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Utilize Evidence-Based Practices Advance Research Promote Integrative Care Educate Caregivers Develop New Roles Balance Quality Care and Health Care Costs

Gerontological Nursing Ninth Edition

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Gerontological Nursing Ninth Edition

Charlotte Eliopoulos, PhD, MPH, RN Specialist in Holistic Gerontological Care

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Acquisitions Editor: Natasha McIntyre Director of Product Development: Jennifer K. Forestieri Development Editor: Meredith L. Brittain Editorial Assistant: Leo Gray Production Project Manager: Priscilla Crater Design Coordinator: Elaine Kasmer Illustration Coordinator: Jennifer Clements Manufacturing Coordinator: Karin Duffield Production Services/Compositor: SPi Global

9th Edition

Copyright © 2018 Wolters Kluwer

All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at lww.com (products and services).

Nursing diagnoses in this title are reprinted with permission from: Herdman, T.H. & Kamisuru, S. (Eds.) Nursing Diagnoses — Definitions and Classification 2015-2017. Copyright © 2014, 1994-2014 NANDA International. Used by arrangement with John Wiley & Sons Limited. In order to make safe and effective judgments using NANDA-I nursing diagnoses it is essential that nurses refer to the definitions and defining characteristics of the diagnoses listed in this work.

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Printed in China

Cataloging in Publication data available on request from publisher ISBN 9780060000387

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.

LWW.com

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Not authorised for sale in United States, Canada, Australia, New Zealand, Puerto Rico, and U.S. Virgin Islands.

Acquisitions Editor: Natasha McIntyre Director of Product Development: Jennifer K. Forestieri Development Editor: Meredith L. Brittain Editorial Assistant: Leo Gray Production Project Manager: Priscilla Crater Design Coordinator: Elaine Kasmer Illustration Coordinator: Jennifer Clements Manufacturing Coordinator: Karin Duffield Production Services/Compositor: SPi Global

9th Edition

Copyright © 2018 Wolters Kluwer

All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at lww.com (products and services).

Nursing diagnoses in this title are reprinted with permission from: Herdman, T.H. & Kamisuru, S. (Eds.) Nursing Diagnoses — Definitions and Classification 2015-2017. Copyright © 2014, 1994-2014 NANDA International. Used by arrangement with John Wiley & Sons Limited. In order to make safe and effective judgments using NANDA-I nursing diagnoses it is essential that nurses refer to the definitions and defining characteristics of the diagnoses listed in this work.

9 8 7 6 5 4 3 2 1

Printed in China

Cataloging in Publication data available on request from publisher ISBN 9781496377258

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.

This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments.

Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work.

LWW.com

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This book is dedicated to my husband, George Considine, for his unending patience, support, and encouragement.

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Preface

Whether they are aware of it or not, most nurses today are doing some form of gerontological nursing. Hospitals are caring for increasing numbers of older adults whose age-related changes, multiple diagnoses, and psychosocial complexities present many challenges. Settings that provide long-term care are expanding beyond the nursing home. More older adults are remaining in the community and presenting new demands for nursing services to be provided in innovative ways. Growing numbers of older individuals are heading multigenerational households and caring for younger family members, which brings them into contact with nurses in specialties beyond geriatrics.

Not only do older individuals have a greater presence in various specialties but they also are presenting new challenges. They are better informed about their health conditions and expect to have explanations for treatment decisions. Many are using complementary and alternative therapies and desire approaches that integrate those therapies into conventional care. They not only want their diseases managed but they also want to enhance their function so they can enjoy an active, meaningful life. They may make choices that forfeit treatments that can extend the quantity of life for those that offer the freedom to enjoy a high quality of life for whatever time remains. Such challenges demand that nurses not only be knowledgeable about aging and geriatric care but also skillful at assessing that which is important to the older person and providing care that addresses the person holistically. It is indeed an exciting time to be a gerontological nurse!

Gerontological Nursing has evolved since its first publication. In the early editions of the text, the focus was on providing facts about the aging process and the unique modifications that were necessary to properly assess, plan, and provide care to older adults. We now understand that a “one size fits all” approach to nursing older adults is inappropriate as the diversity of this population grows. In addition to expecting from the gerontological nurse assistance with managing their medical conditions, today’s older adults may seek guidance on the selection of brain exercises to improve mental function, the value of an herbal supplement over their prescription drug, strategies to fill the void resulting from retiring from a job they enjoyed, suggestions for the best lubricant to facilitate sexual intercourse, opinions as to the value of marijuana in controlling their pain, and recommendations for the best type of approach to reduce their wrinkles. This edition of Gerontological Nursing provides the evidence-based knowledge that can help the gerontological nurse address, with competency and sensitivity, the complexities of meeting the comprehensive, holistic needs of the older population.

