Preoperative Patient

K. Reese

1/11/00

Read pages 929 – 958 in Clinical nursing skills (SMITH & DUELL)

The science of treating diseases, injuries and deformities by operation and instrumentation.

Diagnosis, palliation, cosmetic, prevention, exploration

Hospital OR and emergency rooms, outpatient OR’s (free standing surgical clinics), MD’s offices

Care for post-op same day surgery falls to patients and nurses.

PSYCHOLOGICAL REACTIONS Practice good pain management

• FEAR OF PAIN AND DISCOMFORT
• FEAR OF THE UNKNOWN
• FEAR OF MUTILATION
• FEAR OF DEATH
• FEAR OF ANESTHESIA
• FEAR OF DISRUPTION OF LIFE PATTERNS

• Obtain patient information
• Provide information about surgery and anesthesia
• Get patient’s consent for surgery
• Assess patient’s emotional and readiness for procedure
• Explore patient’s expectations, answer questions
• Provides baseline data

Cardiovascular

Respiratory status

Integumentary and musculosketal status

Nutritional status

Situational changes

Concerns with the unknown

Concerns with body image

Past experiences

Knowledge deficit

UA – catheterize patient you don’t want to introduce more bacteria or move bacteria upward towards bladder – r/o pre-existing infection

CXR – r/o pneumonia or an obstruction, verify all is clear

CHEM 7 (Cr, Glucose, CO2, K+, CL, BUN, Na) -electrolyte status, kidney function.

CBC – platelets count, Hematocrit, WBC, r/o systemic infection, anemia

Type and screen – in case of needs for blood

PTT, PT w/ INR – r/o bleeding disorders or potentials

ABG’s – r/o pulmonary problems, look at oxygenation saturation.

LFT’s – determine how liver is doing

BHcG – r/o or confirm pregnancy

ECG- r/o past MI, or any other heart arrhythmia’s or potential problems

• relieve apprehension and anxiety
• promote sedation and amnesia
• provide analgesia
• facilitate induction of anesthesia
• prevent nausea and vomiting
• prevent autonomic reflex response
• decrease anesthetic requirements
• decrease respiratory and GI secretions

Benzodiazepines = reduces anxiety, induce sedation and induce amnesia

Narcotics = relieve discomfort during preop procedures

Antacids = increase gastric pH

Antiemetics = increase gastric emptying, decrease nausea and vomiting

Anticholinergics = decrease oral and respiratory secretions, prevent bradycardia

• must verify the nature of the disorder requiring surgery and any co-existing diseases
• must know the individuals patient’s response to a stressful response
• must assess the results of appropriate diagnostic tests done preoperatively
• must consider the bodily alterations and risks of complications.

• Done close to time of surgery
• Includes any special procedures needed to be completed before surgery
• Instruct in fluid and food restriction
• Obtain legal consent

Prep – GO LIGHTLY can get an MD order for using an NG tube.

• Done prior to surgery (at least 12 hours)
• Do not tell patient what is going to happen, that is MD’s job
• Ask patient (watch the way you word it) Do you have any questions regarding the surgery ______________? If it is beyond your scope of practice get the MD.
• IT IS NOT OUR ROLE TO INFORM THE PATIENT OF CONSENT FOR SURGERY!!!!!!

LAST THOUGHTS

Reinforce pulmonary toilet

TCDB and incentive spirometer

Use splinting technique for postoperative cough, teach preoperatively

Leg exercises – eliminate DVT (clots)

• determine the adequacy of the patient’s heath
• identify and correct any operative risk factors
• determine the appropriate site for surgery
• Establish a baseline data – so if anything happens you have something to compare to or question.
• Plan and institute pre operative care

************************HOMEWORK ******************

Major complication

Answer these: Postop to discharge

What is the assessment for?

Nursing diagnosis’s

Implementation

How do we try to keep them from developing these problems?

Respiratory

Heart

Neurological

GI

Physiologically

GI -