PREOPERATIVE PREPARATION OF PATIENTS

1. PREOPERATIVE PREPARATION OF PATIENTS PRPD/DN/11

2. Preadmission Procedure • Medical history and physical examination – performed and documented by a physician and nurse establishes the baseline for the patient’s vital signs. • Laboratory tests – specific clinical indicators or risk factors that could affect surgical management and anaesthesia. Ideally tests should be completed 24 hours before admission so the results are available for review. E.g. Haemoglobin, Blood glucose, U&E, blood count & chemistry profile, urinalysis etc. PRPD/DN/PON/11

3. Cont... • Blood type and cross match – if a transfusion is anticipated, the patient’s blood is typed and crossmatched. • Chest radiographic study – required by facility policy or medically indicated as an adjunct to the clinical evaluation of patients with cardiac or pulmonary disease for smokers, patients age 60 years or older, and cancer patients. • Electrocardiogram (ECG). If the patient has known or suspected cardiac disease, routine for patient ages 40 years or older. PRPD/DN/PON/11

4. Cont.... • Written instructions – preoperative instructions to follow before admission for the surgical procedure. a) To prevent regurgitation or emesis and aspiration of gastric contents. The patient should not ingest solid foods before the surgical procedure. “NPO after midnight Latin: nil per os, or nothing by mouth. Solid food takes 12 hrs to be emptied, clear fluid may be unrestricted until 2 to 3 hrs before the surgical procedure. b) The physician may want the patient to take any essential oral medications that he or she normally takes. These can be taken as prescribed with a minimal fluid intake (a few sips of water) up to 1hr before the surgical procedure. PRPD/DN/PON/11

5. Cont... c) The skin should be cleansed to prepare the surgical site. Patients who will undergo a surgical procedure on the face, ear, or neck are advised to shampoo their hair before admission, because this may not be permitted for a few days or weeks after the procedure. d) Nail polish and acrylic nails should be removed to permit observation of and access to the nailbed during the surgical procedure. e) Jewelry and valuables should be left at home to ensure safekeeping. If electrosurgery will be used, patients should be informed that all metal jewelry, including wedding bands and religious artifacts, should be removed to prevent possible burns. Loss prevention is a consideration as well. PRPD/DN/PON/11

6. Cont... • Informed consent – the physician should obtain informed consent from the patient or legal designee. After explaining the surgical procedure and its risks, benefits and alternatives, the surgeon should document the process and have the patient sign the consent form. This documentation becomes part of the permanent record and accompanies the patient to the OR. PRPD/DN/PON/11

7. Cont... • Nurse interview – a perioperative nurse/peri anaesthesia nurse should meet with the patient to make a preoperative assessment. Through physiologic and psychosocial assessments, the nurse collect data for the nursing diagnoses, expected outcomes and plan of care. The nurse also provides emotional support and teaches the patient in preparation for postoperative recovery. PRPD/DN/PON/11

8. Cont... • Anaesthesia assessment – an anaesthesia history and physical assessment are performed before a general or regional anaesthetic is administered. An interview by an anaesthesia provider may be conducted before admission re: complex medical history, is high risk, or has a high degree of anxiety. All patients should understand the risks of and alternatives to the type of anaesthetic to be administered. PRPD/DN/PON/11

9. Evening before an elective surgical procedure Some patients may require the following: 1) Bowel preparation e.g. Gastrointestinal procedure such as resection or endoscopy, surgical procedures in the pelvic, perineal or perineal areas. 2) Bedtime sedation for sleep in select circumtances. PRPD/DN/PON/11

10. Before leaving for the Operating Room Immediate preoperative care: • The patients put on a clean hospital gown. • Jewelry is removed for safe keeping. • Dentures and removable bridges are removed before the administration of the general anaesthetic to safeguard them to prevent from obstructing respiration. • All removable prostheses (e.g. Eye, extremity, contact lenses, hearing aids, eyeglasses) are removed for safe keeping. • Long hair may be braided. Wigs should be removed. Hairpins are removed to prevent scalp injury. PRPD/DN/PON/11

11. Cont... • Antiembolic stockings or elastic bandages may be ordered for the lower extremities to prevent embolic phenomena and long procedures. • The patient voids to prevent overdistention of the bladder or incontinence during unconsious -ness. This is especially important for abdominal or pelvic procedures in which a large bladder may be traumatized or may interfere adequate exposure of the abdominal contents. The time of voiding is recorded. PRPD/DN/PON/11

12. Cont... • Preanaesthesia medications are given as ordered. Their purpose is to eliminate apprehension by making the patient calm, drowsy and comfortable. Raise the side rails. • The patient, bed, and chart are accurately identified, and identifications are fastened securely in place. Allergies should be prominently noted on the chart and patient’s wristband. The End PRPD/DN/PON/11