Discussion Reponse

One risk that is increased in the hospitalized older adult is falls. Ehrenclou (2018) explains that families cannot simply drop the older adult at the hospital doors and expect all to go well. It is important when at all possible that a family member remain at the bedside as Ehrenclou (2018) explains it can help prevent falls. While working in New Mexico, Colorado and Hawaii when patients were noted to be at risk for falls a safety sitter could be obtained to monitor and prevent falls. When I left my home to begin travel nursing my home town hospital had not yet began a safety sitter program leaving the only option as family, low beds, bed alarms and one to one monitoring. At the time the House Supervisors strongly discouraged nurses from getting one to one order. It was not uncommon once the order was obtained for the house supervisor to call the doctor and get it rescinded. Each hospital had a fall policy which include special colored wrist bands and symbols on the room door or doorway. Additional risk for the older adult are identified by Ehrenclou (2018) including delirium, pressure ulcers, increased confusion, adverse reaction to new medication, malnutrition and hospital acquired infection. As with fall prevention family at the beside can be beneficial in dealing with confusion, cuing the older adult to reposition and encouraging eating. The Interdisciplinary team can identify through assessment risk factors and develop a preventive plan of care. The dietitian can recommend that calorie dense supplements can be given to support nutrition for those with poor intake, wounds or skin impairment. As part of the nursing admission assessment fall risk scores and skin risk scores are identified based on age, continence of bowel and bladder, ability to turn in bed. A special mattress is provided for individuals with high skin risk scores. Staff will assist mobility impaired individuals to turn from side to side to prevent sores. Physical therapy can assess the patient and assist with developing an activity routine or exercises to maintain or even improve mobility and strength. Mody ( 2011) states the introduction of alcohol-based hand cleaners in hospitals has improved health care workers compliance with hand hygiene. Hand hygiene is the front line for preventing the spread of germs. Mody (2011) discusses additional infection control tactics of standard precautions and ongoing staff education. Flu shots though there has been some controversy are another way to protect the older adult and at-risk population. ***Please respond with a minimum of 200 words, to classmate discussion post*** Discussion #2 The elderly face many hazards during hospitalization. A good nurse is aware of these hazards and does her best to help prevent any harm to the patient, because first and foremost, we should do no harm. ” Older adults have a much greater chance of being admitted to the hospital than any other age group in the United States. People aged 65 years and older make up 13% of the U.S. population but account for 36% of hospital admissions for acute care and nearly half of hospital spending for adult care. This trend is expected to increase rapidly as the population continues to age and the needs of the older adult become more complex” (Clohesy-Pizzingrillo, 2010). Falls: The elderly are most at risk for falls in the hospital because they may be more confused than usual and not ask for assistance to get out of the bed. They should be placed in a room close to the nurses’ station and fall alarms should be used at all times. If possible, auditory reminders to stay in bed can be activated. Infection: The nurse is the primary candidate to prevent hospital acquired infections. Adhering to strict hand hygiene is the first line of defense against infections. Adhering to sterile technique when changing central line dressings, placing urinary catheters, and changing wound dressings are ways the nurse can help to prevent the most common hospital acquired infections. The elderly are also at risk of developing c-diff from strong antibiotic therapy, so getting antibiotics discontinued that are unnecessary is another way to help infection risk. Pressure Ulcers: Immobility, dehydration, and malnutrition lead to skin breakdown and pressure ulcers in the elderly. Patients should be placed on specialty mattresses if they are at risk for breakdown and turned every two hours with continuous inspection of bony prominences. Any sign of breakdown should be assessed by a wound care nurse. Medication side effects: Many medications given to the elderly are excreted more slowly because of chronic renal disease. Medications can build up and cause sedation and polypharmacy toxicity in the elderly. Also the elderly may have side effects to medications that are not normally seen in younger patients. Lorazepam can cause agitation and delirium in some elderly patients, so it’s use for sedation should be cautiously used. The nurse is the primary advocate for this vulnerable population and is the first line of defense and the first to notice complications. Diligent care by a seasoned nurse can save someone’s life, especially in the elder adult population. ***Please respond with a minimum of 200 words, to classmate discussion post***

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