Aging Test 2
Discuss ways in which nurses can support other nursing staff dealing with dying patients.
it may be extremely difficult for staff not only to accept a particular patitnet's death but also to come to terms with the whole issue of death. some nursing staff share the difficulty that any persons have in realizing their own moratlity. nursing staff may feel powerless as they realize that their best efforts can do little to overcome the reality of impending death. the staff working with a dying PT requires a great deal of support. collegues should help coworkers explore their own reactions to ding PT and recognizing when those reactions interfere witha therapeutic nurse - PT relationship. the attitude of colleagues and the envornment should be such that nursing staff can retreat from a situation that is not therapuetuci either for them or for the PT. to encourage the nurse to cry or show emotions in other forms may be extremely beneficial. the use of thanatologists, hospice staff, and other resource people may also be valuable in providing support to nurses as they assist an individuals through the dying process.
constipation
knowing that the risk of this problem is high, nursing staff should take measures to promote regular bowel elimination in terminally ill patients. increasing activity and the intake of fluids and fibers are beneficial; laxatives usually are admin on a regular schedule, and bowel elimination patterns should be recorded and assessed. it must be remembered that what may appear to be diarrhea may actually be seepage of liquid wastes around fecal impaction.
Discuss the reasons family members may have when dealing with death or approaching death of a loved one
many people have very limited experiences with death or the dying process, but this was not always the case. this chagne is due in part to decreases in the mortality rate. today, nuclear families are mobile and frequently composed of young members; older parents and grandparents live in different households, often in different parts of the country. more deaths occur in an institutional or hospital setting. how inhumane to remove dying persons from intimate involvement with their support systems at the tie of their greatest need for support. as direct experiences with dying and death are lessened, death becomes a more impersonal and unusual event. its reality is difficult to internalize. perhaps this explains why many persons have difficulty accepting their own mortality. nurses who understand their own moratlity are more comfortable helping individuals through the dying process.
pain
nurse can reduce distress for patients by supplying them with realistic info regarding pain. complaints of pain or discomfort or discomfort, nausea, irritability, restlessness, and anxiety are common indicators of pain; sleep disturbances, reduced activity, diaphoresis, pallor, poor appetite, grimacing, and withdrawal may provide clues to the presence of pain. palliative care is care that prevents and relieves pain in persons with incurable conditions. Nurses must regularly assess pain; PT should be encouraged to report their pain. for the dying PT, the goal of pain management is to prevent pain from occurring rather than to respond to it after it occurs. after the pain has been assessed, analgesics can be developed aspirin or acetaminophen for mild pain; codeine or hydrocodone for moderate pain; morphine or hydromorphone for severe pain
describe the legal nursing responsibilities in response to suspected or actual abuse
nurses have a legal responsibility to report all cases of known or suspected abuse. states vary regarding reporting mechanisms; nurses should thus consult specific state laws. The resources listing includes organizations that can provide information on elder abuse and guidance on finding attorneys to assist a person who is the victim of abuse
Discuss ways in which the nurses can support the family and friends of dying individuals
nurses must respect the personal desires of the family and friends and be careful not to make value judgements of the family's reaction based on their own attitudes and beliefs. it is beneficial to encourage the family and friends to express their grief openly. crying and shouting may help people cope with and work through their feelings about the death more than suppressing their feelings to achieve a calm composure. whether it is the nurse, a member of the clergy, or a neighbor, it is valubabe to identify some person who can be an advocate for the family at this difficult time and prevent them from being taken advantage of.
