Chapter 14: Developmental Considerations and Chronic Illness in the Nursing Care of Adults

Reality Orientation

A communication technique that makes an older adult more aware of time, place, and person

Depression

A mood disturbance characterized by feelings of sadness and despair Also the Fourth stage of Kubler-Ross's stages of grief and dying.

Instrumental Activities of Daily Living (IADL)

Activities necessary for independence in society beyond eating, grooming, transferring, and toileting; include such skills as shopping, preparing meals, banking, and taking medications.

Activities of Daily Living (ADL)

Activities usually performed in the course of a normal day in the patient's life such as eating, dressing, bathing, brushing the teeth, or grooming. Sudden change in these may indicate illness.

Delirium

Acute state of confusion that is potentially reversible and often has a physical cause.

Which of the following might be a cause of stress for the older adult?

Adjusting to decreasing health and physical strength

Sexuality is maintained throughout our lives. Which answer below best explains sexuality in an older adult?

All older adults, whether healthy or frail, need to express sexual feelings.

Urinary Incontinence

An abnormal condition that can occur in both older men and women resulting in an urge to urinate and inability to control the bladder

Adverse Reaction

Any harmful, unintended effect of a medication, diagnostic test, or therapeutic intervention- may cause cognitive changes

Kyphosis, a change in the musculoskeletal system, leads to:

Changes in the configuration of the spine that affect the lungs and thorax.

A major life event such as the death of a loved one, a move to a nursing home, or a cancer diagnosis could precipitate:

Depression

A nurse has conducted an assessment of a new patient who has come to the medical clinic. The patient is 82 years old and has had osteoarthritis for 10 years and diabetes mellitus for 20 years. He is alert but becomes easily distracted during the nursing history. He recently moved to a new apartment, and his pet beagle died just 2 months ago. He is most likely experiencing.

Depression

Alzheimer's Disease

Disease of the brain parenchyma that causes a gradual and progressive decline in cognitive functioning.

Osteoporosis

Disorder characterized by abnormal rarefaction of bone- occurring most frequently in postmenopausal women, sedentary or immobilized individuals, and patients on long-term steroid therapy.

Kyphosis

Exaggeration of the posterior curvature of the thoracic spine.

Adult Day Care Centers

Facility for the supervised care of older adults; provides activities such as meals and socialization during specified day hours.

Medicare

Federally funded national health insurance program in the United States for people over 65 years of age. The program is administered in two parts. Part A provides basic protection against costs of medical, surgical, and psychiatric hospital care. Part B is a voluntary medical insurance program financed in part from federal funds and in part from premiums contributed by people enrolled in the program.

Acceptance

Fifth stage of Kubler-Ross's stages of grief and dying- An individual comes to terms with a loss rather than submitting to resignation and hopelessness.

Older adults experience a change in sexual activity. Which best explains this change?

Frequency and opportunities for sexual activity may decline.

Dementia

Generalized impairment of intellectual functioning that interferes with social and occupational functioning.

Acute Illness

Illness characterized by symptoms that are of relatively short duration, are usually severe, and affect the functioning of the patient in all dimensions.

Chronic Illness

Illness that persists over a long time and affects physical, emotional, intellectual, social, and spiritual functioning.

A 71-year-old patient enters the emergency department after falling down stairs in the home. The nurse is conducting a fall history with the patient and his wife. They live in a one-level ranch home. He has had diabetes for over 15 years and experiences some numbness in his feet. He wears bifocal glasses. His blood pressure is stable around 130/70. The patient does not exercise regularly and complains of weakness in his legs when climbing stairs. He is alert, oriented, and able to answer questions clearly. What are the fall risk factors for this patient? (Select all that apply.)

Impaired vision. Leg weakness. Exercise history.

Spiritual Well-Being

Individual's spirituality that enables a person to love, have faith and hope, seek meaning in life, and nurture relationships with others.

Coping

Making an effort to manage psychological stress.

