Adult 1 Exam 1: Chronic Illness (6 questions)

Many factors put community-dwelling older adults at risk for domestic EM. These include

(1) physical or cognitive dysfunction that leads to an inability to perform ADLs (and therefore produces dependence on others for care) (2) any psychiatric diagnoses (especially dementia and depression) (3) alcohol abuse (4) decreased social support

Long term care (LTC): Three factors appear to precipitate placement

(1) rapid patient deterioration or function (2) caregiver inability to continue care because of stress and burnout (3) an alteration in or loss of the family support system *Progressive dementia, incontinence, or a major health event can accelerate long-term care placement. *Caregiver concerns = will the older pt resist the admission, level of care, loneliness of pt, affordable

Ethical issues surround care of the older adult and may include:

-Assessing the patient's ability to make decisions and end-of-life care including initiating resuscitation -Treating infections -Providing nutrition and hydration -Transferring to more intensive treatment units.

Home Health

-can be cost-effective, but patients must meet criteria. -Not an alternative for adults in need of 24-hour ADLs assistance or continuous safety supervision (may need private duty care) -Services require physician recommendation and skilled nursing care for Medicare reimbursement. -Respite, personal care, and homemaker services also help older adults stay at home

Care of the hospitalized older adult

-consider d/c needs early --> assistance with ADLs, IADLs, meds -screen for UTI, falls, delirum = common for pop -mobility -monitor and prevent skin breakdown -prevent falls, safety

Adult Day Care

-provide social, recreational, and health-related services to individuals in a safe community-based environment. -Daily supervision, social activities, social interaction, and ADL assistance for cognitively impaired and those unable to independently perform ADLs -are for people with disabilities who need a higher level of care, such as health monitoring, therapeutic activities, ADLs training, and personal services

Foods that CAUSE inflammation Try to avoid or limit these foods as much as possible:

-refined carbohydrates, such as white bread and pastries -French fries and other fried foods -soda and other sugar-sweetened beverages -red meat (burgers, steaks) and -processed meat (hot dogs, sausage) -margarine, shortening, and lard

An anti-inflammatory diet should include these foods:

-tomatoes -olive oil -green leafy vegetables, such as -spinach, kale, and collards -nuts like almonds and walnuts -fatty fish like salmon, mackerel, tuna, and sardines -fruits such as strawberries, blueberries, cherries, and oranges

Informatics & older adults:

-track wt, diet, exercise using apps -

Social Support: 3 levels

1. Family = Primary -Can be elderly themselves -Many family caregivers are caring for themselves, their aging parents, as well as their children and grandchildren. -Caregiving contributes to stress or burden 2. Clubs, religious orgs, neighborhoods, adult day care, senor citizen centers -Semi Formal level of support 3. Social welfare agencies, health care facilities, gov support, nurses -Formal systems

The ten leading chronic diseases for people 65 and older are:

1. HTN 2. High cholesterol 3. Arthritis 4. Ischemic Heart Disease 5. DM 6. CKD 7. HF 8. Depression 9. Alzehimers 10. COPD

Assessments:

1. mental status 2. *fall risk* -including fear of falling and causes of past falls is important. 3. nutritional 4. living conditions 5. access to care 6. SAFETY 7. Assistive Devices -Does the client have assistive devices? Glasses, hearing aides, walker, cane? 8. Med Admin 9. Sleep

Assessment (at least annually) for pt with chronic illnesses

ADLs IADLs Perception of relative health/illness Level of function

CDC Chronic Disease Prevention System: Community programs linked to clinical services

Improve and sustain management of chronic conditions through referral of patients to programs that improve prevention and management of chronic conditions. Improving community conditions to support healthful behaviors and promote effective management of chronic conditions will deliver: 1. Healthier students to schools 2. Healthier workers to businesses and employers 3. A healthier population to the health care system

Older adults (65 or older) Gender differences:

Men increase Living with spouse, health insurance, and income. Decrease in: health problems Women increase in living alone, r/f loss of income, poverty, being a caregiver, chronic illnesses. Decrease in health insurance

Frail older adults are especially at risk for malnutrition and dehydration, which are related to factors such as living alone, depression, and low income.

