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A heart rate in the 60s might be the expected result of a patient on a beta blocker. "But, it may really be a masked tachycardia limited by the medication," says Barb Smith, RN, BSN, MSA, CEN, trauma program manager at Botsford Hospital in Farmington Hills, MI.
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Do you suspect your elder patient is having a seizure? "Remember that presenting clinical features differ between the old and young," says Alison Hofheinz, RN, MSN, CPNP, a clinical nurse specialist in Bronson Methodist Hospital's Trauma & Emergency Center in Kalamazoo, MI. Hofheinz says to keep in mind these three things, Hofheinz says:
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Do you expect to see tachycardia in a septic patient? Don't forget that this response will be masked in elders taking beta blockers.
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Elders often have duplicate prescriptions and might take herbal supplements without telling ED nurses, warns Carol Howat, RN, BSN, CEN, clinical educator for the ED at Northwest Community Hospital in Arlington Heights, IL.
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ED nurses are caring for increasing numbers of elders with traumatic brain injuries, mostly due to fall injuries, says a report from the Centers for Disease Control and Prevention (CDC).
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There is no question that handoffs between long-term care facilities and EDs are high-risk times for elder patients. "Transfers because of an acute deterioration of the patient can result in a lack of communication related to pertinent history, medications, allergies, and code status," says Samuel Shartar, RN, CEN, director of the ED at Emory University Hospital in Atlanta.
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Early antibiotic administration was associated with reduced likelihood of death, mechanical ventilation, and readmission (but increased risk of Clostridium difficile infection) among patients hospitalized for acute exacerbations of COPD.
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An analysis of more than 1 million persons in Alberta, Canada, showed that laboratory reporting of estimated glomerular filtration rate (GFR) beginning in 2004 resulted in more referrals to nephrologists, but no apparent improvement in outcomes.