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Text Organization Gerontological Nursing, Ninth Edition, is organized into five units. Unit 1, The Aging Experience, provides basic knowledge about the older population and the aging process. The growing cultural and sexual diversity of this population is discussed, along with the navigation of life transitions and the changes to the body and mind that typically are experienced.

Unit 2, Foundations of Gerontological Nursing, provides an understanding of the development and scope of the specialty, along with descriptions of the various settings that provide services to older persons. This unit reviews legal and ethical issues that are relevant to gerontological nursing and offers guidance in applying a holistic model to gerontological care.

Unit 3, Health Promotion, addresses the importance of measures to prevent illness and maximize function. Chapters dedicated to nutrition and hydration, sleep and rest, comfort and pain management, safety, and medications guide the nurse in promoting basic health and preventing avoidable complications. A chapter dedicated to spirituality supports the holistic approach that is meaningful in gerontological care. In addition, because people often feel sufficiently comfortable with nurses to discuss sensitive matters, a chapter on sexuality and intimacy is included.

Unit 4, Geriatric Care, encompasses chapters dedicated to respiration, circulation, digestion and bowel elimination, urinary elimination, reproductive system health, mobility, neurologic function, vision and hearing, endocrine function, skin health, and cancer. A review of the impact of aging, interventions to promote health, the unique presentation and treatment of illnesses, and integrative approaches to illness are discussed within each of these areas. In addition to a chapter on mental health disorders, a chapter reviewing delirium and dementia is included in recognition of the prevalence and care challenges of these conditions in the geriatric population. Because chronic conditions affect most of this population, the last chapter of this unit is dedicated to nursing actions that can assist older individuals in living a full life with chronic conditions.

The unique challenges gerontological nurses face in various care settings are discussed in Unit 5, Settings and Special Issues in Geriatric Care. Chapters in this unit cover rehabilitative care, acute care, long-term care, family caregiving, and end-of-life care.

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Features A variety of features enrich the content:

Learning Objectives prepare the reader for outcomes anticipated in reading the chapter. Chapter Outlines present an overview of the chapter’s content. Terms to Know define new terms pertaining to the topic. Communication Tips offer suggestions to facilitate patient education and information exchange with older adults. Consider This Case features present clinical situations that offer opportunities for critical thinking. Concept Mastery Alerts clarify fundamental nursing concepts to improve the reader’s understanding of potentially confusing topics, as identified by Misconception Alerts in Lippincott’s Adaptive Learning Powered by prepU. Key Concepts emphasize significant facts. Points to Ponder pose questions to stimulate thinking related to the content. Assessment Guides outline the components of general observations, interview, and physical assessment of major body systems. Nursing Diagnosis Highlights provide an overview of selected nursing diagnoses common in older adults. Nursing Care Plans demonstrate the steps in developing nursing diagnoses, goals, and actions from identified needs. Bringing Research to Life presents current research and describes how to apply that knowledge in practice. Practice Realities pose real-life examples of challenges that could be faced by a nurse in practice. Critical Thinking Exercises guide application. Resources and References assist with additional exploration of the topic.

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Teaching and Learning Package A comprehensive teaching/learning package has been developed to assist faculty and students.

Resources for Instructors Tools to assist you with teaching your course are available upon adoption of this text at http://thePoint.lww.com/Eliopoulos9e.

An E-book on gives you access to the book’s full text and images online. The Test Generator lets you put together exclusive new tests from a bank containing hundreds of questions to help you in assessing your students’ understanding of the material. Test questions link to chapter learning objectives. This test generator comes with a bank of more than 900 questions. PowerPoint Presentations provide an easy way for you to integrate the textbook with your students’ classroom experience, via either slide shows or handouts. Multiple choice and true/false questions are integrated into the presentations to promote class participation and allow you to use i-clicker technology. Clinical Scenarios posing What If questions (and suggested answers) give your students an opportunity to apply their knowledge to a client case similar to the one they might encounter in practice. Assignments (and suggested answers) include group, written, clinical, and web assignments. An Image Bank lets you use the photographs and illustrations from this textbook in your PowerPoint slides or as you see fit in your course. A QSEN Competency Map and a BSN Essentials Map show you how content connects with these important competencies. Suggested Answers to the Critical Thinking Exercises in the book allow you to gauge whether students’ answers are on the right track by giving you main points that students are expected to address in the answers. Plus a Sample Syllabus, Strategies for Effective Teaching, and Learning Management System Cartridges.

