Preoperative Care Flashcards
Preoperative
period of time from when the decision for surgical intervention is made to when the patient is transferred to the operative room table
Intraoperative
Period of time from when the patient is transferred to the operating room table or when he/she is admitted to the PACU
Postoperative
period of time that begins with the admission of the patient to the PACU and ends after the follow-up evaluation in the clinical setting or home
Perioperative
Period of time that constitutes the surgical experience; includes the preoperative, intraoperative, and postoperative phases of nursing care
Types of Surgery (3)
Emergency
Urgent (within 24 hours)
Elective (planned)
Purposes of Surgery (6)
Diagnostic
Cure or repair
Palliative
Exploration
Prevention
Cosmetic improvement
Informed Consent
Informed surgical consent is an active process between the surgeon and the patient that allows the patient to assess information and make an informed decision
ENSURE that informed consent has been signed before administering psychoactive premedication b/c pt not able to give mentally sound consent
In all provinces and territories except Quebec there is no chronological age of consent it is determined by level of maturity. children and youth are allowed to consent if they fully comprehend the consequences of their decisions
If the patient is unconscious, or incompetent permission must be obtained from a responsible family member
FOLLOW THE AGENCY POLICY
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
According to the Canadian Medical Protective Association for consent to be considered valid it must have the 3 following elements:
- Mental capacity
- Voluntary
- Properly Informed
Responsibilities of the provider (surgeon) in informed consent include:
Description of the treatment/procedure
The professionals who will be performing the treatment
Risk of anesthesia
Description of the benefits of the treatment/procedure
Description of the potential harm, pain, and/or dis-comfort that can occur
Options of other treatment
The right to refuse treatment
Nursing responsibilities in informed consent:
witness informed consent by doing the following:
- ensure that the provider gave the patient the necessary information
- ensure that the patient is competent and understood the information
- notify the provider if the patient has more questions or appears to not understand the information
Assessment
Before any surgical treatment begins, a history and physical exam are performed. BASELINE vitals are obtained, databases established, indicated tests are completed. These preliminary contacts with the health care team provide the patient with opportunities to ask questions.
Nursing Assessment of the Client Before Surgery (9) Overall goals
confirm and identify changes to physical status
determine psychological status
establish baseline data
review medications
ensure preoperative lab and diagnostic tests are completed and documented
support the client and family
determined informed decision to have surgery
understand discharge plan
Allergies (drug and non drug)
Pts that report the following are at a high risk for a latex allergy (3)
Hx of contact dermatitis or atopic immunological reactions
Allergies to fruits, nuts, bananas, avocados, figs, chestnuts, papayas
Repeated exposure to latex
Health History: What is important to know?
- Diagnosed medical conditions
- Current Health issues
- Health history
- family health history, e.g., heart, diabetes
- woman - menstrual and obstetrical history
- malignant hyperthermia - Does patient understand the reason for surgery?
Psychosocial Assessment
Stress directly influences body functioning
Address anxiety and fears, concerns and “loss” (job, burdens, responsibilities), and previous hospital experiences (positive and/or negative)
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 and Surgery
- Fear is expressed several ways; asking a lot of questions, withdrawing, reading, trivial talk
- Determine the patient’s support networks
- Be empathetic, listen well and provide infor prn to help alleviate concerns
- if the fear appears to be extreme, the nurse should notify the anesthesiologist
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. Jehovah’s Witness/blood transfusions -DOCUMENT)
Psychological Interventions
Reducing Anxiety
Decreasing fear
- encourage useful coping strategies
- inform pts where family will be
- offer a spiritual advisor
Previous Medication Use
- Document all medications used. include OTC and herbal agents
- Be especially concerned with aspirin
- Some herbal agents interfere with coagulation
- some medications like warfarin and aspirin need to be discontinued as many as 5 to 7 days prior to surgery
- Certain medications are given the day of surgery, certain ones are not, make sure you consult with the Dr. on this and you know which ones to withhold and which ones to give!
Which herbal agents interfere with coagulation?
Garlic and ginger
how long before surgery should warfarin and aspirin be d/c
5-7 days
Drug/Alcohol Use
The nurse who is obtaining the patient’s history needs to ask frank questions with patience, care and non-judgemental attitude. Keep in mind - people who abuse drugs or alcohol frequently deny it
- surgery is postponed if the patient is acutely intoxicated
- a history of alcoholism is often accompanies by malnutrition and be concerned with delirium tremens (happens when you withdraw from alcohol)
How does alcohol affect drug metabolism
alcohol use affects liver function which affects the metabolism of drugs making it last longer in the system
Smoking and Surgery
Quitting smoking before surgery is recommended because smoking complicates anesthesia
Makes the heart work harder
Wounds take longer to heal
