Comprehensive Gerontological Nursing Study Guide
Introduction to Gerontology and Clinical Terms
Gerontology Etymology and Definition: * The term gerontological is derived from two Greek words: * Gero: Meaning related to old age. * Ology: Meaning the study of. * The word gerontology refers to the comprehensive study of the complex topic of human aging. * Wait, it covers more than just biology; it includes physical, emotional, social, spiritual, and economic considerations.
Critical Activity for Holistic Care: * According to the third paragraph on the right side of page five, the single most critical activity to promote holistic care is listening.
Social Determinants and Nursing Philosophy
Social Determinants of Health (SDOH): * These are defined as the conditions in which people are born, live, learn, work, play, worship, and age. * SDOH are nonmedical factors that constitute the majority of an individual's health, well-being, and quality of life. * In clinical settings, these are frequently viewed as negative factors. Specific examples include: * Living in an unsafe neighborhood. * Living alone (social isolation). * Inability to afford adequate medical care, food, or transportation. * Understanding these determinants is essential for the LPN role to provide effective holistic care.
Developing a Nursing Philosophy: * A nursing philosophy serves as a personal guide and a measure for the work a nurse performs. * It is a personal statement that comes from within the individual. * For a beginning nurse, a philosophy may start as a simple physiological statement that evolves as they gain education and clinical experience. * It defines the nurse's "purpose" and the "why" behind their practice.
Physiological Theories and Physical Changes of Aging
Theories of Aging: * There are three primary physiological theories categorized under biological aging: 1. Genetic Factors. 2. Wear and Tear. 3. Nutrients.
Integumentary System and Thermoregulation: * Body temperature regulation is impaired in older adults due to decreased sweat production. * Older adults may not exhibit diaphoresis (sweating) even with elevated body temperatures. * Baseline Temperature Importance: Because older adults often have lower baseline temperatures (e.g., ), a temperature of might actually indicate a fever for them. Nurses must know the patient's individual baseline.
Gastrointestinal (GI) Changes: * Older adults often experience a feeling of fullness after eating only small amounts of food. * This is caused by the slowing of peristalsis and the loss of smooth muscle tone, which results in delayed gastric emptying.
Functional Ability and Mobility
The Concept of "Function": * In the context of gerontology, function refers to the older adult's ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). * Functional independence is a key component of the individual's quality of life. * As age-related changes increase in number and intensity, functional independence is often jeopardized.
ADL Assessment Tasks: * Standard ADLs include: * Bathing. * Dressing. * Toileting. * Eating. * Ambulating. * Transferring. * Continence. * The Katz ADL Scale is a widely used tool to assess these abilities.
Bladder Health and Incontinence
Stress Incontinence: * This involves the leakage of urine that occurs during physical exertion such as coughing, sneezing, laughing, or lifting. * While urinary incontinence is not a normal outcome of aging, cumulative damage to pelvic floor muscles (often from pregnancy and childbirth) contributes significantly to stress incontinence. * Management: Pelvic floor exercises (Kegels) are an effective strategy to strengthen muscle tone and prevent leakage.
Functional Bladder Changes: * Decreased bladder capacity can lead to frequent urination, nocturia, and retention of urine. * These changes may lead to infection, urgency, and dysfunction.
Promoting Continence vs. Bladder Training: * Bladder Training: Usually involves voiding at a set interval, such as every , to increase capacity. * Prompted Voiding (Promoting Continence): The goal is to teach awareness of needs. The schedule follows natural triggers: upon awakening, before meals, at bedtime, and if awakened at night.
Sleep, Rest, and Exercise
Sleep Disturbances: * Common disorders include insomnia and sleep apnea. * Other causes of disruption include frequent nocturnal urination (nocturia), GERD (acid reflux), COPD, heart failure, depression, anxiety, and side effects of medications. * Intervention: Raising the head of the bed is beneficial for patients with COPD, heart failure, GERD, and sleep apnea.
Exercise Program Components: * A properly designed exercise program for older adults must include three key components: 1. Strengthening. 2. Flexibility. 3. Endurance.
Incentives for Health Promotion: * Studies show older adults participate in health promotion when they believe: * Activities improve fitness and health. * They enjoy the socialization aspect. * Activities help maintain independence. * Significant others influence their participation.
Nutrition and Therapeutic Diets
Nutritional Risk Factors: * Weight loss in older adults is typically tied to physical changes (e.g., taste, digestion) or socio-environmental changes (e.g., affordability, location).
Carbohydrates and Dietary Management: * Simple Carbohydrates: These come from milk and foods with high sugar content. * Therapeutic Diets: These are specialized diets for specific conditions, such as Diabetics (carbohydrate control), Heart Failure (sodium restriction), Stroke (texture modification), or Chronic Kidney Disease (fluid restrictions).
Cognitive Health: Dementia, Delirium, and Sun-Downing
Dementia and Safety: * Sun-Downing: Cognitive and functional impairment that exacerbates in the evening hours; symptoms include wandering, confusion, and agitation. * Pick’s Disease (Frontotemporal Dementia): A rare form of dementia in late middle age characterized primarily by early and significant changes in personality.
PLST Model (Progressive Lowered Stress Threshold): * This model focuses on decreasing stressors in the environment to assist patients with dementia. * Interventions include decreasing options (offering only two choices) and reducing overstimulating environmental triggers to prevent acting out.
Nursing Process and Clinical Judgment
Definitions and Steps: * The nursing process is a problem-solving model that describes what nurses do. * Planning Phase: Includes setting priorities, goal setting, and designing/documenting a care plan. * Goals must be specific, measurable, and appropriate for the patient.
