1. Chapter 33 Acute Care

2. Introduction Acute care and the older adult population
Higher rates of hospitalization
Longer length of stay (LOS)
Significant consumers of outpatient hospital services
Age-related changes increase the risk of injuries, infections, and complications
Older adults have unique care needs while hospitalized

3. Risks Associated with Hospitalization of Older Adults
Decreased functional status
Nosocomial infections
Iatrogenic complications
Delirium, falls, pressure ulcers, dehydration, incontinence, constipation, and loss of functional independence

4. Question Is the following statement true or false?
Many older adults who have lived independently in their homes prior to hospitalization are not discharged with the same level of function and may require nursing home transfer.

5. Answer
True
Rationale: Many older adults who have lived independently prior to hospitalization are discharged with a significant decrease in functional status. This decline is related to effects of aging, risk for nosocomial infections, and iatrogenic complications. Rather than being discharged to home, they may require transfer to a nursing home.

6. Nursing Interventions to Minimize Risk and Promote Optimal Function
Assessment to identify problems and risks
Early discharge planning
Encouragement of independence
Monitoring of medications
Prevention of complications
Environmental safety protections
Education

7. Surgical Care
More adults of advanced age are undergoing surgical procedures
Independent functional status and quality of life (QOL) can be improved
Age-related changes alter normal surgical procedures in this population

8. Surgical Care (cont.) Special risks for older adults
Smaller margin of physiologic reserve
Less ability to adapt to physiologic changes
Age changes can cause greater risk of complications
Proactive strengthening of capacities
Nursing diagnoses

9. Surgical Care (cont.) Preoperative considerations
Sensitivity to fears of older adults
Understanding of how surgical procedures have advanced
Reassurance and support
Patient education regarding what to expect before, during, and after the procedure
Review of medications
Preoperative screening completed

10. Question
Which of the following herbal medications may have an effect on blood clotting and must be documented in the medical record prior to any surgical procedure?
Garlic
Ginkgo biloba
Black cohosh
Rose hips

11. Answer
B. Gingko biloba
Rationale: Because cardiac and pulmonary functions can be altered by certain drugs, it is important to make sure this information is communicated to the physician. It is important to know about herbal medications that the patient may be using because some—such as ginseng and gingko biloba—can affect clotting.

12. Surgical Care (cont.) Operative and postoperative care considerations
Use of anesthetics in older adults
Prolonged surgery discouraged
Careful positioning
Close monitoring of body temperature
Infection control measures

13. Surgical Care (cont.)
Operative and postoperative care considerations (cont.)
Close observation and monitoring of vital signs
Evaluation of the potential for shock and hemorrhage including blood loss
Assessment for hypoxia, urinary output, fluid and electrolyte balance, and infection
Strict documentation of intake and output
Relief of pain is essential

14. Surgical Care (cont.)
Operative and postoperative care considerations (cont.)
Attention to nutritional status
Maintaining regular bowel and bladder elimination
Keeping joints mobile
Interventions to promote mobilization and prevent postoperative complications

15. Question Is the following statement true or false?
Older adults may demonstrate restlessness as the primary symptom of hypoxia after surgery.

16. Answer
True
Rationale: Although not fully conscious after surgery, the older person may demonstrate restlessness as the primary symptom of hypoxia. It is important that this restlessness not be mistaken for pain; administration of a narcotic could deplete the body’s oxygen supply even more.

17. Emergency Care
Occurrence is often because of age-related changes that lower resistance and increase the risk of injury and illness
Atypical presentation of disease that complicates diagnosis
More difficult to treat and stabilize
Greater risk of complications and death

18. Emergency Care (cont.) Goals guiding nursing actions
Err on the side of safety
Obtain necessary diagnostic tests
Emergency conditions
Nursing interventions

19. Infections
Factors responsible for the high risk of infection in older adults
Atypical presentation of symptoms
Abrupt, unexplained change in physical or mental function
Leading causes of infection-related deaths
Urinary tract infection (UTI)
Bacterial pneumonia
Measures that prevent infections

20. Question Is the following statement true or false?
Gerontological nurses should suspect an infection when there is any abrupt, unexplained change in physical or mental function in the older adult.

21. Answer
True
Rationale: Infections in older adults develop more easily and are more difficult to identify early because of altered symptomatology. Gerontological nurses should suspect an infection when there is any abrupt, unexplained change in physical or mental function in the older adult.

22. Discharge Planning for Older Adults
Early and competent discharge planning is essential
Goals: prevent complications, reduce risk for re- hospitalization, and minimize stress
Factors influencing postdischarge outcomes
Interdisciplinary geriatric team function
Discharge plans must address family and caregiving needs