Nursing Care Plans For Atrial Septal Defect

Nursing Care Plans For Patient With Atrial Septal Defect

In patients with an atrial septal defect, an opening between the left atrium and the right atrium allows blood to shunt between the chambers.  Because atrial pressure normally is slightly higher in the left atrium than in the right, blood typically shunts from left to right. The pressure difference may force large amounts of blood through the defect during diastole. If the hole is more than 1/8 (1 cm) in diameter, the atria act as a single chamber.

Most infants with an atrial septal defect have no significant left-to-right shunt and no symptoms because during diastole, blood flows toward the ventricular chamber (usually the right), which has thinner, more compliant walls.

Symptoms of left-to-right shunt typically develop in adolescents and young adults because the left ventricle becomes thicker over the years from increased left ventricular end-diastolic pressure. This increased ventricular resistance forces blood through the defect rather than into the ventricles.

An atrial septal defect is found in about 10% of children who have congenital heart disease and who have lived past their first birthday. It's almost twice as common in females as in males and has a strong familial tendency.

Although an atrial septal defect is benign during infancy and childhood, delayed development of signs and symptoms and complications makes it one of the most common congenital heart defects diagnosed in adolescence and adulthood. Although the prognosis is excellent in asymptomatic people, it's poor in those with cyanosis caused by large, untreated defects.

Causes

The cause of an atrial septal defect is unknown. In this disorder, left-to-right shunt results in right ventricular volume overload, which affects the right atrium, right ventricle, and pulmonary arteries. Eventually, the right atrium enlarges and the right ventricle dilates to accommodate the increased blood volume.

Complications

In some adult patients, fixed (irreversible) pulmonary hypertension causes the shunt to reverse direction; unoxygenated blood enters the systemic circulation, causing cyanosis. Right and left ventricular hypertrophies become significant. Atrial arrhythmias, heart failure, and emboli may occur.

Children with an atrial septal defect seldom develop heart failure, pulmonary hypertension, infective endocarditis, or other complications.

Assessment Nursing Care Plans For Atrial Septal Defect

Small defects typically go undetected in a preschooler, although the child may have a history of fatigue, shortness of breath after extreme exertion, and frequent respiratory tract infections.

A large defect may retard a child's growth. Cyanosis may develop, especially if right ventricular outflow is obstructed. Inspection of the jugular vein may reveal a strong pulse preceded by a systolic collapse. Inspection of the chest wall may reveal left chest prominence. An impulse may be palpable in that area.

In children, auscultation may reveal an early to midsystolic murmur, superficial in quality, heard at the second or third left intercostal space. If the patient has a large shunt the result of increased tricuspid valve flow a low-pitched diastolic murmur at the lower left sternal border can be heard. The murmur becomes more pronounced on inspiration. The intensity of the murmur is a rough indicator of left-to-right shunt size, but its low pitch can make it difficult to hear.

The most diagnostic sounds are a fixed, widely split S1 (caused by delayed closure of the pulmonic valve) and a systolic click or late systolic murmur at the apex (resulting from mitral valve prolapse, which occasionally affects older children with atrial septal defects).

Adult patients with atrial septal defect complain of more pronounced symptoms, such as fatigue and exertional dyspnea. Symptoms may become severe enough to sharply limit the patient's activities, especially after age 40.

If the patient has a large, uncorrected defect and fixed pulmonary hypertension, auscultation reveals an accentuated S2 and, possibly, a pulmonary ejection click and an audible S4. The patient becomes cyanotic and develops clubbed nails; severe pulmonary vascular disease may lead to syncope and hemoptysis.

Diagnostic tests Nursing Care Plans For Atrial Septal Defect

Chest X-rays show an enlarged right atrium and right ventricle, a prominent pulmonary artery, and increased pulmonary vascular markings. The sinus venosus defect is characterized by an absent right superior vena cava shadow and entrance of the horizontal pulmonary vein into the upper right cardiac shadow.

