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122 Cards in this Set

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Geriatrics
Branch of medicine with focus on abnormal conditions of elderly & their medical treatment
Gerontology
Study of all aspects of the aging process, learn how to extend life span & quality of life
Gerontics
Nursing care & service provided to the aged
What age makes someone "elderly?"
Think 65 & up
1904
1st AJN article on Care of Aged
1935
Federal Old Age Insurance Law (government assistance in medical care)
What became of the Federal Old Age Insurance Law?
It became the social security act
1920's
Elderly lived on "poor farms"
1940's
Elderly cared for in hospitals (no place else to go)
1960's
Movement for elderly care began
1975
J. Gerontological Nursing published
ANA offered certification in Geriatric nursing
1965
AAA (Administration of Aging Agencies) established
Medicare & Medicaid established
Older Americans Act established
What is the Older Americans Act?
provide access to community based services & supplements housing
1972
SSI program instituted (supplemental security income for widowed/disabled/orphaned)
1987
OBRA passes (omnibus reconciliation act)
Federal legislation to oversee how monies are spent in nursing homes.
Why? To improve quality of care in extended care facilities.
State surveyors report goes to OBRA.
Also involved in law making to protect pts.
Includes MDS & self medicating rights.
1990
Self Determination Act passed, allowed for resident rights, advanced directives, living will, etc.
What are the roles of the Gerontological Nurse?
We are the "CREAM" of the medical profession: Consultant, Researcher, Educator, Advocate, Manager
The Advocate Role
We advance the rights of older persons & educate others on negative stereotypes of aging
The Educator Role
We organize & provide instruction regarding:
healthy aging,
disease detection & treatment,
& rehabilitation
to older adults & their families.
We participate in in-service education, continuing education & training of ancillary personnel as appropriate.
The Manager Role
We maintain current relevant information (e.g. federal & state regulations) & provide leadership in a variety of settings
The Consultant Role
We consult with & advise others who are providing care to older pts with complex healthcare problems. We participate in development of clinical pathways & quality assurance standards & implementation of evidence-based practices
The Researcher Role
We collaborate with established researchers in development of clinical studies, assist with data collection & identification of appropriate research sites, & participate in the presentation of findings at gerontological conferences and publications.
What is a clinical pathway?
They are clear steps an average person is to take through medical services (without complications)
What is the Goal of the gerontological nurse?
To help pts achieve their optimal level of physical, mental, & psychosocial well-being.
The gerontological nurse may focus on what areas?
Improvement of the pts quality of life
improvement of functional status
& promotion of well-being.
(Other areas of nursing may focus on functional status/restoration)
Why do we have standards of practice?
To provide a baseline to ensure quality of care to 1. protect the pt 2. protect the nurse
There are 11 standards of gerontology practice. What is the Theory standard?
We use evidence based practice & nursing process to guide our nursing
There are 11 standards of gerontology practice. Standard V: Planning & Continuity of care is met how?
We meet this standard by developing a nursing care plan specific to our pts.
There are 11 standards of gerontology practice. Standard VI: Intervention is met how?
By implementing the care plan we have developed
There are 11 standards of gerontology practice. Standard X: Ethics is governed/outlined by whom?
ANA
There are 11 standards of gerontology practice. Standard XI: Professional Development is the responsibility of whom?
It is the nurse's personal responsibility
What are the 4 principles of Gerontological Nursing Practice?
Aging is a natural process to all organisms
Many factors influence aging
(e.g. Lifestyle & environmental: diet, drugs, exercise, etc.)
Elders share similar universal self care needs
Strive to help older adults achieve optimum levels of physical, psychological, social & spiritual health so that they can achieve personhood
*Remember: Disease in old age in not normal*
There are several National resources for Gerontological Nursing. What are the 3 main ones we should know?
AARP
(American Association of Retired Persons)
National Council on Aging
(addresses concerns of elders, conducts research, *provides informational workshops)
National Gerontological Nursing Association
(fosters development & improvement of nursing care of the older adult. Membership includes RNs, LPNs, CNAs)
In what settings may the Gero nurse practice?
