Nursing Care of the Hospitalized Older Patient

Nursing Care for the Hospitalized Older Patient is a comprehensive, quick-reference resource for registered and advanced practice nurses working with older patients in a hospital setting. Organized in user-friendly format, the book provides vital information on all aspects of hospital care and the full range of health issues encountered by elderly patients.

The book is organized into four major sections. The first section provides an overview of the aging patient, including demographics, normal aging changes, and the general impact of hospitalization. The second section covers proper health assessment, providing guidance on history taking and evaluating laboratory values. The third section is the largest part of the book and is made up of short, similarly-structured chapters dedicated to individual clinical issues ranging from burns to depression. These chapters are organized by body system to maximize ease of use. The book concludes with a section on special considerations that cross common clinical areas, such as palliative care, pain management, fall prevention, and discharge planning.

Contributors xiii

Preface xix

Acknowledgments xxi

1 Introduction 1
Terry Mahan Buttaro

2 Health Assessment 9
Kate A. Barba

3 Clinical Issues 22

Unit 1 Skin Disorders 22

Part 1 Overview 22
Terry Mahan Buttaro

Part 2 Burns 24
Terry Mahan Buttaro

Part 3 Cellulitis 27
Terry Mahan Buttaro

Part 4 Contact Dermatitis 31
Terry Mahan Buttaro

Part 5 Herpes Zoster 33
Terry Mahan Buttaro

Part 6 Purpura 37
Terry Mahan Buttaro

Part 7 Pruritus 41
Terry Mahan Buttaro

Part 8 Acne Rosacea 44
Terry Mahan Buttaro

Part 9 Seborrheic Dermatitis 46
Terry Mahan Buttaro

Part 10 Thrush 50
Terry Mahan Buttaro

Part 11 Tinea 52
Terry Mahan Buttaro

Part 12 Pressure Ulcers 56
Linda Olson

Part 13 Lower Extremity Ulcers 64
Linda Olson

Part 14 Skin Tears 74
Linda Olson

Unit 2 Cardiovascular Disorders 79

Part 1 Acute Coronary Syndrome 79
Sharon Zisk

Part 2 Atrial Fibrillation 86
Theresa E. Evans

Part 3 Venous Thromboembolism 92
Eva Beliveau

Part 4 Heart Failure 99
Theresa E. Evans

Part 5 Hypertension 105
Chelby Cierpial and Susan Stengrevics

Part 6 Peripheral Vascular Disease 112
Ashley Moore Gibbs

Part 7 Heart Valve Disease 117
Theresa E. Evans

Unit 3 Respiratory Disorders 124

Part 1 Asthma 124
Marian Jeffries and Rosemarie Marks

Part 2 Chronic Obstructive Pulmonary Disease (COPD) 128
Marian Jeffries and Rosemarie Marks

Part 3 Influenza 134
Marian Jeffries and Rosemarie Marks

Part 4 Pneumonia 138
Marian Jeffries and Rosemarie Marks

Unit 4 Gastrointestinal Disorders 148

Part 1 Appendicitis 148
Patricia Fitzgerald

Part 2 Diverticular Disease 152
Patricia Fitzgerald

Part 3 Ischemic Bowel 158
Patricia Fitzgerald

Part 4 Pancreatitis 162
Patricia Fitzgerald

Part 5 Constipation 167
Patricia Fitzgerald

Part 6 Diarrhea 173
Patricia Fitzgerald

Part 7 Gastroesophageal Reflux Disease 178
Patricia Fitzgerald

Unit 5 Genitourinary Disorders 183

Part 1 Acute Kidney Injury 183
Carol A. Tyksienski

Part 2 Chronic Kidney Disease 191
Carol A. Tyksienski

Part 3 Urinary Tract Infections 197
Terry Mahan Buttaro

Unit 6 Neurologic Disorders 202

Part 1 Dementia 202
Constance Cruz, Sara A. Fisher, Mary Lussier-Cushing and Jennifer Repper-DeLisi

Part 2 Delirium in the Older Hospitalized Adult 209
Mary Lussier-Cushing, Jennifer Repper-DeLisi, Sara A. Fisher and Constance Cruz

