Preoperative Review of Systems

Question 1

Nervous System

Answer 1

Cognitive function how would you assess this? A+Ox3/4
Hearing and vision should also be assessed why? so the patient can understand the surgery and details you’re given

Question 2

Cardiovascular

Answer 2

A well functioning cardiovascular system is needed to meet the oxygen, fluid and nutritional needs of the perioperative period
Assess cardiovascular function with HR, BP, pulse, ECG, cap refill, edema, stress test
If uncontrolled BP, surgery may be postponed
Coagulation/INR/Medications

Question 3

Respiratory

Answer 3

The goal is optimal respiratory status
assess lung sounds, resp rate, O2 sats, ABGs
Teach DB & C exercises, incentive spirometers
Surgery postponed when the patient has a respiratory infection
Smokers:
- urged to stop 6 weeks before surgery
- at the very least, 24 hours before surgery
Inquire about recent airway infections
- procedure could be cancelled because of increased risk

Question 4

What increases the risk of respiratory complications

Answer 4

History of dyspnea, coughing, or hemoptysis reported to operative team
COPD or asthma
- high risk for bronchospasm, larygnospasm, hypoxemia, atelectasis

Question 5

Hepatic/Renal Function

Answer 5

Optimal functioning ensures medications, anesthetics, body wastes and toxins are adequately processed and removed from the body
How would you assess renal and hepatic function (lab work, urine output)
Remember where are most drugs metabolized and secreted? liver metabolizes and kidneys secrete, bot going to metabolize or excrete the anesthetic as quickly. toxicity is a concern. gentamcin is hepatotoxic and renal toxic

Question 6

Renal

Answer 6

Renal function tests
Voiding especially in males because inability to void can be due to enlarged prostate which can make urinating difficult
history of urinary or renal diseases
note problems voiding and inform operative team

Question 7

Integumentary

Answer 7

All skin abnormalities or dermatological conditions should be noted
- history of pressure ulcers
Extra padding during procedure
Affects postoperative healing

Question 8

Musculoskeletal

Answer 8

Mobility
Mobility restrictions may affect positioning and ambulation
Bring mobility aids to surgery
Report problems affecting neck or lumbar spine (can affect airway management and anesthesia delivery)
spinal anesthesia can be difficult if the patient cannot flex their lumbar spine because they need to be able to sit up and bend over forward to get a spinal

Question 9

Endocrine what is the patient with diabetes at risk for? (6)

Answer 9

cardiovascular issues
hyperglycemia (bigger response, stress response)
hypoglycemia
ketosis
infection
delayed wound healing

Question 10

Insulin and Surgery

Answer 10

Blood Glucose levels should be stabilized 12-16 hours before surgery
It is important to clarify with the surgeon the dose of insulin before surgery
Capillary blood glucose tests should be taken throughout the surgery and managed if necessary

Question 11

Endocrine (thyroid)

Answer 11

Hyper and hypothyroidism alter the metabolic rate possibly putting the patient at risk
Lab tests should be done and the nurse must check if the thyroid medication is to be given

Question 12

Immune Function

Answer 12

Determine existence of allergies, especially to medications
Have they reacted to blood transfusions? Latex? Food products?
Are they immunosuppressed?
What is their temperature?
Impairment of the immune system can increase the risk of infection

Question 13

Fluid/Nutritional/Electrolyte Status

Answer 13

Fluid and electrolyte status:
- vomiting, diarrhea, or difficulty swallowing can cause imbalance
- most patients are NPO before surgery
- Identify drugs that alter status (Diuretics)
Why is good nutritional status important to surgical outcomes?

Question 14

Lab and Diagnostic Testing

Answer 14

what different lab or diagnostic tests do you think may be performed before a patient has surgery?
- CBC, Cross and match, electrolytes, INR, CRP
- Ensure all tests are done and in the chart

Question 15

Preop Medications (8)

Answer 15

1. Benzodiazepines (anxiety)
2. Anticholinergics (dries up resp and oral secretion)
3. Opioids (pain and decrease amount of anesthetic needed)
4. Antiemetics (nausea and vomiting)
5. Antacids (decreased gastric secretions)
6. Antibiotics (prophylaxis of infection)
7. Eye drops (specifically for eye surgery)
8. Usual meds

Question 16

Preoperative Teaching

Answer 16

• Teach each patient as an individual
• Use multiple strategies (verbal, written, audio/visual)
• Should be started ASAP
• When and what to teach?
  Ideally spaced over time and allowing for questions
  Be aware of patient’s anxiety level
  Include the sensations patient will feel
  Teach what to expect, when they can see family, how long it will take, meds they need to consider, d/c NSAIDS 48-72 hours before surgery

Question 17

Special Considerations: The older adult

Answer 17

Often have a combination of chronic illnesses and other health problems
The aged patient has less ability of an organ to return to normal after a disturbance in its equilibrium

Question 18

The older adult

Answer 18

Many surgical patients are over 65 years of age and have challenges related to age
Age-related changes to hepatic and renal function alter clearance of anesthetic agents and opioids
Greater risk of adverse reactions to pre-op meds
Co-morbidities (chronic disease processes; poly-pharmacy, multiple medications). (diabetes, heart disease)

Question 19

General pre-operative Nursing Interventions

Answer 19

Managing nutrition and fluids
- what is NPO (nothing by mouth)
- Different procedures have different requirements
- MAKE SURE you know what is required for your client before their surgery!!!
- A clear liquid diet is usually initiated by midnight before surgery
- Make sure NPO is indicated on your pts door and in their chart and that they and their families are aware of this

Question 20

Immediate Preoperative Nursing Interventions

Answer 20

hospital gowns, braid hair, remove hair pins, inspect mouth and remove dentures/plates, remove jewelry, articles of value given to family, voiding prior to surgery, catheterize if indicated. Make sure nail polish is removed.