Case Studies in Gerontological Nursing for the Advanced Practice Nurse

Case Studies in Gerontological Nursing for the Advanced Practice Nurse

Editors

Meredith Wallace Kazer, PhD, APRN, A/GNP-BC, FAAN

Leslie Neal-Boylan, PhD, RN, CRRN, APRN, FNP-BC

A John Wiley & Sons, Inc., Publication

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Library of Congress Cataloging-in-Publication Data

Case studies in gerontological nursing for the advanced practice nurse / editors, Meredith Wallace Kazer, Leslie Neal-Boylan. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-8138-2378-2 (pbk.: alk. paper) ISBN-10: 0-8138-2378-1 (pbk.: alk. paper) 1. Geriatric nursing–Case studies. I. Kazer, Meredith Wallace, PhD, RN. II. Neal-Boylan, Leslie. [DNLM: 1. Nursing Care–Case Reports. 2. Aged. WY 152]RC954.c42 2012618.97′0231–dc23 2011017809

A catalogue record for this book is available from the British Library.

Set in 10/12pt Palatino by Toppan Best-set Premedia Limited

1 2012

v

Contents

Contributors ixIntroduction xviiAbbreviationsandAcronyms xxi

Section 1 The Aging Population 1

Case1.1 RecipeforSuccessfulAging 3By Christine Tocchi, PhD(C), MSN, APRN, GNP-BC

Case1.2 CulturalCompetenceIsaJourney 15By Jina Ko, MSN, RN, ANP-C and Julie M. L. Lautner, MSW, MSN, RN

Case1.3 TheUglyFaceofAgeism 23By Shelley Yerger Hawkins, DSN, APRN, FNP, GNP, FAANP

Case1.4 IfOnlyWeHadNationalHealthInsurance 31By Philip A. Greiner, DNSc, RN

Section 2 Common Health Challenges of Aging 37

Case2.1 TheHeartofItAll 39By Jaclyn R. Jones, MSN, APRN, NP-C

Case2.2 IHaveThisThingonMySkin 47By Everol M. Ennis, Jr., MSN, APRN, A/GNP-BC

Case2.3 WhyIsMyMotherWearingaDiaper? 57By Annemarie Dowling-Castronovo, PhD(c), RN

Case2.4 MyAchingBack 65By Anne Moore, DNP, RN

vi    Contents

Case2.5 MoreThanJustConstipation 75By Frieda R. Butler, PhD, MPH, FAAN, FGSA

Case2.6 AreYouintheHospitalAgain? 85By Kimberly O. Lacey, DNSc, MSN, CNS

Case2.7 ItHurtsWhenIPee 93By Rebecca Herter, MSN, RN

Case2.8 TheHistoryRevealsAll 101By Devon Kwassman, MSN, RN

Case2.9 KneedlessPain 111By Maureen E. O’Rourke, RN, PhD, and Kenneth S. O’Rourke, MD

Case2.10 LifeafteraRightCVA 125By Cynthia S. Jacelon, PhD, RN, CRRN, FAAN

Case2.11 ItTakesMyBreathAway 135By Kathy Murphy, RN, BA, DipN, RNT, MSc, PhD,Dympna Casey, RGN, BA, MA, PhD,and Bernard McCarthy, MSc

Case2.12 What’sShaking? 145By Donna Packo Diaz, MS, RN, and Cathi A. Thomas, MS, RN, CNRN

Case2.13 TooMuchtoManage 153By Melanie J. Holland, BSN, MS

Case2.14 ThemBones,ThemBones 167By Ivy M. Alexander, PhD, APRN, ANP-BC, FAAN

Section 3 Health Promotion 181

Case3.1 NeverTooOldtoQuit 183By Geraldine Marrocco, EdD, APRN, CNS, ANP-BC and Amanda LaManna, MSN, RN, NP-C

