Sean Whitfield - NURS 3540 Gerontological Nursing Module 10 ALG - Completed PDF

NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide Module 10 Active Learning Guide Chapters 21 & 29 Purpose/Overview Active learning guides help students focus their study time using knowledge-level information, then concentrate on applying and analyzing knowledge to provide a contex...

NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide Module 10 Active Learning Guide Chapters 21 & 29 Purpose/Overview Active learning guides help students focus their study time using knowledge-level information, then concentrate on applying and analyzing knowledge to provide a context concerning the course and career skills. Students should review the active learning guide before engaging with the module content, then work to complete the guide both during and after engaging with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate the course and content. The active learning guide is not a complete composite of the information needed for the exam but a guide to navigating the content delivery. Instructions Review the active learning guide before you begin reading and engaging with other content in the module. Looking at the questions beforehand will preview the information you will be learning, including the key concepts and takeaways. As you work through the module content, complete the active learning guide. Some questions may be reflective and require that you finish all content before responding. Students will turn in the completed learning guide Sunday by 1159 pm. Faculty will review, award points, and return them to students to review prior to the exam. There are a possible 5 earned points for this learning guide. Reading Focus Areas In the text, you will see essential boxes, such as Safety Alerts, which discuss issues related to the care of older adults. Research Highlights contain a summary of pertinent current research related to chapter topics. Resources for Best Practice provide suggestions for further information for chapter topics and tools for practice. Healthy People boxes refer to goals cited in Healthy People 2030. Clinical judgment and next generation NCLEX examination style questions are located at the end of every chapter. Please review these questions as they are good practice for the exam. I. Safety A. Environmental Safety 1. Home a. Define a “safe environment”. A safe environment is one in which one is capable, with reasonable caution, of carrying out activities of daily living (ADLs), instrumental activities of daily living (IADLs), and the activities that enrich one’s life without fear of attack, accident, or imposed interference. b. What are the important components of home safety? 1) Bathroom grab bars near the toilet and in the shower or the tub. 2) Railings on both sides of a stairway, if possible. 3) Widening of door frames for greater access to common areas such as bathrooms, kitchens, and bedrooms. NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide 4) Repair and removal of structural barriers such as inadequate flooring, uneven transitions between flooring surfaces, and other non-structural barriers such as furniture. 5) Put rubber mats in the bathtub to prevent slipping. c. Look up the Home Safety Self – Assessment Tool 1) Identify 5 potential hazards at the entrance to any residence and the solutions to correct. Remember we are assessing the home of someone elderly. Lack of railings or unstable railing. ◦ Add at least one railing, ideally one on each wall. ◦ Have unstable railing stabilized. Unsafe steps (too steep/cracked) ◦ Have damaged or broken steps repaired. Unmarked or raised threshold ◦ Mark end of steps or thresholds with contrasting tape or paint color to increase awareness of changes in height. Lack of lighting at night ◦ Add an outdoor light fixture if not present. ◦ Add a sensor light that automatically turns on and off. Lack of a ramp for a wheelchair ◦ Have a remodeler or home contractor construct a ramp that will allow wheelchair access in and out of the home. 2) Identify 4 potential hazards in a living room and the solutions to correct. Presence of throw or scatter rug. ◦ Remove a scatter rug or use a double sided rug tape or a rug pad to secure the rug to the floor. Presence of clutter. ◦ Eliminate clutter on floor surfaces by placing items on shelves or storage. ◦ Consider donating or throwing out the items you no longer use. ◦ Avoid carpets with confusing patterns. Presence of electric cords across the floor. ◦ Run your cords behind furnishings. ◦ Use extension cords to accomplish this. ◦ Rearrange items that must be plugged in to areas near an outlet. Poor lightingIncrease wattage to allowable limits in lamps/lights. ◦ Add additional lamps or wall/overhead lights. 