Preoperative Nursing Flashcards
What is the focus of the preoperative phase?
-Nursing and anesthesia provider assessment -Planning of care -Interventions to prepare for surgical procedure
Reasons why patients have surgery
- Diagnosis
- Cure
- Palliation
- Prevention
- Exploration
- Cosmetic improvement
What are the different types of surgery?
Ambulatory
Same day admit
Inpatient
What is an ambulatory surgery?
comes in, has surgery and goes home on the same day
What is a same day admit surgery?
comes in for surgery, post-op admit
What is an inpatient surgery?
admitted to
hospital, has surgery,
stays post-op
How urgent is an elective surgery? What are the risks?
•Improve quality of life (physically or psychologically) • Cataract removal; breast reduction • Time is not of the essence in scheduling •General risks include: • Bleeding • Infection • Anesthetic exposure • Relatively low mortality/morbidity risk
How urgent is a semi-elective surgery? What are some examples?
• More time-sensitive than elective • Although not required within 24 hours, scheduling should be considered a priority • Cholecystectomy for gallstone removal • Uterine artery ablation for postmenopausal bleeding from fibroids
What is an urgent surgery? Give examples?
Surgery is required within 24 hours of diagnosis; done to prevent unnecessary
complications that can occur with waiting
• Hip fracture repair
• Appendectomy
What is an emergency surgery?
Cannot be delayed and must occur within 24 hours; ideally, scheduled within 2 hrs. • Any delay may promote critical injury or systemic deterioration; required as a result of an urgent medical condition • Stabilize a GI bleed • Subdural hematoma
When is the patient interview/History taken?
•Occurs in advance or on
day of surgery
Check documented information prior to interview to avoid annoying
repetition
What is the purpose of an interview/history?
• Obtain health information • Determine expectations • Provide and clarify information on procedure • Assess emotional state and readiness
10 Essential parts to a patient interview/history
- patient understanding of surgery
- surgical history
- patient and family health history
- review ALL meds
- review allergies
- review drug use
- tobacco use
- date of Last menstrual
period for females
What are risks for latex allergies?
Food allergies (kiwi, bananas, avocados, chestnuts)
Allergy to poinsettia plant
Daily exposure to latex
Hx reactions to latex (balloons, condoms)
Hx allergies or asthma
How do you end a patient interview/history?
“Is there anything else
you would like to share
with me or think I should
know?”
What is a review of systems?
An inventory of body systems obtained through a series of questions seeking to identify signs and/or
symptoms that confirm the presence vs absence of
any disease
ROS assessing for pulmonary problems
Atelectasis
Infection
Prolonged mechanical
ventilation
Respiratory failure
Bronchospasm
Exacerbation of underlying chronic lung
diseaseROS assessing for cardiac problems
Due to increase myocardial oxygen demands
ROS assessing for neurological problems
Hearing, vision, cognition (baseline?)
ROS assessing for GU problems
Renal function; pregnancy
ROS assessing for hepatic problems
Clotting, metabolism issues
ROS assessing for integumentary problems
Rashes, pressure ulcers
ROS assessing for musculoskeletal problems
Mobility restrictions (intra- and postop)
ROS assessing for endocrine problems
Diabetes, thyroid problems
ROS assessing for immune system problems
Steroid therapy
ROS assessing for fluid electrolyte problems
N/V/D; narrow margin of fluid safety with older
patients
ROS assessing for nutritional problems
Obesity vs. malnourishment
Objective data that must be in the chart before surgery?
Physical Exam:
The Joint Commission requires all patients
admitted to the OR have both a history &
physical exam (“H&P”) in their chart
Diagnostic Studies:
• Per provider order, patient-dependent
• Make sure results are in chart
What information will we share with the patient to prepare them for the experience of surgery?
Sensory information
• Noise, lights, temperature
• Procedural information
• What it will look like to get ready for surgery
• Process information (about general flow of surgery)
How will you care for the patients family during surgery?
Explain the rules for caregivers and show them where they can wait
Who is responsible for getting informed consent?
the surgeon
Legally what information must the surgeon disclose about the surgery?
- Diagnosis • Purpose of surgery • Risks of surgery • Alternative treatments and risk • Risks of not treating • Who will be conducting procedure • Short- and long-term costs: • Short term: pain, length of stay, recovery time • Long term: loss of function, restriction of activity
What is the nurses role in informed consent?
- Witness the patient’s
signature - Act as patient advocate
In a true medical emergency can consent be overridden?
yes
If a patient is a minor, unconscious, or is
mentally incompetent to sign consent can someone sign it for them?
yes, by a legally appointed
representative or responsible family member.
Can emancipated minors sign their own consent?
yes