List physical, nutritional and hydration needs of dying individuals and related nursing interventions.
pain respiratory distress constipation poor nutritional intake
respiratory distress
physical discomfort resulting form dyspnea, PT can experience tremendous psycholigical distress associated with the fear, anxiety, and helplessness that results from the though of suffocating. Interventions: raising HOB, teaching PT relaxing exercises, admin O2, atropine or furosemide may be admin to reduce bronchial secretions; narcotics may be use to control resp. symptoms by blunting the medullary response
poor nutritional intake
serving small portioned meals that have alluring appearances and aromas can stimulate the appetite, give PT their favorite foods. An alcoholic drink before meals can boost the appetite of some people. N/V can be controlled with the use of antiemtics and antihistamines; ginger assist with oral hygeine, offering a clean and pleasant environment for dining, providing pleasant environemtn for dining, providing pleasant company during mealtime and assisting with feeding as necessary
depression
the depression of the dying person is usually a silent one. it is important for the nurse to understand that cheerful words may be far less meaningful to dying individuals than holding their hand or silently sitting with them. being with the dying person who is openly or silently contemplates the future is a significant nursing action during this stage. the nurse should be particularly sensitive to the dying person's religious needs and facilitate the clergy-patient relationship in every way possible. the nurse may need to help the family understand this depression, explaining that their efforts to the dying person can hinder rather than enhance the patient's emotional preparation. the nurse may emphasize that this type of depression is necessary for the individuals to be able to approach death with a sense of acceptance.
Denial
the nurse must be sensitive to the person's need for defenses while also being ready to participate in discussions on death when the person needs to do so. the nurse should try to accept the dying person's use of defenses rather than focus on the conflicting messages. perhaps the most important nursing action during this stage is to accept the dying individual's reactions and to provide an open door for honest dialogue
bargaining
the nurse should be aware that dying persons may disappointed at not having their bargain honored or guilty over the fact that, having gained time, they want an additional extension of life even though they agreed that the request would be their last
anger
the nurse should help the family gain insight into the individual's behavior. the nurse should also guard against responding to the dying person's anger as a personal affront. it is important that the nurse assess such behavior and understand that is may reflect the anger of the second stage of the dying process. instead of responding to the anger, the nurse should be accepting, implying to the dying person that it is fine to vent these feelings.
acceptance
touching, comforting, and being near the person are valuable nursing actions. an effort to simplify the environment may be required as the dying person's circle of interests gradually shrinks
List the S/S indicating death is approaching or imminent
when death is near, bodily functions will slow and certain signs and symptoms will occur, including: - decline in blood pressure - rapid, weak pulse - dyspnea and periods of apnea - slower or no pupil response to light - profuse perspiration - cold extremities - bladder and bowel incontinence - pallor and mottling of skin - loss of hearing and vision
Identify measures to help nurses make ethical decisions
- Encourage PT to express their desires - Identify significant others who impact and are impacted - Know yourself - Read - Discuss - Form an ethics committee - Consult - Share: when faced with a difficult ethical decision, talk with others and seek guidance and support. - Evaluate decisions
list factors that have increased ethical dilemmas for nurses
- Expanded Role of Nurses: now perform sophisticated assessments, diagnose nursing problems, monitor and give complicated treatments, use alternative modalities of care, and, particularly in geriatric care settings, increasingly make independent judgements about patients' clinical conditions. This wider scope of functions, combined with higher salaries and greater status, has increased the accountability and responsibility of nurses for the care of patients. - Medical Technology: artificial organs, genetic screening, new drugs, computers, lasers, ultrasound, and other innovations have increased the medical community's ability to diagnose and treat problems and to save lives; however, new problems have accompanied these advances, such as determining on whom, when, and how this technology should be used. - New Fiscal Constraints: quality services to help people maintain and restore health vs. being cost-effective, minimizing bad debts, and developing alternate sources of revenue. PT needs are weighed against economic survival, resulting in some difficult decisions. - Conflict of Interest - Greater Number of Older Adults: growing numbers of people spending more years in old age and the increasing ratio of dependent individuals to produce workers, society it beginning to feel the burden - Assisted Suicide: nurses may face the dilemma of knowing that competent patient is arranging an assisted suicide and believing that they must intervene. Or, they may know that a competent patient is arranging an assisted suicide, and while understanding and respecting the patient's decision, they feel they are violating professional standards by not reporting it so that it may be halted.
