Gerontological Nursing

by Tabloski, Patricia A.

• ISBN13: 9780130941558
• ISBN10: 0130941557
• Edition: 1st
• Format: Paperback
• Copyright: 2006-01-01
• Publisher: Prentice Hall

Summary

Patricia Tabloskis Gerontological Nursing is a comprehensive, research-based text that will guide nursing students in their care of older patients. The text presents information related to normal and pathological changes of aging, with an emphasis on the critical information that nurses need for assessment, diagnosis, planning and evaluating care outcomes for their older clients. Bolstered by current research in nursing, medicine, sociology and psychology, this book combines information on medical-surgical care for older patients with issues facing the older population. It emphasizes both critical thinking and application of the nursing process to give students the confidence they need to provide the highest level of care.

Author Biography

Patricia A. Tabloski is a faculty member at the William F. Connell School of Nursing at Boston College.

Table of Contents

Unit One Foundations of Nursing Practice	1	(82)
Principles of Gerontology	2	(25)
Demographics and Aging	6	(1)
Longevity and the Sex Differential	6	(7)
Life After 65	9	(3)
Living Longer or Living Better?	12	(1)
Healthy People 2010	13	(2)
Theories of Aging	15	(6)
Biological Aging Theories	18	(1)
Psychological Aging Theories	19	(1)
Sociological Aging Theories	20	(1)
Patient and Family Teaching	21	(6)
Gerontological Nursing Issues	27	(27)
Scope of Practice	29	(1)
Advanced Gerontological Nursing	29	(1)
Standards of Gerontological Nursing	30	(4)
Functional Health Patterns and Nursing Diagnosis	34	(8)
Care Planning and Setting Realistic Goals	35	(3)
Implementation of the Nursing Care Plan	38	(2)
Evaluation	40	(1)
Research Agenda	40	(2)
Role by Setting	42	(2)
Trends in Financing Healthcare for Older Persons	44	(1)
Ethics	45	(2)
Communication	47	(1)
Patient and Family Teaching	48	(6)
Principles of Geriatrics	54	(29)
Components of Comprehensive Geriatric Assessment	57	(8)
Contextual Variables Affecting Holistic Geriatric Assessment	57	(5)
Minimum Data Set	62	(2)
Health Promotion and Disease Screening	64	(1)
Healthy People 2010	65	(11)
Health Status	65	(3)
Pain	68	(2)
Legal Issues	70	(3)
Patient Confidentiality	73	(1)
Use of Technology in Assessment	73	(1)
Health Insurance Portability and Accountability Act	73	(2)
Informed Consent and Competence	75	(1)
End-of-Life Issues	76	(1)
Patient and Family Teaching	77	(6)
Unit Two Challenges of Aging and the Cornerstones of Excellence in Nursing Care	83	(244)
Cultural Diversity	84	(26)
National Standards for Culturally and Linguistically Appropriate Services in Health Care	85	(1)
Cultural Care Nursing	86	(2)
CulturalCare Triad	88	(2)
Demographic Change	88	(1)
The Nurse	88	(1)
The Caregiver	89	(1)
The Patient	90	(1)
Ethnocultural Heritage	90	(2)
Culture	90	(1)
Ethnicity	91	(1)
Religion	91	(1)
Socialization	91	(1)
Examples of Heritage Consistency	92	(1)
Ethnocultural Life Trajectories	93	(4)
Heritage Assessment Tool	97	(3)
Best Nursing Practices	100	(1)
Providing CulturalCare	100	(3)
Cultural Sensitivity	100	(2)
Cultural Appropriateness	102	(1)
Steps to Cultural Competency	102	(1)
Implementing CulturalCare Nursing	103	(1)
Patient and Family Teaching	103	(7)
