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

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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

Author(s): Raelene V. Shippee-Rice, Susan Fetzer, Jennifer V. Long, Alexandra Armitage
Publisher: Springer Publishing Company
Year: 2011

Language: English
Pages: 640
City: New York

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