APPENDIX A

American Nurses' Association Standards of Gerontological

Nursing Practice*

Standard I

Data collected about the health status of the older adult are systematically and continuously. The data are accessible, commu­nicated and recorded.

Standard II

Nursing diagnoses are derived from the identified normal responses of the individual to ageing and the data collected about the health status of the older adult.

Standard III

A plan of nursing care is developed in conjunction with the older adult and/or significant others, that includes goals derived from the nursing diagnosis.

Standard IV

The plan of nursing care includes priorities and prescribed nursing approaches, and measures to achieve the goals derived from the nursing diagnosis.

• American Nurses' Association. 1976. Standards of Gerontological Nursing Practice. Kansas City, MO: American Nurses' Association.

165

Standard V

The plan of care is implemented, using appropriate nursing actions.

Standard VI

The older adult and/or significant other(s) participate in determin­ing the process attained in the achievement of established goals.

Standard Vll

The older adult and/or significant others participate in the ongoing process of assessment, the setting of new goals, the reordering of priorities, the revision of plans for nursing care, and the initiation of new nursing actions.

166

APPENDIX B

Approved nursing diagnoses (North American Nursing Diagnosis

Association-NANDA) 1990

Activity intolerance Activity intolerance, potential Adjustment, impaired Airway clearance, ineffective Altered nutrition: more than body requirements Altered nutrition: less than body requirements Altered nutrition: potential for more than body requirements Altered protection Anxiety Aspiration, potential for Body image disturbance Body temperature, altered: potential Bowel incontinence Breast feeding, effective Breast feeding, ineffective Breathing pattern, ineffective Cardiac output, decreased Communication, impaired: verbal Constipation Constipation, colonic Constipation, perceived Coping, defensive Coping, family: potential for growth Coping, ineffective family: compromised Coping, ineffective family: disabling Coping, ineffective individual Decisional conflict (specify)

167

Denial, ineffective Diarrhoea Disuse syndrome, potential for Diversional activity deficit Dysreflexia Family processes, altered Fatigue Fear Fluid volume deficit Fluid volume deficit, potential Fluid volume excess Gas exchange, impaired Grieving, anticipatory Grieving, dysfunctional Growth and development, altered Health maintenance, altered Health-seeking behaviours (specify) Home maintenance management, impaired Hopelessness Hyperthermia Hypothermia Infection, potential for Injury, potential for Knowledge deficit (specify) Mobility, impaired physical Noncompliance (specify) Oral mucous membrane, altered Pain Pain, chronic Parental role conflict Parenting, altered Parenting, altered: potential Personal identity disturbance Poisoning, potential for Post-trauma response Powerlessness Rape-trauma syndrome Rape-trauma syndrome: compound reaction Rape-trauma syndrome: silent reaction Role-performance, altered Self-care deficit: bathing/hygiene Self-care deficit: dressing/grooming

168

Self-care deficit: feeding Self-care deficit: toileting Self-esteem disturbance Self-esteem, low: chronic Self-esteem, low: situational Sensory-perceptual alterations: visual, auditory, kinaesthetic, gustatory, tactile, auditory (specify) Sexual dysfunction Sexuality, altered patterns Skin integrity, impaired Skin integrity, impaired: potential Sleep pattern disturbance Social interaction, impaired Social isolation Spiritual distress (distress of the human spirit) Suffocation, potential for Swallowing, impaired Thermoregulation, impaired Thought processes, altered Tissue integrity, impaired Tissue perfusion, altered: renal, cerebral, cardiopulmonary, gastro­intestinal, peripheral (specify type) Trauma, potential for Unilateral neglect Urinary elimination, altered Urinary incontinence, functional Urinary incontinence, reflex Urinary incontinence, stress Urinary incontinence, total Urinary incontinence, urge Urinary retention Violence, potential for: self-directed or directed at others

169

NOTES AND REFERENCES

Introduction

I Bury, M. and Holme, A. 1991. Life after Ninety. London: Routledge, I. 2 Coni, N., Davison, W. and Webster, S. 1988. Lecture Notes on

Geriatrics (3rd edn). Oxford: Blackwell Scientific Publications, 19. 3 Guardian, 8 May 1991 (Society Today). 4 Project 2000: A new Preparation for Practice. 1986. London: UKCC.

Chapter 1

I For a discussion of various classifications of ADLs, see Twining, C. 1991. Quality of Life: Assessment and Improvement. In Denham, M. J. (ed.), Care of the Long-Stay Elderly Patient (2nd edn). London: Chapman and Hall.

2 Sendell, B. and Hunt, P. 1987. Nursing the Adult with a Specific Physiological Disturbance (2nd edn). London: Macmillan.

3 Booth, B. 1990. Does it really matter at that age? Nursing Times 86(3), 5(}-2.

Chapter 2

I Morton, P. G. (ed.) 1990. Health Assessment (Nurse's Clinical Guide). Springhouse, Pa.: Springhouse Corporation.

2 Eliopoulos, C. 1984. Health Assessment of the Older Adult. Reading, Mass.: Addison-Wesley.

3 Coni, N., Davison, W. and Webster, S. 1988. Lecture Notes on Geriatrics (3rd edn). Oxford: Blackwell Scientific Publications, 19.

4 Storer, R. 1985. The gastrointestinal system - the oral tissues. In Brocklehurst, J. C. (ed.) 1985. Textbook of Geriatric Medicine and Gerontology (3rd edn). Edinburgh: Churchill Livingstone.

5 Thurlbeck, W. M. 1981. The ageing lung. In Scadding, J. G. and Cumming, G. (eds), Scientific Foundations of Respiratory Medicine. London: Heinemann.

6 Armstrong, M. and Cleary, M. 1982. Physiology of Ageing, Part II. Villanova, Pa.: ProScientia.

7 Interpreting arterial blood gases. 1980. American Journal of Nursing 80 (12), 2197-2201.

170

8 Carotenuto, R. and Bullock, J. 1980. Physical Assessment of Gerontological Client. Philadelphia, Pa.: Davis.

9 Malasanos, L., Barkauskas, V., Moss M. and Stoltenberg-Allen, K. 1981. Health Assessment. St. Louis, Miss.: Mosby.

10 Walsh, M. and Ford, P. 1989. Nursing Rituals: Research and Rational Actions. Oxford: Heinemann Nursing.

11 Caird, F. 1., Dall, J. L. C. and Williams, B. 0. 1985. The cardiovascular system. In Brocklehurst, J. C. (ed.), Textbook of Geriatric Medicine.

