CHAPTER 1- AGING POPULATION

 Improvement in the health care and general

living
Learning Objectives:
I. Explain the different ways in which older
adults have been viewed throughout
history. Characteristic of the older adult population
II. Describe characteristics of today’s older
persons in regard to:  Older adults are generally defined as
* Life expectancy * Income & employment individual aged 65 years and older.
* Marital status * Health Status  Young old – 65 to 74 years
* Living arrangements  Old – 75 to 84 years
III. Discuss projected changes in future  Oldest – old 85+
generations of older people and the  Chronological age, the years a person has
implications for health care. lived since birth.
 Functional age is described physical,
psychological and social function.
INTRODUCTION  Perceived age is described how people
estimate a person’s age based on
- Aging is part of the life course. appearance.
- Families forget their older relatives.  Age identity is how people feel or perceive
their own age
- Majority of older people reside in nursing
homes. Population Growth and Increasing Life
expectancy
- Gerontological nurses must know the facts
about the older population to effectively deliver  The life In 1930, slightly more than 6
services and educate the general public. million persons were aged 65years or older,
and the average expectancy was 59.7 years.
Views of Older Adults Through History  The life expectancy in 1965 was 70.2 years,
and the number of older adults exceed 2
million.
Confucius time  Life expectancy has now reached 78.3 years,
with over 34 million persons exceeding age
 Person’s age and the degree of respect. 65 years.
 Dreaded growing old and experimented  The population over age 85 years is
 Society’s best leaders projected to double by the year 2036 and
 Denied any role in governmental matters. triple by 2049.
 Sick & the aged were customarily the first to  The life span currently is 122 years for
be killed. humans.
 Compressed Comorbidity – serious illness
England law (17th century)
and decline can be delayed.
• Provide home for the destitute elderly  Life expectancy differs in race and gender
without family resources  Race:
Gap between life expectancy
During Industrial revolution between white people & black people has
widened because the life expectancy of
 *Beg on the street for their sustenance
black people has declined
In America  Gender:
The gap is narrowing between
 Federal Old Age Insurance Law sexes.

1
 * The growing number of persons older than 65
years impacts health and social services agencies
and health care providers

Marital Status and Living Arrangement

 Higher survival rates of a women

 Married people have a lower mortality rate Impact of the Baby Boomers
than unmarried people
 Most older adults live in a household with a Baby boomers
spouse or other family member.
 those born between 1946 and 1964
 The likelihood of living alone increases with
age of both sexes.  who will be the next wave of senior citizen.

Income & Employment

 Most older people depend on social security

for more than half of their income. Characteristics:
 Steadily declining percentage of workers in
1. Most have children but this generation’s
the labor force.
low birth rate
 Most baby boomers are expressing a desire
2. Better educated
and need to continue working as they enter
3. Their household incomes tend to be higher
retirement stage.
4. Casual dress code
Health Insurance 5. They are enamored with “high-tech”
products
 Medicare is the health insurance program 6. Their leisure time is scarcer
for older adults 7. They exercise more frequently
 Medicare Part A, primarily covers hospital
and physician services Provisions of and Payment for Services
 Medicare Part B, which include physician • Increasing demand for the provision of and
and nurses’ services, diagnostic test, payment for services to this group.
vaccines, and treatments.
 Medicare Part C or Medicare advantage • Gerontological nurse must be actively
Plans involved in discussions and decisions.
 Medicare Part D, also known as a Medicare
advantage Prescription Drug Plan
 Medicaid, the health insurance program for
the poor of any age.
 Long-term Care Insurance can be purchase
by any age.

Health Status

 The older population experiences fewer

acute illnesses
 Chronic illness is a major problem for the
older population
 The older the person is, the greater the
likelihood of difficulty with self-care
activities and independent living.

Implications of an Aging Population

2
 CHAPTER 2 – THEORIES OF AGING

Lipofuscin Theories

Learning Objectives: A positive relationship exists between an

I. Discuss the change in focus regarding individual’s age and the amount of lipofuscin in the
learning about factors influencing aging.
II. List the major biological theories of aging.
III. Describe the major psychosocial theories
of aging.
IV. Identify factors that promote a healthy
aging process.
V. Describe the way in which gerontological
nurses can apply theories of aging to nursing
practice.

INTRODUCTION

• Theories of aging have been debated since

the time of ancient Greeks.
• Theories of aging attempts to explain this
phenomenon of aging as it occurs over the
life span.
body.
Biological theories of aging

• No two individuals age identically.

2 CATHEGORIES:
Wear and Tear Theories
1. Stochastic theories view the effects of
Wear
biological aging as resulting from random
and
assaults from both the internal and external
Tear
environment.
theories
2. Nonstochastic theories see aging changes
attribute aging
resulting from a complex, predetermined
to the
process.
repeated use
STOCHASTIC THEORY and injury of the
body over time
Cross-linking Theory as it performs its highly specialized functions
* This theory proposes that cellular division is
threatened as a result of radiation or a chemical
reaction in which a cross-linking agent attaches Evolutionary Theory
itself to a DNA strand and prevents normal parting
Evolutionary theories of aging are related to
of the strands during mitosis.
genetics and hypothesize that the differences in the
Free Radicals and Lipofuscin Theories aging process and longevity of various species
occur.
The free radical theory suggests that aging
is due to oxidative metabolism and the effects of Mutation Accumulation Theory
free radicals.
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* It suggests that aging occurs due to a declining Environmental Theory
force of natural selection with age.
Several environmental factors are known to
threaten health and are thought to be associated
with the aging process.

Antagonistic Pleiotropy Theory

SOCIOLOGIC THEORIES OF AGING
* Suggests that accumulated mutant genes that have
negative effects in late life may have had beneficial Disengagement Theory
effects in early life.
It views aging as a process in which society
Disposable Soma Theory and the individual gradually withdraw, or
This theory states that aging is related to the use of disengage, from each other, to the mutual
satisfaction and benefit of both.
the body’s energy rather than genetics.

Biogerontology Activity Theory

The activity theory asserts that an older

* The study of the connection between aging and
disease processes. person should continue a middle – aged lifestyle,
denying the existence of old age
NONSTOCHASTIC THEORY
Subculture Theory (Rose’s theory)
Apoptosis
This theory views older adults as a group
Apoptosis is the process of programmed cell with distinct norms, beliefs, expectations, habits
death that continuously occurs throughout life due and issues that separate them the rest of society.
to the biochemical events.
Continuity Theory
Genetic theory
Referred to as the development theory.
* The programmed theory of aging proposes that
It relates personality and predisposition
animals and humans are born with a genetic
toward certain actions in old age to similar factors
program or biological clock that predetermines the
during other phases of the life cycle.
life span.
Age Stratification Theory
Error Theory
This theory suggests that society is
* This theory holds that genetic mutations are
stratified by age groups.
responsible for aging causing organ decline as a
result of self-perpetuating cellular mutations. PSYCHOLOGICAL THEORIES OF AGING

Neuroendocrine and Neurochemical Theories Psychological theories of aging explore the mental
processes, behavior, and feelings of persons
Neuroendocrine and neurochemical
throughout the life span.
theories suggest that aging is the result of changes
in the brain and endocrine glands. Developmental Tasks are the challenges that must
be met and adjustments that must be made in
Radiation Theories response to life experiences.
In human beings, repeated exposure to NURSING THEORIES OF AGING
ultraviolet light is known to cause Solar Elastosis.
Functional Consequences Theory
In animals, has shown that a decreased life
span results from nonlethal doses of radiation The Functional consequences theory for
promoting wellness in older adults integrates
Nutrition Theory
theories from aging and holistic nursing.
That diet impacts health and aging.
Theory of Thriving
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 They based their theory on the failure to
thrive concept

GEROTRANSCENDENCE (TORNSTAM)

Gerotranscendence is a recent theory that

suggests aging entails a transition from a rational,
materialistic metaperspective to a cosmic and
transcendent vision.

Theory of Successful Aging

The theory of successful aging not only considers

successful aging in terms of the older adult’s
physical, mental and spiritual well-beings but also
includes the individual’s self-appraisal.

APPLYING THEORIES OF AGING TO NURSING

PRACTICE

The number, diversity, and complexity of

factors that potentially influence the aging process
show that no theory can adequately explain the
cause of this phenomenon.

The biological, psychosocial, and social

processes of aging are interrelated and
interdependent.

Nurses can adapt these theories by

identifying elements known to influence aging and
using them as foundation to promote positive
practices.

In addition, gerontological nurses play a

significant role in helping aging persons experience
health, fulfillment, and a sense of well-being.

