NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
Associate Degree Registered Nurse Program
One College Drive, Bentonville, AR 72712
Office (479) 619-4151
Fax (479) 619-4332
Website www.nwacc.edu/nursing
Email nursing@nwacc.edu
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NURS 9203
NURSING CARE OF THE OLDER ADULT
SYLLABUS
FALL 2006
September 2006
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
TABLE OF CONTENTS
CREDIT HOURS ------------------------------------------------------------------------------------------------------------------------- 3
CLASSROOM HOURS ----------------------------------------------------------------------------------------------------------------- 3
PLACEMENT
------------------------------------------------------------------------------------------------------------------------- 3
FACULTY AND CLINICAL AGENCY --------------------------------------------------------------------------------------------- 3
PREREQUISITES ------------------------------------------------------------------------------------------------------------------------ 3
COREQUISITES--------------- ---------------------------------------------------------------------------------------------------------- 3
COURSE DESCRIPTION -------------------------------------------------------------------------------------------------------------- 3
TEXTBOOKS
------------------------------------------------------------------------------------------------------------------------- 3
COURSE OBJECTIVES ---------------------------------------------------------------------------------------------------------- 4
COURSE CONTENT UNITS ---------------------------------------------------------------------------------------------------------- 7
UNIT I
UNDERSTANDING THE AGING POPULATION --------------------------------------------------------- 7
UNIT II
HIERARCHY OF NEEDS OF THE OLDER ADULT – WELLNESS PROMOTION---------------- 8
UNIT III
PHYSIOLOGICAL AGING CHANGES ---------------------------------------------------------------------- 9
UNIT IV
PSYCHOLOGICAL AGING CHANGES --------------------------------------------------------------------- 12
UNIT V
GERIATRIC REHABILITATION ----------------------------------------------------------------------------------------------- 13
UNIT VI
SAFE DRUG USE IN THE OLDER ADULT ---------------------------------------------------------------- 14
UNIT VII LEGAL/ETHICAL CONSIDERATIONS IN NURSING CARE OF THE OLDER ADULT -------- 15
UNIT VIII END OF LIFE CYCLE -------------------------------------------------------------------------------------------- 16
UNIT IX
COMMUNITY RESOURCES FOR THE OLDER ADULT ---------------------------------------------------------------- 17
TEACHING METHODS ----------------------------------------------------------------------------------------------------------- 4
EVALUATION METHODS
1. CLASSROOM
2. THEORY GRADING SCALE ---------------------------------------------------------------------------------------------- 5
STUDENTS WITH A DISABILITY-------------------------------------------------------------------------------------------------- 5
INCLEMENT WEATHER OR EMERGENCY POLICY ------------------------------------------------------------------------- 5
CLASSROOM ATTENDANCE POLICY ------------------------------------------------------------------------------------------- 6
APPENDIX
CLASS REQUIREMENTS / ASSIGNMENT DETAILS-------------------------------------------------------------------19
PRINCIPLES OF GERONTOLOGICAL NURSING PRACTICE -------------------------------------------------------- 22
DETERMINE YOUR NUTRITIONAL HEALTH CHART ---------------------------------------------------------------- 23
D.E.T.E.R.M.I.N.E. CHART ------------------------------------------------------------------------------------------------------ 24
PHYSICAL INDICATORS OF ADULT ABUSE, NEGLECT AND EXPLOITATION ------------------------------ 25
ENVIRONMENTAL INDICATORS OF ADULT ABUSE, NEGLECT, AND EXPLOITATION ------------------ 27
BEHAVIORAL INDICATORS OF ADULT ABUSE, NEGLECT AND EXPLOITATION ------------------------- 29
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
CREDIT HOURS:
3 credit hours
CLASSROOM HOURS:
48 hours
PLACEMENT:
Second semester
Fall 2006
FACULTY
Kisha M. Farrell, RN BSN
Email kfarrell@nwacc.edu
Course Coordinator
Office: 619-4213
CLINICAL AGENCIES
Circle of Life Hospice
St Mary’s Hospice
Village House Bella Vista—Adult Day Care Center
Friend’s House Rogers – Adult Day Care
PREREQUISITES: NURS 9108 Fundamentals of Nursing
*All nursing general education prerequisites and
corequisites must be completed with a “C” or better
prior to entering Access Nursing.
COREQUISITES:
NURS 9206 Care of Adults I
COURSE DESCRIPTION
The content of this course focuses on the unique characteristics of older adults and their
biopsychosocial needs and developmental tasks. The student is provided with knowledge to
aid understanding of the aging population. The normal aging process and health promotion in
the older adult, as well as the theories of aging and other geriatric care issues are addressed.
The nursing process is utilized to meet the older client’s needs.
REQUIRED TEXT: Eliopoulos, C; Gerontological Nursing. 6th edition. 2005 LWW
SUPPLEMENTAL READINGS: Assigned supplemental readings are available to copy in the
NWACC library. You may request instructor reserve notebook at the library circulation desk.
The notebook may be read / copied in the library, but cannot be checked out for use.
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
ADDITIONAL JOURNAL ARTICLES: Additional articles may be referenced during class time.
Most of these articles can be found at www.nursingcenter.com/AJNolderadults
COURSE OBJECTIVES
Following completion of this course the student
As a direct care provider will:
1.
