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Preoperative Period NUR 112 Lisa M. Dunn RN, MSN/ED In

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Preoperative Period NUR 112 Lisa M. Dunn RN, MSN/ED In completing the preoperative checklist on a client scheduled for general surgery, the nurse recognizes which of ... – PowerPoint PPT presentation

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Title: Preoperative Period NUR 112 Lisa M. Dunn RN, MSN/ED In


1
Preoperative Period
  • NUR 112
  • Lisa M. Dunn RN, MSN/ED

2
Purpose of Surgery
  • Diagnostic
  • Curative
  • Restorative
  • Palliative surgery, which makes the patient
    more comfortable
  • Cosmetic surgery, which reconstructs the skin
    and underlying structures

3
Nursing Process Pre-Operative Period Surgical
Procedure Suffixes
  • -ectomy excision or removal of
  • appendectomy
  • -lysis destruction of
  • electrolysis
  • -orrhaphy repair or suture of
  • Herniorrhaphy
  • -oscopy looking into
  • endoscopy
  • -ostomy creation of opening into
  • Colostomy
  • -otomy cutting into or incision of
  • Tracheotomy
  • -plasty repair or reconstruction of
  • mammoplasty

4
Question
  • The nurse understands that the rationale for
    palliative surgery
  • is to
  • Resolve a health problem by repairing the cause
  • Improve functional ability
  • Enhance personal appearance
  • Relieve symptoms of a disease

5
Collaborative Management Assessment
  • History and data collection

-Age -Drug and substance use -Medical history,
including cardiac and pulmonary
histories -Previous surgery and anesthesia -Blood
donations -Discharge planning
6
Physical Assessment/ Clinical Manifestation
  • Obtain baseline vital signs
  • Focus on problem areas identified by the
    patients history on all body systems affected by
    the surgical procedure.
  • Report any abnormal assessment findings to the
    surgeon and the anesthesiology personnel.

7
System Assessment
  • Cardiovascular system
  • Respiratory system
  • Renal/urinary system
  • Neurological system
  • Musculoskeletal system
  • Nutritional status
  • Psychosocial assessment

8
Question
In assessing the client preoperatively, which of
the following statements by the client requires
further follow-up? A I usually skip breakfast,
so I will not be hungry before
surgery. B I started taking a multivitamin
last week. C I have been using several
different herbs for my health over the past
year. D I usually work out three times per
week.
9
Laboratory Assessment
  • Urinalysis
  • Blood type and crossmatch
  • Complete blood count or hemoglobin and hematocrit
  • Clotting studies
  • Electrolyte levels
  • Serum creatinine level
  • Pregnancy test
  • Chest x-ray
  • Electrocardiogram (EKG or ECG)

10
Question
  • The nurse reports which of the following
    electrolyte
  • laboratory results immediately to the
    anesthesiologist?
  • Potassium 3.9 mEq/L
  • Sodium 140 mEq/L
  • Fasting glucose 80 mg/dL
  • Creatinine 1.9 mg/dL

11
Knowledge Deficit Interventions
  • Preoperative teaching
  • Informed consent
  • The surgeon in responsible for obtaining signed
    consent before sedation is given and surgery is
    performed.
  • The nurses role is to clarify facts presented by
    the physician and dispel myths that the client or
    family may have about surgery.

12
Implementing Dietary Restrictions
  • The patient is given nothing by mouth (NPO) for 6
    to 8 hours before surgery.
  • NPO status decreases the risk for aspiration
  • Failure to adhere may result in cancellation of
    surgery or increase the risk of aspiration during
    or after surgery.

13
Administering Regularly Scheduled Medications
Notify the physician and anesthesia provider for
instructions about medications such as
  • Diabetes medications
  • Cardiac medications
  • Glaucoma medications
  • Anticoagulants
  • corticosteriods

14
Intestinal Preparation
  • Bowel and intestinal preparations are performed
    to prevent injury to the colon and to reduce the
    number of intestinal bacteria.
  • Enema and/ or laxative may be ordered.

15
Question
  • In preparing a client for gastrointestinal
    surgery, the nurse
  • explains the reason for the bowel prep is to
  • Eliminate any risk of infection
  • Reduce bacteria that is normally found in the
    bowel
  • Ensure the bowel is sterile
  • Decrease expected blood loss during surgery

16
Skin Preparation
  • Skin is the bodies first line of defense against
    infection.
  • A break in the barrier increases the risk of
    infection.
  • Shower using antiseptic solution.
  • Shaving as a procedure before surgery is viewed
    as controversial.

17
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19
Preoperative Education
  • Possible placement of drains, tubes and vascular
    access devices.
  • Teach patient about postoperative procedures and
    exercises.
  • Breathing exercises
  • Incentive spirometry
  • Coughing and splinting

20
Pre-Operative Education Diaphragmatic Breathing
Exercises
21
Properative Education Diaphragmatic Breathing
  • High or semi-fowlers position
  • Place hands lightly on the abdomen
  • Inspire deeply while allowing the abdomen to
    expand outward.
  • Hold breath for a count of 5
  • Exhale completed through pursed lips, allowing
    the cheeks and abdomen to deflate
  • On expiration, the abdomen contracts inward as
    air from the lungs is expelled
  • Repeat 5 times consecutively slowly
  • Perform q1-2 hours while awake

