Pre- & Intra-Operative Care Flashcards
-Prioritize responsibilities related to day-of-surgery preparation for the surgical patient.
* Identify the goals and categories of preoperative medications.
* Explain the objectives of informed consent for surgery.
* Examine and synthesize the nursing role in preparation for physical, psychological, and educational dimensions of surgical patients
Prioritize responsibilities related to day-of-surgery preparation for the surgical patient.
- consent
Informed surgical consent
-surgeon & patient
-pt can assess with information
Canadian Medical Protective Association valid consent means:
1. mental capacity
2. has to be voluntary
3. properly informed
contents of proper consent:
-tx/procedure
-who will be performing
-benefits/harms/pain/discomfort
-risk of anesthesia
-other options
-right to refuse
Nursing responsibility:
1.Witness informed consent which includes:
-right information
-competent to decide
-notify surgeon if pt has Q’s
- ENSURE that informed consent has been signed before administering psychoactive premedication.
when the pt cant give consent
If the patient is unconscious, or incompetent permission must be obtained from a responsible family member.
In an emergency, a surgeon may operate as a lifesaving measure without the patient’s consent. Every effort must be made to contact the patient’s family.
Prioritize responsibilities related to day-of-surgery preparation for the surgical patient.
- Assessment
health hx, family health hx, menstrual, obstetric, hx of Malignant hyperthermia reactions to meds used for anesthesia.
physical exam
psychological status
baseline VS, neuroVS, labs, diagnostic tests
medication hx
understand discharge plan
allgeries
if allergic = risk of latex allergy
- bananas, fruit, nuts, avocados, figs, chestnuts,
papayas,
also hx of contact dermatitis or atopic
immunological reactions, allergic to repeated
exposure to latex
psychological status exam
5 Most Common Fears:
Fear of death
Fear of pain and discomfort
Fear of mutilation or alteration in body image
Fear of anesthesia
Fear of disruption of life functioning or pattern
Fear is expressed several ways: asking a lot of questions, withdrawing, reading, trivial talk
N Responsibility:
-Determine the patient’s support network
-Be empathetic, listen well and provide info prn to help alleviate concerns
-If the fear appears to be extreme, the nurse should notify the anesthesiologist
-Reducing Anxiety
-Decrease fear
Encourage useful coping strategies
Inform pts where family will be
Offer a spiritual advisor
Spiritual/Cultural Beliefs
Before surgery health care providers must be aware of and support the cultural perceptions and beliefs of patients.
Spiritual beliefs are therapeutic and should be encouraged and supported. This builds rapport and trust
Respecting cultural, spiritual, and religious beliefs
= Recognize/be aware of different responses
i.e. Jehovah’s Witness/blood transfusions – DOCUMENT!
MEdication Hx
prescribed, herbal, OTC
because Ginger and garlic interfere with coagulation = increase INR when taking warfarin
ASA (aspirin) and warfarin need to be discontinued 5-7 days before sx
Drug/alcohol abuse
Alcohol use affects liver function which affects the _metabolism______ of drugs making it __prolonged effects
Sx is postponed if the patient is acutely intoxicated
Hx of alcoholism is often accompanied by malnutrition and be concerned with delirium tremens.
Smoking
quit smoking before sx because:
-Complicates Anesthesia
-slow wound healing
-makes heart work harder
Physical exam
COG
-Ax3
-Hearing + vision – so pt can understand and hear you
CVS
-VS, peripheral
-If uncontrolled blood pressure, surgery may be postponed
-Coagulation/INR/Medications
RESP
-Sx postponed when the patient has a respiratory infection
-Smokers:
Urged to stop 6 weeks before surgery
At the very least, 24 hours before surgery
-Inquire about recent airway infections
Procedure could be cancelled because of increasedrisk
-hx dyspnea, coughing, or hemoptysisreported to operative team
-COPD, asthma= High risk for bronchospasm, laryngospasm,hypoxemia, and atelectasis
Renal & Hepatic func:
-GFR, BUN, LFTs
-urine output
-hx liver/kidney disease because drugs are Metabolized- liver. Excreted- kidneys
-Note problems voiding and inform operativeteam
Integumentary:
-abnormal lesions
-hx pressure ulcers = more padding during sx
Musculoskeletal:
-Mobility, restrictions
-Bring mobility aids to surgery
-Report problems affecting neck or lumbar spine
= can affect airway management and anaesthesiadelivery
-Spinal anesthesia may be difficult if the patient cannot flex their lumbar spine
Endocrine:
-DM risks:
Poor wound healing
Infection
Hyperglycemia (more common, dt stress response and blood sugar spike)
Hypoglycemia
Ketosis
-Blood Glucose levels should be stabilized 12-16 hours before surgery.
-It is important to clarify with the surgeon the dose of insulin before surgery
-Capillary blood glucose tests should be taken throughout sx and managed if necessary.
-Hyper and Hypothyroidism alter the metabolic rate possibly putting the patient at risk.
-Higher metabolism = anesthetic lasts shorter
-take labs
-ask Doc if thyroid meds are given/held
Immune Function:
-allergies
-hx of reactions to blood, latex, anes ex malignant hyperthermia
-High temp = unlikely to go to surgery
Fluid/Nutritional/Electrolyte Status:
-Most patients are NPO before surgery
-Diuretics excrete K and Na too
-vomiting and diarrhea or difficulty swallowing can cause an imbalance
-goes along with poor nutrition
Poor nutrition= Delayed healing, increased infection
Lab and Diagnostic Testing:
-CBC, cross match for blood type, WBC
-INR, PT
-electrolytes
Preop Medications
Benzodiazepines - reduce anxiety
Anticholinergics - Dry up secretions
Opioids - Pain relief, reduce amount of anesth needed
Antiemetics - Decrease n/v
Antacids - Reduce gastric secretion prevent from going to lungs
Antibiotics - prophylactic infection control
Eye drops - Eye surgery
Usual meds - Do they need their usual meds or not- think hold anticoagulant
Preoperative Teaching
-procedure
-stop aspirin/warfarin 5-7 days, stop NSAIDS 42-78 hrs before surgery
-teaching Should be started ASAP
-Use multiple strategies (verbal, written, audio/visual)
-Ideally spaced over time and allowing for questions
-Be aware of pt anxiety level
-Include the sensations pt will feel
General pre-operative Nursing interventions
Managing nutrition and fluids
-MAKE SURE you know what is required for your client before their surgery!!!
-Different procedures have different requirements
-NPO: clear liquid diet is usually initiated by midnight before surgery
-Make sure NPO is indicated on your pts door and in their chart and that they and their families are aware of this!
Immediate Preoperative Nursing Interventions
Hospital gowns
braid hair, remove hair pins,
inspect mouth and remove dentures/plates,
remove jewelry, articles of value given to family, voiding prior to surgery, catheterize if indicated.
No nail polish as they affect O2 sats
