(Chapter 18-20)
Preoperative Care
Role of the Nurse:
ASSESS
o Assess medications bc of potential complications of those
TEACHING
o Pain medications largest complication = RESP DEPRESSION
RISK FACTORS
o Must be aware of the risk factors and the complications of those
Surgery
Performed for:
o Diagnosis
o Cure
o Palliation
o Prevention
o Cosmetic improvement
Surgical Settings
Elective surgery v. Emergency Surgery
Inpatient
o Same-day admission
Ambulatory (outpatient)
Our Role Pre-Op
Have knowledge of the nature of the disorder requiring surgery
Identify the individual patient's response to the stress of surgery
Have knowledge of the results of preop diagnostic tests
Patient Interview
Purpose:
o Obtain health info
o Determine expectations
o Provide & clarify info about surgery and anesthesia
o Assess emotional state & readiness
Nursing Assessment
Overall goals
o Identify R/F
o Plan care to ensure patient safety
o Establish baseline data
Influencing factors
o Age
o Past experience
o Current health
, o Socioeconomic status
o Religious & cultural beliefs
Fears
o Death or disability
May prompt postponement
Influence outcome
o Pain
Consult w/ACP
Confirm drugs will be available
Health Hx
o Familial diseases
Conditions
o Reactions/problems to anesthesia (patient or family)
Current Meds
o Prescription & OTC
o Herbals
o Dietary supps
o Antiplatelets/NSAIDs
o Recreational
Drugs - alc - tobacco
Allergies (drug & nondrug)
o Screen for latex allergy
R/F
Contact urticaria or dermatitis
Aerosol rxns
Hx of reactions suggesting latex allergy
Cardiovascular System
o Report
Any <3 problems so they can be monitored during the intraoperative period
Use of <3 drugs
Presence of pacemaker/ICD
Respiratory System
o Inquire about recent airway infxns
Procedure could be cancelled bc of ^ risk of laryngo/bronchospasm or decreased
SaO2
o History of dyspnea, coughing, or hemoptysis reported to operative team
o COPD or asthma
High risk of atelectasis & hypoxemia
o Smokers should be encourages to quit 6 weeks before procedure
Decreases risk of complication
Greater years and number of packs = greater risk
o Sleep apnea, obesity, and airway deformities affect respiratory function
Genitourinary System
o Hx of urinary or renal diseases
o Renal dysfunction contributes to:
Fluid & electrolyte imbalances
^ risk of infxn
, Impaired wound healing
Altered response to drugs and their elimination
o Renal function tests
o Note problems voiding, and inform operative team
o Assess women for possibility of pregnancy
Hepatic System
o Liver detoxifies many anesthetics & adjunctive drugs
o Hepatic dysfunction may ^ risk of post-op complications
Endocrine System
o Pts with diabetes mellitus are especially at risk for:
Hypo/hyperglycemia
Ketosis
<3 alterations
Delayed wound healing
Infection
o Pts with DM
Serum or cap glucose tests morning of surgery (baseline)
Clarify w/physician regarding insulin dose
o Pts with Addison's Disease
Abruptly stopping replacement corticosteroids could cause Addisonian crisis
Stress of surgery may require increased dose of IV corticosteroids
Immune System
o Pts w/ hx of compromised immune system or use of immunosuppressive drugs can have:
Delayed wound healing
^ risk for infection
F&E Status
o Vomiting, diarrhea, or difficulty swallowing can cause imbalances
o Identify drugs that alter F&E status
Diuretics
o Eval serum electrolyte levels
o NPO status
May require additional F&E before surgery if dehydration occurs
Nutritional Status
o Deficits include over- & under-nutrition
o Obesity
Stressed <3 & pulmonary systems
^ risk of wound dehiscence, infection and incisional hernia
Slower recovery from anesthesia
Slower wound healing
o Providing extra padding to underweight pts to prevent pressure ulcers
o May be protein & vitamin deficient
o Identify dietary habits that may affect recovery (caffeine)
Nursing Management
Preop teaching
o Deep breathing, coughing and early ambulation as appropriate
o Inform if tubes, drains, monitoring devices or special equipment will be used post-op
