Guin P R, Freudenberger K
AACN Clin Issues Crit Care Nurs. 1992 Feb;3(1):98-105. doi: 10.4037/15597768-1992-1012.
The elderly patient may present to the critical care unit with neurologic deficits such as acute confusion, loss of consciousness, or signs of a cerebrovascular accident. Recognizing the normal age-related changes that occur in the nervous system enables the critical care nurse to evaluate the patient's response to neurologic disorders. The normal neurologic changes associated with aging provide implications for assessment, response to the critical care environment, and the time needed for education and rehabilitation. Other changes, especially decreased immunity, malnutrition, and pulmonary and cardiac pathology, significantly increase the risk for morbidity and mortality after an acute neurologic event. Changes in pharmacokinetics and the likelihood of polypharmacy in the older patient greatly increase the risk for complications and side effects of the commonly used treatments. Important elements of nursing management for the elderly neuroscience patient include performing an accurate neurologic assessment, including noting changes in cognition, observing for adverse drug reactions, optimizing ventilation, and maximizing mobility and nutritional status. This article focuses on these aspects of nursing care for the elderly neuroscience patient.
老年患者可能因急性意识模糊、意识丧失或脑血管意外迹象等神经功能缺损而被送至重症监护病房。认识到神经系统中与年龄相关的正常变化，有助于重症护理护士评估患者对神经系统疾病的反应。与衰老相关的正常神经变化对评估、对重症监护环境的反应以及教育和康复所需时间具有启示意义。其他变化，尤其是免疫力下降、营养不良以及肺部和心脏疾病，会显著增加急性神经事件后发病和死亡的风险。老年患者药代动力学的变化以及多重用药的可能性，大大增加了常用治疗的并发症和副作用风险。老年神经科学患者护理管理的重要内容包括进行准确的神经评估，包括注意认知变化、观察药物不良反应、优化通气以及最大限度地提高活动能力和营养状况。本文重点关注老年神经科学患者护理的这些方面。