Nutrition and Aging	110	(45)
Normal Aging and Nutrition	111	(4)
Changes in Body Composition	111	(1)
Oral and Gastrointestinal Changes With Aging	112	(1)
Sensory Changes	113	(1)
Social and Economic Changes Affecting Nutrition	114	(1)
Nutritional and Disease-Related Health Changes	115	(1)
Nutritional Requirements and Aging	115	(10)
Unique Nutrient Recommendations	117	(6)
Supplement Savvy: Beyond the RDAs	123	(1)
Alcohol and Vitamins	124	(1)
Nutritional Assessment	125	(9)
Nutritional Assessment Parameters	125	(5)
Screening Tools	130	(4)
Common Nutritional Concerns in the Older Person	134	(12)
Unintentional Weight Loss	134	(10)
Medical Nutritional Therapy for Chronic Diseases	144	(1)
Nursing Diagnoses	144	(2)
Patient and Family Teaching Guidelines	146	(9)
Pharmacology and Older Adults	155	(33)
Cultural Diversity and Medication Safety	156	(1)
Pharmacokinetic Alterations in the Older Person	157	(7)
Pharmacodynamic Alterations in the Older Person	159	(1)
Impact of Concurrent Conditions and Therapy on Drug Therapy	159	(2)
Adverse Drug Reactions and latrogenesis	161	(2)
Reporting Adverse Drug Effects	163	(1)
Prevention of Adverse Drug Effects in the Older Person	164	(1)
Polypharmacy	164	(3)
Adverse Drug Effects of Concern in the Older Person	165	(2)
Alternative and Complementary Medicine	167	(4)
Over-the-Counter Medications	169	(1)
Appropriate Versus Inappropriate Prescribing Practices	169	(2)
Appropriate Use of Psychotropics in the Older Person	171	(3)
OBRA Regulations and Interpretive Guidelines	171	(1)
Use of Antipsychotic Drugs	172	(1)
Short-Acting Benzodiazepines and Other Anxiolytics	173	(1)
Evaluating Appropriate Prescribing of Medications	173	(1)
Promoting Adherence and Compliance	174	(3)
Assessing Older Patients' Appropriate Use of Medications	177	(1)
Medication Management	178	(2)
Healthcare Fraud	179	(1)
Costs of Medication	179	(1)
Use of Internet Pharmacies	180	(1)
Unsafe Medication Practices	180	(1)
Patient and Family Teaching	180	(8)
Psychological and Cognitive Function	188	(36)
Normal Changes With Aging	191	(2)
Personality and Self-Concept	193	(1)
Personality Disorders	194	(1)
Elder Abuse or Mistreatment	195	(1)
Psychotic Disorders	196	(1)
Life Satisfaction and Life Events	196	(2)
Adjustment Disorder	197	(1)
Bereavement	197	(1)
Stress and Coping	198	(1)
Depression	199	(10)
Nursing Assessment of Depression	202	(1)
Suicide	203	(2)
Alcohol Abuse	205	(2)
Basic Principles Relating to Psychological Assessment in Older Adults	207	(2)
Cultural Considerations	209	(1)
Nursing Interventions	210	(7)
Nonpharmacological Treatments	210	(6)
Best Practices	216	(1)
Nursing Diagnosis	216	(1)
Patient and Family Teaching	217	(7)
Sleep and the Older Adult	224	(25)
Sleep Architecture	225	(2)
Normal Sleep and Aging	227	(2)
Health Problems and Sleep Disruption	229	(1)
Sleep Disruption	230	(6)
Dementia	231	(1)
Snoring	231	(1)
Sleep Apnea	232	(2)
Urinary Problems	234	(1)
Sleep Problems in Hospitals and Nursing Homes	235	(1)
Alcohol and Caffeine	235	(1)
Sleeping Medications	235	(1)
Nursing Assessment	236	(1)
Best Practices	237	(1)
Nursing Interventions	237	(12)
Additional Nonpharmacological Measures	240	(1)
Pharmacological Treatments for Altered Sleep Patterns	241	(8)
Pain Management	249	(22)
Pathophysiology of Pain	251	(1)
