199
CHAPTER 7 Life Span: Older Adults
Promoting Safe, Effective Nursing Care boxes emphasize how to provide safe and effective care by highlighting an example of a competency expressed in practice.
EXAMPLE CLIENT CONDITION: Elder Abuse Key Point: Like domestic violence, elder abuse is seen in all cultures and socio- economic groups. Abuse Types Abuse takes many forms: Physical Emotional Sexual Financial Neglect Abandonment Risk Factors CLIENT CONDITION
Risk Factors Mental illness Alcoholism or drug abuse in patient or caregiver Dependence on others Past history of abusive relationships Depression Low self-esteem Poor health of patient or caregiver Caregiver stressed or frustrated with difficult caregiving tasks Social Determinants of health: Ageism Social isolation or poor social network Low-income status Financial or other family problems (of patient or caregiver) Inadequate or unsafe housing Lack of health insurance
656
UNIT 3 Essential Nursing Interventions
Preventing Ventilator-Associated Pneumonia (VAP) Chapter Key Concepts: Infection Prevention and Control Competencies: Provide safe, quality client care; Collaborate with the interprofessional healthcare team You and your colleagues can help improve the quality of patient care.Think about the following project and consider what Thinking, Doing, and Caring skills are required for its success.
3. The result. Incidence of VAP declined 72%, and after changing the tooth cleanser to chlorhexidine gluconate, VAP declined by 90% (Hutchins et al., 2009). Other researchers interested in preventing VAP reviewed 28 clinical trials in the scientific literature.They found that chlorhexidine rinses, gels, and swabs also lower the risk for HAIs for patients receiving mechanical ventilation (Datta, 2024; El-Rabbany et al., 2015;Yusef, 2013; Zhao et al., 2020). Think about it: Reflect on the following and discuss the questions with your peers: ➤ What information did nurses and team members need before changing the care of patients on ventilators? ➤ How does the intervention improve patient comfort? ➤ How significant do you think the team’s work was? How will their efforts affect patients? ➤ What do you think the team should measure to determine whether the intervention worked?
Key Point: The risk of abuse is higher for women and those with physical and cognitive vulnerabilities. Advanced age Physical, functional, or cognitive impairment
Key Point: If an older adult has an injury such as maxillofacial trauma, dental trauma, subdural hematomas, periorbital and laryngeal trauma, rib fractures, or upper extrem- ity injuries, along with a wasted and unkempt appearance, it is possible that the injury was inflicted. Elder abuse takes many forms, including the following: • Battering • Inappropriate use of drugs and physical restraints • Force-feeding, physical punishment • Nonconsensual sexual contact • Treating an older person like an infant, including infantilizing communication (also referred to as elderspeak ) • Giving an older person the “silent treatment” • Enforced social isolation • Demeaning an older adult • Neglect • Abandonment • Financial or material exploitation, such as illegal or improper use of an older adult’s funds, property, assets, or Social Security checks • Assess older adults for abuse anytime there is a possibility that an injury may have been inflicted rather than accidental. • Assess for social determinants, risk factors, and etiology of the abuse. • For a screening tool and a procedure to aid you in assessing for abuse,
RECOGNIZING CUES
Scenario. Nurses and physicians at the Mercy Medical Center wanted to reduce the rate of VAP in the ICU. 1. They collected data to establish the current VAP rate of 12.6 cases per 1,000 ventilator days. 2.Then they developed and implemented an intervention. Nurses provided oral care with cetylpyridinium chloride using a suction toothbrush every 4 hours.After that, they cleaned the patient’s mouth with a hydrogen peroxide– treated suction swab, performed deep oropharyngeal suctioning, and applied mouth moisturizer.
