Gerioperative Nursing Care : Principles and Practices of Surgical Care for the Older Adult

The authors of this book share decades of geriatric perioperative nursing care experience with readers in a thorough, systematic manner....[This book] would be an excellent addition to the library of any health care professional, especially a perioperative nurse, who provides care to older adults."-- AORN Journal, the official publication of the Association of Perioperative Registered Nurses This is a solid, well thought out book. The text has a clarity and focus which enhances understanding of the topics presented. It is particularly notable for crisp reading and uncomplicated, meaningful illustrations. Kudos to the authors for presenting such a medically solid book without losing the art of nursing care or the vision of a well tended patient."-- Nursing News This timely volume introduces gerioperative care, a new model of surgical care for the elderly designed to improve surgical outcomes and prevent complications through a focus on communication and relationship-centered care. It is the only book to specifically address the care of older adults undergoing surgery, providing practitioners with critical, practical, and theoretical information from the initial decision to have surgery through the first follow-up visit post-discharge. The text includes the anatomy and physiology of aging, preoperative care, intraoperative and post-anesthesia care, postoperative care, returning home, risk appraisal, education, prevention, early intervention, multidisciplinary team collaboration, and effective communication across all systems of care. Gerioperative Nursing Care is an essential resource for students and practitioners of surgical, critical/acute care, and geriatric nursing, along with clinical and case managers. The tools presented help to sustain and enhance quality nursing care for older adults considering surgery, undergoing surgery, and during post-surgery visits. Key Features Presents a comprehensive new gerioperative care model for older adults undergoing surgery Follows patient from primary to follow up care, including hospital care, ambulatory care, emergency and elective surgery, and perioperative care Applies primary, secondary, and tertiary care concepts to surgery Presents innovative focus on case management, with new care guidelines Provides new applications in preoperative training, family coaching, and post-operative cognitive dysfunction prevention Describes how to make quality improvements in current surgical care practices Identifies and discusses major health problems of older adults through EBP Includes case studies with discussion questions Gerioperative Nursing Care Principles and Practices of Surgical Care for the Older Adult Half Title About the Author Title Page Copyright Table of Contents Contributing Authors Illustrators Foreword Preface Acknowledgments Part I. Introduction to Gerioperative Care Chapter I. Gerioperative Demographics Demograhy of Aging Aging of the Oldest Old Aging in Men and Women Aging in Racial and Ethnic Populations Aging and Chronic Disease Aging and Health Care Aging and the Demand for Surgical Care Aging and Surgical Care Summary Key Points Chapter II. Introduction to Gerioperative Care Gerioperative Care Key Elements of Gerioperative Care Assessment Risk Identification Primary and Secondary Prevention Care Transitions Gerioperative Facilitated Care Uniqueness of Gerioperative FAcilitated Care Gerioperative Facilitated Care Team Core Principles Impact Structure Gerioperative Care Facilitator Gerioperative Companion-Coach Gerioperative Facilitated Care Practice Model Comfort Theory Best Practice Relationship-Centered Care Evaluation Gerioperative Facilitated Care Access to the Gerioperative Care Facilitator Related Transitional Care Models Summary Key Points Chapter III. Gerioperative Practice Standards and Quality Care Professional Practice Standards Nursing Scope and Standards of Practice Nursing Clinical Specialty Standards of Practice Allied Health Professional Standards Position Statements Nursing Position Statements Practice Guidelines Protocols Order Sets Quality Care Measuring Quality Care: