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Chapter 16Chapter 16

Care of Preoperative PatientsCare of Preoperative Patients

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Preoperative PeriodPreoperative Period

Begins when the patient is scheduled for Begins when the patient is scheduled for surgery and ends at the time of transfer to surgery and ends at the time of transfer to the surgical suite.the surgical suite.

Nurse functions as educator, advocate, Nurse functions as educator, advocate, and promoter of health and safety.and promoter of health and safety.

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Reason for SurgeryReason for Surgery

DiagnosticDiagnostic CurativeCurative RestorativeRestorative PalliativePalliative CosmeticCosmetic

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Urgency and Degree of Risk of Urgency and Degree of Risk of SurgerySurgery

Urgency:Urgency: ElectiveElective UrgentUrgent EmergentEmergent

Degree of Risk:Degree of Risk: MinorMinor MajorMajor

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Extent of SurgeryExtent of Surgery

SimpleSimple RadicalRadical Minimally invasiveMinimally invasive

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Collaborative Management Collaborative Management AssessmentAssessment

History and data collection:History and data collection: AgeAge Drugs and substance useDrugs and substance use Medical history, including cardiac and Medical history, including cardiac and

pulmonary historiespulmonary histories Previous surgical procedures and anesthesiaPrevious surgical procedures and anesthesia Blood donationsBlood donations Discharge planningDischarge planning

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Physical Assessment/Clinical Physical Assessment/Clinical ManifestationsManifestations

Obtain baseline vital signs.Obtain baseline vital signs. Focus on problem areas identified by the Focus on problem areas identified by the

patient’s history and on all body systems patient’s history and on all body systems affected by the surgical procedure.affected by the surgical procedure.

Report any abnormal assessment findings Report any abnormal assessment findings to the surgeon and to anesthesiology to the surgeon and to anesthesiology personnel.personnel.

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System AssessmentSystem Assessment

Cardiovascular systemCardiovascular system Respiratory systemRespiratory system Renal/urinary systemRenal/urinary system Neurologic systemNeurologic system Musculoskeletal systemMusculoskeletal system Nutritional statusNutritional status Psychosocial assessmentPsychosocial assessment

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Laboratory AssessmentLaboratory Assessment

UrinalysisUrinalysis Blood type and crossmatchBlood type and crossmatch Complete blood count or hemoglobin level Complete blood count or hemoglobin level

and hematocritand hematocrit Clotting studiesClotting studies Electrolyte levelsElectrolyte levels Serum creatinine levelSerum creatinine level Pregnancy testPregnancy test Chest x-ray examinationChest x-ray examination ElectrocardiogramElectrocardiogram

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Deficient Knowledge Deficient Knowledge InterventionsInterventions

Preoperative teaching.Preoperative teaching. Informed consent:Informed consent:

Surgeon is responsible for obtaining signed Surgeon is responsible for obtaining signed consent before sedation and/or surgery.consent before sedation and/or surgery.

The nurse’s role is to clarify facts presented by The nurse’s role is to clarify facts presented by the physician and dispel myths that the patient the physician and dispel myths that the patient or family may have about surgery.or family may have about surgery.

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Implementing Dietary Implementing Dietary RestrictionsRestrictions

NPO: Patient advised not to ingest NPO: Patient advised not to ingest anything by mouth for 6 to 8 hours before anything by mouth for 6 to 8 hours before surgery:surgery: Decreases the risk for aspiration.Decreases the risk for aspiration. Patients should be given written and oral Patients should be given written and oral

directions to stress adherence.directions to stress adherence. Surgery can be cancelled if not followed.Surgery can be cancelled if not followed.

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Administering Regularly Administering Regularly Scheduled MedicationsScheduled Medications

Medical physician and anesthesia provider Medical physician and anesthesia provider should be consulted for instructions about should be consulted for instructions about regularly taken prescriptions before regularly taken prescriptions before surgery.surgery.

