lecture 12: preoperative care Flashcards
what is surgery
- art and science of treating diseases, injuries, and deformities by operation and instrumentation
what is surgery for
- diagnosis
- cure or repair
- palliation
- prevention
- exploration
- cosmetic improvement
what are 3 surgical settings
- inpatient (requires overnight stay, same-day admission) emergency**
- ambulatory (outpatient, requires some monitoring in the PACU) elective**
4 purposes of the preoperative nursing assessment
- decrease surgical delays
- reduce patient anxiety
- educate and allow questions from patient and family
- help patients and families know what to expect
when does preoperative assessment occur
- in advance: pre-admission clinic or inpatient unit
- on day of surgery: same-day admission unit, emergency department
what is the purpose of the preoperative assessment
- obtain health info
- determine expectations
- provide and clarify info on procedure
- assess emotional state and readiness
- begin some postoperative teaching
- current medications
what are the 9 goals of nursing assessment
- determine psychological status to reinforce coping strategies
- **establish baseline data
- identify medications and herbs taken that may affect surgical outcome
- ensure patient understands the D/C plan and has postoperative support
- identify, document, and communicate results of tests
- identify cultural/ethnic factors that may affect surgical experience
- determine receipt of adequate info from surgeon in order to sign informed consent
- identify any psychosocial needs of the client
- ensure all preoperative consultations are complete and communicate mobility/sensory deficits to the team
psychosocial assessment of factors that can influence surgery
- excessive stress
- age, past experience, current health, socioeconomic status
- communication is key for lowering stress
- identify stressors
what can anxiety do, what interventions can we do
- can impair cognition, deicison-making, and coping abilities
- can arise from lack of knowledge, unrealistic expectations, conflict interventions and religious/cultural beliefs
interventions:
- provide info and clarify misconceptions
- identify beliefs and discuss with surgeon and operative staff
what can fears be for the patient
- death/disability
- pain
- mutilation/alteration in body image
- anesthesia
- disruption of life functioning
what should you look for in their health history
- diagnosed medical conditions
- previous surgeries and problems
- familial diseases
- reactions/problems to anesthesia
- menstrual/obstetric history
malignant hyperthermia**
- inherited genetic mutation
- exposure to volatile anesthetic agents
- sympt: muscle rigidity, hyperthermia, tachycardia
- treatment: dantrolene, rapid cooling, oxygen, supportive care, fluids
which allergies should an RN be aware of in preop
- drug and non-drug
- latex allergy: screen for risk factors
- history of reactions suggesting latex allergy
what is the CVS considerations b4 surgery that should be documented
- baseline VS recorded
- lab reports
- ECG, cardiac ultrasound
- use of cardiac drugs, presence of pacemaker
What should be considered from the respiratory system in preop
- history of dyspnea, coughing, or sputum
- history of smoking; should be advised to quit 6 weeks before
- COPD/asthma: must know if they have had their inhalers
- obstructive sleep apnea
- COVID screening
What should be considered from the nervous system in preop
- cognitive function (assess for any deficits b4 surgery)
- risk for delirium (major surgery, dehydration, etc)
What should be considered from the urinary system in preop
- history of urinary or renal disease
- renal function tests (Cr and BUN)
- report problems voiding
- renal dysfunction can contribute to: electrolyte/fluid imbalance, increased risk for infection, impaired wound healing, etc
What should be considered from the hepatic system in preop
- consider presence of liver disease if there is a history of: jaundice, hepatitis, alcohol abuse, cirrhosis
What should be considered from the integumentary system in preop
- history of pressure ulcers
- poor wound healing (are they diabetic?
