Pre-Operative Nursing Care Study Notes

Introduction to Pre-Operative Nursing Care

  • The lecture covers pre-operative nursing care of surgical patients.

  • Objectives for this lecture include:

    • Define pre-operative nurse.

    • List responsibilities of the pre-operative nurse.

    • Identify major concerns of pre-operative patient care.

    • Explain the importance of informed consent.

Definition of Surgery

  • Surgery: Defined by purpose, body location, extent, and degree of urgency.

  • Surgical settings include:

    • Hospitals

    • Outpatient ambulatory surgical centers

    • Outpatient offices

  • Discharge can be same day or require admission post-surgery.

  • Safety: Always a top goal regardless of setting or demographics.

National Patient Safety Goals (NPSGS)

  • Focus on communication among surgical teams to achieve desired outcomes.

  • Key points (2020 focus):

    • Correct procedure on the correct patient at the correct body location.

    • Correct site marking for surgery.

    • Conducting a surgical timeout to prevent errors.

Role of the Perioperative Nurse

  • Vital in ensuring correct patient identification, chart accuracy, and avoiding wrong site surgery.

  • SBAR Communication System: Ensures appropriate situation, background, assessment, and recommendations are communicated.

  • Surgical Care Improvement Project (SCIP): Initiated in 2006, aimed at tracking compliance to reduce surgical complications, focusing on:

    • Antibiotic administration

    • Hair removal process

    • Urinary catheter discontinuation timing

    • VTE prophylaxis.

Surgical Safety Checklist

  • Ensures patient readiness for scheduled procedures.

  • Important elements include:

    • Removal of jewelry and personal items to prevent contamination and loss.

    • Appropriate medication administration or withholding before procedures.

    • Inclusion of all necessary pre-surgery paperwork: HMP, pre-anesthetic eval, DNR, pregnancy test, imaging, etc.

Pre-Operative Phase

  • Duration: From scheduling until transfer to the surgical suite.

  • Thorough Assessment: Critical for positive surgical outcomes, focused on:

    • Patient’s physical, psychological, psychosocial, cultural, and spiritual needs.

  • Assessment aids in identifying problems, planning care, and anticipating outcomes.

Patient History

  • Detailed, confidential history must be taken:

    • Can be conducted pre-surgery or directly before.

    • Includes:

    • Patient's age, general health, review of systems.

    • Medical, surgical, family history (e.g., reactions to anesthesia, relevant familial surgeries).

    • Current medications, allergies (especially latex), substance use (alcohol, tobacco, illicit drugs, vaping).

    • History of malignant hyperthermia, cancer, or bleeding disorders.

    • Psychosocial status, support systems, understanding of the procedure.

    • Cultural and spiritual needs (e.g., blood transfusions, religious practices pre-surgery).

Laboratory Assessments

  • Common labs that may be assessed include:

    • Type and screen

    • CBC

    • Clotting studies

    • Metabolic panel

    • Pregnancy tests (if applicable)

    • Urinalysis (for drug screening)

    • EKG (especially if patient has pacemaker, ICD).

Patient Education

  • Teaching pre-operative interventions crucial for preparation:

    • Use of incentive spirometer before surgery.

    • Education on post-surgery aids (crutches, braces, wheelchairs).

    • Ensures patients understand usage before the need arises.

Discharge Planning

  • Begins during the initial assessment:

    • Assess home environment and support systems.

    • Identifies anticipated needs proactively.

Common Perioperative Nursing Diagnoses

  • Common diagnoses may include:

    • Fear and anxiety

    • Knowledge deficit

    • Impaired coping

    • Hypoalmia

  • Important interventions include teaching and preparation.

Informed Consent

  • Informed: Patients must be educated about the procedure.

    • Education is the responsibility of the proceduralist/surgeon, while the nurse ensures the patient is informed.

  • Consent: Signifies agreement or permission to proceed with the surgery.

    • Cannot sign consent without prior information.

  • Obtain: Refers to the nurse's duty to witness the informed consent process, signing only after observing the conversation between the patient and the physician.

  • Example scenario: Night nurse must sign consent if they witnessed the consent process.

  • Must be obtained before sedation—patient needs to be of sound mind to sign; otherwise, POA signs.

  • For patients under 18, a parent or guardian signs unless emancipated.

  • Patients can withdraw consent up to anesthesia induction regardless of consequences.

Advanced Directives

  • Defined by Patient Self-Determination Act:

    • Includes living wills and durable power of attorney.

    • Must be honored regardless of patient’s surgical status.

NPO Status

  • NPO (nothing per os): Prohibits eating, drinking, smoking, or medications unless approved by the surgeon.

  • Purpose: Ensure an empty stomach pre-anesthetic administration to prevent aspiration.

  • Fasting guidelines:

    • 8 hours for fatty or protein foods.

    • 6 hours for other foods.

    • 2 hours for clear liquids.

    • Adhere to facility policies and surgeon orders.

Medications on the Day of Surgery

  • Typically, most routine medications are held pre-surgery.

  • Exceptions may include:

    • Cardiac medications (beta blockers)

    • Seizure medications

    • Respiratory medications (albuterol)

    • Antihypertensives (with small sips of water).

  • Diabetic patients require special considerations for blood glucose management.

Skin and Bowel Preparation

  • Bowel Prep: Necessary to prevent colon injuries and reduce bacteria before abdominal or pelvic surgeries:

    • Potential interventions: enemas or laxatives; may stress the patient and lead to complications.

  • Skin Prep: Ensures skin integrity to prevent microbial entry:

    • Antimicrobial soap (e.g., chlorhexidine gluconate) usage 1-2 days prior to surgery.

Conclusion

  • Pre-operative nursing care is essential for optimizing surgical outcomes and ensuring patient safety throughout the surgical process. This lecture has provided an overview of the responsibilities, concerns, and preparations needed leading up to surgery.