The Art and Science of Pain Relief	251	(2)
Pharmacological Management	253	(3)
Adjuvant Drugs for Older Patients With Pain	253	(1)
Special Pharmacological Issues Regarding Pain Management in the Older Person	254	(1)
Pharmacological Principles for Successful Pain Management	255	(1)
Nonpharmacological Methods to Manage Pain in the Older Person	256	(1)
Consequences of Unrelieved Pain	257	(8)
Acute Pain in Elderly Adults	258	(2)
Chronic Pain in the Older Person	260	(1)
Pain Assessment Techniques	260	(2)
Analysis of the Pain Management Plan	262	(3)
Patient and Family Teaching	265	(6)
Violence and Elder Mistreatment	271	(22)
National Incidence and Prevalence of Elder Mistreatment	272	(7)
Legal Issues	272	(1)
Categories of Elder Mistreatment	273	(1)
Institutional Mistreatment	273	(1)
Definitions of Elder Mistreatment	274	(1)
Characteristics of Older Adults at Risk	275	(1)
Characteristics of People Who Mistreat Older Adults	275	(1)
Cultural Perceptions of Elder Mistreatment	275	(1)
Theories of Elder Mistreatment	276	(3)
Assessment	279	(6)
Physical Examination	279	(4)
Nursing Diagnoses	283	(1)
Interventions	283	(1)
Documentation	284	(1)
Implications for Gerontological Nursing Practice	284	(1)
Future Considerations	285	(8)
Care of the Dying	293	(34)
The Changing Face of Death	296	(1)
Palliative Care	297	(1)
Hospice Care	298	(2)
Stages of the Dying Process	299	(1)
Complementary and Alternative Care	300	(1)
The Nurse's Role	301	(19)
Pain Relief at the End of Life	302	(2)
Pain During the Dying Process	304	(1)
Effects of Unrelieved Pain During the Dying Process	304	(1)
Principles of Pain Relief During the Dying Process	304	(1)
Pharmacological Approach to Pain Management During the Dying Process	305	(3)
Nursing Care at the End of Life	308	(2)
Nursing Diagnoses at the End of Life	310	(1)
Postmortem Care	311	(1)
Designations of Level of Care	312	(1)
Advance Directives	313	(3)
Use of Feeding Tubes for Artificial Nutrition	316	(1)
Mercy Killing or Euthanasia	317	(1)
Cultural Issues	317	(1)
Preparing for Death	318	(1)
Grief	318	(2)
Caring for the Caregiver	320	(1)
Patient and Family Teaching	320	(7)
Unit Three Physiological Basis of Practice	327	(482)
The Integument	328	(37)
Usual Structure and Function of Skin Layers	329	(1)
Epidermis	329	(1)
Dermis	329	(1)
Hypodermis	329	(1)
Dermal Accessory Structures	330	(1)
Hair	330	(1)
Nails	330	(1)
Glands	330	(1)
Usual Functions of the Skin	331	(1)
Regulation of Body Fluids and Temperature	331	(1)
Regulation of the Immune Function	331	(1)
Production of Vitamin D	331	(1)
Sensory Reception	331	(1)
Normal Changes of Aging	332	(3)
Epidermis	332	(2)
Dermis	334	(1)
Subcutaneous Layer	334	(1)
Hair	335	(1)
Nails	335	(1)
Glands	335	(1)
Sebaceous Glands	335	(1)
Common Illnesses of Older Persons	335	(11)
Skin Cancer	335	(1)
Actinic Keratosis	336	(2)
Skin Tears	338	(1)
Pressure Ulcers in the Older Person	338	(3)
Wound Healing	341	(2)
Cellulitis	343	(1)
Fingernail and Toenail Conditions	344	(1)
Nursing Diagnoses	344	(1)
Laboratory and Testing Values	345	(1)
Laboratory Values to Determine Risk for Pressure Ulcer	346	(1)
Pharmacology and Nursing Responsibilities	346	(1)
Topical Antifungal Agents	346	(1)
Topical Antibiotics	346	(1)
Systemic Antibiotics	347	(1)
Selected Antimicrobials	347	(1)
Aminoglycosides	347	(1)