Clinical Judgment Model: * Consists of four aspects: Noticing, Interpreting, Responding, and Reflecting.
Interdisciplinary Team and CNA Role
- Interdisciplinary Team (IDT) Collaboration: * To be successful, nursing interventions must include input from the CNA (Certified Nursing Assistant). * CNAs are vital because they spend more time with residents in nursing facilities, assisted living, and retirement communities than any other member of the IDT.
Professional Standards: Nurse Practice Acts and State Regulations
- State Variations: * Nurse Practice Acts vary from state to state. * Every nurse is legally responsible for being familiar with the specific act in the state where they are currently practicing. * If a nurse practices in multiple states, they must know the differences between each state's laws.
Rights, Ethics, and Mandated Reporting
Patient Autonomy and Refusal of Care: * Competent individuals have the legal right to refuse any therapy or treatment, such as the placement of a pacemaker, even if the procedure is benign and refusal results in death. * The nurse’s role is to educate the patient, respect the decision, and verify competence, but not to argue or force care.
Sexual Rights and Intimacy: * Every human being has the right to express sexual feelings and have intimacy needs met. * As long as the behavior occurs in a private location, is appropriate, and involves consent, nurses should not interfere. This includes acts such as masturbation.
Mandated Reporting (Elder Abuse): * Nurses are mandated reporters under the law. * They are responsible for reporting all suspected cases of elder abuse. This is a legal obligation to protect the patient, regardless of personal discomfort.
Patient Safety and Environmental Management
Environmental Management: * The first step is the assessment of the environment where the older adult lives. * Home Modifications for Mobility: For patients in wheelchairs, accommodations include installation of a ramp, lower sinks, accessible countertops, and bathroom renovations.
Restraint-Free Environment: * Creating a restraint-free facility requires education on clear definitions and alternatives to restraints. * Appropriate Interventions: Redirecting, rounding, and addressing specific needs (like the need to use the bathroom). * Safety with Physical Restraints: If used, nurses must use the least restrictive device, check the patient frequently, and remove restraints every for a brief period. * Note: Bedrails and restraints to prevent a patient from getting up to use the bathroom are often inappropriate.
Relocation Stress Syndrome: * Signs and symptoms include disorientation, agitation, acting out, and hallucinations.
Safety Bag Items: * Standard items for a safety bag are listed in Box 7.6 on page .
Temperature Safety: * Hypothermia Signs: Refer to Box 7.2. * Hyperthermia Prevention: Mitigate heat-associated risks through proper cooling and hydration strategies.
End-of-Life Care, Grief, and Advanced Directives
The Living Will: * This is a legal document detailing an individual's wishes regarding their death while they are in a competent state of mind. * Legal Precedence: The living will must be followed regardless of family wishes. If a living will states "no intubation," a family member cannot change this during a code situation. * Types of treatments included in a living will can be found on page .
Five Stages of Grief (Elisabeth Kübler-Ross): 1. Denial. 2. Anger: Patients or families may yell; the nurse should stay calm and ensure safety. 3. Bargaining. 4. Depression. 5. Acceptance.
Hospice Care and the LPN Role: * Hospice focuses on managing pain and symptoms, providing medications/equipment, and supporting the family through the emotional/spiritual aspects of dying. * Respite Care: Provides a break for the primary caregiver to attend to their own needs.
Psychological Assessment and Mental Health Groups
Assessment Factors: * Successful psychological assessments require proper timing, privacy, elimination of interruptions, and a positive introduction. * Education Factor: The educational level of the person influences test results and must be considered during scoring. * Scores: A lower score may indicate a suspected mental illness.
Therapeutic Groups: * Reminiscence and Life Review: Assists older people in reviewing their lives to find appreciation or resolve old issues. * Groups like Reminiscence, Remotivation, and Resocialization are particularly effective for those with low self-esteem. * Failure to Thrive: Often associated with depression (the "giving up complex") and malnutrition.
Infection Control: * CDC Handwashing: Soap, water, and friction for a minimum of . * UTIs: Often manifest as new-onset confusion in older adults. Nurses should check vitals and compare them to baseline temperatures. * Drug Resistance: Caused by the overuse and inappropriate prescription of antibiotics.
Health Management and Chronic Conditions
Chronic vs. Acute: * Chronic Conditions: Develop over time and often go unnoticed until major deficits manifest. * Acute Conditions: Develop quickly.
Stroke Management: * Hypertension: The most important changeable risk factor for stroke. * Hemispheric Differences: Nurses must know the difference in behaviors associated with Right vs. Left side hemisphere strokes. * Dysphagia: Difficulty swallowing, a major complication following a stroke that increases aspiration risk.
Shingles (Varicella Zoster): * Caused by the same virus as chickenpox; anyone who had chickenpox can develop shingles. * Painful skin rash with blisters; vaccination is recommended for older adults because they are more susceptible.
Questions & Discussion
Discussion on "Focus With Me" Study Tool: * A student mentioned just learning how to use the "focus with me" tool after attempting to study entire chapters (e.g., ) instead of looking at the specific highlighted portions. The teacher agreed that it makes the process more efficient and that future classes should be explicitly taught how to utilize it from the beginning.
Discussion on Mandated Reporting: * A student expressed hesitation about getting into the "line of fire" regarding elder abuse reporting. The instructor clarified that in the workplace, you are a mandated reporter, and the focus is on protecting the patient, not personal involvement in a conflict.
Exam Details: * The upcoming exam consists of questions. * Includes to Select All That Apply questions.