One of the greatest challenges with geriatric patients is maintaining homeostasis and managing pain during multisystem failure. With geriatric patients the body’s ability to regulate itself physiologically in response to changes due to illness is decreased, there by leading to multisystem failure. Elderly display shock with minimal signs and symptoms which leaves little time for intervention. The best treatment form multisystem failure is prevention. This can be obtained by collaborating with multidisciplinary team including; MD, nurse, lab, radiology, respiratory and spiritual care. The prevention of infection can be obtained by using universal precautions , discontinuing IV lines, frequent turning, encouraging cough and deep breathing as well as using a Incentive Spirometer to prevent pneumonia. To ensure optimal oxygen perfusion and to decrease workloads on the heart supplemental oxygen may be required.
I’m going to review the case of a 73 year old female who was transferred to the Emergency room after collapsing in back yard. Prior to her collapse she was talking on the phone with a friend who reported “patient seemed confused”. Upon arrival to the hospital patient complains of difficulty with breathing. Her respirations and heart rate are elevated and her previous history includes diabetes and hypertension. Patient states she “just started a new blood pressure medication, Lisinopril”. Her other medications include metformin for diabetes and hydrochlorothiazide for fluid retention. Patient becomes unresponsive and is having more difficult time breathing.
Assessment of Patient:
Upon admission to ER nurse would immediately get set of VS including blood pressure looking for range of systolic <120 and diastolic <80, heart rate 60-100 bpm, respirations 12-20 breaths per minute, oxygen saturation >90% and temperature of 98.6 orally. Nurse would listen to lung sounds for fluid and/or atelectasis. Nurse would obtain apical heart rate observing regularity and rate. Nurse would listen to bowel sounds in all four quadrants listening for activity of function and to rule out any blockage or ischemia. While assessing patients’ pain level by using number scale 0-10, would also assess patient’s mentation by asking patient to state her date of birth, full name, current date and location. Assessment of skin integrity, noting any edema, skin discolorations, open areas, moisture of skin and tenting of skin to check for dehydration. Review of VS as well as assessing circulation by checking capillary refill is less than 3 seconds and checking skin temperature and moisture. Nurse would report findings to the MD and request orders. Such as pain medications, chest x-ray, oxygen, labs and IV’s.
Patient would be on continuous telemetry monitoring as well as continuous pulse oximetry. Close monitoring of oxygen perfusion is imperative because sepsis interferes with normal systemic blood flow to organs therefor depriving vital organs...