geriatric nurse

["Sleep and Rest\u2003 CHAPTER 20\t 333 SLEEP DISORDERS Box 20-2\u2003 Risk Factors Related to Sleep or Rest Insomnia Problems in Older Adults The risk for sleep disorders increases with age. Studies show that up to 40% of older individuals report expe- \u2022\t Pain riencing sleep difficulties at least a few nights each \u2022\t Chronic respiratory or cardiovascular problems month. The most common sleep disorder is insomnia, \u2022\t Frequent elimination which is defined as difficulty falling asleep or remain- \u2022\t Nocturnal movement disorders ing asleep or the belief that one is not getting enough \u2022\t Anxiety, depression, or delirium sleep. Insomnia can be a disorder in its own right \u2022\t Drugs likely to interfere with sleep but is more frequently associated with an underlying \u2022\t Excessive environmental stimuli medical problem. Insomnia can be acute (occurring \u2022\t Excessive caffeine, alcohol, or tobacco use one or several nights) or chronic (lasting longer than \u2022\t Sedentary lifestyle one month). Different types of insomnia are identified based on the phase of sleep affected: (1) sleep onset of normal wakefulness). People with dementia often problems: those related to falling asleep; (2) sleep experience abnormal sleep cycles and are prone to maintenance problems: those related to staying asleep; waking and wandering during the night. Many pre- or (3) terminal insomnia problems: those related to scription and OTC medications affect sleep in older abnormally early awakening. Identification of the adults. Commonly prescribed insomnia medications type of insomnia problem can help nurses identify the are listed in Table 20-1. Many medications prescribed underlying cause or causes and result in the best for various disorders interfere with sleeping (Table interventions. 20-2). There are other medications that can result in hypersomnolent responses. Did You Know? Behaviors that contribute to sleep problems include \u2002 physical inactivity, poor sleep routines, late-night eating or exercise, the use of tobacco, and consumption Baby Boomers have been found to be chronically sleep- of alcohol or caffeine. Environmental factors, such deprived with more than half of adults over age 50 reporting as excessive noise, light, activity, or other distracting that they get fewer than 7 hours of sleep per night. According stimuli, can also contribute to the problem. Afternoon to a study done by the Institute of Medicine, 50 to 70 million sleepiness is common with aging. Naps may adversely Americans suffer from sleep disorders, which have been\t affect nighttime sleeping, particularly if the nap is late associated with a wide range of adverse health conditions, in the afternoon or lasts too long. Occasional naps of including increased risk for hypertension, diabetes, obesity, less than 30 minutes are usually not a problem. Box depression, heart attack, and stroke. The magnitude of prob- 20-2 lists risk factors for problems related to sleep or lems reported does not bode well for the future, as Baby rest in older adults. Boomers continue to age. Occasional problems with insomnia are experienced Older adults with existing health problems are more by individuals of all ages, but these random, acute likely to experience sleep problems than those who episodes are likely to result in chronic insomnia if report themselves to be in good health. Insomnia not properly addressed. Chronic insomnia can result can be related to a variety of medical conditions, in daytime sleepiness, irritability, decreased ability to medications, and psychological, behavioral, or envi- concentrate, and other problems related to sleep depri- ronmental factors. Medical conditions that cause pain, vation. Daytime sleepiness is often ignored or excused interfere with breathing, or cause frequent bladder or as a normal change of aging rather than viewed as a bowel elimination contribute to frequent awakening. symptom of sleep deprivation. Common medical problems that may lead to insomnia include arthritis, bursitis, chronic pain, diabetes, gas- Health Promotion troesophageal reflux, chronic obstructive pulmonary disease (COPD), congestive heart failure, sleep apnea, \u2002 prostatic problems, cystitis, and others. Nocturnal movement disorders, including restless leg syndrome Sleep Hygiene Practices (RLS), which is an irresistible urge to move the lower \u2022\t Establish a regular bedtime and wake-up time, and follow extremities, or nocturnal myoclonus, which causes sudden repetitive jerking or kicking movements of this schedule as closely as possible. the lower extremities, also contributes to insomnia in \u2022\t Develop a daily exercise program, preferably outdoors. older adults. \u2022\t Increase overall light exposure. \u2022\t Avoid naps or limit them to no more than 30 minutes and Anxiety is likely to be related to difficulty falling asleep and interrupted sleep. Depression is most likely no later than early afternoon. to be associated with early awakening but may also be \u2022\t Avoid caffeine, alcohol, and tobacco after lunchtime. related to hypersomnia (excessive sleepiness at a time \u2022\t Eat a light snack before bed, but avoid large meals. \u2022\t Take a warm bath or shower before going to bed \u2022\t Use relaxation breathing or meditation techniques. \u2022\t Try listening to relaxing music.","334\t UNIT IV\u2003 Physical Care of Older Adults Table 20-1\u2003 Medications to Treat Insomnia CLASSIFICATION EXAMPLES NOTES PRECAUTIONS Older medications, high potential for Short term use only; Benzodiazepines \u2022\t Estazolam (FDA-approved for \u2022\t Flurazepam dependence cautious use in insomnia) \u2022\t Quazepam respiratory or liver \u2022\t Temazepam Same as above problems \u2022\t Triazolam Newer medications; safe for older adults; fewer Same as above Benzodiazepines \u2022\t Lorazepam side effects (FDA-approved for \u2022\t Clonazepam Cautious use in anxiety) \u2022\t Alprazolam Newer medication; can cause paradoxical respiratory or liver (opposite) reactions including anxiety and problems; depression \u201cNonbenzodiazepines\u201d \u2022\t Eszopiclone excitement; unusual activities (e.g., cooking, or psychiatric disorders (FDA-approved for \u2022\t Zaleplon driving) not remembered the next day have insomnia) \u2022\t Zolpidem tartrate been reported by patients taking this Contraindicated in \u2022\t Zolpidem tartrate medication patients with COPD, sleep apnea, liver extended release) disease; should not be used in anyone at risk Melatonin receptor \u2022\t Ramelteon for suicide agonist (FDA- approved for insomnia) Important Note: Observe anyone taking medications for grogginess or \u201cmedication hangover\u201d the following day; report any patient mention of suicidal thoughts immediately. Data from Neikrug AB, Ancoli-Israel S: Sleep disorders in the older adult\u2014A mini-review, Gerontology, 2010;56:181\u2013189; Stanford Hospital and Clinics: Treating Insomnia with Medications, 2014, http:\/\/stanfordhospital.org\/clinicsmedServices\/clinics\/sleep\/treatment_options\/insomnia-medications.html; and U.S. National Library of Medicine, National Institutes of Health: Medline Plus: Drug Information, 2014, www.nlm.nih.gov\/medlineplus\/druginformation.html COPD, chronic obstructive pulmonary disease; FDA, Food and Drug Administration. \u2022\t Establish a restful sleep environment with a comfortable retention, drowsiness, fatigue, confusion, and dis- bed, good pillow and covers, shades or curtain to block turbed coordination, which increases fall risk. out light, and a slightly cool temperature. Complementary and Alternative Therapies \u2022\t If you cannot fall asleep after 30 minutes, do not get upset. Get up. Read, watch TV, or do something relaxing \u2002 until you feel tired. Then go back to bed. Alternative Treatments for Insomnia Treatment of insomnia includes both nonpharmaco- logic and pharmacologic approaches. Nonpharmaco\u00ad \u2022\t Valerian Root: May help with sleep onset and sleep logic approaches include sleep hygiene education, maintenance, although effectiveness is not proven. relaxation therapies, cognitive behavioral therapy (CBT), and other behavioral interventions. Of these, \u2022\t Chamomile: Shown to be effective and safe sleep aid in CBT has been shown to be the most effective therapy animals. FDA considers it safe with no known adverse for insomnia (Neikrug & Ancoli-Israel, 2010). The effects. \u201ccognitive\u201d part of CBT deals with retraining one\u2019s expectations about sleep, such as an absolute number \u2022\t Melatonin: Hormone produced by the pineal gland, helps of hours of sleep needed. The \u201cbehavioral\u201d part of CBP regulate sleep\/wake cycles. May produce coronary includes teaching behaviors promoting sleep, such as vasoconstriction and paradoxical reactions (increased sleep hygiene practices; breaking the mental associa- alertness). tion between the bedroom and being awake, for example, using the bed only for sleep; and getting rid \u2022\t Acupuncture: Has shown to improve sleep quality in of thoughts that hinder sleep such as, \u201cIt\u2019s no use!\u201d and people with insomnia. \u201cI\u2019ll never get to sleep.\u201d Pharmacologic approaches include the use of drugs such as antihistamines, anti- \u2022\t Relaxation, meditation, yoga: Can be very effective but depressant agents (most often benzodiazepines), and can take several weeks to master the technique. May hypnotic agents. These medications are usually pre- increase blood levels of melatonin. scribed temporarily while the person is learning CBT techniques. The common rule, as with all medications \u2022\t Exercise, tai chi: Helpful in enhancing sleep quality, as for the older adult, is to \u201cstart low (dosage) and go long as not done late in the day. slow.\u201d Sleep-inducing medications are likely to have adverse effects on older adults, such as urinary Sleep Apnea Sleep apnea, also called sleep disordered breathing, is a common problem with aging. Studies report that as many as 45% to 65% of the older adult population are suspected to have some breathing problem that dis- turbs sleep. Obstructive sleep apnea caused by airway blockage or collapse is the most common problem experienced. Men are more likely to experience sleep apnea, and about half sleep apnea sufferers are","Sleep and Rest\u2003 CHAPTER 20\t 335 \u2002 Table 20-2\u2003 Top 10 Types of Medication Categories That Cause Insomnia DRUG CATEGORY EXAMPLES REASON TAKEN HOW THEY INTERRUPT SLEEP Decreases REM sleep; increases Alpha blockers Alfuzosin, doxazosin, Hypertension; benign prazosin, silodosin, prostatic hyperplasia; daytime sedation terazosin, tamsulosin Raynaud disease Inhibits melatonin; leads to Beta blockers Atenolol, carvedilol, Angina; tremors; nighttime awakening and metoprolol, propranolol, migraine headaches; nightmares sotalol, timolol glaucoma Stimulates the adrenal gland Corticosteroids Cortisone, Inflammation; arthritis; methylprednisolone, gout; allergic Unknown mechanism, but causes prednisone, triamcinolone reactions insomnia in up to 20% of those who take them SSRI antidepressants Citalopram, escitalopram, Moderate to severe fluoxetine, fluvoxamine, depression Interrupts sleep caused by the paroxetine, sertraline common side effects of hacking; dry cough; potassium overload in ACE inhibitors Benazepril, captopril, Hypertension and the body leading to body aches, enalapril, fosinopril, congestive heart leg cramps, and diarrhea lisinopril, moexipril, failure perindopril, quinapril, Potassium overload in the body ramipril, trandolapril leading to body aches, leg cramps, and diarrhea Angiotensin II-receptor Candesartan, irbesartan, blockers (ARBs) losartan, telmisartan, Inhibits the neurotransmitter valsartan acetylcholine; disrupts sleep; can cause nightmares Cholinesterase inhibitors Donepezil, galantamine Memory loss (Alzheimer disease and other Block acetylcholine, causing dementias) insomnia and anxiety Second-generation Azelastine nasal spray, Allergies and allergic Unknown mechanism; nausea; (nonsedating) H1 cetirizine, desloratadine, reactions headaches; diarrhea; insomnia antagonists fexofenadine, levocetirizine, loratadine Insomnia caused by the common side effect of muscle pain Dietary supplements Glucosamine, chondroitin Joint pain; stiffness; regulated by the FDA inflammation as food, not medication Atorvastatin, lovastatin, rosuvastatin, simvastatin High cholesterol Statins Data from Neel AB: 10 Types of meds that can cause insomnia, 2013, www.aarp.org\/health\/drugs-supplements\/info-04-2013\/medications-that-can-cause-insomnia .1.html ACE, angiotensin-converting-enzyme; FDA, Food and Drug Administration; SSRI, serotonin-specific reuptake inhibitor, REM, rapid eye movement. overweight. Other things correlated with sleep apnea recommended. Mechanical oral or dental devices that are hypertension, metabolic syndrome, smoking, and prevent relaxation of tissues may help some individu- diabetes. Sleep apnea has been found to be more als. Continuous positive airway pressure (CPAP) common in blacks under age 35 than in Caucasians. devices are another common treatment. Occasionally, Signs of sleep apnea include excessively loud snoring surgery is recommended. Many individuals need a interspersed with periods of apnea lasting 10 to 30 combination of interventions to control the problem. seconds. Lack of oxygen causes the person to awaken frequently throughout the night, although the person Circadian Rhythm Sleep Disorders may not be aware of it. This cycle repeats hundreds Changes in the circadian rhythm can cause unusual of times each night. Recurrent disturbance of sleep sleep disorders. This can occur for many reasons, such results in dayt\u00adime sleepiness. Individuals experienc- as working nightshift, jet lag, and certain medications. ing obstructive sleep apnea are also at increased It has been long documented that blind people often risk for developing cardiovascular complications, experience a circadian rhythm change, known as Non- including hypertens\u00ad ion, arrhythmias, myocardial 24-Hour Sleep Wake Disorder, or \u201cNon-24,\u201d since light infarctions, and stroke. People experiencing sleep does not stimulate their brain and they cannot syn- apnea should try to lose weight and avoid alcohol, chronize their body clock to the 24-hour light-dark sedatives, and muscle relaxants, which can worsen the cycle. In 2014, the FDA approved a medication called condition. Sleeping in the supine position may also Hetlioz (tasimelteon), which stimulates melatonin make the condition worse, so a side-lying position is receptors and theoretically improves sleep caused by","336\t UNIT IV\u2003 Physical Care of Older Adults NURSING DIAGNOSIS circadian rhythm changes. Because of the exorbitant \u2002 cost of this medication, however (estimated to be $60,000 to $90,000 per year), you might not see it on Disturbed sleep pattern your clinical unit anytime soon. NURSING GOALS\/OUTCOMES IDENTIFICATION REM Sleep-Behavior Disorder REM sleep-behavior disorder is another less common \u2002 problem seen most often in men in their sixties and seventies. Muscle activity is normally inhibited during The nursing goals for older individuals diagnosed with REM, so little or no gross muscle movement occurs disturbed sleep pattern are to (1) verbalize an under- during dreams. However, when a person experiences standing of sleep changes associated with aging; (2) REM sleep behavior disorder, this protective mecha- verbalize appropriate interventions to promote sleep; nism does not operate effectively, and the older indi- and (3) report feeling rested and refreshed on rising. viduals may thrash around in bed, jump or fall out of bed, or sustain an injury (or injury to their partner) as NURSING INTERVENTIONS\/IMPLEMENTATION they attempt to protect themselves from vivid or violent dreams. Manifestation of this disorder may be \u2002 a predecessor to the development of Parkinson disease or dementia. Long-acting benzodiazepines are fre- The following interventions should take place in hos- quently effective in treating this disorder; studies have pitals and extended-care facilities: also shown melatonin to have promising results. 1.\t Identify the factors that contribute to sleep dis- NURSING PROCESS FOR DISTURBED turbance. Identify the cause of sleep disturbance so that the most appropriate interventions can \u2002 be selected. Various internal and external factors can interfere with sleep. Pain, whether it is chronic SLEEP PATTERN or acute, interrupts or prevents sleep. Identify the causes of pain and take measures to make the To assess sleep patterns in older adults, use a com\u00ad older person as comfortable as possible. Medical bination of objective and subjective data. Simply conditions and the medications taken to treat because an older individual\u2019s eyes are closed during them can affect sleep. Older people with cardio- nighttime checks does not mean that the person vascular disease may experience anginal pain is asleep. Watch closely for signs of fatigue and during REM sleep that causes them to awaken. decreased participation in activities and ask older Patients with ulcers secrete excessive amounts adults how they feel about the adequacy of their sleep of acid during REM sleep, causing pain and awak- and rest. ening. Individuals with COPD may experience ASSESSMENT\/DATA COLLECTION dyspnea related to lying flat, or orthopnea. This may result in oxygen hunger and anxiety and may \u2002 interfere with sleep. Anxiety and depression often result in early-morning rising and an inability to \u2022\t Does the person feel rested after a night\u2019s sleep? return to sleep once awakened. Medications for \u2022\t What time does the person normally go to bed hypertension commonly cause altered sleep pat- terns. Environmental factors, including lighting, and rise? noise, and temperature change, also should be \u2022\t Is the person allowed to choose the bedtime, or is it considered. 2.