NURS 3540 Gerontological Nursing Module 4 Active Learning Guide PDF

NURS 3540 – Gerontological Nursing Module 4 Active Learning Guide Module 4 Active Learning Guide Chapters 9 & 10 Purpose/Overview Active learning guides help students focus their study time using knowledge-level information, then concentrate on applying and analyzing knowledge to provide a context c...

NURS 3540 – Gerontological Nursing Module 4 Active Learning Guide Module 4 Active Learning Guide Chapters 9 & 10 Purpose/Overview Active learning guides help students focus their study time using knowledge-level information, then concentrate on applying and analyzing knowledge to provide a context concerning the course and career skills. Students should review the active learning guide before engaging with the module content, then work to complete the guide both during and after engaging with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate the course and content. The active learning guide is not a complete composite of the information needed for the exam but a guide to navigating the content delivery. Instructions Review the active learning guide before you begin reading and engaging with other content in the module. Looking at the questions beforehand will preview the information you will be learning, including the key concepts and takeaways. As you work through the module content, complete the active learning guide. Some questions may be reflective and require that you finish all content before responding. Students will turn in the completed learning guide on Sunday night at 1159 pm. Faculty will review and award points and return to the student to review prior to the exam. There are a possible 5 earned points for this learning guide. Reading Focus Areas In the text, you will see essential boxes, such as Safety Alerts, which discuss issues related to the care of older adults. Research Highlights contain a summary of pertinent current research related to chapter topics. Resources for Best Practice provide suggestions for further information for chapter topics and tools for practice. Healthy People boxes refer to goals cited in Healthy People 2030. Clinical judgment and next generation NCLEX examination style questions are located at the end of every chapter. Please review these questions as they are good practice for the exam. I. Heath Assessment For assessment techniques please review your Health Assessment notes and text you are learning from this semester. For Gerontology focus on the techniques that may need to be modified for the elderly client. 1 - Assessment of History Interview- Remember to be tactful when interviewing an elderly client. This is the time in their life that conditions from aging and co-morbidities influence the collection of information. NURS 3540 – Gerontological Nursing Module 4 Active Learning Guide Review: Zembrzuski, C. (2013). Communication difficulties: Assessment and interventions in hospitalized older adults with dementia. try this: Best Practices in Nursing Care to Older Adults. https://hign.org/consultgeri/try-this-series/communication-difficultiesassessment-and-interventions-hospitalized 1. List six factors that may alter the collection of information p 95 Visual and auditory acuity Manual dexterity Language and health fluency Adequacy of translation of materials Availability of a trained interpreter as needed Cognitive ability and reading level 2 - Assessment of Function Tools used to assess Geriatric Syndromes: 2. Fancapes. What does FANCAPES stand for? P 98 F: Fluids A: Aeration and circulation N: Nutrition C: Communication A: Activity P: Pain E: Elimination S: Social skills 3. SPICES – Most Widely Used. This pneumonic helps nurses remember the key aspects of the assessment for the elderly individual. Each letter stands for a serious geriatric syndrome that requires nursing interventions. Please complete the following pneumonic by placing the syndrome and issues for the patient related to the corresponding letter p101       S – Sleep disorders P – Problems with eating I - Incontinence C - Confusion E – Evidence of falls S – Skin breakdown 4. Fill out the tables below: Activities of Daily Living (ADL’s)- Functions related to personal needs p101 1. 2. 3. 4. Bathing Dressing Toileting Transferring NURS 3540 – Gerontological Nursing Module 4 Active Learning Guide 5. Continence 6. Eating Instrumental Activities of Daily Living (IADL’s) – activities needed for independent living p102 1. 2. 3. 4. 5. 6. 7. 