Acute Care Surgery in Geriatric Patients

Foreword
Foreword
Prologue
Contents
1: Acute Care Surgery in the Geriatric Patient Population: General Principles
	Acute Care Surgery Evolution
	Acute Care Surgery Principles
	Emergency General Surgery in Elderly Patients
	Geriatric Trauma
	Surgical Rescue
	Goal Concordant Decision-Making
	Summary
	References
2: Healthcare Economics and Aging
	Population Trends
	How Medicare Rates Are Determined
		Physician Charges (Medicare Part B)
		Facility Charges (Part A)
	Medicare Budgets and Projected Payment Levels
	Medicare Rates are Insufficient and not Keeping Up with Cost Inflation
		Physician and Surgeon Reimbursement
		Hospital Reimbursement
	Tactics Medicare Uses to Decrease Reimbursements
	Bundled Payments: A Major Medicare Cost Savings Initiative
	Impact on Facilities and Providers
	Looking to the Future
	References
3: A Rationale and Systems Impact for Geriatric Trauma and Acute Care Surgery
	Introduction
	Rationale for Geriatric Trauma and Acute Care Surgery
		Medical Comorbidities and Surgical Risk
		Frailty and Sarcopenia
		Cognitive Impairment and Postoperative Delirium
		Nutrition
		Polypharmacy
		Geriatric Vulnerabilities
	Care Planning and Shared Decision-Making
		Capacity
		Surrogates
		Palliative Care
		Advance Care Planning and Goals of Care
		Withdrawing and Withholding Therapy
		Care at the End of Life
	Geriatric-Specific Prediction Models in Trauma and EGS
	Opportunities for Improvements in Geriatric Care
	National Quality Programs for Geriatric Patients
	Conclusions
	References
4: Physiology of Aging
	Introduction
	Various Issues Specific to the Elderly Population
		Frailty
		Function
		Nutritional Status
		Medications/Polypharmacy
		Medical Decision-Making in the Elderly Population
		Elder Abuse
		Neuropsychiatric
			Physiology
			Clinical Issues
		Cardiovascular
			Physiology
			Clinical Context
		Pulmonary
			Physiology
			Clinical Context
		Gastrointestinal
			Physiology
			Clinical Context
		Renal/Volume/Electrolytes
			Physiology
			Clinical Context
		Endocrine
			Physiology
			Clinical Context
		Common Emergency General Surgery Cases
			Small Bowel Obstruction
			Acute Mesenteric Ischemia
			Diverticulitis
		Trauma
			Falls
			Rib Fractures
			Traumatic Brain Injury
	References
5: Frailty in Geriatric Trauma and Emergency General Surgery
	Overview
	Frailty in Geriatric Trauma
		Measuring Frailty
		Association Between Frailty and Outcomes Among Geriatric Trauma Patients
		Optimization of Frail Trauma Patients
	Frailty in Geriatric Emergency General Surgery
		Measuring Frailty
		Association Between Frailty and Outcomes Among Geriatric EGS Patients
		Optimization of Frail EGS Patients
		Geriatric Specialists and Multidisciplinary Care
	References
6: Hematologic Changes with Aging
	Overview of the Hematologic System
	Effects of Aging on the Hematologic system
	Anticlotting Medications in the Geriatric Population
	Conclusion
	References
7: Sarcopenia
	Introduction
		Background
		Relation to Frailty
	Diagnostic Modalities
	Imaging
		Computed Tomography (CT)
		Ultrasonography (US)
		Magnetic Resonance Imaging (MRI)
		Dual Energy X-Ray Absorptiometry (DEXA)
	Functional Assessments
		Hand Grip Strength
		Stair Climbing
		SARC-F Questionnaire
	Outcomes
		Trauma
		General Surgery
		Critical Care
		Financial Impact
	Conclusions
	References
8: Immunology: Features of Immunesenescence
	Introduction
	Immunesenescence and Inflammaging
		Impact of Ageing on Innate Immunity
		Impact of Ageing on Adaptive Immunity