2. Society – Crimes Against Older Adults a. What type of crimes are older adults more likely to be victims? Every year millions of older adults fall victim to some type of financial fraud or confidence scheme. Common scams include investment fraud, tech support scams, romance scams, grandparent scams, government impersonation scams, sweepstakes or lottery scams, home repair scams, family caregiver scams, and TV or radio scams. b. The nurse must be instrumental in reducing fear of crime and assisting older adults in exploring ways to be safe. List 5 crime reduction suggestions that should be discussed with the elderly. NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide Box 21.2 Crime-Reduction Suggestions Walking Plan your route and stay alert to your surroundings. Walk confidently Have a companion accompany you Stay in well-lighted areas Have your key ready when approaching your front door Don’t dangle your purse away from your body; carry only what you need c. How does the elderly population protect themselves from Fraud? Box 21.3 Protection Against Fraud and Cybercrime Recognize scam attempts and end all communication with the perpetrator Search online for the contact information and the proposed offer. Other people likely have posted information online about individuals and businesses trying to run scams Resist the pressure to act quickly. Call the police if you feel there is danger to yourself or a loved one Be cautious of unsolicited phone calls, mailings, and door-to-door service offers Never give or send any personally identifiable information, money, jewelry, gift cards, checks, or wire information to unverified people or businesses Make sure all computer antivirus and security software and malware protections are up to date Disconnect from the internet and shut down your device if you see a pop-up message or locked screen Be careful what you download, never open an email attachment from someone you don’t know, and be wary of email attachments forwarded to you Take precautions to protect your identity if a criminal gains access to your device or account. Immediately contact your financial institutions to place protections on your accounts and monitor your accounts and personal information for suspicious activity d. What resources are available in your area to prevent or assist those who may be vulnerable to criminal activity? Adult Protective Services https://humanservices.arkansas.gov/divisions-sharedservices/aging-adult-behavioral-health-services/adult-protective-services/ 3. Fire a. Fire related deaths are three times higher in people older than 80 years than the rest of the population. Please provide the rational. The risk of injury during a fire is greater if medication, illness, mobility, and sensory impairments slow response time or decision making and if help is not available to contain the fire and help the person escape. b. What factors predispose the older adult to fire injuries? NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide A number of factors predispose the older adult to fire injuries. In home-dwelling older adults, economic or climatic conditions may promote the use of ill-kept heating devices. Attempts to cook over an open flame while wearing loose-fitting clothing, or inability to manage spattering grease from a frying pan, can often start a fire from which the individual cannot escape. Failing vision can contribute to a person setting a cooktop burner, heating pad, or hot plate at too high a temperature, resulting in fire or thermal injury. Most fires occur at home during the night, and deaths are attributed to smoke injury more often than burns. 4. Temperatures a. Heat related and cold related deaths increase with age. Please provide the rational Neurosensory changes in thermoregulation delay or diminish the individual’s awareness of temperature changes and may impair behavioral and thermoregulatory response to dangerously high or low environmental temperatures. These changes vary widely among individuals and are related more to general health than to age. The ability to sense heat, to sweat, and to increase skin blood flow are all reduced in healthy older adults. The risk of heat-related illnesses or injuries are increased in older adults with obesity, cardiovascular disease, respiratory disease, and diabetes, which affect normal thermoregulatory responses. In addition, many drugs affect thermoregulation by affecting the ability to vasoconstrict or vasodilate, both of which are thermoregulatory mechanisms. Other drugs inhibit neuromuscular activity (a significant source of kinetic heat production), suppress metabolic heat generation, or dull awareness (tranquilizers, pain medications). Alcohol inhibits thermoregulatory function by affecting vasomotor responses in either hot or cold weather. b. Describe interventions to prevent hyperthermia. Preventing Hyperthermia Drink 2 to 3 L of cool fluid daily and eat smaller, more frequent meals. Minimize