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caring for those over the age of 65
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gerontological nursing
caring for those over the age of 65
demographics of people over 65
2002- 35.6 million older adults, 12.3% of population; 20.8 mil women over 65, 14.8 mil men; 85+ increase to 9.6 mil by 2030; ave life span 79 yrs w, 72.9 for men
holism
emphasizes the importance of understanding a person's whole being rather than treating only specific parts
theory "the science of human caring"
a theory assists us, as nurses, to "see" what it is we do more clearly; nurses give care as a whole human being, with attention needed for the body, mind and spirit; use your imagintion and creativity to solve problems in ways that are personal fot the people to whom you give care
young-old
65-74 yrs
middle-old
75-84 yrs
old-old
85-100 yrs
elite-old
over 100 yrs
65+ yrs will
double in the next 25 yrs; 65% of patients in acute-care hospitals; 83% of those in home care and 92% in nursing homes
Anderson's philosophy
Serve the sick as though they were Christ in person
critical activity to promote holistic care is to
listen
3 components of holistic nursing
develop a healing relationship, work with a team, excellent clinical skills
develop a healing relationship
unrushed time, truly listen, determine what has worked in the past and discuss options
work with a team
family, friends, and pets; IDT (interdisciplinary team-dietitian, physical therapist, nurse, pharmacist, social worker)- meet at least monthly to discuss each resident ; other specialists; neither you or the patient is alone
excellent clinical skills
holistic communication, medication administration, assessment, bedside skills
4 concepts of holistic nursing
always follow the physician's orders, use your clinical expertise, draw on others intuition and creativity to resolve health problems, take every opportunity to develop a closer relationship with family members
foundation of caring, you will
view all humans as a valued person to be cared for, understood, nurtured, and assisted; place emphasis on the human relationship and the relationship the person has with the environment, human-to-human relationship (transpersonal caring)- focus on them while you are with them, promote health and healing
climate of caring: environmental management
privacy, personal space, safety, stimulation/personalization
privacy
knock before entering, privacy w/ family, respect time alone, pull curtain
personal space
respect personal items, respect personal space, use touch only if acceptable
safety
no clutter or throw rugs, proper shoes, sometimes pets, no frayed cords or broken furniture
stimulation/personalization
multiple opportunities for individual choice, encourage independent funcitons, cherished furniture and decorations, meaningful pictures
marginalized people
people without insurance, who live at or below poverty level, people who do not speak english, homeless, and/or people with disabilities
ageism
negative attitudes and practices directed toward the aged; stereotyping and discrimination against the old
6 theories of aging
physiological- genetic factors, wear and tear, nutrients; psychological- developmental tasks, subculture, continuity
cardiovascular
require less O, but compensate for changes in circulatory functions; cardiac muscle strength diminished; heart valves thicken, more rigid; sinoatrial node less efficient, impulses slowed; systemarteries less elastic; capillary walls thicken and slow exchange of nutrients and waste products between blood/tissue; greater rigidity of the vascular walls increases both systolic and diastolic pressures; blood volume reduced, decline in total body water; bone marrow activity reduced, slight drop in red blood cells, hematocrit, and hemoglobin; heart contractions weaker, blood volume decreases, cardiac output drops at a rate of 1%/yr below the value of 5L normally found in younger people
respiratory system
minimal age-related decline; gradual so compensation well; rib cage rigid (cartilage calcifies); thoracic spine may shorten, osteoporosis, decrease lung space limiting thoracic movement; ab muscles weaken, decreasing inspiratory/expiratory effort; lung elastic recoil progressively lost with advancing age; alveoli enlarge, thin, functions decrease; alveolu-capillary membrane thickens, reducing surface area for gas exchange; partial pressure of O in alveoli (PAO2) 75mm of Hg at 70 is acceptable (90mm Hg younger person)
musculoskeletal system
loss of bone mass-brittle, weak bones; vertebral column may compress, reduced height; muslce wasting occurs, muscle tissue slows; ROM may be limited;
integumentary system
melanocytes cluster- age spots; decreased melanin- graying; women develop hair on chin/upper lip; decreased blood flow to nailbed- thick, dull, hard, brittle, longitudinal lines; body temp regulated is impaired by decreased sweat production
gastrointestinal system
reabsorption of bone- loosens teeth, reduce ability to chew; gag relex weakens, increased risk of aspiration; smooth muscle weakness delays emptying time; decreased gastric acid impair absorption of Fe, vit B12, and protein; peristalsis decreases; weakening of the sphincter muscle leads to inompetent emptying of the bowel;
genitourinary system
renal blood flow decreases because of cardiac potput and reduced glomerular filtration rate; ability to concentrate urin impaired; loss of muscle tone and incomplete emptying may occur; capacity decrease in bladder; increased freq. of micturition due to enlargement of the prostate, in men; in women, relation of the perineal muscle will cause increased freq of micturition; vulva may atrophy; pubic hair may fall out (F); vaginal secretions dimish, walls thin, less elastic; testes decrese in size; prostate may enlarge
neurological system
neurons are steadily lost in the brain/spinal cord; synthesis and metabolism of neurotransmitters are diminished; brain mass is progressively lost; kinesthetic sense is less efficient; balance impaired; reaction time decreases; insomnia and increased night wakening; deep sleep and REM sleep decrease
special senses
most difficult change for a person to accept and cope; focus on close objects diminished; increaes density of the lens occurs, lipid accumulates around iris, grayish/yellow ring; tear production decreases; pupils decrease, less responsive to light; night vision decreases, iris loses pigment eyes become light blue/gray; high-freq tones decrease; cerumen has more keratine, hardens in ears; bitter, salty, sour dimishes; feel light touch, pain, diff temps may decrease
important demographic info
older, white population with grow more slowly than before; fastest growing segment of the population those over 85
healthcare workers wil spend
75% of their working lives caring for older people
geriatrics
medical study of older adults
