Unit 4 Flashcards
Computers can be found at the bedside, in nurses’ pockets, and in strategic
locations around the unit. Nurses are given passwords that may be more
important than their name tags. Bar codes and even fingerprints are scanned
both for access to records, the administration of treatment and medications
and the identification of patients
Electronic Medical Record
▪ involves formal symptom assessment and treatment, aid with
decision making and establishing goals of care
▪ practical support for patients and their caregivers, mobilization of
community support and resources to ensure secure and safe living
environments
▪ collaborative and seamless models of care (hospital, home, nursing
homes, and hospice).
Palliative Care
When a thiazide or loop diuretic
therapy is prescribed, electrolytes
should be checked within 1 week
after initiation and at least
annually.
Monitoring diuretic
therapy
a.k.a., health care proxy
* A document that designates a surrogate (also called an “agent,” “proxy,” or
“attorney-in-fact”) to make medical decisions on a person’s behalf should
that person become unable to make a decision.
Durable power of attorney (DPA)
sequential, with each discipline applying their assessment and intervention
within their own silo
Multidisciplinary teams
An act to maximize the contribution of senior citizens to nation building, grant
benefits and special privileges and for other purposes.
Republic Act 7432
Annual TaxabIe does
not exceed P60k or such
amount determined by
NEDA
RA 7432
The patient is assessed (usually with a checklist); problems are identified and
care plans of interventions are developed.
Problem-oriented notes
include such basic functions as
eating, bathing, dressing, getting into and out of bed or a chair, and using
the toilet.
Activities of daily living (ADLs)
Words backed by actions help develop trust. A relationship built on trust and
concern for the welfare of others is critical to optimal health outcomes.
Follow up and follow through
s a tool that empowers the family of the dying patient to
provide the best care possible
- Based from the GSF, patients are identified based on this premise
that they have at most 6 months to live
Gold Standard Framework
Assesses and treats functional, sensory, and perceptual deficits
that impact ADLs. Assesses need for assistive devices. Assesses
and treats cognitive deficits. Provides rehabilitative services in
geropsychiatric services.
Occupational
Therapist
Allows identification and
elimination of duplicate
therapies, corrects drug
interactions, and streamlines the
drug regimen to improve
adherence.
Medication list
the concept that each person has a right to make independent choices and
decisions. It is reflected in guidelines and laws regarding patient rights and
self-determination.
Autonomy
- An act granting additional benefits and privileges to senior citizens amending for
the purpose Republic Act 9257.
.Republic Act 9994
Gerontological nurses are responsible for assessing the older person and
the environment for hazards that threaten safety, as well as planning and
intervening appropriately to maintain a safe environment. Gerontological nurses
collaborate with the older person and care partners in acknowledgement of their
right to live at risk and need for autonomy
STANDARD V: SAFE CARE
are additional tasks
necessary to maintain independence, such as preparing meals, managing
medications, shopping for groceries, and using transportation.
Instrumental activities of daily living (IADLs)
Provides primary care including history and physical, and
chronic disease management
Advanced
gerontological
nurse practitioner
function as a group (multiple) of professionals who work loosely in the same
area or with the same client.
Multidisciplinary teams
If older adult does require the
therapy for control of seizures, do
not use barbiturates.
Avoid barbiturates
also provides the communication needed to ensure that a person
continues to receive continuity of care—from one shift to another and one caregiver to
another and across settings.
Documentation
Assists with coping and problem solving as individuals and
families adjust to and face changes with aging and chronic
illness.
Provides counseling and psychotherapy.
Social worker
- A document describing a patient’s preferences for the initiation, continuation,
or discontinuation of particular forms of treatment
Living will
Skills and Techniques
S is for SIMPLIFY
A is for ASSURE
G is for GIVE information
E is for EASE into it.
