4.2 Professional and Ethical Responsibilities

Question 1

Abuse: The size of the problem

Answer 1

Elder mistreatment is defined as intentional actions that cause harm or create a serious risk of harm (intended or not) to a vulnerable elder by a caregiver or other person who stands in a trusting relationship to the elder. This includes failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm.

Question 2

Abuse: The size of the problem

Interesting Data

Answer 2

Interesting Data:
Abuse signs often missed by people r/t lack of training on how to detect it.
Only 1 in 14 cases of elder abuse ever come to attention of authorities
Females more likely to be abused.
Abuse risks rise as persons age increases
Majority of abusers are family members.

Question 3

Types of Elder Abuse

Answer 3

Physical- use of force to threaten or injure, force feeding
Emotional- verbal attacks, threats, isolation, “silent treatments”, treat like child “elderspeak”
Sexual- contact without consent
Exploitation- theft, fraud, misuse, undue “influence” over money or property
Neglect- caregiver refusal to meet needs
Abandonment- desertion of vulnerable person by anyone with duty of care
Self-neglect- mentally competent elder willingly engages in acts that threaten their safety. Personal choice.

Question 4

Characteristic Risk Factors for Elder Abuse

Answer 4

Advanced age
Physical, functional, or cognitive impairment
Mental illness
Substance abuse (drugs or alcohol)
Social isolation or poor social network
Dependence on others
Past history of abusive relationships
Low income status
Depression/ low self-esteem
Financial or unsafe housing
Poor health ( patient or caregiver)
Caregiver stress/frustration

Question 5

Perpetrator Characteristics for Elder Abuse

Answer 5

Vast majority of abusers are family members (approx. 90%!!)
Often by adult children, spouses, partners, & others.

Family members who:
Abuse drugs or ETOH
Have mental/emotional illness
Feel burdened by caregiving responsibilities
Abuse at higher rates than those who do not have these qualities.

Question 6

Assessment Findings of Elder Abuse Physical

Answer 6

Physical
Bruises, fractures, sprains, dislocations
Broken eyeglasses, signs of restraints
Med overdose or underuse

Question 7

Assessment Findings of Elder Abuse Sexual

Answer 7

Sexual
Torn stained or blood underclothes
Unexplained vaginal discharge, anal bleeding, infections.

Question 8

Assessment Findings of Elder Neglect

Answer 8

Neglect
Dehydration, malnourished, poor hygiene
Bed sores
Unsafe/unclean living environment

Question 9

Assessment Findings of Elder
Abandonment
Exploitation

Answer 9

Abandonment
Desertion at facility, shopping center, hospital.
Exploitation
Abrupt will changes
Large amount $$ withdrawals
Forged elder signatures
Sudden appearance of family not usually involved claiming rights to assets

Question 10

Assessment Findings of Elder

Emotional

Answer 10

Emotional
Extremely withdrawn/ non communicative
Unusual behavior (rocking, sucking, biting)
Emotionally upset or agitated

Question 11

Nursing Responsibilities

Recognize Risk Factors & Behaviors

Answer 11

Excessive controlling behaviors
Substance abuse issues
Isolation of elder
Emotional/financial dependency on elder
Threatening to leave or send to LTC
Minimizing injury/ blaming others
Threats to pet
Name calling
Previous criminal history & violence
Most abusers are family members.

LTC:
https://www.youtube.com/watch?v=1KSn-G1VwQA
https://www.youtube.com/watch?v=ehPSQJG_wVc
Short staffing, high turnover, poor training, negligent hiring practices increase abuse risks.

Always ask questions!!!
Look for Signs!!!!
Report actual or suspected abuse to Adult Protective Services it’s your duty!!!!!

Question 12

Nursing Interventions for Elder Abuse

Answer 12

Perform good assessments – know abuse s/s
Interview patient in private!
Ask patient how injuries happened
Ensure patient safety
Report suspected abuse to APS
Know community resources- respite care, Senior Resources, Life circles.

Question 13

Advance Directives

Answer 13

Legal documents that allow an individual to plan their healthcare in the event they are incapacitated. They facilitate patient-centered care. They include:
Living wills
Durable power of attorney (DPOA)
Healthcare surrogate
Physician orders for life-sustaining treatment (POLST)

Question 14

Living Will

Answer 14

Living Will
Legal document that expresses pt. wishes regarding life-sustaining tx in terminal illness or permanent unconsciousness.

Does NOT designate a substitute decision maker.
Responsibility of the nurse to advocate & record in plan of care.

**Facilities that receive Medicare & Medicaid funds are required to provide all patients
with written info & counselling about AD & the institutions policies governing them.

NURSES HAVE A DUTY TO ADVOCATE FOR PATIENTS END-OF LIFE PREFERENCES TO BE
HONORED

Question 15

DPOA

Answer 15

DPOA
Document that delegates authority to make health, financial, and or legal decisions on the individuals behalf.

It must be in writing & state that the person is authorized to make healthcare decisions.

**Facilities that receive Medicare & Medicaid funds are required to provide all patients
with written info & counselling about AD & the institutions policies governing them.

NURSES HAVE A DUTY TO ADVOCATE FOR PATIENTS END-OF LIFE PREFERENCES TO BE
HONORED

Question 16

Do Not Resuscitate

Answer 16

“Full Code” – presumed status unless documentation/orders to limit intervention.

