Chapter14

Chapter 14: Preoperative Nursing Management

Overview of the Perioperative Phases

• Preoperative Phase: Begins when surgical intervention decision is made and ends with patient transfer to the operating room (OR).

• Intraoperative Phase: Starts at patient transfer to OR bed and ends with admission to the PACU (Post-Anesthesia Care Unit).

• Postoperative Phase: Begins with PACU admission and ends with follow-up evaluation in clinical or home setting.

Surgical Classifications

• Purpose: Facilitate diagnosis, enable cure/repair.

• Types of Surgery:

  • Reconstructive

  • Cosmetic

  • Palliative

  • Rehabilitative

• Urgency Levels:

  • Emergent

  • Urgent

  • Required

  • Elective

  • Optional

Preadmission Testing

• Initiates nursing assessment process.

• Admission Information Includes:

  • Demographics

  • Health history

  • Surgical procedure specifics.

• Verifies completion of preoperative diagnostic tests as needed.

• Starts discharge planning by assessing transportation and postoperative care needs.

Preoperative Assessment #1

• Components to Review:

  • Health history and physical examination

  • Current medications and allergies

  • Nutritional and fluid status

  • Dentition health

  • Drug or alcohol use

  • Respiratory and cardiovascular status

  • Hepatic and renal function

Preoperative Assessment #2

• Additional Components:

  • Endocrine function

  • Immune function

  • Previous medication uses

  • Psychosocial factors

  • Spiritual and cultural beliefs

Medications Affecting Surgical Experience

• Important medications to assess include:

  • Corticosteroids

  • Diuretics

  • Phenothiazines

  • Tranquilizers

  • Insulin

  • Antibiotics

  • Anticoagulants

  • Anticonvulsants

  • Thyroid hormones

  • Opioids

  • Over-the-counter and herbal medications.

Question Discussion

• Question #1:

  • Identify medication classification assessed during preoperative period due to risk of electrolyte imbalance: Answer: Diuretics.

  • Rationale: Diuretics can lead to respiratory depression due to electrolyte imbalance; corticosteroids may cause cardiovascular collapse if stopped suddenly; phenothiazines increase anesthetic hypotensive actions; insulin requires careful consideration in diabetic patients.

Gerontologic Considerations

• Decreased cardiac reserves and compromised renal/hepatic function.

• Reduced gastrointestinal activity and respiratory function.

• Increased susceptibility to temperature changes due to decreased subcutaneous fat.

• May require more time and varied educational formats for understanding.

Special Considerations During Preoperative Period

• Patients with obesity or disabilities.

• Individuals undergoing ambulatory or emergency surgery.

Informed Consent

• Must be in writing prior to non-emergent surgeries.

• Legal Mandate: Surgeon explains procedure, benefits, risks, and complications.

• Nurse clarifies information and witnesses signature.

• Consent is valid only if signed before psychoactive premedication is administered and accompanies the patient to the OR.

Question Discussion

• Question #2:

  • Is voluntary, written informed consent required before non-emergent surgery just to protect the surgeon? Answer: False.

  • Rationale: Consent protects the patient from unauthorized surgery and helps ensure the patient understands the procedure.

Patient Education

• Focus on:

  • Deep breathing and coughing techniques; use of incentive spirometry.

  • Mobility and active movement.

  • Pain management strategies.

  • Cognitive coping techniques.

  • Instructions specific to ambulatory surgery patients.

Immediate Preoperative Nursing Interventions

• Ensure patient changes into gown, covers hair, inspects mouth, removes jewelry, and secures valuables.

• Administer preanesthetic medication.

• Maintain preoperative records.

• Transport patient to presurgical area.

• Attend to family needs.

General Preoperative Nursing Interventions

• Provide psychosocial support:

  • Reducing anxiety and fear.

  • Respecting cultural, spiritual, and religious beliefs.

• Maintaining patient safety.

• Managing nutrition and fluids.

• Preparing bowel and skin.

Question Discussion

• Question #3:

  • What is the first action the nurse should take before administering premedication? Answer: Have the patient void.

  • Rationale: Ensuring the patient's safety to prevent falls post-medication is crucial; shaving is outdated; family presence and warmth can be addressed later.

Expected Outcomes

• Relief of anxiety and decreased fear.

• Understanding of the surgical procedure.

• No evidence of preoperative complications.