Chapter 14
What is the most common mental health problem in the geriatric age group and what are the causes?
Late-life depression due to isolation, change in environment, low self-esteem, loss of loved ones, and general loss of control over life.
What is a normal part of the life cycle?
Death
What are the core responsibilities of the healthcare professional to help the patient and family go through the process of bereavement?
erbal and nonverbal communication, therapeutic presence, and collaboration with the multidisciplinary healthcare team.
What is, "It's not easy for you. Tell me more about the person you lost," an example of?
Therapeutic communication
What is the study of a rapidly expanding age group and has become a speciality in the health-care field?
Geriatrics
One of Healthy People 2030 goals for advanced old age and geriatrics includes reducing the rate of hospital visits for what?
Pneumonia, UTIs, diabetes, falls and pressure ulcers
The care of the dying person or end-of-life (EOL) care, involves what considerations that need to be addressed by the health-care team?
Ethical and legal issues as well as religious and cultural responsibilities
Understanding what can enable healthcare workers to individualize their approach to the grieving survivor and family following the death of a loved one?
Understanding common religious and cultural practices
What can be assembled to include items of importance to parents after the loss of a child in the early life cycle?
Memory kit
What process dictates the occurrence of menopause in women and contributes to the body changes that ultimately result in death?
Biological clock
What can be helpful for the decrease in men's sexual function or male climacteric with symptoms of hot flashes, feelings of suffocation and depression?
Hormone Replacement Therapy (HRT) - testosterone, synthetic androgens and in some cases estrogen.
What is the goal of pain related to a dying patient and what techniques can help?
Pain relief as much as possible while allowing dying person to complete any unfinished tasks; massage, positioning and supports, scented oils or candles, acupressure, acupuncture, herbs, nonnarcotic or opioid pain relievers.
What are nursing tasks of the grieving process and suggested interventions?
Notification of death - assist with coping, refer to community resource, assess support system.
Recognition of reality of death - understand anger may be directed toward health care professional. Help survivors with feelings of guilt.
Adjustment/reintegration - help set up memory book, plan for future, and reintegrate into society.
What is the difference between sympathy and empathy when offering condolences?
Sympathy - can be pure in form but has negative meaning of unwanted, pity-based response, with a lack of understanding
Empathy - emotional response that acknowledges and attempt to understand the suffering of the other person
Psychological death
What factors influence sexuality in the geriatric adult?
Previous experiences, body-image perception, mental function, self-expectations, social contact/isolation, environment/privacy, incontinence, urinary/fecal devices, mobility, impotence, menopause, illness, and medication side effects
What are nursing interventions for family members who are experiencing helplessness and guilt in response to a loved one dying?
Educate and inform family members about the dying process; allow family to assist in providing care,(washing patient's face, adjusting pillow, holding hands with patient and being present); help family members resolve feelings of guilt.
What are special aspects of grief following a suicide?
What includes profound sadness, pessimism about life, irritability, anger, bitterness, sleep disturbances, declining attention to personal appearance, withdrawal from society, denial, defensiveness, distracted job performance, worsening mental health conditions, obsessing over avoiding mementos of deceased, inability to manage daily affairs, reckless, impulsive, self-destructive behavior, talk of suicide or suicide attempts?
Dysfunctional grief
What can be a grandchild, property, a culture, an organization or writings?
Legacy
Although expensive, what can help with aging in place so seniors can live in their own home and community safely?
Widen doorways for walkers or wheelchairs, replace door knobs with levers, add indoor and outdoor ramps, lower sinks/counters/microwaves, add walk-in shower/bathtub, add bench in tub or shower, install safety bars, elevate the toilet, short carpet on floors, bright lighting, install medical alert systems.
What are common signs of impending death?
Increasing weakness, weight loss, decreased appetite, loss of bowel/bladder control, decreased awareness of surroundings, diaphoresis (sweating), lung congestion (death rattle), altered breathing patterns (Cheye-Stokes respirations), decreased urine output, slow pulse, cold and mottled extremities, and relaxed/open jaw.
What is Elizabeth Kubler-Ross' proposed "Stage Theory" when grief follows a series of predictable stages?
1 - shock/denial/isolation
2 - anger
3 - bargaining/resentment/guilt
4 - depression
5 - acceptance
What is a document written by a health-care provider during a conversation with the patient that equates to a physician order outlining specific medical treatments that the patient wishes to have immediatley based on their diagnosis, prognosis, and goals of care?
POLST - Physicians Order for Life-sustaining treatment
What can be prolonged and debilitating, complicated by a sense of disbelief regarding the death, anger and bitterness, painful emotions with intense yearning and intrusive and distressing thoughts of the deceased, all of which remain severe and impairing?
Complicated grief