388 - Week 3 - Older Adults in Transition/Mental Health in Older Adults Flashcards
What nursing implications surround the housing of older adults in transition?
- Goal = older adults should be able to live in the least restrictive environment possible
- Important to adapt home to meet the needs of the older adult (grab bars, raised toilet seats, removing throw rugs)
- Careful and complete Nursing assessments are vital to ensure the older adult is living in the safest environment possible (need to be thorough -> identify what resources they have available including food in fridge and cupboards)
Discuss the “Diagnostic/Assessment” Nursing Implications regarding dementia
- up to 20% of cases of memory loss are treatable or reversible (require medical attention however)
- Need to be able to discern between symptoms of delirium and dementia)
- When dementia suspected -> Full blood work completed, CT scan of brain to rule out hematoma or tumors, urinalysis can rule out UTI or STI infections
- Dementia dx only when all other possibilities are ruled out
Discuss the “Pharmacological” Nursing implications regarding dementia
-Cholinesterase inhibitors: given for early stage dementia as they can help to slow progression (ECG required to ensure safety of pt prior to med initiation)
-examples include:
->Aricept (only effective for ~6mo usually)
->Exelon
->Reminyl
Symptoms for all include: electro-conductivity problems, nausea and vomiting
Describe the various safety issues regarding a patient w/ “early stage” dementia
- heightened risk for suicide (this is the time when it is greatest because they are still competent enough to plan and carry out an act of suicide)
- Impaired judgement may lead to poor decisions regarding finances and work (increased risk for financial strain and possible job loss)
Describe the various safety issues regarding a patient w/ “Mild Stage” dementia
- increased danger related to initiation of “wandering”
- progressive agnosia may lead to harmful actions (i.e. brushing teeth with razor blade) because of the inability to recognize objects, persons, sounds, smells, etc.
Describe the various safety issues regarding a patient w/ “End Stage” dementia
- Immobility can increase risk for bedsores and infections
- Decreased ability to chew and swallow can increase risk for aspiration
- Eating significantly decreases and can lead to severe nutritional deficiencies (family may need to explore alternate methods of providing nutritional sustenance to pts.)
How might the spouse or caregiver of a pt with dementia be impacted throughout the progression of the disease?
- it is not uncommon for these individuals to develop health problems
- they may even pass before their family member because of the significant ill health experienced as a secondary impact of their loved ones decline
What educational components are important for RN’s to communicate to family members/care givers regarding dementia?
- explain the progression and disease processes of the disease to the patient and family members (may last 2-12 years -> how is speech, motor skills impacted as disease progresses?
- how can the home be adapted to protect the safety of the individual w/ dementia and to prevent them from engaging in harmful activities?
- Discussion regarding appointing an enduring power of attorney especially while pt is in mild stage
- discuss future life decisions -> personal directives, advanced care plan, assigning guardians
- discuss trusteeship
What non-pharmacological Nursing interventions are encouraged/or may be required for patients w/ dementia and their families?
- Encourage participation in meaningful activities (or activities previously enjoyed by the ind)
- Reminiscence therapy
- OT/RT assessment may be useful to decipher ind level of functional ability and their areas of enjoyment
- Increase socialization (for both pt and caregiver)
- Assistance with grieving/loss and accompanying emotions
- Family counseling -> may be necessary if they are external family issues impacting the care of the pt
- Assist caregiver w/ processing difficult decisions (move pt to LTC, end of life decisions -> feeding tubes, treating infections, goals of care)
How can RN’s combat ageism and overcome ageist beliefs?
- learn more about ageism and discrimination
- examine our own values and beliefs
- identify and speak up re myths and misinformation
- build intergenerational bridges to promote understanding
- learn more about active healthy aging
- listen to seniors who have experienced ageism
- avoid over-accomodation & elder-speak
- address in a respectful manner
- clarify purpose of interaction or assessment
- frame conversation first and set the stage
- encourage older adults to bring a friend or family member if they feel more comfortable
- develop a genuine partnership with older adult and their family
- assess the older adults within the context of a family
- identify resources and strengths to assist families address the life event
- assess hearing and speak in a low, moderate voice
How should RN’s approach their work with older adults?
- Address threats to self-esteem: inclusion, respect, focus on strengths, privacy
- be aware of perceived actions (verbal and non verbal) avoid depersonalization
- identify causative factor for complaints through comprehensive assessment and problem solving
- recognize the importance of social supports
- be a good listening to maintain the self-esteem of an older adult by taking time to reminisce and by creating opportunities for social interaction
Age-related change interventions should focus on…
- the whole person to identify changes that can be strengthened to improve individuals ability to adapt (coping skills, aids)
- operate from a position that every older adult has strengths that can help them adapt
Under what circumstances should a comprehensive Nursing Assessment be completed with an older adult?
- Change in ability to complete ADL’s
- Change in health status, illness or deterioration
- Change in behavior
- After a fall
- If a caregiver(s) tells you they are no longer able to cope with the challenges of care giving for the ind
A Nursing Assessment of an older adult should explore on…
- Age related changes
- Risk Factors
- (-) & (+) Functional consequences
- Medication reconciliation (BEERS??)
- Consideration of ind’s life stage and possible transitions
- assess the impact of transitions upon the older adult and their family
- assess for issues of grief and loss
- assess the living environment
- assess available support systems (informal and formal)
Nursing Interventions for the older adults should…
- address any issues found during the assessment
- address home environment: safety, ability to access and prepare food
- Educate pt’s about meds
- Provide assistance with ADL’s and IADL’s where necessary
- Identify and connect older adult with support persons during times of grief and loss (family members, friends, community supports)
- Refer to additional HCP’s and agencies when necessary (physician -> for health issues and meds, community seniors center, support groups for those suffering with dementia)