A is for ACKNOWLEDGE. In
D is for DISCOVERY
V is for VALUE
I is for INDIVIDUALIZE
C is for COMMUNICATE
E is for EMPATHIZE
general care generated from assessment, ACP
discussions and any recorded wishes/choices
Plan
.Republic Act 9994
Expanded Senior Citizens Act of 2010.
the personal quest for understanding answers to ultimate questions about life, about
meaning, and about relationships that are sacred or transcendent
Spirituality
Every new drug prescribed on an
ongoing basis (e.g., for a chronic
condition) should have
documentation of response of
therapy within 6 months.
Response to therapy
Risk of hypokalemia because of
diuretic therapy
Monitoring diuretic
therapy
When warfarin is prescribed,
international normalized ratio
(INR) should be evaluated within
4 days and at least every 6 weeks
Monitoring warfarin
therapy
This therapy is associated with an
increased risk for delirium and
may be associated with the
development of seizures.
Avoid meperidine as an
opioid analgesic
Geropsychiatry. Evaluates, treats, and manages mental health
issues faced by the elderly. Includes pharmacotherapy,
evaluation of cognition, and psychotherapy.
Psychiatrist
is a system-focused approach formalizing best practice for
individuals in their last year of life.
▪ It provide tools and resources that can be used by professionals to
identify, assess and plan care in more coordinated and
communicated way
Gold Standard Framework
the foundation of a humanistic approach to
provide high-quality care for older people and their care partners and is dependent
upon empathy and understanding
. Relationship-centered care
Assesses, plans, provides, coordinates, and evaluates care,
which
focuses on health, optimal wellness, disease prevention, and advocacy
Registered nurse
Gerontological nurses develop and preserve relationship care.
Gerontological nurses understand that reciprocal communication and respectful
interactions are central to the central human enterprise of nursing
STANDARD I: HUMANISTIC AND RELATIONAL CARE
is a tool encompassing assessment and care plan for patients
identified as dying
Liverpool Care Pathway
the last year of life (6-12 months) and list those
identified patients for the MDT to proactively plan care.
The care plan is based on the stage of the disease that is
predicted using the needs Based Coding:
✓ All from diagnosis; stable; years plus prognosis
✓ benefits; unstable/advanced disease; months
prognosis
✓ continuous care; deterioration; needs prognosis
✓ days/final days; terminal care; days prognosis “After
Care”
Identify
We must be open minded and provide opportunities for the individual to
share their thoughts with us. It means allowing time to communicate and
focusing attention on the person at the time of the conversation.
Maximize understanding
Long-term care supports older adults in two distinct realms:
Activities of daily living (ADLs)
Instrumental activities of daily living (IADLs)
When prescribing a new drug, the
patient or caregiver should be
educated about the optimal use
of the therapy and the
anticipated adverse events
Patient Education
The GSF comprises:
One aim
to deliver a “gold” standard of care for all patients nearing
the end of life
Health care professionals have an ethical obligation to good stewardship of both
the patient’s and the organization’s funds—fiduciary responsibility. This refers to
using both fiscal reserves and caregiving resources wisely, potentially requiring a
cost-benefit analysis to facilitate decision making
Fiduciary Responsibility
s distinct from acute or episodic medical interventions because care must be
integrated into an individual’s daily life over an extended time period.
Long-term care
basic principles of Communicating with Older Adults
invite, arrange environment, maximize communication, maximize understanding and follow
through
has become a new phenomenon encompassing all aspects of care at the
end of individuals life. It is now a preferred term when identifying a person who is in
the final stages of life which may last years, months, weeks or days.
End-of life Care
refers to the use of facial gestures, body
posture, eye contact, and touch as a means of communication.
Nonvocal nonverbal communication
refers to the tone, pitch, speech rate, or fluency
of verbal communication.
Vocal nonverbal communication
gerontological nurses seek
to connect to the human experience of sickness, suffering, recovery, transitioning
and death through provision of care that is artful, person-centred, and grounded in
evidence-informed, ecopsychosocial practices. Gerontological nurses understand
that environmental strategies are effective in supporting the delivery of
person-centered care and can have a strong potential in making positive impact on
aging experiences. Gerontological nurses understand that the ‘experience’ of care is
highly influenced by the social and physical environment within which care is
delivered.