5
 CHAPTER 3- DIVERSITY
o Espiritualistas: persons who analyze
dreams, cards, and premonitions
Learning Objectives:
I. Describe projected changes in the diversity of Black Americans
the older population in the US.
II. Describe unique views of health and healing  8.4% of Black American is older persons
among major ethnic groups.  Old age may be considered a personal
III. Identify ways in which nursing care may triumph by black people
need to be modified to accommodate persons of  HIV and AIDS have become the third leading
diverse ethnic backgrounds. cause of death among African American
males
 African American individuals are more
Hispanic Americans likely to smoke, be obese, and have a poor
health status.
 The term Hispanic encompasses a variety of
Spanish-speaking persons in America * Possess many health problems
 250,000 Hispanic Americans living in the * Hold health beliefs and practices
United States
 Mexican immigration occurred during the * Are twice as likely to live in poverty
20th century * Look to family members for decision making and
 Population: 8 million care
 Puerto Rican stayed in US after World War
II (2 mil)  May have a degree of caution in interacting
 Most Cuban immigrants are recent with and using health services
newcomers to America (more than 1 mil)  Black skin color is the result of high melanin
 Many Hispanic people view states of health content
and illness as the actions of God
Asian Americans
 The Hispanic population holds older
relatives in high esteem.  10 million Asian Americans reside in the US
 Chinese laborers lived in America for
 Traditional practioners: centuries before the mid-1800s
o Curanderos:  Chinese medicine is based on the belief of
women who the balance of yin and yang
have special  Chinese people have used the senses for
knowledge and assessing medical problems also used
charismatic herbs, acupuncture, acupressure, and other
qualities treatment modalities
o Sobadoras: persons who give massages  Chinese culture, achieving old age is a
and manipulate bones and muscles blessing, and older adults are held in high
o Brujos: women who practice witchcraft esteem.
o Senoras: older women who have  Similar to the Chinese, Japanese Americans
learned special healing may subscribe to traditional health
practices.
 Today, Japanese have a higher percentage of
professional
 Filipino started to work in US as farm
laborers.
 Korean people immigrated to America to
measures work on plantations.
6
  Vietnamese and Cambodian seek for Gay, lesbian, bisexual & transgender
political refuge.
 Similarities among Asian: *Organizations providing needs of LGBT
 Strong family networks  Nurses need to appreciate that the LGBT
 The expectation that family members will elder population represents unique
care for their older relatives at home individuals with different experiences,
profiles, and needs.
Jewish americans
 Nurses need to assure that LGBT individuals
 Jewish Americans have demonstrated can receive services without prejudice,
profound leadership in business stigmatization, or threat.
 Scholarship is important in the Jewish
Among LGBT elderly
culture
 Religious traditions are important in the * Nearly 1/2 have a disability and nearly 1/3 report
Jewish faith depression.
 Family bonds are strong in Jewish American
culture * There are higher rates of mental distress and
 Modern medical care is encouraged. smoking and excessive drinking.
 Rabbinical consultation may be desired for * Almost 2/3 have been victimized 3 or more times.
decisions involving organ transplantation
or life-sustaining measures. * 13% have been denied health care/received
 Rituals may be practiced at death inferior care.
 Autopsy is usually opposed. More than 20% do not disclose their sexual or
gender identity to their physician.
Native americans
NURSING CONSIDERATIONS FOR CULTURALLY
 Native American culture emphasizes a
SENSITIVE CARE OF OLDER ADULTS
strong reverence for the Great Creator.
 Elders are respected and viewed as leaders, *The effectiveness of care can be largely influenced
 teachers, and advisors to the young. by the initial impression made by the nurse.
 Native American patient may be ambivalent
about accepting services from agencies and *Nurses need to be familiar with patiens culture &
professionals. beliefs.
 Rise in certain preventable diseases among *Nurses need to ensure that cultural, religious, and
Native Americans. sexual orientation differences of older adults are
 The right to make decisions that affects understood, appreciated, and respected.
their lives.
 Various tribes may have specific rituals

Muslims

 Muslim customs and traditions are centered

on religious beliefs
 Muslim patient may prefer to be cared for
by a person of the same sex
 Muslim patients who are unconscious or
terminally ill should be positioned facing
Mecca.
 Older adults represent less than 1% of the
Muslim population.
 Muslims eat only meat that has been
slaughtered according to religious
requirements
 Water typically is consumed with every
meal.
7
 CHAPTER 4 – LIFE TRANSITIONS AND STORIES
 Grandparenting is not usually as active role
Learning Objectives:
as in the past
I. Discuss ageism and its consequences.
II. Discuss changes that occur in aging Parenting
families.
III. Describe challenges faced by widows.  During middle and later life, parents must
IV. Outline the phases and challenges of adjust to the independence of their children
retirement. as they become responsible adult citizens.
V. Discuss the impact of age-related changes in  Today’s older woman has been influenced
health and functioning on roles.
by a historical period that emphasized the
VI. Describe cumulative effects of life
role of wife and mother.
transitions.
VII. List nursing measures to assist  Changes in family function of older adults
individuals in adjusting to the challenges and are not necessarily negative.
changes of aging.
Grandparenting

American grandparents are:

Ageism
 Most are baby boomers, more likely to be
* Ageism (Butler, 1969) is a term
college educated and employed
to describe the deep and
 One in five grandparents is African
profound prejudice in US society
American, Hispanic, or Asian
against the older persons.
 They are spending more on grandchildren
• It is a process of than previous generations.
systematic stereotyping of and  Older adults may need to be guided in
discrimination against people. thinking through issues such as:
1. Respecting their children as parents
Ageism carries several consequences:
2. Calling before visiting
1. Younger people are less likely to see the 3. Establishing rules for babysitting
similarities between themselves. 4. Allowing their children to establish
their own traditions within their
2. Reduce the opportunities for the young to family
gain realistic insights into aging.  Changes in the family structure and
Misconception among the elderly activities present new challenges to today’s
grandparents.
 Old people are sick and disabled  Older adults having to adapt to new family
 Most old people are in nursing homes. lifestyles and structure
 Dementia comes with old age
Nursing responsibilities:
 Old people have lower intelligence and are
resistant to change 1. Nurses can help families locate resources
 There are few satisfactions in old age
2. Nurses can suggest activities that can help
Changes in Family Roles and Relationships grandparents be connected with their
grandchildren
 Older parents are expected to have limited
input into the lives of their adult children. 3. Older adults can be encouraged to keep files
 Children are not required to meet the needs of memory
of their aging parents for financial support.
 Parents increasingly do not depend on their
children for their needs.


8
Questions That Nurses Can Raise With Developing a lifestyle that provides
Grandparents one satisfaction.

•How will raising this child affect your own health,

marriage, and lifestyle? 5. Retirement routine phase
•Can you afford to care for the child, pay medical An understanding of the retirement
and educational expenses, and the like? role is achieved
6. Termination of retirement
*Do you have the legal right to serve as a surrogate The retirement role is lost as a
parent? Have you consulted with an attorney? result of either the resumption of a work
role or dependency due to illness or
Loss of spouse disability.
• The death of a spouse is a common event Reduced income
that alters family life for many older
persons.  Retirement often requires older adults to
live on a reduced income.
• The death of a spouse affects more women
 Only a minority of the older population has
than men.
income from a private pension plan.
• The unemployed widow, may learn that  A reduction in income is a significant
sources of income may be reduced adjustment for many older persons
• Older adult remarrying after the loss of a Changes in Health & Functioning
spouse diminishes with age
 Adjusting to new body image.
Nursing responsibilities:  The manner in which individuals perceive
1. May facilitate the adjustment to themselves and their functional abilities can
widowhood. determine the roles they play.
 Common results of declining function are
2. Reassuring the widow to enjoy her new illness and disability.
freedom  Nurses should help aging persons
understand and face the common changes.
Retirement
CUMULATIVE EFFECTS OF LIFE TRANSITIONS
Major adjustments of an aging individual.
1. Shrinking Social World
Loss of the Work Role
• Loss of social connections and increasing
 Retirement is difficult in Western society
risk of loneliness.
 Aging individuals should be urged to
develop interests unrelated to work. • Hearing and speech deficits and language
differences can also foster loneliness.
Phases Of Retirement:
• Nurses should attempt to intervene when
1. Preretirement phase
they detect isolation and loneliness in an
Preparation for leaving one’s job
older person.
begins.
2. Retirement phase 2. Awareness of Mortality
Following the retirement event, a
• Widowhood
somewhat euphoric period begins a
“honeymoon period” in which fantasies from • The thought of impending death maybe
the preretirement phase are tested. more tolerable if people understand that
3. Disenchantment phase their life has had depth and meaning.
As life begins to stabilize, a letdown,
sometimes a depression, is experienced. 3. Awareness of Mortality
4. Reorientation phase

9
Signs that elderly accept the reality of death • Novices to journaling can be encouraged to
start by reflecting on their lives
1. Interest in fulfilling dreams
2. Deepening religious convictions Writing Letters and E-Mails
3. Strengthening family ties
4. Providing for the ongoing welfare of family • Thoughts and feelings that individuals may
5. Leaving a legacy not feel comfortable verbalizing can be
expressed in writing.

• Share relevant family history

Responding to Life Transitions
• Older adults may enjoy communicating by
Nursing responsibility: e-mail

 Facilitating life review and eliciting a life Reflecting through Art

story
• Many people find that painting, sculpting,
 Promoting self-reflection
weaving, and other forms of creative
 Strengthening older adults’ inner resources.
expression facilitate self-reflection and
Life review and Life Story expression.

 Life review is the process of intentionally Strengthening Inner Resources

reflecting on past experiences. • Comprehensive and regular assessment of
 Discussing the past is therapeutic. health status and interventions to promote
 Life review can be a painful experience. health provide a solid base from which
 Older adults can benefit by discussing them inner strengths can be nurtured.
openly.
 The young can gain a new perspective on • Nurses can support older adults’ inner
life. strengths

 Nurses’ role: Nurses can facilitate empowerment by:

o Facilitate life review by eliciting the • Including and encouraging the active
older adult’s life story. participation.
o Older adult who may require some • Avoiding ageist attitudes
facilitation, creative activities may
help the process. • Providing a variety of options

Self - reflection • Equipping older adults

• Advocating for older adults
• One of the hallmarks of successful aging is
knowledge of self. • Offering feedback
• Exploring and learning about one’s true self * A sense of hope fosters empowerment.
are significant to holistic health in late life.
• Self-reflection does not come easily or
naturally for some individuals.

Activities That Facilitate Self-Reflection

Journaling

• It is done with pencil and paper or a word

processing program.
• Nurses can assist individuals by guiding
them in the selection of a blank book.

