Gerontological nursing

Description

Focusing on the content that students need to know for effective practice, this text offers engaging, evidence-based coverage of the aging process, factors contributing to healthy aging, and unique aspects of disease presentation and management in older adults. Updated to help students meet the challenges of this increasingly diverse population, the ninth edition retains its acclaimed holistic approach through insightful coverage of the psychosocial, legal, ethical, and spiritual elements of patient care.  Read more... Half Title......Page 2 Title......Page 3 Copyright......Page 4 Dedication......Page 7 Preface......Page 8 Reviewers......Page 15 Acknowledgments......Page 20 Brief Contents......Page 21 Contents......Page 23 Index of Selected Features......Page 37 UNIT 1 THE AGING EXPERIENCE......Page 41 1 The Aging Population......Page 43 Views of Older Adults Through History......Page 46 Characteristics of the Older Adult Population......Page 48 Population Growth and Increasing Life Expectancy......Page 50 Marital Status and Living Arrangements......Page 52 Income and Employment......Page 53 Health Insurance......Page 55 Health Status......Page 56 Implications of An Aging Population......Page 58 Impact of the Baby Boomers......Page 59 Provision of and Payment for Services......Page 61 2 Theories of Aging......Page 68 Biological Theories of Aging......Page 71 Stochastic Theories......Page 73 Nonstochastic Theories......Page 76 Disengagement Theory......Page 81 Activity Theory......Page 82 Continuity Theory......Page 83 Subculture Theory......Page 84 Age Stratification Theory......Page 85 Developmental Tasks......Page 86 Gerotranscendence......Page 88 Nursing Theories of Aging......Page 89 Functional Consequences Theory......Page 90 Theory of Thriving......Page 91 Theory of Successful Aging......Page 92 Applying Theories of Aging to Nursing Practice......Page 94 3 Diversity......Page 103 Increasing Diversity of The Older Adult Population......Page 105 Overview of Diverse Groups of Older Adults In The United States......Page 107 Hispanic Americans......Page 108 Black Americans......Page 110 Asian Americans......Page 113 Jewish Americans......Page 117 Native Americans......Page 120 Muslims......Page 122 Gay, Lesbian, Bisexual, and Transgender Older Adults......Page 123 Nursing Considerations for Culturally Sensitive Care of Older Adults......Page 124 4 Life Transitions and Story......Page 133 Ageism......Page 136 Changes In Family Roles and Relationships......Page 138 Parenting......Page 139 Grandparenting......Page 141 LOSS OF SPOUSE......Page 145 Retirement......Page 149 Loss of the Work Role......Page 150 Reduced Income......Page 154 Changes In Health and Functioning......Page 155 Shrinking Social World......Page 157 Awareness of Mortality......Page 160 Responding To Life Transitions......Page 161 Life Review and Life Story......Page 162 Self-Reflection......Page 166 Strengthening Inner Resources......Page 170 5 Common Aging Changes......Page 179 Cells......Page 182 Physical Appearance......Page 183 Respiratory System......Page 186 Cardiovascular System......Page 188 Gastrointestinal System......Page 191 Urinary System......Page 194 Reproductive System......Page 196 Musculoskeletal System......Page 198 Nervous System......Page 201 Sensory Organs......Page 204 Endocrine System......Page 208 Integumentary System......Page 210 Immune System......Page 211 Thermoregulation......Page 212 Changes to The Mind......Page 213 Personality......Page 214 Memory......Page 215 Intelligence......Page 216 Learning......Page 217 Attention Span......Page 218 Nursing Implications Of Age-Related Changes......Page 219 UNIT 2 FOUNDATIONS OF GERONTOLOGICAL NURSING......Page 229 6 The Specialty of Gerontological Nursing......Page 232 Development of Gerontological Nursing......Page 236 Core Elements of Gerontological Nursing Practice......Page 240 Evidence-Based Practice......Page 241 Standards......Page 242 Competencies......Page 244 Principles......Page 246 Gerontological Nursing Roles......Page 251 Healer......Page 252 Caregiver......Page 253 Educator......Page 254 Advocate......Page 256 Innovator......Page 257 Advanced Practice Nursing Roles......Page 258 Self-Care And Nurturing......Page 259 Following