Case3.2 ProtectionbyPrevention 189By Kimberlee-Ann Bridges, MSN, RN-BC, CNL

Case3.3 IsBeingCarefulEnough? 195By Bonnie Cashin Farmer, PhD, RN

Case3.4 SickandTiredofBeingSickandTired 203By Kathleen Lovanio, MSN, APRN, F/ANP-BC, Patricia C. Gantert, MSN, RN-BC, and Susan A. Goncalves, DNP(c), MS, RN-BC

Case3.5 ToScreenorNottoScreen 213By Meredith Wallace Kazer, PhD, APRN, A/GNP-BC, FAAN

Contents    vii

Section 4 Environments of Care 221

Case4.1 WhoSaysICan’tGoHome 223By Antoinette Larkin, RGN, H. Dip. Gerontology, and Claire Welford, RGN, DipNS, BNS–Hons., MSc, PGC–TLHE

Case4.2 RegressinginRehab 231By Kendra M. Grimes, MSN, APRN, GNP-BC

Case4.3 There’sNoPlaceLikeHome 239By Nicholas R. Nicholson, Jr., PhD, MPH, RN, PHCNS-BC

Case4.4 CaringfortheCaregiver 245By Evanne Juratovac, PhD, RN (GCNS-BC)

Case4.5 Transitions 253By Elizabeth McGann, DNSc, RN, and Lynn Price, JD, MSN, MPH, FNP-BC

Case4.6 ShiftingtheFocusofCare 261By Alison Kris, PhD, RN

Case4.7 WithoutaHome 267By Mary Shelkey, PhD, ARNP

Case4.8 APlaceCalledHome 277By Kelly Smith Papa, MSN, RN, and Eileen O’Connor Smith BSN, RN-C

Case4.9 AginginPlace 285By Karen Dick, PhD, GNP-BC, FAANP

Section 5 Cognitive and Psychological Issues in Aging 293

Case5.1 TheDiabolicalDs 295By Kathleen Lovanio, MSN, APRN, F/ANP-BC, Patricia C. Gantert, MSN, RN-BC, and Susan A. Goncalves, DNP(c), MS, RN-BC

Case5.2 WhataDifferenceaDayMakes 305By Cora D. Zembrzuski, PhD, APRN

Case5.3 IDon’tFeelGood 313By Evanne Juratovac, PhD, RN (GCNS-BC)

Case5.4 UnderstandingDistress 323By Eileen O’Connor Smith, BSN, RN-C, and Kelly Smith Papa, MSN, RN

Section 6 Issues of Aging and Independence 333

Case6.1 TooMuchofaGoodThing 335By Susan C. Frazier, MS, NP-C, GNP-BC

viii    Contents

Case6.2 DrivinginMyCar 343By Valerie C. Sauda, RN-BC, MS

Case6.3 SexDoesNotStopwithSeniority 351By Ashley Domingue, MSN, RN, ANP-BC, GNP-C

Case6.4 HiddenPathology 359By Marie Boltz, PhD, APRN, BC

Case6.5 TakingControlofthePain 367By Alison Kris, PhD, RN

Case6.6 TheRoadtowardEnd-of-LifeDecisionMaking:WhoHastheRightofWay? 373By Barbara L. Kramer, MSN, RN, CHPN, and Christine M. Goldstein, LCSW-R, OCW-C

Index 381

ix

Contributors

EDITORS

Meredith Wallace Kazer, PhD, APRN, A/GNP-BC, FAANAssociate Professor and Graduate Program DirectorSchool of NursingFairfield UniversityFairfield, CT

Leslie Neal-Boylan, PhD, RN, CRRN, APRN, FNP-BCProfessor and Graduate Program CoordinatorNursing DepartmentSouthern Connecticut State UniversityNew Haven, CT

CONTRIBUTORS

Ivy M. Alexander, PhD, APRN, ANP-BC, FAANProfessorDirector—Adult, Family, Gerontological and Women’s Health Primary

