Gerontology Term Test 6-11 PDF

Gerontology Term Test 6-11 Nonfatal Chronic Illness: Conditions such as osteoarthritis or hearing or vision problems Serious, eventually fatal chronic conditions: Cancers, Organ system failures, dementia, strokes Chronic illness is not cured, it can be managed so that an individual can have quality of life, and can aﬀect any body system & can start with one particular system & then move to another system. Risk factors for Chronic illness is poor diet, inactivity, and smoking *Modifiable Chronic illness & aging implications: Can involve multiple diseases, long term implications (quality of life), Unpredictable patterns, Aﬀect self-concept, often results in chronic residual disability, treatments can lead to iatrogenic complications Iatrogenesis: A complication or by-product of a health care intervention or the environment itself (ex. Loss of mobility because insuﬃcient ambulation, functional incontinuance, adverse eﬀects of meds Frailty Syndrome: A term referring to older adults having multiple comorbidities/chronic illnesses, A condition including both mental and physical decline, Associated with sarcopenia (muscle wasting), atherosclerosis, cognitive impairment & malnutrition S/S: Weight loss, fatigue, weakness, unsteady gait, and decrease in activity Coping with chronic illness: factors to consider -Gender, Sexuality, Fatigue/pain, Multiple losses, Accessing continuing care, relocation, Latrogenic complications, Self-care(self-management programs), Availability & use of assistive devices, support (family, spouse, and friends) Common Chronic Illnesses are high blood pressure (B/P), Periodontitis*, Arthritis, Glaucoma, Heart disease, Diabetes Arthritis: the term used to refer to more than 100 diseases that aﬀect 6 million Canadians, #1 reason for activity limitations in older adults, Most common: Osteoarthritis, Polymyalgia, rheumatica, rheumatoid arthritis & gout (in descending order) Osteoarthritis (OA) -Degenerative joint disease. -aﬀects 1 in 7 Canadians -Risk factors: age, obesity, family history, repetive use, trauma -Joint cartridge becomes thin and damaged, joint spaces narrows S/S: Stiﬀness (relieved by activity), Pain (related to activity) relieved by rest, as disease progresses, pain increases, even at rest. -It can have joint instability/crepitus Most common in knees, hips, neck, lower back, fingers and thumbs Polymyalgia Rheumatica (PMR) -Common form of arthritis in older adults -Acute onset of pain in neck and upper arms & may spread to the pelvis & pectoral girdle. Pain and stiﬀness comes from muscles in the neck, shoulders, lower back, buttocks and thighs. -Assoc, with inflammation of blood vessels -More common in woman, seems to be genetic S/S: low grade fever, fatigue & pain and stiﬀness at night/early a.m. treatment (Rx): small doses of corticosteroids (prednisone) it can resolve in one or two years. Rheumatoid Arthritis (RA) -Chronic systemic inflammatory joint disorder. - Autoimmune disease -inflamed joints begin to destroy lining of joint (synovial lining), joint destruction. Can be debilitating S/S: Pain & swelling in multiple joints, hands, wrists, ankles, knees and hips, usually smaller joints, symmetrical, morning stiﬀness>30 mins, experience with disease is variable Rx: Anti-inflammatory drugs (ex. Indocid, Ibprophen) -DMARDS (disease modifying anti-rheumatic drugs) including biological -Corticosteriods (prednisone) -Joint replacements (OA & RA) Rx: Non-pharmacological/nontraditional: -Heat & cold applications. - Ultrasound. -Music therapy -Acupuncture. -Massage. -Glucosamine supplement Gout -Common form resulting from an accumulation of uric acid crystals in the joint -Acute attack, very painful. -Joint is bright purple red, painful to touch. -most common location-proximal joint of great toe Risk factors: -Diet in high purines: Asparagus, steak, organ meats, Seafood(scallops), brain, Sweet bread, gravy, alcohol(beer) -High B/P -Meds that can increase risk of gout (ex.Thiazide diuretics, aspirin Rx: Allopurinal, increase fluids, decrease alcohol Arthritis Nursing Implications -Educate -Appropriate use of the heat and cold -ROM(Range of Motion exercises ) -Conserving energy -Recommended self-management programs -Arthritis Society(community resource) -Be knowledgeable - alternative therapies Hypertension(HTN) -Hypertension (High Blood Pressure) *Systolic > 140 & Diastolic > 90 (on 2 separate occasions) -Classification: *Normal: Systolic < 120; diastolic > 90 *Prehypertension: S 120-139; D 80-89 *Stage 1 HTN: S 140-159; D 90-99 Stage 2 HTN: S > 160; D > 100 -Often onset is asymptomatic - Organ damage is likely(if not treated) -“White coat syndrome” - Postural Hypotension(Orthostatic) often as adverse eﬀect of medications Risk Factors of Hypertension -Cigarette smoking - Excessive alcohol intake -Sedentary lifestyle -Inadequate stress management, anger management, or both -Unhealthy diet(High in sodium, trans fat or both; low in fibre) Chronic Illness: Coronary Heart Disease [CHD] -CHD: Result of untreated hypertension, narrowing of the arteries(arteriosclerosis), may lead to a blockage & Myocardial infarction(MI) or heart attack -Diabetes-significant risk factor -S/S of a MI/Heart attack: Older adults often do not have the typical ‘gripping chest pain’, More likely to have a ‘silent MI’ (myocardial infarction), presenting as discomfort localized to the back, abdomen, shoulders & or one or both arms, Nausea & vomiting (N & V) or heart burn may also be symptoms, Older woman may have S/S of weakness & lethargy Heart Failure(HF): -Also called congestive heart failure(CHF), Damage to the heart caused by CHD/MI, Other causes; hypertension excessive us of drugs & alcohol diabetes obesity infection high cholesterol & other medical conditions, Most frequent cause of hospitalization of older adults, Heart can no longer pump enough blood eﬃciency to meet the needs of body -S/S of heart failure: Shortness of breath(SOB), dyspnea with exertion or at rest, Orthopnea (can’t lie flat) *Elevated bed to help, Fatigue, Swelling in lower extremities, weight gain Diabetes Type 1 & 2 -11 million Canadians have diabetes/pre diabetes, NIDDM(Type 2) diagnosed in later life, Pancreas make insulin not enough for the body needs, insulin resistance, many go undiagnosed/serious complications develop, death likely due to MI(heart attack) or stroke -S/S: Polydipsia(thirsty), Polyuria( voiding frequently), polyphasic(hungry) and weight loss *Classic s/s of diabetes not often Seen in older adults -Older adults presentation: fatigue,Change in weight, recurrent Infections Diabetes-Complications -foot problems which impact functional status, heart disease(3x more likely to die with heart disease), heart failure, chronic kidney disease, stroke, lower limb amputations, vision impairment -Management of diabetes: Important to learn self-care skills, Understand treatment:Hypoglycemic medications(lower blood sugar), or insulin(injection) to balance blood glucose (BG) levels, need to understand drug interactions, foot assessment, prevention of infections, diet IMPORTANT *Caution: hypoglycemic medications may lower Bg