exertion, especially during the warmest times of the day. Use air conditioning or go to where air conditioning is available (malls, library); use fans. Wear light, loose-fitting cotton clothing and hat when outside; remove most clothing when indoors. Take tepid baths or showers. Apply cold wet compresses or immerse the hands and feet in cool water. Evaluate medications for risk of hyperthermia. Avoid alcohol. Describe interventions to prevent hypothermia Preventing Cold Discomfort and Development of Accidental Hypothermia in Frail Older Adults Maintain a comfortably warm ambient temperature no lower than 68°F. Many frail older adults will require much higher temperatures. NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide Provide generous quantities of clothing and bedcovers. Layer clothing and bedcovers for best insulation. Be careful not to judge your patient’s needs by how you feel working in a warm environment. Provide a head covering whenever possible—in bed, out of bed, and particularly outdoors. Cover patients well when in bed or bathing. The standard—a light bath blanket over a naked body—is not enough protection for frail older adults. Cover patients with heavy blankets for transfer to and from showers; dry quickly and thoroughly before leaving the shower room; cover the head with a dry towel or hood while wet. Shower rooms and bathrooms should have warming lights. Dry wet hair quickly with warm air from an electric dryer. Never allow the hair of frail older adults to air-dry. Use absorbent pads for individuals with urinary incontinence who are unable to ambulate to the toilet rather than allowing urine to wet large areas of clothing, sheets, and bedcovers. Provide as much exercise as possible to generate heat from muscle activity. Provide hot, high-protein meals and bedtime snacks to add heat and sustain heat production throughout the day and as far into the night as possible. 5. Natural Disasters a. Why are older adults at greater risk during natural disasters than younger adults? Older adults may be less likely to seek formal or informal help during disasters or may be unable to do this independently. Many lack access to the technology that supplies communication during disasters. Many older adults cannot easily evacuate because they do not drive, are physically unable to evacuate, or may refuse. Older adults at most risk include but are not limited to those who depend on others for daily functioning, the medically frail, those with limited mobility, those who are socially isolated or live alone, and those who are cognitively impaired or institutionalized. The older and poorer the individual, the more likely the person is to be isolated and vulnerable. B. Transportation Safety 1. Driving a. Driving is a highly complex activity that requires a variety of visual, motor, and cognitive skills. Age alone is not a good indicator of ability but rather the health conditions that the elder may have. What conditions (illnesses) of the elderly may contribute to the inability to drive safely? Cognitive functions necessary for driving, such as attention and spatial orientation, are especially impaired with dementia, making this population especially vulnerable to unintentional vehicle injury and death. b. What are the legal regulations for license renewal in older drivers for the state of Arkansas? https://www.dmv.com/ar/arkansas/senior-drivers? tg1=DVA&utm_content=dmv.com&utm_medium=dmv_&tg7=dmv_&utm_source=dmv. com&tg9=dmv.com&utm_term=organic_dmv&utm_campaign=organic_dmv NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide ◦ Those who are 70 years of age or older at the time their current driver license expires are generally required to renew their license in person at a local OMV office. ◦ The Office of Driver Services reexamination is when a person’s driving skills must be reevaluated based on one or more factors, including the driver’s physical or mental condition, or driving record. ◦ Sometimes, a physical or mental condition can impair a driver’s ability to safely operate a motor vehicle. The most common of these conditions is a poor vision, but others which may be age-related include cognitive skills like memory, coordination and flexibility. ◦ In some circumstances, older drivers may have a restriction placed on their driver license. The types of restrictions vary, and are based on the results of your vision test, driving test, and the driving examiner’s assessment.  Require eyeglasses, corrective contact lenses, or bioptic telescopic lens to be worn at certain times.  Permit driving from sunrise to sunset only, or prohibit driving during rush hour.  Restrict the geographical area in which a person is permitted to drive, or prohibit freeway driving.  Require special mechanical devices, or an additional side mirror on the vehicle.  Require extra support in order to ensure a safe and correct driving position.  