... The Older Adult High-Acuity...
... The Older Adult High-Acuity Patient...
...Objectives: 1. Describe the characteristics of the...
...the characteristics of the aging population. 2....
...Apply knowledge of the age-related changes in...
...Apply knowledge of the age-related changes in...
...Apply knowledge of the age-related changes in...
...Apply knowledge of the age-related changes in...
...their impact on older high-acuity patients and...
...impact hospitalization in the older patient. 9....
...hospitalization in the older patient. 9. Demonstrate...
...patient. 9. Demonstrate the use of common...
...tools. 10. Demonstrate the nursing management of...
...nursing management of older patients with high-risk...
...special situations including the culture of caring...
...of caring for older adults and end-of-life...
...end-of-life care. I. The Older Adult Patient...
...care. I. The Older Adult Patient A....
...Adult Patient A. The older adult patient...
...Patient A. The older adult patient 1....
...areas should understand the age-related changes that...
...changes that make older patients vulnerable to...
...that might impact the outcome of their...
...their hospitalization. 2. Older adults may present...
...are less predictable; older patients may have...
...critically ill. 3. The application of early...
...and provide for the best possible outcomes...
...B. Characteristics of the older adult population...
...Characteristics of the older adult population 1....
...Demographic characteristics in the U.S. (people are...
...people 85+. (5) The “age wave” will...
...care services by the older population (1)...
...services by the older population (1) Older...
...older population (1) Older adults will be...
...(b) 55% in the intensive care unit...
...minority populations. (2) Older adults; changing percentages....
...to assess each older adult individually. Multiple...
...permanently critically ill. Older patients may have...
...Demographics Characteristics in the U.S. Population aged...
...care services by the older population: Older...
...services by the older population: Older adults...
...the older population: Older adults will be...
...and minority populations. Older adults; changing percentages....
...Changes associated with the normal aging process...
...pathological process c) The application of early...
...complications. (4) Provides the best possible outcomes....
...Age-related alterations in the central nervous system...
...not synthesized at the same rate. (3)...
...nervous changes impact the neurologic exam: (1)...
...in all of the sensory receptors: (1)...
...(2) Negatively impacts older adults’ ability to...
...common). c) Smell: The sensitivity to smells...
...Touch: Sensitivity in the fingertips, palms, and...
...to changes in the environment. (1) Decline...
...Changes associated with the normal aging process...
...pathological process 3. The application of early...
...Prevents complications. Provides the best possible outcomes....
...Age-related alterations in the central nervous system...
...not synthesized at the same rate. Declines...
...nervous changes impact the neurologic exam: Mental...
...in all of the sensory receptors. Decline...
...45–65. Negatively impacts older adults’ ability to...
...common). 9. Olfactory: The sensitivity to smells...
...Touch: Sensitivity in the fingertips, palms, and...
...to changes in the environment: Decline in...
...a) CHD is the leading cause of...
...age 65 or older. 2. Cardiovascular changes...
...Cardiovascular changes alter the function of myocardium...
...Increased stiffness of the arterial walls (3)...
...less reliable in the older patient. a)...
...reliable in the older patient. a) 50%...
...might be in the normal range. 6....
...Surface area of the lungs is decreased,...
...of care of the elderly patient on...
...prevention guidelines. (3) Older patient might experience...
...statistics: CHD is the leading cause of...
...age 65 or older. 2. Cardiovascular (CV)...
...(CV) changes alter the function of myocardium...
...less reliable in the older patient: 50%...
...reliable in the older patient: 50% do...
...might be in the normal range. 6....
...Therapeutic interventions in the elderly: Therapeutic treatments...
...Surface area of the lungs is decreased...
...through changes in the skin: a) Wrinkling...
...with aging, predisposing the patient to: a)...
...a contamination of the deep layer of...
...surfaces. (b) Reposition the patient frequently. (c)...
...temperature. (b) Keep the patient covered while...
...musculoskeletal issues in the older adult: a)...
...issues in the older adult: a) Decreased...
...4. Osteoarthritis is the most common arthritic...
...arthritic condition among older adults: a) Affects...
...directly related to the aging process. c)...
...5. Compression of the spinal column or...
...spinal column or the spinal nerves is...
...stenosis (narrowing of the spinal canal). b)...
...b) Thinning of the cartilage between the...
...the cartilage between the vertebrae. c) Development...