		Inflammaging
	Accelerating Immunesenescence in a Geriatric patient’s Post-Surgery
	Prevention of Accelerated Immunesenescene Post-Surgery in Older Patients
		Statins
		Senolytics
		Caloric Restriction Mimetics
		P38 MAPK Inhibitors
		Probiotics
	Conclusion Remarks
	References
9: Epidemiology of Injury in the Elderly: Use of DOACs
	Introduction
	Epidemiology of Injury
	Trauma Assessment
	Direct Oral Anticoagulants (DOACs)
	Organ-Specific Injury
		Traumatic Brain Injury
		Cervical Spine Injury
		Chest Trauma/Rib Fractures
		Abdominal Trauma
		Musculoskeletal Injuries: Hip and Pelvic Fractures
		Skin
	Multidisciplinary Hospital Care/Disposition Planning
	Dementia after Traumatic Brain Injury
	Conclusion
	References
10: Injury Prevention in the Geriatric Population
	Introduction
	Physiology
		Hearing Loss
		Vision Loss
	Environment
	Gait and Mobility
	Cognition
	Substance and Alcohol Abuse
	Polypharmacy
	Comorbidities
	Orthostatic Hypotension
	Environment
	Types of Injury
		Falls
		Motor Vehicle Crashes
	Summary
	References
11: Neurobehavioral Aspects of Acute Care Surgery in Geriatric Patients
	The Prevalence of Neurocognitive Impairment and Psychiatric Illness Among Geriatric Patients
	The Interplay Between Injury and the Baseline Neuropsychiatric Health of Geriatric Patients
	The Interplay Between Stroke and the Baseline Neuropsychiatric Health of Geriatric Patients
	Postoperative Delirium
		The Risk Factors for Postoperative Delirium
			Intraoperative Hypotension
			Hyponatremia
		Identifying Postoperative Delirium and Postoperative Cognitive Decline
			Diagnosing Delirium
		Preventing and Managing Neurocognitive and Psychiatric Sequelae of Surgery and Anesthesia
		Pathophysiology of Postoperative Delirium and Postoperative Cognitive Dysfunction
			Neuroinflammation
			Neurochemical Changes
			Oxidative Stress
		When Neurologic Burden Overwhelms Cognitive Reserve
	Conclusion
	References
12: Initial Evaluation of the Geriatric Injured Patient
	General Evaluation
		Airway
		Breathing
		Circulation
		Disability
			Calculate the Glasgow Coma Score
		Exposure
	References
13: Emergency Medical Services and the Elderly Patient: Prehospital Management
	Introduction
	The Evolving Importance of Geriatrics to EMS
	EMS History in US
	EMS Training and the National Model
		Emergency Medical Responder (EMR)
		Emergency Medical Technician (EMT)
		Advanced Emergency Medical Technician (AEMT)
		Paramedic
	State Variation in EMS Practice
	Geriatric Training in EMS
	The Impact of Geriatrics to EMS
	Community Paramedicine
	Conclusion
	References
14: Discussing Goals of Care in the Geriatric Acute Care Surgery Patient
	Introduction
		Determination of Decision-Making Capacity
		Setting the Stage
	Goals of Care
		Ask and Assess Understanding
		Build Rapport
		Communicate Prognosis and Outcomes
		Develop a Treatment Plan
		Evaluate and End
	Conclusion
	References
15: Traumatic Brain Injury
	Traumatic Brain Injury
	Concussion
	Traumatic Subarachnoid Hemorrhage
	Subdural Hematoma
	Conclusion
	References
16: Neurocritical Care in the Elderly
	Traumatic Brain Injury
		Epidemiology
		Clinical Assessments
		Intracranial Pressure Monitoring
		Intracranial Pressure and Cerebral Perfusion Pressure Goal
		Medical Management of Intracranial Hypertension
		Surgical Management of Intracranial Hypertension
		Other Complications of Traumatic Brain Injury to Consider in the Elderly
			Delirium in the Elderly
			Post-Traumatic Seizures
		When to Restart Antithrombotic Agents After Traumatic Brain Injury
