Preoperative Care

(relates to Chapter 17, “Nursing Management:

Preoperative Care,” in the textbook)

1
Surgery
• Performed for:
– Diagnosis
– Cure
– Palliation
– Prevention
– Exploration
– Cosmetic improvement

2
Patient Interview

• Purpose
– Obtain health information
– Determine expectations
– Provide and clarify
information on procedure
– Assess emotional state and
readiness

3
Nursing Assessment of the
Preoperative Patient
• Subjective Data
- Psychosocial Assessment
Anxiety
Common fears
Hope

4
Nursing Assessment
(Subj. data cont’d)

• Health history

• Medications

• Allergies

5
Nursing Assessment

Review of systems
• Cardiovascular function

• Respiratory system

• Nervous system

• Urinary system
6
Nursing Assessment

– Review of systems (cont’d)

• Integumentary system
• Musculoskeletal system
• Endocrine system
• Immune system
• Fluid & Electrolyte status
• Nutritional status

7
Nursing Assessment-
Objective Data

• Physical examination

• Laboratory and diagnostic

testing

– Indicator of perioperative
risk and overall outcome

8
Nursing Management

Preoperative teaching
• Patient has right to know what
to expect and how to participate
– Increases patient satisfaction
– Reduces fear, anxiety, stress,
pain, and vomiting

9
Nursing Management

– Teaching documented in
medical record (pt. chart)
– Sensory information
– Instruction on deep breathing,
coughing, and moving
postoperatively
• Teach rationale to reinforce
• Practice

10
 Pre-Operative Teaching

• Deep breathing, coughing,

incentive spirometry
• Mobility and active body
movement
– Ambulation/leg exercises

11
Patient Teaching

– Inform patients and families

if there will be tubes, drains,
monitoring devices, or
special equipment
postoperatively
– Discuss pain management

12
Patient Teaching

– Provide patient with

information
• Fluid/food restrictions
(prevents aspiration, N/V)
• Need for enema
• Need for shower
preoperatively/ skin prep

13
Nursing Management

Legal preparation
• Check that all forms have been
correctly signed and are present
in chart
– Informed consent
– Blood transfusion

14
Nursing Management

• Must include adequate

disclosure of diagnosis,
treatment, risks, and
probability of success

15
Nursing Management

• Patient must demonstrate clear

understanding and
comprehension
– Signed before any
preoperative drugs given
• Voluntary consent

16
Nursing Management

• Surgeon responsible for

obtaining consent
– Nurse may obtain and
witness signature (varies)
– Verify patient has
understanding
• Permission may be withdrawn
at any time

17
Nursing Management

• Advance directives, living wills,

and power of attorney included
in chart

18
Nursing Management

Day-of-surgery preparation
• Final preoperative teaching
• Assessment & communication
of pertinent findings
• Ensure completion of pre-op
prep orders

19
Nursing Management

Day-of-surgery preparation (pre-

op checklist)
– Labs
– Verify signed consent
– History and physical exam
– Baseline vitals
– Consultation records
– Nurse’s notes
20
Nursing Management

• Patient should not wear any

cosmetics
– Observation of skin color is
important
– Remove nail polish for pulse
oximeter
• Identification and allergy bands

21
Nursing Management

• Valuables returned to family

member or locked up
– Wedding ring taped to finger
• Dentures, contacts, prostheses
are removed

22
Nursing Management

• Void before surgery

– Prevents involuntary
elimination under anesthesia
or early postoperative
recovery
– Done before administration
of medication

23
Nursing Management
• Pre-operative Medications
– Give as ordered (scheduled
time, on call, sent to OR)
• Safety considerations
– Regularly scheduled
medications
• Verify with MD
• Cardiac meds, asthma
• Insulin

24
Nursing Management

Transportation to OR
• In-patients transported by cart
to surgery from room
– Side rails raised and secured
– Chart and preoperative
equipment with patient
– Family may accompany to
holding
25
Nursing Management

• Outpatients transported by
cart, wheelchair, or may walk
– Method of transport
documented by nurse
responsible for transfer
• Family instructed on waiting
area where they can be
informed of progress

26