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Care of Preoperative Patients

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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. – PowerPoint PPT presentation

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Title: Care of Preoperative Patients


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
    patients 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 nurses 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
Patient and Family Teaching
  • Tubes
  • Drains
  • Vascular access

16
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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 (Contd)
  • 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 (Contd)
  • 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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