Positive Health Care Practices......Page 260 Strengthening and Building Connections......Page 261 Committing to a Dynamic Process......Page 265 The Future of Gerontological Nursing......Page 266 Utilize Evidence-Based Practices......Page 267 Advance Research......Page 268 Promote Integrative Care......Page 269 Educate Caregivers......Page 270 Develop New Roles......Page 271 Balance Quality Care and Health Care Costs......Page 272 7 Holistic Assessment and Care Planning......Page 280 Holistic Gerontological Care......Page 283 Holistic Assessment of Needs......Page 284 Health Promotion–Related Needs......Page 285 Health Challenges–Related Needs......Page 289 Requisites to Meet Needs......Page 290 Gerontological Nursing Processes......Page 292 Examples of Application......Page 294 Applying the Holistic Model: The Case of Mrs. D......Page 296 The Nurse As Healer......Page 304 Healing Characteristics......Page 305 8 Legal Aspects of Gerontological Nursing......Page 313 Laws Governing Gerontological Nursing Practice......Page 316 Legal Risks In Gerontological Nursing......Page 317 Malpractice......Page 319 Confidentiality......Page 322 Patient Consent......Page 323 Patient Competency......Page 326 Staff Supervision......Page 328 Medications......Page 329 Restraints......Page 330 Telephone Orders......Page 331 Do Not Resuscitate Orders......Page 332 Advance Directives and Issues Related to Death and Dying......Page 334 Elder Abuse......Page 337 Legal Safeguards For Nurses......Page 339 9 Ethical Aspects of Gerontological Nursing......Page 346 Philosophies Guiding Ethical Thinking......Page 349 External and Internal Ethical Standards......Page 351 Ethical Principles......Page 352 Cultural Considerations......Page 355 Ethical Dilemmas Facing Gerontological Nurses......Page 357 Changes Increasing Ethical Dilemmas for Nurses......Page 359 Measures to Help Nurses Make Ethical Decisions......Page 361 10 Continuum of Care in Gerontological Nursing......Page 370 Services In The Continuum of Care For Older Adults......Page 373 Supportive and Preventive Services......Page 374 Partial and Intermittent Care Services......Page 380 Complete and Continuous Care Services......Page 387 Complementary and Alternative Services......Page 389 Matching Services To Needs......Page 391 Settings and Roles For Gerontological Nurses......Page 393 UNIT 3 HEALTH PROMOTION......Page 403 11 Nutrition and Hydration......Page 405 Quantity and Quality of Caloric Needs......Page 408 Nutritional Supplements......Page 414 Special Needs of Women......Page 417 Hydration Needs of Older Adults......Page 418 Promotion of Oral Health......Page 420 Indigestion and Food Intolerance......Page 422 Anorexia......Page 423 Dysphagia......Page 424 Constipation......Page 425 Malnutrition......Page 426 Addressing Nutritional Status And Hydration In Older Adults......Page 430 12 Sleep and Rest......Page 439 Age-Related Changes in Sleep......Page 442 Circadian Sleep–Wake Cycles......Page 443 Sleep Stages......Page 444 Sleep Efficiency and Quality......Page 445 Sleep Disturbances......Page 446 Insomnia......Page 447 Nocturnal Myoclonus and Restless Legs Syndrome......Page 448 Sleep Apnea......Page 449 Medical Conditions That Affect Sleep......Page 450 Drugs That Affect Sleep......Page 451 Other Factors Affecting Sleep......Page 452 Promoting Rest and Sleep in Older Adults......Page 453 Pharmacologic Measures to Promote Sleep......Page 454 Nonpharmacologic Measures to Promote Sleep......Page 455 Pain Control......Page 460 13 Comfort and Pain Management......Page 467 Comfort......Page 469 Pain: A Complex Phenomenon......Page 470 Prevalence of Pain In Older Adults......Page 471 Types of Pain......Page 472 Pain Perception......Page 473 Effects of Unrelieved Pain......Page 474 Pain Assessment......Page 475 An Integrative Approach to Pain Management......Page 479 Complementary Therapies......Page 481 Dietary Changes......Page 484 Medication......Page 485 Comforting......Page 487 14 Safety......Page 495 Aging And Risks to Safety......Page 499 Importance Of The Environment To Health And Wellness......Page 501 Impact Of Aging On Environmental Safety And Function......Page 503 Lighting......Page 505 Temperature......Page 506 Colors......Page 509 Scents......Page 510 Floor Coverings......Page 