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With the continued rapid growth of the older adult popu- tests with accompanying results are used to form a differen-
lation, there remains an increased demand for health-care tial diagnosis.
providers to deliver age-specific care and direct disease man- Unit III, “Treating Disorders,” provides 11 chapters of
agement. Advanced Practice Nursing in the Care of Older Adults concise, updated information pertaining to disease manage-
will serve as a guide for advanced practice nurses who are ment of illnesses common in older adults, presented by body
privileged to provide care to older adults. Designed as a text for systems. Each chapter opens with an assessment section that
students, as well as a reliable source of evidence-based prac- provides the reader with a focused review of systems and the
tice for advanced practice nurses, this book contains informa- physical examinations needed to obtain pertinent informa-
tion on healthy aging, comprehensive geriatric assessment, tion for diagnosis and treatment of the older adult. Signal
and common symptoms and illnesses that present in older symptoms indicating atypical presentation of illness are
adults. Given the complexity of prescribing for older adults highlighted at the beginning of each condition. The discus-
taking multiple medications, a new chapter on polyphar- sion of each problem and disorder follows a consistent mono-
macy is included. The book concludes with a chapter on care graph format:
delivery for patients with chronic illnesses who face end-of-
■ Signal symptoms
life care.
■ Description
Throughout the book, case studies are included to provide
■ Etiology
further practice and review. An important feature of this
■ Occurrence
book is the use of the Strength of Recommendation Taxon-
■ Age
omy (SORT) [Ebell, M. H., Siwek, J., Weiss, B. D., Woolf, S. H.,
■ Ethnicity
Susman, J., Ewigman, B., & Bowman, M. (2004). Strength
■ Gender
of recommendation taxonomy (SORT): A patient-centered
■ Contributing factors
approach to grading evidence in medical literature American
■ Signs and symptoms
Family Physician, 69(3), 548–556], which provides a direct
■ Diagnostic tests
reference to evidence-based practice recommendations for
■ Differential diagnosis
clinicians to consider in the care of older adults.
■ Treatment
In Unit I, “The Healthy Older Adult,” the first chapter,
■ Follow-up
“Changes with Aging,” addresses the normal changes of
■ Sequelae
aging, expected laboratory values in older adults, presen-
■ Prevention/prophylaxis
tation of illness, atypical disease presentation, bimodal
■ Referral
conditions, and the impact of chronic illness on functional
■ Education
capacity. In the second chapter, “Health Promotion,” updated
information pertaining to health promotion and disease pre- Unit IV, “Complex Illness,” addresses complex manage-
vention strategies for older adults from Healthy People 2020 ment of patients requiring chronic illness management, pal-
and the U.S. Preventive Services Task Force (USPSTF) is pro- liative care, and supportive care at end of life, and includes a
vided, including an immunization schedule and information new chapter on polypharmacy. The text concludes with two
on the Welcome to Medicare Visit. Also covered is an over- appendices—“Physiological Influences of the Aging Process”
view of physical activity, sexual behavior, dental health, and and “Laboratory Values in the Older Adult”—both of which
substance use, as well as a section pertaining to the older are ready references for the busy practitioner.
traveler. Recommendations for exercise and safe physical In addition to the content of the book, a Bonus Chapter,
activity are provided in this unit. Nutritional Support in the Older Adult, selected Refer-
Unit II, “Assessment,” opens with a detailed chapter on ences, and other online resources to aid the user in practice
comprehensive geriatric assessment. Information on phys- and review of the key concepts are available at DavisPlus.
ical, functional, and psychological health is delineated, and Case studies are provided to support critical thinking and
information on quality of life measures is included. Next is are available for users to complete on their own or for edu-
the fifth chapter, “Symptoms and Syndromes,” which pro- cators to incorporate into their course requirements. To
vides the clinician with a concise description of more than 20 enhance the delivery of competency-based education, the
symptoms prevalent in older adults. A rapid reference detail- case studies were mapped to the Adult-Gerontology Primary
ing common contributing factors and associated symptoms Care Nurse Practitioner Competencies (2016).
and clinical signs that should be worked up for each present- For the faculty, there are PowerPoint presentations
ing condition is included. Recommendations for diagnostic and a well-developed test bank located on DavisPlus. The
vii
viii Preface
Active Classroom Instructors’ Guide is an online faculty practice guidelines on prevention and management of condi-
resource that maps the resources available with the text and tions common in older adults.
includes lecture notes and additional case studies.
This book is written by and for advanced practice nurses REFERENCE
involved in the care of older adults across multiple settings of National Organization of Nurse Practitioner Faculties. (2016). Adult-
care. While intended as a guide for the management of care Gerontology Acute Care and Primary Care Nurse Practitioner com-
for older adults, clinicians are encouraged to deliver individ- petencies. Retrieved from http://c.ymcdn.com/sites/www.nonpf.org/
ualized, patient-centered care considering the latest clinical resource/resmgr/competencies/NP_Adult_Geri_competencies_4.pdf.