gerontology
nursing study of older adults
genetic factors theory of aging
we are born with a genetic program that predetermines our life span; accept aging as teh inevitabel process that it is, including abnormal aspects and death
wear and tear theory of aging
body parts show the effects of aging; accept they do things at a slower pace
nutrients theory of aging
aging and quality of aging depend on nutrition throughout the life
developmental tasks theory of aging
Erickson- ego development (strength to manage your life); Integrity vs. Despair- find meaning in life or be depresses, anger
subculture theory of aging
older people are subculture; they have their own cultural norms and standards; understand their differences and needs
continuity theory of aging
as people change, thier basic personality and behavioral patterns do not change; young angry person will be angry at 70; recognized unique characteristics of people and their ways of adapting to aging
normal aging process
patterns of aging vary dramatically among older adults; they become more diverse not more alike; development of disease in not a normal part of aging
health for older adults
the ability to function at an indiviual's highest potential despite the presence of age-related changes and risk factors
essential facts about the normal aging process
at aging, they become more diverse, not more alike; changes develop in each individual in a unique way; normal aging and disease are two separate entities; includes both gains and losses and doesn't necessarily indicate decline; successful adaptation to the aging process ins accomplished by most older adults
function
ability to perform ADLs and independent ADLs and take into consideration the quality of life of the individual
5 stages of the nursing process
assessment, nursing diagnosis, planning, implementation, evaluation
wellness clinics
independent apartments
continung care retirement communities
skilled nursing facilities, assisted living, independent living apartments
assessment
collect all data; starts with the call/written summary from the dept that is transferring the resident; important info (name, age, insurance #, med diagnoses, advanced directives, disease prognosis, fam support, need for equipment, functinal ability, meds, congitive abilities, special needs)
admission assessment includes
observations, physical exams, review of lab values, interview, nursing history
OBRA
omnibus budge reconciliation act of 1987; set miminum standards for the assessment and care-planning processes in nursing facilities certified for Medicare reimbursement
MDS
minimum data set; component of the mandated assessment process entitled the Residnet Assessment Instrument (RAI); provides outline of most essential info
RAPs
resident assessment protocols; lists areas that require further assessment and consideration before designing the plan of care
developing the nursing diagnosis is a
primary respinsibility of the RN; involves diagnostic reasoning to reflect patient strengths, problems, and potential problems
Nursing Diagnosis Assoc. (NANDA)
identifed diagnoses that are widely accepted and understood by multiple disciplins and are viewed as national standards
nursing diagnoses for older adults
self-care deficit, physical mobility, nutrition, injury, urinary elimination, constipation, thought process, sin integrity
nursing diagnosis addresses
the potential and actual problems of the older adult
2 basic ways to communicate the nature of older adults health problems
medical diagnoses, nursing diagnoses
medical diagnoses
by physician and describe a disease or a disease process
problem with planning care based only on medical diagnoses
do not describe the individual problems of the older adult or the impact the disease has on the person's every day life
nursing diagnoses are
specific to the individual older person's nursing care needs and frequently relate to the areas in which the older person has difficulty functioning
planning
setting priorities, identifying goals and outcomes of care, and designing and documenting intervention
maslow's hierarchy of needs
life-sustaining needs the highest then safety/security, love and belonging needs, self-esteem needs, and self-actualization needs
resident's priority is
to go home
after setting priorities then nurse identifies
goals or outcomes for each of the nursing diagnoses
goals must be
measurable, realistic, specific, timely, attainable; identifies something the resident will/will not do or will/will not experience; behavior is the major focus of goals/outcomes
measurable
outcomes need to be identified
realistic
must fit in with the resident's ability
specific
identify certain behaviors or conditions to aid in their attainment and evaluation
timely
time frame
attainable
be written to communicate a motivating factor to the resident and the nursing care staff
under OBRA
status of goal attainment be systematically addressed; these documentation requirements are the monthly summaries (30 day) and the quarterly reviews (90 days)
assessments needed for each nursing home resident
Comprehensive Aadmission Assessment includes Rresident Assessment Instrument (RAI): minimum data set (MDS), resident assessment protocols, ongoing nursing assessment; Annual rRassessment including RAI Significant Change InStatus Assessment including RAI Quarterly Assessment including part of MDS
planning phase involves
discussion and pen-paper activity; allows input from all members
all residents are required to have
written comprehensive and interdisciplinary plan of care; must include problem/potential problem, actions/interventions to be taken, perons or discipline responsible for each action, goals to achieve
planned interventions must complement the
interventions of other therapies
all disciplines must discuss and develop
the components of the interdisciplinary plan of care so that confusion among staff doesn't occur
nursing intervention must include
resident's input; continuing assessment and monitoring of disease processes and effects of medications and treatments
implementation
puts plan of care into action; all aspects must be documented
challenges for PN is
communicatig plan of care back to all CNAs
flowsheets
completed by CNAs; document interventions as ADLs, walking programs bowel/bladder training programs, dietary intake, feeding programs
evaluation
decide if resident has met the identified goals and to assess the outcomes of the nursing care provided; goal achievement goes in mon, quart reports or nursing notes
during evaluation
nurse should review nursing process; keep it up to date, reflect changes, which interventions were ineffective
evaluation is
ongoing and takes place daily
most time-consuming portions of the MDS
computing the triggers (identifying the potential problem areas that need to be assessed through RAPs)
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