______________________________________________________________ Chapter 11 The Older Patient 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the goals of gerontological nursing.
Consider the differences between the
treatment required for this population and
the needs of the younger adult, as well as
the nurse’s role in meeting the needs of the
older patient.
• Discuss the levels of nursing practitioners
outlined in the Management and Supervision
box. Consider the ways in which these
different functions can work together to
ensure that the older patient’s needs are
wholly met during this period.
• As a class, compare and contrast the
opportunities for the gerontological nurse in
the following settings:
• Hospital
• Long-term care
• Assisted living
• Community/public health
Next, discuss how the gerontological nurse
can be a positive influence for older adults in
these settings, as well as improve
awareness of aging-related issues.
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
16 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
2
DISCUSS
• Discuss the myths and stereotypes of aging
relative to statistical trends that contradict
them. Discuss ways in which the nurse can
ensure that these misconceptions about the
older patient do not compromise treatment.
• Discuss the importance of encouraging
activity, both mental and physical, in older
patients to ensure long-term health. Discuss
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Review online
literature which compares what individuals
“used to do” in their 60s and 70s compared
to activities they partake in now. What did
you find out?
3
DISCUSS
• Discuss theories of aging listed in Table 11–
1. Consider the ways in which the views of
aging have progressed in the last century.
Discuss how information about aging has
improved as the average life expectancy has
increased during this period.
• Discuss the physiological changes that
occur as a consequence of aging. Consider
POST AND COMMENT
• Post the following discussion topic online
and have students comment. List five
common changes that occur as an individual
ages. What can you as the nurse do to help
delay some of those changes? Are all of
these changes inevitable?
______________________________________________________________ Chapter 11 The Older Patient 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.1
Critical Thinking Question
An 82-year-old retired professor recently sold her home to move into an assisted living
facility because of declining eyesight and worsening congestive heart failure. Since she
moved in, she has kept to herself. A nurse is assigned to gather data from the patient and
attempts to draw her out of her room. The patient becomes teary and verbalizes how she
wants to die because she is so lonely. “I should have married and had a family. I always
wanted to see Paris and never went. I always wanted to retire to San Francisco, but now I’m
stuck in here. My life has meant nothing.” How can the nurse assist the patient?
Discussion Guidelines: The patient may need some additional assessments for depression and
Instructor Notes/Student Feedback
18 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.2
Instructor Preparation
Textbook Objectives Covered
5. Explain why drug dosage adjustments may be needed for older persons.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: occupational therapist
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying the care and treatment of the older patient, including:
• The role of the nurse
• The current state of aging as revealed in statistical trends as compared to the myths and
stereotypes surrounding this period
• The biologic, physiologic, and psychosocial factors associated with aging
Materials and Supplies
• computer and PowerPoint
projector
• drug references
Key Terms
• ageism (p. 138)
• gerontological nurse (p. 137)
• presbycusis (p. 143)
______________________________________________________________ Chapter 11 The Older Patient 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.2
Student Preparation
Assignments 2 hours
READ – Textbook (pp. 145-147)
ANSWER – Text
• Review Questions for the NCLEX Examination: 7 (p. 150)
ANSWER – Study Guide
• Part IIB: 13 (p. 55)
• Part IIIC: 11 (p. 56)
READ – Textbook (pp. 147-149)
REVIEW
• Table 11-2: Association between age-related physiologic changes and drug effects (p. 147)
• Table 11-3: Drugs commonly associated with adverse drug reactions (p. 148)
ANSWER – Study Guide
• Part IA: 6 (p. 54)
• Part IIB: 14 (p. 55)
• Part IIIC: 8-10 (p. 56)
Lecture Outline 20 minutes
Slide 39
Psychosocial Factors Associated with Aging
• Older adults show cumulative developmental effects that produce unique personality
styles, coping mechanisms, challenges, and growth
• Effective adaptation:
• Meeting environmental and functional needs
TALKING POINTS:
• Family, friends, and the community are influential in the aging process and can support
20 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.2
Slide 40
Psychosocial Factors Associated with Aging (cont.)
• Movement toward Erikson’s ego integrity is facilitated when the older person
• Recognizes and accepts changes in physical and mental capabilities
• Gives up some roles and develops new ones
• Develops new activities that can be carried out successfully with aging
TALKING POINTS:
• The developmental challenge is to review life and gain a feeling of accomplishment and
fulfillment.