8. Ability to use telephone Abilities related to travel Shopping Self-medication administration Food preparation Handling finances Housekeeping Laundry 5. What makes these two tables different? To complete the IADL’s, a higher cognitive and higher physical capable functioning person is needed to complete the IADL tasks. 3 - Assessment of Cognition Read: Doerflinger, D.M. (2013). Mental status assessment of older adults: The mini-cog. https://hign.org/consultgeri/try-this-series/mental-status-assessment-older-adultsmini-cog 6. What is the proper administration of the following cognition assessments? P 103 a. Mini-Mental Status Exam - Completion requires functional vision, hearing, and manual dexterity to complete the exam to screen the ability to recognize cues. The score will be adjusted for individuals that have low education levels and or disabilities. b. Mini-Cog – 3-5 minute test that is as accurate and reliable as the MMSE, but does not include the bias. Test is also more sensitive to dementia. The test only focuses on recognizing and analyzing dementia cues. The Mini-Cog combines the assessment of short-term memory with those of executive function from the clock test c. Clock Drawing test – The exam is not appropriate for use with individuals that are blind or who have limiting conditions such as tremors or a stroke that may affect the dominant hand. While reading fluency is not necessary, completion requires number fluency, the ability to hear and see, manual dexterity must be adequate enough to use a writing implement, and experience with analog clocks. The clock test is evidence based instrument that is useful across cultures and languages and is not determined by education level. The test cannot be used a primary or sole determination of dementia, but does test for constructional apraxia. Scoring is based on the analysis of the position of both the numbers and the hands. NURS 3540 – Gerontological Nursing Module 4 Active Learning Guide 4 - Assessment of Mood Depression Review: Greenberg, S. (2012). The geriatric depression scale (GDS). try this: Best Practices in Nursing Care to Older Adults. https://hign.org/consultgeri/try-thisseries/geriatric-depression-scale-gds 7. What is the Geriatric Depression scale and how is it used in screening an elderly client? P 104 The Geriatric Depression Scale is a 30 item assessment that focuses on screening older adults. There is a shorter 15 and 5 item version that have also been developed. The test takes about one minute to administer and is accurate up to 90 percent in predicting depression. A score of 2 or more is an indicator for late life depression. It has been suggested that the short version can be used by some who are aphasic but are able to use a pointboard. It also has been found to be useful in persons with some dementia with a score of 15 or above on the MMSE. What are questions from the short form that could be used in the screening? Geriatric Depression Scale (Short Form) Are you basically satisfied with your life? Yes No* Do you often get bored? Yes* No Do you often feel helpless? Yes* No Do you prefer to stay at home, rather than going out and doing new things? Yes* No Do you feel pretty worthless about the way you are now? Yes* No II. Lab and Diagnostics in the Geriatric Population 8. Develop a chart that could be used in the clinical setting showing the most significant laboratory tests for older patients. Include values or ranges, as well as any other relevant components listed in the chapter figures, tables, or boxes. NURS 3540 – Gerontological Nursing Module 4 Active Learning Guide Test CBC RBC Normal Ranges # of RBCs, WBCs, platelets and hematocrit and hemoglobin in the blood. RBC Male: 4.7 to 6.1 million cells per microliter (cells/mcL) Female: 4.2 to 5.4 million cells/mcL. Ranges for Elderly The CBC results are slightly lower in the elderly patient population. Possibly due to the reduced ingestion of protein. RBC Male: 4.2 to 5.6 million cells per microliter (cells/mcL) Female: 3.8 to 5.3 WBC WBC 4,500 to 11,000 WBCs per microliter (4.5 to 11.0 × 109/L). Platelets Platelets 150,000 to 450,000 platelets per microliter of blood. ESR Male: 0 – 15 mm/h Female: 0 – 20 mm/h In the elderly, the total WBC will decrease moderately. In reaction to acute infection, trauma or inflammation, 65–355 × 109/L for females, and 150–300 × 109/L (60–69 years), 130–300 (70–79 years), and 120–300 (80 years and above) for males. Measures for the degree of inflammation, necrosis, infection or advanced neoplasm. ESR > 100mm indicates serious illness. BMP Basic Metabolic Panel documents 7 to 8 values. K K: 3.6-5.2 mEq/L K: 3.5-5.0 mEq/L Na Na: 136-48 mEq/L Na: 135-145 mEq/L Glucose Glucose: average about 200 mg/dL Glucose: 90-150 mg/dL NURS 3540 – Gerontological Nursing Module 4 Active Learning Guide HA1C HA1C: values below 5.7%, 4%-5.9%. 