COURSE SYLLABUS VNSG 1126 (1:1:0) **********

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COURSE SYLLABUS
VNSG 1126 (1:1:0)
GERONTOLOGY
**********
VOCATIONAL NURSING
NURSING DEPARTMENT
HEALTH OCCUPATIONS DIVISION
LEVELLAND CAMPUS
SOUTH PLAINS COLLEGE
FALL 2012
Levelland
Campus
COURSE SYLLABUS
COURSE TITLE: Gerontology, VNSG 1126
INSTRUCTOR: Jennifer Ponto, R.N., B.S.N
OFFICE LOCATION AND PHONE/E-MAIL:
Room TA 204, 716-2471, [email protected]
OFFICE HOURS:
By Appointment
SOUTH PLAINS COLLEGE IMPROVES EACH STUDENT’S LIFE
I.
GENERAL COURSE INFORMATION
A. COURSE DESCRIPTION:
This course is an overview of the normal physical, psychological and cultural aspects
of the aging process. It addresses common disease processes of aging and
exploration of attitudes toward care of the older adult. Literature review and
research activity allow the student to relate common issues and needs of the older
adult. Also covered are preventative care and restorative measures for the older
adult. An emphasis is given on adaptations in the provision of nursing care to the
older individual.
B. STUDENT LEARNING OUTCOMES:
(DECS)
1. Discuss systems changes during the aging process.
2. Discuss life style changes during the aging process.
3. Discuss common issues and needs of the older adult. .
4. Discuss the emotional and physical needs of the older adult.
5. Describe disease processes common in the older adult.
6. Describe the effect of medications on the older adult.
WECM:
1. Describe the normal aspects of aging
2. Discuss common disease processes associated with aging
3. Identify common attitudes related to care of the aging
1
Specific Goals/Objective of this course
1. Relate the unique physical, social, psychological needs of the older adult.
2. Identify expected growth and developmental characteristics of the older adult.
3. Relate possible solutions to common problems faced by the older adult, based
on literature review and independent work activities.
4. Relate necessary adaptation in the provision of nursing care to the older adult
with patient safety emphasized.
5. Relate appropriate preventive & restorative measure commonly adapted to the
needs of the older adult.
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VNSG 1126
C. COURSE COMPETENCIES:
Grading Scale:
A
(100-93)
B
( 92-83)
C
( 82-77)
Below 77 is failing
D. ACADEMIC INTEGRITY:
Please refer to SPC Catalog and Vocational Nursing Student Handbook.
E. SCANS AND FOUNDATION SKILLS:
C1, 2, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 19
F1, 2, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17
F. VERIFICATION OF WORKPLACE COMPETENCIES:
No external learning experiences provided. Successful completion of the NEAC
Competency statements at the level specified by the course (Level Objectives) will
allow the student to continue to advance within the program. Upon successful
completion of the program, students will be eligible to take the state board exam
(NCLEX) for vocational nurse licensure.
II.
SPECIFIC COURSE/INSTRUCTOR REQUIREMENTS
A. REQUIRED TEXTBOOKS:
White L. et. al. Medical-Surgical Nursing. An Integrated Approach. 3rd Edition.
Delmar. 2013.
B. ATTENDANCE POLICY:
(16 Clock Hours) See SPC catalogue and Vocational Nursing Student Handbook.
Students are expected to attend all classes arrive on time and to remain for the
entire class period. Attendance will be taken at the beginning of class; students not
present will be marked absent in the attendance record. Students who miss more
than two (2) hours will be removed from the course. Three (3) tardies count as one
(1) hours' absence.
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VNSG 1126
C. ASSIGNMENT POLICY:
All class assignments are to be turned in by 8:00 a.m. on the due date announced or
the paper will be considered late. Ten (10) points will be deducted from the paper
for each day turned in late. Failure to complete assignments will result in a grade of
INCOMPLETE. Please refer to the Student Handbook for vocational nursing
D. GRADING POLICY/METHODS OF EVALUATION:
Methods of evaluation:
Unit Exams
60%
Self Awareness
5%
Research Paper
25%
Safety Assessment
10%
E. SPECIAL REQUIREMENTS:
There will be an exam after the completion of each assigned unit. Exams will be
made up at the discretion of the instructor. If an exam is missed, an essay exam may
be given at the discretion of the instructor.