657
ANANLYZING CUES/ DIAGNOSING
CHAPTER 19 Promoting Asepsis & Preventing Infection
hands and rub until dry. This should take 20 to 30 seconds. In a surgical setting, wash for 2 to 6 minutes, depending on the soap or other product used. ■ Water. Use warm water and rinse off soap completely. ■ Soap and Antimicrobial Products. Use agency-approved soap. The CDC (2022) recommends using a 60% alcohol- based solution (rubs, sprays, gels) for routine hand cleansing and plain or antimicrobial soap and water when hands are visibly dirty (Boyce & Pittet, 2002). Iodine compounds are also effective, but they are usually too irritating for regular hand hygiene. ! If there is a potential for contact with bacterial spores (e.g., when caring for a client with a C. difficile infection), you must wash your hands with soap and water; alcohol-based solutions are not effective against spores. ■ Friction. Rub all surfaces of the hands and wrists vigorously, including the backs of the hands and between the fingers. Remove jewelry and clean areas underneath. Clean thor- oughly underneath the fingernails using a brush or nail pick. ■ Drying. Use single-use towels or hand dryers to remove all moisture after washing the hands. If using antimicrobial hand gels, apply and rub hands until dry. (continued) 24/03/23 5:17 PM
disposable basins and cloths with 2%–4% chlorhexidine glu- conate (CHG) to reduce colonization of specific bacteria and infections with MDROs (American Association of Critical-Care Nurses, 2013; Chapman et al., 2021; Musuuza et al., 2019; Petlin et al., 2014; Siegel et al., 2017, last update).Apply emollients after bathing to prevent dry skin. Rest and Sleep Advise patients that 6 to 9 hours per night is considered fully restorative for most people. However, sleep needs and patterns vary. Rest and sleep conserve energy needed for healing. Exercise and Activity Emphasize that exercise is just as important as rest and sleep. Too little activity causes circulation to slow and the lungs to supply less oxygen. Excessive exercise leads to fatigue and joint injury. Chapters 28 and 30 provide in- depth discussion of rest, sleep, activity, and exercise. Stress Reduction Inform clients of the need to reduce stress. Laughing increases immune responses, improves oxy- genation, and promotes body movement. In contrast, physical or mental stress decreases the body’s immune defense. Studies demonstrate a correlation between stress and disease (Cous- ins, 1979; Franco et al., 2003; Wang et al., 2022). See Chapter 8 if you want additional details about stress. Immunizations Encourage clients to follow recommenda- tions for immunizations (e.g., via vaccination) to protect against several common infectious diseases (e.g., COVID-19, measles, mumps, pertussis, polio, pneumonia, influenza, smallpox, and shingles). Unfortunately, some pathogens, such as the common cold virus, mutate too rapidly for an immunization to be devel- oped. KEY POINT: For most diseases, at least 85% of the popula- tion must be immunized in order to protect the entire population from the disease. Refer to the CDC for recommended vaccination schedules for infants, children, adolescents, and adults; during pregnancy; and prior to international travel. Knowledge Check 19-5 What actions improve the host’s ability to prevent infection?
Go to Procedure 6-1 in Volume 2.
PRACTICING MEDICAL ASEPSIS Asepsis is a term that refers to the absence of contamination by disease-causing microorganisms. Medical asepsis (“clean technique”) refers to procedures that decrease the potential for the spread of infection. You likely already practice medical asepsis in other settings without realizing it. For example, at home, you wash your hands before and after handling food. In the healthcare setting, medical asepsis includes hand hygiene, environmental cleanliness, standard precautions, and protec- tive isolation. Infection prevention and the patient’s safety depend on nurses’ ability to follow the principles of asepsis rigorously and consistently. When you are hurrying, you may be tempted to take shortcuts or forget to follow a guideline. KEY POINT: Cutting corners can put your patient, and possibly yourself, at risk for a serious infection. Maintaining Clean Hands KEY POINT: Hand hygiene is the single most important activ- ity for preventing and controlling infection. The WHO (2011) chose the reduction of HAIs as the first “global patient safety challenge,” with the theme “clean care is safer care.” Hand hygiene is the cornerstone strategy because it is simple, standardized, low cost, and based on solid scien- tific evidence. Although you may think you already know how to wash your hands, decisions about the type of hand hygiene to use, how long to wash, when to wash, and so on are based on the amount of contact you have with patients or contaminated objects, as well as the patient’s infection status and susceptibil- ity to infection. Hand washing involves five key factors: time, water, soap, friction, and drying.
