Interventions for Preoperative Clients Care

Perioperative Care Three Phases Preoperative Intraoperative Postoperative

Surgical Classifications 1. Optional surgery: decision rests with patient (eg, cosmetic surgery). 2. Elective surgery refers to procedures that scheduled at the client's convenience (eg, cyst removal, repair of scars simple hernia or vaginal repair). 3. Required surgery: is warranted for conditions necessitating intervention within a few weeks (eg, cataract surgery, thyroid disorders). 4. Urgent surgery: is indicated for a problem requiring intervention within 24 to 48 hours (eg, some cancers, acute gallbladder infection and appendicitis, Kidney stones). 5. Emergency surgery: describes procedures that must be done immediately to sustain life or maintain function (eg, repair of a ruptured aortic aneurysm, gunshot, or knife wounds, extensive burns , fractures skull, intestinal obstruction)

Informed Consent Information on the surgical procedure is provided by the physician Explanation includes permission a client gives after an explanation of the risks, benefits, and alternatives A signed form, witnessed by a nurse is evidence that consent has been obtained If the client is mentally confused, unconscious, or mentally incompetent, the client’s spouse, nearest blood relative, or someone with durable power of attorney for the client’s health care must sign the consent form.

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

SURGERY CHECKLIST

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

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

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

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

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

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

Implementing Dietary Restrictions Client is given nothing by mouth (NPO) for 6 to 8 hours before surgery. NPO status decreases the risk for aspiration. Failure to adhere can result in cancellation of surgery or increase the risk for aspiration during or after surgery. Sentences and phrases

Administering Regularly Scheduled Medications Consult the medical physician and anesthesia provider for instructions about drugs, such as those taken for diabetes, cardiac disease, glaucoma, regularly scheduled anticonvulsants, antihypertensives, anticoagulants, antidepressants, or corticosteroids.

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

Skin Preparation The skin is the body’s first line of defense against infection; a break in the barrier increases the risk for infection. Shower using antiseptic solution. Shaving as a procedure before surgery is viewed as controversial.

Preparing the Client Possible placement of tubes, drains, and vascular access devices Teaching about postoperative procedures and exercises: Breathing exercises, incentive spirometry, coughing and splinting (Continued)

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

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.

DEEP BREATHING & COUGHING

LEGS EXERCISES

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

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. (Continued)

Preoperative Chart Review (Continued) Ensure results of all laboratory and diagnostic tests are on the chart. Document and report any abnormal results. Report special needs and concerns.

Preop Client Prep Client 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 can’t be removed. Remove all pierced jewelry. (Continued)

Preop Client Prep (Continued) Client wears an identification band. Dentures, prosthetic devices, hearing aids, contact lenses, fingernail polish, and artificial nails must be removed.

Preoperative Medication Reduce anxiety. Promote relaxation. Reduce pharyngeal secretions. Prevent laryngospasm. Inhibit gastric secretion. Decrease amount of anesthetic needed for induction and maintenance of anesthesia.

PREOPERATIVE MEDICATIONS ANTICHOLINERGICS: Glycopyrrolate (robinal) decreases respiratory secretions. ANTIANXIETY: Lorazepam (ativan) reduces anxiety. HISTAMINE-2 RECEPTOR ANTAGONIST: Cimetidine (tagamet) decreases gastric acidity and volume. NARCOTICS: Demerol (meperidine) decreases the amount of anesthesia needed to sedate the client. SEDATIVES: Midazolam (versed) promotes sleep or conscious sedation and decrease anxiety. ANTIBIOTICS: Kanamycin (Kantrex) destroy enteric microorganisms.