Unit 1 chronicity older adult gordons functional health pattern self perception and self concept
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UNIT 1 Chronicity: Older Adult Gordons Functional Health Pattern Self-Perception and Self-Concept. Unit objectives: The student will be able to: Discuss the effects of aging. Define chronic illness

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Unit 1 chronicity older adult gordons functional health pattern self perception and self concept

UNIT 1 Chronicity: Older AdultGordons Functional Health Pattern Self-Perception and Self-Concept

  • Unit objectives: The student will be able to:

  • Discuss the effects of aging.

  • Define chronic illness

  • Describe characteristics of chronic conditions and implications for people with chronic conditions and for their families.

  • Discuss four functional health patterns [FHP’s] that most elderly and/or chronically-ill clients would fit.

  • List measures to promote safe drug use in the elderly.

    6. Describe the legal and ethical responsibilities in caring for the elderly and/or clients with chronic conditions.


Unit 1 chronicity older adult gordons functional health pattern self perception and self concept

  • Describe the use of effective teaching methods for the elderly.

  • Identify specific needs of the chronically-ill client as related to their stage of development according to the last two stages of Erickson’s psychosocial theory.

    10. Describe the components of the Patient Self-Determination Act.

    11. Descibe how nurses should use “people-first” language

    12. Required Reading:

    Smeltzer: Chapters: 7,10,12

    Eliopoulos: Chapters: 1,6,17,29,32,35,36

    Case Studies in this syllabus (end of powerpoint)

    Hand in the answers at the first class meeting.


Changes of aging

Changes of Aging

  • Aging is not a disease

    • Intrinsic aging – normal aging, genetically programmed

    • Extrinsic – air pollution, sunlight, occupation


Physical changes of aging

Physical Changes of Aging

  • Body composition-

    • Body cells become less able to replace themselves

    • Reduced lean body mass

    • Decreased in ICF  risk of dehydration

    • Hair thinning/loss, grey hair

    • Body fat atrophies  double chin, baggy eyelids, deepening of intercostals spaces,

    • Skin-folds thickness is reduced in forearm & back of hands, loss of sub q fat “c/o being cold”

    • Body shrinkage due to loss of cartilage & thinning of vertebrae

    • Lower normal temperature


Physical changes of aging1

Physical Changes of Aging

  • Cardiovascular changes-

    • Decreased contractility, impaired coronary blood flow, altered preload & afterload, increased atherosclerotic plaques, vessels tortuous, heart valves thick & rigid

  • Respiratory events-

    •  rigidity of thoracic cage, decreased vital capacity, decreased cough efficiency , decrease ciliary action

  • Renal changes-

    • Decrease bladder capacity, decreased concentrating and diluting abilities, decreased creatinine clearance &  prostate size

  • Endocrine changes-

    • Thyroid – fibrosis & increased nodularity, decreased basal metabolism,

    • Pancreas - delayed & insufficient release of insulin by beta cells,

    • Pituitary - decrease in volume by approx 20%.


Physical changes of aging2

Physical Changes of Aging

  • Gastrointestinal changes

    • Tooth loss, decreased saliva, altered nutritional digestion, weakening of lower esophageal sphincter, decrease in blood flow, decrease size in organs, decrease peristalses

  • Nervous system

    • Structural changes: decreased neurons & speed of conduction, brain wt, & peripheral nerve function,

    • Functional changes: decreased reaction time, impaired thermoregulation, changes in sleep patterns


Physical changes of aging3

Physical Changes of Aging

  • Sensory-

    • Vision changes: presbyopia; susceptible to glare; difficult distinguishing blue & green

    • Hearing changes: presbycusis, loss of high frequency sounds,  wax build up

    • Taste: decreased sweet, salt & seasoned food taste

  • Reproductive-

    • Female: vaginal mucosa thinning, atrophy, decreased breast tissue,

    • Male: decreased libido


Physical changes of aging4

Physical Changes of Aging

  • Dermatologic

    • Decreased elasticity, decreased secretion of natural oil & perspiration, decreased heat regulation, decreased epidermal renewal, decreased inflammatory


Critical thinking multiple response select all of the normal age related physiological changes

Critical Thinking: Multiple Response(Select all of the normal age-related physiological changes)

  • -Decline in visual acuity

  • -Decreased Respiratory rate

  • -Increased hear rate

  • -Increased heart rate

  • -Increased susceptibility to UTIs

  • -Decline in long-term memory

  • -Increased incidence of awakening after sleep onset


Chronic illness

Chronic illness

  • Occur in people of every age, socioeconomic level, and culture.

  • Medical conditions or health problems with associated symptoms that require long-term (3 months or longer) management.

  • Conditions that do not resolve or for which complete cures are rare.

  • Management means that people must learn to live with the symptoms or disabilities, and carry out lifestyle changes or treatment regimens.


