NUR 3289 Public Schools Pressure Ulcers Discussion

Gerontological Nursing: Competencies for Care Fourth Edition Edited by Kristen L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, FAAN Professor of Nursing Colorado Christian University President Senior Care Central/International Rehabilitation Consultants, LLC Ridgway, Colorado JONES & BARTLETT LEARNING 2 The Pedagogy Gerontological Nursing: Competencies for Care, Fourth Edition drives comprehension through various strategies that meet the learning needs of students, while also generating enthusiasm about the topic. This interactive approach addresses different learning styles, making this the ideal text to ensure mastery of key concepts.

The pedagogical aids that appear in most chapters include the following: 3 4 World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington, MA 01803 978-443-5000 info@jblearning.com www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers. To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978443-8000, or visit our website, www.jblearning.com.

Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations. For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to specialsales@jblearning.com. 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. 5 The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC.

Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement purposes. All trademarks displayed are the trademarks of the parties noted herein. Gerontological Nursing: Competencies for Care, Fourth Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product. There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images.

Any screenshots in this product are for educational and instructive purposes only. Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only. The authors, editor, and publisher have made every effort to provide accurate information. However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described. Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial.

Research, clinical 6 practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used. 13116-1 Production Credits VP, Executive Publisher: David D. Cella Executive Editor: Amanda Martin Editorial Assistant: Emma Huggard Production Manager: Carolyn Rogers Pershouse Director of Vendor Management: Amy Rose Vendor Manager: Juna Abrams Senior Marketing Manager: Jennifer Scherzay Product Fulfillment Manager: Wendy Kilborn Composition: S4Carlisle Publishing Services Project Management: S4Carlisle Publishing Services Cover Design: Kristin E. Parker Director of Rights & Media: Joanna Gallant Rights & Media Specialist: Wes DeShano Media Development Editor: Shannon Sheehan Cover Image: © thinair28/Vetta/Getty Printing and Binding: LSC Communications Cover Printing: LSC Communications Library of Congress

Cataloging-in-Publication Data 7 Names: Mauk, Kristen L., editor. Title: Gerontological nursing : competencies for care / [edited by] Kristen Mauk. Other titles: Gerontological nursing (Mauk) Description: 4th edition. | Burlington, MA : Jones & Bartlett Learning, [2018] | Includes bibliographical references and index. Identifiers: LCCN 2016056996 | ISBN 9781284104479 (pbk. : alk. paper) Subjects: | MESH: Geriatric Nursing–methods | Clinical Competence | Aging–physiology | Aging–psychology Classification: LCC RC954 | NLM WY 152 | DDC 618.97/0231–dc23 LC record available at https://lccn.loc.gov/2016056996 6048 Printed in the United States of America 21 20 19 18 17 10 9 8 7 6 5 4 3 2 1 8 Dedication and Acknowledgments Dedication To Deanne, Cody, Amelia, Luke, and JJ my wonderful grandchildren who make it fun to get older Acknowledgments Thanks to the parents and grandparents who have been a part of my life and the lives of my children: Pete and Kay Gibson Larry and Gracie Mauk Phyllis Hays Pat and Marvin Bell Your legacies are a great gift to all the people in your lives, and you have each been influential in shaping mine.

I would also like to thank the excellent staff at Jones & Bartlett Learning for all their help, especially Emma Huggard and Amanda Martin. 9 Contents Preface Foreword Contributors Reviewers UNIT I Foundations for Gerontological Nursing (Competencies 1, 8, 9, 19) CHAPTER 1 Introduction to Gerontological Nursing Jeanne St. Pierre Deborah Marks Conley (Competencies 1, 9, 19) Landmarks in the Development of Gerontological Nursing Attitudes Toward Aging and Older Adults Definitions Roles of the Gerontological Nurse Direct-Care Provider Teacher Leader Advocate Evidence-Based Clinician Certification Gerontology Certification–Entry Level Advanced Practice Certification Nurse Practitioner (NP) 10 Clinical Nurse Specialist (CNS) Scope and Standards of Practice Core Competencies Research in Gerontological Nursing Summary References CHAPTER 2 The Aging Population Cynthia S. Jacelon (Competencies 1, 8, 19) Demographics Centenarians Genetics and Genomics Gender and Older Age Race and Ethnicity and Older Adults Health Disparities Mortality and Morbidity Chronic Diseases Causes of Death Healthy Aging Summary References CHAPTER 3 Theories of Aging Jean Lange Sheila Grossman (Competencies 1, 19) Psychosocial Theories of Aging Sociological Theories of Aging 11 Psychological Theories of Aging Biological Theories of Aging Stochastic Theories Nonstochastic Theories Implications for Nursing Nursing Theories of Aging Summary References CHAPTER 4 Review of the Aging of Physiological Systems Janice Heineman Jennifer Hamrick-King Beth Scaglione Sewell (Competencies 9, 19) The Cardiovascular System Overview of the Cardiovascular Structure and Function Aging Changes in Cardiovascular Structure Aging Changes in Cardiovascular Function The Respiratory System Structure and Function of the Respiratory System Aging of the Respiratory System Age-Related Pathologies of the Respiratory System