10
 CHAPTER 5- COMMON AGING CHANGES
Cardiovascular System

1. Heart size does not change significantly due

to age
Learning Objectives:
2. Incomplete valve closure
IV. List common age-related changes at the
3. Heart muscle loses its efficiency and
cellular level; in physical appearance, and
to the respiratory, cardiovascular, contractile strength
gastrointestinal, urinary, reproductive, 4. Pacemaker cells become increasingly
musculoskeletal, nervous, endocrine, irregular and decrease in number
integumentary, and immune systems, the 5. Shell surrounding the sinus node thickens.
sensory organs and thermoregulation.
V. Describe psychological changes Digestive System
experienced with age. 1. Tooth enamel becomes harder and more
VI. III. Discuss nursing action to promote
brittle. Tooth loss is not normal.
health and reduce risks associated with
age-related changes. 2. Taste sensations become less acute because
the tongue atrophies
3. Diminished muscle strength and tongue
pressure
CHANGES TO THE BODY 4. Presbyesophagus is present
5. Gradual reduction in the weight of the small
Cells intestine
1. The number of cells is gradually 6. Fat absorption is slower
reduced 7. Loss of tone in the internal sphincter
2. Total body fat as a proportion of the 8. Liver has reduced weight and volume
body’s composition increases. Urinary System
3. Extracellular fluid remains fairly
constant, intracellular fluid decreases. 1. Renal tissue growth declines
2. Tubular function decreases.
Physical Appearance 3. Bladder muscle weaken and bladder
1. Hair loss, develop gray hair and capacity decreases.
wrinkles. 4. Stress incontinence
2. Body’s contours gain a bony appearance Reproductive System
3. Elongated ears, a double chin, and baggy
eyelids For men
4. Skinfold thickness is significantly
1. Seminal vesicle is affected
reduced
2. Reduction in sperm count
5. Stature decreases
3. Prostatic enlargement occurs
Respiratory System
For women
1. Connective tissue changes 1. Female genitalia demonstrate many
2. Mouth breathing during sleep becomes changes
more common 2. Uterus shrinks and the endometrium
3. The submucosal glands have decreased atrophies
secretions 3. Fallopian tubes atrophy and shorten with
4. Calcification of costal cartilage age
5. Alveoli reduce in number 4. Ovaries atrophy and become thicker and
6. Less effective gas exchange & lack of smaller.
basilar inflation 5. Estrogen depletion

11
Musculoskeletal System 5. Perspiration is slightly reduced

1. Kyphosis and Sarcopenia is present Immune System

2. Reflexes are lessened in the arms, are
1. Immunosenescence
nearly totally lost in the abdomen, but are
maintained in the knee. Older person should:
3. Bone mineral and bone mass are reduced
4. Limit joint activity and motion  Maintaining a good nutritional state
 Daily multivitamin and mineral supplement
Nervous System  Regular physical activity
1. Decline in brain weight and blood flow  Stress can affect the function of the immune
2. Reduction in neurons, nerve fibers, cerebral system
blood flow, and metabolism Thermoregulation
3. Nerve conduction velocity is lower
4. Frequent awakening during sleep is not 1. Normal body temperature are lower
unusual 2. Reduced ability to respond to cold
temperatures
Sensory Organ
CHANGES TO MIND
Vision
Personality
1. Presbyopia develops
2. Visual field narrows 1. Drastic changes in basic personality
3. Pupil less responsive to light normally do not occur as one ages.
4. Alterations in the blood supply of the retina
and retinal pigmented epithelium Memory
5. The density and size of the lens increase 1. Three types of memory
6. Depth perception becomes distorted 2. Retrieval of information from long-term
7. Eyes are dull & dry memory can be slowed
8. Visual acuity declines
9. Corneal sensitivity is diminished Intelligence

Hearing 1. In general, it is wise to interpret the

findings related to intelligence and the
1. Presbycusis is observed
older population with much caution
Taste and smell because results may be biased from the
measurement tool or method of
1. loss of their ability to smell and alters taste evaluation used.
Touch *Basic intelligence is maintained.
1. Tactile sensation is decreased Learning
Endocrine System
Factors that interfere ability to learn:
1. Thyroid gland undergoes fibrosis, cellular 1. Motivation
infiltration, and increased nodularity 2. Attention span
2. Reduction in triiodothyronine 3. Delayed transmission of information to
3. Delayed and insufficient release of insulin the brain
Integumentary System 4. Perpetual deficits and illness.
1. May display less readiness to learn &
1. Skin becomes irritated, subcutaneous fat is depend on previous experience for
lost solutions to problems
2. Reduction in the number of melanocytes 2. Learning occurs best when the new
3. Skin immune response declines information is related to previously learned
4. Scalp, pubic, and axillary hair thins and information.
grays

12
 3. Greater problem to learn new habits when  Care of Older adults was an unpopular
old habits exist branch of nursing practice
 Conference Group on Geriatric Nursing
Attention Span
Practice (1962)
1. Demonstrate a decrease in vigilance  Standards for geriatric Nursing Practice
performance (1970)
 Gerontological Nursing (1975)
Nursing implication of aged-related changes

1. Can aid in promoting practices

2. Reducing risks to health and well-being.
1. Invaluable in identifying pathology and
obtaining treatment in a timely manner

Chapter 6 – THE SPECIALTY OF GERONTOLOGICAL NURSING

Learning Objectives:
 In 1976, the Geriatric Nursing Division
I. Describe the importance of evidence-
became the Gerontological Nursing
based practice in gerontological nursing.
II. Identify standards used in gerontological Division.
nursing practice.  Harford Institute for Geriatric Nursing
III. List principles guiding gerontological (1990)
nursing practice.  Hartford Geriatric Nursing (2003)
IV. Discuss major roles for gerontological
nurses. Complexity of gerontological nursing:
V. Discuss further challenges for 1. Older people exhibit great diversity
gerontological nursing.
VI. Describe activities that contribute to self- 2. Most have chronic conditions that uniquely
care for gerontological nurses. affect acute illnesses
3. The risk of complications is high
Definitions of terms
CORE ELEMENTS OF GERONTOLOGICAL
 Geriatric nursing nursing care of sick older NURSING PRACTICE
adults
 Gerontological nursing nursing practice Evidence-Based Practice
that promotes wellness and highest quality  A systematic approach that uses existing
of life for aging individuals research for clinical decision making.
 Standard desired, evidence-based  Synthesis and analysis of available
expectations of care that serve as a model information from research.
against which practice can be judged  Meta – Analysis and Cost- analysis
DEVELOPMENT OF GERONTOLOGICAL NURSING

 American Journal of Nursing (1904)

 Federal Old Age Insurance Law (1935)

13
Standards Various factors influence aging process:
1. Heredity
 Standards reflect the level and expectations 2. Nutrition
of care that are desired and serve as a 3. Health Status
model against which practice can be judged. 4. Life Experience
 Standards arise from a variety of sources. 5. Environment
6. Activity
Gerontological competencies:
7. Stress
 Differentiate normal from abnormal
findings  Unique data and knowledge are used in
 Assess physical, emotional, mental, social applying the nursing process to the older
and spiritual status and function population.
 Provide information and education on a  Older adults share similar self-care and
level and in a language appropriate for the human needs with all other human beings.
individual  Gerontological nursing strives to help older
*Individualize care planning and adults achieve wholeness by reaching
implementation optimum levels of physical, psychological,
 Identify and reduce risks. social, and spiritual health.
 Empower to exercise maximum decision
making GERONTOLOGICAL NURSING ROLES
 Identify and respect preferences.
Healer
 Advocate for and protect the rights
 Facilitates discussion of and honor advance • Early nursing practice was based on the
directives Christian concept of the intertwining of the
flesh and spirit.
Principles
Caregiver
 Nursing principles are those proven facts or
widely accepted theories that guide nursing • Use theory in the application of the nursing
process to the care of older adults.

Educator

• Share knowledge and skills related to the

care of older adults
• Effective communicator

• Routine nurse-patient interactions

Advocate

 Aiding older adults in asserting their rights

and obtaining required services.

Innovator

 *Nurse assumes an inquitive style

SELF-CARE & NURTURING

action.
1. Following Positive health care Practices
PRINCIPLES OF GERONTOLOGICAL NURSING o Periodic check – up
PRACTICE o Plan a realistic action
2. Strengthening and Building Connections
 Aging is a natural process common to all
o The richness of nurses’ connection
living organisms.
in their personal lives provides


14
 fertile soil to grow meaningful - Keep abreast of new findings
connections with patients.
Promote Integrative Care
3. Strengthening and Building Connections
o The challenges nurses may face are - Care of medical conditions
finding and protecting the time and
energy to connect with others. - Holistic approach

Strengthening And Building Connections - Alternative & complementary therapy

1.Relationship - Care for caregivers

2.Spirituality Educate Caregivers

2.1. God - Gerontological nurses can influence the

education of caregivers by:
2.2. Nondescript higher power
- Helping nursing schools identify relevant
2.3. Connection with nature & all living issues for inclusion in the curricula
things
- Participating in the classroom and field
3. Connecting with self experiences of students
*This begins with a realistic self-appraisal. - Gerontological nurses can influence the
4. Sharing Life Stories education of caregivers by:

* Helps people gain self-insight - Attending and participating in continuing

education program
• Able to reflect on positive experienced
- Serving as a role model
• A permanent record
- * Reading current nursing literature
• Offer rich life lessons
Develop New Roles
Connecting With Self
o Independent case manager
1. Journaling o Columnist
a. Writing personal notes o Owner or director
2. Meditating o Geropsychiatric nurse
a. Several techniques to use o Faithe community nurse
3. Taking Retreats o Consultant
a. Retreats is a withdrawal from
normal activities Balance Quality Care and Health Care Costs

3. Committing to a Dynamic Process  Test creative staffing

 Use lay caregivers
o That one is willing to face the  Abolish unnecessary practices
uncomfortable feelings experienced during
 Advocate for older adults
the process of reflecting on less than
pleasant life experiences

THE FUTURE OF GERONTOLOGICAL NURSING

Utilized Evidence-Based Practices

- The body of knowledge continuously grows and

changes.

Advance Research

- Network with nurse researchers

- Support research

15
 CHAPTER 7- HOLISTIC ASSESSMENT & CARE PLANNING

Learning Objectives:
I. Explain holistic gerontological nursing
care.
II. Describe the needs of older adults
pertaining to the promotion of health and
the management of health challenges.
III. List the responsibilities that influence
older person’s abilities to most self-care
needs.
IV. Describe four characteristics of nurse
who function as healers.
V. Describe the general types of nursing
interventions that are employed when
older adults present self - care deficits.

