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Chapter 16

Chapter 16. Care of Preoperative Patients. Preoperative Period. Begins when the patient is scheduled for surgery and ends at the time of transfer to the surgical suite. Nurse functions as educator, advocate, and promoter of health and safety. Reason for Surgery. Diagnostic Curative

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Chapter 16

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  1. Chapter 16 Care of Preoperative Patients

  2. Preoperative Period • Begins when the patient is scheduled for surgery and ends at the time of transfer to the surgical suite. • Nurse functions as educator, advocate, and promoter of health and safety.

  3. Reason for Surgery • Diagnostic • Curative • Restorative • Palliative • Cosmetic

  4. Urgency and Degree of Risk of Surgery • Urgency: • Elective • Urgent • Emergent • Degree of Risk: • Minor • Major

  5. Extent of Surgery • Simple • Radical • Minimally invasive

  6. Collaborative Management Assessment • History and data collection: • Age • Drugs and substance use • Medical history, including cardiac and pulmonary histories • Previous surgical procedures and anesthesia • Blood donations • Discharge planning

  7. Physical Assessment/Clinical Manifestations • Obtain baseline vital signs. • Focus on problem areas identified by the patient’s history and on all body systems affected by the surgical procedure. • Report any abnormal assessment findings to the surgeon and to anesthesiology personnel.

  8. System Assessment • Cardiovascular system • Respiratory system • Renal/urinary system • Neurologic system • Musculoskeletal system • Nutritional status • Psychosocial assessment

  9. Laboratory Assessment • Urinalysis • Blood type and crossmatch • Complete blood count or hemoglobin level and hematocrit • Clotting studies • Electrolyte levels • Serum creatinine level • Pregnancy test • Chest x-ray examination • Electrocardiogram

  10. Deficient Knowledge Interventions • Preoperative teaching. • Informed consent: • Surgeon is responsible for obtaining signed consent before sedation and/or surgery. • The nurse’s role is to clarify facts presented by the physician and dispel myths that the patient or family may have about surgery.

  11. Implementing Dietary Restrictions • NPO: Patient advised not to ingest anything by mouth for 6 to 8 hours before surgery: • Decreases the risk for aspiration. • Patients should be given written and oral directions to stress adherence. • Surgery can be cancelled if not followed.

  12. Administering Regularly Scheduled Medications • Medical physician and anesthesia provider should be consulted for instructions about regularly taken prescriptions before surgery. • Drugs for certain conditions often allowed with a sip of water before surgery: • Cardiac disease • Respiratory disease • Seizures • Hypertension

  13. Intestinal Preparation • Bowel or intestinal preparations performed to prevent injury to the colon and to reduce the number of intestinal bacteria. • Enema or laxative may be ordered by the physician.

  14. Skin Preparation • A break in the skin increases risk for infection. • Patient may be asked to shower using antiseptic solution.

  15. Skin Preparation for Common Surgical Sites

  16. Patient and Family Teaching • Tubes • Drains • Vascular access

  17. Prevention of Respiratory Complications • Breathing exercises • Incentive spirometry • Coughing and splinting

  18. Patient Using Incentive Spirometer

  19. Prevention of Cardiovascular Complications • Be aware of patients at greater risk for DVT • Antiembolism stockings • Pneumatic compression devices • Leg exercises • Mobility

  20. External Pneumatic Compression Devices

  21. Anxiety Interventions • Preoperative teaching • Encouraging communication • Promoting rest • Using distraction • Teaching family members

  22. Preoperative Chart Review • Ensure all documentation, preoperative procedures, and orders are complete. • Check the surgical consent form and others for completeness. • Document allergies. • Document height and weight.

  23. Preoperative Chart Review (Cont’d) • Ensure results of all laboratory and diagnostic tests are on the chart. • Document and report any abnormal results. • Report special needs and concerns.

  24. Preoperative Patient Preparation • Patient should remove most clothing and wear a hospital gown. • Valuables should remain with family member or be locked up. • Tape rings in place if they cannot be removed. • Remove all pierced jewelry.

  25. Preoperative Patient Preparation (Cont’d) • Patient wears an identification band. • Dentures, prosthetic devices, hearing aids, contact lenses, fingernail polish, and artificial nails must be removed.

  26. Preoperative Drugs • Reduce anxiety • Promote relaxation • Reduce nasal and oral secretions • Prevent laryngospasm • Reduce vagal-induced bradycardia • Inhibit gastric secretion • Decrease the amount of anesthetic needed for the induction and maintenance of anesthesia

  27. Patient Transfer to Surgical Suite

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