Preoperative Phase Module 1

Preoperative Phase Goals

• Assess and correct physiologic and psychological issues to mitigate surgical risks.
• Provide comprehensive learning materials for patients and their relatives about the surgery.
• Instruct postoperative exercises to facilitate recovery.
• Plan for discharge and potential lifestyle changes due to surgery.

Legal Aspects

• Informed consent is crucial to protect both the surgeon and the patient.
• Consent ensures clients are aware of surgery risks and prevents unauthorized procedures.
• The surgeon must obtain the operative permit, explaining the procedure, alternatives, and complications.

Consent for Minor Patients

• Consent for surgery must be signed by parents or nearest relatives for minor patients.
• Emancipated minors may sign their own consent.

Emergency Situations

• Consents are not required for emergency care if:
  • There is an immediate threat to life.
  • Experts confirm it’s an emergency.
  • The client cannot consent.
  • No legally authorized person can be contacted.

Site Marking

• An identifiable mark is made by the surgeon with patient involvement.
• The mark must be visible post-preparation and applicable to procedures with laterality or multiple structures.

Physiologic Assessment Factors

• Evaluate age, nutritional status, fluid and electrolyte balance, general and mental health, and economic/occupational status.

Regular Medication Review

• Steroids should not be stopped abruptly before surgery.
• Watch for anticoagulants and salicylates, which could increase bleeding.
• Awareness of antibiotics' effects on anesthesia.
• Tranquilizers may enhance narcotic effects and cause hypotension.
• Antihypertensives risk shock from blood pressure drop.
• Diuretics may lead to potassium loss.
• Chronic alcohol use poses surgical risks.

Psychological Assessment

• Address fears related to the unknown, anesthesia, pain, death, body image disturbance, and concerns about finances or roles.

Nursing Interventions for Anxiety

• Understand clients' fears and coping patterns.
• Build a trusting relationship with clients.
• Explain routine procedures and allow questions.
• Show confidence in medical staff.
• Provide spiritual care as needed.

Physiologic Preparation

• Respiratory: chest x-ray.
• Cardiovascular: ECG, CBC, blood typing, PT/PTT, electrolytes.
• Renal: urinalysis.

Past Medical History Considerations

• Identify allergies and provide an allergy band.
• Assess for bleeding tendencies and medications that affect clotting.
• Regular use of steroids may increase infection risk.
• Monitor diabetes management for proper glucose control.
• Evaluate history of embolic events due to immobility risks.

Preoperative Teaching

• Instruct leg/foot exercises to prevent venous stasis and thrombus.
• Teach diaphragmatic breathing and coughing for lung health.
• Encourage the use of an incentive spirometer to prevent atelectasis.
• Positioning and ambulation to promote circulation.

Evening Before Surgery Preparations

• Ensure a full bath to decrease skin microorganisms.
• Remove hair with electric clippers if needed.
• Prepare GI tract, ensuring the client is NPO and may require a cleansing enema.
• Advise against alcohol/smoking for 24 hours pre-surgery.
• Administer sedatives for rest if ordered.

Day Of Surgery Preparations

• Morning tasks include hygiene, gowning, and removing accessories.
• Verify vital signs and consent documentation.
• Confirm pre-op checklist and special orders.
• Support clients emotionally.

Preoperative Medications Purpose

• Administer medications 60-90 minutes prior to anesthesia to alleviate anxiety, decrease secretions, reduce anesthesia dosage, and create amnesia.

Types of Preoperative Medications

• Sedatives: Decrease anxiety and reduce BP/pulse (e.g., midazolam, lorazepam).
• Tranquilizers: Lower anxiety levels but may cause hypotension (e.g., Thorazine, Phenergan).
• Narcotic Analgesics: Reduce anxiety and narcotics use during surgery (e.g., Morphine, Fentanyl).
• Vagolytics: Manage tracheobronchial secretions to prevent complications (e.g., Atropine).

Final Preparation and Transportation

• Document all preparations and emotional states before surgery.
• Use woolen/synthetic blankets with caution due to static electricity risks during transport to the OR.
• Clients should be positioned 30-60° in the holding area.

Surgical Checklist

• Verify consent for surgery and anesthesia.
• Confirm NPO status and completion of lab exams.
• Ensure clearance and necessary imaging is completed.