Characteristics of the full-scale burnout phase are
1] Loneliness, emptiness, depression, and despair.
2] Anger, increased frustration, cynicism, and criticism.
3] Disillusionment, confusion, hard work, and boredom.
4] Despair and a need to be surrounded by family and friends.
•Culture and nonverbal communication play important roles in
patient perceptions. For example, Russian immigrants new to
the United States may perceive that they are being treated
incompetently and without adequate respect, based on cultural misunderstandings.
•In Russia, illness is viewed as a serious matter, and patients
expect to be treated by stern, authoritarian care providers
who give
directions and do not seek input from the patients.
Care providers wear appropriate uniforms, indicating their
role and status.
•By contrast, in the United States, the patient is likely to be
attended to by smiling, friendly, nonauthoritarian care providers who seek to involve the patient in decision making.
•These caregivers are normally dressed in scrubs or casual
clothing that does little to identify their role or status. This contrast can lead to the mistaken interpretation
that the caregivers are inexperienced and do not take the patient's
concerns seriously.
Culture, language, and communication are closely connected.
Failure to recognize the impact of culture on communication
can be a barrier to effective health care.
Health care providers, like others, often base their evaluation
of a patient's words or behavior on their own culture and ethnic
assumptions. To minimize cultural misunderstanding,
health
care providers need to do the following:
•Recognize their own cultural biases and assumptions.
•Increase their knowledge and understanding of the attitudes,
beliefs, and communication styles of cultures other than their
own.
•Recruit, retain, and promote health care providers from
diverse ethnic and cultural backgrounds.
•Provide skilled interpreters, visual aids, and educational
materials for predominant language groups.
•Address complaints or grievances
that arise from crosscultural misunderstandings so that care becomes more
culturally sensitive.
Fat-soluble vitamins
Vitamin A Found in milk, butter, cheese, fortified margarine, liver, green and yellow vegetables, and fruits
Promotes healthy epithelium, ability to see in dim light, normal mucus formation
Many older people may be deficient in vitamin A because of chronic conditions that interfere with fat
absorption such as gallbladder disease
and colitis
Vitamin D Found in fortified milk and margarine, cod liver oil, fatty fish, and eggs
Promotes absorption of calcium
May contribute to skeletal changes with aging
Vitamin E Found in corn and safflower oils, margarine, seeds, nuts, and leafy green vegetables
Promotes integrity of red blood cells
Vitamin K Found in leafy green vegetables and liver; synthesized by bacteria in the colon
Essential for formation of prothrombin, which is necessary for blood
clotting
Water-soluble vitamins
Vitamin B1 [thiamine
hydrochloride]
Found in organ meats, pork, legumes, and whole grains
Essential for carbohydrate metabolism
Vitamin B2 [riboflavin] Found in milk, cheese, eggs, organ meats, legumes, and leafy green vegetables
Essential for normal tissue maintenance and tear production
Niacin Found in lean meats, liver, whole grains, and legumes
Essential for energy release from fats, carbohydrates, and proteins
Vitamin B6
[hydrochloride] Found in whole grains, vegetables, legumes, meats, and bananas
Acts in the processes of protein synthesis and amino acid metabolism
May interact with levodopa taken by patients with Parkinson's disease
Folacin [folic acid] Found in whole wheat, legumes, and green vegetables
Important in hemoglobin synthesis and in metabolism of amino acids
Common deficiency in older adults
Vitamin B12
[cyanocobalamin]
Found in muscle and organ meats, eggs, shellfish, and
dairy products
Requires production of intrinsic factor by the stomach for absorption; inadequate absorption can
result in pernicious anemia
Needed for maturation of red blood cells
Deficiency is commonly seen with folacin deficiency
Vitamin C [ascorbic acid] Found in citrus fruits, tomatoes, cabbage, melons, strawberries, green peppers, and leafy green
vegetables
Important in the formation and maintenance of collagen structure of connective tissue
Promotes healing and
elasticity of capillary walls
Wold, Gloria [2011-10-15]. Basic Geriatric Nursing [Wold, Basic Geriatric Nursing] [Page 107]. Elsevier Health. Kindle Edition.
•Nutritional and fluid problems are common in the aging
population.
•Knowledge of a wide range of facts and concepts about
nutrition and the nutritional needs of older adults is
important. This text addresses the basics only. For greater
understanding, texts that specialize in
geriatric nutrition
should be consulted.
•A wide range of factors increases the risk for malnutrition in
the elderly population. These should be taken into account
when assessing the nutritional status of older adults.
•Sensory or cognitive changes, weakness, activity
intolerance, and loss of interest in food as a result of
depression or other emotional disturbances contribute to
these problems.
•Signs and symptoms of poor nutrition such as
confusion, weight loss,
lethargy, and lightheadedness
may be mistakenly attributed to an illness or
medication reaction rather than to the underlying
nutritional problem.