\t Schedule nursing interventions to allow for ade- chosen by someone else? quate undisturbed sleep. Nursing and medical \u2022\t Does the person sleep continuously through the interventions can interfere with sleep. Medication administration, dressing changes, or toileting can night, or is sleep interrupted? interrupt sleep. Although you may not have total \u2022\t Does the caregiver or bed partner report any abnor- control over medication and treatment scheduling, attempt to formulate a plan that causes the least mal breathing pattern, excessive snoring, or unusual interference with sleep. For example, if diuretic movement during sleep? medications are given close to bedtime, urinary \u2022\t What causes the person to awaken? Pain? Noise? frequency may prevent the individual from getting Other factors? continuous sleep. Scheduling the diuretic agent \u2022\t Does the person have difficulty falling asleep? early in the morning will decrease this problem. \u2022\t Does the person awaken early? If a procedure is not essential for the well-being \u2022\t Does the person nap or sleep during the day? of an individual, it should not be scheduled during \u2022\t Does the person ever fall asleep during daytime the night. Many treatments and medications are activities? now specifically ordered to be given to the patient \u2022\t Has the person\u2019s behavior changed? Is the person \u201cwhile awake\u201d to eliminate any confusion or increasingly irritable, disoriented, or lethargic? concern regarding interpretation of the order. The \u2022\t Does the person appear tired? Does the person com- benefits to the patient must be weighed against the plain of tiredness? When? risks of sleep deprivation. \u2022\t Have any signs such as yawning or dark circles under the eyes been observed?","Sleep and Rest\u2003 CHAPTER 20\t 337 it is at the same time each night. If possible, place Clinical Situation individuals who have sleep difficulties in rooms away from noisy work areas. Noise that goes \u2002 unnoticed during the day, particularly conversa- tion near the nurses\u2019 station and unanswered call Sleep and Rest systems, can disturb sleep at night. Because of changes in circulation, many older individuals Mrs. Nguyen, age 79, had some problems with incontinence need an extra blanket for comfort at night. A warm, but no difficulty participating in her activities of daily living until light blanket that does not feel heavy is preferred she was placed on a toileting schedule in which she was by many older adults. reminded to use the bathroom every 3 hours, day and night. After being awakened five nights in a row, she began to display Coordinated Care an inability to dress and feed herself. Staff members began to search for symptoms of illness or disease to account for this \u2002 change, but they found none. Nursing notes indicated that Mrs. Nguyen was attending fewer activities, and she was Supervision observed napping in her room on several occasions. On the MINIMIZING DISTURBANCES AT NIGHT sixth night of toileting, Mrs. Nguyen remarked, \u201cIf you would Schedule activities such as treatments and medications to just let me sleep, I\u2019d feel better.\u201d minimize the number of times a patient will be disturbed during the night. In addition, communicate to other staff members that The nurse put these pieces of information together\t excessive noise from conversations or equipment use should and realized that, although the toileting schedule reduced be minimized, because it can easily disturb the sleep of older problems with incontinence, it caused other problems related patients who already may have difficulty sleeping. to sleep. After a discussion with Mrs. Nguyen, her primary care provider, and her family, it was determined that using inconti- 6.\t Modify lighting through the day to imitate nence briefs during the night would be a better alternative. normal daily patterns. Most institutions do not After three nights of uninterrupted sleep, Mrs. Nguyen began provide adequate light during the day to allow to dress and feed herself again and to participate in social the body to maintain normal circadian rhythm. activities instead of napping. Provide bright lighting during the daytime, par- ticularly during winter months. Dark rooms are 3.\t Plan bedtimes and wake-up times to meet the best for sleep, but this may not be feasible in insti- individual\u2019s needs and desires rather than the tutional settings. Provide lighting that allows for institution\u2019s. Although a regular bedtime schedule safety but does not interfere with sleep. Ensure is advisable, set the schedule with input from the that curtains and doors are positioned to block older adult. The fact that an older person resides light. Some individuals can sleep only if there is a in an institutional setting does not mean that sleep night-light; others are disturbed by any light. patterns established over a lifetime should change to fit the institution. The institution should allow 7.\t Provide comfort measures to promote sleep. A for individual preferences. Many older adults find comfortable environment promotes sleep. Provide that they cannot sleep once they have gone to bed. clean, dry, and wrinkle-free bed linens. Tighten or They often lie awake and become increasingly loosen top linens to provide the greatest comfort. anxious. This anxiety further interferes with their Sleepwear should be nonrestricting and of the ability to fall asleep. If the person is unable to sleep type preferred by the individual (Figure 20-2). after 20 to 30 minutes, encourage the person to get Encourage or provide oral hygiene. Remind older up and quietly watch television, read, or listen to music. A lounge should be available so that this FIGURE 20-2\u2003 Nonrestricting sleepwear. (\u00a9 2010 Photos.com, activity does not disturb the sleep of others. When a division of Getty Images. All rights reserved.) the person is tired, he or she should then return to bed. This supports the mental connection that bed is a place for sleep. 4.\t Allow the individual to maintain rituals that help induce sleep. Many older adults have rituals that help them sleep. These pre-sleep rituals are highly individual and include hygiene activities, the use of special pillows, praying, and a variety of other activities. Discuss individual preferences and incorporate these into the plan of care. 5.\t Assist in providing an environment that is con- ducive to sleep. To prevent awakening roommates, use the minimum amount of light necessary and make as little noise as possible when checking patients or performing required treatments. Ideally, individuals sharing a room should have similar sleep schedules. Establish a schedule for routine rounds so that even if nightly sleep is interrupted,","338\t UNIT IV\u2003 Physical Care of Older Adults or fatigue during the day can interfere with night- time sleep. Assess for daytime behaviors that affect adults to empty the bladder before going to bed to sleep. If individuals spend too much time napping, avoid the need to get up once they become sleepy. determine the reason. If boredom is the cause, Nocturia occurs most commonly within a few encourage diversional activities. If the individual hours of going to sleep. In addition, if the older is too fatigued or stimulated by the day\u2019s activities, person is left wet, sleep is disturbed for several encourage more frequent rest periods. hours. Awakening the person and changing wet The following interventions should take place in clothes usually results in a return to normal sleep. the home: 8.\t Administer sleep medications (sedatives and 1.\t Use a journal to assess sleep and rest patterns. hypnotics) as a nursing intervention of last resort, Many older individuals who complain of sleep and watch carefully for side effects. Assess problems are unaware of their daily routines. patients or residents for desired effects and untow- Keeping a journal to record naps, bedtimes, periods ard effects of sleep medications. Because many of awakening, and time of rising in the morning medications that are used to promote sleep can often yields important information. If the individ- cause orthostatic hypotension, observe the indi- ual cannot do this alone, a spouse or relative may viduals for dizziness, make position changes assist. Any information that may be relevant (e.g., slowly, and assist with ambulation to reduce the pain and nocturia) should be noted. Loud snoring risk for falls or other injuries. Offer medications to and apnea are more likely to be noticed by a close promote sleep only as a last resort because many family member than by the affected party. Refer any sedative and hypnotic drugs can leave older adults reports of these behaviors to the primary care pro- with lingering or hangover effects and can contrib- vider for follow-up. ute to insomnia. These drugs can actually lead to 2.\t Explain the importance of adequate activity and disturbed sleep because they alter the nature and exercise throughout the day. Adequate exercise and quality of sleep. Long-acting drugs can be retained activity help promote good sleep. Excessive activity in the body for an excessive amount of time, poten- should be avoided within 2 hours of bedtime tially leading to confusion, disorientation, and because such activity may raise body temperature daytime sleepiness. Use medications that affect and actually interfere with sleep. respiration with extreme caution in older adults. 3.\t Assist older adults in establishing an environment Low doses of drugs with short half-lives are best that promotes rest and sleep. Verify that the condi- tolerated by older adults. tions in the home promote rest and sleep and that 9.\t Provide nutritional supplements that aid sleep. A the older adult has an adequate bed and suitable light snack or beverage before bed is commonly covers. Make sure heating is adequate. If noise from requested. Discourage caffeinated beverages, such neighbors or traffic is a problem, discuss possible as coffee, because caffeine can interfere with sleep. ways of dealing with this. Decaffeinated coffee, herbal tea, and milk are good 4.\t Discuss limiting fluid intake at night if nocturia is choices. Milk is often suggested because it contains a problem. If nocturia is interrupting sleep, encour- tryptophan, which has sleep-inducing properties. age older adults to decrease fluid intake for 1 to 2 Heavy meals put extra stress on the body and hours preceding bedtime. However, it is important should be avoided near bedtime. Discourage alco- that adequate fluid be consumed earlier in the day holic beverages because they may interfere with to prevent fluid balance problems. the normal sleep cycles and may lead to awaken- 5.\t Encourage the use of relaxation exercises, creative ing because of diuresis. visualization, self-hypnosis, or other relaxation 10.\t Promote emotional comfort by spending time lis- techniques. Many techniques that promote relax- tening to concerns. Anxiety and depression inter- ation can be used to help induce sleep. Numerous fere with sleep. A back rub or a few minutes of CDs, DVDs, and books are available to describe quiet conversation at bedtime may help relieve the these techniques, many of which could benefit older concerns of the day and promote sleep in older adults and are unlikely to cause the problems that adults. Relaxation training or other stress manage- are caused by medications. ment techniques may be appropriate for some 6.\t Use any appropriate interventions that are used in individuals. the institutional setting (Nursing Care Plan 20-1). 11.\t Observe patients for patterns of fatigue or napping throughout the day. Excessive napping","Sleep and Rest\u2003 CHAPTER 20\t 339 \u2002 Nursing Care Plan 20-1\u2003 Disturbed Sleep Pattern Mrs. Star, age 83, lives at Larkspur Court Residence Center. Her room is near the nurses\u2019 station. She is frequently observed to be awake during the night. She often does not want to get up for breakfast, stating, \u201cI\u2019m too tired.\u201d She yawns often during the day and takes frequent naps in her room. She complains, \u201cI can\u2019t get comfortable. There is just too much noise around here.\u201d NURSING DIAGNOSIS Disturbed Sleep Pattern DEFINING CHARACTERISTICS \u2022\t Change from normal sleep pattern \u2022\t Observed periods of awakening at night \u2022\t Complaints of not feeling well rested \u2022\t Decreased ability to function PATIENT GOALS\/OUTCOMES IDENTIFICATION Mrs. Star will report feeling adequately rested. NURSING INTERVENTIONS\/IMPLEMENTATION 1.\t Identify specific factors that make sleep difficult for Mrs. Star. 2.\t Ask Mrs. Star whether she can identify any changes that would help her sleep. 3.\t Consider a room change if possible. 4.\t Close her door to reduce extraneous noise. 5.\t Place \u201cQUIET\u201d signs on her door at night. 6.\t Discourage daytime napping. 7.\t Encourage daytime physical activities, outdoors if possible. 8.\t Recommend that she avoid caffeine after dinner. 9.\t Teach relaxation techniques. 10.\t Provide comfort measures at bedtime. 11.\t Assess the need for further therapies. EVALUATION Mrs. Star now states, \u201cI really like my new room. It\u2019s much quieter, so I don\u2019t have trouble sleeping at night. In fact, I\u2019ve even started going to more activities now that I\u2019m feeling more rested during the day. The lawn bowling club is really fun!\u201d She is observed to be sleeping soundly when checked at night. Fewer daytime naps are documented in her chart. You will continue the plan of care. CRITICAL THINKING QUESTIONS A new resident who calls out loudly day and night was admitted to the room next door. Mrs. Star states to another resident, \u201cI just started getting a good night\u2019s sleep, and now he\u2019s keeping me awake again.\u201d 1.\t What would your most appropriate response be to Mrs. Star\u2019s concerns? 2.\t How could you resolve this problem for her and other residents who may be disturbed? Get Ready for the NCLEX\u00ae Examination! Additional Learning Resources Key Points \u2002 Go to your Evolve website at http:\/\/evolve.elsevier .com\/Williams\/geriatric for the additional online resources. \u2022\t Changes related to sleep are a major concern for many older adults. Review Questions for the NCLEX\u00ae Examination \u2022\t Because sleep problems can result from normal 1.\t In promoting sleep hygiene practices for her older age-related changes or other problems, concerns about adult patient, what should the nurse suggest? (Select sleep should not be taken lightly. all that apply.) 1.\t Implement a routine of bedtime cocoa. \u2022\t A thorough assessment of sleep behaviors and 2.\t Make the bedroom warm for a comfortable sleep. appropriate interventions help older adults achieve the 3.\t Eat a light snack before bedtime. rest and sleep they require to function at the highest 4.\t Develop a daily exercise program, preferably possible level. outdoors. 5.\t If the older adult cannot fall asleep, lay there until it \u2022\t Sleep medications should be implemented only as an eventually happens. intervention of last resort, and for as short of a duration as possible.","340\t UNIT IV\u2003 Physical Care of Older Adults 2.\t List four factors that are likely to cause sleep problems 5.\t A patient, who lost his wife six months ago, has been in older adults. diagnosed with clinical depression. He plans to ask \t 1.\t ____________________________________________ his primary care provider for a prescription for sleep 2.\t ____________________________________________ medication. He asks for advice about what else he can 3.\t ____________________________________________ do. The lack of sleep is interfering with his daytime 4.\t ____________________________________________ activities, making him feel like he\u2019s \u201cin a fog,\u201d and he states that his chronic obstructive pulmonary disease 3.\t The wife of an overweight older adult reports that her (COPD) is getting worse. What should the nurse keep in husband snores very loudly, then stops breathing mind when providing an answer? several times each night. In addition to recommending 1.\t Most of the newer sleep medications are safe a visit to the primary care provider, what should the choices for people with depression. nurse suggest? 2.\t Benzodiazepines carry a low risk of dependence. 1.\t The husband should have a glass of wine at bedtime 3.\t Cognitive behavioral therapy has been shown to be to promote relaxation. more effective than medications in treating insomnia. 2.\t The husband should use an OTC decongestant to 4.\t The newer medication, Ramelteon, is the best open the respiratory passages. choice for someone with COPD. 3.\t The husband should sleep in the supine position with two pillows to open the airway. 6.\t Which of the following are true statements regarding 4.\t The husband should try to lose weight and sleep in insomnia and its treatment? (Select all that apply.) a side-lying position. 1.\t Sleep medications can be useful in short-term management of insomnia. 4.\t An older patient requests an evening snack. Which 2.\t Cognitive behavioral therapy may be indicated when food is most appropriate to facilitate sleep? sleep medications fail. 1.\t Graham cracker with banana and milk 3.\t Valerian root is the most effective herb for the 2.\t Cheese, toast, and hot chocolate treatment of insomnia. 3.\t Slice of cake and hot tea 4.\t Tai chi at bedtime has been shown to be effective in 4.\t Fruit, cheese, and a glass of wine preventing insomnia. 5.