An older woman has a wound infection 5 days after a below-the-knee amputation brought about by diabetes mellitus

Question

Which of the following is the nurse's priority intervention to prevent cogni-tive dysfunction and postoperative complications in this older adult? a. Remove invasive devices as soon as possible.
b. Minimize the administration of opioid analgesics.
c. Allow for self-care and independent activ-ities.
d. Administer short-acting benzodiazepines as needed.

Answer 1

A
To help prevent cognitive dysfunction, postoperative complications, and an increased risk of morbidity and mortality, the nurse recognizes that the risk factors this older adult has for delirium include stressors, infection, and surgery; therefore to prevent cognitive decline and additional postoperative complications, the nurse promptly removes invasive devices such as intravenous infusions, urinary catheters, and wound drains. Removing these devices not only reduces the risk of infection, thromboembolic events, blood loss, injury, and fluid imbalance, but they also serve to promote mobility, promote a sense of control for the patient, and reduce the types of situations that can frighten the patient or that the patient can misinterpret.
Poor pain management can contribute to delirium in older patients. A patient with mul-tiple stressors and risk factors for delirium needs additional nursing care and attention to provide a calming, caring therapeutic environment. The nurse must assess the patient's functional status before allowing self-care and independent activities. In addition, this older adult is likely to need extensive physical therapy to maintain mobility. Benzodiazepines are a poor pharmacological choice for older adults for sedation or sleep; they can contribute to delirium, are highly addictive, and can cause rebound insomnia if suddenly withdrawn.