12 Matteson, M.A. and McConnell, E. S. (eds) 1988. Gerontological Nursing: Concepts and Practice. Philadelphia, Pa.: W. B. Saunders.

13 Dayan, A. D. and Lewis, P. D. 1985. The central nervous system -neuropathology of ageing. In Brocklehurst, J. C. (ed.), Textbook of Geriatric Medicine.

14 Alcott, D. 1990. Normal ageing. In Stokes, G. and Goudie, F., Working with Dementia. Bicester, Oxon.: Winslow Press.

I 5 An excellent text, which covers the subject of memory and the older person comprehensively, is by Twining, C. 1991. The Memory Handbook. Bicester, Oxon.: Winslow Press.

16 Estimates vary between texts, from definite percentages to general statements, hedged with qualifications. For example, in Martin, A. and Gambrill, E. C. 1986. Geriatrics. Lancaster: MTP Press, the authors state that 'psychiatric disorders' in the over-65s is 'around 5%', rising to 'over 20%' by age 80; but Post reviews a large number of surveys, without giving any definitive estimates, in Post, F. 1985. The central nervous system - the emotional disorders. In Brocklehurst J. C. (ed.) Textbook of Geriatric Medicine.

17 Malasanos et al. 1981. Health Assessment. 18 Goudie, F. 1990. Intellectual and behavioural assessment. In Stokes, G.

and Goudie, F. Working with Dementia. 19 Pathy, M.S. J. 1985. The central nervous system- clinical presentation

and management of neurological disorders in old age. In Brocklehurst, J. c. (ed.).

20 Ibid. 21 Blacklock, N.J. 1985. The genitourinary system - the prostate. In

Brocklehurst, J. C. (ed.) Textbook of Geriatric Medicine. 22 In the editor's opinion, the best book on this subject to have been

published to date is by Gibson, H. B. 1992. The Emotional and Sexual Lives of Older People- A Manual for Professionals. London: Chapman and Hall.

23 Bellack, J. and Bamford, P. 1984. Nursing Assessment: A Multi­dimensional Approach. Monterey, Calif.: Wadsworth Health Science Division.

24 Sundwall, D., Rolando, J. and Thome, G. 1981. Endocrine and metabolic function. In O'Hara-Devereaux, M., Andrus, L. and Scott, C. (eds) 1981. Eldercare. New York: Grune and Stratton.

25 For a comprehensive discussion of theories of ageing, see ch. 5 of Matteston, M.A. and McConnell, E. S. 1988. Gerontological Nursing.

26 Davies, I. 1985. Biology of ageing - general principles. In Brocklehurst, J. C. Textbook of Geriatric Medicine.

171

Part 0 Introduction Nursing Times commissioned two articles in 1992 about the possible use of nursing diagnoses in this country: one for, and one against. They are: Booth, B. One step forward ... and Webb, C. ... Or two steps back? Nursing Times 88 (7), 32-4.

2 Orem, D. 1985. Nursing: Concepts of Practice (3rd edn). New York: McGraw-Hill.

3 Marks-Maran, D. 1983. Can nurses diagnose? Nursing Times 19 (4), 68-9.

4 Roper, N., Logan, W. W. and Tierney, A.J. 1985. The Elements of Nursing. Edinburgh: Churchill Livingstone.

5 Miller, J., Steele, K. and Boisen, A. 1987. The impact of nursing diagnoses in a long-term setting. Nursing Clinics of North America 22(4), 905--15.

6 Field, P. A. 1990. The impact of nursing theory on the clinical decision­making process. In lsmeurt, R. L., Arnold, E. N. and Benner Carson, V. (eds) 1990. Concepts Fundamental to Nursing. Springhouse, Pa.: Springhouse Corporation.

7 Omaha VNA Problem Classification Scheme. 1991. In Carlson, J. H., Craft, C. A., McGuire, A. D. and Pop kess-Vawter, S. Nursing Diagnosis: A Case Study Approach. Philadelphia, Pa.: Saunders.

8 The North American Nursing Diagnosis Association (NANDA) has been working towards a standardisation of nursing diagnosis categories since 1973.

9 Although it is not easy reading, the text by Carlson et a/. mentioned in Note 7 above is.a comprehensive guide to the whole subject. A good introduction to the use of nursing diagnoses in elderly care is: Maas, M. Buckwalter, K.C. and Hardy, M. (eds) 1991. Nursing Diagnoses and Interventions for the Elderly. Redwood City, Calif.: Addison-Wesley Nursing.

Chapter 3

I Schoenbaum, S.C., McNeil, B.J. and Kavet, J. 1976. The swine­influenza decision. The New England Journal of Medicine 295, 759---{;5.

2 Fox, R. A. 1985. Immunology of ageing. In Brocklehurst, J. C. (ed.): Textbook of Geriatric Medicine and Gerontology. Edinburgh: Churchill Livingstone, 96--7.

3 Parkin, D. 1985. Revise Nursing RGN. London: Letts, 15. 4 A clearly-written, step-by-step guide to relaxation techniques can be

found in King, P. 1990. Living with stroke. Manchester University Press, ch. 7.

5 Freeman, E. 1985. The respiratory system. In Brocklehurst, J. C. Textbook of Geriatric Medicine. 15Q-l.

Chapter 4 I Booth, B. 1990. Aggressive treatment and the elderly. Nursing Standard

4(26), 29-31.

172

2 Eliopolous, C. Gerontological Nursing. New York: Harper & Row, 143. 3 Kintzel, K. Advanced Concepts in Clinical Nursing (2nd ed.).

Philadelphia, Pa.: Lippincott, 503. 4 Howser, D. 1976. Ice water for MI patients! Why not? American

Journal of Nursing, 16 (3), 432-4. 5 Carotenuto, R. and Bullock, J. 1980. Physical Assessment of the

Geronto/ogic Client. Philadelphia, Pa.: Davis, 95. 6 Hooker, S. 1990. Caring for Elderly People (2nd edn). London:

TavistockfRoutledge, 113. 7 British Medical Association/Royal Pharmaceutical Society of Great

Britain: (1991). British National Formulary.

Chapter 5

I Martin, A. and Gambrill, E. C. Geriatrics. Lancaster: MTP Press, 97-8. 2 Norton, C. 1991. Eliminating. In Redfern, S. J. (ed.): Nursing Elderly

People (2nd edn). Edinburgh: Churchill Livingstone, 193. 3 Ibid. 195.