\t Taking the medication cortisone, especially late in the day, can contribute to insomnia.","Laboratory Values for Older Adults appendix A TEST NAME ADULT NORMALS OLDER ADULT NORMALS SIGNIFICANCE OF DEVIATIONS Hematology Red blood cells M 4.7\u20136.1 Unchanged with aging Low: hemorrhage, anemia, chronic illness, renal F 4.2\u20135.4\u202fmillion\/ Values may be slightly failure, pernicious anemia (RBCs) Hemoglobin unit decreased High: high altitude, polycythemia, dehydration M 14\u201318\u202fg\/dL Hematocrit F 12\u201316\u202fg\/dL Values may be slightly Low: anemia, cancer, nutritional deficiency, kidney decreased disease White blood cells M 42%\u201352% (WBCs) (total) F 37%\u201347% Unchanged with aging High: polycythemia, CHF, chronic obstructive Unchanged with aging pulmonary disease (COPD), high altitudes, Neutrophils 5.0\u201310.0 dehydration thousand\/mm3 Unchanged with aging Eosinophils Unchanged with aging Low: anemia, cirrhosis, hemorrhage, malnutrition, 55%\u201370% Unchanged with aging rheumatoid arthritis Basophils Unchanged with aging Monocytes 1%\u20134% High: polycythemia, severe dehydration, severe Unchanged with aging diarrhea, COPD Lymphocytes 0.5%\u20131% 2%\u20138% Unchanged with aging Low: drug toxicity, infections, autoimmune disease, Folic acid Unchanged with aging dietary deficiency 20%\u201340% Unchanged with aging Vitamin B12 High: infection, trauma, stress, inflammation Total iron binding 5\u201325\u202fng\/mL Low: dietary deficiency, overwhelming bacterial Iron (Fe) 160\u2013950\u202fpg\/mL infection, viral infections, drug therapy 250\u2013460\u202fmcg\/dL High: physical and emotional stress, trauma, M 80\u2013180\u202fmcg\/ inflammatory disorders dL Low: increased adrenosteroid production F 60\u2013160\u202fmcg\/dL High: parasitic infections, allergic reactions, autoimmune disorders Low: acute allergic reactions, stress reactions High: myeloproliferative disease Low: drug therapy (predisposition) High: chronic inflammatory disorders, tuberculosis, chronic ulcerative colitis Low: leukemia, sepsis, systemic lupus erythematosus, chemotherapy, radiation High: chronic bacterial infection, viral infections, radiation, infectious hepatitis Low: malnutrition, folic acid anemia, hemolytic anemia, alcoholism, liver disease, chronic renal disease High: pernicious anemia Low: hypoproteinemia, cirrhosis, hemolytic capacity (TIBC) anemia, pernicious anemia High: polycythemia, iron-deficiency anemia Low: insufficient dietary iron, chronic blood loss, inadequate absorption of iron High: hemochromocytosis, hemolytic anemia, hepatitis, iron poisoning Continued 341","342\t APPENDIX A\u2003 LABORATORY VALUES FOR OLDER ADULTS TEST NAME ADULT NORMALS OLDER ADULT NORMALS SIGNIFICANCE OF DEVIATIONS Uric acid May be slightly M 4.0\u20138.5\u202fmg\/dL Low: lead poisoning F 2.7\u20137.3\u202fmg\/dL increased High: gout, increased ingestion of purines, chronic Prothrombin time (PT) 11\u201312.5\u202fsec Unchanged with aging renal disease, hypothyroidism Partial thromboplastin 60\u201370\u202fsec Unchanged with aging High: liver disease, vitamin-K deficiency, warfarin time (PTT) 30\u201340\u202fsec ingestion, bile-duct obstruction, salicylate intoxication Partial tromboplastin 150,000\u2013 time\u2014activated 400,000\/mm3 Low: early stages of disseminated intravascular (APTT) coagulation, metastatic cancer Platelets High: coagulation factor deficiency, cirrhosis, vitamin-K deficiency, heparin administration Unchanged with aging Low: hemorrhage, thrombocytopenia, systemic lupus erythematosus, pernicious anemia, chemotherapy, infection High: malignancy, polycythemia, rheumatoid arthritis, iron-deficiency anemia Blood Chemistry 136\u2013145\u202fmEq\/L Unchanged with aging Low: decreased intake, diarrhea, vomiting, diuretic Sodium administration, chronic renal failure, CHF, Unchanged with aging peripheral edema, ascites Potassium 3.5\u20135.0\u202fmEq\/L Chloride 98\u2013106\u202fmEq\/L Unchanged with aging High: increased intake, Cushing syndrome, extensive thermal burns Calcium 9.0\u201310.5\u202fmg\/dL Tends to stay the Phosphate 3.0\u20134.5\u202fmg\/dL same or decrease Low: deficient intake, burns, diuretics, Cushing syndrome, insulin administration, ascites Magnesium 1.3\u20132.1\u202fmEq\/L Slightly lower High: excessive dietary intake, renal failure, infection, Glucose, fasting 70\u2013110\u202fmg\/dL Decreases 15% acidosis, dehydration (FBS) between third and eighth decade Low: overhydration, CHF, vomiting, chronic gastric Glucose, postprandial Less than suction, chronic respiratory acidosis, hypokalemia, 140\u202fmg\/dL 2 Increase in normal diuretic therapy Amylase hours after range after age 50 Glycosylated meal High: dehydration, Cushing syndrome, kidney Less than 160\u202fmg\/dL dysfunction, metabolic acidosis, hyperventilation hemoglobin 60\u2013120 Somogyi 2 hours after meal (Hgb\u202fA1c) units\/dL Low: renal failure, vitamin-D deficiency, osteomalacia, Slightly increased in malabsorption 4.0%\u20135.9% elderly High: Paget disease of the bone, prolonged Unchanged with aging immobilization, lymphoma Low: inadequate dietary ingestion, chronic antacid ingestion, hypercalcemia, alcoholism, osteomalacia, malnutrition High: renal failure, increased dietary intake, hypocalcemia, liver disease Low: malnutrition, malabsorption, alcoholism, chronic renal disease High: renal insufficiency, ingestion of magnesium- containing antacids or salts, hypothyroidism Low: hypothyroidism, liver disease, insulin overdose, starvation High: diabetes mellitus, acute stress response, diuretic therapy, corticosteroid therapy Low: hypothyroidism, insulin overdose, malabsorption High: diabetes mellitus, malnutrition, Cushing syndrome, chronic renal failure, diuretic therapy, corticosteroid therapy High: acute pancreatitis, perforated bowel, acute cholecystitis, diabetic ketoacidosis Low: hemolytic anemia, chronic renal failure High: newly diagnosed diabetes, poorly controlled diabetes, nondiabetic hyperglycemia","LABORATORY VALUES FOR OLDER ADULTS\u2003 APPENDIX A\t 343 TEST NAME ADULT NORMALS OLDER ADULT NORMALS SIGNIFICANCE OF DEVIATIONS Total protein 6.4\u20138.3\u202fg\/dL Unchanged with aging Low: liver disease, malnutrition, ascites Albumin 3.5\u20135\u202fg\/dL High: hemoconcentration Blood urea nitrogen 10\u201320\u202fmg\/dL Decrease slightly with aging Low: malnutrition, liver disease, overhydration (BUN) M 0.6\u20131.2\u202fmg\/dL High: dehydration Creatinine F 0.5\u20131.1\u202fmg\/dL May be slightly higher M 107\u2013139\u202fmL\/ Low: liver failure, overhydration, malnutrition Creatinine clearance Decrease in muscle High: hypovolemia, dehydration, alimentary tube min mass may cause Cholesterol (total) F 87\u2013107\u202fmL\/min decreased values feeding, renal disease High-density <200\u202fmg\/dL Values decrease Low: debilitation, decreased muscle mass lipoprotein (HDL) 6.5\u202fmL\/min\/decade High: reduced renal blood flow, diabetic neuropathy, M >45\u202fmg\/dL of life after age 20 Low-density F >55\u202fmg\/dL due to a decline in urinary tract obstruction lipoprotein (LDL) <130\u202fmg\/dL GFR Low: impaired kidney function, CHF, cirrhosis Alkaline phosphatase 30\u2013120 units\/L Increases until about High: high cardiac output syndromes Acid phosphatase 0.13\u20130.63 units\/L middle age but decreases Low: malabsorption, malnutrition, cholesterol- Aspartate 0\u201335 units\/L thereafter (or can lowering medication, pernicious anemia, liver transaminase (AST) increase abruptly disease, hyperthyroidism M 55\u2013170 units\/L in\u202fwomen) Creatinine kinase (CK) F 30\u2013235 units\/L High: hypercholesteremia, hyperlipidemia, Thyroid Testing 4\u201312\u202fmcg\/dL Unchanged with aging hypothyroidism, uncontrolled diabetes mellitus, Thyroxine (T4)\u2014total hypertension, stress 70\u2013205\u202fng\/dL Increases with aging Triiodothyronine (T3) 40\u2013180 after menopause Low: familial low HDL, liver disease, hypoproteinemia Age 20\u201350 High: familial HDL lipoproteinemia, excessive exercise \u2003 >50 2\u201310\u202fmcU\/mL Slightly higher Thyroid-stimulating Low: hypolipoproteinemia Yellow; amber Unchanged with aging High: hypothyroidism, alcohol consumption, chronic hormone (TSH) Clear Urine Chemistry 1.005\u20131.030 Values slightly higher liver disease, Cushing syndrome Color Appearance Unchanged with aging Low: hypothyroidism, malnutrition, pernicious anemia Specific gravity High: cirrhosis, healing fracture, Paget disease Slightly decreased Low: thrombosis Slightly decreased High: heparin administration, cirrhosis, prostate Unchanged with aging cancer Same Low: acute renal disease, diabetic ketoacidosis, Same chronic renal dialysis Values decrease with High: myopathy, hepatitis, cirrhosis, multiple trauma, aging acute hemolytic anemia High: diseases or injury affecting heart muscle, skeletal muscle, and brain Low: hypothyroidism, malnutrition, renal failure, cirrhosis High: hyperthyroidism, hepatitis Low: hypothyroidism, pituitary insufficiency, protein malnutrition, renal failure, liver diseases, Cushing syndrome High: hyperthyroidism, hepatitis, hypoproteinemia Low: pituitary dysfunction, hyperthyroidism High: primary hypothyroidism Straw-colored urine indicates dilution. Cloudy urine may indicate presence of pus, casts, blood, and bacteria. Low: overhydration, renal failure, diuresis, hypothermia High: dehydration, water restriction, vomiting, diarrhea Continued","344\t APPENDIX A\u2003 LABORATORY VALUES FOR OLDER ADULTS TEST NAME ADULT NORMALS OLDER ADULT NORMALS SIGNIFICANCE OF DEVIATIONS pH 4.6\u20138.0 Same Acidic urine: diarrhea, metabolic acidosis, diabetes Protein 0\u20138\u202fmg\/mL Same mellitus, respiratory acidosis, emphysema Glucose Negative Ketones Negative Same Alkaline urine: respiratory alkalosis, metabolic alkalosis, vomiting, gastric suctioning, diuretic Blood Negative Same therapy, UTI Leukocyte esterase Negative Bacteria Negative Same Positive: diabetes mellitus, CHF, systemic lupus erythematosus, malignant hypertension Arterial Blood Gases 7.35\u20137.45 Same pH 80\u2013100\u202fmm\u202fHg May be seen in older Positive: diabetes mellitus, Cushing syndrome, Po2 severe stress, infection, drug therapy 35\u201345\u202fmm\u202fHg adults without Pco2 95%\u2013100% symptoms; evaluate Positive: uncontrolled diabetes mellitus, starvation, O2 saturation 21\u201328\u202fmEq\/L for pyuria and excessive aspirin ingestion, high-protein diet, HCO3 symptoms dehydration Positive: renal trauma, renal stones, cystitis, prostatitis Positive: possible UTI Positive: UTI Same Low: respiratory or metabolic acidosis High: respiratory or metabolic alkalosis Decreases 25% Low: cardiac or respiratory disease between 30 and 80\u202fyears old Low: respiratory alkalosis High: respiratory acidosis Same Low: impaired gas exchange Low: metabolic acidosis 95% High: metabolic acidosis Same Adapted from Pagana KD, Pagana TJ: Diagnostic and laboratory test reference, ed 10, 2011, St. Louis: Mosby; and Pagana KD, Pagana TJ: Manual of diagnostic and laboratory tests, ed 4, 2010, St. Louis: Mosby.","The Geriatric Depression Scale (GDS) appendix B The Geriatric Depression Scale (GDS) was developed as a basic screening tool for depression in older adults and is used in the clinical setting. It is a short questionnaire that requires a yes or no response from the participant, based on how the person feels on the day the tool is administered. GERIATRIC DEPRESSION SCALE Patient ___________________________ Examiner ___________________________ Date __________________________ Directions to Patient: Please choose the best answer for how you have felt over the past week. Directions to Examiner: Present questions VERBALLY. Circle answer given by patient. Do not show to patient. \u2002 1. Are you basically satisfied with your life? yes no (1) \u2002 2. Have you dropped many of your activities and interests? yes (1) no \u2002 3. Do you feel that your life is empty? yes (1) no \u2002 4. Do you often get bored? yes (1) no \u2002 5. Are you hopeful about the future? yes no (1) \u2002 6. Are you bothered by thoughts you can\u2019t get out of your head? yes (1) no \u2002 7. Are you in good spirits most of the time? yes no (1) \u2002 8. Are you afraid that something bad is going to happen to you? yes (1) no \u2002 9. Do you feel happy most of the time? yes no (1) 10. Do you often feel helpless? yes (1) no 11. Do you often get restless and fidgety? yes (1) no 12. Do you prefer to stay at home rather than go out and do things? yes (1) no 13. Do you frequently worry about the future? yes (1) no 14. Do you feel you have more problems with memory than most? yes (1) no 15. Do you think it is wonderful to be alive now? yes no (1) 16. Do you feel downhearted and blue? yes (1) no 17. Do you feel pretty worthless the way you are now? yes (1) no 18. Do you worry a lot about the past? yes (1) no 19. Do you find life very exciting? yes no (1) 20. Is it hard for you to get started on new projects? yes (1) no 21. Do you feel full of energy? yes no (1) 22. Do you feel that your situation is hopeless? yes (1) no 23. Do you think that most people are better off than you are? yes (1) no 24. Do you frequently get upset over little things? yes (1) no 25. Do you frequently feel like crying? yes (1) no 26. Do you have trouble concentrating? yes (1) no 27. Do you enjoy getting up in the morning? yes no (1) 28. Do you prefer to avoid social occasions? yes (1) no 29. Is it easy for you to make decisions? yes no (1) 30. Is your mind as clear as it used to be? yes no (1) TOTAL: Please sum all bolded answers (worth one point) for a total score. ________________ Scores: 0\u20139 Normal, 0\u201319 Mild Depressive, 0\u201330 Severe Depressive. From Brink TL, Yesavage JA, Lum O, Heersema P, Adey MB, Rose TL: Screening tests for geriatric depression. Clinical Gerontologist 1:37\u201344, 1982. 345","appendix C Dietary Information for Older Adults RDA1 OR AI* TOLERABLE UPPER INTAKE MEN WOMEN LEVELS (MEN AND WOMEN) Vitamins, Elements, Electrolytes 30* 30* ND Biotin (mcg) ND ND 20 Boron (mg) 1200* 1200* 2000 Calcium (mg) 2.0* (age 51\u201370) 2.0* (age 51\u201370) 3.6 Chloride (g) 1.8* (age 70+) 1.8* (age 70+) 550* 425* 3500 Choline (mg) 30* 20* ND Chromium (mcg) 900 900 10,000 Copper (mcg) 4* 3* 10 Fluoride (mg) 400 400 1000 Folate (mcg) 150 150 1100 Iodine (mcg) 8 8 45 Iron (mg) 420 320 350 Magnesium (mg) 2.3* 1.8* 11 Manganese (mg) 45 45 2000 Molybdenum (mg) 16 14 35 Niacin (mg) ND ND 1 Nickel (mg) 5* 5* ND Pantothenic Acid (mg) 700 700 4000 (age 51\u201370) Phosphorus (mg) 3000 (age 70+) 4.7 4.7 Potassium (g) 1.3 1.1 ND Riboflavin (mg) 55 55 400 Selenium (mcg) 1.3* (age 51\u201370) 1.3* (age 51\u201370) 2.3 Sodium (g) 1.2* (age 70+) 1.2* (age 70+) 1.2 1.1 ND Thiamin (mg) ND ND 1.8 Vanadium (mg) 900 700 3000 Vitamin A (mcg) 1.7 1.5 100 Vitamin B6 (mg) 2.4 2.4 ND Vitamin B12 (mcg) 90 75 2000 Vitamin C (mg) 15* (age 51\u201370) 15* (age 51\u201370) 100 Vitamin D (mcg) 20* (age 70+) 20* (age 70+) 15 15 1000 Vitamin E (mg) 120* 90* ND Vitamin K (mcg) 11 8 40 Zinc (mg) 346","DIETARY INFORMATION FOR OLDER ADULTS\u2003 APPENDIX C\t 347 RDA1 OR AI* TOLERABLE UPPER INTAKE MEN WOMEN LEVELS (MEN AND WOMEN) Macronutrients, Fiber, Water 2204 (age 51\u201370) 1978 (age 51\u201370) Energy2 (Kcal) 2054 (age 70+) 1873 (age 70+) 56 46 Protein3 (g) (10\u201335% AMDR) Carbohydrates4 (g) (45%\u201365% AMDR) 130 130 Total Fat5,6 (% Kcal) (20%\u201335% AMDR) n-6 PUFA (g) (5%\u201310% AMDR) 20\u201335 20\u201335 n-3 PUFA (g) (0.6\u20131.2% AMDR) Total Fiber 14* 11* Drinking water, beverages, water in food (L) 1.6* 1.1* 30* 21* 3.7* (age 51\u201370) 2.7* (age 51\u201370) 2.6* (age 70+) 2.1* (age 70+) AMDR, acceptable macronutrient distribution range for intakes of carbohydrates, proteins, and fats expressed as % of total calories; ND, not determined. *Adequate intakes (AIs). 1Recommended dietary allowances (RDAs) are in bold. 2Values are based on Table 5-22 Estimated Energy Requirements (EER) for Men and Women 30 Years of Age. Used height of 5\u20327\u2033 and \u201clow active\u201d physical activity level (PAL) and calculated the median BMI and calorie level for men and women. Caloric values based on age were calculated by subtracting 10\u202fkcal\/day for males (from 2,504\u202fkcal) and 7\u202fkcal\/day for females (from 2,188\u202fkcal) for each year of age above 30. For ages 51\u201370, calculated for 60 years old, for 70+, calculated for 75 years old. 80-year-old male calculated to require 2,004\u202fkcal, female 1,838\u202fkcal. 3The RDA for protein equilibrium in adults is a minimum of 0.8\u202fg\/kg body weight for reference body weight. 4The RDA for carbohydrate is the minimum adequate to maintain brain function in adults. 5Because % of energy consumed as fat can vary greatly and still meet energy needs, an AMDR is provided in absence of AI, EAR, or RDA for adults. 6Values for monounsaturated and saturated fats and cholesterol not established as \u201cthey have no role in preventing chronic disease, thus not required in the diet.\u201d Modified from the National Policy and Resource Center on Nutrition and Aging, Florida International University, Revised 3\/19\/04. Data compiled from the Institute of Medicine, Dietary Reference Intakes: Applications in Dietary Assessment, 2000; Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Protein and Amino Acids (Macronutrients), 2002; and Dietary Reference Intakes: Water, Potassium, Sodium, Chloride, and Sulfate, 2004. For more information, go to http:\/\/fnic.nal.usda.gov\/dietary-guidance\/dietary-reference-intakes\/dri-tables","appendix Resources for Older Adults D ORGANIZATIONS National Senior Citizens Law Center 1444 Eye St., NW Suite 1100 Administration for Community Living Washington, DC 20005 One Massachusetts Avenue NW (202) 289-6976 Washington, DC 20201 FAX (202) 289-7224 (202) 619-0724 www.nsclc.org FAX (202) 357-3555 National Indian Council on Aging www.acl.gov 10501 Montgomery Blvd NE Alzheimer\u2019s Association Suite 210 225 N. Michigan Ave., Fl. 17 Albuquerque, NM 87111 Chicago, IL 60601-7633 (505) 292-2001 (312) 335-8700 FAX (505) 292-1922 TDD (312) 335-5886 nicoa.org FAX (866) 699-1246 National Institute on Aging www.alz.org Public Information Office American Geriatrics Society Building 31, Room 5C27 40 Fulton St., 18th Floor 31 Center Drive MSC 2292 New York, NY 10038 Bethesda, MD 20892-2292 (212) 308-1414 (301) 496-1752 FAX (212) 832-8646 FAX (301) 496-1072 americangeriatrics.org National Council on the Aging American Society on Aging 1901\u202fL Street, NW, 4th Floor 575 Market St., Washington, DC 20036 Suite 2100 (202) 479-1200 San Francisco, CA 94105-2869 National Long-Term Care Resource Center (415) 974-9600 Institute for Health Services Research FAX (415) 974-0300 University of Minnesota School of Public Health www.asaging.org\/index.cfm 420 Delaware SE Clearinghouse on Abuse and Neglect of the Elderly D-527 Mayo, MMC 197 University of Delaware Minneapolis, MN 55455 Dept. of Consumer Studies (612) 624-5171 Alison Hall West\u2013Rm. 211 FAX (612) 624-5434 Newark, DE 19716 (302) 831-3525 AGING ASSOCIATIONS AND SOCIETIES FAX (302) 831-6081 www.cane.udel.edu\/ Alzheimer\u2019s Association Disabled American Veterans www.alz.org\/ 807 Maine Avenue SW American Association of Retired Persons Washington, DC 20024 www.aarp.org\/ (202) 554-3501 www.dav.org\/about\/Default.aspx 348","RESOURCES FOR OLDER ADULTS\u2003 APPENDIX D\t 349 American Geriatrics Society JOURNALS\/PERIODICALS www.americangeriatrics.org\/ American Society on Aging Generations www.asaging.org\/ www.asaging.org\/ Gerontological Society of America Geriatric Nursing www.geron.org\/ www.sciencedirect.com\/science\/journal\/01974572 National Council on Aging The Gerontologist www.ncoa.org\/ www.geron.org\/ National Gerontological Nursing Association Journal of Gerontological Nursing www.ngna.org\/ www.slackinc.com\/jgn.htm Journals of the Gerontological Society of America GERONTOLOGY CENTERS\/EDUCATION www.gerontologyjournals.org\/ CENTERS\/INSTITUTES EDUCATIONAL RESOURCES Brookdale Center on Aging www.brookdale.org\/ American Association of Colleges of Nursing Consortium of New York Geriatric Education Centers www.aacn.nche.edu\/Education\/gercomp.htm www.nygec.org\/ GeroNet Health & Aging Resources for University of Iowa College of Nursing Evidence Based Practice Guidelines Higher Education www.nursing.uiowa.edu\/excellence\/evidence-based www.ph.ucla.edu\/sph\/geronet.html National Gerontological Nursing Association -practice-guidelines www.ngna.org\/ Hartford Institute for Geriatric Nursing INFORMATION ON EXERCISE www.hartfordign.org\/ National Association of Geriatric Education Centers American Association of Family Practitioners www.nagec.org\/ www.aafp.org\/afp\/2010\/0101\/p60.html UAMS Reynolds Institute on Aging American Heart Association http:\/\/aging.uams.edu\/ www.heart.org\/HEARTORG\/Human Kinetics\u2014 Wayne State University Institute of Gerontology www.iog.wayne.edu\/ Active Aging www.humankinetics.com\/activeaging STATISTICS AND GOVERNMENT SITES International Council on Active Aging www.icaa.cc Administration on Aging National Institute on Aging www.aoa.gov\/ www.nia.nih.gov\/health\/publication\/exercise Department of Health and Human Services -physical-activity\/introduction (CMS\/AHRQ) National Institute of Diabetes and Digestive and www.hhs.gov\/ Fastats Kidney Diseases www.cdc.gov\/nchs\/fastats\/Default.htm http:\/\/win.niddk.nih.gov\/publications\/young National Institute on Aging www.nia.nih.gov\/ _heart.htm President\u2019s Council on Fitness, Sports & Nutrition www.fitness.gov Robert Wood Johnson Foundation www.rwjf.org","References CHAPTER 1 Kronos Longevity Research Institute: KEEPS results, 2012. Centers for Medicare and Medicaid Services: Quick facts about www.keepstudy.org\/news\/index.cfm. programs for all-inclusive care for the elderly (PACE), 2011. Lunde A: Antipsychotics overused in people with Alzheim\u00ad www.medicare.gov\/Publications\/Pubs\/pdf\/11341.pdf. er\u2019s, 2012. www.mayoclinic.com\/health\/antipsychotics-and Central Intelligence Agency: Country comparison: life expec\u00ad -alzheimers\/MY02213. tancy at birth, 2014. World Factbook. https:\/\/www.cia.gov\/ library\/publications\/the-world-factbook\/rankorder\/ Mayo Clinic Staff: DHEA, 2014. http:\/\/www.mayoclinic.org\/ 2102rank.html. drugs-supplements\/dhea\/background\/hrb-20059173. Congressional Budget Office: Historical budget data\u2014February 2013, www.cbo.gov\/publication\/43904. National Digestive Diseases Information Clearinghouse: Eating, John A. Hartford Foundation: John A. Hartford Foundation diet, and nutrition for peptic ulcer disease, 2014. http:\/\/ public poll: \u201cHow does it feel? 