Electrocardiography results may be normal but usually show right-axis deviation, a prolonged PR interval, varying degrees of right bundle-branch block, right ventricular hypertrophy, atrial fibrillation (particularly in severe cases after age 30) and, in patients with ostium primum, left-axis deviation.

Echocardiography shows volume overload on the right side of the heart and is used to measure right ventricular enlargement. It also may be used to locate the defect and estimate the size and direction of the shunt. (Other causes of right ventricular enlargement must be ruled out.)

Cardiac catheterization can be used to confirm an atrial septal defect by demonstrating that right atrial blood is more oxygenated than superior vena caval blood, which indicates a left-to-right shunt. Catheterization also can be used to help determine the degree of shunting and pulmonary vascular disease. Pulmonary artery systolic pressures are usually positive. Dye injection shows the defect's size and location, the location of pulmonary venous drainage, and atrioventricular valve competence. Cardiac catheterization is performed only if inconsistencies in the clinical data exist or if significant pulmonary hypertension is suspected.

Treatment

Operative repair is advised for patients with uncomplicated atrial septal defect and evidence of significant left-to-right shunting. Ideally, this is performed when the patient is between ages 2 and 4. Operative repair shouldn't be performed on a patient with a small defect and trivial left-to-right shunt. Because an atrial septal defect seldom produces complications in infants and toddlers, surgery may be delayed until they reach preschool or early school age. A large defect may need immediate surgical closure with sutures or a patch graft. Alternatively, placement of an atrial occluder during cardiac catheterization is becoming a more common intervention than open-heart surgery.

Diagnoses Nursing Care Plans For Atrial Septal Defect

• Activity intolerance
• Decreased cardiac output
• Deficient knowledge (diagnosis and treatment)
• Fatigue
• Impaired gas exchange
• Risk for infection

Key outcomes Nursing Care Plans For Atrial Septal Defect

• The patient will carry out activities of daily living without weakness or fatigue.
• The patient will maintain hemodynamic stability, and cardiac output will remain adequate.
• The patient or her parents will verbalize understanding of the atrial septal defect and plans for treatment.
• The patient will report that she has more energy.
• The patient will maintain adequate ventilation and oxygenation.
• The patient will remain free from signs and symptoms of infection.

Interventions Nursing Care Plans For Atrial Septal Defect
Encourage the child to engage in any activity she can tolerate. Living as normally as possible is important to avoid illness-dependent behavior patterns.

After surgery

• Closely monitor vital signs, central venous and intra-arterial pressures, and intake and output.
• Watch for atrial arrhythmias.
• Give an antibiotic and an analgesic, as ordered.
• Provide range-of-motion exercises and coughing and deep-breathing exercises.

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Nursing Care Plans For Delusional Disorders

Nursing Care Plans For Patient With Delusional Disorders

DELUSIONAL DISORDERS

According to the DSM-IV-TR, delusional disorders are characterized by false beliefs with a plausible basis in reality. Formerly referred to as paranoid disorders, delusional disorders are known to involve erotomanic, grandiose, jealous, or somatic themes as well as persecutory delusions. Some patients experience several types of delusions; other patients experience unspecified delusions that have no dominant theme.

Delusional disorders commonly begin in middle or late adulthood, usually between ages 40 and 55, but they can occur at a younger age. These uncommon illnesses affect less than 1% of the population; the incidence is about equal in males and women. Typically chronic, these disorders often interfere with social and marital relationships but seldom impair intellectual or occupational functioning significantly.

Causes

Delusional disorders of later life strongly suggest a hereditary predisposition. At least one study has linked the development of delusional disorders to inferiority feelings in the family. Some researchers suggest that delusional disorders are the product of specific early childhood experiences with an authoritarian family structure. Others hold that anyone with a sensitive personality is particularly vulnerable to developing a delusional disorder.

Certain medical conditions are known to exaggerate the risks of delusional disorders: head injury, chronic alcoholism, deafness, and aging. Predisposing factors linked to aging include isolation, lack of stimulating interpersonal relationships, physical illness, and diminished hearing and vision. In addition, severe stress (such as a move to a foreign country) may precipitate a delusional disorder.