Students are expected to read the assigned chapters prior to lecture time.
III.
COURSE OUTLINE
A.
B.
C.
D.
E.
F.
G.
H.
IV.
Geriatrics -- Self Awareness Study
Self Awareness Survey
Geriatrics Written Assignment
Bibliography For Written Assignment
Research Paper -- Grading Criteria
Geriatrics -- Suggested Topics For Research Paper
Topics and Reading Assignments
Elderly Abuse Outline
ACCOMMODATIONS
Students with disabilities, including but not limited to physical, psychiatric, or learning
disabilities, who wish to request accommodations in this class should notify the Special
Services Office. In accordance with federal law, a student requesting accommodations
must provide acceptable documentation of his/her disability to the Special Services
Coordinator. For more information, call or visit the Special Services Office in the
Student Services Building, 894-9611 ext. 2529, 2530.
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VNSG 1126
Diversity: In this class, the teacher will establish and support an environment that
values and nurtures individual and group differences and encourages engagement and
interaction. Understanding and respecting multiple experiences and perspectives will
serve to challenge and stimulate all of us to learn about others, about the larger world
and about ourselves. By promoting diversity and intellectual exchange, we will not only
mirror society as it is, but also model society as it should and can be.
5
Geriatrics
Self Awareness Study
Answer the following questions truthfully. This will help you understand your own feelings
toward the elderly. This will be graded according to completeness and details given. Example:
100% detailed + complete = 100%.
1.
How old is old?
2.
What do you value most?
3.
What do you feel an elderly person would value most?
4.
How do you feel when you are with older adults?
5.
What has been your experience with older adults?
6.
How have these experiences influenced your relationship with other older people?
7.
How do you feel when an older person is very demanding of your time and attention?
8.
How do you feel about older adults having sexual relationships?
9.
How do you feel about communicating with an elderly person who has a language
deficit?
6
Self Awareness Survey
10.
What is your reaction when an elderly person does not act as quickly as you wish?
11.
Name three older adults whom you feel have had the greatest impact on your life. Then
list five traits that you have associated with each person.
INITIALS __
1.
2.
3.
4.
5.
INITIALS
INITIALS
12.
Identify your feelings as you think of each person.
13.
Look at the list of characteristics. Could these characteristics have affected how you feel
about older adults? In what way?
14.
Do you have similar characteristics?
15.
How do you think you will feel about going into the nursing home for clinicals?
7
GERIATRICS WRITTEN ASSIGNMENT
Problems and Issues of the Elderly
Using the grading criteria and the selected topics, write a paper about a problem or issue
affecting the elderly.
Utilize 3 different references, besides your textbooks or dictionary. The sources must have
been published within the past 5 years if the source is a periodical or within the past 10 years if
the source is a book. REFERENCES SELECTED MUST BE PROFESSIONAL, HEALTH CARE RELATED
PUBLICATIONS.
The student must include a photocopy of the first page of each article utilized or the cover page
if a book is used with the rough draft.
Website resources are not acceptable. If journal article are retrieved online, a copy of the first
page of the article must be included with the rough draft.
A bibliography sheet must be attached to the paper. Each article or book used in the paper
must be referenced on the bibliography sheet. The easiest way is to number each source on
the bibliography page and use that number whenever the information from that source is used
in your paper. The items on the bibliography sheet must be alphabetized and numbered. Each
reference used on the bibliography sheet must be used in your paper.
Use any standard college format for the bibliography page and the paper. The paper must be
typed or 5 points will be deducted. The paper should be 2 to 4 typed, double-spaced, 1 sided
pages in length, not including the cover sheet and bibliography page and font size should be 1112.
The topics selected for the paper are suggested in the syllabus or you may choose one of your
own with approval from the instructor.
A bibliography page and the topic selected will be due 4 weeks before the paper is due. 5
points will be deducted from the final paper for each late day.
A rough draft and copy of the 1st page of each reference is required to be turned in 2 weeks
before the final paper is due. 5 points will be deducted from the final paper for each late day.
THE FINAL PAPER IS DUE AT 08:00 ON THE DAY ASSIGNED. 10 POINTS PER DAY WILL BE
DEDUCTED FOR EACH LATE DAY.
