Special needs of older adults undergoing surgery

AORN Journal,  March, 2008  by Judith L. Clayton

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Literature does not substantiate delaying surgery because of the patient's age. (12) Early surgical treatment should be considered whenever possible because emergency procedures increase perioperative risk. Every effort should be made to perform a thorough preoperative evaluation aimed at identifying intra-operative risk and the risk of postoperative complications and optimizing the status of the patient's chronic medical conditions as much as possible before surgery. There may not be time to perform a complete evaluation and correct risk factors before emergency surgery; however, even performing a partial evaluation and correction can reduce surgical risks. Assessment and care should continue postoperatively, especially after emergency surgery in which there was insufficient time for preoperative stabilization. (12)

PREOPERATIVE PHASE

The goal of the preoperative phase is to ensure that the patient is in the best possible condition for surgery through careful assessment and thorough preparation. A preoperative evaluation geared toward risk assessment and implementation of risk-reduction strategies will decrease the risk of perioperative morbidity and mortality. Factors that are most likely to contribute to a successful surgical experience include

* stabilizing nutritional and hydration status;

* controlling related comorbidities and evaluating medications; and

* preparing the patient physically and psychologically for the perioperative experience, including adequate explanations about what to expect during and after surgery.

BASELINE DATA. Baseline data on all body systems is important for comparison with assessment data obtained postoperatively. The preoperative assessment should include the patient's skin status, psychological status, ability to perform activities of daily living and adequate range of motion, and nature of the home environment and family members' competence to provide care after discharge. Assessment of nutritional status and adequate hydration should include documenting recent weight loss, laboratory values, intake and output (I&O), and IV therapy for replacement of fluid and electrolytes. Enemas and diuretics should be avoided before surgery because they increase the risk of dehydration. If possible, surgery should be scheduled early in the day, or, if that is not possible, the patient should be allowed to have a light breakfast (eg, clear liquids and easily digested toast) first thing in the morning. (11) The most prevalent chronic health problems of older adults include arthritis; cataracts or glaucoma; circulatory problems; hypertension; osteoporosis; presbycusis (ie, hearing loss associated with aging); and urinary tract infections (UTIs). Perioperative nurses should recognize how these conditions will affect the care of the surgical patient during the entire perioperative period.

MEDICATION HISTORY. Older adult patients are likely to be taking numerous medications, both prescription and over-the-counter. Medications that an older adult may have been taking routinely before surgery and that may cause complications during the perioperative period include