1. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 16 Care of Preoperative Patients

2. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2 Preoperative Period Begins when the patient is scheduled for surgery and ends at the time of transfer to the surgical suite. 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. Nurse functions as educator, advocate, and promoter of health and safety.

3. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 Reason for Surgery Diagnostic Diagnostic Curative Curative Restorative Restorative Palliative Palliative Cosmetic Cosmetic

4. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 Urgency and Degree of Risk of Surgery Urgency: Urgency: Elective Elective Urgent Urgent Emergent Emergent Degree of Risk: Degree of Risk: Minor Minor Major Major

5. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 Extent of Surgery Simple Simple Radical Radical Minimally invasive Minimally invasive

6. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 Collaborative Management Assessment History and data collection: History and data collection: Age Age Drugs and substance use Drugs and substance use Medical history, including cardiac and pulmonary histories Medical history, including cardiac and pulmonary histories Previous surgical procedures and anesthesia Previous surgical procedures and anesthesia Blood donations Blood donations Discharge planning Discharge planning

7. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7 Physical Assessment/Clinical Manifestations Obtain baseline vital signs. Obtain baseline vital signs. Focus on problem areas identified by the patients history and on all body systems affected by the surgical procedure. 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. Report any abnormal assessment findings to the surgeon and to anesthesiology personnel.

8. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 System Assessment Cardiovascular system Cardiovascular system Respiratory system Respiratory system Renal/urinary system Renal/urinary system Neurologic system Neurologic system Musculoskeletal system Musculoskeletal system Nutritional status Nutritional status Psychosocial assessment Psychosocial assessment

9. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 Laboratory Assessment Urinalysis Urinalysis Blood type and crossmatch Blood type and crossmatch Complete blood count or hemoglobin level and hematocrit Complete blood count or hemoglobin level and hematocrit Clotting studies Clotting studies Electrolyte levels Electrolyte levels Serum creatinine level Serum creatinine level Pregnancy test Pregnancy test Chest x-ray examination Chest x-ray examination Electrocardiogram Electrocardiogram

10. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10 Deficient Knowledge Interventions Preoperative teaching. Preoperative teaching. Informed consent: Informed consent: Surgeon is responsible for obtaining signed consent before sedation and/or surgery. 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. The nurses role is to clarify facts presented by the physician and dispel myths that the patient or family may have about surgery.

11. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 Implementing Dietary Restrictions NPO: Patient advised not to ingest anything by mouth for 6 to 8 hours before surgery: NPO: Patient advised not to ingest anything by mouth for 6 to 8 hours before surgery: Decreases the risk for aspiration. Decreases the risk for aspiration. Patients should be given written and oral directions to stress adherence. Patients should be given written and oral directions to stress adherence. Surgery can be cancelled if not followed. Surgery can be cancelled if not followed.

12. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 Administering Regularly Scheduled Medications Medical physician and anesthesia provider should be consulted for instructions about regularly taken prescriptions before surgery. 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: Drugs for certain conditions often allowed with a sip of water before surgery: Cardiac disease Cardiac disease Respiratory disease Respiratory disease Seizures Seizures Hypertension Hypertension

13. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 Intestinal Preparation Bowel or intestinal preparations performed to prevent injury to the colon and to reduce the number of intestinal bacteria. 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. Enema or laxative may be ordered by the physician.

14. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14 Skin Preparation A break in the skin increases risk for infection. A break in the skin increases risk for infection. Patient may be asked to shower using antiseptic solution. Patient may be asked to shower using antiseptic solution.

15. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 Skin Preparation for Common Surgical Sites

16. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 Patient and Family Teaching Tubes Tubes Drains Drains Vascular access Vascular access

17. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17

18. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 Prevention of Respiratory Complications Breathing exercises Breathing exercises Incentive spirometry Incentive spirometry Coughing and splinting Coughing and splinting

19. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19 Patient Using Incentive Spirometer

20. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20 Prevention of Cardiovascular Complications Be aware of patients at greater risk for DVT Be aware of patients at greater risk for DVT Antiembolism stockings Antiembolism stockings Pneumatic compression devices Pneumatic compression devices Leg exercises Leg exercises Mobility Mobility

21. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21 External Pneumatic Compression Devices

22. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22 Anxiety Interventions Preoperative teaching Preoperative teaching Encouraging communication Encouraging communication Promoting rest Promoting rest Using distraction Using distraction Teaching family members Teaching family members

23. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 23 Preoperative Chart Review Ensure all documentation, preoperative procedures, and orders are complete. Ensure all documentation, preoperative procedures, and orders are complete. Check the surgical consent form and others for completeness. Check the surgical consent form and others for completeness. Document allergies. Document allergies. Document height and weight. Document height and weight.

24. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 24 Preoperative Chart Review (Contd) Ensure results of all laboratory and diagnostic tests are on the chart. Ensure results of all laboratory and diagnostic tests are on the chart. Document and report any abnormal results. Document and report any abnormal results. Report special needs and concerns. Report special needs and concerns.

25. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 25 Preoperative Patient Preparation Patient should remove most clothing and wear a hospital gown. Patient should remove most clothing and wear a hospital gown. Valuables should remain with family member or be locked up. Valuables should remain with family member or be locked up. Tape rings in place if they cannot be removed. Tape rings in place if they cannot be removed. Remove all pierced jewelry. Remove all pierced jewelry.

26. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 26 Preoperative Patient Preparation (Contd) Patient wears an identification band. Patient wears an identification band. Dentures, prosthetic devices, hearing aids, contact lenses, fingernail polish, and artificial nails must be removed. Dentures, prosthetic devices, hearing aids, contact lenses, fingernail polish, and artificial nails must be removed.

27. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 27 Preoperative Drugs Reduce anxiety Reduce anxiety Promote relaxation Promote relaxation Reduce nasal and oral secretions Reduce nasal and oral secretions Prevent laryngospasm Prevent laryngospasm Reduce vagal-induced bradycardia Reduce vagal-induced bradycardia Inhibit gastric secretion Inhibit gastric secretion Decrease the amount of anesthetic needed for the induction and maintenance of anesthesia Decrease the amount of anesthetic needed for the induction and maintenance of anesthesia

28. Elsevier items and derived items © 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 28 Patient Transfer to Surgical Suite