Causes of the increase in chronic conditions include

Causes of the Increase in Chronic Conditions Include:

  • Decrease in mortality for infectious diseases.

  • Longer life spans.

  • Improved diagnostic and screening procedures.

  • Improved management of acute conditions.

  • Chronic illness is more likely to develop with advanced age.

  • Lifestyle factors such as smoking, stress, sedentary lifestyle, and obesity.


Characteristics of chronic conditions

Characteristics of Chronic Conditions

The patient must adapt and change physically, socially, and emotionally.

  • Usually involve different phases over the person's lifetime to which the person must adapt.

  • Require adherence to therapeutic regimen.

  • One chronic disease or problem can lead to another.

  • Chronic disorders contribute to higher risk of mortality and morbidity from other illnesses.


Characteristics of chronic conditions1

Characteristics of Chronic Conditions

  • Affect the entire family.

  • Day-to-day management is the responsibility of the person and/or his/her family.

  • Each person’s management of his/her condition and his/her body’s response to the condition is unique.

  • Management is collaborative.

  • Management is expensive.

  • Ethical issues may be raised; for example, cost control and quality of life.

  • Living with chronic illness means living with uncertainty.


Question

Question

Which of the following is an inaccurate cause of the increase in the number of chronic conditions?

  • Lifestyle factors, such as smoking and stress

  • Improved diagnostic procedures

  • Shorter life spans

  • Improved management of acute problems


Implications for managing chronic conditions

Implications for Managing Chronic Conditions

  • Importance of prevention

  • Lifestyle changes/interventions to prevent chronic disease

  • Once the disease occurs, focus shifts to:

    • Managing symptoms

    • Avoiding complications

    • Avoiding acute illness

    • Promoting health

    • Maintaining functional status


Challenges of living with chronic illness include

Challenges of Living with Chronic Illness Include:

  • Alleviating and managing symptoms.

  • Psychologically adjusting to and physically accommodating disabilities.

  • Carrying out treatment regimens.

  • Validating self-worth and family functioning.

  • Managing threats to identity.


Challenges of living with chronic illness include1

Challenges of Living with Chronic Illness Include:

  • Normalizing personal and family life as possible.

  • Living with altered time, social isolation, and loneliness.

  • Establishing support networks.

  • Returning to a satisfactory way of life.

  • Dying with dignity.

  • Being aware that the patient may need to deal with multiple chronic problems at one time.


Use of nursing process

Use of Nursing Process

  • Identify problems; assessment.

  • Establish and prioritize goals.

  • Define the plan of action.

  • Implement the plan:

    • Work with patient and family.

    • Adherence to treatment regimen

    • Disease and complication prevention

    • Deal with psychosocial issues.

  • Follow-up and evaluate


Medication usage

Medication Usage

  • Yr 2000 – 16% of adults are over 60 and take 40% of drugs prescribed

    • 4.5 drugs / person

  • 40 -50% of OTC drugs used by elders


Drug misuse

Drug misuse

  • Memory impairment

  • Failure to accept diagnosis

  • Unacceptable side effects

  • Inaccessibility to drugs

  • Knowledge deficit

  • Vision impairment

  • Low literacy


Multiple drug use

Multiple drug use

  • Multiple drug use  hospitalizations:

    • Decrease absorption, distribution, metabolism & excretion

    • Impaired circulation causes decrease transport to tissue

    •  deposit in fat causes high risk for cumulative effects

    • ↓ liver & kidney function


Promotion of safe drug use

Promotion of safe drug use

  • Simplify the medication administration process

    • Is drug necessary? Smallest possible dose ordered? Undesirable Side effects? Interactions w other drugs? Induce malnutrition? Allergies?

  • Disseminate knowledge

    • Patient & family education: oral & written explanation, [graphics, info sheets, Rx labels, booklets]

  • Teach proper medication management skills

    • Written schedule of administration

    • Daily/weekly drug containers

    • Drug containers: non-childproof; large print; color coded


M a s t e r

M.A.S.T.E.R.

  • Minimize the number of meds needed

  • Alternate drugs (if possible)

  • Start w a low dose and go slow if dose has to be increased

  • Titrate therapy to the individual patient

  • Educate the patient

  • Review regularly


Legal ethical issues

Legal & Ethical Issues

  • Adult Protective Services = refers to range of services – medical, social, and legal that are provided to the frail elderly

  • Conservatorship – court appointed conservator makes decision about where an individual lives and how his/her needs are met

  • .


Patient self determination act

Patient Self Determination Act

  • Mandated by Congress in 1990 to preserves an individuals right to decisions related to personal survival

  • Relates to any medical situation in which the individual becomes unable to communicate their choices

  • Written info is given at time of admission


Advance directives

Advance directives

  • Power of attorney – affords assistance in handling legal affairs; valid if the person granting PoA is capable of doing so; time limits must be specified

  • Durable P of A for health care – appointed by the individual to make decisions regarding care in acute illnesses; may be family, friend, or significant other; must be notarized.