		Prognosis of Traumatic Brain Injury in the Elderly
	Ischemic and Hemorrhagic Stroke
		Background
		Pathophysiology and Causal Mechanisms
		Prevention
		Risk Factors
		Presentation
		Treatment
	References
17: Cervical and Thoracic Spine Trauma in the Elderly
	Elderly Population Worldwide
	Basic Cervical and Thoracic Spine Anatomy
	Spinal Cord Anatomy
	Spinal Cord Assessment
	Patterns of Incomplete Injuries
	Cervical and Thoracic Spine in the Elderly
	Cinematics of injuries
	Mechanism of Injury
	Specific Types of Cervical Vertebral Fractures
	Fractures to the Thoracic Spine
	Initial Assessment
	Spine Clearance
	Imaging and Workup
	Therapeutic Options
	References
18: Hollow Viscus Injury
	Injury to the Stomach
		Introduction
		Incidence
		Degrees of Injury
		Diagnosis
		Treatment
		Complications
	Injury to the Small Bowel and Mesentery
		Introduction
		Incidence
		Degrees of Injury
		Diagnosis
		Treatment
	Injuries to the Large Intestine
		Introduction
		Incidence
		Degrees of Injury
		Diagnosis
		Treatment
		Complications
	Rectal Trauma
		Introduction
		Incidence
		Degrees of Injury
		Diagnosis
		Treatment
	References
19: Management of Pancreatic Trauma
	Introduction
	Anatomy
	Diagnosis
	Management
		Blunt
		Penetrating
	Conclusions
	References
20: Injury to the Spleen
	Introduction
	Injury Mechanisms with Risks of Splenic Injury
	Injury Work-Up
	Severity Scores and Classification
	Management of Splenic Injury in the Elderly
	Outcomes
	Vaccination After Splenectomy or Angioembolization
	References
21: Geriatric Liver Trauma
	Introduction
	Patient Assessment and Initial Diagnostic Studies
	Selective Nonoperative Management
	Operative Management
	Complications
	References
22: Injury to Kidney
	Introduction
	Physiologic Changes of Kidney in Elderly
	Trauma Mechanisms and Diagnosis
	Management
	Conclusions
	References
23: Emergency Hernia Repair in the Elderly
	Introduction
	Basic Principles of Emergency Hernia Repair in the Geriatric Patient
	Preoperative Workup
	Ventral Hernia Repair
	Mesh Selection
	Inguinal Hernia Repair
	Parastomal Hernia Repair
	Postoperative Management and Complications
	Summary
	References
24: Lower Genitourinary Tract Trauma
	Bladder Injuries
	Urethral Injuries
		Posterior Urethra
			Management
		Anterior Urethra
	Genital Injuries
		Penile Fracture
	Gunshot and Penetrating Wounds
	References
25: Pelvic Trauma in Geriatric Patients
	Introduction
	Classification of Pelvic Fractures
	Assessment of the Elderly Patient with Pelvis Fracture
		Clinical History
		Physical Examination
		AP Pelvis Imaging
		Focused Abdominal Ultrasound in Trauma (eFAST)
		Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI)
	Treatment
		Use of Anticoagulants/Antiplatelet
		Aggressive Fluid Resuscitation
		Angioembolization
	Conclusions
	References
26: Geriatric Hip Fractures
	Introduction
	Epidemiology
	Pathogenesis
	Classification
	Management of Anticoagulation
	Treatment
		Medial Femoral Neck Fracture
		Lateral Femoral Neck Fracture
		Per- /Sub-Trochanteric Femoral Fracture
		Periprosthetic Femoral Fracture
	Conclusions
	References
27: Acetabulum Fractures
	Epidemiology and Pathophysiology
	Classification
	Diagnostic
	Therapy
		Conservative Treatment
		Surgical Treatment
		Preferred Treatment Method
	Prognosis and Complications
	References
28: Long Bone Fractures
	Introduction
	Radiological Examination After Geriatric Extremity Trauma
	Standard Classification of Long Bone Fractures
	Treatment of Long Bone Fractures
	Geriatric Upper Extremity Fractures
