Intro to preoperative nursing

Question 1

Definition of preoperative nursing

Answer 1

Delivery of patient care in preoperative, intraoperative and postoperative periods of patients’ experience during operative or other invasive procedure using the framework of the nursing process,

Question 2

Types of surgical setting

Answer 2

Elective Surgery - subject to choice based on medical condition
Emergency surgery - unexpected, urgency, deal with acute threat

Both can be Day Surgery (stay in Hospital for less than 24h) or Same Day Admission (don’t admit in advance)

Question 3

Sterile team

Answer 3

Surgeons, surgical first assist, scrub nurse

Question 4

Non-sterile team

Answer 4

Reception nurse, anaesthetist, anaesthetic nurse, circulating nurse and recovery room nurse

Question 5

Perioperative nursing

Answer 5

Communication, teamwork and patient assessment are crucial in ensuring good outcomes in perioperative period

It is made up of various healthcare professionals

Question 6

Preoperative Phase

Answer 6

Begins when the decision is made to undergo a surgical intervention and ends when the patient is transferred to operating room table.

Pre-op visit (counselling clinic)
Pre-op checklist

Made up of

a) Pre-operative assessment
b) Pre-operative nursing intervention - patient education

Question 7

Preoperative Roles

Answer 7

Reception, anaesthetic, scrub and circulating nurse

Question 8

Role of reception nurse #1

Answer 8

Prepare the patient for surgery physically and emotionally.

Perform pre-operative checks and documentation.

Question 9

Role of reception nurse #2

Answer 9

1. Receive hand over report from ward nurse
2. Verification process
3. Preop checklist
4. Ensure patient dignity and privacy
5. Provide psychological support to patient and their family members
6. Early recognition and intervention for any discrepancies identified

Question 10

What are the 5 pre-operative assessment and what is the goal for pre-operative assessment

Answer 10

Review of systems, Anaesthetic review, medication, psychosocial and preoperative checklist.

Identify risk factor and plan care to ensure patient safety

Question 11

Pre-operative assessment #1

Answer 11

Review of system - To optimised patient for surgery such as the cardiovascular, nervous system, respiratory and fluid electrolytes status

Question 12

Pre-operative assessment #2

Answer 12

Ensure anaesthetist review - current prescribed medications and any over counter drugs

Past health history

• Any problems with previous surgery
• Menstural cycle
• Possible inherited condition if not known (HTN)

Question 13

Pre-operative assessment #3 (Medications)

Answer 13

Some drugs and herbs may interfere with anaesthesia or affecting clotting process (Eg, anti platelet - aspirin should be stopped 2 weeks prior to surgery)

Question 14

Pre-operative assessment #3 (Medications)

Answer 14

Anti-hypertensive drug may increase patient chances of developing shock due to effect of anaesthesia

Question 15

Pre-operative assessment #3 (Medications)

Answer 15

Oral hypoglycaemic drugs will need adjustment secondary to increased body metabolism - NBM

Question 16

Pre-operative assessment #3 (Medications)

Answer 16

Any chronic alcohol use - increased risk for liver damage & metabolism anaesthetic agent may be prolonged

Question 17

Pre-operative assessment #3 (Medications)

Answer 17

Drug tolerance and allergy status

Question 18

Pre-operative assessment #4

Answer 18

Psychological assessment - surgery is a “frightening event”

Question 19

Factors that increase susceptibility to stress

Answer 19

Age, socioeconomic, past experience, Curren health status

Question 20

What are the common fears of surgery

Answer 20

Fear of death, past experience, fear of pain and discomfort, alteration in body image, cost of hospitalisation

Question 21

Pre-operative assessment #5

Answer 21

Pre-op checklist

1. Psychological factors - baseline vital signs
2. Preparation of patient
3. Preparation of documents - consent form
4. Pre-operative lab and diagnostic tests
5. Transfer of care to OT and ensure patient safely
   Others: cultural and ethnic consideration

Question 22

What are the 3 preoperative nursing intervention (patient education)?

Answer 22

Process information, sensory information and procedure information.

Question 23

What are the process information?

Answer 23

Visitors information and recovery area

Question 24

What are the sensory information?

Answer 24

1. OR temperature is low
2. Talking may be heard while lying on the OR table but can be distorted with mask on
3. Patient bed and OR table is narrow
4. Lights in OR is bright
5. Sounds of patient can be heard

Question 25

What are the procedure information?

Answer 25

1. Types of clothes to bring and wear after day surgery
2. Surgery time and any unexpected changes to schedule
3. Fasting protocols
4. Physical preparation (bowel or skin)
5. Frequency of vital sign assessment
6. Pain control and other discomfort management
7. Deep breathing and coughing exercise
8. Intravenous line

Question 26

When does the intraoperative phase begin and ends?

Answer 26

Begins with the placement of patient on the OR table and continues until the patient is in the transferred to the postoperative area

Question 27

Who are involved in the intraoperative phase?

Answer 27

Circulating nurse, scrub nurse and anaesthetic nurse

Question 28

What is the role of a circulating nurse during intraoperative period #1

Answer 28

a) Patient safety
i. Time out - Correct patient for the correct surgery
ii. Positioning
iii. Monitor aseptic technique
iv. Documentation

Question 29

What is the role of a circulating nurse during intraoperative period #2

Answer 29

b) Assist scrub nurse - work very closely with scrub nurse
i. Provide/ open sterile item
ii. Proper label/ handle specimen

Question 30

What are the role of a circulating nurse during intraoperative period #3

Answer 30

c) Collaboration

With surgeon, anaesthetist, health care assistant and vendors

Question 31

What are the roles of a scrub nurse? #1

Answer 31

Patient safety

1. prevent diathermy burnt
2. Swabs, sharp and instrument count
3. Aseptic practice
4. Specimen

Question 32

What are the roles of a scrub nurse? #2

Answer 32

Assist surgeon

1. Proactive in anticipation
2. Care the sterile field
3. Prevent contamination of instruments
4. Set up the sterile trolley

Question 33

What are the roles of a anaesthetic nurse?

Answer 33

1. Assist anaesthetist in various anaesthetic procedure such as intubation
2. Ensure all anaesthetic drugs, machine and monitoring equipment are available
3. Anticipate for any difficult airway problem or emergency
4. Ensure patient safety in OT

Question 34

When does post-operative phase begin?

Answer 34

Begins with transfer of patient to the post-operative area and ends when surgeon discontinues follow-up care