Chapter 6

I Walsh, M. and Ford, P. 1989. Nursing: Rituals, Research and Rational Actions. Oxford: Heinemann Nursing, 113.

2 Morgan, W. Thomas, C. and Schuster, M. 1981. Gastrointestinal system. In O'Hara-Devereaux, M. (eds), Eldercare. New York: Grune and Stratton, 203.

3 Brick and Amory (1950), cited in Dymock, I. W. 1985. The gastro­intestinal system - the upper gastrointestinal tract. In Brocklehurst, J. C. Textbook of Geriatric Medicine, 512.

4 Billings, D. and Stokes, L. 1982. Medical- Surgical Nursing. StLouis,: Miss. Mosby, 977.

5 Hyams, D. E. and Fox, R. A. 1985. The gastrointestinal system - the liver and biliary system. In Brocklehurst, J. C. Textbook of Geriatric Medicine, 516.

6 Morgan et a/, 1981. Gastrointestinal System, 202. 7 Mager-O'Connor, E. 1984. How to identify and remove faecal

impactions. Geriatric Nursing, S (3), 158-61.

Chapter 7

Exton-Smith, A. N. 1985. The musculoskeletal system - bone ageing and metabolic disease. In Brocklehurst J. C. Textbook of Geriatric Medicine, 160.

2 Richards, M. 1982. Osteoporosis. Geriatric Nursing, 3 (2), 98-102. 3 Rossman, I. 1981. Human ageing changes. In Burnside, I. M. (ed.),

Nursing and the Aged (2nd edn) New York: McGraw-Hill, 39. 4 Keene, J. and Anderson, C. Hip fractures in the elderly. Journal of the

American Medical Association, 248 (5), 564--7.

173

Chapter 8

I Atkinson, D. (director of the Chest, Heart and Stroke Association), in Swaffield, L. 1990. Stroke - the Complete Guide to Recovery and Rehabilitation. Wellingborough: Thorsons, 6.

2 Williams, M. 1987. Aphasia. In Gregory, R. L. (ed.); The Oxford Companion to the Mind. Oxford University Press.

3 WHO. 1971. Cerebrovascular Diseases: Prevention, Treatment and Rehabilitation. WHO Technical Report Series, no. 469.

4 WilJiams, H. McDonald, E., Daggett, M., Schut, B. and Buckwalter, K. 1983. Treating dysphagia. Journal of Gerontological Nursing, 9(12), 638-47.

5 Andrews, K. 1987. Rehabilitation of the Older Adult. London: Edward Arnold, 305--6.

6 Farber, S. 1982. Neurorehabilitation: A Multisensory Approach. Philadelphia, Pa.: Saunders, 258.

7 WilJiams, M. 1987. Aphasia. 8 Rosenzweig, M. R. and Leiman, A. L. 1982. Physiological Psychology.

Lexington, Mass. DC Heath, 652. 9 Weitzel, E. A. 1991. Unilateral neglect. In Maas, M. Buckwalter, K. C.

and Hardy, M. (eds); Nursing Diagnoses and Interventions for the Elderly. Redwood City, Cal.: Addison-Wesley Nursing, 393.

10 Sagar, H. 1991. Parkinson's Di.sease. London: Optima, 36. II Ibid., 71. 12 Ibid., 56. 13 Wolanin, M. and PhilJips. L. 1981. Confusion: Prevention and Care. St

Louis, Miss.: Mosby. 14 Riordan, J. and Whitmore, B. 1990. Living with Dementia. Manchester

University Press, 136. 15 Ibid., 135. 16 Neshkes, R. E. and Jarvik, L. F. 1985. The central nervous system­

dementia and delirium in old age. In Brocklehurst, J. C. Textbook of Geriatric Medicine, 312-3.

Chapter 9

I Podlone, M. and Millican, C. 1981. Neurology. In O'Hara-Devereaux eta/. Eldercare, 118.

Chapter 10

I Sundwall, D. Rolando, J. and Thorn, G. 1981. Endocrine and metabolic systems. In O'Hara-Devereaux eta/. Eldercare. 142.

2 Ibid., 139-40. 3 Schteingart, D. 1978. Endocrinology and metabolism: principles of

pathophysiology. In Price, S. and Wilson, L. (eds), Pathophysiology: Clinical Concepts of Disease Processes. New York: McGraw-Hill, 699.

4 Doenges, M. Jeffries, W. and Moorhouse, F. 1984. Nursing Care Plans: Nursing Diagnoses in Planning Patient Care. Philadelphia, Pa,: Davis, 469.

174

Chapter 11

Norton, D. Exton-Smith, A. N. and McLaren, R. 1975. An Investigation of Geriatric Nursing Problems in Hospital (1962; reprinted and reissued by Churchill Livingstone).

2 Waterlow, J. 1985. Risk assessment card. Nursing Times, 81(48), 4<)..!55. 3 Byrne, N. and Feld, M. 1984. Preventing and treating decubitus ulcers.

Nursing 84 14 (4), 5~. 4 The Code of Professional Conduct for Nurses, Midwives and Hea/Jh

Visitors. 1983. London: United Kingdom Central Control for Nurses, Midwives and Health Visitors.

5 Bates, B. 1983. A Guide to Physical Examination (3rd edn). New York: McGraw-Hill), 318-9.

6 Ibid.

Chapter 12

Donne, John, Meditation, XVII. The whole of it reads: 'No man is an Island, entire of itself; every man is a piece of the Continent, a part of thl' main; if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friends or of thine own were; any man's death diminishes me, because I am involved in Mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.' Some sociologists have used thousands of words to say the same thing, only not as clearly.

2 Riordan, J. and Whitmore, B. 1990. Living with Dementia. Manchester University Press, 2.

3 Haywood, S. Standards of institutional care for the elderly. In Denham, M. J.(ed.), Care of the Long-stay Elderly Patient (2nd edn). London: Chapman and Hall, 12-13.

4 If the reader does not believe in self-fulfilling prophecies, or is unfamiliar with the term, it is strongly recommended that they read Rosenthal and Jacobson, 1968 'Self-Fulfilling Prophecies in the Classroom: Teachers' Expectations as Unintended Determinants of Pupils' Intellectual Competence', in Deutsch eta/. (eds). Social Class. Race, and Psychological Development (New York: Holt, Rinehart and Winston, 219-54). Very briefly, they told teachers that certain pupils (secretly selected at random) would shine in the forthcoming academic year; and every one of their 'predictions' came true. This has a lot of implications for nurses working with the elderly, because we often make assumptions about how well people are going to respond to treatment, within minutes of meeting them; in the author's experience, this is particularly true of 'confused' people, whom we may unconsciously 'write ofr as candidates for progress.