75 years of age: 125 pg/mL 70 years old. Digoxin 2.5 – 3.5 for patients with a mechanical heart valve, pulmonary embolism and deep vein thrombosis. 11 – 13.5 seconds. 0.9 – 2.0 ng/mL < 3.0 ng/mL = toxic levels. Analysis/Application Questions: Janelle Waldrop is a 78-year-old female who is living at her daughter’s home after suffering a mild CVA. She has some residual weakness on her right side and needs assistance with ambulation and activities of daily living. The current plan is to have Mrs. Waldrop stay with her daughter for a few weeks until she is stronger and safe enough to return to her own home. Her physician has authorized home health nursing and physical therapy to work on medication management, medication education, strengthening exercises, and safe ambulation techniques. Mrs. Waldrop is first seen by the home health registered nurse, who conducts the initial assessment. 1. Which portion of the health history will be most pertinent in planning the care needs of Mrs. Waldrop? NURS 3540 – Gerontological Nursing Module 4 Active Learning Guide An accurate physical assessment of what Mrs. Waldrop is capable of and how limiting the weakness of her right side is. 2. Discuss the functional assessment findings that may be encountered in a patient with a new-onset CVA. The functional assessment findings will be able to detail, impairment, participation, activity and quality of life. Psychometrics will be assessed and documented based on validitiy, responsiveness, feasibility and reliability. What will be a primary factor in getting Mrs. Waldrop moved back into her own home? A primary metric to get Mrs. Waldrop back into her own home will be to assess her independence in completing ADL’s and evaluating the findings after the care plan has been implemented. Howard Woods is an 85-year-old male who suffered a fall at home that resulted in a hip fracture. Surgical repair was delayed by 2 days because Mr. Woods needed cardiac clearance for surgery due to his history of atrial fibrillation and the need to ensure that he was on therapeutic levels of digoxin. His current medications include digoxin, warfarin, opioids, and ibuprofen. Mr. Woods is recovering on the medicalsurgical unit and working with physical therapy for ambulation with a walker. The discharge plan is to transfer him to inpatient rehab for a few weeks to ensure that he is ambulating safely before returning home. Mr. Woods lives alone in a singlelevel apartment. 3. Monitoring for therapeutic blood levels of medications is important in the care of the older adult. Discuss the medications this patient is taking, and the laboratory orders the nurse would expect to monitor. There are not any contraindications between the drugs digoxin, warfarin or opioids. If digoxin is to be taken with ibuprohen the dose may need to be adjuested due to an increase in digoxin concentration levels, possibly becoming toxic. The patient would need to be educated on contacting his HCP if he develops nausea, visual changes, bradycardia, irrgular heartbeats or loss of appetite. The nurse would continue to monitor for any value changes in his hemoglobin that may make the patient sensitive to toxic level of digoxin. 4. What are the expected therapeutic blood levels of INR and digoxin? INR levels on warfarin male > 70 years of 1.6 to 2.6 Digoxin levels on warfarin male > 70 years of age 0.125 – 0.25 mg. 5. What nursing intervention would be completed with the administration of digoxin? NURS 3540 – Gerontological Nursing Module 4 Active Learning Guide Follow up about possible reactions and side effects, possible interactions with other prescribed medications. Consistent vital sign documentation. Consistent lab tests to document and monitor electrolyte levels and digoxin blood concentration values to be cleared for surgery. 6. Mr. Woods is preparing for discharge to the inpatient rehab. After ambulating 20 feet with the physical therapist, he complains of bilateral calf pain and returns to bed. Discuss the nursing priorities with this scenario. The priorities of nurse are to take an assessment of the patients mobility and assess for pain of the calves to determine if an acute critical priority has developed. To determine a diagnosis and develop a plan to implement. If the patient is not able to bear weight and ambulate then the facilities to be discharged to may be limited and not able to meet the patients needs for rehab.