CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
AN EDUCATION MODEL FOR
NURSING CARE OF AGED PATIENTS
A project submitted in partial satisfaction of the
requirements for the degree of Master of
Public Health
by
Amy B. Ayers
May 1985
The Project of Amy B. Ayers is approved:
Shelia C. Harbet, H. S.D., Cnair
CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
ii
ACKNOWLEDGEMENTS
I would like to express my sincere gratitude to
the members of my project committee:
Dr. Shelia Harbet,
Dr. Michael Kline, and Lorretta Worthington for their
guidance, knowledge and encouragement throughout this
project.
Special appreciation to Ethel Riggs, Ann Lawbaugh,
Brenda Allocco and Cassandra Carraway for their advice and
assistance.
I would like also to thank my friends and my
husband, Robert Ayers, for their prayers and support.
For all of the "older adults" who have influenced
my life, I include this poem:
YOUNG AT HEART
If you should say I'm old
Then I would say you're wrong;
And though my sight is dim
My heart is young and strong.
If you should think I'm old
Don't breathe it with your tongue
For though my back is bent
My heart is brave and young
If you should think I'm old,
I may agree in part;
My body did grow old
But I stayed young at heart.
Perry Tanksley
iii
TABLE OF CONTENTS
Page
ACKNOWLEDGEMENTS
iii
ABSTRACT . . . .
vi
Chapter
1.
2.
3.
4.
INTRODUCTION . . . . . . .
Statement of the Problem
Purpose of the Study . .
Limitation of the Study
Definition of Terms
1
REVIEW OF THE LITERATURE
.
The Need for Courses Relating to
the Nursing Care of Aged Patients
General Concerns Related to the
Health of the Aged . . . . . . . .
Preventive Care and Health Maintenance
for the Aged . . . . . . . . . . . .
General Considerations and Approaches
in Nursing Care of the Aged . . .
Planning Nursing Care for Aged
Patients in Specific Problem Areas
5
METHODOLOGY . . . . . . . . .
Phase I: The Review of the
Literature . . . . . . . .
Phase II: The Needs Assessment
Questionnaire
.....
Phase III: The Development of the
Education Model . . .
Phase IV: Validation of the
Education Model . . .
THE EDUCATION MODEL FOR NURSING CARE
OF AGED PATIENTS . . . . . . .
Proposed Implementation Plan .
The Evaluation Scheme . . . .
An Education Model for Nursing Care
of Aged Patients . . . . . . . . .
iv
2
3
3
3
5
8
11
14
22
24
24
25
27
28
30
30
31
33
TABLE OF CONTENTS (continued)
Page
BIBLIOGRAPHY
106
APPENDICES . . . . . . . . . . .
A. NEEDS ASSESSMENT FOR CARE OF
AGED PATIENTS . . . . .
B. CURRICULUM EVALUATION FOID-1 .
C. EVALUATORS OF THE EDUCATIONAL MODEL
FOR NURSING CARE OF AGED PATIENTS
D. AN OUTLINE FOR THE EDUCATIONAL MODEL
FOR CARE OF THE AGED PATIENT
E. EXPRESSIONS OF STEREOTYPING . . . .
F. ROLE-PLAYING SITUATION . . . . . .
G. NURSING DATA BASE FOR OLDER ADULTS
H. NURSING DATA BASE FOR FICTITIOUS
ELDERLY PATIENT
. . . . . .
I. NURSING CARE PLAN FOR FICTITIOUS
ELDERLY PATIENT
. . . . . . .
J. NURSING CARE PLAN FOR~~T . . . .
K. EXAMPLE TEST ITEMS FOR POST-TEST
L. EVALUATION QUESTIONNAIRE . . . .
111
v
112
115
117
119
127
129
132
137
143
151
153
155
ABSTRACT
AN EDUCATION MODEL FOR
NURSING CARE OF AGED PATIENTS
by
Amy B. Ayers
The purpose of this project was to develop an
education model for the nursing care of aged patients
which could be utilized for second year students in an
associate degree nursing program.
Preparation for the
development of the model included a search of current
literature, and an analysis of the results from the
"Needs Assessment for Care of the Aged Patients."
This
needs assessment tool was developed from materia] taken
from the literature search and was administered to second
year students currently enrolled in an associate degree
program.
Much attention has been centered on the nursing
care of elderly patients recently.
This is due largely to
the increasing numbers of elderly patients in health care
centers, and to the crisis in health care costs.
vi
This
attention has revealed a growing need for nurses to have
additional information about the aged
to meet their health care needs.
patient in order
This education model is
an attempt to increase awareness in associate degree
nursing programs and promote inclusion of more information
specific to aged patients, with an emphasis on preventive
care and health maintenance.
The Education Model for Nursing Care of Aged
Patients is divided into four units:
1) Introduction to
Concerns Related to the Aged, 2) Preventive Care and
Health Maintenance for the Aged, 3) General Considerations
and Approaches in Nursing Care of the Aged, and 4) Planning Nursing Care for Aged Patients in Specific Problem
Areas.
Health generalizations, behavioral objectives,
suggested learning opportunities and a list of resources
were developed for each unit.
The content outline for the
model was derived from the results of the literature
search for current information, and the analysis of the
need assessment questionnaire.
Special effort was made to
identify material that is appropriate for the second year
nursing student, and does not unnecessarily duplicate
information which is covered in other courses in a
nursing program.
A curriculum evaluation form was developed to be
completed by four evaluators who are actively involved in
some facet of
nursi~g
care of aged patients.
vii
The
evaluators generally agree that the Education Model for
Nursing Care of Aged Patients would be a worthwhile
addition to the curriculum of the second year of an
associate degree nursing program.
viii
Chapter 1
INTRODUCTION
The elderly population has increased steadily in
number and proportion to the total population in the United
States.
In 1981 an estimated 25.6 miJlion people in the
United States were age 65 or above, slightly more than
11% of the population; and about 33% of this population
were 75 plus.
This graying of America and the fact that
elderly persons often require assistance with health care
needs are significant in pointing out the need for
learning more about the health care needs of older adults
(Gress and Bahr, 1984).
With aging, the homeostatic mechanisms become less
efficient and reserve power is lost.
When external stress
occurs, there is little or no reserve capacity.
turn makes the person more vulnerable to disease.
This in
Health
problems are more serious for the aged, usually requiring
a longer recovery, and often involving multiple complications.
As more and more elderly people become part of the
nurses' clientele, all of the nurses' scientific and
humanistic resources are tapped.
Not only are there
multiple medical problems and nursing needs that must be
managed simultaneously, but psychological and socioeconomic problems must be attended as well.
1
When one
2
approaches a frail older person with multiple diseases
that require several modes of treatment, more than the
usual degree of assessment, clinical judgment and nursing
proficiency is required
(Brunner and Suddarth, 1984).
Illness and the disabilities of the aged have been
disproportionately emphasized for too long.
Resulting
negative attitudes about the elderly have become societal
stereotypes even among health care personnel.
Most
nursing curriculums and clinical experiences have concentreated heavily on acute illness and exacerbation of
chronic disease.
absorbed
Many older persons have themselves
these negative societal attitudes, with the
result that they do not perceive themselves as being in
control of their own lives.
The first step is to change
the focus in the care of elderly persons from illness to
wellness, with emphasis on preventive care and health
maintenance
(Dunn and Agel, 1983).
Statement of the Problem
Until recently, nursing education had focused
mainly on the care of the young and the adult.
There had
been only minimal recognition of the health problems
specific to the older individual.
Therefore there was a
need for an education model for nursing care of aged
patients that was appropriate for the second year curriculum of a nursing program.
3
Purpose of the Study
The purpose of the study was to utilize the current information to develop a contemporary education model
for the nursing care of aged patients that can be utilized
for the instruction of second year nursing students.
Limitation of the Study
The needs assessment results are limited to the
completion of the "Need Assessment for Care of Aged
Patients" by enrolled students in the second year of the
Associated Degree Nursing Program at Los Angeles Valley
College in Van Nuys, California.
The information included in the education model
does not necessarily include basic information which is
usually included in the first year of an associate degree
nursing program.
Definition of Terms
To assist the reader, the following is a list of
terms defined as they apply to this study:
Geriatric nursing:
is concerned with meeting the
needs of the "ill" elderly.
Gerontological nursing:
is concerned with meeting
all of the health care needs of the elderly, with emphasis
on preventing illness; and promoting, maintaining, and
restoring health.
4
Aged, elderly, and older adult:
are used inter-
changeably to refer to individuals over the age of 65.
Preventive care and health maintenance:
include
maintaining health and function with an accent on wellness;
as well as detecting disease at an early stage and preventing the deterioriation of an existing condition.
Homeostasis:
refers to the state of equilibrium
of the internal environment, usually relating to the state
of relative constancy of body fluids as to their chemical
and physical properties.
Acute disease:
having a rapid onset, severe
symptoms, and a short course.
Chronic disease:
disease.
long drawn out, or long term
Chapter 2
REVIEW OF THE LITERATURE
The review of the literature involved five areas
that were relevant to this study.
They were:
(1) the
need for courses relating to the nursing care of aged
patients; (2) concerns related to the health of the aged;
(3) preventive care and health maintenance for the aged;
(4) general considerations and approaches in the nursing
care of aged patients; and (5) planning nursing care for
aged patients in specific problem areas.
The Need for Courses Relating to the
Nursing Care of Aged Patients
The need for courses relating to the nursing care
of aged patients was addressed by Dunn and Abel (1983)
Gerontological content in basic curriculums is
too often lacking or poorly focused.
America's
burgeoning over-65 population calls out for nurses
with the specific education required to understand
the needs and strengths of older adults (p. 111).
This need was also recognized by Futrell, et al, (1980),
as follows:
Although interest and concern for the health
and well-being of all persons seem to be growing,
social enlightenment with regard to health matters
of persons over 65 years of age has not kept pace
with that of other age groups.
Even those in the
health care professions of medicine, nursing, and
social work tend to focus on the acute illnesses
of the young and middle-aged rather than on the
health problems of the older individual (p. 32).
5
6
In 1980 the population 1n the sixty-five years of age and
older was estimated to be twenty-four million or about 11%
of the total population.
By the year 2020 the proportion
was projected to be about 16% of the total population
(Bureau of Census, 1978).
This rapid increase of the
elderly in numbers and in proportion to the total population and the strong association between age and morbidity
and disability for chronic diseases indicate a continued
increase in the demand for health related services to the
elderly (Coe, 1983).
With the growing number of older patients in the
health-care facilities, there came an increasing indication that health problems were more serious for the aged
than for younger people.
Eliopolus (1979) states that,
once present, health problems are more troublesome for
the aged, usually requiring a longer recovery period and
often subjecting the individual to multiple complications.
A simple health problem for.the younger adult can be lifethreatening to the aged individual.
It becomes evident
that the nursing education which was originally centered
upon the needs of the young and the adult, has been sadly
lacking in information relative to meeting the needs of
this prevalently older patient population.
Another strong factor influencing the interest in
the care of the older patient was related to the recent
legislation which established a prospective payment system
7
based on Diagnostic Related Group [DRGs] categories that
allowed pretreatment diagnostic billing categories for
almost all United States hospitals reimbursed by Medicare.
According to Shaffer (1983), this legislation developed in
an effort to resolve the chronically inflated cost of
hospital treatment which had contributed to the looming
federal deficit and the dangerof insolvency of the Medicare trust fund.
Lee (1984) stated that
With the limiting of the amount of reimbursement,
there has been a challenge to nurses to improve the
quality of care for the older patient in order to
conform with earlier discharge, and an emphasis on
the prevention of complications during the hospital
stay (p. 28).
Also involved with this problem of lack of
information about the specific needs of the aged patient
in nursing education, was the general unwillingness or
reluctance of nurses to work with geriatric patients in
general hospitals and extended care facilities.
Research
has shown a positive correlation between the numbers of
misconceptions about the aged, and the expressed interest
in working with them among nurses.
In addition it was
found that nurses who showed greater preference for
working with geriatric patients actually had spent more
time caring for them (Campbell, 1971).
8
Kayser (1978) indicated that
If nursing educators want students to consider
working with the elderly after they finish their
professional education, theoretical content and
clinical experience related to the aged patient
must be provided during their educational career
(p. 230).
/
General Concerns Related to the
Health of the Aged
According to Eliopoulos (1979), the multiple and
often simultaneous changes associated with the aging
process require complex and arduous adjustments.
It has
been sometimes difficult for the aging person to accept
the declining efficiency of the body.
Common results of
declining function are illness and disability.
Eliopoulus (1979) goes on to say:
A fear that the aged have is that their illness
or disability may cause them to loose their independence.
Becoming a burden to one's family, being
unable to meet the demands of daily living and
having to enter a nursing home are some of the fears
associated with dependency .... Children and parents
may have difficulty exchanging dependent-independent
roles.
The physical pain which an illness produces
may not be nearly as intolerable as the dependency
it causes (p. 44).
At a time when physical problems brought a financial drain, the aging person often also faced a reduced
income, usually because of retirement.
Futrell, et al.
(1980) contended that the elderly had lower incomes than
most younger people do.
Statistics show that a greater
proportion of the elderly (15%) than of the total United
States population (12%) are poor.
A reduction in income
9
triggers off a whole series of other adjustments.
Eliopoulos (1979) indicated that relocation to a less
expensive housing may be necessary.
Dietary practices may
be severely altered, and health care viewed as a luxury
over which basic expenses such as food and rent take
priority.
Lowered income was not all that resulted from
retirement.
As discussed by Eliopoulos (1979):
Retirement is especially difficult in a society
like ours, where an individual's worth is commonly
judged by his or her productivity. Also, occupational identity is largely responsible for an
individual's social position and for the social role
attached to that position ....
The social and emotional impact from retirement
is compounded by separation in today's nuclear
family unit as well as the possible death of a
spouse .... Thus, loneliness and desolation often
emphasize the other changes that occur with growing
old (p. 36).
When one experiences altered dietary practices,
infrequent health care, a decrease ln feelings of selfworth, loneliness, and desolation; an increased risk of
physical illness exists.
Even the physical illness of the elderly person
were more difficult.
Adams (1977) recognized three
predominent patterns of disease in old age; a preeminence
of degenerative diseases, a chronic nature of diseases,
10
and the presence of multiple pathology.
He further
stated,
In early life the symptoms and signs of illness
can usually be explained by a single diagnosis, but
in old age, both precise diagnosis as a basis of
treatment and the assessment of disability, are
often compounded by the number or active, or inactive,
pathological processes affecting the outcome (p. 15).
The increase in numbers of elderly people, and the
resulting increase in the incidence of chronic diseases
seemed to reveal a lack in our health services to deal
with the problem.
Coe (1983) expressed this as follows:
Many observers have noted that the success of
public health measures and medical technology in
controlling many infectious diseases has not yet
been duplicated for chronic diseases. By almost
any conventional yardstick of health of illness,
there has been less improvement for the elderly
than for other age groups. There are many reasons
for this "failure of success" beyond the limitations
of medical technology. One is that health services
in the United States are organized and financed to
deal primarily with acute illness, hence the heavy
emphasis on inpatient care, episodic treatment, and
specialized facilities.
Care of persons with chronic
conditions does involve acute care, but mostly it
requires services that emphasize out-of hospital care,
continuous monitoring, and coordination of medical
with support services ....
Another factor is the attitude of health care
providers toward aging as a process and toward the
care of the elderly. To some extent, providers
share prevailing societal values, which may include
negative stereotypes of elderly persons. It is
important that health professionals be aware of their
own attitudes and the influence they may have on
providing care for elderly patients (p. 5).
With all the adjustments and problems that the
elderly face along with the aging process, it seems
ridiculous that elderly people should also have to deal
11
with negative attitudes from society and health care
providers about "old" people!
Epstein (1977) observed
that:
Even those of us who seem pretty free of the
constraints of stereotyping and prejudices are often
surprised to discover in our own thinking errors
and misconceptions on which we are basing our
decisions and attempting our communications: Old
people are conservative and rigid; therefore, old
people should be forced out of key decision-making
positions if we are to make progress as an institution and as a nation.
Old people prefer to associate
with people their own age; therefore, assign them to
room together and to live together.
Old people are
concerned mainly with their children and grandchildren; therefore, don't talk to them about politics
or sex ....
Unless we die young, old age is inevitable.
It
can be a good time for us when we come to it, but
only if we make it a good time for those who are
there now.
The answer lies largely in the willingness to enter upon a process of fostering communication, the ultimate result of which is the ability to
see every person as unique, with an essential dignity
that is a function of his own conception of self
(p. xii).
Preventive Care and Health Maintenance
for the Aged
Preventive care for the aged included most of the
same elements as those required for younger people.
However, there were some significant variables.
Brunner
and Suddarth (1984) explained them as follows:
Preventive health care in the elderly is most
important because people in this age group have
less resilience and suffer more deleterious consequences from any breakdown in homeostasis.
Preventive care in the elderly means maintaihing health
and function, detecting disease at an early stage,
and preventing the deterioration of an existing
condition.
'
6
12
People who care for and about the aged must have
a positive feeling about the health potential of
these elderly patients.
[One has to be "tough" to
reach old age.]
Older persons must be educated about
health conservation (p. 260)
Futrell, et al, (1980) refered to it as health
promotion and said,
Health promotion for the elderly, then, may be
defined as the promotion of all those factors that
help them achieve the maximum level of wellness or
functioning of which they are capable (p. 30).
They identified the important elements for health promotion as being; regular health appraisal, nutritional
support, planned regular exercise, and avoidance of
substances injurious to health.
Accident prevention was also an important part of
health promotion.
Combs (1978) said that changes to reduce
risks can often mean the difference between healthful
living and crippling disabilities.
She commented further:
The contributing factors to accidents are both
physiological and environmental.
Changes that occur
with aging result in a slowed response or reaction
time under stress, accompanied by a decrease in
reserve capacities of organ systems.
Other factors
that increase the likelihood of accidents are acute
illnesses, uncertain gait, changes in the balancing
mechanisms, changes in vision and hearing, a decrease
in sensation of pain, and effects of medication.
If
an accident, such as a fall, does occur, the older
adult is most likely to suffer some disability from
it because of such preexisting problems as osteoporosis.
Safety precautions recommended for the home are
not different, from other age groups.
The major
areas that need assessment are lighting, flooring,
stairways, bathing facilities, and medications (p. 49).
13
Rodstein (1981) recognized the importance of falls
in the aged by saying,
Falls in the aged account for a disproportionate
number of disabling injuries and hospitalization; as
well as prolonged stays in hospitals and other
institutions (p. 109).
He made the following statements about falls in hospitals:
The hospitalized aged are particularly
susceptible to falls.
As many as 90% of all
hospital accidents among the aged are falls,
more than half of which are falls out of bed.
In addition to the many instrinsic accident
hazards inherent to the hospital environment
and the appreciable number due to staff negligence, many age-related factors increase accident
liability (p. 114)
Just teaching the patient about the risk factors for
preventing accidents, or about important health habits will
not necessarily lead to compliance.
Health teaching was an important part of health
promotion as a whole, but it involved much more than
imparting knowledge.
Futrell, et al.
(1980) made the
following suggestions:
The nurse and client may concur that some of
the client's health care needs can be met through
health teaching. At this stage the nurse must
remember that change in health-related behavior
is seldom brought about by new knowledge alone.