Preoperative Care
Role of the Nurse:
ASSESS
o Assess medications bc of potential complications of those
TEACHING
o Pain medications largest complication = RESP DEPRESSION
RISK FACTORS
o Must be aware of the risk factors and the complications of those
Surgery
Performed for:
o Diagnosis
o Cure
o Palliation
o Prevention
o Cosmetic improvement
Surgical Settings
Elective surgery v. Emergency Surgery
Inpatient
o Same-day admission
Ambulatory (outpatient)
Our Role Pre-Op
Have knowledge of the nature of the disorder requiring surgery
Identify the individual patient's response to the stress of surgery
Have knowledge of the results of preop diagnostic tests
Patient Interview
Purpose:
o Obtain health info
o Determine expectations
o Provide & clarify info about surgery and anesthesia
o Assess emotional state & readiness
Nursing Assessment
Overall goals
o Identify R/F
o Plan care to ensure patient safety
o Establish baseline data
Influencing factors
o Age
o Past experience
o Current health
, o Socioeconomic status
o Religious & cultural beliefs
Fears
o Death or disability
May prompt postponement
Influence outcome
o Pain
Consult w/ACP
Confirm drugs will be available
Health Hx
o Familial diseases
Conditions
o Reactions/problems to anesthesia (patient or family)
Current Meds
o Prescription & OTC
o Herbals
o Dietary supps
o Antiplatelets/NSAIDs
o Recreational
Drugs - alc - tobacco
Allergies (drug & nondrug)
o Screen for latex allergy
R/F
Contact urticaria or dermatitis
Aerosol rxns
Hx of reactions suggesting latex allergy
Cardiovascular System
o Report
Any <3 problems so they can be monitored during the intraoperative period
Use of <3 drugs
Presence of pacemaker/ICD
Respiratory System
o Inquire about recent airway infxns
Procedure could be cancelled bc of ^ risk of laryngo/bronchospasm or decreased
SaO2
o History of dyspnea, coughing, or hemoptysis reported to operative team
o COPD or asthma
High risk of atelectasis & hypoxemia
o Smokers should be encourages to quit 6 weeks before procedure
Decreases risk of complication
Greater years and number of packs = greater risk
o Sleep apnea, obesity, and airway deformities affect respiratory function
Genitourinary System
o Hx of urinary or renal diseases
o Renal dysfunction contributes to:
Fluid & electrolyte imbalances
^ risk of infxn
, Impaired wound healing
Altered response to drugs and their elimination
o Renal function tests
o Note problems voiding, and inform operative team
o Assess women for possibility of pregnancy
Hepatic System
o Liver detoxifies many anesthetics & adjunctive drugs
o Hepatic dysfunction may ^ risk of post-op complications
Endocrine System
o Pts with diabetes mellitus are especially at risk for:
Hypo/hyperglycemia
Ketosis
<3 alterations
Delayed wound healing
Infection
o Pts with DM
Serum or cap glucose tests morning of surgery (baseline)
Clarify w/physician regarding insulin dose
o Pts with Addison's Disease
Abruptly stopping replacement corticosteroids could cause Addisonian crisis
Stress of surgery may require increased dose of IV corticosteroids
Immune System
o Pts w/ hx of compromised immune system or use of immunosuppressive drugs can have:
Delayed wound healing
^ risk for infection
F&E Status
o Vomiting, diarrhea, or difficulty swallowing can cause imbalances
o Identify drugs that alter F&E status
Diuretics
o Eval serum electrolyte levels
o NPO status
May require additional F&E before surgery if dehydration occurs
Nutritional Status
o Deficits include over- & under-nutrition
o Obesity
Stressed <3 & pulmonary systems
^ risk of wound dehiscence, infection and incisional hernia
Slower recovery from anesthesia
Slower wound healing
o Providing extra padding to underweight pts to prevent pressure ulcers
o May be protein & vitamin deficient
o Identify dietary habits that may affect recovery (caffeine)
Nursing Management
Preop teaching
o Deep breathing, coughing and early ambulation as appropriate
o Inform if tubes, drains, monitoring devices or special equipment will be used post-op
