NCM 114 LEC FINALS • REALITY: SENILITY OR MENTAL

INCOMPETENCE IS NOT A NATURAL

CARE OF THE OLDER ADULT WITH PART OF OLD AGE
MENTAL HEALTH DISORDER
• COGNITIVE FUNCTION IN LATER LIFE IS
INTRODUCTION HIGHLY INDIVIDUALIZED, BASED ON
PERSONAL
• MENTAL HEALTH INDICATES A RESOURCES, HEALTH STATUS AND THE
CAPACITY TO COPE EFFECTIVELY WITH UNIQUE EXPERIENCES OF THE
AND MANAGE LIFE'S INDIVIDUAL'S LIFE
STRESSES IN AN EFFORT TO ACHIEVE A
STATE OF EMOTIONAL HOMEOSTASIS • INCIDENCE: MENTAL ILLNESS IN
OLDER ADULTS IS HIGHER THAN THE
• OLDER PEOPLE MAY HAVE THE YOUNG
ADVANTAGE OVER OTHER AGE GROUPS
IN THAT THEY • DEPRESSION INCREASES IN
PROBABLY HAVE HAD MORE PREVALENCE AND INTENSITY WITH AGE
EXPERIENCE WITH COPING, PROBLEM- • REASONS:MULTIPLE LOSSES, ALTERED
SOLVING, AND MANAGING SENSORY FUNCTION AND
CRISES BY VIRTUE OF YEARS THEY ALTERATIONS,
HAVE LIVED DISCOMFORTS, AND DEMANDS
ASSOCIATED WITH ILLNESSES THAT
• HOWEVER PSYCHIATRIC ILLNESS MAY OLDER ADULTS
STILL AFFLICT THE OLDER POPULATION FREQUENTLY ENCOUNTER SET THE
• MANY LOSSES AND CHALLENGES OF STAGE FOR A VARIETY OF MENTAL
LATE LIFE MAY EXCEED PHYSICAL, HEALTH PROBLEMS
EMOTIONAL, SOCIAL
RESOURCES OF SOME PERSONS AND
THUS FOSTER MENTAL ILLNESS PROMOTING MENTAL HEALTH IN
OLDER ADULTS
• BY PROMOTING MENTAL HEALTH,
DETECTING PROBLEMS EARLY AND • MENTAL HEALTH IN OLD AGE IMPLIES
MINIMIZING THE IMPACT A SATISFACTION AND INTEREST IN LIFE.
OF EXISTING PSYCHIATRIC PROBLEMS, THIS
GERONTOLOGICAL NURSES CAN HELP CAN BE DISPLAYED IN VARIETY OF
OLDER PEOPLE ACHIEVE OPTIMAL WAYS RANGING FROM SILENT
SATISFACTION AND FUNCTION REFLECTION TO ZEALOUS ACTIVITY.

