Module 1: Preoperative Phase PDF

MODULE 1: PREOPERATIVE PHASE Goals: üAssessing and correcting physiologic and psychologic problems that might increase surgical risk üGiving the person and significant others complete learning/ teaching guidelines regarding surgery üInstructing and demonstrating exerci...

MODULE 1: PREOPERATIVE PHASE Goals: üAssessing and correcting physiologic and psychologic problems that might increase surgical risk üGiving the person and significant others complete learning/ teaching guidelines regarding surgery üInstructing and demonstrating exercises that will benefits the person during post-op period üPlanning for discharge and any projected changes in lifestyle due to surgery LEGAL ASPECT: “INFORMED CONSENT”, OPERATIVE PERMIT, SURGICAL CONSENT üThis is to protect the surgeon and the hospital against claims that unauthorized surgery has been performed and that the client was unaware of the potential risks of complications involved üProtects the client from undergoing unauthorized surgery 1.) THE SURGEON OBTAINS OPERATIVE PERMIT OR INFORMED CONSENT üSurgical procedure, alternatives, possible complications, disfigurements, or removal of body parts are explained üIt is part of the nurse’s role as a client advocate to confirm that the client understands information given üConsent must be signed before giving pre- op medications Minor Patients ü If the client is minor allow the parents or the nearest relative to sign the consent for the procedure ü For EMANCIPATED CLIENTS, they are allowed to sign the consent Consents are not needed for emergency care if all four of the following criteria are met: 1. There is an immediate threat to life 2. Experts agree that it is an emergency 3. Client is unable to consent 4. A legally authorized person cannot be reached Site Marking üInstantly identifiable mark üSame process throughout the organization üMade the individual performing the procedure (Surgeon) üInvolve patient üMark- visible after patient is prepped and draped üMarked in all places involving laterality or multiple structures  Physiologic Assessment I. Age 2. Nutritional status 3. State of fluid and electrolytes balance 4. General health 5. Mental Health 6. Economic and occupational status Types of drugs taken regularly: 1). Steroids -not to be discontinued abruptly before the surgery 2). Anticoagulants and salicylates - may increase bleeding during and after surgery 3). Antibiotics - maybe incompatible with or potentiate anesthetic agents 4). Tranquilizers - potentiate the effect of narcotics and can cause hypotension 5). Antihypertensives - may predispose to shock by the combined effect of blood pressure reduction and anesthetic vasodilation 6). Diuretics - may increase potassium loss 7). Alcohol - will place the surgical client at risk when used chronically  PSYCHOLOGICAL ASSESSMENT Ø Fear of Unknown ( Anxiety ) Ø Fear of Anesthesia Ø Fear of Pain Ø Fear of Death Ø Fear of disturbance on Body image Ø Worries – loss of finances, employment, social and family roles.  Nursing Interventions to Minimize Anxiety ü Assess client’s fears, anxieties, support systems, and patterns of coping ü Establish trusting relationship with client and significant others üExplain routine procedures, encourage verbalization of fears, and allow client to ask questions üDemonstrate confidence in surgeon and staff üProvide for spiritual care if appropriate 1. PHYSIOLOGIC PREPARATION 1) Respiratory preparation: - chest x-ray 2) Cardiovascular preparation: - ECG, CBC, blood typing, cross-matching, PT/PTT (prothrombin time, partial thromboplastin time), serum electrolytes 3) Renal preparation: Urinalysis 4. Past Medical History A Allergy to medications, chemicals, and other environmental products such as latex üIf allergy exist, an allergy band must be placed in the client’s arm immediately  Bleeding tendencies or the use of B medications that deter clotting, such as aspirin, heparin, and warfarin sodium. üHerbal medications may also increase bleeding time or mask potential blood- related problems C Cortisone and steroid use ü This predisposes client to infection D Diabetes mellitus, a condition that not only requires strict control of blood glucose levels but also known to delay wound healing E Emboli; previous embolic events ( such as lower leg blood clots) may recur because of prolonged immobility 2. PRE-OPERATIVE TEACHING Leg and Foot exercises To stimulate blood circulation in the extremities to prevent venous stasis and thrombus formation, thrombophlebitis, and emboli.  