UNIT 6 HOMEWORK
Hinkle Chapter 17: Preoperative Nursing Management
I. Define the phases of perioperative patient care.
- Preoperative phase: begins when the decision to proceed with surgical
intervention is made and ends with the transfer of the patient onto the operating
room (OR) bed
- Intraoperative phase: begins when the patient is transferred onto the OR bed and
ends with admission to the PACU (post anesthesia care unit)
- Postoperative phase: begins with the admission of the patient to the PACU and
ends with a follow-up evaluation in the clinical setting or home
II. Describe a comprehensive preoperative assessment to identify pertinent health and
surgical risk factors.
- Health history and physical exam
- Medications and allergies
- Nutritional, fluid status
- Dentition
- Drug or alcohol use
- Respiratory and cardiovascular status
- Hepatic, renal function
- Endocrine function
- Immune function
- Previous medication use
- Psychosocial factors
- Spiritual, cultural beliefs
III. Describe considerations related to preoperative nursing care of older adult patients,
patients who are obese, and patients with disabilities.
- Geriatric: Cardiac reserves are lower, Renal and hepatic functions are depressed,
Gastrointestinal activity is likely to be reduced, Respiratory compromise,
decreased subcutaneous fat; more susceptible to temperature changes, may need
more time and multiple explanations to understand and retain what is
communicated restrictions
- Obese: Increased fatty tissue leads to an increased risk for infections, more
technical and mechanical problems, shallow respirations when in supine position
can lead to hypoventilation, dehiscence and wound infections more common
1
, - Disabilities: Assistive devices, modifications in education, additional assistance
with and attention to positioning or transferring
IV. Identify legal and ethical considerations related to obtaining informed consent for
surgery.
Informed consent is necessary in the following circumstances:
- Invasive procedures, such as a surgical incision, a biopsy, a cystoscopy, or
paracentesis; Procedures requiring sedation and/or anesthesia; A nonsurgical
procedure, such as an arteriography, that carries more than a slight risk to the
patient; Procedures involving radiation; Blood product administration
Must be voluntary, competent (or legal guardian), informed, and able to comprehend all
information related.
V. Describe preoperative nursing measures that decrease the risk for infection and
other postoperative complications.
A plan of action is designed so that potential complications are averted. Before any
surgical treatment is initiated, a health history is obtained, a physical examination is
performed during which vital signs are noted, and a baseline is established for future
comparisons. The nurse should ask about any allergies and comorbid conditions that may
affect anesthesia. Genetic considerations are also taken into account during assessment to
prevent complications with anesthesia. Asking the patient about use of prescription and
over-the-counter (OTC) medications, including herbal and other supplements provides
useful information. Activity and functional levels should be determined, including that
involving regular aerobic exercise. Known allergies to drugs, foods, and latex could avert
an anaphylactic response. If a patient states that he or she is allergic to kiwi, avocado, or
banana, or cannot blow up balloons, there may be an association with an allergy to latex.
VI. Describe the immediate preoperative preparation of the patient.
Administering Preanesthetic Medication: The use of preanesthetic medication is minimal with ambulatory
or outpatient surgery. If prescribed, it is usually given in the preoperative holding area. If a preanesthetic
medication is given, the patient is kept in bed with the side rails raised, because the medication can cause
lightheadedness or drowsiness.
Maintaining the Preoperative Record: The completed medical record (with the preoperative checklist and
verification form) accompanies the patient to the OR with the surgical consent form attached, along with all
laboratory reports and nurses’ records.
Transporting the Patient to the Presurgical Area: The patient is brought to the holding area or presurgical
suite about 30 to 60 minutes before the anesthetic is to be given.
Attending to Family Needs: The family and significant others should never judge the seriousness of an
operation by the length of time the patient is in the OR. A patient may be in the OR much longer than the
actual operating time for several reasons:
2
, - Patients are routinely transported well in advance of the actual operating time.
