vn057 gerontology 4. health promotion what do you think?

VN057 gerontology 4

Health promotion

• What do you think?

Assistance at home• What are the needs/goals?• Family, friends, neighbors, spouse• Unskilled• Home health aide• Licensed

– Rn assessment of need/environment– LVN

• Case management• hospice

Patient rights

• The individual has the right to not comply with your plan

• Thoughts?

skills

• Informing• Direct questions• Open ended strategies

– Therapeutic communication• Confronting

– Generally used only when there are inconsistencies• Know your audience….• Patient teaching

communication

• Tone of voice– Lower tone easier for elderly

• Space, distance, position• Pace, timing• Touch

– Cultural considerations

communication• Verbal vs non-verbal• Formal vs informal• Cultural considerations

– Different styles– Direct vs indirect

• Slang: different meanings to the same words• Medicalese

– Problems and misunderstandings

More on Medicalese

• As you’re learning….

– Medicalese is like learning another language– You learn the new language in bits and pieces

during your program/class– Your client hasn’t had the benefit of classes to

learn the new language– Remember, if you speak to your client in another

language, they won’t be able to understand you

Medicalese• Hey mom, what’d the doctor say?• “I don’t know”• Did you have a heart attack after all?• “I don’t know”• What did the doctor say?• “A bunch of stuff I didn’t understand”

Medicalese

• I’m going to take your vitals• I’m going to do your assessment• This is your antihypertensive • It’s to treat your myocardial infarction and the

side effect is orthostatic hypotension• It’s for your seizure disorder [off label uses ]

Nutrition

• Adequate calories– Medications– Changes in taste– Reduced appetite

• Nutrient density– Not calorie density

Caloric Intake

• Many factors influence how many calories will be used by a person– Activity patterns– Gender– Body size– Age– Body temperature– Emotional status– Temperature of the climate in which the person lives

Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

13

Nutrients

• Foods high in nutritional value and relatively low in calories must be selected to maximize the amount of nutrients the body receives while reducing the number of calories

• Vital nutrients needed by all people include carbohydrates, protein, fats, vitamins, minerals, and fluids


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Distribution of calories

• Old food pyrimid


• New food pyrimid


• My plate…

Distribution of calories• Protein-4 cal/gram

– Tissue repair and maintainence. – Fluid balance

• Carbohydrates-4 cal/gm– Energy; fiber source; many vitamins

• Fats-9 cal/gm– Energy; fat soluble vitamins– Hormone production & balance, inflammation– Can be good or bad

• Alcohol-7 cal/gm– No nutritional benefit– Truly “empty” calories

Vitamins

• Organic compounds found naturally in foods• Needed for a variety of metabolic and

physiologic processes• Fat-soluble vitamins include vitamins A, D, E,

and K• Water-soluble include the B-complex vitamins

and vitamin C

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Minerals

• elements required in many of the body’s functions as well as structure

• small proportion of total body weight, yet a slight mineral imbalance can have serious effects– Seizures; heart stops….

• Calcium, phosphorus, iron, sodium, potassium, magnesium, manganese and zinc

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Poor Nutrition Checklist


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fluids

Water• Essential for normal body functioning• Needed to form many of the body’s secretions,

including tears, perspiration, and saliva• Aids in digestion and transport of electrolytes

and nutrients• Elimination of waste products

– Bowel– bladder

• temperature regulation

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Factors Affecting Nutrition in the Elderly

• Physiologic risk factors– Chronic health factors– Alcoholism– Sensory changes– Pain– Medications– Problems with chewing, swallowing, or digesting– Malabsorption

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Factors Affecting Nutrition in the Elderly (cont.)

