CH 33: Acute Care Flashcards
older adults and acute care
Older adults have a higher rate of hospitalization and longer length of hospital stay
Age-related changes increase the risk of injuries and infections and can cause complications with the chronic conditions
risk for hospitalization of older adults
Delirium
Falls
Pressure injuries
Dehydration
Incontinence
Constipation
Loss of functional dependence
measures to reduce risk of hospitalization
Careful assessment
Early discharge planning
Encouragement of independence
Close monitoring of medications and assurance
Reminders and assistance to patient with frequent repositioning, coughing, deep breathing, toileting
Early identification and correction of complications, recognizing that atypical signs and symptoms may be present
Avoidance of urinary catheterization if possible
Strict adherence to aseptic techniques and infection control practices
Environmental modifications to accommodate older patients’ needs
Assistance, as necessary, with activities of daily living
Patient and family education
Reality orientation
Referral to resources
surgical care of older adults
Surgical intervention improves life span and functionality of older adult
Older adults less able to compensate for and adapt to physiologic changes
Problems r/t surgery
–Anxiety
–Pain
–Constipation
–Dehydration
–Confusion
–Risk for infection, injury, urinary incontinence, nutritional deficits, & self-care deficits
–Poor sensory function
–Altered self-concept
–Reduce physical mobility
preop considerations for older adults
Address fears and concerns
Teach what to expect during the surgical experience & document
Routine meds may still be given despite NPO; inform provider
Ensure basic pre-op screening
Careful positioning and padding during prolonged surgeries
Infection control with CHG bath
Informed consent
operative considerations for older adults
Careful dosing with anesthesia
Prolonged surgery is discouraged
Slower elimination of inhaled anesthetics with older adults
Close monitoring
Lower body temps, cool OR temp, and meds decreasing metabolism _ hypothermia
–Shivering (occurs less) can increase cardiac output and ventilation
–Closely monitor; proper warming measures intraop and early post-op
post-op considerations for older adults
Frequent post-op assessments/monitoring
Detect and treat complications EARLY
Relieve pain & soreness
Maintaining regular bowel and bladder elimination
Keep joints mobile
Cautious with pain medication administration
Consider age-related changes in post-op care for older adults
common surgical complications for older adults
F&E imbalance
–Decreased renal function of older adult
–Interventions
Malnutrition
–Decreased secretion, motility, and absorption of GI system; loss of appetite; decreased basal metabolic rate
–Interventions
Pneumonia/Atelectasis
–Reduced pulmonary movement and function
–Interventions
Pressure Injury
–Moisture loss, thinning epidermis, loss of sensory receptors, loss of SQ fat
–Interventions
Wound dehiscence/evisceration
–Delayed immune response and wound healing; decreased muscle strength
–Interventions
Incidental hypothermia
–Impaired thermoregulatory mechanisms, decreased metabolic rate
–Interventions
Joint stiffness/contractures
–Decreased muscle strength and wasting, decreased bone mass, stooped posture, slowed movement, gait changes
–Interventions
Acute confusion
–Loss of neurons, brain atrophy, decreased clearance of drugs, sensory losses, decreased cardiopulmonary reserves
–Interventions
Cardiac failure
–Decreased CO, altered 02 transport, widening pulse pressure, fat accumulations
–Interventions
emergency care of older adults
Occur frequently _ age-related changes, atypical symptoms, altered response to treatment
Greater complication of death in older adults
If suspected, err on side of caution
Interventions
–Maintain life functions
–Prevent and treat shock
–Control bleeding
–Prevent complications
–Keep the patient physically and psychologically comfortable
–Observe and record signs, treatments, and responses
–Assess for causative factors
infections in older adults due to
*Age-related changes
*Altered antigen–antibody response
*Decreased respiratory activity
*Reduced ability to expel secretions from the lungs
*Weaker bladder muscles facilitating urinary retention
*Prostatic hypertrophy
*Increased alkalinity of vaginal secretions
*Increased fragility of the skin and mucous membrane
*High prevalence of chronic disease
*Immobility
*Greater likelihood of malnutrition, urinary catheter use, invasive procedures, hospitalization, and institutionalization
difficult infections to treat in older adults with atypical symptoms
Pneumonia (confusion, anorexia, lethargy) and UTI (confusion, vague abd. pain, N/V/A, incontinence)
interventions to prevent infections
-Promoting good hydration and nutritional status
-Monitoring vital signs, mental status, and general health status
-Maintaining intact skin and mucous membrane
-Avoiding immobility
-Ensuring pneumococcal and influenza vaccines have been administered (unless contraindicated)
-Maintaining a clean environment
-Restricting contact with persons who have infections or suspected infections
-Storing foods properly
-Preventing injuries
-Adhering to infection control practices
discharge planning from acute care for older adults
STARTS EARLY!
Must work for all parties involved (including patient and family)
Ask questions to assess factors that can influence postdischarge outcomes
Plan for several sessions
Use of interdisciplinary geriatric team and gerontological nurse specialist
