Mental Health Chapter 31 (part 2)

What are late onset use problems of alcohol use disorder? (7)

What are late onset use problems of alcohol use disorder? (7)

*Retirement
*Widowed
*Loneliness
*Male
*Less than high school education
*Cigarette smoking
*Depression

How is assessment for pain in older adults? How should pain be assessed? How might older adults describe pain? What might hinder assessment?

-Often inadequate assessment by health professionals

-Open ended questions + pain scale - best

-Older adults might use milder words to describe

-Sensory impairments, memory loss, dementia, depression may hinder assessment- use family, caregivers, friends.

What are examples of assessment tools for pain? (2) (pg 571-573)

-Wong-Baker FACES pain rating scale
-Pain assessment in advanced dementia (PAINAD)-neurocognitive disorders

What is administration of analgesics for pain management like? Why should they used with caution? What is an effective analgesic? What is a risk with NSAIDs? What meds are used initially and what narcotic is used?

-Safe administration of analgesics complicated
-Caution- many adverse drug reactions
-Acetaminophen effective analgesic
-NSAIDS - risk of GI bleeding
-Anticholinergics, NSAIDS (initial), Pentazocine -(Talwin) narcotic, pain management, can cause confusion
-pg 568 box 31.2

What kind of meds are used for moderate to severe pain? But why should they be avoided? What is an example of a med and it's side effects (3)? What function is assessed? What is a better choice for meds (3)?

*Opiates - greater analgesic effect and longer duration
*But...Avoid... metabolic accumulation
*Meperidine - confusion, seizures, mood alterations
*Assess bowel function- constipation frequent side effect of opiates
*Better choice - pain modulators- Neurontin(Gabepentin),SNRI's, tricyclics

What insufficiency occurs with opioids? What doses should be given? What are risks with opioids?

*Renal insufficiency often occurs- metabolite accumulation
*Low doses
*Risks- falls, fractures, hospitalizations

What are non-pharmacological pain management? (4)

*Physical therapy
*Heat and cold packs
*Yoga
*Massage
*Pg. 569

What can financial issues cause a risk for? How much are healthcare expenses compared to the younger population? What is education is important?

-Can be a risk for Mental Health Issues and medical problems
-Healthcare expenses nearly 4 x greater than younger population
-Education about resources important part of care.

What is caregiver burden? What generation experiences this? What education is important?

-Amount of financial, physical, social support
-"Sandwich Generation" care of older parents and care of young children
-Education about resources important - Page 569

What are examples of legal policies?

*Full code
*DNR-CCA
*DNR-CCO
*Ethical Dilemmas
*Guardianship, Advance Directives, Power of attorney

What are facts vs myths of aging?

pg 571, box 31.5

What are assessment strategies for older adults?

• Conducting the interview in a private area.
• Introducing oneself and asking patients what they would like to be called (unless you are an older adult, the use of the first name is rarely appropriate unless you are asked to do so).
• Establishing rapport and putting the patient at ease by sitting or standing at the same level as the patient.
• Ensuring that lighting is adequate and noise level is low in recognition of the fact that hearing and vision may be impaired.
• Using touch (with permission) to convey warmth while at the same time respecting the patient's comfort level with personal touch.
• Summarizing the interaction, inviting feedback and questions, and thanking patients for giving their time and information.

What is part of the nurses role in terms of medication?

-Importance of medication reconciliation

*Prescribing cascades

-Pharmacists can be very helpful

-Patient and family medication education

-Beers List (https://straightanursingstudent.com/beers-list-explained/): inappropriate prescribing of medication as those drugs whose risks outweigh the benefits, namely as it relates to the geriatric population

What is polypharmacy?

Risk of adverse reactions: doubles when taking 5 to 7 medications, Increases four times 8 or more medications

What is the geriatric depression scale? (pg 573, box 31.6)

What are examples of care settings for older adults?

*Skilled nursing facilities
*Residential care settings
*Partial hospitalization
*Day treatment programs
*Behavioral health home care
*Community-based programs