Care SpecialtyYale University School of NursingNew Haven, CT

Marie Boltz, PhD, APRN, BC Associate Director for Practice, Hartford Institute for Geriatric Nursing Assistant Professor, New York University College of Nursing New York, NY

x    Contributors

Kimberlee-Ann Bridges, MSN, RN-BC, CNLSurgical Unit Clinical Nurse LeaderDanbury HospitalDanbury, CT

Frieda R. Butler, PhD, MPH, FAAN, FGSAGerontological Consultant and Professor EmeritaCollege of Health and Human ServicesDepartment of Global and Community HealthGeorge Mason UniversityFairfax, VA

Dympna Casey, RGN, BA, MA, PhDAras MoyolaSchool of Nursing and MidwiferyNational University of IrelandGalway, Ireland

Donna Packo Diaz, MS, RNCoordinatorAPDA Parkinson CenterHospital of Saint RaphaelNew Haven, CT

Karen Dick, PhD, GNP-BC, FAANPGraduate Program Director and Clinical Associate Professor College of Nursing and Health Sciences University of Massachusetts Boston Boston, MA

Ashley Domingue, MSN, RN, ANP-BC, GNP-CFoundation Medical PartnersNashua, NH

Annemarie Dowling-Castronovo, PhD(c), RNAssistant Professor and Jonas ScholarEvelyn L. Spiro School of NursingWagner CollegeStaten Island, NY

Everol M. Ennis, Jr., MSN, APRN, A/GNP-BCNurse PractitionerCommunity Health Services, Inc. Hartford, CT

Contributors    xi

Bonnie Cashin Farmer, PhD, RNAssociate ProfessorSchool of NursingUniversity of Southern MainePortland, Maine

Susan C. Frazier, MS, NP-C, GNP-BCSteward Skilled Care TeamFall River, MA

Patricia C. Gantert, MSN, RN-BCMedical Educator/Diabetes Resource NurseSt. Vincent’s Medical CenterBridgeport, CT

Christine M. Goldstein, LCSW-R, OSW-CGood Samaritan Home Health AgencyBay Shore, NY

Susan A. Goncalves, DNP(c), MS, RN-BCNurse Manager Med/Surg UnitSt. Vincent’s Medical CenterBridgeport, CT

Philip A. Greiner, DNSc, RNAssociate Dean for Faculty Development in Scholarship and Teaching

and ProfessorCollege of Health ProfessionsPace UniversityPleasantville, NY

Kendra M. Grimes, MSN, APRN, GNP-BCYale University School of NursingNew Haven, CT

Shelley Yerger Hawkins, DSN, APRN, FNP, GNP, FAANPAssociate Professor of NursingCoordinator, Nurse Practitioner ProgramsUniversity of Arkansas Medical SciencesLittle Rock, AR

Rebecca Herter, MSN, RNA/GNP CandidateYale University School of NursingNew Haven, CT

xii    Contributors

Melanie J. Holland, BSN, MSAdjunct ProfessorQuinnipiac UniversityHamden, CTOutreach NurseSt. Vincent’s Medical CenterBridgeport, CT

Cynthia S. Jacelon, PhD, RN, CRRN, FAANAssociate ProfessorSchool of NursingUniversity of MassachusettsAmherst, MA

Jaclyn R. Jones, MSN, APRN, NP-CYale School of NursingYale UniversityNew Haven, CT

Evanne Juratovac, PhD, RN (GCNS-BC)Assistant Professor, Frances Payne Bolton School of NursingFaculty Associate, University Center on Aging and HealthCase Western Reserve UniversityCleveland, OH

Jina Ko, MSN, RN, ANP-CNurse PractitionerWhite Memorial Medical CenterLos Angeles, CA

Barbara L. Kramer, MSN, RN, CHPN Palliative Care CoordinatorGood Samaritan Home Health Agency and Catholic Home CareBay Shore, NY

Alison Kris, PhD, RNAssistant ProfessorFairfield UniversitySchool of NursingFairfield, CT

Devon Kwassman, MSN, RNA/GNP CandidateYale University School of NursingNew Haven, CT

