Gerontologic Nursing

PART I Introduction to Gerontologic Nursing

1 Overview of Gerontologic Nursing
Foundations of the Specialty of Gerontologic Nursing
Professional Origins
Standards of Practice
Roles
Terminology
Demographic Profile of the Older Population
The Older Population
Highlights of the Profile of Older Americans
Sex and Marital Status
Race and Ethnicity
Living Arrangements
Geographic Distribution
Education
Income and Poverty
Employment
Health Status of Older Adults
Self-Assessed Health and Chronic Disease
Functional Status
Healthcare Expenditure and Use
Implications for Healthcare Delivery
Acute Care Setting
Nursing Facilities
Home Care
Continuum of Care
Effect of an Aging Population on Gerontologic Nursing
Ageism
Nursing Education
Nursing Practice
Nursing Research

2 Healthcare Policy that Affects Older Adults
Scope of Practice and Professional Standards: Legal
Significance Overview of Relevant Healthcare Policies
Sources of Law
Health Insurance Portability and Accountability Act (HIPAA) of 1996
Elder Abuse and Protective Services
Medicare and Medicaid
Nursing Facility Reform
OBRA’s Three Major Parts
Affordable Care Act
The Patient Self-Determination Act
Autonomy and Self-Determination
Do Not Resuscitate Orders
Legal Tools
Communication Between Patient’s Directives and Family Desires
Nurses’ Ethical Code and Practice Decisions
Ethical Dilemmas and Considerations
Experimentation and Research
Organ Donation
Ethics Committees
Social Media

3 Assessment of the Older Adult
Special Considerations Affecting Assessment
Interrelationship Between Physical and Psychosocial Aspects of Aging
Nature of Disease and Disability and Their Effects on Functional Status
Tailoring the Nursing Assessment to the Older Person
The Health History
The Interviewer
The Patient
Electronic Health Records
The Health History Format
Approach to Physical Assessment
Equipment and Skills
Additional Assessment Measures
Functional Status Assessment
Cognitive and Affective Assessment
Social Assessment
Laboratory Data

PART II Influences on Health and Illness

4 Family Influences
Role and Function of Families
Planning in Advance of Need
Common Late-life Family Issues and Decisions
The Issue of Driving
Financial and Legal Concerns
End-of-Life Healthcare Decisions
Family Caregiving
Caregiver Education
Respite Programs
Support Groups
Assessing the Family
Past Relationships
Family Dynamics
Roles
Dependence and Independence
Changes in Living Arrangements
Deciding About a Care Facility

5 Socioeconomic and Environmental Influences
Socioeconomic Factors
Generational Differences
Income
Education
Health Status and Healthcare Coverage
Environmental Influences
Geographic Location of Residence
Housing
Transportation
Advocacy

6 Health Promotion and Illness/Disability Prevention
Essentials of Health Promotion for Aging Adults
Terminology
Barriers to Health Promotion and Disease
Prevention
Models of Health Promotion
Transtheoretical Model
Health Belief Model
Health Promotion Model
Disease Prevention
Primary Preventive Measures
Secondary Preventive Measures
Tertiary Preventive Measures
Nursing Role in Prevention
Nursing Care Guidelines for Health Promotion and Disease Prevention
Supporting the Empowerment of Older Adults

PART III Influences on Quality of Life

7 Nutrition
Malnutrition
Factors Influencing Nutritional Risk in Older
Adults
Drug–Nutrient Interactions
Dehydration
Micronutrient Deficiency
Indicators of Malnutrition
Oral Health
Nutritional Screening and Assessment
Nutritional Screening
Nutritional Assessment
Patient Problems Associated with Nutritional Problems
Evidence-based Strategies to Improve Nutrition
Components of a Healthy Diet
Dysphagia
Specialized Nutritional Support

8 Sleep and Activity
Sleep and Older Adults
Biologic Brain Functions Responsible for Sleep
Stages of Sleep
Sleep and Circadian Rhythm
Insomnia
Age-Related Changes in Sleep
Factors Affecting Sleep
Sleep Disorders and Conditions
Components of the Sleep History
Further Assessment of Sleep
Getting a Good Night’s Sleep
Activity and Older Adults
Activities of Daily Living
Physical Exercise
Activity as Affected by Lifestyle Changes
Activity Affected by Alzheimer Disease and Other
Dementias

