Bringing It All Together at the Bedside: A Patient's Story

Gloria Lopez, age 85, arrived at the emergency room of her local hospital delirious and unable to articulate her symptoms. After a diagnostic work-up and care in the ER, which included placement of a Foley catheter (used for patients with urinary incontinence and often ordered by well-meaning physicians for older patients), she was admitted to the hospital with an uncertain diagnosis and sent to a general medical unit.

For many older people, a scenario such as this can signal the beginning of a long and arduous hospitalization, fraught with the potential for hospital acquired infections and complications, while physicians search for the underlying cause of illness. Fortunately for Mrs. Lopez, this hospital had recently undergone an extensive review and overhaul of policies and procedures regarding nursing care of older adult patients. Jacqueline Bennett, a trained Geriatric Resource Nurse, utilized a series of evidence–based nursing assessment tools to evaluate Mrs. Lopez. She immediately realized that there was no reason for the catheter and removed it.

Use of a Foley catheter raises the risk for urinary tract infections and can potentially lead to delirium and falls. Best nursing practice dictates that they be avoided unless there is a compelling reason for their use. Ms. Bennett also found that Mrs. Lopez had been prescribed the drug meperidine for pain. Meperidine can be dangerous in elderly patients, causing delirium and confusion. Ms. Bennet asked the physician to switch Mrs. Lopez to a different pain medication. Mrs. Lopez was eventually diagnosed with pneumonia. She was treated and released back home under the care of her daughter, with no adverse effects from her stay in the hospital.

Under different circumstances, Mrs. Lopez might have developed a urinary tract infection, which can cause mental confusion in older people. This, along with the use of the pain medication meperidine, could have exacerbated her condition and quite possibly resulted in the need to release her to a nursing home. The nursing staff had spared Mrs. Lopez numerous potential complications of hospitalization because the nurses had specialized training and knew what to look for when an older patient was admitted, and the unit had spent the time to establish policies and procedures for best practices for nursing care of older patients.