2.
3.
4.
5.
6.
7.
Verbalize an increased awareness of the qualities, rights and unique features of older
adults and their needs.
Analyze own attitudes towards aging and the older adult.
Identify biopsychosocial stressors associated with the aging population and utilize the
nursing process to provide care for older adults based on biopsychosocial needs and
developmental tasks.
Discuss ways in which the older adult can maintain or enhance his/her position on the
health-illness continuum or meet death with dignity by utilizing appropriate promotion,
restoration and maintenance nursing behaviors.
Describe ways to communicate with the older adult enumerating specific measures to
overcome sensory deficits.
Discuss ways in which the principles of teaching - learning can be adapted to minimize
potential problems and maximize strengths and talents of the older adult when providing
health care teaching.
Describe the legal/ethical issues related to care of the older adult.
As a manager of client care will:
8.
Identify community resources that are available to assist the older adult.
As a member within the profession of nursing will:
9.
Evaluate own learning needs and seek out opportunities to meet these needs.
COURSE CONTENT UNITS
UNIT I
UNIT II
UNIT III
UNIT IV
UNIT V
UNIT V
UNIT VII
UNIT VIII
UNIT IX
Understanding the Aging Population
Hierarchy of Needs of the Older Adult - Wellness Promotion
Physiological Aging Changes
Psychosocial Aging Changes
Geriatric Rehabilitation
Safe Drug Use in the Older Adult
Legal/Ethical Considerations in Nursing Care of the Older Adult
End of Life Issues
Community Resources for the Older Adult
TEACHING METHODS
This course will include the following methods/approaches to teaching:
1.
2.
Lecture/Guest Speakers
Class Discussion
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
3.
4.
Fall 2006
Audio-Visuals
Case Studies
EVALUATION METHODS
1.
Classroom (theory) grade is calculated as follows:
a)
Unit Exams (2)
b)
Final Exam
c)
Quizzes/Class requirements
d)
Case Studies
* IMPORTANT:
2.
40 %
25 %
15 %
20 %
100 %
The student must make an average of 78% on unit exams and
final exam BEFORE other projects will be averaged into theory
grade.
Theory Grading Scale
A = 92 – 100
B = 86 – 91
C = 78 – 85
D = 71 – 77
F = 70 & below
Numerical grades will be carried to the hundredth place until computation of the final
grade, at which point the fractional parts will be dropped. Grades will not be rounded
up, i.e., 77.8 becomes 77.
STUDENTS WITH A DISABILITY
If you are a student with a disability, and if you will be requesting accommodations, it is your
responsibility to contact the director of the Office for Students with Disabilities at the Life
Development Center in Burns Hall, 619-4230. After you have submitted the appropriate
documentation, the director of the office will recommend appropriate accommodations to your
instructor. You must bring these accommodations to your instructor at the beginning of the
semester.
INCLEMENT WEATHER OR EMERGENCY POLICY
Announcements of decisions to close and/or open will normally be announced at
approximately 6:00 a.m. for day activities and 3:00 p.m. for evening activities through the local
media and on the College Hotline, 479-619-4377. Due to air time and broadcast area, KURM
790 AM in Rogers will be used, and other appropriate media will be utilized once they are on
the air.
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
CLASSROOM ATTENDANCE POLICY
It is the belief of the Nursing Faculty that classroom attendance is important to academic
achievement and professional development. Due to the nature of Nursing, which is a practice
discipline, safe performance dictates that learning in class be transferred to clinical decision
making. Any absence can leave the student subject to information gaps that jeopardize client
safety and care.
The Nursing Program follows the NWACC class attendance policy. See the current College
Catalog. When absent, students are responsible for classroom announcements, information
and content. Any quizzes given during an absence will not be made up, and lecture content
missed will not be repeated. To gain credit for any designated take-home work, the student
must be present on both the distribution date and the due date.
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Fall 2006
UNIT I
UNDERSTANDING THE AGING POPULATION
COURSE CONTENT
STUDENT OBJECTIVES
LEARNING ACTIVITIES
1. Myths/Attitudes about Aging
1. Explore commonly held
myths/attitudes about aging
in American society
PRE-CLASS
Eliopoulos, Chapters 1 – 4 & 6
2. Facts about Aging
3. Theories of Aging:
a. Biologic
b. Psychosocial
4. Culture/Ethnicity Related to
Aging
5. The Aging Family and Its
Relationships
6. Adjustments to Aging
7. History of Gerontological
Nursing
8. Principles of Gerontological
Nursing Practice
2. Explore your own
feelings/attitudes about the
older adult and how these
feelings/attitudes may
influence your ability to
provide nursing care to the
older adult
IN CLASS
Aging IQ quiz
Lecture
Food for thought
Discussion
3. Summarize the implications
of an aging society on the
nation’s as well as a state’s
health care system.
4. Compare and contrast the
biological and psychosocial
theories used to describe
aging.
POST CLASS
Written assignment “When I am
an old person I shall…..”
5. Relate how the theories of
aging may impact nursing
care
Noel Johnson case study
6. Summarize the following
biopsychosocial stressors
as the relate to the aging
process:
a. Cultural
b. Family
c. Role adjustment
SUPPORTIVE
Haight, B.; Barbara, B.; Tesh, A.
and Courts, N. Thriving: A
life span theory. Journal of
Gerontological Nursing
March 2002 pp. 14-22.
