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Gerontological Nursing Exam One - Coggle Diagram
Gerontological Nursing Exam One
CH 1 - Gerontological Nursing 101
Why is Gerontology so Important for Nurses?
Gero Nursing Education
Important because we need more specialists
Starting in 2010, it became a BSN requirement
Clinical experiences in multiple settings
One class
All classes must have gero content
Organizations for Gero Research (Do NOT Memorize the List)
The Hartford Institute for Geriatric Nursing
National Gerontological Nursing Association
Gerontological Advanced Practice Nurses Association
National Association Directors of Nursing Administration/Long-Term Care
American Association of Directors of Nursing Services
American Assisted Living Nurses Association
Canadian Gerontological Nursing Association
National Institute on Aging
National Institution of Nursing Research
National Institute of Mental Health
Agency for Healthcare Research and Quality
Gerontological patients are more complex than other patients
Volume/Proportion of patients is increasing over time
Who will take care of all of these elders?
<1% of RN's are certified
no teachers available
General healthcare worker shortage
We will need 1.3 billion additional workers by 2030
Family members
History of Gero
Current Initiatives
Evidence-based practice
The Hartford Institute for Geriatric Nursing
funds education and research
National Hartford Centers of Gerontological Nursing Excellence
Works with ANA to publish the educational recommendations
Leadership confrences
Sigma Theta Tau
Center for Nursing Excellence in Long-Term Care
provides resources for professional development in LTC
funds the Geriatric Nursing Leadership Academy
ANCC provides credentials
1906: Lavinia Dock almshouses for elderly
1912: ANA appoints almshouses to oversee eldercare
1935: Social Security Act
1940: Centers for Geriatric Excellence created
1950: First textbook
1968: ANA publishes Standards of Practice
1984: Specialty for geriatrics is created
2010: First educational Scope and Standards of Practice, the class becomes a requirement
Aging Research
Nursing Research
Only developed in the last 60 years
Aging does NOT = disease, but they often occur together
Gero Nursing Roles
Specialist
Generally work in OP or research settings
Acute Care NP
Primary Care NP
Clinical Nurse Specialist
APRN
Generalist
Works in the hospital, community, case management, and SNF's
CH 2 - Healthy Aging
The Years Ahead
2020: those over 60 > those under 5
Most people over 65 are in East and South East Asia
The most important thing for nurses is to have a good attitude about the elderly
The elderly can contribute to society by...
Being research subjects
Focusing on their wellbeing
Being primary sources for historical knowledge
How We Define Old
Functional
Social
Biological
Chronological
Begins at 50-65 years and can last over 40 years
Generations
Super-centenarians
110+ years, very rare
No cancer, cardiac problems, diabetes, dementia, obesity, or out-of-control stress
Centenarians
100 - 109 years
independent
Delayed disease onset
Survived the childhood diseases
Those in Between
80 - 99 years
chronic disease
decreased functionality
somewhat independent
Baby Boomers
60 - 70 years
Largest group by far
major cultural shifts
medical advances
Healthy Aging
Healthy - holistic and based on functionality, highly subjective
Mostly Japanese women get to age
Flower Model of Holistic Health (Factors that Influence Aging Experience)
Biological
Functional
Environmental
Intellectual
Psychological
Spiritual
Social
Wellness does NOT = lack of disease
Clinical Judgement
Enhance, empower, and support wellness
Use available resources
Work with person and their people to develop care plan
Use preventative measures to promote wellness
CH 3 - Cross-Cultural Settings
Culture 101
Culture - a set of learned values, beliefs, expectation and behaviors of a group
How Culture Impacts Healthcare
Aging beliefs
Health
Health seeking
Illness treatment
Preventative care
Diversity
The 7 Ethnoracial Groups
Black/African American
Asian American
Native Hawaiian/Pacific Islander
White
American Indian/Alaskan Native
Hispanic/Latino
Multiracial
Health Disparities and Inequities
Disparity - a difference in health outcomes between groups, includes access problems, nutrition, and violence
Inequity - a difference in the prevalence of illness in a population when compared to the whole population, includes socioeconomic status, and sickle cell anemia
Moving Towards Cultural Proficiency to Improve Health Outcomes
Steps to Cultural Proficiency
1) Destructiveness - intentional destruction of a cultural group
2) Blindness - refusal to acknowledge cultural diversity
Could lead to poor health outcomes
Patient needs may go unmet
3) Pre-compotence
Begins with introspection and willingness to learn
4) Competence - gaining knowledge about different cultures, especially those in your area
5) Proficiency - care from the nurse is respectful, compassionate, and relavent to the patient's culture
Cultural Knowledge - the 3 orientations
Family and Self
