Preoperative Nursing Management

Question	Answer
What Is Perioperative Nursing?	Perioperative nursing is nursing care that spans the entire surgical experience which occurs in three phases: The Preoperative phase, The Intraoperative phase, and The Postoperative phase.
What is the Preoperative phase?	The Preoperative phase begins with the decision to proceed with surgical intervention and ends with the patient's transfer to the operating room bed.
What are the benefits of technological advancements in surgical operations?	They have lead to providers being able to preform more complex procedures, less invasively and lowered the morbidity during the recovery phase of surgery.
How have advancements in anesthesias and medications benefitted the surgical process?	- Modern methods of achieving airway patency, sophisticated monitoring devices, and new pharmacologic agents have created a safer atmosphere to operate in. - Effective antiemetics have reduced postoperative N/V. -Improved postoperative pain management and shortened procedure and recovery times have improved experiences for patients.
What are the surgical classifications?	Diagnostic - to find a diagnosis [ex. biopsy] Curative - to cure [ex. appendectomy] Reparative - to fix [ex. multiple wound repair] These can be reconstructive or cosmetic, palliative [pain relieving or problem solving], or rehabilitative. Surgerys can also be classified by urgency: emergent, urgent, required, elective, and optional.
Why do we do preadmission testing?	To reduce hospital stay time and contain costs.
What are some special considerations during the perioperative period?	Gerontologic considerations, Bariatric patients, patients with disabilities, Patients undergoing ambulatory surgery, and Patients undergoing emergency surgery.
Gerontologic Considerations	-Older patients have less physiologic reserve [the ability of an organ to return to normal after disturbance in its equilibrium] than younger patients. -Cardiac reserves are lower, renal and hepatic functions are depressed and GI activity is likely reduced. -Respiratory and cardiac complications are the leading cause of postoperative morbidity and mortality in older adults. -Dehydration, constipation, and malnutrition may occur postoperatively. -Sensory limitations frequently interact with the postoperative environment, increasing the likelihood of falls. -Arthritis, common amongst older adults, affects mobility, potentially causing difficulty with turning patients or ambulating without discomfort. Requires protective measures. -Skin may be fragile and easily abraded. -Decreased subcutaneous fat causes increased susceptibility to temperature changes.
Bariatric Considerations	-Fatty tissues are more susceptible to infection. -Obesity increase risk of technical and mechanical problems related to surgery. [ex. dehiscence] -Increased cardiac demand due to excess weight. -Risk for hypoventilation and postoperative pulmonary complications when supine. -Acquired physical characteristics impede intubation.
Considerations for Patients with Disabilities	-Need for assistive devices, modification of patient education, and additional assistance with positioning and transfer.
Considerations for Patients Undergoing Ambulatory Surgery	-Limited time to assess and anticipate the needs of the patient and at the same time planning for discharge and follow-up home care.
Considerations for Patients Undergoing Emergency Surgery	-Limited preparation and unpredictability poses challenges. Calm and effective communication with patient and team members is increasingly important in these situations. -Factors affecting patients undergoing planned surgery still apply, but must be met within a condensed time frame.
What is Informed Consent?	Informed consent is the autonomous decision on whether to undergo a procedure. Informed consent requires that the patient understand the procedure to be preformed, benefits of the procedure, alternatives, risks, or complications of the procedure. Informed consent is only valid if the patient is mentally capable, of legal consenting age, and not coerced into agreement in anyway. Consent can be given by surrogate for those not of age or mental capability. Consent can be redacted. The patient has the legal right to refuse treatment.
What is the nurse's role in obtaining informed consent?	The nurse may ask the patient to sign the consent form and witness the signature. The surgeon is responsible for providing clear and simple explanation what the surgery will entail prior to consent. The nurse clarifies any information given and notifies the physician of a questions or concerns.
What must be assessed during the preoperative phase?	Assess allergies, medications, activity levels,. Assess nutritional and fluid status, dentition, drug or alcohol use, respiratory status, cardiovascular status, hepatic and renal function, endocrine function, immune function, previous medication use, psychosocial factors, spiritual and cultural beliefs.
Nutritional and Fluid Status	-Assessment identifies factors affecting surgical course, such as obesity, weight loss, malnutrition, nutrient deficiencies, metabolic abnormalities, and the effect of medications on nutrition. -Nutritional deficiencies can negatively affect recovery postoperatively -Dehydration, hypovolemia, and electrolyte imbalances can lead to significant problems in patients with comorbid medical conditions or in elderly patients.
Dentition	-Dental carries, dentures, and partial plates are particularly significant as the decayed teeth or dental prostheses may become dislodged during intubation and occlude the airway. -Any infection of the mouth may also cause postoperative infection.
Alcohol or Drug Use	-Ingestion of alcohol prior to surgery can weaken the immune system and increase the risk of postoperative infection. -Drug/Alcohol use may impede medication effectiveness. -If drug or alcohol use has occurred and the procedure cannot be delayed, to prevent vomiting and potential aspiration, a nasogastric tube should be placed prior to anesthesia. -A history of alcohol or drug abuse raises the patient's surgical risk -An alcohol dependent patient may experience withdrawal 2-4 day after their last drink. This increases risk of mortality due to dysrhythmias, cardiomyopathy, and bleeding tendencies seen with long-term alcohol abuse.