Resources for Students An exciting set of free resources is available to help students review material and become even more familiar with vital concepts. Students can access all these resources at http://thePoint.lww.com/Eliopoulos9e using the codes printed in the front of their textbooks.

Current Journal Articles offer access to current research available in Wolters Kluwer journals. Watch & Learn Video Clips explain How to Assist a Person Who Is Falling, Alternatives to Restraints, and the Five Stages of Grief. (Icons in the textbook direct readers to relevant videos.) Recommended Readings expand the network of available information. Plus Learning Objectives from the textbook, Nursing Professional Roles and Responsibilities, and Heart and Breath Sounds.

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A Fully Integrated Course Experience We are pleased to offer an expanded suite of digital solutions and ancillaries to support instructors and students using Gerontological Nursing, Ninth Edition. To learn more about any solution, please contact your local Wolters Kluwer representative.

Lippincott CoursePoint+ Lippincott CoursePoint+ is an integrated digital learning solution designed for the way students learn. It is the only nursing education solution that integrates:

Leading content in context: Content provided in the context of the student learning path engages students and encourages interaction and learning on a deeper level. Powerful tools to maximize class performance: Course-specific tools, such as adaptive learning powered by prepU, provide a personalized learning experience for every student. Real-time data to measure students’ progress: Student performance data provided in an intuitive display lets you quickly spot which students are having difficulty or which concepts the class as a whole is struggling to grasp. Preparation for practice: Integrated virtual simulation and evidence-based resources improve student competence, confidence, and success in transitioning to practice.

vSim for Nursing: Co-developed by Laerdal Medical and Wolters Kluwer, vSim for Nursing simulates real nursing scenarios and allows students to interact with virtual patients in a safe, online environment. Lippincott Advisor for Education: With over 8,500 entries covering the latest evidence-based content and drug information, Lippincott Advisor for Education provides students with the most up-to-date information possible, while giving them valuable experience with the same point-of- care content they will encounter in practice.

Training services and personalized support: To ensure your success, our dedicated educational consultants and training coaches will provide expert guidance every step of the way.

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Simulation and Other Resources

vSim for Nursing | Gerontology, a virtual simulation platform (available via ). Co-developed by Laerdal Medical and Wolters Kluwer, vSim for Nursing | Gerontology includes 12 gerontology patient scenarios that correspond to the National League for Nursing (NLN) Advancing Care Excellence for Seniors (ACES) Unfolding Cases. vSim for Nursing | Gerontology helps students develop clinical competence and decision-making skills as they interact with virtual patients in a safe, realistic environment. vSim for Nursing records and assesses student decisions throughout the simulation, then provides a personalized feedback log highlighting areas needing improvement.

Lippincott DocuCare (available via thePoint). Lippincott DocuCare combines web-based electronic health record simulation software with clinical case scenarios. Lippincott DocuCare’s nonlinear solution works well in the classroom, simulation lab, and clinical practice.

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Reviewers

Carol Amann, PhD, RN-BC, CDP

Assistant Professor for the Villa Maria School of Nursing Gannon University Erie, Pennsylvania

Jan Atwell, MSN, RN

Clinical Assistant Professor Missouri State University Springfield, Missouri

Judy L. Barrera, RN, CNS

Clinical Learning Lab Coordinator Galen College of Nursing Louisville, Kentucky

Evelyn Biray, RN, MS, PMed, CCRN, CMSRN

Professor of Nursing Long Island University Brooklyn New York, New York

Dr.Melissa Brock , MSM, MSN, ANP-C, DHEd

Nursing Professor Indiana Wesleyan University Indianapolis, Indiana

Celeste Brown-Apoh, RN, MSN

Instructor Rowan College at Burlington County Pemberton, New Jersey

Jean Burt, MSN, RN

Instructor Wilbur Wright College Chicago, Illinois

Nicola Contreras, MSN, RN

VN/ADN Faculty

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Galen College of Nursing San Antonio, Texas

Sherri Cozzens, RN, MS

Nursing Faculty De Anza College Cupertino, California

Jodie Fox, MSN, RN-BC

Assistant Professor Viterbo University Lacrosse, Wisconsin

Florida Freeman, PhD, MSN, RN

Professor of Nursing University of St. Francis Joliet, Illinois

Betsy D. Gulledge, PhD, RN, CNE, NEA-BC

Associate Dean/Assistant Professor of Nursing Jacksonville State University Jacksonville, Alabama