Family oriented
May leave decisions to family
family can take care of patient upon discharge
Self oriented
May not have anyone to care for them upon discharge
May be more secretive about their health information
Time
perception of time varies by culture
Health Beleifs
Western Biomedical System
Disease = change of structure or function of bodily organs caused by germs
Treatment focuses on destroying the invader
Prevention = avoiding pathogens to begin with
Personalistic
Disease = upsetting a supernatural entity
Health = a blessing/reward
Treatment = rituals
Holistic
Health = balance
Disease = disturbance in the balance
Treatment = determining type of imbalance and adressing it
Stems from China, India, and Greexce
Clinical Judgement (LEARN Model)
Nurses must find the balance between treating the patient and respecting their cultural beliefs and wishes
L = Listen = verbal + nonverbal cues
Physical Contact
Eye contact
Verbal Communication
Interpreters
E = Explain = gathering information + planning + hypothesize diagnosis
A = Acknowledge the patient's priorities
R = Recommend = plan based on cultural needs and propose plan to patient
N = Negotiate = working together to ensure all needs are met
Integration of Knowledge
Cultural origin can increase vulnerability
Degrees of assimilation can lead to communication problems
Why ageism is to be avoided
decreased self-esteen
decreased sense of compotence
Increase memory problems
CH 4 - Theories of Aging
Biological Aging
Cellular Function and Aging
increased rate of deterioration
decreased efficiency of DNA repair mechanisms
Evolution and Aging
We age because we used our metabolic resources wisely to meet the essential metabolic needs (Disposable Soma theory)
Metabolic Needs
Repair DNA
remove antioxidants
stress control
accurate DNA replication
suppress tumor growth/good immunity
Free Radicals = reactive oxygen species that damages cells
Inflamm-aging
aging = free radicals + chronic inflammation + accumulated damage to immune system
Mitochondrial Dysfunction = free radical damage -> mtDNA mutations
Telomeres
aging = shortened telomeres
Normal Changes with Aging
Prevention techniques
Avoid free radicals
consume antioxidants
Cell reproduction slows
immunity decreases
Physical Changes
Integumentary
Epidermis
Thins - makes vessels and bruises more visible
decreased meloncytes
Lentigines
Seborrheic keratosis
Dermis
thins
reduced vascularity
collagen decreases
elastin fibers thicken + fragment
Hypodermis
Atrophies -> decreased temperature regulation
Sebaceous glands atrophy
thins in some areas and thicken in others
Poor temperature regulation
Hair
Thins on head
increases in ears, nose, chin, and eyebrows
Women lose hair in axillary areas, legs, and pubic area
Nails
harder, thicker, more brittle
vertical ridges
slow growth
Musculoskeletal
reduced flexibility
reduced muscle mass
reduced bone density -> thinned vertebral disks -> kyphosis
reduced body water
Cardiovascular
L ventricle wall thickens
L atrium gets bigger
Blood flow, elasticity, cardiac output, and stroke volume decrease
Slowed cardiac acceleration and deceleration
veins stretch and valves become loose
Respiratory
loss of recoil and stiffening or chest wall
resistance to air flow
less effective cough
less effective cilia
inefficient gas exchange
decreased lung capacity
Renal
loss of up 50% of nephrons
decreased blood flow, size, urine creatinine, and function of kidneys
high risk of electrolyte imbalance
Endocrine
glands and rate of secretion decreases
Insulin resistance increases
Rates of type II diabetes and hypothyroidism are higher in elders
Reproductive
Female
Breasts shrink, soften and sink
primary sex organs atrophy
estrogen decreases
vagina wall cannot lubricate
Male
testes atrophy and soften
ejaculation is slow and less forceful
testosterone decreases
urinary retention
Gastrointestinal
Mouth
teeth lose enamel and dentin
tastebuds and saliva decrease
Stomach
sluggish emptying
decreased gastric motility and volume
decreased intrinsic factor
Intestines
Villi lose function
peristalsis slows
Neurological + Sensory
CNS
brain size decreases
cognitive and motor functional decline
mild memory impairment
tasks take longer
PNS
decreases kinesthetic senses
delayed rxn time
Vision
near and peripheral vision decrease
lenses thicken
eyelids lose elasticity
lower lids turn inside out
decreased intraocular fluid absorption
Hearing
earlobes sag
hair growth
thick, dry ear wax
hearing loss
Immunity
decreased temperature
decreased immunity
CH 5 - Psychological, Spiritual, and Cognitive Health
Psychological
1st Generation
Role Theory - self identity is defined by role which changes as we age
Activity Theory - ability to maintain an active lifestyle
2nd Generation
Disengagement Theory - a withdrawal from society, the basis for ageism
Continuity Theory - ability to maintain a role or find a replacement
Age-Stratification - grouping cohorts by age (think baby boomers vs the silent generation)
Social Exchange Theory - based on financial health, leads to loss of social status, self-esteem, and political power