9 Safety
Falls
Overview and Magnitude of the Problem
Definition of Falling
Meaning of Falling
Normal Age-Related Changes Contributing to Falling
Fall Risk
Fall Antecedents and Fall Classification
Fall Consequences
History
Physical Examination
Special Testing
Management
Safety and the Home Environment
Burn Injuries in the Home
Other Injuries in the Home
Foodborne Illnesses
Seasonal Safety Issues
Hypothermia and Hyperthermia in Older Adults
Disasters
Storage of Medications and Health Care Supplies in the Home
Crime Prevention
Automobile Safety
Abuse and Neglect
Firearms


10 Sexuality and Aging
Older Adult Needs for Sexuality and Intimacy
The Importance of Intimacy Among Older Adults
Nursing’s Reluctance to Manage the Sexuality of Older Adults
Normal Changes of the Aging Sexual Response
Physiologic Changes
Genitourinary Syndrome of Menopause
Pathologic Conditions Affecting Older Adults’ Sexual
Responses
Illness, Surgery, and Medication
Human Immunodeficiency Virus
Malignancies
Dementia
Environmental and Psychosocial Barriers to Sexual Practice
Lesbian, Gay, Bisexual, and Transgender Older Adults
Adults
Nursing Care Guidelines for Sexuality and Aging
Recognize Cues (Assessment)
Analyze Cues and Prioritize Hypotheses
(Patient Problems)
Generate Solutions (Planning)
Take Actions (Nursing Interventions)
Evaluate Outcomes (Evaluation)

11 Pain
Understanding Pain
Definition
Scope of the Problem of Pain
Consequences of Unrelieved Pain
Pathophysiology of Pain in Older Adults
Perception of Pain in Older Adults
Barriers to Effective Pain Management in Older
Adults
Pain Assessment
Pain Assessment and Culture
Pain Assessment Tools
Nursing Care Guidelines for Older Adults
with Pain
Pharmacologic Treatment
Planning Pain Relief

12 Infection and Inflammation
Immunologic Theory
Age-Related Changes in the Immune System
Factors Affecting Immunocompetence
Nutritional Factors
Psychosocial Factors
Drugs
Complementary and Alternative Medications
Infections
The Chain of Infection
Common Problems and Conditions
COVID-19, Influenza, and Pneumonia
Cancer
Autoimmunity
HIV Infection in Older Adults
Significant Healthcare-Associated Pathogens
Clostridium difficile
Vancomycin-Resistant Enterococcus
Methicillin-Resistant Staphylococcus aureus
Extended Spectrum b-Lactamase-Positive
Escherichia coli
Nursing Care Guidelines for Infection
Recognize Cues (Assessment)
Analyze Cues and Prioritize Hypotheses
(Patient Problems)
Generate Solutions (Planning)
Take Actions (Nursing Interventions)
Evaluate Outcomes (Evaluation)

PART IV Diagnostic Studies and Pharmacologic Management

13 Laboratory and Diagnostic Tests
Hematologic Testing
Red Blood Cells
White Blood Cells
Folic Acid
Vitamin B12
Total Iron-Binding Capacity
Iron
Uric Acid
Prothrombin Time
Partial Thromboplastin Time
d-dimer Test
Erythrocyte Sedimentation Rate
C-Reactive Protein
Platelets
Components of Blood Chemistry Testing
Electrolytes
Amylase
Total Protein
Albumin and Prealbumin
Blood Urea Nitrogen
Creatinine
Creatinine Clearance
Triglycerides
Total Cholesterol
High-Density Lipoprotein
Low-Density Lipoprotein
Brain Natriuretic Peptide
Alkaline Phosphatase
Aspartate Aminotransferase
Creatine Kinase
Lactate Dehydrogenase
Troponin
Thyroid Function Tests
Prostate-Specific Antigen
Urinalysis
Protein
Glucose
Bacteria
Ketones
pH
Blood
Components of Arterial Blood Gas Testing
Partial Pressure of Oxygen
pH of the Blood
Bicarbonate
Oxygen Saturation
Therapeutic Drug Monitoring

14 Drugs and Aging
Overview of Drug Use and Problems
Demographics of Drug Use
Changes in Drug Response With Aging
Pharmacodynamic Changes: What the Drug Does to the Body
Drugs and Quality of Life
Pharmacologic Contributors to Risk
Commonly Used Drugs
Antipsychotics
Anxiolytics and Hypnotics
Antidepressants
Cardiovascular Drugs
Antimicrobials
Opioid Analgesics
Nonprescription Agents
Dietary Supplements
Drug Adherence
Assessing for Risk Factors
Strategies for Improving Adherence
Reviewing the Drug List for Problems
Substance Use Disorders
Definitions and Common Usage
Difficulty in Identification of SUD
Physiologic Changes
Psychological Changes
Sociologic Changes
Nursing Care Guidelines for SUDs
Recognize Cues (Assessment)
Analyze Cues and Prioritize Hypotheses
(Patient Problems)
Take Actions (Nursing Interventions)
Evaluate Outcomes (Evaluation)
Commonly Misused Substances in Older Adults
Alcohol
Prescription Drugs
Nicotine
Cannabis
Future Trends