Discuss types of elder abuse and indications it may be occurring
- Physical abuse - Emotional abuse - Sexual abuse - Exploitation - Neglect - Abandonment Abuse can assume many forms, including inflicting pain or injury, staling, mismanaging funds, misusing medications, causing psychological distress, withholding food or care, or confining a person. - Delay in seeking necessary medical care - Malnutrition - Dehydration - Unexplained bruises - Poor hygiene and grooming - Urine odor, urine-stained clothing/linens - Excoriation or abrasions of genitalia - Inappropriate administration of medications - Repeated infections, injuries, or preventable complications from existing diseases - Evasiveness in describing condition, symptoms, problems, and home life - Unsafe living environment - Social isolation - Anxiety, suspiciousness, and depression
Nurses may witness subtle or blatant violations of respect to older adults' sexual identity such as the following:
- belittling older adults interest in clothing, cosmetics, and hairstyles - dressing men and women residents of a nursing home in similar asexual clothing - denying a woman's requiest for a female aide to bathe her - forgetting to button, zip, or fasten clothing when dressing older persons - unnecessarily exposing older individuals during examination or care activities - discussing incontinent episodes when the involved individual's peers are present - ignoring a mans request to be cleaned and shaven before a female friend comes to visit - ignoring attempts by older adults ot look attractive - not considering that an older adult's spouse or partner can be of the same sex - joking about two senior citizen's interest in and flirtation with each other
Describe ethical standards and principles guiding nursing practice
A professional code; ethical standards created outside of the nursing profession. Federal, state, and local standards, in the form of regulations, guide the nursing practice. In addition, various organizations such as the Joint Commission and the American Healthcare Association develop standards for specific practitioners and care settings. Individual agencies, too, have philosophies, goals, and objectives that support a specific level of nursing practice. Individual nurses possess values that they have developed throughout their lives that will largely influence ethical thinking. Beneficence: to do good for patients. This principle is based on the belief that the education and experience of nurses enable them to make sound decisions that serve patients' best interests Nonmaleficence: to prevent harm to patients; this principle could be viewed a subset of beneficence because the intent is ultimately to take action that is good for the patients Justice: to be fair, treat people equally, and give patients the service they need; At the foundation of this principle is the belief that patients are entitled to services based on need, regardless of ability to pay Fidelity and veracity: fidelity means to respect our words and duty to our patients' veracity means truthfulness. This principle is central to all nurse-patient interactions because the quality of this relationship depends on trust and integrity. Autonomy: to respect patients' freedoms, preferences, and rights Confidentiality: to respect the privacy of patients; in addition to respecting confidentiality as being a morally sound principle, the Health Insurance Portability and Accountability Act and other laws have afforded people the legal right to privacy and consequences if this violated. Nurses need to appreciate that ethical issues are influence by culture. Learning about a patient's culture and preferences bases on it are essentials to assuring actions do not inadvertently produce ethical conflicts.
