1. Interventions for Preoperative Clients Care

2. Perioperative Care Three Phases Preoperative Intraoperative
Postoperative

3. Miss Iman Shaweesh 3

5. PREOPERATIVE NURSING CARE
CONDUCT A NURSING ASSESSMENT
PROVIDE PREOPERATIVE TEACHING
PERFORM METHODS OF PHYSICAL
PREPARATION
ADMINISTER MEDICATIONS
ASSIST WITH PSYCHOSOCIAL PREPARATION
COMPLETE THE SURGICAL CHECKLIST

6. SURGERY CHECKLIST

7. Purposes of Surgery Diagnostic Curative Restorative
Palliative surgery, which makes the client more comfortable
Cosmetic surgery, which reconstructs the skin and underlying structures
Sentences and phrases

8. Collaborative Management Assessment
History and data collection
Age
Drugs and substance use
Medical history, including cardiac and pulmonary histories
Previous surgery and anesthesia
Blood donations
Discharge planning

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

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

11. 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

12. Preparing the Client (Continued)
Leg procedures and exercises, antiembolism stockings and elastic wraps, early ambulation, and range-of-motion exercises

13. DEEP BREATHING, COUGHING, LEG EXERCISES
Deep breathing is a form of controlled ventilation that opens and fills small air passages in the lungs to prevent atelectasis and pneumonia.
Coughing is a natural method of clearing secretions from the airways.
Leg exercises help promote circulation and reduce the risk of forming a thrombus in the veins.
Antiembolism stockings help prevent thrombi and emboli by compressing superficial veins and capillaries redirecting blood to larger and deeper veins, where it flows more effectively toward the heart.

14. DEEP BREATHING & COUGHING

16. Pre-Operative Education Diaphragmatic Breathing Exercises

17. Pre-Operative Education Splinting Abdomen while Coughing

18. Spirometry

20. Use of preoperative spirometry to predicted PPCs
Jacob 1997
Bando 1997
Kocabas 1996
Kroenke 1993
Kispert 1992
Swensson 1991
Fogh 1987
Appleberg 1974
Stein 1970
Collin 1968 1 2 4 6 8 10 12 14 16
Adapt from Smetana GW,et al. New Engl J Med 1999;340:

22. Preoperative Care of Pulmonary Patients: Example
Male 60 yrs.
Dx: NSCLC stage Ib , RUL
Underlying COPD
Assessment
Not urgent surgery, high benefit
Risk ; elderly, COPD
History / Physical examination
Laboratory

23. Spirometry of the patient
Pre-RX(%)
Post –RX(%)
%CHG
FEV1/FVC (%) 55 60
FEV1 (L)
1.31(48)
1.39(53) 5
FVC (L)
2.40(66)
2.50(69) 4
FEF25- 75%
(L/min)
0.43(15)
0.6(22) 22
Irreversible airway obstruction

24. Further evaluation PPO-FEV1 Rt=0.45(45%) Lt=0.55(55%)
RUL = 24.7%
LL = 55%
RLL= 20.3%
RUL : RLL= 0.55: 0.45
Acceptable, See Mx
PPO-FEV1=1.04(39%)

25. Preoperative Care of Pulmonary Patients
Many factors related to PPCs
Working as a team plays major roles
Assessment of the risks ,do appropriated testing and modifying are the keys of preoperative caring

26. Recommendation for preoperative CXR
Age > 50 years
Known pre-existing cardiopulmonary diseases
S/S like hoods of cardiopulmonary disease
Smetana GW, et al Med Clin N Am 2003

27. PFTs and PPCs Case-control study, elective abdominal surgery:
CXR highly associated with PPCs (OR 5.8)
Abnormal PE associated with PPCs
Whereas PFTs were not predictive
Lawrence VA, et al. Chest 1996;110:

28. PFT Diagram in Preoperative Evaluation
PFT(FEV1,MVV,DLCO)
FEV1 >2 L
MVV >50%
DLCO >60%
FEV1 > 2 L
MVV<50%
DLCO <60%
FEV1 <2 L
High risk consider exercise test
Cleared for any resection
Perfusion Scanning PPO-FEV1
PPO-FEV1 >1.3
PPO-FEV1 >0.8, <1.3
PPO-FEV1 <0.8
High risk consider exercise test
Cleared for any resection
Consider “Lesser” resection
Non surgical therapy

29. Preoperative PFTs : Summary
Thoracic surgery
Upper abdominal surgery with respiratory symptoms remain unexplained after careful evaluation
Routine PFTs should not ordered solely without clinical assessment

30. Risk indices for preoperative assessment
Risk class
Pneumonia Risk
(total point)
Predicted
Prob. pneumonia
(%)
Respiratory
Failure
Prob.
Res. failure 1
0-15
0.2
0-10
0.5 2
16-25
1.2
11-19
2.2 3
26-40
4.0
20-27
5.0 4
41-55
9.4
28-40
11.6 5
>55
15.4
>40
30.5
Arozullah AM,et al. Med Clin N Am 2003

31. Preoperative smoking cessation and PPCs
% Complication
Prospective study 200 patients, CABG
Warner MA,et al. Mayo Clin Proc 1989

32. Preoperative smoking cessation and PPCs
% Complication
Retrospective study 288 patients, pulmonary surgery
Nakagawa M, et al Chest 2001;120:705-10

33. Examples of external pneumatic compression devices used to promote
venous return and prevent deep vein
thrombosis (DVT)

34. Kendall SCD machine, sleeves, and TED stockings.

35. Venodyne pneumatic compression system

36. Flowtron DVT calf garments

37. Anxiety Interventions
Preoperative teaching
Encouraging communication
Promoting rest
Using distraction
Teaching family and significant others

38. 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.
Most institution have some sort of preop check list.
Surgical consents forms filled out without abbreviations. Make sure consent for anesthesia and blood consent filled out before sedation given. 38