HOLISTIC GERONTOLOGICAL CARE HEALTH CHALLENGES – RELATED NEEDS

 Holism refers to the integration of the Needs of the elderly:

biologic, psychological, social and spiritual
1. Education 6. Therapies
dimensions
 Holistic gerontological care incorporates 2. Counseling 7. Advocacy
knowledge and skills from a variety of
disciplines 3. Coaching
 Holistic gerontological care is concerned 4. Monitoring
with:
o Facilitating growth toward 5. Coordination
wholeness
REQUISITES TO MEET NEEDS
o Promoting recovery and learning
from an illness.  Physical, Mental and Socioeconomic
o Maximizing quality of life when one Abilities
possess an incurable illness or  Knowledge, Experience and Skills
disability  Desire and Decision to Take Action
o Providing peace, comfort, and
dignity as death is approached. GERONTOLOGICAL NURSING PROCESS
 It is by using evidence-based assessment
Nursing interventions:
tools that can be useful to gerontological
nurses. 1. Empowering the older individual
 Identifies patient needs. 2. Eliminating or minimizing self-care
 Fulmer SPICES limitations
3. Providing direct services
HEALTH PROMOTION – RELATED NEEDS

 Optimal health of older adults’ rests on the

degree to which the needs for physiological
balance,
 connection, and gratification are satisfied


16
Examples of Application

• Implementing actions when health

conditions exist.

• When individuals face health challenges,

new needs frequently arise

• In geriatric nursing:
1. Assess the impact of the health
challenge on the individual’s self-care
capacity
2. Identify appropriate nursing
interventions

NURSE AS A HEALER

Characteristics:

 Presence
 Availability
 Willingness to form connections
 Models of Holism

17
 CHAPTER 8 – LEGAL & ETHICAL ASPECTS OF
GERONTOLOGICAL NURSING

Learning Objectives: INVASION OF PRIVACY

I. Discuss laws governing
gerontological nursing practice.  Invading the right of an individual to
II. Describe legal issues in gerontological personal privacy.
nursing practice and ways to
LARCENY
minimize risks.
III. Discuss various philosophies  Unlawful taking of another person’s
regarding right and wrong. possession
IV. Describe ethical standards, principles
& cultural considerations guiding NEGLIGENCE
nursing practice.
V. List factors that have increased  Omission or commission of an act that
ethical dilemmas for nurses. departs from acceptable and reasonable
VI. Identify measures to help nurses standards
make ethical decisions.
MALPRACTICE
LAWS GOVERNING GERONTOLOGICAL NURSING  When performance deviates from the
PRACTICE standard of care.
 Public law governs relationships between CONFIDENTIALITY
private parties and the government
 Health Insurance Portability and
 Private law governs relationships among
Accountability Act (HIPAA)
individuals or between individuals and
organizations PATIENT CONSENT
ACTS THAT COULD RESULT IN LEGAL LIABILITY  Consent must be obtained before the
FOR NURSES procedure
 Consent must be informed
ASSAULT
 Refusing a consent
 A deliberate threat or attempt to harm
PATIENT COMPETENCY
another person
 Persons who are mentally incompetent are
BATTERY
unable to give legal consent.
 Unconsented touching of another person in  When the patient’s competency is
a socially impermissible manner questionable

DEFAMATION OF CHARACTER STAFF SUPERVISION

 An oral/written communication to a third Various types of situations can create risks for
party that damages a person’s reputation. nurses:

FALSE IMPRISONMENT 1. Permitting unqualified persons to

deliver care
 Unlawful restraint or detention of a person. 2. Failing to follow up on delegated tasks
FRAUD 3. Assigning tasks to staff members for
which they are not qualified or
 Willful and intentional misrepresentation competent
that could cause harm or cause a loss to a 4. Allowing staff to work under conditions
person or property with known risks
18
MEDICATION  Report and document any unusual
occurrence.
 Safe administration of prescribed
medications PHILOSOPHIES GUIDING ETHICAL THINKING
RESTRAINTS Ethics
 Chemical restraints  Revolve around the concept of accepted
 Improperly used restraining devices standards of conduct and moral judgment.
 Documentation
 Patient refuses to have a restraint used. Utilitarianism

TELEPHONE ORDERS  This philosophy holds that good acts are

those from which the greatest number of
 Accepting telephone orders predisposes people will benefit and gain happiness.
nurses to considerable risks
 Do not involve third parties in the order Egoism
 Obtain the physician’s signature within 24  An act is morally acceptable if it is of the
hours. greatest benefit to oneself.
 Recorded telephone orders may be a helpful
way Relativism
 Write down the order as it is given  This philosophy can be referred to as
 Communicate relevant information situational ethics, in that right and wrong
 Do not offer diagnostic interpretation are relative to the situation.
 Place the order in doctor’s order sheet
Absolutism
ELDER ABUSE
 There are specific truths to guide actions.
 Elder abuse can occur in patients’ homes The truths can vary depending on a
 Types of abuse person’s belief.
 Abuse can assume many forms
 Nurses should assess, and have a legal ETHICS IN NURSING
responsibility to report all cases of known
External & Internal Ethical Standards
or suspected abuse.
 Indications of possible abuse or neglect  Professions such as nursing require a code
Delay in seeking medical care of ethics on which practice can be based and
Dehydration evaluated.
Unexplained bruises
Malnutrition ETHICAL PRINCIPLES
Urine odor, urine-stained clothing Beneficence.
Poor hygiene
Inappropriate administration of  To do good for patients.
medications
Nonmaleficence.
Repeated infections, injuries
 To prevent harm to patients. This principle
LEGAL SAFEGUARDS FOR NURSES
could be viewed as a subset of beneficence
Nurses should protect themselves in the following
Autonomy
ways:
 To respect patients’ freedom, preferences,
 Familiarize themselves with the laws and
and rights.
rules
 Become knowledgeable about their agency’s Justice
policies and procedures
 To be fair, treat people equally
 Function within the scope of nursing
practice. Confidentiality

 To respect the privacy of patients.

19
Fidelity and veracity New Fiscal Constraints

 Fidelity means to respect our words & duty  The right of older adults to expect a high
to patients; quality and quantity of health and social
 Veracity means truthfulness. services whitleather groups lack basic
assistance.
CULTURAL CONSIDERATIONS
Conflict of Interests
 The belief that individuals have the right to
make their own decisions regardless of  Nurses can face a variety of situations that
their sex and should be empowered to do present a conflict of interests
so. Greater Numbers of Older Adults
 Women are equal to men
 Prayer is a beneficial supplement to medical  With growing numbers of people spending
treatment more years in old age and increasing ratio
 People have the right to have the of dependent individuals to productive
confidentiality of their health information workers, society is beginning to feel
 People have the right to have the burdened.
confidentiality of their health information Assisted Suicide
protected, even from relatives. To individuals
who view family involvement in decision  The ANA has been clear in its objection to
making as natural and preferable, there may assisted suicide.
be a desire to have health information  Nurses may face the dilemma of knowing
shared with the family. that a competent patient is arranging an
assisted suicide, and while understanding
ETHICAL DILEMMAS FACING GERONTOLOGICAL and respecting the patient’s decision.
NURSES
MEASURES TO HELP NURSES MAKE ETHICAL
Nursing practice involves many situations DECISIONS
that could produce conflicts-conflicts between
nurses’ values and external systems affecting their  Encourage patients to express their desires
decisions and conflicts between the rights of  Identify significant others who impact and
patients and nurses’ responsibilities to those are impacted.
patients.  Know yourself.
 Read
EXPANDED ROLE OF NURSES
 Discuss
 They now perform sophisticated  Form an ethics committee.
assessments, diagnose nursing problems,  Eliopoulos
monitor and give complicated treatments  Share
 Use alternative modalities of care  Consult
 Independent judgments about patients’  Evaluate decision
clinical conditions.

MEDICAL TECHNOLOGY

 Artificial organs
 Genetic screening
 New drugs
 Computers
 Lasers
 Ultrasound

20
 CHAPTER 9 – CONTINUUM OF CARE IN
GERONTOLOGICAL NURSING
Learning Objectives: Counseling
I. Describe the continuum of services
available. Consume Affairs (Better Business Bureau)
II. Discuss factors that influence service Legal and Tax Services
selection for older adults
III. Describe various practice settings for  Bar Association
gerontological nurses  Internal Revenue Services
IV. List major functions of gerontological
nurses. Transportation

 American Red Cross

Education
SERVICES IN THE CONTINUUM OF CARE FOR
OLDER ADULTS Personal Emergency Response Systems (PERS)

Supportive and Preventive Services Shopping at home

Nurses will be involved with the following: Volunteer work

 Identifying service needs  American Red Cross

 Referring older adults to appropriate  Service Corps of Retired Executives
services  Retired and Senior Volunteer Program
 Supporting and coordination services Partial and Intermittent Care Services
Financial Services Assistance with Chores
 Director office of the Social Security Home – delivered Meals
 Department of Veterans Affairs
 Wartime Veterans  Meals on wheels
 Banks, social services agencies, religious Home monitoring
org.
 Tele management Technologies
Employment  Two-way audio & video device
Nutrition  Medication administration system

 Department of Social Services Telephone Reassurance

Housing Home Health Care

 Local social service agencies  Medicare is limited to skilled home care:

o Be homebound
Health Care o Have services ordered by a primary
care provider
 Health dep’t, private practitioners,
o Rehabilitative services
outpatient services
o Need intermittent
Health care
Foster Care & Group Homes
 Social support & activities
Adult day Services
o churches, synagogues, mosques
o Bureau of recreation  Day Treatment and Day Hospital programs
o AARP (American Association of  Assisted Living
Retired Persons)  Respite Care
21
  Health Ministry and Parish Nurse Program
 Care & Case Management
EFFECTS OF AGING ON RESPIRATORY HEALTH
Programs of All-Inclusive Care for the Elderly
 Nose experiences connective tissue
 Hospice changes.
 Thicker hair in the nostril
Complete and Continuous Care Services
 Trachea stiffens
Hospital care  Lungs becomes smaller in size and weight
 Elastic recoil during expiration is decreased
 Measures That Enhance the Quality of
 Alveoli are less elastic, develop fibrous
Hospital Care:
tissue, and contain fewer functional
o Perform a comprehensive
capillaries.
assessment
o Recognizes differences  Loose /brittle tooth can dislodge
o Reduce risks  Relaxed sphincters & slower gastric motility
 Impaired mobility, inactivity, & s/e from
medications used

FACTORS IN MATCHING SERVICES TO NEEDS

 Services address physical, emotional, social

and spiritual factor
 Services must consider unique and
changing needs
 Care and services must be flexible
 Services must be tailored to needs
 Guide elderly toward a healthy aging
process.
 Eliminate ageism.
o Maintain & promote function

CHAPTER 10 – GERIATRIC CARE ON

RESPIRATION
o  Respect the rights of older adults
Nursing Homes
 Teach and support caregivers.
Complementary & alternative services  Listen and support.
 Implement restorative & rehabilitative
measures.
 Coordinate and manage care.