Describe legal issues in gerontological nursing practice and ways to minimize risks. (106-114)
Acts that could result in legal liability for nurses: malpractice (when performance deviates from standard of care), confidentiality, patient consent, PT must be informed, patient competency, staff supervision, medications, restraints, telephone orders, DNR orders, advance directive and issues related to death and dying [durable power of attorney: document that appoints a person selected by the PT to make decisions on the patient's behalf should the patient be unable to make or communicate his or her decisions; a living will: describes a PT preference and gives instructions to health care providers if at a future time her or she is unable to make or communicate decisions and has not one appointed as proxy], elder abuse. - Be familiar with and follow the nurse practice act that governs nursing practice act that governs nursing practice in that specific state - Keep current of and adhere to policies and procedures of the employing agency - Ensure that policies and procedures are revised as necessary - Do not discuss a patient's conditions, share PT info, or allow access to a T medical record to anyone unless the PT has provided written consent - Consult with the physician when an order is unclear or inappropriate - Know patients' normal status and promptly report changes in status - Assess patients carefully and develop realistic care plans - Read patients carefully and develop realistic care plans. - Rea patients care plans and relevant nursing documentation before giving care - Identify PT before administering meds or treatments - Document observations about PT status, care given, and significant occurrences - Assure that documentation be self and subordinates is accurate and that documentation reflects care that was actually provided - Know the credentials and assure competency of all subordinate staff - Discuss with supervisory staff assignments that cannot be competed due to insufficient staff or supplies. - Do not accept responsibilities that are beyond your capabilities to perform and do not delegate assignments to others unless you are certain that they are competent to perform the delegated tasks. - Report broken equipment or other safety hazards - Report or file an incident report when unusual situations occur - Promptly report all actual or suspected abuse to the appropriate state and local agencies - Attend continuing education programs and keep current of knowledge and skills pertaining to your practice
Legal Safeguards for Nurses
Common sense can be the best ally of sound nursing practice. Never forget that PT, visitors, and employees do not forfeit their legal rights or responsibilities when they are within the health care environment. - Familiarize themselves with the laws and rules governing their specific care agency/facilities, their state's nurse practice act, and labor relations - Become knowledgeable about their agency's policies and procedures and adhere to them strictly - Function within the scope of nursing practice - Determine for themselves the competency for employees for whom they are responsible - Check the work of employees under their supervision - Obtain administrative or legal guidance when in doubt about the legal ramifications of a situation - Report and document any unusual occurrent - Refuse to work under circumstances that create a risk to safe patient care - Carry liability insurance
Describe the stages people commonly go through when facing death and describe related nursing interventions
Denial Anger Bargaining Depression Acceptance
Discuss the effects of societal attitudes towards sex and older adults
For many years, sex was taboo talk; now it is an open conversation but still taboo for the older adults. When the topic of sex and older adults is confronted, much ignorance and prejudice concerning sex reappear. Myths about older adults run rampant such as: women lose all desire for sex after menopause, older men cannot achieve erection, older people are not interested in sex. Respect for older adults as vital, sexual beings is minimized by the lack of privacy afforded to them, by the lack of credence given to their sexuality, and by the lack of acceptance, respect, and dignity granted to their continued sexual expression. these misconceptions and prejudices are an injustice to persons of all age. They reinforce any fears and aversion the young have to growing old. they impose conformity on older adults, requiring that they either forfeit warm and meaningful sexual experiences or suffer feelings of guilt and abnormality. Older adults are entitled to the same privacy and respect as younger adults. Bc sex is overlooked in the older population - safe sex practices are not discussed and AIDS is rising in the older population. The incidence of AIDS has increased more than twice as quickly in people over age 50 than younger adults. Older adults do not have a fear of pregnancy or have misconceptions about if the STD can affect them or that the S/S are a part of normal aging. They are normally embarrassed to seek help with prevention or treatment. AIDS can be misdiagnosed as alzheimers. It is important for nurses to reinforce safe sex practices to older persons and to ask about safe sex practices and risk factors for HIV during the assessment.
Identify process of obtaining a sexual assessment
Interview Lab test Meds DXN PAGE 216
Laws governing gerontological nursing practice
Many laws are developed at the state and local levels, variation exists among the states. Public law: governs relationships between private parties and the government and includes criminal law and regulation of organizations and individuals engaged in certain practices. The scope of nursing practice and the requirements for being a licensed home health agency fall under the enforcement of public law. Private law: governs relationships among individuals or between individuals and organizations and involves contracts and torts. These laws protect individuals rights and also set standards of conduct, which, if violated, can result in liability of the wrongdoer. The American Nurses Association publication Scope and Standards of Gerontological Nursing provides guidelines for gerontological nurses that offer descriptions of what is considered safe and effective care.
