Geriatric Nursing Midterms PDF

MIDTERMS FJVM GERIATRIC ASSESSMENT  Psychological well-being  Caregiver stress or burd...

MIDTERMS FJVM GERIATRIC ASSESSMENT  Psychological well-being  Caregiver stress or burden  Patterns of health and health care GERIATRIC ASSESSMENT  Review of preferences for advanced care  A multidimensional, multidisciplinary planning assessment designed to evaluate an older person’s functional ability, physical health, FREQUENT PROBLEMS TO ADDRESS IN AN ASSESSMENT cognition and mental health, and socio- environmental circumstances  Sexual frustration  It is usually initiated when the physician  Depression identifies a potential  Incontinence  It is more complex, more detailed, and is longer  Alcoholism to perform  Hearing loss  Oral health PURPOSE OF GERIATRIC ASSESSMENT  Environmental safety 1. Aids in the diagnosis of medical conditions; development of treatment and follow-up plans; SPECIAL ASSESSMENT ABILITIES coordination of management of care; and  Listen patiently evaluation of long-term care needs and optimal  Allow for pauses placement  Ask question that are not often asked 2. It usually yields a more complete and more  Obtain data from all available sources relevant list of medical problems, functional  Know that not all positive findings need problems, and psychosocial issues interventions TECHNIQUES IN CONDUCTING ASSESSMENT  Know normal changes  Pace the assessment according to the patient’s 1. The setting: privacy and comfort stamina 2. Establishing rapport 3. Communication techniques COLLECTING ASSESSMENT DATA GUIDELINES FOR COMMUNICATING WITH - Establishing rapport HEARING IMPAIRED PERSON 3 APPROACHES USED IN COLLECTING ASSESSMENT  Get the older person’s attention before speaking DATA  Face him directly SELF-REPORT  Speak slowly and clearly in a normal tone of  Questions are either asked directly or the person voice, slightly louder but no shouting is expected to respond to written questions about  Turn off background noise his or her health status. Patients tend to  If the older person does not understand what overestimate their own abilities and older adults you are saying rephrase message rather than in particular have been found to under-report repeat word for word symptoms, often due to the erroneous belief that  Signify changes in topic by pausing long enough what they are experiencing are normal parts of before proceeding aging  Avoid movements while talking  End the session properly by saying it is ended REPORT BY PROXY  Assessment information is obtained indirectly. GUIDELINES FOR COMMUNICATING WITH The nurse asks another person, such as a staff CONFUSED AND/OR DEMENTED PERSON nurse, aide, spouse, or friend, relative or  Invest time in establishing rapport caretaker to report their observations  Always stress who you are and what your job is   Remain pleasant, calm and supportive BY OBSERVATION  Minimize other sounds in the background  The nurse collects and record the data as she  Get inside the person’s attention bubble observe using what she believed in objective  Maintain physical and eye contact parameters [it can be measured, such as VS, lab  Ask the person to do one task at a time, findings, use your own senses] breaking down complicated steps into simpler ones GUIDELINES FOR AN ASSESSMENT OF THE OLDER  Speak slowly and wait for the person to respond ADULT  Keep the meeting short and gauge the response 1. Conduct the assessment at a time when the you get client is at his or her best  Expect slight suspicion or being thought of as a 2. Avoid biasing the response family or relative 3. Explore more information, but only if needed 4. Approach sensitive information in a matter-of- ASSESSMENT COMPONENTS fact manner 5. Record the client’s word for accuracy COLLECTION OF DATA  Biological, psychosocial, and functional WHEN DOING AN ASSESSMENT information ASSES, don’t assume  Cultural and spiritual assessments WATCH, don’t just ask  Cognitive abilities - Obtain baseline information  MIDTERMS FJVM o It is important to know what is normal o Increased glare sensitivity, decreased for this individual contrast sensitivity and need for more - Identify what helpers, equipment, and support light to see and read make doing activities of daily life possible  Ensure that waiting rooms, HEALTH ASSESSMENT hallways, and exam rooms are adequately lit HEALTH HISTORY o Decrease color discrimination may  Collected in a face-to-face approach with the affect ability to self-administer client or a review of the client’s written history medications safely g. Mouth  Includes medical history, review of systems, o Excessive dryness and exacerbated by medication history , nutritional history, and many medications factors that influence the person's quality of life, o Cannot use mouth moisture to estimate including: hydration status o Living arrangements h. Neck o Financial resources o Due to loss of subcutaneous fat it may o Support appear that carotid arteries are enlarged when they are not PHYSICAL ASSESSMENT i. Chest  It is time consuming o Any kyphosis will alter the location of  Begins the moment the nurse sees the person. the lobes, making careful assessment  Perform a problem assessment first because of more important the length of time it takes to conduct an o Risk for aspiration pneumonia