“DNR”- Order written by Dr. based on patient/family wishes. NO CPR performed for respiratory or cardiac arrest. DNAR means same thing as DNR.

“Comfort Measures”- a Dr. order that means no further life-sustaining interventions are necessary (antibiotics, feedings, etc). Goal of care is comfortable, dignified death. Agency protocols should be established defining comfort care to prevent confusion.

Question 17

Euthanasia

Answer 17

A deliberate ending of a life of someone suffering from a terminal or incurable illness.
“slow codes” – considered malpractice

Voluntary Euthanasia- competent adult patient makes decision to terminate life.

Involuntary- mercy killing performed without the patient’s consent. (example: brain injury, too young, coma, mentally retarded patients )
https://www.youtube.com/watch?v=4yudXVb_HlE

ANA (2013) position statement opposes nurse participation in euthanasia & emphasizes obligation of nurse to provide compassionate EOL care aimed at promoting comfort and providing adequate pain control.

Question 18

Nursing Interventions for Comfort Care

Answer 18

Clean skin & linens
Comfort positioning 
Foley or bed pads for incontinence
Gentle massage to improve circulation & shift edema
Small frequent sips of fluids
Oral care
Clear secretions from eyes & nose
Administer ordered pain meds prn
Oxygen as ordered to relieve dyspnea

Question 19

The client has grown very fond of the nurse. Which items may the nurse accept from the client? Select All That Apply.

A. A token gift from the client to the individual nurse.
B. The client’s permission to be a contact on a social networking site
C. A position as a private duty nurse for the client upon the client’s discharge.
D. A hug from the client upon the client’s discharge .
E. A thank-you basket of candy and fruit from the client for the unit staff.

Answer 19

D. A hug from the client upon the client’s discharge

E. A thank-you basket of candy and fruit from the client for the unit staff.

Question 20

The competent 90 year old client admitted to an ED with an MI declines treatment and wishes to be discharged home. Which statement best supports the client’s right to refuse care?

A. “I have lived a full life; I want to go home to die”
B. “I understand that without treatment, I could die”
C. “It is too expensive to stay in the hospital”
D. “My family wants me to go home; I will be okay”

Answer 20

B. “I understand that without treatment, I could die”

Question 21

The nurse sees the HCP reviewing the client’s medical record. After the HCP leaves, the nurse picks up the chart and notices that this HCP is not involved in the client’s care. Which professional action should be taken by the nurse?

A. Report the event to the immediate supervisor.
B. Call the HCP and confront him/her with reading the medical record.
C. Report the HCP to the chief of staff.
D. No action is required; all HCP’s may look at any records.

Answer 21

A. Report the event to the immediate supervisor.

Question 22

The RN is working with the UAP and the LPN in providing care to a group of clients. Which tasks should the nurse plan to delegate? Select all that apply.

A. LPN to administer oral and intramuscular medications
B. UAP to perform chest tube dressing changes
C. LPM to assess and care for two noncomplex patients.
D. UAP to empty and record urinary catheter bag drainage.
E. UAP to take and document vital signs on all clients
F. LPN to initiate the discharge paperwork for two clients.

Answer 22

A. LPN to administer oral and intramuscular medications

D. UAP to empty and record urinary catheter bag drainage.

E. UAP to take and document vital signs on all clients

Question 23

The nurse has been assigned four clients. In what order should the nurse plan to assess clients?

A. 14 yo with UTI who reports urinary burning at a 2/10
B. 6 yo 1 day postop appendectomy with a temp of 102.2 F
C. 5 yo newly admitted with pharyngitis and drooling.
D. 2 yo admitted with diarrhea who had 3 loose stools on the previous shift.

Answer 23

C. 5 yo newly admitted with pharyngitis and drooling.

B. 6 yo 1 day postop appendectomy with a temp of 102.2 F

D. 2 yo admitted with diarrhea who had 3 loose stools on the previous shift.

A. 14 yo with UTI who reports urinary burning at a 2/10

Question 24

An experienced LPN is caring for a client with acute substernal chest pain. Which actions should the nurse delegate to the LPN? Select all that apply.

A. Give 325mg chewable aspirin to client
B. Give Heparin 5000 units IV
C. Administer morphine sulfate 4 mg IV
D. Apply oxygen at 2-4 liters per nasal cannula
E. Place leads on the client’s chest for cardiac monitoring.

Answer 24

A. Give 325mg chewable aspirin to client

D. Apply oxygen at 2-4 liters per nasal cannula

E. Place leads on the client’s chest for cardiac monitoring.

Question 25

A client with end-stage cardiomyopathy states, “I do not want to be resuscitated if I stop breathing.” Full resuscitation is noted on the client’s medical record under code status. Based on the information, which action should the nurse take first.

A. Inform the client’s health care provider (HCP) of the client’s request
B. Ask if the client wishes to complete an advance health care directive
C. Document the client’s statements in quotes in the client’s medical record.
D. Advise the client to discuss these wishes with the surrogate decision maker.

Answer 25

A. Inform the client’s health care provider (HCP) of the client’s request

Question 26

Abrupt will changes, large amounts of money withdrawals, forged elder signatures, sudden appearance of family not usually involved claiming rights to assets are examples of assessment findings for what type of elder abuse?
A. Physical
B. Emotional
C. Abandonment
D. Exploitation

Answer 26

D. Exploitation