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This is an example of one easy way to use a bibliography page and references in your paper.
Pets And The Elderly
In 2005, a survey revealed that 20% of adult females over the age of 60 lived alone. (3) This has
tremendous implications for planning the care of these patients since no one may be available
to take care of these patients.
Older adults who live alone may have difficulty meeting their need to socialize. Some older
adults have difficulty making new friends because they are afraid to initiate conversations. One
way to encourage older adults to talk with others is to have them talk about their own pets. (1)
Having a pet in the home of an older adult may have physical benefits also. Older adults who
have a pet have 33% fewer visits to the doctor and fewer stress-related illnesses. (2) Nurses
could incorporate this information when advising patients considering getting a pet.
Pet ownership does involve some costs, however. Some types of pets such as fish or cats may
require less hands on care. (1) The elderly may prefer a smaller type of dog or cat. The Sheltie
type of dog seems to be a favorite of the elderly due to its small size, intelligence and patience.
(3) Some elderly patients elect not to own a pet because of veterinary bills, food and other
costs. (2)
(On a separate Bibliography Page)
Use alphabetical order by the author’s name
See example #1 for a book and #2 and #3 for magazine articles.
Use any standard college level guide for writing research papers.
YOU MUST USE ALL THE REFERENCES LISTED ON THE BIBLIOGRAPHY PAGE SOMEWHERE IN
YOUR PAPER. ALL WORK WHICH IS SOMEONE ELSE’S IDEA MUST BE LISTED AS SUCH.
(Top of the Bibliography Page)
(1)
(2)
(3)
Nightingale, F. (2009). The Benefits of Pets for the Elderly. New York: Medical
Publishing pp. 127,145,234,248.
Ponto, J (2011) The Social Benefits of Pet Visitation in the Nursing Home. U.S. Journal of
Nursing, Issue 38, P 543-545.
Wise, B and Smart, B (2010, December) Do the Elderly Need Pets? Geriatric Nursing
Today. p 70-76
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RESEARCH PAPER
GRADING CRITERIA
Possible points:
Definition and discussion of the problem or issue in detail
2-3 paragraphs
How does the problem affect the elderly individual in these
categories: physically, emotionally, socially, financially, spiritually
MUST USE 2 OF THESE CATEGORIES
1 paragraph for each category
List possible solutions to the problem or issue
(Use solutions proposed by the authors or describe your
suggestions for solutions)
2-3 paragraphs
35
35
15
Spelling, punctuation, and neatness
10
Bibliography
5
10
GERIATRICS -- SUGGESTED TOPICS FOR RESEARCH PAPER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Poverty and the older adult
Depression and the older adult
Malnutrition and the older adult
Sexuality and the older adult
Abuse and the older adult – Be specific such as financial, emotional abuse or abuse
by family members etc. May not utilize the topic of
physical abuse.
Death and dying and the older adult
Exercise and the older adult
Substance abuse and the older adult (specify alcohol abuse or drug abuse)
Pet therapy and the older adult
Crimes against the older adult (may be hard to find research)
Medication errors and the older adult
Grandparents as parents (may be hard to find research)
Do not include topics of medical diseases such as Parkinson's Disease, Alzheimer's, Diabetes,
et cetera.
11
Reading Assignments and Textbook
Medical-Surgical Nursing 3rd Edition by Lois White, Delmar Publishing
See Syllabus for lecture outline.