Acute Care

Pattern of health care in which a patient is treated for an acute episode of illness, for the sequelae of an accident or other trauma, or during recovery from surgery.

Convalescence

Period of recovery after an illness, injury, or surgery.

You are working with an older adult after an acute hospitalization. Your goal is to help this person be more in touch with time, place, and person. What might you try?

Reality orientation.

Assisted Living

Residential living facilities in which each resident has his or her own room and shares dining and social activity areas.

Taste buds atrophy and lose sensitivity, and appetite may decrease. As a result, the older adult is less able to discern:

Salty, sour, and bitter tastes.

A nurse is caring for a patient preparing for discharge from the hospital the next day. The patient does not read and has a hearing loss. His family caregiver will be visiting before discharge. What can you do to facilitate the patient's understanding of his discharge instructions? (Select all that apply.)

Sit facing the patient so he is able to watch your lip movements and facial expressions. Present one idea or concept at a time. Include the family caregiver in the teaching session.

Older Adult Interview Techniques

Sit or stand at eye level, in front of the patient in full view. Face the older adult while speaking; do not cover your mouth. Speak clearly. Provide diffuse, bright, nonglare lighting. Encourage the older adult to use his or her familiar assistive devices such as glasses or magnifiers

Medicaid

State medical assistance to people with low incomes, based on Title XIX of the Social Security Act. States receive matching federal funds to provide medical care and services to people meeting categorical and income requirements.

You are caring for an 80-year-old man who recently lost his wife. He shares with you that he has been drinking more than he ever did in the past and feels hopeless without his wife. He reports that he rarely sees his children and feels isolated and alone. This patient is at risk for: .

Suicide.

Cultural Assessment

Systematic and comprehensive examination of the cultural care values, beliefs, and practices of individuals, families, and communities.

During a home health visit a nurse talks with a patient and his family caregiver about the patient's medications. The patient has hypertension and renal disease. Which of the following findings places him at risk for an adverse drug event? (Select all that apply.)

Taking a total of eight different medications during the day. Patient's health history.

A student nurse is caring for a 78-year-old patient with multiple sclerosis. The patient has had an indwelling Foley catheter in for 3 days. Eight hours ago the patient's temperature is 37.1 C (99 F); the Foley catheter is still in place, draining dark urine; and the patient is uncertain what time of day it is. From what the RN knows about presentation of symptoms in older adults, what should he recommend?

Tell the student that he will notify the physician of the findings.

Polypharmacy

The concurrent use of many medications- increases the risk for adverse drug effects, inappropriate use of medications, and falls in older adults

A 63-year-old patient is retiring from his job at an accounting firm where he was in a management role for the past 20 years. He has been with the same company for 42 years and was a dedicated employee. His wife is a homemaker. She raised their five children, babysits for her grandchildren as needed, and belongs to numerous church committees. What are your major concerns for this patient? (Select all that apply.)

The loss of his work role. How the wife expects household tasks to be divided in the home in retirement.

A patient's family member is considering having her mother placed in a nursing center. You have talked with the family before and know that this is a difficult decision. Which of the following criteria would you recommend in choosing a nursing center? (Select all that apply.)

There should be adequate staffing on all shifts. Social activities should be available for all residents. Family involvement in care planning and assisting with physical care is necessary.

Sam performs his assessment of Mr. Calder. What findings are considered normal for a patient of Mr. Calder's age?

Thin skin Decreased saliva production Decreased muscle strength

Reminiscence Therapy

Uses the recollection of the past to bring meaning and understanding to the present and to resolve current conflicts

Cardiac Output

Volume of blood expelled by the ventricles of the heart, equal to the amount of blood ejected at each beat multiplied by the number of beats in the period of time used for computation (usually 1 minute). Decreases with age.

Validation Therapy

an alternative approach to communication with a confused older adult

Percentage of adults over 65 that have at least one chronic illness

approximately 80%