1. Interventions for Preoperative Clients Care

2. Perioperative Care Three Phases Preoperative Intraoperative
Postoperative

3. 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)

4. 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.

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. 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.

13. 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

14. 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.

15. 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.

16. 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.

17. 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)

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

19. 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.

20. DEEP BREATHING & COUGHING

21. LEGS EXERCISES

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

23. 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)

24. 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.

25. 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)

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

27. 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.

28. 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.