The nurse cares for an older adult who has a prealbumin level of 10 mg/dl and an infection in a large wound.Which intervention is the nurse's priority?

Question

Quizplus · Accepted Answer

The nurse's priority is to maintain oxygen saturation above 95% to help provide oxygen that the heart is unable to provide.The heart of this older adult is less able to respond to increased oxygen demands from infection because of age-related changes in the myocardium including ventricular hypertrophy and decreased coronary blood flow and changes in pulmonary function.Further,because this older adult is malnourished and thus likely to have anemia,any capacity to meet increased oxygen demand is stymied.Along with airway,breathing and circulation are two of the three most basic needs.Similarly,the older heart may not be able to respond to other calls for increased cardiac demand such as infection,anemia,pneumonia,cardiac dysrhythmias,surgery,diarrhea,hypoglycemia,malnutrition,and drug-induced and noncardiac illnesses such as renal disease and prostatic obstruction.
Monitoring temperature and leukocytes is important to implement for anyone with an infection,but it is not as important as breathing and circulation.Besides,fever is an unreliable indicator of infection in an older adult.Providing assistance with meal planning is a reasonable nursing intervention,but it is not as important as breathing and circulation.The nurse provides high-quality protein in this individual's diet because of malnutrition,but this teaching is not as important as breathing and circulation.

The Nurse Cares for an Older Adult Who Has a Prealbumin