511 Furniture......Page 512 Sensory Stimulation......Page 513 Noise Control......Page 514 Bathroom Hazards......Page 515 Fire Hazards......Page 517 Psychosocial Considerations......Page 518 The Problem Of Falls......Page 520 Risks and Prevention......Page 521 Risks Associated With Restraints......Page 525 Interventions To Reduce Intrinsic Risks To Safety......Page 528 Reducing Hydration and Nutrition Risks......Page 529 Addressing Risks Associated With Sensory Deficits......Page 530 Addressing Risks Associated With Mobility Limitations......Page 532 Monitoring Body Temperature......Page 533 Preventing Infection......Page 534 Suggesting Sensible Clothing......Page 535 Using Medications Cautiously......Page 536 Avoiding Crime......Page 537 Promoting Safe Driving......Page 538 Promoting Early Detection of Problems......Page 539 Addressing Risks Associated With Functional Impairment......Page 540 15 Spirituality......Page 548 Spiritual Needs......Page 551 Love......Page 552 Meaning and Purpose......Page 553 Hope......Page 554 Dignity......Page 555 Forgiveness......Page 556 Gratitude......Page 557 Transcendence......Page 558 Expression of Faith......Page 559 Assessing Spiritual Needs......Page 560 Addressing Spiritual Needs......Page 562 Being Available......Page 563 Honoring Beliefs and Practices......Page 564 Providing Opportunities for Solitude......Page 569 Promoting Hope......Page 570 Assisting in Discovering Meaning in Challenging Situations......Page 571 Facilitating Religious Practices......Page 572 Praying With and for......Page 573 16 Sexuality and Intimacy......Page 580 Attitudes Toward Sex And Older Adults......Page 582 Realities Of Sex In Older Adulthood......Page 585 Sexual Behavior and Roles......Page 586 Intimacy......Page 587 Age-Related Changes and Sexual Response......Page 590 Menopause As A Journey To Inner Connection......Page 592 Symptom Management and Patient Education......Page 593 Self-Acceptance......Page 597 Andropause......Page 598 Identifying Barriers To Sexual Activity......Page 599 Unavailability of a Partner......Page 604 Psychological Barriers......Page 605 Medical Conditions......Page 609 Erectile Dysfunction......Page 610 Medication Adverse Effects......Page 611 Cognitive Impairment......Page 612 Promoting Healthy Sexual Function......Page 613 17 Safe Medication Use......Page 623 Effects Of Aging On Medication Use......Page 627 Polypharmacy and Interactions......Page 630 Altered Pharmacokinetics......Page 633 Altered Pharmacodynamics......Page 636 Increased Risk of Adverse Reactions......Page 637 Avoiding Potentially Inappropriate Drugs: Beers Criteria......Page 639 Reviewing Necessity and Effectiveness of Prescribed Drugs......Page 642 Promoting Safe and Effective Administration......Page 643 Providing Patient Teaching......Page 645 Monitoring Laboratory Values......Page 648 Alternatives To Drugs......Page 649 Review Of Selected Drugs......Page 650 Analgesics......Page 651 Antacids......Page 653 Antibiotics......Page 654 Anticoagulants......Page 656 Anticonvulsants......Page 658 Antidiabetic (Hypoglycemic) Drugs......Page 660 Antihypertensive Drugs......Page 661 Nonsteroidal Anti-inflammatory Drugs......Page 663 Cholesterol-Lowering Drugs......Page 665 Cognitive Enhancing Drugs......Page 667 Digoxin......Page 668 Diuretics......Page 669 Laxatives......Page 671 Psychoactive Drugs......Page 672 UNIT 4 GERIATRIC CARE......Page 682 18 Respiration......Page 683 Effects Of Aging On Respiratory Health......Page 686 Respiratory Health Promotion......Page 688 Chronic Obstructive Pulmonary Disease......Page 692 Pneumonia......Page 700 Influenza......Page 702 Lung Cancer......Page 703 Lung Abscess......Page 704 Recognizing Symptoms......Page 705 Preventing Complications......Page 706 Ensuring Safe Oxygen Administration......Page 707 Performing Postural Drainage......Page 710 Promoting Productive Coughing......Page 712 Using Complementary Therapies......Page 714 Promoting Self-Care......Page 715 Providing Encouragement......Page 716 19 Circulation......Page 723 Effects Of Aging On Cardiovascular Health......Page 726 Cardiovascular Health Promotion......Page 728 Proper Nutrition......Page 729 Adequate Exercise......Page 732 Cigarette Smoke Avoidance......Page 733 Stress Management......Page 