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Karen Kopan

2018 CSA Conference

 

Karen L. Kopan, DNP, APN, ACNP-BC

Intensive Karen
Nurse Practitioner
karenkopan@comcast.net
www.intensivekaren.com

 

Intensive Care 101: Common Older Adult Diagnoses and Life-Sustaining Technologies

Despite 70% of Americans preferring to die at home, nearly 70% percent die in a hospital, nursing home or long-term care facility (CDC, 2007).  80% of patients with chronic diseases say they want to avoid hospitalization and intensive care when they are dying and yet only 12 to 30% percent of Americans report having an advance directive such as a living will (AP, 2010). Technological devices in the intensive care unit are able to sustain multiple organ systems through acute illness and injury.  However, most people are unaware of the risks and benefits of these devices.  A review of the common older adult diagnoses and life-sustaining technological therapies will be presented.

After a brief introduction of older adult critical care statistics, a review of the history, purpose and varieties of intensive care units is presented. The first intensive care units and their progression to todays' specialized units is explored.  Reasons for monitoring in the intensive care unit and various types of intensive care units are discussed.  
Next, a description of the various team members in intensive care provides insight into the routines and treatments typically encountered.  Their titles, training and what to expect is briefly outlined.

The ABC's of intensive care (Airway, Breathing, and Circulation), along with corresponding devices ranging from minimal routine support to full life-sustaining support, demonstrates the complexity the older adult encounters.  For instance, with breathing devices, a simple nasal cannula with oxygen progresses to masks and then ventilators and then extracorporeal membranes oxygenation (ECMO) devices are shown.  Risks and benefits of these devices as they pertain to discussions and informed consent are reviewed.  People are often making these decisions in a highly charged stressful situation. 

Case studies are used to demonstrate commonly encountered scenarios.

Lastly, decision making support available through family and friends as well as provided by the hospital and a review of the importance of advanced directives is addressed.

Learning Objectives

  1. List the top five common intensive care diagnoses of the older adult
  2. Describe the risks and benefits of common life-sustaining therapies including ventilators and mechanical heart support
  3. Describe common intensive care medical decisions presented to older adults and their families

About Karen

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