Contributors    xiii

Kimberly O. Lacey, DNSc, MSN, CNSAssistant ProfessorDepartment of NursingSouthern Connecticut State UniversityNew Haven, CT

Amanda LaManna, MSN, RN, NP-CAdult Nurse PractitionerMiami University Student Health ServicesOxford, Ohio

Antoinette Larkin, RGN, H. Dip. GerontologyClinical Nurse Specialist in Elderly CarePortiuncula HospitalBallinalsoe Galway, Ireland

Julie M. L. Lautner, MSW, MSN, RNA/GNP CandidateYale University School of NursingNew Haven, CT

Kathleen Lovanio, MSN, APRN, F/ANP-BCAssistant Professor, VANAFairfield University School of Nursing Fairfield, CT

Geraldine Marrocco, EdD, APRN, CNS, ANP-BCAssistant ProfessorYale University School of NursingNew Haven, CT

Bernard McCarthy, MSc Lecturer School of Nursing and Midwifery National University of Ireland Galway, Ireland

Elizabeth McGann, DNSc, RN, GCNS-BCProfessor of NursingDepartment of NursingQuinnipiac UniversityHamden, CT

xiv    Contributors

Anne Moore, DNP, RNDirector of Spine and Surgical Business PlanningHospital of Saint RaphaelNew Haven, CT

Kathy Murphy, RN, BA, DipN, RNT, MSc, PhDProfessor of NursingSchool of Nursing and MidwiferyNational University of Ireland Galway, Ireland

Nicholas R. Nicholson, Jr., PhD, MPH, RN, PHCNS-BCPostdoctoral FellowGeriatric Clinical Epidemiology and Aging Related ResearchSchool of MedicineYale UniversityNew Haven, CT

Kenneth S. O’Rourke, MDAssociate ProfessorSection on Rheumatology and ImmunologyWake Forest University School of MedicineWinston-Salem, NC

Maureen E. O’Rourke, RN, PhDAdjunct Assistant Professor of Internal Medicine-Hematology/

OncologyWake Forest University School of MedicineWinston-Salem, NC

Kelly Smith Papa, MSN, RNDirector of EducationAlzheimer’s Resource Center of ConnecticutPlantsville, CT

Lynn Price, JD, MSN, MPH, FNP-BCAssociate ProfessorDepartment of NursingQuinnipiac UniversityHamden, CT

Valerie C. Sauda, RN-BC, MS Geriatric Nurse Service InstructorNursing DepartmentEastern Maine Community CollegeBangor, ME

Contributors    xv

Mary Shelkey, PhD, ARNPAssistant ProfessorCollege of NursingSeattle UniversitySeattle, WA

Eileen O’Connor Smith, BSN, RN-CDirector of NursingAlzheimer’s Resource Center of ConnecticutPlantsville, CT

Cathi A. Thomas, MS, RN, CNRN Assistant Clinical Professor, Neurology Parkinson Disease and Movement Disorder CenterBoston University Medical Campus Boston, MA

Christine Tocchi, PhD(C), MSN, APRN, GNP-BCPre-Doctoral ScholarYale University School of NursingYale UniversityNew Haven, CT

Claire Welford, RGN, DipNS, BNS–Hons., MSc, PGC–TLHESchool of Nursing and MidwiferyNational University of IrelandGalway, Ireland

Cora D. Zembrzuski, PhD, APRNGero-psychiatric ConsultantMedOptions, Inc.Behavioral Health ConsultantsOld Saybrook, CT

xvii

IntroductionBy Meredith Wallace Kazer and Leslie Neal-Boylan

Older adults are the fastest growing population cohort worldwide. In the U.S., the Administration on Aging (2009) reports that there were over 38.9 million older adults in the country, which reflects a 13.0% increase over the last decade for a total of 12.8% of the total population. One in every eighth person in the U.S. is an older adult. If individuals survive to the age of 65, they will likely live an average of 18.6 more years for an average life span of approximately 84 years. It is predicted that the older adult population will increase from 40 million in 2010 to 55 million in 2020, which represents a 36% increase for this decade. The fastest growing population of older adults is the 85+ population, which is expected to increase from 5.7 million in 2010 to 6.6 million in 2020.

