Case Study 2: 63-year-old K.S. has just arrived to the PACU, where the nurse makes the initial assessment. K.S. is turned, the OR sheets are removed, his skin is observed for redness and pooling of blood, and his head is elevated 45 degrees. He is on 40% humidified oxygen via a Ventimask mask. K.S’s initial set of vital signs are 140/80, HR 92, RR 14, T 99° and pulse ox 98%. Fifteen minutes later, the nurse charts his vital
signs as 144/76, HR 100; RR 10, T 99.1° and pulse ox 88%.
1. What action would be appropriate by the nurse based on the vital signs assessment 15 minutes after arrival to PACU?
2. What age-related factors would the nurse want to consider regarding K.S.’s nursing care?
SOLUTION TO THE CASE
The respiration rate is low, which is a cause for concern. To get the client to wake up and take several deep breaths, the nurse should gently excite him by calling his name and caressing his shoulder. Stimulating the patient and urging him to take a few deep breaths is frequently enough to raise the oxygen level. Other therapies, such as raising his oxygen concentration on his Ventimask, can be used if stimulation does not increase his oxygen saturation (Vacas et al., 2021). Respiratory rates, rhythms, depths, and breath sounds, as well as oxygen saturation levels determined through pulse oximetry, must all be closely monitored by nurses to ensure that patients receive the best possible treatment. The nurses should monitor vital signs after every 15 minutes for the first hour.
The patient is more likely to develop confusion, hypotension, cardiac dysrhythmias, drug toxicity, overdose, and mortality if given this medication. Because of several age-related declines in organ function, including the heart, lungs, liver, and kidneys, older adult patients are at greater risk of having adverse consequences from anesthesia. Other age-related hazards include slowed metabolism, decreased excretion, and an increased risk of heart problems, among other things. In older persons, drug toxicity increases, as does the risk of taking drugs in dangerous amounts or taking an overdose (Vacas et al., 2021). Older persons are more vulnerable to medications that impact the central nervous system (CNS).
Modern surgery and anesthesia can improve older patients’ quality of life, but at the expense of their brain health. Postoperative neurocognitive deterioration is a serious and growing global health care burden (Vacas et al., 2021). Before surgery, surgeons and anesthesiologists should identify, discuss, and minimize potential risks. Best practices and interventions can begin well before surgery and continue well after. These interventions require family involvement, an interdisciplinary health care team, and comprehensive care systems to be effective.
Vacas, S., Cole, D. J., & Cannesson, M. (2021). Cognitive decline associated with anesthesia and surgery in older patients. JAMA, 326(9), 863-864.
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