Only if the clients see the health information or
self-care procedure as a direct solution to a felt
need will they change their behavior. Human motivation, or what people feel they want or need, is
one of the most important determinants of behavioral
change. When planning care with the elderly,
listening carefully to what they see as their
problems or needs is therefore crucial.
14
Success in teaching the elderly depends a great
deal on the initial assessment and mutual planning
with the client.
Unless aged persoffi can appreciate
the difference this new knowledge will make in their
lives, little change in behavior will take place.
Questions relating to the patient's perceived needs
could help to establish teaching priorities (p. 42)
Eliopoulos (1979) indicated that established
principles of teaching that were used in any patient
education situation would apply when teaching the elderly
patient.
General Considerations and Approaches
1n Nursing Care of the Aged
Basic nursing care for the aged differed somewhat
from that for younger persons.
Many of the adjustments
necessary were small in themselves, but for the aged person
they meant the difference between comfort and well being,
and persistent discomfort of even predisposition to
disease (Newton, 1966).
One of these considerations
involved the regulation of environmental temperature.
As a
person ages the temperature regulation of the body becomes
less efficient.
As Adams (1977) indicated
Like other homeostatic mechanisms responsible
for the constancy of the internal milieu, its
efficiency and responsiveness are apt to be impaired
by age changes .... Hypothermia has been recognized as
a special hazard of old age (p. 55).
-15
Brunner and Suddarth (1984) reported
The skin often shows aging signs first.
With
aging the skin becomes thin and inelastic, predisposing elderly patients to pressure sores .... In the
aged person there is a reduction of sebum, sweat
and the water binding capacity of the skin, resulting
in a tendency to crack.
Keeping the skin clean,
careful rinsing and drying, and lubrication are
necessary (p. 259).
They also emphasized strongly that there was the need for
special care of the feet of an elderly patient and maintain, "The feet of older people have survived a lifetime
of use, misuse, and trauma" (Brunner and Suddarth, 1984,
p. 270).
Another problem that accompanied growing old concerned nutritional inadequacies.
Futrell, et al.
(1980)
considered the problem as follows:
Some of the most common nutritional problems of
the elderly are overnutrition, undernutrition,
dehydration, and iron-deficiency anemia .... Overnutrition, especially in carbohydrates, coupled with
decreased physical activity, causes many of the aged
to become overweight or obese.
Statistics indicate
that obesity reduces life expectancy in the middleaged and aged population; and clearly many conditions known to decrease longevity are less severe
when uncomplicated by obesity ....
Undernutrition among the elderly is also common
partly because budgetary restraints often force them
to skimp on food purchases.
Other factors that may
contribute to undernutrition are reduced perception
of smell and taste and limiting enjoyment of eating,
depression, chronic illness, and drug therapy.
The
aged often eat alone, and grocery shopping and meal
preparation can be difficult, especially if sensory
deprivation or other physical limitations exist ....
There is a prevalence of dietary iron deficiency
in older age groups. Usually an iron supplement or
a diet high in iron is prescribed after a complete
and thorough health assessment ....
16
Dehydration is seen frequently in the elderly;
they need to be continually reminded that adequate
hydration is necessary for proper body functioning.
Dehydration and lack of fiber in the diet of the
aged frequently cause and aggravate constipation
(pp 34-35).
It was not uncommon for the aged to be bothered by
and concerned about constipation.
Constipation was due to
slower peristalsis, inactivity, and a lack of bulk and
fluid in the diet, according to Eliopoulos (1979).
She
recommended plenty of fluids, fruits, vegetables and
activity to prevent and/or treat the condition.
Inactivity, especially bedrest, was extremely
hazardous for the aged person.
Adams (1977) maintained
that, when a patient had to stay in bed, he was exposed
to the risks of thrombo-embolism, osteoporosis,
constipa~
tion, pneumonia, bedsores, incontinence, and apathy.
The apathy that occurred with elderly patients
might also have been a sign to indicate that a patient had
emotional needs.
Brunner and Suddarth (1984) made the
following observations:
Sometimes the transition to a new environment
may bring on temporary states of anxiety, confusion,
regression, and disorientation. Senile behavior may
be exhibited without physiologic cause. The patient
may be misjudged as being senile when the real causes
are fear, depression, and a feeling of hopeless
inadequacy. When symptoms of senility occur, such
as confusion, incontinence, etc., act on the assumption that they are temporary. The nursing approach
should be a positive one, conveying the idea that the
problem can be altered ....
17
The elderly fear loneliness and dependency with
all their attendant pains and anguish. As soon as
the patient enters the hospital, references and
plans should be made concerning discharge from the
hospital. This dispels much of the ever-present
fear of invalidism, dependency and death.
The understanding nurse can do much to help the
patient over this hump of transition between home
and institution. Placing the patient near another
patient provides an opportunity to talk to someone
and helps in making the necessary adjustments to
the hospital environment. Touching the patient's
hand or shoulder when giving explanations is
especially helpful in promoting acceptance, relaxation, and confidence. Many older people have lost
all of their social contacts, and the nurse may be
the only "caring" person (p. 266).
In order for the nurse to become aware of the
emotional and spiritual needs of an elderly patient it
was necessary to establish a "communicating relationship."
Futrell, et al. (1980) explained why this may take time and
patience.
The development of relationships may be impeded
by fear resulting from the elderly's experiences of
coping with multiple losses. Multiple losses of
spouse, relatives, and friends, as well as bodily
functions can contribute to their feelings of helplessness and hopelessness. Under these circumstances, the elderly may be fearful of establishing
new relationships that could again lead to feelings
of loss. Recognizing this fact, the nurse should
attempt to establish the relationship slowly.
Although it may take some time before rapport is
accomplished, the relationship must be built on
trust because the nurse often becomes a "significant
other" in a patient's life (p. 66)
One of the most significant developments in
recent years to assist the elderly patient in maintaining
integrity and self-respect has been the self-care theory.
'
0
18
Gress and Bahr (1984) explained some of the aspects of
this theory as follows:
A key component for maintaining health is control
over decisions that affect one's life. Gerontological
nursing standards of practice identify the importance
of having the older person promote, in conjunction
with the gerontological nurse, certain goals and
priorities. Self-care theory requires that the older
individual always retain control of the environment,
decision making, and health practices. The older
person realizes that caring does mean loving by the
gerontological nurse in the self-care modality. The
concern and respect for personhood is an attitude
that cannot be denied to the older person. Self care
as a theory in nursing promotes the individual's
personhood in body, mind, and spirit. To neglect
any area or dimension of personhood is a violation of
the trust placed in the gerontological nurse by the
older person. To assist the elderly person in maintaining integrity and self-respect as aging takes
place is a responsibility of the gerontological
nurse ....
To help older people fulfill their potential
will profit society at large. A healthier older
population generally and each older person specifically are on the brink of self-actualization. What
greater goal could gerontological nursing ask?
(p 137).
An additional concern for the elderly patient
involved changes in response to medications that occur
with age.
Hayter (1981) summarized these changes thus:
Physiological alterations affect all of us as we
age, but individuals vary widely in function and not
all drugs are affected identically. Furthermore,
the body acts as a unit, not as separate physiological systems, so one change affects other body
functions- an extra load on the kidneys affects the
heart, changes in liver function affect elimination,
and so on. It is impossible, therefore, to derive a
formula for calculating geriatric doses similar to
the formulas for calculating pediatric doses.
19
Each individual's response to each drug is
unique, but some generalizations can be drawn:
-Slower absorption and distribution of drugs
mean that drug effect is not likely to be apparent
as soon as in a younger person. Therefore, the
nurse would guard against repeating the dose or
notifying the physician that the expected effect
did not occur.
-Less rapid breakdown and excretion mean that
drugs may remain active for a longer time.
-Cumulative effects are likely if a drug is
taken for several days, so smaller doses are
needed.
-Reduced absorption but normal metabolism and
excretion, on the other hand, will require larger
than average doses.
No one would deny the benefits that drugs
afford older persons, but all of us need to recognize
the risks involved. Although solutions are not
available for all the problems, enough is known to
decrease significantly the hazards faced by the
elderly and, thus, to improve the quality of their
lives (p. 17).
Poe and Holloway (1980) listed other risks in drug
therapy including; drug interactions in multiple pathology,
the similarity of drug side effects with the characteristics of old age, further physiological changes due to
the stress of illness, and the questionable compliance of
elderly people to medical regimen.
Brunner and Suddarth
(1984) maintained that patient compliance would be
improved when the drug regimen was kept as simple as
possible, and when the patient was made a partner in the
drug-taking regimen.
In recent years there has been an emphasis upon a
"new" approach to health care for the elderly.
Stimulated
by pressures from Medicare DRGs the health care experts,
in looking for more cost-effective alternative health care
20
methods, have been giving more attention to ''home health
care."
Burnside (1980) provided some insight into this
trend:
The home has always been the primary institution for care of the sick, disabled, and elderly;
in the past, such care was rendered by family and
friends. Reliance on institutional care in hospitals and nursing homes is a twentieth century
phenomenon, as is the professionalization of home
health care.
Using the services of the family, friends, and
home health care should be the first alternative
when an elderly person cannot manage alone.
Priority should be placed on a continuity of effort
through a multidisciplinary team approach to make
the home not only the place of choice, but the
place where adequate care can and will be provided
as long as it is needed (p 90).
In his book, Home Health Care for the Aged,
Bricker (1978) made the following observation:
Older people have positive feelings about their
own homes because there they are in a familiar
environment. They can eat, watch television, sleep,
and rise on their own schedule. They can keep the
light on late, find the bathroom in the dark.
Independence is limited only by degree of frailty
(p 57).
In 1974, the U.S. Senate Subcommittee on Long Term
Care concluded:
If home health care services are readily
available prior to placement in a nursing home,
there is convincing evidence to conclude that such
-care may not only postpone, but possibly prevent
more costly institutionalization. What is
particularly appealing from the standpoint of the
elderly, is that home health services can enable
them to live independently in their own homes,
where most of them prefer to be (Dept. of Health,
Education and Welfare, 1976, p 16).
21
The use of the Nursing Process appears to be a
particularly effective tool to use in planning nursing
care for elderly patients.
This opinion was upheld by
Gress and Bahr (1984):
The older person is characterized in part by
unique health care needs and problems, which are
of concern to health care providers. The Nursing
Process is a descriptive framework used in the
problem solving approach to health care needs and
problems. The Nursing Process can be used with
individuals in varying stages of development and
experiencing varying levels of wellness. It
provides a means of initiating a systematic approach
to the health care of older adults in various
settings through an individualized plan of care.
Documentation of the Nursing Process's various
steps aids in formalizing nursing practice (p 192).
Eliopoulos (1979) enlarged on this theme in the
opening paragraph of her chapter, "The Nursing Process
and the Aged,":
As mentioned in the previous chapter, the
Nursing Process requires an orderly, organized,
and intentional approach to the delivery of nursing
services. When knowledge regarding both normal
aging and the specific differences of aged persons
is added, the result is a complete system of nursing
care for aged individuals. There are four phases
of the nursing process: (1) an initial assessment,
(2) specific planning to compensate for limitations
and to maintain and strengthen the capacities of
the individual, (3) implementation of these plans
through a variety of selected nursing actions, and
(4) evaluation of the effectiveness of these
actions in achieving the desired outcomes. This
evaluation, in turn, provides feedback that may
stimulate a reassessment and establishment of new
plans, and so on (p 84).
22
Planning Nursing Care for Aged Patients
in Specific Problem Areas
In the aging process, physiological changes seem
to give way to pathophysiological changes, and as a
result there are some diseases to which the aging person
is prone.
Cape (1983) stated:
There are some main physiological changes
which accompany aging. These modify and alter the
behavior of disease. As function tends to be
reduced with aging, morbidity increases.
From 60
years onward there is an intermingling of aging
and morbidity which results in the complexity of
clinical presentations and the frequency of
multiple pathological changes found in the old
(p 37).
Brunner and Suddarth (1984) indicated that some of
the specific diseases that occurred frequently with
ag1ng were as follows:
The aged are particularly vulnerable to disease
because of such factors as their decreased physiologic reserve, a less flexible homeostatic mechanism,
and lessened defense mechanisms of the bGdy.
Chronic
diseases have been called the companions of the aged,
and most persons over 65 are affected by at least
one chronic disease. The major disorders of old age
include heart disease, malignancy, cerebrovascular
disease (mainly senile dementia and stroke)
influenza, and pneumonia.
Coronary heart disease
is the most frequently seen cardiac condition ....
Many of the disabilities associated with old age
develop as a result of degenerative vascular
disease, namely, arteriosclerosis (pp 261-262).
No matter which pathophysiological changes have
beset an elderly patient, if the nurse uses the Nursing
Process in an orderly manner, she should be able to plan
and provide effective nursing care for that patient.
However, increased research in the area of effective
23
geriatric nursing practice is necessary to develop specific standards by which the application of the Nursing
Process to aged individuals can be evaluated.
Perhaps the most significant use of the Nursing
Process pertains to the promotion of emphasis upon preventive care and health maintenance.
With this tool
nurses will be stimulated to give early attention to all
the potential threats to the "wellness" of the elderly
patient.
Chapter 3
METHODOLOGY
The methods used to develop the education model
for nursing care of aged patients involved four phases:
(1) a search of the current literature and textbooks to
identify material which is specifically relevant to
enlightened nursing care of the aged patient; (2) the
construction, pre-testing, administration and analysis of
the needs assessment questionnaire;
(3) the development
of the education model; and (4) the validation of the
education model.
Phase I: The Review of
the Literature
The initial part of the review of the literature
consisted of material which offered a rationale for the
development of the education model for nursing care of
aged patients.
The remaining portions of the review
contained material which related directly to the content
for the education model.
Special effort was made to
identify material that was appropriate for the second year
nursing student, not necessarily duplicate information
covered in other courses in a nursing program (i.e.: fundamentals of nursing and medical-surgical nursing).
24
25
The materials thus chosen were divided into four
categories, or units for organization into the education
model.
These units were:
(1) introduction to concerns
related to the aged, (2) preventive care and health
maintenance for the aged,
(3) general considerations and
approaches in nursing care of the aged, and (4) planning
nursing care for aged patients in specific problem areas.
(Chapter 2 presents the review of the literature).
Phase II: The Needs Assessment
Questionnaire
The purpose of the questionnaire was to assess
the knowledge of the students concerning the nursing care
of the aged patient, to identify areas in which knowledge
was particularly lacking, and to further justify the
development of the education model.
The construction of the needs assessment questionnaire involved the formulation of twenty "true-false"
items.
These items were chosen from the material included
in the review of the literature and consists of information from each of the four categories selected for the
education model.
(See Appendix A)
Pre-testing of the needs assessment questionnaire
was accomplished by administering it to twenty second year
nursing students at Los Angeles Valley College.
The
questionnaire was administered under the conditions
similar to those planned for its final implementation .
•
rl
26
The results of the pre-testing were analyzed to decide the
effectiveness of the trial questionnaire, and appropriate
modifications were made.
Administration of the needs assessment questionnaire required from ten to fifteen minutes and was administered to fifty second year nursing students in a
medical-surgical class at Los Angeles Valley College, at
the beginning of a regular class session.
Voluntary
participation was solicited and a brief oral explanation
was made to assure the students of their anonymity.
After
the directions were read, the questionnaires and answer
sheets were distributed.
Analysis of the needs assessment questionnaire
indicated that there was a definite need for instruction
in all four categories, particularly in the area of
"planning nursing care for aged patients in specific
problem areas."
Although the results as a whole indicated
that 76% of the total items were answered correctly, the
fact that 30% (n=6) of the items had 30% or more incorrect answers and 20% of the students (n=lO) missed 40% or
more of the items would lead to the conclusion that the
second year nursing students had a need for a course
which provided specific information about the nursing care
of aged patients.
27
Phase III: The Development of
the Education Model
Through utilization of the review of the literature and the results of the needs assessment questionnaire,
the Education Model for Nursing Care of Aged Patients was
developed for second year nursing students in an associate
degree program.
Essential prerequisites for students
would include college classes in pharmacology, physiology,
fundamentals of nursing and psychiatric nursing.
The following units were developed for the model:
I.
II.
Introduction to Concerns Related to the Aged
Preventive Care and Health Maintenance for
the Aged
III.
General Considerations and Approaches 1n
Nursing Care of the Aged
IV.
Planning Nursing Care for Aged Patients in
Specific Problem Areas
The theories of health instruction as presented
by Fodor and Dalis were adapted throughout the model:
with health generalizations, learning objectives, content
outlines, learning opportunities, and resources developed
for each unit (Fodor and Dalis, 1981).
28
Phase IV: Validation of the
Education Model
A Curriculum Evaluation Form (See Appendix B) was
prepared to assess the efficacy of the model.
Seven
specific components were included:
1)
That the information about nursing care of
aged patients was up-to-date.
2)
That the model was directed at the level of
the second year nursing student.
3)
That the behavioral objectives were realistic.
4)
That the model content was presented in an
organized manner.
5)
That the model content was presented ln an
interesting manner.
6)
That the learning opportunities were applicable
to the classroom.
7)
Suggestions that the evaluator could make for
the improvement of the model.
The Education Model for Nursing Care of Aged
Patients was submitted to a jury of experts.
These
experts have been actively involved in some facet of
nursing care of aged patients.
(See Appendix C)
The
experts were contacted in person prior to their receipt
of the Education Model for Care of Aged Patients.
They
were given a copy of the model, a Curriculum Evaluation
Form, and requested to return the material within two
29
weeks.
Those experts who failed to meet the deadline
were contacted and asked to complete their evaluation.
The evaluations were utilized to refine the
curriculum and suggestions from the experts were incorporated into the final curriculum.
Chapter 4
THE EDUCATION MODEL FOR CARE
OF THE AGED PATIENT
The Education Model for Care of the Aged Patient
is divided into four units:
(1) Introduction to Concerns
Related to the Aged; (2) Preventive Care and Health
Maintenance for the Aged; (3) General Considerations and
Approaches in Nursing Care of the Aged; and (4) Planning
Nursing Care for Aged Patients in Specific Problem Areas.
Health generalizations and behavioral objectives were
developed for each unit.
Suggested learning opportunities
and resources were also included for each health generalization.
The main points of the model are outlined in
Appendix D.
Proposed Implementation Plan
The Education Model for Nursing Care of Aged
Patients was designed specifically for the second year
nursing student in an associate degree nursing program.
It was designed for a one unit semester course.
The classroom should be well ventilated and well
lit, with chalkboards available.
The classroom should
have adequate space to permit small discussion groups
that would not disturb each other.
The equipment for the
implementation of the course should include:
30
a
31
duplicating machine, pamphlets, handouts, overhead projector, transparencies, projector screen, film strip
projector, film strips, chalkboard, chalk, chalk eraser,
paper, pens, and pencils.
The Evaluation Scheme
Evaluation is not just a terminal activity, rather
it should begin before the development of a program in
order to provide a meaningful program to meet the needs
of learners.
Evaluation provides the opportunity to
determine the effectiveness of the instruction and to
identify areas of strengths and weaknesses (Fodor and
Dalis, 1981).
It is necessary to evaluate anyone who is
involved with the instructional program.
The learners can be evaluated by paper and pencil
tests, which would be given as post-tests.
