Preoperative Assessment for Anesthesia

Gastro-Intestinal-Nutritional System

• History of gastro-intestinal disorders or problems with elimination are identified
• Food and fluid intake patterns and recent weight loss are determined
• Patient's weight is assessed
• Presence of dentures and bridges is assessed to prevent dislodging during intubation

Preoperative Laboratory and Diagnostics

• Common lab tests completed pre-operatively:
  • CBC (Hgb, WBC)
  • Renal studies (electrolytes, glucose)
  • Liver studies
  • Coagulation studies (PTT, INR, aPTT)
  • Blood type and screen (in case patient requires blood transfusion)
  • Urine analysis and pregnancy test
• Preoperative laboratory and diagnostics are obtained to determine surgical and anesthetic risk

Preoperative Education

• Empowers patients to make informed health decisions and participate effectively during the surgical experience
• Increases patient satisfaction and reduces fear and anxiety
• Involves three types of information:
  • Sensory: what patients will see, hear, smell, and feel during surgery
  • Process: general flow of what is going to happen
  • Procedural: specific details of the surgery

Informed Consent

• Critical that nurses understand ethical and legal tenets of informed consent
• Patients have autonomous right to make informed decisions regarding health care
• Informed consent must be voluntary, with mental capacity, and properly informed
• Required for non-emergency surgery, invasive procedures, and procedures with more than a slight risk of complications

Physical Preparation

• Patient is required to shower or bathe before surgery
• Dressed in a hospital gown; underclothes may or may not be permitted
• Nail polish is removed to prevent skewing pulse oximeter results
• Identification band and allergy band are placed on the patient
• Valuables are returned to a family member or locked up according to institutional protocol
• Jewelry and prostheses are removed to prevent loss or damage

Preoperative Medications

• Used for various reasons, including:
  • Bowel preparations (e.g., Pico salax)
  • Reducing anxiety and sedating the patient (e.g., Ativan)
  • Pain control (e.g., Morphine)
  • Prophylaxis against infection (e.g., Ancef)
  • Reducing post-operative nausea (e.g., Gravol/Maxeran)

Intraoperative Care

• Five major components:
  • Physical environment
  • Surgical team members and roles
  • Nursing management and responsibilities
  • Anesthesia
  • Unexpected clinical events

Physical Environment

• Surgical suite is a controlled environment designed to maximize infection control and provide a seamless flow of patients, personnel, and operative instruments, equipment, and supplies
• Divided into three areas:
  • Unrestricted: provides access to all people in street clothes
  • Semi-restricted: includes peripheral support areas for clean and sterile supplies
  • Restricted: includes ORs and areas where sterile supplies are opened

Surgical Positioning

• Principles for positioning include:
  • Ensuring correct skeletal alignment
  • Preventing pressure on nerves, skin over bony prominences, and eyes
  • Providing for adequate thoracic excursion
  • Preventing occlusion of arteries and veins
  • Providing modesty in exposure
  • Recognizing and respecting individual needs

Anesthesia

• Classified into four types:
  • General anesthesia: altered physiological state characterized by reversible loss of consciousness, skeletal muscle relaxation, amnesia, and analgesia
  • Local anesthesia: loss of sensation without loss of consciousness
  • Regional anesthesia: reversible loss of sensation to a region of the body
  • Procedural (conscious) sedation: mild depression of consciousness for minor procedures

Exceptional Clinical Events

• Anaphylaxis: severe allergic reaction with abdominal distention and tenderness
• Paralytic ileus: impairment of intestinal motility postoperatively
• Urinary function complications: decreased urinary output, urinary retention, and impaired sphincter control
• Alterations in skin and surgical wounds: surgical site infection, indicators include purulent discharge, isolation of organisms, pain, tenderness, local edema, and warmth