klevels too low & cause hypoglycemia *s/s: The person feels clammy or cold, sweaty, shaky & confused, may precipitate a medical emergency if not treated immediately *Nursing action: Provide client with orange/apple juice(check agency policy). May need intravenous glucose Challenges; diabetes management -Cognitive ability to manage level of support, aﬀordability(ex. Costs of medications, transportation to health clinics), visual deficits *Goal: manage blood glucose levels to prevent serious complications Cerebral Vascular accident (CVA) stroke -Risk increases with uncontrolled high B/P & diabetes, residual eﬀects: balance, spatial awareness, sensation, range of motion control, risk for depression increases when recovery not favourable, safety issues mobility impairment, rehabilitation important to optimize level of function Chronic Obstructive Pulmonary disease (COPD) -Involves all conditions that aﬀect airflow(ex. Asthma, bronchitis, emphysema), caused by tobacco use & exposure to pollutants (COPD) s/s: varies depending on type of illness, Sputum production(colour significant), pale or blueish colour, dyspnea, low oxygen levels -OXYGEN: COPD: 85-90% Healthy: 95-100% -Treatment and nursing considerations: Smoking cessation, Nutritious diet, exercise as tolerated, educated re signs of lung infection *Medications/RX: bronchodilators, corticosteroids, antibiotics(infection), oxygen therapy *Energy conservation is important Cancer -Cancer & Aging: Older adults have increased risk(advancing age is a risk factor), when treatment options are explored should consider overall health & function NOT just age, treating cancer in older adults is complex because of multiple co-existing or co-morbid conditions (Cancer in older people are often undertreated, it is also important to have shared decision making between the client & healthcare providers to ensure that the best decision around all treatment is arrived at for the individual) -Prevention: Not smoking, watch sun exposure and burning, healthy diet, healthy weight, keeping active, no ore than 1 drink of alcohol per day, ensure work environment safety -Older adults with cancer concerns: Maintaining independence, feelings of social isolation, spiritual concerns, financial concerns, physical limitations, transportation, screening is important Theoretical Frameworks: Chronic illness Chronic illness trajectory [CIT] -preventive phase(pre-trajectory)-everyone’s here -Definitive phase(trajectory onset)-diagnose(big curve) -Crisis phase -Acute phase- when you start feeling crapy -Stable phase-starting to manage -unstable phase-more sick -downward phase-download stage -Dying phase-nothing more they can do Chronic illness Trajectory(CIT) Goals for clients -After a persons condition stabilizes,the nurse can help the patient by encouraging adherence to the right treatment regimen so that the person may reach the highest level of function within the limits of his disability (ex. Adhering to a diabetic diet, or an exercise program) *CIT: is the course or pathway of a chronic illness *Goals of management of bionic illness: Multi-dimensional, ranging from symptom relief & comfort, to psychological adaptations & stress reduction, and the prevention of complications *Nurses roles: Assessing;teaching, encouraging/supporting;conceling, assisting to access to resources Medication use Facts: Older adult & medications -Largest consumers of prescription & over the counter(OTC) medications -Challenges: Polypharmacy, expense, adherence, absorption & elimination -Many old person use complementary alternatives medicine(CAM) *Drug use (includes OTC, prescribed medications, CAM) depends on/influenced by beliefs (perception of the need for meds) understanding about illness, functional & cognitive status, severity of illness s/s Trends/Issues: Medication Use -Older clients are becoming more aware/knowledgable of new meds(advertised on TV & elsewhere), Challenges with coordinating care between specialists, Pharmacists taking active role in educating clients, Medication costs often exceed income of older adults Pharmacokinetics The movement of a drug into the body from the point of drug administration, considering absorption, distribution, metabolism & excretion -Absorption: The route is important(ex.oral(PO) vs intravenous(IV)), Age related changes in stomach related to pH & motility which aﬀects absorption, Younger person might get PO because they can handle it, older person will get IV -Distribution: The drug is transported to target organ to exert eﬀect, the action of the drug depends on the availability of plasma protein(albumin) percentage of drug that binds to the protein and the amount of free drug circulating Pharmacokinetics -Distribution(cont’d): Many older adults have an increase in body fat decrease in lean body mass & total body water, dehydration & decrease in serum albumin can increase serum levels of medications *These changes may extend & possibly elevate the med eﬀect -Metabolism: The liver is involved with changing the composition(chemical structure) of the drug so it can be excreted from the body, decreased liver mass & reduced circulation to the liver with aging impacts their ability to metabolize drug *In older adults, because metabolism of drugs is slower, they are at increase risk for Adverse Drug Eﬀects(ADR) - side eﬀect -Excretion: kidneys are the major organs involved with excretion of drug by-products,Also excreted via sweat & saliva other body fluids(ex. Somebody on dialysis their kidneys doesn’t work), Due to age related changes(recall glomerular flirtation rate decreases, kidney shrinks) it takes longer for drugs to be excreted *Therefore, older adults are more at risk for adverse eﬀects & potential toxicity Pharmacodynamics -The interaction between a medication and the body, with age there is an altered & or unreliable response to medications, sensitivity to many drugs(ex.benzodiazepines [Ativan, Valium] anti- cholinergic meds & others) Polypharmacy -The use of multiple medications use of meds that are contraindicated or potentially inappropriate, common issue with older adults, contributes to morbidity & mortality, can be accidental by the older person(one person gets medication but they all take it) *Two concerns: Risk for drug interactions, Risk for adverse drug events Adverse drug reactions (ADR) in older adults -Often due to inappropriate use of certain drugs, may occur when starting doses are too high, insuﬃcient monitoring of blood levels(people that take seizures), Fluid intake, less body water, drug can induce delirium in older adults(ex.antipsychotics, anti-cholinergic), Common ADRs include lethargy & confusion *More at risk because of age-related changes Adverse Drug Reactions -50% of prescription drugs react with alcohol(Alcohol is a sedative some medications are too) -Common medication: acetaminophen (Tylenol) taken regularly can lead to liver failure in the older person(Ibprofen is very hard on stomach) Toxicity -Can occur when concentration of drug in the blood circulation exceeds the level needed for therapeutic eﬀect, toxic responses are most life treating of ADRS Safe medication