Modernization Theory - when technology outpaces elder learning
Developmental Theories
Erik Erikson - Integrity vs despair
Maslow's Hierarchy of Needs
Gerotranscendence Theory - withdrawal from society for self-reflection or spiritual reasons
3rd Generation
Life story = Reminiscing + Journaling + Life Review + Guided Autobiography
Reminiscing - any recall of the past , a therapeutic intervention, improves quality of life and mood
Life Review = solving unresolved business, formal therapeutic technique
Spiritual
Spirituality = values + beliefs + search for meaning + relationships with other beings
increases importance as one ages
a coping mechanism
FICA Assessment (Faith, Importance/Influence, Community, and Address in Care/Accommodate)
Cognitive
Cognition = acquiring + storing + sharing knowledge
Can remain stable with age, but does tend to slow a little
Neuroplasticity - ability to learn new things
Fluid Intelligence - skills that are independent of learning or experience, decreases with age
Crystalized Intelligence - based on skills acquired in life, remains stable
Memory
There is a normal amount of loss and a pathological amount of loss
Learning
Must be relevant and practical
Literacy level plays a role
Culture plays a role
Older adults are starting to own computers
Basic intelligence does NOT change
Speed slows due to overload of information in an elder's brain
Can be enhanced with a health lifestyle
CH 6 - Continuum of Care
Community Care
Program for All-Inclusive Care for the Elderly (PACE) - an alternative to home care
Adult Day Care - Health services + Supervision + Socialization + Safety, a type of respite care
Education, support, and counseling for caregivers
Continuing Care Retirement Communities (CCRC) - allows one to transition between levels of care without moving
Residential Care/Assisted Living - like an SNF minus nursing care, patient can be selective about what services they receive
Nursing Facilities = hospital + rehab + hospice + dementia units
Two Levels
Chronic Care - what you'd think of as a traditional nursing home, also known as Long-Term Care
The US Health Care System
most residents are dependent, widowed women over 80
variety of services of the elderly or disabled, can be formal or informal (done by the family)
Paid by Medicaid, Private Insurance, and Medicare but is generally very expensive
Skilled Nursing Care/ Subacute
more intense than home care but less intense than acute care
discharge to home, stay 1-3 months
reimbursed by Medicare
Emphasis on rehab
Quality of Care on Skilled Nursing Facilities (SNF's)
Regulatory Acts
Omnibus Reconciliation Act of 1987
Affordable Crae Act
Quality Assurance Performance Improvement
Centers for Medicare & Medicaid Services
Resident's Bill of Rights - determined by federal and state law
Long-Term Care Ombudsman Program supports residents and facilities
Residents can choose providers but not staff in facility
They are becoming more home-like to increase quality of life for patients
Transitions Across the Continuum
Why Transitions Occur
Rehospitalization
it's a work in prograss
1/5 elderly get rehospitalized within 30 days of discharge and Medicare does not reimburse for that
Infection
New Diagnosis
Relapses
Transitional Care Model
reduces preventable bad outcomes,costs, and rehospitalizations
Nurses play a role as a transition coach, care coordinator, and/or case managers
Nurses need to be particularly meticulous with medication lists
CH 7 - Economic and Legal Issues
Late Life Income
Social Security - an age entitlement program
Supplemental Security Income
Private Investments
Pensions
Health Insurance
Medicare
Part C - Medicare Advantage, replaces parts A&B, can be HMO or PPO
Part D - Prescription Drugs, Part of Medicare Modernization Act of 2003
Part B - OP, apply in the 6 months surrounding 65th birthday or wait for open enrollment, monthly premium, deductible, and copay
Part A - acute care, short-term rehab, free to those on Social Security, Auto-enrollment on first day of month of 65th birthday
Must be eligible for Social Security first
Supplement - Think Plan G or F, Mutual of Omaha, or AARP, covers everything not covered by Parts A&B
Medicaid
State (40%) and Federal Funding (60%)
Low-income insurance
Covers more than Medicare would
Veterans Administration (VA)
Provides care to active duty + retired military and their dependents
VA Hospitals only take patients for service-related problems
TRICARE For Life
Must be enrolled in Medicare A&B but covers everything Medicare does not cover
Legal Issues
Capacity - ability to understand the problem, consider pros and cons, and make a decision
only a court can declare someone as incapacitated
Nurse has responsibility of being the first to speak up when there is a change in capacity
POA
Regular POA - financial ONLY
kinda like a conservator, but a conservator is permanent whereas a POA can be temporary if the person regains capacity
Durable POA - financial and healthcare, AKA: Healthcare Proxy
Kinda like a guardian but a guardian is permanent where as a Durable POA can be temporary if the perosn regains capacity