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, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN ).