• Grief: define and describe the physical symptoms, psychological and social responses and its spiritual aspects.
  • Summarize the types of grief.
  • Although death is a universal human experience, please specify culture-specific considerations that exist regarding attitudes toward the loss of a loved one, including age (child or older adult) and cause of death.

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

  

Supplemental Materials & Resources

Visit the CINAHL Complete under the A-to-Z Databases on the University Library’s website and locate the articles below:

  1. Ellington, L., Reblin, M., Clayton, M. F., Berry, P., & Mooney, K. (2012). Hospice Nurse Communication with Patients with Cancer and their Family Caregivers.Journal of Palliative Medicine,15(3), 262–268.
  2. Duke, G., Thompson, S. & Hastie, M. (2007). Factors influencing completion of advanced directives in hospitalized patients. Journal of Palliative Nursing, 13(1), 39-43.
  3. Bockhold, C., Hughes, R., & Ashley, K. (2016). The ethics of opioids for chronic noncancer pain. Nursing 2016, 46(10), 63-67.

Chapter 28

Cancer

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Risk for developing cancer increases with age.

Adults over the age of 65 account for 60% of all new cancer diagnosis.

Most common cancers in older adults are: (1) lung cancer, (2) prostate and breast cancers, and (3) colon and rectal cancers.

Introduction

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2

The number of new cases in a given time period, usually a year, in general population

Leading types of cancer in men are lung, prostate, and colorectal.

Leading types of cancer in women are lung, breast, and colorectal.

Many persons survive cancer.

Some cancers have relatively high incidence rates and relatively low death rates.

Cancer Incidence

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3

Racial and ethnic group age cohorts demonstrate different patterns of cancer incidence.

Examination of patterns of cancer among racial or ethnic groups should include age and environmental considerations.

Race and ethnicity are highly correlated with socioeconomic status.

Racial and Ethnic Patterns

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4

4

Cancer is a disease of aging.

Cancer develops from “genetic mutations that are either inherited or acquired through errors in DNA replication and environmental insults.”

Cancer results from cancer stem cells (CSCs) that retain their ability to proliferate repeatedly without losing their ability to initiate uncontrolled growth, leading to cancer.

Aging and Relationship to Cancer

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5

5

Process of cancer growth is believed to occur in four steps: tumor initiation, tumor promotion, malignant conversion, and tumor progression.

Oncogenes are genes that produce abnormal codes for growth-regulating substances and are believed to play a role in the development of cancers because, once activated, they interfere with normal physiologic regulation of cell growth.

Oncogenes can cause improper regulation of cell growth, leading to cancerous transformation in normal cells.

Cancer Growth and Development

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6

6

The study of what genes do and their interaction with each other

Cancer genome research studies the differences in genes found in tumors to understand which ones cause development and proliferation of a tumor.

Different genes are involved in different tumor types.

Learning which genes cause certain cancer has led to impro

Chapter 29

Loss and End-of-Life Issues

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Employment to retirement

Lifelong home to a smaller home or senior apartment

Very active to being less so

Health to chronic illness

Marriage to widowhood

Extensive social networks to smaller circles of family and friends

Losses Associated With Aging

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2

Successful aging requires learning to deal with losses and adapting to changes over time

2

Loss: broad term that connotes losing or being deprived of something such as one’s health, home, or a relationship

Bereavement: the state or situation of having experienced a death-related loss

Grief: one’s psychologic, physical, behavioral, social, and spiritual reactions to loss

Mourning: used to refer to ritualistic behaviors in which people engage during bereavement

Definitions

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3

Life transitions such as retirement, ill health, and death of loved ones evoke varying responses of grief.

Many older adults experience multiple losses with little time for grieving between losses.

Individual coping styles, support systems, ability to maintain a sense of control, griever’s health status, and spiritual beliefs all influence responses to multiple losses.

Response to Multiple Losses

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4

4

Bereavement includes grief and mourning.

Death of a spouse is most significant loss.

Surviving spouses must take on new responsibilities while coping with the loss.

Perceived social support after death of a spouse has been shown to be a factor affecting adjustment of many surviving spouses.

