Geriatric Nursing Care

• A 70-year-old woman with diminished hearing, bilateral cataracts, and taking antihypertensive medications means the priority nursing problem is potential for injury.
• Regarding home safety discharge instructions for a 78-year-old woman, the patient statement indicating a need for further teaching is scatter rugs would be useful in decreasing glare from shiny floors.
• A 78-year-old woman admitted with sudden onset of confusion and disorientation during the early evenings means it is likely recommended to keep lighting without glare or shadows on during the evening.
• After failure of less restrictive measures, physical restraints to a confused older adult man includes the following measures for safe use of physical restraints, promptly attend to the toileting needs of the patient, reevaluate use of the restraints every shift, ensure adequate nutrition and hydration, and provide frequent range-of-motion exercises.
• During a home visit with scatter rugs, a dirty kitchen sink, odor from toilet and expired food pantry items, and disheveled 76 year old can indicate the nursing problem is altered self-care ability
• Suspect early complications of decreased mobility in a 45-year-old patient admitted after surgery with multiple stab wounds to the chest, so expect the following signs, decreased breath sounds, limited range of motion, and pain with repositioning
• A patient with a blunt chest injury, the incentive spirometer understanding of instructions is clear when the patient seals the mouthpiece during inhalation.
• An 84 year old female with heart failure due to hypertension, atherosclerosis, arthritis, and right sided weakness is on fall precautions and a heart healthy diet
• The following actions can be delegated to the nursing assistant: assist with bathing, assist to bathroom
• The following actions must be done by a licensed nurse: weigh daily at the same time, listen to heart and lungs, assess leg swelling, administer mediations, assess fall risk

LPN/LVN role in Home Care

• Work under RN case manager supervision
• Provide private-duty service

Assessing Caregiver Stress

• Important to assess caregiver stress including if they have help, cultural values towards caregiving, sleep habits, family responsibilities, are feeling edged or irritable & overwhelmed
• Also need to assess difficulty making decisions, physical pain & support groups

Functional Independence and Rehab

• Totaled scores indicate independent (6-7), modified dependence (3-5), or complete dependence (1-2).
• Assess mental outlook as an ongoing nursing function

Rehabilitation

• LPN/LVN contributes to providing the plan of care
• Interdisciplinary plan is devised for each patient and periodically assessed
• Positive feedback is given in a manner that encourages patients to do as much as possible

Cardiac Rehabilitation Programs

• Consists of monitored exercise, diet counseling, medication counselling group sessions on stress reduction.

Rehabilitation Teams

• Needs to be flexible and creative
• Assist the patient to achieve an optimal state of wellness
• Collaborate and offer patient centered care

Security Devices

• When a resident frequently forgets instructions to call for assistance, the use may be applied
• They should only be used when all else has failed and after determining underlying causes that can be treated

Alternatives to Security Devices

• Reviewing medications, alerting team members, facilitating bowel/bladder function, sleep-wake practices, enhance orientation, communicate clearly and placing a high risk in nurses proximity are all alternatives

Safety

• Maintaining a safe environment, providing autonomy, and independence is a great challenge
• Keep patients within area boundaries.

Care Plan

• Call lights and personal items nearby for unsteady gait and to prevent falls
• Provide activity to assist activity intolerence

Long-Term Care

• RN supervisors typically manage the care and delegate tasks to LPN/LVNs
• CNAs provide much of the basic care to residents