Surgery - pre operative care

Surgery

Art & science of treating disease, injuries, and deformities by operation & instrumentation.

·         Performed for

-          Diagnosis

-          Cure or repair

-          Palliation

-          Prevention

-          Exploration

-          Cosmetic improvement

 

Surgical Settings

·         Inpatient

: Same day admission

·         Ambulatory (outpatient)

: less than 3 to 4 hrs in PACU

·         Regardless of type of surgical setting, client will have a preoperative assessment completed.

 

The Health History: Client Interview

·         Check information prior to interview – avoid repetition

·         Occurs in advance or on day of surgery

·         Purpose

-          health information

-          Determine expectations

-          Provide & clarify info on procedure

-          Assess emotional state & readiness

-          Begin some post-operative teaching.

 

Nursing Assessment

·         Overall goal:

-          Identify risk factors

-          Plan care to ensure client safety

·         Nursing Assessment Goal

-          Determine psychological status to reinforce coping strategies.

-          Determine psychological factors of procedure contributing to risks.

-          Establish baseline data

-          Identify medications & herbs that may affect surgical outcome.

-          Identify documents & communicate results of laboratory/diagnostic tests.  

-          Identify cultural & ethic factors that may affect surgical experience

-          Determine receipt of adequate information from surgeon to sign informed consent

-          Identify any psychosocial needs of the client.

·         Psychosocial assessment

-          Excessive stress response can be magnified & recovery affected.

·         Influencing factors

-          Age

-          Past experience

-          Current health

-          Socioeconomic status.

·         Use common language

·         Use translators if needed- decrease level of anxiety

·         Identify stressors

-          Stressors may be originating from

®      Anxiety

®      Fears

·         Healthy History

·         Physical Assessment of all system

 

Nursing Assessment: Physical Assessment

·         Findings enable anaesthesiologist to rate client for anaesthesia administration

-          Indicator of perioperative risk & overall outcome

·         Document relevant findings & report to perioperative team

·         Obtain & evaluate lab results

Monitor blood glucose for diabetics.

 

Nursing Management

·         Preoperative teaching

-          Client has right to know what to expect & how to participate

®      ↑ client satisfaction

®      ¯ fear, anxiety, stress, pain & vomiting

-          Limited time available

®      Address needs of highest priority

®      Include information focused on safety

®      Provide written material

-          Several days before surgery

®      Observe & listen to determine amount of teaching

®      Anxiety & fear can hinder learning

®      Give priority to client’s concerns.

-          Must be documented & reported to postoperative nurses

®      Learning can be reinforced & supplemented

®      Assess learning; community nurses must be informed if client has ongoing learning needs.

-          Teach deep breathing, coughing, & moving for postop

-          Inform if tubes, drains, monitoring devices, or special equipment will be used postoperatively.

-          Ensure that the surgeon has obtained the consent.

·         Day of surgery preparation (complete pre-op checklist)

-          Final preoperative teaching

-          Assessment & report of pertinent findings

-          Verify signed consent*

-          Labs

-          History & physical examination

-          Baseline vitals

-          Consultation records

-          Nurse’s notes

-          Client should not wear any cosmetics

®      Observation of skin color is important

®      Remove nail polish for pulse oximeter

-          Valuables returned to family member or locked up

-          Dentures, contacts, prostheses are removed

-          Identification & allergy bands on wrist

?          pertinent: relevant or applicable to a particular matter, apposite

·         Void before surgery

-          Prevent involuntary elimination under anaesthesia or urinary retention during early postoperative recovery

-          Before medication administration

·         Preoperative medications

-          May be used for a variety of reasons

®      Benzodiazepines & Barbiturates (for sedative & amnestic properties)

?          Amnestic: characterized by or pertaining to amnesia – impairment in the ability to learn & recall new information

®      Anticholinergics (to reduce secretions)

®      Narcotics (to decrease post-operative nausea & vomiting)

-          Other medications may be administered preoperatively

®      Antibiotics

®      Eyedrops

®      Routine prescription drugs.

 

Informed consent ·         What is your role as a RN in obtaining informed consent from a client? ·         What is your role as a student? ·         What are some potential legal implications associated with informed consent?