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

This quiz assesses the steps involved in preoperative assessment for anesthesia, including patient history, physical examination, and laboratory tests. It covers the evaluation of gastro-intestinal disorders, nutritional status, and other factors that may impact anesthesia care.