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Define commonality and what are the barriers of quality care?
- Commonality is the statistical appreciation of differences in the incidence, prevalence, mortality, and burden of disease and other adverse health conditions.
- Barriers to quality care range from those related to geographical location to age, gender, race, ethnicity, and sexual orientation.
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Ex. of health disparities of African Americans in stroke, heart disease, htn, diabetes, amputations, and ischemic attacks.
50% more likely to have stroke
50% more likely to die of stroke
20% more likely to die of heart disease
1.5 times more likely to have hypertension
2.5 times more likely to have diabetes
30% more likely to have diabetes-related amputations
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Ex. of Health Disparities of Mexican Americans and Native Americans
- Mexicans get 2 times more likely to have diabetes mellitus and 36% fewer prescriptions after myocardial infarction
- Native Americans are 5.7 times more likely to have DM than whites living in Hawaii.
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How do you reduce health disparities ?
- Health care providers must be culturally competent
- Culturally proficient: able to move smoothly btw the world of the nurse and the world of the patients and requires cultural awareness and sensitivity, knowledge, and skills
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Culture awareness is:
- Openness
- Recognizing the presences of isms
- Self reflection
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What is cultural knowledge?
- What a nurse brings to caring situations as well as what a nurse learns about older adults, their families, their communities, their behaviors, and their expectations
- Essential knowledge includes elder's way of life
- Sterotyping
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Working with interpreters:
- Interpretations: The process of rendering oral expressions made in one language system into another in a manner that preserves the meaning and tone of the original without adding or deleting anything.
- Respectful Communication: Addressing the person in the appropriate manner. Using body language that is acceptable in the culture.
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Implications for Gerontological Nursing include:
Assessment: listening is key to assessment as nurse tries to understand situation and person, health beliefs, and cultural beliefs
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Cross-Cultural Caring in the Long-term care setting
- Ensuring that resident has access to professional interpreter services if needed
- Developing programs that reflect diversity of residents and staff
- Considering monocultural facilities or units where population demographics warrant
- Employing staff who reflect diversity of residents or clients
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Culture, Nursing, and Maslow's hierarchy of needs
Promoting healthy aging in care of ethnic elders frequently provides gerontological nurse with new challenges, and necessitates different conceptualization of Maslow's hierarchy
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Nutrition and Aging: Adequate Nutrition (3)
- Critical to preserving the health of older people
- An integral part of health, happiness, independence, quality of life, and physical and mental functioning
- All of the essential nutrients are adequately supplied and used to maintain optimal health and well-being
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Major nutrition-related concerns in older adults:
Obesity and Malnutrition
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Factors affection fulfillment of nutritional needs: Age related changes (4)
- Taste
- Smell
- Digestive System
- Regulation of appetite
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Factors affecting fulfillment of nutritional needs: Lifelong Eating Habits
- Socialization
- Income
- Transportation
- Housing
- Dentition
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Implication for Gerontological Nursing and healthy aging:
Assessment: Good oral hygiene and assessment of oral health are essentials of nursing care.
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Implications for gerontological nursing and healthy aging: Interventions
Oral hygiene: When the person is unable to carry out his or her dental/oral regimen, it is the responsibility of the caregiver to provider oral care.
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Implications for Geri Nursing: Hospitalization and Institutional living
- Assessment of nutritional status to identify malnutrition and the risk factors for malnutrition.
- If caloric supplements are used, they should be administered at least one hour before meals or they interfere with meal intake
- Attention to the environment in which meals are served is important.
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Health conditions affecting nutrition: Chronic Diseases (9)
- Osteoporosis
- Gastrointestinal Disorders
- Obesity
- Diabetes
- Cardiovascular and respiratory diseases
- Cancer
- Dysphagia
- Dementia
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Dementia (3)
- Affects adequate nutritional intake, and in late dementia weight loss becomes a considerable concern
- Establishing a routine so the elder does not have to remember times and places for eating
- Serve well-balanced foods and fluids that the person likes and has always eaten.
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Dysphagia (4)
- May occur as a result of neurologic diseases such as stroke, Parkinson's disease, multiple sclerosis, and dementia
- Negative consequences including weight loss, malnutrition, dehydration, and aspiration
- Carries a sevenfold increased risk of aspiration pneumonia
- Classified as oropharyngeal or esophageal
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Implications for gerontological nursing and healthy aging: Assessment
Obtain a careful history of the elders response to dysphagia and observe the person during mealtime
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Interventions (2)
- Suctioning equipment should be available
- Should have supervision at mealtimes.
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Feeding Tube (3)
- A common approach to problems with nutritional intake in older.
- Percutaneous endoscopic gastrostomy (PEG)
- --- Complications: aspiration pneumonia, diarrhea, metabolic problems, and cellulitis
- Nurse and dietician must work closely together to determine the appropriate formula and rate of administer
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Constipation
- Most common GI compliant
- Constipation is a symptom: poor habits, postponed passage of stool, chronic illnesses-- both physical and psychological, side effect of medication
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Assessment (4)
- The precipitants and causes of constipation
- Clarification of what the patient means by constipation
- Bowel history: usual pattern, frequency of bowel movement, size, consistency, and any changes
- Physical examination is needed to rule out systemic causes
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Interventions (8)
- Examine the medications the person is taking
- Fiber
- Exercise
- Positioning during defecation
- regularity
- laxatives
- enemas
- fecal impaction removal
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Protein-Calorie Malnutrition and serious consequences
- Most common form of malnutrition in older adults
- Characterized by the presence of clinical signs and biochemical indicators indicative of insufficient intake
- Serious Consequences: Infections, pressure ulcers, anemia, htn, impaired cognition, hip fractures, and increased mortality and morbidity.
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Nutritional Assessment (4)
- Interview
- Physical examination
- anthropometrical measurements
- biochemical analysis
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Intervention (3)
- Centered on techniques to increase food intake and enhance and manage the environment to promote increased food intake
- Pharmacological therapy
- Patient education
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Application of Maslow's hierarchy
- Food is a basic human need for people of all ages
- Not only does adequate nutrition satisfy biological needs, but also the experience of eating provides opportunities for belonging.
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