NURS 371 EXAM: Priorities for the Preoperative Patient guide 2022

NURS 371 EXAM: Priorities for the Preoperative Patient
guide 2022

 Preoperative nurse
 Educator
 Advocate
 Preoperative checklist
 Documentation
 Assessment
 Physical preparation
 Educational needs
The preoperative phase commences when the decision for surgery is made and ends when the pt is
transferred to the surgical suite during this time, the preoperative nurse takes on a multitude of roles,
including educator, advocator, and admitted nurse. The nurse’s main priority is to complete a
preoperative checklist. Each facility’s unique checklist that is the necessary documentation, admission
assessment, physical preparation, and education needs have been completed prior to the pt entering the
surgical suite.
Informed consent
 Components include:
 Consent for procedure itself
 Name of surgeon to perform surgery
 Reason intervention will benefit the patient
 Alternative options to surgery
 Consent for anesthesia
 Consent to administer blood products
Informed consent is when a pt autonomously & cognitively grants permission to a provider to perform a
surgical procedure after considering all alternative, benefits, & risks of the procedure. Although
obtaining consent is not the role of the nurse but that of the provider, it is the nurse's responsibility to
ensure that the pt has all the information needed & an informed decision about the procedure being
offered.
Advance Directives
 Patient Self-Determination Act of 1991
 Defines patient’s wishes
 Name power of attorney
The pt self- determination Act of 1991 grants all pts the right to determine and direct their care in times
of medical emergency: The right to create an advance directive defines a pt’s wishes should he or she be
deemed incompetent to express his or her wishes in a medical emergency. Facilities are required by law
to provide the means and guidance to complete an advance directive if desired prior to surgery.
Within the advance directive the pt may name a durable medical power of attorney, usually a spouse or
adult child, who is designated to make all medical decisions should the pt become incompetent. The
advance directive also allows the pt to express desire related to organ donation and end-of-life issues.
Obtaining Informed Consent
 Surgeon

,NURS 371 EXAM: Priorities for the Preoperative Patient
guide 2022

 Preoperative nurse
The role of the surgeon is to obtain consent for the procedure. The surgeon is soley responsible for
obtaining consent in the presence of the patient and one witness.


Time out /Pause for a cause
 Correct patient
 Correct procedure
 Correct surgical site


Patient Assessment
 Patient History
 Age
 Allergies & sensitivities to latex
 Current meds, including over-the-counter medications, vitamins, & herbal supplements
 Medical history & treatment plans
 Surgical history
 Previous anesthesia & 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
Completed pt medical, social, and surgical histories are the key to a successful surgical experience.
These questions may be asked during a preoperative work-up or upon admission to the surgical
procedure. As the nurse prepares the pt fur surgery, he or she asks a series of detailed questions. Some of
the questions may be very personal, and at times, uncomfortable for the pt to answer. The nurse should
remind the pt that this information is important in providing a safe outcome. It is also important to assure
the pt that no judgement will be made on his or her responses & that the information will be used only for
medical purposes.
 Medical history
 Full medical history
 Chronic conditions
 Implants
 Surgical and anesthesia history
 Previous surgery
 Poor healing

, NURS 371 EXAM: Priorities for the Preoperative Patient
guide 2022

 Negatives responses to anesthesia
 Allergies
 Thorough document
 Medications, food, medical dyes, latex, medical adhesives, environmental conditions
 Medications
 Identify all home medications
 Medications taken prior to surgery
 Include herbal remedies and over-the-counter
 Last oral intake
 Guidelines dependent upon institution and population
 Full stomach increases risk for aspiration
 Alcohol
 Smoking
 Drug use
 Special considerations
 Use care when collecting information
Physical assessment
 Height and weight
 Vital signs
System assessment
 Cardiovascular:
 Respiratory
 Neurological
 Liver/renal
 Integumentary
 Gastrointestinal
 Genitourinary
Patient preparation for the surgical experience
 Laboratory assessment: Complete metabolic panel, complete blood count, Urinalysis, pregnancy
test, hemoglobin
 Radiological assessment: chest x-ray
 Patient teaching
 Anticipatory guidance
 Recovery
 D V T prophylaxis
 Mobility
 Preventing pneumonia
Physical Preparations
 Intravenous line
 Bowel and bladder preparation
 Skin preparation