Assessment Nursing Care Plans For Delusional Disorders

The psychiatric history of a delusional patient may be unremarkable, aside from behavior related to his delusions. He's likely to report problems with social and marital relationships, including depressive symptoms or sexual dysfunction. In fact, about one-third of delusional patients are widowed, divorced, or separated at the time of first admission. Others describe a life marked by social isolation or hostility. Such patients may deny feeling lonely, relentlessly criticizing or placing unreasonable demands on others.

Also watch for nonverbal cues, indicating suspiciousness or mistrust, such as excessive vigilance or obvious apprehension on entering the room. During questions, the patient may listen intently, reacting defensively to imagined slights or insults. He may sit at the edge of his seat or fold his arms as if to shield himself. If he carries papers or money, he may clutch them firmly.

Diagnostic Nursing Care Plans For Delusional Disorders
Psychiatric examination confirms the presence of the following diagnostic criteria in the DSM-IV-TR:

1. Nonbizarre delusions of at least 1 month's duration are present, involving real-life situations, such as being followed, poisoned, infected, loved at a distance, or deceived by one's spouse or lover.
2.  Auditory or visual hallucinations, if present, aren't prominent.
3. Apart from the delusion or its ramifications, behavior isn't obviously odd or bizarre, and the patient isn't markedly impaired functionally. 
4. If a major depressive or manic syndrome has been present during the delusional disturbance, the total duration of all episodes of the mood syndrome has been brief relative to the total duration of the delusional disturbance.
5. The patient has never met diagnostic criteria for schizophrenia (presence of characteristic psychotic symptoms in the active phase for at least 1 week), and it can't be established that an organic factor initiated and maintained the disturbance.
6. In addition, blood and urine tests, psychological tests, and a neurologic evaluation rule out organic causes of the delusions, such as amphetamine-induced psychoses and Alzheimer's disease. Endocrine function tests are performed to rule out hyperadrenalism, pernicious anemia, and thyroid disorders such as “myxedemic madness

Treatment

Effective treatment of delusional disorders, consisting of a combination of drug therapy and psychotherapy, must correct the behavior and mood disturbances that result from the patient's mistaken belief system. Treatment may also include mobilizing a support system for the isolated, aged patient.

Drug treatment with antipsychotic agents is similar to that used in schizophrenic disorders. Antipsychotics appear to work by blocking postsynaptic dopamine receptors. These drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, and relieve anxiety and agitation. Other psychiatric drugs, such as antidepressants and anxiolytics, may be prescribed to control associated symptoms.

High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low-potency agents. Haloperidol and fluphenazine are depot formulations that are implanted I.M. to release the drug gradually over a 30-day period, improving compliance.

Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard neuroleptic treatment. This agent effectively controls a wider range of psychotic symptoms without the usual adverse effects.

However, clozapine can cause drowsiness, sedation, excessive salivation, tachycardia, dizziness, and seizures, as well as agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia. Routine blood monitoring is essential to detect the estimated 1% to 2% of all patients taking clozapine who develop agranulocytosis. If caught in the early stages, the disorder is reversible.

Diagnoses that may occur in Nursing Care Plans For Delusional Disorders

1. Anxiety
2. Disabled family coping
3. Disturbed personal identity
4. Disturbed sensory perception (visual, auditory)
5. Disturbed thought processes
6. Fear
7. Imbalanced nutrition: Less than body requirements
8. Impaired home maintenance
9. Impaired social interaction
10. Ineffective coping
11. Powerlessness
12. Risk for injury
13. Risk for other-directed violence
14. Risk for self-directed violence
15. Social isolation

Key outcomes Nursing Care Plans For Delusional Disorders

• The patient will consider alternative interpretations of a situation without becoming hostile or anxious.
• The patient and his family will participate in care and prescribed therapies.
• The patient will identify internal and external factors that trigger delusional episodes.
• The patient will maintain functioning to the fullest extent possible within the limitations of his visual or auditory impairment.
• The patient will remain oriented to person, place, time, and situation.
• The patient will express all fears and concerns.
• The patient will show no signs of malnutrition.
• The patient will recognize symptoms and comply with medication regimen.
• The patient will demonstrate effective social interaction skills in both one-on-one and group settings.
• The patient will demonstrate adaptive coping behaviors.
• The patient will identify and perform activities that decrease delusions.
• The patient will remain free from injury.
• The patient won't harm others.
• The patient won't harm self.
• The patient will maintain family and peer relationships.