- recognizing potential mobility restrictions postoperatively
What should be considered from the musculoskeletal system in preop
- identify any MSK issues: arthritis, chronic back pain
- mobility restrictions may affect intraoperative positioning and postoperative ambulation
- bring mobility aids to surgery
- report problems affecting neck or spine
What should be considered from the endocrine system in preop
- diabetes
- risk for hyper/hypoglycemia/ketosis
- CVS alterations
- delayed wound healing and infection
- baseline capillary blood glucose preop
- clarify if usual dose of insulin should be given - thyroid dysfunction
- hyper/hypothyroidism are surgical risks due to elevated metabolic rate
What should be considered from the immune system in preop
- pt’s w a history of compromised immune sys or use of immunosuppressive drugs can have:
1. delayed wound healing
2. increased risk for infection
What should be considered from the fluid/electrolyte imbalance in preop
- vomiting, diarrhea, or difficulty swallowing
- identify drugs that alter status (diuretics)
- evaluate serum electrolyte levels
- NPO status (additional fluid/electrolytes prior to surgery if dehydration occurs
What should be considered from the nutritional status/GI system in preop
- underweight (provide extra padding to prevent pressure ulcers)
- obesity (increased risk for cardiac and pulmonary complications)
- GI sys
what are some elective surgery preoperative teaching
teaching occurs in pre-admission clinic, same-day admission unit and inpatient unit
what are some emergency surgery preoperative teaching
- teaching occurs in ER or inpatient unit if there is time
- emphasis on teaching w family
what are some if limited time preoperative teaching
- address needs of highest priority
- include information focused on safety
- provide written material
what is preop teaching
- patient has right to know what to expect and how to participate
- make sure you know pt literacy level (so they can understand what you are saying)
- documented and reported to postoperative nurses
- basic information before arrival on surgical date
- postoperative expectations
legal preparation for surgery
(what are the 4 things we have to have signed)
- all required forms are signed and in the chart
1. informed consent
2. blood transfusions
3. advanced directives
4. power of attorney
what is consent
- legally appointed representative of family may consent if client is: a minor, unconscious, mentally incompetent
preoperative fasting recommendations
- clear liquids: 2 hrs
- breast milk: 4 hrs
- nonhuman milk and formula: 6 hrs
- light meal: 6 hrs
regular or heavy meal: 8 hrs
day of surgery prep
(what should be taken off, what should be done, etc)
- client not wearing any cosmetics
- valuables locked up or returned to family
- dentures/contacts/jewlery and prosthetics removed
- identification on wrist
- allergies confirmed and identified in chart
- void before surgery
7 preoperative medications
- benzodiazepines and barbiturates (sedative and amnestic properties/reduce anxiety)
- anticholinergics (to reduce secretions)
- narcotics (decrease intraoperative anesthetic requirements and pain)
- antiemetics (decrease postoperative nausea and vomiting)
- antibiotics
- routine prescription drugs
- tylenol
who completes the pre-op checklist?
- completed by unit nurse/SDAC nurse (1 column) and or nurse (1 column)
- completed for all surgerys
- completed for invasive procedures
what should be checked/completed in the preoperative checklist components
- ID band matches chart and addressograph
- allergies on chart
- weight and height
- NPO for solids and liquids
- VS and glucometer
- mental status
- preop meds and on call meds
- removal of hearing aids, glasses, dentures, jewelry, prostheses
- chart orders complete
- location of relatives/escorts/corrections officers
age-related considerations
- greater risks associated w general anesthesia
- greater risk for post op complications
- an event that has little effect on a younger patient may be overwhelming to the older adult
what should be done/completed for pre-printed orders before surgery
- orders to match recommendations outlined as “best practice”
- surgeon must choose from certain options and choose med doses based on best practice
- includes space for patient-specific orders and free text
what is the #1 part of nursing assessment in preop
establish baseline also informed consent!
what are the function tests for liver
- liver function tests: ALT, ALP, AST, Bilirubin
what are the renal function tests
- renal function tests (Cr and BUN)
what’s the. #1 pre-op consideration for integ sys
pressure injuries!
who gets the consent for surgery
the SURGEON
when the pt is unconscious or mentally incompetent who consents to the surgery
legally appointed power of attorney/family member