assessment. increased and therefore the importance  When the focus is a well-check assessment, the of the lateral exam emphasis is placed on health problems in later j. Heart life. o Listen carefully for third and fourth heart a. Height and weight sounds o Monitor for changes in weight o Fourth heart sounds common o Weight gain: especially important if the o Determine if this has been found to be persons has any heart disease, being present in the past of is new alert for early signs of heart failure k. Extremities o Weight loss: be alert for indications of o Dorsalis pedis and posterior tibial malnutrition from dental problems, pulses very difficult or impossible to depression, or cancer. Check for mouth palpate lesions from ill-fitting dentures. o Must look for other indications of b. Temperature vascular integrity o Even a low-grade fever could be an l. Abdomen indication of a serious illness. o Due to disposition of fat in the Temperatures of as low as 100° F may abdomen, auscultation of bowel tones indicate pending sepsis. maybe difficult c. Blood pressure m. Musculoskeletal o Positional blood pressure readings o Osteoarthritis very common and pain should be obtained due to high often untreated. occurrence of orthostatic hypotension. o Ask about pain and function in joints o Both arms should be checked (at heart o Conduct very gentle passive range of level) and recording of the highest one motion if active rage of motion is not used. Isolated systolic hypertension is possible common. o Do not push pass comfort level d. Skin n. Neurological o Check for indications of solar damage, o Although there is a gradual decrease in especially among persons who worked muscle strength, it still should remain outdoor climates. equal bilaterally o Due to thinning, “tenting” cannot be o Greatly diminished or absent ankle jerk used as a measure of hydration status (Achilles) tone tendon reflex is very e. Ears common and normal o Cerumen impactions are common o Decreased or absent vibratory sense of o These must be removed before hearing lower extremities, testing unnecessary can be adequately assessed o High-frequency hearing loss COMPREHENSIVE ASSESSMENT (presbycusis) is common  A model for a comprehensive yet prioritized, o The person often complains that he or primarily physical assessment that is especially she can hear but understand as some, useful for the frail elder but not all sounds are lost.  Emphasizes the determination of the very basic o The person with severe but needs and the individual functional ability to unrecognized hearing loss may be meet these needs independently incorrectly thought to have dementia f. Eyes  MIDTERMS FJVM ACTIVITIES OF DAILY LIVING Ask if need help with activities done every day, such as: - Bathing and grooming - Ambulation - Transfers - Toileting - Eating - Dressing Frail and medically complex “FANCAPES” F – Fluids (state of hydration) INSTRUMENTAL ACTIVITIES OF DAILY LIVING A – Aeration (respiratory function) Ask if need help with activities which are more complex, N – Nutrition (type & amount of food consumed) such as C – Communication (adequate ability to communicate - Writing needs) - Reading A – Activity (ability to meet basic needs - Cooking toileting/grooming/meal prep) - Cleaning P – Pain (physical, spiritual, psychological) - Shopping E – Elimination (difficulty w/bladder or bowel) - Doing laundry S – Socialization and Social Skills (give & receive love - Going up stairs and friendship) - Using the telephone - Outside activities “QUADRUPLE A’S NUTRITION” - Managing medications Appearance – does the person look well nourished? - Managing money Appetite – how is the person’s appetite? - Transportation Access – does the person have access to fund to buy food? Get to the store? FUNCTIONAL ASSESSMENT TOOLS Ability – can the person prepare for her own meals?  Tools for ADLs Open cans? Cook safely? o Katz Index  a basic framework for most of FUNCTIONAL ASSESSMENT the measures of ADLs since  Determine the functional status of the client: its development in 1963 o Identifying areas where help is needed  the most appropriate o Determining whether a change in instrument to assess abilities from period to another has functional status as a occurred measurement of the client's o Assisting in the determination of need ability to perform activities of o Determining the safety of the client’s daily living independently and living situation to plan care accordingly  If the client is healthy and active record a simple  A score of 6 indicates full statement function, 4 indicates moderate o “The client is active and independent impairment, and 2 or less and denies functional difficulties” indicates severe functional impairment. FUNCTIONAL STATUS  most useful when baseline o Refers to a person’s ability to perform measurements are taken tasks that are required for living when the client is well and  Activities of Daily Living: self- compared to periodic or care activities that a person subsequent measures performs daily o Barthel Index  Instrumental Activities of Daily  Commonly used in Living: activities that are rehabilitation settings to needed to live independently measure the amount of o ACTIVITIES OF DAILY LIVING (ADLs) physical assistance required  Eating/Feeding when a person can no longer  Toileting carry out ADLS.  