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Focus on Preoperative Care

Focus on Preoperative Care. (Relates to Chapter 18, “Nursing Management: Preoperative Care,” in the textbook). Surgery. Art and science of treating diseases, injuries, and deformities by operation and instrumentation. Surgery (Cont’d). Performed for Diagnosis Cure Palliation

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Focus on Preoperative Care

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  1. Focus onPreoperative Care (Relates to Chapter 18, “Nursing Management: Preoperative Care,” in the textbook)

  2. Surgery • Art and science of treating diseases, injuries, and deformities by operation and instrumentation

  3. Surgery (Cont’d) • Performed for • Diagnosis • Cure • Palliation • Prevention • Exploration • Cosmetic improvement

  4. Surgical Settings • Inpatient • Same day admission • Ambulatory (outpatient) • Usually less than 3 to 4 hours in PACU

  5. Patient Interview • Check documented information prior to interview • Avoids repetition • Occurs in advance or on day of surgery

  6. Patient Interview (Cont’d) • Purpose • Obtain health information • Determine expectations • Provide and clarify information on procedure • Assess emotional state and readiness

  7. Nursing Assessment • Overall goal • Identify risk factors • Plan care to ensure patient safety

  8. Nursing Assessment Goals • Determine psychologic status to reinforce coping strategies • Determine psychologic factors of procedure contributing to risks

  9. Nursing Assessment Goals (Cont’d) • Establish baseline data • Identify medications and herbs taken that may affect surgical outcome • Identify, document, and communicate results of laboratory/diagnostic tests

  10. Nursing Assessment Goals (Cont’d) • Identify cultural and ethnic factors that may affect surgical experience • Determine receipt of adequate information from surgeon in order to sign informed consent

  11. Nursing Assessment • Psychosocial assessment • Excessive stress response can be magnified and recovery affected

  12. Nursing Assessment (Cont’d) • Influencing factors • Age • Past experience • Current health • Socioeconomic status

  13. Nursing Assessment (Cont’d) • Use common language • Use translators if needed • Decreases level of anxiety • Communicate all concerns to surgical team

  14. Nursing Assessment (Cont’d) • Anxiety can impair cognition, decision making, and coping abilities • Lack of knowledge • Unrealistic expectations • Information lessens anxiety

  15. Nursing Assessment (Cont’d) • Anxiety may arise from conflict with interventions (e.g., blood transfusions) and religious/cultural beliefs • Identify beliefs and discuss with surgeon and operative staff

  16. Nursing Assessment (Cont’d) • Fears • Death or disability • May prompt postponement • Influence outcome • Pain • Consult with ACP • Reassure that drugs will be available

  17. Nursing Assessment (Cont’d) • Fears • Mutilation/alteration in body image • Assess concerns nonjudgmentally • Anesthesia • ACP for consult • Assess malignant hyperthermia risk

  18. Nursing Assessment (Cont’d) • Fears • Disruption of life functioning • Range from fear of permanent disability to temporary loss • Include family and financial concerns • Consultations PRN

  19. Nursing Assessment (Cont’d) • Hope • May be strongest positive coping mechanism • Never deny or minimize • Assess and support

  20. Nursing Assessment (Cont’d) • Health history • Diagnosed medical conditions • Previous surgeries and problems • Menstrual/obstetric history

  21. Nursing Assessment (Cont’d) • Health history • Familial diseases • Conditions • Reactions/problems to anesthesia (patient or family)

  22. Nursing Assessment (Cont’d) • Current medications • Prescription and OTC • Herbs • Vitamins • Recreational • Drugs • Alcohol • Tobacco

  23. Nursing Assessment (Cont’d) • Allergies (drug and nondrug) • Screen areas: • Risk factors • Contact urticaria • Aerosol reactions • History of reactions suggesting latex allergy

  24. Nursing Assessment (Cont’d) • Cardiovascular system • Report • Problems for effective monitoring • Use of cardiac drugs • Presence of pacemaker/MI

  25. Nursing Assessment (Cont’d) • Cardiovascular system • Vitals recorded preoperatively for baseline • Bleeding/clotting times • Laboratory reports • Possible prophylactic antibiotics

  26. Nursing Assessment (Cont’d) • Respiratory system • Inquire about recent airway infections • Procedure could be cancelled because of increased risk of laryngo/bronchospasm or decreased SaO2