Monitor frail older adults for adequate calorie, protein, iron, calcium, vitamin D, and fluid intake

NESTLE Mini Nutritional Assessment scores =

Normal nutrition: a score of 24-30 points Risk for malnutrition: 17-23.5 points Malnourished: less than 17 *Anyone at risk or who has nutritional deficits should have a consult with a dietician.

polypharmacy

Nurses along with other health care disciplines (such as pharmacy) need to look at the medication reconciliation for the patient. The nurse should ask the client to bring in the all of the medications (to include OTC) so a review of the medications can be completed. The nurse should ask the client how many pharmacies are utilized and encourage only one to be used.

Risk Factors For Chronic Illnesses:

Use of tobacco smoking & second hand smoke exposure High blood pressure High body mass index Excessive alcohol use Elevated cholesterol High BP Diet lacking in fruits & vegetables High sodium/saturated fats Physical inactivity.

Care coordination:

a key strategy that has the potential to improve the effectiveness, safety, and efficiency of the American health care system. nvolves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care the patient's needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient examples: Communicating/sharing knowledge. Helping with transitions of care. Assessing patient needs and goals. Creating a proactive care plan. Monitoring and followup, including responding to changes in patients' needs.

SPICES

common syndromes of the elderly requiring nursing intervention: S is for Sleep Disorders P is for Problems with Eating or Feeding I is for Incontinence C is for Confusion E is for Evidence of Falls S is for Skin Breakdown

what is chronic illness? Describe the characteristics of chronic illness?

disease that are prolonged, do not resolve spontaneously, and are rarely cured completely Characteristics: -perm impairment or deviation from normal -irreversible pathological changes -residual disbailiy -special rehab required -need for long term medical/and or nursing mgmt

slide 15-16

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Elder mistreatment (EM)

intentional acts of omission or commission by a caregiver or "trusted other" that cause harm or serious risk of harm to a vulnerable older adult. EM may occur in community or long-term care settings. *Victims and health care providers underreport for many reasons. Family members are responsible for up to 90% of EM.

Describe the trajectory of chronic illness. ****

know the graph**

Older people often sleep

less deeply and wake up more often throughout the night, which may be why they nap more often during the day time. = normal Many older adults report being less satisfied with sleep and more tired during the day. There is an increase in time it takes to fall asleep (sleep latency) and overall decline in REM sleep, and increase in sleep fragmentation Snoring is the primary cause of sleep disruption for approx. 90 million American adults. *Cutting back on caffeine and napping may help solve some sleep issues.

Relocation stress syndrome

nursing dx associated with the disruption, confusion, and challenges that older adults face when moving from one environment to a new one and may result in adverse health effects including anxiety, depression, and disorientation involvement in decisions, pictures, orientation by staff, or partnering with a seasoned resident buddy may be helpful.

Types of EM

physical and/or mental abuse sexual abuse medical abuse financial exploitation neglect violation of personal rights abandonment look at doc for pic of description slide 14

Prevalent problems experienced by older adults include:

sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown.

Ethnogeriatric

specialty area of providing culturally competent care to older adults. family, religious practices, lang, etc

Telehealth devices for monitoring those more isolated can enhance ability to provide care.

telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

what are advance directives? nurses role? reviewed how often?

the client have advance directives? If not, the nurse can be an important player in helping the client obtain the information needed to assure the healthcare team know's what medical decisions need to be made when the individual is too ill to speak for themselves. Advance directives can be obtained from the health care provider, their attorney, the local area Agency on Aging, and the state health department. *Advance directives should be reviewed yearly.

Evaluation of mental status is particularly important for older adults because

these results often determine the potential for independent living.

SCALES stands for and is used for? ****

what areas put an individual at risk for nutrition problems. SCALES: -Sadness -Cholesterol -Albumin -Loss/gain wt -Eating problems -Shopping/food prep problems

Advance directives A health care proxy may be appointed

written statements of a person's wishes regarding medical care. for those unable to make their own medical decisions.