The rapid growth of older adults in the U.S. positions this popula-tion in almost every care setting in which clinicians practice. Except for those clinicians who choose to work solely with maternal clients, most clinicians will care for older adults in an array of care environments. Even pediatric clinicians will encounter older adult parents as grand-parents raising grandchildren, and these situations will require knowl-edgeable and experienced clinicians to assist in negotiating the many challenges of older adulthood. However, geriatric education or educa-tion that focuses on the care of this population has not kept pace with the increased prevalence of older adults in health care settings. In the latest available survey, Gilje, Lacey, and Moore (2007) revealed that just over 50% of baccalaureate nursing programs surveyed offered a stand-alone geriatric course. In order to provide cost-effective and evidence-based care to meet the great needs of the rising population of older adults, geriatric education is needed in all educational institutions that prepare clinicians to care for older adults. Most importantly, resources with which to facilitate geriatric education are greatly needed.

xviii    Introduction

This book was developed as a resource for geriatric clinical educa-tion. Using real cases, this book provides thoughtful clinical scenarios through which clinicians can enhance clinical reasoning and gain geri-atric nursing knowledge. The cases in this book were chosen to illus-trate both typical and atypical situations that occur in geriatric practice. Readers are encouraged to go beyond simply trying to find the answers regarding the diagnoses and treatment plans for the patients involved in these cases toward the development of new ideas and knowledge. The usefulness of each case is enhanced if readers consider various scenarios for the patient in light of how the patient’s conditions or circumstances might affect the family within the care setting. Remembering that the patient is part of an environment will help enhance readers’ understanding of the condition from multiple perspectives.

This book is organized around 6 sections that focus on conditions and environments that impact older adults. The first section provides an overview of issues that impact the geriatric population. Contained within this section is a case study that discusses the elements of suc-cessful aging. The section proceeds with an issue that is becoming more prevalent within health care education—the need for cultural compe-tence. The Administration on Aging (2009) reports that in 2008, 19.6% of older adults were minorities: 8.3% were African American, 6.8% were persons of Hispanic origin (who may be of any race), approxi-mately 3.4% were Asian or Pacific Islander, and less than 1% were American Indian or Native Alaskan. By the year 2010, these minority populations are projected to increase from 5.7 million in 2000 (16.3% of the older adult population) to 8.0 million in (20.1% of older adults) and then to 12.9 million in 2020 (23.6% of older adults). This drastic increase in the cultural diversity of older adults requires that clinicians analyze their views and values regarding other cultures, learn essential ele-ments of these cultures that impact health care choices, and facilitate the delivery of culturally competent health care interventions across care settings.

Section 1 proceeds to focus on two other major issues that impact older adults. Ageism, which is defined as a negative attitude or bias toward older adults that results in the belief that older people cannot or should not participate in societal activities or be given equal oppor-tunities afforded to others (Holohan-Bell & Brummel-Smith, 1999), affects health care of older adults and impacts access to services. Ageism has the power to deprive older adults of their dignity and respect and may facilitate the disengagement of older adults from society. Ageism also has the potential to influence policies and care decisions for older adults. The rising costs of health care, limited reimbursement options for older adults, and low income among older adults also impact health care greatly. The median income of older adults in 2008 was only $25,503 for males and $14,559 for females, and approximately 3.7

Introduction    xix

million older adults (9.7%) were below the poverty level in 2008. Section 1 includes cases that address both of these issues.

Section 2 focuses on common health conditions that affect older adults. In developing a framework for cases in this section, a review-of-systems approach was used. Thus, the cases reflect health care con-ditions that impact all systems from head to toe. Because cardiac conditions are major challenges as patients age, this section begins with a case study that focuses on this system. Common skin conditions, bowel and bladder issues, and musculoskeletal concerns are repre-sented within the early cases in this section. Other commonly occurring conditions such as stroke, sexually transmitted diseases, chronic obstructive pulmonary disease, Parkinson disease, and osteoporosis are also featured within this section.