• THERE IS NO SINGLE PROFILE FOR

AGING AND MENTAL HEALTH MENTAL HEALTH THUS ATTEMPTS TO
ASSESS AN
• MYTH: SENILITY OR MENTAL
INCOMPETENCE IS NOT A NATURAL
PART OF OLD AGE
OLDER ADULT'S METAL STATUS BASED • INCREASED VULNERABILITY
ON ANY GIVEN STEREOTYPE MUST BE • SOCIAL ISOLATION
AVOIDED • SENSORY DEFICITS
• GREATER AWARENESS OF THEIR OWN
• GOOD MENTAL HEALTH PRACTICES MORTALITY
THROUGHOUT THE INDIVIDUAL'S • INCREASED RISK OF
LIFETIME INSTITUTIONALIZATION, DEPENDENCY
PROMOTE GOOD MENTAL HEALTH IN
LATER LIFE MENTAL HEALTH DISORDERS OF
OLDER ADULT
• TO PRESERVE MENTAL HEALTH,
PEOPLE NEED TO MAINTAIN THE
ACTIVITIES AND INTERESTS THAT THEY
FIND SATISFYING. THEY NEED DEPRESSION
OPPORTUNITIES TO SENSE THEIR VALUE • Geriatric depression is a mental and emotional
AS A MEMBER OF SOCIETY AND TO disorder affecting older adults. Feelings of
HAVE THEIR SELF-WORTH sadness and occasional "blue" moods are
normal. However, lasting depression is not
• SECURITY THRU PROVISION OF a typical part of aging.
ADEQUATE INCOME, SAFE HOUSING, • Depression is the most frequent problem that
MEANS TO MEET BASIC HUMAN NEEDS, psychiatrists treat in older adults, minor
SUPPORT AND ASSISTANCE TRU depressions increases in incidence with age
STRESSFUL SITUATIONS CONNECTION • Signs and symptoms: vegetative symptoms
WITH OTHERS AND OPTIMUM HEALTH such as insomnia, fatigue, anorexia, weight
ARE IMPT ASPECTS OF MENTAL HEALTH loss, constipation and decreased interest in sex
• Depressed persons may express self-
Principles in Mental health Care of Older deprecation(belittling oneself), quilt, apathy(loss
Adults of
interest), remorse(deep regret), helplessness,
• STRENGTHEN THE INDIVIDUAL'S hopelessness, feeling of being a burden
CAPACITY TO • Hygienic practices can be neglected, headache,
MANAGE THE CONDITION indigestion, altered cognition,
• ELIMINATE OR MINIMIZE THE problems in personal relationships and losing
LIMITATIONS IMPOSED BY THE interest in people
CONDITION • Symptoms of depression can mimic symptoms
• ACT FOR OR DO FOR THE INDIVIDUAL of dementia (pseudodementia)
ONLY WHEN ABSOLUTELY NECESSARY •Underlying problem in depression should be
addressed, prompt treatment can hasten
CHALLENGES IN OLDER ADULT'S recovery
HOMEOSTASIS
• ILLNESS NOTE: • Serotonin is the key hormone that
• DEATH ( family members, significant others, stabilizes our mood, feelings of well-being, and
favorite pet) happiness. This hormone impacts the entire
• RETIREMENT body. It enables brain cells and other nervous
system cells to communicate with each other. • ELECTROCONVULSIVE THERAPY
Serotonin also helps with sleeping, eating, and (SERIOUS DEPRESSIONS)
digestion • ACUPRESSURE, ACUPUNCTURE,
• Research shows that high levels of serotonin in GUIDED IMAGERY, LIGHT THERAPY IN
the brain are linked to elevated mood and feeling CONJUNCTION WITH PSYCHOTHERAPY
happy, whereas low levels of serotonin are
linked to the symptoms of depression, including ANTIDEPRESSANT: SEROTONIN
feeling sad, upset, and generally low in mood. REUPTAKE
INHIBITORS
GERIATRIC DEPRESSION SCALE • Escitalopram (Lexapro)
(15 questions) • Fluvoxamine (Luvox)
>5 suggestive of depression • Fluoxetine (Prozac)
>10 almost always indicative of depression • Paroxetine (Paxil)
• Sertraline (Zoloft)
GUIDED IMAGERY
1. Begin by breathing slowly and deeply. CYCLIC COMPOUNDS
2. Think of yourself in a place where you feel • Amoxapine ( Asendin)
relaxed and at ease, such as your favorite • Desipramine HCL (Norpramin, Pertofrane)
vacation spot. • Doxepin HO (Adapin, Sinequan)
3. Create all the details in your mind such as the • Imipramine pamoate (Tofranil)
sights, sounds, smells, and colors of this special • Nortriptyline HCL (AventyI0, Pamelor)
place. Most importantly, think of how you feel MONOAMINE OXIDASE INHIBITORS
when you are experiencing this place. • Phenelzine (Nardil)
• Tranylcypromine (Parnate)
LIGHT THERAPY
works on the body's biological clock by aligning
the Nursing Guidelines
brain's 24-hour cycle (aka circadian rhythm) • Dosages for older adults should begin at about
balances the activation of serotonin circuitry in ½ that recommended for the general adult
the brain, which is a key component in mood population
regulation • Sedation commonly occurs during the initial
contributes to stable and consistent sleep few days of treatment; precautions to reduce risk
patterns of falls
increases alertness • At least 1 month of therapy is needed before
therapeutic effects is noted
TREATMENT OF DEPRESSION • Bedtime administration of therapy is preferable
PSYCHOTHERAPY for antidepressants that produce sedative effect
• Psychotherapy is a general term for treating • Prepare patient for side effects: dry mouth,
mental health problems by talking with a diaphoresis, urinary retention, indigestion,
psychiatrist, psychologist or other mental health constipation, hypotension, blurred vision,
provider. During psychotherapy, you learn about drowsiness, increased appetite, weight gain,
your condition and photosensitivity, and fluctuating blood glucose
your moods, feelings, thoughts and behaviors levels
• Be alert to anticholinergic symptoms, • OTHERS SIGNS:IGNORING DIETARY
particularly when cyclic compounds are used RESTRICTIONS OR REFUSING A
• Ensure clients, caregivers understand dosage, PARTICULAR THERAPY, WALKING
intended effects and adverse reactions to the THROUGH DANGEROUS AREAS, DRIVING
drugs WHILE INTOXICATED, SUBJECTING
• Instruct about drug-drug and drug food ONESELF TO OTHER RISKS
interactions SUICIDAL OLDER PERSONS NEED CLOSE
OBSERVATION, CAREFUL PROTECTION
Drug -drug and drug-food interactions AND PROMPT THERAPY
• Antidepressants can increase effects of •THE ENVIRONMENT SHOULD BE MADE
anticoagulants, atropine-like drugs, SAFE BY REMOVING ITEMS THAT COULD
antihistamines, sedatives, tranquilizers, narcotics BE USED FOR SELF HARM
and levodopa • NURSES NEED TO CONVEY A
• Antidepressants can decrease the effects the WILLINGNESS TO LISTEN TO AND
effects of clonidine, phenytoin, and some DISCUSS THOUGHTS AND FEELINGS
antihypertensives ABOUT SUICIDE (BEING ABLE TO REACH
• Alcohol and thiazide diuretics can increase the OUT FOR HELP BY EXPRESSING THEIR
effects of antidepressants. SUICIDAL THOUGHTS TO NURSING
STAFF MAY PREVENT PATIENTS FROM
SUICIDE RISK TAKING ACTIONS TO END THEIR LIVES
• SUICIDE IS A REAL AND SERIOUS RISK
AMONG DEPRESSED PERSONS NURSING CONSIDERATIONS IN CARING
• SUICIDE RATE WITH PERSONS AGE 85 FOR DEPRESSED PATIENTS
AND OLDER IS 18 PER 100,000 PEOPLE • HELP THE PATIENT DEVELOP A
WHILE THOSE AGE 45-64 AT 19 PER 100,00 POSITIVE SELF.CONCEPT
PEOPLE • ENCOURAGE THE EXPRESSION OF
• MALES HAVE A HIGHER RATE THAN FEELINGS
FEMALES AT ALL AGES • AVOID MINIMIZING FEELINGS
• HEALTH PROBLEMS, POOR SLEEP • ENSURE THAT PHYSICAL NEEDS ARE
QUALITY CAN INCREASE RISK FOR MET
SUICIDE • OFFER HOPE (Demonstrate love and care,
make them feel they deserve happiness, show
REMEMBER them acceptance, offer help, show them
•ALL SUICIDE THREATS FROM OLDER appreciation)
PERSONS SHOULD BE TAKEN SERIOUSLY
• MEDICATION MISUSE (OVERDOSE OR O PANUORIN NYO DAW SI “TECHRAM”
OMISSION OF DOSAGES) MAYBE A HAHAHAHAHA
SUICIDAL GESTURE
• STARVATION IS ANOTHER SIGN AND ANXIETY
CAN OCCUR EVEN IN AN INSTITUTIONAL • Anxiety refers to anticipation of a future
SETTING IF STAFF concern and is more associated with muscle
MEMBERS ARE NOT ATTENTIVE TO tension and avoidance behavior.
MONITORING INTAKE AND • Fear is an emotional response to an immediate
NUTRITIONAL STATUS threat and is more associated with a fight or
flight reaction - either staying to fight or leaving • ENCOURAGE AND RESPECTS PTS
to escape danger. DECISION OVER MATTERS AFFECTING
HIS OR HER LIFE
ANXIETY REACTIONS IN OLDER • PREPARE INDIVIDUAL FOR ALL
ADULTS ANTICIPATED ACTIVITIES
•SOMATIC COMPLAINTS • PROVIDE THOROUGH, HONEST AND
(PSYCHOSOMATIC PROBLEMS) BASIC EXPLANATION
•RIGIDITY IN THINKING AND BEHAVIOR • CONTROL THE NUMBER AND VARIETY
•INSOMNIA, FATIGUE, HOSTILITY, OF PERSONS WITH WHOM THE PATIENT
RESTLESSNESS, CHAIN SMOKING, MAY INTERACT
PACING, FANTASIZING, • ADHERE TO ROUTINES
CONFUSION AND INCREASED • KEEP AND USE FAMILIAR OBJECTS
DEPENDENCY • PREVENT OVERSTIMULATION OF THE
• INCREASED BP. PULSE, RESPIRATIONS, SENSES BY REDUCING NOISE, USING
PSYCHOMOTOR ACTIVITY, FREQUENCY SOFT LIGHTS
OF AND MAINTAINING STABLE ROOM
VOIDING TEMPERATURE
•APPETITE MAY INCREASE OR
DECREASE WHAT IS BIOFEEDBACK?
•OFTEN HANDLE PERSONAL EFFECTS •During a biofeedback session, electrodes are
(CLOTHING, JEWELRY OR UTENSILS) attached to the skin. Finger sensors can also be
EXCESSIVELY used. These
•HAVE DIFFICULTY CONCENTRATING electrodes/sensors send signals to a monitor,
ON THE ACTIVITY AT HAND which
displays a sound, flash of light, or image that
TREATMENT represents the heart and breathing rate, blood
• FIND OUT CAUSE SUCH AS RECENT pressure, skin temperature, sweating, or muscle
STRESSES activity.
• AVOID CONSUMPTION OF CAFFEINE, • Several different relaxation exercises are used
ALCOHOL, NICOTINE AND OTC DRUGS in biofeedback therapy,
THAT MAY HAVE CAUSED ANXIETY including:
• SIMPLIFY LIFE • Deep breathing
• CONTROL ENVIRONMENTAL STIMULI • Progressive muscle relaxation - alternately
• DRUGS, INTERVENTIONS, tightening and then relaxing different muscle
BIOFEEDBACK, GUIDED IMAGERY AND groups
RELAXATION THERAPY • Guided imagery - concentrating on a specific
image (such as the color and
NURSING INTERVENTIONS FOR texture of an orange) to focus your mind and
ANXIETY make you feel more relaxed
• ALLOW ADEQUATE TIME FOR • Mindfulness meditation - focusing your
CONVERSATIONS, PROCEDURES AND thoughts and letting go of negative emotions
OTHER ACTIVITIES
SUBSTANCE ABUSE IN OLDER ADULT
• The use of illegal drugs or the use of
prescription or over-the-counter drugs or • Cirrhosis is scarring (fibrosis) of the liver
alcohol for purposes other than those for caused by long-term liver damage. The scar
which they are meant to be used, or in tissue prevents the liver working properly.
excessive amounts. Substance abuse may lead Cirrhosis is sometimes called end-stage liver
to social, physical, emotional, and job-related disease because it happens after other stages of
problems. damage from conditions that affect the liver,
• SUBSTANCE ABUSERS COME IN MANY such as hepatitis.
FORMS AND OFTEN DO NOT FIT THE
STEREOTYPICAL PROFILE CHRONIC ALCOHOLISM
• SUBSTANCE ABUSE CAN CAUSE: GI • CAN CAUSE MAGNESIUM
BLEEDING, HPN, MUSCLE WEAKNESS, DEFICIENCIES, GASTRITIS,
PERIPHERAL NEUROPATHY AND PANCREATITIS, AND POLYNEUROPATHY
SUSCEPTIBILITY TO INFECTIONS • CARDIAC DISORDERS CAN ALSO
RESULT SUCH AS HPN, IRREGULAR
• ABUSE OR DEPENDENCY ON OR HEARTBEAT AND HEART FAILURE DUE
ADDICTION TO SUBSTANCES AMONG TO CARDIOMYOPATHY
OLDER ADULTS • COGNITION MAY BE IMPAIRED BY THE
OFTEN GOES UNNOTICED (BECAUSE IT LOSS OF BRAIN CELLS AND
IS UNEXPECTED OR IT MIMICS ENLARGEMENT OF THE VENTRICLES
SYMPTOMS OF • TREATMENT: LONG -TERM
COMMON GERIATRIC CONDITIONS) GOAL:SOBRIETY
• SUBSTANCE ABUSE MAY RESULT TO • Sobriety is the condition of not having any
FALLS /INJURIES AND SELF-NEGLECT measurable levels or effects from alcohol or
• SUBSTANCE ABUSE MAY COME EARLY drugs. A person in a state of sobriety is
IN LIFE BUT CLIENTS DIE EARLY AND IT considered sober
MAY COME Sobriety can only be achieved if only the patient
LATER IN LIFE DUE TO RETIREMENT, acknowledges the problem and takes
WIDOWHOOD OR POOR HEALTH STATUS responsibility for doing something about it
Alcoholic anonymous- pwede sa individual
ALCOHOL USE pwede sa family sumali ganyan (rehabilitation
• OR Alcohol use disorder is a pattern of alcohol for alcoholism)
use that involves problems controlling drinking, •Family involvement can be significant to the
being preoccupied with alcohol or continuing to success of the tx plan
use alcohol even when it causes problems. • Outcomes in treatment plan can be negatively
• This disorder also involves having to drink affected by loved ones denying or enabling the
more to get the same effect or drinking problem
having withdrawal symptoms when one rapidly
decreases or stops drinking. CRITERIA FOR ALCOHOLISM
• Alcohol use disorder includes a level of Criteria (diagnosing alcoholism)
drinking that's sometimes called alcoholism.
• SYMPTOMS SECONDARY TO • DRINKS A FIFTH OF WHISKEY (1
COMPLICATIONS FROM ALCOHOLISM: BOTTLE OR 750 ML OR 16 SHOTS) A DAY
cirrhosis, hepatitis and chronic infection
OR ITS EQUIVALENT WINE OR BEER(FOR • OLDER PEOPLE ARE FREQUENT
A 190 LB PERSON) VICTIMS OF CRIME AND
• ALCOHOLIC BLACK OUTS UNSCRUPULOUS PRACTICES
• BLOOD ALCOHOL LEVEL GREATER • INTERVENTION: REDUCE INSECURITY
THAN 150 MG/100 ML AND MISPERCEPTION (CORRECTIVE
- WITHDRAWAL SYNDROME: LENSES, HEARING AIDS, SUPPLEMENTAL
HALLUCINATIONS, CONVULSIONS INCOME NEW HOUSING AND A STABLE
GROSS TREMORS, DELIRIUM TREMENS ENVIRONMENT
CONTINUED DRINKING DESPITE • TREATMENT: PSYCHOTHERAPY AND
MEDICAL ADVICE OR PROBLEMS MEDICATIONS
CAUSED BY DRINKING
NURSING CONSIDERATIONS
• Tremors are unintentional and uncontrollable • MONITORING MEDICATIONS
rhythmic movements of one limb or part of your Adverse effects of medication in older adult
body. -loss of appetite
• Gross tremor is characterized by wide back and -anorexia
forth motions, usually of the arms or legs. -falls
• The term "seizure" is often used -incontinence
interchangeably with "convulsion." During -anemia
convulsions a person has uncontrollable shaking -lethargy
that is rapid and rhythmic, with the muscles -confusion
contracting and relaxing repeatedly. There are Older Adult: lowest prescribed dosage
many different types of seizures. Some have
mild symptoms without shaking • PROMOTING POSITIVE SELF-CONCEPT
•Delirium tremens (DTs) is manifested by Sense of meaninglessness and hopelessness
altered mental status (global confusion) and Activities like life review, compiling scrapbooks
sympathetic overdrive (autonomic etc.
hyperactivity), which can progress to Meaningful social interaction- they socialize into
cardiovascular collapse. Minor alcohol the people who are meaningful to them like
withdrawal is characterized by tremor, family, friends and significant others.
anxiety,nausea, vomiting, and insomnia.
• MANAGING BEHAVIORAL PROBLEMS
PARANOIA Behavioral therapy and psychosexual therapy
•is a thought process that causes an irrational Stress also contribute to behavioral conditions
suspicion or mistrust of others. People with Room temp. 70 degree fahrenheit
paranoia may feel like they're being persecuted Avoiding wall covering
or that someone is out to get them. They may Limiting traffic flow
feel the threat of physical harm even if they Controlling the noise
aren't in danger. Preventing drama transition
• CAUSES: SENSORY LOSSES, ILLNESS, Installing safety devices like alarms and video
DISABILITY, LIVING ALONE, LIMITED cameras wander
BUDGET
BEHAVIOR CAUSES NURSING
ACTION
 Dementia
VIOLENT DEMENTIA, AVOID
PARANOIA, TRIGGER, Agitation
ANGER, RECOGNIZ Boredom
ANXIETY, E
FATIGUE WARNING Wandering - cause: dementia, restlessness and
SIGNS, GET anxiety
HELP, NURSING ACTION
ADDRESS
- Schedule time for supervise on walking
IN CALM
QUIET. - Provide activities
MOVE - Safe guard on environment like alarm
PERSON on doors
AWAY - Use lock with codes and windows
FROM screen lock plexiglass
OTHERS - Make sure client wear ID bracelet or
card with information
- Familiarized the person in environment
VERBALLY DEMENTIA, AVOID
ABUSIVE ANGET, ARGUING, Night Wandering - cause: dementia, excess
POWETLES DISTRACT daytime sleeping, misinterpretation in
S WITH environment and sundowners syndrome
ACTIVITIES
Medications - sedative, laxative and diuretics
(can cause restlessness)
RESISTING DEMENTIA PREPARE NURSING ACTION
CARE MISINTERP FOR - Provide daytime activity
RETATION ACTIVITIES - Provide late day exercise
OF ,
- Before sleep use toilet
ACTIONS, BREAK
OBJECTS INTO - Nightlight on bedroom and bathroom to
AN EVT SMALL avoid disturbance of sleep
DEPRESSIO STEPS, - Reassure person when awaken
N USE
ALTERNATI NAGHUHUBAD - Cause: Dementia,
VE misinterpretation of action
UNDRESSIN PREPARE NURSING ACTION
G DEMENTIA, AS - relocate in private area
INAPPROPR SOILED NECESSAR - Distract with other activities
IATELY CLOTHING. Y, - Set limit firmly ( acceptable behavior)
IRRITATIO EXAMINE - Review medication for dose can cause
N CLOTHING inhibition ( nakakawala ng hiya na
CLOTHING WHICH IS
gamot) called anti anxiety agent
FEELING DIFFICULT
TOC - Medication increased Libido (levodopa)
WARM - Provide acceptable of touch like
( tapping shoulder and holding hands

