Perioperative Care of the Transgender Patient

Abstract

Background Information It is estimated that 3% of the population in the United States are transgender which is equivalent to approximately 1.4 million people. This number is only an estimate; many experts feel the number is actually much higher. With the rising number of people in this community we will be caring for more people with these health situations. Perioperative nurses must be aware of the unique physical as well as emotional changes that occur in the care of a transgender patient. Objectives of Project To deliver safe care for the transgender patient by providing information regarding the physical changes and how care should be altered. Process of Implementation For the second year we have presented information surrounding the differences and possible complications in the care of a person who has had sexual reassignment surgery (SRS) and/or who is on hormonal therapy. Some of the potential complications include difficult intubations due to a thyroid chondroplasty or a laryngoplasty done to alter the pitch of the voice or to change the shape of the neck. These procedures may damage the vocal cords, create tracheal stenosis or decrease the lumen of the trachea. Certain procedures involving the urethra may cause changes requiring the use of a much smaller urinary catheter or to have an urologist to insert it. Hormonal therapy can alter lab values, affect the GFR of the kidneys which must also be considered when using imaging, and place the patient at a higher risk for venous thromboembolism, cardiovascular disease, liver disease, breast cancer, prolactiomas and mood disorders. Transgender males who have not had “top” surgery may wear breast binders that can lead to restrictive problems in the respiratory system Statement of Successful Practice Staff was very curious and asked many questions regarding the potential for problems associated with SRS and hormonal therapy. The information provided a plan of action to provide safe and high quality care for all patients. Implications for Advancing the Practice of Perianesthesia Nursing To provide high quality, safe, effective, and culturally competent care for all patients in the perioperative arena. It is estimated that 3% of the population in the United States are transgender which is equivalent to approximately 1.4 million people. This number is only an estimate; many experts feel the number is actually much higher. With the rising number of people in this community we will be caring for more people with these health situations. Perioperative nurses must be aware of the unique physical as well as emotional changes that occur in the care of a transgender patient. To deliver safe care for the transgender patient by providing information regarding the physical changes and how care should be altered. For the second year we have presented information surrounding the differences and possible complications in the care of a person who has had sexual reassignment surgery (SRS) and/or who is on hormonal therapy. Some of the potential complications include difficult intubations due to a thyroid chondroplasty or a laryngoplasty done to alter the pitch of the voice or to change the shape of the neck. These procedures may damage the vocal cords, create tracheal stenosis or decrease the lumen of the trachea. Certain procedures involving the urethra may cause changes requiring the use of a much smaller urinary catheter or to have an urologist to insert it. Hormonal therapy can alter lab values, affect the GFR of the kidneys which must also be considered when using imaging, and place the patient at a higher risk for venous thromboembolism, cardiovascular disease, liver disease, breast cancer, prolactiomas and mood disorders. Transgender males who have not had “top” surgery may wear breast binders that can lead to restrictive problems in the respiratory system Staff was very curious and asked many questions regarding the potential for problems associated with SRS and hormonal therapy. The information provided a plan of action to provide safe and high quality care for all patients. To provide high quality, safe, effective, and culturally competent care for all patients in the perioperative arena.