Clinical Indicators Gerioperative Care Clinical Indicators Nursing Quality Indicators Gerioperative Care Quality Indicators Implementing Quality Care Summary Keypoints Chapter IV. Gerioperative Informed Consent Definition Legal Perspective Ethical Perspective Professional Standards Provider-Patient Communication Elements of Informed Consent Information Sufficiency Culture and Language Literacy Voluntary Action Medication Administration Competence and Capacity Informed Consent and Aging Decisional Support Gerioperative Communication and Informed Consent Communication Elements of Informed Consent and the Gerioperative Patient Understanding Capacity Transient Capacity Depression, Executive Function, and Decisional Capacity Provider Attitudes, Ageism and Decision Capacity Voluntariness Anesthesia, Capacity, and Informed Consent Preoperative Considerations Advance Directives Do Not Resuscitate Informed Consent for Research Summary Key Points Chapter V. Gerioperative Medication Safety Pharmacokinetics and Pharmacodynamics Age-Related Changes Comorbidity Adverse Drug Events Epidemiology Medication Errors Risk Factors Promoting Medication Safety Prescribing Cascade and Drug Underutilization Gerioperative Care Preoperative Considerations Preoperative Testing Preoperative Intervention Intraoperative Considerations Postoperative Considerations Intervention Medication Reconciliation Reducing Polypharmacy Patient-Provider Communication Reflective Practice Discharge Considerations Transitional Care System-Level Activities Summary Key Points Chapter VI. Gerioperative Coaching Definition Benefits Process of Gerioperative Coaching Evidence of Support Gerioperative Coaching Stages of Change Implementing Gerioperative Health Coaching Determining Readiness for Change Measuring Change Readiness and Confidence Ambivalence Facilitating Change Feedback Implementing Health Coaching Brief Gerioperative Coaching Intervention Alternate Models Training for Health Coaching Summary Key Points Chapter VII. Gerioperative Assessment Communication Assessment Environment Assessment Elements Comprehensive Geriatric Assessment Screening Gerioperative Assessment Informed Consent Advance Directives Comorbid Disease Functional Status Mobility Cognition Sensory Changes Depression Pain Nutrition and Hydration Polypharmacy Sleep Patterns Smoking Social Support Home Environment Spiritual Support Patient Strengths Physical Examination Preoperative Testing Prevention and Intervention: Prehabilitation Summary Key Points Part II. Aging and Gerioperative Care Chapter VIII. Gerioperative Anesthesia Preoperative Assessment Anesthetic Medications Benzodiazepines Interventions Narcotic Medications Interventions Morhpine Sulfate Fentanyl Hydromorphone Meperidine Sufentanil Alfentanil Remifentanil Naloxone Nonopioid Pain Control Acetaminophen Nonsteroidal Anti-Inflammatory Drugs Ketorolac Induction Agents Propofol Etomidate Ketamine Methohexital, Thiopental Muscle Relaxants Succinylcholine Rocuronium and C isatracrium Interventions Reversal Agents Anticholinergic Medications Glycopyrolate Atrophine Inhilation Agents Sevoflurane Desflurane Nitrous Oxide Interventions Types of Anesthesia General Anesthesia Monitored Anesthesia Care Monitored Anesthesia Care Postoperative Considerations Total Intravenous Anesthesia Regional, Spinal, and Epidural Anesthesia Fluid Administration Age-Related Anesthesia Considerations Interventions Positioning Supine Beach Chair Lithotomy Lateral Position Prone Fracture Bed Anesthesia Emergency Malignant Hyperthermia Surgical Care Improvement Project Summary Key Points Chapter IX. Cardiovascular Cardiac Considerations Age-Related Changes Heart Failure Coronary Artery Disease Valvular Heart Disease Cerebral Vascular Accident (Stroke ) Gerioperative Care Preoperative Considerations History Assessment Preoperative Testing Preoperative Interventions Intraoperative Considerations Postoperative Considerations Summary Key Points Chapter X. Renal Renal Considerations Age-Related Changes Renal Blood Flow Age-Related Changes Glomerular Filtration Age-Related Changes Kidney Function and Hormonal Influence Renin Age-Related Changes Aldosterone Age-Related Changes Atrial