Unit A
Introduction
Why Study Geriatrics?1315-6
Theories
1316
Mythes and realities
1316-8
Health and Aging
1318-21
Health Promotion,
Disease prevention
Medications
1321-1323
Unit B Psychososcial and Financial Concerns
Growth and Development
Strengths
Elder Abuse
Legal Issues
Depression
Finances
Alternate Settings
lecture
1321, 1324
syllabus
lecture
1331, 32
1340-42
lecture
Unit C Physiological Changes
Integumentary system
1337-1340
Decubitus ulcers
1087-89
Herpes Zoster
1074-76
Skin Cancer
1072-73
Gastrointestinal
1326-27
Nutrition
1326-27
Constipation
1327
Dehydration
1327
Dental
1327
Urinary
1327-29
Incontinence
1328
UTI
1329
Musculoskeletal
1329-30
Osteoporosis
1329
Degenerative Arthritis1329-30
Hip Fracture
1330, 966-67
Endocrinology
Hypothyroidism
609
Diabetes
625, 626, 633, 635 (diet), 636-39 (complications), 1336
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Unit D Physiological Changes
Respiratory
1322-25
Pneumonia
1322
TB
656
COPD
1323-241325
Cardiovascular
1325-26
PVD
1325
Hypertension
1326
CHF
1326
Angina MI
434-35, 441-45
Neurological
1330-32
Alzheimer’s
1331, 1334-36
Parkinson’s Disease 811-813
Stroke
843-49
Vision
1332
Hearing
1333
Reproductive
1336-37
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Elderly Abuse
The following information is from the Texas Department of Protective and Regulatory Services-Adult Protective Services
Abuse: "Willful infliction of injury, unreasonable confinement, or cruel punishment... "
Physical:
scratches, cuts, bruises, burns, broken bones, decubitus ulcers,
refusal to take to Dr., welts etc. Sexual abuse—forcing acts upon patient
Emotional:
threats, yelling at patient, ridiculing pt etc
Financial:
Taking social security checks for self, abusing joint checking account,
taking property and other resources, Food Stamp theft
Neglect: "The failure to provide…goods or services which are necessary to avoid physical
harm, mental anguish, or mental illness…
Physical:
Malnourishment, dehydration, over/under medication, lack of heat,
running water, electricity, unsanitary living conditions, lack of hygiene,
clothing, lack of medical care
Emotional:
Ignoring patient's need for interaction, leaving patient alone for long
periods of time
Financial:
Ignoring patient's needs, passively allowing funds to be used
inappropriately
Party responsible: Usually family member or "friend", somebody known to patient, less likely,
health care workers, nursing home employees, least likely, strangers
"Causes"
aging population, elderly adults caring for very elderly relatives
alcohol and drug dependence
unemployment
lack of alternative -nursing home costs, availability decreasing, waiting lists
exhaustion and inability to cope, physical and emotional stress
anger, inability to control anger and frustration
"payback" from childhood abuse
violence as a coping mechanisms
Statistics:
Nearly 40,000 cases reported in 1993, reports and incidence increasing, with
small percentage of reported cases being "invalid" reports
Nursing Responsibilities
Assessment Skills—Physical Abuse/Neglect Suspect Abuse when actual injury doesn't
correlate with history—example wheelchair bound patient "fell out of bed" or ran into
the door.
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Patient/Victim response—may deny abuse or "cover" for abuser
If abuse suspected—nurse MUST report to Adult Protective Services. Investigation will occur
according to priority—Pt at high risk of serious injury vs. financial neglect etc. Nurses are
"Mandatory Reporters" State that you are mandatory reporter when you contact APS.
Good Faith Reporting
Licensed nurses MUST report suspected cases of abuse to APS. Good Faith means that
nurse has made report without malice or intent to harass but has professional opinion
that abuse or neglect has occurred. (Trust your instinct). If report is later found to be
not abuse, nurse unlikely to be prosecuted or sued as long as report was made in good
faith, based on nurse's professional opinion.
Nursing License Concerns
Licensed Nurses—RN's and LVN's can have sanctions taken against their license if nurse
does NOT report cases of abuse against the elderly (and children).
Prevention:
Educating family members and other health care workers ways to reduce stress,
workload. Example-lifting techniques etc.
Provide respite care. Sometimes family unable to ask for help.
Frequent assessments, early detection and referrals.
Counseling for anger, drug and alcohol use
Referral to Social Services for financial assistance, placement of patient
15
Outline Geriatrics Unit D
PARKINSON'S DISEASE
Signs & Symptoms
Tremors—usually in hands "pill rolling"
muscle rigidity
blank facial expression, diff. speech, drooling
stooped posture, shuffling gait
Complications
very ↑risk falls, injury, aspiration > pneumonia,
complications of immobility, DVT, contractures, decubitus
constipation, urinary retention, malnutrition
Nursing Interventions see care plan
Meds control symptoms only, freq. AR's, numerous dose adjustments
meds freq. difficult to swallow
Nutrition puree diet, c aspiration precautions, suction equip nearby
special diet, ↑fluids and fiber, may need tube feeding in later stage
Immobility
↑Risk injury
Elimination and Hygiene
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DIABETES
Type I : AKA Insulin Dependent Diabetes Mellitus, IDDM, Juvenile onset, brittle diabetes
total failure of pancreas --- requires insulin to treat
Type II: AKA Non Insulin Dependent Diabetes Mellitus, NIDDM, Adult Onset
partial failure of pancreas - can be treated with PO meds which stimulate pancreas to
release insulin, or help the body utilize insulin better . Most common c elderly.