•Indicators of nutritional and metabolic alteration are most
commonly observed in the skin, mucous membranes, hair,
and nails. Assessment of these structures can tell nurses a
great deal about an aging person's nutritional status and
fluid balance.
•Good nutrition has been shown to be one of the most
significant factors
in the prevention of skin breakdown.
•Nurses play an important role in the recognition of nutritional
and fluid balance problems, identification of contributing
factors, and development of an appropriate plan of care.
•Nurses should recognize the importance of consultation
with the dietitian and referral to community agencies that
can provide nutritional support.
Wold, Gloria [2011-10-15]. Basic Geriatric Nursing [Wold, Basic Geriatric Nursing] [Page 129]. Elsevier Health. Kindle Edition.
Precautions When Using Transdermal Patches
1. Check the dosage strength of the patch.
2. Verify the correct site or sites for administration.
3. Remove any protective liner so that the medication is in
contact with the skin.
4. Handle with caution so that the nurse's skin does not
come in contact with the medicated portion.
5. Document where each patch is applied. Be sure to
rotate sites.
6. Remove all old
patches, and clean the skin before applying a new one [pay special attention for clear patches
that are difficult to see on the skin].
7. Avoid use of heat over a patch because this causes
vasodilation, which increases the rate of absorption.
8. Dispose of old patches by folding sticky edges together
and placing in the sharps container. [For environmental
reasons, it is not acceptable to use the toilet or wastebasket for disposal.]
9. Teach patient safe application, removal,
and disposal of
patch. Also teach patients to report use of a patch, as
well as any other medications, when seeking medical
attention, particularly during emergency care or when
magnetic resonance imaging [MRI] is anticipated
because many patches contain metal.
Wold, Gloria [2011-10-15]. Basic Geriatric Nursing [Wold, Basic Geriatric Nursing] [Page 145]. Elsevier Health. Kindle Edition.
Medications
Nurses who work in home health have a
great opportunity to
evaluate patients' knowledge of the medications they are taking
and their compliance with medication therapy. The number of
drugs prescribed and the risk for drug-drug interactions increase
when a patient is being seen by more than one physician. Compliance issues are also likely to occur when a patient is taking multiple medications. Here are some steps the nurse can take to
increase patient awareness and compliance:
1. Explain why it is important to do a
thorough medical history
and review of medications to gain the older adult's
cooperation.
2. Determine what drugs [prescription, OTC, and herbal] are
kept in the house. If possible, go around with the elderly
person and identify where medications are stored. Be sure
to check places such as medicine cabinets, the kitchen
table, counters or cabinets, on top of and inside the
refrigerator, at the bedside, and in purses.
3. Check whether there are any other "old
medications" stored
in a shoebox, bag, or anywhere else.
4. If possible, gather all of the medications in the house and go
through them one at a time. Ask the patient to point out
which ones are taken daily, occasionally, and as needed.
If more than one elderly person lives in the home, separate
the medications and evaluate each separately. Watch for
drugs that do not relate to any identified health problems,
for any drug duplications due to orders under both
generic
and trade names, for potential drug-drug interactions, and
for inappropriate drug dosages.
5. Review each medication to determine whether the patient
knows why he or she is taking it, when to take it, and any
precautions to use regarding the drug.
6. Discuss what method [if any] the older person uses to verify
that the appropriate doses of all medications are taken each
day [e.g., Does the person use a daily or weekly pillbox?].
7. After obtaining the patient's
consent, discard any expired
drugs.
Wold, Gloria [2011-10-15]. Basic Geriatric Nursing [Wold, Basic Geriatric Nursing] [Page 147]. Elsevier Health. Kindle Edition.
•On average, older adults take three or more medications
each day, not including OTC preparations.
•Drug use, misuse, and abuse present serious threats to the
well-being of older individuals and increase the risk for
hospitalization resulting from adverse drug
reactions.
•The chance of adverse reactions is increased by the
normal physiologic changes of aging, pathologic changes
related to the higher incidence of acute or chronic
diseases, and a myriad of other factors.
•The medical community has long recognized that children
require special considerations with regard to medication,
and we are now aware that the aging population also
requires special considerations.
•Geropharmacology, the study of how older adults
respond
to medications, is an expanding area of study.
•Physicians who prescribe medication, pharmacists who
dispense medication, and nurses who administer
medication must continue to work together to understand
the unique problems and needs of older adults with regard
to these potentially dangerous substances.
•Nurses must work diligently to build a knowledge base of
the medications administered to their patients or
residents, know how to administer each
medication
safely, know how to assess the aging person's need for
and response to each medication, and develop an
appropriate plan of care that includes safety concerns and
teaching needs.
Wold, Gloria [2011-10-15]. Basic Geriatric Nursing [Wold, Basic Geriatric Nursing] [Page 149]. Elsevier Health. Kindle Edition.
Sets with similar terms