Prescription Creams and Lotions for Dry Skin	347	(1)
Nonpharmacological Treatment of Skin Problems in Older Persons	347	(10)
Skin Cancer and Precancer Conditions	348	(1)
Nonpharmacological Treatment of Skin Cancer	349	(1)
Prevention and Management of Skin Tears	350	(1)
Nonpharmacological Treatment of Pressure Ulcers	350	(3)
Treatment of Pressure Ulcers	353	(4)
Nonpharmacological Treatment of Fingernail and Toenail Conditions	357	(1)
Nursing Management Principles	357	(8)
Nursing Process and Documentation	357	(1)
Knowledge-Based Decision Making	357	(1)
Evaluation and Revision of Nursing Care Plan	358	(7)
The Mouth and Oral Cavity	365	(18)
Normal Changes of Aging	366	(1)
Common Diseases of Aging Relating to the Mouth and Oral Cavity	367	(2)
Barriers to Mouth Care	368	(1)
Negative Effects of Poor Oral Care	368	(1)
Risk Factors for Oral Problems	369	(1)
Nursing Assessment of Oral Problems	369	(2)
Common Oral Problems	371	(7)
Xerostomia	371	(1)
Oral Candidiasis	371	(1)
Oral Pain	372	(1)
Gingivitis and Periodontal Disease	372	(2)
Stomatitis	374	(1)
Oral Cancer	374	(1)
Nursing Strategies for Providing Oral Care to Patients with Cognitive Impairments	375	(3)
Nursing Diagnoses	378	(5)
Sensation: Hearing, Vision, Taste, Touch, and Smell	383	(76)
Vision	384	(13)
Normal Age-Related Changes	386	(2)
Nursing Implications Related to Caring for Patients With Vision Problems	388	(2)
Visual Problems	390	(7)
Nursing Diagnoses Associated With Visual Impairment	397	(1)
Hearing	397	(10)
Age-Related Changes	398	(2)
Types of Hearing Loss	400	(2)
Assessing Hearing Loss	402	(2)
Hearing Aids	404	(1)
Assistive Listening Devices	405	(1)
Common Hearing Problems in Older Persons	405	(1)
Nursing Diagnoses Associated With Hearing Impairment	406	(1)
Taste	407	(3)
Nursing Assessment of the Older Patient With Taste Disturbances	408	(2)
Nursing Diagnoses Associated With Taste Impairment	410	(1)
Smell	410	(3)
Nursing Assessment of the Older Patient With Disturbances of Smell	411	(1)
Nursing Diagnosis	412	(1)
Physical Sensation	412	(1)
Nursing Assessment of the Older Person With Tactile Impairment	413	(8)
Nursing Diagnoses Associated With Tactile Impairment	413	(1)
Teaching Guidelines for Patient and Family With Sensory Impairments	413	(8)
The Cardiovascular System	421	(1)
Structure and Function	422	(5)
Conduction System	424	(1)
Electrocardiogram	425	(1)
The Circulatory System	425	(1)
Regulation of Blood Flow	426	(1)
Cardiac Circulation	427	(1)
Normal Changes With Aging	427	(4)
Common Illnesses With Older Persons	431	(28)
Hypertension	432	(3)
Hypotension	435	(1)
Hyperlipidemia	435	(3)
Chest Pain	438	(1)
Angina	439	(1)
Myocardial Infarction	439	(2)
Valvular Heart Disease	441	(1)
Congestive Heart Failure	442	(4)
Arrhythmias and Conduction Disorders	446	(1)
Peripheral Vascular Disease	447	(1)
Nursing Management Principles	448	(11)
The Respiratory System	459	(58)
Anatomy and Physiology	460	(2)
Normal Changes of Aging	462	(3)
Changes in Cardiovascular Function	463	(1)
Changes in Immune Function	463	(2)
Changes in Neurologic, Neuromuscular, and Sensory Functions	465	(1)
Respiratory Diseases Common in Older People	465	(46)
Asthma	465	(22)
Chronic Obstructive Pulmonary Disease	487	(12)
Tuberculosis	499	(4)
Lung Cancer	503	(1)
Respiratory Infections	504	(5)
Acute Bronchitis	509	(1)