5 Welford, A. T. 1987. Ageing- memory and learning. In Gregory, R. L. (ed.); The Oxford Companion to the Mind. Oxford University Press. 14.

6 Twining, C. The Memory Handbook. Bicester: Winslow Press 9-10. 7 Sourander, L. B. and Rowe, J. W. 1985. The ageing kidney. In

Brocklehurst, J. C. (ed.); Textbook of Geriatric Medicine and Gerontology (3rd edn). Edinburgh: Churchill Livingstone, 608-10.

8 'The Seven Ages of Man', from Shakespeare's As You Like It.

175

9 The entry for 'psychiatry' in R. L. Gregory, 1987. Oxford Companion to the Mind, 649, says that it emerged as a branch of medicine in Britain during the first half of the nineteenth century; some textbooks treat anything before 1880 as being too primitive to deserve the name, whilst still others do not consider that there was any such speciality until this century.

10 Pitt, B. 1982. Psychogeriatrics - An Introduction to the Psychiatry of Old Age (2nd edn). Edinburgh: Churchill Livingstone, I.

II Murphy, E. 1986. Dementia and Mental Illness in the Old. London: Papermac Health, 169.

12 Sagar, H. 1991. Parkinson's Disease. London: Optima 49. 13 ZangwiU, 0. L. 1987. Delirium. In Gregory, R. L. Oxford Companion

to the Mind. Oxford University Press. 184. 14 Rabins, P. V. 1985. The reversible dementias. In Arie, T. (ed.), Recent

Advances in Psychogeriatrics: no. I. Edinburgh: Churchill Livingstone, 93.

15 Riordan. S. and Whitmore, B. 1990. Living with Dementia, 2. 16 Stokes, G. and Holden, U. 1990. Dementia: causes and clinical

syndromes. In Stokes, G. and Goudie, F. (eds), Working with dementia. Bicester: Winslow Press, 16.

17 Dartington, T. The Limits of Altruism: Elderly Mentally Infirm People as a Test Case for Collaboration. London: King Edward's Hospital Fund for London, 27-72.

18 Riordan. S. and Whitmore, B. 1990. Living with Dementia, 14. 19 This survey, conducted by the Health Services Management Centre,

showed NHS and private nursing home beds for the elderly to total 54 775 and 56 779 respectively. Cited in Haywood, S. 1991. Standards of institutional care, 13.

20 Dartington, T. 1986. The Limits of Altruism, particularly the introduction.

21 Summaries of these can be found in: Post, F. 1985. The emotional disorders, in Brocklehurst, J. C. Textbook of Geriatric Medicine, 330; Henderson, A. S. 1989. Epidemiology of mental illness, in Hafner, H. Moschel, G. and Sartorius, N. (eds), Mental Health in the Elderly: A Review of the Present State of Research. Berlin: Springer-Verlag, 29 (this book is available in Britain); and Post, F. and Shulman, K. 1985. New views on old age affective disorders, in: Arie, T. Recent Advances, 119--20.

22 Gianturco, D. T. and Busse, E. W. 1978. Psychiatric problems encountered during a long-term study of ageing volunteers. In Isaac, A. D. and Post, F. (eds): Studies in General Psychiatry. Chichester: John Wiley and Sons 1-16.

23 Gurland eta/, cited in Post, F. The emotional disorders, 330. 24 Blazer and Williams, 1985. The emotional disorders. 'Dysphoric

syndrome' certainly sounds better than the term used previously for sub-acute depression in the elderly, which was 'senile demoralisation'.

25 Evans, J. G. Physical factors in mental health in the elderly: gerontological and internal medical aspects. In Hafner et a/, Mental Health, 51.

26 Post, F. 1985. The emotional disorders. 120.

176

27 A very welcome backlash to negative attitudes towards ageing came from many authors in the 1970s and 1980s, with books like Alex Comfort's A Good Age, Muriel Skeet's The Third Age, and others, none of which appear on recommended reading lists with the frequency one might hope for.

28 Seligman, M. 1975. Helplessness. San Francisco: Freman. 29 Norman, I. J. 1991. Depression in old age. In Redfern, S. J. (ed.): Nursing

Elderly People (2nd edn) Edinburgh: Churchill Livingstone 366--8. 30 Murphy, E. 1986. Dementia, 166. 31 Post, F. Paranoid, schizophrenic-like and schizophrenic states in the

aged. In Birren, J. E. and Sloane, R. B. (eds), Handbook of Mental Health and Ageing. Englewood Cliffs, NJ: Prentice-Hall, 591--615.

32 For a thoughtful discussion of this issue, see Gilhooly, M. L. M. Ethical and legal issues in therapy with the elderly, in Hanley, I. and Gilhooly, M. L. M. (eds): Psychological Therapies for the Elderly. London: Croom Helm, 173-97, but particularly the section on 'consent', 178-82.

33 'Neurosis', in Gregory, R. L. 1987. The Oxford Companion, 549. 34 Pitt, B. 1982. Psychogeriatrics. 110. 35 ibid. 36 'Diogenes' syndrome' is marked by gross self-neglect and a tendency

towards hoarding; any reader who has met someone with this condition will know what a convincing defence of their lifestyle the 'sufferer' can put up. (See Clark, A. N. G, Mankikar, G. D, and Gray, I. 1975. Diogenes syndrome: a clinical study of gross neglect in old age. Lancet i, 366--73.)

37 Pitt, B. 1982. Psychogeriatrics: an introduction to the psychiatry of old age (2nd edn). Edinburgh: Churchill Livingstone.

38 'DSM-III' is the usual way texts refer to: American Psychiatric Association. 1980. Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington DC: APA.

39 McConnell, E. S. 1988. Nursing diagnoses related to psychosocial alterations. In: Matteson, M. A, and McConnell, E. S. Gerontological Nursing: Concepts and Practice. Philadelphia, Pa. WB Saunders, 529-86.

Chapter 13

DHSS. 1979. Nutrition and health in old age. Report on Health and Social Subjects, No.l6. London: HMSO.

2 Pritiken, N. and Cisney. 1986. Dietary recommendations for older Americans. In Dychtwald, K. (ed.), Wei/ness and Health Promotion for the Elderly. Rockville, MD. Aspen Systems.

3 Hooker, S. 1990. Caring for Elderly People (3rd edn). London: Routledge.

4 Brereton, P. J. 1991. Nutritional care of the long-stay patient. In Denham, M. J. ( ed. ), Care of the long-stay elderly patient (2nd edn). London: Chapman and Hall.