Interventions Nursing Care Plans For Delusional Disorders

• In dealing with the patient, be direct, straightforward, and dependable. Whenever possible, elicit his feedback. Move slowly, with a matter-of-fact manner, and respond without anger or defensiveness to his hostile remarks.
• Accept the patient's delusional system. Don't attempt to argue with him about what's real.
• Respect the patient's privacy and space needs. Avoid touching him unnecessarily.
• Take steps to reduce social isolation, if the patient allows. Gradually increase social contacts after he has become comfortable with the staff.
• Watch for refusal of medication or food, resulting from the patient's irrational fear of poisoning.
• Monitor the patient carefully for adverse effects of neuroleptic drugs: drug-induced parkinsonism, acute dystonia, akathisia, tardive dyskinesia, and malignant neuroleptic syndrome.

Patient teaching Nursing Care Plans For  Delusional Disorders

• If the patient is taking clozapine, stress the importance of returning weekly to the hospital or outpatient setting to have his blood monitored.
• Emphasize the importance of complying with the prescribed medication treatment. Instruct the patient to report any adverse effects instead of stopping the drug. If he's taking a slow-release formulation, be sure he understands when to return to the physician for his next dose.
• Involve family members in treatment. Teach them how to recognize an impending relapse, and suggest ways to manage symptoms. These include tension, nervousness, insomnia, decreased concentration ability, and loss of interest.

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Nursing Care Plans For Schizophrenia

Nursing Care Plans For Patient With Schizophrenia

Schizophrenia is characterized by disturbances (for at least 6 months) in thought content and form, perception, affect, language, social activity, sense of self, volition, interpersonal relationships, and psychomotor behavior. The DSM-IV-TR recognizes catatonic, paranoid, disorganized, residual, and undifferentiated schizophrenia.

Schizophrenia affects approximately 0.85% of individuals worldwide, with a lifetime prevalence of 1% to 1.5%. Onset of symptoms usually occurs during late adolescence and has an insidious onset and poor outcome. It can progress to social withdrawal, perceptual distortions, chronic delusions, and hallucinations
This disorder produces varying degrees of impairment. As many as one-third of schizophrenic patients have just one psychotic episode and no more after that. Some patients have no disability between periods of exacerbation; other patients need continuous institutional care. The prognosis worsens with each acute episode


Causes For Schizophrenia
Schizophrenia may result from a combination of genetic, biological, cultural, and psychological factors with genetic and environmental insults most associated. For example, some evidence supports a genetic predisposition to this disorder. Close relatives of schizophrenic patients are up to 50 times more likely to develop schizophrenia; the closer the degree of biological relatedness, the higher the risk.

The most widely accepted biochemical hypothesis holds that schizophrenia results from excessive activity at dopaminergic synapses. Other neurotransmitter alterations may also contribute to schizophrenic symptoms.

Numerous psychological and sociocultural causes, such as disturbed family and interpersonal patterns, also have been proposed as possible causes. Schizophrenia has a higher incidence among lower socioeconomic groups, possibly related to downward social drift or lack of upward socioeconomic mobility, and to high stress levels, possibly induced by poverty, social failure, illness, and inadequate social resources. Gestational and birth complications, such as Rh factor incompatibility, prenatal exposure to influenza during the second trimester, and prenatal nutritional deficiencies, have been associated.



Complications For Schizophrenia
Because of disordered thought processes, the schizophrenic patient often neglects personal hygiene or ignores health needs. As a result, the patient has a shorter life expectancy than the general population. Ten percent of schizophrenic patients commit suicide.