  27. Nursing Assessment (Cont’d) • Respiratory system • History of dyspnea, coughing, or hemoptysis reported to operative team • COPD or asthma • High risk for atelectasis and hypoxemia

  28. Nursing Assessment (Cont’d) • Respiratory system • Smokers should be encouraged to quit 6 weeks before procedure • Decreases risk of complications • Greater years and number of packs = greater risk

  29. Nursing Assessment (Cont’d) • Nervous system • Evaluation of neurologic functioning • Vision or hearing loss can influence results

  30. Nursing Assessment (Cont’d) • Nervous system • Cognitive function • Assess or correct any deficits before surgery • Durable power of attorney for health care should be obtained if deficits cannot be corrected

  31. Nursing Assessment (Cont’d) • Nervous system • Cognitive function • Postoperative delirium (falsely labeled senility or dementia) can occur with dehydration, hypothermia, and adjunctive medications

  32. Nursing Assessment (Cont’d) • Urinary system • History of urinary or renal diseases • Renal dysfunction contributes to • Fluid and electrolyte imbalances • Increased risk of infection • Impaired wound healing • Altered response to drugs and their elimination

  33. Nursing Assessment (Cont’d) • Urinary system • Renal function tests • Note problems voiding and inform operative team

  34. Nursing Assessment (Cont’d) • Integumentary system • History of skin and musculoskeletal problems • History of pressure ulcers • Extra padding during procedure • Affect postoperative healing

  35. Nursing Assessment (Cont’d) • Musculoskeletal system • Identify joints affected with arthritis • Mobility restrictions may affect positioning and ambulation • Bring mobility aids to surgery

  36. Nursing Assessment (Cont’d) • Musculoskeletal system • Report problems affecting neck or lumbar spine to ACP • Can affect airway management and anesthesia delivery

  37. Nursing Assessment (Cont’d) • Endocrine system • Patients with diabetes mellitus especially at risk for: • Hypo/hyperglycemia • Ketosis • Cardiovascular alterations • Delayed wound healing • Infection

  38. Nursing Assessment (Cont’d) • Endocrine system • Patients with diabetes mellitus • Serum glucose tests morning of surgery (baseline) • Clarify with physician or ACP if usual dose of insulin is taken

  39. Nursing Assessment (Cont’d) • Endocrine system • Patients with thyroid dysfunction • Hyper/hypothyroidism are surgical risks due to altered metabolic rate • Verify with ACP about giving medications

  40. Nursing Assessment (Cont’d) • Endocrine system • Patients with Addison’s disease • Abruptly stopping replacement corticosteroids could cause addisonian crisis • Stress of surgery may require increased dose of corticosteroids

  41. Nursing Assessment (Cont’d) • Immune system • Patients with history of compromised immune system or use of immunosuppressive drugs can have • Delayed wound healing • Increased risk for infection

  42. Nursing Assessment (Cont’d) • Fluid and electrolyte status • Vomiting, diarrhea, or difficulty swallowing can cause imbalance • Identify drugs that alter status • Diuretics • Evaluate serum electrolyte levels

  43. Nursing Assessment (Cont’d) • Fluid and electrolyte status • NPO status • May require additional fluids and electrolytes before surgery if dehydration occurs

  44. Nursing Assessment (Cont’d) • Nutritional status • Obesity • Stresses cardiac and pulmonary systems • Increased risk of wound dehiscence and infection • Slower recovery from anesthesia • Slower wound healing

  45. Nursing Assessment (Cont’d) • Nutritional status • Provide extra padding to underweight patients to prevent pressure ulcers • Identify dietary habits that may affect recovery (e.g., caffeine)

  46. Nursing Assessment: Exam • Findings enable ACP to rate patient for anesthesia administration • Indicator of perioperative risk and overall outcome

  47. Nursing Assessment: Exam (Cont’d) • Document relevant findings and report to perioperative team • Obtain and evaluate results of laboratory tests • Monitor blood glucose for diabetics

  48. Nursing Management • Preoperative teaching • Patient has right to know what to expect and how to participate • Increases patient satisfaction • Reduces fear, anxiety, stress, pain, and vomiting

  49. Nursing Management (Cont’d) • Preoperative teaching • Limited time available • Address needs of highest priority • Include information focused on safety • Provide written material

  50. Nursing Management (Cont’d) • Preoperative teaching • Several days before surgery • Observe and listen to determine amount of teaching for each session • Anxiety and fear can hinder learning • Give priority to patient’s concerns

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