administration Medications prescribed to older adults should ‘start low and go slow’ to determine therapeutic level or intended response (you don’t know how much it’s going to aﬀect a person) Issues/patterns of drug use in order persons -Polypharmacy(sharing meds) -Self-prescribing(ex.taking left-over meds; sharing meds, use of OTC drugs -Using herbal/natural remedies -Non-adherence(Ex. Not finishing prescription; not following instructions, memory loss, not understanding how to take meds, due to literacy level Medication Assessment -First step is comprehensive medication assessment determine if meds are taken safely & eﬀectively -Ask client what the med is taken for & when it is taken? What is their understanding? -Assess their comprehension, mental status & ability to function(risk for ADR) Safe Medication Practices Assess -Sensory function? -Eﬀectiveness of medication -The need for ongoing teaching & follow-up? -Who is responsible for administering meds? -Are the rights of meds. Administration being followed? TPR—Triple D’s -T: Right time -P: Right patient -R: Right route, reason -D: Right Drug -D: right Dose -D: Right Documentation *Right to refuse* (If they don’t wanna talk their meds you can’t force them) Barriers how much assistance does the client need: -Can the client open the med. cap, & break a med in half(if indicated)? -Does the client have diﬃculty in swallowing(Dysphagia)? If so they may need liquid form -Are reminders to take medications needed? Goals -To manage a schedule for taking meds -To understand instructions(Small font) -To be able to read labels(can the patient read) -To be able to open & dispense medication(child proof bottle) -To report anything unusual ex. Bruising(Abnorms, gas, constipation) -To have an ongoing rapport with care-provider Interventions: To promote Adherence -Memory aids to prompt(Posted-notes) -Calendars/visual reminders -pill containers labeled with times and days of week -Blister-pack dispensing -Easy to open containers -Journal/log when meds taken -Regular check-in Pain: Defined -A sensation of distress, A multidimensional phenomenon as it occurs at a physical psychological & spiritual level Pain & older adults Pain -Considered one of the most common feelings/systems experienced by older adults, opposite of ‘comfort’, Without achieving a level of comfort, wellness is diﬃcult to achieve, most feared feeling Pain -Known as the 5th vital sign, requires a comprehensive history and physical assessment *vital sign is a measure of not only body function but also a measure of how a person feels Unrelieved Pain - consequences -Physiological & psychological dimensions may be aﬀected, can lead to activity & immobility, may lead to experimentation with multiple self directed and ineﬀective interventions, may result in reduced socialization/isolation, can lead to depression/examining meaning in one’s life Acute Pain -Temporary pain includes pain that is experienced post-op, during a procedure, due to trauma(accident), or an exacerbation of a chronic illness. Acute illness psychological & spiritual pain (ex. Early stages of grieving or in depression) Chronic pain -As health problems ageing risk for chronic pain, Not time limited and its ongoing, may vary in intensity & change with activity, can be physical psychological & spiritual, can significantly aﬀect a persons ability to function & quality of life *Know the diﬀerence* Acute Pain: Sudden, short time Chronic Pain: On going pain, the older you get the more chance you’d get chronic pain(ex. Back pain) Myths about aging -Pain is expected with aging -Pain sensitivity & perception decreases with aging -If older adults do not complain of pain, they are not in pain -People with dementia or cognitive impairment do not feel pain Narcotic use in older adults is not appropriate/dangerous Facts about pain: Older adult -Pain is not a normal part of aging, although occurrence with age, Narcotic Analgesics are safe to use OLDER ADULTS: -May have tolerance to pain, often under report pain, have a variety of reactions to pain How is pain expressed in older adults -Influenced by history, culture & meaning it has for the individual -Not uncommon to express psychological & spiritual pain as somatic complaints -Diﬃcult to assess pain in a person with dementia, aphasia, hearing loss, depression Cognitively impaired older adults -Often have diﬃculty expressing pain, often have diﬃculty in responding to questions asked in a health assessment, often diﬃcult for a care provider to discern between vocalizations that are characteristic of dementia vs. Vocalizations that are characteristics of pain cues in older adults -Careful observation of behaviour & caregiver reports need to be considered if a person cannot reliably communicate pain Other factors influencing assessment of pain -Individuals personality/variation of expressions -Nurses own bias & beliefs about pain & how it should be treated(can aﬀect assessment & treatment) Implications for gerontological nursing -Function: how is it aﬀecting function, Activities of daily living? -Expression of pain: behaviour cues, non-verbal? -Social support: resources available to help cope? Aﬀecting roles & relationships? -Pain history: How has it been managed in the past? Cultural factors that may impact meaning, accepting Rx, expression Pain inventory tools -Comprehensive health assessment Pain Control Strategies Analgesics(pain medication) Non-Narcotic Meds: Mild-moderate pain -Acetaminophen, Tylenol (first line) -Anti-inflammatory drug: Ibprofen(Advil), Indocid, Adverse eﬀects: GI irration, potential GI bleed, assess risk -Narcotic Analgesics: Acute & persist pain(moderate to severe), ex. Morphine *Opioids used cautiously in older adults: Adverse eﬀects; Gait disturbances, dizziness, hypotension, sedation, falls, nausea, pruritis & constipation Non-pharmacological Non-pharm measure to manage pain include: -Physical therapy -Biofeedback -Distraction -Imagery -hypnosis -massage -Acupuncture -Heat vs cold packs Pain Management A combination of both pharmacological & nonpharmacological measures is the most eﬀective for relieving pain -Goal of pain management: promotes comfort and maintain the greatest level of function Considerations/pharmacological VS non-pharmacological interventions -Pharmacological Interventions: Older adults are more at risk for adverse drug eﬀect -Non-pharmacological Interventions: Requires time and interaction with a care-provider, must become a routine rather than a ‘one-time’ intervention, could be costly *often requires that the person is cognitively intact* Pain management: Other considerations -The client is the best judge of pain, medication administration should be based on ongoing assessments, no individual should be left with unmanaged pain -Encourage ‘Pain’ management workshops/programs for chronic pain management -Assess for adverse eﬀects of analgesics & anticipate drug interactions -Listen to client: Encourage expression of pain; may need to get ‘surrogate report’ (from family/ friends) -never minimize pain Additional barriers to pain management -Cost of medications, fear of addiction to