Naturietic Hormone Age-Related Changes Antidiuretic Hormone Age-Related Changes Parathyroid Hormone Age-Related Changes Erythropoietin Age-Related Changes Fluid and Electrolyte Balance Sodium Age-Related Changes Potassium Age-Related Changes Acid-Base Balance Age-Related Changes Body Water Age-Related Changes Urine Excretion Age-Related Changes Gender Differences in Voiding Age-Related Changes Continence Age-Related Changes Urinary Tract Infection Gerioperative Care Preoperative Consideratons History Physical Assessment Preoperative Testing Glomerular Filtration Rate Creatinine Blood Urea Nitrogen Cystatin C Urinalysis Electrolytes Intravenous Fluid Administration Intravenous Fluid Choices Age-Related Changes Vasopressors Age-Related Changes Intravenous Fluid Considerations Fluid Balance Renal Blood Flow Nephrotoxicity Postoperative Considerations Water and Electrolyte Balance Renal Blood Flow Nephrotoxicity Diuretics Excretion Summary Key Points Chapter XI. Pulmonary Pulmonary Considerations Age-Related Changes Upper Respiratory Tract Age-Related Changes Pharynx Age-Related Changes Larynx Age-Related Changes Lower Respiratory Tract Trachea Lungs Elasticity, Lung Compliance, and Surface Tension Age-Related Changes Bronchial Tree and Alveoli Age-Related Changes Mechanics of Ventilation Age-Related Changes Control of Ventilation Age-Related Changes Respiratory Pressures Lung Volumes and Lung Capacities Age-Related Changes Pulmonary Circulation Age-Related Changes Pulmonary Processes Ventilation Diffusion Age-Related Changes Perfusion Age-Related Changes Gerioperative Care Preoperative Considerations Respiratory Comfort and Functional Status Health History Chronic Disease Cough and Sputum Production Comorbid Diseases Lifestyle Habits Medications Nutritional Status and Hydration Planning for Discharge Physical Assessment Breath Sounds Neurological and Neuromuscular Changes Preoperative Testing Albumin and Prealbumin Pulse Oximetry Pulmonary Function Testing Bronchial Challenge Testing Preoperative Interventions Prehabilitation Physical Exercise Smoking Cessation Managing Sputum Production Patient Coaching Epidural Analgesia Intraoperative Considerations Postoperative Considerations Pulmonary Compromise Hypoxemia and Hypoventilation Bronchospasm and Laryngospasm Aspiration Atelectasis Pneumonia Pulmonary Edema, Pulmonary Embolus, And Pneumothorax Discharge Considerations Summary Key Points Chapter XII. Neurological Neurological Considerations Central Nervous System Age-Related Changes Neurotransmitters Age-Related Changes Effect on Function Cerebral Blood Flow and Metabolism Age-Related Changes Blood-Brain Barrier Age-Related Changes Spinal Cord Age-Related Changes Peripheral Nervous System Age-Related Changes Sensoriperceptual Age-Related Changes Psychomotor Speed Sleep Age-Related Changes Interventions Cognition Neuropathic Pain Gerioperative Care Preoperative Considerations History Medications Physical Examination Intervention Parkinson's Disease Intraoperative Considerations Parkinson’s Disease Postoperative Considerations Patients With Parkinson’s Disease Summary Key Points Chapter XIII. Musculoskeletal Musculoskeletal Considerations Skeletal Muscle Age-Related Changes Tendons, Ligaments, and Articular Cartilage Age-Related Changes Degenerative Osteoarthritis Bony Skeleton Age-Related Changes Estrogen Osteoporosis Strength and Endurance Flexibility Balance Gait Gerioperative Care Preoperative Considerations History Medication History Social Support Physical Examination Range of Motion Proprioceptionn, Gait, and Balance Muscle Strength Assessing Fall Risk Preoperative Testing Urine Culture Imaging Studies Radiology Documentation Preoperative Intervention Prehabilitation: A Primary Intervention Intraoperative Considerations Postoperative Considerations Patient Safety Pain Assistive Technolgy Assessing Mobility and Function Intervention Preventing Contractures Range of Motion Promoting Activity Increasing Activity Levels Fall Prevention Promoting Self-Care Decisional Support Discharge Considerations Summary Key Points Chapter XIV. Skin Skin Considerations Epidermis Age-related changes Dermal-Epidermal Junction Dermis Age-related Changes