Corbin and Strauss identified seven tasks of those who are chronically ill:

*1. *Preventing and managing a crisis* -Examples include the patient with heart disease who has another myocardial infarction or the patient with asthma who has a severe attack. -A major task for the patient and caregiver is to learn to prevent or manage the crisis. 2. *Carrying out prescribed treatment regimens* -Treatment regimens may appear challenging or time consuming, such as changing a dressing multiple times a day or instituting a toileting program. 3. *Controlling symptoms* -Some individuals redesign their lifestyle by learning to plan ahead, such as individuals with heart failure adjusting the time they take diuretics to avoid needing to rush to a bathroom if going out for the day. -Others may redesign their living space. 4. *Reordering time* -People with chronic illness often report having too much or too little time. -Example: the patient with a new ileostomy needs to plan for increased time in the bathroom to change the drainage bag. 5. *Adjusting to changes in course of disease* -ex: an individual taking warfarin (Coumadin) due to a mechanical heart valve may need to avoid extreme physical sports that have a high potential for injury -Part of the individual's task is to develop a personal identity that includes the chronic illness and adjust to the lifestyle changes it necessitates. 6. *Preventing social isolation* 7.* Attempting to normalize interactions with others* -Ex: woman with heart failure who stops walking to catch her breath but appears to be inspecting a plant or looking in a store window.

what are the differently levels of prevention? describe them and give examples

*Primary prevention*: refers to measures that prevent the occurrence of a specific disease (proper diet, exercise, immunizations). *Secondary prevention*: refers to actions aimed at early detection of disease that can lead to interventions to prevent disease progression. ex: screenings, BSE *Tertiary prevention*: refers to activities (e.g., rehabilitation) that limit disease progression or return the patient to optimal functioning. ex: rehab, meds

Programs for All-Inclusive Care for the Elderly (PACE)

-For adults 55 or older -community-based services to people who are frail elderly who qualify for nursing facility placement. -providing an array of services for a capitated monthly fee that is below the cost of comparable nursing facility care. Examples of services: -Prescription medications and wound care -Physical, occupational, recreational, and speech therapy -Adult day care -Dental care -Podiatry -Social services -Home Health care

EM screening and interventions

-Perform a thorough history and physical exam including screening for mistreatment. -*Interview patients alone and tend to inconsistencies or contradictions between behavior, history, and symptoms. -contradictory explanations between the patient and the caregiver, or behavioral clues that suggest the patient is being threatened or intimidated -*If the older adult appears to be in immediate danger, develop and implement a safety plan in collaboration with the interprofessional team involved in the person's care. -Identify, collect, and preserve physical evidence (e.g., dirty or bloody clothing, dressings, sheets). -After obtaining consent, take photographs to document physical findings of suspected abuse or neglect. If possible and appropriate, do this before treating or bathing the alleged victim. -*If you suspect that mistreatment is occurring, report your findings to the appropriate state agency and/or law enforcement as mandated by the laws in your state. -Initiate social work, forensic nursing, adult protective services, and other consultations as appropriate.

_____________ is a common clinical syndrome seen in older adults. Clinical manifestations of frailty include three or more of the following criteria:

-Unintentional weight loss (greater than or equal to 10 pounds in a year) -Self-reported exhaustion -Weakness (measured by grip strength) -Slow walking speed -Low level of physical activity *The frail older adult is usually over age 75 and has physical, cognitive, and/or mental conditions that may interfere with independently performing ADLs.

Rural older adults Experience five barriers to health care access:

1. Transportation 2. Limited health care workers and facilities 3. Lack of quality health care 4. Social isolation 5. Financial limitations *Are particularly vulnerable when of racial or ethnic minority *May be less likely to engage in health-promoting activities

____________ is one of the most common complications of chronic illness.

Depression *Screening and early referrals are necessary.

onset = stable = acute phase = comeback phase = crisis = unstable phase = downward = dying = ***

Onset- s/s are present; disease dx Stable- when the s/s are controlled; person maintains ADLs Acute phase- the illness is active with severe unrelieved s/s which may or may not require hospitalization Comeback phase- the person has a gradual recovery to an accepable way of life Crisis- this is a life threatening event requiring emergency services Unstable phase- life is disrupted, the person is unable to keep s/s under control. Hospitalization is not required. Downward- gradual progression of deterioration and alterations of daily life activities; contiguous alterations Dying- pt has to relinquish everyday life interested and activities, let go, and die peacefully; immediate weeks, day, hrs preceding death

Most chronic illnesses may be viewed as a trajectory with overlapping phases, in which an individual moves

from a level of optimum functioning, with the illness in good control, to a period of instability where they may need assistance

Self-management

individual's ability to manage symptoms, medications and treatment, physical and psychosocial consequences, and lifestyle changes in response to living with a chronic illness.

The majority of referrals made to Adult Protective Services are for

self-neglect. -Often unable to meet their basic needs and refuse help -Have multiple, untreated medical or psychiatric conditions -Live alone and often in squalor -Face higher risk for mortality