SUSPICIOUSNESS - cause dementia,

REPETITIVE ACTION
Medication (levodopa, tolbutamide) hyperactive less active than normal or fluctuate
NURSING ACTION between both extremes
- Provide explanation •Recovery: disease can be reversed and normal
- Prepare activities mental status restored if the cause is
- Afford decision making treated promptly
- Limit thing’s can trigger suspiciousness
•The onset of symptoms with delirium tends
CARE OF OLDER CLIENT WITH to be rapid and can include disturbed
DELIRIUM AND DEMENTIA intellectual
function; disorientation of fme and place but
INTRODUCTION usually not of identity, altered attention span
worsened memory, labile mood meaningless
•WITH ADVANCING YEARS, THERE IS chatter, poor judgment and altered level of
INCREASED RISK OF DELIRIUM, THE consciousness, including hypervigilance, mild
REVERSIBLE ALTERATION IN drowsiness and semi comatose status
COGNITION CAUSED BY ACUTE
CONDITIONS •Significant perceptual changes hallucinations
AND DEMENTIA, THE IRREVERSIBLE (visual) and illusions (misinterpreting caregivers
IMPAIRMENT IN COGNITION CAUSED as police guards), restlessness and sleep
BY disturbances
DISEASE OR INJURIES TO THE BRAIN.
Although both conditions cause cognitive •Suspicious, personality changes experiences
impairment, there are significant differences illusions more than delusions