Learning Objectives:
I. List the impact of age-related changes
on respiratory health.
II. Describe measures to promote RESPIRATORY HEALTH PROMOTION
respiratory health in older adults.
III. Discuss the risks, symptoms, and care 1. Obtaining influenza and pneumonia
considerations associated with vaccines.
selected respiratory illnesses. 2. Avoiding exposure to individuals who have
IV. Describe interventions that can aid in respiratory infections
preventing complications and
3. Nurses should teach all older adults to do
promoting self-care in older persons
deep breathing exercises several times daily
with respiratory conditions.
22
 4. Smoking cessation o Low oxygen level rather than a high
5. When immobility is unavoidable, hourly carbon dioxide level
turning, coughing, and deep breathing will o Sedatives, hypnotics, & narcotics
promote respiratory activity may be contraindicated
6. Review all medications used by older o Complications should be avoided.
persons.  Observation of the following to determine
7. Environmental factors resp. status:
8. Oral cavity infections o Color
o Chest structure and pasture
Quality of Indoor air can be improved by:
o Breathing pattern
1. Installing and maintaining air filters in o Cough
heating and air-conditioning systems
2. Vacuuming regularly
3. Damp-dusting furnishings
4. Discouraging cigarette smoking
5. Opening windows to air out rooms
6. Maintaining green houseplants

SELECTED RESPIRATORY CONDITIONS Pneumonia

Asthma  Factors:
o Poor chest expansion and more shallow
 Older adult asthmaticus
breathing
 Precautions to avoid adverse drug effect o High prevalence of respiratory diseases
 Overuse of bronchodilator nebulizer o Lowered resistance to infection
 New steroid inhalants o Reduced sensitivity of pharyngeal
Chronic Bronchitis reflexes
o Pneumococcal pneumonia is the most
 Recurrent inflammation & mucus common type of pneumonia in older
production in the bronchial tubes adults.
 Sign & symptoms may include persistent,  Symptoms may include a slight cough,
productive cough; wheezing; recurrent fatigue, rapid respiration, confusion,
respiratory infections; and shortness of restlessness, and behavioral changes
breath  Management:
 Episodes of hypoxia begin to occur o Close observation
 Management: o Pneumococcal vaccines
o Maintain good fluid intake
o Discouraging chronic respiratory Influenza
irritation  Types of Influenza:
Emphysema o Influenza A
o Influenza B
 Causative factors:  Symptoms include fever, myalgia, sore
o Chronic bronchitis throat, and nonproductive cough.
o Chronic irritation  Annual influenza vaccines
o Cigarette smoking  Caregiver should be immunized too.
 Sign & symptoms include dyspnes, chronic
cough, fatigue, weight loss, anorexia and Lung Cancer
weakness.  Factors:
 Management: o Increase prevalence rate in black
o Postural drainage, bronchodilators, men
avoidance of stressful situations, & o Cigarette smokers
breathing exercises. o Chronically exposed to chemical
o Smoking should be stop
23
  Symptoms: Dyspnea, coughing, fatigue,  Drugs
anorexia  Handwashing & oral hygiene
 Diagnostic test
 Treatment COMPLEMENTARY THERAPIES

Lung Abscess  Herbs are believed to affect respiratory

health
 Causes include pneumonia, tuberculosis, a  Aromatherapy
malignancy, or trauma to the lung,  Hot spicy foods
aspiration of foreign material  Acupuncture, yoga, Rolfing
 Symptoms are anorexia, weight loss, fatigue,  Nurse should keep an open mind
temperature elevation, and a chronic cough.
 Postural drainage PROMOTING SELF-CARE
 High protein, high caloric diet
 Bronchodilator
 Home-ventilator used

PROVIDING ENCOURAGEMENT

 Psychological support and reassurance

 Repeated encouragement

GENERAL NURSING CONSIDERATIONS

Recognizing symptoms
LANDMARK IN THE GROWTH OF
 Seek medical attention promptly GERONTOLOGICAL NURSING
 Report changes in the character of sputum
1902 First article on care of aged in American Journal
Preventing complications of Nursing written by a physician
 Close monitoring 1904 First article on care of aged in American Journal
of Nursing written by a nurse
ENSURING SAFE OXYGEN ADMINISTRATION
1950 First geriatric nursing text published (Geriatric
 Monitor blood gas Nursing, K. Newton)
 Watch out for signs of carbon dioxide
narcosis First master’s thesis on care of aged (Eleanor Pingrey)
 Appropriate oxygen administration Geriatrics recognized as an area of specialization in
 Nasal passages should be clean regularly nursing
 Home environment needs to be evaluated
for safety. 1952 First nursing study on care of aged published in
Nursing Research
POSTURAL DRAINAGE
1961 American Nurses Association (ANA)
 Prescribed for removing bronchial recommends specialty group for geriatric nurses
secretions
1962 First national meeting of ANA Conference on
 Aerosol medication
Geriatric Nursing Practice
 Position of postural drainage
 Oral hygiene & period of rest 1966 Formation of Geriatric Nursing Division of ANA
 Cupping and vibration First gerontological nursing clinical specialist nursing
 Documentation program (Duke University)
PROMOTING PRODUCTIVE COUGHING 1968 First nurse makes presentation at International
Congress of Gerontology (Laurie Gunter)
 Hard candy and other sweets
 Breathing exercises 1969 Development of standards for geriatric nursing
 Fluid intake practice

24
 CHAPTER 11 – GERIATRIC CARE ON DIGESTIVE &
BOWEL ELIMINATION
1970 First publication of ANA Standards of 2001 ANA publishes revised Standards and Scope of
Gerontological Nursing Practice Gerontological Nursing Practice
1973 First offering of ANA Certification in 2002 Nurse Competence in Aging initiative to provide
Gerontological Nursing (74 nurses certified) gerontological education and activities within
1975 First specialty publication for gerontological specialty nursing associations2004 American
nurses, Journal of Gerontological Nursing Association of Colleges of Nursing publishes
competencies for advanced practice
First nursing conference at International Congress of
Gerontology programs in gerontological nursing
1976 ANA changes name from Geriatric Nursing 2007 American Association for Long-Term Care
Division to Gerontological Nursing Division. Nursing formed
Publication of ANA Standards of Gerontological 2008 Retooling for an Aging America published by the
Nursing Institute of Medicine recommending improved
ANA Certification of Geriatric Nurse Practitioners geriatric competencies for health care workers
initiated
1980 Geriatric Nursing journal launched by American
Journal of Nursing company
1981 First International Conference on Gerontological
Nursing
ANA Division of Gerontological Nursing develops
statement on scope of practice
1982 Development of Robert Wood Johnson Teaching
Home Nursing Program
1983 First university chair in gerontological nursing in
the United States (Case Western Reserve)
1984 National Gerontological Nursing Association
(NGNA) formed
ANA Division of Gerontological Nursing Practice
becomes Council on Gerontological Nursing
1986 National Association for Directors of Nursing
Administration in Long-Term Care
(NADONA/LTC) formed
1987 ANA published combined Scope and Standards
of Gerontological Nursing Practice
1989 ANA Certification of Gerontological Clinical
Specialists first offered
1990 Division of Long-Term Care established within
ANA Council of Gerontological Nursing
1996 Hartford Gerontological Nursing Initiatives
funding launched by John A. Hartford Foundation

25
Learning Objectives: 2. Altered taste sensation, poor diet, low-
VII. Describe how aging affects budget carbohydrate diet with excessive
gastrointestinal health. intake of sweets
VIII. Discuss measures to promote 3. Deficiencies of vitamin B complex and
gastrointestinal health in older adults. calcium,
IX. List symptoms and management of 4. Hormonal imbalances,
selected gastrointestinal conditions in hyperparathyroidism, diabetes,
older adults.
osteomalacia, Cushing’s disease, syphilis
5. Drugs
EFFECTS OF AGING ON GASTROINTESTINAL  Benign neoplastic lesions develop
HEALTH  Periodontal disease
 Dental caries
 Xerostamia
 Decreased stomach elasticity and higher PH Management:
 Constipation 1. Good oral hygiene
 Bile salt synthesis decreases 2. Daily flossing
 Intolerance for fatty foods 3. Regular dental examination
 Reduced hepatic blood flow 4. Instruct patients to inform their dentists
about health problems & medication they
GASTROINTESTINAL HEALTH PROMOTION take.
 Good dental hygiene & regular visits to the 5. Fluoride treatment
dentist Dysphagia
 Natural means to promote bowel
elimination Causes:
 Dietary fiber intake of 20 to 35 g/d is 1. GERD
advisable 2. Stroke
 Attempt a bowel movement following 3. Structural disorder
breakfast - Symptoms: occasional difficulties
 Ensure complete elimination swallowing to a complete inability to
swallow.
SELECTED GASTROINTESTINAL CONDITIONS
Management:
Xerostomia
1. Careful assessment & observation
Causes:
2. Speech-language therapist
1. Medication 3. Prevention of aspiration
2. Sjogren’s Syndrome 4. Promotion of adequate nutritional status
3. Mouth breathing 5. Suctioning

Management: Hiatal Hernia

1. Oral hygiene 2 types:

2. Saliva substitutes
1. Sliding
3. Sipping of water
2. Rolling
4. Sugarless candy
- Symptoms: Heartburn, dysphagia, belching,
vomiting, regurgitation, pain & bleeding
- Diagnostic: Barium swallow and
Esophagoscopy.