Pulmonary Embolism	509	(1)
Severe Acute Respiratory Syndrome (SARS)	510	(1)
Patient-Family Teaching Guidelines	511	(6)
The Genitourinary and Renal Systems	517	(34)
Normal Changes of Aging	518	(6)
Age-Related Changes in the Kidney	518	(3)
Bladder and Urethral Changes With Aging	521	(1)
Antidiuretic Hormone and the Aging Process	522	(1)
Male Reproductive System and Advanced Age	522	(1)
Female Reproductive System and Advanced Age	523	(1)
Gay and Lesbian Older Adults	523	(1)
Common Genitourinary Concerns in Older Adults	524	(15)
Acute and Chronic Renal Failure	525	(2)
Urinary Tract Infection	527	(1)
Urinary Incontinence	528	(5)
Benign Prostatic Hyperplasia	533	(1)
Menopause-Related Concerns	534	(1)
Genitourinary Malignancies	535	(4)
Sex and the Senior Citizen	539	(12)
Discussing Sexuality With Older Adults	542	(1)
Sexuality in Long-Term Care	542	(1)
Erectile Dysfunction	543	(1)
Sexually Transmitted Diseases	543	(8)
The Musculoskeletal System	551	(49)
The Normal Musculoskeletal System and Joints	552	(2)
Skeletal System: Structure and Function	552	(1)
Joints: Structure and Function	553	(1)
Muscles: Structure and Function	554	(1)
Normal Changes of Aging	554	(2)
Skeleton: Normal Changes of Aging	554	(2)
Muscles: Normal Changes of Aging	556	(1)
Joints, Ligaments, Tendons, and Cartilage: Normal Changes of Aging	556	(1)
Common Musculoskeletal Illnesses of Older Persons	556	(12)
Osteoporosis	557	(1)
Osteomalacia	558	(2)
Paget's Disease	560	(1)
Joint Disorders: Noninflammatory and Inflammatory Categories	561	(7)
Falls and the Older Person	568	(1)
Hip Fracture	568	(1)
Selected Nursing Diagnoses for Common Musculoskeletal Illnesses of Older Persons	569	(6)
Selected Diagnostic Tests and Values for Musculoskeletal Problems	572	(3)
Common Diagnostic Findings for Musculoskeletal Illnesses	575	(1)
Pharmacology and Nursing Responsibilities	575	(7)
Pharmacology and Nursing Responsibilities for Osteoporosis	575	(3)
Pharmacology and Nursing Responsibilities for Paget's Disease	578	(1)
Pharmacology and Nursing Responsibilities for Osteomalacia	578	(1)
Pharmacology and Nursing Responsibilities for Osteoarthritis	579	(1)
Pharmacology and Nursing Responsibilities for Rheumatoid Arthritis	579	(1)
Disease-Modifying Antirheumatic Drugs	580	(1)
Pharmacology and Nursing Responsibilities for Acute Gout and Chronic Gout	581	(1)
Pharmacological Treatment of Bursitis	582	(1)
Nonpharmacological Treatment of Musculoskeletal Problems	582	(2)
Nonpharmacological Treatment of Osteoporosis	582	(1)
Assessment and Prevention of Risk Factors for Osteoporosis	582	(1)
Nonpharmacological Treatment of Osteomalacia	583	(1)
Nonpharmacological Treatment of Paget's Disease	584	(1)
Healthy People 2010 and Living With Arthritis	584	(16)
Nonpharmacological Treatment of Osteoarthritis	584	(1)
Prevention and Treatment of Osteoarthritis	585	(2)
Nonpharmacological Treatment for Rheumatoid Arthritis	587	(1)
Teaching Guidelines for Rheumatoid Arthritis	588	(1)
Nonpharmacological Treatment to Prevent Falls and Fall-Related Injuries	588	(2)
Treatment of Hip Fractures	590	(10)
The Endocrine System	600	(42)
Diabetes Mellitus	601	(10)
Complications of Diabetes Mellitus	601	(3)
Pathophysiology of DM	604	(1)
Risk Factors for Development of Diabetes Mellitus	605	(1)
Diagnostic Criteria	606	(5)