5 Trollinger, J. Dowhler, D. and Calin, A. 1981 Musculoskeletal system. In O'Hara-Devereaux et a/. (eds), Eldercare. New York: Grune and Stratton.

177

6 For a summary of fairly recent thought on the subject, see Exton­Smith, A. N. 1985. The musculoskeletal system - bone ageing and metabolic disease. In Brocklehurst, J. C. Textbook of Geriatric Medicine and Gerontology (3rd edn). Edinburgh: Churchill Livingstone.

7 Yen, P. K. 1986. Ten tips for teaching. Geriatric Nursing [US] 7(2), 112. 8 Bailey, L. B. and Certa, J. J. 1986. Diagnoses and treatment of

nutritional disorders in older patients. Geriatrics, 39 (8), 67-74. 9 Dickman, S. R. 1979. Nutritional needs and effects of poor nutrition in

elderly persons. In Reinhart, A.M. et a/. (eds), Current Practice in Geronto/ogic Nursing. StLouis: Mosby.

10 Moehrlin, B., Wolanin, M. 0. and Burnside, I. M. 1981. Nutrition and the elderly. In Burnside, I. M. (ed.), Nursing and the Aged. New York: McGraw-Hill.

II Brereton, P.J. 1991. Nutritional care. 109-25.

Chapter 14

I Christopher, M.A. 1986. Home care for the elderly. Nursing 86, 16 (7), 50-5.

2 For a thoughtful discussion of the pros and cons of restricting a confused person's ability to leave the house, see Chapter 6 of Riordan, J. and Whitmore, B. 1990. Living with Dementia. Manchester University Press.

Chapter 15

'Hughes, R.' 1990. An odyssey through the Eighties. Nursing Times 86 (26), 28-32.

2 McGuire, A. D. 1991. The genesis and nature of nursing diagnoses. In Carlson, J. H., Craft, C. McGuire, A. and Popkess-Vawter, S. (eds); Nursing Diagnosis: A Case Study Approach. Philadelphia: WB Saunders, 3-20.

3 Several authors, including Bloch, D. Roy, C. Mundinger, M. and Jauron, G. have used this 'five-step' definition of the nursing process. For further discussion, see the references passim in McGuire 1991, the genesis and nature of nursing diagnoses.

4 Gordon, M. 1982. Nursing Diagnosis: Process and Application. New York: McGraw-Hill.

5 Each architect of a nursing model has something to say about setting goals; for a selection of examples, using different models, see Easterbrook, J. (ed.) 1987. Elderly Care - Towards Holistic Nursing. London: Hodder and Stoughton.

6 Bahr, R. T. and Gress, L. 1985. The 24-hour cycle: Rhythms of healthy sleep. Journal of Gerontological Nursing, 11(4), 14-17.

7 Lyon, B. 1983. Nursing Practice: An Exemplification of the Statutory Definition. Birmingham, Ala.: Pathway Press.

8 Schmadl, J. 1979. Quality assurance: examination of the concept. Nursing Outlook 27(7), 462-46~.

9 Andrews, K. 1987. Rehabilitation of the Older Adult. London: Edward Arnold.

178

10 Evers, H. K. 1982. Multidisciplinary teams in geriatric wards: myth or reality? Journal of Advanced Nursing, 6, 205--14.

II Hewner, S. 1986. Bringing home the health care. Journal of Gerontological Nursing, 12(2), 29-35.

179

INDEX

Abbreviated Mental Test Score 33 see also mental status

questionnaire abdomen

age changes 31 physical assessment 31, 40

acoustic nerve 34 see also hearing

activities of daily living (ADLs) 170

and Alzheimer's disease 98 assessment 5, 7, II, 19 and osteoarthritis 84

activity and Alzheimer's disease 99-100 assessment 18-19

acute brain syndrome 95----{) causes 9 5----{) nursing diagnoses and

interventions 96 address, forms of 4 admission to hospital see

hospitalisation affective illness 124--6 ageing

and loss 118, 124-5 negative expectations 116-17,

125----{), 129, 175, 177 physical changes 26-43

agnosia 98 AIDS-related dementia 97 airway clearance 50, 51, 53, 54,

62-3 case study 162 and CV A 88, 89 nursing diagnoses 167

alcohol usage 13 Alzheimer's disease 97

assessment 98 case study 122-3, 156-8 nursing diagnoses and

interventions 98-101 signs and symptoms 98 stages of 97-101

American Nurses' Association standards of practice 165----{)

anaemias 56, 63--5 iron deficiency 64, 131 pernicious 64-5

angina pectoris 56 nursing diagnoses and

interventions 61-2 anxiety 128

case study 161 and emphysema 53, 54 and myocardial infarction 57 nursing diagnoses 167 reduction of 54

aphasia 87, 98 expressive and receptive 88

apraxia 98 assessment 145

initial interview 5-23 physical assessment

worksheet 36-42, 151 assistive devices

assessment 14 and CVA 90 hearing loss 103, 137 and home environment 138,

139, 142 and rheumatoid arthritis 84

atherosclerosis 56 attitudes

positive of carers 5 to ageing 116-17, 125----{), 129,

175, 177 audiometric testing 103, 104 auscultation 26

of chest 29

Babinski sign 34 behaviour disorders 127 bladder see incontinence; urinary

tract blood pressure 30, 60

see also hypertension body image and CV A 89

180

Bouchard's nodes 32 bowel elimination

and Alzheimer's disease 99 assessment 18, 41 and CVA 88 nursing diagnoses 167 see also constipation;

incontinence bradykinesia 92 brain, age changes 32-3

see also acute brain syndrome; cerebrovascular; chronic brain syndrome; normal pressure hydrocephalus; organic brain diseases

brain failure see chronic brain syndrome

breasts, assessment 28, 40 breathing, assessment 20 Byrne, N. 110

caffeine and incontinence 68 calcium requirements 131 calorie requirements 130 carbohydrate requirement 130,

