Therapeutic Nursing: Internal Medicine and Geriatrics
What the exam tests
This domain focuses on nursing care of adults with common internal-medicine conditions and older adults: chronic disease control, functional assessment, geriatric syndromes, nutrition, mobility, and goals of care.
Core rules
- Assess function, not only diagnosis: ADLs, mobility, falls risk, cognition, mood, continence, nutrition, and skin integrity.
- Distinguish delirium from dementia. Delirium is acute, fluctuating, and often caused by infection, hypoxia, pain, medications, urinary retention, constipation, or withdrawal.
- Review all medicines for polypharmacy and anticholinergic burden; older adults are sensitive to sedatives and diuretics.
- Prevent complications: pressure injury, dehydration, constipation, aspiration, falls, and functional decline.
- Use swallowing precautions for dysphagia: upright position, appropriate texture, small volumes, and observation for coughing or voice change.
- Discuss goals of care and advance wishes early; do not assume that a frail patient wants every intervention.
Worked example
An 82-year-old with pneumonia becomes confused and tries to climb out of bed. The nurse does not request a restraint first. She checks oxygen saturation, glucose, temperature, pain, bladder and bowel function, and the medication chart. Reasoning: new confusion is a geriatric emergency. Treating the cause and using orientation, glasses, hearing aids, family presence, and frequent supervision is safer than sedation or bed rails, which increase injury risk.
Traps
Calling acute confusion “just aging”; using physical restraints without a lawful indication and monitoring; over-sedating agitation; ignoring orthostatic hypotension after starting antihypertensives; and documenting refusal of food without assessing swallowing or dentition.