STANDARD IV: AESTHETIC/ARTFUL CARE
Provides a rationale for
continuation of the therapy if
effective, or change or
discontinuation if ineffective.
Response to therapy
Gerontological nurses understand the importance of the ethical
underpinnings of nursing. Gerontological nurses are consciously aware of and think
critically about what ought to happen, what should be done and what is fair and just.
Gerontological nurses are respectful of the person’s right to self-determination,
choice and collaborative decision-making.
STANDARD II: ETHICAL CARE
When prescribing an oral
hypoglycemic agent,
chlorpropamide should not be
used.
Avoid use of
chlorpropamide as a
hypoglycemic
Agent
Assesses hearing including audiometric studies, evoked
potentials, and other diagnostic procedures and treatment of
hearing loss
Audiologist
Assesses mobility and functional capacity of the elderly.
Treatment includes rehabilitation, strengthening, mobility, and
use of assistive devices
Physical
Therapist
Annual TaxabIe does not exceed the
poverty level as determined by NEDA
RA 9257
Do not prescribe drug therapies
with a strong anticholinergic
effect if alternative therapies are
available.
Avoid drugs with strong
anticholinergic
Properties
supplements documentation with more details regarding a person’s
wishes and include who they want involved in their care, who they want to have access
to their records, and their wishes related to everything from organ donation to the use
of cardiopulmonary resuscitation (CPR) and the handling of their bodies after death.
nursing records
Standards of Gerontological Nursing Practice
STANDARD I: HUMANISTIC AND RELATIONAL CARE
STANDARD II: ETHICAL CARE
STANDARD III: EVIDENCE-INFORMED CARE
STANDARD IV: AESTHETIC/ARTFUL CARE
STANDARD V: SAFE CARE
STANDARD VI: SOCIO-POLITICALLY ENGAGED CARE
These therapies are potent
central nervous system
depressants, have a low
therapeutic index, are highly
addictive, cause drug
interactions, and are associated
with an increased risk for falls
and hip fracture
Avoid barbiturates
- These concepts of do good and do no harm are integral to healthcare. Nurses intend to do good for their patients.Nurses are also
concerned about situations thatcan result in harm to p
Beneficence/Nonmaleficence
Annual drug regimen review.
Periodic drug review
Geropsychology. Assesses, consults, intervenes in, and manages
conditions related to adaptation, bereavement, counseling, and
treatment for clinical, cognitive, and behavioral needs
Psychologist
the right to privacy.
- requiring that only persons with a need to know access the patient’s record or
receive information about the patient.
Confidentiality
Gerontological nurses recognize that nursing care of older people and
their care partners must reflect aesthetic practices, the art of nursing. Gerontological
nurses recognize the importance of searching for the deeper meaning of the older
person’s health/illness/dying experience.
STANDARD IV: AESTHETIC/ARTFUL CARE
A holistic common assessment is essential:
o Patient-centered
o Continuous process
- are an interconnected group of professionals who have common and
collective goals. - have an interactive approach to care.
Interdisciplinary teams
quoted as saying, “When a person is born we rejoice,
and when they’re married we jubilate, but when they die we try to pretend nothing happened.”
Anthropologist Margaret Mead
Monitoring may prevent the
development of renal
insufficiency and hyperkalemia
Monitor renal function
and potassium in
patients
prescribed
angiotensin-converting
enzyme
inhibitors
These therapies are associated
with adverse events such as
confusion, urinary retention,
constipation, and hypotension
Avoid drugs with strong
anticholinergic
Properties
- refers to myriad services designed to provide assistance over prolonged periods to
compensate for loss of function due to chronic illness or physical or mental
disability. - varies in frequency and intensity according to the needs of the recipients, and it
includes both hands-on, direct care as well as general supervisory assistance.
