Module 1: Preoperative Phase
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Questions and Answers

What is the goal of the preoperative phase?

Assessing and correcting physiologic and psychologic problems that might increase surgical risk.

What must be explained to the client before obtaining informed consent?

  • Hospital amenities
  • Surgical procedure and alternatives (correct)
  • Insurance coverage
  • Recovery duration

    • Emergency care does not require consent if certain criteria are met.

    True

    A legally authorized person must be reached for obtaining consent unless there is an immediate threat to _____

    <p>life</p> Signup and view all the answers

    Which of the following is a type of drug that should not be discontinued abruptly before surgery?

    <p>Steroids</p> Signup and view all the answers

    What are common fears associated with surgery?

    <p>Fear of the unknown, fear of anesthesia, fear of pain, fear of death, fear of disturbance to body image.</p> Signup and view all the answers

    An allergy band must be placed in the client’s arm if there is an allergy to _____

    <p>medications</p> Signup and view all the answers

    What is the purpose of leg and foot exercises before surgery?

    <p>To stimulate blood circulation in the extremities and prevent venous stasis and thrombus formation.</p> Signup and view all the answers

    What type of preparation involves performing an ECG and CBC?

    <p>Cardiovascular preparation</p> Signup and view all the answers

    Consent for minor patients must be obtained from the patient themselves.

    <p>False</p> Signup and view all the answers

    The surgeon is responsible for obtaining the operative permit or informed consent from the patient.

    <p>True</p> Signup and view all the answers

    Site marking is a process that can be performed by any medical personnel involved in the surgery.

    <p>False</p> Signup and view all the answers

    Consent is required for emergency care if a legally authorized person cannot be reached.

    <p>False</p> Signup and view all the answers

    Patients taking anticoagulants need to be monitored closely due to the increased risk of bleeding during surgery.

    <p>True</p> Signup and view all the answers

    Antihypertensives can lead to shock due to blood pressure reduction and anesthetic vasodilation.

    <p>True</p> Signup and view all the answers

    Chronic alcohol use has no risk implications for surgical clients.

    <p>False</p> Signup and view all the answers

    Cortisone use may enhance a client's ability to resist infection during surgery.

    <p>False</p> Signup and view all the answers

    Fear of death is one of the psychological assessments that should be considered before surgery.

    <p>True</p> Signup and view all the answers

    Leg and foot exercises before surgery are intended to reduce blood circulation in the extremities.

    <p>False</p> Signup and view all the answers

    Study Notes

    Goals of the Preoperative Phase

    • Assess and correct potential physiologic and psychological problems that may increase surgical risk.
    • Provide comprehensive learning and teaching guidelines about the surgical procedure to clients and their significant others.
    • Instruct and demonstrate beneficial exercises for the post-operative period.
    • Plan for discharge and address potential lifestyle changes due to surgery.
    • Informed consent protects both the surgeon and the hospital from claims of unauthorized surgery.
    • Ensures the client is aware of the surgery's risks and implications.
    • The surgeon is responsible for obtaining the operative permit or informed consent, ensuring clients understand the procedure, alternatives, and complications.
    • Consent must be signed prior to administration of pre-operative medications.
    • Parents or nearest relatives must sign consent for minors undergoing procedures.
    • Emancipated minors can sign their own consent.
    • Consent is not required during emergencies if:
      • There's an immediate threat to life.
      • Experts agree the situation is an emergency.
      • The client is unable to consent.
      • A legally authorized person is unreachable.

    Site Marking for Surgery

    • Each surgical site must be distinctly marked by the surgeon.
    • Markings should be visible post-prep and reflect any laterality or multiple structures involved.
    • Patient involvement in site marking is encouraged to enhance safety.

    Physiologic Assessment Factors

    • Age, nutritional status, fluid and electrolyte balance, general health, mental health, and economic/occupational status are key assessment components.

    Regular Medications and Their Implications

    • Steroids: Should not be stopped abruptly before surgery.
    • Anticoagulants and Salicylates: Risk of increased bleeding during and after surgery.
    • Antibiotics: May interact negatively with anesthetic agents.
    • Tranquilizers: Can enhance narcotic effects, risking hypotension.
    • Antihypertensives: May lead to shock due to blood pressure reduction.
    • Diuretics: Risk of potassium loss.
    • Alcohol: Chronic use poses additional surgical risks.

    Psychological Assessment of Patients

    • Common fears include the unknown, anesthesia, pain, death, body image disturbances, and concerns about finances, employment, and family roles.
    • Key nursing interventions to minimize anxiety include:
      • Assessing fears, anxieties, and support systems.
      • Building a trusting relationship with the client.
      • Explaining procedures and encouraging questions.
      • Demonstrating confidence in the surgical team.
      • Providing spiritual care if appropriate.