Management:
Dental Problems 1. Diet
Causes: 2. Position
3. Drugs
1. Poor condition of teeth

26
Esophageal Cancer - Treatments: Reducing infection, providing
nutrition, relieving discomfort, and
- Causes: Poor oral hygiene and chronic
promoting rest
irritation from tobacco, alcohol, Barrett’s
Esophagus Colorectal CA
- Symptoms: Dysphagia, weight loss,
- Symptoms: fatigue, bloody stools, change in
excessive salivation, thirst, hiccups, anemia,
bowel pattern, abdominal discomfort, rectal
and chronic bleeding
bleeding, unexplained weight loss, anemia
- Diagnostic: Barium swallow,
- Diagnostics: Digital rectal exam, Fecal
esophagoscopy, & biopsy
Occult test, Colonoscopy
- Management: surgical resection, radiation,
- Treatment: Surgery
chemotherapy, laser therapy, and
photodynamic therapy. Chronic constipation
Peptic Ulcer - Factors: Inactive lifestyle, Low fiber and low
fluid intake, depression, laxative abuse,
- Causes: Stress, diet, genetic predisposition,
medications, dulled sensations, failure to
drugs
complete emptying of the bowel
- Risk Factors: smoking, heavy alcoholic
- Management: Diet, Drugs, Records
beverage
- consumption, caffeine & Helicobacter pylori Flatulence
infection
- Symptoms: pain, bleeding, obstruction, & - Causes: Constipation, irregular
perforation bowelmovements, certain foods, poor
- Treatments: Addressing risk factors, neuromuscular control of the anal
prevent sphincter.
- Complications - Management: Avoiding flatus-producing
foods, sitting upright after meals, increased
CA of Stomach activity, knee–chest position.
- Prevalent among men, cigarette smokers, Intestinal Obstruction
poor socioeconomic groups, African
American, Hispanic - Causes: cancer of the colon, adhesions &
- Symptoms: Anorexia, epigastric pain, hernias; Diverticulitis, ulcerative colitis,
weight loss, anemia, bleeding and hypokalemia, vascular problems, and
enlargement of the liver paralytic ileus
- Diagnostics: Barium swallow & Gastroscopy - Symptoms: pain, abdominal distention,
with biopsy bowel sound
- Treatments: Diet, surgery - Diagnostic: X-ray, blood test
- Prognosis: Good/bad - Management: Intestinal intubation, surgery

Diverticular Disease Diverticulosis Fecal Impaction

- Causes: Chronic constipation, obesity, hiatal - Indications: Distended rectum, Abdominal

hernia, and atrophy of the intestinal wall and rectal discomfort, oozing of fecal
muscles material, often mistaken as diarrhea,
- Symptoms: Slight bleeding, change in bowel Palpable, hard fecal mass, Fever
habits, tenderness - Management: Enema, manual breaking &
- Diagnostic: Barium enema removal of feces, injecting 50 mL hydrogen
- Treatments: Diet, avoidance of constipation, peroxide through a rectal tube, prevention
surgery of constipation
- Causes: Overeating, straining during a -
bowel movement, alcohol, and irritating Fecal Incontinence
foods
- Symptoms: Nausea, vomiting, constipation, - Causes: decreased contractile strength,
diarrhea, low-grade fever, and blood or impaired automaticity of the puborectal and
mucus in the stool, pain
27
 external anal sphincter, loss of cortical - Symptoms: Anorexia, weakness, weight
control, and reduced reservoir capacity loss, fever,
- Diagnostic: Proctosigmoidoscopy, - Dyspepsia, belching, nausea, diarrhea,
proctography, and anorectal manometry constipation, and obstructive jaundice, pain
- Management: bowel retraining drugs, - Management: surgery
- surgery, biofeedback.
Biliary Tract Disease
Acute Appendicitis
- Cholelithiasis
- Symptoms: severe pain, Fever, and - Symptoms: pain
leukocytosis - Treatment: Rotary lithotrite treatment and
- Management: Surgery Extracorporeal shock wave lithotripsy
- CA of Gallbladder
- Symptoms: Pain in the right upper
Learning Objectives: quadrant, anorexia, nausea, vomiting,
weight loss, jaundice, weakness, and
constipation

CHAPTER 12 – GERIATRIC CARE ON REPRODUCTIVE

SYSTEM HEALTH
I. List changes to the male and female - Prognosis: poor
reproductive systems that occur with
age.
II. Describe measures to promote Male reproductive
reproductive system health in older
adults. - Structural changes in the seminiferous
III. Outline factors to consider in tubules
assessing reproductive system health - Enlargement of the prostate gland
in older adults.
IV. Describe the symptoms and REPRODUCTIVE SYSTEM HEALTH PROMOTION
management of selected disorders of
the reproductive system. Female:
V. Outline care plan measures for the  Annual gynecologic examination
patient who has had prostate surgery.
Male
EFFECTS OF AGING ON REPRODUCTIVE SYSTEM  Prostate-specific antigen (PSA)
 Testicular self-examination
Female reproductive
 Complete history and physical examination
- Flattening of the labia and loss of
SELECTED REPRODUCTIVE SYSTEM
subcutaneous fat and hair
CONDITIONS
- Vaginal epithelium becomes thin, & the
vaginal environment is drier and more Infections and Tumors of the Vulva
alkaline
- Uterus and ovaries also decrease in size Vulvitis
- Breasts sag, less firm; firm linear strands - Incontinence and poor hygienic practices
may develop - Pruritus
- Treatment aims to find and manage any
underlying cause.
Cancer of the Pancreas
Vulvar Tumor
- Symptoms: Pruritus, mass at clitoris
28
CA of Vulva

- Symptoms: large, painful, foul-smelling Dyspareunia

fungating ulcerating tumors
- Cause: Vulvitis, vaginitis, and other
- Treatment: Radical vulvectomy, Radiation
gynecologic problems
therapy, Counseling
- Treatment: Gynecological examination
Vaginitis
Breast CA
- Symptoms: Soreness, pruritus, burning, and
- Regular breast examination
a reddened
- Annual mammograms
- vagina, foul smelling vaginal discharge is
clear, brown, or white, bleeding Problems of the Male Reproductive System
- Treatments: Local estrogens, topical
medication, douches, good hygiene Erectile Dysfunction

CA of Vagina - Causes: alcoholism, diabetes, dyslipidemia,

HTN hypogonadism, multiple sclerosis,
- Diagnostic: Biopsy, Paps smear renal failure, spinal cord injury, thyroid
- Treatment: Irradiation, topical conditions, drugs
chemotherapeutic agents, or surgery - Treatment: oral erectile agents, drugs
injected into the penis, penile implants, and
Cancer of the Cervix
vacuum pump devices.
- Symptom: Vaginal bleeding & Leukorrhea;
Benign Prostatic Hyperplasia
urinary retention or incontinence, fecal
incontinence, and uremia - Symptoms: dysuria, dribbling, poor control,
- Treatment: Radiation, surgery, regular overflow urine incontinence, bleeding
screening - Treatment: prostatic massage, use of
urinary antiseptics, diuretics,
Problems of the Cervix
anticholinergics, and antiarrhythmic agents,
- Nabothian cysts Transurethral surgery
- Regular gynecologic examinations
CA of the Prostrate
Endometrium CA
- Diagnostic: Digital rectal examination
- Causes: late onset of menstrual periods, - Symptoms: Back pain, anemia, weakness,
been infertile, HNPCC , obese. and weight loss can develop as a result of
- Diagnostic: D & C metastasis.
- Treatment: Surgery, irradiation, or a - Treatment: Monitoring, irradiation, or a
combination of both radical prostatectomy; palliative treatment

CA of Ovaries Tumors of the Penis

- Symptom: bleeding, ascites, and the - Diagnostic: Biopsy
presence of multiple masses. - Treatment: Irradiation and local excision
- Treatment: Surgery or irradiation. - Testicular Tumor
- Symptoms: testicular enlargement and pain
Perineal Herniation
and enlargement of the breasts
- Types: Cystocele, rectocele, and prolapse of - Treatment: Chemotherapy, irradiation,
the uterus orchiectomy
- Symptom: lower back pain, pelvic
Scrotal masses
heaviness, and a pulling sensation. Urinary
and fecal incontinence, retention, and - usually benign, can result from
constipation, pressure or palpate a mass in - Causes: Hydrocele, spermatocele,
her vagina varicocele, hernia
- Treatment: Surgical repair - Treatment: Counsellin
29
 CHAPTER 13 – GERIATRIC CARE ON URINARY
ELIMINATION
- Symptoms: burning, urgency, and fever;
Learning Objectives: incontinence,delirium
I. Describe age-related changes that
- Management: Antibiotic therapy, note the
affect urinary elimination.
patient’s fluid intake and output, forcing
II. List measures that promote urinary
system health. fluids is advisable, observation for new
III. Outline factors to consider in symptoms, cranberry juice
assessing the urinary system. - Complication: Septicemia, Urosepsis
IV. Describe the incidence, symptoms,
Prostatitis
and management of selected urinary
conditions. - Cause: bacterial in origin
V. Outline a care plan for the patient - Symptoms: fever, chills, and malaise
who is incontinent of urine.. - Diagnostic: Clean-catched urine sample
- Treatment: antibiotic
EFFECTS OF AGING ON URINARY ELIMINATION Urinary Incontinence
- Decreases the ability of the bladder to Types: Transient/Established
expand and reduces storage capacity
- Nocturia Types of Established Incontinence:
- Retention of large volume of urine
1. Stress Incontinence
- Higher blood urea nitrogen levels
2. Urgency Incontinence
- Increase in the renal threshold for glucose
3. Overflow Incontinence
URINARY SYSTEM HEALTH PROMOTION 4. Neurogenic Incontinence
5. Functional Incontinence
- Good fluid intake 6. Mixed Incontinence
- Taking Vitamin C and food
- Catheterization should be avoided Bladder CA
- Nightlights should be used to improve
- Risk factors: Chronic irritation of the
visibility
bladder, exposure to dyes, and cigarette
- Reducing fluids immediately before bedtime
smoking
- Set a comfortable tone & display sensitivity
- Symptoms: bladder infection, urgency,
during the assessment
dysuria.
Prevent urine retention by: - Diagnostic: Cytoscopic Exam.
- Treatment: surgery, radiation,
1. Voiding in upright position immunotherapy, or chemotherapy,
2. Massaging bladder area observation of symptoms of metastasis
3. Rocking back and fort -
4. Running water
5. Soaking hands in warm water Renal Calculi

