1Point to Ponder: page 7A 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?
14Chapter 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 2Read and Review Key Concepts from Chapter 2
15Chapter 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 grandparentingLoss 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
16Chapter 4Changes in Health and Functioning- changes in appearance and bodily function occurCumulative Effects of Life Transitions- Shrinking Social World and Awareness of MortalityResponding to Life Transitions- Life Review, Life Story and Self Reflection, and Strengthening Inner ResourcesReview Key Concepts and Box 4-1, 4-2
17Chapter 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 – 1962Older 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.
18Chapter 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 practiceStandards= 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.
19Chapter 6 Factors Influencing the Aging Process: Heredity Nutrition Health StatusLife ExperienceEnvironmentActivityStressNurses must understand the multitude of factors that influence the aging process and recognize the unique outcomes for each individual.
20Chapter 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.
21Chapter 6Educator- Nurses must take advantage of formal and informal opportunities to share knowledge and skills related to the care of older adultsAdvocate- For individual older adults, and to facilitate a community’s efforts to affect changeInnovator- Nurses need to think “out of the box” and take risks associated with traveling down new roads, and transform visions into reality.
22Chapter 6Point 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?
23NCLEX QuestionsA 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.
24NCLEX QuestionsNurses 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.
25NCLEX QuestionsMr. 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:MortalityUnemploymentFamilyDependency
26NCLEX QuestionsGerontological 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.
27Update!!!! Quiz #2 on Sept. 26th will cover Chapters 8,9,13 Chapter 16 will not be covered- please cross it off of your schedule
28Chapter 8: Legal aspects of gerontological nursing Laws Governing Gerontological Nursing Practice- Box 8-1Because laws are developed at the state and local levels, variation exists among the states.Constitutions- basic rights, grant powers, and place limits on government agenciesCourt decisions- establish precedents from cases heard in state or federal courtsStatutes- 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
29Chapter 8Acts that could result in legal liability for nurses- Box 8-2Negligence- 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)
30Chapter 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 personPower of Attorney- Competent individuals appoint parties to make decisions for them (Box 8-4)
31Chapter 8 Restraints- chemical and physical Anything that restricts a patient’s movement can be considered a restraintAlternatives should be used whenever possible- alarmed doors, wristband alarms, bed alarm pads, beds and chairs close to the floor, increased staff and supervisionWhen restraints are necessary, a physician’s order must be obtained- must include the type of restraint, condition of patient, and duration of use
32Chapter 8 No-code orders: Terminally ill patients that are going to die and resuscitation attempts would not be therapeuticA physician order must be obtained to clearly state the wishes for no resuscitation- it is negligence to withhold CPR without an orderDNR at bedside is not valid without an official order
33Chapter 8 Advance Directives or a Living Will: Protects the patients right to make decisions about terminal careExpress the desires of competent adults regarding terminal care, life-sustaining measures, and other issues pertaining to their death and dying1990- 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
34Chapter 8Elder abuseMany forms- inflicting pain or injury; stealing, mismanaging funds, misusing medications, causing psychological distress, withholding food or care, sexual abuse, confinementThreatening to commit these acts is a crimeNurses have a legal responsibility to report cases of known or suspected abuseSigns of abuse- see page 104
35Chapter 9 Chapter 9: Unit 2 Ethical Aspects of Gerontological Nursing Ethics- ancient Greece- ethos means those beliefs that guide lifeThe concept of accepted standards of conduct and moral judgmentEthics help determine right and wrong courses of actionThe 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
36Chapter 9 Ethical Principles- Beneficence- to do good for patients- nurses are challenged to take actions that are good for patients’ desiresNonmaleficence- to prevent harm to patientsJustice- to be fair, treat people equally, and give patients the service they needFidelity and veracity- fidelity means to respect our words and duty to patients; veracity is truthfulnessAutonomy- to respect patients’ freedoms, preferences, and rightsSee Box 9-1
37Chapter 13Chapter 13: Unit 3SpiritualityA positive, harmonious relationship with God or other higher power (the Divine) helps individuals to feel unified with other people, nature, and the environmentSpirituality 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.
38Chapter 13 Spiritual Needs- Love- people need to feel love regardless of physical or mental condition, social position, material possessionsMeaning 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 purposeHope- 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
39Chapter 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 circumstancesExpression of Faith- practices include prayer, worship, scripture reading, rituals, and celebration on specific holy days
40Unit 4: Ch. 17 safetyOlder 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
41Chapter 17 Importance of the Environment to Health and Wellness: Environment can be considered in two parts-Microenvironment- our immediate surroundings with which we closely interactMacroenvironment- elements in the larger world that affect groups of people or entire populationsNursing Diagnosis- table 17-3
42Chapter 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 behaviorTemperature= 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 relaxingOrange?Green?Black? Grey?
43Chapter 17Scents- used for aesthetic and medicinal purposes- aromatherapyFloor Coverings- pros and cons- rugs?Furniture- functional, comfortable, easy to cleanSensory Stimulation- soft blankets, pictures, sculptures, plants, flowers, coffee, food cooking, soft music, textured wallsNoise control- many sounds create difficulties for older adults
44Chapter 17 Bathroom Hazards- cause of many accidental injuries Lighting- urinary frequencyFloor surface- de cluttered and no throw rugsFaucets- lever-shaped vs. roundTubs and shower stalls- nonslip surfaces, grab barsToilets- grab bars, raised seatElectrical appliances- accidental fall into waterPsychosocial Considerations-Feelings and behavior influence and are influenced by the individual’s surroundings- depression, regression, humiliation, angerImportant to recognize the need for personal space
45Chapter 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-
46Chapter 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 metabolismDistribution- dehydration will decrease drug distribution, and lower dosage levels may be necessaryMetabolism, 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.