Contributors
Sue A. Anderson, PhD, RN, FNP-BC Lisa Byrd, PhD, FNP, GNP, FAANP
Associate Professor, Family Nurse Practitioner Practice Administrator
Program Coordinator Florida Health Care Plans
Saint Mary’s College Nurse Practitioner, Assistant Professor
Notre Dame, Indiana University of South Alabama
Epistaxis; Rhinitis; Asthma Lake Mary, Florida
Bowel Incontinence; Diarrhea; Fatigue; Urinary Incontinence;
Louann Bailey, CRNP Wandering
Nurse Practitioner
Inpatient Medical Services Carol Calianno, RN, MSN, CWOCN, CRNP
Akron, Ohio Nurse Practitioner – Dermatology and Wound Ostomy
Chest Pain Continence Specialist
Philadelphia VA Medical Center
Tracy Ballard, MSN, GNP-BC Philadelphia, Pennsylvania
Nurse Practitioner Skin Cancer
Optum
Greensboro, North Carolina Christina Coletta-Hansen, MSN, ANP-BC, ACHPN
Gastroenteritis Palliative Care Nurse Practitioner
Einstein Medical Center Montgomery
Judith A. Berg, PhD, RN, WHNP-BC, FAANP, FNAP, Norristown, Pennsylvania
FAAN Palliative and End of Life Care
Clinical Professor
The University of Arizona College of Nursing Kristin R. Curcio, DNP, AGPCNP-BC, AOCNP
San Diego, California Nurse Practitioner
Atrophic Vaginitis; Breast Cancer Cone Health Cancer Center at Wesley Long
Greensboro, North Carolina
Sharon Biby, MSN, APRN, ANVP-BC, AGPCNP-BC Lung Cancer; Bladder Cancer; Liver Cancer; Brain Tumor;
Nurse Practitioner, Advanced-Practice Stroke Nurse Pancreatic Cancer
Cone Health
Greensboro, North Carolina Nancy Dirubbo, DNP, FNP-BC, FAANP, Certificate
Stroke in Travel Health
Director
Anna Wentz Boone, PhD, ANP-BC Travel Health of New Hamsphire, PLLC
Adult Nurse Practitioner Laconia, New Hampshire
Rockingham Gastroenterology, Cone Health Medical Travel and Leisure
Group
Reidsville, North Carolina Brenda L. Douglass, DNP, APRN, FNP-BC, CDE,
C. Difficile; Cholecystitis; Peptic Ulcer Disease; Gastritis CTTS
DNP Program Director, Assistant Clinical Professor,
Angela Brown, DNP, FNP-BC, ANP-BC, CDE Family Nurse Practitioner
Clinical Assistant Professor, Family Nurse Practitioner Drexel University
University of Arizona Philadelphia, Pennsylvania
Tucson, Arizona Chronic Obstructive Pulmonary Disease
Cellulitis; Hearing Loss
ix
x Contributors
Janet DuBois, DNP, APRN, FNP-BC, FAANP, FNAP Debra A. Friedrich, DNP, FNP-BC, CLS, BC-ADM,
Associate Professor FNLA, FAANP
Loyola University New Orleans Diplomate, Accreditation Council for Clinical
New Orleans, Louisiana Lipidology
Pneumonia; Upper Respiratory Tract Infection Assistant Professor
University of South Florida College of Nursing
Kristen Tomblin Duffy, CRNP Tampa, Florida
Nurse Practitioner Hyperlipidemia
Lehigh Valley Health Network
Allentown, Pennsylvania Cynthia Gerstenlauer, ANP-BC, GCNS-BC, CDE,
Dysphagia; Hematuria CCD
Nurse Practitioner
Renee E. Edkins, DNP, ANP-C, Fellow, American Troy Internal Medicine
Society of Lasers in Medicine & Surgery Troy, Michigan
Director Laser Surgery Program, UNC Division of Osteoporosis
Plastic & Reconstructive Surgery, Medical Laser
Safety Officer Larry Ryan Gibson, MSN, AGNP-C
University of North Carolina, Department of Surgery Nurse Practitioner
Chapel Hill, North Carolina Alliance Urology Specialists
Burns Greensboro, North Carolina
Cystitis
Vaunette P. Fay, PhD, RNC, FNP, GNP
Director, Continuing Education; Lead Nurse Planner; Eric Gill, DNP, AGNP-C
Professor of Nursing Nurse Practitioner
The University of Texas Health Science Center at Rockingham Gastroenterology Cone Health Medical
Houston, Cizik School of Nursing Group
Houston, Texas Reidsville, North Carolina
Dehydration; Pruritus Cirrohsis; Esophagitis; Gastroesophageal Reflux Disease; Irritable
Bowel Syndrome; Acute Pancreatitis; Chronic Pancreatitis
Carrie Fernald, DNP, AGPCNP-BC
