Patient orientation
The period after surgery can be a very disorienting time. Personal
items (family photos) and aids (hearing aids, dentures and eyeglasses)
can help older patients adjust after they awake from anesthesia. If we can
orient patients and make them feel comfortable after surgery, we might
be able to decrease the period of delirium — or prevent it altogether.
Sometimes, delirium and post-op cognitive decline can be hard to
spot soon after surgery. A patient with hypomanic delirium, which can
occur in 70% of episodes, who appears to be lethargic and content
could actually be confused upon further questioning. You'll need help
from the patient's at-home caregiver to track his progress and ensure
improvement. Don't let patients drive or leave them alone until they're
back to their pre-op baseline.
Medication reminders
Be careful with anticholinergic agents and benzodiazepines.
These drugs can be associated with post-op delirium. Take meperidine
(Demerol) out of your order sets. Not only won't it help your elderly
patients' pain, but it's been linked to delirium and seizures as well.
You should be wary of giving Benadryl to older patients because it
can be associated with post-op confusion and cognitive decline. At
our facility, we stopped using the drug except in extreme cases.
It's important to remember other ways to help patients beyond med-
ication. Having family present, favorite songs and photos may help
reorient patients and break the delirium. Medication shouldn't be your
crutch or your first resort.
Patients should check with their physician about their post-op med-
ications, particularly if they are looking to take drugs for anxiety, mus-
cle spasms, seizures or difficulty sleeping.
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