6. Preoparative Phase.pdf

Preoperative Care Ms. Hiranga Wijedasa B.Sc.(hons) in Nursing [USJP] M.Sc. [UOK], MNE [KIU] Objectives: After completing this session student should be able to;  perform a preoperative physical assessment (Systematic Health Assessment) and identify the findings of the assessment that ma...

Preoperative Care Ms. Hiranga Wijedasa B.Sc.(hons) in Nursing [USJP] M.Sc. [UOK], MNE [KIU] Objectives: After completing this session student should be able to;  perform a preoperative physical assessment (Systematic Health Assessment) and identify the findings of the assessment that may require intervention  outline the surgical risk factors and prevention  discuss the legal aspect of “written informed consent”  describe the procedure of preparing a patient for transferring to the operating room  discuss the importance of Preoperative teaching  perform a Preoperative teaching session  Preoperative Phase  The 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 table. Preoperative Assessment  Health History  Psychosocial Assessment  Physical Assessment Systematic health assessment Attention needs to be paid on focusing :  All body systems : Specially CV Status, Respiratory , Renal, Hepatic and Endocrine Function  Nutritional and Fluid Status  Electrolyte imbalance  Immune Function  Previous Medication Use  Psychosocial Factors  Spiritual and Cultural Beliefs etc. Identifying surgical Risk Factors  Obesity  Poor nutrition  Fluid and electrolyte imbalance  Aging  Presence of Cardiovascular disease  Presence of Chronic diseases  Presence of Alcoholism  Presence of Respiratory diseases Tutorial Question 1 : Q: Describe how the above mentioned risk factors increase the severity of post-operative complications.  Psychosocial Factors Psychological distress directly influences body functioning. Therefore, it is imperative to identify any anxiety the patient is experiencing.  Spiritual and Cultural Beliefs spiritual beliefs can be as therapeutic as medication. Showing respect for a patient’s cultural values and beliefs facilitates rapport and trust.  Psychological Assessment Possible psychological nursing assessments during the preoperative period: - Fear of the unknown - Fear of death - Fear of anesthesia - Concerns about loss of work, time, job and support from the family - Concerns on threat of permanent incapacity - Spiritual beliefs - Cultural values and beliefs - Fear of pain Preoperative psychosocial interventions  Reducing Preoperative Anxiety & Fear  general preoperative teaching Tutorial Q2. Discuss what are the aspects.  Encourage the patient to verbalize feelings  Let the patient explore his fears, worries, and concerns.  Provide information that helps to allay fears and concerns of the patient  Give empathetic support  Prepare the therapeutic environment: Music therapy, friendly environment  Assist the patient in identifying coping strategies that he/she has previously used to decrease fear  Spiritual advising & and showing respect to cultural, Spiritual and Religious Beliefs.  You haveto consider following points:  Asses the patient's psychosocial adjustment to impending surgery  Determine what the patient already knows  Check what he/ she wants to know  You can gather information by;  reading the patient's BHT  interviewing the patient  communicating with family  From the other members of the health staff.  Determine cultural or religious health beliefs and practices that may have an impact on the patient's surgical experience.  Patient should be aware of :  Skin Preperation  Type of Anesthesia  Ambulation  Pain Management  Post operative equipment such as urinary catheters, colostomy bags, drains etc.  Rest and Sleep, Post op excercises  During the hospital visits before the surgery, patient can meet and ask questions from the perioperative nurse, view audiovisuals, receive written materials, and be given the telephone number to call as questions arise closer to the date of surgery. Preparing patients for surgery Patient Preparation - Skin Preparation - Bowel Preparation - Maintaining Nutrition and Fluid balance - Premedication - Preoperative Checklist  Skin Preparation  Human skin normally harbors transient and resident bacterial flora, some of which are pathogenic.  Skin cannot be sterilized without destroying skin cells.  It is ideal for the patient to bathe or shower using a bacteriostatic soap on the day of surgery. Skin Preparation - Shaving  The Centers for Disease Control and Prevention recommend that hair not be removed near the operative site unless it will interfere with surgery. Skin is easily injured during shaving and often results in a higher rate of postoperative wound infection.  Shaving should be performed as close to the time of the operation as possible  For head surgery, obtain specific instructions from the surgeon concerning the extent of shaving. Bowel Preparation  Describe the Procedure Premedication  Administer oral antimicrobial agents suppress the colon's potent microflora.  medication may facilitate:  administration of an anesthetic agent  minimize respiratory tract secretions  minimize changes in heart rate  relaxation and reduce anxiety.  Have the medication ready and administer it as soon as the call is received from the operating room  Indicate the time when the medication was administered and by whom on BHT or preoperative checklist. Preparation for Surgery may depend on: Tutorial Question 3: Identify the factors affecting the preparation for surgery  the type of surgery  Duration  Surgeon's preference  Infection control manuals and proceduresInfection control manuals and procedures Preparation for Surgery Preparing for an elective surgery includes;  selecting a surgeon and a health care center to perform the procedure  scheduling the surgery  undergoing pre-surgical testing  meeting with health care professionals and the surgical team  receiving education about the procedure  receiving and following all of the appropriate preoperative instructions  signing a consent form. What is “INFORMED CONSENT”?  