Drugs for certain conditions often allowed Drugs for certain conditions often allowed with a sip of water before surgery:with a sip of water before surgery: Cardiac diseaseCardiac disease Respiratory diseaseRespiratory disease SeizuresSeizures HypertensionHypertension

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Intestinal PreparationIntestinal Preparation

Bowel or intestinal preparations performed Bowel or intestinal preparations performed to prevent injury to the colon and to reduce to prevent injury to the colon and to reduce the number of intestinal bacteria.the number of intestinal bacteria.

Enema or laxative may be ordered by the Enema or laxative may be ordered by the physician.physician.

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Skin PreparationSkin Preparation

A break in the skin increases risk for A break in the skin increases risk for infection.infection.

Patient may be asked to shower using Patient may be asked to shower using antiseptic solution.antiseptic solution.

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Skin Preparation for Common Skin Preparation for Common Surgical SitesSurgical Sites

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Patient and Family TeachingPatient and Family Teaching

TubesTubes DrainsDrains Vascular accessVascular access

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Prevention of Respiratory Prevention of Respiratory Complications Complications

Breathing exercisesBreathing exercises Incentive spirometryIncentive spirometry Coughing and splintingCoughing and splinting

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Patient Using Incentive Patient Using Incentive SpirometerSpirometer

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Prevention of Cardiovascular Prevention of Cardiovascular ComplicationsComplications

Be aware of patients at greater risk for Be aware of patients at greater risk for DVTDVT

Antiembolism stockingsAntiembolism stockings Pneumatic compression devicesPneumatic compression devices Leg exercisesLeg exercises MobilityMobility

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External Pneumatic External Pneumatic Compression DevicesCompression Devices

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Anxiety InterventionsAnxiety Interventions

Preoperative teachingPreoperative teaching Encouraging communicationEncouraging communication Promoting restPromoting rest Using distractionUsing distraction Teaching family membersTeaching family members

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Preoperative Chart ReviewPreoperative Chart Review

Ensure all documentation, preoperative Ensure all documentation, preoperative procedures, and orders are complete.procedures, and orders are complete.

Check the surgical consent form and Check the surgical consent form and others for completeness.others for completeness.

Document allergies.Document allergies. Document height and weight.Document height and weight.

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Preoperative Chart Review Preoperative Chart Review (Cont’d)(Cont’d)

Ensure results of all laboratory and Ensure results of all laboratory and diagnostic tests are on the chart.diagnostic tests are on the chart.

Document and report any abnormal Document and report any abnormal results.results.

Report special needs and concerns.Report special needs and concerns.

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Preoperative Patient Preoperative Patient PreparationPreparation

Patient should remove most clothing and Patient should remove most clothing and wear a hospital gown.wear a hospital gown.

Valuables should remain with family Valuables should remain with family member or be locked up.member or be locked up.

Tape rings in place if they cannot be Tape rings in place if they cannot be removed.removed.

Remove all pierced jewelry.Remove all pierced jewelry.

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Preoperative Patient Preoperative Patient Preparation (Cont’d)Preparation (Cont’d)

Patient wears an identification band.Patient wears an identification band. Dentures, prosthetic devices, hearing aids, Dentures, prosthetic devices, hearing aids,

contact lenses, fingernail polish, and contact lenses, fingernail polish, and artificial nails must be removed.artificial nails must be removed.

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Preoperative DrugsPreoperative Drugs

Reduce anxietyReduce anxiety Promote relaxationPromote relaxation Reduce nasal and oral secretionsReduce nasal and oral secretions Prevent laryngospasmPrevent laryngospasm Reduce vagal-induced bradycardiaReduce vagal-induced bradycardia Inhibit gastric secretionInhibit gastric secretion Decrease the amount of anesthetic Decrease the amount of anesthetic

needed for the induction and maintenance needed for the induction and maintenance of anesthesiaof anesthesia

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Patient Transfer to Surgical Patient Transfer to Surgical Suite Suite