PART V Nursing Care of Physiologic and Psychological Disorders

15 Integumentary Function
Age-Related Changes in Skin Structure and Function
Epidermis
Dermis
Subcutaneous Fat
Dermal Appendages
Dermatoporosis
Common Problems and Conditions
Benign Skin Growths
Inflammatory Dermatoses
Psoriasis
Pruritus
Candidiasis
Herpes Zoster (Shingles)
Premalignant Skin Growths: Actinic Keratosis
Malignant Skin Growths
Basal Cell Carcinoma
Squamous Cell Carcinoma
Melanoma
Nursing Care Guidelines for Malignant Skin
Growths
Lower Extremity Ulcers
Arterial Ulcers
Venous Ulcers
Diabetic Foot Lesions
Nursing Care Guidelines for Lower Extremity
Ulcers
Pressure Injuries
Epidemiology of Pressure Injuries
Etiology of Pressure Injuries
Risk Assessment Tools
Preventive Strategies
Pressure Injury Management

16 Sensory Function
Vision
Age-Related Changes in Structure and Function
Common Complaints
Common Problems and Conditions
Hearing and Balance
Age-Related Changes in Structure and Function
Common Problems and Conditions
Taste and Smell
Age-Related Changes in Structure and Function
Common Problems and Conditions
Touch

17 Cardiovascular Function
Age-Related Changes in Structure and Function
Conduction System
Vessels
Response to Stress and Exercise
Common Cardiovascular Problems
Hypertension
Risk Factors for Heart Disease
Coronary Artery Disease
Arrhythmia
Orthostatic Hypotension
Syncope with Cardiac Causes
Valvular Heart Disease (VHD)
CHF
Peripheral Artery Disease
Chronic Venous Insufficiency
Anemia

18 Respiratory Function
Age-Related Changes in Structure and Function
Factors Affecting Lung Function
Exercise and Immobility
Smoking
Obesity
Anesthesia and Surgery
Respiratory Findings Common in Older Patients
Respiratory Alterations in Older Patients
Obstructive Pulmonary Disease
Asthma
Chronic Bronchitis
Emphysema
Chronic Obstructive Pulmonary Disease
Restrictive Pulmonary Disease
Lung Cancer
Tuberculosis
Pneumonia
Other Respiratory Alterations
Cardiogenic and Noncardiogenic Pulmonary
Edema
Pulmonary Emboli
Obstructive Sleep Apnea

19 Gastrointestinal Function
Age-Related Changes in Structure and Function
Oral Cavity and Pharynx
Esophagus
Stomach
Small Intestine
Large Intestine
Gallbladder
Pancreas
Liver
Prevention
Common GI Symptoms
Nausea and Vomiting
Anorexia
Abdominal Pain
Gas
Diarrhea
Constipation
Fecal Incontinence
Common Diseases of the GI Tract
Gingivitis and Periodontitis
Dysphagia
Gastroesophageal Reflux and Esophagitis
Vitamin B12 Deficiency
Gastritis
Peptic Ulcer Disease
Enteritis
Intestinal Obstruction
Diverticula
Colon Polyps
Hemorrhoids
Disorders of the Accessory Organs
Cholelithiasis and Cholecystitis
Pancreatitis
Hepatitis
Cirrhosis Secondary to Alcohol Use Disorder
Drug-Induced Hepatitis
GI Cancers
Esophageal Cancer
Gastric Cancer
Colorectal Carcinoma
Pancreatic Cancer
Liver Cancer

20 Urinary Function
Age-Related Changes in Structure and Function
Prevalence of UI
Common Incontinence Problems and Conditions
Transient Incontinence
Established Incontinence
Nursing Care Guidelines for Incontinence
Recognize Cues (Assessment)
Analyze Cues and Prioritize Hypotheses
(Patient Problems)
Generate Solutions (Planning)
Take Actions (Nursing Interventions)
Evaluate Outcomes (Evaluation)
Age-Related Renal Changes
Common Renal Problems and Conditions
Acute Kidney Injury
Chronic Kidney Disease
Urinary Tract Infection
Bladder Cancer
Benign Prostatic Hyperplasia
Prostate Cancer