7. Evaluate how nursing is
modified to meet the
biopsychosocial needs of
the aging individual
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NURS 9203 NURSING CARE OF THE OLDER ADULT
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UNIT II
HIERARCHY OF NEEDS OF THE OLDER CLIENT – WELLNESS PROMOTION
COURSE CONTENT
STUDENT OBJECTIVES
LEARNING ACTIVITIES
1. Biologic Needs:
a. Nutrition
b. Rest and sleep
c. Activity
d. Sexuality
1. Explore Maslow’s Hierarchy
of needs as it relates to the
aging process:
a. Nutrition
b. Sleep
c. Exercise
d. Injury prevention
e. Love and belonging
f. Sexuality
g. Self esteem
h. Self actualization
PRE CLASS
Eliopoulos, Chapters
12,13,16,18,19 & 22
2. Safety/Security:
a. Types of injuries
b. Promotion nursing
behaviors
3. Love/Belonging:
a. Touch
b. Sexuality
c. Secondary relationships
4. Self-Esteem
2. Devise a nursing plan of
care to meet the identified
problems of older adults as
it relates to Maslow’s
hierarchy.
IN CLASS
Lecture
Discussion
POST CLASS
Case study: Nutrition
Case study: Falls
5. Self-Actualization
SUPPORTIVE
Callen, B. (2004) Understanding
Nutritional Health in Older
Adults Journal of
Gerontological Nursing
January (2004) pp 36-43
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NURS 9203 NURSING CARE OF THE OLDER ADULT
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Fall 2006
UNIT III
PHYSIOLOGICAL AGING CHANGES
COURSE CONTENT
STUDENT OBJECTIVES
LEARNING ACTIVITIES
1. Age-Related Changes in the
Integument System:
a. Normal changes
b. Common disorders:
1) Pruritus
2) Neoplastic
3) Herpes zoster
1. Describe the normal agerelated changes in the following
body systems:
 Integumentary
 Musculoskeletal
 Cardiovascular
 Respiratory
 Nerulogical
 Gastrointestinal
 Genitalurinary
 Endocrine
 Special senses
PRE CLASS
Eliopoulos, Chapters 5 & 24–32
2. Age-Related Changes in the
Musculoskeletal System:
a. Normal changes
b. Nursing process
3. Age-Related Changes in the
Cardiovascular System:
a. Normal changes
b. Nursing process
4. Age-Related Changes in the
Respiratory System:
a. Normal changes
b. Nursing process
5. Age-Related Changes in the
Neurological System:
a. Normal changes
b. Changes in functional
ability
c. Nursing process
6. Age-Related Changes in the
Gastrointestinal System:
a. Normal changes
b. Common disorders:
1) Xerostomia
2) Presbyesophagus
c. Nursing process
7. Age-Related Changes in the
Genitourinary System:
a. Normal changes
b. Common disorders:
1) Vaginitis
c. Nursing process
2. Analyze how each agerelated change in the
various systems may impact
an older adult’s functional
ability.
3. Analyze how age-related
changes in each body
system may impact nursing
care.
4. Apply nursing interventions
to alleviate discomforts
associated with age-related
physical changes
5. Compare and contrast the
various types of dementia
seen in older adults
6. Correlate clinical
manifestations of dementia
with appropriate medical
interventions.
7. Apply drug therapy used in
the treatment and
management of individuals
with a diagnosis of
Alzehemiers
8. Generate a nursing plan of
care for an individual with a
diagnosis of Alzhemiers.
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IN CLASS
Lecture
Geriatric assessment videos
Hearing exercise
POST CLASS
Case study - Thermoregulation
Case study – Incontinence
SUPPORTIVE
Audio Visuals:
Geriatric Symptom Assessment
and Management.
Modules:
1. Symptom assessment
2. Cardiopulmonary
3. Neuromuscular
4. GI
Boyd-Monk, H. (2005) Not Fade
Away: The Aging Eye
Nursing Made Incredibility Easy
Vol 3 (5) pp 34-45
NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
COURSE CONTENT
Fall 2006
STUDENT OBJECTIVES
8. Age-Related Changes in the
Endocrine System:
a. Normal changes
b. Nursing process
9. Age-Related Changes in the
Special Senses:
a. Normal changes
b. Nursing process
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LEARNING ACTIVITIES
NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
UNIT III – PART 2
PROBLEMATIC PHYSIOLOGICAL CHANGES
COURSE CONTENT
STUDENT OBJECTIVES
1. Problematic Age related
changes
a. Atypical Presentations
b. Benign Prostatic
Hypertrophy
c. Osteoporosis
d. Incontinence
1. Define what is meant by the
terminology “atypical
presentation”.
2. Dementia
a. Alzheimer’s
b. Vascular
c. Lewy Body
d. Mixed
2. Differentiate between
dementia and delirium
LEARNING ACTIVITIES
PRE CLASS
Eliopoulos, Chapter 34
3. Modify your nursing plan of
care to be more therapeutic
for a client with dementia
4. Discuss the clinical
manifestations of failure to
thrive in the older adult
3. Failure to thrive
IN CLASS
Lecture
Discussion
Video scenarios demonstrating
atypical presentations in
older adults
4. Caregiver role strain
POST CLASS
Develop an Alzheimer’s unit
SUPPORTIVE
Specht, J, (2005) 9 Myths of
Incontinence in Older Adults
AJN Vol 105 (6) pp 58-68
Smith, M. and Buckwalter,K.
