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F E B R U A R Y 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E
SAFETY
We also conduct caregiver burden interviews to understand the bur-
dens the elderly place on their loved ones' lives. (We follow up 6 months
post-op to see if surgery made the burdens greater or lesser.)
Pre-op staff should carefully review patients' medications and give
clear instructions on exactly which medicines they can take and
which ones to stop after surgery.
This more exhaustive evaluation, which can be done on patients
older than 75 years, should take nurses or nurse practitioners an
extra 15 minutes to complete.
Ideally, you'll input the results of the pre-op assessment into an elec-
tronic health record, so caregivers can access the information
throughout the patients' stay. That's important because after an opera-
tion, patients who might appear cognitively impaired might be exhibit-
ing behavior that matches baselines measured in pre-op.
In the OR
The elderly lose body heat rapidly because their skin is extremely thin,
so properly warming these patients is essential in order to stave off
hypothermia (see "The Unintended Consequences of Unintended
Hypothermia" on page 46). It's a good idea to use forced-air warming
for surgeries lasting any significant length of time.
Local and regional anesthesia is typically used more often in elderly
patients, although deep sedation is sometimes required, even for these
inhalational-anesthesia-avoiding techniques.
Employ "just right care," which involves paying particular attention
to the wishes of individual patients. Quality of life is more important to
many elderly patients than length of life. For example, most patients of
advanced age would opt for less invasive cancer surgery with less
of a chance of cure compared to a more invasive operation
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