21 Musculoskeletal Function
Age-Related Changes in Structure and Function
Common Problems and Conditions of the Musculoskeletal System
Hip Fracture
Colles Fracture
Clavicular Fracture
Casts and Cast Care
Osteoarthritis
Spinal Stenosis
Rheumatoid Arthritis
Gouty Arthritis
Osteoporosis
Paget’s Disease
Osteomyelitis
Amputation
Polymyalgia Rheumatica
Foot Problems
Muscle Cramps

22 Cognitive and Neurologic Function
The Central Nervous System
The Brain
Spinal Cord
Evaluation of Cognitive Function
Cognitive Function in Typical Aging
Cognitive Disorders Associated with Altered Thought Processes
Depression
Delirium
Dementia
Resources
Other Common Problems and Conditions
Suicide
Parkinson Disease
Cerebrovascular Accident
Anxiety
Schizophrenia
Mental Health Resources
E4 Center

23 Endocrine Function
Endocrine Physiology in Older Adults
Andropause and Menopause
Adrenopause
Somatopause
Common Endocrine Pathophysiology in Older
Adults
Metabolic Syndrome–Diabetes Continuum
Type 2 Diabetes Mellitus
Hyperthyroidism
Hypothyroidism
Primary Osteoporosis
Sexual Dysfunction

PART VI Health Care Transitions

24 Health Care Delivery Settings and Older Adults
Characteristics of Older Adults in Acute Care
Characteristics of the Acute Care Environment
Philosophy of Care
Risks of Hospitalization
Safety Features
Nursing in the Acute Care Setting
Nursing-Specific Competency and Expertise
Critical Care and Trauma Care
Continuity of Care
Benefits of Home Care
Role of Home Care Agency
Implementing the Plan of Treatment
The Nurse’s Role
Role of the Home-Health Aide
Oasis
Community-Based Providers
Factors Affecting the Health Care Needs of Older Adults
Functional Status
Cognitive Function
Housing Options for Older Adults
Profile of Community- and Home-Based
Services
Home Health Care
Home Health Agency
Proprietary Agencies
Facility-Based Agencies
Visiting Nurse Associations
Overview of Long-Term Care
Definition
Factors Associated with Institutionalization
Medical and Psychosocial Models of Care
Clinical Aspects of the Nursing Facility
Resident Rights
Resident Assessment
Skin Care
Incontinence
Nutrition
Drug Administration
Rehabilitation
Infection Control
Mental Health
End-of-Life Care
Management Aspects of the Nursing Facility
The Nursing Department
Nursing Care Delivery Systems
Specialty Care Settings
Assisted-Living Programs
Special Care Units
Subacute Care
Innovations in the Nursing Facility
Creativity in “Everyday” Nursing Facilities
Nurse Practitioners in the Nursing Facility
The Future of the Nursing Facility
Hospice
Hospice Philosophy

25 Chronic Illness and Rehabilitation Chronicity
Prevalence of Chronic Illness
Cultural Competency
Quality of Life and Health-Related Quality of Life
Adherence in Chronic Illness
Patient-Centered Approach
Psychosocial Needs of Older Adults With Chronic Illness
Physiologic Needs of Chronically Ill Older Adults
Effect of Chronic Illness on Family and Caregivers
Nursing Implications of Caregiver Stress
Rehabilitation
Care Environments
Reimbursement Issues
Public Policy and Legislation
Enhancement of Fitness and Function
Functional Assessment
The Impact Act of 2014
Keys for Completing a Functional Assessment
Health Promotion
Management of Disabling Disorders
Life Issues
Nursing Strategies

26 Cancer
Incidence
Racial and Ethnic Patterns
Aging and Its Relationship to Cancer
Aging and Cancer Prevention
Common Malignancies in Older Adults
Lung Cancer
Breast Cancer
Prostate Cancer
Colorectal Cancer
Screening and Early Detection: Issues for Older Adults
Major Treatment Modalities
Surgery
Radiation Therapy
Chemotherapy
Targeted Therapy
Immunotherapy
Hormone Therapy
Bone Marrow/Stem Transplant
Common Physiologic Complications
Bone Marrow Suppression
Nausea and Vomiting
hemotherapy-Induced Oral Mucositis
Anorexia and Cachexia
Diarrhea
Alopecia
Older Adults’ Experience of Cancer
Quality of Life
Depression
Grief and Loss
Social Isolation and Loneliness
Resources and Support

27 Loss and End-of-Life Issues Definitions
Losses
Bereavement
Grief
Mourning
Approaching Death
Comfort Theory
General Health-Care Needs
Effects of Age-Related Changes
Nursing Care Guidelines for the Older Adult Who is Dying
Hospice
Palliative Care
Legislative Initiatives

Appendix A: Resources and Advocacy Groups for Older Adults