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CHAPTER 3 National Institutes of Health [NIH]: Hormone therapy, Alzheimer\u2019s Association: 2012 Alzheimer\u2019s disease facts and 2011. www.nlm.nih.gov\/medlineplus\/ency\/article\/007111 .htm. figures. www.alz.org\/downloads\/facts_figures_2012.pdf. Alvarado J: Diabetes and your eyesight, 2011. www.glaucoma.org\/ Taylor JP, O\u2019Brien JT: Parkinson\u2019s disease with dementia, psy\u00ad chiatry of Parkinson\u2019s disease, Adv Biol Psychiatry 27:103\u2013124, glaucoma\/diabetes-and-your-eyesight.php. 2012. American Cancer Society: What are the key statistics about Yawn BP: Differential assessment and management of asthma lung cancer?, 2014a. www.cancer.org\/cancer\/lungcancer vs chronic obstructive pulmonary disease, Medscape J Med -non-smallcell\/detailedguide\/non-small-cell-lung-cancer 2009. www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC2654706\/. -key-statistics. American Cancer Society: How many people get chronic CHAPTER 4 lymphocytic leukemia?, 2014b. www.cancer.org\/cancer\/ Centers for Disease Control and Prevention [CDC]: National leukemia-chroniclymphocyticcll\/overviewguide\/leukemia -cll-overview-key-statistics. cholesterol education month, 2013a. www.cdc.gov\/features\/ American Heart Association: High blood pressure, 2013. cholesterolawareness\/. www.heart.org\/idc\/groups\/heart-public\/@wcm\/@sop\/ Centers for Disease Control and Prevention [CDC]: Study @smd\/documents\/downloadable\/ucm_319587.pdf. shows flu vaccination prevents hospitalizations in older Arthritis Foundation: Osteoarthritis, 2014. http:\/\/www.arthritis adults, 2013b. www.cdc.gov\/flu\/spotlights\/flu-vaccination .org\/arthritis-facts\/disease-center\/osteoarthritis.php. -older-adults.htm. 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Potter PA, Perry AG, Stockert PA, et\u202fal: Fundamentals of nursing, 8th ed, St. Louis, 2013, Mosby. Sollitto M: The skinny on skin problems, 2015. www.agingcare .com\/Articles\/senior-skin-problems-146550.htm. Stein PS, Henry RG: Poor oral hygiene in long-term care, Am J Nurs 109(6):44\u201350, 2009. Stotts N, Gunningberg L: Predicting pressure ulcer risk, Am J Nurs 107(11):40\u201348, 2007. Tirth A: Oral health in older adults\u2014an overlooked issue, J Gerontol Geriat Res 1(4):2012. www.omicsgroup.org\/ journals\/oral-health-in-older-adults-an-overlooked-issue -2167-7182.1000111.pdf. 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Frugal Nurse: The high cost of non-24, 2014. http:\/\/frugalnurse .com\/2014\/05\/high-cost-non24\/. Fiore K: Endo type: who really has non-24?, 2014. www .medpagetoday.com\/Endocrinology\/GeneralEndocrinology\/ 44984. Kam K: Coping with excessive sleepiness, 2010. http:\/\/www .webmd.com\/sleep-disorders\/excessive-sleepiness-10\/ sleepy-all-the-time.","Glossary A Blood urea nitrogen\u2002 A measure of the amount of urea, the end product of protein metabolism, in the blood. Absorption\u2002 As in drug absorption, the process whereby a Body image\u2002 A person\u2019s concept of his or her physical drug moves from the muscle, digestive tract, or other site of appearance. entry into the body toward the circulatory system. Body mass index\u2002 A measure of relative size based on the Abuse\u2002 Intentional or unintentional mistreatment or harm\u2014 height and mass of a person. physical, psychological, emotional, or financial\u2014of another Boredom\u2002 The state of being made weary by dullness, tedium, person. repetitiveness. Adverse drug reaction\u2002 A harmful or unpleasant reaction to a medication. C Ageism\u2002 Prejudice or discrimination against a particular age group, especially older adults. Cachexia\u2002 General ill health and malnutrition, marked by Agility\u2002 Ability to move quickly and smoothly. weakness and emaciation, usually associated with severe Agnostic\u2002 A person who neither believes nor denies the disease, such as tuberculosis or cancer. existence of god. Calorie\u2002 Unit of heat that is used to measure the available Alignment\u2002 The placing or maintaining of body structures in energy in consumed food. their proper anatomic positions. Carbohydrates\u2002 Sugars and starches that constitute the main Alopecia\u2002 Partial or complete lack of hair resulting from source of energy for all body functions, particularly brain normal aging, endocrine disorder, drug reaction, anticancer functions, and that are necessary for the metabolism of other medication, or skin disease. nutrients. Anemia\u2002 A hematologic disorder marked by a decrease in Carcinoma\u2002 Malignant epithelial neoplasm that tends to hemoglobin in the blood to abnormally low levels, caused by a invade surrounding tissue and to metastasize to distant decrease in red blood cell production, an increase in red blood regions of the body. cell destruction, or a loss of blood. Iron-deficiency anemia Cardiomegaly\u2002 Enlargement of the heart, often related to heart results from inadequate intake of dietary iron, and pernicious failure. anemia results from a deficiency in intrinsic factor secreted by Caries\u2002 As in dental caries, a tooth disease caused by the the stomach. complex interaction of food, especially starches and sugars, Anorexia\u2002 Lack or loss of appetite, resulting in the inability with the bacteria that form dental plaque; cavities. to eat. Cataract\u2002 Clouding of the lens of the eye, developing over time Antioxidants\u2002 Chemicals or other agents that retard or and resulting in progressive, painless loss of vision. inhibit oxidation of a substance to which they are added. Catastrophic reactions\u2002 Excessively emotional responses. Examples are vitamins, carotenoids, selenium, and Catheterization\u2002 Introduction of a catheter (a hollow flexible phytochemicals. tube) into a body cavity or organ to inject or remove a fluid. Anxiety\u2002 A vague, uneasy feeling, the source of which is often Cheyne-Stokes\u2002 As in respirations, an abnormal pattern of nonspecific or unknown to the individual. respirations, characterized by alternating periods of apnea and Aphasia\u2002 Abnormal neurologic condition in which language deep, rapid breathing. function is disordered or absent because of an injury to certain Chronologic age\u2002 The number of years a person has lived. areas of the cerebral cortex. May be a result of stroke. Circadian\u2002 As in circadian rhythm, a pattern based on a Apnea\u2002 An absence of spontaneous breathing or respiration. 24-hour cycle, especially the repetition of certain physiologic Arthritis\u2002 Any inflammatory condition of the joints, phenomena such as sleeping and eating. characterized by pain, swelling, heat, redness, or limitation of Cognitive\u2002 Pertaining to the mental processes of movement. comprehension, judgment, memory, and reasoning, as Aseptic\u2002 Free of living pathogenic organisms or infected contrasted with emotional processes. material. Cognitive behavioral therapy\u2002 A form of psychotherapy used Assessment\u2002 In medicine and nursing, an evaluation or to replace inaccurate or negative thoughts with more positive appraisal of a condition or the process of making such an or constructive thoughts. evaluation, including the patient\u2019s subjective report of the Cohort\u2002 Term used by demographers to describe a group of symptoms and the examiner\u2019s objective findings of data people born within a specified time period. obtained through laboratory tests, physical examination, \u2002 Complementary protein\u2002 Two or more incomplete proteins and medical history. being combined to form a complete protein. Atheist\u2002 A person who does not believe in the existence Complete protein\u2002 A protein containing all of the essential of god. amino acids necessary for the dietary needs of humans. Auscultation\u2002 A technique of assessment that uses the sense of Complicated grief\u2002 Grief that is complicated by adjustment hearing to detect sounds produced within the body, such as disorders such as depression, alcohol abuse, or post-traumatic heart, lung, and bowel sounds. stress disorder. Confrontation\u2002 A communication technique used when there B are inconsistencies in information or when verbal and nonverbal messages appear contradictory. Basal metabolic rate\u2002 Rate at which the body uses calories. Confusion\u2002 A mental state characterized by disorientation Biologic\u2002 Pertaining to organisms; biologic aging views aging regarding time, place, or person that leads to bewilderment, from a genetic perspective. 364","GLOSSARY\t 365 perplexity, lack of orderly thought, and the inability to choose Dysarthria\u2002 Difficult, poorly articulated speech, resulting from or act decisively and to perform activities of daily living. interference in the control and execution over the muscles of Constipation\u2002 Difficulty in passing stools or incomplete or speech, usually caused by neurologic damage. infrequent passage of hard stools. Dysfunctional\u2002 Unable to function normally. Coordination\u2002 Harmonious functioning of muscles or groups Dysgeusia\u2002 A distortion of the sense of taste. of muscles in the execution of movements. Dyspareunia\u2002 Discomfort during intercourse. Coping\u2002 Process by which a person deals with stress, solves Dysphagia\u2002 Difficulty swallowing. problems, and makes decisions. Dysphasia\u2002 See aphasia. Creatinine\u2002 A substance formed from the metabolism of Dyspnea\u2002 A distressful sensation of uncomfortable breathing creatine commonly found in blood. It is measured in blood that may be caused by certain heart or respiratory conditions, and urine tests as an indicator of kidney function. strenuous exercise, or anxiety. Crystallized intelligence\u2002 Knowledge that comes from past learning and prior experiences. E Cultural awareness\u2002 Knowledge of a people\u2019s history and ancestry and an appreciation for their artistic expressions, Edema\u2002 The abnormal accumulation of fluid in the interstitial foods, and celebrations. spaces of tissues, caused by increased capillary fluid pressure. Cultural competence\u2002 A set of behaviors that includes Edentulous\u2002 Lacking teeth; toothless. understanding the impact of cultural values and beliefs on Electrocardiogram (ECG)\u2002 A graphic record produced by an human experiences, while maintaining awareness of own electrocardiograph, a device for recording electrical conduction cultural values and their effect on the perception of self and through the heart. others. Electrolyte\u2002 An element or compound that, when melted or Custodial focus\u2002 As in custodial care, services and care of a dissolved in water or another solvent, dissociates into ions and nonmedical nature provided on a long-term basis, usually for is able to conduct an electric current. convalescent and chronically ill individuals. Empathy\u2002 The willingness to attempt to understand the unique world of another person; the ability to put oneself in another D person\u2019s place and to understand what he or she is feeling and thinking in various situations. Defecation\u2002 The elimination of feces from the digestive tract Enema\u2002 The introduction of a solution into the rectum for through the rectum. cleansing or therapeutic purposes. Delirium\u2002 A mental disorder characterized by disturbances in Ethical dilemmas\u2002 Questions or problems related to moral cognition, attention, memory, and perception. Symptoms values or principles. include confusion, disorientation, restlessness, clouding of Eustress\u2002 Stress that is perceived as positive; \u201cgood stress.\u201d consciousness, incoherence, fear, anxiety, and excitement. It is Excretion\u2002 As in drug excretion, the process of eliminating, also often characterized by illusions; hallucinations, usually of shedding, or getting rid of a drug by body organs or tissues as visual origin; and at times, delusions. part of natural metabolic activity. Dementia\u2002 A general term for a permanent or progressive Exudate\u2002 Fluid, cell, or other substance that has been slowly organic mental disorder, characterized by personality changes, discharged from cells or blood vessels through small pores or confusion, disorientation, and deterioration of intellectual breaks in cell membranes. functioning and by impaired control of memory, judgment, and impulses. F Demographics\u2002 The statistical study of human populations. Depression\u2002 A mental state of depressed mood characterized Fatigue\u2002 A state of exhaustion or a loss of strength or by feelings of sadness, despair, and discouragement, ranging endurance, such as that which may follow strenuous physical from normal feelings of \u201cthe blues\u201d all the way to major activity. clinical depression. Resembling the grief and mourning that Faith\u2002 Belief in God or in a set of religious doctrines. follow bereavement, the symptoms of depression include Fear\u2002 A response to a perceived threat that is consciously feelings of low self-esteem, guilt, and self-reproach; recognized as a danger. withdrawal from interpersonal contact; and somatic Fecal impaction\u2002 An accumulation of hardened feces in the symptoms, such as eating and sleep disorders. rectum or sigmoid colon that the individual is unable to move Dexterity\u2002 Skillfulness in the use of one\u2019s hands or body; the or pass. ability to perform fine, manipulative skills. Feedback\u2002 Information produced by a receiver and perceived Diarrhea\u2002 The frequent passage of loose, watery stools. by a sender that informs the sender of the receiver\u2019s reaction Dietary reference intake\u2002 Guidelines developed by the U.S. to the message. National Academy of Sciences to provide guidelines for First pass effect\u2002 The phase of drug absorption when oral estimating nutrient intake for planning and evaluating diets of medications take a first pass through the liver before entering healthy people. the systemic circulation. Distress\u2002 An emotional or physical state of pain, sorrow, Free radical\u2002 Unstable molecule produced by the body during misery, suffering, or discomfort. the normal processes of respiration and metabolism or Distribution\u2002 As in drug distribution, the pattern of following exposure to radiation and pollution. Free radicals distribution of drug molecules by various tissues after the are suspected of causing damage to the cells, DNA, and chemical enters the circulatory system. immune system. Diuretics\u2002 Drugs that promote the formation and excretion of urine. G Diurnal\u2002 Occurring daily, as sleeping and eating. Diversional\u2002 As in diversional activity, stimulation from or Gastroesophageal reflux disease\u2002 A condition in which interest or engagement in recreational or leisure activities. condition in which acidic stomach contents leak backward Diverticulosis\u2002 The presence of pouchlike herniations from the stomach into the esophagus. (diverticula) throughout the muscular layer of the colon, Geriatrics\u2002 The branch of medicine dealing with the which develop because of weaknesses in the intestinal \u2002 physiologic characteristics of aging and the diagnosis and mucosa. treatment of diseases affecting older adults. Gerontology\u2002 The study of all aspects of the aging process, including the clinical, psychologic, economic, and sociologic","366\t GLOSSARY I problems of older adults and the consequences of these Imaging\u2002 Formation of a mental picture or representation of problems for older adults and society. someone or something using the imagination. Gerontics\u2002 The nursing care and the service provided to older Immunologic\u2002 Related to the immune system. The adults. immunologic theory of aging proposes that aging is a function Gerontophobia\u2002 The fear of aging and the refusal to accept of changes in the immune system, which weakens over time to older adults into the mainstream of society. make an aging person more susceptible to disease. Geropharmacology\u2002 The study of how older adults respond to Incontinence\u2002 Inability to control urination or defecation. medication. Insomnia\u2002 Chronic inability to sleep or to remain asleep Gingivitis\u2002 Inflammation of the gingiva (gums), with throughout the night; wakefulness; sleeplessness. symptoms that may include redness, swelling, and bleeding. Inspection\u2002 The most commonly used method of physical Glaucoma\u2002 Disease characterized by increased fluid pressure assessment in which the senses of vision, smell, and hearing (intraocular pressure) within the eye that may result in are used to collect data. damage to the retina. Intelligence\u2002 The potential ability and capacity to acquire, Grief\u2002 A combination of sorrow, loss, and confusion that comes retain, and apply experience, understanding, knowledge, when someone or something of value is lost. reasoning, and judgment in coping with new experiences and in solving problems. H Intercourse\u2002 Sexual intercourse between