Preoperative Patient Priorities
- Components include:
- Consent for the procedure itself
- Name of 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
- Names power of attorney
- Surgeon:
- Solely responsible for obtaining consent in the presence of the patient and one witness.
- Preoperative nurse:
- Role is to clarify information and ensure patient understanding.
- Corrects common misconceptions and eases concerns of the patient, family members, or support persons.
Time Out/Pause for a Cause
- Ensures:
- Correct patient
- Correct procedure
- Correct surgical site
Patient Assessment - Patient History
- Age
- Allergies and sensitivities to latex
- Current medications, including over-the-counter medications, vitamins, and herbal supplements
- Medical history and treatment plans
- Surgical history
- Previous anesthesia and responses to anesthesia
- Last oral intake
- Any medical implants or devices
- Any piercings
- Dental implants
- Nutrition deficiencies
- Family history
- Social history, including smoking and drug and alcohol habits
- History of mental illness or abuse
- Support system and living conditions
- Advance directives
- Full medical history
- Chronic conditions
- Implants
Patient Assessment - Surgical and Anesthesia History
- Previous surgery
- Poor healing
- Negative responses to anesthesia
- Allergies:
- Thoroughly document medications, food, medical dyes, latex, medical adhesives, environmental conditions
Patient Assessment - Medications and Intake
- Identify all home medications
- Medications taken prior to surgery
- Include herbal remedies and over-the-counter drugs
- Last oral intake:
- Guidelines dependent upon institution and population
- Full stomach increases risk for aspiration
- Alcohol, smoking, drug use
Patient Assessment - Special Considerations
- Use care when collecting information
- All psychosocial questions, such as questions about abuse at home and gynecological and mental illness, must be asked with no other family or support persons present.
- Height and weight
- Vital signs
Systems Assessment
- Cardiovascular
- Respiratory
- Neurological
- Liver/renal
- Integumentary
- Gastrointestinal
- Genitourinary
Patient Preparation for the Surgical Experience – Laboratory Assessment
- Type and screen
- Complete metabolic panel
- Coagulation studies
- Complete blood count
- Urinalysis
- Pregnancy test
Patient Preparation for the Surgical Experience – Radiological Assessment
- MRI
- Ultrasound
- CAT Scans
- X-rays
Patient Preparation - Teaching
- Patient teaching
- Anticipatory guidance
- Recovery
- DVT prophylaxis
- Mobility
- Preventing pneumonia
Physical Preparations
- Intravenous line
- Bowel and bladder preparation
- Skin preparation
- Medications
Transfer - Ensuring Completion
- Consents completed
- History and assessment complete
- Learning needs met
- Skin and bowel prep complete
- Preoperative medication administered
Nursing Management - Diagnoses
- Nursing diagnoses
- Fear and anxiety related to loss of control and the unknown
- Knowledge deficit: treatment procedure
Nursing Management - Assessments
- Assessments
- Vital signs
- Physical examination
- Laboratory analysis
- Last oral intake
- Confirm skin and bowel prep completed
Nursing Management - Actions
- Actions
- Ensure removal of jewelry and prosthetics
- Inform anesthesia and surgical personnel of presence of any implants
- Time-out
- I V insertion
- Teaching
- What to expect of the OR experience helps control anxiety and increase patient comfort.
- How to prevent postoperative complications
- Knowledge of postoperative teaching, such as coughing, deep breathing, early ambulation, and leg and ankle exercises, significantly reduces the risk of postoperative complications.