Coping and Adaptation
• Old age has been described as the season of losses
TALKING POINTS:
Slide 42
Coping and Adaptation (cont.)
• The older person may cope with these losses with positive or negative adaptation
• Positive adaptation
• Include rational action, perseverance, positive thinking, intellectual denial,
Slide 43
Coping and Adaptation: Family
• Most older adults in the U.S. occupy a variety of family roles
• Marital relations and the relationships between parent and child seem to be most
important
TALKING POINTS:
______________________________________________________________ Chapter 11 The Older Patient 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.2
Slide 44
Coping and Adaptation: Family (cont.)
• The combination of personal limitations, competing roles, and stresses generated by the
care recipient’s behavior and the physical demands created by various levels of
emotional, physical, financial, and family strain places enormous stress on informal
caregivers
• Caregivers frequently report symptoms of depression, anxiety, helplessness, low morale,
and emotional exhaustion
TALKING POINTS:
Slide 45
Coping and Adaptation: Family (cont.)
• More than 1 million older adults are abused physically and psychologically each year by
their caregivers
• Education for learning and positive adaptive behaviors can assist caregivers and
recipients
• Families must be part of the holistic approach in the assessment and care of the aged
TALKING POINTS:
• What can nurses do to make caregivers happier?
• You are in an excellent position to assess stress, depression, and abuse among
caregivers and care recipients and to recommend interventions to alter these conditions.
Slide 46
Functional Assessment
• Activities of daily living; environmental, financial, family, economic, and community
resources
• Data useful during times of health, at the onset of illness, at the beginning of treatment,
and following therapeutic interventions
• Knowing what activities an individual performs alone, what activities require assistance,
and what activities the person is totally unable to perform or to perform safely is essential
to define care needs
TALKING POINTS:
Slide 47
Functional Assessment (cont.)
• The older person’s database should describe both basic and instrumental activities of
daily living
• Basic
• Grooming, bathing, dressing, eating, elimination, and mobility
• Instrumental
• Prepare a meal, shop for groceries, use the telephone, negotiate transportation,
take medications, housekeeping, and laundry tasks
TALKING POINTS:
22 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.2
Slide 48
Drug Therapy and Older Adults
• 88% of older adults who reside in the community use one or more medications
• In long-term care facilities:
• More than 75% receive four or more medications
• 33% receive 7 to 10 medications
• Age- and disease-related changes slow the clearance of drugs, which increases the risk
of adverse effects
Slide 49
Drug Therapy and Older Adults (cont.)
• Reduction in body size
• Decrease in lean body mass and water content (extracellular volume)
• Increase in fat
• Serum albumin concentration is lower
TALKING POINTS:
• What is an example of how the reduced clearance of drugs through the liver or kidneys
Slide 50
Drug Therapy and Older Adults (cont.)
• The liver and kidneys prepare drugs for elimination in the urine or in feces
• Age-related changes that have an impact on the inactivation of drugs by the liver include
decreased liver size, reduced hepatic blood flow, and reduced liver enzyme activity on
drugs
• These changes increase drug concentrations in the blood and possibly increase the
amount of time it takes the body to get rid of the drug
Slide 51
Drug Therapy and Older Adults (cont.)
• Older adults tend to respond more vigorously to drugs that act on the central nervous
system because of a greater tissue sensitivity and altered physiologic changes
• Adverse effects: postural imbalance, staggering, uncoordinated movements, respiratory
depression, and changes in mental alertness
TALKING POINTS:
______________________________________________________________ Chapter 11 The Older Patient 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.2
Slide 52
Drug Therapy and Older Adults (cont.)
• Risk factors for adverse drug reactions
• Age, sex, race (more frequent in older white females), number of drugs consumed,
dosage, duration of treatment, severity of illness, and patient cooperation
• Symptoms and signs
• Restlessness, falls, depression, confusion, loss of memory, constipation, and urinary
incontinence
TALKING POINTS:
• What are some drugs associated with adverse drug reactions in the older adult?
Drug Therapy and Older Adults (cont.)
• Baseline and continual assessments
Slide 54
Drug Therapy and Older Adults (cont.)