Respiratory Status	-The potential compromise of ventilation during the surgical period necessitates a proactive response to respiratory infection. -Patients with underlying respiratory diseases must be carefully assessed for threats to their pulmonary system. -Patients who smoke are advised to quit 4-8 weeks prior to surgery to reduce pulmonary and wound healing complications. -Patients who smoke are more likely to experience poor wound healing, SSI, and complications that include VTE and pneumonia.
Cardiovascular Status	-Assess the cardiovascular system's ability to support the oxygen, fluid, and nutritional needs of the perioperative period. -Surgery may be postponed if the patient has uncontrolled hypertension.. - Surgical treatment can at times be modified to meet the cardiac tolerance.
Hepatic and Renal Function	-Function of the liver and kidneys is needed so that medication, anesthetic agents, body wastes, and toxins are properly metabolized and removed from the body. -Surgery may be contraindicated in a patient who has acute renal problems as the kidneys are heavily involved in excreting anesthetic medications and their metabolism. (Exceptions being life-saving surgeries or those to improve urinary function or create easier access for dialysis.)
Endocrine Function	-Patients with diabetes undergoing surgery are at risk for hypo- and hyperglycemia. -Patients who have received corticosteroids must be monitored for adrenal insufficiencies . -Patients with uncontrolled thyroid disorders must be monitored for thyrotoxicosis or respiratory failure.
Immune Function	-Assessment of allergies, medication sensitivities, and past adverse reactions. -The mildest symptoms or slightest elevated temperature must be investigated.
Previous Medication Use	-Assess for possible interactions with medications to be administered and the effects that may any of these past medications may have on the perioperative course. -Include current and past medication, OTC medication, and herbal agents. -Any use of aspirin should be stopped 7-10 days prior to surgery.
What nursing interventions should take place during the preoperative phase?	Providing Patient Education, Providing Psychosocial Interventions, Maintaining Patient Safety, Managing Nutrition and Fluids, Preparing the Bowel, and Preparing the Skin.
What are some patient teachings a nurse might provide during the preoperative phase?	-Deep breathing, coughing, and incentive spirometry + Used to promote optimal lung expansion and resulting blood oxygenation +A sitting position enhances lung expansion +Patient is instructed to breath in deeply, exhale through the mouth, take a short breath and cough deeply within the lungs. +If an abdominal or thoracic incision is anticipated, the patient is taught to splint the site for incision support. +Proper deep breathing and coughing help mobilize secretions to be removed and help prevent atelectasis, pneumonia, or other lung complications. -Mobility and active body movement teachings +Improves circulation, prevents venous stasis, and promotes optimal respiratory function. +Early and frequent ambulation postoperatively can prevent complications +The Nurse teaches how to move side-to-side without pain or disrupting IV line, drainages tubes or other equipment. +Exercise of the extremities, unless contraindicated, helps to maintain ROM and muscle tone for easier ambulation
What are some patient teachings a nurse might provide during the preoperative phase? (Cont'd.)	-Pain management +Postoperatively medications should be administered to relieve pain with suppressing respiratory function. +The method of medication delivery should be discussed with the patient prior to surgery. +The patient's willingness and interest in using pain reliever medications should be assessed. -Cognitive coping strategies +May be used to decrease anxiety or fear, relieve tension, or achieving relaxation +Strategies include imagery, distractions, optimistic self-recitation, and music.
Managing Nutrition and Fluids	-The major purpose behind withholding food and fluids prior to surgery is to prevent aspiration. -Healthy patients are typically allowed clear fluids up to two before an elective procedure -Specific recommendations depend on the patient's age and the type of food eaten.
Preparing the Bowel	-Enemas are not typically prescribed unless the surgery is an abdominal or pelvic surgery. The goal is to allow visualization of the surgical site and and prevent trauma to the intestine or contamination by fecal matter.
Preparing the Skin	-The patient may be instructed to use a detergent-germicide to cleanse the of bacteria prior to the operation. -Generally hair is not removed unless expected to interfere. -To ensure correct site, the surgical site is marked by the patient and the surgeon prior to the procedure.
What immediate interventions should be done prior to the procedure?	Administering Preanesthetic Medication, Maintaining the Preoperative Record, Transporting the Patient to the Presurgical Area, and Attending to the Families Needs. The patient will don a hospital gown left untied and open, a paper cap is used to cover hair, jewellery is removed, and glasses, dentures, and other devices are removed,
Administering Preanesthetic Medication	-If prescribed, administered in preoperative holding area, patient is kept in the bed with rails raised, because medication can cause lightheadedness or drowsiness.
Maintaining the Preoperative Record	-Contains critical elements that must be checked and verified preoperatively -Attach consent, laboratory results, and nurses records.

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Preoperative Nursing Management

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	Created by Nicole Collins over 8 years ago