•Assisting with the prevention, diagnosis and •Physical signs; shortness of breath, fatigue and
treatment of these cognitive impairments, is an slower psychomotor activities may accompany
important responsibility of the gerontological behavioral changes
nurse
•Labile mood: unpredictable,rapid often
DELIRIUM exaggerated
•Delirium is a serious disturbance in mental changes in mood where strong emotions or
abilities that results in confused Thinking and feelings
reduced awareness of the environment The start occur. Client show uncontrollable laughing ,
(onset) of delirium is usually RAPID within crying or
hours or a few days, heightened irritability or temper(inappropriate at
times.
•A VARIETY OF CONDITIONS CAN The emotions are expressed in a way that is
IMPAIR CEREBRAL CIRCULATION AND greater than the person's emotions
CAUSE
DISTURBANCE IN COGNITIVE FUNCTION Illusions: misleading perceptions;
misinterpretations of actual external stimuli
•LOC. Alertness Is changed (highly agitated or Delusion: false belief that is maintained even it
very dull Behavior changes (can be it is contradicted
Hypervigilance: elevated style of constantly •GENETIC FACTORS: GENETIC
assessing potential threats FORMULATION OF THE DISEASE STEMS
around you- often the result of trauma FROM ITS
CONNECTION WITH DOWN'S SYNDROME;
REMEMBER PEOPLE WITH Down Syndrome
DELIRIUM ALTERS LEVEL OF BEGIN TO DEVELOP SYMPTOMS OF
CONSCIOUSNESS, WHEREAS DEMENTIA DEMENTIA AFTER THE AGE OF 35 AND
DOES NOT PREVALENCE OF DS IS HIGHER IN
- NURSES CAN PLAY SIGNIFICANT ROLE FAMILIES WITH DS
BY DETECTING SIGNS OF CONFUSION •FREE RADICALS ; MOLECULES THAT
PROMPTLY CAN BUILD UP IN NEURONS, RESULTING
A GOOD HISTORY AND ASSESSMENT OF IN
MENTAL STATUS ON INITIAL DAMAGE (CALLED OXIDATIVE DAMAGE)
CONTACT CAN PROVIDE THE BASELINE WHICH BLOCKS SUBSTANCES FROM
DATA WITH WHICH CHANGES CAN FLOWING IN AND OUT OF THE CELL,
BE COMPARED LEADING TO BRAIN DAMAGE
•ENVIRONMENTAL TOXINS; HIGHER
DEMENTIA THAN NORMAL LEVELS OF ALUMINUM
•AN IRREVERSIBLE, PROGRESSIVE AND MERCURY HAVE BEEN FOUND IN
IMPAIRMENT IN COGNITIVE FUNCTION THE BRAIN CELLS OF ALZHEIMER'S
AFFECTING MEMORY, ORIENTATION, DISEASE PATIENTS
JUDGMENT, REASONING, ATTENTION,
LANGUAGE AND PROBLEM SOLVING SYMPTOMS
•IT IS CAUSED BY DAMAGE OR INJURY -DEVELOP GRADUALLY AND PROGRESS
TO THE BRAIN AT DIFFERENT RATES AMONG
•AN ESTIMATED 5% OLDER ADULTS AFFECTED INDIVIDUALS
SUFFER SOME FORM OF DEMENTIA - EARLY IN THE DISEASE, THE CLIENT
•MOST COMMON: ALZHEIMER'S DISEASE MAY BE AWARE OF CHANGES IN
INTELLECTUAL ABILITY AND BECOME
ALZHEIMER’S DISEASE DEPRESSED OR ANXIOUS OR ATIEMPI TO
•MOST COMMON FORM OF COMPENSATE BY WRITING DOWN
DEMENTIA INFORMATION,STRUCTURING ROUTINES
•Characterized by 2 changes in the brain AND SIMPLIFYING RESPONSIBILITIES.
•1st change: presence of neuritic -IT MAY TAKE SOMETIME FOR
plagues, which contain deposits SYMPTOMS TO BE DETECTED, EVEN BY
of P amyloid protein THOSE
•2nd change: neurofibrillary Tangles in the CLOSE TO THE PATIENT
cortex. Microtubules, structures within healthy
neurons, are normally stabilized by a specialized TREATMENT
protein called tau -Currently there NO treatment to prevent or cure
Alzheimer's disease
POSSIBLE CAUSES -Because acetylcholine(chit neurotransmitter in
parasympathetic nervous
system) that contracts smooth muscles. Dilates •STAGE 5 (Moderate AD) DISORIENTED TO
blood vessels, increases bodily secretions and TIME AND PLACE, NEEDS ASSISTANCE IN
slows heart rate) falls sharply in people wit CLOTHING SELECTION
Alzheirer's Disease, medications that stop or
slow the enzyme (acetylcholinesterase that •STAGE 6 (Moderately severe AD] FORGES
breaks down acetylcholine have been developed NAME OF SPOUSE AND OTHER FAMILY
to help people with AD. ; these drugs include MEMBERS, PERSONALITY AND
DONEPEZIL EMOTIONAL CHANGES; INABILITY TO
(ARICEPT), RIVASTIGMINE (EXELON) PERFORM MANY ADLS; AGITATION
AND GALANTAMINE (REMINYL)
•STAGE 7 (Severe AD) LOSS OF VERBAL
REMEMBER AND PSYCHOMOTOR SKILLS;
-Greatest risk of suicide for a person with INCONTINENCE;NEEDS TOTAL
dementia is in the early stage of the disease ASSISTANCE
when the individual is aware of the changes
experienced OTHER DEMENTIAS
- Diagnosis is aided with brain scans that can •VASCULAR: results from small cerebral
reveal changes in the brain's structure that are infarctions, associated with risk factors such as
consistent with the disease, neuropsychological smoking, HPN, hyperlipidemia, inactivity and a
testing that evaluates cognitive functioning and history of stroke or cardiovascular
laboratory less and neurological examinations
•FRONTOTEMPORAL: characterized by
STAGES OF ALZHEIMER’S neuronal atrophy affecting the frontal
lobes of the brain of the brain, Pick's Disease is
•STAGE 1 NO IMPAIRMENT he is the most common form

•STAGE 2 SELF-REPORT OF MEMORY •LEWY BODY: also known as cortical Lewy

IMPAIRMENT; NO OBJECTIVE COGNITIVE body de; associated with subcortical pathology
IMPAIRMENTS NOTED and the presence of lewy body substance in the
cerebral cortex. hey hove fluctuations in mental
•STAGE 3 (Compatible with early AD] status, decompensates rapidly (high rate of
COGNITIVE IMPAIRMENTS RECOGNIZED morbidity, idiosyncratic reactions to cholinergic
BY lype
OTHERS; ANXIETY, IMPAIRED medications (e.g, sedatives and antipsychotics)
PERFORMANCE IN DEMANDING WORK
AND SOCIAL SETTINGS •IDIOSYNCRATIC REACTIONS:
UNTOWARD REACTIONS TO DRUGS
•STAGE 4 (Mild AD] WITHDRAWAL, THAT OCCUR IN A SMALL FRACTION OF
DENIAL PATIENTS AND HAVE NO OBVIOUS
DEPRESSION, INABILITY TO PERFORM RELATIONSHIP TO DOSE OR DURATION
IADI'S AND COMPLEX TASKS, OF THERAPY
FLATTENING OF AFFECT, COGNITIVE
IMPAIRMENT EVIDENT ON EXAM OTHER DEMENTIAS
•CREUTZFELDT-JAKOB DISEASE; •CLEANING SOLUTIONS PESTICIDES,
extremely rare brain disorder that causes MEDICATIONS, INEDIBLE ITEMS ARE
dementia. Has a rapid onset and progression and STORED IN
is characterized by severe neurological LOCKED CABINETS; COVER SOCKETS,
impairment that accompanies dementia. ELECTRICAL OUTLETS, FANS, MOTORS,
Pathological process displays MATCHES, LIGHTERS SHOULD NOT BE
SPONGE LIKE APPEARANCE of cerebral ACCESSIBLE, CLOSE SUPERVISION TO
cortex CLIENTS WHO SMOKE

•Symptoms: psychotic behavior(hallucinations, •WINDOWS AND DOORS CAN BE

delusions, strong inappropriate emotions or no PROTECTED WITH PLEXIGLASS AND
emotions at all (labile mood), withdrawing NONREMOVABLE SCREENS TO AVOID
from friends and families; memory impairment, FALLS
loss of muscular function, muscle spasms,
seizures and visual disturbances. The de •PROVIDE SAFE AREA WHERE CLIENTS
progressed rapidly and death typically occurs CAN WANDER; INSTALL PROTECTIVE
GATES; ALARMS AND BELLS ON DOORS
OTHERS CAUSES OF AD CAN SIGNAL IF THEY ARE ATTEMPTING
-WERNICKE'S encephalopathy and TO EXIT
Parkinson's disease
- AIDS •LET CLIENT WEAR IDENTIFICATION
-TRAUMA AND TOXINS BRACFIFTS AT ALL TIMES AND TO
ALWAYS HAVE A RECENT PHOTO

DELIRIUM VS. DEMENTIA •PREVENTION OF ABUSE

•ITEMS TO TRIGGER MEMORY:

PHOTOGRAPHS OF PATIENT,
CONSISTENTLY USED SYMBOL
(FLOWER, SYMBOLS] ON BEDROOM
DOOR OR PERSONAL POSSESSIONS

•NOISE, ACTIVITY AND LIGHTING

LEVELS CAN OVERSTIMULATE THE
PATIENT AND FURTHER DECREASE
FUNCTION, IHUS THEY NEED TO BE
CONTROLLED THIS IS USEFUL IN
PREVENTING AND MANAGING
SUNDOWNER SYNDROME
CARING FOR CLIENTS WITH
DEMENTIA WANDERING
•COMMON AMONG DEMENTIA PALENIS;
•ENSURE SAFETY: MAINTAIN SAFE AND RAIHER THAN RESTRAIN OR RESTRICT
STRUCTURED ENVIRONMENT
THEM, PROVIDE A SAFE AREA IN WHICH NOISE AND TRAFFIC FLOW, ENSURE
THEY CAN WANDER. BASIC NEEDS ARE MET
PROTECTIVE GATES CAN BE INSTALLED
TO PREVENT PATIENTS FROM MODIFIED COMMUNICATION
WANDERING AWAY; ALARMS AND TECHNIQUES
BELLS ON DOORS CAN SIGNAL THEN •USE SIMPLE SENTENCES THAT CONTAIN
THEY ARE ATTEMPTING TO EXIT ONLY ONE IDEA OR INSTRUCTION
•SPEAKING IN A CALM MANNER USING
•LET PATIENT WEAR IDENTIFICATION ADULT TONE (NOT BABY TALK)
BRACELETS AT ALL TIMES AND TO •AVOIDING WORDS OR PHRASES THAT
HAVE A CAN BE MISINTERPRETED OR SARCASM
RECENT PHOTOGRAPH AVAILABLE •OFFERING OPPORTUNITIES FOR SIMPLE
DECISIONS
ABUSE •AVOIDING ARGUMENTS
• PATIENTS WITH DEMENTIA MAY BE •RECOGNIZING EFFORTS WITH POSITIVE
ABUSED BY THEIR CARERS FEEDBACK
• IT IS IMPT TO ASSESS HOW WELL •OBSERVING NON VERBAL EXPRESSIONS
CAREGIVERS ARE MANAGING AND AND BEHAVIORS
COPING
WITH THE PERSONS THEY CARE FOR Respecting the individual by maintaining and
AND TO PROVIDE SUPPORT AND promoting the following:
ASSISTANCE TO PREVENT THEM FROM - Individuality
BECOMING OVERWHELMED - Independence
- Freedom
SUNDOWNER SYNDROME - Dignity
- NOCTURNAL CONFUSION - Connection