Assessment Nursing Care Plans For Schizophrenia
Schizophrenia is associated with a wide variety of abnormal behaviors; therefore, assessment findings vary greatly, depending on both the type and phase of the illness. The individual may exhibit a decreased emotional expression, impaired concentration, and decreased social functioning, loss of function, or anhedonia. Individuals with these particular symptoms (present in one-third of the schizophrenic population) are associated with poor response to drug treatment and poor outcome.

Although behaviors and functional deficiencies can vary widely among patients and even in the same patient at different times, watch for the following characteristic signs and symptoms during the assessment interview:

1. ambivalence coexisting strong positive and negative feelings, leading to emotional conflict
2. apathy
3. clang associations words that rhyme or sound alike used in an illogical, nonsensical manner; for instance, It's the rain, train, pain.
4. concrete thinking inability to form or understand abstract thoughts
5. delusions false ideas or beliefs accepted as real by the patient. Delusions of grandeur, persecution, and reference (distorted belief regarding the relation between events and one's self; for example, a belief that television programs address the patient on a personal level) are common in schizophrenia. Also common are feelings of being controlled, somatic illness, and depersonalization.
6. echolalia meaningless repetition of words or phrases
7. echopraxia involuntary repetition of movements observed in others
8. flight of ideas rapid succession of incomplete and poorly connected ideas
9. hallucinations false sensory perceptions with no basis in reality. Usually visual or auditory, hallucinations may also be olfactory (smell), gustatory (taste), or tactile (touch).
10. illusions—false sensory perceptions with some basis in reality; for example, a car backfiring might be mistaken for a gunshot.
11. loose associations not connected or related by logic or rationality
12. magical thinking belief that thoughts or wishes can control other people or events
13. neologisms bizarre words that have meaning only for the patient
14. poor interpersonal relationships
15. regression return to an earlier developmental stage
16. thought blocking sudden interruption in the patient's train of thought
17. withdrawal disinterest in objects, people, or surroundings
18. word salad illogical word groupings; for example, She had a star, barn, plant. It's the extreme form of loose associations.

Diagnostic criteria Nursing Care Plans For Schizophrenia

Complete physical and psychiatric examinations rule out an organic cause of schizophrenic symptoms such as an amphetamine-induced psychosis. Diagnosis rests on fulfilling the criteria in the DSM-IV-TR.

Several tests, including brain imaging studies, tissue studies, functional and metabolic studies, and psychological tests, can be helpful in the diagnosis of schizophrenia

Treatment For Schizophrenia

In schizophrenia, treatment focuses on meeting both the physical and psychosocial needs of the patient based on his previous level of adjustment and his response to medical and nursing interventions. Treatment typically includes a combination of drug therapy, long-term psychotherapy for the patient and his family, vocational counseling, and the use of community resources

The primary treatment (for more than 30 years), antipsychotic drugs (sometimes called neuroleptic drugs) appear to work by blocking postsynaptic dopamine receptors. These antipsychotic drugs reduce the incidence of psychotic symptoms, such as hallucinations and delusions, as well as relieve anxiety and agitation. Other psychiatric drugs, such as antidepressants and anxiolytics, may also be prescribed to control associated signs and symptoms.

Some antipsychotic drugs cause numerous adverse reactions, several of which are irreversible. Most experts admit that patients who are withdrawn, isolated, or apathetic show little improvement after this drug treatment.

High-potency antipsychotics include fluphenazine, haloperidol, thiothixene, and trifluoperazine. Loxapine, molindone, and perphenazine are intermediate in potency, and chlorpromazine and thioridazine are low in potency. Haloperidol and fluphenazine are depot formulations that are implanted I.M. to provide gradual release over a 30-day period, thus improving compliance.

Risperidone (Risperdal), ziprasidone (Geodon), and olanzapine (Zyprexa) are atypical antipsychotic agents used to treat both the positive and negative symptoms of schizophrenia. A newer drug, aripiprazole (Abilify), is a dopamine system stabilizer that also shows promise in treating both the positive and negative symptoms of schizophrenia. Clozapine, which differs chemically from other antipsychotic drugs, may be prescribed for severely ill patients who fail to respond to standard treatment. This agent effectively controls a wider range of signs and symptoms without the usual adverse effects. However, clozapine can cause drowsiness, sedation, excessive salivation, hyperglycemia, tachycardia, dizziness, seizures, and agranulocytosis, a potentially fatal blood disorder characterized by a low white blood cell count and pronounced neutropenia.