Identify measures to manage menopausal symptoms
Menopause, the permanent cessation of menses of at least 1 year, occurs for most women around the fifth decade of life. Physical symptoms: hot flashes, fatigue, new onset of migraines, symptoms or arthritis, fibromyaliga, heart palpitations, atypical angina, restless leg syndrome, vaginal dryness and itchiness, loss of subcutaneous fat in labia, insomnia, decreased metabolic rate, weight gain, increased fat on stomach and hips, lower urinary tract symtoms, bladder and vaginal infections, increased risk of osteoporosis/heart disease/colon cancer Emotional/Cognitive Symptoms: moodiness, depression, memory problems, fuzzy thinking, lack of concentration, lower tolerance for annoyance, quick to anger, greater impatience, anxiety, restlessness, new onset of panic disorder, paranoia, psychotic syndromes it has long been known that hormone therapy can reduce symptoms associated with menopause; only estrogen use is safer than estrogen + progesterone study showed that estrogen may protect younger women's hearts and may reduce the risk of hip fracture, diabetes, and colon cancer, it also revealed that hormones increases the risk of other problems such as bld clots and stroke. due to increased risk of breast cancer and breast cancer mortality, EPT should be limited to 3-5 years and ET can be used for approx 7 years. It is contraindicated in women with breast cancer, a hxn of breast cancer, suspected or known estrogen sensitive cancers, CAD, intreated HTN, active liver disease, PE, undiagnosed vaginal bleeding, or high sensitivity to hormone therapy. Standardized extract of rhapontic rhubarb has been shown to significantly reduce hot flashes and other symptoms of menopause middle aged women can benefit from basic education - acupuncture - diet: food rich in estrogen (apples, beans, carrots, celery, nuts, seeds, soy broducts, wheat, whole grains), foods rich in boron to increase estrogen retention (asparagus, beans, broccoli, cabbage, peaches, prunes, strawberries, and tomatoes), avoidance of adrenal stimulating foods (alcohol, caffeine, refined carbs, salts, and sugar) - exercise - imagery - meditation - homeopathic remedies: vaginal lubrication (bryonia), general symptoms (amyl nitrosum, natrum murisaticum, sepia, sulfur) - regular adequate sleep - stress management practices - t-ai chi - vaginal moisturizing - vitamins and minerals such as calcium, chromium, magnesium, selenium, and vitamins c/d/e - yoga
List age-related factors that affect dietary requirements in late life.
Several factors contribute to the older person's reduced need for calories: the older body has less lean body mass and relative increase in adipose tissue. Adipose tissue metabolizes more slowly than lean tissue and does not burn calories as quickly. // Basal metabolic rate declines 2% for each decade of life after age 25, which contributes to weight increased when the same caloric intake of younger years is consumed. // The activity level for most older adults is usually lower than that during their younger years. Caloric needs gradually decrease throughout adulthood as a result of age-related changes, and a reduction in calories is recommended beginning in the fourth decade of life. In addition to measuring quantity, it is important to measure quality of calories consumed. Limiting dietary fat intake to less than 30% of total calories consumed is a good practice for older adults. Fiber is particularly important; soluble fibers, found in foods such as oats and pectin, help to lower serum cholesterol; improve glucose tolerance in diabetics ;and prevent obesity, cardiovascular disease, and colorectal cancer. Insoluble fibers promote good bowel activity and can be found in grains and many vegetables and fruits. Carbohydrates provide important sources of energy and fiber. However, because of a decreased ability to maintain a regular blood glucose level, older adults need a reduced carbohydrate intake. At least 1 gram of protein per kilogram is necessary to renew body protein and protoplasm and maintain enzyme systems. If 10%-20% of daily caloric intake is derived from protein, protein requirements should be met. Calcium is still required in the diet to maintain a helathy musculoskeletal system, as well as to promote the proper functioning of the body's blood clotting mechanisms. A good intake of Vitamin D and magnesium facilitates calcium absorption. Recommended to eat at least five servings of fruits and vegetables daily.
