Geriatric and Community Nursing
This domain tests aging physiology, falls, delirium, dementia, polypharmacy, pressure injury prevention, home safety, and community resources for older adults.
Core rules
- Perform a comprehensive geriatric assessment: function, cognition, mood, nutrition, continence, mobility, medications, and social supports.
- Falls are multifactorial: review vision, gait, footwear, environment, sedatives, blood pressure, and vitamin D.
- New confusion in an older adult is delirium until proven otherwise; look for infection, dehydration, pain, constipation, drugs, and hypoxia.
- Review medications with the Beers criteria; avoid anticholinergics and sedatives when safer alternatives exist.
- Prevent pressure injuries with risk assessment, repositioning, moisture management, nutrition, and offloading.
- Report suspected elder abuse according to law and institutional policy.
- Support caregivers and coordinate community services.
Worked example
An 82-year-old with a urinary tract infection becomes acutely confused at home. Do not label this as “just dementia.” Assess for hypoxia, dehydration, pain, constipation, and drug effects, check glucose and vital signs, and arrange urgent review. Reason: acute fluctuation in attention and cognition suggests delirium, which is a medical emergency and often reversible.
Traps
- Attributing acute confusion to dementia without assessment.
- Prescribing sedatives that increase falls and delirium.
- Missing dehydration because the patient is not thirsty.
- Ignoring caregiver strain and unsafe home conditions.