Geriatric Nursing Midterm PDF

NCM 114 | geriatric nursing (midterm) |01 MOVEMENT ➔ provides important information on...

NCM 114 | geriatric nursing (midterm) |01 MOVEMENT ➔ provides important information on environment ➔ elicits information if used with other senses ➔ uses non-verbal gestures & facial expressions SPEECH MODULE 5: COMMUNICATION ➔ primary form of communication ➔ requires both visual & auditory input, motor output, & central processing COMMUNICATION ➔ involves articulation & pronunciation ➔ It is an important skill that allows us to survive in DISABILITY and interact with our world. It is one way wherein we express our needs and wishes, understand needs ➔ plays a major role in affecting communication and wishes of others, negotiate adversity, and convey our feelings. The ability to communicate depends on physiological and psychological processes. MODULE 6: NORMAL & PATHOLOGICAL AGE-RELATED CHANGES THAT AFFECT COMMUNICATION PHYSICAL Listening The number of individuals with sensory deficits Speaking increases with age as age-related changes takes place. Gesturing The following are age-related changes that occur to the Reading sensory faculties that could affect communication. Writing Touching VISION Moving THE LENS PSYCHOLOGICAL Changes in color (yellowed or amber, opaque) Attention Begins to change after age of 40 Memory Self-awareness Organization THE IRIS & PUPIL Reasoning Slower pupillary reflex at age 50 SENSORY MODALITIES INVOLVED IN Pupil does not dilate completely (senile miosis) COMMUNICATION At age 60, 70% less accommodation of light TYPICAL VISION PROBLEMS VISION Poor visual acuity ➔ 70% of all information coming through the eyes Presbyopia ➔ visual information makes interaction sensible & add Sensitivity to light & glare meaning to verbal messages Senile miosis Problems with color contrast HEARING BEHAVIORAL CUES TO VISUAL DEFECTS ➔ major source of communication is the content of auditory information Adjustment of distance ➔ reception of communication Squinting or focusing ➔ The non-verbal auditory information includes the Difficulties in ADL's pitch (tone) and timber (quality) COMMON VISUAL DISEASES TOUCH As an individual ages, chronic diseases may also contribute to ➔ substitute for sight changing visual acuity of a person. ➔ conveys meaning for anger or love ➔ may communicate danger MACULAR DEGENERATION a condition that affects the macula of the eye as the person age. OLFACTION & GUSTATION TWO TYPES 1. Dry Macular Degeneration ➔ Sense of smell may trigger feelings or memories 2. Wet Macular Degeneration ➔ Sense of taste may convey meanings Diabetic Retinopathy 1  Glaucoma VERBAL APRAXIA Senile Cataracts A neurological disorder caused by damage to the Retinal Detachment parietal lobe which results in difficulties executing mouth & speech movements HEARING (HEARING LOSS) Person has intention & capacity to move muscles for speech, but have no volitional control over the muscles TYPES OF HEARING LOSS APHASIA Conductive Problems (outer to inner) Most common speech disorder usually following after Reduction of sound transmission stroke (left hemisphere) Sensorineural Problems (inner to cortex) Inability to express or understand the meaning of Caused by genetics & acquired factors words Mixed Hearing Loss Mixture of sensorineural & conductive 2 Types of Aphasia: 1. Receptive (fluent) aphasia ➔ inability to comprehend spoken or written PATHOLOGICAL CHANGES TO HEARING language but intact expressive ability ➔ due to damage in the Wernicke's area (meaning) Persistent exposure to noise pollution ★ Damage due to environmental noise or pressure 2. Expressive (non-fluent) aphasia changes ➔ inability to produce language but intact language ★ Can be temporary or permanent comprehension ★ Can result to tinnitus ➔ due to damage in the Broca's area (speech production) EXPOSURE TO OTOTOXIC SUBSTANCES COMMUNICATION TIPS Medications Poisons Low distractions Position yourself in close proximity MEDICAL CONDITIONS Use multiple forms of communications Acute trauma Use short uncomplicated sentences Cardiovascular diseases (smoking) Chronic viral or bacterial infection TOUCH/SOMATOSENSORY SYSTEM Measles, mumps, or meningitis The skin responds to external stimuli Interpreted as softness, pain, or heat INDICATIONS OF HEARING LOSS Reduction in tactile and vibration sensation; Inattentiveness/inappropriate responses decreased sensitivity to warm or cold stimuli Repetitions Sensitivity is reduced more in the fingertips than in Complains of "mumbling" other location Increased reaction to loud sounds Somatosensory information plays an important role in Increased or unusually loud speech ensuring safety Tilting/cocking of head Volume up