Nursing Care of the Hospitalized Older Patient Nursing Care of the Hospitalized Older Patient Edited by Terry Mahan Buttaro and Kate A. Barba A John Wiley & Sons, Inc., Publication This edition first published 2013 © 2013 by John Wiley & Sons, Inc Wiley-Blackwell is an imprint of John Wiley & Sons, formed by the merger of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing. Editorial Offices 2121 State Avenue, Ames, Iowa 50014-8300, USA The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell. 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It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. Library of Congress Cataloging-in-Publication Data Nursing care of the hospitalized older patient / edited by Terry Mahan Buttaro and Kate A. Barba. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8138-1046-1 (pbk. : alk. paper) I. Buttaro, Terry Mahan. II. Barba, Kate A. [DNLM: 1. Geriatric Nursing–methods. 2. Aged. 3. Hospitalization. WY 152] 618.970231–dc23 2012004865 A catalogue record for this book is available from the British Library. Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. Cover design by Buffy Clatt Set in 9/12.5pt Interstate by SPi Publisher Services, Pondicherry, India 1 2013 Dedication We dedicate this book to our husbands and children who have supported us throughout this endeavor. We always have and always will cherish the love you have shown us. Kate A. Barba Terry Mahan Buttaro Contents 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 vii viii Contents 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 Contents ix 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 x Contents 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 Contents xi 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 xii Contents 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