three basic concepts in care of geriatric patient for entry-level nurses

1. Three Basics in
Geriatrics
Every nurse needs competencies in geriatrics.
85% of hospitalized patients are elderly.


2. Too Many Medications and
Too Many Reactions

 With aging, stomach absorption, metabolism and
liver and kidney function all change.
 Most seniors require increasingly lower doses of
medications as they age. They fail to clear
medications before the next dose, so doses
accumulate. Some take 20 or more prescriptions.
 First reaction to a symptom is to call a doctor to add
meds. But often medications are the problem.
 Especially those on Beer’s List
 http://www.americangeriatrics.org/files/document
s/beers/PrintableBeersPocketCard.pdf

3. Too Many Medications and
Too Many Reactions

Consider
reducing
doses and
numbers
of meds.

4. Dementia with Delirium

 Be alert to subtle changes in
mental status
 Learn to tell when delirium
superimposes onto dementia
 “Yes, he is very forgetful,
but this is much worse.”
 Hospitalization = stress
 Been abducted by aliens
 Look at new meds, an
infection brewing, mild fluid
overload
 Simulation helps students
learn to recognize delirium
being imposed onto
Alzheimer’s dementia

5. End of Life

 NP Kim, Vanderbilt, helps us sort out their feelings and ours
 There as many ways to die as there are to live
 We all have really different end-of-life wishes—advanced
directives
 Some want any intervention possible regardless of their
condition or prognosis
 Others define a threshold at which they no longer
consider life worth living.
Everything Possible Done// Comfortable Interventions Only// I’m Done

6. End of Life

 End of life wishes—
clearly point out exactly
what that threshold
means for each
individual
 A person’s resting place
is hallowed ground,
venerated. It is an Expertinfantry, Final plays of Taps for former Sergeant Major of Army,
uploaded 1/28/09 via Flickr, Attribution 20 generic
honor to be there. It is
greater than you.