Pre-op care Flashcards
Preoperative
period of time from when the decision for surgical intervention is made to when the pt is transferred to OR
Intraoperative
period of time from when the pt is transferred to the OR or when pt is admitted to PACU
PACU
Post-Anesthesia Care Unit
Post operative
period of time that begins with the admission of the pt to the PACU and ends after follow up evaluation in the clinical setting/home
Perioperative
Period of time that constitutes the surgical experience (all levels)
Types of surgery
Emergency (STAT)
Urgent (Within 24 hours)
Elective (planned)
Purposes of surgery
Diagnostic
Curative
Preventative
Exploratory
Cosmetic
Informed Consent
- ACTIVE PROCESS
- 3 elements (voluntary, mental capacity, properly informed)
What is the nurses role in informed consent?
Ensure all info is known by pt
Notify physician if pt has more questions or unclear
What is the surgeon’s role in informed conset?
tx/procedure
professionals involved
anesthesia risks
benefits
potential harm
options
right to refuse
What does the nurse have to do before the premedication is given?
Make sure informed consent has been signed
Assessment pre-op
hx
physical assessment
baseline VS
tests are completed
What are the goals of pre-op care?
Physical status changes
psychological status
baseline data
review meds
tests are completed
consent
pt support
discharge plan
Latex allergies often…
hx of contact dermatitis or atopic immunological rxns
allergies to fruits, nuts, avocados, figs, chestnuts, papayas
repeated exposure to latex
What is included in a health hx?
Diagnosed medical conditions
Current health issues
health hx (family, woman, malignant hyperthermia)
Does pt understand reason for surgery
What is involved in a psychological assessment?
Stress often influences body functioning –> address fears, anxiety, concerns about loss, previous hospital experiences
determine social network
be empathetic and provide info prn
notify anesthesiologist if fear is extreme
What are the 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 and pain
How are fears expressed?
asking a lot of questions, withdrawing, reading, trivial talk
Previous med use
document ALL meds (OTC, herbal)
What does aspirin cause?
Bleeding
What does garlic and ginger do?
interfere with coagulation
When does warfarin and aspirin need to be discontinued
5-7 days before surgery
What to remember with med use
some meds are given and not depending on doctors orders the day of surgery, talk to doctor
What to remember with drug and alcohol use
Surgery is postponed if pt is acutely intoxicated
hx of alcoholism is often accompanied by malnutrition and delirium trenems
alcohol use affects liver function affecting metabolism making drugs last longer
What is delirium trenems
confusion, irregular HR and shaking
What does smoking do for the surgical pt?
complicates anesthesia (makes heart work harder, wounds take longer to heal)
Nervous system assessment
A + O x 3 (cognitive function)
Hearing and vision
Cardiovascular assessment
Auscultate, BP, HR, pulse (if BP is uncontrolled, surgery may be held)
ECG, coagulation/INR/meds
Respiratory assessment
RR, O2, sat, ABG
DB and C exercises, incentive spirometry
inquire about recent airway infections
hx of dyspnea, cough, hemoptysis told to OR team
smoker?
COPD or asthma? - high risk of bronchospasm, laryngospasm, hypoxemia and atelectasis
surgery is postponed if pt has resp infection
When do smokers have to stop smoking before surgery?
6 weeks before surgery or at least 24 hours
Hepatic/Renal function
optimal functioning ensures meds, anesthetics, body wastes and toxins are processed and removed from body
LFT<BUN, creatinine
Renal assessment
Function tests
voiding b/c males inability to void can be due to enlarged prostate which can make catheterization difficult
hx of urinary and renal diseases
note problems voiding and inform OR
Integumentary assessment
all abnormalities noted
hx of pressure ulcers = extra padding, affects postop healing
Musculoskeletal assessment
mobility
bring mobility aids to surgery
report problems affecting neck or lumbar spine (can effect airway management and anesthesia delivery
spinal anesthesia may be difficult if pt can not flex lumbar spin (need to bend when administering)
Endocrine assessment
pt with diabetes are at risk for:
- hypoglycemia
- hyperglycemia (high stress)
- ketosis
- Cardiovascular issues
- delayed wound healing
- infection
Insulin and Surgery
blood sugar should be stabilized 12-16 hours before surgery
clarify with surgeon insulin dose before surgery
capillary blood glucose should be take throughout surgery
What does hyper and hypothyroidism affect the pt?
alter metabolitic rate
lab tests need to be done and nurse should find out if thyroid meds are to be given
Immune function
allergies?
has the pt reacted to blood transfusion before? Latex?
is the pt immunocompromised?
what is the pts temp? (if too high, surgery is postponed)
What causes surgery to be postponed?
High temp
Uncontroled BP
Smoking, alcohol and drug intoxication/use
Uncontrolled BG
Resp infection
Fluid and electrolyte status assessment
V + D or difficulty swallowing can cause imbalance
most pts are NPO before surgery
Diuretics!!! –> get rid of K –> look at lab tests
good nutritional status = good wound healing
Lab and diagnostics
taken before surgery (CBC, INR, WBCs, platelets)
make sure all are done and in chart
Pre-op meds
Benzos (reduce anxiety)
Anticholinergics (reduce secretions)
Opioids (pain)
Antiemetics (nausea)
Antacids (prophylactic)
Eye drops (eye surgery)
Usual meds
Preop teaching
teach as individual
use multiple strategies
should be started ASAP
leave room for questions
be aware of anxiety
include sensations the pt will feel
teaching = decreased stress
Older Adult considerations
Combination of chronic illnesses
decreased ability for organ to return to normal after a disturbance
most pt >65 have challenges
altered affects of opiods and anesthesia
increased risk of adverse rxns to meds
comorbidities (chronic disease, polypharm)
Pre-op interventions for nurses
management of nutrition and fluids (NPO?, clear liquid diet - usually by midnight before surgery)
Make sure pt:
- hospital gown
- braid hair, remove pins
- remove jewelery
- inspect mouth, remove dentures
- void prior to surgery, cath?
- nailpolish removed