K)
(See Appendix
It would also be interesting to use the Needs Assess-
ment for Care of the Aged Patient (See Appendix A) as a
pre-test and post-test to compare the results.
If
desired, the Nursing Care Plan, which was assigned in
Unit IV., Health Generalization B, could be used as an
objective evaluation tool, by assigning value to the
various parts of the Nursing Care Plan.
"The Education Model for Nursing Care of Aged
Patients" should also be evaluated by the learners.
learners could be asked to fill out the Evaluation
.
tl
The
32
Questionnaire (See Appendix L) in the last fifteen minutes
of the course, following the post-test.
The questionnaire
includes questions about the total course, including
objectives, content, learning opportunities, and resources.
The instructor can be evaluated by the learners
by adding another page to the Evaluation Questionnaire.
Questions about the instructor might include the following
points:
voice and manner, knowledge of the subject,
organized approach, ability to arouse interest, use of
teaching aids, thoroughness, use of questions, practical
application of information, answering students' questions,
and variety of learning opportunities.
. u
AI\! EDUCATION MODEL FOR NURSING CARE
OF AGED PATIENTS
33
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION A. There are interlocking reasons for the increase in the
hospitalization of older adults in the United States.
OBJECTIVE - Following instruction, the student will be able to discuss at least
three underlying reasons for the increased hospitalization of older adults
in the United States. (interpretation)
CONTENT OUTLINE
I. Population Changes in U.S.
in the over 65 age group
A. In 1980
1. Estimated 24,000,000
2. About 11% of the
'
total
B. By 2020 projected to be
16% of the total
II. Increase in health
problems in over 65 age
group
A. More degenerative
conditions, physical
and mental
B. Multiple pathology and
chronic diseases
I.
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
In a lecture format, the
instructor will introduce the
lesson by presenting the
information about the
increased hospitalization of
of older adults.
Teacher
Cape, Ronald D. ,
Rodney M. Coe, and
Isadore Rossman
(editors) Fundamentals of Geriatric
Medicine, Raven
Press, New York
1983, pp. 3-5/
IIa. The instructor will stimulate
a class discussion by asking
the following questions:
1. Have you been aware of the
increase in numbers of older
adult patients?
2. Do you feel that the
illnesses of older adults
Adams, George,
Essentials of
Geriatric Medicine,
Oxford University
Press, 1977,
pp. 13-19.
(.N
..;:::.
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION A~ There are interlocking reasons for the increase in the
hospitalization of older adults in the United States. (continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
C. Accidents common and
more serious due to:
1. weakness
2. confusion
I Ib.
3. poor eyesight
D. Insidious onset of
certain diseases
E. Altered responses to
illness including:
1. unstable regulation
of body temperature
2. irregular water/
electrolyte balance
3. diminished pain
sensitivity
4. changes in
responses to drugs
5. loss of initial
organ reserves
6. retarded healing.
RESOURCES
are more serious and prone Teacher and Students
to complications?
Eliopoulos, Charlotte,
Gerontological
Nursing, Harper & Row,
In a lecture format, the
New York, 1979,
instructor will present the
pp. 1-33.
various types of illnesses
Brunner, Lillian S.,
that are more common to the
& Doris S. Suddarth,
elderly population, using a
Textbook of Medicalpreviously prepared transparSurgical Nurs1ng,
ency projected by an overhead
J.B. Lippencott,
projector.
1984, pp. 256-258.
The students will take notes.
Gault, Patricia L.
"Plan for a Patchwork
of Problems When Your
Patient is Elderly."
Nursing 82, 12:1,
pp. 50-54.
.(J..l
U1
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION B. The increase in hospitalization of older adults has had an
appreciable impact upon the available health care.
OBJECTIVE - Following instruction the student will be able to list five of the
current factors which limit adequate health care for the older adult.
(knowledge)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
I. Factors limiting the
provision of health care
A. Complexity of the
health problems of
the elderly
B. Inadequate preparation
of professionals in
specific needs of the
elderly
C. Lack of emphasis upon
preventive and
maintenance care
D. Lack of retirement
incomes
Ia. In a lecture format, the
instructor will introduce the
lesson by providing the five
factors limiting the provisions of adequate health
care for the older adult.
The student will take notes.
Ib. The instructor will stimulate
a class discussion by asking
the following questions:
1. What are some of the
factors which we talked
about previously which
result in difficulty in
care of the elderly?
RESOURCES
Teacher
Futrell, May, et al.,
Primary Health Care
of the Older Adult,
Dusbury Press,
N. Scituate, Mass.,
1980' pp. 11-23.
Adams, George,
Essentials of
Geriatric Medicine,
Oxford University
Press, 1977,
pp. 13-19.
(j-1
0\
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION B. The increase in hospitalization of older adults has had an
appreciable impact upon the available health care. (continued)
CONTENT OUTLINE
E. Recent changes in the
Medicare System of
reimbursement
involving:
1. limitation of
coverage
2. earlier discharge
SUGGESTED
LEARNING OPPORTUNITIES
2. Do you recognize any
inadequacies in the
approach of the health
care personnel to the
care of the elderly?
3. In what ways do you feel
preventive health care
might improve the health
status of older adults?
4. Have you recognized any
potential problems that
are related to the recent
requirement for earlier
discharge?
The student will take part
in the discussion.
RESOURCES
Teacher and Students
Eliopoulos,
Charlotte, Gerontological Nursing,
Harper & Row,
New York, 1979,
p. 44.
Vl
"'--J
""
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION C. Increased knowledge concerning aging and the needs of the
elderly may lead to more positive attitudes and more enlightened health care.
OBJECTIVE #1 - Following instruction, the student will be able to list at least
six ways in which negative attitudes toward the elderly are manifested during
the health care of the elderly patient. (knowledge)
OBJECTIVE #2 - Following instruction, the student will be able to identify at
least four requirements more enlightened health care of the older adult.
(knowledge)
OBJECTIVE #3 - Following instruction, the student will be able to detect the
underlying stereotype that is evidence in at least seven of the examples
given in the list in Appendix E. (analysis)
CONTENT OUTLINE
I. Evidence of negative attitudes shown by health
professionals toward the
elderly.
A. Stereotyping
B. Reinforcing dependency
by making decisions
for them
C. Insensitivity to
individual identity and
SUGGESTED
LEARNING OPPORTUNITIES
I. The instructor will introduce
the lesson by asking the
students to recall any
examples that they have
observed that might indicate
negative attitudes toward the
elderly.
The students will take part
in the discussion
RESOURCES
Teacher
Epstein, Charlotte,
Learning to Care for
the Aged, Reston
Press, Reston, Va.,
19 7 7 ' pp . 4 5 - 7 7 .
(.N
00
""
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION C. Increased knowledge concerning aging and the needs of the
elderly may lead to more positive attitudes and more enlightened health care.
(continued)
CONTENT OUTLINE
D.
E.
F.
G.
H.
SUGGESTED
LEARNING OPPORTUNITIES
dignity shown by
assembly line
approach
Calling them "pet
names"
Not consulting them
about their
preferences
Lack of respect for
their individuality
Segregation
Not taking time to
listen to them
II. Examples of stereotyping
which relate to the
elderly:
A. Old people are sick
and disabled.
B. Most old people are
in nursing homes.
RESOURCES
Teachers and Students
Eliopoulos,
Charlotte, Gerontological Nursing,
Harper & Row,
New York, 1979,
p. 4 7.
IIa. The instructor will hand out
3x5 cards, each one with one
of the i terns from Appendix
E "Stereotyping," written on
it, one card to each of ten
students. Those students
will take turns in reading
Appendix E.
"Stereotyping."
lN
1.0
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION C. Increased knowledge concerning aging and the needs of the
elderly may lead to more positive attitudes and more enlightened health care.
(continued)
CONTENT OUTLINE
C. Senility comes with
old age.
D. Old people are
cranky.
E. Old people have lower
intelligence.
F. Old people are
resistant to change.
G. Old people aren't
able to have sexual
intercourse.
H. Old people aren't
interested in sex.
I. Old people are weak
and incompetent.
J. Old people have the
same interests.
K. Old people cannot
handle stress
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
the item and asking the
other students to respond
to the item from the standpoint of a person age 70.
lib. The instructor will ask the
students to recall examples
of stereotyping that they
have observed concerning
elderly people. After they
have finished, the
instructor will use one
word clues to try to get the
students to complete the
list in the content outline.
The student will take part
in the exercise.
.j::>.
0
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION C. Increased knowledge concerning aged and the needs of the
elderly may lead to more positive attitudes and more enlightened health care.
(continue d)
CONTENT OUTLINE
SUGGESTED
OPPORTUNITIES
RESOURCES
LEAR~ING
L. Old people aren't
interested in modern
activities.
M. Old people don't have
common sense.
I I I. Requirements for
enlightened care of the
elderly:
A. Gaining knowledge of
true effects of
aging.
B. Development of a
relaxed and respectful approach.
C. Recognizing
individual needs and
expectations.
D. Working for more
successful
communication.
Ilia. The instructor will ask the
students for suggestions for
more enlightened care of the
elderly, while she writes
them on the chalkboard. She
will stimulate them with
clues to complete the list
in the content outline.
Concept Media, Myths
and Reali ties: Perspectives on Aging,
35 mm. Filmstrip,
25 minutes, Irvine,
Ca. 19 79.
IIIb. The instructor will show the
filmstrip, Myths and
Realities. Then, the
instructor will stimulate
class discussion by asking:
+:>
f-l
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION C. Increased knowledge concerning aging and the needs ''of the
elderly may lead to more positive attitudes and more enlightened health care.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
E. Making the effort to
see the individual
as a whole person.
F. Using restraints only
as a last resort.
G. Stimulating an
interest in the
outside world.
1. Did the filmstrip mention any myths that you
had never heard of
before?
2. Did you feel any of the
situations shown as
reality were exaggerated
or understated?
3. Were there any parts of
the filmstrip that caught
your special interest?
The students will take part
in the discussion.
RESOURCES .
..j::>.
N
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION D. The multiple changes associated with aging require complex
and arduous adjustments.
OBJECTIVE - Following instruction, the student will be able to recall at least two
specific adjustments that are related to each of the three major areas of
adjustments involved with aging.
(knowledge)
CONTENT OUTLINE
SUGGESTED
OPPORTUNITIES
RESOURCES
LEAP~ING
--------------------------4-----------------~-----------
I. Three major areas of
adjustment
A. Functional adjustments
1. Changes in appearance
2. Declining body
function
a.. slow response
b. loss of strength
c. easy fatigue
3. Men tal changes
a. poor memory
b. slower thinking
B. Adjustments to reduced
income
1. Changes in life
style
2. Food buying
restrictions
Ia. The instructor will draw
three columns on the chalkboard, and fill in the three
headings of: Functional
Adjustments, Adjustments to
Reduced Income, and Psychosocial Adjustments. 1~en
a class discussion will be
stimulated by asking the
students to suggest specific
adjustments under each
heading along with an
explanation for each.
Ib. The students wi 11 then be
asked to share any insights
they might have about which
of these adjustments would
Teacher
Futrell, May, et al.,
Primary Health Care
of the Older Adult,
Dusbury Press,
N. Scituate, Mass.
1980,pp. 11-22.
Muhlenkamp, Ann F.,
et al., "Perception
of Life Change
Events by the
Elderly," Nursing:
The Older Adult,
compiled by Andre a
B. O'Connor.
American Journal of
Nursing Co., New
York, 19 7 8, pp. 52-60.
~
V'l
UNIT I.
Introduction to Concerns Related to the Health of the Aged
HEALTH GENERALIZATION D. The multiple changes associated with aging require complex
and arduous adjustments.
(continued)
CONTENT OUTLINE
3. Dependence on others
C. Psychosocial adj us tmen ts
1. Retirement
2. Family changes
3. Awareness of
mortality
4. Loneliness
5. Societal prejudice
SUGGESTED
LEARNING OPPORTUNITIES
be the most difficult.
The students will take part
in the discussion.
RESOURCES
Teacher and Students
Eliopoulos,
Charlotte, Gerontological Nursing,
Harper & Row,
New York, 19 79,
pp. 3 7-48.
~
~
"'
_uNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION A. Accidental injuries may be prevented by following some
relatively simple guidelines.
OBJECTIVE #1 - Following instruction, the student will be able to recall at least
three guidelines to prevent falls in the home.
(knowledge)
OBJECTIVE #2 - Following instruction, the student will be able to recall at least
four approaches to prevent falls in each of the three hazard are as in the
hospital.
(knowledge)
OBJECTIVE #3 - Following instruction, the student will be able to recall at least
four risk factors related to aging which might increase the chances for
accidents.
(knowledge)
CONTENT OUTLINE
SUGGESTED
OPPORTUNITIES
RESOURCES
LEA~~ING
I. Guidelines to prevent
falls in the home
A. All stairs should have
hand rails.
B. Grab bars should be by
bathtub, shower, and
toilet.
C. Shoes should fit
properly and be
fastened.
(loose
slippers are a hazard)
I. The instructor will ask the
students to suggest guidelines to prevent falls in
the home. The instructor
lists the suggestions· on the
chalkboard and prompts the
students as necessary by
using the content outline.
The students take part in
the exercise.
Teacher
Combs, Karen L. ,
"Preventive Care in
the Elderly,"
Nursing:
The 01 de r
Adult, compiled by
Andre a B. 0 'Connor,
American Journal of
Nursing Co. ,
NewYork, 1978,
pp. 45-51.
+:>
V1
UNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION A. Accidental injuries may be prevented by following some
relatively simple guidelines.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
D. Frequently used objects
should be stored at low
levels to avoid
climbing and bending.
E. Throw rugs should not
be used.
F. Night lights should
be left on.
II. Guidelines to prevent
falls in the hospital
A. Falling out of bed
1. Instruction on use
of the call bell
for help
2. Keeping the call
bell within reach
3 . I ns t ru c t i on on us e
of side rails
4. Keeping side rails
up
RESOURCES
Newton, Kathleen,
and Helen C.
Anderson, Geriatric
Nursing, The C.V.
Mosby Co.,
S t . L o ui s , 19 6 6 ,
pp. 86-90 & 62-64.
II. The instructor will write
the three hazard areas for
falls on the chalkboard.
Then the students will be
asked to suggest guidelines
which wi 11 prevent falls in
the hospital, while the
instructor writes their
suggestions on the chalkboard, prompting students as
necessary from the content
outline.
Teachers and Students
Eliopoulos,
Charlotte, Gerontological Nursing,
Harper & Row,
New York, 1979,
pp. 188-190.
Brunner, Lillian S.,
and Doris S.
Suddarth, Textbook
of Medical-Surgical
Nu rs in g , J . B •
Lippencott, 1984,
p. 261.
.(::.
0\
UNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION A. Accidental injuries may be prevented by following some
relatively simple guide lines.
(continued)
CONTENT OUTLINE
SUGGESTED
OPPORTUNITIES
RESOURCES
LEA~~ING
5. Keeping bed at low
level
6. Keeping beside
tables close to
bed
B. Falling when walking
1. Instruction on
asking for help
when getting out
of bed.
2. Using non-skid
supportive bedslippers
3. Instruction on use
of walker,
crutches, wheelchair, etc.
4. Use of night
lights
The students will take part
in the exercise.
+::>
--J
UNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION A. Accidental injuries may be prevented by following some
relatively simple guidelines. (continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
C. Falling in the bathroom
1. Instruction on use
of the emergency
call-light in the
bathroom
2. Instruction on
use of grabbars
3. Instruction on
use of shower
chair
III. Risk factors that
increase the chance for
accidents
A. Acute illnesses
B. Uncertain gait
C. Changes in the
balancing mechanisms
D. Changes in vision
and hearing
Ilia. The instructor will ask the
students to suggest some of
the risk factors that are
related to aging that might
increase the chance for
accidents, while the
instructor writes their
suggestions on the chalkboard, prompting the
students as necessary from
+:>
00
UNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION A. Accidental injuries may be prevented by following some
relatively simple guidlines. (continued)
CONTENT OUTLINE
E. A decrease in
sensation of
pain
F. Effects of
medications
SUGGESTED
LEARNING OPPORTUNITIES
the content outline.
The students will take
part in the exercise
IIIb. The instructor will
show the filmstrip,
Safety for the Elderly
Patient. Then, the
instructor will stimulate class discussion
by asking:
1. Did the filmstrip
mention any safety
information that you
never heard of before?
2. What parts of the
filmstrip caught your
interest?
The student will take
part in the discussion.
RESOURCES
Concept Media,
Safety for the
Elderly Patient:
Fundamental Concepts in Nursing,
35 mm. Filmstrip,
23 minutes,
Irvine, Ca. 1979.
..p.
'-0
UNIT II.
Preventive Care and Health Maint~nance for the Aged
HEALTH GENERALIZATION B. Positive measures for maintaining health should contribute
to improved health and longevity for older adults.
OBJECTIVE #1 - Following instruction, the student will be able to recall three
positive measures for improving the health of older adults. (knowledge)
OBJECTIVE #2 - Following instruction~ the student will be able to discuss the
importance of at least three of the positive measures for improving the health
of older adults. (interpretation)
CONTENT OUTLINE
I.
Measures important for
maintaining health for
older adults
A. Regular health
appraisal and
counseling
1. Differentiate
between problems
due to aging and
those due to
treatable diseases.
2 . I den ti fy and treat
di s e as e s b e fore
they are advanced.
3. Identify people at
risk for certain
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
Ia. The instructor will ask the
students to recall from
previous lectures the measures
that are important for maintaining health, and the
instructor will write the
suggestions on the chalkboard.
The students will make
suggestions.
Teacher
Fu t r e 11 , May , e t
al., Primary Health
Care of the Older
Adult, Dusbury
Press, N. Scituate~
Mass. 19 80,
pp. 32-39.
Ib. The instructor will then ask
the students to explain why
these health measures are
especially important for older
adults, prompting them as
Teacher and Students
Eliopoulos,
Charlotie~ Gerontological Nursing,
Harper & Row, New
York, 1979, pp. 110114 &117-119.
U"1
0
UNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION B. Positive measures for maintaining health should contribute
to improved health and longevity for older adults. (continued)
CONTENT OUTLINE
conditions while they
can be prevented.
B. Beneficial nutritional
practices
1 . Regulation of
caloric intake on an
individual basis.
2. Maintaining adequate
protein, mineral and
vitamin intake.
C. Planned exercise program
1. Individual plan to
prevent overexertion
2. Relaxation and
stretching of tight
muscles
3. Strengthening weak
muscles
4. Gradual progression
of intensity.
SUGGESTED
LEARNING OPPORTUNITIES
necessary from the content
outline.
The students will take part
in the exercise.
RESOURCES
Brunner, Lillian S.
& Doris S. Suddarth,
Textbook or MedicalSurgical Nursing,
J.B. Lippencott 1984,
pp. 259-270.
Dunn, Betty and
Elizabeth Abel,
"Focus on Wellnes s,"
Geriatric Nursing,
March/April, 1983,
pp . 111 -112 .
(Jl
1--'
UNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION B. Positive measures for maintaining health should contribute to
improved health and longevity for older adults. (continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
D. Avoidance of substances
injurious to health
1. Smoking
2. Excess coffee or tea
3. Alcohol
4. Drugs
c.n
N
""
UNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION C. Teaching and motivating older adults about health and health
hazards requires special understanding and skills.
