Preoperative Care

1. Preoperative Care

2. Preoperative Period • Begins when the patient is scheduled for surgery and ends at the time of transfer to the surgical suite. • Nurse functions as educator, advocate, and promoter of health and safety.

3. Reason for Surgery • Diagnostic • Curative • Palliative • Preventive • Explorative • Cosmetic

4. Urgency of Surgery • Urgency: • Elective • Emergent May be performed in a variety of settings.

5. Patient Interview and Nursing Assessment • Psychosocial Assessment • Patient Interview

6. Nursing Assessment • Past Health History • Medications • Allergies

7. Review of Systems • Cardiovascular system • Respiratory system • Neurologic system • Genitourinary system • Hepatic system • Integumentary system • Musculoskeletal system • Endocrine system • Immune system • Fluid and Electrolyte status • Nutritional status

8. Objective DataPhysical ExaminationLaboratory and Diagnostic Testing • Urinalysis • Blood type and crossmatch • Complete blood count or hemoglobin level and hematocrit • Clotting studies • Electrolyte levels • Serum creatinine level, BUN • Pregnancy test (HCG) • Chest x-ray examination • Electrocardiogram

9. Nursing Management • Preoperative teaching. • Informed consent: • Physician is responsible for obtaining signed consent before sedation and/or surgery. • The nurse’s role may be witnessing the patient’s signature on the consent form and being a patient advocate, verifying that the patient or family understands the information presented in the consent form and that consent for surgery is truly voluntary. Consent can be withdrawn at any time.

10. Day of Surgery Preparation • Nursing responsibilities immediately before surgery • Final preoperative teaching • Assessment and communication of pertinent findings • Ensuring that all preoperative preparation orders have been completed • Ensuring that records and reports are present and complete to accompany the patient to the OR.

11. Preoperative Chart Review • Ensure all documentation, preoperative procedures, and orders are complete. • Check the surgical consent form and others for completeness. • Document allergies. • Document height and weight. • History and Physical. • Baseline vital signs.

12. Preoperative Chart Review (Cont’d) • Ensure results of all laboratory and diagnostic tests are on the chart. • Document and report any abnormal results. • Report special needs and concerns.

13. Preoperative Patient Preparation • Patient should remove most clothing and wear a hospital gown. • Valuables should remain with family member or be locked up. • Tape rings in place if they cannot be removed. • Remove all pierced jewelry.

14. Preoperative Patient Preparation (Cont’d) • Patient wears an identification band. • Dentures, prosthetic devices, hearing aids, contact lenses, fingernail polish, and artificial nails must be removed.

15. Preoperative Drugs • Reduce anxiety • Promote relaxation • Reduce nasal and oral secretions • Inhibit gastric secretion • Decrease the amount of anesthetic needed for the induction and maintenance of anesthesia • Prevent Post-Op infection • Increase gastric emptying; prevent nausea and vomiting • Relieve pain during preoperative procedures

16. Patient Transfer to Surgical Suite