734 Proactive Interventions......Page 735 Cardiovascular Disease And Women......Page 738 Hypertension......Page 739 Hypotension......Page 745 Congestive Heart Failure......Page 746 Pulmonary Emboli......Page 748 Coronary Artery Disease......Page 751 Hyperlipidemia......Page 753 Arrhythmias......Page 755 Peripheral Vascular Disease......Page 757 Prevention......Page 761 Keeping the Patient Informed......Page 762 Preventing Complications......Page 763 Promoting Circulation......Page 766 Providing Foot Care......Page 768 Managing Problems Associated With Peripheral Vascular Disease......Page 769 Promoting Normality......Page 770 Integrating Complementary Therapies......Page 771 20 Digestion and Bowel Elimination......Page 781 Effects Of Aging On Gastrointestinal Health......Page 784 Gastrointestinal Health Promotion......Page 785 Dry Mouth (Xerostomia)......Page 792 Dental Problems......Page 793 Dysphagia......Page 795 Hiatal Hernia......Page 796 Esophageal Cancer......Page 798 Peptic Ulcer......Page 799 Cancer of the Stomach......Page 800 Diverticular Disease......Page 801 Colorectal Cancer......Page 802 Chronic Constipation......Page 804 Flatulence......Page 807 Intestinal Obstruction......Page 808 Fecal Impaction......Page 810 Fecal Incontinence......Page 811 Acute Appendicitis......Page 812 Cancer of the Pancreas......Page 813 Biliary Tract Disease......Page 814 21 Urinary Elimination......Page 821 Effects Of Aging On Urinary Elimination......Page 824 Urinary System Health Promotion......Page 826 Urinary Tract Infection......Page 829 Urinary Incontinence......Page 831 Bladder Cancer......Page 837 Renal Calculi......Page 838 Glomerulonephritis......Page 839 General Nursing Considerations For Urinary Conditions......Page 840 22 Reproductive System Health......Page 847 Effects Of Aging On The Reproductive System......Page 849 Reproductive System Health Promotion......Page 850 Problems of the Female Reproductive System......Page 852 Problems of the Male Reproductive System......Page 857 23 Mobility......Page 867 Effects Of Aging On Musculoskeletal Function......Page 870 Promotion of Physical Exercise in All Age Groups......Page 872 Exercise Programs Tailored for Older Adults......Page 874 The Mind–Body Connection......Page 883 Prevention of Inactivity......Page 884 Nutrition......Page 889 Selected Musculoskeletal Conditions......Page 891 Fractures......Page 892 Osteoarthritis......Page 898 Rheumatoid Arthritis......Page 902 Osteoporosis......Page 903 Gout......Page 906 Podiatric Conditions......Page 907 Managing Pain......Page 911 Preventing Injury......Page 914 Promoting Independence......Page 915 24 Neurologic Function......Page 924 Effects Of Aging On The Nervous System......Page 927 Neurologic Health Promotion......Page 928 Selected Neurologic Conditions......Page 933 Parkinson’s Disease......Page 934 Transient Ischemic Attacks......Page 937 Cerebrovascular Accidents......Page 938 Promoting Independence......Page 941 Preventing Injury......Page 945 25 Vision and Hearing......Page 953 Terms to Know......Page 955 Effects of Aging on Vision and Hearing......Page 956 Promoting Vision......Page 957 Promoting Hearing......Page 959 Assessing Problems......Page 960 Visual Deficits......Page 963 Hearing Deficits......Page 973 General Nursing Considerations for Visual and Hearing Deficits......Page 978 26 Endocrine Function......Page 986 Effects Of Aging On Endocrine Function......Page 988 Diabetes Mellitus......Page 989 Hypothyroidism......Page 1004 Hyperthyroidism......Page 1006 27 Skin Health......Page 1013 Effects Of Aging On The Skin......Page 1016 Promotion Of Skin Health......Page 1017 Pruritus......Page 1022 Keratosis......Page 1023 Seborrheic Keratosis......Page 1024 Skin Cancer......Page 1025 Vascular Lesions......Page 1028 Pressure Injury......Page 1029 Promoting Normalcy......Page 1035 Using Alternative Therapies......Page 1036 28 Cancer......Page 1043 Unique Challenges for Older Persons With Cancer......Page 1046 Explanations for Increased Incidence in Old Age......Page 1047 Risk Factors, Prevention, And Screening......Page 1048 Conventional Treatment......Page 1052 Complementary and Alternative Medicine......Page 1053 Providing Patient Education......Page 1055 Promoting Optimum Care......Page 1056 Providing