Routine blood monitoring is essential to detect the estimated 1% to 2% of all patients taking clozapine who develop agranulocytosis. If the disorder is caught in the early stages, agranulocytosis is reversible.

Clinicians disagree about the effectiveness of psychotherapy in treating schizophrenia. Although a patient who has experienced a single acute psychotic episode may respond, psychotherapy is often futile in a patient with a long history of chronic disease. Nonetheless, some physicians use it as an adjunct to reduce loneliness, isolation, and withdrawal and enhance productivity.

Other studies suggest that psycho-education and social skills training are a more productive approach for the chronic schizophrenic. Besides improving understanding of the disorder, these methods teach the patient and his family coping strategies, effective communication techniques, and social skills such as grocery shopping.

Because schizophrenia is so disruptive to the family, all members may require psychotherapy. Family therapy can reduce guilt and disappointment as well as improve acceptance of the patient and his bizarre behavior.

Diagnoses Nursing Care Plans For Schizophrenia

• Anxiety
• Bathing or hygiene self-care deficit
• Disabled family coping
• Disturbed body image
• Disturbed personal identity
• Disturbed sensory perception (auditory, visual, kinesthetic)
• Disturbed sleep pattern
• Disturbed thought processes
• Dressing or grooming self-care deficit
• Fear
• Hopelessness
• Imbalanced nutrition: Less than body requirements
• Impaired home maintenance
• Impaired social interaction
• Impaired verbal communication
• Ineffective coping
• Ineffective role performance
• Powerlessness
• Risk for injury
• Risk for other-directed violence
• Risk for self-directed violence
• Social isolation

Key outcomes Nursing Care Plans For Schizophrenia

1. The patient will consider an alternative interpretation of a situation without becoming unduly hostile or anxious.
2. The patient will perform bathing and hygiene activities to the fullest extent possible.
3. The patient's family will demonstrate adaptive coping behaviors.
4. The patient will verbalize positive feelings about self.
5. The patient will identify internal and external factors that trigger delusional episodes.
6. The patient will maintain maximum functioning within the limits of his auditory, visual, or kinesthetic impairment.
7. The patient will resume appropriate rest and activity patterns.
8. The patient will identify and perform activities that decrease delusions.
9. The patient will perform dressing and grooming activities to the fullest extent possible.
10. The patient will express fears and concerns.
11. The patient and his family will participate in care and prescribed therapies.
12. The patient will remain free from signs of malnutrition.
13. The patient will develop effective coping behaviors.
14. The patient will maintain usual roles and responsibilities to the fullest extent possible.
15. The patient will recognize symptoms and comply with medication regimen.
16. The patient will demonstrate effective social interaction skills in both one-on-one and group settings.
17. The patient will express his needs.
18. The patient will gradually join in self-care and the decision-making process.
19. The patient will remain free from injury.
20. The patient won't harm others.
21. The patient won't harm self or others.
22. The patient will maintain family and peer relationships.