(2005) Behaviors Associated
with Dementia AJN 105(7)
Pp 40-52
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Fall 2006
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
UNIT IV
PSYCHOLOGICAL AGING CHANGES
COURSE CONTENT
STUDENT OBJECTIVES
LEARNING ACTIVITIES
1. Psychosocial Aging
Changes:
a. Normal changes
1. Summarize age-related
changes in intelligence,
cognition, learning, memory
personality and self-concept
PRE CLASS
Eliopoulos, 34 and pp 112, 547
2. Describe the developmental
task of the older adult years
according to Erikson, and
the role of the nurse in
helping the client meet this
task
IN CLASS
Lecture
Discussion
AUDIOVISUAL:
“The Challenges of Aging:
Change and Loss”
2. Common Psychosocial
Problems Related to the
Older Adult:
a. Elder abuse
b. Alcoholism
c. Depression
d. Suicide
3. Nursing Process for
Common Psychosocial
Problems
4. Role of the Caregiver /
Caregiver Role Strain
3. Explore the biopsychosocial
stressors which may
contribute to the
development of the
following in an older adult:
a. Elder abuse
b. Alcoholism
c. Depression
d. Suicide
4.
5.
Apply the nursing process
to implement strategies to
help an older adult with the
problems in objective 3
Implement strategies to help
an older adult improve his
placement on the health
wellness continue
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POST CLASS
Case Study - Abuse / Isolation
SUPPORTIVE
NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
UNIT V
GERIATRIC REHABILITATION
COURSE CONTENT
STUDENT OBJECTIVES
LEARNING ACTIVITIES
1. Rehabilitation:
a. Definition
b. Disabilities that benefit
c. Assessment
d. Effects of aging
e. Goals
f. Principles
g. Impact
h. Resources
1. Compare and contrast the
type of rehabilitation
available to older adults with
various health care needs
PRE CLASS
Eliopoulos, Chapter 37
2. Physical Rehabilitation
Cardio vascular
Respiratory
Endocrine
3. Nursing Process
2. Describe the components of
assessing functional
capacity, social support,
psychological state and
environment
IN CLASS
Lecture
Discussion
3. Analyze the effects of aging
process on rehabilitation
4. Implement a nursing plan of
care which promotes
rehabilitation in the older
adult and enhances his
position on the health care
continuum
POST CLASS
Case Study - Falls
SUPPORTIVE
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NURS 9203 NURSING CARE OF THE OLDER ADULT
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Fall 2006
UNIT VI
SAFE DRUG USE IN THE OLDER ADULT
COURSE CONTENT
STUDENT OBJECTIVES
LEARNING ACTIVITIES
1. Pharmacokinetics in the
Older Adult:
a. Absorption
b. Distribution
c. Metabolism
d. Excretion
1. Explore age related
changes in
pharmacokinetics of drugs
that influence how drugs act
in the older adult
PRE CLASS
Eliopoulos, Chapter 35
2. Disease Conditions Effects
on Pharmacokinetics
3. Common Drug-Induced
Pathologies:
a. Confusion
b. Falls
c. Incontinence
d. Immobility
4. Major Drug Groups Used by
the Older Adult
5. Noncompliance in the Older
Adult / Caregiver role
2. Analyze common drug
induced pathologies in the
older adult and describe
appropriate promotion and
restorative nursing
behaviors
IN CLASS
Lecture
Discussion
3. Review the major drug
groups used by the older
adult and highlight major
nursing considerations
when monitoring drug
therapy in the older adult
POST CLASS
Case Study – Polypharmacy
4. Apply the nursing process
to ensure safe medication
usage in the older adult.
SUPPORTIVE
6. Client Education and Safe
Drug Use
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
UNIT VII
LEGAL/ETHICAL CONSIDERATIONS IN NURSING CARE OF THE OLDER ADULT
COURSE CONTENT
STUDENT OBJECTIVES
LEARNING ACTIVITIES
Legal/Ethical Issues
1. Explore the medical and
legal issues related to care
of the older adult:
a. Informed consent
b. Living wills
c. Mental competency
d. Use of restraints
e. Intentional torts
f. “No code” order
PRE CLASS
Eliopoulos Chapters 8 & 9
2. Identify guidelines that the
nurse may follow that can
help when faced with ethical
dilemmas
3. Evaluate case examples of
ethical dilemmas and
discuss methods of
reasoning through the
dilemma
IN CLASS
Guest speaker Dr. Wright
Pending finalization
POST CLASS
Complete a living will for
yourself.
SUPPORTIVE
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
UNIT VIII
END OF LIFE CYCLE
COURSE CONTENT
STUDENT OBJECTIVES
LEARNING ACTIVITIES
1. Chronic Ilness
2. End of life Issues
1. Discuss the difficulty people
have when facing death
3. Palliative Care
4. Care giver role strain
2. Summarize barriers to end-oflife care and potential
solutions
PRE CLASS
Eliopoulos Chapter 20
IN CLASS
Lecture
Discussion
3. Implement the nursing
process to assist the
client with end-of-life needs
4. Identify appropriate nursing
interventions to support
caregivers .