Topical Medication Patches Subcutaneous Tissue Age-related Changes Skin Appendages Sweat Glands Sebaceous Glands Hair Nails Age-Related Changes Wound Healing Age-Related Changes Xerosis Intervention Pruritis Interventions Skin Lesions Gerioperative Care Preoperative Considerations Intraoperative Considerations Postoperative Considerations Wound Care Pressure Ulcers Surgical Site Infections Interventions Summary Key Points Chapter XV. Gastrointestinal Gastrointestinal considerations Age-Related Changes Dentures Swallowing Age-Related Changes Stomach Age-Related Changes Small Intestine Age-Related Changes Large Intestine Age-Related Changes Liver Age-Related Changes Gallbladder Age-Related Changes Nutrition and Aging Energy Body Mass Index Protein Fat Carbohydrates Vitamins and Minerals Gerioperative Care Preoperative Considerations History Physical Assessment Interventions Postoperative Considerations Summary Key Points Chapter XVI. Hematology Blood components Platelets Red Blood Cells White Blood Cells Age-Related Changes Anemia Age-Related Changes Gerioperative Care Preoperative Considerations Intraoperative Considerations Postoperative Considerations Hemostasis Age-Related Changes Gerioperative Care Summary Key Points Chapter XVII. Immunity Immune and Lymphatic Considerations Lymphatic System Lymphatic Vessels Lymph Nodes Age-Related Changes Immune Defense Cells of Immunity Macrophages Age-Related Changes Polymorphonuclear Leukocytes Age-Related Changes Immunocytes Natural Killer Cells Age-Related Changes T-Cells (Cell-mediated Immunity) Age-Related Changes B-Cells (Humoral Response) Age-Related Changes Antibodies Age-Related Changes Spleen Age-Related Changes Thymus Age-Related Changes Immunity Age-Related Changes Autoimmunity Age-Related Changes Gerioperative Care Preoperative Considerations Intraoperative Considerations Postoperative Considerations Summary Key Points Chapter XVIII. Endocrine Endocrine Considerations Hypothalamus-Pituitary-Adrenal Axis Age-Related Changes Sex and Growth Hormones Age-Related Changes Adrenal Glands Cortex Medulla Age-Related Changes Gerioperative Care Preoperative Considerations Intraoperative Considerations Postoperative Considerations Thyroid Age-Related Changes Gerioperative Care Preoperative Considerations Intraoperative Considerations Postoperative Considerations Parathyroid Age-Related Changes Intraoperative Considerations Pancreas Age-Related Changes Gerioperative Care Preoperative Considerations Laboratory Assessment Interventions Intraoperative Considerations Postoperative Considerations Summary Key Points Chapter XIX. Frailty and Reserve Capacity Models of Frailty Biological Model Dynamic Model Reserve Capacity and Resilience Pathophysiology Characteristics of Biologic Frailty Multidimensional Frailty Gerioperative Care Preoperative Considerations Assessment Physical Assessment Preoperative Testing Prehabilitation Fitness and Conditioning Nutrition Optimizing Clinical Conditions Maximizing Cognition and Mood Intraoperative Considerations Hypothermia Postoperative Considerations Mobility Discharge Considerations Summary Key Points Part III. Gerioperative Considerations Chapter XX. Depression and Dementia Depression Late-Onset Depression Pathophysiology Detecting Depression Depression and Dementia Dementia Alzheimer’s Disease Vascular Dementia Mixed Dementia Gerioperative Care Preoperative Considerations History Chronic Disease Persistent Pain Medication Special Concerns Social Support Depression and Dementia Screening Changes in Affect and Cognition Suicide ideation Depression Screening Dementia Screening Physical Assessment Preoperative Testing Prehabilitation Intraoperative Considerations Postoperative Considerations Postoperative Onset Depression Postoperative Onset Dementia Postoperative Interventions Summary Key Points Chapter XXI. Delirium and Postoperative Cognitive Dysfunction Delirium Epidemiology Pathophysiology Neurotransmitter Hypothesis Age-Related Changes Inflammatory Processes Risk Factors Cognitive Reserve Delirium Trajectory Delirium Outcomes Gerioperative Care Preoperative Considerations Assessment Age Cognitive Status Depression Preexisting Disease Medication Visual and