		Distal Radius Fractures
			Diagnosis and Classification
			Non-operative Treatment
			Surgical Treatment
		Proximal Humeral Fracture
			Classification
			Non-operative Treatment
			Surgical Treatment
		Osteosynthesis
		Joint Replacement
	Lower Extremity Fractures in Old Age
		Distal Femur Fractures
			Classification
			Non-operative Treatment
			Surgical Treatment
				Retrograde Intramedullary Nails
				Plate Osteosynthesis
				Rescue Surgery of Distal Femur Fractures
			Special Case: Periprosthetic Distal Femur Fracture
	References
29: Thoracic Trauma in the Elderly
	Introduction
	The Thorax as We Age
	Rib Fractures
		Evaluation and Diagnostic Imaging
		Epidemiology and Etiology of Rib Fractures
	Rib Fracture Management
		Supportive Measures and Monitoring
		Pharmacologic Analgesia
		Regional Anesthesia
		Surgical Management
	Flail Chest
	Sternal Fractures
	Associated Injuries and Pulmonary Sequelae
	Concluding Remarks
	References
30: Esophageal Injuries and Esophageal Emergencies in Geriatric Patients
	Anatomy and Physiology of the Esophagus
	Changes to the Esophagus in Older Adults
	Iatrogenic Esophageal Injury Epidemiology
	Presentation and Diagnosis of Iatrogenic Esophageal Injury
	Traumatic Esophageal Injury Epidemiology
	Penetrating Injury to the Esophagus
	Blunt Injury to the Esophagus
	Diagnosis of Traumatic Injury of the Esophagus
	Principles of Surgical Management of Traumatic Esophageal Injury
	Endoluminal Management of Esophageal Perforation
	Conclusion
	References
31: Pulmonary Injury
	Introduction: Aging of the Lungs and the Chest
	Epidemiology
	Mechanisms of Injury
	Initial Trauma Evaluation and Resuscitation
	Management of Specific Injuries
		Rib Fractures and Pulmonary Contusions
		Traumatic Hemothorax
		Delayed Hemothorax
		Traumatic Pneumothorax
		Sternal Fractures
	Penetrating Trauma
	Conclusion
	References
32: Tracheobronchial Injuries
	Introduction
	Epidemiology
		Iatrogenic Injuries
		Traumatic Injuries
	Tracheal and Bronchial Surgical Anatomy
	Clinical Findings
	Investigations
	Management
		Airway Management
		Surgical and Endobronchial Management
	Postoperative Management
	Outcomes and Complications
	Conclusion
	References
33: Geriatric Cardiac Trauma
	Introduction
	Trauma Mechanisms
		Blunt Cardiac Trauma
			Evaluation
			Treatment
		Penetrating Trauma
	Prognosis
	Summary
	References
34: Vascular Trauma and Vascular Emergencies in the Elderly
	Introduction
	The Effect of Aging on Vascular Biology, Physiology, and Injury Outcomes
	Initial Assessment of the Geriatric Trauma Patient
	General Operative Approach to Vascular Trauma
	Abdominal Vascular Trauma
		Abdominal Aortic Injury
		Inferior Vena Cava Injury
		Mesenteric Vessel Injury
		Porta Hepatis Injuries
		Renal Vasculature Injury
		Pelvic Vasculature Injury
	Thoracic Vascular Trauma
		Ascending Thoracic Aortic Injury
		Innominate Artery Injury
		Descending Thoracic Aortic Injury
		Thoracic Vena Cava Injury
		Pulmonary Artery and Vein Injury
		Subclavian Artery Injury
		Axillary Artery and Vein Injury
	Peripheral Vascular Trauma
		Upper Extremity Arterial Injuries
		Lower Extremity Arterial Injuries
	Conclusion
	References
35: Injury Due to Extremes of Temperature
	Introduction
	Accidental Hypothermia
		Demographic and Risk Factors
		Management
		Active Internal Rewarming
			Warm Intravenous Fluid Rewarming Technique
			Body Cavity Lavage Rewarming Techniques
			Extracorporeal Rewarming Techniques
	Cold Injury
		Classification and Clinical Manifestations of Frostbite