47Chapter 18 Promoting the Safe Use of Drugs: Avoiding Inappropriate Drugs (Box 18-1)Reviewing Necessity and Effectiveness of Prescribed DrugsWhy 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?
48Chapter 18 Safe Use Con’t: Promoting Safe and Effective Administration Encourage good oral hygiene, fluids, proper positioning to facilitate swallowingFrequently an older person will bleed or ooze after an injection because of decreased tissue elasticity.Provide Patient TeachingAssess a patient’s risk for medication errors (Box 18-2)
49Unit 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.
50Chapter 19: respiration Age related changes= Respiratory problems can develop more easily and be more difficult to manageConnective tissues for respiration and ventilation are weakerElastic recoil of the lungs during expiration is decreasedAlveoli are less elastic, develop fibrous tissue, and contain fewer functional capillariesLoss of skeletal muscle strength in the thorax and diaphragm = barrel chestThe 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)
51Chapter 19: respiration Health Promotion for the Elderly Person Risks, symptoms, and care associated with:AsthmaChronic BronchitisEmphysemaLung CancerLung Abscess
53Unit 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.
54CirculationHeartThe 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).
56Aging & Circulation Heart Blood Vessels Blood Aorta dilates and valves thickenBaroreceptors (monitor the pressure of the blood being delivered to the brain) become less sensitive= orthostatic hypotensionReduction in total body water= blood volume decreasesPathways develop fibrous tissue and fat depositsCapillary walls thicken# of RBC’s are reduced= fatigueHeart wall thickens= may have slower fill timeAorta becomes thick, stiff, less flexible= HTN# of lymphocytes decreases= decreased ability to fight infectionAbnormal ECG (afib)Heart muscle cells degenerate slightly
57Common “heart” conditions Coronary artery disease (CAD)-a narrowing of the small blood vessels that supply blood and oxygen to the heart
58Common “heart” conditions Congestive heart failure (CHF)-condition in which the heartcan no longer pump enoughblood to the rest of the body
59Common “heart” conditions Myocardial infarction-“heart attack”-interruption of blood supply to a part of the heart, causing heart cells to die.
60Common “vessel” conditions Aneurysm-an abnormal wideningor ballooning of aportion of an arterydue to weakness inthe wall of the bloodvessel.
61Common “vessel” conditions Pulmonary embolism-“blockage”caused by blood clots that travel to your lungs from another part of your body
62Common “vessel” conditions Stroke-Occurs when a blood vessel in the brain bursts or, more commonly, when a blockage develops
63Unit 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.
64Unit 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.
65Normal Age Related Changes- Chapter 24Normal 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
66Chapter 24Decrease body strength and the flexibility of joints and musclesImpaired capacity for muscle regenerationExercise has been considered of great interest in treatment of sarcopenia!!!!!
67Managing Musculoskeletal Pain Chapter 24Managing Musculoskeletal PainDegenerative 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.
68Chapter 24Heat= a warm bath at bedtime and warm blankets can reduce spasms and crampsPassive stretching= help to control muscle crampsExcessive exercise and stress= should be avoidedRest and correct positioning= weight-bearing joints and proper body alignmentAlternative therapies= therapeutic touch, chiropractic therapyUnrelieved pain can significantly affect an older person’s independence and quality of life!!!
69Unit 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.
70Unit 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.
71Unit 5: chapter 28 Integumentary Function Objectives: Identify age-related changes and the common health deviations in the integumentary systemState the warning signs of cancer.State the general nursing considerations for Integumentary conditions.
72Unit 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.
73Cognition/Mental Health Unit 6: Chapter 32 & 33Cognition/Mental HealthWhat does mental health mean to you?DementiaConfusedMemory lossDisorientedDecreased level of functioningCoping effectivelyWellbeing“Happy place”
74Cognition/Mental Health Unit 6 Chapter 32 & 33Cognition/Mental HealthMental 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.
75Unit 6 chapter 32 & 33 Challenging Emotional Homeostasis- Illness DeathRetirementIncreased vulnerabilitySocial isolationSensory deficitsGreater awareness of own mortalityIncreased risk of institutionalization
76Unit 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.
77Unit 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-
78Unit 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.
79Unit 6 chapter 32 & 33 Table 33-1 Delirium vs. Dementia State: cause onsetmental statuslevel of consciousnessbehaviorrecovery
81Unit 7: Chapters 37 & 39Only Chapters 37 & 39 will be required for Unit 7You 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.
82Unit 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.
83Unit 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”.
84Unit 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”.
85Unit 7: Chapter 39 The five stages of the dying process include: DenialAngerBargainingDepressionAcceptance
86Unit 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.
87Unit 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.
88Unit 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 eliminationLaxatives usually are administered on a regular schedule.
89Unit 7: chapter 39 Poor Nutritional Intake Anorexia, nausea, and vomiting can prevent the ingestion of nutrientsServe small-portioned meals that have appealing appearances and aromas that can boost appetite.Control nausea and vomiting.
90Unit 7: chapter 39 Signs of imminent death- Decline in blood pressure Rapid, weak pulseDyspnea and periods of apneaSlower or no pupil response to lightProfuse perspirationCold extremitiesBladder and bowel incontinencePallor and mottling of skinLoss of hearing and vision