SELECTED URINARY CONDITIONS - Causes: infection, changes in the pH, chronic

diarrhea, dehydration, excessive
Urinary Tract Infection elimination of uric acid, and hypercalcemia
- Cause: poor hygienic practices, improper - Symptoms: Pain, hematuria
cleansing after bowel elimination, low fluid - Management: Preventing urinary stasis,
intake and excessive fluid loss, and providing ample fluids, and facilitating
hormonal changes prompt treatment of UTIs.
- Causative agent: Escherichia coli, Proteus
species
30
 GENERAL NURSING CONSIDERATIONS FOR
URINARY CONDITIONS
Glomerulonephritis
- Nurses need sensitivity in dealing with
- Symptoms: fever, fatigue, nausea, anorexia,
patients’ urinary problems.
abdominal pain, anemia, edema, arthralgias,
- Realistic explanation
hypertension, increased sedimentation rate,
- Minimize embarrassment and promote a
Oliguria
positive self-concept.
- Management: Antibiotic, restricted sodium,
protein diet, monitor intake & output,

CHAPTER 14 – GERIATRIC CARE ON MOBILITY

MUSCULOSKELETAL HEALTH PROMOTION

Learning Objectives: Promotion of Physical Exercise in All Age

I. Describe the effects of aging on Groups
musculoskeletal function.
II. Describe the adjustments that may  Activities that hinder the elderly in physical
need to be made in exercise programs activities
in late life.  All exercise program should address:
III. Discuss the challenges older adults o Cardivascular endurance
may face in maintaining an active o Flexibility
state. o Strength training
IV. List actions that could benefit an
older adult who has impaired Exercise Programs Tailored for Older Adults
mobility.
V. Describe factors contributing to, Advantages:
symptoms of, and related nursing 1. Improve body tone, circulation, appetite,
care for fractures, osteoarthritis, digestion, elimination, respiration,
rheumatoid arthritis, osteoporosis,
immunity, sleep, and self-concept.
gout, and podiatric conditions.
2. Provide opportunities for socialization and
VI. Discuss pain management measures
for musculoskeletal problems. recreation
VII. Describe measures to facilitate Guidelines for Exercise Programs for Older
independence in persons with Adults:
musculoskeletal problems.
 Ensure that a recent physical examination
has been done
EFFECTS OF AGING ON MUSCULOSKELETAL
 Determine the training heart rate and
FUNCTION
evaluate heart rate during exercise
 Decline in the number and size of muscle  Encourage warm-up exercises
fibers and subsequent reduction in muscle
Alternative exercises:
mass
 Sarcopenia develops  Suggest to do foot, leg, shoulder, and arm
 Activity can be impacted by psychosocial circling
factors.  Instruct to do deep-breathing and limb
- Loss of spouse exercises
- Retirement  Encourage to wash dishes / light laundry by
- Relocation hand
 During bathing activities, to flex and extend
all body parts.

31
  Management: Rest, massage; Splints, braces,
and canes; proper nutrition; weight
The Mind–Body Connection
reduction; nutritional supplements
 Cognitive and emotional states can  Arthroplasty / joint replacement
influence the physical activity.
Rheumatoid Arthritis
 Promotion of physical activity
 Therapeutic recreation is structured leisure  Symptoms: Joints are painful, stiff, swollen,
with a specific goal in mind red, and warm to the touch; fatigue, malaise,
weakness, weight loss, wasting, fever, and
Prevention of Inactivity
anemia
1. Inactivity can result in deconditioning  Management: rest, splints, range of motion
2. Educate the caregivers exercise, heat & gentle massage, drugs,
3. Suggesting pastimes surgery,
4. Enhance motivation  Health education
5. Local resources
Osteoporosis
6. Unique capacities, limitation & interest
 Risk factors: Calcium and Vit. D deficiency,
Nutrition
smoking, prolonged immobility, increase
 Good nutrition is an important factor alcoholic intake, family history
 1,500 mg calcium should be included in the  Symptoms: Kyphosis, pain
diet daily  Management: Diet, brace, bed board,
 Obesity places strain on the joints regular exercise, avoid heavy lifting, ROM,
handle with gentleness
SELECTED MUSCULOSKELETAL CONDITIONS
Gout
Fractures
 Symptoms: Pain, tenderness of the joint,
Prevention of fall:
warmth, redness, and swelling of the
1. Nightlight surrounding tissue.
2. Avoid risky activities  Management: Diet, avoid alcohol intake,
3. Rise from a kneeling or sitting position herbs, good fluid intake, drugs
slowly
Podiatric Conditions
4. Fitting shoes with a low, broad heel
5. Careful where they are walking * Callusses
 Causes: Trauma, cancer metastasis to the
 Causes: Reduced fat padding of the foot,
bone, osteoporosis, and other skeletal
dryness of the skin, decreased toe function,
diseases
and poor fitting shoes
 Symptoms: Pain, change in the shape or
 Symptoms: not painful, seen in heels and
length of a limb, edema, discoloration of
tissue, and bone protruding through the soles
tissue.  Management: massage with oils/lotion;
avoid to shave or cut off calluse
 Management: Limit activity within the limit,
fluids should be encouraged, good nutrition, * Corns
correct body alignment, keep skin dry &
clean  Symptoms:
 Complications: Pneumonia, thrombus discomfort, pain
formation, pressure ulcers, renal calculi,  Management: avoid
fecal impaction, and contractures to remove corns

Osteoarthritis * Bunions (Hallux Valgus)

 Causes: Trauma, obesity, low vitamin D and  Causes: heriditary,

C levels, and genetic factors shoe’s style
 Symptoms: Crepitation, bony nodules  Management: Shoe
repair shops can;
32
 CHAPTER 15 – GERIATRIC CARE ON ENDOCRINE
FUNCTION
custom-made shoes,
surgery

* Hammer Toe
(Digiti Flexus)

 Symptom:
discomfort
 Mangement:
Orthotics,
surgery
* Plantar Fasciitis

 Symptom: Pain
 Management:
Orthotics,
symptomatic
treatment

* Infections

 Onychomycosis
o pain, antifungal
treatment
 Tinea pedis
o burning, itching,
crack, peeling of
skin

Ingrown Nails (Onychocryptosis)

 Cause: Tight-fitting shoes/ cutting the nail

excessively short.
 Management: Soaks and topical antibiotics

Learning Objectives:
I. Summarize the effects of aging on
endocrine function.
II. Describe unique manifestations of
diabetes in older adults.
III. Outline a teaching plan for the older
person with diabetes.
IV. List symptoms of hypothyroidism and

33
 hyperthyroidism in older adults. - Endocrine health promotion
SELECTED ENDOCRINE CONDITIONS AND
RELATED NURSING CONSIDERATIONS

Diabetes Mellitus
- Risk factors: Obesity, inactivity, an
increased amount of fat tissue, and genetic
factor
- Diagnostic: Fasting Blood Sugar, Urine test
for glucose, Glucose tolerance test
- Criteria in diagnosing DM:
1. Symptoms of diabetes & a random blood
GENERAL NURSING CONSIDERATIONS FOR glucose concentration ≥200 mg/dL.
MUSCULOSKELETAL CONDITIONS 2. Glycosylated hemoglobin (HbA1c) ≥6.5%.
3. Fasting blood glucose concentration ≥126
Managing Pain mg/dL
4. Blood glucose concentrations 2 hours after
- Warm bath at bedtime
an oral glucose intake ≥200 mg/dL
- Passive stretching of the extremity
- Management: Patient education
- Correct positioning
1. Teaching plan
- Back rubs
2. Fear & Anxiety
- Gentleness in turning and lifting older
- Guidelines for Patient Education:
patients 1. Assess readiness to learn
- Divertional activities 2. Assess learning capacities and limitations
- Complementary therapy 3. Outline content of presentation
Preventing injury 4. Prepare the patient for the teaching-
learning session
- Using both feet for support 5. Provide environment conducive to
- Using railings and canes for added balance learning
- Wearing properly fitting, safe shoes 6. Most effective individualized educational
- Avoiding long trousers, nightgowns, or materials
robes 7. Leave material with patient
- Gentle handling 8. Obtaining feedback
9. Re-evaluate periodically
Promoting Independence
10. Documentation
- Canes, walkers, and other assistive devices - Drug therapy
- Physical and occupational therapists 1. Metformin
2. Sulfonylurea drugs
3. Acarbose
4. Rosiglitazone and pioglitazone
5. Oral hypoglycemic agents
- Patient Self-care and Monitoring
1. Insulin injection
2. Blood glucose level testing using a finger-
prick method
3. Tryglyceride monitoring
4. Hemoglobin A1c Test
EFFECTS OF AGING ON ENDOCRINE FUNCTION
- Thyroid gland progressively atrophies and
thyroid gland activity decreases
- Adrenocorticotropic hormone secretion
decreases with age
- Insulin secretion is also affected by age
34
Learning Objectives:

