Chapter 38Acute CareChapter 38Acute Care

Measures to Promote Optimal Functional IndependenceMeasures 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.)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 ElderlyFactors 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 ProceduresAdvances 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 ProceduresPatient 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 ScreeningBasic Preoperative Screening

• Analysis of blood samples

• Chest x-ray

• Electrocardiogram

• Pulmonary function testing

• Nutritional assessment

• Mental status

Surgical InterventionsSurgical Interventions

• Padding of body prominences

• Infection control procedures

• Close monitoring of anesthesia during surgery

• Close monitoring for hypothermia

Postoperative Complications in the ElderlyPostoperative 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.)Postoperative Complications in the Elderly (cont.)

• Wound infection

• Incidental hypothermia

• Joint stiffness

• Cardiac failure

Goals for Emergency CareGoals 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 PersonsProblematic 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 EmergenciesCommon Emergencies

• Acute abdomen

• Acute confusion/delirium

• Aspiration

• Corneal abrasion

• Dehydration

• Detached retina

• Diarrhea

• Fainting

Common Emergencies (cont.)Common Emergencies (cont.)

• Falls

• Frostbite

• Hemorrhage

• Myocardial infarction

• Seizure

• Suicide attempt

Age-Related Factors Contributing to High Risk of Infection in Older AdultsAge-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 AdultsOther 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 AdultsPreventing 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.)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 ElderlyFactors 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

SourceSource

• Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).