22
Splinting Abdomen
  • Coughing Exercises
  • Taught preop
  • Purpose to loosen, mobilize, and remove
    pulmonary secretions
  • Splinting the incision decreases the physical and
    psychologic discomfort associated with coughing
  • Diaphragmatic breathing
  • Splint the incision with interlocked hand or
    pillow
  • Three deep breaths and then cough forcefully
  • Repeat 5 x q2h while awake with rest periods

23
Pre-Operative Education Splinting Abdomen while
Coughing
24
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25
Question
In teaching the client with planned surgery using
general anesthesia, it is a priority for the
nurse to include which statement in the
preoperative teaching? A. You many wake up with
a tube in your throat to help you
breath. B. Your surgery will last about 2
hours. C. Your family will be allowed to visit
you in the operating room. D. We will
not be able to give you pain medications until
you are fully awake.
26
Question
  • The nurse includes which of the following
    statements for a
  • client undergoing general anesthesia?
  • You will be able to talk with the surgeon during
    the
  • procedure.
  • You will have a breathing tube in your throat
    during the
  • procedure.
  • Your family will need to stay in the waiting
    room in order to
  • talk with the surgeon.
  • No information can be given to your family until
    you are
  • fully awake in the PACU.

27
Pre-Operative Education Pain Management Education
  • Pain Assessment 5th Vital Sign
  • Instruct in use of pain intensity rating scale
  • Initial postoperative period
  • Patient Controlled Analgesia
  • Patient Controlled Epidural Analgesia
  • Medication prescribed IV/IM at prescribed time
  • Other therapies Positioning, back rubs, ice,
    elevation
  • Progress to oral analgesic agents
  • 2nd or 3rd postop day or Ambulatory Surgery

28
Preoperative Education Continued
  • Leg procedures and exercises such as
  • - calf pumping
  • - antiembolism stocking
  • Sequential compression device
  • (SCD)
  • elastic wraps
  • Early ambulation
  • Range-of-motion exercises

29
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30
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31
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32
Anxiety Interventions
  • Preoperative teaching
  • Encouraging communication
  • Promoting rest
  • Using distraction
  • Teaching family and significant others

33
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.

34
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35
Question
  • In completing the preoperative checklist on a
    client scheduled for general surgery, the nurse
    recognizes which of the following as
  • the greatest risk for the planned procedure?
  • Age 59
  • Ten pounds over ideal body weight
  • Diet Controlled diabetes mellitus
  • Brother had complications with general anesthesia

36
Question
  • The nurses role in informed consent includes
    which of the
  • following?
  • Taking the client on a tour of the operating room
  • Teaching the client about the planned procedure
  • Witnessing the operative consent
  • Ensuring the client talks with the primary
    surgeon before
  • the procedure.

37
Preoperative Chart Review Continued
  • All diagnostic test results and diagnostic tests
    are on the chart.
  • Document and report any abnormal results
  • Report special needs and concerns

38
Preop Patient Prep
  • Patients should remove clothing and only have on
    hospital gown.
  • Ensure adequate intravenous access
  • Valuables should be with a family member or
    locked up in hospital safe.
  • Tape rings in place if they cannot be removed.
  • Remove all pierced jewelry

39
Preop Patient Prep Continued
  • Client must be wearing an identification band
  • Notation of allergies noted on a wrist band
  • Dentures must be removed (note if patient has
    missing teeth or any loose teeth)
  • Remove hearing aids
  • Remove glasses
  • Remove nail polish
  • Remove hair pieces and any kind of hair pins or
    bands

40
Patient Gets a Time-Out!!!
Most facilities have some kind of check system in
place to make sure -Right patient -Right
procedure -Right surgical site
41
2009 Patient Safety Goals
The purpose of The Joint Commissions National
Patient Safety Goals (NPSGs) is to promote
specific improvements in patient safety. The
Requirements highlight problematic areas in
health care and describe evidence and
expert-based solutions to these problems. The
Requirements focus on system-wide solutions,
wherever possible.
42
Patient identification
Goal 1 Improve the accuracy of patient
identification
NPSG.01.01.01 Use at least two patient
identifiers when providing care, treatment and
services.
NPSG.01.02.01 Prior to the start of any surgical
or invasive procedure, individuals involved in
the procedure conduct a final verification
process, such as a time-out, to confirm the
correct patient, procedure and site using active,
not passive, communication techniques.
43
Health Care Associated Infections
Goal 7 Reduce the risk of health care
associated infections
NPSG.07.05.01 Implement best practices for
preventing surgical site infections.
44
Preoperative Medication
  • Reduce anxiety
  • Promote relaxation
  • Reduce pharyngeal secretions
  • Prevent laryngospasm
  • Inhibit gastric secretions
  • Decrease amount of anesthetic needed for
    induction and maintenance of anesthesia.
  • Administer antibiotics if ordered

45
Pre-Operative Period Preoperative Medications
  • Frequently used preoperative medications
  • Benzodiazepines They reduce anxiety, induce
    sedation and induce amnesia by slowing down the
    central nervous system.
  • midazolam (Versed)
  • diazepam (Valium)
  • lorazepam (Ativan)

46
Question (pick all that apply)
  • The nurse assumes the role of client advocate in
    the preoperative period.
  • A. notifying the physician of abnormal lab
    results
  • B. verifying that informed consent has been
    obtained
  • C. cosigning the operative consent form
  • D. reviewing preoperative teaching
  • E. providing support to family members
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