POST CLASS
Journal entry regarding hospice
experience
SUPPORTIVE
Clinical day with hospice nurse
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
UNIT IX
COMMUNITY RESOURCES FOR THE OLDER ADULT
COURSE CONTENT
STUDENT OBJECTIVES
Community Resources
1. Compare and contrast
community resources
available in Northwest
Arkansas for the older adult:
a. Housing
b. Food services
c. Leisure
d. Financial
e. Support
f. Medical services
g. Transportation
h. Legal aspects
2. Implement nursing
strategies to help the older
adult to maximize assistant
from local community
resources.
LEARNING ACTIVITIES
PRE CLASS
Eliopoulos Chapter 10, review
chapter 1.
IN CLASS
POST CLASS
SUPPORTIVE
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Fall 2006
APPENDIX
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Fall 2006
Annotated Bibliography
Due Date: Friday Nov. 10, 2006
The annotated bibliography assignment is, in essence, a web assignment.
1.
Go to the AJN website regarding older adults. You will find a series of articles
regarding nursing care of the older adult.
www.nursingcenter.com/AJNolderadults
2.
Choose an article of interest to you. You may print the article if you wish, but it is not
necessary to turn the copy in with the completed assignment.
Read the article.
3.
Create an annotated bibliography using either APA or MLA format. If you are not
familiar with either format, I have posted a link for you on MY NWACC Connection.
You are also able to access this information via the NWACC library web site and link for
documenting sources. You will be required to address all of the following criteria in the
bibliography.
1.
Title of the article, author and date of publication.
2.
What motivated you to choose this particular article?
3.
Summarize the main idea(s) of the article.
4.
What are the nursing implications of the identified main idea(s)?
5.
How will you implement the implications for nursing into your clinical practice?
The paper should be written in an easy flow format and not in a question – answer style.
The assignment is valued at 15 class requirement points.
Extra Credit quizzes/class requirements points available.
Each of the following assignments is worth three (3) extra credit points applied to class
requirements. You may complete one or two of the options listed below for an opportunity to
gain a total six (6) extra credit points. The extra credit assignment will only be accepted with
the original assignment on or before the due date listed above.
Option # 1: On a separate document, develop a chapter / article review guide such as the
ones in your text books. This guide should include the following:
Key terms with definitions
Key concepts in review (summarize ALL of the main ideas from the article).
Option # 2: On a separate document, develop a case study that will provide for application of
your stated nursing implications and appropriate intervention. There should be a well
developed scenario with appropriate information to come to thoughtful conclusions. Your
conclusions for the case study must be included-- i.e. What is the point of the case study.
With what key points would you like participants (students) to respond? What is the point of
the case study?
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NURS 9203 NURSING CARE OF THE OLDER ADULT
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Options # 3: May only be completed if option #2 is completed. You may apply the nursing
process to your own case study as we have in class. Option number 2 MUST be completed in
it’s entirety. This is not an alternative.
Hospice Observational Experience
Due Date: One week following individual experience
The assignment:
This paper is based upon the time you spend observing with the hospice nurse. The paper is
due one week (7 days) after you complete your observational experience. For example, you
are assigned your hospice rotation on Monday, October 9th. Your paper is then due on
Monday October 16th. You may email this assignment or give it to your clinical instructor
to time, date, and initial as completed. Please email, but if you are unable to email it, show
this page of your syllabus to your clinical instructor. You may also bring it to my office after
your clinical day. Be sure someone is available to date and time the document if you plan to
leave it in my mailbox. This assignment is valued at 10 class requirement points.
You will need to address and answer the following questions:
1.
Describe how nursing care delivery in the home/hospice setting differs from
nursing care in the acute setting (hospital).
2.
Summarize a description of the clients you visited today. Including: client initials,
age, purpose of the visit, and nursing care provided.
3.
What was the one thing that influenced you the most today? What had the
strongest impact on you?
4.
Discuss how this experience will influence your practice as a professional nurse.
Community Resources Group Presentation
Due Date: Thursday Nov. 16th
The assignment:
This group project is worth 15 class requirement points. As a group you will identify 4
community resources for older adults. Of these four resources, you will be assigned one to
present to the class. The presentation should last 10 – 20 minutes. Each student should
commit and equal effort in the project. Your group will be required to document a brief, one
page outline of the presentation to be handed in prior to the presentation itself. Here are
some guidelines:
- Explore 4 possible resources and turn the list in to the instructor by Nov. 2nd. The
instructor will make your group assignment. Identify a group leader for communication
purposes.
1. Name, location, and mission statement of agency / resource identified.
2. Contact person with contact information.
3. Client base – who receives services, how many (size of client base)?
4. Services provided – specific to older adult. Other services if applicable.
5. Eligibility criteria, if any. Through what process are resources distributed?
6. Approximate size of agency / resource – facility, personnel, and area served.
7. How will you use this information as a professional nurse?
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8. Overall impression of the community resource. What is perfect, and what could be
improved? In what ways?