Ambulation  It is useful as a method of  Bathing documenting improvement of  Dressing a patient's ability especially  Grooming for those who have suffered a o INSTRUMENTAL ACTIVITIES OF stroke. DAILY LIVING (IADLs)  Ranks the functional status as  House cleaning either independent or  Shopping dependent and then allows for  Managing money further classification of  Administering own medication independent into intact or  Preparing meals limited, and dependent into  Using the telephone needing a helper or unable to do the activity at all  MIDTERMS FJVM o Half = help with bottons, zips, etc GUIDELINES FOR THE BARHEL INDEX OF ADLs (check!), but can put on some garments General alone  The index should be used as a record of what - Stairs the patient does, not as a record of what the o Must carry any walking aid used to be patient could do independent  The main aim is to establish degree of - Bathing independence from any help, physical or verbal, o Usually the most difficult activity however minor and for whatever reason o Must get in and out unsupervised, and  The need for supervision renders the patient not wash self independent o Independent in shower = independent if  A patient’s performance should be established unsupervised/unaided using the best available evidence o Asking the patient, friends/relatives, & FUNCTIONAL ASSESSMENT TOOLS nurses will be the usual source, but  Barthel Index direct observation and common sense  Functional Index Measure are also important o However, direct testing is not needed Tools to assess instrumental activities of daily living  Usually the performance over the preceding 24- (IADLs) 48 hours is important, but occationally longer periods will be relevant  Unconscious patients should score ‘0’ throughout, even if not yet incontinent o Middle categories imply that the patient MENTAL STATUS ASSESSMENT supplies over 50% of the effort  Assesses whether an increase in chronological o Use of aids to be independent is age has resulted in an increase rate of allowed dementing illness - Bowles (preceding week)  Assesses cognition and mood o If needs enema from nurse, then incontinent COGNITIVE MEASURES o Occasional = once a week  Mini mental status examination - Bladder (preceding week) o A 30-item instrument that has been o Occasiona; = less than once a day used to screen for cognitive difficulties o A catheterized patient who can and is one of the tools often used in the completely manage their catheter alone determination of a diagnosis of is registered as continent dementia or delirium - Grooming (preceding 24-48 hours) o It tests orientation, short-term memory o Refers to personal hygiene: doing teeth, and attention, calculation ability, fitting false teeth, doing hair, shaving, language, and construction washing face. Implements can be o NA to person who cannot see or write provided by helper or who are not proficient in English - Toilet use o Scores interpretation: o Should be able to reach  30 – no impairment toilet/commode, undress sufficiently,  5 suggests depression and through the process of dementia indicated a complete assessment o Provides caregivers an overview of the should follow the GDS stages of cognitive function for those o Scores >/= 10 typically indicates suffering from a primary degenerative depression dementia such as Alzheimer’s disease. o It comprises 7 different stages  Stage 1-3 – pre-dementia stages  Stage 4-7 – dementia stages MOOD MEASURES  Geriatric depression scale o Self-report screening tool to identify depression in older adults INTEGRATED ASSESSMENT o Originally developed as a 30-item  Social resources measure (Geriatric Depression Scale –  Economic resources Long Form: GDS-L) by J.A. Yesavage  Mental health and others  Physical health o Shortened form is 15-item measure  Activities of daily living (Geriatric Depression Scale – Short OTHER TOOLS Form: GDS-S) developed by J.I Sheikh  Blessed Dementia Score and J.A. Yesavage in 1986  Clinical Dementia Rating Scale o Completed in approximately 5 to 7  Global Deterioration Scale minutes  Fulmer SPICES (Sleep disturbance, Problems GERIATRIC DEPRESSION SCALE with eating and feeding, Incontinence,  Research shows the GDS-L and GDS-S are Confusion, Evidence of falls, and Skin both successful in recognizing depressive breakdown) symptoms  Used with healthy, medically ill, and mild to IMPLICATIONS FOR GERONTOLOGICAL NURSING moderately cognitively impaired older adults AND HEALTHY AGING  Used in any setting: community, acute and long-  Goal is to promote healthy aging term care  Tools serve as a way to collect data and  Easy to administer and score organize data o Yes/No format  Each tool has strengths and weaknesses o Takes approximately 5-7 minutes to administer  How to administer o Can be completed before clinical visit or during provider interview, in-person or by telephone o Administer in private, quiet room o Speak slowly and clearly o Eye contact o Introduce GDS and provide instructions  I’m going to ask you some questions about your mood. Please answer “yes” or “no” based on how you have felt over the past week”  Scoring of GDS o The answers of “I” emphasize significance to depression o Max score = 15 o Add up the total points from yes or no responses  How to interpret Results o A score of:  0-4 = Normal  Depending on age, education, and complains  5-8 = mild depression  9-11 = moderate depression  MIDTERMS FJVM Use charts, models and pictures to illustrate your message.  