Drivers suspected of not being able to safely drive may have their license revoked or suspended. A notice will be sent from the ODS, and for reinstatement, a medical report should be submitted, and all driving license tests may need to be passed. c. What are the health consequences of driving cessation? Relinquishing the mobility and independence afforded by driving one’s own car has many psychological ramifications and inconveniences. Giving up driving is a major loss for an older adult both in terms of independence and pleasure and in feelings of competence and self-worth. The health consequences of driving cessation include social isolation, health problems, institutionalization, higher mortality, and an approximately doubled risk of depression. d. What are the best strategies to use to bring about driving cessation? Voluntarily giving up a driver’s license, rather than having it revoked, is associated with more positive outcomes. Specialized driving cessation support groups aimed at the transition from driver to nondriver also may be beneficial in decreasing the negative outcomes associated with this decision. III. Technology Describe the following types of technological advancements that will keep the older adult safe. a. Telehealth → Telehealth is the use of technologies to enable clinicians to remotely diagnose, monitor, and treat patients. Telehealth offers exciting possibilities for managing medical problems in the home or other setting, reducing health care costs, and promoting self-management of illness, particularly in rural and underserved areas. NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide Telehealth reduces health care costs, transportation, and time on the part of the patient. b. Smart Homes → Many exciting technologies are being developed to support monitoring and management of older adults’ health and homes and to support aging in place and remote caregiving. c. Robots → Robotic technology for health care is more advanced in Europe and Japan than in the United States at this time, but we can expect to see increased development and use of robotics in nursing. Already developed are robots that can help lift both individuals and objects, remind patients to take their medicine or administer the medication, check a person’s vital signs, provide help in the event of a fall, and assist with baths and meals. A child-sized therapist robot on wheels with a humanlike torso is being developed for use in homes and long-term care facilities to assist with the high level of attention that individuals with dementia require for safety and function. II. Pain 1. What are the goals of pain management? 2. How does pain in the older adult differ from pain experiences in younger years? The perception of pain is altered by many factors, including the type of pain; the person’s prior experience and expressions of pain; and the person’s cultural, cognitive, functional, and psychological status, especially depression and anxiety. Inadequate treatment of pain leads to impaired functional status and in some cases transient cognitive impairment that can become permanent. The gerontological nurse may hear the comment that older adults “feel less pain” than younger adults, especially when referring to those with dementia. However, the amount of pain is the same but there are age-related differences in both its perception and tolerance. With aging there is a decrease in the density of both myelinated and unmyelinated nerve fibers that slightly delay the transmission of the sensation of pain from the periphery to the brain (Box 29.6). At the same time, the sensation is slower to resolve, and relief is delayed once pain is triggered. 3. Differentiate between acute pain and persistent pain. Acute pain has a distinct and sudden onset, is of short duration, and is self-limiting. The cause is clear (e.g., fracture, infection), and the pain is expected to end when the problem is resolved. It is expected by the circumstances, temporary, and usually controllable. Persistent pain is that which lasts beyond the time it would be expected and is present at least half of the time in the previous 6 months (Reuben et al., 2020). It is most often associated with progressive disease (e.g., arthritis) or a known syndrome (e.g., stroke). 4. Identify factors that affect the perception of pain. The type of pain; the person’s prior experience and expressions of pain; and the person’s cultural, cognitive, functional, and psychological status, especially depression and anxiety. 