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OR Nurse:
doi: 10.1097/01.ORN.0000452046.09119.25
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Optimizing the perioperative nursing role for the older adult surgical patient

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INSTRUCTIONS Optimizing the perioperative nursing role for the older adult surgical patient


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* Registration deadline is August 31, 2016.

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Lippincott Williams & Wilkins, publisher of ORNurse2014 journal, will award 2.3 contact hours for this continuing nursing education activity. Lippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

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Optimizing the perioperative nursing role for the older adult surgical patient

Purpose statement: The purpose of this learning activity is to provide information related to needs of the older adult surgical patient. Objectives: After reading this article and taking this test, you should be able to: 1. Describe the physiologic, psychosocial, and cognitive changes associated with aging. 2. Identify implied actions nurses should use to prevent complications in the older adult surgical patient.

1. Which of the following statements is relevant to the assessment of the older adult surgical patient?

a. Fewer procedures are being performed on older adults than in past years.

b. The physiologic age of the patient is more relevant than the chronologic age.

c. Older adult patients tolerate surgery better than younger adults.

d. Older adult surgical patients today have fewer comorbidities than in past years.

2. Compared with younger patients, older adults have

a. fewer allergies.

b. better developed stress responses.

c. less friable skin.

d. slower metabolism.

3. Frailty takes into consideration the patient's

a. body mass index.

b. family history.

c. physiologic versus chronologic age.

d. vulnerability to stressors.

4. The Braden Scale

a. is solely used to predict the risk of pressure damage.

b. is used to assess frailty preoperatively.

c. measures four characteristics predictive of vulnerability to adverse outcomes.

d. includes the assessment of mobility, nutrition, communication, and pain level.

5. Changes in the immune system place the older adult surgical patient at risk for

a. prolonged emergence from general anesthesia.

b. infection.

c. adverse outcomes of positioning.

d. dysrhythmias.

6. Aspiration in older adult surgical patients can be related to

a. delayed gastric emptying.

b. reduced lung elasticity.

c. increased gastric emptying.

d. reduced lung vital capacity.

7. Surgery is most hazardous for older patients due to

a. the deterioration of body systems as a result of aging.

b. their intolerance of medications that could prevent complications.

c. prevalence of comorbidities that may lead to complications.

d. their decreased activity level.

8. Medications that many older patients take

a. can interfere with or intensify the effects of anesthetic agents.

b. will prolong the recovery period.

c. should be continued on schedule perioperatively.

d. should be discontinued at least 2 days prior to surgery.

9. Which of the following statements is correct?

a. An age-related cardiovascular change is increased vascular elasticity.

b. Older adults should be instructed to stop all medications before surgery.

c. Malnutrition increases the risk of wound infection and sepsis.

d. Older adults have increased muscle mass and more friable skin.

10. What daily protein intake is recommended for older adults with comorbidities?

a. 1.2 to 1.5 g/kg of body weight

b. 1.7 to 2.0 g/kg of body weight

c. 2.2 to 2.5 g/kg of body weight

d. 3.0 to 3.5 g/kg of body weight

11. Wrist drop is caused by damage to the

a. ulnar nerve.

b. radial nerve.

c. median nerve.

d. brachial plexus.

12. Thermoregulation is a challenge for the older adult patient due to

a. increased metabolism.

b. respiratory compromise.

c. increase in adipose tissue.

d. decreased metabolism.

13. Shivering can increase oxygen consumption in an older adult by

a. 100%.

b. 125%.

c. 150%.

d. 500%.

14. Maintaining normothermia in the older adult during surgery is important because

a. hypothermia decreases the oxygen demand.

b. respiratory morbidity increases as body temperature decreases .

c. cardiac morbidity increases as body temperature decreases.

d. shivering is very common in older adults.

15. Which of the following drugs is associated with gastrointestinal bleeding?

a. acetaminophen

b. ibuprofen

c. morphine

d. codeine

16. The postoperative pain management plan for the older adult should

a. avoid the use of opioid analgesics.

b. use analgesics combined with complementary and alternative measures.

c. alternate NSAIDs and acetaminophen.

d. start with low-dose codeine.

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