individuals; coitus. Intermittent claudication\u2002 Cramplike pains in the calves Half-life\u2002 The amount of time required to reduce a drug level caused by poor circulation of the blood to the leg muscles, to half of its initial value. commonly associated with atherosclerosis (the tissues of the Halitosis\u2002 Offensive bad breath, resulting from poor oral lower extremities are deprived of oxygen); manifested only at hygiene, dental or oral infections, ingestion of certain foods, certain times, usually after walking; and relieved by rest. tobacco use, or some systemic diseases such as the odor of Interstitial\u2002 Pertaining to the space between cells, as in acetone in diabetes. interstitial fluid, or between organs. Health maintenance\u2002 A systemic program planned to prevent Intracellular\u2002 Pertaining to the interior of a cell, as in illness, to maintain maximal function, and to promote health. intracellular fluid, a fluid within cell membranes throughout Health promotion\u2002 Lifestyle and health care practices that most of the body, containing dissolved solutes that are improve overall health and quality of life. essential to electrolytic balance and healthy metabolism. Heatstroke\u2002 Resulting condition that occurs if heat exhaustion, Intravascular\u2002 Pertaining to the inside of a blood vessel. a gradually developing condition caused by water or sodium Ischemic\u2002 Related to a decreased supply of oxygenated blood, depletion, is not recognized and treated. as in ischemic heart disease, a pathologic condition caused by Helplessness\u2002 A feeling of a loss of control or ability, usually lack of oxygen in cells of the myocardium. after repeated failures, or of being immobilized or frozen by Isometric\u2002 As in isometric exercise, a form of active exercise in circumstances beyond one\u2019s control, with the result that one is which muscle tension is increased while pressure is applied unable to make autonomous choices. against stable resistance. Hematocrit\u2002 A measure of the packed cell volume of red blood Isotonic\u2002 As in isotonic exercise, a form of active exercise in cells, expressed as a percentage of the total blood volume. which muscles contract and cause movement. Because there is Hemianopsia\u2002 Vision loss in half of the visual field of one or no significant change in resistance throughout the movement, both eyes. the force of contraction remains constant. Hemiparesis\u2002 Muscular weakness of one side of the body. Hemiplegia\u2002 Paralysis of one side of the body. L Hemoglobin\u2002 A complex protein-iron molecule that is responsible for the transport of oxygen and carbon dioxide Laxatives\u2002 Laxative agents that promote bowel evacuation by within the bloodstream. increasing the bulk of the feces, softening the stool, or Heterogeneous\u2002 As in a heterogeneous society, a more complex lubricating the intestinal wall. one in which the members of many diverse cultures with Leukoplakia\u2002 A precancerous, slowly developing change in a different historical and cultural experiences interact. mucous membrane, characterized by white, thickened, firmly Hiatal hernia\u2002 A condition in which part of the stomach attached patches that are slightly raised and sharply pushes up through the diaphragm muscle. circumscribed. Homogeneous\u2002 As in a homogeneous society, a simple one in which all members share a common historical and cultural M experience. Hopelessness\u2002 A state in which an individual sees limited or Malnutrition\u2002 Any disorder of nutrition, resulting from an no alternatives in personal choices available and is unable to unbalanced, insufficient, or excessive diet or from impaired mobilize energy on his or her own behalf. absorption, assimilation, or use of foods. Hospice\u2002 A multidisciplinary system of family-centered care Mandated reporter\u2002 Professionals who are required by law to designed to assist the terminally ill person to be comfortable report reasonable suspicions of abuse. and to maintain a satisfactory lifestyle through the phases of Mantra\u2002 From Hinduism; a sacred verbal formula repeated in dying. prayer, meditation, or incantation, such as an invocation of a Hyperkeratosis\u2002 Overgrowth of the epithelial layer of the skin. god, a magic spell, or a syllable or portion of scripture Hyperthermia\u2002 A much higher than normal body temperature. containing mystic potentialities. Hypnotics\u2002 A class of drugs often used as sedatives. Masturbation\u2002 Sexual self-gratification; sexual activity in Hypothermia\u2002 A core body temperature of 95\u00b0 F or lower. which the penis or clitoris is stimulated, usually to orgasm, by Hypothyroidism\u2002 Reduced function of the thyroid gland. means other than intercourse. Symptoms include cold intolerance, dry skin, dry and thin Meditation\u2002 A state of consciousness in which the individual body hair, constipation, depression, and lack of energy. eliminates environmental stimuli from awareness so that the Hysterectomy\u2002 Surgical removal of the uterus to treat fibroid mind has a single focus, producing a state of relaxation and tumors, pelvic inflammatory disease, severe recurrent relief from stress. endometrial hyperplasia, uterine hemorrhage, and Memory\u2002 The mental faculty or power that enables one to precancerous and cancerous conditions of the uterus. retain and to recall, through unconscious associative processes,","GLOSSARY\t 367 previously experienced sensations, impressions, ideas, Phase advance\u2002 A shifting in circadian rhythm, causing a concepts, and all information that has been consciously person to feel sleepy earlier in the evening and to awake learned. earlier in the morning. Metabolism\u2002 As in drug metabolism, the transformation of a Pigmentation\u2002 Organic color produced in the body, such as drug by the body tissues into a metabolite as the body readies melanin. the agent for elimination. Polypharmacy\u2002 The prescription, administration, or use of Minerals\u2002 Inorganic chemical elements that are required in more medications than are clinically indicated, a common many of the body\u2019s functions. problem among older adults. Morgue\u2002 A unit of a hospital with facilities for the storage and Powerlessness\u2002 A perceived lack of control over a current autopsy of the dead. situation or problem and the person\u2019s perception that any action he or she takes will not affect the outcome of the N particular situation. Presbycusis\u2002 Hearing loss associated with aging, particularly Nasogastric\u2002 Pertaining to the nose and stomach, as in of higher-pitched sounds. nasogastric intubation, the placement of a nasogastric tube Presbyopia\u2002 Found in older people, farsightedness resulting through the nose into the stomach to relieve gastric distention from a loss of elasticity of the lens of the eye and resulting in a by removing gas, gastric secretions, or food; to instill decrease in the power of accommodation. medication, food, or fluids; or to obtain a specimen for Pressure ulcers\u2002 Inflammations, sores, or ulcers in the skin laboratory analysis. over a body prominence occurring most commonly on the Neglect\u2002 Passive form of abuse in which caregivers fail to sacrum, elbows, heels, outer ankles, inner knees, hips, provide for the needs of the person under their care. shoulder blades, and occipital bones of high-risk patients, Nocturnal\u2002 Pertaining to or occurring during the night. most often aged, debilitated, immobilized, or cachectic Nonadherence\u2002 Lack of patient compliance with providers\u2019 patients. recommendations about the daily timing, dosage, and Proactive\u2002 Creating or controlling a situation by causing frequency of medication use or other recommended health something to happen rather than responding to it after it has practices. See noncompliance. happened. Noncompliance\u2002 Failure of a patient to follow through with Prophylactic\u2002 Preventing the spread of disease. recommended health practices. Prostate-specific antigen (PSA) test\u2002 A blood test used to Nystagmus\u2002 Rapid, involuntary eye movement. measure the level of prostate-specific antigen, which may be present at elevated levels in patients with cancer or other O diseases of the prostate, and to monitor the patient\u2019s response to therapy. Objective data\u2002 Information obtained through the senses or Protein\u2002 Any of a large group of naturally occurring complex measured by instruments. organic compounds, composed of amino acids, essential for Orthodox\u2002 Adhering to the accepted and traditional or tissue repair and healing. established faith, especially in religion. Proxemics\u2002 Study of the use of personal space in Orthopnea\u2002 Dyspnea related to lying flat. communication. Orthostatic hypotension\u2002 Condition that occurs because the Pruritus\u2002 Itching; an uncomfortable sensation leading to the circulation does not respond quickly to postural changes. urge to scratch, which may result in a secondary infection. Osteoporosis\u2002 Disorder characterized by porous, brittle, fragile Pulse deficit\u2002 The absence of palpable pulse beats in a bones that are susceptible to breakage, caused by excessive peripheral artery for one or more heart beats when loss of calcium from bone combined with insufficient simultaneously compared with an apical pulse measurement. replacement. Psychosocial\u2002 Pertaining to a combination of psychological Otosclerosis\u2002 A hereditary condition of the bony labyrinth of and social factors. The psychosocial theories of aging attempt the ear in which there is formation of spongy bone, resulting to explain why older adults have different responses to the in hearing loss. aging process. P R Palliative\u2002 As in palliative treatment, therapy designed to Rapport\u2002 Atmosphere of mutual respect and understanding. relieve or reduce intensity of uncomfortable symptoms but not Reactive\u2002 Acting in response to a situation rather than creating to produce a cure, such as narcotics to relieve pain. or controlling it. Palpation\u2002 A method of physical assessment that uses the Rehabilitation\u2002 The restoration of an individual or a part to sense of touch in the fingers and hands to obtain data. normal or near normal function after a disabling disease or Parasitic\u2002 Of an organism living in or on and obtaining injury. nourishment from another organism. Rehabilitative focus\u2002 The result of high expectations and Perception\u2002 The conscious recognition and interpretation of high-level focus in planning care. sensory stimuli that serve as a basis for understanding, Relationships\u2002 Connections formed by the dynamic interaction learning, and knowing or for motivating a particular action or of individuals who play interrelated roles. reaction. Relaxation\u2002 As in relaxation therapy; treatment in which Percussion\u2002 A technique of physical assessment in which patients are taught to perform breathing and relaxation the size, position, and density of structures under the skin \u2002 exercises and to concentrate on a pleasant situation. are assessed by tapping the area and listening to the \u2002 Religious\u2002 Having belief in or reverence for God or a deity. resonance of the sound. Depending on the amount of vibration Reminiscence\u2002 Also called life review, involves allowing the (sound) heard, the presence of masses, fluid, or air can be older adult to think back and reflect on past experiences. determined. Respite\u2002 As in respite care; allows the primary caregiver to Pharmacokinetics\u2002 The study of the action of drugs within the have time away from the constant demands of caregiving, body, including the mechanisms of absorption, distribution, thereby decreasing caregiver stress and the risk for abuse. metabolism, and excretion; onset of action; duration of effect; Retention\u2002 The inability to urinate or defecate. biotransformation; and effects and routes of excretion of the metabolites of the drug.","368\t GLOSSARY Sphincter\u2002 A circular band of muscle fibers that constricts a passage or closes a natural opening in the body, such as the Ritual\u2002 Formal and observable ceremonies used to affirm faith external anal sphincter, which closes the anus, or the hepatic and sense of belonging to a spiritual community. sphincter in the muscular coat of the hepatic veins near their Role\u2002 A socially accepted behavior pattern. union with the superior vena cava. Spiritual\u2002 Of or relating to the nature of spirit; not tangible or S material. Stimuli\u2002 Things that excite or incite an organism or part to Scabies\u2002 Contagious disease caused by a mite, characterized function, become active, or respond. by intense itching of the skin and excoriation from \u2002 Stress\u2002 Any emotional, physical, social, economic, or other scratching. factor that requires a response or change. Screenings\u2002 As in health screenings, which are done to identify Subjective data\u2002 Data obtained orally. older people who are in need of further, more in-depth Sundowning\u2002 A condition in which persons with cognitive assessment. Examples are screenings for high blood pressure, impairment (e.g., people with Alzheimer disease) and older hearing problems, foot problems, and problems with activities people tend to become confused or disoriented at the end of of daily living. the day, exhibiting such behaviors as wandering, Seborrheic dermatitis\u2002 An unsightly skin disorder combativeness, suspiciousness, hallucinations, and delusions. characterized by yellow, waxy crusts that can be either dry or Supplement\u2002 As in nutritional supplement, which is added to moist, which is caused by sebum production and occurs on complete, make up for a deficiency, and extend or strengthen the scalp, eyebrows, eyelids, ears, axilla, breasts, groin, and the diet. gluteal folds. Symbol\u2002 An object, action, or other stimulus that represents Seborrheic keratosis\u2002 Skin disorder in which lesions ranging something else by conscious association, convention, or in color from light tan to black appear as slightly raised, another relationship. wartlike macules with distinct edges. Sedative\u2002 An agent that decreases functional activity, T diminishes irritability, and allays excitement. Self-esteem\u2002 The degree of worth and competence one Tachycardia\u2002 A common sign of decreased cardiac output, attributes to oneself. when the heart beats more rapidly to compensate for the Self-hypnosis\u2002 Process of putting oneself into a trancelike state decreased volume. by autosuggestion, such as concentration on a single thought Theory\u2002 An abstract statement formulated to predict, explain, or object. or describe the relationships among concepts, constructs, or Senile lentigo\u2002 Skin disorder whereby clusters of melanocytes events. form areas of deepened pigmentation; often called age spots or Thermoregulation\u2002 The ability to maintain body temperature liver spots. in a safe range, controlled by the hypothalamus. Senile purpura\u2002 Red, purple, or brown areas commonly Trace element\u2002 An element essential to nutrition or physiologic seen on the legs and arms, resulting from hemorrhaging \u2002 processes, found in such minute quantities that analysis yields as the walls of the capillaries become increasingly fragile \u2002 the presence of only trace amounts. with age. Sexual dysfunction\u2002 A persistent impairment of a person\u2019s V usual pattern of sexual functioning. Sexuality\u2002 The sum of the physical, functional, and Vitamins\u2002 Organic compounds found naturally in foods or psychological attributes that are expressed by one\u2019s gender produced synthetically. identity and sexual behavior, regardless of the relationship to the sex organs or to procreation. X Shearing forces\u2002 Applied forces that causes a downward and forward pressure on the tissues beneath the skin. Xerosis\u2002 Dry skin caused by a decrease in the function of Social isolation\u2002 A condition in which a feeling of aloneness is sebaceous and sweat gland secretion. experienced, which the person acknowledges as a negative or Xerostomia\u2002 Dryness of the mouth caused by cessation of threatening state imposed by others. normal salivary secretion.","Index Page numbers followed by \u201cf\u201d indicate figures, \u201ct\u201d indicate tables, and \u201cb\u201d indicate boxes. A Age discrimination, 5\u20136 Alzheimer disease (Continued) Age spots, 32\u201333 AARP. see American Association of Ageism, 4\u20135, 202 assistive sensory devices, 189 Retired Persons (AARP) Age-related macular degeneration, facts about, 187b nursing process for, 183f Abandonment, 23 63\u201364 stages of, 188b Abdominal aortic aneurysm, 47 Aggregate income, 9, 10f Ambulation, assistance during, Absorption, drug, 131 Agility, 306 Abuse, 21\u201324, 23b Aging 313\u2013314, 314f American Association of Retired responses to, 23\u201324 activity and, 306\u2013308 by unrelated caregivers, 24\u201325, 25b alternative and complementary Persons (AARP), 11, 11b Acceptance American Indians in communication, 93\u201394 therapies to slow or reverse, of death and dying, 259 28b death in, 251 Accessibility, and health promotion attitudes toward, 3\u20136, 3b and spirituality, 236\u2013237 current knowledge about, 3b American Seniors Association (ASA), and maintenance, 80 economics of, 9\u201312 Accessory muscles, with oxygenation fear of, 4 11, 11b historical perspective on study of, Amino acids, 104 problems, 318 1\u20132 Anemia, 49 Accidents. see Safety problems nutrition and, 102\u2013110 Accommodation, 61 perceptions of, 79, 202\u2013203 due to vitamin B12 deficiency, 106 Acetylcholine, 55 process of, 2 iron-deficiency, 108 \u201cActing out\u201d behavior, with disturbed sexuality and, 261\u2013266 pernicious, 108 theories of, 27\u201329 Aneurysm, 47 thought processes, 191, 191b values about, 3b Anger, related to death and dying, Active listening, 94 Aging family members, impact of, Active range-of-motion exercises, 316 18\u201325, 19b, 19f 259 Activities department for deficient Aging population Angina pectoris, 45 categorization of, 2\u20133, 2t Anginal pain, with oxygenation diversional activities, 325 demographics of, 6\u20139, 7f, 8b Activities of daily living, with scope of, 6, 7f problems, 319 Air exchange, 40 Anorexia, during dying, 255 disturbed thought processes, Air sacs, 40 Anterior cavity, 61 190\u2013191, 191f Air-fluidized surfaces, 279t Antianxiety agents, 138t Activity(ies), 305\u2013330 Albumin, 47\u201348, 108t Antidepressants, 138t and aging, 306\u2013308 Alcohol, and sexual function, 263 Antidiuretic hormone, 66 for deficient diversional activities, Alcohol consumption, for health Antihypertensive, 138t promotion and maintenance, 75 