A Short Note On Intensive Care And The Elderly Essay

Australia is one of the most advantaged aged care systems in the world. The increasing numbers of ageing population is one of the major transformations being experienced by

This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of

Postoperative delirium (POD) is a pervasive complication in elderly surgical patients that is associated with increased morbidity and mortality. Depending on

The investigation of how anesthesia effects cognitive functioning has had a long history. Overtime, it has been suggested that there is an association between anesthesia, surgery, delirium, dementia and postoperative cognitive dysfunction (Inan & Ozkose Satirlar, 2015). The theory of anesthesia’s impact on cognitive functioning was derived in 1887, by Savage, who began to observe the “insanity” that follows the use of anesthesia. He suggested that “Any cause which will give rise to delirium may set up a more chronic form of mental disorder quite apart from any febrile disturbance” (Savage, 1887, p. 1199). Delirium can be defined as an altered level of consciousness that may cause a sudden decline in attention and focus perception (Isik, 2015). Postoperative delirium was reevaluated in 1955 when Bedford used a series of case studies collected over a 50 year span to describe a connection between anesthesia and dementia. The results suggest that 10% of the patients had postoperative cognitive dysfunction (Bedford, 1955). Since these initial studies, research has persisted using a variety of methods, in an attempt to determine: both long- and short-term effects of anesthesia on cognitive functioning and memory; whether the anesthesia administration technique will change the outcome of postoperative cognitive dysfunction; and other risk factors that may be associated to AD.

Enhanced assessment and nursing implementations to better prevent and detect ICU delirium will bring improved outcomes for this particular patient population. There are many ways to assess for ICU delirium. Two of the most reliable and easiest methods are basic observations from the bedside nurse and The Confusion Assessment Method (CAM). The CAM includes nine different criteria for delirium (1) acute onset and fluctuation, (2) inattention, (3) disorganized thinking, (4) altered level of consciousness, (5) disorientation, (6) memory impairment, (7) perceptual disturbances, (8) psychomotor agitation or retardation, and (9) altered sleep-wake cycle. A delirium diagnosis is given when criteria one and two and either three or four are present. The second assessment tool for delirium detection is made from nursing observations. The nurse observes the patient throughout their

In the second article, by authors Morgan, Lancaster, Walters,Owczarski, Clark, McSwain, and Adams, a retrospective study was done to determine and compare the outcomes between groups of patients who had surgery before and after the ERAS protocols were implemented. The purpose was to determine the impact that the ERAS protocols were having with regards to patient safety and efficiency. The study highlighted pre, intra and postoperative elements of ERAS and concluded that ERAS protocols are safe and effective at reducing morbidity, length of stay and cost. (Morgan , et al., 2016)

The elderly population and woman are mostly at risk of having operation. Most patients who undergo

Delirium is a serious decline in mental capacity of an individual that results in confused thinking and reduced awareness. Although difficult to accurately define, delirium is a major factor in reducing quality of life for inpatients and affects up to half the hospitalized elderly. However, despite its prevalence and seriousness, delirium is often undiagnosed and can lead to poorer prognosis through noncompliance or risky activities such as unsupervised movement. Some risk factors of delirium are nonmodifiable such as prior dementia, advancing age or other previous neurological diseases, but others can be controlled such as emotional distress, environment and medical interventions. Thus, to reduce the load on medical interventions required for progressed delirium, it is important to educate and support patients and their families to reduce the risk of delirium occurring. This can happen in the hospital through staff of volunteers who are trained to recognise and help delirium or confusion before it can progress to a more permanent dementia. This assignment details the

The American Association of Critical Care Nurses (AACN) is the largest non-profit specialty nursing organization in the world. There are over 500,000 nurses involved in the AACN and its mission is to provide its members with the latest knowledge and resources for providing the best care possible to acutely and critically ill patients. They do this through education of products, seminars and even national conferences where critical care nurses can learn about the latest in technology and treatment techniques.

During the intraoperative phase, identifying outcomes related to patient care during surgery is paramount due to the fact the patient is under anesthesia and completely dependent on the surgical team, and the nurse acting as their advocate. Examples of identifying outcomes prior to surgery would include; the prevention of electrical burns from cautery equipment, proper positioning during the procedure to prevent nerve or skin damage. Collaborating with other members of the surgical team regarding this information, and utilizing evidence-based nursing knowledge is necessary for the surgical plan. My responsibility as a nurse is to alleviate suffering during the intraoperative phase and as the patient’s advocate ensuring no further injury occurs.

“Surgical Outcomes for Patients Aged 80 and Older: Morbidity and Mortality from Major Noncardiac Surgery” by Hamel, Henderson, Khuri, and Daley (2005) was a prospective cohort study in which VA patients >/= 80 years of age were selected based on non-cardiac related surgeries from 1991 to 1998. The purpose of the study was to determine the efficacy of the use of the NSQIP program guidelines to the elderly population.

This article looks at negative effects after surgery that can be avoided by ambulating patients early. The purpose of this study is to provide evidence to the outcomes of mobilizing patients versus not mobilizing them. The article states that

Delirium is all too common in the intensive care unit (ICU) and should not be taken lightly. A 2009 observational cohort study performed in post-acute care facilities found that the one-year mortality rate for patients with delirium was 39% and that “subjects with persistent delirium were 2.9 times more likely to die during the one-year follow-up compared to subjects who resolved their delirium” (Kiely, et al., 2010, p. 55). Unfortunately, the change in mentation caused by delirium is often overlooked as a side-effect of sedative and analgesic medications often administered in the critical care setting or as symptoms of dementia or depression (Girard, Pandharipande, & Ely, 2008). Girard states, “The prevalence of delirium reported in medical and surgical ICU cohort studies has varied from 20% to 80%, depending upon severity of illness observed and diagnostic methods used” (Girard, Pandharipande, & Ely, 2008, p. S3). This variance is most likely due to the complications in defining the pathophysiology of delirium, as well as the difficulty in categorizing its signs and symptoms, which can range from mild confusion to full-blown hallucinations. Despite new scoring tools intended to identify delirium early in their hospital stay, many

Over the past decade, various studies have been directed on the recognition of delirium in acute care settings. Though most studies have focused on the optimal intervention for improving care among patients who have delirium, there is no quality evidence regarding the treatment of delirium with antipsychotics outside the ICU setting. Delirium affects approximately 60-80% and 20-50% of mechanically and non- ventilated patients, respectively. In the ICU, delirium is directly linked to high healthcare costs, prolonged ICU and hospital stays, and higher mortality rates. The risk of delirium-related mortality doubles when the patients are hospitalized. The predisposing factors for delirium included age, dementia, mechanical ventilation, delirium

A systematic review undertaken by Smetana (2009) identifies postoperative respiratory failure as an example of cascade iatrogenesis i.e. serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event. In this case, Mrs Hilton’s open cholecystectomy is that first event. Smetana (2009) points out that: when an older patient with postoperative pain is over-sedated, a decline in respiratory function occurs, that if not recognized, can result in respiratory failure that requires mechanical ventilation, that again, if not managed properly can culminate in ventilator-associated pneumonia and even sepsis and death (p.1529). After her upper abdominal surgery Mrs Hilton may have difficulty with deep breathing and coughing due to pain however both are essential interventions for prevention and treatment of respiratory infections and complications. Brown et al. (2008) recommend that when Mrs Hilton is awake, turning, coughing and deep breathing should be encouraged every one to two hours as this aids in the removal of secretions and prevents mucous plugs. They also encourage mobility when possible to increase respiratory excursion. Moreover, as Mrs Hilton