Long-term care
gerontological nurses are sophisticated in their ability to
interact with older people and their care partners to create a holistic environment
that is pleasing, comforting and supportive. I
STANDARD IV: AESTHETIC/ARTFUL CARE
Principles of Gerontological Nursing
- Aging is a natural process.
- Various factors influence the aging process.
- Nursing of the elderly requires unique information and skills.
- There are common needs shared by the elderly and all age.
- Gerontological Nursing’s goal is to promote optimum levels ofphysical, psychological,
social and spiritual health.
Three steps of Gold Standard Framework:
identify, assess, plan
Five Domains of Assessment: These form an essential part of the Gold
Standard Framework
i. Background information and assessment preferences
ii. physical needs
iii. social and occupational needs
iv. Physical well-being
v. spiritual well being and life goal
Medical records (outpatient or
hospital) should contain a current
medication list
Medication list
standards for clinical gerontological nursing include
assessment, diagnosis, outcome
identification, planning, implementation, and evaluation (
The medication may have been
prescribed for an indication that
was unclear or transient.
Indication
“There may be no single thing more important in our efforts to achieve
meaningfulwork and fulfilling relationships than to learn to practice the art of
communication
Max DePree
the major means for the nurse to demonstrate the quality of care he
or she provides.
Documentation
The End-of-Life Strategy
Step 1 – Discussion as the end of life approaches
Step 2 – Assessment, care planning, and review
Step 3. Coordination of Care
Step 4. Delivery of high quality services
Step 5. Care in the last days of life
6. Step 6. Care after Death
refers to loyalty and a championing of the needs and interests of others requiring
the nurse to educate patients and their families so that they know their rights,
are fully informed, and are able to access all the benefits they are entitled to
Advocacy
Assesses nutritional status and implements nutritional plan.
Dietician
This therapy has a prolonged
half-life that can result in serious
hypoglycemia and is more likely
than other agents to cause the
syndrome of inappropriate
secretion of antidiuretic
hormone.
Avoid use of
chlorpropamide as a
hypoglycemic
Agent
refers to keeping promises or being true to another; being faithful to
commitments and responsibilities
Fidelity
▪ focuses on comfort rather than cure
▪ focuses on the treatment of symptoms rather than disease
▪ focuses on quality of life left rather than quantity of life
Palliative Care
is one’s personal perception of the conditions of life
Quality of life
Communicating with Older Persons includes
- Information Sharing
- Non-verbal Communication
- Communicating with Older Adults
- Barriers to Communication
- Skills and Techniques
Provides an opportunity to
discontinue unnecessary therapy
or to add needed drug therapies.
Periodic drug review
is a feature of integrity concerned with the ability to be true to one’s self while
respecting and supporting the values and views of another.
Reciprocity
Education may improve
adherence, clinical outcomes,
and alert patients or caregivers
to potential adverse events.
Patient Education
refers to behaviors or gestures that convey a message without the use of
verbal language.
Non-verbal Communication
a set of instructions indicating a competent person’s preferences
for future medical care should the person become incompetent or unable to
communicate. Advance directives typically focus on the conditions of being terminal,
comatose, or in a state of irreversible suffering
Advance directive
is interdisciplinary care focused on the relief of suffering and
achieving the best possible quality of life for patients and their loved ones.
- It is offered simultaneously with life-prolonging and curative therapies for persons
living with serious, complex, and eventually terminal illness.
Palliative Care
means truthfulness and refers to telling the truth, or, at the very least, not
misleading or deceiving patients or their families.
Veracity
standards of professional
gerontological nursing performance include
quality of care, performance appraisals, education,
collegiality, ethics, collaboration, research, and research utilization
focus of care at end of life should center on living with terminal illness—with
medical care, support, and interventions geared toward quality of life and
comfort, rather than on prolonging suffering or the dying process—if that is what
patient wants.
End-of life Care
most important aspect of the holistic assessment is verifying
verifying levels of
understanding of the diagnosis, treatment options, and prognosis
An act granting additional benefits and privileges to senior citizens amending for
the purpose Republic Act 7432.