Other factors: ambivalent or dependent relationships, mental illness, low self-esteem, and multiple prior bereavements

Bereavement

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5

Bereavement adjustments are multidimensional.

It is a highly stressful process.

The overall effect on the physical and mental health is not as devastating as expected.

Older bereaved spouses commonly experience both positive and negative feelings simultaneously.

Loneliness and problems with the tasks of daily living are two of the most common and difficult adjustments.

The process is most difficult in the first several months.

Much diversity in how older adults adjust to the death of a spouse

Bereavement Experiences of
Older Persons

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6

Chapter 27

Chronic Illness and Rehabilitation

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1

Chronic disease affects physical, psychologic, and social aspects of lives of individuals and families.

Many with chronic illness become homebound; decreased outside contact leads to social isolation.

Chronic disease is the leading cause of death and disability in the United States.

Chronic Disease

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2

Disease refers to a condition viewed from a pathophysiologic model, such as an alteration in structure and function; it is a physical dysfunction of the body.

Illness is what the individual (and family) are experiencing, how the disease is perceived, lived with, and responded to by individuals and families.

Disease vs. Illness

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3

Noncommunicable illnesses that are prolonged in duration, do not resolve spontaneously, and are rarely cured completely (Bernall & Howard, 2016)

Nurses need to consider the illness related issues that the patient and family experiences.

Understanding the perception of and response to the disease will allow for a more individualized plan of care.

Chronic Disease Defined

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4

Increase in chronic conditions is caused by: Lifesaving and life-extending technologies not previously available, increase in population of older adults, and increasing life expectancy

The health care system applies the “acute care model” to those individuals with chronic conditions, and as a result, the needs of older adults and what the system can provide do not match.

This results in fragmented care, inadequate or inappropriate care from the system, and dissatisfaction on the part of the patient.

Chronic Conditions

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5

The State of Aging and Health in America (CDC, 2013) reports two out of three older Americans have multiple chronic diseases and account for 66% of the health care budget.

Nursing care needs to focus on increasing functional ability, preventing complications, promoting the highest quality of life, and, when the end stage of life occurs, providing comfort and dignity in dying.

Prevalence of Chronic Illness

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6

Include hypertension, hyperlipidemia, heart disease, arthritis, diabetes, chronic kidney disease, ischemic heart disease, dementia, depression, and chronic obstructive pulmonary disease.

Repeated hospitalizations are common to treat exacerbati

Chapter 26

Health Care Delivery Settings and Older Adults

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Most Common Diagnosis-Related Groups (DRGs) in Hospitalized Adults 85+

Heart failure

Pneumonia

Urinary tract infections

Cerebrovascular disorders

Digestive disorders

Gastrointestinal hemorrhages

Nutritional and metabolic disorders

Rehabilitation

Renal failure

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2

Heart disease

Malignant neoplasms

Chronic lower respiratory disease

Cerebrovascular disease

Alzheimer’s disease

Major Causes of Death in
Adults 65+

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3

Arthritis, diabetes mellitus, hypertension, and heart disease are the most prevalent chronic diseases in older adults and are the leading causes of disability.

Chronic Conditions and Disability

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4

Effective caregiving practices can enable older persons to maintain or improve their independence and to return to their preferred setting at discharge.

Focus needs to be on not only the restoration of health but also the promotion and preservation of health.

Focusing on a functional model addresses concerns related to medical and functional stability.

Philosophy of Care in the
Acute Care Environment

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5

Adverse drug reactions—polypharmacy

Falls—Risk factors for hospital falls include intrinsic and extrinsic factors

Infections—UTI, GI, skin, and bloodstream

Hazards of immobility

Unfamiliar environment

Risks of Acute Care Hospitalization

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6

6

All staff members must have competency assessment specific to patient age groups that are being cared for in the assigned area.

Nursing expertise is particularly needed to guide staff in understanding the unique needs of older patients and enhancing their skill in managing common geriatric syndromes.

Advanced practice nurses can develop and implement protocols for managing common geriatric syndromes—like those defined in the geriatric triad.

Nursing-Specific Competency and Expertise

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7

7

Includes falls, changes in cognitive status and incontinence

Falls—may be a classic sign of illness for older adults

A strange environment, confusion, medications, immobility, urinary urgency, and age-related