Preoperative Phase, Preoperative Care, Preoperative Medications

PREOPERATIVE PHASE Routine Preoperative Screening Test

extends from the time the client is admitted in the
surgical unit, to the time he/she is prepared for the
surgical procedure, until he is transported into the
operating room.

PREOPERATIVE PHASE GOALS

✓ Assessing & correcting physiologic psychologic
problems that may increase surgical risk.
(Goal is to let the patient be as healthy as possible
before the operation.)
- Ask the pt if they drink (2 weeks after surgery)
or smoke (30 days after surgery)
✓ Giving the person and significant others
complete learning / teaching guidelines
regarding surgery.
(Give teachings before operation like using
incentive spirometer, deep breathing exercise. Kasi
di pa nila nararamdaman yung pain)
✓ Instructing and demonstrating exercises that
will benefits the person during postop period.
✓ Planning for discharge and any projected
changes in lifestyle due to surgery.
(sa early as preop dapat may NCP NA)
Psychosocial Assessment and Care
Causes of Fears ▪ Fear of Unknown ( Anxiety )
Physiologic Assessment of the Client Undergoing Surgery
▪ Fear of Anesthesia, Pain
✓ Presence of Pain
▪ Fear of Death, disturbance on
(saan, gaano kasakit, Kailan bumabalik, kailan
Body image (insecure)
nagkakaroon, gaano katagal yung pain)
▪ Worries on loss of finances,
✓ Nutritional & Fluid and Electrolyte Balance
employment, social and family
(Para macorrect, if ever)
roles.
✓ Cardiovascular / Pulmonary Function
Manifestation of ▪ Anxiousness, Bewilderment
✓ Renal Function
Fears ▪ Anger, tendency to exaggerate
✓ Gastrointestinal / Liver Function
▪ sad, evasive, tearful, clinging
(Need yung kidney, liver, lungs function to be
▪ inability to concentrate
checked kasi need sila for elimination ng meds,
▪ short attention span
anesthesia, and toxic waste)
▪ failure to carry out simple
✓ Endocrine Function
directions, dazed
(Checked to know if may DM si pt, sugar level
should be at 80 - 110 mg/dL before surgery)
- Hypoglycemia – because of anesthesia Nursing Intervention to Minimize Anxiety
- Hyperglycemia – stress during surgery ➢ Explore client's feeling
✓ Neurologic Function ➢ Allow client’s to speak openly about fears/concern.
(Check NVS) ➢ Give accurate information regarding surgery (brief,
✓ Hematologic Function direct to the point and in simple terms)
(Check ptt, pag hindi ok may riskof leeding si pt) ➢ Give empathetic support
✓ Use of Medication ➢ Consider the person’s religious preference and
(Aspirin- 7-10 days before surgery itigil na) arrange for visit by a priest / minister as desired.
✓ Presence of Trauma & Infection
Preoperative Phase, Preoperative Care, Preoperative Medications
INFORMED CONSENT
Patient is willingly/voluntarily agreeing to the procedure
Good for only 24 hours, before surgery.
Do not promise anything, esp on pedia pt (trust vs mistrust)
PURPOSE
✓ To ensure that the client understand the nature of
the treatment including the potential complications
and disfigurement (explained by AMD)
✓ To indicate that the client’s decision was made
without pressure.
✓ To protect the client against unauthorized
procedure.
✓ To protect the surgeon and hospital against legal
action by a client who claims that an authorized
procedure was performed.
Circumstances Requiring Consent
▪ Anything na may ipapasok or itutusok sa pt
▪ Any surgical procedure where scalpel, scissors,
suture, hemostats of electrocoagulation be used.
▪ Entrance into body cavity.
▪ Radiologic procedures, particularly if a contrast
material is required.
- Before giving contrast ask pt if they have
allergies to iodine or seafood
▪ General anesthesia, local infiltration and regional
block.
Essential Elements of Informed Consent
✓ The diagnosis and explanation of the condition.
✓ A fair explanation of the procedure to be done and
used and the consequences.
✓ A description of alternative treatment or procedure.
✓ A description of the benefits to be expected.
✓ The prognosis, if the recommended care,
procedure is refused.
Requisites for Validity of Informed Consent
Written permission is best and legally accepted.
Signature is obtained with the client’s complete
understanding of what to occur.
- Printed name with signature sa taas
✓ adult sign their own operative permit
✓ obtained before sedation
➢ For minors, parents or someone standing in their
behalf, gives the consent.
- Note: for a married emancipated minor parental
consent is not needed anymore, spouse is
accepted
➢ For mentally ill and unconscious patient, consent
must be taken from the parents or legal guardian.
➢ If the patient is unable to write, an “X” is accepted
if there is a witness to his mark.
✓ Secured without pressure and threat
✓ A witness is desirable — nurse, physician or
authorized persons.
✓ When an emergency situation exists, no consent is
necessary because inaction at such time may
cause greater injury (permission via
telephone/cellphone is accepted but must be
signed within 24hrs)
Preoperative Phase, Preoperative Care, Preoperative Medications
Pre Operative Care (Physical Preparation Before Surgery)
✓ Correct any dietary deficiencies
✓ Reduce an obese person’s weight
✓ Correct fluid and electrolyte imbalances
✓ Restore adequate blood volume with BT
✓ Treat chronic diseases
✓ Halt or treat any infectious process
✓ Treat an alcoholic person with vit.
✓ supplementation, IVF or fluids if dehydrated
Incentive Spirometer (for good lung expansion)
✓ Encouraged to use incentive spirometer about 10
to 12 times per hour.
✓ Deep inhalations expand alveoli, which prevents
atelectasis and other pulmonary complication.
✓ There is less pain with inspiratory concentration
than with expiratory concentration.