- FACTORS THAT INCREASE THE RISK OF Supporting Client’s Family

SS:UNFAMILIAR ENVIRONMENT, -Assistance and support to families of patients
DISTURBED SLEEP PATTERNS, USE OF are
RESTRAINTS, EXCESS SENSORY integral parts of nursing care for persons with
STIMULATION, SENSORY. DEPRIVATION dementia
OR CHANGE IN CIRCADIAN RHYTHM - The physical, emotional and socioeconomic
burden of
- HOW TO PREVENT SS: PLACE FAMILIAR caring for a cognitively impaired relative can be
OBJECTS IN PT'S ROOM, PHYSICAL immense . The nurse needs to review basic,
ACTIVITY IN THE AFTERNOON, specific care
ADJUSTING LIGHT TO THE ROOM AT techniques, including lifling, bathing and
NIGHT, KEEPING NIGHT-LIGHT managing
THROUGHOUT THE NIGHT IT, FREQUENT inappropriate behaviors
CONTACT TO THE PERSON, USF OF - Help families plan respite, network with
TOUCH, ENVIRONMENTAL support groups
TEMPERATURE IS WITHIN and obtain counseling may be beneficial
COMFORTABLE RANGE; CONTROLLING
 AND SPIRIT TO CONTROL
LIVING IN HARMONY WITH CHRONIC SYMPTOMS, PROMOTE A SENSE
CONDITIONS OF WELL BEING AND ENHANCE
THE QUALITY OF LIFE
-accepting na may chronic condition at ano ang
gagawin ● THE NURSE SERVES A HEALING
ROLE IN FACILITATING THIS
Chronic care refers to medical care which PROCESS AND GUIDING
addresses pre- existing or long-term illness, as INDIVIDUALS WITH CHRONIC
opposed to acute care which is concerned with CONDITIONS TO ACHIEVE THEIR
short term or severe illness of brief duration. MAXIMUM POTENTIAL AND
HIGHEST ATTAINABLE QUALITY
•More than 80% of older adults possess at least OF LIFE
one chronic disease
● The nurse stimulates PATIENT'S SELF-
•MOST CHRONIC CONDITIONS THAT ARE HEALING CAPABILITIES BY
COMMON IN OLDER ADULTS CAN CREATING A THERAPEUTIC
SIGNIFICANTLY AFFECT THE QUALITY HUMAN AND PHYSICAL
OF DAILY LIFE ENVIRONMENT; EDUCATING,
EMPOWERING; REINFORCING;
MAJOR CHRONIC CONDITIONS OF AFFIRMING AND VALIDATING
OLDER ADULTS AND REMOVING BARRIERS TO
● Nearly half of older adults suffer from SELF-CARE AND SELF-
Arthritis AWARENESS.
● More than 1/3 have Hypertension
● Nearly 1/3 of older adults have Hearing GOALS OF CHRONIC CARE
impairment •Maintain and improve self-care capacity
● More than 1% of older adults have a •Manage condition effectively
Heart condition •Boost the body's healing abilities
● More than 1/8 of older adults have •Prevent complications
Visual impairment •Delay deterioration and decline when
● 1/8 of older adults have deformity or unavoidable
orthopedic impairment •Achieve the highest possible quality of life
● Almost 10% of older adults have •Die with comfort and dignity
diabetes
● Approx. 1-12 older adults are affected ASSESSMENT OF CHRONIC CARE
by hemorrhoids and varicose veins NEEDS
- ASSESSMENT OF THE CAPACITY
NOTE! OF THE CLIENT FOR SELF CARE
● HEALING INSTEAD OF CURING IS AND THE CAPACITY OF THE
OF UTMOST IMPORTANCE FAMILY TO ASSIST AND COPE
WITH CARE-GIVING IS ESSENTIAL
● HEALING IMPLIES THE
MOBILIZATION OF BODY, MIND
 - CARE NEEDS SHOULD BE C–CLARIFY
REVIEWED WITH PATIENT AND H–HELP
FAMILY I–INSPIRE
- SETTING GOALS IS IMPORTANT N–NURTURE
FOR REALISTIC DIRECTION OF G–GUIDE
CARE (LONG TERM AND SHORT
TERM COMPLEMENTARY AND
ALTERNATIVE THERAPIES FOR
SELECTING APPROPRIATE PHYSICIAN PEOPLE WITH CHRONIC
- EXPERTISE CONDITIONS
- ACCESSIBILITY - ACUPRESSURE
- OPEN COMMUNICATION; CLIENT - AROMATHERAPY
IS AT EASE (COMFORTABLE WITH -BIOFEEDBACK
EACH OTHER) -LIGHT THERAPY
- RESPECTFUL -HYPNOTHERAPY
- ATTITUDE OF HOPE AND -MASSAGE THERAPY
OPTIMISM -MEDITATION
- TẠI CHI
CHRONIC CARE COACH -YOGA
❖PROVIDER OF SUPPORT AND -THERAPEUTIC TOUCH
ASSISTANCE
❖SPOUSE, CHILD, FRIEND ETC… REMEMBER
IN CHRONIC CARE, THE ENTIRE
FUNCTIONS OF CHRONIC CARE FAMILY IS THE PATIENT
COACH
- REGULAR CONTACT WITH REHABILITATIVE AND
PATIENT RESTORATIVE CARE
- REINFORCE CARE PLAN
- ASSIST PATIENT IN DEVELOPING TERMINOLOGIES
DAILY, WEEKLY AND MONTHLY 1. Disability: inability to perform
GOALS activities normally
- REMIND PATIENT'S 2. Frailty: condition in which a person
APPOINTMENTS, ACTIVITIES has weakness and poor endurance (weak
- LISTEN TO CONCERNS WITHOUT grip strength, low activity level, reduced
JUDGMENT speed in ambulation, fatigue, increased
- OFFER FEEDBACK risk for adverse outcomes)
- USE HUMOR THERAPEUTICALLY 3. Handicap: limitation to fulfill a role
- ACCOMPANY TO PHYSICIAN'S 4. Impairment: physical and
OFFICE VISITS psychological restriction
- PROVIDE INSPIRATION AND HOPE 5. Instrumental Activities of Daily
STEPS IN CHRONIC COACHING Living: tasks required for community
C–CONTACT living such as shopping, meal
O–OBSERVE preparation, laundry, housekeeping, use
A–AFFIRM
 of telephone, money management, •They may have angry outbursts
medication management •They may shop for medical advice (multiple
6. Sarcopenia: age-related loss of advice) or invest in faith healers
muscle mass •Their reactions may fluctuate

TERM- EXAMPLE NOTE:

Disability-Inability to cut food due to arthritic •Previous attitudes, personality and lifestyle
fingers have a strong influence on reactions to disability
Frailty- Self-care neglect due to weakness, •The family's response to the disabled person
fatigue will also influence that person's reactions
Impairment- Loss of limb due to amputation
Handicap- Loss of job due to amputation PRINCIPLES OF REHABILITATIVE
NURSING
REHABILITATIVE AND RESTORATIVE ● INCREASE SELF-CARE
CARE CAPACITY
-Rehabilitative care involves therapies ● ELIMINATE OR MINIMIZE
developed by physicians and therapists focused SELF-CARE LIMITATIONS
on returning individuals to their previous level ● ACT FOR OR DO FOR THE
of functions PERSON WHEN THE
PERSON IS UNABLE TO
Skilled rehabilitative care involves services TAKE ACTION FOR
offered by physical, occupational and speech HIMSELF OR HERSELF
therapists
● REMEMBER: IMPROVING
Restorative care is primarily offered by nursing THE FUNCTIONAL
staff and does not require a medical order. It can CAPACITY OF OLDER
occur in any setting and includes efforts to help ADULTS CAN PROMOTE A
individuals: maintain their current level of SENSE OF WELL-BEING
function improve their functional ability, prevent AND A HIGHER QUALITY
decline and complications and promote the OF LIFE
highest possible quality of life
GUIDELINES TO REMEMBER IN
REHABILITATIVE AND RESTORATIVE
NURSING
- KNOW THE UNIQUE CAPACITIES
CHALLENGES FOR OLDER ADULTS AND LIMITATIONS OF THE OLDER
WHO ARE LIVING WITH DISABILITY ADULT
- EMPHASIZE FUNCTION RATHER
•Many losses may accompany disability such as THAN DYSFUNCTION AND
the loss of function, role, income, status, CAPABILITIES RATHER THAN
independence or body part. Older adults DISABILITIES
demonstrate the same reactions experienced - PROVIDE TIME AND FLEXIBILITY
during the stages of dying ESPECIALLY DURING ROUTINES
•They may deny their disabilities (ENCOURAGE INDEPENDENCE)
 - RECOGNIZE AND PRAISE
ACCOMPLISHMENTS Intervention to facilitate and improve
- DO NOT EQUATE PHYSICAL functioning
DISABILITY WITH MENTAL ● Positioning
DISABILITY ● Range of motion exercises
- PREVENT COMPLICATIONS ● Use of mobility aids
- DEMONSTRATE HOPE, OPTIMISM ● Bowel and bladder training
AND SENSE OF HUMOR ● Activities to promote mental function
- KEEP IN MIND THAT
REHABILITATION IS A HIGHLY Facilitating proper positioning
INDIVIDUALIZED PROCESS - Correct body alignment facilitates
REQUIRING MULTIDISCIPLINARY optimal respiration, circulation and
TEAM EFFORT FOR OPTIMAL comfort and prevents complications
RESULTS such as contractures and pressure ulcers

