Saint Louis University School of Nursing Baguio City Dollaga, Melissa Joy D.

BSN IV-O2 December 18, 2011

Factors to consider if a patient is admitted for Surgery

1. Age

In the elderly, the hazards of surgery are proportional to the existence of comorbid diseases and the nature and duration of the surgery. Elderly patients have less physiologic reserve (the ability of the organ to return to normal after a disturbance in its equilibrium) as compared to younger patients. For the very young (toddlers and infants) have higher chances of developing complications during surgery due to underdeveloped vital organs.

2. Nutritional Status weight loss may lead to complications such as delayed wound healing Morbid obesity causes restrictive lung disease, decreases thoracic compliance, and leads to alveolar hypoventilation, furthermore, obesity increases the technical and mechanical problems related to surgery related to surgery therefore dehiscence and wound infections are more common. 3. Comorbidities and other conditions Respiratory diseases (COPD, Asthma, and other disease affecting the Respiratory system such as multiple sclerosis, and Guillian Barre Syndrome) they may experience difficulties due to the side effects of anesthesiathese should be communicated to the anesthesiologist for the adjustment in doses of the medication. Cardiovascular diseases (Hypertension, Heart Failure, CAD) the primary goal in preparing a patient for surgery is to ensure a wellfunctioning cardiovascular system to meet the oxygen demand, fluid and nutritional status. Pregnancy diminished maternal physiologic reserve

Endocrine dysfunction (Diabetes Mellitus, Thyroid disorders) Mortality rates in diabetic patients have been estimated to be up to 5 times greater than in nondiabetic patients, often related to the end-organ damage caused by the disease. Infections account for 66% of postoperative complications and nearly one quarter of perioperative deaths in patients with DM. Data suggest impaired leukocyte function, including altered chemotaxis and phagocytic activity due to sluggish blood flow. Patients with uncontrolled thyroid isorders are at risk for thyrotoxicosis (with hyperthyroidism) and respiratory failure (with hypothyroid disorders) Hepatic diseases (Cirrhosis of the liver and Hepatitis) the liver is important in biotransformation of anesthetic compunds therefore any dysfunction in the liver is associated with high surgical mortality. Renal Diseases (Nephristsi, ESRD) the likdenysa re involved in excreting anesthetic compounds and other metabolites. Surgery is contraindicated if a patient has acute nephritis, acute renal insufficiency. Immunosuppression (Corticisterios theraphy, Renal Transplant, Cancer, HIV) they are highly susceptible to infection, there should be strict maintenance of aspepsis during the procedure.

4. History Smoking decreases the respiratory capacity of a person, thereby increasing the chances post-operative complications such as decreased wound healing and pulmonary depression. Alcohol and Drug use a person with chronic alcoholism often suffers from malnutrition and other systemic problems (liver cirrhosis) thus increasing surgical risks. Use of OTC preparations Aspirin is the most common OTC medication taken by clients; it inhibits platelet aggregation thus increasing the tendency of bleeding. 5. Informed consent There should be a full disclosure of information regarding the surgery, including its effects on the life of the patient. These criteria should be seen in the consent for it to be considered valid: - The signee should be 18 y/o and above unless an emancipated minor or < 65y/o - In sound mind

Obtained by physician and must be witnessed by a professional staff member

6. Mental status preoperative mental status is critical to understanding the etiology of postoperative cognitive status in the elderly: Dementia is an extreme predictor of poor outcome, with surgical mortality rates increased by 52% Mental status is also considered in the perioperative period because the client should understand the terms and conditions of the surgery; in addition assessing the mental status is a very accurate way to assess the qualification of the patient in signing the informed consent. It is also necessary in educating the client regarding post-operative care 7. Psychosocial, Emotional Status, Spiritual Beliefs Psychological distress influences body functioning therefore it is imperative to identify any anxiety the patient is experiencing. Spiritual beliefs play an important role in coping with fear and anxiety these are as effective as medications. Reference: Smeltzer et al, Brunner and Suddarths Textbook of Medical-Surgical Nursing, Volume 1, 12th Edition. Lippincott, Williams and Wilkins, 2010 Rabkin and Lee, PREOPERATIVE ASSESSMENT, retrieved at http://www.medicineclinic.org/AmbulatorySyllabus4/FINAL%20Preop.htm, on December 18, 2011