Hospitals
Community Agencies:
-Adult Day Care
-Continuing Care Retirement Communities
-Assisted Living Residences
-Home Health Care
Long Term Care Facilities:
-Skilled nursing facilities
-Intermediate care facilities
*Majority of elderly live in private homes*
What are rest homes?
Homes that provide supervision care. They don't have the same regulations, don't have to provide medical care. Mostly "out of pocket pay" & few professionals & limited services.
What is Adult Day Care?
a community based group program designed to meet needs of functionally impaired adults through an individual plan of care *This is the fastest growing division of services*
What are the 2 types of Adult day care centers?
Medical centers
(has skilled nurse & can meet some medical needs)
Social centers
(no medically trained staff & no medical care)
Why was adult day care developed?
To provide an alternative to institutionalization
What can an adult day care provide a participant?
health &/or social services
What is the goal of adult day care service?
to maximize existing self care capacity of the participant
Describe the programs offered at an adult day care center.
They are structured & comprehensive
Describe care by a Home Health Agency
The client must be homebound (doesn't leave the house) and if paid for by Medicare, their must be a Dr. order for skilled care. Then the care must be provided under the direction of an RN. The RN is the backbone of home health services and supplies an increased opportunity for RN employment. Pt may need dressing changes, therapies, etc.
What are the 3 levels of care found in retirement communities?
independent, assisted, total care
Do retirement communities employ RNs?
yes
What are some other names for retirement communities?
Continuing care communities
Life care communities (total care up to end of life - even if can't pay)
A large majority of what age group can be found in acute care hospitals?
>65 yo (60-70% of pts are elderly, they are the fastest growing population, >84 is the fastest)
What are some other names for Long Term Care facilities?
Nursing home, Convalescent center
About how many elderly live in LTC/nursing home facilities?
Aprox. 5%
Describe the caregivers in a LTC facility.
LPNs & CNAs give most direct care while RNs are usually nurse managers
What are the 2 types of Long Term Care Facilities?
Intermediate Care Facility (ICF) & Skilled Nursing Facility (SNF)
Describe the difference in Intermediate vs. Skilled nursing facilities.
Intermediate Care Facility (ICF): 1/3 of all nursing home beds, Medicare does not pay but Medicaid may; Skilled Nursing Facility (SNF): Medicare will pay up to 100 days if meet criteria (3 night hospital stay)
What are the goals of LTC?
rehabilitate to max functional independence
maintain function
quality of life
provide for a dignified & comfortable death
What are the 10 major responsibilities of the LTC nurse?
1. Assist resident/families in selection of & adjustment to the facility
2. Assess & develop an ICP (interdisciplinary care plan)
3. Monitor resident's health statue
4. Use rehab & restorative care techniques when possible
5. Evaluate care effectiveness/appropriateness
6. Identify changes in pts condition & take action
7. Communicate/coordinate care with interdisciplinary team
8. Protect & advocate for resident's rights
9. Promote high quality of life for residents
10. Ensure/promote competency of staff
What do restorative care aids do?
CNAs who help get pts up, work on interaction & socialization
What are ethics?
Beliefs that guide life & help in determining right from wrong, "Doing the right thing"
What are the rights of the institutionalized elderly?
It is the Self Determination Act 1990
It arises from the constitution & results from legislation
Clients must be informed of their right to have an Advanced Directive, Living Will, Durable Power of Attorney & their Resident Rights
This act can be enforced by the constitution
What is ageism?
a dislike of aging and the elderly; it is an emotional prejudice
What is age discrimination?
it goes beyond emotions and leads to actions
Is Gerontophobia a real thing?
Yes, it is an abnormal fear of aging.
Abuse against elders is usually a result of what?
Caregiver stress
What are some forms of abuse?
Care without compassion, infliction pain/injury (physical or psychological), stealing/mishandling of funds, withholding food/care, sexual abuse, exploiting, confining
Why may abuse not be reported?
The older adult may be reluctant to report or admit to abuse, fear of retribution
What are some clues of abuse?