analgesics, pain is viewed as a normal burden of ‘old age’ older adults are expected to ‘learn to life with it’ Evaluation -Hospitalized client/LTC: Observe for behaviours & after administration of pain medication, document. Ask client direct questions about pain relief? Explore all comfort measures -Recommendations for community client: Keep a journal & record: What causes the pain? How he/she felt after taking pain medication? What makes it worse or better? Any adverse eﬀects? What else helps to relieve pain? Cognitive Function & Aging -With age the number of neutrons & brain size, dendrites shrink which impairs synapses & eﬀects transmission of neurotransmitters, mental function & cognitive abilities remain intact & older adults are able to continue to carry out regular everyday activities. Disturbances in cognitive impairment(CI) three D’s of CI: Delirium, dementia, & depression -Risk increases with older adults -Diﬃcult to diﬀerentiate between the 3 D’s -Delirium usually has a rapid onset,Usually over hours or days -Dementia usually has a gradual Onset and slow steady patterns Of Diﬀerentiating the 3 D’s -Onset -Consciousness -Alertness -Psychomotor Activity -Duration(how long it last) -Attention -Orientation -Thinking -Perception -Aﬀect Delirium Often referred to in several forms: -“acute confusion state” -“Acute brain syndrome” -“Confusion” -“Reversible dementia” -“Metabolic encephalopathy” -“toxic psychosis” Distinguishing features of delirium: -Onset:sudden, abrupt onset -Course over 24 hr: fluctuates, may be worse at night -Attention: Disordered/Fluctuates -Consciousness: Disturbances -Psychomotor Activity: up or down -Duration: hours to weeks -Thinking: disorganized -Perception: Delusional, paranoid(disturbances sleep/wake cycle) Delirium: risk factors -Infection*Big one -Demographics-age and gender -Hospitalizations (change of environment) -Medication(& taking multiple meds) -Dehydration(Risk for infections like UTI) -Restraint’s(if they are confused and they are put in restraints its a risk) -Losses -Sensory impairment -pain -dementia -Co-morbidities *May aﬀect 50% of hospitalized older adults* Delirium confusion assessment method(CAM) -Through health assessment required including lab values -Imp, to determine cause Treatment & approach -Use calm, supportive approach -Minimize environmental stimuli -Benzodiazepines/psychotropic meds(For alcohol withdrawal) -Best management is non-pharmacological Best evidence suggests prevention of delirium: -Focuses on managing the 6 known risk factors for delirium(cognitive impairment, sleep deprivation, immobility, visual and hearing impairments & dehydration) Interventions for prevention: -keeping the units quiet at night(ex.using vibrating pagers) -placing volunteers/family with restless clients -Fall risk strategies -Try to encourage other sleep measures besides medications -Manage pain, encourage mobilization -correct hearing & vision deficits, if possible Dementia 5 types of dementia: -Alzheimer’s disease -Parkinson’s -Frontotemperal -Lewy bodies -Vascular Dementia The A’s (s/s) -Apraxia: inability to perform purposeful actions/movements (sensory & motor abilities are intact) -Agnosia: Inability to recognize common objects & people, despite good vision or intact sensory abilities -Aphasia: Loss of the ability to express & understand spoken & written language *Loss of executive function(Planning & organizing life) Dementia -Person may use ‘nonsensical’ words (ex. They will rename an object using a word that has no associated meaning), the meaning of the language is lost (ex. Cannot detect humour or sarcasm) Types: 1) Degenerative: -Alzheimer’s [AD] (50%-70%)* -Parkinson’s Disease Dementia* -Lewy body dementia -Frontotemporal dementia 2) Vascular Cognitive Impairment (several syndromes) -Vascular dementia -Mixed dementia: neurodegenerative & vascular -A group of disorder arising from cerebrovascular insuﬃciency or damage (poor circulation to brain) *May result after a stroke (CVA), brain trauma, anoxia, and may be associated with disease like diabetes, cardiac disease, respiratory disease, alcohol abuse Alzheimer’s Disease -Most common type -increasing memory loss, inability to concentrate, personality deterioration & impaired judgement -Progresses slowly, course of disease 1-20 years with life expectancy of 8-9 years after symptom onset -The disease destroys nerve proteins in the cerebral cortex by the infiltration of neurofibrillary tangles & amyloid plaques -This causes cell death & the brain shrinks to 1/3 of its weight -impairment in the communication between neuron’s -can be prescribed medications that may decrease speed of decline Parkinson’s Disease A disease caused by a destruction of the cells in the substantial ingrained in the brain & loss of production of dopamine (neurotransmitter) -Most common neurodegenerative disease -1/2 people have depression felt to be mostly related to changes in the brain -In PD, Lewy bodies or deposits of protein in the brain cause dementia Classic symptoms: -Bradykinesia (slowness of movement) -Tremor at rest (shaking) -Cogwheel rigidity -Postural instability (very unsteady) -Other: shuﬄing gait (festination very short steps) Flat expression Treatment: taking meds that replace dopamine, relieving symptoms, function, preventing excess disability & risk of injury Nonpharmacological interventions: Exercise, relaxation, stress management, education, & self-care management *Note: Dopamine is a neurotransmitter that regulates movement in the body Study Guide Know what chronic illness is Chronic illness is not cured, it can be managed so that an individual can have quality of life, and can aﬀect any body system & can start with one particular system & then move to another system. Chronic illness are conditions that last a year or more and require ongoing medical attention and or limits activities of daily living Know what the diﬀerence between chronic and acute illness is Acute Pain: Sudden, short time Chronic Pain: On going pain, the older you get the more chance you’d get chronic pain(ex. Back pain) Know what Iatrogenesis is Iatrogenesis: A complication or by-product of a health care intervention or the environment itself (ex. Loss of mobility because insuﬃcient ambulation, functional incontinuance, adverse eﬀects of meds Know the definition to frailty syndrome Frailty Syndrome: A term referring to older adults having multiple comorbidities/chronic illnesses, A condition including both mental and physical decline, Associated with sarcopenia (muscle wasting), atherosclerosis, cognitive impairment & malnutrition S/S: Weight loss, fatigue, weakness, unsteady gait, and decrease in activity Know the factors to considered when it comes to chronic illness Know common chronic illness Know gout (s/s) Common form resulting from an accumulation of uric acid crystals in the joint -Acute attack, very painful. -Joint is bright purple red, painful to touch. -most common location-proximal joint of great toe Risk factors: -Diet in high purines: Asparagus, steak, organ meats, Seafood(scallops), brain, Sweet bread, gravy, alcohol(beer) -High B/P -Meds that can increase