Pre Operative Teaching

▪ Diaphragmatic Breathing
▪ Incentive Spirometer
▪ Foot and Leg Exercise
▪ Early Ambulation
▪ Coughing
▪ Splinting
Coughing and Splinting
▪ Turning
Promotes removal of chest secretions.
(Para di bumuka sugat and less pain)
Diaphragmatic Breathing (for good lung expansion) ▪ Interlace his fingers and place hands over the
Refers to a flattening of the dome of the diaphragm proposed incision site, this will act as a splint and
during inspiration, with resultant enlargement of upper will not harm the incision.
abdomen as air rushes in. During expiration, ▪ Lean forward slightly while sitting in bed.
abdominal muscles contract. ▪ Breath, using diaphragm
▪ Inhale fully with the mouth slightly open.
▪ In a semi-Fowlers position, with your hands
▪ Let out 3-4 sharp hacks.
loose- fist, allow to rest lightly on the front of
▪ With mouth open, take in a deep breath and quickly
lower ribs.
give 1-2 strong coughs.
▪ Breathe out gently and fully as the ribs sink
down and inward toward midline.
▪ Then take a deep breath through the nose and Foot and Leg Exercise
mouth, letting the abdomen rise as the lungs fill Moving the legs improves circulation and muscle tone.
with air.
▪ Have the patient lie supine, instruct patient to bend
▪ Hold breath for a count of 5.
a knee and raise the foot — hold it a few seconds
▪ Exhale and let out all the air through your nose
and lower it to the bed.
and mouth.
▪ Repeat above about 5 times with one leg and then
▪ Repeat this exercise 15 times with a short rest
with the other. Repeat the set 5 times every 3-5
after each group of 5.
hours.
▪ Then have the patient lie on one side and exercise
the legs by pretending to pedal a bicycle.
▪ For foot exercise, trace a complete circle with the
great toe.
Preoperative Phase, Preoperative Care, Preoperative Medications
Preparing the Patient the Evening Before Surgery Preoperative Checklist
Preparing the ✓ have a full bath to reduce
Skin 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 ✓ NPO for better visualization,
G.I tract cleansing enema as required for
Abdominal or pelvis surgery.
Preparing for ✓ Avoid alcohol and cigarette
Anesthesia smoking for at least 24 hours
before surgery.
Promoting rest ✓ Administer sedatives as ordered
and sleep

ASA (American Society of Anesthesiologists)

Guidelines

Pre Operative Medications GOALS

✓ To aid in the administration of an anesthetics.
✓ To minimize respiratory tract secretions and
changes in heart rate.
✓ To relax the patient and reduce anxiety.

Pre Operative Medications PURPOSE

Preparing the Person on the Day Of Surgery
Early A.M Care
✓ Awaken 1 hour before preop medications
✓ Morning bath, mouth wash
✓ Provide clean gown (open sa likod)
✓ Remove hairpins, braid long hair, cover hair with
cap if available.
Need ng S2 prescriptions (Anesthesiologist)
✓ Reduce anxiety – antiolitics
✓ Promote relaxarion – muscle relaxant and sedation
✓ Reduce pharyngeal secretion
✓ Prevent laryngospasm
✓ Inhibit gastric secretions – PPI
✓ Decrease amount of anesthetic required for
induction and maintenance of anesthesia

✓ Remove dentures, colored nail polish, hearing aid,

Commonly used Preop Meds.
contact lenses, jewelries. Tranquilizers & ▪ Midazolam
✓ Take baseline vital sign before preop medication. Sedatives ▪ Diazepam ( Valium )
✓ Check ID band, skin prep ▪ Lorazepam ( Ativan )
▪ Diphenhydramine
✓ Check for special orders — enema, IV line
Analgesics ▪ Nalbuphine ( Nubain )
✓ Check NPO (kung ilang oras) Opioid Analgesics ▪ Morphine
✓ Have client void before preop medication Anticholinergics ▪ Atropine Sulfate
✓ Continue to support emotionally Proton Pump ▪ Omeprazole ( Losec )
✓ Accomplished “preop care checklist Inhibitors ▪ Famotidine
Preoperative Phase, Preoperative Care, Preoperative Medications
Transporting the Patient to the OR Operative Site Identification
➢ Adhere to the principle of maintaining the comfort
and safety of the patient.
➢ Accompany OR attendants to the patient’s bedside
for introduction and proper identification.
➢ Assist in transferring the patient from bed to
stretcher.
➢ Complete the chart and preoperative checklist.
➢ Make sure that the patient arrive in the OR at the
proper time.
(30-60 mins before administration of anesthesia
dapat nasa OR na si pt)

Patient’s Family
➢ Direct to the proper waiting room.
➢ Tell the family that the surgeon will probably
contact them immediately after the surgery.
➢ Explain reason for long interval of waiting:
anesthesia prep, skin prep, surgical procedure, RR.
➢ Tell the family what to expect postop when they see
the patient

Process of Preoperative