Bruises, breaks, falls, injuries, malnutrition, failure to thrive, over sedation, depression
What should the nurse do if abuse is suspected?
Assess degree of immediate danger & take action
(we are legally & morally bound to report it)
*First: stop the abuse!
What is assault?
deliberate threat or attempt to harm another
What is battery?
touching without client consent (includes procedures)
What is false imprisonment?
unlawful restraint or detention
What is invasion of privacy?
entering without client consent
What is negligence?
omission or commission of an act that departs from acceptable & reasonable standards
What are the nurse's ethical resources?
ANA code & ethics committees
What is leadership?
the interpersonal process that involves motivating & guiding others to achieve goals
What is management?
the accomplishment of tasks either by oneself or by directing others
What are the functions of a manager?
(PODE)
Planning
Organizing
Directing (involves supervision & delegation)
Evaluating
What skills are needed for effective management?
Ability to …
problem solve
manage change
communicate (*most important, is what you are saying being understood?)
What are the roles/responsibilities of medical team members in LTC?
MD required to visit q 30 days for 1st 90 days, then q 60 days. Most facilities have standing Dr. orders. Medical Director in facility manages most residents although pts have right to have own/outside dr.
What are the roles/responsibilities of Nutritionists in LTC?
Assesses the nutritional status of resident (Nurse monitors intake)
What are the roles/responsibilities of occupational therapists (OT) in LTC?
to enable the resident become more self sufficient & identify assistive devices that promote independence. (includes help with ADLs)
What are the roles/responsibilities of physical therapists (PT) in LTC?
They provide education, guidance, & direct care to improve mobility, transfer techniques, balance, ambulation, and use of assistive devices
What are the roles/responsibilities of speech therapists (ST) in LTC?
Help residents (such as stroke pts) with comprehension & expression, teach swallowing techniques to dysphagic pts.
What are the roles/responsibilities of recreational therapists (RT) in LTC?
They plan/direct activities and document every activity.
What are the roles/responsibilities of social workers in LTC?
They provide counseling, link pt/family with community resources & help with resident to resident or resident to family issues.
What are the roles/responsibilities of RNs in LTC?
We are the backbone of care & coordinate care between disciplines.
-Assessment:
take PMH (previous medical history?)
self-care capacity & nursing needs
-Planning
-Implementation
-Evaluation
-Managing
(delegation/accountability)
-Record & Report
(response to care)
-Collaborate
-Administer Nursing Services
(identify standards & management of licensed/unlicensed personnel)
-Teach & Counsel
What are the roles/responsibilities of LPNs in LTC?
They are to perform delegated duties safely:
Assess (participate in)
Plan (identify interventions for RN review)
Implement (plan delegated & supervised by RN)
Evaluate (propose modifications for RN review)
Report & record
Collaborate
Teach & Counsel (reinforced activities as planned & initiated by RN)
What are the roles/responsibilities of CNAs in LTC?
Perform common, repetitive tasks which do not require professional judgment:
CNA I: most invasive task is enemas/douches (& 4 additional CNA II tasks with BON approval)
CNA II: more invasive/sterile tasks
Discuss the legal parameters of practice of RNs.
As RNs, we must be familiar with responsibilities of RN by BON. As managers, we must be familiar with legal parameters of other members of nursing team as to insure all staff stay within parameters of their practice.
What are some essential time management steps?
1. Formulate goals that are realistic, measurable, acceptable, clear & concise
2. Set priorities: If no ABC concerns, use maslow's hierarchy as a possible guide (consider other factors such as schedules, policies, procedures, time to complete task, health status, & *resident preferences*)
3. Delegate tasks
How long is a short term goal?
< 1 week
How long is a long term goal?
1 week to a month
What is delegation?
assigning activities of pt care to personnel qualified to accept responsibility according to certification
What is supervision?
Validates that nursing care activities have been performed as delegated. RN is responsible for delegated tasks.
What are the 4 rights of delegation?
Right Task (can this task be delegated?)
Right Person (are they qualified?)