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• Economic risk factors– Cost – transportation– Obtaining variety and amount of food

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• Social risk factors– Depression– Loneliness or social isolation– Lack of motivation

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Social and Cultural Aspects of Nutrition

• More than a means of meeting nutritional needs

• Religious ceremonies• Social interactions• Cultural expression• Many major religions, such as Islam, Judaism,

and Catholicism, include some dietary restrictions

• Good nutrition can be achieved in any culture28

Assessment: risk for imbalanced nutrition

• Appetite changes• Nutritional intake-can be food or fluid

– Swallowing problems; obtaining food; feeding ability• Social and cultural factors

More or less than body requirements

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Chapter 7Medications and Older Adults

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Geropharmacology• The study of how older adults respond to

medication • Drug testing & establishing therapeutic

dosages does not take into account unique needs of older adults

• Older adults normally have some change in body function

• likely to suffer from at least one disease process

• not physiologically the same as younger adults31

Pharmacokinetics• Study of drug actions in the body: absorption,

distribution, metabolism, and excretion• Drug absorption

– Gastric acid secretion decreases as we age– When the concentration of acid is lower than

normal, drug absorption is reduced– Decreased acidity affects breakdown of capsules

and tablet coatings in the stomach• variable absorption rate depending on the way a drug is

manufactured

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Pharmacokinetics (cont.)

• Drug distribution– Water-soluble drugs-higher concentrations in the

bloodstream due to less total body water– Fat-soluble drugs-trapped in the fatty tissue due to

decreased muscle mass & increased fatty tissue– Decreased hemoglobin and albumin=fewer

available sites for protein-bound drugs

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• Drug metabolism– Decreased activity of liver cells– Reduction in perfusion decreases the liver’s

effectiveness in metabolizing drugs– Increased risk for toxicity due to decreased

metabolism by liver

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• Drug excretion– kidneys significantly less effective at removing

waste, including medications• more drug remains in the circulation, leading to

elevated drug levels and symptoms of drug toxicity

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Pharmacodynamics

• Polypharmacy– The prescription, administration, or use of more

medications than are clinically indicated, is a common problem in older adults

– The more medications taken, the greater the risk for untoward reactions, drug interactions, and drug toxicities

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Polypharmacy

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Cognitive Changes

• Lack of the literacy skills needed to read the labels and directions

• Inability to understand and comply with directions

• Inability to make correct judgments about medications

• May not recognize that they have to take medication

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Sensory Changes

• Vision changes- unable to read a medication label or recognize different sizes, shapes, or colors of medications

• Adequately assessing the person’s ability to read labels accurately, proper teaching, and using special labels or magnifying devices may help reduce the risks

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Sharing Medications With Friends or Relatives

• Practice is common and persists because many older adults are unaware of the dangers

• All people, particularly older adults, must be aware that it is not safe to take a medication prescribed for someone else

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Over-the-Counter (OTC) Preparations

• Many do not think of OTC medications as “real” drugs, because no prescription is needed to purchase them

• OTC medications are capable of potentiating or interfering with the effects of prescription medications, possibly resulting in serious harm

• Can also create or mask symptoms of disease

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Alcohol

• The most commonly consumed nonprescription drug used by adults

• Most older adults do not think of alcohol as a drug, so they do not think about it when taking medications

• Alcoholic beverages can cause adverse reactions when taken in conjunction with many prescription and OTC drugs

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Prescription Medications

• The directions provided may be very clear to a knowledgeable health care professional, but are often misunderstood or misinterpreted by older adults

• Even simple misunderstandings can lead to serious consequences

• To reduce risk, older adults often require additional instruction

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Saving Money

• fail to take their medications or make changes in the amount or frequency to conserve their supply

• save medications that were prescribed in the past, even if the drugs are no longer part of their therapy

• Often reluctant to discard costly medications, holding on to them “just in case.”