		Surgical and Nonsurgical Management of Frostbite
	Morbidity and Mortality
	Conclusion
	References
36: Plastic Surgery and Soft-Tissue Injury Trauma
	Introduction
	Soft-Tissue Changes and Unique Considerations in the Elderly
	Management
		Non-surgical Wound Management
		Wound Optimization
		Reconstructive Surgery
		Complications of Acute Soft-Tissue Trauma in the Elderly
	Prevention
	Soft-Tissue Trauma and Elder Abuse
	Conclusion
	References
37: Wound Healing in the Geriatric Population
	Introduction
	The Biology of Aging Skin
		Stem Cell Dysfunction and Senescence
		Perturbations in Inflammatory Cells and Cytokines
		Degradation of Extracellular Matrix
		Reduction in Microvascular Perfusion
		Alterations of the Microbiome
	Venous Leg Ulcers
	Pressure Injuries
		Diabetic Foot Ulcers
		Care Coordination
		Assessment
		Assessment Tool
		Case Study
		Psycho-Social
		Elimination
		Regulatory
		Sensory-Motor
		Oxygenation
		Nutrition and Hydration
	Conclusion
	References
38: Necrotizing Soft Tissue Infections
	Case Presentation
	Introduction
	Epidemiology
	Etiology/Risk Factors
	Classification
	Presentation and Diagnosis
	Workup
	Treatment
	Outcomes
	References
39: Perioperative Management of Geriatric Patients
	Introduction
	Recommendations for the Pre-operative, Intra-operative, and Post-operative Periods
		Pre-operative
			Nutrition and Fasting
		Intra-operative
			Anesthesia
			Perioperative Analgesia
			Intra-operative Management
			Hypothermia
		Post-operative
			Nutrition in the Post-operative Period
			Post-operative Delirium and Cognitive Dysfunction
			Pulmonary Complications
			Urinary Retention
	Conclusion
	References
40: Surgical Risk Assessment in the Elderly
	Risk Stratification Assessments
	Pre-operative Workup and Perioperative Management
	Conclusion
	References
41: General Surgical Emergencies
	Introduction
	Physiologic Changes in Geriatrics
	Approach, Clinical Assessment, and Preoperative Preparation
		Risk and Clinical Assessment and Preoperative Preparation of EGS Cases
		Emergency General Surgery Cases
	The Challenges
		Intraoperative Challenges
	Outcomes and Complications in the Elderly
	Mortality in General Surgical Emergencies
	References
42: Options on Conservative Treatment in Acute Surgical Emergencies
	Introduction
	Gastroduodenal Problems
	Perforated Peptic Ulcer
		Eligibility to Non-operative Treatment
		Endoscopic Closure of the Perforation
	Acute Appendicitis
		Non-operative Management
	Colonoscopy Perforation
		Conservative Treatment
		Endoluminal Repair
		Endoscopic Band Closure
	Acute Diverticulitis
		Non-operative Treatment
	Splenic Trauma
		Conservative and Minimally Invasive Treatment
		Angioembolization
	Liver Trauma
	Pancreatic Trauma
		Main Duct Disruption
		Pancreatic Necrosis and Abscess
		Percutaneous Drainage
	Nonsurgical Pneumoperitoneum
		Common and Infrequent Conditions
	Case Report
	References
43: Appendicitis in Elderly
	Introduction
	Clinical Manifestations
	Pathology
	Diagnosis
	Non-operative Management
		Uncomplicated Appendicitis
		Phlegmon and Appendiceal Abscess
	Operative Management
	Conclusion
	References
44: Management of Pancreaticobiliary Disease in the Geriatric Patient Population
	Introduction
		Initial Evaluation of Geriatric Biliary Pathology in Acute Care Surgery
			History and Physical Examination
			Laboratory and Radiographic Evaluation
		Treatment of Geriatric Pancreaticobiliary Pathology in Acute Care Surgery
			Considerations of Initial Resuscitation
