Special needs of older adults undergoing surgery

AORN Journal,  March, 2008  by Judith L. Clayton

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* uncovering the patient for a minimal amount of time only (eg, during positioning and skin preparation). (14)

The circulating nurse should carefully prepare the patient's skin using the solution that is least likely to irritate the sensitive, fragile skin of the older adult. As with all patients, it is particularly important for the circulating nurse to prevent chemical burns to the patient by ensuring that the prep solution does not pool underneath the patient or under equipment such as tourniquet cuffs. "Skin preparation solutions should be used at a temperature recommended by the solution manufacturer. Heating some skin preparation agents may increase the risk of a chemical thermal burn." (14(p413))

THROMBOEMBOLISM. Pulmonary embolism may be the most frequent cause of death postoperatively in the older adult age group. (11) Thromboembolic disease stockings may have been applied in the preoperative area. Sequential compression devices or foot compression devices should be used intraoperatively to prevent thrombophlebitis.

FLUID AND ELECTROLYTE PROBLEMS. Decreases in renal function caused by aging affect fluid, electrolyte, and acid-base balance. The stress of the surgical procedure, pain, anesthetics, and many medications given preoperatively increase the patient's serum levels of sodium and fluid-retaining hormones. (11) An excess of these electrolytes and hormones and a decreased ability of the cardiovascular system to expand make the older patient prone to hypovolemia. Electrolyte imbalances occur because the kidneys are no longer able to reabsorb or secrete electrolytes well. Acid-base imbalances may occur as the kidneys lose their ability to secrete ammonia. Hypovolemia and electrolyte and acid-base imbalances can be prevented or at least minimized through careful monitoring of I&O. Fluid status and vital signs should be assessed frequently during surgery, especially on patients undergoing long procedures, and should be reported to the postanesthesia care unit (PACU) nurse when the patient is transferred to the recovery area.

POSITIONING INJURIES, Perioperative personnel should transfer the older adult patient to and from the OR bed carefully and slowly, endeavoring to prevent hypotension, muscle or joint discomfort, skin injury, and psychological trauma. After the patient is transferred to the OR bed and anesthetized, perioperative personnel should carefully place the patient in the required position. Positioning should allow for optimal exposure without patient compromise, optimal body alignment, anesthesia access, safety, and adequate body system functioning. Musculoskeletal changes to be considered include

* loss of protective tone as a result of aging and muscle relaxants that further reduce muscle tone;

* strain on muscles resulting in injury and needless postoperative discomfort; and

* that tension is placed on ligaments and tendons at joint lines when the muscles relax, causing the ligaments and tendons to become overstretched.