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Announcements
Retakes for Drug Calc & MKDQ – Thurs from 11-12pm in the Computer Lab
T-Shirt Sales $15.00 & Water bottles $ 10.00
Chronic Illness, Older Adults, & End of Life Care
Medical Surgical II
Chronic Illnesses
Acute vs Chronic (Tables 5-1, 5-2) How does chronic illness affect quality of life?
Trajectory of Chronic Illness (Table 5-3) Seven tasks … (Table 5-4)
Prevention of Chronic Illnesses Define Primary, Secondary, Tertiary
prevention
Nursing Management
Remember to follow the Nursing Process Early diagnosis and interventions Complete assessments, then focused Education -> self-management
Treatment plan, symptomatology management strategies, and outcome goals
Include care givers, if permission from patient
Dept of Health & Human ServicesAdministration on Aging www.aoa.gov
43.1 million in 2012 (65+ years), 44.7 million in 2013 (1 in every 7 Americans) 25.1 million women, 19.6 million men
By 2019, the Hispanic population is projected to be the largest ethnic minority in this age group
Over 3.9 million elderly persons (9.1%) were below the poverty level in 2012
Sources: U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2013. Release Date: June 2014;
Older Adults
Demographics of Aging Why are older adults living longer?
Describe their adult developmental needs Generativity vs. Stagnation (40-65) Ego Integrity vs. Despair (65+)
Describe the needs of the aging population
Ageism & Elder Abuse Why does this occur?
Cost of Dying – End of Life Care
https://www.youtube.com/watch?v=F6xPBmkrn0g
Gerontology Assessments(Table 5-6)
Most common chronic conditions:Cardiovascular / RespiratoryIntegumentaryUrinaryReproductiveGIMusculoskeletalNervousVisual / AuditoryImmuneMental Health
SPICES
Sleep Disorders
Problems with eating or feeding
Incontinence
Confusion
Evidence of Falls
Skin Breakdown
SCALES: Nutritional AssessmentTable 5-8
Sadness or change in mood Cholesterol, /\ Albumin Loss or gain of weight Eating issues Shopping and food prep issues
Complexity of Care
Cognitive Impairment
Older Adult Females (p. 65)
Rural Older Adults
Homeless Older Adults
Frail Older Adults
Chronically ill Older Adults
Cognitive Function
Short Term Memory Memory Aids
Long Term Memory
Synthesis of New Information
Acute Care of the Older Adult
What are common reasons for hospitalization?
What are the risks with hospitalization?
Medications
Restraints (physical &chemical)
Why do we use Restraints? Types?
Do you need an order?
What additional paperwork?
Assessment?
Social Services
Medicare Medicare coverage Part A , B, C, and D
Medicaid Medicaid requirements anc coverage
2010 Healthcare Reform Healthcare Reform Housing
Adult Day Care Programs Retirement Communities Assisted Living Facility Long Term Care Facility
Legal & Ethical Issues
Estate Planning
Legal Aid
Tax issues
Advance Directives Living Will – Natural Death Acts Durable Power of Attorney
Palliative Care at End of Life Care
Palliative care: any intervention focusing on \/’ing severity of disease symptoms. Table 10-1
Death: the irreversible cessation of cardiovascular, respiratory, and brain function.
Brain death: the irreversible cessation of all functions of the entire brain, including the brainstem. Heart may continue and can be maintained on mechanical ventilation.
What Are The Nurse’s Goals?
How Would We Achieve Those Goals?
Physical ManifestationsTable 10-2
Sensory Changes Cardiovascular
Respiratory Urinary
GI Musculoskeletal Integumentary
Mottling
Psychosocial Manifestation
Grief- emotional and behavioral response to loss
What are some factors that influence grief reactions?Religion
Prior ExperiencesValue SystemCoping Skills
Support SystemRelationship with dying person
Model of Grieving
Kubler-Ross (1969) (Table 10-4)
Denial Anger
Bargaining Depression Acceptance
The Grief Wheel Model (Fig. 10-6)
Normal Loss
Protest Disorganization Reorganization New Normal
Legal & Ethical IssuesTable 10-6
Organ/Tissue Donation Resuscitation/Removal of mechanical
ventilation, IV fluids Tube feeding
Advance Directives Living Wills
Durable Power of Attorney
Resuscitation
HospiceHospice and Palliative Care
What is Hospice Care?
When is it Applicable?
Who can request Hospice Care?
What are the top five illnesses of hospice patients?
Nursing Care
Nursing care becomes symptom management rather than cure
Psychosocial care Postmortem care
Prepare for immediate viewing for family
Care for your fellow nurses – debrief We all need a hug !!!!