			Indications for Emergent Operative Intervention for Geriatric Biliary Pathology
			Multidisciplinary Approaches for the Management of Non-emergent
				Acute symptomatic cholelithiasis
				Acute Cholecystitis
				Primary Choledocholithiasis
				Acute Pancreatitis
				Management of Infected Pancreatic Necrosis in the Geriatric Population
				Malignant Pancreaticobiliary Disease
	Conclusion
	References
45: Acute Diverticulitis in the Elderly
	Introduction
	Immune System Changes and Physiologic Response to Infection and Sepsis in the Elderly
	Epidemiology
	Clinical Features
	Radiological Features
	Laboratory Features
	Management
	Surveillance
	Conclusion
	References
46: Upper Gastrointestinal Bleeding
	Upper Gastrointestinal Bleeding (UGIB)
		Introduction
		Etiology/Pathophysiology
			Peptic Ulcer Disease (PUD)
			Esophageal Varices
			Esophagitis
			Mallory-Weiss
			Gastric Cancer
			Rare Causes
		Evaluation
		Management
			Acute Bleed
			Special Considerations
				Aortoenteric Fistulas
				Varices
			Chronic Bleed
				PUD
				Esophagitis
				Gastric Cancer
	References
47: Gastrointestinal Hemorrhage in the Elderly
	Introduction
	Initial Evaluation
	Initial Treatment
		Resuscitation
		Management of Antiplatelet and Anticoagulant Agents
	Risk Stratification
	Multidisciplinary Care and Treatment Algorithms
	Stable or Unstable Bleeding
	Upper GI Bleeding
		Endoscopy
		Endoscopic Management
		Endovascular Treatment
		Surgery for Upper GI Bleeding
	Lower GI Bleeding
		Colonoscopy
		Endoscopic Management
		Endovascular Treatment
		Surgery for Lower GI Bleeding
	Conclusion
	References
48: Small and Large Bowel Obstruction
	Small Bowel Obstruction
		Introduction and General Considerations
		Clinical Presentation
		Evaluation
		Etiologies
			Adhesive Disease
			Hernias
			Malignancy
				Adenocarcinoma
				Carcinoid Tumors
				Peritoneal Carcinomatosis
			Gallstone Ileus
		Outcomes
	Large Bowel Obstructions
		Epidemiology
		Presentation
		Diagnosis and Radiologic Findings
		Etiologies
			Colorectal Cancer
			Volvulus
				Sigmoid Volvulus
				Cecal Volvulus
			Diverticulitis
			Benign Stricture
			Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome)
			Constipation
	References
49: Critical Care Management of Older Adults
	Epidemiology and Outcomes of Critically Ill Older Adults
	The Physiology of Aging and Critical Care Medicine Considerations
		The Central Nervous System
		The Cardiovascular System
		The Respiratory System
		The Renal System
		Energy Expenditure and Nutrition
	Polypharmacy
	Geriatric Critical Care: A Model for an Interdisciplinary Approach
	Ethical Challenges: Withholding, Discontinuation of Life Sustaining Measures, and Futility
	References
50: Cardiac Hemodynamic Monitoring
	Introduction
		Recognition of Shock
		Goals of Resuscitation
		Hemodynamic Changes with Age
	Cardiac and Hemodynamic Monitoring
		Standard Monitoring
		Advanced Monitoring
			Arterial Catheters, Central Venous Pressure, Pulmonary Artery Catheters
			Transthoracic Echocardiography
			Pulse Contour Analysis to Measure Cardiac Output
				PiCCO
				LiDCO
				Vigileo/FloTrac
				Most Care PRAM
			Bioreactance
				Transesophageal Doppler
	Conclusion
	References
51: Nutritional Assessment and Therapy
	Introduction
	Incidence
	Diagnosis and Management
		Functional Status
		Muscle Mass
	Conclusion
	References
52: Acute Kidney Injury in the Geriatric Population
	Introduction and Epidemiology
	Definition and Staging
	Etiology
	Diagnostic Testing
	Management
	Renal Replacement Therapy
	Outcomes and Follow-Up