Frequently summarize the most important points.  Give patients an opportunity to ask questions and express themselves.  Schedule older patients earlier in the day.  Greet them.  Allow them to sit in a quiet and comfortable area.  Make things easy for them to read by making signs, forms and brochures.  Be ready to physically escort the patient.  Check on them from time to time.  Keep the patient relaxed and focused by using touch.  Say goodbye to end the visit on a positive note. Walk with the patient to the checkout desk, COMMUNICATING WITH THE OLDER ADULT thank them for their visit and tell them goodbye. COMMUNICATION CHANGES TYPICAL WITH AGING WHY IS COMMUNICATION IMPORTANT WITH THE  Changes in physical health ELDERLY?  Depression  Cognitive decline COMMUNICATION:  Physiologic changes in hearing, voice, and  retains good physical and emotional wellbeing; speech processes  maintains a sense of control and achievement in the modern world; COMPENSATING FOR HEARING DEFICITS  communicate feelings, needs, opinions, and  Make sure your patient can hear you wishes for the future; and  Talk slowly and clearly in a normal tone  allows to talk about and cope with difficult  Avoid using a high-pitched voice situations.  Face person directly at eye level (lip-read or pick up visual clues) WHY ARE OLDER ADULTS AFRAID OF  Keep your hands away from your face while COMMUNICATION? talking  Keep a notepad handy so you can write what THE OLDER ADULTS: you are saying  don't want to bother others or be seen as  Tell you patient when you are changing the someone who is a complainer; and subject  don't have the mental capacity to talk to others  Background noises can mask what is being said or to fully express themselves immediately.  If your patient has difficulty with letters and  It is only over time that you get the whole story. numbers, give a context for them TIPS TO IMPROVE COMMUNICATION WITH THE COMPENSATING FOR VISUAL DEFICITS OLDER ADULTS  Use proper way in addressing them.  Provide adequate lighting, including sufficient  Make older patients comfortable. light on your face and try to minimize glare  Take a few moments to establish rapport.  Let patients wear eyeglasses if needed  Try not to rush.  Provide handwritten instructions  Avoid interrupting.  If the patient has trouble reading, consider alternatives such as recording instructions,  Use active listening skills. providing large pictures or diagrams, or using  Demonstrate empathy. aids especially configured pillboxes.  Avoid medical jargons.  When using printed materials, make sure the  Be careful about language. type is large enough and the typeface is easy to  Write down take-away points. read. COMMUNICATING WITH THE OLDER ADULTS BARRIERS TO EFFECTIVE COMMUNCATION  Allow extra time for older patients.  Physical barriers  Avoid distractions.  Perceptual barriers  Minimize visual and auditory distractions.  Emotional barriers  Sit face to face.  Cultural barriers  Maintain eye contact.  Language barriers  Listen without interrupting the patient.  Gender barriers  Speak slowly, clearly and in normal tone.  Interpersonal barriers  Use short, simple words and sentences.  Withdrawal  Stick to one topic at a time.  Simplify and write down your instructions.  MIDTERMS FJVM PHASES OF CHRONIC ILLNESS 1. Onset  Signs and symptoms are present  Disease diagnosed 2. Stable  Illness course and symptoms controlled by treatment regimen  Person maintains everyday activities 3. Acute  Active illness with severe and unrelieved symptoms or complications  Hospitalization may be required for management 4. Comeback  Gradual return to acceptable way of life 5. Crisis  Life-threatening situation occurs  Emergency services are necessary 6. Unstable  Unable to keep symptoms or disease under control CARE OF THE CHRONICALLY ILL AND OLDER  Life becomes disrupted while patient ADULT works to regain stability  Hospitalization not required CHRONIC ILLNESS 7. Downward  Any disorder that persists over a long period  Gradual and progressive deterioration and affects physical, emotional, intellectual, in physical or mental status social or spiritual functioning  Accompanied by increasing disability  A disease that is long-lasting or recurrent and symptoms  Continuous alterations in everyday life ACUTE ILLNESS activities  Any illness characterized by signs and 8. Dying symptoms that are of rapid onset and short  Patient has to relinquish everyday life duration; it may be severe and impair normal interest and activities, let go, and die functioning of the patient peacefully  Immediate weeks, days, hour preceding REASONS FOR INCREASE INCIDENCE OF CHRONIC death ILLNESS  decrease in mortality of infectious disease PRETRAJECTORY PHASE (smallpox, diphtheria, AIDS), and from - genetic factors or lifestyle behaviors that place a acute conditions because of prompt and person or community at risk from a chronic aggressive management of acute conditions condition (MI, trauma) - Focus of Nursing Care  life style factors (smoking, chronic stress and o refer for genetic testing and counseling sedentary