Right Communication (clear, concise objective & expectation)
Right Feedback
What problems do RNs encounter with delegation?
1. Think they can do it faster/better
2. Lack of knowledge on abilities of other team members
What are RNs accountable for in Managing/Delegating?
(APIE VCR)
-Assess pt health care status & care requirements
-Plan care based on pts needs & qualifications of personnel
-Implement (includes Delegate appropriately & Supervise personnel & assure appropriately performed
-Evaluate care given & pt response
-Validate competence of nursing personnel, Orientation & ongoing performance expectations
-Communicate significant info regarding care
-Review/modify plan
What are LPNs accountable for in delivering care?
Assess (participate in), Give care (directly), Delegate to LPNs/NAs (specific tasks personnel is qualified for), Supervise, Evaluate (participate in), Report & Record (assessment, care, response to care)
What does the nurse manager do?
They are essential in coordinating the plan of care, especially with interdisciplinary collaboration
What is an MDS?
Minimum Data Set: a standardized assessment tool developed for consistency. Completed by MDS coordinator & updated when there is a significant change in pts mental or physical condition. It is required to receive federal money.
What is a RAP?
Resident Assessment Protocol form. This is used in the planning stage to set priorities & help identify problems. The plan of care is based on RAP data. It makes sure all areas have been accounted for and a plan is in place. Required to receive money from Medicare.
What should the residents environment provide?
More than shelter:
promote continued development, stimulation & satisfaction to enhance psychological well-being.
What does the Social Security Act do?
Intended to be a supplemental income but has become a primary source of income. Most common source of income for elders
What is Medicare?
A Federal program. Pays most hospital care if > 65. It is automatic at age 65 & is the primary payer for acute care. Several Parts. Most people don’t pay a premium for part A.
What does Part A of Medicare cover?
Hospital insurance.
Helps cover in-pt hospital care
skilled nursing facilities
hospice
some home health care
(Must meet criteria)
What does Part B of Medicare cover?
Medical Insurance. Helps cover dr. services & outpt care. Must pay a premium & deductible & it is optional.
What does Part D of Medicare cover?
Prescription coverage. Must pay a separate premium
What is Medicaid?
A joint Federal/State program. It is based on financial need/income. It is not age based, it is need based. Largest funding source for long term care
Why do LTC facilities often use volunteers?
A cost saving measure.
How do we age?
Chronologically, Physiologically, Functionally
(It is a complex process!)
What is old?
It is subjective and is how one feels
What is the single most important factor that influences aging?
ATTITUDE!
By how long do women outlive men?
12 years
What is mortality due to?
Heart disease & cancer
What is the greatest health problem in the elder population?
Hypertension
Approx. how many elderly fall below poverty level?
9%
What are baby boomers?
People born between 1946 & 1964.
Make up 1/3 of population & have more living parents than children.
Known as sandwich generation.
Not known for saving.
Will be major drain on economy when retire.
What are the housing options available to the elderly?
Private homes
Subsidized housing (must have low income)
Assisted living/Independent Resident homes (expensive)
Life lease/Life contract (large initial investment & monthly fee)
Long Term Care facilities (placement becoming more difficult)
What are the major concerns of the elderly?
-Healthcare
80% have chronic illness
most frequent is HTN
fewer acute illness but longer recovery/more complications
higher rate of medical visits
-Safety
violence becoming greater
-Financial Security
often taken advantage of
-**Fear loss of independence**
What is the biggest lighting problem for the elderly?
Fluorescent lights due to glare (next would be insufficient lighting , shadows & glare)
What should the temp be in rooms for the elderly?
no lower than 75 with 60-65% humidity
(lower can cause hypothermia)
What is the best flooring for the elderly?
solid color, non-glare, cushioned surface
True or False? Older adults cannot learn complex new skills.
False, the speed with which they process info is slower.
True or False? Most old people are depressed.
False, only about 1/3 exhibit depressive symptoms
True or False? Some senility is normal in very old people.
False, senility is always caused by a pathological process & is not normal
What are people referring to when they use the word senile?
The dementing process