OBJECTIVE #1 ~ Following instruction~ the student will be able to recall at least
four questions to help the nurse and patient to determine priorities for health
teaching. (knowledge)
OBJECTIVE #2 - Following instruction, the student will be able to list at least
nine guidelines to follow when teaching the elderly patient. (knowledge)
CONTENT OUTLINE
I.
Questions for establishing
teaching priorities
A. What knowledge is of
most worth at this
time?
B. What lack of knowledge
will contribute to the
deterioration of
health?
C. What information could
be given later?
D. What teaching could
best be done by a home
health nurse in the
home?
SUGGESTED
LEARNING OPPORTUNITIES
I. In a lecture format the
instructor will introduce the
topic and present the
questions for establishing
the teaching priorities one
at a time from a previously
prepared transparency, using
an overhead projector.
Then the instructor will ask
the students to suggest any
additional questions that
they feel might be helpful.
The students will take notes
and possibly make suggestions.
RESOURCES
Teacher
Futrell, May, et
al., Primary Health
Care of the Older
Adult, Dusbury
Press, N. Scituate,
Mass., 1980,
pp. 39-47.
Newton, Kathleen
and Helen G.
Anderson, Geriatric Nursing; The
C. V. Mosby Co. ,
St. Louis, 1966.
pp. 87-90.
Ul
t..N
I
~
UNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION C. Teaching and motivating older adults about health and health
hazards requires special understanding and skills. (continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
E. What does the patient
see as the most
important problem or
need right now?
F. What written information would help the
patient or those who
care for the patient?
G What are the patient's
attitudes toward
health care, that can
be explained by
cultural differences?
II. Guidelines for teaching
the elderly patient
A. Assess the readiness
to learn.
B. Assess the learning
capacities and
limitations.
RESOURCES
Teacher and Students
Eliopoulos,
Charlotte, Geronto~_Q_g_ical Nursing,
Harper & Row,
New York, 1979,
pp. 188-190.
IIa. The instructor will ask the
students to recall the
principles of education
which they recall from
previous classes, while the
instructor writes them on
the chalkboard. Then the
instructor will ask the
tr1
...,.
UNIT I I.
Pre ven ti ve Care and Health Main terrance for the Aged
HEALTH GENERALIZATION C. Teaching and motivating older adults about health and health
hazards requires special understanding and skills. (continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
C. Outline what to teachstudents to suggest any
guide lines that that
teach small amounts at
students can think of which
a time.
might be especially useful
D. Alter the teaching plan
in teaching elderly patients,
in view of developments.
prompting them as necessary
E. Prepare the patient for
from the content outline.
the teaching-learning
The students will try to
session.
recall principles of e duF. Provide an environment
cat ion~ and think of any
conductive to learning.
guidelines for teaching
G. Use individualized
elderly
patients.
teaching aids.
H. Use several approaches
1Ib. The instructor will show the
to the same material.
filmstrip, Implications for
I. Reinforce key points.
Teaching
Aging Patients.
J. Obtain feedback.
Following
this, the instructor
K. Reevaluate periodically.
will
stimulate
discussion of
L. Document carefully.
the filmstrip by asking:
1. Was there anything in the
filmstrip that we have not
RESOURCES
Concept Media,
Implications for
Teaching Perspectives on Aging.
35 mm, Filmstrip,
26 minutes, Irvine,
Ca., 1979.
lr1
lr1
UNIT II.
Preventive Care and Health Maintenance for the Aged
HEALTH GENERALIZATION C. Teaching and motivating older adults about health and health
hazards requires special understanding and skills (continued).
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
considered in this class
before?
2. Did you disagree with any
of the techniques
used in the filmstrip?
The students will watch the
filmstrip, and take part in
the discussion.
tJ:1
0\
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A.
Elderly patients have some special needs in addition to the
daily care needs of all adult patients.
OBJECTIVE #1 - Following instruction~ the student will be able to discuss why it is
necessary to check elderly patients frequently in extremes of hot and cold
environments.
(interpretation)
OBJECTIVE #2 - Following instruction, the student will be able to discuss why
scrupulous care of the skin and feet is essential for older patients.
(interpretation)
OBJECTIVE #3 - Following instruction, the student will be able to discuss at least
three reasons why elderly patients lpve increased problems with bowel
elimination.
(interpretation)
OBJECTIVE #4 - Following instruction, the student will be able to list at least
three major dietary problems of the elderly patient.
(knowledge)
OBJECTIVE #5 -Following instruction~ the student will be able to discuss the
underlying reasons for at least three dietary problems of the elderly patient.
(interpret at ion)
OBJECTIVE #6 -Following instruction, the student will be able to list at least
three nursing interventions that are important in encouraging elderly patients
to eat.
(knowledge)
OBJECTIVE #7 -Following instruction, the student will be able to discuss at least
three ways in which inactivity is a serious threat to the aged patient.
(interpretation)
V1
-..)
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to the
daily care needs of all adult patients.
(continued)
OBJECTIVE #8 - Following instruction, the student will be able to discuss the
advantages to the patient in promoting self-care within the individual
abilities of the aged patient.
(interpretation)
OBJECTIVE #9 - Following instruction, the student wiJl b~ able to discuss at
least three factors related to the hospitalization of the elderly patient
that require emotional support.
(interpretation)
OBJECTIVE #10 - Following instruction, the student wiJl be able to discuss at
least four elements related to life changes of aging that suggest the need
for emotional and spiritual support for th~ elderly patient.
(interpretation)
OBJECTIVE #11 - Following instruction, the student will be able to recall at
least three of the nursing interventions which can provide emotional
support.
(knowledge)
VI
00
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to
the daily care needs of all adult patients.
(continued)
CONTENT OUTLINE
I I a.
becomes less effective
in temperature
regulation.
A. Higher risk of
exaggerated reaction
to even mildly cold I Ib.
conditions.
B. Higher risk of heat
exhaustion in higher
temperatures.
I. With age the body
I I. Scrupulous care of skin I I I.
and feet is essential for
older patients.
A. Predisposition to
cracking skin and
SUGGESTED
LEARNING OPPORTUNITIES
The instructor will introduce the topic, risk to
elderly patients from
extremes of heat and cold,
in a lecture format.
The instructor will
provide the booklet,
A Winter Hazard for the
Old-Accidental Hypothermia,
for supplemental information.
The students will read the
booklet for supplemental
information.
The instructor will present
the physiological changes
in the skin and feet due to
aging, and ask the students
RESOURCES
Teacher
Futrell~ May, et al.,
Primary Health Care
of the Older Adult,
Dusbury Press,
N. Scituate, Mass.,
1980, pp. 34-38.
Burnside, Irene M.,
(Editor) Psychosocial
Nursing Care of the
Aged, McGraw-Hill,
NewYork~ 1983,
pp. 179-194.
Butler, Robert N. and
Myrna I. Lewis,
Aging and Mental
Health, C.V. Mosby
Co., St. Louis, 1977,
pp. 38-44.
Ul
(.!)
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to
the daily care needs of all adult patients.
(continued)
CONTENT OUTLINE
pressure areas.
1. Skin becomes thin
and less elastic
with age.
2. Skin has less
function-oil
glands.
3. Decrease in
peripheral circulation results in
slowed healing.
SUGGESTED
LEARNING OPPORTUNITIES
to discuss the reasons for
scrupulous care of the skin
and feet of older adults.
The student will take part
in the discussion.
RESOURCES
Teacher
Kohut, Sylvester Jr.,
Jeraldine J. Kohut,
and Joseph J.
Fleishman, Reality
Orientation for the
Elderly, Medical
Economics Co.
Oradell, N.J., 1983,
pp. 73-89.
Teacher and Students
Eliopoulos,
Charlotte, Gerontological Nursing,
Harper & Row, New
York. 1979,
pp. 108-130.
0\
0
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to the
· daily care needs of all adult patients.
(continued)
CONTENT OUTLINE
III. Causes of poor bowel
elimination for the
elderly patient:
A. Poor habits of
elimination
B. Diet lacking in
fiber and bulk
C. Decreased activity
D. Reduces Gastrointestinal rnotiljty
IV. Four major dietary
problems for the
elderly patient:
A. Over-nutritionObesity
1. snack foods
2. processed foods
3. excess carbohydrates.
SUGGESTED
LEARNING OPPORTUNITIES
III. The instructor will ask the
students to recall the
causes of poor bowel
elimination for the bedrest
patient, and stimulate them
to determine other causes
relating to the elderly
patient, using content
outline.
The students will take part
in the exercise.
IV. The instructor will ask
students to recall from
their care of elderly
patients in the past, four
major categories of dietary
problems of the elderlyguiding them to recognize,
at least those listed in the
content outline.
RESOURCES
Teacher and Stud~nts
Brunner, L1llian S. &
Doris S. Suddarth,
Textbook of MedicalSurgical Nursing,
J.B. Lippencott, 1984,
pp. 259-270.
Expand Associates,
A Winter Hazard for
the Old-Accidental
Hypothermia, N.I.A.
publication, Silver
Spring, Maryland,
1985.
Demmerle, Barbara,
"General Nursing
Care," Geriatric
Nursing, 3:5t Sept/
Oct, 1982,
pp. 316-321.
0\
J-1
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to the
daily care needs of all adult patients.
(continued)
COURSE OUTLINE
B. Under-nutrition
1. budgetary
restrictions.
2. poor dental
condition-can't
chew well.
3. reduced perception
of smell and taste.
4. being alone.
C. Dehydration
D. Dietary iron
deficiency
V. Nursing interventions
important in encouraging
elderly patients to eat.
A. Stimulating appetites
with fruit juices and
soups.
B. Frequent small
feedings.
SUGGESTED
LEARNING OPPORTUNITIES
The students will take part
in the exercise.
RESOURCES
Teacher and Students
Gress, Luc1lle D.
and Sister Rose
Therese Bahr,
The Aging PersonA Holistic Perspective. The C.V. Mosby
Co., St. Louis, 1984,
pp. 13 7.
Va. The instructor will ask the
students to suggest some
nursing interventions which
might encourage elderly
patients to eat, while she
writes their suggestions on
the chalkboard, and prompts
them from the list in the
content outljne.
0\
N
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to the
daily care needs of all adult patients.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
C. Match consistency
of food with ability
to chew.
D. Engineer group eatingiVb.
experiences when
possible.
E. Teaching why
specific dietary
habits are
important.
RESOURCES
The students will take part
in the exercise.
The instructor will show the
filmstrip, Food For Older
Adults. Following this,
the instructor will
stimulate discussion of
the filmstrip by asking
the following:
1. What were the foods that
the filmstrip stated
were not good for older
adults?
2. What were the foods
that were considered
best for older adults?
3. Was there anything in
the filmstrip that you
had not learned in
previous classes about
nutrition?
Career Aids, Inc.,
Food for Older Adults,
35 mm. Filmstrip,
20 minutes, Chatsworth,
Ca., 1983.
0\
VI
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to the
daily care needs of all adult patients.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
4. Were there some parts
of the filmstrip that
caught your special
interest?
The students will take part
in the discussion.
VI. Results of inactivity
for thP- aged patient
A. Weakness and
stiffness
B. Diminished muscle
tone
C. Decreased blood
circulation
D. Shallow breathing
E. Slowed peristalsis
VI. The instructor will ask the
students to recall what are
results of inactivity for
any patient, and stimulate
them to determine any that
are not mentioned. Then
the instructor will ask the
students to ascertain why
each of those results cause
a threat to the well-being
of an elderly patient.
The students will take part
in the exercise.
a.
+:>
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to the
daily care needs of all adult patients.
(continued)
CONTENT OUTLINE
VII. Changes due to illness
and hospitalization
that require emotional
support
A. Helplessness and
dependency
B. Fear of unknown
C. Relocation confusion
- due to strange
environment.
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
VII. The instructor will ask for
two volunteers from the
class to take part in a
role-playing exercise.
See suggested Role-playing
situation, Appendix F.
After the role-playing is
completed, ask students to
identify the different
needs for emotional and
spiritual support that they
observed that are due to
illness and hospitalization.
Appendix F Role-Playing
Situat1on - (Relocation Confusion)
0\
Ul
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to the
daily care needs of all adult patients.
(continued)
CONTENT OUTLINE
VIII. Life changes due to
aging that suggest the
need for emotional and
spiritual support
A. Family changes
1. Children grown up
and moving away
2. Death of spouse
3. Death of friends
or family
members
B. Awareness of
mortality
C. Declining function
D. Lack of meaning and
purpose in life
E. Perception of
unfinished business
1. Unresolved guilt
2. Unachieved
aspirations
3. Perceived failure
F. Lack of self esteem
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
VIII. The instructor will then
ask the students to think
of other needs which an
elderly patient might have,
relative to life changes.
The instructor can use the
list in the content outline to guide the students
as she lists their ideas
on the chalkboard.
The students will observe
the role-play situation
and take part in the
discussion.
0\
0\
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to the
daily care needs of all adult patients.
(continued)
CONTENT OUTLINE
IX. Advantages of self-care
A. Older patients retains
control
1. Decision making
2. Health practices
B. Promotes individual's
personhood
1. Body
2. Mind
3. Spirit
C. Older patient maintains
integrity and selfrespect
X. Nursing Interventions
which help to provide
emotional support.
A. Acceptance and concern
B. Listening attentively
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
IX. In a discussion mode, the
instructor will ask the
students to suggest th~
advantages of self-care to
the elderly patient, and
prompt them from the content
outline.
The students will take part
in the discussion.
X. Continuing the discussion,
the instructor will ask the
students to review from other
classes the nursing interventions which can provide
emotional support.
0\
--...J
UNIT III.
General Considerations and Approaches in Nursing Care of the. Aged
HEALTH GENERALIZATION A. Elderly patients have some special needs in addition to the
daily care needs of all adult patients.
(continued)
CONTENT OUTLINE
C. Giving understanding
responses
1. Reflecting feelings
2. Reflecting behaviors
D. Touching, to communicate
caring.
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
The students will take
part in the discussion.
0\
00
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION B. Health care professionals need to be aware of the complex
risks involved with drug therapy for the elderly.
OBJECTIVE #1 - Following instruction, the student will be able to recall at least
four types of body changes due to age which can alter the effects of drugs.
(knowledge)
OBJECTIVE #2 - Following instruction, the student will be able to discuss how
decreased metabolism by the liver in aging alters the effects of drugs.
(interpretation)
OBJECTIVE #3 - Following instruction, the student will be able to discuss the
risks related to the decreased excretion of drugs by the kidneys of elderly
patients.
(interpretation)
OBJECTIVE #4 - Following instruction, the student will be able to discuss how
mult1ple pathology increases the risks related to the altered actions of
drugs for the elderly.
OBJECTIVE #5 - Following instruction, the student will be able to recall at least
three approaches to use when teaching elderly patients about drug therapy,
which will help to promote compliance.
(knowledge)
0\
\D
UNIT TI I.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION B. Health care professionals need to be aware of the complex
--r].sks involved with drug therapy for the elderly.
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
I. Changes in the body's
structure and function,
occuring with age, which
can alter the effects of
drugs.
A. Absorption and distribution changes
1. Changes in the pH of
the stomach which
alters the soluability and ionization of drugs and
thus alter their
absorption.
2. Reduced peristaltic
activity in the
gastrointestinal
tract may impair
absorption of drugs.
Ia. In a lecture format, the
instructor will introduce
the lesson by presenting
the various changes in
structure and function due
to age, which can alter
the effects of drugs.
Teacher
Poe, William De.,
and Donald A.
Holloway, Drugs and
the Aged, McGraw
Hill Inc., New York,
pp. 14-24.
Hanan, Zachary I.,
"How Aging Alters
the Actions of
Drugs~" Practical
Guide to Geriatric
Medication, Ralph
Bryant, editor,
Medical Economics
Co. Oradell, New
Jersey, 1980,
pp. 2 7-42.
Ib. The instructor will show
the videocassette,
Distribution and Action
of Drugs. Then the
instructor will stimulate
discussion by asking:
1. In view of the usual
ways in which drugs are
handled by the body,
and the various changes
in the digestive and
circulatory systems,
how would the effects
-......)
0
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION B. Health care professionals need to be aware of the complex
risks involved with drug therapy for the elderly.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
3. Reduced blood flow
to the GI tract may
also impair
absorption.
4. An increased proportion of £at tissue
results in accumulation of fat
soluble drugs and
thus slows distribution
5. A lower serum
albumin effects the
action of proteinbound drugs.
6. Reduced cardiac
output slows the
distribution of
drugs.
of drugs be altered by
changes in absorption?
2. How would the effects
of drugs be altered by
changes in distribution?
3. How would the effects
of drugs be altered by
changes in metabolism?
4. How would the effects
of drugs be altered by
changes in excretion?
The instructor would
attempt to stimulate the
students to come-up with
all the explanations
listed in the Content Outljne, and then supply those
which were missed.
The students will take
notes on the lecture and
take part in the
discussion.
RESOURCES
Teacher and Students
Eliopoulos,
Charlotte, Gerontological Nursing,
Harper & Row, New
York, 1979,
pp. 2 9 5- 315
Brunner, Lill.ian S.
and Doris S.
Suddarth, Textbook of
Medical-Surgical
Nurs1ng, J.B.
Lippencott, 1984,
0
p. 269.
Concept Media,
Distribution and
Action of Drugs, 3/4"
U-Matic Videocassette,
26 minutes, Irvine,
Ca., 1979
'-.]
f-.'
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION B. Health care professionals need to be aware of the complex
risks involved with drug therapy for the elderly.
(continued)
CONTENT OUTLINE
B. Decreasing amounts of
liver enzymes alter
metabolism.
1. Prolonged effects
from drugs which
are usually
deactivated by the
1 i ver.
2. Reduced effectiveness
from drugs which need
to be fully metabolized
for full effect.
3. Slowed gastrointestinal
motility slows excretion of drugs excreted
through the intestines.
4. Decrease in kidney
function slows excretion through the urine.
a. Drugs may remain active
in the bloodstream longer.
b. Drugs may accumulate
to a toxic level.
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
Teacher and Students
Hayter, Jean, "Why
Response to
Medication Changes
With Age,"
Geriatric Nursing,
Nov/Dec. 1981,
pp. 411-416.
-.....]
N
1
UNIT III.
General Considerations'and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION B. Health care professionals need to be aware of the complex
· risks involved with drug therapy for the elderly.
(continued)
CONTENT OUTLINE
II. Other factors which
increase the risks
related to altered
effects of drugs
A. Multiple pathology in
older patients
1. Taking several
medications at a
time with multiple
side-effects
2. Increased risk of
drug interactions.
B. Drugs induced illness
mimic stereotyped
characteristis of old
age.
1. forgetfullness &
confusion
2. weakness and
tremors
3. anxiety
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
II. The instructor will prompt
the students to discuss
the following questions:
1. How would the altered
effects of drugs be
increased by multiple
pathology of the
older adult?
2. What stereotyped
characteristics of
old age might be
mimicked by a drug
induced illness?
3. How would the stress
of illness compromise
the already altered
effect?
