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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).