There is a common misconception prevalent in health care that health promotion activities are not useful for older adults in their later years. Many clinicians incorrectly believe that after 60, 70, or 80 years of poor health behaviors such as drinking, smoking, or poor nutrition, older adults cannot benefit from programs focused on improving health practices acquired early in life and continued into older adult-hood. The reality is that older adults are certainly not “too old” to stop smoking and drinking excessive amounts of alcohol, improve food choices, start exercising, develop sleep hygiene habits, and enhance their overall health and safety. Older adults may benefit from health promotion activities, even in their seventh, eighth, ninth, and tenth decades of life. Section 3 provides case studies in which older adults find themselves in need of health promotion activities and successfully engage in them. Contained within this section are cases discussing older adults challenged with primary prevention interventions, such as immunizations, smoking cessation, and good sleep hygiene devel-opment. This section also discusses secondary prevention strategies such as screening for prostate cancer.

While the majority of older adults live in their own homes, the Administration on Aging (2009) reports that approximately 31% (11.2 million) of noninstitutionalized older adults live alone (8.3 million women; 2.9 million men). As individuals age, living alone presents a number of challenges to living a quality life. For many older adults, institutional living and assisted living are often alternatives to living alone; but these alternatives also involve challenges. Section 4 presents case studies on the challenges of living alone and in institutions. The transition between environments, homeless older adults, and lack of fit in care environments are also among the cases presented in this section.

Many older adults approach their later years cognitively intact. However, a syndrome commonly known as the three Ds (delirium, depression, and dementia) occurs frequently in the older adult popula-tion. Section 5 presents cases that illustrate the similarities and differ-ence in the presentation of the three Ds and provides information to

xx    Introduction

help clinicians to effectively detect these conditions and to implement early treatment. In so doing, the consequences of these cognitive and psychological conditions may be prevented.

Finally, the last section of this book presents cases on special issues among older adults that may impact levels of independence. Polypharmacy and its impact on one older adult is the focus of the first case study in this section. The section continues to explore the chal-lenge of driving, as well as the challenge of continued sexual health among older adults, amidst declining function and overall health. Pain management and end-of-life decision making cases are also present in this section to help clinicians anticipate and manage these special issues among the older adult population.

As readers progress through this book, they will be interested in and impressed with the depth and breadth of the case studies in geronto-logical nursing. Each section focuses on a different area of concern for older adults and contains cases that illustrate the issue in a manner that enhances the readers’ understanding. Using this pedagogical method of learning, readers will enhance their knowledge and understanding regarding the vast array of issues of interest to clinicians who provide advanced care to older adults. Consequently, improved health care may be provided, resulting in improvement of the quality of life of the fastest growing U.S. population.

REFERENCES

Administration on Aging (2009). Profile of Older Americans. Washington, D.C: Journal of Professional Nursing, 23, 21–29.

Gilje, F., Lacey, L., & Moore, C. (2007). Gerontology and geriatric issues and trends in U.S. Nursing programs: A national survey.

Holohan-Bell, J., & Brummel-Smith, K. (1999). Impaired mobility and decon-ditioning. In J. Stone, J. Wyman, & S. Salisbury (Eds.), Clinical gerontological nursing. A guide to advanced practice (pp. 267–287). Philadelphia, PA: W.B. Saunders.