FUNCTIONAL ASSESSMENT
- INVOLVES DETERMINING AN
INDIVIDUAL'S LEVEL OF
INDEPENDENCE IN PERFORMING
ADLs AND INSTRUMENTAL
ACTIVITIES OF DAILY LIVING
- ASSESSMENT OF IADLS
EXAMINES THE SKILLS BEYOND
THE BASICS THAT ENABLE THE
INDIVIDUAL TO FUNCTION
INDEPENDENTLY IN THE ASSISTING WITH ROM
COMMUNITY, SUCH AS THE
ABILITY TO PREPARE MEALS,
SHOP, USE A TELEPHONE, SAFELY
USE MEDICATIONS, CLEAN,
TRAVEL IN THE COMMUNITY
AND MANAGE FINANCES
- PERSONS CAN BE TOTALLY
INDEPENDENT, PARTIALLY
INDEPENDENT, OR DEPENDENT IN
THEIR ABILITY TO PERFORM
THESE ACTIVITIES Signs that would warrant stopping any
exercise regimen
● Resting HR greater than or equal to 100
bpm
● Exercise HR greater than or equal to
35% above resting HR
● Increase or decrease in systolic BP by
20 mmHg
 ● Angina Acute care is a branch of secondary health care
● Pallor, dyspnea, cyanosis where a patient receives active but short-term
● Dizziness, poor coordination treatment for a severe injury or episode of
● Diaphoresis illness, an urgent medical condition, or during
● Acute confusion, restlessness recovery from surgery. In medical terms, care
for acute health conditions is the opposite from
chronic care, or longer-term care.

POTENTIAL RISKS OF OLDER ADULTS

ASSOCIATED WITH HOSPITALIZATION

RISK CONTRIBUTING
Canes, walkers and wheelchairs
● Canes: Used to provide a wider base of DELIRIUM New environment,
support and should not be used for sensory deprivation
bearing weight; used on unaffected side
FALLS Excess stimuli,
of the body, advanced when affected
adverse drug
limb advances reactions
● Walkers offer broader base of support
than canes and can be used for weight PRESSURE Immobilization, lack
bearing ULCERS of assistance
● Wheelchairs provide mobility for
persons unable to ambulate because of DEHYDRATION Age-related decrease
various disabilities, such as paralysis or INCONTINENCE in thirst sensation
severe cardiac disease CONSTIPATION Lack of assistance
LOSS OF Effects of
Teaching about Bowel and bladder training FUNCTIONAL medications
•The nurse must evaluate the physical and INDEPENDENCE Immobility
mental capacity of the patient to achieve
continence before a training program is begun
•Consistency is a crucial factor in training Nursing measures to minimize the common
programs risks
•Adherence to toileting schedule by all ● Careful assessment to identify problems
caregivers on all shifts is essential to bladder and and risks
bowel retraining programs ● Early discharge planning
● Encouragement of independence
Maintaining and promoting mental function ● Close monitoring of medications
•Reminiscence or life review ● Reminders and assistance to patient with
•Reality orientation frequent repositioning, coughing, deep
•Using community resources breathing, toileting
● Early identification and correction of
ACUTE CARE complications
● Avoidance of urinary catheterization if
WHAT IS ACUTE CARE? possible
 ● Strict aseptic technique PLASMA PROTEINS,
● Close monitoring of intake and output, ABGs,CARDIAC ENZYMES,
VS, mental status and skin status LYMPHOCYTE COUNTS, SERUM
● Environmental modifications ALBUMIN, HEMOGLOBIN,
● Assistance if necessary in ADLs HEMATOCRIT, TOTAL IRON-
● Patient and family education BINDING CAPACITY,
● Reality orientation as necessary TRANSFERRIN,CXR, ECG,
● Referral to resources to promote self- PULMONARY FUNCTION
care ability and independence TEST,NUTRITIONAL ASSESSMENT,
MENTAL STATUS
SURGICAL CARE
● BASIC PRE OP SCREENING ● PREOPERATIVE CARE
(BLOOD SAMPLES, CREATININE CONSIDERATIONS: PREOP PREP;
CLEARANCE, GLUCOSE, TYPES OF ANESTHESIA,LENGTH
ELECTROLYTES, CBC, TOTAL OF SURGERY, ROUTINE
PLASMA PROTEINS, ABGs, RECOVERY ROOM PROCEDURES,
CARDIAC ENZYMES, PAIN MGT, AMBULATION
LYMPHOCYTE COUNTS, SERUM (TURNING, COUGHING, DEEP
ALBUMIN, HEMOGLOBIN, BREATHING EXERCISES),
HEMATOCRIT, TOTAL IRON- DRESSING CHANGES,
BINDING CAPACITY, SUCTIONING, USE OF OXYGEN,
TRANSFERRIN, CXR, ECG, CATHETERS AND OTHER
PULMONARY FUNCTION TEST, ANTICIPATED PROCEDURES
NUTRITIONAL ASSESSMENT,
MENTAL STATUS ● ANTICIPATE NEEDS: PAD BONY
PROMINENCES FOR PROLONGED
● PREOPERATIVE CARE SURGERY, CAREFUL
CONSIDERATIONS: PREOP PREP; POSITIONING; INFECTION
TYPES OF ANESTHESIA, LENGTH CONTROL, PROMOTE GOOD
OF SURGERY, ROUTINE NUTRITIONAL STATE,
RECOVERY ROOM PROCEDURES, CORRECTING EXISTING
PAIN MGT, AMBULATION INFECTIONS
(TURNING, COUGHING, DEEP
BREATHING EXERCISES), ● PREPARE FOR THREE (3) PREOP
DRESSING CHANGES, BATHING : MORNING, BEDTIME-
SUCTIONING, USE OF OXYGEN, DAY BEFORE SURGERY AND
CATHETERS AND OTHER MORNING AT THE DAY OF
ANTICIPATED PROCEDURES SURGERY
BASIC ● OBTAIN INFORMED CONSENT

● PREOP SCREENING (BLOOD OPERATIVE AND POSTOPERATIVE

SAMPLES, CREATININE CONSIDERATIONS
CLEARANCE, GLUCOSE, ● EFFECT OF ANESTHESIA:
ELECTROLYTES, CBC, TOTAL MONITOR FOR DEPRESSION OF
 THE FUNCTIONS OF BOTH NEUROMUSCULAR BLOCKING
CARDIOVASCULAR AND AGENTS
RESPIRATORY SYSTEMS
● HYPOTHERMIA: MAJOR
COMPLICATION: CLOSELY
MONITOR VITAL SIGNS ESP. NURSING DIAGNOSES
TEMPERATURE ● ACTIVITY INTOLERANCE
● SHOCK AND HEMORRHAGE: ● DANXIETY
CLOSELY MONITOR FOR ● CONSTIPATION
HYPOXIA(RESTLESSNESS due to ● DECREASED CARDIAC OUTPUT
hypoxia and not PAIN); ● ΡΑΙΝ
PROPHYLACTIC ● IMPAIRED VERBAL
ADMINISTRATION OF OXYGEN IS COMMUNICATION
BENEFICIAL; CLOSELY MONITOR ● FEAR
BLOOD LOSS (I AND O) ● FLUID VOLUME DEFICIT
● INAPPROPRIATE ● POTENTIAL FOR INJURY
ADMINISTRATION OF NARCOTIC
COULD FURTHER DEPLETE THE EMERGENCY CARE
BODY'S OXYGEN SUPPLY ● MAINTAIN LIFE FUNCTIONS
● STRICT STERILE TECHNIQUE IN (HOMEOSTASIS)
CARING FOR SURGICAL ● PREVENT AND TREAT SHOCK
WOUNDS/CHANGE DRESSINGS ● CONTROL BLEEDING
● GOOD NUTRITION STATUS ● PREVENT COMPLICATIONS
● RELIEF OF PAIN ● KEEP PATIENT PHYSICALLY AND
● REGULAR BOWEL AND BLADDER PSYCHOLOGICALLY
ELIMINATION COMFORTABLE
● KEEP JOINTS MOBILE ● OBSERVE AND RECORD SIGNS,
● MAINTAIN COMFORTABLE TREATMENTS AND RESPONSES
POSITION ● ASSESS CAUSATIVE FACTORS
● OBSERVE RESPIRATORY ● OBTAIN XRAY OR ECG OR ANY
COMPLICATIONS: PNEUMONIA DIAGNOSTIC PROCEDURE
PULMONARY EMBOLI, NEEDED TO AID DIAGNOSIS
ATELECTASIS
● *OBSERVE FOR SELECTED EMERGENCY CONDITIONS
CARDIOVASCULAR FOR OLDER ADULTS
COMPLICATIONS (CVA, MI, ● ACUTE CONFUSION/DELIRIUM
EMBOLI, THROMBI, ● DEHYDRATION
ARRHYTHMIAS) ● FALLS
● PRESSURE ULCERS PREVENTION ● MYOCARDIAL INFARCTION
● DRUG-INDUCED RENAL FAILURE: ● INFECTIONS
CIMETIDINE, DIGOXIN,
AMINOGLYCOSIDES, DISCHARGE PLANNING FOR OLDER
CEPHALOSPORINS, AMPICILLIN, ADULTS
 ● EARLY AND COMPETENT assistance to other family members beyond that
DISCHARGE PLANNING TO required as part of normal everyday life'
PREVENT COMPLICATIONS, (Walker et al 1995)
REDUCE RISK OF RE-
HOSPITALIZATION AND MINIMIZE Family caregiving is often equated with
STRESS TO THEMSELVES AND informal caregiving, which refers to the 'unpaid
THEIR CAREGIVERS care provided to an older and dependent person
by someone with whom they have a social
● NURSE SHOULD ASSESS POST relationship, such as a spouse, parent, child,
DISCHARGE NEEDS, MAKE other relative, neighbor, friend, or other non-kin'
REFERRALS AND SUGGEST HOME (Triantafillou et al 2010) - UNPAID
PREPARATIONS CAREGIVING