CHAPTER 16 – GERIATRIC CARE ON VISION & HEARING

I. Explain the importance of good vision and Hyperthyroidism
hearing & the impact of visual and hearing
deficits on elderly. The thyroid gland secretes excess amounts of
II. Describe the effects of aging on vision and
thyroid hormones.
hearing.
III. List measures to promote healthy vision and - *Causes: Amiodarone
hearing. - *Diagnostic: Thyroid function test,
IV. Identify signs of and nursing interventions for Radionuclide thyroid scans
older adults with cataracts, glaucoma, macular
- Symptoms: Increased perspiration may not
degeneration, detached retina, corneal ulcers,
and hearing impairment. occur, and for the person with a history of
chronic constipation, diarrhea
- Exercise & Nutrition - Treatment: Antithyroid medications or
1. Benefits of regular exercise radioactive iodine, surgery
2. Nutritional supplements
3. Financial, energy, or social limitations.
- Complications: TERMS TO KNOW
1. Peripheral vascular disease
2. Retinopathy Cataract: clouding of crystalline lens of eye
3. Hypoglycemia Glaucoma: eye disease involving increased
4. Drug interactions intraocular pressure
5. Neuropathies Macular degeneration: loss of central vision
Presbycusis: age-related high-frequency
Hypothyroidism sensorineural hearing loss
Presbyopia: age-related decrease in eye’s
A subnormal concentration of thyroid
ability to focus on near objects
hormone in the tissues.
*Types: Primary and Secondary EFFECTS OF AGING ON VISION AND
- Symptoms: Fatigue, weakness, and lethargy, HEARING
Depression and disinterest in activities,
Anorexia, Weight gain and puffy face, - Presbyopia
impaired hearing, Periorbital or peripheral o Inability to focus.
edema, Constipation, Cold intolerance, - Visual acuity declines
Myalgia, paresthesia, and ataxia, Dry skin - Light perception threshold decreases
- Treatment: Replacement of thyroid hormone - Visual fields become smaller
- Eyes produce fewer tears and drier
- Legally blind
- Lip reading is difficult
- Visual limitations can make communication
problematic
- Presbycusis
o age related sensorineural hearing loss
- Limiting social contact
- Difficulty hearing telephone conversation

35
 - Management: Professional evaluation Detached Retina
SENSORY HEALTH PROMOTION Symptoms: Perception of spots moving across
the eye, blurred vision, flashes of light, feeling
Promoting Vision that a coating is developing over the eye
- Tonometry Management: Bed rest, use of bilateral eye
- Annual eye examination patches, surgery
- Prompt evaluation
- Review diet (Vit. C, E, Selenium, Zinc) Corneal Ulcer
Promoting Hearing
Symptoms: Irritation, dietary deficiencies,
- Complete treatment of ear infections
lowered resistance, pain, photophobia
- Prevention of trauma to the ear
Management: prompt assistance, early care,
- Regular audiometric examinations
drugs, sunglass, surgery
- Education
- Assess for cerumen accumulation Hearing Deficits
SELECTED VISION CONDITIONS RELATED Factors: exposure to noise, drugs, illness
NURSING INTERVENTIONS
Otosclerosis
Visual Deficits
Tinnutus
Cataracts
Patient Care: - encourage audiometric
Factors: Ultraviolet B, DM, smoking, alcohol, examination; explanation and instruction in
eye injury writing, neighbor should be alerted.
Symptoms: Vision is distorted, night vision is
decreased, objects appear blurred, nuclear Hearing Aids
sclerosis - Not all problems are solved
Treatment: Surgery, Ophthalmologists visit - It should be prescribed
Glaucoma - Variety of style is available
- Speech may sound distorted
Factors: Increased size of the lens, iritis, - Aid must be checked regularly
allergy, endocrine imbalance, emotional
instability, family history. Anticholinergic Hearing Aid Care:
drugs 1. Turn the aid off or remove the battery when
Acute Glaucoma the aid is not being worn.
2. Clean the aid at least weekly.
Symptoms: severe eye pain, headache, nausea 3. Protect the aid from exposure to extreme heat
& vomiting, blurred vision 4. When changing the battery, turn off the aid
Diagnostic test: Tonometer, Gonioscopy first
Management: Surgery, Iricdectomy 5. Keep several new batteries available.
Chronic Glaucoma GENERAL NURSING CONSIDERATIONS FOR
VISUAL AND HEARING DEFICITS
Symptoms: peripheral vision becomes slowly,
central vision is affected, tired feeling in their Hearing
eyes, headaches, misty vision, seeing halos
around lights - Diet
Management: Drugs, surgery - Different textures
Preventions: - Clocks that chime
- Avoiding to increase IOP - Large prints materials
- Carrying a card -
- Abuse and overuse of the eyes
- Periodic evaluation

Macular Degeneration
Diagnostic: Ophthalmic exam.
Treatment: Laser therapy
36
 CHAPTER 17 – GERIATRIC CARE ON SKIN HEALTH

Learning Objectives Keratosis

I. Summarize the effects of aging on the skin.
II. List practices that promote good skin health in - Symptoms: Slightly reddened and swollen
elderly. lesion
III. Describe signs and nursing care for skin
problem in older adults.
- Management: Freezing agents and acids;
IV. Discuss measures that help older patients surgery, close observation
cope with skin alterations.
V. Identify alternative therapies that promote Seborrheic Keratosis
good skin health in older adults.
- Symptoms: Lesions appear dark and oily; dry
in appearance and of a light color.
EFFECTS OF AGING ON THE SKIN - Management: Gauze pad containing oil,
- Common aging changes freezing agents or by a curettage and
cauterization procedure.
- Increased fragility of the skin
- Effects on appearance Skin CA
PROMOTION OF SKIN HEALTH 1. Basal cell CA
- Risk factors: Advanced age and
- Avoid using drying agents, rough clothing,
exposure to the sun, ultraviolet
highly starched linens, and other items
radiation, therapeutic radiation.
irritating to the skin.
- Symptoms: Small, dome-shaped
- Good skin nutrition and hydration
elevations, dark, rather than shiny
- Skin care
2. Squamous cell CA
- Avoid exposure to ultraviolet rays
- Firm, skin-colored or red nodules.
- Use of sun-screening lotions
- Stays in the epidermis but can
- Health teaching
metastasize
In detecting unhealthy moles: 3. Melanoma
- Melanomas can be classified as
A—Asymmetry follows:
B—Border Irregularity o Lentigo maligna melanoma
o Superficial spreading
C—Color melanoma
D—Diameter o Nodular melanoma
- Management: Biopsy, excision
SELECTED SKIN CONDITIONS
Vascular Lesions
Pruritus
- Causes: Obesity and hereditary factors
- Causes: Excessive bathing and dry heat, - Symptoms: Stasis ulcer
Illness - Management: Good nutrition, elastic support
- Management: Bath oils, moisturizing lotions, stockings, Ligation & stripping
and massage; vitamin supplements; drugs
Vision
Pressure Injury
- Ample lighting
- Causes: Tissue anoxia and ischemia
- Management: Encouraging activity, urged to
move, kept wrinkle free, check the bed
frequently, diet, skin care, Bath oils, ROM

37
- Stage 1
o Sore are not open wound.
- Stage 2
o The skin usually breaks open/form ulcers.
- Stage 3
o The sore gets worse.
- Stage 4
o Pressure injury is very.
- Treatment measures defends on symptoms:
1. Hyperemia
2. Ischemia
3. Necrosis
4. Deep tissue damage

38
 CHAPTER 18 – GERIATRIC CARE ON CANCER
AGING AND CANCER

Learning Objectives: Unique Challenges for Older Persons with Cancer

I. Discuss the prevalence and risks of cancer in
the older population. Highest rate of most cancers
II. Describe reasons for cancer being more Have another health condition
complex in older adults.
III. List factors that increase the risk of cancer.
Toleration of treatment
IV. Outline preventive measures that can reduce Survival rates for older adults are lower
the risk of cancer in older adults.
V. Describe increased risks for older adults Explanations for Increased Incidence in Old Age
receiving conventional cancer treatment.
VI. Discuss reasons for patients’ choice to use 2 Major theories:
complementary and alternative medicine
(CAM). 1. Biological, age-related changes
VII. List issues to evaluate in the selection of CAM 2. Prolonged exposure to carcinogens
for patients with cancer.
VIII. Discuss nursing considerations in caring for RISK FACTORS, PREVENTION, AND
older patients with cancer.
SCREENING
Risk factors for cancers offer insights into
TERMS TO KNOW
some of the preventive measures that could prove
BRCA - blood tests can be done to identify useful in avoiding these diseases.
mutations in either one or two breast cancer
CANCER RISK FACTORS AND ACTIONS TO
susceptible genes
REDUCE RISK
CAM - those therapies that fall outside of
mainstream Western medical practices - Avoid the use of and exposure to tobacco
SPF - rating used for sunscreens to indicate the products.
protection they offer from sun - Limit exposure to the sun.
- Maintain weight within an ideal range;
exercise and be physically active.
- Tool for assessing pressure injury: - Protect against exposure to known
1. Braden Scale carcinogens.
2. Norton Scale - Limit alcohol consumption.
3. Pressure Score Status Tool (PSST) - Discuss chemoprevention
- Diet
GENERAL NURSING CONSIDERATIONS FOR
SKIN CONDITIONS RECOMMENDED CANCER SCREENING FOR
OLDER ADULTS
- Promoting Normalcy
- Psychological support - Annual checkup
- Treat elderly as normal persons - Annual mammogram
- Avoiding excess sun exposure and using a - Annual fecal occult blood test.
sunscreen - Colonoscopy
- Cosmetic surgery - Annual PSA tests
- Pap test
Using Alternatives Therapies
TREATMENT
- Use of herbs
- Use of essentials oils Conventional Treatment
- Homeopathic and naturopathic remedies
1. Surgery
- Nutritional supplements
2. Radiation
3. Chemotherapy
4. Biologic Therapy

39
Complementary and Alternative Medicine
1. Relationship-centered care
2. Support
3. Healing partnership
4. Comfort
5. Hope
NURSING CONSIDERATIONS FOR OLDER
ADULTS WITH CANCER
Providing Patient Education
C - hange in bowel or bladder habits
A - sore that does not heal
U - nusual bleeding or drainage
T - hickening or lump in the breast or
elsewhere
I - ndigestion or swallowing difficulty
O - bvious change in a wart or mole
N - agging persistent cough or hoarseness
Promoting Optimum Care
- Close monitoring and taking actions
- The nurse should regularly assess for pain
Providing Support to Patients and Families
- Patients will need strong support
- The nurse assesses the patient’s understanding,
clarifies misconceptions and offers
explanations where needed.
- Providing ample opportunity
- Physical, emotional, and spiritual support

40