The elderly neuroscience patient: implications for the critical care nurse

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.