Interventions Nursing Care Plans For Schizophrenia

1. Assess the patient's ability to carry out the activities of daily living, paying special attention to his nutritional status. Monitor his weight if he isn't eating. If he thinks that his food is poisoned, allow him to fix his own food when possible, or offer him foods in closed containers that he can open. If you give liquid medication in a unit-dose container, allow the patient to open the container.
2. Maintain a safe environment, minimizing stimuli. Administer medication to decrease symptoms and anxiety. Use physical restraints according to your facility's policy to ensure the patient's safety and that of others.
3. Adopt an accepting and consistent approach with the patient. Don't avoid or overwhelm him. Keep in mind that short, repeated contacts are best until trust has been established.
4. Avoid promoting dependence. Meet the patient's needs, but only do for the patient what he can't do for himself.
5. Reward positive behavior to help the patient improve his level of functioning.
6. Engage the patient in reality-oriented activities that involve human contact: inpatient social skills training groups, outpatient day care, and sheltered workshops. Provide reality-based explanations for distorted body images or hypochondriacal complaints. Clarify private language, autistic inventions, or neologisms, explaining to the patient that what he says isn't understood by others. If necessary, set limits on inappropriate behavior.
7. If the patient is hallucinating, explore the content of the hallucinations. If he has auditory hallucinations, determine if they're command hallucinations that place the patient or others at risk. Tell the patient you don't hear the voices but you know they're real to him. Avoid arguing about the hallucinations; if possible, change the subject.
8. Don't tease or joke with the patient. Choose words and phrases that are unambiguous and clearly understood. For instance, a patient who's told, That procedure will be done on the floor, may become frightened, thinking he is being told to lie down on the floor.
9. Don't touch the patient without telling him first exactly what you're going to do. For example, clearly explain to him, I'm going to put this cuff on your arm so I can take your blood pressure. If necessary, postpone procedures that require physical contact with facility personnel until the patient is less suspicious or agitated.
10. Remember, institutionalization may produce new symptoms and handicaps in the patient that aren't part of his diagnosed illness, so evaluate symptoms carefully.
11. Mobilize community resources to provide a support system for the patient and reduce his vulnerability to stress. Ongoing support is essential to his mastery of social skills.
12. Encourage compliance with the medication regimen to prevent relapse. Also monitor the patient carefully for adverse effects of drug therapy, including drug-induced parkinsonism, acute dystonia, akathisia, tardive dyskinesia, and malignant neuroleptic syndrome. Make sure you document and report such effects promptly.

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NURSING CARE OF OLDER ADULTS

Geriatrics, the study of old age, includes the physiology, pathology, diagnosis, and management of the diseases of older adults. The broader field of gerontology, or the study of the aging process, draws from the biologic, psychological, and sociologic sciences.

Because hospitalized patients are being discharged to home “quicker and sicker” than ever before, nurses in all settings, including hospital, home care, rehabilitation, and outpatient settings, need to be knowledgeable about geriatric nursing principles

and skilled in meeting the needs of elderly patients.

Gerontologic or geriatric nursing is the field of nursing that specializes in the care of the elderly. The Standards and Scope of Gerontological Nursing Practice were originally developed in 1969 by the American Nurses Association; they were revised in 1976 and again in 1987. The nurse gerontologist can be either a specialist or a generalist offering comprehensive nursing care to older persons by combining the basic nursing process of assessment, diagnosis, planning,

implementation, and evaluation with a specialized knowledge of aging. Currently, nurses from all nursing programs, including vocational programs (LPN/LVN), traditional hospital programs,

and college degree programs (ADN/BSN), as well as master’s prepared advanced practice nurses (clinical nurse specialists, nurse practitioners, and nurse anesthetists), care for older adults. Gerontologic nursing is provided in acute care, skilled and assisted living, community, and home settings. Its goals include promoting and maintaining functional status and helping older adults to identify and use their strengths to achieve optimal

independence. The nurse helps the older person to maintain dignity and maximum autonomy despite physical, social, and psychological losses. The nurse who becomes certified in gerontologic

nursing has specialized knowledge in the acute and chronic changes specific to older people. The use of advanced practice nurses (APNs) in long-term care has proved to be very effective:

when APNs using current scientific knowledge about clinical problems interface with nursing home staff, significantly less deterioration in affect and overall health issues has been demonstrated (Ryden et al., 2000). Because old age is a normal occurrence that encompasses all experiences of life, care and concern for the elderly cannot be limited to one discipline, but is best provided through a cooperative effort. An interdisciplinary team, through comprehensive geriatric assessment, can combine expertise and resources to provide insight into all aspects of the aging process. Nurses collaborate with the interdisciplinary team to obtain non-nursing services and provide a holistic approach to care.

from: Brunner and Suddarth's Textbook of Medical-Surgical Nursing

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