131 cardiovascular system

age changes 29-31 nursing interventions 56 physical assessment 40 problems 56--65

care audits of 148 numbers in long-term 116 see also care plans; nursing

diagnoses; nursing process care plans 3, 48, 116

American Standards 165--6 and discharge of patients 3, 4 and environment 138 formulating and following

up 145--52 as goal-orientated 147, 150 holistic 120 and hospital admission 4 multidisciplinary 149-50

case studies 153--64 cataracts 26, 102 catheterisation 70, 151

indwelling 71-2

181

nursing diagnoses and interventions 71-2

cellular ageing 36 cerebrovascular accident 88-92

and environment 136 example of evaluation 147-8 potential nursing

diagnoses 88-92 rehabilitation 88 signs and symptoms 87

cerumen age changes 26--7 and hearing loss 103

chest, physical assessment 29, 30, 39-40

chiropody 106 chronic brain syndrome 97-101

symptoms 97 Chvostek's sign 34 circulatory problems

assessment 19 client participation 146, 166 cognitive status assessment 15 communication 150

and acute brain syndrome 96 and Alzheimer's disease 98, 99 between nurses 146 and CVA 88, 91 and hearing loss I 03--4 impaired 4, 128 nursing diagnoses 167 and Parkinson's disease 93, 94

community care 122, 123, 150 discharge into 3, 7 and information collection 10 liaison letter 3 loans 141-2

community nurse and care plans 4 case study 160--4 role of 152 see also home care

confusional states and home care 141 and paranoia 126 see also delirium; dementia

congestive cardiac failure 58-9 potential nursing diagnoses and

interventions 58-9

congestive cardiac failure (cont.) signs 58

constipation 79-80 and Alzheimer's disease 99,

100-1 case study 161 and CV A 88, 90 and diverticulitis 76 and haemorrhoids 78 nursing diagnoses 79, 167 nursing interventions 79-80 and Parkinson's disease 92, 93,

94, 95 prevention of 52, 79

contact lenses I 02 continuing care settings

and environment 135 and nutrition 132

coping assessment II, 15 ineffectual 128 nursing diagnoses 167

counselling on nutrition 134 and Parkinson's disease 95

cranial nerves assessment 33--4, 42 Creutzfeld-Jakob's disease 97 cultural factors 6, 22

and nutrition 6, 134 CV A see cerebrovascular accident

Dartington, T. 124 death, attitudes towards 22 decubitus ulcers 109-11

see also pressure sores degenerative changes 36 delirium 120--1 dementia 121--4

delirium 120--1 diagnosing 121 incidence of 116, 117, 121-2 multi-infarct 97 wandering 141 see also chronic brain syndrome;

wandering demographic changes 123 dental hygiene 27 dentition, case study 163 dentures 27, 39

and anaemias 63, 64

and CVA 90 and nutrition 133

depression 118, 124--6, 176 causes 124 and CVA 88 incidence of 124, 125

diabetes mellitus 105--6 case study 153--5 potential nursing diagnoses and

interventions 106-7 symptoms 105 types of 105

diagnoses, nursing 47-9 taxonomy of 48

diet see nutrition digitalis preparations 63

see also medication Diogenes syndrome 127, 177 discharge 3, 7

and information 3 planning 116

disease and ageing 36, 47 diuretics 59 diverticulitis 76-7

nursing diagnoses and interventions 76-7

Donne, John 115, 175 douching 73 DSM-III 129, 177 Dupuytren's contractures 32 dying, case study 158-9

see also loss dysphasia 87 dysphoric syndrome 124, 176

ears 26, 27 physical assessment 38 see also hearing

elimination patterns assessment 17-18

Eliopoulos, C. 26 emotional illness 33, 176 emotional status assessment 15 emphysema 50, 53--4

case study 162 nursing diagnoses and

interventions 53--4 endocrine system 35--6 enema 79, 80

182

environment and acute brain syndrome 96 aesthetic stimulation 137 and Alzheimer's disease 99,

100, 101 case study 162 facilitative 135-42 home 138--42, 152 andincontinence 67 and individual needs 136, 137 privacy 136, 138 and visual loss 91-2, 103 see also home environment

epistaxis 60 ethnic groups

dietary practices 6, 134 and information collection 6, 8

examination, physical nurses' role 24, 25 strategies of 26

exercises 90 musculoskeletal problems 82--4 and Parkinson's disease 94

expanded role 24--5 expressive aphasia 88 extended role 24 eyes 26

and hyperthyroidism I 08 physical assessment 37-8 see also vision

facial nerves 34 faecal impaction 79--80 family

assessment 20 care by 122--4 and care planning 116 and information collection 4,

8-9, 13 nursing diagnoses 168 and psychosocial disorders 128

fat requirement 130, 131 fear see anxiety feet

assessment 28, 41 care and diabetus mellitus 106

Feld, M. llO female reproductive system

assessment 21-2, 35, 41 problems 72-3

fever and gallbladder disease 77 and rheumatoid arthritis 84 and urinary tract infections 69,

70 financial status

assessment 1(}...-11, 23 and nutrition 132, 133, 134

fluid intake and Alzheimer's disease 99, 100 case study 162, 164 and CCF 58, 59 and constipation 79 and CV A 88, 89 and diabetus mellitus 106 and diverticulitis 76 and incontinence 67-8 and prostatic hypertrophy 70 requirements 131 and urinary tract infections 69

foot care see feet footboards 91 Ford, P. 75 friends, role in assessment 20

gallbladder disease, nursing diagnoses and interventions 77

gastrointestinal problems 74--80 genitourinary system 35

see also female reproductive; male reproductive; urinary tract

glaucoma I 02 glossitis 65 glossopharyngeal nerve 34 Gordon, M. 146

183

graphic ability 33 grieving see loss Griffiths Report 150

haemorrhoids 63 nursing diagnoses and

interventions 78 hallucinations 95, 96, 98 hands, examination of 32 head, physical assessment 26-8,

37-9

Heaf test 55 health history 3, ll-15 hearing

age changes 26--7 assessment 14, 34 environmental

considerations 137 nursing diagnoses and

intervention 103--4 problems 103--4

heart age changes 29-31 murmurs 30 see also cardiovascular system

heart attack see myocardial infarction

heartburn 75 Heberden's nodes 32, 83 help, summoning 139 hemianopia 88

and environment 136 Hewner, S. 152 hiatal hernia, nursing diagnoses and

interventions 75 hip fractures, nursing diagnoses and

interventions 85--6 holistic care 115--16 home care

case study 160--4 nursing diagnoses 168 and physical assessment 25 role of nurse 15~2. 152

home environment 138--42, 152 assessment 20, 142 bathroom 1~1 illumination 140 and information collection 9 locks 141 and safety 138, 139--41

home help 140 case study 164

hormone disorders 105 hospitalloans 141-2 hospitalisation

admission 7; and assessment 25

and nutrition 132 housing and home care 140 Huntington's chorea 97 hydration see fluid intake