The Gastrointestinal System Aging in Key Components of the Gastrointestinal Tract 12 Aging in Accessory Glands and Organs Gastrointestinal Immunity The Genitourinary System Overview of the Genitourinary System Urinary Structural Changes with Age Urinary Functional Changes with Age The Reproductive System Female Reproductive Aging Male Reproductive Aging The Nervous System Introduction to the Nervous System The Aging Brain The Aging Spinal Cord The Aging Peripheral Nervous System The Endocrine System The Thyroid Gland The Parathyroid Gland The Pineal Gland The Adrenal Glands Reproductive Hormones The Muscle Skeletal Muscle: Structure and Function Aging of the Skeletal Muscle Resistance Training and Aging Muscle The Skeletal System Bone Aging of the Bone 13 Age-Related Disease and Injury of the Bone The Sensory System Touch Smell Taste Vision Hearing The Integumentary System Skin: Structure and Function The Aging Skin Aging of Skin Accessory Structures The Immune System Innate Immunity Acquired Immunity Immunosenescence The Hematopoietic System Hematopoiesis The Blood Cells Aging of the Hematopoietic System Anemia and Aging Genetics and Aging Summary References UNIT II Communication and Assessment (Competencies 2–6, 13, 15) CHAPTER 5 Teaching and Communication with Older Adults and Their Families 14 Dennis Ondrejka (Competencies 2, 5, 13, 15) Communication Basics for Older Adults Building a Framework for Understanding Normal and Abnormal Aging Normal Language and Speech Categories of Normal and Abnormal Barriers to Communication Internal Barriers and Interventions Interventions for Those with Cognitive and Language Barriers External Barriers and Interventions Language for Improving Communication with Older Adults Building Trust and Respect Using the Communication Enhancement Model Regulatory Communication Goals for Older Adults Communicating with Families and Significant Others Quick Intervention Table Teaching Older Adults and Their Families Theory of Adult Learning Technology for Older Adults’ Lifelong Learning Summary References

CHAPTER 6 Comprehensive Assessment of the Older Adult 15 Lorna Guse (Competencies 3, 4, 6) Functional Assessment Activities of Daily Living Instrumental Activities of Daily Living Advanced Activities of Daily Living Physical Performance Measures Physical Assessment Circulatory Function Respiratory Function Gastrointestinal Function Genitourinary Function Sexual Function Neurological Function Musculoskeletal Function Sensory Function Integumentary Function Endocrine and Metabolic Function Hematologic and Immune Function Cognitive Assessment Psychological Assessment Quality of Life Depression Social Assessment Spiritual Assessment Other Assessment: Obesity Developing an Individualized Plan of Care Advanced Assessment for Graduate Students 16 Summary References UNIT III Health Promotion, Risk Reduction, and Disease Prevention (Competencies 3–6, 9, 17, 18) CHAPTER 7 Promoting Healthy Aging, Independence, and Quality of Life David Haber (Competencies 4, 5, 9, 17, 18) Medicare Prevention Health Behavior Change Exercise Nutrition Mediterranean Diet Dietary Implications for Older Adults Nutrition Advocacy and Education Mental Health Life Review Depression Dependency Quality of Life and Wellness Model Health Promotion Programs for Older Adults Healthwise Chronic Disease Self-Management Program Project Enhance Cardiac Wellness Re-Engagement Instead of Retirement 17 Green House Summary References CHAPTER 8 Identifying and Preventing Common Risk Factors in the Elderly Joan M. Nelson (Competencies 3, 4, 6, 9, 17) Health Promotion and Disease Prevention Definitions Screening The Focus of Health Promotion Efforts Self-Management Physical Activity Nutrition Tobacco Use Safety Polypharmacy and Medication Errors Immunizations Mental Health Screening Depression Dementia Alcohol Abuse Elder Abuse and Neglect Heart and Vascular Disease Lipids Hypertension Aspirin