• Effectiveness of the medication over time
• Whether any of the drugs taken can be discontinued or decreased in dose
• Assessment of drug effects and adverse reactions must be documented
TALKING POINTS:
• Assess for potential drug interactions between over-the-counter medications and
24 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.2
Activities
Classroom Choose from below to make 30 minutes
Online
4
DISCUSS
• Discuss the need for adaptation throughout
life, and the special challenges faced in
caring for older adults. Review adaptations
to new and often positive psychosocial roles,
as well as the skills required to cope with the
losses that are an inevitable part of aging.
• Discuss the role of the family in helping the
gerontological patient to make positive
adaptations to required changes. Consider
the role of the nurse and the patient
education needed to assist with this process.
• Divide the class into small groups. Assign
each group one of the following scenarios
and ask them to discuss nursing
interventions for each that can aid the older
adult in minimizing despair and building ego
integrity. Have the groups share their
findings with the class.
• A 75-year-old former librarian is
• Discuss the importance of assessment of
functional status in determining
modifications of daily living that may be
required in the aging patient. Review Box
independent activities of daily living.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe some
of tasks of growing old you consider to be
more difficult. Why do you think they are
more difficult?
• Post the following discussion topic online
and have students comment. You are the
home health nurse caring for an older
individual. What are some modifications for
the home you can recommend to ensure he
or she can accomplish ADLs?
______________________________________________________________ Chapter 11 The Older Patient 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.2
5
DISCUSS
• Discuss the age-related changes that affect
drug efficacy as outlined in Table 11-2.
Review the consequences of these changes
and the alterations in drug dosages that are
needed for the elderly patient.
• Discuss the types of adverse drug reactions
that may occur when normal adult dosages
of some medications are given, rather than
dosages adjusted for the altered physiology
of the elderly patient.
• Divide the class into six groups and assign
each group one of the following drug
classes:
• Analgesics
Using a drug reference, ask each group to
choose two common medications from its
particular group and develop two patient
information sheets for each, one for a
middle-aged adult and one for an older
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Review current
guidelines for use of medications in the
elderly online. Post here a synopsis of what
you were able to find out. Make sure to
include references.
26 Chapter 11 The Older Patient _______________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 11.2
Critical Thinking Question
An 86-year-old woman lives independently and takes several medications, including aspirin,
Lanoxin, Lasix, Diabeta, calcium, and Estrace. However, she cannot remember which pill is
which and if she took the right ones at the right time. Her family believes she is forgetful
about her medications because she is anxious about taking so many. Although the woman
says that she has never been a “detail person,” she worked as an office manager before
retirement. Her former position required many organizational skills such as keeping lists,
inventories, and scheduling. How can a nurse help this patient remember her medications
and when to take them?
Discussion Guidelines: This is a common problem with older adults. Fortunately, community
health professionals are quite knowledgeable about providing such assistance. The nurse should
Instructor Notes/Student Feedback
______________________________________________________________ Chapter 11 The Older Patient 27
Introduction to Medical-Surgical Nursing, 6th ed.
11
Assessments for
The Older Patient
CHAPTER OBJECTIVES
Lesson 11.1:
1. Describe the roles of the gerontological nurse.
3. Describe biologic and physiologic factors associated with aging.
Lesson 11.2:
5. Explain why drug dosage adjustments may be needed for older persons.
Assessments by Lesson & Objective
Study Guide
• Part IIB: 18 (p. 55)
Evolve Instructor Resources
• Test Bank: 3
Evolve Student Resources
Study Guide
• Part IIB: 1-3, 5, 7 (p. 54)
Evolve Instructor Resources
• Test Bank: 1, 2, 4, 5
Evolve Student Resources
• NCLEX Review: 4, 8
Study Guide
• Part IA: 1-5 (p. 53)
• Part IIB: 4, 7-12, 15-17 (pp. 54-55)
• Part IIIC: 2-7 (pp. 55–56)
Evolve Instructor Resources
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
Lesson 11.2
• NCLEX Review: 10
Study Guide
• Part IIB: 13 (p. 55)
• Part IIIC: 11 (p. 56)
Evolve Instructor Resources
• Test Bank: 21
Evolve Student Resources
Study Guide
• Part IA: 6 (p. 54)
• Part IIB: 14 (p. 55)
• Part IIIC: 8-10 (p. 56)
Evolve Instructor Resources
• Test Bank: 23
Evolve Student Resources
• NCLEX Review: 2, 3
Instructor’s Notes/Student Feedback