'-l
'.N
1
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION B. Health care professionals need to be aware of the complex
risks involved with drug therapy for the elderly.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
C. The stress of illness
further reduces the
physiological ability
to handle drugs.
4. How would the altered
physiological ability to
handle drugs in old age
be further compromised
by the stress of illness?
5. What information about
drugs would be important to teach elderly
patients in order to
increase compliance?
The students will take part
in the discussions.
III. Compliance can possibly
be increased by patient
teaching of elderly
patients about drug
therapy
A. Keep information
simple
RESOURCES
III. In a discussion format, the
instructor will ask the
students for suggestions
about ways to teach elderly
patients about drug therapy
that might increase
compliance.
--.1
+:>.
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION B. Health care professionals need to be aware of the complex
risks involved with drug therapy for the elderly.
(continued)
CONTENT OUTLINE
B. Respect the intelligence of the patient
by explaining the
important facts.
1. why the drug is
given
2. correct dosage
3. side effects and
toxic effects
C. Write out drug regimen
D. Explain that drug
therapy is not a
substitute for sound
health habits.
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
Students will take part
in the discussion.
'-.]
V1
t
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION C. Health care professionals need to be aware of the recent
move toward home care for the elderly patient.
OBJECTIVE #1 - Following instruction, the student will be able to discuss, in
his/her own words two of the reasons for the recent move toward home care
of the elderly patient.
(interpretation)
OBJECTIVE #2 - Following instruction, the student will be able to discuss the
elements that are necessary for successful home care.
(interpretation)
CONTENT OUTLINE
I. Reasons for recent move
toward home care for
the elderly
A. Patients comfort and
self-esteem
1. Familiar surroundings and
routines
2. Closer association
with friends and
loved ones
3. More feeling of
control
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
I. The instructor will ask the
students to suggest reasons
for the home care of
elderly care, write their
suggestions on the chalkboard, and prompting them
from the content outline.
The students will take
part in the exercise.
Teacher
Burnside, Irene M.,
(Editor) Psychosocial Nursing Care
of the Aged, McGrawHill, New York, 1980,
pp. 87-99.
Teacher and Students
Eliopoulos,
Charlotte, Gerontological Nursing,
Harper & Row, New
York, 1979, p. 353.
-.....]
0\
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION C. Health care professionals need to be aware of the recent move
toward home care for the elderly patient. (continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
4. Ability to be part of
family activities
5. Maximum attention to
dietary preferences
B. Financial benefits
1. More cost effectiveness
2. Medicare benefits
available
C. Recent increase in
home-care services
II. Elements necessary for
effective home care.
A. Efficient and early
discharge planning
B. Consistent coordination and cooperation
between involved
individuals and
providers.
1. Patient and
family
II. The instructor, in a
lecture format, will
present the information
related to the necessary
elements for effective
home care, using the
content outline as a
guide.
The students will take
notes.
RESOURCES
Kleyman, Paul, "Home
Care Controversy,"
The Continuing Care
Coordinator, 3:8,
September 1984,
pp. 18 & 19.
Samuels, Arthur,
"A Doctor's View of
Home Care," The
Continuing Care
Coordinator, 3:8,
September 1984,
pp. 3 7 & 38.
Dobihal, Shirley,
"Hospice: Enabling
a Patient to Die at
Home," American
Journal of Nursing,
80:8, August, 1980,
pp. 1448-1451.
'-.]
'-.]
""
YNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION C. Health care professionals need to be aware of the recent move
toward home care for the elderly patient. (continued)
CONTENT OUTLINE
2. Physician
3. Hospital health team
4. Social worker
5. Home care providers
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
Putnam, Saundra T.,
"Home as a Place to
Die," American
Journal of Nursing,
80:8, August, 1980,
pp. 1451-1453.
'-.J
00
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION D. The Nursing Process is an efficient tool to use in planning
the care of elderly patients.
OBJECTIVE #1 - Following instruction, the student will be able to list the four
component parts of the Nursing Process.
(knowledge)
OBJECTIVE #2 - Following instruction, the student will be able to recall the
sources of data collection in the assessment part of the Nursing Process.
(knowledge)
OBJECTIVE #3 - Following instruction, the student will be able to recall the three
major sources for identifying problems during assessment for the Nursing
Process.
(knowledge)
OBJECTIVE #4 - Following instruction, the student will be able to demonstrate the
identification of Nursing Diagnoses during assessment for the Nursing Process.
(interpretation)
OBJECTIVE #5 - Following instruction, the student will be able to discuss the
four steps for the planning part of the Nursing Process.
(knowledge)
OBJECTIVE #6 - Following instruction, the student will be able to discuss the
Implementation part of the Nursing Process.
(knowledge)
OBJECTIVE #7 - Following instruction, the student will be able to discuss the
evaluation part of the Nursing Process.
(knowledge)
OBJECTIVE #8 - Following instruction, the student will be able to propose
approaches to overcome the four difficulties in assessment for elderly
patients as listed in the Content Outline.
(extrapolation)
--....]
'-0
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION D. The Nursing Process is an efficient tool to use in planning
the care of elderly patients.
(continued)
OBJECTIVE #9 - Following instruction, the student will be able to recall at least
five important considerations to use in the planning part of the Nursing
Process when planning care for elderly patients.
(knowledge)
OBJECTIVE #10 - Following instruction, the student will be able to recall at least
three guidelines to follow in the implementation part of the Nursing Process
in caring for elderly patients.
(knowledge)
OBJECTIVE #11 - Following instruction, the student will be able to recall at least
two guidelines to use in the evaluation part of the Nursing Process when
planning care for elderly patients.
(knowledge)
CONTENT OUTLINE
I. Parts of the Nursing Process
A. Assessment
1. Data collection
a. Nursing history
b. Medical diagnosis
c. Patient profile
d. Health history
e. Physical
examination
f. Laboratory Data
SUGGESTED
LEARNING OPPORTUNITIES
I. In a discussion mode the
instructor will ask the
students to discuss the
following topics concerning
the Nursing Process, while
she writes replies on
chalkboard.
1. The four component
parts of the Nursing
Process
RESOURCES
Teacher
Aspinall, Mary Jo
and Christine
Tanner, Decision
Making for Patient
Care, AppletonCentury-Crofts,
New York, 1981,
pp. 1-13.
00
0
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION D. The Nursing Process is an effective tool to use in planning
the care of elderly patients.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
2. Identifying patient
problems
a. Related to
Medical diagnosis
b. Related to other
Medical conditions and complications
c. Related to
individual
characteristics
and situations
3. Formulation of the
Nursing Diagnoses from
Handbook of Nursing
Diagnosis.
B. Planning
1. Prioritising the
Nursing Diagnoses
2. Specifying shortterm and long-term
goals.
2. The sources of data
3.
4.
5.
6.
7.
collection during
Assessment.
Three major sources
for identifying
problems during
Assessment
Use of the Handbook
of Nursing Diagnoses
to identify Nursing
Diagnoses from a
problem list
The four steps for
the Planning part
of the Nursing
Process.
The factors involved
in Implementation.
The factors involved
in evaluation
RESOURCES
Gress, Lucille D. and
Sister Rose Therese
Bahr, The Aging PersonA Holistic Perspective,
C.V. Mosby Co,
St. Louis, 1984,
pp. 192-224.
Gordon, Marjory,
Nursing Diagnosis,
McGraw-Hill, New York,
19 8 2' pp. 1- 50.
Teacher and Students
Brunner, Lillian S. and
Doris S. Suddarth,
Textbook of MedicalSurgical Nursing,
J.B. Lippencott, 1984,
pp. 18-28.
00
f-'
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION D. The Nursing Process is an effective tool to use in planning
the care of elderly patients.
(continued)
CONTENT OUTLINE
3. Identifying specific
nursing interventions
4. Initiating the
written Patient
Care Plan
C. Implementation
1. Carrying out the
nursing interventions
2. Documenting outcomes
D. Evaluation
1. Determining if
the planned goals
were achieved
2. Identifying need
areas for reapplication of the
Nursing Process
SUGGESTED
LEARNING OPPORTUNITIES
The students will take
part in the discussion.
RESOURCES
Carpenito, Lynda J.
Handbook of Nursing
Diagnosis,
J.B. Lippencott Co.
Philadelphia, 1984.
Eliopoulos,
Charlotte, Gerontological Nursing,
Harper & Row, New
York, 1979,
pp. 84-106.
Gault, Patricia L.
"Plan for a Patchwork
of Problems When Your
Patient is Elderly,"
Nursing 82, 12:1,
January, 1982,
pp. 50-54.
00
N
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION D. The Nursing Process is an efficient tool to use in planning
the care of elderly patients.
(continued)
CONTENT OUTLINE
II. Difficulties and approaches
in the Assessment for
elderly patients
A. Reluctance to share
personal life with
strangers
1. Need for time to
establish trust.
2. Need to establish a
method of communication
a. patient's lack of
knowledge about
health
b. different
language
c. neurological
speech difficulties
SUGGESTED
LEARNING OPPORTUNITIES
II. The instructor will write
on the chalkboard four
difficulties that might
be experienced in the
Assessment part of the
Nursing Process when
used to plan care for
elderly patients. Then
the instructor will ask
the students to suggest
approaches to use for
each of the difficulties
that has been listed,
prompting them as
necessary from the
content outline.
The students will take
part in the exercise.
RESOURCES
De Young, Monica,
"Planning for
Discharge,"
Geriatric Nursing,
3:6, Nov/Dec. 82,
pp . 3 9 6 - 3 9 9 .
Hudson, Margaret,
"Safeguard Your
Elderly Patient's
Health Through
Accurate Physical
Assessment,"
Nursing 83, 13:11,
November, 1983,
pp. 58-61.
00
(.M
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION D. The Nursing Process is an efficient tool to use in planning
the care of elderly patients.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
B. Possible confusion and/or
disorientation
1. Need for gentleness
and patience
2. Frequent reorientation
C. Tendency to focus on the
pathology and limitations
1. Need to recognize
capacities
2. Identification of
relief and supportive
measures
D. Misleading effect of
multiple pathology and
patient's perceived
priorities
1. Use of patient profile
2. Use of physical exam
3. Use of medical information
4. Listening to patient
co
_.,..
""
UNIT III.
. I
I
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION D. The Nursing Process is an efficient tool to use in planning
the care of elderly patients.
(continued)
CONTENT OUTLINE
III. Considerations to use in the
Planning part of the Nursing
Process for elderly
patients.
A. Necessity to involve both
patient and patient's
family, if possible
1. Give explanations that
recognize intelligence
2. Patient may be reluctant to attempt new
approaches
B. Long-term and short-term
goals must be reasonable
and mutually acceptable
C. Preventive measures must
have high priority
D. Self-care capabilities
must be progressively
increased
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
III. In a lecture format, the
instructor will present
six important considerations concerning elderly
patients to use in the
Planning part of the
Nursing Process.
Then the instructor
will ask the students
for additional suggestions which they
might have.
Students will take notes
and possibly make
suggestions.
00
U1
"'"
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION D. The Nursing Process is an efficient tool to use in planning
the care of elderly patients.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
E. Plans must be coordinated
with other members of
the health team
F. Plan of care must be
carefully documented
1. Everyone can know
the plan
2. Care can be consistent
3. Legal requirements
G. Discharge planning starts
on admission
IV. Guidelines for Implementation
of plan of care for elderly
patients.
A. Plan of care must be
consistently followed.
1. Maintain safety
2. Strengthen individual
3. Supervision of those
who perform direct
care
IV. In a lecture format, the
instructor will present
two important guidelines
to remember during the
Implementation of the
Plan of Care for elderly
patients.
Then the instructor will
ask the students for any
co
0\
UNIT III.
General Considerations and Approaches in Nursing Care of the Aged
HEALTH GENERALIZATION D. The Nursing Process is an efficient tool to use in planning
· the care of elderly patients.
(continued)
CONTENT OUTLINE
B. Changes in capacities and
limitations must be
recognized early for
evaluation
V. Guidelines for Evaluation of
plan of care for elderly
patients
A. Involve both patient and
family in evaluation, if
possible
1. Be positive without
unreal optimism
2. Be sure patient does
not feel guilt for
goals not met
B. Identify new data for
the Nursing Process
C. Update the Plan of Care
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
suggestions which they
might have.
Students will take notes
and possibly make
suggestions.
V. In a discussion format, the
instructor will ask the
students to make suggestions
for guidelines to use for
Evaluation of the Plan of
Care for elderly patients,
and the instructor will
write their suggestions on
the chalkboard, prompting
them as necessary from the
content outline.
The students will take part
in the discussion.
00
-.....!
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION A. There is reduced efficiency of most body systems, due to
aging, which are not apparent unless a disease or disability causes unusual
demands upon the body.
OBJECTIVE #1 - Following instruction, the student will be able to recall two
common changes in cardiovascular functioning which are due to aging.
(knowledge)
OBJECTIVE #2 - Following instruction, the student will be able to recall one
common change in respiratory functioning which is due to aging.
(knowledge)
OBJECTIVE #3 - Following instruction, the student will be able to recall two
common changes in musculoskeletal functioning which are due to aging.
(knowledge)
OBJECTIVE #4 - Following instruction, the student will be able to recall one
common change in hematological functioning which is due to aging.
(knowledge)
OBJECTIVE #5 - Following instruction, the student will be able to recall two
common changes in gastrointestinal functioning which are due to aging.
(knowledge)
OBJECTIVE #6 - Following instruction, the student will be able to recall one
common change in genitourinary functioning which is due to aging.
(knowledge)
OBJECTIVE #7 - Following instruction, the student will be able to recall one
common change in regulatory functioning which is due to aging.
(knowledge)
00
00
UNIT IV.
'
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION A. There is reduced efficiency of most body systems, due to
aging, wh1ch are not apparent unless a disease or disability causes unusual
demands upon the body. (continued)
I
I
I
!
OBJECTIVE #8 - Following instuction, the student will be able to recall one
common change in nervous functioning which is due to aging.
(knowledge)
CONTENT OUTLINE
I. Common changes in body systems
due to aging
A. Cardiovascular
1. Heart contractions weaker
2. Cardiac output reduced
3. Loss of elasticity of
blood vessels and valves
B. Respiratory
1. Higher residual volume
2. Lower vital capacity
C. Musculoskeletal
1. Reduction in muscle
strength and endurance
2. Bones more brittle
3. Joints less mobile
D. Hematologic
1. Degrease in oxygen
carrying ability
SUGGESTED
LEARNING OPPORTUNITIES
I. In a lecture mode the
instructor will provide
the information about
common changes in body
systems due to aging,
one at a time from a
previously prepared
transparency using an
overhead projector.
The students will take
notes.
RESOURCES
Teacher
Futrell, May, et al.,
Primary Health Care
of the Older Adult,
Dusbury Press,
N. Scituate, Mass.,
1980, pp. 274-409.
Teacher and Students
Eliopoulos,
Charlotte, Gerontological Nurs1ng,
Harper & Row,
New York, 1979,
pp. 140-273.
00
\D
UNIT IV.
I
I
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION A. There is reduced efficiency of most body systems, due to
aging, which are not apparent unless a disease or dsiability causes unusual
demands upon the body.
(continued)
.I
I
I
I
I
I
CONTENT OUTLINE
E.
F.
G.
H.
2. Decrease in resistance
to infection
Gastrointestinal
1. Diminished secretions
2. Reduced peristalsis
3. Reduced absorption of
nutrients
Genitourinary
1. Reduced kidney function
Regulatory
1. Slowed basal metabolism
rate
2. Elevated blood glucose
Nervous
1. Short term memory loss
2. Slower decision making
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
Brunner, Lillian S.
and Doris S.
Suddarth, Textbook
of MedicalSurglcal Nursing,
J.B. L1ppencott,
19 8 4' pp. 2 56 ' 2 57.
\.0
0
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to
·
which older adults are more prone.
II
I
I
I
I
I
OBJECTIVE #1 - Following instruction, the student will be able to recall at
least five disease entities involving the cardiovascular classification,
to which older adults are prone.
(knowledge)
OBJECTIVE #2 - Following instruction, the student will be able to determine
at least six nursing diagnoses that are commonly associated with patients
with cardiovascular diseases.
(extrapolation)
OBJECTIVE #3 - Following instruction, the student will be able to recall at
least three disease entities involving the respiratory classification,
to which older adults are prone.
(knowledge)
OBJECTIVE .#4 - Following instruction, the student will be able to determine
at least four nursing diagnoses that are commonly associated with patients
with respiratory diseases.
(extrapolation)
OBJECTIVE #5 - Following instruction, the student will be able to recall at
least two disease entities involving the musculoskeletal classification,
to which older adults are prone.
(knowledge)
OBJECTIVE #6 - Following instruction, the student will be able to determine
at least four nursing diagnoses that are commonly associated with patients
with musculoskeletal diseases.
(extrapolation)
OBJECTIVE #7 - Following instruction, the student will be able to recall at
least one disease entity involving the neurological classification, to
which older adults are prone.
(knowledge)
(.!)
I-'
""
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to
which older adults are more prone. (continued)
OBJECTIVE #8 - Following instruction, the student will be able to determine at
least seven nursing diagnoses that are commonly associated with patients
with neurological diseases.
(extrapolation)
OBJECTIVE #9 - Following instruction, the student will be able to recall at
least five disease entities involving the gastrointestinal classification,
to which older adults are prone.
(knowledge)
OBJECTIVE #10 - Following instruction, the student will be able to determine
·
at least three nursing diagnoses that are commonly associated with patients
with gastrointestinal diseases.
(extrapolation)
OBJECTIVE #11 - Following instruction, the student will be able to recall at
least five disease entities involving the genitourinary classification,
to which older adults are prone.
(knowledge)
OBJECTIVE #12 - Following instruction, the student will be able to determine
·
at least three nursing diagnoses that are commonly associated with patients
with genitourinary diseases.
(extrapolation)
OBJECTIVE #13 - Following instruction, the student will be able to recall at
least seven disease entities involving the sensory classification, to
which older adults are prone.
(knowledge)
OBJECTIVE #14 - Following instruction, the student will be able to determine
at least four nursing diagnoses that are commonly associated with patients
with sensory diseases.
(extrapolation)
\.0
N
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to which
older adults are more prone.
(continued)
CONTENT OUTLINE
I. Diseases in the cardiovascular
classification to which older
adults are more prone
A. Congestive heart failure
B. Pulmonary heart disease
C. Coronary artery disease
D. Hypertension
E. Arrhythmias
F. Thromboembolism
G. Varicose veins
II. Nursing diagnoses commonly
associated with cardiovascular
diseases
A. Decreased activity
tolerance
B. Alteration in cardiac
output
C. Impaired gas exchange
D. Alteration in tissue
perfusion
E. Alteration in comfort
SUGGESTED
LEARNING OPPORTUNITIES
I. The instructor will ask the
students to suggest diseases
to which older adults are
more prone for each of the
following disease classifications in turn:
1. cardiovascular
2. respiratory
3. musculoskeletal
4. neurological
5. gastrointestinal
6. genitourinary
7. sensory
The instructor will make a
column on the chalkboard
for each disease classification, and then,
write the suggested
diseases in the appropriate category as they
are suggested. The
instructor will use the
RESOURCES
Teacher
Futrell, May,
et al., Primary
Health Care of
the Older Adult,
Dusbury Press,
N. Scituate,
Mass., 1980,
pp. 273-442.