Hearing Impairment Nutrition and Dehydration Rapidity of Insult Intervention Intraoperative Considerations Primary Intervention Postoperative Considerations Assessing Postoperative Delirium Intervention Delirium Package of Care Oxygenation and Glucose Preventing Postoperative Complications Cognitive Engagement Vision, Hearing, and Environment Pain Relief Nutrition and Hydration Delirium and Postoperative Cognitive Dysfunction Postoperative Cognitive Dysfunction Definition Assessing Postoperatve Cogntive Dysfunction Postoperative Cognitive Dysfunction Trajectory Etiology Risk Factors Gerioperative Care Preoperative Assessment Intervention Intraoperative Considerations Postoperative Considerations Discharge Considerations Summary Key Points Chapter XXII. Gerioperative Pain Relief Gerioperative Pain Defined Categories of Pain Acute Pain Persistent Pain Preexisting Pain Postoperative Pain Pain Origin Somatic Pain Visceral Pain Neuropathic Pain Nonphysical Pain Physiology of Pain Age-Related Changes Undertreated Pain Outcomes Assessing Gerioperative Pain Quantifying the Subjective Experience Gerioperative Pain and Cognitive Impairment Variables in Pain Assessment Age Cohorts Gerioperative Care Preoperative Considerations Health History and Pain Assessment Physical Assessment Diagnostic Testing Intervention Patient Coaching Pain Relief Interventions Preemptive Pain Analgesia Epidural Analgesia Intraoperative Considerations Postoperative Considerations Environmental Strategies Mind-Body Strategies Physical Strategies Pharmacologic Strategies Nonopioid Analgesia Opioid Analgesia Intravenous or Epidural Strategies Intramuscular Administration Oral Administration Equianalgesic Dosing Documentation Discharge Considerations Summary Key Points Chapter XXIII. Promoting Discharge Wellness Background Transitional Care Goals Gerioperative Considerations Transition Planning Comprehensive Geriatric Assessment Cognition and Depression Polypharmacy Pain Mobility, Activity, and Functional Status Wound Healing and Nutrition Social Support Health Coaching Discharge Information Transition Support Evaluating Transitional Care Summary Key Points Chapter XXIV. Summary Appendix I. Protocol for Prevention, Early Detection, and Treatment of Postoperative Delirium in the Older Adult Medication Reconciliation Protocol Appendix II. Hendrich II Fall Risk Model Geriatric Depression Scale–Short Form Geriatric Depression Scale Scoring Instructions Patient Health Questionnaire (PHQ-9) The NEECHAM Confusion Scale* Summary of Psychometric Data Instructions for Scoring the Neecham Confusion Scale Cognitive-Information Processing Behavior and Performance Physiologic Control Helpful Hints for Scoring the Neecham Confusing Scale References Bibliography Index The authors of this book share decades of geriatric perioperative nursing care experience with readers in a thorough, systematic manner....[This book] would be an excellent addition to the library of any health care professional, especially a perioperative nurse, who provides care to older adults."--**AORN Journal, the official publication of the Association of Perioperative Registered Nurses** This is a solid, well thought out book. The text has a clarity and focus which enhances understanding of the topics presented. It is particularly notable for crisp reading and uncomplicated, meaningful illustrations. Kudos to the authors for presenting such a medically solid book without losing the art of nursing care or the vision of a well tended patient."--**Nursing News** This timely volume introduces gerioperative care, a new model of surgical care for the elderly designed to improve surgical outcomes and prevent complications through a focus on communication and relationship-centered care. It is the only book to specifically address the care of older adults undergoing surgery, providing practitioners with critical, practical, and theoretical information from the initial decision to have surgery through the first follow-up visit post-discharge. The text includes the anatomy and physiology of aging, preoperative care, intraoperative and post-anesthesia care, postoperative care, returning home, risk appraisal, education, prevention, early