Kris Hale, MSN, RN

Professor/Department Chair San Diego City College San Diego, California

Cheryl Harrington, MSN, RN, MHA

Clinical Simulation Specialist Morningside College Sioux City, Iowa

Mary Jane Holman, RN

Instructor Louisiana State University Shreveport Shreveport, Louisiana

Laly Joseph, DVM, DNP, MSN, RN, C, ARNP, BC

Clinical Assistant Professor Fairleigh Dickinson University Teaneck, New Jersey

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Ronnie Knabe, MSN, RN, CCRN

Associate Professor, Nursing Bakersfield College Bakersfield, California

Amy Langley

Health Science Division Director Snead State Community College Boaz, Alabama

Debora Lemon, MN, RN

Associate Professor Lewis-Clark State College Lewiston, Idaho

Susan McClendon, MSN, RN, CNS

Nursing Faculty Lakeland Community College Kirkland, Ohio

Mary Alice Momeyer, DNP, ANP-BC, GNP-BC

Assistant Clinical Professor The Ohio State University College of Nursing Columbus, Ohio

Jon F. Nutting, MA, RN-BC

Instructor Galen College of Nursing Tampa Bay Campus St. Petersburg, Florida

Teresa M. Page, DNP, EdS, MSN, RN, FNP-BC

Assistant Professor of Nursing Liberty University Lynchburg, Virginia

LoriAnn Pajalich, MS, RN, CNS, GCNS-BC

Assistant Professor of Nursing Wilkes University Wilkes-Barre, Pennsylvania

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Debra Parker, DNP, RN

Assistant Professor Indiana Wesleyan University Marion, Indiana

Cordelia Schaffer, MSN, RN, CHPN

Associate Professor Westminster College Salt Lake City, Utah

Crystal Schauerte-O’Connell

Program Coordinator, Year 2 Algonquin College Ottawa, Ontario

Maura C. Schlairet, EdD, MA, MSN, RN, CNL (A/H)

Professor of Nursing Valdosta State University Valdosta, Georgia

Nichole Spencer, MSN, APRN, ANP-C

Assistant Professor of Nursing William Jewell College Liberty, Missouri

Carolyn Sue-Ling, MSN, MPA, RN

Instructor University of South Carolina Aiken Aiken, South Carolina

Michael T. Valenti, AAS, BS, MS

Assistant Professor of Nursing Long Island University Brookville, New York

Stephanie Vaughn, PhD, RN, CRRN, FAHA

Professor/Director School of Nursing California State University, Fullerton Fullerton, California

Erica Williams-Woodley, MSN, NP

Assistant Professor of Nursing

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Bronx Community College New York, New York

Jane Zaccardi, MA, RN, GCNS-BC

Director of Practical Nursing and Health Occupations Programs Johnson County Community College Overland Park, Kansas

 

 

 

For a list of the contributors to the Instructor Resources and a list of the reviewers of the Test Generator questions accompanying this book, please visit http://thepoint.lww.com/Eliopoulos9e.

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Acknowledgments

There are many individuals who played important roles in the birth and development of this book. I will always be grateful to Bill Burgower, a Lippincott editor, who decades ago responded to my urging that the new specialty of gerontological nursing needed resources by encouraging me to write the first edition of Gerontological Nursing. Many fine members of the Wolters Kluwer team have guided and assisted me since, including Natasha McIntyre, Acquisitions Editor, who consistently offered encouragement and direction; Meredith Brittain, Senior Development Editor, who brought a new set of eyes to the book and ironed out the rough edges through her fine editorial skills; Dan Reilly and Leo Gray, Editorial Assistants at different points in this project, who attended to the details that contribute to a quality finished product; and Priscilla Crater, Production Project Manager, who shepherded the book from manuscript through printed pages.

Lastly, I am deeply indebted to those mentors and leaders in gerontological care who generously offered encouragement and the many older adults who have touched my life and showed me the wisdom and beauty of aging. The insight these individuals provided could have never been learned in a book!