Nurse Practitioner Mary Jane Griffith, RN, MSN, GNP-BC, ACHPN
PACE of Triad Nurse Practitioner
Greensboro, North Carolina LTC Health Solutions
Joint Pain; Osteoarthritis Columbia, South Carolina
Palliative and End of Life Care
Diana Filipek-Oberg, RN, BSN, MSN, AGACNP-BC
Surgery APN Mary Guhwe, DNP, FNP-BC, SCRN
Cooper University Hospital Nurse Practitioner
Camden, New Jersey Duke University Hospital
Clinical Adjunct Faculty Durham, North Carolina
Drexel University Dizziness
Philadelphia, Pennsylvania
Chapter 7 Case Study; Assessment of the Respiratory System; Candace Currie Harrington, PhD, DNP, APRN,
Chapter 8 Case Study AGPCNP-BC, CDP
Clinical Professor
Nancy A. Fisher, RN, MSN, GNP-BC East Carolina University
Nurse Practitioner, Rheumatology Greenville, North Carolina
Cleveland Department of Veterans Affairs Heart Failure
Cleveland, Ohio
Gout; Rheumatoid Arthritis Melodee Harris, PhD, APRN, GNP-BC, AGPCNP-BC
Assistant Professor
University of Arkansas for Medical Sciences College of
Nursing
Little Rock, Arkansas
Delirium; Dementia
Contributors xi
William J. Lorman, JD, PhD, MSN, PMHNP-BC, D. Che Navey, A-GNP, MSN, RN
CARN-AP Neurohospitalist, Advanced Practice Clinician
Vice President & Chief Clinical Officer Novant Health Presbyterian Medical Center
Livengrin Foundation Charlotte, North Carolina
Bensalem, Pennsylvania Tremor
Alcohol Abuse; Prescription Drug Abuse
Olivia Faith Ogburn, AGPCNP
Denise Lucas, PhD, FNP-BC, CRNP, FAANP Nurse Practitioner
Chair, Advance Practice Programs Gastroenterology Oncology Clinic
Duquesne University Wake Forest Baptist Medical Center
Pittsburgh, Pennsylvania Winston Salem, North Carolina
Benign Prostatic Hyperplasia; Drug-Induced Impotence; Prostate Gastric Cancer
Cancer; Prostatitis
Loretta Phillips, RN, NP-C, APRN, BC
Rhonda W. Lucas, MSN, AGNPC Nurse Practitioner
House Calls Provider Capital Nephrology Associates
Optum Raleigh, North Carolina
United Healthcare Acute Kidney Injury; Chronic Kidney Disease
Reidsville, North Carolina
Herpes Zoster
xii Contributors
Sabrina Pickens, PhD, RN, ANP-BC, GNP-BC Susan D. Ruppert, PhD, RN, FNP-C, ANP-BC, FNAP,
Assistant Professor – Tenure Track, Faculty FCCM, FAANP, FAAN
University of Texas Health Science Center at Houston Professor, Associate Dean of Graduate Studies
Cizik School of Nursing Cizik School of Nursing at The University of Texas
Houston, Texas Health Science Center at Houston
Elder Abuse Houston, Texas
Anemia of Chronic Disease; Anemia; Iron Deficiency
Allen V. Prettyman, PhD, FNP-BC, FAANP
Associate Professor – College of Nursing Valerie K. Sabol, PhD, ACNP-BC, GNP-BC, ANEF,
University of Arizona FAANP
Tucson, Arizona Professor and Division Chair, Healthcare in Adult
Pulmonary Tuberculosis Populations
Duke University School of Nursing
Catherine R. Ratliff, PhD, GNP-BC, CWOCN, CFN Adult Acute Care & Gerontology Nurse Practitioner
Nurse Practitioner/Clinical Associate Professor, School Department of Medicine, Division of Endocrinology,
of Nursing Metabolism and Nutrition
University of Virginia Health System Duke University Medical Center
Charlottesville, Virgina Durham, North Carolina
Peripheral Vascular Disorders Obesity
Barbara Reall, MBA, MSN, CRNP Susan Kate Sandstrom, MSN, APRN-BC, ADCN
Senior Clinical Services Manager Nurse Practitioner
Optum University Hospitals, Seidman Cancer Center
Horsham, Pennsylvania Cleveland, Ohio
Hypertension Oral Cancer
Luann Richardson, PhD, DNP Jennifer Serafin, RN, BSN, MS, GNP-BC
Associate Professor Nurse Practitioner
Robert Morris University Kaiser Permanente
Moon Township, Pennsylvania South San Francisco, California
Anxiety; Bipolar Disorder Endometrial Cancer; Ovarian Cancer
Sharon Chalmers, PhD, CNE, APRN, FNP-BC Ann McDonald, DNP, MSN