Cape, Ronald D.,
Rodney M. Coe,
and Isadore
Rossman (editors)
Fundamentals of
Geriatric Medicine, Raven
Press, New York,
19 8 3 ' pp . 19 7256.
'-.0
V-1
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to
which older adults are more prone.
(continued)
CONTENT OUTLINE
F. Mild to severe anxiety
G. Self-care deficit
H. Alteration self-concept
III. Diseases in the respiratory
classification to which older
adults are more prone
A. Pneumonia
B. Chronic Obstructive
Pulmonary Disease
(C.O.P.D.)
C. Tuberculosis
D. Lung Cancer
IV. Nursing diagnoses commonly
associated with respiratory
diseases
A. Decreased activity
tolerance
B. Ineffective airway
clearance
SUGGESTED
LEARNING OPPORTUNITIES
content outline to prompt
the students, if
necessary.
The students will take
part in the exercise.
II. The instructor will ask
the students to use their
copies of Gordon's Manual
of Nursing Diagnosis to
determine the nursing
diagnoses which are
commonly associated with
patient5 who have
diseases in each of the
following disease classifications in turn:
1. cardiovascular
2. respiratory
3. musculoskeletal
4. neurological
RESOURCES
Newton, Kathleen,
and Helen G.
Anderson,
Geriatric
Nursing, The C.V.
Mosby Co.,
St. Louis, 1966,
pp. 170-365.
Teacher and Students
Eliopoulos,
Charlotte,
Gerontological
Nursing, Harper &
Row, New York,
19 7 9 ' pp . 14 0273.
Gordon, Marjory,
Manual of Nursing
Diagnosis,
McGraw-Hill Co.,
New York, 1982.
tO
..,..
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to
which older adults are more prone.
(continued)
CONTENT OUTLINE
C. Ineffective breathing
patterns
D. Impaired gas exchange
E. Mild to severe anxiety
F. Self-care deficit
V. Diseases in the musculoskeletal classification to
which older adults are more
prone
A. Osteoporosis
B. Fractures
C. Arthritis
VI. Nursing diagnoses commonly
associated with musculoskeletal diseases
A. Potential for physical
injury
B. Impaired skin integrity
C. Imparied physical
mobility
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
5. gastrointestinal
6. genitourinary
7. sensory
The instructor will make
a column on the chalkboard
for each disease classification, and then, write
the suggested nursing
diagnoses in the appropriate column as they are
suggested. The instructor
will use the content
otitline to prompt the
students, if necessary.
The students will take
part in the exercise.
1.0
U"1
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to
which older adults are more prone.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
D. Self-care deficit
E. Alteration in comfort
F. Body image disturbance
VII. Diseases in the
neurological classification
to which older adults are
more prone
A. Cerebral Vascular
Accident (C.V.A or
stroke)
B. Brain tumor
VIII. Nursing diagnoses commonly
associated with neurological
diseases
A. Potential for physical
injury
B. Impaired skin integrity
C. Impaired physical mobility
D. Potential for joint
contractures
\.0
Q\
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to
which older adults are more prone.
(continued)
CONTENT OUTLINE
1
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
E.
F.
G.
H.
I.
Self-care deficit
Impaired thought processes
Mild to severe anxiety
Self-esteem disturbance
Impaired urinary
elimination
J. Impaired verbal
communication
IX. Diseases in the gastrointestinal classification
to which older adults arc
more prone
A. Hiatus hernia
B. Cancer of the esophagus
C. Peptic Ulcer
D. Cancer of the stomach
E. Cancer of the colon
F. Cancer of the pancreas
G. Diverticulosis
1.0
---.]
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to
which older adults are more prone.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
X. Nursing diagnoses commonly
associated with gastrointestinal
diseases
A. Potential fluid volume
deficit
B. Alteration in nutritional
requirements
C. Al tera ti on in bowel
elimination (diarrhea or
constipation)
D. Alteration in comfort
XI. Diseases in the genitourinary
classification to which older
adults are more prone
A. Pyelonephritis
B. Glomerulonephritis
C. Bladder cancer
D. Benign prostatic
hypertrophy
E. Cancer of the prostate
F. Cancer of the uterus
G. Breast cancer
\.0
00
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to
which older adults are more prone.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
XII. Nursing diagnoses commonly
associated with genitourinary
diseases
A. Alteration in urinary
elimination
B. Alteration in comfort
C. Self-esteem disturbance
D. Body image disturbance
XIII. Diseases in the sensory
classifcation to which older
adults are more prone
A. Cataracts
B. Glaucoma
C. Retinal detachment
D. Diabetic retinopathy
E. Corneal ulcers
F. Presbycusis
G. Conduction deafness
H. Sensory deafness
(.,0
(.,0
""
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION B. There are some specific pathophysiological problems to
which older adults are more prone.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
XIV. Nursing diagnoses commonly
associated with sensory
diseases
A. Potential for physical
injury
B. Mild to severe anxiety
C. Sensory deficit
D. Self-esteem disturbance
E. Impaired communication
F. Depression
1-'
0
0
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION C. Effective use of the Nursing Process to plan patient care
for older adults requires practice.
OBJECTIVE #1 - Following instruction, the student will be able to identify at
least e1ght major problem areas from an example Nursing Data Base for Older
Patients which has been filled out for a fictitious patient [See Appendix H].
(application)
OBJECTIVE #2 - Following instruction, the student will be able to determine at
least six Nursing Diagnoses and the supportive dat8 [from the major problem
list from Objective 1].
(application)
OBJECTIVE #3 - Following instruction, the student will be able to determine an
appropriate goal for each of the Nursing Diagnoses determined in Objective 2.
(application)
OBJECTIVE #4 - Following instruction, the student will be able to recall at least
four feasible Nursing Interventions for each of the Nursing Diagnoses
determined in Objective 2.
(application)
OBJECTIVE #5 - Following instruction, the student will be able to identify at
least four evaluative crjteria which would evaluate the effectiveness of
the Nursing Interventions from Objective 4 in meeting the goal determined
in Objective 3.
(application)
OBJECTIVE #6 - Following instruction, the student will be able to apply the
-Nursing Process to plan care for an elderly patient with one of the conditions
listed under Health Generalization A, Unit IV.
(The student will have
provided total patient care for this patient in the Clinical-lab/hospital
setting.) The plan should be comparable in make-up with Appendix I.
(synthesis)
f--'
0
f--'
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION C. Effective use of the Nursing Process to plan patient care
for older adult patients requires practice.
(continued)
CONTENT OUTLINE
I. Guidelines for discussion
groups
A. Choose a group leader
to keep the discussion
moving on the topic.
B. Choose a group
recorder to record
decisions of the
group.
C. Each group member
should take part in
the discussion.
SUGGESTED
LEARNING OPPORTUNITIES
Ia. The instructor will supply
each student with a copy of
Appendix G, and discuss
with them how it could be
used to gather nursing data
from a patient in order to
prepare a patient care plan.
Ib. The instructor will then
review the functions of
group discussion and write
the Guidelines for
discussion groups, from the
Content Outline, on the
chalkboard.
Ic. Then the instructor will
supply each student with
a copy of Appendix H, and
divide the class into
groups of 5-6 students for
the following tasks
RESOURCES
Teacher and Students
Gordon, Marjory,
Manual of Nursing
Diagnosis, McGrawHill Co., New York,
1982.
Carpenito, Lynda J.,
Handbook of Nursing
Diagnosis,
J.B. Lippencott Co.,
Philadelphia, 1984.
Appendix G., Nursing
Data Base For Older
Adults.
Appendix H., Nursing
Data Base For A
Fictitious Patient.
I-'
0
N
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION C. Effective use of the Nursing Process to plan patient care
for older adult patients requires practice.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
relating to the fictitious
patient in Appendix H.
1. List all of the major
problems identified.
2. Determine the Nursing
Diagnoses from the major
problems listed with the
help of the Handbook of
Nursing Diagnosrs.
3. Formulate an appropriate
goal for each of the
Nursing Diagnoses.
4. Identify as many Nursing
Interventions as possible
for each Nursing Diagnosis.
S. Identify the evaluative
criteria which would
evaluate the effectiveness
of the Nursing Interventions
in meeting the goal for
each of the Nursing
Diagnoses.
RESOURCES
Doenges, Marilynn
E., Mary F.
Jeffries and Mary F.
Moorhouse, Nursing
Care Plans,
F .A. Davis,
Philadelphia, 1984.
......
0
lN
,..
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION C. Effective use of the Nursing Process to plan patient care
for older adult patients requires practice.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
RESOURCES
The instructor will allow 10-15
minutes for each task and bring
the groups together to share
their discussion results by
having the recorders from each
group write the group results
on the chalkboard.
Id. The instructor will then supply
each student with copies of
Appendix F, and ask the students
to point out the differences
between the Care Plan Example in
Appendix I, and their own
production on the chalkboard.
The students will follow the
guidelines in the discussions.
Appendix I. ,
Nursing Care Plan
for a Fictitious
Elderly Patient.
Ie. The instructor will then explain
the assignment which will be due
from each student the following
week, eg; each student will be
assigned to an elderly patient
f---1
0
..p.
UNIT IV.
Planning Nursing Care for Aged Patients in Specific Problem Areas
HEALTH GENERALIZATION C. Effective use of the Nursing Process to plan patient care
for older adults requires practice.
(continued)
CONTENT OUTLINE
SUGGESTED
LEARNING OPPORTUNITIES
in clinical-lab the next day.
The student will prepare a
nursing care plan for that
patient by using Appendix G,
Nursing Data Base for Older
Adults to gather data from
the patient, and following
the Nursing Care Plan Format,
Appendix J to prepare the
Nursing Care Plan. The
instructor will remind the
students that they have
Appendix H as an example
for using the Nursing Data
Base, as well as Appendix I
as an example for preparing
the nursing care plan.
The students will prepare the
nursing care plan as homework
for the next week.
RESOURCES
Appendix J,
Nursing Care Plan
Format.
f-1
0
u-J
BIBLIOGRAPHY
. u
106
107
BIBLIOGRAPHY
Adams, George. Essentials of Gerjatric Medicine.
New York: Oxford Univ. Press, 1977.
Aspinall, Mary J. and Christine Tanner.
Decision Making
for Patient Care.
New York: Appleton-Century-Crotfs,
1981.
Bozian, Marguerite W., and Helen M. Clark.
"Counteracting
Sensory Changes in the Aging." American Journal of
Nursing, (March 1980) ,473-76.
Bricker, Phillip W. Home Health Care for the Aged,
New York: Appleton-Century-Crofts, 1978.
Brunner, Lillian S. and Doris S. Suddarth.
Textbook of
Medical-Surgical Nursing.
J.B. Lippencott, 1984.
Burant, Ralph J., ed.
Practical Guide to Geriatric
Medication. Oradell, N.J.: Medical Economics Co.,
1980.
Burnside, Irene M., ed.
Psychosocial Nursing Care of the
Aged.
New York: McGraw-Hill, 1983.
Butler, Robert N. and Myrna I. Lewis. Aging and Mental
Health.
St. Louis:
C.V. Mosby Co., 1977.
Campbell, Mary F.
"Study of the Attitudes of Nursing
Personnel Toward the Geriatric Patient." Nursing
Research, 20(3) :150, March 1980.
Cape, Ronald D., Rodney M. Coe and Isadore Rossman, eds.
Fundamentals of Geriatric Medicine.
New York:
Raven Press, 1983.
Carpenito, Lynda J. Handbook of Nursing Diagnosis.
Philadelphia: J.B. Lippencott, 1984.
Coe, Rodney M.
"Comprehensive Care of the Elderly."
Fundamentals of Geriatric Medicine.
eds. Ronald D.
Cape, Rodney M. Doe, and Isadore Rossman.
New York:
1983, p. 3.
108
Combs, Karlen L. "Preventive Care in the Elderly." In
Nursing the Older Adult. ed. Andrea B. O'Connor.
New York: American Journal of Nursing Co., 1978,
pp. 45-51.
De Lapp, Rena D. "Helping the Elderly Live Longer and
Better." Nursing 83. 13(11) :61-63, 1983.
Demmerle, Barbara. "General Nursing Care."
Nursing. 3(5) :316-321, 1982.
Geriatric
De Young, Monica. "Planning for Discharge."
Nursing. 3(6) :396-399, 1982.
Geriatric
Dobihal, Shirley, "Hospice: Enabling a Patient to Die
at Home." American Journal of Nursing. 80(8) :14481451, 1980.
Doenges, Marilynn E., Mary F. Jeffries and Mary F.
Moorhouse. Nursing Care Plans. Philadelphia:
F.A. Davis Co., 1984.
Dunn, Betty and Elizabeth Abel. "Focus on 1.1/ellness."
Geriatric Nursing. 4(2) :111, 1983.
Eliopoulos, Charlotte, Gerontological Nursing.
Harper and Row, 1979.
New York:
Epstein, Charlotte. Learning to Care for the Aged.
Reston, Va.: Reston, 1977.
Fodor, John T. and Gus T. Dalis. Health Instruction:
Theory and Application. Philadelphia: Lea and
Febiger, 1981.
Food for Older Adults, Career Aids, Inc., Chatsworth,
Ca., 1983.
Futrell, May et al. Primary Health Care of the Older
Adult. N. Scituate: Dusbury Press, 1980.
Gault, Patricia L. "Plan for a Patchwork of Problems
When Your Patient is Elderly." Nursing 82.
12(1) :50-54.
Gordon, Marjory. Manual of Nursing Diagnosis.
McGraw-Hill, 1982
Nursing Diagnosis.
1982.
New York:
New York:
McGraw-Hill,
109
Gress, Lucille D. and Sister Rose Therese Bahr.
The Aging Person-A Holistic Perspective.
St. Louis:
C.V. Mosby, 1984.
Hannanan, Sachary I.
"How Aging Alters the Actions of
Drugs." Practical Guide to Geriatric Medication.
ed. Ralph Bryant.
Oradell: Medical Economics,
19 80. pp. 2 7-4 2.
Hayter, Jean.
"Why Response to Medication Changes With
Age." Geriatric Nursing.
2(6) :411-416, 1981.
Hudson, Margaret.
"Safeguard Your Elderly Patient's
Health Through Accurate Physical Assessment."
Nursing 83.
13(11) :58-61, 1983.
Implications for Teaching:
Perspectives on Aging,
Concept Media, Irvine, Ca., 1979.
Kayser, Jeanie Schmitt and Fred Minnigerode.
"Increasing
Nursing Students' Interest in Working With Aged
Patients." In Nursing The Older Adult.
ed.
Andrea B. O'Connor.
New York: American Journal of
Nursing Co.
pp. 230-231.
Kleyman, Paul.
"Home Care Controversy."
Care Coordinator.
3(8):18-19, 1984.
The Continuing
Kohut, Sylvester, Jr., Jeraldine J. Kohut and Joseph J.
Fleishman.
Reality Orientation for the Elderly.
Oradell: Medical Economics Co., 1983.
Lee, Anthony and Ronni Sandroff.
"1984 and Beyond:
What ' s Ahead for Nu r s in g . " R . N .
4 7 ( 1) : 2 6 - 2 9 , 19 8 4 .
lV1angieri, Dorothy.
"Saving Your Elderly Patient's Skin."
Nursing 82.
12(10) :44-45, 1982.
Mayers, Mary N.
"Legal Guideline."
2(6) :417-421, 1981.
Geriatric Nursing.
Morrissey, Barbara G.
Therapeutic Nutrition.
Philadelphia: J.B. Lippencott, 1984.
Muhlenkamp, Ann F., et al.
"Perception of Life Change
Events by the Elderly." Nursing the Older Adult. ed.
Andrea B. O'Connor.
New York: American Journal of
Nursing Co., 1978.
110
Myths and Realities:
Perspectives on Aging, Concept
Media, Irvine, Ca., 1979.
Newton, Kathleen and Helen C. Anderson.
Geriatric
Nursing, St. Louis: C.V. Mosby, 1966.
O'Connor, Andrea B., ed.
Nursing The Older Adult.
New York: American Journal of Nursing Co., 1978.
Poe, William D. and Donald A. Holloway.
Drugs and the
Aged.
New York: McGraw Hill, 1980.
Putnam, Saundra T.
"Home as a Place to Die."
American Journal of Nursing.
80(8) :1451-1453, 1980.
Rodstein, Manuel.
"Falls by the Aged."
In Fundamentals
of Geriatric Medicine.
eds.
Ronald D. Cape,
New York:
Rodney M. Coe, and Isadore Rossman.
Raven , 19 81 , p p . 1 0 9 - 115 .
Safety for the Elderly Patient:
Fundamental Concepts in
Nursing, Concept Media, Irvine, Ca., 1979.
Samuels, Arthur, "A Doctor's View of Home Care."
The Continuing Care Coordinator.
3(8) :37-38, 1984.
Shaffer, Frankl in A.
"DRGs:
Nursing and Health Care.
History and Overview."
4(8) :388-389, 1983.
APPENDICES
. '
111
APPENDIX A
NEEDS ASSESSMENT FOR CARE
OF AGED PATIENTS
'
6
112
113
NEEDS ASSESSMENT FOR CARE
OF THE AGED PATIENT
Directions:
Read each item carefully; if the item is
true, darken the bubble in the "TRUE" column
on the left.
If the item is false, darken
the bubble in the "FALSE" column on the
right.
(Please use the answer sheet provided.)
TRUE/FALSE
• tJ
1.
Health care professionals, generally, have optimistic
and unprejudiced attitudes about the elderly.
2.
The older members of the population are essentially
part of a low income group.
3.
The perception of some kinds of pain decreases for
an elderly person.
4.
Body temperature is a reliable gauge of an elderly
person's response to disease.
5.
Non-compliance to a medical regimen indicates that
the elderly person is senile.
6.
Changes in the diet of the elderly person should
include decreased calcium.
7.
There should be an overall decrease in the number of
calories in the diet of an elderly person.
8.
There should be a decrease in the amount of protein
in the diet of an elderly person.
9.
A beneficial way to handle urinary incontinence of
an elderly patient is to limit intake below
2,000 cc. in 24 hours.
10.
Elderly patients are less apt to have unusual
reactions to drugs.
11.
Most drugs remain active in the body of an elderly
person for a longer time than a younger person.
12.
The effects of drugs are usually apparent earlier
for elderly persons than for younger ones.
13.
A lower than normal serum protein can effect the
actions of drugs.
114
TRUE/FALSE
14.
To prevent embarrassment from spills, it is better
for an elderly patient to eat alone.
15.
Home health care can be more cost effective than
hospitalization, when the situation is not acute.
16.
Under normal circumstances, the kidneys of the
elderly person continue to function adequately
throughout life.
17.
As a result of changes due to aging, the cardiac
output increases.
18.
Aging usually results in a decrease in intelligence.
19.
As a result of aging there is a reduced vital
capa~ity in th~ lungs.
20.
The Nursing Process can assist the nurse in planning
preventive care for the elderly patient.
APPENDIX B
CURRICULUM EVALUATION FORM
115
CURRICULUM EVALUATION FORM
very
good
good
Information on the nursing care of aged patients
is up-to-date.
2 .. The model is directed at the second year nursing
student's level of understanding.
3. The behavioral objectives are realistic
for students.
