Exam 26: Geriatric Surgery

Age-related skin changes include a thinning epidermis and decreased subcutaneous fat and elasticity.What special consideration will the perioperative nurse provide,in terms of additional attention and care,in one of the following nursing actions?

During the preoperative assessment and interview with a patient scheduled for a transurethral resection of the prostate (TURP),the perioperative nurse notes that the patient has an inguinal hernia.What would be an appropriate statement that the nurse might make to the patient?

Gregorio Halverson is an 82-year-old diabetic patient with several other co-morbidities in addition to recent withdrawal from alcohol after he was admitted for emergency bowel obstruction surgery.He is both hearing-impaired and visually-impaired.His wife states that Gregorio has only an eighth-grade education and has occasional bouts of depression.The anesthesia provider classified Gregorio as an ASA IV for his surgery.He is now postoperative day 1,in the ICU,and exhibits confusion and delirium.His presentation suggests disorganized thinking,pain,and an acute onset of change in mental status.What risk reduction strategy before Gregorio's surgery might have provided substantial information for the care team to proceed with implementing corrective measures?

Anita Gergen,an 83-year-old woman admitted for an abdominal perineal resection for early sigmoid cancer,has a recent history of a 4% weight loss.On admission to the OR she is tachy-pneic,her tongue and mucous membranes of her mouth are dry,her speech is slurred,and she is confused.Her surgical unit nurse states that Anita's bowel prep the night before was successful.Anita states that she has to vomit.The anesthesia provider tries to find a good vein for an intravenous access and asks the perioperative nurse to look for a possible vein on Anita's other arm as the left arm veins are flat.Based on these conditions,what would be Anita's presenting nursing diagnosis?

Impaired nutritional status is highly prevalent among the elderly;as many as 12% of men and 8% of women in the healthy geriatric population are considered undernourished.During the preoperative assessment and interview,what information will the perioperative nurse review,in addition to a thorough assessment including body mass index and Mini Nutritional Assessment?

The predominant reason for urologic surgery in elderly men is benign prostatic hypertrophy (BPH).What appropriate assessment question would the perioperative nurse ask the patient scheduled for a TURP during the preoperative interview?

The most common causes of acute abdominal complaints in older patients are biliary tract disease,intestinal obstruction,GI hemorrhage,hernia,diverticulitis,and appendicitis.Common abdominal procedures in people older than 65 years include cholecystectomy,lysis of adhesions,appendectomy,and partial excision of the small bowel.Many important clinical signs of abdominal disease may be less obvious in the elderly patient.What would be an appropriate question for the perioperative nurse to ask during the preoperative interview and assessment?

A number of screening tools have been developed to accurately establish biologic age.One tool,the Comprehensive Geriatric Assessment (CGA),is a multidimensional evaluation that scrutinizes medications,functional ability,co-morbid conditions,cognitive ability,mental function,nutritional status,and socioenvironmental factors.In geriatric medical studies,the CGA has been valuable in providing a metric for describing healthy aging and:

The perioperative nurse,Lynne,assigns the patient scheduled for cataract surgery the following nursing diagnosis:Ineffective Breathing Patterns attributable to the patient's chronic lung disease.Lynne also documents a secondary nursing diagnosis:High Risk for Injury related to increased intraocular pressure.What potential event can result in this secondary nursing diagnosis?

Age-related changes cause decreased blood flow to the kidneys with a resultant decrease in nephron function.What condition is created from the cumulative effect of the multiple drugs that the elderly patient will receive during the perioperative phase?

Perioperative nurses caring for older adults must consider factors that affect the choice of medications and the effects of those medications on this population.Physiologic changes may affect the absorption,distribution,metabolism,and excretion of medications.What statement about medication metabolism is true?

Changes to the elderly person's skeleton,such as the loss of bone mass,contribute to skeletal instability and make fractures of the hip,rib,distal radius,and vertebrae very common.What special intervention will the perioperative nurse provide,in terms of additional attention and care,in one of the following nursing actions?

As a person ages digestive secretions decrease,mucus becomes thicker (causing dysphagia),and saliva becomes more alkaline.Decreased peristalsis and gastric motility,resulting in muscle tone loss,will cause delayed stomach emptying.What perioperative concern may be influenced by this age-related digestive condition?

What action is considered a best practice when communicating with geriatric patients with cognitive impairments?

The occurrence of perioperative mortality in geriatric surgical patients is influenced by several evidence-based factors.Select the patient most at risk for perioperative mortality.

Elderly patients have an increased tendency for slower metabolism,multiple chronic diseases,and a decreased reserve capacity of their organs to respond to stress,when compared to younger patients.When considering the decision for surgery,the risk of surgery should be measured against the risk of not operating,and the expected postoperative quality of life.What important factors should be evaluated in the decision-making? Select all that apply.

Hyperthyroidism is the great masquerader in the elderly population and can easily be missed in patients older than 60 years.It can be severe and even life-threatening.An important assessment point during the preoperative interview,that could influence the positioning for the surgical procedure,is based on which true statement?

Martha Boyer,an 82-year-old woman with a displaced intertrochanteric fracture of the upper femur,is scheduled for an open reduction and internal fixation of her right hip.Martha had been scheduled for a total hip replacement for degenerative joint disease before this injury.The perioperative nurse assists with positioning Martha's affected hip and positions the other leg and her arms with equally as much care,using gentle handling,padding,and natural range of motion.In addition to Martha's osteoarthritis,what is the nurse's concern with positioning Martha's other limbs?

Wilbur Jenkins,a 92-year-old man,is scheduled for emergency surgery for a strangulated scrotal hernia.He is thin and frail with a preoperative body temperature of 97.2° F.His skin is pink and he is not shivering even though he states that he is cold.The perioperative nurse and the anesthesia provider have planned for Wilbur's hypothermia before he was transferred to the OR.What therapeutic measures will they implement to raise and maintain his core body temperature?

Ruth Calaveras is an 87-year-old woman who has been scheduled for a right cataract extraction with intraocular lens implant of her right eye.She also has a cataract in her left eye and is hearing-impaired in both ears.The perioperative nurse conducted a preliminary nursing assessment of Ruth 1 day earlier by telephone,and has documented her preliminary nursing interventions for the intraoperative nurse.What nursing action by the preoperative nurse will assist Ruth to maintain accurate perception and interpretation of environmental and sensory stimuli throughout the perioperative period?