FAMILY CAREGIVING FOR OLDER There are three distinct groups receiving
ADULTS informal care, roughly defined by the age of
the care recipients:
TERMINOLOGIES: • Children with chronic illness and disability
● SANDWICH GENERATION: who are typically cared for by young adult
middle-aged persons who are caring for parents
their own children and their parents •Adult children suffering from conditions such
(kasama lolo, lola at magulang) as mental illness who are cared for by middle
aged parents
● SKIPPED GENERATION • Older individuals who are cared for by their
HOUSEHOLD: household in which spouses or their middle-aged children.
grandparent is raising minor grandchild
with no parent present (alagang • Family caregivers play a key role in delaying
lola/lolo) and possibly preventing institutionalization of
chronically ill older patients. Although
● CAREGIVER BURDEN: stresses, neighbors and friends may help, about 80% of
challenges and negative consequences help in the home (physical, emotional, social,
associated with providing assistance to a economic) is provided by family caregivers.
person in need (challenges ng mga
caregiver) • When the patient is mildly or moderately
impaired, a spouse or adult children often
● ELDER ABUSE: the infliction of provide care, but when the patient is severely
physical or emotional harm, neglect, disabled, a spouse (usually a wife) is more
financial exploitation, sexual likely to be the caregiver, often along with
mistreatment or abandonment of an others in or outside the family.
older adult
•Approximately 39 million Americans, more
WHAT IS FAMILY CAREGIVING? than 16% of the US population, were estimated
to have served as an unpaid caregiver for
Family caregiving is defined as occurring when someone age 50 or older in the year 2020.
one or more family members give aid or
•About 38% of people ≥ 80 years and 76% of ALL PERSONS FULFILLING SIGNIFICANT
people ≥ 90 years require routine help with self- FAMILY FUNCTIONS SHOULD BE
care and household tasks. INCLUDED IN THE DEVELOPMENT AND
EVALUATION OF THE CARE PLANS OF
•The Philippine Elderly Survey 1996 found that OLDER ADULTS
44% of older Filipinos received some form of
care from their children (Concepcion and Perez,
2006) Family members roles
•Cruz et al (2016 using data From the 2007 ● Decision-maker
Philippine Study of Aging reported that 48% of ● Caregiver
older Filipinos expect their children to take care ● Deviant (blacksheep)
of them in times of illness while 35% mentioned ● Dependent
their spouses as possible ● Victim
Caregivers.
FAMILY DYNAMICS AND
THE OLDER ADULT’s FAMILY RELATIONSHIPS
● Couples (married, unmarried, Dynamics among family members can have
heterosexual, and same sex) positive or negative effects on older
● Couples with children (married, individuals. In assessing the family unit, it is
unmarried, heterosexual, and same sex) useful to explore the following issues:
● Parent and child or children
● Siblings • HOW THE FAMILY MEMBERS FEEL
● Groups of unrelated individual ABOUT EACH OTHER
● Multigenerations • MANNER OF COMMUNICATION
•ATTITUDES, VALUES AND BELIEFS
• LINKS WITH ORGANIZATIONS AND THE
Identification of family members who COMMUNITY
perform family functions for the older adult
Impact of Family Roles
Ask the following questions: • Nurses must be sensitive to the fact that certain
● Who checks on them personally? "negative" roles may not have the adverse
● Who shops with or for them? effects on the family unit that would be
● Who escorts them to the clinic or anticipated; likewise, "positive" roles may not be
physician? welcomed by the family
● Who assists with or manages their
problems? • Remember: even seemingly negative roles can
● Who takes care of them when they are be fostered by and meet certain needs of the
ill? family
● Who helps them make decisions?
● Who assists them with banking, paying Family Dynamics
bills and managing financial matters? • How family members feel about each other?
● Whom they seek for emotional support? • Manner of communication
•Attitudes, values and beliefs
• Links with organizations and the community
 • The average woman will spend more time
SKIPPED-GENERATION HOUSEHOLDS providing care for parents and children often
● DEFINED AS: household in which they are called " sandwich generation
grandparent is raising minor grandchild •The average woman will spend more time
with no parent present providing care for parents and children often
● 9 out of 10 older people are they are called " sandwich generation"
grandparents • SANDWICH GENERATION: middle-aged
● Grandparents assume parenting persons who are caring for their own children
responsibilities and their parents
● Grandparents raise grandchildren with
no parents present
● Grandchildren can provide new interests Types of assistance families provide to their
and meaning to life. In turn, older member
grandchildren usually receive the benefit
of unconditional love and attention ● Maintaining and cleaning home
● As grandchildren grow, their ● Managing finances
involvement with grandparents often ● Shopping
lessens but a strong bond continues to ● Transporting
exist ● Providing opportunities for socialization
● SIBLING RELATIONSHIPS: siblings ● Advising
can provide socialization, emotional ● Explaining
support and financial and household ● Troubleshooting
assistance ● Accompanying to the doctor
● Relationships in old age are affected by ● Negotiating services
the forms of relationships experienced ● Cooking
throughout life (parents who ignored or ● Reminding to case medications keep
abused their children early in life appointments, Take actions
produce children who want nothing to ● Monitoring and administering
do with them in adulthood) medications
● Remember: children who feel their ● Performing treatments
parents were insensitive to their needs ● Supervising, protecting, bathing and
throughout their lives may be reluctant dressing, feeding, toileting, assisting in
caregivers to these parents in old age decision making and maintaining files of
health. documents
SCOPE OF FAMILY CAREGIVING
• Most of home care of older persons is provided Health documents caregivers should maintain
by family members not formal agencies in a file
• It is estimated that more than 10 million people ● Birth certificate
are involved in parent care, approximately half ● Social security and Medicare numbers
of whom provide care on a regular basis ● Person's employment history
• More than 45% of caregivers are 65 years of ● Insurance policies
age or older themselves ● Advance directives
• Nearly half of caregivers are wives, nest: ● Durable power of attorney
daughters and daughters in law ● Wills
 ● Deeds •Nurses recommend to long distance caregivers
● Prepaid funeral arrangements, cemetery that their plan their visits at times when medical
plots appointments are scheduled so that they can
● Military discharge records receive direct information about health care
● Titles to vehicles owned status and care and ask many questions that they
● Sources of income may have
● Monthly expenses
● Bank accounts, safe deposit boxes
● Debt (Morten pes, credit card, personal) • CAREGIVER BURDEN: stresses, challenges
● Recent tax returns and negative consequences associated with
● Location of valuables owned providing assistance to a person in need