Therapy Stroke 18 Thyroid Disease Osteoporosis Vision and Hearing Prostate Cancer Breast Cancer Colorectal Cancer Screening Summary References UNIT IV Illness and Disease Management (Competencies 9, 15–18) CHAPTER 9 Management of Common Illnesses, Diseases, and Health Conditions Kristen L. Mauk Amy Silva-Smith (Competencies 9, 15, 17, 18) Cardiovascular Problems Hypertension Coronary Heart Disease Heart Failure Stroke Peripheral Artery Disease (PAD) Respiratory Problems Pneumonia Chronic Obstructive Pulmonary Disease Tuberculosis Gastrointestinal Disorders Gastroesophageal Reflux Disease 19 Peptic Ulcer Disease Diverticulitis Constipation Cancers Genitourinary Problems Urinary Tract Infection Bladder Cancer Female Reproductive System Male Reproductive System Neurological Disorders Parkinson’s Disease Dizziness Seizures Musculoskeletal Disorders Osteoporosis Arthritis Rheumatoid Arthritis Joint Replacement Amputation Sensory Impairments Cataracts Glaucoma Macular Degeneration Diabetic Retinopathy Retinal Detachment Corneal Ulcer Chronic Sinusitis 20 Integumentary Problems Skin Cancers Herpes Zoster (Shingles) Endocrine/Metabolic Disorders Diabetes Mellitus Hypothyroidism Summary References CHAPTER 10 Nursing Management of Dementia Prudence Twigg Christine E. Schwartzkopf (Competencies 9, 15, 16) Dementia Risk Factors for Dementia Medical Diagnosis of Alzheimer’s Disease and Dementia Stages of Alzheimer’s Disease Pharmacological Intervention for Dementia Medications That Can Cause or Worsen Confusion Delirium Depression Caring for the Person with Dementia Theories of Dementia Care Behavioral and Psychological Symptoms of Dementia Pharmacological Treatment for Behavioral and Psychological Symptoms of Dementia 21

Nonpharmacological Treatment for Dementia Pain Management and Alzheimer’s Disease Activity Interventions Communication Interventions Interventions for Particular Behaviors Activities of Daily Living Settings for Care: Focus on Adult Day Services Hospice/Palliative Care Who Can Benefit? Advance Directives Legislative Action Summary References UNIT V Management of Geriatric Syndromes (Competencies 3, 7, 12, 17, 18) CHAPTER 11 Polypharmacy Demetra Antimisiaris Dennis J. Cheek (Competencies 7, 17) Significance of the Problem Morbidity, Mortality, and Costs An Important Historical Perspective Guidelines and Medical Literature on Polypharmacy Risk Factors Multiple Medications: The Prescribing Cascade–Is It the Medication or the Disease? 22 Multiple Prescribers and Iatrogenic Harm Older Age: Frailty, Chronic Disease, Cognitive Impairment, and Altered Pharmacokinetics Warning Signs of Medication Misadventure Assessment Diagnosis Interventions and Strategies for Care Summary References

CHAPTER 12 Falls in Older Adults DeAnne Zwicker (Competencies 3, 7, 12, 17) Falls in the Hospital Setting Consequences of Falls Fall Risk Factors Fall Risk Assessment Post-Fall Assessment Fall Prevention and Safety Promotion Strategies Summary References CHAPTER 13 Delirium Susan Saboe Rose Background Significance of the Problem Risk Factors Warning Signs Assessment 23 Mental Status Examination Confusion Assessment Method Diagnosis Interventions Pain Agitation Combativeness Inattentiveness Wandering and Exit-Seeking Sleep When a “Sitter” Is the Wrong Approach Safety Concerns Home Management after Discharge Prognosis Summary References CHAPTER 14 Anxiety and Depression in the Older Adult Lisa Byrd Cynthia Luther (Competencies 7, 17) Behavioral Changes Associated with Aging Anxiety Understanding Anxiety Common Causes of Anxiety Anxiety Assessment Types of Anxiety and Symptoms of Anxiety Differential Diagnoses for Anxiety 24 Anxiety and Dementia Managing Anxiety Depression Prevalence of Depression in the Aging Population Types of Depression and Presentation Manifestations of Depression Relationship of Depression to Chronic Disease Diagnosing Depression Differential Diagnoses for Depression Depression and Dementia Managing Depression Nursing Interventions Suicide Summary References CHAPTER 15 Urinary