Abbreviations and Acronyms

AAA AreaAgencyonAgingABG arterialbloodgasABMT autologousbonemarrowtransplantationACE angiotensin-convertingenzymeACOG AmericanCollegeofObstetriciansandGynecologistsACS AmericanCancerSocietyAD AlzheimerdiseaseADH antidiuretichormoneADL activitiesofdailylivingADR adversedrugreactionsA-fib atrialfibrillationAHI apnea-hypopneaindexAHRQ AgencyforHealthcareResearchandQualityAIMS AbnormalInvoluntaryMovementScaleAL assistedlivingAM/CL amoxicillin/clavulanateAMI acutemyocardialinfarctionANA antinuclearantibodyAP anteroposteriorAPDA AmericanParkinsonDiseaseAssociation,Inc.ARN AmericanRehabilitationNurseART antiretroviraltherapyASA AmericanSocietyofAnesthesiologistsASO titre antistreptolysinOtitreATC aroundtheclockATS AmericanThoracicSocietyBKA below-the-kneeamputationBM bowelmovementBMI bodymassindexBPH benignprostatichypertrophyBUN bloodureanitrogenC&S cultureandsensitivityCAD coronaryarterydisease

xxi

xxii    Abbreviations and Acronyms

CAM confusionassessmentmethodCAP community-acquiredpneumoniaCA-UTI catheter-associatedurinarytractinfectionCBC completebloodcountCBT cognitivebehavioraltherapyCCRC continuingcareretirementcommunityCDC CentersforDiseaseControlCDT ClockDrawingTestCES-D CenterforEpidemiologicStudiesDepressionScaleCFO chieffinancialofficerCHF congestiveheartfailureCMC carpometacarpalCMP comprehensivemetabolicpanelCMS CentersforMedicareandMedicaidStudiesCN cranialnerveCOPD chronicobstructivepulmonarydiseaseCOX-2 cyclooxygenase-2CP chestpainCPAP continuouspositiveairwaypressureCPR cardiopulmonaryresuscitationCrCl creatinineclearanceCSDD CornellscalefordepressionindementiaCT computertomographyCTA cleartoauscultationCVA cerebrovascularaccidentDAT dementiaofAlzheimer’stypeD/C dischargeDCCT DiabetesControlandComplicationsTrialDDX differentialdiagnosisDIP distalinterphalangealDJD degenerativejointdiseaseDNR donotresuscitateDOE dyspneaonexertionDRE digitalrectalexaminationDSM-IV DiagnosticandStatisticalManualofMentalDisordersDVT deepveinthrombosisDXA dual-energyx-rayabsorptiometryEAI elderassessmentinstrumentECT electroconvulsivetherapyED emergencydepartmentEDS excessivedaytimesleepinessEEG electroencephalographyEKG electrocardiogramELISA enzyme-linkedimmunosorbentassayEMG electromyogramEMS emergencymedicalsystem

Abbreviations and Acronyms    xxiii

EOAD earlyonsetAlzheimerdiseaseEOG electrooculographyEOM extraocularmovementER emergencyroomESR erythrocytesedimentationrateESS EpworthSleepinessScaleFAST functionalassessmentstagingtoolFBS fastingbloodsugarFEV1 forcedexpiratoryvolumein1secondFVC forcedvitalcapacityGD globaldepressionGDR gradualdosereductionGDS GeriatricDepressionScaleGERD gastroesophagealrefluxdiseaseGFR glomerularfiltrationrateGFRS GeriatricFunctionalRatingScaleHAD HIV-associateddementiaHART highlyactiveantiretroviraltherapyHbA1c hemoglobinA1cHCAP healthcareassociatedpneumoniaHCP healthcareproviderHCTZ hydrochlorothiazideHDL high-densitylipoproteinHIV humanimmunodeficiencyvirusHOH hardofhearingHPA hypothalamic-pituitary-adrenalHRQOL healthrelatedqualityoflifeHRSA HealthResourcesandServicesAdministrationHT hormonetherapyHTN hypertensionHZ herpeszosterIA intraarticularIADL instrumentalactivitiesofdailylivingIBS irritablebowelsyndromeICS intercostalspaceIDSA InfectiousDiseasesSocietyofAmericaIM intramuscularINR internationalnormalizedratioI/O intakeandoutputIT intensivetherapyIV intravenousLDL low-densitylipoproteinLI limitedinformationLLN lowerlimitofnormalLR likelihoodratioLSO lumbarsacralorthosis

