NURS 4200 CH 18.pdf

Chapter 18: Preoperative Care Overview Discusses the art and science of treating diseases, injuries, and deformities through surgery. Discusses the different types of surgeries: diagnosis, cure, palliation, prevention, cosmetic improvement, and exploration. Discusses the different surgical se...

Chapter 18: Preoperative Care Overview Discusses the art and science of treating diseases, injuries, and deformities through surgery. Discusses the different types of surgeries: diagnosis, cure, palliation, prevention, cosmetic improvement, and exploration. Discusses the different surgical settings: inpatient, same-day admission, ambulance, minimally invasive, endoscopy or surgical clinics, and hospital outpatient surgery clinics. Case Study: J.D. A 45-year-old female patient presents for presurgical workup for right breast lumpectomy. The patient's response to surgery stress, preoperative diagnostic tests results, and potential risks and complications are assessed. The patient's role is to obtain health information, provide and clarify information about the surgery and anesthesia, assess emotional state and readiness, and determine expectations. Overall Goals and Assessment Goals Identify risk factors and plan care to ensure patient safety. Establish baseline data for comparison between intraoperative and postoperative. Determine psychologic status to reinforce coping strategies. Determine physiologic factors related to planned procedure contributing to risks. Identify and document surgical site, prescription drugs, OTC medications, and herbs taken that may affect surgical outcome. Identify cultural and ethnic factors that may affect surgical experience. Psychosocial Assessment Discusses the impact of excessive stress response on recovery. Discusses the influence of age, illness experiences, current health, and socioeconomic status on anxiety. Discusses the importance of using common words and language to reduce anxiety. Discusses the impact of anxiety on cognition, decision-making, and coping abilities. Common Fears and Fears Discusses common fears such as death or disability, pain, and altered body image. Discusses fears related to anesthesia, loss of control, and disruption of life functioning. Discusses hope as a strength of coping. Case Study: J.D. Discusses her history of hypertension and type 2 diabetes. Discusses her health history, health problems, understanding of reasons for surgery, and previous surgeries. Assessment of Patient's Health Prior to Surgery Inherited Traits Heart and endocrine diseases Reactions to anesthesia Malignant hyperthermia Medications Prescription and OTC medications Herbs Diet supplements Antiplatelets/NSAIDs Recreational Drugs Alcohol Tobacco Drug intolerances and allergies Latex allergy/risk factors Hay fever  Asthma Food allergies Allergic reactions to penicillin. Cardiovascular System Report of cardiac problems Hypertension, angina, dysrhythmias, HF, MI Current treatment for CV conditions Presence of pacemaker/ICD Respiratory System History of respiratory disease Respiratory tract infections Risk of procedure cancellation due to increased risk Neurologic System Evaluation of neurologic functioning Vision or hearing loss can affect responses Cognitive deficits can cause adverse outcomes during and after surgery Genitourinary System History of renal and urinary tract diseases Fluid and electrolyte imbalances Coagulopathies Increased risk of infection Impaired wound healing Alternated response to drugs and their elimination Hepatic System Liver detoxification may increase risk of perioperative complications Skin History of skin problems History of pressure injuries Extra padding during surgery Affects postoperative healing Musculoskeletal System Identify any joints affected by arthritis Mobility restrictions may affect positioning and ambulation Report problems affecting neck or lumbar spine to ACP Endocrine System Patients with diabetes at risk for hyper/hyperglycemia Delayed wound healing Infection assessment Endocrine System Patients with thyroid problems Hyper/hypothyroidism poses surgical risks Verify with ACP about giving thyroid medications Laboratory tests to determine thyroid function Endocrine System Patients with Addison’s disease Abruptly stopping replacement corticosteroids could cause Addisonian crisis Stress of surgery may require increased dose of IV corticosteroids Immune System  Patients with history of compromised immune system or use of immunosuppressive drugs can have delayed wound healing. Preoperative Nursing Assessments Increased infection risk: Cancellation of elective surgery for acute infections and potential for surgery for chronic infections. Fluid and electrolyte status: Imbalances from vomiting, diarrhea, or preoperative bowel preps can cause imbalances. NPO status: Surgery delay may lead to dehydration, requiring additional fluids and electrolytes. Nutritional status: Customize care for patients with nutritional problems and provide extra padding to underweight patients. Obesity: Stresses cardiac and pulmonary systems, increases risk of wound dehiscence, infection, and incisional hernia, and slows recovery from anesthesia. Anesthesia Administration: Exam: Complete a physical assessment, record findings, and monitor blood glucose for patients with diabetes. Preoperative Teaching: Patient has the right to know what to expect and how to participate, increasing patient satisfaction, reducing fear, anxiety, and stress, and potentially reducing complications. Nursing Management: Document and report preoperative teaching to postoperative nurses, evaluate patient learning, and provide surgery-specific information. Ambulatory Surgery Information: Basic information before arrival, including arrival time, place, registration, parking, what to wear and bring, and fluid and food restrictions. Legal Preparation: Check all required forms, including informed consent, blood transfusions, advance directives, and power of attorney. Nursing Management Overview Voluntary Consent: The surgeon is responsible for obtaining consent, and the nurse may witness the signature. Legally Appointed Family Representative: The family representative may provide consent if the patient is minor, unconscious, mentally incompetent, or emancipated minor. Consent for Surgery: The need for consent may be overridden by medical emergencies or immediate medical treatment. Day-of-surgery Preparation: The surgeon conducts final preoperative teaching, assessments, and verification of signed informed consent. Day-of-surgery Preparation: The patient is prepared for the operating room (OR) by wearing a hospital gown, observing skin color, and removing any cosmetics. Preoperative Medication: The patient is prescribed preoperative medications such as benzodiazepines, anticholinergics, opioids, antiemetics, and antibiotics. Transport to the OR: The patient is transported via a stretcher, wheelchair, or bed, and hand-off communication is conducted. Special Concerns: The patient's cultural competence, pain expression, family expectations, and decision making are considered. Geriatric Considerations: The patient may have sensory deficits or decreased cognitive function, and the surgical event may be overwhelming. Preoperative Instruction: The nurse provides techniques of deep breathing and coughing, descriptions of the planned surgical procedure, physical procedures or preparation required before surgery, and withholding of all oral fluids or food after midnight on the day of surgery.