IMPACT OF SOMATOSENSORY DEFICITS ON COMMUNICATION COMMUNICATION TIPS Imposes danger due to loss of sensation Do not shout May use other senses to identify characteristics & Use touch or visual cues quality of objects Use gestures or objects Can cause other forms of disorders Limit background noise COMMUNICATION TIPS SPEECH AND LANGUAGE Use verbal explanations to describe physical activities NORMAL AGING CHANGES Encourage older adults to revert to other activities that Decreased respirations capitalize on their current strength and abilities Change in laryngeal structure Reduced saliva MOVEMENT Loss of teeth Decreased elasticity & muscle tone An important ability that fosters independence and Cognitive changes promotes interaction & understanding of the environment It is a function of many variables: PATHOLOGICAL CHANGES ★ Posture ★ Balance DYSARTHRIA ★ Flexibility Disturbed articulation due to disturbance in control of ★ Tone speech muscle ★ Strength May be related to stroke, brain tumors, degenerative ★ Sensory integration & metabolic diseases, or toxins ★ Reflexes May lead to anarthria (severe form) ★ Motor planning 2  MODULE 7 - PHYSIOLOGICAL CHANGES IN COMMUNICATION MOVEMENT DISORDER IN OLDER ADULTS (COGNITIVE CHANGES) PARKINSON’S DISEASE A chronic neurodegenerative condition characterized TWO TYPES OF INTELLIGENCE by impairment of the nerves that control movement 1. Fluid Intelligence Major symptoms include: Acquisition of new information ★ Tremors ★ Rigidity & stiffness 2. Crystallized Intelligence ★ Slowness of movement Accumulation of knowledge over life span ★ Postural instabilit ★ Impaired balance & coordination FLUID INTELLIGENCE VS. CRYSTALLIZED INTELLIGENCE Other symptoms may include: ★ Memory problems ★ Depression FLUID INTELLIGENCE ★ Hallucinations ★ Mild vision loss Decline over time Information processing speed Divided attention HOW PARKINSON'S DISEASE AFFECT Sustained attention COMMUNICATION Visuospatial tasks Abstraction Speech may become slurred, soft, hoarse, or have an Mental flexibility inappropriate rhythm Rapid naming ability Writing may become smaller, shaky, and difficult to Long term memory read Facial expression may be lost CRYSTALLIZED INTELLIGENCE DISABILITY Remain stable Verbal comprehension A decrease in the performance of ADLs and IADLs Verbal expression independently can have a negative impact on the older adult's Vocabulary quality of life. Wisdom Expertise ACTIVITIES OF DAILY LIVING/INSTRUMENTAL ACTIVITIES OF DAILY LIVING PATHOLOGICAL COGNITIVE CHANGES ADLs are basic tasks one perform to survive Impairment in ADLs are more severe DELIRIUM ADLs & IADLs are used to assess functioning Common in hospital settings IADLs are more complex tasks Prevalent in the terminally ill Impairment is most common among elderlies Definition (according to DSM-MHD) ★ Disturbance of consciousness with reduced RISK FACTORS FOR IMPAIRMENT OF ADLS AND ability to focus, sustain, shift attention IADLS ★ A change in cognition or development of perceptual disturbance that is not better Age accounted for by a preexisting, established or Gender-female evolving dementia Chronic diseases ★ Disturbance develops over a short period of Cognitive impairment time and tends to fluctuate over the course of Lack of exercise the day Subjective health problems There is evidence from history, physical examination Low socioeconomic status or laboratory findings that the disturbance is caused by several different possible events It could easily be misinterpreted as any number of MEASURING ADLS/IADLS disorders including psychotic disorders, dementia and Presence or absence of medical diagnosis mood disorders with psychotic features Self-report Good to excellent recovery if correctly identified but Direct observation unlikely in the geriatric population It is associated with increased risk of developing medical complications and functional decline COMPENSATING FOR ADL/IADL IMPAIRMENT Can be life threatening leading to coma, seizures and eventual death Assistive devices Clients with delirium often experiences hallucinations Easy to wear clothing Tends to be disoriented and confused Handrails Communications is often fraught with Ready to cook meals misinterpretation and inappropriate responses 3 GUIDELINES FOR COMMUNICATION IMPACT OF DEMENTIA ON COMMUNICATION Keep discussions simple and questions concise Use Early stages large-print calendars and clocks to assist with Frustrations, embarrassment, & can be upset about orientation to time inability to communicate Pictures of family members and loved ones Reduction in social contact & reduced feelings of Well-lit place self-worth Frequent reassurance No restraints Moderate to severe Distraction