intervention, multidisciplinary team collaboration, and effective communication across all systems of care. __Gerioperative Nursing Care__ is an essential resource for students and practitioners of surgical, critical/acute care, and geriatric nursing, along with clinical and case managers. The tools presented help to sustain and enhance quality nursing care for older adults considering surgery, undergoing surgery, and during post-surgery visits. * Presents a comprehensive new gerioperative care model for older adults undergoing surgery * Follows patient from primary to follow up care, including hospital care, ambulatory care, emergency and elective surgery, and perioperative care * Applies primary, secondary, and tertiary care concepts to surgery * Presents innovative focus on case management, with new care guidelines * Provides new applications in preoperative training, family coaching, and post-operative cognitive dysfunction prevention * Describes how to make quality improvements in current surgical care practices * Identifies and discusses major health problems of older adults through EBP * Includes case studies with discussion questions Gerioperative demographics / Raelene V. Shippee-Rice, Susan J. Fetzer, and Jennifer V. Long Gerioperative care / Raelene V. Shippee-Rice, Susan J. Fetzer, and Jennifer V. Long Gerioperative practice standards and quality care / Raelene V. Shippee-Rice, Jennifer V. Long, and Susan J. Fetzer Gerioperative informed consent / Jennifer V. Long, Raelene V. Shippee-Rice, and Susan J. Fetzer Gerioperative medication safety / Raelene V. Shippee-Rice, Jennifer V. Long, and Susan J. Fetzer Gerioperative coaching / Donna Pelletier ... [et al.] Gerioperative assessment / Raelene V. Shippee-Rice, Jennifer V. Long, and Susan J. Fetzer Gerioperative anesthesia / Jennifer V. Long, Susan J. Fetzer, and Raelene V. Shippee-Rice Cardiovascular / David Durant, Susan J. Fetzer, and Jennifer V. Long Renal / Susan J. Fetzer, Jennifer V. Long, and Raelene V. Shippee-Rice Pulmonary / Jennifer V. Long, Raelene V. Shippee-Rice, and Susan J. Fetzer Neurological / Raelene V. Shippee-Rice, Jennifer V. Long, and Susan J. Fetzer Musculoskeletal / Raelene V. Shippee-Rice, Jennifer V. Long, and Susan J. Fetzer Skin / Jennifer V. Long, Susan J. Fetzer, and Raelene V. Shippee-Rice Gastrointestinal / Susan J. Fetzer, Jennifer V. Long, and Raelene V. Shippee-Rice Hematology / Susan J. Fetzer, Jennifer V. Long, and Raelene V. Shippee-Rice Immunity / Kathleen M. Gilkey, Jennifer V. Long, and Susan J. Fetzer Endocrine / Susan J. Fetzer, Jennifer V. Long, and Raelene V. Shippee-Rice Frailty and reserve capacity / Raelene V. Shippee-Rice, Susan J. Fetzer, and Jennifer V. Long Depression and dementia / Raelene V. Shippee-Rice, Susan J. Fetzer, and Jennifer V. Long Delirium and postoperative cognitive dysfunction / Raelene V. Shippee-Rice, Susan J. Fetzer, and Jennifer V. Long Gerioperative pain relief / Raelene V. Shippee-Rice, Jennifer V. Long, and Susan J. Fetzer Promoting discharge wellness / Raelene V. Shippee-Rice, Susan J. Fetzer, and Jennifer V. Long Summary / Susan J. Fetzer, Raelene V. Shippee-Rice, and Jennifer V. Long. Gerioperative care is a new paradigm Focused on improving the outcomes of older adults by carefully considering the implications and consequences of age related surgical recovery. This is the only volume to specifically address the surgical care of older adults providing practitioners with critical, practical, and theoretical information from the initial decision to have surgery through the first follow up visit after discharge. The text uses a systems approach to describe age related changes and the impact on perioperative considerations. It addresses the anatmoy and physiology of aging, and discusses specific areas of gerioperative vulnerbility and how they create grater risk for postop complications. Enhanced with case studies, the book addresses all aspects of preoperative care, intraoperative and postanesthesia care, postoperative care, returning home, risk appraisal and education, prevention, early intervention multidisciplinary team collaboration and effective communication across all systems of care