Advance directives1

Advance directives

  • Living will – a personal statement of how one wishes to die. Sets forth choices and instructions for end - of- life care.


Unit 1 chronicity older adult gordons functional health pattern self perception and self concept

DNR

DNR is an order written by a physician when a client has indicated a desire to be allowed to die if the client stops breathing or the client’s heart stops beating.


Elder abuse

Elder abuse

  • Abuse & neglect of the elderly are used to describe elders > 65 experiencing battering, verbal abuse, exploitation, denial of rights, forced confinement, neglected medical needs at the hands of people responsible for assisting them w their ADL’s.

    • Estimated 1 – 2 million per yr.

    • Mandatory reporting


Psychosocial

Psychosocial

  • Erickson’s Development Tasks

    • Generativity vs. Self-absorption

    • Integrity vs. Despair - one could look back on life with integrity or despair


Psychosocial1

Psychosocial

  • Learning/education

    • The normal aging process

    • Lifestyle changes to stay healthy

    • Their chronic illness

    • Organizations/services to help w independence,

      • AARP, Gray Panthers, senior citizen center, assisted living centers, day care programs, home delivered meals, long term care facilities, hospice


Psychosocial2

Psychosocial

  • Sexual

    • Lack of a partner

    • Psychological barriers

    • Physical barriers

    • Cognitive impairment

  • Economic

    • Retirement issues

  • Intrafamily problems

  • Cultural

    • Ageism- prejudice against or dislike of older people purely because of their age


Modification of strategies specific for the elderly

Modification of Strategies Specific for the Elderly

  • Slower pace of presentation of material

  • Adjust time for learner condition and attention span

  • Use repetition/reinforcement

  • Avoid distractions; modify the teaching environment

  • Large print, non-glare paper, use of color

    • Difficulty seeing and difficulty with color perception

  • Voice

    • Difficulty hearing

  • Involve family and significant


Implementation

IMPLEMENTATION

  • education

    • Address client’s needs, and let the needs ‘direct” the content.

    • Focus on the “must know” information

    • Be specific & unambiguous

    • Teach at every opportunity

    • Seek frequent feedback

    • Respect and build on the elder’s experience


Guidelines for effectively teaching older adults

Guidelines for effectively teaching older adults

  • Vision – large easy-to-read typeface; emphasize black & white; avoid blues & greens; use non-glare paper, write short simple paragraphs, make sure glasses are clean & in place.

  • Hearing – speak slowly; enunciate clearly; lower pitch of your voice, eliminate background noise; face the learner; use nonverbal cues; have hearing aid in place & working correctly


Guidelines for effectively teaching older adults1

Guidelines for effectively teaching older adults

  • Energy level / attention – use short teaching sessions, offer liquid refreshments & bathroom breaks, promote comfort

  • Information processing/memory – present most important info first, clarify information w use of examples; motor skills – teach one step at a time {have written easy to understand instructions}; be concrete & specific, eliminate distractions; correct wrong answers/ reinforce correct answers; offer praise & encouragement


Questions to ask to ensure quality care

Questions to Ask to Ensure Quality Care

  • Does the patient require or prefer special accommodations?

  • Are special accommodations made to communicate with the patient?

  • Are efforts made to direct all conversations to the patient rather than to others who have accompanied the patient?


Accessibility of health care

Accessibility of Health Care

  • Are health care facilities accessible as legally required?

  • Has accessibility been verified by a person with a disability?

  • Is a sign interpreter, other than the family, available?

  • Does the facility have appropriate equipment to provide heath care for a person with disabilities?


Health promotion

Health Promotion

  • Do not neglect health promotion issues.

  • Need for healthy diet

  • Exercise

  • Social interaction

  • Preventive health screening


Importance of language

Importance of Language

  • Use “people-first” language.

  • The person, not the illness or disability, is most important.


Question1

Question

Tell whether the following statement is true or false.

An example of people-first language is “the person with a disability.”


Unit 1 chronicity older adult gordons functional health pattern self perception and self concept

Case Study, Unit 1 , Health Care of the Older Adult  

The nurse is completing the admission assessment for a patient scheduled for cataract surgery in the outpatient center. Because the patient is over the age of 70 and has several chronic conditions, including hypertension and congestive heart failure, the nurse focuses on completing a thorough medication history.

What questions should the nurse include in the medication history?

The patient states that she stopped taking one of her medications due to cost, since her health insurance would not reimburse for the medication. What are other reasons that older adults may be noncompliant with ordered medications?

How does aging affect drug absorption, metabolism, distribution, and excretion?


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