It is a process of communication between a patient and physician that results in the patient's authorization or agreement to undergo a specific medical intervention  The consent implies that patient has been provided with the knowledge necessary to understand the nature of the procedure as well as the possible consequences of the procedure  Informed consent should be in writing. It should contain the following: Explanation of procedure and its risks Description of benefits and alternatives An offer to answer questions about procedure A statement informing the patient if the protocol differs from customary procedure  Informed consent should be taken before patient receives any sedatives  When the patient is a minor or unconscious or incompetent, permission must be obtained from a responsible family member or legal guardian.  Informed consent is necessary in the following circumstances: Invasive procedures such as a surgical incision a biopsy, a cystoscopy Procedures like, paracentesis Procedures requiring sedation and/or anesthesia A nonsurgical procedure, such as an arteriography, that carries more than slight risk to the patient. Procedures involving radiation Pre-surgical testing  Pre-surgical testing, also called preoperative testing or surgical consultation, includes a review of the patient's medical history, a complete physical examination, a variety of tests.  The review of the patient's medical history includes:  an evaluation of the patient's previous and current medical conditions  surgeries and procedures  medications  any other health conditions such as allergies that may impact the surgery. Pre-surgical testing is generally scheduled within one week before the surgery Preoperative Investigations?  Systemic investigations:  Blood Investigations  Other Investigations / diagnostic Procedures Group Work:  Tutorial Question 04 (Pair Work): Discuss how you prepare your patient for following diagnostic procedures ▪ X-ray ▪ US Scan ▪ CT Scan ▪ MRI ▪ Endoscopy ▪ Laparoscopy  Scope of nursing activities on the day before surgery:  Establish a baseline evaluation of the patient by carrying out a preoperative interview Including: -physical and emotional assessment -previous anesthetic history -identification of known allergies or genetic problems that may affect the surgical outcome ✓ ensure that necessary tests have been or will be performed ✓ provide preparatory education about recovery from anesthesia and postoperative care ✓ Review patient teaching ✓ Verify the patient’s identity and the surgical site ✓ Confirm written informed consent ✓ Prepare for intravenous infusion, catheterization etc. ✓ If the patient is going home the same day, the availability of safe transport and the presence of an accompanying responsible adult is verified. Nursing actions in the immediate pre- operative care of the patient  Emotional care of patient and family  Observations/ Assessments  Instructions to the family  Maintain proper personal hygine  Pre-medications  Transportations to the theatre IMMEDIATE PREOPERATIVE NURSING INTERVENTIONS  Change the patient into a hospital/theatre gown  remove hairpins and braid the long hair and cover the head completely with a disposable paper cap.  Jewelry should be removed  Remove prosthesis – Ex:  All articles of value, including assistive devices, are given to family members or are labeled clearly with the patient’s name and handed over to nurse in-charge to store in a safe place according to the hospital policy. Preoperative Teaching Objectives of Preoperative education:  Increase the knowledge of the patient regarding surgical procedure  Obtain the fullest cooperation of the patient  Prevent Postoperative Complications  minimize anxiety  promote full recovery  Research has shown that preoperative education can improve patient outcomes and satisfaction with the surgical experience  The ideal timing for preoperative teaching is not on the day of surgery but during the preadmission visit when diagnostic tests are performed  During this visit, the patient can meet and ask questions from the perioperative nurse, view audiovisuals, receive written materials, and be given the telephone number to call as questions arise closer to the date of surgery  Instruction should be based on the individual’s learning needs and level of understanding  Preoperative education can offer through multiple teaching strategies such as;  Conversation  Discussion  Use of audiovisual aids  Demonstrations and return demonstrations Admitting the patient to Surgery  Final check list  Preoperative check list is the last procedure before taking the patient to the operating theatre  Most institutions have a standard form for this check list Tutorial Question 05 (Group Work):  Develop a preoperative checklist Preoperative Checklist On the preoperative checklist, the nurse should document the following actions including:  patient identification  removing jewelry or other assisting devices  asking patient to void  ensuring all needed documentation ( consent, all diagnostic test results, NPU states)  Allergies  Mark the site of surgery  skin preparation, Bowel preparation  Premedication  attire  Admitting the patient to Surgery (ctd)  Transporting the patient to the operating room  Ensure the comfort and safety of the patient  Assist in transferring the patient from bed to stretcher  Make sure that the patient arrives in the operating room at the proper time  Admitting the patient to Surgery (ctd)  Patient’s Family  Direct the patient’s family to proper waiting room if possible  Inform them after the surgery when the patient is taken to the recovery room  Tell the family what to expect postoperatively when they see the patient. Thank You