risk of gout (ex.Thiazide diuretics, aspirin) -Rx: Allopurinal, increase fluids, decrease alcohol Know CVA Risk increases with uncontrolled high B/P & diabetes, residual eﬀects: balance, spatial awareness, sensation, range of motion control, risk for depression increases when recovery not favourable, safety issues mobility impairment, rehabilitation important to optimize level of function Know FAST know what COPD is Involves all conditions that aﬀect airflow(ex. Asthma, bronchitis, emphysema), caused by tobacco use & exposure to pollutants s/s: varies depending on type of illness, Sputum production(colour significant), pale or blueish colour, dyspnea, low oxygen levels -OXYGEN: COPD: 85-90% Healthy: 95-100% -Treatment and nursing considerations: Smoking cessation, Nutritious diet, exercise as tolerated, educated re signs of lung infection *Medications/RX: bronchodilators, corticosteroids, antibiotics(infection), oxygen therapy *Energy conservation is important Know your rights of medication administration (TPR-TRIPLE D’s) -T: Right time -P: Right patient -R: Right route, reason -D: Right Drug -D: right Dose -D: Right Documentation *Right to refuse* (If they don’t wanna take their meds you can’t force them) Know the barriers/considerations are for medication administration how much assistance does the client need: -Can the client open the med. cap, & break a med in half(if indicated)? -Does the client have diﬃculty in swallowing(Dysphagia)? If so they may need liquid form -Are reminders to take medications needed? Know about the interventions to promote adherence Memory aids to prompt(Posted-notes) -Calendars/visual reminders -pill containers labeled with times and days of week -Blister-pack dispensing -Easy to open containers -Journal/log when meds taken -Regular check-in Know what pain is Pain: A sensation of distress, A multidimensional phenomenon as it occurs at a physical psychological & spiritual level Know that pain is the 5th vital sign Known as the 5th vital sign, requires a comprehensive history and physical assessment *vital sign is a measure of not only body function but also a measure of how a person feels Know consequences of pain Physiological & psychological dimensions may be aﬀected, can lead to activity & immobility, may lead to experimentation with multiple self directed and ineﬀective interventions, may result in reduced socialization/isolation, can lead to depression/examining meaning in one’s life Know acute and chronic pain (diﬀerences) Acute Pain: Temporary pain includes pain that is experienced post-op, during a procedure, due to trauma(accident), or an exacerbation of a chronic illness. Acute illness psychological & spiritual pain (ex. Early stages of grieving or in depression) Chronic illness: As health problems ageing risk for chronic pain, Not time limited and its ongoing, may vary in intensity & change with activity, can be physical psychological & spiritual, can significantly aﬀect a persons ability to function & quality of life Diﬀerence is: Acute Pain: Sudden, short time Chronic Pain: On going pain, the older you get the more chance you’d get chronic pain(ex. Back pain) Know some of the myths about aging and pain -Pain is expected with aging -Pain sensitivity & perception decreases with aging -If older adults do not complain of pain, they are not in pain -People with dementia or cognitive impairment do not feel pain -Narcotic use in older adults is not appropriate/dangerous Know CIT (may or may not be on the exam, just look anyways) After a persons condition stabilizes,the nurse can help the patient by encouraging adherence to the right treatment regimen so that the person may reach the highest level of function within the limits of his disability (ex. Adhering to a diabetic diet, or an exercise program) *CIT: is the course or pathway of a chronic illness *Goals of management of bionic illness: Multi-dimensional, ranging from symptom relief & comfort, to psychological adaptations & stress reduction, and the prevention of complications *Nurses roles: Assessing;teaching, encouraging/supporting;conceling, assisting to access to resources Chronic illness trajectory [CIT] -preventive phase(pre-trajectory)-everyone’s here -Definitive phase(trajectory onset)-diagnose(big curve) -Crisis phase -Acute phase- when you start feeling crapy -Stable phase-starting to manage -unstable phase-more sick -downward phase-download stage -Dying phase-nothing more they can do Know what pharmacokinetics is (absorption.. etc) The movement of a drug into the body from the point of drug administration, considering absorption, distribution, metabolism & excretion -Absorption: The route is important(ex.oral(PO) vs intravenous(IV)), Age related changes in stomach related to pH & motility which aﬀects absorption, Younger person might get PO because they can handle it, older person will get IV -Distribution: The drug is transported to target organ to exert eﬀect, the action of the drug depends on the availability of plasma protein(albumin) percentage of drug that binds to the protein and the amount of free drug circulating Know Pharmacodynamics The interaction between a medication and the body, with age there is an altered & or unreliable response to medications, sensitivity to many drugs(ex.benzodiazepines [Ativan, Valium] anti- cholinergic meds & others) Know what polypharmacy means and its concerns The use of multiple medications use of meds that are contraindicated or potentially inappropriate, common issue with older adults, contributes to morbidity & mortality, can be accidental by the older person(one person gets medication but they all take it) *Two concerns: Risk for drug interactions, Risk for adverse drug events Know what cancer is and the preventions of it Cancer & Aging: Older adults have increased risk(advancing age is a risk factor), when treatment options are explored should consider overall health & function NOT just age, treating cancer in older adults is complex because of multiple co-existing or co-morbid conditions (Cancer in older people are often undertreated, it is also important to have shared decision making between the client & healthcare providers to ensure that the best decision around all treatment is arrived at for the individual) -Prevention: Not smoking, watch sun exposure and burning, healthy diet, healthy weight, keeping active, no ore than 1 drink of alcohol per day, ensure work environment safety -Older adults with cancer concerns: Maintaining independence, feelings of social isolation, spiritual concerns, financial concerns, physical limitations, transportation, screening is important Know the facts about pain Pain is not a normal part of aging, although occurrence with age, Narcotic Analgesics are safe to use OLDER ADULTS: -May have tolerance to pain, often under report pain, have a variety of reactions to pain Know how pain aﬀects older adults Influenced by history, culture & meaning it has for the individual -Not uncommon to express psychological & spiritual pain as somatic complaints -Diﬃcult to assess pain in a person with dementia, aphasia, hearing loss, depression Know how to do a pain