    Physiologic Preparation Tasks

    • Respiratory: Chest X-ray required.
    • Cardiovascular: ECG, CBC, blood typing, PT/PTT, and serum electrolytes necessary.
    • Renal: Urinalysis is conducted.

    Important Past Medical History Considerations

    • Allergies: Document allergies with a band; includes medications, chemicals, and latex.
    • Bleeding Tendencies: Assess for use of medications like aspirin or warfarin that may cause prolonged bleeding.
    • Corticosteroids: Impose a high infection risk.
    • Diabetes Mellitus: Requires control of blood glucose levels to enhance wound healing.
    • Previous Emboli: Identify history of embolic events to prevent recurrence.

    Preoperative Teaching Strategies

    • Leg and Foot Exercises: Stimulate circulation to prevent venous stasis and thrombus formation.
    • Diaphragmatic Breathing and Coughing/Splinting Exercises: Aid lung aeration and secretion mobilization to prevent complications like atelectasis.

    Preoperative Phase Goals

    • Assess and correct physiological and psychological issues that may increase surgical risk.
    • Provide comprehensive education to the patient and their significant others regarding the surgery.
    • Instruct on exercises beneficial for post-operative recovery.
    • Plan for discharge and any necessary lifestyle changes post-surgery.
    • Informed consent protects against unauthorized surgeries and ensures patients understand risks.
    • Consent must be signed before administering preoperative medications.
    • Minors require parental consent; emancipated minors can consent themselves.
    • Emergency care does not require consent if there's an immediate threat to life and the patient cannot consent.

    Site Marking

    • Marking must be visible after prepping and draping, involving the patient and consistent across the organization.
    • Essential for laterality or multiple structures.

    Physiological Assessment

    • Consider age, nutritional status, fluid and electrolyte balance, general health, mental health, and socioeconomic factors.
    • Review regular medications for risks:
      • Steroids: Do not abruptly discontinue.
      • Anticoagulants: Increase bleeding risk.
      • Antibiotics: Potential interactions with anesthesia.
      • Tranquilizers: Can enhance narcotics effects.
      • Antihypertensives: May lead to shock.
      • Diuretics: Risk of potassium loss.
      • Alcohol: Chronic use poses risks.

    Psychological Assessment

    • Address fears such as the unknown, anesthesia, pain, death, and body image disturbances.
    • Support with confidence-building, routine explanations, and opportunity for questions.

    Physiological Preparation

    • Conduct necessary tests:
      • Respiratory: Chest x-ray.
      • Cardiovascular: ECG, CBC, blood typing, coagulation tests, electrolytes.
      • Renal: Urinalysis.

    Past Medical History Considerations

    • Allergies: Immediate allergy band placement.
    • Bleeding disorders or anticoagulant use.
    • Cortisone/steroid use increases infection risk.
    • Diabetes requires strict glucose management.
    • History of embolic events poses risk due to immobility.

    Preoperative Teaching

    • Leg and foot exercises to enhance circulation and prevent thrombus formation.
    • Diaphragmatic breathing to promote lung function and prevent pneumonia.
    • Use of an incentive spirometer for lung expansion.
    • Positioning and ambulation to improve circulation.
    • Skin preparation to minimize microorganism presence.
    • GI tract preparation includes NPO status and cleansing enemas.
    • Avoid alcohol and smoking 24 hours prior.

    Day of Surgery Preparation

    • Early morning care includes hygiene, gown change, and removal of accessories.
    • Baseline vital signs taken prior to medications and check ID bands.
    • Ensure emotional support and checklist completion.

    Preoperative Medications

    • Administered 60-90 minutes before anesthesia to reduce anxiety and secretions.
    • Types include:
      • Sedatives: Decrease anxiety and blood pressure (e.g., midazolam).
      • Tranquilizers: Lessen anxiety but may cause hypotension (e.g., Thorazine).
      • Narcotics: Reduce anxiety; can cause respiratory issues (e.g., Morphine).
      • Vagolytics: Reduce secretions; overdose can cause tachycardia (e.g., Atropine).

    Final Preparations

    • Document emotional responses and final preparations.
    • Ensure appropriate blankets for transport to OR, avoiding sources of static electricity.

    Surgical Checklist

    • Confirm surgery and anesthesia consent.
    • Verify NPO status.
    • Review lab exams and necessary clearances.

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    Related Documents

    Preoperative Phase Module 1 PDF
    Module 1: Preoperative Phase PDF

    Description

    This quiz focuses on the critical aspects of the preoperative phase of surgery, including the assessment of physiological and psychological issues that may impact surgical risk. Learn about informed consent, patient education, and postoperative exercise instructions. It’s essential for healthcare professionals involved in surgical care to understand these foundational concepts.

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