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Medication Administration in the Institutional Setting

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Safe Drug Administration

• Before administering a medication, nurses should have the following information– The therapeutic effects of the medication– The reasons this individual is receiving the

medication– The normal therapeutic dosage of the medication– The normal route or routes of administration– Any special precautions related to administration– The common side effects or adverse effects of the

medication46

Assessment• Nurses must be sure to assess older residents

thoroughly before administering any medications

• After administration, nurses should monitor older adults continually to determine whether the medication is having the desired effect

• Residents should also be observed for any untoward effects or significant changes in medical condition or behavior

• Nurses should be particularly watchful for any signs of overdose or toxicity

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CARE Acronym for Medication Assessment

• C – Caution/compliance• A – Adjust• R – Review regimen regularly• E – Educate

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Nursing Interventions Related to Medication Administration

• Right resident• Right medication• Right amount• Right dosage form• Right route• Right time• Right documentation

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Patient’s Rights

• Right to know what medication they are receiving and why they are receiving it

• Right to refuse medication• Right to privacy during injections or any other

procedures• Use of psychotropic drugs as chemical

restraints presents a risk to the rights of older adults

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In an Institutional Setting

• Under OBRA legislation, residents of care facilities should have the option of self-medication if they are capable of doing so safely

• A physician’s order stating that self-medication is permitted is usually required

• The nurse remains responsible for monitoring the resident’s compliance and response to the medications

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In the Home

• older adults who live independently must learn to take medications properly

• The responsibility of assessing medication-taking behaviors and teaching safe self-administration falls to the nurse

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Safety Alert

• Identification must be checked (following agency policies) each time a medication is administered

• Failure to do this can result in serious errors and harm to older adults

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Risk for Noncompliance• Cognitive and sensory limitations• Special precautions and complicated time

schedules• To reduce risk for noncompliance

– encourage clients to talk to physician &/or pharmacist to see if it’s possible to safelyreduce the number of medications or simplify the medication schedule

– Alarms– Alarmed pill boxes– Assistance of family/friends/caregiver

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Techniques That Improve Safety and Compliance

• Associating medication schedules with regular daily events

• importance of preparing medication in a well-lit area

• containers are properly labeled• color codes, tape strips, pictures, or textures

to containers to help older adults recognize them

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Techniques That Improve Safety and Compliance (cont.)

• Modify containers for ease of use• measures to distinguish and separate similar

containers• Teach to store medications properly• Obtain or devise a system to promote

compliance• importance of being alert when taking

medications

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Safety Alert




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Risk for Noncompliance

• Cognitive and sensory limitations• Special precautions and complicated time

schedules• To reduce the risk for noncompliance, nurses

should encourage older adults to talk to the physician and/or the pharmacist to see whether there is any safe way to reduce the number of medications or simplify the medication schedule


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• Explain the importance of preparing medication in a well-lit area

• Ensure that containers are properly labeled• Apply color codes, tape strips, pictures, or

textures to containers to help older adults recognize them


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• Modify containers for ease of use• Establish measures to distinguish and separate

similar containers• Teach older adults to store medications

properly• Obtain or devise a system to promote

compliance• Stress the importance of being alert when

taking medicationsCopyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

61

Safety Alert




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Risk for Noncompliance

• Cognitive and sensory limitations• Special precautions and complicated time

schedules• To reduce the risk for noncompliance, nurses

should encourage older adults to talk to the physician and/or the pharmacist to see whether there is any safe way to reduce the number of medications or simplify the medication schedule


63



• Explain the importance of preparing medication in a well-lit area

• Ensure that containers are properly labeled• Apply color codes, tape strips, pictures, or

textures to containers to help older adults recognize them


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• Modify containers for ease of use• Establish measures to distinguish and separate

similar containers• Teach older adults to store medications

properly• Obtain or devise a system to promote

compliance• Stress the importance of being alert when

taking medications65

Chapter 8

Health Assessment of Older Adults

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Health Screenings• Identify individuals who are in need of further,

more in-depth assessment• high blood pressure• hearing problems• foot problems• problems with activities of daily living • Often performed at senior centers & clinics• Special screenings for depression and suicide

risk are recommended for the older adult population

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Health Assessments

• Used to formulate nursing diagnoses and to plan patient care

• essential that accurate and complete data be collected

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Health Assessments (cont.)

