199
CHAPTER 7 Life Span: Older Adults
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 .
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
Key Point: The risk of abuse is higher for women and those with physical and cognitive vulnerabilities. Advanced age Physical, functional, or cognitive impairment
657
CHAPTER 19 Promoting Asepsis & Preventing Infection
656 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 help improve clinical practice by serving as a role model for good hand hygiene. Maintaining a Clean Environment ! 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. 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. 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, A clean environment includes the surfaces in a patient’s room, as well as supplies, equipment, and other objects brought into the room. The floor, soiled dressings and tissues, sinks, com- modes, and bedpans are examples of contaminated items. An object becomes contaminated or unclean if it contacts a con- taminated surface—or if you suspect, for whatever reason, that it may contain pathogens. Agency policies determine whether a reusable item is cleaned, disinfected, or sterilized based on how the item is used. Cleaning 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 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 Go to Procedure 6-1 in Volume 2. • Low self-esteem related to physical abuse and demeaning communication • Risk for Injury related to physical or psychological abuse (continued) 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. 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) • Remains safe and free from physical and/or psychological harm • Maintains dignity • Verbalizes positive self-worth
RECOGNIZING CUES
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: 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. ■ 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 and respiratory therapy and anesthesia equipment ■ Noncritical items are supplies and equipment that contact intact skin but not mucous membranes. They do not carry a high risk of infection transmission, and they can be decon- taminated where they are used. Examples: Bedpans, stethoscopes, and blood pressure cuffs Examples of noncritical environmental surfaces: Floors, food utensils, bed linens, and bed rails Sterilizing 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
ANANLYZING CUES/ DIAGNOSING
200
UNIT 11 Factors Affecting Health
PRIORITIZING HYPOTHESES
EXAMPLE CLIENT CONDITION: Elder Abuse—cont’d
GENERATING SOLUTIONS
TAKING ACTION
4797_Ch07_185-206.indd 199
24/03/23 5:17 PM
EVALUATING OUTCOMES
UNIT 3 Essential Nursing Interventions
effective care by highlighting an example of a competency expressed in practice. 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. 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.
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.
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 ■ Critical items are ones that pose a high risk for infection if they are contaminated with any microorganism—that is, those that enter the vascular system or sterile tissue or those items through which blood flows. Examples: IV catheters, needles for injections, urinary catheters, surgical instruments, some wound dress- ings, and chest tubes 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? Sterilization is the elimination of all microorganisms (except prions) in or on an object. The most common sterilizing meth- ods used in hospitals are (1) autoclaving with moist heat, also called immediate use steam sterilization; (2) gas or vapor (e.g., ethylene oxide gas at low heat); (3) dry heat; (4) ozone; (5) liq- uid chemicals (e.g., peracetic acid); and (6) low-temperature hydrogen peroxide gas (Association of periOperative Regis- tered Nurses [AORN], 2024). KEY POINT: Sterilization is used when the absolute purity of an object or surface is critical. 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
Promoting Safe, Effective Nursing Care boxes emphasize how to provide safe and
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.
Contact us at Hello@FADavis.com or visit FADavis.com/DavisAdvantage Cleaning is the removal of visible soil (organic and inorganic) from objects and surfaces. In healthcare agencies, it is usually accomplished manually or mechanically using water with deter- gents or enzymatic products formulated to inhibit microbial growth. A goal of medical asepsis is to keep all public and patient care areas within the facility clean and free from dust, debris, and contamination. Any spilled liquids, dirty surfaces, or potentially contaminated areas should be cleaned immediately. Items must be cleaned thoroughly before they can be disinfected or sterilized. Disinfecting ■ Activities of Daily Living. You can use the Katz Index of Independence in Activities of Daily Living to rate a client’s independence in bathing, dressing, toileting, transferring, continence, and feeding (Katz et al., 1970; Katz Index, 2007). To use the Katz assessment tool, Go to https://hign.org/consultgeri/try-this-series/ katz-index-independence-activities-daily-living-adl ■ Instrumental Activities of Daily Living. IADLs are the activities needed to maintain one’s immediate Assessment/Recognizing Cues (Young-Old) Your assessments of young-old patients should also include the following: ■ Daily routines, social interactions, and short- and long- term goals: This helps to identify cues about the degree to which the person has adapted to retirement.
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. 24/03/23 5:17 PM
4797_Ch07_185-206.indd 200
7
Disinfection removes pathogens on inanimate objects by physical or chemical means, including steam, gas, chemicals, and ultraviolet light.
Powered by FlippingBook