Preoperative Care relates to Chapter 17 Nursing Management

Preoperative Care (relates to Chapter 17, “Nursing Management: Preoperative Care, ” in the textbook) 1

Surgery • Performed for: – Diagnosis – Cure – Palliation – Prevention – Exploration – Cosmetic improvement 2

Patient Interview • Purpose – Obtain health information – Determine expectations – Provide and clarify information on procedure – Assess emotional state and readiness 3

Nursing Assessment of the Preoperative Patient • Subjective Data - Psychosocial Assessment Anxiety Common fears Hope 4

Nursing Assessment (Subj. data cont’d) • Health history • Medications • Allergies 5

Nursing Assessment Review of systems • Cardiovascular function • Respiratory system • Nervous system • Urinary system 6

Nursing Assessment – Review of systems (cont’d) • Integumentary system • Musculoskeletal system • Endocrine system • Immune system • Fluid & Electrolyte status • Nutritional status 7

Nursing Assessment. Objective Data • Physical examination • Laboratory and diagnostic testing – Indicator of perioperative risk and overall outcome 8

Nursing Management Preoperative teaching • Patient has right to know what to expect and how to participate – Increases patient satisfaction – Reduces fear, anxiety, stress, pain, and vomiting 9

Nursing Management – Teaching documented in medical record (pt. chart) – Sensory information – Instruction on deep breathing, coughing, and moving postoperatively • Teach rationale to reinforce • Practice 10

Pre-Operative Teaching • Deep breathing, coughing, incentive spirometry • Mobility and active body movement – Ambulation/leg exercises 11

Patient Teaching – Inform patients and families if there will be tubes, drains, monitoring devices, or special equipment postoperatively – Discuss pain management 12

Patient Teaching – Provide patient with information • Fluid/food restrictions (prevents aspiration, N/V) • Need for enema • Need for shower preoperatively/ skin prep 13

Nursing Management Legal preparation • Check that all forms have been correctly signed and are present in chart – Informed consent – Blood transfusion 14

Nursing Management • Must include adequate disclosure of diagnosis, treatment, risks, and probability of success 15

Nursing Management • Patient must demonstrate clear understanding and comprehension – Signed before any preoperative drugs given • Voluntary consent 16

Nursing Management • Surgeon responsible for obtaining consent – Nurse may obtain and witness signature (varies) – Verify patient has understanding • Permission may be withdrawn at any time 17

Nursing Management • Advance directives, living wills, and power of attorney included in chart 18

Nursing Management Day-of-surgery preparation • Final preoperative teaching • Assessment & communication of pertinent findings • Ensure completion of pre-op prep orders 19

Nursing Management Day-of-surgery preparation (preop checklist) – Labs – Verify signed consent – History and physical exam – Baseline vitals – Consultation records – Nurse’s notes 20

Nursing Management • Patient should not wear any cosmetics – Observation of skin color is important – Remove nail polish for pulse oximeter • Identification and allergy bands 21

Nursing Management • Valuables returned to family member or locked up – Wedding ring taped to finger • Dentures, contacts, prostheses are removed 22

Nursing Management • Void before surgery – Prevents involuntary elimination under anesthesia or early postoperative recovery – Done before administration of medication 23

Nursing Management • Pre-operative Medications – Give as ordered (scheduled time, on call, sent to OR) • Safety considerations – Regularly scheduled medications • Verify with MD • Cardiac meds, asthma • Insulin 24

Nursing Management Transportation to OR • In-patients transported by cart to surgery from room – Side rails raised and secured – Chart and preoperative equipment with patient – Family may accompany to holding 25

Nursing Management • Outpatients transported by cart, wheelchair, or may walk – Method of transport documented by nurse responsible for transfer • Family instructed on waiting area where they can be informed of progress 26