	Conclusion
	References
53: Sepsis, Septic Shock, and Its Treatment in Geriatric Patients
	Introduction
	Aging Population and Physiological Changes Impacting the Acute Care Surgeon
		Age-Related Organ-Specific Physiologic Changes Important for the Acute Care Surgeon
			Cardiovascular System
			Renal System
			Hepatic System
	Diagnosis
	Treatment
		Source Control and Antibiotics
		Volume Expansion
		Resuscitation of the Microcirculation
	Conclusions
	References
54: Elder Abuse
	Introduction
	Definition of Elder Abuse
	Incidence and Prevalence
		Physical Abuse
		Sexual Abuse
		Financial Abuse
		Psychological Abuse
		Neglect
	Impact of COVID-19
	Signs of Abuse
	Risk Factors for Elder Abuse
	Prevention Strategies
		Multidisciplinary Teams
		Helplines
		Money Management
		Caregiver Support
		Shelter
	Reporting and Documenting Elder Abuse
	Conclusion
	References
55: Post-Operative Care in Skilled Nursing and Long-Term Care
	Overview
	Understanding Skilled Nursing Facility Admission Categories
	Payor Sources and their Influence on Length of Stay (Los)
	SNF Care for Post-Operative Patients
	Specific Post-Operative Specialty Considerations
		Orthopedic Surgery
		Cardiac Surgery
		Urologic Surgery
		Surgical Management of Wounds
		Vascular Surgery
		Trauma
	How to Compare Skilled Nursing Facilities
	Telehealth in Skilled Nursing Facility Care
	Conclusions
	References
56: Nursing Considerations in Management of Geriatric Patients
	Introduction
		Physical and Physiological Changes in the Older Adult
		Geriatric Syndromes
		Geriatric Assessment
		Functional Decline
		Patient Safety
		Elder Abuse
		Medications
	Nursing Evaluation of the Geriatric Patient
		Health History, Physical Exam, and Assessment
		Advance Directive
		Communication and Trust
		Patient and Family Centered Care
		Culture/Health Belief Assessment
	General Nursing Considerations in the Care of the Geriatric Patient
		Skin Assessment and Care
			Pressure Ulcers
		Cardiovascular Assessment and Care
			Hypertension
			Venous Thrombus
			Medications
			Thermoregulation
			Anemia
			Dehydration
		Pulmonary Assessment and Care
			Aspiration
			Hypoventilation and Atelectasis
		Musculoskeletal Assessment and Care
			Fall Risk
			Frailty
		Neurological Assessment and Care
			Cognitive Impairment/Delirium
			Delirium
		Gastrointestinal/Genitourinary Assessment and Care
			Nutrition and Fluids
			Urinary Tract Infections
	Nursing Care and Management in the Perioperative and Postoperative Periods
		Preoperative Management
		Intraoperative Management
		Post Anesthesia Management
		Postoperative Management
			Pain Control
			Discharge
	Conclusion
	References
57: Emergency Nursing Considerations
	Background
	Patient Evaluation
	Triage
	Initial Nursing Assessment
	Primary Assessment
	Secondary Assessment
	The ED Workup
	Older Adult Common Presentations
	Disposition
	References
58: Perioperative Nursing Considerations
	Introduction
	Preoperative Considerations
		Physical Assessment
		Psychological Assessment
		Nutritional Status
		Medication Review
		Safety Measures
	Intraoperative Considerations
		Anesthesia Induction
		Positioning of the Geriatric Patient
		Thermoregulation
		Safety Measures
	Postoperative Considerations
		Pain Management
		Postoperative Delirium
		Infection
		Safety Measures
	Future of Perioperative Care of the Geriatric Nurse
	Conclusion
	References
59: Implementing Nursing Care Plans
	The Nursing Care Plan
		Main Reasons to Write a Nursing Care Plan
		Introduction to the Nursing Process