- The anesthesiologist or CRNA often makes additional preparations that may take 30 to 60 minutes.
- The surgeon may take longer than expected with the preceding case, which delays the start of the next
surgical procedure.
VII. Develop a preoperative education plan designed to promote the patient’s recovery
from anesthesia and surgery, thus preventing postoperative complications.
- Deep Breathing, Coughing, and Incentive Spirometry: educate the patient how to
promote optimal lung expansion and resulting blood oxygenation after anesthesia.
The patient assumes a sitting position to enhance lung expansion. The nurse then
demonstrates how to take a deep, slow breath and how to exhale slowly. After
practicing deep breathing several times, the patient is instructed to breathe deeply,
exhale through the mouth, take a short breath, and cough deeply in the lungs.
- Mobility and Active Body Movement: early and frequent ambulation
postoperatively, as tolerated, will help prevent complications. The goals of
promoting mobility postoperatively are to improve circulation, prevent venous
stasis, and promote optimal respiratory function. The nurse explains the rationale
for frequent position changes after surgery and then shows the patient how to turn
from side to side and how to assume the lateral position without causing pain or
disrupting intravenous (IV) lines, drainage tubes, or other equipment.
- Pain Management: A pain intensity scale should be introduced and explained to
the patient to promote more effective postoperative pain management.
Preoperative patient education also needs to include the difference between acute
and chronic pain so that the patient is prepared to differentiate acute postoperative
pain from a chronic condition such as back pain.
Hinkle 35: Assessment of Immune Function
1. Describe the body’s general immune responses.
Natural immunity: nonspecific response to any foreign invader
- White blood cell action: release cell mediators such as histamine, bradykinin, and
prostaglandins and engulf (phagocytize) foreign substances
- Inflammatory response
- Physical barriers, such as intact skin, chemical barriers, and acidic gastric secretions or
enzymes in tars and saliva
Acquired immunity: specific against a foreign antigen
- Result of prior exposure to an antigen
3
Hinkle Chapter 17: Preoperative Nursing Management
I. Define the phases of perioperative patient care.
- Preoperative phase: begins when the decision to proceed with surgical
intervention is made and ends with the transfer of the patient onto the operating
room (OR) bed
- Intraoperative phase: begins when the patient is transferred onto the OR bed and
ends with admission to the PACU (post anesthesia care unit)
- Postoperative phase: begins with the admission of the patient to the PACU and
ends with a follow-up evaluation in the clinical setting or home
II. Describe a comprehensive preoperative assessment to identify pertinent health and
surgical risk factors.
- Health history and physical exam
- Medications and allergies
- Nutritional, fluid status
- Dentition
- Drug or alcohol use
- Respiratory and cardiovascular status
- Hepatic, renal function
- Endocrine function
- Immune function
- Previous medication use
- Psychosocial factors
- Spiritual, cultural beliefs
III. Describe considerations related to preoperative nursing care of older adult patients,
patients who are obese, and patients with disabilities.
- Geriatric: Cardiac reserves are lower, Renal and hepatic functions are depressed,
Gastrointestinal activity is likely to be reduced, Respiratory compromise,
decreased subcutaneous fat; more susceptible to temperature changes, may need
more time and multiple explanations to understand and retain what is
communicated restrictions
- Obese: Increased fatty tissue leads to an increased risk for infections, more
technical and mechanical problems, shallow respirations when in supine position
can lead to hypoventilation, dehiscence and wound infections more common
1
, - Disabilities: Assistive devices, modifications in education, additional assistance
with and attention to positioning or transferring
IV. Identify legal and ethical considerations related to obtaining informed consent for
surgery.
Informed consent is necessary in the following circumstances:
- Invasive procedures, such as a surgical incision, a biopsy, a cystoscopy, or
paracentesis; Procedures requiring sedation and/or anesthesia; A nonsurgical
procedure, such as an arteriography, that carries more than a slight risk to the
patient; Procedures involving radiation; Blood product administration
Must be voluntary, competent (or legal guardian), informed, and able to comprehend all
information related.
