Hospital care of elderly patients Flashcards
1
Q
Hospital associated disability
A
- Hospitalization-associated disability is a common & feared
complication of hospitalization for older adults. - Deficits in activities of daily living (ADLs) occur in as many as
30% of patients 70 years of age or older who are admitted to
the hospital. - Bed rest & low mobility are major causes of decline.
- Even shorts periods of bed rest can result in significant loss of
muscle mass & strength in older adults
2
Q
Ambulation limitation during hospitalization
A
- Beds that are difficult to get in & out of
- Slick floors
- IV poles, oxygen tubing, urinary catheters, cardiac
monitoring - Concerns about falls result in inappropriate confinement to
bed - Most pts will not ambulate on own unless otherwise
instructed
3
Q
_____ contributes to functional decline
A
Undernutrition
4
Q
Factors influencing undernutrition in elderly
A
- NPO status
- Poor appetite
- Eating unfamiliar or unappetizing diet 8
5
Q
Successful Models of Care
A
- Acute Care for Elders (ACE) units
- Hospital Elder Life Program (HELP)
- Clinical pathways & care maps
- Geriatrician–surgical comanagement
6
Q
What is Acute Care for Elders (ACE)?
A
- Developed to prevent functional decline & ↑ quality of care for
older adults during acute hospitalization. - Prepared environment that promotes
1. Mobility (raised toilet seats, low beds, carpeted hallways, handrails, &
assistive devices)
2. Orientation (clocks, calendars, rooms for group meals to increase
socialization).
7
Q
Nursing protocols for ACE promote:
A
- Continence
- Sleep (nonpharmacologic means)
- Good nutrition,
- Skin integrity, &
- Frequent reorientation &
- Inclusion of patients in care
planning
8
Q
Hospital Elder Life Program (HELP)
A
- Developed to prevent
delirium in older hospitalized
adults - Uses hospital volunteers
- Focused on at risk patients
- Address specific risk
factors of the patient
9
Q
Clinical Pathways or Care Maps
A
- Standardized, problem- specific management plans
- Outline key steps to achieve specific goals
- Each map or pathway is problem specific & ideally developed around evidence-based care
10
Q
Comprehensive Geriatric Assessment
A
- Patient’s physical, cognitive,
psychological, & social
functioning needs to be
assessed. - Comprehensive assessment
ensures an appropriate care
plan is implemented. - Underlying reasons for the
hospitalization of an older
adult may be multifactorial, - Care plan must address
these multiple factors
11
Q
Social Assessment in the elderly
A
- The patient’s social context
is necessary for an effective
after hospital care plan. - Amount of in-home
supportive services - Meals & transportation
- Assistive devices 26
Social isolation, loneliness, & lack of support are common in hospitalized older adults - Explore for evidence of
physical, sexual, emotional or
financial abuse
12
Q
Indwelling Catheters in Elderly
A
- Avoid whenever possible*
- Risk of infection
- esp in elderly
- Clean intermittent
catheterization - Preferable to long term
catheterization 27 - Alternatives
- Condom catheter
- Suprapubic catheter
13
Q
Indications for Urinary Catheters - long term
A
- Uncorrectable bladder obstruction
- Neurogenic bladder
- Palliative care
- Patient preference
- Skin breakdown 2° to incontinence
14
Q
Indications for Urinary Catheters - short term
A
- Urologic surgery
- Surgery on contiguous
structures - Critically ill pt
- Acute urinary retention
15
Q
Many iatrogenic complications can be prevented through a dedicated effort to _____
A
maintain mobility in the hospita