Goals of Management	611	(15)
Weight Management	612	(5)
Medications Used to Control Diabetes Mellitus	617	(6)
Effect of Acute Illness	623	(1)
Nonketotic Hyperglycemic-Hyperosmolar Coma	623	(1)
Difficulties in Caring for Older Patients With DM	624	(1)
General Health Promotion for the Older Person With Diabetes	625	(1)
Hope for the Future	626	(1)
Thyroid Disorders	626	(16)
Normal Anatomy and Physiology	626	(2)
Normal Changes of Thyroid Function With Aging	628	(1)
Thyroid Function Testing	628	(1)
Hypothyroidism	629	(4)
Hyperthyroidism	633	(2)
Nursing Diagnoses Associated With Endocrine Problems	635	(7)
The Gastrointestinal System	642	(42)
Normal Changes of Aging	643	(3)
Common Disorders in Aging	646	(29)
Esophageal Disorders	646	(1)
Dysphagia	646	(5)
Gastroesophageal Reflux Disease	651	(7)
Gastric Disorders	658	(4)
Lower Gastrointestinal Tract Disorders	662	(13)
Endoscopic Gastrointestinal Procedures	675	(1)
Nursing Diagnoses for Older Patients With Gastrointestinal Tract Problems	676	(8)
The Hematologic System	684	(27)
Normal Changes of Aging	686	(1)
Common Disorders in Aging	686	(12)
Anemia	688	(6)
Transfusions	694	(1)
Chronic Myeloproliferative Disorders	695	(1)
Hematologic Malignancies	696	(1)
Lymphomas	697	(1)
Nursing Assessment of Older Patients With Hematologic Abnormalities	698	(6)
Hypercoagulability and Anticoagulation	700	(4)
Nursing Assessment of the Older Patient With Hypercoagulability	704	(7)
The Neurologic System	711	(43)
Normal Changes of Aging	712	(1)
Dementia	713	(4)
Progressive Dementias	715	(1)
Alzheimer's Disease	715	(1)
Vascular Dementia	716	(1)
Lewy Body Disease	716	(1)
Frontotemporal Dementia	717	(1)
Alzheimer's Disease	717	(18)
Stages of Alzheimer's Disease and Implications for Nursing Care	718	(17)
Parkinson's Disease	735	(3)
Stroke	738	(6)
Seizures	744	(10)
The Immune System	754	(33)
The Immune System	755	(2)
Characteristics Unique to the Immune System	756	(1)
Types of Immunity	756	(1)
Components of the Immune Response	757	(1)
Humoral Immune Response	757	(4)
Primary and Secondary Immune Responses	759	(1)
Cell-Mediated Immune Response	760	(1)
Changes in Immunity with Aging	761	(4)
Factors Affecting Aging of the Immune System	762	(3)
Excessive Immune Responses	765	(5)
Hypersensitivity	766	(4)
Deficient Immune Responses	770	(4)
Primary Immunodeficiency Disorders	770	(3)
Secondary Immunodeficiency Disorders	773	(1)
Susceptibility to Infections	774	(13)
Pneumonia	774	(1)
Urinary Tract Infection	775	(1)
Bacteremia	775	(2)
Tuberculosis	777	(1)
Skin Infections	777	(1)
Nursing Assessment	778	(1)
Nursing Interventions to Improve Immune Status	779	(8)
Multisystem Problems: Caring for Frail Elders With Comorbidities	787	(22)
Risks of Frailty	788	(1)
The Paths to Frailty	789	(3)
Social and Psychological Environments As Contributors to Frailty	792	(1)
Common Diagnoses Associated With Frailty in the Older Adult	792	(17)
Cumulative Effect of Comorbidities	792	(1)
Pathways to Frailty	793	(2)
Trajectories of Functional Decline	795	(1)
Frailty and Emotional Health	796	(1)
Frailty, Comorbidities, and Functional Status	796	(4)
Long-Term Care	800	(1)
Making Treatment Decisions	801	(1)
Acute Illness and Hospitalization	802	(5)
Palliative Care	807	(2)
Conclusion	809	(10)
Appendix A	819	(2)
Appendix B	821	(10)
Index	831