Pre-op Care Flashcards
What is surgery? Why is it performed? (6)
Surgery: art & science of treating diseases, injuries, and deformities by operation and instrumentation
Performed for:
- Diagnosis (determine extent of cancer)
- Cure or repair (remove tumor or fix fracture)
- Palliation (alleviate symptoms but not a cure)
- Prevention (history of breast cancer so mastectomy)
- Exploration (exploratory laparotomy)
- Cosmetic Improvement (plastic surgery)
What are the various surgical settings?
Emergency vs. Elective Surgery
Inpatient
- Requires overnight stay
- Same-day admission
Ambulatory (Outpatient)
- Requires some monitoring in the post-anesthetic care unit (PACU)
What is the purpose of a pre-op nursing assessment? (9)
- Decrease surgical delays
- Reduce patient anxiety
- Educate and allow questions from patient and family
- Help patients and families know what to expect
- Obtain health information
- Determine expectations
- Provide and clarify information on procedure
- Assess emotional state and readiness
- Begin some postoperative teaching
When does the pre-op assessment occur? (2)
- In advance (pre-admission clinic or inpatient unit)
- Or, on the day of surgery (same-day admission unit, ER)
What are the nursing assessment goals? (9)
1) Determine psychological status to reinforce coping strategies
2) Establish baseline data
3) Identify medications and herbs taken that may affect surgical outcome
4) Ensure patient understands the D/C plan and has postoperative support
5) Identify, document, and communicate results of laboratory/diagnostic tests
6) Identify cultural and ethnic factors that may affect surgical experience
7) Determine receipt of adequate information from surgeon in order to sign informed consent
8) Identify any psychosocial needs of the client
9) Ensure all preoperative consultations are complete and communicate mobility/sensory deficits to the team
Why is the psychological assessment done?
Used to identify stressors.
Excessive stress response can affect surgery (e.g. pain control, blood sugar).
What are the influencing factors that may impact a pt’s experience during surgery that may be identified pre-op? (4)
- Age
- Past experience
- Current health
- Socioeconomic status
What can pt anxiety result in? Why may it arise? As a nurse, what can you do to help?
It can impair cognition, decision-making, and coping abilities
It may arise from lack of knowledge, unrealistic expectations, conflict with interventions (e.g. blood transfusions) and religious/cultural beliefs
As a nurse, you can provide information & clarify misconceptions, and identify beliefs and discuss with surgeon and operative staff
What might a pt fear about surgery?
Death/Disability
Pain
Mutilation/alteration in body image
Anesthesia
- Consult with anesthesiologist
Disruption of life functioning
- Range from temporary to permanent disability
- Include family and financial concerns
- Consultations (e.g. Social Worker or Spiritual Care)
What does the health history include? (6)
Diagnosed medical conditions
Previous surgeries and problems
Familial diseases
Conditions
Reactions/problems to anesthesia (patient or family – malignant hyperthermia)
Menstrual/obstetric history
- Is there a possibility the patient is pregnant (e.g. fetal exposure to anesthetic)
What is some other information a nurse should collect during their assessment?
Current medications
- Prescription & OTC
- Herbs
- Vitamins
- Recreational Drugs
- Alcohol
- Tobacco
Potential interactions with anesthetics
Potential complications following surgery
What kind of allergies should you assess for?
Drug & non-drug
Latex allergy: screen for risk factors
- Long-term exposure to latex products
- History of asthma & hay fever
- Food allergies: avocadoes, kiwi, bananas, peaches, apricots, potatoes
- Contact dermatitis
- Contact urticaria e.g. hives
- Aerosol reactions
History of reactions suggesting latex allergy
- Rash, itchy or swollen eyes, running nose or sneezing
- Wheezing, chest tightness, coughing or shortness of breath
During the CVS assessment, what are you testing/assessing?
Baseline VS recorded
Lab Reports
- CBC, electrolytes
- Bleeding/clotting times (PT/INR, PTT)
- BNP. (B-type natriuretic peptide)
ECG, Cardiac Ultrasound
Report
- Use of cardiac drugs
- Presence of pacemaker/MI
During the respiratory assessment, what are you testing/assessing?
History of dyspnea, coughing or sputum
- Recent airway infections; procedure may be cancelled due to increase risk of respiratory complications
History of smoking; should be advised to quit 6 weeks before to decrease the risk of intraoperative and postoperative complications
- Higher pack years; greater risk
COPD/Asthma
- At risk for bronchospasm, laryngospasm, hypoxemia and atelectasis
- Must know if they have had their inhalers (e.g. bronchodilators/corticosteroids)
Obstructive Sleep Apnea
During the nervous system assessment, what are you testing/assessing?
Cognitive function
- Assess for any deficits before surgery (e.g. answering questions, following commands, motor movement)
- Vision or hearing loss is documented
- If impaired cognition is present, make sure there are appropriate resources to support/assist client postoperatively.
Risk for delirium
- Major surgery
- Dehydration, hypothermia, malnutrition, urinary catheters, medications, changes in environment
During the urinary system assessment, what are you testing/assessing?
History of urinary or renal disease
Renal function tests (Cr & BUN)
Report problems voiding
Renal dysfunction can contribute to:
- Fluid and electrolyte imbalance
- Increased risk for infection
- Coagulopathies
- Impaired wound healing
- Altered response to drugs and their elimination