	Components of a Nursing Care Plan
		STEP 1: Assessment (Gathering the Data)
		STEP 2: Diagnosis (Analyzing the Data)
		Types of Nursing Diagnoses
		STEP 3: Planning (Formulating Goals, Outcomes, and Interventions)
		STEP 4: Implementation
		STEP 5: Evaluation
	Implementing the Nursing Care Plan for the Geriatric Patient
	Special Considerations for Implementing the Nursing Care Plan for the Geriatric Patient
	Risks of Hospitalization for the Geriatric Patient
		Implementation of Nursing Care Plans for the Geriatric Patient Status Post-Acute Surgery Would Include the Following Common Risks (Would Require Prioritization Based on Patient Needs and Assessment)
			Immobility
		Implementation: Nursing Interventions Aimed at Promoting Mobility Include (Not Limited to) Interventions Must Be Prioritized Based on the Patient’s Assessment
		Falls
		Implementation: Nursing Interventions Aimed at Preventing Falls Include (Not Limited to). Interventions Must Be Prioritized Based on the Patient’s Assessment
		Infection
		Implementation: Nursing Interventions Aimed at Preventing Infections (Not Limited to). Interventions Must Be Prioritized Based on the Patient’s Assessment
		Delirium
		Implementation: Nursing Interventions Aimed at Preventing Delirium (Not Limited to). Interventions Must Be Prioritized Based on the Patient’s Assessment
		Impaired Skin Integrity/Pressure Injuries
		Implementation: Nursing Interventions Aimed at Preventing Pressure Ulcers and Skin Breakdown (Not Limited to). Interventions Must Be Prioritized Based on the Patient’s Assessment
		Acute Pain
		Implementation: Nursing Interventions Aimed at Acute Pain (Not Limited to). Interventions Must Be Prioritized Based on the Patient’s Assessment
		Implementation of the Nursing Care Plan for the Geriatric Patient Status Post-Acute Surgical Procedure
	References
60: Nursing and Polypharmacy
	Introduction
		Statistics
		Prevalence of Polypharmacy
		Nonprescription (Over the Counter) Medications, Vitamins, and Herbal Therapies
		Adverse Outcomes
		Adverse Drug Event/Adverse Drug Reactions
		Drug–Drug Interactions
		Medical Interventions
		Deprescribing
		Resource to Assist Prescribers
		American Geriatrics Society
	Nursing Interventions/Implications
		Health History
		Chart Review
		Medication Reconciliation
		Medication Adherence Assessment
		Symptom Identification
		Patient Safety
			Comorbidities and Falls
			Acute Care Issues
	Medications Used Preoperatively, Perioperatively, Postoperatively
	Patient Education
	Conclusion
	References
61: Outcomes in Geriatric Trauma and Emergency General Surgery
	Introduction
	Geriatric Trauma
		In-Hospital and Post-Injury Mortality
		Incidence of Morbidity and Common Causes of Death Following Blunt Injury
		Penetrating Injury and Severe Hemorrhage
		Post-Discharge Outcomes and Readmission
		Frailty in Trauma
	Geriatric Emergency General Surgery
		Emergency Laparotomy and Damage Control Laparotomy
		Appendicitis
		Biliary Disease
		Small Bowel Obstruction
	Stratification and Prognostication
	Geriatric Specific Care in EGS
	Conclusion
	References
62: The Elderly and Pandemics: COVID-19 and Others
	Life Expectancy
	The SARS-CoV-2 Pandemic and the Elderly
		Why Are the Elderly more Vulnerable?
		The Effects of the Pandemic in Different Scenarios
		The Omicron Surge and Vaccination
		The Argentinean Experience at the Main COVID-19 Referral Hospital
	Other Pandemics and the Elderly
		Influenza
		Influenza Pandemic in 1918
		Influenza Pandemic in 2009
		HIV Pandemic
	References
Index