******Please note: Credit for class assignments and extra credit will not be awarded for effort
alone. You must complete the assignment to the best of your ability in a neat and presentable
way. IF YOU ARE UNSURE whether your work will meet standard, PLEASE come and see
me in my office for review prior to due date. You may also email or call with specific questions.
All papers and homework will be graded for organization, readability (content flow), and
quality of content.
I make myself available to you so that you can get the most out of this class. Please
feel free to take advantage of this offering.
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Access Nursing
Fall 2006
PRINCIPLES OF GERONTOLOGICAL NURSING PRACTICE
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Aging is a natural process common to all living organisms. Not pathological.
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Various factors influence the aging process.
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Unique data and knowledge are used in applying the nursing process to the older
population.
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Older Adults share similar universal self-care demands with all other human beings.
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Gerontological nursing strives to help older adults achieve optimum levels of physical,
psychological, social and spiritual health so that they can achieve personhood.
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
The Warning Signs of poor nutritional health care are often overlooked. Use this checklist to
find out if you or someone you know is at nutritional risk.
Read the statements below. Circle the number in the yes column for those that apply to you or
someone you know. For each yes answer, score the number in the box.
Total your nutritional score.
DETERMINE YOUR NUTRITIONAL HEALTH
YES
I have an illness or condition that made me change the kind and/or amount of
food I eat.
2
I eat fewer than 2 meals per day.
3
I eat few fruits or vegetables, or milk products
2
I have 3 or more drinks of beer, liquor or wine almost every day.
2
I have tooth or mouth problems that make it hard for me to eat.
2
I don’t always have enough money to buy the food I need.
4
I eat alone most of the time.
1
I take 3 or more different prescribed or over-the-counter drugs a day.
1
Without wanting to, I have lost or gained 10 pounds in the last 6 months
2
I am not always physically able to shop, cook and/or feed myself
2
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
TOTAL
Total Your Nutritional Score. If it is --0-2
These materials developed and distributed
Good! Recheck your nutritional score in 6 by the Nutrition Screening Initiative, a project
of:
months.
3-5
You are at moderate nutritional risk. See
what can be done to improve your eating
habits and lifestyle. Your office on aging,
senior nutrition program, senior citizens
center or health department can help.
Recheck your nutritional score in 3
months.
6 or + You are at high nutritional risk. Bring this
checklist the next time you see your
doctor, dietitian or other qualified health or
social service professional. Talk with
them about any problems you may have.
Ask for help to improve your nutritional
health.
AMERICAN ACADEMY OF
FAMILY PHYSICIANS
THE AMERICAN
DIETETIC ASSOCIATION
NATIONAL COUNCIL
ON THE AGING, INC.
Remember that warning signs suggest risk,
but do not represent diagnosis of any
condition. Turn the page to learn more about
the Warning Signs of poor nutritional health.
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
Use the word DETERMINE to remind you of the Warning Signs
D
ISEASE
Any disease, illness or chronic condition, which causes you to change the way you eat, or
makes it hard for you to eat, puts your nutritional health at risk. Four out of five adults
have chronic diseases that are affected by diet. Confusion or memory loss that keeps
getting worse is estimated to affect one out of five or more of older adults. This can make
it hard to remember what, when or if you’ve eaten. Feeling sad or depressed, which
happens to about one in eight older adults, can cause big changes in appetite, digestion,
energy level, weight and well being.
E
ATING POORLY
Eating too little and eating too much both lead to poor health. Eating the same foods day
after day or not eating fruit, vegetables, and milk products daily will also cause poor
nutritional health. One in five adults skips meals daily. Only 13% of adults eat the
minimum amount of fruit and vegetables needed. One in four older adults drinks too much
alcohol. Many health problems become worse if you drink more than one or two alcoholic
beverages per day.
T
OOTH LOSS/MOUTH PAIN
A healthy mouth, teeth, and gums are needed to eat. Missing, loose or rotten teeth or
dentures that don’t fit well or cause mouth sores make it hard to eat.
E
CONOMIC HARDSHIP
As many as 40% of older Americans have incomes of less than $6,000 per year. Having
less – or choosing to spend less – than $25-30 per week for food makes it very hard to get
the foods you need to stay healthy.
R
EDUCED SOCIAL CONTACT
One-third of all older people live alone. Being with people daily has a positive effect on
morale, well being and eating.
M ULTIPLE MEDICINES
Many older Americans must take medicines for health problems. Almost half of older
Americans take multiple medicines daily. Growing old may change the way we respond to
drugs. The more medicines you take, the greater the change for side effects such as
increased or decreased appetite, change in taste, constipation, weakness, drowsiness,
diarrhea, nausea, and others. Vitamins or minerals when taken in large doses act like
drugs and can cause harm. Alert your doctor to everything you take.
I
NVOLUNTARY WEIGHT LOSS/GAIN
Losing or gaining a lot of weight when you are not trying to do so is an important warning
sign that must not be ignored. Being overweight or underweight also increases your
chance of poor health.
N
EEDS ASSISTANCE IN SELF CARE
Although most older people are able to eat, one of every five have trouble walking,
shopping, buying and cooking food, especially as they get older.
E
LDER YEARS ABOVE AGE 80
Most older people lead full and productive lives. But as age increases, risk of frailty and
health problems increase. Checking your nutritional health regularly makes good sense.