Sometimes treated with diet, wt. loss and exercise. MAY NEED TO TAKE INSULIN
DURING TIMES OF STRESS, SURGERY
BOTH TYPES HAVE SEVERE, SYSTEMIC COMPLICATIONS
Signs and symptoms: Usually more pronounced in IDDM c sudden onset
polyuria—urination of large amounts
polydipsia—intake of large amounts of water
polyphagia—intake of large amounts of food, hunger
NIDDM:
fatigue, freq. infections, poor peripheral circulation, visual changes, gradual onset
Nursing Interventions
Diet: exchange system. Pt needs proper balance of fats, carbs and protein, needs to eat certain
amounts of food groups. If pt doesn't want particular food, must exchange within that group
example: cereal, bread, roll, pasta, rice
Consider pt likes, dislikes, culture, finances, lifestyle etc.
Requires extensive teaching, common for pt to go off diet
Carb counting: patient counts carb grams and calculates insulin dosage from that.
Trying to keep fast acting carbs at minimum.
Meds: Insulin injections at least twice daily, occasionally, more frequently based on BS results
PO meds-for Type II
BOTH REQUIRE EXTENSIVE TEACHING
Exercise and Activity Encourage to extent possible see.
Prevention of Complications
17
Hyperglycemia High Blood Sugar
Hypoglycemia Lo Blood Sugar
S&S
S&S Cool, clammy skin
shakiness, headache
mental confusion →coma
Hot dry skin
polyuria, polydipsia, polyphasia
dehydration, coma
abnormal metabolism of fats and Proteins
Diabetic Ketoacidosis (DKA)
medical emergency—S&S fruity breath
Kussmaul's respirations, deep, loud, fast
HYPERGLYCEMIA:
Causes Not taking insulin
Eating too much
Stress, Infection, Trauma, Surgery
HYPOGLYCEMIA:
Causes Too much insulin
Not eating enough
Too much exercise
Interventions
Insulin (sometimes IV)
Treat dehydration
Treat acidosis
Interventions
Orange Juice c sugar
IF pt alert, taking PO
Carb and Pro snack—
PB & J sandwich
IF not alert, contact MD
may need IV
glucose
Chronic Complications with both types:
Poor circulation, gangrene
Peripheral neuropathy
foot ulcers, infection,
infections—even with normal flora
chronic renal failure
retinopathy
MI, CVA
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ALZHEIMER'S DISEASE
S&S see stages
Interventions
Safety—Do assessment first, pt changes day to day
uncluttered environment, water temperature
wandering—ID bracelet, alarms, photo of pt.
meds and poisons, sharps
driving and keys
activity and gait—shoes, gates over stairs etc
Self Care Deficit
one step instructions
own self care to extent possible
2 choices
don't hurry pt
check elimination status
Agitation/Confusion
Routine, consistent environment
quiet, non-confrontive approach, don't argue, lie to or agitate pt
consider need to eat, eliminate etc.