• Objective data– Information that can be gathered using the senses

of vision, hearing, touch, and smell– direct observation, physical examination, and

laboratory or diagnostic tests• Subjective data

– Information gathered from the client’s point of view

– Best described in the individual’s own words

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Preparing the Physical Setting

• Distractions should be minimal• Lighting -diffuse• Furniture -comfortable• Privacy is very important• room comfortably warm & free from drafts• Assist to the bathroom or mention that a

bathroom is available nearby if needed

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Establishing Rapport

• begin the interview by greeting the older person and introducing yourself

• Appropriate use of names indicates respect and helps build rapport

• Use of the individual’s first name only without the person’s consent is presumptuous and overly familiar

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Establishing Rapport (cont.)

• briefly explain the purpose of the interview so that the individual will know what to expect

• Nurses should focus on and speak directly to the older person being interviewed

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Conducting an Interview

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Obtaining the History

• Identify basic data• history of health concerns & review current

health issues• depends on the cognitive level of the individual &

complexity of his or her particular medical history• Information gathered will help the nurse form an

overall impression and help the nurse focus on those areas most in need of further exploration and assessment

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Physical Assessment of the Older Adult

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Inspection

• The most commonly used method of physical assessment in which the senses of vision, smell, and hearing are used to collect data

• General inspection is used to detect the need for more specific inspection

• Used when assessing the overall level of function, as well as when looking for specific areas of need within any particular area of function


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Palpation

• Uses the sense of touch in the fingers and hands to obtain data

• Used for evaluation in many parts of a physical assessment, including pulses, temperature and texture of the skin, texture and condition of the hair, presence and consistency of tumors or masses under the skin, distention of the urinary bladder, and presence of pain or tenderness


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Auscultation

• Uses the sense of hearing to detect sounds produced within the body

• Heart, lung, and bowel sounds are typically assessed using auscultation

• Involves the use of a stethoscope or other sound amplifier (such as a Doppler) to make the sounds louder and more easily heard

• Sounds are described according to their quality, pitch, intensity, and duration


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Percussion

• A technique in which the size, position, and density of structures under the skin are assessed by tapping the area and listening to the resonance of the sound

• Depending on the amount of vibration (sound) heard, the presence of masses, fluid, or air can be determined


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Assessing Vital Signs in Older Adults


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Temperature

• Oral (sublingual) route– Used most commonly for temperature assessment– Either an electronic thermometer or a glass

thermometer that does not contain mercury can be used to take an oral temperature


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Temperature (cont.)

• Axillary route– Not generally used for older adults– Time-consuming; the accuracy of temperature

readings may be affected by environmental conditions


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Pulse

• Position should be consistent (e.g., lying, sitting, standing) each time pulse is checked

• Can be assessed at various sites on the body, including the temporal, carotid, brachial, radial, femoral, popliteal, posterior tibial, and dorsalis pedis arteries, as well as at the apex of the heart

• The normal pulse rate in adults ranges from 60 to 90 beats per minute


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Assessing Vital Signs


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Respirations

• The older person should be placed in a comfortable position to maximize ease of breathing

• The rate, depth, and ease of breathing must be assessed

• A range of 12 to 20 breaths per minute is considered normal

• Slightly irregular breathing rhythms are not unusual in the aging population


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Measuring Respirations


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Blood Pressure

• To obtain the most accurate readings, the patient should be positioned so that the upper arm is at the level of the heart

• Cuff selection should be based on the patient’s upper arm size

• Aging individuals are susceptible to posture-related changes in blood pressure


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Body Systems Approach

• Skin• Nails• Hair• Skull, face, neck• Eyes• Ears


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• Respiratory• Cardiovascular• Gastrointestinal• Musculoskeletal • Neurologic• Genitourinary

Sensory Assessment of Older Adults

• Simple assessments of vision and hearing ability are based on empiric data (the way the individual responds to visual or auditory clues)

• Nurses should observe whether the person is able to read or do close work that requires good central vision or whether he or she participates in television viewing or other sight-related activities

• Talking with older adults can reveal the presence or absence of hearing


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vn057 gerontology 4. health promotion what do you think?

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