Republic Act 9257
describes competent patients discussing and then
documenting their preferences for future medical care. This preserves patients’
self-determination even after they have lost decision-making capacity. The classic
mechanism to do this is an advance directive
Advance care planning
Four aspects of awareness
i. Closed awareness
ii. Suspicion
iii. Mutual preference
iv. Open awareness
Utilizes knowledge of normal aging as part of assessment.
Specializes in the diagnosis and treatment of the elderly
Geriatrician
Exemption from Income Tax who are considered to be minimum
wage earners under RA 9504.
RA 9994
fundamental part of geriatrics. Ethics, or the provision of ethical care, refers to
a framework or guideline for determining what is morally good or bad.
Ethics
referring to the value of life and the right to live.
sanctity of
life,
o defined as the prescription, administration, or use of more medications than are
clinically indicated in a given patient.
polypharmacy
multiple medication use, often referred to as
polypharmacy
environment should be comfortable, provide privacy, and minimize distractions that
could be barriers to communication, such as noise or poor lighting
Arrange the environment
Gerontological nurses recognize that nursing care for older people and
their care partners is based on evidence-informed knowledge, which is
comprehensive and complex. Gerontological nurses have inquiring minds, question
the status quo, and seek new evidence-informed knowledge to answer questions
when faced with nursing care challenges.
STANDARD III: EVIDENCE-INFORMED CARE
Prepares and dispenses medication. Provides clinical
consultation and education for patient and geriatric team.
Pharmacist
When prescribing a new drug, the
therapy should have a clearly
defined indication documented in
the medical record.
Indication
If angiotensin-converting enzyme
inhibitor therapy is initiated,
potassium and creatinine levels
should be monitored with 1 week
of initiation of therapy.
Monitor renal function
and potassium in
patients
prescribed
angiotensin-converting
enzyme
inhibitors
Provides, directs, and influences care of older adults and
families in various settings
Clinical specialist
in gerontological
nursing
Provide support to the client/patient, family, and others as it
relates to spiritual needs. May assist in identifying resources
from within congregation for support, visitation, or respite
Religious workers,
Including chaplain,
priest, rabbi, minister
term describing that assessment should
encompass all aspects of a person.
- Patient-centered
Barriers to Communication
- hearing impairment;
- declining sight or vision;
- declining memory and,
- inability to read or understand.
provides the data needed for the careful development of the
individualized plan of care and the evaluation of patient outcomes.
recorded assessment
Assesses and treats communication, disorders including speech,
language, and hearing, as well as swallowing and cognitive
deficits.
Speech-language
Pathologist
used to predict and document the care provided within a preestablished
trajectory and to anticipate the day of discharge
Care maps
refers to the fairness of an act or situation.
Justice
through holistic common assessment
✓ Assess needs for anticipatory care
✓ Assess for carers’ needs
✓ Assess if patient is entitled to some benefits
Assess
When analgesia is required, avoid
use of meperidine
Avoid meperidine as an
opioid analgesic
An invitation says to the other person that you are interested in them and sharing
time with them
Invite
Republic Act 9257
- Expanded Senior Citizens Act of 2003
Gerontological nurses are aware of the socio-economic-political contexts
that influence all aspects of care. As such, Gerontological nurses collaborate with
older people and their care partners to advocate for equitable access to health
system resources that address their care needs.
STANDARD VI: SOCIO-POLITICALLY ENGAGED CARE
serves as the basis for the determination of reimbursement in most
settings.
Documentation
- use communication strategies that maximize the individual’s ability to
understand the message. This includes using language and terminology that
are familiar to the patient. - Periodically ask the receiver to clarify what he or she is hearing as a means of
ensuring accurate interpretation of your message.
Maximize communication
Older adults are at high risk for
drug toxicity that can be
identified earlier if there is close
monitoring
for agents with a narrow therapeutic range
Monitoring warfarin
therapy