5. Discuss barriers to pain assessment and treatment in older adults. Health Care Provider NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide Lack of education regarding pain assessment and management Concern regarding regulatory scrutiny Fears of opioid-related side effects and addiction Belief that pain is a normal part of aging Belief that cognitively impaired older adults have less pain Personal beliefs and experiences with pain Failure to accept self-report without “objective” signs Polypharmacy Personal Lack of ability to assess pain by those with cognitive impairments Fear of medication side effects and addiction Personal and societal belief that pain is a normal part of aging Belief that nothing can be done for pain in “old people” Fear of being a “bad patient” if complaining Fear of what pain may signify 6. Discuss consequences of untreated pain. Falls and other accidents Functional impairment Slowed rehabilitation Mood changes: depression, anxiety, fear Caregiver strain: increased dependency Sleep disturbance Anorexia Impaired cognition Decline in social and recreational activities Increased health care use and costs Loss or worsening of physical function and fitness Potential for drug or alcohol abuse or misuse 7. Discuss data to include in a pain assessment. Onset, Location, Duration, Characteristics, Aggravating and Relieving factors, and Treatments used in the past. 8. Discuss the problem of assessing pain in cognitively impaired older adults. Describe the nurse’s responsibility in managing pain in cognitively impaired older adults. Identify tools that can be used to assess pain in the cognitively impaired older adult. 9. Discuss pharmacological pain management therapies. Pharmacological interventions to promote comfort in older adults are a significant part of gerontological nursing. The approaches are based on action plans collaboratively created by persons in pain, their significant others, and other health care professionals. Achieving comfort NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide is a process of trial and error to find a balance between potential benefits and harm and must always be at the forefront of care. Persons with persistent pain are often afraid of becoming addicted when they may need pharmacological intervention for the rest of their lives to maintain some level of independence. To achieve the highest level of comfort, it is necessary to ease the “memory of pain,” especially for those with persistent pain. This means that it is necessary to prevent the pain, not simply relieve it. The most effective way to do this is to provide doses around the clock (ATC); with the most appropriate medication and at the appropriate dosage, a more stable therapeutic plasma level can be reached and the extremes of overmedication and undermedication eliminated. Nonopioid analgesics Nonopioid drugs (e.g., acetaminophen, ibuprofen, naproxen) are considered the initial treatment for mild to moderate pain in older adults. Wheras a 24-hour maximum of 4 grams of acetaminophen may be appropriate for younger adults, a maximum 24-hour dose is 3 grams for older adults and 2 grams for those who are frail, are over age 80, drink alcohol on a regular basis, or have any renal or hepatic insufficiency. It has been found to be effective for the most common causes of pain, such as osteoarthritis and back pain. With few side effects or drug interactions, acetaminophen can be used for ATC management if this provides relief. Unfortunately, if used regularly, it will increase the risk for bleeding if the person is taking the anticoagulant warfarin. Opioid analgesics Many older adults have comorbid conditions that prevent the use of some nonopioid medications or cannot afford alternatives. For pain that has not been relieved by nonopioids or where their use has resulted in impaired function and quality of life, opioids may be needed. When carefully selected and monitored, they can be used safely and effectively in older adults with moderate to severe pain. Initially a short trial of fast-acting formulations is recommended. When the pain is persistent, ATC dosing is needed. After the 24-hour dose is determined, longacting, extended-release formulations of the same medication can be used for ease in dosing and maintenance of comfort. A short-acting medication is used for breakthrough pain, and when this is needed regularly, the baseline long-acting dose will need adjustment. Unfortunately, too often the titration of dosing is not done, and pain relief is inadequate, especially in the longterm care setting. 