2. Announcements Retakes for Drug Calc & MKDQ – Thurs from 11-12pm in the Computer Lab T-Shirt Sales $15.00 & Water bottles $ 10.00

3. Chronic Illness, Older Adults, & End of Life Care Medical Surgical II

4. Chronic Illnesses Acute vs Chronic (Tables 5-1, 5-2) How does chronic illness affect quality of life? Trajectory of Chronic Illness (Table 5-3) Seven tasks … (Table 5-4) Prevention of Chronic Illnesses Define Primary, Secondary, Tertiary prevention

5. Nursing Management Remember to follow the Nursing Process Early diagnosis and interventions Complete assessments, then focused Education -> self-management Treatment plan, symptomatology management strategies, and outcome goals Include care givers, if permission from patient

6. Dept of Health & Human Services Administration on Aging www.aoa.gov  43.1 million in 2012 (65+ years), 44.7 million in 2013 (1 in every 7 Americans)  25.1 million women, 19.6 million men By 2019, the Hispanic population is projected to be the largest ethnic minority in this age group Over 3.9 million elderly persons (9.1%) were below the poverty level in 2012 Sources: U.S. Census Bureau, Population Division, Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2013. Release Date: June 2014;

7. Older Adults Demographics of Aging Why are older adults living longer? Describe their adult developmental needs Generativity vs. Stagnation (40-65) Ego Integrity vs. Despair (65+) Describe the needs of the aging population Ageism & Elder Abuse Why does this occur?

8. Cost of Dying – End of Life Care https://www.youtube.com/watch?v=F6xPBmk rn0g https://www.youtube.com/watch?v=F6xPBmk rn0g

9. Gerontology Assessments (Table 5-6) Most common chronic conditions: Cardiovascular / Respiratory Integumentary Urinary Reproductive GI Musculoskeletal Nervous Visual / Auditory Immune Mental Health

10. SPICES S leep Disorders P roblems with eating or feeding I ncontinence C onfusion E vidence of Falls S kin Breakdown

11. SCALES: Nutritional Assessment Table 5-8 Sadness or change in mood Cholesterol, /\ Albumin Loss or gain of weight Eating issues Shopping and food prep issues

12. Complexity of Care Cognitive Impairment Older Adult Females (p. 65) Rural Older Adults Homeless Older Adults Frail Older Adults Chronically ill Older Adults

13. Cognitive Function Short Term Memory Memory Aids Long Term Memory Synthesis of New Information

14. Acute Care of the Older Adult What are common reasons for hospitalization? What are the risks with hospitalization? Medications

15. Restraints (physical &chemical) Why do we use Restraints? Types? Do you need an order? What additional paperwork? Assessment?

16. Social Services Medicare Medicare coverageMedicare coverage Part A, B, C, and D Medicaid Medicaid requirements anc coverageMedicaid requirements anc coverage 2010 Healthcare Reform Healthcare ReformHealthcare Reform Housing Adult Day Care Programs Retirement Communities Assisted Living Facility Long Term Care Facility

17. Legal & Ethical Issues Estate Planning Legal Aid Tax issues Advance Directives Living Will – Natural Death Acts Durable Power of Attorney

18. Palliative Care at End of Life Care Palliative care: any intervention focusing on \/’ing severity of disease symptoms. Table 10-1 Death: the irreversible cessation of cardiovascular, respiratory, and brain function. Brain death: the irreversible cessation of all functions of the entire brain, including the brainstem. Heart may continue and can be maintained on mechanical ventilation. What Are The Nurse’s Goals? How Would We Achieve Those Goals?

19. Physical Manifestations Table 10-2 Sensory Changes Cardiovascular Respiratory Urinary GI Musculoskeletal Integumentary

20. Mottling

21. Psychosocial Manifestation Grief- emotional and behavioral response to loss What are some factors that influence grief reactions? Religion Prior Experiences Value System Coping Skills Support System Relationship with dying person

22. Model of Grieving Kubler-Ross (1969) (Table 10-4) Denial Anger Bargaining Depression Acceptance

23. The Grief Wheel Model (Fig. 10-6) Normal Loss Protest Disorganization Reorganization New Normal

24. Legal & Ethical Issues Table 10-6 Organ/Tissue Donation Resuscitation/Removal of mechanical ventilation, IV fluids Tube feeding Advance Directives Living Wills Durable Power of Attorney Resuscitation

25. Hospice Hospice and Palliative Care Hospice and Palliative Care What is Hospice Care? When is it Applicable? Who can request Hospice Care? What are the top five illnesses of hospice patients?

26. Nursing Care Nursing care becomes symptom management rather than cure Psychosocial care Postmortem care Prepare for immediate viewing for family Care for your fellow nurses – debrief We all need a hug !!!!