...bone spurs around the vertebrae. 6. Nursing...
...support surfaces. Reposition the patient frequently. Optimize...
...room temperature. Keep the patient covered while...
...musculoskeletal issues in the older adult: Decreased...
...issues in the older adult: Decreased muscle...
...11. Osteoarthritis is the most common arthritic...
...stenosis. Thinning of the cartilage between vertebrae....
...a) Changes affecting the teeth include: (1)...
...or atrophy of the jawbone 2. Esophageal...
...pylori) (1) Increases the risk for growth...
...of bacteria in the stomach (2) Increases...
...stomach (2) Increases the risk of aspiration...
...altered. b) Impacts the absorption of vitamins...
...Diminished compliance of the rectum. 6. Pancreas...
...Blood flow to the liver is reduced....
...that relate to the health of the...
...the health of the GI system: (1)...
...(1) Atrophy of the efferent and afferent...
...to reflux of the vesicoureteral junction b)...
...4. Problems in the urination process might...
...f) Sensation of the need to void....
...genitourinary function in the older adult: a)...
...function in the older adult: a) Increased...
...c) Attributed to the presence of indwelling...
...indwelling catheters in the hospital d) Often...
...not apparent e) Older adult patient might...
...changes Changes affecting the teeth include: Oral...
...or atrophy of the jawbone. 2. Esophageal...
...is altered. Impacts the absorption of vitamins...
...Diminished compliance of the rectum. 6. Pancreas...
...Blood flow to the liver is reduced....
...to reflux of the vesicoureteral junction. Leads...
...13. Problems in the urination process can...
...Obstruction. Sensation of the need to void....
...genitourinary function in the older adult: Increased...
...function in the older adult: Increased prevalence...
...bacteremia Attributed to the presence of indwelling...
...are not apparent Older adult patient might...
...d) Increase in the prevalence of diabetes...
...(1) ~25.8% of the population with diabetes...
...Immune system 1. The immune system of...
...system of an older person is more...
...atypically in an older person. a) Fever...
...influenza are among the top ten causes...
...of death for older adults. a) It...
...pneumococcal vaccines decrease the risk for pneumonia....
...of SIRS in older adults is significant....
...develop sepsis in the U.S. are 65+...
...glucose. Increase in the prevalence of diabetes...
...3. Changes in the thyroid Aging body...
...Heart complications. 6. The immune system of...
...system of an older person is more...
...atypically in an older person. Fever might...
...influenza are among the top ten causes...
...of SIRS in older adults is significant....
...Impacting Hospitalization A. The “three Ds”-dementia, depression,...
...one another 3. The normal older adult...
...3. The normal older adult retains memory...
...b) When an older patient exhibits these...
...disease (responsible for the largest percentage) (2)...
...neurofibrillary tangles in the brain d) Course:...
...slow progression of the disease. C. Depression...
...in10–12% of community-dwelling older adults. b) Rates...
...institutional settings. c) The highest rate of...
...group is among older men. d) Very...
...Very common in older people with conditions...
...very treatable in the older adult. c)...
...treatable in the older adult. c) Newer...
...(acute confusion) is the rapid onset of...
...an insult to the brain as a...
...status (can be the first sign of...
...to 62% of older people in the...
...older people in the hospital overall b)...
...half of postoperative older patients c) Can...
...normal. When an older patient exhibits these...
...10–12% of community-dwelling older adults. Rates are...
...suicide is among older men. Very common...
...is treatable in the older adult. Newer...
...treatable in the older adult. Newer medications...
...10. Delirium is the rapid onset of...
...an insult to the brain as a...
...to 62% of older people in the...
...older people in the hospital overall. Develops...
...half of postoperative older patients. Can be...
...of stay in older patients. 2. Older...
...older patients. 2. Older patients are at...
...Fall prevention for older adults in acute...
...ambulation or getting older patients up in...
...patients up in the chair as able....
...pain control for the older adult in...
...control for the older adult in the...
...older adult in the high-acuity setting can...
...2. Pain affects older adults’ ability to...
...Age-related changes impact the ability to perceive...
...age. c) Impacts the ability to accurately...
...commonly described among older adults. b) Leads...
...environment to decrease the perception of pain....
...a challenge in the older patient. a)...
...challenge in the older patient. a) Nonsteroidal...
...causes neurotoxicity in older patients). c) Evaluating...