10. Discuss nonpharmacological therapies for pain management. Mind-body practices Distraction, relaxation, and mindfulness meditation all enable the quieting of the mind and muscles, releasing tension and anxiety and in doing so relieving or lessening pain sensation. Heat and cold Heat and cold have been used for centuries to relieve pain. Neither should have direct exposure to skin to avoid burns. Cold reduces muscle and nerve irritation and is ideal for both acute and persistent muscle pain. A product such as IcyHot can be purchased, but frozen food or ice is more accessible. Ice is the most effective when it is used 24 to 48 hours after an injury. Heat NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide increases circulation to an area and is very comforting to areas affected by arthritis, and a warm cloth or a paraffin bath is ideal as the heat moves into the tissue. Both dry and moist heat can be use for 15 to 20 minutes at a time for those with mild pain and for 30 to 120 minutes for more severe pain. Exercise It is thought that the less active an individual is, the less tolerable activity becomes. Anyone who becomes inactive may feel more general discomfort than the active person. Both passive and active range of motion and stretching can be used with heat and cold. Tightened muscles can be warmed, stretched, and then cooled. Exercises can be guided by an informed nurse or, when more complex movement and stretching is needed, a physical therapist. Transcutaneous electrical nerve stimulation Transcutaneous electrical nerve stimulation (TENS) and transcutaneous vagal nerve stimulation have been studied for many years. Although there have been some promising results in the treatment of acute pain, especially as an adjuvant to medications, its effectiveness is still inconclusive (Abd-Elsayad et al., 2021). It is often used by physical therapists in combination with stretching and strengthening exercises. Patients often anecdotally report that at least they were doing “something.” TENS units are now available commercially without a prescription. Acupuncture and acupressure In acupuncture tiny needles are inserted along specific meridians or pathways in the body consistent with the locations used in traditional Chinese medicine (meridians). It is thought to stimulate the body to heal in locations associated with the location of needle placement. It should not be used by persons with a bleeding disorder or who have a pacemaker. Acupressure is pressure applied with the thumbs or tips of the index finger at the same locations. Acupuncture and acupressure have been used for thousands of years. Evidence supports the benefit of acupuncture specifically for several conditions, including low back pain, neck pain, knee pain and arthritis, and headaches (Horgas et al., 2021; NCCIH, 2022c). Energy and touch therapies Some say the use of touch therapy is a legacy in nursing. Over the years, different kinds of touch have been formalized to include those referred to as contact therapy (e.g., massage) and noncontact therapies (e.g., healing touch, therapeutic touch, Reiki). Like acupuncture, the goal is to stimulate the body’s own healing properties. The acceptability of touch by individuals and cultures varies considerably. Some physical contact may never be acceptable, such as crossgender touch in strict Muslim or Orthodox Jewish traditions. The culturally sensitive nurse makes no assumptions and always requests permission before touching a patient. Assistive devices Assistive devices are used to “offload” to reduce stress and weight on painful joints. Custom orthotics, lumbar supports, canes, and walkers are common. Nursing actions include both teaching how to use these devices and monitoring technique. Psychological therapy and self-care education NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide Psychological therapy in pain management is a means of helping persons learn that self-efficacy and self-care skills are both powerful mediators of pain and that the coping skills they used in the past can be used in new ways. Cognitive behavioral therapy (CBT) has been found to be particularly effective (Horgas et al., 2021). Spiritual coping strategies may further enhance selfconfidence and comfort. Music Music as an adjunct to pharmacological treatment of pain has been found to be especially useful postoperatively. Studies have shown a decrease in the intensity of pain and/or opioid requirements while listening to preferred music (Laframboise et al., 2021). The use of music for relief of pain in persons with dementia is promising but not yet conclusive (Moreno-Morales et al., 2020). Audio/Video Focus Areas Please watch the following videos and answer the questions provided. 1. Seniors and Chronic Pain (2:52) Fifty percent of pain goes untreated in the elderly population. Why? Many seniors believe pain is a normal part of aging. This population just tries to endure the pain without getting the treatments they need. Is pain a normal part of aging? No. Untreated or undertreated pain may result in what conditions? Depression, decreased mobility, social isolation and poor sleep. Why is the elderly population skeptical about receiving “dope” (medicine) for pain? The population has not been adequately educated on the benefits of the opiod medications or have been given something that caused a side effect that was not anticipated. Website Focus Areas Access the website www.oatstransit.org and evaluate the