About Protecting Patients From the Spread of Infection Care enough to: ■ Be knowledgeable about your organization’s policy and procedures. ■ Spend the time for thorough hand washing and strict aseptic technique when needed. ■ Never use shortcuts when it comes to hand hygiene and asepsis. ■ Remind others about diligent hand hygiene and the use of PPE and sterile techniques. ■ Be bold and call people out on breaks in aseptic technique when violations occur. ■ Caring is being an advocate for infection prevention. ♥ iCare Box 19-1
200
UNIT 11 Factors Affecting Health
• Low self-esteem related to physical abuse and demeaning communication • Risk for Injury related to physical or psychological abuse
PRIORITIZING HYPOTHESES
EXAMPLE CLIENT CONDITION: Elder Abuse—cont’d
Key Point: Prevention is key: listen, intervene, educate. Prevention Measures • Screen for social determinants and risk factors associated with elder abuse. • Observe for injuries indicative of elder abuse. • Determine congruence of injury and the description of cause. • Remove patient from dangerous situation. • Notify appropriate authorities of suspected abuse.
GENERATING SOLUTIONS
Stop Elder Abuse: REPORT IT. • Suspicion of elder abuse must be reported to adult protective services and/or the authority designated by law in each state to investigate and prosecute elder abuse. • Call the police or 9-1-1 immediately if someone you know is in immediate, life-threatening danger. Elder Abuse Resources • The National Center on Elder Abuse (NCEA) (https://ncea.acl.gov/) • Clearinghouse on Abuse and Neglect of the Elderly (CANE) (https://www.nsvrc.org/ organizations/133)
TAKING ACTION
4797_Ch07_185-206.indd 199
• Remains safe and free from physical and/or psychological harm • Maintains dignity • Verbalizes positive self-worth
EVALUATING OUTCOMES
■ Time. In a nonsurgical setting, wash the hands vigorously for at least 20 seconds for a soap-and-water scrub, longer if hands are visibly soiled. When using an alcohol-based hand rub, apply the antimicrobial product to all surfaces of the iCare boxes and icons highlight the important role of caring in nursing by modeling behaviors and conversations that demonstrate how a nurse can provide compassionate care. Request preview access • Schedule a walkthrough • Learn more | Contact us at Hello@FADavis.com or visit FADavis.com/DavisAdvantage Example Client Conditions are graphically driven exemplars that tie together key concepts within a chapter and reflect the cognitive skills of the NCSBN Clinical Judgment Measurement Model . remain alert to early signs or symptoms of cognitive impairment (for example, problems with memory or language) and evaluate as appropriate. Assessing the mental status of older adults can help guide decisions about when it may be appropriate to screen for cogni- tive impairment in the primary care setting. environment, for example, shopping, using the tele- phone, housekeeping, managing money, preparing food, and managing one’s medications. Loss of ability to per- form IADLs frequently marks a need for assisted living, nursing home placement, or the aid of family or home- maker services to allow an older adult to age in place. Assessing for Depression For more specific details, guidelines, and step-by-step instructions for hand hygiene, see Clinical Insight 19-1: Guide- lines for Hand Hygiene, and Procedure 19-1: Hand Hygiene . KEY POINT: Failure to perform standards of care (e.g., hand hygiene) constitutes medical negligence and can result in harm to the patient. Despite the importance of clean hands, research demonstrates that clinical staff members do not consistently observe hand hygiene guidelines (Pittet et al., 2017). You can For more information about depression in older adults, see the box Example Client Condition: Depression in Chapter 10. To assess for depression, you may wish to use the Geriatric Depression Scale (GDS), a 30-item questionnaire that screens for depression. It is tailored to the concerns that older adults face. To learn more: Go the The Geriatric Depression Scale (GDS): http://www. stanford.edu/~yesavage/GDS.html AU: please verify cross- reference Also see the Example Client Condition: Dementia. For a step-by-step procedure for a complete assess- ment of mental status, Go to Procedure 19-16, Assessing the Sensory-Neurological System, in Volume 2. Assessing Functional Status Functional status is the ability to perform self-care and other ADLs and IADLs. ■ Activities of Daily Living. You can use the Katz Index of Independence in Activities of Daily Living to rate a 2. Intermediate-level disinfection kills bacteria, mycobacteria, and most viruses. 3. Low-level disinfection kills some viruses and bacteria. Semi- and Noncritical Items Disinfection is used for semicritical and noncritical items: ■ Semicritical items are those that contact mucous membranes or nonintact skin. They must be free of all microorganisms except bacterial spores, so they must at least be disinfected and sometimes sterilized. Examples: Reusable devices, such as flexible endoscopes
7
Powered by FlippingBook