Diaphragmatic Breathing and Coughing/ Splinting Exercises To facilitate lung aeration and secretion mobilization to prevent atelectasis and hypostatic pneumonia, resulting from stagnation of fluid in the lungs. Done every two to four hours Incentive Spirometer Encouraged to use incentive spirometer about 10 to 12 times per hour. Deep inhalations expand alveoli, which prevents atelectasis and other Pulmonary complication. Positioning and Ambulation To improve circulation, prevent venous stasis, and promote optimal respiratory function. Preparing the Patient the Evening Before Surgery Preparing the Skin - have a full bath to reduce microorganisms in the skin. - hair should be removed within 1-2 mm of the skin to avoid skin breakdown, use of electric clipper is preferable. Preparing the G.I tract - NPO, cleansing enema as required Preparing for Anesthesia - Avoid alcohol and cigarette smoking for at least 24 hours before surgery. Promoting rest and sleep - Administer sedatives as ordered ASA (American Society of Anesthesiologists) Guidelines for Preoperative Fasting Preparing the Person on the Day Of Surgery Early A.M Care üAwaken 1 hour before pre-op medications üMorning bath, mouth wash üProvide clean gown üRemove hairpins, braid long hair, cover hair with cap if available. üRemove dentures, colored nail polish, contact lenses, jewelries. üRetain , hearing aid üTake baseline vital sign before pre-op medication. Check ID band üCheck for special orders – enema, IV line üCheck NPO üHave client void before pre-op medication üContinue to support emotionally üAccomplished “pre-op care checklist  PRE-OPERATIVE MEDICATIONS Generally administered 60-90 min before induction of anesthesia Purpose: ü To allay anxiety: the primary reason for pre- operative medications ü To decrease the flow of pharyngeal secretions ü To reduce the amount of anesthesia to be given ü To create amnesia for the events that precedes surgery  PRE-OPERATIVE MEDICATIONS Types of Pre-Operative Medications: 1) Sedative: a) Given to decrease the client’s anxiety to lower BP and pulse b) Reduce the amount of general anesthesia: an overdose can result to respiratory depression Ex: (midazolam, lorazepam, diazepam)  PRE-OPERATIVE MEDICATIONS Types of Pre-Operative Medications: 2) Tranquilizer - lowers the client’s anxiety level (ataractic) - Ex: Thorazine 12.5 - 25 mg IM 1-2 hours prior to surgery Phenergan 12.5 - 25 mg IM 1-2 hours prior to surgery * Note: can cause a dangerous hypotension, both during and after surgery 3) Narcotic analgesia - given to reduce patients to reduce anxiety and to reduce the amount of narcotics given during surgery - Ex: Morphine sulfate 8-15 mg SC 1 hour prior to preoperative - Fentanyl * Can cause vomiting, respiratory depression and postural hypotension 4) Vagolytic or drying agents - to reduce the amount of tracheobronchial secretions which can clog the pulmonary tree and result in atelectasis and pneumonia - Ex: Atropine sulfate 0.3-0.6 mg IM 45 min before surgery * An overdose can result to severe tachycardia Recording: all final preparation and emotional response before surgery should be noted down Transportation to the OR Woolen or synthetic blankets must never be sent to the OR because they are source of static electricity Transporting the client to the OR 30-60° in the holding area  Surgical Checklist Name:_______________________________________________ Ward :__________ Room No: __________ Date: ______ 1. Consent for surgery and anesthesia 2. NPO 3. Lab. Exams, CBC, CT-BT, Blood typing, Urinalysis and stool exam 4. Clearance 5. X-Ray 6. Notify Or surgeon/assistant surgeon, anesthesiologist, pediatrician, cardiologist, hospital director 7. Xylocaine testing and other medication  8. Skin Prep 9. Site for Spinal Anesthesia Prep 10. SS/Cleansing Enema 11. Remove prosthesis, jewelries, nail polish And make-up 12. Oral Hygiene 13. OR Gown 14. Wrist Tag 15. Blood 16. Partial payment for surgery 17. Partial payment for Ortho plants (If any) 18. Administration of on-call meds __________________________ Nurse on-Duty 19. Vital Signs before pre-op meds: after pre-op meds: T= T= P= P= R= R= B/P = B/P = FHT = FHT = __________________________ Nurse on-Duty