Antiinfectives, 138t 325 Alcoholism, and nutrition, 111 Antioxidant(s), 28 effects of disease processes on, Alcohol-related problems, 284 Antioxidant therapy, for aging, 28 in older adults, 230b, 230f Antioxidant vitamins, 106 308\u2013309 Alignment, 310 Antipsychotics, 138t negative attitudes about, 327\u2013328 Allergic dermatitis, 35, 35f Antiulcer medications, 138t normal patterns of, 305\u2013306 Alopecia, 272\u2013275 Anxiety, 208\u2013209 pacing of, 306 Alternative and complementary positive attitudes about, 328\u2013330 therapies. see Complementary and about dying, 253 voluntary, 306 alternative therapies nursing process for, 208\u2013209, 209f Activity intolerance, 315\u2013317, 315b Aluminum hydroxide, 138t and sleep disorders, 333 Activity theory, 29 Alveoli, 40 Aorta, 43 Address in communication, 93 Alzheimer disease, 58\u201359, 58b, 58f Aphasia, 91\u201392, 95, 181, 193, 194t Adenosine triphosphate (ATP), 37 and activity, 308 Apical pulse, 154 Adipose tissue, 32 alternative treatment for, 59 Apnea, sleep, 334\u2013335 Adrenal cortex, 66\u201367 Appetite changes, assessment of, 115 Adrenal glands, 66\u201367 Aqueous humor, 61 Adrenal medulla, 66\u201367 Arcus senilis, 62, 62f Advance directives, 18, 18b, 247 Areolar connective tissue, 32 Aerobic exercise, 37, 307 Arteries, 43 African Americans, and spirituality, Arthritis, and activity, 308 236 369","370\t INDEX Artificial saliva for impaired mucous Bile pigment, 48 Captopril, 138t membranes, 288 Bilirubin, 48 Carbohydrates, 104 Biocultural differences, 78b Carcinogenic agents, 43 ASA. see American Seniors Association Biofeedback, for stress reduction, Cardiac arrhythmias, 45 (ASA) Cardiac muscle, 36, 43 228\u2013229 Cardiac output, risk factors related to Ascending colon, 50\u201351 Biologic theories, of aging, 27\u201329 Aseptic technique for wound Bisexual, older people, 264 decreased, 318b Bladder, 53 Cardiac sphincter, 50 cleansing, 279\u2013280 Bleeding, 162t\u2013163t Cardiomegaly, 46 Asians, roles and relationships of, Blepharitis, 63 Cardiovascular changes, at end-of-life, Blood, 47\u201348 214b Blood glucose level, 115 255 Aspiration pneumonia, 42 Blood pressure (BP), 155\u2013156 Cardiovascular signs of stress, 226t Aspiration risk, nursing process for, Cardiovascular system, 43\u201347 with activity intolerance, 316\u2013317 126\u2013127, 126b Blood tests, 75 assessment of, 156t\u2013158t Aspirin, 138t Blood urea nitrogen, 54, 108t common disorders seen with aging Assertiveness, 210f Blood vessels, 43\u201344 Asset income, 10 Body fluids, 120 in, 45\u201347 Assisted-living centers, 13\u201314, 14f Body image, nursing process for expected age-related changes in, Assistive devices, 79 disturbed, 204\u2013205 44\u201345, 44t for imbalanced nutrition, 119 Body language, 91 CARE acronym for medication for impaired physical mobility, 313, Body mass index (BMI), 103, 103f Body temperature, 154 assessment, 137b 313f Bones, 35\u201336 Care area assessments (CAAs), 160 for injury prevention, 167, 174, Boredom, and sleep disorders, 338 Care area triggers (CATs), 160 Bowel elimination, 292 Caregiver(s) 175f Bowel incontinence, 296 for self-care deficits, 322 paid, 81, 82b for tooth brushing, 287, 287f nursing process for, 296\u2013299 unpaid, 80\u201381, 81b Asthma, 41 Braden scale, 274t\u2013275t Caregiver choices, 4b Astigmatism, 62 Breast cancer, 71 Caregivers, 19, 19b Atrioventricular node, 44 Breastbone, 43 Caries, 282\u2013283, 283f Atrophic vaginitis, 262 Breathing, sleep disordered, 334\u2013335 Cartilage, 36 Attitudes Broca area, 56 Cataracts, 63, 180\u2013181, 181f about death, 247\u2013248, 248b Broca\u2019s aphasia, 193\u2013194, 194t Catastrophic reactions, 188 maintaining healthy, 77, 77f Broca\u2019s area, 192\u2013193 Catheterization Auditory changes, 180\u2013181 Bronchioles, 40 for urinary incontinence, 297\u2013299, Auscultation, 153 Bronchodilators, 138t Automobile accidents, 165 Bronchogenic cancer, 43 303f Avoidance, 228 Brushes, long-handled, 324f for urinary retention, 297 Axillary temperature, 154 Buddhism, death in, 251\u2013252 Cell body, 55 Axon, 55 Bulk laxatives, 293t Cellular theories, 28 Bumetanide, 138t Central deafness, 65 B Bundle of His, 44 Central nervous system, 55\u201356 Bureau of the Census, 6 Cephalosporins, 138t B lymphocytes, 48 Burn prevention, 169 Cerebellum, 56 Baby Boomers, 8, 171b, 216, 216b, Burning mouth syndrome, 65 Cerebrovascular accident (CVA), Bursa, 36 333 Bursitis, 39 59\u201360 Bacterial pneumonia, 42 Button hook, 323f Cerebrum, 56 Bad news, delivering, 98 Chest pain, 162t\u2013163t Balance training, 307 C Chewing difficulties, and nutrition, Ball and socket joint, 36f Bargaining, related to death and Cachexia, during dying, 255 111, 119 Calcitonin, 36 Chewing gum for impaired mucous dying, 259 Calcium, 107\u2013108, 108t Basal cell carcinoma, 33\u201334 Call signal for injury prevention, membranes, 288 Basal metabolic rate, 103 Cheyne-Stokes respiration, 255 Bathing, reducing frequency of, 277 174 Chlorpromazine, 138t Beds to reduce pressure, 279 Caloric intake, 102\u2013103 Choices and powerlessness, 211 Beliefs, 235\u2013244 Calorie(s), 102\u2013103 Choroid, 61 Calorie-restricted diet, for aging, 28 Christianity, death in, 251 about death, 247\u2013248, 248b Candidiasis, oral, 284 Chronic atrophic gastritis, 52 cultural competence related to, Canines, 50 Chronic bronchitis, 41 Cap(s), uniform, 90 Chronic health factors and nutrition, 237b Capillary refill time, 318 of older adults, 238\u2013241 110, 110f risk factors related to problems Chronic lymphocytic leukemia, 49 Chronic obstructive pulmonary with, 241b spiritual, 239\u2013241 disease, 41\u201343 values and, 235\u2013244 Chronic renal failure, 55 Bereavement, 259 Chronologic age, 2 Bile, 50","INDEX\t 371 Chyme, 50 Communication (Continued) Coping, 224\u2013232 Ciliary body, 61 skills and techniques of, 97\u2013101 normal, 224\u2013229 Cimetidine, 138t styles of, 89b nursing process for ineffective, Circadian rhythm, 331 technology to enhance, 207b 229\u2013231, 230f Claudication, intermittent, with time and timing of, 92\u201393 strategies for, 228\u2013229 with visitors and families, 97\u201398 oxygenation problems, 319 \u201cyou\u201d messages in, 94b Coping mechanism for stress, 228, Cleaning carts, locking of, 175, 175b 228b Clinker theory, 28 Community resources for disturbed Clonidine, 138t thought processes, 192 Cornea, 61 Clothing, for exercise, 310, 315 Coronary arteries, 44 Clutter, as hazard, 169, 175\u2013176 Community-based residential facility Coronary artery disease, 45 Cochlea, 64 (CBRF), 14f, 15 Coronary valve disease, 45 Cognition, 180\u2013199, 186b, 192b Cortisol, 67, 332 Complementary and alternative Coughing, effective, 318 defined, 180 therapies, 229b Crackles, 156t\u2013158t and intelligence, 181 Creams, 277 and language, 181\u2013182, 182f geriatric massage as, 229b Creatinine, 108t and perception, 186b light therapy as, 190b Cross-cultural misunderstandings, 215 risk factors related to, 183b music therapy as, 176b, 190b Crosslink theory, 28 Cognitive changes for postmenopausal discomforts, Crown of tooth, 50 at end of life, 257 Crow\u2019s feet, 33 and health promotion and 262b Cruise Care, 13b prayer as, 240b Crushed medication, 141 maintenance, 79\u201380 Qi gong and tai chi as, 307b\u2013308b Crystallized intelligence, 181 Cognitive development, 181 for stress reduction, 229b Cultural beliefs, for health promotion Cognitive functioning, normal, Complementary proteins, 105\u2013106 and maintenance, 78, 78f 180\u2013182 Complete proteins, 105\u2013106 Cultural bias, prevention of, 92b Cognitive impairment, nursing Complex carbohydrates, 104 Cultural considerations, 78b Compressed O2 cylinders, 320 process for, 187\u2013188, 188b Concentrator, 320 and role of family, 4b Cognitive signs of stress, 226\u2013227 Condition change, assessment of, Cultural perspectives, on end-of-life, Cohort, 8 Collagen, 32 161\u2013162 251 Colon cancer, 53 Conduction system, 44 Cultural values, 238\u2013239 Combs, long-handled, 324f Conductive hearing loss, 65 Culture, assessment and, 150b Comfort measures, for pain, 197 Condyloid joint, 36f \u201cCulture shock,\u201d 239 Communication, 88\u2013101, 89b, 94b Cones, 61 Cushions to reduce pressure, 279 Confrontation, 97 Custodial care, 15 about death, 251 Confusion, 185\u2013186 Custodial focus, 327 acceptance, dignity, and respect in, Cutaneous papilloma, 32\u201333 acute, 186 Cyanosis, for oxygenation problems, 93\u201394 chronic, 185\u2013192, 193b address in, 93 general approaches for, 189b 318 barriers to, 94\u201397 idiopathic, 186\u2013187 clinical situation, 101b Congestive heart failure, 45\u201346 D critical thinking, 96b\u201398b Conjunctiva, 61 cultural considerations, 89b\u201390b, Connective tissue theory, 28 Dark adaptation, 62 Constipation, 162t\u2013163t, 290\u2013291 Data, 149 92b, 96b assessment of, 291\u2013292 Deafness, 65 cultural differences, 96\u201397 criteria for, 290b Death, 257\u2013258 with disturbed sensory perception, defined, 290 in dying person, 256 attitudes toward, 246\u2013247 183\u2013184 fiber and, 290 bereavement after, 259 effective, 88 fluids and, 292 causes of, 246b empathy in, 93 new medications for, 293b communication about, 251 at end of life, 249\u2013251 nursing care plan for, 295b funeral arrangements after, 258\u2013259 formal or therapeutic, 89 nursing process for, 291\u2013294 \u201cgood,\u201d 248, 248b informal or social, 88\u201390 peristalsis and, 290 indicators of imminent, 258 for information sharing (framing the positioning and, 291\u2013293 personal beliefs and attitudes about, risk factors related to, 292b message), 88\u201389 urge to defecate and, 291 248b listening in, 94 when it may be more than, 291b recognizing imminent, 258 misunderstanding of medical Contact dermatitis, 35, 35f stages of, K\u00fcbler-Ross, 259b Continuity, for disturbed thought values clarification related to, jargon, 89 nonverbal, 89\u201393, 90b, 90f processes, 190 247\u2013248, 247b between older adult and physician, Control and self-esteem, 201b where people die, 249 Controlling focus, 327\u2013328 Defecate, urge to, and constipation, 291 99 Cool-down exercise, 315 Defecation with older adults, 89t Coordination, 306 and aging, 289 pace or speed of, 92 normal patterns of, 289 with physicians, 99\u2013100, 99b and self-esteem, 207","372\t INDEX Developmental stages, 29 Dry mouth Developmental theories, 29 with aging, 283\u2013284 Defense mechanisms for stress, 228b Dexterity, 306 of dying person, 256 Degenerative joint disease, 38\u201340 Diabetes mellitus, 68\u201369 Dehydration, 120, 162t\u2013163t Diabetic retinopathy, 63\u201364 Dry skin, 270\u2013271, 271f Delirium, 162t\u2013163t Diagnosis-related group (DRG) Duodenal ulcers, 52, 52b Duodenum, 50 acute, 186 system, 15\u201316 Duration, of sound, 153 causes of, 186 Diaphragm, 40 Dying defined, 186 Diarrhea, 162t\u2013163t, 294 in dying person, 257 amount and type of intervention, mnemonic assessment for, 186, 186t defined, 294 252 nursing interventions for, 187t in dying person, 256\u2013257 vs. dementia, 187t nursing process for, 294\u2013296 cardiovascular changes during, 255 Dementia, 57\u201358 Diazepam, 138t cognition changes during, 257 advanced, 188 Diet. see also Nutrition communication during, 249\u2013251 as barrier to communication, 95\u201396 and constipation, 290 cultural perspectives on, 251 chronic irreversible, 187\u2013188 for health promotion and decision-making process, 251\u2013252 critical thinking on, 188b depression, anxiety, and fear related delirium vs., 187t maintenance, 74 early stages of, 188 Dietary record, for imbalanced to, 253 general approaches for dealing fatigue and sleepiness, 255 nutrition, 117 gastrointestinal changes during, with, 189b Dietary Reference Intakes (DRIs), 104, incidence of, 188 255\u2013257 nursing interventions for, 187t 105f integumentary changes during, 257 pacing with, 189 Dietary restrictions, religious, 112 Maslow\u2019s hierarchy of needs, 248f physical activity with, 189 Dietitians, 117, 125, 127 pain during, 253\u2013255, 254f pseudo-, 185 Difficult conversations, 98\u201399 respiratory changes during, 255 risk of injury and personal neglect Digestion problems, 111 sensory changes during, 257 Digestive juice, 50 significance of pain and suffering with, 188 Digital rectal examination for and sleep disorders, 333 during, 252 types of, 186b constipation, 291 spiritual needs during, 252\u2013253, wandering with, 188 Dementia with Lewy bodies (DLB), Dignity in communication, 93\u201394 252b Digoxin, 138t stages of, K\u00fcbler-Ross, 259b 57\u201358 Diplopia, 63 urinary changes during, 257 Demographic changes affecting family, Direct questioning, 97 Dysarthria, 192 Discharge planning, nutrition in, 116 Dyspareunia, 262 19b, 19f, 19t Disengagement theory, 29 Dysphagia, 193 Demographics, 6\u20139, 7f, 8b Distance, in nonverbal Dysphasia, 193 Dendrites, 55 Dyspnea, 318 Denial of death and dying, 259 communication, 91 during dying, 255 Dental care, 282 Distress, 224 Dental caries, 51, 282\u2013283, 283f Diuretics, 138t E Dental examinations, 76\u201377 Diurnal rhythm, 331 Dental hygiene, 286 Diversional activity deficient Ear(s), 64\u201365 Dental hygienist, referral to, 285 assessment of, 156t\u2013158t Dentures, 283 nursing process for, 323\u2013327, 326f common disorders seen with aging risk factors related to, 325b in, 64\u201365 dental examinations with, 77 Diverticulitis, 52\u201353 expected age-related changes in, 64, and dysphagia, 124 Diverticulosis, 52\u201353 64t learning to use, 77 \u201cDo Not Use\u201d list of abbreviations, poor fit of, 77 Eardrum, 64 Depression, 162t\u2013163t, 226 140t Early retirement, 10 about dying, 253 Documentation, 142 Eating device, 324f and aging, 203 Donne, John, 245 Eccrine glands, 32 goals of treatment for, 227b \u201cDonut hole,\u201d in prescription Economic risk factors for malnutrition, incidence of, 203 and nutrition, 111 coverage, 16 111 related to death and dying, 259 Door knob turner, 323f Economic values, 238 and risk of suicide, 209 Doppler, 155 Economic well-being, 12 signs of, 203 Driving by elderly, 171, 171b Economics of aging, 9\u201312, 12b and sleep disorders, 333 Drug absorption, 131 Edema, 120, 162t\u2013163t symptoms of, 227b Drug distribution, 131\u2013132 Educational status, 8\u20139 Depth perception, 61 Drug excretion, 132 Effluent, 51 Dermis, 32 Drug metabolism, 132 Ego integrity, 202 Descending colon, 50\u201351 Drug-induced skin reactions, 271f Elder abuse, 21, 24b Despair, 202 Drug-testing methods, risks related to, Elder Hostel, 327 Detrusor spasms, 298 Elderspeak, 93\u201394 130\u2013131 Electric safety, 169 Dry age-related macular degeneration, Electrolyte imbalances, 115 63 Dry lips, 286","INDEX\t 373 Elimination, 289\u2013303 Environmental modification Fall(s) (Continued) and aging, 289\u2013291 (Continued) normal patterns of, 289 specific strategies to, 167\u2013169 for injury prevention, 175 tools to assess for, 167, 168t Embolus, 47 for malnutrition, 118 Family(ies) Emesis, 162t\u2013163t for powerlessness, 211 abuse or neglect by, 21\u201324 Emollients, 277 for self-care deficits, 322 as caregivers, 80\u201381 Emotional abuse, 22 Epicardium, 43 communication with, 97\u201398 Emotional disorders, and activity, 309 Epidermis, 32 cultural considerations and role of, Empathetic listening, 94 Epiglottis, 40 Empathy, 93 Erectile dysfunction, 262\u2013263 4b Emphysema, 41 Erikson\u2019s theory, 29 demographic changes affecting, 19b, Enamel, 50 Error theory, 28 End-of-life care, 245\u2013259 Erythrocytes, 48 19f, 19t Esophageal dilation, 51 of elder with disturbed thought advance directives for, 247 Esophagus, 50 caregiver attitudes toward, 247 Essential hypertension, 47 processes, 191 collaborative assessment and Ethnic disparity, 6\u20138 impact of aging members on, 18\u201325 Eustachian tube, 64 separation from, 203 interventions for, 249 Exercise(s), 305\u2013330 Family home, 13 communication, 249\u2013251 aerobic, 307 Family process, nursing process for costs and, 17, 17b benefits of, 314, 314b cultural considerations in, clothing and footwear for, 310, 315 interrupted, 220\u2013221 for health promotion and FANCAPES mnemonic, for condition 251b\u2013252b cultural perspectives, 251 maintenance, 74, 74f change, 162, 162t\u2013163t decision-making process, 251\u2013252 isometric, 310 Fasting glucose, 108t delegation and supervision of, 258b isotonic, 310 Fat(s), 106 ethical dilemmas related to, normal patterns of, 305\u2013306 Fat-soluble vitamins, 106 for older adults, 306\u2013308 Fatigue 247\u2013248, 248b Qi gong and tai chi as, 307b\u2013308b pain, 253\u2013255, 254f range-of-motion, 310 during dying, 255 palliative care, 249 schedule for, 314\u2013315, 314f and sleep disorders, 338 patients\u2019 wishes related to, 248b and sleep disorders, 338 Fear(s), 207\u2013208 physiologic changes, assessments, stretching, 307 of dying, 253 trapeze bar for, 310, 313f Fecal impaction, 291 and intervention, 253\u2013257 warm-up and cool-down, 315 Fecal incontinence, 296 psychosocial perspectives, Exhalation, 40 Fecal softeners, 293t Expiration, 40 Feedback, 200 assessments, and interventions, Expressive aphasia, 193\u2013194 Feet, 75, 275, 275f 251\u2013253 External physical threats, 224 Female reproductive organs, 70 religious practices regarding, External risk factors, for accidents or Fiber, 290 251b\u2013252b Fibrinogen, 47\u201348 sedation in, 255 injuries, 169\u2013174 Fibrous pericardium, 43 spiritual considerations in, 252\u2013253 External social threats, 224 Fight-or-flight response, 224\u2013226 values clarification related to, External standards and self-esteem, 200 Finances, and health promotion and 247\u2013248, 247b External urethral sphincter, 53 End-of-life planning, attitudes toward, Extracellular fluid (ECF), 120 maintenance, 80 246\u2013247 Financial abuse, 22\u201323 Endocardial tissue, 43 Exudate, 277 Fire hazards, 169\u2013170 Endocrine system, 66\u201369 Eye contact, 92, 93f First pass effect, 131 common disorders seen with aging Eyeglasses, verifying functionality of, Floaters, 63 in, 68\u201369 Flu, 41\u201342 expected age-related changes in, 184 Fluid, 48 67\u201368, 67t Eyelids, 61 Fluid balance, 102\u2013127 Endothelial tissue of heart, 43 Eyes, 61\u201364 Fluid intake, 177 Endothelium, 43 Enema use in constipation, 290 assessment of, 156t\u2013158t and constipation, 294 Energy conservation, 317 common disorders seen with aging decreasing, 123\u2013124 Energy expenditure, 305 for diarrhea, 294 Environmental hazards, 169 in, 63\u201364 maintaining adequate, 120 fire hazards as, 169\u2013170 expected age-related changes in, monitoring of, 123 home security as, 170, 170b for oxygenation problems, 319\u2013320 prevention of, 169, 169b 61\u201363, 62t and sleep disorders, 338 thermal hazards as, 