Charlotte Eliopoulos

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Brief Contents

UNIT 1 THE AGING EXPERIENCE 1 The Aging Population 2 Theories of Aging 3 Diversity 4 Life Transitions and Story 5 Common Aging Changes

UNIT 2 FOUNDATIONS OF GERONTOLOGICAL NURSING 6 The Specialty of Gerontological Nursing 7 Holistic Assessment and Care Planning 8 Legal Aspects of Gerontological Nursing 9 Ethical Aspects of Gerontological Nursing 10 Continuum of Care in Gerontological Nursing

UNIT 3 HEALTH PROMOTION 11 Nutrition and Hydration 12 Sleep and Rest 13 Comfort and Pain Management 14 Safety 15 Spirituality 16 Sexuality and Intimacy 17 Safe Medication Use

UNIT 4 GERIATRIC CARE 18 Respiration 19 Circulation 20 Digestion and Bowel Elimination 21 Urinary Elimination 22 Reproductive System Health 23 Mobility 24 Neurologic Function 25 Vision and Hearing

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26 Endocrine Function 27 Skin Health 28 Cancer 29 Mental Health Disorders 30 Delirium and Dementia 31 Living in Harmony With Chronic Conditions

UNIT 5 SETTINGS AND SPECIAL ISSUES IN GERIATRIC CARE 32 Rehabilitative and Restorative Care 33 Acute Care 34 Long-Term Care 35 Family Caregiving 36 End-of-Life Care Index

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Contents

UNIT 1 THE AGING EXPERIENCE 1 The Aging Population Views Of Older Adults Through History

Characteristics Of The Older Adult Population

Population Growth and Increasing Life Expectancy Marital Status and Living Arrangements Income and Employment

Health Insurance

Health Status Implications Of An Aging Population

Impact of the Baby Boomers Provision of and Payment for Services

2 Theories of Aging Biological Theories Of Aging

Stochastic Theories Nonstochastic Theories

Sociologic Theories of Aging

Disengagement Theory Activity Theory Continuity Theory Subculture Theory Age Stratification Theory

Psychological Theories of Aging

Developmental Tasks Gerotranscendence

Nursing Theories of Aging

Functional Consequences Theory Theory of Thriving Theory of Successful Aging

Applying Theories of Aging to Nursing Practice

3 Diversity Increasing Diversity Of The Older Adult Population

Overview Of Diverse Groups Of Older Adults In The United States

Hispanic Americans Black Americans Asian Americans Jewish Americans

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Native Americans Muslims Gay, Lesbian, Bisexual, and Transgender Older Adults

Nursing Considerations For Culturally Sensitive Care Of Older Adults

4 Life Transitions and Story Ageism

Changes In Family Roles And Relationships

Parenting Grandparenting

Loss Of Spouse

Retirement

Loss of the Work Role Reduced Income

Changes In Health And Functioning

Cumulative Effects Of Life Transitions

Shrinking Social World Awareness of Mortality

Responding To Life Transitions

Life Review and Life Story Self-Reflection Strengthening Inner Resources

5 Common Aging Changes Changes To The Body

Cells Physical Appearance Respiratory System Cardiovascular System Gastrointestinal System Urinary System Reproductive System Musculoskeletal System Nervous System Sensory Organs Endocrine System Integumentary System Immune System Thermoregulation

Changes To The Mind

Personality Memory Intelligence

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Learning Attention Span

Nursing Implications Of Age-Related Changes

UNIT 2 FOUNDATIONS OF GERONTOLOGICAL NURSING 6 The Specialty of Gerontological Nursing Development Of Gerontological Nursing

Core Elements Of Gerontological Nursing Practice

Evidence-Based Practice Standards Competencies Principles

Gerontological Nursing Roles

Healer Caregiver Educator Advocate Innovator

Advanced Practice Nursing Roles

Self-Care And Nurturing

Following Positive Health Care Practices Strengthening and Building Connections Committing to a Dynamic Process

The Future Of Gerontological Nursing

Utilize Evidence-Based Practices Advance Research Promote Integrative Care Educate Caregivers Develop New Roles Balance Quality Care and Health Care Costs

7 Holistic Assessment and Care Planning Holistic Gerontological Care

Holistic Assessment Of Needs

Health Promotion–Related Needs Health Challenges–Related Needs Requisites to Meet Needs

Gerontological Nursing Processes

Examples Of Application

Applying the Holistic Model: The Case of Mrs. D The Nurse As Healer

Healing Characteristics

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8 Legal Aspects of Gerontological Nursing Laws Governing Gerontological Nursing Practice

Legal Risks In Gerontological Nursing

Malpractice Confidentiality Patient Consent Patient Competency Staff Supervision Medications Restraints Telephone Orders Do Not Resuscitate Orders Advance Directives and Issues Related to Death and …