transportation system that Missouri offers throughout most of the state. Does your state offer a similar opportunity for transportation for older adults? Yes. The state of Arkansas has multiple programs ranging from taxi and transit passes, non emergency senior transportation services for individuals and groups. Application Questions or Case Studies The following case studies were retrieved from the textbook: Touhy, T.A., & Jett, K.F. (2020). Ebersole & Hess' toward healthy aging: Human needs & nursing response (10th ed.). Elsevier. NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide A 75-year-old male has a history of diabetes, renal failure, and congestive heart failure. He lives alone, is wheelchair bound, and has chronic diabetic ulcers on both lower extremities. He has continuous oxygen in use. He is ordered to be seen by a home health nurse for dressing changes and home physical therapy for home exercises and safe ambulation and transfers. The skilled nurse is the first to arrive in the home for the assessment. The nurse finds that the home is extremely cluttered and difficult to maneuver in even without the wheelchair. The house appears very dirty with unclean floors, cobwebs in the corners, and dirty dishes on the counters and in the sink. There are multiple cats and dogs walking freely throughout the home, which smells strongly of pet urine. The nurse immediately recognizes the need for education about home safety. 1. Based on the information presented in the case study, what are the immediate concerns for patient education and monitoring? The need to declutter the home to improve safety to reduce the risk of falls. The need to find homes for the pets the resident is unable to care for. 2. Discuss the elements of oxygen and fire safety that would be included in patient education.                Notify the fire department and the electric company that you are using oxygen. Place “Oxygen in Use” signs in visible areas. Never place the tank or machine near an open flame (e.g., matches, lit candles, a stove in use). Keep the oxygen tank at least six feet away. Always turn your oxygen off when not in use. Always check the oxygen levels on your oxygen tank. This includes the backup tank as well as the tank that is in use. The oxygen backup tank should be stored lying flat (or upright and secured) and in a safe, wellventilated place. Check the oxygen tubing for cracks and leaks. Clean the nasal prongs to keep them open. Check the prongs daily. Never smoke when the oxygen source is in your residence. Do not allow anyone else to smoke. Always have a “No Smoking” sign posted in a visible spot. Do not use your oxygen within six feet of electrical appliances, especially stoves, heaters, toasters, or hair dryers. Do not use your oxygen in an area where combustible materials, such as oils, greases, aerosol sprays, lotions, or solvents, are present. Do not use petroleum-based products while oxygen is in use. Avoid the use of products that contain alcohol (e.g., skin products). Get into the habit of checking the batteries of your smoke detector every month and change batteries as needed. Call the Durable Medical Equipment (DME) company for service or any questions you might have. Have fire extinguishers on hand. 3. Discuss the factors that predispose an older person to fire injuries. What other resources could the nurse include in the plan of care for this patient? NURS 3540 – Gerontological Nursing Module 10 Active Learning Guide Anthony Jameson is an 82-year-old male with metastatic lung cancer. He was a smoker for many years and finally quit smoking at the age of 76. He lives at home with his younger wife, who is his primary caregiver. She is available around the clock and assists him with all of his care needs including medication management. The couple never had children but they have support from friends at church to provide respite care. Mr. Jameson is visited by a hospice nurse, who assists with pain and symptom management. Anthony has been experiencing increased pain and shortness of breath during the night and needs to have a pain assessment. 1. A key element in the assessment of pain is the perceived meaning of pain as perceived by the person. 2. Which of the following pain assessment tools is used with the individual who cannot reliably express pain? a. Comprehensive Pain Assessment b. Pain Assessment in Advanced Dementia Scale c. Numeric Rating Scale d. Faces Pain Scale 3. Which of the following analgesics is contraindicated in the older adult? a. Tramadol b. Oxycodone c. Demerol d. Hydromorphone 4. How is opioid treatment initiated? a. Begin with as-needed doses and titrate based on need b. Monitor for side effects weekly in the hospice patient c. Begin with the highest dose possible to control severe pain d. Begin with around-the-clock formations unless patient exhibits addictive behavior