assessment (numeric rating system, visuals) Often have diﬃculty expressing pain, often have diﬃculty in responding to questions asked in a health assessment, often diﬃcult for a care provider to discern between vocalizations that are characteristic of dementia vs. Vocalizations that are characteristics of pain cues in older adults -Careful observation of behaviour & caregiver reports need to be considered if a person cannot reliably communicate pain Know what pain strategies are (non-narcotic, anti-inflammatory, etc..) Analgesics(pain medication) Non-Narcotic Meds: Mild-moderate pain -Acetaminophen, Tylenol (first line) -Anti-inflammatory drug: Ibprofen(Advil), Indocid, Adverse eﬀects: GI irration, potential GI bleed, assess risk -Narcotic Analgesics: Acute & persist pain(moderate to severe), ex. Morphine *Opioids used cautiously in older adults: Adverse eﬀects; Gait disturbances, dizziness, hypotension, sedation, falls, nausea, pruritis & constipation Know non-pharmacological measures for pain relief Non-pharm measure to manage pain include: -Physical therapy -Biofeedback -Distraction -Imagery -hypnosis -massage -Acupuncture -Heat vs cold packs Know diﬀerent ways to control pain management A combination of both pharmacological & nonpharmacological measures is the most eﬀective for relieving pain -Goal of pain management: promotes comfort and maintain the greatest level of function The client is the best judge of pain, medication administration should be based on ongoing assessments, no individual should be left with unmanaged pain -Encourage ‘Pain’ management workshops/programs for chronic pain management -Assess for adverse eﬀects of analgesics & anticipate drug interactions -Listen to client: Encourage expression of pain; may need to get ‘surrogate report’ (from family/ friends) -never minimize pain Know what hypertension is, and the classification table Hypertension (High Blood Pressure) *Systolic > 140 & Diastolic > 90 (on 2 separate occasions) -Classification: *Normal: Systolic < 120; diastolic > 90 *Prehypertension: S 120-139; D 80-89 *Stage 1 HTN: S 140-159; D 90-99 Stage 2 HTN: S > 160; D > 100 -Often onset is asymptomatic - Organ damage is likely(if not treated) -“White coat syndrome” - Postural Hypotension(Orthostatic) often as adverse eﬀect of medications Risk Factors of Hypertension -Cigarette smoking - Excessive alcohol intake -Sedentary lifestyle -Inadequate stress management, anger management, or both -Unhealthy diet(High in sodium, trans fat or both; low in fibre) Know what coronary heart disease is CHD: Result of untreated hypertension, narrowing of the arteries(arteriosclerosis), may lead to a blockage & Myocardial infarction(MI) or heart attack -Diabetes-significant risk factor -S/S of a MI/Heart attack: Older adults often do not have the typical ‘gripping chest pain’, More likely to have a ‘silent MI’ (myocardial infarction), presenting as discomfort localized to the back, abdomen, shoulders & or one or both arms, Nausea & vomiting (N & V) or heart burn may also be symptoms, Older woman may have S/S of weakness & lethargy Know heart failure Also called congestive heart failure(CHF), Damage to the heart caused by CHD/MI, Other causes; hypertension excessive us of drugs & alcohol diabetes obesity infection high cholesterol & other medical conditions, Most frequent cause of hospitalization of older adults, Heart can no longer pump enough blood eﬃciency to meet the needs of body -S/S of heart failure: Shortness of breath(SOB), dyspnea with exertion or at rest, Orthopnea (can’t lie flat) *Elevated bed to help, Fatigue, Swelling in lower extremities, weight gain Know the types of diabetes (complications/management) Type 1 & 2 -11 million Canadians have diabetes/pre diabetes, NIDDM(Type 2) diagnosed in later life, Pancreas make insulin not enough for the body needs, insulin resistance, many go undiagnosed/serious complications develop, death likely due to MI(heart attack) or stroke -S/S: Polydipsia(thirsty), Polyuria( voiding frequently), polyphasic(hungry) and weight loss *Classic s/s of diabetes not often Seen in older adults -Older adults presentation: fatigue,Change in weight, recurrent Infections Diabetes-Complications -foot problems which impact functional status, heart disease(3x more likely to die with heart disease), heart failure, chronic kidney disease, stroke, lower limb amputations, vision impairment Management of diabetes: Important to learn self-care skills, Understand treatment:Hypoglycemic medications(lower blood sugar), or insulin(injection) to balance blood glucose (BG) levels, need to understand drug interactions, foot assessment, prevention of infections, diet Know toxicity Can occur when concentration of drug in the blood circulation exceeds the level needed for therapeutic eﬀect, toxic responses are most life treating of ADRS Know what adverse drug reactions are and what they can lead to -50% of prescription drugs react with alcohol(Alcohol is a sedative some medications are too) -Common medication: acetaminophen (Tylenol) taken regularly can lead to liver failure in the older person(Ibprofen is very hard on stomach) Know diﬀerent barriers in pain management Cost of medications, fear of addiction to analgesics, pain is viewed as a normal burden of ‘old age’ older adults are expected to ‘learn to life with it’ Know the 3 D’s of cognitive impairment (know how to diﬀerentiate between them) three D’s of CI: Delirium, dementia, & depression -Risk increases with older adults -Diﬃcult to diﬀerentiate between the 3 D’s -Delirium usually has a rapid onset,Usually over hours or days -Dementia usually has a gradual Onset and slow steady patterns Of Diﬀerentiating the 3 D’s -Onset -Consciousness -Alertness -Psychomotor Activity -Duration(how long it last) -Attention -Orientation -Thinking -Perception -Aﬀect Know the forms of arthritis (4 types s/s) Arthritis: the term used to refer to more than 100 diseases that aﬀect 6 million Canadians, #1 reason for activity limitations in older adults, Most common: Osteoarthritis, Polymyalgia, rheumatica, rheumatoid arthritis & gout (in descending order) Osteoarthritis (OA) -Degenerative joint disease. -aﬀects 1 in 7 Canadians -Risk factors: age, obesity, family history, repetive use, trauma -Joint cartridge becomes thin and damaged, joint spaces narrows S/S: Stiﬀness (relieved by activity), Pain (related to activity) relieved by rest, as disease progresses, pain increases, even at rest. -It can have joint instability/crepitus Most common in knees, hips, neck, lower back, fingers and thumbs Polymyalgia Rheumatica (PMR) -Common form of arthritis in older adults -Acute onset of pain in neck and upper arms & may spread to the pelvis & pectoral girdle. Pain and stiﬀness comes from muscles in the neck, shoulders, lower back, buttocks and thighs. -Assoc, with inflammation of blood vessels -More common in woman, seems to be genetic S/S: low grade fever, fatigue & pain and stiﬀness at night/early a.m. treatment (Rx): small doses of corticosteroids (prednisone) it can resolve in one or two years. Rheumatoid Arthritis (RA) -Chronic systemic inflammatory joint disorder. - Autoimmune