4. The model content is presented in an organized
manner.
5. The model content is presented in an interesting
manner.
6. The learning opportunities are applicable to the
classroom.
unsatisfactory
no basis
for eval.
1.
7.
i
i
!
Suggestions for the improvement of the model:
--------
---
--
-
Signature
-------------------------------------------------
Date________________
f-1
f-1
Q\
APPENDIX C
EVALUATORS OF THE EDUCATIONAL MODEL FOR
NURSING CARE OF AGED PATIENTS
117
118
JURY OF EXPERTS FOR THE EVALUATION OF
THE EDUCATION MODEL FOR NURSING CARE
OF AGED PATIENTS
Ethel Riggs, R.N.
Director of Nurses·
Mountain View Sanitarium
13333 Fenton Avenue
Sylmar, Ca.
91342
Lorretta Worthington, R.N., M.P.H.
Chairman, Health Science Dept.
Los Angeles Valley College
5800 Fulton Ave.
Van Nuys, Ca.
91401
Brenda Allodco, R.N., M.N.
Professor, Health Science Dept.
Los Angeles Valley College
5800 Fulton Ave.
Van Nuys, Ca.
91401
Ann Lawbaugh, R.N., M.N.
Professor, Health Science Dept.
Los Angeles Valley College
5800 Fulton Ave.
Van Nuys, Ca.
91401
• 0
APPENDIX D
AN OUTLINE FOR THE EDUCATION MODEL FOR
CARE OF THE AGED PATIENT
119
120
Conceptual Scheme
Unit I.
Introduction to Concerns Related to the Aged
Health Generalization A. There has recently been a
remarkable increase in the hospitalization of
older adults in the U.S.
Objective - Following instruction the student
will be able to discuss at least three underlying
reasons for the increased hospitalization of
older adults in the U.S. (interpretation)
Health Generalization B. The increase in hospitalization of older adults has had an appreciable
impact upon the available health care.
Objective - Following instruction the student
will be able to list five of the current factors
which limit adequate health care for the older
adult.
(knowledge)
Health Generalization C.
Increased knowledge concerning aging and the needs of the elderly may
lead to more positive attitudes and more
enlightened health care.
Objectives - Following instruction, the student
will be able to:
1) list at least six ways in which negative
attitudes toward the elderly are manifested
during the health care of the elderly
patient.
(knowledge)
2) identify at least four requirements that
are necessary for more enlightened health
care of the older adult.
(knowledge)
3) detect the underlying stereotype that is
evident in at least seven of the examples
given in the list in the content outline.
(analysis)
Health Generalization D. The multiple changes
associated with aging require complex and arduous
adjustments.
Objective - Following instruction, the student
will be able to recall at least two specific
121
adjustments that are related to each of the three
major areas of adjustments involved with aging.
(knowledge)
Unit I I.
Preventive Care and Health Maintenance for
the Aged
Health Generalization A. Accidental injuries may be
prevented by following some relatively simple
guidelines.
Objectives - Following instruction, the student
will be able to:
1) recall at least three guidelines ~to prevent
falls in the home.
(knowledge)
2) recall at least four approaches to prevent
falls in each of the three hazard areas in
the hospital.
(knowledge)
3) recall at least four risk factors related
to aging which might increase the chances
for accidents.
(knowledge)
Health Generalization B.
Positive measures for
maintaining health should contribute to improved
health and longevity for older adults.
Objectives - Following instruction, the student
will be able to:
1) recall two of the positive measures for
improving the health of older adults.
(knowledge)
2) discuss the importance of at least three
of the positive measures for improving the
health of older adults.
(interpretation)
Health Generalization C. Teaching and motivating
older adults about health and health hazards
requires special understanding and skills.
Objectives - Following instruction, the student
will be able to:
1) recall at least four questions to ask
patients in order to determine priorities
for health teaching.
(knowledge)
2) list at least nine guidelines to follow
when teaching the elderly patient.
(knowledge)
122
Unit III.
General Considerations and Approaches in
Nursing Care of the Aged
Health Generalization A. Elderly patients have some
special needs in addition to the daily care needs
of all adult patients.
Objectives - Following instruction, the student
will be able to:
1) discuss why it is necessary to check
elderly patients frequently in extremes of
hot and cold environments.
(interpretation)
2) discuss why careful care of the skin and
feet is essential for older patients.
(interpretation)
3) discuss at least three reasons why elderly
patients have increased problems with bowel
elimination.
(interpretation)
4) list at least three major dietary problems
of the elderly patient.
(knowledge)
5) discuss the underlying reasons for at least
three dietary problems of the elderly
patient.
(interpretation)
6) list at least three nursing interventions
that are important in encouraging elderly
patients to eat.
(knowledge)
7) discuss at least three ways in which
inactivity is a serious threat to the aged
patient.
(interpretation)
8) discuss the advantages to the patient in
promoting self-care within the individual
abilities to the aged patient.
(interpretation)
9) discuss at least three factors related to
the hospitalization of the elderly patient
that require emotional support.
(interpretation)
10) discuss at least four elements related to
life changes of aging that suggest the need
for emotional and spiritual support for the
elderly patient.
(interpretation)
Health Generalization B. Health care professionals
need to be aware of the complex risks involved
with drug therapy for the elderly.
Objectives - Following instruction, the student
will be able to:
1) recall at least four types of body changes
due to age which can alter the effects
of drugs.
(knowledge)
123
2) discuss how decreased metabolism by the
liver in aging alters the effects of drugs.
(interpretation)
3) discuss the risks related to the decreased
excretion of drugs by the kidneys of elderly
patients.
(interpretation)
4) discuss how multiple pathology increases
the risks related to the altered actions of
drugs for the elderly.
(interpretation)
5) recall at least three approaches to use
when teaching elderly patients about drug
therapy, which will help to promote
compliance.
(knowledge)
Health Generalization C. Health professionals need to
be aware of the recent move toward home care for
the elderly patient.
Objectives - Following instruction, the student
will be able to:
1) discuss, in his/her own words two of the
reasons for the recent move toward home
care of the elderly patient.
(interpretation)
2) discuss the elements that are necessary for
successful home care.
(interpretation)
Health Generalization D. The Nursing Process is an
efficient tool to use in planning the care of
elderly patients.
Objectives - Following instruction, the student
lvill be able to:
1) list the four component parts of the
Nursing Process.
(knowledge)
2) recall the sources of data collection in
the assessment part of the Nursing Process.
(knowledge)
3) recall the three major sources for
identifying problems during assessment for
the Nursing Process.
(interpretation)
4) demonstrate the method of identifying
Nursing Diagnoses during assessment for the
Nursing Process.
(application)
5) discuss the four steps for the planning
part of the Nursing Process.
(interpretation)
6) discuss the implementation part of the
Nursing Process.
(interpretation)
7) discuss the evaluation part of the Nursing
Process.
(interpretation)
124
8) propose approaches to overcome the four
difficulties in assessment for elderly
patients as listed in the content outline.
(extrapolation)
9) recall at least five important considerations to use in the planning part of the
Nursing Process, when planning care for
elderly patients.
(knowledge)
10) recall at least three guidelines to follow
in the implementation part of the Nursing
Process in caring for elderly patients.
(knowledge)
11) recall at least two guidelines to use in
the evaluation part of the Nursing Process
when planning care for elderly patients.
(knowledge)
Unit IV.
Planning Nursing Care of Aged Patients in
Specific Problem Areas
Health Generalization A. There is reduced efficiency
of most body systems, due to aging, which are not
apparent unless a disease process or disability
causes unusual demands upon the body.
Objectives - Following instruction, the student
will be able to:
1) recall two common changes in cardiovascular
functioning which are due to aging.
(knowledge)
2) recall one common change in respiratory
functioning which is due to aging.
(knowledge)
3) recall two common changes in musculoskeletal functioning which are due to
aging.
(knowledge)
4) recall one common change in hematological
functioning which is due to aging.
(knowledge)
5) recall two comma~ changes in gastrointestinal functioning which are due to
aging.
(knowledge)
6) recall one common change in genitourinary
functioning which is due to aging.
(knowledge)
7) recall one common change ln regulatory
functioning which is due to aglng.
(knowledge)
8) recall one common change in nervous
functioning which is due to aging.
(knowledge)
125
Health Generalization B. There are some specific
pathophysiological problems to which older adults
are more prone.
Objectives - Following instruction, the student
will be able to:
1) recall at least five disease entities
involving the cardiovascular classification,
to which older adults are prone.
(knowledge)
2) determine at least six nursing diagnoses
that are commonly associated with patients
with cardiovascular diseases.
(extrapolation)
3) recall at least three disease entities
involving the respiratory classification,
to which older adults are prone.
(knowledge)
4) determine at least four nursing diagnoses
that are commonly associated with patients
with respiratory diseases.
(extrapolation)
5) recall at least two disease entities
involving the musculoskeletal classification, to which older adults are prone.
(knowledge)
6) determine at least four nursing diagnoses
that are commonly associated with patients
with musculoskeletal diseases.
(extrapolation)
7) recall at least one disease entity
involving the neurological classification,
to which older adults are prone.
(knowledge)
8) determine at least seven nursing diagnoses
that are commonly associated with patients
with neurological diseases.
(ext rapol a ti on)
9) recall at least five disease entities
involving the gastrointestinal classification, to which older adults are prone.
(knowledge)
10) determine at least three nursing diagnoses
that are commonly associated with patients
with gastrointestinal diseases.
(extrapolation)
11) recall at least five disease entities
involving the genitourinary classification,
to which older adults are prone.
(knowledge)
.
"
126
12) determine at least three nursing diagnoses
that are commonly associated with patients
with genitourinary diseases.
(extrapolation)
13) recall at least seven disease entities
involving the sensory classification, to
which older adults are prone.
(knowledge)
14) determine at least four nursing diagnoses
that are commonly associated with patients
with sensory diseases.
(extrapolation)
Health Generalization C. Effective use of the Nursing
Process to plan patient care for older adults
requires practice.
Objectives - Following instruction, the student
will be able to:
1) identify at least eight major problem areas
from a Nursing Data Base For Older Patients
which has been filled out for a fictitious
patient.
(application)
2) determine at least six Nursing Diagnoses
and the supportive data, from the major
problem list from Objective 1.
(application)
3) determine an appropriate goal for each of
the Nursing Diagnoses determined in
Objective 2.
(application)
4) determine at least four nursing interventions for each of the Nursing Diagnoses
determined in Objective 2.
(application)
5) identify at least four evaluative criteria
which could establish the effectiveness
of the nursing interventions from Objective
4 in meeting the goal determined in
Objective 3.
(application)
6) apply the Nursing Process to plan care for
an elderly patient with one of the conditions listed under Health Generalization
A, Unit IV.
(The student will have
provided total patient care for this
patient in the Clinical-lab/hospital
setting.)
The plan should be comparable in
make-up with Appendix I.
(synthesis)
.
0
APPENDIX E
EXPRESSIONS OF STEREOTYPING
127
128
UNIT I.
EXPRESSIONS OF STEREOTYPING
Directions:
Each one of the following items is to be
written on a 3 x 5 card:
1.
"She's aged so gracefully."
2.
"I'm younger, so it's up to me to apologize."
3.
"Why doesn't he act his age?"
4.
"He ' s 7 0 y e a r s o 1 d , but he ' s r e a 11 y very sharp . "
5.
"The women's dresses are on the next floor; this 1s
the misses' department."
6.
"He wouldn't enjoy that film; he's 68 years old!"
7.
"Don't tell her about Mary; she'll only worry."
8.
"I don't think you ought to be out in this weather."
9.
Young man bypasses the old people on the street
and asks only young people to sign his petition.
10.
Acquaintance talking about the old man or woman to
the younger person with him:
"How is he feeling?
He looks fine."
APPENDIX F
ROLE-PLAYING SITUATION
129
130
UNIT II.
ROLE-PLAYING SITUATION
(Relocation Confusion)
Directions:
Two students, who volunteer for the roleplaying, go to a quiet place for about ten
minutes and discuss the situation.
No
script should be prepared, rather, each
should try to take on the identity of the
part being played and react to each other
spontaneously.
The scene- all that is
required is a bed and a chair.
The action
might take place in a Nursing-lab where a
hospital bed is available, or, if the
classroom must be used, a bed could be
simulated with several chairs placed
together.
(Provide a B/P cuff and
stethoscope.)
The Parts:
Mrs. Duncan is a 76-year-old patient who
has been admitted to the hospital with
pneumonia.
She has never been in the
hospital before.
One month ago her husband
died.
She has three grown children.
Two
sons, one is married with two teen aged
children, both live out of town.
The
daughter is unmarried, and is a practicing
attorney.
She lives close by, but has
only been to visit her mother once since
she was admitted two days ago.
Mrs. Duncan
has not been sleeping or eating well since
her husband died.
She is grieving for him,
and having a difficult time facing life
without him.
Last night they gave Mrs. Duncan a sleeping
pill, and she slept restlessly all night.
When the nurse wakes her up she is confused
about where she is, and who the nurse is.
The nurse reminds her of her sister Grace,
so she calls her Grace, and asks what she
is doing here, and where they are.
(Mrs. Duncan should only reveal this
information if the nurse is empathetic and
asks the right questions.)
131
Role-Playing Situation
(continued)
The nurse is an RN.
Her name is Ruth Marsh.
She is 30 years old, and has a husband and
a four-year-old daughter, who kept her up
last night crying with an earache. She carne
on duty at 11 PM, it is now 4 AM, and she
has just come in to check Mrs. Duncan and
take her B/P, etc.
She has had a busy night
and cannot spend too much time with
Mrs. Duncan, but she sees how important it
is to reorient Mrs. Duncan, and calm her
down.
The instructor should give a brief explanation of the
scene with no details before the interaction begins.
APPENDIX G
NURSING DATA BASE
FOR OLDER ADULTS
.
0
132
133
NURSING DATA BASE FOR OLDER ADlll,TS
I.
Profile of Patient
Name7 7
Sex
Date of birth
Admi t t-e,.d-f7""r_o_m_::-----A"';;"dm..,-l,_.s-s-ci:-o-n--:::D:--ate
time
---Home
Language barrier: No Yes __Type_ _ __
Nursing Home
Religion~~------------------------Other
-Spouse: L1ving: yes
no
How Admitted:
year deceased
w/c
Children: #living
#deceased - - - ---ambulance
none
.----Significant other_________________
Occupation____________________
II.
Health History
Reason for Hospitalization (in patient's words) ________
Previous Hospitalizations, surgeries, and other relevant
illness (patient's words) ________________________
Allergies:
Food
Drug-------------------------Other ____
Blood transfusion_s
_______________________
w~~-~e-n
Tobacco use
type
Current Medications: --------------------------------Name
Dosage
when taken why taken
--
III.
Physical Status:
Ht.
--------Wt.
Recent wt. change
Temp_ _ _ __
sit
B/P Rt. lying
Resp.
quality
stand
Pulse
quality- - - - B/P Lt. lying
sit
-irregular- - ---stand
--Skin: · Color
Dry
-=D~i-s-co~1~o-r-a~t~i-o-n~(~s~i~t-e~&-d'e_s_c_r~i-p~t~i-o-n')______
------------
Rash(site &description) __~-----------------------Lesions(site & description--------------------------Scars(site & description) ________________________
134
NURSING DATA BASE FOR OLDER ADULTS (continued)
III.
IV.
Hair condition
~~--------------------------------------Fingernail condition
Toenail condition ---------------------------------------Arnbulation: Assistance required------reason-------------Mobility devices: prosthesis
type
crutches
---------------cane
w/c - - - - - - Nursing Assessment (symptoms)
Neuromuscular:
symptoms
None
--Arthritis(site)
--Contractures(site)
--Fractures(site)
--Paralysis(site)
--Amputation(site)
--Back problem(site)
--Painful movement(site)
--Fainting(recency)
--Dizziness(recency)
-weakness (site)
-Seizures(describe)
-Tingling (site)
-Nwnbnes s (site)
--Other
------------------Corrrrnents
-----------------
Nutritional/gastrointestinal:
symptoms
None
-Dentures(describe)
--Special diet(type)
--Indigestion(precipitating
-factor)
Loss of appetite(recency)
-Loss of taste(recency)
--Chewing problems
-S\vallowing problems
-Feeding tube(type)
-Nausea/vomiting(recency)
-Diarrhea(recency)
--Constipation(laxi tive used)
-Last B.M.
--Type of s...,-to_o_,l.-------------Hemorrhoids
--Other
----------------Corrrrnents
Cardiovascular:
symptoms
None
--Chest pain(describe)
--Palpitations
--High blood pressure
--Edema (site)
--Cramping(site)
--Peripheral pulses
-- Rt
Lt____________________
Color of extremities
--Temp of extremities
-Other
Corrrrnent_s_____________
------------------
Respiratory:
symptoms
None
--Dyspnea (frequency)
--Shortness of breath
(frequency)
~~eezing(frequency)
-Asthma (frequency)
-Cough
-Sputum( describe)
-Adventitious breath sounds
--Other_______________
Comments __________________
135
NURSING DATA BASE FOR OLDER ADULTS
IV.
(continued)
Nursing Assessment (symptoms)
Urinary : symptoms
None
--Paintful urination
--Difficult urination
--Nocturia
--Incontinence
--Frequency/urgency
--Character or urine
--Other
Comment_s________________
I
Sensory: symptoms
Hearing loss
Rt
Lt
--Hearing aid --- - -Sight loss
Rt
Lt
--Glasses
Contact lens
--Cataracts
--Glaucoma(medication used)
--Headaches(cause-recency)
--Sinusitis
--Other
Comment_s____________________
Female Reproductive factors:
None
-Breast mass
-Vaginal discharge
--vaginal itching
--J'.iastectomv Rt Lt
--Other
, __ -
Hale Reproductive factors:
None
--Scrotal swelling
-Scrotal lesions(describe)
-Prostate disorder
-vasectomy
-Other
Connnents-------------
Comments
Mental Status:
Alert Oriented
-Disoriented
person
-place
-time
Stuporous
Comatose
-Listless
Drowsy
-Forgetful
-Slow response
--Other
Emotional Status:
Calm
Irritable
-Friendly
-Angry
Cooperative --Fearful
Interested --Depressed
in life --Suspicious
-Suicidal
Sleep &Rest
Insomnia
--Ni~1t restlessness
--Ni~1t confusion
--Other
-----------------
Comments- - - - - - - - - - -
-------------------------------------------
----------------------Comments
----------------------
136
NURSING DATA BASE FOR OLDER ADULTS (continued)
V. Discharge Assessment
1. Do you anticipate changes in your living situation after
discharge?
Yes
No
----
2. Areas that may require alteration
Physical layout of home
- - - -Food preparation
-------Additional
help in home
---~Shopping
Transportation
Living facility other
- - - - - - than home
------Ambulation
3. Areas requiring teaching and/or assistance
Wolli1d care
----~Medication
------Treatments
Comments
---------------~----------------------
Infonnation obtained from:
---Patient----Other(specify)
APPENDIX H
NURSING DATA BASE FOR FICTITIOUS
ELDERLY PATIENT
137
138
NURSING DATA BASE FOR OLDER ADULTS
I.