hygiene practices and Alzheimer's disease 98

hyperglycaemia 105, 106 hypertension 56, 59-{)()

and blood pressure 30 nursing diagnoses and

interventions 60 hyperthermia, nursing

diagnoses 168 hyperthyroidism 107-8

nursing diagnoses and interventions 108

hypoglossal nerve 34 hypoglycaemia 105, 106 hypothermia

and hypothyroidism 107 nursing diagnoses 168

hypothyroidism, nursing diagnoses and interventions l 07

hypoxia 95

immune system, age changes 35--6 imrnunisations 50 incontinence 66--9

and Alzheimer's disease 98, 99, 101

bladder retraining 68--9, 72 bowel 167 causes 66, 67 and CVA 90 and normal pressure

hydrocephalus 101

and Parkinson's disease 93, 94 potential nursing

diagnoses 66--7 potential nursing

interventions 67-9 independence of client 150

and osteoarthritis 83 indwelling catheters 71-2 infection

and catheterisation 71 and confusional state 121 nursing diagnoses 168 and Parkinson's disease 93, 94

influenza 50 information collection

American Standards 165 assessment document 5--7, 151

184

as counter-productive procedure 23

health history 5--7 initial interview 3-7 sources of 3-4 types of 4--5

inhalers 54 injury, physical

and Alzheimer's disease 99, 100 and anaemias 65 and angina pectoris 61 case study 157, 163 and hypertension 60 and Lenegre's disease 62 see also musculoskeletal system

insomnia and CCF 58 insulin, age changes 35 integumentary system, physical

assessment 28, 37 see also skin

intelligence, age changes 33 interview, initial 3-23

duration 6, 23 home care 150-1 see also information collection

intestinal tract 31 iron deficiency anaemia 64, 131 isolation and nutrition 132, 133

see also social isolation

jargon, medical 4 joint contractures 85, 86

and CVA 88, 91

ketoacidosis I 05 kidneys 66

age changes 35 knowledge deficit 128

case study 154, 159 gynaecological examinations 72 nursing diagnoses 168

learned helplessness 125 Lenegre's disease 62-3

nursing diagnoses and interventions 62-3

symptoms 62 leucorrhoea 72 levodopa therapy 93 'Lifeline' 139

lipofuscin 36 liver

age changes 31 physical assessment 41

loan, community 141-2 locks, home environment 141 loneliness

assessment 20 home care: case study 161-2 and nutrition 132, 133

long-term care and environment 135--8 numbers in 116

loss and ageing 118, 124-5 case study 163 and nutrition 133

lungs, assessment 29, 39-40 see also respiratory system

McConnell, E.S. 129 male reproductive system,

assessment 22, 35, 41 Mantoux test 55 Meals on Wheels 132, 140

case study 154, 164 medical jargon 4 medication

case study 161 and diabetus mellitus 105, 106 digitalis peparations 63 and information collection 5,

185

13 and mental dysfunction 119 and nutrition 133 over-the-counter 5--6 Parkinson's disease 93, 95 and rheumatoid arthritis 85 and xerostomia 74

mental confusion and anaemias 63 and CCF 58 see also confusional states

mental disorders, classification 119-20

Mental Health Act (1983) 126 mental health see psychosocial

aspects of care mental status questionnaire 33, 96

case study 157

metabolic disorders 105--8 metabolism assessment 15, 16 mirror sign 98 mobility

assessment 18-19 changes in 65 and CV A 88, 89, 90 and hip fractures 85, 86 nursing diagnoses 168 and nutrition 132 and osteoarthritis 83-4 and Parkinson's disease 93, 94

Morton, P.G. 25 motor functions assessment 41, 42 multidisciplinary care

plans 149-50 muscle function 32 muscle rigidity and Parkinson's

disease 92, 94 musculoskeletal system

age changes 32, 178 physical assessment 41 problems 81-6 see also hip fractures;

osteoarthritis; osteoporosis; rheumatoid arthritis

myocardial infarction 56-8, 121 nursing priorities 57 potential nursing

interventions 57-8 myxoedema coma I 07

nails, assessment 37 see also toenails

NANDA 167-8, 172 taxonomy 49, 172

National Health Service continuing-care beds 122, 176

nebulisers 54 neck, assessment 26-8, 37, 39 neglect, self- 127, 177 neurological system

age changes 32-5 disorders 88-1 0 I physical assessment 42 see also acute brain syndrome;

cerebrovascular; chronic brain syndrome; normal pressure hydrocephalus;

organic brain diseases; Parkinson's disease

neuroses, defined 126-7 non-steroidal anti-inflammatory

drugs 85 normal pressure

hydrocephalus 101 North American Nursing

Diagnosis Association see NAND A

Norton, D. 109 nose, assessment of 27, 38 NSAIDs 85 nurse, role of 24

expanded 24 extended 24 extinction 24, 25

nursing diagnoses 47-9, 145-6, 172

case studies 153, 154-64 classification 146 identification of goals 146, 178 identification of

interventions 146 NANDA see separate entry taxonomy 48, 118-19 see also care plans; nursing

process nursing homes

attitudes to 152 case study 156-7 and environment 135 private 122, 176

nursing process 115, 178 and client participation 146 evaluation 146-9; case

studies 153-5, 156, 158, 160

home care 150-2 intervention case

studies 154-64 quality assurance 148-9 quality of care 146-7 stages 145, 146

nutrition 74, 130-4

186

and Alzheimer's disease 99, 100 and anaemias 63, 64, 65 and angina pectoris 61 assessment 5, 15--16, 133 at-risk groups 133

and cardiovascular problems 56

case study 156--7, 159--{i(), 162, 163

and constipation 79 and CV A 88, 89-90 and diabetus mellitus 106 and diverticulitis 77 fibre 131 and gallbladder disease 77 and hiatal hernia 75 and hyperthyroidism l 08 nursing diagnoses 167 and osteoporosis 81, 82 overweight 134 and Parkinson's disease 93, 94 and pneumonia 51-2 promotion of 132-4 psychosocial and cultural

factors 134 requirements 130--l and tuberculosis 55 see also fluid intake

occupational therapist 138 Omaha VNA/PCS

taxonomy 48-9 oral cavity 74--5

age changes 27 hygiene and nutrition 133 physical assessment 38-9

organic brain diseases 95--101 diagnostic tests 95

orientation 96, 99 case study 157

osteoarthritis 81, 83-4 nursing diagnoses and

interventions 83-4 osteoporosis 81-2

and nutrition 81, 82 and physical injury 81, 82

over-the-counter medications 5--6

pain 57 and angina pectoris 61 case study 158, 159 and CCF 59 and diverticulitis 76 and gallbladder disease 77 and haemorrhoids 78

and hip fractures 85 and hypertension 60 and information collection 5 nursing diagnoses 168 nursing interventions 52 and osteoarthritis 83 and osteoporosis 81, 82 and prostatic hypertrophy 70,

