Transcript Airgas template

Chapter 38
Acute Care
Measures to Promote Optimal Functional
Independence
• Careful assessment to identify problems and risks
• Early discharge planning
• Encouragement of independence
• Close monitoring of medications
• Frequent repositioning, coughing, deep breathing,
toileting
• Early identification and correction of complications
• Avoidance of urinary catheterization if possible
Measures to Promote Optimal Functional
Independence (cont.)
• Close monitoring of vital signs
• Environmental modifications
• Assistance with activities of daily living
• Patient and family education
• Orientation as necessary
• Referral to resources
Factors Influencing Risk of Surgical
Problems in the Elderly
• Smaller margin of physiologic reserve
• Less ability to adapt to physiologic changes
• Greater risk of infection, hemorrhage, anemia, blood
pressure changes, and fluid and electrolyte imbalances
• Greater frequency of complications related to aging
factors
Advances Promoting Increased Success of
Surgical Procedures
• Better diagnostic tools
– Earlier diagnosis and treatment
• Improved therapeutic measures
– Surgical techniques and antibiotics
• Increased knowledge of the unique characteristics of
older adults
Patient Teaching for Surgical Procedures
• Preoperative preparation
• Reactions to anesthesia
• Length and description of the surgery
• Routine recovery room procedures
• Expected pain and its management
• Turning, coughing, and deep-breathing exercises
• Other anticipated procedures
Basic Preoperative Screening
• Analysis of blood samples
• Chest x-ray
• Electrocardiogram
• Pulmonary function testing
• Nutritional assessment
• Mental status
Surgical Interventions
• Padding of body prominences
• Infection control procedures
• Close monitoring of anesthesia during surgery
• Close monitoring for hypothermia
Postoperative Complications in the Elderly
• Higher incidence of delirium
• Paralytic ileus
– Fever, dehydration, abdominal tenderness, and
distention
• Fluid and Electrolyte imbalances
• Malnutrition
• Pneumonia; atelectasis
• Pressure ulcers
Postoperative Complications in the Elderly
(cont.)
• Wound infection
• Incidental hypothermia
• Joint stiffness
• Cardiac failure
Goals for Emergency Care
• Maintaining life functions
• Preventing and treating shock
• Controlling bleeding
• Preventing complications
• Keeping the patient comfortable
• Observing and recording signs, treatments, and
responses
• Assessing for causative factors
Problematic Nature of Emergencies in
Older Persons
• Frequent occurrence due to age-related changes
• Presentation as an atypical picture complicating diagnosis
• Greater difficulty to treat or stabilize because of altered
response to treatment
• Greater risk of causing serious complications and death
Common Emergencies
• Acute abdomen
• Acute confusion/delirium
• Aspiration
• Corneal abrasion
• Dehydration
• Detached retina
• Diarrhea
• Fainting
Common Emergencies (cont.)
• Falls
• Frostbite
• Hemorrhage
• Myocardial infarction
• Seizure
• Suicide attempt
Age-Related Factors Contributing to High
Risk of Infection in Older Adults
• Altered antigen-antibody response
• Decreased respiratory activity
• Decreased ability to expel secretions from lungs
• Weaker bladder muscles
• Prostatic hypertrophy
• Increased alkalinity of vaginal secretions
• Increased fragility of skin and mucous membranes
Other Factors Contributing to High Risk of
Infection in Older Adults
• High prevalence of chronic diseases
• Immobility
• Greater likelihood of:
– Malnutrition
– Urinary catheterization
– Invasive procedures
– Hospitalization and institutionalization
Preventing Infection in Older Adults
• Promote good hydration and nutritional status.
• Monitor vital signs, mental status, and general health
status.
• Maintain intact skin and mucous membrane.
• Avoid immobility.
• Ensure pneumococcal and influenza vaccines have been
administered.
Preventing Infection in Older Adults
(cont.)
• Maintain a clean environment.
• Restrict contact with persons who have infections or
suspected infections.
• Store foods properly.
• Prevent injuries.
• Adhere to infection-control practices.
Factors Influencing Postdischarge
Outcomes of Hospitalized Elderly
• Patient’s perception of health status and prognosis
• Number and complexity of medical conditions
• Prior history of self-care practices
• Family or social support and resources
Source
• Eliopoulos, C. (2005). Gerontological Nursing, (6th
ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN
0-7817-4428-8).