hiding objects, stealing accusations very common, may hide own money, dentures etc
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) EMPHYSEMA
S&S
dyspnea, eventually dyspnea at rest
sputum production
barrel chest, use of accessory muscles
retention of C02
Interventions—No cure, stop smoking, bronchodilators, ABX
Activity
freq. dyspneic—alternate activity c rest
Oxygen usage—Normal resp drive is hi C02 level, pts with COPD always have hi C02 level— their
resp. drive is low O2. If pt c COPD is given excessive 02, resp drive will be diminished. c pts c
COPD, need specific MD order to ↑ 02. If 02 ↑ per MD order, monitor pt carefully for resp
suppression
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FRACTURED HIP
S&S -- Sometimes even c “minor” fall
external rotation, adduction, shortening of leg, pain, inability to move leg
Intervention—surgical repair
post op care—careful pt positioning to prevent joint dislocation
abductor pillow, turn to un-operative side only, follow MD orders for allowed activity
Prevent immobility complications, infections, deep vein thrombosis
Pain management, frequently difficult to manage c elderly
CONGESTIVE HEART FAILURE (CHF)
S&S
dyspnea, esp. on exertion, fatigue
distended neck veins, enlarged liver, crackles—lung sounds
edema, usually pedal, sacral if on bed rest, if severe, general edema
Causes:
muscle damage from MI, heart valve problems, excess fluid, hypertension, lung disease
Interventions:
02 and Airway ** * Priority
Digoxin—decreases heart rate, ↑ heart’s muscle tone, freq. causes toxicity, "even at normal
doses" usually S&S of dig toxicity are vague (nausea, vomiting, anorexia, slow heart rate)---check apical pulse x 1 minute prior to giving medication. If P < 60/min, assess for dig. toxicity,
hold med. and contact MD
Diuretics—Lasix, causes fluid to be eliminated. May lower potassium (Pt usually given
supplement)
Diet—Low salt, no table salt, avoid salty items, canned or processed food, pickles, chips etc
Activity—alternate activity c rest, bathe when most rested
Complication—Pulmonary Edema—Fluid backs up into lungs
S&S Pink frothy sputum, extreme hypoxia and dyspnea,
Intervention: M orphine
A irway ***
D igoxin
D iuretics
O xygen ***
G o Get Dr!!
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HYPERTENSION
Risk Factors: Smoking, ↑fat and/or salt diet, diabetes, stressful lifestyle
Interventions:
Meds: frequent med changes, dose adjustments with freq. AR's
Diet: Low sodium, fat c instructions and encouragement
Follow-up care: Freq. BP checks, Lifetime Therapy
Complications: MI, stroke, renal failure etc.
ANGINA/MI
S&S: Chest pain, dyspnea, pallor, weakness, diaphoretic, feeling of impending doom, N&V, can
be confused c "gas" or indigestion. Pain can be in jaws, shoulders, arms, back etc.
Causes: Narrowed blood vessels on heart cause decrease in blood supply
See risk factors. Fatty plaque builds up, clot forms. Area of heart supplied by vessel can be
damaged → heart muscle death (MI)
Interventions: Assume pain is MI until proven otherwise. Have pt rest, give SL, Nitro
sublingual x 3-4 q 5 mint over 15 - 20 minutes. If not relieved completely contact MD, get EKG
Take VS, contact MD if BP< 90 syst. before giving Nitro, stay with pt, watch for irregular beats,
be prepared to start BLS, call for ACLS
Meds—Nitrates- dilates coronary blood vessels
BP meds- dilates coronary blood vessels, diminishes workload of heart
anticoagulants, aspirin, etc- prevents and/or treats clots
Other treatments: "clot busters", Angioplasty (Balloon), bypass surgery
Diet: low fat, low salt c instructions
Activity: Bedrest while acute, gradually ↑per MD order, sexual activity—usually OK when pt
able to walk 2 flights of stairs s problems
Long-term care: Meds as listed above. Teach warning signs of Ml, don't overexert, diet, risk
factor reduction, cardiac rehab (supervised)
21
CARDIOVASCULAR ACCIDENT (CVA) AKA STROKE, BRAIN ATTACK
Types:
TIA Transient ischemic attack "mini stroke" "warning stroke"
temporary deficit in neuro status R/T temp loss of blood supply
S&S sudden onset of motor or sensory dysfunction ie blindness, speech diff,
paralysis of 1 side of body, usually resolves in 24 hours
Interventions—carefully monitoring, neuro checks, make sure symptoms ARE
resolving, anticoagulants, teaching RE S&S of stroke
Hemorrhagic aneurysm or intracerebral bleed
S&S very sudden s warning—paralysis, sensory and motor dysfunction
Interventions—may require surgery, DON'T give anticoagulants
Embolic traveling clot. Frequently from Atrial fibrillation or DVT, previous surgery etc.
S&S very sudden, s warning
Interventions, see below
Ischemic—most common in elderly
Risk Factors smoking ↑BP, renal problems, diabetes, ↑fat, salt diet etc.
