Special Considerations in the Perioperative Environment for Registered Nurses

Considerations when Caring for Geriatric Patients in the OR

The baby boom population began to turn 65 in 2011. That means that in 2022, the baby boomer generation is in their mid 70s.

Although there have been many improvements in technology and medicine, age remains a significant risk factor within surgical care. Pre-operative assessment and workup is vital in the geriatric population to ensure best outcomes.

When evaluating a geriatric patient for surgery, it is important to consider numerous factors. Click on the links below to learn more:

Perioperative Considerations for Geriatric Patients

When preparing to care for an older adult patient, it is important to consider the anatomical and physiologic changes.

Delirium and Cognitive Impairment in the Elderly

Acute cognitive impairments can occur when elderly patients are under stress, in pain, or have changes to their medications. Delirium has been shown to occur in more than 80% of elderly patients in the intensive care unit and over 50% of hospitalized patients near the end of life. Delirium can be related to poorer outcomes and increased hospital stays. Delirium in older adults can be demonstrated by agitation, aggressiveness, and paranoia.

Older adults may also have chronic cognitive impairments such as dementia or depression, which can make it challenging to communicate, especially when bringing the patient to the OR.

Strategies to support an elderly patient in the OR who may have an acute or chronic cognitive impairment include:

Approaching them slowly and not from behind

Identifying yourself clearly

Ensuring the OR and assessment areas are quiet and well lit. Remove all distractions

Ensuring you have the patient’s attention before beginning to talk

Only asking one question at a time. Be noticeably clear and ready to rephrase

Gesturing, showing words or pictures to explain

Paying attention to the patient’s body language

Talking slowly, being patient

Being ready to repeat

(Allen, 2019)

Differences in the Operating Room When Caring for a Geriatric Patient

Anesthesia – Because of physiological changes in the elderly patient, there are multiple considerations for the anesthesia care provider and circulating nurse, including:

  1. Other diseases/medical conditions that may be unstable or affected by the anesthetic being provided.
  2. Decreased mobility of the patient may make positioning the airway more difficult.
  3. Changes in airway anatomy may make intubation more difficult.
  4. Potential alterations to cardiac and respiratory reserves.

Fluids – The older adult is overly sensitive to fluid volume changes which can lead to impaired respiratory function, swelling of extremities and even heart failure. Fluid volume excess can easily occur when providing fluid replacement intraoperatively. It is essential to monitor fluid losses carefully.

📽️ AORN CINE-MED VIDEO 

Navigate to the AORN Cine-Med website and make sure that you are logged in before clicking on the link below.