disease -inflamed joints begin to destroy lining of joint (synovial lining), joint destruction. Can be debilitating S/S: Pain & swelling in multiple joints, hands, wrists, ankles, knees and hips, usually smaller joints, symmetrical, morning stiﬀness>30 mins, experience with disease is variable Rx: Anti-inflammatory drugs (ex. Indocid, Ibprophen) -DMARDS (disease modifying anti-rheumatic drugs) including biological -Corticosteriods (prednisone) -Joint replacements (OA & RA) Know the diﬀerent conditions that will aﬀect gait Know osteoporosis Degenerative joint disease. -aﬀects 1 in 7 Canadians -Risk factors: age, obesity, family history, repetive use, trauma -Joint cartridge becomes thin and damaged, joint spaces narrows S/S: Stiﬀness (relieved by activity), Pain (related to activity) relieved by rest, as disease progresses, pain increases, even at rest. -It can have joint instability/crepitus -Most common in knees, hips, neck, lower back, fingers and thumbs Know arthritis, Parkinson’s Parkinson’s: A disease caused by a destruction of the cells in the substantial ingrained in the brain & loss of production of dopamine (neurotransmitter) -Most common neurodegenerative disease -1/2 people have depression felt to be mostly related to changes in the brain -In PD, Lewy bodies or deposits of protein in the brain cause dementia Classic symptoms: -Bradykinesia (slowness of movement) -Tremor at rest (shaking) -Cogwheel rigidity -Postural instability (very unsteady) -Other: shuﬄing gait (festination very short steps) Flat expression Treatment: taking meds that replace dopamine, relieving symptoms, function, preventing excess disability & risk of injury Nonpharmacological interventions: Exercise, relaxation, stress management, education, & self-care management *Note: Dopamine is a neurotransmitter that regulates movement in the body Arthritis: Nursing Implications -Educate -Appropriate use of the heat and cold -ROM(Range of Motion exercises ) -Conserving energy -Recommended self-management programs -Arthritis Society(community resource) -Be knowledgeable - alternative therapies Risk factors for falls/preventions -Previous falls (High risk for falls) -Medications (When they are taking meds) -Vision (Do they need to get tested for glasses?) -postural hypotension -Balance & Gait (Do they need have a normal gait or stride) -Neurological assessment: proprioception, cognitive fx (Are they alert? Time, place) -Underlying cardiac disease (Afib, HBP, LBP) -Home environment (Do they live alone? Is there stairs?) Fall preventions -Health assessment of all systems -Identify risk factors -Environmental modifications (lighting, loose rugs) Assistive devices (note: avoid rubber-soled shoes) -Education (older adults + caregivers) -Programs to promote age-appropriate activities/exercise (movies, cards, crafts) Know diﬀerent types of restraints -Chemical: drugs (psychotropics) -Physical/Non-chemical: Posey restraint products, Geri-chairs, dinner trays, wander guards, side- rails, caregiver, strangers, family members -Environment: Secure unit *Posey restraint is a belt* Know thermoregulation (hypo/hypertherma) Hyper: -Keep out of direct sun -Stay inside if home cooler, use fans -Drink lots of water(keep hydrated) -Take a cool shower/bath -Limit physical activity (Makes you over sweat) -Ask about adverse eﬀects of medications -Avoid sugary drinks (Makes you pee and you will lose fluids) -Take extra salt if having muscle cramps Hypo: -Maintain a warm temperature, not less than 18 degree Celsius (which is common heat) -Ensure enough clothing & bed clothes are worn (make sure they have comfier) -Cover the person when bathing, dry hair -Provide as much exercise/activity as possible (to generate heat) -Provide hot high protein meals to sustain heat production (Produce heat to digest protein) FANCAPES Useful for assessing the frail elderly, assessses the basic needs and the individuals ability to meet these needs -Fluids -Aeration -Nutrition -Communication -Activity -Pain -Elimination -Socialization Know that raising your voice is not eﬀective More consonants drop out of the speech & person hears mostly vowel sounds, Without consonants in world just garble.. Know problems with touch as your age -Falls (Not able to ascertain position of feet) -Calluses, foot lesions (further decreases sensitivity) -Risk for injury NURSING IMPLICATIONS -Assessment -Education -Proper footwear, oven mitts, etc.. Know how aging aﬀects mobility (the changes in gait, etc..) -Velocity: decreases, steps are slower -Decrease in step height: (lifting foot when taking steps) -Length of stride: Decreases -Width of stride: Increases (wider side to side swaying) -Narrowing standing base -More deliberate, cautious movement -Slower responses -Diminished arm swing -Mental health: depression, substance abuse -Neuromuscular: Parkinson’s, dementia -Musculoskeletal: arthritis; fractures, osteoporosis -Neurnseosory: Tinnitus; vertigo -Cardiovascular: Circulation problems, CVA Know mobility risk factors -Sedentary lifestyle -Excess weight (eﬀect how you move) -Smoking (Eﬀect how you breathe, short of breath, not going to move as fast or far) Know negative consequences of immobility -Dehydration -Pneumonia (if you don’t move around it will stay) -Contractions (Hands stays in a fist, when they move they stay) -DVT(Deep Vein Thrombosis) *blood clot in vain* -Constipation ( the more you move the more your bowels move) -Pressure ulcers (if not moving and circulation is impedance your leg will start dying) -Incontinence -Isolation & depression (if not going out your by yourself you will get depressed) Know the diﬀerent forms of dementia (the 3 A’s) and how each are diﬀerent The A’s (s/s) -Apraxia: inability to perform purposeful actions/movements (sensory & motor abilities are intact) -Agnosia: Inability to recognize common objects & people, despite good vision or intact sensory abilities -Aphasia: Loss of the ability to express & understand spoken & written language *Loss of executive function(Planning & organizing life) Know medication assessment First step is comprehensive medication assessment determine if meds are taken safely & eﬀectively -Ask client what the med is taken for & when it is taken? What is their understanding? -Assess their comprehension, mental status & ability to function(risk for ADR) Know what sundown syndrome is (s/s) It happens in approx, 66% of individuals with dementia who become more confused & agitated around late afternoon into sun fall, felt to be the result of fatigue & not able to cope S/s: -Becoming demanding, irritable -Experiencing delusions & hallucinations -Pacing or wondering -Doing impulsive things (smacking things oﬀ the wall) -Attempting to leave home (Can’t multitask) -Having diﬃculty doing tasks that were done without diﬃculty earlier in the day (Can’t focus) Know risk factors for depression, symptoms, outcomes, and treatments Altered mental function, brought about by chemical imbalances in brain, can be related to adverse eﬀects of medications; reactions to life events/losses; eﬀects of polypharmacy; family history; chronic illness *Most common mental health problem in