The Nutrition Screening Initiative, 2626 Pennsylvania Avenue, NW, Suite 301, Washington, DC 20037
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
The Nutrition Screening Initiative is funded in part by a grant from Ross Laboratories, a division of Abbott Laboratories.
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
PHYSICAL INDICATORS OF ADULT ABUSE, NEGLECT AND EXPLOITATION
1.
Unexplained Bruises and Welts:
 On face, lips, mouth
 On torso, back, buttocks, thighs
 In various stages of healing
 Clustered, forming regular patterns
 Reflecting shape of article used to inflict (electric cord or belt buckle)
 On several different surface areas
 Bilateral bruises on upper arms from shaking
 Clustered bruises on trunk from repeated striking
 Old and new bruises
 Injury repeated
2.
Unexplained Fractures:
 To skull, nose, facial structure
 In various stages of healing
 Multiple or spiral fractures
3.
Unexplained Burns:
 Cigar, cigarette burns, especially on palms, legs, arms, back or soles of feet
 Immersion burns (sock-like, glove-like, doughnut-shaped on buttocks)
 Patterned like objects (electric burner, etc.)
 Rope burns on arms, neck or torso (from improperly applied restraints)
4.
Unexplained lacerations or abrasions to mouth, lips, gums, eyes
5.
Appears mentally confused
6.
Hears screams or sounds of physical abuse
7.
Strong odor of alcohol or drugs
8.
Bedsores (decubitus ulcers)
9.
Unhealed sores/untreated injuries
10.
Severe or constant pain
11.
Body not clean; has bad odor
12.
Bedfast
13.
Limited ability to go from room to room
14.
Obvious illness which requires medical or dental attention (open sores, draining ulcer,
rash)
15.
Appears acutely ill and unable to ask for help (coma, unconscious)
16.
Lacks eyeglasses, hearing aid, teeth, walker, crutches, wheelchair and/or other
prosthetic devices that are needed
17.
Obese or emaciated (so that individual can hardly move or so thin his bones protrude)
18.
Unusual lumps, bumps, or protrusions under the skin
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
19.
Fall 2006
Discoloration of the skin (too white, gray-color of malnutrition, dark color of dehydration,
red spots, yellow color of jaundice)
20.
Bulging eyeballs or other unusual disfiguration
21.
Excessive number of old medicine bottles with outdated prescriptions
22.
Nervous, avoiding eye contact
23.
Radical change in behavior
24.
Slow, slurred, hesitant speech
25.
Bodily indications of inappropriate temperature reactions (flushed, sweating, shivering)
26.
Person not wearing any clothing
27.
Clothing not proper for the temperature or are so big they fall off with every move
28.
Lack of clothing
29.
Same clothing all of the time
30.
Shoes on wrong feet
31.
Fleas, lice on individual
32.
Rash, impetigo, eczema
33.
Green, yellow, red, brown sputum
34.
Unkept, dirty
35.
Hair matted, tangled or not combed
36.
Unintentionally noncommunicative
37.
Swollen feet and ankles
38.
Changes in appearance
39.
Vomiting
40.
Sudden weight loss/gain
41.
Blood in excretion
42.
Loss of sight or hearing
43.
Dehydration
44.
Hair thin as though pulled out, bald spots
45.
Scars
46.
Sudden illness
47.
Loss of equilibrium
48.
Dilated pupils
49.
Nails need clipping
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
ENVIRONMENTAL INDICATORS OF ADULT ABUSE, NEGLECT, AND EXPLOITATION
1.
HOUSE:
 Garbage thrown about yard and house, high weeds and overgrown yard
 House is hazardous because of the lack of repairs such as broken porch rails or
planks, rotted steps or floors, holes in windows or walls, leaking roof, dangling
electrical wires
 Human and/or animal excrement on floors and furniture
 Evidence of fleas, rats, mice, roaches or other vermin, rotted food present in the
house or yard
 Evidence of obvious fire hazards such as piles of boxes, newspapers, and old
clothes,
 Unvented gas heaters and blocked exits
 House is cold or wet
 Utilities have been cut off
 House is overcrowded
 House lacks minimum equipment and facilities (no furniture, no stove or hotplate,
 Refrigerator, electricity, plumbing)
 House is isolated from other houses
 House has architectural barriers such as steps, narrow doorways, cabinets too high,
switches
 Too high, doors too heavy, rooms too small
 Fecal/urine smell in house
 Soiled or urine soaked bedding
 Evidence of restraints
 House not ventilated, no screens on windows or doors
 Large number of animals lacking care
 Bottles of liquor (empty)
 Large quantity of medication laying around, outdated and from different doctors
 Medicines not clearly marked
 Contaminated well
 Piles of dirty clothes and linen
 Frequent moving
 Number of locks and bolts
 Change in housekeeping
2.
FOOD AND CLOTHING:
 Little or no food in the house
 Little or no food available for special diet needs
 No accessible food market or source of food
 Limited variety of food
 Food is spoiled or laying around
 Food stored improperly
 No evidence of food preparation
 Insufficient or inappropriate clothing for the weather
 Clothing does not properly fit (too large or too small)
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
3.