172\u2013174 and urinary incontinence, 297\u2013299 vehicular accidents as, 170\u2013172 F Fluid intelligence, 181 Environmental modification Fluid restriction, 120 for activity intolerance, 317 Face, assessment of, 156t\u2013158t Fluid volume for disturbed sensory perception, 184 Facial expressions, 92 risk of deficient, 121, 121b at home, 185 Fall(s), 162t\u2013163t, 166, 167b risk of excess, 121\u2013122, 121b risk of imbalanced, 120\u2013124, 121b cultural considerations in, 169b Flurazepam, 138t prevention, 167, 168b\u2013169b","374\t INDEX Geriatric nursing, introduction to, 1\u20132 Health care setting, abusive behaviors Gerontic nursing, defined, 2 in, 25b Foam overlay surfaces, 279t Gerontics, defined, 2 Folic acid, 108t Gerontology, defined, 2 Health history, 151, 152b Folic acid-deficiency anemia, 49 Gerontophobia, 4\u20136, 5b Health promotion and maintenance, Food cost, and nutrition, 111 Geropharmacology, 130\u2013131 Food intake, 177 Gestures, in communication, 91\u201392 73\u201386, 74b Food likes and dislikes, for Gingiva, 50 factors affecting, 77\u201380 Gingivitis, 283 nursing process for ineffective, imbalanced nutrition, 117 Glaucoma, 63 Food variety, and nutrition, 111 Gliding joint, 36f 82\u201384, 84b Foot. see Feet Global aphasia, 194 recommended health practices for, Foot care, 280 Globulins, 47\u201348 Foot problems, 276 Glomerular filtration rate, 54 74\u201377 Glucose, fasting, 108t Health screening, 148, 149t and activity, 308 Glucose level, blood, 115 Hearing aids, 184, 184f Footwear, for exercise, 310, 315 Gonadotropic hormones, 66 Hearing changes, and safety problems, Formal communication, 89 Gout, and activity, 308 Fractures, and activity, 308 Gouty arthritis, 39\u201340 165 Frailty syndrome, 110 Government-subsidized housing, 14 Hearing examinations, 75 Framing the message, 88\u201389 Grandparenting, 216\u2013217, 217f Hearing impairment Free radical theory of aging, 28 Grief, 217 Frequency, of sound, 153 Grief reactions, normal, 218b as barrier to communication, 94\u201395, Friction rub, 156t\u2013158t Grieving 95b, 95f Friends, loss of, 217 Frontal lobe, 56 nursing process for complicated, communication with, 184 Fulmer SPICES, for condition change, 217\u2013219 nursing interventions in home for, 161\u2013162, 161b\u2013162b phases of, 218t 185 Functional foods, 109 Grip assistance, in injury prevention, special devices for, 185 Functional incontinence, 298\u2013299, 299t Hearing loss, 182b Funeral arrangements, 258\u2013259 169 Heart, 43 Fungal infections of nails, 276 Grip bars, in bathtub, 324f Heart block, 45 Furosemide, 138t Group-housing plans, 14\u201315 Heart failure, 45\u201346, 46b Growth hormone, 66 Heat exhaustion, 174 G Heatstroke, 174 and sleep, 332 Heberden nodes, 38\u201339 Gag reflex, 51 Gurgles, 156t\u2013158t Helicobacter pylori, 52 Gait, 75 Helper T cells, 48 Gait belts, 313\u2013314, 314f H Helplessness, 201 Gas exchange problem. see Hematocrit, 108t Hair Hematopoietic system, 47\u201349 Oxygenation problems age-related changes in, 269\u2013276, 270t common disorders seen with aging Gastric juice, 50 amount, distribution, appearance, Gastric ulcer, 52, 52b and consistency of, 272\u2013276 in, 49 Gastritis, 52 assessment of, 156t\u2013158t, 269\u2013270 expected age-related changes in, Gastroesophageal reflux disease risk factors for alterations in, 276b 48\u201349, 49t (GERD), 52 Half-life, 131\u2013132 Heme, 48 Gastrointestinal changes, at end-of- Halitosis, 283 Hemianopsia, 184, 184f Haloperidol, 138t Hemiparesis, 310 life, 255\u2013257 Handrails, in injury prevention, 169, Hemiplegia, 310 Gastrointestinal signs of stress, 226t Hemoglobin, 108t, 115 Gastrointestinal system, 49\u201353 175f, 176 Hemorrhagic stroke, 60 Hard candy for impaired mucous Hemorrhoids, 53 assessment of, 156t\u2013158t Hepatitis-B immunization, 75\u201376 common disorders seen with aging membranes, 288 Herpes zoster infection, 75\u201376 Havighurst\u2019s theory, 29 Heterogeneous society, 215 in, 51\u201353 Health assessment, of older adults, Hiatal hernia, 51\u201352, 52f expected age-related changes in, 51, High-density lipoproteins (HDLs), 106 148\u2013162 Hinduism, death in, 251\u2013252 51t Health care agent, 18 Hinge joint, 36f Gay, older people, 264 Health care cost, 16 Hobbies, for deficient diversional Gender disparity, 6\u20138 Health care directives for nonrelated Gene theory, 27 activities, 325 General adaptation syndrome, 224 caregivers, 265b Home care, and nutrition, 116, General inspection, 153 Health care provisions, 15\u201318 Genitourinary system. see also 118f\u2013119f advance directives and POLST as, Home health, 80\u201382 Reproductive system; Urinary 18, 18b Home health agency, selection of, 81, system assessment of, 156t\u2013158t costs and end-of-life care in, 17, 17b 82b Geographic distribution of older adult Medicare and Medicaid, 15\u201316 Home oxygen systems, 320\u2013321, 320b population, 8, 9f rising costs and legislative activity Home remedies, 78, 78f Geriatric, defined, 2 Home security, 170 Geriatric massage, 229b on, 16\u201317, 17f Home services, types of, 81\u201382","INDEX\t 375 Homemaker, role of, 216 Insomnia, 333\u2013334 K Homogeneous society, 215 medication that cause, 335t Hopelessness, 209 treatment of, 333\u2013334, 334b, 334t Kegel exercises, 300b Hormone therapy, for aging, 28 Keratinized cells, 32 Hormones, 66 Inspection, 152\u2013153 Ketoacidosis, 68\u201369 Hospice care, 249, 249f Inspiration, 40 Ketones, 68\u201369 Hospital insurance, 15\u201316 Intake and output (I&O) Kidneys, 53 Housing arrangements, 12\u201315, 13b, Kinetic surfaces, 279t measurement, 122 Knowledge and health promotion and 14f Integumentary changes, at end-of-life, Human growth hormone therapy, 68b maintenance, 78\u201379 Hydralazine, 138t 257 K\u00fcbler-Ross stages of grief, 259b Hypercalcemia, 107\u2013108 Integumentary system, 32\u201335 Kussmaul respirations, 68\u201369 Hyperkeratosis, 275\u2013276 Kyphosis, 37\u201338 Hyperopia, 62 common disorders seen with aging Hypertensive disease, 47 in, 33\u201335 L Hyperthermia, 172b, 173 expected age-related changes, 32\u201333, Lacrimal glands, 61 nursing process for, 177\u2013178 33t Language, 192 prevention of, 178 symptoms of, 173 Intelligence, 181 cognition and, 181\u2013182 Hypnotics, for sleep disorders, Intelligence quotients (IQs), 181 Large intestine, 50\u201351 Intelligence tests, 181 Larynx, 40 333\u2013334, 338 Intensity, of sound, 153 Latinos, and spirituality, 236 Hypoglycemia, 69 Intentional abuse, 21 Laxatives, 293t Hypothalamus, 56 Intentional isolation, 220 Learning, 181 Hypothermia, 35, 172\u2013173, 172b Intercostal muscles, 40 Left atrium, 43 Intercourse, 261 Left brain hemisphere damage, 60b nursing process for, 177\u2013178 Interests for deficient diversional Left ventricle, 43 prevention of, 178 Legal blindness, 62 signs of, 173b activities, 325 Legislation and economics of aging, Hypothyroidism, 69 Intermediate care, 15 Hysterectomy, 263 Intermittent claudication, 46, 319 11, 11t Internal risk factors, for accidents or Legislative activity, 16\u201317 I Lens, 61 injuries, 165\u2013169, 166b Lesbian, gay, bisexual, and Ibuprofen, 138t Internal sphincter, 53 Ideal, 200\u2013201 Internal threats, 224 transgendered (LGBT), older Identification bracelet and medication Internal values, and self-esteem, 200 people, 264 Interpersonal values, 238 Leukemia, 49 administration, 139f, 141 Interpreter, 96 Leukocytes, 48 Ileocecal, 50 Interstitial fluids, 120 Leukoplakia, 284, 284f Ileum, 50 Intervertebral disks, 36 Levy, Becca, 5 Illness, atypical presentation of, 152t Interview, structuring the, 151 Life expectancy, 6, 7f Imaging for stress reduction, 230\u2013231 Intracellular fluid, 120 gender and ethnic disparity in, 7 Immunity, 48 Intravascular fluids, 120 Life review, and self-esteem, 206 Immunization, 75\u201376 Intruders, 170 Life-contract facilities, 13\u201314 Immunologic theory, of aging, 28\u201329 Involuntary muscle, 36 Life-course theories, 29 Incisors, 50 I&O (intake and output), 122 Life-lease facilities, 13\u201314 Income, 9\u201312, 10f Iris, 61 Ligaments, 36 Incontinence, 289 Iron (Fe), in diet, 108, 108t Lipofuscin in free radical theory of Incontinence garments, 302, 302f Iron-deficiency anemia, 49, 108 aging, 28 Incontinence pads, 302, 302f Ischemic heart disease, 45 Lipoproteins, 106 Independence, loss of, 20, 217 Ischemic stroke, 60 Liquid oxygen systems, 320 Independent-living centers, 13\u201314 Islam, death in, 251 Listening, 94 Infection(s) Islamic spirituality, 236, 242f Liver spots, 32\u201333 Isometric exercises, 37, 310 Living will, 18 changes in integumentary system Isotonic exercises, 37, 310 Loneliness, and nutrition, 111 and, 34\u201335 Loss(es), 202 J Lotions, 277, 277b urinary tract, 297 Low-air loss surfaces, 279t Inflammation, changes in Jaw pain, 283b Low-density lipoproteins (LDLs), 106 Jejunum, 50 Lower respiratory tract, 40 integumentary system and, 34\u201335 Jewish people, spirituality of, Lung cancer, 43 Influenza, 41\u201342 Lymph system, 48 Influenza vaccine, 75 236b\u2013237b Lymph vessels, 48 Informal communication, 88\u201390 Joint(s), 36, 75 Lymphatic system, 47\u201349 Information sharing, 88\u201389 Joint replacement surgery, and common disorders seen with aging Informing, 97 Inhalation, 40 activity, 308 in, 49 Inhalation drugs, 142 Judaism Injury prevention, in home, 169, 169b death in, 251 spirituality in, 240f Jung\u2019s theory, 29","376\t INDEX Medication(s) (Continued) Motor vehicle accidents, 170 polypharmacy with, 132\u2013133, 132f, Mouth, suprainfections, 284 Lymphatic system (Continued) 133b, 134t, 136b Mucous membranes, care of aging, expected age-related changes in, to promote sleep, 338 48\u201349, 49t prophylactic, 76 269\u2013288 safety and nonadherence Muscle mass Lymphocytes, 48 (noncompliance) issues, Lysozyme, in lacrimal glands, 61 144\u2013145 decrease of, 38 and sexual dysfunction, 263, 263t loss of, 306 M teaching older adults, 144, 144b Muscle sense, 37 transdermal, 141, 142b Muscle tone, decrease of, 38 Macula lutea, 61 and urinary incontinence, 297\u2013298 Muscles, 36\u201337 Macular degeneration, age-related, when a patient refuses, 141b Musculoskeletal signs of stress, 226t Musculoskeletal system, 35\u201340 63\u201364 Medication administration assessment of, 156t\u2013158t Magnesium hydroxide, 138t guiding rule for, 140b common disorders seen with aging Malabsorption, and nutrition, 111 in the home, 143, 143b Male reproductive organs, 70 inhalation, 142 in, 38\u201340, 166 Malnourishment, and activity, 309 in institutional setting, 137, 143, expected age-related changes, 37\u201338, Malnutrition, 110\u2013114 143b nursing interventions related to, 37t nursing process for risk of imbalanced, 139\u2013142 Music therapy, 176b 114\u2013120, 116b, 118f parenteral, 142 Muslim spirituality, 236, 242f \u201crights\u201d of, 139\u2013140, 139b, 139f, 140t, Mycobacterium tuberculosis, 42 risk factors for, 110 141b, 141f, 142 Myocardial infarction (MI), 45, 45b economic, 111 Myocardium, 43 physiologic, 110\u2013112 Medication carts, locking of, 175 MyPlate, 103, 104f social, 111 Medication error, 162t\u2013163t Medication risks N Mandated reporters, 25 Marital status, 8 factors that increase, 131b Nails, 275\u2013276 Marriage and older adults, 263\u2013264 related to cognitive or sensory age-related changes in, 269\u2013276, Massage for stress reduction, 229b 270t Mastectomy, 263 changes, 134\u2013136 assessment of, 156t\u2013158t, 269\u2013270 Master gland, 66 related to drug-testing methods, fungal infections of, 276 Mastication, 50 risk factors for alterations in, 276b Masturbation, 266 130\u2013131 Mattresses to reduce pressure, 279, related to financial factors, 137 Napping, and sleep disorders, 338 related to inadequate knowledge, Naproxen, 138t 279t Nasal cannula, for oxygenation Meals-on-Wheels, 111\u2013112, 112f 136 Median income, 9, 10f related to physiologic changes of problems, 319, 319f Medic Alert bracelet, 76 Nasogastric tube feeding, 119 Medicaid, supplemental, 16, 16b aging, 131\u2013133, 131t Nasopharynx, 40 Medical insurance, 16 \u201cMedigap,\u201d 16 Nausea, in dying person, 256 Medicare, 15, 17f Meditation for stress reduction, 229b Neck, assessment of, 156t\u2013158t Medulla, 55 Negative feedback, 200 advantage plans, 16 Melanin, 32 Neglect, 22 Medication(s), 76b, 130\u2013145, 166 Melanoma, 33\u201334 Melatonin, and sleep, 332 by family, 21\u201324 absorption of, 131, 131t Memory, 181 Nephrons, 53 assessment and ethnicity, 137b\u2013138b Memory loss, 182 Nerve deafness, 65 Beers criteria for inappropriate use M\u00e9ni\u00e8re disease, 65 Nervous system, 55\u201360 Methyldopa, 138t of, 133\u2013134 Midbrain, 56 assessment of, 156t\u2013158t clinical situation on, 133b Middle ear, 64 common disorders seen with aging and constipation, 290\u2013291 Midlife crisis, 29 correct, 139 Mineral(s), 107\u2013109 in, 166 cost of, 137 Mini-cognitive assessment instrument, Neuroendocrine theory, 28\u201329 crushed, 140 Neurologic condition and oral and diarrhea, 295 159b distribution of, 131, 131t Minimum data set (MDS), 159, 160f hygiene, 284\u2013285 excretion of, 131t, 132 Mitral valve, 43 Neurologic damage, and activity, 308 half-life of, 131\u2013132 Mixed dementia, 58 Neurons, 55 and imbalanced nutrition, 119 Mixed incontinence, 299 Neurotransmitters, 55 list of, 76 Mobility, 79 Newman\u2019s theory, 29 metabolism of, 131t, 132 Molars, 50 Niebuhr, Reinhold, 6 nursing assessment and, 137\u2013138, Molecular theories, of aging, 28 Night blindness, 62, 180\u2013181 Mortgages, reverse, 11 Nocturnal movement disorders, 333 137b, 138t Motivation, 78\u201379 Nodes, 48 and nursing care plan, 139\u2013142 Nonadherence, 84 and nutrition, 111 lack of, 111\u2013112 Noncompliance, nursing process for, over-the-counter (OTC), 76, 130 patient rights and, 143 84\u201386, 85b pharmacodynamics of, 132\u2013133 Non-English speakers, 96 pharmacokinetics of, 131\u2013132","O INDEX\t 377 Non-rapid eye movement (NREM) Obama, Barack, 16\u201317 Ovaries, 67 sleep, 332 Objective data, 149 Overflow, retention with, 297 Obstructive sleep apnea, 334\u2013335 Overflow incontinence, 298 Nonsteroidal antiinflammatory drugs Occlusive peripheral vascular Overprotective and powerlessness, 211 (NSAIDs), 138t Over-the-counter (OTC) medications, problems, 46\u201347 Nonverbal communication, 89\u201393, 90b, Occupational therapist, for dysphagia, 76, 130 90f Oxygen, supplemental, 319 125 Oxygen concentrator, 320\u2013321 Norton risk assessment scale, 275t Oils, 277 Oxygen cylinder, portable, 320, 320f Nurse, and family interactions, 20\u201321, Old, defined, 2 Oxygen equipment, use of, 320\u2013321 Old person, role of, 217 Oxygenation problems, nursing 21b Older adults, 130\u2013145 Nursing, implications for, 29 process for, 317\u2013321 Nursing care plan, 83b, 127b\u2013128b factors affecting drug response in, 131t P for constipation, 295b for impaired physical mobility, health assessment of, 148\u2013162 Pace, of communication, 92 condition change in, 161\u2013162 Pacific Islanders, roles and 311f\u2013312f interviewing, 150\u2013151 for impaired verbal communication, minimum data set 3.0 as special relationships of, 214b assessments in, 159\u2013161, 160f Pacing with dementia, 189 195b physical assessment, 151\u2013153, Pads to reduce pressure, 279 for powerlessness, 212b 152t, 156t\u2013158t Pain, 162t\u2013163t for relocation stress syndrome, psychosocial assessment in, 158\u2013161, 159b assessment of, 197, 198t 233b sensory assessment in, 158 nursing process for, 195\u2013199, 196f for sexual dysfunction, 266b\u2013267b special assessments in, 159\u2013161 and nutrition, 111 for sleep disorders, 339b vital signs in, 153\u2013156 with oxygenation problems, 319 for social isolation, 222b response to, 195\u2013196 for spiritual distress, 242b\u2013243b herbal and supplement Pain log, 253 Nursing Competence in Aging (NCA) considerations for, 134t Pain management, end-of-life care, initiative, 5 potentially inappropriate medication 254\u2013255 Nursing home(s), 15 use in, 133\u2013134, 133b Pain medication Nursing home insurance, 15b Nursing interventions, for health self-medication and, 143 and exercise, 313 Older Women\u2019s League (OWL), 11, 11b with oxygenation problems, 319 promotion and maintenance, Oliguria, in dying person, 257 Palliative care, 249 83\u201386 Open-ended communication Palpation, 153 Nutrients, 103\u2013109 Pancreas, 66 carbohydrates as, 104 techniques, 97 Pancreatic juice, 50 fats as, 106 Oral cancer, 284 Papillae, of tongue, 50 minerals as, 107\u2013109 Parasitic diarrhea, 295 proteins as, 104\u2013106 symptoms of, 284b Parathyroid glands, 66 vitamins as, 106\u2013107 Oral care, preventive, 76\u201377 Parent, role of, 216 water as, 109\u2013110 Oral cavity, 50 Parenteral medications, 142 Nutrition Oral hygiene Parietal lobes, 56 and aging, 102\u2013110 Parietal pericardium, 43 assessment of, 112b for dysphagia, 125 Parkinson disease, 57 caloric intake in, 102\u2013103 for fluid restriction, 123 Parkinson disease dementia (PDD), 58 coordinated care for, 112b for imbalanced nutrition, 119 Passive range-of-motion exercises, 310 cultural considerations, 117b, neurologic problems and, 284\u2013285 Patient Protection and Affordable Care on unconscious patient, 286 120b Oral hygiene care plan, 282b Act (PPACA), 16\u201317 culture and food preferences, 117b, Oral mucous membranes Patient rights and medication, 143 age-related changes in, 282\u2013285 Patient teaching, 100\u2013101, 101b 118f nursing process for impaired, Penicillins, 138t factors affecting, 110\u2013112 Pensions, 10 mal-, 110\u2013114 285\u2013288 Peptic ulcer, 52, 52b nursing process for risk of risk factors for problems with, 285b Perception(s), 180\u2013199, 186b Oral pain, 283 imbalanced, 114\u2013120, 116b, Oral temperature, 153 of aging, 79, 202\u2013203 118f Orthodox dietary and hygiene cognition and, 186b social and cultural aspects of, defined, 180 112\u2013114, 113t\u2013114t, 115f, 116 practices, 239 nursing process for disturbed, Nutritional intake Orthopnea, 336 assessment of, 115\u2013116 Orthostatic hypotension, 44\u201345, 156 182\u2013185 nursing interventions to decrease, Osmotic agents, 293t risk factors related to, 183b 119 Osmotic pressure, 47\u201348 Perceptual functioning, normal, nursing interventions to increase, Osteoarthritis, 38\u201339 122\u2013123 Osteoporosis, 38 180\u2013182 for oxygenation problems, 319\u2013320 Otosclerosis, 64\u201365, 180\u2013181 Percussion, 153 Nutritional supplements, for sleep Oval window, 64 Pericardial cavity, 43 disorders, 338 Nystagmus, 65","378\t INDEX Polydipsia, 68\u201369 Pulse deficit, 154\u2013155 Polyphagia, 68\u201369 Pupil, 61 Pericardial membranes, 43 Polypharmacy, 132\u2013133, 132f, 133b, Purkinje fibers, 44 Periodontal disease, 283 