later life* More common in LTC, associated with chronic illness, decreased quality of life, Not a normal part of aging Risk factors: -Dementia -Loss/grief -Caregiving -History of depression -medications -Living alone/widowed -Multiple. Losses that are exhausting coping abilities *Assess for sucked risk, High probability with older people* S/S: -Decreased energy & motivation -Frequent complaints (somatic) -Altered appetite (increase or decrease) -Decrease in ability to concentrate -Perceived cognitive deficits -Critical or envious of others -Loss of self-esteem -‘ model’ patient Know woman and driving (how its aﬀected) Know common stressors for delirium Know the behaviours of dementia patients (when they change) could be a good indication of pain Responsive behaviours: Restlessness, agitation, combativeness,confusion, paranoid, depression -Physical stressors: Fatigue, hunger, illness, sleep deprivation -Change-in: environment, routine, caregivers, restraints, misinterpreting environment -Stimuli: Excessive or inappropriate -Performance demands: beyond abilities pressured to do something not able, rushed care (A.M care is a time that is challenging) -Physical discomfort e.g.. pain -Depression, loss of control, social isolation -restraints -Emotional distress: loneliness, fear, depression, need for socialization Know some interventions for addressing feeding diﬃculties in dementia patients -Reduce distractions -Medicate for pain pm -Arrange the tray to facilitate self-feeding -Serve one food at a time -Serve finger foods if the person can not manage utensils -Remove hot items until they cool -Use verbal cueing with simple instructions Know what the risk factors/ distinguishing features of delirium Know the senses (changes aﬀected by aging) Smell (Olfactory) decrease sensitivity to odours after age 60; loss of cells in olfactory bulb of brain; decrease number of sensory cells in nasal lining. *Safety issues: aﬀects ability to smell toxic fumes and smoke* Also contributing to loss of smell-chronic sinister, smoking, medications, periodontal disease, repeated viral infections. Changes in the sense. Of smell-can be associated with Alzheimer’s disease & parkinsons disease (Smoking kills sense of smell) Taste: Age related changes do not aﬀect all taste sensations, but decrease in taste perception. ability to detect sweet remains stable whereas bitter, salty & sour may decrease. Dentures cover palate & interfere with tasting Know the diﬀerent complications of sight for an older adult Several diseases can aﬀect vision of the older population. Eyes can’t adapt as well to environment, Decreased ability to adapt to light, 30% of persons 60+ have some form of visual impairment Sight: -Lens becomes thicker -Colour perception decreases -Glare from sunlight & reflection on objects -Decline starts as young as age 40 -Aﬀects more woman than men Know about mental capacity A persons ability to make decisions, people are presumed to have capacity unless there is clear evidence that this is not the case, To be deemed capable of making a decision the person must be able to understand information that is relevant to making a decision evaluate data and appreciate the consequences of the decision of or not making a decision Types of decisions: -Financial -housing -personal care/daily activities -health related, consent for treatment *Capacity can fluctuates, its fluid* Assessment is important Consult with legal representatives as needed Be familiar with provincial laws, power of attorney, guardianship, advance care directives Know the changes of hearing (4 types of hearing impairment in an older person) Presbycusis: Most common cause of hearing loss is a high frequency, sensorineural loss, the joints between the malleus and stapes become calcifies decrease vibrations & sound waves via auditory nerve to the brain, slowly progressive; more severe in men, reduced ability to hear high frequency sounds (ex. Consonants, chirping of birds and rustling of leaves, background noise further complicates), takes pain longer to decipher language. Cerumen impaction: Wax build-up due to reduction in activity of cerumen glands, & shrinkage or atrophy, wax thicker & dryer needs to careful remove (safety), wax causes obstruction, hearing loss that can be reversed Tinnitus: Perception of sound in the absence of acoustic stimuli, ringing in the ear (buzzing, hissing, bells, roaring, pulsating) causes: Loud noises, excess wax, disorders of cervical vertebrae & TMJ (temporomandibular joint), Thyroid diseases, CVD, tumours, anxiety, depression, injury adverse eﬀects meds (Ex. Adverse eﬀect of aspirin) Prelingual deafness: Older adults deaf since childhood, learn to decipher audible speech (hearing aids), sign language, lip read. Aging changes/diseases challenge individuals ability to communicate, vision losses, mobility issues in hands (CVA, arthritis) impaired signing Know the characteristics of hearing loss -Hearing only muﬄed sounds(not able to decipher) -Hearing only parts of sentences on certain consonants -Hearing only when one is facing you directly when speaking -Hearing nothing at all -Partial hearing loss; total hearing loss -Sometimes mis-labelled as dementia Know the types of hypertension, and what are the risk factors to hypertension are Hypertension (High Blood Pressure) *Systolic > 140 & Diastolic > 90 (on 2 separate occasions) -Classification: *Normal: Systolic < 120; diastolic > 90 *Prehypertension: S 120-139; D 80-89 *Stage 1 HTN: S 140-159; D 90-99 Stage 2 HTN: S > 160; D > 100 -Often onset is asymptomatic - Organ damage is likely(if not treated) -“White coat syndrome” - Postural Hypotension(Orthostatic) often as adverse eﬀect of medications Risk Factors of Hypertension Know the diﬀerent therapies for cognitive impairment/dementia Non-pharmacological approaches: Reality therapy/orientation therapy, validation therapy, touch therapy, recreation therapy, music therapy and socialization (get them out dancing, movies) Reality/orientation therapy: Based on premise that if the person is orientated to person, place & environment the responsive behaviours will be decreased this may have to be done frequently(ex. The nurse should provide their name, verbalized the place where they are, & reinforce what is going on in the moment) Validation therapy: The caregiver validates the feelings expressed by the person with dementia. This is thought to reduce irritability. (Ex. ‘I see you are upset..’) Touch therapy: Touch and other forms of reassurance may help the person refocus on a diﬀerent thoughts and sets of feelings. Person may feel supported and understood. Caution - assess appropriateness for use ( time and place for touch, validation therapy) Socialization: engage persons with dementia in meaningful social interactions, enhances their quality of life and provides a positive distraction (They won’t get irritated because they are having fun Music therapy: research supports that participation in music therapy is eﬀective in reducing disruptive behaviour during and immediately after the therapy

Gerontology Term Test 6-11 PDF

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