T3-Blueprint: Suicide-Care plan for elderly-Life review-Meds Flashcards Preview

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Flashcards in T3-Blueprint: Suicide-Care plan for elderly-Life review-Meds Deck (28):
1

15% of all suicides are committed by persons ____

65 and older, especially white men

2

What are predisposing factors to suicide?

Loneliness
Financial problems
Physical illness
Loss
Depression

3

Who are especially vulnerable to suicide after losing a spouse: men or women?

Men

4

What is a significant predictor of suicide in older adults?

Major depression

5

Risk for trauma r/t confusion, disorientation, muscular weakness, spontaneous fractures, and falls.

What are some interventions to help ensure client safety in older adult?

-Arrange furniture to accommodate disabilities
-Put frequently used items in easy reach
-Bed in elevated position, pad side rails and headboard if client has seizures
-Bed rails up when client is in bed (per hospital policy)
-Room needs to be near nurse station
-Assist with ambulation
-Dim light on at night
-Cigs and lighters kept at nursing station and dispensed only when someone is able to be with client as they smoke
-Frequently orient client x3
-Soft restraints may be required if client is very disorientated and hyperactive

6

Self-care deficit r/t weakness, disorientation, confusion, memory deficit AEB inability to filfill ADL

What are the nursing interventions to help provide a simple, structured environment with the rational being to minimize confusion?

Provide a simple, structured environment!!
-Identify self care deficit and provide assistance as needed
-Promote independence as abled!
-Allow plenty of time for client to perform tasks
-Provide guidance and support for independent actions by talking through it step by step
-Structured schedule of activities that DO NOT change from day to day
-ADLs should be like home routine as much as possible
-Allow consistency of daily caregivers

7

Low self-esteem r/t loss of pre-retirement status; earl cognitive decline AEB verbalization of negative feelings about self and life

Encourage client to express honest feelings in relation to loss of their _____. Acknowledge pain of ___. Support client though process of grieving.

Loss of their prior status; acknowledge pain of loss

Do this bc client may be fixed in ANGER stage of grieving, which is turned INWARD on the self, resulting in diminished self-esteem

8

Low self-esteem r/t loss of pre-retirement status; earl cognitive decline AEB verbalization of negative feelings about self and life

If lapses in memory are occurring, we need to devise method for assisting client with memory deficit. How?

-Name on door identify client
-Sign on outside of room door so they know it is dining room, restroom, etc
-Large clock, oversized numbers and hands (appropriately placed) & large calendar, indicating one day at a time with month, day and year in BOLD
-Printed, structured daily schedule for client and one on unit wall
-"News board" on unit wall so client can see current news


*These aids assist client to function more independently--> increases self esteem

9

Low self-esteem r/t loss of pre-retirement status; earl cognitive decline AEB verbalization of negative feelings about self and life

Encourage clients attempts to communicate. What if verbalizations are not understandable?

Express to client what you think he/she meant to say--it may be necessary to reorient client frequently

*the ability to communicate with others may enhance self esteem

10

Low self-esteem r/t loss of pre-retirement status; earl cognitive decline AEB verbalization of negative feelings about self and life

Encourage ____ and discussion of ______. How? Also discuss what?

Reminiscence and discussion of life review
Ex: pictures
Also discuss present day events

Reminiscence and life review help client resume progression through grief process associated with disappointing life events and increase self esteem as successes are reviewed

11

Low self-esteem r/t loss of pre-retirement status; earl cognitive decline AEB verbalization of negative feelings about self and life

We need to encourage participation in group activities. Is it okay to accompany the client?

Yes, at first until he/she feels secure that group members will be accepting, regardless of limitations in verbal communication

*Positive feedback from group members= increase self esteem

12

Low self-esteem r/t loss of pre-retirement status; earl cognitive decline AEB verbalization of negative feelings about self and life

Encourage client to be as independent ad possible in self care activities!! How can we help with this?

Give a written schedule of tasks to be performed
*intervent when client needs assistance

Ability to perform independently--> preserves self esteem!!

13

Reminiscence and life review: "Stimulation of life memories helps older adults to work through their _____ and maintain _____. Life review provides older adults with an opportunity to come to grips with ___ and ____, and to emerge feeling good about themselves"

"Stimulation of life memories helps older adults to work through their LOSSES and maintain SELF-ESTEEM. Life review provides older adults with an opportunity to come to grips with GUILT and REGRETS, and to emerge feeling good about themselves"

14

Thinking about the past and reflecting on it

Reminiscence

*can promote better mental health in old age
*can take place one-on-one or in group

15

Life review is RELATED to reminiscence. How does it differ?

Differs from reminiscence in that life review is more GUIDED or DIRECTED cognitive process that constructs a history or story in an autobiographical way

16

Elderly individuals who spend time thinking about the past experience an increase in ____ and are less likely to suffer ___

Increase in self-esteem; less likely to suffer depression

17

Reminiscence on a ____ basis can provide a way for elderly individuals to work through unresolved issues from the past

One-to-one basis

*painful issues may be too difficult to discuss in group

18

As the individual reviews his or her life process, the nurse can validate feelings and help the elderly client come to terms with painful issues that ma have been long suppressed. Why is this process necessary?

If the elderly individual is to maintain (or attain) a positive identity and self esteem and ultimately achieve the goal of ego integrity

19

What are ways to provoke memories from the clients past?

Pets
Music
Special foods

20

What are ways to guide the elderly client though his or her autobiographical review?

Photos of family members
Past significant events

21

Care must be taken in the life review to assist clients to work though unresolved issues. What may result if the individual is unable to work though the problems and accept them?

Anxiety
Guilt
Depression
Despair

22

How can a life review work in a negative way?

If the individual comes to believe that his or her life was meaningless

23

How can a life review work in a positive way?

If the person can take pride in their past accomplishments and feel satisfied with his or her life, resulting in a sense of serenity and inner peace

24

Why are elderly more sensitive to opioids?

Body does not metabolize or excrete them as efficiently--this does NOT justify withholding narcotics and failing to relieve pain

25

Who is adverse reactions greater risk in: younger or older?

Older

26

What are some reasons older adults have altered absorption, detoxification, and excretion?

-Decreased ICF
-Decreased gastric blood flow and motility
-Decreased CO and circulation
-Decreased liver function
-Slower metabolism
-Increased gastric pH

27

What are absorbed better: drugs given IM, SQ, PO, PR ...OR... drugs that are inhaled, topical, IV?

Better absorbed= inhaled, topical, IV

28

What is greater in elderly regarding meds?

1. Polypharmacy
2. IV infiltration is greater in elderly!!!--> use of patches is a POSITIVE way to introduce meds through skin w/o breaking skin