Part 3 Ischemic Stroke 221
Marion Phipps

Part 4 Dizziness 230
Jean B. Fahey

Part 5 Normal Pressure Hydrocephalus 236
Jean B. Fahey

Part 6 Parkinson’s Disease 241
Marion Phipps

Part 7 Seizures 249
Susan R. Gavaghan

Unit 7 Endocrine 255

Part 1 Diabetes 255
Susan L. Wood

Part 2 Hypo/Hyperthyroidism 269
Susan L. Wood

Part 3 Hyperparathyroidism/Hypoparathyroidism 275
Susan L. Wood

Part 4 Syndrome of Inappropriate Antidiuretic Hormone Secretion 283
Susan L. Wood

Unit 8 Musculoskeletal 288

Part 1 Septic Arthritis 288
Susan Bardzik

Part 2 Gout 292
Sharon R. Smart

Part 3 Joint Replacement 296
Nichole Spencer

Part 4 Osteomyelitis 303
Lesley Caracci

Part 5 Metabolic Bone Disease: Osteoporosis and Paget’s Disease 308
Nichole Spencer

Unit 9 Hematology/Oncology 316

Part 1 The Oncology Patient 316
Kristina N. Wickman

Unit 10 Infectious Disease 324

Part 1 HIV/AIDS 324
Caroline Sturm-Reganato

Part 2 Sepsis and ARDS 337
Vince M. Vacca, Jr .

Part 3 Tuberculosis 343
Melissa Donovan

Unit 11 Multisystem Disorders 351

Part 1 Fever 351
Monica G. Staples

Part 2 Polymyalgia Rheumatica 359
Monica G. Staples

Part 3 Rheumatoid Arthritis 364
Monica G. Staples

Part 4 Systemic Lupus Erythematosus 369
Kate Roche

Part 5 Temporal Arteritis 376
Kate Roche

Part 6 Vasculitis 379
Kate Roche

Unit 12 The Surgical Patient 386

Part 1 The Surgical Patient 386
Deanne C. Munroe

Unit 13 Fluid and Electrolytes 403

Part 1 Dehydration and other Hypovolemic Fluid Disorders 403
Terry Mahan Buttaro

Part 2 Hypercalcemia and Hypocalcemia 408
Nancy A. Kelly

Part 3 Hyperkalemia and Hypokalemia 416
Grace A. Good

Part 4 Hyponatremia and Hypernatremia 423
Grace A. Good

Part 5 Hypomagnesemia and hypermagnesemia 432
Nancy A. Kelly

Unit 14 Psychological Issues 440

Part 1 Anxiety Disorders 440
Constance Cruz, Sara A. Fisher, Mary Lussier-Cushing and Jennifer Repper-DeLisi

Part 2 Depression 445
Jennifer Repper-DeLisi, Constance Cruz, Sara A. Fisher and Mary Lussier-Cushing

4 Special Considerations 454

Part 1 Nosocomial Infections 454
Hallie S. Greenberg

Part 2 Elder Abuse and Neglect 461
Margaretta Byrne

Part 3 Advance Directives 469
Anita M. Coppola-Ash

Part 4 Nutrition and Older Adults 474
Deborah A. D ’ Avolio

Part 5 Fall Prevention 480
Deborah A. D’Avolio

Part 6 Pain and Older Adults 488
Deborah A. D’Avolio

Part 7 Palliative Care 494
Jennifer R. Howard

Part 8 Medications and Older Adults 501
Deborah A. D’Avolio

Part 9 Sleep Disorders 506
Donna M. Glynn

Part 10 Urinary Incontinence 511
Mary L. McDonough

Part 11 Discharge Planning and Teaching 518
Arlene J. Lowenstein

Part 12 SBAR Communication 525
Eva Beliveau

Glossary 531

Selected Websites for Geriatric Information 536

Index 537

Kate A. Barba, RN, MS, GNP-BC, is Clinical Nurse Specialist at Massachusetts General Hospital in Boston Massachusetts.