...of medications to the older adult is...
...medications to the older adult is complicated...
...surface area of the small intestine (2)...
...active in an older person’s system longer...
...4. Polypharmacy a) Older adult might have...
...Prescription medications. (2) Over-the-counter medications. (3) Vitamins...
...Inappropriate medications for the elderly—problems, solutions, considerations....
...Identify medications increasing the risk for adverse...
...Medication Use in the Elderly b) When...
...b) When an older adult receives a...
...go slow.” c) The therapeutic window might...
...in acute care. Older patients are at...
...Fall prevention for older adults in acute...
...stimuli declines. Impacts the ability to accurately...
...surface area of the small intestine Decreased...
...Evaluate Prescription medications. Over-the-counter medications. Vitamins and...
...reactions. When an older adult receives new...
...and go slow.” The therapeutic window might...
...Assessment Tools for the High-Acuity Nurse 1....
...for problems in older patients. A. Assessment...
...methods determine if the person has normal...
...items (2) Draw the face of a...
...try to repeat the original three items...
...Screening instrument walks the nurse through the...
...the nurse through the patient assessment. b)...
...about mood over the past two weeks....
...is based on the number of answers...
...prevented by reducing the risk factors. C....
...patient’s account of the pain. b) Assess...
...pain: impact on the older adult’s ability...
...impact on the older adult’s ability to...
...to recover from the present health condition....
...pain assessment. e) The most important consideration...
...important consideration in the assessment of the...
...the assessment of the presence and severity...
...of pain is the patient’s account of...
...patient’s account of the pain. f) Nurses...
...be aware of the age-related alterations in...
...for problems in older patients. 2. Mental...
...about mood over the past two weeks....
...or no. Score the number of depressed...
...Patient’s account of the pain. Nurses work...
...of death in the elderly. Contributing factors:...
...traumatic injuries a) Falls—the most common cause...
...crashes account for the most fatalities. c)...
...mortality rate in the elderly. 3. Nursing...
...aimed at stabilizing the injuries and preventing...
...for care in the high-acuity area include:...
...monitoring is important; older adults don't tolerate...
...be obscured, as the heart rate might...
...impaired. 4. Determining the cause a) Perform...
...reserve: (1) Increase the risk of pulmonary...
...wall: (1) Increase the likelihood of abdominal...
...and osteoporosis increase the susceptibility of the...
...the susceptibility of the older adult to...
...susceptibility of the older adult to traumatic...
...burn in an older adult is very...
...healing (particularly in the presence of malnutrition)....
...include: Falls are the most common. MVC...
...common. MVC have the most fatalities. Burns...
...nursing care: Stabilize the injuries, prevent complications:...
...nursing care in the high-acuity area include:...
...impaired. 5. Determining the cause of injury:...
...of caring for older adults 1. Hartford...
...Nursing, funded by the John A. Hartford...
...b) Provides steps the nurse can follow...
...better care for the older high-acuity patient....
...care for the older high-acuity patient. c)...
...psychological needs of older adults. B. End-of-life...
...care 1. End-of-life care—the problem a) In...
...acute care settings, the focus of patient...
...b) Needs of the elderly person at...
...elderly person at the end of life...
...care. 2. End-of-life care—the solution a) Palliative...
...resuscitation efforts at the end of life:...
...decisions (1) In the later stages of...
...Nursing responsibilities at the end of life...
...rate of an older adult has less...
...be given to the elderly patient population:...
...Nursing, funded by the John A. Hartford...
...issues Provides steps the nurse can follow...
...better care for the older high-acuity patient....
...care for the older high-acuity patient. Physiologic,...
...psychological needs of older adults. 3. End-of-life...
...adults. 3. End-of-life care—the problem In most...
...curative. Needs of the elderly person are...
...care. 4. End-of-life care—the solution • Palliative...
...Nursing responsibilities at the end of life:...
...rate of an older adult has less...
...summarizes changes in the central nervous system...
...nervous system in the older adult. Discuss...
...system in the older adult. Discuss this,...
...center or invite older seniors to the...
...older seniors to the classroom. Specifically, meet...
...centenarian to appreciate the healthy seniors that...
...their health through the years, their secrets...
...administrator to visit the classroom). Ask about...
...classroom). Ask about the most common health...
...care problems of the elderly that they...
...this compares with the list of problems...