Priorities for the Preoperative Patient
Chapter 15: Priorities for the Preoperative Patient
Introduction
Roles of the Preoperative Nurse:
Educator
Advocate
Preoperative Checklist Components:
Documentation
Assessment
Physical Preparation
Educational Needs
Informed Consent
Components of Informed Consent:
Consent for the procedure itself
Name of the surgeon performing the surgery
Reason the intervention will benefit the patient
Alternative options to surgery
Consent for anesthesia
Consent to administer blood products
Advanced Directives
Patient Self-Determination Act of 1991:
Defines patient's wishes regarding medical interventions
Designation of a power of attorney for healthcare decisions
Obtaining Informed Consent
Key Personnel Involved:
Surgeon
Preoperative nurse
Time Out/Pause for a Cause
Purpose of Time Out:
To ensure the following are correct:
Correct patient
Correct procedure
Correct surgical site
Patient Assessment
Comprehensive Patient History:
Vital Aspects of History:
Age
Allergies and sensitivities (especially to latex)
Current medications, including over-the-counter, vitamins, and herbal supplements
Medical history and treatment plans
Previous surgical history
Reactions to previous anesthesia
Last oral intake
Presence of medical implants or devices
Body piercings and dental implants
Additional Items in Patient History:
Nutritional deficiencies
Family history of health issues
Social history (smoking, drug and alcohol use)
Any history of mental illness or abuse
Support systems and living conditions
Existence of advance directives
Specific Areas of Medical History to Assess:
Chronic Conditions:
Document any chronic medical conditions and treatments
Surgical and Anesthesia History:
Prior surgeries and responses to anesthesia
Document any conditions related to healing processes
Allergy Assessments:
Includes medications, food, dyes, latex, adhesives, and environmental factors
Medication Assessment:
Identify all home medications
Medications taken before the surgery, including herbal remedies
Last Oral Intake:
Varies by institution and clinical situation
Importance: A full stomach increases the risk of aspiration
Special Considerations
Collecting Sensitive Information:
Approach with care and sensitivity
Physical Assessment
Key Components:
Height and weight
Vital signs
Systems Assessment
Areas Assessed:
Cardiovascular
Respiratory
Neurological
Liver/Renal
Integumentary
Gastrointestinal
Genitourinary
Patient Preparation for the Surgical Experience
Diagnostic Assessments:
Laboratory Assessment
Radiological Assessment
Teaching Patients:
Anticipatory guidance about surgery and recovery
Deep vein thrombosis (DVT) prophylaxis
Mobility post-surgery
Preventing pneumonia
Physical Preparations
Preoperative Actions:
Establish IV line
Prepare bowel and bladder
Perform skin preparation
Administer necessary medications
Transfer to Surgical Unit
Checklist Before Transfer:
Ensure consents are completed
Verify history and assessment completeness
Confirm learning needs have been addressed
Ensure skin and bowel prep are complete
Preoperative medications administered
Nursing Management
Common Nursing Diagnoses:
Fear and anxiety
Knowledge deficit
Essential Assessments:
Monitor vital signs
Conduct physical examination
Lab analyses
Last oral intake verification
Confirm completion of skin and bowel prep
Nursing Actions:
Finalize preoperative checklist
Verifiably remove jewelry and prosthetics
Inform anesthesia/surgical team about implants
Conduct time-out procedure
Insert IV
Patient Teaching Objectives:
Provide an overview of the OR experience
Educate on postoperative complication prevention
Discuss pharmacological and non-pharmacological pain management options
Case Study: Episode 1
Patient Profile:
Name: Maria Gonzalez
Age: 40
Children: 2 (aged 4 and 6)
Medical History: Fibroid tumors, history of deep vein thrombosis (DVT) during last pregnancy
Allergies: Penicillin and latex
Smoking History: 10 cigarettes/day for 20 years
Vital Signs Noted:
Blood Pressure: 140/88 mm Hg
Heart Rate: 80 bpm
Respirations: 20/min
Temperature: 98.7°F (37°C)
Pain Score: 0 out of 10
Case Study: Episode 1 Continued
Patient Concerns:
Expressed anxiety about hospital stay and upcoming procedure
Comments on lack of previous hospital experience (other than childbirth)
Anxiety regarding anesthesia and post-discharge childcare considerations
Case Study Wrap-Up
Nursing Responses:
Completed preoperative prep, inserted IV line
Initiated normal saline
Informed anesthesia provider about allergies and smoking history
Assisted Maria in understanding what to expect in the OR and postoperative care, including childcare plans
Case Study Questions
Maria expresses anxiety about the procedure and anesthesia. What is the most appropriate response?
A. Tell her, “It’s okay; we do this every day.”
B. Assure her that her fears are normal and encourage her to use consultation time with the surgeon and anesthesiologist.
C. Share a friend's similar experience.
D. Document her concerns for PACU nurse awareness.
Maria's allergy to latex. What action prevents an allergic reaction during surgery?
A. Clean OR thoroughly and remove all latex products.
B. Schedule her as the first case for the day with non-latex items.
C. Assume all surgical suites are latex-free.
D. Prepare for emergency response due to the impossibility of ensuring a latex-free environment.
Given Maria's smoking history, she is at risk for which issues? (Select all that apply.)
A. Increased postoperative pain
B. Difficulty with anesthesia
C. Respiratory depression during the procedure
D. Slower healing time post-surgery
E. Increased risk of DVT
How can the nurse determine effective teaching?
A. “My neighbor could eat right up to her procedure.”
B. “Nothing can be done about nausea post-surgery.”
C. “That IV line will stay during the procedure.”
D. “I will need blood during this procedure.”
What is the nurse's priority responsibility before the procedure?
A. Explain procedure and obtain consent signature
B. Discuss anesthesia risks
C. Mark surgical site with patient
D. Ensure preoperative assessment completion