Incontinence B. Renee Dugger (Competencies 7, 17) Prevalence Implications of Urinary Incontinence Physical, Psychological, and Social Implications Economic Implications Assessment of Urinary Incontinence Data Gathering Physical Assessment Interventions and Care Strategies 25 Summary References CHAPTER 16 Sleep Disorders Carol Enderlin Melodee Harris Karen M. Rose Lisa Hutchison Ellyn E. Matthews (Competencies 7, 17, 18) Sleep and Quality of Life Sleep Regulation Sleep Architecture Sleep and the Aging Process Assessment of Sleep Physical Assessment Common Sources of Geriatric Sleep Disturbance Common Sleep Disorders Geropsychiatric Disorders and Sleep Sleep Management Complementary and Alternative Medicine (CAM) Summary References CHAPTER 17 Dysphagia and Malnutrition Neva L. Crogan (Competency 7) Dysphagia Prevalence 26 Implications of Dysphagia Warning Signs and Risk Factors for Dysphagia Assessment Bedside Poststroke Swallowing Tests The Nurses Role in Screening for Dysphagia Interventions and Strategies for Care Malnutrition Prevalence Micronutrient Deficiency Implications Factors Influencing Nutritional Risk Assessment Evidence-Based Strategies to Improve Nutrition The 2015–2020 Dietary Guidelines for Americans Summary References CHAPTER 18 Pressure Ulcers Sandra Higelin (Competencies 7, 17) Etiology Implications, Prevalence, and Incidents of Pressure Ulcers Pressure Ulcer Prevalence in Healthcare Settings Pressure Ulcer Prevention Assessment 27 Interventions for the Prevention of Pressure Ulcers The Challenges of Pressure Ulcer Prevention Pressure Ulcer Prevention Performance Improvement Pressure Ulcer Management Classification of Pressure Ulcers Assessment and Monitoring Treatment Modalities Critical Factors Special Populations Emerging Therapies for Pressure Ulcer Prevention and Management Summary References UNIT VI Leadership and Responsibility (Competencies 1, 11–13)

CHAPTER 19 The Gerontological Nurse as Manager and Leader within the Interprofessional Team Brenda Tyczkowski Kristen L. Mauk Deborah Dunn Dawna S. Fish (Competencies 1, 11, 13) The Nurse Manager The Leader Within: Creating the Leader in Yourself 28 The Art of Leadership: Leading the People The Interdisciplinary Team The Science of Leadership: Managing the Business The Nurse Leader Leader Performance Improvement Catalyst Interpersonal Relations Facilitator Human Resources Developer Resource and Financial Manager Standards and Compliance Expert Resource Customer Service Advocate Leadership Qualities and Theories Qualities of Effective Leaders Transactional Leadership Behavior Theory 21st Century Leadership Transformational or Charismatic Leadership Servant Leadership Complexity Leadership Effective Communication Nursing Leadership Roles in Caring for Older Adults Professional Associations Summary References 29 CHAPTER 20 Ethical and Legal Principles and Issues Janice Edelstein Carolyn A. Laabs (Competencies 1, 11, 12, 13)

Conflict and Dilemma Moral Principles and the Nurse–Patient Relationship Beneficence and Nonmaleficence Advocacy, Confidentiality, Fidelity, and Veracity Justice and Autonomy Informed Consent Quality and Sanctity of Life Patient Rights Advance Directives and Living Wills Durable Power of Attorney Competence Guardianship Assisted Suicide Ethics in Practice Medical Errors Conflict of Interest Summary References UNIT VII Information and Health Care Technologies (Competencies 5, 18) 30 CHAPTER 21 Technology and Care of Older Adults Linda L. Pierce Victoria Steiner (Competencies 5, 18) Introduction to Assistive Technology Assistive Device Use Evaluating the Use of Assistive Technology Common Applications of Assistive Technology Position and Mobility Environmental Access and Control Self-Care Sensory Impairment Cognitive Impairment Social Interaction and Recreation Computer-Based As