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Week 1 Older Adults Cancer-2
Integration of Nursing Concepts (NURS 493)
West Coast University
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Week 1 Older Adults/Cancer
1. Older Adults
- Care Alternatives
1.1. Nursing home: immobile, unable to do ADLs, very sick or rather unstable; need total care; long term; caregiver can no longer provide safe and proper care; 24/7 nursing care
1.1. Assisted living: partial help sometimes; must have good ability to do ADLs; "old people college;" caregivers/med aides present
1.1. Home health: done in own home; nursing care in home; cost-effective for homebound care; PT/OT in home
1.1. Adult Day Care: stay in facility for daytime and go home with family at end of day; need supervision i. dementia pts; helps with socialization
1.1. Rehab: short stay with intense PT/OT/ST services; after surgery; recovering after illness/injury to relearn ADLs, etc;
- Mistreatment
1.2. Neglect: not meeting every day needs; food, water, shelter, safety, dentures, glasses, etch
1.2. Abandonment: leaving them unattended for long periods of time; dropping them off somewhere and never coming back
1.2. Physical: Locking them in a room for long periods of time; bruises, burns, hitting, etc; ask questions but don't automatically assume abuse if bruises present; untreated broken bones,
1.4. Medications: Polypharmacy (multiple meds for multiple illnesses; worry about contraindications, overdose, and interactions); start low, go slow re: dosing; metabolism declines; need to do med recs including vitamins, herbals, OTC, and rx meds; must do med recs at admission, discharge/transfer, and at outpatient doctor's appointments
1.4. Maintain independence!!!!
2. Chronic Illnesses
8 Phases: Onset (s/s present), stable (s/s controlled by tx plan), acute (severe/unrelieved symptoms), comeback (gradual return to acceptable way of life), crisis (life-threatening situation), unstable (dz not under control yet), downward (gradual deterioration), dying (let go of activities and die peacefully)
Tasks: prevent/manage a crisis, carry out treatment plan, reorder time, control sx, adjust to change, prevent social isolation, normalize interactions with others
Prolonged disease; irreversible; perm impairments; deviation from normal; long term management
3. Cancer
- Surgery
3.1. remove cancer completely, control it and remove as much as possible, palliation to provide comfort
- Radiation
3.2. How it works: Kills cancer cells DNA, "burn the bonds."
3.2. Reproductive: can damage repro organs; talk to fertility counselor; wear lead
aprons/diapers
3.2. Integumentary: Desquamation occurs; dry desquamation: looks like reddened area; wet desquamation: broken skin, appears weepy/oozing; dry desquamation: aloe vera, nonperfume and moisturizing lotion (cerave, aquaphor); wet desquamation: clean it and place vaseline gauze; no heat on skin or sun exposure; no cold packs; no tight clothing on area
3.2. Pulmonary: if present, use bronchodilators and oxygen as needed; sx don't mean getting sicker necessarily; rest periods and sit upright
3.2. Brachytherapy: internal radiation; pt is radioactive; limit exposure to pt to 30 mins, no children or pregnant women; use own bathroom and own silverware; proper disposal of solid linens; bodily fluids are radioactive; nurses wear dosimeter and lead apron
- Chemotherapy
3.3. How it works: "good poison" that can kill cancer and healthy cells
3.3. Gastrointestinal: nausea/vomiting/diarrhea, loss of appetite, mouth sores (risk of infx, admin magic mouthwash); smaller meals throughout day; high calorie and high protein foods; admin zofran for n/v; monitor electrolytes; keep hydrated; admin low fiber, low residue foods; antidiarrheal meds admin
3.3. Integumentary: hair loss; educate on hair growth after treatment is complete; mentally prepare pt on hair loss; offer hats and wraps; risk of extravasation: meds leaks out of IV and vein and damages peripheral tissue, to prevent use CVAD; or monitor IV for redness, drainage, and complaints of pain (Cut It off, counteract it, and contain it.)
3.3. Hematological: neutropenia (monitor for infx, no fresh flowers, no fresh fruit, no undercooked meat, everything cooked, mask up and wash hands, monitor temp), thrombocytopenia (bleeding precautions, avoid nsaids), and anemia (rest periods, transfuse
