By Thomas T. Yoshikawa, Dean C. Norman
This incisive reference systematically studies the prognosis and therapy of universal surgical and clinical emergencies in aged patients-thoroughly studying surgical interventions, drug cures and drug prescribing protocols, life-threatening drug reactions, moral matters, and techniques of profiling sufferers for nursing care. Evaluates disorder states and gauges optimum responses to every, assisting suggestions with important case experiences. Written by way of over forty exotic health workers, Acute Emergencies and significant Care of the Geriatric sufferer ·describes perfect patient-physician relationships in severe care settings ·highlights emergency administration of myocardial infarction and cardiogenic pulmonary edema ·illuminates moral questions surrounding confidentiality, educated consent, surrogate selection making, and sufferer convenience ·assesses exact pharmacokinetic and pharmacodynamic stipulations in geriatric sufferers ·provides important info on stroke, seizures, and spinal twine compression ·investigates severe issues attributable to pneumonia, meningitis, and endocarditis ·explores acute lung issues akin to emphysema, continual bronchitis, pneumonia, significant worried approach disorder, and irregular regulate of air flow ·clarifies preoperative systems for emergency surgical procedure ·reviews anesthesia thoughts for pulmonary, cardiovascular, renal, hepatic, and neurological stipulations within the aged ·and extra! together with over one thousand references, tables, and illustrations, Acute Emergencies and important Care of the Geriatric sufferer is an crucial source for geriatricians, basic care physicians, internists, emergency drugs physicians, intensivists, hosptialists, surgeons, anesthesiologists, orthopedists, cardiologists, psychiatrists, neurologists, and internists/residents in those disciplines, in addition to nurses, pharmacists, and scientific scholars.
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Careful physical assessment provides the basis for good symptom management. Pain may manifest in a variety of ways. If the patient is not able to verbally report pain, the clinician should note behaviors such as agitation or aggression that may reﬂect pain. Opioids should be used if needed. To begin, small doses of morphine can be used, and the dose and frequency can be increased as needed to achieve comfort. Opioid drugs that are titrated to effect are rarely a contributing cause of death. If anything, they are likely to extend life by preserving energy and allowing more movement.
Although the patient lacked the capacity to make health care decisions because of her impaired sensorium, her advance directive clearly stated that she did not want aggressive medical care under such circumstances but wanted the goals of her care to be focused on comfort and dignity. The emergency department staff, the primary care physician, and her family agreed that hospice care would be most appropriate. She was transferred from the emergency department to the inpatient hospice facility in the community.
Close attention should be paid to continuous monitoring of the patient’s comfort, with treatment of pain, shortness of breath, tachypnea, and other uncomfortable symptoms as needed until they are relieved. Even when the patient is not awake, the appearance of tachypnea raises concern that the patient is experiencing distress and warrants treatment. Securing a measure of privacy shows respect for the patient and family and is appreciated. The presence of a spiritual counselor such as the hospital chaplain may be welcomed.