and soothing conversation Agitation Easy irritability DEMENTIA COMMUNICATION TIPS A progressive illness that impairs social and occupational functioning Be calm, reassuring & confident Get the person's attention before starting a Criteria for Dementia: conversation Orient the person to yourself and the ★ Cannot recall new or previously learned person's name information Reduce or eliminate background noise ★ Memory problems must be present Provide clear and simple instructions for tasks ★ With one or more of the following: Frequently remind the person of the task he is doing ➔ Apraxia (impaired movement) Use concrete or familiar words ➔ Aphasia (inability to comprehend) Encourage discussion of significant life events ➔ Agnosia (inability to interpret) Establish familiar environment ➔ Disturbed executive functioning PSYCHOLOGICAL CHANGES IN COMMUNICATION - TYPES MENTAL ILLNESS Irreversible Dementia ➔ Inability to cure or reverse the symptoms with medical or psychological treatment DEPRESSION Reversible Dementia (Pseudodementias) A very serious condition associated with increased ➔ Potential for reversibility depending on risk of death, a greater number of medical conditions, etiology and treatment availability higher healthcare costs, & longer hospital stays Risk of suicide is common/highest among older ALZHEIMER'S DISEASE Caucasian men May also affect family members & caregivers of The most common type of Dementia in older adults depressed elders 60 years & up (50%-60%) This is one disease that has no definite diagnosis until after autopsy; disease of "rule out SYMPTOMS OF DEPRESSION Progression of dementia in 3 stages Sadness Anhedonia 3 STAGES OF DEMENTIA TYPE ALZHEIMER'S Significant weight loss or gain Increased or decreased sleep Stage 1 (2-4 years leading up to and including diagnosis) Psychomotor agitation or retardation Progressive memory loss & confusion Fatigue or loss of interest Mood & personality changes Feelings of worthlessness or guilt Loss of spontaneity & initiative Impaired ability to concentrate or think Decreased concentration abilities Recurrent thoughts of death or suicide ideation or Impaired judgment & thinking attempts Stage 2 (2-8 years) Increasing memory loss & confusion UNIQUE CHARACTERISTICS IN ELDERLY Poor impulse control with frequent outbursts May display aggressive behavior Multiple medical conditions Hallucinations or delusions Life transitions & change in status and role Aphasia & confabulations beg Loss of family members & friends Agraphia & agnosia Wandering & restlessness WHAT CAUSES DEPRESSION IN OLDER ADULTS? Hyperorality Chemical changes in the brain & chemical imbalance Stage 3 (1-3 years) Experiences of helplessness Loss of weight or binge eating Negative views of oneself, the world and others Loss of self-care skills Exposure to severe and prolonged stress Incontinence Or maybe...some combination of all these Progressive decrease in ability to respond to explanations environmental stimuli Multiple physical health problems & eventual death TREATMENT OF DEPRESSION Medications Anti-depressants Talk therapy Psychiatrists or Psychologists 4  Electroconvulsive therapy STRUCTURAL MODEL OF COMMUNICATION Electrical shock IMPACT ON COMMUNICATION Loss of inclination to interact (withdrawn) Social isolation NURSE'S ROLE Self-awareness Encourage the elder to engage in minor activities Be respectful & understanding ANATOMY AND PHYSIOLOGY OF COMMUNICATION Offer your availability for communication Use memory aids MODULE 8-THERAPEUTIC COMMUNICATION WITH OLDER ADULTS Communication of ideas, facts, feelings, and information is very vital for facilitating human interactions The Cortex "If the interaction facilitates growth, development, ➔ Primary repository of cognition maturity, improved functioning, or improved coping it ➔ Language production - ability to speak is considered therapeutic." The Speech Center-cortical center DEFINITION OF COMMUNICATION ➔ Language development ➔ Speech production Imparting, conveying or exchange of ideas, knowledge, meanings, etc. among individuals through APHASIA- an acquired loss or impairment of language the medium of a sign of some kind Broca's aphasia "A process by which two or more people exchange ➔ characterized by non-fluent speech; speech ideas, facts, feelings, 'common understanding of perception is not affected, and language meaning, intent, and use of a message' (Paul comprehension is normal Leagens) Wernicke's aphasia ➔ deficits in the comprehension of language, speech is fluent, but it may appear to not make ELEMENTS OF COMMUNICATION sense to listeners Consists of 6 small messages: What do you mean to say? What do you actually say? Please click on the link to see