Explain the effects of aging on sexuality and sexual function
There is a general pattern of sexual behavior throughout life. Sexual styles, interests, and expression must be viewed in the context of the individual's total life experience. Perceptions of male and female roles have changed over time. Many of today's older population were socialized to accept certain masculine and feminine roles. Sexuality also encompasses much more than physical acts. it includes love, warmth caring, and sharing between individuals; seeing beyond gray hair, wrinkles, and other manifestations of aging; and the intimate exchange of words and touches by sexual human beings. feeling important to and wanted by another person promotes security, comfort, and emotional well being. With the multiple losses that older adults experience, the comfort and satisfaction derived from a meaningful relationship are especially significant. - there is a decrease in sexual responsiveness and a reduction in the frequency of orgasm - older men are slower to erect, mount, and ejaculate - older women may experience dyspareunia as a result of less lubrication, decreased distensibiility, and thinning of vaginal walls. - many older women gain a new interest in sex, possibly because they no longer have to fear and unwanted pregnancy or because they have more time and privacy with their children grown and gone. The frequency of sexual activity may decrease, but that is not necessarily accompanied by a reduction in sexual interest or ability.
discuss various philosophies regarding right and wrong
Utilitarianism: holds that good acts are those form which the greatest number of people will benefit and gain happiness Egoism: an act is morally acceptable if it is of the greatest benefit to oneself and there is no reason to perform an act that benefits other unless one will personally benefit from it as well Relativism: can be referred to as situational ethics, in that right and wrong are relative to the situation Absolutism: under the theory of absolutism, there are specific truths to guide actions; the truths can vary depending on a person's beliefs; for example, a Christian's view may differ from an atheist's view on certain moral behavior
Describe factors that can contribute to sexual dysfunction
age related dryness and fragility of vaginal canal, vaginal infection, venereal disease, neurological disease, cardiovascular disease, diabetes mellitus, decreased hormone production, pulmonary disease, arthirtis, pain, prostatitis, prolapsed uterus, cystocele, rectocele, medications, overeating, obesity, fatigue, alcohol consumption, fear or worsening health problem, lack of partner, unwilling or unable partner, boredom with partner, fear of failure, guilt, anxiety, depression, stress, negative self-concept, lack of privacy, religious conflict, and altered appearance pg 214-220
Recognize and identify issues that could result in legal liability for nurses
assault, battery, defamation of character, false imprisonment, fraud, invasion of privacy, larceny, negligence (pg. 107)
Describe ways for nurses can promote healthy sexual function in older adults.
basic education, teach about sexual functioning during routine health assessments/part of structured health education/discharge planning, willingness of nurse to discuss openly with PT, identify physical/emotional/& social threats, promote practices that can enhance sexual function including: regular exercise, good nutrition, limited alcohol intake, ample rest, stress management, good hygiene, and grooming, enjoyable foreplay older people in an institutional setting have a right to privacy that goes beyond lip service. they should be able to close and lock a door, feeling secure that this action will be honored. Their sexuality should not be sanctioned, screened, or severed by another person. masturbation is often beneficial for releasing sexual tensions and maintaining continued function of the genitalia. in addition, nurses must appreciate that sexual satisfaction can have different meaning to older people than to the young (touching, caressing, etc.) for older adults in any setting, nurses can facilitate connections, which are essential for sexual relationships. Strategies to facilitate connections: - assist patiens in evaluating current relationships - guide PT in becoming aware of their behaviors and responses - teach strategies that promote effective expression of inner feelings - provide info on sources of social activities - refer PT for hearing and/or vision examinations as needed. - respect patients' interests and efforts to be sexually active - assist patients in improving sexual function provide positive feedback for efforts PT have when taken to improve the quantity and quality of connections with others.