S&S sometimes have warning c TIA's
Hemiparesis—paralysis of 1 side of body
L sided weakness (caused by problems with right side of brain). Pt has:
Spatial/depth perception
poor judgment, impulsive, easily distracted
neglect L side, don't shave or wash L side—may not face left side or ignore objects on L
side of meal tray etc.
R sided weakness (caused by problems with left side of brain) Pt has:
difficulties with speech
slow, cautious movements
depression and emotional changes
Interventions:
Airway problems *** Priority*** Stroke may cause decreased LOC, may need intubation, 02,
suction etc.
Vital Signs—BP and VS freq. unstable, usually admitted to ICU 1st
22
aphasia—can't communicate, needs speech therapy, communication board c pictures, try to
communicate needs, use gestures, yes and no questions, encouragement and patience
dysphagia—impaired swallowing-- very ↑risk aspiration. *** check gag reflex before
feeding*** Use puree, thickened liquids, not liquids or solids at first, feed on unaffected side of
mouth. Occasionally severe and req. feeding tube.
Inactivity/Immobility prevent complication PT consultation when stable, turn q 2 hours, skin
care, DVT prevention etc ROM as prescribed
Emotional lability—may laugh or cry inappropriately, be supportive, teach pt/family
Meds: thrombolytic "clot buster" meds can be given c in 3 hours of onset of symptoms but
need early CT scan and diagnoses—only given if ischemic
BP meds, anticoagulants, anticonvulsants, steroids to reduce inflammation
Safety needs—may not recognize unsafe situations or be able to correct on own
Elimination—common to have incontinence. Physical immobility may also contribute
Nutrition see dysphagia—pts freq. need assist, encourage independence when possible
Long-term care, Family support, Support Groups, Education, Risk Factor Reduction and how to
prevent long-term complications
23
Safety Assessment: Due date to be announced
Make comments on the safety of a patient’s environment. The “patient” is 83 years old, and is
recuperating from a hip fracture. She uses a walker and is visually impaired. You may utilize
your own home or the home of a family member. Observe the environment critically, as if you
were the home health nurse making a home visit.
Grading: 70% on DETAILS!!!! 30% on critical thinking
Outside home
Roof (leaks, missing shingles, fire hazard etc)
______________________________________________________________________________
______________________________________________________________________________
Sidewalk in front of house (dirt or pavement?, cracks, uneven, obstructions etc)
Porch, stairs, steps/driveway to home (see sidewalk info.)
Windows (cracks, missing windows, unable to open/shut etc. means of escaping house?)
Doors (security? lock functioning?, doorbell audible?, close/open completely? Etc)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Yard/fence (fence/gate functioning? Level/unlevel? Weeds/yard condition?, hazards,
obstructions? Etc.)
______________________________________________________________________________
______________________________________________________________________________
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Other observations on outside house?
______________________________________________________________________________
______________________________________________________________________________
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Inside home
Floors: (safety: waxed, slippery, clutter, cords, missing tiles etc) Need LOTS of details here.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Carpet/Rugs: (holes, worn spots, stains, use of throw rugs, etc) Need LOTS of details here.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Inside Steps/Stairs/uneven areas, basements, sunken or raised areas of home?
______________________________________________________________________________
______________________________________________________________________________
Bathroom(s) Describe ALL possible hazards
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Bedroom (s) Describe ALL possible hazards
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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______________________________________________________________________________
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Kitchen (Stove, pots, pans, chemicals, step stools, availability of fire extinguisher?) Describe
ALL possible hazards
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Electrical Hazards: Describe all potential hazards noted (frayed cords, wires, sparks, etc.)
Medication Hazards: Describe all potential hazards noted (won’t go into drug interactions or
adverse effects). Focus on medication storage and ability to access medications.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Discuss availability of: Telephone service ___________________ Lighting ______________
Hot and cold running water ________________ Heating and Air conditioning ____________
Family member or close friend nearby ____________
If home has pet (s), what is patient’s ability to care for pet while using walker, visually
impaired?
______________________________________________________________________________
______________________________________________________________________________
Comments and suggestions for improvement: Must describe 5, in priority order. Use details.
1.
2.
3.
4.
5.
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