Profile of Patient
Name ffir:~ C l cwi.ssa.2 rO, !ton Sex F Date of birth.;?/Li;,/4¢'
Admitted from:
Admission Datei.:Q343._..- time .3AM
'
Home X
Language barrier: NoL_Yes_Type_ _ __
Nursing Home____
Religion~c:~~~-T.h~.wo~'l~c-~-------------------Other
Spouse: LlVlng: yes ___no)(_
How Admitted:
yearaeceased 19'gl/
w/c fr~m of\
Children: #living
#deceased_ _ __
none,...._,.x._·---=
ambulance
Significant other .S i.SU..v j i'l Idoho
Occupation Rel.ir- ed S.....boo1 -r.e.c.>£ heV
II.
when
-------------------------------
~=---
Dosage
-~·
III.
s<.:.:s
Physical Status: Ht.
IJ
Wt. I.Yt? Recent wt. change
.
.~~
Temp CJ9 If
_
B/P Rt. lyingl~s'-"l~-t-----Resp. 30
quallty dt;spnd{,.
stand--=-·~-;:..___,.-Pulse te>'f
quality W«tl">.
B/P Lt. lyingt='~/?sit_-_··_ _
irre~J aY !Jitt;:Cc•fi.Jr(!/11(;!fht •
stand. :_ .. _
.
Skin: Col01
Qale..-. v.J\tb·..$\~ l"~n.q!il~AI".ourtlwno~
Dry -=Di~coloratiori{Sitei&~escrriptlon) ________________
Rash(site &description) ·-·
Lesions(site &descripti-on-)~::~----------------------------Scars(site
. il
&description) __---~---------------------------------
139
NURSING DATA BASE FOR OLDER ADULTS (continued)
III.
IV.
Hair condition
c.l~
- (,food
Fingernail condition 0 ·
--~~---------------------------------Toenail condition~--~/2~·~¥\~~--~--------------------------­
Ambulation: Assistance required '4e..s reason wec....~ne.s:;,
Mobility devices: prosthesistype--crutches ..- cane
w/c --.-----~··:_------Nursing Assessment (syrnptom5)
Neuromuscular:
symptoms
None
--Arthritis(site)
--Contractures(site)
--Fractures(site)
--Paralysis(site)
--Amputation(site)
--Back problem(site)
--Painful movement(site)
--Fainting(recency)
I(Dizziness(recency)~'fh;~
)(Yve~kness (site)
.0. e~Yc-\
· SelZures (descnbe)
--Tingling(site)
--Nurnbness(site)
--Other
-------------------
Comm~nts
Pa:b'1'"ed with
e xeVIua·,
Cardiovascular:
any
/
S)1Tiptoms
None
)(_Chest pain(describe)
· Palpitations
--High blood pressure
-Edema (site)
-Cramping(si te)
)(Peripheral pulses
Rt) pa-t ruated I Wea.k
Lt
·
r
·
](color of extremities
}(Temp of extremities .}(_Other D1sRndt"d fW~:.t\V'e>JOS
'Comments 4 D<ft oa pam '1"$/<':_gky
e x-treru~s cald and 'i!fatiahc .
.
tl
Nutritional/gastrointestinal:
symptoms
None
--Dentures(describe)
-Special diet (type)
-Indigestion(precipitating
factor)
X Loss of appetite (recency 16 .no
f-+-Loss of taste (recencv)
-Ole\\'ing problems
-SHallowing problems
--Feeding tube (type)
---:~ausea/vomi ting (recency)
--Diarrhea (recency)
)lConstipation(laxitive used)
Last BJ·L
-Type of s..,.t-oo_,l.----------Hemorrhoids
-Other
-----------------
Respiratory:
symptoms
None
~Dyspnea(frequency)
)(Shortness of breath
(frequency)
h1lee zing (frequency)
--Asthma(frequency)
.)(Cough
~Sputum( describe)
~dventitious breath sounds
Other
-----------------ba-$t5 .
~a.\eS 1r1 p<;~j;ler;ov
E:e~~rt~~~
140
\1JRSING DATA BASE FOR OLDER ADULTS
n:.
(continued)
Nursing Assessment (symptoms)
Urinary : symptoms
None
Paintful urination
--Difficult urination
1'-Jocturia
-Incontinence
-Frequency /urgency
--Character or urine
-Other
Comment_s______________
A
Sensory: symptoms
Hearing loss
Rt
Lt
-Hearing aid - - - --Sight loss
Rt
Lt
--Glasses
Contact lens
-Catarac~
--Glaucoma(medication used)
~eadaches(cause-recency)
")(Sinus it is
~Other
Comment_s_&_?r-,-,-,<-,-;r-~~."_"___--_-s_t_i~-,_-,,-c_--1
l·-\ c ~ ~:_,.·t ,-,..- 1.-1 (7-' -- ,. J/_-t ,_..--.t: c 5 ·: .;-"'d \ •-(
'
Female Reproductive factors:
~-1ale
Breast mass
--Vaginal discharge
-Vaginal itching
)liastectomy Rt Lt
-Scrotal swelling
-Scrotal lesions(describe)
-Prostate disorder
--vasectomv
-Other
,
-------. ------------
Comments ---------------
Comments
)(Jione
Reproductive factors: .fW\
~~one
-Other
-- -
Mental Status:
__Alert~Oriented
Disoriented
person
_place
time
Stuporous
Comatose
-Listless
Drowsy
-Forgetful
¥Slow response
Other
-----------------
---------------------
Emotional Status:
Calm
)(Irritable
1 -Friendly
· Angry
I -Cooperative )(Fearful
-Interested
Depressed
in life -Suspicious
-Suicidal
Sleep &Rest
~Insomnia
_Night restlessness
Night confusion
)(_Other Rest L~Vu::-4H?.
cor:rrnents .Jh.~ a.n.xi®s-c-;pressinn
~~*tg·J;;t~2t%~WZ!~"
'
tl
141
~1ffiSING
DATA BASE FOR OLDER
.~ULTS
(continued)
V. Discharge Assessment
1. Do you anticipate changes in your living situation after
discharge?
Yes
X
~o
----
2. Areas that may require alteration
Physical layout of home
_;<~·~-~Food preparation
---,--,.-Additional help in home
_ _ _-.Shopping
)(
Transportation
Living facility other
------than home
-----Ambulation
3. Areas requiring teaching and/or assistance
Wound care
-----.Medication
- - - -TreatT'l.ents
Comments
( h0 ,
Ye c t'2ve red
1
re'\'" iv«
e;<ki ~u:k b<id
p
M~nt,, ~tdJ_~
v
Information obtained from: X
P~;tient
X Oth<;r(specify)
•
net<ryhbae
142
MEDICAL ORDERS FOR FICTITIOUS PATIENT:
Oxygen 6 L. per mask continuously
bedrest with high back rest and bedside commode
I.V. 5% Dextrose/Water with 20 meq. Potassium at 50 cc./
hour
Lasix 40 mg. I.V. push stat
Digoxin 0.75 mg. I.M. stat
Colace 100 mg daily
Isordil 2.5 mg. sublingually P.R.N. angina pain
Phenobarbital 30 mg. Bid
Low sodium diet
Daily weight
Limit fluid intake to 800 cc./24 hours
Intake and Output
APPENDIX I
NURSING CARE PLAN FOR FICTITIOUS
ELDERLY PATIENT
143
NURSING CARE PLAN FOR A FICTITIOUS ELDERLY PATII3NT
PATIENT DATA: Mrs. C.M., 76-year-old female, retired grade school teacher. Husband
deceased six months ago, no children. Sister living in Idaho. Catholic.
Admitted through the hospital emergency room at 3:00 A.M., accompanied by
concerned neighbor. Patient states that she had some angina pain on the evening
before, and that she couldn't sleep and called her neighbor when she started
having difficulty breathing. Admits that she hasn't been taking medicine
"right lately".
Main symptoms: dyspnea and shortness of breath, pallor with cyanosis around mouth,
distended neck veins, frequent cough with frothy white sputum,
fatigability, weakness, restlessness, and irritability.
(From
examination) rapid weak pulse with occasional irregularity, rales
in lung bases bilaterally, decreased peripheral pulses, and cold
cyanotic extremities.
MEDICAL DIAGNOSIS: Congestive heart failure, with pulmonary congestion-secondary to
·coronary atherosclerosis.
Congestive heart failure is the occurrence of circulatory congestion from decreased
myocardial contractility resulting in inadequacy of cardiac output to maintain the
blood flow to body organs and tissues.
Pulmonar~ congestion refers to the presence of serous fluid in the alveoli, as a
result o the increasing pulmonary-venous pressure which engorges the capillaries
and causes the leaking of fluid into the alveoli. This, in turn, interferes with
the gas exchange in the alveoli, with decreasing oxygen supply to the brain and
other tissues.
Coronary atherosclerosis can lead to congestive heart failure by interfering with
the normal blood supply to the cardiac muscles which decreases their contractility.
MEDICAL ORDERS: Oxygen 6 L. per mask continuously, bedrest with high back rest and
bedside commode. Intravenous infusion of 5% Dextrose/Water with 20 meq. Potassium
at 50 cc. per hour. Lasix 40 mg. I.V. push stat, Digoxin 0.75 mg. I.M. stat,
Colace 100 mg. daily, Isordil 2.5 mg. sublingually P.R.N. for anginal pain,
Phenobarbital 30 mg. Bid, low sodium diet, daily weight, limit fluid intake to
800 cc./24 hours, intake and output.
I-'
_.,.
_.,.
MAJOR PROBLEM LIST: dyspnea, cyanosis and rales
anxiety and restlessness
fatigability
insomnia
cold cyanotic extremities
decreased peripheral pulses
grieving, recent death of husband
NURSING DIAGNOSIS
SUPPORTING DATA AND GOAL
rapid weak heart beat
alteration in fluid volume
potential for thrombosis
potential for skin breakdown
knowledge deficit
non-compliance with medical
regimen
NURSING INTERVENTIONS
EVALUATIVE
CRITERIA
IMPAIRED GAS EXCHANGE
Supporting data:
dyspnea, cyanosis
irritability, anxiety
cold extremities
rapid pulse, insomnia
Goal: The patient will
have normal gas exchange
1. Maintain oxygen administration
per order
2. Maintain upright position
3. Take vital signs q 15 minutes
until stable
4. Assess breath sounds q 4hr.
5. Provide a calm atmosphere
6. Splint chest when coughing
7. Monitor blood gas reports
8. Assess sensorium q 4hr.
1.
2.
3.
4.
5.
6.
POTENTIAL FOR EXCESS IN
FLUID VOLUME
Supporting data:
pulmonary congestion, rales
left-sided heart failure
patient's non-compliance
in medical regimen
distended neck veins
dyspnea and cyanosis
Goal: The patient will have
normal fluid volume
1. Monitor blood pressure q hr.
2. Evaluate breath sounds for
increase in rales
3. Observe for increase in
cyanosis, dyspnea, and cough
4. Observe for increased sputum
5. Weigh daily
6. Monitor fluid intake and
output
1. Rales absent
2. Vital signs normal
for patient
3. Respirations easy
4. Color normal
5. Cough absent
6. Decrease in weight
7. Fluid intake
maintained
8. Urine output
increased
respirations easy
color normal
patient more calm
extremities warm
vital signs normal
improved rest and
sleep pattern
7. normal blood gas
reports
!--'
.+::>
VI
EXAMPLE NURSING CARE PLAN (continued)
!
NURSING DIAGNOSIS
SUPPORTING DATA AND GOAL
ALTERATION IN TISSUE PERFUSION
Supporting data:
patient noncompliance with
medical regimen
restlessness, irritability
anxiety, anorexia
dyspnea, cyanosis
distended neck veins
Goal: The patient will have
improved tissue
perfusion
CR1TERIA
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
POTENTIAL FOR FLUID VOLUME
DEFICIT
Supporting data:
diuretics being used
fluid restriction
Goal:
The patient will have
normal fluid volume
EVA~UATIVE
NURSING INTERVENTIONS
Maintain patient on bedrest
Assess sensorium q 4hrs.
Assess anxiety
Majntain quiet environment
Arrange frequent rest
periods
Give small frequent feedings
Monitor. vital signs
Take apical rate
Monitor blood gas levels
Monitor serum digoxin levels
Administer medications as
ordered
Assess for angina pain
1. Monitor output
2. Monitor serum electrolyte
levels
3. Monitor vital signs
q. 15 minutes until stable
4. Observe for pulse irregularities
5. Report diarrhea or
constipation.
.
. I
1 . resp1TIIat1ons easy
2. color normal
3. senso~ium normal
4. patient calm
5. non-d~stended neck
veins
6. appet~· te improved
7. blood gas reports
norma
I
1. Vital lsigns normal
2. No pu]se irregularit~es
3. Serumielectrolyte
4.
i~~:tJ ~~~m~~tput
in ba:Ilance
5. Good kin turgor
6. Norma] bowel
movemJnts
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EXAMPLE NURSING CARE PLAN (continued)
NURSING DIAGNOSIS
SUPPORTING DATA AND GOAL
NURSING INTERVENTIONS
EVALUATIVE
CRITERIA
6. Observe for nausea and
other signs of digitalis
toxicity.
7. Monitor skin turgor.
POTENTIAL FOR ALTERATION IN
COMFORT
Supporting data:
Coronary atherosclerosis
History of Angina pain
Non-compliance with
medication regimen
Anxiety and fear
Coal:
The patient will
verbalize relief of
pain, and will have
decreasing incidents
of pain.
1. Maintain bedrest.
2. Maintain quiet environment.
3. Avoid visitors which
upset patient.
4. Give small frequent
meals.
5. Monitor vital signs.
6. Assess for anginal pain
(by verbal and non
verbal clues
eg. diaphoreses).
7. Administer PRN Isordil
as necessary.
8. Assist patient to
identify situations
which precipitate pain
episodes, and discuss
possible changes in
daily activities.
1. Episodes of
anginal pain
occur.
2. Vital signs
normal for
patient.
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EXAMPLE NURSING CARE PLAN (continued)
NURSING DIAGNOSIS
SUPPORTING DATA AND GOAL
NURSING INTERVENTIONS
EVALUATIVE
CRITERIA
9. Check vital signs
immediately after giving
pain medication, and q
15 minutes until stable.
10. Maintain patient I.V.
line.
POTENTIAL IMPAIRMENT OF
SKIN INTEGRITY
1. Assist patient to change
2.
Supporting data:
required bedrest
decreased tissue perfusion
Goal:
The patient will have
an absence of reddened
or ulcerated skin
areas.
3.
4.
5.
6.
position q hr.
Observe for reddened or
broken areas on the
skin, especially over
bony areas.
Use of eggcrate mattress
Frequent skin care
Linen change and
tightening as necessary
If reddness occurs, report
it to physician.
1. All skin areas in
good condition
or
2. Reddened areas
identified and
treated before
breaks in skin
occur.
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EXAMPLE NURSING CARE PLAN (continued)
NURSING INTERVENTIONS
NURSING DIAGNOSIS
SUPPORTING DATA AND GOAL
KNOWLEDGE DEFICIT CONCERNING
DISEASE AND TREATMENT REGIMEN
1. Discuss the normal heart
2.
Supporting data:
patient's stated noncompliance with medication
regimen
3.
4.
Goal:
The patient will
verbalize understanding of information, and intention
to maintain compliance
to treatment regimen.
5.
(> •
EVALUATIVE
CRITERIA
I
1. Patient verbalizes
action.
Discuss the disease
process
I 2.
Discuss the purpose and
side effects of patient's
medications
Discuss the low sodium
diet and the reasons
I 3.
for it
Discuss signs and symptoms
that must immediately be
reported to physician
Discuss stress and risk
factors that may
influence the patient's
condition
understanding of
information given.
Patient discusses
her episodes of
non-compliance and
possible precipitating factors.
Patient verbalizes
her intent to
maintain compliance,
and ways to remind
herself and record
the times medications are taken.
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EXAMPLE NURSING CARE PLAN (continued)
NURSING DIAGNOSIS
SUPPORTING DATA AND GOAL
POSSIBLE UNRESOLVED GRIEVING
Supporting data:
recent death of spouse
clinging to neighbor's hand
non-compliance to me
regimen
Goal:
The patient will be
able to recognize and
discuss feelings
NURSING INTERVENTIONS
1. Identify the stage of
grieving and the degree
of dysfunction.
2. Provide open relationship in which patient
feels free to discuss
feelings.
3. Reflect perceived
feelings to the patjent.
4. Listen actively and be
available.
5. Provide information to
the patient that
indicates that her
feelings are normal and
should be shared with
someone.
EVALUATIVE
CRITERIA
1. Patient discusses
the feelings of
loss, loneliness,
anger, sadness,
etc.
2. Patient discusses
the possibility of
non-compliance
being related to
her grief.
3. Patient verbalizes
understanding that
her feelings are
normal.
4. Patient discusses
various ways of
coping with her
grief.
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NUF.SING CARE PLAN FORMAT
DATE
STUDENT
-------------------
---------------------
PATIENT DATA: Initials, age, sex, occupation, family orientation, ethnic, cultural,
religious and s.ocial status, any other pertinent factors, admission information,
recent history, and main symptoms.
MEDICAL DIAGNOSIS:
SURGERY:
(define and describe)
(if pertinent, describe)
HEDICAL ORDERS:
MAJOR PROBLEMS LIST:
NURSING DIAGNOSIS
SUPPORTING DATA AND GOAL
NURSING INTERVENTIONS
EVALUATIVE
CRITERIA
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EXAl!JPLE TEST ITEMS FOR POST-TEST
Multiple Choice:
1.
Changes in the diet of the elderly person should
include:
A.
B.
C.
D.
2.
decrease in the number of calories.
in the ratio of protein.
in the calcium intake.
low-fiber foods.
Cardiovascular changes in the aged person include:
A.
B.
C.
D.
3.
an overall
a decrease
a decrease
more bland
increase
lessened
increase
increase
in cardiac output and stroke volume.
blood flow through coronary arteries.
in peripheral circulation.
in elasticity of blood vessels.
The danger of pneumonia in the aged, bedrest
patient is due to:
A. diminished elasticity of the alveoli and
enlargement of the heart.
B. increased chest compliance and vital capacity.
C. decreased lung expansion and fixity of the
rib cage.
D. decrease in residual volume.
4.
The symptom which most frequently occurs with the
deterioration of aging is:
A.
B.
C.
D.
loss of creativity
lack of judgment
decrease in intelligence
short term memory loss.
5.
Bone changes associated with aging frequently result
from a lack of:
·
A. magnesium
C. potassium
B. vitamin A
D. calcium
6.
In relation to drug therapy for the aged person,
all of the following statements are true,
EXCEPT:
(which one is NOT true)
A; older patients have multiple medical problems.
B. with age the response to specific drugs is
better established.
C. with age the margin between too much and too
little of any drug is more narrow.
D. Patient compliance to a drug therapy may be poor.
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156
EVALUATION QUESTIONNAIRE
Directions:
Please rate the various components of the
course by checking the appropriate squares.
If there is an area which you rate as
"unsatisfactory," please make suggestions
in the lines provided for comments.
good
~J
very
good
unsatisfactory
:he objectives clear?
le content up to date?
-
,e content based upon
-iectives?
I
II
le content interesting?
le content useful to you?
e content presented in
;anized way?
y of the material
ssary?
I
I
I
I
he learning experiences
enough?
he methods of
.tation effective?
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