FINANCIAL:
 Little or no money available until the next check arrives
 Unusual activity in bank accounts
 Activity in bank accounts that is inappropriate to the aged person or disabled adult
(withdrawals from automated banking machines when the person cannot walk or get
to the bank)
 Power of attorney given when the individual is unable to comprehend the financial
situation
 Recent will when the individual is clearly incapable of making a will
 Caregiver asks only financial questions; does not ask caring questions
 Lack of amenities (tv, personal grooming items, appropriate clothing when the estate
can well afford such items)
 Personal belongings missing (includes art, silverware, jewelry)
4.
SOCIAL DEPRIVATIONS:
 There is no one to talk to or who will listen
 There is no evidence of social visits, television, radio, books, or any kind of social,
mental, or emotional stimulation
 House is physically isolated from community
 Lack of friends of a similar age and/or interest
 Individual resists going outside
 Little or no contact with others
 Does not know neighbors
 Relatives live far away
 Only one person to call in times of crisis
 Dependent on only one caregiver for financial/physical/emotional support
 No assistance provided by friends, relatives, or neighbors
 Lives alone or else in an overcrowded home
 Community refuses support; individual is ostracized
 Conflicts with the community
 Pets replace affection from others
 Does not want counselor to leave
 No hobbies or interests
 Undesirable friends
 Visitors only on check day
 Caregivers who provide help for pay
 Unable to read or write
 Attempt to isolate the individual from old friends by caregiver or others
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
Fall 2006
BEHAVIORIAL INDICATORS OF ADULT ABUSE, NEGLECT AND EXPLOITATION
VICTIM: AGED PERSON OR DISABLED ADULT
1.
DESTRUCTIVE BEHAVIOR:
 Yells obscenities at others
 Assaults others
 Tears up belongings of others or themselves
 Writes abusive or threatening letters, or makes abusive or threatening telephone
calls
 Threatens self-harm or suicide
 Refuses needed mental or medical care (life-sustaining services)
 Inappropriately displays rage in public
 Steals without an apparent need for the things stolen
 Refuses to use money for needs when it is available
 Is afraid of being robbed
 Loneliness
 Recent or sudden changes in behavior or attitudes
 Unjustified fear
 Unwarranted suspicion
 History of mental illness
 Alcohol or drug abuse
 Bizarre behavior
 Unwillingness to talk
 Denial of problems
2.
OTHER BEHAVIOR:
 Stops talking to family or others
 Pulls away from social contacts
 Is afraid of being alone
 Is very suspicious of other people and extremely afraid they will harm him
 Is uninterested in any activity
 Is very depressed or despairing
 Experiences delusions or hallucinations
 Shows symptoms of withdrawal, severe hopelessness, helplessness
 Denies problems
 Excessive crying
 Constantly moves from place to place
 Wanders the streets (because he forgets where he lives or has no permanent place
to live)
 Spends all of his money on alcohol or drugs and begs until the next check comes
 Forgets to eat
 Cannot remember where he put his money, the source, or amount
 Misuse of money
 Falling frequently
 Unable to cook
 High dependence on others, animals, or agency
 Telephone for help
 Carelessness in smoking
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NURS 9203 NURSING CARE OF THE OLDER ADULT
Access Nursing
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3.
Fall 2006
Cannot remember who you are or who they are
Frightened of caregiver
No pride in themselves or their home; low self-esteem
Feelings of inadequacy
Overly quiet, passive, timid
Asks how to do things he has always done for himself
Forgets to turn off the heater or stove and creates a fire hazard
Unable to use medical services, public transportation, etc., That he could use before
Take medication properly
FAMILY OF CAREGIVER:
 Marital or family discord
 Continuous friction
 Striking, shoving, beating, name calling, scapegoating, yelling going on between
family members
 Conflicts with others or the community
 Hostile, secretive, frustrated, shows little concern, poor self-control, blames aged
person or disabled adult, impatient, irresponsible
 Blaming someone or something else for problems
 Denial of problems
 Arguments within extended family on care provided to individual
 Family imposes obligations
 Manipulates overly passive individual into baby-sitting, paying bills, loaning money
 Recent family crisis
 Inability to handle stress
 Recent loss of spouse, family member or close friend
 Alcohol or drug use by family
 Caregiver lacks knowledge of individual’s condition and needed care
 History of mental illness in family
 Treats individual as child
 Overprotection by family
 Individual left alone for extended periods of time
 Caregiver does not provide needed personal care
 Withholds food, medication
 Overly frugal
 Isolates individual from others in the household
 Caregiver will not allow visitors
 Family does not interact with individual
 Lack of physical, facial, eye contact with individual
 Family has other illnesses to deal with
 Resentment by caregiver toward individual
 Financial problems/lack of money
 Inter-generational households
 Prolonged interval between treatment and injury
 Change doctor frequently without specific cause
 Explanation of injury not feasible
 Other injuries found which were not reported
 Past history of similar incidents
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NURS 9203 NURSING CARE OF THE OLDER ADULT
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Fall 2006
Inconsistent explanations
Sudden appearance of previously uncaring relatives
Transfer of property, savings, insurance, wills
Unexplained cash flow
Evasiveness on payment of bills
Excessive payment for care
Unusual expenses and no visible means of income
Unusual household composition
Competition in family for attention
Resentment, jealousy
Unrealistic expectations of individual
Someone other than caregiver brings individual for medical or other treatment
35