Peripheral nervous system, 56 134t, 136b Q Polyuria, 68\u201369 common disorders seen with aging Pons, 56 Qi gong, 307b\u2013308b in, 57\u201360 Positive feedback, 200 Quad cane, 313f Possessions, loss of, 217 Quality, of sound, 153 expected age-related changes in, Posterior pituitary, 66 Questioning, direct, 97 56\u201357, 56t Postmenopausal discomforts, 262b Postmortem care, 258 R Peripheral pulse, 155 Poverty, 9 with oxygenation problems, 318 Powerlessness, 210\u2013211 Radial pulse, 154 PQRST method, for pain assessment, Ram\u2019s horn nails, 276 Peripheral vascular disease, 46 Range-of-motion exercises, 310 Peristalsis, 50 197, 198t Ranitidine, 138t Prayer, 240b Rapid eye movement (REM) sleep, and constipation, 290 Pernicious anemia, 49, 108 for stress reduction, 229b 332 Personal rights, of older adults, 265 Premolars, 50 Rapid eye movement (REM) sleep Personal space, in communication, 91 Presbycusis, 64, 180\u2013181 Personal value system, 235 Presbyopia, 62, 180\u2013181 behavior disorder, 336 Pet therapy, 326, 326f Prescription drug coverage, 16 Rapport, 88 Pharmacodynamics, 132\u2013133 Prescription medications, 76 Pharmacokinetics, 131\u2013132 Pressure ulcers, 34, 34f, 162t\u2013163t, establishing, 150\u2013151, 150f Pharynx, 40 Rashes, 271 Phosphorus, in diet, 108 272 Rate of living theory, 27 Physical abuse, 22 bony prominences underlying, 273f, \u201cReachers,\u201d 323f Physical activity, 292 Receptive aphasia, 193 278f Receptor site, 55 and aging, 289\u2013291, 306\u2013307 cultural considerations with, 270b Rectal prolapse, 53 for constipation, 290\u2013291 prevention of, 272t Rectal temperature, 153\u2013154 with dementia, 189 stages of, 273f, 280t\u2013281t Rectum, 50\u201351 effects of disease processes on, 309 Preventive overall care, 75\u201376 Reflection for stress reduction, 229b normal patterns of, 305 Reflex incontinence, 298 Physical assessment, 151\u2013153, Primary caregivers, 80\u201381 Refraction, 61 Privacy, 293b Refractive errors, 61 156t\u2013158t Refusal of care, 211 Physical examinations, 75\u201376 of older adults, 265\u2013266 Rehabilitation, 327\u2013330, 329b Physical mobility and health Progeria, 31 Programmed theory, 27 after joint replacement surgery, 308 promotion and maintenance, 79 Progressive relaxation, 230\u2013231 Rehabilitative focus, 327 Physical mobility impairment Prophylactic medications, 76 Relationship(s), 214\u2013223 nursing care plan for, 309\u2013315, 316b prescription and over-the-counter, and aging, 215\u2013217 risk factors related to, 309b 76 of Asian and Pacific Islanders, 214b Physical setting, preparing the, 150 cultural considerations with, 214b Physical signs of stress, 226, 226t Propranolol, precautions related to defined, 214\u2013215 Physical theories of aging, 29 aging, 138t normal, 214\u2013215 Physician orders for life-sustaining risk factors related to changes in, Proprioceptors, 37 treatment (POLST), 18, 18b Prostate cancer, 71 219b Physicians, communication with, Prostate gland, 70 and self-image, 215 Prostheses, verifying functionality of, standards for, 215 99\u2013100, 99b Relaxation techniques, for stress- Physiologic changes, 31\u201371 184, 184f Protein(s), 104\u2013106, 104b reduction, 228\u2013229 medication risks related to, 131\u2013133, Proxemics, in communication, 91 Religious aspects of nutrition, 112 131b Pruritus, 33, 269 Religious beliefs, for health promotion Pruritus vulvae, 262 and safety problems, 165\u2013166 Pseudodementia, 185 and maintenance, 78 Physiologic risk factors, for Psychological threats, 224 Religious practices regarding end of Psychosocial assessment, 158\u2013161, malnutrition, 110\u2013112 life, 251b\u2013252b Phytoestrogens, 262 159b Religious rituals, 240\u2013241, 240f Pigmentation, 271 Psychosocial theories, of aging, 29 Religious service, 240f Piles, 53 Psychotherapeutic medications, for Religious values, 239\u2013241 Pinna, 64 Relocation stress syndrome, 231 Pitch, of sound, 153 disturbed thought processes, 190 Pituitary gland, 66 Psychotropics, 138t nursing care plan for, 233b Pivot joint, 36f Public space, in communication, 91 nursing process for, 231\u2013232 Plasma, 47\u201348, 120 Pulmonary veins, 43 Remarriage, 264 Plasma cells, 48 Pulp cavity, 50 Reminiscence, and self-esteem, 206, Platelets, 48 Pulse, 154\u2013155, 154f Pneumonia, 42 207f Pneumonia vaccine, 75 with oxygenation problems, 318 Political activism, and economics of aging, 11","Root, 50 INDEX\t 379 Rosacea, 34, 34f Reproductive system, 69\u201371 Rug(s), as hazards, 169 Self-perception, 200\u2013213 common disorders seen with aging Run-out-of-program theory, 27 and aging, 202\u2013203 in, 71 behaviors related to, 201 expected age-related changes in, S normal, 200\u2013202 70\u201371, 70t nursing process for disturbed, Saddle joint, 36f 203\u2013204 Resident assessment protocols (RAPs), Safety problems, 165 risk factors related to, 204b 160 external risk factors for, 169\u2013174 Selye, Hans, 224 Resistance exercise, 307\u2013308 falls as, 166, 167b Senile lentigo, 32\u201333 Respect in communication, 93\u201394 internal risk factors for, 165\u2013169, Senile purpura, 33 Respiration, 40, 155, 155f, 318 Senior citizen groups, politically Respiratory changes, at end-of-life, 166b nursing process for, 174\u2013177, 175f active, 11b 255 Saliva, 50 Senses, special, 60\u201365 Respiratory effort, with oxygenation Salivary glands, 50 Sensorineural deafness, 65 Scabies, 271, 271f Sensory changes problems, 318 Schwann cells, 56 Respiratory signs of stress, 226t Sclera, 61 at end-of-life, 257 Respiratory system, 40\u201343 Screening tool of older person\u2019s and health promotion and assessment of, 156t\u2013158t prescriptions (STOPP), 134 maintenance, 79\u201380 common disorders seen with aging criteria, 135t and nutrition, 111 Screening tool to alert doctors to right and safety problems, 165 in, 41\u201343 Sensory nerve receptors, 32 expected age-related changes in, treatment (START), 134 Sensory perception, nursing process criteria, 135t 40\u201341, 41b, 41t Sebaceous glands, 32 for disturbed, 182\u2013185 Respite care, 25, 322 Seborrheic dermatitis, 35, 35f Separation, from family, 203 Rest, 331\u2013338 Seborrheic keratosis, 32\u201333, 32f Serenity prayer, 6 Secondary caregivers, 80\u201381 Serous fluid in pericardial cavity, 43 clinical situation, 337b Secondary hypertension, 47 Sex partner, loss of, 263, 263f and incontinence, 337b Secretions, clearing of, 318 Sexual dignity of confused older normal, 331\u2013332 Sedatives, 319, 338 risk factors related to, 333b Seizures, 162t\u2013163t adults, 266 Restless leg syndrome, 333 Self-care activities, and self-esteem, Sexual dysfunction, 261 Restraints, 176b for disturbed thought processes, 205\u2013206, 206f medications and, 262, 263t Self-care deficits, 321\u2013323, 321b nursing care plan for, 266b\u2013267b 190 Self-concept, 200\u2013213 nursing process for, 265\u2013266 Retention, 297 Retina, 61 and aging, 202\u2013203 assessment\/data collection, Retinal detachment, 63\u201364 normal, 200\u2013202 265\u2013266 Reverse mortgages, 11 nursing process for disturbed, Rheumatoid arthritis, 39 diagnosis, 266 Rheumatologist, 39 203\u2013204 goals\/outcomes identification, Rhus dermatitis, 35f risk factors related to, 204b Right atrium, 43 Self-destructive behaviors, 209 266 Right brain hemisphere damage, 60b Self-esteem, 200 interventions\/implementation, Right to refuse care, 211 actions to promote, 201b Right ventricle, 43 behaviors related to, 201 266 Rising cost, 16\u201317 communication and, 207 risk factors related to, 266b Rituals, 240\u2013241, 240f external standards and, 200 Sexual health Rods, 61 feedback and, 200\u2013201 alcohol on, 263 Role(s), 214\u2013223 internal values and, 200 impact of illness, 263 nursing process for risk for medications on, 263 and aging, 215\u2013217 Sexual intercourse, 261 of Asian and Pacific Islanders, 214b situational low, 205\u2013207 Sexual orientation of older adults, 264 cultural considerations with, 214b reminiscence and, 206, 207f Sexuality, 261, 262f defined, 214 self-care activities and, 205\u2013206 caregivers and, 264 of grandparents, 216\u2013217, 217f taking control and, 201b erectile dysfunction in men, 262\u2013263 of homemaker, 216 Self health management. see also factors that affect, 261\u2013263 normal, 214\u2013215 loss of sex partner, 263 of old person, 217 Health promotion and marriage and, 263\u2013264 of parent, 216 maintenance men, age-related changes in, risk factors related to changes in, nursing process for ineffective, 262\u2013263 219b 82\u201384, 84b privacy and personal rights and, and self-image, 215 Self-hypnosis for stress reduction, 230 of spouse, 217 Self-identity, 200 265, 265f standards for, 215 Self-medication, 143 women, age-related changes in, 262 Role conflict, internal, 215 Self-neglect, 21 Sexually inappropriate behaviors of Rome III criteria, for constipation, confused older adults, 266 290b Sexually transmitted disease, 264\u2013265, 265b Shingles vaccine, 75\u201376","380\t INDEX Shoe remover, 323f Sleep-wake patterns, 331 Stomach, 50 Shortness of breath, 162t\u2013163t Sleepiness, during dying, 255 Stress, 224\u2013232 Sick sinus syndrome, 45 Sleeping difficulties, 162t\u2013163t Sigmoid colon, 50\u201351 Small intestine, 50 behavioral signs of, 226\u2013227 Significant others, communication Smell, 65, 165 cognitive signs of, 226\u2013227 coping or defense mechanisms, with, 97\u201398 expected age-related changes in, 65, Signs indicating need for prompt 66t 228b due to relocation. see Relocation medical attention, 76, 76b Smoking, 74\u201375 Silence, 93 Smooth muscle, 36 stress syndrome Simple carbohydrates, 104 Soaps, 277 emotional signs of, 226 Sinoatrial node, 44 Social aspects, of nutrition, 112\u2013114, and illness, 227\u2013228 Sinus node dysfunction, 45 and life events, 228 Situational low self-esteem, nursing 115f, 116 normal, 224\u2013229 Social communication, 88\u201390 physical signs of, 226t process for risk for, 205\u2013207 Social interaction, nursing process for physiologic response to, 224 Skeletal muscle, 37 Stress incontinence, 298 Skilled care, 15 impaired, 219\u2013220, 220f Stress tolerance, risk factors related to Skin Social isolation, 111, 219, 220f, 231f Social risk factors, for malnutrition, problems with, 230b age-related changes in, 269\u2013276, Stressors, 224 270t 111 Stress-reduction strategies, 228\u2013229 Social Security income, 9\u201310 assessment of, 156t\u2013158t, 269\u2013270 Social Security program, 2\u20133 for activity intolerance, 317 body diagram, 270f Social space, in communication, 91 geriatric massage as, 229b care of aging, 269\u2013288 Sock assist, 323f for oxygenation problems, 319 risk factors for alterations in, 276b Sodium, in diet, 108\u2013109 progressive relaxation, 230\u2013231 Skin care, for imbalanced fluid Somatic mutation theory, 28 Stretching exercises, 307 Space, in nonverbal communication, Stroke, 59\u201360 volume, 123 and activity, 308 Skin color, 270 91 Subacute care facilities, 15 Skin integrity, nursing process for Spasmolytics, 138t Subcutaneous tissue, 32 Subjective data, 149\u2013150 impaired, 276\u2013282, 278f Special assessments, 159\u2013161 Sublingual temperature, 153 Skin irritation, 271 Special senses, 60\u201365 Suction equipment, 125\u2013126 Skin pigmentation, 271 Specialty care facilities, 15 Suicidal ideation, 162t\u2013163t Skin rash, 162t\u2013163t Specific inspection, 153 Suicide, 203, 210b Skin tags, 32\u201333 Speech, 192 Sulfonamides, 138t Skull, assessment of, 156t\u2013158t Speech therapist, 125 Sun exposure, 282, 282b Sleep, 331\u2013338 Speed, of communication, 92 Sundown syndrome, 188 Spinal cord, 36 Sundowning, 188 and aging, 332 Spiritual assessment Supplement(s), to slow or reverse clinical situation, 337b comfort measures to promote, for nurses, 241b aging, 28 SPIRIT Mnemonic for, 241b Supplemental Medicaid, 16 337\u2013338, 337f Spiritual beliefs, 239 Supplemental oxygen, for oxygenation hygiene practices, 333b\u2013334b Spiritual considerations, in end-of-life and incontinence, 337b problems, 319, 319f medications used to promote, 338 care, 252\u2013253 Supplemental tube feedings, 119 neurologic control of, 332 Spiritual counselor, 242 Support groups, 25 normal, 331\u2013332 Spiritual distress, 241\u2013242, 242b\u2013243b Suppressor T cells, 48 NREM and REM, 332 Spiritual objects, 242 Surfactant, 40 nursing process for disturbed, Spirituality Swallowing impairment, 111, 124b 336\u2013338 African Americans and, 236 nursing process for, 124\u2013126 risk factors related to, 333b American Indians and, 236\u2013237 Symbols, in communication, 90, 90b supervisory issues related to, 337b Euro-Americans and, 237 Symptoms indicating need for prompt Sleep apnea, 334\u2013335 Jewish, 236 Sleep cycle, 332, 332b, 332f Latinos and, 236 medical attention, 76, 76b Sleep disordered breathing, 334\u2013335 Muslim\/Islamic, 236 Synapse, 55 Sleep disorders, 333\u2013336 Spirometers, 319 Synovial joints, 36f behaviors that contribute to, 333 Spleen, 48 circadian rhythm in, 335\u2013336 Spouse, role of, 217 T drugs that contribute to, 338 Staffing, 329 insomnia as, 333\u2013334 Standards for roles and relationships, T lymphocytes, 48 napping and, 338 Tachycardia, 316\u2013318 nursing care plan for, 339b 215 Tai chi, 307b\u2013308b nursing process for, 336\u2013338 Static air-filled overlay surfaces, 279t Taste, 65 REM sleep-behavior disorder as, 336 Stem cells, 48 sleep apnea as, 334\u2013335 Sternum, 43 expected age-related changes in, 65, Sleep maintenance problems, 333 Stimulant laxatives, 293t 66t Sleep-rest health pattern, 331\u2013336 Stimuli, 180 Stokes\/Gordon stress scale, 225t Technology to enhance communication, 207b","Trust, actions that promote, 219b INDEX\t 381 Tube feeding(s) Teeth, health promotion and Values (Continued) maintenance for, 76 for aspiration, 126 cultural competence related to, for dysphagia, 124 237b Temperature, 153\u2013154 supplemental, 119 economic, 238 Temporal lobes, 56 Tuberculosis, 42\u201343 interpersonal, 238 Tendons, 36 Tunica externa, 43 of older adults, 238\u2013241 Terminal insomnia problems, 333 Tunica intima, 43 risk factors related to problems Testes, 67 Tunica media, 43 with, 241b Testosterone, 67 Tympanic membrane temperature, 154 spiritual or religious, 239\u2013241 Tetanus, diphtheria, pertussis Type 1 diabetes mellitus, 68\u201369 Type 2 diabetes mellitus, 69 Values clarification related to death vaccines, 75 and end-of-life care, 247\u2013248 Tetracyclines, 138t U Theophylline, 138t Valves in veins, 43\u201344 Theories of aging, 27\u201329, 28b Ulcers, pressure, 272 Varicose veins, 47 Therapeutic communication, 89 bony prominences underlying, 273f Vascular dementia, 57 Thermal hazards, 172\u2013174 cultural considerations with, 270b Vehicular accidents, 170\u2013172 prevention of, 272t Veins, 43\u201344 nursing process for, 177\u2013178 stages of, 273f, 280t\u2013281t Ventilation, 40 risk factors for, 172 Venules, 43\u201344 Thermoregulation, 172, 172b Uniforms, in communication, 90 Vertebrae, 36 Thioridazine, 138t Unintentional abuse, 21 Vertebral canal, 36 Thought processes, nursing process Upper respiratory tract, 40 Very-low-density lipoproteins Ureters, 53 for disturbed, 192 Urge incontinence, 298 (VLDLs), 106 Thrombocytes, 48 Urinary changes, at end-of-life, 257 Villi, 50 Thrombophlebitis, 46\u201347 Urinary elimination, 301t Viral pneumonia, 42 Thrombus, 46 Visceral pericardium, 43 Thymus, 48 and aging, 289\u2013291 Vision, assessment of, 75 Thyroid gland, 66 impaired Vision examination, 75 Thyroid-stimulating hormone, 66 Visitors, communication with, 97\u201398 Time of communication, 92\u201393 nursing intervention for, 299\u2013303 Visual changes, 162t\u2013163t, 180\u2013181 Timing of communication, 92\u201393 nursing process for, 299\u2013303 Tinnitus, 65, 180\u2013181 urinary retention as, 297 and safety problems, 165 Tissue healing, measures to promote, risk factors related to, 299b Visual impairment, 62 Urinary incontinence, 54\u201355, 297\u2013299, 279\u2013280 297b nursing interventions in home for, Tissue integrity, 272 functional, 298\u2013299 185 Title 19, 16 mixed, 299 Tobacco, for health promotion and overflow, 298 Visual pain, scales, 195, 196f prevention of, 297b\u2013298b Vital signs, 153\u2013156, 162t\u2013163t maintenance, 74\u201375 reflex, 298 Tobacco-related problems, 284 risk factors associated with, 297b for activity intolerance, 316\u2013317 Toileting for imbalanced nutrition, 119 stress, 298 blood pressure as, 155\u2013156 Toileting schedule urge, 298 for oxygenation problems, 318 Urinary meatus, 53 pulse as, 154\u2013155 for bowel incontinence, 296 Urinary retention, 297 respiration as, 155 for constipation, 290\u2013291 Urinary signs of stress, 226t temperature as, 153\u2013154 for urinary elimination, 297\u2013299 Urinary system, 53\u201355 Vital statistics, 6 Tolmetin, 138t common disorders seen with aging Vitamin(s), 106\u2013107, 107t Tone of voice, in communication, 91 Vitamin deficiencies, 106\u2013107, 284 Tongue, 50 in, 54\u201355 Vitreous, 61 Tooth decay, 282\u2013283, 283f expected age-related changes, 54, Vitreous humor, 61 Touch in communication, 93, 93f Vocal folds, 40 Trace elements, 109 54t Voice, tone of, in communication, Trachea, 40 benign prostatic hyperplasia as, Transdermal medication, 141, 142b 91 Transgender, older people, 264 54 Voice box, 40 Transience, 182b in bladder capacity, 54 Voluntary activity, 306 Transient ischemic attack, 59 in kidney size and function, 54 Voluntary muscles, 37 Transportation Urinary tract infection, 55, 55b, 297 Volunteers, for deficient diversional for deficient diversional activities, Urine, characteristics of, 54 Uterine prolapse, 71 activities, 326 327 Vomiting, in dying person, 256 and nutrition, 111 V Transverse colon, 50\u201351 W Trapeze bar, 310, 313f Vaginal infection, 71 Trends and issues, 1\u201325 Values, 235\u2013244 Walker, 313, 313f clinical situation on, 23b Walking pneumonia, 42 Triazolam, 138t and beliefs, 235 Wandering with dementia, 188 Tricuspid valve, 43 cultural, 238\u2013239 Warm-up exercise, 315 Water, as nutrient, 109\u2013110 Water fluoridation, 282","382\t INDEX Wheelchair-bound patients, activity X for, 313 Water-soluble vitamins, 106 Xerosis, 33, 34f Wealth, 12 Wheezes, 156t\u2013158t Xerostomia Wear-and-tear theory, 28 White blood cells (WBCs), 32 Weight changes, 117 Wisdom, 181 with aging, 283\u2013284 Weight checks, for imbalanced Wold, Gloria, 19 in dying person, 256 Wong FACES Pain Rating Scale, nutrition, 117 Y Wernicke\u2019s aphasia, 193\u2013194, 194t 196f Wernicke\u2019s area, 192\u2013193 Wound cleansing, aseptic technique, Yeast infection, 284 Western cultures, death in, 245\u2013246 Wet age-related macular degeneration, 279\u2013280 Z Wrinkles, 33 63 Zinc, in diet, 109"]