xxiv    Abbreviations and Acronyms

MCL midclavicularlineMCP metacarpophalangealMDR multidrugresistantMI myocardialinfarctionMMSE Mini-MentalStateExaminationMRI magneticresonanceimagingMRSA methicillin-resistantstaphylococcus aureusNASS NationalAssociationofSpineSurgeonsNC nasalcannulaNCSDR NationalCenteronSleepDisordersResearchNG nasogastricNHLBI NationalHeartLungandBloodInstituteNIDDM Non-insulindependentdiabetesmellitusNIH NationalInstitutesofHealthNKA noknownallergiesNKDA noknowndrugallergiesNKF NationalKidneyFoundationNKFA noknownfoodallergiesNNRTI nonnucleosidereversetranscriptaseinhibitorNP nursepractitionerNRT nicotinereplacementtherapiesNSAID nonsteroidalantiinflammatorydrugNSF NationalSleepFoundationNTG nitroglycerinOA osteoarthritisOFI oralfluidintakeOP osteoporosisORIF openreductioninternalfixationOTC overthecounterPainAD painassessmentforadvanceddementiaPC palliativecarePCA patientcontrolledanalgesiaPCR polymerasechainreactionPERRLA pupilsareequal,round,andreactivetolightand

accommodationPHN postherpeticneuralgiaPI proteaseinhibitorPIP proximalinterphalangealPO bymouthPPD packperday;purifiedproteinderivativePPI proton-pumpinhibitorPR pulmonaryrehabilitationPSA prostatespecificantigenPSG polysomnographyPSI pneumoniaseverityindexPSQI PittsburghSleepQualityIndex

Abbreviations and Acronyms    xxv

PTSD posttraumaticstressdisorderPVD peripheralvasculardiseasePVR postvoidresidualRA rheumatoidarthritisorriskdiseaseRCVA rightcerebrovascularaccidentREM rapideyemovementRF rheumatoidfactorROM rangeofmotionSBGM self–bloodglucosemonitoringSIADH syndromeofinappropriatediuretichormone

hypersecretionSOB shortnessofbreathSPT suprapubictubeSS specificsuggestionSSRI selectiveserotoninreuptakeinhibitorSTART ScreeningTooltoAlertdoctorstoRightTreatmentSTI sexuallytransmittedinfectionSTOPP ScreeningToolofOlderPerson’sPotentially

inappropriateprescriptionsT2DM Type2diabetesmellitusTAH BSO totalabdominalhysterectomyandbilateral

salpingo-oopherectomyTB tuberculosisTBW totalbodywaterTC taichiTCM transitionalcaremodelTENS trancutaneouselectricalnervestimulationTIA transientischemicattackTIBC totalironbindingcapacityTM tympanicmembraneTMS trimethoprim-sulfamethoxazoleTPN totalparenteralnutritionTRUS transrectalultrasoundTSH thyroidstimulatinghormoneTZD thiazolidinedioneUA urinalysisUI urinaryincontinenceUSPSTF U.S.PreventativeServicesTaskForceUTI urinarytractinfectionVA Veteran’sAdministrationVCF vertebralcompressionfractureVS or V/S vitalsignVZV varicella-zostervirus;varicella-zostervaccineWBC whitebloodcellWOCN woundostomycontinencenurse

Section 1The Aging Population

Case 1.1 Recipe for Successful Aging 3By Christine Tocchi, PhD(C), MSN, APRN, GNP-BC

Case 1.2 Cultural Competence Is a Journey 15By Jina Ko, MSN, RN, ANP-C and Julie M. L. Lautner, MSW, MSN, RN

Case 1.3 The Ugly Face of Ageism 23By Shelley Yerger Hawkins, DSN, APRN, FNP, GNP, FAANP

Case 1.4 If Only We Had National Health Insurance 31By Philip A. Greiner, DNSc, RN