Professor of Nursing Assistant Professor
University of North Georgia Western Carolina University
Dahlonega, Georgia Cullowhee, North Carolina
xv
Acknowledgments
The second edition of this book would not be a reality if crew for carrying us over the finish line, without which we
not for the kind assistance and guidance of some wonderful would not have completed the charge. To Ashleigh Lucas,
people whom we would like to thank. To Susan R. Rhyner, Amy Daniels, and Tyesha Harvey who assisted in informa-
our Senior Acquisitions Editor, who believed in the timeli- tion retrieval, thanks for your timely research. We are most
ness of updating this edition given the impact that the APRN appreciative to our dedicated contributors who believe in the
consensus model for advanced practice registered nurses has importance of creating a reference specific to the care of older
on nursing education and practice with the required inclu- adults written by advanced practice registered nurses. We
sion of gerontology and geriatrics for all advanced practice also would like to acknowledge those who have contributed
nurses taking care of older adults. To Christine M. Abshire, to our previous books. We especially want to thank Kathleen
our Senior Content Project Manager, who kept us on track Ryan Fletcher for being a part of the journey over the past
and provided us order. To Teresa Wilson for your quick turn- 20 years; your expertise and dedication to advanced practice
around editing and to Sharon Y. Lee, Daniel Domzalski, and gerontological nursing will not be forgotten.
xvii
Contents in Brief
xix
Exploring the Variety of Random
Documents with Different Content
Siks taivahan toivo on turtunut,
elonriemu on ruosteen syömä,
siks uskon muuri on murtunut
ja lempi on — leinin lyömä.
1896.
Hanget soi!
1897.
Hämärissä.
(1897).
Villon.
1.
Vai loistiko niist' oma onneni tuo, jota eloni halki ma hain,
joka kutsuvi luo, joka käskevi luo, mut kaikuna karkaa ain?
2.
3.
4..
Oi, istuos impeni tänne, niin annamme aattehen, niin
annamme aattehen lentää yli vuorien, laaksojen.
5.
En tiedä, miks sua pelkään, kun noin sua katselen. On kuin
sun silmies yöstä sois kaikuja kellojen.
6.
7.
Hän kulkevi kuin yli kukkien, hän käy kuni sävelten siivin,
niin norjana notkuvi varsi sen, kun vastahan vaiti ma hiivin.
8.
Leikitäänkö? Leikitään.
Kisasilla kiistellään.
Ole sinä kissa, minä olen hiiri!
Täss’ on tanhumme piiri.
9.
10.
11.
12.
13.
Sa kuuletko laulua kummaa, joka lemmikin lehdiltä soi, se
minulle mielen oudon ja haavehet herkät toi.
14.
15.
Elä pelkää, impeni nuori, ei emo sua peloittais, häll' oli niin
lempeät silmät — jo kirkkokin jäädä tais.
16.
18.
19.
20.
Oi poimikaamme, oi poimikaamme,
kesä kestihin kutsuvi meitä!
Ken ties, koska … toisti me juhlitaan.
Pian synkeä syksy on peittävä maan
ja kylvävä kyyneleitä.
22.
24.
Näkinkenkiä.
(1898.)
1.
2. Rauha.
3.
4. Kultainen kirja.
Niin kauas kuin silmä kantaa sua yksin, yksin ma näin, niin
kauas kuin aatos antaa olet ollut mun mielessäin.
8.
Suo, että sun helmahas peitän minä raskahan, sairaan
pään, suo, että sun helmahas heitän minä mieleni murheen
tään.
9. Kuka on hän?
En tiedä, mut aave jos ollut hän lie, niin johtanut ei hän
harhaan, ja jos oli laulu hän rinnastain, niin lauloin ma lauluni
parhaan.
10.
13. Omenankukat.
15. Hanhipaimen.
19. Indiaani.
20. Irma-impi.
Ja kansa kaikki rauhassa makas majoissaan,
mut murhe oli rinnassa kuninkahan,
ja suuri on kuninkaiden murhe.
21. Lohdutus.
22. Ihme.
23.
24. Salaisuus.
Minä tahtoisin olla kuin valmu aron polttavan aavikolla ja
koota kansoja juurellein — tai tuoksuta vain kuin valmu yön
helmassa, yksiksein.
25.
26.
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