Chapter 18 Preoperative Care Flashcards
Surgery
Art & science of treating diseases, injuries, & deformities by operation & instrumentation
Purposes of Surgery
Diagnosis Cure Palliation Prevention Exploration Cosmetic improvement
Surgical Settings
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
Nursing Role
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
Patient Interview - Primary Purposes
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
Patient Interview - Purposes
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
Preoperative Patient - Psychosocial Assessment
8-10
Review of Systems: Cardiovascular
Cardiovascular
Check EKG
Rhythm disturbances (pacemaker requires a cardiologist)
HTN, MI, angina
Review of Systems: Respiratory
Check oxygenation
Steroids (inhaled or oral)
Cough or SOB (shortness of breath)
May need ABGs prior to surgery
Review of Systems: Nervous System
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
Review of Systems: Urinary
Renal dysfunction
Fluid and electrolyte imbalance
Altered response to drug/drug elimination
Frequent UTIs, prostate enlargement
Review of Systems: Hepatic system
Check liver function tests (AST/ALT, alkaline phosphatase, prothrombin time, platelet count)
Review of Systems: Integumentary system
Skin rashes, pressure ulcers
Review of Systems: Musculoskeletal
Arthritis, back problems, mobility restrictions
Review of Systems: Endocrine (diabetics at risk)
Check blood glucose levels (may need HgA1C)
Hypoglycemia (insulin issues), hyperglycemia, cardiovascular, risk for infection
Thyroid (risk: alteration in metabolic rate)
Review of Systems: Immune (Immunocompromised)
Increased risk for infection
Active infections…may cancel elective surgery
Review of Systems: Nutritional Status (over nutrition, undernutrition)
Obesity risks: cardiac, wound dehiscence, infection, incisional herniation, (adipose tissue is less vascular)
Undernutrition: vitamin deficiencies,
Note individuals with high caffeine intake
Special diet
Review of Systems: GI
Patterns of elimination
Preoperative teaching
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
Educational content
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
Legal Preparation for Surgery
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
Day-of-Surgery
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
Preoperative medications
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
Transportation to the OR
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
Considerations for Special Populations
Cultural Decision making Language/consent Pain tolerance Communication post op
Elderly (physiologic vs chronologic age) Greater risks Support systems Slow thought processes Discharge planning