LONG DISTANCE CAREGIVING TLC for Caregivers

● An individual who assists someone in • T- training in care techniques
need of care who lives more than 1 how • L- leaving the care situation periodically
away • C-aring for themselves by having adequate
● 'The assistance offered can include sleep, rest, exercise, nutrition, socialization,
managing and coordinating in-home solitude, support, financial aid, stress reduction
care, managing finances and providing and health management
respite
● They begin with occasional visits, NURSING STRATEGIES TO ASSIST
telephone calls and troubleshooting and FAMILY CAREGIVERS
then progress to daily telephone calls • Guide the family to view the situation
and regular visits to the person's home realistically
• Provide information that can assist in
NURSES ROLES IN LONG DISTANCE anticipating needs
CAREGIVING Assess and monitor the impact of the caregiving
on the total family unit
•Nurse guide families in their decision making • Introduce and promote a review of care options
about long distance caregiving responsibilities
by helping them review the task needed by the Elder Abuse
person and to evaluate which family members is • 1 out 10 individuals over the age of 60
the best able to assist experiences some form of abuse
• ELDER ABUSE: the infliction of physical or
•Nurse can link families with services in the emotional harm,
person’s community as well resources to educate neglect, financial exploitation, sexual
them about care and condition of the older mistreatment or abandonment of an older adult
family members • Profile of older adults at greatest risk for
abuse: disabled woman, older than 75 years of
•Nurses should advise long distance caregivers age, who lives with a relative and is physically,
about what issues they should review during socially, financially dependent on others.
telephone calls with their relatives that can aid in
identifying needs, risk and changes in status.
Forms of elder abuse
● Infliction of pain or injury
● Withholding of food, money, END OF LIFE CARE
medications or care
● Confinement, physical or chemical Introduction
(drug) restraint • DEATH is an inevitable, universal experience,
● Thich or intentions) mismanagement of common to all. However, it is a
assets reality that majority of deaths occur among older
● Sexual alone adults
● Verbal in emotional al isp • Gerontological nurses will need competency in
● Neglect assisting individuals with the dying process
● Abandonment •A holistic approach is needed- in which the
nurse assures that the dying individuals and their
Why elder abuse happens? loved ones are provided physical, emotional and
• Abuse can be associated with family pattern of spiritual support
violence,
emotional or cognitive dysfunction of the abused PALLIATION - Relief of symptoms and
or suffering caused by cancer and other life-
abuser threatening diseases. Palliation helps a patient
• abusers may be distressed persons coping feel more comfortable and improves the quality
ineffectively in of life, but does not cure the disease.
caregiving
PALLIATIVE CARE - Palliative care is an
Stop the abuse interdisciplinary medical caregiving approach
•Nurses can assess for abuse using a tool such as aimed at optimizing quality of life and
the Elder Mistreatment Assessment Instrument mitigating suffering among people with serious,
developed by Fulmer (2012) complex, and often terminal illnesses. Within
• Nurses must manage potentially abusive the published
situations tactfully literature, many definitions of palliative care
•Once abuse is detected, the nurse needs to exist.
assess the degree of immediate danger and take DEFINITIONS OF DEATH
appropriate actions • FINAL TERMINATION OF LIFE
•Assure abused persons that their plight will not •CESSATION OF ALL VITAL FUNCTIONS
be worsened by making the abuse public •THE ACT OR FACT OF DYING
•Ongoing interventions are necessary to prevent
future abuse after immediate episode had been
resolved
HOSPICE CARE
Rewards of Caregiving • Hospice care is a type of health care that
Caregiving experiences provide opportunities focuses on the palliation of a terminally ill
for relatives to learn more about each other as patient's pain and symptoms and attending to
individuals and to obtain their emotional and spiritual needs at the end of
gratification in the young giving something back life. Hospice care prioritizes comfort and quality
to the aged who may have sacrificed for them of life by reducing pain and suffering.
• Most hospice care is provided in the home and 1. Denial: "The doctor is wrong.
nursing home settings 2. Anger: "Its unfair, why me?"
• First hospice program: St. Christopher's 3. Bargaining:"I'll be kinder if I can just
Hospice in London live to see my grandson graduate.
• First hospice in the USA: Hospice Inc. New 4. Depression: "What's the point of living
Haven, Connecticut (1974) another day."
• Hospice care aids in adding quality and 5. . Acceptance: "I've had a good life.
meaning into remaining period of life.
• The care involves interdisciplinary efforts to Nurses role in the 5 stages of dying
address. physical, emotional, and spiritual needs • Denial: nurse should try to accept the dying
including pain person's use of defenses rather than focus on
relief, symptom control, home care and conflicting messages; provide an open door for
institutional honest dialogue
care coordinated among an interdisciplinary • Anger: assess behavior and be accepting,
team, social work and counseling services, implying that it is fine to vent feelings of anger;
medical equipment and nurses may discuss their feelings about patient's
supplies, volunteer assistance and support and anger with an objective colleague who can serve
bereavement follow-up and counseling as a sounding board
• Bargaining: nurses must explore covert
STAGES OF DYING feelings of bargaining with the dying person
Elizabeth Kubler-Ross developed a conceptual • Depression: touch like holding their hands or
framework sitting
outlining the coping mechanisms of dying in silently with the dying patient; allow moments
terms of five stages. of silence,
• The nurse needs to be familiar with these prayers or intentions of seeing clergy
stages to be able to provide the most therapeutic • Acceptance: Touching, comforting and being
nursing interventions during each stage near the
• Not all dying persons will progress thru the 5 dying person are valuable nursing actions
stages in an orderly sequence
PHYSICAL CARE CHALLENGES
● Denial: denying the reality of situation • Pain: Palliative care is a care that prevents and
● Anger: dying person expresses the relieves pain in persons with incurable
feeling that nothing is right conditions, nurses must regularly assess pain,
● Bargaining: dying person may attempt encourage patient to report pain in timely
to negotiate postponement of the manner utilizing pain scale of 0-10, the goal of
inevitable pain mgt is to prevent pain
● Depression: being silent, there is interest • Assess the pattern of pain then administration
in prayer of analgesics
● Acceptance individual has come to is scheduled.
terms with death and has found a sense
of peace PREVENTION OF PAIN
• For the dying patient, the goal of pain is mgt is
5 STAGES OF DYING TO PREVENT PAIN FROM OCCURRING
Elisabeth Kubler-Ross
RATHER THAN TO RESPOND TO IT AFTER - CONSTIPATION
IT OCCURS - POOR NUTRITIONAL INTAKE
• PAIN PREVENTION NOT ONLY HELPS
PATIENTS AVOID RESPIRATORY DISTRESS
DISCOMFORT BUT ALSO ULTIMATELY ● Common problem in dying patients
REDUCES THE AMOUNT OF ANALGESICS NURSING ACTIONS
THEY USE - Elevate head of bed
- Pacing activities
REMEMBER - Teach relaxation exercises
• PATIENTS PERCEIVE AND EXPRESS - Administer oxygen
PAIN DIFFERENTLY BASED ON THEIR - Atropine or furosemide to reduce
MEDICAL DX, EMOTIONAL STATE, bronchial secretions
COGNITIVE FUNCTION, CULTURAL - Narcotics to control respiratory
BACKGROUND AND OTHER FACTORS symptoms
•ABSENCE OF EXPRESSION OF PAIN
(imitability, restlessness, anxiety, nausea) does CONSTIPATION
not mean pain does not exist in the person. Some NURSING ACTIONS
patients do not overtly express their pain • Increasing activity
•Clues such as sleep disturbances, reduced • Increase intake of fluids and fibers
activity, diaphoresis, pallor, poor appetite, • Laxatives are given regularly
grimacing and withdrawal (in some instances; • Bowel elimination pattern is recorded and
confusion) may provide ches to presence of pain assessed

PAIN MEDICATION POOR NUTRITIONAL INTAKE

• Depends on the intensity of pain: NURSING ACTIONS
•Aspirin, acetaminophen for mild pain • Serve small portioned meals that have alluring
• Codeine or oxycodone for moderate pain appearances and aromas
• Morphine or hydromorphone for severe pain • Provide favorite food
•Contraindicated: Meperidine and pentazocine • Control nausea and vomiting with antiemetics
for older adults due to high incidence of and antihistamines
psychosis • Taking ginger ale (NATURAL
ANTIEMETIC)
ALTERNATIVE PAIN PROGRAM •Assist with oral care, offering clean and
● Guided imagery pleasant environment for dining
● Hypnosis • Pleasant company during mealtime
● Relaxation exercises •Assisting feeding if necessary
● Massage, acupressure
● Acupuncture SPIRITUAL NEEDS
● Therapeutic touch, diversion ● Respect religious practices of client to
● Application of heat or cold promote spiritual needs
● To determine the significance of
CONDITIONS THAT MAY ADD TO THE spirituality and spiritual needs nurses
DISCOMFORT OF LYING CLIENT can ask the ff questions:
- RESPIRATORY DISTRESS
• What gives you the strength to face life's • Clergy may be called depending on the wishes
challenges? of the patient
• Do you feel a connection with a higher being • Do not leave the patient alone
or spirit? • Even if a client is unresponsive, the client
• What gives your life meaning: should be spoken to and touched.
● Clergy and congregation members of the • The last sense to go is hearing
faith group to which the patient belongs
should be invited; ensure prayers Supporting family and friends
offered are consistent with patient's • Offer appropriate support throughout the
belief system process of
dying and death may prevent unnecessary stress
RELIGIOUS BELIEFS AND PRACTICES and may
RELATED TO DEATH provide immense comfort to those involved with
● Baplist: prayer, communion the dying
● Catholic: last rites by priest, prayer
● Buddhist: last rites by buddhist priest SUPPORTING NURSING STAFF
● Hindu; risit br priest to perform ritual of •Staff working with dying patients need support
tying thread around peck or wrist, water • Nurses need to explore their own reactions to
put in mouth family cleanses body after death
death, cremation accepted experiences
● Jewish: after death washed by religious •Acknowledgment of feelings
person •Resource people available to assist nurses
● Muslim: confession, prayers from the through
Quran, Family prepares body after providing support
death, decease must lace Mecca
● Pentecostal: prayer, communion REMEMBER; • NURSING STAFF SHOULD
● Seventh day Adventist: baptism, BE ENCOURAGED TO EXPRESS THEIR
communion FEELINGS ABOUT PATIENT'S DEATHS

Signs of imminent death

(SLOWER BODILY FUNCTIONS)
• Decline in BP, rapid, weak pulse, dyspnea and
periods of apnea
• Slower or no pupil response to light
• Profuse perspiration, cold extremities
• Bladder and bowel incontinence, pallor and
mottling (spotting) of skin
• Loss of hearing and vision

NURSING ROLE APPROACHING DEATH

• Notify family
* Remain with the patient if family is not
present