Geriatric risks such as malnutrition, falls, iatrogenic complications, and hemodynamic fluctuations pose a significant threat to older adults and require proactive management. This study evaluates the impact of home telemonitoring, using hemodynamic sensors and geriatric questionnaires via the MyPredi platform, combined with coordinated interventions to prevent the exacerbation of risks in older patients.

This case report presented a unique, integrated nursing management strategy for a 47-year-old male with extreme complexity arising from radiation-induced enterovesical fistula and severe malnutrition-sarcopenia syndrome following irradiated rectal cancer surgery, addressing a critical literature gap in systematic protocols for high-mortality cases. It demonstrated the practical application and sequencing of advanced, refined interventions within a Damage Control Surgery (DCS) framework, offering a replicable model. Key admission findings included severe metabolic derangement (BMI 13.2 kg/m[2], serum albumin 20 g/L, handgrip strength 12 kg), uncontrolled intra-abdominal and gluteal abscesses with multidrug-resistant organisms, complex skin integrity issues (chronic sacrococcygeal pressure injury, incontinence-associated dermatitis), and anatomical complications (presacral abscess, small bowel dilation of 9.87 × 9.86 cm, right ureteric obstruction). Primary diagnoses were radiation-induced multivisceral fistula, severe malnutrition-sarcopenia, and intra-abdominal infection. A phased, MDT-driven approach included: infection control via dual-catheter negative pressure irrigation; nutritional rehabilitation using a stepwise protocol from parenteral to enteral nutrition (short-peptide formula) guided by precise energy calculation and managed with a "ten-aspect" strategy; advanced wound care combining recombinant human epidermal growth factor (rh-EGF) gel with silver ion dressings; and comprehensive functional rehabilitation through a personalized graded exercise prescription, including respiratory training via balloon blowing exercises enhanced by motivational tools (e.g., hanging inflated balloons bedside for engagement). Outcomes after 118 days showed substantial improvement: nutritional and metabolic recovery (weight increased from 38 kg to 41 kg, albumin rose to 35 g/L, electrolyte imbalances corrected); infection resolution (drainage cultures negative, abscesses resolved, bowel dilation reduced to 3.4 × 3.5 cm); physical function restoration (handgrip strength improved from 12 kg to 25 kg, patient progressed from bedbound to ambulating 2 h daily); and complete wound healing. The paramount lesson was that successful management required a systematic, phased, MDT-based nursing model integrating advanced technical interventions with meticulous, protocol-driven supportive care (e.g., structured nutrition and rehabilitation), proving critical for transforming prognosis in similar complex scenarios.