71 and rheumatoid arthritis 84 and urinary tract infections 69 and vaginitis 72

palpation 26 paranoid states 126 paraphrenia 126 Parkinson's disease 92-5

potential nursing diagnoses 93 potential nursing

interventions 94--5 signs of 92-3

patches, nitrate 61, 62 pelvic examination, internal 35 percussion 26

of chest 29 periodontal disease 27, 74

and nutrition 133 peripheral vascular disease 56 pernicious anaemia 64--5 personal hygiene

and incontinence 68 and initial interview 5

personal space 136 personality disorders 127 phenothiazines 93 physical assessment

worksheet 36--42, 151 Pick's disease 97 Pitt, B. 119,127 plan of care see care plans pneumonia 50--2

and Parkinson's disease 93 potential nursing

diagnoses 50-I potential nursing

interventions 51-2 presbycusis 27, 103-4 pressure area care 52

187

and CCF 59 and hip fractures 86 see also pressure sores

pressure sores 1 09-11 case study 158, 159 classification 110 mattresses 109 prevention 110 treatment 110

privacy 136, 138 private nursing homes 122, 176 prolapse 73 prostatic examination 35 prostatic hypertrophy 66, 70-1

nursing diagnoses and interventions 70-1

symptoms 70 protein requirement 130, 131 psychiatry 176

see also psychosocial disorders psychogeriatrics 119 psychosis 127 psychosocial aspects of

care 115--29 psychosocial disorders

classification 119-20 holistic approach 129 incidence of 171 nursing diagnoses 128-9 see also depression; neuroses;

paranoid states pulse rate, assessment 40

quality assurance 148-9

reality orientation 96, 99 receptive aphasia 88 rectum, physical assessment 41 reflexes 42 relatives

case study 158 and information 4

relaxation techniques 60, 163, 172 religion

and assessment 22 and information collection 6, 8

relocation confusion 137 reminiscence therapy I 00

case study 157 reproductive system see female

reproductive system; male reproductive system

188

residential homes and environment 135

see also nursing homes respiratory system

age changes 28-9 problems 50-5

rest and angina pectoris 61 and emphysema 54 and pneumonia 52 and prostatic hypertrophy 70

restraints 178 undesirability of 96, 136

resuscitation 58 rheumatoid arthritis, nursing

diagnoses and interventions 84-5

Rinne test 27 role of nurse see nurse, role of

safety 135 case study 157 home environment 138,

139-41; case study 160, 163--4

self-perception see self-concept self-care practices

and CVA 89 deficit and nursing

diagnoses 168-9 and information collection 5

self-concept 128 assessment 20-1 ano incontinence 67' 68 nursing diagnoses 168, 169 and Parkinson's disease 93, 95

Seligman, M. 125 sensation assessment 34-5 sensory changes see hearing;

vision sexuality 116

age changes 35 assessment 7, 21, 23 nursing diagnoses 169

skin care practices, assessment 17 skin integrity

and angina pectoris 61 assessment 15, 17, 28, 37 case study 155, 159

and CCF 59 and CVA 89, 91 and diabetus mellitus 106 disorders I 09--12 example of evaluation 147 and gallbladder disease 77 and hip fractures 85 nursing diagnoses 169 and Parkinson's disease 93, 95 and vaginitis 72 see also decubitus ulcers; pressure

sores; stasis ulcers sleep pattern 51, 70, 128

and Alzheimer's disease 99, 100

assessment 18, 19-20 case study 163 example of evaluation 148 nursing diagnoses 169 see also rest

smell age changes assessment

smoke alarms smoking 13

27, 34 14 139

case study 161, 162 social isolation 128

nursing diagnoses 169 and nutrition 132, 133

speech and Alzheimer's disease 98 assessment 14, 33 and CVA 91 and Parkinson's disease 92

spinal accessory nerve 34 spinal column

age changes 32 assessment 29, 41 and osteoporosis 82

spiritual distress 128 nursing diagnoses 169

stasis ulcers 111-12 stomach examination 31 stress

and ageing 36, 118 assessment II, 13, 14

stroke see cerebrovascular accident

suicide 126 syphilis-related dementia 97

tactile sensation 14, 137-8 taste assessment 14 taxonomy of nursing diagnosis 48,

118-19 teeth 74

age changes 27 physical assessment 39

telephone and home care 139 territory of clients 136, 137 thyroid gland 27, 39 toenails

assessment 28, 41 and diabetus mellitus 106

toilets 52 and home care 140 seats 136

touch 137-8 assessment 14

transfer of patient 3, 7 and environment 136-7 relocation confusion 137 to another ward 3

transient ischaemic attack 87-8 trigeminal and facial nerves 34 tuberculosis 50, 54-5

nursing diagnoses and interventions 55

UKCC 25 ulcers see decubitus ulcers; stasis

ulcers United States

community nurse 152 defining dementia 121 emotional illness studies 33 evaluation of nursing 146-7 hip fractures 85 nurses' role 24, 25 Standards of Gerontological

Nursing Practice 165-6 urinary tract

age changes 35

189

assessment of patterns 17-18 bladder infections 69-70 incontinence 66-9; nursing

diagnoses 169 infections 66, 69-70; nursing

diagnoses and interventions 69-70; symptoms 69

urinary tract, infections (cont.) problems 66--72; and

CVA 90; and Parkinson's disease 92, 93, 94

testing urine 67

vaginitis 72 values and beliefs 20, 22 Vaughan, Barbara 24-5 violence 128

and Alzheimer's disease 99, 101 nursing diagnoses 169

vision age changes 26, 34 assessment 14, 37--8 and CVA 88, 89, 91-2 and environment 136, 137, 138 nursing diagnoses and

intervention 102-3

190

and nutrition 132 problems 102-3

vitamin and mineral requirements 131

voluntary sector 138-9, 142

Walsh, M. 75 wandering 178

and acute brain syndrome 95, 96

jingle bells 141 Waterlow, J. 109 Weber test 27 wound care see decubitus ulcers;

pressure sores; skin integrity; stasis ulcers

Xerostomia 74-5