NURS 3620 Adult Health I Nursing
Surgical Nursing – Chapters 17-19
Chapter 17 Perioperative Care
I. Surgical Settings
A. What are the three types of surgery?
1. Elective surgery carefully planned event
2. Emergency surgery unexpected surgery
3. Ambulatory surgery majority of surgical procedures (also called same-day or
outpatient surgery)
II. Patient Interview
A. What are the primary purposes of the patient interview?
The primary purposes of the interview are to obtain the patient’s health
information, provide information regarding the surgical experience, and assess the
patient’s readiness for surgery. It provides the patient and caregiver an opportunity
to ask questions.
B. What is the overall goal of the preoperative assessment?
The preoperative assessment is performed to determine the patient’s psychological
status and physiologic factors that may contribute to operative risk factors
1. In order to meet the overall goal of preop assessment, what actions must the
nurse take?
Establish baseline detail, determine psychological status to reinforce use of
coping strategies, determine physiologic factors, identify and document the
surgical site, identify prescription, over-the-counter drugs, and herbs taken by
the patient; confirm lab and diagnostic study results; note cultural and ethnic
factors that may affect the surgical experience; and validate that the informed
consent form has been signed and witnessed
C. Subjective Data
1. Psychosocial Assessment
a. Anxiety
What often is the cause of anxiety in surgical clients?
Fear of the unknown, lack of knowledge, also when surgery is in conflict with
their religious or cultural beliefs
b. Fears
What are the five fears faced by surgical clients?
Fear of death – notify HCP if pt has strong fear of death b/c emotional state
influences stress response and surgical outcome
Fear of pain and discomfort – notify ACP
Fear of mutilation or alteration in body image
Fear of anesthesia – notify ACP is fear is identified
Fear of disruption of life functioning
, c. Hope
Positive attribute, may be the patient’s strongest method of coping
2. Past Health History
What is the significance of knowledge of pt’s past health history?
Determine if pt understands the need for surgery for example, a patient scheduled
for a total knee replacement may indicate that increasing pain and immobility are
the reasons for surgery
- Ask about inherited traits because it can contribute to surgical outcome
3. Medications
Why is review of current medications prior to surgery important?
To determine if the interaction of the pt’s current drugs and anesthetics can
increase or decrease the desired physiologic affect of anesthetics – include
herbals and recreational drug use
Should patients take their prescribed medications?
Patients on long term anticoagulation therapy (Warfarin, rivaroxaban,
dibagatran, apizaban) present a unique challenge. The options include
a) Continuing therapy
b) Withholding therapy for a time before and after surgery
c) Withholding the therapy and starting subq or IV heparin therapy during the
peri-op period
4. Allergies
If a client reports an allergy, of any kind what should the nurse do?
Record all drug intolerances and allergies and, if appropriate, place an allergy
identification band on the patient on the day or surgery
- Notify the ACP if the pt reports an allergy to sulfur-containing drugs
5. Review of Systems REFER TO TABLE 17-4
Review of the component and identify the nurse’s responsibility to assess and
document
a. Cardiovascular
- Inquire about the pt’s current treatment and the level of functioning. A
cardiology consult is often required before surgery if pt has a significant CV
history
- If pt has a history of hypertension, the ACP may give vasoactive drugs to
maintain adequate BP during surgery
- If pt has prosthetic heart valve, antibiotic prophylaxis may be needed before
surgery to decrease endocarditis
- Postop venous thromboembolism (VTE) ** CONCERN**. Amtiembolism
stockings or sequential compression devices may be applied in the postop
holding area
b. Respiratory
- Elective surgery may be postponed if the person has an upper respiratory
infection = increased risk of bronchospasm, laryngospasm, decreased O2 sat,
and problems w/respiratory secretions
Surgical Nursing – Chapters 17-19
Chapter 17 Perioperative Care
I. Surgical Settings
A. What are the three types of surgery?
1. Elective surgery carefully planned event
2. Emergency surgery unexpected surgery
3. Ambulatory surgery majority of surgical procedures (also called same-day or
outpatient surgery)
II. Patient Interview
A. What are the primary purposes of the patient interview?
The primary purposes of the interview are to obtain the patient’s health
information, provide information regarding the surgical experience, and assess the
patient’s readiness for surgery. It provides the patient and caregiver an opportunity
to ask questions.
B. What is the overall goal of the preoperative assessment?
The preoperative assessment is performed to determine the patient’s psychological
status and physiologic factors that may contribute to operative risk factors
1. In order to meet the overall goal of preop assessment, what actions must the
nurse take?
Establish baseline detail, determine psychological status to reinforce use of
coping strategies, determine physiologic factors, identify and document the
surgical site, identify prescription, over-the-counter drugs, and herbs taken by
the patient; confirm lab and diagnostic study results; note cultural and ethnic
factors that may affect the surgical experience; and validate that the informed
consent form has been signed and witnessed
C. Subjective Data
1. Psychosocial Assessment
a. Anxiety
What often is the cause of anxiety in surgical clients?
Fear of the unknown, lack of knowledge, also when surgery is in conflict with
their religious or cultural beliefs
b. Fears
What are the five fears faced by surgical clients?
Fear of death – notify HCP if pt has strong fear of death b/c emotional state
influences stress response and surgical outcome
Fear of pain and discomfort – notify ACP
Fear of mutilation or alteration in body image
Fear of anesthesia – notify ACP is fear is identified
Fear of disruption of life functioning
, c. Hope
Positive attribute, may be the patient’s strongest method of coping
2. Past Health History
What is the significance of knowledge of pt’s past health history?
Determine if pt understands the need for surgery for example, a patient scheduled
for a total knee replacement may indicate that increasing pain and immobility are
the reasons for surgery
- Ask about inherited traits because it can contribute to surgical outcome
3. Medications
Why is review of current medications prior to surgery important?
To determine if the interaction of the pt’s current drugs and anesthetics can
increase or decrease the desired physiologic affect of anesthetics – include
herbals and recreational drug use
Should patients take their prescribed medications?
Patients on long term anticoagulation therapy (Warfarin, rivaroxaban,
dibagatran, apizaban) present a unique challenge. The options include
a) Continuing therapy
b) Withholding therapy for a time before and after surgery
c) Withholding the therapy and starting subq or IV heparin therapy during the
peri-op period
4. Allergies
If a client reports an allergy, of any kind what should the nurse do?
Record all drug intolerances and allergies and, if appropriate, place an allergy
identification band on the patient on the day or surgery
- Notify the ACP if the pt reports an allergy to sulfur-containing drugs
5. Review of Systems REFER TO TABLE 17-4
Review of the component and identify the nurse’s responsibility to assess and
document
a. Cardiovascular
- Inquire about the pt’s current treatment and the level of functioning. A
cardiology consult is often required before surgery if pt has a significant CV
history
- If pt has a history of hypertension, the ACP may give vasoactive drugs to
maintain adequate BP during surgery
- If pt has prosthetic heart valve, antibiotic prophylaxis may be needed before
surgery to decrease endocarditis
- Postop venous thromboembolism (VTE) ** CONCERN**. Amtiembolism
stockings or sequential compression devices may be applied in the postop
holding area
b. Respiratory
- Elective surgery may be postponed if the person has an upper respiratory
infection = increased risk of bronchospasm, laryngospasm, decreased O2 sat,
and problems w/respiratory secretions
