Chapter 14 Preoperative Nursing Management PDF

Chapter 14 Preoperative Nursing Management Perioperative Nursing Preoperative phase: begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) bed Intraoperative phase: begins when the patient is transfe...

Chapter 14 Preoperative Nursing Management Perioperative Nursing Preoperative phase: begins when the decision to proceed with surgical intervention is made and ends with the transfer of the patient onto the operating room (OR) bed Intraoperative phase: begins when the patient is transferred onto the OR bed and ends with admission to the PACU (postanesthesia care unit) Postoperative phase: begins with the admission of the patient to the PACU and ends with a follow-up evaluation in the clinical setting or home Copyright © 2022 Wolters Kluwer · All Rights Reserved Surgical Classification Facilitating a diagnosis, a cure, or repair Reconstructive, cosmetic, or palliative Rehabilitative Based upon the degree of urgency involved: emergent, urgent, required, elective, and optional Copyright © 2022 Wolters Kluwer · All Rights Reserved Preadmission Testing Initiates the nursing assessment process Admission data: demographics, health history, other information pertinent to the surgical procedure Verifies completion of preoperative diagnostic testing according to patient’s needs Begins discharge planning by assessing patient’s need for postoperative transportation and care Copyright © 2022 Wolters Kluwer · All Rights Reserved Preoperative Assessment #1 Health history and physical exam Medications and allergies Nutritional, fluid status Dentition Drug or alcohol use Respiratory and cardiovascular status Hepatic, renal function Copyright © 2022 Wolters Kluwer · All Rights Reserved Preoperative Assessment #2 Endocrine function Immune function Previous medication use Psychosocial factors Spiritual, cultural beliefs Copyright © 2022 Wolters Kluwer · All Rights Reserved Medications That Potentially Affect Surgical Experience Corticosteroids Anticoagulants Diuretics Anticonvulsant Phenothiazines medications Thyroid hormone Tranquilizers Opioids Insulin Over-the-counter and Antibiotics herbals Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Which medication classification must be assessed during the preoperative period because it can cause an electrolyte imbalance during surgery? A. Corticosteroids B. Diuretics C. Phenothiazines D. Insulin Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 B. Diuretics Rationale: Diuretics during anesthesia may cause excessive respiratory depression resulting from an associated electrolyte imbalance. Corticosteroids can cause cardiovascular collapse if discontinued suddenly. Phenothiazines may increase the hypotensive action of anesthetics. Interaction between anesthetics and insulin must be considered when a patient with diabetes mellitus undergoes surgery. Copyright © 2022 Wolters Kluwer · All Rights Reserved Gerontologic Considerations Cardiac reserves are lower Renal and hepatic functions are depressed Gastrointestinal activity is likely to be reduced Respiratory compromise Decreased subcutaneous fat; more susceptible to temperature changes May need more time and multiple education formats to understand and retain what is communicated Copyright © 2022 Wolters Kluwer · All Rights Reserved Special Considerations During Preoperative Period Patients with obesity Patients with disabilities Patients undergoing ambulatory surgery Patients undergoing emergency surgery Copyright © 2022 Wolters Kluwer · All Rights Reserved Informed Consent Should be in writing before nonemergent surgery Legal mandate Surgeon must explain the procedure, benefits, risks, complications, etc. Nurse clarifies information and witnesses signature Consent is valid ONLY when signed before administering psychoactive premedication Consent accompanies patient to OR Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 Is the following statement true or false? Voluntary and written informed consent from the patient is necessary before nonemergent surgery can be performed solely to protect the surgeon from claims of an unauthorized operation or battery. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 False Rationale: Voluntary and written informed consent from the patient is necessary before nonemergent surgery can be performed to protect the patient from unsanctioned surgery and protect the surgeon from claims of an unauthorized operation or battery. Consent is a legal mandate, but it also helps the patient to prepare psychologically, because it helps to ensure that the patient understands the surgery to be performed. Copyright © 2022 Wolters Kluwer · All Rights Reserved Patient Education Deep breathing, coughing, incentive spirometry Mobility, active body movement Pain management Cognitive coping strategies Instruction for patients undergoing ambulatory surgery Copyright © 2022 Wolters Kluwer · All Rights Reserved Immediate Preoperative Nursing Interventions Patient changes into gown, hair covered, mouth inspected, jewelry removed, valuables stored in a secure place Administering preanesthetic medication Maintaining preoperative record Transporting patient to presurgical area Attending to family needs Copyright © 2022 Wolters Kluwer · All Rights Reserved General Preoperative Nursing Interventions Providing psychosocial interventions o Reducing anxiety, decreasing fear o Respecting cultural, spiritual, religious beliefs Maintaining patient safety Managing nutrition, fluids Preparing bowel Preparing skin Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 The nurse is preparing to administer a premedication. Which of the following actions should the nurse take first? A. Have the family present B. Ensure that the preoperative shave is completed C. Have the patient void D. Make sure the patient is covered with a warm blanket Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 C. Have the patient void Rationale: Having the patient void prior to administering a premedication is necessary for patient safety to prevent falls and injury. Shaving is no longer recommended; clipping the hair is evidence-based practice. The family can be present, and a warm blanket can be provided any time patient appears cold or asks for it, but the patient fall risk is greatly increased after receiving preoperative medications that are sedative or amnesic. Copyright © 2022 Wolters Kluwer · All Rights Reserved Expected Outcomes Relief of anxiety Decreased fear Understanding of the surgical intervention No evidence of preoperative complications Copyright © 2022 Wolters Kluwer · All Rights Reserved