Chapter 18 Preoperative Care

Question 1

Surgery

Answer 1

Art & science of treating diseases, injuries, & deformities by operation & instrumentation

Question 2

Purposes of Surgery

Answer 2

Diagnosis
Cure
Palliation
Prevention
Exploration
Cosmetic improvement

Question 3

Surgical Settings

Answer 3

Sameday/Ambulatory/Outpatient (way of the future of healthcare)
Pre-op Suites
Operating Rooms
PACU post anesthesia care unit
Procedure Rooms (colonoscopy done every 5 years)
Cardiac Catheterization Labs
Critical Care Areas

Question 4

Nursing Role

Answer 4

Knowledge of nature of disorder requiring surgery & any coexisting disease process

Identify individual patients response to the stress of surgery

Assess results of preoperative diagnostic tests

Consider bodily alterations/potential risks/complications associated with procedure & any coexisting medical problem

Question 5

Patient Interview - Primary Purposes

Answer 5

Obtain patient health information

Determine patients expectations about surgery & anesthesia

Provide & clarify information about the surgical experience

Assess the patients emotional state & readiness for surgery

Question 6

Patient Interview - Purposes

Answer 6

Gather data to:  
Plan care
Identify risk factors
Physiologic, Psychologic, Sociocultural, Developmental
Assess patient safety issues
Identify learning needs
Determine patients discharge needs
Assess coping strategies
Spiritual needs
Evaluate lab results 
Informed consent
Past health history

Question 7

Preoperative Patient - Psychosocial Assessment

Answer 7

8-10

Question 8

Review of Systems: Cardiovascular

Answer 8

Cardiovascular
Check EKG
Rhythm disturbances (pacemaker requires a cardiologist)
HTN, MI, angina

Question 9

Review of Systems: Respiratory

Answer 9

Check oxygenation
Steroids (inhaled or oral)
Cough or SOB (shortness of breath)
May need ABGs prior to surgery

Question 10

Review of Systems: Nervous System

Answer 10

Check LOC (level of consciousness)
Pre op comparison of status (alert, oriented, able to respond to questions)
Cognitive function (older adult, mental health, child)
Diseases of CNS

Question 11

Review of Systems: Urinary

Answer 11

Renal dysfunction
Fluid and electrolyte imbalance
Altered response to drug/drug elimination
Frequent UTIs, prostate enlargement

Question 12

Review of Systems: Hepatic system

Answer 12

Check liver function tests (AST/ALT, alkaline phosphatase, prothrombin time, platelet count)

Question 13

Review of Systems: Integumentary system

Answer 13

Skin rashes, pressure ulcers

Question 14

Review of Systems: Musculoskeletal

Answer 14

Arthritis, back problems, mobility restrictions

Question 15

Review of Systems: Endocrine (diabetics at risk)

Answer 15

Check blood glucose levels (may need HgA1C)
Hypoglycemia (insulin issues), hyperglycemia, cardiovascular, risk for infection
Thyroid (risk: alteration in metabolic rate)

Question 16

Review of Systems: Immune (Immunocompromised)

Answer 16

Increased risk for infection

Active infections…may cancel elective surgery

Question 17

Review of Systems: Nutritional Status (over nutrition, undernutrition)

Answer 17

Obesity risks: cardiac, wound dehiscence, infection, incisional herniation, (adipose tissue is less vascular)
Undernutrition: vitamin deficiencies,
Note individuals with high caffeine intake
Special diet

Question 18

Review of Systems: GI

Answer 18

Patterns of elimination

Question 19

Preoperative teaching

Answer 19

Begins with initial contact
Phone call to schedule surgery
Discussion about surgery in physicians office
Nurses’ roles include:
Education of patient and family
Clarifying
Ensuring patient or family understands risks and benefits
Without overwhelming all!!
Communicating education / documentation/report/flow sheet

Question 20

Educational content

Answer 20

General surgery information
NPO (rationale)
Cough, deep breathing
Tubes, drains, monitors, IVs
Intubated (tell pt about inability to speak)
Paralytic drugs (tell pt about inability to move)

Clarification about specific surgical procedure

Ambulatory surgery information

Question 21

Legal Preparation for Surgery

Answer 21

Informed Consent
Active, shared decision-making process between the provider & recipient of care
Three conditions to be valid
Adequate disclosure
Clear understanding & comprehension
Giving of consent voluntarily

Question 22

Day-of-Surgery

Answer 22

Final pre-op teaching

Assessment & communication of pertinent findings

Ensure completion of all pre-op prep orders

Records/reports complete to accompany patient to OR

Question 23

Preoperative medications

Answer 23

Opiods
Morphine, meperidine, fentanyl

Anticholinergics (decrease secretions)
atropine, scopolamine, glycopyrrolate

Benzodiazepines (relaxants)
midazolam (Versed), diazapam (Valium), lorazepam (Ativan)

Antiemetics
metochopramide (Reglan), droperidol (Inapsine)

Histamine H2 receptor antagonists
Cimetidine (Tagamet); Famotidine (Pepcid); Ranitidine (Zantac)

Oral meds 60-90 minutes prior to OR

SC, IM 30-60 minutes prior to OR

IVs in holding area or in OR

Question 24

Transportation to the OR

Answer 24

Inpatient
OR staff send transport personnel to patients room with a stretcher

Outpatient
Stretcher/wheelchair/ ambulate

Family should be instructed where to wait for patient during surgery

Inpatient room should be prepared for patient’s return

Question 25

Considerations for Special Populations

Answer 25

Cultural
Decision making
Language/consent
Pain tolerance
Communication post op

Elderly (physiologic vs chronologic age)
Greater risks
Support systems
Slow thought processes
Discharge planning