PRE-OPERATIVE PHASE

Begins when the client decides to have surgery and ends when the client is transferred to the operating bed. Nursing Activity Assessment of client Identification of potential or actual health problems. Planning specific care based on the individuals need. Pre-operative teaching including client and support persons.

TYPES OF SURGERY
a. Degree of Urgency 1.Elective Surgery - planned weeks or months ahead and is based on the clients well being though not absolutely necessary in life.

2. Emergency Surgery - Frank attention within 24-48 hours. Performed to preserve the clients life, body parts , or body functions.

B. Degree of Risk b.1.Major Surgery - Involves a high degree of risk for a variety of reasons: It may be complicated or prolonged. Large losses of blood. Vital organs may be involved. b.2. Minor surgery - Involves little risk, produces few complications.

C. Purpose
1. DIAGNOSTIC to confirm a diagnosis Example: Excision Biopsy 2. EXPLORATORY To estimate the extent of a disease and confirm diagnosis as well. Example: Exploratory Laparotomy 3. CURATIVE a. ABLATIVE Removal of a diseased organ. Example: Hysterectomy

b. CONSTRUCTIVE Repair of congenital defects. Example: Cheiloplasty c. RECONSTRUCTIVE Restoration of damaged organ or cosmetic revision. Example: Episiorrhaphy, Rhinoplasty 4. PALLIATIVE relieves symptom but does not cure the disease. Example: Myringotomy (Otitis media)

DOS AND DONTS OF A PREOPERATIVE VISIT

DOS when conducting a Preoperative visit: 1. Do greet the patient by his name. 2. Do introduce yourself and state your purpose 3. Do verify with the patient if your visit is timely for him. 4. Do sit down if possible to show that this is only a friendly visit.

5. Do give patient information about the ff: a. b. c. d. e. f. Anesthesia Diet Intravenous therapy Bowel preparation Medication Skin preparation

g. Voiding h. Clothing i. Operating room j. Recovery room k. Pain control l. Family teaching

6. Do demonstrate the important postoperative exercises 7. Do provide psychological support 8. Do a chart review and check the ff:  Validity of consent  Clearance : pediatric or cardio pulmonary.  Results of routine preoperative screening tests .

9. Do obtain history of past and present illness including past surgeries, and medications taken. 10. Do identify risk factors that may interfere with surgery like obesity, old age.. 11. Do assess and document allergies to foods and drugs.

Donts when doing preoperative visits

1. Dont use medical jargons. 2. Dont be too specific when discussing the procedure to be done. 3. Dont treat all surgical patients alike. 4. Dont forget to allow the patient to demonstrate the taught post-operative exercise. 5. Dont take too long. Preoperative visits should not exceed 20 minutes. 6. Dont use memorized speeches.

7. Dont label patients as major or minor. 8. Dont forget to document your visit. 9. Dont forget that as an OR nurse you are special because . We operate everyday and an operation is but an incident in our days work. For the patient, it is his whole life and he must and will walk through the valley of shadow of death alone. He certainly cannot pay us a greater compliment than by putting his life into our hands and nothing but the very heart and back breaking best must be given in return.

PREOPERATIVE ASSESSMENT
INFORMED CONSENT (Operative permit/ Surgical Consent) - An agreement by a client to accept a course of treatment or a procedure after complete information, including the risk of treatment and facts relating to it has been provided by the physician. - A client signs the form and the nurse acts as a witness.

3 ELEMENTS OF INFORMED CONSENT

1. The consent must be given voluntarily. 2. The consent must be given by an individual with the capacity and competence to understand. - 18 years and above, conscious and oriented - Confused, sedated disoriented, minors, unconscious, mentally ill are not considered functionally competent. 3. The client must be given enough info to be the ultimate decision maker.

CIRCUMSTANCES REQUIRING A PERMIT

1. Any surgical procedure where scalpel, scissors, sutures, hemostats maybe used. 2. Entrance into a body cavity 3. General anesthesia, local infiltration, regional block.

PRE-OP TEACHINGS
a. Deep Breathing Exercise and Coughing exercises b. Nutrition and Fluids c. Elimination d. Hygiene e. Rest f. Valuables and Prosthesis g. Skin preparation

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