lifestyle) which increases the if indicated, provide education about risk of chronic health problems (respiratory prevention of modifiable risk factors and disease, hypertension, cardiovascular behaviors disease, obesity)  longer lifespan because of advances in TRAJECTORY PHASE technology and pharmacology, improved nutrition, safer working conditions, and - appearance of noticeable symptoms associated greater access (for some people) in with a chronic disorder, includes period of healthcare diagnostic workup and announcement of  improved screening and diagnostic procedures, diagnosis enabling early detection and treatment of - provides explanation of diagnostic tests and diseases procedures and reinforce information and explanation given by primary health care provider; provide emotional support PROBLEMS ON MANAGING CHRONIC ILLNESS  alleviating and managing symptoms STABLE PHASE  psychological adjustment - illness course and symptoms are under control  preventing and managing complications as symptoms, resulting disability and everyday  carrying out regimen as prescribed life activities are being managed within  validating self-worth limitations of illness; illness management  managing threat to identity centered in the home  social isolation and loneliness - reinforce positive behaviors and offer ongoing  returning to satisfactory lifestyle monitoring; provide education about health  MIDTERMS FJVM promotion and encourage participation in health processes, biographical disengagement and promoting activities and health screening closure, and relinquishment of everyday life interests and activities UNSTABLE PHASE - provide direct and supportive care to patients - characterized by exacerbation of illness and their families through hospice programs symptoms, development of complications or - When death seems imminent: Nurse’s Role = reactivation of an illness in remission Trajectory of death and dying episodes - provide guidance and support; reinforce previous o To die is to cease all bodily functions teaching o To die is to depart from this world to - period of inability to keep symptoms under enter another life. control or reactivation of illness; difficulty in o Dying is a very important event, hence, carrying out everyday life activities  All hurt feelings must be - may require more diagnostic testing and trail of settled, total forgiveness new treatment regimens or adjustment of current  All debts, borrowed things regimen must be paid and returned  All mundane things must be ACUTE PHASE detached  All enemies must be amicably - severe and unrelieved symptoms or the reunited development of illness complications o Gratitude and appreciation must be necessitating hospitalization, bed rest, or accorded to the dying person interruption of the person’s usual activities to o Visit the dying person as soon as bring illness course under control possible, say appreciation and gratitude - provide direct care and emotional support to the - must be expressed and told to the patient and family members person o If this is done, dying becomes smooth CRISIS PHASE process - critical or life-threatening situation requiring emergency treatment or care and suspension of SIGNS OF IMMINENT DEATH everyday life activities until the crisis has passed  Stares at people - provide direct care, collaborate with other health  Silent communication care team members to stabilize patient’s  Innate need of presence condition  Vital signs diminish  Cold clammy skin COMBACK PHASE  Breathing difficulties - gradual recovery after an acute period and  Unexpressed anxiety learning to live with or to overcome disabilities  Nurses’ Role and return to an acceptable way of life within the  Accompany the person never limitations imposed by the chronic condition or leave alone disability  Keep person - clean - dry – - assist in coordination of care; rehabilitative focus comfortable may require care from other health care  Say intermittently your caring providers; provide positive reinforcement for presence goals identified and accomplished  Pray in your heart quietly - involves physical healing, limitations stretching  Show utmost respect to the through rehabilitative procedures, psychosocial dying person by your attitude, coming-to-terms and biographical reengagement presence caringness with adjustments in everyday life activities  Be extra kind and polite to relatives and friends who visit DOWNWARD PHASE the person - illness course characterized by rapid or gradual  Encourage them to say words worsening of a condition; physical decline of forgiveness and accompanied by increasing disability or difficulty grateful appreciation in controlling symptoms  Whisper with prayer your - provide home care and other community-based innermost desire care to help patient and family adjust to changes  Give the kindest act in your and come to terms with these changes attitude - requires biographical adjustment and alterations  Assure the person of your in everyday life activities with each major goodness downward step  Pray a lot - assist patient and family to integrate new treatment and management strategies; encourage identification of end-of-life preferences and planning DYING PHASE - final days or weeks before death; characterized by gradual or rapid shutting down of body