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Advanced Directives

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Documents that express specific end of life decisions. * living will *durable power of attorney for health care

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Durable Power of Attorney for Health Care

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Transfers authority to make health care decisions to a health care agent. *applies only when patient is unable to make decisions for themselves.

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Living Will

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Document that informs the physician that the individual wishes to die naturally instead of using life-prolonging measures and equipment. *2 physicians must agree.

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DNR

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Do Not Resuscitate. Do not attempt to resuscitate the patient.

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Dementia

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A slow, insidious process that results in the progressive loss of cognitive function. * caused by damage to the cerebral cortex

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Early Signs of Dementia

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Forgetfulness Decreased judgment loss of spontaneous emotional response decreased ambition decreased mental abilities

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Advanced signs of Dementia

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inability to communicate loss of contact with the environment total physical dependency total incontinence

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Delirium

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Disturbances in cognition, attention, memory, and perception. Caused by a physiological process that affects ANS

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Symptoms of Acute delirium

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Rapid mood swings Disorganized sleep signals Tremors Rapid speech patterns Loss of attention Rapid onset; lasts hours or days

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Nursing Interventions for Dementia

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Designed to maximize level of funtion Environment modification, activity based therapies Communication Strategies

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Nursing Interventions for Delirium

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Treat pathologic condition Administer fluids, nutrition, oxygen, medications, etc. Control environmental stressors, maintain safety, etc.

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Sundowning Syndrome

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Agitated behaviors of dementia that are worse later in the day

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Conditions That Cause Delirium

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uncontrolled pain infection metabolic disturbances vitamin deficiences uremia, hypoxia hypercalcemia endocrine imbalance myocardial infarction constipation drug toxicity drug withdrawal

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Depression

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Disorder that changes feelings or mood. Hopelessness, sadness, blue acute, reccurent, chronic

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Signs of Depression

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Neglected self care, agitation, stopping normal routines, weight changes, sleeping changes, decreased energy, isolation, etc.

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Effects of Institutional Placement

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Damages self-worth by stripping adult of personal belongings

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Effects of Loss of Loved Ones

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Often feel as though there is no reason for living Loss of emotional support No sources of positive feedback that nourish self worth

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Body Image Disturbances

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Refuses to look at changed body part Unwilling to discuss with others Refuse to participate in own care/rehabilitiation

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Nursing Interventions For Body Image Disturbances

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Identify adult's perception of self Establish a trusting relationship Provide care in non-judgmental manner Encourage to look and touch affected area Focus on abilities, not disabilities Dress in manner that deemphasizes body changes Carefully groomed Coordinate rehabilitative care

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Symptoms of Low Self Esteem

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Disinterested and out of control unkempt or disheveled Slump or slouch Avoid social contact

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Nursing Interventions for Low Self Esteem

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Express feelings and concern Demonstrate acceptance of older adults as people Encourage participation in self-care Provide opportunites for reminiscense Encourage family to participate

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Relocation Stress Syndome

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The physiologic or psychological stress that occurs when a person is transferred from one environment to another.

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Nursing Interventions for Relocation Stress Syndrome

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Encourage verbalization of feelings Discuss reasons for move Include adult in care planning Encourage positive attitude Maintain continuity of care Encourage use of familiar objects

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Alcohol and Substance Abuse

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A response to dealing with stress Baby Boomers expected to increase rates 1/3 addictions occur later in life

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Suicidal Idealation

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Expression of plan for suicide.

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Internal Role Conflict

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Occurs when demands of multiple roles and relationships must be met at the same time.

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Phases of Grieving

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1. Shock and numbness (2 weeks) 2. Searching and Yearning (2 wks to 4 months) 3. Diorientation (4 to 7 months) 4. Reorganization (up to 18 to 24 months)

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Shock and Numbness Symptons

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Disbelief, anger, denial, guilt

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Searching and Yearning

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Despair, apathy, depression, anger, guilt, hopelessnes, self-doubt

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Disorientation

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Depression, guilt, disorganization

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Reorganization

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Sense of release, decreased sense of obsession with loss, renewed hope and optimism

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Cardiovascular Symptons of Stress

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*racing heart *Elevated pulse rate *Increase BP *cold, clammy hands

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Respiratory Symptoms of Stress

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Increase rate and depth Hyperventiliation Acid-base balance compromised

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Musculoskeletal Symptons of Stress

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Increase blood glucose level Increased muscle tension Complaint of tension headaches, teeth grinding, backaches

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Gastronintestinal Symptoms of Stress

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Decreased peristalsis Loss of appetite, nausea, abdominal distention Vomiting, heartburn, ulcers

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Urinary Symptoms of Stress

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Decreased urine production Increased urine frequency

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Common Coping Mechanisms

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Repression Denial Rationalization Intelectualization Displacement Suppresion Projection Substitution

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Problem-focused Coping Strategies

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Attempt to change or eliminate the stressful event or threat.

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Economic Values of Older Adults

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Financial independence is important Affected by the depression "waste not, want not"

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Nursing Interventions for Spiritual Distress

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Determine spiritual practices/restrictions Identify signifcant spiritual support persons Determine how you can meet their needs Provide opportunities for them to express spiritual thoughts Determine spiritual objects that can be used Provide opp. for spiritual guidance Encourage contact with spiritual counselor

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Orthostatic hypotention

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A sudden drop in blood pressure that occurs when a person changes from a laying to a sitting or standing position

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Health Screenings

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Used to identify older individuals who are in need of further, more in-depth assessment Not designed to provide treatment Used to refer to appropriate resource May focus on a single health concern; not comprehensive

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Health Assessment

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Time consuming and done by professional Includes collection of all important health-related data Used to formulate nursing diagnosis and plan patient care

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Health Interview

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Prepare the physical setting Establish rapport Structure the interview Obtain health history Physical assessment

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Maturbation

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Normal and common Distraction used to reduce incidence of public masturbation Or take confused person to room to provide privacy Nurse should not overreact to behavior.

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Sexual Practice of Males

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Delayed reaction to sexual stimuli Orgasm takes longer to achieve and has shorter duration Time between orgasms increases Orgasms might not be achieved every time

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