Announcements

Retakes for Drug Calc & MKDQ – Thurs from 11-12pm in the Computer Lab

T-Shirt Sales $15.00 & Water bottles $ 10.00

Chronic Illness, Older Adults, & End of Life Care

Medical Surgical II

Chronic Illnesses

Acute vs Chronic (Tables 5-1, 5-2) How does chronic illness affect quality of life?

Trajectory of Chronic Illness (Table 5-3) Seven tasks … (Table 5-4)

Prevention of Chronic Illnesses Define Primary, Secondary, Tertiary

prevention

Nursing Management

Remember to follow the Nursing Process Early diagnosis and interventions Complete assessments, then focused Education -> self-management

Treatment plan, symptomatology management strategies, and outcome goals

Include care givers, if permission from patient

Dept of Health & Human ServicesAdministration on Aging www.aoa.gov

43.1 million in 2012 (65+ years), 44.7 million in 2013 (1 in every 7 Americans) 25.1 million women, 19.6 million men

By 2019, the Hispanic population is projected to be the largest ethnic minority in this age group

Over 3.9 million elderly persons (9.1%) were below the poverty level in 2012

Sources: U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2013. Release Date: June 2014;

Older Adults

Demographics of Aging Why are older adults living longer?

Describe their adult developmental needs Generativity vs. Stagnation (40-65) Ego Integrity vs. Despair (65+)

Describe the needs of the aging population

Ageism & Elder Abuse Why does this occur?

Cost of Dying – End of Life Care

https://www.youtube.com/watch?v=F6xPBmkrn0g

Gerontology Assessments(Table 5-6)

Most common chronic conditions:Cardiovascular / RespiratoryIntegumentaryUrinaryReproductiveGIMusculoskeletalNervousVisual / AuditoryImmuneMental Health

SPICES

Sleep Disorders

Problems with eating or feeding

Incontinence

Confusion

Evidence of Falls

Skin Breakdown

SCALES: Nutritional AssessmentTable 5-8

Sadness or change in mood Cholesterol, /\ Albumin Loss or gain of weight Eating issues Shopping and food prep issues

Complexity of Care

Cognitive Impairment

Older Adult Females (p. 65)

Rural Older Adults

Homeless Older Adults

Frail Older Adults

Chronically ill Older Adults

Cognitive Function

Short Term Memory Memory Aids

Long Term Memory

Synthesis of New Information

Acute Care of the Older Adult

What are common reasons for hospitalization?

What are the risks with hospitalization?

Medications

Restraints (physical &chemical)

Why do we use Restraints? Types?

Do you need an order?

What additional paperwork?

Assessment?

Social Services

Medicare Medicare coverage Part A , B, C, and D

Medicaid Medicaid requirements anc coverage

2010 Healthcare Reform Healthcare Reform Housing

Adult Day Care Programs Retirement Communities Assisted Living Facility Long Term Care Facility

Legal & Ethical Issues

Estate Planning

Legal Aid

Tax issues

Advance Directives Living Will – Natural Death Acts Durable Power of Attorney

Palliative Care at End of Life Care

Palliative care: any intervention focusing on \/’ing severity of disease symptoms. Table 10-1

Death: the irreversible cessation of cardiovascular, respiratory, and brain function.

Brain death: the irreversible cessation of all functions of the entire brain, including the brainstem. Heart may continue and can be maintained on mechanical ventilation.

What Are The Nurse’s Goals?

How Would We Achieve Those Goals?

Physical ManifestationsTable 10-2

Sensory Changes Cardiovascular

Respiratory Urinary

GI Musculoskeletal Integumentary

Mottling

Psychosocial Manifestation

Grief- emotional and behavioral response to loss

What are some factors that influence grief reactions?Religion

Prior ExperiencesValue SystemCoping Skills

Support SystemRelationship with dying person

Model of Grieving

Kubler-Ross (1969) (Table 10-4)

Denial Anger

Bargaining Depression Acceptance

The Grief Wheel Model (Fig. 10-6)

Normal Loss

Protest Disorganization Reorganization New Normal

Legal & Ethical IssuesTable 10-6

Organ/Tissue Donation Resuscitation/Removal of mechanical

ventilation, IV fluids Tube feeding

Advance Directives Living Wills

Durable Power of Attorney

Resuscitation

HospiceHospice and Palliative Care

What is Hospice Care?

When is it Applicable?

Who can request Hospice Care?

What are the top five illnesses of hospice patients?

Nursing Care

Nursing care becomes symptom management rather than cure

Psychosocial care Postmortem care

Prepare for immediate viewing for family

Care for your fellow nurses – debrief We all need a hug !!!!