Support to Patients and Families......Page 1057 29 Mental Health Disorders......Page 1067 Aging And Mental Health......Page 1070 Promoting Mental Health In Older Adults......Page 1071 Depression......Page 1074 Anxiety......Page 1083 Substance Abuse......Page 1084 Paranoia......Page 1087 Monitoring Medications......Page 1089 Promoting a Positive Self-Concept......Page 1091 Managing Behavioral Problems......Page 1092 30 Delirium and Dementia......Page 1102 Delirium......Page 1105 Dementia......Page 1110 Alzheimer’s Disease......Page 1111 Other Dementias......Page 1116 Caring for Persons With Dementia......Page 1118 31 Living in Harmony With Chronic Conditions......Page 1133 Chronic Conditions And Older Adults......Page 1136 Goals For Chronic Care......Page 1139 Assessment Of Chronic Care Needs......Page 1142 Maximizing The Benefits Of Chronic Care......Page 1145 Selecting an Appropriate Physician......Page 1146 Using a Chronic Care Coach......Page 1147 Increasing Knowledge......Page 1150 Locating a Support Group......Page 1151 Making Smart Lifestyle Choices......Page 1152 Using Complementary and Alternative Therapies......Page 1154 Factors Affecting The Course Of Chronic Care......Page 1156 Defense Mechanisms and Implications......Page 1157 Psychosocial Factors......Page 1158 Impact of Ongoing Care on the Family......Page 1159 The Need for Institutional Care......Page 1160 Chronic Care: A Nursing Challenge......Page 1161 UNIT 5 SETTINGS AND SPECIAL ISSUES IN GERIATRIC CARE......Page 1167 32 Rehabilitative and Restorative Care......Page 1168 Rehabilitative And Restorative Care......Page 1171 Living With Disability......Page 1173 Importance of Attitude and Coping Capacity......Page 1174 Losses Accompanying Disability......Page 1175 Principles Of Rehabilitative Nursing......Page 1176 Functional Assessment......Page 1178 Interventions To Facilitate And Improve Functioning......Page 1181 Facilitating Proper Positioning......Page 1182 Assisting with Range-of-Motion Exercises......Page 1183 Assisting with Mobility Aids and Assistive Technology......Page 1188 Teaching About Bowel and Bladder Training......Page 1194 Maintaining and Promoting Mental Function......Page 1195 Using Community Resources......Page 1197 33 Acute Care......Page 1206 Risks Associated With Hospitalization Of Older Adults......Page 1208 Surgical Care......Page 1211 Special Risks for Older Adults......Page 1212 Preoperative Care Considerations......Page 1214 Operative and Postoperative Care Considerations......Page 1216 Emergency Care......Page 1220 Infections......Page 1224 Discharge Planning For Older Adults......Page 1226 34 Long-Term Care......Page 1234 Development Of Long-Term Institutional Care......Page 1237 Before the 20th Century......Page 1238 During the 20th Century......Page 1240 Lessons to Be Learned From History......Page 1242 Nursing Homes Today......Page 1243 Nursing Home Standards......Page 1244 Nursing Home Residents......Page 1245 Nursing Roles and Responsibilities......Page 1251 Assisted Living Communities......Page 1255 Community-Based and Home Health Care......Page 1256 Looking Forward: A New Model Of Long-Term Care......Page 1257 35 Family Caregiving......Page 1266 The Older Adult’S Family......Page 1269 Identification of Family Members......Page 1270 Family Member Roles......Page 1271 Family Dynamics and Relationships......Page 1273 Scope Of Family Caregiving......Page 1276 Long-Distance Caregiving......Page 1278 Protecting The Health Of The Older Adult And Caregiver......Page 1280 Family Dysfunction And Abuse......Page 1284 Rewards Of Family Caregiving......Page 1286 36 End-of-Life Care......Page 1295 Definitions Of Death......Page 1298 Family Experience With The Dying Process......Page 1299 Supporting The Dying Individual......Page 1301 Stages of the Dying Process and Related Nursing Interventions......Page 1305 Rational Suicide and Assisted Suicide......Page 1309 Physical Care Challenges......Page 1310 Spiritual Care Needs......Page 1313 Signs of Imminent Death......Page 1315 Advance Directives......Page 1316 Supporting Family And Friends......Page 1317 Supporting Through the Stages of the Dying Process......Page 1318 Helping Family and Friends After a Death......Page 1320 Supporting Nursing Staff......Page 1322 Index......Page 1329