V. Describe preoperative nursing measures that decrease the risk for infection and
other postoperative complications.
A plan of action is designed so that potential complications are averted. Before any
surgical treatment is initiated, a health history is obtained, a physical examination is
performed during which vital signs are noted, and a baseline is established for future
comparisons. The nurse should ask about any allergies and comorbid conditions that may
affect anesthesia. Genetic considerations are also taken into account during assessment to
prevent complications with anesthesia. Asking the patient about use of prescription and
over-the-counter (OTC) medications, including herbal and other supplements provides
useful information. Activity and functional levels should be determined, including that
involving regular aerobic exercise. Known allergies to drugs, foods, and latex could avert
an anaphylactic response. If a patient states that he or she is allergic to kiwi, avocado, or
banana, or cannot blow up balloons, there may be an association with an allergy to latex.
VI. Describe the immediate preoperative preparation of the patient.
Administering Preanesthetic Medication: The use of preanesthetic medication is minimal with ambulatory
or outpatient surgery. If prescribed, it is usually given in the preoperative holding area. If a preanesthetic
medication is given, the patient is kept in bed with the side rails raised, because the medication can cause
lightheadedness or drowsiness.
Maintaining the Preoperative Record: The completed medical record (with the preoperative checklist and
verification form) accompanies the patient to the OR with the surgical consent form attached, along with all
laboratory reports and nurses’ records.
Transporting the Patient to the Presurgical Area: The patient is brought to the holding area or presurgical
suite about 30 to 60 minutes before the anesthetic is to be given.
Attending to Family Needs: The family and significant others should never judge the seriousness of an
operation by the length of time the patient is in the OR. A patient may be in the OR much longer than the
actual operating time for several reasons:
2
, - Patients are routinely transported well in advance of the actual operating time.
- The anesthesiologist or CRNA often makes additional preparations that may take 30 to 60 minutes.
- The surgeon may take longer than expected with the preceding case, which delays the start of the next
surgical procedure.
VII. Develop a preoperative education plan designed to promote the patient’s recovery
from anesthesia and surgery, thus preventing postoperative complications.
- Deep Breathing, Coughing, and Incentive Spirometry: educate the patient how to
promote optimal lung expansion and resulting blood oxygenation after anesthesia.
The patient assumes a sitting position to enhance lung expansion. The nurse then
demonstrates how to take a deep, slow breath and how to exhale slowly. After
practicing deep breathing several times, the patient is instructed to breathe deeply,
exhale through the mouth, take a short breath, and cough deeply in the lungs.
- Mobility and Active Body Movement: early and frequent ambulation
postoperatively, as tolerated, will help prevent complications. The goals of
promoting mobility postoperatively are to improve circulation, prevent venous
stasis, and promote optimal respiratory function. The nurse explains the rationale
for frequent position changes after surgery and then shows the patient how to turn
from side to side and how to assume the lateral position without causing pain or
disrupting intravenous (IV) lines, drainage tubes, or other equipment.
- Pain Management: A pain intensity scale should be introduced and explained to
the patient to promote more effective postoperative pain management.
Preoperative patient education also needs to include the difference between acute
and chronic pain so that the patient is prepared to differentiate acute postoperative
pain from a chronic condition such as back pain.
Hinkle 35: Assessment of Immune Function
1. Describe the body’s general immune responses.
Natural immunity: nonspecific response to any foreign invader
- White blood cell action: release cell mediators such as histamine, bradykinin, and
prostaglandins and engulf (phagocytize) foreign substances
- Inflammatory response
- Physical barriers, such as intact skin, chemical barriers, and acidic gastric secretions or
enzymes in tars and saliva
Acquired immunity: specific against a foreign antigen
- Result of prior exposure to an antigen
3