and hear how people with What the other person hears? aphasia communicate. What the other person thinks that he hears? What the other person says? Wernicke's Aphasia- https://youtube/3oef6@YabDo What you think the other person says? Broca's Aphasia- https://youtu.be/JWC-CVQmEmY OBJECTIVES KINDS OF COMMUNICATION Awareness of information Verbal Communication Action information communication that involves speech and language Continuing information Non-verbal Communication Updating information behaviors or gestures that conveys a message without the use of verbal language PURPOSES VERBAL COMMUNICATION It has to be expressed in terms of human behavior. All words a person speaks It should be specific enough able to relate it to actual communication behavior. It should be consistent with Communicates the ways s in which people do communicate ➔ Beliefs and values ➔ Perceptions and meaning COMMUNICATION PROCESS Can convey THREE ELEMENTS OF COMMUNICATION PROCESS ➔ Interest and understanding ➔ Insult and judgment Perception-activation of receiver's sensory end ➔ Clear or conflicting messages organs ➔ Honest or distorted feelings Evaluation-results to cognitive (informational part) & effective (relationship aspect) responses Transmission- feedback NON-VERBAL COMMUNICATION Can be either of two (2) forms 5  Vocal nonverbal communication. This refers to: Assess literacy & comprehension ➔ Tone of voice Use appropriate language ➔ Pitch Show respect by addressing client with surname ➔ Speech rate Avoid "terms of endearment" ➔ Fluency of verbal communication ➔ Emphasis of certain words "Mistakes occur when we make assumptions and fail to validate understanding." "What we say and HOW we say it is essential for therapeutic communication." Maximize Understanding - learning to listen is essential to good communication; listening differs Non-vocal nonverbal communication. This refers to from hearing the use of: ➔ Physical appearance ★ Strategies: ➔ Facial expressions Understand meaning and context in which ➔ Body posture they are spoken ➔ Amount of eye contact Be open-minded & provide opportunities to ➔ Hand gestures/Touch share thoughts Allow time to communicate and focus "Non-verbal communication speaks louder than words. attention to conversation COMMUNICATION IN HEALTH CARE "Minimizing distractions not only helps the individual to whom we are communicating, but also helps us maintain focus." TYPES OF COMMUNICATION IN HEALTH CARE (PATIENT PERSPECTIVE) Follow Through - words backed by actions develop trust Instrumental or task-focused communication ➔ Behavior necessary for assessing & solving ★ Strategies: problems Intend to do what has been said (follow up) ➔ Formal & structured (i.e. admission interviews, Build relationship based on trust and concern health assessment, discussion of advanced directives, or patient-family education) "Trust & concern is critical to optimal health outcomes." ➔ May include informal conversations CHALLENGES IN COMMUNICATING WITH OLDER Affective communication ➔ Focuses on how the health care provider is ADULTS caring about the patient and their feelings Memory or Cognitive Deficits Speech Deficits or Impairment (Aphasia) BASIC PRINCIPLES IN MAKING PATIENT CONTACT Speech Impairments (Dysarthria) Visual Impairments According to Satir (1976), there are 5 principles in Hearing Impairments/Deaf "making contact" in communicating with patients: Invite - this would say to the other person that you are interested in them & sharing time with them TECHNIQUES IN COMMUNICATING WITH OLDER ADULTS ★ Strategies: ➔ Arrange time for a conversation rather than Identify yourself. an assessment Be aware of how you present yourself. ➔ Greet the elderly by name Look directly at patient. Speak slowly and distinctly. ➔ Ask non-threatening open-ended questions Explain what you are going to do before you do it. Listen to the answer the patient gives you. Show the patient respect. REMEMBER: START A CONVERSATION AND NOT Do not talk about the patient in front of him or her AN INTERROGATION. Be patient! Older patients: ★ Often do not feel much pain Arrange Environment ★ May not be fully aware of important changes in ➔ prepare a communication-conducive their body system environment ★ You must be especially vigilant for objective changes. ★ Strategies: When possible, give patients time to pack a few Provide comfort personal items before leaving for hospital. Provide privacy Minimize distractions ★ Can be done in a nurse's or patient's space Face to face; 3-6 feet apart Ask permission to move or touch anything (if in patient's space) Consider disability of the elderly Maximize Communication use appropriate language to deliver health literacy ★ Strategies: 6