Pre-op care Flashcards
- Pre admissions units – Preop assessment & investigations – Final check and checklist – Preop meds, education, fasting & skin preparation – Postop and discharge preparation
What does a pre-op plan entail?
- Preoperative plan for the best patient outcomes
- Gather and record all relevant information
- Optimise patient condition
- Surgery should be considered to offer minimal risk and maximum benefit to the patient
- Adverse events need to be anticipated
- Inform everyone concerned in the perioperative experience for the patient
What is a pre admission and what does it add to pre-op care?
A pre-admission session involves answering a series of questions and tests to eliminate the possibility of allergic reactions, drug counteractions, or physical complications before, during, and after the surgical process. Blood tests also may be conducted for certain patients and surgical procedures.
It adds:
– Patient Assessment
– Patient Education
– Discuss post-operative care
– Fasting Instructions and specific preparation instructions
– Ensure all forms are completed
– Consent & documentation check
- Controlling co morbidities and evaluating medications
– Stabilising nutritional and hydration status
– Preparing the patient physically and psychologically
– Advise abstinence from smoking and support where
required
What does a pre-op assessment involve?
It involves a nursing history/interview, observations, physical examination
Which is through the medical and surgical history:
- family medical history
- medications
- social history
- airway considerations
- allergies
What are some pre-op investigations?
Investigations: - ECG (cardiac History) - Pathology - Imaging (chest Xray \+/- surgical requirement - Laboratory &/ or diagnostic testing
Describe some considerations that need to be remembers pre operatively.
- Language barriers (NESB - ?interpreter requirements)
– Cultural considerations (closed theatres, female/ male
only care)
– Religion (Jehovah’s Witness)
– Discharge requirements (?who will care for person on
discharge; how to get home)
List some education program types.
– Information session
– Information Pamphlets
– Videos
– Structured instruction: Web site programs
Explain the benefits to effective pre-op care.
Pts who are well prepared: – Understand more about the surgery they are about to have – Feel more in control of their actions – Experience less pain and anxiety postop – Better motivated for self care – Require less time in hospital – Have a shortened recuperative period
What things should the family be educated about pre-operatively?
- What to bring – Any changes (timing) – Fasting – Physical prep – Insertion of invasive instruments – Purpose of vital sign monitoring – Analgesia – Process – admission & traffic flow – For families – Where to wait & how notified once surgery finished
What should the patient be told before surgery (what to expect in the operating room and post op)?
– Noises (equipment; general thoroughfares;
general communication)
– Smells (cleaning agents; surgical plume)
– Brightness (OT lights)
– Temperature : it’s cold
Education should also include information about postoperative recovery. – Mobilisation – Nutrition – Pain Management – Deep breathing and coughing exercises – Leg exercises
Describe the skin prep procedure and the purpose.
The goal is to decrease bacteria-prevent surgical site infection
it involves:
- Preoperative shower with an antimicrobial solution
– Chlorhexidine Gluconate (CHG) 2% - 4%
– Povidine Iodine but shorter acting than CHG
and hair removal:
- Hair shouldn’t be removed unless it impedes surgery
– Use of clippers is the referred method- less skin abrasions
Fasting is necessary pre-operatively, what are the different procedures and guidelines for children, infants and adults?
Healthy children over six weeks of age
- limited solid food & formula milk up to 6 hours
- breast milk up to four hours
- clear fluids up to 2 hours prior
Healthy infants under six weeks of age
- formula or breast milk up to 4 hours
- clear fluids up to 2 hours prior
Healthy adults
- limited solid food up to 6 hours prior
- clear fluids totalling not more than 200 mls per hour up to 2
hours prior
– Only medications with a little water if required as ordered by
the anaesthetist should be taken less than two hours prior
What are some pre-operative medications?
– Benzodiazepines-reduce anxiety, induce sedation and
amnesia
– Opioids-relieve discomfort during preop procedures
– Histamine H2-receptor agonists-increase gastric ph,
decrease gastric volume
– Antacids-increase gastric pH
– Anticholinergics-decrease oral secretions, prevent
bradycardia
What information should be provided to the patient about discharge planning?
- How long will I be in hospital? – What should I expect during my recovery period? – How long will my recovery take? – Will there be any restriction on my activities after leaving hospital? – Will I need physiotherapy? Other factors: - support network - patient as a carer - shopping/ housekeeping
Describe what assessments are involved in admission to the clinical area?
– Pressure injury – Venous thromboembolism – Falls – Malnutrition screening – Baseline observations
What are some of the final pre-operative preparation for the patient?
- Makeup nail polish removed – Showered – Hospital gown – ID band x 2—allergy band if applicable – All jewellery to be removed or taped – Bladder emptied – Pre-medication given if applicable -Glasses, hearing aids, dentures to be removed reading glass case if required – Health record, valid consent form, observation chart, drug chart (pre-med) and completed pre-procedure handover – Old notes and Xrays
